Objective: to evaluate the benefit of coverage of
the urethral repair by dorsal dartos flap as a second
layer for preventing fistula and V like incision on
the tip of the glans for preventing meatal stenosis.
Patients and Methods:
Forty five children included in this study age
ranged ( 11 months – 7 years), they underwent
hypospadias repair between December 2008 to
March 2012, all cases with distal hypospadias,
same technique used for all patients, a combination
of techniques used for reconstruction starting
withtubularized incised plate urethroplasty with deepithelialized
or stripping of the skin from both
sides of U shaped incision surrounding the urethral
plate, adding a V like incision on the top (tip of
glans) of the midline urethral plate incision that
give wide meatus subsequently prevent meatal
stenosis and no need for dilatation after stent
removal, followed by harvesting well vascularized
dartos flap from de-epithelialized preputial skin
and transposing itventrally by buttonholing
maneuver and suturing the flap as a second layer
along the neourthral suture line, finally
approximation of glans , so achieving three layer
closure.
Results :All patients are followed for (6 months-
24 months) mean was 15 months, only two patients
(4.4%) complicated with small fistula at the
subcoronal region at the beginning of the study
operated after 6 months and the fistula closed
successfully. Twenty five cases (55.5%) with
Chordee were completely released with no
recurrence. No dilatation was needed after removal
of stent for neomeatus developed a good stream of
urine with no problems regarding stenosis.
Conclusions: In this study hypospadias repair
should achieve three layer closures by using a
dartosfalp as a second layer to cover neourethral
suture line combined with stripping the skin on the
edge of the U shaped incision to gain secure
closure of the neourethra, which will prevent
fistula formation. We recommend adding a
Vincision on the tip of the glans connected with
midline urethral plate incision to prevent meatal
stenosis.
Many critics suggest that Beckett’s early plays are comic because they focus their analyses on the use comic elements. Waiting for Godot is one of Beckett’s early plays, and it has been heavily analyzed and read as a comic text partly because its subtitle is “a tragicomedy in two acts” and also because of the comic techniques used in the play. The present paper, however, attempts to read the play as a piece in which comedy fails to produce any effects on the characters who remain apparently very desperate and frustrated throughout the play. The characters perform different comic acts, but they do not really feel amused or entertained. The paper suggests that the acts these characters put on stage are only means to pass t
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The most important results reached by the re
The study aimed at interpreting the role of architectural design quality in in build competitiveness model in accordance with the proposal included the idea of architectural design quality for its removal; interesting design factors of the environment, good design of the spaces, and design aesthetic explanatory variable. The competitiveness dimensions; the level of innovation, stimulate research, and the quality of the company's products, and activating the role of human resources, entrepreneurship, profitability, market share and competitiveness, variable responsive. The study of construction companies in the Ministry of Housing and Construction has taken the Iraqi society for the study. The sample consisted of (48) manage
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