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.
In Iraq, more than 1031 school projects have been halted due to disputes and claims resulting from financial, contractual, or other issues. This research aims to identify, prioritize, and allocate the most critical risk factors that threaten these projects’ success for the duration (2017-2022). Based on a multi-step methodology developed through systematic literature reviews, realistic case studies, and semi-structured interviews, 47 risk factors were identified. Based on 153 verified responses, the survey reveals that the top-ranked risk factors are corruption and bribery, delaying the payments of the financial dues to the contractors or sub-contractors, absence of risk management strategy, multiple change orders due
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... Show MoreThe current study included a review of the registration and description of the Theretra alecto Boi, 1827 (Levant hawk moth), samples were collected from various areas of the Baghdad belt and the provinces of the Middle Euphrates, confirmation in the description was on the most important parts of the body included the head and it's appendages, pronotum, wings as well as male and female genitalia. The morphological characteristics under study were enhanced by illustrations and images. Information on the locations and date of the collection was also confirmed. This study aims to identify the most important characteristics of the diagnosis of the species and the review of appearance variations, especially the analytical style of wings, coupling
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