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.
ABSTRUCT
This research aims at examining the expected gap between the fact of planning and controlling process of production at the State Company for Electric Industries and implementation of material requirements planning system in fuzzy environment. Developing solutions to bridge the gap is required to provide specific mechanisms subject to the logic of fuzzy rules that will keep pace with demand for increased accuracy and reduced waiting times depending on demand forecast, investment in inventory to reduce costs to a minimum.
The proposed solutions for overcoming the research problem has required some questions reflecting the problem with its multiple dimensions, which ar
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Public debt has posed a major challenge to both developing and developed countries, which has focused attention on the optimal limits (threshold of debt) and its determinants.
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Travel Time estimation and reliability measurement is an important issues for improving operation efficiency and safety of traffic roads networks. The aim of this research is the estimation of total travel time and distribution analysis for three selected links in Palestine Arterial Street in Baghdad city. Buffer time index results in worse reliability conditions. Link (2) from Bab Al Mutham intersection to Al-Sakara intersection produced a buffer index of about 36% and 26 % for Link (1) Al-Mawall intersection to Bab Al- Mutham intersection and finally for link (3) which presented a 24% buffer index. These illustrated that the reliability get worst for link
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The question are included anumber of qnestions that gave answers to
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