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Poster - 45
OUR SURGICAL RESULTS OF CASES WITH HYPOSPADIAS REPAIRED SINGLE STAGE
C Özmen, A Cerrah Celayir, OZ Pektaş, S Moralıoğlu
Zeynep Kamil Maternity and Children’s Training and Research Hospital, Department of Pediatric Surgery
Background/Aim: Methods used in hypospadias repair varies according to the type of hypospadias, and the severity of chordee, and the preference of surgeon. The aim of this study was to evaluate our results of the one-stage hypospadias repair.
Material/Methods: Between January 2004 and 2014, children who underwent primary one-stage hypospadias repair by three training surgeons or under the supervision of these surgeons were evaluated from hospital records retrospectively. Results were analyzed according to the percentage distribution.
Results: During the 10-year period, 354 hypospadias cases were operated with single stage repair. The mean age was 4.9 years (1years-10years). According to meatus, 158 glanular/coronal(44.6%) had 27 chordee(17%). 116 subcoronal(32.7%) had 48 chordee(41.3%). 57 penile(16.1%) had 41 chordee(71.9%). 23(6.4%) penoscrotal had severe chordee. After the circumcision incision preserving urethral plate, penile skin was deglowed and fibrotic tissues were excised for chordee correction in 139 cases(39.2%). In 52 cases of 139 whose urethral plate wasn’t improved depending chordee, chordees were corrected completely with cutting of urethral plate.
In 158 glanular/coronal hypospadias, 132(83.5%) of them were treated by TIPU, 18(11.3%) by Duplay, 8(5.06%) by MAGPI. In 116 subcoronal hypospadias, 68(58.6%) of them were treated by TIPU, 21(18.1%) by Duplay, 18(15.5%) by ONLAY, and 9(7.7%) of them by Duckett. In 57 penile hypospadias, 23(40.3%) of them were treated by Duckett, 16(28.0%) by TIPU, 13(22.8%) by ONLAY, 5(8.7%) by Duplay. In 23 penoscrotal hypospadias, 16(69.5%) of them were treated by Duckett, 4(17.3%) by Duplay+Duckett, 3(13.0%) by ONLAY.
Complications such as post-operative bleeding, urethral/meatal stenosis, early wound detachment or fistula, which had required hospitalization or surgery; occured in 48(13.5%) patients. In 2(1.3%) with glanular/coronal hypospadias, in 20(17.2%) with subcoronal hypospadias, in 12(21.0%) with penile hypospadias, and in 14(60.8%) with penoscrotal hypospadias had been progressed complications; 28(7.9%) of them were fistula.
Conclusion: After surgical correction with single-stage hypospadias repair, rate of our complications and fistula were similar to the literature.
TEK SEANSLI HİPOSPADİAS ONARIMI YAPILAN OLGULARDA CERRAHİ SONUÇLARIMIZ
C Özmen, A Cerrah Celayir, OZ Pektaş, S Moralıoğlu
Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Cerrahisi Kliniği
Giriş/Amaç: Hipospadias onarımında kullanılan cerrahi yöntemler, hipospadiasın ve kordinin ağırlık derecesi ile beraber ameliyatı yapan cerrahın tercihine göre değişmektedir. Bu çalışmada, kliniğimizde tek seanslı hipospadias onarımı yapılan olgularda cerrahi sonuçlarımız değerlendirildi.
Materyal/Metod: Ocak 2004-Ocak 2014 tarihleri arasında kliniğimizde üç eğitim görevlisi tarafından veya gözetiminde primer hipospadias onarımı yapılan olguların tüm hastane kayıtları retrospektif olarak değerlendirildi. Bulgular yüzdelik dağılımlarına göre analiz edildi.
Bulgular: 10 yıllık sürede 354 olguda tek seanslı yöntemlerle hipospadias onarımı yapıldı. Yaş ortalamaları 4,9 yıl (1- 10 yıl) idi. Meatus yerleşimine göre; 158'i (%44.6) glanüler/koronal hipospadias olup 27'sinde kordi (%17) mevcuttu. 116’sı (%32.7) subkoronal hipospadias olup, 48'inde (%41.3) kordi mevcuttu. 57’si (%16.1) penil hipospadias olup, 41’inde (%71.9) kordi mevcuttu. 23’ü (%6.4) penoskrotal hipospadias olup tümünde ağır kordi mevcuttu. 139 kordili olguda (%39.2) önce üretral plate’i koruyan circumcision insizyonu ile penis cildi soyuldu, ardından fibrotik dokular eksize edilerek kordi düzeltildi. Üretral plate’e bağlı olarak kordisi düzelmeyen 52 olguda plate kesilerek kordi tamamen düzeltildi.
158 glanüler/koronal hypospadias olgusunun 8'inde MAGPI(%5,06), 18'inde Duplay(%11,3); 132'sinde TIPU(%83,5); 116 subkoronal hipospadias olgusunun 21'inde Duplay(%18,1), 68'inde TIPU(%58,6), 18'inde ONLAY(%15,5), 9'unda Duckett(%7,7 ); 57 penil hipospadias olgusundan 5'inde Duplay(%8,7), 16'sında TIPU(% 28,0), 13'ünde ONLAY(%22,8), 23'ünde Duckett(%40,3); 23 penoskrotal hipospadias olgusundan 3'ünde ONLAY(%13,0) 16'sında Duckett(%69,5), 4'ünde Duplay+Duckett(%17,3), yöntemi ile hipospadias onarımı yapıldı.
Kanama, üretral/meatal darlık, erken yara detaşmanı veya fistül olmak üzere hastanede yatış ve ameliyat gerektiren komplikasyolar; glanüler hipospadiaslı olgulardan 2'sinde(%1.3), subkoronal hipospadiaslı olgulardan 20'sinde(%17.2), penil hipospadiaslı olgulardan 12'sinde(%21.0), penoskrotal hipospadiaslı olgulardan 14'ünde(%60.8) olmak üzere toplam 48 olguda (%13.5) gelişti. Komplikasyonlardan 28’i (%7.9) fistül idi.
Sonuç: Kliniğimizde tek seanslı primer hipospadias onarımı sonrası görülen komplikasyon ve fistül oranı literatürde bildirilen sonuçlara benzerdi.