The Effect of Staged Transverse Preputial Island Flap Urethroplasty for Proximal Hypospadias with Severe Chordee.

PURPOSE: We compare the effects of staged tranverse preputial island flap urethroplasty and the Byars 2-stage procedure in patients with proximal hypospadias and severe chordee. MATERIALS AND METHODS: We studied 87 consecutive children referred for proximal hypospadias with severe chordee between March 2011 and March 2014. Of the cases 42 were repaired with staged tranverse preputial island flap (group 1) and 45 were managed by 2-stage Byars urethroplasty (group 2). Mean ± SD age at first stage surgery was 26.6 ± 13.3 months in group 1 and 24.8 ± 14.7 months in group 2. Postoperative complications in both groups were assessed regarding fistulas, urethral strictures, diverticula, meatal stenosis and glanular dehiscence. RESULTS: After the second stage 2 patients (4.8%) in group 1 and 10 (23.2%) in group 2 had urethrocutaneous fistulas (p <0.05). One patient (2.4%) in group 1 and 2 patients (4.4%) in group 2 had urethral strictures (p >0.05). All patients with stricture were cured by repeated dilation and no patient required reoperation. One patient (2.4%) in group 1 and no patient in group 2 had diverticulum (p >0.05). No patient in either group had signs or symptoms of meatal stenosis or residual chordee. Three patients (7.1%) in group 1 and 12 (26.7%) in group 2 needed reoperation (p <0.05). CONCLUSIONS: Two-stage urethroplasty, particularly tranverse preputial island flap partial urethroplasty, is appropriate for treating patients with proximal hypospadias and severe chordee. Use of the tranverse preputial island flap can decrease complications associated with the second stage and significantly improve the success rate.

Relationship between apolipoprotein E gene polymorphism with triglyceride level in patients with renal diseases.

Apolipoprotein E (apoE), one of the major plasma lipoproteins, plays a major role in the transport and metabolism of lipids by acting as a ligand. apoE gene contains three potential alleles: ϵ2, ϵ3 and ϵ4, forming six genotypes: E2E2, E2E3, E2E4, E3E3, E3E3 and E4E4. Association between apoE gene polymorphism and triglyceride (TG) is still controversial. There was not any meta-analysis to explore the association of apoE gene polymorphism with triglyceride level, and this meta-analysis was performed to evaluate the association between apoE gene polymorphism and triglyceride in patients with renal diseases. A predefined literature search and selection of eligible relevant studies were performed to collect data from electronic databases. Twenty-four articles were identified for the analysis of association between apoE gene polymorphism and triglyceride level. Subjects with E2E3 or E3E4 had a higher TG than those with E3E3. Subjects with ϵ4 had a higher TG than those with ϵ3. Subjects with ϵ2 had a slightly higher TG than those with ϵ3, although there was no statistical difference. Interestingly, subjects with ϵ4 had a much higher TG than those with ϵ2. In conclusion, E2E3, E3E4 or ϵ4 was associated with higher level of TG. However, more studies should be performed in the future.

[Modified Mathieu urethroplasty for failed hypospadias repair].

OBJECTIVE: To review the indications, techniques and complications of reoperation for failed hypospadias repair using modified Mathieu urethroplasty. METHODS: Using modified Mathieu urethroplasty, we treated 24 hypospadias patients aged 3-12 (mean 4.5) years for whom the first (n = 20) or the second hypospadias repair (n = 4) had failed, including 13 cases of large coronary sulcus urethrocutaneous fistula, 5 cases of urethral meatus retraction and 6 cases of anterior urethra dehiscence. The modified procedure involved median longitudinal incision of the urethral posterior wall, dorsal tunica albuginea plication under the vascular and nerve bundle, and double dartos flap protection of the neourethra. RESULTS: Of the 24 patients, 19 (79.2%) were successfully treated by the first operation, which achieved desirable straightness, good cosmetic appearance and normal urethral meatus of the penis, without postoperative complications. Small urethrocutaneous fistula developed in 4 cases, of which 3 were cured by fistula repair and 1 self-healed. Urethral meatus stenosis occurred in 1 case, which was restored by meatal dilation. Urethrocele and urethrostenosis were not found in any of the cases. Two cases received urethroscopy postoperatively, which revealed no hypertrophic cicatrix at the site of median longitudinal incision in the urethral posterior wall. CONCLUSION: Modified Mathieu urethroplasty can be applied to hypospadias reoperation, particularly in such cases as large coronary sulcus urethrocutaneous fistula, urethral meatus retraction and anterior urethra dehiscence. The modified procedure includes median longitudinal incision of the urethral posterior wall, dorsal tunica albuginea plication under the vascular and nerve bundle, and double dartos flap protection of the neourethra.

[Treatment and outcome of 14 children with hepatoblastoma].

OBJECTIVE: To assess the outcome of childhood hepatoblastoma after a combination therapy of resection and chemotherapy. METHODS: The clinical data of 14 children with hepatoblastoma was retrospectively reviewed. Their long-term survival was followed-up. RESULTS: Twelve cases received surgery and planned chemotherapy. The follow-up duration averaged 18 months (range 1.5-74 months). Nine survived free of events, 1 died, 1 survived with multiple lung metastases, and 1 with increased alpha-fetoprotein (AFP) content but without residual tumor. CONCLUSIONS: Surgery assisted with chemotherapy can improve the outcome of hepatoblastoma.

Effects of modified penoplasty for concealed penis in children.

PURPOSE: To evaluate the effect of modified penoplasty in the management of concealed penis. METHODS: We retrospectively reviewed 96 consecutive patients with concealed penis, which had been surgically corrected between July 2013 and July 2015. All patients underwent modified Shiraki phalloplasty. All patients were scheduled for regular follow-up at 1, 3, and 6 months after the surgery. Data on the patients' age, operative time, postoperative complications, and parents' satisfaction grade were collected and analyzed. RESULTS: The mean follow-up period was 17.4 months (range 7-31 months). The mean operative time was 63.2 ± 8.7 min. The mean perpendicular penile length was 1.89 ± 0.77 cm preoperatively and 4.42 ± 0.87 cm postoperatively, with an improved mean length of 2.5 ± 0.68 cm in the flaccid state postoperatively (p < 0.05). The patients' satisfaction grades after the surgery were improved significantly (p < 0.05). Fifty-two patients had penile lymphedema postoperatively; however, it disappeared spontaneously within 3 months. Additionally, postoperative wound infection occurred in two patients. There were no complications such as flap necrosis, penile shaft contracture, voiding difficulty, and erection difficulties. CONCLUSION: The modified Shiraki phalloplasty for concealed penis can achieve maximum utilization of prepuce to assure coverage of the exposed penile shaft. It has fewer complications, achieving marked asthetics, and functional improvement. It is a relatively ideal means for treating concealed penis.