ABSTRACT
OBJECTIVES: A number of factors potentially influence the outcome of hypospadias surgery. We evaluate the effect of catheter-size used during urethroplasty (a detail related to the depth of the urethral groove and width/elasticity of the urethral plate) on the complication rate following Duplay-Snodgrass repair. METHODS: The data of 113 patients undergoing primary hypospadias repair was retrospectively reviewed. Patients were divided into two groups based on the urethral plate width evaluated by the catheter-size used during urethral reconstruction, and the rate of complications was compared in the two groups. Other factors evaluated included age of patients and severity of the defect. RESULTS: Complications (urethro-cutaneous fistula and meatal stenosis) were more common in the narrow urethral plate 8F catheter group (three fistulae among 18 patients) compared to the wide urethral plate 10F catheter group (six fistulae and one meatal stenosis in 95 patients) (p=0.08). CONCLUSION: The width of the urethral plate during a modified Duplay urethroplasty has a significant impact on outcome. A smaller-sized catheter for neo-urethral reconstruction, implying a shallow urethral groove and a narrow or inelastic urethral plate, is associated with a higher rate of urethrocutaneous fistula and meatal stenosis.
Subject(s)
Hypospadias/surgery , Surgical Flaps , Urologic Surgical Procedures, Male/methods , Child , Child, Preschool , Cutaneous Fistula/etiology , Cutaneous Fistula/surgery , Humans , Hypospadias/complications , Hypospadias/diagnosis , Infant , Male , Medical Records , Retrospective Studies , Risk Factors , Severity of Illness Index , Suture Techniques , Treatment Outcome , Urethral Stricture/etiology , Urethral Stricture/surgery , Urinary Fistula/etiology , Urinary Fistula/surgery , Urodynamics , Urologic Surgical Procedures, Male/adverse effectsABSTRACT
AIM: To analyze the attitudes of the Guinean and of the Ivory Coast communities leading to delayed consultation despite apparent malformations in children. PATIENTS AND METHODS: From January 1, 2000 to December 31, 2002, we carried out a prospective investigation in the paediatric surgery units of the Donka teaching hospital (Conakry) and Cocody, Treichville and Yopougon (Abidjan) teaching hospital. One hundred and two children affected with apparent malformations were included. The studied variables were: age, sex, ethnos group, religion, socio-economic level and the cultural designs of the families. RESULTS: Sex ratio male/female was 1,5 and the average age at first consultation was 17 months. Seventy-six per cent of the children carrying apparent malformations at birth were seen at an age ranging from 1 to 30 months. Orthopaedic malformations were prominent (44%) and led especially to negative reactions of the entourage of the patients. Some religious beliefs took a part of the delayed consultation and impaired relationships between the 2 parents. The low socio-economic level (54%) was determining in the delayed consultation. The birth of a child with malformation in the malinké, akan krou community could be understood like a parchment from a god or a witchcraft. CONCLUSION: The contributive factors of the delay to the consultation of the children carrying apparent malformations in the communities Guinean and of the Ivory Coast are poverty, ignorance and some religious beliefs. Education and well understanding of these reasons in developing country should improve the acceptance and taking care of these children as well as the development of medical insurance system.