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Response to the Commentary by R. Kočvara
Journal of Pediatric Urology (2009) 5, 428
ˇvara Response to the Commentary by R. Koc Katsuya Aoki* Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan Received 18 March 2009; accepted 19 March 2009 Available online 26 May 2009 My procedure allows the flap to be optimally tailored by recreating a new urethral plate and a new urethra to construct a tube of ideal caliber, and was more likely to reduce the development of diverticulum and stenosis at the anastomosis site. The concept of this procedure is very similar to that of the inlayeonlay island flap. There are times when we need to transect the urethral plate and dysplastic spongiosum because of severe chordee. The
patient with severe hypospadias often has a shallow groove and small flattened glans. In such a case, I think that the glans part of the urethral plate has to be removed because of preventing the tilt of the glans. Therefore, I performed a modified TPIF procedure. Also, the V-incision suture is very useful for creating the wide slit-like meatus in cases with a shallow groove and small flattened glans. Using the relaxed and well vascularized flap is the key to success.
DOI of original article: 10.1016/j.jpurol.2009.03.018. * Tel.: þ81 744 22 3051; fax: þ81 744 22 8522. E-mail address: [email protected] 1477-5131/$36 ª 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2009.03.020
ˇvara Response to the Commentary by R. Koc Katsuya Aoki* Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan Received 18 March 2009; accepted 19 March 2009 Available online 26 May 2009 My procedure allows the flap to be optimally tailored by recreating a new urethral plate and a new urethra to construct a tube of ideal caliber, and was more likely to reduce the development of diverticulum and stenosis at the anastomosis site. The concept of this procedure is very similar to that of the inlayeonlay island flap. There are times when we need to transect the urethral plate and dysplastic spongiosum because of severe chordee. The
patient with severe hypospadias often has a shallow groove and small flattened glans. In such a case, I think that the glans part of the urethral plate has to be removed because of preventing the tilt of the glans. Therefore, I performed a modified TPIF procedure. Also, the V-incision suture is very useful for creating the wide slit-like meatus in cases with a shallow groove and small flattened glans. Using the relaxed and well vascularized flap is the key to success.
DOI of original article: 10.1016/j.jpurol.2009.03.018. * Tel.: þ81 744 22 3051; fax: þ81 744 22 8522. E-mail address: [email protected] 1477-5131/$36 ª 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2009.03.020