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UP-2.111: Ureterocele Management: Evaluation in Jazan Region of Saudi Arabia with Transurethral Inverted Y-V Deroofing
UNMODERATED POSTER SESSIONS
permitted when the child indicated maximum capacity was reached. Results: Children presented with retention (14-26.4%), difficulty (8-15.1%), UTI (6-11.3%), nocturnal enuresis (2-3.8%).In the remaining 23 (43.4 patients, presentation was antenatal hydronephrosis. Renal US revealed unilateral backpressure in 17 (32.1%), bilateral in 25 (47.2%), no backpressure in11 (20.8%). Reflux was seen in 31 children (58.5%) from the study group. Mean bladder capacity was 276.9 ⫾135.3cc (range 80- 800), while the mean expected capacity for the age was 291.5 ⫾96.4cc. Mean compliance was 16.9⫾ 7.7 ml/cmH2O. In 31 (58.5%) children, overactivity was evident. In 7, leakage occurred during filling with a mean detrusor LPP of 53.6 cmH2) (range: 22-110). PUV affects both lower and upper urinary tract. Its tools in inducing negative effects range from high filling pressure to infravesical obstruction. Presentation in majority of cases was antenatal hydronephrosis. In those diagnosed postnatal, retention or difficulty accounted for 41.5% of cases. Conclusions: PUV is associated with significant affection of urinary tract function. Affection of the kidney is evident in almost all patients. Back pressure (unilateral or bilateral) was seen in over 80% and reflux in more than 58%. Bladder capacity tends to be smaller with poorer compliance than expected for the age. Overactivity was noticed in well above half the cases. UP-2.109 Neonatal Circumcision: A Single Surgeon’s Experience of 250 Cases in the United Kingdom Hudd C, Rao A The Princess Margaret Hospital, Windsor, UK Introduction and Objectives: Circumcision dates to times well beyond 3000 years past, possibly 15000 years; across continents, religions and cultures. It remains one of the most commonly performed operations worldwide. Proponents speak of cleanliness, reduced incidences of carcinoma of the penis or infections including HIV. Detractors mention reduced sensation, which is debatable, but also the abuse of the baby’s ‘human rights’! Materials and Methods: Two hundred and fifty neonates (age: 1 day to 3 months; ‘prem’ corrected), were prospectively audited. Each child underwent Plastibell circumcision by a Consultant Urological Surgeon of many years’ standing.
Age, caesarean or natural birth, prematurity, paediatric assessment, jaundice requiring treatment, testicular descent, ethnic origin, present geographical location, “home” location, reason for requesting circumcision and operative notes were all assessed and recorded. Results: Most of the babies were from cultures or countries that practice circumcision as the norm. 41% cited religious reasons for requesting circumcision Of these, 66% were Muslim 20% were Jewish 14% were Catholic or other 66% cited cultural/social reasons (some cited more than one reason). Major complications were minimal: Buried penis: 1 Bleeding requiring admission and transfusion: 1 Stenosis: Redo @10/52: 1 Minor complications: Adhesion to the glans: manual retraction only: 3 (Not really complications) Adhesion to the glans: hydrocortisone and retraction: 5 Bleeding: minor: 3 Oedema: 3 250 babies underwent neonatal circumcision. The complication rate was below many previously published rates: why? Is it acceptable that this procedure remain available to those whose parents request it? The fact that this is not the norm for many indigenous British families is not a reason to prohibit these British or nonBritish-origin families to avail themselves of their religious or culturally led decisions! Conclusion: Neonatal circumcision remains controversial in the United Kingdom but, realistically, is here to stay so let us make it as safe as possible! UP-2.110 Posterior Urethral Valve: Our Experience in Jazan Region of Saudi Arabia Jha A, Al Faifi H King Fahd Central Hospital, Jazan, Saudi Arabia Introduction: Post-urethral valve is the most common cause of bladder outlet obstruction in neonate and children. It is prevalent in the Jazan region of Saudi Arabia due to cosanguinity. Materials and Methods: The 20 year (Jan. 1988-Jan. 2008) retrospective study of 52 cases, focused on parameters - clinical presentation, the best diagnostic tools, management, result and prognosis. The
UROLOGY 74 (Supplment 4A), October 2009
cases were divided into three groups, A, B and C, according to age, 0 to 1 month, 1 month to 2 years, 2 to 12 years, respectively. The age presentation ranged between 20 days to 12 years. The average -2.6 years, 57 % below one year. Results: Most common presentation found: Group A (14.3%), renal failure and septicemia (66%); Group B (52.3%), weak stream (54.51%); Group C (33.4%), dribbling and weak stream (27%). Common factor was urinary infection. Associated conditions: prunebelly syndrome, cryptorchidism, vesical stone, urinoma and urinary asciitis. - 85% of cases were young type I, 11.2%, type II and 3.8% type III. 50.2% had hydronephrosis, VUR (bilateral, 60.1%, unilateral, 9.5%, 2/3 grade -3,4 reflux) - Catheterization, Micturatingcystourethrogram, ultrasound, CT were helpful. Procedure: Transurethral valve ablation, 95% cases. Vesicostomy, ureterostomy, redo ablation, 2 each. Cystolithotomy in 3, PCN in 4 and nephrectomy 1 case. Average hospital stay was 15 days (range 6-60 days). Ureteroneocystostomy, 52% of grade III. and IV reflux cases. - Three-year follow-up result: 90% (60% good, 30% moderate). Criterion: normal creatinine, growth. - Poor result cases (10%) all in neonate (Group A) associated with following combination: prematurity, urinary asciitis, septicemia, cyanosis, Renal failure (creatinine ⬎400) - 7-10 yrs follow-up: 20% cases (50% needed dialysis, 20% incontinent) Average pre-op creatinine level: In mmol 146.33, postop 76.22. Conclusion: Cosanguinity in Jazan region is the cause of prevalence. Early endoscopy gives best result. Micturating cystourethrogram is the best diagnostic tool. Successful in 90.5% cases. P⬍0.01 significant. Creatinine improvement post endoscopy is good prognostic predictor (146.33 to 76.22). P⬍0.02 significant. More than 400 signified poor prognosis. Despite best effort long term prognosis, remains guarded in some cases. UP-2.111 Ureterocele Management: Evaluation in Jazan Region of Saudi Arabia with Transurethral Inverted Y-V Deroofing Jha A, Al Faifi H King Fahd Central Hosptial, Jazan, Saudi Arabia Introduction and Objective: Prevalence of ureterocele like other congenital anomalies is high in this region due to cosanguinity. Over all evaluation, with special
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reference to endoscopic management with our technique of transurethral inverted Y-V, ablation for intravesical ureterocele up to 4 years follow up done. All had (100%) U.S. and I.V.U., C.T. in 50% cases and MRI in 10%, MCU in N20 (32.8%) pre or post op standard resectoscope paedia size 11FG and adult 26 FG used with Collinge knife for adult and hook for children and neonate for ablation. Litholapexy, Ultrasonic Lithotripsy done in same sitting for stone in ureterocele cases after above. Anaesthesia used 60% GA 40% spinal. Plunging (prolapsing) ureteroceles (N-3) in 3 females (2 adult 1 neonate) dealt in similar fashion after pushing back into bladder-20 mgs IV Lasix injected on table in 10 adult (62) showed ballooning with efflux in small ureterocele. Materials and Methods: In retrospective study of 65 cases managed by us from July 1988 to July 2008 (20 years duration), of all varieties of intravesical ureteroceles, we made significant observations. Results: Of 65 intravesical cases 45 (69.23%) had single orthotopic ureters-14 had duplex (21.5%) AND 6 (9.23%) bilateral ureterocele 52 (80%) has small less than 2 cms X 2 cm diameter (cobrahead type) and 13 (20%) had large ballooned type (between over 2 ⫻ 2 cm to 6 ⫻ 6 cm size (of that 3 (4.6%) prolapsing type in females with retention) and renal colic and UTI in 58 (89.2%), asymptomatic incidental findings in 4 (6.15%), ‘stone in ureterocele’ in 26 (40%) 16 of stone dealt with by litholapexy, 10 by ultrasonic lithotripsy. Reflux study (MCU) done in 20 (30%) cases pre and post op showed Grade I & II reflux in 6 of 20 (30%) of which 15 % (3) responded to chemoprophylaxis long term. Other 15% needed ureteroneocystostomy, after 6 months of ablation. 10 cases (15.5%) had IV Lasix 20 mgs injected during cystoscopy to view ballooning with efflux. Conclusions: Cosanguinity is cause for high incidence in Jazan Region of Saudi Arabia. I.V.U. more useful than U.S. / CT. Lasix 20 mgs IV injection during cystoscopy useful in small cystocele in identifying ballooning with efflux and helpful in ablation. Transurethral inverted Y-V ablation very useful in 62 of 65 (95.3%) with good result (P value ⬍0.02). Significant all stone endoscopically dealt with in the same session. Small no. only needed ureteroneocystostomy with persistent obstructioin, due to thick muscular walls and recurrence. Reflux not a significant problem in our series. Plunging ureterocele (U.G.S) had treatment similar to others after pushing back into bladder with good results.
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UP-2.112 Analysis of Uroflowmetry in Enuretic Children Konomoto T, Noda N, Koikawa Y, Yamaguchi T Fukuoka Children’s Hospital and Medical Center for Infectious Diseases, Fukuoka, Japan Introduction and Objective: To assess the utility of uroflowmetry (UFM) as a non-invasive examination in evaluation of enuretic children. Materials and Methods: 131 samples (87 boy examples and 44 girl examples) that consult our hospital with chief complaint of nocturnal and/or diurnal enuresis were examined. The amount of urination and Qmax in UFM was classified as normal, high, and low flow compared with the Segura nomogram. Moreover, the urination pattern in UFM was classified into three categories (Bell-shape, Plateau, and Staccato). Differences of these factors between the groups divided by sex and the symptom were examined. Results: Normal flow was observed in 71 (54%) of 131 children (47 boys and 24girs, respectively). High flow (19 cases) was likely to be seen in boys (18/87 cases and 1/44 cases). In contrast low flow (40 cases) was prefer to be seen in girls (18/44 cases and 22/87 cases). Cases with diurnal enuresis showed higher rates of high and low flow (25/45 cases; 55%) than ones only with nocturnal enuresis (34/86 cases: 40%). Abnormal urination pattern (11 plateau and 39 staccato pattern) was observed in 50/131 cases (38%), especially in boys with also nocturnal and diurnal enuresis (22/31cases; 7 plateau and 15 staccato pattern). Plateau pattern was not seen in the girl, that suggests the gender gap. Conclusions: UFM is an easy and noninvasive method for evaluation of enuretic children. Abnormal urological condition should be considered when the flow rate or its pattren is not normal in UFM.
UP-2.113 Free Tube Graft Urethroplasty for Repair of Moderate to Severe Hypospadias Obara K1, Mizusawa T1, Tsutsui T2, Hara N1, Kasahara T1, Suzuki K1, Anraku T1, Ishizaki F1, Ando T1, Takahashi K1 1 Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University; 2Division of Urology, Niigata City General Hospital, Niigata, Japan Introduction and Objective: We report the outcome of applying free tube graft
urethroplasty for repair of moderate to severe hypospadias with chordee. Materials and Methods: We retrospectively evaluated our series of 20 patients (median age 22 months) who underwent the free tube graft urethroplasty for repair of moderate to severe hypospadias with chordee. Complete degloving of prepuce other than the mucosal collar and urethral plate was carried out. The urethral plate and dysplastic corpus spongiosum were transected at the coronal sulcus. Free graft was harvested from the dorsal prepuce that is at least 17mm width and at a distance that is longer than the length needed to replace the urethra. Then, the graft was rolled over a 10-Fr catheter and approximate it with a running subcuticular 7-0 polyglactin suture. Free tube graft was anastmosed to native urethra with running 7-0 polydioxanone suture. A second layer with interrupted 7-0 polydioxanone subcutaneous suture was applied. The glans was divided in the midline to create glanular wings. The glanular wings were approximated using 7-0 polydioxanone suture. Well-vascularized tissue was brought over the graft and skin closure was achieved using a Byars flap. We used a 8 -Fr silicon catheter as a urethral stent that leave in place for 7 to10 days. Prophylactic antibiotics were administered for three days. Patients were followed for a mean period of 10 months. Results: After releasing the chordee, the hypospadiac orifice was retracted to become penile in nine patients (45%), penoscrotal in seven (35%), and scrotal in four (20%). The median length of the neourethra was 29 mm (range:25-35 mm). A single-stage repair was successful in 18 patients (90%) without any complications. of the remaining two patients with postoperative complications requiring surgical intervention, meatal stenosis developed in one (5%) and urethrocutaneous fistula in one (5%). In all patients the meatus became clearly slit-like. Conclusions: The free tube graft is appropriate for repair of moderate to severe hypospadias. Our procedure yielded favorable outcomes functionally and cosmetically with a low postoperative morbidity rate. UP-2.114 Diphallus with Ectopic Bowel Segment: A Case Report Priyadarshi S Dept. of Urology, S.M.S Hospital, Jaipur, India Introduction and Objective: Duplication of penis or clitoris known as diphallus is
UROLOGY 74 (Supplment 4A), October 2009
permitted when the child indicated maximum capacity was reached. Results: Children presented with retention (14-26.4%), difficulty (8-15.1%), UTI (6-11.3%), nocturnal enuresis (2-3.8%).In the remaining 23 (43.4 patients, presentation was antenatal hydronephrosis. Renal US revealed unilateral backpressure in 17 (32.1%), bilateral in 25 (47.2%), no backpressure in11 (20.8%). Reflux was seen in 31 children (58.5%) from the study group. Mean bladder capacity was 276.9 ⫾135.3cc (range 80- 800), while the mean expected capacity for the age was 291.5 ⫾96.4cc. Mean compliance was 16.9⫾ 7.7 ml/cmH2O. In 31 (58.5%) children, overactivity was evident. In 7, leakage occurred during filling with a mean detrusor LPP of 53.6 cmH2) (range: 22-110). PUV affects both lower and upper urinary tract. Its tools in inducing negative effects range from high filling pressure to infravesical obstruction. Presentation in majority of cases was antenatal hydronephrosis. In those diagnosed postnatal, retention or difficulty accounted for 41.5% of cases. Conclusions: PUV is associated with significant affection of urinary tract function. Affection of the kidney is evident in almost all patients. Back pressure (unilateral or bilateral) was seen in over 80% and reflux in more than 58%. Bladder capacity tends to be smaller with poorer compliance than expected for the age. Overactivity was noticed in well above half the cases. UP-2.109 Neonatal Circumcision: A Single Surgeon’s Experience of 250 Cases in the United Kingdom Hudd C, Rao A The Princess Margaret Hospital, Windsor, UK Introduction and Objectives: Circumcision dates to times well beyond 3000 years past, possibly 15000 years; across continents, religions and cultures. It remains one of the most commonly performed operations worldwide. Proponents speak of cleanliness, reduced incidences of carcinoma of the penis or infections including HIV. Detractors mention reduced sensation, which is debatable, but also the abuse of the baby’s ‘human rights’! Materials and Methods: Two hundred and fifty neonates (age: 1 day to 3 months; ‘prem’ corrected), were prospectively audited. Each child underwent Plastibell circumcision by a Consultant Urological Surgeon of many years’ standing.
Age, caesarean or natural birth, prematurity, paediatric assessment, jaundice requiring treatment, testicular descent, ethnic origin, present geographical location, “home” location, reason for requesting circumcision and operative notes were all assessed and recorded. Results: Most of the babies were from cultures or countries that practice circumcision as the norm. 41% cited religious reasons for requesting circumcision Of these, 66% were Muslim 20% were Jewish 14% were Catholic or other 66% cited cultural/social reasons (some cited more than one reason). Major complications were minimal: Buried penis: 1 Bleeding requiring admission and transfusion: 1 Stenosis: Redo @10/52: 1 Minor complications: Adhesion to the glans: manual retraction only: 3 (Not really complications) Adhesion to the glans: hydrocortisone and retraction: 5 Bleeding: minor: 3 Oedema: 3 250 babies underwent neonatal circumcision. The complication rate was below many previously published rates: why? Is it acceptable that this procedure remain available to those whose parents request it? The fact that this is not the norm for many indigenous British families is not a reason to prohibit these British or nonBritish-origin families to avail themselves of their religious or culturally led decisions! Conclusion: Neonatal circumcision remains controversial in the United Kingdom but, realistically, is here to stay so let us make it as safe as possible! UP-2.110 Posterior Urethral Valve: Our Experience in Jazan Region of Saudi Arabia Jha A, Al Faifi H King Fahd Central Hospital, Jazan, Saudi Arabia Introduction: Post-urethral valve is the most common cause of bladder outlet obstruction in neonate and children. It is prevalent in the Jazan region of Saudi Arabia due to cosanguinity. Materials and Methods: The 20 year (Jan. 1988-Jan. 2008) retrospective study of 52 cases, focused on parameters - clinical presentation, the best diagnostic tools, management, result and prognosis. The
UROLOGY 74 (Supplment 4A), October 2009
cases were divided into three groups, A, B and C, according to age, 0 to 1 month, 1 month to 2 years, 2 to 12 years, respectively. The age presentation ranged between 20 days to 12 years. The average -2.6 years, 57 % below one year. Results: Most common presentation found: Group A (14.3%), renal failure and septicemia (66%); Group B (52.3%), weak stream (54.51%); Group C (33.4%), dribbling and weak stream (27%). Common factor was urinary infection. Associated conditions: prunebelly syndrome, cryptorchidism, vesical stone, urinoma and urinary asciitis. - 85% of cases were young type I, 11.2%, type II and 3.8% type III. 50.2% had hydronephrosis, VUR (bilateral, 60.1%, unilateral, 9.5%, 2/3 grade -3,4 reflux) - Catheterization, Micturatingcystourethrogram, ultrasound, CT were helpful. Procedure: Transurethral valve ablation, 95% cases. Vesicostomy, ureterostomy, redo ablation, 2 each. Cystolithotomy in 3, PCN in 4 and nephrectomy 1 case. Average hospital stay was 15 days (range 6-60 days). Ureteroneocystostomy, 52% of grade III. and IV reflux cases. - Three-year follow-up result: 90% (60% good, 30% moderate). Criterion: normal creatinine, growth. - Poor result cases (10%) all in neonate (Group A) associated with following combination: prematurity, urinary asciitis, septicemia, cyanosis, Renal failure (creatinine ⬎400) - 7-10 yrs follow-up: 20% cases (50% needed dialysis, 20% incontinent) Average pre-op creatinine level: In mmol 146.33, postop 76.22. Conclusion: Cosanguinity in Jazan region is the cause of prevalence. Early endoscopy gives best result. Micturating cystourethrogram is the best diagnostic tool. Successful in 90.5% cases. P⬍0.01 significant. Creatinine improvement post endoscopy is good prognostic predictor (146.33 to 76.22). P⬍0.02 significant. More than 400 signified poor prognosis. Despite best effort long term prognosis, remains guarded in some cases. UP-2.111 Ureterocele Management: Evaluation in Jazan Region of Saudi Arabia with Transurethral Inverted Y-V Deroofing Jha A, Al Faifi H King Fahd Central Hosptial, Jazan, Saudi Arabia Introduction and Objective: Prevalence of ureterocele like other congenital anomalies is high in this region due to cosanguinity. Over all evaluation, with special
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reference to endoscopic management with our technique of transurethral inverted Y-V, ablation for intravesical ureterocele up to 4 years follow up done. All had (100%) U.S. and I.V.U., C.T. in 50% cases and MRI in 10%, MCU in N20 (32.8%) pre or post op standard resectoscope paedia size 11FG and adult 26 FG used with Collinge knife for adult and hook for children and neonate for ablation. Litholapexy, Ultrasonic Lithotripsy done in same sitting for stone in ureterocele cases after above. Anaesthesia used 60% GA 40% spinal. Plunging (prolapsing) ureteroceles (N-3) in 3 females (2 adult 1 neonate) dealt in similar fashion after pushing back into bladder-20 mgs IV Lasix injected on table in 10 adult (62) showed ballooning with efflux in small ureterocele. Materials and Methods: In retrospective study of 65 cases managed by us from July 1988 to July 2008 (20 years duration), of all varieties of intravesical ureteroceles, we made significant observations. Results: Of 65 intravesical cases 45 (69.23%) had single orthotopic ureters-14 had duplex (21.5%) AND 6 (9.23%) bilateral ureterocele 52 (80%) has small less than 2 cms X 2 cm diameter (cobrahead type) and 13 (20%) had large ballooned type (between over 2 ⫻ 2 cm to 6 ⫻ 6 cm size (of that 3 (4.6%) prolapsing type in females with retention) and renal colic and UTI in 58 (89.2%), asymptomatic incidental findings in 4 (6.15%), ‘stone in ureterocele’ in 26 (40%) 16 of stone dealt with by litholapexy, 10 by ultrasonic lithotripsy. Reflux study (MCU) done in 20 (30%) cases pre and post op showed Grade I & II reflux in 6 of 20 (30%) of which 15 % (3) responded to chemoprophylaxis long term. Other 15% needed ureteroneocystostomy, after 6 months of ablation. 10 cases (15.5%) had IV Lasix 20 mgs injected during cystoscopy to view ballooning with efflux. Conclusions: Cosanguinity is cause for high incidence in Jazan Region of Saudi Arabia. I.V.U. more useful than U.S. / CT. Lasix 20 mgs IV injection during cystoscopy useful in small cystocele in identifying ballooning with efflux and helpful in ablation. Transurethral inverted Y-V ablation very useful in 62 of 65 (95.3%) with good result (P value ⬍0.02). Significant all stone endoscopically dealt with in the same session. Small no. only needed ureteroneocystostomy with persistent obstructioin, due to thick muscular walls and recurrence. Reflux not a significant problem in our series. Plunging ureterocele (U.G.S) had treatment similar to others after pushing back into bladder with good results.
S266
UP-2.112 Analysis of Uroflowmetry in Enuretic Children Konomoto T, Noda N, Koikawa Y, Yamaguchi T Fukuoka Children’s Hospital and Medical Center for Infectious Diseases, Fukuoka, Japan Introduction and Objective: To assess the utility of uroflowmetry (UFM) as a non-invasive examination in evaluation of enuretic children. Materials and Methods: 131 samples (87 boy examples and 44 girl examples) that consult our hospital with chief complaint of nocturnal and/or diurnal enuresis were examined. The amount of urination and Qmax in UFM was classified as normal, high, and low flow compared with the Segura nomogram. Moreover, the urination pattern in UFM was classified into three categories (Bell-shape, Plateau, and Staccato). Differences of these factors between the groups divided by sex and the symptom were examined. Results: Normal flow was observed in 71 (54%) of 131 children (47 boys and 24girs, respectively). High flow (19 cases) was likely to be seen in boys (18/87 cases and 1/44 cases). In contrast low flow (40 cases) was prefer to be seen in girls (18/44 cases and 22/87 cases). Cases with diurnal enuresis showed higher rates of high and low flow (25/45 cases; 55%) than ones only with nocturnal enuresis (34/86 cases: 40%). Abnormal urination pattern (11 plateau and 39 staccato pattern) was observed in 50/131 cases (38%), especially in boys with also nocturnal and diurnal enuresis (22/31cases; 7 plateau and 15 staccato pattern). Plateau pattern was not seen in the girl, that suggests the gender gap. Conclusions: UFM is an easy and noninvasive method for evaluation of enuretic children. Abnormal urological condition should be considered when the flow rate or its pattren is not normal in UFM.
UP-2.113 Free Tube Graft Urethroplasty for Repair of Moderate to Severe Hypospadias Obara K1, Mizusawa T1, Tsutsui T2, Hara N1, Kasahara T1, Suzuki K1, Anraku T1, Ishizaki F1, Ando T1, Takahashi K1 1 Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University; 2Division of Urology, Niigata City General Hospital, Niigata, Japan Introduction and Objective: We report the outcome of applying free tube graft
urethroplasty for repair of moderate to severe hypospadias with chordee. Materials and Methods: We retrospectively evaluated our series of 20 patients (median age 22 months) who underwent the free tube graft urethroplasty for repair of moderate to severe hypospadias with chordee. Complete degloving of prepuce other than the mucosal collar and urethral plate was carried out. The urethral plate and dysplastic corpus spongiosum were transected at the coronal sulcus. Free graft was harvested from the dorsal prepuce that is at least 17mm width and at a distance that is longer than the length needed to replace the urethra. Then, the graft was rolled over a 10-Fr catheter and approximate it with a running subcuticular 7-0 polyglactin suture. Free tube graft was anastmosed to native urethra with running 7-0 polydioxanone suture. A second layer with interrupted 7-0 polydioxanone subcutaneous suture was applied. The glans was divided in the midline to create glanular wings. The glanular wings were approximated using 7-0 polydioxanone suture. Well-vascularized tissue was brought over the graft and skin closure was achieved using a Byars flap. We used a 8 -Fr silicon catheter as a urethral stent that leave in place for 7 to10 days. Prophylactic antibiotics were administered for three days. Patients were followed for a mean period of 10 months. Results: After releasing the chordee, the hypospadiac orifice was retracted to become penile in nine patients (45%), penoscrotal in seven (35%), and scrotal in four (20%). The median length of the neourethra was 29 mm (range:25-35 mm). A single-stage repair was successful in 18 patients (90%) without any complications. of the remaining two patients with postoperative complications requiring surgical intervention, meatal stenosis developed in one (5%) and urethrocutaneous fistula in one (5%). In all patients the meatus became clearly slit-like. Conclusions: The free tube graft is appropriate for repair of moderate to severe hypospadias. Our procedure yielded favorable outcomes functionally and cosmetically with a low postoperative morbidity rate. UP-2.114 Diphallus with Ectopic Bowel Segment: A Case Report Priyadarshi S Dept. of Urology, S.M.S Hospital, Jaipur, India Introduction and Objective: Duplication of penis or clitoris known as diphallus is
UROLOGY 74 (Supplment 4A), October 2009