OPTIMIZATION OF PLASTICS URETHRAL IN TREATING CHILDREN WITH DISTAL HYPOSPADIAS AND SREDNESTVOLOVOY

TIP (Snodgrass) procedure is most common for the correction of distal and midshaft hypospadias. The technique is simple and has excellent cosmetic results. However, many authors point to the signs of narrowing of the distal urethra and reduced flow of urine in the postoperative period. For the period 2012-2014 operated 120 children with hypospadias at the age of 10 months to 17 years. The study included previously operated patients. With distal hypospadias (DH) were 101 patients, with the midshaft form of hypospadias (MH) - 19. Patients divided into 2 groups. The children in the groups did not differ in age and form of hypospadias. The first group included patients (60) who underwent standard surgery TIP. The second group consisted of boys (60), which were optimized approach to the correction of distal hypospadias with a modification of the technique TIP. Performed increasing the length of the wings of the glans penis by applying longitudinal incisions and stitching wings of glans surface at a depth of 2 mm to short for 5-8 mm in the upper half of the glans. Deeper longitudinal incision of the urethral plate. Economical foreskin resection with preservation of the stock of skin on the ventral surface. Sequential drainage of the bladder catheter with end hole (feeding tube) for 7 days. Then the catheter was pulled up and transferred to the stent, which was removed on the 14th to 17th day after surgery. Conducted preliminary preparation of patients with hypospadias testosterone drugs to increase penis size and improve circulation of the skin of the trunk and the foreskin. Outcomes were systematized during the follow up (6 months up to 1,5 years). The complications in the first group such as fistula and urethral stenosis were observed in 11 (18%) patients. In the second group we have not observed urethral stenosis, urethral fistula was diagnosed in 3 patients (5%). Proposed measures to optimize the treatment of patients with distal hypospadias by TIP method allowed us to improve the results of hypospadias repair and to reduce the number of postoperative complications more than tripled, from 18 to 5% and to ensure the prevention of violations of the flow of urine after these operations.

детская урология, дистальная и стволовая гипоспадия, одномоментная пластика уретры, pediatric urology, and a stem distal hypospadias, one-stage plastic urethra