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Challenges of Surgical Repair of Hypospadias in Ile-Ife, Nigeria
AO Olajide, AO Sowande, AA Salako, FO Olajide, O Adejuyigbe
African Journal of Urology , 2009,
Abstract: Objective: To document the presentation, outcome and challenges of management of hypospadias in a resource-limited setting. Patients and Methods: For this retrospective study we analyzed the files of all patients with hypospadias managed at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria between 1996 and 2006. The parameters studied were the patients’ bio-data, clinical presentation, treatment and outcome. Results: During the 10-year period under review 51 cases of hypospadias were managed. The majority of the patients (n=39, 76.5%) presented within the first year of life with a mean age at presentation of 1 year and 8 months, though most of the repairs were done in the 2nd, 3rd and 4th years of life. Of the 51 patients 46 (90.2%) came from rural and semi-urban areas and 18 (35.3%) had been circumcised before presentation. Surgical repair consisted of preputial island flap in 22 patients (43.1%) followed by a peri-meatal based flap (Mathieu procedure) in 16 patients (31.4%). The MAGPI procedure was used in 5 patients (9.8%) and the Snodgrass procedure in 1 (2%). Staged repair was necessary in 7 patients (13.7%). Post-operative complications were encountered in 15 patients with urethrocutaneous fistula being the commonest one (11 patients, 21.6%). Conclusion: Our results show that hypospadias can be successfully managed in a low- resource setting.
Distally Folded Onlay Flap – A New Technique for Repair of Hypospadias
AM Abdel Moniem
African Journal of Urology , 2004,
Abstract: Objective: This study was carried out to evaluate the cosmetic and functional results of this new technique for repair of hypospadias. Patients and technique: 28 patients (2-22 years) with distal penile hypospadias were included in the study. Eleven of them had had a failed previous repair. An unhealthy urethral plate and/or thin ventral penile skin were found in 17 patients. The technique follows the steps of the island onlay preputial flap or dorsal penile fasciocutanous flap except in that the length of the flap is, at least, 1 cm longer than the length of the urethral plate. The proximal part of the flap is used for urethral reconstruction. The distal free part of the flap is reflected back to be sutured to the edges of the glanular wings and the penile skin. The urethral stent is removed after 5 days. The patients were followed monthly up to 6 months. Results: In 26 patients an excellent cosmetic appearance of both the penile shaft and glans was achieved with a slit-like or elliptic neo-meatus resulting in a good urine stream satisfying both the patients and their parents. Partial disruption of one side of the suture line and urethrocutanous fistula was reported in one patient each. These two complications were corrected surgically with good results. Conclusion: We conclude that this new technique that we named distally folded onlay flap is easy and versatile with excellent cosmetic and functional results and a low rate of complications when used for the repair of distal and mid-shaft hypospadias in either virgin or redo cases. It should also be considered as a salvage procedure when other techniques are no feasible options. Le lambeau croisé distal selon onlay. Une nouvelle technique de cure d\'hypospadias Objectifs: Evaluer les résultats esthétiques et fonctionnels de cette nouvelle technique pour la réparation d\'hypospadias. Patients et Méthode: Vingt-huit patients (2-22 ans) présentant un hypospadias distal ont été inclus dans cette étude. Onze patients présentaient un échec d'une réparation antérieure. Une plaque urétrale de mauvaise qualité et/ou une peau pénienne ventrale épaisse ont été décrites chez 17 patients. La technique utilisée est celle de ONLAY du lambeau préputial ou du lambeau de fascia de la peau dorsale pénienne, par contre là le lambeau est de 1 cm plus long que la plaque urétrale. Le bout proximal du lambeau est utilisé pour l'urétroplastie alors que le bout distal libre est inversé pour être suturé aux berges de la peau pénienne et au gland. Le cathéter urétral est enlevé après 5 jours. Les malades ont un suivi mensuel jusqu\'à 6 mois. Résultats: Chez 26 patients l'esthétique de la verge et du gland est excellente, complétée par une fente ou un néo-méat elliptique qui permet un bon écoulement urinaire qui satisfait les patients et leurs parents. Des complications ont été rapportées chez deux patients: le lachage partiel d\'un c té de la ligne de suture chez un patient et fistule urétro cutanée chez l\'autre. Ces deux
Onlay free preputial graft for mid and distal penile hypospadias  [cached]
Gangopadhyay A,Sharma Shilpa,Mongha Ritesh
Journal of Indian Association of Pediatric Surgeons , 2005,
Abstract: Tubularized free preputial graft for hypospadias repair had been tried in the past and discarded due to high incidence of graft shrinkage causing stricture formation. We have tried to revive the technique using onlay method thus avoiding stricture formation. The technique was used in 33 subjects (Group A) and compared with 33 subjects in control group (Group B) in whom other techniques of urethroplasty were used. The study was a randomized controlled trial. The mean length of the free preputial graft was 22.06 + 4.68 mm (16-35 mm) and breadth was 9.0 + 1.32 mm (7-11 mm). Fistulae developed in 3 patients in group A out of which one healed spontaneously. In group B, 6 patients had fistula formation. Complications developed in 18% cases in group A and 50% cases in group B. There was significant difference between the cosmetic results (p < 0.05) with 58% excellent results in group A and 27% in group B. Free preputial graft onlay urethroplasty has better functional and cosmetic results.
Inner Preputial Flap as Tunica Albuginea Replacement in The Management of Previously
A Bhat, B Sharma, M Dawan, G Saxena
African Journal of Urology , 2010,
Abstract: Objectives: To assess the efficacy of an inner preputial skin flap as replacement for the tunica albuginea of the corpus cavernosum after excision of fibrous plaque. Patients and Methods: In this retrospective study we evaluated 5 men who presented with impotence, chordee, painful erection and/or painful coitus after previously undiagnosed or untreated penile fracture. In two patients soft tissue X-rays suggested calcification of the plaque, while ultrasonography revealed extension of fibrosis in four cases. In all patients the plaque was excised and the defect in the tunica albuginea was closed with an inner preputial pedicle skin flap. Results: The flaps had taken well in all cases at 3 months follow-up and all patients reported having normal sexual intercourse. Conclusion: Surgical excision is the treatment of choice for management of symptomatic fibrous plaques occurring in undiagnosed, untreated or conservatively managed penile fracture. A defect of more than 1.5 cm after excision of the plaque requires tunica replacement, and an inner preputial flap is a good replacement.Key Words: Penile fracture, complications, fibrous plaque, tunica replacement, inner preputial flap, erectile dysfunction
Free Radial Forearm Flap in an Adult with Hypospadias  [PDF]
Chih-Cheng Luo,Chen-Sheng Huang,Jeng-Yee Lin,Chi-Feng Huang
Chang Gung Medical Journal , 2007,
Abstract: A 22-year-old man presented with a scarred neophallus and complex hypospadias. Thelocal penile skin was inadequate for urethral repair. A 16 cm free radial forearm flap wasused for urethral replacement. Microvascular anastomosis allowed this flap to remain viableand functional. One year postoperatively, the patient had satisfactory functional and cosmeticoutcomes. A small fistula developed in the course of the proximal anastomosis, and it wassuccessfully repaired. Our case describes the successful use of a free radial forearm flap forurethral reconstruction.
Dartos flap coverage of the neourethra following repair for primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas: it is a safe approach
Ozturk, Hayrettin;
Acta Cirurgica Brasileira , 2010, DOI: 10.1590/S0102-86502010000200012
Abstract: purpose: urethrocutaneous fistula and neourethral dehiscence are frequently seen complications of hypospadias surgery requiring reoperation. in this study we report the experience of one surgeon with dartos flap coverage in primary hypospadias, reoperative hypospadias and urethrocutaneous fistulas repair. methods: a total of 23 patients underwent hypospadias and urethrocutaneous fistulas repair from january 2006 to may 2009. fourteen patients were operated on for primary hypospadias repair at our institution and 9 patients were admitted for hypospadias complications such as failed hypospadias repair and urethrocutaneous fistula. in all the patients, the dartos flap was dissected and transposed to cover the neourethra. operative results were recorded. results: the primary surgical procedure was a one-stage repair in 61% (n = 14); tubularised incised plate (tip) urethroplasty in 43% (n = 6) and a mathieu procedure in 57% (n = 8). urethrocutaneous fistulas complicating the previous initial hypospadias repair were anterior in 33% (n = 2), middle in 33% (n = 2) and proximal in 33% (n = 2). repair of the fistula was successful on the first attempt in all patients. the reason for redo surgery in 3 patients was complete dehiscence and the patients had distal shaft hypospadias. conclusion: dartos flap coverage of the neourethra seems to be an effective method of reducing the fistulous complication rate following primary and secondary hypospadias repair.
Moremi Statue in Ile- Ife: A Symbol of Yoruba Aesthetics
A Yemisi, J Igbaro
African Research Review , 2010,
Abstract: Moremi was a Yoruba heroine whose statues are in Ile-Ife as a memorial of her votive sacrifice to save her people from annihilation. The paper focuses primarily on the importance of Moremi on Ife people, which led to her been immortalized. It is also an attempt to analyse the aesthetic qualities of Moremi statue in relation to Yoruba cosmology, which emphasizes and promotes the attributes of Yoruba philosophy of beauty which is more of an inward rather than an outward issue. The study makes use of two statues of Moremi in Ile-Ife. The symbolism of the dress items is discussed so as to drive home the inherent Yoruba aesthetic terms portrayed in the statues visà- vis its relevance in the society. The paper also compares the two statues so as to draw attention to the different aesthetic portrayals. The Moremi statue in the Ooni of Ife palace is actually the object of interest of this study; however the other statue at Moremi hall, Obafemi Awolowo University Ile-Ife is also studied for comparative analysis. The findings among others revealed that, though Moremi is still well revered in Ile-Ife, yet, the statues are not well maintained.
Management of cystic lymphangiomas in Ile-Ife, Nigeria
OA Sowande, O Adejuyigbe, AM Abubakar
Nigerian Journal of Surgical Research , 2003,
Abstract: Background: The management of cystic lymphangiomas is and challenging. Of all the available modalities of treatment, surgery remains the gold standard but it is associated with significant morbidity and mortality. Method: Retrospective analysis of 28 cases of cystic lymphangioma seen at the Obafemi Awolowo University Teaching Hospital, Ile-ife, Nigeria. Results: There were 16 boys and 12 girls with a median age of 6 months. The cervical region was most commonly involved site in 19(67.9%) children. Eight (28.6%) of the patients had morbidity at presentation. Only 24 of the 28(86%)patients had surgical excision. Complete macroscopic excision was possible in 15 (62.5%) patients. There was one death (4.2%) at induction of anaesthesia due to rupture of a cervical cyst at intubation with aspiration. Post-operative complications occurred in 10 (41.7%) patients. Recurrence was reported in 1(4.6%) patient. Conclusion: The presentation of cystic lymphangiomas in our own environment is diverse. There is a high preoperative morbidity. Surgery remains the only option available in this environment but is associated with a high e complication rate. (Nig J Surg Res 2003; 5: 32 – 37)
Market Supply Response of Cassava Farmers in Ile-Ife, Osun State  [cached]
O. F. Adesiyan,A. T. Adesiyan,R. O. Oluitan
Canadian Social Science , 2012, DOI: 10.3968/j.css.1923669720120803.1125
Abstract: This study examined the market supply response of cassava farmers in Ile-Ife, Osun State. Data were collected from 80 cassava farmers from four cassava producing Local Government Areas (LGAs) namely; Ife-East, Ife-Central, Ife-North and Ife-South. These were analysed using descriptive statistics and regression technique. The results of the descriptive analysis showed that method of cassava farming was mainly traditional and cassava was mostlly cultivated with maize. Majority of the cassava farmers were married, literate and of about 35 years meaning that more young people were into cassava cultivation in Ile-Ife. Also, the farmers had an average of 8 members per household. The results of the regression analysis revealed that 97% of the variations in the marketed surplus of cassava were explained by the variables in the model. The result also revealed that the quantity of cassava output in kg and the family size had positive and significant effects on the marketed surplus while losses, quantity of cassava consumed in kg, payments in kind in kg, size of land in hectares had negative effects on the marketed surplus. The elasticity of marketed surplus was 1.6 meaning that the supply response was elastic indicating that the higher the price of cassava output in kg the more the quantity of cassava that will be supplied. Key words: Cassava Farmers; Market supply response; Nigeria; Osun State
One stage repair in Hypospadias by prepucial island flap technique  [cached]
Dogra B
Indian Journal of Plastic Surgery , 2003,
Abstract: Surgical repair of hypospadias has taxed the skills of surgeons the world over. One stage repair is preferable as it decreases operative trauma, allows use of virgin unscarred skin, decreases number of hospitalisations and hence is economical. During last 4 years the author has managed 60 cases of hypospadias and their complications in a tertiary care service hospital. The author has randomly used onlay prepucial flap technique and tubularisation of prepucial flap in roughly equal number of cases of hypospadias to assess the advantages and limitations of these techniques in service clientele and their dependents.
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