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    COMPARISON OF THE EFFECT OF DIFFERENT SURGICAL METHODS IN PROXIMAL AND DISTAL HYPOSPADIAS
    (Medknow Publications & Media Pvt Ltd, 2012) Selcuk, Caferi Tayyar; Aksoy, Kadir; Karamursel, Sebat; Civelek, Birol; Celebioglu, Selim
    Introduction: Hypospadias is a congenital anomaly observed in approximately one in every 200 to 300 male births. To date, there is no method universally agreed upon for repair of hypospadias. The aim of our study is to retrospectively compare the methods chosen according to the location of the meatus and their outcomes in a group of 75 patients. Material and Methods: Between 2002 and 2008, seventy-five patients with primary hypospadias underwent surgical repairs. The age range of the patients was between 8 and 140 months, and the mean age was 61.8 months. The repairs in the patients with distal hypospadias were performed through urethral advancement (n=27) and the Mathieu technique (n=17). The repairs in the patients with proximal hypospadias were performed with onlay preputial island flap urethroplasty (n=8), the Asopa technique (n=19), and skin graft urethroplasty (n=4). Results: Patients where a satisfactory reconstruction was achieved were followed up for an average period of 54.6 months (range: 29-92 months). None of the patients developed any infection, hematoma, wound dehiscence or diverticula. During the follow-up period, the total complication rate was 14.6%, of which 8% were fistulae and 6.6% were meatal stenoses. The lowest complication rates were observed with the onlay preputial island flap method (25%) applied in patients with proximal hypospadias and with the urethral advancement (3.7%) applied in patients of distal hypospadias. Conclusion: In our study, the onlay preputial island flap urethroplasty in patients with proximal hypospadias and the urethral advancement in patients with distal hypospadias were found to be the most effective techniques.
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    Reconstruction of large meningomyelocele defects with rotation- transposition fasciocutaneous flaps
    (2012) Selçuk, Caferi Tayyar; Civelek, Birol; Bozkurt, Mehmet; Kapı, Emin; Kuvat, Samet Vasfi
    Meningomyelocele is one of the most common congenital defects of the central nervous system. Reconstruction of these defects must be performed immediately after delivery to prevent complications such as primary meningitis and to protect the neural tissues. The most important factors in the surgical treatment of meningomyelocele defects are the size of the defect, its location, the presence of kyphosis, and the quality of the surrounding tissue. The chosen method must be a simple one that causes minimal blood loss, requires a short duration of surgery, and covers the surface of the neural defect with a soft-tissue mass enabling closure without tension. In our study, satisfactory results have been obtained using 1 or 2 fasciocutaneous flaps based on the midline in 20 patients with large meningomyelocele defects where primary closure was not possible. A single flap based superiorly on the midline was sufficient to close the defects in patients without kyphosis. In patients with concurrent kyphosis, a second flap based inferiorly on the midline has been used. All flaps survived, except for a distal partial necrosis observed in 1 patient. In the method we used, we adopted a defect reconstruction that is similar to the normal anatomic structures and resistant to trauma and infections, and does not sacrifice any muscle tissue. According to our clinical experiences, this method is useful for large meningomyelocele defects that are unsuitable for primary closure.