TIP Repair Research Articles

Current trends in the management of hypospadias: the Ibero-American experience

Introduction: Hypospadias management has seen various trends over the years, likely due to the diverse clinical presentations and evolving surgical techniques. However, there is a lack of consensus among pediatric urologists on many aspects of hypospadias management. To address this, our research aims to survey specialists and establish a consensus on hypospadias management. Methodology: In July 2021, a cross-sectional study was conducted using a Survey Monkey questionnaire consisting of 23 questions. The survey aimed to gather information about the generalities and management preferences of distal and proximal hypospadias from specialists belonging to the Ibero-American Society of Pediatric Urology (SIUP). The data collected was categorized into subgroups based on surgical techniques, perioperative preferences, and complications. Results: Most hypospadias surgeries are performed between 13-18 months. Penile curvature is evaluated with artificial erection and visual inspection. The Nesbit technique (36.1%) and ventral corportomies (26.9%) corrections are more common, while grafts corporoplasties are used less frequently (10.2%) for correction. For urethroplasty, the surveyed group prefers using a running suture or a combination of continuous and interrupted stitches (49.1% and 24.3%, respectively). The use of Polydioxanone 6-0 in a double-layer suture group yielded a higher response rate. The use of prophylactic antibiotics and their maintenance when the catheter is in place was also favored by most surgeons. Discussion: When repairing hypospadias, the surgeon must consider factors such as the quality of the urethral plate, the presence of penile curvature, and the location of the urethral opening. This study highlights the different strategies and technical preferences used for hypospadias repair by a group of specialists from different countries. Conclusion: The survey describes current trends in hypospadias management. Two-stage repair is commonly used for proximal hypospadias, while TIP repair is the most used technique for distal hypospadias. The most common complication is the development of an urethrocutaneous fistula.

The use of an autologous platelet-rich fibrin membrane in urethroplasty for cases of distal hypospadias

BackgroundAmong pediatric surgical procedures, hypospadias surgery is one of the most difficult. The most prevalent complication following hypospadias repair is urethrocutaneous fistula. Numerous procedures have been developed to prevent and resolve this issue. One such method is platelet-rich fibrin (PRF) membrane preparation, which is a straightforward process requiring only the patient’s serum. It has already been utilized successfully in plastic and reconstructive surgeries, where it significantly enhances the healing capacity and decreases the risk of infections. The purpose of this study is to assess the efficacy of an autologous PRF membrane in promoting healing and reducing fistula occurrence in cases of de novo distal hypospadias.MethodsForty patients with primary distal hypospadias underwent TIP repair, as a part of a prospective controlled randomized study from April 2017 to February 2018. The cases were randomly allocated into two categories. TIP repair done in all cases by the same surgeon. Twenty cases comprised group A, which utilized a preputial or local dartos flap as an additional protective layer over the urethroplasty. In contrast, group B comprised 20 cases in which the urethroplasty was covered with a PRF membrane. The initial follow-up duration was 6 months. Each group’s fistula incidence and other associated complications were documented.ResultsTwo groups were compared during the initial 6-month follow-up period. There were seven cases of urethrocutaneous fistula in group A, representing a 35% incidence rate. In group B, there were two cases that had fistula with an incidence of 10% in the early postoperative period. Two patients (10%) in group A developed meatal stenosis and only one patient in group B (5%) developed meatal stenosis. Glandular dehiscence occurred in one patient (5%) in group B. There was no skin wound infection in both groups.ConclusionThe PRF membrane may be a promising method as a coverage layer over the urethroplasty aiming to reduce the fistula rate after the repair. A larger comparative study is needed to evaluate the efficacy of PRF membranes in promoting wound healing.

PD06-07 HOW DURABLE IS THE CHILDHOOD HYPOSPADIAS REPAIR? A DATA-LINKAGE STUDY OF PENILE REOPERATIONS OVER 30 YEARS

You have accessJournal of UrologyCME1 Apr 2023PD06-07 HOW DURABLE IS THE CHILDHOOD HYPOSPADIAS REPAIR? A DATA-LINKAGE STUDY OF PENILE REOPERATIONS OVER 30 YEARS Sergey Vavilov, Erin Nolan, Grahame H. Smith, Peter Pockney, Malcolm Starkey, and Aniruddh V. Deshpande Sergey VavilovSergey Vavilov More articles by this author , Erin NolanErin Nolan More articles by this author , Grahame H. SmithGrahame H. Smith More articles by this author , Peter PockneyPeter Pockney More articles by this author , Malcolm StarkeyMalcolm Starkey More articles by this author , and Aniruddh V. DeshpandeAniruddh V. Deshpande More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study is to estimate the overall risk of penile reoperations after a childhood hypospadias repair, especially in the second and third decades of life, and explore the risk factors of reoperations. METHODS: All children operated on for hypospadias in three children’s hospitals in NSW Australia between April 1991 and December 2006 were identified and their health records linked (July 2001 to December 2020) using the Centre of Health Record Linkage NSW. The details regarding penile reoperations (procedure codes and dates) were captured. Patients were then grouped in three age categories for the analysis: 1 - 0-10, 2 - 10-20, and 3 - 20-30 years old. Primary reconstructive operations performed over 15 years (between 1991 and 2006) were classified into six categories: Distal – Hemicircumcision, Distal – MAGPI, Distal – TIP, Distal – Other, Proximal, Multi-Stage Repair. The reoperations were collapsed into four patient relevant categories: 1) Urethroplasty related, 2) Chordee related 3) Cystoscopies, and 4) Others. The cumulative incidence rate was measured by calculating the sum of reoperations divided by 100 person years at risk. The differences in the incidence of reoperations by hypospadias severity, urethral plate division and persistent chordee after degloving were calculated using chi-square tests with the Yates continuity correction to account for smaller cell sizes. RESULTS: 1105 patients (group 1=617, group 2=1099, group 3=473) were identified with a median follow-up of 18.4 years. The cumulative incidence rate of a penile reoperation in group 1 was 7.3, in group 2 was 1.7, and in group 3 was 0.6 per 100-patient years at risk. The cumulative incidence (risk) of a penile reoperation over 20 years was 37%. Over the entire follow-up period, the highest incidence rate of penile reoperations was after multi-stage (9.9) and single-stage proximal hypospadias repair (5.7) and TIP repair (3.6). There was a higher penile reoperation risk after proximal hypospadias repair, if at primary repair the native urethral plate was divided (p<0.0001), and if there was a persistent chordee after degloving (p=0.04). No reoperations for chordee were identified. CONCLUSIONS: This study is the first of its kind that identifies the quantum and the risk factors for reoperations over 30 years of follow-up and will inform not only better counselling but also further research into technical and non-technical aspects of hypospadias care. Source of Funding: 1. School of Medicine and Public Health, University of Newcastle, Small Project Grant. 2. Hunter New England Research and Translation Centre Research Grant 3. Priority Research Centre GrowUpWell Seed Funding 2020 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e158 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sergey Vavilov More articles by this author Erin Nolan More articles by this author Grahame H. Smith More articles by this author Peter Pockney More articles by this author Malcolm Starkey More articles by this author Aniruddh V. Deshpande More articles by this author Expand All Advertisement PDF downloadLoading ...

MP18-11 DOES LEVEL OF TRAINEE INVOLVEMENT HAVE AN IMPACT ON HYPOSPADIAS TIP REPAIR OUTCOME?

You have accessJournal of UrologyCME1 Apr 2023MP18-11 DOES LEVEL OF TRAINEE INVOLVEMENT HAVE AN IMPACT ON HYPOSPADIAS TIP REPAIR OUTCOME? Vinaya Bhatia, Rocio Goodman, Maria Jabbour, and Walid Farhat Vinaya BhatiaVinaya Bhatia More articles by this author , Rocio GoodmanRocio Goodman More articles by this author , Maria JabbourMaria Jabbour More articles by this author , and Walid FarhatWalid Farhat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Teaching hypospadias repair to trainees is a major component of pediatric urology fellowship training but is not a focus of training junior residents. Herein, we reviewed outcomes of distal hypospadias repairs performed by a single surgeon in the proficiency stage of practice in a residency program and compared these outcomes to those for the same surgeon in the same stage in a fellowship program. METHODS: We reviewed all distal tubularized incised plate repairs performed by a single surgeon from 2019-2021. Data included age, meatal location, presence of curvature, operative time, occurrence of complications, and follow-up duration. Of note, resident involvement comprised mainly assisting in penile degloving urethroplasty and included skin closure under direct supervision. Our outcomes were compared to previously published data using descriptive statistics and Fisher’s exact tests, in which a p<0.05 was designated as statistically significant. RESULTS: A total of 52 patients met our inclusion criteria. A total of 5 patients had a megameatus, 6 had a glanular hypospadias, and 34 had a distal shaft hypospadias. The median age at surgery was 0.72 months (IQR 0.75 months). All patients did have an indwelling stent post-operatively. One patient (3.3%) was found to have complications, which were fistulae and meatal stenosis (Table 1). The time to complication for this patient was 6 months. When comparing previous data to the current data, the overall complication rates were lower (p=0.03), with overall complication rates of 15% (29/187) versus 3% (1/52). CONCLUSIONS: This is the first study directly comparing hypospadias surgical outcomes for the same surgeon in a different practice setting, specifically fellowship and residency programs. Though the detailed role of fellows in hypospadias repair might not be well delineated, it did entail autonomy and delegation, while residents only assisted or performed skin closure under supervision. Our data suggest that fellowship training programs might need to determine key steps for hypospadias repair they teach or delegate. This process should be delivered in a gradual manner gauged to the level of trainees to ensure that outcomes are improved. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e227 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vinaya Bhatia More articles by this author Rocio Goodman More articles by this author Maria Jabbour More articles by this author Walid Farhat More articles by this author Expand All Advertisement PDF downloadLoading ...

Calcium Transport along the Axial Canal in Acropora

In Acropora, the complex canals in a coral colony connect all polyps to a holistic network, enabling them to collaborate in performing biological processes. There are various types of canals, including calice, axial canals, and other internal canals, with structures that are dynamically altered during different coral growth states due to internal calcium transport. In this study, we investigated the morphological changes in the corallite of six Acropora muricata samples by high resolution micro-computed tomography, observing the patterns of calcium carbonate deposition within axial corallite during processes of new branch formation and truncated tip repair. We visualized the formation of a new branch from a calice and the calcium carbonate deposition in the axial canal. Furthermore, the diameter and volume changes of the axial canal in truncated branches during rebuilding processes were calculated, revealing that the volume ratio of calcareous deposits in the axial canal exhibit significant increases within the first three weeks, returning to levels in the initial state in the following week. This work demonstrates that calcium carbonate can be stored temporarily and then remobilized as needed for rapid growth. The results of this study shed light on the control of calcium carbonate deposition and growth of the axial corallite in Acropora.

QS7: Digit Tip Regeneration Following Amputation Is Not True Regeneration

Purpose:Repair of distal phalanx amputation is widely studied and thought to occur through a regenerative process. Single-cell RNA sequencing (scRNA) has greatly improved the ability to characterize the cells that are involved in regeneration and abnormal healing of bone and soft tissue. Given the disorganized architecture of digit tip “regenerated” bone and its common progenitor cell to the pathologic process of heterotopic ossification, we hypothesized that digit tip repair after injury follows a program of aberrant wound repair rather than true regeneration of normal bone tissue.Methods:ScRNA data of mouse digit tip amputation (DTA) and embryonic limb development (EMB) was downloaded from NBCI GEO data base ascension number GSE135985. Additionally, scRNA data from heterotopic ossification (HO) was downloaded from GSE126060. HO, DTA, and EMB datasets were clustered individually. HO was merged and aligned with EMB and DT in separate analyses. Cells expressing the mesenchymal progenitor cell (MPC) marker Pdgfra, which we have shown to differentiate into HO and others have shown to differentiate into bone after DTA, were identified and analyzed in the HO-DTA and HO-EMB datasets. Monocle 2, Seurat 3.1.1, and Pearson correlation analysis were used for analysis and visualization. Immunostaining for markers present in DTA (ACAN, FBN-2, LTBP2) was performed on sections collected from a murine model of traumatic HO in Pdgfra-CreER;TdTomato mice induced with tamoxifen one-week prior to HO-forming injury.Results:MPC clusters from DTA and HO and from EMB and HO were aligned and projected using UMAP to compare transcription profiles. Across the timepoints, MPCs in the DTA and HO occupy similar regions of the UMAP plot, while MPCs in EMB and HO occupy largely independent regions, with only overlap at the latest time points. Using Monocle 2, cells were placed on a virtual timeline based on similarities in transcription. MPCs from DTA and HO meet at the same location on the trajectory following injury. In the EMB to HO comparison, cells only occupy similar regions of the trajectory at post-natal day 3 suggesting that bone is formed by different pathways. To understand correlations between time points, transcriptomes were also compared by Pearson analysis. MPCs following HO and DTA injuries occupy similar regions of the plot while MPCs in EMB and HO only occupy similar regions of the correlation plot at P3. Markers previously identified to be upregulated in MPCs in DTA were also upregulated in MPCs in HO by both scRNA and immunofluorescent histology.Conclusions:Cells responsible for bone repair following DTA show similar transcriptional profiles as MPCs in traumatic HO and dissimilar to MPCs in EMB. Furthermore, MPCs in both digit tip repair and HO follow trajectories that do not overlap with embryonic limb development. Thus, we demonstrate for the first time, that the process following DTA is not truly regeneration and follows programs of aberrant repair as seen in HO.

Is Tip Repair in Hypospadias is a Confidence Building Procedure? Analysis of early Hundred Cases at A Pediatric Surgical Centre

Purpose: The tubularized incised plate (TIP) technique for hypospadias repairis a well-known procedure for urethroplasty. The authors in this studyanalyze the application and outcome of TIP by the Pediatric Surgeon. They describe how this procedure helps to start hypospadias surgery services especially to the newly established centres. The procedure can provide surgeons required confidence and prepare them to undertake the complex surgeries for hypospadias. Method: This is a prospective study done on all cases of hypospadias operated with TIP technique in a newly established centre for Pediatric Surgery for a period of two years. The results were evaluated on the basis of outcome in the form location and shape of meatus, correction of curvature. The complications were noted and individually treated. Results: Total 100 patients were operated with TIP technique during the study period. The Distal type of the hypospadias was the main variety treated (n=64) followed by mid penile and proximal penile type of hypospadias (n=21 and n=13 respectively). All patients were offered TIP as the method of urethroplasty and were operated by a single surgeon. The procedure was well tolerated by all the patients. There were few complications, mainly meatal stenosis and urethrocutaneous fistula. No Major complications were found. The cosmetic and functional outcome was good in all cases. Conclusion: The TIP urethroplasty offers a considerable safe technique in the patients of hypospadias. It can be easily learnt and reproduced. There is a learning curve associated with the procedure. The authors can conclude that the procedure of TIP in the cases of hypospadias brings a good amount of confidence in a Pediatric Surgeon to offer the services of hypospadias surgery especially in newly established setup. Keywords: Hypospadias; Pediatric; Fistula; Hypospadias.

A different approach to distal hypospadias repair: The GUD (glandular urethral disassembly) technique

Distal hypospadias represent the most frequent clinical presentation of hypospadias. In spite of more than 300 techniques available, there is not an ideal approach. We have proposed an alternative procedure based on the combination of minor urethral mobilization and major glans deconstruction and partial disassembly from the corpora, the GUD technique. We want to present our clinical experience with the procedure and describe it in detail. The technique consists of disconnecting the spongious tissue and the distal urethra from the corpora and detaching partially the glans as well, from 2 to 10 o'clock. The glans is opened in midline and the procedure combines cranially mobilization of urethra with caudal and medial rotation of glans wings to refurbish the glans correcting the hypospadia without urethroplasty. We have treated 164 patients with distal hypospadia. Median age at the surgery was 22.4 months (1-184 months). The meatal position after penile degloving was coronal at 108 cases, subcoronal at 54 and 2 patients presented megameatus and intact foreskin. Three patients (1.8%) had mild penoscrotal transposition in addition to hypospadia. Twenty-eight patients were treated as a secondary repair (17%). We found complications in 6 patients (3.6%) consisting of five fistulas (3%) and three glans dehiscence (1.8%). Two patients had both complications. Follow up was 21 months (1-42 months) and the median follow-up time was 18 months. We acknowledge that this procedure is intended only to distal hypospadias (coronal and subcoronal). We stress that the GUD procedure can be performed irrespectively of any urethral plate "quality" as it does not require a minimum glans width as the TIP repair. Moreover, there is no need for preoperative testosterone treatment. The absence of suture and urethroplasty minimizes the risk of coronal fistulas after surgery. We believe that this procedure is a viable alternative to distal hypospadias repair.

Turbine Blade Tip Repair by Laser Directed Energy Deposition Additive Manufacturing Using a Rene 142–MERL 72 Powder Blend

Laser directed energy deposition (LDED) was used with a powder blend comprising 75 wt.% Rene 142 and 25 wt.% of Merl 72 (4275M72) for turbine blade tip repair applications. Sound samples could be deposited at ambient temperature on Haynes 230. The microstructural analyses showed the presence of fine gamma prime precipitates in the as-deposited samples, while after aging, the alloy possessed around 40 vol.% with a bimodal precipitate size distribution. Also, the alloy contained Ta-Hf-W carbides in different sizes and shapes. Tensile testing from room temperature up to 1366 K was performed. The 4275M72 deposits possessed higher tensile properties compared to Rene 80 in this temperature range but lower elongations at the elevated temperatures. The creep properties of 4275M72 samples at 1255 K were superior to Rene 80. Also, the oxidation resistance of deposited 4275M72 was similar to Rene 142. The combination of high mechanical properties, creep behavior, and oxidation resistance of LDEDed 4275M72 makes it a suitable alloy for tip repair of turbine blades.

Recurrent ventral curvature after proximal TIP hypospadias repair

Most boys with proximal hypospadias have ventral curvature (VC) which must be straightened while preserving the urethral plate to use TIP repair. That is usually done by dorsal plication (DP). However, we reported recurrent VC was commonly found after DP in boys with proximal urethroplasty complications, and have diagnosed VC in patients similarly straightened by WS. We reviewed our proximal TIP patients and now report their recurrent VC. We used a prospectively-maintained database to identify all patients with proximal TIP by WS and document recurrent VC. Penile straightening was primarily done by midline DP using 5-0 or 6-0 polypropylene, and/or other maneuvers including combinations of urethral plate elevation off the corpora, mobilization of the urethra to the external sphincter, and ventral corporotomies. Recurrent VC was suspected by a characteristic 'hunched-over' appearance and resistance to lifting the glans cephalad (Figure), and confirmed in all cases by artificial erection intraoperatively. 58 of the 77 patients with follow up had VC straightened. Recurrent VC was diagnosed in 26%. It was suspected during this review in another 10% who had recurrent urethroplasty complications which we now know often indicate VC, or urethral plate elevation with no treatment for corporal disproportion. This recurrent VC was objectively measured in nearly half those diagnosed, averaging 52 (30-75). It was diagnosed before puberty in all cases. There was no difference in recurrent VC in those managed with DP alone versus those straightened by DP and/or other maneuvers. The finding that 1 of every 4 patients had recurrent VC after proximal TIP, and that as many as 1 of every 3 might have had that complication, is concerning. During most the study the extent of VC was visually estimated, and most patients were thought to have <45° with no tension on the UP after straightening. We reported 70% of patients operated elsewhere for proximal hypospadias and presenting with urethroplasty complications had recurrent VC≥30° following earlier DP. In that series, in the current patients, and in an earlier report by Braga etal., an intact urethral plate correlated with increased risk for recurrent VC. Despite our improved ability to diagnose recurrent VC, we have not found it in boys who underwent STAG repair with urethral plate transection. Recurrent VC after proximal TIP repair occurred in at least 1 of every 4 patients despite DP and/or additional maneuvers to straighten the penis while preserving the urethral plate. Accordingly, we now only perform proximal TIP when there is little (<30°) or no VC.

Comparison of effect between dartos fascia and tunica vaginalis fascia in TIP urethroplasty: a meta-analysis of comparative studies

BackgroundTubularized incised plate (TIP) urethroplasty is the most commonly performed procedure for hypospadias. Several flap procedures have been recommended to decrease the postoperative complication rate in TIP repair, but no single flap procedure is ideal. This study aimed to compare the outcomes of dartos fascia (DF) and tunica vaginalis fascia (TVF) as intermediate layers in TIP urethroplasty.MethodsWe searched PubMed, EMBASE, the Cochrane Library, Web of Science, clinicaltrials.gov, and other sources for comparative studies up to April 16, 2020. Studies were selected by the predesigned inclusion criteria. The primary outcomes were postoperative complications. The secondary outcomes were functional and cosmetic outcomes.ResultsThe pooled RR with 95% CI were calculated. We extracted the relevant information from the included studies. Only 6 comparative studies were included. No secondary outcomes were reported. The RR of the total complications rate for DF was 2.41 (95% CI 1.42–4.07, P = 0.0001) compared with TVF in TIP repair. For each postoperative complication, the RRs were 6.48 (2.20–19.12, P = 0.0007), 5.95 (1.13–31.30, P = 0.04), 0.62 (0.25–1.52, P = 0.29), and 0.75 (0.23–2.46, P = 0.64) for urethrocutaneous fistula, prepuce-related complications, meatal/urethral stenosis, and wound-related complications, respectively.ConclusionsThis meta-analysis reveals that compared to DF, TVF is a better option in TIP repair in terms of decreasing the incidence of the total postoperative complications, urethrocutaneous fistula, and prepuce-related complications. However there is limited evidence for functional and cosmetic outcomes. Overall, larger prospective studies and long-term follow-up data are required to further demonstrate the superiority of TVF over DF.Trial registration PROSPERO CRD42019148554.

Current Trends in Hypospadias Repair. Where are we Standing?

Purpose: Although several surgical approaches are suggested for hypospadias reconstruction but there is not a consensus on the best surgical method of hypospadias repair. This is a survey about technique of choice in treatment of various types of hypospadias. Method and materials: We asked about preferred method of treatment for three different hypospadias scenarios. 170 surgeons completed the questionnaire and enrolled in this study. Results: 51 general urologists, 61 pediatric surgeon, 16 plastic surgeons and 42 pediatric urologists joined the survey. Preferred method of surgery for a distal hypospadias was TIP in 53.5%. TIP was offered by 39.4% , Two stage Urethroplasty in 24.7% and Island On lay Flap in 21.2% to repair a proximal hypospadias without cordee. Two-stage Bracka or Durham Smith were common surgical options in proximal hypospadias surgery with cordee. Conclusion: A growing trend was detected on TIP repair of distal and proximal hypospadias without cordee.

Does intraoperative penile tourniquet application during hypospadias repair affect the patients and surgeons reported outcomes? A randomized controlled trial

Hemostasis aimed to maintain the bloodless surgical field for better exposure for the surgeon. There are no trials regarding the impact of hemostasis techniques for hypospadias surgery on surgeon satisfaction and patients' reported outcomes. Application of penile tourniquet is a common practice in hypospadias surgery that aims at reducing blood loss and improving visualization. Yet, scarce data exist on the effect of penile tourniquet on hypospadias repair outcomes. To evaluate the safety and efficacy of restraining penile perfusion using a tourniquet in hypospadias repair on the surgical outcome, also surgeons and patients reported outcomes. To evaluate the effect of penile tourniquet application on hypospadias repair outcome and surgeon's satisfaction with intraoperative hemostasis. In this single-blinded randomized controlled trial, a total of 110 children with distal hypospadias amenable for TIP repair were assigned to hypospadias repair with or without intraoperative application of a penile tourniquet. Surgeries were performed by a junior (2-5 years of experience in TIP repair) or a senior pediatric urologist (with >5 years of experience). Intraoperative blood loss, the number of times bipolar diathermy was used, hemoglobin deficit, and operative time were compared. Surgeon's satisfaction with intraoperative hemostasis was evaluated using a 4-tiered questionnaire. Patients were followed up for a minimum of one year. Complications and readmission rates were compared. The patient-reported outcome of hypospadias repair was assessed using the hypospadias objective scoring evaluation (HOSE). Baseline patient demographics and hypospadias characteristics were comparable between the study groups. Bipolar diathermy was more often used in the non-tourniquet group (mean±SD=5.7±1.8 times vs. 6.7±1.9 for the tourniquet group; p=0.007). Also, the operative time was longer in non-tourniquet group [mean=54.7±14.9 vs. 60.8±12.5min (p=0.028)]. Junior surgeons were more likely to be satisfied with hemostasis when a tourniquet was used (97.4% vs. 79.5%, p=0.02). Postoperative complications, readmission rates, and patient-reported outcomes were similar between both groups. The application of penile tourniquet during hypospadias repair can reduce operative time and the need for diathermy use; and also improves junior surgeon's satisfaction with intraoperative hemostasis without adversely affecting success rates or patient-reported outcomes.

Migrating Schwann cells direct axon regeneration within the peripheral nerve bridge.

Schwann cells within the peripheral nervous system possess a remarkable regenerative potential. Current research shows that peripheral nerve-associated Schwann cells possess the capacity to promote repair of multiple tissues including peripheral nerve gap bridging, skin wound healing, digit tip repair as well as tooth regeneration. One of the key features of the specialized repair Schwann cells is that they become highly motile. They not only migrate into the area of damaged tissue and become a key component of regenerating tissue but also secrete signaling molecules to attract macrophages, support neuronal survival, promote axonal regrowth, activate local mesenchymal stem cells, and interact with other cell types. Currently, the importance of migratory Schwann cells in tissue regeneration is most evident in the case of a peripheral nerve transection injury. Following nerve transection, Schwann cells from both proximal and distal nerve stumps migrate into the nerve bridge and form Schwann cell cords to guide axon regeneration. The formation of Schwann cell cords in the nerve bridge is key to successful peripheral nerve repair following transection injury. In this review, we first examine nerve bridge formation and the behavior of Schwann cell migration in the nerve bridge, and then discuss how migrating Schwann cells direct regenerating axons into the distal nerve. We also review the current understanding of signals that could activate Schwann cell migration and signals that Schwann cells utilize to direct axon regeneration. Understanding the molecular mechanism of Schwann cell migration could potentially offer new therapeutic strategies for peripheral nerve repair.

Classic Snodgrass Versus Inner Preputial Inlay Grafted Snodgrass in Distal Penile Hypospadias Repair

Assessment of the outcome of G-TIP technique in primary distal hypospadias repair in comparison to TIP repair using HOSE score This study had been performed between June 2018 and June 2019 which included 50 patients all presented to urological outpatient clinic of Benha university hospital -Egypt- with different types of primary distal hypospadias. They were divided into two groups (Group A operated upon using classic Snodgrass TIP urethroplasty and Group B operated upon using G-TIP urethroplasty technique), each group included 25 patients. Circumcised cases or cases with penile chordea more than 30 degree were excluded from the study. Urethral catheter might have been exited set up for particular case week on 10 times. Catch up might have been consistently during 1st, 3rd Also 6th months (3 patients didn't go to the 6th month catch up 2 from one assembly An tip Also particular case starting with the G-TIP assembly B). Mean hose score a t 6th month might have been 15. 7 out about 16 Previously, tip and 15. 5 Previously, G-TIP (P 0. 52 (NS)). In the tip aggregation those score might have been because of difficulties which incorporated an instance for urethrocutaneous fistula and an instance about meatal stenosis with urethrocutaneous fistula same time in the G-tip an instance from claiming glans dehiscence What's more an instance about gentle remaining chordea. Constantly on effects demonstrated no noteworthy measurable distinction between the two bunches but more agent chance 91. 4±6. 2 minutes in the G-TIP assembly contrasted with main 85. 2±6. 3 to tip gathering (P 0. 002 (S)), those time used for harvesting, get ready Also inlaying those graft. We finished up that G-TIP urethroplasty is a great elective procedure of the excellent tip repair shed for tantamount comes about Furthermore Despite there were no noteworthy measurable distinction the middle of those 2 gatherings in regards complications, G-TIP gatherings demonstrated preferred outcomes Concerning illustration view meatal stenosis Also urethrocutaneous fistula yet all the for longer agent run through.

Process Development for Tip Repair of Complex Shaped Turbine Blades with IN718

One of the most common defects during the operation of turbine blades is wear of the blade tip, which can lead to scrap of the blades. Additive Manufacturing (AM) offers the possibility to avoid a cost-intensive replacement of the complete blade with repair processes via Laser Material Deposition (LMD, also known as Direct Energy Deposition, DED) processes. Due to the industrial relevance of the application, only limited information regarding the exact deposition strategy and the process parameters used for the LMD process is available. The blade geometry used in this study is characterized by the variation of the profile cross-sections over the height of the blade. In addition, the profiles are rotated around the center of their skeleton line, which is known as twist. Furthermore, the profiles are shifted along their tendon line towards the leading edge, which is referred to as the forward sweep. First, a suitable set of process parameters is determined with which pore- and crack-free basic probes with IN718 can be manufactured. In order to transfer these parameters to the turbine blade, various process strategies are investigated which take into account both the sensitive blade geometry and the kinematics of the production system used. These strategies include the adjustment of contour and hatch tracks, design of suitable fly-in and fly-out strategies, as well as measures for the production of the overhang. The shape accuracy after the process is assessed by comparing the repaired blade with its target geometry with optical measurements. In summary, the three-dimensional build-up strategy used enables a stable reproduction of the twist and forward sweep and achieves a sufficient oversize for machining. Thus, the developed process represents a basic solution for the near-net-shape repair of blade tip damage of complex blade geometries, which can be applied to other blade geometries.

Technological and economical consideration for turbine blade tip restoration through metal deposition technologies

In the oil and gas industry, repair activities are critical to keep the maintenance costs of turbomachinery equipment down. Several repair technologies can be applied to various components of turbomachines. When dealing with gas turbines, the repair of turbine rotor blades has always been a very sensitive topic, given their critical application and their impact in terms of cost on the whole turbine lifecycle. Specifically, cracking and wearing of blade tips are some of the most common failure modes. Thus, the repair of these failure modes is of paramount importance, both for the original manufacturer as well as its aftermarket competitors. The present paper describes blade tip repair technologies from an original equipment manufacturer standpoint. Three different approaches are introduced and described for tip restoration. Laser cladding is presented first, since it is one of the most common technologies for this application, and then original equipment manufacturer which is currently being applied is presented. Then, cold metal transfer and direct metal laser melting technologies are investigated. A technologic and financial assessment is made to drive the technology selection for the turbine blades restoration.

Outcome of Snodgrass Repair of Distal Penile Hypospadias with Stented and Unstented Urethra

Background: Hypospadias is the most common congenital malformation of penile shaft occurring in 1 per 300 male births; it is considered a common clinical problem as it causes not only functional problems but also psychological problems for parents. Objective: The objectives of this study is to review the result of TIP repair of distal penile hypospadias in terms of outcome and complications of stenting and unstenting the urethra. Patients and methods: As a prospective randomized study; this study has included patients with distal penile hypospadias operated with Snodgrass between year 2011-2018 and had divided to (group A) included 40 patients operated upon with stent preservation for a week (group B) was 20 patients with stent removed at the end of the operation. Results: Regarding group (A) the stent of 10 cases had slipped at the first 8 hour postoperative so they have been added to the count of (group B) and considered as unstented repair. It is clear here in our study that meatal stenosis rate were different from Snodgrass rate but were similar to other published studies. Other comparable items as fistula rate, urinary retention and hospital stay, were the same as published studies. Conclusion: It could tell that removing the catheter can reduce bladder spasm , urinary tract infections, and patient discomfort and improve the familiar compliance without increasing acute retention episodes and fistula rate, so that at least in some cases specially in distal types, leaving stent can be avoided.

Outcome of Snodgrass Repair of Distal Penile Hypospadias with Stented and Unstented Urethra

Background: Hypospadias is the most common congenital malformation of penile shaft occurring in 1 per 300 male births; it is considered a common clinical problem as it causes not only functional problems but also psychological problems for parents. Objective: The objectives of this study is to review the result of TIP repair of distal penile hypospadias in terms of outcome and complications of stenting and unstenting the urethra. Patients and methods: As a prospective randomized study; this study has included patients with distal penile hypospadias operated with Snodgrass between year 2011-2018 and had divided to (group A) included 40 patients operated upon with stent preservation for a week (group B) was 20 patients with stent removed at the end of the operation. Results: Regarding group (A) the stent of 10 cases had slipped at the first 8 hour postoperative so they have been added to the count of (group B) and considered as unstented repair. It is clear here in our study that meatal stenosis rate were different from Snodgrass rate but were similar to other published studies. Other comparable items as fistula rate, urinary retention and hospital stay, were the same as published studies. Conclusion: It could tell that removing the catheter can reduce bladder spasm , urinary tract infections, and patient discomfort and improve the familiar compliance without increasing acute retention episodes and fistula rate, so that at least in some cases specially in distal types, leaving stent can be avoided.

Role of Women in Contemporary Society: Contributions &amp; Challenges

Introduction - Hypospadias is a common congenital anomaly of the male gender. It is classified into distal or anterior, middle and proximal or posterior hypospadias which are further sub-divided into different types on the basis of the location of the meatus. Aims - To compare between tubularised incised plate and preputial flap onlayurethroplasty for single stage urethroplasty for anterior and mid penile hypospadias without or minimal chordee. Materials And Methods - 75 boys were selected from patients presenting to the LLR Hospital, having hypospadias anomaly. All had comparable anterior and mid-penile deformities with no apparent or minimal chordee. Result - Both technique result in acceptable anterior position of neomeatus and had comparable complication rates. Onlay flap repair have more fistula rate and dehiscence rate. TIP repair has more meatal stenosis rate Conclusion- We prefer TIP repair as being technically easier with simple complications, superior cosmetic outcome and satisfying vertical slit like meatus.