Title : My innovations in hypospadias surgery
Abstract:
Introduction: Last 20 years I performed 1978 cases of hypospadias surgeries and made various innovations in the technique of surgery. Most innovations are reported for the first time in medical literature.
Materials and methods: 1) 718 cases done with continuous interlocking stitches instead of simple and every 5 The stitch a knot is taken. They are water tight and knot prevents unwinding of complete suture line. 2) 1568 cases, IV amino acid solution was given which supplies essential amino acids which led to much better healing. 3) Glutaraldehyde Albumin induced laser tissue welding in 318 cases which reinforces skin suture line making it waterproof. 4) 13 hypospadias fistulae closed without surgery by above technique. 5) Methylene blue dye induced laser tissue welding in 58 cases, stopped bleeding which did not with cautery. 6) Urethral pull up operation on 135 cases, free of complications such as fistula, meatal stenosis, meatal regression and residual chordee and one that does not require Dartos flap and suprapubic diversion 7) Modified urethral pull up operation on 78 cases with urethra pulled through “Glans Tunnel”. 8) Appendicular Mucosal Tube Implant with Dartos Wrap Operation in 23 cases of bad quality urethral plate. 9) Extended Urethral Plate Mobilization and reimplantation surgery in proximal hypospadias with severe chordee in 108 cases. Urethral plate lifted, chordee released and proximal mobilization till bulbar urethra. 10) Implanting delipated full thickness graft from inguinal area in stage 1 cases with bad quality urethral plates in proximal hypospadias. 11) Suprapubic diversion even in distal hypospadias cases as collagen is laid down in 3 weeks. 12) Low dose oral steroids in 38 cases for severe post op pain and in urethral stenosis requiring repetitive dilatations.
Discussion: With techniques described conventionally, success rate could not cross 60%. All above innovations improved success rate from 60 to 99%. Results: Results were much better and statistically significant compared to control group.
Conclusion: We need constant modifications in conventional techniques of hypospadias surgery for better results.
