Hypospadias – Historical Aspects · Hypospadias – Historical Aspects A R MundyA.R.Mundy & D E...
Transcript of Hypospadias – Historical Aspects · Hypospadias – Historical Aspects A R MundyA.R.Mundy & D E...
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Hypospadias – Historical AspectsAspects
A R Mundy & D E AndrichA.R.Mundy & D.E.AndrichInstitute of Urology
London
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What Is Hypospadias?What Is Hypospadias?
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Not In AsiaNot In Asia
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(Thiersch) Duplay(Thiersch) Duplay
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Excellent Results Hendren (1980)Excellent Results – Hendren (1980)
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Meatal SiteMeatal Site
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Changing AttitudesChanging Attitudes
WasWas• No real attention to the glans and meatus
NowNow• Mainly attention to the glans and meatus
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MAGPIMAGPI
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MAGPIMAGPI
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‘S d ’ i l ill i‘Snodgrass’ - optical illusion
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Unnecessary TraumaUnnecessary Trauma
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Post Operative GeneralPost-Operative - General
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Glans CleftGlans Cleft
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Short UrethraShort Urethra
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Deficient DartosDeficient Dartos
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????
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The UrethraThe Urethra
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What Makes It Difficult? 1What Makes It Difficult? - 1
• Small glans• Traumatic soft tissue lossTraumatic soft tissue loss• No dartos• No spongiosum• Previous graft or flap requiring excision• Previous graft or flap requiring excision• Significant chordee• Stricture in previous urethroplasty >3cm• Associated lichen sclerosus• Associated lichen sclerosus
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What Makes It Difficult? 2What Makes It Difficult? - 2
• Small penis• Large fistula or multiple fistulaeLarge fistula or multiple fistulae• Scarred penile shaft• Associated bulbar stricture• Associated peno-scrotal transposition• Associated peno-scrotal transposition• Associated obesity
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ProblemsProblems
• How to test the listHow to test the list• How to quantify e.g. ‘small’, ‘deficient’• How to score severity:
– Groups of problems = Grade 1,2 or 3p p ,– Score each problem 1,2 3 etc to give a total