Hypospadias Surgery: An Illustrated Guide PDF
Preview Hypospadias Surgery: An Illustrated Guide
HADIDI •AZMY Hypospadias Surgery Springer-Verlag Berlin Heidelberg GmbH Ahmed T. Hadidi· Amir F. Azmy (Eds.) Hypospadias Surgery An Illustrated Guide With 173Figures in 482Separate Illustrations, Mostly in Color • Springer ProfessorDr,AhmedT.Hadidi Cairo UniversityHospital 32HaroonStreet32,EIMessahaDokki Cairo 12311,Egypt Mr.AmirF.Azmy RoyalHospitalfor Siek Children Yorkhill, GlasgowG38ST,UnitedKingdom ISBN 978-3-662-07843-3 ISBN 978-3-662-07841-9 (eBook) DOI10.1007/978-3-662-07841-9 LibraryofCongressCataloging-in-Publication Hypospadias surgery:anillustratedguide/]edited by]AhmedT.Hadidi,AmirF.Azmy.p.;cm. Includesbibliographicalreferencesand index. 1. Hypospadias-Surgery. 2. Genitourinary organs-Surgery. 3.Pediatric urology.4. Children Surgery.1.Hadidi,Ahmed T.(AhmedTaher),1958-II.Azmy,A.A.F. [DNLM:1.Hypospadias surgery.2.Hypospadias-complications.3.SurgicalProcedures, Operative-methods. WJ 600 H998 2004] RD137.H976.2004 617.4'63-dc21 2003045746 Thisworkissubjecttocopyright.Allrights arereserved,whetherthewho1eorpartofthema terial isconcerned,specificallythe rights of translation,reprinting,reuse of illustrations, recitation,broadcasting,reproductiononmicrofilmorinanyotherways,andstorageindata banks.Duplicationofthispublicationorpartsthereofispermittedon1yunderthe provision ofthe GermanCopyrightLawofSeptember9,1965,initscurrentversion,andpermissionfor use mustalwaysbe obtainedfrom Springer-VerlagBerlin HeidelbergGmbH.Vio1ations are http://www.springer.de ©Springer-VerlagBerlinHeidelberg2004 OriginallypublishedbySpringer-VerlagBerlinHeidelbergNewYorkin2004 Softcoverreprintofthehardcover1stedition2004 Theuse ofdescriptive names,registered names,trademarks,etc.in this publicationdoes not imply,evenin the absence ofaspecificstatement,that such names areexemptfrom the rele vantprotectivelawsand regulationsand thereforefreeforgeneraluse. Productliability:Thepublishercan not guaranteethe accuracy ofanyinformation about do sageand application containedinthisbook.Ineveryindividual casetheusermust checksuch informationbyconsulting therelevantliterature. Cover-Design:ErichKirchner,Springer-Verlag,Heidelberg,Germany Drawings:Reinhold Henkel,Heidelberg,Germany Typesetting:Fotosatz-ServiceKöhlerGmbH,Würzburg,Germany Printedonacid-freepaper. 24/3150ih-543210 To my father, Taher, for leadinghis children into intellectualpursuits; my mother,Mawaheb, for devoting herlifeto her children; my uncle, Helmy, for setting an outstanding example to follow; my professors,A. Loutfiand N.Kaddah, for showingme the excitement andjoy ofpaediatric surgery; my mentors,Dan Youngandlohn Duckett, for paving the wayto international recognition. A.T.H. To mywife,Fatma, for herlove,encouragement and continuing support; my daughter,Iman, and my son, Ayman, for their understanding; my mentor,Herbert Eckstein, for introducingme to paediatric urology. A.F.A. Foreword The challenge of hypospadias correction has always lopment and its consequences as wellas giving gui tested the ingenuityofsurgeons and, although many dance on methods of surgical correction.The edito of the older methods have been discredited and rial duo ofHadidi and Azmyare tobe congratulated discarded, the diversity of procedures in current on assembling a distinguished and expert team to practicesuggests that theperfectoperationhasyetto fulfilthis requirement.Thisvolume willbeindispen be devised. Evidently there have been important sable readingforallthose called upon to treathypo advances during the past 30 years, and the results spadias, but it is gratifying to see that although the nowobtainedwould bethe envyofoldersurgeons. It techniques ofplasticsurgeryhavecontributedto the isinstructiveto note that particularattention isnow newer methods, it is the paediatric urologists who given to securing a meatus at the tip of the glans are now principally concerned. Hopefully they will (even in those minor degrees of hypospadias which ensurethat hypospadiasisfullycorrectedearlyinlife would formerly have been left untreated), reflecting and that adult urologists will no longer be asked to the pursuit of physical perfection which now fuels rescue sadly mismanaged young men with serious the popularityofcosmeticsurgery. sexual and psychologicalhandicaps. There wasundoubtedlyaneed foracornprehensi vetextdealingwith allaspects ofthe abnormaldeve- SirDavidInnesWilliams Foreword An illness or abnormality that attracts a continuing nage systems. Although the penile repairs can be bibliography of many hundreds of journal articles groupedinto fiveor six major principles,depending implies that there are unresolved problems.Such is on the tissues used, each has been subject to count the situationin hypospadias.And yet,at first glance, lessvariations asone surgeon after anotheradds yet this is very surprising. Here is a deformity in an another modification to an already thrice-rnodified organ so overtlyrecognisable for c1inicaland epide variation of a procedure adapted from a principle miologicalstudy,so easilyaccessiblefor tissuehisto derived from the original! Further,some repairs are logyandhistochemistry,andsoamenable,one could successful only in the hands of the original propo assume, to the simplest of plastic surgical repair, nent, and the subtleties escape the novice, who, in giventhatthereistotal surgicalaccessandexposure, frustration, flips to yet anothertechnique. Hypospa surrounded by ample available tissues, and with a dias isbedevilledbysurgeonswho swap to the latest rich bloodsupplyforhealing; itshouldbe a"gift"for gimmickandnever acquirethe expertiseofapracti even moderate surgical prowess! Yet nothing could cedtechnique,which isessentialforgoodresults.We be further from the truth. still debate the place of one- or two-stage repairs. Inalmosteveryfacetwelackcompleteunderstan Some repairs frankly offend major surgical princi ding. We have gaps in genetic information; the plesin theircomplexity,in the fashioning offlaps,in embryologyisunsettledastothe natureofthe tissue disrespectfor bloodsupply,andin inadequatelayers organizers,the relative contributions ofthe ectoder and tension.What are the indications to use aspeci mal folds and rnesothelium, or whether the defor ficrepairinagivenc1inicalsituation?Doweneed ten mityisnot"developmental"atall,butrather,asDou different proceduresfor ten different situations,with glas Stephens asserts, the result of distortion and the attendantrisk ofinsufficientvolume ofexperien displacementofearly foetal cellsbyexternalpressu ceto acquire the necessaryexpertisein any ofthem, re;whythe great variationin c1inicaltypes, e.g.vari or can we reduce these to a manageable and well ations in orifice size andsite and degree of chordee, practiced two or three adequate techniques with or a large penile shaft orifice but no chordee, or a appropriate adaptations? In what circumstances is coronalorifice with completeprepuce,or anormally urinary diversion required and by means of which sited terminal orifice but marked chordee? Wehave technique? incomplete understandingof the pathologyof chor The problems do not stop with the completion of dee, from the simplistic and probably mythical apparently successful surgery. I know of no surgery "whiteband"ofDenis Browneto the varyingcontri that can quite humble a surgeon as much as hypo butions of skin, fasciallayers and corpora,andwhat spadias-it carries avicious bite with its list of com determines their contributions. The confusion is plications, most galling when they can occur years evenmoremarkedinthe surgicalmanagement.With later,suchasaverylatefistula orthemanifestationof alesioninwhich over200differentrepairshavebeen recurrentchordee.Addtothis listproblemsofejacu described, a cynic may be excused in c1aimingthat lation or sexual function and the psychological none can be very satisfactory! We have proceeded effectsbefore andafter surgeryorinlaterlife,and we through Browne repairs and scrotal flaps,to Duplay have alesion to test the ingenuity,inventiveness and tubes,tofreeskin grafts,toislandflapsand onlays,to resilience ofsurgeons asmuch asanyin surgery. bladderand buccal mucosal repairs,to ahost ofsin Thesearejustsome ofthe unresolvedproblemsin gle-stage innovations, to different concepts of chor the surgery of hypospadias. Given this maelstrom dee correction andwith all manner ofbladderdrai- therecould benobettertimeforthe compilationofa X Foreword volume bringingtogetherthe verybestauthoritiesin In asubjectwith reportsspreadsowidelythroug acritical analysis ofallaspects ofthe malformation. hout a vast list of publications, the book is a major Under the stimulating editorship of Ahmed Hadidi contribution to the effort to reduce to manageable andAmir Azmy,themselves leaders in this field, the proportions the current accumulated knowledge of contributions of an international faculty of world hypospadias,with each area beingassessedandana leadershavebeenassembled.Asaperusalofthe table lysed by experts.We surely need such a volume. I of contents will show,the book covers all the major have everyexpectationthat the breadthofcoverand operative repairs, described in many cases by their the quality of the contributors are such that our originators,butthebookismuchmorethanacollec puzzling unknowns will be addressed,and surgeons tion of techniques.It rightly also covers the general will have at hand an authoritative guide to practical aspectsofhistory,epidemiology,genetics,ernbryolo management. gy and pathology; surgical principles,ancillary aids andanaesthesia;the long- termevaluationofresults, E.Durham Smith,AO,MD,MS,FRACS,FACS, induding early and late complications; and, impor Hon.FRCS(Eng.,Edin.,Glas.,Ire.) tantly,an overview ofmanagementtobringperspec EmeritusConsultantSurgeon tiveto this complexlesion. RoyalChildren'sHospital, Melbourne,Australia Preface HypospadiasSurgery:AnIllustrated Guide and paediatricsurgical associations in the USA,UK, Australia,Japan and Europe. Someofthe chaptersarewrittenbynon-surgeons Hypospadiasisagrievousdeformitywhichmustever and present new and important knowledge concer move us to the highestsurgicalendeavour.The refas ning epidemiology,genetics,and childpsychology. hioningofthe urethraoffers aproblem as formidable Thebook isweIlillustratedwithamplecolourdia asanyinthewide fieldofourart.The fruitsofsuccess grams and photographs ofvarious operations toget are beyond rubies - the gratitude of a boy has to be her with manytechnical tips.There isawidediversi experiencedto be believed. ty of opinion and a large number of operations are T.TwistlugtonHiggins,London,1941 described. Information is occasionally intentionally repeated when the circumstancesdemand. Hypospadiology,defined as the in-depth studyof the Thebookconsists ofthree sections. art andscienceofthe surgicalcorrectionofhypospa Section 1 contains chapters dealing with the dias, iscurrentlyflourishing. Recently,heateddebates historical perspective:the evolution ofhypospadias have ensured,challengingthe age-old truthingrained surgery,the basic principles of repair, the detailed in the historieteachingson this fascinatinganomaly. Thesenew conceptshave promptedthis treatiseas embryology and anatomical studies, the epidemio acontributiontothisanthologyonthesubject.Appro logyandgeneticsofhypospadias.Furthercontribu priateto the momentare two ofourfavourite quota tions deal with general principles,includingexami tions:"Scepticisrn blossoms on the compost of expe nation,imaging,intersexuality,preoperative prepa rience"and"Opinions abound where truths are hard rationandhormonalstimulation,assessmentofthe to prove", results of hypospadias surgery, principles of plastic lohn Duckett,Philadelphia,1995 surgeryand general principles of hypospadias sur gery. Sutures, stenting materials and dressings are described,and acomprehensivechaptercoverspain The purpose of this comprehensive, weIl-illustrated control. textbook is to help interested surgeons to develop Section 2indudeschaptersdescribing the operati vision, philosophy and talent, rather than just enu ve techniques for correction of the proximal and merate techniques. In this wayweaim to provide an distaltypes ofhypospadias.There isemphasis onthe up-to-date global view of the management of the useofsingle-stage repairinseveretypes ofhypospa child with hypospadias, focusing primarily on the dias. However, the need for two-stage repair is care of the condition and its associated problems. discussed indetail.Currentcontroversial issuessuch Thebookwillbeofspecificinteresttopaediatricand as the relative merits of single- versus two-stage adulturologists,paediatricand general surgeons and repair, flaps versus grafts, dressings and urinary plastic surgeons. diversion aredebated in depth. Thebook isan example ofinternational coopera Section 3dealswith thecomplicationsofhypospa tion.Forty-sixexperts from 12countriesonfivecon dias surgery and their management, complex redo tinents havecontributedtoit. repairs, long-term results in adolescence, and Eachof the chapters in the book iswritten byan psychologicaladjustments. authority in the field of hypospadiology.Ateam of Lastly,the editorspresenttheirpersonal overview world dass contributors present their expert opi of the current surgical techniques and potential nions. Theauthors are members ofmajor urological developments inhypospadias surgery.
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