Tips & tricks of Hypospadias surgery 1.pptx

Academic presentation for pediatric urology

1. Topic: Presenter: Prof. Dr. Samidur Rahman Department of Pediatric Surgery DMCH WELCOME Tips & Tricks of Hypospadias Surgery

2. Introduction One of the most frequent congenital urogenital defect in our pediatric surgical practice. Easy to diagnose but hard to manage. Comprehensive afford needed for persistent good result. patience

3. Components of Hypospadias surgery Pre-operative Post operative Per-operative Assessment Brain Storming Planning Maintaining of principle Essentials Surgical Streamline OT note by surgeon General medical Postmortem Success Failure

4. Essentials for Hypospadias Surgery Fine instruments Loupe Sutures & others

5. Surgical streamline 1 st step: Stay sutures 2 nd step: Marking 3 rd step: Measurements 4 th step: Incisions 5 th step: Neo-urethra 6 th step : 2 nd supporting layer 7 th step: Glanuloplasty 8 th step: Degloving 9 th Step: Skin coverage 10 th Step: Haemostasis 11 th Step: Dressing Consists of 10-12 steps

6. Stay Suture Entry point – just beyond tip Sufficient glans tissue(1cm) Pedicle (1-1.5cm) As many as required Trainer & Trainee – Every Alternate cases. Tips & Tricks : 1 st Step :

7. Marking Inverted V at the glans Sub-coronal uniform (1cm) collar Peri-urethral plate Dorsal penile skin Trainer and trainee Participated partly 2 nd Step: Tips & Tricks : Tips & Tricks : Inverted V

8. Measurements 3 rd Step: Use of slide calipers Urethral plate ( before & after incision) Glans width Penile length Degree of chordee BMG/ Skin graft Tips & Tricks :

9. Incision 4 th Step: Tips & Tricks : Should not cross V point Sharp Dartos incorporate with UP Mid-line incision 1. deep enough 2. Not reached up-to the tip 3. Extend proximally 2-3mm

10. Incision 4 th Step: If peri-Meatal skin thin Cut back up to white dartos Anchor outer skin with urolithium (7/0 vicryl ) Tips & Tricks :

11. New urethra formation Stitching starting beyond (1cm) from V point Interrupted Regular Subcuticular OR Uniformly continues 2 nd layer ( Lumbered) 5 th Step: Tips & Tricks :

12. Regional dartos flap Dorsal dartos flap Sometimes tunica vagainalis De-epithelize dermal layer 6 th Step: Supporting 2 nd layer Tips & Tricks :

13. Glanuloplasty Adrenal mixed local in Spongio -Cavernous space making a space with tip of scissors Wide glans wing Apposition of glans wing at the level of corona Snugly with 6/0 vicryl 7 th Step: Tips & Tricks :

14. Degloving As much as required for correction of skin chordee and facilitation of penile skin Strictly maintain Tissue plane(sub- dartos ) Avoidance of neuro -vascular bundle injury 8 th Step: Tips & Tricks :

15. Skin coverage Intradermal Continuous/interrupted Ventral midline incision start first up to corona Dorsal midline incision up to corona stitched with 7/0vicryl 9 th Step: Tips & Tricks :

16. Hemostosis Bipolar low voltage Adrenal mixed normal saline Repeat irrigation mixing adrenalin+Gentamycin Torniquate Adrenalin soaked gauge Pressure bandage with surgin pad 10 th Step: Tips & Tricks :

17. Dressing Surgical pad Soaking Double layer pad 11 th Step: Tips & Tricks : 1 st layer dressing 2 nd layer dressing

18. Final Appearance