Objectives To report the results of the tubularized-incised taneously. Dilatation was instituted in all the remaining patients and no fistula or meatal stenosis occurred. urethral plate repair of hypospadias. Patients and methods Twenty-seven patients (mean ageOther complications included haematoma formation in one patient, urinary tract infection in another and 8 years, range 6-18) had their hypospadias corrected using the tubularized-incised urethral plate technique. frequent bladder spasm in two. Conclusions The tubularized-incised urethral plate Five patients had glanular, 16 had coronal, and two had recurrent hypospadias after a failed Mathieu repair, urethroplasty is a simple and versatile technique that provides an excellent cosmetic appearance of the glans. and four patients required a second-stage repair. The urethral plate was incised in the midline and tubularizedIt can be applied not only for the primary repair of distal hypospadias, but also for re-operation of recurover a suitably sized stent. In patients who required second-stage repair a Thiersch-Duplay neourethra was rent hypospadias. The technique is ideal for constructing a glanular urethra when the Thierschconstructed from the hypospadiac orifice to the corona and the glanular urethra was constructed by tubularizDuplay operation is used to repair posterior hypospadias. Regular urethral dilatation is important in preation of the incised urethral plate. Results The functional and cosmetic results were excelventing adhesions between both sides of the incised plate, which can result in meatal stenosis and fistula. lent. Of the first seven patients, four had a small fistula associated with meatal stenosis. By regular dilatation

Objectives To report the outcome of managing urethrocutaneous ®stula after hypospadias repair over 10 years. Patients and methods Forty-seven patients (mean age 7.6 years, range 2±18) underwent repair of 57 urethrocutaneous ®stulae after hypospadias surgery.The ®stula was single in 37 patients and multiple in 10; 42 ®stulae were small (<4 mm) and 15 large (>4 mm). Twenty-one ®stulae were at the corona, 15 at the anterior shaft, 16 at the mid-shaft and ®ve were penoscrotal. The interval between primary hypospadias repair and the ®rst attempt at ®stula repair was 6±12 months. Small ®stulae were repaired using a multilayer simple closure technique, and large ®stulae repaired using rotational and advancement skin¯aps. Suprapubic urinary diversion was used in all patients with large ®stulae or small multiple ®stulae (25 patients); an overnight urethral catheter was used in the remaining patients. Results Simple closure was successful in 30 of 42 small ®stulae (71%); eight were successfully closed by secondary closure, while four needed a third closure. Rotational and advancement skin¯aps were successful in 13 of 15 large ®stulae; one required secondary¯ap repair and one was closed simply. Most recurrences (78%) were of coronal ®stulae; there was recurrence in four of 25 (16%) patients in whom suprapubic diversion was used, in contrast to 10 of 22 (45%) with no suprapubic diversion. Conclusions Although simple closure of a ®stula is easy and not time-consuming it is followed by a signi®-cantly higher rate of recurrence than when skin aps are used. Rotational and advancement¯aps are the optimal methods for repairing ®stulae after hypospadias, particularly for large and coronal ®stulae. Thus, the appropriate indication for simple closure is small ®stulae at the penile shaft. Suprapubic diversion is important in those with large or multiple ®stulae.

Objectives To report further experience of hypospadias repair using the tubularized-incised urethral plate (TIP) technique and to evaluate the role of postoperative neourethral dilatation as a method of preventing complications. Patients and methods The study included 64 patients (aged 2±18 years) who underwent TIP repair of hypospadias; 47 required a primary and 17 a secondary repair. After removing the stent they were randomized into two groups; group 1 (38 patients) underwent regular neourethral dilatation for 12 weeks and group 2 (26 patients) did not. Patients were followed for a mean (range) of 28 (6±52) months. Results The functional and cosmetic results were excellent in all patients in group 1, except for slight meatal regression in one patient (3%). In group 2, 17 patients had excellent results; eight (31%) were re-operated upon to correct complications, six developed a ®stula (four of which were associated with meatal stenosis) and two developed a neourethral stricture. Conclusions TIP urethroplasty is a versatile technique that provides an excellent functional and cosmetic outcome. Regular urethral calibration after repair should be considered as an integral part of the technique, to prevent neourethral and/or meatal stenosis with subsequent ®stula formation.

Introduction The effect of parenteral testosterone replacement therapy on prostatic specific antigen (PSA) level or the development or growth of prostate cancer is unclear. Aim To assess the effect of testosterone replacement on PSA level in patients with hypogonadism associated with erectile dysfunction (ED). Methods A total of 187 male patients above the age of 45 with hypogonadism associated with ED were enrolled in this study. Patients were screened for ED by the erectile function domain of the International Index of Erectile Function (IIEF). Patients underwent routine laboratory investigations, plus total testosterone, and PSA assessment. Replacement treatment with parenteral testosterone every 2–4 weeks for 1 year was instituted. Total testosterone and PSA serum levels were assessed every 3 months during the treatment course. Results Mean age ± SD was 62.8 ± 11.4. Of the patients 87.7% were sexually active. Of the patients 10.2% had mild, 40.6% had moderate and 49.2% had severe ED. Of the study population, 62.5% had ED complaints for less than 5 years and 84.5% had gradual onset of their complaint. The majority of the patients (91.4%) had either progressive or stationary course while the minority reported regressive course and improvement of the condition. There was a significant increase of the post-treatment testosterone level in comparison to pretreatment level (P &lt; 0.05). No significant increase in the post-treatment PSA level in comparison to pretreatment (P &gt; 0.05). No significant difference between pre- and post-treatment categories of PSA level (normal, borderline, high) in relation to the severity of ED (P &gt; 0.05). There was no significant association between PSA level and the duration of testosterone replacement therapy in the study population (P &gt; 0.05). Conclusion The current study demonstrated that the level of PSA was not significantly changed after 1 year of testosterone replacement therapy in patients with hypogonadism associated with ED.

ObjectivesTo compare the outcome of hypospadias repair using tubularised incised-plate (TIP) urethroplasty and tubularisation of an intact and laterally augmented urethral plate.Patients and methodsThis prospective randomised study included 370 patients with primary distal hypospadias. All had urethral plate widths of 8–10 mm and a glans of ⩾15 mm. Exclusion criteria were previous repair, circumcision, a wide urethral plate of >10 mm or a narrow plate of <8 mm in diameter, a small glans of <15 mm in diameter, chordee of >30°, and hormonal stimulation. Patients were randomised into two groups: Group 1 (185 patients) underwent TIP urethroplasty and Group 2 (185 patients) underwent tubularisation of the intact plate with lateral augmentation of the urethral plate using penile skin. The follow-up period was 12–28 months.ResultsThere were 172 evaluable patients in Group 1 and 177 in Group 2. The urethroplasty was successful in 83.2% and 94.4% in Groups 1 and 2, respectively. Complications occurred in 16.8% in Group 1 and 5.6% in Group 2 (P = 0.001). Meatal stenosis occurred in 7% and 3.4% in Groups 1 and 2, respectively (P = 0.130). There were statistically significant differences in the wound dehiscence, fistula, and re-operation rates of Group 1 versus Group 2, at 6% versus 0%, 9.8% versus 2.8%, and 13.4% versus 5.6%, respectively. The presence of mild chordee did not affect the complication rate (P = 0.242). The mean (SD) operative time was 56.7 (8.9) min in Group 1 and 93.7 (8.3) min in Group 2 (P < 0.001).ConclusionThe outcome of tubularised intact and laterally augmented plate is better than classical TIP urethroplasty of hypospadias. Further trials are mandatory to extend the indications of the technique.