Background: Hypospadias is one of the most common congenital anomalies, occurring approximately 1in 200 to 1in 300 live birth. Urethrocutaneous fistula (U-C fistula), and meatal stenosis are the most common complication of hypospadias surgery. To reduce these complications there are different surgical procedures. Snodgrass technique is now the popular technique for its low complication rate and better cosmetic outcome. Objective: To explore the short term outcome of interrupted suture compared to continuos suture in snodgrass technique urethroplasty for distal penile hypospadias. Method: It was a randomized control trial study carried out in the department of Paediatric surgery, BSMMU during the period of June 2008 to September 2009. 32 patients with distal penile hypospadias were selected according to set inclusion and exclusion criteria. Subjects who included in the study were randomly distributed in two groups. In group A odd number of patients and in group B even number of patients were included for randomization. Group A (interrupted suture) was treated as interventional group and Group B (continuous suture) as control group. Penile stent was removed on 8th and 10th POD after snodgrass technique of urethroplasty in coronal and subcoronal hypospadias respectively and observed for 4 weeks for two common complications- Urethrocutaneous fistula (U-C fistula), and meatal stenosis. Unpaired t test, Fisher’s exact test were used to see the level of significance. Result: In group A out of 16 subjects; 2 subjects (12.5%) develop Urethrocutaneous fistula and 1 subject (6.3%) had developed meatal stenosis. In group B out of 16 subjects 6 subjects (37.5%) had developed Urethrocutaneous fistula and 3 subjects (18.8%) developed meatal stenosis. Conclusion: Urethrocutaneous fistula (U-C fistula), and meatal stenosis are the most common complication of hypospadias repair and the occurrence of these two complications are less in interrupted suture than that of continuous suture in Snodgrass technique urethroplasty for distal hypospadias. DOI: http://dx.doi.org/10.3329/jpsb.v2i1.15160 Journal of Paediatric Surgeons of Bangladesh (2011) Vol. 2 (1): 26-30

Background: Hydronephrosis in children is a common abnormality of the kidney. Surgical intervention in patient with hydronephrosis is to improve urinary drainage and to preserve renal function. Surgery (Anderson Hynes pyeloplasty: A-H pyeloplasty ) can be done with or without (Nephrostomy tube) D-J stent.Here we are describing our comparative experience between A-H pyeloplasty with D-J stent and A-H pyeloplasty with nephrostomy tube, at Bangabandhu Sheikh Mujib Medical University(BSMMU) to show the postoperative advantages of the former over the latter. Objectives: To assess functional outcome after A-H pyeloplasty with or without D-J stent in patients of unilateral hydronephrosis. Post operatively renal function was estimated after 3 months by DTPA renogram. Methods: It was a prospective study at Paediatric Surgery department of Bangabandhu Sheikh Mujib Medical University from April 2009 to October 2010. Twenty eight ( age, sex, side and type of operation matched) patients of unilateral hydronephrosis were included in the study and divided into two Groups: Group A (na =15) and Group B (nb=13) patients who underwent A-H pyeloplasty with D-J stent and A-H pyeloplasty with nephrostomy tube respectively. Child with bilateral hydronephrosis, hydronephrosis with associated anomalies like horseshoe kidney, ectopic kidney, solitary kidney, hydronephrosis with vesico ureteric reflux and redopyeloplasty were excluded in this study. Unpaired “t” test and Chi-square test were used for statistical analysis whereas postoperative hospital stay and renal functional improvement were used as parameters of the study. Results: For study Group A (A-H pyeloplasty with D-J stent) postoperative hospital stay were significantly lesser (P<0.00) than the GroupB ( A-H pyeloplasty with nephrostomy tube). Post operative split renal function and glomerular filtration rate (GFR) in Group A was improved (percentage) than Group B. Conclusion: This study reveals postoperative shorter hospital stay and improved postoperative split renal function in A-H pyeloplasty with D-J stent. DOI: http://dx.doi.org/10.3329/jpsb.v2i1.15159 Journal of Paediatric Surgeons of Bangladesh (2011) Vol. 2 (1): 22-25

Background: Hypospadias is a common congenital anomaly of male urethra. Surgical repair is the only treatment of this defect, but there is no single, universally acceptable technique for its repair . Snodgrass technique is now popular for its low complication rate, shorter operative time, vertically oriented slit like meatus and better cosmetic outcome. Objective: To evaluate the role of vascularized dorsal dartos pedicle flap over the neourethra in terms of postoperative urethrocutaneous fistula formation between two groups of patients of distal penile hypospadias. Methodology: Thirty two patients were included in this study. They were divided in group A and group B on the basis of serial number of patients. Snodgrass urethroplasty was done in group A considered as control and in group B, Snodgrass urethroplasty was done with additional dorsal dartos flap by buttonhole technique considered as interventional group. The outcome of both groups in terms of post operative urethrocutaneous fistula were evaluated. Results: In this study in group A, urethrocutaneous fistula developed in 6 patients out of 16 patients. Among the fistulas, 5 were situated at the coronal level and 1 at the hypospadiac meatus level. In group B, urethrocutaneous fistula developed in 1 patient out of 16 patients and the fistula occurred at the coronal level. In either group, all the fistulas are developed after removal of the catheter. In terms of post operative urethrocutaneous fistula formation in between the two groups, the results were statistically significant. Conclusion: Snodgrass urethroplasty with additional dorsal dartos flap by buttonhole technique have better outcome than without additional dorsal dartos flap in terms of postoperative fistula formation. DOI: http://dx.doi.org/10.3329/jpsb.v2i1.15161 Journal of Paediatric Surgeons of Bangladesh (2011) Vol. 2 (1): 31-35

Background: Hypospadias where surgery is the only option to correct this birth defect which is usually associated with post-operative urethrocutaneous fistula formation even in best hands. The site of fistula is mostly at coronal level (80%) and less common at meatal level. Many factors are supposed to be responsible for causation of this fistula, important one is the developmentally defective ventral penile skin at and / or distal to the urethral meatus where some local healing factors like vascular and collagen tissues are insufficient. Objective: To determine histologically whether the ventral skin of hypospadiac penis at the meatal and coronal levels differ from the corresponding dorsal skin levels in terms of vascular and collagen tissue. Representative skin tissues were collected from ventral skin and corresponding dorsal skin of the meatal and coronal levels of every patient. Haematoxylin-eosin stained slides were prepared from each tissue specimen and were examined under microscope to determine the differences in blood vessels and collagen tissues distribution. Paired 't' test was used to test the significance of differences. Results: Significantly lower proportion of HISTOLOGICAL ANALYSIS OF VASCULAR AND COLLAGEN TISSUES IN THE VENTRAL AND CORRESPONDING DORSAL SKIN OF MID-PENILE HYPOSPADIAC PENIS AT THE MEATAL AND CORONAL LEVELS: A COMPARATIVE STUDY

The traditional practice of post operative starvation after gut resection and primary anastomosis has been recently challenged. Contrary to wide spread opinion, evidence from clinical studies suggest that initiating feeding early is advantageous in postoperative patients. Various clinical trials have shown that early enteral feeding helps in the reduction of post operative ileus, anxiety and hospital stay. The purpose of this study was to compare the effects of early and traditional feeding, and was conducted among patients who underwent gut resection and primary end to end anastomosis. The study population (n=50) was divided into two arms. Arm-A (n=25) was given feeding after passage of flatus, stool when bowel sound was present, usually within second to fourth post operative day. Arm-B (n=25) was given early enteral feeding, started within 16-24 hours, in the first Post operative day (POD) after removal of the naso gastric tube. There were no statistically significant variations in age, sex, bodyweight, average hemoglobin level, antibiotics, and suture materials used in both arms. Post operative hospital stay was 9.09 days in Arm-A and 5.42 days in Arm-B. It was significantly low (P < 0.05) in Arm-B. The complications after operation were also low in Arm-B. Early enteral feeding can help to decrease the negative impact of the metabolic response to injury. It also stimulates restoration of the barrier functions of the intestine, improve the return of the functions and reduce the duration of post operative ileus and hence reduce the risk of serious complications.DOI: http://dx.doi.org/10.3329/jpsb.v2i1.15142 Journal of Paediatric Surgeons of Bangladesh (2011) Vol. 2 (1): 7-11