Objective: to evaluate the benefit of coverage of
the urethral repair by dorsal dartos flap as a second
layer for preventing fistula and V like incision on
the tip of the glans for preventing meatal stenosis.
Patients and Methods:
Forty five children included in this study age
ranged ( 11 months – 7 years), they underwent
hypospadias repair between December 2008 to
March 2012, all cases with distal hypospadias,
same technique used for all patients, a combination
of techniques used for reconstruction starting
withtubularized incised plate urethroplasty with deepithelialized
or stripping of the skin from both
sides of U shaped incision surrounding the urethral
plate, adding a V like incision on the top (tip of
glans) of the midline urethral plate incision that
give wide meatus subsequently prevent meatal
stenosis and no need for dilatation after stent
removal, followed by harvesting well vascularized
dartos flap from de-epithelialized preputial skin
and transposing itventrally by buttonholing
maneuver and suturing the flap as a second layer
along the neourthral suture line, finally
approximation of glans , so achieving three layer
closure.
Results :All patients are followed for (6 months-
24 months) mean was 15 months, only two patients
(4.4%) complicated with small fistula at the
subcoronal region at the beginning of the study
operated after 6 months and the fistula closed
successfully. Twenty five cases (55.5%) with
Chordee were completely released with no
recurrence. No dilatation was needed after removal
of stent for neomeatus developed a good stream of
urine with no problems regarding stenosis.
Conclusions: In this study hypospadias repair
should achieve three layer closures by using a
dartosfalp as a second layer to cover neourethral
suture line combined with stripping the skin on the
edge of the U shaped incision to gain secure
closure of the neourethra, which will prevent
fistula formation. We recommend adding a
Vincision on the tip of the glans connected with
midline urethral plate incision to prevent meatal
stenosis.
The Quality function deployment (QFD) tool is an important tool of total quality management because its a link between two important parts customer and production process of the product, using advanced House of quality, which contributed to provide more details about improving the product before it had a vision for the future of the product be improved. Also the identification of the two competitors (Alwazeer , Altouri) bases on the survey of retailers which they identified five competitors products (Alwazeer , Altouri , Ferry , Jif , Dina)for the product (Zahi). Then House of quality to product (Zahi) has been developed By using a Kano Model to classify of customer's requirements for the
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The educational process has aim determined by the society for him self through its working establishments in this field and these are the official and public establishments. And as he feels that the establishments have failed to achieve its d
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This research deals with the two item namely, the monetary policy central Bank of Iraqi and money supply . that contribute in up the problem of the paper that is concerned with the fact that to what extent the effectiveness of monetary policy conducted by the central Bank of Iraqi is valid in controlling money supply as well as the possibility of applying it in practical environment restricted to the scope of financial in stitiutions particularly in research population represented by central Bank of Iraqi .
For the purpose of a practical contribution for monetary and financial institutions . To achieve this , A hypothesis has been carried out and it suggested that the mon
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