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 tourism industry has undergone exponential transformation, reshaped by online travel agencies (OTAs), shifting consumer preferences, and technological advancements. Established OTAs like TripAdvisor and Travelocity face pressures to adapt their strategies to capitalize on these disruptive landscape changes. This research involves a comparative analysis examining the key challenges confronting TripAdvisor and Travelocity, with a focus on opportunities to leverage artificial intelligence (AI) in enhancing personalization and the traveler experience. The study utilizes publicly available data on the companies and academic literature on AI innovation diffusion. Findings reveal that while TripAdvisor has actively developed AI-based trip plan
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The research problem lies in the weakness of the relationship between internal auditing and external auditing as a result of not applying INTOSAI Standard (9150) coordination and joint cooperation
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The research in the role of variables contact for non-state actors have become more influential in the current of contemporary events, that related with the reality of seeking services and providing all of that in favor of maintaining the social peace, and ensuring its empowerment in order to make peace and stability outcomes as a real fa
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