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    Detection of Meatal Stenosis with Uroflowmetry in Cases of Distal Hypospadias that are Operated with the TIPU Technique
    (MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2016) Guvercin, Emre; Temiz, Gokhan; Cakmakoglu, Cagri; Yesiloglu, Nebil; Faydaci, Gokhan; Filinte, Gaye Taylan; Bozkurt, Mehmet; Akoz, Tayfun
    Objective: Meatal stenosis after hypospadias surgery causes difficulty in urination and intermittent cessation in urinary stream at the early postoperative period. Increasing the duration of catheterization, meatotomy, and meatal revision surgeries are among the procedures applied for meatal stenosis. If the diagnosis of meatal stenosis is made at an earlier stage, it is easier to manage it, especially in the younger age group. We aimed to determine whether the uroflowmetry technique can be a guide for detecting and following meatal stenosis. Material and Methods: Forty-one cases with distal hypospadias operated with the Tubularized Incised Plate Urethroplasty (TIPU) technique were involved in this study. At the postoperative 1st month, all the patients with or without complaints of meatal stenosis had uroflowmetries with an effort to provide an objective data for diagnosing stenosis at the early stages. The results of uroflowmetries were compared with the clinical signs of meatal stenosis. Results: The average maximum flow rate was found to be 11.3 mL/s (6.7-31.6), and the average voided quantity of urine was detected as 181.7 mL/s (71-283) as result of uroflowmetry. Ureteral stenosis was clinically diagnosed in three patients with intermittent urination, prolonged urination with poor flow, and with difficulty in starting urination. All patients were found to be similar. The uroflowmetry results were parallel to the clinical outcome in all patients. Conclusion: In the early stages, uroflowmetry can assist clinical observation as a non-invasive method. In addition, it makes it possible to perform earlier therapeutic interventions.
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    A New Perspective for Spreader Graft Use in Severely Deviated Septum: Is Septal Continuity an Obligation for a Stable and Straight Nasal Septum?
    (THIEME MEDICAL PUBL INC, 2016) Sirinoglu, Hakan; Yesiloglu, Nebil; Ersoy, Burak
    Severe septal deviation is a challenging deformity usually treated using aggressive surgical methods, and extracorporeal septoplasty (ECS) is a commonly used method for this issue. However, this method has severe risks and complications such as the recurrent deformity or nasal saddling. In this article, we present an alternative solution to ECS procedure for the correction of severe septal deviation. Sixteen patients with severe c- or s-shaped septal deviation with a mean age of 26.5 years were included in the study. The entire deviated part of the septal cartilage was resected as a vertical block creating a full-thickness defect between the most cranial and caudal parts of the septal cartilage. After that, two spreader grafts were placed bilaterally facilitating the septal integrity and leaving the full-thickness septal defect unchanged. The surgical results were evaluated using the preoperative and postoperative facial photographs and patient satisfaction was determined using nine relevant questions of DAS-59 scale. The only complication observed in the follow-up period of 19 months was hanging columella deformity which was corrected at the postoperative first year. The mean length of the resected septal segment was 12.4 mm. The mean length of the resultant septal cartilage defect after the vertical resection was 5.9 mm. The mean length of the placed spreader grafts was 25.6 mm. The comparison of the preoperative and postoperative photographs showed significant improvement of the nasal contour and considerable correction of the septal deviation. The statistical evaluation of the answers given to the questions of the DAS-59 scale clearly demonstrates that a significant degree of patient satisfaction was achieved. Severe septal deviation may be successfully corrected by full-thickness resection of the deviated part and reconstruction with bilateral spreader grafts with a low risk of postoperative complications.