Jasim Abdoalhasan Jasim Almayali

ABSTRACT Background: Undescended testis is a common urological problem affecting children, age of 1 year, it affect about 1% of boys. Of them, about 20% are a non-palpable testis. This might had a major impact on the fertility, in addition to increase possibility of malignancy in these testes. Laparoscopy-assisted orchiopexy is a promising procedure for management of cases with non-palpable testes in terms of efficacy, feasibility and safety. Laparoscopy provides an accurate and safe modality in diagnosis and management of cases with non-palpable undescended testes. Laparoscopic orchiopexy appears to be an effective and feasible in managing patient with high intraabdominal undescended testes. Materials and Methods: In this, study 40 patients with 52 non-palpable teste were referred to Al-Ghadeer Private Hospital and Al-Sadar Teaching Hospital for surgery from March 1, 2016 to March 1, 2019 were enrolled in our study. Patients had been evaluated postoperatively in order to check the size and location of the testes and to exclude any possible complications. Results: Forty patients with 52 non-palpable teste, there age was ranging from 3-25 years (mean 7 years). Median follow up from three months to 36 months (average 14 months). Overall success rates were 80.76%. Overall rates of testicular atrophy in our study were 19.233%. Orchiectomy was done for four atrophic testes. Conclusions: Laproscopical ligation of gonadal vessels in cases of high intraabdominal testis with staged approach to preserve collateral testicular blood supply can provide adequate viability with a high success rate. A further well-conducted studies are desired to confirm findings in our study for management of cases with high intraabdominal undescended testis. Keywords: Cryptorchidism, non-palpable testis, laparoscopy, orchiopexy

ABSTRACT Background: The tubularized incised plate urethroplasty procedure is the operation of choice for hypospadias. The most common complication is urethrocutaneous fistula and various procedures have been described for preventing it. Objectives: to evaluate the outcome of dorsal versus ventral dartos flaps coverage of the neourethra after tubularized incised plate repair of distal hypospadias. Patients and methods: our study including 85 cases, aged 10 months to 12 years (mean age 3.4 years) with distal hypospadias were evaluated from April 2017 to April 2020 at alnajaf medical center, Najaf, Iraq. All patients underwent the tubularized incised plate urethroplasty operation. The Patients divided in two groups: group A (41 patients) dorsal dartos flap was used; and group B (44 patients) a ventral dartos flap was used. Results: The postoperative follow-up was 6–24 months (mean 9 months). Urethrocutaneous fistulas were observed 2 patients (4.8%) in groups A and 3 patients (6.8%) in group B. one patient in each group developed meatal stenosis. Two cases (4.8%) of iatrogenic penile torsion in a dorsal flap group. Conclusion: No significant difference between dorsal and ventral flap for fistula prevention. Ventral flaps are easier to obtain and interpose the neourethra.

BSTRACT: Tension free vaginal tape (TVT) is a minimally invasive operation that gained increase popularity at the surgical field for management of patients with stress urinary incontinence. The use of SPMUS (suprapubic midurethral sling) has significantly simplified the surgical procedure and made it safer. OBJECTIVES: evaluation the effictivity of the SPMUS procedure in ladies with stress urin incontinence. PATIENTS AND METHODS:Twenty six female patients were assigned to undergo SPMUS procedure in Al-Sadar Medical City from January 2010 to July 2011. Sixteen of the cases wth pure SUI and ten had mixed UI. The procedures were done either under spinal anaesthesia (SA) or under general anaesthesia (GA). SPMUS implies the placement of a polypropylene tape at the mid-uretha via a minimal vaginal incision. Patients were monitored during outpatient visits at 2 weeks and 3monthly after surgery. RESULTS:The mean follow-up time was 12±1 months (3 to 19 months). avarage surgical time was 35 min (20–50 min). overall complications rate was 42.3%(11/26) . The intraoperative complications rate was 15.4%, including three bladder injuries, and one case of paraurethral hemorrhage . The postoperative complications rate was 26.9% (n=7 cases). Most serious complication was difficulty in urinnation in three ladies which required CIC (clean intermittent catheter) for about 21 days .The de novo urgency had occurred in one women. The objective cure rate about 96.2%. CONCLUSIONS: SPMUS operation is an effective method for the manegment of patients with stress urine incontinence. KEY WORDS: Midurethral Sling, Stress Urine Incontinence (SUI), SPMUS

Abstract Background: epispadias is an unusual congenital malformation of the penis and is often part of the condition termed epispadias exstrophy complex. There are different surgical techniques for repair of epispadias. Objective: evaluation of our experience in male epispadias repair by modified Cantwell - Ransley technique. Patients and Methods: Twenty-four male patients with epispadias (eighteen cases with isolated epispadias and six cases associated with bladder Exstrophy) had undergone repair by modified Cantwell-Ransley technique in Al-Sader Medical City, Najaf. The patients age range from 1 year to 26 years with mean age 8.6 years. Primary repair was achieved in 20 patients and secondary repair was accomplished after prior unsuccessful closure in four patients. Results: The patients were followed up at 3, 6 and 12 months postoperatively. No patient develops major complication like urethrocutaneous fistula or urethral stricture. One patient develops minor skin dehiscence. Conclusion: Epispadias repair by modified Cantwell-Ransley technique have excellent functional and cosmetic result.

To evaluate the role of Urodynamic study (UD) in children with non neurogenic voiding dysfunction. A total number of 52 children (age 5 to 12 years) with non neurogenic voiding dysfunction symptoms (frequency, urgency, incontinence, with or without nocturnal enuresis) were evaluated in a period from February 2013 to October 2014 in AL-Sadar Medical City, Najaf. All patients had a noninvasive screening assessment consisting of a detailed voiding history, physical examination, urinalysis, ultrasonography and measurement of post voiding residual urine. All the patients had also undergone Urodynamic (UD), 12 of them the Urodynamic study was done under light general anesthesia (low dose ketamine) or sedative (midozalam) due to patient's un-cooperation. The following urodynamic parameters were measured for maximum bladder capacity (the infused volume immediately before the initiation of micturition), maximum detrusor pressure (Pdet max), bladder compliance and residual urine volume (measured by urethral catheterization). Children with clinical neurological problem were excluded from the study. 41 (78.8%) of 52 children with non neurogenic voiding dysfunction have abnormal Urodynamic findings (detrusor instability, low compliance, reduce bladder capacity). Urodynamic study have a important role in evaluation of children with non neurogenic voiding dysfunction.

ABSTRACT: BACKGROUND: Vesical stones in children are common in developing countries. Historically, open cystolithotomy has been the treatment of choice in the management of bladder calculi. Recently there are different treatmrnt of vesical stones like Transurethral Holmium laser cystolithotripsy and Percutaneous cystolithotripsy. OBJECTIVE: To Compare between transurethral Holmium :YAG laser cystolithotripsy and percutaneous suprapubic cystolithotomy in the management of bladder stones in children. PATIENTS AND METHODS : A total of 33 children (31 boys and 2 girls) with vesical stones were treated at Urology Department of Al-Sadder Medical City in Najaf between January 2013 and June 2014 . Mean patient age at the time of diagnosis was 4.2 years (range 8 months to 10 years). The patients were divided into 2 groups according to the procedure of stone removal. Group 1 (15 patients) underwent percutanous suprapubic cystolithotomy and group 2 (18 patients) underwent transurethral Holmium :YAG laser cystolithotripsy. Stone size ranged from 7 to 25 mm (mean 16.2mm). RESULTS: Operative time ranged from 10 to 25 minutes (mean 18 minutes) in percutanous suprapubic cystolithotomy (group 1) and was ranged from 15 to 70 minutes (mean 30 minutes) in transurethral Holmium :YAG laser cystolithotripsy (group 2). The day of catheter removal was 24 to 96 hours (mean 36 hours) in group 1, while it range 0 to 48 hours (mean 8 hours) in group 2. The hospital stay was shorter after transurethral Holmium :YAG laser compared to percutanous suprapubic cystolithotomy (30 vs. 72 hours). No significant intraoperative or postoperative complication was encountered except prolong urinary leak in two patients (13.3) in group 1 and transient mild haematuria in three children (16.6%) and low grade fever in two children (11%) in group 2. In all cases (100%) the stones were removed successfully in first session in group 1 while one patient (5.5%) need second session due to residual small stone in group 2. CONCLUSION: Transurethral Holmium :YAG laser and percutanous suprapubic cystolithotomy management of vesical stones in children are efficient, with a low incidence of complications. Transurethral Holmium :YAG laser offers a shorter hospital stay and urethral catheterization but longer operative time compared to percutanous suprapubic cystolithotomy. KEYWORDS: vesicalstone, holmium:yaglaser, percutanous suprapubic,cystolithotomy, cystoscope