A review of studies published during 1998 examining the treatment and management of benign prostatic obstruction

Lessons learnt from Snodgrass tip urethroplasty: a study of 75 cases

INTRODUCTION AND OBJECTIVES

Snodgrass tubularized incised plate urethroplasty and 2 modifications were evaluated in 75 hypospadiacs (distal and midpenile).

PATIENTS AND METHODS

The initial 25 patients (group A), underwent Snodgrass tubularized incised plate urethroplasty. In the next 25 patients (group B), the urethral plate defining incision and Snodgrass urethrotomy were not extended distally to the glans tip and the neourethra was reconstructed (distal to proximal) over a spacer. In the last 25 patients (group C), dorsal free skin grafting of the raw area (following Snodgrass urethrotomy) was done.

RESULTS

In group A, all patients developed meatal stenosis and required intermittent dilatation for 3 months. In groups B and C meatal stenosis did not occur.

CONCLUSIONS

Restriction or elimination of the raw area in the region of the neomeatus as in groups B and C effectively prevents meatal stenosis following Snodgrass repair.

Unique methodological issues facing randomized controlled trials of endourologic procedures

Randomized controlled trials provide the optimal design for evaluating the effectiveness of treatment but have not been widely accepted by surgical investigators. Although there are several methodological and ethical difficulties, none is insurmountable. In the United Kingdom, a regulatory agency has been established to supervise the introduction of new medical procedures, and something similar might be seen in the United States, particularly given the pressure from the government and third-party payors for proof of efficacy and cost effectiveness. Endourologists have responded to similar challenges in the past and must continue to do so.