We describe our experience with complete repair of severe penoscrotal hypospadias in 1 stage. The operative technique includes several innovative points, such as release of chordee by urethral mobilization (without detaching it from the glans) after penile degloving of dartos chordee, wing flap-flipping urethroplasty to the tip of the glans and incrimination of "glanulomeatoplasty" for better cosmetic and functional results. Our technique is compared to other 1-stage methods.
We report our experience with 17 cases of paraureteral diverticula seen in the last 12 years. These 17 cases represent a particular group of patients with ureteral reflux in that they often had ureteral obstruction too. Early operative intervention is recommended. There is a trend towards renal dysmorphism and dysplasia as the position of the ureteral orifice laterlizes in the diverticulum. A paraureteral diverticulum was considered to be the developmental extravesical expansion of the terminal ureteral end by virtue of the caudally positioned ureteral bud in the wolffian duct.
The structures of the ureter, ureterovesical junction, bladder and sphincteric urethra were investigated histologically in 17 human fetuses (from 3rd to 21st weeks) and 2 neonates, with particular emphasis on their muscular development. The differentiation of ureteral muscle begins from the upper part of the ureter at the 12th week and muscle bundles run spirally. The purely longitudinal intramural ureteral muscle differentiates much later than the upper ureteral muscle and begins to form muscle bundles at the 17th week. The deep periureteral sheath and the trigonal muscle differentiate at an almost similar pace to the intramural ureteral muscle. The detrusor muscle begins to differentiate from the apical dome of the bladder at the 7th week. Distinct superficial periureteral sheath is also seen around the 12th week. The urethral striated muscle is recognized at the 8th week. It starts to develop in the anterior wall of the urethra as a dense cellular accumulation which eventually extends caudolaterally to form a U-shaped figure. The urethral smooth muscle starts its differentiation between the 9th and 11th weeks inside the urethral striated muscle.
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