الفهرس 
Title : High magnification versus optical magnification in hypospadias surgery : A Randomized controlled trial
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Abstract
Hypospadias is the most common congenital abnormality of the
urethra affecting 1:300 live male births worldwide. The incidence is on the
rise with the increasing environmental pollution as the suspected cause (1).
In 1993, the Birth defects Monitoring Program (BDMP) has reported a
doubling of the rates of hypospadias since 1970s in the United States(2).
By meatal location hypospadias is classified as anterior (glanular
and subcoronal), mid- penile (distal penile, midshaft, and proximal penile),
and posterior (penoscrotal, scrotal, and perineal) accounting for 50%, 30%
and 20%, respectively.(3)
Minimal tissue trauma, minimal/pin-point use of cautery and wellvascularized
tension free repair of all layers with epithelial inversion are
the general principles of hypospadias repair. The goal of hypospadias
repair is to build confidence in the child by creating a straight penis with a
slit-like meatus at the tip of the glans and a urethra of uniform caliber and
adequate length, reconstructing a symmetrical glans and penile shaft and
achieving projectile stream and normal erection.(3)
Even when patients receive surgery in their first 2 years of life they
may encounter severe medical, social and sexual problems later in life.
After long-term follow-up (10 years) of mainly patients with anterior
hypospadias who underwent 1-stage repair, different rates of complications
in up to 50% of patients were reported, depending on the inclusion of
different aspects.(4)
Although most studies conclude that psychosocial development is
not seriously altered, patients do suffer from negative genital appraisal,
sexual inhibition and more erection and ejaculation pro blems.(5)
Hypospadias can be associated with other urogenital tract anomalies
such as pelvi-ureteric junction (PUJ) obstruction, vesico-ureteric reflux and
renal agenesis which should be excluded by ultrasonographic scan in every
hypospadias patient.(3)
The choice of the procedure is based on the characteristics of the
urethral plate irrespective of the meatal location. The hypospadias repairs
can be classified into single-stage procedures and two-stage urethral plate
substitution procedure (Bracka’s repair). The single-stage procedures are
(a) urethral plate tubularization (glanular approximation and Snodgrass
repair) and (b) urethral plate augmentation (e.g onlay flap and Snodgraft
repair).(6)
When the urethral plate does not need transection then it can be
tubularized either by Zaonz’s GAP (glanular approximation procedure
when the plate is wide and deep or by Snodgrass’s TIP in cases of narrow,
shallow urethral plates. (6)
Optical magnification is an essential tool in the practice of pediatric
surgery. Magnifying loupes are the most frequently used instrument,
although their use often comes at the expense of neck pain experienced by
the operating surgeon. Recent advances have led to the development of a
compact video microscope (VITOM; Karl Storz Endoscopy GmbH,
Tuttlingen, Germany) that displays high-definition magnified images on a
flat screen. (7) Along with the surgical microscope they represent a great
advancement in the hypospadias repair surgeries.