However, some problems that were not adequately repaired in childhood may become more pronounced when the penis grows at puberty, such as residual penile curvature or urine spraying due to rupture of the repair at the head of the penis.Complications are usually corrected with another operation, most often delayed for at least six months after the last surgery to allow the tissues to heal sufficiently before attempting another repair. Results when circumcision or foreskin reconstruction are done are the same. (Figure 4a, 4b)
Patients and surgeons had differing opinions as to outcomes of hypospadias repair, that is, patients might not be satisfied with a cosmetic result considered satisfactory by the surgeon, but patients with a cosmetic result considered not very satisfactory by the surgeon may themselves be satisfied. Overall, patients were less satisfied than surgeons.Living with hypospadias can present challenging emotional obstacles. Many men, whether they have had surgical repair of their hypospadias as a child or not often are very guarded in school bathrooms or locker rooms. Secrecy about the condition can complicate emotional pain, because talking about the penis is often a taboo subject. Worry, anxiety and feelings of shame are common among adult men born with hypospadias.
Diagnosis
Electrocardiographic features include:
Atrial rate: 100 to 250 BPM
Ventricular conduction can be variable
Irregular or irregularly irregular in the setting of variable AV block
Regular if 1 to 1, 2 to 1, or 4 to 1 AV block
P wave morphology
Unifocal, but similar in morphology to each other
Might be inverted
Differs from normal sinus P wave
May exhibit either long RP or short PR intervals
Rhythm may be paroxysmal or sustained
May demonstrate an increase in the rate at initiation (e.g., "warm up," or "rev up")
May demonstrate a decrease in the rate at termination (e.g., "cool down")

Treatment
Initial management of focal atrial tachycardia should focus on addressing underlying causes: treating acute illness, cessation of stimulants, stress reduction, appropriately managing digoxin toxicity, or chronic disease management. The ventricular rate is controllable with the use of beta blockers or calcium channel blockers. If atrial tachyarrhythmia persists and the patient is symptomatic, the patient may benefit from class IA, IC, or class III antiarrhythmics. Catheter ablation of focal atrial tachycardia may be appropriate in patients failing medical therapy. Epidemiology
A European study of young males applying for pilot licenses demonstrated that 0.34% had asymptomatic atrial tachycardia and 0.46% had symptomatic atrial tachycardia. References


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