Powell C R, Mcaleer I, Alagiri M, Kaplan G W
Department of Urology, Naval Medical Center San Diego, California, USA.
J Urol. 2000 Apr;163(4):1286-8; discussion 1288-9.
We analyzed the complication rate in patients who underwent proximal hypospadias repair using preputial skin as a flap or free graft.
We retrospectively reviewed the records of 142 patients who underwent proximal hypospadias repair. Repairs were subdivided into tubed and onlay repairs within the flap and free graft groups. We analyzed postoperative complications, including fistulas, proximal strictures, diverticula and meatal stenosis.
Median patient age at followup was 11.3 months and median followup was 9.4 months. Two-thirds of the repairs were performed with free grafts. A proximal stricture developed in 8 and 0 patients who underwent free tubed graft and free onlay repair, respectively (p = 0.047). Otherwise there was no significant difference in the complication rate of the various types of repair. Of the 43 patients who had stricture, fistula or meatal stenosis 29 (67%) presented more than 1 year after surgery.
In repairs performed with free grafts there is a significantly higher proximal stricture rate when a tube rather than an onlay is used. Otherwise we noted no significant difference in the complication rates of flaps and grafts used to repair proximal hypospadias. A significant number of complications presented more than 1 year postoperatively and they may even present as late as 4 years. This finding suggests that longer followup may be necessary to assess completely the outcome of proximal hypospadias surgery.
我们分析了采用包皮瓣或游离移植片进行近端尿道下裂修复的患者的并发症发生率。
我们回顾性分析了142例行近端尿道下裂修复患者的病历。修复方法在皮瓣组和游离移植片组中又细分为管状修复和覆盖修复。我们分析了术后并发症，包括瘘管、近端狭窄、憩室和尿道口狭窄。
随访时患者的中位年龄为11.3个月，中位随访时间为9.4个月。三分之二的修复采用游离移植片。分别有8例和0例接受游离管状移植片和游离覆盖修复的患者发生近端狭窄（p = 0.047）。除此之外，各种修复方式的并发症发生率无显著差异。在43例发生狭窄、瘘管或尿道口狭窄的患者中，29例（67%）在术后1年以上出现症状。
在采用游离移植片进行修复时，使用管状修复而非覆盖修复时近端狭窄率显著更高。除此之外，我们注意到用于修复近端尿道下裂的皮瓣和移植片的并发症发生率无显著差异。相当数量的并发症在术后1年以上出现，甚至可能在4年后才出现。这一发现表明，可能需要更长时间的随访才能全面评估近端尿道下裂手术的结果。
