Castañón M, Muñoz E, Carrasco R, Rodó J, Morales L
Department of Pediatric Surgery, Integrated Unit Hospital de Sant Joan de Déu-Hospital Clinic, Barcelona, Spain.
J Pediatr Surg. 2000 Oct;35(10):1453-5. doi: 10.1053/jpsu.2000.16412.
BACKGROUND/PURPOSE: The onlay island flap urethroplasty was first described in the repair of mid and distal penile hypospadias. Since then, this technique has been increasingly used in more severe cases of hypospadias, because of the complications of tubularized flaps, mainly megaurethra and proximal anastomotic strictures. The aim of this study was to compare the morbidity of these 2 techniques.
Between April 1994 and December 1998, 80 patients underwent surgical treatment for hypospadias. A tubularized island flap (Ducketttechnique) was performed in 42 cases, and the onlay island flap technique was used in 38 patients. The authors retrospectively compared the complication rate and type of these 2 procedures.
Altogether, fistula was the most frequent complication without any significant difference between the 2 groups (21.4% for Duckett technique and 18.4% for onlay repair; P > .05). However, the anastomotic stricture was much more common in the tubularized flap group (7.14% v 2.63%; P < .05). Moreover, a megaurethra was found only in the Duckett technique group (4.7%). There was no case of chordee recurrence, but 6 patients (15.7%) treated with the onlay technique required urethrolysis including dissection of the chord behind the urethral plate, and in the other 3 patients of the same group (7.9%), a dorsal Nesbit plication also was necessary. In all these cases, the urethroplasty included an island cutaneous flap to provide ventral coverage to the neourethra.
The authors conclude that both techniques present similar complications. However, proximal strictures and megaurethra are more common after the Duckett technique. This procedure is of choice in patients with scrotal hypospadias. Conversely, the onlay repair should be completed with other procedures (urethrolysis, dorsal Nesbit plication) to obtain good results in patients with severe degree of chordee.
背景/目的：带蒂岛状皮瓣尿道成形术最初用于修复阴茎中、远端尿道下裂。自那时起，由于管状皮瓣的并发症，主要是巨尿道和近端吻合口狭窄，该技术越来越多地用于更严重的尿道下裂病例。本研究的目的是比较这两种技术的发病率。
1994年4月至1998年12月期间，80例患者接受了尿道下裂手术治疗。42例采用管状岛状皮瓣（达克特技术），38例采用带蒂岛状皮瓣技术。作者回顾性比较了这两种手术的并发症发生率和类型。
总体而言，瘘管是最常见的并发症，两组之间无显著差异（达克特技术组为21.4%，带蒂修复组为18.4%；P>.05）。然而，吻合口狭窄在管状皮瓣组更为常见（7.14%对2.63%；P<.05）。此外，仅在达克特技术组发现了巨尿道（4.7%）。没有阴茎下弯复发的病例，但采用带蒂技术治疗的6例患者（15.7%）需要进行尿道松解术，包括切开尿道板后方的阴茎下弯，同一组的另外3例患者（7.9%）还需要进行背侧内斯比特折叠术。在所有这些病例中，尿道成形术包括一个岛状皮瓣，为新尿道提供腹侧覆盖。
作者得出结论，两种技术的并发症相似。然而，达克特技术术后近端狭窄和巨尿道更为常见。该手术是阴囊型尿道下裂患者的首选。相反，对于阴茎下弯严重程度较高的患者，带蒂修复应与其他手术（尿道松解术、背侧内斯比特折叠术）联合进行，以获得良好效果。
