Smith D P
East Tennessee Children's Hospital and Division of Urology, Departments of Pediatrics and Surgery, University of Tennessee Medical Center at Knoxville, Knoxville, Tennessee, USA.
Urology. 2001 Apr;57(4):778-81; discussion 781-2. doi: 10.1016/s0090-4295(00)01062-1.
To critically evaluate my experience using a modified tubularized incised plate (TIP) hypospadias repair.
Sixty-four boys, 7 months to 11 years old (mean age 22.9 months), underwent a TIP urethroplasty by a single pediatric urologist for primary hypospadias. The hypospadias defects included 53 distal and 11 midshaft. The incision of the urethral plate was always deep and proximal but never extended the entire length of the plate. In 25 cases (39%), the incision was less than one half the length of the urethral plate. A two-layer urethroplasty was always obtained. A vascularized subcutaneous pedicle was always placed onto the urethroplasty. This pedicle was ventrally based in 56 of the repairs (87.5%). Postoperative urethral stents were not used in 52 boys (81.3%), including 7 with midshaft repairs. All children were scheduled for a postoperative evaluation at 1 month. A confidential phone survey was later conducted by someone other than the surgeon. The parents were asked if they were satisfied or dissatisfied with the direction and caliber of the urinary stream, chordee correction, and overall general appearance.
The clinical evaluation was performed in 54 boys (84.7%) not earlier than 1 month after the repair. The examination revealed a conical glans, slit meatus, circumferential mucosal collar, and a straight phallus in all cases. No cases of fistula, stricture, or dehiscence occurred. A follow-up phone survey 3 to 43 months (mean 21 months) postoperatively was obtained from the parents of 40 patients. Without exception, the parents were satisfied with the urinary stream, chordee correction, and overall appearance.
Without incising the entire urethral plate and stenting the repair, a TIP urethroplasty can still be expected to provide excellent results when correcting distal and midshaft hypospadias. Parents were satisfied with the long-term cosmetic and functional results obtained with a TIP urethroplasty.
批判性地评估我使用改良管状切开板（TIP）修复尿道下裂的经验。
64名年龄在7个月至11岁（平均年龄22.9个月）的男孩，由一名小儿泌尿科医生进行TIP尿道成形术治疗原发性尿道下裂。尿道下裂缺损包括53例远端型和11例中段型。尿道板的切口总是深且靠近近端，但从不延伸至板的全长。25例（39%）的切口长度小于尿道板长度的一半。总是进行两层尿道成形术。总是在尿道成形术上放置带血管蒂的皮下组织。该组织蒂在56例修复手术中（87.5%）位于腹侧。52名男孩（81.3%）术后未使用尿道支架，其中包括7例中段型修复的患儿。所有儿童均安排在术后1个月进行评估。随后由外科医生以外的人员进行了一次保密电话调查。询问家长对尿流方向和管径、阴茎弯曲矫正以及整体外观是否满意。
54名男孩（84.7%）在修复术后不早于1个月进行了临床评估。检查发现所有病例均有圆锥形龟头、裂隙状尿道口、环形黏膜皱襞和阴茎伸直。未发生瘘管、狭窄或裂开病例。对40名患者的家长进行了术后3至43个月（平均21个月）的随访电话调查。无一例外，家长对尿流、阴茎弯曲矫正和整体外观均感到满意。
在不切开整个尿道板且不对修复进行支架置入的情况下，TIP尿道成形术在矫正远端和中段尿道下裂时仍有望取得优异效果。家长对TIP尿道成形术获得的长期美容和功能效果感到满意。
