Samuel M, Capps S, Worth A
Department of Paediatric Surgery, St. George's Health Care NHS Trust, London, UK.
Eur Urol. 2001 Oct;40(4):463-8. doi: 10.1159/000049817.
Comparative analysis of functional results, complications, cosmesis, operative time and hospital stay between staged urethroplasty and single-stage on-lay island flap for proximal hypospadias.
Non-randomised single observer study of two groups of patients over a 5-year period with proximal hypospadias. Group 1 had 17 patients (mean age 17.7+/-1.6 months) who underwent a staged urethroplasty. Urethral plate was tubularised and proximal hypospadias converted to a distal hypospadias. Hooded dorsal prepuce was buttonholed and transposed ventrally to cover the neo-urethra. Subsequently a parameatal based flip flap urethroplasty completed urethral reconstruction. Group 2 had 17 patients (mean age 18.2+/-2.2 months) with a single stage inner preputial on-lay island flap based on superficial dorsal vessels.
Mean period of follow-up has been 2.8+/-1.7 years in group 1 vs. 3.2+/-1.6 years in group 2 (p = 0.2). In both groups (34), 79% of the children who are now toilet trained and standing to void have a good calibre straight single stream of urine in a forward direction (p = 1.00). Main complication seen in both groups was urethrocutaneous fistulae: 6% (1/17) in group 1 vs. 59% (10/17) in group 2 (p = 0.0002). In both groups (34) cosmetic appearance of a natural vertical slit glanular meatus situated at the normal position on the glans was achieved (p = 1.00). Total mean duration of operative time in group 1 was 193.5+/-42.9 vs. 203+/-27.6 min in group 2 (p = 0.24). Total mean duration of hospital stay in group 1 was 3.4+/-0.6 vs. 9.2+/-2.9 days in group 2 (p = 0.0001). Total mean cost of the procedure in group 1 was 2,347.3 pounds +/- 220 vs. 3,753.5 pounds +/- 75 in group 2 (p = 0.002).
Staged urethroplasty for proximal hypospadias results in a normal penis with good function, minimal complications and excellent cosmesis. Hospital stay was shorter and overall cost lower than a single stage on-lay island flap urethroplasty.
比较分期尿道成形术与一期带蒂岛状皮瓣修复术治疗近端型尿道下裂在功能恢复、并发症、美观效果、手术时间及住院时间方面的差异。
对两组近端型尿道下裂患者进行为期5年的非随机单观察者研究。第1组有17例患者（平均年龄17.7±1.6个月），接受分期尿道成形术。将尿道板管状化，近端型尿道下裂转变为远端型尿道下裂。将带帽状的背侧包皮戳孔并向腹侧移位以覆盖新建尿道。随后进行基于尿道口的翻转皮瓣尿道成形术完成尿道重建。第2组有17例患者（平均年龄18.2±2.2个月），接受基于浅表背侧血管的一期内侧包皮带蒂岛状皮瓣修复术。
第1组平均随访时间为2.8±1.7年，第2组为3.2±1.6年（p = 0.2）。两组共34例患者中，79%已接受如厕训练且站立排尿的儿童尿液排出顺畅，呈良好的单股向前直线尿流（p = 1.00）。两组主要并发症均为尿道皮肤瘘：第1组为6%（1/17），第2组为59%（10/17）（p = 0.0002）。两组共34例患者均实现了龟头尿道口呈自然垂直裂隙状且位于龟头正常位置的美观效果（p = 1.00）。第1组手术总平均时间为193.5±42.9分钟，第2组为203±27.6分钟（p = 0.24）。第1组住院总平均时间为3.4±0.6天，第2组为9.2±2.9天（p = 0.0001）。第1组手术总平均费用为2347.3英镑±220，第2组为3753.5英镑±75（p = 0.002）。
分期尿道成形术治疗近端型尿道下裂可使阴茎功能良好、并发症少、美观效果佳。与一期带蒂岛状皮瓣尿道成形术相比，住院时间更短，总体费用更低。
