尿道下裂手术后尿道皮肤瘘成功修复的相关变量。

Variables in successful repair of urethrocutaneous fistula after hypospadias surgery.

作者信息

Waterman Bradley J, Renschler Todd, Cartwright Patrick C, Snow Brent W, DeVries Catherine R

机构信息

Division of Urology, University of Utah School of Medicine and Primary Children's Medical Center, Salt Lake City, Utah, USA.

出版信息

J Urol. 2002 Aug;168(2):726-30; discussion 729-30.

PMID:12131360

Abstract

PURPOSE

We evaluate variables affecting the success of repairs of urethrocutaneous fistula after hypospadias surgery.

MATERIALS AND METHODS

The records of 123 boys who underwent fistula repair at Primary Children's Medical Center were reviewed. Of these patients 100 underwent initial fistula repair at our center (surgery was performed at our center in 82 and elsewhere in 18) and 23 were referred from elsewhere after unsuccessful fistula repairs. Patient age was 6 months to 34 years (median 3.21 years) and interval between surgeries was 3.7 months to 12 years (median 12.6 months). Several variables potentially affecting the success of fistula closure were retrospectively assessed.

RESULTS

Including those patients referred from outside hospitals, fistulas were successfully closed in 71%, 72%, 77%, 100% and 100% of these patients after fistula repairs 1 to 5, respectively. Variables studied yielded stent 67.7% (36 of 54 cases) versus no stent 76.1% (35 of 46) and operating microscope 70.4% (59 of 71) versus loupes 72.4% (21 of 29) in terms of success. Success based on patient age yielded 65.5% for younger than 2 years (n = 29 patients), 71.7% for 2 to 5 (46), 64.7% for 6 to 12 (17) and 87.5% for older than 12 (8). When considering the type of original hypospadias repair and its affect on fistula closure success, a significantly lower success was noted with Yoke and King procedures (p = 0.007 and 0.037, respectively). In patients who underwent hypospadias surgery and all subsequent fistula closure attempts at our center, fistulas were successfully repaired in 72%, 67% and 100% of patients after attempts 1 to 3, respectively. Initial fistula repair was successful in 72% (59 of 82) of patients who underwent original hypospadias surgery at our center and in 67% (12 of 18) of those referred after hypospadias surgery at an outside hospital.

CONCLUSIONS

Regarding urethrocutaneous fistula closure, the data from this study suggest that there is no clear difference in stent versus no stent and microscope versus loupes, age at fistula closure does not affect success, type of original hypospadias procedure may influence success (King and Yoke procedures were least successful), success rate is not negatively impacted in recurrent fistula cases, given a diverse group of fistulas, success of fistula repair for attempts 1 to 5 was 71%, 72%, 77%, 100% and 100%, respectively, and success rate in a tertiary pediatric urology setting is not influenced by whether the original hypospadias procedure or initial fistula closure was performed in the pediatric urology setting versus outside hospital.

摘要

目的

我们评估影响尿道下裂手术后尿道皮肤瘘修补成功的相关变量。

材料与方法

回顾了在 Primary Children's Medical Center 接受瘘修补手术的 123 名男孩的记录。其中 100 例患者在我们中心接受了初次瘘修补手术（82 例手术在我们中心进行，18 例在其他地方进行），23 例是在其他地方瘘修补手术失败后转诊而来。患者年龄为 6 个月至 34 岁（中位年龄 3.21 岁），手术间隔时间为 3.7 个月至 12 年（中位时间 12.6 个月）。对几个可能影响瘘闭合成功的变量进行了回顾性评估。

结果

包括那些从外院转诊来的患者，在第 1 至 5 次瘘修补术后，分别有 71%、72%、77%、100%和 100%的患者瘘成功闭合。在成功方面，所研究的变量显示使用支架的成功率为 67.7%（54 例中的 36 例），未使用支架的成功率为 76.1%（46 例中的 35 例）；使用手术显微镜的成功率为 70.4%（71 例中的 59 例），使用放大镜的成功率为 72.4%（29 例中的 21 例）。按患者年龄计算的成功率，2 岁以下为 65.5%（29 例患者），2 至 5 岁为 71.7%（46 例），6 至 12岁为 64.7%（17 例），12 岁以上为 87.5%（8 例）。当考虑最初尿道下裂修补术的类型及其对瘘闭合成功的影响时，发现 Yoke 和 King 手术的成功率显著较低（分别为 p = 0.007 和 0.037）。在我们中心接受尿道下裂手术及所有后续瘘闭合尝试的患者中，第 1 至 3 次尝试后，分别有 72%、67%和 100%的患者瘘成功修复。在我们中心接受初次尿道下裂手术的患者中，初次瘘修补成功的比例为 72%（82 例中的 59 例），在外部医院接受尿道下裂手术后转诊而来的患者中这一比例为 67%（18 例中的 12 例）。

结论

关于尿道皮肤瘘的闭合，本研究数据表明，使用支架与不使用支架、手术显微镜与放大镜之间没有明显差异，瘘闭合时的年龄不影响成功率，最初尿道下裂手术的类型可能影响成功率（King 和 Yoke 手术成功率最低），复发性瘘病例的成功率不受负面影响，鉴于瘘的类型多样，第 1 至 5 次瘘修补尝试的成功率分别为 71%、72%、77%、100%和 100%，在三级儿科泌尿外科环境中，成功率不受最初尿道下裂手术或初次瘘闭合是在儿科泌尿外科环境还是外部医院进行的影响。