Gershbaum Meyer D, Stock Jeffrey A, Hanna Moneer K
Department of Urology, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
J Urol. 2002 Oct;168(4 Pt 2):1727-8; discussion 1729. doi: 10.1097/01.ju.0000027276.83141.8b.
In the majority of children hypospadias can be corrected in a single stage procedure. However, there is a subgroup of patients with perineoscrotal meatus and severe chordee who frequently exhibit some degree of penile scrotal transposition. It is this subgroup of patients in whom a critical review of the long-term results is examined.
Between 1980 and 1995, 1,934 children underwent repair of hypospadias and chordee. Of these patients 51 had perineoscrotal hypospadias with severe chordee and 40 underwent single stage repair (23), which included either full thickness skin graft urethroplasty (6), a proximal Thiersch procedure with distal free preputial skin graft (7) or an island tubularized flap (10). The chordee were corrected by either Nesbit or tunica albuginea plication. A 2-stage repair was performed in the remaining 11 children. Stage 1 consisted of chordee repair by either dermal (5) or tunica vaginalis (6) grafting of the ventral tunica albuginea surface, while stage 2 urethroplasty was performed 6 months later. These 2 groups were compared in regard to function status and cosmetic results.
Of the patients 34 (61%) were available for a greater than 5-year followup. An excellent outcome (terminal meatal voiding, near normal appearance, no complications) was obtained in only 5 (21%) patients of the single stage repair group, while satisfactory (subterminal meatus, irregularities in meatal, glandular or penile skin) or complicated results were obtained in 4 (17%) and 14 (61%), respectively. The overall complication rate was 61% (14 of 23 patients), including fistula, urethral diverticulum, distal breakdown or stricture formation. Recurrent chordee was noted in 5 (22%) children. Of the 2-stage group excellent results were obtained in 7 (63%), patients, while satisfactory and complicated results was seen in 2 (18%) and 2 (18%), respectively. Overall complication rate was 18%, and included fistula and diverticular formation. However, no recurrence of the initial chordee was noted.
Our long-term followup suggests that ventral grafting of the corporal wall in patients with severe chordee as a staged procedure is superior to the dorsal plication or Nesbit procedure. The overall functional and cosmetic results are excellent with the 2-stage compared to the single stage repair.
大多数儿童的尿道下裂可通过一期手术矫正。然而，有一小部分会阴阴囊型尿道口和重度阴茎下弯的患者经常表现出一定程度的阴茎阴囊转位。正是对这一小部分患者的长期结果进行了批判性回顾。
1980年至1995年间，1934名儿童接受了尿道下裂和阴茎下弯修复术。其中51例为会阴阴囊型尿道下裂合并重度阴茎下弯，40例接受一期修复（23例），包括全厚皮片尿道成形术（6例）、近端蒂尔施手术加远端游离包皮皮片（7例）或岛状管状皮瓣（10例）。阴茎下弯通过内斯比特手术或白膜折叠术矫正。其余11名儿童接受了两期修复。第一期包括通过腹侧白膜表面的真皮（5例）或鞘膜（6例）移植来修复阴茎下弯，而第二期尿道成形术在6个月后进行。比较这两组患者的功能状态和美容效果。
34例（61%）患者获得了超过5年的随访。一期修复组仅5例（21%）患者获得了优异的结果（尿道口排尿正常、外观接近正常、无并发症），而4例（17%）和14例（61%）患者分别获得了满意的结果（尿道口位于阴茎头下方、尿道口、阴茎头或阴茎皮肤不规则）或复杂的结果。总体并发症发生率为61%（23例患者中的14例），包括瘘管、尿道憩室、远端裂开或狭窄形成。5例（22%）儿童出现复发性阴茎下弯。两期修复组7例（63%）患者获得了优异的结果，而2例（18%）和2例（18%）患者分别获得了满意的和复杂的结果。总体并发症发生率为18%，包括瘘管和憩室形成。然而，未发现初始阴茎下弯复发。
我们的长期随访表明，对于重度阴茎下弯患者，分阶段进行阴茎体壁腹侧移植优于背侧折叠术或内斯比特手术。与一期修复相比，两期修复的总体功能和美容效果优异。
