Imamoğlu M Abdurrahim, Bakirtaş Hasan
Department of Urology, SSK Ankara Hospital, Ankara, Turkey.
Urol Int. 2003;71(3):251-4. doi: 10.1159/000072674.
Perimeatal flap (Mathieu) and tubularized incised-plate (Snodgrass) methods were compared regarding success rate, postoperative complications, and cosmetic appearance in primary and recurrent distal hypospadias cases with normal urethral plates.
Between 1995 and 2001 Snodgrass-type repair was done in 32 primary and in 24 recurrent hypospadias cases (total 56 patients; mean age 5.8, age range 3-17 years), and Mathieu-type repair was done in 33 primary and in 21 recurrent distal hypospadias cases (total 54 patients; mean age 5.2, age range 2-19 years). There was no statistically significant difference between groups regarding demographics. Patients with primary hypospadias either without or with minimal chordee and patients with recurrent hypospadias only with a normal urethral plate were included in the study. The mean postoperative follow-up period was 24 months.
Meatal stricture formation, fistula formation, wound dehiscence, and flap necrosis were seen in 2, 4, 4, and 2 patients, respectively, treated with the Mathieu technique and in 5, 4, 3, and 0 patients, respectively, treated with the Snodgrass technique. Wound dehiscence and flap necrosis were seen less frequently, whereas meatal stenosis was more common in the Snodgrass group (p < 0.05, p < 0.05, and p > 0.05, respectively; chi(2) test). There was no difference between groups regarding fistula formation. Mean hospital stay, time to stent withdrawal, and urinary diversion period were shorter in the Mathieu group (7.5 +/- 1.19 vs. 5.7 +/- 1.38 days, 7.1 +/- 0.67 vs. 5.4 +/- 0.85 days, and 14.1 +/- 1.17 vs. 10.2 +/- 1.72 days, respectively; p < 0.001 for all). The total success rates were similar (78.6% in the Snodgrass group and 77.8% in the Mathieu group). Cosmetic appearance was highly satisfactory in the Snodgrass group.
We believe that the Snodgrass method should be preferred for primary and recurrent hypospadias cases without chordee or with minimal chordee and with a normal urethral plate due to its lower complication rate and its satisfactory cosmetic appearance. However, when a healthy urethral plate is not available, Mathieu-type repair can be preferred.
比较了尿道口皮瓣（马蒂厄）法和管状切开-板层（斯诺德格拉斯）法在原发性和复发性远端尿道下裂且尿道板正常病例中的成功率、术后并发症及外观。
1995年至2001年期间，对32例原发性和24例复发性尿道下裂患者（共56例；平均年龄5.8岁，年龄范围3 - 17岁）实施了斯诺德格拉斯式修复，对33例原发性和21例复发性远端尿道下裂患者（共54例；平均年龄5.2岁，年龄范围2 - 19岁）实施了马蒂厄式修复。两组在人口统计学方面无统计学显著差异。纳入研究的患者包括原发性尿道下裂且无或仅有轻度阴茎下弯者以及复发性尿道下裂且尿道板正常者。术后平均随访期为24个月。
采用马蒂厄技术治疗的患者中，分别有2例、4例、4例和2例出现尿道口狭窄形成、瘘管形成、伤口裂开和皮瓣坏死；采用斯诺德格拉斯技术治疗的患者中，分别有5例、4例、3例和0例出现上述情况。伤口裂开和皮瓣坏死的发生率较低，而斯诺德格拉斯组尿道口狭窄更为常见（分别为p < 0.05、p < 0.05和p > 0.05；卡方检验）。两组在瘘管形成方面无差异。马蒂厄组的平均住院时间、拔管时间和尿流改道时间较短（分别为7.5 ± 1.19天对5.7 ± 1.38天、7.1 ± 0.67天对5.4 ± 0.85天、14.1 ± 1.17天对10.2 ± 1.72天；均p < 0.001）。总成功率相似（斯诺德格拉斯组为78.6%，马蒂厄组为77.8%）。斯诺德格拉斯组的外观满意度很高。
我们认为，由于并发症发生率较低且外观满意，对于原发性和复发性无阴茎下弯或仅有轻度阴茎下弯且尿道板正常的尿道下裂病例，应首选斯诺德格拉斯法。然而，当没有健康的尿道板时，可首选马蒂厄式修复。
