El-Sherbiny M T
Mansoura Urology & Nephrology Center, Mansoura University, Egypt.
BJU Int. 2003 Dec;92(9):1003-5. doi: 10.1111/j.1464-410x.2003.04513.x.
To evaluate the role of stenting in toilet-trained children undergoing tubularized incised plate (TIP) repair of distal hypospadias, as a stent-free TIP in boys who are not toilet-trained has been successful with no unusually prolonged discomfort.
The study included all toilet-trained children with distal penile shaft hypospadias who were not suitable candidates for meatal advancement procedures and who underwent TIP repair, by one surgeon, between March and August 2001. Patients were prospectively randomized at the end of surgery to either leaving a stent for 1 week (stented) or no stent (unstented). The study included 64 children (35 stented and 29 unstented; median age 6 years, range 2-17). In the stented group the stent was placed in the bladder for continuous bladder drainage. An adjunct penile block instead of caudal or epidural analgesia was used in all patients, to avoid drug-induced urinary retention. The early evaluation included an assessment of bladder spasms, dysuria, urinary retention and extravasation. Regular meatal dilatation was provided only to patients with voiding difficulty and an obvious tendency to stenosis.
The median (range) follow-up was 6 (3-11) months. Voiding was painful in the first week in five (14%) and 13 (45%) of the stented and unstented patients, respectively (P < 0.01); there were bladder spasms in three (8%) and none, respectively (P > 0.05). None of stented patients developed urinary retention or extravasation, compared with seven (24%) and five (17%) in the unstented group, respectively (P < 0.05). Meatal dilatation was required in two (6%) and five (17%) of the stented and unstented patients, respectively (P > 0.05). There were complications requiring re-operation in nine boys (14%), of whom seven (10%) developed small fistulae and two (4%) had meatal stenosis. Although the re-operation rate was lower in the stented (9%) than in the unstented group (20%), the difference was not statistically significant (P > 0.05).
The use of a stent in TIP repair in toilet-trained children is advantageous; it significantly eliminates the risk of urinary retention and extravasation, and reduces the overall patient discomfort. It is also associated with a lower re-operation rate.
评估支架置入在已接受如厕训练的远端尿道下裂患儿行管状切开板（TIP）修复术中的作用，因为在未接受如厕训练的男孩中，无支架TIP修复已取得成功，且无异常延长的不适。
本研究纳入了2001年3月至8月间所有已接受如厕训练、阴茎远端尿道下裂且不适合行尿道口前移手术的患儿，均由同一位外科医生进行TIP修复。患者在手术结束时前瞻性随机分为两组，一组留置支架1周（有支架组），另一组不留置支架（无支架组）。研究包括64名儿童（35名有支架组和29名无支架组；中位年龄6岁，范围2 - 17岁）。在有支架组中，支架置于膀胱内用于持续膀胱引流。所有患者均采用阴茎阻滞替代骶管或硬膜外镇痛，以避免药物引起的尿潴留。早期评估包括膀胱痉挛、排尿困难、尿潴留和外渗的评估。仅对排尿困难且有明显狭窄倾向的患者进行定期尿道口扩张。
中位（范围）随访时间为6（3 - 11）个月。有支架组和无支架组分别有5名（14%）和13名（45%）患者在第一周排尿时疼痛（P < 0.01）；分别有3名（8%）和0名患者出现膀胱痉挛（P > 0.05）。有支架组无患者发生尿潴留或外渗，无支架组分别有7名（24%）和5名（17%）患者发生（P < 0.05）。有支架组和无支架组分别有2名（6%）和5名（17%）患者需要进行尿道口扩张（P > 0.05）。有9名男孩（14%）出现需要再次手术的并发症，其中7名（10%）形成小瘘管，2名（4%）出现尿道口狭窄。虽然有支架组再次手术率（9%）低于无支架组（20%），但差异无统计学意义（P > 0.05）。
在已接受如厕训练的儿童TIP修复术中使用支架是有益的；它显著消除了尿潴留和外渗的风险，减轻了患者的总体不适。它还与较低的再次手术率相关。
