Nelson Caleb P, Bloom David A, Kinast Robert, Wei John T, Park John M
Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
J Urol. 2005 Sep;174(3):1075-8. doi: 10.1097/01.ju.0000169421.27043.f2.
There is a paucity of long-term patient reported outcome data on surgery for hypospadias. We sought to evaluate genitourinary function and satisfaction after oral mucosa graft urethroplasty (OMGU) for hypospadias.
We identified 65 patients who had undergone OMGU at our institution between 1992 and 2003, and surveyed these patients to evaluate oral health, urinary function and satisfaction with outcomes.
We located 51 patients who had undergone OMGU, of whom 43 (84%) agreed to participate in the study. Median followup was 6.9 years. Mean study age was 15.1 years. Of the patients 47% had severe hypospadias with failed previous repair and 42% had severe hypospadias with previous first stage surgery. Oral complaints were rare and primarily cosmetic. No patient whose oral harvest was limited to the cheek (vs lip) had cosmetic complaints. Urinary spray and stream deviation were reported by 11 patients (26%) and 12 patients (28%), respectively. American Urological Association symptom scores were generally low (mean 5.6 +/- 6.0, range 0 to 21) but 7 patients (16%) had moderate symptoms and 2 (5%) had severe symptoms. Of the patients 60% were mostly satisfied or better with urinary function. Although satisfaction with penile appearance varied (51% of patients were satisfied), most patients (84%) were satisfied with the overall hypospadias care. Urinary symptom scores were significantly worse among patients who had post-OMGU complications (p = 0.004). Of these patients 38% had moderate or severe urinary symptoms, while 95% of patients without complications had mild symptoms (p = 0.01).
Many patients report good long-term outcomes of OMGU, although a subset of patients has significant urinary and cosmetic complaints that are more prevalent in association with surgical complications.
关于尿道下裂手术的长期患者报告结局数据较少。我们试图评估口腔黏膜移植尿道成形术（OMGU）治疗尿道下裂后的泌尿生殖功能和满意度。
我们确定了1992年至2003年间在本机构接受OMGU的65例患者，并对这些患者进行调查以评估口腔健康、泌尿功能和对治疗结果的满意度。
我们找到了51例接受过OMGU的患者，其中43例（84%）同意参与研究。中位随访时间为6.9年。研究对象的平均年龄为15.1岁。47%的患者患有重度尿道下裂且既往修复失败，42%的患者患有重度尿道下裂且曾接受过一期手术。口腔方面的问题较少，主要是外观问题。口腔取材仅限于脸颊（而非嘴唇）的患者没有外观方面的抱怨。分别有11例患者（26%）和12例患者（28%）报告有尿流喷洒和尿线偏斜情况。美国泌尿外科学会症状评分总体较低（平均5.6±6.0，范围0至21），但7例患者（16%）有中度症状，2例患者（（5%）有重度症状。60%的患者对泌尿功能大多感到满意或更满意。虽然对阴茎外观的满意度各不相同（51%的患者满意），但大多数患者（84%）对尿道下裂的总体治疗感到满意。OMGU术后出现并发症的患者，其泌尿症状评分明显更差（p = 0.004）。在这些患者中，38%有中度或重度泌尿症状，而无并发症的患者中95%有轻度症状（p = 0.01）。
许多患者报告OMGU的长期效果良好，尽管有一部分患者有明显的泌尿和外观方面的抱怨，且这些抱怨在手术并发症患者中更为普遍。
