Lam Po N, Greenfield Saul P, Williot Pierre
Department of Pediatric Urology, Women and Children's Hospital of Buffalo, Buffalo, New York 14222, USA.
J Urol. 2005 Oct;174(4 Pt 2):1567-72; discussion 1572. doi: 10.1097/01.ju.0000179395.99944.48.
Urinary and sexual functions were assessed in post-pubescent boys who had undergone 2-stage hypospadias repair in infancy for severe hypospadias with chordee.
A total of 44 boys who had undergone 2-stage hypospadias repair from 1985 to 1993 and who were at least 13 years old were contacted. Of the 44 boys 27 (61%) with an average age of 15.4 years (range 13 to 21) responded. Meatal locations were midshaft in 14 cases, penoscrotal in 9 and perineal in 4. Four boys had bifid scrotum and 5 had intersex disorders. Intramuscular testosterone was administered preoperatively to 15 (56%) boys. A Nesbit procedure was performed in 18 boys (67%). Average patient age at stage 2 repair was 2.3 years. Mean followup was 12.7 years (range 10.7 to 17.2). Additional surgery was performed for diverticuli in 5 cases, fistula in 3 and minor strictures in 4. Of the 27 patients 25 presented for examination and 2 responded to questionnaire only.
All patients had normal meatal position, normal glanular anatomy, a well-defined coronal sulcus, normal cylindrical shafts without extra skin and well-defined penoscrotal junctions. Ten boys (40%) had minor spraying of stream, all stood to void and 10 (40%) milked the urethra after voiding. None had chordee. Twenty patients were able to ejaculate and 9 (42.9%) had to milk the ejaculate. Two patients (7.7%) had minor pain with erection. All subjects were satisfied with urinary, erectile and ejaculatory functions, and 23 (92%) were pleased with appearance.
The 2-stage approach for severe hypospadias results in excellent function, cosmesis and patient satisfaction after puberty, with no chordee. Minor voiding and ejaculatory problems are to be expected. Late complications are rare. The use of extragenital skin to either primarily repair or salvage a "cripple" has not been necessary.
对青春期后因重度尿道下裂合并阴茎下弯在婴儿期接受两阶段尿道下裂修复术的男孩的泌尿和性功能进行评估。
联系了1985年至1993年间接受两阶段尿道下裂修复术且年龄至少13岁的44名男孩。44名男孩中，27名（61%）回复，平均年龄15.4岁（范围13至21岁）。尿道口位置：阴茎中段14例，阴茎阴囊型9例，会阴型4例。4名男孩有阴囊分裂，5名有两性畸形。15名（56%）男孩术前接受了肌肉注射睾酮。18名男孩（67%）进行了Nesbit手术。二期修复时的平均患者年龄为2.3岁。平均随访12.7年（范围10.7至17.2年）。5例因憩室、3例因瘘管、4例因轻度狭窄接受了额外手术。27例患者中，25例前来接受检查，2例仅回复了问卷。
所有患者尿道口位置正常、龟头解剖结构正常、冠状沟清晰、阴茎体圆柱形正常无多余皮肤且阴茎阴囊交界处清晰。10名男孩（40%）有轻度尿流喷洒，均站立排尿，10名（40%）排尿后挤压尿道。均无阴茎下弯。20名患者能够射精，9名（42.9%）需挤压精液。2名患者（7.7%）勃起时有轻度疼痛。所有受试者对泌尿、勃起和射精功能均满意，23名（92%）对外观满意。
重度尿道下裂的两阶段手术方法在青春期后可带来优异的功能、美容效果和患者满意度，无阴茎下弯。可预期有轻度排尿和射精问题。晚期并发症罕见。无需使用生殖器外皮肤进行一期修复或挽救“残废”。
