Baskin Laurence S, Ebbers Michele B
Pediatric Urology, Department of Urology, UCSF Children's Hospital, University of California-San Francisco, San Francisco, CA 94143-0738, USA.
J Pediatr Surg. 2006 Mar;41(3):463-72. doi: 10.1016/j.jpedsurg.2005.11.059.
Hypospadias is one of the most common congenital anomalies defined by abortive development of the urethral spongiosum, the ventral prepuce and in more severe cases penile chordee. The etiology of hypospadias remains unknown with environmental exposure in the form of endocrine disruptors the most likely explanation for the worldwide increase in incidence in the last three decades. There are five sequential steps for the successful repair of hypospadias: 1) Orthoplasty or penile straightening, 2) Urethroplasty, 3) Meatoplasty and Glanuloplasty, 4) Scrotoplasty, and 5) Skin Coverage. The major technical advances in hypospadias surgery that have improved surgical outcomes are 1) Preservation of the urethral plate, 2) Incision of the urethral plate, 3) Dorsal midline plication, 4) Deepithelized urethroplasty dartos flap coverage, and 5) Two stage alternative techniques. This article reviews the pertinent embryology, anatomy and the most common hypospadias reconstructive operations to accomplish a successful repair.
尿道下裂是最常见的先天性畸形之一，其特征为尿道海绵体、腹侧包皮发育不全，在更严重的情况下还伴有阴茎下弯。尿道下裂的病因尚不清楚，内分泌干扰物形式的环境暴露最有可能解释过去三十年来全球发病率的上升。成功修复尿道下裂有五个连续步骤：1）矫形术或阴茎伸直术，2）尿道成形术，3）尿道口成形术和龟头成形术，4）阴囊成形术，5）皮肤覆盖。改善手术效果的尿道下裂手术的主要技术进展包括：1）保留尿道板，2）切开尿道板，3）背侧中线折叠术，4）去上皮尿道成形术肉膜瓣覆盖，5）两阶段替代技术。本文回顾了相关的胚胎学、解剖学以及最常见的尿道下裂重建手术，以实现成功修复。
