Asanuma Hiroshi, Satoh Hiroyuki, Shishido Seiichiro
Department of Urology, Tokyo Metropolitan Kiyose Children's Hospital, Tokyo, Japan.
Int J Urol. 2007 Jan;14(1):43-7. doi: 10.1111/j.1442-2042.2006.01662.x.
Tubularized incised plate urethroplasty has become a popular technique for repairing distal and proximal hypospadias in many institutions. Dorsal inlay graft urethroplasty has been used in our institution since 2003 to reduce the risk of meatal stenosis. In the present study, we evaluated the results of the dorsal inlay graft procedure.
A total of 28 patients with no deep groove and no severe curvature underwent one-stage urethroplasty using an inner preputial-based dorsal inlay graft. The medical records of all patients were retrospectively reviewed with regard to complication rate and cosmetic appearance.
Mean patient age at surgery was 21 months (range, 14 months to 4.6 years). Preoperatively the urethral meatus was coronal in two cases, distal shaft in 17, proximal shaft in six and penoscrotal in three. Nine patients required testosterone therapy before surgery. Mean operative time was 200 min (range, 154-249 min). Mean length of inlay graft was 20.9 mm (range, 12-30 mm). In all patients, a straight penis was achieved without dorsal plication of the corposa cavernosa, and the neomeatus with a slit-like appearance was positioned at the glans tip. At a mean of 22 months of follow up, a urethrocutaneous fistula developed in only one patient (3.6%), requiring repair surgery 6 months after urethroplasty. No patient had meatal stenosis, neourethral stricture or urethral diverticulum along the inlay graft.
Dorsal inlay graft urethroplasty is an effective method for hypospadiac repair and leads to good cosmetic outcome with low risk of complications.
管状切开板尿道成形术已成为许多机构修复远端和近端尿道下裂的常用技术。自2003年以来，我们机构一直采用背侧镶嵌移植尿道成形术来降低尿道口狭窄的风险。在本研究中，我们评估了背侧镶嵌移植手术的结果。
共有28例无深沟且无严重弯曲的患者接受了基于包皮内板的背侧镶嵌移植一期尿道成形术。回顾性分析所有患者的病历，统计并发症发生率和外观情况。
手术时患者的平均年龄为21个月（范围为14个月至4.6岁）。术前，尿道口位于冠状沟的有2例，阴茎体远端的有17例，阴茎体近端的有6例，阴茎阴囊的有3例。9例患者在手术前需要睾酮治疗。平均手术时间为200分钟（范围为154 - 249分钟）。镶嵌移植的平均长度为20.9毫米（范围为12 - 30毫米）。所有患者均实现了阴茎伸直，无需对海绵体进行背侧折叠，新尿道口呈裂隙状位于龟头顶端。平均随访22个月时，仅1例患者（3.6%）出现尿道皮肤瘘，在尿道成形术后6个月需要进行修复手术。没有患者出现尿道口狭窄、新尿道狭窄或沿镶嵌移植部位的尿道憩室。
背侧镶嵌移植尿道成形术是修复尿道下裂的有效方法，能带来良好的外观效果，且并发症风险低。
