Kajbafzadeh Abdol-Mohammad, Arshadi Hamid, Payabvash Seyedmehdi, Salmasi Amirali Hassanzadeh, Najjaran-Tousi Vahid, Sahebpor Ali Reza Alam
Department of Urology, Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
J Urol. 2007 Sep;178(3 Pt 1):1036-42; discussion 1042. doi: 10.1016/j.juro.2007.05.062. Epub 2007 Jul 16.
We report the results of corporeal tunica vaginalis free graft for single stage correction of severe chordee in children with proximal hypospadias.
A total of 18 children with proximal hypospadias and severe chordee underwent tunica vaginalis free graft for correction of chordee and urethroplasty. The graft was anastomosed to the ventral surface of the corpus cavernosum to correct severe penile curvature without dorsal plication of the corpus cavernosum. Single stage urethroplasty was then performed. In cases where the urethral plate was too short for urethral reconstruction a transverse preputial island flap was used for single stage urethroplasty. If the incised urethral plate did not have a well vascularized and supple appearance or the prepuce was not sufficient for phallic coverage, we transected the urethral plate and staged urethroplasty was done.
Mean followup was 27.5 months. In 13 patients ventral chordee was corrected using tunica vaginalis free graft without transecting the urethral plate, and urethroplasty was performed in 1 stage. In 3 patients the urethral plate was transected and a transverse preputial island flap was used for single stage urethroplasty. In 2 patients the urethral plate was transected and interposed with dermal graft and tunica vaginalis free graft, followed by staged urethroplasty. There was mild residual chordee in 2 cases. One child had a urethrocutaneous fistula at 2 weeks postoperatively, and 1 presented with obstructive pattern uroflowmetry due to meatal stenosis.
In this preliminary report the majority of patients with proximal hypospadias and severe chordee were successfully treated with single stage repair using tunica vaginalis free graft for correction of severe chordee.
我们报告了采用体部鞘膜游离移植对近端尿道下裂患儿的重度阴茎下弯进行一期矫正的结果。
共有18例近端尿道下裂合并重度阴茎下弯的患儿接受了鞘膜游离移植以矫正阴茎下弯并行尿道成形术。将移植物吻合至海绵体腹侧以矫正重度阴茎弯曲，而不进行海绵体背侧折叠。然后进行一期尿道成形术。在尿道板过短无法进行尿道重建的病例中，采用横行包皮岛状皮瓣进行一期尿道成形术。如果切开的尿道板外观血运不佳且不柔软，或者包皮不足以覆盖阴茎，则横断尿道板并分期进行尿道成形术。
平均随访27.5个月。13例患者采用鞘膜游离移植矫正腹侧阴茎下弯，未横断尿道板，并进行了一期尿道成形术。3例患者横断尿道板，采用横行包皮岛状皮瓣进行一期尿道成形术。2例患者横断尿道板，置入真皮移植物和鞘膜游离移植物，随后分期进行尿道成形术。2例有轻度残余阴茎下弯。1例患儿术后2周出现尿道皮肤瘘，1例因尿道口狭窄出现排尿梗阻型尿流率曲线。
在本初步报告中，大多数近端尿道下裂合并重度阴茎下弯的患者采用鞘膜游离移植一期修复重度阴茎下弯获得成功治疗。
