Kureel Shiv N, Vasudeva Pawan, Sinha Shandip K, Dalela Divakar
Department of Paediatric Surgery, Chhatrapati Shahuji Maharaj Medical University (Upgraded King George Medical University), Lucknow, Uttar Pradesh, 226003, India.
Int Urol Nephrol. 2008;40(3):569-72. doi: 10.1007/s11255-008-9354-7. Epub 2008 Mar 5.
Double dorsal dartos flap coverage of the neourethra has been reported to be superior to single flap coverage for the prevention of urethrocutaneous fistula following hypospadias surgery. Conventional flap coverage involves covering the entire neourethra with vascularised flap. We describe a "limited" double dorsal dartos flap coverage of the neourethra following Mathieu repair for subcoronal hypospadias.
In a prospective study conducted between Feb 2003 and Feb 2007, 31 patients with primary subcoronal hypospadias who had a flat and narrow urethral plate with a healthy urethral meatus and minimal or no chordee underwent Mathieu hypospadias repair. A "limited" double dorsal dartos flap coverage of the neourethra was done in all patients. This involved covering only that portion of the neourethra which remained exposed after glans closure, i.e. the proximal neourethra. Primary surgical outcome assessed was the development of urethrocutaneous fistula following surgery.
The mean age at the time of repair was seven years and mean follow up was eight months. There was no flap loss, urethrocutaneous fistula formation, or glanular dehiscence in any of the 31 patients. One patient developed meatal stenosis which was managed by dilatation. One patient developed superficial sloughing of the penile skin. Overall complication rate was 6.45%.
"Limited" double dorsal dartos flap coverage of the neourethra seems to be an effective method to reduce the fistulous complication rate following Mathieu repair for subcoronal hypospadias. A larger comparative study needs to be done to evaluate conventional neourethral coverage with "limited" neourethral coverage.
据报道，在尿道下裂手术中，采用双背侧肉膜瓣覆盖新尿道在预防尿道皮肤瘘方面优于单瓣覆盖。传统的瓣覆盖是用带血管蒂的皮瓣覆盖整个新尿道。我们描述了一种在马蒂厄修复冠状沟下型尿道下裂后对新尿道采用“有限”双背侧肉膜瓣覆盖的方法。
在2003年2月至2007年2月进行的一项前瞻性研究中，31例原发性冠状沟下型尿道下裂患者，其尿道板扁平狭窄，尿道口健康，阴茎弯曲轻微或无阴茎弯曲，接受了马蒂厄尿道下裂修复术。所有患者均对新尿道采用“有限”双背侧肉膜瓣覆盖。这仅涉及覆盖在龟头闭合后仍暴露的新尿道部分，即近端新尿道。评估的主要手术结果是术后尿道皮肤瘘的发生情况。
修复时的平均年龄为7岁，平均随访时间为8个月。31例患者中无一例出现皮瓣丢失、尿道皮肤瘘形成或龟头裂开。1例患者出现尿道口狭窄，通过扩张进行处理。1例患者出现阴茎皮肤浅表脱屑。总体并发症发生率为6.45%。
对新尿道采用“有限”双背侧肉膜瓣覆盖似乎是一种有效降低马蒂厄修复冠状沟下型尿道下裂术后瘘管并发症发生率的方法。需要进行更大规模的比较研究来评估传统新尿道覆盖与“有限”新尿道覆盖的效果。
