Aminsharifi Alireza, Taddayun Alireza, Assadolahpoor Ardalan, Khezri Abdolaziz
Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran.
Urology. 2008 Aug;72(2):305-8. doi: 10.1016/j.urology.2008.02.034. Epub 2008 May 27.
To introduce a simple and effective technique for urethroplasty of distal hypospadias, using the advantages of both standard techniques of Snodgrass and Mathieu to reduce or eliminate the shortcomings of each.
Forty patients with primary distal hypospadias were randomized between two groups (20 in each). Patients in group I underwent standard Snodgrass urethroplasty, whereas those in group II were operated with our novel technique, Mathieu-Incised Plate (Mathieu-IP), comprising preparation of a parameatal-based skin flap as in the Mathieu procedure together with modifications (adopted from Snodgrass urethroplasty) such as a complete longitudinal incision on the urethral plate as well as coverage of the neourethra with an inner preputial flap. Operative data and outcomes of both procedures were analyzed prospectively after 1 year of follow-up.
Both groups were age matched (group I: 7.05 +/- 4.85 years; group II: 7.31 +/- 2.17 years), and there were no significant differences in mean operative time (95 minutes versus 100 min in groups I and II, respectively). There were significant differences between the two groups in terms of complications. Whereas 3 cases of posturethroplasty meatal stenosis and 2 of urethrocutaneous fistula (5 complications, 25%) were detected in the Snodgrass group, neither of these complications occurred in the Mathieu-IP group. All 40 patients benefited from a slit-like meatus.
Combining the Mathieu procedure with plate incision could be considered a promising simple technique to achieve a normally shaped meatus and to reduce the rate of meatal-related complications, the major concern with the Snodgrass procedure.
介绍一种简单有效的远端尿道下裂尿道成形术技术，利用Snodgrass和Mathieu标准技术的优点来减少或消除各自的缺点。
40例原发性远端尿道下裂患者随机分为两组（每组20例）。第一组患者接受标准的Snodgrass尿道成形术，而第二组患者采用我们的新技术——Mathieu切开皮板术（Mathieu-IP），该技术包括像Mathieu手术那样制备尿道口周围皮瓣，并进行一些改良（借鉴Snodgrass尿道成形术），如在尿道板上做完整的纵向切口，并用内侧包皮瓣覆盖新尿道。随访1年后，对两种手术的手术数据和结果进行前瞻性分析。
两组患者年龄匹配（第一组：7.05±4.85岁；第二组：7.31±2.17岁），平均手术时间无显著差异（第一组和第二组分别为95分钟和100分钟）。两组在并发症方面存在显著差异。Snodgrass组检测到3例尿道成形术后尿道口狭窄和2例尿道皮肤瘘（共5例并发症，占25%），而Mathieu-IP组未发生这些并发症。所有40例患者的尿道口均呈裂隙状。
将Mathieu手术与尿道板切开相结合可被认为是一种有前景的简单技术，可实现正常形状的尿道口，并降低与尿道口相关的并发症发生率，而这正是Snodgrass手术的主要问题。
