儿童期修复的尿道下裂患者的长期功能结局及满意度
Long-term functional outcome and satisfaction of patients with hypospadias repaired in childhood.
作者信息
Hoag Chris C, Gotto Geoff T, Morrison Kevin B, Coleman Gerald U, Macneily Andrew E
机构信息
Department of Pediatric Urology, University of British Columbia, Vancouver, BC.
出版信息
Can Urol Assoc J. 2008 Feb;2(1):23-31. doi: 10.5489/cuaj.521.
INTRODUCTION
Potential long-term sequelae of hypospadias and its surgical correction include difficulties in voiding, sexual function, psychosexual adjustment and self-appraisal. These difficulties often evolve long after surgical repair as children grow to adulthood. Despite this, patient-driven data on long-term functional outcomes and satisfaction are limited, leaving the true success of hypospadias surgery essentially unknown. The aim of this study was to address these deficiencies.
METHODS
We conducted a chart review for all patients operated on by a single urologist from 1981 to 1988. Extensive efforts were made to obtain accurate current address information for patients. A database of patient demographics and pathology, operative details and complications was created. A 22-item questionnaire was mailed to study subjects. Telephone follow-up by an independent research nurse bolstered response rates. Responses from returned questionnaires were pooled and analyzed.
RESULTS
The chart review included 115 patients. Of 100 patients (with address information) who were sent questionnaires, 28 ultimately responded. The chart review group was comparable to groups in other published studies. Despite a slightly higher initial major complication rate (57.2%), respondents reported few long-term complications (11% fistula, 29% persistent chordee and 10% stricture) and excellent urinary and sexual functional results. The most common functional complaints were spraying and hesitancy during micturition. Overall, 86% of patients were satisfied with their surgical result, and 52% wished they had been provided longer follow-up.
CONCLUSION
Long-term outcomes data are critical to an honest account of success rates for hypospadias surgery. Obtaining these data remains challenging. In this series, despite high initial complication rates, most patients reported excellent long-term functional results and were quite satisfied with their overall outcome.
引言
尿道下裂及其手术矫正的潜在长期后遗症包括排尿困难、性功能障碍、心理性适应和自我评估问题。随着儿童成长至成年，这些问题通常在手术修复后很长时间才会出现。尽管如此，由患者提供的关于长期功能结果和满意度的数据有限，使得尿道下裂手术的真正成功率基本未知。本研究的目的是解决这些不足。
方法
我们对1981年至1988年由一位泌尿外科医生实施手术的所有患者进行了病历回顾。为获取患者准确的当前地址信息付出了巨大努力。创建了一个包含患者人口统计学和病理学、手术细节及并发症的数据库。向研究对象邮寄了一份包含22个项目的问卷。由一名独立的研究护士进行电话随访以提高回复率。对回收问卷的回复进行汇总和分析。
结果
病历回顾纳入了115例患者。在被发送问卷的100例（有地址信息）患者中，最终有28例回复。病历回顾组与其他已发表研究中的组具有可比性。尽管初始严重并发症发生率略高（57.2%），但回复者报告的长期并发症较少（11%为瘘管、29%为持续性阴茎下弯和10%为狭窄），且泌尿和性功能结果良好。最常见的功能主诉是排尿时尿液喷洒和排尿犹豫。总体而言，86%的患者对手术结果满意，52%的患者希望能得到更长时间的随访。
结论
长期结果数据对于如实说明尿道下裂手术的成功率至关重要。获取这些数据仍然具有挑战性。在本系列研究中，尽管初始并发症发生率较高，但大多数患者报告长期功能结果良好，并对总体结果相当满意。
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