Wood Hadley M, Kay Robert, Angermeier Kenneth W, Ross Jonathan H
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Urol. 2008 Oct;180(4 Suppl):1753-6. doi: 10.1016/j.juro.2008.03.112. Epub 2008 Aug 21.
We evaluated the timing of the presentation of urethrocutaneous fistulas after hypospadias repair and the development of recurrent urethrocutaneous fistulas after prior fistula repair.
We reviewed the charts of all patients with urethrocutaneous fistulas following hypospadias repair who were seen from 1995 to 2005. Age at hypospadias repair, hypospadias level, hypospadias repair type, time when the parent/patient noted the fistula, date/type of fistula repair, time when fistula recurrence was noticed, date/type of secondary repair and date of last followup were documented.
A total of 26 patients with urethrocutaneous fistula were seen, of whom 15 had undergone at least 1 prior operation elsewhere. Of the patients 58% and 61% with fistulas following hypospadias repair and recurrent fistulas following the initial fistula, respectively, presented in the immediate postoperative period. Of the patients 23% with initial fistulas presented more than 2 years after hypospadias repair (up to 17 years later), while only 5.5% with recurrent fistulas presented more than 1 year after fistula repair. Age at presentation with initial fistulas after hypospadias repair was 0 to 12 months in 5 patients, 12 to 24 in 6, 24 to 36 in 6, 36 to 48 in 2 and more than 48 in 7. Mean followup was 5.5 months (range 0 to 69).
While many urethrocutaneous fistulas develop immediately following hypospadias repair, almost a quarter present well beyond the typical followup of many urologists. These findings suggest that reported rates of urethrocutaneous fistula may be underestimated and longer followup may be warranted. Late recurrence of urethrocutaneous fistula is rare with 5.2% seen at more than 1 year, suggesting that more limited followup may be appropriate in these patients.
我们评估了尿道下裂修复术后尿道皮肤瘘出现的时间，以及既往瘘管修复术后复发性尿道皮肤瘘的发生情况。
我们回顾了1995年至2005年间所有尿道下裂修复术后出现尿道皮肤瘘患者的病历。记录尿道下裂修复时的年龄、尿道下裂程度、尿道下裂修复类型、家长/患者发现瘘管的时间、瘘管修复日期/类型、发现瘘管复发的时间、二次修复日期/类型以及最后随访日期。
共观察到26例尿道皮肤瘘患者，其中15例曾在其他地方至少接受过1次手术。尿道下裂修复术后出现瘘管的患者中，分别有58%和61%的初次瘘管修复术后复发性瘘管在术后即刻出现。初次瘘管患者中有23%在尿道下裂修复术后2年以上出现（最长达17年后），而初次瘘管修复术后复发性瘘管患者中只有5.5%在瘘管修复术后1年以上出现。尿道下裂修复术后初次出现瘘管时的年龄，5例为0至12个月，6例为12至24个月，6例为24至36个月，2例为36至48个月，7例超过48个月。平均随访时间为5.5个月（范围0至69个月）。
虽然许多尿道皮肤瘘在尿道下裂修复术后即刻出现，但几乎四分之一的患者在许多泌尿外科医生的典型随访期之后才出现。这些发现表明，报道的尿道皮肤瘘发生率可能被低估，可能需要更长时间的随访。尿道皮肤瘘的晚期复发很少见，1年以上出现的占5.2%，这表明对这些患者进行更有限的随访可能是合适的。
