Malone Peter R
Harold Hopkins Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, Berks, UK.
BJU Int. 2009 Aug;104(4):550-4. doi: 10.1111/j.1464-410X.2009.08350.x. Epub 2009 Feb 27.
To describe a novel technique for repairing penile urethrocutaneous (UC) fistula, by dissecting out the fistula tract, but instead of excising it, to preserve it and turn it inside out (PATIO); this creates a flap valve inside the urethral lumen that prevents the ingress of urine allowing the fistula to heal.
Five UC fistulae in four patients (two adults and two children) were repaired using the PATIO technique over a 4-year period. The two adults had developed the UC fistula after complex salvage hypospadias repair for failed surgery as children. In addition, three UC fistulae were recurrent after failed attempts to close them using conventional techniques, including the interposition of locally sourced 'waterproofing' subcutaneous tissue and, in one child, a rotational skin flap. One child had a difficult coronal UC fistula with little more than a skin bridge distally.
Four operations were performed as day-cases with no catheter; one child was catheterized and kept in hospital overnight to prevent retention after a caudal anaesthetic. The catheter was removed, before discharge, the following morning. All five repairs were successful with no complications or recurrence, with a mean (range) follow-up of 18 (2-50) months.
The PATIO technique is easy to perform and can be done as a day-case with no need for urethral catheterization. It does not preclude the use of other techniques to minimize the risk of recurrence, but so far these have not been necessary. As with all new operations, reported after only a few cases, caution must be used when interpreting the results and more studies are needed. Nevertheless, the concept makes sense and the early results are encouraging, particularly as it has been used on UC fistulae most liable to recur.
描述一种修复阴茎尿道皮肤瘘（UC瘘）的新技术，即解剖出瘘管，但不切除，而是保留并将其翻转（PATIO）；这会在尿道腔内形成一个瓣状瓣膜，防止尿液进入，使瘘管愈合。
在4年期间，对4例患者（2名成人和2名儿童）的5处UC瘘采用PATIO技术进行修复。2名成人在儿童期复杂的挽救性尿道下裂修复手术失败后出现UC瘘。此外，3处UC瘘在尝试使用传统技术（包括置入局部取材的“防水”皮下组织，以及1名儿童采用旋转皮瓣）闭合失败后复发。1名儿童患有困难的冠状UC瘘，远端仅有一个皮肤桥。
4例手术作为日间手术进行，未留置导尿管；1名儿童接受了导尿，并在医院过夜，以防止骶管麻醉后尿潴留。次日早晨出院前拔除导尿管。所有5处修复均成功，无并发症或复发，平均（范围）随访18（2 - 50）个月。
PATIO技术操作简便，可作为日间手术进行，无需尿道插管。它并不排除使用其他技术以降低复发风险，但目前尚无此必要。与所有仅在少数病例后报道的新手术一样，在解释结果时必须谨慎，还需要更多研究。然而，该概念合理，早期结果令人鼓舞，特别是因为它已应用于最易复发的UC瘘。
