Sarhan Osama M, El-Hefnawy Ahmad S, Hafez Ashraf T, Elsherbiny Mohamed T, Dawaba Mohamed E, Ghali Ahmad M
Pediatric Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
J Pediatr Urol. 2009 Oct;5(5):378-82. doi: 10.1016/j.jpurol.2009.02.204. Epub 2009 Jul 25.
To review our experience of tubularized incised plate (TIP) urethroplasty in children with hypospadias defects.
Of 500 children (mean age 6 years) who received a TIP urethroplasty, 439 (87.8%) had primary hypospadias and 61 had one failed previous repair. The hypospadias defects were coronal in 110 (22%), distal penile in 261 (52.2%), midpenile in 78 (15.6%) and proximal in 51 (10.2%). Chordee was present in 98 (19.6%) patients. Presence of complications requiring re-operation and overall general appearance was recorded.
The mean (SD, range) follow-up was 34 (18, 7-77) months. Overall success rate was 81.4%. Re-operation was required in 93 patients (18.6%); for urethrocutaneous fistula in 47 (9.4%), complete disruption of the repair in 32 (6.4%) and meatal stenosis in 14 (2.8%). In univariate analysis, complications were significantly higher in stented repairs, posterior hypospadias, those with no neourethral coverage (spongioplasty), and repairs early in the study. The last three factors were the only significant independent risk factors in multivariate analysis.
TIP is a reliable method for treating both distal and proximal hypospadias and is suitable for both primary and re-operative cases with a low rate of complications. A significantly better outcome is achieved with distal hypospadias, covering the neourethra with the mobilized corpus spongiosum (spongioplasty) or a flap, and experience. Stenting of the repair, patient age, or previous failed repair has no statistically significant impact on outcome.
回顾我们采用管状切开板（TIP）尿道成形术治疗小儿尿道下裂缺陷的经验。
500例接受TIP尿道成形术的儿童（平均年龄6岁）中，439例（87.8%）为原发性尿道下裂，61例曾有过一次修复失败。尿道下裂缺陷位于冠状沟的有110例（22%），阴茎远端的有261例（52.2%），阴茎中段的有78例（15.6%），近端的有51例（10.2%）。98例（19.6%）患者存在阴茎下弯。记录需要再次手术的并发症情况及总体外观。
平均（标准差，范围）随访34（18，7 - 77）个月。总体成功率为81.4%。93例（18.6%）患者需要再次手术；47例（9.4%）因尿道皮肤瘘，32例（6.4%）因修复完全破裂，14例（2.8%）因尿道口狭窄。单因素分析显示，支架修复、后尿道下裂、无新尿道覆盖（海绵体成形术）以及研究早期进行的修复并发症明显更高。多因素分析中，最后三个因素是仅有的显著独立危险因素。
TIP是治疗远端和近端尿道下裂的可靠方法，适用于原发性和再次手术病例，并发症发生率低。远端尿道下裂采用游离海绵体（海绵体成形术）或皮瓣覆盖新尿道并积累经验可取得显著更好的效果。修复时使用支架、患者年龄或既往修复失败对结果无统计学显著影响。
