Scarpa Maria Grazia, Castagnetti Marco, Berrettini Alfredo, Rigamonti Waifro, Musi Luciano
Paediatric Surgery Unit, S. Bortolo Hospital, Vicenza, Italy.
Pediatr Surg Int. 2010 May;26(5):519-22. doi: 10.1007/s00383-010-2569-6. Epub 2010 Feb 19.
To evaluate urinary function in patients with distal hypospadias undergoing repair by the tubularized incised-plate urethroplasty (TIP or Snodgrass), compare the results with those in patients treated by the Mathieu technique, and show the potential issues inherent to the evaluation of such results.
A cross-sectional assessment was performed of uncomplicated distal hypospadias operated on during a 3-year period, already toilet trained, and able to void volitionally. Evaluation included clinical assessment urinary symptoms and urinary stream, and uroflowmetry.
Out of 83 patients operated on during the study period, 10 (12%) developed complication and 32 were not toilet trained or refused to participate in the study. Median follow-up in the remaining 41 patients included in the study was 20 (3-36) months. None of these patients presented voiding symptoms or urinary stream abnormalities. Uroflowmetry was normal in 30 cases and obstructive in 11 (27%). An obstructive flow pattern was more common in patients undergoing TIP versus Mathieu repair, 8 of 19 (42%) versus 3 of 22 (14%), respectively (P = 0.07). Four TIP cases with an obstructive uroflow pattern were managed conservatively.
Although both the TIP and the Mathieu repair allow good results in terms of urinary function after distal hypospadias repairs, the TIP technique seems more likely to be associated with urine flow pattern abnormalities. The actual clinical relevance of this finding remains ill defined.
评估采用管状切开板尿道成形术（TIP或斯诺德格拉斯术式）修复远端尿道下裂患者的排尿功能，将结果与采用马蒂厄技术治疗的患者进行比较，并揭示评估此类结果所固有的潜在问题。
对在3年期间接受手术治疗的无并发症远端尿道下裂患者进行横断面评估，这些患者已接受如厕训练且能够自主排尿。评估包括临床评估排尿症状和尿流情况以及尿流率测定。
在研究期间接受手术的83例患者中，10例（12%）出现并发症，32例未接受如厕训练或拒绝参与研究。纳入研究的其余41例患者的中位随访时间为20（3 - 36）个月。这些患者均未出现排尿症状或尿流异常。30例患者尿流率测定正常，11例（27%）存在梗阻。与马蒂厄修复术相比，TIP修复术患者出现梗阻性尿流模式更为常见，分别为19例中的8例（42%）和22例中的3例（14%）（P = 0.07）。4例TIP修复且尿流率测定呈梗阻模式的患者接受了保守治疗。
尽管TIP修复术和马蒂厄修复术在远端尿道下裂修复术后的排尿功能方面均能取得良好效果，但TIP技术似乎更易与尿流模式异常相关。这一发现的实际临床意义仍不明确。
