2nd Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical School, Beijing, China.
Int J Urol. 2011 Feb;18(2):155-61. doi: 10.1111/j.1442-2042.2010.02684.x.
To report the outcomes of two-stage repair for adult hypospadias using a buccal mucosa graft as a tube.
A total of 57 adult patients who underwent surgery for severe urethral defect at our institution from January 2002 to March 2010 were included in this analysis. The urethroplasty procedure included penile urethra reconstruction with the buccal mucosa graft used as a tube in the first stage, anastomosis of the unobstructed urethra in the second stage and a scrotal fascio-cutaneous flap transferred to resurface the reconstructed urethra for waterproofing.
No complications occurred after the first stage, whereas postoperative infections occurred in six cases and distal necrosis of the scrotal flap occurred in two cases after the second stage. All eight of these patients had the complication of urethrocutaneous fistula, which healed after 2-4 weeks by cleaning and changing dressings in six patients. Twelve patients complained of straining at voiding in the early postoperative period. However, nine of these patients had an obvious increase in maximum flow rate without any intervention 3 months after the operation. Follow up ranged from 6 to 62 months (mean 28 months) in 46 patients. Most of the patients presented terminal meatus, no chordee, no urethral stricture and normal voiding. The majority of patients achieved excellent cosmetic and functional results.
A buccal mucosa graft as a tube is a reliable and durable method of two-stage repair for severe and complicated hypospadias in adults. The use of scrotal flaps seems to contribute to a good vascularized waterproof cover.
报告采用颊黏膜移植物作为管状物进行两阶段修复成人尿道下裂的结果。
回顾性分析 2002 年 1 月至 2010 年 3 月我院收治的 57 例严重尿道缺损的成人患者。尿道成形术包括一期阴茎尿道重建，使用颊黏膜移植物作为管状物；二期吻合通畅的尿道，并转移阴囊筋膜皮瓣覆盖重建的尿道以防水。
一期手术后无并发症发生，二期手术后 6 例发生感染，2 例阴囊皮瓣远端坏死。所有 8 例患者均出现尿道皮肤瘘并发症，其中 6 例经清洁换药后 2-4 周愈合。12 例患者术后早期排尿费力，但术后 3 个月 9 例最大尿流率明显增加，无需干预。46 例患者随访 6-62 个月（平均 28 个月）。大多数患者尿道口位置正常，无阴茎下弯、尿道狭窄和正常排尿。大多数患者获得了良好的美容和功能效果。
颊黏膜移植物作为管状物是治疗成人严重和复杂尿道下裂的可靠且持久的两阶段修复方法。使用阴囊皮瓣似乎有助于形成良好的血运防水覆盖。
