Department of Paediatric Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
J Pediatr Urol. 2012 Feb;8(1):108, 108e1. doi: 10.1016/j.jpurol.2011.10.001. Epub 2011 Nov 25.
Proximal hypospadias is associated with poorly defined urethral plate and often with chordee. A two-staged Bracka's repair is reproducible and has been used routinely in our practice. We present the key steps of this technique on a 13-month-old boy.
This boy presented with proximal penile hypospadias, hooded foreskin and mild chordee. He underwent stage one Bracka's repair. The steps included: 1) Artificial erection test to define extent of chordee; 2) inner preputial graft harvest and preparation; 3) glans and urethral plate incision down to corpora cavernosa; 4) partial release of chordee by division of aberrant corpus spongiosum, without degloving of penile skin; 5) laying of preputial graft; 6) dressing.
The patient had catheter removed on second, and dressing removed on seventh, post-operative days, without complication. The patient is planned for second stage repair in 6 months. Our standard approach includes either removal of catheter on the second or seventh post-operative day, according to surgeon preference. The three senior surgeons have used this method in 54 patients without significant complication. The graft has taken in 100% of cases.
The Bracka's staged repair of proximal hypospadias is a versatile technique that gives reproducible and sound results.
近端型尿道下裂与尿道板界限不清晰且常伴有阴茎下弯有关。两期 Bracka 修复术具有可重复性，已在我们的实践中常规应用。我们现介绍该技术在一名 13 月龄男婴上的关键步骤。
该男婴患有近端阴茎型尿道下裂、包皮过长和轻度阴茎下弯。他接受了一期 Bracka 修复术。手术步骤包括：1）人工勃起试验以确定阴茎下弯的程度；2）内包皮移植物的获取和准备；3）龟头和尿道板向下切开至海绵体；4）通过切开异常海绵体以部分松解阴茎下弯，而不进行阴茎皮肤脱套；5）铺设包皮移植物；6）包扎。
患儿于术后第 2 天和第 7 天去除导尿管，无并发症。计划在 6 个月后进行二期修复。根据术者的偏好，我们的标准方法包括术后第 2 天或第 7 天去除导尿管。三位资深外科医生已在 54 例患者中使用该方法，未出现明显并发症。移植物 100%存活。
近端尿道下裂的 Bracka 分期修复术是一种多功能技术，可获得可重复且可靠的结果。
