Yildiz Abdullah, Bertozzi Mirko, Akin Melih, Appignani Antonino, Prestipino Marco, Dokucu Ali Ihsan
Department of Paediatric Surgery, SisliEtfal Training and Research Hospital, Istanbul, Turkey.
Afr J Paediatr Surg. 2012 Jan-Apr;9(1):8-12. doi: 10.4103/0189-6725.93294.
Reoperation for failed hypospadias has been considered to be seriously problematic. The dense fibrotic tissue causes difficulties in wound healing and increases the rate of complications. The tubularised incised-plate urethroplasty (TIPU) method has become a preferred method for all varieties of hypospadias in the past decade. However, fistulas are still one of the most common complications of this technique. The aim of this paper was to present the preliminary results of TIPU procedure with double de-epithelised dartos flaps in failed hypospadias repair.
All patients were treated between January 2009 and August 2010 by the same procedure, utilising TIPU with double de-epithelised dartos flaps. Vascularised ventral dartos flaps harvested from each side of the penis with their vascular supply were transposed to cover the suture line by wrapping them from either side of the penis.
There were 21 boys with failed hypospadias: 20 had previously undergone TIPU, and one Koyanagi repair. Patients presented with very large fistulas in four and dehiscence in 17. Repair of the failed hypospadias using TIPU with double de-epithelised dartos flaps was quite successful, with no fistula recurrence or dehiscence observed.
The preliminary results showed that TIPU with double de-epithelised dartos flaps is a useful method of successfully repairing failed hypospadias.
尿道下裂修复失败后的再次手术一直被认为是极具问题的。致密的纤维化组织导致伤口愈合困难，并增加了并发症的发生率。在过去十年中，管状切开板尿道成形术（TIPU）已成为治疗各种类型尿道下裂的首选方法。然而，瘘管仍然是该技术最常见的并发症之一。本文旨在介绍在尿道下裂修复失败病例中采用双去上皮化肉膜瓣的TIPU手术的初步结果。
所有患者均在2009年1月至2010年8月期间接受了相同的手术，即采用双去上皮化肉膜瓣的TIPU手术。从阴茎两侧获取带有血管供应的带血管蒂腹侧肉膜瓣，将其从阴茎两侧包裹并移位以覆盖缝线。
有21例尿道下裂修复失败的男孩：20例先前接受过TIPU手术，1例接受过小柳修复术。4例患者出现非常大的瘘管，17例出现裂开。采用双去上皮化肉膜瓣的TIPU修复失败的尿道下裂相当成功，未观察到瘘管复发或裂开。
初步结果表明，双去上皮化肉膜瓣的TIPU是成功修复失败尿道下裂的一种有效方法。
