Paediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria.
J Pediatr Urol. 2013 Apr;9(2):206-11. doi: 10.1016/j.jpurol.2012.02.004. Epub 2012 Mar 4.
The wide spectrum of circumcision urethral injury/fistula makes selection of appropriate repair methods challenging in sub-Saharan Africa. This paper reports on the outcome of repair-oriented categorization in a Nigerian center.
Consecutive children presenting with circumcision urethral injury/fistula at the University of Benin Teaching Hospital were categorized into six repair-oriented groups in 2009-2011.
21 children were treated. Except in 2 cases, early neonatal circumcision at an average age of 8 days (range 4-14 days) had been performed, the majority (52%) by paramedics at home. Categories of injury/fistula based on severity ranged from isolated fistula (38%) which required fistula excision and repair (category A) to severe ventral urethral/coronal/glanular avulsion (29%) which required urethral plate tubularization/ventral penile reconstruction (category F). Overall, successful first-stage repair was achieved in 19 (91%) children. Meatal stenosis (2), urethral stricture (1), which responded to serial dilatation, and minor urinary leakage (2), which was closed at second stage, were the post-repair complications. Adequate penile size and straight penis on erection were achieved in all cases. Cosmetic outcome was excellent in 16 (76%) cases, good in 4 (19%) and fair in 1 (5%).
Repair-oriented categorization, which could be useful to practitioners in similar settings, was satisfactory in managing urethral injury/urethrocutaneous fistula.
在撒哈拉以南非洲地区，由于包皮环切术后尿道损伤/瘘的种类繁多，选择合适的修复方法具有挑战性。本文报告了尼日利亚一家中心对修复为导向的分类的结果。
2009 年至 2011 年，在贝宁大学教学医院，连续有因包皮环切术后尿道损伤/瘘而就诊的儿童被归入六个修复为导向的组别。
21 名儿童接受了治疗。除了 2 例之外，大多数儿童（52%）在平均 8 天龄（4-14 天）时由非医务人员在家中进行早期新生儿包皮环切术。根据严重程度划分的损伤/瘘管类别范围从单纯瘘管（38%），需要瘘管切除和修复（A 类）到严重的尿道腹侧/冠状/龟头撕裂（29%），需要尿道板管化/阴茎腹侧重建（F 类）。总体而言，19 名（91%）儿童的一期修复成功。二期修复时，有 2 名出现尿道狭窄，1 名出现尿道狭窄，均经尿道扩张治疗；2 名出现轻微尿漏，均行二期修复。所有病例的阴茎大小和勃起时阴茎的笔直度均良好。16 例（76%）的美容效果极佳，4 例（19%）良好，1 例（5%）一般。
修复为导向的分类对于类似环境下的从业者可能有用，它在处理尿道损伤/尿道皮肤瘘方面是令人满意的。
