Department of Urology, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.
Curr Opin Urol. 2012 Nov;22(6):447-52. doi: 10.1097/MOU.0b013e328357bc62.
Hypospadias is one of the most common congenital anomalies in men. We searched the recent literature (since 1 January 2011) using the following keywords in the title or abstract: hypospadia or hypospadias, in order to provide the reader with an updated view of the subject.
Early repair is recommended; distal forms are mainly treated by the tubularized incised plate technique; however, meatal stricture concerns are still noticed, limiting its use on proximal forms. The debate of proximal primary repair in either one or two stages is still ongoing. Minor modifications for preparing the distal bed for the urethroplasty in two stages are presented. One-stage repairs, either with reconstruction of the urethral plate (three-in-one concept) or simply with the onlay to tunica albuginea (Rigamonti), is a viable option with over 70% success in one surgery. The importance of barriers, such as tunica vaginalis and dartos flap, was reassessed and flow rates may indicate obstructive voiding patterns after 1-year follow-up.
Further experience and comparative studies for distal and proximal hypospadias are required. Long-term data may indicate the appropriate procedure selected for primary repair.
尿道下裂是男性中最常见的先天性畸形之一。我们检索了自 2011 年 1 月 1 日以来的最新文献,在标题或摘要中使用了以下关键词:尿道下裂或尿道下裂,以便为读者提供该主题的最新观点。
早期修复被推荐;管状切开板技术主要用于治疗远端形式;然而,仍注意到尿道口狭窄的问题,限制了其在近端形式上的使用。近端一期修复在一期或两期的争论仍在继续。介绍了两种方法中用于为尿道成形术准备远端床的轻微修改。一期修复,无论是尿道板重建(三合一概念)还是简单的白膜镶嵌(Rigamonti),对于超过 70%的一次手术成功率都是一种可行的选择。诸如鞘膜和精索皮瓣等屏障的重要性得到了重新评估,并且在 1 年随访后,流速可能表明存在阻塞性排尿模式。
需要进一步的经验和对远端和近端尿道下裂的比较研究。长期数据可能表明选择了适当的术式进行一期修复。