School of Medicine, Southern Illinois University, Springfield, Illinois; School of Medicine and Public Health, University of Wisconsin (PHM), Madison, Wisconsin.
J Urol. 2013 Oct;190(4 Suppl):1545-8. doi: 10.1016/j.juro.2013.02.038. Epub 2013 Feb 20.
Many options are available for repairing mid shaft to distal hypospadias. Reported complications include poor cosmesis, persistent chordee, meatal stenosis and fistula. We hypothesized that advancing the intact native urethra would facilitate chordee correction and minimize complications.
We retrospectively reviewed our records of all 248 hypospadias repairs done from July 2003 to May 2009 and identified patients younger than 18 years with distal or mid shaft hypospadias who underwent repair by urethral mobilization. The outcomes recorded were patient satisfaction, bladder scan volume, and the rate of fistula, meatal stenosis or other complications.
Of the patients 83 met study inclusion criteria, including 5 (6%) treated with previous failed hypospadias operations. The hypospadias site was the distal, mid shaft and megameatal intact prepuce variant in 69 (83.1%), 11 (13.3%) and 3 patients (3.6%), respectively. Chordee was present in 80 patients (96.4%). The mean degree of chordee was 61.5 degrees, mean age at operation was 35.7 months and mean followup was 18 months (range 0.25 to 79). Of parental responses 94% were pleased or very pleased. Mean bladder volume on bladder scan was 9.7 ml (range 0 to 81). Fistula developed in 1 patient (1.2%). There were no meatal stenosis cases.
Urethral mobilization results in excellent cosmesis and a low complication rate. This technique is especially well suited to patients with prior operations or deficient preputial skin. Using the native urethra with its blood supply is our preferred method of repairing distal and mid shaft hypospadias with chordee.
修复中下段尿道下裂有多种选择。报道的并发症包括美容效果差、持续出现阴茎下弯、尿道口狭窄和瘘管。我们假设推进完整的固有尿道将有助于纠正阴茎下弯并将并发症最小化。
我们回顾性分析了 2003 年 7 月至 2009 年 5 月期间所有 248 例尿道下裂修复术的记录，并确定了年龄小于 18 岁的伴有远端或中段尿道下裂的患者，这些患者接受了尿道松解术。记录的结果包括患者满意度、膀胱扫描容积以及瘘管、尿道口狭窄或其他并发症的发生率。
83 例患者符合研究纳入标准，其中 5 例（6%）曾接受过先前失败的尿道下裂手术。尿道下裂部位分别为远端、中段和巨大包皮完整的龟头前型，分别为 69 例（83.1%）、11 例（13.3%）和 3 例（3.6%）。80 例（96.4%）患者存在阴茎下弯。阴茎下弯的平均程度为 61.5 度，手术时的平均年龄为 35.7 个月，平均随访时间为 18 个月（范围 0.25 至 79）。家长的反馈中，94%表示满意或非常满意。膀胱扫描容积的平均值为 9.7ml（范围 0 至 81）。1 例（1.2%）患者出现瘘管。无尿道口狭窄病例。
尿道松解术可获得良好的美容效果，且并发症发生率低。该技术特别适用于有既往手术史或包皮皮肤不足的患者。使用带血供的固有尿道是我们修复伴有阴茎下弯的远端和中段尿道下裂的首选方法。
