Karakuş O Z, Ateş O, Tekin A, Hakgüder G, Olguner M, Akgür F M
Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey.
Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey.
J Pediatr Urol. 2014 Jun;10(3):455-8. doi: 10.1016/j.jpurol.2013.10.020. Epub 2013 Nov 20.
Urethrocutaneous fistula is the most common complication of hypospadias repair. Tubularized incised plate urethroplasty (TIPU) has been used for the management of distal fistulas. This study reports the usage of TIPU in the treatment of large penile fistulas.
Between April 2002 and September 2012, 15 patients with large penile fistulas who were managed with TIPU were included in the study. The fistulas were sited along the penile shaft from proximal to distal penile localization. Glanular and coronal fistulas were excluded. The surgical technique was completed according to the standard TIPU technique. The surrounding scar tissue of the fistula was circumferentially excised, and the urethral plate at the level of the fistula was incised to provide performance of loose urethral tubularization. A urethral stent was kept for 5-7 days.
The mean age of the patients was 7.3 ± 3.1 years. Primary operation of these patients was tubularized preputial island flap (n = 6), on-lay preputial island flap (n = 4), and TIPU (n = 5). The sites of the hypospadias fistulas were as follows; penoscrotal (three), mid-penile (eight) and subcoronal (four). Fistulas recurred in two patients after fistula repair. The postoperative follow up of the patients was 12.4 ± 7.7 months.
TIPU may be used safely for the treatment of fistulas after hypospadias repair.
尿道皮肤瘘是尿道下裂修复术后最常见的并发症。管状切开尿道板尿道成形术（TIPU）已用于治疗远端瘘。本研究报告TIPU在治疗大型阴茎瘘中的应用。
2002年4月至2012年9月，15例接受TIPU治疗的大型阴茎瘘患者纳入本研究。瘘沿阴茎干从近端到远端定位。排除龟头和冠状沟瘘。手术技术按照标准TIPU技术完成。瘘周围的瘢痕组织被环形切除，在瘘水平切开尿道板以进行宽松的尿道管状化。留置尿道支架5 - 7天。
患者的平均年龄为7.3±3.1岁。这些患者的初次手术方式为管状化包皮岛状皮瓣（n = 6）、覆盖式包皮岛状皮瓣（n = 4）和TIPU（n = 5）。尿道下裂瘘的部位如下：阴茎阴囊部（3例）、阴茎中部（8例）和冠状沟下（4例）。2例患者瘘修复后复发。患者术后随访时间为12.4±7.7个月。
TIPU可安全用于尿道下裂修复术后瘘的治疗。
