Nerli Rajendra B, Guntaka Ajaykumar K, Patil Ranjeet A, Patne Pravin B
Department of Urology, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
Afr J Paediatr Surg. 2014 Apr-Jun;11(2):105-8. doi: 10.4103/0189-6725.132789.
The most commonly performed operation to repair distal hypospadias is the Tubularised incised plate (TIP) repair. The key step is midline incision of the urethral plate, which widens a narrow plate and converts a flat into a deep plate groove, ensuring a vertical, slit neomeatus and a normal-calibre neourethra. At times in cases of proximal hypospadias, the urethral plate is very narrow and needs to be augmented or substituted for further tubularisation. We report our experience with primary single stage dorsal inlay urethroplasty using preputial skin grafts.
Children with proximal hypospadias with a narrow urethral plate formed the study group. Children needing transection of the urethral plate, having undergone circumcision/hypospadias repair previously or having an inadequate prepuce was excluded.
Twelve children with a mean age of 48.83 months underwent primary dorsal inlay preputial graft urethroplasty for proximal hypospadias with a very narrow urethral plate. At an average follow-up of 42.16 months, 2 (16.66%) children had a breakdown of ventral shaft skin. None of the children had meatal stenosis, and none of these 12 children developed urethrocutaneous fistula.
Primary dorsal inlay inner preputial graft urethroplasty successfully fulfills all traditional hypospadias repair criteria. It offers a viable, safe, rapid and easy option in the management of proximal hypospadias with a narrow urethral plate.
修复远端尿道下裂最常用的手术是管状切开包皮板（TIP）修复术。关键步骤是尿道板的中线切开，这会扩宽狭窄的尿道板并将扁平的尿道板转变为深的板状沟，确保尿道口垂直、呈裂隙状且新尿道管径正常。有时在近端尿道下裂病例中，尿道板非常狭窄，需要进行增宽或替代以进一步形成管道。我们报告了使用包皮皮肤移植进行一期原发性背侧镶嵌尿道成形术的经验。
尿道板狭窄的近端尿道下裂患儿组成研究组。排除需要横断尿道板、既往已行包皮环切术/尿道下裂修复术或包皮不足的患儿。
12名平均年龄为48.83个月的患儿因近端尿道下裂且尿道板非常狭窄接受了一期原发性背侧镶嵌包皮移植尿道成形术。平均随访42.16个月时，2名（16.66%）患儿出现腹侧阴茎皮肤裂开。所有患儿均未发生尿道口狭窄，这12名患儿中也均未出现尿道皮肤瘘。
一期原发性背侧镶嵌包皮内移植尿道成形术成功满足了所有传统尿道下裂修复标准。它为治疗尿道板狭窄的近端尿道下裂提供了一种可行、安全、快速且简便的选择。
