Zheng Da-Chao, Yao Hai-Jun, Cai Zhi-Kang, Da Jun, Chen Qi, Chen Yan-Bo, Zhang Ke, Xu Ming-Xi, Lu Mu-Jun, Wang Zhong
Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China.
Asian J Androl. 2015 Jan-Feb;17(1):94-7. doi: 10.4103/1008-682X.137688.
It is still debatable whether single- or two-stage urethroplasty is a more suitable technique for treating hypospadias with severe chordee after urethral plate transection. This retrospective study evaluated these two techniques. A total of 66 patients of proximal hypospadias with severe chordee were divided into two groups according to the techniques they underwent: 32 and 34 patients underwent single-stage (Duckett) or two-stage urethroplasty, respectively. Median ages at presentation were 7.5 years and 11.0 years in single-stage and two-stage repair groups, respectively. Median follow-ups were 28.5 months (20-60 months) and 35 months (18-60 months) in the single-stage and two-stage groups, respectively. The meatus of the neourethra was located at the top of the glans in all patients. No recurrence of chordee was found during follow-up, and all patients or parents were satisfied with the penile length and appearance. Complications were encountered in eight patients in both groups, with no statistically significant differences between the two techniques. The late complication rate of stricture was higher after the single-stage procedure (18.75% vs 0%). The complication rate after single-stage repairs was significantly lower in the prepubescent subgroup (10.52%) than in the postpubescent cohort (46.15%). These results indicate that the urethral plate transection effectively corrects severe chordee associated with proximal hypospadias during the intermediate follow-up period. Considering the higher rate of stricture after single-stage urethroplasty, two-stage urethroplasty is recommended for proximal hypospadias with severe chordee after urethral plate transection.
对于尿道板横断术后治疗重度阴茎下弯的尿道下裂，采用一期还是二期尿道成形术更为合适仍存在争议。本回顾性研究对这两种技术进行了评估。共有66例近端尿道下裂合并重度阴茎下弯的患者，根据所接受的技术分为两组：分别有32例和34例患者接受了一期（Duckett）或二期尿道成形术。一期和二期修复组患者就诊时的中位年龄分别为7.5岁和11.0岁。一期和二期组的中位随访时间分别为28.5个月（20 - 60个月）和35个月（18 - 60个月）。所有患者新尿道外口均位于龟头顶端。随访期间未发现阴茎下弯复发，所有患者或家长对阴茎长度和外观均满意。两组均有8例患者出现并发症，两种技术之间无统计学显著差异。一期手术后狭窄的晚期并发症发生率较高（18.75%对0%）。青春期前亚组一期修复后的并发症发生率（10.52%）显著低于青春期后队列（46.15%）。这些结果表明，在中期随访期间，尿道板横断术能有效矫正与近端尿道下裂相关的重度阴茎下弯。考虑到一期尿道成形术后狭窄发生率较高，对于尿道板横断术后合并重度阴茎下弯的近端尿道下裂，建议采用二期尿道成形术。
