Seo Shogo, Ochi Takanori, Yazaki Yuta, Okawada Manabu, Doi Takashi, Miyano Go, Koga Hiroyuki, Lane Geoffrey J, Yamataka Atsuyuki
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan,
Pediatr Surg Int. 2015 Mar;31(3):297-303. doi: 10.1007/s00383-015-3655-6. Epub 2015 Jan 22.
Soft tissue interposition (STI) during hypospadias repair (HR) purportedly prevents postoperative urethrocutaneous fistula (PUF) by supporting the neourethra. We report our experience.
Data from 243 hypospadias patients treated by a single surgeon from 1997 to 2014 by urethroplasty (UP) with STI (n = 229; UP + STI) and UP without STI (n = 14; UP-STI) were collated prospectively and compared for incidence of PUF. Re-operative UP were excluded.
Hypospadias was distal (n = 55), mid-shaft (n = 59), proximal/penoscrotal (n = 109), scrotal (n = 15), and perineal (n = 5). UP was single-staged in 86, multi-staged in 157; mean age at UP was 3.1 ± 2.4 years. Soft tissue used for STI was prepucial inner dartos fascia (inner dartos: n = 88), ventral dartos fascia (ventral dartos: n = 15), pedicled external spermatic fascia (ESF: n = 84), adipose tissue surrounding the spermatic cord (pericordal: n = 9), scrotal adipose tissue (n = 8), or a combination of tissues (combined: n = 25). Mean follow-up was 6.4 ± 4.6 (range 0.6-16.8) years. Overall incidence of PUF was 10/243 (4.1 %); 7/229 (3.1 %) for UP + STI and 3/14 (21.4 %) in UP-STI (p < 0.05); incidence versus type of hypospadias was 1/55 for distal (1.8 %), 3/59 for mid-shaft (5.1 %), 5/109 for proximal/penoscrotal (4.6 %), 0/15 for scrotal (0 %), and 1/5 for perineal (20 %); incidence versus type of STI was 7/88 for inner dartos, 0/15 for ventral dartos, 0/84 for ESF, 0/9 for pericordal adipose tissue, 0/8 for scrotal adipose tissue, and 0/25 for combined. All PUF were repaired successfully. Satisfaction with penile cosmesis was acceptable (10.3 %) or good (89.7 %) without any testicular complications or scrotal deformity.
STI, especially ESF, would appear to effectively prevent PUF in HR.
尿道下裂修复术（HR）期间的软组织植入（STI）据称通过支撑新尿道来预防术后尿道皮肤瘘（PUF）。我们报告我们的经验。
前瞻性整理了1997年至2014年由单一外科医生采用尿道成形术（UP）并进行STI（n = 229；UP + STI）和未进行STI（n = 14；UP - STI）治疗的243例尿道下裂患者的数据，并比较PUF的发生率。排除再次手术的UP。
尿道下裂为远端型（n = 55）、阴茎体中段型（n = 59）、近端/阴茎阴囊型（n = 109）、阴囊型（n = 15）和会阴型（n = 5）。UP为一期手术的有86例，多期手术的有157例；UP时的平均年龄为3.1±2.4岁。用于STI的软组织为包皮内肉膜筋膜（内肉膜：n = 88）、腹侧肉膜筋膜（腹侧肉膜：n = 15）、带蒂精索外筋膜（ESF：n = 84）、精索周围脂肪组织（精索周围：n = 9）、阴囊脂肪组织（n = 8）或组织组合（组合：n = 25）。平均随访时间为6.4±4.6（范围0.6 - 16.8）年。PUF的总体发生率为10/243（4.1%）；UP + STI组为7/229（3.1%），UP - STI组为3/14（21.4%）（p < 0.05）；PUF发生率与尿道下裂类型的关系为：远端型1/55（1.8%），阴茎体中段型3/59（5.1%），近端/阴茎阴囊型5/109（4.6%），阴囊型0/15（0%），会阴型1/5（20%）；PUF发生率与STI类型的关系为：内肉膜7/88，腹侧肉膜0/15，ESF 0/84，精索周围脂肪组织0/9，阴囊脂肪组织0/8，组合0/25。所有PUF均成功修复。阴茎美容满意度为可接受（10.3%）或良好（89.7%），无任何睾丸并发症或阴囊畸形。
STI，尤其是ESF，似乎能有效预防HR中的PUF。
