Joshi Rakesh S, Bachani Mitesh K, Uttarwar Amit M, Ramji Jaishri I
Department of Pediatric Surgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India.
J Indian Assoc Pediatr Surg. 2015 Apr-Jun;20(2):72-6. doi: 10.4103/0971-9261.151549.
Surgical correction of severe proximal hypospadias represents a significant surgical challenge and single-stage corrections are often associated with complications and reoperations. Bracka two-stage repair is an attractive alternative surgical procedure with superior, reliable, and reproducible results.
To study the feasibility and applicability of Bracka two-stage repair for the severe proximal hypospadias and to analyze the outcomes and complications of this surgical technique.
This prospective study was conducted from January 2011 to December 2013. Bracka two-stage repair was performed using inner preputial skin as a free graft in subjects with proximal hypospadias in whom severe degree of chordee and/or poor urethral plate was present. Only primary cases were included in this study. All subjects received three doses of intra-muscular testosterone 3 weeks apart before first stage. Second stage was performed 6 months after the first stage. Follow-up ranged from 6 months to 24 months.
A total of 43 patients operated for Bracka repair, out of which 30 patients completed two-stage repair. Mean age of the patients was 4 years and 8 months. We achieved 100% graft uptake and no revision was required. Three patients developed fistula, while two had metal stenosis. Glans dehiscence, urethral stricture and the residual chordee were not found during follow-up and satisfactory cosmetic results with good urinary stream were achieved in all cases.
The Bracka two-stage repair is a safe and reliable approach in select patients in whom it is impractical to maintain the axial integrity of the urethral plate, and, therefore, a full circumference urethral reconstruction become necessary. This gives good results both in terms of restoration of normal function with minimal complication.
重度近端型尿道下裂的手术矫正面临重大挑战，单阶段矫正常伴有并发症及再次手术。Bracka两阶段修复术是一种颇具吸引力的替代手术方法，效果卓越、可靠且可重复。
研究Bracka两阶段修复术治疗重度近端型尿道下裂的可行性与适用性，并分析该手术技术的疗效及并发症。
本前瞻性研究于2011年1月至2013年12月进行。对于存在重度阴茎下弯和/或尿道板不佳的近端型尿道下裂患者，采用阴茎内包皮皮肤作为游离移植物进行Bracka两阶段修复术。本研究仅纳入初发病例。所有受试者在第一阶段手术前3周每隔3周接受3剂肌肉注射睾酮。第二阶段在第一阶段术后6个月进行。随访时间为6个月至24个月。
共有43例患者接受了Bracka修复术，其中30例患者完成了两阶段修复。患者的平均年龄为4岁8个月。我们实现了100%的移植物存活，无需进行修复。3例患者出现瘘管，2例出现尿道狭窄。随访期间未发现龟头裂开、尿道狭窄及残留阴茎下弯，所有病例均获得了满意的美容效果及良好的尿流。
对于无法维持尿道板轴向完整性因而有必要进行全周尿道重建的特定患者，Bracka两阶段修复术是一种安全可靠的方法。该方法在恢复正常功能且并发症最少方面均取得了良好效果。
