Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3rd Floor Wood Center, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3rd Floor Wood Center, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
J Pediatr Urol. 2016 Aug;12(4):196.e1-5. doi: 10.1016/j.jpurol.2016.05.002. Epub 2016 May 26.
Hypospadias surgery is a humbling art form. Although outcomes with distal hypospadias are favorable, recent publications have suggested that the complication rates are much higher than previously anticipated for proximal hypospadias. The present review examined the literature concerning proximal hypospadias, to explore some of the inadequacies and identify some of the reasons behind these shortfalls in the reported data.
A systematic review of the published literature was conducted using keywords relevant to proximal hypospadias and long-term outcomes.
The literature for hypospadias was reviewed, and outcomes for distal vs proximal variants were compared. The quality of the literature for proximal hypospadias was examined, and the shortcomings that led to underreporting of the surgical outcomes were identified. Special focus was on the lack of standardized documentation, the subsequent inability to objectify the severity of the phenotype, and the underestimation of complications due to lack of long-term follow-up. There was also a great deal of variability in the utilized techniques, and the literature was filled with small case series from single institutions. To enable scientific assessment of outcomes, it is proposed that the following be implemented: acceptance and incorporation of standardized phenotype assessment scores in the pre-operative period, objective intraoperative hypospadias characterization, and postoperative score assessment.
Treatment of proximal hypospadias is much less successful than the distal variant. A specialty wide commitment to standardize the hypospadias language is required to make advancement in surgical outcomes. Boys need to be followed through puberty into adulthood, and honest reporting of outcomes must be discussed so that surgical techniques for this complicated disease process can be advanced.
尿道下裂手术是一门令人谦逊的艺术。尽管远端尿道下裂的治疗效果良好，但最近的研究表明，近端尿道下裂的并发症发生率远高于预期。本综述检查了有关近端尿道下裂的文献，探讨了一些不足之处，并确定了导致报告数据存在这些缺陷的部分原因。
使用与近端尿道下裂和长期结果相关的关键词，对已发表的文献进行系统综述。
对尿道下裂文献进行了综述，并比较了远端和近端变体的结果。检查了近端尿道下裂文献的质量，并确定了导致手术结果漏报的不足之处。特别关注缺乏标准化记录、随后无法客观评估表型严重程度以及由于缺乏长期随访而低估并发症的问题。所采用的技术也存在很大差异，文献中充斥着来自单一机构的小病例系列。为了能够对结果进行科学评估，建议采用以下方法：在术前阶段接受并纳入标准化表型评估评分、客观的术中尿道下裂特征描述以及术后评分评估。
近端尿道下裂的治疗效果远不如远端变体。需要整个专业领域致力于标准化尿道下裂术语，以提高手术结果。男孩需要在青春期和成年期进行随访，并且必须讨论诚实报告结果的问题，以便能够推进这种复杂疾病过程的手术技术。
