Schlomer Bruce J
Department of Urology, University of Texas Southwestern, 2350 Stemmons Freeway, Suite D-4300, MC F4.04, Dallas, TX, 75207, USA.
Curr Urol Rep. 2017 Feb;18(2):13. doi: 10.1007/s11934-017-0659-x.
The first stage of a 2-stage proximal hypospadias repair involves division of the urethral plate and correction of any residual ventral penile curvature (VPC). Options to correct residual VPC include dorsal corporal shortening or ventral corporal lengthening techniques. This review discusses these options and suggests an approach to management.
Recent reports of 2-stage proximal hypospadias repairs indicate low rates of recurrent VPC with either dorsal corporal shortening or ventral corporal lengthening. Dorsal corporal shortening with dorsal plication may be preferentially used for mild to moderate residual VPC after division of urethral plate and ventral corporal lengthening reserved for severe residual VPC. Ventral corporal lengthening with grafts has been associated with urethroplasty complications after the second stage hypospadias surgery. Ventral corporal lengthening with relaxing incisions of corpora has been reported, but concerns about adverse effects require longer term studies. Little guidance exists to choose the best technique for VPC correction during first stage hypospadias repair after division of urethral plate. Reported literature suggests good results with dorsal plication techniques and ventral corporal lengthening. A practical approach is to use dorsal plication techniques for mild to moderate residual VPC after division of urethral plate (<45°) and reserve ventral corporal lengthening for severe residual VPC (>45°).
两期近端尿道下裂修复的第一阶段包括尿道板离断及纠正任何残留的阴茎腹侧弯曲（VPC）。纠正残留VPC的方法包括阴茎背侧海绵体缩短或阴茎腹侧海绵体延长技术。本综述讨论了这些方法，并提出了一种处理方法。
近期关于两期近端尿道下裂修复的报道表明，采用阴茎背侧海绵体缩短或阴茎腹侧海绵体延长技术，VPC复发率均较低。阴茎背侧海绵体缩短联合背侧折叠术可优先用于尿道板离断后轻度至中度的残留VPC，而阴茎腹侧海绵体延长术则留用于严重的残留VPC。采用移植物进行阴茎腹侧海绵体延长与二期尿道下裂手术后的尿道成形术并发症有关。有报道采用阴茎海绵体松弛切口进行阴茎腹侧海绵体延长，但对其不良反应的担忧需要进行长期研究。在尿道板离断后的第一期尿道下裂修复中，对于选择最佳的VPC纠正技术几乎没有指导意见。报道的文献表明，背侧折叠技术和阴茎腹侧海绵体延长术均有良好效果。一种实用的方法是，对于尿道板离断后轻度至中度的残留VPC（<45°）采用背侧折叠技术，而对于严重的残留VPC（>45°）则采用阴茎腹侧海绵体延长术。
