Marte Antonio, Pintozzi Lucia
Department of Pediatric Surgery, University of Campania Luigi Vanvitelli, Naples.
Pediatr Med Chir. 2017 Jun 23;39(2):151. doi: 10.4081/pmc.2017.151.
The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass) procedure, 23 were selected between January 2013 and January 2016 (19.1%). This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2). No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25th percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique.
本研究的目的是通过尿流率测定，验证管状近端切开板技术在选定的远端/中段尿道下裂病例中的有效性、可行性和功能结果。在计划接受TIP（或Snodgrass）手术的120例患者中，2013年1月至2016年1月期间选择了23例（19.1%）。该病例系列包括16例远端尿道下裂患者和7例中段尿道下裂患者。手术时的平均年龄为2.9岁。纳入标准为腺体沟深且宽以及近端尿道板狭窄。手术按照Snodgrass所述进行，但尿道板的切口，包括黏膜和黏膜下组织，仅在近端进行，即在原尿道口和腺体沟之间，在任何情况下都不延伸至板的全长。术后留置Foley导尿管4至7天。当患者年龄在2.5至5.7岁之间（平均年龄3.11岁，平均随访1.8年，体表面积2）时进行尿流率测定。无患者出现瘘管或围手术期并发症。在尿流率测定时，18例患者的值高于第25百分位数，5例显示临界流量。该组所有患者均保持稳定，无泌尿症状。在选定病例中，管状近端切开板在治疗中段近端尿道下裂方面产生了令人满意的美容和功能结果。需要进行长期随访研究以作进一步评估。患者选择对该技术的成功至关重要。
