Faasse Mark A, Liu Dennis B
Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Advocate Children's Hospital, Chicago, IL, USA.
Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Pediatr Urol. 2017 Aug;13(4):354.e1-354.e5. doi: 10.1016/j.jpurol.2017.05.017. Epub 2017 Jun 19.
Complications after primary hypospadias repair often present late, that is, more than 1 year postoperatively. This has important implications for clinical practice and prospective research protocols. Follow-up regimen-or lack thereof-may contribute to delayed diagnosis of complications.
To characterize and compare the follow-up regimens of patients with early and late-presenting urethroplasty complications after primary hypospadias repair, specifically noting the length of time between encounters during which complications emerged.
Boys who underwent repair of urethroplasty complications after hypospadias surgery were identified, and retrospective chart reviews were performed. Late complications were defined by presentation more than 1 year after primary repair; all others were designated as early. We recorded the encounter at which each patient was first noted to have a complication, as well as the last encounter prior to this. Follow-up intervals during which complications emerged were determined. Comparisons of the type of primary repairs, complications, and follow-up regimens (prescribed as well as actual) were performed between patients with early and late complications.
A total of 51 patients underwent repair of 57 hypospadias complications. Eighteen patients (35%) had complications that presented late. Complications after a midshaft/distal hypospadias repair were more likely to present late than complications following a one- or two-stage proximal repair (59% vs. 31% vs. 6%, respectively; p = 0.003). The median interval between encounters during which late complications emerged was 24 months (IQR 16-43), compared with 1.2 (0.7-2.2) months for early-presenting complications (p < 0.001). Eleven of the 18 patients with late complications (61%) had not had an encounter beyond 3 months postoperatively prior to presentation of their complications; only four patients (8%) had a late complication that was unrecognized at a follow-up visit more than 6 months postoperatively (Figure). Patients with late complications had a greater discrepancy between prescribed and actual follow-up intervals, averaging 11 months (p = 0.001).
Late presentation of urethroplasty complications after hypospadias repair is relatively common. There is typically a lengthy follow-up interval during which late complications emerge. Many patients who presented with late complications had not previously been examined beyond the early postoperative period. Adherence to a more structured follow-up regimen that includes a visit outside of the early postoperative period (e.g. routine encounters at 6 months postoperatively) may facilitate earlier detection and reduce late presentation of complications, especially among patients with midshaft or distal primary repairs. Earlier diagnosis would allow secondary procedures to be completed sooner.
一期尿道下裂修复术后并发症往往出现较晚，即术后1年以上。这对临床实践和前瞻性研究方案具有重要意义。随访方案（或缺乏随访方案）可能导致并发症的诊断延迟。
描述并比较一期尿道下裂修复术后尿道成形术并发症早期和晚期出现患者的随访方案，特别注意并发症出现期间两次就诊之间的时间长度。
确定接受尿道下裂手术后尿道成形术并发症修复的男孩，并进行回顾性病历审查。晚期并发症定义为一期修复后1年以上出现；所有其他并发症则指定为早期并发症。我们记录了首次发现每位患者出现并发症的就诊情况，以及在此之前的最后一次就诊情况。确定并发症出现期间的随访间隔。对早期和晚期并发症患者的一期修复类型、并发症和随访方案（规定的以及实际的）进行比较。
共有51例患者接受了57例尿道下裂并发症的修复。18例患者（35%）出现了晚期并发症。阴茎中段/远端尿道下裂修复术后的并发症比一期或二期近端修复术后的并发症更可能出现较晚（分别为59%、31%和6%；p = 0.003）。晚期并发症出现期间两次就诊之间的中位间隔为24个月（四分位间距16 - 43），而早期出现并发症的患者为1.2个月（0.7 - 2.2）（p < 0.001）。18例晚期并发症患者中有11例（61%）在出现并发症之前术后3个月内未进行过就诊；只有4例患者（8%）在术后6个月以上的随访中未发现晚期并发症（图）。晚期并发症患者规定的和实际的随访间隔之间差异更大，平均为11个月（p = 0.001）。
尿道下裂修复术后尿道成形术并发症出现较晚相对常见。通常在较长的随访间隔期间会出现晚期并发症。许多出现晚期并发症的患者在术后早期之后未曾接受过检查。坚持更结构化的随访方案，包括在术后早期之外进行一次就诊（例如术后6个月进行常规就诊），可能有助于更早发现并减少并发症的晚期出现，特别是在阴茎中段或远端一期修复的患者中。更早的诊断将使二次手术能够更快完成。
