Department of Paediatric Surgery, SKIMS, Soura, Srinagar, Jammu and Kashmir, India.
Department of Paediatric Surgery, SKIMS, Soura, Srinagar, Jammu and Kashmir, India.
J Pediatr Urol. 2017 Dec;13(6):633.e1-633.e5. doi: 10.1016/j.jpurol.2017.06.015. Epub 2017 Jul 16.
Hypospadias is a common problem encountered in surgical practice and its repair is challenging because of various complications. Urethro-cutaneous fistula is the most common postoperative complication (incidence of 0-33%). Different types of intermediate protective layers have been used in attempts to decrease UCF formation; however, no single surgical technique is ideal.
The aim of this study was to compare use of dartos fascia and Buck's fascia as intermediate layers in prevention of the formation of UCF.
This was a prospective, comparative study conducted over a period of 2 years from January 2014 to December 2015. Patients with primary hypospadias without or with mild ventral penile curvature were included in the study. Patients were categorised into two groups, A and B, with alternate patients assigned to each group. Patients in group A underwent Snodgrass repair with urethroplasty by two-layer subepithelial closure and dartos tissue as an intermediate layer. Patients in group B underwent a urethral repair followed by Buck's fascia repair as intermediate layer and glanuloplasty after excision of a triangular skin strip on either side of the urethral plate. Patients were followed at regular intervals for a minimum of 6 months and complications were noted.
Over a period of 2 years, 160 patients were included in the study: 80 patients in group A and 80 patients in group B. The age of patients ranged from 1 year to 4.6 years, with a mean age of 1.8 years. Postoperative complications are listed in the summary table.
A protective intermediate layer between the neourethra and the skin can be used to reduce fistula formation. We describe a technique of urethroplasty using Buck's fascia as intermediate layer and glanuloplasty, with excellent results. Buck's fascia over the corpora spongiosum which is deficient ventrally in hypospadias is not completely absent, and can be easily used to cover the neourethra, needs minimal dissection and hence vascularity of tissues is preserved (summary Fig.). We used this Buck's fascia as a second protective layer over the neourethra in an attempt to decrease UCF formation, and compared it with use of dartos fascia. In our study, UCF occurred in 2.5% of patients in the Buck's fascia group and 12.5% of patients in the dartos group, a statistically significant difference. We believe that the native Buck's fascia lateral to spongiosum is a more appropriate, natural, and strong layer to cover the neourethra.
Use of Buck's fascia as an intermediate layer along with glanuloplasty is simple and very effective in preventing UCF formation and glanular dehiscence. We recommend the use of Buck's fascia as an intermediate layer to cover the neourethra to reduce incidence of postoperative complications and improve results.
尿道下裂是外科实践中常见的问题，由于各种并发症，其修复具有挑战性。尿道-皮肤瘘是最常见的术后并发症（发生率为 0-33%）。已经尝试使用不同类型的中间保护层来减少 UCF 的形成；然而，没有一种单一的手术技术是理想的。
本研究旨在比较使用筋膜和Buck's 筋膜作为中间层预防 UCF 形成的效果。
这是一项前瞻性、比较性研究，于 2014 年 1 月至 2015 年 12 月进行了 2 年。本研究纳入了原发性尿道下裂且无或仅有轻度阴茎腹侧弯曲的患者。将患者分为两组，A 组和 B 组，每组交替分配患者。A 组患者接受 Snodgrass 修复术，尿道成形术采用双层黏膜下闭合和筋膜作为中间层。B 组患者行尿道修复术，然后用 Buck's 筋膜作为中间层修复，在尿道板两侧切除一个三角形皮条后行龟头成形术。患者定期随访至少 6 个月，并记录并发症。
在 2 年的时间里，共有 160 名患者纳入研究：80 名患者在 A 组，80 名患者在 B 组。患者年龄 1 岁至 4.6 岁，平均年龄 1.8 岁。术后并发症总结于附表。
在新尿道和皮肤之间使用保护中间层可以减少瘘管形成。我们描述了一种使用 Buck's 筋膜作为中间层和龟头成形术的尿道成形术技术，效果非常好。在尿道下裂中，海绵体的腹侧存在 Buck's 筋膜缺陷，但并非完全缺失，可轻松用于覆盖新尿道，需要的解剖范围小，因此保留了组织的血管（总结图）。我们将这种 Buck's 筋膜作为新尿道的第二层保护，试图减少 UCF 的形成，并将其与筋膜的使用进行了比较。在我们的研究中，Buck's 筋膜组中有 2.5%的患者出现 UCF，筋膜组中有 12.5%的患者出现 UCF，差异有统计学意义。我们认为，海绵体侧的固有 Buck's 筋膜是覆盖新尿道的更合适、自然和强大的层。
使用 Buck's 筋膜作为中间层联合龟头成形术是预防 UCF 形成和龟头裂开的简单而有效的方法。我们建议使用 Buck's 筋膜作为中间层覆盖新尿道，以降低术后并发症的发生率并改善手术效果。
