Rampersad Rajay, Nyo Yoke Lin, Hutson John, O'Brien Mike, Heloury Yves
Department of Paediatric Urology, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
Pediatr Surg Int. 2017 Oct;33(10):1131-1137. doi: 10.1007/s00383-017-4151-y. Epub 2017 Aug 30.
The purpose of the study was to determine if there were differences in the complication rates between foreskin reconstruction (FR) and circumcision (CIRC) in distal hypospadias repairs. The primary outcomes were urethrocutaneous fistula (UF) and dehiscence.
The data of distal hypospadias operated between 2005 and 2013 were retrospectively reviewed. The inclusion criteria were any distal hypospadias repair that required an urethroplasty. The exclusion criteria were follow-up <1 year, redo procedures, chordee greater than 20°, and incomplete data. Univariate and multivariate analysis was performed on the results.
213 patients were included (95 FR and 118 CIRC). The 2 groups were comparable for age at surgery 19.32 months in FR and 14.25 months in CIRC. Mathieu repair was more common in FR (47/95-49.47%) than in CIRC (45/118-38.14%). The total subsequent procedures required were 23 in FR and 57 in CIRC. The incidence of UF was 6.3% (6/95) in FR and 27.1% (32/118) in CIRC (p < 0.001, OR 5.52, 95% CI 2.2-13.9). Complete dehiscence rates were 3.16% (3/95) FR vs 11.02% (13/118) for CIRC (p = 0.037, OR 3.8, 95% CI 1.05-13.74). The incidence of patients requiring reoperation was 18.9% (18/95) in FR versus 45.8% (54/118) in CIRC (p < 0.001, OR 3.61, 95% CI 1.93-6.76).
Foreskin Reconstruction conferred a significantly lower rate of complications, particularly the UF rate, dehiscence rate, and number of patients that required reoperation. Our rate of complications in the CIRC group is much higher than other published data.
本研究旨在确定远端尿道下裂修复术中包皮重建术（FR）与包皮环切术（CIRC）之间的并发症发生率是否存在差异。主要结局指标为尿道皮肤瘘（UF）和裂开。
回顾性分析2005年至2013年间接受手术治疗的远端尿道下裂患者的数据。纳入标准为任何需要进行尿道成形术的远端尿道下裂修复术。排除标准为随访时间<1年、再次手术、阴茎下弯大于20°以及数据不完整。对结果进行单因素和多因素分析。
共纳入213例患者（95例行FR，118例行CIRC）。两组患者手术时的年龄具有可比性，FR组为19.32个月，CIRC组为14.25个月。Mathieu修复术在FR组（47/95 - 49.47%）比在CIRC组（45/118 - 38.14%）更为常见。FR组总共需要进行23次后续手术，CIRC组为57次。FR组UF的发生率为6.3%（6/95），CIRC组为27.1%（32/118）（p < 0.001，OR 5.52，95% CI 2.2 - 13.9）。FR组完全裂开率为3.16%（3/95），CIRC组为11.02%（13/118）（p = 0.037，OR 3.8，95% CI 1.05 - 13.74）。FR组需要再次手术的患者发生率为18.9%（18/95），CIRC组为45.8%（54/118）（p < 0.001，OR 3.61，95% CI 1.93 - 6.76）。
包皮重建术的并发症发生率显著较低，尤其是UF发生率、裂开率以及需要再次手术的患者数量。我们CIRC组的并发症发生率远高于其他已发表的数据。
