Huang Li-Qu, Guo Yun-Fei, Ge Zheng, Lu Ru-Gang, Deng Yong-Ji, Ma Geng, Chen Fang
Department of Urology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, Jiangsu, China.
Department of Urology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China.
Int Urol Nephrol. 2017 Dec;49(12):2091-2097. doi: 10.1007/s11255-017-1690-z. Epub 2017 Sep 15.
The study aimed to evaluate the new modification of the Duckett technique in decreasing the incidence of urethral strictures for urethral plate transected hypospadias and also explored its clinical application.
Thirty-three patients (aged 7 months to 12 years, mean age 2.8 years) who underwent repair of primary hypospadias using the new one-stage urethroplasty were enrolled. Clinical data, including cosmetic and its complications, and uroflowmetry data were documented. Uroflowmetry data of 19 patients who underwent Duckett urethroplasty were used as a comparison.
The length of the urethral defect ranged from 2.5 to 5.0 cm. The postoperative follow-up was 14-30 months. Ten patients (30.3%) had fistulas; no patients had strictures or diverticula. All ten fistulas were small (<0.5 cm) and repaired with fistula repairing operation. The appearance of the penis remained satisfactory, and the meatus was located in the normal anatomic position. Among 17 patients who underwent uroflowmetry, all patients were bell-shaped or platforms, and Q was 7.37 ± 2.45 ml/s. Compared with 14 of 19 patients who underwent Duckett urethroplasty, the urethral function achieved with new one-stage urethroplasty was significantly better (p < 0.05).
The incidence of strictures was dramatically lowered in patients with proximal hypospadias. Small fistulas are common complications and can be repaired easily. Based on the uroflow pattern results, the quality of neourethra and function of it were better than Duckett urethroplasty. These preliminary results suggested that the modified procedure seems to be reliable and can be a suitable option for proximal hypospadias.
本研究旨在评估改良的达克特技术在降低尿道板横断型尿道下裂尿道狭窄发生率方面的效果，并探讨其临床应用。
纳入33例（年龄7个月至12岁，平均年龄2.8岁）采用新型一期尿道成形术修复原发性尿道下裂的患者。记录临床资料，包括外观及其并发症，以及尿流率数据。将19例行达克特尿道成形术患者的尿流率数据作为对照。
尿道缺损长度为2.5至5.0厘米。术后随访14至30个月。10例患者（30.3%）出现瘘管；无患者出现狭窄或憩室。所有10例瘘管均较小（<0.5厘米），通过瘘管修复手术修复。阴茎外观仍令人满意，尿道口位于正常解剖位置。在17例行尿流率检查的患者中，所有患者的尿流率曲线均为钟形或平台形，Qmax为7.37±2.45毫升/秒。与19例行达克特尿道成形术的患者中的14例相比，新型一期尿道成形术实现的尿道功能明显更好（p<0.05）。
近端尿道下裂患者的狭窄发生率显著降低。小瘘管是常见并发症，易于修复。根据尿流率模式结果，新尿道的质量及其功能优于达克特尿道成形术。这些初步结果表明，改良手术似乎可靠，可作为近端尿道下裂的合适选择。
