González Ricardo, Lingnau Anja, Ludwikowski Barbara Magda
Pediatric Surgery and Urology, Kinder- und Jugendkrankenhaus AUF DER BULT, Hanover, Germany.
Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany.
Front Pediatr. 2018 Feb 8;6:19. doi: 10.3389/fped.2018.00019. eCollection 2018.
To report current results of preputial flap onlay urethroplasty using the principle of the total preputial flap (TPF) for the one-stage repair of mid- and proximal hypospadias.
This study was a retrospective chart review of patients in a prospectively kept database of all hypospadias operations performed at two institutions from January 1 2011 to August 2017. Inclusion criteria: all patients who underwent hypospadias repair using a preputial only flap urethroplasty based on the principle of the TPF. Demographic data, duration of follow-up, complications, and reoperations were recorded. A successful result was considered to be a straight penis, a glanular meatus, and absence of voiding symptoms. Whenever possible an uroflow was obtained during the follow-up visits.
Forty-nine children met the inclusion criteria. All patients had marked penile curvature. Three patients had chromosomal abnormalities. The mean age at the time of surgery was 22 months (11-110) and the mean duration of follow-up 23.4 months (1-79). In 48 cases, the urethral plate could be preserved without dividing it. The penile curvature was corrected with chordectomy alone in 10 patients, 38 required a dorsal plication of the tunica albuginea, and 1 required an additional ventral dermal graft. In 38 patients (77.5%), the initial operation was successful, and no further operations were needed. There were eight urethrocutaneous fistulas, three dehiscences of the glans approximation. One patient suffered a wound infection and partial loss of the flap.
One-stage repair of mid- and proximal hypospadias preserving the urethral plate and using a TPF for the urethroplasty and coverage of the ventral penis is successful in 77.5% of cases. Complications in the remaining patients were easily managed or did not require treatment. Compared to a planned two-stage approach, the technique described in this report resulted in significantly fewer procedures till complete resolution of the problem.
报告采用全包皮瓣（TPF）原则进行包皮瓣覆盖尿道成形术一期修复中、近端尿道下裂的当前结果。
本研究是一项回顾性图表审查，对2011年1月1日至2017年8月在两家机构进行的所有尿道下裂手术的前瞻性保存数据库中的患者进行分析。纳入标准：所有基于TPF原则采用仅包皮瓣尿道成形术进行尿道下裂修复的患者。记录人口统计学数据、随访时间、并发症和再次手术情况。成功的结果定义为阴茎伸直、尿道口位于龟头且无排尿症状。随访时尽可能获取尿流率。
49名儿童符合纳入标准。所有患者均有明显的阴茎弯曲。3例患者有染色体异常。手术时的平均年龄为22个月（11 - 110个月），平均随访时间为23.4个月（1 - 79个月）。48例患者中，尿道板可在不切断的情况下保留。10例患者仅通过白膜切除术矫正阴茎弯曲，38例需要进行白膜背侧折叠，1例需要额外的腹侧真皮移植。38例患者（77.5%）初次手术成功，无需进一步手术。有8例尿道皮肤瘘，3例龟头愈合裂开。1例患者发生伤口感染，皮瓣部分坏死。
保留尿道板并采用TPF进行尿道成形术及覆盖阴茎腹侧的中、近端尿道下裂一期修复在77.5%的病例中是成功的。其余患者的并发症易于处理或无需治疗。与计划的两期手术方法相比，本报告中描述的技术在问题完全解决之前所需的手术显著减少。
