Helmy Tamer E, Ghanem Wael, Orban Hesham, Omar Helmy, El-Kenawy Mahmoud, Hafez Ashraf T, Dawaba Mohammed
Urology and Nephrology Center, Mansoura University, Egypt.
Urology and Nephrology Center, Mansoura University, Egypt.
J Pediatr Surg. 2018 Aug;53(8):1461-1463. doi: 10.1016/j.jpedsurg.2018.03.019. Epub 2018 Mar 21.
To detect whether grafting the incised plate during Snodgrass repair would improve outcome.
Sixty patients with primary distal hypospadias were included. Patients were equally randomized using closed envelop method to either Snodgrass or grafted tubularized incised plate repair (GTIP). All operations were performed by a single surgeon. All intaroperative data were recorded. All patients were followed up for 1 year. Success was defined as slit shaped meatus at the tip of the glans with no stenosis, fistula or diverticulum.
All 60 patients were evaluated at 1 year of follow-up. Mean age at surgery was 40±15months. Both groups were comparable as regard to patients' age, meatus location, length and width and depth of urethral plate and glans width. Success was documented in 29/30 patients (96.7%) in the Snodgrass group. The only complication was meatal stenosis in one patient, whereas success was documented in 28/30 patients (93.3%) in the GTIP group. The two failures were secondary to partial glans dehiscence. Success rate was not statistically different. Flow rate data at 1 year showed insignificant difference between both groups as regards Q-max and voiding time. The only statistically significant difference between both groups was a longer operative time 106±12min in the GTIP group compared to only 77±9 for the Snodgrass group (p = 0.005).
Snodgrass and GTIP techniques for primary distal hypospadias repair have similar outcome. With a significantly shorter operative time, Snodgrass repair remains the first choice for primary distal hypospadias repair.
Prospective randomized study.
Level I.
检测在Snodgrass修复术中移植切开的尿道板是否会改善治疗效果。
纳入60例原发性远端尿道下裂患者。采用封闭信封法将患者随机分为Snodgrass组或移植管状化切开尿道板修复术（GTIP）组，每组各30例。所有手术均由同一外科医生完成。记录所有术中数据。所有患者随访1年。成功定义为龟头顶端尿道口呈裂隙状，无狭窄、瘘管或憩室。
60例患者均获得1年随访。手术时的平均年龄为40±15个月。两组患者在年龄、尿道口位置、尿道板长度及宽度和深度以及龟头宽度方面具有可比性。Snodgrass组29/30例患者（96.7%）治疗成功，唯一的并发症是1例患者出现尿道口狭窄；GTIP组28/30例患者（93.3%）治疗成功，2例失败均继发于部分龟头裂开。两组成功率无统计学差异。1年时的尿流率数据显示，两组在最大尿流率（Q-max）和排尿时间方面无显著差异。两组之间唯一具有统计学意义的差异是，GTIP组手术时间较长，为106±12分钟，而Snodgrass组仅为77±9分钟（p = 0.005）。
Snodgrass术式和GTIP术式修复原发性远端尿道下裂的效果相似。由于手术时间明显较短，Snodgrass修复术仍是原发性远端尿道下裂修复的首选术式。
前瞻性随机研究。
I级。
