处理近端型尿道下裂的挑战：17 年单中心经验。

Challenges in managing proximal hypospadias: A 17-year single-center experience.

机构信息

Department of Paediatric Urology and Paediatric Surgery, The Royal London Hospital, London, United Kingdom.

出版信息

J Pediatr Surg. 2019 Oct;54(10):2125-2129. doi: 10.1016/j.jpedsurg.2019.04.019. Epub 2019 Apr 30.

DOI:10.1016/j.jpedsurg.2019.04.019

PMID:31079867

Abstract

BACKGROUND

There are only a few publications in the medical literature reporting on complication rates in proximal hypospadias surgery, particularly with regard to long-term follow-up.

METHODS

Over a 17.5-year period, we operated 100 patients with penoscrotal, scrotal and perineal hypospadias. Sixty-four had a single-stage repair, including 15 who received a buccal mucosa inlay "Snodgraft" repair. Thirty-six had a two-stage Bracka repair of which 19 received buccal or lower lip grafts and 17 had preputial grafts. Overall, 34 patients received buccal grafts. The median follow-up was eight years (range 1-16 years). Three patients were operated for residual chordee years later.

RESULTS

Urethral fistulae occurred in a total of 26/100 (26.0%) cases, meatal stenosis in 16/100 (16.0%), wound breakdown in six (6.0%) and graft failure in one (1.0%). The fistula rate after the single-stage approach was 15/64 (23.4%), whereas it was 11/36 (30.6%) following two-stage repair (P = 0.4811).

CONCLUSIONS

Proximal hypospadias remains a challenging condition to treat. It is possible to perform a single-stage repair in 64.0% of cases. This brings down the median number of operations to only two. Lower lip grafts were used in 34.0% but are now used in redo-surgeries only. Our fistula rate was 26.0% but has decreased significantly in recent years.

LEVEL OF EVIDENCE

Level III.

摘要

背景

仅有少数医学文献报道了近端尿道下裂手术的并发症发生率，特别是在长期随访方面。

方法

在 17.5 年的时间里，我们为 100 名患有阴茎阴囊型、阴囊型和会阴型尿道下裂的患者进行了手术。64 例患者接受了一期修复，其中 15 例接受了颊黏膜镶嵌“Snodgraft”修复。36 例患者接受了两期 Bracka 修复，其中 19 例接受了颊黏膜或下唇移植物，17 例接受了包皮移植物。总共，34 例患者接受了颊黏膜移植物。中位随访时间为 8 年（范围 1-16 年）。3 例患者在数年后因残余尿道下弯而再次手术。