尿道下裂修复术后尿流率的时间变化：一项观察性研究。
Chronological Changes In Uroflowmetry After Hypospadias Repair: An Observational Study.
作者信息
Al Adl Ahmed Mahmoud, Omar Rabea Gomaa, Mohey Ahmed, El Mogy Ahmed Abd El Naeem, El Karamany Tarek Mohammed
机构信息
Urology Department, Faculty of Medicine, Benha University, Benha, Egypt.
出版信息
Res Rep Urol. 2019 Oct 21;11:269-276. doi: 10.2147/RRU.S227601. eCollection 2019.
AIM
Urinary flow after urethroplasty is of paramount importance. The aim of this study is to evaluate the progression of uroflowmetry (UF) parameters after different distal and proximal hypospadias repair techniques.
METHODS
In this cohort study, cases that underwent primary hypospadias repair at our institution between March 2010 and December 2018 were included when uncomplicated, asymptomatic and toilet-trained. UF findings and post void residual were described after each specific technique.
RESULTS
In all, 88 patients were eligible. Time to last UF ranged from 35 to 138 months postoperatively. Significant increase started 36 months after distal tubularized incised plate urethroplasty (TIP) and afterwards than Mathieu technique. While was noticed 24 and 36 months after Onlay technique and proximal TIP, respectively; however, TIP showed steady significant increase atall time intervals. Duckett repair exhibited insignificant change in maximum flow rate (Qmax) values, buccal mucosal graft (BMG) and inner preputial graft (IPG), significant increase in the Qmax values after 6 and 24 months, respectively, then remained steady high. Transposed preputial flap (TPF) showed significant increase at 6-12 months only, then remained steady lower than the other two techniques. Obstructed flow was 37% after distal TIP, 30% after Mathieu, 25% after proximal TIP, 66.7% after Duckett repair, and 33.3% after TPF. There were no obstructed cases after BMG and IPG.
DISCUSSION
Improvement by time varied between techniques. After repair most cases are below the 50th percentile, implying that the reconstructed urethra is not functioning as a normal urethra. Staged repair for proximal hypospadias is preferable to a heroic one-stage procedure.
CONCLUSION
Choice of the surgical technique for hypospadias repair had impact on the improvement of Qmax values. TIP improved 36 months postoperatively. However, for proximal cases staged graft repair had earlier improvement and higher Qmax values than proximal TIP and Onlay techniques.
目的
尿道成形术后的尿流情况至关重要。本研究旨在评估不同远端和近端尿道下裂修复技术后尿流率（UF）参数的变化情况。
方法
在这项队列研究中，纳入了2010年3月至2018年12月期间在本机构接受初次尿道下裂修复且无并发症、无症状并已接受如厕训练的病例。每种特定技术后均描述了UF检查结果及排尿后残余尿量。
结果
总共88例患者符合条件。最后一次UF检查的时间为术后35至138个月。远端管状切开板尿道成形术（TIP）术后36个月开始显著增加，此后比Mathieu技术增加明显。Onlay技术和近端TIP术后分别在24个月和36个月时出现显著增加；然而，TIP在所有时间间隔均显示出持续显著增加。Duckett修复术的最大尿流率（Qmax）值变化不显著，颊黏膜移植（BMG）和包皮内板移植（IPG）分别在术后6个月和24个月时Qmax值显著增加，然后保持稳定高位。移位包皮瓣（TPF）仅在6至12个月时显著增加，然后保持稳定且低于其他两种技术。远端TIP术后梗阻性尿流发生率为37%，Mathieu术后为30%，近端TIP术后为25%，Duckett修复术后为66.7%，TPF术后为33.3%。BMG和IPG术后无梗阻病例。
讨论
不同技术随时间的改善情况各不相同。修复后大多数病例低于第50百分位数，这意味着重建尿道的功能未达到正常尿道水平。对于近端尿道下裂，分期修复优于激进的一期手术。
结论
尿道下裂修复手术技术的选择对Qmax值的改善有影响。TIP术后36个月有所改善。然而，对于近端病例，分期移植修复比近端TIP和Onlay技术改善更早且Qmax值更高。
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