Paediatric Surgery Unit, Polyclinic G.B. Morgagni, Catania, Italy.
Paediatric Surgery Unit, Polyclinic G.B. Morgagni, Catania, Italy.
J Pediatr Urol. 2020 Feb;16(1):69.e1-69.e5. doi: 10.1016/j.jpurol.2019.10.015. Epub 2019 Oct 23.
To determine the outcome of distal hypospadias repairs performed using bipolar diathermy (BD) for all the dissection.
Retrospective review of 310 patients undergoing distal hypospadias (264 subcoronal/distal penile and 46 coronal/glanular) over a 11-year period. Median age at surgery was 2.0 years (range 9 months-15 years). Caudal anesthesia was performed in all patients. All children underwent an in situ tubularization of the urethral plate, which was combined with midline incision of the plate in 30 (10%). Preputial reconstruction was performed in 303 (98%) patients. BD forceps was used for coagulation and for all the dissection including skin incision, elevation of glans wings, separation of the corpus spongiosum from the corpora cavernosa, and urethral plate incision, when deemed appropriate. The authors assessed surgical complications and cosmetic results. The latter using the hypospadias objective score (HOSE), with a score ≥ 14 considered as acceptable.
The average operative time was 70 min. There was no postoperative bleeding or hematomas that required surgical intervention. There were no wound infections or necrosis. Complications occurred in 37 patients (11.9%). Urethral fistula formation was the commonest (n = 18). Postoperative persistent preputial swelling occurred in 3.5% of cases. Two hundred twelve patients (90.6%) had a HOSE score ≥ 14, and no patient required revision surgery for skin problems after a median follow-up of 8.1 (range 1.2-13.1) years.
The study is limited by its retrospective nature and by the fact that a number of other pre-operative, intra-operative, and postoperative variables can affect outcome.
Bipolar diathermy can be safely used for distal hypospadias repairs. It allowed careful control of intra-operative bleeding and also clear visualization of tissue planes. Complication rate overall compares favorably with the literature, and cosmetic results were satisfactory.
本研究旨在探讨使用双极电凝（BD）进行所有解剖操作在治疗远端型尿道下裂中的治疗效果。
本研究回顾性分析了 11 年间 310 例远端型尿道下裂（264 例冠状沟型/阴茎型，46 例龟头型/冠状沟型）患者的临床资料。患者中位年龄为 2.0 岁（9 个月-15 岁）。所有患者均行鞍麻。所有患儿均行原位管状化尿道板成形术，其中 30 例（10%）联合尿道板中线切开。303 例（98%）患儿行包皮重建。BD 止血钳用于止血和所有解剖操作，包括皮肤切口、掀起龟头翼、分离海绵体与阴茎海绵体以及适当情况下的尿道板切开。作者评估了手术并发症和美容效果。采用尿道下裂客观评分（HOSE）评估后者，评分≥14 分认为可接受。
平均手术时间为 70 分钟。术后无出血或血肿需手术干预。无伤口感染或坏死。37 例（11.9%）患儿出现并发症。最常见的并发症是尿道瘘（n=18）。术后持续包皮肿胀发生率为 3.5%。212 例（90.6%）患者 HOSE 评分≥14 分，中位随访 8.1 年（1.2-13.1 年）后无患者因皮肤问题需行再次手术。
本研究受限于其回顾性特征以及其他一些术前、术中及术后变量可能影响结果的事实。
BD 可安全用于治疗远端型尿道下裂。它可以精细控制术中出血，并清晰显示组织层面。总体并发症发生率与文献报道相当，美容效果满意。
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