Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100190, China.
Adv Ther. 2020 Apr;37(4):1425-1435. doi: 10.1007/s12325-020-01254-9. Epub 2020 Feb 15.
The complication rates of proximal hypospadias, especially fistula, are much higher than those of distal hypospadias. Urethral coverage is an effective method for reducing fistulas. Acellular dermal matrix (ADM) has been shown to exhibit structural compatibility and biocompatibility, both of which promote tissue healing.
The present non-randomized study evaluated the efficiency, feasibility, and safety of using ADM for urethroplasty coverage in patients with proximal hypospadias. This prospective study enrolled 35 patients (age range 15-60 months) with proximal hypospadias who underwent operation between September 2018 and March 2019 at Beijing Children's Hospital (Beijing, China). Urethroplasties were performed by the transverse preputial island flap (TPIF) technique. ADM was applied and sutured over the urethroplasty as an additional covering layer. Patient outcomes were compared with those of 80 non-matched control patients with proximal hypospadias who underwent the same procedure, with dartos as a covering layer.
During a median follow-up of 11.56 months (range 9-15 months), urethral fistula occurred in six patients (17.1%) in the ADM group and 28 patients (35%) in the dartos group. Superficial wound infection was observed in six patients (17.1%) in the ADM group and 10 patients (12.5%) in the dartos group. One patient in the ADM group had diverticulum, compared with five patients (6.25%) in the dartos group. Meatal stenosis and urethral stricture were observed in four patients (11.4%) in the ADM group and six patients (7.5%) in the dartos group; all of these complications were treated conservatively. No glans dehiscence was observed in either group.
Use of ADM may be a safe and efficient covering technique to provide an additional coverage layer for proximal hypospadias repair, thereby reducing the incidence of fistula formation, especially among patients who have poor-quality covering materials.
近端尿道下裂，尤其是瘘的并发症发生率远高于远端尿道下裂。尿道覆盖是减少瘘的有效方法。脱细胞真皮基质 (ADM) 已显示出结构相容性和生物相容性，这两者都促进组织愈合。
本非随机研究评估了在近端尿道下裂患者中使用 ADM 进行尿道成形术覆盖的效率、可行性和安全性。这项前瞻性研究纳入了 2018 年 9 月至 2019 年 3 月在北京儿童医院（中国北京）接受手术的 35 例（年龄 15-60 个月）近端尿道下裂患者。尿道成形术采用横形包皮岛状皮瓣（TPIF）技术。将 ADM 用作附加覆盖层覆盖在尿道成形术上。将患者的结果与 80 例接受相同手术但使用腹侧筋膜作为覆盖层的近端尿道下裂非匹配对照患者的结果进行比较。
在中位随访 11.56 个月（9-15 个月）期间，ADM 组中有 6 例（17.1%）发生尿道瘘，而腹侧筋膜组中有 28 例（35%）发生。ADM 组中有 6 例（17.1%）发生浅表伤口感染，而腹侧筋膜组中有 10 例（12.5%）发生。ADM 组中有 1 例发生憩室，而腹侧筋膜组中有 5 例（6.25%）发生。ADM 组中有 4 例（11.4%）发生尿道口狭窄，而腹侧筋膜组中有 6 例（7.5%）发生尿道狭窄；所有这些并发症均经保守治疗。两组均未发生龟头裂开。
ADM 的使用可能是一种安全有效的覆盖技术，可为近端尿道下裂修复提供附加的覆盖层，从而降低瘘形成的发生率，特别是在覆盖材料质量较差的患者中。
