Department of Urology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China.
Department of Urology, Children's hospital Affiliated to Zhengzhou University, Henan, China.
Int Braz J Urol. 2020 Sep-Oct;46(5):772-777. doi: 10.1590/S1677-5538.IBJU.2019.0484.
Transverse preputial island flap urethroplasty (TPIFU) is one of the most frequently performed technique for single-stage repair in proximal hypospadias. It was reported that the subepithelial urethroplasty would obviously decrease urethrocutaneous fistula (UF) complication after proximal TIP. But in the process of TPIFU, it had not been reported yet.
We reviewed our experience to evaluate and compare the effect of continuous eversion suture (CES) versus continuous inversion subepithelial suture (CIS) on complication rates in the TPIFU.
A retrospective review of all patients operated with CES and CIS in our institution between January 2017 and Jun 2017 was performed.
A total of 161 patients were enrolled in the research. Patients were followed up for 1217 months. Total success rate was 73.9% (119/161). No statistically difference was found between the two groups with regard to age of patients (P=0.097), catheter size (P=0.52), time of catheterization (P=0.47), length of neourethra (P=0.20), non-urethral comorbidity (P=0.44) and post-operative infection (P=1.0). The overall postoperative complications had no statistically difference between the two groups (P=0.067). There were no statistically significant differences in the incidence of urethra-cutaneous fistula (UF) (OR=0.07, 95% CI: -0.240.037, P=0.22), urethral diverticulum (UD) (OR=0.026, 95% CI: -0.16-0.056, P=0.323), urethral stricture (US) (OR=0.081, 95% CI: -0.150.15, P=1.0) and breakdown of urethral repair (BU) (OR=0.02, 95% CI: -0.118~-0.044, P=1.0).
The comparison of two group's postoperative complications was feasible because there were no statistically differences among perioperative variables. It seemed as if continuous inversion subepithelial suture would promote healing. However, it indicated that the overall success rate and the incidences of UF, UD, US and BU complications had no statistically difference between groups. It might be accounted for the subtle differences of techniques changing the process of establishing prime and side branches vascularization.
The CIS technique had no significantly different effect on the four complications rates when compared with CES in TPIFU. Thus, CES and CIS could be randomly adopted in TPIFU as personal preference.
横形包皮岛状皮瓣尿道成形术（TPIFU）是治疗近端尿道下裂一期修复最常用的技术之一。有报道称，在近端 TIP 后，皮下尿道成形术可明显降低尿道-皮肤瘘（UF）并发症。但在 TPIFU 过程中，尚未有报道。
我们回顾了我们的经验，以评估和比较连续外翻缝合（CES）与连续反转皮下缝合（CIS）对 TPIFU 并发症发生率的影响。
对 2017 年 1 月至 2017 年 6 月期间在我院采用 CES 和 CIS 治疗的所有患者进行回顾性分析。
共纳入 161 例患者进行研究。患者随访 1217 个月。总成功率为 73.9%（119/161）。两组患者在患者年龄（P=0.097）、导管大小（P=0.52）、置管时间（P=0.47）、新尿道长度（P=0.20）、非尿道合并症（P=0.44）和术后感染（P=1.0）方面无统计学差异。两组术后总体并发症发生率无统计学差异（P=0.067）。尿道-皮肤瘘（UF）（OR=0.07，95%CI：-0.240.037，P=0.22）、尿道憩室（UD）（OR=0.026，95%CI：-0.16-0.056，P=0.323）、尿道狭窄（US）（OR=0.081，95%CI：-0.150.15，P=1.0）和尿道修复破裂（BU）（OR=0.02，95%CI：-0.118~-0.044，P=1.0）的发生率无统计学差异。
对两组术后并发症进行比较是可行的，因为围手术期变量之间无统计学差异。似乎连续反转皮下缝合术会促进愈合。然而，这表明两组在 UF、UD、US 和 BU 并发症的总成功率和发生率方面无统计学差异。这可能是由于技术的细微差异改变了主支和侧支血管化的过程。
与 CES 相比，CIS 技术在 TPIFU 中对四种并发症的发生率没有显著影响。因此，CES 和 CIS 可根据个人喜好随机应用于 TPIFU。
