Aritonang Johannes, Rodjani Arry, Wahyudi Irfan, Situmorang Gerhard Reinaldi
Department of Urology, Cipto Mangunkusumo General Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Res Rep Urol. 2020 Oct 16;12:487-494. doi: 10.2147/RRU.S266886. eCollection 2020.
Chordee correction, urethroplasty, and tissue reconstruction are performed to correct and retain standard functionality of the penis in hypospadias. Conventional reconstruction techniques, such as onlay island flap and the dorsal inlay graft, can be performed based on the classification of hypospadias. However, the outcomes and complication rates have not been widely studied. Thus, we aimed to provide preliminary evidence regarding the efficacy and safety of both approaches in hypospadias reconstruction.
A prospective study with two time evaluations of 14 and 180 days post-operatively was performed at the Urology outpatient clinic from October 2014 to September 2019. A proportion comparison of success rate, time to the complication, operation time, catheterization duration, uroflowmetry parameter post-surgery, and mean scores comparison of PPPS were measured as the intended outcomes.
In a total of 59 pediatric hypospadias, patients who had undergone reconstruction are included in this study. Higher subjects' age and severe chordee severity were more common in the dorsal inlay graft group (age=7.50 [1-26] months; severe chordee 45.8%) compared to the onlay island flap group (age=4.0 [1-67] months; severe chordee 31.4%), both groups showed similar satisfaction regarding meatal shape and position (=0.618), glands shape (=0.324), penile skin shape (=0.489), and general cosmetic appearance (=0.526). Complication occurrence and time to complication duration of both groups were also not statistically significant (=0.464 and =0.413). There are no significant differences in Q, Q, voided volume, and PVR of both groups (=0.125, 0.136, 0.076, 0.260, respectively). Significant differences in operation times and catheterization duration are found in this study (<0001).
Outcome evaluation regarding functional, complication and patient satisfaction comparing onlay flap and dorsal inlay graft for hypospadias patients is scarce. This study found that both procedures can be considered safe with comparable incidence of complications.
阴茎下弯矫正、尿道成形术和组织重建用于矫正并保留阴茎下裂患者阴茎的标准功能。传统的重建技术，如覆盖岛状皮瓣和背侧嵌入移植术，可根据阴茎下裂的分类进行操作。然而，其疗效和并发症发生率尚未得到广泛研究。因此，我们旨在提供关于这两种方法在阴茎下裂重建中有效性和安全性的初步证据。
2014年10月至2019年9月在泌尿外科门诊进行了一项前瞻性研究，术后14天和180天进行两次评估。测量成功率、并发症发生时间、手术时间、导尿持续时间、术后尿流率参数的比例比较以及阴茎外观患者满意度评分比较作为预期结果。
本研究共纳入59例接受重建手术的小儿阴茎下裂患者。与覆盖岛状皮瓣组（年龄=4.0[1-67]个月；重度阴茎下弯31.4%）相比，背侧嵌入移植组（年龄=7.50[1-26]个月；重度阴茎下弯45.8%）患者年龄较大且重度阴茎下弯更为常见。两组在尿道口形状和位置（=0.618）、龟头形状（=0.324）、阴茎皮肤形状（=0.489）和总体外观（=0.526）方面的满意度相似。两组的并发症发生率和并发症持续时间也无统计学差异（=0.464和=0.413）。两组的Q、Q、排尿量和残余尿量均无显著差异（分别为=0.125、0.136、0.076、0.260）。本研究发现手术时间和导尿持续时间存在显著差异（<0.001）。
关于阴茎下裂患者使用覆盖皮瓣和背侧嵌入移植术的功能、并发症及患者满意度的结果评估较少。本研究发现这两种手术均可认为是安全的，并发症发生率相当。
