Alshammari D, Harper L
Department of Pediatric Surgery and Pediatric Urology, CHU Bordeaux, Bordeaux, France.
Department of Pediatric Surgery and Pediatric Urology, CHU Bordeaux, Bordeaux, France.
J Pediatr Urol. 2021 Feb;17(1):59.e1-59.e8. doi: 10.1016/j.jpurol.2020.10.005. Epub 2020 Oct 19.
Our objective was to present our experience with a novel technique for distal hypospadias repair consisting of deepithelialized glans reconfiguration.
We reviewed the clinical data of all patients who underwent distal hypospadias using Deepithelialized Glans Reconfiguration between January 2015 and December 2019. We noted age at surgery, position of meatus, duration of urethral catheterization and hospitalization, as well as early and late complications. Standard postoperative care included follow-up examination at 1, 6 and 12 months. Successful repair was defined as a patient presenting with a straight penis with an apical meatus, no stricture nor fistula.
Sixty-seven patients were included. Average age at surgery was 12.5 months (6-23 months). All patients presented distal hypospadias (3 glanular, 61 coronal, 3 subcoronal). 36% of patients were operated as day case surgery. No intra-operative complications were recorded. Eleven patients did not complete the designated follow up. They attended the post-operative appointment at six months but not the one-year visit. All patients presented satisfactory urinary streams according to the parents. All parents were satisfied with the cosmetic appearance of their child's penis. Two patients presented with glans dehiscence (3%). The mean HOPE score for the last 10 patients was 47.4 ± 3.2 out of a maximum of 50.
Deepithelialized Glans Reconfiguration is a simple technique with satisfactory results. Though it has similarities with existing techniques, it contains specific aspects not described previously. Contrary to the MAGPI technique, there is no meatal advancement, no rotation of the glans wings, and it is the glans lateral and proximal to the meatus which is approximated in the midline. As opposed to the GAP procedure, there is no closure of the ventral aspect of the urethra. We rely on secondary healing within the glans to reconstruct the missing ventral aspect of the urethra. We reserve this technique for coronal hypospadias with a wide, deep glanular groove. Deepithelialization favours rapid healing of the glans wings on the midline. There is no formal urethroplasty. The limits to this study include lack of long-term (>1 year) follow-up and uroflow. Though careful observation did not identify fistulas, the absence of functional stenosis has to be more clearly evaluated at a later age. Finally, this technique is not suitable for the completely flat glans as it relies on being able to approximate the glans ridges in the midline.
Deepithelialized Glans Reconfiguration is a simple technique which achieves good cosmetic results, without complications associated with meatal or urethral advancement or formal urethroplasty.
我们的目的是介绍一种用于远端尿道下裂修复的新技术，该技术包括去上皮化龟头重建。
我们回顾了2015年1月至2019年12月期间所有采用去上皮化龟头重建术进行远端尿道下裂修复的患者的临床资料。我们记录了手术年龄、尿道口位置、导尿和住院时间，以及早期和晚期并发症。标准的术后护理包括在1、6和12个月时进行随访检查。成功修复的定义为患者阴茎伸直，尿道口位于顶端，无狭窄或瘘管。
共纳入67例患者。平均手术年龄为12.5个月（6 - 23个月）。所有患者均为远端尿道下裂（3例为龟头型，61例为冠状沟型，3例为冠状沟下型）。36%的患者作为日间手术进行。未记录术中并发症。11例患者未完成指定的随访。他们参加了6个月的术后预约，但未参加1年的随访。根据家长反馈，所有患者的尿流情况均令人满意。所有家长对孩子阴茎的外观均感到满意。2例患者出现龟头裂开（3%）。最后10例患者的平均HOPE评分为47.4 ± 3.2（满分50分）。
去上皮化龟头重建是一种简单的技术，效果令人满意。尽管它与现有技术有相似之处，但包含一些先前未描述的特定方面。与MAGPI技术不同，它没有尿道口前移，没有龟头翼旋转，而是将尿道口外侧和近端的龟头在中线处靠拢。与GAP手术相反，它没有关闭尿道腹侧。我们依靠龟头内的二期愈合来重建尿道缺失的腹侧部分。我们将此技术保留用于冠状沟型尿道下裂且龟头沟宽而深的患者。去上皮化有利于龟头翼在中线处快速愈合。无需进行正式的尿道成形术。本研究的局限性包括缺乏长期（>1年）随访和尿流率检查。尽管仔细观察未发现瘘管，但在更大年龄时功能性狭窄的情况仍需更明确地评估。最后，该技术不适用于完全扁平的龟头，因为它依赖于能够在中线处使龟头嵴靠拢。
去上皮化龟头重建是一种简单的技术，能取得良好的美容效果，且无尿道口或尿道前移及正式尿道成形术相关的并发症。
