Omran Mohamed, Sakr Ahmed, Elgalaly Hazem, Fawzy Amr, Abdalla Mohamed
Department of Urology, Faculty of Medicine, Zagazig University, Sharkia Governorate, Zagazig City, 44519, Egypt.
Department of Urology, Faculty of Medicine, Zagazig University, Sharkia Governorate, Zagazig City, 44519, Egypt.
J Pediatr Urol. 2021 Apr;17(2):216.e1-216.e8. doi: 10.1016/j.jpurol.2020.11.026. Epub 2020 Nov 25.
The measurement of the urethral plate width (as an objective parameter) and its effect of this width on the results of tubularized incised plate urethroplasty (TIPU) have been reported in two series and both authors reported that a urethral plate width < 8 mm is associated with higher complication rates. The augmentation of the urethral plate either by dorsal inlay graft urethroplasty (DIGU) or Onlay flap has been compared with the original TIPU in different degrees of hypospadias with better surgical results in augmented cases.
To evaluate the surgical results of longitudinal Onlay preputial flap (LOF) vs (DIGU) techniques in augmentation of the narrow urethral plate.
Primary anterior and middle hypospadias cases with narrow urethral plates were randomly allocated into two groups; group one operated by DIGU and group two operated by (LOF). The Success rate, individual complication rate, and operative times were compared.
39 cases completed the study. No significant differences in patients' characteristics were detected. In the DIGU group, one case (5.3%) complicated with fistula and glandular dehiscence wherein in the LOF group, 7 cases (35%) Complicated with 5 fistulae, 2 glanular dehiscences, one flap loss, one diverticulum (p= .02). No significant differences in the rates of individual complications.
Variables affecting the success of hypospadias repairs are many. Urethral plate quality is an important variable among these variables. The definition of urethral plate quality is usually subjective. In the DIGU group, only 1/19 (5.3%) case had two complications, fistula and glandular dehiscence. Mouravas et al., in their comparative study between TIPU and G-TIP without mention of urethral plate width reported a significant reduction of the overall complications and urethral stenosis without significant reduction in fistula rate. In their G-TIP group, only 2 cases out of 24 (8.3%) were complicated with one fistula and one glandular dehiscence where in the TIPU group, 7 cases (30.4%) were complicated with one glandular dehiscence and 6 cases with urethral stenosis. In the LOF group, fistula in 5/20 cases (25%) was the commonest complication followed by glandular dehiscence in 2 cases (10%). Diverticulum and flap loss occurred in one case for each (5%). In the multivariate analysis of 474 patients' cohort by Spinoit et al., there were no significant differences between the risk of re-intervention after TIP and Onlay flap in anterior and middle hypospadias (25.8% vs. 18.8%), and (22.2% vs. 20%) respectively.
Our data suggest that augmentation of the narrow urethral plate with DIGU has a better surgical outcome than with LOF. No significant difference in cosmetic outcomes detected.
尿道板宽度的测量（作为一个客观参数）及其宽度对管状切开板尿道成形术（TIPU）结果的影响已在两个系列研究中报道，两位作者均报告尿道板宽度<8mm与较高的并发症发生率相关。通过背侧镶嵌移植尿道成形术（DIGU）或覆盖皮瓣对尿道板进行扩大，已在不同程度的尿道下裂中与原始TIPU进行了比较，扩大病例的手术效果更好。
评估纵向覆盖包皮瓣（LOF）与（DIGU）技术在扩大狭窄尿道板方面的手术效果。
将原发性前位和中位尿道下裂且尿道板狭窄的病例随机分为两组；第一组采用DIGU手术，第二组采用（LOF）手术。比较成功率、个体并发症发生率和手术时间。
39例完成研究。未检测到患者特征的显著差异。在DIGU组，1例（5.3%）出现瘘管和腺体裂开并发症；而在LOF组，7例（35%）出现5例瘘管、2例腺体裂开、1例皮瓣丢失、1例憩室（p = 0.02）。个体并发症发生率无显著差异。
影响尿道下裂修复成功的变量众多。尿道板质量是这些变量中的一个重要变量。尿道板质量的定义通常是主观的。在DIGU组，仅1/19（5.3%）病例有两种并发症，即瘘管和腺体裂开。Mouravas等人在他们对TIPU和G-TIP的比较研究中，未提及尿道板宽度，报告总体并发症和尿道狭窄显著减少，但瘘管率无显著降低。在他们的G-TIP组中，24例中有2例（8.3%）出现1例瘘管和1例腺体裂开并发症，而在TIPU组中，7例（30.4%）出现1例腺体裂开并发症，6例出现尿道狭窄。在LOF组，5/20例（25%）出现瘘管是最常见的并发症，其次是2例（10%）出现腺体裂开。憩室和皮瓣丢失各发生1例（5%）。在Spinoit等人对474例患者队列的多变量分析中，TIP和覆盖皮瓣修复前位和中位尿道下裂后再次干预的风险之间无显著差异（分别为25.8%对18.8%）和（22.2%对20%）。结论：我们的数据表明，用DIGU扩大狭窄尿道板比用LOF手术效果更好。未检测到美容效果的显著差异。
