Ali Mostafa M, El-Hawy Mamdouh M, Galal Ehab M, Tawfiek Ehab R, Anwar Ahmed Z
University Hospital, School of Medicine, Department of Urology, Minia, Egypt.
Cent European J Urol. 2021;74(1):89-94. doi: 10.5173/ceju.2021.0245.R2. Epub 2021 Jan 15.
Reconstruction of proximal hypospadias with chordee remains a difficult task. Our work aims to evaluate the role of two-stage transverse preputial island flap urethroplasty for repair of proximal hypospadias with chordee.
This is a retrospective study including 57 children who underwent two-stage transverse preputial island flap urethroplasty. Glans meatus shaft (GMS) score was applied to 24 cases. Patient's characteristics, operative details and complications were assessed. Hypospadias objective scoring evaluation was used for postoperative assessment.
The mean age at the first stage operation was 23.6 months (9-84); the mean time interval between the first and second stage operations was 8.1 months (6-12) and the mean follow-up duration was 52.1 months (24-96). Urethral meatus was proximal penile in 18 patients, penoscrotal in 24 and scrotal in 15. The mean degree of ventral curvature (VC) was 51.5° (30-90). After the second stage operation, postoperative complications occurred in 16 (28.1%) patients with urethrocutaneous fistula in 6 (10.5%) cases, diverticulum in 3 (5.3%), glans dehiscence in 5 (8.8%) and meatal stenosis in 2 (3.5%). All cases of glans dehiscence occurred in severe hypospadias and small glans. Moderate GMS score was present in 10 (41.7%) cases and severe GMS in 14 (58.3%). Complications occurred in 7 (29.1%) patients with 5 (20.8%) with a severe GMS score and 2 (8.3%) with a moderate GMS score. The hypospadias objective scoring evaluation showed satisfactory results, with 39 (68.4%) patients achieving a score of 16 points.
Two-stage transverse preputial flap is a good choice for repair of proximal hypospadias with an acceptable complication rate of 28.1%.
伴有阴茎下弯的近端尿道下裂重建仍是一项艰巨任务。我们的研究旨在评估两期横向包皮岛状皮瓣尿道成形术在修复伴有阴茎下弯的近端尿道下裂中的作用。
这是一项回顾性研究，纳入了57例行两期横向包皮岛状皮瓣尿道成形术的儿童。对其中24例应用了龟头尿道口阴茎体（GMS）评分。评估了患者的特征、手术细节及并发症。术后采用尿道下裂客观评分评估。
一期手术的平均年龄为23.6个月（9 - 84个月）；一期与二期手术之间的平均时间间隔为8.1个月（6 - 12个月），平均随访时间为52.1个月（24 - 96个月）。尿道口位于阴茎近端的有18例，阴茎阴囊型的有24例，阴囊型的有15例。腹侧弯曲（VC）的平均度数为51.5°（30 - 90°）。二期手术后，16例（28.1%）患者出现术后并发症，其中尿道皮肤瘘6例（10.5%），憩室3例（5.3%），龟头裂开5例（8.8%），尿道口狭窄2例（3.5%）。所有龟头裂开病例均发生在重度尿道下裂和小龟头患者中。10例（41.7%）患者GMS评分为中度，14例（58.3%）为重度。7例（29.1%）患者出现并发症，其中GMS评分重度者有5例（20.8%），中度者有2例（8.3%）。尿道下裂客观评分评估结果满意，39例（68.4%）患者评分达16分。
两期横向包皮皮瓣是修复近端尿道下裂的良好选择，并发症发生率为28.1%，可接受。
