Ain Shams University, Cairo, Egypt.
Ain Shams University, Cairo, Egypt.
J Pediatr Urol. 2021 Aug;17(4):519.e1-519.e7. doi: 10.1016/j.jpurol.2021.04.021. Epub 2021 May 6.
Hypospadias is one of the most common anomalies of male external genitalia. The aim of hypospadias repair is to achieve a normal phallus with a satisfactory functional and cosmetic result and to develop a single and consistent urinary stream while in standing position. The introduction of tubularized incised plate (TIP) urethroplasty by Snodgrass in 1994 resulted in revolutionizing management of different types of hypospadias. While there is consensus on the use of absorbable sutures in hypospadias repair, there are no specific guidelines for the suturing technique and the technique itself remains debatable.
To compare the outcome of interrupted- and continuous-suture in hypospadias repair using TIP technique.
This was a prospective randomized study. It comprised 260 uncircumcised hypospadiac boys with adequate urethral plate who underwent TIP repair. Boys with glanular, recurrent, proximal hypospadias and inadequate urethral plate were excluded from the study. The boys were randomized into two groups: Group A consisted of 130 boys who underwent TIP repair using continuous subcuticular suture urethroplasty and Group B of 130 boys who underwent TIP repair using interrupted subcuticular suture urethroplasty.
The operative time was of lower statistical significance in group A (P = 0.006) while the rate of complications were of higher statistical significance in group A (P = 0.027). Urethrocutaneous fistulae occurred in 20 patients (14 in Group A and six in Group B), which is a statistically significant difference (P = 0.048). On the other hand, superficial wound infection, partial glans dehiscence, meatal stenosis, urethral stricture, and aesthetic appearance were statistically insignificant.
The effect of suturing techniques in bowel anastomosis has been studied and it has been found that the use of an interrupted-suturing technique results in a decreased complication rate compared to continuous suturing. This agrees with our study where the running sutures groups was associated with a higher complication rate compared to interrupted sutures.
尿道下裂是男性外生殖器最常见的畸形之一。尿道下裂修复的目的是获得正常的阴茎，同时达到满意的功能和美容效果，并在站立位时形成单一、一致的尿流。1994 年，Snodgrass 引入了管状切开皮瓣（TIP）尿道成形术，彻底改变了各种类型尿道下裂的治疗方法。虽然在尿道下裂修复中使用可吸收缝线已达成共识，但对于缝合技术尚无具体指南，而且该技术本身仍存在争议。
比较 TIP 技术中间断缝合与连续缝合在尿道下裂修复中的效果。
这是一项前瞻性随机研究。共纳入 260 例未行包皮环切的 TIP 修复术的尿道下裂男孩，这些男孩均具有足够的尿道板。本研究排除了龟头型、复发性、近端尿道下裂和尿道板不足的患儿。这些男孩被随机分为两组：A 组 130 例患儿采用连续皮下缝合尿道成形术，B 组 130 例患儿采用间断皮下缝合尿道成形术。
A 组的手术时间具有统计学意义（P=0.006），而 A 组的并发症发生率具有统计学意义（P=0.027）。20 例（A 组 14 例，B 组 6 例）患儿出现尿道瘘，差异具有统计学意义（P=0.048）。另一方面，浅层伤口感染、部分龟头裂开、尿道口狭窄、尿道狭窄和外观美观在统计学上无显著差异。
已经研究了缝合技术在肠吻合中的作用，发现与连续缝合相比，间断缝合技术可降低并发症发生率。这与我们的研究结果一致，即连续缝合组的并发症发生率高于间断缝合组。
