一种不同的远端尿道下裂修复方法：GUD（尿道海绵体分离）技术。
A different approach to distal hypospadias repair: The GUD (glandular urethral disassembly) technique.
机构信息
Department of Urology, CACAU-NUPEP, São Paulo, Brazil; Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
Department of Urology, CACAU-NUPEP, São Paulo, Brazil.
出版信息
J Pediatr Urol. 2021 Oct;17(5):690.e1-690.e6. doi: 10.1016/j.jpurol.2021.06.001. Epub 2021 Jun 6.
INTRODUCTION
Distal hypospadias represent the most frequent clinical presentation of hypospadias. In spite of more than 300 techniques available, there is not an ideal approach. We have proposed an alternative procedure based on the combination of minor urethral mobilization and major glans deconstruction and partial disassembly from the corpora, the GUD technique. We want to present our clinical experience with the procedure and describe it in detail.
METHODS
The technique consists of disconnecting the spongious tissue and the distal urethra from the corpora and detaching partially the glans as well, from 2 to 10 o'clock. The glans is opened in midline and the procedure combines cranially mobilization of urethra with caudal and medial rotation of glans wings to refurbish the glans correcting the hypospadia without urethroplasty.
RESULTS
We have treated 164 patients with distal hypospadia. Median age at the surgery was 22.4 months (1-184 months). The meatal position after penile degloving was coronal at 108 cases, subcoronal at 54 and 2 patients presented megameatus and intact foreskin. Three patients (1.8%) had mild penoscrotal transposition in addition to hypospadia. Twenty-eight patients were treated as a secondary repair (17%). We found complications in 6 patients (3.6%) consisting of five fistulas (3%) and three glans dehiscence (1.8%). Two patients had both complications. Follow up was 21 months (1-42 months) and the median follow-up time was 18 months.
DISCUSSION
We acknowledge that this procedure is intended only to distal hypospadias (coronal and subcoronal). We stress that the GUD procedure can be performed irrespectively of any urethral plate "quality" as it does not require a minimum glans width as the TIP repair. Moreover, there is no need for preoperative testosterone treatment. The absence of suture and urethroplasty minimizes the risk of coronal fistulas after surgery.
CONCLUSIONS
We believe that this procedure is a viable alternative to distal hypospadias repair.
简介
远端型尿道下裂是尿道下裂中最常见的临床表现。尽管有 300 多种技术可供选择，但没有一种是理想的方法。我们提出了一种基于尿道轻微移动和龟头大部分解构以及从阴茎体部分拆卸的替代方法，即 GUD 技术。我们希望介绍我们的临床经验并详细描述该技术。
方法
该技术包括将海绵体组织和尿道远端与阴茎体分离，并部分分离龟头，从 2 点到 10 点。龟头在中线打开，该过程结合了尿道的颅侧移动和龟头翼的尾侧和内侧旋转，以修复龟头，纠正尿道下裂，而无需尿道成形术。
结果
我们共治疗了 164 例远端型尿道下裂患者。手术时的中位年龄为 22.4 个月（1-184 个月）。阴茎脱套后尿道口位置为冠状位者 108 例，冠状下 54 例，2 例患者存在巨大尿道口和完整的包皮。3 例（1.8%）患者除了尿道下裂外还存在轻度阴茎阴囊转位。28 例（17%）患者为二期修复。我们发现 6 例（3.6%）患者出现并发症，包括 5 例（3%）瘘管和 3 例（1.8%）龟头裂开。2 例患者同时存在这两种并发症。随访时间为 21 个月（1-42 个月），中位随访时间为 18 个月。
讨论
我们承认该手术仅适用于远端型尿道下裂（冠状和冠状下）。我们强调，GUD 手术可以在任何尿道板“质量”的情况下进行，因为它不需要像 TIP 修复那样需要最小的龟头宽度。此外，不需要术前睾丸激素治疗。由于没有缝线和尿道成形术，术后冠状瘘的风险最小化。
结论
我们认为该手术是治疗远端尿道下裂的一种可行的替代方法。
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