Department of Urology, Shiraz University of Medical Sciences, Shiraz; Histomorphomettery and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz.
School of Medicine, Shiraz University of Medical Sciences, Shiraz.
Arch Ital Urol Androl. 2021 Jun 29;93(2):244-247. doi: 10.4081/aiua.2021.2.244.
During meatotomy procedure for children with meatal stenosis (MS), a straight clamp used as a hemostat on the ventrum of the meatus before incised with scissors for clamping and holding bleeding from the site of operation. The aim of this study was to evaluate the optimum clamping time for meatotomy in children with MS.
All the patients with MS between 2014 to 2019 were enrolled in this retrospective study. Patients with uncircumcised penis, traumatic catheterization, any kind of penile abnormality such as hypospadias or penile curvature, and active urinary tract infection (UTI) were excluded. The indication of meatotomy was a pinpoint meatus that develops with dorsal or lateral deflection of the urinary stream and high-velocity urine flow. During meatotomy procedure, clamping time was examined in different groups such as 2, 3, and 4 minutes. The main symptoms of presentation and ultrasonography (US) findings were recorded and compared between groups. To assess the optimum time clamping, postoperative bleeding was noted carefully in all groups. The success rate was recorded at onemonth postoperative follow-up in the clinic.
Of the 120 patients with MS who underwent a meatotomy procedure, there were 40 (33.3%) participants in each group. The main symptoms were painful urination and urine stream deviation that represented in 54 (46%) patients. Bladder wall thickness was the main pre-operation finding in the US which was observed in 67 (55.8%) patients. In comparison between the groups related to clamping time, bleeding was observed and required suturing when clamping was applied for 2 minutes in 4 (3.3%) patients (p = 0.016). With a minimum follow-up of 12 months, no recurrent meatal stenosis was reported.
Clamping time for more than 2 minutes may prevent bleeding during and after meatotomy.
在儿童尿道口狭窄（MS）行尿道口切开术时，先用直钳夹住尿道口腹侧，再用剪刀切开，以夹住并止血。本研究旨在评估 MS 患儿尿道口切开术的最佳夹闭时间。
本研究回顾性纳入 2014 年至 2019 年间所有 MS 患儿。排除未行包皮环切术、外伤性导尿、存在尿道下裂或阴茎弯曲等任何阴茎异常、活动性尿路感染（UTI）的患儿。尿道口切开术的适应证为尿道口呈针尖状，伴有尿流向背侧或侧方偏斜和高速尿流。在尿道口切开术中，检查了 2、3 和 4 分钟的不同夹闭时间。记录并比较了各组的主要临床表现和超声（US）结果。为了评估最佳夹闭时间，仔细观察了所有组的术后出血情况。术后 1 个月在门诊进行随访，记录手术成功率。
120 例 MS 患儿行尿道口切开术，每组 40 例（33.3%）。主要症状为尿痛和尿流偏斜，54 例（46%）患儿存在上述症状。67 例（55.8%）患儿 US 检查的主要术前发现为膀胱壁增厚。在与夹闭时间相关的组间比较中，夹闭 2 分钟时 4 例（3.3%）患儿出现出血，需要缝合（p=0.016）。随访至少 12 个月，无复发性尿道口狭窄。
夹闭时间超过 2 分钟可能预防尿道口切开术后出血。
