Rutgers New Jersey Medical School, Newark, NJ, USA.
New York Presbyterian Weill-Cornell Medical Center, New York, USA.
J Pediatr Urol. 2021 Dec;17(6):814.e1-814.e5. doi: 10.1016/j.jpurol.2021.08.019. Epub 2021 Sep 2.
Several popular surgical techniques have been described for the repair of distal hypospadias; however, the role of repairing the corpus spongiosum was rarely discussed. Herein we review our experience with adolescents who underwent hypospadias repair during childhood. Their main complaints were partially or totally related to spongiosum deficiency, the surgical outcomes are also discussed.
Between 2007 and 2018, 25 patients aged between 13 and 28 years of age (median 19 years) were operated upon to repair the deficiency or absence of corpus spongiosum in addition to a Thiersch-Duplay urethroplasty. Their records indicated that the primary hypospadias repairs during childhood included MAGPI (N = 10) and TIPU (N = 9), in 6 patients the repair of the distal hypospadias was unknown. The main complaints were; abnormal urinary stream which patients described as spraying and/or dripping of urine (N = 10) and distal urethral swelling during voiding and dripping of urine post voiding (N = 15). Eight patients reported that they were treated for symptomatic recurrent urinary tract infections by their primary physicians. In 5 patients, the urethral wall was thin and covered with adherent epidermis only. In 20 patients, the laterally displaced spongiosum pillars were well-defined, 4 of whom exhibited mild chordee. In 14 patients the spongiosum pillars were mobilized and approximated using interrupted absorbable sutures. Four patients had spongiosum deficiency and urethral swelling resulting in mild diverticulum formation. The urethral wall was plicated and covered with the spongiosum and/or dartos flaps. In 4 patients the spongiosum pillars were fixed and could not be mobilized to provide a tension-free closure. In these cases, a dartos flap harvested from the scrotum, and used to cover the urethral wall and was sutured on either side to the spongiosum pillars. 12/25 patients underwent glandular contouring and/or meatoplasty simultaneously to improve the penile esthetics.
The follow-up period varied between 18 months and 7 years (mean 3.5 years). 24/25 patients reported a normal steady urinary stream, absence of urethral swelling during voiding and none (22) or minimal (2) postvoid droplets of urine which soiled the underwear. One patient developed glans dehiscence and is voiding through a coronal meatus; he declined further surgery. None developed symptomatic urinary infection. The spongioplasty corrected the mild curvature in all 4 patients.
Failure to recognize and/or correct the deficient corpus spongiosum during the repair of distal hypospadias during childhood may become symptomatic during adolescence however, the abnormality can be corrected successfully.
已经描述了几种流行的手术技术来修复远端尿道下裂；然而，很少讨论修复海绵体的作用。在此，我们回顾了我们在童年时期接受尿道下裂修复的青少年患者的经验。他们的主要抱怨部分或完全与海绵体缺陷有关，还讨论了手术结果。
在 2007 年至 2018 年间，对 25 名年龄在 13 至 28 岁之间的患者（中位数 19 岁）进行了手术，除了 Thiersch-Duplay 尿道成形术外，还修复了海绵体的缺陷或缺失。他们的记录表明，童年时期的主要尿道下裂修复术包括 MAGPI（N=10）和 TIPU（N=9），在 6 名患者中，远端尿道下裂的修复术未知。主要抱怨是；异常的尿流，患者描述为尿液喷洒和/或滴注（N=10）和排尿时尿道远端肿胀以及排尿后滴尿（N=15）。8 名患者报告说，他们因症状性复发性尿路感染而接受过主治医生的治疗。在 5 名患者中，尿道壁薄，仅覆盖有附着的表皮。在 20 名患者中，海绵体支柱侧向移位，定义明确，其中 4 名患者存在轻度弯曲。在 14 名患者中，使用间断可吸收缝线移动并接近海绵体支柱。4 名患者存在海绵体缺陷和尿道肿胀，导致轻度憩室形成。尿道壁被折叠并用海绵体和/或 dartos 皮瓣覆盖。在 4 名患者中，海绵体支柱固定且无法移动以提供无张力闭合。在这些情况下，从阴囊中采集 dartos 皮瓣，用于覆盖尿道壁，并在海绵体支柱的任一侧缝合。25 名患者中有 12 名同时进行了腺体整形和/或肉毒杆菌素注射术，以改善阴茎美观度。
随访时间为 18 个月至 7 年（平均 3.5 年）。25 名患者中有 24 名报告说，他们的尿流正常、稳定，排尿时尿道无肿胀，无（22 名）或仅有微量（2 名）尿液滴落后弄脏内衣。1 名患者出现龟头裂开，现在通过冠状尿道口排尿；他拒绝了进一步的手术。没有人出现症状性尿路感染。海绵体成形术纠正了所有 4 名患者的轻度弯曲。
在童年时期修复远端尿道下裂时未能认识到和/或纠正海绵体缺陷可能会在青春期出现症状，但可以成功纠正这种异常。
