Vu Tuan Hong, Viet Nguyen Hoa, Quy Hong Quan, Quang Pham Hung, Thanh Pham Tung, Hai Do Đang, Đo Truong Thanh
Department of Pediatric Surgery, Viet Duc Hospital, 40 TrangThi, Hoankiem, Hanoi, Viet Nam.
Department of General Surgery, Hanoi Medical University, Viet Nam.
Ann Med Surg (Lond). 2021 Nov 2;71:103012. doi: 10.1016/j.amsu.2021.103012. eCollection 2021 Nov.
Proximal hypospadias is the most severe type of hypospadias. Our approach to Koyanagi technique for proximal hypospadias aims to improve the blood supply to the neourethral flaps and reduce meatal complications.
Our prospective study included 75 patients who were operated for proximal hypospadias by our Koyanagi technique at Viet Duc hospital between January 2019 and December 2020. The clinical information obtained included a detailed medical history; preoperative, intraoperative, and postoperative data; short-term outcomes by the HOSE score were evaluated by a different physician.
The mean (range) age was 3.59 ± 2.41 years (1.5-14), 86.7% under 5 years old. There are 31 penoscrotal, 31 scrotal, and 13 perineal hypospadias. The length of the neourethra ranged from 3.5 to 8 cm, mean 5.02 ± 0.88 cm. Evaluation of the surgeon at 6 months after surgery: primary success 81.3%. Complications occurred in 14 cases (18.7%), included 10 urethrocutaneous fistula and 4 dehiscence of the urethra. No cases of meatal stenosis or recession, urethral stricture, urethral diverticula. The mean HOSE score was found to be 14.47 ± 1.35, ranged 11 to 16. 57 patients (76%) had a total HOSE 14 and above and 18 patients had score below 14 (24%).
Our modified Koyanagi technique give us a good result for one-stage reconstruction of proximal hypospadias. Applying the HOSE score makes postoperative evaluation of hypospadias more objective and reliable.
近端型尿道下裂是尿道下裂最严重的类型。我们采用小柳技术治疗近端型尿道下裂的方法旨在改善新尿道皮瓣的血供并减少尿道口并发症。
我们的前瞻性研究纳入了2019年1月至2020年12月期间在越南德医院接受小柳技术治疗近端型尿道下裂的75例患者。获得的临床信息包括详细的病史；术前、术中和术后数据；由另一位医生通过HOSE评分评估短期结果。
平均（范围）年龄为3.59±2.41岁（1.5 - 14岁），86.7%在5岁以下。有31例阴茎阴囊型、31例阴囊型和13例会阴型尿道下裂。新尿道长度为3.5至8厘米，平均5.02±0.88厘米。术后6个月外科医生评估：一期成功率为81.3%。14例（18.7%）出现并发症，包括10例尿道皮肤瘘和4例尿道裂开。无尿道口狭窄或退缩、尿道狭窄、尿道憩室病例。发现平均HOSE评分为14.47±1.35，范围为11至16。57例患者（76%）的HOSE总分在14分及以上，18例患者得分低于14分（24%）。
我们改良的小柳技术在近端型尿道下裂一期重建中取得了良好效果。应用HOSE评分使尿道下裂术后评估更客观、可靠。
