Abdel-Hamid El-Hawy Mamdouh, Ali Mostafa Magdi, Abdelhamid Amr M, Fawzy Ahmed M, Hussein Alayman, Elsharkawy Mostafa Sh Mohamed
Urology and Nephrology Hospital, School of Medicine, Minia University, Minia, Egypt.
Cent European J Urol. 2021;74(4):595-600. doi: 10.5173/ceju.2021.R1.0063. Epub 2021 Sep 6.
Although it is apparently simpler to perform unstented tubularized incised plate (TIP) repair for distal hypospadias repair, consensus on feasibility of the use of unstented repair is still a matter of debate. Evidence reporting that unstented repair outcome is comparable to stented repair, especially in the long-term, is still weak due to reporting outcome inconsistencies, different study designs, inclusion of more than one technique, and inherent variability in meatal locations. Thus, we need a continuous and evolving assessment of the outcome of unstented repair to compile adequate evidence on the advantage of unstented TIP repair in distal hypospadias entity. The aim of this article was to review our long-term results with tubularized incised plate urethroplasty for distal hypospadias repair without a postoperative stent to determine its outcome which might justify its use.
After a review of 154 patients with distal penile hypospadias, who underwent repair in Minia Urology & Nephrology University Hospital in the period between June 2015 and February 2018, we excluded cases who underwent MAGPI repair, redo cases and patients who failed to complete follow-up. We chose 72 patients who had only 1 time TIP repair and whom we could contact. A total of 44 out of 72 cases with stented repair were assigned to Group A, while 28 cases with unstented repair were assigned to Group B. Success was assessed based on Hypospadias Objective Penile Evaluation (HOPE) score by three separate senior pediatric urology consultants, independent of the surgeon and in the absence of high post-void residual urine (PVR). Average rate was calculated to be compared between both study groups.
There was no statistically significant difference regarding preoperative meatal location and age at repair and short-term complications. In the long-term; there was no statistically significant difference between the occurrence of urethrocutanous fistula (UCF, 4 vs 2 cases in Group A & B, respectively) and complete disruption (2 cases in each group) with need for redo repair. Results of total mean of HOPE score calculated showed no statistically significant differences between study groups and also failed to showed statistical significance on individual domains of HOPE score.
Unstented TIP repair showed a similar outcome to stented TIP repair of distal hypospadias especially in the long-term despite a more troublesome early postoperative period.
尽管对于远端尿道下裂修复而言，进行无支架管状切开板（TIP）修复表面上似乎更为简单，但对于无支架修复使用可行性的共识仍存在争议。由于报告结果不一致、研究设计不同、纳入多种技术以及尿道口位置的固有变异性，关于无支架修复结果与有支架修复相当，尤其是长期结果相当的证据仍然不足。因此，我们需要对无支架修复的结果进行持续且不断发展的评估，以收集充分的证据证明无支架TIP修复在远端尿道下裂中的优势。本文的目的是回顾我们采用管状切开板尿道成形术修复远端尿道下裂且术后不放置支架的长期结果，以确定其结果是否能证明该方法的合理性。
在回顾了2015年6月至2018年2月期间在米尼亚泌尿外科与肾病大学医院接受修复的154例远端阴茎型尿道下裂患者后，我们排除了接受MAGPI修复的病例、再次手术病例以及未能完成随访的患者。我们选择了72例仅接受过1次TIP修复且我们能够联系到的患者。72例中有支架修复的44例被分配到A组，28例无支架修复的被分配到B组。由三位独立的资深儿科泌尿外科顾问根据尿道下裂客观阴茎评估（HOPE）评分评估手术成功与否，评估独立于手术医生且在无高残余尿量（PVR）的情况下进行。计算平均发生率以比较两个研究组。
术前尿道口位置、修复时年龄以及短期并发症方面无统计学显著差异。从长期来看；尿道皮肤瘘（UCF，A组和B组分别为4例和2例）和完全裂开（每组2例）需要再次手术修复的发生率之间无统计学显著差异。计算得出的HOPE评分总平均值结果显示，研究组之间无统计学显著差异，并且在HOPE评分的各个领域也未显示出统计学显著差异。
无支架TIP修复显示出与有支架TIP修复远端尿道下裂的结果相似，尤其是长期结果，尽管术后早期阶段更为棘手。
