Wu Shijian, Ye Chenglong, Yang Huai, Chen Bote, Nie Haibo, Li Shaowei
Department of Urology, General Hospital of Southern Theatre Command, Guangzhou, China.
Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China.
Front Pediatr. 2022 Mar 9;10:774973. doi: 10.3389/fped.2022.774973. eCollection 2022.
Urethrocutaneous fistula is one of the most common complications arising from hypospadias surgery. The purpose of our study was to investigate the effectiveness and safety of allogeneic human acellular dermal matrix (HADM) application as a means of preventing the occurrence of urethrocutaneous fistula following hypospadias surgery.
This is a non-randomized study of 219 cases (out of 270 patients with hypospadias) which satisfied inclusion and exclusion criteria. These patients were divided into two groups: 101 HADM patients, and 118 control patients (who did not receive HADM). In the control group, 77 boys were treated by single-stage urethroplasty (TIP) and 41 underwent staged urethroplasty (Thiersch-Duplay). In the HADM group, 59 boys underwent the TIP and 42 underwent the Thiersch-Duplay. In the postoperative period, we recorded the incidence of infection, urethrocutaneous fistula, and urethral stricture complications in these two groups of patients. The effectiveness and safety of HADM in preventing urethrocutaneous fistula following hypospadias surgery were evaluated according to these indicators.
In the control group, following the operation there were 16 cases of infection, 38 cases of urethrocutaneous fistula after extubating, and 5 cases of urethral stricture. In the HADM group, there were 19 cases of postoperative infection, 12 cases of urethrocutaneous fistula after extubating, and 5 children with urethral stricture. In comparing the two groups, it was found that the postoperative infection rate (13.6 vs. 18.8%) and the incidence of urethral stricture (4.2 vs. 5.0%) were not statistically significant ( > 0.05), while the postoperative urethrocutaneous fistula rate (32.2 vs. 11.9%) was statistically significant ( < 0.001).
It is found that HADM application can significantly reduce the incidence of urethrocutaneous fistula complications, without increasing the risk of infection and urethral stricture.
尿道皮肤瘘是尿道下裂手术最常见的并发症之一。本研究的目的是探讨应用同种异体人脱细胞真皮基质（HADM）预防尿道下裂手术后尿道皮肤瘘发生的有效性和安全性。
这是一项对219例（共270例尿道下裂患者）符合纳入和排除标准的非随机研究。这些患者被分为两组：101例使用HADM的患者和118例对照患者（未接受HADM）。对照组中，77名男孩接受一期尿道成形术（TIP）治疗，41名接受分期尿道成形术（Thiersch-Duplay）。在使用HADM的组中，59名男孩接受了TIP手术，42名接受了Thiersch-Duplay手术。在术后期间，我们记录了这两组患者感染、尿道皮肤瘘和尿道狭窄并发症的发生率。根据这些指标评估HADM在预防尿道下裂手术后尿道皮肤瘘方面的有效性和安全性。
对照组术后有16例感染，拔管后38例尿道皮肤瘘，5例尿道狭窄。在使用HADM的组中，有19例术后感染，拔管后12例尿道皮肤瘘，5例儿童尿道狭窄。比较两组发现，术后感染率（13.6%对18.8%）和尿道狭窄发生率（4.2%对5.0%）无统计学意义（>0.05），而术后尿道皮肤瘘发生率（32.2%对11.9%）有统计学意义（<0.001）。
发现应用HADM可显著降低尿道皮肤瘘并发症的发生率，且不增加感染和尿道狭窄的风险。
