Kurdi Mazen Omar, Eldessouki Nagi Ibrahim, Khirallah Mohammad Gharieb
Pediatric Surgery Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Pediatric Surgery Unit, Tanta University Hospital, Tanta University, Tanta, Egypt.
Front Pediatr. 2022 Apr 5;10:876791. doi: 10.3389/fped.2022.876791. eCollection 2022.
Distal hypospadias is a common anomaly. Different surgical techniques have evolved through the years to manage this anomaly. Several factors may affect the prognosis. One of them is glans size. We compared the hybrid Mathieu urethroplasty (HMU) and the tubularized incised plate urethroplasty (TIPU) for the management of distal hypospadias with a small glans.
Sixty-eight patients with distal hypospadias were included and categorized into two groups. Group A ( = 33) and group B ( = 35) patients were treated by HMU and TIPU, respectively. All patients had a small glans. In group A, the patients underwent Mathieu urethroplasty plus a deep incision of the urethral plate. In group B, the patients underwent TIPU. Urethral stents were used in all cases. Hypospadias objective score evaluation (HOSE) was used to assess the results.
Urethrocutaneous fistulae developed in two cases in group A and six cases in group B. Meatal stenosis was significantly lower (one case in group A vs. eight cases in group B). Glanular dehiscence occurred in two cases in group A and five cases in group B. The small glans strongly correlated with the development of both urethrocutaneous fistulae and meatal stenosis where the odd ratios were 3.500 (1.383-7.879) and 9.481 (1.114-12.669), respectively.
Both techniques showed efficacy during management of patients with a small glans. HMU had better outcomes, shorter duration of stent and lesser incidence of complications than TIPU. Small glans was significantly related to urethrocutaneous fistulae and meatal stenosis in group B.
远端尿道下裂是一种常见的先天性畸形。多年来，为处理这种畸形已发展出不同的手术技术。有几个因素可能影响预后。其中之一是龟头大小。我们比较了混合马蒂厄尿道成形术（HMU）和管状切开尿道板尿道成形术（TIPU）在治疗龟头较小的远端尿道下裂中的应用。
纳入68例远端尿道下裂患者并分为两组。A组（n = 33）和B组（n = 35）患者分别接受HMU和TIPU治疗。所有患者龟头均较小。A组患者接受马蒂厄尿道成形术加尿道板深度切开。B组患者接受TIPU。所有病例均使用尿道支架。采用尿道下裂客观评分评估（HOSE）来评估结果。
A组有2例发生尿道皮肤瘘，B组有6例。尿道口狭窄情况在A组显著更低（A组1例 vs. B组8例）。A组有2例发生龟头裂开，B组有5例。小龟头与尿道皮肤瘘和尿道口狭窄的发生密切相关，其优势比分别为3.500（1.383 - 7.879）和9.481（1.114 - 12.669）。
两种技术在治疗龟头较小的患者时均显示出疗效。与TIPU相比，HMU效果更好，支架留置时间更短，并发症发生率更低。在B组中，小龟头与尿道皮肤瘘和尿道口狭窄显著相关。
