鞘膜瓣和肉膜瓣在原发性尿道下裂修复中管状切口板的作用：一项回顾性单中心研究。

Role of tunica vaginalis flap and dartos flap in tubularized incisional plate for primary hypospadias repair: A retrospective monocentric study.

机构信息

Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb.

Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol.

出版信息

Arch Ital Urol Androl. 2022 Jun 30;94(2):206-210. doi: 10.4081/aiua.2022.2.206.

DOI:10.4081/aiua.2022.2.206

PMID:35775348

Abstract

BACKGROUND

In the tubularized incised plate (TIP) procedure, flap interposition between the skin and neourethra is highly recommended to decrease the postoperative fistula rate. However, there is no consensus regarding the ideal flap for this procedure. This study aimed to report our experiences in the one-stage TIP hypospadias surgery utilizing dartos flap (DF) (penile skin subcutaneous tissue) and tunica vaginalis flap (TVF) (parietal layer of the testis) as a tissue coverage of neourethra.

METHODS

In a retrospective study from Sep 2018 to May 2021, 16 cases of hypospadias with different types, ranging from midpenile to penoscrotal types, were managed with TIP urethroplasty using DF or TVF as a tissue coverage of neourethra were enrolled. The demographic characteristics of the participants, type of hypospadias, outcome, and complications were analyzed and compared.

RESULTS

We used TVF and DF as soft tissue coverage in 11 (68.8%) and 5 (31.3%) patients, respectively. The mean age was 56.38 ± 47.83 months. Mid-penile, proximal, and penoscrotal hypospadias were presented in 3 (18.8%), 8 (50.0%), and 5(31.2%) patients, respectively. The total success rate was 14 (87.5%), while 2 (12.5%) patients developed a urethrocutaneous fistula, which required delayed closure later. In comparison between TVF and DF groups: the TVF was applied in all patients with moderate and severe chordee and all patients with penoscrotal hypospadias, and six patients with proximal hypospadias, while only three patients with mild chordee and two patients with proximal hypospadias used the DF and showed statistical significance between groups (p < 0.001 and 0.012) respectively. The success rate was 90.9% vs. 80.0% in TVF and DF groups, respectively, with no statistical significance between groups (p = 1.000).

CONCLUSIONS

In the primary TIP repair, the TVF is a practical option as a DF for the interposition cover of a neourethra, especially in penoscrotal and proximal hypospadias with severe chordee.

摘要

背景

在管状切开皮瓣（TIP）手术中，强烈建议在皮肤和新尿道之间插入皮瓣，以降低术后瘘管的发生率。然而，对于该手术，哪种皮瓣是理想的选择，目前尚无共识。本研究旨在报告我们应用腹侧皮瓣（DF）（阴茎皮肤皮下组织）和鞘状突皮瓣（TVF）（睾丸壁层）作为新尿道组织覆盖物，行一期 TIP 尿道下裂手术的经验。

方法

回顾性研究 2018 年 9 月至 2021 年 5 月，收治了 16 例不同类型的尿道下裂患者，包括阴茎型至阴囊型，均采用 TIP 尿道成形术，DF 或 TVF 作为新尿道的组织覆盖物。分析比较了患者的人口统计学特征、尿道下裂类型、手术结果和并发症。

结果

我们分别用 TVF 和 DF 作为 11 例（68.8%）和 5 例（31.3%）患者的软组织覆盖物。平均年龄为 56.38±47.83 个月。中阴茎型、近端型和阴囊型尿道下裂患者分别为 3 例（18.8%）、8 例（50.0%）和 5 例（31.2%）。总成功率为 14 例（87.5%），2 例（12.5%）患者发生尿道皮肤瘘，后行延期闭合。与 TVF 组和 DF 组相比：TVF 组应用于所有中重度尿道下弯和所有阴囊型尿道下裂患者，以及 6 例近端尿道下裂患者，而仅 3 例轻度尿道下弯和 2 例近端尿道下裂患者使用 DF，组间差异有统计学意义（p<0.001 和 0.012）。TVF 组和 DF 组的成功率分别为 90.9%和 80.0%，组间差异无统计学意义（p=1.000）。