Marcou Marios, Bobbe Sarah-Magdalena, Wullich Bernd, Hirsch-Koch Karin
Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany.
Clinic of Urology, Dr. Lubos Kliniken Bogenhausen, Munich, Germany.
Front Pediatr. 2022 Jul 8;10:900514. doi: 10.3389/fped.2022.900514. eCollection 2022.
To investigate whether a two-stage repair of distal- and mid-shaft hypospadias (non-proximal hypospadias) could eliminate the risk factors resulting from adverse urethral plate characteristics and eventually reduce complication rates.
We retrospectively reviewed all cases of primary surgical repair of non-proximal hypospadias performed in our center between 2009 and 2018. In all cases where adverse urethral plate characteristics were found, such as meatal stenosis, a shallow urethral groove, a thick web of tissue between the native meatus and the urethral groove or in the presence of a very "thin," skin-like distal urethra, a two-stage repair was routinely undertaken. In cases of native meatal stenosis, a meatotomy, and meatoplasty were performed. In cases of a very "thin" distal urethra we incised the skin proximally up to the point of a normal urethral fold and a meatoplasty was performed at that point. Hypospadias repair was then performed in a second operation, 3-6 months following the first procedure. Urethroplasty, both in cases of a single-stage repair and in cases of a two-stage repair, was always performed using the Thiersch-Duplay technique. Patients with a follow-up of less than 12 months were excluded from this study.
Over a period of 10 years, 208 boys underwent primary surgical repair of non-proximal hypospadias. Eighty-nine of the 208 patients (42.8%) underwent single-stage hypospadias repair. Two-stage repair of the hypospadias was required in 119 (57.2%) of the patients. The overall complication rate was 3.4% in the group operated in a single stage and 7.6% in the group that required a two-stage repair ( = 0.09). The most frequent complication reported was urethrocutaneous fistula ( = 0.31), followed by meatal stenosis ( = 0.37), urethral stricture ( = 0.08) and wound dehiscence ( = 0.16). There was no significant difference between the complication rates of the two groups.
Patients with distal hypospadias and poor urethral plate characteristics repaired in a two-stage approach have comparable low-complications to those with favorable urethral plate characteristics repaired in a single-stage.
探讨远端和中段尿道下裂（非近端尿道下裂）的两阶段修复是否可以消除由不良尿道板特征导致的风险因素，并最终降低并发症发生率。
我们回顾性分析了2009年至2018年在本中心进行的所有非近端尿道下裂一期手术修复病例。在所有发现尿道板特征不良的病例中，如尿道口狭窄、尿道沟浅、尿道口与尿道沟之间或存在非常“薄”的、类似皮肤的远端尿道处有厚的组织条索，常规进行两阶段修复。对于尿道口狭窄的病例，进行尿道口切开术和尿道口成形术。对于非常“薄”的远端尿道病例，我们在近端切开皮肤直至正常尿道皱襞处，并在该点进行尿道口成形术。然后在第一次手术后3 - 6个月进行第二次手术修复尿道下裂。无论是一期修复还是两阶段修复的病例，尿道成形术均采用蒂尔施 - 杜普莱技术。随访时间少于12个月的患者被排除在本研究之外。
在10年期间，208名男孩接受了非近端尿道下裂的一期手术修复。208例患者中有89例（42.8%）接受了一期尿道下裂修复。119例（57.2%）患者需要进行尿道下裂的两阶段修复。一期手术组的总体并发症发生率为3.4%，两阶段修复组为7.6%（P = 0.09）。报告的最常见并发症是尿道皮肤瘘（P = 0.31），其次是尿道口狭窄（P = 0.37）、尿道狭窄（P = 0.08）和伤口裂开（P = 0.16）。两组并发症发生率之间无显著差异。
采用两阶段方法修复远端尿道下裂且尿道板特征不良的患者与采用一期方法修复尿道板特征良好的患者并发症发生率相当低。
