Xie Qike, Liu Yuling, Zhao Xiangyou, Huang Junqiang, Chen Chao
Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Front Surg. 2022 Aug 25;9:892048. doi: 10.3389/fsurg.2022.892048. eCollection 2022.
Proximal hypospadias with severe chordee is still a formidable challenge for most pediatric urologists, and the treatment approach remains controversial. Here, we describe a modified two-stage technique to repair proximal hypospadias with severe chordee.
We retrospectively identified 53 children referred for proximal hypospadias with severe chordee from July 2016 to July 2019, who underwent a two-stage urethroplasty. In group 1, the children were repaired with staged tubularized incised plate (TIP) urethroplasty, while Byars' two-stage urethroplasty was attempted in group 2. We corrected chordee by releasing all remaining attachments to the corpora after degloving the penis, transceting the urethral plate, and dorsal plication. The mean age of patients in the first stage of surgery was 26.6 months in group 1 and 24.8 months in group 2. Postoperative complications in the two groups included: fistula, urethral stricture, urethral diverticulum, and glanular dehiscence.
A total of 20 cases were repaired with staged TIP urethroplasty (group 1), and 33 cases were repaired with Byars' two-stage urethroplasty (group 2). The length of follow-up in group 1 was 39.8 ± 10.1 months, and in group 2, it was 38.1 ± 8.7 months ( > 0.05). After the second stage of surgery, 1 case (5%) in group 1 and 11 cases (33.3%) in group 2 developed a urinary fistula ( < 0.05). One case (5%) in group 1 and three cases (9.1%) in group 2 had urethral stricture ( > 0.05). All strictures were cured by repeated dilation, and no patient required reoperation. No cases in group 1 and one case (3%) in group 2 had urethral diverticulum ( > 0.05). There was no residual chordee in both groups. Two cases (10%) in group 1 and 13 cases (39.3%) in group 2 required reoperation ( < 0.05).
Staged urethroplasty is appropriate to repair proximal hypospadias with severe chordee. Particularly, staged TIP urethroplasty is a good choice for patients with proximal hypospadias and severe chordee, especially those with better penile development, wider urethral plate, larger glans, and deeper navicular fossa of the urethra.
对于大多数小儿泌尿外科医生而言，伴有重度阴茎下弯的近端型尿道下裂仍是一项严峻挑战，治疗方法仍存在争议。在此，我们描述一种改良的两阶段技术来修复伴有重度阴茎下弯的近端型尿道下裂。
我们回顾性纳入了2016年7月至2019年7月因近端型尿道下裂伴重度阴茎下弯前来就诊并接受两阶段尿道成形术的53例患儿。第1组患儿采用分期管状化切开尿道板（TIP）尿道成形术进行修复，而第2组尝试采用拜尔斯两阶段尿道成形术。我们通过在阴茎脱套后松解所有与阴茎海绵体的剩余附着、横断尿道板以及背侧折叠来矫正阴茎下弯。第1组手术第一阶段患者的平均年龄为26.6个月，第2组为24.8个月。两组术后并发症包括：尿瘘、尿道狭窄、尿道憩室和龟头裂开。
共有20例采用分期TIP尿道成形术修复（第1组），33例采用拜尔斯两阶段尿道成形术修复（第2组）。第1组的随访时间为39.8±10.1个月，第2组为38.1±8.7个月（>0.05）。在第二阶段手术后，第1组有1例（5%）发生尿瘘，第2组有11例（33.3%）发生尿瘘（<0.05）。第1组有1例（5%）发生尿道狭窄，第2组有3例（9.1%）发生尿道狭窄（>0.05）。所有狭窄均通过反复扩张治愈，无患者需要再次手术。第1组无尿道憩室病例，第2组有1例（3%）发生尿道憩室（>0.05）。两组均无残余阴茎下弯。第1组有2例（10%）需要再次手术，第2组有13例（39.3%）需要再次手术（<0.05）。
分期尿道成形术适用于修复伴有重度阴茎下弯的近端型尿道下裂。特别是，分期TIP尿道成形术是近端型尿道下裂伴重度阴茎下弯患者的良好选择，尤其是那些阴茎发育较好、尿道板较宽、龟头较大且尿道舟状窝较深的患者。
