Sholklapper Tamir, Crigger Chad, Morrill Christian, Harris Thomas G W, Haney Nora, Lue Kathy, Young Ezekiel, Gearhart John P
James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD.
Division of Plastic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Urology. 2023 Jan;171:190-195. doi: 10.1016/j.urology.2022.10.015. Epub 2022 Nov 3.
To describe long-term outcomes and experience with the tunica vaginalis flap (TVF) as a tissue augment for complex epispadias repair.
A prospectively maintained institutional database was reviewed for patients who underwent epispadias repair with TVF from 2010 to 2021. Evaluation of patient characteristics between those who developed dehiscence or UCF and those who did not was performed via Mann-Whitney U, Kruskal-Wallis, or Fisher's exact test, as appropriate.
A total of 47 male patients were identified, of whom, 1 (2.1%) had cloacal exstrophy, 38 (80.9%) had classic bladder exstrophy or a variant, and 8 (17.0%) had epispadias as their primary exstrophy-epispadias complex diagnosis. The median age at epispadias repair was 13 months (IQR 11 - 19). The overall rate of fistula or dehiscence development was 19.1% (9 patients), of whom, 7 developed urethrocutaneous fistulae, 1 dehiscence, and 1 both. Notably, 0 of the 5 patients who had undergone prior epispadias repair and 0 of the 8 patients with a diagnosis of isolated epispadias developed a UCF or dehiscence after repair with TVF. Differences in age at repair, primary EEC diagnosis, prior epispadias repair, pre-repair testosterone, fibrin sealant utilization, closure layers, stent removal time, and bladder capacity at repair were not statistically significant (P>.05) CONCLUSION: Our expanded evaluation indicates that utilization of the tunica vaginalis as an adjunct to epispadias repair may provide durable protection against fistula development in EEC patients who have undergone prior epispadias repair and in primary repair of patients with isolated epispadias.
描述采用睾丸鞘膜瓣（TVF）作为组织补片进行复杂型尿道上裂修复的长期疗效及经验。
回顾2010年至2021年期间采用TVF进行尿道上裂修复的患者的前瞻性维护机构数据库。根据情况，通过Mann-Whitney U检验、Kruskal-Wallis检验或Fisher精确检验，对发生裂开或尿道皮肤瘘（UCF）的患者与未发生者的患者特征进行评估。
共确定47例男性患者，其中1例（2.1%）患有泄殖腔外翻，38例（80.9%）患有典型膀胱外翻或变异型，8例（17.0%）以尿道上裂作为其主要的膀胱外翻-尿道上裂综合征诊断。尿道上裂修复时的中位年龄为13个月（四分位间距11 - 19）。瘘管或裂开的总体发生率为19.1%（9例患者），其中7例发生尿道皮肤瘘，1例发生裂开，1例两者皆有。值得注意的是，在5例曾接受过尿道上裂修复的患者中无人发生UCF或裂开，在8例诊断为孤立性尿道上裂的患者中也无人在采用TVF修复后发生UCF或裂开。修复时的年龄、主要膀胱外翻-尿道上裂综合征诊断、既往尿道上裂修复史、术前睾酮水平、纤维蛋白密封剂使用情况、闭合层数、支架移除时间以及修复时的膀胱容量差异均无统计学意义（P>0.05）。结论：我们扩大后的评估表明，在曾接受过尿道上裂修复的膀胱外翻-尿道上裂综合征患者以及孤立性尿道上裂患者的初次修复中，采用睾丸鞘膜作为尿道上裂修复的辅助手段可能为预防瘘管形成提供持久保护。
