Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Urology, Jeffs Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD.
Urology. 2023 Jun;176:150-155. doi: 10.1016/j.urology.2023.03.007. Epub 2023 Mar 20.
To report the technique and outcomes of tissue expansion (TE) for generating additional penile skin for urethroplasty and/or skin coverage during primary or redo hypospadias repair in penoscrotal transposition (PST) patients with a proximal hypospadias.
Proximal hypospadias and PST patients with a lack of penile skin, congenitally or after failed repair, who underwent TE assisted reconstruction were reviewed. TE were placed under the penile shaft and expanded skin was used for tubularized incised plate repair. Success was defined as urethral advancement to the corona or more distal with tension free skin coverage.
A total of 24 patients underwent reconstruction including 16 as part of primary repair and for redo repairs in 8. Nine patients experienced expander extrusion and posturethroplasty complications occurred in 43.8% of primary repairs and 75.0% of redo repairs; a urethrocutaneous fistula was most common (n = 8). Overall, success was achieved in 87.5% of patients with postoperative meatal locations almost all coronal (45.8%) or glanular (50.0%).
Proximal hypospadias reconstruction is challenging, and complications are not infrequent. TE is a useful alternative for complex patients with a skin paucity such that cutaneous coverage would be difficult following urethroplasty. Although the complication rate was 43.8% for primary repair, TE generated sufficient residual skin for success after additional reconstruction. For redo repair early use is most beneficial as there is more expandable skin. The pseudocapsules provide vascularized coverage to reinforce the urethra while there is sufficient skin to minimize the need for a skin graft for penile coverage.
报告在近端尿道下裂合并阴茎阴囊转位（PST）患者中，应用组织扩张术（TE）为尿道成形术提供额外阴茎皮肤和/或初级或再次修复时的皮肤覆盖的技术和结果。
回顾了近端尿道下裂和 PST 患者，这些患者存在阴茎皮肤缺乏，无论是先天性的还是修复失败后的，他们接受了 TE 辅助重建。TE 被置于阴茎干下，扩张的皮肤用于管状切开板修复。成功定义为尿道向冠状沟或更远端推进，且皮肤张力正常。
共有 24 例患者接受了重建，其中 16 例为初次修复，8 例为再次修复。9 例患者发生扩张器脱出，43.8%的初次修复和 75.0%的再次修复发生术后尿道下裂并发症；最常见的是尿道-皮肤瘘（n=8）。总体而言，87.5%的患者获得成功，术后尿道口位置几乎都在冠状位（45.8%）或龟头位（50.0%）。
近端尿道下裂的重建具有挑战性，且并发症并不少见。TE 是一种有用的替代方法，适用于皮肤缺乏的复杂患者，在尿道成形术后，皮肤覆盖将变得困难。虽然初次修复的并发症发生率为 43.8%，但 TE 产生了足够的残余皮肤，为进一步重建后的成功提供了保障。对于再次修复，早期应用 TE 最为有益，因为此时有更多可扩张的皮肤。假性包膜提供了血管化覆盖，以加强尿道，同时有足够的皮肤，最大限度地减少对阴茎覆盖的皮肤移植的需求。
