Wu Yong, Guan Yong, Wang Xin, Wang Cong, Ma Xiong, Guan Heyang
Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, China.
Graduate School of Tianjin Medical University, Tianjin, China.
Transl Pediatr. 2023 Mar 31;12(3):387-395. doi: 10.21037/tp-23-75. Epub 2023 Mar 27.
Surgical correction of proximal hypospadias is challenging. The complication rate of proximal hypospadias is still high, and the debate over its optimal treatment is ongoing. Duckett's method is a classic non-staging operation, and two-stage Bracka repair is an attractive alternative procedure. Herein, we retrospectively analyzed the effects of two surgical techniques on proximal hypospadias in order to reduce the complication rates of proximal hypospadias, and analyzed the various risk factors that cause complications.
This study retrospectively evaluated 94 consecutive patients who underwent repair of penoscrotal or proximal defects between 2015 and 2019. Patients were assigned to two groups: 46 patients were treated with Bracka and 48 with Duckett. Patient age at surgery, urethral meatus location, and postoperative complications were recorded. One-way analysis of variance (ANOVA) was used to analyze the length and curvature of the penis and the length of the urethral defect.
There was no significant difference between the two groups in terms of age and type of hypospadias. In the Bracka group, there was 1 case (2.2%) of meatal stenosis after the first stage, which was restored with ureteral dilatation. After second-stage repair, a urethral fistula was noted in 4 cases (8.7%) and strictures in 2 cases (4.3%). In the Duckett group, urethral fistulas were noted in 8 cases (16.7%), strictures in 4 cases (8.3%), partial glans dehiscence in 4 cases (8.3%), and diverticulum in 1 case (2.1%) postoperatively. Compared with the Duckett group, the overall complication rate for Bracka repair was lower (35.4% 13%, P=0.016). In addition, compared with the Duckett group, children with perineal hypospadias who were treated with the Bracka operation had fewer postoperative complications (100% 13%, P=0.015). Risk factor analysis showed that the initial curvature of the penis, initial urethral defect, and degree of penile curvature after skin degloving were not correlated with complications. There was a significant correlation between urethral defects after correction of the chordee and urethral fistulas (P0.019).
Compared with the Duckett procedure, the Bracka two-stage repair may be a safer and more reliable approach for proximal hypospadias in children. The Bracka two-stage repair should be used for perineal hypospadias. The larger the urethral defect after chordee correction, the greater the possibility of a postoperative urethral fistula.
近端尿道下裂的手术矫正具有挑战性。近端尿道下裂的并发症发生率仍然很高，关于其最佳治疗方法的争论仍在继续。达克特（Duckett）法是一种经典的非分期手术，而两阶段布拉克（Bracka）修复术是一种有吸引力的替代手术。在此，我们回顾性分析了两种手术技术对近端尿道下裂的影响，以降低近端尿道下裂的并发症发生率，并分析了导致并发症的各种风险因素。
本研究回顾性评估了2015年至2019年间连续接受阴茎阴囊或近端缺损修复的94例患者。患者被分为两组：46例接受布拉克手术治疗，48例接受达克特手术治疗。记录患者手术时的年龄、尿道口位置和术后并发症。采用单因素方差分析（ANOVA）分析阴茎的长度和弯曲度以及尿道缺损的长度。
两组在年龄和尿道下裂类型方面无显著差异。在布拉克组中，第一阶段后有1例（2.2%）出现尿道口狭窄，经输尿管扩张恢复。第二阶段修复后，4例（8.7%）出现尿道瘘，2例（4.3%）出现狭窄。在达克特组中，术后8例（16.7%）出现尿道瘘，4例（8.3%）出现狭窄，4例（8.3%）出现部分龟头裂开，1例（2.1%）出现憩室。与达克特组相比，布拉克修复术的总体并发症发生率较低（35.4%对13%，P = 0.016）。此外，与达克特组相比，接受布拉克手术治疗的会阴型尿道下裂患儿术后并发症较少（100%对13%，P = 0.015）。风险因素分析表明，阴茎的初始弯曲度、初始尿道缺损以及脱套后阴茎弯曲度与并发症无关。矫正阴茎下弯后尿道缺损与尿道瘘之间存在显著相关性（P<0.019）。
与达克特手术相比，布拉克两阶段修复术可能是治疗儿童近端尿道下裂更安全、更可靠的方法。布拉克两阶段修复术应用于会阴型尿道下裂。矫正阴茎下弯后尿道缺损越大，术后发生尿道瘘的可能性越大。
