Oshiba Ahmed, Kotb Mostafa
Department of Pediatric Surgery, Alexandria Faculty of Medicine, Alexandria, Egypt.
Front Surg. 2023 Jun 23;10:1202539. doi: 10.3389/fsurg.2023.1202539. eCollection 2023.
Proximal hypospadias is considered the most severe subtype of the hypospadias spectrum and represents approximately one-fifth of the total cases. It is well-evidenced by many studies that the rate of postoperative complications following the repair of this complex subtype is significantly higher when compared to the distal variants. Few reports described the proximal hypospadias from the other perspective which is the preoperative one. Most pediatric surgeons notice an unexplained incidence of lower urinary tract infection and occasional difficulty of urinary catheterization in those children. This sometimes requires the use of additional measures such as the use of urethral sounds, filiforms and followers, and even catheterization under anesthesia. The aim of the work is to evaluate the role of preoperative cystourethroscopy in detecting associated anomalies in cases of proximal and severe hypospadias.
This prospective study was conducted in the pediatric surgery unit at Alexandria Faculty of Medicine between July 2020 and December 2021 and included all children with severe grades of hypospadias. After thorough evaluation, all children underwent cystourethroscopy just before the procedure. Any abnormalities in the urethra, urinary bladder, or ureteric openings were recorded if present. Finally, the definitive operation was performed as per schedule.
Fifty-two patients (41 fresh and 11 redo patients) with a median (range) age at presentation of 5 (1-16) years were enrolled in this study. The intraoperative cystourethroscopy was done in all of the patients. Significant abnormal findings were recorded in 32 patients (61.5%), while the other 20 patients (38.5%) were revealed to be normal. The most common abnormal findings were dilated prostatic utricle opening and hypertrophied verumontanum (in 23 and 16 cases, respectively).
Although most of the associated anomalies with proximal hypospadias are asymptomatic, cystourethroscopy is better used owing to a high incidence of these anomalies. This can facilitate an early diagnosis as well as early detection and intervention at the time of repair.
近端型尿道下裂被认为是尿道下裂谱系中最严重的亚型，约占所有病例的五分之一。许多研究充分证明，与远端型尿道下裂相比，修复这种复杂亚型术后并发症的发生率显著更高。很少有报告从术前这一角度描述近端型尿道下裂。大多数小儿外科医生注意到这些儿童下尿路感染的发生率不明原因，且偶尔存在导尿困难。这有时需要采取额外措施，如使用尿道探子、丝状探子和跟随探子，甚至在麻醉下进行导尿。本研究的目的是评估术前膀胱尿道镜检查在检测近端型和重度尿道下裂病例相关异常中的作用。
本前瞻性研究于2020年7月至2021年12月在亚历山大医学院儿外科进行，纳入所有重度尿道下裂患儿。经过全面评估后，所有患儿在手术前均接受膀胱尿道镜检查。记录尿道、膀胱或输尿管开口处的任何异常情况（如有）。最后，按计划进行确定性手术。
本研究共纳入52例患者（41例初治患者和11例再次手术患者），中位（范围）就诊年龄为5（1 - 16）岁。所有患者均进行了术中膀胱尿道镜检查。32例患者（61.5%）记录到显著异常发现，而其他20例患者（38.5%）显示正常。最常见的异常发现是前列腺囊开口扩张和精阜肥大（分别为23例和16例）。
尽管近端型尿道下裂的大多数相关异常无症状，但由于这些异常的发生率较高，膀胱尿道镜检查仍更适用。这有助于早期诊断以及在修复时进行早期发现和干预。
