Jiang Jia-Bin, Chao Min, Zhang Yin, Zhang Ye, Zhang Kai-Ping, Hao Zong-Yao
Department of Urology / Anhui Medical University Research Institute of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui 230051, China.
Zhonghua Nan Ke Xue. 2022 Feb;28(2):135-139.
To study the effects of staged Duckett urethroplasty and Byars reconstruction in the treatment of severe hypospadias with dysplastic glans.
We retrospectively analyzed the clinical data on 57 cases of severe hypospadias with dysplastic glans treated by two-stage Duckett urethroplasty or Byars reconstruction from September 2015 to May 2020. At stage-Ⅰ treatment, the patients were aged from 5 to 47 (mean 21) months, the diameter of the glans less than 1.4 cm, and the interval between the two stages from 6 to 41 (mean 14) months. The patients underwent Duckett urethroplasty, distal in stage Ⅰ and proximal in stage Ⅱ (group A, n = 25) or Byars reconstruction with the urethral plate in stage Ⅰ and Duplay urethroplasty in stage Ⅱ (group B, n = 32). Postoperative follow-up lasted 12－56 (mean 35) months.
After stage Ⅱ surgery, penile straightening and smooth appearance of the graft were achieved in all the patients. Six cases of postoperative complications (24%) were observed in group A, including 4 cases of urinary fistula, 1 case of glans dehiscence, 1 case of urethral diverticulum and 1 case of urethral stricture, while 14 cases (43.8%) were observed in group B, including 9 cases of urinary fistula, 9 cases of glans dehiscence and 2 cases of urethral diverticulum, with a remarkably lower incidence rate of glans dehiscence in group A than in B (P = 0.043), but no statistically significant difference in the other observations between the two groups (P > 0.05).
Both staged strategies of Duckett urethroplasty and Byars reconstruction can be used for the treatment of severe hypospadias with dysplastic glans, but the latter may result in a higher incidence rate of glans dehiscence postoperatively and bring more difficulties to subsequent repair.
探讨分期行Duckett尿道成形术和拜尔斯重建术治疗阴茎头发育不良的重度尿道下裂的效果。
回顾性分析2015年9月至2020年5月采用两期Duckett尿道成形术或拜尔斯重建术治疗的57例阴茎头发育不良的重度尿道下裂患者的临床资料。Ⅰ期治疗时，患者年龄5至47（平均21）个月，阴茎头直径小于1.4 cm，两期手术间隔6至41（平均14）个月。患者接受Duckett尿道成形术，Ⅰ期行远端手术，Ⅱ期行近端手术（A组，n = 25）或Ⅰ期行带尿道板的拜尔斯重建术，Ⅱ期行杜普莱尿道成形术（B组，n = 32）。术后随访12至56（平均35）个月。
Ⅱ期手术后，所有患者阴茎均伸直，移植物外观平整。A组观察到6例术后并发症（24%），包括4例尿瘘、1例阴茎头裂开、1例尿道憩室和1例尿道狭窄，而B组观察到14例（43.8%），包括9例尿瘘、9例阴茎头裂开和2例尿道憩室，A组阴茎头裂开的发生率明显低于B组（P = 0.043），但两组其他观察指标差异无统计学意义（P > 0.05）。
分期Duckett尿道成形术和拜尔斯重建术均可用于治疗阴茎头发育不良的重度尿道下裂，但后者术后阴茎头裂开的发生率可能较高，给后续修复带来更多困难。
