Al-Salihi Muthana, Abbas Tariq, Albakr Ahmed, Vallasciani Santiago, Elkadhi Abderrahman, Salle J L Pippi
Department of Surgery, Division of Urology, Sidra Medicine, Doha, Qatar; Department of Surgery, Weill Cornel Medicine - Qatar, Doha, Qatar.
Urology Department, Hamad Medical Corporation, Qatar.
J Pediatr Urol. 2023 Dec;19(6):699.e1-699.e7. doi: 10.1016/j.jpurol.2023.07.018. Epub 2023 Aug 1.
Management of proximal hypospadias remains challenging. We assessed the results of staged preputial graft repairs (SPG) for proximal hypospadias and hypothesize that post-operative vacuum physiotherapy (VP) improves graft suppleness and overall outcomes.
Retrospective analysis of n = 71 patients with proximal hypospadias and severe ventral penile curvature (PC) of ≥50° after degloving. PC was corrected using ventral transverse incisions of the tunica albuginea (VTITA) without applying a tourniquet, taking care to avoid injuring the underlying erectile tissue. The ventral raw area at the penile shaft, including VTITA, were covered with either divided and partially mobilized urethral plate, or with the inner preputial graft itself. During the second stage, a tunica vaginalis flap was often used to cover the tubularized neourethra. Outcomes and post-op complications were assessed after each stage, comparing patients who received vacuum physiotherapy (VP+, n = 49) with those who did not (VP-, n = 22).
Mean PC was 66°, average follow-up duration was 13.01 months, and overall complication rate was 22.5%. Only 6 of 49 VP + patients experienced complications (12.24%; 4 fistulas; 2 urethral strictures) and no recurrence of PC after second stage was observed in this group. VP- patients displayed a significantly higher rate of complications, with 10 of 22 cases (45.45%) exhibiting fistula development (n = 5) and glans dehiscence (n = 5). Recurrence of mild PC after first-stage repair was comparable between patient groups (12% VP+, 18% VP-) and easily corrected by simple graft tubularization or dorsal plication during second-stage repair.
Staged repair using VTITA is effective for correcting proximal hypospadias with severe chordee. VP appears to promote and expedite graft suppleness and significantly improves patient outcomes.
近端尿道下裂的治疗仍然具有挑战性。我们评估了分期包皮移植修复术（SPG）治疗近端尿道下裂的效果，并推测术后真空物理治疗（VP）可改善移植组织的柔韧性及总体治疗效果。
对71例近端尿道下裂且脱套术后阴茎腹侧严重弯曲（PC）≥50°的患者进行回顾性分析。采用白膜腹侧横向切口（VTITA）矫正PC，不使用止血带，注意避免损伤其下方的勃起组织。阴茎体腹侧的创面，包括VTITA，用分离并部分游离的尿道板或包皮内板移植片覆盖。在第二阶段，常使用睾丸鞘膜瓣覆盖管状化的新尿道。在每个阶段评估治疗效果及术后并发症，比较接受真空物理治疗的患者（VP +，n = 49）和未接受该治疗的患者（VP -，n = 22）。
平均PC为66°，平均随访时间为13.01个月，总体并发症发生率为22.5%。49例VP +患者中仅6例出现并发症（12.24%；4例瘘管；2例尿道狭窄），且该组第二阶段后未观察到PC复发。VP -患者的并发症发生率显著更高，22例中有10例（45.45%）出现瘘管形成（n = 5）和龟头裂开（n = 5）。第一阶段修复后轻度PC的复发在两组患者中相当（VP +组为12%，VP -组为18%），且在第二阶段修复时通过简单的移植片管状化或背侧折叠很容易纠正。
采用VTITA分期修复对于矫正伴有严重阴茎下弯的近端尿道下裂有效。VP似乎可促进并加快移植组织的柔韧性，并显著改善患者治疗效果。
