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尿道下裂治疗的进展:趋势、技术、培训及以患者为中心的结果

Advancements in Hypospadias Management: Trends, Techniques, Training, and Patient-Centric Outcomes.

作者信息

Bhatia Vinaya, Fernandez Nicolas, Long Christopher, Sturm Renea, Farhat Walid, O'Kelly Fardod

机构信息

Department of Urology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA.

Department of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA.

出版信息

Urol Res Pract. 2024 Mar 31;50(2):94-101. doi: 10.5152/tud.2024.23219.

Abstract

Hypospadias has drawn increasing attention due to its prevalence, complex etiology, and significant impacts on psychological and sexual quality of life. This comprehensive review delves into the facets of hypospadias management, exploring pivotal themes that shape present understanding and practice. We demonstrate potential explanatory factors for its incidence through an analysis of geographic, genetic, and environmental influences. We then contextualize care by exploring historical and evolving surgical techniques, and highlight that advances in surgical approaches employ a spectrum of repair strategies. Innovation in surgical training, with a focus on simulation-based methodologies, offers a bridge between didactic learning and real-world application, which is particularly relevant due to the demonstrated effect of personal experience with hypospadias repair outcomes. Considering the importance of mentorship, case exposure, and hands-on practice, a holistic understanding of expertise cultivation at each training stage is essential. Lastly, patient-centric outcomes research must take center stage, particularly as the impact of our interventions on children with hypospadias will be judged by them as adults. Shifting from solely surgeon-reported outcomes to patient-reported outcomes is emphasized in the review, allowing for a more comprehensive assessment of the influence of surgical interventions across the lifespan. Integrating patients' perspectives refines surgical decision-making to align with expectations, ultimately enhancing overall satisfaction. Our multi-pronged exploration of advancements in hypospadias underscores the symbiotic relationship between evolving surgical techniques, training methodologies, personal experience, and patientreported outcomes. As the field progresses, these insights will collectively contribute to optimizing hypospadias care, advancing both medical practice and patient well-being.

摘要

由于尿道下裂的患病率、复杂的病因以及对心理和性生活质量的重大影响,它已引起越来越多的关注。这篇综述深入探讨了尿道下裂治疗的各个方面,探索了塑造当前理解和实践的关键主题。我们通过分析地理、遗传和环境影响来展示其发病率的潜在解释因素。然后,我们通过探索历史和不断发展的手术技术来阐述护理情况,并强调手术方法的进步采用了一系列修复策略。以模拟方法为重点的手术培训创新,为理论学习与实际应用之间架起了一座桥梁,鉴于尿道下裂修复结果的个人经验所显示的效果,这一点尤为重要。考虑到导师指导、病例接触和实践操作的重要性,全面了解每个培训阶段的专业技能培养至关重要。最后,以患者为中心的结果研究必须占据核心地位,尤其是因为我们的干预措施对患有尿道下裂的儿童的影响将由他们成年后进行评判。综述强调从仅由外科医生报告的结果转向患者报告的结果,以便更全面地评估手术干预在整个生命周期中的影响。纳入患者的观点可以优化手术决策以符合期望,最终提高总体满意度。我们对尿道下裂进展的多方面探索强调了不断发展的手术技术、培训方法、个人经验和患者报告结果之间的共生关系。随着该领域的发展,这些见解将共同有助于优化尿道下裂护理,推动医学实践和患者福祉的提升。

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