Xie Qi-Gen, Xue Ting-Ting, Chen Xu-Ren, Li Zhao-Ying, Xu Zhe, Li Zuo-Qing, Luo Peng
Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
Department of Thoracic Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510620, China.
Asian J Androl. 2025 Jan 1;27(1):65-71. doi: 10.4103/aja202470. Epub 2024 Sep 6.
This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias. We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between October 2012 and October 2022. In total, 31 patients underwent the conventional Byars procedure (conventional group), and 45 patients underwent the modified Byars staged procedure (modified group). Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage. Notably, there were no statistically significant differences in the preoperative baseline characteristics, duration of surgery, amount of blood loss, or occurrence of postoperative complications, including urethral fistula, stricture and diverticulum, or penile curvature, between the conventional and modified groups. However, there was a significantly lower incidence of coronal sulcus fistula (0 vs 16.1%, P = 0.02) and glans dehiscence (0 vs 12.9%, P = 0.02) in the surgical group than that in the conventional group. In addition, the modified group exhibited a notably greater rate of normotopic urethral opening (100.0% vs 83.9%, P = 0.01) and a higher mean score on the Hypospadias Objective Penile Evaluation (HOPE; mean ± standard error of mean: 8.6 ± 0.2 vs 7.9 ± 0.3, P = 0.02) than did the conventional group. In conclusion, the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula. Consequently, it offers a promising approach for achieving favorable penile esthetics, thereby providing a reliable therapeutic option for severe hypospadias.
本研究旨在介绍一种改良的拜尔斯分期手术，并探讨其在重度尿道下裂患者中的应用价值。我们回顾性分析了2012年10月至2022年10月期间在中山大学附属第一医院（中国广州）收治的重度尿道下裂患者的临床资料。共有31例患者接受了传统的拜尔斯手术（传统组），45例患者接受了改良的拜尔斯分期手术（改良组）。我们的改良策略是在标准拜尔斯手术的基础上，在第一阶段纳入龟头成形术，并在第二阶段采用Y形皮瓣联合腺体隧道进行尿道成形术。值得注意的是，传统组和改良组在术前基线特征、手术时间、失血量或术后并发症（包括尿道瘘、狭窄和憩室或阴茎弯曲）的发生率方面，均无统计学显著差异。然而，手术组冠状沟瘘（0%对16.1%，P = 0.02）和龟头裂开（0%对12.9%，P = 0.02）的发生率明显低于传统组。此外，改良组的尿道口正常位置率（100.0%对83.9%，P = 0.01）明显高于传统组，在尿道下裂客观阴茎评估（HOPE；平均值±平均标准误差：8.6±0.2对7.9±0.3，P = 0.02）中的平均得分也更高。总之，改良的拜尔斯分期手术显著降低了龟头裂开和冠状沟瘘的风险。因此，它为实现良好的阴茎美学提供了一种有前景的方法，从而为重度尿道下裂提供了一种可靠的治疗选择。
