Department of Urology, Children's Hospital of Nanjing Medical University, Jiangsu Provincial Children's Medical Center, Nanjing, Jiangsu, China.
Department of Urology, Children's Hospital of Nanjing Medical University, Jiangsu Provincial Children's Medical Center, Nanjing, Jiangsu, China.
J Plast Reconstr Aesthet Surg. 2024 Nov;98:331-336. doi: 10.1016/j.bjps.2024.09.046. Epub 2024 Sep 17.
Urethral plate (UP) reserved Onlay urethroplasty is currently used widely in mid-distal hypospadias. However, for children with 15-30° residual curvature after degloving, only dorsal tunica albuginea plication is performed to correct penile ventral curvature (VC), and long-term follow-up showed a high recurrence rate of penile curvature. We developed a modified Onlay urethroplasty, which dissociates the UP and completely removes the tissue beneath the UP to fully correct penile curvature. Furthermore, we compared it with the standard Onlay urethroplasty to explore its rationality and feasibility.
We prospectively collected clinical data from 68 children with hypospadias who underwent standard or modified Onlay urethroplasty between September 2019 and June 2021, and evaluated the interim outcomes to identify the complications between the two groups. Additionally, we conducted histological examination of the tissue beneath the UP.
A total of 32 patients underwent modified Onlay urethroplasty. Intraoperative curvature measurements showed that 37.5% (12/32) of the patients had completely straightened their penis after UP dissection and removal of the fibrous tissue beneath it. A total of 36 patients underwent standard Onlay urethroplasty. Totally, five fistulas each were reported in the first and second groups, and the complication rates were 15.6% and 13.9%, respectively (P > 0.05). The histological results showed that the tissue below the UP contains a large amount of collagen, mainly type I collagen.
The dissociated UP Onlay urethroplasty can maximally remove factors limiting penis growth and completely correct penile curvature, without increasing the incidence of postoperative complications. Therefore, we recommend the application of the improved Onlay urethroplasty in children with mid-distal hypospadias.
尿道板（UP）保留式尿道成形术目前广泛应用于中远端尿道下裂。然而，对于去套后残余弯曲度为 15-30°的儿童，仅行背侧白膜折叠术来矫正阴茎腹侧弯曲（VC），长期随访显示阴茎弯曲复发率较高。我们开发了一种改良的尿道板保留式尿道成形术，该术式将 UP 分离并完全去除 UP 下方的组织，以充分矫正阴茎弯曲。此外，我们将其与标准尿道板保留式尿道成形术进行比较，以探讨其合理性和可行性。
我们前瞻性收集了 2019 年 9 月至 2021 年 6 月期间 68 例接受标准或改良尿道板保留式尿道成形术的尿道下裂患儿的临床资料，并对中期结果进行评估，以确定两组之间的并发症。此外，我们对 UP 下方的组织进行了组织学检查。
共 32 例患者接受了改良的尿道板保留式尿道成形术。术中弯曲度测量显示，37.5%（12/32）的患者在 UP 分离和去除其下方纤维组织后阴茎完全伸直。共 36 例患者接受了标准的尿道板保留式尿道成形术。第一组和第二组各有 5 例出现瘘管，发生率分别为 15.6%和 13.9%（P>0.05）。组织学结果显示，尿道板下方组织含有大量胶原，主要为 I 型胶原。
分离的 UP 保留式尿道成形术可最大限度地去除限制阴茎生长的因素，完全矫正阴茎弯曲，且不会增加术后并发症的发生率。因此，我们建议在中远端尿道下裂患儿中应用改良的尿道板保留式尿道成形术。
