Zulli Andrea, Mantovani Alberto, Gigola Francesca, Landi Luca, Taverna Maria, Cini Chiara, Bortot Giulia, Olivera Laura, Masieri Lorenzo, Elia Antonio
Department of Pediatric Surgery and Urology, Meyer Children's Hospital IRCCS, Viale Pieraccini 24, 50134, Florence, Italy.
Neurofarba Department, University of Florence, Florence, Italy.
Pediatr Surg Int. 2024 Dec 16;41(1):29. doi: 10.1007/s00383-024-05926-3.
Urethrocutaneous fistula (UCF) is the most common complication after hypospadias repair, with an variable incidence of 2-35%, depending on defect type. The interposition of tissue between the neourethra and the skin or glans is considered an important factor to reduce the risk of UCF. Literature has focused on the comparison of different types of second layers, but there is still no consensus regarding the best tissue to adopt. By contrast, literature regarding not-covered urethroplasty is lacking. Our aim is to investigate the value of hypospadias repair without a second-layer and to compare the results with hypospadias repaired with the use of an alternative, easily available second layer of periurethral tissue.
All distal and mid-penile hypospadias treated with single-stage urethroplasty at our centre between 2016 and 2020 were reviewed. Cases were divided according to the surgical technique: Group-A (urethroplasty with a second layer of periurethral tissue) and Group-B (single-layer urethroplasty). Anagraphic data and complications such as UCF and meatal stenosis were analysed.
425 single-stage urethroplasties were collected. 30 cases of UCF were observed (7%), 11/164 for Group A (6,7%) and 19/261 for Group B (7,3%) at a mean follow-up of 3 years. The difference was not statistically significant (p = 0.8). In 11/30 patients (37%) the UCF was associated with meatal stenosis.
A well-performed urethral suture, more than a second layer, is fundamental to prevent UCFs. Periurethral tissue is a valid second layer, providing good coverage with minimal tissue manipulation. Larger, prospective and randomised studies could be encouraged to confirm our data.
尿道皮肤瘘（UCF）是尿道下裂修复术后最常见的并发症，其发生率在2%至35%之间，因缺损类型而异。在新尿道与皮肤或龟头之间置入组织被认为是降低UCF风险的重要因素。文献主要集中在不同类型的第二层组织的比较上，但对于最佳采用组织仍未达成共识。相比之下，关于无覆盖尿道成形术的文献较少。我们的目的是研究无第二层组织的尿道下裂修复术的价值，并将结果与使用替代的、易于获取的尿道周围组织第二层进行修复的尿道下裂结果进行比较。
回顾了2016年至2020年在我们中心接受单阶段尿道成形术治疗的所有阴茎远端和中段尿道下裂病例。根据手术技术将病例分为：A组（使用尿道周围组织第二层的尿道成形术）和B组（单层尿道成形术）。分析了患者的基本数据以及诸如UCF和尿道口狭窄等并发症。
共收集到425例单阶段尿道成形术。平均随访3年时，观察到30例UCF（7%），A组164例中有11例（6.7%），B组261例中有19例（7.3%）。差异无统计学意义（p = 0.8）。在30例患者中有11例（37%）的UCF与尿道口狭窄相关。
良好的尿道缝合比第二层组织更重要，是预防UCF的关键。尿道周围组织是有效的第二层组织，能在最小限度的组织操作下提供良好的覆盖。鼓励开展更大规模的前瞻性随机研究以证实我们的数据。
