Gupta Survesh Kumar, Singh Sudhir, Pant Nitin, Rawat Jiledar, Wakhlu Ashish
Department of Paediatrics Surgery, King George Medical University, Lucknow, Uttar Pradesh, India.
Int J Appl Basic Med Res. 2025 Jan-Mar;15(1):18-24. doi: 10.4103/ijabmr.ijabmr_301_24. Epub 2025 Jan 9.
Hypospadias is a common congenital malformation, with proximal hypospadias occurring in 20% of cases and having a higher incidence of complications than distal hypospadias. Surgical reconstruction varies between single-stage and multi-stage procedures, with no consensus on the optimal approach.
This study aimed to compare the outcomes of single-stage and staged repairs for proximal hypospadias in a lower middle-income country, focusing on complications, operative time, patient satisfaction, and overall surgical success.
An ambispective observational study was conducted at King George's Medical University, Lucknow, from May 2014 to February 2020. Sixty patients with proximal penile hypospadias and chordee were selected (29 from previous medical records and 31 were enrolled prospectively) and divided into two groups of 30 each: single-stage reconstruction and staged repair. Data on demographics, follow-up duration, complications, reoperations, and satisfaction were collected. The Hypospadias Objective Scoring Evaluation (HOSE) system as well as cosmesis was used to assess outcomes at 6-week follow-up.
The mean age was 3.8 years for single-stage and 4.5 years for staged repair, with no significant age difference ( = 0.725). The mean operating time was 90 min for single-stage and 210 min for staged repair. Complication rates, including meatal stenosis and urethral stricture, showed no significant differences. However, graft rejection occurred in four staged repair cases ( = 0.112). The staged repair group had higher reoperation rates (26.67% vs. 13.33%, = 0.062) and longer hospital stays (26.47 vs. 13.87 days, = 0.0001). Staged repair achieved better slit-like meatus shapes (83.3% vs. 60%, = 0.021) and higher satisfaction with residual skin ( = 0.004). HOSE scores showed significant advantages for staged repair in the urinary stream ( = 0.048) and erection outcomes ( = 0.001).
Staged repair showed better cosmetic outcomes and satisfaction in specific areas but required more operative time and hospital stay. Single-stage reconstruction was more cost-effective and had fewer reoperations. The choice of procedure should consider patient-specific factors and resource availability.
尿道下裂是一种常见的先天性畸形，近端尿道下裂占病例的20%，其并发症发生率高于远端尿道下裂。手术重建分为单阶段和多阶段手术，对于最佳方法尚无共识。
本研究旨在比较低收入中等收入国家近端尿道下裂单阶段和分期修复的结果，重点关注并发症、手术时间、患者满意度和总体手术成功率。
2014年5月至2020年2月在勒克瑙的乔治国王医学院进行了一项前瞻性观察研究。选择60例近端阴茎型尿道下裂合并阴茎下弯患者（29例来自既往病历，31例前瞻性纳入），分为两组，每组30例：单阶段重建组和分期修复组。收集人口统计学、随访时间、并发症、再次手术和满意度数据。在6周随访时，使用尿道下裂客观评分评估（HOSE）系统以及美容效果来评估结果。
单阶段修复组的平均年龄为3.8岁，分期修复组为4.5岁，年龄差异无统计学意义（P = 0.725）。单阶段修复的平均手术时间为90分钟，分期修复为210分钟。包括尿道口狭窄和尿道狭窄在内的并发症发生率无显著差异。然而，分期修复组有4例发生移植物排斥反应（P = 0.112）。分期修复组的再次手术率更高（26.67%对13.33%，P = 0.062），住院时间更长（26.47天对13.87天，P = 0.0001）。分期修复在尿道口形状呈裂隙状方面效果更好（83.3%对60%，P = 0.021），对残留皮肤的满意度更高（P = 0.004）。HOSE评分显示分期修复在尿流（P = 0.048）和勃起结果（P = 0.001）方面具有显著优势。
分期修复在特定方面显示出更好的美容效果和满意度，但需要更多的手术时间和住院时间。单阶段重建更具成本效益，再次手术较少。手术方式的选择应考虑患者的具体因素和资源可用性。
