Greenfield S P, Sadler B T, Wan J
Department of Urology, Children's Hospital of Buffalo, New York.
J Urol. 1994 Aug;152(2 Pt 1):498-501. doi: 10.1016/s0022-5347(17)32781-7.
In 39 patients a 2-stage modified Belt-Fuqua repair was performed for severe hypospadias and chordee. Patient age at initial surgery averaged 2 years and stage 2 was done 7 months later. Testosterone was given before stage 1 to 22 patients (56%) and before both stages to 13 (33%). Of 5 patients with intersex 2 had mixed gonadal dysgenesis, 1 was a true hermaphrodite and 2 were 46 XX male subjects. The preoperative meatal location was subglanular in 9 cases, mid shaft in 8, proximal shaft in 2, penoscrotal in 15 and perineal in 5. Those with subglanular meatus had hypoplastic distal urethras and severe chordee. A dorsal Nesbit procedure for chordee correction was done in 24 cases (62%). Neourethral length ranged from 3 to 7 cm. (average 4 cm.) and average followup was 16 months. Neourethral diverticula developed in 8 cases (21%) and they were repaired uneventfully an average of 7 months (range 2 to 24) after stage 2. Minor urethral strictures (3 distal and 4 proximal) were treated with a single visual internal urethrotomy and there was 1 (2.5%) urethrocutaneous fistula. All children had excellent cosmetic and functional outcomes. A staged approach allows for cosmetic reconstruction of the glans and mucosal collar during stage 1 and offers 2 opportunities to augment penile size with testosterone. Bladder or buccal mucosal grafts are avoided since the prepuce is always adequate. There are no hypospadias deformities, penile shaft torsion or asymmetry. Fistula formation is minimal and strictures are minor. The 2-stage repair remains a safe, reliable alternative for boys with severe hypospadias.
对39例重度尿道下裂合并阴茎下弯患者实施了两阶段改良Belt-Fuqua修复术。初次手术时患者的平均年龄为2岁，第二阶段手术在7个月后进行。22例患者（56%）在第一阶段手术前接受了睾酮治疗，13例患者（33%）在两个阶段手术前均接受了睾酮治疗。在5例两性畸形患者中，2例为混合性性腺发育不全，1例为真两性畸形，2例为46,XX男性。术前尿道口位置：冠状沟下9例，阴茎体中部8例，阴茎体近端2例，阴茎阴囊型15例，会阴型5例。冠状沟下尿道口的患者远端尿道发育不全且阴茎下弯严重。24例患者（62%）采用了阴茎背侧Nesbit手术矫正阴茎下弯。新尿道长度为3至7厘米（平均4厘米），平均随访时间为16个月。8例患者（21%）出现了新尿道憩室，在第二阶段手术后平均7个月（范围为2至24个月）进行了顺利修复。3例远端和4例近端出现轻度尿道狭窄，通过单次直视下尿道内切开术进行了治疗，出现1例（2.5%）尿道皮肤瘘。所有患儿的外观和功能均取得了良好的效果。分期手术方法在第一阶段允许对龟头和黏膜环进行外观重建，并提供了两次使用睾酮增加阴茎大小的机会。由于包皮总是足够的，因此避免了膀胱或颊黏膜移植。不存在尿道下裂畸形、阴茎扭转或不对称情况。瘘管形成极少，狭窄程度较轻。对于重度尿道下裂的男孩，两阶段修复术仍然是一种安全、可靠的选择。
