Demirbilek S, Atayurt H F
Clinics of Pediatric Surgery, Social Security Council, Ankara Children's Hospital, Turkey.
J Pediatr Surg. 1997 Dec;32(12):1711-2. doi: 10.1016/s0022-3468(97)90511-x.
The authors report on 105 consecutive patients who underwent one-stage hypospadias repair based on use of suprapubic diversion or transurethral drainage with stenting.
The surgical procedures included 52 metal-based flap urethroplasty (Mathieu) for coronal, subcoronal, and distal shaft hypospadias; 32 transverse island pedicle graft (Duckett) for mid and proximal shaft hypospadias; 21 transverse island pedicle (Duckett) plus rolled midline tube (Thierchs) for penoscrotal and scrotal hypospadias. To accomplish urinary drainage, suprapubic diversion (cystofix) was used in 28 of 52 Mathieu operations, in 17 of 32 Duckett operations, and in 11 of 21 transverse island pedicle graft plus rolled midline tube operations. In the rest of the cases, transurethral drainage with stenting was used.
All children had excellent cosmetic and functional outcomes. But the rates of complications such as fistula and meatal stenosis were significantly different between the groups in which suprapubic tube or urethral stent was used. In 56 of the 105 patients in whom suprapubic diversion was used, four (7.14%) had fistulas and three (5.35%) had meatal stenosis, in contrast to a fistula rate of 14.28% and meatal stenosis rate of 12.24% in patients that urethral stent is used for urinary drainage.
The authors believe that the use of suprapubic diversion is advantageous for the outcome of one-stage hypospadias repair in relation to fistula occurrence and meatal stenosis.
作者报告了105例连续接受一期尿道下裂修复术的患者，手术基于耻骨上引流或经尿道支架引流。
手术方式包括52例用于冠状沟、冠状沟下及阴茎体远端尿道下裂的金属基皮瓣尿道成形术（马蒂厄手术）；32例用于阴茎体中段及近端尿道下裂的横行岛状带蒂皮瓣移植术（达基特手术）；21例用于阴茎阴囊及阴囊型尿道下裂的横行岛状带蒂皮瓣（达基特手术）加中线卷管（蒂尔希手术）。为实现尿液引流，52例马蒂厄手术中的28例、32例达基特手术中的17例以及21例横行岛状带蒂皮瓣移植加中线卷管手术中的11例采用了耻骨上引流（膀胱固定术）。其余病例采用经尿道支架引流。
所有患儿均获得了极佳的外观和功能效果。但在使用耻骨上引流管或尿道支架的组间，瘘管和尿道口狭窄等并发症发生率存在显著差异。在105例采用耻骨上引流的患者中，56例中有4例（7.14%）发生瘘管，3例（5.35%）出现尿道口狭窄，相比之下，使用尿道支架进行尿液引流的患者瘘管发生率为14.28%，尿道口狭窄发生率为12.24%。
作者认为，就瘘管发生和尿道口狭窄而言，耻骨上引流有利于一期尿道下裂修复的效果。
