Glassberg K I, Hansbrough F, Horowitz M
Division of Pediatric Urology, State University of New York Health Science Center at Brooklyn, USA.
J Urol. 1998 Sep;160(3 Pt 2):1104-7; discussion 1137. doi: 10.1097/00005392-199809020-00038.
We report our experience with 1-stage Koyanagi-Nonomura hypospadias repair, which may be performed even when penoscrotal transposition is present. Repair involves bilateral parameatal skin flaps based on the meatus and urethral plate.
A total of 14 boys 10 to 20 months old underwent 1-stage Koyanagi-Nonomura repair for severe hypospadias. The meatus was proximal to the penoscrotal junction in all patients, and in 8 penoscrotal transposition was corrected during the same operation.
In 7 of the 14 boys 1 or more fistulas developed that were subsequently repaired. In all cases the fistula was on the proximal shaft and/or penoscrotal junction. In no case was there stenosis or breakdown of the distal neourethra.
The Koyanagi-Nonomura 1-stage repair provides excellent cosmetic results in severe hypospadias while preserving the available urethral plate tissue. It is particularly suitable when there is associated penoscrotal transposition. Most if not all 1-stage repairs are inappropriate in patients with severe hypospadias and penoscrotal transposition. In other repairs vascular supply to Byar's flaps and the neourethra may be compromised by mobilization of the anteriorly transposed scrotal tissue. We expect that the fistula rate will decrease with experience but now it is acceptable, considering the severity of hypospadias.
我们报告一期小柳-野村尿道下裂修复术的经验，即使存在阴茎阴囊转位也可进行该手术。修复包括基于尿道口和尿道板的双侧尿道口旁皮瓣。
共有14名10至20个月大的男孩因重度尿道下裂接受了一期小柳-野村修复术。所有患者的尿道口均位于阴茎阴囊交界处近端，其中8例在同一手术中矫正了阴茎阴囊转位。
14名男孩中有7名出现1处或多处瘘管，随后进行了修复。所有病例的瘘管均位于近端阴茎干和/或阴茎阴囊交界处。无一例远端新尿道出现狭窄或破裂。
小柳-野村一期修复术在重度尿道下裂中可提供出色的美容效果，同时保留可用的尿道板组织。当伴有阴茎阴囊转位时尤其适用。大多数（若非全部）一期修复术对于重度尿道下裂合并阴茎阴囊转位的患者并不适用。在其他修复术中，向前移位的阴囊组织的游离可能会损害拜尔皮瓣和新尿道的血供。我们预计随着经验的积累，瘘管发生率将会降低，但考虑到尿道下裂的严重程度，目前这一发生率是可以接受的。
