Rushton H G, Belman A B
Department of Pediatric Urology, Children's National Medical Center, Washington, DC 20010, USA.
J Urol. 1998 Sep;160(3 Pt 2):1134-6; discussion 1137.
We describe the surgical technique and report the results of the first 100 patients who underwent a modification of the onlay hypospadias repair, which we refer to as split prepuce in situ onlay repair.
We treated 100 boys with a mean age of 11 months at surgery who had coronal to mid shaft hypospadias with split prepuce in situ onlay hypospadias repair. The operative technique varies from that of the standard onlay procedure by preserving the whole blood supply of the half of the prepuce used for the island onlay flap, and using its abundant subcutaneous tissue to cover completely the suture lines used to create the neourethra.
Only 5 complications required reoperation, including 1 hematoma evacuation and 4 urethrocutaneous fistulas. No patient had meatal stenosis, urethral stricture, meatal retraction or acquired urethral diverticulum necessitating reoperation. A good cosmetic result was obtained in all cases.
Split prepuce in situ onlay hypospadias repair is applicable in virtually all cases of coronal to mid shaft hypospadias. It optimizes the blood supply to the island flap and provides well vascularized coverage of the neourethra, resulting in a decreased complication rate.
我们描述了手术技术，并报告了首批100例行改良的覆盖法尿道下裂修复术（我们称之为原位包皮劈开覆盖法修复术）患者的治疗结果。
我们对100例平均手术年龄为11个月、患有冠状沟至阴茎体中段尿道下裂的男孩采用原位包皮劈开覆盖法尿道下裂修复术进行治疗。该手术技术与标准覆盖法不同，保留了用于岛状覆盖皮瓣的一半包皮的全部血供，并利用其丰富的皮下组织完全覆盖用于构建新尿道的缝合线。
仅5例并发症需要再次手术，包括1例血肿清除和4例尿道皮肤瘘。无患者出现尿道口狭窄、尿道狭窄、尿道口回缩或后天性尿道憩室而需要再次手术。所有病例均获得了良好的美容效果。
原位包皮劈开覆盖法尿道下裂修复术几乎适用于所有冠状沟至阴茎体中段尿道下裂病例。它优化了岛状皮瓣的血供，并为新尿道提供了血运良好的覆盖，从而降低了并发症发生率。
