Abstract：
To report the technique and outcomes of tissue expansion (TE) for generating additional penile skin for urethroplasty and/or skin coverage during primary or redo hypospadias repair in penoscrotal transposition (PST) patients with a proximal hypospadias.
Proximal hypospadias and PST patients with a lack of penile skin, congenitally or after failed repair, who underwent TE assisted reconstruction were reviewed. TE were placed under the penile shaft and expanded skin was used for tubularized incised plate repair. Success was defined as urethral advancement to the corona or more distal with tension free skin coverage.
A total of 24 patients underwent reconstruction including 16 as part of primary repair and for redo repairs in 8. Nine patients experienced expander extrusion and posturethroplasty complications occurred in 43.8% of primary repairs and 75.0% of redo repairs; a urethrocutaneous fistula was most common (n = 8). Overall, success was achieved in 87.5% of patients with postoperative meatal locations almost all coronal (45.8%) or glanular (50.0%).
Proximal hypospadias reconstruction is challenging, and complications are not infrequent. TE is a useful alternative for complex patients with a skin paucity such that cutaneous coverage would be difficult following urethroplasty. Although the complication rate was 43.8% for primary repair, TE generated sufficient residual skin for success after additional reconstruction. For redo repair early use is most beneficial as there is more expandable skin. The pseudocapsules provide vascularized coverage to reinforce the urethra while there is sufficient skin to minimize the need for a skin graft for penile coverage.
Proximal hypospadias and PST patients with a lack of penile skin, congenitally or after failed repair, who underwent TE assisted reconstruction were reviewed. TE were placed under the penile shaft and expanded skin was used for tubularized incised plate repair. Success was defined as urethral advancement to the corona or more distal with tension free skin coverage.
A total of 24 patients underwent reconstruction including 16 as part of primary repair and for redo repairs in 8. Nine patients experienced expander extrusion and posturethroplasty complications occurred in 43.8% of primary repairs and 75.0% of redo repairs; a urethrocutaneous fistula was most common (n = 8). Overall, success was achieved in 87.5% of patients with postoperative meatal locations almost all coronal (45.8%) or glanular (50.0%).
Proximal hypospadias reconstruction is challenging, and complications are not infrequent. TE is a useful alternative for complex patients with a skin paucity such that cutaneous coverage would be difficult following urethroplasty. Although the complication rate was 43.8% for primary repair, TE generated sufficient residual skin for success after additional reconstruction. For redo repair early use is most beneficial as there is more expandable skin. The pseudocapsules provide vascularized coverage to reinforce the urethra while there is sufficient skin to minimize the need for a skin graft for penile coverage.
摘要：
目的：报告在伴有近端尿道下裂的阴囊转位（PST）患者的原发性或重发尿道下裂修复期间，组织扩张（TE）为尿道成形术和/或皮肤覆盖生成额外的阴茎皮肤的技术和结果。
方法：阴茎皮肤缺乏的近端尿道下裂和PST患者，先天性或修复失败后，对接受TE辅助重建的患者进行了审查.将TE置于阴茎轴下，并将扩张的皮肤用于管状切开的钢板修复。成功被定义为尿道向电晕或更远的方向推进，并具有无张力的皮肤覆盖。
结果：共有24例患者接受了重建，其中16例作为初次修复的一部分，8例进行了重做修复。9例患者发生扩张器挤压和尿道成形术并发症，占43.8％的初次修复和75.0％的重做修复；尿道皮肤瘘最常见（n=8）。总的来说,在87.5%的患者中,术后产肉部位几乎全部为冠状(45.8%)或腺体(50.0%).
结论：尿道下裂近端重建具有挑战性，并发症并非罕见。对于皮肤缺乏的复杂患者，TE是一种有用的替代方法，因此在尿道成形术后难以覆盖皮肤。虽然一期修复的并发症发生率为43.8%,TE产生足够的残余皮肤以在额外的重建后成功。对于重做修复，早期使用是最有益的，因为有更多的可扩张的皮肤。假胶囊提供血管化覆盖以增强尿道,同时存在足够的皮肤以最小化用于阴茎覆盖的皮肤移植物的需要。
方法：阴茎皮肤缺乏的近端尿道下裂和PST患者，先天性或修复失败后，对接受TE辅助重建的患者进行了审查.将TE置于阴茎轴下，并将扩张的皮肤用于管状切开的钢板修复。成功被定义为尿道向电晕或更远的方向推进，并具有无张力的皮肤覆盖。
结果：共有24例患者接受了重建，其中16例作为初次修复的一部分，8例进行了重做修复。9例患者发生扩张器挤压和尿道成形术并发症，占43.8％的初次修复和75.0％的重做修复；尿道皮肤瘘最常见（n=8）。总的来说,在87.5%的患者中,术后产肉部位几乎全部为冠状(45.8%)或腺体(50.0%).
结论：尿道下裂近端重建具有挑战性，并发症并非罕见。对于皮肤缺乏的复杂患者，TE是一种有用的替代方法，因此在尿道成形术后难以覆盖皮肤。虽然一期修复的并发症发生率为43.8%,TE产生足够的残余皮肤以在额外的重建后成功。对于重做修复，早期使用是最有益的，因为有更多的可扩张的皮肤。假胶囊提供血管化覆盖以增强尿道,同时存在足够的皮肤以最小化用于阴茎覆盖的皮肤移植物的需要。
