Abstract：
To compare the surgical outcomes and complications of boys who underwent double-face onlay-tube-onlay transverse preputial island flap (DFOTO) one-stage repair vs. two-stage repair for proximal hypospadias.
Males with proximal hypospadias who underwent DFOTO or two-stage repair at a single institution from 2008 to 2021 were identified. Patients who had prior hypospadias surgery were excluded. Outcomes were surgical complications, number of surgical procedures, operative time, and post-operative uroflowmetry results.
Fifty-three males who underwent DFOTO and 39 who underwent two-stage repair were included. Median age at surgery was 1.1 years (IQR 0.83-1.6) and median follow-up was 3.0 years (IQR 1.2-6.8). Although not statistically significant, the DFOTO group had higher rates of urethrocutaneous fistula (30% vs. 15%, p = 0.10), urethral stricture (15% vs. 3%, p = 0.07) and urethral diverticulum (8% vs. 3%, p = 0.39). Although the unplanned re-operation rate was higher in DFOTO (58% vs. 33%, p = 0.02), the mean number of procedures and median total surgical time were lower in DFOTO (1.8 ± 0.9 vs. 2.4 ± 0.8, p = 0.0004; 337 min [IQR 278-460] vs. 468 min [IQR 400-563], p = 0.008). There were no significant differences between groups for mean peak flow rates and post void residuals.
In males who underwent DFOTO, 42% achieved completion of their proximal hypospadias repair with one operation, while the remainder had largely minor complications. Accounting for reoperation rates, the mean number of procedures per patient was lower in the DFOTO group. Comparable results can be achieved with both techniques; the risks of higher unplanned operation rates in the DFOTO group should be considered with the benefit of fewer total procedures.
Males with proximal hypospadias who underwent DFOTO or two-stage repair at a single institution from 2008 to 2021 were identified. Patients who had prior hypospadias surgery were excluded. Outcomes were surgical complications, number of surgical procedures, operative time, and post-operative uroflowmetry results.
Fifty-three males who underwent DFOTO and 39 who underwent two-stage repair were included. Median age at surgery was 1.1 years (IQR 0.83-1.6) and median follow-up was 3.0 years (IQR 1.2-6.8). Although not statistically significant, the DFOTO group had higher rates of urethrocutaneous fistula (30% vs. 15%, p = 0.10), urethral stricture (15% vs. 3%, p = 0.07) and urethral diverticulum (8% vs. 3%, p = 0.39). Although the unplanned re-operation rate was higher in DFOTO (58% vs. 33%, p = 0.02), the mean number of procedures and median total surgical time were lower in DFOTO (1.8 ± 0.9 vs. 2.4 ± 0.8, p = 0.0004; 337 min [IQR 278-460] vs. 468 min [IQR 400-563], p = 0.008). There were no significant differences between groups for mean peak flow rates and post void residuals.
In males who underwent DFOTO, 42% achieved completion of their proximal hypospadias repair with one operation, while the remainder had largely minor complications. Accounting for reoperation rates, the mean number of procedures per patient was lower in the DFOTO group. Comparable results can be achieved with both techniques; the risks of higher unplanned operation rates in the DFOTO group should be considered with the benefit of fewer total procedures.
摘要：
目的：比较男孩进行双面置管-置管横型包皮岛状皮瓣（DFOTO）一期修复的手术效果和并发症。近端尿道下裂的两阶段修复。
方法：确定了2008年至2021年在单个机构接受DFOTO或两阶段修复的近端尿道下裂男性。既往有尿道下裂手术的患者被排除在外。结果是手术并发症，外科手术的数量，手术时间,和术后尿流率测定结果。
结果：纳入了53名接受DFOTO的男性和39名接受两阶段修复的男性。手术年龄中位数为1.1岁（IQR0.83-1.6），随访中位数为3.0年（IQR1.2-6.8）。虽然没有统计学意义，DFOTO组尿道皮肤瘘发生率较高(30%vs.15%,p=0.10),尿道狭窄（15%vs.3%,p=0.07)和尿道憩室(8%vs.3%,p=0.39）。尽管DFOTO的计划外再手术率较高(58%与33%,p=0.02),DFOTO的平均手术次数和中位总手术时间较低(1.8±0.9vs.2.4±0.8，p=0.0004；337分钟[IQR278-460]vs.468分钟[IQR400-563]，p=0.008)。两组之间的平均峰值流速和空隙后残留物没有显着差异。
结论：在接受DFOTO的男性中，42％的人通过一次手术完成了近端尿道下裂的修复，而其余患者大多有轻微的并发症。计入再操作率，DFOTO组每名患者的平均手术次数较低.使用这两种技术都可以获得可比的结果；DFOTO组的计划外手术率较高的风险应考虑在内，而总程序较少。
方法：确定了2008年至2021年在单个机构接受DFOTO或两阶段修复的近端尿道下裂男性。既往有尿道下裂手术的患者被排除在外。结果是手术并发症，外科手术的数量，手术时间,和术后尿流率测定结果。
结果：纳入了53名接受DFOTO的男性和39名接受两阶段修复的男性。手术年龄中位数为1.1岁（IQR0.83-1.6），随访中位数为3.0年（IQR1.2-6.8）。虽然没有统计学意义，DFOTO组尿道皮肤瘘发生率较高(30%vs.15%,p=0.10),尿道狭窄（15%vs.3%,p=0.07)和尿道憩室(8%vs.3%,p=0.39）。尽管DFOTO的计划外再手术率较高(58%与33%,p=0.02),DFOTO的平均手术次数和中位总手术时间较低(1.8±0.9vs.2.4±0.8，p=0.0004；337分钟[IQR278-460]vs.468分钟[IQR400-563]，p=0.008)。两组之间的平均峰值流速和空隙后残留物没有显着差异。
结论：在接受DFOTO的男性中，42％的人通过一次手术完成了近端尿道下裂的修复，而其余患者大多有轻微的并发症。计入再操作率，DFOTO组每名患者的平均手术次数较低.使用这两种技术都可以获得可比的结果；DFOTO组的计划外手术率较高的风险应考虑在内，而总程序较少。
