背景:尿道下裂修复中最常见的并发症是瘘管形成。坚持提供尿道成形术覆盖的原则,以减轻瘘管的发生,我们通过在尿道成形术和dartos皮瓣之间整合海绵状层进行了修改。我们的假设认为,这种方法将导致瘘管形成率降低。
方法:本研究是一项比较分析,涉及18岁以下接受原发性尿道下裂修复的患者。将病例分为两组。在研究小组中,除了进行管状切开钢板(TIP)修复外,从尿道两侧收获的海绵状层用于覆盖尿道成形术(Y-to-I尿道成形术的改进).对照组接受标准TIP修复。主要结果是评估尿道皮肤瘘的形成。次要结果包括评估肉孔狭窄和龟头裂开的发展,以及通过尿道下裂客观阴茎评估(HOPE)评分评估美容结果。
结果:总体而言,154例尿道下裂病例纳入研究。87名患者(56%)被分配到研究组,67例(44%)被分配到对照组.研究组和对照组分别有3例(3.4%)和11例(16.4%)患者发生尿道瘘,分别(p=0.006)。研究组2例(2.3%)患者和对照组4例(6%)患者发生龟裂(p=0.198)。研究组中4例(4.6%)患者和对照组中5例(7.5%)患者(p=0.452)观察到气孔狭窄。两组的平均HOPE评分均为59分(p=0.36)。
结论:本研究详述了我们与新型修饰的相遇,并将结果与标准TIP进行了比较。我们的数据表明,在尿道成形术上增加一层海绵状组织可以减少尿道皮肤瘘的并发症,而不会增加裂开的发生率。显著的气孔狭窄,或损害美容效果。
结论:我们主张实施所述的手术改良作为尿道下裂修复的可行选择。
BACKGROUND: The most prevalent complication in hypospadias repair is fistula formation. Adhering to the principle of providing urethroplasty coverage to mitigate fistula occurrence, we implemented a modification by integrating a spongiosum layer between the urethroplasty and the dartos flap. Our hypothesis posited that this approach would result in a reduced fistula formation rate.
METHODS: This study is a comparative analysis involving patients under 18 years of age who underwent primary hypospadias repair. The cases were allocated into two groups. In the study group, in addition to performing tubularized incised plate (TIP) repair, a spongiosum layer harvested from both sides of the urethra was used to cover the urethroplasty (modification of the Y-to-I urethroplasty). The control group underwent a standard TIP repair. The primary outcome was to assess urethrocutaneous fistula formation. Secondary outcomes included evaluating the development of meatal stenosis and glans
dehiscence, along with assessing cosmetic results by the Hypospadias Objective Penile Evaluation (HOPE) score.
RESULTS: Overall, 154 hypospadias cases were included in the study. Eighty-seven patients (56%) were allocated to the study group, and 67 (44%) were allocated to the control group. Urethrocutaneous fistula developed in 3 (3.4%) and 11 (16.4%) patients in the study and control group, respectively (p = 0.006). Glans
dehiscence occurred in 2 (2.3%) patients in the study group and 4 (6%) patients in the control group (p = 0.198). Meatal stenosis was observed in 4 (4.6%) patients in the study group and 5 (7.5%) patients in the control (p = 0.452). The mean HOPE score was 59 in both groups (p = 0.36).
CONCLUSIONS: This study details our encounters with the novel modification and compares the results with standard TIP. Our data suggest that adding a layer of spongiosum tissue over the urethroplasty reduces the complication of urethrocutaneous fistula without increasing the occurrence of
dehiscence, significant meatal stenosis, or compromising cosmetic outcomes.
CONCLUSIONS: We advocate for implementing the described surgical modification as a viable option for hypospadias repair.