应用显微外科技术转移带蒂包皮内板皮管法尿道下裂一期成形术

应用显微外科技术转移带蒂包皮内板皮管法尿道下裂一期成形术21例、其中冠状沟型5例，阴茎型9例，阴囊型7例。取包皮内板制成带蒂皮管尿道，长度1．7～4．5cm，一期手术成功率85．7％。婴幼儿组8例，仅失败1例。术后平均住院12天。认为采用该法不仅可提早尿道下裂修复的年龄，还能明显提高一期尿道下裂修复术成功率。     

纵形包皮皮管治疗小儿尿道下裂(附8例报告)

目的：探讨纵形包皮皮管一期成形术治疗小儿尿道下裂的疗效。方法：回顾性分析采用纵形包皮包管一期成形术治疗小儿阴茎型尿道下裂8例的临床资料。结果：8例采用该法治疗的患儿痊愈出院，无尿道瘘等手术并发症。结论：纵形包皮皮管一期成形术治疗小儿尿道下裂是一种较理想的手术方法。     

不同术式一期正位开口修复先天性尿道下裂：附114例报告

总结１１４例不同手术方式一期修复各种类型尿道下裂的经验。本组中阴茎型３０例，阴茎阴囊型６３例，会阴型２１例。阴茎型尿道下裂宜采用包皮内板转移皮瓣尿道成形术。阴囊型根据缺损尿道长短采用阴囊纵带蒂皮瓣术或包皮内板阴囊纵隔联合皮瓣尿道成形术。会阴型采用包皮内板阴囊纵隔联合皮瓣术或膀胱粘膜尿道造成形术本组一期手术的成功率为８４．８％。     

带蒂包皮内板皮管法尿道下裂一期成形术

１９９３年以来，采用带蒂包皮内板皮管法行尿道下裂一期成形术１２例，其中冠状沟型５例，阴茎型７例。裁取包皮内板作成带蒂皮管尿道，长度１．５～４．０ｃｍ，平均２．５ｃｍ。全部病例一次手术成功，无尿瘘，３例有轻度尿道外口狭窄，需短期尿道扩张，术后平均住院７天。包皮内板制成带蒂皮管管腔宽、血供好、易成活，不易形成瘘管及瘢痕狭窄，该术式适用于冠状沟型和阴茎型的尿道下裂。     

自制多孔平行双支架管在尿道下裂手术中的应用

目的 探讨提高各型尿道下裂修复手术成功率的方法.方法 220例尿道下裂患者,均采用一期尿道成形术.阴茎伸直后,用带蒂包皮内板尿道成形术(Duckett术)195例;阴囊中隔+带蒂包皮内板联合成形术20例;膀胱黏膜游离移植尿道成形术5例.用自制带有多个侧孔的平行双硅胶管作为尿道下裂修复手术中新形成的尿道支架管.结果 术后随访1～8年,208例一期手术成功,排尿通畅;2例术后出现尿瘘;6例手术1个月后出现尿道吻合口狭窄,4例术后1个月尿道外口狭窄.结论 本组一期手术成功率达94.5%,自制带有多侧孔的平行双硅胶管作为尿道支架管,具有通畅引流、利于冲洗等优点,可减少感染、尿瘘、狭窄的发生率.     

弧形带蒂阴茎皮肤联合皮瓣Ⅰ期治疗重度尿道下裂

目的：报道弧形带蒂包皮内板阴茎背侧皮肤联合皮瓣治疗阴囊型及会阴型尿道下裂。方法：22例阴囊型及会阴型尿道下裂患者，均采用弧形带蒂包皮内板阴茎背侧皮肤联合皮瓣(Ducrett Perovic’s)制成皮管I期成形尿道。术中常规耻骨上膀胱穿刺造瘘引流尿液，经尿道置F10-12多侧孔硅胶管支架引流尿道分泌物，术后应用头孢曲松钠抗感染治疗1周，保留尿道支架管6～8d，膀胱造瘘管10～12d。结果：18例I期成功，4例发生尿瘘，均于6个月后修补瘘管痊愈。均排尿正常，无痛性勃起，阴茎无扭转，腹侧无臃肿。结论：此法治疗包皮阴茎皮肤充裕之重度尿道下裂效果确切，外观满意，是一种较好的手术方式．     

尿道口周蒂肉膜瓣在阴茎中段型尿道下裂一期修复中的应用

目的探讨采用横形包皮岛状皮瓣管状尿道成形术一期修复阴茎中段型尿道下裂的方法及临床效果。方法对自2010年1月至2014年12月收治的46例男性先天性阴茎中段型尿道下裂患者,行阴茎矫直、横形包皮岛状皮瓣管状尿道法一期尿道再造术。术中保护尿道口近端区域的肉膜组织,形成尿道口周蒂肉膜瓣;翻转肉膜瓣、覆盖尿道吻合口并固定,将皮瓣转移覆盖至阴茎腹侧的皮肤缺损。结果所有患者术后随访5~36个月,仅发现1例吻合口尿道瘘,1例阴茎腹侧部分皮肤血运欠佳而致切口瘢痕愈合,但无尿瘘发生,其余患者均愈合良好,无尿道裂开、皮瓣坏死、感染、尿道(口)狭窄、尿道憩室等并发症发生。结论采用横形包皮岛状皮瓣管状尿道成形术一期尿道再造治疗阴茎中段型尿道下裂,并采用尿道口周蒂肉膜瓣覆盖吻合口,是一种简单且可有效预防其吻合口尿瘘发生的较好方法。     

应用显微外科手术转移带蒂包皮内板皮管法尿道下裂一期成形术

应用显微我科技术转移带蒂包皮内板皮管法尿道下裂一期成形术２１例，其中冠状沟型５例，阴茎型９例，阴囊型７例，取包皮内板制成带蒂皮瓣尿管道，长度１．７～４．５ｃｍ，一期手术成功率８５．７％。婴幼儿组８你，仅失败１例，手术平均住院１２天，认为采用地不仅可提早尿道下裂修复的年龄，还能明显提高一期尿道下裂修复成功率。     

阴囊正中带蒂皮条尿道下裂一期修复术

阴囊正中带蒂皮条尿道下裂一期修复术张应权，李文艳，陈辉，刘云涛我院自１９９０年３月～１９９４年６月共收治小儿先天性尿道下裂５４例，其中阴茎阴囊型尿道下裂３２例，１８例采用阴囊正中带蒂皮条一期修复术，均治愈。现将此术介绍如下，供；临床借鉴。１资料与方法...     

包皮横形岛状皮瓣一期成形术治疗小儿尿道下裂

目的：探讨包皮横形岛状皮瓣一期成形术(Duckett术)治疗小儿尿道下裂的效果。方法：采用Duckett术一期成形修复小儿尿道下裂56例，Ⅰ度(阴茎头、冠状沟型)8例，Ⅱ度(阴茎体型)33例，Ⅲ度(阴茎阴囊型)11例，Ⅳ度(会阴型)4例。其中4例Ⅳ度病例行Duckert加Dupaly术。结果：一次性治愈39例。术后出现尿瘘15例，尿道狭窄2例，均经再次手术治愈。随访32例，时间为1～6年，无一例排尿异常。绪论：Duckett术式将包皮内板及内外板交界部带蒂皮瓣制成管，因该皮瓣具有质地柔软、表面光滑、伸展性强等特点，成形的尿道顺应性好，管腔宽，血供较好。本术式是修复Ⅰ～Ⅳ度尿道下裂的较为理想的术式。     

Prepuce-Sparing hypospadias repair with tubularized incised plate urethroplasty

Objectives:   Modifications in surgical methods of hypospadias repair have been influenced by social considerations. Most Japanese parents wish their children to retain their foreskin during hypospadias repair. We report on short-term results of foreskin reconstruction associated with hypospadias repair.
Methods:   Of 44 tubularized incised plate urethroplasty-patients, 42 (95%) underwent foreskin reconstruction at the time of urethroplasty during the last 2 years. After the urethroplasty was completed, the foreskin was re-approximated in three layers.
Results:   Complications related to urethroplasty consisted of fistula in two patients with penoscrotal hypospadia, and mild stenosis of the glandular urethra in one patient. Complications related to foreskin reconstruction included dehiscence of the ventral foreskin in two patients. In all cases parents were well satisfied with the reconstructed prepuce.
Conclusions:   Pre-operative information about preputial reconstruction should be given to parents if they would prefer their son to be uncircumcised.     

A combined tubularized/onlay graft technique for total correction of severe hypospadias.

BACKGROUND/PURPOSE: A combined tubularized/onlay graft technique is described for the complete correction of chordee with urethroplasty in a single stage in cases of severe hypospadias. METHODS: Twenty-two patients with severe hypospadias ranging in age from 9 months to 11 years underwent single-stage correction using a technique developed by the author. In this method, chordee is first completely excised by removing all fibrotic tissue both proximal and distal to the urethral orifice, preserving the meatal groove. A dorsolateral preputial flap is then raised and tubularized to form the neourethra. The proximal end of this tube is anastomosed to the urethral opening using a continuous absorbable suture. Two parallel incisions are made in the glans on either side of the meatal groove. The distal part of the neourethral flap is laid over the groove and sutured on either side to create the glanular part of the urethra, after which the glans is reconstructed with the new meatal opening at the tip. The neourethral suture line is covered with a layer of vascularized subcutaneous tissue to protect against fistula formation, and the rest of the preputial skin is transferred ventrally to provide cover for the penile shaft. RESULTS: There were no major complications with minimum follow-up of 20 months. Meatal stenosis developed in two patients, and one had stricture at the proximal anastomosis. These were treated successfully with minor corrective procedures. All other patients had good results, and there were no cases of fistula. CONCLUSIONS: The method described has proved successful in the surgical correction of severe hypospadias in a single stage. It is easily adapted to permit urethral reconstruction after varying degrees of tissue excision required to obtain satisfactory correction of chordee. Patients do not need to undergo multiple procedures, and no major complications were encountered in this series.     

Dorsal dartos flap for preventing fistula in the Snodgrass hypospadias repair

OBJECTIVE: To evaluate the importance of urethral covering using vascularized dorsal subcutaneous tissue for preventing fistula in the Snodgrass hypospadias repair. PATIENTS AND METHODS: The study included 67 children (aged 1-11 years) who had hypospadias repaired between April 1998 and May 2003, including 51 with distal and 16 with midshaft hypospadias. In all children, a standard tubularized incised-plate urethroplasty was followed by reconstruction of new surrounding urethral tissue. A longitudinal dartos flap was harvested from excessive dorsal preputial and penile hypospadiac skin, and transposed to the ventral side by a buttonhole manoeuvre; it was sutured to the glans wings around the neomeatus, and to the corpora cavernosa over the neourethra. Thus the neourethra was completely covered with well-vascularized subcutaneous tissue. RESULTS: At a mean (range) follow-up of 21 (6-65) months, the result was successful, with no fistula or urethral stenosis, in all 67 children. CONCLUSION: We suggest that urethral covering should be part of the Snodgrass procedure. A dorsal well-vascularized dartos flap, buttonholed ventrally, is a good choice for preventing fistula. Redundancy of the flap and its excellent vascularization depends on the harvesting technique.     

Longitudinal dorsal dartos flap for prevention of fistula after a Snodgrass hypospadias procedure

OBJECTIVES: The Snodgrass technique presents the procedure of choice for distal hypospadias. Fistula formation is the most common complication with various rates. We evaluated the importance of a urethral covering using vascularized dorsal subcutaneous tissue for fistula prevention. METHODS: Our study included 126 patients, aged 10 months to 16 years, who underwent hypospadias repair from April 1998 through June 2005. Of the patients, 89 had distal, 30 had midshaft and 7 had penoscrotal hypospadias. All patients underwent standard tubularized incised plate urethroplasty, which was followed by reconstruction of new surrounding urethral tissue. A longitudinal dorsal dartos flap was harvested and transposed to the ventral side by the buttonhole manoeuvre. The flap was sutured to the glans and the corpora cavernosa to completely cover the neourethra with well-vascularized subcutaneous tissue. RESULTS: Mean follow-up was 32 (6-87) months. A successful result without fistula was achieved in all 126 patients. In six patients, temporary stenosis of the glandular urethra occurred and was solved by dilation. CONCLUSIONS: A urethral covering should be performed as part of the Snodgrass procedure. A dorsal well-vascularized dartos flap that is buttonholed ventrally represents a good choice for fistula prevention. Redundancy of the flap and its excellent vascularization depend on the harvesting technique.     

Complete repair of bladder exstrophy: management of resultant hypospadias

PURPOSE: In our hands complete primary repair (CPR) of bladder exstrophy results in hypospadias in two-thirds of boys. To our knowledge hypospadias repair following CPR of bladder exstrophy has not been reported previously. We report our experience with hypospadias repair following CPR of bladder exstrophy. MATERIALS AND METHODS: A total of 22 boys with bladder exstrophy underwent CPR using Mitchell's technique between November 1998 and January 2002. The procedure resulted in hypospadias in 15 boys (68%). The site of the meatus was distal penile in 5 patients, mid penile in 3 and proximal penile in 7. Hypospadias repair was performed in all 15 boys. The 5 patients with distal penile hypospadias underwent repair consisting of Thiersch-Duplay urethroplasty with dorsal incision in 3 and tubularized vertical island flap with glanular tunnel in 2. All patients with mid (3) or proximal (7) penile hypospadias underwent Mustarde repair with glanular tunnel. RESULTS: Followup ranged from 6 to 18 months (median 13). The Thiersch-Duplay procedure with dorsal incision resulted in fistula/stenosis in 2 of 3 boys. None of the remaining 12 boys with tubularized penile flap urethroplasty (tubularized vertical island flap or Mustarde) with glanular tunneling had development of fistula or stenosis. Complete degloving of the penis and penile skin redistribution were not necessary with the Mustarde technique. CONCLUSIONS: Thiersch-Duplay urethroplasty with dorsal incision does not seem to be a good option for hypospadias repair following CPR of bladder exstrophy. The use of penile skin as a tubularized flap with glanular tunneling seems to yield excellent functional/cosmetic results.     

Unstented tubularized incised plate urethroplasty combined with foreskin reconstruction for distal hypospadias

BACKGROUND AND AIM: Urethral stent has recently been proven to be unnecessary for normal healing in an animal model of tubularized incised plate (TIP) urethroplasty. We report our experience with unstented TIP repair combined with foreskin reconstruction for distal hypospadias in children. PATIENTS AND METHODS: We retrospectively reviewed the records of 162 children consecutively treated by TIP urethroplasty for a distal or mid-shaft hypospadias without urethral stent over a 6 years period. The mean age +/- SEM at surgery was 15.7 +/- 1.2 months. A foreskin reconstruction was performed with the hypospadias repair in 136 boys (84%). One hundred thirty one children (81%) underwent this surgery as an outpatient procedure. RESULTS: With a mean follow-up of 12.4 +/- 1.0 months, urethrocutaneous fistula was observed in 9 children (5.6%), and meatal stenosis in 4 (2.5%). Postoperative urinary retention requiring suprapubic catheter insertion was observed in 4 cases (2.5%) without later complications. Cutaneous dehiscence of the reconstructed foreskin occurred in 6 children (4.4%) and phimosis in 13 (9.5%). CONCLUSIONS: Absence of urethral stent after TIP urethroplasty for distal hypospadias repair does not seem to increase postoperative complication rate. Foreskin reconstruction in distal hypospadias surgery has an acceptable complication rate.     

Tubularized incised plate urethroplasty for hypospadias reoperations in 100 patients

Objectives To determine the key points for a successful redo hypospadias procedure using tubularized incised plate urethroplasty operation. Methods A retrospective chart review of a cohort of 100 patients (Mean age: 4.5 years, range: 2–12) who had undergone a redo tubularized incised plate urethroplasty operation was performed. Fischer exact and Chi square tests were used for statistical analysis. Results The incidence of complications of tubularized incised plate urethroplasty reoperation after failed repairs of meatal advancement and glanuloplasty procedure (n: 14), meatal based flap (n: 36), and tubularized incised plate urethroplasty (n: 50) were 29% (n: 4), 22% (n: 8) and, 28% (n: 14) respectively (P > 0.05). The overall complication rate was 26% (n: 26). Eighteen patients (18%) had fistula, five had meatal stenosis (5%), two had dehiscence (2%) and one had neourethral stenosis (1%). Postoperatively, fistula was closed in 18 patients and 5 underwent meatoplasty. Two patients with dehiscence and one with neourethral stenosis underwent an unsuccessful third redo tubularized incised plate urethroplasty reoperation and they were candidates for a complex hypospadias repair (3%). The ultimate success rate of tubularized incised plate urethroplasty reoperation after treatment of complications was 97%. Conclusion Tubularized incised plate urethroplasty is a safe and efficacious alternative procedure for hypospadias reoperations if the urethral plate has no scars and outcome is favourable if the first failed hypospadias repair is a meatal based flap procedure. The complication rate increases if the urethral plate has been previously incised in the midline and a redo third redo must be avoided.     

加盖与管形包皮岛状皮瓣法在尿道下裂治疗中的应用

目的评价加盖包皮岛状皮瓣法（Onlay island flap法）与管形包皮岛状皮瓣法（Tubularized island flap法）手术治疗尿道下裂的适应证及疗效.方法总结分析166例尿道下裂修复手术及术后并发症.患儿年龄1～15岁,平均5.1岁.冠状沟型及阴茎体前型尿道下裂36例,阴茎体型81例,阴茎根型36例,阴囊及会阴型13例,其中外院行阴茎下弯矫正术后11例.合并阴茎下弯139例,轻度43例,中度43例,重度53例.采用加盖包皮岛状皮瓣法79例,管形包皮岛状皮瓣法87例.结果 166例手术成功率为90.4%.166例随访2年均未发生尿道狭窄、尿道憩室、阴茎皮肤坏死等合并症.加盖包皮岛状皮瓣法术后发生尿瘘4例（5.1%）,阴茎下弯复发7例（8.9%）,手术成功率为86.1%.管形包皮岛状皮瓣法术后发生尿瘘4例（4.6%）,阴茎下弯复发1例（1.1%）,手术成功率为94.2%.2种术式尿瘘发生率比较,差异无统计学意义;而阴茎下弯复发率比较,差异有统计学意义.结论加盖包皮岛状皮瓣法适用于尿道板发育好的阴茎体及阴茎根型病例,管形包皮岛状皮瓣适用于尿道口位于冠状沟至会阴合并重度阴茎下弯的各型尿道下裂.     

Y形阴囊皮瓣修复小儿重度尿道下裂12例报告

目的:探讨Y形阴囊皮瓣治疗小儿重度尿道下裂的适用范围和疗效。方法:背侧包皮不充裕的重度尿道下裂患儿12例,包括阴囊型7例,会阴型5例;合并阴茎阴囊不全转位11例,完全转位1例。年龄11个月～12岁,平均4.2岁。采用Y形阴囊皮瓣成形尿道并同期纠正阴茎阴囊转位。结果:平均随访2年,术后阴茎伸直及外观满意,尿道口位置正常。发生尿瘘4例(33.3%),尿道狭窄1例(8.3%),手术总成功率达58.3%。结论:Y形阴囊皮瓣适用于背侧包皮少的小儿重度尿道下裂的治疗,且能同期纠正阴茎阴囊转位,疗效肯定。     

纵行带蒂岛状包皮瓣治疗尿道下裂44例报告

目的:总结近4年来应用纵行带蒂岛状包皮瓣一期尿道成形术治疗尿道下裂的临床经验,并评价其疗效.方法:本组44例患者中,阴茎型尿道下裂34例,阴茎阴囊型尿道下裂10例.均采用纵行带蒂岛状包皮瓣一期尿道成形术,平均重建尿道长度2.8 cm.结果:一期手术成功率90.9%(40/44例),尿瘘9.1%(4/44例).所有患者术后1个月复查1次,随访3个月以上,阴茎外观及排尿均良好.结论:纵行带蒂岛状包皮瓣一期尿道成形术对伴有阴茎下曲、尿道板发育不好的阴茎型及阴茎阴囊型尿道下裂患者治疗效果良好,并发症少.