不同方法治疗尿道下裂16年回顾

目的　探讨尿道下裂不同术式效果及特点。方法　回顾分析 16年 2 3 1例尿道下裂手术资料 ,分别采用游离移植物尿道成形术、带蒂包皮内板尿道成形术、前尿道延伸术和前尿道延伸术加带蒂包皮内板尿道成形术等术式 ,观察手术效果。结果　游离移植物尿道成形术 :膀胱黏膜尿道成形术 12 0例 ,成功率 83 .3 %;游离包皮内板尿道成形术 2 3例 ,成功率 78.2 %。带蒂包皮内板尿道成形术 3 0例 ,成功率 80 .0 %。前尿道延伸术 45例 ,成功率 95 .5 %。前尿道延伸术和前尿道延伸术加带蒂包皮内板尿道成形术 13例 ,成功率 69.2 %。结论　尿道下裂术式各具优缺点 ,应根据尿道缺损的长度及术者的经验选取术式     

镶嵌式唇黏膜和膀胱黏膜修复复杂性尿道皮肤瘘的临床疗效分析

目的:比较镶嵌式唇黏膜和膀胱黏膜在治疗尿道下裂手术后复杂性尿道皮肤瘘手术成功率和并发症发生率。方法:对符合手术指征的55例尿道下裂术后复杂性尿道皮肤瘘患者,随机分成唇黏膜取材组(36例)和膀胱黏膜取材组(19例),于术中分别应用自体游离唇黏膜和膀胱黏膜行尿道成形术,并评估手术并发症和术后尿道皮肤瘘的再发率。结果:镶嵌式唇黏膜和膀胱黏膜在治疗复杂性尿道皮肤瘘术后,均有2例出现尿道皮肤瘘,1例出现尿道狭窄,手术成功率分别为91.7%、84.2%,无统计学差异(P0.05);术后阴茎外形美观。两组术后并发症发生率也无统计学差异(11.1%vs 26.3%,P0.05)。结论:镶嵌式唇黏膜和膀胱黏膜修复复杂性尿道皮肤瘘均取得了理想的效果,但唇黏膜修复供材区创伤更小,手术简单快捷,值得在临床上推广应用。     

尿道下裂手术15年回顾(附322例报告)

目的　探讨尿道下裂不同术式效果及特点。　方法　回顾 15年 32 2例尿道下裂手术资料 ,将术式分为原位皮瓣尿道成形、带蒂皮瓣尿道成形、游离组织尿道成形 ,观察手术效果。　结果　原位皮瓣尿道成形 :阴茎皮条埋藏尿道成形术 2 6例 ,成功 6 9.2 % ;阴茎皮管尿道成形术 33例 ,成功率 6 9.7%。带蒂皮瓣尿道成形 :带蒂阴囊皮瓣尿道成形术 146例 ,成功率 80 .8% ;横行带蒂包皮瓣尿道成形术 6 5例 ,成功率 81.5 %。游离组织尿道成形 :游离包皮瓣尿道成形术 9例 ,成功 7例 ;颊粘膜尿道成形术 1例 ,失败 ;膀胱粘膜尿道成形术 42例 ,成功率 88.1%。　结论　尿道下裂术式 ,各具优缺点 ,选取术式应综合多因素考虑。膀胱粘膜尿道成形术是目前成功率较高 ,合乎生理的术式     

Snodgrass尿道成形术Ⅰ期修复尿道下裂(附42例报告)

目的总结Snodgrass尿道成形术I期修复尿道下裂的手术经验。方法回顾性分析运用Snodgrass法I期修复尿道下裂42例患者的临床资料。结果本组患者术后均获随访2～18个月,平均(9.3±1.2)个月。治愈39例(92.9%),术后发生尿瘘2例(4.8%),尿道外口狭窄1例(2.3%)。尿道口位置于龟头顶端,阴茎外观满意,排尿通畅,未见其它并发症发生。结论 Snodgrass尿道成形术治疗尿道下裂手术操作简单,取材方便,并发症少,手术成功率高,效果肯定。     

Snodgrass尿道成形术I期修复尿道下裂（附42例报告）

目的总结Snodgrass尿道成形术I期修复尿道下裂的手术经验。方法回顾性分析运用Snodgrass法I期修复尿道下裂42例患者的临床资料。结果本组患者术后均获随访2—18个月,平均（9．3±1．2）个月。治愈39例（92．9％）,术后发生尿瘘2例（4．8％）,尿道外口狭窄1例（2．3％）。尿道口位置于龟头顶端,阴茎外观满意,排尿通畅,未见其它并发症发生。结论Snodgrass尿道成形术治疗尿道下裂手术操作简单,取材方便,并发症少,手术成功率高,效果肯定。     

先天性尿道下裂的手术治疗体会

目的 总结尿道下裂手术治疗的经验体会,进一步提高手术治疗水平。方法 回顾性分析86例尿道下裂的临床资料,分析不同术式的治疗效果。结果 尿道外口前移阴茎头成形术未见尿漏及尿道狭窄等并发症。游离包皮内板尿道成形术后并发症发生率为12．5％,游离膀胱粘膜尿道成形术后并发症发生率为17％。结论 根据不同类型的尿道下裂选择不同的手术方式才能达到满意的治疗效果,阴茎头型尿道下裂采取尿道外口前移、阴茎头成形术,阴茎体型尿道下裂采用游离包皮内板代尿道Ⅰ期尿道成形术,阴茎阴囊型及会阴型尿道下裂采用游离膀胱粘膜代尿道Ⅰ期尿道成形术。     

尿道下裂术后尿道憩室的处理与预防

目的 总结尿道下裂术后尿道憩室发生的原因,提出合理的治疗与预防措施.方法 回顾分析2000年1月至2007年6月首诊治疗尿道下裂术后发生尿道憩室患儿的临床资料,包括Ⅰ期尿道成形术的方法 、憩室发生的时间、临床表现、部位、憩室裁剪术中所见等.结果 首诊治疗尿道下裂266例,Duckett术式187例(含Duckett + Duplay术式32例),Onlay术式48例,Snodgrass术式22例.尿道口前移、阴茎头成形术式9例.术后并发尿道憩室20例,均发生于Duckett术式(含Duckett + Duplay术式)术后.憩室裁剪尿道修复术后随诊6个月以上,2例术后发生尿道瘘,2例术后再次发生憩室样扩张,1例术后尿道狭窄,余一次治愈.结论 憩室裁剪尿道修复术是治疗尿道憩室样扩张的手术方法 .Ⅰ期尿道成形术时避免尿道狭窄和裁剪新尿道宽度适中可防止尿道下裂术后尿道憩室的发生.     

逆行复合尿道板皮瓣联合阴囊瓦合皮瓣尿道成形修复重度尿道下裂

目的：探讨一种新的对重度尿道下裂的修复方法.方法：应用逆行复合尿道板皮瓣联合阴囊瓦合皮瓣尿道成形修复重度尿道尿道下裂患者.结果：手术获得成功.术后12d拔除导尿管自行排尿,无尿瘘和尿道狭窄发生.结论：逆行复合尿道板皮瓣血运丰富,伸延性好,手术操作简单,联合阴囊瓦合皮瓣尿道成形术可一期完成尿道下裂修复,成形效果好,是一期修复重度尿道下裂的一种比较理想的术式.     

膀胱黏膜尿道成形术一期治疗尿道下裂

目的探讨膀胱黏膜尿道成形术一期治疗尿道下裂的疗效.方法 1991年8月～2003年8月对38例先天性尿道下裂患者阴茎下曲矫正后行一期膀胱黏膜尿道成形术治疗.结果 38例均一期成形,术后随访6个月～9年,尿道外口修复至正常阴茎头位置,达到外观美观,恢复正常排尿.其中2例一期手术失败,二期再行膀胱黏膜尿道成形术仍获得成功.一期手术成功率为95%,术后3例尿瘘再行尿瘘修补术,2例轻度尿道狭窄,经尿道扩张后解除.余无并发症.结论一期膀胱黏膜尿道成形术治疗尿道下裂具有并发症少,成功率高等优点.     

斜行包皮岛状皮瓣尿道成形术治疗尿道下裂

目的:探讨斜行包皮岛状皮瓣尿道成形术治疗尿道下裂的效果。方法:采用斜行包皮岛状皮瓣尿道成形术治疗尿道下裂51例。结果:所有病例均自正位尿道口排尿,尿道外口呈纵向裂隙状,阴茎的外观满意,无阴茎下弯或侧弯,并发症发生率11.8%(6/51),其中尿瘘3例,尿道外口狭窄3例。结论:本术式具有取材范围大、皮瓣血运可靠、成形阴茎外观满意、并发症少等优点,适合阴茎型和阴茎-阴囊型尿道下裂的I期修复。     

Laser tissue soldering for hypospadias repair: results of a controlled prospective clinical trial

PURPOSE: Laser tissue soldering has been shown to provide safe and effective tissue closure by creating an immediate leak-free anastomosis with minimal scar formation. We compared the results of laser tissue soldering and conventional suturing for hypospadias repair. MATERIALS AND METHODS: A consecutive group of 138 boys 4 months to 8 years old (mean age 15 months) was divided into a standard suturing (84) and a sutureless laser (54) hypospadias repair group. Urethral repair was defined as simple (Thiersch-Duplay or Snodgrass) and complex (onlay island flap or tube) in 101 and 37 cases, respectively. Laser tissue soldering was performed with 50% human albumin solder doped with 2.5 mg./ml. indocyanine green dye using an 808 nm. diode laser at 0.5 W. In the laser group sutures were used for tissue alignment only. At surgery neourethral and penile length, operative time for neourethral construction and the number of sutures or throws were measured. Postoperatively patients were examined for complications of wound healing, stricture or fistula. RESULTS: Mean patient age, urethral defect severity, type of repair, neourethral length and stenting time plus or minus standard error of mean were not significantly different in the 2 groups. Mean operative time was a fifth as long for laser tissue soldering in simple and complex hypospadias repair compared to controls (1.5 +/- 0.1 and 5.1 +/- 0.3 versus 8.5 +/- 0.8 and 26.7 +/- 1.7 minutes, respectively, p <0.001). The mean number of sutures used for tissue alignment in the laser group for simple and complex repair was significantly less than in controls (3.0 +/- 0.2 and 8.2 +/- 0.6 versus 8.5 +/- 0.8 and 23.2 +/- 1.5, respectively, p <0.001). All patients were followed a mean of 12 months (minimum 6, maximum 22). The complication rate was 4.7% in the laser group and 10.7% in controls with fistula in 2 of 54 cases, and fistula and meatal stenosis in 7 and 2 of 84, respectively. CONCLUSIONS: These preliminary results indicate that laser tissue soldering for hypospadias repair may be performed in almost sutureless fashion and more rapidly than conventional suturing. The ease of the laser technique and the lower complication rate in the laser group indicate that laser tissue soldering is an acceptable means of tissue closure in hypospadias repair.     

Comparative study of dartos fascia and tunica vaginalis pedicle wrap for the tubularized incised plate in primary hypospadias repair

OBJECTIVES: To report a prospective comparative study on using dartos fascia, i.e. subcutaneous tissue of penile skin and tunica vaginalis pedicled wrap (TVPW) from the parietal layer of the tunica vaginalis of the testis, for a one-stage tubularized incised-plate (TIP) repair for hypospadias. PATIENTS AND METHODS: Forty-nine patients (mean age 4.6 years, range 1-22) with hypospadias of different types (varying from coronal to penoscrotal) were repaired in one of three hospitals over 3 years. All patients were repaired using the TIP technique, with dartos fascia wrap used in 20 and TVPW in 29, without using a loupe or microscope during surgery. Urinary diversion and splinting were provided by a urethral catheter. The operative duration for both groups was similar at approximately 2 h. RESULTS: In the dartos fascia group there were three (15%) fistulae, but there were none in the TVPW group. CONCLUSIONS: Although the dissection for TVPW seems to be cumbersome theoretically, it is not difficult. The combination of TIP and TVPW in primary repair may be a good alternative to other techniques.     

Clinical statistics on outpatients, inpatients and operations in 1985

Statistical studies were made on 1,795 outpatients, 528 inpatients and 518 operative procedures at our department in 1985. The most frequent diseases among the outpatients were urogenital infections followed by anomalies, stones and tumors. The major diseases among the inpatients were hypospadias, vesicoureteral reflux, congenital urethral stenosis, bladder tumor and benign prostatic hypertrophy. A total of 518 operations were performed. The five major operations were optic internal urethrotomy, hypospadias repair, ureterocystoneostomy, and transurethral resection of prostate and of bladder tumors.     

Clinical statistics on outpatients, inpatients and operations in 1987

Statistical studies were made on 1,859 outpatients, 587 inpatients and 601 operative procedures at our department in 1987. The most frequent diseases among the outpatients were urogenital infections followed by anomalies, tumors and stones. The major diseases among the inpatients were hypospadias, vesicoureteral reflux, congenital urethral stenosis, benign prostatic hypertrophy and bladder tumor. A total of 601 operations were performed. The five major operations were hypospadias repair, optic internal urethrotomy, transurethral resection of prostate, ureterocystoneostomy and transurethral resection of bladder tumor.     

Clinical statistics on outpatients, inpatients and operations in 1988

Statistical studies were made on 1,766 outpatients, 657 inpatients and 687 operative procedures at our department in 1988. The most frequent diseases among the outpatients were urogenital infections followed by anomalies, tumors and stones. The major diseases among the inpatients were congenital urethral stenosis, hypospadias, vesicoureteral reflux, benign prostatic hypertrophy and bladder tumor. A total of 687 operations were performed. The five major operations were optic internal urethrotomy, hypospadias repair, transurethral resection of prostate, ureterocystoneostomy and transurethral resection of bladder tumor.     

Results of single-stage repair of distal hypospadias using the King modification

From 1975 to 1986 34 patients undergoing repair of distal hypospadias between the age of 2 and 11 were explored. Standard method of the one-stage correction of distal hypospadias without or with moderate chordee was the operative technique according to the modification of King. After rolling the urethral groove into a tube the neourethra is covered with an asymmetrical part of dorsal hood. Thus the operative aims such as nonproblematic micturition, normal cohabitation and ejaculation and a good cosmetic result, avoiding psychological problems, can be obtained. The total complication rate was 23.4%; the correction of urethral fistulas in two layers as ambulatory operations was nonproblematic. By using Silastic foam the incidence of postoperative edema could be reduced significantly.     

Complications of hypospadias repair

Any surgeon performing hypospadias repair must be prepared to manage the surgical complications. From January 1976 to December 1982, 176 cases of hypospadias treated with a number of different operations were critically analyzed for complications. There were no complications in 143 cases (81 per cent). However, there were 44 surgical complications in the remaining 33 patients (19 per cent), which included stricture formation (11), urethral fistula (11), severe skin edema (2), subcutaneous hematoma (2), persistent chordee (2), scrotal abscess (1) and bladder calculus (1). Treatment of the various complications is discussed along with suggestions on how to avoid them. When only 3 operations are considered (meatal advancement and glanuloplasty, flip-flap procedure and free graft tubed urethroplasty), surgical repair of all types of hypospadias was accomplished, without any complications in 89 per cent of the cases. The results of hypospadias repair have improved because of the availability of these more reliable procedures that provide a lower incidence of complications and improved cosmetic appearance.     

Hypospadias

Hypospadias repair is one of the more common operations in pediatric urology centers, with an incidence of 1 in 200 to 1 in 300. This review provides an overview of the prevalence, epidemiology, etiology, and treatment of this condition. Indications for hypospadias repair and preoperative hormonal treatment are discussed. The principles of the different operations and their countless modifications are explained.Hypospadias repair has a long and flat learning curve and requires patience, experience, and great enthusiasm to achieve acceptable results. The results published on the various operative techniques need to be repeated and validated by other surgeons, and long-term results (up to adulthood) are essential to justify operative methods and identify late complications.     

Clinical experiences with different one-staged surgical methods for primary hypospadias cases

The success of various types of operations for primary hypospadias was assessed taking the location of meatus and the degree of chordee as the basis. Totally 258 patients with primary hypospadias were operated: 94 by meatal and urethral advencement, 110 by perimeatal flap and tube repair and 54 by preputial flap.The rates of success in cases with meatal advencement, perimeatal flap and preputial flap were found as 88%, 81% and 66%respectively.The success of treatment in hypospadias cases is closely related to the age of the patient, the experience of the surgeon and the choice of an appropriate method. However, the presence of chordee and the proximally located meatus are among the leading factors that influence the rate of success.