尿道下裂修复术中的龟头塑形

目的:探讨先天性尿道下裂手术中的龟头塑形方法,从而提高手术后阴茎龟头的美观效果。方法:对一组尿道下裂修复术的龟头塑形方法进行分析,26例患者,20例采用翼状分离龟头成形,6例龟头发育较差者,采用翼状分离加龟头腹侧带蒂包皮瓣嵌插成形以增大龟头。结果:所有病例术后恢复良好,龟头及尿道外口接近生理状态,排尿顺利,尿线正常。结论:翼状分离龟头成形有利于尿道下裂术后龟头的美观塑形,龟头腹侧带蒂皮瓣嵌插成形对发育不良的龟头的增大和塑形效果良好。     

显微外科技术及带蒂包皮岛状皮瓣法在尿道下裂治疗中的应用

目的总结应用显微外科及带蒂包皮皮瓣一期修复尿道下裂的经验,提高手术成功率。方法回顾性分析38例一期尿道下裂修复手术及术后并发症。患儿年龄3～22岁,平均7．5岁。阴茎头冠状沟型12例,阴茎体型19例,阴茎根部型7例,其中6例曾在院外行阴茎下屈矫正术。应用显微外科技术,单纯选择带蒂包皮岛状皮瓣法一期修复尿道下裂32例,联合应用Duplay术式6例。结果随访3个月～2年,35例患儿术后阴茎外观满意,排尿通畅,无明显并发症:术后发生尿瘘2例,再次手术后治愈。1例术后3月出现尿道外口狭窄,经尿道扩张治愈。手术成功率为94．7％。结论应用显微外科及带蒂包皮岛状皮瓣一期修复尿道下裂,成功率高,并发症少,是治疗尿道下裂的良好方法。     

显微外科技术纵形带蒂岛状包皮瓣一期修复尿道下裂

目的 探讨显微外科技术纵形带蒂岛状包皮瓣修复尿道下裂的临床效果.方法 伴明显阴茎下弯的尿道下裂患者42例.年龄1～19岁,中位6.4岁.阴茎头冠状沟型6例、阴茎体型28例、阴茎阴囊型8例.4倍显微镜下采用纵形带蒂岛状包皮瓣术式33例,纵形带蒂岛状包皮瓣联合阴囊纵隔皮瓣成形9例.42例重建尿道平均3.6(2.5～6.0)cm. 结果 一次手术治愈38例(90.5%).术后出现尿瘘1例,行尿瘘修补治愈;尿道口狭窄2例,尿道吻合口狭窄1例,行尿道扩张后治愈.41例获随访9～52个月,平均27个月,患者均符合尿道下裂治愈标准. 结论 显微外科技术纵形带蒂岛状包皮瓣行一期尿道下裂修复手术成功率高,并发症少,值得临床推广.     

带蒂皮瓣尿道外口成形术治疗炎症性尿道外口狭窄

目的:探讨带蒂皮瓣尿道外口成形术治疗炎症性尿道外口狭窄的疗效。方法:2009年9月至2013年12月采用带蒂皮瓣法治疗尿道外口狭窄患者32例。所有患者既往均有慢性阴茎头炎病史,曾行尿道外口扩张或尿道外口切开,效果欠佳,最大尿流率(4.3±2.4)ml/s。术中于系带处"∧"形切开正常表皮,向阴茎近端游离表皮获得带蒂皮瓣,纵形切开尿道外口腹侧,充分切除无弹性瘢痕组织,将游离的"∧"形皮瓣嵌入尿道吻合,并重建尿道外口。结果:术后随访6~30个月,全部患者尿道外口狭窄完全解除,排尿通畅,最大尿流率(26.7±4.5)ml/s,无排尿刺激感,无勃起功能障碍。结论:本术式创伤小,并发症少,术后效果理想,是一种有效的、可行的手术方法。但术后阴茎头正常外观存在一定改变,远期疗效有待进一步观察。     

阴茎背侧纵形带蒂皮瓣修复小儿尿道下裂38例临床分析

目的 总结阴茎背侧纵形带蒂皮瓣Ⅰ期修复小儿尿道下裂的经验.方法 1998年9月～2008年8月,对38例尿道下裂患儿采用阴茎背侧纵形带蒂皮瓣进行Ⅰ期修复手术,年龄2～12岁,平均（5.2±2.8）岁.其中阴茎型30例,阴茎阴囊型6例,阴囊型2例.结果 38例转移皮瓣全部成活,Ⅰ期治愈32例,治愈率84.2% 出现尿道瘘6例,其中1例为尿道外口狭窄并尿道憩室、吻合口瘘.出现并发症的6例患者中,阴茎型3例（10.00%）,阴茎阴囊型1例（16.67%）.会阴型2例（100.00%）.随访3～6月,阴茎外观满意,尿道开口正位,排尿功能良好.结论 阴茎背侧纵形带蒂皮瓣治疗小儿尿道下裂,手术设计合理,并发症少,术后阴茎外形美观,不臃肿,无扭转,是治疗阴茎型小儿尿道下裂较理想的手术方式.     

带蒂阴囊纵隔皮瓣Ⅰ期修复尿道下裂26例报告

目的：探讨带蒂阴囊纵隔皮瓣Ⅰ期修复尿道下裂的效果。方法：应用带蒂阴囊纵隔皮瓣形成尿道，皮瓣的宽度一般为：儿童1.2-1.6cm，成人1.6-2.0cm；长度为阴茎伸直后从阴囊根部至龟头的长度。结果：本组26例，2例尿道口局部坏死，痂下愈合；1例尿道外口狭窄。结论：应用该方法Ⅰ期修复尿道下裂效果好、并发症少，不失为一种较好的方法。     

一期正位开口修复尿道下裂

自1991～1995年,我们采用包皮带蒂皮瓣和阴茎背侧纵行带蒂皮瓣一期正位开口治疗16例阴茎型和阴茎阴囊型尿道下裂,取得较为满意的疗效,现介绍如下。1　资料与方法1.1　一般资料本组16例,年龄3～12岁,平均4.6岁。阴茎型尿道下裂9例,阴茎阴囊型7例。1.2　手术方法阴茎伸直:距冠状沟0.5cm作包皮内板环形切开,直达阴茎海绵体白膜。阴茎腹侧正中纵行切口,自冠状沟切口至原尿道外口,彻底切除阴茎腹侧及尿道口周围纤维组织。人工勃起方法检验阴茎伸直效果,并测量尿道缺损长度。尿道成形:首先测量包皮皮肤,如可达到形成新尿道的宽度及长度,即采用Duc…     

“?”形阴茎阴囊联合皮瓣一期修复重度尿道下裂

我院从1987年1月起采用自行设计“?”形阴茎阴囊带蒂转移皮瓣一期惨复阴茎阴囊型、阴囊型、会阴型尿道下裂共5例,效果满意,介绍如下。一、手术方法 1.早期做耻骨上膀胱穿刺造瘘,近期选用F_(8～10)硅胶管自尿道外口置入膀胱,作为新成形尿道的支架管并引流尿液。 2.矫正阴茎下曲:沿冠状沟下3mm处做环形切口,于阴茎腹侧正中向下绕过尿道外口,逐层切开达阴茎海绵体的白膜表面,彻底切除腹侧纤维索条,使阴茎充分伸直(附图1)。     

膀胱粘膜尿道成形术治疗尿道下裂二例

近年来,国内采用膀胱粘膜代尿道治疗尿道下裂取得了进展。我院从1982年8月以来收治先天性尿道下裂2例,均采用膀胱粘膜尿道成形一期手术,获得了满意效果。现报道如下。例1.男,25岁。患先天性尿道下裂,12岁时曾在某医院治疗手术失败。检查:阴茎无明显弯曲,尿道外口开口于阴茎腹侧距冠状沟4cm处,尿道外口狭窄,直径为0.2cm。以先天性尿道下裂(阴茎型),行膀胱粘膜尿道成形一期手术。     

帽状包皮腹侧转移纵形带蒂皮管一期尿道下裂成形术

目的：探讨利用包皮行尿道下裂一期尿道成形的手术方式。方法：先天性尿道下裂患者28例，采用包皮腹侧转移纵型带蒂皮管一期尿道下裂成形术治疗。结果：术后10－12d拔除支架管，排尿正常，仅1例术后1个月并发尿道外口狭窄，其余患者未发生任何并发症。结论：帽状包皮腹侧转移纵型带蒂皮管一期尿道下裂成形术是治疗先天性尿道下裂简单，有效，可靠的手术方式。     

Use of distal Thiersch-Duplay urethroplasty for proximal hypospadias repairs in conjunction with short island pedicle flap

Experience with 8 boys having proximal hypospadias with severe chordee and a foreshortened dorsal hooded foreskin is presented. Use of a distal Thiersch-Duplay tube was incorporated in addition to an island pedicle flap to achieve the correct meatal location on the glans. One boy with perineal hypospadias required both proximal and distal Thiersch tube with an island flap interposition. Follow-up of nine months to 3.5 years demonstrated excellent cosmetic and functional results with no recurrent chordee or urethral stenosis. The only fistula noted developed at the proximal Thiersch tube-island flap anastomosis in the boy with perineal hypospadias. Advantages of the aforementioned procedure include decreasing the risk of chordee on the basis of a foreshortened island pedicle flap, use of vascularized flaps, and completing the procedure in one stage with a satisfactory result.     

Urethral advancement and glanuloplasty with V flap of the glans in the repair of anterior hypospadias

BACKGROUND: Hypospadias is a common urethral anomaly in boys. More than 65% of hypospadias cases are anterior (glanular, coronal and distal penile shaft). More than 200 original techniques have been applied to correct hypospadias. Each of these techniques has some complications, the most common of which are fistula and meatal stenosis. METHODS: A total of 74 boys with anterior hypospadias underwent the procedure of urethral advancement and glanuloplasty (UAGP) with V flap of the glans in our medical centres between March 1994 and March 2000. The procedure included degloving, correction of chordee, urethral mobilization and glans plasty. RESULTS: Cosmetic results were excellent in most patients. There was no fistula, and meatal stenosis was also not observed after applying V flap of the glans. In a 1-6-year follow-up (mean +/- SD, 3.15 +/- 1.79 years), the results, functionally and cosmetically, were satisfactory in all cases, with no long-term complication or chordee. CONCLUSION: Our findings suggest that UAGP is an excellent technique for repairing anterior hypospadias with satisfactory results and low complication rate.     

袖状蒂岛状环形包皮瓣尿道成形术一期修复会阴型尿道下裂

目的 探讨袖状蒂岛状环形包皮瓣尿道成形术一期修复会阴型尿道下裂的临床效果.方法 距冠状沟0.5 cm处环形切开包皮内板和尿道板,脱套以纠正阴茎下曲.沿尿道板两侧平行切开,近端绕尿道口后会合,呈U形,远端环绕包皮到背侧,使新尿道皮瓣呈环状.解剖供应皮瓣的深层皮下组织与阴茎皮肤,形成血管蒂.经纽扣样孔隙,转移环状皮瓣至腹侧.缝合岛状环形皮瓣的内、外缘,形成新尿道.术后尿液转流时间10～14 d,平均12.8 d.结果 1997年以来,于临床应用22例,一期手术成功18例(81.8%),尿瘘4例,均位于阴茎阴囊交界近端,其中伴尿道外口狭窄1例,经尿道扩张后治愈,另3例经再次修补后愈合.新尿道长度为3.50～18.00 cm,平均4.93 cm.术后随访6个月以上,外观的满意度为72.7%(16/22).结论 袖状蒂岛状环形包皮瓣具有血供丰富、尿道成形材料天然的优点,能一期纠正阴茎弯曲和尿道成形,特别适用于伴有阴茎严重弯曲或阴茎阴囊转位和阴囊分裂的会阴型尿道下裂患者.     

One-stage hypospadias repair. Experience with 544 cases.

PURPOSE: We evaluated one-stage hypospadias repairs in providing a normal looking penis with a normal functioning urethra. Also we looked critically at the effects of the severity of hypospadias, the type of repair and the experience of the surgeon on the outcome. Materials and METHODS: From 1987 to 1996 we performed 578 primary hypospadias repairs. The type and surgical results as well as the effects of certain variables on outcome were reviewed retrospectively. RESULTS: 544 single-stage hypospadias repairs have been followed up for a mean of 19 months (range 12-49). They included: MAGPI (92), ARAP (78), Mathieu (205), Mustarde (12), Duckett's tubularized preputial flap (142) and Onlay preputial flap (15). Despite an initial overall complication rate of 19%, the final success rate was 96%, after a mean of 1.3 procedures. Complications included fistula in 48 (9%) cases, meatal stenosis or retraction in 28 (5%), residual chordee in 17 (3%), stricture in 14 (2.5%), tubal abnormality in 10 (2%), and flap necrosis in 9 (2%). Complication rates were significantly higher (p < 0.05) when the meatus was proximal, the degree of chordee was moderate or severe and in the early series. Complication rates were also significantly higher with flap procedures and when the urethral plate was resected. Cosmetic defects occurred mainly with meatal advancement procedures. CONCLUSIONS: A repertoire of different types of single stage procedures has allowed the successful treatment of most hypospadias cases presenting to one surgeon. Complication rates increases with the severity of hypospadias or transection of the urethral plate. A cumulative experience allows for better results via a proper selection of the procedure and a perfection of a few techniques.     

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.     

One-stage reconstruction of moderately severe hypospadias

Single stage repair of moderately severe degrees of hypospadias with correction of chordee and reconstruction of the neourethra presents a difficult challenge for the surgeon. Traditionally, a 2-stage approach to correct these defects has been used. However, more recently a 1-stage repair with correction of chordee and creation of a neourethra has increased in popularity. From 1978 to 1985 we treated 86 patients with moderately severe hypospadias and chordee with a 1-stage technique using either a transverse island pedicle flap, a Hodgson III hypospadias repair or a free preputial skin graft. Despite an over-all complication rate of 50 per cent, our final results based on cosmesis and function were deemed excellent in 90 per cent of the cases. Of the 44 complications 23 were strictures, most frequently at the proximal anastomosis. Two-thirds of these strictures responded to a single dilation with the patient under anesthesia. Our fistula rate was 10 per cent and flap necrosis, meatal stenosis or prolapse and residual chordee accounted for the remaining 12 complications. Our experience indicates that a 1-stage repair for moderately severe hypospadias and chordee can be performed in patients with a satisfactory success rate of more than 90 per cent, minimal morbidity and an acceptable complication rate.     

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.     

Mathieu's urethroplasty in surgery for hypospadia postoperative complications

The aim of the study was to report the results of meatal based flap urethroplasty called Mathieu urethroplasty, in failed preliminary surgery for hypospadias. PATIENTS AND METHODS: Fourteen boys aged three to 14 years underwent surgery using a meatal-based flap urethroplasty for the correction of prior hypospadia repair complications. The secondary procedure was performed for glandular or coronal urethrocutaneous fistula in ten cases, completely failed urethroplasty in three cases, and for severe meatal retraction in one case. The surgical technique was the same as that used for the primary Mathieu procedures. RESULTS: Only one meatal retraction occurred; the other 13 cases had satisfactory procedure of hypospadias repair failures. Despite the scar skin used for secondary meatal based flap, good results can be achieved specially in two favorite indications: juxta coronal urethrocutaneous fistula and meatal retraction.     

Nuances of distal hypospadias

The MAGPI procedure should be the procedure of choice and is applicable for most boys with coronal/subcoronal hypospadias. The excellent results of the MAGPI are reliable and reproducible. However, careful evaluation of meatal configurations is essential, as is assessing for the existence of fibrous chordee. Should subcoronal meatal variation or possible chordee exist, the creation of a vascularized meatal-based flap provides excellent flexibility as well as many options to the surgeon.     

The forked flap repair for hypospadias

Context:

Despite the abundance of techniques for the repair of Hypospadias, its problems still persist and a satisfactory design to correct the penile curvature with the formation of neourethra from the native urethral tissue or genital or extragenital tissues, with minimal postoperative complications has yet to evolve.

Aim:

Persisting with such an endeavor, a new technique for the repair of distal and midpenile hypospadias is described.

Materials and Methods:

The study has been done in 70 cases over the past 11 years. The “Forked-Flap” repair is a single stage method for the repair of such Hypospadias with chordee. It takes advantage of the rich vascular communication at the corona and capitalizes on the established reliability of the meatal based flip–flap. The repair achieves straightening of the curvature of the penis by complete excision of chordee tissue from the ventral surface of the penis beneath the urethral plate. The urethra is reconstructed using the native plate with forked flap extensions and genital tissue relying on the concept of meatal based flaps. Water proofing by dartos tissue and reinforcement by Nesbit''s prepucial tissue transfer completes the one stage procedure.

Statistical Analysis:

An analysis of 70 cases of this single stage technique of repair of penile hypospadias with chordee, operated at 3 to 5 years of age over the past 11 years is presented.

Results and Conclusion:

The Forked Flap gives comparable and replicable results; except for a urethrocutaneous fistula rate of 4% no other complications were observed.KEY WORDS: Chordee, fistula, forked flap, hypospadias, urethral plate