尿道下裂伴发前列腺囊的诊断及治疗

目的 探讨尿道下裂伴发前列腺囊的诊断及治疗方法。方法 对近4年收治的重型尿道下裂进行尿道造影检查，然后根据尿道下裂程度、囊肿大小、位置，分别采用经会阴、经腹会阴囊肿切除，同时行尿道成形治疗。结果 重型尿道下裂146例确诊伴发前列腺囊18例（12．3％），其中尿道造影证实13例，手术探查证实5例。经会阴囊肿切除14例中行Dupply＋DuckettⅠ期尿道成形6例，Ⅰ期治愈4例，另8例先行Dupply尿道成形术，半年后再次尿道成形治愈；经腹会阴囊肿切除＋Dupply尿道成形1例；保留囊肿仅行阴囊中隔皮瓣翻转尿道成形3例均I期治愈。结论尿道造影对术前明确重型尿道下裂是否伴发前列腺囊很有必要，伴发前列腺囊者大多可经会阴切除，囊肿切除并不影响尿道下裂治疗效果。     

阴茎阴囊皮瓣翻转埋藏法治疗各型尿道下裂的改进

目的：探讨保留尿道板与翻转阴茎阴囊皮瓣或皮管形成尿道法治疗各型尿道下裂的效果。方法：对我院１９８４年前采用的单纯阴茎阴囊皮瓣埋藏法进行改进，包括保留尿道板并与翻转阴茎阴囊皮瓣或皮管形成尿道，保证尿道正位开口，伴阴茎阴囊转位者一期矫正，取消膀胱造瘘等。结果：用改进术式治疗各型小儿尿道下裂３１２例，一期成功２６６例（８５．３％），因尿瘘、尿道狭窄等手术失败４６例（１４．７％）。结论：改进后的保留尿道板并与翻转之阴茎阴囊皮瓣或皮管形成尿道法是治疗本病较理想的方法，支架管替代膀胱造瘘和同时矫正阴茎阴囊转位不但简化了手术步骤，而且有利于手术一期成功     

不同手术方法治疗先天性尿道下裂

198 8年以来 ,我们采用 4种手术方法Ⅰ期治疗先天性尿道下裂 74例 ,效果满意 ,报告如下。临床资料膀胱粘膜法尿道成形术 16例 ,其中阴茎型 8例 ,阴茎阴囊型 6例 ,阴囊型2例 ;阴囊隔皮瓣法尿道成形术 16例 ,均为阴茎阴囊型 ;横裁包皮内板岛状皮瓣法 (Ｄｕｃｋｅｔｔ)尿道成形术 36例 ,其中阴茎型 33例 ,阴茎阴囊型 3例 ;Ｄｕｃｋｅｔｔ 尿道口周围皮瓣法 (Ｄｕｐｌａｙ)尿道成形术 8例 ,其中阴囊型 5例 ,会阴型 3例。所有手术均要求用小儿外科器械轻柔操作 ,Ⅰ期正位口尿道成形 ,新建尿道段置多孔硅胶管 ,常规经膀胱尿流改道 ,全身及局部应用…     

正位尿道口带蒂阴茎阴囊联合皮瓣Ⅰ期修复会阴型及阴囊型尿道下裂

尿道下裂其矫治手术方法繁多,各有其优缺点。作者从1983年起用带蒂包皮、阴茎、阴囊联合皮瓣Ⅰ期修复阴囊型尿道下裂5例及会阴型尿道下裂1例。现总结如下。     

联合带蒂皮瓣尿道成形术一期治疗小儿会阴型尿道下降

用会阴、阴囊、阴茎、包皮联合带皮瓣手术治疗会阴型尿道下裂，成形尿道之皮管无吻俣口、长度易调节、易存活，并且一期完成，外形美观。共治疗８例，效果良好。     

联合带蒂皮瓣尿道成形术一期治疗小儿会阴型尿道下裂

用会阴、阴囊、阴茎、包皮联合带蒂皮瓣手术治疗会阴型尿道下裂，成形尿道之皮管无吻合口、长度易调节、易存活，并且一期完成，外形美观。共治疗８例，效果良好。     

包皮岛状皮瓣联合阴囊正中皮瓣成形术治疗阴囊型尿道下裂

目的　探讨包皮岛状皮瓣尿道成形术 (Duckett)联合阴囊中隔皮瓣尿道成形术治疗小儿阴囊型尿道下裂的疗效。方法　 2～ 12岁 18例尿道缺损长度 (4 .0～ 6 .0 )cm的严重阴囊型尿道下裂患儿 ,均应用包皮岛状皮瓣成形术联合阴囊中隔成形术治疗。结果　术后 10～ 12d拔除支架管 ,排尿正常 ,1例术后 2个月出现尿道外口狭窄 ,余患儿未发生并发症。结论　联合手术方法治疗阴囊型尿道下裂效果满意。     

带蒂包皮双面皮瓣法联合DuplayⅠ期修复重度尿道下裂

目的 总结带蒂包皮双面皮瓣法(PPDIF)联合原位尿道板卷管(Duplay)治疗重度尿道下裂的方法及疗效.方法 1998年1月至2010年3月采用带蒂包皮双面皮瓣法加原位近端尿道板卷管(PPDIF+ Duplay)术式治疗重度尿道下裂72例,包括阴囊型50例,会阴型22例.结果 平均随访23个月,术后阴茎伸直及外观满意,尿道口位置正常.发生尿瘘10例(13.9％),尿道狭窄4例(5.6％),手术总成功率达80.6％.结论 PPDIF联合Duplay术式 Ⅰ期修复重度尿道下裂疗效肯定,具有术后外形美观,尿道狭窄、尿瘘等并发症少等优点.     

尿道下裂Ⅰ期手术术式疗效对比分析

目的 提高尿道下裂Ⅰ期手术治愈率。方法 对1984~1992年112例尿道下裂不同术式Ⅰ期修复术疗效及1993~2003年262例尿道下裂改进术式Ⅰ期修复术疗效对比分析。结果 改进后的尿道下裂Ⅰ期术式治愈率提高阴茎头型(76.1％→94.2％)、阴茎型(53.7％→95.5％)、阴茎阴囊型(55.5％→89.2％)、会阴型(25.0％→88.8％)。经统计学处理,提高率均有显著差异。结论　选择改进后的各种术式修复尿道下裂有助于提高手术治愈率。     

TIP术治疗小儿尿道下裂及尿瘘

目的评价尿道板切开成管尿道成形术(TIP术)治疗小儿尿道下裂及尿瘘的疗效。方法采用TIP术治疗年龄2～10岁男童尿道下裂及尿瘘共35例，其中巨尿道1例，阴茎型14例、阴茎阴囊型7例，阴囊型1例，尿道下裂Ⅰ期伸直术后7例，尿瘘5例。结果阴茎型尿道下裂成功13例，瘘1例；阴茎阴囊型成功6例，瘘1例；Ⅰ期伸直术后成功6例，瘘1例；尿瘘成功2例，瘘复发3例，阴囊型尿道下裂及巨尿道各1例均成功。结论TIP术治疗小儿尿道下裂，其手术方法操作相对简便，取材合理，术后效果好，值得推广。     

445例先天性尿道下裂的治疗

目的 探讨不同术式对445例不同类型先天性尿道下裂患儿的手术治疗效果。方法 回顾性分析我院1988年—2003年445例先天性尿道下裂病例资料，其中采用阴茎阴囊纵隔带蒂皮瓣尿道成型术311例，包皮内板带蒂皮瓣尿道成型术52例，包皮及阴茎阴囊联合皮瓣尿道成型术61例，膀胱粘膜代尿道术21例。每例均同时行耻骨上膀胱造瘘术。结果 治愈率90．6％，并发症为9．4％。其中尿道狭窄11例，尿瘘31例。尿道狭窄中膀胱粘膜法1例，包皮内板法2例，阴茎阴囊纵隔法5例，联合皮瓣法3例；尿瘘中膀胱粘膜法1例，包皮内板法3例，阴茎阴囊纵隔法24例，联合皮瓣法3例。结论 根据尿道下裂类型选择不同的术式 尿流改道，并严格遵守整形外科的原则是尿道下裂手术成功的关键。     

尿道板正中纵切移植皮片卷管尿道成形术治疗尿道下裂

目的探讨尿道板正中纵切后在皮损区移植皮片卷管尿道成形术治疗尿道下裂的疗效及优势。方法2010年3月至2012年10月应用尿道板正中纵切移植皮片卷管尿道成形术治疗尿道下裂23例，其中阴茎体型19例，阴茎阴囊型2例，外院行一期阴茎矫直术后1例，手术后尿道裂开1例；年龄1．5—6．0岁，平均年龄3．75岁，均采取尿道板正中纵切后在皮损区移植皮片卷管尿道成形术治疗。结果患儿均顺利完成手术，均于出院后随访6个月，所有患儿阴茎外观形似包皮环切术后，尿道外口位于阴茎头尿道沟正位，呈裂隙状。一期治愈22例（95．7％），术后尿道瘘1例，1个月后自愈；无尿道狭窄发生。结论尿道板正中纵切移植皮片卷管尿道成形术治疗尿道下裂效果满意，一期愈合率高，术后并发症的发生率较低，方法简单，容易开展。     

The Single Stage Dorsal Inlay Skin Graft for Hypospadias Reoperations: Long-Term Follow-Up

PurposeDespite high success rates for primary hypospadias repair, some patients still require multiple sessions for ultimate functional reconstruction. We report our long-term experience with single stage dorsal inlay urethroplasty using skin grafts for complex hypospadias reoperations.Material and Methods35 patients (mean 13.8 years) with failed hypospadias surgery (mean 4.2 times) were included. Indications comprised fistulas, strictures, diverticula, and repair breakdown. The urethral plate had been removed or was scarred in all patients. After excision of fibrotic tissue a free penile or groin skin graft was sutured and quilted to the corpora cavernosa. The neourethra was tubularized followed by glanuloplasty in a single stage. Clinical outcome was considered a failure when any postoperative instrumentation was needed.ResultsPenile skin was used in 31 and inguinal skin in 4 cases.The average graft length was 4.87 cm. Initial graft healing was successful in all cases. We did not note complications from the graft donor sites. After a mean follow up of 55.73 +/- 18.26 months 5 patients underwent redo surgery leaving a complication rate of 14.3 %. Urethral stricture of the proximal anastomosis was the most frequent finding. Single internal urethrotomy was sufficient for 2 boys whereas 2 finally required another urethroplasty using the same technique.ConclusionsThis single stage approach using dorsal inlay skin grafts is a reliable method to create a substitute urethral plate for tubularization. Complication rates are equivalent to those of staged strategies with the advantage of only one hospital stay. Residual penile skin should be used as a graft donor site to optimize the outcome if available. Given the excellent long term follow-up, this approach represents a safe option for hypospadias re-operations even if the urethral plate or midline penile skin is grossly scarred.     

精索外筋膜联合唇黏膜移植一期修复尿道下裂修复失败的初步报告

目的通过预置精索外筋膜改良唇黏膜移植的方法,同期联合局部皮瓣尿道成形一期修复术治疗手术修复失败的尿道下裂,并评价其疗效。方法2014年12月至2017年4月作者采用预置精索外筋膜移植床一期治疗13例修复手术失败的尿道下裂患儿,年龄2.5~6岁,患儿至少经历1次失败的尿道下裂手术,阴茎体与睾丸大小、质地均尚可,术前合并不同程度阴茎弯曲。沿原手术切口暴露原手术建立的尿道,人工勃起试验均提示存在阴茎体下弯(弯曲15°~45°)。自腹侧弯曲最显著处完全离断原尿道海绵体,深达阴茎海绵体白膜后完全伸直阴茎,剔除白膜表面原手术后瘢痕组织,尿道缺损长度2.2~4.9 cm;于一侧睾丸鞘膜表面自睾丸底部到腹股沟管处解剖长段精索外筋膜后,将其转移覆盖于白膜表面尿道缺损处,取同等长度的下唇黏膜移植于精索外筋膜表面,固定后游离局部带蒂阴茎皮肤加盖成型新尿道,一期完成重建手术。结果13例患儿留置导尿管3周后拔除,随访12~40个月后,2例出现尿道瘘(1例位于冠状沟、1例位于阴茎根部),均再次行手术修补;1例阴茎头裂开未予处理,1例尿道外口狭窄行尿道外口扩张后治愈。所有患儿阴茎勃起时无下弯,患儿家长对其术后阴茎体外观满意。结论通过预置精索外筋膜可增加唇黏膜的获取率,有效避免移植物挛缩的问题,可一次性完成尿道重建手术。     

尿道板纵切卷管尿道成形术在失败的尿道下裂治疗中的应用

目的 探讨尿道板纵切卷管尿道成形术（Snodgrass法）在失败的尿道下裂病例治疗中的应用。方法 2001～2005年应用Snodgrass尿道成形术治疗失败的尿道下裂病例84例。年龄2～16岁，平均3．7岁。并与在同期应用Duplay尿道成形术修复的阴茎皮肤充裕的失败尿道下裂76例作比较。结果 应用Snodgrass手术84例，成功64例（76．2％）；尿道瘘14例，尿道狭窄6例。Duplay手术76例，成功61例（80．3％），尿道瘘11例，尿道狭窄5例。结论Snodgrass尿道成形术用于阴茎腹侧皮肤少的失败尿道下裂病例修复，可取得满意效果。     

Snodgrass手术在治疗失败尿道下裂中的应用

目的探讨尿道板纵切卷管尿道成形术(Snodgrass法)对治疗失败尿道下裂的临床疗效。方法回顾性分析广州军区总医院泌尿外科2002年3月-2011年4月接受Snodgrass法治疗的81例阴茎皮肤少的治疗失败尿道下裂患者的临床资料,并与36例同期应用Duplay尿道成形术修复的阴茎皮肤相对充裕的治疗失败尿道下裂患者进行比较。2种治疗方法均留置尿道U形支架管,U形支架管两端分别从会阴部尿道及尿道外口引出,均采用肉膜瓣覆盖成形尿道。结果随访6个月～2 a,应用Snodgrass手术治疗81例,成功65例(80.2%),术后并尿道瘘11例,尿道狭窄5例。Duplay尿道成形术治疗36例,成功29例(80.6%),术后并尿道瘘5例,尿道狭窄2例。2组手术成功率比较差异无统计学意义(P>0.05)。结论 Snodgrass手术用于儿童阴茎皮肤少的治疗失败尿道下裂的修复,可取得满意效果。     

Circumcised hypospadias

Purpose  Patients with circumcised hypospadias have been of significant concern over many decades due to the belief that prior circumcision might negatively affect the results of hypospadias’ repair. We evaluated outcomes in consecutive males with anterior, distal penile, and the megameatus with intact prepuce variant of hypospadias (MIP). Methods  After IRB approval a retrospective of 48 consecutive males with circumcised hypospadias was reviewed. In all cases the urethroplasty was accomplished with either urethral plate tubularization or a MAGPI procedure. No skin flaps were used. Results  A total of 48 patients with circumcised hypospadias (anterior, MIP variant, and distal penile) underwent operative reconstruction by one of us (RVP). All patients were followed for at least 8 months. Conclusions  Prior circumcision did not negatively affect the results of subsequent urethroplasty in patients with anterior, distal penile, and the MIP variant of hypospadias. The use of the tubularized incised plate urethroplasty (TIP) has virtually eliminated the need for skin flaps in anterior hypospadias repair.     

Correction of penile torsion by mobilization of urethral plate and urethra

ObjectiveTo assess the feasibility of correction of torsion by mobilization of the urethral plate with the corpus spongiosum and the proximal urethra.Patients and methodsOf 27 cases of congenital penile torsion, 18 had hypospadias, seven were chordee without hypospadias, and two were isolated penile torsion. Age of patients varied from 2 to 26 years (mean 6 years, 8 months). Correction of torsion was performed: (1) penile skin de-gloving; (2) mobilization of the urethral plate with the corpus spongiosum up to the corona; (3) mobilization of the proximal urethra up to the perineum; and (4) mobilization of the hypoplastic urethra/urethral plate into the glans. Tubularized incised plate urethroplasty with spongioplasty was done in cases of hypospadias, as compared to spongioplasty alone in cases of chordee without hypospadias.ResultsDegree of torsion varied from 45 to 180 degrees (mean 68.70); 74% of the patients had left and 26% had right penile torsion. Correction of torsion was possible by penile de-gloving (4%), mobilization of urethral plate and spongiosum (26%), mobilization of proximal urethra (22%), and mobilization of urethral plate/hypoplastic urethra with spongiosum into glans (48%).ConclusionsExtended urethral mobilization corrected penile torsion in almost all cases. The technique is simple, safe, reproducible and effective for correction of both torsion and chordee.