尿道板纵切卷管尿道成形术治疗儿童尿道下裂

目的总结尿道板纵切卷管尿道成形术（tubalarized incised plate urethroplasty，TIP或Snodgrass手术）矫治尿道下裂的经验。方法回顾性总结分析2001年5月～2004年11月采用Snodgrass手术治疗的尿道下裂82例，年龄1岁6个月～16岁，平均5岁。将资料按前后时期、不同的病情特点分为前期手术组34例，后期手术组48例；其中近侧型组19例，远侧型和中段型组63例；初次手术组49例，再次手术组33例，对并发症发生情况进行分析。结果术后并发尿瘘12例，尿瘘发生率14．6％；阴茎头裂开1例。各组尿瘘情况：前期手术组11例（32．4％），后期手术组1例（2．1％）；近侧型组2例（10．5％），远侧型和中段型组10例（15．9％）；初次手术组8例（16．3％），再次手术组4例（12．1％）。尿瘘发生率，前期手术组与后期手术组差异有统计学意义（P〈0．01），近侧型组与远侧型和中段型组、初次手术组与再次手术组之间差异无统计学意义（P〉0．05）。术后随访均在1个月以上，阴茎外观满意，尿道开口正位，排尿功能良好。其中15例连续随访1．5～6个月，平均3个月，平均尿流率7．8ml／s（6．8～10．5ml／s），最大尿流率均值10．5ml／s（8．8～14．5ml／s）结论Snodgrass手术适用于无弯曲或伴有轻度弯曲的各型尿道下裂以及再手术者，术后具有阴茎外观好、尿道口正位垂直裂隙状、排尿功能良好、并发症低的优点，但对有明显阴茎下曲、尿道板短缩者仍应首选带蒂包皮瓣手术。     

尿道板卷管尿道成形术治疗小儿尿道下裂

目的探索一种新的尿道下裂的手术方法。方法212例4月龄～9岁尿道下裂男性患儿,其中阴茎头冠状沟型8例、阴茎体型181例、阴茎阴囊型23例,采用单纯尿道板卷管尿道成形术(Snodgrass术)治疗。结果随访2～34个月,188例尿道下裂患者术后阴茎完全伸直,尿道开口于龟头正位,排尿通畅,尿线粗,无尿道憩室,阴茎外观满意;22例有尿瘘,其中16例2次手术修补后成功,6例待手术;2例成形尿道全长裂开,1年后再次行Snodgrass手术治愈。结论尿道板卷管尿道成形术是一种方法简便、术后并发症少、手术效果确切、术后外形美观的新型尿道下裂矫形术,尤其适合不伴有严重阴茎下弯的尿道下裂患者。     

尿道板宽度对尿道下裂行尿道板纵切卷管成形术疗效的影响

目的 探讨尿道板宽度对尿道下裂行尿道板纵切卷管成形术（tubularized incised plate,TIP）术后并发症、外观、排尿功能等的影响。方法 回顾性分析2018年4月至2019年6月山东省立医院收治的行TIP尿道成形术的89例尿道下裂患儿的临床资料。根据尿道板宽度分为A组（尿道板平均宽度≥6 mm） 52例和B组（尿道板平均宽度<6 mm） 37例,通过随访并发症的发生率、阴茎外观及排尿情况,观察对比两组患儿的术后疗效。结果 A组患儿尿道板平均宽度6.15（6.00～7.45） mm,B组平均宽度5.00（3.50～5.30） mm。两组患儿手术年龄（P=0.28）、尿道下裂类型（P=0.10）、阴茎头直径（P=0.11）、是否行背侧白膜紧缩（P=0.05）及留置尿管型号（P=0.30）等差异均无统计学意义。A组术后并发症10例（19.23%）,包括尿道瘘7例,阴茎头裂开2例和尿道外口狭窄1例;B组术后并发症7例（18.92%）,包括尿道瘘5例,尿道外口狭窄2例;两组术后总并发症发生率（P=0.97）和尿道瘘的发生率（P=0.99）均无明显统计学差异。两组无并发症患...     

尿道板纵切卷管尿道成形在尿道下裂中的应用

目的：总结尿道板纵切卷管尿道成形术（Snodgrass法）治疗尿道下裂的经验，方法：对43例尿道下裂患儿行Snodgrass尿道成形术，其中阴茎体型35例，阴茎阴囊交界型8例，9例为上次尿道成形失败者；10例阴茎下弯者先行阴茎背侧折叠；患儿尿道置管10天，拔管后常规前尿道扩张，结果：43例随访4－11个月，阴茎外观正常，无下弯；尿道开口于阴茎头前端，呈纵行裂隙状，排尿通畅，无尿道狭窄，术后5例发生尿瘘，4例已做修补，均成功，结论：Snodgrass尿道成形术可应用于近，远端型及有阴茎下弯的尿道下裂患儿，对尿道成形失败而阴茎皮肤所剩极少者也是一种非常有效的方法。     

尿道板纵形切开卷管尿道成形术治疗小儿尿道下裂

目的探讨尿道板纵形切开卷管（TIP）尿道成形术治疗小儿尿道下裂的适用范围和疗效。方法2000年3月至2005年12月,收治尿道下裂患儿171例,手术年龄10个月～16岁,中位数3岁。尿道下裂程度按Barcat分型：前型65例（38．0％）、中间型29例（17．0％）、后型77例（45．0％）。术中根据病因分类,将尿道下裂阴茎下弯程度分为0～4级。原则上首选TIP尿道成形术式,少数无法一期完成手术者,在矫正阴茎下弯后中转其他方法。结果171例患儿中,完成了TIP手术161例（94．2％）。术中测量尿道板宽度0．6～0．9cm,平均（0．72±0．06）cm,修复尿道缺失长度0．4～4．5cm,平均（1．87±0．78）cm。阴茎下弯彻底矫正129例,新建尿道口位于阴茎头部,阴茎外观类似于包皮环切术后形态,一次性手术成功率80．1％（29/161）。1例阴茎阴囊型尿道下裂伴4级阴茎下弯者,术后1年阴茎下弯复发,行前尿道延伸再手术治愈。术后并发尿道口狭窄2例（1．2％）,经定期尿道口扩张后治愈。并发尿瘘26例（16．1％）,14例经再手术修补治愈。新建尿道裂开1例（0．6％）、新建尿道口裂开后移2例（1．2％）。结论TIP尿道成形术适用于大多数小儿尿道下裂病例的治疗。对于尿道板下组织有明显纤维索带造成严重阴茎下弯者,需横断尿道板才能彻底矫正阴茎下弯,不适用TIP手术。     

尿道板纵切在远端型尿道下裂选择Mathieu术式中的应用

目的:比较尿道板纵切联合尿道口基底血管皮瓣法(Mathieu)与尿道板纵切卷管法(TIP)治疗远端型尿道下裂疗效。方法:回顾性分析2016年8月至2019年1月72例远端型尿道下裂临床资料,21例行尿道板纵切联合Mathieu术(Mathieu-IP组),其中5例尿道板狭窄、小扁平阴茎头、浅尿道;51例行TIP术(TIP组);随访观察尿道口位置、形状、阴茎头裂开、尿瘘、狭窄、憩室,并进行分析比较。结果:Mathieu-IP组与TIP组垂直裂隙状口分别为19例(90.5%)、46例(90.2%),外观无明显差异(P>0.05);Mathieu-IP组较TIP组尿瘘发生率显著降低(P=0.048),分别为1例(4.8%)和15例(29.4%);Mathieu-IP组无尿道狭窄,TIP组12例(23.5%),Mathieu-IP组显著降低(P=0.037);Mathieu-IP组和TIP组阴茎头裂开、憩室发生率均无统计学差异(P>0.05),阴茎头裂开分别为1例(4.8%)和2例(9.8%),憩室分别为1例(4.8%)和6例(11.8%);5例尿道板狭窄、小扁平阴茎头、浅尿道患者术后均无并发症。结论:尿道板纵切用于Mathieu术修复远端型尿道下裂,可使尿道口垂直裂隙状,形成合理尿道口径,尿瘘、狭窄发生率明显降低,适用于尿道板狭窄、小扁平阴茎头、浅尿道沟患者。     

尿道板纵切卷管尿道成形术和包皮内板岛状皮瓣加盖尿道成形术治疗尿道下裂的临床疗效

目的:探讨尿道板纵切卷管尿道成形术(tubularized incised plate,TIP)和包皮内板岛状皮瓣加盖尿道成形术(onlay island flap,OIF)治疗尿道下裂的临床疗效。方法:取2014年1月~2015年2月在我院治疗的尿道下裂患儿71例,其中接受TIP治疗的患儿40例(TIP组),接受OIF治疗的患儿31例(OIF组),观察两组患儿的手术时间、治疗效果、并发症发生情况等。结果:TIP组和OIF组患儿年龄及病例类型差异无统计学意义(P0.05);TIP组手术时间为(82.13±7.94)min,明显短于OIF组的(119.07±11.08)min,差异有统计许学意义(P0.05)。TIP组和OIF组一次手术成功率分别为85.00%和87.10%,差异无统计学意义(P0.05)。TIP组术后发生尿瘘6例,阴茎头裂开1列,发生率为17.50%;OIF组术后发生尿瘘5例,阴茎头裂开1例,发生率为19.35%,两组术后并发症比较,差异无统计学意义(P0.05)。结论:尿道板纵切卷管尿道成形术和包皮内板岛状皮瓣加盖尿道成形术治疗尿道下裂均有较好效果;尿道板纵切卷管尿道成形术具有操作简便且手术时间短等优点。     

肉膜瓣覆盖在尿道板纵切卷管尿道成形术中的应用

目的:探讨肉膜覆盖在尿道板纵切卷管尿道成形术(TIP)中预防尿瘘的应用。方法:140例尿道下裂患者均行TIP术式修复,其中85例远端型尿道下裂采用纵行腹外侧阴茎肉膜瓣覆盖新尿道;55例近端形尿道下裂采用阴囊前动脉带蒂肉膜瓣覆盖新尿道。结果:12例患者出现尿道皮肤瘘,其中远端型尿道下裂患者7例;近端型尿道下裂5例。结论:远端型选择腹外侧阴茎肉膜瓣覆盖,近端型选择阴囊前动脉带蒂肉膜瓣覆盖,较少出现尿瘘的并发症,是TIP术中较理想的覆盖方式。     

切开尿道板管状成形术治疗尿道下裂35例报告

目的 :探讨切开尿道板管状成形术治疗小儿尿道下裂的临床效果。　方法 :尿道下裂患者 35例 ,年龄 1～12岁 ,均属阴茎型尿道下裂 ,其中 ,阴茎头型 5例、阴茎体型 2 7例、阴茎阴囊型 3例。采用正中切开尿道板 ,应用手术放大镜进行显微外科技术缝合 ,管状尿道成形术一期修复尿道下裂。　结果 :本组 35例患者 ,一次性治愈 30例 ,术后出现尿瘘 2例 ,尿道口狭窄 3例 ;随访 1～ 5年 ,32例无排尿异常。　结论 :尿道板接近正常尿道粘膜 ,血运丰富、伸延性好 ,切开尿道板管状成形术是一期修复阴茎型尿道下裂比较理想的术式。     

尿道板纵切卷管尿道成形术治疗尿道下裂

目的探讨尿道板纵切卷管尿道成形术（Snodgrass手术）治疗尿道下裂的临床效果。方法对采用尿道板纵切卷管尿道成形术治疗31例尿道下裂患者进行同颐性分析。,尿道下裂患者31例,年龄1～14岁,其中阴茎头型5例、阴茎体型14例、阴茎阴囊型4例,二期尿道成形术8例。结果本组31例患者,一次性治愈26例,术后出现尿瘘2例,均已修补成功。尿道口狭窄3例,经尿道扩张后治愈.结论尿道板纵切卷管尿道成形术可应用于多种类型的尿道下裂治疗。手术操作简便易行,手术成功率高。     

镶嵌式口腔黏膜尿道成形术治疗尿道下裂的临床分析

目的 探讨镶嵌式口腔黏膜尿道成形术治疗尿道下裂的效果. 方法 2005年1月至2010年12月343例尿道下裂患者行镶嵌式口腔黏膜尿道成形术.年龄6个月～61岁,平均7岁.初次手术147例,其中远端型尿道下裂124例,近端型23例;再手术196例,其中远端型尿道下裂137例,近端型59例.手术方法:将取下唇口腔黏膜补片填补于尿道板中间切开间隙,再将尿道板卷管成形尿道;切取口腔黏膜宽0.5 ～2.5 cm,长1.0～8.5 cm.对于再次手术病例,术中需切除瘢痕组织.结果 术后随访6～36个月,平均16个月.147例初次手术病例中,手术成功132例(89.8％),发生尿瘘14例(9.5％),尿道狭窄2例(1.4％),其中1例近端型病例为尿瘘合并尿道狭窄.196例再手术病例中手术成功157例(80.1％),发生尿瘘32例(16.3％)、尿道狭窄13例(6.6％),其中1例远端型和5例近端型病例为尿瘘合并尿道狭窄. 结论 尿道板切开后镶嵌口腔黏膜治疗尿道下裂具有成功率高,整形效果好,对口腔外观、功能无影响等优点.     

Further experience with the tubularized-incised urethral plate technique for hypospadias repair

OBJECTIVES: To report further experience of hypospadias repair using the tubularized-incised urethral plate (TIP) technique and to evaluate the role of postoperative neourethral dilatation as a method of preventing complications. PATIENTS AND METHODS: The study included 64 patients (aged 2-18 years) who underwent TIP repair of hypospadias; 47 required a primary and 17 a secondary repair. After removing the stent they were randomized into two groups; group 1 (38 patients) underwent regular neourethral dilatation for 12 weeks and group 2 (26 patients) did not. Patients were followed for a mean (range) of 28 (6-52) months. RESULTS: The functional and cosmetic results were excellent in all patients in group 1, except for slight meatal regression in one patient (3%). In group 2, 17 patients had excellent results; eight (31%) were re-operated upon to correct complications, six developed a fistula (four of which were associated with meatal stenosis) and two developed a neourethral stricture. CONCLUSIONS: TIP urethroplasty is a versatile technique that provides an excellent functional and cosmetic outcome. Regular urethral calibration after repair should be considered as an integral part of the technique, to prevent neourethral and/or meatal stenosis with subsequent fistula formation.     

Comprehensive analysis of six years experience in tubularised incised plate urethroplasty and its extended application in primary and secondary hypospadias repair

OBJECTIVE: We evaluated the potential of tubularised incised plate (TIP) urethroplasty in primary and secondary hypospadias repair focusing on the extended application of this procedure, the utility and handling of the urethral plate and operative results. METHODS: In this retrospective study, we analysed the medical records of 228 children with different levels of the hypospadiac meatus who underwent a TIP procedure between February 1997 and December 2002. The children were followed a mean of 42 months. Our medical records provided us with details about the location of the hypospadiac meatus, the width of the urethral plate before and after midline incision, primary versus secondary surgery, complications as well as notes on the extended application of the TIP procedure. RESULTS: The overall postoperative complication rate was 7.8%. The overall fistula rate was 5.7%, with 4.1% in primary distal, 9.6% in primary proximal and 7.5% in secondary repair respectively. We had one case of meatal stenosis (0.4%) and one of urethral stricture (0.4%) and 3 cases of glandular dehiscence (1.3%). Due to the encouraging results, the frequency of TIP procedure in hypospadias surgery increased from 33% in 1997 to 82% in 2002. CONCLUSION: In our study the TIP procedure has emerged as the first-choice technique in primary hypospadias repair--irrespective of the level of the hypospadiac meatus and the width of the original urethral plate. This procedure has also proved to be favourable for many cases at secondary surgery.     

Tubularized incised plate urethroplasty: 5 years' experience

OBJECTIVE: To evaluate the results of tubularized incised plate (TIP) urethroplasty in a series of primary hypospadias repairs. PATIENTS AND METHOD: The medical records of 360 children (Mean age: 4.3 years, range: 2-14 years) with primary hypospadias undergoing TIP urethroplasty repair and treatment of complications were reviewed. A good result is a direct urinary steam through a slit and vertically oriented meatus and mild angled urinary stream through a slightly regressed meatus is a satisfactory result. RESULTS: The sum of good (74%) and satisfactory results (3%) was the overall success rate (77%) which was increased to 95% after a second surgical procedure for the treatment of complications. In 30 patients with single fistula (8%), fistula healed spontaneously in 2 patients and 20 patients had successful fistula closure. Redo TIP urethroplasty (n = 30) was performed for dehiscence (n = 15, 3%), neourethral stricture (n = 3, 1%) and multiple fistula with meatal stenosis (n = 12, 3%). The complication rate after redo TIP urethroplasty is 30%. Twenty-four (7%) patients underwent meatoplasty for meatal stenosis. CONCLUSION: TIP urethroplasty can be used to repair primary hypospadias. After a learning curve and attention to surgical details, cosmetic and functional outcome become excellent. Redo TIP urethroplasty can be performed in the treatment of complications.     

Tubularized incised-plate urethroplasty for proximal hypospadias

OBJECTIVE: To report the experience of one surgeon using tubularized incised-plate (TIP) urethroplasty to repair proximal hypospadias in a consecutive series of boys. PATIENTS AND METHODS: The records of 33 consecutive patients with midshaft to scrotal hypospadias undergoing TIP repair by one surgeon were reviewed. Dorsal plication was used as necessary for penile straightening, to preserve the urethral plate. Standard TIP urethroplasty was undertaken, and the follow-up included the selective use of neourethral calibration and urethroscopy. RESULTS: Plication was necessary in 18 (55%) patients. The incised plate had a supple appearance in all but two boys. The mean (range) follow-up was 9 (1-48) months and included calibration in 16 (48%) and urethroscopy in 13 (39%) patients. Complications were noted in 11 (33%) boys, of whom seven (21%) developed small fistulae. The two patients in whom the incised plate appeared unhealthy had dehiscence of the repair and contracture of the neourethra with recurrent penile curvature, respectively. There was one meatal stenosis and one short neourethral stricture. CONCLUSIONS: TIP urethroplasty can be used to repair proximal hypospadias in the absence of severe penile curvature, and if the incised urethral plate has a supple appearance. As with distal hypospadias repair, the procedure creates a normal-appearing penis with a slit-like meatus.     

Regular dilatation is unnecessary after tubularized incised-plate hypospadias repair

OBJECTIVE: To determine if patients who undergo tubularized incised-plate (TIP) urethroplasty need regular dilatation to prevent neourethral strictures or meatal stenosis. PATIENTS AND METHODS: The follow-up of two consecutive series of patients who underwent primary TIP hypospadias repair by one surgeon was reviewed. The first 72 patients (group 1) had periodic neourethral calibrations for 1 year after repair, while the next 62 patients (group 2) had no routine dilatation, except for six patients (10%) in whom the meatus appeared to be small. Urethroscopy was performed in both groups at the time of fistula repair, skin revisions or during anaesthesia for unrelated procedures. RESULTS: There was no evidence of scarring in group 1; one case of meatal stenosis and one neourethral stricture were detected in group 2. The difference in outcome was not statistically significant (P = 0.4). Overall, the incidence of meatal stenosis was low (0.7%) and comparable with most recent series in which postoperative calibration was not used routinely. CONCLUSION: Dilatation of the neourethra is unnecessary after TIP urethroplasty. Calibration or uroflowmetry 6 months after surgery may be useful to detect subclinical obstruction.     

分期包皮岛状皮瓣尿道板重建术式治疗重度尿道下裂的疗效评价

目的:评价分期包皮岛状皮瓣尿道板重建术式治疗重度尿道下裂的疗效.方法:回顾性分析南京医科大学附属儿童医院泌尿外科2014年5月至2019年2月收治的重度尿道下裂患者91例的临床资料.按手术方法不同分为一期手术组和分期手术组.分析比较两组患者手术年龄、阴茎头直径、矫直后尿道缺损长度及术后尿道瘘、阴茎头裂开、尿道憩室、尿道...     

微创钨针在横形包皮岛状皮瓣法尿道下裂一期修复术中的应用

目的 总结微创钨针在横形包皮岛状皮瓣管状尿道成形法尿道下裂一期修复术的应用方法及术后效果。方法 我科2013年5月至2019年10月收治的其中226例尿道下裂患者,年龄6月~26岁（平均3.8岁）,其中阴茎体型119例,阴茎阴囊型83例,阴囊型及会阴型24例。术中应用微创钨针进行阴茎矫直、阴茎包皮脱套、横形包皮岛状皮瓣的切取及解剖等操作,将成形的横形包皮岛状皮瓣缝合成管状尿道,对各型尿道下裂进行一期尿道重建术。结果 术后7~8天拔除硅胶尿管排尿后,共发现12例伤口愈合不良、尿外渗及尿瘘形成。全部病例随访3月~2年,共发现尿瘘及尿道部分裂开24例,尿道外口狭窄2例,尿道（吻合口）狭窄3例,尿道憩室1例,阴茎下弯复发2例,总的并发症发生率为32/226（14.2%）。结论 在尿道下裂一期修复手术中,合理应用微创钨针的电切及电凝功能的优势特点,可精细分离解剖横形包皮岛状皮瓣,可安全有效获取尿道再造所需要的血运良好的包皮瓣等组织,有利于提高手术效率、减轻组织的损伤,可促进组织愈合、降低术后并发症。     

成人尿道下裂分期手术探讨

目的:探讨成人尿道下裂分期手术的必要性,提高成人尿道下裂的手术成功率。方法:回顾性分析我院泌尿外科2004年1月至2012年1月收治成人尿道下裂患者52例。52例男性患者,平均年龄22岁,所有患者过去均有尿道成形手术史,患者局部阴茎皮肤有瘢痕组织,均有阴茎下弯。术中行阴茎包皮脱鞘切除腹侧瘢痕纤维索带切断尿道板,仍存在阴茎下弯患者行阴茎背侧海绵体白膜折叠伸直阴茎,伸直阴茎后前尿道缺损长度占阴茎长度比例大于50%。根据术中是否行分期手术将患者分为两组,1组(20例)患者行I期包皮带蒂皮瓣卷管术尿道成型,2组(32例)患者阴茎伸直后将整个阴茎多余包皮转移至腹侧,做成形缝合为II期尿道成型预留尿道板,6¹2个月后行阴茎腹侧皮管卷管尿道成形术。结果:两组患者分别在Ⅰ期和Ⅱ期尿道成形术后发生尿瘘比例为50%、21.9%,尿道狭窄15%、9.4%,伤口感染30%、25%,尿道裂开20%、12.5%,尿道成形手术成功率分别为25%、56.3%。两组尿道成形术后发生尿瘘和尿道成形成功率的差异有统计学意义(P<0.05),术后发生尿道狭窄、伤口感染及尿道裂开并发症的差异无统计学意义。结论:对有尿道下裂手术史的成人患者,尤其对那些阴茎下弯明显,前尿道缺损长且局部包皮材料不足的患者分期手术更适合,Ⅱ期尿道成形的成功率得到提高。     

成人尿道下裂的临床处理

目的探讨成人尿道下裂的临床特点,提高成人尿道下裂的手术成功率。方法2001年9月至2005年12月治疗16-62岁(平均22．9岁)尿道下裂28例,共计施行各种手术39例次,其中尿道成形手术34例次,单纯补瘘5例次。通过临床观察、随访,对几种常用手术方法进行评估。此外,根据成人特点设计改良了术后包扎方法以帮助提高手术的成功率。结果28例单次手术的成功率19例(67．9％)。尿道成形术的34例次共发生尿瘘10例次(29．4％),其中1例在术后2个月自愈(尿瘘发生率26．5％)。发生尿瘘的分布为:Snodgrass术7例次(7／21,33．3％),镶嵌式唇粘膜尿道成形术1例次(1／7,14．3％),Duckett术1例(1／2,50％),Methieu术1例。单纯补瘘的5例中1例术后尿瘘复发。尿道成形术后尿道狭窄发生6例(6／34,17．6％),4例表现为严霞尿道狭窄。尿道狭窄发生的分布为:4例发生于用Snodgrass方法的再手术病例(4／21,19％),1例发生于Duckett术后(1／2,50％),另1例发生于邻近包皮皮瓣再次尿道成形术后。5例目前已经镶嵌式唇粘膜尿道成形术再次手术治愈,1例等待再次手术。结论成人尿道下裂手术容易出现并发症,手术方法的选择是减少并发症的关键。合理的阴茎包扎方法和术后处理对手术的成败有重要影响。