保留尿道板尿道成形术91例报告

目的评价保留尿道下裂尿道板尿道成形术的疗效。方法回顾性分析2004年6月～2006年6月我院91例尿道下裂患儿行保留尿道板尿道成形术的诊治经过。平均年龄5.3岁(2～12岁),冠状沟型12例,阴茎体型53例,阴茎阴囊型20例,阴囊型6例。结果手术治愈80例,治愈率为87.0%。10例发生尿瘘,尿瘘发生率为10.9%。1例出现尿道狭窄。1例阴茎头裂开。所有尿瘘患儿均于术后半年行尿瘘修补术,并获痊愈。结论保留尿道板尿道成形术,操作简单,手术时间短,成功率高,手术效果好。     

尿道板双侧旁正中纵切卷管尿道成形术

目的 总结尿道板双侧旁正中纵切卷管尿道成形术治疗尿道下裂的经验.方法 2008年6月至2009年5月应用尿道板双侧旁正中纵切卷管尿道成形术治疗尿道下裂31例,其中阴茎体型28例,阴茎阴囊型3例.本组平均年龄2.7岁(1.6～5.2岁),平均手术时间91.6 min(80～105 min).结果 本组病例均在术后随访超过3个月,外观满意,多数病例形似包皮环切术后阴茎外观.尿道外口位于龟头尿道沟正位,裂隙状.术后尿道瘘3例,发生率为9.7%;尿道口狭窄2例,发生率为6.5%,均在尿道扩张后缓解;没有发生尿道狭窄.结论 尿道板双侧旁正中纵切卷管尿道成形术治疗尿道下裂效果满意,术后并发症发生率较低.且容易开展.     

Snodgrass尿道成形术在小儿尿道下裂中的应用

目的 总结Snodgrass尿道成形术治疗小儿尿道下裂的适应证及方法、并评价其疗效。方法总结行Snodgrass尿道成形术的78例尿道下裂患儿的病例资料,其中冠状沟型18例,阴茎体型54例,阴茎阴囊型6例。14例为尿道成型失败者,52例合并阴茎下弯畸形行阴茎背侧12点处白膜折叠短缩,留置导尿管12～14d。拔管后常规前尿道扩张。结果术后随访4个月～2年,一次手术成功71例（91．0％）,阴茎外观正常。无下弯畸形,尿道口位于阴茎头正位,成纵行裂隙状,排尿通畅,无尿道狭窄。7例（9．0％）发生尿道瘘,经尿道扩张后自愈2例,4例已行尿瘘修补术,1例再行Snodgrass尿道成形术,均成功。结论Snodgrass尿道成形术适用于近、远端型,无或有轻中度阴茎下弯,尿道板发育良好的患儿,手术保留了尿道板,操作简单,并发症较少,手术成形效果好,易于掌握及推广。对尿道成形失败而阴茎所剩皮肤极少者也是一个非常有效的手术方法。     

尿道板纵切卷管尿道成形术治疗小儿尿道下裂

目的 评价尿道板纵切卷管尿道成形术(Snodgrass手术)治疗尿道下裂的疗效。方法 总结了2年间21例行Snodgrass手术的尿道下裂患儿的手术资料。患儿年龄2～12岁，平均6．2岁，其中阴茎头型3例，阴茎体型17例，阴囊型1例。结果 手术治愈19例(90．5％)，有2例患儿发生尿瘘，尿瘘发生率为9．5％，2例尿瘘患儿半年后再行Snodgrass手术，均获得成功，无尿道狭窄发生。结论 Snodgrass手术保留了尿道板，操作简单，手术时间短，仅40min；并发症较少；手术成形效果好；对于首次手术失败后再次尿道成形效果良好，是适用于各型尿道下裂治疗的较好方法。     

保留尿道板手术在尿道下裂治疗中的应用

目的：探讨保留尿道板手术在尿道下裂的疗效，方法。总结分析189例保留尿道板的尿道下裂修复手术。结果：保留尿道板手术总成功例数177／189（93．65％），其中采用尿道口基底皮瓣法（Mathieu法）39／42例（92．86％），加盖岛状皮瓣法(Onlay island flap法）138／147例（93．88％），结论：保留尿道板手术适用于无或伴有轻度阴茎下弯的尿道下裂治疗，可按尿道口位置选择手术方法：冠状沟型及阴茎体前型尿道下裂采用Mathieu法，阴茎体型及阴茎根型尿道下裂采用Onlay island flap法。     

巨尿道口伴完整包皮(MIP)型尿道下裂的认识和处理

目的 探讨巨尿道口伴完整包皮型尿道下裂的认识和处理.方法 回顾性分析2004年7月至2010年2月同一治疗组收治的巨尿道口伴完整包皮型尿道下裂病例.本组13例,年龄4岁5个月至12岁1个月,平均8岁1个月.就诊原因包括尿道口位置异常2例、阴茎外观短小1例、包茎10例.尿道开口于冠状沟3例,开口于阴茎远段10例.10例行尿道板纵切卷管尿道成形术(TIP)尿道成形,3例行Duplay尿道成形.术后随访3～45个月,平均9个月.结果 9例患儿成形尿道0.5～1.3 cm,平均0.9cm.术后尿瘘1例,再次手术矫治满意.其余病例外观满意,呈包皮环切术后外观,尿流尿线正常.结论 MIP型尿道下裂常因包茎手术时发现,阴茎弯曲多不明显,矫治时可保留尿道板,Duplay或TIP手术矫治效果满意.     

裁剪加盖带蒂尿道憩室皮瓣治疗尿道下裂术后尿道憩室并远端尿道狭窄

目的：探讨裁剪加盖带蒂尿道憩室皮瓣治疗尿道下裂术后尿道憩室并远端尿道狭窄的临床疗效。方法2例尿道下裂术后出现尿道憩室并远端尿道狭窄的患儿,均距离上次尿道下裂手术6个月以上,均采用裁剪加盖带蒂尿道憩室皮瓣手术治疗尿道狭窄,裁剪尿道憩室,修复尿道。结果2例均阴茎外观正常,尿道口正位,排尿粗,尿程远。随访6个月以上无尿瘘、尿道狭窄及尿道憩室。结论尿道下裂术后假性尿道憩室是尿道下裂成形术后并发症之一,重新修复尿道和解除远端尿道梗阻是唯一有效的治疗方法。裁剪加盖带蒂尿道憩室是创新及可行术式之一。     

游离膀胱粘膜或包皮内板尿道成形术治疗尿道下裂的评价

对一期膀胱粘膜尿道成形术和游离包皮内板尿道成形术治疗下裂的长期疗效进行评价。方法统计分析我院１９７７年１月－１９９７年１２月尿道下裂病例，共施行尿道成形术治疗１４岁以下小儿尿道下裂５７３例次。而运用一期膀胱粘膜尿道成形术或游离包皮内板尿道成形术治疗５６４例次，占同期尿道成形术的９８．４％。     

预置"尿道板"的分期手术治疗严重尿道下裂

目的 评价分期手术治疗严重尿道下裂的效果.方法 2001年12月至2009年8月治疗27例严重尿道下裂患儿,年龄8个月至17岁,平均4.3岁.近端型伴重度阴茎下弯23例,既往手术失败组织挛缩4例.Ⅰ期手术:完全脱套包皮,切除阴茎腹侧纤维束带或瘢痕组织,完全伸直阴茎,游离带蒂岛状包皮内板转移至腹侧填补缺损,预置"尿道板",包皮内板缺乏侧取下唇口腔黏膜皮瓣.术后6个月Ⅱ期手术:手术方式采用尿道板纵切卷管尿道成形术.4例皮瓣与尿道板连接处出现瘢痕愈合,予瘢痕切除,口腔黏膜镶嵌后卷管成形尿道.结果 27例患儿中,无尿道狭窄、皮瓣坏死等发生,4例术后尿瘘,6个月后再修补.结论 严重尿道下裂病例采用预置"尿道板"的分期手术,单次的手术操作简化,充分结合了传统尿道板卷管术式的优点,成功率高,整形效果好.     

预置"尿道板"的分期手术治疗严重尿道下裂

目的 评价分期手术治疗严重尿道下裂的效果.方法 2001年12月至2009年8月治疗27例严重尿道下裂患儿,年龄8个月至17岁,平均4.3岁.近端型伴重度阴茎下弯23例,既往手术失败组织挛缩4例.Ⅰ期手术:完全脱套包皮,切除阴茎腹侧纤维束带或瘢痕组织,完全伸直阴茎,游离带蒂岛状包皮内板转移至腹侧填补缺损,预置"尿道板",包皮内板缺乏侧取下唇口腔黏膜皮瓣.术后6个月Ⅱ期手术:手术方式采用尿道板纵切卷管尿道成形术.4例皮瓣与尿道板连接处出现瘢痕愈合,予瘢痕切除,口腔黏膜镶嵌后卷管成形尿道.结果 27例患儿中,无尿道狭窄、皮瓣坏死等发生,4例术后尿瘘,6个月后再修补.结论 严重尿道下裂病例采用预置"尿道板"的分期手术,单次的手术操作简化,充分结合了传统尿道板卷管术式的优点,成功率高,整形效果好.     

加盖带蒂包皮瓣一期尿道成形术修复小儿尿道下裂

目的：探讨加盖带蒂包皮瓣Ⅰ期尿道成形术修复小儿尿道下裂的手术要点和临床效果,提高手术技巧。方法对50例小儿尿道下裂应用onlay island flap术式（横裁带蒂岛状包皮瓣加盖法）行一期尿道成形手术。观察阴茎伸直和尿瘘、尿道狭窄的发生情况,总结和完善手术技巧。结果50例手术患儿获随访3个月至2年,均阴茎伸直满意,尿道位于龟头前端开口,外观良好。44例尿道下裂一次性手术成功,4例发生尿瘘;2例发生尿道外口狭窄,行尿道扩张后痊愈。结论加盖带蒂包皮瓣Ⅰ期尿道成形术修复小儿尿道下裂符合解剖生理,术后阴茎外形美观,并发症少,是一种修复阴茎下弯较轻的尿道下裂的理想术式。手术成功的关键在于保护皮瓣血管蒂的血供,掌握合理的尿道板皮条和岛状包皮瓣宽度及娴熟的缝合技巧。     

Combined use of perimeatal-based flap urethroplasty (Mathieu) with midline incision or urethral plate in hypospadias repair.

Perimeatal-based flap urethroplasty is commonly used for the primary correction of distal hypospadias. The Mathieu repair provides excellent function and satisfactory cosmetic results, but the risk of devascularisation of the neourethral flap is an inherent problem of this technique. The midline incision of the urethral plate is part of the Snodgrass method, which offers good urethral calibre and tension-free closure. Our aim was to test the effectiveness of the use of the perimeatal-based flap combined with a midline incision of the urethral plate in hypospadias repair. 19 boys, aged 20 months to 5 years, with distal hypospadias, underwent a one-stage repair using the above-described modification of the Mathieu technique. The meatal-based flap with a midline incision of the urethral plate was similar in all cases. The hypospadias repair was successful in all patients, only one boy developed a urethrocutaneous fistula which required subsequent operation. There was no postoperative scarring, chordee or urethral stricture during follow-up. Hypospadias repair using a perimeatal-based skin flap and combined with an incision of the urethral plate reduces complication rates and offers good cosmetic results.     

Hypospadias repair using a double onlay preputial flap

 From an anatomical view, a more reasonable blood supply can be achieved in hypospadias repair using a double-faced onlay flap. A urethroplasty was performed in 15 patients with middle or posterior hypospadias using a double-faced onlay preputial flap (DOPF). In this method, the urethral plate is preserved and a double-faced preputial flap is developed. The inner face of the flap is sutured to the urethral plate to create the neourethra and the outer face together with the rest of the dorsal prepuce is used for ventral skin coverage. Postoperative complications occurred in 2 patients: 1 developed a fistula in the subcoronal region and 1 had dorsal skin necrosis and suture disruption of the glanular wings. The overall complication rate was 13%. The DOPF provides a well-vascularized ventral skin cover and reduces the area of avascular dorsal skin. The viability of the neourethra can be evaluated by simply looking at the outer face of the flap. However, the complication rate is similar to that of other techniques. Accepted: 27 October 2000     

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。     

Use of an inner preputial free graft to extend the indications of Snodgrass hypospadias repair (Snodgraft)

Tubularized incised plate (tip) urethroplasty or Snodgrass repair has become the most commonly used procedure for distal hypospadias repair. However, where the urethral plate is narrow or shallow, the good results may be compromised. We present our experience of using a small inner preputial graft to deepen and widen the urethral plate (Snodgraft). This procedure has certainly reduced the number of two-stage hypospadias repairs in patients who lack a urethral groove or have a small glans. The cosmetic and functional results are excellent.     

Bracka's staged repair of proximal hypospadias--revisiting a versatile technique

ObjectiveProximal hypospadias is associated with poorly defined urethral plate and often with chordee. A two-staged Bracka’s repair is reproducible and has been used routinely in our practice. We present the key steps of this technique on a 13-month-old boy.Patient and methodThis boy presented with proximal penile hypospadias, hooded foreskin and mild chordee. He underwent stage one Bracka’s repair. The steps included: 1) Artificial erection test to define extent of chordee; 2) inner preputial graft harvest and preparation; 3) glans and urethral plate incision down to corpora cavernosa; 4) partial release of chordee by division of aberrant corpus spongiosum, without degloving of penile skin; 5) laying of preputial graft; 6) dressing.ResultThe patient had catheter removed on second, and dressing removed on seventh, post-operative days, without complication. The patient is planned for second stage repair in 6 months. Our standard approach includes either removal of catheter on the second or seventh post-operative day, according to surgeon preference. The three senior surgeons have used this method in 54 patients without significant complication. The graft has taken in 100% of cases.ConclusionThe Bracka’s staged repair of proximal hypospadias is a versatile technique that gives reproducible and sound results.     

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.     

应用Snodgrass尿道成形术治疗远端尿道下裂

目的探讨Snodgrass尿道成形术治疗远端尿道下裂的体会。方法2001-2005年应用Snodgrass尿道成形术治疗146例尿道下裂。年龄1～16岁，平均3岁。其中治疗首诊病例62例；治疗已经过手术修复失败的病例84例。在同期，修复远端尿道下裂应用最多的是加盖岛状皮瓣法（onlay island flap法），共266例。结果首诊Snodgrass手术62例，成功57例（91．9％），2例尿道狭窄，3例尿道瘘。对失败的尿道下裂病例应用Snodgrass手术84例，成功64例（76．2％），尿道瘘14例，尿道狭窄6例。Onlay手术266例，成功256例（96．2％），尿道瘘10例。结论Snodgrass尿道成形术适合尿道板发育好的无阴茎下弯的远端尿道下裂病例，以及部分失败的尿道下裂修复、长段尿道瘘病例。尿道板发育差的病例适合Onlay手术。     

横裁岛状包皮皮瓣一期修复尿道下裂的经验

目的总结横裁岛状包皮皮瓣法修复先天性尿道下裂的经验。方法对1999年-2005年我科56例采用横裁岛状包皮皮瓣法进行尿道成形的尿道下裂患儿进行回顾性分析。其中5例加用尿道口为基底的阴囊矩形皮瓣作Duplay尿道成形。结果本组病例均获随访,时间3个月-4年,阴茎外观良好,阴茎下弯矫正满意,排尿通畅。一次手术成功49例,占89．3％;术后尿瘘5例,经第二次手术修补后痊愈,尿道狭窄1例,经尿道扩张后排尿改善。结论横裁岛状包皮皮瓣符合阴茎皮肤的解剖生理特点,设计合理,采用吻合口连续缝合,更加降低了尿瘘的发生率,避免耻骨上造瘘及带来的膀胱损伤。对多数尿道下裂尤其是有阴茎下弯的尿道下裂,采用横裁包皮岛状皮瓣法并灵活加用尿道口基底矩形皮瓣是一个很好的选择。     

Is tubularization of the mobilized urethral plate a better alternative to tubularization of an incised urethral plate for hypospadias repair?

Introduction  Trial of a new procedure of hypospadias repair based on the incorporation of the entire available innate urethral tissue for the formation of neo-urethra in patients with hypospadias. Materials and methods  Fifteen consecutive children, nine with distal hypospadias and six with proximal hypospadias (all with severe chordee), whose parents consented to application of a new procedure of hypospadias repair, were the study subjects. This procedure is inspired by Cantwell Ransley procedure for epispadias repair and Snodgras procedure for hypospadias repair. The entire urethral plate was mobilized (i.e., lifted off the corpora) distal to the urethral meatus and was tubularized in two layers; inner urethral skin and outer spongiosal tissue, in Duplay fashion. The repair was reinforced with dartos vascularized flap. The skin incisions on the urethral strip are guided by the disposition of the spongiosal tissue underlying the urethral plate (rather than the conventional U-shaped incision on either side of hypospadiac urethral meatus). In the patients with proximal hypospadias with severe chordee urethral advancement was combined to achieve orthoplasty and a single stage hypospadias repair. The catheter was removed on tenth postoperative day. Results  Even in patients with proximal hypospadias with severe chordee, good single staged repair was achieved without resorting to dorsal plication that would have been necessary had any other methods based on the preservation of urethral plate was performed in these subjects. Therefore, the procedure was found to have an extended applicability to even those patients where tubularized incised urethral plate urethroplsty is not advised. All patients had good results (in 1 year follow-up), except in three early subjects of the series; two of whom developed minor urethrocutaneous fistulae (probably due to frank urinary leak secondary to repeated catheter blockade) and one developed partial glanular wound dehiscence. Conclusions  Though the authors have an initial limited experience with this procedure, the procedure is likely to have a promising future due to its versatility and utilization of the entire urethral tissue.