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。     

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.     

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。     

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。     

阴囊中缝带蒂皮瓣治疗尿道下裂的临床应用体会

目的 探讨带蒂阴囊中缝带蒂皮瓣转移覆盖技术在治疗尿道下裂病例多次手术后皮肤缺损中的适应证与疗效.方法 2014年2月至2015年1月,收集我院12例患儿,年龄5～15岁,平均8.4岁.均为外院多次尿道下裂术后失败患儿.为再次治疗入我院.所有患儿均接受口腔黏膜镶嵌尿道成形术一次完成手术.完成尿道重塑后,在阴囊皮肤血供解剖学的基础上,对于重度尿道下裂患儿经多次术后皮瓣遭严重破坏而不足的患儿,采用阴囊中缝皮瓣游离,转移覆盖于阴茎腹侧创面皮肤缺损处.结果 术后随访6～12个月,平均8.3个月,12例患儿全部获得随访,所有患儿皮瓣完全成活,无尿道瘘及尿道憩室,术后2周出现尿道狭窄1例.接受会阴尿道镜检查,确定为口腔黏膜与原尿道吻合口狭窄,扩张后治愈.长期随访患儿阴茎下弯矫正满意,尿道外口位于阴茎头正位,排尿通畅,无尿道瘘、尿道狭窄、尿道憩室等.阴茎及阴囊外观满意.结论 对于接受多次尿道下裂修补术后需要重新接受手术的患儿,由于多次手术对阴茎皮瓣破坏严重,再次行尿道下裂修补术时,我们选择游离带蒂阴囊中缝皮瓣覆盖新尿道,较传统上阴茎阴囊皮肤覆盖新尿道的张力较低,覆盖范围广并避免了皮肤的臃肿感.该手术方法简单,操作难度不高,成功率高,术后并发症少,外形美观,值得临床推广应用.     

会阴、包皮联合岛状皮瓣一期尿道成形治疗会阴型尿道下裂

目的研究会阴型尿道下裂新手术方法的可行性。方法对16例会阴型尿道下裂,根据尿道缺损长度采用会阴正中岛状皮瓣、包皮横行岛状皮瓣一期尿道成形术。裁取带蒂会阴皮瓣约1.5cm×2.5cm～2.0cm×5.0cm,包皮皮瓣约1.5cm×3.0cm～2.5cm×4.0cm各制管道,成形尿道。结果16例病人14例痊愈,2例术后并发尿道瘘。6个月后尿道瘘修补成功。结论会阴、包皮联合岛状皮瓣一期尿道成形治疗会阴型尿道下裂具有能解决成形尿道材料不够,成形尿道血运好、术后并发症少、手术成功率高、安全可靠等特点。     

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.     

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.     

冠状沟型尿道下裂一期修复术

目的 提出冠状沟型尿道下裂一期手术新术式。方法 应用包皮和阴茎皮肤联合皮瓣成形尿道，利用原龟头裂与包皮皮瓣成形尿道外口。结果 临床应用２０例，一次手术成功１９例，１例并发尿道瘘。结论 本法成形尿道皮瓣血运良好，不易发生皮瓣坏死，并发症少。利用龟头裂成形尿道外口，避免了尿道外口狭窄，术后尿道外口位于龟头顶端，阴茎外形接近于正常。     

提高Duckett术式治疗尿道下裂治愈率的相关因素分析

目的 分析影响Ｄｕｃｋｅｔｔ术式治疗尿下裂的相关因素,探讨提高治愈率治疗方法。方法 对Ｄｕｃｋｅｔｔ术式进行改良,充分游离岛状皮瓣的血管蒂,使皮瓣转至阴茎腹侧后血管蒂较松,将皮管分别与近端尿道口斜形吻合及龟头顶端吻合后,再把血管蒂远端盘膜向对侧铺开,与该侧阴茎白膜及尿道近端海绵体缝合固定,使皮管缝合缘两侧及尿道近端吻合口能完全覆盖于血管蒂筋膜之下。并对术后处理方法亦作改进。结果 术式改良前、后分别     

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     

应用血管蒂筋膜覆盖--预防尿道下裂术后尿瘘的一种有效措施

目的 分析在应用带血管蒂的皮瓣尿道成形术中，应用血管蒂筋膜覆盖尿道的要点，探讨提高治愈率的措施。方法 改进包皮岛状皮瓣及阴囊中隔带蒂皮瓣尿道成形术。在完成常规步骤后，将血管蒂筋膜缝合固定在阴茎白膜及尿道海绵体上，使尿道完全被血管蒂筋膜覆盖，增加了覆盖在尿道表面组织的厚度及血供。对是否使用血管蒂筋膜覆盖病例的Ⅰ期治愈率等效果进行统计学分析。结果 与对照组相比，应用血管蒂筋膜覆盖者，包皮岛状皮瓣尿道成形术Ⅰ期治愈率由64．8％提高到93．3％（P〈0．01），尿道瘘发生率南24．1％降到1．9％。阴囊中隔皮瓣尿道成形术Ⅰ期治愈率由84．2％提高N95．7％（P〈0．01），尿道瘘发生率由7．0％降到1．2％。结论 应用血管蒂筋膜覆盖尿道能增加新形成尿道及吻合口的组织覆盖面及厚度，保证良好的血供，是减少尿道下裂术后尿道瘘的一种有效措施。     

One-stage repair of severe hypospadias using modified tubularized transverse preputial island flap with V-incision suture

PurposeAlthough hypospadias repair for preserving the urethral plate is popular among pediatric urologists, applying this procedure to severe hypospadias is controversial. We report the outcome of applying additional modifications to the modified tubularized transverse preputial island flap (TPIF) procedure reported previously [Patel RP, Shukla AR, Austin JC and Canning DA. Modified tubularized transverse preputial island flap repair for severe proximal hypospadias. BJU Int 2005;95:901–4] for repairing severe hypospadias.Materials and methodsWe retrospectively evaluated our series of 22 patients (mean age 17.5 months) who underwent the modified TPIF with an additional simple modification of meatoplasty with V-incision suture. Patients were followed for a mean period of 18 months.ResultsAfter releasing the chordee, the hypospadiac orifice was retracted to become penile in five patients (22.7%), penoscrotal in six (27.3%), scrotal in nine (40.9%), and perineal in two (9.1%). The median length of the neourethra was 46 mm. One-stage repair was successful in 19 patients (86.4%) without any complications.ConclusionOur modified TPIF procedure yielded favorable outcomes functionally and cosmetically with a low postoperative morbidity rate. Such a procedure can be considered useful for repairing severe hypospadias when the urethral plate cannot be preserved.     

Neo-modified Koyanagi technique for the single-stage repair of proximal hypospadias

PurposeTo retrospectively analyze the results of a modification of the Koyanagi hypospadias repair developed to reduce complications.Materials and methodsTwelve boys underwent a modified Koyanagi repair over the past 3 years. The technique included the preservation of a wide vascular pedicle for each parameatal flap. The distal urethral plate was left intact and attached on each lateral side to the medial side of each distal Koyanagi pedicle flap.ResultsOne boy (8%) developed a urethral fistula. There was no instance of meatal stenosis, sacculation or urethral stricture.ConclusionsModifying the Koyanagi repair by preserving a wide vascular pedicle for the distal skin flaps and utilizing the distal urethral plate as the base for the distal neourethra has lowered the incidence of complications. This technique is a suitable alternative to a two-stage approach for the correction of proximal hypospadias.     

Surgical technique for antegrade dissection of the preputial vascular pedicle during hypospadias repair

ObjectiveBoth layers of the prepuce can be used as vascularized flaps in hypospadias repair. The aim of this communication is to describe an antegrade approach to the harvesting of the vascular pedicle.Surgical techniqueThe vascular pedicle is isolated at the level of the penopubic junction where it is most robust. Dissection then proceeds distally towards the prepuce fanning laterally.ResultsOf 306 boys presenting for hypospadias repair in 2002–2008, this approach was utilized in 235 (77%). The vascularized flap was used as 1) a classic single or double faced onlay flap in 95, 2) a vascularized layer to cover a tubularized incised plate urethroplasty in 68, 3) a tube-onlay in 39, 4) a tubularized urethroplasty in 23, 5) for ventral skin coverage alone in 7, and 6) for a planned first stage repair in 3. Age at repair averaged 12 months (range 2–160) and follow up 36 months (range 2–68).ConclusionsAntegrade dissection of the vascular pedicle is a simple, expeditious and reliable way of isolating the prepuce on its blood supply. The versatility of the resulting flaps allows the repair to be adapted to the individual anatomic conditions as opposed to one type of repair being used for all variants.     

Snodgrass hypospadias repair with onlay overlapping double-layered dorsal dartos flap without urethrocutaneous fistula: Experience of 156 cases

ObjectiveTo evaluate the neourethra covering created by a vascularized overlapping double-layered dorsal dartos flap for preventing urethrocutaneous fistula in the Snodgrass hypospadias repair (tubularized incised plate).Patients and methodsBetween March 2003 and January 2008, 156 boys (mean age, 4.5 years) were enrolled for hypospadias repair. Preoperative position of the urethral meatus was subcoronal in 37, at the distal shaft in 61 and mid-shaft in 58 boys. All patients underwent the Snodgrass hypospadias repair. The neourethra was then covered with an overlapping double-layered dorsal dartos flap before glans and skin closure.ResultsAll 156 patients underwent successful reconstruction. With a mean follow up of 23 months (range 6–42), all boys had a satisfactory subjective cosmetic and functional result with a vertically oriented, slit-like meatus at the tip of the glans. No urethrocutaneous fistula or urethral stenosis occurred.ConclusionAs the neouretha covering is an integral part of the Snodgrass hypospadias repair, a dorsal well vascularized double-layered dartos flap is a good choice for preventing urethrocutaneous fistula formation.     

The use of a perimeatal-based penile skin flap to cover the repair of a tubularized incised plate urethroplasty: From experimental surgery to clinical practice

ObjectiveTo prospectively evaluate the efficacy and safety of a perimeatal-based penile skin flap for neourethral coverage after repair of distal hypospadias with tubularized incised plate urethroplasty (TIPU).MethodsIn 12 New Zealand white rabbits a ventral urethral defect was created and reconstruction was accomplished with continuous suture. An epithelialized defect-based flap was harvested from the penile skin to cover the repaired defect. The animals were euthanized on the 28th postoperative day and their penises were processed for microscopic examination. In 32 children with distal hypospadias a TIPU was performed. A penile skin flap was created immediately below the distal end of the neourethra and used to cover the urethroplasty.ResultsHistological examinations revealed complete restoration of continuity of the stratified squamous epithelium without evidence of inflammation or fistula formation with full consistency with the underlying papillary reticular and corium. There were no cases of fistula formation. One patient developed meatal stenosis. All patients had a satisfactory cosmetic appearance and excellent functional results.ConclusionThe formation of a perimeatal-based skin flap is a simple and safe method of providing additional cover for the constructed neourethra after TIPU, minimizing the fistula rate.