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。     

改良尿道板纵切卷管尿道成形术治疗尿道下裂

目的 总结改良尿道板纵切卷管尿道成形术(Snodgrass手术)治疗尿道下裂的经验体会.方法 对46例首诊病例及再次手术病例采用改良Snodgrass手术.结果 成功40例,4例尿道狭窄,行尿道扩张后痊愈,2例尿瘘,予以行二期尿瘘修补术痊愈.结论 改良Snodgrass手术适用于尿道板发育好,轻度或中度阴茎下弯尿道下裂病例以及残余尿道板条件好的二次手术病例,手术效果满意.     

尿道板纵切卷管尿道成形术在尿道下裂术后尿道裂开中的应用

尿道裂开是发生于尿道下裂术后较严重的并发症，因多无可利用的包皮材料修补尿道，给再次手术带来困难。Snodgrass在1994年首先介绍了“尿道板纵切卷管尿道成形法”治疗尿道下裂的手术方法。我院近年开展用此方法治疗尿道下裂，并且从2001年1月～2002年12月应用尿道板纵切卷管尿道成形术(Snodgrass法)治疗尿道下裂术后尿道裂开患儿24例，效果良好，报告如下。     

尿道板纵切卷管尿道成形术治疗尿道下裂38例体会

尿道下裂是男性外生殖器最常见的泌尿生殖系先天性畸形,其发病率约为1/300,属常染色体显性遗传性疾病,需要手术矫正治疗,且手术是矫治本病的唯一手段。现将我科2001年1月～2008年9月采用尿道板纵切卷管尿道成形术（Snodgrass术）治疗尿道下裂38例,效果满意。     

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。     

保留尿道板纵切卷管尿道成形术治疗成人尿道下裂

目的 探讨保留尿道板纵切卷管尿道成形术(TIP)在成人尿道下裂治疗中的价值.方法 回顾性总结分析我院2004-2006年间采用保留尿道板纵切卷管尿道成形术治疗成人尿道下裂46例(年龄17～28.5岁,平均年龄为21.2岁).结果 术后5例出现尿瘘;2例尿道狭窄:3例术后仍有阴茎向下弯曲.结论 对于尿道及阴茎发育条件好的成人尿道下裂,TIP可以一期完成修复.阴茎向下弯曲严重或尿道瘢痕严重者一期尿道成形并发症较多.早期拔除尿道支架管,合理使用敏感抗生素和术后良好的处理是提高手术成功率、减少并发症发生率的重要冈素.     

保留尿道板纵切卷管尿道成形术治疗尿道下裂的体会(附56例报告)

目的 探讨保留尿道板纵切卷管尿道成形术(TIP)在尿道下裂治疗中的价值.方法 回顾性总结分析本院2005年7月～2009年9月采用保留尿道板纵切卷管尿道成形术治疗尿道下裂56例(成人3例,儿童53例).结果 术后8例出现尿瘘;13例尿道口狭窄;无阴茎向下弯曲.结论 对于尿道及阴茎发育条件好的尿道下裂患者,TIP可以一期完成修复.保留尿道板纵切卷管尿道成形手术操作相对简单,易掌握,成功率高,对于尿道下裂者是一种非常有效的治疗方法.     

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...     

改良尿道板纵切卷管技术在尿道下裂治疗中的临床应用

目的:探讨尿道板纵切卷管技术(TIP)在尿道下裂治疗中的临床应用和体会。方法:收集行TIP手术的尿道下裂患儿169例,年龄1.5~12岁,平均3.68岁,术后平均随访2年(6个月至3年)。TIP技术在Snodgrass手术的基础上进行改进,即纵切开尿道板,术后留置尿道支架,平均住院时间10 d。结果:169例患儿中18例(10.6%)术后有并发症,最常见并发症为尿道狭窄(9例,5.3%),其次为尿道皮肤瘘(8例,4.7%)。结论:TIP技术是一种可以适用于大多数尿道下裂的手术方法,临床经验和技术的总结,有助于提高使用这种方法的成功率,减少并发症的发生。     

尿道板纵切卷管法和加盖岛状皮瓣法尿道成形术治疗尿道下裂的比较

目的总结尿道板纵切卷管法（TIP）与加盖岛状皮瓣法（OIF）尿道成形术治疗尿道下裂的疗效,并对其进行比较,探讨术式选择的条件。方法回顾性总结42例TIP术和26例OIF术治疗尿道下裂的临床资料。TIP术组年龄2～13岁,平均4．76岁;其中Ⅱ型3例,Ⅳ型1例。38例为初次行尿道成形术者,4例为初次尿道成形术失败、再次行尿道成形术者。OIF术组年龄2～10岁,平均4．72岁,其中Ⅱ型23例,Ⅲ型3例,均为初次行尿道成形术者。结果TIP术平均手术时间80min,有尿瘘7例,阴茎头裂开1例,无尿道狭窄,但有尿道外口狭窄1例,3例再次尿道成形术者未发生并发症;OIF术平均手术时间115min,有尿瘘5例,阴茎头裂开l例,无尿道狭窄。两种手术方法的尿瘘、尿道狭窄、阴茎头裂开、一次手术成功率,差异无统计学意义（P〉0．05）,而两组平均手术时间的差异有统计学意义（P〈0．05）。结论TIP与OIF尿道成形术可用于阴茎头冠状沟、阴茎体、阴茎阴囊型尿道下裂的治疗,TIP术操作简单,且更适用于初次手术失败、需再次行尿道成形术的病例。对于阴茎发育差,尿道板条件不好的初次手术病例,仍以选择OIF术为宜。     

Tubularized incised plate urethroplasty for hypospadias reoperations in 100 patients

Objectives To determine the key points for a successful redo hypospadias procedure using tubularized incised plate urethroplasty operation. Methods A retrospective chart review of a cohort of 100 patients (Mean age: 4.5 years, range: 2–12) who had undergone a redo tubularized incised plate urethroplasty operation was performed. Fischer exact and Chi square tests were used for statistical analysis. Results The incidence of complications of tubularized incised plate urethroplasty reoperation after failed repairs of meatal advancement and glanuloplasty procedure (n: 14), meatal based flap (n: 36), and tubularized incised plate urethroplasty (n: 50) were 29% (n: 4), 22% (n: 8) and, 28% (n: 14) respectively (P > 0.05). The overall complication rate was 26% (n: 26). Eighteen patients (18%) had fistula, five had meatal stenosis (5%), two had dehiscence (2%) and one had neourethral stenosis (1%). Postoperatively, fistula was closed in 18 patients and 5 underwent meatoplasty. Two patients with dehiscence and one with neourethral stenosis underwent an unsuccessful third redo tubularized incised plate urethroplasty reoperation and they were candidates for a complex hypospadias repair (3%). The ultimate success rate of tubularized incised plate urethroplasty reoperation after treatment of complications was 97%. Conclusion Tubularized incised plate urethroplasty is a safe and efficacious alternative procedure for hypospadias reoperations if the urethral plate has no scars and outcome is favourable if the first failed hypospadias repair is a meatal based flap procedure. The complication rate increases if the urethral plate has been previously incised in the midline and a redo third redo must be avoided.     

Tubularized incised plate urethroplasty for proximal hypospadias

OBJECTIVE: To review our experience of using the tubularized incised plate (TIP) urethroplasty (useful in the treatment of distal hypospadias) to treat proximal hypospadias. MATERIALS AND METHODS: From March 1997 to March 2000 primary repairs were carried out on 40 boys (mean age 4.5 years) with proximal hypospadias. After degloving the penile skin the meatus was at the mid-shaft in 10 boys, at the proximal penile shaft in 11, at the penoscrotal junction in 16, at the scrotum in two and at the perineum in one. The 21 patients with a mid or proximal shaft meatus were categorized as having mid-shaft and the other 19 as having posterior hypospadias. Tunica albuginea plication (TAP) was used to correct residual ventral curvature. The method of urethroplasty was adapted from that described by Snodgrass. The key step of the TIP repair is a midline incision of the urethral plate; a subcutaneous tissue flap dissected from the inner prepuce is used to cover the neourethra. An 8 or 10 F nasogastric tube is used as a urethral stent and removed 7 or 8 days after surgery. Follow-up endoscopy and urethral sounding were carried out in 17 of the patients aged < 6 years; the mean follow-up was 12.5 months. RESULTS: TAP was used to correct penile curvature in nine (23%) of the patients. Excluding stenosis, the TIP repair was successful in 20 (90%) of those with mid-shaft and in 16 of the 19 with posterior hypospadias; for all complications the respective rates were 19 of 22 and 15 of 19. The overall success rate was 88% for all 40 patients with proximal hypospadias; a urethrocutaneous fistula occurred in two of those with mid-shaft and three of those with posterior hypospadias. Urethral meatal stenosis occurred in four (12%) of the patients (two in each group); two were associated with a fistula and the other two had only mild meatal stenosis. The overall complication rate was 17.5% (three and four in the mid and the posterior hypospadias groups, respectively). The meatal stenosis was managed by simple dilatation in three and meatoplasty in one patient. Endoscopically, the mucosa of neourethra was pink and smooth in all 17 patients assessed. The calibre of all 17 neourethra was > or = 8 F and in 13 was > or = 10 F. CONCLUSION: TIP repair is a reliable method for treating both mid-shaft and posterior hypospadias.     

Tubularized incised plate urethroplasty for proximal hypospadias

OBJECTIVES: Numerous surgical procedures have been used to correct distal hypospadias. Among them, the tubularized incised plate urethroplasty (Snodgrass procedure) has become a mainstay for the repair of distal hypospadias. We applied the procedure to proximal hypospadias. METHODS: Three patients with proximal hypospadias underwent a tubularized incised urethral plate urethroplasty. The location of the meatus was proximal penis in one, penoscrotal margin in one and scrotum in one. A perimeatal incision was made and the two paramedian incisions were extended to the tip of the glans. The skin of the penile shaft was dissected free to the penoscrotal junction and bands of fibrous tissue were excised until the corpus spongiosum proximal to the meatus was completely exposed inside the scrotum. The urethral plate was then incised in its midline from the tip of the glans to the hypospadiac meatus and was tubularized without tension. The neourethra was covered with a pedicle of subcutaneous tissue dissected from the dorsal skin or the scrotal skin to avoid fistula formation. RESULTS: The tubularized incised urethral plate urethroplasty was carried out successfully in one stage on three patients with proximal hypospadias. CONCLUSIONS: The Snodgrass procedure is suitable for correcting hypospadias in patients with a healthy urethral plate. It is also suitable in patients with proximal hypospadias.     

Tubularized incised plate urethroplasty for distal and mid-penile hypospadias

Tubularized incised plate urethroplasty was performed to repair 20 distal and 5 mid-penile hypospadias cases. In distal hypospadias repair meatal stenosis occurred in 1 patient and urethral fistula in another. The overall complication rate in this group was thus 10%. Among midpenile hypospadias cases meatal stenosis was observed in 1 (20%) patient. As a conclusion, tubularized incised plate urethroplasty was found to be a successful method for treating distal hypospadias and encouraging results were obtained in mid-penile hypospadias cases.     

Tubularized incised plate urethroplasty for megameatus intact prepuce hypospadias variant: First reported case in Indonesia

Introduction and importanceMegameatus intact Prepuce (MIP) is a rare variant of hypospadias characterized by a wide meatus with a normally conformed prepuce, no chordee, and usually no effects in micturition or sexual physiology. However, quality of life and psychosexuality may be affected.Case presentationA 6-year-old-boy was referred by a general practitioner to the hospital due to an abnormality of the urethral meatus. The patient did not have any complaints. A large external urethral orifice at the ventral area of the coronal glans was discovered. The prepuce was normally-conformed, and there weren’t any signs of chordee. The patient was diagnosed with an MIP hypospadias variant and underwent a tubularized incised plate (TIP) urethroplasty. During the follow-up, one week after the procedure, the patient did not have any complaints. Physical examination showed excellent anatomical and functional outcome based on the cosmetic appearance resembling a normal penis and urinary stream.Clinical discussionAwareness regarding this abnormality is necessary as MIP is often not diagnosed until circumcision. Even though MIP patients are usually asymptomatic, surgery should still be considered based on aesthetic and psychosexual reasons. TIP urethroplasty was chosen for this patient based on the clinical findings of this patient. TIP procedure for MIP patients could result in an excellent penile performance and function with a very low complication rate.ConclusionTIP urethroplasty is able to fulfil satisfactory cosmetic and functional outcomes for the MIP hypospadias variant. Awareness of the disorder should be increased to prevent potential psychosexual disturbances.     

TIP术治疗尿道下裂分析(附27例报告)

目的 评价TIP术(尿道板纵切卷管尿道成形术)治疗尿道下裂的体会.方法 先天性尿道下裂患儿27例,年龄1-14岁,平均2岁.冠状沟型3例,阴茎体型16例,阴茎阴囊型5例,阴囊型3例.伴阴茎弯曲22例.均采用TIP术(尿道板纵切卷管尿道成形法),8例阴茎头明显向下弯曲者采用阴茎背侧白膜折叠术纠正.结果 随访6个月至3年,TIP术中20例手术一次成功.结论 TIP术手术简单,疗效好,是一种较好的尿道下裂成形术.