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。     

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。     

保留尿道板一期尿道成形治疗尿道下裂

目的：探讨尿道板在尿道成形术中的应用价值。方法：对31例尿道下裂患儿施行保留尿道板一期尿道成形术。术式主要有Mathieu术(14例)、Onlay island flap术(7例)和Snodgrass术(10例)。31例均为阴茎体型尿道下裂。表现为阴茎轻度下弯,其中7例为第一次尿道成形术失败者。结果：总成功率为90．3％。术后2例出现尿漏,1例出现尿道狭窄。全部病例随访3～12个月,阴茎外观均接近正常,无下弯。尿道开口于阴茎头部,排尿通畅。结论：保留尿道板成形手术操作相对简单,易掌握,成功率高,适用于阴茎体型及阴茎下弯较轻的尿道下裂患者,对于尿道成形失败者也是一种非常有效的治疗方法。     

改良尿道板卷管纵切尿道成形术治疗尿道下裂

目的 总结改良尿道板卷管纵切尿道成形术(Snodgrass手术)治疗尿道下裂的体会.方法 对2003年1月至2008年8月应用改良Snodgrass手术治疗的尿道下裂18例的临床资料进行回顾性分析,其中冠状沟型3例,阴茎体型13例,阴茎阴囊型2例,均有轻、中度阴茎下曲.结果 术后随访6～18个月,15例Ⅰ期成功,2例尿道外口狭窄,行尿道扩张后痊愈;1例尿瘘,予以行Ⅱ期尿瘘修补术痊愈,无尿道其他部位狭窄.结论 改良Snodgrass手术既矫正尿道下裂,又保留了尿道板.具有操作简单、成功率高、并发症少、阴茎外形美观的优点.     

尿道下裂尿道成形术后尿道狭窄的处理

目的 探讨尿道下裂尿道成形术后尿道狭窄的病因及治疗方法。方法 对１９８５－１９９８年７７例尿道下裂术后尿道狭窄患者的临床资料进行回顾性分析。结果 单纯尿道扩张９例,治愈２例（２２％）;尿道扩张放钛镍合金支架２２例,治愈１７例（７７％）;狭窄段尿道切开皮肤造瘘２３例,其中１８例行二期尿道成形术,治愈１６例;５例待手术;切开狭窄段同期尿道成形术２３例,治愈１２例。     

Snodgrass尿道成形术治疗小儿尿道下裂

SnodgmSs尿道成形术最早开始于1993年，主要特点为尿道板中线全层切开，尿道板两侧切开包绕支架管缝合形成尿道。该手术操作简便，整形效果满意。我院自2001年7月～2002年12月对7例尿道下裂患儿施行Snodgrass尿道成形术，疗效满意，现介绍如下。     

尿道板与带蒂包皮内板一期尿道成形术治疗尿道下裂

本院近年来采用保留尿道板与带蒂岛状包皮内板一期尿道成形术治疗尿道下裂23例,取得了良好的效果.现报告如下.     

膀胱粘膜尿道成形术治疗复杂性尿道下裂

目的对膀胱粘膜尿道成形术治疗复杂性尿道下裂的适应证及手术方法进行讨论，以重新认识其应用价值。方法总结2002～2004年经多次手术失败的复杂性尿道下裂7例，平均尿道缺损5、7cm，采用改进后的膀胱粘膜尿道成形术Ⅰ划尿道成形的资料。结果术后均获得较为满意的疗效，阴茎伸直满意，外形好，尿线粗，开口近似正常位置。2例术后尿瘘，6个月后再次修补获成功，手术一次成功率71.4％。结论对多次手术失败、阴茎疤痕严重、局部取材困难、尿道缺损过长的复杂尿道下裂的病例，采用膀胱粘膜尿道成形术Ⅰ期尿道成形仍是目前合理、有效的手术方法。     

皮肤袖套膀胱粘膜尿道成形术治疗重型尿道下裂

我科2000年8月～2001年1月对已作阴茎下曲矫正的重型尿道下裂患儿采用皮肤袖套膀胱粘膜尿道成形术(简称皮袖粘膜法)治疗，全部成功，介绍如下。1资料与方法患儿共7例，年龄4～8岁。阴茎下曲均已得到较好的矫正，尿道短缺4.5～7.5 cm。尿道成形术的手术操作步骤：①在阴茎头下约0.8 cm阴茎腹面正中作纵形切开，深达白膜浅面，并向中线两侧解剖形成0.6 cm宽的深槽，然后顺延切口环形切开固有尿道口皮肤，并游离出约0.4 cm的尿道口，修整成斜面。②靠阴茎头处用小弯钳穿过皮桥下经阴茎头尿道原凹处穿出，并锐性解剖将隧道扩宽至约0.8 cm。皮桥…     

切断尿道口保留并加长尿道板尿道成形术治疗尿道下裂的初步研究

目的:探讨用切断尿道口保留并加长尿道板尿道成形术治疗尿道下裂的可行性。方法:选择尿道下裂患者48例,其中冠状沟下型18例,阴茎体型21例,阴囊阴茎交界型8例,阴囊型1例,采用切断尿道口保留并加长尿道板尿道成形术治疗,并观察其术后效果。结果:术后随访6～27个月,一期手术成功44例,2例出现尿瘘,2例出现尿道狭窄,尿瘘以及尿道狭窄均再次治疗而治愈。阴囊阴茎外观满意,阴茎伸展自如。结论:切断尿道口保留并加长尿道板尿道成形术是操作简单,安全有效的术式,可广泛应用于治疗尿道下裂。     

二期膀胱黏膜尿道成形术治疗重型尿道下裂的评价

目的：对膀胱黏膜尿道成形术治疗重型尿道下裂的一期或二期手术疗效进行分析与评价。方法：对1998年1月～2007年10月采用一期或二期膀胱黏膜尿道成形术进行治疗的33例重型尿道下裂进行对照回顾分析。结果：一期膀胱黏膜尿道成形术18例,一次成功率55．6％（10／18）,尿瘘发生率27．8％（5／18）,外口狭窄发生率16．7％（3／18）;二期膀胱黏膜尿道成形术15例,一次成功率66．7％（10／15）,尿瘘发生率13．3％（2／15）,外口狭窄发生率20．0％（3／15）。结论：结合临床观察及相关数据,二期膀胱黏膜尿道成形术在重型尿道下裂的治疗中似具有一定的优势,但尚需继续积累病例,通过有效的统计学分析进一步确证这一推论。     

Duckett术式一期治疗尿道下裂的临床研究

目的:探讨横裁包皮带蒂岛状皮瓣尿道成形术(Duckett术)一期治疗尿道下裂的临床效果。方法:回顾性研究我科2003年～2007年采用Duckett术式一期修复尿道下裂患者20例,年龄2～22岁,平均11.3岁,其中阴茎体型3例,阴茎阴囊型17例;另外收集同期行膀胱粘膜代尿道术尿道下裂30例,年龄7～34岁,平均16.1岁,其中阴茎体型10例,阴茎阴囊型16例,会阴型2例,阴囊型2例。膀胱粘膜术全部行膀胱造瘘及留置尿道支架管,Duckett术仅留置尿道支架管。结果:Duckett术:1次手术成功17例(85%),术后尿瘘2例(10%),尿道狭窄1例(5%),2例尿瘘术后6个月修补成功,人均手术次数为1.1次;膀胱粘膜代尿道术:手术均分二期完成,手术成功26例(86.7%),术后尿瘘3例(10%),尿道狭窄1例(3.3%),再次手术修补瘘口治愈,人均手术次数为2.1次。2例尿道狭窄行尿道扩张后基本痊愈。结论:Duckett术一期修复尿道下裂效果良好,手术成功率与其他术式相近、术后并发症低,与膀胱粘膜尿道成形术相比,术后阴茎外观更满意,主要优点是一次完成手术。     

带蒂睾丸鞘膜瓣代尿道治疗尿道下裂合并睾丸鞘膜积液(附9例报告)

目的:探讨尿道下裂合并睾丸鞘膜积液的治疗方法。方法:对9例2～12岁尿道下裂合并睾丸鞘膜积液患儿行带蒂睾丸鞘膜瓣代尿道术。结果:①效果满意者7例,均正位开口排尿,切口无感染,术后7～10d出院;②较满意者1例,局部感染,尿道外口狭窄,行尿道扩张后,排尿通畅;③不满意者1例,发生尿瘘,为阴囊型。结论:带蒂睾丸鞘膜瓣代尿道术疗效满意,手术创伤小、取材方便、组织修复迅速,对合并有睾丸鞘膜积液的尿道下裂患者值得推广。     

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.     

改良Thiersch法正位尿道口尿道成形术

目的 评价改良Thiersch手术治疗尿道下裂的疗效。方法 对18例已矫正阴茎下曲的尿道下裂病人，采用偏离中线的阴茎腹侧皮瓣，避免缝合线重叠；并利用包皮作皮瓣延伸，通过阴茎头内隧道，使尿道口达生理位。结果 修复尿道长度3－15cm。发生尿瘘3例，尿道口狭窄2例。一次手术成功率达83．3％。结论 改良Thiersch手术具有术式简单、手术成功高、并发症少、术后阴茎外形美观等特点。     

Clinical Review Of The ‘Snodgrass’ Hypospadias Repair

Background : Snodgrass first described the tubularized, incised plate (TIP) urethroplasty for distal hypospadias repair in 1994 based on the concept of hingeing the incised urethral plate. The use of this technique allows a vertically orientated glanular meatus to be produced. A retrospective review of patients who had this procedure for the primary repair of distal hypospadias at New Children’s Hospital was performed to objectively assess the cosmetic and functional outcomes of this technique. Methods : All patients having a TIP urethroplasty for the primary repair of distal hypospadias between 1996 and 1998 were requested to attend for review in an independent clinic. The parents were interviewed and the patient was examined to determine meatal location, meatal size, glanular configuration, urinary stream, straightness of erections, cosmesis, and the presence or absence of cutaneous sinus tracts or a urethral fistula. Results : Sixty patients were identified. Forty‐nine were reviewed in person, 10 were reviewed by telephone and one could not be traced. The median age at surgery was 13 months (range: 6–144 months), with a median follow up of 27 months (range: 2–33 months). A glanular meatus was achieved in 57 patients (97%) and a conical glanular configuration was achieved in 58 patients (98%). The urinary stream and erections were straight in 54 (89%) and 58 patients (98%), respectively. Suture sinus tracts were present in 14 (24%) patients. Six patients (10%) developed a urethral fistula and three (5%) developed meatal stenosis. A good or satisfactory final cosmetic and functional result was achieved in 58 patients (98%). Conclusions : The results of TIP urethroplasty are satisfactory at New Children’s Hospital with the benefit of a cosmetic final outcome similar to a circumcised penis.     

Tubularized incised-plate urethroplasty for secondary hypospadias surgery

PURPOSE: Reoperation for failed hypospadias has been considered to be seriously bothersome because abundant penile skin does not tend to remain for urethroplasty or for penile shaft skin coverage. In this study, the tubularization of incised urethral plate was employed for those who had no excessive penile skin after failure of hypospadias repair. METHODS: Five patients with hypospadias underwent tubularized incised-plate urethroplasty as salvage surgery. The surgical techniques necessary for the performance of the reoperation were not different from those for the primary repair. The urethral plate was incised sufficiently deeply in its midline from the tip of the glans to the regressed meatus. The incised urethral plate was tubularized without tension over a catheter of an appropriate size. RESULTS: Four of those who underwent secondary tubularized incised-plate urethroplasty were successfully repaired without complications. A urethrocutaneous fistula occurred at the corona in the remaining patient. CONCLUSIONS: The absence of preputial skin in reoperative cases makes tubularized incised-plate urethroplasty the ideal option, although the series was small and postoperative duration is still short. In addition, this procedure can give excellent functional and cosmetic results even in patients who require revisional hypospadias surgery.     

成人尿道下裂的手术治疗

目的总结成人尿道下裂的手术经验。方法22例18-29岁成人尿道下裂患者,其中阴茎型12例,阴茎阴囊型9例,阴囊型1例,行一期尿道下裂修复术,其中阴囊纵隔皮瓣法14例,横行带蒂包皮瓣法（Duckett术）7例,原位阴囊皮管加横行带蒂包皮瓣法（Duckett＋Dup lay术）1例。所有患者均未行尿液转流,采用多侧孔硅胶管引流和支撑。结果22例术后随访5-24个月。治愈14例（63.6%）。术后发生尿瘘6例（27.3%）,经再次手术治愈;尿道毛石形成2例（9.1%）,在膀胱镜下清除。结论成人尿道下裂术后容易出现并发症。通过改进手术操作、手术材料和术后尿液引流等方法,可提高治愈率,减少并发症。     

Achieving a natural glanular meatus for distal hypospadias with a narrow and shallow plate: Tubularized incised plate versus modified Barcat repair

Objectives:   Although the tubularized incised plate (TIP) repair has become the most popular surgical procedure for distal hypospadias, some authors suggest that this is not suitable for hypospadias with a narrow plate or shallow groove.
Methods:   The configuration and position of the reconstructed meatus were postoperatively analyzed in patients with distal hypospadias whose preoperative urethral plates were shallow or narrow. The findings were compared between six patients undergoing TIP repair and seven patients undergoing modified Barcat (BAVIS) repair.
Results:   Among those undergoing the TIP procedure, a slit-like meatus at the tip of the glans was achieved in one patient, a slit-like meatus at the mid portion of the glans in four patients and a round meatus at the mid portion of the glans in one patient. In those repaired by the BAVIS procedure, a slit-like meatus at the tip of glans was achieved in three patients, a round or irregularly shaped meatus at the tip of the glans in two patients, an irregularly shaped meatus at the mid portion of the glans in one patient and neourethral dehiscence in one patient.
Conclusions:   The present study confirms that a higher rate of achieving slit-like meatus but a lower rate of locating in the glans tip can be attained after TIP repair. On the other hand, there is a higher rate of locating the meatus in the glans tip but a lower rate of achieving a slit-like meatus after BAVIS repair.