组织瓣覆盖技术在尿道下裂手术及术后尿瘘修复中的应用

目的探讨组织瓣覆盖技术在尿道下裂手术及尿瘘修复手术的效果。方法1998年3月至2003年5月，73例尿道下裂手术及术后尿瘘修复手术中，采用5种组织瓣覆盖技术覆盖新尿道及尿瘘内口。尿道下裂组45例中采用带蒂背侧皮下组织瓣转移法27例，带蒂鞘膜瓣转移法3例，局部阴囊推进肉膜瓣法15例；尿瘘组28例中采用带蒂背侧皮下组织瓣转移法4例，局部X—V皮瓣法14例，局部U形组织瓣法10例。结果随访3～36个月，尿道下裂组45例术后3例出现尿瘘，尿瘘组28例均未再发尿瘘，成功率95．9％。结论尿道下裂手术及尿瘘修复手术中采用组织瓣多层覆盖技术，可提高手术成功率，降低术后尿瘘发生率。     

改良Snodgrass术治疗小儿尿道下裂47例临床分析

目的评价改良Snodgrass手术治疗小儿尿道下裂的效果。方法小儿先天性尿道下裂47例,予改良Snodgrass术行尿道成形。其中阴茎体型40例,阴囊型7例;首次手术失败者8例。结果术后随访6～24个月,一期手术治愈44例(93.6%),余3例发生尿瘘,其中新尿道渗尿1例,予重置导尿管2周后治愈,冠状沟处漏尿2例,6月后行尿瘘修补术治愈。结论改良Snodgrass手术一期治疗小儿尿道下裂疗效确切,操作简单。     

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.     

改良Snodgrass术治疗尿道下裂疗效观察

目的：评价尿道板纵切卷管尿道成形术（Snodgrass术）治疗尿道下裂的疗效。方法：回顾性分析2005年1月～2008年12月间31例行改良Snodgrass术的尿道下裂患者临床资料：患者年龄2～18岁,平均7．2岁,其中阴茎头型尿道下裂11例,阴茎体型尿道下裂18例,阴囊型尿道下裂2例。结果：一次手术治愈29例（93．55％）;1例（3．22％）发生尿道狭窄,经尿道扩张治愈;1例（3．22％）发生尿瘘．术后6个月再次行改良Snodgrass术治愈。结论：改良Snodgrass术保留了尿道板,操作简单,手术时间短,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。     

阴茎两侧肉膜蒂组织双层覆盖在Snodgrass尿道下裂修复中的应用

目的介绍一种Snodgrass尿道下裂修复中新尿道覆盖方法，并对应用结果进行评估。方法2003年4月至2006年2月收治尿道下裂患儿289例。年龄3个月-12岁，平均2．4岁。其中冠状沟型78例、阴茎体型136例、阴茎阴囊型36例、阴囊型16例、Ⅱ期手术和再手术23例。均应用自阴茎体两侧分别游离的血管蒂肉膜瓣皮下组织对Snodgrass法修复的新尿道进行交替覆盖。结果289例患儿随访3—24个月，术后出现尿瘘32例（11％），其中11例术后4周内自行愈合，实际尿瘘发生率为7％（21／289）。21例未愈尿瘘中，远端型尿道下裂（冠状沟和阴茎体型）的尿瘘发生率为5％（11／214），近端型（阴茎阴囊型和阴囊型）、Ⅱ期手术和前次手术失败再次手术者为13％（10／75）。无伤口裂开或尿道憩室病例，结合黏膜领技术可以在腹侧正中线上原位缝合阴茎皮肤。术后能获包皮环切术样满意外观者277例。结论阴茎两侧肉膜组织双层覆盖新尿道是一种防止尿瘘和伤口裂开的可靠方法，并能有效重建类似正常阴茎外观。     

阴囊纵隔去皮组织瓣治疗尿道下裂术后尿瘘(附27例报告)

尿道下裂是男性泌尿生殖系统较常见的先天性畸形，尿道成形术后尿瘘是术后最常见的并发症之一，修补尿瘘的方法各家医院根据手术习惯不同，方法各异。我科1999年3月～2008年3月采用阴囊纵隔去皮组织瓣治疗尿道下裂术后尿瘘27例，获得满意效果，现报告如下。     

尿道板瓣与包皮瓣联合修复先天性尿道下裂

目的:探讨尿道板瓣在尿道成形中的价值;提高先天性尿道下裂的一次手术成功率.方法:将残余尿道粘膜及粘膜下组织一起形成尿道板瓣,与一侧包皮岛状瓣结合形成缺损段尿道,转移另一侧包皮瓣完成阴茎腹侧创面覆盖,尿道板瓣最大面积为2.0cm×0.5cm.治疗先天性阴茎型尿道下裂患者34例.结果:本组患者除3例患者术后出现尿道外口包皮瓣部分坏死,尿道外口狭窄,二次手术切开外,余者均Ⅰ期愈合,随访1～3年,无再造尿道狭窄及尿瘘等并发症出现.结论:先天性尿道下裂患者残余尿道粘膜及粘膜下组织可以形成具有良好血供的尿道板瓣,有效地解决了一侧包皮瓣再造尿道组织量不足的问题,提高了一次手术成功率.     

Snodgrass手术治疗46例尿道下裂患儿的临床体会

目的：总结Snodgrass手术治疗小儿尿道下裂的手术经验与体会。方法：于2004年12月～2009年8月间,对46例尿道下裂患儿采用Snodgrass方法进行手术治疗,患儿年龄2～16岁,平均5．6岁;其中冠状沟型6例,阴茎体型40例。结果：经1～26个月随访（平均随访21个月）,所有患儿术后阴茎外形满意,有3例患儿术后出现尿瘘,经再次手术修补后治愈。无尿道憩室和尿道狭窄发生。结论：Snodgrass手术治疗小儿尿道下裂手术方法简单,手术成功率高,术后外形美观,适合于不伴有严重阴茎下弯的尿道下裂患儿。     

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。     

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。     

Dorsal double-layer dartos flap for preventing fistulae formation in the Snodgrass technique

INTRODUCTION: The Snodgrass technique and its modifications have become a preferred method for all varieties of hypospadias in the past decade. However, fistula is the most common complication of this technique. The aim of this study was to investigate the importance of the single and double flap to prevent fistula formation in the Snodgrass procedure. MATERIALS AND METHODS: Tubularized incised plate urethroplasty, using a single or the double flap, was undertaken in 74 consecutive boys (median age 6.6 years old, range 1-15) within the last 4 years. In the first 29 patients (group 1), a dorsolateral flap was rotated laterally for covering the neourethra and in the remaining 45 patients (group 2) the neourethra was covered with dorsal double dartos flaps. RESULT: In group 1, fistula in 4 patients and partial glanular dehiscence in 1 patient were detected. There was no fistula formation in group 2. CONCLUSION: For preventing fistula formation, urethral covering by a well-vascularized dorsal double-layer dartos flap should be the basic part of the Snodgrass procedure.     

Tubularization of the incised urethral plate (Snodgrass procedure) for primary hypospadias surgery

OBJECTIVE: To evaluate the Snodgrass procedure for patients with hypospadias who have not undergone previous surgery and whose urethral plate is too narrow for tubularization alone. PATIENTS AND METHODS: Thirty-two boys (mean age 18 months) underwent primary hypospadiac surgery performed by one surgeon (P.S.M.). Twenty-five boys had a distal hypospadias (coronal, subcoronal) and seven had a more proximal defect (penile shaft, penoscrotal). The operation involved incision of the urethral plate, which was then tubularized (Snodgrass procedure). The neourethra was then covered with a de-epithelialized pedicled dartos flap from the inner prepuce before glans and skin closure. RESULTS: With a mean follow-up of 10 months (range 2-14) there were two complications; one child with a coronal hypospadias developed a fistula whist one with a penile shaft defect had complete breakdown of the neourethra. The cosmetic appearance in the other 30 patients is that of a normal slit-like terminal meatus. CONCLUSION: Tubularization of the incised urethral plate is a safe advance in the surgery of hypospadias. We recommend it for both distal and proximal defects, in patients where the urethral plate is insufficient for tubularization alone.     

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.     

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.     

Tubularized incised plate urethroplasty: expanded use in primary and repeat surgery for hypospadias

PURPOSE: We evaluated the impact of tubularized incised plate urethroplasty on primary and repeat hypospadias repair. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all boys who underwent hypospadias repair at our institution during a recent 3-year period. The level of the hypospadias defect, technique of repair, primary repair versus reoperation, age at surgery and complications were recorded. RESULTS: A total of 520 hypospadias repairs were done from May 1996 through June 1999. We began to perform tubularized incised plate urethroplasty in November 1996. During the ensuing consecutive 32 months 181 primary and 25 repeat hypospadias repairs were done using this technique. Mean patient age at surgery was 22 months (range 3 months to 30 years). During the 6 months immediately before we began to use this method the Mathieu flip-flap procedure was the most commonly performed technique, accounting for 38% of all hypospadias repairs. In contrast, during the last 6 months reviewed tubularized incised plate urethroplasty accounted for 63% of all repairs, including 41 of 65 primary operations (63%) and 4 of 6 reoperations (67%), while no Mathieu procedures were performed. Postoperative followup was 6 to 38 months for tubularized incised plate repair. Overall meatal stenosis and a urethrocutaneous fistula developed in 1 and 14 boys, respectively (7% complication rate). CONCLUSIONS: Tubularized incised plate urethroplasty has become the preferred technique of primary and repeat hypospadias repair at our institution. The technique has few complications as well as proved success and versatility that continues to expand its applicability and popularity.     

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.     

Repair of hypospadias complications using the tubularized, incised plate urethroplasty

BACKGROUND/PURPOSE: Secondary procedures to correct complications after hypospadias repair remain challenging especially for "hypospadias cripples." The tubularized, incised plate urethroplasty was first introduced by Snodgrass for the repair of primary hypospadias in 1993. The authors used this procedure to correct the complications after hypospadias repair in patients who had no abundant local skin flaps to be used for a neourethra. METHODS: Six patients underwent tubularized, incised plate urethroplasty for the correction of complications of hypospadias repair performed the previous year, including a large urethrocutaneous fistula (n = 1) and disruption of the neourethra (n = 5). Prior surgical procedures included transverse island tube urethroplasty in 4 cases and 2-stage urethroplasty in 2 cases. The average patient age at the time of secondary procedure was 4.6 years (range, 1 to 12 years). RESULTS: The mean follow-up period was 6 months (range, 2 months to 1 year). All the patients obtained a functional neourethra with a vertical, slitlike meatus. A small fistula developed in one child and mild meatal retraction in another. CONCLUSIONS: The tubularized, incised plate urethroplasty offers few complications and good cosmetic results. The authors recommend its use for patients who have had repeated surgeries for hypospadias repair, especially those in whom only limited local skin flaps can be utilized for a neourethra.     

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.     

Tubularized incised plate for mid shaft and proximal hypospadias repair

PURPOSE: We report outcomes from tubularized incised plate repair of mid shaft and proximal hypospadias by a single surgeon. MATERIALS AND METHODS: Chart review of all patients undergoing mid shaft and proximal hypospadias was performed. Those with tubularized incised plate were divided into 2 groups for mid shaft and proximal repairs. Group 1 underwent single layer urethroplasty using chromic catgut suture, while group 2 underwent 2-layer polyglactin subepithelial closure. All patients had a dartos barrier flap, while spongioplasty was also done in group 2 when possible. RESULTS: A total of 30 patients underwent mid shaft repairs, while 35 had more proximal defects. Complication rates for mid shaft repairs did not differ between the 2 groups, and averaged 13%. However, complications in mid shaft vs proximal repairs (37%) were significantly different (p = 0.04). Overall complications (53% vs 25%) and incidence of fistulas (33% vs 10%) decreased in proximal repairs from group 1 to 2. CONCLUSIONS: Tubularized incised plate repair was applicable for all mid shaft hypospadias cases and for those more proximal cases when ventral curvature could be straightened without plate transection and the incised plate was grossly supple. Outcomes were improved using 2-layer subepithelial tubularization of the neourethra. Results of mid shaft vs proximal hypospadias repairs are significantly different and should be reported separately.