尿道下裂术后尿道狭窄继发附睾炎的诊治

【摘要】〓目的〓探讨尿道下裂术后尿道狭窄继发附睾炎的临床特点与疗效。方法〓2005年1月至2011年2月收治的尿道下裂术后尿道狭窄46例患者中8例继发附睾炎,对该类患者予抗感染及对症治疗后,尽早行尿道探查、尿道狭窄段切开或切除及组织瓣移植尿道成形术等方法修复尿道狭窄。结果〓8例尿道狭窄继发急性附睾炎患者术后8天内附睾炎症状基本消失。1例患者阴茎伤口感染致阴茎中部尿瘘于3月后成功行尿瘘修补术,余7例患者伤口愈合良好,无尿瘘发生,排尿通畅,尿线粗。随访3~12月,8例患者均无尿道狭窄复发,无急性附睾炎复发,慢性附睾炎者临床症状较术前明显改善。结论〓本组患者中,尿道下裂术后尿道狭窄继发附睾炎见于严重的尿道狭窄患者及年龄偏大患者;尿道下裂术后尿道狭窄应积极处理,一旦出现急性附睾炎时应在抗感染等保守治疗前提下,尽早行尿道成形修复狭窄段尿道,恢复正常尿流。

Clinical diagnosis and treatment on epididymitis secondary to urethral stricture after hypospadias repair

Objective To investigate the clinical features and curative effect of epididymitis sec-ondary to urethral stricture after hypospadias repair. Methods Eight cases with epididymitis secondary to urethral stricture were found in 46 patients with urethral stricture after hypospadias repair and were admitted in our hospital from January 2005 to February 2011. These 8 patients then received urinary tract exploration and urethroplasty with local pedicle flap or free tissue transplantation as soon as possible to repair urethral stricture based on anti-infection and other symptomatic treatments. Results The symptoms of 8 cases with acute epididymitis secondary to urethral stricture disappeared within 8days postoperative. One case encountered central penis fistula caused by wound infection, and wounds of other 7 patients healed well with smooth urination and no urinary fistula.One case with urinary fistula underwent urinary fistula repair 3 months postoperatively healed well without urinary fistula.In follow-up of 3 to 12 months,all patients had no urethral stricture or epididymitis recurrence performance.Conclusion Epididymitis secondary to urethral stricture after hypospadias repair were found in elder patients with severe urethral stricture. Urethral stricture after hypospadias repair should be treated actively.After anti-infection and other conservative treatments in the premise when the acute epididymitis occurs,urethroplasty should be applied as soon as possible to repair urethral stricture in favor of restoring normal urine flow.