Abstract:Objective: To summarize the operative key points of hypospadias in perioperative period and discuss the precautions for prevention and control of surgical complications. Methods: A total of 156 patients with hypospadias admitted to our urology department from January 2013 to December 2017 were selected as research objects. During the operation, penile bending and urethral plate development were assessed by artificially induced erection, and stage I or stage I operations were performed. The surgical plan was based on urethral plate-based urethral reconstruction technology. Results: There were 123 cases of 156 patients undergoing one stage operation and 33 cases undergoing stage operation. Sixty-seven patients underwent one stage operation and 28 patients underwent stage operation for the first time. Fifty-six patients underwent one stage operation and five patients underwent staging operation. Twenty-one cases of moderate curvature received dorsal penile fold correction, and all cases of severe curvature received dorsal penile fold correction. During the postoperative follow-up period of 6 months to 1 year, there were 11 cases of urinary fistula (7.1%) and 14 cases of urethral stricture (8.9%) [including 6 cases of anastomotic stricture (42.9%) and 8 cases of external urethral stricture (57.1%)]. Sixteen cases (10.3%) were accompanied by downward curvature of the penis, and the degree of penile bending was less than 15°. Conclusion: To evaluate the types of hypospadias and the development of penis comprehensively, choose reasonable operation methods, and master the key points of operation can effectively improve the success rate of hypospadias.
[1] CARMICHAEL SL, SHAW GM, LAMMER EJ. Environmental and genetic contributors to hypospadias: A review of the epidemiologic evidence. Birth Defects Res A Clin Mol Teratol, 2012,94(7):499-510. [2] 徐秀娟,陈恕柱,吴旻,等.保留尿道板尿道下裂修复术后并发症危险因素分析.中华男科学杂志,2017,23(4):347-352. [3] 刘国庆. 婴幼儿尿道下裂综合分型在手术治疗中的意义.中华男科学杂志,2013,19(9):849-852. [4] 田军,张潍平,孙宁,等.延长留置导尿管在减少尿道下裂术后尿道狭窄中的作用.中华小儿外科杂志,2014,35(9):679-682. [5] 刘伟,吴荣德,焦晨炜.尿道下裂专题研讨会会议纪要.中华小儿外科杂志,2013,34(2):150-152. [6] MACEDO A, LIQUORI R, OTTONI SL, et al. Long-term results with a one-stage complex primary hypospadias repair strategy (the three-in-one technique). J Pediatr Urol, 2011,7(3):299-304. [7] 谢林海,杨军,习娅琦,等.尿道板镶嵌及尿道海绵体成形在TIP尿道下裂修复中的应用.中国美容整形外科杂志,2018,29(1):48-51. [8] SNODGRASS W, PATTERSON K, PLAIRE JC, et al. Histology of the urethral plate: implications for hypospadias repair. J Urol, 2000,164(3 Pt 2):989-990; discussion 989-990. [9] JIA W, LIU GC, ZHANG LY, et al. Comparison of tubularized incised plate urethroplasty combined with a meatus-based ventral dartos flap or dorsal dartos flap in hypospadias. Pediatr Surg Int, 2016,32(4):411-415. [10] 段光琦,毕允力,张敏,等.Koyanagi手术和改良手术治疗重型尿道下裂.临床小儿外科杂志,2011,10(5):389-391. [11] 任晓敏,王忠.尿道下裂行分期手术的优势.现代泌尿外科杂志,2011,16(4):370-371. [12] 淡明江,吕军,胡卫列,等.分期手术在严重尿道下裂中的应用.中华男科学杂志,2012,18(3):278-280. [13] SNODGRASS W, BUSH N. Recent advances in understanding/management of hypospadias. F1000 Prime Rep, 2014,6:101. [14] SEO S, OCHI T, YAZAKI Y, et al. Soft tissue interposition is effective for protecting the neourethra during hypospadias surgery and preventing postoperativeurethrocutaneous fistula: a single surgeon's experience of 243 cases. Pediatr Surg Int, 2015,31(3):297-303. [15] 陈海琛,胡杨,吴永隆,等.尿道海绵体重建覆盖在TIP手术中的应用.现代泌尿外科杂志,2018,23(2):114-118. [16] CARMICHAEL SL, SHAW GM, LAMMER EJ. Environmental and genetic contributors to hypospadias: a review of the epidemiologic evidence. Birth Defects Res A Clin Mol Teratol, 2012,94(7):499-510.