Wu Shaofeng,He Rong,Sun Jie,et al.Efficacies of ventral lengthening versus dorsal plication for severe ventral curvature during proximal hypospadias repair[J].Journal of Clinical Pediatric Surgery,,19():603-607.[doi:10.3969/j.issn.1671-6353.2020.07.008]
Efficacies of ventral lengthening versus dorsal plication for severe ventral curvature during proximal hypospadias repair
- Keywords:
- Hypospadias/SU; Treatment Outcome; Comparative Study
- CLC:
- R726.9;R699.8
- Abstract:
- Objective Correcting severe ventral curvature is an essential step of proximal hypospadias repair.The goal was to compare the outcomes of ventral lengthening (VL) versus dorsal placation (DP) for severe curvature.Methods Retrospective analysis was conducted for 224 children with proximal hypospadias undergoing straightening curvature from January 2010 to December 2015 at a single institution.Based upon operative approaches,they were divided into two groups of VL (n=63) and DP (n=161).Meatal location,preoperative HCG stimulation,severe ventral curvature before and after degloving,urethral plate transection and staged operation were compared between two groups.The complications of recurrent curvature,urethral fistula,urethral diverticulum and reoperation were recorded.Univariate analysis was performed for assessing the association with recurrent curvature.Results The mean initial operative age was 12.3(8-48) months in DP group and 11.5(10-62) months in VL group.The mean follow-up period was 62.4(44-110) months in DP group and 55.7(41-96) months in VL group.For only scrotal/perineal hypospadias,the proportion in DP group was less that in VL group (72/161,44.7% vs 39/63,61.9%,P=0.021) and preoperative HCG stimulation was administered in a similar proportion between two groups(27/161 or 16.8% vs 22/63 or 34.9%,P=0.225).DP group underwent urethral plate transection while VL group had urethral plate transection (52/161,32.3% vs 63/63,100%).The overall complication requiring additional unplanned operations were compared (DP 54/33.5% vs VL 26/41.3%,P=0.278,including fistulas in 44/27.3% vs 20/31.7%,diverticula in 8/4.97% vs 4/6.35%).Univariate analysis revealed that use of dorsal plication was significantly associated with an elevated risk of recurrent curvature (19.3% vs 7.9%,P=0.038).Conclusion For short-term outcomes,dorsal plication for correcting ventral curvature is sufficient with excellent results.However,for proximal hypospadias with severe curvature,ventral lengthening is associated less frequently with recurrent curvature than dorsal plication.Further long-term observations should be conducted through puberty into adulthood.
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Memo
收稿日期:2019-09-15。
基金项目:国家自然科学基金青年基金资助项目（编号：81100477）；上海市自然科学基金资助项目（编号：11ZR1423300）
通讯作者:赵海腾,Email:zhaohaiteng@scmc.com.cn