Shen Yiding,Zhu Linfeng,Wang Xiaohao,et al.Treatment of recurrent curvature after hypospadias repair[J].Journal of Clinical Pediatric Surgery,,20():177-180.[doi:10.12260/lcxewkzz.2021.02.013]
Treatment of recurrent curvature after hypospadias repair
- CLC:
- R726.9 R697+.11 R695
- Abstract:
- Objective To retrospectively analyze the treatment outcomes of recurrent penile curvature after hypospadias repair.Methods From 2010 to 2019,36 children with recurrent penile flexion after hypospadias repair were treated.Angle of penile flexion was measured with a protractor after artificial erection test.Penile flexion was treated according to the correction strategy.Penile flexion was completely ungloved and penile flexion stretched after removing scar tissue on ventral penis.If penile underbend was <30°,white membrane folding was performed in group B(n=5).If > 30°,urethra was separated from penile trunk under coronal sulcus and urethra at the proximal end stripped along the surface of cavernous body to remove the influence of short urethra on penile downbends.If downbends persisted,white membrane folding was performed in group D(n=7).Treatment of urethro-related complications resulted in tension-free coverage of penile skin in groups A and B.In groups C and D,oral and labial mucosa urethroplasty was performed under general anesthesia with nasal intubation.Results During an average follow-up period of 5.8(1-9.2) years,there was no instance of urethral cutaneous fistula,urethral diverticulum or urethral deja.In groups C and D,6 cases (22.2%,6/27) had urethral stricture.Urethrostomy was performed in emergency.Fistula was closed at Month 3 after urethrostomy.In 5 cases (18.5%,5/27),urethral cutaneous fistula was repaired at Month 6 post-operation. Conclusion During previous operations,the pathological factors of ventral penis and urethral traction were neglected and initial treatment was too conservative.Programmed treatment strategy may correct recurrent penile flexion after hypospadias.
References:
1 Wilcox D,Snodgrass W.Long-term outcome following hypospadias repair[J].World J Urol,2006,24(3):240-243.DOI:10.1007/s00345-006-0059-1.
2 Menon V,Breyer B,Copp HL,et al.Do adult men with untreated ventral penile curvature have adverse outcomes?[J].J Pediatr Urol,2016,12(1):31.e31-e37.DOI:10.1016/j.jpurol.2015.09.009.
3 Snodgrass W,Bush NC.Persistent or recurrent ventral curvature after failed proximal hypospadias repair[J].J Pediatr Urol,2019,15(4):344.e341-e346.DOI:10.1016/j.jpurol.2019.03.028.
4 Chertin B,Koulikov D,Fridmans A,et al.Dorsal tunica albuginea plication to correct congenital and acquired penile curvature:a long-term follow-up[J].BJU Int,2004,93(3):379-381.DOI:10.1111/j.1464-410x.2003.04621.x.
5 Snodgrass W.A farewell to chordee[J].J Urol,2007,178(3 Pt 1):753-754.DOI:10.1016/j.juro.2007.06.011.
6 Baskin LS,Ebbers MB.Hypospadias:anatomy,etiology and technique[J].J Pediatr Surg,200,41(3):463-472.DOI:10.1016/j.jpedsurg.2005.11.059.
7 Snodgrass WT.Management of penile curvature in children[J].Curr Opin Urol,2008,18(4):431-435.DOI:10.1097/MOU.0b013e32830056d0.
8 沈一丁,唐达星,徐珊.先天性单纯阴茎下弯的手术矫治[J].中华泌尿外科杂志,2016,37(11):837-840.DOI:10.3760/cma.j.issn.1000-6702.2016.11.011. Shen YD,Tang DX,Xu S.Management of congenital penile curvature in children[J].Chin J Urol,2016,37(11):837-840.DOI:10.3760/cma.j.issn.1000-6702.2016.11.011.
9 贾幸,谢华.尿道下裂阴茎下弯的组织学和手术治疗研究进展[J].临床小儿外科杂志,2019,18(9):795-799,802.DOI:10.3969/j.issn.1671-6353.2019.09.018. Jia X,Xie H.Research advances in histology and surgery of ventral penile curvature in hypospadias[J].J Clin Ped Sur,2019,18(9):795-799,802.DOI:10.3969/j.issn.1671-6353.2019.09.018.
10 Faure A,Bouty A,Nyo YL,et al.Two-stage graft urethroplasty for proximal and complicated hypospadias in children:A retrospective study[J].J Pediatr Urol,2016.DOI:10.1016/j.jpurol.2016.02.014.
11 Barbagli G,Balo S,Montorsi F,et al.History and evolution of the use of oral mucosa for urethral reconstruction[J].Asian J Urol,2017,4(2):96-101.DOI:10.1016/j.ajur.2016.05.006.
12 Markiewicz MR,Lukose MA,Margarone JE,et al.The oral mucosa graft:a systematic review[J].J Urol,2007,178(2):387-394.DOI:10.1016/j.juro.2007.03.094.
13 Chen KL,Wu HC,Chang CH.Tissue-engineered constructs for urethal regeneration[J].Urological Science,2012,23(2):42-44.DOI:10.1016/j.urols.2012.04.003.
14 沈一丁,诸林峰,茹伟,等.改良带蒂包皮瓣法分期治疗重度尿道下裂的疗效分析[J].中华泌尿外科杂志,2019,40(6):431-435.DOI:10.3760/cma.j.issn.1000-6702.2019.06.008. Shen YD,Zhu LF,Ru W,et al.Efficacy of modified two-stage procedure for severe hypospadias with preputial flap[J].Chin J Urol,2019,40(6):431-435.DOI:10.3760/cma.j.issn.1000-6702.2019.06.008.
Memo
收稿日期:2020-01-30。
基金项目:浙江省基础公益研究项目（编号：LGF19H05002）
通讯作者:陈光杰,Email:dr.chenguangjie@zju.edu.cn