Qin Daorui,Wang Xuejun,Mao Yu,et al.Application of limited volume reduction of dorsal navicular fossa during repairing hypospadias with a preservation of urethral plate[J].Journal of Clinical Pediatric Surgery,,21():13-17.[doi:10.3760/cma.j.cn.101785-202110036-003]
Application of limited volume reduction of dorsal navicular fossa during repairing hypospadias with a preservation of urethral plate
- Keywords:
- Hypospadias/SU; Reconstructive Surgical Procedures; Postoperative Complications; Treatment Outcome
- Abstract:
- Objective To explore the application and follow-up results of limited volume reduction of dorsal navicular fossa during repairing hypospadias with a preservation of urethral plate. Methods From January 2019 to April 2021, limited volume reduction of dorsal navicular fossa was employed for 64 hypospadiacs.Based upon an operative history or not, they were divided into two groups of initial treat and redo.Basic demographic profiles, preoperative status and surgical approaches were reviewed.Perioperative scores of hypospadias objective scoring evaluation (HOSE) for reoperated cases were recorded.Urodynamic study was performed at Month 3 post-operation.The incidence of complications was recorded.The perioperative changes of HOSE score were compared. Results All operations were successful.During a postoperative follow-up period of (6-24) months, the overall incidence of postoperative complications was 17.19% (10.00% in initial treat group versus 20.45% in redo group).There was no statistical difference (χ2=0.450, P=0.500).Urethral orifice presented the postoperative appearance of longitudinal fissure and urinary line showed a horizontal parabola.Qmax of initial treat and redo groups was (9.49±1.74) and (9.75±1.85) ml/s.There was no statistical difference (t=0.520, P=0.610).And HOSE score of initial treat group was (15.55±0.69); the score of redo group was (13.32±1.12) pre-operation and (15.55±0.76) post-operation.There was no statistically significant difference (t=0.001, P=0.980).The pre/post-operation difference of HOSE score was statistically significant in redo group (t=-11.600, P<0.001). Conclusion Limited volume reduction of dorsal navicular fossa is both safe and feasible for hypospadiacs.And it may improve the morphology of external urethra and direction of urinary flow.
References:
[1] 高媛媛,张兹镇,张亚.先天性尿道下裂自然病因研究进展[J].临床小儿外科杂志,2021,20(1):81-85.DOI:10.12260/lcxewkzz.2021.01.016. Gao YY,Zhang ZZ,Zhang Y.Recent advances in etiology of environmental factors in congenital hypospadias[J].J Clin Ped Sur,2021,20(1):81-85.DOI:10.12260/lcxewkzz.2021.01.016.
[2] 覃道锐,唐耘熳,王学军,等.阴茎头海绵体减容技术在中重度尿道下裂修复手术阴茎头成形中的应用[J].中国修复重建外科杂志,2018,32(11):1454-1457.DOI:10.7507/1002-1892.201801135. Qin DR,Tang YM,Wang XJ,et al.Application of cavernosum reduction technology during glanuloplasty for repairing moderate-severe hypospadias[J].Chin J Repar Reconstr Surg,2018,32(11):1454-1457.DOI:10.7507/1002-1892.201801135.
[3] Holland AJ,Smith GH,Ross FI,et al.HOSE:an objective scoring system for evaluating the results of hypospadias surgery[J].BJU Int,2001,88(3):255-258.DOI:10.1046/j.1464-410x.2001.02280.x.
[4] lavien PA,Barkun J,de Oliveira mL,et al.The Clavien-Dindo classification of surgical complications:five-year experience[J].Ann Surg,2009,250(2):187-196.DOI:10.1097/SLA.0b013e3181b13ca2.
[5] 沈一丁,诸林峰,王晓豪,等.尿道下裂术后再发阴茎下弯的处理策略[J].临床小儿外科杂志,2021,20(2):177-180.DOI:10.12260/lcxewkzz.2021.02.013. Shen YD,Zhu LiF,Wang XH,et al.Treatment of recurrent curvature after hypospadias repair[J].J Clin Ped Sur,2021,20(2):177-180.DOI:10.12260/lcxewkzz.2021.02.013.
[6] Winberg H,Arnbj rnsson E,Anderberg M,et al.Postoperative outcomes in distal hypospadias:a meta-analysis of the Mathieu and tubularized incised plate repair methods for development of urethrocutaneous fistula and urethral stricture[J].Pediatr Surg Int,2019,35(11):1301-1308.DOI:10.1007/s00383-019-04523-z.
[7] Snodgrass WT,Bush NC.Management of Urethral Strictures After Hypospadias Repair[J].Urol Clin North Am,2017,44(1):105-111.DOI:10.1016/j.ucl.2016.08.014.
[8] Talab SS,Cambareri GM,Hanna MK.Outcome of surgical management of urethral stricture following hypospadias repair[J].J Pediatr Urol,2019,15(4):354.e1-e6.DOI:10.1016/j.jpurol.2019.05.025.
[9] 王学军,唐耘熳,毛宇,等.尿道下裂术后尿道狭窄的再手术方法及疗效分析[J].中国修复重建外科杂志,2019,33(2):223-226.DOI:10.7507/1002-1892.201810057. Wang XJ,Tang YM,Mao Y,et al.Reoperative approaches and effectiveness of urethral stricture after urethroplasty of hypospadias[J].Chin J Repar Reconstr Surg,2019,33(2):223-226.DOI:10.7507/1002-1892.201810057.
[10] Lucas J,Hightower T,Weiss DA,et al.Time to complication detection after primary pediatric hypospadias repair:a large,single center,retrospective cohort analysis[J].J Urol,2020,204(2):338-344.DOI:10.1097/JU.0000000000000762.
[11] 唐耘熳,陈绍基.纵行带蒂岛状包皮瓣尿道成形术矫治近端型尿道下裂[J].现代泌尿外科杂志,2021,26(4):277-280.DOI:10.3969/j.issn.1009-8291.2021.04.001. Tang YM,Chen SJ.Vertical preputial island flap urethroplasty for repairing proximal hypospadias[J].J Mod Urol,2021,26(4):277-280.DOI:10.3969/j.issn.1009-8291.2021.04.001.
[12] 刘愉,覃道锐,王学军,等.初治尿道下裂TIP手术后并发症的相关因素分析:309例单中心研究[J].临床小儿外科杂志,2020,19(12):1094-1099.DOI:10.3969/j.issn.1671-6353.2020.12.007. Liu Y,Qin DR,Wang XJ,et al.Analysis of related factors of complications after tubularized incised plate for initial hypospadias:a sin-gle-center report of 309 cases[J].J Clin Ped Sur,2020,19(12):1094-1099.DOI:10.3969/j.issn.1671-6353.2020.12.007.
[13] Loloi J,Harrington S,Boltz S,et al.Ingrafts in hypospadias surgery:longer-term outcomes[J].J Pediatr Urol,2020,16(5):555.e1-e5.DOI:10.1016/j.jpurol.2020.04.030.
[14] Winberg H,Arnbj rnsson E,Anderberg M,et al.Postoperative outcomes in distal hypospadias:a Meta-analysis of the Mathieu and tubularized incised plate repair methods for development of urethrocutaneous fistula and urethral stricture[J].Pediatr Surg Int,2019,35(11):1301-1308.DOI:10.1007/s00383-019-04523-z.
[15] Long CJ,Chu DI,Tenney RW,et al.Intermediate-term follow-up of proximal hypospadias repair reveals high complication rate[J].J Urol,2017,197(3 Pt 2):852-858.DOI:10.1016/j.juro.2016.11.054.
[16] 孙珑,赵冬艳,唐达星.尿道下裂术后中远期效果评价及研究进展[J].临床小儿外科杂志,2020,19(12):1100-1106.DOI:10.3969/j.issn.1671-6353.2020.12.008. Sun L,Zhao DY,Tang DX,et al.Evaluations and research advances of medium-to-long term follow-up outcomes of hypospadias repair[J].J Clin Ped Sur,2020,19(12):1100-1106.DOI:10.3969/j.issn.1671-6353.2020.12.008.
[17] 余克驰,李宁,袁继炎,等.TIP手术治疗儿童尿道下裂的远期疗效分析[J].临床小儿外科杂志,2020,19(12):1076-1081.DOI:10.3969/j.issn.1671-6353.2020.12.004. Yu KC,Li N,Yuan JY,et al.Long-term outcomes for using tubularized incised plate procedure during hypospadias surgery[J].J Clin Ped Sur,2020,19(12):1076-1081.DOI:10.3969/j.issn.1671-6353.2020.12.004.
[18] 中华医学会小儿外科学分会泌尿学组.尿道下裂专家共识[J].中华小儿外科杂志,2018,39(12):883-888.DOI:10.3760/cma.j.issn.0253-3006.2018.12.002. Subspecialty Group of Urology,Society of Pediatric Surgery,Chinese Medical Association:Expert Consensus on Hypospadias[J].Chin J Pediatr Surg,2018,39(12):883-888.DOI:10.3760/cma.j.issn.0253-3006.2018.12.002.
Memo
收稿日期:2021-09-14。
基金项目:国家自然科学基金青年基金(82101666)
通讯作者:唐耘熳,Email:hypospadias@126.com