Guo Huijie,Sun Xuerui,Li Shoulin,et al.Variation tendency of urinary flow after tubularized incised plate urethroplasty in children with hypospadias[J].Journal of Clinical Pediatric Surgery,2023,22(02):129-133.[doi:10.3760/cma.j.cn101785-202211059-006]
儿童尿道下裂TIP手术后近期尿流率变化研究
- Title:
- Variation tendency of urinary flow after tubularized incised plate urethroplasty in children with hypospadias
- Keywords:
- Hypospadias; Surgical Procedures; Operative; Postoperative Complications; Voiding Frequency; Maximum Urine Flow Rate; Child
- 摘要:
- 目的 探讨尿道下裂患儿尿道板纵切卷管尿道成形术(tubularized incised plate urethroplasty,TIP手术)术后尿流率的变化,为临床治疗提供依据。 方法 收集2019年1月至12月在深圳市儿童医院行TIP手术的尿道下裂病例,分别于术前及术后1个月、3个月、6个月、1年行尿流率测定,分析尿流率变化。同时收集180例正常男童的尿流率,作为正常对照组。最大尿流率低于正常对照组均数的2个标准差定义为梗阻尿流。 结果 共有92例尿道下裂患儿纳入本研究,术前最大尿流率为(10.4±4.3)mL/s,术后1个月为(5.6±2.4)mL/s,术后3个月为(4.9±2.2)mL/s,术后6个月为(7.0±2.5)mL/s,术后1年为(8.1±2.4)mL/s。尿道下裂TIP手术后梗阻型尿流于后期逐渐减少,尿道梗阻减轻。与正常对照组儿童最大尿流率比较,尿道下裂患儿术前及术后不同时段尿流率均低于正常男童。 结论 尿道下裂患儿行TIP手术后尿流率较术前下降,手术后3个月尿流率下降至最低,6个月以后尿流率逐渐升高。尿道下裂TIP手术后梗阻型尿流常见,若无临床症状,无需治疗,大部分可自行好转。
- Abstract:
- Objective To explore variation tendency of urinary flow after tubularized incised plate (TIP) urethroplasty in children with hypospadias.Methods Retrospective review was conducted for 92 boys with hypospadias undergoing TIP urethroplasty from January 2019 to December 2019.Uroflowmetry was performed at Month 1/3/6/12 preoperatively to examine the variation of urinary flow.Also the data of urinary flow were collected from 180 normal boys as a control group.Obstructive urinary flow was present if maximal urinary flow (Qmax) dropped by 2 standard deviation lower than normal.Results Preoperative Qmax was (10.4±4.3) mL/s and postoperative Qmax (5.6±6.4),(4.9±9.2),(7.0±0.5) and (8.1±1.4) ml/s at Month 1/3/6/12.Obstructive flow was relieved in late stage after TIP urethroplasty.However,preoperative and postoperative urinary flows were lower in hypospadiacs than that in normal boys.Conclusion Urinary flow declines after TIP urethroplasty in hypospadiacs.It drops to the lowest level at Month 3 post-operation and then rises.Unless symptomatic,a conservative approach is preferable.
参考文献/References:
[1] Bergman JEH,Loane M,Vrijheid M,et al.Epidemiology of hypospadias in Europe:a registry-based study[J].World J Urol,2015,33(12):2159-2167.DOI:10.1007/s00345-015-1507-6.
[2] Zu’bi F,Chua M,El Ghazzaoui A,et al.Competency in tubularized incised plate repair for distal hypospadias:cumulative sum learning curve analysis of a single surgeon experience[J].J Urol,2020,204(6):1326-1332.DOI:10.1097/JU.0000000000001231.
[3] Alshafei A,Cascio S,Boland F,et al.Comparing the outcomes of tubularized incised plate urethroplasty and dorsal inlay graft urethroplasty in children with hypospadias:a systematic review and Meta-analysis[J].J Pediatr Urol,2020,16(2):154-161.DOI:10.1016/j.jpurol.2020.01.009.
[4] Snodgrass WT.Tubularized incised plate (TIP) hypospadias repair[J].Urol Clin North Am,2002,29(2):285-290.DOI:10.1016/s0094-0143(02)00045-9.
[5] Bush NC,Snodgrass W.Pre-incision urethral plate width does not impact short-term tubularized incised plate urethroplasty outcomes[J].J Pediatr Urol,2017,13(6):625.e1-625.e6.DOI:10.1016/j.jpurol.2017.05.020.
[6] 徐万华,赵为广,尹鉴淳,等.主动分期尿道下裂修复术的临床研究及近期尿动力学评估[J].中华小儿外科杂志,2016,37(12):924-927.DOI:10.3760/cma.j.issn.0253-3006.2016.12.010. Xu WH,Zhao WG,Yin JC,et al.Staged surgery for proximal hypospadias in children:a retrospective study and urinary functional evaluations[J].Chin J Pediatr Surg,2016,37(12):924-927.DOI:10.3760/cma.j.issn.0253-3006.2016.12.010.
[7] 王玮,张旭辉,陈柏峰,等.单中心225例尿道下裂患儿术后自由尿流率分析与评价[J].中国药物与临床,2021,21(16):2799-2801.DOI:10.11655/zgywylc2021.16.012. Wang W,Zhang XH,Chen BF,et al.Analysis and evaluation of postoperative free urine flow rate in 225 children with hypospadias at a single center[J].Chinese Remedies & Clinics,2021,21(16):2799-2801.DOI:10.11655/zgywylc2021.16.012.
[8] Snodgrass WT,Nguyen MT.Current technique of tubularized incised plate hypospadias repair[J].Urology,2002,60(1):157-162.DOI:10.1016/s0090-4295(02)01620-5.
[9] Eldeeb M,Nagla S,Abou-Farha M,et al.Snodgrass vs Snodgraft operation to repair the distal hypospadias in the narrow urethral plate[J].J Pediatr Urol,2020,16(2):165.e1-165.e8.DOI:10.1016/j.jpurol.2020.01.006.
[10] Sarhan OM,El-Hefnawy AS,Hafez AT,et al.Factors affecting outcome of tubularized incised plate (TIP) urethroplasty:single-center experience with 500 cases[J].J Pediatr Urol,2009,5(5):378-382.DOI:10.1016/j.jpurol.2009.02.204.
[11] Snodgrass W,Cost N,Nakonezny PA,et al.Analysis of risk factors for glans dehiscence after tubularized incised plate hypospadias repair[J].J Urol,2011,185(5):1845-1849.DOI:10.1016/j.juro.2010.12.070.
[12] Erlich RM.Tubularized-incised urethral plate urethroplasty:is regular dilatation necessary for success?[J].BJU Int,2000,86(1):145.
[13] Zarenezhad M,Hosseini SMV.Regular dilatation in tubularized-incised urethral plate urethroplasty for prevention of fistula formation[J].Iran Red Crescent Med J,2013,15(12):e6871.DOI:10.5812/ircmj.6871.
[14] Piplani R,Aggarwal SK,Ratan SK.Role of uroflowmetry before and after hypospadias repair[J].Urol Ann,2018,10(1):52-58.DOI:10.4103/UA.UA_78_17.
[15] Andersson M,Doroszkiewicz M,Arfwidsson C,et al.Normalized urinary flow at puberty after tubularized incised plate urethroplasty for hypospadias in childhood[J].J Urol,2015,194(5):1407-1413.DOI:10.1016/j.juro.2015.06.072.
[16] Lorenzo AJ,Snodgrass WT.Regular dilatation is unnecessary after tubularized incised-plate hypospadias repair[J].BJU Int,2002,89(1):94-97.DOI:10.1046/j.1464-4096.2001.01901.x.
[17] 徐万华,尹鉴淳,李守林,等.尿道下裂术前尿道功能的尿动力学评估[J].中华小儿外科杂志,2010,31(4):255-257.DOI:10.3760/cma.j.issn.0253-3006.2010.04.005. Xu WH,Yin JC,Li SL,et al.Urodynamic evaluations before surgery for hypospadias[J].Chin J Pediatr Surg,2010,31(4):255-257.DOI:10.3760/cma.j.issn.0253-3006.2010.04.005.
[18] 王健健,李守林,陈进军,等.Snodgrass术治疗尿道下裂术前术后尿流率联合残余尿检测的意义[J].实用医学杂志,2019,35(2):217-220.DOI:10.3969/j.issn.1006-5725.2019.02.012. Wang JJ,Li SL,Chen JJ,et al.Detections of urinary flow rate plus postvoid residual urine before and after Snodgrass therapy for coronal hypospadias[J].J Pract Med,2019,35(2):217-220.DOI:10.3969/j.issn.1006-5725.2019.02.012.
[19] Olsen LH,Grothe I,Rawashdeh YF,et al.Urinary flow patterns in infants with distal hypospadias[J].J Pediatr Urol,2011,7(4):428-432.DOI:10.1016/j.jpurol.2010.05.013.
[20] Perera M,Jones B,O’Brien M,et al.Long-term urethral function measured by uroflowmetry after hypospadias surgery:comparison with an age matched control[J].J Urol,2012,188(4 Suppl):1457-1462.DOI:10.1016/j.juro.2012.04.105.
[21] Idzenga T,Kok DJ,Pel JJM,et al.Is the impaired flow after hypospadias correction due to increased urethral stiffness?[J].J Pediatr Urol,2006,2(4):299-303.DOI:10.1016/j.jpurol.2005.11.016.
[22] Holmdahl G,Karstr?m L,Abrahamsson K,et al.Hypospadias repair with tubularized incised plate.Is uroflowmetry necessary postoperatively?[J].J Pediatr Urol,2006,2(4):304-307.DOI:10.1016/j.jpurol.2005.11.018.
[23] Lopes JF,Schned A,Ellsworth PI,et al.Histological analysis of urethral healing after tubularized incised plate urethroplasty[J].J Urol,2001,166(3):1014-1017.
[24] González R,Ludwikowski BM.Importance of urinary flow studies after hypospadias repair:a systematic review[J].Int J Urol,2011,18(11):757-761.DOI:10.1111/j.1442-2042.2011.02839.x.
[25] 王永前,李森恺.尿道下裂术后尿道狭窄的尿流率特点[J].中国美容整形外科杂志,2014,25(9):530-532.DOI:10.3969/j.issn.1673-7040.2014.09.006. Wang YQ,Li SK.Characteristics of urine flow of urethral stenosis after hypospadias repairing[J].Chin J Aesthet Plastic Surg,2014,25(9):530-532.DOI:10.3969/j.issn.1673-7040.2014.09.006.
相似文献/References:
[1]杜朝峻,丁力,胡英超,等.手术治疗婴幼儿法洛四联症83例[J].临床小儿外科杂志,2010,9(06):413.
DU Chao jun,DING Li,HU Ying chao,et al.Surgical treatment of Tetralogy of Fallot in infancy: Experiences of 83 cases.[J].Journal of Clinical Pediatric Surgery,2010,9(02):413.
[2]李勇,尹强,周小渔,等.术中胆道造影在先天性胆总管囊肿手术中的应用[J].临床小儿外科杂志,2010,9(06):430.
LI Yong,YIN Qiang,ZHOU Xiao yu,et al.The clinic application experience on intraoperative cholangiography in pediatric surgery.[J].Journal of Clinical Pediatric Surgery,2010,9(02):430.
[3]许芝林,王强,李琰,等.乙状结肠冗长症的术式选择探讨[J].临床小儿外科杂志,2010,9(06):432.
XU Zhi lin,WANG Qiang,LI Yan,et al.Initiatory exploration of the standard of surgical treatment methods for Dolichosigmoid.[J].Journal of Clinical Pediatric Surgery,2010,9(02):432.
[4]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[5]罗洪,孙德霞,强红家,等.不同部位皮肤再造尿道的病理学研究[J].临床小儿外科杂志,2010,9(06):443.
[6]胡明,施诚仁,严志龙.脐环小切口治疗婴幼儿腹盆腔疾病的探讨[J].临床小儿外科杂志,2010,9(06):471.
[7]江峰赵阳孙莲萍金惠明马杰.婴幼儿阻塞性脑积水两种手术方式的疗效比较[J].临床小儿外科杂志,2011,10(01):0.
JIANG Feng,ZHAO Yang,SUN Liang ping,et al.Endoscopic third ventricul ostomy versus ventricul operitoneal shunt:clinical study of obstructive hydro cephalus in infants.[J].Journal of Clinical Pediatric Surgery,2011,10(02):0.
[8]王伟程少文彭磊林忠勤张伟陈庆玉寇冬权.弹性髓内钉在儿童肱骨骨折中的应用[J].临床小儿外科杂志,2011,10(01):0.
WANG Wei,CHENG Shaowen,PENG Lei,et al.Application of elastic intramedullary nailing in pediatric humeral fractures.[J].Journal of Clinical Pediatric Surgery,2011,10(02):0.
[9]陈快 黄金狮 戴康临 陶俊峰 赖勇强 陶强. 腹腔镜与开腹Ladd手术治疗新生儿肠旋转不良效果比较[J].临床小儿外科杂志,2011,10(02):128.
[J].Journal of Clinical Pediatric Surgery,2011,10(02):128.
[10]郑里乐 许慧萍 彭牡丹. 产时子宫外胎儿手术的护理配合[J].临床小儿外科杂志,2011,10(02):157.
[J].Journal of Clinical Pediatric Surgery,2011,10(02):157.
[11]丁勇,魏华,孔燕,等.横裁包皮岛状皮瓣法在尿道下裂治疗中的应用[J].临床小儿外科杂志,2010,9(06):474.
[12]景登攀张根领孙蔓丽.改良Snodgrass术治疗尿道下裂疗效观察[J].临床小儿外科杂志,2011,10(01):0.
[13]白明 张敬悌 葛文安 王盛兴 郭涛 张岗 杨增雷. 医用透明硅胶膜在尿道下裂手术伤口包扎中的应用[J].临床小儿外科杂志,2012,11(02):91.
[14]刘波 陈太忠 李光亮 舒中甫 石代红 杨英.改良尿道板纵切卷管尿道成型术治疗儿童尿道下裂６例[J].临床小儿外科杂志,2013,12(01):72.
[15]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(09):795.[doi:10.3969/j.issn.1671-6353.2019.09.018]
Jia Xing,Xie Hua.Research advances in histology and surgery of ventral penile curvature in hypospadias[J].Journal of Clinical Pediatric Surgery,2019,18(02):795.[doi:10.3969/j.issn.1671-6353.2019.09.018]
[16]杨珍珍,李佳义,刘沛,等.一期Duckett与分期Bracka尿道成形术治疗非远端型尿道下裂术后并发症的Meta分析[J].临床小儿外科杂志,2023,22(02):168.[doi:10.3760/cma.j.cn101785-202202018-014]
Yang Zhenzhen,Li Jiayi,Liu Pei,et al.Efficacy of one-stage Duckett versus staged Bracka urethroplasty for nondistal hypospadias: a meta-analysis[J].Journal of Clinical Pediatric Surgery,2023,22(02):168.[doi:10.3760/cma.j.cn101785-202202018-014]
[17]王登辉,崔梦杰,韩晓江,等.性别发育异常合并近端尿道下裂尿道成形术后并发症的危险因素分析[J].临床小儿外科杂志,2023,22(09):849.[doi:10.3760/cma.j.cn101785-202211056-010]
Wang Denghui,Cui Mengjie,Han Xiaojiang,et al.Risk factors of complications after urethroplasty in children with gender dysplasia and proximal hypospadias[J].Journal of Clinical Pediatric Surgery,2023,22(02):849.[doi:10.3760/cma.j.cn101785-202211056-010]
[18]周谦,张潍平,宋宏程,等.尿道板切开卷管尿道成形术治疗尿道下裂的近期疗效及术后尿道瘘相关危险因素分析[J].临床小儿外科杂志,2023,22(12):1139.[doi:10.3760/cma.j.cn101785-202202009-009]
Zhou Qian,Zhang Weiping,Song Hongcheng,et al.Analysis of risk factors for urethral fistula of hypospadias repair with tubularized incised plate urethroplasty[J].Journal of Clinical Pediatric Surgery,2023,22(02):1139.[doi:10.3760/cma.j.cn101785-202202009-009]
备注/Memo
收稿日期:2022-11-30。
基金项目:国家自然科学基金联合基金项目(U1904208); 由广东省高水平医院建设专项经费资助; 深圳市医学重点学科(2020-2024)(SZXK035)
通讯作者:杨志林,Email:yangzhilin207@163.com