Two-stage urethroplasty is a better choice for proximal hypospadias with severe chordee after urethral plate transection： a single-center experience  

二期尿道成型术更适合于需要横断尿道板并伴有严重弯曲畸形的近段型尿道下裂

作　　者：Da-Chao Zheng Hai-Jun Yao Zhi-Kang Cai Jun Da Qi Chen Yan-Bo Chen Ke Zhang Ming-Xi Xu Mu-Jun Lu Zhong Wang 

机构地区：[1]Department of Urology, Shanghai 9th People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China.

出　　处：《Asian Journal of Andrology》2015年第1期94-97,I0009,共5页亚洲男性学杂志（英文版）

摘　　要：It is still debatable whether single- or two-stage urethroplasty is a more suitable technique for treating hypospadias with severe chordee after urethral plate transection. This retrospective study evaluated these two techniques. A total of 66 patients of proximal hypospadias with severe chordee were divided into two groups according to the techniques they underwent： 32 and 34 patients underwent single-stage （Duckett） or two-stage urethroplasty, respectively. Median ages at presentation were 7.5 years and 11.0 years in single-stage and two-stage repair groups, respectively. Median follow-ups were 28.5 months （20-60 months） and 35 months （18-60 months） in the single-stage and two-stage groups, respectively. The meatus of the neourethra was located at the top of the glans in all patients. No recurrence of chordee was found during follow-up, and all patients or parents were satisfied with the penile length and appearance. Complications were encountered in eight patients in both groups, with no statistically significant differences between the two techniques. The late complication rate of stricture was higher after the single-stage procedure （18.75% vs 0%）. The complication rate after single-stage repairs was significantly lower in the prepubescent subgroup （10.52%） than in the postpubescent cohort （46.15%）. These results indicate that the urethral plate transection effectively corrects severe chordee associated with proximal hypospadias during the intermediate follow-up period. Considering the higher rate of stricture after single-stage urethroplasty, two-stage urethroplasty is recommended for proximal hypospadias with severe chordee after urethral plate transection.对于伴有严重阴茎弯曲的尿道下裂，横断尿道板后是选择一期还是二期手术仍存在争议。这项回顾性研究比较评价了这两种方法的优劣。本研究共收集66例伴有严重阴茎弯曲的近端型尿道下裂的患者，根据手术方式分成两组，其中32例行一期手术（Duckett），34例行二期手术。一期和二期手术组的中位年龄分别为7．5岁和11．0岁，中位随访时间分别为28．5个月和35个月。所有患者术后尿道外口均位于龟头顶端。随访期间无患者出现阴茎弯曲复发，患者及其家属对阴茎的长度和外观均满意。术后两组各有8例患者出现并发症，两组间并发症率无统计学差异。一期手术尿道狭窄的远期并发症率高j（18．75％1，JO％）。在一期手术组中，青春期前患者的并发症率显著低于青春期后患者（10．52％w46．15％3。中期随访结果提示，横断尿道板可有效矫正近端型尿道下裂合并的重度阴茎弯曲。考虑到一期手术组中较高的尿道狭窄发生率，本文认为分期手术更适合伴有严重阴茎弯曲需要横断尿道板的近端型尿道下裂。

关 键 词：CHORDEE proximal hypospadias single-stage urethroplasty two-stage urethroplasty 

分 类 号：R[医药卫生]