尿道下裂术后假性尿道憩室诊治体会

Diagnosis and treatment of urethral psuedodiverticula after hypospadias repair

目的探讨尿道下裂术后假性尿道憩室的诊断、治疗及预防.方法回顾性分析1988年1月至2002年6月收治的尿道下裂术后假性尿道憩室15例,年龄1.5～14岁,原临床分型均为中～重度尿道下裂,全部病例首次手术均接受了正位尿道口一期尿道成形术.出院时排尿正常,阴茎外形满意.结果出院后7～90 d开始尿线变细、排尿费力,呈进行性加重,排尿时阴茎腹侧局限性隆起,排尿后滴沥,用手挤压阴茎腹侧隆起处可见尿液从尿道外口溢出,类似于先天性尿道憩室.15例均接受了手术治疗.术后随访0.5～13年,14例痊愈,1例术后半年症状复发经再次手术治愈.结论尿道下裂术后假性尿道憩室是尿道下裂成形术后常见并发症之一,其主要临床表现为排尿困难和排尿后滴沥,重新修复尿道和解除远端尿道或外口狭窄是唯一有效的治疗方法.

Objective To explore the diagnosis, the treatment and the prevention of urethral pseu-dodiverticula after hypospadias repair. Methods Fifteen patients with urethral psuedodiverticula after hypospadias urethroplasty were treated from Jan. 1988 to Jun.2002. The ages ranged from 1.5 to 14 years. All patients with mid-penile or proximal hypospadias underwent one-stage urethroplasty. Satisfied penis shape and normal micturition were achieved in all patients at discharge. Results All patients complained that there were progressive difficulty in micturition after hypospadias repair 7 to 90 days after discharge. During voiding, the ventral of penis expanded, and the flow of voiding dribbled. Urine flew out from the urethra when pressing the ventral of penis, similar to that of congenital urethral diverticula. All patients underwent operative procedures and followed-up for 0. 5 to 13 years. Fourteen patients cured and one patient recurred after six months postoperatively. Conclusions Urethral psuedodiverticula is one of the common complications after hypospadias repair. The major findings are difficult micturition and dribbling after micturition. Apart form the prevention, which is very important, the only way to treat the urethral psuedodiverticula is surgery, aiming at tapering the diverticula and relieving the distal stenosis of the urethra.