成人尿道下裂的临床处理

Management of hypospadias in adult

目的探讨成人尿道下裂的临床特点,提高成人尿道下裂的手术成功率。方法2001年9月至2005年12月治疗16-62岁(平均22．9岁)尿道下裂28例,共计施行各种手术39例次,其中尿道成形手术34例次,单纯补瘘5例次。通过临床观察、随访,对几种常用手术方法进行评估。此外,根据成人特点设计改良了术后包扎方法以帮助提高手术的成功率。结果28例单次手术的成功率19例(67．9％)。尿道成形术的34例次共发生尿瘘10例次(29．4％),其中1例在术后2个月自愈(尿瘘发生率26．5％)。发生尿瘘的分布为:Snodgrass术7例次(7／21,33．3％),镶嵌式唇粘膜尿道成形术1例次(1／7,14．3％),Duckett术1例(1／2,50％),Methieu术1例。单纯补瘘的5例中1例术后尿瘘复发。尿道成形术后尿道狭窄发生6例(6／34,17．6％),4例表现为严霞尿道狭窄。尿道狭窄发生的分布为:4例发生于用Snodgrass方法的再手术病例(4／21,19％),1例发生于Duckett术后(1／2,50％),另1例发生于邻近包皮皮瓣再次尿道成形术后。5例目前已经镶嵌式唇粘膜尿道成形术再次手术治愈,1例等待再次手术。结论成人尿道下裂手术容易出现并发症,手术方法的选择是减少并发症的关键。合理的阴茎包扎方法和术后处理对手术的成败有重要影响。

Objectives To discuss the characteristics in adult with hypospedias and try to increase the achievement ratio in hypospadias repair. Methods From Sept. 2001 to Dec. 2005 we have 29 patients age from 16 years old to 62 years old （average 22.9 yr） with hypospadias undergoing 39 times operations. The procedures include 34 urethroplasty and 5 fistula repair. We evaluated the procedures and discussed how to management the adult patients with hypospedias. Result 19 of 28 （67.9%） of primary cases were successful. Fistula developed in 10 of 34 （29.4%） cases. Urethra stricture developed in 6 of 34 （17.6%） in all urethroplasty surgery. Conclusion Urethroplasty methods is the key point for hypospadias repair surgery in adults. TIP urethroplasty is suitable for most single cases. Inlay labial mucosal graft with TIP urethroplasty is a good choice for complicated hypospadias repair with or without urethrostenosis. Dressing technique also play an important role in management of hypospadias in adults.