尿道下裂术后尿道狭窄的处理

Treatment of urethral stricture after hypospadias repair

目的提高尿道下裂术后尿道狭窄的手术治疗水平。方法尿道下裂术后尿道狭窄患者37例，年龄2～36岁，中位年龄5岁。其中尿道末段狭窄6例、吻合口狭窄30例，尿道末段及吻合口同时狭窄1例。单纯狭窄13例中行尿道末段切开4例、行加盖术6例、行经尿道钬激光狭窄切开术3例。复杂尿道狭窄24例，狭窄长度〉0．5cm，其中伴复杂尿道瘘8例、尿道憩室6例、阴茎弯曲4例、多次手术后尿道狭窄6例，行狭窄段切开加盖术或狭窄段切除、带蒂皮瓣尿道成形术，同时矫正阴茎弯曲、憩室切除、瘘口修补。结果单纯狭窄组一次手术治愈12例，1例狭窄内切开术后尿道狭窄者二次手术治愈。复杂狭窄组中8例伴复杂尿道瘘一次矫治术治愈7例，二次手术治愈1例；6例伴尿道憩室者均一次手术治愈；4例伴阴茎弯曲者一次手术成功3例；二次手术治愈1例；6例多次矫治术后尿道狭窄者均一次手术治愈。37例随访12～24个月，立位排尿通畅。结论尿道下裂术后单纯尿道末段狭窄采用狭窄切开术或加盖术，单纯吻合口狭窄采用加盖术或经尿道钬激光狭窄切开术，复杂性尿道狭窄采用狭窄切开加盖术或狭窄段切除阴茎或阴囊中隔皮管尿道成形肉膜蒂加盖术，效果良好。

Objective To discuss the treatment of urethral stricture after hypospadias repair. Methods Thirty-seven cases of urethral stricture after hypospadias repair from 1999 to 2006 were retrospectively analyzed. Of 37 patients, the stricture was located at the distal end of urethra in 7 cases. There were 31 cases with anastomotic stricture. There was 1 case with distal urethral stricture and anastomotic structure. There were 13 patients with the simple urethral stricture and the complicated 24 cases. Of 13 simple urethral stricture patients, 4 patients were repaired with urethro-meatomy, 6 patients with shelf operation and 3 patients with transurethral holmium laser urethrotomy. Eight pa- tients with complicated urethral fistula, 6 patients with urethral diverticula, 4 patients with phallocampsis and 6 patients with many times of postoperative urethral stricture were repaired with shelf operation or penis skin flap or septum of scrotum skin flaps urethroplasty. Results The simple strictures of 12 patients were cured by stage 1 operation, the other one cured after second surgery. Of 8 patients with fistula, 7 were cured at stage 1, the other one was cured at the stage 2. Of 6 patients with diverticulum, all were cured at stage 1. Of 4 patients with phallocampsis, 3 cases were cured at stage 1, the other one was cured at the stage 2. Of 6 patients with recurrent strictures, all were cured at stage 1. All patients were followed up 12 to 24 months. The micturition was without difficulty at stand position. Conclusions Urethral stricture is one of the most common complications after hypospadias repair. The simple urethral stricture could be repaired with urethro-meatomy or shelf operation or transurethral holmium laser urethrotomy. The complicated urethral stricture could be repaired with shelf operation or penis skin flaps or septum of scrotum skin flaps urethroplasty and overjetted with dortos of scrotum flaps.