尿道下裂术后尿道狭窄致肾积水35例诊治探讨

Hydronephrosis induced by urethral stricture after hypospadias in 35 cases

目的探讨尿道下裂术后长期尿道狭窄导致肾积水的诊断和治疗。方法 35例尿道下裂术后长期尿道狭窄患者通过行排泄性尿道造影、发射单光子计算机断层扫描(ECT)、超声、静脉肾孟造影及尿路造影(MRU)等检查后确诊。分别对狭窄距尿道口小于1 cm患者行尿道外口切开及外翻缝合;对长度大于1 cm患者行狭窄段尿道剖开及二期成形尿道;皮瓣成形尿道与原尿道吻合处重度狭窄患者行狭窄段切除后再端端吻合;轻度狭窄患者采取输尿管镜下钬激光内切开术;输尿管明显扩张返流者行抗返流再植术;膀胱容量小于100 mL的患者行膀胱扩大术。结果 20例患者肾脏轻中度积水且膀胱内有小梁增生;9例患者肾脏中重度积水且膀胱内有大量的小梁增生,隐窝形成。5例术后再次出现尿道狭窄(2例重新手术,3例定期行尿道扩张)。其余30例患者术后肾脏积水较术前明显减轻。结论尿道狭窄是尿道下裂术后的常见并发症,如果发生狭窄需及时采取扩尿道及再次手术等方式解除尿道梗阻,防止长时间下尿路梗阻致肾积水和肾功能损害。

Objective To explore the diagnosis and treatment of hydronephrosis induced by urethral stricture after operation for hypospadias.Methods Totally 35 patients with hydronephrosis induced by urethral stricture after operation for hypospadias were confirmed by excretory urethrography,emission computerized tomography（ECT）,ultrasound,intravenous pyelography and magnetic resonance urography（MRU）.Meatotomy and everting suture were applied to patients with urethra stricture less than 1 cm to external orifice of urethra;split of strictured urethral part and stageⅡurethral plasty were applied to patients with urethra stricture more than1 cm to external orifice of urethra.Excisions of the stricture and end-to-end anastomosis were performed on patients with severe junction stricture between original urethra and urethra formed with skin flap while holmium laser endoincision with ureteroscopes was performed on patients with slight junction stricuture.Reimplantation to oppose back flow was performed on patients with obvious ureter extension and augmentation of bladder was performed on patients whose bladder capacity was less than 100 mL.Results Twenty cases of light hydronephrosis and trabecula hyperplasia,9 cases of severe hydronephrosis and abound rabecula hyperplasia were observed.Recurrences were found in 5 cases after operation,2 cases received reoperation and 3 cases received urethral dilatation regularly.Allievation of hydronephrosis was observed in the other 30 cases.Conclusion Urethral stricture is the most common complications of hypospadias operation.Urethral dilatation and reoperation should be adopted in time to avoid urethremphraxis,which will induce hydronephrosis and lesion of kidney functional if lasts for long time.