尿道下裂术后反复尿路感染原因分析

Recurrent urinary tract infections after hypospadias repair in children

目的：探讨尿道下裂修补术后反复尿路感染的原因，以提高尿道下裂手术成功率。方法回顾性分析2004年至2014年实施尿道下裂手术或再手术后反复尿路感染患儿的临床资料，分析患儿年龄、手术情况、术后并发症以及影像学检查情况，寻找尿道下裂修补术后反复尿路感染的危险因素。结果449例患儿中，43例（占1．91％）诊断为尿道下裂术后反复尿路感染，患儿平均手术年龄14个月（6-24个月），平均随访6．5（0．5-10）年。其中一期 Snongrass 术和 Ducket 术分别占47％（20／43）和35％（15／43），再手术病例占18％（8／43）。最初病例包括全部 Ducket 术后和再手术患儿，Snon-grass 术仅1例。这些患儿术后进行排尿性膀胱尿道造影25例（58％，25／43），超声39例（90％，39／43），DMSA 二巯基丁二酸扫描检查8例（19％，8／43）。检查结果显示患儿存在不同尿道畸形，Ducket 修补术后患儿中47％（7／15）有尿道憩室，47％（7／15）有尿道瘘；而在 Snongrass 修补术后患儿，残尿量增多，膀胱输尿管反流十分常见，分别占40％（8／20）和50％（10／20）。结论尿道下裂术后反复尿路感染的病因是多方面的，与术式有一定关联。建议对尿道下裂术后反复尿路感染患儿检查术式相关尿道畸形，并及时矫治。

Objective To discuss the causes of recurrent urinary tract infections （UTIs）in boys who have undergone hypospadias repair. Methods A retrospective analysis was made on the records of all boys who had recurrent UTIs after primary or redo tubularized incised plate （Snodgrass）or transverse island flap （Ducket）repairs,from 2004 to 2014.Data on age,operating details,postoperative complications and imaging studies were collected.We attempted to identify risk factors for recurrent UTIs after hypospadias repair. Re-sults During the study period,43 /449 boys （1.91%）were diagnosed with recurrent UTIs after hypospadias repair.The boys′mean （range）age at repair was 14 （6 -24）months and the median （range）follow-up was 6.5 （1.5 -11）years.Primary Snodgrass and Ducket were performed in 47% （20 /43）and 35% （15 /43）of the boys,respectively.Redo surgeries were performed in 18% of the boys （8 /43）.The initial meatal location was proximal in all Ducket and redo repairs,and in one of the Snodgrass repairs.Postoperative voiding cysto -urethrography,ultrasonography and dimercapto -succinic acid （DMSA）scans were performed in 58% （25 /43）,90% （39 /43）and 19% （8 /43）of the boys,respectively.Abnormalities were noted.Of those boys who underwent a Ducket repair,urethral diverticula were seen in 47% （7 /15）and urethral fistulae were also seen in 47% （7 /15）.Conversely,in those who had a Snodgrass repair,an elevated PVR and vesico-ureteric reflux were more common;they were found in 40% （8 /20）and 50% （10 /20）of patients,respectively. Conclu-sions The pathophysiology of recurrent UTI is multifactorial,but postoperative complications seem to vary with type of procedure.Recurrent UTIs after hypospadias surgery should prompt a specific assessment for potentially functionally relevant and correctable anatomical abnormalities.