间置尿道成形术治疗特殊形态阴茎头型尿道下裂和单纯性严重阴茎弯曲

Interposition urethroplasty for glandular hypospadias and severe penile curvature

目的探讨间置尿道成形术在特殊形态阴茎头型尿道下裂和单纯性严重阴茎弯曲中的应用价值。方法回顾性分析2008年11月至2019年12月在深圳市儿童医院实施间置尿道成形术治疗的特殊形态阴茎头型尿道下裂伴严重弯曲(>30°)或伴阴茎体段尿道菲薄者9例和单纯严重阴茎弯曲畸形(>30°)2例患儿的临床资料。患儿初次手术年龄25-109个月,中位年龄40个月。手术方法包括:不分期间置尿道成形术2例,分期间置尿道成形术9例。术后随访8个月-12年,随访内容包括阴茎形态、排尿情况,有无尿瘘、尿道狭窄和检测尿流率。尿流率数据以±s表示,组间比较采用t检验。结果术中间置尿道长度为2.2-4.2 cm,平均长度3.2 cm。术后随访阴茎无弯曲,排尿顺畅且尿线不分叉,阴茎外形满意。并发尿瘘2例,其中分期和不分期手术各1例,经再次手术修复成功;无尿道狭窄和尿道憩室患儿。最大尿流率术后3个月为(8.3±1.0)mL/s、6个月为(6.7±1.9)mL/s,与健康对照组[(12.3±3.0)mL/s]比较,差异有统计学意义(t=3.221、3.864,均P<0.05),而术后1年最大尿流率[(10.5±3.7)mL/s]与健康对照组比较,差异无统计学意义(P>0.05)。结论间置尿道成形术治疗儿童轻微的阴茎头型尿道下裂同时伴严重阴茎弯曲和/或阴茎体段尿道发育不良者及严重阴茎弯曲畸形是一种行之有效的手术方式。

Objective To evaluate the therapeutic efficacy of interposition urethroplasty on glandular hypospadias and severe penile curvature.Methods A total of 9 cases of congenital glandular hypospadias and 2 cases of congenital severe penile curvature(>30°)treated with the interposition urethroplasty technique in the Shenzhen Children′s Hospital from November 2008 to December 2019 were retrospectively analyzed.The mean age of initial surgery was 40(25-109)months.Two cases were surgically treated with one-staged interposition urethroplasty and the remaining were treated with two-staged interposition urethroplasty.They were followed up for 8 months to 12 years,including the penile morphology,urination,urethrocutaneous fistula,urethral stricture and uroflowmetry.Continuous variables were presented as±s deviation,Student′s t-test was used for comparison between groups.Results The median length of interposition urethra was 3.2(2.2-4.2)cm.The cosmetic appearance of penis was good without residual chordee,urethral stricture or urethral diverticulum in all patients.Two cases had urethrocutaneous fistula(one-staged repair and two-staged repair were performed in one case respectively),which were successfully repaired by re-operation.The maximum of uroflowmetry in patients at 3 months[(8.3±1.0)mL/s]and 6 months[(6.7±1.9)mL/s]after surgery was significantly lower than that of children in healthy control group[(10.5±3.7)mL/s](t=3.221,3.864,all P<0.05).However,there was no significant difference in 1-year maximum of uroflowmetry postoperatively between surgically treated patients[(10.5±3.7)mL/s]and healthy control group(P>0.05).Conclusions Interposition urethroplasty is an effective and safe treatment for glandular hypospadias and/or severe penile curvature in children.