尿道下裂术后尿道裂开的处理

Management of urethral dehiscence after hypospadias repair

目的 探讨尿道下裂术后尿道裂开的原因和处理方法。 方法 根据尿道外口位置和局部皮肤发育情况分别采用包皮岛状皮瓣、阴囊中隔皮瓣及膀胱粘膜行尿道重建术处理尿道下裂术后尿道裂开患儿 2 3例。 结果 2 3例随访 1～ 9年 ,15例手术一次成功。 3例出现尿瘘经修补后愈合 ;4例出现吻合口或尿道外口狭窄 ,留置支架管 (45d～ 5个月 )后治愈 ;1例阴茎轻度下弯 ,但不影响勃起。 结论 尿道下裂术后尿道裂开尿道重建术应首选包皮或阴囊中隔皮瓣 ,膀胱粘膜仅适用于局部取材困难的病例 ;手术应由有经验的小儿泌尿外科医师操作 。

Objective To investigate the cause and management of urethral dehiscence after hypospadias repair. Methods 23 cases of urethral dehiscence after hypospadias repair were reviewed.According to the location of meatus and the status of available skin, urethroplasty was performed by preputial island flap, scrotal island flap or bladder mucosa translocation. Results 23 cases were followed up from 1 to 9 years.15 cases were cured.3 developed urethral fistulae after the secondary repair, which were subsecondary closed up successfully by Thiersch procedure,4 had stricture at the anastomosis site or at the meatal stenosis , which were cured by a silastlic tube stent ( 1.5～5.0 months ). 1 had a mild penile curvature yet erection was satisfactory. Conclusions Preputial or scrotal island flap translocation should be the primary choice of secondary urethral reconstruction, whereas bladder mucosa graft is used in case of local skin deficiency.A secondary surgery should be performed by experceinced uro pediatric surgeons.