Urethrocutaneous fistula may complicate hypospadias repair.We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula.The aim...Urethrocutaneous fistula may complicate hypospadias repair.We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula.The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula.A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital(Amman,Jordan).Boys who were aged between 6 months and 5 years,diagnosed with distal hypospadias,and not circumcised were included.The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap.The results showed a total of 163 boys with distal hypospadias;among them,116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap,and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap.The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month,6 months,and 12 months(6.9%vs 0,10.3%vs 0,and 5.2%vs 0,respectively),and the difference after 6 months was statistically significant(P=0.02).展开更多
Repairing glans dehiscence after failed hypospadias repair is challenging for pediatric surgeons.Here,we introduced and evaluated a newly modified Mathieu technique,Mathieu combined tunnel(MCT),which involves multiple...Repairing glans dehiscence after failed hypospadias repair is challenging for pediatric surgeons.Here,we introduced and evaluated a newly modified Mathieu technique,Mathieu combined tunnel(MCT),which involves multiple custom-designed flaps for the shortage of flap source material after repeated operations;we also constructed a tunnel to avoid the glans incision that may carry new risks of dehiscence.This retrospective study included 26 patients who were consecutively admitted to the First Affiliated Hospital of Sun Yat-Sen University(Guangzhou,China)for glans dehiscence repair after failed hypospadias repair from October 2014 to October 2020;sixteen patients underwent surgery using the MCT(MCT group)and ten patients underwent surgery using the tubularized incised plate(TIP)technique(TIP group).The operative time,blood loss,postoperative complications,normal urethral meatus rate,success rate,and Hypospadias Objective Penile Evaluation(HOPE)score were compared between the two groups.The MCT group achieved an overall satisfactory penile appearance and voiding function,with a higher rate of normal urethral meatus(15/16,93.8%)and a lower rate of glans dehiscence(1/16,6.2%),compared with the TIP group(70.0%and 30.0%,respectively).However,these differences were not statistically significant,possibly because of the limited number of patients(all P>0.05).Mean postoperative HOPE scores were similar in the MCT group(mean±standard deviation:8.83±0.89)and TIP group(8.94±0.57)(P>0.05).No significant differences were found between the two groups in terms of blood loss and success rate,nor in the rates of various complications(e.g.,fistula,urethral stricture,and glans dehiscence).In conclusion,the MCT technique appears to be feasible and reliable for repairing glans dehiscence after failed hypospadias repair.展开更多
文摘Urethrocutaneous fistula may complicate hypospadias repair.We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula.The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula.A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital(Amman,Jordan).Boys who were aged between 6 months and 5 years,diagnosed with distal hypospadias,and not circumcised were included.The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap.The results showed a total of 163 boys with distal hypospadias;among them,116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap,and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap.The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month,6 months,and 12 months(6.9%vs 0,10.3%vs 0,and 5.2%vs 0,respectively),and the difference after 6 months was statistically significant(P=0.02).
基金supported by grants from the National Natural Science Foundation of China(No.81971314)。
文摘Repairing glans dehiscence after failed hypospadias repair is challenging for pediatric surgeons.Here,we introduced and evaluated a newly modified Mathieu technique,Mathieu combined tunnel(MCT),which involves multiple custom-designed flaps for the shortage of flap source material after repeated operations;we also constructed a tunnel to avoid the glans incision that may carry new risks of dehiscence.This retrospective study included 26 patients who were consecutively admitted to the First Affiliated Hospital of Sun Yat-Sen University(Guangzhou,China)for glans dehiscence repair after failed hypospadias repair from October 2014 to October 2020;sixteen patients underwent surgery using the MCT(MCT group)and ten patients underwent surgery using the tubularized incised plate(TIP)technique(TIP group).The operative time,blood loss,postoperative complications,normal urethral meatus rate,success rate,and Hypospadias Objective Penile Evaluation(HOPE)score were compared between the two groups.The MCT group achieved an overall satisfactory penile appearance and voiding function,with a higher rate of normal urethral meatus(15/16,93.8%)and a lower rate of glans dehiscence(1/16,6.2%),compared with the TIP group(70.0%and 30.0%,respectively).However,these differences were not statistically significant,possibly because of the limited number of patients(all P>0.05).Mean postoperative HOPE scores were similar in the MCT group(mean±standard deviation:8.83±0.89)and TIP group(8.94±0.57)(P>0.05).No significant differences were found between the two groups in terms of blood loss and success rate,nor in the rates of various complications(e.g.,fistula,urethral stricture,and glans dehiscence).In conclusion,the MCT technique appears to be feasible and reliable for repairing glans dehiscence after failed hypospadias repair.
