Critical Outcome Analysis of Staged Buccal Mucosa Graft Urethroplasty for Prior Failed Hypospadias Repair in Children
Critical Outcome Analysis of Staged Buccal Mucosa Graft Urethroplasty for Prior Failed Hypospadias Repair in Children
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DOI：
10.1016/j.juro.2010.10.047
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发表时间：
2011-03-01
影响因子：
6.6
通讯作者：
Salle, Joao L. Pippi
中科院分区：
文献类型：
--
作者：
Leslie, Bruno;Lorenzo, Armando J.;Salle, Joao L. Pippi
目的：虽然分期颊粘膜移植尿道成形术是一种被广泛接受的挽救性尿道成形术，但很少有关于该手术用于儿童尿道下裂修复术的报道。 材料和方法：我们回顾了接受分期颊粘膜移植尿道成形术以重做尿道下裂修复术的患者。记录年龄、管状化前移植物的质量、开口位置、是否存在干燥性闭塞性龟头炎和并发症。结果：在 5 年期间，共有 30 名患者接受了 32 次修复。第一阶段的平均年龄为 7 岁（范围 1 至 17），阶段之间的平均间隔为 9.3 个月（5 至 13）。第二阶段后的平均随访时间为 25 个月（范围 10 至 46 个月）。第一阶段前，44% 的患者位于近端，39% 位于中轴，16% 位于远端。九名患者的活检证实患有干燥性闭塞性龟头炎。没有出现供体部位并发症。四名患者接受了重做移植手术。 32 例修复术中有 11 例（34%）发生第二阶段后的并发症，其中 5 例发生尿道狭窄，3 例发生尿道裂开，3 例发生尿道皮肤瘘。三分之一的患者在第一阶段后出现一定程度的移植物纤维化/硬结。与没有这些不利结果的患者（21 名患者中的 4 名，19%；p < 0.001）相比，这些患者在第二阶段更容易出现更多并发症（11 名患者中的 9 名，82%）。干燥性闭塞性龟头炎的存在和尿道口位置并不是与不良结果相关的显着因素。结论：分期颊粘膜移植尿道成形术是挽救性尿道成形术的合适技术。大约三分之一的患者出现第二阶段后的并发症，主要是那些移植物纤维化/硬化的患者。
Purpose: Although staged buccal mucosa graft urethroplasty is a well accepted technique for salvage urethroplasty, there are few reports on this procedure for redo hypospadias repair in children.Materials and Methods: We reviewed patients who underwent staged buccal mucosa graft urethroplasty for redo hypospadias repair. Age, quality of graft before tubularization, meatal position, presence of balanitis xerotica obliterans and complications were recorded.Results: A total of 30 patients underwent 32 repairs during a 5-year period. Mean age at first stage was 7 years (range 1 to 17) and mean interval between stages was 9.3 months (5 to 13). Mean followup after second stage was 25 months (range 10 to 46). Meatal position before first stage was proximal in 44% of patients, mid shaft in 39% and distal in 16%. Nine patients had biopsy proved balanitis xerotica obliterans. There were no donor site complications. Four patients underwent a redo grafting procedure. Complications after second stage occurred in 11 of 32 repairs (34%), consisting of urethral stenosis in 5, glanular dehiscence in 3 and urethrocutaneous fistula in 3. A third of the patients had some degree of graft fibrosis/induration after the first stage. These patients were prone to more complications at second stage (9 of 11, 82%), compared to patients without these unfavorable findings (4 of 21, 19%; p < 0.001). Presence of balanitis xerotica obliterans and meatal position were not significant factors associated with adverse outcomes.Conclusions: Staged buccal mucosa graft urethroplasty is a suitable technique for salvage urethroplasty. Complications after second stage were seen in approximately a third of patients, mainly those with fibrotic/indurated grafts.