Impact of patient age on distal hypospadias repair: A surgical perspective
Impact of patient age on distal hypospadias repair: A surgical perspective
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DOI：
10.1016/j.urology.2006.03.079
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发表时间：
2006-09-01
期刊：
影响因子：
2.1
通讯作者：
Tarry, William F.
中科院分区：
文献类型：
--
作者：
Perlmutter, Adam E.;Morabito, Rocco;Tarry, William F.
目标。目的探讨初次行尿道下裂修复术的年龄是否影响尿道下裂修复术的并发症发生率。我们回顾了325例连续接受初次尿道下裂修复的患者的记录。腺状和冠状尿道下裂的患者采用肉成形术和腺状成形术或龟头近似术进行修复。冠状下尿道下裂及阴茎尿道下裂行管状切开钢板尿道成形术。将患者分为6个月年龄组，采用卡方检验分析各年龄组并发症发生率。1999年1月至2005年1月，同一位外科医生共进行了325例尿道下裂修复手术。在325例病例中，194例进行了管状切开钢板手术，69例进行了肉糜成形术和龟头成形术，53例进行了龟头近似手术。9例经管状岛状皮瓣尿道成形术治疗阴囊尿道下裂的病例被排除，因为我们没有进行大量的近端尿道成形术。19例（6.0%）出现尿道瘘，6例（1.9%）出现裂口。总的来说，2例（2.2%）在6个月以内接受手术修复的患者出现并发症，而23例（10.3%）在6个月以上接受首次尿道下裂修复的患者（P = 0.006）。在适当选择的患者中，管状切开钢板、肉糜成形术和腺体成形术以及龟头近似尿道成形术都是尿道下裂手术矫正的良好选择。我们的研究结果表明，当患者在4至6个月大时进行尿道下裂修复时，并发症最少。
Objectives. To assess whether the age at which the initial hypospadias repair is performed influences the complication rate of hypospadias repair.Methods. The records of 325 consecutive patients who underwent initial hypospadias repair were reviewed. The patients with glanular and coronal hypospadias underwent repair with either meatoplasty and glanuloplasty or a glans approximation procedure. Patients with subcoronal hypospadias and penile hypospadias underwent repair with tubularized incised plate urethroplasty. The patients were divided into 6-month age groups, and the complication rates were analyzed by age group using the chi-square test.Results. A total of 325 hypospadias repairs were performed from January 1999 to January 2005 by a single surgeon. Of the 325 cases, 194 tubularized incised plate procedures were performed, 69 meatoplasty and glanuloplasty procedures were performed, and 53 glans approximation procedures were performed. Nine tubularized island flap urethroplasties performed for penoscrotal hypospadias were excluded because we did not perform a significant number of proximal urethroplasties. Nineteen patients (6.0%) developed urethrocutaneous fistulas and six (1.9%) demonstrated dehiscence. Overall, 2 patients (2.2%) who underwent surgical repair within the first 6 months of age developed complications compared with 23 patients (10.3%) who underwent initial hypospadias repair when they were older than 6 months of age (P = 0.006).Conclusions. Tubularized incised plate, meatoplasty and glanuloplasty, and glans approximation urethroplasty are all excellent options for the surgical correction of hypospadias in the appropriately selected patient. The results of our study have indicated that complications are minimized when hypospadias repair is performed when the patient is 4 to 6 months of age.