Comparative analysis of treatment strategies for distal and middle hypospadias
Liu, Y1; Zhang, M1; Lu, M1; Jiang, X1; Ye, W1
1: , China
Objective: To investigate the effects of two different surgical methods on the urethral plate-preserving procedures in distal and middle hypospadias
Methods: The clinical data of 136 patients with distal and middle hypospadias were collected and retrospectively analyzed. All patients were treated with penile curvature and urethral plate-preserving urethroplasty or glansoplasty simultaneously. Patients aged from 8 months to 32 years, mean age 13.5 years. After 136 patents were performed with treatments of chordee, the external urethral orifice is located between the coronal sulcus and the root of the penis, about 3-8cm away from the glans posterior-anterior position. And then according to the type of urethroplasty, it was divided into two groups. A group: local flap method (including Onlay / Mathieu and other methods) to repair the urethra in 52 cases, B group: TIP (Tubularized incised plate) 84 cases. All patients then performed with glansoplasty, the new external urethral orifice were retrieved to the penis glans anteroposterior.
Results: All patients were successfully completed the operation. The average operation time was 86 minutes in group A and 67 minutes in group B. Postoperative follow-up of all patients ranges from 1 to 12 years. In group A, there were 5 cases of urinary fistula, 1 case of urethral stricture, 4 cases of wound dehiscence, 6 cases of urethral resuscitation. The overall complication rate was 13.46% (7/52); In Group B，there were 8 cases of urinary fistula, 2 cases of external orifice stricture, 5 cases of wound dehiscence, 1 case of urethral resuscitation. The complication rate was 11.90% (10/84).
Conclusion: There is no significant difference in the overall complication of the two surgical methods for urethral plate-preserving procedures in distal and middle hypospadias. Local flap operation requires a more advanced skill, more time, and a lower proportion of urinary fistula; However, the long-term effect of TIP is better. The shape of the new urethra is similar to the normal fissure shape and urinary stream return to normal. The retraction rate of urethral is very low. These two methods are applicable to the distal and middle hypospadias. The patients with urethral plate-preserved after a combine treatment of glansoplasty and correction of chordee can achieve an normal appearance just like the patients performed with circumcision.
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