尿道下裂术后尿道狭窄的再手术方法及疗效分析
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摘要
目的探讨尿道下裂术后尿道狭窄的再手术方法及疗效。方法 2010年9月—2018年4月,对169例尿道下裂术后尿道狭窄经保守治疗无效患者行再手术处理。患者年龄1岁7个月～41岁,中位年龄5岁8个月。尿道外口狭窄80例、吻合口狭窄87例、新建尿道部位狭窄2例。尿道下裂术后2周～52个月出现尿道狭窄症状,中位时间4.5个月。尿道外口狭窄患者中,74例行外口成形术,6例行狭窄段切除尿道前移术;吻合口狭窄患者中,10例行尿道镜下冷刀切开,26例行狭窄段切除或切开并同期尿道重建,51例行狭窄段造瘘、其中43例12个月后完成二期尿道重建;新建尿道部位狭窄患者行外瘢痕松解术。结果术后154例患者获随访,随访时间6～86个月,平均47个月。其中,137例治疗后狭窄缓解;12例狭窄复发,4例出现尿瘘,均对症处理;1例残留轻度尿道憩室未行手术处理。结论尿道下裂术后尿道狭窄,如经保守治疗无效,可根据狭窄位置、长度、局部组织条件以及合并症等情况选择合适术式治疗。
Objective To discuss the reoperation methods of urethral stricture after urethroplasty of hypospadias and their effectiveness. Methods Between September 2010 and April 2018, 169 patients with urethral stricture after urethroplasty of hypospadias, who underwent ineffective conservative treatments first, were accepted. The age ranged from 1 year and 7 months to 41 years with a median age of 5 years and 8 months. The stricture located at the external urethral orifice in 80 cases, internal anastomosis connection in 87 cases, and constructed urethra in 2 cases. The symptoms of urethral stricture occurred at 2 weeks to 52 months after urethroplasty, with a median time of 4.5 months. The patients with external urethral orifice stenosis were treated with urethral meatus augmentation(74 cases) and urethral advancement(6 cases). The patients with internal anastomosis connection stenosis were treated with internal urethrotomy with urethroscopy(10 cases), urethrotomy and one-stage urethroplasty(26 cases), and urethrostomy(51 cases) including43 cases of two-stage urethroplasty. The patients with constructed urethral stricture were treated with urethrolysis. Results One hundred and fifty-four patients were followed up 6–86 months with an average of 47 months. The stenosis was relieved in 137 cases, and re-stenosis in 12 cases, urethral fistula in 4 cases, all of which were treated successfully. In addition, 1 case with mild urethral diverticulum did not need to be treated. Conclusion If it is ineffective for the conservative treatment of urethral stricture after urethroplasty of hypospadias, appropriate surgical treatments could be selected according to the location and length of the stricture, local tissue conditions, complications, and so on.
Objective To discuss the reoperation methods of urethral stricture after urethroplasty of hypospadias and their effectiveness. Methods Between September 2010 and April 2018, 169 patients with urethral stricture after urethroplasty of hypospadias, who underwent ineffective conservative treatments first, were accepted. The age ranged from 1 year and 7 months to 41 years with a median age of 5 years and 8 months. The stricture located at the external urethral orifice in 80 cases, internal anastomosis connection in 87 cases, and constructed urethra in 2 cases. The symptoms of urethral stricture occurred at 2 weeks to 52 months after urethroplasty, with a median time of 4.5 months. The patients with external urethral orifice stenosis were treated with urethral meatus augmentation(74 cases) and urethral advancement(6 cases). The patients with internal anastomosis connection stenosis were treated with internal urethrotomy with urethroscopy(10 cases), urethrotomy and one-stage urethroplasty(26 cases), and urethrostomy(51 cases) including43 cases of two-stage urethroplasty. The patients with constructed urethral stricture were treated with urethrolysis. Results One hundred and fifty-four patients were followed up 6–86 months with an average of 47 months. The stenosis was relieved in 137 cases, and re-stenosis in 12 cases, urethral fistula in 4 cases, all of which were treated successfully. In addition, 1 case with mild urethral diverticulum did not need to be treated. Conclusion If it is ineffective for the conservative treatment of urethral stricture after urethroplasty of hypospadias, appropriate surgical treatments could be selected according to the location and length of the stricture, local tissue conditions, complications, and so on.
引文
1 Macedo A Jr, Rondon A, Ortiz V. Hypospadias. Curr Opin Urol,2012, 22(6):447-452.
2 Myers JB, McAninch JW, Erickson BA, et al. Treatment of adults with complications from previous hypospadias surgery. J Urol,2012, 188(2):459-463.
3 Blaschko SD, McAninch JW, Myers JB, et al. Repeat urethroplasty after failed urethral reconstruction:outcome analysis of 130patients. J Urol, 2012, 188(6):2260-2264.
4田军,张潍平,孙宁,等.延长留置导尿管在减少尿道下裂术后尿道狭窄中的作用.中华小儿外科杂志,2014, 35(9):679-682.
5 Radojicic ZI, Perovic SV, Stojanoski KD. Calibration and dilatation with topical corticosteroid in the treatment of stenosis ofneourethral meatus after hypospadias repair. BJU Int, 2006, 97(1):166-168.
6唐耘熳.尿道下裂术后尿道狭窄、阴茎头裂开及尿道憩室的认识及处理.临床小儿外科杂志,2017,16(3):212-214.
7陈方.儿童尿道下裂术后尿道狭窄的预防和处理.中华实用儿科临床杂志,2017, 32(11):805-807.
8 Gargollo PC, Cai AW, Borer JG, et al. Management of recurrent urethral strictures after hypospadias repair:is there a role for repeat dilatation or endoscopic incision? J Pediatr Urol, 2011, 7(1):34-38.
9 Andersson M, Doroszkiewicz M, Arfwidsson C, et al. Normalized urinary flow at puberty after tubularized incised plate urethroplasty for hypospadias in childhood. J Urol, 2015, 194(5):1407-1413.
10 Osterberg EC, Gaither TW, Awad MA, et al. Current practice patterns among members of the American Urological Association for male genitourinary lichen sclerosus. Urology, 2016, 92(1):127-131.
11陈绍基.尿道下裂观念变迁及研究展望.临床小儿外科杂志,2012,11(2):81-83.
12 Huang Y, Xie H, Lv Y, et al. One-stage repair of proximal hypospadias with severe chordee by in situ tubularization of the transverse preputial island flap. J Pediatr Urol, 2017, 13(3):296-299.
13谢华,陈方,黄轶晨,等.包皮岛状皮瓣尿道板重建尿道成形术初步报告.中华小儿外科杂志,2014, 35(5):370-373.
14唐耘熳,王学军,毛宇,等.横行带蒂岛状包皮瓣尿道成形造瘘术分期矫治尿道下裂.中国修复重建外科杂志,2016, 30(5):594-598.
15 Keays MA, Starke N, Lee SC, et al. Patient reported outcomes in preoperative and postoperative patients with hypospadias. J Urol,2016,195(4 Pt 2):1215-1220.
16孙宁.关于提高尿道下裂手术技能的一些思考.临床小儿外科杂志,2018,17(8):561-563.
17韩文文,张潍平,孙宁,等.小儿泌尿外科医师尿道下裂学习曲线探讨.继续医学教育,2016, 30(3):51-52.
18 Ansari MS, Agarwal S, Sureka SK, et al. Impact of changing trends in technique and learning curve on outcome of hypospadias repair:An experience from tertiary care center. Indian J Urol, 2016, 32(3):216-220.
19唐耘熳,陈绍基.尿道下裂分期修复的再认识.中华实用儿科临床杂志,2016, 31(11):818-820.
20王永前,李森恺.尿道下裂术后尿道狭窄的尿流率特点.中国美容整形外科杂志,2014, 25(9):530-532.
21 Perera M, Jones B, O'Brien M, et al. Long-term urethral function measured by uroflowmetry after hypospadias surgery:comparison with an age matched control. J Urol, 2012, 188(4 Suppl):1457-1462.
2 Myers JB, McAninch JW, Erickson BA, et al. Treatment of adults with complications from previous hypospadias surgery. J Urol,2012, 188(2):459-463.
3 Blaschko SD, McAninch JW, Myers JB, et al. Repeat urethroplasty after failed urethral reconstruction:outcome analysis of 130patients. J Urol, 2012, 188(6):2260-2264.
4田军,张潍平,孙宁,等.延长留置导尿管在减少尿道下裂术后尿道狭窄中的作用.中华小儿外科杂志,2014, 35(9):679-682.
5 Radojicic ZI, Perovic SV, Stojanoski KD. Calibration and dilatation with topical corticosteroid in the treatment of stenosis ofneourethral meatus after hypospadias repair. BJU Int, 2006, 97(1):166-168.
6唐耘熳.尿道下裂术后尿道狭窄、阴茎头裂开及尿道憩室的认识及处理.临床小儿外科杂志,2017,16(3):212-214.
7陈方.儿童尿道下裂术后尿道狭窄的预防和处理.中华实用儿科临床杂志,2017, 32(11):805-807.
8 Gargollo PC, Cai AW, Borer JG, et al. Management of recurrent urethral strictures after hypospadias repair:is there a role for repeat dilatation or endoscopic incision? J Pediatr Urol, 2011, 7(1):34-38.
9 Andersson M, Doroszkiewicz M, Arfwidsson C, et al. Normalized urinary flow at puberty after tubularized incised plate urethroplasty for hypospadias in childhood. J Urol, 2015, 194(5):1407-1413.
10 Osterberg EC, Gaither TW, Awad MA, et al. Current practice patterns among members of the American Urological Association for male genitourinary lichen sclerosus. Urology, 2016, 92(1):127-131.
11陈绍基.尿道下裂观念变迁及研究展望.临床小儿外科杂志,2012,11(2):81-83.
12 Huang Y, Xie H, Lv Y, et al. One-stage repair of proximal hypospadias with severe chordee by in situ tubularization of the transverse preputial island flap. J Pediatr Urol, 2017, 13(3):296-299.
13谢华,陈方,黄轶晨,等.包皮岛状皮瓣尿道板重建尿道成形术初步报告.中华小儿外科杂志,2014, 35(5):370-373.
14唐耘熳,王学军,毛宇,等.横行带蒂岛状包皮瓣尿道成形造瘘术分期矫治尿道下裂.中国修复重建外科杂志,2016, 30(5):594-598.
15 Keays MA, Starke N, Lee SC, et al. Patient reported outcomes in preoperative and postoperative patients with hypospadias. J Urol,2016,195(4 Pt 2):1215-1220.
16孙宁.关于提高尿道下裂手术技能的一些思考.临床小儿外科杂志,2018,17(8):561-563.
17韩文文,张潍平,孙宁,等.小儿泌尿外科医师尿道下裂学习曲线探讨.继续医学教育,2016, 30(3):51-52.
18 Ansari MS, Agarwal S, Sureka SK, et al. Impact of changing trends in technique and learning curve on outcome of hypospadias repair:An experience from tertiary care center. Indian J Urol, 2016, 32(3):216-220.
19唐耘熳,陈绍基.尿道下裂分期修复的再认识.中华实用儿科临床杂志,2016, 31(11):818-820.
20王永前,李森恺.尿道下裂术后尿道狭窄的尿流率特点.中国美容整形外科杂志,2014, 25(9):530-532.
21 Perera M, Jones B, O'Brien M, et al. Long-term urethral function measured by uroflowmetry after hypospadias surgery:comparison with an age matched control. J Urol, 2012, 188(4 Suppl):1457-1462.