膀胱尿道镜检术诊治重度尿道下裂合并前列腺囊的单中心临床研究
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摘要
目的探讨膀胱尿道镜检术在重度尿道下裂合并前列腺囊诊治中的必要性和临床经验。方法回顾性分析本院收治的47例重型尿道下裂合并前列腺囊患者临床资料,年龄1.2~15岁,平均年龄2.8岁。其中尿道开口于阴茎阴囊交界处18例,开口于阴囊15例,开口于会阴部14例。47例均于尿道成形术前行膀胱尿道镜检术,其中3例行前列腺囊切除术。记录所有患者的临床资料,包括B超检查、影像学检查以及膀胱尿道镜检查结果,并进行分析。结果 47例重型尿道下裂患者通过膀胱尿道镜观察到前列腺囊大小不一,长度0.3~3.6 cm,以会阴型的前列腺囊长度最长。通过B超发现前列腺囊31例(59.5%),通过VCUG发现前列腺囊3例(6.4%)。临床表现为反复尿路感染、附睾睾丸炎4例(8.5%),其中3例行腹腔镜下膀胱镜辅助前列腺囊切除术,术后随访临床症状消失,1例拒绝手术,随访中仍存在反复感染症状。结论膀胱尿道镜检术能准确发现尿道下裂患者的前列腺囊,并能测量前列腺囊的大小、位置。在前列腺囊切除术中,膀胱尿道镜辅助腹腔镜操作,能准确显示前列腺囊的位置,有助于精准完整地切除前列腺囊。
Objective To explore the necessity and application of cystourethroscopy in the diagnosis and treatment of hypospadias with prostatic utricle. Methods A total of 47 patients of severe hypospadias with prostatic utricle were recruited. The average age was 2. 8( 1. 2 ~ 15) years. The locations of urethral orifice were at the junction of penis & scrotum( n = 18),scrotum( n = 15) and perineum( n = 14). Prior to urethroplasty,cystourethroscopic examination was performed. Three of them underwent cystoscopic-assisted laparoscopic excision of prostatic utricle. Clinical data and results of ultrasound,imaging examinations and cystourethroscopic examination were recorded. Results Under cystourethroscope,the sizes of prostatic utricle varied greatly. The length was 0. 3 ~ 3. 6 cm and the length of perineum was the longest. Among them,31 cases of prostatic utricle were detected by ultrasound( 59. 5%). Three patients( 6. 4%) had prostatic utricle on voiding cystourethrography( VCUG). Among 4 patients( 8. 5%) with epididymitis,3 underwent cystoscopic-assisted laparoscopic excision of prostatic utricle and the symptoms disappeared during postoperative follow-ups. One case refused surgery and developed recurrent infection. Conclusion Cystourethroscopy may detect prostatic utricle in patients with hypospadias and it can measure the size and location of prostatic utricle while other examinations tend to miss its diagnosis. During cystoscopic-assisted laparoscopic excision of prostatic utricle,cystourethroscopic assistance may facilitate counter-traction movements and accurate dissections.
Objective To explore the necessity and application of cystourethroscopy in the diagnosis and treatment of hypospadias with prostatic utricle. Methods A total of 47 patients of severe hypospadias with prostatic utricle were recruited. The average age was 2. 8( 1. 2 ~ 15) years. The locations of urethral orifice were at the junction of penis & scrotum( n = 18),scrotum( n = 15) and perineum( n = 14). Prior to urethroplasty,cystourethroscopic examination was performed. Three of them underwent cystoscopic-assisted laparoscopic excision of prostatic utricle. Clinical data and results of ultrasound,imaging examinations and cystourethroscopic examination were recorded. Results Under cystourethroscope,the sizes of prostatic utricle varied greatly. The length was 0. 3 ~ 3. 6 cm and the length of perineum was the longest. Among them,31 cases of prostatic utricle were detected by ultrasound( 59. 5%). Three patients( 6. 4%) had prostatic utricle on voiding cystourethrography( VCUG). Among 4 patients( 8. 5%) with epididymitis,3 underwent cystoscopic-assisted laparoscopic excision of prostatic utricle and the symptoms disappeared during postoperative follow-ups. One case refused surgery and developed recurrent infection. Conclusion Cystourethroscopy may detect prostatic utricle in patients with hypospadias and it can measure the size and location of prostatic utricle while other examinations tend to miss its diagnosis. During cystoscopic-assisted laparoscopic excision of prostatic utricle,cystourethroscopic assistance may facilitate counter-traction movements and accurate dissections.
引文
1 Priyadarshi V,Singh JP,Mishra S,et al.Prostatic utricle cyst:a clinical dilemma[J].APSP J Case Rep,2013,4(2):16.
2 Hester AG,Kogan SJ.The prostatic utricle:An under-recognized condition resulting in significant morbidity in boys with both hypospadias and normal external genitalia[J].J Pediatr Urol,2017,13(5):492.e1-492.e5.DOI:10.1016/j.jpurol.2017.01.019.
3 Howard FS.Hypospadias with enlargement of the prostatic utricle[J].Surg Gynecol Obstet,1948,86:307-316.
4 Cifti AO,Senocak ME,Büyükpamuku N,et al.Abnormal prostatic utricle configuration in hypospadias and intersex patients[J].Eur J Pediatr Surg,1999,9(3):167-172.
5 Wongprasert H,Somanunt S,De Filippo R,et al.A novel mutation of anti-Mullerian hormone gene in Persistent Mullerian Duct Syndrome presented with bilateral cryptorchidism:a case report[J].J Pediatr Urol,2013,9(4):e147-149.DOI:10.1016/j.jpurol.2013.03.004.
6 Goruppi I,Avolio L,Romano P,et al.Robotic-assisted surgery for excision of an enlarged prostatic utricle[J].Int JSurg Case Rep,2015,10:94-96.DOI:10.1016/j.ijscr.2015.03.024.
7 Johnson D,Parikh K,Schey W,et al.MRI in diagnosis of a giant prostatic utricle[J].Case Rep Radiol,2014,2014:217563.DOI:10.1155/2014/217563.
8 Kojima Y,Hayashi Y,Maruyama T,et al.Comparison between ultrasonography and retrograde urethrography for detection of prostatic utricle associated with hypospadias[J].Urology,2001,57(6):1151-1155.
9 Baldisserotto M,Lorenzoni C.Perineal US in the diagnosis of a prostatic utricle cyst in an infant[J].Pediatr Radiol,2009,39(12):1373-1375.DOI:10.1007/s00247-009-1414-3.
10刘静,赵夭望.儿童上尿路结石内镜治疗进展[J].临床小儿外科杂志,2015,14(6):540-542.DOI:10.3969/j.issn.1671-6353.2015.06.024.Liu J,Zhao YW.Progress of endoscopic treatment of upper urinary calculi in children[J].Journal of Clinical Pediatric Surgery,2015,14(6):540-542.DOI:10.3969/j.issn.1671-6353.2015.06.024.
11 Ikoma F,Shima H,Yabumoto H.Classification of enlarged prostatic utricle in patients with hypospadias[J].Br J Urol,1985,57(3):334-337.
12 Mostafa IA,Woodward MN,Shalaby MS.Cystoscopic-assisted laparoscopic excision of prostatic utricle[J].J Pediatr Urol,2018,14(1):77-78.DOI:10.1016/j.jpurol.2017.09.024.
13 Meisheri IV,Motiwale SS,Sawant VV.Surgical management of enlarged prostatic utricle[J].Pediatr Surg Int,2000,16(3):199-203.DOI:10.1007/s003830050722.
14 Jia W,Liu GC,Zhang LY,et al.Comparison of laparoscopic excision versus open transvesical excision for symptomatic prostatic utricle in children[J].J Pediatr Surg,2016,51(10):1597-1601.DOI:10.1016/j.jpedsurg.2016.06.004.
15 Willetts IE,Roberts JP,Mac Kinnon AE.Laparoscopic excision of a prostatic utricle in a child[J].Pediatr Surg Int,2003,19(7):557-558.DOI:10.1007/s00383-003-0993-6.
16杨洋,张潍平,孙宁,等.腹腔镜技术在小儿尿道下裂合并前列腺囊治疗中的应用[J].中华小儿外科杂志,2017,38(6):420-423.DOI:10.3760/cma.j.issn.0253-3006.2017.06.006.Yang Y,Zhang WP,Sun N,et al.Application of laparoscopic technique in prostatic utricle associated with hypospadias in children[J].Chin J Pediatr Surg,2017,38(6):420-423.DOI:10.3760/cma.j.issn.0253-3006.2017.06.006.
17 Kumar V,Punatar C,Jadhav K,et al.Accidental cystectomy during laparoscopic excision of prostatic utricle cyst:a rare complication[J].Int Braz J Urol,2018,44.DOI:10.1590/S1677-5538.IBJU.2017.0284.
2 Hester AG,Kogan SJ.The prostatic utricle:An under-recognized condition resulting in significant morbidity in boys with both hypospadias and normal external genitalia[J].J Pediatr Urol,2017,13(5):492.e1-492.e5.DOI:10.1016/j.jpurol.2017.01.019.
3 Howard FS.Hypospadias with enlargement of the prostatic utricle[J].Surg Gynecol Obstet,1948,86:307-316.
4 Cifti AO,Senocak ME,Büyükpamuku N,et al.Abnormal prostatic utricle configuration in hypospadias and intersex patients[J].Eur J Pediatr Surg,1999,9(3):167-172.
5 Wongprasert H,Somanunt S,De Filippo R,et al.A novel mutation of anti-Mullerian hormone gene in Persistent Mullerian Duct Syndrome presented with bilateral cryptorchidism:a case report[J].J Pediatr Urol,2013,9(4):e147-149.DOI:10.1016/j.jpurol.2013.03.004.
6 Goruppi I,Avolio L,Romano P,et al.Robotic-assisted surgery for excision of an enlarged prostatic utricle[J].Int JSurg Case Rep,2015,10:94-96.DOI:10.1016/j.ijscr.2015.03.024.
7 Johnson D,Parikh K,Schey W,et al.MRI in diagnosis of a giant prostatic utricle[J].Case Rep Radiol,2014,2014:217563.DOI:10.1155/2014/217563.
8 Kojima Y,Hayashi Y,Maruyama T,et al.Comparison between ultrasonography and retrograde urethrography for detection of prostatic utricle associated with hypospadias[J].Urology,2001,57(6):1151-1155.
9 Baldisserotto M,Lorenzoni C.Perineal US in the diagnosis of a prostatic utricle cyst in an infant[J].Pediatr Radiol,2009,39(12):1373-1375.DOI:10.1007/s00247-009-1414-3.
10刘静,赵夭望.儿童上尿路结石内镜治疗进展[J].临床小儿外科杂志,2015,14(6):540-542.DOI:10.3969/j.issn.1671-6353.2015.06.024.Liu J,Zhao YW.Progress of endoscopic treatment of upper urinary calculi in children[J].Journal of Clinical Pediatric Surgery,2015,14(6):540-542.DOI:10.3969/j.issn.1671-6353.2015.06.024.
11 Ikoma F,Shima H,Yabumoto H.Classification of enlarged prostatic utricle in patients with hypospadias[J].Br J Urol,1985,57(3):334-337.
12 Mostafa IA,Woodward MN,Shalaby MS.Cystoscopic-assisted laparoscopic excision of prostatic utricle[J].J Pediatr Urol,2018,14(1):77-78.DOI:10.1016/j.jpurol.2017.09.024.
13 Meisheri IV,Motiwale SS,Sawant VV.Surgical management of enlarged prostatic utricle[J].Pediatr Surg Int,2000,16(3):199-203.DOI:10.1007/s003830050722.
14 Jia W,Liu GC,Zhang LY,et al.Comparison of laparoscopic excision versus open transvesical excision for symptomatic prostatic utricle in children[J].J Pediatr Surg,2016,51(10):1597-1601.DOI:10.1016/j.jpedsurg.2016.06.004.
15 Willetts IE,Roberts JP,Mac Kinnon AE.Laparoscopic excision of a prostatic utricle in a child[J].Pediatr Surg Int,2003,19(7):557-558.DOI:10.1007/s00383-003-0993-6.
16杨洋,张潍平,孙宁,等.腹腔镜技术在小儿尿道下裂合并前列腺囊治疗中的应用[J].中华小儿外科杂志,2017,38(6):420-423.DOI:10.3760/cma.j.issn.0253-3006.2017.06.006.Yang Y,Zhang WP,Sun N,et al.Application of laparoscopic technique in prostatic utricle associated with hypospadias in children[J].Chin J Pediatr Surg,2017,38(6):420-423.DOI:10.3760/cma.j.issn.0253-3006.2017.06.006.
17 Kumar V,Punatar C,Jadhav K,et al.Accidental cystectomy during laparoscopic excision of prostatic utricle cyst:a rare complication[J].Int Braz J Urol,2018,44.DOI:10.1590/S1677-5538.IBJU.2017.0284.