PD2-4: The learing curve in hypospadias and chordee surgery
  • 2017-12-22,
  • 上傳者: TUA秘書處,
  •  0
林介山1, 2、江恆杰1、陳建廷1、王百孚1、張進寶1、嚴孟意1、黃勝賢1、石宏仁1
彰化基督教醫院 外科部 泌尿科1;中山醫學大學醫學研究所2
Jesun Lin1, 2 Herng-Jye Jiang1, Jian Ting Chen1, Bai-Fu Wang1, Chin-Pao Chang1, Mon-I Yen1, Sheng-Hsien Huang1, Hon-Jen Shi1, and Ming-Chih Chou2
1Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua
2Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
Purpose: The surgery of hypospadias and chordee is one of the most common and difficult procedures in pediatric urology. We would provide an insight into the “learning curve” of fellowship-trained pediatric urologists associated with reconstruction of hypospadias and chordee. I would present and share the experiences of learning the surgery in more than 30 years.
Materials and Methods: We evaluated the factors that may influence the results of surgery for hypospadias and chordee. We reviewed our experiences in the management of fresh and redo patients in order to understand and resolution of the presenting Problems.
It was a retrospective observational study. Patients with complete record available were included in the study. We reviewed the records of 118 redo-operations and 868 fresh hypospadias patients between January 1986 and December 2016. We underwent MAGPI and Mathieu's repairs for most patients who had penile or distal hypospadias, TIP (Tubularized Incised Plate) urethroplasty was performed for the middle and proximal types. Patients with severe chordee had Duckett Island flap urethroplasty(OIP) procedure. Patients having moderate or mild chordee were subjected to the orthoplasty and/or Nesbit Procedure. The presenting problems of failed hypospadias repair might be various in the same patient. The main problems to be (1) 86 urethrocutaneous fistulae, (2) 36 urethral strictures, (3) 15 meatal stenosis (4) 36 remaining chordee, (5) 14 diverticula and (6) 6 hairy urethra. The penile shaft and perineum fistulas were repaired with the “pants-over-vest¨ urethroplasty modified to the procedure of Turner-Warwick. We wrapped Dorsal dartos or subcutaneous flap to cover the neourethra for preventing urethrocutaneous fistula. We performed double-tube stent for stent and drainage. We used Mini-Vac vacuum drain in subcutaneous layer for prevention of hematoma and infection.
Results: The over all successful rate for urethrocutaneous fistula including perineal, scrotal, penile shaft and coronal regions is 76%. The successful rate for urethral strictures is 82%, for meatal stenosis is 70%, for chordee is about 70%, for diverticula is about 85%, for the hairy urethra is about 70%. We followed up the outcome of consequent surgery from 6 months to more than ten years. The number of redo-operations ranged from 1 to 8 attempts.
Conclusions: We have to correct them in a single stage preferably at least 3 months after previous repair. In redoing this reconstruction, we should be conversant with all the existing methods for hypospadias and chordee repair and be able to apply them appropriately.
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    2017-12-22 16:43:29
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