概述成功重建尿道下裂及陰莖彎曲手術技術
-彰化基督教醫院最近三十年的經驗分享
林介山1,2,3、江恆杰1、陳建廷1、王百孚1、周明智2
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
；彰化基督教兒童醫院3
An Overview of surgical Technique for Successful Reconstruction of Hypospadias and Chordee - Share the over 30 years experience of CCH
Jesun Lin 1,2,3, Herng-Jye Jiang 1, Jian Ting Chen 1, Bai-Fu Wang 1, and Ming-Chih Cho
1, Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua
2, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
3, Division of Pediatric Urology, Changhua Christian Children Hospital, Changhua
Purpose: Hypospadias is one of the most common congenital anomalies affect the male external genitalia. The incidence is about one in 250 male newborn. The surgical treatments are changed by the experiences and the repeating strategies of reconstructions decades ago. We would present our experience of pearls, tricks, and quirks of hypospadias and chordee surgery in the recent over 30 years.
Materials and Methods: This is a review article of our 1248 hypospadias patients between January1984 and January 2022. We performed one stage surgical reconstruction of these patients. The basic frames of reconstruction for hypospadias are: Mathieu technique, MAGPI( Meatoplasty and Glanuloplasty), TIP (Tubulized incised urethral Plate) and Island Flap. The basic frames of reconstruction for chordee are: chordectomy, orthoplasty, and dorsal plication. We preserved the best vascularized skin flap for a new urethra. Dartos flap was performed as new corpus spongiosum. We used double-tube for urethra stent and urine catheterization. MiniVac vacuum was inserted for drainage of subcutaneous hemorrhage. We follow up the outcome of surgical consequences from 6 months to more than ten years or to their adolescence for the possible events of complications.
Results: The number of redo-operations for their presenting problems ranged from 1 to 5 attempts. The successful surgery of the redo operation requires radical correction of all deformities of fistula, remaining chordee, and remaining hypospadias in the same procedure of reconstruction.
Conclusions: We have to correct them in a single stage preferably. we should be proficient with virtually all the existing methods of hypospadias and chordee reconstructions. We wish the technique and subsequent good results of individual method could be transferable to the successors.