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、

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

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 Chou 2

1 Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

2 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

 

We reviewed our 33 years experience in the management of hypospadias , chordee and their complications after reconstruction in order to understand their presenting Problems. We would recommend the factors of successful techniques for this congenital disease of penis.

We reviewed the records of 998 hypospadias and chordee patients between January 1981 and December 2014. The complications after reconstruction might be single or combined with several presenting problems in the same patient. This article represents a collection of recommendations, technical nuances, and innovative management techniques that have been found to contribute to the success of hypospadias and chordee surgery. We would classify the main problems of complications to be (1) 89 urethrocutaneous fistulae, (2) 36 urethral strictures, (3) 15 meatal stenosis (4) 38 remaining chordee, (5) 14 diverticula and (6) 6 hairy urethra. The penile shaft and perineum fistulae were repaired with the “pants-over-vest¨ urethroplasty modified to the procedure of Turner-Warwick. The coronal fistulas were converted into repair for coronal hypospadias. The remaining urethral plate was tubularized with or without a relaxing midline incision (Reddy-Snodgrass). We wrapped dorsal dartos or subcutaneous flap to cover the neourethra for preventing urethrocutaneous fistula. The meatal stenosis was performed with dorsal meatotomy, Y-V glans flap, meatal skin graft and transverse meatotomy. Residual chordee were performed with dorsal plication, excision the chordee, the urethral diverticula were excised and tailored for redo-urethroplasty. Hairy urethra were resected and then urethroplasty. We performed double-tube stent and vacuum drain in subcutaneous layer for prevention of bladder spasm, hematoma and infection.

The over all successful rate is 85% in one stage surgery for the fresh cases. The number of redo-operations for their presenting problems of complications ranged from 1 to 8 attempts. The successful rate for urethrocutaneous fistula is 76%, 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 successful surgery of the hypospadias, chordee redo operation for them requires radical correction of all deformities. It is true that“Experience is by far the best teacher. It might be said that unless the technique and subsequent good results of an individual method are transferable to others, the technique as taught is suspect”said by Dr. John W. Duckett.