The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft （LMG） after failed hypospadias repairs. Inclusion ...The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft （LMG） after failed hypospadias repairs. Inclusion criteria included a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of an oral mucosal graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair using the foreskin or a multistage repair urethroplasty. Between January 2008 and December 2012, 110 patients with failed hypospadias repairs were treated in our center. Of these patients, 56 underwent a one-stage onlay or inlay urethroplasty using LMG. The median age was 21.8 years （range： 4-45 years）. Of the 56 patients, one-stage onlay LMG urethroplasty was performed in 42 patients （group 1）, and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 14 （group 2）. The median LMG urethroplasty length was 5.6 ± 1.6 cm （range： 4-13 cm）. The mean follow-up was 34.7 months （range： 10-58 months）, and complications developed in 12 of 56 patients （21.4%）, including urethrocutaneous fistulas in 7 （6 in group 1, 1 in group 2） and neourethral strictures in 5 （4 in group 1, 1 in group 2）. The total success rate was 78.6%. Our survey suggests that one-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient＇s age.展开更多
Pelvic fracture urethral distraction defects(PFUDDs)are relatively infrequent in boys,and treatment for PFUDDs presents one of the most difficult problems in urological practice.Anastomotic urethroplasty is considered...Pelvic fracture urethral distraction defects(PFUDDs)are relatively infrequent in boys,and treatment for PFUDDs presents one of the most difficult problems in urological practice.Anastomotic urethroplasty is considered an ideal surgical procedure for PFUDDs in boys.However,various surgical approaches for anastomotic urethroplasty have been proposed,including a simple transperineal approach,a tran sperineal in tercorporal septal separati on approach,a tran sperineal in ferior pubic approach,and a combined transpubic・perineal approach.This study aims to determine which surgical approach is best for PFUDDs in boys.We retrospectively identified 22 boys with PFUDDs aged 2-14 years who underwent anastomotic urethroplasty via different approaches between January 2008 and December 2017.Follow-up was performed in all the 22 patients for 6-123(mean:52.0)months.Finally,20 of the 22 boys(90.9%)were successfully treated,including 1 of 2 patients treated with a simple transperineal approach,3 of 3 with a transperineal approach with intercorporal septal separation,14 of 15 with a transperineal inferior pubic approach,and 2 of 2 with a combined transpubic-perineal approach.Two patients had failed outcomes after the operation,and stenosis recurred.Based on the outcome of the 22 patients,we can draw a preliminary conclusion that most boys(20/22)can be treated with a transperineal inferior pubic approach or simpler procedures without the need of completely removing or incising the pubis.The combined transpubic-perineal approach can be used in cases of extremely long urethral distract defects.展开更多
文摘The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft （LMG） after failed hypospadias repairs. Inclusion criteria included a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of an oral mucosal graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair using the foreskin or a multistage repair urethroplasty. Between January 2008 and December 2012, 110 patients with failed hypospadias repairs were treated in our center. Of these patients, 56 underwent a one-stage onlay or inlay urethroplasty using LMG. The median age was 21.8 years （range： 4-45 years）. Of the 56 patients, one-stage onlay LMG urethroplasty was performed in 42 patients （group 1）, and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 14 （group 2）. The median LMG urethroplasty length was 5.6 ± 1.6 cm （range： 4-13 cm）. The mean follow-up was 34.7 months （range： 10-58 months）, and complications developed in 12 of 56 patients （21.4%）, including urethrocutaneous fistulas in 7 （6 in group 1, 1 in group 2） and neourethral strictures in 5 （4 in group 1, 1 in group 2）. The total success rate was 78.6%. Our survey suggests that one-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient＇s age.
文摘Pelvic fracture urethral distraction defects(PFUDDs)are relatively infrequent in boys,and treatment for PFUDDs presents one of the most difficult problems in urological practice.Anastomotic urethroplasty is considered an ideal surgical procedure for PFUDDs in boys.However,various surgical approaches for anastomotic urethroplasty have been proposed,including a simple transperineal approach,a tran sperineal in tercorporal septal separati on approach,a tran sperineal in ferior pubic approach,and a combined transpubic・perineal approach.This study aims to determine which surgical approach is best for PFUDDs in boys.We retrospectively identified 22 boys with PFUDDs aged 2-14 years who underwent anastomotic urethroplasty via different approaches between January 2008 and December 2017.Follow-up was performed in all the 22 patients for 6-123(mean:52.0)months.Finally,20 of the 22 boys(90.9%)were successfully treated,including 1 of 2 patients treated with a simple transperineal approach,3 of 3 with a transperineal approach with intercorporal septal separation,14 of 15 with a transperineal inferior pubic approach,and 2 of 2 with a combined transpubic-perineal approach.Two patients had failed outcomes after the operation,and stenosis recurred.Based on the outcome of the 22 patients,we can draw a preliminary conclusion that most boys(20/22)can be treated with a transperineal inferior pubic approach or simpler procedures without the need of completely removing or incising the pubis.The combined transpubic-perineal approach can be used in cases of extremely long urethral distract defects.
