Application of Inlay Preputial Graft Combined with Buck Fascia Integral Covering Technique in Hypospadias Repair
10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2021.0110
- VernacularTitle:游离包皮内板尿道板镶嵌联合Buck筋膜整体覆盖在尿道下裂手术中的应用
- Author:
Yin ZHANG
1
;
Min CHAO
2
;
Jia-bin JIANG
2
;
Ye ZHANG
2
;
Xiang FANG
2
;
Teng-yun LONG
2
;
Kai-ping ZHANG
2
;
Xian-sheng ZHANG
1
Author Information
1. Department of Urology， The First Affiliated Hospital of Anhui Medical University， Hefei 230022， China
2. Department of Urology， Anhui Provincial Children’s Hospital/ Anhui Branch of Children’s Hospital Affiliated to Fudan University， Hefei 230051 China
- Publication Type:Journal Article
- Keywords:
hypospadias;
free graft;
inlay;
buck fascia;
urethral dehiscence;
TIP
- From:
Journal of Sun Yat-sen University(Medical Sciences)
2021;42(3):400-405
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo investigate the practicability and efficacy of Inlay preputial graft urethroplasty combined with Buck fascia integral covering technique （Inlay-BFIC） in the treatment of hypospadias. MethodsA total of 85 surgeries of hypospadias with urethral plate width of 3-5mm at the level of the glans navicular fossa from January 2018 to August 2020 were retrospectively analyzed. The patients were divided into two groups according to the time of technique applied. Group A： from November 2018 to December 2020， 38 consecutive patients， including 5 re-operation cases， were operated with Inlay-BFIC urethroplasty. Surgical approach： a thin and full-thickness free preputial graft was embedded in the middle incision of the urethral plate when patients underwent TIP procedure； after the urethroplasty， the pre-reserved Buck fascia combined with glans wings was sutured at the midline as an intermediate layer to cover the neo-urethra. Group B： from January 2018 to December 2018， 47 consecutive primary hypospadias patients underwent conventional TIP procedure. The data of perioperative period and postoperative follow-up were recorded and analyzed statistically. ResultsTotally 85 patients were repaired by one-stage procedure. Group A with Inlay-BFIC vs. group B with conventional TIP： the mean age （39.46±34.66） vs.30.23±26.02） m， t=1.362， P=0.178， the mean length of penis （3.53±1.00） vs. （3.46±0.76） cm， t=0.373， P=0.710， the mean width of glans （1.32±0.36） cm vs. （1.37±0.22） cm， t=-0.779， P=0.438， the mean length of urethroplasty （2.10±0.68） vs.（1.92±0.61） cm， t=1.282， P=0.203. There was no significant difference between the two groups. The preoperative degree of ventral curvature and the mean operative time between group A and group B were （28.29±21.38） vs. （19.68±7.62）°， t=2.364， P=0.023 and （135.29±39.79） vs. （96.60±27.21） min， t=5.107， P=0.000. There was significant difference between the two groups. The postoperative follow-up time was 4 to 36 months. There were 2 cases of urinary fistula in Group A and 6 cases in Group B （χ2=1.387，P=0.239）， 1 cases of urethral stricture in Group A and 3 in Group B （χ2=0.659，P=0.417）. There was no significant difference between the two groups. There was no recurrent ventral curvature and urethral diverticulum in both groups. There were 4 cases of glans or urethral dehiscence in Group A and 17 cases in Group B （χ2=7.428，P=0.006）. There was significant difference between the two groups. Fifteen patients in each group received urinary flow rate test. There was no significant difference between two groups in maximum flow rate （Qmax）， average flow rate （Qavc）， flow time （FT） and voided volume （V）. ConclusionsFor the treatment of hypospadias by Buck fascia integral covering technique combined with Inlay preputial graft urethroplasty， the incidence of urinary fistula， urethral stricture， urethral diverticulum， residual penis curvature and postoperative urinary flow rate are similar to those of conventional TIP procedure， but it can significantly reduce the occurrence of glans or urethral dehiscence.
