The comparison of results of our surgical techniques in the hypospadias treatment; a retrospective study

Yıl 2013, Cilt: 40 Sayı: 2, 269 - 274, 01.06.2013

Hikmet Zeytun Murat Yiğiter Ahmet Bedii Salman

https://doi.org/10.5798/diclemedj.0921.2013.02.0268

Öz

Objectives: The aim of this study was to investigate the results of hypospadias surgery. Methods: In this study the results of 87 patients who underwent hypospadias repair surgery between 2005 and 2010 were evaluated retrospectly. Results: 21 patients; Meatal Advancement and Glanuloplasty (MAGPI), 33 patients; Tubularized Incised Plate Urethroplasty (TIPU), 21 patients; Parameatal Based Flap (Mathieu), 6 patients; Mathieu and Incision Sutured (MAVIS) and the other 6 patients were operated via Transvers Tubularized Preputial Island Flap (TTPIF). To prevent fistula formation double layer dartos flap (DLDF) was applied to all patients to whom MAVIS had been applied and to 27 of the patients to whom TIPU had been applied, and tunica vaginalis flap over neourethra was placed to the patients to whom TTPIF was applied. While fistula was not seen in the patients to whom flap was used, it was seen that the urethrocutaneous fistula ratio was high in the patients without flap uses. Conclusions: TIPU is a kind of method which can be easily applied and preferred regardless of localization of urethral meatus. A barrier layer placed between skin and neourethra to prevent fistula formation significantly decreases the fistula ratio. Preputial dartos flap is a good preference, But tunica vaginalis must be kept in mind as an alternative to this flap in the patients who underwent urethroplasty with preputial dartos flap or who had circumflex before. TTPIF can be used as an alternative method to TIPU method in patients with more proximal localized hypospadias, especially if the urethral plate was exiced because of chordee and it is successful when combined with tunica vaginalis flap.

Anahtar Kelimeler

Hypospadias, urocutaneous fistula, flap

Hipospadias tedavisinde uygulanan cerrahi tekniklerin retrospektif karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı hipospadias cerrahisi uygulanan hastaların tedavi sonuçlarını incelmektir. Yöntemler: Bu çalışmada, 2005 ve 2010 tarihleri arasında hipospadias onarımı geçiren 87 hastanın sonuçları geriye dönük olarak incelendi. Bulgular: 21 hasta; Meatal Advancement and Glanuloplasty (MAGPI), 33 hasta; Tubularized Incised Plate Urethroplasty (TIPU), 21 hasta; Parameatal Based Flap (Mathieu), 6 hasta; Mathieu and Incision Sutured (MAVIS) ve kalan 6 hasta ise Transvers Tubularized Preputial Island Flap (TTPIF) yöntemi ile opere edildi. Fistül oluşumunu engellenmek amacı ile MAVIS yöntemi uygulanan hastaların tamamına, TIPU yöntemi uygulanan hastaların 27\'sine çift tabaka dartos flebi (ÇDF) ve TTPIF yöntemi uygulananların tamamına neoüretra üzerine tunika vaginalis flebi(TVF) yerleştirildi. Flep kullanılan hastalarda hiç fistül gözlenmezken, kullanılmayanlarda ürokütanöz fistül oranlarının yüksek olduğu görüldü. Sonuç: TIPU, uygulaması kolay ve üretral meanın lokalizasyonuna bakılmaksızın tercih edilebilecek bir yöntemidir. Fistül oluşumunun önlenmesinde neoüretra ile cilt arasına koyulan bir bariyer tabaka, fistül oranını anlamlı şekilde düşürmektedir. Prepüsiyal dartos flebi iyi bir tercihtir. Ancak üretroplasti için prepüsiyel dartos flebinin kullanıldığı veya evvelce sünnet olmuş hastalarda tunika vajinalis bu flebin alternatifi olarak akılda tutulmalıdır. Daha proksimal hipospadias vakalarında özellikle kordi nedeni ile üretral plağı eksize edilenlerde TTPIF yöntemi, TIPU yöntemine alternatif olarak kullanılabilen ve TVF ile kombine edildiğinde fistül oranları açısından başarılı bir tekniktir.

Anahtar Kelimeler

Hipospadias, ürokütanöz fistül, flep

Kaynakça

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