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首页> 外文期刊>Advances in Surgical Sciences >Paediatric Redo Urethroplasty for Hypospadias: A Comparative Evaluation
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Paediatric Redo Urethroplasty for Hypospadias: A Comparative Evaluation

机译：腹盆多地下症儿科重做尿道术：比较评估

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Introduction: The burden of a failed hypospadias repair can be devastating for a patient and his family. Urethrocutaneous fistula after hypospadias surgery is the most common complication and remains a frustrating problem that precludes the goal of hypospadias surgery leading to failure of primary surgery. Aim of the Study: The aim of this study was to assess the outcome of pediatric salvage urethroplasty for hypospadias and to compare among three procedures. Material & Methods: It was an interventional study which was carried out from July 2011 to June, 2016 in the Department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh. The study was designed with randomized control trial. Simple Random sampling technique was followed to select groups for each sample by means of lottery. BM GRAFT (Buccal Mucosal Graft) was grouped as group A, DORSAL FLAP (Dorsal transposition flap) was grouped as group B, FLIP FLAP (Distally based flip-flap) was grouped as group C. The primary outcome measure was the evaluation of the recurrence of fistula among the surgical procedures. For a valid comparison of the outcomes of traditional and innovative surgical procedures patients were evaluated by objective scoring system. Informed consent was obtained from parents in the consent form. Collected data was arranged in systemic manner, presented in various tables and figures and statistical analysis was made to evaluate the objectives of this study with the help of SPSS. Results: The age range of the studied patients were started from 2 to 13 years and was divided into three age groups such as 2-5 years, 6-9 years and 10-13 years. Out of total 189 patient's BM graft consisted 61 patients, Dorsal flap comprised 69 patients and Flip flap patient consisted 59 patients. The distribution patterns of prior types of surgeries were presented, which showed that among the preceding primary procedures Tubularized incised plate urethroplasty (TIP) demonstrated highest frequency. The differences of re-fistula rate in primary surgery were significantly less in Buccal Mucosal Graft group (group A) in comparison to Distally based flip-flap group (group C) and Dorsal transposition flap group (group B), at p0.05. It was observed that the fistula recurrence frequency of secondary surgery was higher than primary surgery among the three tested redo urethroplasty groups. Duncan multiple range test (DMRT) revealed that refistula was higher at the sub- coronal area than other locations in case of flip-flap (46.66%) and BM groups (42.85%). Conclusion: Staged repair using buccal mucosa was a better option for urethral reconstruction in large (4mm) or multiple -small (4mm) fistulae, than dorsal transposition flap and flip flap procedures (group A group B group C).
机译：介绍：失败的软盆地修复的负担可以为病人和家人造成毁灭性。尿道神经血吸虫瘘是最常见的并发症，仍然是一个令人沮丧的问题，妨碍了腹期期疾病的目标导致初级手术失败。该研究的目的：本研究的目的是评估儿科救生尿道成形术的结果，用于腹盆间隙，并在三个程序中进行比较。材料和方法：它是一项介入研究，该研究是从2011年7月至2016年6月在孟加拉国rajshahi rajshahi医院医院的儿科手术部门进行的。该研究设计有随机控制试验。遵循简单的随机采样技术，通过彩票选择每个样本的组。将BM移植物（颊粘膜移植物）分组为A组，将背侧瓣（背部转子瓣）分组为B组，将翻盖（基于远端的叉形）分组为C组。主要结果措施是评价外科手术中瘘的复发。对于有效的比较，通过客观评分系统评估了传统和创新的外科手术程序的结果。以同意书的父母获得知情同意书。收集的数据以系统方式排列，呈现在各种表格和数据中，并在SPSS的帮助下评估本研究的目标。结果：学习患者的年龄范围从2〜13年开始，分为三年龄段，如2-5岁，6-9岁和10-13岁。除了189例患者的BM移植术中，组成61名患者，背部皮瓣组成69名患者，翻转皮瓣患者组成59名患者。提出了先前类型的手术的分布模式，表明前一程水管状切割板尿道成形术（尖端）显示出最高频率。与远沿基于折叠组（C）和背部转子瓣组（B组）相比，P <0.05的脑粘膜移植基团（A组）相比，脑膜粘膜移植基团（A组）中，初级手术中重新瘘管率的差异显着较低。观察到，继发手术的瘘管复发频率高于三个测试的重做尿道术组中的初级手术。 Duncan多个范围试验（DMRT）显示，在触发器（46.66％）和BM组（42.85％）的情况下，子冠状区的归晶区域高于其他位置。结论：使用颊粘膜的分阶段修复是大（> 4mm）或多个-small（<4mm）瘘管的尿道重建的更好选择，而不是背部转位瓣和翻转翼片程序（A组> B组C组）。

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