To Cultivate Neourethra of Autologous for Proximal Hypospadias Repair of No Associated with Severe Chordee

Abstract

Background: Hypospadias is a common congenital disease and the incidence of live birth is about 1/1250~1/1830 [1]. The most typical is ectopic urethra, the ventral curved downwards of penis, and dorsal skin is "hooded". According to the urethral open position, 80% of patients have a distal malpositioning of the meatus that requires a single-stage repair and nearly 20% have a more severe proximal meatus malposition, which may require two to three stage repair operations. The more serious the initial problem, the higher the complication rate, and the more operations the patient is likely to require. The common postoperative complications of hypospadias include urethrocutaneous fistula, urethral stricture (dysuria) and ventral penile curvature. In a large number of reports of surgical treatment of hypospadias, the evaluation indicators are all complications that are easy to find in the early stages. The performance and acceptability are based on short-term observations. As for satisfaction, it is not possible to seek the opinions of the patients. The final assessment of the effect of the operation can only be determined based on their parents' "degree of satisfaction". In view of the incomplete evaluation index of existing treatment effects, many authors proposed the appearance of the penis, penile curvature and urination function as a new index of hypospadias surgery. Research suggests that the preoperative assessment of the severity of hypospadias and the rational choice of surgical methods are important guarantees for the reduction of postoperative complications of hypospadias, and also for the satisfaction of the appearance of the penis and normal sexual function.Surgical operation is the only way to treat hypospadias, but, due to the great reasons, occurrence rates of complications such as the urethral fistula or constriction, reoccurrence of clubbed penis, poor development of penis and poor appearance of penis are still quite high after operation, indicating that the therapeutic effect of operation have relativities with selected the cure technique.Purpose: To describe a new technique which to Cultivate Neourethra of Autologous(CUA) for proximal hypospadias repair. Material and MethodsClinical Material: A total of 287 patients with hypospadias ranged in age from 1 month to 7 years (average 10.5 months), of which 164 patients in the cured group and 123 patients in the control group had proximal hypospadias.Operation Methods: To utilize the urethra plate to reconstruct a neourethral, longitudinal incision of the septum of scrotum and dartos muscle of scrotum, imbedding the ventral prepuce and corpus spongiosum together with the neourethral and dartos muscle of scrotum, stratified the dartos muscle of scrotum and the skin of septum of scrotum and ventral prepuce corresponding suture, the neourethral was cultivated with a good blood supply of the dartos muscle of scrotum. After 6 months, the second-stage surgery will be performed Meatoplasty and Glanuloplastyto correct abnormal ventral curvature of the penis. Resu...