Андрология и генитальная хирургия. 2022; 23: 68-77
Стриктуры уретры у мальчиков после лечения гипоспадии: заместительная буккальная уретропластика
https://doi.org/10.17650/2070-9781-2022-23-2-68-77Аннотация
Введение. Наиболее распространенной причиной возникновения стриктур уретры у мальчиков являются осложнения лечения гипоспадии. Протяженные и осложненные стриктуры представляют самый сложный сегмент проблемы и вопросов выбора метода хирургической коррекции.
Цель работы – рассмотрение техники и результатов заместительной уретропластики буккальным трансплантатом при стриктурах уретры, возникших после лечения гипоспадии в детском возрасте.
Материалы и методы. Ретроспективное исследование проведено в ГБУЗ «Научно-исследовательский институт неотложной детской хирургии и травматологии» Департамента здравоохранения города Москвы с 2017 по 2020 г. Были изучены истории болезни 34 пациентов, перенесших этапную заместительную буккальную уретропластику по поводу осложненной стриктуры уретры. В ходе обследования выявляли осложнения, такие как Lichen sclerosus, короткая уретра, свищи, дивертикулы, множественные (двойные) и протяженные стриктуры.
Результаты. Осложнения возникли у 3 (8,8 %) пациентов: у 2 детей возник кожно-уретральный свищ, у 1 ребенка произошло частичное рубцевание свободного трансплантата. Отдаленные результаты оценены в среднем через 16 мес. Опыт лечения 34 пациентов детского и подросткового возраста с постгипоспадическими стриктурами показал, что ведущей причиной образования стриктур после лечения гипоспадии является Lichen sclerosus, встретившийся у 16 пациентов.
Заключение. В течение последнего столетия было предложено множество донорских тканей для свободной пластики уретры, однако именно буккальный трансплантат приобрел наибольшее число сторонников, а этапная уретропластика стала методом выбора при стриктурах передней уретры. Значительный опыт хирурга в выполнении буккальной уретропластики, соблюдение нюансов техники и методики ведения пациента в послеоперационном периоде как на 1-м, так и на 2-м этапе лечения позволяют получить хороший косметический и функциональный результат даже после ряда неудачных операций.
Список литературы
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Andrology and Genital Surgery. 2022; 23: 68-77
Urethral strictures in boys after hypospadias treatment: two-staged buccal urethroplasty
https://doi.org/10.17650/2070-9781-2022-23-2-68-77Abstract
Introduction. The most common cause of urethral strictures in boys is a complication of hypospadias treatment. Extended and complicated strictures represent the most difficult segment of the problem and the choice of the method of surgical correction.
The study objective is to review the technique and results of replacement urethroplasty with buccal graft in urethral strictures that occurred after treatment of hypospadias in childhood.
Materials and methods. A retrospective study conducted at the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma from 2017 to 2020. Cases of 34 patients who underwent staged replacement buccal urethroplasty for complicated urethral stricture were studied. The examination revealed complications such as: Lichen sclerosus, short urethra, fistulas, diverticula, multiple (double) and extended strictures.
Results. Complications occurred in 3 (8.8 %) patients: cutaneous urethral fistula developed in two, partial scarring of the free graft occurred in one child. Long-term results were assessed after an average of 16 months. Our experience of treating 34 pediatric and adolescent patients with p after-hypospadias strictures showed that the leading cause of stricture formation after hypospadias treatment is Lichen sclerosus, which occurred in 16 patients.
Conclusion. During the last century, many donor tissues have been proposed for free urethroplasty, but it is the buccal graft that has won the largest number of supporters, and two-staged urethroplasty has become the method of choice for strictures of the anterior urethra. The surgeon’s considerable experience in performing buccal urethroplasty, adherence to the nuances of the technique and methodology of postoperative management, both at the first and second stages, allows you to obtain a good cosmetic and functional result even after a number of unsuccessful operations.
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