| Objective: Hypospadias is a congenital difficult problemin orthopedic and urology,that surgery is the only current treatment methods. For different type of hypospadias, different surgical methods were used. Classic snodgrass technique favored by many doctors,then this method for improved operation is also increasing by continuous improvement.This paper aims to study and analysis that the clinical effect of the treatment under a modified snodgrass hypospadias.Methods: The clinical data of 84 cases patients with congenital hypospadias were collected. Surgery age from 18 months to 26 years old. 84 cases were classified by the location of hypospadias : 25 cases in penis head(29.8%), 39 cases in penis size(46.4%) and 20 cases in penis or scrotum(23.8%). The patients were randomly divided into two groups, 41 cases in the test group, which were used by modified Snodgrass technique; control group of 43 patients were used by classic Snodgrass technique. That is the classic technique which urethral plate coil slitting angioplasty, design U-shaped incision, cut along the longitudinal center line of the urethral plate, fully extend to both sides in order to achieve sufficient support tube surrounding the urethra to form a new urethra. Coronal penis along the island below the design package flap, spin coating new urethra. The modified technique by Snodgrass intact urethral plate, loosen the two side plates and cut the urethra of the penis skin, made without any tension surrounding the urethra tube. Joint scrotal flap coverage legacy mediastinal wound.Result: Patients were followed up from three to six mouths, to analysis the statistical data about that the success rate of surgery, postoperative complications, age at surgery and different splitting type urethra.The results are as follows:(1)the success rate of test group for the first time to repair the urethra is 85.36%; the success rate of control group for the first time to repair the urethra is 79.06%; two surgical success rate of operation by chi-square test showed no significant difference(χ2 = 0.23, P = 0.64> 0.05).(2)four cases of fistula(9.8%), one case of urethral stenosis(2.4%) and one case of skin flap necrosis(2.4%) were happened in experimental group. Six cases of fistula(14.0%), three cases of urethral stenosis(7.0%) and no case of skin flap necrosis(2.4%) were happened in control group.To compared the experimental group and control group, that there was no significant statistically difference in the incidence of urinary fistula, urethral stricture, skin flap necrosis(χ2values were 0.353,0.215,0.001, P values were 0.553,0.643,0.981,> 0.05).(3) to compared the age of all patients, there was no significant statistically difference between experimental group and control group in the success rate which division age group(median 12.0 to as a dividing line).(χ2 = 0.257, P = 0.612> 0.05).(4) there were 8 cases glans,17 cases penis size,16 cases penis and scrotum in test group. Different type of urethral contrast between the splitting result was no significant statistically difference(χ2 = 0.358, P = 0.836> 0.05).(5)there were23 cases of patients with mild penile curvature, 18 cases with moderate penile curvature in test group.to compare the success rate of different indexing surgery, the difference was statistically significant(χ2=4.437, P=0.035<0.05)Conclusions: Improved Snodgrass technique preserves intact urethral plate, causing no damage to the urethral plate structure, the joint use of both sides of the urethral plate penis and scrotum skin flap reconstruction mediastinal form a new urethra. This minor surgical foreskin urethral plate width and content requirements, simple operation, fewer complications, a wider scope, to repair hypospadias effective surgical one. |
PDF Full Text Request