요도하열 교정술: 20년 경험

Abstract

The key for assessing the outcome of hypospadias repair is a long-term, continuous follow-up. We report our 20-year experience of hypospadias repairs carrying by one surgeon. From January 1986 to December 2005, 235 patients with hypospadias underwent surgical correction by one surgeon. We analyzed the changing patterns and complications of our major procedures. During the first 10 years, a total of 99 hypospadias repairs (27 for anterior type, 72 mid or posterior type) were performed; 8 meatal advancement and glanuloplasties (MAGPI), 8 Mathieues, 5 meatal advancements, 4 pyramids, and 2 onlay island flaps (OIF) for anterior type, 31 transverse preputial island flaps (TPIF), 18 OIFs, 17 staged repairs, and 6 Thiersch-Duplays for mid or posterior type. During the latter 10 years, a total of 136 repairs (70 for anterior type, 66 for mid or posterior type) were performed; 24 meatal advancements, 22 tubularized incised plate (TIP), 15 MAGPIs, 4 pyramids, 2 OIFs, 2 Kings, and 1 Mathieu for anterior type, 32 OIFs, 18 staged repairs, 10 TIPs, and 6 TPIFs for mid or posterior type. Complication rates were 37.8% in TPIFs, 24.1% in OIFs, 20.0% in staged repairs, and 9.4% in TIPs. In mid and posterior type with severe ventral curvature, the rates of redo operation due to residual or recurrent curvature were 2.9% in staged repairs and 24.9% in TPIFs. Urethral plate preserving procedure have extended its application into posterior hypospadias. TIP showed best results in correcting essentially all anterior and many posterior hypospadias. For posterior hypospadias with fibrotic chordee, staged repair resulted in better outcome compared to TPIFs in our hand.