Caferi Tayyar SELÇUK, Kadir AKSOY, Sebat KARAMÜRSEL, Birol CİVELEK, Selim ÇELEBİOĞLU

PROKSİMAL VE DİSTAL HİPOSPADİAS OLGULARINDA FARKLI CERRAHİ YÖNTEMLERİN ETKİNLİKLERİNİN KARŞILAŞTIRILMASI

Giriş: Hipospadias yaklaşık her 200-300 erkek doğumda bir görülen, üretral meatusun normal anatomik pozisyonundan daha proksimalde yerleşimi ile karakterize bir anomalidir. Hipospadias onarımı için tüm dünyada geçerli tek bir yöntem yoktur. Çalışmamızda retrospektif olarak 75 vakalık bir seride, lokalizasyonlara göre kullanılan yöntemler ve bunların sonuçlarının karşılaştırılması amaçlandı. Gereç ve Yöntem: Kliniğimize 2002 – 2008 tarihleri arasında başvuran 75 primer hipospadias olgusuna cerrahi onarım uygulandı. Hastaların yaş aralığı 8 – 140 ay ve ortalama yaş 61.8 ay idi. Distal hipospadias olgularında üretral ilerletme (n=27) ve Mathieu tekniği (n=17) ile onarım uygulandı. Proksimal hipospadias olgularında onlay prepüsial ada flep (n=8), Asopa tekniği (n=19) ve deri grefti üretroplasti (n=4) yöntemleri ile onarım uygulandı. Bulgular: Ortalama 54.6 ay (29 - 92) süre ile takip edilen olgularda tatminkar bir onarım sağlandı. Olguların hiçbirinde enfeksiyon, hematom, yara ayrılması ve divertikül tablosu ile karşılaşılmadı. Takiplerde %8 fistül ve %6.6 meatal stenoz olmak üzere toplam %14.6 komplikasyon oranı gözlendi. Komplikasyon oranı, proksimal hipospadias olgularında onlay prepüsial ada flep yönteminde (%25) ve distal hipospadias olgularında ürteral ilerletme tekniğinde (%3.7) en az gözlendi. Sonuçlar: Çalışmamızda, proksimal hipospadias olgularında onlay prepüsial ada flep yöntemi ve distal hipospadias olgularında ürteral ilerletme tekniği daha başarılı bulundu.

Anahtar Kelimeler:

Hipospadias, üretral ilerletme, onlay prepüsial ada flep, Asopa, Mathieu

COMPARISON OF THE EFFECT OF DIFFERENT SURGICAL METHODS IN PROXIMAL AND DISTAL HYPOSPADIAS

Introduction: Hypospadias is a congenital anomaly observed in approximately one in every 200 to 300 male births. To date, there is no method universally agreed upon for repair of hypospadias. The aim of our study is to retrospectively compare the methods chosen according to the location of the meatus and their outcomes in a group of 75 patients. Material and Methods: Between 2002 and 2008, seventy-five patients with primary hypospadias underwent surgical repairs. The age range of the patients was between 8 and 140 months, and the mean age was 61.8 months. The repairs in the patients with distal hypospadias were performed through urethral advancement (n=27) and the Mathieu technique (n=17). The repairs in the patients with proximal hypospadias were performed with onlay preputial island flap urethroplasty (n=8), the Asopa technique (n=19), and skin graft urethroplasty (n=4). Results: Patients where a satisfactory reconstruction was achieved were followed up for an average period of 54.6 months (range: 29–92 months). None of the patients developed any infection, hematoma, wound dehiscence or diverticula. During the follow-up period, the total complication rate was 14.6%, of which 8% were fistulae and 6.6% were meatal stenoses. The lowest complication rates were observed with the onlay preputial island flap method (25%) applied in patients with proximal hypospadias and with the urethral advancement (3.7%) applied in patients of distal hypospadias. Conclusion: In our study, the onlay preputial island flap urethroplasty in patients with proximal hypospadias and the urethral advancement in patients with distal hypospadias were found to be the most effective techniques.

Keywords:

Hypospadias, urethral advancement, onlay preputial island flap, Asopa, Mathieu,

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