Hipospadias cerrahisi sonrası gelişen meatus darlıklarının tedavisinde meatotomi dilatasyona göre daha başarılı mıdır?
Öz
Amaç: Yeni üretra dış meatusunda darlık, hipospadias cerrahisi sonrası en sık görülen komplikasyonlardan biridir. Tedavide meatotomi ve dilatasyon en yaygın kullanılan yöntemlerdir. Bununla birlikte, hangi tedavinin hangi sıra ile kullanılacağı veya tedavi algoritması konusunda yeterli bilgi bulunmamaktadır. Bu çalışmada hipospadias cerrahisi sonrası meatus darlığı gelişmiş olgularda kullanılan tedavi yöntemlerinin etkinlikleri karşılaştırmalı olarak değerlendirilmiştir.
Gereç ve Yöntem: 2009-2019 yılları arasında, daha önce distal hipospadias nedeniyle ameliyat edilen ve meatus darlığı tanısı alarak genel anestezi altında meatotomi veya üretra dilatasyonu ile tedavi edilmiş olguların kayıtları geriye dönük olarak incelendi. Hastaların demografik özellikleri, hipospadias onarımında kullanılan ilk cerrahi yöntem, hipospadias onarımı sonrası meatus darlığı tedavisine kadar geçen süre, tedavi başarısı, nüks darlık tedavisinde kullanılan yöntem kaydedildi. Kontrollerde yakınması tekrar etmeyen olgular başarılı olarak tedavi edilmiş kabul edildi. statistiksel analiz için IBM- SPSS Statistics 23 programı yardımı ile Ki-kare, Student T ve Kolmogorov-Smirnov testleri kullanıldı.
Bulgular: Çalışmaya dahil edilen 10 yıllık sürede, distal hipospadias cerrahisi sonrası meatus darlığı gelişen, yaş ortalaması 45,07 ± 36,60 ay olan 56 hasta saptandı. Meatus darlığı için yapılan işlem sayısı hasta başına ortalama 1,67±0,91 idi. Hipospadias onarımı ile meatus darlığı için ilk uygulanan tedavi arasındaki ortanca süre sırasıyla; meatotomide 25,97 ay, dilatasyon olgularında 13,72 aydı (p<0,05). lk tedavi seçeneği olarak dilatasyon uygulanan 42 olguda başarı oranı %45,2, meatotomi uygulanan 14 olguda ise %78,6 idi (p<0,05). Nüks olan 10 olgunun tedavisinde dilatasyon %40, 16 olgunun tedavisinde ise meatotomi %87,5 başarılı idi (Tablo-3, p<0,05). lk darlık tedavisi dilatasyon olan olguların ortalama işlem sayısı 1,83±0,98, meatotomi olanların ise 1,21±0,42 idi (p<0,05).
Sonuç: Hipospadias cerrahisi sonrası gelişen meatus darlığı ve nükslerinin tedavisinde meatotomi dilatasyona göre daha başarılı bir yöntemdir. Sonuç vermeyen dilatasyonlarda ısrar etmek yerine erken dönemde meatotomi ile daha başarılı sonuç alınabilir.
Anahtar Kelimeler
hipospadias meatus darlığı çocuk meatotomi üretral dilatasyon
Kaynakça
- Agrawal K, Misra A. Unfavourable results in hypospadias. Indian J Plast Surg 2013; 46 (2): 419–27.
- Snodgrass WT. Tubularized incised plate hypospadias repair: Indications, technique, and complications. Urology 1999; 54 (1): 6–11.
- Pat Malone. Meatal Stenosis and Urethral Strictures After Hypospadias Surgery. In: Hadidi AT, Azmy AF. Hypospadias Surgery. Berlin, Springer Berlin Heidelberg; 2004: 294-300.
- Snodgrass WT, Bush NC. Hypospadiology. 1st ed. Texas, Operation Happenis, Inc.; 2015:138-48.
- Snodgrass WT, Nguyen MT. Current technique of tubularized incised plate hypospadias repair. Urology. 2002 Jul 1; 60 (1): 157–62.
- Lorenzo AJ, Snodgrass WT. Regular dilatation is unnecessary after tubularized incised-plate hypospadias repair. BJU Int. 2002; 89 (1): 94–7.
- Radojicic ZI, Perovic S v., Stojanoski KDJ. Calibration and dilatation with topical corticosteroid in the treatment of stenosis of neourethral meatus after hypospadias repair. BJU International 2006; 97 (1): 166–8.
- Sultan M, El-Shazly M, Elsherif E, Younes S, Selim M. Role of urethral plate and fossa navicularis biopsies in the detection of balanitis xerotica obliterans in boys undergoing redo hypospadias repair. Arab J Urol 2017; 15 (4): 326–30.
- Ransley PG, Duffy PG, Oesch IL, van Oyen P, Hoover D. The use of bladder mucosa and combined bladder mucosa/preputial skin grafts for urethral reconstruction. J Urol 1987;138 (4 II): 1096–8.
- Joudi M, Fathi M, Hiradfar M. Incidence of asymptomatic meatal stenosis in children following neonatal circumcision. J Pediatr Urol 2011 Oct 1; 7 (5): 526–8.
- Kim KS, King LR. Method for correcting meatal stenosis after hypospadias repair. Urology 1992 Jun;39 (6): 545–6.
- Litvak AS, Morris JA, McRoberts JW. Normal size of the urethral meatus in boys. J Urol 1976; 115 (6): 736–7.
- Orkiszewski M, Madej J. The meatal/urethral width in healthy uncircumcised boys. J Pediatr Urol 2009; 6: 130–3.
- Godley SP, Sturm RM, Durbin-Johnson B, Kurzrock EA. Meatal stenosis: A retrospective analysis of over 4000 patients. J Pediatr Urol 2015 Feb 1; 11 (1): 38.
Is meatotomy more successful than dilatation in the treatment of meatal stenosis developing after hypospadias surgery?
Öz
Aim: Stenosis in the external orifice of the neo-urethra is one of the most common complications after hypospadias surgery. Meatotomy and dilation are the most commonly used methods in the treatment of these cases. However, there is insufficient data about which treatment will be used in what order or the treatment algorithm. In this study, we aimed to evaluate the effectiveness of treatment methods used in patients with meatal stenosis after hypospadias surgery.
Materials and Methods: Hospital records of patients who were operated for distal hypospadias and diagnosed with meatal stenosis and underwent meatotomy or urethral dilatation under general anesthesia were reviewed retrospectively between 2009-2019. The demographic data of the patients, the first surgical method used for hypospadias repair, the duration between the treatment of meatal stenosis and hypospadias repair, the success of the treatment and the method used in the treatment of recurrent stenosis were recorded. Patients whose complaints did not recur during controls were considered to have been successfully treated. Chi-square, Student T, and Kolmogorov-Smirnov tests were used for statistical analysis with help of IBS-SPSS Statistics 23 program.
Results: In the 10-year period included in the study, 56 patients with a mean age of 45.07 ± 36.60 months developed meatal stenosis after distal hypospadias surgery distal hypospadias surgery. The mean number of procedures for meatal stenosis was 1.67 ± 0.91 per patient. The median duration between the hypospadias surgery and the first treatment for meatal stenosis was 25,97 months in meatotomy and 13,72 months in dilatation cases, respectively (p <0.05). The success rate of the first treatment was 45.2% in 42 patients who underwent dilatation as the first treatment option, and 78.6% in 14 patients who underwent meatotomy (p <0.05). Dilatation was successful in the 40% of the recurrent cases, and meatotomy was 87.5% (Table-3, p <0.05). According to the initial treatments, the mean number of procedures was 1.83 ± 0.98 in patients who underwent dilatation,and 1.21 ± 0.42 in those who underwent meatotomy (p <0.05).
Conclusion: Meatotomy is a more successful method than dilatation in the treatment of meatal stenosis and relapses after hypospadias surgery. Instead of insisting on ineffective dilatations, more successful results can be obtained with early meatotomy.
Anahtar Kelimeler
Meatal stenosis hypospadias urethral dilation meatotomy children
Kaynakça
- Agrawal K, Misra A. Unfavourable results in hypospadias. Indian J Plast Surg 2013; 46 (2): 419–27.
- Snodgrass WT. Tubularized incised plate hypospadias repair: Indications, technique, and complications. Urology 1999; 54 (1): 6–11.
- Pat Malone. Meatal Stenosis and Urethral Strictures After Hypospadias Surgery. In: Hadidi AT, Azmy AF. Hypospadias Surgery. Berlin, Springer Berlin Heidelberg; 2004: 294-300.
- Snodgrass WT, Bush NC. Hypospadiology. 1st ed. Texas, Operation Happenis, Inc.; 2015:138-48.
- Snodgrass WT, Nguyen MT. Current technique of tubularized incised plate hypospadias repair. Urology. 2002 Jul 1; 60 (1): 157–62.
- Lorenzo AJ, Snodgrass WT. Regular dilatation is unnecessary after tubularized incised-plate hypospadias repair. BJU Int. 2002; 89 (1): 94–7.
- Radojicic ZI, Perovic S v., Stojanoski KDJ. Calibration and dilatation with topical corticosteroid in the treatment of stenosis of neourethral meatus after hypospadias repair. BJU International 2006; 97 (1): 166–8.
- Sultan M, El-Shazly M, Elsherif E, Younes S, Selim M. Role of urethral plate and fossa navicularis biopsies in the detection of balanitis xerotica obliterans in boys undergoing redo hypospadias repair. Arab J Urol 2017; 15 (4): 326–30.
- Ransley PG, Duffy PG, Oesch IL, van Oyen P, Hoover D. The use of bladder mucosa and combined bladder mucosa/preputial skin grafts for urethral reconstruction. J Urol 1987;138 (4 II): 1096–8.
- Joudi M, Fathi M, Hiradfar M. Incidence of asymptomatic meatal stenosis in children following neonatal circumcision. J Pediatr Urol 2011 Oct 1; 7 (5): 526–8.
- Kim KS, King LR. Method for correcting meatal stenosis after hypospadias repair. Urology 1992 Jun;39 (6): 545–6.
- Litvak AS, Morris JA, McRoberts JW. Normal size of the urethral meatus in boys. J Urol 1976; 115 (6): 736–7.
- Orkiszewski M, Madej J. The meatal/urethral width in healthy uncircumcised boys. J Pediatr Urol 2009; 6: 130–3.
- Godley SP, Sturm RM, Durbin-Johnson B, Kurzrock EA. Meatal stenosis: A retrospective analysis of over 4000 patients. J Pediatr Urol 2015 Feb 1; 11 (1): 38.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Mart 2021 |
| Gönderilme Tarihi | 6 Temmuz 2020 |
| Yayımlandığı Sayı | Yıl 2021 |