요도하열 교정수술 후 발생한 요도-피부 누공과 요도협착의 치료
Management of Urethral Fistulas and Strictures after Hypospadias Repair
권택민, 송채린, 김건석, 송강현, 송기현,
소속 상세정보
권택민 ( Kwon Taek-Min )
울산대학교 의과대학 비뇨기과학교실
송채린 ( Song Cheryn )
울산대학교 의과대학 비뇨기과학교실
김건석 ( Kim Kun-Suk )
울산대학교 의과대학 비뇨기과학교실
송강현 ( Song Kang-hyon )
울산대학교 의과대학 비뇨기과학교실
송기현 ( Song Gee-Hyun )
울산대학교 의과대학 비뇨기과학교실
KMID : 0358320090500010046
Abstract
Purpose: Urethrocutaneous fistulas and urethral strictures are the most frequent complications after hypospadias repair. We reviewed outcomes after surgical repair of these complications to evaluate the factors determining successful outcome.
Materials and Methods: In 60 patients with fistula or stricture after hypospadias repair performed between September 1993 and January 2008, we reviewed incidences, clinical features, and outcome after repair with respect to initial hypospadias types.
Results: Fistulas were observed in 42 patients and were surgically repaired in 39(92.8%). In 8(19.0%) and 3(7.1%) patients, concurrent meatal and urethral strictures were noted, respectively. The number of fistulas was single in 38(90.5%) and 2 in 4(9.5%) patients. Fistulas occurred most frequently from the penoscrotal type hypospadias(22/65, 33.8%) and had initially undergone transverse preputial island flap repair(13/26, 50%). Complete excision of the fistulous tract and multilayer advancement flap closure was the most common method for fistula repair(24), followed by cross-suture in 9 and repeat urethroplasty in 6. Initial management was successful in 35(89.7%) patients. Urethral strictures were observed in 16 patients with equal incidences at the meatus and the other portion of the urethra. Successful outcome was achieved in all metal stenosis after repeat meatoplasty, whereas for urethral strictures, 4(20%) patients who underwent visual urethrotomy experienced recurrent strictures.
Conclusions: Urethrocutaneous fistulas can be successfully repaired by complete excision and cross-suture closure and multiple coverage with healthy tissues. In urethral strictures, reconstruction of ample neo-meatus is the key to achieving sufficient stream regardless of the stricture site. (Korean J Urol 2009;50:46-50)
키워드
Hypospadias;Fistula;Urethral obstruction
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