フリーグラフト法による一期的尿道下裂修復術の経験

Abstract

尿道下裂に対する陰茎背側包皮を用いたフリーグラフト法は, 皮膚管の長さが3cm程度迄に収まる陰茎開口型の症例に対して一期的修復術を行うのに適した術式の一つと考えられた

We treated 14 patients with moderately severe hypospadias and chordee without hypospadias using a free graft of prepuce by a modified Devine-Horton technique, between September 1993 and April 1995. There were 12 primary cases and 2 secondary cases in which prior operations had already been done. Four (33%) of the primary cases required a second procedure; 3 for urethrocutaneous fistula and 1 for urethral shrinkage. Both of the secondary cases needed further procedures; 1 for meatal stenosis and 1 for urethral stricture and diverticula. Although the need for reoperation is unfortunately high, six of the 7 recently treated patients experienced no complications. Thirteen of the 14 patients (93%) achieved excellent functional and cosmetic results with 1 or 2 procedures. We believe the use of free grafts allows a better functional and cosmetic outcome because the secondary torsion and bulkiness of the penile shaft caused by a vascular pedicle are eliminated.