Amaç: Tubularize insize plak üretroplasti (TIPU) ameliyat›
pek çok klinikte giderek yayg›n biçimde uygulanmaya
bafllanm›flt›r. Bu çal›flmada bir cerrah›n bu teknikle elde
etti¤i sonuçlar geriye dönük olarak de¤erlendirilmifltir.
Yöntem: Befl y›ll›k bir sürede ayn› cerrah taraf›ndan ameliyat
edilen 86 primer hipospadiasl› olgunun 53'ünde (%
62) TIPU uyguland›. Hastalar›n yafl ortancas› 2.5 y›ld›
(aral›k: 11 ay-12 y›l). Olgular›n 39'unda (% 74) mea koronal/
distal penil, 5'inde (% 9) orta penil ve 9'unda (% 17)
proksimal penil yerleflimdeydi. Ameliyatlar, ana hatlar›yla
Snodgrass taraf›ndan tan›mland›¤› biçimde yap›ld›ysa da
yeni üretran›n ilk dikiflinin zamanla daha da proksimale
konmas› gibi teknik de¤ifliklikler oldu.
Bulgular: Ameliyat sonras› 6-55 ayda (ortalama, 33 ay),
43 (% 81) hastada tek aflamada iyileflme sa¤land›. Komplikasyonlar
nedeniyle, 10 hastaya ikinci ve 3 hastaya üçüncü
cerrahi giriflim gerekti. Sonuçlar iki grupta de¤erlendirildi¤
inde, ilk 24 ayda ameliyat edilen 24 hastan›n 3'ünde
fistül, 4'ünde mea stenozu ve 1'inde fistül ve mea stenozu
geliflti¤i görüldü. ‹zleyen sürede ameliyat edilen 29 hastan›
n 2'sinde fistül geliflti ve baflka komplikasyon izlenmedi.
Böylelikle, tek ameliyatla düzelme oran› birinci gruptaki %
67'den (n=16) ikinci grupta % 93'e (n=27) ç›kt›.
Sonuç: Bu çal›flma TIPU ameliyat›n›n farklı mea yerleflimlerinde
uygulanabilen tek aflamal›, kozmetik sonuçlar› başarı
lı bir yöntem olarak primer hipospadias cerrahisinde
giderek artan oranlarda kabul görmesini desteklemektedir.
Ancak, her ne kadar ilgili literatürde “ö¤renmesi” ve “uygulanmas›
kolay” bir teknik oldu¤u varsay›lsa da, tatminkar
sonuçlar›n al›nmas› ancak cerrah›n deneyiminin artmas›
ile mümkündür.
Aim: Tubularized incised plate urethroplasty (TIPU) has
become the procedure of choice in many centers for primary
hypospadias repair. The results obtained from the
technique performed by a single surgeon were retrospectively
evaluated.
Methods: During a-five-year period, 86 children with primary
hypospadias were treated by the same surgeon, 53
(62 %) of whom underwent TIPU repair. The median age
was 2.5 years (range: 11 month-12 years). The location of
meatus was coronal/distal penile in 39 (74 %) patients,
mid-penile in 5 (9 %) and proximal penile in 9 (17 %). All
operations were basically done as described by Snodgrass
but minor alterations like a more proximally located first
neo-urethral stitch were inevitable.
Results: Within a mean postoperative follow up period of
33 months, a total of 43 (81 %) patients were healed after
the first surgery. Secondary surgery was done for ten and
additional tertiary surgery was needed for three children.
Of 24 patients operated on within the first 24 months,
complications occurred in eight: fistula in three, meatal
stenosis in four, and fistula and meatal stenosis in one.
There were two complications observed in the remaining
29 children operated on in the ensuing period: fistula formation
in both. The rate of healing by one operation increased
from 67 % in the first group to 93 % in the second.
Conclusions: This study supports the view that TIPU is a
one-stage versatile operation that can be applied for various
meatal locations with cosmetically good results. Although
it has been postulated to be an “easy-to-learn and -
apply operation”, it is apparent that the cumulative experience
of the surgeon on the technique has a major impact
on the results obtained.
Key words: Hypospadias, Snodgrass