Comparing Two-Stage And One-Stage Duckett Urethroplasty In Clinical Curative Effect Of Hypospadias

Objective:Through comparing two-stage and one-stage Duckett urethroplasty in clinical curative effect of curve hypospadias,to summarize the indications of surgery and the clinical rule of complications.Methods:Retrospective analysis in October 2012 to December 2014,the First Affiliated Hospital of Guangxi Medical University, Pediatric Surgery, the treatment of 162 cases of patients of hypospadias,of which one-stage Duckett surgery 130 cases, aged 2 years to 15 years, mean age (5.31 ± 2.35) years. Two-stage Duckett surgery in 32 patients aged 2 years to 13 years, mean age (4.59±2.58) years. Comparison of the two groups were the local anatomy penis conditions such as penis head diameter, urethral plate development, the penis and scrotum translocation, the degree of bending of the penis, The penis bending degree,urethral position after penis straight, urethral defect length and other indicators. Meanwhile clinical results of surgery were compared, such as fistula, urethral stricture, incidence and surgical success rate urethral diverticulum, urethral crack and other postoperative complications.Results:94 cases one-stage Duckett surgery in 130 cases of were successful,surgical success rate was 72.3%; 29 cases two-stage Duckett surgery in 32 cases of were successful, surgical success rate was 90.6%, consisting of two-stage Duckett surgical success rate was significantly higher than one-stage Duckett surgery,difference was statistically significant (X2= 4.714, P= 0.030 <0.05).130 cases of one-stage Duckett surgery, a surgical complications occur in 36 cases, the complication rate of 27.7%,32 cases of two-stage Duckett surgery in three cases of postoperative complications, the complication rate of 9.4%, after two-stage Duckett surgery fistula, urethral stenosis and urethral diverticulum, and other major complication rate of less than one-stage Duckett surgery, the difference was statistically significant (P=0.030<0.05). one-stage Duckett surgery the penis head diameter≤1.2cm surgery group 43 cases, accounting for 33.1% (43/130 cases), head of the penis surgery group stage Duckett diameter< 1.2cm cases 25 cases (25/32 cases), accounting for 78.1%. two-stage Duckett surgery patients≤1.2CM penis head diameter of more than one-stage Duckett surgery(X2=21.396, P=0.000<0.05), the difference was statistically significant.one-stage Duckett surgery group after a straight penis urethral orifice is located at the junction of the penis and scrotum scrotum 29 cases, accounting for 22.3% (29/130 cases), after two-stage Duckett surgery straight penis urethral orifice is located at the junction of the penis and scrotum scrotum 25 cases, accounting for 78.1% (25/32 cases). After two-stage Duckett surgery straight penis urethral orifice is located proximal (scrotum and penis and scrotum junction) high ratio (X2= 36.002, P=0.0000.05) than that of one-stage Duckett surgery. A urethral defect length in one-stage Duckett surgery(3.24±0.89cm), two-stage Duckett surgery rethral defect length (3.90± 0.66cm), two-stage Duckett surgery urethral defect length greater than one-stage Duckett surgery group (t= 2.930, = 0.006<0.05), the difference was statistically significant. one-stage Duckett surgery scores of penis bending degree is moderate in 96 cases,73.8% (96/130 cases), severe 34 cases,26.2% (34/130 cases), two-stage Duckett surgery group scores penis bending degree is moderate in 5 cases,15.6%(5/32 cases), a severe 27 cases,84.4% (27/32 cases), two-stage Duckett surgery group scores penis bending degree in severe cases of high rate than those who did one-stage Duckett surgery(X2= 37.078, P=0.000 < 0.05), the difference was statistically significant.one-stage Duckett surgery urethral plate poorly developed (<0.4cm) 106 cases, accounting for 81.5% (106/ 130 cases), two-stage Duckett surgery group stage urethral plate poorly developed (<0.4cm) 30 cases, accounting for 93.8%(30/32 cases). Differences between the two groups were in the urethral plate was no significant development of the situation (X2= 2.842, P= 0.092> 0.05). A combination of surgery and penis and scrotum Duckett partially or fully indexable 22 cases, accounting for 16.9%(22/130 cases), staging a combination of surgery and penis and scrotum Duckett partially or fully indexable 6 cases, accounting for 18.8%(6/32 cases). Differences between the two groups of cases of penile and scrotal transposition was not statistically significant (X2= 0.0, P= 060.807> 0.05).Conclusion:Treatments of the hypospadias strategy must be in the comprehensive assessment of the penis head size, urethral plate development situation, the penis scrotal transposition, bending degree, after the penis straight urethral mouth location and after urethral defect length can make reasonable decision, two-stage Duckett surgical indications as follows:1, a narrow head of the penis (diameter=≤1.2CM), penis dysplasia, who one-stage surgery can not reach the urethral mouth location 2, urethral plate fibrous scar contracture cause severe penile curvature, to be cut off. urethral plate can be fully extended, while causing long segment urethral defect; 3, local skin material deficiencies or poor growth, it is difficult to repair one of the urethra and penis shaped appearance of persons;.4,patients who lack the technical level because unskilled or Inexperienced operation of Duckett,unable to complete a surgical repair. To select the right surgical method will significantly reduce the incidence of postoperative complication such as urinary fistula or urethral stricture, thus improve the success rate of surgery.