Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2006 / Cilt: 32 - Sayı: 1
Hangi diversiyon tübülarize insize plak üretroplasti (TIPU)'de başarıyı etkiler?
- Sayfa
- 106–109
- DOI
- —
Özet
Hipospadiyas tamirinde başarılı sonuç alınabilmesi için, hipospadiyas tiplerine göre uygun cerrahi seçim, yeni oluşturulan üretranın uzunluğu, dikiş tekniği ve ameliyat sonrası bakım önemli olduğu gibi, aynı zamanda üriner diversiyonun seçimi de etkilidir. Çalışmamızda, TIPU’de diversiyon olarak perkütan sistostomi ve ekstravezikal üretral stent birlikteliği ile intravezikal üretral stent uygulanmasının komplikasyonlara etkisini geriye dönük olarak inceledik. 2001-2004 yılları arasında TIPU uyguladığımız 59 hasta değerlendirildi. Birinci gruba, 29 olgu, perkütan sistostomi ve ekstravezikal üretral stent birlikte, 2. gruba, 30 olgu, sadece intravezikal üretral stent diversiyon olarak uygulanmıştı. Olgular ameliyat sonrası 6. ayda değerlendirildi. Olguların istatistiksel karşılaştırılmasında T Testi, Levene’s Test for Equality of Variances and Independent Samples Test kullanıldı. Birinci grupta yaş ortalaması 7.4±3.4 yıl olan 24 distal ve 5 proksimal hipospadiasa TIPU yapıldı. Olguların 16’sı primer, 13’ü sekonderdi. İkinci gruptaki olguların yaş ortalaması 6.8±3.5 yıldı. 28’i distal, 2’si proksimal hipospadiyastı ve 21’i primerdi. 9’u ise sekonderdi. Her iki grup arasında yaş, kordi, meanın yeri, primer-sekonder onarımlı olgu, fistül, mea darlığı ve toplam istenmeyen yan etkiler açısından anlamlı fark görülmedi (p>0.05). Yaptığımız bu çalışmada geleneksel olarak kullandığımız perkütan sistostominin intravezikal üretral stent kullanımına göre fistül, meatal darlık ve toplam istenmeyen yan etkilerin azaltılması açısından hiçbir üstünlüğü bulunamamıştır.
Abstract
Introduction: TIPU, as defined by Snodgrass has begun to be used widely; the cosmetic and functional results are rather good and have fairly decreased the complication rates. In order to obtain successful results, in addition to the choice of appropriate surgery according to the type of hypospadias, the length of the newly formed urethra, suture technique and the post-operative care that has to be made, the choice of urinary diversion is also effective. In this study, we have investigated retrospectively, the effects of the application of intravesical urethral stent versus the combination of percutaneous suprapubic cystostomy and extravesical urethral stent as a diversion on the complication rate of TIPU. Materials and Methods: We evaluated 59 patients to whom we had performed TIPU between 2001 and 2004. Percutaneous cystostomy plus extravesical urethral stent was applied as a diversion to 29 patients in the first group and intravesical urethral stent alone was applied as a diversion to 30 patients in the second group. All patients in both groups were given antibiotics and antiinflammatory treatment postoperatively and elastic bandage were used. Urinary diversion catheters were removed at day 10. The cases were evaluated on the 6th month after the operation to establish the complications. T Test, Levene’s Test for Equality of Variances and Independent Samples Test was used in the comparison of the cases. Results: In the first group with an average age of 7.4±3.4 years, 24 distal and 5 proximal hypospadias TIPU was performed. Sixteen of the cases were primary and 13 were secondary. The average age of the cases in the second group was 6.8±3.5 years. Twenty-eight were distal penile and 2 were proximal hypospadias. Twenty-one were primary and nine were secondary. A slight degree of chordee was present in 5 cases in the first group and in 10 in the second group. There was no statistically meaningful difference between groups in age, chordee, location of meatus, being primary or secondary of the repair and complication rates (p>0.05). When the definite complications were evaluated after a follow-up period of 6 months; 3 fistulas and one detachment of the new urethra in the first group and 6 fistulas and two meatal stenosis in the second group were observed. The complication rate in the first group was found to be 13.7% while it was 23.3% in the second group. A statistically meaningful difference was not found between the two groups in terms of fistula, meatal stenosis and full complications (p>0.05). Conclusion: In our study when the complications between the groups were compared, no difference was found which was statistically significant. Because of this finding we think that the kind of urinary diversion does not affect the complication rate.