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Orta ve aşağı penil hipospadiyas cerrahisinde başarıyı etkileyen etkenler: Mathieu ve TIPU teknikleri için karşılaştırmalı bir çalışma
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Orta ve aşağı penil hipospadiyas cerrahisinde başarıyı etkileyen etkenler: Mathieu ve TIPU teknikleri için karşılaştırmalı bir çalışma
Uğraş, Murat Yahya; Ergin, Hüseyin; Kılıç, Sülayman; Güneş, Ali; Baydinç, Ali
Tarih:
2006
Özet:
Öz:Kliniğimizde orta ve aşağı penil hipospadiyas için yapılan Mathieu ve TIPU ameliyatlarında başarı ve istenmeyen yan etki oranlarımızı etkileyen etkenleri tespit etmeyi amaçladık. 1999-2004 yılları arasında orta ve aşağı penil hipospadiyas için yapılan ameliyatların kayıtlarını inceledik. Gerekli durumlarda hastalara ulaşarak verileri güncelledik. Mathieu ve TIPU yapılmış olgularda yaş, geçirilmiş cerrahi öyküsü, meatusun yeri, kordi varlığı, anestezi tekniği, üriner diversiyon şekli ve süresi, ameliyat öncesi ve sonrası kullanılmış olan ilaçlar ve kullanım süreleri, hastanede kalış süresi ile istenmeyen yan etkileri kaydettik. Bu verilerle başarı arasında istatistiksel ilişki varlığını araştırdık. Toplam 34 (%63,0) hastada Mathieu, 20 (%37,0) hastada ise TIPU teknikleri kullanılmış olup, ilk ameliyatın başarı oranları sırasıyla 28/34 (%82,4) ve 15/20 (%75,0) idi. Mathieu sonrası 5 (%14,7) hastada üretrokutanöz fistül, bir hastada yara enfeksiyonu ve cilt açıklığı; TIPU sonrası 3 (%15,0) hastada üretrokutanöz fistül, bir meatus darlığı ve bir cilt insizyonu açıklığı gelişmişti. Ameliyat başarısı ve istenmeyen yan etkilerin hasta yaşı, hipospadiyasın yeri ve diversiyon süresi ile ilişkisini saptayamazken, Foley sonda kullanılmasının (r: 0,45; p=0,001) ve spinal-kaudal anestezi yapılmasının (r: 0,38; p=0,005) istenmeyen yan etkileri artırdığını saptadık. Bu çalışmada, hipospadiyas cerrahisinde başarıyı etkileyen etkenler yayınlarla uyumlu bulunmuştur. Cerrahi sonrası diversiyon için Foley sonda kullanılması istenmeyen yan etki gelişimini artırmış, cerrahinin genel anestezi ile yapılması ise azaltmıştır.
Açıklama:
Öz (İngilizce):Introduction: Surgical repair of hypospadias is influenced by many factors, the most important being the experience of surgeon. In this study, we aimed to determine factors affecting success in Mathieu and TIPU procedures conducted for mid- and distal penile hypospadias. Since we have some differences in patient profile regarding age, previous circumcision and hospital stay, we think that we need our own data to evaluate factors affecting surgical success. Materials and Methods: We retrospectively evaluated our surgical records and retrieved data on primary surgery for mid- and distal penile hypospadias, using either Mathieu or TIPU techniques. We reached patients and refreshed data when necessary. We gathered data on age, family history, previous surgery (circumcision or chordee), native meatal place, existence of chordee, anesthesia technique, type and time of urinary diversion, medications, hospital stay and complications. We analyzed data with software (SPSS 10.0, SPSS inc. ILL, USA) using parametric tests (ANNOVA, Student's T Test, Pearson) and nonparametric (Kruskal Wallis Test, Mann Whitney-U Test) accepted p<0,05 as statistically significant. Results: Among a total of 149 hypospadias patients presented between 1999 and 2004, 54 meeting our criteria were enrolled. Mathieu and TIPU operations were conducted in 34 (63%) and 20 (37%) patients, respectively. Mean age was 9.6±6.2 years. Regarding age groups, 15 patients (27.8%) were at 0-5, 25 (46.3%) at 6-12 and 14 (25.9%) at 12< years of age. Native meatus was placed at coronal, subcoronal, distal and mid penis in 16 (29,.5%), 8 (14.8%), 19 (35.2%) and 11 (20.5%) patients, respectively. Initial operation was successful in 28/34 (82.4%) of Mathieu and 15/20 (75.0%) of TIPU procedures. The difference was not statistically significant (p>0.05). Considering age groups or place of native meatus, success rates of both procedure were not significantly different (p>0.05). Hospital stay ranged between 5 and 33 (mean 8.4±4.7) days. Postoperative complications were as follows: After Mathieu procedure, 5 (14.7%) urethrocutaneous fistulas were seen and 3 were treated surgically. One patient had wound infection and skin disruption with an intact tube. He had debridement, antibiotic therapy and late closure of skin. After treatment of complications, success rate was 32/34 (94.1%). After TIPU procedure, 3 (15.0%) urethrocutaneous fistulas were seen, 2 that applicated were treated surgically. One patient had meatal stenosis and another had skin disruption with intact tube, both treated surgically. After treatment of complications, success rate was 19/20 (95.0%). Complication rates of both procedures were similar (p>0.05). Foley and Nelaton catheters were used as urethral stents in 17 (31.5%) and 37 (68.5%) patients, respectively. Complication rate was significantly higher with Foley Catheter (r: 0.45; p=0.001). General and spinal-caudal anesthesia were performed in 30 (55.6%) and 24 (44.4%) patients, respectively. Complication rate was significantly higher with regional anesthesia (r: 0.38; p=0,005). Conclusion: In this series, we encountered factors that affect surgical success, which was in concordance with literature. Due to significantly higher complication rate, Foley catheter is not recommended as drain after both procedures. Regardless of age, we prefer to use general anesthesia in all patients.
