Clinical curative effect and comparative observation in the Duckett operation between glans tunnel and longitudinal cutting glans to form urethral opening

Abstract

Objective To explore clinical curative effect and compare observations of the Duckett operation between glans tunnel and longitudinal cutting glans to form urethral opening. Methods Retrospective study from 2011 to 2013 in Wuhan Children's Hospital, of 86 cases of hypospadias in children undergoing surgery to form urethra, with surgical procedures adopting Duckett surgical method to form the urethra.Urethroplasty was performed through glans tunnel or longitudinal incision to form urethral opening, and postoperation results were compared according to the conditions of the children with distal urethral stricture, urethral fistula, urethral diverticulum, glans wound dehiscence and wound recovery. Results Eighty-six cases were followed up for 6 to 12 months, with satisfaction of the straight penis, without recurved residue, or glans necrosis.Among the 49 cases of big glans in cylindrical shape without obvious scap-hoid fossa, 26 cases of children underwent longitudinal incision to form urethra, in which urethral fistula occurred in 3 cases.There were 3 cases of urethral stricture, including 2 cases of distal urethral stricture.There were 1 case of urethral diverticulum and 2 cases of glans wound dehiscence.Twenty-three cases adopted the tunnel method with the occurrence of urethral fistula in 1 case and urethral stricture in another, which both occurred at the ventral penile coronal proximal end.Among the 37 cases with small glans in flat shape and deep scaphoid fossa, 21 cases adopted the tunnel method with the occurrence of urethral fistula in 3 cases.Five cases of urethral stricture occurred at the distal urethra, 2 cases of urethral diverticulum, and 1 case of distal urethral split.Sixteen cases underwent vertical cutting method with the occurrence of urethral fistula at penis coronal sulcus in 2 cases, 1 case of distal urethral stricture.Children who had similarity in penis head shape, size and coronal sulcus depth adopted separately longitudinal incision or tunnel method to form urethra and prognosis difference was of statistical significance (P<0.05). The children with similarity in penis head shape, size and coronal sulcus depth adopted the same method (longitudinal incision or tunnel method) and there was a significant statistical difference in prognosis (P<0.05). Conclusions Tunneling method is suitable for the children with big glans in cylindrical shape without obvious scaphoid fossa; while longitudinal incision method is suitable for the children whose penis are small and flat with deep scaphoid fossa. Key words: Urethroplasty; Glans tunnel; Longitudinal incision of glans; Hypospadias