| Abstract | Cilj istraživanja: Cilj ovog istraživanja bio je usporediti ishode liječenja u smislu ranih i kasnih poslijeoperacijskih komplikacija Snodgrass i MEMO (engl. Meatal mobilisation) tehnike u dječaka operiranih zbog distalne hipospadije.
Ispitanici i metode: U ovu retrospektivnu studiju uključeno je 105 dječaka kojima je dijagnosticirana distalna hipospadija te koji su operirani u Klinici za dječju kirurgiju kliničkog bolničkog centra Split u razdoblju od 1. siječnja 2019. do 31. prosinca 2023. godine. Ispitanici su podjeljeni u dvije skupine prema učinjenoj kirurškoj tehnici za ispravak anomalije. Prvu skupinu je činilo 49 dječaka operiranih MEMO tehnikom, a drugu 56 dječaka operiranih Snodgrass tehnikom. Skupine smo usporedili prema demografskim i kliničkim podatcima te ishodima liječenja i razvijenim komplikacijama.
Rezultati: Značajno niža učestalost poslijeoperacijskih komplikacija zabilježena je u MEMO skupini u odnosu na Snodgrass skupinu (n=4; (8,2%) naspram n=14 (25%); P=0,037). Uretrokutana fistula bila je najčešća komplikacija u Snodgrass skupini (n=8; 14,3%), dok je samo 1 (2%) dječak u MEMO skupini razvio fistulu (P=0,034). Učestalost stenoze meatusa (P=0,621) i infekcija rane (P=0,999) bila je niska u obje ispitivane skupine. U dječaka operiranih MEMO tehnikom zabilježeno je kraće trajanje operacije (41 min (Interkvartilni raspon–IQR 38, 47) u odnosu na 51 min (IQR 45,5; 61); P<0,001), kraće trajanje hospitalizacije (1 dan (IQR 1, 2) naspram 3 dana (IQR 2, 6); P<0,001) te kraće trajanje kateterizacije (3 dana (IQR 2,5; 5) naspram 6 dana (IQR 6, 8); P<0,001). Ni u jednoj skupini nije bilo slučajeva iznenadnog povratka u operacijsku dvoranu, a u skupini Snodgrass zabilježen je samo 1 slučaj ponovnog prijema. Učestalost reoperacija bila je značajno niža u MEMO u odnosu na Snodgrass skupinu (n = 3; 6,1% naspram n = 11; 19,6%; P=0,048)
Zaključak: MEMO je sigurna i učinkovita kirurška opcija u liječenju distalne hipospadije. U dječaka operiranih MEMO tehnikom zabilježeni su izvrsni ishodi liječenja, estetski rezultati i niska učestalost komplikacija kao i značajno kraće trajanje operacije u odnosu na Snodgrass tehniku. |
| Abstract (english) | Objectives: The aim of this study was to compare treatment outcomes in terms of early and late postoperative complications, between the Snodgrass and MEMO techniques in patients operated on for distal hypospadias.
Patients and methods: This retrospective study included 105 boys who were diagnosed with distal hypospadias and were operated on at University Hospital of Split between January 1st, 2019 and December 31st, 2023. The patients were divided into two groups according to the surgical technique used to correct the anomaly. The first group consisted of 49 boys operated on by the MEMO technique, while the second group was consisted of 56 boys operated on by the Snodgrass technique. Demographic and clinical dana, as well as clinical outcomes and complication rates were obtained for each group.
Results: Regarding the incidence of postoperative complications a significantly lower incidence of postoperative complications was found in the MEMO group compared to the Snodgrass group (n=4; 8.2% vs. n=14(25%); P=0.037). A urethrocutaneous fistula was the most common complication in the Snodgrass group (n=8; 14.3%), while in the MEMO group only one patient (2%) developed a fistula (P=0.034). The incidence of meatal stenosis (P=0.621) and wound infections (P>0.999) was low in both groups. Duration of surgery (41 min (Interquartile range–IQR 38, 47) vs. 51 min (IQR 45.5, 61); P<0.001); duration of hospitalisation (1 day (IQR 1, 2) vs. 3 days (IQR 2, 6); P<0.001) and time to catheter removal (3 days (IQR 2.5, 5) vs. 6 days (IQR 6, 8); P<0.001) were all significantly lower in patients operated on with MEMO compared to the Snodgrass technique. No cases of uROR occurred in either group. Only one case of ReAd was recorded in the Snodgrass group. The incidence of redo surgery was significantly lower in the MEMO group than in the Snodgrass group (n=3; 6.1% vs. n=11; 19.6%; P=0.048).
Conclusion: MEMO is safe and effective technique that can be used for treatment of distal hypospadias. It showed excellent outcomes, cosmetic results and low incidence of complications as well as significantly shorter duration of surgery compared to Snodgrass technique. |
