Thực trạng và khó khăn trong chăm sóc trẻ có phẫu thuật lỗ tiểu lệch thấp tại Việt Nam
Nội dung chính của bài viết
Tóm tắt
Lỗ tiểu lệch thấp (LTLT) là dị tật bẩm sinh niệu dục thường gặp ở trẻ trai (1/200-1/300 trẻ nam). Phẫu thuật chỉnh hình niệu đạo là phương pháp điều trị chính, song hiệu quả lâu dài phụ thuộc nhiều vào chăm sóc sau mổ. Mục tiêu: Bài viết tổng hợp các khuyến cáo quốc tế, mô tả thực trạng chăm sóc sau phẫu thuật LTLT tại Việt Nam và đề xuất định hướng chuẩn hóa quy trình chăm sóc điều dưỡng. Nội dung: Các hướng dẫn quốc tế nhấn mạnh vai trò của chăm sóc sau mổ, bao gồm quản lý ống thông tiểu, thay băng, phòng ngừa nhiễm trùng và giáo dục gia đình. Ở Việt Nam, quy trình chăm sóc chưa thống nhất, chủ yếu dựa vào kinh nghiệm từng cơ sở, thiếu tài liệu hướng dẫn chuẩn hóa. Kết luận: Chăm sóc sau mổ LTLT đóng vai trò then chốt trong giảm biến chứng và cải thiện kết quả điều trị. Cần xây dựng khuyến cáo và đào tạo điều dưỡng chuyên biệt để tiệm cận xu hướng quốc tế.
Chi tiết bài viết
Từ khóa
Lỗ tiểu lệch thấp, chăm sóc, phẫu thuật, trẻ em, Việt Nam
Tài liệu tham khảo
1. EAU Guidelines on Paediatric Urology - Uroweb. Accessed September 2, 2025. https://uroweb.org/guidelines/paediatric-urology.
2. Ceccarelli PL, Lucaccioni L, Poluzzi F, et al. Hypospadias: clinical approach, surgical technique and long-term outcome. BMC Pediatr. 2021; 21(1): 523.
3. Shi XQ, Guo SL, Zheng W, Zhang BS, Wang J, Yang B. Effect of Preventive Nursing on Male Children with Hypospadias in Preventing Postoperative Complications. J Coll Physicians Surg Pak. 2023; 33(10): 1153-1158.
4. Wang L, et al. Preoperative parent education and postoperative nurse-led care for boys versus routine hospital care for urethroplasty for hypospadias in Western China: a retrospective study. Turk J Med Sci. 54(2): 459-470.
5. Ji Y, Choi EK, Han SW. The association between nurse continuity and hypospadias repair patient outcomes: A retrospective study. J Adv Nurs. 2023; 79(9): 3513-3521.
6. Dung PT, Trang LT, Tung HH. Nurses’ Knowledge, Practice, and Confidence after the Training Program on Wound Care at the Agriculture General Hospital in Vietnam. OJN. 2020; 10(06): 646-656.
7. Hild O, Fotso Kamdem A, Boulard N, Auber F, Chaussy Y. Primary hypospadias repair outcomes: results from a retrospective cohort of 292 children. World J Urol. 2024; 42(1): 137.
8. Gabra A, Beyari BM, AlNuwaiser SJ, et al. Outcomes of Hypospadias Repair Based on Surgical Techniques: A 4-Year Retrospective Study. Res Rep Urol. 2024; 16: 79-87.
9. Fang Y, Sun N, Song H, et al. A multicenter study on surgical procedure selection and risk factor analysis of postoperative complications after TIP and Duckett hypospadias repair. BMC Urology. 2022; 22(1): 131.
10. Hammouda HM, Shahat AA, Safwat AS, Taha TM. The long-term consequences of the hypospadias salvage repair issue. BMC Pediatrics. 2024; 24(1): 58.
11. Satjakoesoemah AI, Situmorang GR, Wahyudi I, Rodjani A. Single-stage urethroplasty: An eight-year single-centre experience and its associated factors for urethrocutaneous fistula. Journal of Clinical Urology. 2021; 14(3): 190-195.
12. Tian G, Guo B, Zhang L. Analysis of influencing factors of multiple urethrocutaneous fistula after urethroplasty in children with hypospadias. Front Pediatr. 2023; 11: 1103200.
13. Wood HM, Kay R, Angermeier KW, Ross JH. Timing of the presentation of urethrocutaneous fistulas after hypospadias repair in pediatric patients. J Urol. 2008; 180(4 Suppl): 1753-1756.
14. Ziylan O, Selvi I, Dönmez Mİ, Aydın AB, Oktar T. Two-Stage Repair for re-do Hypospadias: Results of Over 5-Year Follow-Up. Int J Urol. 2025; 32(8): 1045-1053.
15. Kim JK, Shiff M, Chua ME, et al. Time to event analysis for post-hypospadias repair complications: a single-surgeon experience. World J Urol. 2021; 39(10): 3913-3919.
16. Ye ZH, Wang C, Zhang ZC, et al. Efficacy of Body Wash and Povidone-Iodine in Skin Preparation in Reducing Surgical Site Infections After Hypospadias Repair Among Adolescents: A Prospective Cohort Study With Retrospective Controls. Surgical Infections. 2023; 24(9): 823-829.
17. Lê Nguyễn Yên, Lê Tấn Sơn, Ngô Xuân Thái, Lê Thanh Hùng, Nguyễn Thị Trúc Linh, Huỳnh Công Chấn. Kết quả bước đầu trong điều trị miệng niệu đạo đóng thấp thể nặng bằng kỹ thuật Koyanagi cải biên.
18. Trần Văn Trung, Đậu Anh Trung, Hồ Toàn Định. Đánh giá kết quả phẫu thuật lỗ tiểu lệch thấp tại Bệnh viện Sản Nhi Nghệ An. YHCĐ. 2025;66(CĐ6-HNKH Bệnh viện Sản nhi Nghệ An).
19. Kumar A, Ram Dhayal I. A Comparative Study on the Outcomes of Hypospadias Surgery Following Early Versus Late Bladder Catheter Removal. Cureus. 2022; 14(6): e26104.
20. Burki T, Al Hams AW, Nazer A, et al. Outcome of stented versus unstented mid-shaft to distal hypospadias repair. Urology Annals. 2022; 14(2): 147.
21. Chua M, Welsh C, Amir B, et al. Non-stented versus stented urethroplasty for distal hypospadias repair: A systematic review and meta-analysis. Journal of Pediatric Urology. 2018; 14(3): 212-219.
22. Rowe CK, Jamdee T, Foster C, Burke KA. Do the materials matter? A review of the literature and analysis of the materials properties of urethral stents for hypospadias repair. J Pediatr Urol. 2022; 18(2): 160-167.
23. Kaya C, Eryılmaz S, Kapisiz A, et al. Post-operative Dressing for Paediatric Hypospadias Repair. Published online December 5, 2023. Accessed October 8, 2025.
24. Shah T, Khattak I. Comparison of outcome after occlusive Hydrocolloid dressing and Petroleum-impregnated gauze with zinc oxide adhesive plaster following Hypospadias repair. Pakistan Journal of Intensive Care Medicine. 2025; 5(01): 76-76.
25. Indriasari V, Evila Y, Diposarosa R, Syukriani YF, Rachmadi D. Outcomes of a 3-day transparent film dressing protocol after hypospadias repair. Sci Rep. 2024; 14(1): 24192.
26. Karakaya AE, Güler AG, Doğan AB. Dressing or Not after Tubularized Incised Plate Urethroplasty. Urol Int. 2021; 105(11-12): 1029-1033.
27. Fuentes Carretero S, Grande Moreillo C, Vicente Sánchez N, Margarit Mallol J. Postoperative care in hypospadias. Common practices and evidence available. Cir Pediatr. 2024; 37(2): 79-83.
28. Senevirathne S, Ekanayake G, Samarathunge D, Basnayke O. The Use of Polyhexanide and Betaine Combined Preparation in Adult Burn Care in Sri Lanka. Cureus. 16(8): e67274.
29. Baillargeon E, Duan K, Brzezinski A, Jednak R, El-Sherbiny M. The role of preoperative prophylactic antibiotics in hypospadias repair. Can Urol Assoc J. 2014; 8(7-8): 236-240.
30. Tang R, Wan L, Yi Z, et al. The effect of the use of postoperative antibiotic prophylaxis compared with non-use for stented distal hypospadias repair wound: A meta-analysis. Int Wound J. 2023; 20(8): 3073-3080.
31. Basin MF, Gopalakrishnan M, Ackerman N, et al. Utility of Preoperative Antimicrobial Prophylaxis in Hypospadias Repair: Results From National Surgical Quality Improvement Program Pediatric Registry. J Urol. 2025; 214(2): 210-218.
32. Białek Ł, Rydzińska M, Vetterlein MW, Dobruch J, Skrzypczyk MA. A Systematic Review on Postoperative Antibiotic Prophylaxis after Pediatric and Adult Male Urethral Reconstruction. J Clin Med. 2023; 12(19): 6162.
33. Basin MF, Gopalakrishnan M, Ackerman N, et al. Utility of Preoperative Antimicrobial Prophylaxis in Hypospadias Repair: Results From National Surgical Quality Improvement Program Pediatric Registry. J Urol. 2025; 214(2): 210-218.
34. Doersch KM, Logvinenko T, Nelson CP, et al. Is parenteral antibiotic prophylaxis associated with fewer infectious complications in stented, distal hypospadias repair? J Pediatr Urol. 2022; 18(6): 759-763.
35. Faasse MA, Farhat WA, Rosoklija I, et al. Randomized trial of prophylactic antibiotics vs. placebo after midshaft-to-distal hypospadias repair: the PROPHY Study. J Pediatr Urol. 2022; 18(2): 171-177.
36. Post-Operative Instructions for Hypospadias Repair | Patient Education | UCSF Benioff Children’s Hospitals. Accessed September 29, 2025.
37. Do Thi Thu Hien, Finlayson K, Edwards H. Surgical wound assessment in Vietnam: a think-aloud technique and interview analysis. J Wound Care. 2020; 29(Sup4): S4-S13.
38. Lê Nguyễn Yên, Ngô Xuân Thái, Lê Thanh Hùng, Trần Thuỷ Tiên, Nguyễn Bình An, Lê Thị Duyên Ngọc. Phẫu thuật điều trị miệng niệu đạo đóng thấp thể nặng bằng kỹ thuật Koyanagi cải biên: kinh nghiệm qua 30 trường hợp. Nghiên cứu y học Thành phồ Hồ Chí Minh. 2019; 23(1).
2. Ceccarelli PL, Lucaccioni L, Poluzzi F, et al. Hypospadias: clinical approach, surgical technique and long-term outcome. BMC Pediatr. 2021; 21(1): 523.
3. Shi XQ, Guo SL, Zheng W, Zhang BS, Wang J, Yang B. Effect of Preventive Nursing on Male Children with Hypospadias in Preventing Postoperative Complications. J Coll Physicians Surg Pak. 2023; 33(10): 1153-1158.
4. Wang L, et al. Preoperative parent education and postoperative nurse-led care for boys versus routine hospital care for urethroplasty for hypospadias in Western China: a retrospective study. Turk J Med Sci. 54(2): 459-470.
5. Ji Y, Choi EK, Han SW. The association between nurse continuity and hypospadias repair patient outcomes: A retrospective study. J Adv Nurs. 2023; 79(9): 3513-3521.
6. Dung PT, Trang LT, Tung HH. Nurses’ Knowledge, Practice, and Confidence after the Training Program on Wound Care at the Agriculture General Hospital in Vietnam. OJN. 2020; 10(06): 646-656.
7. Hild O, Fotso Kamdem A, Boulard N, Auber F, Chaussy Y. Primary hypospadias repair outcomes: results from a retrospective cohort of 292 children. World J Urol. 2024; 42(1): 137.
8. Gabra A, Beyari BM, AlNuwaiser SJ, et al. Outcomes of Hypospadias Repair Based on Surgical Techniques: A 4-Year Retrospective Study. Res Rep Urol. 2024; 16: 79-87.
9. Fang Y, Sun N, Song H, et al. A multicenter study on surgical procedure selection and risk factor analysis of postoperative complications after TIP and Duckett hypospadias repair. BMC Urology. 2022; 22(1): 131.
10. Hammouda HM, Shahat AA, Safwat AS, Taha TM. The long-term consequences of the hypospadias salvage repair issue. BMC Pediatrics. 2024; 24(1): 58.
11. Satjakoesoemah AI, Situmorang GR, Wahyudi I, Rodjani A. Single-stage urethroplasty: An eight-year single-centre experience and its associated factors for urethrocutaneous fistula. Journal of Clinical Urology. 2021; 14(3): 190-195.
12. Tian G, Guo B, Zhang L. Analysis of influencing factors of multiple urethrocutaneous fistula after urethroplasty in children with hypospadias. Front Pediatr. 2023; 11: 1103200.
13. Wood HM, Kay R, Angermeier KW, Ross JH. Timing of the presentation of urethrocutaneous fistulas after hypospadias repair in pediatric patients. J Urol. 2008; 180(4 Suppl): 1753-1756.
14. Ziylan O, Selvi I, Dönmez Mİ, Aydın AB, Oktar T. Two-Stage Repair for re-do Hypospadias: Results of Over 5-Year Follow-Up. Int J Urol. 2025; 32(8): 1045-1053.
15. Kim JK, Shiff M, Chua ME, et al. Time to event analysis for post-hypospadias repair complications: a single-surgeon experience. World J Urol. 2021; 39(10): 3913-3919.
16. Ye ZH, Wang C, Zhang ZC, et al. Efficacy of Body Wash and Povidone-Iodine in Skin Preparation in Reducing Surgical Site Infections After Hypospadias Repair Among Adolescents: A Prospective Cohort Study With Retrospective Controls. Surgical Infections. 2023; 24(9): 823-829.
17. Lê Nguyễn Yên, Lê Tấn Sơn, Ngô Xuân Thái, Lê Thanh Hùng, Nguyễn Thị Trúc Linh, Huỳnh Công Chấn. Kết quả bước đầu trong điều trị miệng niệu đạo đóng thấp thể nặng bằng kỹ thuật Koyanagi cải biên.
18. Trần Văn Trung, Đậu Anh Trung, Hồ Toàn Định. Đánh giá kết quả phẫu thuật lỗ tiểu lệch thấp tại Bệnh viện Sản Nhi Nghệ An. YHCĐ. 2025;66(CĐ6-HNKH Bệnh viện Sản nhi Nghệ An).
19. Kumar A, Ram Dhayal I. A Comparative Study on the Outcomes of Hypospadias Surgery Following Early Versus Late Bladder Catheter Removal. Cureus. 2022; 14(6): e26104.
20. Burki T, Al Hams AW, Nazer A, et al. Outcome of stented versus unstented mid-shaft to distal hypospadias repair. Urology Annals. 2022; 14(2): 147.
21. Chua M, Welsh C, Amir B, et al. Non-stented versus stented urethroplasty for distal hypospadias repair: A systematic review and meta-analysis. Journal of Pediatric Urology. 2018; 14(3): 212-219.
22. Rowe CK, Jamdee T, Foster C, Burke KA. Do the materials matter? A review of the literature and analysis of the materials properties of urethral stents for hypospadias repair. J Pediatr Urol. 2022; 18(2): 160-167.
23. Kaya C, Eryılmaz S, Kapisiz A, et al. Post-operative Dressing for Paediatric Hypospadias Repair. Published online December 5, 2023. Accessed October 8, 2025.
24. Shah T, Khattak I. Comparison of outcome after occlusive Hydrocolloid dressing and Petroleum-impregnated gauze with zinc oxide adhesive plaster following Hypospadias repair. Pakistan Journal of Intensive Care Medicine. 2025; 5(01): 76-76.
25. Indriasari V, Evila Y, Diposarosa R, Syukriani YF, Rachmadi D. Outcomes of a 3-day transparent film dressing protocol after hypospadias repair. Sci Rep. 2024; 14(1): 24192.
26. Karakaya AE, Güler AG, Doğan AB. Dressing or Not after Tubularized Incised Plate Urethroplasty. Urol Int. 2021; 105(11-12): 1029-1033.
27. Fuentes Carretero S, Grande Moreillo C, Vicente Sánchez N, Margarit Mallol J. Postoperative care in hypospadias. Common practices and evidence available. Cir Pediatr. 2024; 37(2): 79-83.
28. Senevirathne S, Ekanayake G, Samarathunge D, Basnayke O. The Use of Polyhexanide and Betaine Combined Preparation in Adult Burn Care in Sri Lanka. Cureus. 16(8): e67274.
29. Baillargeon E, Duan K, Brzezinski A, Jednak R, El-Sherbiny M. The role of preoperative prophylactic antibiotics in hypospadias repair. Can Urol Assoc J. 2014; 8(7-8): 236-240.
30. Tang R, Wan L, Yi Z, et al. The effect of the use of postoperative antibiotic prophylaxis compared with non-use for stented distal hypospadias repair wound: A meta-analysis. Int Wound J. 2023; 20(8): 3073-3080.
31. Basin MF, Gopalakrishnan M, Ackerman N, et al. Utility of Preoperative Antimicrobial Prophylaxis in Hypospadias Repair: Results From National Surgical Quality Improvement Program Pediatric Registry. J Urol. 2025; 214(2): 210-218.
32. Białek Ł, Rydzińska M, Vetterlein MW, Dobruch J, Skrzypczyk MA. A Systematic Review on Postoperative Antibiotic Prophylaxis after Pediatric and Adult Male Urethral Reconstruction. J Clin Med. 2023; 12(19): 6162.
33. Basin MF, Gopalakrishnan M, Ackerman N, et al. Utility of Preoperative Antimicrobial Prophylaxis in Hypospadias Repair: Results From National Surgical Quality Improvement Program Pediatric Registry. J Urol. 2025; 214(2): 210-218.
34. Doersch KM, Logvinenko T, Nelson CP, et al. Is parenteral antibiotic prophylaxis associated with fewer infectious complications in stented, distal hypospadias repair? J Pediatr Urol. 2022; 18(6): 759-763.
35. Faasse MA, Farhat WA, Rosoklija I, et al. Randomized trial of prophylactic antibiotics vs. placebo after midshaft-to-distal hypospadias repair: the PROPHY Study. J Pediatr Urol. 2022; 18(2): 171-177.
36. Post-Operative Instructions for Hypospadias Repair | Patient Education | UCSF Benioff Children’s Hospitals. Accessed September 29, 2025.
37. Do Thi Thu Hien, Finlayson K, Edwards H. Surgical wound assessment in Vietnam: a think-aloud technique and interview analysis. J Wound Care. 2020; 29(Sup4): S4-S13.
38. Lê Nguyễn Yên, Ngô Xuân Thái, Lê Thanh Hùng, Trần Thuỷ Tiên, Nguyễn Bình An, Lê Thị Duyên Ngọc. Phẫu thuật điều trị miệng niệu đạo đóng thấp thể nặng bằng kỹ thuật Koyanagi cải biên: kinh nghiệm qua 30 trường hợp. Nghiên cứu y học Thành phồ Hồ Chí Minh. 2019; 23(1).