Erol A, Baskin L S, Li Y W, Liu W H
Departments of Urology and Paediatrics, University of California School of Medicine, San Francisco, California 94143, USA.
BJU Int. 2000 Apr;85(6):728-34. doi: 10.1046/j.1464-410x.2000.00486.x.
To describe the detailed anatomy of the urethral plate in relation to its controversial role in hypospadias surgery.
A newborn penis with proximal penile hypospadias and two fetal penises with distal shaft hypospadias were included in the study; 30 normal fetal penises served as the control. Specimens were embedded in paraffin and serially sectioned (6 microm) after formalin fixation. Every 10th section was stained with haematoxylin and eosin. Immunohistochemical staining for nerves (S100), smooth muscles (alpha-actin), blood vessels (factor VIII) and epithelium (cytokeratins 7, 14 and 18) were used on selected sections, with particular attention to the urethral plate. Masson's trichrome and Sirius Red stains were used to localize collagen.
There were extensive blood vessels, glands and smooth muscle under the urethral plate in the hypospadias specimens. These relatively well organized tissues corresponded to an abnormally formed corpus spongiosum. The glands underneath the urethral plate and adjacent to the normal urethra showed positive staining for cytokeratins 7 and 18, respectively (markers of endodermal origin) but were negative for cytokeratin 14 (a marker of ectodermal origin). Penile skin and urethral plate epithelium stained positively for cytokeratin 14 but not for cytokeratin 7 and 18. The urethral plate has a rich nerve supply, as determined by S100 staining. Collagen intensity under the urethral plate was no different from that in normal areas. Tunica albuginea stained intensely for type I and III collagen.
These results show that the urethral plate is well vascularized, has a rich nerve supply and an extensive muscular and connective tissue backing. These features may explain the lower complication rate with onlay flaps than with tube flaps. Therefore, from these anatomical findings, we continue to advocate preservation of the urethral plate and the onlay island flap for hypospadias reconstruction.
描述尿道板的详细解剖结构及其在尿道下裂手术中存在争议的作用。
本研究纳入1例患有近端阴茎型尿道下裂的新生儿阴茎以及2例患有远端阴茎型尿道下裂的胎儿阴茎；30例正常胎儿阴茎作为对照。标本经福尔马林固定后，嵌入石蜡并连续切片（6微米）。每隔10张切片进行苏木精和伊红染色。在选定的切片上对神经（S100）、平滑肌（α-肌动蛋白）、血管（因子VIII）和上皮（细胞角蛋白7、14和18）进行免疫组织化学染色，特别关注尿道板。采用马松三色染色法和天狼星红染色法定位胶原蛋白。
尿道下裂标本中尿道板下方有丰富的血管、腺体和平滑肌。这些组织相对排列有序，对应于异常形成的海绵体。尿道板下方且与正常尿道相邻的腺体分别对细胞角蛋白7和18呈阳性染色（内胚层起源标志物），但对细胞角蛋白14呈阴性（外胚层起源标志物）。阴茎皮肤和尿道板上皮对细胞角蛋白14呈阳性染色，但对细胞角蛋白7和18呈阴性染色。通过S100染色确定尿道板有丰富的神经供应。尿道板下方的胶原蛋白强度与正常区域无差异。白膜对I型和III型胶原蛋白染色强烈。
这些结果表明，尿道板血管丰富，神经供应充足，并有广泛的肌肉和结缔组织支持。这些特征可能解释了与管状皮瓣相比，覆盖皮瓣并发症发生率较低的原因。因此，基于这些解剖学发现，我们继续主张保留尿道板并采用覆盖岛状皮瓣进行尿道下裂重建。
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