Yucel Selcuk, Guntekin Erol, Kukul Erdal, Karaguzel Gungor, Ciftcioglu Akif, Melikoglu Mustafa, Baykara Mehmet
Department of Urology, Pediatric Surgery and Pathology, Akdeniz University School of Medicine, Antalya, Turkey.
J Urol. 2004 Nov;172(5 Pt 1):1973-6; discussion 1976. doi: 10.1097/01.ju.0000142131.37693.05.
Data about the differences between the vascularization of normal and hypospadiac prepuce are lacking. We investigated the course of the preputial arterial blood vessels in normal controls and children with hypospadias by using transillumination, arterial methylene blue injection and 3-dimensional (3-D) reconstruction of serial histological sections focusing on arterial vessels.
Prepuce of 48 normal controls and 15 children with hypospadias was transilluminated by a front and back lighting technique and then photographed. All of the normal and 12 of hypospadiac prepuces not used for urethroplasty or penile body skin reconstruction were removed. The blood vessels of normal prepuce were also identified after arterial injection of methylene blue. Selected prepuce of normal controls and children with hypospadias was serially sectioned, and arterial and venous vessels were histologically distinguished. A 3-D computer reconstruction of the arterial system of normal and hypospadiac prepuces was performed.
We confirmed the reliability of the transillumination technique to describe the arterial vascular anatomy of the prepuce by comparing the transillumination to methylene blue injection and 3-D reconstruction of histological sections. We classified the arterial vascular anatomy of normal prepuce as 1 artery predominant (41.67%), 2 arteries predominant (25%), H-type arching artery (12.5%) and net-like arterial system (20.83%). However, hypospadiac prepuce revealed a net-like arterial system more frequently (50%). We noted that the frequency of net-like arterial system was higher in more severe hypospadiac prepuce.
Understanding the differences between normal and hypospadiac prepuce vascular anatomy is germane to hypospadias surgery. The arterial blood supply of the hypospadiac prepuce is different than normal. A better knowledge of the vascular anatomy of the hypospadiac prepuce may improve the surgical results of hypospadias repair.
关于正常包皮与尿道下裂包皮血管化差异的数据尚缺。我们通过透照法、动脉亚甲蓝注射以及对连续组织学切片进行三维（3-D）重建（聚焦于动脉血管）来研究正常对照者和尿道下裂患儿的包皮动脉血管走行。
采用前后照明技术对48例正常对照者和15例尿道下裂患儿的包皮进行透照，然后拍照。切除所有正常对照者的包皮以及12例未用于尿道成形术或阴茎体皮肤重建的尿道下裂患儿的包皮。在动脉注射亚甲蓝后，也对正常包皮的血管进行了识别。对正常对照者和尿道下裂患儿选取的包皮进行连续切片，并在组织学上区分动脉和静脉血管。对正常和尿道下裂包皮的动脉系统进行了三维计算机重建。
通过将透照结果与亚甲蓝注射及组织学切片的三维重建结果进行比较，我们证实了透照技术描述包皮动脉血管解剖结构的可靠性。我们将正常包皮的动脉血管解剖结构分为1条动脉为主型（41.67%）、2条动脉为主型（25%）、H型弓状动脉（12.5%）和网状动脉系统（20.83%）。然而，尿道下裂包皮更常表现为网状动脉系统（50%）。我们注意到，在更严重的尿道下裂包皮中，网状动脉系统的频率更高。
了解正常与尿道下裂包皮血管解剖结构的差异与尿道下裂手术密切相关。尿道下裂包皮的动脉血供与正常情况不同。更好地了解尿道下裂包皮的血管解剖结构可能会改善尿道下裂修复手术的效果。
