Esposito Ciro, Savanelli Antonio, Escolino Maria, Giurin Ida, Iaquinto Marianna, Alicchio Francesca, Roberti Agnese, Settimi Alessandro
Department of Pediatrics, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
Department of Pediatrics, Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
J Pediatr Urol. 2014 Apr;10(2):294-9. doi: 10.1016/j.jpurol.2013.09.003. Epub 2013 Oct 10.
Most surgical procedures for correction of hypospadias involve the removal of foreskin resulting in a circumcised penis. We report our experience and the medium-term results in the reconstruction of the foreskin during the correction of distal hypospadias.
Between January 2007 and December 2011, 445 patients aged between 8 and 120 months underwent surgical correction of hypospadias. In 354 out of 445 patients, we performed the reconstruction of the foreskin. Urethroplasty was performed according to either the TIPU (tubularized incised urethral plate urethroplasty; Snodgrass) technique (233/354, 66%) or MAGPI (meatal advancement glanduloplasty incorporated) procedure (121/354, 34%). In 91 out of 445 patients urethroplasty was performed using classic TIPU technique and they were circumcised. The cosmetic and functional results were evaluated using the Hypospadias Objective Penile Evaluation (HOPE) scoring system.
At a 12 months follow-up, 300 patients (84.7%) had retractable foreskin while 54 patients (15.3%) required postoperative steroid application. We had a total complication rate of 8.7%. As for preputioplasty, 16 patients (4.5%) had partial or total dehiscence of the reconstructed foreskin, one patient was circumcised for persistent phimosis (0.2%). As for urethroplasty complications, we recorded 11 fistulas (3.1%) and three stenosis (0.9%). The complication rate of the control group of circumcised patients was of 3.3% (2 fistulas [2.1%] and 1 stenosis [1.2%]).
Our experience shows that foreskin reconstruction can be performed successfully in selected patients with distal hypospadias. However, preputioplasty add an additional 4.7% complication rate. As for the complications of urethroplasty, it seems that preputioplasty does not increase the incidence of complications on the urethra reconstruction. We propose a new objective scoring system (modified HOPE score) for evaluation of esthetic and functional outcome.
大多数矫正尿道下裂的外科手术都需要切除包皮，导致阴茎呈环切状。我们报告了我们在远端尿道下裂矫正术中重建包皮的经验及中期结果。
2007年1月至2011年12月期间，445例年龄在8至120个月的患者接受了尿道下裂的外科矫正手术。在445例患者中的354例中，我们进行了包皮重建。尿道成形术根据TIPU（管状切开尿道板尿道成形术；Snodgrass）技术（233/354，66%）或MAGPI（尿道口前移阴茎头成形术）手术（121/354，34%）进行。在445例患者中的91例中，采用经典TIPU技术进行尿道成形术并进行了环切。使用尿道下裂客观阴茎评估（HOPE）评分系统评估美容和功能结果。
在12个月的随访中，300例患者（84.7%）包皮可回缩，54例患者（15.3%）术后需要应用类固醇。我们的总并发症发生率为8.7%。关于包皮成形术，16例患者（4.5%）重建的包皮出现部分或完全裂开，1例患者因持续性包茎接受了环切（0.2%）。关于尿道成形术并发症，我们记录了11例瘘管（3.1%）和3例狭窄（0.9%）。环切患者对照组的并发症发生率为3.3%（2例瘘管[2.1%]和1例狭窄[1.2%]）。
我们的经验表明，在选定的远端尿道下裂患者中可以成功进行包皮重建。然而，包皮成形术会额外增加4.7%的并发症发生率。至于尿道成形术的并发症，包皮成形术似乎不会增加尿道重建并发症的发生率。我们提出了一种新的客观评分系统（改良HOPE评分）用于评估美学和功能结果。
