Elbakry Adel, Matar Adel, Zalata Khaled, Zakaria Ahmed, Al Atrash Gamal
Suez Canal University, Ismailia, Egypt,
Int Urol Nephrol. 2015 Feb;47(2):217-22. doi: 10.1007/s11255-014-0881-0. Epub 2014 Nov 20.
To assess healing potential of the inner and the outer layers of the prepuce and to determine which layer is better for hypospadias neourethral reconstruction.
The study has been carried out to assess the microvessels density and epidermal growth factor receptor (EGFR) concentration in the inner and the outer preputial layers. Specimens from the outer and the inner prepuce were harvested during hypospadias repair in 26 children. Control specimens were collected during elective circumcision of 10 normal and age-matched children. Sections were prepared, and immunohistochemical staining was done using monoclonal antibodies of CD34 (vascular marker) and of the EGFR. CD34-positive microvessels were assessed under the outer and the inner layers of the prepuce and were counted in five high-power fields under each layer. Expression of EGFR in both layers was assessed using H-score system.
The density of microvessels and EGFR expression are significantly higher in control group either for inner or for outer preputial layers (p < 0.05). Microvessels density in the inner prepuce in hypospadias group is slightly higher than that of the outer prepuce (p < 0.05). However, the wider lumen and well-developed wall of the microvessels in the outer layer may compensate for decreased number in comparison with the inner layer. Expression of EGFR was reduced in both inner and outer layers of the hypospadias prepuce with no significant difference (p > 0.05).
In hypospadias patients, the healing potential of both inner and outer prepuce is nearly similar. However, it is markedly reduced than that of normal prepuce. It seems that both layers can be used for hypospadias repair without obvious preference to either of them. The usual tradition to use inner prepuce in hypospadias repair has no scientific evidence.
评估包皮内外层的愈合潜力，并确定哪一层更适合用于尿道下裂的新尿道重建。
本研究旨在评估包皮内外层的微血管密度和表皮生长因子受体（EGFR）浓度。在26例儿童尿道下裂修复术中采集包皮外层和内层的标本。对照组标本取自10例年龄匹配的正常儿童的择期包皮环切术。制备切片，使用CD34（血管标记物）和EGFR的单克隆抗体进行免疫组织化学染色。评估包皮外层和内层下的CD34阳性微血管，并在每层的五个高倍视野中计数。使用H评分系统评估两层中EGFR的表达。
无论是包皮内层还是外层，对照组的微血管密度和EGFR表达均显著更高（p < 0.05）。尿道下裂组包皮内层的微血管密度略高于外层（p < 0.05）。然而，与内层相比，外层微血管更宽的管腔和更发达的管壁可能弥补了数量的减少。尿道下裂包皮的内层和外层中EGFR的表达均降低，无显著差异（p > 0.05）。
在尿道下裂患者中，包皮内外层的愈合潜力几乎相似。然而，与正常包皮相比，其明显降低。似乎两层均可用于尿道下裂修复，对两者无明显偏好。在尿道下裂修复中使用包皮内层的传统做法没有科学依据。
