Moriya Kimihiko, Nakamura Michiko, Nishimura Yoko, Kitta Takeya, Kanno Yukiko, Chiba Hiroki, Kon Masafumi, Shinohara Nobuo
Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo, 060-0824, Japan.
World J Urol. 2016 Sep;34(9):1317-21. doi: 10.1007/s00345-016-1763-0. Epub 2016 Jan 20.
To evaluate actual post-pubertal penile size and factors affecting it in hypospadias patients, we retrospectively reviewed medical charts.
Hypospadias patients whose external genitalia were categorized into Tanner stage 5, and whose stretched penile length was evaluated at 15 years old or older from April 2008 to April 2015, were enrolled in the present study. Stretched penile length was measured by a single examiner. Actual post-pubertal stretched penile length and factors affecting the post-pubertal stretched penile length were estimated. Statistical analysis was performed using Mann-Whitney U test and univariate and multivariate linear regression models for the determination of independent factors.
Thirty patients met the inclusion criteria. Median age at evaluation was 17.2 years. Thirteen and 17 had mild and severe hypospadias, respectively. Endocrinological abnormality was identified in 5. Multivariate analysis showed that the severity of hypospadias and endocrinological abnormality were significant factors affecting stretched penile length. Stretched penile length in 25 patients without endocrinological abnormality was significantly longer than that in those with endocrinological abnormality (p = 0.036). Among patients without endocrinological abnormality, stretched penile length in 13 with severe hypospadias was significantly shorter than that in 12 with mild hypospadias (p = 0.004).
While the severity of hypospadias and endocrinological abnormality at post-pubertal evaluation were factors affecting post-pubertal penile size, stretched penile length in patients with severe hypospadias was shorter even in cases without endocrinological abnormality. These results suggest that severe hypospadias is not only a disorder of urethral development, but also a disorder of penile development.
为评估尿道下裂患者青春期后的实际阴茎大小及其影响因素，我们回顾性分析了病历。
本研究纳入了2008年4月至2015年4月期间外生殖器处于坦纳5期、且在15岁及以上时评估了阴茎牵拉长度的尿道下裂患者。阴茎牵拉长度由一名检查者测量。评估青春期后的实际阴茎牵拉长度及其影响因素。采用曼-惠特尼U检验以及单变量和多变量线性回归模型进行统计分析，以确定独立因素。
30例患者符合纳入标准。评估时的中位年龄为17.2岁。其中13例和17例分别患有轻度和重度尿道下裂。5例存在内分泌异常。多变量分析显示，尿道下裂的严重程度和内分泌异常是影响阴茎牵拉长度的重要因素。25例无内分泌异常患者的阴茎牵拉长度显著长于有内分泌异常的患者（p = 0.036）。在无内分泌异常的患者中，13例重度尿道下裂患者的阴茎牵拉长度显著短于12例轻度尿道下裂患者（p = 0.004）。
青春期后评估时尿道下裂的严重程度和内分泌异常是影响青春期后阴茎大小的因素，即使在无内分泌异常的情况下，重度尿道下裂患者的阴茎牵拉长度也较短。这些结果表明，重度尿道下裂不仅是尿道发育障碍，也是阴茎发育障碍。
