Section of Paediatric Urology, Urology Unit, University Hospital of Padova , Padua , Italy.
Pediatric Surgery, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo" , Trieste , Italy.
Front Pediatr. 2016 Apr 28;4:41. doi: 10.3389/fped.2016.00041. eCollection 2016.
We performed a systematic review of the literature on preputial reconstruction (PR) during hypospadias repair to determine the cumulative risk of preputial skin complications and the influence of PR on urethroplasty complications, namely, fistula formation and overall reoperation rate of the repair.
A systematic search of the literature published after 06/1995 was performed in 06/2015 using the keyword "hypospadias." Only studies on the outcome of PR in children, defined as dehiscence of the reconstructed prepuce or secondary phimosis needing circumcision, were selected. A meta-analysis of studies comparing PR vs. circumcision was performed for the outcomes "hypospadias fistula formation" and "reoperation rate."
Twenty studies were identified. Nineteen reported the outcome of PR in 2115 patients. Overall, 95% (2016/2115) of patients undergoing PR had distal hypospadias. The cumulative rate of PR complications was 7.7% (163/2115 patients), including 5.7% (121/2115 patients) preputial dehiscences and 1.5% (35/2117 reported patients) secondary phimoses needing circumcision. A meta-analysis of seven studies comparing patients undergoing PR vs. circumcision showed no increased risk of urethral fistula formation associated with PR, odds ratio (OR) (Mantel-Haenszel, Fixed effect, 95% CI), 1.25 (0.80-1.97). Likewise, two studies comparing the overall reoperation rate did not show an increased risk of reoperation associated with PR, OR (Mantel-Haenszel, Random effect, 95% CI), 1.27 (0.45-3.58).
PR carries an 8% risk of specific complications (dehiscence of reconstructed prepuce or secondary phimosis needing circumcision), but does not seem to increase the risk of urethroplasty complications, and the overall reoperation rate of hypospadias repair.
我们对文献进行了系统性回顾，以了解在尿道下裂修复过程中进行包皮重建（PR）的相关内容，以确定包皮皮瓣并发症的累积风险，以及 PR 对尿道成形术并发症（即瘘管形成和修复术的总再手术率）的影响。
我们于 2015 年 6 月使用“尿道下裂”这一关键词对 1995 年 6 月后发表的文献进行了系统性搜索，仅选择研究儿童 PR 结果的文献，即重建包皮裂开或需要行包皮环切术的继发性包茎。对比较 PR 与包皮环切术的研究进行了“尿道下裂瘘管形成”和“再手术率”的荟萃分析。
共确定了 20 项研究。19 项研究报告了 2115 例患者的 PR 结果。总体而言，95%（2115 例患者中的 2016 例）接受 PR 的患者存在远端尿道下裂。PR 并发症的累积发生率为 7.7%（2115 例患者中的 163 例），包括 5.7%（2115 例患者中的 121 例）包皮裂开和 1.5%（35 例报告患者中的 35 例）需要行包皮环切术的继发性包茎。对 7 项比较 PR 与包皮环切术患者的研究进行荟萃分析显示，PR 与尿道瘘管形成的风险无显著增加，比值比（Mantel-Haenszel，固定效应，95%CI）为 1.25（0.80-1.97）。同样，两项比较总再手术率的研究也未显示 PR 与再手术风险增加相关，比值比（Mantel-Haenszel，随机效应，95%CI）为 1.27（0.45-3.58）。
PR 存在 8%的特定并发症风险（重建包皮裂开或继发性包茎需要行包皮环切术），但似乎不会增加尿道成形术并发症和尿道下裂修复术的总再手术率。
