Morris Brian J, Krieger John N
School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, New South Wales, Australia; University of Washington School of Medicine, Department of Urology, Seattle, WA.
School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, New South Wales, Australia; University of Washington School of Medicine, Department of Urology, Seattle, WA.
Urology. 2017 Dec;110:16-26. doi: 10.1016/j.urology.2017.07.027. Epub 2017 Aug 4.
Meatal stenosis (MS) as a potential complication of male circumcision and controversy regarding the magnitude of risk.
To conduct a systematic review and meta-analyses to assess (1) MS diagnosis after circumcision, (2) the potential association of MS with circumcision, and (3) a potential method of prevention.
PubMed, Google Scholar, Cochrane Library and bibliographies of original studies were searched using the keywords circumcision and stenosis or stricture.
Studies containing original data on MS following circumcision at any age.
Two reviewers independently verified study design and extracted data.
Thirty eligible studies were retrieved. A random effects meta-analysis of 27 studies (350 MS cases amongst 1,498,536 males) found that the risk of MS in circumcised males was 0.656% (95% confidence interval 0.435-0.911). Meta-analysis of 3 observational studies that compared MS prevalence in circumcised and uncircumcised males found non-significantly higher prevalence in circumcised males (odds ratio 3.20; 95% confidence interval 0.73-13.9). Meta-analysis of 3 randomized controlled trials investigating the effect of petroleum jelly application to the glans after circumcision found that this intervention was associated with MS risk reduction (relative risk 0.024; 95% confidence interval 0.0048-0.12).
MS risk after circumcision is low (< 1%). Weak evidence suggests that MS risk might be higher in circumcised boys and young adult males. Risk is reduced by petroleum jelly application. Further research on MS arising from lichen sclerosus in older uncircumcised males is needed.
尿道口狭窄（MS）是男性包皮环切术的一种潜在并发症，且关于风险程度存在争议。
进行系统评价和荟萃分析，以评估（1）包皮环切术后的MS诊断，（2）MS与包皮环切术之间的潜在关联，以及（3）一种潜在的预防方法。
使用关键词“包皮环切术”和“狭窄”检索了PubMed、谷歌学术、Cochrane图书馆以及原始研究的参考文献。
包含任何年龄包皮环切术后MS原始数据的研究。
两名评审员独立核实研究设计并提取数据。
检索到30项符合条件的研究。对27项研究（1498536名男性中有350例MS病例）进行的随机效应荟萃分析发现，包皮环切男性患MS的风险为0.656%（95%置信区间0.435 - 0.911）。对3项比较包皮环切和未包皮环切男性MS患病率的观察性研究进行的荟萃分析发现，包皮环切男性的患病率略高，但差异无统计学意义（优势比3.20；95%置信区间0.73 - 13.9）。对3项调查包皮环切术后在龟头涂抹凡士林效果的随机对照试验进行的荟萃分析发现，这种干预措施与MS风险降低相关（相对风险0.024；95%置信区间0.0048 - 0.12）。
包皮环切术后MS风险较低（<1%）。有微弱证据表明，包皮环切男孩和年轻成年男性患MS的风险可能更高。涂抹凡士林可降低风险。需要对未包皮环切老年男性因硬化性苔藓引起的MS进行进一步研究。
