Bhat Amilal, Bhat Mahakshit, Bhat Akshita, Singh Vikash
Department of Urology, Dr. S.N. Medical College, Jodhpur, Rajasthan, India.
Department of Surgery, M.G. Medical College, Jaipur, Rajasthan, India.
Indian J Urol. 2017 Oct-Dec;33(4):315-318. doi: 10.4103/iju.IJU_361_16.
The megameatus variant of anterior hypospadias with an intact complete foreskin occurs in approximately 1%-3% of hypospadias. Hence, the objective of the study was to evaluate the results of tubularized urethral plate urethroplasty (TUPU) in megameatus intact prepuce (MIP).
A retrospective study (June 1996-June 2015) of MIP from our hypospadias registry was conducted. All patients with megameatus, either with an intact prepuce or with one previously removed, were included in the study. Case sheets of clinical records, investigations, clinical photographs, and videos were reviewed. Patients were classified into, glanular, coronal, subcoronal, and distal penile. TUPU were done. Patients were called for follow-up at 1, 3, 6, and 12 months postoperatively, and then yearly for the assessment of the cosmetic appearance and fistula, meatal stenosis, or other complications.
Of 1026 patients with hypospadias, we identified 13 cases of megameatus variant of hypospadias; three of the 13 had been circumcized previously. Glanular approximation was done for the one patients of the glanular variant, and another had frenuloplasty. These two patients were excluded from the study. Incision in the inner preputial skin was closed in 10 patients to have an intact prepuce. Follow-up period varied from 6 months to 4 years (median follow-up 2½ years). None of the patients developed complications such as fistula, meatal stenosis, and/or wound dehiscence.
Surgical correction of MIP in the era of increased cosmetic awareness is justified. Excellent results are obtained with TUPU and along with spongioplasty and frenuloplasty because of availability of wide urethral plate and well-developed spongiosum in these patients. TUPU should be the preferred procedure in cases of MIP.
前尿道下裂合并完整包皮的巨尿道口变异型约占尿道下裂患者的1%-3%。因此，本研究的目的是评估管状化尿道板尿道成形术（TUPU）治疗巨尿道口完整包皮（MIP）患者的效果。
对我院尿道下裂登记处1996年6月至2015年6月期间的MIP患者进行回顾性研究。所有巨尿道口患者，无论包皮是否完整或之前是否已行包皮环切术，均纳入本研究。查阅临床记录、检查、临床照片及视频的病历资料。将患者分为龟头型、冠状沟型、冠状沟下型及阴茎远端型。行TUPU手术。术后1、3、6及12个月对患者进行随访，之后每年随访，评估外观及有无瘘管、尿道口狭窄或其他并发症。
在1026例尿道下裂患者中，我们确定了13例尿道下裂巨尿道口变异型患者；其中13例中有3例之前已行包皮环切术。对1例龟头型变异患者行龟头贴合术，另1例患者行系带成形术。这2例患者被排除在研究之外。10例患者的包皮内板切口予以缝合以保留完整包皮。随访时间为6个月至4年（中位随访时间2.5年）。所有患者均未出现瘘管、尿道口狭窄和/或伤口裂开等并发症。
在对外观要求日益提高的时代，对MIP进行手术矫正具有合理性。由于这些患者尿道板宽且海绵体发育良好，TUPU联合海绵体成形术和系带成形术可取得优异效果。TUPU应作为MIP病例的首选术式。
