Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA.
Department of Urology, New York-Presbyterian Weill Cornell Medical Center (MKH), New York, NY, USA.
J Pediatr Urol. 2018 Dec;14(6):545.e1-545.e4. doi: 10.1016/j.jpurol.2018.04.031. Epub 2018 Jun 8.
The desire to preserve the prepuce is often based on cultural norms. Recently, the concept of "genital autonomy" has been invoked to delay circumcision (or any genital altering procedure) until the individual reaches maturity and can make his or her own decision. However, some uncircumcised boys develop one or more episodes of balanitis resulting in scarring of the prepuce and pathologic phimosis which is difficult to treat. Herein we report on the management of severe phimosis and preputial scarring using preputial Z-plasties.
We reviewed the records of 28 patients, aged 3-12 years who underwent prepuce-sparing surgery within the previous 5 years with a minimum follow-up of 6 months. All patients were uncircumcised, with severe phimosis defined as a tight, pinpoint opening. All patients failed to respond to 6-10 weeks of betamethasone treatment. All parents requested preservation of as much of the foreskin as possible.
All patients healed satisfactorily, without infection, hematoma, or flap necrosis. One child developed mild scarring which responded to local steroid application. At follow-up evaluation, ranging from 6 to 24 months, the prepuce was fully retractable in all patients (Fig.).
Excision of the scarred preputial ring results in a circular suture line, which is in essence a straight line, curved and connected at each end, and this is likely to contract over time. The principle of Z-plasty can be exploited to elongate and interrupt the straight line, preventing contracture thus widening and sparing the prepuce.
保留包皮的愿望通常基于文化规范。最近，“生殖器自主权”的概念被援引，以延迟割礼（或任何生殖器改变程序），直到个人达到成熟并能够做出自己的决定。然而，一些未割礼的男孩会出现一次或多次龟头炎，导致包皮疤痕和病理性包茎，难以治疗。在此，我们报告使用包皮 Z 成形术治疗严重包茎和包皮疤痕的情况。
我们回顾了过去 5 年内 28 名年龄在 3-12 岁之间接受包皮保留手术的患者的记录，随访时间至少为 6 个月。所有患者均未割礼，严重包茎定义为紧的、针尖状的开口。所有患者对 6-10 周的倍他米松治疗均无反应。所有家长都要求尽可能保留更多的包皮。
所有患者均愈合良好，无感染、血肿或皮瓣坏死。1 名儿童出现轻度疤痕，局部应用类固醇后得到缓解。在 6 至 24 个月的随访评估中，所有患者的包皮均可完全缩回（图）。
切除疤痕包皮环会导致圆形缝线，本质上是一条直线，在两端弯曲并连接，这可能会随着时间的推移而收缩。Z 成形术的原理可用于延长和中断直线，防止收缩，从而扩大并保留包皮。
