University Medical Center Utrecht (UMC Utrecht), The Netherlands.
University Children's Hospital UMC Utrecht, The Netherlands.
J Pediatr Urol. 2019 Feb;15(1):47.e1-47.e9. doi: 10.1016/j.jpurol.2018.08.001. Epub 2018 Aug 20.
A normal penile cosmesis is an important goal in distal hypospadias repair. Depending on cultural standards, repairs are combined with a preputioplasty or circumcision to attain a 'normal' penile appearance. Although short-term complication rates of preputioplasty are available, data on long-term outcomes are scarce. Therefore, this study assessed long-term functional and cosmetic outcomes of distal hypospadias repair with either a preputioplasty or a circumcision.
Eligible for inclusion were patients with distal hypospadias operated in childhood between 1987 and 1993. Complications and reasons for secondary circumcision were extracted from the medical charts. Participants completed a questionnaire including the International Index of Erectile Function (IIEF-15), the International Prostate Symptom score (IPSS), and additional non-validated questions. Penile cosmesis was judged with the Penile Perception Score (PPS), stretched penile length was measured, and uroflowmetry was performed.
Of the 86 eligible and traceable patients, 40 (47%) participated; of them, 27 had a preputioplasty and 13 a circumcision. Six patients underwent a secondary circumcision due to a preputial defect (n = 2), unsatisfactory cosmetic result (n = 2), religious reason (n = 1), or phimosis (n = 1). Complication rates were similar in both the groups. Long-term outcomes in the preputioplasty and circumcision group were comparable regarding cosmetic, sexual, and micturition outcomes.
Distal hypospadias correction combined with preputioplasty had complication rates similar to those of hypospadias repair with circumcision. In these patients, preputioplasty had a failure rate of 22%. In both the groups, long-term outcomes of urinary function, sexual function, and cosmesis were good.
阴茎外观正常是修复远端型尿道下裂的重要目标。根据文化标准，修复术通常结合包皮成形术或包皮环切术，以获得“正常”的阴茎外观。尽管已有包皮成形术的短期并发症发生率数据，但长期结果数据却很少。因此，本研究评估了远端型尿道下裂修复术采用包皮成形术或包皮环切术的长期功能和美容结果。
纳入标准为 1987 年至 1993 年期间在儿童期接受远端型尿道下裂手术的患者。从病历中提取并发症和二次行包皮环切术的原因。参与者完成了一份问卷，其中包括国际勃起功能指数（IIEF-15）、国际前列腺症状评分（IPSS）和其他未经验证的问题。阴茎外观用阴茎感知评分（PPS）进行判断，测量伸展阴茎长度，并进行尿流率检查。
86 名符合条件且可追踪的患者中，有 40 名（47%）参与了研究；其中 27 名患者行包皮成形术，13 名患者行包皮环切术。6 名患者因包皮缺陷（n=2）、不满意的美容效果（n=2）、宗教原因（n=1）或包茎（n=1）而进行了二次包皮环切术。两组的并发症发生率相似。包皮成形术和包皮环切术组的美容、性功能和排尿结果的长期结果相似。
远端型尿道下裂矫正术联合包皮成形术的并发症发生率与包皮环切术相似。在这些患者中，包皮成形术的失败率为 22%。在两组中，尿功能、性功能和外观的长期结果均良好。
