Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, United Kingdom.
Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, United Kingdom.
J Pediatr Urol. 2019 May;15(3):243.e1-243.e6. doi: 10.1016/j.jpurol.2019.02.007. Epub 2019 Feb 20.
The understanding of the aetiopathogenesis and the long-term outcomes of correctional repair of congenital megaprepuce (CMP) remains unestablished. Different techniques have been described; however, optimum results have been difficult to achieve.
The aim of our study was to review our experience of the 'anatomical approach' to the correction of CMP.
This is a retrospective review of boys who underwent CMP repair between 2003 and 2014. All of them had the anatomical approach: A curved incision is made between the scrotal and penile skin. Circumferential dissection superficial to Buck's fascia frees the penis and allows the scrotum to assume a more caudal position. The dissection distally lifts the preputial sac that is opened ventrally. The redundant inner preputial skin is excised. After full degloving, the dorsal flap of skin is thinned. The base of the flap is anchored, and the rectangle of skin is wrapped around the shaft. The remaining diamond-shaped incision is closed in a vertical line. Postoperatively, foam dressings and urethral catheter are left in place. Symptomatology, hospital stay, postoperative complications, redosurgery, voiding and cosmesis were evaluated.
Sixty-one patients had surgery at 5-151 months (median 17 months). Median hospital stay was 24 h (12-168 h). Foam dressings and urethral catheter were used in 47 boys and removed in outpatient clinic after 3-7 days. There were two immediate postoperative complications requiring surgery. One due to severe oedema and constriction ring, and the other had wound infection with wound breakdown, both in patients with no dressings (P < 0.05). Follow-up was available for 58 patients, with a median of 22 months (3-79 months). Two required redosurgery (3.5%), one with poor cosmetic result and one recurrence. In all patients, a normal circumcised appearance had been achieved and in 47, cosmetic result was excellent (81%). Five patients have residual suprapubic fat, and four, excess ventral skin. One with residual suprapubic fat has reached puberty and it has resolved. All declared good stream. The same technique was used for six patients with poor cosmetic result after surgery elsewhere. The outcome is excellent for all, with median follow-up of 20.5 months (5-31 months).
The 'anatomical' repair provides the ability to create the appearance of a standard circumcision, which is generally accepted as normality. Apart from the penis itself, this technique facilitates correction of the penoscrotal transposition, giving the external genitalia the best appearance. It seems to provide good functional and cosmetic outcomes, and it holds true at mid- to long-term follow-up. Dressings and catheter can potentially prevent postoperative complications. However, a prospective study with standardised parameters is required to confirm these findings.
先天性巨大包茎（CMP）的病因发病机制和长期治疗效果仍不明确。已经描述了不同的技术，但很难达到最佳效果。
我们旨在回顾我们采用“解剖学方法”治疗 CMP 的经验。
这是一项回顾性研究，纳入了 2003 年至 2014 年间接受 CMP 修复的男孩。所有患者均采用解剖学方法：在阴囊和阴茎皮肤之间做一个弧形切口。在 Buck 筋膜浅层进行环形解剖，游离阴茎并使阴囊更靠近尾部。解剖术可提起阴茎套状鞘的远端，将其向腹侧切开。切除多余的内层阴茎套状鞘皮肤。充分脱套后，皮瓣的背侧变薄。将皮瓣的底部固定，然后将矩形皮瓣包裹在阴茎上。剩余的菱形切口以垂直线闭合。术后，留置泡沫敷料和尿道导管。评估症状、住院时间、术后并发症、再次手术、排尿和美容效果。
61 例患者在 5-151 个月（中位数 17 个月）时接受手术。中位住院时间为 24 小时（12-168 小时）。47 例患儿使用泡沫敷料和尿道导管，3-7 天后在门诊取出。有 2 例患者术后立即出现并发症，需要手术治疗。1 例因严重水肿和缩窄环，1 例因无敷料的情况下发生伤口感染和伤口裂开（P<0.05）。58 例患者获得随访，中位数为 22 个月（3-79 个月）。2 例需要再次手术（3.5%），1 例美容效果不佳，1 例复发。所有患者均获得正常的环状阴茎外观，47 例患者（81%）美容效果极佳。5 例患者仍有耻骨上脂肪残留，4 例患者有多余的腹侧皮肤。1 例有耻骨上脂肪残留的患者已经进入青春期，且脂肪已经消退。所有患者排尿均正常。我们对 6 例在其他地方手术后美容效果不佳的患者采用相同的技术。所有患者的随访时间为 5-31 个月（中位数 20.5 个月），均获得了极佳的效果。
“解剖学”修复能够使阴茎外观接近标准的环状阴茎，这种外观通常被认为是正常的。除了阴茎本身，该技术还可以矫正阴茎阴囊转位，使外生殖器具有最佳的外观。该技术似乎能获得良好的功能和美容效果，且在中至长期随访中仍然有效。敷料和导管可能有助于预防术后并发症。但是，需要前瞻性研究来证实这些发现。
