Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany.
Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany.
J Pediatr Urol. 2019 Aug;15(4):401.e1-401.e6. doi: 10.1016/j.jpurol.2019.05.018. Epub 2019 May 25.
Congenital megaprepuce is a malformation consisting of a great redundancy of the inner preputial skin over a penis with normal shaft and glans and is combined with a severe phimosis. Patients suffer from difficulties in voiding because the urine is trapped in the large dome-shaped megaprepuce. We describe a modification of the surgical technique of reconstructing a megaprepuce initially presented by Leao et al.
We retrospectively reviewed 7 patients aged 6-53 months (mean age 17 months, 6 were younger than 18 months) who underwent congenital megaprepuce repair between 02/2014 and 05/2018 in our institution. All these otherwise healthy children suffering from difficulties in voiding and reporting genital ballooning during micturition and urinary retention were referred to our hospital. In all cases, parents needed to express the trapped urine. Four of these patients additionally showed a glanular hypospadias, another one a distal penile hypospadias. In addition to the repair of the megaprepuce, six patients needed correction of a penile curvature, five of whom needed correction of the chordee and one a corporoplasty (Schröder-Essed). The patient showing the distal penile hypospadias additionally underwent hypospadias repair. During the follow-up, we evaluated the cosmetic result and complications such as secondary concealed penis, difficulties in voiding, urinary retention, and urinary infections.
Mean follow-up was 18 months. All patients following surgery showed normal voiding without urinary retention or urinary infections and good cosmetic results resembling a circumcised penis in appearance without reconcealment. No intraoperative complications occurred. One patient had a scrotal hematoma postoperatively. Mild transient edema of the penis was seen in all patients, which disappeared spontaneously within one week after surgery.
Our surgical approach is a safe and relatively simple procedure with a low rate of complications, good cosmetic results, and functional outcome. Whether the hypospadias associated with ventral curvature was a coincidence or part of the disease pattern remains unclear but will probably be the object of further investigations.
先天性巨大包茎是一种由阴茎内的多余内层包皮引起的畸形，其阴茎干和龟头正常，但伴有严重的包茎。患者排尿困难，因为尿液被困在巨大的圆顶状巨大包茎内。我们描述了一种由 Leao 等人最初提出的重建巨大包茎的手术技术的改良。
我们回顾性分析了 2014 年 2 月至 2018 年 5 月期间在我院接受先天性巨大包茎修复的 7 例年龄在 6-53 个月（平均年龄 17 个月，6 例小于 18 个月）的患者。所有这些患有排尿困难、报告排尿时生殖器膨胀和尿潴留的健康儿童均被转诊至我院。所有病例中，家长均需挤净潴留尿液。其中 4 例患儿还伴有龟头型尿道下裂，另 1 例伴有阴茎远端型尿道下裂。除修复巨大包茎外，6 例患儿还需要矫正阴茎弯曲，其中 5 例需要矫正阴茎下弯，1 例需要行阴茎海绵体白膜折叠术（Schröder-Essed）。伴有阴茎远端型尿道下裂的患儿还需要行尿道下裂修复术。在随访期间，我们评估了美容效果和并发症，如继发性隐匿阴茎、排尿困难、尿潴留和尿路感染。
平均随访时间为 18 个月。所有术后患儿排尿正常，无尿潴留或尿路感染，外观美观，类似行包皮环切术的阴茎，无隐匿。术中无并发症发生。1 例患儿术后出现阴囊血肿。所有患者均出现轻度、短暂的阴茎水肿，术后 1 周内自然消退。
我们的手术方法是一种安全、相对简单的手术，并发症发生率低，美容效果好，功能效果好。与腹侧弯曲相关的尿道下裂是巧合还是疾病模式的一部分尚不清楚，但可能会成为进一步研究的对象。
