Shoor Gunjan, Sugandhi Nidhi, Acharya Samir Kant, Chakraborty Goutam, Teckchandani Narinder, Dixit Anand, Kour Harshita, Bagga Deepak
Department of Paediatric Surgery, VMMC and Safdarjung Hospital, New Delhi, India.
Department of Paediatric Surgery, VMMC and Safdarjung Hospital, New Delhi, India.
J Pediatr Urol. 2020 Jun;16(3):319.e1-319.e7. doi: 10.1016/j.jpurol.2020.04.014. Epub 2020 Apr 21.
Preputioplasty as a part of hypospadias repair restores the normal appearance of phallus, which is especially important in distal and mid penile hypospadias. However possibility of its inherent complications such as iatrogenic phimosis or preputial breakdown are the cause of controversy and reluctance regarding this procedure.This study evaluates the results of preputial reconstruction with TIP urethroplasty in distal and mid penile hypospadias repair and analyses if preputioplasty may be offered to these patients.
MATERIALS & METHODS: In this prospective observational study, 48 cases of distal and mid penile hypospadias underwent TIP urethroplasty and preputioplasty and results were assessed at 2 weeks, 3 months and 6 months. Major complications included preputial dehiscence, tight prepuce (iatrogenic phimosis) and minor complications included ventral tethering, persistent dorsal whorls and redundant prepuce. Data was analysed with Microsoft Excel spreadsheet where descriptive statistics were obtained.
Preputioplasty was performed in 48 children with a mean age of 5.1 years. Preputioplasty dehiscence was seen in three (6%) patients, which gave an appearance of irregular prepuce on 6 m follow up. Two patients (4%) were confirmed to have preputial tightness at 3 months but this resolved conservatively in one patient and only one patient (2%) required circumcision for a tight prepuce. Minor complications included ventral tethering, persistence of dorsal whorls and redundant prepuce. Ventral tethering was present in 3 patients (6.25%). Redundant prepuce was observed in 2 patients (4.16%). Additionally, unsightly dorsal whorls were found to be persistent in 2 children (4.16%). None of these patients opted for circumcision. The rest of the children had a cosmetically and functionally normal prepuce. Two patients (4%) developed urethrocutaneous fistula at 3 months' follow-up.
Preputial reconstruction is feasible with a good cosmetic outcome and minimal complications in patients of distal and mid penile hypospadias undergoing TIP urethroplasty. Mild preputial tightness evolves over time and resolves with conservative measures. In patients with very prominent dorsal whorls and underlying bulky tissues the preputioplasty does not appear to be of satisfactory cosmesis. To help the patient and parents take a well informed decision, it would be useful to explain all possible major and minor foreskin complications, and their rectification.
包皮成形术作为尿道下裂修复的一部分，可恢复阴茎的正常外观，这在阴茎远端和中段尿道下裂中尤为重要。然而，其固有并发症如医源性包茎或包皮破裂的可能性，是关于该手术存在争议和顾虑的原因。本研究评估了在阴茎远端和中段尿道下裂修复中采用尿道口前移阴茎头成形术（TIP）进行包皮重建的结果，并分析是否可以对这些患者施行包皮成形术。
在这项前瞻性观察研究中，48例阴茎远端和中段尿道下裂患者接受了TIP尿道成形术和包皮成形术，并在2周、3个月和6个月时评估结果。主要并发症包括包皮裂开、包皮过紧（医源性包茎），次要并发症包括阴茎腹侧粘连、持续性阴茎背侧包皮螺旋和包皮过长。数据用Microsoft Excel电子表格进行分析，得出描述性统计结果。
48名儿童接受了包皮成形术，平均年龄为5.1岁。3例（6%）患者出现包皮成形术裂开，在6个月随访时包皮外观不规则。2例（4%）患者在3个月时被证实存在包皮过紧，但其中1例经保守治疗后缓解，只有1例（2%）患者因包皮过紧需要行包皮环切术。次要并发症包括阴茎腹侧粘连、阴茎背侧包皮螺旋持续存在和包皮过长。3例（6.25%）患者存在阴茎腹侧粘连。2例（4.16%）患者观察到包皮过长。此外，2名儿童（4.16%）的阴茎背侧包皮螺旋外观不佳且持续存在。这些患者均未选择包皮环切术。其余儿童的包皮在外观和功能上均正常。2例（4%）患者在3个月随访时出现尿道皮肤瘘。
对于接受TIP尿道成形术的阴茎远端和中段尿道下裂患者，包皮重建是可行的，美容效果良好，并发症最少。轻度包皮过紧会随时间发展，可通过保守措施缓解。对于阴茎背侧包皮螺旋非常明显且下方组织肥厚的患者，包皮成形术的美容效果似乎并不理想。为帮助患者及其家长做出明智的决定，解释所有可能的包皮主要和次要并发症及其矫正方法会很有帮助。
