Shokri Varniab Zahra, Pourabhari Langroudi Ashkan, Neishabouri Afarin, Torabinavid Parham, Arbab Mona, Heidari Firouzeh, Milani Seyed Mohammad, Eftekharzadeh Sahar, Sabetkish Shabnam, Kajbafzadeh Abdol-Mohammad
Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran.
Department of Radiation Oncology, Indiana University, Indianapolis, IN, USA.
Ir J Med Sci. 2023 Apr;192(2):707-711. doi: 10.1007/s11845-022-03040-8. Epub 2022 Jun 3.
Despite the simplicity of male circumcision, complications occur frequently. Post-circumcision meatal stenosis is a concerning complication that might require several interventions.
This study aims to evaluate the incidence of meatal stenosis in long-term follow-up, following three common circumcision methods: frenular artery preservation, frenular ligation, and the Plastibell device.
This study is the continuation of the previous randomized clinical trial, the preliminary abstract of which has been accepted in the annual meeting of the American Urological Association in 2011. However, in this paper, we only included the patients with results of long-term follow-up. Patients were followed for a median of 11 years (range, 7-17). Follow-ups were recorded by evaluation of meatus and signs and symptoms of meatal stenosis.
Two hundred six boys (80 neonates and 126 non-neonates) at the time of procedure were included in this study. The circumcision was conducted on 23.3% (48/206) of boys with the Plastibell device (PD) and 39.3% (81/206) of cases with frenular artery preservation (FAP) and 37.4% (77/206) of cases with frenular artery ligation (FAL). Meatal stenosis presented in 13 children during follow-up. Considering the three methods of circumcision, a significant difference in the incidence of meatal stenosis among the types of circumcisions was observed (6.3% in PD and 1.2% in FAP, 11.7% in FAL, P = 0.026).
The present study revealed that the technique preserving the frenular artery is associated with a significantly lower incidence of meatal stenosis. Hence, the FAP is the recommended technique for circumcision as compared to two other methods.
尽管男性包皮环切术操作简单，但并发症却经常发生。包皮环切术后尿道口狭窄是一种令人担忧的并发症，可能需要多次干预。
本研究旨在评估三种常见包皮环切术（保留系带动脉、系带结扎和包皮环套术）在长期随访中尿道口狭窄的发生率。
本研究是之前随机临床试验的延续，其初步摘要已于2011年在美国泌尿外科学会年会上被接受。然而，在本文中，我们仅纳入了有长期随访结果的患者。患者的中位随访时间为11年（范围7 - 17年）。通过评估尿道口以及尿道口狭窄的体征和症状来记录随访情况。
本研究纳入了206名手术时的男孩（80名新生儿和126名非新生儿）。采用包皮环套术（PD）的男孩占23.3%（48/206），采用保留系带动脉（FAP）的病例占39.3%（81/206），采用系带结扎（FAL）的病例占37.4%（77/206）。随访期间有13名儿童出现尿道口狭窄。考虑到三种包皮环切方法，观察到不同类型包皮环切术在尿道口狭窄发生率上存在显著差异（PD组为6.3%，FAP组为1.2%，FAL组为11.7%，P = 0.026）。
本研究表明，保留系带动脉的技术与显著更低的尿道口狭窄发生率相关。因此，与其他两种方法相比，FAP是推荐的包皮环切技术。
