Yadav Priyank, Bobrowski Adam, Ahmad Ihtisham, Kim Jin Kyu, Chancy Margarita, Alshammari Dheidan, Rickard Mandy, Lorenzo Armando J, Bagli Darius, Chua Michael E
Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada.
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Indian J Urol. 2024 Jan-Mar;40(1):17-24. doi: 10.4103/iju.iju_277_23. Epub 2023 Dec 29.
Congenital penile curvature (PC), often concomitant with hypospadias, poses challenges in urology. Surgical correction techniques, including plication and corporotomy, lack standardized guidelines. This study aims to address the paucity of high-level evidence by comprehensively reviewing the outcomes of PC correction procedures in patients with and without hypospadias. This will inform clinical decision-making and provide insights for future research and meta-analyses.
We conducted this scoping review in accordance with the JBI Manual for Evidence Synthesis and PRISMA-ScR guidelines. An extensive literature search was performed and comparative studies published in English up to June 2023 were included. The studies were divided into three categories: PC without hypospadias, PC with hypospadias, and studies comparing two or more materials for covering the ventral corporotomy. Data extraction comprised author details, patient characteristics, study design, interventions, outcomes, and complications. Methodological quality was assessed using the Newcastle-Ottawa Scale.
Forty-two studies were included in the review, which collectively comprised 3180 patients. Thirteen comparative studies reported the outcomes of surgery for congenital PC without hypospadias, 22 studies compared different techniques of PC correction in patients with hypospadias and 7 studies compared the type of materials for coverage following ventral corporotomy. In cases of PC without hypospadias, the most commonly reported surgery was the Nesbit's plication. For PC with hypospadias correction, the results of ventral corporotomy were superior to that of dorsal plication in most of the studies. The two-stage repair had better results when compared to the one-stage repair for patients with perineo-scrotal hypospadias. In studies comparing materials for coverage of ventral corporotomy, the tunica vaginalis flap or graft was utilized most commonly. The majority of the studies reported a success rate ranging from 85% to 100%. The methodological quality was high in all but four studies.
Plication procedures are generally preferred for PC without hypospadias, but they result in penile shortening. For those with hypospadias, corporotomy is associated with superior outcomes than plication, especially for those with severe curvature and redo procedures. For ventral corporotomy coverage, the tunica vaginalis flap or graft is the most commonly reported tissue in the literature.
先天性阴茎弯曲（PC）常与尿道下裂并发，给泌尿外科带来挑战。包括折叠术和白膜切开术在内的手术矫正技术缺乏标准化指南。本研究旨在通过全面回顾有无尿道下裂患者的PC矫正手术结果，以解决高级别证据匮乏的问题。这将为临床决策提供依据，并为未来的研究和荟萃分析提供见解。
我们按照JBI证据综合手册和PRISMA-ScR指南进行了这项范围综述。进行了广泛的文献检索，纳入了截至2023年6月以英文发表的比较研究。这些研究分为三类：无尿道下裂的PC、有尿道下裂的PC以及比较两种或更多种用于覆盖腹侧白膜切开处材料的研究。数据提取包括作者详情、患者特征、研究设计、干预措施、结果和并发症。使用纽卡斯尔-渥太华量表评估方法学质量。
本综述纳入了42项研究，共3180例患者。13项比较研究报告了无尿道下裂的先天性PC手术结果，22项研究比较了尿道下裂患者的不同PC矫正技术，7项研究比较了腹侧白膜切开术后覆盖材料的类型。在无尿道下裂的PC病例中，最常报告的手术是内斯比特折叠术。对于有尿道下裂矫正的PC，在大多数研究中，腹侧白膜切开术的结果优于背侧折叠术。对于会阴阴囊型尿道下裂患者，两阶段修复比一阶段修复效果更好。在比较腹侧白膜切开处覆盖材料的研究中，最常使用的是睾丸鞘膜瓣或移植片。大多数研究报告成功率在85%至100%之间。除四项研究外，所有研究的方法学质量都很高。
对于无尿道下裂的PC，通常首选折叠术，但会导致阴茎缩短。对于有尿道下裂的患者，白膜切开术的效果优于折叠术，特别是对于那些有严重弯曲和再次手术的患者。对于腹侧白膜切开术的覆盖，睾丸鞘膜瓣或移植片是文献中最常报道的组织。
