Prasad Gaurav, H Himanshu, Dhua Anjan Kumar, Kaushal Seema, Prabakaran Aswini, Lone Shahnaz Ahmad, Goel Prabudh, Agarwala Sandeep, Yadav Devendra Kumar, Sati Hem Chandra
Department of Paediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Department of Pathology, AIIMS, New Delhi, India.
Urol Res Pract. 2025 May 21;51(1):1-6. doi: 10.5152/tud.2025.24132.
Objective: Preputial flaps are frequently used in hypospadias repair, but the healing potential of preputial tissue remains a concern. This study aimed to evaluate the microvessel density (MVD) and growth factor receptor levels (VEGFR and TGF-!R) in the prepuce of patients with hypospadias compared to controls and to compare these parameters between the inner and outer preputial layers to determine their relative suitability for hypospadias repair. Methods: The study included children under 14 years of age undergoing primary distal hypospadias surgery as cases and individuals undergoing elective circumcision as controls. Specimens from the inner and outer prepuce were collected, and immunohistochemical staining was performed using CD31 antibodies to assess MVD and VEGFR and TGF-!R antibodies to evaluate growth factor levels. The staining intensity was semi- quantitatively analyzed using a histological scoring system. Results: Microvessel density was significantly higher in the inner prepuce than the outer prepuce in both cases and controls (P < .05), suggesting a potential advantage of inner prepuce tissue in hypospadias repair. Conversely, VEGFR levels were significantly higher in the outer prepuce in cases (P < .05), indicating different healing potentials between these layers. Transforming growth factor ! receptor levels were significantly lower in both the inner and outer prepuce of controls compared to cases (P < .05). Other findings did not reach statistical significance. Conclusion: The higher MVD in the inner prepuce suggests it may be preferable for hypospadias repair. However, the differential VEGFR levels between the inner and outer prepuce highlight complex healing dynamics, emphasizing the need for further research to draw definitive conclusions.
包皮瓣常用于尿道下裂修复，但包皮组织的愈合潜力仍令人担忧。本研究旨在评估尿道下裂患者包皮与对照组相比的微血管密度（MVD）和生长因子受体水平（VEGFR和TGF-βR），并比较包皮内外层之间的这些参数，以确定它们对尿道下裂修复的相对适用性。方法：该研究包括14岁以下接受原发性远端尿道下裂手术的儿童作为病例，以及接受选择性包皮环切术的个体作为对照。收集包皮内外层的标本，使用CD31抗体进行免疫组织化学染色以评估MVD，使用VEGFR和TGF-βR抗体评估生长因子水平。使用组织学评分系统对染色强度进行半定量分析。结果：病例组和对照组中，包皮内层的微血管密度均显著高于外层（P <.05），提示包皮内层组织在尿道下裂修复中具有潜在优势。相反，病例组中外层包皮的VEGFR水平显著更高（P <.05），表明这些层之间的愈合潜力不同。与病例组相比，对照组包皮内外层的转化生长因子β受体水平均显著更低（P <.05）。其他结果未达到统计学意义。结论：包皮内层较高的MVD表明其可能更适合尿道下裂修复。然而，包皮内外层之间VEGFR水平的差异突出了复杂的愈合动态，强调需要进一步研究以得出明确结论。
