Miglani Harparkash Singh, Agrawal Vikesh, Das Debjani
Child Surgery Centre, Miglani Hospital, Amritsar, Punjab, India.
Department of Pediatric Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India.
J Indian Assoc Pediatr Surg. 2025 Sep-Oct;30(5):648-656. doi: 10.4103/jiaps.jiaps_57_25. Epub 2025 Jul 25.
Hypospadias repair has traditionally involved tubularized incised plate urethroplasty, often necessitating circumcision or preputial sacrifice due to dartos flap usage for waterproofing. However, many parents prefer preputial preservation for cultural and aesthetic reasons. No standardized technique currently exists for preputial reconstruction in distal and mid-penile hypospadias. We describe the hypospadias penile skin landmarks (HPS landmarks) technique based on ventral raphe classification and dorsal skin landmarks, a refined surgical approach leveraging natural penile skin creases to facilitate effective preputial reconstruction while maintaining functional and cosmetic outcomes.
This prospective study, conducted at two centers in India (January 2021-June 2024), included 67 patients (6 months-18 years) with distal and mid-penile hypospadias. A new classification system for ventral raphe and dorsal skin landmarks was proposed to guide preputial reconstruction. Surgical principles involved three key steps: (1) identifying and marking anatomical skin landmarks, (2) selective tissue dissection and preservation, and (3) midline approximation for symmetrical preputial restoration. Functional and cosmetic outcomes, including urethral patency, urinary stream, preputial symmetry, and complications, were assessed postoperatively.
Among 67 cases (52 distal, 15 mid-penile hypospadias), the median age was 14 months, and the mean operative time was 110 ± 18 min. Urethrocutaneous fistula occurred in two patients (2.98%), preputial dehiscence in two (2.98%), and three (4.48%) exhibited persistent dorsal hooding. No cases of glans dehiscence, metal stenosis, or residual chordee were noted. Parental satisfaction was high, with favorable functional and aesthetic outcomes.
The HPS landmarks technique provides a refined surgical approach to preputial reconstruction in distal and mid-penile hypospadias, preserving prepuce integrity while ensuring functional and cosmetic success. By leveraging anatomical skin creases using the described classification, this technique minimizes preputial complications and offers a culturally acceptable alternative for patients desiring preputial preservation. Further long-term studies are warranted to validate its widespread applicability.
传统上，尿道下裂修复术采用管状切开包皮板尿道成形术，由于使用肉膜瓣进行防水处理，常常需要进行包皮环切术或牺牲包皮。然而，出于文化和美学原因，许多家长更倾向于保留包皮。目前，对于阴茎远端和中段尿道下裂的包皮重建，尚无标准化技术。我们描述了基于腹侧中线分类和背侧皮肤标志的尿道下裂阴茎皮肤标志（HPS标志）技术，这是一种经过改进的手术方法，利用阴茎自然皮肤褶皱，在保持功能和美观效果的同时，促进有效的包皮重建。
这项前瞻性研究在印度的两个中心进行（2021年1月至2024年6月），纳入了67例年龄在6个月至18岁之间的阴茎远端和中段尿道下裂患者。提出了一种新的腹侧中线和背侧皮肤标志分类系统，以指导包皮重建。手术原则包括三个关键步骤：（1）识别和标记解剖学皮肤标志；（2）选择性组织解剖和保留；（3）中线对合以实现对称的包皮修复。术后评估功能和美观效果，包括尿道通畅性、尿流、包皮对称性和并发症。
67例患者中（52例阴茎远端尿道下裂，15例阴茎中段尿道下裂），中位年龄为14个月，平均手术时间为110±18分钟。2例患者（2.98%）发生尿道皮肤瘘，2例（2.98%）出现包皮裂开，3例（4.48%）存在持续性背侧包皮过长。未发现龟头裂开、尿道狭窄或残留阴茎下弯病例。家长满意度较高，功能和美观效果良好。
HPS标志技术为阴茎远端和中段尿道下裂的包皮重建提供了一种改进的手术方法，在确保功能和美观成功的同时，保留了包皮的完整性。通过使用所描述的分类方法利用解剖学皮肤褶皱，该技术可将包皮并发症降至最低，并为希望保留包皮的患者提供一种在文化上可接受的替代方案。需要进一步的长期研究来验证其广泛适用性。
