Nonomura K, Kakizaki H, Shimoda N, Koyama T, Murakumo M, Koyanagi T
Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan.
Eur Urol. 1998 Oct;34(4):368-71. doi: 10.1159/000019742.
A variant form of anterior hypospadias, called a megameatus and intact prepuce (MIP), is thought to be less amenable to conventional distal hypospadias repair. The feasibility of using the standard technique with a parameatal-based foreskin flap is described herein.
Nine children with the MIP variant underwent repair. A foreskin flap for urethroplasty was harvested from either the ventral (Mathiew) or unilateral site. The glans was split along with the cleft glanular groove to create the glans wings. The flap was laid on the urethral plate to form a neourethra, and glanulomeatoplasty was completed by approximation of the glans wings. Sleeve reapproximation of the penile foreskin was performed for uncircumcised skin closure.
The functional and cosmetic results of the procedure were excellent in 8 cases including 1 with temporary postoperative edema of redundant foreskin. The last case underwent excision of the ventral excess foreskin for cosmetic reasons.
Although the etiology of the MIP variant remains obscure, the urethral plate distal to the meatus is uniformly pliable and healthy in this variant. Furthermore, the ventral portion just proximal to the meatus is well developed and not atretic so that the parameatal ventral foreskin is safely harvested for onlay urethroplasty.
一种名为巨尿道口及完整包皮（MIP）的前尿道下裂变异形式，被认为较难采用传统的远端尿道下裂修复方法。本文描述了使用基于尿道口旁包皮瓣的标准技术的可行性。
9例患有MIP变异的儿童接受了修复手术。用于尿道成形术的包皮瓣取自腹侧（马蒂厄法）或单侧部位。将龟头与裂开的龟头沟一起劈开以形成龟头翼。将皮瓣置于尿道板上以形成新尿道，通过使龟头翼靠拢完成龟头尿道口成形术。对于未行包皮环切术的患儿，进行阴茎包皮的袖套式重新缝合以闭合皮肤。
8例手术的功能和美容效果极佳，其中1例术后出现包皮冗余的暂时性水肿。最后1例出于美容原因切除了腹侧多余的包皮。
尽管MIP变异的病因仍不明确，但在这种变异中，尿道口远端的尿道板始终是柔韧且健康的。此外，尿道口近端的腹侧部分发育良好且无闭锁，因此可以安全地获取尿道口旁腹侧包皮用于覆盖尿道成形术。
