Diagnosis and Treatment of Hypospadias With Megameatus Intact Prepuce
Diagnosis and Treatment of Hypospadias With Megameatus Intact Prepuce
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包皮过长尿道下裂的诊治
DOI：
10.3389/fped.2020.00128
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发表时间：
2020-03-31
影响因子：
2.6
通讯作者：
Ma, Shu Hua
中科院分区：
文献类型：
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作者：
Duan, Shou Xing;Li, Jianhong;Ma, Shu Hua
目的：探讨伴有巨大包皮完整包皮（MIP）的尿道下裂的诊断和治疗方法。 材料与方法：对27例MIP儿童进行回顾性分析，其中13例行管状切开板尿道成形术（TIP手术），7例行Duplay手术，5例行Mathieu手术，1例行尿道前移及尿道口成形术（MAGPI手术），1例行尿道口成形术。龟头近似手术（GAP）。对患者进行6-36个月的随访，通过小儿阴茎感知评分（PPPS）评估手术结果。结果：共有27例平均年龄为8.12+/-3.0岁的患者纳入本研究，其中25例（25/27，92.6%）在首次就诊时意外发现包茎。患者的尿道已形成0.5至1.5厘米。 27例患者中有4例（14.81%）出现并发症：尿道瘘2例，尿道口狭窄2例。 1例尿道瘘自愈，其余3例再次手术。所有患者术后效果满意，尿流及排尿时尿流正常。非手术外科医生和家长的总体平均 PPPS 评分令人满意。 Mathieu、TIP 和 Duplay 手术中的鼻道外观、龟头外观、皮肤外观和总体外观 PPPS 评分没有显着差异。结论：MIP 临床表现是隐蔽的，通常在尝试包皮环切术时注意到。应根据每个患者的解剖特征制定适合的手术，并且可以使用多种技术来获得良好的功能和美容效果。
Purpose: To evaluate the diagnosis and treatment methods of hypospadias with megameatus intact prepuce (MIP).Materials and Methods: A retrospective analysis was performed in 27 MIP children, 13 of whom underwent tubularized incised plate urethroplasty (TIP procedure), 7 underwent the Duplay procedure, 5 underwent the Mathieu procedure, 1 underwent meatal advancement and glanuloplasty (MAGPI procedure), and 1 underwent the glans approximation procedure (GAP). The patients were followed for 6-36 months to evaluate the surgical outcomes by the Pediatric Penile Perception Score (PPPS).Results: A total of 27 patients with a mean age of 8.12 +/- 3.0 years were enrolled in this study, and 25 cases (25/27, 92.6%) were accidentally discovered during the first visit for phimosis. The patients had a formed urethra of 0.5 to 1.5 cm. Complications occurred in 4 of the 27 patients (14.81%): 2 patients with urethral fistula and 2 patients with meatal stenosis. One patient had a case of self-healed urethral fistula, and the remaining 3 patients underwent reoperation. The post-operative effect was satisfactory in all patients, and the urinary flow and stream during urination were normal. The overall average PPPS score of non-operative surgeons and parents was satisfactory. There were no significant differences in meatus appearance, glans appearance, skin appearance, and general appearance PPPS score among the Mathieu, TIP, and Duplay surgical procedures.Conclusions: MIP clinical manifestations are concealed and usually noted when circumcision is attempted. The suitable procedure for each patient should be tailored according to the anatomic features, and several techniques can be used with good functional and cosmetic results.