巨尿道口伴完整包皮(MIP)型尿道下裂的认识和处理

目的 探讨巨尿道口伴完整包皮型尿道下裂的认识和处理.方法 回顾性分析2004年7月至2010年2月同一治疗组收治的巨尿道口伴完整包皮型尿道下裂病例.本组13例,年龄4岁5个月至12岁1个月,平均8岁1个月.就诊原因包括尿道口位置异常2例、阴茎外观短小1例、包茎10例.尿道开口于冠状沟3例,开口于阴茎远段10例.10例行尿道板纵切卷管尿道成形术(TIP)尿道成形,3例行Duplay尿道成形.术后随访3～45个月,平均9个月.结果 9例患儿成形尿道0.5～1.3 cm,平均0.9cm.术后尿瘘1例,再次手术矫治满意.其余病例外观满意,呈包皮环切术后外观,尿流尿线正常.结论 MIP型尿道下裂常因包茎手术时发现,阴茎弯曲多不明显,矫治时可保留尿道板,Duplay或TIP手术矫治效果满意.

Recognition and management of megameatus with intact prepuce (MIP): a variant of hypospadias

Objective To discuss the recognition and management of megameatus with intact prepuce (MIP) variant of hypospadias.Methods From July 2004 to Febrary 2010,patients diagnosed with MIP were treated by a single pediatric urology team.The clinical data were analysed retrospectively.Thirteen patients were included with a mean age of 8 years and 1 month (range from 4 years and 5 months to 12 years and 1 month).Results The referral reasons included obvious penile deformity in 2 cases,inconspicuous penis in 1,and penile deformity recognized at attempted circumcision in 10.The meatus was positioned at sulcus coronarius in 3 cases,and distal shaft in 10.Snodgrass procedure was applied in 10 cases and Duplay in 3 for surgical correction.The mean follow-up period was 9 months (range 3 to 45 months).The mean length of urethral replacement was 0.9cm (range 0.5 cm to 1.3 cm).All patients attained satisfactory cosmetic and functional results.One patient had a fistula but eventually had a satisfactory outcome with redo surgery.Conclusions MIP is usually noted when circumcision was attempted.TIP and Duplay procedures should lead to satisfactory outcome.