巨尿道口伴完整包皮（MIP）型尿道下裂的认识和处理

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

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0．5～1．3cm，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。

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 i 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. 9 cm （range 0. 5 em 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.