The Microvessel Density Of Prepuce And Its Relationship To The Severity Of Hypospadias And The Postoperative Complications

Objective To investigate the mean preputial micro vessel density,its distribution and relationship with the severity and postoperative complications of hypospadias.Methods The experimental group consisted of children with hypospadias.The control group consisted of children with phimosis of the same age group.Excess dorsal foreskins of the patients in the experimental group and the control group were trimmed and retained before being embedded for sections with formalin fixation.In all sections of a sample,5 sections were randomly selected.Microvessel endothelial cells(CD31)were labeled with monoclonal antibody to show foreskin microvessels.A microvascular hotspot(more concentrated areas of microvessels)was discovered in each section under low magnification,and high magnification was used to calculate the number of microvessels in a single high magnification view as the value of microvessel density.The mean micro vessel density of the sample was calculated by taking the mean of 5 sections.Statistical analysis of the mean preputial microvessel density data in all experimental groups and control groups were conducted to find its distribution.Postoperative follow-up in hypospadiac children underwent urethra reconstruction was conducted for 1 year.Statistical analysis was performed to determine whether there was a correlation between the mean vascular density and the postoperative complications.Result Compared with the control group,more irregular foreskin microvessels and the uneven distribution were found in the experimental group under the microscope.The experimental groups were divided into the mild hypospadias group and the severe hypospadias group.The mean microvessel density in the mild hypospadias group(19.27±4.42)was statistically different from that in the severe hypospadias group(15.51 ±3.53).The mean microvessel density in the mild hypospadias group was not statistically different from that in the control group(21.64±6.39).The mean microvessel density in the severe hypospadias group was statistically different from that in the control group.Follow-up was performed in 36 children who underwent tubularized incised plate procedure.There were 3 cases of urethral fistula and 2 cases of urethral stricture.The median of mean microvessel density in control group was 21.8.All the cases we followed-up were divided into low density group(mean microvessel density was lower than 21.8)and high density group(mean micro vessel density was equal to or higher than 21.8).The incidence of complication in low density group(13.9%)was higher than that in high density group(0%).The incidence was statistically different.Two children with urethral stricture were treated with catheterization again and the urinary catheters were removed 2 to 3 weeks later.Three children with urethral fistula underwent operation again six months after first operation.All children were cured and no complications occurred.Conclusions Compared with that of the normal foreskin,preputial microvessels in hypospadias are more irregular and distributed unevenly.The mean preputial micro vessel density of children with severe hypospadias is significantly lower than that of the normal children.The more severe the hypospadias,the lower the mean preputial microvessel density,and the severity of the hypospadias is negatively correlated with the mean preputial microvessel density.The lower the mean preputial microvessel density,the higher the incidence of postoperative complication,and the mean preputial microvessel density of hypospadias is negatively correlated with the incidence of postoperative complication.The mean preputial micro vessel density value 21.8 can be used to evaluate the prognosis of operation clinically.