改良切口的套袖式包皮环切术和包皮背侧切开术

目的:探讨改良切口的套袖式包皮环切术和包皮背侧切开术治疗包皮过长及包茎的方法和效果。方法:采用改良切口的套袖式包皮环切术和包皮背侧切开术治疗包皮过长及包茎患者576例。将传统的包皮内、外板椭圆形切口改良为两个相对的曲线切口,保留完整的包皮系带。结果:患者术中出血少,术后伤口水肿轻,恢复快,无皮下硬结,切口愈合后外形美观。结论:改良切口的套袖式包皮环切术和包皮背侧切开术对包皮过长及包茎患者治疗效果满意。     

Clinical application of a new device for minimally invasivecircumcision

Objective:Aim:To study the clinical effects of a disposable circumcision device in treatment of male patients of different ageswith either phimosis or excess foreskin.Methods:One thousand two hundred patients between the age of 5 and 95years underwent circumcision using this procedure in the 2-year period between October 2005 and September 2007.Of these cases,904 had excess foreskin and 296 were cases of phimosis.Results:In 96.33% of the cases theincision healed,leaving a minimal amount of the inner foreskin with no scarring and producing good cosmetic results.There were no incidents of device dislocation or damage to the frenulum.The average operative time was 2.5 min forexcess foreskin,and 3.5 min for phimosis.During the 7 days of wearing the device,mild to moderate edemaoccurred in 10.08 % of cases with excess foreskin and in 2.58 % of those with phimosis.Edema in the frenulum wasseen in 1.67% of patients,and only 0.67% had an infection of the incision.A total of 86.25% of patients reported paindue to penile erection.After removal of the device,0.58% of the cases had minimal bleeding around the incision,and2.42% had wound dehiscence.Conclusion:The new device can be applied to an overwhelming majority of patientswith phimosis and excess foreskin.This technique is relatively simple to perform,and patients who underwent thissurgery had very few complications.Antibiotics were not required and patients reported less pain than those whowere circumcised using conventional methods.Circumcision with this device requires minimal tissue manipulation,and is quicker and safer than circumcision using conventional techniques.     

Meatus tightly covered by the prepuce is associated with urinary infection

BACKGROUND: Almost all newborns have phimosis, which is known as one of the risk factors for urinary infection. The present study analyzed which specific prepuce conditions correlated with the development of febrile urinary infection in Japanese male infants. METHODS: The subjects consisted of 100 children, 64 boys and 36 girls, with febrile urinary infection. Prepuces were classified by their retractability in the male patients and in 714 healthy boys. RESULTS: Ninety-four percent of first febrile urinary infections occurred before 7 months of age in boys, whereas only 37% of the girls had first infections by that age. The prepuce covered the external urethral meatus in 96% of the healthy boys aged 3 years or less. A gentle retraction maneuver could not uncover the urethral meatus in approximately 40% of the boys aged 0-6 months. The frequency started to decline spontaneously after that age. Male patients aged 0-6 months significantly more often had tightly covered meatus than did healthy neonates (85%vs 42%, P < 0.0001). CONCLUSIONS: These findings indicate that it is specifically those boys whose external urethral meatus are tightly covered with foreskin who constitute the high-risk group for urinary infection. Awareness of this observation should help with diagnosing and managing urinary infection in young boys.     

无痛液压扩张法治疗小儿假性包茎的临床应用

目的探讨无痛液压扩张法治疗小儿假性包茎的临床效果。方法自2009年7月至2019年1月应用无痛液压扩张法治疗小儿假性包茎489例。采用利多卡因凝胶充分麻醉包茎腔隙后,以注射器液压注射扩张包皮,于充分扩张后以手法翻开包皮。结果本组中327例患儿通过1次扩张成功翻开包皮;48例通过2次扩张翻开包皮;29例通过3次扩张翻开包皮;总成功率83%。其余85例患者转为手术治疗。术后随访1个月,效果较满意。结论采用无痛液压扩张法治疗小儿假性包茎,效果较明显,疼痛反应小,且家长可陪同治疗,是一种较好的治疗方法,值得临床推广。     

Preputial Bacterial Colonisation in Preschool and Primary School Children

Objectives: Preputial bacterial colonisation was investigated in preschool and primary school children with and without phimosis before the circumcision procedure. Method: The study group consisted of 32 boys admitted to our clinic consecutively between June 2003 and September 2003 for circumcision. The indication for surgery was religious belief in all patients. Immediately before the procedure, a swab was swept circumferentially once around the surface of the glans starting just proximal to the urethral meatus. In case of phimosis the same procedure was performed after complete retraction of the foreskin avoiding external contamination. The cultures were repeated in all patients after cleansing the glans and nearby preputium with polyvidon-iodine solution. Results: The mean age of the patients’ was 6 (4–12) years. All 5 (100%) patients with phimosis had clinically significant (≥100,000 cfu/ml) uropathogenic bacterial colonisation. In 27 (84.3%) patients without phimosis culture reports revealed the absence of growth in 8 (29.6%) patients while 3 (11.1%) had Diphteroids and 1 (3.7%) had α-haemolytic Streptococci isolated from their preputial swabs which were accepted as harmless skin commensals. The rest of the boys (55.5%) had uropathogenic species in their preputium and all except 2 (7.4%) cases had counts exceeding 100,000 cfu/ml. The overall rates for individual species including any count were found as E. coli 3.1%, Klebsiella 18.8%, coagulase-negative Staphylococci12.5% and Enterococcus 43.8%. Cleansing of perimeatal and periurethral region with 10% polyvidon-iodine solution markedly decreased the bacterial count in 80% of the patients with phimosis. Including eight patients with no growth before cleansing 88.9% of the patients in the non-phimosis group were free of preputial bacteria after cleansing with iodine solution. Conclusion: Significant preputial colonisation with uropathogens might still be present in preschool and primary school children.     

Histology and immunohistochemical evaluation of phimotic prepuce: The role of steroid therapy

Phimosis is one of the most frequent andrological diseases in paediatric age. Steroids are useful to treat phimosis. Through a retrospective study of histological and immunohistochemical analysis, we evaluated the effectiveness of topical steroid treatment in patients undergoing circumcision. Cases of patients treated for phimosis were selected during the two-year study period. All patients underwent circumcision and were divided into four groups: groups A (religiously circumcised patients), B (phimotic patients not undergoing steroid treatment), C (phimotic patients who do not respond to cortisone treatment) and D (hypospadic patients undergoing urethroplasty). An histological evaluation of the degree of fibrosis and an immunohistochemical evaluation of collagen IV and tenascin were carried out. Study results demonstrate that the grade of fibrosis is age-related. On histological and immunohistochemical evaluation, fibrosis was found to be lower in patients receiving steroids; higher degrees of fibrosis were found in older patients (p < .05). Different degrees of fibrosis have also been found in hypospadic patients. We can conclude that study results correlated with the clinical history of the patients. The success rate of medical therapy seems to be age-related.     

早期扩张法治疗小儿包茎的临床研究

目的：探讨早期扩张法治疗小儿包茎的可行性及疗效。方法：收治包茎患儿120例,随机分为治疗组和对照组,治疗组行扩张分离术,对照组行包皮环切术,比较治疗效果。结果：120例患儿中有3例患儿因疼痛而退出。在观察期内,治疗组的治疗时间（2．0±1．2）分钟及术后疼痛持续时间（2．1±1．2）小时均小于对照组,差异具有统计学意义（P〈0．05）;治疗组的术后水肿、瘢痕形成及感染发生例数等均小于对照组,差异具有统计学意义（P〈0．05）。结论：早期扩张法治疗小儿包茎是一种安全、有效的方法。     

CO2激光Colles筋膜外包皮环切术临床应用探讨

目的研究CO2激光Colles筋膜外包皮环切法的优越性。方法对600例包茎、包皮过长患者,采用CO2激光包皮分层环切法,术中用CO2激光在Colles筋膜外疏松结缔组织中剥离内、外板皮肤组织,避免损伤阴茎背静脉及淋巴管。术后观察阴茎外观、水肿、伤口恢复及功能情况。结果600例患者伤口均一期愈合,阴茎水肿程度轻、恢复快、外形美观。422例患者随访3—12个月,患者对外形、功能满意。结论CO2激光Colles筋膜外包皮分层环切法术后恢复快、外形美观、功能良好,是一种理想的包皮环切方法。值得临床推广。     

Circumcision with plastic Alisclamp technique in 4733 boys: our experiences to reduce complications

Background/aim We aim to report the outcomes of circumcisions performed with Alisclamp and our experiences to reduce the complications.Material and methodsComplications among circumcised males with Alisclamp between 2015 and 2018 were retrospectively analyzed. Patients were divided into two groups: Group 1 (n = 1429); patients circumcised in 2015–2016 and Group 2 (n = 3304); patients circumcised in 2017–2018. The different technical approaches in Group 2 are as follows: 1) Prevention of bleeding: In Group 2, we didn’t pull the ventral prepuce to reduce the risk of frenulum injury and the foreskin was excised approximately 1–2 mm above the base. 2) Prevention of secondary phimosis: In Group 2, regular manual pressure had been applied to mons pubis and we postponed some of the overweight children’s circumcision. 3) Prevention of excessive foreskin: The clamp was placed carefully to prevent the glans from moving back and forth.Results Secondary phimosis was significantly lower in Group 2 (p = 0.003). Total bleeding and bleeding requiring suturing were significantly lower in Group 2 (p = 0.001 and p = 0.026, respectively). ConclusionTechnique-specific complications of Alisclamp can reduce with technique-specific modifications.