游离包皮内板一期尿道成形术修复先天性尿道下裂——附54例分析

目的：探讨游离包皮内板一期尿道成形术修复先天性尿道下裂的疗效。方法：既往未做过手术的轻、中度尿道下裂患儿54例,年龄1—14岁,其中阴茎型30例、会阴型15例、阴茎头型8例、阴囊型1例。所有患儿接受游离包皮内板一期尿道成形术治疗,于阴茎背侧裁取包皮内板游离皮片卷成管状延长尿道,将阴茎背侧皮肤纵行切开转移至腹侧覆盖新尿道。术后予随访中位时间3年,最长7年。结果：裁取游离包皮长度3．0—5．5cm（平均4．0cm）,手术时间120～240min（平均150min）,所有游离皮片均存活。术后发生尿瘘2例,尿道狭窄4例,经尿瘘修补、尿道扩张治愈,所有患儿阴茎外观良好。结论：游离包皮内板一期成形术对轻、中度尿道下裂治疗效果较好。     

阴茎根部皮肤环切术治疗包皮过长

目的：探讨包皮环切一种全新的手术方法,从而最大可能地避免常规包皮环切手术所带来的并发症。方法：在传统术式的基础上进行改良,采用阴茎根部包皮环切术治疗包皮过长,环切多余的阴茎根部皮肤,术中注意保护阴茎背侧浅静脉,从而达到根治包皮过长的目的。结果：本组80例,年龄8～64岁,平均年龄32．4岁,均为包皮过长,采用该法均取得满意疗效,术后无1并发症。结论：采用阴茎根部包皮环切术治疗包皮过长是一种全新的手术方法,手术方法简单,无特殊并发症,疗效佳,临床上有广泛的推广价值。     

Tubularized incised plate urethroplasty for megameatus intact prepuce hypospadias variant: First reported case in Indonesia

Introduction and importanceMegameatus intact Prepuce (MIP) is a rare variant of hypospadias characterized by a wide meatus with a normally conformed prepuce, no chordee, and usually no effects in micturition or sexual physiology. However, quality of life and psychosexuality may be affected.Case presentationA 6-year-old-boy was referred by a general practitioner to the hospital due to an abnormality of the urethral meatus. The patient did not have any complaints. A large external urethral orifice at the ventral area of the coronal glans was discovered. The prepuce was normally-conformed, and there weren’t any signs of chordee. The patient was diagnosed with an MIP hypospadias variant and underwent a tubularized incised plate (TIP) urethroplasty. During the follow-up, one week after the procedure, the patient did not have any complaints. Physical examination showed excellent anatomical and functional outcome based on the cosmetic appearance resembling a normal penis and urinary stream.Clinical discussionAwareness regarding this abnormality is necessary as MIP is often not diagnosed until circumcision. Even though MIP patients are usually asymptomatic, surgery should still be considered based on aesthetic and psychosexual reasons. TIP urethroplasty was chosen for this patient based on the clinical findings of this patient. TIP procedure for MIP patients could result in an excellent penile performance and function with a very low complication rate.ConclusionTIP urethroplasty is able to fulfil satisfactory cosmetic and functional outcomes for the MIP hypospadias variant. Awareness of the disorder should be increased to prevent potential psychosexual disturbances.     

不同年龄包茎和包皮过长患者包皮组织中触觉小体的观察

目的观察不同年龄包皮组织中触觉小体的变化规律。方法收集3～59岁包茎及包皮过长组织标本204例。免疫组化方法对标本中触觉小体进行染色，观察每例标本中触觉小体密度。应用卡方检验和线性回归方法分别对包茎和包皮过长触觉小体密度差异以及与年龄相关性进行统计学分析。结果包皮过长组织中触觉小体密度婴幼儿期以后渐增加，15岁达到最高，20岁前包茎和包皮过长组织中触觉小体密度无明显差异，其后，包皮过长组织呈下降趋势。包皮过长组织中触觉小体密度与年龄呈负相关关系（r=-0、236，P=0．009），包茎组织中触觉小体密度与年龄间虽呈正相关关系，但无统计学意义（r=0、193，P=0．084）。结论包皮过长组织中触觉小体密度与外生殖器发育成熟同步，并与成年男性性功能状态一致。成年包茎组织中触觉小体持续较高水平可能是一种生理性代偿。     

Naturally acquired bovine besnoitiosis: Disease frequency,risk and outcome in an endemically infected beef herd

The recent spread of bovine besnoitiosis warrants further epidemiological investigations to improve the knowledge on disease development. Thus, a 4‐year longitudinal open cohort study was conducted in the first German cattle herd naturally infected with Besnoitia besnoiti . At seven herd‐visits between 2008 and 2012, fourteen breeding bulls (>1.5 years) and 131 females (>1 year) were examined clinically and serologically. In females, clinical and serological prevalences, incidence and remission rates were determined. In addition, the association of age, antibody levels and number of visible parasitic cysts with clinical and serological outcome was investigated. The seroprevalence (89.4%–100%) and serological incidence rate (140.5 per 100 animal‐years) were considerably higher than the clinical prevalence (23.5%–36.6%) and clinical incidence rate (16.7 per 100 animal‐years). Of 33 new clinical and 12 new serological cases, only 6.7% (3/45) attracted attention with clinical signs of acute bovine besnoitiosis. The apparent serological remission rate (1.9 per 100 animal‐years) was considerably lower than the clinical remission rate (37.3 per 100 animal‐years). A median cyst score of <1 and mean immunofluorescent antibody test (IFAT ) titre of ≤1,600 over the entire observation period was significantly associated with a negative clinical outcome at the end. Overall cyst score was not significantly associated with serological outcome and age had no significant influence on clinical and serological outcome. Within 4 years, there was a significant reduction in cyst scores and IFAT titres in the same animals, leading to eight clinically and serologically negative animals in the end. Two initially negative animals achieved clinical and apparent serological remission in about 2.5 years. In bulls, the time between herd entry and seroconversion was 7–30 months and the serological incidence rate was nearly identical to the rate in females (142.0 per 100 animal‐years). This shows that a high B. besnoiti prevalence leads to infection of bulls within a short time period.     

内板下塞入纱布手术刀环剥式包皮环切术

目的:介绍内板下塞入纱布手术刀环剥式包皮环切术的优点。方法:2000年11月～2006年3月对2100例包皮过长患者行内板下塞入纱布手术刀环剥式包皮环切术,患者年龄6～78岁,平均26岁,其中Ⅰ型包皮过长1799例,Ⅱ型237例,Ⅲ型64例。结果:切口均一期愈合,切口美观。术后6～48h出血12例,迟发性血肿3例,无切口裂开,无切口感染。结论:内板下塞入纱布手术刀环剥式包皮环切术在张力状态下剥离皮肤容易进行,安全,出血少,浅筋膜组织保留多且连续,内板保留少,切口美观,虽然操作较繁琐,仍值得临床推广。     

Case report. Paraphimosis due to erotic dancing

Paraphimosis usually develops when a tight foreskin is retracted over the glans penis for a prolonged period. Many esoteric aetiologies have been implicated in the development of paraphimosis including piercing the foreskin, Plasmodium falciparum infection, application of celadine juice to the foreskin, chancroid, pessaries and the implantation of pearls. We report the first two cases of paraphimosis developing during wining, an erotic dance native to Trinidad & Tobago.     

包皮过长的手术治疗进展

自上个世纪80年代以来,泌尿外科手术技术不断进步,逐步向着减轻伤痛,减少出血等微创方式发展。如今,临床采取的包皮手术普遍还是以传统、电刀、激光等方式进行环切术为主。该文对治疗包皮过长中常用的治疗方法和研究进展综合文献进行综述。     

包皮外板目标切割标记定位在小儿包皮环扎术中的应用研究

目的：观察术前包皮外板目标切割标记定位在小儿包皮环扎术中的临床效果。方法对135例患者在麻醉前行包皮外板目标切割标记定位、在定位标记线的指引下完成包皮环扎术。观察手术时间、手术失血、术后疼痛、术后水肿、术后包皮形态等指标。结果135例患者均一次完成包皮环扎手术。手术时间4~10 min,平均（6.37±1.12）min,手术出血量0~3 ml,平均（1.13±0.48）ml,术后无继发性出血。套扎环脱落时间7~28 d,平均（16.87±4.32）d,均自行脱落。135例均一期愈合,切缘整齐,瘢痕平滑。结论术前包皮外板目标切割标记定位在小儿包皮环扎术中具有可操作性,有助于提高手术的精准切割。     

包皮过长或包茎患者的性功能状况与心理状态关系的研究

目的:通过分析泌尿男科门诊包皮过长或包茎患者的性功能状况与心理状态,探讨性功能障碍与心理异常之间的相互关系。方法:随机选择包皮过长或包茎患者216例,问卷调查患者的一般情况、中国早泄患者性功能评价表、国际勃起功能指数问卷、症状自评量表。调查研究患者的早泄与勃起功能障碍情况,心理状态抑郁、焦虑等症状,统计其发生率,分析各症状间的相互关系。85例健康男性志愿者为正常对照组。结果:病例组的症状自评量表总分、躯体化因子分、强迫症状因子分、抑郁因子分、焦虑因子分、其他因子分明显高于正常对照组(P<0.05)。相关分析显示:早泄评分与症状自评量表总分、躯体化因子分、强迫症状因子分、人际关系敏感因子分、抑郁因子分、焦虑因子分及其他因子分有显著相关性。勃起功能障碍评分与症状自评量表总分及各项因子分无相关性。结论:泌尿男科门诊包皮过长或包茎患者的心理健康水平较差,早泄与心理状态存在相互影响。