环切人路和耻骨上入路隐匿阴茎矫正术疗效比较

目的 比较环切入路和耻骨上入路术式矫正隐匿阴茎的疗效.方法 隐匿阴茎患者33例,随机接受环切人路(18例)或耻骨上入路(15例)手术.比较手术前后阴茎疲软时长度、患者满意度和术后并发症发生率.33例随访至少6个月.结果 环切入路组患者手术前后阴茎平均长度分别为(1.78±0.41)和(3.974±0.47)cm,差异有统计学意义(P<0.01),患者对手术效果满意度83%(15例);耻骨上入路组患者手术前后阴茎平均长度分别为(2.07±0.53)和(4.05±0.81)em,差异有统计学意义(P<0.01),患者对手术效果满意度87%(13例).2组患者阴茎长度增加差异无统计学意义(P>0.05).环切入路组术后出现包皮水肿10例(56%),耻骨上入路组2例(13%),均于3个月内消退;耻骨上入路组切口出现脂肪液化2例(13%).结论 环切入路和耻骨上入路术式矫正隐匿阴茎的效果相近,患者对疗效满意度较好,环切入路术式简单.     

隐匿型阴茎合并阴囊脂肪增生的手术治疗及效果分析

目的报道小儿隐匿型阴茎患者中合并阴囊脂肪增生的手术切除方法,并分析手术效果及意义。方法自2006年1月到2016年12月,我科共收治合并阴囊内脂肪增多的小儿隐匿型患者16例。在进行隐匿型阴茎矫正过程中,于阴囊纵隔设计手术切口,切开阴囊纵隔,可见大量异常增生脂肪暴露,睾丸及精索外观正常。保护好睾丸及精索,将脂肪予以完整切除,关闭切口。切除的脂肪组织送病理检查。结果 16例患者切口愈合良好,仅1例出现部分阴囊皮肤坏死,未予特殊处理,自行愈合。在6个月至8年的随访期间,患者阴囊无增大,无脂肪复发状况发生。病理证实切除的为成熟脂肪组织和结缔组织。结论在矫正隐匿型阴茎合并阴囊内脂肪增多的患儿中,对阴囊内脂肪增生进行手术切除是一种有效的手术方式,可明显缩小阴囊体积。在避免出现阴囊脂肪潜在的危害方面具有重要的意义,但仍需进一步的远期随访及效果观察。     

Hidden penis: a rare case of delayed complication after a pelvic blunt trauma

Penile dislocation following a traumatic pubic bone fracture is a very rare condition. Only a few cases are reported in the literature and the presentation mechanism is still not completely understood. The impact energy on the pelvis usually causes a displaced fracture with concomitant withdrawal of the pubic bone. The retraction of the pubic bone pulls the penis by its suspensory ligament leading to penile dislocation. We describe a rare case of a “hidden” penis 2 months after a blunt pelvic trauma following a motor vehicle accident. Clinical examination revealed a retracted penile skin. The penis was not visible, neither palpable in the expected position. Micturition took place by dripping urine from the opening of the prepubic skin where urine got trapped in the surrounding skin. He also complained of not having erections. A magnetic resonance imaging that showed invaginated penis, located in the anterior pelvic wall, adjacent to the right inguinal canal. Surgical repair was performed trough an inverted “V” suprapubic incision that allowed exploring the pubic area. The degloved penile shaft was identified and isolated from fibrotic adhesions to the surrounding tissue. The invaginated penile skin that was thin and retracted. The point of fixation was located deeply in the right pubic area where the subcutaneous tissue and skin were firmly attached to a spike of the fractured pubic bone. This adhesion was sharply resected and the penis and its skin were restored in their anatomical position. The suspensory ligament was partially detached. Erection was simulated using saline solution injection into the corpora cavernosa to exclude penile curvature. Postoperative course was uneventful. One year after surgery, the penis had a normal appearance without retraction and sexual function was completely restored. Our case pointed out the importance of genitalia evaluation by practitioners involved in the care of pelvic trauma patients.     

A training model for suprapubic catheter insertion: the UroEmerge suprapubic catheter model

Suprapubic catheter insertion is a fundamental practical skill that all clinicians should be familiar with, yet there are great practical difficulties in training in this area. A training model was designed to facilitate teaching, and then this model was subsequently tested in an emergency urology practical skills course.     

Bulbocavernosus muscle responses after suprapubic stimulation: analysis and measurement of suprapubic bulbocavernosus reflex latency

Our objective was to describe pelvic floor responses with measurement of reflex latency after suprapubic mechanical stimulation. Twenty-one patients without neurological disease were studied. They were 14 women and seven men. The mean age was 51 (SD = 14.2). Motor responses were recorded with a needle electrode inserted in the left bulbocavernosus muscle. Stimulation was delivered with an electromechanical hammer, tapping directly on the suprapubic area. A polyphasic muscular response was always easily elicited in all patients. The man latency was 67.5 milliseconds (SD = 14.7). The reproducibility between the first and second mechanical responses was good with no statistical difference (r=0.966;P = 0.0001). In three patients who underwent cystometry, no rise in detrusor pressure was observed during mechanical stimulation of the suprapubic area. Our study clearly demonstrates a suprapubic bulbocavernosus reflex (SBR). Tapping the suprapubic area is a strong stimulus, reflexively mediated, used in the management of neurogenic bladder to determine a bladder contraction. However, the reflex consisting of pelvic floor muscle contraction after suprapubic stimulation was not specifically studied in humans. Many arguments can be put forth for a polysynaptic reflex (polyphasic response, habituation and short latency of the reflex, mean latency in the habitual values of R2 responses after electrical stimulation of the dorsal nerve of the penis). We hypothesize that the true stimulus is the stimulation of the bladder wall tensoreceptors, the integration level of the SBR is the sacral segments and the efferent limb the pudendal nerve, and afferent pathways could be conducted by pelvic nerve fibers. Competition between a preponderant (or exaggerated) SBR and a bladder contraction after suprapubic tapping may constitute an equivalent of detrusor-sphincter dyssynergia in some suprasacral bladders.     

Suction lipectomy: the gold triangle at the neck

Cervical suction lipectomy is a simple procedure that poses no technical problems. Evaluation of the amount of fat to remove is easy since the deposit is superficial and the skin considerably more supple than over the body. Although postoperative changes may be slow to develop, the skin usually exhibits outstanding adaptability in this area and this adaptability improves over time. On the basis of these favorable features occurring in the same location, a cervical gold triangle can be defined. In this area, where excellent results can be expected, indications of suction-assisted lipectomy can be very broad.     

A new device for suction-assisted lipectomy: a flexible cannula

A new type of cannula, "Flex," has been designed for suction-assisted lipectomy. It is flexible, permitting easy access to areas distant from the skin incision. Flex is best characterized by one word: Bend.     

Suction-assisted lipectomy of the upper arm: a four-cannula technique

A new technique for suction-assisted lipectomy of the upper arm is described. It uses four separate cannulas of varying lengths, all with an internal diameter of only 3.0 mm. Only a single incision is required. The benefits include the elimination of the complication of excessive fat suctioned from the middle of the arm, reduced scarring, and reduced surgical time. The patient recovers quickly with less bruising and more comfort. Results are pleasing with virtually no complications.     

Suction-assisted lipectomy of the upper arm: A four-cannula technique

A new technique for suction-assisted lipectomy of the upper arm is described. It uses four separate cannulas of varying lengths, all with an internal diameter of only 3.0 mm. Only a single incision is required. The benefits include the elimination of the complication of excessive fat suctioned from the middle of the arm, reduced scarring, and reduced surgical time. The patient recovers quickly with less bruising and more comfort. Results are pleasing with virtually no complications.Presented at the 7th Annual Meeting of the Lipoplasty Society of San Francisco, California, October 29, 1989     

Urinary catheterization: transurethral or suprapubic approach?

75 patients, needing a bladder drainage for nonurological indications and having sterile urines were studied after randomization into two groups. In the first group, drained with an urethral catheter, urinary infection took place in 12 (= 30%) patients, while it was detected in 4 (= 11%) drained with a suprapubic catheter. In this latter group, patients felt more comfortable, had less pain; the duration of urinary drainage and hospital stay was shorter.     

Fractured penis: a review

Fracture of the penis is a well-recognized clinical entity. The ideal management has evolved and repair remains largely surgical. We present the etiology and pathophysiology of this condition and outline the therapeutic options.     

Hypersensitivity dermatitis following suction-assisted lipectomy: a complication of local anesthetic

We report a case of severe dermatitis involving the abdomen and thighs following suction-assisted lipectomy of these areas wherein local anesthetic containing the preservative methylparaben was used for infiltrative anesthesia. This use of local anesthetics with epinephrine can be of value in the performance of suction-assisted lipectomy to reduce blood loss, serve as an adjunct to other intraoperative anesthetic techniques, and for postoperative analgesia. Local anesthetic solutions commonly contain additives, which serve as antioxidants and antimicrobials. The most common of these preservatives is methylparaben, which can cause delayed hypersensitivity reactions. These reactions may be neither recognized nor clinically significant in small areas of infection, whereas in large body surface infiltrative procedures, such as suction-assisted lipectomy, these reactions may be of considerable consequence. This article reviews the pathophysiology and treatment of these reactions and gives recommendations for avoiding them.     

Vesicovaginal fistula repair: A simple suprapubic transvesical approach

Simple suprapubic closure operations were performed for complicated vesicovaginal fistulas in 23 patients. Fistulas with previous unsuccessful attempts (13 patients), fistulas located above the interureteric ridge (5 patients) and fistulas including the ureteral orifice (5 patients) were considered as good candidates for suprapubic approach. There have been 3 failures and, thus, the initial success rate is 86.9 per cent.