阴囊纵隔皮瓣与阴囊中厚皮片对合移植Ⅰ期修复重型尿道下裂

目的探索一种可行的安全可靠的手术方法修复尿道,矫正重型尿道下裂畸形。方法对于严重型尿道下裂而阴囊发育正常的患者,运用阴囊纵隔岛状皮瓣同时对合取舍自阴囊的中厚皮片移植,Ⅰ期修复尿道治疗尿道下裂畸形。结果共计15例,术后随访1年,包括阴茎近端和阴茎阴囊及阴囊型尿道下裂,Ⅰ期完成治疗,治疗效果良好,没有尿道狭窄和尿瘘等并发症发生,手术后的尿道外口正位于阴茎头中央,阴茎矫直,无偏曲,排尿尿线直,尿道镜检查再造尿道内壁平整光滑。结论利用阴囊纵隔瓣对合阴囊中厚皮片Ⅰ期成形尿道,完成严重型尿道下裂的修复,效果可靠,操作简单,对合技术同时综合了皮片和皮瓣再造尿道的优点,并且能充分保证矫正阴茎下弯畸形,取得再造阴茎外观和功能上的满意疗效,是一种较理想的治疗手段。     

尿道海绵体游离术治疗尿道下裂并阴茎弯曲的疗效观察

目的:探讨尿道海绵体游离术在治疗尿道下裂并阴茎腹侧弯曲的适应证与疗效。方法:2009年9月~2013年7月采用尿道海绵体游离术治疗尿道下裂阴茎腹侧弯曲患者16例,其中阴茎远端型4例,阴茎近端型6例,阴茎阴囊型6例。结果:术后14~21天拔除导尿管,均排尿顺利。随访12~24个月,1例术后尿道狭窄,行尿道镜直视下扩张后治愈;余均对阴茎外观满意,排尿通畅,无尿瘘及尿道狭窄,勃起时无阴茎下弯。结论:尿道海绵体游离术适用于治疗尿道板、尿道海绵体发育良好合并阴茎腹侧弯曲的尿道下裂患者,手术方法简单,成功率高,术后并发症少,值得临床推广应用。     

Duplay结合Duckett术式一期治疗重度尿道下裂

目的 评价原位尿道板卷(Duplay)加带蒂包皮皮管(Duckett)治疗重度下弯尿道下裂的临床效果.方法 1995年至2008年间笔者采用原位近端尿道板卷管加横向带蒂包皮皮管(Duplay+Duckett术式)治疗阴囊型和会阴型重度尿道下裂63例.结果 发生尿瘘5例,原位阴囊皮管与横向带蒂包皮皮管吻合口狭窄1例,总并发症发生率9.5%,成功率达90.5%.结论 对重度阴茎下弯畸形和近端尿道下裂,Duplay联合Duckett术式疗效肯定,可作为一期手术治疗的首选方法.     

会阴型尿道下裂的矫形和尿道重建

目的 探讨采用分期手术治疗会阴型尿道下裂,行阴茎、阴囊矫形、重建缺损尿道的临床效果.方法 22例会阴型尿道下裂采用分期手术：一期手术将阴茎海绵体完全伸直,阴茎包皮内板和背侧皮肤预置于阴茎腹侧和阴囊裂缝凹陷处;二期手术重建阴茎尿道采用半环状阴茎皮岛＋半环状膀胱黏膜丛行侧面缝合形成阴茎尿道,阴囊尿道采用一期预置的组织丛行卷曲侧侧缝合重建阴囊尿道,在两尿道的接合点端端吻合,同时施行阴囊矫形.结果 22例会阴型尿道下裂矫形后几乎接近正常状态,重建阴茎尿道长度为4～9 cm,平均7 cm.手术的成功率为68%（15/22）,尿瘘发生率为32%（7/22）,5例（5/22）发生阴茎阴囊尿道交界处狭窄,经尿道扩张治疗后痊愈.结论 会阴型尿道下裂行分期手术治疗可以修复超过10 cm长的缺损尿道,而且完成手术以后外形形态较好.     

镍钛尿道支架管在尿道下裂修复术中的作用

目的探讨镍钛记忆合金尿道支架管在预防尿道下裂术后尿瘘及尿道狭窄中的作用.方法 2001年1月～2004年12月,应用镍钛记忆合金尿道支架管作为尿道支架修复63例尿道下裂,其中阴茎近端型19例,阴茎阴囊型22例,阴囊会阴型8例,为一期尿道重建;尿道下裂术后尿瘘行尿瘘修补术10例;尿道下裂术后尿道狭窄再次重建尿道4例.结果 63例伤口均Ⅰ期愈合,术后获随访2个月～2年,排尿通畅,均无尿瘘和尿道狭窄发生.其中62例于术后2～3个月后拔除尿道支架,1例于12个月后拔除.结论镍钛记忆合金尿道支架管可有效预防尿道下裂术后尿瘘及尿道狭窄的发生.     

自制尿道引流管在尿道下裂手术中的应用

目的观察自制尿道引流管在尿道下裂手术中的应用效果,探讨尿道下裂术后合适的引流方法。方法2001年1月至2006年1月,应用自制尿道引流管联合Foley导尿管引流修复74例尿道下裂,其中远端型尿道下裂(阴茎头、冠状沟、阴茎前1/3)22例,中段尿道下裂(阴茎中1/3)28例,近端型尿道下裂(阴茎阴囊交界、阴囊、会阴)10例,行一期尿道重建;尿道下裂术后尿道狭窄5例,尿道下裂术后尿瘘9例,行再次手术。结果74例患者术后获随访4个月~4年,3例拔导尿管后出现尿瘘,3例术后出现尿道狭窄,其中5例均已获二期手术治愈。其余67例一期治愈,无尿瘘和尿道狭窄发生。结论尿道引流管和Foley导尿管联合经尿道引流是一种尿道下裂术后有效、可行的引流方法。     

尿道板卷管尿道成形术治疗小儿尿道下裂

目的探索一种新的尿道下裂的手术方法。方法212例4月龄～9岁尿道下裂男性患儿,其中阴茎头冠状沟型8例、阴茎体型181例、阴茎阴囊型23例,采用单纯尿道板卷管尿道成形术(Snodgrass术)治疗。结果随访2～34个月,188例尿道下裂患者术后阴茎完全伸直,尿道开口于龟头正位,排尿通畅,尿线粗,无尿道憩室,阴茎外观满意;22例有尿瘘,其中16例2次手术修补后成功,6例待手术;2例成形尿道全长裂开,1年后再次行Snodgrass手术治愈。结论尿道板卷管尿道成形术是一种方法简便、术后并发症少、手术效果确切、术后外形美观的新型尿道下裂矫形术,尤其适合不伴有严重阴茎下弯的尿道下裂患者。     

微粒黏膜复合明胶海绵移植耦合局部皮瓣再造尿道

目的 探讨明胶海绵复合微粒包皮内板黏膜或尿道板黏膜游离移植,并耦合局部皮瓣治疗阴囊型及阴茎阴囊型尿道下裂的手术方法及疗效.方法 2006年4月-2007年12月,收治8例重度尿道下裂患儿,年龄8个月～3岁.阴囊型尿道下裂3例,余均为阴茎阴囊型尿道下裂.阴茎牵拉长度为2.5～4.5 cm.应用明胶海绵复合微粒包皮内板黏膜或尿道板黏膜游离移植,并与大小为2.5 cm×1.0 cm～4.5 cm×1.2 cm的局部皮瓣耦合再造尿道.其中一期修复7例,二期修复1例.结果 患儿手术时间为(150×35)min,术中测量修复尿道缺失长度为(3.38×0.79)cm.皮瓣均顺利成活.8例均获随访,随访时间2～24个月.无尿瘘和尿道狭窄并发症发生.患儿阴茎下弯彻底矫正,再造尿道口位于阴茎头部,能正常勃起和站立排尿,尿道顺应性良好.1例术后12个月出现轻度阴茎下弯,未行治疗.结论 明胶海绵复合微粒包皮内板黏膜或尿道板黏膜游离移植耦合局部皮瓣修复阴囊型及阴茎阴囊型尿道下裂,具有减少局部皮肤应用、改善成形龟头外观、减少尿道并发症的优点,近期疗效较好.     

联合口腔黏膜与阴囊皮瓣重建尿道一期修复尿道下裂

目的 总结联含口腔黏膜和阴囊皮瓣重建尿道一期修复尿道下裂的手术方法及临床效果.方法 2002年3月-2007年12月,联合口腔黏膜和阴囊皮瓣重建尿道一期修复尿道下裂42例.年龄1岁6个月～18岁.阴茎阴囊型21例,阴囊型12例,会阴型9例.34例为既往尿道下裂修复手术失败,初次于术至该次手术时间为6～19个月,平均10个月:8例为初次手术.术中阴茎矫直后尿道缺损3～7 cm,平均4.2 cm.将人小为3.0 cm×1.2 cm～7.0 cm×1.5 cm的口腔黏膜移植于阴茎腹侧白膜,与大小为3.0 cm×1.5 cm～7.0 cm×1.5 cm的阴囊皮瓣对合形成完整尿道.结果 38例术后切口期愈合,无并发症发生.4例术后7 d分别于冠状沟及吻合口端出现尿瘘,其中1例尿瘘于术后2个月自行封闭,3例于术后6个月行尿瘘修补术后愈合.42例均获随访,随访时间3～48个月,平均18个月.术后排尿通畅,重建尿道口均位于阴茎头远端,无回缩,外形接近正常尿道外口形态.阴茎阴囊彤态较满意,阴茎完全矫直.口腔形态、功能无异常.结论 联合口腔黏膜和阴囊皮瓣重建尿道组织量充裕,形成尿道狭窄率低,是一期修复尿道下裂的有效方法之一.     

改良带蒂阴囊中隔皮瓣修复尿道下裂

1998年5月至2003年3月,本院泌尿外科以改良带蒂阴囊中隔皮瓣修复尿道下裂27例,效果良好。报告如下。1临床资料1.1一般资料:本组27例。年龄7个月～16岁,平均3岁。阴茎型(近端1/3)16例,阴茎阴囊型8例,阴囊型(轻度)3例,均伴不同程度的阴茎下弯。1.2治疗方法1.2.1手术方法:常规行膀胱造瘘。纵行切开异位尿道口至正常的尿道海绵体,扩大尿道外口。沿冠状沟下0.5～0.8cm环行切开包皮,近端脱套至阴茎根部,阴茎腹侧切口向上延长与冠状沟切口会合,切除腹侧挛缩的纤维索带,使阴茎伸直,伸直后尿道口位置退至阴茎根部或近端阴囊。依照尿道缺损长度,在阴囊…     

Radical bulbar dissection to correct severe chordee and proximal hypospadias

PURPOSE: We describe a technique of proximal hypospadias correction that involves freeing the proximal normal bulbar urethra from perineal attachments to lengthen the ventral penis and decrease chordee. MATERIALS AND METHODS: Correction was performed in 9 patients with a mean age of 11.5 months who had proximal hypospadias and severe chordee that was perineal in 2, mid scrotal in 6 and penoscrotal in 1. After the penis was degloved the bulbar urethra was detethered to or beyond the perineal body without lifting the urethra from the corpora cavernosa. Any remaining penile chordee was corrected and the urethral plate was transected only when chordee persisted. When the urethral plate was intact and the penis straight, tubularized incised plate urethroplasty was done to correct hypospadias in 1 stage. Otherwise 2-stage repair was performed. RESULTS: Using this maneuver penile straightening was achieved in 2 of the 9 patients, resulting in a glanular urethral or penoscrotal meatus. Dorsal plication sutures required in 4 cases resulted in a mid shaft and penoscrotal meatus in 1 and 3, respectively. Residual chordee in the remaining 3 patients necessitated division of the urethral plate and 2-stage repair despite aggressive mobilization of the proximal urethra. Simultaneous tubularized incised plate urethroplasty was then performed in the 4 penoscrotal and 1 mid shaft meatus. All 6 patients who underwent a successful 1-stage procedure have excellent cosmetic results, while 1 required meatotomy. No fistula or chordee was present at a mean of 13.8 months of followup (range 3.9 to 27.1). CONCLUSIONS: This safe, rapid technique may compensate for significant penile tethering and chordee in a subpopulation of patients with proximal hypospadias, such as 6 of the 9 in our study. It also allows successful tubularized incised plate urethroplasty to be done simultaneously.     

Long-term followup of cosmetic appearance and genital function in male epispadias: review of 70 patients

In male patients who undergo surgery for epispadias the major postoperative complaint often concerns the cosmetic appearance of the penis and the failure to correct the dorsal chordee rather than the urinary incontinence. In the past straightening and lengthening of the penis were not given adequate consideration, and penile elongation was limited to release of dorsal skin chordee only. Recently, however, additional penile length has been achieved by partial mobilization of the crura of the corpora cavernosa from the pubic rami. In a series of 70 patients penile lengthening and urethroplasty were performed separately or were combined as a 1-stage procedure with full thickness grafts or preputial flaps. The recent use of hair-bearing groin flaps has provided excellent skin coverage for the large dorsal defect at the penoabdominal angle. A satisfactory cosmetic appearance of the external genitalia, with a straight penis angulated downward in the standing position, was achieved in 67 per cent of the patients. Normal erectile function was preserved in all patients, 80 per cent of whom have had a straight penis with erection and satisfactory intercourse. Of the patients 29 are married and 19 have fathered children. Meticulous attention to the technical aspects of reconstructive surgery usually can result in a gratifying cosmetic appearance, normal genital function and preservation of fertility potential in most patients.     

A novel approach to skin coverage for epispadias repair

PURPOSE: Current techniques for epispadias repair have resulted in significant improvement in the reconstruction of the urethra, corpora and glans. The final challenging step is to enhance the cosmetic result by accomplishing skin coverage for the penis and subpubic area, creating a penopubic and penoscrotal angle without dorsal suture lines, and avoiding future dorsal tethering of the penis as a result of scar contraction. We report a novel technique for penile skin coverage in the patient with epispadias that results in a superior cosmetic outcome. MATERIALS AND METHODS: The technique involves creation of 2 flaps-a ventral preputial transverse island flap rotated dorsally to cover the dorsal aspect of the penile shaft, and an advancement flap from the patch of skin present between the penis and scrotum in epispadias, which is advanced distally to cover the ventral aspect of the penis. The 2 flaps are sewn to each other with 2 lateral suture lines. Thus, the dorsal and ventral aspects of the penis are covered with intact skin devoid of suture lines. RESULTS: This technique was used in 8 males 2 days to 15 years old. The epispadias was part of exstrophy in 5 patients and an isolated defect in 3. Both flaps healed well in 7 of 8 patients. In 1 exstrophy case a segment of the transverse island flap became ischemic and was discarded intraoperatively. Dorsal skin coverage in this patient was achieved using a laterally based flap from the inguinal area, which healed without problem. Followup was 6 to 33 months. No patient had development of skin tethering, curvature or recurrence of the dorsal chordee. The cosmetic appearance of the penis was subjectively superior to that of boys who underwent skin closure using reverse Byars flaps. CONCLUSIONS: The cosmetic appearance of the penis using this novel technique is superior because of the absence of the dorsal scar that may cause chordee, the development of penopubic and penoscrotal angles, which gives the penis a more normal appearance, and the absence of the redundant patch of skin between the shaft of the penis and the scrotum.     

尿道口前移-龟头成形术与尿道延伸术联合治疗尿道下裂

目的 探索一种治疗伴有严重阴茎下弯的冠状沟或冠状沟下型尿道下裂的新方法。方法 尿道口前移-龟头成形术与尿道延伸术联合治疗有严重阴茎下弯的冠状沟或冠状沟下型尿道下裂。在术中切除阴茎腹侧的纤维索带后，如阴茎下弯仍无法矫正，同时尿道海绵体发育好，则采用部分尿道海绵体游离延伸的方法使阴茎下弯得到矫正。结果 19例患儿，手术一期完成，均获成功。结论 尿道口前移．龟头成形术与尿道延伸术联合是一种治疗伴有严重阴茎下弯的冠状沟或冠状沟下型尿道下裂的有效的手术方式。     

Tunica vaginalis free graft for the correction of chordee

Tunica vaginalis free grafts were used to correct severe chordee not amenable to other surgical maneuvers in 11 boys. Postoperatively, the penis was straight in 10 patients and had some degree of downward angulation in 1 boy. The tunica vaginalis free graft seems to be a useful technique for the correction of severe chordee.     

Hypospadias: simple, safe, and complete correction in two stages

Hypospadias is a common abnormality treated by surgeons with different training and experience, using a wide variety of surgical methods. Ideally, reconstruction ought to be simple and safe with few complications, and the resulting penis should be satisfactory both functionally and cosmetically. These criteria are met by the following technique in which the first stage includes meatotomy, correction of the chordee, partial splitting of the glans penis, and covering the defect with a pedicle flap from the preputial hood. The second stage, performed six months later, is then easily carried out using available tissue to reconstruct the glans penis and the urethra. Urethrostomy or cystostomy is not necessary. More than 80 patients have undergone our two-stage operation, with very few complications. The procedure is suitable for all degrees of hypospadias and for congenital short urethra.     

耻骨前入路阴茎肉膜固定术治疗小儿埋藏式阴茎

目的:观察耻骨前入路阴茎肉膜固定术治疗小儿埋藏式阴茎的效果。方法:2002年8月~2003年12月共采用该术式治疗小儿埋藏式阴茎34例,并进行随访,观察术后效果及复发情况。结果:平均手术时间为45m in,34例患儿术后均获满意疗效。获1年以上随访21例,失访13例。随访病例中未见复发。结论:该术式设计合理、简单、有效,适合于无包皮不足的小儿埋藏式阴茎。     

Embryogenesis of chordee.

Gross and microscopic examination of 46 consecutive male therapeutic abortion specimens, ranging in size from 60 to 180 mm. crown-rump, demonstrated that 89 per cent of the fetuses had some ventral curvature of the penis. Athough presumably all penises are ventrally curved through the tenth week of gestation, in our study this curvature was most prominent in the sixteenth through twentieth weeks of gestation and in 44 per cent of the fetuses it persisted through the sixth lunar month. Examination of premature infants revealed a 31 per cent incidence of chordee and serial examinations of a 27-week gestational age infant demonstrated gradual complete correction of the chordee during the ensuing 6 weeks. We propose that ventral curvature of the penis is a normal stage of embryogenesis and chordee without hypospadias may represent an arrest of development at this earlier stage.     

Recurrent epididymitis in a boy with a webbed penis without chordee: a case report

An 11-year-old boy visited our clinic complaining of recurrent epididymitis for 2 years. No abnormal findings were found in urine and blood sampling tests, ultrasonography of the urinary tracts or in a pelvic magnetic resonance imaging examination. Induration of the left epididymal tail, webbed penis and true phimosis were observed. Neither hypospadias nor chordee were identified, thus the diagnosis of "webbed penis without chordee" was made. The operation for webbed penis by transverse incision followed by longitudinal suture and dorsal incision for true phimosis was performed successfully. The postoperative course was uneventful and no recurrence of epididymitis has occurred.     

尿道下裂手术方式的选择

尿道下裂手术以达到：阴茎下曲完全纠正、阴茎头呈圆锥状、尿道外口位于或接近阴茎头、外观满意，能站立排尿，能进行正常性生活为目的。力求下曲矫直和尿道成形一次完成。尽管手术方式多达300余种，但各种尿道成形效果都不尽满意。保留尿道板能提高尿道成形成功率、减少并发症。尿道成形可取材自身移植物，而更多取材于阴茎包皮，要不烦于精细，提高手术技巧。作者推荐远端尿道下裂首选TIP术式，近端尿道下裂应当选择Duckett术式或OIF术式。