经包皮内板切口阴茎延长增粗术的研究

目的探讨经包皮内板切口阴茎延长增粗术的方法.方法通过阴茎包皮内板切口进行阴茎浅悬韧带和部分深悬韧带的切断,以及真皮脂肪游离移植的阴茎延长增粗术.结果本组12例患者行包皮内板切口阴茎延长术,其中3例同时行阴茎增粗术,阴茎静态长度增加2.0～3.5 cm,静态周径增加1.5～2.5 cm,术区无血供障碍,感觉良好,效果满意.结论经包皮内板切口的阴茎延长增粗术用于包皮过长的患者可以获得更佳的手术效果,且切口隐蔽,避免了耻骨区的瘢痕形成.     

经包皮内板切口阴茎延长增粗术的研究

目的探讨经包皮内板切口阴茎延长增粗术的方法。方法通过阴茎包皮内板切口进行阴茎浅悬韧带和部分深悬韧带的切断,以及真皮脂肪游离移植的阴茎延长增粗术。结果本组12例患者行包皮内板切口阴茎延长术,其中3例同时行阴茎增粗术,阴茎静态长度增加2.0~3.5cm,静态周径增加1.5~2.5cm,术区无血供障碍,感觉良好,效果满意。结论经包皮内板切口的阴茎延长增粗术用于包皮过长的患者可以获得更佳的手术效果,且切口隐蔽,避免了耻骨区的瘢痕形成。     

正常男性的阴茎延长术

目的：探讨应用耻骨上倒U形切口、阴茎背侧浅悬韧带及部分深悬韧带切断的方法对正常男性阴茎延长的效果。方法：总结8年来收集的130例阴茎短小患者的资料,年龄16～53岁,平均年龄24岁,均采用同样的阴茎延长术式。结果：130例全部成功,仅1例发生切口脂肪液化,经定期换药处理后愈合,术后静态长度平均延长2.5～4cm,勃起后长度平均延长2～3.5cm。术后随访6～12个月,患者对阴茎外形、长度均满意,其中,有性生活的患者对术后性生活质量满意度均有不同程度的提高。结论：应用耻骨上倒U形切口、阴茎背侧浅悬韧带及部分深悬韧带切断的方法行阴茎延长术,具有手术成功率高、术后并发症少、术后瘢痕隐蔽及效果满意的优点。     

硅胶片置入及自体颗粒脂肪注射阴茎延长增粗术

目的探讨防止阴茎延长后回缩的阴茎延长增粗手术。方法在阴茎根部背侧V形切开,将全部阴茎浅悬韧带及部分深悬韧带切断,为了防止切断的阴茎韧带与耻骨联合重新粘连而回缩,根据阴茎悬韧带附着于耻骨联合的面积,采用宽1.5～2.5cm,长2.3～3.6cm,厚2～3mm的硅胶片置入,缝合于其表面,采用自体颗粒脂肪30～48ml,行阴茎背侧深筋膜表面注射。结果16例患者,阴茎静态下延长长度为1.8～5.1cm,平均2.91cm;增粗直径0.6～1cm,平均0.85cm,观察期为3个月～2年,回缩率小于8%,阴茎增粗后缩小率低于10%。结论硅胶片置入结合自体颗粒脂肪注射是一种理想的阴茎延长增粗术,可有效防止阴茎延长后的回缩。     

改良阴茎延长术的解剖学研究和临床应用

目的 对阴茎发育不良症患者,采用阴茎海绵体延伸术和脂肪瓣转移术充分延长短小的阴茎.方法 通过对男性会阴部结构的解剖学研究,了解阴茎悬韧带的厚度、阴茎脚剥离长度与稳定性的关系;通过离断阴茎浅、深悬韧带,并分离部分海绵体脚,使原固定于耻骨下支的阴茎海绵体充分分离,以使阴茎更为延伸;用含血运的脂肪瓣填塞耻骨前间隙,保证术后远期阴茎的有效长度.结果 2001至2009年采用上述方法行阴茎延长术205例,术前阴茎常态下平均长度4.26cm,勃起时平均长度8.13 cm,术后阴茎常态下平均长度8.63 cm,勃起时平均长度12.11 cm.结论 采用本方法可在不影响阴茎勃起时稳定性的前提下,使阴茎海绵体比以往的阴茎延长术多延伸1～2 cm,使之更加满足患者生理和心理上的需求.     

阴茎延长同期行脱细胞异体真皮基质补片双平面植入阴茎增粗术

目的探讨阴茎延长同期行脱细胞异体真皮基质（acellular dermal matrix,ADM）补片双平面植入阴茎增粗术的方法与效果。方法采用阴茎根部倒V形切口。离断阴茎浅悬韧带后,沿阴茎纵轴切开Dartos筋膜,在其深面向远端分离。距冠状沟1．5～2．0cm处环形切开Buck筋膜,将补片前部植于Buck筋膜与白膜间,后部植于Dartos筋膜与Buck筋膜间。缝合Dartos筋膜切口,V—Y成形术闭合阴茎根部切口。结果35例术后无1例发生阴茎皮肤坏死、补片外露并发症。25例获随访6～24个月,对阴茎外形均感满意;无1例出现补片移位或皱褶、阴茎头感觉异常;其中21例已婚者均感性生活满意。结论经阴摹根部切口行脱细胞异体真皮基质补片双平面植入阴茎增粗术,通过调整补片植入层次,在确保补片足够的组织覆盖及刚茎皮肤血供情况下,在I期内行延长并增粗阴：拳术,具有并发症少、疗效满意的优点。     

阴茎海绵体增粗并延长同期整复术

目的 介绍一种阴茎海绵体增粗并延长的新术式。方法 应用自体大隐静脉移植扩大双侧阴茎海绵体白膜、增大阴茎海绵体容积、增粗其周径，并切断阴茎悬韧带延长阴茎长度。结果 临床施行8例阴茎海绵体增粗并同期延长整形术，随访6～12个月，阴茎外形、感觉、勃起功能及性生活均满意。术后除1例阴茎包皮水肿6周才消退外，其余各例未出现较严重的并发症。结论 该手术方法使阴茎增粗效果显著，尤以勃起时更为明显，是一种动态功能性阴茎增大方法。     

悬韧带松解阴茎延长术后延长长度预测模型的建立和验证

目的 研究悬韧带松解阴茎延长术术后延长长度的个体化预测方法.方法 选取第三军医大学第一附属医院整形美容科1988年10月至2011年4月行悬韧带松解阴茎延长术的先天性阴茎发育不良病例322例,随机分为建模组(200例)与验证组(122例),将建模组手术前、后的常态与勃起状态阴茎长度等指标进行相关性或线性回归分析,并推导预测公式,通过建模组与验证组中预测结果与实际结果的一致性来评价预测效果.结果 患者术后常态与勃起状态的延长长度以及术前、术后阴茎由常态到勃起状态的伸长率存在显著的相关性(相关系数分别为0.921、0.803,P＜0.01),由此可推导出延长长度的预测公式,通过对建模组与验证组的数据进行检验,预测误差在±1.5 cm以内时其有效预测率分别为84.5％(169/200)和87.7％(107/122).结论 该预测公式可用于悬韧带松解阴茎延长术后延长长度的初步个体化预测.     

改良阴茎延长加增粗术临床应用分析

目的：探索一种理想的阴茎延长术，同期增粗术式。方法：对10例阴茎短小症患者进行改良的阴茎延长加增粗术式即松解阴茎浅悬韧带，2个交错皮瓣加小阴囊皮瓣减张推进缝合方法；同期PTFE充填，阴茎增粗。结果：10例阴茎短小症患者术后伤口愈合良好，阴茎平均延长3．5～4．5cm，平均增粗2．O～2．5cm，外观改善满意，随访性生活满意。结论：该术式松解延长了阴茎皮肤，较经典的阴茎延长术式术后效果好，手术操作简单，容易掌握。     

阴茎延长术的解剖与临床应用

目的探讨成人阴茎延长术的可行性和安全性。方法在20具正常男性成年人尸体阴茎延长解剖学观测的基础上,选择46例阴茎短小（2.8±1.2）cm（1.6～3.5 cm）患者,在阴茎根部设计＂N＂形切口,左、右径3.0～4.5 cm,保留皮瓣足够厚度和良好血运,从皮肤到阴茎浅韧带的厚度3.0～5.0 cm,直视或指感下完全切断阴茎浅韧带,将深韧带切断1/3,切口留置皮条引流。结果尸体解剖学观测,阴茎浅韧带在阴茎根部的厚度为（0.4±0.1）cm（0.2～0.7 cm）,宽度（3.1±0.9）cm（2.1～5.0 cm）。阴茎深韧带厚度为（2.5±1.0）cm（2.0～3.1 cm）,宽度（0.5±0.1）cm（0.4～0.6 cm）。46例术后测量阴茎自然静态下长度（4.6±1.5）cm（3.5～6.0 cm）,较手术前延长（2.5±0.7）cm（1.9～3.5 cm）,术后与术前比较差异有统计学意义（t=4.228,P=0.000）。3例术后阴茎水肿用1∶5000呋喃西林液浸泡3个月后消退。42例（91.3%）随访8个月～15年,平均6年2个月,〉5年31例,患者自信心增加、自觉性生活满意占85.7%（36/42）,另6例（14.3%）感到延长长度不够,仍不满意。结论切断阴茎浅韧带和部分深韧带行阴茎延长术安全有效,术后阴茎皮下顽固水肿与阴茎背浅静脉及淋巴管损伤有密切关系。     

Penile suspensory ligament division for penile augmentation: indications and results

OBJECTIVE: This study assessed the management of patients requesting penile length enhancement by division of the penile suspensory ligament. METHODS: From September 1998 to January 2005, 42 patients with a variety of etiologies were included; all underwent division of the penile suspensory ligament. The outcome was assessed objectively based on increase in flaccid stretched penile length (SPL) and subjectively using the rates of patient satisfaction. RESULTS: The mean increase in SPL was 1.3+/-0.9 cm (range, -1 to +3 cm), with the addition of a silicone spacer placed between the pubis and penis giving a better outcome (p<0.05). The overall patient satisfaction rate was 35% but lower in the group with penile dysmorphic disorder at 27%. CONCLUSION: Division of the penile suspensory ligament or other augmentation techniques may increase penile length but usually not to a degree that satisfies the patient. Men with penile dysmorphic disorder often have unrealistic expectations regarding the outcome of surgical intervention and should be encouraged to seek psychological help primarily, with surgery reserved as the last resort.     

Penis replantation after self-mutilation

In this case report, the procedure of penis replanting and its complications after genital self-mutilation in a male adult are explained.     

Penile torsion repair by suturing tunica albuginea to the pubic periosteum

Purpose

The aim of the study was to evaluate the effectiveness of a new technique to repair penile torsion in children.

Methods

Eighteen boys with penile torsion were evaluated in our department from 1989 to 2003. Eleven had associated hypospadias, 4 had chordee without hypospadias, and 3 had torsion only. The direction of rotation was counterclockwise in 16 cases and clockwise in 2 cases. Torsion was repaired in 6 patients by degloving the penis and reattaching the dartos and the skin (comparative group). In 11 patients (1 with prior repair), the torsion was corrected by suturing the lateral edge of the corpus cavernosum to the pubic periosteum (study group). Two patients were not treated.

Result

Follow-up ranges from 6 months to 7 years. All of the 11 cases in the study group had satisfactory correction of the penile torsion. All of the urethroplasties for hypospadias were successful. In the comparative group, none of 6 patients had satisfactory correction of the rotation.

Conclusion

The technique of degloving the penis and reattaching the skin cannot reliably correct penile torsion in our experience. Lateral suturing of tunica albuginea to the pubic periosteum to repair penile torsion appears to be a better technique.     

Penile paraffinoma: the delayed presentation

The injection of foreign substances into the penis for the purpose of augmentation may result in erectile dysfunction, voiding difficulties, and severe deformity. We report a case of penile paraffinoma in a 71-year-old man that developed nearly 40 years after undergoing a series of penile injections with an unknown substance. Penile paraffinoma can therefore present a diagnostic dilemma given its protracted latency period, after which time the initial injections have faded into distant memory.     

Peyronie's disease: Epidemiology and clinical presentation of 134 cases

Objective: To investigate epidemiological and clinical features of Peyronie's disease in an unselected group of patients not seen by a urologist before. Patients and methods: A series of 134 consecutive cases with Peyronie's disease was evaluated regarding to the age at diagnosis, the symptoms and signs of the disease, and the site and formation of the scar. The medical history which could be possibly related with the onset of the disease was investigated as well. Results: The disease mainly affected middle-aged men. While all men had a palpable scar, only 51 (38%) had noticed the induration. Curvature (mean: 35°) appeared in 87 men (65%) and caused sexual dysfunction due to severe penile deformity in 16 men (11.9%). 53 patients (39.5%) referred painful erections. In 11 men (8.2%) the onset of the disease was noticed after auto-injections of vaso-active drugs for the treatment of previous erectile dysfunction, while 18 (13.4%) had a history of penile trauma during sexual intercourse or manipulation. No specific relation with diabetes mellitus and Duputren's contracture was identified. Scars, like elongated indurations with vague bounds, were mainly formed (77.6%) in the dorsal midline. Conclusions: The mean age of patients at diagnosis, the site of penile scars, and the activities of the affected men could advocate the hypothesis that trauma is the main causal factor for Peyronie's disease. In 21.6% of the patients, the lesion occurred after a traumatic activity. Sexual dysfunction due to severe penile curvature affected a small proportion of the patients. Thus, due to the diminution of pain spontaneously or after treatment, the patients with Peyronie's disease may have a normal life with satisfactory sexual function. In some selected cases surgery offers an effective result. This revised version was published online in June 2006 with corrections to the Cover Date.     

阴茎浅筋膜后移法阴茎增粗术60例

目的 探讨阴茎浅筋膜后移法行阴茎增粗术的临床应用效果.方法 按常规保留内板0.3 ～0.8 cm,确定第1条环形切口线,根据阴茎勃起长度确定第2条环形切口线,剥除双环之间的皮肤组织,保留阴茎浅筋膜和阴茎背浅静脉系统,在切口两侧皮肤无张力对合的情况下,将双环间的阴茎浅筋膜向阴茎近端推移并分段固定,以增粗阴茎.结果 治疗阴茎细小伴包皮过长或包茎患者60例,随访3 ～12个月,阴茎静息状态与勃起状态时的周径均较术前增加,阴茎头显露于外,包皮外观平滑自然,阴茎功能良好.结论 阴茎浅筋膜后移法阴茎增粗术能够充分利用自体组织增粗阴茎,且能同时解决包皮过长或包茎的问题.     

阴茎勃起功能障碍患者与正常人群的阴茎形态学比较

目的:拟明确阴茎勃起功能障碍患者与正常人群的阴茎长度与周径有无差异。方法:测量80例阴茎勃起功能障碍患者与87例正常男性疲软状态和海绵体注射诱导阴茎勃起时的阴茎长度与周径。结果:80例阴茎勃起功能障碍患者疲软状态阴茎长度与周径分别为(7.55±0.77)cm、(8.74±0.86)cm,于海绵体注射诱导阴茎勃起时长度与周径分别为(10.97±1.21)cm、(10.58±1.05)cm;87例正常男性疲软状态时阴茎长度与周径分别为(8.08±0.80)cm、(8.03±0.80)cm,阴茎勃起状态下分别为(10.46±0.91)cm、(10.18±1.26)cm。本次实验人群中疲软状态时阴茎长度与周径分别为(7.83±0.78)cm、(8.37±0.83)cm,而勃起状态时则分别为(10.70±1.06)cm、(10.37±1.16)cm,阴茎勃起功能障碍患者与正常人群的阴茎长度与周径差异无统计学意义。结论:阴茎勃起功能障碍患者尚未发现阴茎长度与周径的改变。