小儿埋藏阴茎治疗的新术式

目的：探求治疗小儿埋藏阴茎合理简单有效的手术方式。方法：设计了一种新的手术术式。采用耻骨前阴茎根部3点,9点位Buck筋膜与皮肤肉膜固定的方法。结果：2002年8月～200。1年1月期间共治疗小儿埋藏阴茎38例,平均手术时间约45min；获半年以上随访24例．均获得满意疗效。结论：将此新术式与目前治疗埋藏阴茎的主要术式进行了分析比较，提示该术式操作简单易行、效果好。     

改良Devine治疗小儿隐匿性阴茎158例分析

目的总结改良Devine治疗小儿隐匿性阴茎的效果。方法对158例小儿隐匿性阴茎患者采用改良Devine术式治疗,阴茎皮肤完全脱套后,切除发育异常的纤维肉膜组织,阴茎根部皮肤固定成角。结果 158例患儿术后阴茎均显露良好。随访105例,随访2~38个月,105例患儿阴茎均发育正常,效果满意。结论改良Devine术式是治疗小儿隐匿性阴茎的理想术式。该术式操作简单,术后恢复快,并发症少,治疗效果满意。     

经阴茎腹侧阴茎周围组织环形松解、白膜固定包皮整形术治疗小儿埋藏阴茎

目的:探寻治疗小儿埋藏阴茎的简单、有效手术方法。方法:根据埋藏阴茎的临床特点,设计一种新的手术方式即经阴茎腹侧阴茎周围组织环形松解、白膜固定包皮整形术:阴茎根部腹侧"V"形切口,环形松解阴茎浅、深筋膜及异常附着的肉膜肌、纤维索带,阴茎根部左、右侧白膜分别与胸膝位耻骨结节前筋膜的1、11点各缝合固定1针进行手术,共治疗小儿埋藏阴茎38例,术后随访2~6个月。结果:38例出院时阴茎外观形态均满意,阴茎体完全显露。术后随访期间35例(92.1%)阴茎外观形态满意,2例仍有阴茎轻度埋藏,1例出现包皮口瘢痕狭窄。结论:采用经阴茎腹侧阴茎周围组织环形松解、白膜固定包皮整形术治疗小儿埋藏阴茎是一简单、有效的手术方法,具有推广应用价值,但仍需积累更多的病例和更长时间的随访。     

先天性隐匿性阴茎的外科治疗

目的 探讨先天性隐匿性阴茎的手术治疗方法,提高对该疾病的认识以及临床治疗的效果.方法 对15例先天性隐匿性阴茎患儿采用改良Devine术式手术矫正,平均年龄10.5岁,既往均无阴茎手术史,术中将阴茎包皮脱套至阴茎根部,识别并剔除阴茎体部发育不良的条索状组织,术后对所有患者进行随访.结果 本组患者术后随访3～12个月,手术均获得成功,无一例复发,无皮肤缺血、血肿、勃起疼痛等并发症,术后阴茎显露及外观满意,发育良好,排尿及勃起功能正常.2例患者术后包皮出现轻度淋巴回流障碍,数月后自然消退.结论 应严格区分真性隐匿性阴茎与埋藏阴茎、小阴茎、包皮过长,选择合适的手术方法可获得满意疗效.本术式纠正了隐匿性阴茎的病理改变,术后阴茎功能和形态良好,是治疗隐匿性阴茎的理想术式,值得推广.     

改良阴茎脱套固定术治疗小儿隐匿阴茎85例报道

目的:探讨改良阴茎脱套固定术治疗小儿隐匿阴茎的有效性。方法:2004年10月～2011年2月采用改良阴茎脱套固定术治疗小儿隐匿阴茎85例。结果:所有患儿均顺利完成手术,17例患儿术后出现明显包皮水肿,2～3个月恢复正常。术后随访2～14个月,所有患儿阴茎体显露充分,阴茎无明显退缩现象。结论:隐匿阴茎的形成与先天性阴茎皮肤浅筋膜层发育异常有关,改良阴茎脱套固定术式具有手术视野显露良好、操作简单、效果满意等优点,是小儿隐匿阴茎治疗的理想方法。     

阴茎阴囊交界处切口联合Devine术治疗中重度小儿隐匿性阴茎

目的:探讨小儿中重度隐匿性阴茎简便有效的手术治疗方法。方法:应用阴茎阴囊交界处切口联合Devine术式治疗68例中、重度小儿隐匿性阴茎患者,年龄3~13岁,平均6.5岁;其中中度30例,重度38例。结果:术后近远期疗效较好,阴茎显露满意,外观呈包皮环切样,术后3个月随访阴茎长度3.0~5.2 cm,平均延长(2.35±0.35)cm。结论:阴茎阴囊交界处切口联合Devine术是目前治疗中重度小儿隐匿性阴茎简便有效的方法。     

Brisson术矫治小儿隐匿阴茎

目的探讨小儿隐匿阴茎的病因、病理改变、诊治方法,以提高对该病的认识和治疗效果。方法对52例平均年龄4岁8个月的隐匿阴茎患儿采用Brisson矫治术。患儿临床表现为阴茎外观短小,皮肤表面仅见包皮堆积,扪不到阴茎体,指压阴茎皮肤可显露发育正常的阴茎体,有包茎和阴茎皮肤发育不良,其中合并肥胖8例。结果患儿术后阴茎显露良好,疲软时阴茎显露长度平均(3.56±0.49)cm。术后发生轻度包皮水肿16例,7~10d恢复。家长和患儿对效果满意。随访2~12个月,无1例复发,阴茎发育好。结论阴茎肉膜发育异常,束缚阴茎外伸是小儿隐匿阴茎的主要病理改变。早期手术治疗能改善外观和解决包皮阴茎头炎及反复尿路感染等临床症状,避免对患儿及家长造成不必要的心理损害。Brisson术治疗,术后并发症少,外观满意,是治疗小儿隐匿阴茎的理想术式。     

Devine矫正术治疗小儿隐匿性阴茎

目的：探讨小儿隐匿性阴茎的诊断方法,观察Devi ne矫正术治疗小儿隐匿性阴茎的疗效。方法：2008年10月～2010年2月采用Devi ne术治疗小儿隐匿性阴茎14例。结果：本组所有病例术后切口均Ⅰ期愈合,术后阴茎延长长度为2.1～2.8cm,平均延长2.46cm。经9个月～2年随访,14例患儿均阴茎显露及外观正常,无阴茎水肿、皮肤缺血、勃起疼痛等并发症。结论：Devi ne矫正术治疗小儿隐匿性阴茎疗效确切,是一种治疗小儿单纯性隐匿阴茎的有效方法。     

隐匿性阴茎手术技巧的改进

目的:探讨简单、有效、新的隐匿性阴茎术式。方法:1999年1月~2006年1月共治疗隐匿性阴茎患者128例,手术通过Devine术的改进型来完成,阴茎延长、固定与包皮环切一次完成。结果:所有手术均获成功,平均手术时间50min,随访6个月~6年,阴茎发育满意,外观效果好,无并发症。结论:本术式是在Devine术基础上的改进,手术简单易行,术野暴露好,消除了患者潜在的心理影响,是治疗隐匿性阴茎理想的新术式。     

改良Devine术矫正小儿隐匿性阴茎疗效观察

目的：探讨改良Devine术治疗小儿隐匿性阴茎的临床效果。方法：回顾性分析2002年6月～2010年6月间30例行改良Devine术治疗的真性隐匿性阴茎患儿临床资料。结果：全部手术均获成功,术后伤口Ⅰ期愈合。术后随访6个月～2年,阴茎外观好,发育正常。结论：改良Devine术治疗隐匿性阴茎,手术操作简单、创伤小、临床效果较好。     

ANATOMICAL ALIGNMENT FOR THE CORRECTION OF BURIED PENIS

Purpose

We report a straightforward surgical technique for the correction and anatomical alignment of the skin in patients with various degrees of buried penis.

Materials and Methods

A combined series of 74 patients 7 months to 10 years old who were treated for buried penis at 2 institutions during a 7-year period. Patients presented with various symptoms, including balanitis, urinary tract infection, painful voiding, ballooning of the foreskin and urinary retention. In 29 patients (38%) trapped penis was due to previous circumcision. In our estimation the major anatomical defect in buried penis is an insufficient attachment of the dartos fascia and penile skin to Buck's fascia. Our technique involves making a circumferential incision of the inner preputial skin layer proximal to the corona, unfurling it from the shaft skin and leaving a coronal collar of approximately 1 cm. The annular band that usually constricts the corpora on retraction of the penile skin is incised, and the remaining proximal penile skin and dartos fascia are dissected off Buck's fascia proximally to the base of the penis. The penile dermis is sutured to the lateral aspect of the tunica albuginea at the penopubic junction and mid shaft of the penis. This technique restores normal anatomical relationships with excellent cosmetic results and negligible complications.

Results

At a median 5-year followup cosmesis was excellent in all case. Two patients with micropenis who required revision responded to endocrine therapy.

Conclusions

Excellent cosmetic results were obtained in all cases using this surgical technique.     

Penoplasty for buried penis in children: report of 50 cases

PURPOSE: The authors report their experience with a large number of children with buried penis and describe their surgical technique. METHODS: Fifty consecutive cases of buried penis that occurred between 1993 and 1999 were analyzed by chart review. Age at the time of surgery was 11 months to 13 years. Each patient underwent elective surgical repair utilizing a surgical technique not described previously. The authors' technique avoids a circumferential incision at the base of the penis, decreasing postoperative edema. The authors also utilize a unique through and through vertical mattress suture at the base of the penis that firmly attaches the shaft skin to the underlying corpora. RESULTS: All patients had a good to excellent outcome with a low postoperative complication rate. One patient fell during the postoperative period and developed a wound dehiscence. Early in the series 3 patients underwent additional procedures for recurrent retraction (6%). All patients experienced some postoperative discomfort as expected. Edema, when present, was mild and resolved within an acceptable period of time. All patients had a good cosmetic result with increased visualization of the penile shaft. CONCLUSIONS: A surgical approach to the buried penis is warranted in most circumstances. There are psychological benefits to both the patients and the parents. Although the authors perform the procedure as early as 11 months, it can be performed safely at 3 months. The procedure reported here provides immediate excellent cosmetic results with a low complication rate. The authors do not recommend suprapubic lipectomy either alone or in combination with the buried penis procedure. Circumcision should be avoided in an infant with a definite diagnosis of buried penis.     

Der vergrabene Penis

The buried penis describes a bunch etiologies and clinical presentations of which the congenital form is rare. In the past different techniques had been described, using inner prepuce after mobilization to cover the penile shaft. This can lead to persistent edema of the skin. We developed a new technique to reduce the rate of postoperative edema.     

Buried penis: congenital syndrome of a short penile shaft and a paucity of penile shaft skin

PURPOSE: The term "buried penis" has been applied to a variety of penile abnormalities and includes an apparent buried penis that is obvious at birth. The purpose of this study was to examine prospectively the congenital buried penis and to evaluate an operative technique for its management. MATERIALS AND METHODS: A total of 31 males 2 to 28 months old (mean age 12.3 months) with a congenital buried penis underwent surgical correction of the anomaly. Measurements were made of the penile shaft skin, inner leaf of the prepuce, glans length and stretched penile length. Observations of the subcutaneous tissue of the penis were made. The outer leaf of the prepuce was resected, following which covering of the penile shaft was accomplished with a combination of the penile shaft skin and the inner leaf of the prepuce. RESULTS: Stretched penile lengths ranged from 2.3 to 4.1 cm (mean 3.1). The glans length from the tip of the glans dorsally to the corona ranged from 0.9 to 1.6 cm (mean 1.2). The inner leaf of the prepuce ranged from 0.9 to 2.2 cm (mean 1.5) in length, while the dorsal penile skin lengths were 1 to 1.6 cm (mean 0.8). In all patients complete shaft coverage was accomplished using a combination of varying degrees of penile shaft skin and inner leaf of the prepuce. In no case was there a requirement for either unfurling of the inner and outer leaf of the prepuce or mobilization of scrotal flaps to accomplish shaft coverage. All patients healed well and have done well with a followup of 6 months to 1 year. CONCLUSIONS: Congenital buried penis is a syndrome consisting of a paucity of penile shaft skin and a short penile shaft. The anomaly may be successfully repaired by carefully preserving a length of inner leaf of the prepuce sufficient to cover, in some instances, the length of the penile shaft. Anchoring of the penile skin to the shaft is not recommended.     

脱套式阴茎固定术治疗隐匿阴茎(附200例报告)

目的：探讨脱套式阴茎固定术对200例隐匿阴茎患儿的治疗效果。方法：对200例隐匿阴茎患儿采用脱套式阴茎固定术，患者平均年龄6．5岁（3～12岁）。其中并发有包茎的患儿160例，明显肥胖者20例。结果：在平均约10个月的随访中，无明显肥胖者术后阴茎外形及发育良好。20例明显肥胖者中有4例术后2～3个月左右出现轻度阴茎回缩，其余阴茎外形良好，无复发。结论：脱套式阴茎固定术是治疗隐匿阴茎的理想术式，术后并发症少，外观满意。     

Surgical Management of Adult Acquired Buried Penis

Purpose of Review

Adult acquired buried penis is a morbid condition characterized by complete entrapment of the phallus as a result of morbid obesity, post-surgical cicatrix formation, or primary genital lymphedema. Hygienic voiding is not possible and urinary dribbling is frequent with accompanying inflammation, skin breakdown, and infection from the chronic moisture. The end result is penile skin fibrosis resulting in permanent functional loss. Herein, we describe the etiology of adult acquired buried penis, advances in its surgical management, and quality of life outcomes with treatment.

Recent Findings

Adult acquired buried penis is increasing in incidence as morbid obesity becomes more prevalent. Frequently comorbid conditions affect treatment including those affecting wound healing such a diabetes mellitus. Functional and cosmetic surgical outcomes are being published in greater volume in recent years leading to more refined treatment algorithms. Patient quality of life is greatly improved by definitive surgical management.

Summary

Adult acquired buried penis is a morbid condition that is increasing in incidence as obesity becomes more commonplace. Surgical management often necessitates surgical lipectomy of the suprapubic fat pad, scrotoplasty, and penile split thickness skin graft. Substantial quality of life improvements have been consistently reported after surgical treatment.

     

儿童隐匿阴茎的诊断与治疗

目的:提高对隐匿阴茎的认识和临床治疗效果.方法:总结62例儿童隐匿阴茎的临床资料,根据临床表现将其分为轻、中、重三型,采用改良的手术方法进行治疗.结果:术后随访1个月～3年,11例近期内出现较明显的包皮水肿,3例术后包皮过多,其余患者外观满意,无需再次手术.结论:隐匿阴茎是较为常见的先天畸形,宜行保留阴茎皮肤的整形手术,忌行单纯包皮环切术.     

成人隐匿型阴茎误行包皮环切术后矫正手术效果分析

目的探讨隐匿型阴茎的成年男性患者误行包皮环切术后矫正手术的效果。方法2007年至2012年共收治误行包皮环切术的成人隐匿阴茎患者19例,年龄19～27岁,平均（22±2．6）岁。所有患者均存在阴茎显露不良及勃起时阴茎皮肤牵拉不适感,而其中5例伴有明显勃起痛或性交疼痛,13例体型肥胖并伴有耻骨上脂肪堆积。所有手术在全麻或硬膜麻醉下进行。采取原包皮环切切口,将阴茎皮肤完全脱套,切断异常的纤维条索带;然后显露阴茎悬韧带,将全部浅悬韧带及部分深悬韧带切断;在阴茎根部将阴茎白膜与皮下固定以防止阴茎体回缩;采用自体中厚皮片游离移植修复阴茎皮肤缺损。对于伴有耻骨上脂肪堆积的患者,先行去除脂肪：结果所有患者手术顺利,术前及术后静止状态下阴茎长度分别为（2．3±1．5）cm和（5．8±1．2）cm（P〈0．05）。术中补充的皮肤面积为25-65cm^2,平均为（42．6±12．2）cm^2。有2例患者出现移植皮片局限性坏死,经过加强换药后痊愈。所有患者对于术后效果均感满意,阴茎外露明显,无勃起时牵拉感、勃起痛或者性交疼痛发生。鳍论成人隐匿型阴茎容易被误诊为包皮过长而行包皮环切术,导致术后包皮短缩。对于误行包皮环切的阴茎患者,我们首先解除限制阴茎外露的因素,后应用自体皮片游离移植补充短缺的皮肤组织,可以从根本上解决问题,术后效果满意。