Sugita手术治疗小儿先天性隐匿阴茎

目的 观察Sugita术式治疗小儿先天性隐匿阴茎的疗效.方法 对我院2008年1月至2010年12月采用Sugita方法治疗的78例中重度小儿隐匿阴茎患儿的临床资料进行回顾性分析,总结该方法的手术疗效.结果 术后4～5 d去除敷料暴露伤口,拔除尿管,术后5～6 d出院.所有病例均获得随访6个月至3年,平均6.5个月,均排尿正常;8例有包皮内板轻度水肿,其中5例术后6～8周恢复正常,3例术后10～12周恢复正常;74例阴茎体显露良好,家属对阴茎外观满意,4例家属认为阴茎短小.结论 Sugita手术治疗小儿先天性隐匿阴茎设计合理,操作简单,美容效果良好,并发症相对较少,是治疗小儿先天性隐匿阴茎的较好方法.     

改良Shiraki手术治疗隐匿性阴茎

目的 探讨改良Shiraki手术方法在隐匿性阴茎手术中的意义.方法 自2005年5月至2009年12月间对53例隐匿性阴茎患儿采用改良Shiraki手术进行治疗,其主要手术步骤是:①分别在包皮内板的3点、9点处及外板的6点、12点处纵向切开;②内板与外板分离,在阴茎白膜外层行阴茎皮肤脱套至阴茎根部,同时切除阴茎体外层纤维索带,充分松解阴茎使其完全伸展;③包皮系带横切纵缝成形使包皮内板腹侧延长;④剔除内板皮下水肿的筋膜组织,修剪过宽包皮内板皮瓣,外板尽量保留,然后内外板皮瓣嵌插缝合;⑤置Folay导尿管,用网眼纱布均匀包扎阴茎.结果 术后随访18至24个月,阴茎显露明显改善,较术前延长2～4 cm,阴茎皮肤无坏死.阴茎外形均满意,3例术后阴茎皮肤水肿,3个月后消退,此3例为初期病例;随访1年以上者阴茎肿胀基本消失.结论 采用改良Shiraki手术方法进行包皮延长成形术矫正隐匿性阴茎可获得满意的效果,与Shiraki术式相比其有如下优点:①手术操作简化,易掌握并缩短了手术时间;②皮瓣血供好,切口愈合佳,减少了皮瓣坏死的机会;另外对皮瓣淋巴回流阻断明显减轻,术后阴茎皮肤肿胀情况不明显;③不进行阴茎体固定仍可获得满意的效果,并且避免了阴茎背侧血管神经及尿道的损伤.     

带蒂岛状包皮瓣在隐匿阴茎矫治术中的应用

目的 介绍带蒂岛状包皮瓣在隐匿阴茎矫治术中的应用.方法 总结分析四川大学华西医院从1994年7月至2011年8月收治的56例应用带蒂岛状包皮瓣阴茎成形术矫治的完全型隐匿阴茎患儿的临床资料,结合文献探讨该手术的要点及优缺点.结果 所有56例患儿术后获得了1个月至7年(平均1.4年)的随访,术后效果均满意,包皮水肿轻,阴茎显露好,无阴茎回缩及复发发生,未见明显瘢痕挛缩.结论 隐匿阴茎可根据阴茎皮肤的缺失情况分为完全型和部分型以指导手术的选择并评估手术的疗效.恰当的手术年龄以学龄前为佳,伴有肥胖的隐匿阴茎患儿最好在减轻体重后考虑手术,改良Devine法治疗部分型隐匿阴茎,带蒂岛状包皮瓣阴茎成形术用于治疗完全型隐匿阴茎都有较好的手术效果.     

经阴茎根部腹侧阴茎阴囊整形术治疗先天性隐匿阴茎

目的 探讨经阴茎根部腹侧入路的阴茎阴囊整形术治疗先天性隐匿阴茎的临床疗效.方法 针对本病的包茎、阴茎皮肤缺乏、阴茎周围肉膜肌的异常附着、特别是阴茎阴囊交界处皮肤的蹼状改变等,采用不但可使阴茎阴囊蹼状改变得到整形,也利于阴茎的充分松解和固定,还可达到延长阴茎皮肤目的的楔形皮肤切口.同时还采用包皮口横切后外板纵形剪开,背侧楔形切除多余内板的的方法,不但解除了包茎,也避免了过多的内板使用.结果 近10年间用此术式治疗先天性隐匿阴茎359例,年龄最小3岁,最大14岁,其中5～7岁224例(62.4％).术后获半年以上随访者265例(73.8％),其中阴茎显露良好,无退缩现象、无包茎、阴囊皮肤无臃肿现象、切口无瘢痕形成和排尿通畅者共247例(93.2％).术后早期出现阴囊血肿7例.远期并发症包括:腹侧切口瘢痕形成3例,后经瘢痕切除治愈.包皮口出现瘢痕环形狭窄并影响阴茎头外露5例,门诊经瘢痕切除治愈.外观仍显阴茎短小10例(4.6％),但经外用睾酮霜2个月后外观明显改善毋需进一步治疗.结论 结果显示此方法简单,效果显著,且并发症多可预防,是一种治疗先天性隐匿阴茎的好术式.     

Penoplasty for buried penis in infants and children: report of 100 cases

Purpose  The aim of this study is to report single surgeon’s experience in treatment of buried penis in children and describe the surgical technique which was developed by the senior author. Methods  Described surgical technique avoids circumferential incision at the base of the penis and thus prevents formation of post-operative lymphedema. Repair is based on a vertical incision in median raphe, complete degloving of penis and tacking its base to prepubic fascia. Shaft skin is attached to base of penis with vertical mattress sutures. Results  Patient age varied from 1 month to 11.4 years (mean 1.9 years). All patients had good to excellent outcome with uniformly improved visualization of penile shaft post-operatively. There was one case of wound infection successfully treated with oral antibiotics. Revisions were needed in 4% patients. Conclusion  Surgical correction of buried penis in infants and children is safe and effective. Described technique is applicable for essentially all cases of congenital buried penis as well as for iatrogenically entrapped penis after circumcision. In our experience there were no additional procedures required to assure skin coverage of penile shaft. An erratum to this article can be found at     

“V”形切口改良Brisson手术治疗小儿隐匿阴茎

目的 介绍使用“V”形切口改良Brisson手术治疗隐匿性阴茎34例的方法和效果.方法 手术通过用阴茎腹侧“V”形切口改良Brisson术来完成,松解阴茎伸展外露后,修剪包皮系带伸直阴茎头,对合缝合包皮,从阴茎腹侧V形切口,去除发育不良的筋膜组织,在阴茎腹侧根部将皮下筋膜层与尿道前筋膜缝合固定.结果 手术时间约40～60 min,随访6～12个月,阴茎发育及外观效果满意,1例较肥胖的患儿术后显露效果不佳.3例水肿患儿术后2周内均基本消退.结论 本术式相对简单损伤小,外观良好,我们认为是治疗隐匿性阴茎比较理想的手术方式之一.     

改良Brisson术治疗小儿隐匿性阴茎的远期随访结果

目的 探讨改良Brisson术治疗小儿隐匿性茎的远期疗效.方法 回顾2003年1月至2005年12月在本院用改良Brisson术治疗的隐匿性阴茎病例,通过电话访问的形式让家长回答问卷,根据问卷结果评价治疗的远期疗效.结果 在成功受访的39例患儿家长中,患儿术后症状改善36例(92.3％);手术能明显改善家长对患儿阴茎显露的满意率(P＜0.01);手术有助于减轻家长对患儿阴茎显露欠佳的心理负担(P＜0.01);但对学龄期儿童,手术似乎对他们的心理状况改善帮助不大(P＞0.05).对于手术后整体外观效果有21例表示满意(53.8％),13例表示较满意(33.3％),5例表示不满意(12.8％).家长对手术效果评分平均为(8.27±1.39)分(满分10分);其中38例(97.4％)患儿家长表示会把该手术推荐给有类似情况的亲戚或朋友.结论 改良Brisson术治疗隐匿性阴茎能得到较为满意的远期效果.     

渐进性皮瓣转移技术治疗先天性隐匿阴茎

目的 通过总结103例先天性隐匿阴茎的临床资料,探讨渐进性皮瓣转移技术应用于先天性隐匿阴茎的诊治经验.方法 2006年7月至2008年9月,采用渐进性皮瓣转移技术治疗先天性隐匿阴茎患儿103例,年龄为6个月至12.3岁,所有病例均符合先天性隐匿阴茎的诊断,其中3例伴有明显肥胖.结果平均随访1.5年(6个月至2.5年).所有患儿阴茎外观均较满意,阴茎显露好,无包皮臃肿现象.术后1例冈阴茎根部皮肤附着不佳仍有同缩,2例患儿在阴茎根部切口处轻度裂开.结论 渐进性皮瓣转移技术治疗先天性隐匿阴茎,术后阴茎外观接近包茎术后表现,术后再回缩等并发症少.渐进性皮瓣转移技术可以作为治疗先天性隐匿阴茎的常规术式.     

儿童隐匿阴茎分型诊疗的临床探讨

目的 探讨小儿隐匿阴茎的分型及治疗.方法 对我院2009年12月至2013年12月收集的83例小儿隐匿阴茎患儿的临床资料进行回顾性分析,根据包皮口夹角角度对其进行分型,隐匿阴茎Ⅰ型:包皮口夹角为30°～45°,隐匿阴茎Ⅱ型:包皮口夹角为46°～90°,隐匿阴茎Ⅲ型:包皮口夹角为大于90°,其中,Ⅰ型隐匿阴茎3例,Ⅱ型10例,Ⅲ型70例.隐匿阴茎Ⅰ型和Ⅱ型采用改良Brisson术,隐匿阴茎Ⅲ型采用改良Shiraki术,根据Boemers标准评价术后效果,术后总体效果可分为良好、一般和不良.结果 术后5～6 d去除敷料暴露伤口并拔除尿管,术后6～7 d出院.所有病例均获得随访6个月至2年,平均12个月,12例有包皮内板轻度水肿,随访6～12周后均恢复正常;81例阴茎体显露良好,家长对阴茎外观满意,2例阴茎体显露一般.结论 通过不同手术方法治疗不同分型的儿童隐匿阴茎,针对性强,阴茎外观良好,并发症相对较少.     

Preputial intussusception or acquired megaprepuce

Preputial intussusception, or acquired megaprepuce, is a clinical condition whose incidence is increasing. It results from infolding of the outer preputial skin, obstruction of urinary flow, and the development of a phimosis. With time the process continues, resulting in a distinctive clinical picture. Treatment by early circumcision cures the problem and allows resolution of the sequelae. Accepted: 3 June 1997     

Double-V scrotoplasty for repair of congenital penoscrotal webbing: A hidden scar technique

ObjectivePenoscrotal webbing (PSW) is a common reason for deferral of neonatal circumcision. Reports of successful procedures and outcomes in the literature are sparse. We have performed double-V scrotoplasty (DVS), a modification of a V–Y technique, in 138 patients with excellent results.Patients and methodsWe retrospectively reviewed the charts of boys who had undergone DVS for PSW since January 2009 by a single surgeon (S.A.A.). The indications, intraoperative findings, concomitant procedures, outcomes, and complications were recorded.ResultsA total of 138 DVSs were performed. Concomitant genital surgeries included 81 hidden penis repairs and 10 other (hernia, hypospadias, chordee, orchidopexy). The median age at the time of surgery was 9.6 months (6.1 months–9.8 years). Patients were evaluated about 1 month postoperatively. In seven cases (5%), minor skin separation occurred at the penoscrotal junction but all healed completely. Superficial skin infection occurred in one patient. None required reoperation and cosmetic results were subjectively excellent.ConclusionsPSW has been corrected in 138 patients without significant complications and with excellent results. This is the largest known peer-reviewed series evaluating a surgical technique for congenital PSW repair. We believe our technique is simple, reproducible, and, with no diverging suture lines lateral to the median raphe, improves cosmesis.     

Torsion of the penis

Torsion of the penis, with or without a minor degree of hypospadias, is a congenital abnormality that is being diagnosed more frequently and referred to pediatric surgeons. In the 5-year period 1988–1992, 16 boys, 9 with glanular or juxtaglanular hypospadias and 7 with isolated torsion of the penis, were operated upon for penile torsion in our clinic using either a circular incision at the subcoronal sulcus or Johnston's procedure. The functional and cosmetic results in the two groups are compared and specific indications for the two techniques are discussed. The first technique is suggested as the procedure of choice because it involves minimal complications and gives the best cosmetic results.     

Hypercalcemia and carcinoma of the penis

Hypercalcemia is the most common metabolic disorder associated with malignancies. Squamous cell carcinoma of the penis is a tumor for which this abnormality has rarely been described. This report presents a case of hypercalcemia seen in a patient with advanced penile cancer. A chemotherapy regimen of intravenous cisplatin and fluorouracil caused regression of the primary tumor and normalization of the serum calcium. A literature review supported an association between squamous cell carcinoma of the penis and hypercalcemia. Med. Pediatr. Oncol. 29:576–577, 1997. © 1997 Wiley-Liss, Inc.     

Muscular flaps for closure of giant abdominal wall defects

In this article we describe the use of muscle flaps in closing giant abdominal wall defects. The technique used to take the flaps from the anterior rectum, internal and external oblique muscles are shown. We emphasize the advantages of using this technique, which avoids the use of synthetic materials, such as Teflon and Marlex mesh. Correspondence to: Antonio F. Gallardo Meza