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.     

An alternative way to cover ventral penile skin defect in Mathieu technique.

Mathieu technique is used satisfactorily in distal penile hypospadias without chordee or with minimal chordee. After using this technique, a large defect may sometimes appear on the ventral surface of the penis. To cover the defect, a few techniques, including preputial island flap, Byar's flap and Ombrédanne-Nesbit's flap, are used. We describe a new flap to cover the defect more cosmetically. Twenty-four patients ranging in age from one year to 14 years (median age 6.5 years) were operated on. In the patients for whom the defect could not be covered primarily, a longitudinal incision was made along the midline through the penile shaft skin from penile radix up to the border of preputial skin. The relaxed penile skin, which was incised on the dorsal surface, could be approached and sutured easily on the ventral surface without stretching. The new defect that developed on the dorsal surface was closed with the prepuce matching the defect. Nine patients, two with chordee and seven without chordee, underwent this technique. The cosmetic and functional results were excellent in all patients and none of the patient's parents complained about the cosmetic aspect. Only one fistula complication, which healed spontaneously, developed on the 20th postoperative day. Considering these results, we may conclude that excellent cosmetic results can be accomplished by the use of this flap technique.     

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     

改良阴茎成形术治疗重度隐匿阴茎(附42例报告)

目的介绍使用改良Shiraki术联合"V"形切口治疗42例重度隐匿阴茎的方法和效果。方法自2011年8月至2013年8月间本院对42例重度隐匿阴茎患儿采取改良Shiraki联合"V"形切口术,此改良阴茎成形术分3个主要步骤:首先分别在外板的12点处及包皮内板的3点、9点处纵向切开,阴茎皮肤脱套至阴茎根部,同时切除阴茎体外层纤维索带,充分松解阴茎体使其完全伸展;修剪重建包皮系带伸直阴茎头,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;最后取阴茎腹侧V形切口,阴茎腹侧延长,重建阴茎阴囊角。结果手术时间约40~55 min,随访12~24个月,40例阴茎发育及外观效果满意,2例较肥胖的患者术后阴茎体显露效果不佳。13例包皮内板水肿患者术后12周内均基本消退。结论该术式操作相对简单,损伤小,外观良好,并发症少,我们认为是治疗重度隐匿阴茎比较理想的手术方式之一。     

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.     

“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.     

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.     

The Cosmetic Results of a Simple Method for Repairing Preputial Skin Defect in Hypospadias

Objective: Hypospadias is a common birth defect of the penis. Besides the abnormal position of the urethral opening, there is usually a ventral preputial defect with preputial redundancy in dorsal shaft. There are many flap procedures for correcting this defect. Here, we present our experience of skin coverage procedure with better cosmetic results. Methods: It is a prospective study on patients with mid-shaft to glandular hypospadias operated from June 2008 to December 2012. The operations were performed by one surgeon in two hospitals and the cosmetic results were evaluated by the surgeon, parents, and another pediatric surgeon by a satisfaction questionnaire. In this procedure, inner prepuce was incised curvilinearly, remaining 5 mm in medial and 8 mm in lateral aspects of the inner prepuce. For skin repair, dorsal flaps were approximated in midline along median raphe. Findings: Sixty-three patients with mean age of 25.75±8.46 (7-93) months were followed up for 7.06±3.34 (2-15( months. There were 4 complications. The overall satisfaction with penile skin coverage was 93.7% for parents and 98.4% for surgeons. Patients’ age and primary site of meatus had a significant correlation with cosmetic results (P<0.05), while urethroplasty techniques and post-operative complications were not significant. Conclusion: Reapproximation of dorsal flaps in midline is a simple method and can be used in most cases of uncomplicated primary hypospadias. By this technique a more normal appearance can be achieved.Key Words: Hypospadias, Urethroplasty, Cosmetic Surgery, Penis     

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.     

Outpatient catheterless Mathieu repair: how to cover ventral penile skin defect.

A modification of the Mathieu repair eliminating stenting has been described by Rabinowitz which makes the method more convenient for outpatient performance. We report on our experience with this modification with special emphasis on coverage of ventral penile skin defect. To cover the raw area formed on the ventral aspect of penis with the creation of meatal based flap Rabinowitz used Byar's flap. Two different flaps prepared from prepuce were used in this series. In some patients an island flap was used. In others the prepuce was incised transversally on its dorsal aspect and transferred to the ventral surface as a bipedicle visor flap, as described by Ombrédanne and popularized by Nesbit. Twenty-two patients ranging in age from one to twelve years (mean +/- 1SD = 6 +/- 3.28) were operated on using the technique. The meatus was glandular in two, coronal in twelve and distal penile in eight patients. Preputial flap was not used in one patient because the defect was small. Island flap was used in three and Ombrédanne-Nesbit's flap in 18 patients. Complete disruption of the repair occurred in one of the patients in whom an island flap was used. Among 18 patients in whom Ombrédanne-Nesbit's flap was used, one partial necrosis of the preputial flap was encountered which required revision and two urethrocutaneus fistulae occurred which healed spontaneously. The use of the present technique yields a good cosmetic result, a high success rate with minimal complications, and eliminates catheterization; hence, hospitalization is recommended.     

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.     

Primary lymphedema of the penis: Surgical correction by preputial unfurling

Primary lymphedema of the penis (PLP) is a rare disease. We report a case in a 2-year-old, uncircumcised boy where the uninvolved inner preputial skin was unfurled to cover the penile shaft. The uninvolved inner preputial skin is often elongated, and provides a suture-free cover of sufficient length for the small penile shaft of pediatric patients. Accepted: 12 May 2000     

Two-stage complex hypospadias repair when urethral plate has to be divided: Ventral corporoplasty using a tunica vaginalis flap

ObjectiveTo demonstrate ventral corporoplasty, with tunica vaginalis flap to reconstruct the corpora cavernosa, in a two-stage strategy for proximal hypospadias surgery.MethodsAssessment of residual curvature after complete urethral plate division and transverse superficial cuts in albuginea. Ventral incision of tunica albuginea to elongate the ventral surface of the penis and use of a tunica vaginalis flap to reconstruct the defect in corpora cavernosa. Dorsal preputial island flap was used to cover the penile ventral surface, to be tubularized in a second stage, together with the original urethral plate.ResultsPatient had an uneventful follow-up. Penile aspect was very satisfactory with no residual curvature.ConclusionTunica vaginalis is an attractive alternative for ventral corporoplasty in hypospadia repair and has the advantages of prompt disposability, autologous use, and does not represent an extra cost for treatment.     

Surgical correction of congenital megaprepuce

Congenital megaprepuce (CMP) is a rare entity. Two infant boys presented with a tight congenital phimosis resulting in an excessively baggy, urine-filled prepuce and a swollen scrotum. Compression of the scrotum resulted in drainage of urine. We feel this to be a separate entity from a buried penis and recommend early surgery. The phimotic tip of the foreskin was excised and the inner layer preserved to cover the full length of the penile shaft. The outer layer of the foreskin, in reality the penoscrotal junction, was anchored to the base of the penile shaft. A V-shaped edge of ventral skin was excised and the edges approximated, giving the appearance of median raphe. The final appearance was that of a circumcised penis. A third patient awaits operation. Accepted: 25 November 1998     

Concealed penis

A small phallus causes great concern regarding genital adequacy. A concealed penis, although of normal size, appears small either because it is buried in prepubic tissues, enclosed in scrotal tissue penis palmatus (PP), or trapped due to phimosis or a scar following circumcision or trauma. From July 1978 to January 2001 we operated upon 92 boys with concealed penises; 49 had buried penises (BP), while PP of varying degrees was noted in 14. Of 29 patients with a trapped penis, phimosis was noted in 9, post-circumcision cicatrix (PCC) in 17, radical circumcision in 2, and posttraumatic scarring in 1. The BP was corrected at 2-3 years of age by incising the inner prepuce circumferentially, degloving the penis to the penopubic junction, dividing dysgenetic bands, and suturing the dermis of the penopubic skin to Buck's fascia with nonabsorbable sutures. Patients with PP required displacement of the scrotum in addition to correction of the BP. Phimosis was treated by circumcision. Patients with a PCC were recircumcised carefully, preserving normal skin, but Z-plasties and Byars flaps were often required for skin coverage. After radical circumcision and trauma, vascularized flaps were raised to cover the defect. Satisfactory results were obtained in all cases although 2 patients with BP required a second operation. The operation required to correct a concealed penis has to be tailored to its etiology.     

小儿埋藏性阴茎的诊断与外科治疗

为了探讨埋藏阴茎的最佳的手术治疗方法，对近１２年中收治的年龄４～１３岁８５例患儿，应用包括包皮外板多处小切口纵切横缝包茎、耻骨联合前上方皮下组织切除、阴茎筋膜分离和阴茎根部皮肤与耻骨骨膜缝合的方法进行手术。术后半年以上获得随访共６７例，其中效果满意５９例（８８．１％），尚有轻度阴茎埋藏８例（１１．９％）。提示本术式是治疗埋藏阴茎简单有效的方法。     

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.     

儿童隐匿阴茎手术治疗82例

目的：探讨手术治疗儿童隐匿阴茎的疗效。方法回顾性分析2009年1月至2011年12月在本院接受手术治疗的82例隐匿阴茎患儿临床资料。术前检查显示阴茎外观短小,严重者仅见包皮堆而无阴茎体显露,用拇指和食指将阴茎周围皮肤后推可显露发育及长度基本正常的阴茎体,松手后阴茎体迅速回缩。患儿均有包皮口狭窄,阴茎头不外露。手术操作包括：松解包皮狭窄环、脱套阴茎皮肤、转移阴囊皮肤增加阴茎体皮肤覆盖、固定海绵体白膜和阴茎根部皮下组织,重建阴茎阴囊角。结果82例均获随访,平均手术年龄为5（1～13）岁,平均手术时间为40（30～70）min,平均随访时间为6（3～24）个月。术后阴茎体显露良好,阴茎体无明显回缩。结论手术可有效矫正隐匿阴茎外观,改善阴茎体显露。     

Urethral hemangioma in childhood: treatment by total excision and single-stage urethroplasty

We report a 4-year-old boy who had an asymptomatic hemangioma on the ventral aspect of the urethra that caused a dorsal curvature of the penis. Treatment consisted of total excision of the tumor, repair of the urethral defect using a vascularized island flap from the penile skin, and correction of the dorsal curvature of the penis by plication of the ventral aspects of the corpora cavernosa. The cosmetic and functional results were excellent. The peculiar clinical presentation, in which the tumor caused a dorsal curvature of the penis, and the treatment used have not previously been reported in the literature.     

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.