阴囊皮瓣转移修复阴茎皮肤缺损

目的探讨一种操作简便而有效地修复阴茎皮肤缺损的手术方法.方法自1995年1月以来,应用阴囊皮瓣转移修复阴茎皮肤感染坏死所致皮肤缺损8例.其中6例为阴茎全周皮肤缺损,2例为2/3周皮肤缺损.手术切除创面肉芽组织,显露正常的阴茎海绵体或尿道海绵体筋膜,使阴茎充分伸展,设计、解剖、形成阴囊皮瓣,旋转转移至阴茎皮肤缺损区,边缘缝合固定.对阴囊皮肤缺损较大者,同期应用股内侧局部皮瓣转移修复阴囊皮肤缺损.结果本组8例手术全部成功,术后3～12个月随访,阴茎外形良好,生理功能恢复正常.结论阴囊皮瓣转移是一种较好的修复阴茎皮肤缺损的手术方法,具有操作简便、手术Ⅰ期完成、术后阴茎外形和生理功能恢复均佳的优点,值得推广应用.     

应用阴囊皮瓣矫治小儿隐匿阴茎

目的 探讨利用阴囊皮瓣矫治小儿隐匿阴茎的疗效.方法 于阴茎腹侧纵行切开狭窄环,距冠状沟约0.5 cm环状切开包皮内板,将包皮脱套至阴茎根部.完全切除异常附着筋膜,裁剪包皮包绕冠状沟.于阴茎阴囊交界处向阴囊两侧切开,将两侧阴囊皮瓣上移覆盖阴茎根部.缝合包皮,重建阴茎阴囊角,阴囊成形.结果 2009年3月至2011年7月采用阴囊皮瓣矫治隐匿阴茎患儿24例,术后尿道外口粘连2例,经尿道扩张后排尿正常;包皮远端轻度坏死1例,经门诊换药2周后好转,余21例手术效果良好.随访6个月至2年,所有患儿均未发现阴茎回缩,阴茎外观塑形良好,勃起时无侧弯、旋转.结论 应用阴囊皮瓣矫治小儿隐匿阴茎可最大程度地显露阴茎,塑形效果良好,并发症较少,是一种较为理想的手术方法.     

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。     

微创技术治疗隐匿阴茎可以使阴茎更长

作者在此文中介绍了一种微创的手术方法治疗先天性隐匿阴茎。这种技术分两种术式：方法一是在阴茎与阴囊交界处行双弧形切口,从肉膜和阴茎筋膜（Buck’Sfascia）分离至暴露出白膜,然后用两根4-0丝线分别从3点和9点钟方位将阴茎拉伸固定在耻骨前筋膜上,其余皮下组织用丝线固定在阴茎根部;方法二是在阴茎12点钟方向做倒V字型切口     

阴茎癌阴茎全切会阴部小阴茎成形术(附5例报告)

阴茎癌是常见的泌尿系肿瘤之一。以往对阴茎癌施行阴茎全切除术后,残留尿道均移植于会阴部,术后患者均需采取蹲位排尿,使患者在心里上难以适应。此外,会阴移植常由于感染等导致尿道外口狭窄。而行阴茎全切会阴小阴茎成形术,即将残留尿道利用阴囊、会阴交界正中带蒂舌状皮瓣成形———小阴茎,不仅能使患者保持站立排尿功能,而且能避免因感染造成的尿道外口狭窄。本院自2000年以来采用此术式治疗5例患者,获得满意效果。     

隐匿性阴茎的诊断与治疗分析

目的提高隐匿性阴茎的诊断与治疗水平.方法 1998年8月～2004年1月,共收治43例隐匿性阴茎患儿,年龄2～14岁,平均7岁.其中肥胖患儿8例;1例伴蹼状阴茎.本组均采用黄鲁刚等设计的术式,手术的关键是将阴茎海绵体根部的白膜固定在阴茎与腹壁交接处的皮下筋膜上,1例同时行阴茎阴囊交界处横切纵缝,矫正蹼状阴茎;2例肥胖患儿行耻骨前脂肪剔除术.结果术后随访3个月～2年,8例肥胖患儿疗效欠满意,其中2例行耻骨前脂肪剔除术后的患儿,远期效果欠佳.余35例术后阴茎外观改善满意.结论该术式治疗隐匿性阴茎,方法简便,效果满意,但对肥胖患儿手术应慎重.     

应用脱细胞异体真皮植入Bucks筋膜下加大阴茎

目的探讨一种加大阴茎的手术方法。方法将脱细胞异体真皮填充在阴茎Bucks筋膜与白膜之间加大阴茎。结果自2002年3月以来,我们在临床应用12例,术后自然状态下阴茎周径加大13～31cm,平均26cm,术后3个月有正常的性生活。1例因包扎过紧至阴茎皮肤部分坏死,经转移阴囊皮瓣修复愈合。结论该方法用于阴茎加大,创伤小、操作简便、效果确实,无不良反应。     

改良Brisson术治疗重度隐匿性阴茎北大核心CSCD

目的探讨改良Brisson术治疗重度及合并明显肥胖的隐匿性阴茎疗效。方法回顾性分析2014年1月—2016年8月采用改良Brisson术治疗的96例重度隐匿性阴茎患儿临床资料,其中合并明显肥胖53例。患儿年龄1岁～11岁9个月,平均5岁3个月。采用阴茎阴囊正中纵切口替代阴茎阴囊交界处楔形皮肤切口,充分暴露术野;充分松解并切除阴茎周围异常肉膜及筋膜组织;利用原位推进及旋转皮瓣匹配包皮内板,完全去除皮肤狭窄。术后定期随访,采用Boemers标准评价术后疗效。结果术后切口均Ⅰ期愈合,包皮皮瓣无感染、坏死发生。93例患儿获随访,随访时间1年～3年6个月,平均2年4个月。术后48 h内出现2例阴囊血肿、5例阴茎皮肤水肿,1例术后1个月阴茎阴囊角切口瘢痕增生。90例患儿阴茎体显露良好,立位及端坐位均无阴茎体退缩,家属对阴茎外观满意;3例显露一般,端坐位时阴茎部分回缩入耻骨前脂肪,阴茎皮肤附着部分松脱,影响外观。结论采用改良Brisson术治疗重度及合并明显肥胖的隐匿性阴茎,并发症少,效果满意。     

阴囊入路隐匿阴茎成型术初步诊疗体会

目的:探讨隐匿阴茎的发病机制及其对患者生理和心理的不良影响，了解阴囊入路隐匿阴茎成型术治疗隐匿阴茎的必要性和可行性。方法:总结分析天津市津南医院2020年1月—2022年10月诊治的70例隐匿阴茎患者。所有病例均行经阴囊入路的隐匿阴茎成型术，观察手术前后阴囊阴茎角和阴茎牵拉长度的变化，统计患者术后阴茎外观满意度和心理健康恢复情况。结果:70例患者中，31例通过手术证实会阴部脂肪垫增厚，33例肉膜增生异常和纤维条索组织牵拉束缚阴茎体，6例包皮口狭窄束缚为主。术后包皮水肿5例，伤口感染1例，均通过保守治愈。除1例隐匿阴茎术后1个月复诊阴茎体回缩外，余69例术后阴茎外观满意，阴茎延长效果显著，术后焦虑与抑郁评分明显降低。结论:阴囊入路隐匿阴茎成型术治疗隐匿阴茎疗效显著，阴茎外观满意，阴茎牵拉长度增加，心理健康改善，并发症少，预后良好。     

阴茎部整形术的应用解剖学研究

目的 探讨阴茎及其与邻近组织的解剖关系，为阴茎部整形术提供解剖学基础。方法 对30具(左右60侧)成年男性尸体的阴茎和会阴部进行解剖学观察，对阴茎各部的长度，漏斗韧带和悬韧带与阴茎根关系，阴茎海绵体脚与阴茎血管的关系进行观察和测量。结果 所测成人阴茎体长度为8．13cm；阴茎根长度为7．67cm，海绵体脚长度为5.96～5.98cm。漏斗韧带附着于阴茎根前部，阴茎浅筋膜两侧，并向下延伸为阴囊纵隔，参与组成阴囊和阴茎的悬吊结构；悬韧带附着于阴茎深筋膜背侧，后部增厚与耻骨弓状韧带紧密连结，参与尿道悬吊结构。在阴茎根部与阴茎海绵体脚部之间，有一段既无韧带附着又无骨性附着的海绵体，阴茎背动脉和神经在此处从腹侧转向背侧，阴茎背深静脉由此处穿过尿生殖膈注入盆腔内静脉丛。阴茎深动脉在海绵体脚骨性附着中部进入阴茎。结论 本组30例阴茎体长度的分区测量，阴茎悬吊结构的再认识及海绵体脚与阴茎深动脉的解剖关系对阴茎部整形手术具有重要意义。     

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.     

Penoscrotal plication as a uniform approach to reconstruction of penile curvature

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To present our 4‐year experience of using a minimally invasive technique, penoscrotal plication (PSP), as a uniform treatment for men with debilitating penile curvature resulting from Peyronie’s disease.

PATIENTS AND METHODS

In 48 men (median age 58.7 years) with penile curvature the penis was reconstructed by imbricating the tunica albuginea opposite the curvature with multiple nonabsorbable sutures. All patients, regardless of the degree or direction of curvature, were approached through a small penoscrotal incision made without degloving the penis. Detailed measurements of penile shaft angle and stretched penile length were recorded and analysed before and after reconstruction, and the numbers of sutures required for correction were documented.

RESULTS

Nearly all patients had dorsal and/or lateral deformities that were easily corrected via a ventral penoscrotal incision. The median (range) degree of correction was 28 (18–55)° and number of sutures used was 6 (4–17). Stretched penile length measurements before and after plication showed no significant difference. A single PSP procedure was successful in 45/48 (93%) patients; two were dissatisfied with the correction, one having repeat plication and the other a penile prosthesis; one other required a suture release for pain.

CONCLUSIONS

PSP is safe and effective and should be considered even for cases with severe or biplanar curvature.     

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.     

Buried penis: Classification surgical approach

Purpose

The purpose of this study was to describe morphological classification of congenital buried penis (BP) and present a versatile surgical approach for correction.

Materials and Methods

Sixty-one patients referred with BP were classified into 3 grades according to morphological findings: Grade 1—29 patients with Longer Inner Prepuce (LIP) only, Grade II—20 patients who presented with LIP associated with indrawn penis that required division of the fundiform and suspensory ligaments, and Grade III—12 patients who had in addition to the above, excess supra-pubic fat.

Operative Approach

A ventral midline penile incision extending from the tip of prepuce down to the penoscrotal junction was used in all patients. The operation was tailored according to the BP Grade. All patients underwent circumcision. Mean follow up was 3 years (range 1 to 10).

Results

All 61 patients had an abnormally long inner prepuce (LIP). Forty-seven patients had a short penile shaft. Early improvement was noted in all cases. Satisfactory results were achieved in all 29 patients in grade I and in 27 patients in grades II and III. Five children (Grades II and III) required further surgery (9%).

Conclusions

Congenital buried penis is a spectrum characterized by LIP and may include in addition; short penile shaft, abnormal attachment of fundiform, and suspensory ligaments and excess supra-pubic fat. Congenital Mega Prepuce (CMP) is a variant of Grade I BP, with LIP characterized by intermittent ballooning of the genital area.     

Tubularized incised plate urethroplasty for proximal hypospadias

OBJECTIVES: Numerous surgical procedures have been used to correct distal hypospadias. Among them, the tubularized incised plate urethroplasty (Snodgrass procedure) has become a mainstay for the repair of distal hypospadias. We applied the procedure to proximal hypospadias. METHODS: Three patients with proximal hypospadias underwent a tubularized incised urethral plate urethroplasty. The location of the meatus was proximal penis in one, penoscrotal margin in one and scrotum in one. A perimeatal incision was made and the two paramedian incisions were extended to the tip of the glans. The skin of the penile shaft was dissected free to the penoscrotal junction and bands of fibrous tissue were excised until the corpus spongiosum proximal to the meatus was completely exposed inside the scrotum. The urethral plate was then incised in its midline from the tip of the glans to the hypospadiac meatus and was tubularized without tension. The neourethra was covered with a pedicle of subcutaneous tissue dissected from the dorsal skin or the scrotal skin to avoid fistula formation. RESULTS: The tubularized incised urethral plate urethroplasty was carried out successfully in one stage on three patients with proximal hypospadias. CONCLUSIONS: The Snodgrass procedure is suitable for correcting hypospadias in patients with a healthy urethral plate. It is also suitable in patients with proximal hypospadias.     

Electrosurgery for Routine Pediatric Penile Procedures

Purpose

Traditional teaching in urology has been to avoid electrosurgical devices in penile surgical procedures. In the last several years cutting current has been routinely used on the penis for making skin incisions, degloving, creating Byars flaps and destroying skin bridges. The purpose of this study was to determine the complications and final outcomes of electrosurgery.

Materials and Methods

A 5-year retrospective chart review was done to determine the complications and final outcomes of exclusively using electrical current to perform pediatric penile procedures.

Results

Electrosurgery was used to perform the entire surgical dissection in 346 patients, including circumcision in 124, repeat circumcision in 68, penoscrotal fusion/chordee repair in 127 and skin bridge procedures in 27. All patients had a satisfactory cosmetic result. After correction of penoscrotal fusion, separation at the scrotal suture line in 2 patients healed secondarily without sequelae. There was no hematoma, tissue necrosis or skin sloughing and all surgery was performed on an outpatient basis.

Conclusions

Electrosurgery can be used safely and effectively for routine penile procedures, providing a bloodless operative field and excellent cosmetic results.     

Subtotal amputation for carcinoma of the penis with reconstruction of penile stump.

Partial and total amputation are well-accepted procedures for the surgical treatment of carcinoma of the penis. In certain cases after adequate amputation the residual penile stump is too small from the penoscrotal junction to offer useful function, and a total amputation is therefore usually performed. In such cases a subtotal amputation with reconstruction of the penile stump avoids a perineal urethrostomy and permits micturition in the erect posture.     

Penoscrotal transposition with hypospadias: 1-stage repair.

A 1-stage surgical repair of penoscrotal transposition with hypospadias is described. The basic principles are correction of hypospadias with the best vascularized island penile skin flap used for a new urethra and 2 vascularized sliding skin flaps used for reconstruction of the penile skin, and transposition of the penis to the suprascrotal position in the area of the mons pubis, with mobilization plus midline testicular fixation (inter-orchiopexy) and scrotoplasty. This technique was applied in 42 patients 2 to 9 years old between 1986 and 1991. The complications were 2 urethral stenoses on the proximal anastomosis (1 was treated successfully by urethrotomy and 1 by an open operation) and 2 fistulas (successfully treated by surgery), while 2 patients required additional correction of penoscrotal transposition.     

Correction of completely buried penis using the modified preputial island pedicle flap method.

The buried penis is a rare congenital abnormality caused by a deficiency of penile shaft skin and abnormal attachments of the dartos fascia to Buck's fascia. The basis for surgical correction is directed at freeing the penile shaft from abnormal dartos attachments, refixing dartos fascia to Buck's fascia to prevent retraction of the penis, and providing adequate shaft skin coverage with the inner preputial skin. The authors report a modified preputial island pedicle flap method for correcting the completely buried penis performed on 2 patients (ages 9 months and 1 year) at Nagoya City University Medical School.     

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.