阴茎再造勃起功能重建的研究现状

勃起功能重建作为再造阴茎功能重建的重要组成部分,近年来在材料选择、手术方法及组织工程学等方面不断发展,阴茎再造术也获得了不断地改进和完善。本文对近几年阴茎再造勃起功能重建的进展,以及常用的阴茎支撑材料,包括自体组织支撑物、人工假体支撑物及组织工程材料等研究进展进行综述。     

Total Phallic Reconstruction in Female-to-Male Transsexuals

Background

The goal of total phallic construction is the creation of a sensate and cosmetically acceptable phallus. An incorporated neourethra allows the patient to void while standing, and the insertion of a penile implant allows the patient to resume sexual activities, thus improving quality of life.

Objective

To report our experience of total phallic construction with the use of the radial artery free flap in female-to-male transsexuals.

Design, settings, and participants

The notes of the 115 patients who underwent total phallic construction with the use of the radial artery–based forearm free flap between January 1998 and December 2008 were reviewed retrospectively.

Measurements

The surgical outcome, cosmesis of the phallus, complications, eventual need for revision surgery, and patient satisfaction were recorded during the follow-up.

Results and limitations

This technique allowed the reconstruction of a cosmetically acceptable phallus in 112 patients; 3 patients lost the phallus due to venous thrombosis in the immediate postoperative period. After a median follow-up of 26 mo (range: 1–270 mo), 97% of patients are fully satisfied with cosmesis and size of the phallus. Sensation of the phallus was reported by 86% of patients. Urethral strictures and fistulae in the phallus and join-up site were the most common complications, occurring respectively in 9 and 20 patients; however, after revision surgery, 99% of patients were able to void from the tip of the phallus while standing.

Conclusions

The radial artery–based forearm free flap technique is excellent for total phallic construction, providing excellent cosmetic and functional results.     

双渠道血供腹壁皮瓣阴茎再造术

目的 提高再造阴茎的成活率,改善再造阴茎远端运,减少腹直肌损伤、腹疝及尿漏等并发症的发生。方法 设计1－2支脐旁穿支血管及腹壁浅血管两个渠道供血的腹壁皮瓣行阴茎再造16例。结果 手术均获成功,皮瓣100％成活。结论 所用皮瓣的供血充分,尤其静脉回流更为通畅,再造阴茎成活率高,对腹直肌损伤较小,是一较为理想的阴茎再造方法。     

Prefabricated Anterolateral Thigh Flaps for Phalloplasty in Female-to-Male Transsexuals

Background Phalloplasty is still a challenging operation because of the high urethral complication rate.Several options regarding different flaps can be chosen,but there is still no perfect solution for phalloplasty in female-to-male(FTM)transgender patients.Our group tried to use prefabricated anterolateral thigh(ALT)flaps for phalloplasty to overcome the urethral complications.Methods A total of 21 transgender patients were included from 2010 to 2019.A twostage operation was performed to reconstruct the phallus.The vaginal mucosa was prefabricated as neourethra at the first stage,and the shaft of the phallus was reconstructed at the second stage.Results All reconstructed phallus survived completely in our study,and the satisfaction rate was 76.2%.The total complication rate was 57.1%.The occurrence of fistula and strictures after the operation was 52.4%and 5.8%,respectively Conclusion Prefabricated ALT flaps with vaginal mucosa have a lower stricture rate.This technique provides a simple,effective surgical option in FTM transsexuals.     

Comment on: “A case report of a complete degloving injury of the penile skin”

IntroductionWe recently published an article in the International Journal of Surgical Case Reports titled: “Scrotal dartos-fascio-myo-cutaneous flap for penis elongation after catastrophic iatrogenic skin shaft sub-amputation: A case of recovery using an extremely adaptable flap”.Presentation of caseWe propose a comment on a recent article titled “A case report of a complete degloving injury of the penile skin” by Helena Aineskog and Frederik Huss that we read with great interest.DiscussionGenitalia are linked to self-esteem and male sexual identity, especially among young men, who sometimes require a surgical procedure to acquire more confidence. Various techniques are available for pe-nile skin covering, such as skin grafts or cutaneous flaps. The skin of the scrotum seems to be the most suitable tissue to be used to reconstruct the skin covering of the shaft as it is the most similar.ConclusionScrotal flap is a single stage procedure that is easy and safe to perform.     

Comparison of nocturnal penile tumescence monitoring and cavernosal smooth muscle content in patients with erectile dysfunction

Purpose: Nocturnal penile tumescence monitoring was compared to cavernosal smooth muscle content in 48 cases of erectile dysfunction.Materials and methods: Pre-operatively nocturnal penile tumescence rigidity (NPTR) testing, colour Doppler sonography and if needed pharmaco cavernosometry-cavernosography were evaluated in 48 impotent patients before surgical intervention. The 40 patients whom all those diagnostic tools were abnormal constituted the first group. In the remaining 8 patients, which constitutes the second group, NPTR testing were normal but the other tests were abnormal. 10 potent patients with congenital penile curvature constituted the third group. Cavernous biopsies were obtained during the surgery and biopsies stained immunohistochemically to quantify smooth muscle cells (SMC) by anti-desmin and anti-SMA.Results: We observed statistical significant difference of corporeal SMC content with regard to first Vs second group and first Vs third group (p < 0.05). However we did not observe statistically significant difference with regard to second vs third group (p > 0.05).Conclusion: NPTR testing appears to correlate well with corporeal SMC, which is the key structures of erection. We think that with taking into the consideration of its specific reservations, NPTR testing is still one of the best non-invasive tool in the differential diagnosis of erectile dysfunction.     

Surgical management of penile amputation in children

Purpose

Penile amputation in children is rare. If the amputated organ cannot be salvaged, standard treatment options include sex reassignment or creation of a penoid with a musculocutaneous flap. We describe our experience with phallic reconstruction after amputation.

Methods

Between 2005 and 2007, we observed 3 patients with penile amputation. All presented a flat pubic scar and a severe urethral stricture for which urinary diversion had been performed in two.The first step of the procedure was penile augmentation. The latter included dissection and advancement of the residual erectile tissue by either division of the suspensory ligament (n = 2) or detachment of the corpora cavernosa from the pubic bones. Then, meatal advancement was attempted and combined with a staged oral mucosa urethroplasty, if necessary. Finally, skin coverage was achieved using local flaps (n = 2) or a free graft harvested from the inguinal region. In 2 patients, a pseudoglans was sculptured from the pubic scar.

Results

In no case the procedure could be performed in a single stage. In one patient, 2 additional cosmetic revisions were required. Good penile augmentation was achieved in all the 3 cases. All patients presented at least nocturnal erections and reported to be satisfied with the cosmetic results.

Conclusions

Our experience suggests that an attempt to phallic reconstruction by retrieval of any residual erectile tissue might be worthwhile before embarking on a penile replacement. In a few cases, this may allow recreation of a penis with good cosmesis and function.     

Successful microsurgical replantation of an amputated penis

Traumatic amputation of the penis is a rare condition. The paper presents a 22-year old man who suffered a complete penile amputation in a result of an unfortunate accident. Microsurgical replantation of the penis was performed in the case with a complete return of sensation, sexual function and physiologic miction. Microsurgical replantation is the treatment of choice for this injury.