不完全型男性尿道上裂并隐匿型阴茎1例

2007年3月武汉大学人民医院收治1例不完全型男性尿道上裂并隐匿型阴茎患者，经手术治疗，效果满意，现报告如下。     

不完全型男性尿道上裂并隐匿型阴茎1例

2007年3月武汉大学人民医院收治1例不完全型男性尿道上裂并隐匿型阴茎患者,经手术治疗,效果满意,现报告如下.     

阴茎型尿道上裂的解剖学修复

目的 探讨阴茎型尿道上裂的病理解剖特点和解剖学修复方法.方法 以尿道上裂患者局部尿道板成形缺损段尿道,切断阴茎浅悬韧带松解阴茎背侧挛缩,使得阴茎及尿道海绵体复位,从而完成尿道修复.结果 2004年6月至2010年12月,于临床应用26例,术后18例获得随访,时间为6个月至5年,10例手术一次成功,排尿通畅,控尿能力良好,阴茎背侧弯曲消失,尿道外口位于阴茎头端,效果良好;另8例有不同程度的尿失禁,二次手术进行尿道紧缩后消失.结论 将阴茎型尿道上裂的病理解剖结构恢复其正常的解剖学关系,能够达到外形及功能的良好修复.     

改良式尿道会师术9例体会

1995年1月～1998年8月，我们采用改良式尿道会师术治疗骨盆骨折所致新鲜膜部尿道断裂9例，治愈率89％。术后恢复生理排尿，尿流率正常，随访1～2年，无需行尿道扩张，效果良好。现介绍如下：     

带蒂腹壁皮瓣和腹直肌瓣一期修复膀胱外播及尿道上裂

采用自行设计的带蒂腹壁皮瓣和腹直肌瓣一期修复５例完全性膀胱外翻及尿道上裂，效果满意，腹壁和膀胱前壁缺损均得以关闭。４例术后随访１．５－１０．５年。３例采用腹直肌瓣缠绕膀胱颈者，术后能控制排尿；另１例未缠绕者，术后腹压增加时，呈尿失禁状，术后复查肾功能均正常。     

尿道上裂的外科治疗

目的对１２４例各型尿道上裂外科治疗进行分析。其中不伴尿失禁者２７例,伴尿失禁者９７例。不完全型２７例,完全型２１例,复杂型７６例。方法抗尿失禁方法主要采用不作输尿管移植的Ｌｅａｄｂｅｔｅｒ手术。女性完全型尿道上裂采用尿道缩紧术４例。对不完全型男性外生殖器作阴茎伸直术;完全型和复杂型作阴茎伸长术。结果完全控制排尿者７３例,外生殖器成形效果满意。结论男性不完全型应作阴茎伸直术,完全型应作抗尿失禁和阴茎伸长术;女性完全型应作抗尿失禁和外阴成形术。     

改良Black术式修复完全性双侧唇裂畸形

目的 探讨采用改良Black术式修复先天完全性双侧唇裂畸形效果.方法 应用改良的Black术式修复先天完全性双侧唇裂畸形36例,其中前唇组织特别短小者19例,皮肤、唇珠组织不足,均采用裂隙侧唇组织修复.结果 术后随访全部受术者3个月至3年,前唇部唇高正常,两侧唇高对称,唇珠丰满,唇弓静态及动态自然,上唇无明显过长、过紧,唇珠与红唇颜色无差异,切口瘢痕不明显,效果满意.结论 改良术式弥补了Black术式修复双侧完全性唇裂前唇组织特别短小的患者时,出现中央唇高不足、唇珠不够丰满的缺陷,使修复的上唇功能及美容效果更佳,值得临床推广.     

一期手术修复复合型膀胱外翻--尿道上裂

病例　男 ,9岁 ,先天性排尿异常就诊入院。患儿下腹正中粉红色半球形肿物间歇性尿液涌出。直立、咳嗽、腹内压增加时肿物明显膨出。局部因磨擦刺激疼痛 ,反复感染 ,致使患儿走路摇摆。入院检查 :下腹壁正中粉红色椭圆形肿物 ,范围 8cm× 10cm ,凸出体表 ,表面为粘膜组织 ,充血、水肿明显 ,边缘与周围皮肤生长紧密 ,并有上皮组织化生。肿物下部可见两处乳头状突起 ,基底可见输尿管开口 ,有澄清尿液间断涌出 ,肿物质软、触痛。双侧腹直肌前鞘分离约 7 5cm ,耻骨联合分离并旋向前外方 ,间距约 8cm。肿物下方显露扁平龟头。无尿道外口 ,包皮堆积…     

An adult female epispadias without exstrophy was presented with urinary incontinence: a case report

A 39-year-old woman with three children presented with primary severe urinary incontinence. Epispadias without exstrophy was determined in physical examination. The single-stage procedure including vulvoplasty and modified Young-Dees-Leadbetter bladder neck repair was performed to obtain sufficient cosmetic outcome and continence. Excellent functional and cosmetic results were obtained.     

The Cantwell-Ransley technique for repair of epispadias.

A total of 26 boys with bladder exstrophy (20) and epispadias (6) underwent initial urethral reconstruction between 1988 and 1991 using the Cantwell-Ransley technique. Penile reconstruction included wide mobilization of the urethral plate from the underlying corpora based on a mesentery from the ventral penoscrotal skin, corporeal lengthening by dividing the suspensory ligaments and attachments to the undersurface of the pubis, urethral and glandular tubularization, chordee correction by medial incision of the corpora with anastomosis dorsal to the urethra and penile skin coverage. All exstrophy patients had adequate phallic length, with 13 having an intact urethral plate and 13 having had prior paraexstrophy skin flap interposition. Postoperatively, repairs were intubated with silicone stents for 10 days. Two urethrocutaneous fistulas developed, 1 of which closed spontaneously. One patient had a small degree of penile skin loss that did not affect the neourethra. All patients currently have a cosmetically acceptable penis and all but 1 (previously diverted) are voiding per urethram. The neourethra in such patients allows for easier access for endoscopy and the ventral position aids in maintaining correction of the dorsal chordee. The low complication rate of this procedure coupled with the better anatomical configuration of the neourethra makes it useful for urethral and penile reconstruction in the exstrophy and epispadias patient.     

Female epispadias repair: a new 1-stage technique

PURPOSE: Female epispadias is a rare anomaly. According to the literature it is usually treated with staged procedures, including bladder neck reconstruction, to achieve continence. We developed a 1-stage surgical technique that offers the possibility of achieving continence and a cosmetically normal appearance of the vulva. MATERIALS AND METHODS: We treated 4 patients 4 months to 8 years old. The main point of the technique is to free completely the urethral plate and bladder neck from surrounding tissue. After tubularizing the urethral plate into a urethra modified needle suspension brings the bladder neck and proximal urethra into the intra-abdominal position. The pelvic floor is then reconstructed between the anterior vaginal wall and urethra. Thus, continence may be attained by intra-abdominal positioning of the bladder neck and proximal urethra as well as by pelvic floor reconstruction. RESULTS: Of our 4 consecutive cases of primary untreated epispadias the technique proved successful in 3, while followup is too short in 1. One patient is completely dry and voids without a further procedure. Postoperatively 2 patients with 5 years or more of followup required injection of a bulking agent at the bladder neck level to achieve continence, including 1 who is damp during the day without the need to change clothes and 1 on clean intermittent catheterization twice daily because post-void residual urine volume causes recurrent urinary tract infection. CONCLUSIONS: The described technique is promising for treating this disabling anomaly.     

Functional and cosmetic outcome of partial penile disassembly repair in isolated male epispadias patients

Introduction

Epispadias is a rare congenital anomaly and requires a carefully constructed and well-planned approach for the management. Modified Cantwell-Ransley technique and Mitchell's complete penile disassembly are commonly used technique and these may require multiple surgeries in majority of the patients to achieve the goals of cosmesis and continence.

Ventral preputial island flap technique for the repair of epispadias with or without exstrophy

The preputial island flap technique introduced by Duckett for repair of severe hypospadias has met with much clinical popularity. We report the use of a modification of this technique for repair of epispadias in 3 boys with exstrophy of the bladder and in 1 with penile epispadias. The results have been excellent in 3 cases and good in 1. Minimum followup has been 18 months.