不同组织材料再造尿道的远期对比观察

目的 对比应用不同组织材料再造尿道内壁的远期外观和组织结构变化及与正常尿道的区别,遴选用于再造尿道的组织材料.方法 术中直视或应用尿道造影、尿道镜观察再造尿道内壁外观.应用光镜、电镜观察再造尿道切片组织结构.结果 应用皮肤或黏膜再造尿道远期外观均接近正常尿道,远期组织结构也未见改变;应用口腔黏膜再造的尿道,远期组织结构还具备形成正常尿道微环境的一些重要结构基础;应用膀胱黏膜者,远期组织结构接近正常尿道.结论 膀胱黏膜和口腔黏膜可能是较皮肤更适用于再造尿道的组织材料.     

再造尿道组织材料的易感染性研究

目的 观察再造尿道远期变化，对比不同材料的组织易感染性，研究如何降低尿道下裂术后感染率，探讨选择再造尿道组织材料的依据。方法 应用尿道镜、尿道造影观察再造尿道，以光镜、电镜观察再造尿道材料、再造尿道及正常尿道的组织切片。结果 应用皮肤、口腔黏膜、膀胱黏膜再造的尿道远期结构和易感染性均无变化，没有化生为尿道黏膜。结论 再造尿道壁远期仍与同源组织结构相同，组织易感染性相同。从微环境角度而言，膀胱黏膜和口腔黏膜是理想的再造尿道材料。皮肤再造的尿道具有内在固有的组织易感染特性。尿道下裂最佳手术年龄在青春期之前。     

微粒黏膜复合明胶海绵移植耦合局部皮瓣再造尿道

目的 探讨明胶海绵复合微粒包皮内板黏膜或尿道板黏膜游离移植,并耦合局部皮瓣治疗阴囊型及阴茎阴囊型尿道下裂的手术方法及疗效.方法 2006年4月-2007年12月,收治8例重度尿道下裂患儿,年龄8个月～3岁.阴囊型尿道下裂3例,余均为阴茎阴囊型尿道下裂.阴茎牵拉长度为2.5～4.5 cm.应用明胶海绵复合微粒包皮内板黏膜或尿道板黏膜游离移植,并与大小为2.5 cm×1.0 cm～4.5 cm×1.2 cm的局部皮瓣耦合再造尿道.其中一期修复7例,二期修复1例.结果 患儿手术时间为(150×35)min,术中测量修复尿道缺失长度为(3.38×0.79)cm.皮瓣均顺利成活.8例均获随访,随访时间2～24个月.无尿瘘和尿道狭窄并发症发生.患儿阴茎下弯彻底矫正,再造尿道口位于阴茎头部,能正常勃起和站立排尿,尿道顺应性良好.1例术后12个月出现轻度阴茎下弯,未行治疗.结论 明胶海绵复合微粒包皮内板黏膜或尿道板黏膜游离移植耦合局部皮瓣修复阴囊型及阴茎阴囊型尿道下裂,具有减少局部皮肤应用、改善成形龟头外观、减少尿道并发症的优点,近期疗效较好.     

应用口腔黏膜再造尿道远期观察研究

目的观察口腔黏膜再造尿道的远期外观与结构变化,以及与正常尿道黏膜的差异。明确口腔黏膜用作再造尿道材料的优缺点,以及与尿道下裂术后并发症是否有相关性。探讨用口腔黏膜作再造尿道材料的可行性。方法随访应用口腔黏膜再造尿道患者的远期形态与功能。应用尿道镜观察应用口腔黏膜再造尿道的远期外观。应用光学显微镜观察取自口腔黏膜再造尿道内壁的标本,同时对比观察正常口腔黏膜和尿道黏膜标本。结果应用口腔黏膜再造尿道,远期外形良好,排尿功能正常。再造尿道壁大体外观接近正常,但组织结构仍为典型口腔黏膜。结论应用口腔黏膜再造尿道,远期形态、功能均接近正常尿道,但组织结构没有改变。口腔黏膜是良好的再造尿道组织材料。     

应用口腔黏膜再造尿道远期观察研究

目的观察口腔黏膜再造尿道的远期外观与结构变化,以及与正常尿道黏膜的差异.明确口腔黏膜用作再造尿道材料的优缺点,以及与尿道下裂术后并发症是否有相关性.探讨用口腔黏膜作再造尿道材料的可行性.方法随访应用口腔黏膜再造尿道患者的远期形态与功能.应用尿道镜观察应用口腔黏膜再造尿道的远期外观.应用光学显微镜观察取自口腔黏膜再造尿道内壁的标本,同时对比观察正常口腔黏膜和尿道黏膜标本.结果应用口腔黏膜再造尿道,远期外形良好,排尿功能正常.再造尿道壁大体外观接近正常,但组织结构仍为典型口腔黏膜.结论应用口腔黏膜再造尿道,远期形态、功能均接近正常尿道,但组织结构没有改变.口腔黏膜是良好的再造尿道组织材料.     

阴囊前侧双蒂肉膜皮瓣移植覆盖在阴茎皮肤坏死早期处理中的应用

目的探索阴囊前侧双蒂肉膜皮瓣覆盖在阴茎坏死早期处理中的重要性。方法自2003—2019年,南方医科大学珠江医院整形美容外科共治疗了11例行包皮环切术后阴茎皮肤坏死缺损的患者,局部清创后即刻应用阴囊前侧双蒂肉膜皮瓣覆盖创面,供区直接缝合。结果 11例患者术后均未出现皮瓣坏死。其中9例就诊及时,患者对治疗后阴茎外观恢复较满意;1例就诊时尿道海绵体已严重缺损,伴有尿管外露,采用阴囊皮瓣修复后仍遗留尿瘘,但患者对阴茎外观基本满意;1例就诊时阴茎体前2/3组织坏死,因缺损严重,采用阴囊皮瓣手术治疗2周后,阴茎头部出现坏死脱落,但残余阴茎体形态尚可。结论阴囊前侧双蒂肉膜皮瓣的血运及皮源丰富,色泽、质地与阴茎皮肤相近,修复阴茎皮肤缺损后的感觉和形状均良好,故应用于包皮环切术后阴茎皮肤坏死缺损的早期覆盖,可阻止创面的进一步恶化,挽救阴茎,提高患者的生活质量。     

阴茎两侧肉膜蒂组织双层覆盖在Snodgrass尿道下裂修复中的应用

目的介绍一种Snodgrass尿道下裂修复中新尿道覆盖方法，并对应用结果进行评估。方法2003年4月至2006年2月收治尿道下裂患儿289例。年龄3个月-12岁，平均2．4岁。其中冠状沟型78例、阴茎体型136例、阴茎阴囊型36例、阴囊型16例、Ⅱ期手术和再手术23例。均应用自阴茎体两侧分别游离的血管蒂肉膜瓣皮下组织对Snodgrass法修复的新尿道进行交替覆盖。结果289例患儿随访3—24个月，术后出现尿瘘32例（11％），其中11例术后4周内自行愈合，实际尿瘘发生率为7％（21／289）。21例未愈尿瘘中，远端型尿道下裂（冠状沟和阴茎体型）的尿瘘发生率为5％（11／214），近端型（阴茎阴囊型和阴囊型）、Ⅱ期手术和前次手术失败再次手术者为13％（10／75）。无伤口裂开或尿道憩室病例，结合黏膜领技术可以在腹侧正中线上原位缝合阴茎皮肤。术后能获包皮环切术样满意外观者277例。结论阴茎两侧肉膜组织双层覆盖新尿道是一种防止尿瘘和伤口裂开的可靠方法，并能有效重建类似正常阴茎外观。     

计算机三维重现兔先天性尿道下裂包皮血管

目的探寻先天性尿道下裂阴茎包皮血管变异的规律，计算机重现变异血管的三维立体构像。方法新西兰兔服用非那雄胺构建尿道下裂动物模型，阴茎组织连续切片，HE染色，显微镜下数码成像生成JPG格式图像，photoshop7．0软件及3Dmax8．0软件平台重建正常及变异阴茎血管的三维立体构像。结果采用非那雄胺成功构建了尿道下裂兔模型，根据阴茎外观形念分为阴茎头型、阴茎体型和阴囊会阴型尿道下裂。计算机三维立体构像可见正常包皮血管呈单支主干型，阴茎头型及阴茎体型尿道下裂包皮血管呈双支主干型，阴囊会阴型尿道下裂包皮血管呈网状无主干型。结论非那雄胺可以构建稳定兔先天性尿道下裂模型，正常包皮与尿道下裂包皮血管分布存在差别，不同类型尿道下裂之间包皮血管立体构像不同。     

隐匿性阴茎误诊误治后的矫治

目的:探讨隐匿性阴茎被误诊为包皮过长并行包皮环切术后的有效补救手术方法。方法:对21例隐匿性阴茎被误诊为包皮过长并行包皮环切术后的患者,采用改良的Devi ne术式矫治隐匿性阴茎和阴囊中隔带蒂皮瓣修复阴茎的皮肤缺损,观察其疗效。结果:21例患者阴茎外观均获恢复或接近正常,无一例出现皮瓣坏死,其中2例出现阴茎水肿,3月后恢复正常。随访1～2年无一例阴茎回缩,排尿勃起功能正常。结论:隐匿性阴茎误诊为包皮过长行包皮环切后,用改良的Devi ne术式治疗隐匿性阴茎和阴囊中隔带蒂皮瓣修复阴茎皮肤缺损是一种较好的手术补救方法。     

阴囊隔包皮岛状皮瓣尿道再造术

1988年以来,我院采用阴囊隔包皮岛状皮瓣法再造尿道31例,成功率93.5%,现报道如下. 1 临床资料 本组共31例,男性,年龄5～43岁,平均24岁,皆为先天性尿道下裂.有一次再造尿道史11人,二次尿道再造史7人,无手术史13人,尿道外口位于阴茎阴囊交界处或阴囊会阴部.     

Uncircumcision: a technique for plastic reconstruction of a prepuce after circumcision

A simple technique is described for plastic reconstruction of the prepuce. Penile skin is used and the defect created is covered by implantation of the penis into the scrotum. At a second stage the penis is released from the scrotum.     

Results of preputial reconstruction in 77 boys with distal hypospadias

PURPOSE: There is growing interest in preputial reconstruction combined with hypospadias repair. We retrospectively analyzed its results for future developments and patient information. MATERIALS AND METHODS: We evaluated 77 boys who underwent distal hypospadias repair combined with preputial reconstruction to determine complications, risks and failures. RESULTS: At a mean followup of 2.5 years 52 patients had an anatomically normal penis with a normal retractable foreskin, while 25 (33%) presented with a complication. The most common complications were partial dehiscence, and fistula of the prepuce and urethra. There was a complication of the reconstructed foreskin only in 16 cases (21%), a combined problem with the reconstructed foreskin and reconstructed urethra in 7 (9%), and a problem with the reconstructed urethra in 2 (3%). Of the 25 patients with complications 19 underwent reoperation with closure of the fistula or dehiscence and 5 were circumcised, while in 1 the parents accepted the minor cosmetic problem and refused reoperation. CONCLUSIONS: Preputial repair combined with hypospadias repair may lead to anatomically correct reconstruction of the penis at the cost of a 33% complication rate. Parents are informed about this risk and to date in 15% of all boys with distal hypospadias the parents have elected preputial reconstruction.     

后型尿道下裂二期膀胱黏膜半管状重建尿道术的临床研究

目的探讨采用二期膀胱黏膜半管状重建尿道术治疗后型尿道下裂的临床研究。方法81例后型尿道下裂病例采用二期手术：一期手术将阴茎海绵体完全伸直,阴茎包皮内板和背侧皮肤预置于阴茎腹侧;二期手术采用半管状阴茎阴囊皮肤＋半管状膀胱黏膜成形尿道术。结果81例后型尿道下裂患者矫形后形态几乎接近正常。手术成功率为86．4％（70／81）,尿瘘发生率为13．6％（11／81）,8例（9．9％,8／81）发生尿道狭窄,经尿道扩张治疗后痊愈。结论二期膀胱黏膜半管状重建尿道术治疗后型尿道下裂的手术成功率较高,值得临床推荐。     

A method of hypospadias repair

Summary The treatment of hypospadias requires the release of chordee and the reconstruction of a new urethra to provide for a satisfactory sexual function and normal micturition. A technique is described in two stages. In the first stage a large dorsal apron flap of prepuce skin is developed by a pericoronal incision. The chordee is released well beyond the urethral opening. A button-hole incision allows the prepuce flap to be reflected to the ventral surface. The distal part of this flap is formed into a skinlined tube with raw surface outward and pulled through a transglandular tunnel incision to the tip of the glans while rotating it 180 degrees. The ventral surface is closed. After three to six months, the penis presenting with a subglandular opening of the tube and the proximal hypospadiac urethra, the final reconstruction is undertaken. The excess ventrally shifted skin from the first stage between both orifices is incised by means of two parallel incisions and tubed to form one continuous urethral skin tube. A multi-layer closure burying the tube completes the procedure. The technique has given very encouraging results.     

Use of groin and mid-thigh flap in reconstruction of penis with penile and perineal urethra and a dorsal skin-lined socket for a removable prosthesis

Absent or deformed genitalia give rise to profound psychological complexes. In such cases reconstruction of the phallus can help the patient return to leading a normal life. A reconstructed penis must have a normal appearance, feel, and function, which up to now has not been completely possible. Using the method described herein, the penis was reconstructed from a groin and mid-thigh flap. It has a skin-lined tube placed ventrally for urination and has a dorsal skin-lined socket for insertion of a removable prosthesis for artificial erection. Seven stages are required for reconstruction, including reconstruction of a perineal urethra. Appearance of the reconstructed organ is acceptable. The erection device is simple, stable, and not costly, and normal urination and procreation are possible. Part of this method is also applicable for loss of erection and in reconstruction of a perineal urethra only.     

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.     

Personal treatment of congenital penile curvature

Severe type I congenital curvature of the penis is characterised by an almost transparent hypoplasia uretra. Treatment consists of resecetion of the dysplasic urethra and its replacement by tubular grafts of preputial or extragenital skin or of the vesical or buccal mucous membrane. We present our experience of four patient with type I congenital curvature of the penis which we treated with a simple surgical technique consisting of leaving the over-lying skin attached to the hypoplasia urethra and resecting the remaining fibrotic tissue which is connected to and retracts the skin and the cavernous bodies. We performed plastic surgery of the dorsal surface of the tunica albuginea to achieve correct penis hardening and finalized the surgery with reconstruction of the ventral surface of the penis by spreading out the dorsal prepuce or by using a pediculated graft of surplus preputial skin.