Urethral fistula following circumcision: salvaged by buccal mucosa graft urethroplasty

Fistula following circumcision and at times accompanied by disfigurement of the glans penis is a common problem in our country, where a large number of circumcision is performed by untrained professionals. These complications may have profound negative psychological impact on the growing child. Herein, we report the successful closure of such fistula using buccal mucosa, which occurred following circumcision (for phimosis) in a 15 year old boy. This resulted in the disfigurement of the glans penis with a distal urethral fistula. The fistula was managed by dorsal onlay buccal mucosa graft urethroplasty (BMGU). The patient has excellent cosmesis at 6 months followup with a good urinary stream. This technique can give better results than those, where skin grafts or local flaps are used for fistula closure. BMGU is a versatile technique with good long term results. The cosmesis and functional results are satisfactory and help in improving the self esteem and sexual function in the years to come.     

糖尿病患者行包皮环切缝合器手术可行性分析

目的探讨糖尿病患者采用包皮环切缝合器手术的可行性。 方法回顾性研究南京医科大学附属明基医院苏州院区2019年12月至2022年2月收治的行包皮环切术的89例糖尿病患者病历资料。依据切除包皮的手术方式不同,分为包皮环切缝合器手术组(n＝36)、传统包皮环切手术组(n＝53)。患者入院后完善术前常规化验和检查,控制血糖,包皮环切缝合器手术组患者术中选择相应型号的一次性包皮环切缝合器切割、缝合包皮;传统包皮环切手术组患者术中距离冠状沟0.5~1.0 cm处用组织剪剪去多余包皮,电刀严密止血后用可吸收线间断缝合。2组患者均用纱布和弹力绷带加压包扎伤口。术后2组患者均予以口服第2代头孢菌素类抗生素3 d预防感染,术后第1天予以更换纱布和弹力绷带,之后每2 d更换1次,直至伤口愈合拆除纱布和弹力绷带为止。比较2组患者平均手术时间、平均术中出血量、术后并发症以及记录包皮环切缝合器手术组吻合器损伤龟头例数。数据行Mann-Whitney U检验、χ²检验和Fisher确切概率法检验。 结果包皮环切缝合器手术组患者平均手术时间[10.0(6.3,14.8) min]和平均术中出血量[1.0(1.0,2.0) mL]显著短于及少于传统包皮环切手术组[28.0(23.0,33.0)min、2.0(1.0,5.0) mL],差异均有统计学意义(Z＝-7.787、-3.884,P<0.05)。术后包皮环切缝合器手术组伤口瘀斑8例(22.2%),高于传统包皮环切手术组[2例(3.8%)],差异有统计学意义(χ²＝5.583,P＝0.018)。包皮环切缝合器手术组术后伤口血肿5例(13.9%)、伤口感染5例(13.9%)、伤口全部裂开5例(13.9%),与传统包皮环切手术组(0、0、0)比,差异均有统计学意义(P＝0.009、0.009、0.009)。包皮环切缝合器手术组术后未出现伤口局部裂开,与传统包皮环切手术组[1例(1.9%)]比较,差异无统计学意义(P＝0.596)。伤口瘀斑较为常见可自行消退;增加弹力绷带层数基础上加压包扎2 d伤口血肿消失;针对伤口感染、伤口全部裂开,予以拆除全部包皮吻合器的钉和硅胶垫片后消毒、包扎,待伤口感染控制后,用可吸收线重新缝合;针对伤口局部裂开应用苯扎氯铵局部消毒。包皮环切缝合器手术组患者术中均未出现吻合器损伤龟头。 结论术前经过严格筛选和沟通后的糖尿病患者行包皮环切缝合器是安全可行的,而且具有手术便捷和手术体验较好等优点。     

小儿包皮环切术套环法800例体会

目的：总结包皮环切术套环法治疗小儿包皮过长的经验。方法对2003～2013年来我院行包皮环切术套环法治疗小儿包皮过长的800例患儿行回顾性分析。结果800例行小儿包皮环切术套环法患儿术后效果良好。套环脱落时间为7～20d,脱落后切缘整齐,外形美观。26例出现不同程度的并发症。其中,术后出血4例;包皮感染、红肿8例;套环不脱落5例;包皮撕裂3例;包皮环嵌入冠状沟4例;尿潴留2例。结论小儿包皮环切术套环法具有手术时间短,手术出血少,创伤小,并发症少,患儿痛苦小,术后护理方便等优点,手术简单易于推广。     

Ventral slit for phimosis and paraphimosis in children

Phimosis and paraphimosis are usually treated surgically by circumcision or a dorsal slit. However, circumcision may be undesirable for a number of reasons, and a dorsal slit results in an unsatisfactory cosmetic appearance. We describe a new technique, the ventral slit, which is effective and results in a normal appearance of the prepuce.     

中国商环包皮环切手术653例分析

目的探讨中国商环包皮环切的手术治疗效果。方法收集2008年7月至2011年8月应用中国商环行包皮环切术653例的临床资料进行回顾性分析。结果653例中,650例成功行中国商环包皮环切术,手术时间平均（6±1）min,术中无出血,带环期间无出血、血肿形成、切口裂开、感染、商环脱落等;3例手术失败,改行传统包皮环切术。行商环包皮环切术者术后7—10d取环,648例伤口甲级愈合,2例伤口延期愈合。术后随访9—24个月,包皮外形美观,切缘整齐光滑,可见线状环行瘢痕,无狭窄环行成。结论中国商环包皮环切术具有手术方式标准化、操作简单、手术时间短、无出血、痛苦小、术后外形美观等优点,是包皮环切术的一种有效治疗手段。     

手法扩张分离法治疗小儿包茎合并包皮粘连

目的探讨小儿包茎合并包皮粘连的治疗方法。方法采用手法渐行扩张包皮口并手法分离包皮粘连的方法治疗小儿包茎合并包皮粘连,并在龟头及包皮内板上均匀涂上红霉素软膏,术后每天用红霉素软膏涂龟头3．5次,4～7d后复查,龟头发红消退后停止涂药。此后注意经常上翻包皮清洗。结果400例患儿术后4～7d,包皮龟头无红肿,包皮能轻松自如上翻,冠状沟、包皮系带完全暴露,尿线大小正常,小便时无包皮鼓起,且创面愈合无瘢痕或结痂,治愈率为100％。所有患儿随访24个月,均无包皮、龟头及尿道外口红肿,包皮垢均消失,尿线正常,外生殖器无不适感,包皮上翻自如。结论手法扩张包皮外口并手法分离包皮内板与龟头粘连的方法治疗小儿包茎合并包皮粘连效果佳,简单、安全,适宜推广应用。     

Long standing balanitis xerotica obliterans resulting in renal impairment in a child

Balanitis xerotica obliterans (BXO) is the most common cause of pathological phimosis in boys. Presented here is the case of a previously well 13-year-old boy who developed obstructive renal impairment (serum creatinine = 190 mumol/l) at least in part from phimosis due to BXO. A circumcision and, 2.5 months later, meatal dilatation were done. Nine months after his initial presentation, his serum creatinine returned to a permanently elevated nadir of 119 mumol/l. Presentation with the complications of phimosis can be delayed in teenage boys because they may feel embarrassed to come forward. Circumcision remains the definitive treatment of BXO induced phimosis though if the penile meatus is involved, more complex surgery is sometimes required. Topical steroids are useful for residual disease. Follow-up is very important due to the frequent involvement of the skin of the glans. In the very long term there is an increased chance of penile malignancy, which can occur even after circumcision.     

微型腹腔镜下内环高位结扎联合包皮环套术治疗小儿腹股沟斜疝及包茎

目的:探讨微型腹腔镜下内环高位结扎联合包皮环套术治疗小儿腹股沟斜疝及包茎的可行性与优点。方法:对9例斜疝患儿先行微型腹腔镜下内环高位结扎术,随后对有包茎的患儿行包皮环套术。结果:患儿均顺利完成腹腔镜下内环高位结扎术和包皮环套术。术后恢复顺利,随访1-9个月,斜疝无复发。结论:微型腹腔镜下内环高位结扎术治疗小儿腹股沟斜疝较传统手术具有创伤小、美观、操作简便、手术时间短、并发症少、术后康复快等优点,联合包皮环套术术后容易清洗、护理,避免了二次手术和麻醉,减少了患儿的痛苦及治疗费用,是安全可行的。     

Phimotic ring topical corticoid cream (0.1% mometasone furoate) treatment in children

Background/Purpose

Phimosis, owing to the presence of a preputial fibrotic ring, is surgically treated in 1% of children. During the last decade, however, topical steroid treatment has been proposed for phimosis.

Methods

We present a double-blind study comparing 0.1% mometasone furoate topical cream vs moisturizing cream (placebo) for the treatment of phimosis. Children aged from 2 to 13 years (n = 110) presenting with phimosis (Kikiro's classification grade 5) and scheduled for circumcision were included in this trial. The patients were evaluated after 8 weeks of topical treatment with moisturizing cream (n = 54) or steroid cream (n = 56). Nonresponders from both groups received an additional 8 weeks of steroid cream treatment.

Results

In the steroid group, the ring disappeared and glans exposure was obtained in 49 (88%) of 56 patients vs 28 (52%) of 54 patients in the placebo group (P < .05). After a second treatment, in the steroid group, 5 of the 7 patients were finally cured vs 22 of the 26 in the placebo group (P < .05). Two children with persisting phimosis (Kikiro's retractability grade 5 and appearance grade 3) in the steroid group (4%) vs 4 children in the placebo group (7%) ended up receiving postectomy.

Conclusions

The present investigation adds up and supports the effectiveness of phimosis topical corticoid treatment. Nevertheless, hygiene and preputial traction, when appropriately performed, seem to play an important role in the disappearance of the phimotic ring as well. New studies are necessary to confirm if this is true or not.     

改良式商环包皮环切术的临床疗效观察

目的探讨改良式商环包皮环切术的临床效果。方法在距离阴茎冠状沟0．8cm处放置商环内环,回翻包皮后放置外环,将外环与内环锁住后切除多余包皮。结果本组共35例患者,术后切口裂开1例,轻度水肿8例;无切口感染及术后继发出血。切口均I期愈合,平均手术时间为7min。随访1～6个月,切口瘢痕不明显,排尿及阴茎勃起正常,外观效果满意。结论采用改良式商环包皮环切术治疗包茎和包皮过长,是理想的手术方法,值得临床推广应用。