阴茎脱套固定术治疗儿童隐匿阴茎

目的:探讨用阴茎脱套固定术治疗小儿隐匿阴茎的效果。方法:对233例隐匿阴茎患儿采用阴茎脱套固定术治疗。将阴茎脱套至尿道球起始部水平,切断白膜表面纤维束带,将阴茎两上外侧的Scarpa筋膜连同Camper筋膜一起缝合固定于同侧阴茎根部白膜表面。结果:4例(1.7%)术后阴茎回缩,为手术缝合固定不当引起;包皮内板淋巴水肿1例。其余患儿随访4个月~4年,阴茎外观及显露满意,无蹼状结构;排尿及勃起正常。结论:采用的阴茎脱套固定术能够使这些病理改变得以纠正,适用于不同类型的隐匿阴茎,是一种较为理想的治疗选择。

Foreskin-Deglove and Shaft-Fix procedure in treatment of concealed penis in childhood

Objective:Concealed penis has been considered to be a serious condition by patients and/or their parents. It is agreed that deferent type of concealed penis should be treated with deferent surgical procedure. We employed a foreskin-deglove and shaft-fix procedure in treatment of children concealed penis; hence study the keys of this plastic surgery.Methods:233 boys (mean age 6.3 years) were diagnosed with concealed penis over a period of three years(2001.8 2005.8). According to Bergeson's classification, there were 154 boys with trapped penis, 69 with buried penis, and 10 with webbed penis. All of them underwent the foreskin-deglove and shaft-fix procedure, which deglove foreskin from 5mm-7mm proximal to corona deep to the level of distant bulb urethra, and fixing bilateral tunica albuginea at this level to suprapubic Scarpas' fascia, as well as Camper's fascia.Results:Penis shaft retraction occurred in four patients (1.7) after operation, and was corrected by later refixation. All patients were satisfied with the appearance of the penis after plastic surgery. The postoperative recovery and follow-up (4 month to 4 years) were uneventful.Conclusions:Four anatomical factors take part in concealed penis abnormality: attachment of dysgenic band to penis shaft; Camper's facia extending to the distal part of the shaft, abnormal accumulation of pre-pubic fat, and phimosis. These factors, which exist in almost all types of concealed penis, are pivot concern for successful plastic surgery. Foreskin-deglove and shaft-fix procedure can resolve these pathologic problems and has good clinical effect. Our experience suggests that, in choosing a plastic procedure, one should pay more respect to the underlying pathological changes in concealed penis.