前尿道融合术治疗完全型双阴茎畸形一例报告并文献复习

Anterior urethral fusion for treatment of complete penile diphallia： a case report and literature review

目的探讨采用前尿道融合术治疗1例完全型双阴茎畸形的可行性、安全性及临床价值。方法2011年3月收治1例17岁完全型双阴茎畸形患者。体检示两阴茎发育好；尿道造影及尿道镜检查显示两尿道完全分开且分别进入膀胱。术中将两前尿道腹侧从尿道外口到球部尿道分别剖开，4-0可吸收线将两剖开的尿道侧侧连续缝合成一条尿道，双阴茎合二为一。对比分析患者手术前后夜间阴茎勃起试验（nocturnal penile tumescence，NPT）及阴茎震感阈值。结果患者术后随访12个月，术后无血肿、尿瘘、尿失禁等并发症。阴茎外形恢复正常，晨间勃起及排尿正常。术后6个月NPT和生物震感阈值检测显示，患者夜间勃起强度、持续时间及勃起次数与术前相比无明显变化（P〉0．05）。结论前尿道融合术是治疗双阴茎畸形的一种有效途径，不影响患者的排尿功能及性功能，安全可行。

Objective To evaluate the efficacy, safety and clinical value of anterior urethral fusion to treat diphallia. Methods A 17-year-old male patient with complete penile diphallia was treated in March 2011. The physical examination showed two completely separated mature penis; urethrography, and urethroscope showed the two urethras were completely separated and entered the bladder respectively. Two anterior urethras were incised respectively at ventral sides （from the meatus to bulbar urethra） and then two incised anterior urethras were splintered by a continuous suture with 4-0 polyglactin sutures in side and side. Two penises were splintered into one. The nocturnal penile tumescence test and the penis vibration thresholds were assessed before, and after surgery. Results The patient was followed up for 12 months. There was no hematoma, urinary fistula, urinary incontinence and other complications postoperatively. The penis was recovered with normal appearance; urination and morning erection of penile were normal. 6 months after surgery, there was no significant difference in the nocturnal penile tumescence and penis vibration thresholds detection （ P 〉 0.05）. Conclusion The operation cal treatment to treat partial complete penile diphallia and erection of penile. of anterior urethral fusion is a safe and efficient surgiwith less complication and no worse effect on urination and erection of penile.