负压吸引和外用睾酮霜治疗尿道下裂术后小阴茎的疗效

Efficacy of negative pressure suction and external testosterone cream in the treatment of small penis after hypospadias surgery

目的探讨尿道下裂术后阴茎短小的有效治疗方法。方法选取2017年11月至2018年11月新乡医学院第一附属医院门诊复查的尿道下裂术后0.5年的57例患儿,均符合小阴茎诊断标准,年龄4~14岁[(7.91±2.89)岁]。按就诊先后顺序随机分为物理治疗组及药物治疗组,未经治疗的患儿列入对照组。其中物理治疗组21例,使用阴茎康复治疗仪,辅以中药(丹参)药浴,30 min/次,1次/d,10 d为1个疗程,共1个疗程。药物治疗组20例,局部涂抹睾酮霜,3次/d,10 d为1个疗程,共1个疗程。在治疗前后分别测量阴茎松弛长度、牵伸长度及龟头横、纵径。对照组16例,分别测量10 d前后相关指标并与治疗组比较。结果1.物理治疗组阴茎松弛长度从治疗前的(25.48±6.13)mm增至(30.72±6.49)mm,牵伸长度从治疗前的(34.90±7.71)mm增至(41.08±8.43)mm,龟头横径从治疗前的(14.81±3.40)mm增至(16.57±3.42)mm,纵径从治疗前的(13.94±3.15)mm增至(15.82±3.52)mm,差异均有统计学意义(均P<0.05)。2.药物治疗组阴茎松弛长度从治疗前的(21.07±4.26)mm增至(31.32±4.72)mm,牵伸长度从治疗前的(31.94±7.96)mm增至(45.39±7.24)mm,龟头横径从治疗前的(13.38±1.77)mm增至(16.64±2.10)mm,纵径从治疗前的(13.09±1.77)mm增至(16.62±1.86)mm,差异均有统计学意义(均P<0.05)。3.对照组阴茎松弛长度、牵伸长度、龟头横径及纵径10 d前后无明显变化,差异均无统计学意义(均P>0.05)。4.物理治疗组阴茎松弛长度、牵伸长度、龟头横径及纵径与对照组比较均有明显增长,2组增长值比较差异均有统计学意义(均P<0.05)。5.药物治疗组阴茎松弛长度、牵伸长度、龟头横径及纵径与对照组比较均有明显增长,两组增长值比较差异均有统计学意义(均P<0.05)。6.药物治疗组中阴茎松弛长度、牵伸长度及龟头横、纵径的增长均大于物理治疗组,增长值比较差异均有统计学意义(均P<0.05)。结论负压吸引和睾酮霜外用治疗尿道下裂术后阴茎短小均有显著疗效,但睾酮霜较难获取,而负压吸引治疗方法简便,无创、无痛、无不良反应。

Objective To explore the effective method for treatment of small and short penis after hypospadias surgery.Method s From November 2017 to November 2018,57 children aged 4 to 14[mean age(7.91±2.89)years]with hypospadias who met the diagnostic criteria of small penis were reexamined at the First Affiliated Hospital of Xin-xiang Medical University.They were randomly divided into the physical treatment group and the drug treatment group according to the order of visits,and the untreated patients were included in the control group.Among them,21 patients in the physical treatment group were treated with penile rehabilitation therapy apparatus,supplemented by Salvia mil-tiorrhiza bath(30 minutes/time,once/day,10 days),and 20 patients in the drug treatment group were treated with Testosterone cream topically(3 times/day,10 days).Penile relaxation length,stretch length,transverse and longitudinal diameters of glans in 2 groups before and after the treatment were measured.The relevant indexes of 16 patients in the control group measured before and after 10 days and compared with those in the treatment group.Result s(1)The penile relaxation length in the physical treatment group increased from(25.48±6.13)mm to(30.72±6.49)mm,the length of stretch increased from(34.90±7.71)mm to(41.08±8.43)mm,the transverse diameter of glans increased from(14.81±3.40)mm to(16.57±3.42)mm,and the longitudinal diameter increased from(13.94±3.15)mm to(15.82±3.52)mm,and the differences were statistically significant(all P<0.05).(2)The penile relaxation length in the drug treatment group increased from(21.07±4.26)mm to(31.32±4.72)mm,the length of stretch increased from(31.94±7.96)mm to(45.39±7.24)mm,the transverse diameter of glans increased from(13.38±1.77)mm to(16.64±2.10)mm,and the longitudinal diameter increased from(13.09±1.77)mm to(16.62±1.86)mm,and the differences were statistically significant(all P<0.05).(3)There was no significant difference in penile relaxation length,the length of stretch,transverse diameter and longitudinal diameters of glans before and after 10 days in the control group(all P>0.05).(4)Compared with the control group,the penile relaxation length,the length of stretch,transverse diameter and longitudinal diameters of glans in the physical treatment group increased significantly,and the differences of growth values between the two groups were statistically significant(all P<0.05).(5)Compared with the control group,the penile relaxation length,the length of stretch,transverse diameter and longitudinal diameters of glans in the drug treatment group also increased significantly,and the difference of growth values between the two groups were statistically significant(all P<0.05).(6)The growth of penile relaxation length,the length of stretch and transverse and longitudinal diameters in the drug treatment group were higher than those in the physical treatment group,and the difference of growth values were statistically significant(all P<0.05).Conclusions Both the negative pressure suction method and topical application of Testosterone cream are effective in the treatment of small and short penis after hypospadias surgery.However,Testosterone cream is difficult to obtain,and the treatment of negative pressure suction is simple,noninvasive,painless and free of adverse reactions.