A Novel Tool to Predict the Cosmetic Outcome after Circumcision: Penile Visibility Index

Objectives: We aimed to evaluate the circumcision status and complications, and the value of penile visibility index in predicting circumcision complications among elementary school children. Patients and Methods: Elementary school students were evaluated with physical exam in terms of circumcision complications. Visible penile length/stretched penile length ratio was calculated for each subject and recorded as penile visibility index (PVI). Data were assessed with SPSS 15.0 software. Results: Average age was 9.04 (5 - 14) years. Circumcision complications were detected in 84 of 361 circumcised subjects (23.2%). There was no relationship between age at circumcision and complications (p > 0.05). Concealed penis was detected in 3.6% of all subjects. Mean PVI was significantly different between cases with and without glanular adhesion, and between cases with and without residual prepuce. On the overall, mean PVI in complication and no complication groups were 0.52 and 0.59 respectively, and the difference was statistically significant (p < 0.001). Conclusion: PVI calculation before circumcision, might help predict the cosmetic outcome of circumcision beforehand.

Management of Post-Circumcision Trapped Penis with Glanular Amputation

A phenomenon known as trapped penis has numerous origins, including injudicious circumcision. Materials and Methods: Surgery for trapped penis with glanular amputation was performed for 5 children. The surgical policy in these cases included complete penile degloving, excising the scarring due to circumcission, fixing the penile skin at the penopubic and penoscrotal angles and reconstructing the penile skin with full thickness skin graft. Results: Improvement was noted in all cases. Conclusion: Surgery for hidden penis using full thickness skin graft achieves very satisfactory aesthetic and functional improvement.

Disposable circumcision suture device： clinical effect and patient satisfaction

In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device （DCSD）. A total of 942 patients were equally divided into three groups （conventional circumcision, Shang ring and disposable suture device group）. Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group （P 〈 0.001）. Intra-operative pain was less in the suture device group compared With the other two groups （P 〈 0.001）; whereas post-operative pain was higher in the conventional group compared to the other two groups （P 〈 0.001）. Patients in the suture device （80.57%） and Shang ring （73,57%） groups were more satisfied with penile appearances compared with the conventional circumcision group （20.06%, P 〈 0.05）. Patients in suture device group also healed markedly faster than the conventional group （P 〈 0.01）. The overall satisfaction rate was better in the suture device group （78.66%） compared with the conventional （47.13%） and Shang ring （50.00%） groups （P 〈 0.05）. The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.

Ischemic glans penis after circumcision

A 33-year-old male receiving dorsal penile nerve block (DPNB) for circumcision exhibited a postoperative ischemic change over the glans penis. The event occurred nearly 24 hours after the procedure. The patient was treated with intravenous pentoxifyllin and hyperbaric oxygenation. Total reverse of the ischemia was observed. The complications associated with circumcision and DPNB were reviewed and discussed.

Early infant male circumcision:Systematic review,risk-benefit analysis,and progress in policy

AIM To determine whether recent evidence-based United States polices on male circumcision(MC) apply to comparable Anglophone countries,Australia and New Zealand.METHODS Articles in 2005 through 2015 were retrieved from PubM ed using the keyword "circumcision" together with 36 relevant subtopics.A further PubM ed search was performed for articles published in 2016.Searches of the EMBASE and Cochrane databases did not yield additional citable articles.Articles were assessed for quality and those rated 2+ and above according to the Scottish Intercollegiate Grading System were studied further.The most relevant andrepresentative of the topic were included.Bibliographies were examined to retrieve further key references.Randomized controlled trials,recent high quality systematic reviews or meta-analyses(level 1++ or 1+ evidence) were prioritized for inclusion.A risk-benefit analysis of articles rated for quality was performed.For efficiency and reliability,recent randomized controlled trials,metaanalyses,high quality systematic reviews and large welldesigned studies were used if available.Internet searches were conducted for other relevant information,including policies and Australian data on claims under Medicare for MC.RESULTS Evidence-based policy statements by the American Academy of Pediatrics(AAP) and the Centers for Disease Control and Prevention(CDC) support infant and later age male circumcision(MC) as a desirable public health measure.Our systematic review of relevant literature over the past decade yielded 140 journal articles that met our inclusion criteria.Together,these showed that early infant MC confers immediate and lifelong benefits by protecting against urinary tract infections having potential adverse long-term renal effects,phimosis that causes difficult and painful erections and "ballooning" during urination,inflammatory skin conditions,inferior penile hygiene,candidiasis,various sexually transmissible infections in both sexes,genital ulcers,and penile,prostate and cervical cancer.Our risk-benefit analysis showed that benefits exceeded procedural risks,which are predominantly minor,by up to 200 to 1.We estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime.Wide-ranging evidence from surveys,physiological measurements,and the anatomical location of penile sensory receptors responsible for sexual sensation strongly and consistently suggested that MC has no detrimental effect on sexual function,sensitivity or pleasure.United States studies showed that early infant MC is cost saving.The evidence supporting early infant MC has further strengthened since the positive AAP and CDC reviews.CONCLUSION Affirmative MC policies are needed in Australia and New Zealand.Routine provision of accurate,unbiased education,and access in public hospitals,will maximize health and financial benefits.

Glans ischemia after circumcision in children:Two case reports

Circumcision refers to the removal of the skin covering the tip of the penis and is one of the most common surgical procedures performed in childhood.Even though circumcision is a well-standardized operation,several minor and major complications may be experienced by paediatric surgeons.Glans ischemia(GI)has been widely reported in the paediatric literature as a complication following circumcision.Nonetheless,etiopathogenesis of GI is not well defined and management guidelines are lacking.CASE SUMMARY We describe our experience with this rare and scary complication using subcutaneous enoxaparin alone or in association with a topical vasodilator.CONCLUSION Hypothetical causes and different management strategies are discussed.

术前缝扎阴茎背浅静脉在吻合器式包皮套扎环切术中的应用效果分析

目的:探讨术前缝扎阴茎背浅静脉在吻合器式包皮套扎环切术中的应用效果。方法:选取2019年9月—2020年9月于济宁医学院附属滕州市中心人民医院行吻合器式包皮套扎环切术的患者100例作为研究对象,采用随机数字表法分为对照组(n=52)与观察组(n=48)。对照组采用吻合器式包皮套扎环切术治疗,观察组术前缝扎阴茎浅静脉,再实施吻合器式包皮环切术。比较两组治疗效果。结果:观察组术中出血率低于对照组,差异有统计学意义(P=0.002)。观察组术后出血量少于对照组,切口愈合时间短于对照组,差异有统计学意义(P<0.05)。观察组血肿、切口感染、延迟愈合及水肿发生率低于对照组,差异有统计学意义(P<0.05)。结论:吻合器式包皮环切术前行缝扎阴茎背浅静脉,能降低术中出血风险及术后出血量,缩短切口愈合时间,降低术后并发症发生率。

一次性包皮环切吻合器治疗儿童轻型隐匿性阴茎的临床疗效分析

目的 探讨一次性包皮环切吻合器治疗儿童轻型隐匿性阴茎的临床效果。方法 回顾性分析30例轻型隐匿性阴茎患儿的临床资料,均采用一次性包皮环切吻合器进行手术治疗。分析术后效果。结果 术后所有患儿切口均Ⅰ期愈合,包皮无出血、感染、坏死且无阴囊血肿。术后28例患儿获得随访,其中3例肥胖患儿术后出现包皮内板水肿,包皮水肿在吻合器脱落后1个月内均自行吸收;术后阴茎体显露良好25例,端坐位、立位均无阴茎体退缩,家属满意;3例患儿因肥胖显露一般,阴茎部分于端坐位时回缩入耻骨前脂肪,阴茎外观较术前明显改善,包皮上翻可轻松显露龟头,家属满意。结论 采用一次性包皮环切吻合器治疗儿童轻型隐匿性阴茎手术效果明显,并发症少,效果满意。

阴茎背侧根部两点固定联合包皮环切术治疗小儿隐匿阴茎效果分析

目的探讨阴茎背侧根部两点固定联合包皮环切术治疗小儿隐匿阴茎的效果。方法回顾性分析2020-06—2021-10泉州市第一医院小儿外科收治的40例隐匿阴茎患儿的临床资料。年龄8.3岁(范围:3~12岁)。所有患儿均采用一次性包皮环切吻合器行阴茎背侧根部两点固定联合包皮环切术。结果40例患儿均顺利完成手术。手术时间21.0 min(范围:15~25 min),术中出血量1.5 mL(范围:1~2 mL),术后住院时间2.0 d(范围:1~3 d)。术后保留阴茎体敷料时间5.0 d(范围:4~6 d)。术后随访6~22个月,阴茎外露延长值2.1cm(范围:1.8~2.6 cm)。无阴茎回缩及包皮堆积,瘢痕与包皮环切一致。10例患儿出现轻度的包皮水肿,均于4~8周完全消退。40例中,35例患儿家长对手术表示满意,5例表示不满意,满意率为87.5%。结论采用一次性包皮环切吻合器行阴茎背侧根部两点固定联合包皮环切术治疗小儿隐匿阴茎,操作简单、无需进行阴茎脱套,创伤小,术后阴茎显露好、外形美观,回缩率低、并发症少,家长满意度高。

阴茎根部与阴茎背侧皮下固定在接受Devine术真性隐匿性阴茎患儿中的应用效果评价

目的探究Devine术分别采用阴茎根部背侧皮下固定与阴茎根部腹侧皮下固定对真性隐匿性阴茎(CP)患儿术后疼痛、阴茎暴露长度、并发症发生情况及满意度的影响。方法选取2020年2月至2022年1月于周口市妇幼保健院拟行手术治疗的80例真性CP患儿,随机数字表法将患儿分为对照组(n=39)、试验组(n=41)。两组均实施Devine术,试验组术中实施阴茎根部背侧皮下固定,对照组术中实施阴茎根部腹侧皮下固定。比较两组围手术期指标、术后疼痛程度(NRS评分)、阴茎暴露长度、并发症总发生率及满意度。结果试验组手术时间、住院时间、术后水肿时间均短于对照组(P<0.05);两组术中出血量、术后阴茎回缩率、并发症总发生率比较,差异无统计学意义(P>0.05);术后3 h、6 h试验组NRS评分低于对照组(P<0.05);术后即刻、术后1个月、术后3个月试验组阴茎暴露长度均长于对照组(P<0.05);试验组总满意度97.56%(40/41)高于对照组79.49%(31/39)(P<0.05)。结论真性CP在实施Devine术中分别采用阴茎根部背侧皮下固定和阴茎根部腹侧皮下固定安全性较高;但阴茎根部背侧皮下固定手术时间较短,能减轻局部循环障碍,有助于缓解疼痛,且能增加阴茎暴露长度,提高满意度。

阴茎背神经阻滞麻醉包皮环切术的解剖学基础及临床应用

目的：探讨阴茎背神经阻滞麻醉用于包皮环切术的解剖学基础及其临床应用。方法：甲醛浸泡的男尸9具，包括成年男尸1具，童尸3具，婴幼儿尸3具，新生儿尸1具，胎儿尸1具，阴茎局部解剖显露阴茎背侧的血管及神经组织，利用解剖显微镜、放大镜以及肉眼观察阴茎背神经、血管的分布和走行。阴茎背神经的解剖学基础决定麻醉位点的选择，10例包茎患儿经阴茎背神经两点阻滞麻醉实施包皮环切术。使用VAS（视觉模拟分析）来判断麻醉效果。结果：阴茎背神经自耻骨联合下阴茎根部2点及10点处发出，沿阴茎长轴延伸至阴茎头。阴茎背动脉位于神经的内侧，阴茎背静脉位于阴茎的中央。实施阴茎背神经两点阻滞麻醉后即刻的VAS值为0～4mm（即无痛至轻度疼痛），7—15min包皮环切术结束后，VAS值为0～1mm。结论：两点法阴茎背神经阻滞麻醉（耻骨联合下阴茎根部2点及10点）遵循了该神经的解剖学基础，麻醉效果肯定。

先期包皮环切对小儿隐匿性阴茎改良Devine手术疗效的影响

目的:探讨先期包皮环切对小儿隐匿性阴茎矫正手术疗效的影响。方法:选取福建医科大学附属协和医院小儿外科2011年6月至2015年8月收治的隐匿性阴茎患儿89例,其中包括先期包皮环切组41例,未行包皮环切组48例,均采用改良Devine术治疗,比较两组手术成功率、疗效及手术时间差异。结果:先期包皮环切组手术时间较未行包皮环切组手术时间延长,差异有统计学意义(P<0.05);先期包皮环切组手术优良率低于未行包皮环切组,差异有统计学意义(P<0.05)。结论:先期包皮环切不仅增加手术难度,而且影响小儿隐匿性阴茎手术的治疗效果及术后美观度。对于先期已行包皮环切术的患儿,应及时就诊选择合适的手术时机再次行手术矫正。

包皮内板切除矫治包皮过长

目的:评估包皮内板切除矫治包皮过长的效果。方法:将150例包皮过长患者随机分为包皮内板切除组(A组)和传统包皮环切组(B组)。A组患者90例,保留冠状沟处包皮内板5mm,保留系带10mm,切除其余包皮内板,使阴茎的血管和神经保持完整;B组患者60例,采用传统包皮环切术。对两组术中出血量、术后创口出血、血肿、水肿、疼痛、感染、等并发症以及阴茎外形满意度进行比较。结果:A组术中出血量为(5±3)ml,B组为(22±5)ml(P<0.001);A组术后疼痛持续时间为(12±4)h,B组为(36±10)h(P<0.05);A组术后阴茎外形满意度98.3%,发生创口水肿者0例,伴出血、血肿者0例,发生局部感染者1例,总并发症率为1.1%。B组阴茎外形满意度75%,术后创口出血、血肿1例,水肿4例,感染2例,总并发症率为10%(P<0.05)。所有对比项目在两组之间的差异均有统计学意义。结论:包皮内板切除矫治包皮过长手术比传统的包皮环切术更具有优越性。

去表皮包皮环切阴茎增粗术临床疗效分析

目的探讨应用去表皮包皮环切的方法行阴茎增粗术。方法阴茎根部阻滞麻醉下,环形去除多余包皮的表皮部分,保留浅筋膜和血管,内翻折叠缝合皮下浅筋膜形成隆起的环,精确对位缝合伤口。结果共42例患者,术后随访3～12个月,切口愈合好,水肿消退快,阴茎包皮长短合适,无勃起牵扯感,疲软时环切处包皮呈增粗隆起,勃起时更为明显。结论去表皮包皮环切术在微创缩短包皮的同时,具有一定的阴茎增粗效果,值得临床推广。

改进包皮环切术临床应用探讨

目的:对改进的包皮环切术中麻醉方法、手术方式及术后效果进行总结。方法:采用阴茎背神经阻滞麻醉,术前依据阴茎完全勃起的长度准确计算去皮量,采用分层包皮环切术。结果:97例患者伤口均一期愈合,随访3～6个月,其中2例勃起后感觉包皮略紧,但勃起长度不变,1例自认为疲软状态下包皮略长,勃起后长短合适,其他94例对外形满意,性生活满意。结论:改进后的分层包皮环切术,麻醉简便,效果满意,术后恢复快,外形美观,功能良好。

阴茎根部皮肤脱袖状环切术治疗包皮过长

目的介绍与探讨阴茎根部皮肤脱袖状环切术,从而避免常规包皮环切手术所带来的并发症。方法在传统术式的基础上进行改良,对52例包皮过长患者采用阴茎根部脱袖状环切术,切除多余的阴茎根部皮肤,保护阴茎背侧静脉及包皮系带,根治包皮过长。结果本组52例男性包皮过长患者,采用该法均取得满意疗效,术后无出血,系带处无水肿,阴茎勃起及外观均较满意。结论采用阴茎根部皮肤脱袖状环切术治疗包皮过长是一种全新的手术方法,疗效显著,无特殊并发症,临床上有广泛的推广价值。

包皮环切术对阴茎头振动感觉阈的影响

目的:比较单纯包皮过长患者与正常人,以及单纯包皮过长患者在包皮环切术前、术后阴茎头振动感觉阈变化,评估手术对阴茎头敏感度的影响。方法:使用生物振动测试仪,对73例正常志愿者(对照组)及96例包皮过长手术患者(实验组)手术前后示指、阴茎头2个部位皮肤进行振动感觉阈测定,了解体表部位感觉敏感度的改变。结果:阴茎头/示指振动感阈指数对照组为2.39±1.72,实验组术前为1.97±0.71,两组比较无统计学差异(P>0.05)。实验组阴茎头/示指振动感阈指数术前为1.97±0.71;术后1、2、3个月分别为2.64±1.38、3.09±1.46、2.97±1.20;手术前、后比较存在统计学差异(P(0.05)。结论:正常人与包皮过长患者阴茎头/示指振动感阈指数无统计学差异;包皮环切术后患者阴茎头振动感减弱。

整形外科原则在袖套式包皮过长矫正术中的应用及效果研究

目的:将整形外科原则应用于改良袖套式包皮过长矫正术,探讨其与经典包皮环切术相比,在减少术区瘢痕,促进术后恢复,改善术后外观等方面的临床效果。方法:对经典袖套式包皮环切术加以改进,将切口设计在阴茎根部,并在阴茎腹侧形成"V"形切口。剥除多余皮肤的同时注意保护血管淋巴管及皮下神经。本组36例患者,其中20例采用阴茎根部切口袖套式包皮过长矫正术,16例采用经典包皮环切术,对伤口愈合情况、术区瘢痕、阴茎外观、患者主观感觉以及并发症发生情况等方面进行评价。结果:36例患者治疗后包皮过长情况均较前明显改善,所有患者均无出血、血肿等并发症发生,行阴茎根部切口袖套式包皮过长矫正术患者术后恢复快,外观更加理想,无瘢痕挛缩,临床效果更加满意。结论:采用阴茎根部切口袖套式包皮过长矫正术治疗包皮过长患者,效果确切,阴茎外观形态良好,术区瘢痕隐蔽,患者满意。

基于阴茎发育规律的儿童包皮环切术式探讨

目的根据儿童阴茎发育规律,探讨两种包皮环切术式与阴茎直径(d)选择的关系。方法收集本院包皮过长或包茎患儿共358例,其中包茎171例,包皮过长187例,患儿年龄4～16岁,年龄中位数(9.0±2.2)岁;阴茎直径1.2～3.0 cm,中位数(1.5±0.4)cm。按照家属自愿随机原则分组,A组应用一次性缝合器行包皮环切术,共191例;B组行包皮环扎术,共167例。分析阴茎直径发育趋势及两种术式术后并发症与阴茎直径之间的关系,比较两种术式手术时间、术中出血量和治疗费用以及术后30 d随访情况。结果 (1)儿童年龄与阴茎直径呈正相关性(r=0.4,P<0.05)。(2)A组与B组术后总并发症的发生率分别是5.24%(10/191)和2.40%(4/167),差异无统计学意义(P=0.18);在1.2 cm≤d<1.5 cm段,A组术后包皮粘连的发生率83.33%(10/12),B组无一例并发症,差异有显著统计学意义(P<0.0001)。在1.5 cm≤d<2.6 cm段,两组均无并发症。在d≥2.6 cm段,A组无一例并发症,B组并发症的发生率为25%(4/16),差异有统计学意义(P=0.03)。(3)A组和B组平均治疗费用分别为(2 105.81±47.37)元和(526.63±24.58)元,差异有统计学意义(P<0.0001)。(4)术后30 d随访,A组一次性缝合钉未脱并包皮内板分粘率3.66%(7/191);在1.2 cm≤d<1.5 cm段,B组包皮结扎环未脱率7.19%(12/167),在d≥2.6 cm段,两组差异无明显统计学意义(P=0.16)。结论儿童包皮环扎术和一次性缝合器包皮环切术有阴茎直径选择性,包皮环扎术适用于d<1.5 cm的包茎、包皮过长儿童或幼儿;一次性缝合器包皮环切术适用于d≥2.6 cm的包茎、包皮过长大龄儿童或青少年;在1.5 cm≤d<2.6 cm段,两种方法均可。

袖状法包皮环切并改进缝合方法的手术经验

目的探讨包皮环切的理想术式.方法对51例包茎、包皮过长患者采用袖状法包皮环切并间断缝合少许皮缘的方法手术.结果 51例患者,术中出血1～5ml.术后反应性水肿6例,占11.8%,无切口出血或形成血肿,无包皮切除过多或过少病例,术后2周48例患者缝线自动脱落,3例患者需拆线2～3针,切口全部甲级愈合.结论该术式具有出血少、术后并发症少、缝线可自动脱落等优点.