A modified fixation technique for the treatment of buried penis in children

For many years,surgical treatment of buried penis in children has been researched by several scholars,and numerous methods exist.This study aimed to explore the clinical effect of a modified fixation technique in treating buried penis in children.Clinical data of 94 patients with buried penis who were treated using the modified penile fixation technique from March 2017 to February 2019 in Fujian Maternity and Child Health Hospital(Fuzhou,China)were retrospectively collected,compared,and analyzed.Clinical data of 107 patients with buried penis who were treated using traditional penile fixation technique from February 2014 to February 2017 were chosen for comparison.The results showed that at 6 months and 12 months after surgery,the penile lengths in the modified penile fixation group were longer than those in the traditional penile fixation group(both P<0.05).The incidence of postoperative skin contracture and penile retraction in the modified penile fixation group was less than that in the traditional penile fixation group(P=0.034 and P=0.012,respectively).When the two groups were compared in terms of parents'satisfaction scores,the scores for penile size,penile morphology,and voiding status in the modified penile fixation group were higher than those in the traditional penile fixation group at 2-week,6-month,and 12-month follow-ups after surgery(all P<0.05).We concluded that the modified penile fixation technique could effectively reduce the incidence of skin contracture and penile retraction and improve the penile length and satisfaction of patients'parents.

Buried penis:a histological and histochemical study of dartos fascia

This study aimed to determine whether the abnormal deep layer of dartos fascia plays an important role in buried penis.Forty-nine patients with buried penis were treated with anatomical resection of the deep layer of dartos fascia under a microscope.Penile length was measured before and after completely resecting the deep layer to investigate the role of this layer in penile retraction.The superficial and deep layers of dartos fascia were collected from 49 patients with buried penis,the normal superficial layers were collected from 25 children/adults who underwent circumcision for nonmedical reasons,and the normal deep layers were collected from 20 adult cadavers.The penile fascia samples were stained with hematoxylin-eosin,Masson’s trichrome,Sirius red,and Verhoeff’s Van Gieson,and subjected to immunohistochemical examination and scanning electron microscopy.The penile shaft(mean±standard deviation)was found to be significantly elongated after resecting the deep layer compared with that before resection(6.8±1.9 cm vs 6.0±1.6 cm,P<0.001).An abnormal deep layer of dartos fascia characterized by disordered and fragmented elastic fibers was observed in 87.8%(43/49)of buried penis samples,whereas no abnormal deep layer was observed in normal penises from cadavers(0/20,P<0.001).Thus,the abnormal deep layer of dartos fascia plays an important role in the buried penis.Its resection is helpful for avoiding recurrence.

Commentary on“A modified fixation technique for the cure of buried penis in children”

Congenital buried penis is an uncommon urological anomaly affecting approximately 0.3%of young children.1 Buried penis occurs when a normal-length penis appears to be externally small,and congenital forms are associated with poor attachment between the penile base and skin,inelastic dartos fascia,inadequate outer penile skin,or excess suprapubic fat deposition.

Re:Commentary on“A modified fixation technique for the cure of buried penis in children”

In this article,we respond to the comments by Gereta et al.1 on our modified fixation method for congenital buried penis of children.Buried penis is not only associated with the shape and exposed length of the penis,but it is much more important that it may lead to serious psychological problems of children,for example self-confidence,self-esteem,and gender awareness.

Effects of buried penis on the structure and function of corpus cavernosum in a rat model

Background While the abnormal appearance of the concealed penis has been well recognized, the effect of buried penis on the structure and function of corpus cavernosum has not been well studied. To explore this issue, we established a rat model and evaluated the effect of buried penis on cavernosum weight, contents and ultrastructure of tissue, and nitric oxide synthase （NOS） activity. Methods Two hundred and ten rats were randomly divided into 3 equal cohorts for 2, 4 and 6 months study （groups A, B and C）. Each group was randomly divided into buried group （n=40）, control group （n=15）, and normal group （n=15）, respectively. Intra-purse-string suture of the root of the penis was used to establish the model. Macroscopic development was judged by measuring the weight of the corpus cavernosum. Masson＇s trichrome staining was performed for observing microstructure while a transmission electron microscope was used for observing ultrastructure. The NOS activity was detected by a NOS activity assay kit. Results Buried penis had no significant influence on the appearance and weight of the corpus cavernosum. Buried penis resulted in decreased smooth muscle content （P 〉0.05 in group A, and P 〈0.05 in groups B and C） and increased fibrous connective tissue content （P 〉0.05 in groups A and B, and P 〈0.05 in group C） compared with the normal and control groups. Ultrastructural abnormalities of corpus cavernosum were observed in the 6-month buried group. Moreover, there was decrease of NOS activity in groups B and C （P 〈0.05 in group B and P 〈0.01 in group C） when compared with the normal and control groups. Conclusion Buried penis affects the structure and function of corpus cavernosum in rats and the effect is positively correlated with the buried time, but there is no significant effect on the macroscopic development.

改良Devine术治疗先天性隐匿性阴茎临床效果观察

目的 观察改良Devine术治疗小儿先天性隐匿性阴茎的临床效果。方法 选取2019年6月—2022年8月本院收治的86例先天性隐匿性阴茎的患儿作为临床观察对象,均行改良式Devine手术,且术中、术后均不留置导尿管。结果 84例(2例失访)患儿的手术均取得成功,术后随访要求不少于半年,术后患儿阴茎显露均良好,术前阴茎自然状态显露长度(1.46±0.28)cm,术后阴茎自然显露长度(5.30±0.42)cm,术后阴茎自然显露长度与术前相比差异显著,统计学有意义(P<0.05)。手术后无发生尿潴留,3个月内阴茎水肿5例(发生率5.95%),无皮瓣、龟头坏死病例,无伤口裂开、伤口感染病例,无阴茎出现回缩病例。结论 改良Devine术治疗小儿先天性隐匿性阴茎,手术效果良好,手术并发症少,是一种较好的治疗方式。

成人隐匿阴茎的外科矫正

目的 :提高对成人隐匿阴茎的认识和治疗水平。方法 :抽吸或切除阴阜部堆积的大部分脂肪组织 ,切断阴茎根部的Camper筋膜、纤维条索化的Scarpa筋膜和阴茎浅悬韧带延长阴茎。结果 :应用此术治疗 2 3例患者 ,阴茎外形满意。结论 :与其他修复隐匿阴茎的外科方法相比 ,损伤小 ,对改善隐匿阴茎外形及功能更加理想。

经阴茎腹侧阴茎周围组织环形松解、白膜固定包皮整形术治疗小儿埋藏阴茎

目的：探寻治疗小儿埋藏阴茎的简单、有效手术方法。方法：根据埋藏阴茎的临床特点，设计一种新的手术方式即经阴茎腹侧阴茎周围组织环形松解、白膜固定包皮整形术：阴茎根部腹侧“V”形切口，环形松解阴茎浅、深筋膜及异常附着的肉膜肌、纤维索带，阴茎根部左、右侧白膜分别与胸膝位耻骨结节前筋膜的1、11点各缝合固定1针进行手术，共治疗小儿埋藏阴茎38例，术后随访2-6个月。结果：38例出院时阴茎外观形态均满意，阴茎体完全显露。术后随访期间35例（92．1％）阴茎外观形态满意，2例仍有阴茎轻度埋藏，1例出现包皮口瘢痕狭窄。结论：采用经阴茎腹侧阴茎周围组织环形松解、白膜固定包皮整形术治疗小儿埋藏阴茎是一简单、有效的手术方法，具有推广应用价值，但仍需积累更多的病例和更长时间的随访。

耻骨前入路阴茎肉膜固定术治疗小儿埋藏式阴茎

目的：观察耻骨前入路阴茎肉膜固定术治疗小儿埋藏式阴茎的效果。方法：2002年8月-2003年12月共采用该术式治疗小儿埋藏式阴茎34例，并进行随访，观察术后效果及复发情况。结果：平均手术时间为45min，34例患儿术后均获满意疗效。获1年以上随访21例，失访13例。随访病例中未见复发。结论：该术式设计合理、简单、有效，适合于无包皮不足的小儿埋藏式阴茎。

Shiraki-Devine术治疗儿童隐匿阴茎的临床观察

对采用Shiraki-Devine方法治疗的58例中重度小儿隐匿阴茎患儿的临床资料进行回顾性分析。所有患者随访均效果满意;7例有包皮内板轻度水肿,其中5例术后6～8周恢复正常,2例术后10～12周恢复正常;1例阴茎表皮坏死,经相应处理后恢复正常。该'手术方法治疗儿童先天性隐匿阴茎设计合理,美容效果良好,并发症相对较少。

阴茎包埋对海绵体内一氧化氮合酶的影响

目的:探讨阴茎包埋对海绵体内一氧化氮合酶(NOS)活性的影响。方法:通过建立大鼠隐匿阴茎模型获得实验标本,分2个月组、4个月组和6个月组进行观测,每组80只大鼠。各阶段中包括包埋组(n=50)、假手术组(n=15)和正常组(n=15)。称量大鼠体重和海绵体重量后,采用化学比色法检测海绵体内NOS活性。结果:各阶段包埋组阴茎海绵体重量、体重及两者的比值与正常组和假手术组比较均无显著性差异(P>0.05);包埋降低大鼠阴茎海绵体组织的NOS活性(2个月组P>0.05,4个月组P<0.05,6个月组P<0.01)。结论:阴茎包埋可影响海绵体内NOS活性,且与包埋时间呈正相关,但对海绵体外观和重量无明显影响。

小儿阴茎显露不良的诊治进展

小儿阴茎显露不良是由先天性发育异常使阴茎体不能正常显露的一组症状群,而不是单纯的一种疾病。主要包括埋藏阴茎、隐匿阴茎、蹼状阴茎、陷没阴茎等。而由尿道下裂、两性畸形等引起的畸形小阴茎和由内分泌异常引起的小阴茎不属于该范畴。隐匿阴茎、埋藏阴茎和蹼状阴茎的病因和病理改变是先天性的,而陷没阴茎则是后天性原因引起。根据各自的病因病理改变和临床表现,诊断并不困难。根据它们不同的类型、年龄指征和病变程度选择相应的手术方式,会取得好的疗效。

经包皮环切口矫治儿童隐匿型阴茎

目的探讨儿童隐匿型阴茎的手术治疗方法及时机,并通过手术创造良好的宽松环境,便于阴茎的生长发育。方法经包皮环切口,分离切除阴茎背侧增厚的筋膜及纤维组织,松解其对阴茎海绵体的牵拉束缚。结果本组儿童49例,其中28例随访6个月至5年,4例发育缓慢,24例阴茎发育正常,效果满意。结论在Devine手术原理的基础上,提出仅切除阴茎背侧2/3增厚筋膜,重视包皮狭窄环的松解,及严重病例分离切断阴茎浅悬韧带等,有利于儿童阴茎的生长发育,可为临床获得满意的治疗结果。

改良Shiraki法治疗小儿隐匿性阴茎

目的评价改良Shiraki法治疗小儿隐匿阴茎的疗效。方法总结近2年采用改良Shiraki法治疗小儿隐匿性阴茎36例,全部患儿均符合诊断标准,其中重度患儿19例,中度患儿17例。结果 36例患儿手术均获成功,术后随访3～12个月,无神经、尿道等损伤,阴茎外观满意。结论改良Shiraki法治疗隐匿阴茎具有设计合理,操作简单、疗效满意、并发症少等优点,是治疗隐匿阴茎的理想术式。

小儿埋藏阴茎治疗的新术式

目的 :探求治疗小儿埋藏阴茎合理简单有效的手术方式。方法 :设计了一种新的手术术式。采用耻骨前阴茎根部 3点 ,9点位Buck筋膜与皮肤肉膜固定的方法。结果 :2 0 0 2年 8月～ 2 0 0 4年 1月期间共治疗小儿埋藏阴茎 38例 ,平均手术时间约 4 5min ;获半年以上随访 2 4例 ,均获得满意疗效。结论 :将此新术式与目前治疗埋藏阴茎的主要术式进行了分析比较 ,提示该术式操作简单易行、效果好。

脱套式阴茎固定术治疗隐匿阴茎(附200例报告)

目的：探讨脱套式阴茎固定术对200例隐匿阴茎患儿的治疗效果。方法：对200例隐匿阴茎患儿采用脱套式阴茎固定术，患者平均年龄6．5岁（3～12岁）。其中并发有包茎的患儿160例，明显肥胖者20例。结果：在平均约10个月的随访中，无明显肥胖者术后阴茎外形及发育良好。20例明显肥胖者中有4例术后2～3个月左右出现轻度阴茎回缩，其余阴茎外形良好，无复发。结论：脱套式阴茎固定术是治疗隐匿阴茎的理想术式，术后并发症少，外观满意。

儿童隐匿阴茎的诊断与治疗

目的：提高对隐匿阴茎的认识和临床治疗效果。方法：总结62例儿童隐匿阴茎的临床资料，根据临床表现将其分为轻、中、重三型，采用改良的手术方法进行治疗。结果：术后随访1个月-3年，11例近期内出现较明显的包皮水肿，3例术后包皮过多，其余患者外观满意，无需再次手术。结论：隐匿阴茎是较为常见的先天畸形，宜行保留阴茎皮肤的整形手术，忌行单纯包皮环切术。

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.

隐匿阴茎患儿心理状态及家长疾病认知度的调查

目的了解隐匿阴茎患儿家长的心理状态及对疾病的认知度,以制定合理的干预策略。方法对2016年4月—10月泌尿外科收治的72例隐匿阴茎患儿的家长进行问卷调查分析,调查内容为疾病导致患儿自卑的心理与行为的情况(家长评估)及家长对疾病认知度。结果患儿家长认为疾病导致患儿自卑的心理与行为的占66.7%(48/72),患儿年龄越大,患儿自卑的心理与行为发生越多(P<0.05)。有13.9%(10/72)的家长关于疾病和心理问题尝试与患儿进行沟通和疏导。家长认为疾病发生的最重要的相关因素中,肥胖因素为第一位占61.1%(44/72),其次为先天因素占22.2%(16/72);家长受教育程度越高,认为疾病发生与先天因素有关的比例越高(P<0.05)。结论隐匿阴茎患儿心理问题普遍存在,而家长对于隐匿阴茎的认识及与患儿的沟通不足,医务人员应在手术方案制定和对社会的宣教中充分重视患儿的心理问题,促进患儿身心健康发展。

经阴茎腹侧松解固定治疗小儿埋藏阴茎手术前后的护理

目的探讨经阴茎腹侧松解固定治疗小儿埋藏阴茎手术前后的有效护理措施。方法本组38例埋藏阴茎患儿均施行阴茎腹侧松解固定术。术前选择住院恢复期及出院患儿进行择身示教;术后严密观察阴茎血液循环,采用榜样激励、分散注意力的心理支持与镇静镇痛药物相结合的方法来控制及减轻术后疼痛;多饮水内冲洗,0.05%碘伏擦拭尿道口、龟头及周围;出院2月内采用电话方式随访并进行具体指导。结果38例患儿住院期间无并发症发生,出院时阴茎外观形态均满意,阴茎体完全显露。出院后随访35例(92.11%)阴茎外观形态满意。结论术前进行有效干预减轻患儿自卑心理和家属心理压力,术后积极预防并发症,认真做好出院指导是提高患儿阴茎整形成功的有效措施。