Objective To investigate the effectiveness of the penile ventral scrotum cohesion place wedge cutting and improved Brisson technique for congenital buried penis. Methods Between March 2010 and June 2012, 68 boys with congenital buried penis were treated by the penile ventral scrotum cohesion place wedge cutting and improved Brisson technique, with a median age of 4 years and 10 months (range, 3 months-13 years). Of 68 cases, 14 were classified as phimosis type, 14 as rope belt type, 20 as moderate type, and 20 as severe type. The body of penis developed well and had no deformity. After operation, complications were observed, and the effectiveness was evaluated by the designed questionnaire. Results Early postoperative complications occurred in 11 cases, including obvious adhesion of the outside wrapping mouth in 4 cases, scrotal skin bloat in 5 cases, and distal foreskin necrosis in 2 cases; long-term complications occurred in 9 cases, including abdominal incision scar formation in 4 cases, wrapping mouth scar stricture in 3 cases, and short penis in 2 cases. Primary healing of incision was obtained in the other boys. Fifty-four cases were followed up 6-12 months (mean, 8 months). According to the designed questionnaire, satisfaction rate with the overall view in parents was 77.78% (42/54); the clinical improvement rate was 85.19% (46/54); exposure of the penis was satisfactory in parents of 50 cases; and the parents had no psychological burden of penis exposure in 46 cases, which were significantly improved when compared with preoperative ones (P ﹤ 0.05). The boys had no psychological burden of penis exposure in 29 cases (53.70%) after operation, showing no significant difference when compared with preoperative one (18 cases, 33.33%) (χ2=1.22, P=0.31). Conclusion Application of the penile ventral scrotum cohesion place wedge cutting and improved Brisson technique can effectively correct congenital buried penis.
Objective To investigate the effectiveness of longitudinal preputial pedicled flap urethroplasty for chordee of Donnahoo IV type. Methods Between June 1994 and October 2011, 30 patients with chordee (Donnahoo type IV) underwent longitudinal preputial pedicled flap urethroplasty. The patients’ age ranged from 2 to 16 years (mean, 5.8 years). The morphology of the balanus-navicular fossa-external urethral orifice ranged normal; the penis length was 2.5-6.8 cm (mean, 4.3 cm); the penis bending angle was 35-70° (mean, 40.1°). Primary and secondary operation was 27 cases and 3 cases, respectively. The size of flap ranged from 1.5 cm × 1.3 cm to 4.0 cm × 2.0 cm. Results After correction, the penis length was 3.0-8.5 cm (mean, 6.6 cm); the penis bending angle was 0-10° (mean, 1.2°). All patients were followed up 6 months to 12 years (mean, 33 months). No recurrence, stabbing pain of the balanus, or foreign body sensation occurred during follow-up. Of them, 4 patients (13.33%) had urinary fistular, they had satisfactory results after the second operation; 2 patients (6.67%) had urethral stricture 1 month after operation, they also had satisfactory results after arethral dilatation. The other patients showed no scattering urinary flow and good direction without complication. Six patients had satisfactory sexual function after puberty without erection disorder, pain, or dyspareunia. Conclusion Longitudinal preputial pedicled flap urethroplasty can achieve maximum utilization of prepuce and aesthetic and functional improvement with less complication, so it is a relatively ideal mean for treating chordee of Donnahoo type IV.
Objective To investigate the local ization and expression characteristics of androgen receptor (AR) in genital tissue of patients with congenital hypospadias and simple chordee. Methods Between August 2005 and Janury 2007, dorsal prepuce, ventral perimeatal skin, and urethral plate were harvested from 25 patients with congenital hypospadias (aged from 1 year and 11 months to 19 years with an average of 3 years and 7 months) and 4 patients with simple chordee (aged from 3 years and 6 months to 16 years with an average of 7 years and 1 month). Prepuce by circumcision from 18 patients was used as control. The expression intensity and distribution of AR were assessed with mmunohistochemistry. Results AR was expressed in prepuce tissues from congentital hypospadias, simple chordee, and control. The AR positive cell rates were 62.94% ± 5.40% and 62.87% ± 5.33% in dorsal and ventral prepuce of control patients respectively, and were 59.00% ± 3.75%, 58.46% ± 4.14%, and 52.30% ± 3.53% in dorsal prepuce, ventral perimeatal skin, and urethral plate of patients with congenital hypospadias respectively. AR positive cell rate was significantly lower in patients with congenital hypospadias than in control patients (P lt; 0.05), and in urethral plate than in dorsal prepuce and ventral perimeatal skin of patients with congenital hypospadias (P lt; 0.05), and no significant difference was detected between dorsal and ventral specimens (P gt; 0.05). Stratified analysis showed a similar expression mode in severe hypospadias group and severe chordee group (P lt; 0.05). In mild to moderate hypospadias group and mild to moderate chordee group, no significant difference was shown when dorsal and ventral skin specimens were compared to that in normal control (P gt; 0.05), with AR expression diminished in urethral plate (P lt; 0.05), and AR decrease was relative to severity of chordee (P lt; 0.05). The AR positive cell rates were 59.69% ± 2.73%, 55.71% ± 1.67%,and 51.92% ± 1.87% in dorsal, ventral skin, and urethral late of patients with chordee respectively. Reducing tendency of AR expression was observed. Conclusion AR expression decreases in penile skin of patients with congenital hypospadias and simple chordee, especially in urethral plate.
Objective To discuss the severity grading and procedure design of concealed penis. Methods Between June 2004 and April 2008, 196 cases of concealed penis were surgically corrected. The age ranged from 1 year and 4 months to 44 years, with a median of 9 years. They presented with inconspicuous penis and abnormal cavernosa development. Four cases compl icated by glanular hypospadias and 3 cases by penile epispadias. They were classified as mild in 49 cases, moderate in 109, and severe in 38 according to severity. Surgical procedures were selected based on varied anatomical changes in different categories. Results All the patients got satisfactory appearance immediately after surgery. No voiding problem, wound infection, and skin necrosis were found. With 6 months to 48 months (mean 16 months) follow-up, most patients achieved good results and the penile appearance resembled that after circumcision. Mild penile retraction was noted in 1 moderate case and 1 severe case; and recurrence occurred in another one, the result was satisfactory after reoperation. Conclusion Various surgical procedures can be adopted for concealed penis. The key point is to design procedures according to the anatomical abnormalities.
Objective To summarize the cl inical effect of a new operative technique of combining penis flap with buccal mucosa graft in the treatment of phall ical urethral stricture. Methods From March 2006 to December 2007, 6 patients with phall ical urethral stricture, aged 3-26 years old, were treated by the method of combining degloved penis flap with buccalmucosa graft. All of them had the symptom of dysuria within 2-10 months after urethroplasty. The urethral stent of highelasticity sil ica was kept for 2-3 weeks after operation. Results Five patients’ incisions obtained heal ing by first intention with satisfying urination and there were no compl ications. Sl ight infection appeared in 1 case at 3 days after operation, with small quantities of suppurative exudate in the incision, which healed through open drainage and washing with antibacterial 2 weeks later. The thinning of the urinary stream was presented at 1 month after operation, and then disappeared after 2-month urethral dilatation. All the 6 patients were followed up for 6-10 months and they felt satisfied with emiction. They had a l ittle bit thicker urinary streams than those of their own age. There was not any residual urine in bladder after emiction. Conclusion The method of combining penis flap with buccal mucosa graft is effective in the treatment of phall ical urethral stricture. It deserves to be popularized due to its simple operation and credible effects.
Objective To introduce a modified penile elongation method and observe its postoperative compl ications. Methods From January 1993 to December 2007, 130 patients with congenital short and small penis were divided into 2 groups: the routine group and the modified group, with 65 patients in each group. In the routine group, the patients were 18-55 years old (39.6 on average), and the penile length during erection was (4.9 ± 1.4) cm. In the modified group, the patients were 20-56 years old (35.4 on average), and the penile length during erection was (5.0 ± 1.5) cm. There was no significant difference between the two groups (P gt; 0.05). On the basis of scrotal flap which was transferred to cover the prolonged cavernous body of penis, the “+” shaped incision at the root of the penis was made in the routine group, and theincision was shifted upward by 1.5 cm in the modified group. And V-Y incision was made for the penises with more than 4 cm prolonged length. In order to compare the conditions in the two groups, no physical therapy was appl ied in 30 days after the operation. Results All the 130 patients’ incisions obtainedt heal ing by the firs intention, and all flaps survived successfully. Postoperative hydrophallus appeared differently between both groups. In the routine group, obvious hydrophallus appeared on the 3rd day after the operation and lasted for (15.11 ± 2.71) days, with 3 cases (4.62%) suffering from refractory hydrophallus. In the modified group, hydrophallus appeared on the 3rd day after the operation and lasted for (6.65 ± 0.29) days without any refractory hydrophallus. There was significant difference between the two groups in the duration of hydrophallus (P lt; 0.05). All patients were followed up for 6-8 months. After the operation, the shape and function of the penis were found good. The prolonged length was (4.9 ± 1.4) cm in the routine group and (5.0 ± 1.5) cm in the modified group. There was no significant difference between the two groups (P gt; 0.05). The satisfaction rate (according to the patients’ self-rating) was 95% and 98% in the routine group and the modified group, respectively. Conclusion The method using the scrotal flap transferred to cover the prolonged cavernous body of the penis is safe and of low compl ication rate. The modified method is more effective to abate postoperative hydrophallus.
Objective To investigate the anatomical features of congenital chordee without hypospadias in children and to discuss the diagnosis and treatment.Methods From August 1984 to December 2004, 94 children with chordee withouthypospadias treated in the West China Hospital of Sichuan University were classified and analyzed for anatomical alterations. Their ages ranged from 18 months to 13 years (mean 6.9 years). Ninety-four patients were divided into four groups. With intraoperation artificial erection, the patients with penis straightened after degloving were classified as type Ⅰ patients (skin-tethering), those with peins straightened after fibrotic tissue in Buck’s fascia released as type Ⅱ patients (dysgenetic fascia), those with normal urethra and orthoplasty failed after degloving and removing fibrotic tissue as type Ⅲ patients (corporal disproportion), and those with dysgenetic urethra tethering the corpora cavernosa as type Ⅳ patients (short urethra).Results In type Ⅰ (n=31, 32.9%) patients, the ventral skin and dartos fascia were contracted while Buck’s fascia and the urethra was normal, in some (7 cases) scrotal skin extended to the ventral portion of penis (webbed penis). In type Ⅱ (n=45, 47.9%), contracture of Buck’s fascia was evident and the thickening fibrotic tissue constituted the chief obstacle to orthoplasty, though in some skin was shortened. In type Ⅲ (n=6), the dorsal and ventral sides of the corpora cavernosa were disproportionated, and the morphologically normal urethra tightly adhered to the ventral aspect of corpora cavernosa. In some cases ventral skin and fascia were contracted, but orthoplasty could notbe achieved through releasing these layers. In type Ⅳ (n=12, 12.8%), the distal urethra was paper-thin and lacking corpus spongiosum, or dense fibrotic bandswere found to be deep to the urethra. The urethra tethered the corpora cavernosaand formed a bow-to-string relation. The overlying skin and fascia were contracted in varying degrees while none had significance in straightening the penis. After operation, the length of penis increased to 6.9 cm from 5.2 cm on average and the chordee was corrected to 1.6° from 42.6° before operation on average. The patients were followed up 1 months to 15 years. The results were satisfactory.Chordee remained in 2 cases, fistula and urethral stricture occurred in 2 casesrespectively, fistula in association with urethral stricture and diverticulum in 1 case; the operation was given again and the results was satisfactory. Conclusion Patients with chordee without hypospadias may be divided into four types depending on which layer of the ventral penis constitutes thechief contribution to chordee. A systematic approach with repeated artificial erection tests is needed in determining the classification and surgical correction.