Mazza O N, Cheliz G M
Cátedra de Urología at Universidad de Buenos Aires, Hospital Alemán, Buenos Aires, Argentina.
J Urol. 2001 Sep;166(3):887-9.
Reconstructing a penile stump secondary to trauma or cancer should result in satisfactory penile function and appearance. The lack of penile skin, stump retraction in the scrotum and stenosis of the neomeatus must be resolved in these cases.
A 2-stage surgical technique with a scrotal flap was used in 34 patients with a mean age of 43.2 years to reconstruct the glans. Mean followup was 73.2 months. After penectomy a scrotal flap was designed and its distal extreme was transferred to the penile stump. The urethral end was sutured to a hole in the scrotal flap and the flap borders were sutured to the adjacent albuginea. The flap pedicle was resected 4 to 6 weeks later.
Patient recovery was characterized by a normal-appearing penis and unobstructed urinary flow. Definite depilation of the neoglans was required in 17.6% of cases. Partial necrosis of 2 flaps (5.8%) required grafts. Sexual potency was preserved in 7 men (20.5%). In 1 case (2.9%) urethral meatal stenosis resolved with minor surgical procedures.
This technique enables us to design a neoglans with acceptable function and appearance, no penile retraction, satisfactory voiding and in certain cases possible intercourse with vaginal penetration.
因创伤或癌症导致阴茎残端重建应能带来满意的阴茎功能和外观。在这些病例中，必须解决阴茎皮肤缺失、残端回缩至阴囊以及新尿道口狭窄的问题。
采用两阶段阴囊皮瓣手术技术，对34例平均年龄43.2岁的患者进行龟头重建。平均随访73.2个月。阴茎切除术后，设计阴囊皮瓣并将其远端转移至阴茎残端。尿道末端缝合至阴囊皮瓣的一个孔，皮瓣边缘缝合至相邻的白膜。4至6周后切除皮瓣蒂部。
患者恢复情况表现为阴茎外观正常、尿流通畅。17.6%的病例需要对新龟头进行明确脱毛。2例皮瓣（5.8%）出现部分坏死，需要进行植皮。7名男性（20.5%）保留了性功能。1例（2.9%）尿道外口狭窄通过小型手术得到解决。
该技术使我们能够设计出具有可接受功能和外观的新龟头，无阴茎回缩，排尿满意，在某些情况下还能实现阴茎插入阴道的性交。
