Chen Shyh Chyan, Yang Stephen Shei Dei, Hsieh Cheng Hsin, Wang Chung Cheng, Chen Yung Tai
Department of Urology, National Taiwan University Hospital, Taipei.
J Formos Med Assoc. 2002 Jan;101(1):48-51.
Total correction of proximal hypospadias and penoscrotal transposition (PST) is a challenge to surgeons. Staged operation is usually recommended because the blood supply to the neourethra or the skin covering the penile shaft may be severed during scrotoplasty. This paper describes results obtained using a new technique for total correction, which preserves the blood supply to the neourethra in a one-stage operation.
Between July 1998 and March 2000, five boys (mean age 4 yr) with proximal hypospadias and PST underwent total correction in a one-stage operation. The urethral meatus of these patients was located at mid shaft in one, at the penoscrotal junction in two, and at the scrotum in two. Hypospadias was repaired using the Snodgrass procedure and PST was corrected using the Ehrlich and Scardino technique. Radical bulbar urethra dissection and tunica albugineal plication were used to correct penile curvature in all five cases. The urethral stent was removed on the seventh or eighth postoperative day. The meatus was then dilated using the cone tip of an ophthalmic ointment tube two or three times per day for 2 to 4 weeks. Postoperative urinary flow was observed in the outpatient clinic.
The mean follow-up period was 11.2 months. There was no postoperative fistula. One patient had postoperative meatal stenosis that was successfully treated by dilation. Postoperatively, the penile base was well above the scrotal rhugae and the meatus was at the tip of the glans in each patient. The postoperative urinary flow was straight in all patients.
Combining Snodgrass hypospadias repair and Ehrlich and Scardino PST repair in a one-stage operation preserved the blood supply to the neourethra and achieved excellent functional and cosmetic results.
近端尿道下裂合并阴茎阴囊转位（PST）的完全矫正对外科医生来说是一项挑战。通常建议分期手术，因为在阴囊成形术期间新尿道或覆盖阴茎体的皮肤的血供可能会被切断。本文描述了使用一种新的完全矫正技术所取得的结果，该技术在一期手术中保留了新尿道的血供。
1998年7月至2000年3月期间，5名患有近端尿道下裂和PST的男孩（平均年龄4岁）接受了一期完全矫正手术。这些患者的尿道口，1例位于阴茎体中部，2例位于阴茎阴囊交界处，2例位于阴囊。采用Snodgrass手术修复尿道下裂，采用Ehrlich和Scardino技术矫正PST。所有5例均采用根治性球部尿道游离和白膜折叠术矫正阴茎弯曲。术后第7或8天取出尿道支架。然后每天使用眼科药膏管的圆锥头扩张尿道口2至3次，持续2至4周。在门诊观察术后尿流情况。
平均随访期为11.2个月。无术后瘘管形成。1例患者出现术后尿道口狭窄，经扩张成功治疗。术后，每位患者的阴茎根部均明显高于阴囊皱襞，尿道口位于龟头顶端。所有患者术后尿流均通畅。
在一期手术中联合应用Snodgrass尿道下裂修复术和Ehrlich及Scardino PST修复术可保留新尿道的血供，并取得了良好的功能和外观效果。
