Tang Yun-Man, Chen Shao-Ji, Huang Lu-Gang, Wang Ming-He
Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
J Androl. 2007 Jul-Aug;28(4):630-3. doi: 10.2164/jandrol.106.002436. Epub 2007 Apr 4.
A series of Chinese prepubertal patients with congenital chordee without hypospadias is presented and the clinical data described. From July 1999 to September 2006, 79 boys with congenital chordee without hypospadias were treated in the Department of Pediatric Surgery, West China Hospital of Sichuan University, China. The ages ranged from 21 months to 14 years, with a mean of 76.8 months (6.4 years). The patients were categorized according to structural defect into 4 groups, with the aid of intraoperative artificial erection. Group I included those with skin tethering (28 cases, 35.4%); group II, fascial chordee (22, 27.8%); group III, corporal disproportion (10, 12.7%); and group IV, urethral tethering (19, 24.1%). Chordee-related structural defect was considered the only criterion for classification, and urethral dysgenesis influenced the choice of surgical procedure. The chordee in group I patients was corrected with penile degloving; group II, release of dense fibrous tissue in addition; group III, dorsal-midline-plication-based correction; and group IV, longitudinal-island-flap-urethroplasty-based repair. At a mean follow-up of 14.8 months (range, 2 to 63), all patients had penile straightening except 1 group III patient with residual curvature that was managed upon reoperation. Glans dehiscence occurred in 1 group II patient who underwent a tubularized incised plate urethroplasty. Urethrocutaneous fistula and urethral stricture were found in 2 group IV patients who underwent island flap urethroplasty. With the categorization based on structural defect, chordee without hypospadias may be managed well with minimized complications.
本文报告了一系列先天性阴茎下弯但无尿道下裂的青春期前中国患者，并描述了其临床资料。1999年7月至2006年9月，四川大学华西医院小儿外科收治了79例先天性阴茎下弯但无尿道下裂的男孩。年龄范围为21个月至14岁，平均年龄为76.8个月（6.4岁）。借助术中人工勃起，根据结构缺陷将患者分为4组。第一组包括皮肤系带过短者（28例，35.4%）；第二组，筋膜性阴茎下弯（22例，27.8%）；第三组，海绵体不对称（10例，12.7%）；第四组，尿道系带过短（19例，24.1%）。阴茎下弯相关的结构缺陷被视为分类的唯一标准，尿道发育异常影响手术方式的选择。第一组患者的阴茎下弯通过阴茎脱套矫正；第二组，除松解致密纤维组织外；第三组，基于背侧中线折叠的矫正；第四组，基于纵行岛状皮瓣尿道成形术的修复。平均随访14.8个月（范围2至63个月），除1例第三组患者残留阴茎弯曲需再次手术处理外，所有患者阴茎均伸直。1例接受管状切开板尿道成形术的第二组患者发生了龟头裂开。2例接受岛状皮瓣尿道成形术的第四组患者出现了尿道皮肤瘘和尿道狭窄。基于结构缺陷进行分类，先天性阴茎下弯但无尿道下裂可以得到很好的处理，并发症最少。
