Kajbafzadeh Abdol-Mohammad, Sina Alireza, Payabvash Seyedmehdi
Department of Urology, Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
J Urol. 2007 May;177(5):1872-7. doi: 10.1016/j.juro.2007.01.047.
We present the long-term results of our experience with application of tissue expanders for phallic reconstruction in patients with a history of multiple surgical repairs.
We retrospectively reviewed the medical records of 16 patients who underwent penile tissue expansion for treatment of failed phallic reconstruction. The patients were 5 to 22 years old (mean age 9.9) at the time of the procedure. The original diagnoses were congenital adrenal hyperplasia (1 patient), partial penile amputation (1), epispadias (3) and proximal hypospadias (11). We used different shapes and numbers of tissue expanders according to the estimated skin augmentation requirement for final reconstructive surgery. The injection port was placed at the suprapubic area lateral to the penile base, with a small incision between the anticipated expander pouch and the reservoir. Penile tissue expanders were inflated by injections after 1 to 2 weeks postoperatively. Definitive reconstructive surgery was then planned and the tissue expander was removed at penile reconstruction at 2 to 11 months (mean 4.6) after implantation.
Only 1 tissue expander was removed due to erosion. However, sufficient expanded skin was available for urethral reconstructions and penile skin coverage in all patients (100%). There were 2 cases of overlying penile skin redness, which resolved with temporary balloon deflation. Two patients had urethrocutaneous fistulas, which were successfully repaired later. Two additional patients required meatal dilation/urethromeatoplasty for meatal stenosis. These complications were corrected within 1 year postoperatively. After a long-term followup of 3 to 10 years (mean 6.5) as patients progressed through puberty, only 3 had mild chordee. At the end of followup acceptable cosmetic and functional results were achieved in 13 patients (81%).
Tissue expansion is associated with few complications and good cosmetic results for phallic reconstruction in patients with minimal residual skin available for additional reconstructive efforts after repeated surgeries.
我们展示了在有多次手术修复史的患者中应用组织扩张器进行阴茎重建的长期经验结果。
我们回顾性分析了16例行阴茎组织扩张术以治疗阴茎重建失败患者的病历。手术时患者年龄为5至22岁（平均年龄9.9岁）。原诊断为先天性肾上腺增生（1例）、部分阴茎截肢（1例）、尿道上裂（3例）和近端尿道下裂（11例）。根据最终重建手术预计的皮肤扩张需求，我们使用了不同形状和数量的组织扩张器。注射端口置于阴茎基部外侧的耻骨上区域，在预期的扩张器囊袋和储液器之间做一个小切口。术后1至2周通过注射对阴茎组织扩张器进行充气。然后计划进行确定性重建手术，并在植入后2至11个月（平均4.6个月）阴茎重建时取出组织扩张器。
仅1个组织扩张器因侵蚀而取出。然而，所有患者（100%）均有足够的扩张皮肤用于尿道重建和阴茎皮肤覆盖。有2例阴茎上方皮肤发红，通过暂时放气气球得以缓解。2例患者出现尿道皮肤瘘，随后成功修复。另外2例患者因尿道口狭窄需要进行尿道口扩张/尿道外口成形术。这些并发症在术后1年内得到纠正。经过3至10年（平均6.5年）的长期随访，随着患者进入青春期，只有3例有轻度阴茎下弯。随访结束时，13例患者（81%）获得了可接受的美容和功能效果。
对于在多次手术后几乎没有剩余皮肤可用于进一步重建的患者，组织扩张术用于阴茎重建并发症少且美容效果良好。
