Raveenthiran Venkatachalam
Division of Pediatric Surgery, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamilnada, India.
J Pediatr Surg. 2008 Nov;43(11):2082-6. doi: 10.1016/j.jpedsurg.2008.02.006.
Cavernous shunt operations available for treating priapism are frequently unsuitable for children owing to high chances of persistent venous leak that results in postoperative erectile dysfunction. In this article, a modification of Winter's shunt, which is suitable for treating low-flow priapism in children, is described.
Using a large bore needle, multiple punctures were made in the tip of corpora cavernosa through the glans. The needle tracks functioned as temporary cavernoglandular fistula thereby, causing detumescence. This modified technique was used in 7 children all of whom had ischemic priapism. The age range was 9 months to 17 years, and the mean duration of symptom was 11 hours (range, 5-20 hours).
In all the patients, priapism was successfully relieved by the modified technique. Immediate recurrence of priapism was noted in only one patient. In 5 patients for whom adequate follow-up details are available, postprocedure penile erection was confirmed either by self-reporting or by observation. There were no major complications.
This technical modification of the classical Winter's shunt appears to be a useful alternative in the management of pediatric low-flow priapism. A high chance of retaining erectile capacity after this technique is a significant advantage. Further clinical studies are required to confirm the observations of this preliminary report.
由于持续性静脉漏导致术后勃起功能障碍的可能性较高，可用于治疗阴茎异常勃起的海绵体分流手术通常不适用于儿童。本文描述了一种适用于治疗儿童低流量阴茎异常勃起的改良温特分流术。
使用大口径针头，经龟头在海绵体尖端进行多次穿刺。针道因此起到了临时海绵体-尿道海绵体瘘的作用，从而使阴茎消肿。该改良技术应用于7名患有缺血性阴茎异常勃起的儿童。年龄范围为9个月至17岁，症状平均持续时间为11小时（范围为5 - 20小时）。
在所有患者中，改良技术成功缓解了阴茎异常勃起。仅1例患者出现阴茎异常勃起立即复发。在5例有足够随访细节的患者中，通过自我报告或观察证实术后阴茎勃起。无重大并发症。
经典温特分流术的这种技术改良似乎是治疗小儿低流量阴茎异常勃起的一种有用替代方法。该技术术后保留勃起功能的可能性较高是一个显著优点。需要进一步的临床研究来证实本初步报告的观察结果。
