Timsit Marc-Olivier, Mouriquand Pierre E, Ruffion Alain, Bouillot Alain, Dembelé Diala, Mejean Arnaud, Lalloue Fanny, Leriche Albert, Morel-Journel Nicolas
Department of Paediatric Surgery, Necker Hospital, Paris, France.
BJU Int. 2009 May;103(10):1418-21. doi: 10.1111/j.1464-410X.2008.08286.x. Epub 2008 Dec 22.
To assess the long-term outcome and cosmetic results of forearm free-flap phalloplasty for correcting micropenis associated with bladder exstrophy in men.
From 1992 to 2000, six men with bladder exstrophy and unsatisfactory penile appearance underwent phalloplasty at our institution. The mean (range) follow-up was 113 (62-153) months. The surgical procedure consisted of a modified radial free-flap phalloplasty and prosthesis implantation. One-stage urethroplasty was electively performed according to the patient's voiding pattern. Early and late complications were recorded and quality of life after phalloplasty was assessed.
The mean (range) age was 21.2 (17-26) years and flap survival was 100%. Two incontinent patients underwent immediate perineal urethrostomy. One sepsis occurred, requiring the removal of the penile prosthesis and a cutaneous continent urinary diversion; this patient was the only one to complain about the outcome. Two anastomotic urethral strictures were conservatively treated by endoscopic urethrotomy and only one patient underwent subsequent urethral self-dilatations. Five patients were very satisfied with the cosmesis of the neophallus and three patients reported having regular sexual intercourse.
Although short, this series indicates the low incidence of early complications and the excellent long-term satisfaction with forearm free-flap phalloplasty in bladder exstrophy. Phalloplasty has potential indications when adult exstrophy patients are dissatisfied with the cosmetic appearance of their external genitalia or have unsatisfactory sexual intercourse.
评估采用游离前臂皮瓣阴茎再造术矫正男性膀胱外翻相关小阴茎的长期疗效及美容效果。
1992年至2000年，6例膀胱外翻且阴茎外观不佳的男性在我院接受了阴茎再造术。平均（范围）随访时间为113（62 - 153）个月。手术过程包括改良桡侧游离皮瓣阴茎再造术和假体植入。根据患者排尿模式选择性地进行一期尿道成形术。记录早期和晚期并发症，并评估阴茎再造术后的生活质量。
平均（范围）年龄为21.2（17 - 26）岁，皮瓣存活率为100%。2例尿失禁患者立即进行了会阴尿道造口术。发生1例脓毒症，需要取出阴茎假体并进行皮肤可控性尿流改道；该患者是唯一对结果不满意的。2例吻合口尿道狭窄通过内镜下尿道切开术进行保守治疗，只有1例患者随后进行了尿道自我扩张。5例患者对新阴茎的美容效果非常满意，3例患者报告有规律的性生活。
尽管本系列病例数较少，但表明膀胱外翻患者采用游离前臂皮瓣阴茎再造术早期并发症发生率低，长期满意度高。当成年膀胱外翻患者对外生殖器的美容外观不满意或性生活不满意时，阴茎再造术有潜在的适应证。
