Alei Giovanni, Letizia Piero, Alei Lavinia, Massoni Francesco, Ricci Serafino
Ann Ital Chir. 2014 Mar-Apr;85(2):195-200.
Our exeperience with the reconstructive surgery of the adhesion of the glans with the preputial skin due to lichen sclerosus.
Twentyeight patients (mean age, 44 years; range, 28-69) underwent reshaping of the balanopreputial sulcus at our institution. All patients presented with trapped penis resulting from adhesion at the sulcus of glans due to Lichen Sclerosus. The procedure entailed separating the coronal adhesion along its entire length with the use of a blunttipped forceps, then reshaping the balanopreputial sulcus. Though simple, the maneuver is delicate and requires scrupulous attention to the ventral aspect to avoid damaging the urethra. The adhesion is removed circumferentially around the glans by means of electrobistoury.
The duration of the follow-up period was 24 months. All patients stated they were satisfied with the cosmetic results and functional outcome. Recurrence of the condition occurred in 7% of the patients and was treated medically; recurrence of adhesion occurred in 2% of the patients and was treated with repeat surgery.
The indication for medical therapy in early LS is a selective criterion restricted to less severe cases; otherwise, the physician may be held responsible for treatment failure, justified claims for reimbursement, disease progression and the decidedly greater damage that may ensue. Such consequences can be averted when assessment is based on recent scientific evidence and the approach to treatment is appropriate in terms of efficacy and effectiveness. Surgical management is definitive and restores normal penile anatomy and function, including sexual and urinary function, thus enabling the patient to regain sexual confidence
Lichen sclerosus et atrophicus is a rare disease, however, its management is not devoid of medicolegal considerations. The etiopathogenesis of the disease is unknown but progression to carcinoma of the penis has been reported in untreated cases. Consequently, timely diagnosis holds medicolegal relevance for averting delayed initiation of treatment. In cases of balanopreputial adhesion with disappearance of the sulcus of glans, we proceed with lysis and reshaping of the sulcus by means of a simple technique we have developed. The technique involves separating the coronal adhesion circumferentially around the glans using a blunt-tipped forceps, then reshaping the balanopreputial sulcus. Though very simple, the procedure is also delicate as the surgeon must be careful not to damage the urethra beneath the ventral surface.
分享我们因硬化性苔藓导致龟头与包皮皮肤粘连的重建手术经验。
28例患者（平均年龄44岁；范围28 - 69岁）在我院接受了阴茎头包皮沟重塑手术。所有患者均因硬化性苔藓导致龟头沟处粘连而出现阴茎被困。手术步骤包括使用钝头镊子沿冠状粘连全长进行分离，然后重塑阴茎头包皮沟。尽管操作简单，但该操作精细，需要特别注意腹侧以免损伤尿道。通过电灼术在龟头周围环形切除粘连组织。
随访期为24个月。所有患者表示对美容效果和功能结果满意。7%的患者病情复发并接受药物治疗；2%的患者粘连复发并接受再次手术治疗。
早期硬化性苔藓的药物治疗指征是一个仅限于病情较轻病例的选择性标准；否则，医生可能要为治疗失败、合理的报销索赔、疾病进展以及可能随之而来的明显更大损害负责。当评估基于最新科学证据且治疗方法在疗效和有效性方面合适时，这些后果是可以避免的。手术治疗是确定性的，可恢复阴茎的正常解剖结构和功能，包括性功能和排尿功能，从而使患者恢复性自信。
萎缩性硬化性苔藓是一种罕见疾病，然而，其治疗并非没有法医学考量。该疾病的病因尚不清楚，但未经治疗的病例有进展为阴茎癌的报道。因此，及时诊断对于避免延迟治疗具有法医学意义。对于阴茎头包皮粘连且龟头沟消失的病例，我们采用一种我们开发的简单技术进行粘连松解和沟的重塑。该技术包括使用钝头镊子在龟头周围环形分离冠状粘连，然后重塑阴茎头包皮沟。虽然非常简单，但该操作也很精细，因为外科医生必须小心不要损伤腹侧下方的尿道。
