Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK.
Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK; Department of Paediatric Surgery, Ain Shams University, Cairo, Egypt.
J Pediatr Urol. 2018 Feb;14(1):77-78. doi: 10.1016/j.jpurol.2017.09.024. Epub 2017 Oct 27.
We present a video of our technique for resection of a large prostatic utricle (PU) in a patient who presented initially with disordered sexual development. His karyotype was 46XY, and phenotypically had penoscrotal hypospadias, bifid scrotum, and retractile right testis. An initial micturating cystourethrogram (MCUG) demonstrated the utricle but failed to cannulate the bladder. Being asymptomatic, we carried out staged repair of his hypospadias. Later, he started to have recurrent epididymo-orchitis with resistance to multiple antibiotics. Examination under anaesthesia was done and ruled out meatal or neo-urethral strictures. A subsequent MCUG demonstrated the large utricle and its relation to the bladder. We carried out a cystoscopic-assisted laparoscopic excision. There has been no consensus about the best surgical approach to resect a PU and most known procedures involved extensive pelvic dissection and carried a significant risk of damage to the pelvic nerves. The laparoscopic approach seems to be promising in this field as it provides proper view of the deep pelvis with reasonable magnification, less dissection and shorter postoperative pain and scarring. Cystoscopic assistance in this technique was a great addition to provide counter-traction movement and facilitate proper dissection.
我们呈现了一段视频，展示了我们在一名以性发育障碍为首发症状的患者中切除大型前列腺囊（PU）的技术。他的核型为 46XY，表型为阴茎阴囊型尿道下裂、阴囊分裂和右侧睾丸回缩。最初的排尿性膀胱尿道造影（MCUG）显示了囊，但未能给膀胱插管。由于无症状，我们对他的尿道下裂进行了分期修复。后来，他开始反复发生附睾炎-睾丸炎，对多种抗生素有耐药性。全身麻醉下进行了检查，排除了尿道口或新尿道狭窄。随后的 MCUG 显示了大型囊及其与膀胱的关系。我们进行了经膀胱镜辅助腹腔镜切除术。对于切除 PU，目前还没有关于最佳手术方法的共识，大多数已知的手术方法都涉及广泛的骨盆解剖，并且存在骨盆神经损伤的重大风险。腹腔镜方法在这一领域似乎很有前途，因为它可以在合理放大的情况下提供深部骨盆的适当视野，减少解剖和缩短术后疼痛和疤痕。在这项技术中，膀胱镜辅助是一个很好的补充，可以提供反向牵引运动并有助于进行适当的解剖。
