Acimi Smail, Debbous Lamia, Acimi Mohammed Ali, Khelil Amina Leila
Department of Visceral Surgery, Children's Hospital Canastel, Faculty of medicine, University Of Oran, Oran, Algeria.
Department of Visceral Surgery, Children's Hospital Canastel, Faculty of medicine, University Of Oran, Oran, Algeria.
J Plast Reconstr Aesthet Surg. 2018 Nov;71(11):1637-1643. doi: 10.1016/j.bjps.2018.07.002. Epub 2018 Aug 2.
To assess the importance of shortening of the urethral plate that occurred with complete penile disassembly technique in epispadias repair and its impact on cosmetic and functional results (on urinary incontinence).
From January 2009 to December 2016, 26 boys underwent complete penile disassembly technique for proximal epispadias repair. Twenty-one patients had epispadias after primary repair of bladder exstrophy, and 5 patients had isolated penopubic epispadias. The age of the patients ranged from 11 months to 6 years (median 3 years).
After disassembling the penis in three parts, the shortening and narrowing of urethral plate were found in all patients; the shortening varied between 2 and 16 mm. However, in isolated epispadias, the urethral plate is easily extensible. The cosmetic results (after dehiscence and fistulas repair) were found to be satisfactory in 24 patients with conical glans and meatus in the orthotopic position without any necrosis of the glans. However, 18 patients (81.8% of cases) who initially had a bladder exstrophy presented a dehiscence or fistula. The urinary continence ≥ 1 h was observed in 5 patients (19% of cases), and only 3 patients (11.5% of cases) had a urinary continence ≥ 3 h.
The complete penile disassembly procedure restores the normal anatomy of the penis. Despite the shortening and narrowing of the urethral plate, the cosmetic results were good in the majority of patients. However, its functional outcomes on urinary incontinence, particularly for epispadias with bladder exstrophy, remain uncertain.
评估在尿道上裂修复术中采用完全阴茎拆解技术时尿道板缩短的重要性及其对美容和功能结果（对尿失禁）的影响。
2009年1月至2016年12月，26名男孩接受了完全阴茎拆解技术用于近端尿道上裂修复。21例患者在膀胱外翻一期修复后出现尿道上裂，5例患者为孤立性耻骨前尿道上裂。患者年龄为11个月至6岁（中位年龄3岁）。
将阴茎分为三部分拆解后，所有患者均出现尿道板缩短和变窄；缩短范围在2至16毫米之间。然而，在孤立性尿道上裂中，尿道板易于伸展。在24例龟头呈圆锥形且尿道口位于原位且龟头无坏死的患者中，美容效果（在伤口裂开和瘘管修复后）令人满意。然而，最初患有膀胱外翻的18例患者（占病例的81.8%）出现了伤口裂开或瘘管。5例患者（占病例的19%）观察到尿失禁≥1小时，只有3例患者（占病例的11.5%）尿失禁≥3小时。
完全阴茎拆解手术可恢复阴茎的正常解剖结构。尽管尿道板有缩短和变窄，但大多数患者的美容效果良好。然而，其对尿失禁的功能结果，特别是对于伴有膀胱外翻的尿道上裂，仍不确定。
