Department of Urology, SUNY Upstate Medical University, Syracuse, USA.
Departemento Clinico, Universidad Europea de Madrid, Hospital Universitario de Getafe, Madrid, Spain.
Int Urol Nephrol. 2020 Aug;52(8):1491-1497. doi: 10.1007/s11255-020-02437-7. Epub 2020 Mar 12.
Penile adhesions may cause pain, bleeding, disfigurement and distress. In the setting of lichen sclerosus (LS), they often recur but current treatment options are limited. We present a novel surgical technique for treatment of recurrent penile adhesions using sub-coronal buccal mucosal graft (BMG) resurfacing.
A retrospective, international multi-institutional study was conducted to include patients with refractory penile adhesions who were treated with this technique. Patients with > 12-month follow-up were included in analysis. The procedure involved circumferential excision of the diseased skin and replacement with a BMG. The primary outcomes were recurrence and surgical complications. Secondary outcomes were patient-reported outcome measures (PROMs) including Sexual Health Inventory for Men (SHIM) questionnaire and Global Response Assessment (GRA) questionnaire measuring functional and esthetic outcomes.
Twenty-five men underwent the procedure across six institutions between 3/2014 and 11/2019. Twenty-one men met inclusion criteria. Mean operative time and hospital stay for sub-coronal resurfacing were 40 min (25-50) and 0.76 days (1-2), respectively. At the mean follow-up of 18 months (12-61), no patients developed recurrence. All patients who presented with pain and postcoital bleeding saw improvement on follow-up (18/18). There was a significant improvement in SHIM scores after the operation (14.4 pre-op, 17.0 post-op; p = 0.003). Overall improvement of symptoms was reported by all patients: 57% GRA + 3; 29% GRA + 2; 14% GRA + 1. Baseline penile sensation was preserved in 17/21 (81%) patients.
Recurrent penile adhesions in the setting of LS are notoriously difficult to treat. A sub-coronal BMG resurfacing is feasible. This initial patient cohort demonstrated no recurrence and overall high satisfaction.
阴茎粘连可引起疼痛、出血、畸形和痛苦。在硬化性苔藓（LS）的情况下，它们经常复发，但目前的治疗选择有限。我们提出了一种使用冠状下颊黏膜移植物（BMG）覆盖治疗复发性阴茎粘连的新手术技术。
进行了一项回顾性、国际多机构研究，纳入接受该技术治疗的难治性阴茎粘连患者。纳入分析的患者随访时间>12 个月。该过程包括环形切除病变皮肤并用 BMG 替代。主要结局是复发和手术并发症。次要结局是患者报告的结果测量（PROMs），包括男性性健康问卷（SHIM）和全球反应评估（GRA）问卷，用于测量功能和美观结果。
2014 年 3 月至 2019 年 11 月，六家机构的 25 名男性接受了该手术。21 名男性符合纳入标准。冠状下表面重建的平均手术时间和住院时间分别为 40 分钟（25-50）和 0.76 天（1-2）。在平均 18 个月（12-61）的随访中，没有患者复发。所有出现疼痛和性交后出血的患者在随访中均有所改善（18/18）。手术后 SHIM 评分显著改善（术前 14.4，术后 17.0；p=0.003）。所有患者均报告症状总体改善：57% GRA+3；29% GRA+2；14% GRA+1。21 名患者中有 17 名（81%）保留了基线阴茎感觉。
LS 背景下的复发性阴茎粘连难以治疗。冠状下 BMG 覆盖是可行的。初步患者队列未发现复发，总体满意度高。
