阴茎功能不全的生物学男性的阴茎成形术。
Phalloplasty in biological men with penile insufficiency.
作者信息
Sinatti Céline, Wolff Dylan, Buncamper Marlon, Verla Wesley, Claes Karel, Lumen Nicolaas, Waterloos Marjan, Monstrey Stan, Hoebeke Piet, Spinoit Anne-Françoise
机构信息
PhD Student for the Department of Urology, Ghent University Hopsital, Supported by the Gianni Eggermont fonds, Belgium.
Department of Urology, Ghent University Hospital, Belgium.
出版信息
J Pediatr Urol. 2020 Jun;16(3):404-405. doi: 10.1016/j.jpurol.2020.04.015. Epub 2020 Jun 4.
INTRODUCTION
Phalloplasty for penile insufficiency in biological men differs from trans-men by incorporating native tissue. The study objective was to report surgical and functional outcomes of phalloplasty in biological men.
PATIENTS & METHODS: Phalloplasty was performed with a radial free forearm (RFFA) or pedicled anterolateral thigh (ALT) flap. The tube-within-tube technique was used for urethroplasty. Complications <30 d postoperative were categorized according to Clavien-Dindo.
RESULTS
30 patients, median (IQR) age of 21 (18-30)y, were included. 17 patients (57%) had penile insufficiency due to exstrophy or hypospadias surgeries, 7 patients (23%) due to sexual development disorders. In 16 patients RFFA was used. 19 patients needed urethroplasty, the rest catheterized through stoma. Median follow-up was 33 (14-80)mo. Within 30 d postoperative, 1 patients (3.3%) had Clavien-Dindo II and 6 patients (20%) Clavien-Dindo III complications. On long-term, 10 patients (33%) developed fistula, 6 needing urethroplasty. 7 patients (23%) had urethral strictures, all needing surgical intervention. All patients but one (98%) had erogenous sensitivity in the neo-phallus. All urethroplasty patients reported antegrade ejaculation. 16 patients (84%) voided through the urethra. 21 patients (70%) had an erectile device implanted.
CONCLUSION
RFFA and ALT result in good erogenous sensitivity but fistulas and strictures are frequent.
引言
生物学男性阴茎功能不全的阴茎成形术与跨性别男性的不同之处在于采用了自体组织。本研究的目的是报告生物学男性阴茎成形术的手术及功能结果。
患者与方法
采用游离桡侧前臂（RFFA）皮瓣或带蒂股前外侧（ALT）皮瓣进行阴茎成形术。采用管中管技术进行尿道成形术。术后30天内的并发症根据Clavien-Dindo分类。
结果
纳入30例患者，年龄中位数（四分位间距）为21（18 - 30）岁。17例患者（57%）因膀胱外翻或尿道下裂手术导致阴茎功能不全，7例患者（23%）因性发育障碍导致。16例患者使用了RFFA皮瓣。19例患者需要进行尿道成形术，其余患者通过造口进行导尿。中位随访时间为33（14 - 80）个月。术后30天内，1例患者（3.3%）出现Clavien-Dindo II级并发症，6例患者（20%）出现Clavien-Dindo III级并发症。长期来看，10例患者（33%）出现瘘管，其中6例需要进行尿道成形术。7例患者（23%）出现尿道狭窄，均需要手术干预。除1例患者外，所有患者（98%）新阴茎均有性敏感。所有接受尿道成形术的患者均报告有顺行射精。16例患者（84%）通过尿道排尿。21例患者（70%）植入了勃起装置。
结论
RFFA和ALT皮瓣可带来良好的性敏感，但瘘管和狭窄较为常见。
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