New York Presbyterian Weill-Cornell Medical Center, New York, USA.
Masr Elgedida Military Family Hospital, Cairo, Egypt.
J Pediatr Urol. 2021 Jun;17(3):394.e1-394.e6. doi: 10.1016/j.jpurol.2021.01.036. Epub 2021 Feb 3.
The decreased penile length in patients born with BE results partly from pubic symphysis diastasis and the separation of the corporal bodies, which causes a shortened penis as the corporal length is lost in traversing the distance between the pubic rami. However, in some cases there is an intrinsic penile abnormality and dorsal chordee. Furthermore, multiple surgeries has in some cases, resulted in cutaneous and subcutaneous scarring, which contributed to the problem of the short phallus and dorsal tethering to the abdominal wall (figure).
Herein we evaluated the outcome of penile lengthening, repair of penile upward tethering to the abdominal wall and dorsal curvature in males born with bladder exstrophy and epispadias (BEE).
We reviewed the records of 34 patients (11-29 years old) born with BE (31pts.) and epispadias (3 pts.). The parents and/or the young men were referred because of their dissatisfaction with and complains of short penile length, and upward tethering/chordee. The penile lengthening was achieved by detaching the corporal bodies from the pubic rami and suturing the corporal bodies as reported by Johnston (figure) However, in 11 patients who had had multiple surgeries the periosteum was incised and the corporal dissection was performed subperiosteally to protect the erectile tissues. In 16 pts dermal grafts of the dorsal corporal wall was performed to correct the dorsal curvature. 13 patients underwent single stage augmentation urethroplasty.
Surgical complications were encountered in 4 pts (11.7%). Subjective evaluation by the patient and/or parents reported satisfactory and/or very satisfactory results in 31/34 (91%). The degree of penile lengthening measured at 6 months and one year postoperatively showed increased length which varied between 50% and 150% of the preoperative penile length.
As children born with BEE transition to adolescence and adulthood, the external genitalia acquire greater importance. The short phallus and/or dorsal chordee and/or upwards tethering can be corrected successfully in the majority of patients.
患有 BE 的患者的阴茎长度缩短部分是由于耻骨联合分离和阴茎体分离，这导致阴茎体在穿过耻骨支之间的距离时丢失了长度，从而导致阴茎缩短。然而，在某些情况下存在内在的阴茎异常和背侧弯曲。此外，多次手术在某些情况下导致了皮肤和皮下瘢痕形成，这导致了阴茎短小和背侧与腹壁的束缚问题（图）。
本文评估了患有膀胱外翻和尿道上裂（BEE）的男性进行阴茎延长、修复阴茎向上与腹壁的束缚和背侧弯曲的治疗效果。
我们回顾了 34 名（11-29 岁）患有 BE（31 例）和尿道上裂（3 例）的患者的记录。由于对阴茎长度不满意以及向上束缚/弯曲的抱怨，父母和/或年轻人前来就诊。阴茎延长术是通过将阴茎体从耻骨支上分离并按照 Johnston 的报道进行缝合来实现的（图）。然而，在 11 名曾接受多次手术的患者中，切开了骨膜，并在骨膜下进行了阴茎体分离，以保护勃起组织。在 16 例患者中，进行了阴茎体背侧皮肤移植以矫正背侧弯曲。13 名患者接受了一期尿道扩张术。
4 名患者（11.7%）出现手术并发症。34 名患者中的 31 名（91%）患者和/或其父母主观评价报告为满意或非常满意。术后 6 个月和 1 年时测量的阴茎延长程度显示，阴茎长度增加了 50%至 150%不等。
随着患有 BEE 的儿童进入青春期和成年期，外生殖器变得更加重要。大多数患者可以成功矫正阴茎短小和/或背侧弯曲和/或向上束缚问题。
