Pirogov Russian National Research Medical University, Moscow, Russia.
Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, Russia.
Int Braz J Urol. 2024 Sep-Oct;50(5):585-594. doi: 10.1590/S1677-5538.IBJU.2024.0194.
To answer the question of whether it is possible to achieve complete corporal covering of the urethral closure using incomplete penile disassembly in classic bladder exstrophy. We hypothesize that mobilization of the corpora under Buck's fascia, their dorsal translocation through the incisions in Buck's fascia and suturing corporal convex sides above the urethra would allow extend corporal covering of the urethra, reducing the risk of urethra-cutaneous fistula formation.
A prospective follow-up on all boys who underwent the modified Cantwell-Ransley primary penile reconstruction was conducted. Inclusion criteria comprised bladder exstrophy closure in our institution, ensuring a postoperative follow-up period of no less than 24 months. The key innovation of the technique lies in a deep dissection of the dependent corpora under Buck's fascia, followed by their dorsal relocation through extended dorsal incisions in Buck's fascia, and limited external corporal rotation 90 degrees only at the base of the penis.
Between November 2019 and March 2022, 18 boys aged 11 to 35 months met the inclusion criteria and underwent the modified penile reconstruction. Surgical procedures and postoperative period did not include any major complications. Total corporal covering of the urethral sutures was achieved in 15 of 18 patients. No urethra-cutaneous fistulas were observed within 2 years of follow-up. All individuals demonstrated spontaneous erections, and the absence of dorsal curvature was documented.
The modified technique of incomplete penile disassembly applied in a homogenous group of patients with classic bladder exstrophy allows penile shaft elongation, improved aesthetic outcomes, preserved erections, and eliminates dorsal curvature. The technique demonstrated feasibility and reliability while maintaining positive effects on tissue circulation. The absence of urethra-cutaneous fistulae is attributed to the complete corporal covering of the urethral sutures and supports the initial hypothesis.
回答在经典膀胱外翻中，通过不完全阴茎离断是否有可能实现尿道闭合的完全体覆盖的问题。我们假设通过Buck 筋膜下的阴茎体的动员，将其背侧移位穿过 Buck 筋膜的切口并在尿道上方缝合阴茎体凸面，可以延长尿道的体覆盖，降低尿道-皮肤瘘形成的风险。
对所有在我们机构接受改良 Cantwell-Ransley 原发性阴茎重建术的男孩进行前瞻性随访。纳入标准包括在我们机构进行膀胱外翻闭合，确保术后随访期不少于 24 个月。该技术的关键创新在于在 Buck 筋膜下进行深度解剖依赖的阴茎体，然后通过延长的 Buck 筋膜背侧切口将其背侧移位，并仅在阴茎根部将外部阴茎体旋转 90 度。
2019 年 11 月至 2022 年 3 月，18 名年龄在 11 至 35 个月的男孩符合纳入标准并接受了改良的阴茎重建术。手术过程和术后期间没有发生任何重大并发症。18 例患者中有 15 例实现了尿道缝线的完全体覆盖。在 2 年的随访中，没有观察到尿道-皮肤瘘。所有患者均出现自发性勃起，并且记录到无背侧弯曲。
在经典膀胱外翻的同质患者群体中应用的改良不完全阴茎离断技术允许阴茎干延长，改善美学效果，保留勃起功能，并消除背侧弯曲。该技术表现出可行性和可靠性，同时保持对组织循环的积极影响。不存在尿道-皮肤瘘是由于完全体覆盖了尿道缝线，支持了最初的假设。
