Zhao Shimeng, Jia Pengyu, Chai Hongchao, Qi Can, Xin Chaojun, Zhou Yun
Department of Urology, Hebei Children's Hospital, Shijiazhuang, China.
Medical Records Room, Hebei Children's Hospital, Shijiazhuang, China.
Transl Androl Urol. 2025 Mar 30;14(3):602-609. doi: 10.21037/tau-2024-698. Epub 2025 Mar 26.
Penile torsion is a congenital condition characterized by the rotation of the penis along its longitudinal axis. This study aimed to describe a modified Shang Ring circumcision (SRC) surgical technique as a simple and effective approach for correcting penile torsion in children under local anesthesia.
From July 2018 to August 2023, 20 male children with penile torsion underwent the modified SRC technique under local anesthesia, performed by the same surgeon (S.Z.). In our technique, the inner ring of the Shang Ring is placed over the glans penis, while the outer ring is positioned over the outer layer of the foreskin and secured by the first notch of the outer ring. The foreskin is held in place in a semi-locked state between the inner and outer rings. The frenulum is adjusted to achieve mild overcorrection, positioning the urethral opening between the 6 and 7 o'clock positions to correct penile torsion. A good surgical outcome is defined as a postoperative penile torsion angle of less than 30 degrees, while a poor surgical outcome is one with a postoperative penile torsion angle greater than 30 degrees.
All cases involved counterclockwise penile torsion, and surgeries, performed under local anesthesia, with an average surgical time of 8.55±1.61 minutes. The preoperative median angle of penile torsion was 45 [45, 60] degrees, with a maximum torsion angle of 60 degrees. The average time for the Shang Ring to fall off was 23.10±6.38 days. Three cases of the Shang Ring did not naturally fall off and were manually removed 30 days post-surgery. After the Shang Ring removal, the median penile torsion angle at follow-up was 10 [0, 10] degrees, with a median correction angle of 42.5 [35, 48.75] degrees. The average follow-up time was 2.06±0.74 years. At the last follow-up, the median penile torsion angle was 10 [0, 10] degrees, with a median correction angle of 42.5 [35, 50] degrees. No significant difference was observed in the postoperative torsion angle between the mild and moderate torsion patients, both after Shang Ring removal and at the last follow-up (P>0.05). All patients had good surgical outcomes.
The modified SRC technique is feasible, safe, and effective for correcting mild to moderate penile torsion under local anesthesia, offering a new surgical option for children.
阴茎扭转是一种先天性疾病，其特征为阴茎沿其纵轴旋转。本研究旨在描述一种改良的商环包皮环切术（SRC）手术技术，作为在局部麻醉下矫正儿童阴茎扭转的一种简单有效的方法。
2018年7月至2023年8月，20例阴茎扭转男童在局部麻醉下接受了由同一位外科医生（S.Z.）实施的改良SRC技术。在我们的技术中，商环的内环置于阴茎头上方，外环置于包皮外层上方，并通过外环的第一个切口固定。包皮在内环和外环之间以半锁定状态固定。调整系带以实现轻度过度矫正，将尿道口定位在6点和7点位置之间以矫正阴茎扭转。良好的手术结果定义为术后阴茎扭转角度小于30度，而不良的手术结果是术后阴茎扭转角度大于30度。
所有病例均为逆时针阴茎扭转，手术在局部麻醉下进行，平均手术时间为8.55±1.61分钟。术前阴茎扭转的中位角度为45[45,60]度，最大扭转角度为60度。商环脱落的平均时间为23.10±6.38天。3例商环未自然脱落，在术后30天手动拆除。商环拆除后，随访时阴茎扭转的中位角度为10[0,10]度，中位矫正角度为42.5[35,48.75]度。平均随访时间为2.06±0.74年。在最后一次随访时，阴茎扭转的中位角度为10[0,10]度，中位矫正角度为42.5[35,50]度。轻度和中度扭转患者在商环拆除后和最后一次随访时的术后扭转角度均无显著差异（P>0.05）。所有患者手术结果良好。
改良的SRC技术在局部麻醉下矫正轻度至中度阴茎扭转是可行、安全且有效的，为儿童提供了一种新的手术选择。
