Pan Rifang, Li Junzhong, Zhou Zhaowei, Liang Kunlan, Li Zhaopan, Xiao Zhihua
Department of Pediatric Surgery, The Yulin First People's Hospital, Guangxi, China.
Sci Rep. 2025 Apr 25;15(1):14428. doi: 10.1038/s41598-025-99589-2.
To evaluate the clinical efficacy, advantages, and disadvantages of the modified Shiraki procedure and the transverse pedicled island flap phalloplasty in treating severe concealed penis in children. This study included seventy children with severe concealed penis treated at Yulin First People's Hospital from June 2021 to January 2024. They were randomly assigned to either the observation group (n = 35), undergoing the modified Shiraki procedure, or the control group (n = 35), receiving the transverse pedicled island flap phalloplasty. We assessed average operation time, intraoperative blood loss, penile elongation, time until resolution of penile prepuce edema, flap infection or necrosis, penile erectile pain, prepuce skin redundancy, penile retraction, and overall penile appearance score six months postoperatively. The observation group showed significantly better average operative time and intraoperative blood loss compared to the control group (p < 0.05). The time for foreskin edema to regress was longer in the observation group (p < 0.05). No significant differences were noted in penile lengthening between groups (p > 0.05). The observation group had seven cases of refractory inner prepuce plate swelling and skin redundancy post-operation; two of these cases required secondary surgery, and without skin flap infection or necrosis. The control group reported one case of postoperative hemorrhage and four cases of infection and necrosis of the transferred flap, all resolved after prolonged dressing changes, with one case requiring surgical correction for scar contracture on the side of the penis. Neither group experienced penile erectile pain or retraction. Total complications and reoperations were similar between the groups. No significant difference in the overall penile appearance score was observed between the two groups six months post-surgery (p > 0.05). Both the modified Shiraki procedure and the transverse pedicled island flap phalloplasty are effective for treating severe concealed penis in children. The former is characterized by shorter, simpler operations, while the latter offers better cosmetic outcomes despite its complexity.
评估改良白木手术和横蒂岛状皮瓣阴茎成形术治疗小儿重度隐匿阴茎的临床疗效、优缺点。本研究纳入了2021年6月至2024年1月在玉林市第一人民医院接受治疗的70例重度隐匿阴茎患儿。他们被随机分为观察组（n = 35），接受改良白木手术，或对照组（n = 35），接受横蒂岛状皮瓣阴茎成形术。我们评估了平均手术时间、术中出血量、阴茎延长情况、阴茎包皮水肿消退时间、皮瓣感染或坏死情况、阴茎勃起疼痛、包皮皮肤冗余度、阴茎回缩情况以及术后6个月的总体阴茎外观评分。观察组的平均手术时间和术中出血量明显优于对照组（p < 0.05）。观察组包皮水肿消退时间较长（p < 0.05）。两组间阴茎延长情况无显著差异（p > 0.05）。观察组术后有7例顽固性包皮内板肿胀和皮肤冗余；其中2例需要二次手术，且无皮瓣感染或坏死。对照组报告术后出血1例，转移皮瓣感染坏死4例，经长时间换药后均痊愈，其中1例因阴茎侧瘢痕挛缩需手术矫正。两组均未出现阴茎勃起疼痛或回缩。两组的总并发症和再次手术情况相似。术后6个月两组的总体阴茎外观评分无显著差异（p > 0.05）。改良白木手术和横蒂岛状皮瓣阴茎成形术治疗小儿重度隐匿阴茎均有效。前者手术时间短、操作简单，而后者虽操作复杂，但美容效果更好。
