Ochoa B
Department of Pediatric Surgery, Hospital Universitario San Vincente de Paul, Medellin, Colombia.
J Urol. 1998 Sep;160(3 Pt 2):1116-9; discussion 1137. doi: 10.1097/00005392-199809020-00040.
Amputation of the penis or emasculation in children is rarely reported in the medical literature. This study involves 7 children with these injuries admitted to the University Hospital San Vicente de Paul, Medellin, Colombia, from 1960 to 1995. A new surgical technique is described for penile reconstruction that makes sex reassignment to the female gender unnecessary in most if not all cases.
Clinical histories and photographs of 7 boys 4 months to 8 years old with penile amputation or emasculation were reviewed. Five patients were younger than 1 year. Sex reassignment to the female gender was accepted by 1 family and refused by 4. Three boys were hospitalized at ages 3.5, 4 and 4.5 years, respectively, and underwent phalloplasty using the stumps of the remaining corpora cavernosa. The 2 older patients had been emasculated in accidents. In the 8-year-old patient the penis was reattached and the 7-year-old boy awaits myodermal flap phalloplasty.
The boy raised in the female gender requested reassignment as a boy 14 years later. The 3 patients who underwent penile reconstruction were followed for 17, 12 and 8 years, respectively. At the last followup they emptied the bladder, and had normal skin sensitivity and erections. After 3 years the boy with a reattached penis has no problem emptying the bladder but he has lymphedema and decreased skin sensitivity.
Phalloplasty using the remaining stumps of the corpora cavernosa should be first line therapy in children with traumatic loss of the penis. It restore the functional and cosmetic aspects of the organ, and makes sex reassignment to the female gender unnecessary. Replantation of the penis must be attempted when the amputated organ is recovered. A microvascular technique is recommended.
阴茎截肢或去势在儿童中鲜有医学文献报道。本研究纳入了1960年至1995年间在哥伦比亚麦德林圣维森特·德·保罗大学医院收治的7例患有此类损伤的儿童。描述了一种新的阴茎重建手术技术，该技术在大多数（如果不是所有）情况下无需进行性别重新分配为女性。
回顾了7例年龄在4个月至8岁之间阴茎截肢或去势男孩的临床病史和照片。5例患者年龄小于1岁。1个家庭接受了性别重新分配为女性，4个家庭拒绝。3名男孩分别在3.5岁、4岁和4.5岁时住院，并使用剩余海绵体残端进行了阴茎成形术。2名年龄较大的患者在事故中被去势。8岁患者的阴茎已重新接上，7岁男孩等待肌皮瓣阴茎成形术。
以女性身份抚养的男孩在14年后要求重新分配为男孩。接受阴茎重建的3例患者分别随访了17年、12年和8年。在最后一次随访时，他们能够排空膀胱，皮肤感觉和勃起功能正常。阴茎重新接上的男孩3年后排空膀胱没有问题，但有淋巴水肿和皮肤感觉减退。
对于阴茎外伤性缺失的儿童，使用剩余海绵体残端进行阴茎成形术应作为一线治疗方法。它恢复了器官的功能和外观，无需进行性别重新分配为女性。当断离的器官找到时，必须尝试进行阴茎再植。推荐采用微血管技术。
