The operation is divided into two stages.In the first stage, the penile bending deformity was corrected. In the second stage, the urethra (urethral forming) was extended. The surgical interval must be more than half a year.The age of surgery, the first stage is advisable to be before school age, and the second stage can be implemented after school age.If the penis is dysplasia, it can also be postponed to adulthood.
anaesthetization
Lumbar anesthesia, extraordinarily anesthesia, or general anesthesia, large children can also be carried out under the bureau.
(1) Penis curvature correction surgery
Surgical steps
1. Flat up.Wear fine stainless steel wires on the top of the glans. After using hematopoietic pliers, pull it in the direction of the abdominal wall, make the penis straighten, and reveal the abdomen of the penis.Between the glans and the urethral cracking openings, make one or more "defensive" cutting incisions.
2. After the skin is separated, fibrosis can be seen in a very urethral sponge body.The fiber zone is carefully separated by the surgical knife to separate it from the penis sponge body. The upper end of the fiber belt must be separated to the coronary groove, and the lower end must be separated to the piercing opening of the urethra.This fiber is completely removed, but it is necessary to pay attention not to hurt the envelope of the penis sponge body.After the fiber belt is removed, the penis is bending deformity, but the opening of the urethral cracks moves backwards, and the distance from the glans is farther.
3. After the hemostasis is completely stopped, after changing the triangular leather petal of the "Z" incision, the filament wire is interrupted with a filament wire.
4. After the surgery is completed, put the hypocritical catheter at the opening of the urethral cracking opening.Fix the tag on the glans on the abdominal wall.The penis wound is covered with gauze.
(2) Urethral forming surgery
Surgical steps
1. Urethral forming before the bladder oral or perineal urethra surgery.Wear fine steel wires on the top of the glans. After holding hematopoietic pliers, pull it in the direction of the abdomen wall, straighten the penis, and reveal the abdomen of the penis.Two parallel incisions with appropriate width on the abdomen of the penis (about 1/6 of the piaing diameter of the penis).The incision starts from the crown groove, bypasses the urethral opening and is connected to the opposite incision.The skin behind the urethral mouth should not be retained too much, so as not to hinder the discharge of urine in the future.
2. Extension of the skin of the penis on both sides of the incision to reach the back side of the penis, so that the separated penile skin can cover it on top of the leather bar without sutured.Separation.On the abdomen of the penis glans, on both sides of the mid -line leather strips, a triangular skin is removed with each surgery knife, so that two triangular small wound surfaces are formed on the sides of the scrotum skin as a small incision, which is connected with the wounds of the penis and retained as drainage.
3. After careful hemostasis, two rows are divided into two rows.In the first row, the edges of the skin are sutured intermittently with a filament line.The second row is used with a fine stainless steel wire, put a ballpoint (glass or plastic) at one end, and then put a lead pill. After flattening the lead pill with a needle, the ballpoint cannot slip off and get rid of it.EssencePut the skin of the steel wire about 3 or 4 mm from the outside of the first row of stitching, then wear it out of the other side, and then put a ballpoint and a lead ball on the other end of the steel wire.Push forward, put the flap on both sides, and keep it in an appropriate pressure. Finally, the lead pills are flattened. Such two balls of balls can fix the skin petals to produce the effect of closer flap and tension.Healing, generally suture 4-6 stitches.At this time, it must be noted that the two balls of balls must not be squeezed too tightly to avoid compressing the skin by necrosis; not to be overly loose, too loose will make the midline incision not close and affect healing.
4. The remote end of the leather petal is aligned with the edge of the triangular surface on both sides of the distal end of the leather strip, sutured with fine wire wires to cover the triangle area, so that the new urethral opening moves forward.A rubber led strip is placed in the scrotum skin incision to the height in the middle of the penis.
5. The back side of the penis is made of a full -length longitudinal tension incision. The incision is raised from the root of the penis. The remote end can reach the coronary groove to reduce the tension of the stitching of the abdomen.The penis is trapped towards the belly wall, and the fixed method is the same as before.
Postoperative treatment
First, the drainage is removed 2-3 days after surgery.The incision was removed 7 days after surgery; the wire was removed 10 days after surgery, and the penis traction steel wire was removed two weeks after surgery.
Second, the new urethra is formed after two weeks, so the dyspstrais on the bladder category on the pubic bone can generally be removed three weeks after surgery, and the patient can urinate by themselves.
Third, the incision suture treatment can occur in improper urinary fistula, and reinforcement surgery needs to be performed again.
Fourth, postoperative antibacterial drugs to prevent infection.
Fifth, in order to prevent penile erections, bromide can be used, and Blipphenol can be used if necessary.
(Editor in charge: Internship Liu Suling)
