Оптимізація методики хірургічної корекції прихованого статевого члена в дітей

Abstract

The purpose - to optimize the buried penis surgical treatment method in children for the most adequate functional and cosmetic results. Materials and methods. The clinical material includes 28 boys with a buried penis between the ages of 11 months to 7 years. Among them 9 (32.14%) children were admitted for repeated surgical interventions with unsatisfactory cosmetic results after previous surgical interventions in other medical institutions. Results. The method of surgical correction of the buried penis in children was offered. In patients whose penis glans could not be exposed, the foreskin stenotic ring was dissected on both sides on the lateral surfaces, or scar-altered tissues were partially excised circularly. During the maximum vertical traction per the ligature on the penis head, the skin at the base of the penis was circularly dissected. The dissection of the skin was extended to the inguinal folds on both sides. The penis spongy and cavernous bodies were skeletonized from the coronal sulcus to the pubic joint with careful excision of inelastic embryonic cords and scars. The skin of the anterior abdominal wall was lifted up with the help of traction ligatures or hooks and mobilized in an acute way. Maximum excision of subcutaneous fat in the suprapubic and inguinal areas was performed. The penis was moved into the hole formed in the lower part of the demobilized skin flap in the suprapubic area. For stable fixation of the penis, the deep fascia at the base of the corpora cavernosa was sutured to the pubic tubercle at maximum traction per the head, and the skin flap of the anterior abdominal wall was sutured with internal sutures to the crest of the upper pubic bone. The penis trunk was closed due to a sufficiently mobile foreskin, shifting the skin to the penoscrotal angle in the area of the formed hole in the abdomen skin flap. The postoperative wound was sutured in layers. Conclusions. Clinical differentiation of different types for penis size «visual» reduction in boys will allow a balanced approach to adequate correction of the defect. The proposed method of buried penis surgical correction in boys eliminates all the preconditions of the defect and demonstrates good anatomical, functional and cosmetic results. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the listed institution. Informed consent of children and their parents was obtained for the research. No conflict of interests was declared by the authors.