Occult penis is not uncommon in pediatric urology, and there are many surgical methods for its treatment, and the results are not very consistent. In the past, our department has also adopted various surgical procedures, but some of them resulted in recurrence after surgery, some were still poorly exposed, some had unsatisfactory appearance, etc. In short, the results were not very satisfactory. In the past 10 months, we have used the method of symmetrical longitudinal flap transfer from the dorsal side of the penis to the ventral side (or ventral flap transfer to the dorsal side) and have obtained satisfactory results, which are reported as follows.
Clinical data
From June 2006 to March 2007, there were 12 cases of children with occult penis admitted to our department, aged 2.5-13 years old, with an average of 5.2 years old, including one case with left spermatic varicocele and all cases with true prepuce. The examination showed that the penis was short in appearance, the external opening of the foreskin was narrow like a “crater”, the foreskin could not be turned out to reveal the glans, the foreskin was not attached to the corpus cavernosum, but the corpus cavernosum was well developed, similar to children of the same age, and the common feature was that the external plate of the foreskin was very small. This group of cases does not include small penis, obese children with occult penis and non-circumcised occult penis.
Surgical methods:
1. The length of the penile corpus cavernosum is measured outside the pubic symphysis to estimate the size of the penis and the intraoperative flap design;
2.In the incision, lift the foreskin stenosis ring in the dorsal midline or ventral midline of the penis, cut the inner and outer plates of the foreskin, the inner side is 3-5 mm from the coronal sulcus, and the outer plate until the stenosis ring is cut, so that the glans is exposed, when cutting, pay attention to the dorsal nerves and blood vessels of the penis on the dorsal side, and pay attention to the ventral side to protect the ligament at the coronal sulcus of the penis, so that the glans is exposed;
3, in the glans suture traction line, 3-5MM from the coronal sulcus circumferential incision foreskin, and free the fascia layer, so that it becomes thin and evenly distributed outside the spongy body, fully loosen the spongy body, so that the spongy body straighten, at this time the penile foreskin fade to the root of the penis;
4, penile root fixation, the root of the penis on both sides of the 10-11 points and 1-2 points between the spongy body near the pubic bone white membrane in the corresponding penile root skin dermis fixed 1 needle each, the skin and the spongy body fixed, so that the penis revealed satisfactory;
5.Lift the foreskin, which is in the shape of a narrow lower trapezoid, and cut it in the center longitudinally, with the incision long enough to make the two flaps wrap around the penis without tension;
6, the two flaps are transferred to the opposite side, wrapped around the penis, and sutured together, with the distal end of the flap sutured to the inner plate and the proximal end sutured to the outer plate of the proximal foreskin;
7.The urinary catheter was left in place for 5-7 days after the operation, and the penis was wrapped with mesh nylon gauze, and the time of removal of the gauze and discharge was decided according to the intraoperative estimation of foreskin edema.
Results
In all cases, the penis was satisfactorily revealed and there was no postoperative recurrence. However, in one child with combined left spermatic varicocele, the guardian did not agree to perform high spermatic vein ligation at the same time, and the postoperative foreskin edema lasted for 3 months, which may be related to the presence of venous reflux obstruction.
Discussion
1.Anatomical characteristics of occult penis
The occult penis is a condition of abnormal penile exposure, which is manifested by the normal development of the penile corpus cavernosum, but due to the abnormal atrophy of the penile fascial layer or the fleshy membrane layer, causing abnormal attachment, so that the penile skin is separated from the penile body, and there is a serious lack of penile skin, mainly the skin of the outer foreskin, and at the same time, the penile skin is filled with fat underneath, Poor exposure, so that the outer plate of penile skin is less and the relative inner plate is more, resulting in occult penis
2.This group of cases does not include
1.Hidden penis in obese children: this type is due to the thick subcutaneous fatty tissue in front of the pubic symphysis that affects the exposure of the penis, but the penis is satisfactorily exposed in the erect state. There are some doctors who operate on such children to remove the excessive fat in front of the pubic symphysis and fix the penile root, but due to obesity and excessive subcutaneous fat, it is very easy to recur, so we give up operating on these children.
2, webbed penis or penile scrotal fusion: the former is characterized by a thin skin in the penile suture webbed to the ventral side of the scrotum, normal penile development, good penile exposure;
3, small penis: the penis reveals normal, but the penis is stunted, short in appearance, which may be related to gonadal dysplasia, endocrine abnormalities and chromosomal abnormalities, surgery can not be resolved;
In addition, some children have been diagnosed with occult penis, but because of the absence of prepuce, the foreskin can be freely turned up to reveal the glans, the penis can be in the erect state, the foreskin and fascia layer activity is good, does not affect the development and sexual function, only the appearance is not beautiful, also did not operate.