Buried leather strip urethroplasty

Buried cortex urethroplasty for the treatment of hypospadias. Hypospadias is a congenital malformation more common in pediatric genitourinary system. At the 5th week of the embryo, the tissues on both sides of the front of the cloaca are forwarded, producing two reproductive nodules. The reproductive nodules grow rapidly, and the urogenital sinus elongates, forming a longitudinal line on the ventral side of the reproductive nodules. The long groove, the urethral groove, closes from the posterior to the uterus as the fetus develops. In the development process, there are obstacles, and the urethral groove can not be completely closed to the tip of the penis head, which causes partial cracking and formation of hypospadias. The head of the penis is often flat or crescent, and the foreskin of the penis is often defective, or the foreskin is like a turban fold on the dorsal side of the penis. According to the severity of deformity, it can be divided into: penis head type, penis type, penis scrotum type, scrotum type, perineal type, penis head type and penis type urethral opening rely on the former, generally does not hinder urination and reproductive function. The urethra is open at the back of the penis, or in the scrotum or perineum. Due to the fibrotic changes of the corpus cavernosum, a band of fibers is formed, causing the penis to bend to the ventral side. The sick child must be seated or squatted. Fiber ropes affect the normal development of the penis. The scrotal and perineal types are often due to hypoplasia of the corpus cavernosum, which makes the penis abnormally short and resembles a clitoris. The outer urethra is shaped like a funnel in front of the anus and opens like a vaginal opening. The scrotum splits into two lobes. This type often has no testicular drop or hypoplasia. The scrotum is as small as the labia and is often mistaken for women. This condition is a pseudohermaphroditism. Treatment of diseases: hypospadias of children with hypospadias Indication 1. The penile head urethral opening is located a few millimeters below the normal site. Because there is no effect on urination and reproductive function, there is usually no need for surgery or simple urethral advancement. 2. All other types of congenital hypospadias should be treated with hypospadias. Preoperative preparation 1. Patients with perineal hypospadias should be enema before surgery. 2. On the 1st day before surgery, the skin of the field was disinfected with 1:500 benzalkonium solution or 75% ethanol. The urethra was infused with 1:2000 benzalkonium solution 2 to 3 ml to disinfect the urethra. 3. Prepare blood 200 ~ 400ml. 4. Apply antibiotics. 5. Clean the enema. Surgical procedure 1. Incision: A U-shaped incision is made from the coronary sulcus down the urethral opening, and the incision arc is about 0.3 cm away from the urethral opening. The incisions on both sides are extended upward until the head of the penis is equivalent to the normal urethral opening, and then a oblique incision is made to the lateral to the coronary sulcus. The incision then intersects the "U" shaped incision inward along the coronal sulcus to make the ventral side of the penis head. Two triangular incisions cut the skin inside the triangle. An elongated strip is formed in the middle of the "U" shaped incision, and the width of the strip is related to the diameter of the urethral tube that grows later. The average child is 0.6 to 1.0 cm. 2. Separation: The flaps on both sides of the wide incision are separated between the penis fascia and the white membrane. Generally, they must be separated to the penis side back, so that there is no tension when pulling inward. The strips between the ventral "U"-shaped incisions are left in place and are not free. On both sides, the scrotum is made into a small mouth, and each of the rubber drainage sheets is placed. The upper end of the drainage material is placed in the separated wound. 3. Stitching: The urethral strips were fixed to the white membrane with a 4-0 gut to prevent them from shrinking. Insert a 8 to 12 catheter from the urethral opening for use as a stent. The proximal end of the urethral strip was sutured with a 4-0 intestine at the urethral opening, and then sutured 2 to 3 needles to flatten the urethral junction. The stent catheter was removed after surgery. 4. Pull the free flaps on both sides and suture the penis fascia of the flap with a 2-0 filament thread. The needle spacing is about 2 mm. The outer skin is sutured with 2-0 filaments or sutured vertically. 5. The skin incision on the dorsal side of the penis is reduced from the crown groove until it exceeds the root of the penis. The skin and penis fascia are cut to avoid damage to the dorsal vessels and nerves of the penis. The head of the penis was sutured with a thick thread and pulled to the abdominal wall. 6. The suprapubic bladder stoma does not leave a stent catheter in the urethra. Can also do the perineal stoma. complication Because the flap is too thin, the blood supply is insufficient or the penis is small, and the foreskin is not enough, the tension after suturing the flap is too large or the pus in the urethral cavity is not cleared in time, and the wound infection can cause urethral fistula or wound collapse. If the wound infection is not well healed, the vaginal bladder mouth tube is delayed, the urine is not urinated, the secretion of the urethra is often removed, and physical therapy is performed. The small person has the possibility of self-healing. If after 3 to 4 weeks of treatment, the fistula still does not heal, the catheter can be removed, and after 3 to 6 months, the local scar tissue softens and repairs the fistula again. After the operation, the urethral opening is kept open, and the scarring is removed in time to ensure that the formed urethra can be circulated smoothly, which is essential for preventing infection and urinary fistula formation.