Epispadias Correction

Upper urethroplasty is used for the treatment of upper urethra. Upper urethral fissure is a rare congenital malformation, often associated with bladder eversion. Upper urethral fissure repair is usually performed after 1 to 1.5 years of short-term testosterone therapy to increase penis development. In children with bladder valgus, repair can be performed at the same time as suturing the bladder or osteotomy. According to the degree of rupture, male urethral fissures are divided into three types: 1 penis head type: urethral opening in the penis head or coronary sulcus, a crack from the urethral opening to the tip of the penis, the penis head is flat, the penis body Shorter, the foreskin splits on the dorsal side. There is no clinical urinary incontinence. 2 Penis type: the urethral opening is located on the dorsal side of the penis body, and the groove is formed between the tip of the penis and the urethral opening, which is covered by the mucous membrane. The penis is small and the foreskin hangs over the ventral side of the penis. Urinary incontinence can be combined depending on the developmental procedure of the bladder sphincter. 3 penile pubic type: the full length of the urethra is open to the dorsal side, and some of the defect range is extended upwards, involving part of the lower abdomen wall, the pubis are separated, only the fiber bundles are connected to each other, and urinary incontinence can be caused by the urethral sphincter defect. Female urethral fissure can also be divided into 3 types: 1 rupture of the clitoris, the upper side of the urethral opening is slightly enlarged; 2 full rupture of the urethra, but the bladder sphincter is intact, there may be a flat sputum, separation of the labia; 3 the entire urethra, The bladder sphincter is split apart with pubic symphysis. Treatment of diseases: upper urethra Indication Both the penile head type and the penis type can perform urethroplasty to correct urethral malformations. Although the penis pubis is more difficult to form sphincter, it should be used as much as possible to restore control of urination; if sphincter angioplasty fails, consider ureteral sigmoid anastomosis. Contraindications Age is too small to be operated. Surgery should be carried out between the ages of 3 and 6 years. Because the sick children are too young to cooperate, it is not conducive to practice control of urination. Preoperative preparation 1. 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. 2. Prepare blood 200 ~ 400ml. 3. Apply antibiotics. 4. Clean the enema. Surgical procedure 1. First make the penis head forming A longitudinal incision is made from the base of the penis and the pubic region down the sides of the penis to the distal side. 2. Isolation of the foreskin and cavernous ventral skin The incision of the skin is extended from the middle of the urethra above the center of the urethra until the sponge is fully released. The incision and the ventral skin of the corpus cavernosum were separated by incision along both sides and around the coronal groove. 3. The release of the urethral groove It is easier to dissect from the ventral side and retain the vascular pedicle of the meat membrane. Continue to alternate the anatomy of the back and ventral side until the central urethral groove is completely separated from the corpus cavernosum. The adhesion of the dorsal prostate and the sacral sacral sulcus are then separated, completely freeing the urethral groove to the penis head. 4. Anatomy of the vascular bundle and the corpus cavernosum The neurovascular bundle is completely freed from the lateral and ventral surfaces of the midsole of the corpus cavernosum. Dissect the free corpus cavernosum to 1 to 2 cm of the pubic symphysis, but not too much. The neurovascular bundle is retracted from the sponge and properly protected against damage. 5. The urethral disk is sewn into a tube The urethral disc was sutured into a tubular shape with a 10th silicone rubber urethral stent or catheter with a 5-0 absorbable suture interrupted or continuous suture, and the urethra was sutured close to the penis head. Place the urethra on the ventral surface of the penis. 6. Spongiform stoma and rotator The cavernous stoma and rotation are important steps in correcting the painful penile erection and bringing the back of the urethra close to the corpus cavernosum. A transverse incision is made on both sides of the back of the sponge to form a maximum angle. The incision is prismatic, with each prism face abutted together with a 5-0 synthetic suture (with the knot) and the sponge is rotated 90°. 7. Stitching the penis head Part of the penile head tissue was cut off on both sides, the urethral surface was completely sutured, and the dorsal side of the penis head was sutured vertically with a 4-0 synthetic absorbable suture. The suture between the cavernous stoma and the penis head was further sutured to further the sponge. Rotate and approach. 8. The release of the penile skin The inner plate of the penis with a vascular pedicle is transferred to the back of the penis to cover the skin; the ventral surface is covered with an outer plate. 9. suture the skin The penile skin incision was sutured intermittently. complication Wound infection Due to the large wound surface and incomplete hemostasis, localized blood can be formed, which is easy to be infected. In severe cases, the wound can be completely ruptured. Therefore, hemostasis should be completely stopped during operation. 2. Urethral necrosis After the urethral mucosa is sutured into a tubular shape, the indwelling catheter in the urethra can compress the urethra, causing compression necrosis, and generally does not retain the catheter. 3. Urethral stricture Postoperative urinary tract infection and necrosis can be complicated by urethral stricture. Local stenosis can be treated with urethral incision, and long urethral stricture is treated with urethral stricture.