Bladder mucosal urethroplasty for hypospadias

Bladder mucosa urethroplasty for hypospadias 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 in children Indication Bladder mucosa urethroplasty for hypospadias is suitable for scrotal hypospadias and perineal hypospadias. This procedure is also one of the first methods to complete penile orthopedics and urethroplasty. The bladder mucosa is easy to take and is not affected by the size of the lesion. However, the bladder mucosa that constitutes the urethra is thinner than the skin. Some scholars have reported the possibility of urethral stricture and urethral diverticulum complications. 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. Make a circular incision along the coronary sulcus and make a "U" shaped incision in the ventral side of the penis. The lower end of the incision bypasses the outer urethra. Correction of the fiber band with the lower penis. In order to prevent the anastomosis of the external urethra and the bladder mucosa tube from narrowing, when the lower end of the U-shaped incision is free, the skin at the outer edge of the original urethra can be cut off, and the anterior wall of the urethra can be cut slightly to make the anastomosis. Become a bevel. 2. The median incision in the lower abdomen is about 6 cm long from the pubic symphysis. Cut to the bladder by layer to reveal the anterior wall. The bladder is filled with water about 150ml to fill the bladder. Cut the bladder muscle layer longitudinally at the top of the anterior bladder, not too long. Separate the muscle layer and see the bladder mucosa. Open the bladder muscle layer and cut a piece of mucosa. The mucosa should be slightly longer than the urethral defect and the width is 1.5 times the transverse diameter of the urethra. The bladder muscle layer and the margin of the mucosal incision were sutured with a 5-0 gut with 3 to 4 needles to eliminate the wound formed by the mucosa. The bladder wall was sutured in two layers with a 2-0 gut and a 1-0 silk thread. A bladder stoma was made, and a rubber drainage piece was placed in the posterior pubic space, and the abdominal wall was sutured in layers. 3. The free bladder mucosa was placed on the ventral side of the penis, and the side of the mucosa was intermittently sutured with a 5-0 intestinal line to fix the corpus cavernosum between the coronal sulcus and the external urethra. On the white film. The lower end of the bladder mucosa and the posterior wall of the external urethra were sutured 3 to 4 needles with a 5-0 gut. Flip the other side to fold the bladder mucosa in half, and suture the bilateral edges with a 5-0 gut to make the transplanted mucosa line-shaped. The lower end of the mucosa was sutured 4 to 5 times with the anterior wall of the external urethra to complete the anastomosis. The mucosal reflexed portion is also sutured to fix the corpus cavernosum on the other side. When suturing, a catheter can be temporarily placed as a stent, and the catheter is removed after suturing. 4. According to the correction of the penis, the pterygoid flaps on both sides were moved to the ventral side, and the penile fascia and subcutaneous tissue were sutured in two layers on the ventral side of the newly created urethra with 5-0 gut and 3-0 silk. Finally, the coronal sulcus and the ventral skin of the penis were sutured intermittently with a 1-0 silk thread. complication Bleeding After the urethral sponge or the penis leucorrhea is cut, if the suture is not sutured, hemorrhage may occur when the penis is erected. When the compression is used, the wound must be opened to remove the hematoma and suture to stop bleeding. 2. Infection Especially on the basis of bleeding and hematoma, infection is more likely to occur. 3. Necrosis When the tension of the suture is too large, it may cause cracking and partial necrosis. Therefore, if the tension is too large after suturing, the dorsal incision should be made.