RESUMO
【Objective】 To investigate the effects of lamellar surgical techniques with urethral plate to strengthen the tissue of glans penis to widen the two flanks of glans penis on the basis of Duckett method in the treatment of congenital hypospadias with small glans penis deformity. 【Methods】 A total of 22 patients admitted to our hospital during Jun.2017 and Oct.2020 were involved. Urethral plate was used to replace the glans penis tissue to widen the two flanks of glans penis based on Duckett method. Lamellar surgical techniques were adopted to fully dissociate the two flanks of glans penis and urethral plate for urethroplasty. 【Results】 Of the 22 operations, 19 were successful,with a success rate of 86.3%. The success rate of penile head urethroplasty reached 96.1%. 【Conclusion】 Widening the glans penis by using the urethral plate based on Duckett method combined with lamellar surgical techniques can improve the success rate of glans penis urethroplasty.
RESUMO
Objective To explore treatment scheme and surgery for hypospadias with small glans.Methods Between January 2014 and January 2017,40 cases of hypospadias with small glans were enrolled in the study including 13 cases with penile hypospadias and 27 cases with penoscrotal hypospadias.The boys's average age was 1.5 years,aged from 1 to 5 years old.The boys whoes glans width less than 10 mm received the treatment of topical testosterone propionate smeared on penis once a day for 1 or 2 months.The patients received operation when their glans width reached 10 mm to 14 mm.Among of 27 cases of severe penile recurvation patients,17 cases received staging operation,one-stage was correction of penile recurvation and two-stage was Tubularized incised plate with pull-through procedure,10 cases received adopted modified Duplay combined with Duckett operation,then overturn split-skin graft for incision in the urethra located in glans penis.Among of 13 cases with mild and moderate recurvation,after penile correction,3 cases received Tubularized incised plate urethroplasty and 10 cases received Onlay island flap urethroplasty.All of the patients received modified plastic surgery for glans.Results All of patients were followed-up,from 3 months to 3 years.The surgical success rate was 70％ (28/40).12 cases got operative complications,including urinary fistula 6 cases and glans dehiscence 1 case,who were cured by reoperation,external orifice stricture 1 case and urethral stricture 4 cases who were healed by Urethra dilatation.All patients acquired good appearance glans and satisfied void stream.Conclusions Topical use testosterone propionate for hypospadias with small glans helps the growth of penis.Individualized diagnosis and treatment plan should be made for the particular case of hypospadias with small glans.The modified plastic surgery of glans is suitable for hypospadias with small glans,which could improve surgery success rate and reduce the postoperative complication.