ObjectiveTo investigate the clinical features, diagnosis, therapeutic methods of Paget's disease involving the scrotum. MethodsThe clinical data of 18 patients with Paget's disease treated in our hospital between 2008 and 2013 involving the scrotum were analyzed retrospectively. The patients' age ranged from 55 to 81 years old with an average of 69. The disease course ranged from 9 months to 18 years, averaging 6 years and 3 months. The main clinical pr was itching (94.4%), followed by exudation (66.7%), pain (11.1%), and desquamation (5.6%). All patients underwent extended resection. ResultsThe patients were followed up for 8 to 52 months averaging 34 months. Four patients' postoperative pathological report found focus on the excision margin, and one of them had local recurrence after 14 months. The remaining 14 cases had no local recurrence. One patient's pathological findings reported Paget's disease combined with invasive adenocarcinoma which invaded subcutaneous fat tissue layer, and this patient developed inguinal lymph node metastasis 20 months after operation. Another patient combined with adenocarcinoma which invaded deep dermis layer developed liver and lung metastasis 18 months after operation. ConclusionPaget's disease involving the scrotum is more commonly seen in older patients, and its main clinical presentation is itching. Paget's disease is usually misdiagnosed, so patients should undergo pathological examination early to clear diagnosis. Surgery is the main treatment. Paget's disease combined with invasive adenocarcinoma has poor prognosis.
Objective To investigate the effect of scrotal septum vascular pedicle flap with two wing-l ike spl itthickness skin graft in reconstructing urethra in patients with hypospadias and in reducing the compl ications. Methods From January 2007 to March 2008, 30 cases of hypospadias were treated, with a median age of 10 years (2-20 years). There were 13 cases of proximal shaft type, 12 cases of penoscrotal type and 5 cases of scrotal type. There were 8 cases with operation history. The flap size ranged from 4.0 cm × 0.8 cm to 9.0 cm × 1.0 cm and 5 mm with two wing-l ike spl it-thickness skin graft.When the downward curvature corrected, length of the flap could be determined by the length of the urethra that neededto be reconstructed. Results All flaps survived. The incision healed by first intention in all patients except one whose incision healed after change dressing because of frequent erection. Incision at donor site healed well. Eighteen patients were followed up for 6-12 months, including 8 with second operation history. The reconstructed urethras were unobstructed and no urethrostenosis or urinary fistula happened. Conclusion This is an improved technique of the scrotal septum flap in urethra reconstruction. It takes advantages of both flap and spl it-thickness skin graft in reconstructing urethra and avoides the disadvantages of a single tissue. It is a good choice for treating hypospadias whose urinary meatus locates neighborly to penoscrotal junctional zone.
Abstract In order to investigate the different methods of operation to treat lymphatic fistula of scrotum, subtotal scrotectomy, ligation of lymphatic vessel and anastomosis of inguinal lymph nodes with greater saphenous vein were performed. From 1980 to 1994, 15 patients were treated, among them, 2 patients had complicated with chyluria. The clinical results were satisfactory after a follow-up for six months to three years. It was considered thatthe anastomosis of inguinal lymph node with the greater saphenous vein was the most effective method, besides, the method was simple and safe, as well.
OBJECTIVE: To investigate the surgical approach to repair hypospadias. METHODS: From 1992 to 2000, 42 cases with hypospadias accepted secondary urethroplasty after primary operation, which included urethral burying in penile skin, bladder mucosa and scrotal septal vascular pedicled flap urethroplasty, trans-scrotal skin flap covering the wounds with normal meatus urinarius. RESULTS: Only one, out of 42 cases, had early complication of urinary fistula in 7 days after urethroplasty, which was cured by scrotal septal vascular pedicled flap urethroplasty 3 months later and had no further complication. The others were all succeeded once for all, the successful rate was 97.6%. CONCLUSION: The surgical method to repair hypospadias by urethral burying and transscrotal skin flap technique is safe, reliable and recommendable for clinical use.
Objective To investigate a method of repairing hypospadias by combining buccal mucosal graft with scrotal flap and its therapeutic effect. Methods From March 2002 to December 2007, 42 patients with hypospadias underwent primary urethral reconstruction using buccal mucosal graft and scrotal flap. The patients ranged in age from 18 months to 18 years. There were 21 cases of penoscrotal type, 12 cases of scrotal type and 9 cases of perineal type. Among them,8 cases were at initial operation, and 34 cases suffered from the failure of hypospadias repair 6-19 months (average 10 months) after initial operation. During operation, the defect of urethra was 3-7 cm (average 4.2 cm) when the penis was straightened; the buccal mucosa (3.0 cm × 1.2 cm-7.0 cm × 1.5 cm) was transplanted to the tunica albuginea in the ventral aspect of the penis, and was paired with the scrotal flap (3.0 cm × 1.5 cm-7.0 cm × 1.5 cm) to repair urethra. Results The incision of 38 cases healed by first intention, and no compl ication occurred. At 7 days after operation, 4 cases had urinary fistula at either coronary sulcus or anastomotic stoma, one of which spontaneously closed 2 months after operation and the rest 3 recovered by repairing urinary fistula 6 months after operation. All patients were followed for 3-48 months (average 18 months). Urination was smooth, the reconstructed urethral opening was at the tip of glans peins without retraction and with apperance similar to the normal urethral opening. The appearance of penis and scrotum was satisfying, and the penis was straightened completely. Conclusion Combined buccal mucosal graft and scrotal flap, with considerable tissue for uretha tract reconstruction and low incidence rate of urethral stricture, is one of the effective methods to repair hypospadias.
Objective To study diagnosis, treatment and rebuilding of scrotum gangrene. Methods From January 1992 to September 2004, 15 patients with scrotum gangrene were treated and their clinical data were analysed.Their ages ranged from 23 to80 years. The results of bacterial culture were positive for wound sample in 14 cases and for blood in 1 case. All the patients underwent surgical treatment including incision,aggressive debridement,drainage,irrigation and antibiotic therapy. Two patients accepted hyperbaric oxygen therapy. All the patients received scrotum rebuilding by transfer of skin flap, skin grafting and suturation and orchectomy was given in 2 elder patients. Results All the patients received healing by first intention after 21 to 34 days.There was no death. Aftera follow-up of 1 to 3 years, the appearance of scotum was satisfactory and no orchiatrophy occurred. Thirteen patients with testicles had normal sexual function. Conclusion After a definite diagnosis,early aggressive debridement,broad-spectrum antibiotics and sufficient local drainage should be used. If available,hyperbaric oxygen therapy may be used to promote healing of tissue wound. Scrotum should be rebuilt based on different conditions.
ObjectiveTo investigate the effectiveness of penile up transfer method in the treatment of penoscrotal transposition (PST) in children. Methods A clinical data of 46 children with PST admitted between January 2015 and March 2021 and met selective criteria was retrospectively analyzed. The M-shaped scrotal flap method was adopted in 21 cases (group A), and the penile up transfer method was adopted in 25 cases (group B). There was no significant difference in age and PST typing between the two groups (t=0.491, P=0.626; χ2=0.710, P=0.790). The operation time and postoperative complications of the two groups were recorded and compared, and the correction effect of PST was evaluated. Results All operations were successfully completed, and no urethral injury occurred during operation. The operation time was significantly less in group B than in group A [(70.36±9.76) minutes vs. (96.62±13.18) minutes; t=7.553, P=0.000]. All children were followed up 6-33 months (mean, 13.2 months). There were 5 cases (23.8%) of skin necrosis and 6 cases (28.6%) of scar hyperplasia in group A, and 1 case (4.0%) of skin necrosis and 1 case (4.0%) of scar hyperplasia in group B. The incidence of complication was significantly lower in group B than in group A (χ2=3.949, P=0.047; χ2=5.341, P=0.021). In the evaluation of PST correction at 6 months after operation, there were 15 cases of complete correction and 6 cases of incomplete correction in group A, 24 cases of complete correction and 1 case of incomplete correction in group B, and the difference was significant (χ2=5.341, P=0.021). Conclusion The penis up transfer method is not only easy to correct PST, but also can correct scrotal separation at the same time, with fewer postoperative complications and satisfactory correction effect of penile scrotal appearance.
Objective To summarize the methods of repairingthe urethral defect in the penis of an adult and the clinical application of the island skin flaps of the scrotum septum to the reparative treatment. Methods From January 2000 to November 2005, twenty-six cases of urethral defect in penis, including 16 cases of congenital urethral defect, 6 cases of traumatic urethral defect in middle penis, and 4 cases of distal urethral defect, were repairedby the local penis fascia flaps.The island skin flaps of the scrotum septum were transferred to cover the penis wound. The pedicle contained the artery of the posterior scrotum and the artery of the anterior scrotum. The flap taken from the scrotum septum was 2.5 cm×5.5 cm in area. Results After a follow-up of 7months to 4 years, all the 26 patients had the healing of the first intention without urethral fistula, urethral narrowness or penis curvature, except 4 patients who developedinfection and leakage of urine, but the wounds healed spontaneously 2-4 weeks after operation. Conclusion The penis fascia flaps and the island skin flaps of the scrotum septum can be used to repair the urethral defect in the penis of an adult. The blood supply to the flaps is sufficient and all theflaps can survive well. A good shape and function of the penis can be obtained.
Objective To introduce a modified penile elongation method and observe its postoperative compl ications. Methods From January 1993 to December 2007, 130 patients with congenital short and small penis were divided into 2 groups: the routine group and the modified group, with 65 patients in each group. In the routine group, the patients were 18-55 years old (39.6 on average), and the penile length during erection was (4.9 ± 1.4) cm. In the modified group, the patients were 20-56 years old (35.4 on average), and the penile length during erection was (5.0 ± 1.5) cm. There was no significant difference between the two groups (P gt; 0.05). On the basis of scrotal flap which was transferred to cover the prolonged cavernous body of penis, the “+” shaped incision at the root of the penis was made in the routine group, and theincision was shifted upward by 1.5 cm in the modified group. And V-Y incision was made for the penises with more than 4 cm prolonged length. In order to compare the conditions in the two groups, no physical therapy was appl ied in 30 days after the operation. Results All the 130 patients’ incisions obtainedt heal ing by the firs intention, and all flaps survived successfully. Postoperative hydrophallus appeared differently between both groups. In the routine group, obvious hydrophallus appeared on the 3rd day after the operation and lasted for (15.11 ± 2.71) days, with 3 cases (4.62%) suffering from refractory hydrophallus. In the modified group, hydrophallus appeared on the 3rd day after the operation and lasted for (6.65 ± 0.29) days without any refractory hydrophallus. There was significant difference between the two groups in the duration of hydrophallus (P lt; 0.05). All patients were followed up for 6-8 months. After the operation, the shape and function of the penis were found good. The prolonged length was (4.9 ± 1.4) cm in the routine group and (5.0 ± 1.5) cm in the modified group. There was no significant difference between the two groups (P gt; 0.05). The satisfaction rate (according to the patients’ self-rating) was 95% and 98% in the routine group and the modified group, respectively. Conclusion The method using the scrotal flap transferred to cover the prolonged cavernous body of the penis is safe and of low compl ication rate. The modified method is more effective to abate postoperative hydrophallus.