Comparison of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in treatment of complete concealed penis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Ao , LI Xue , ZHANG Zhibo , ZENG Li , HUANG Yidong , MA Xue ,  HUANG Lugang

Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

HUANG Lugang, Email: lugang992001@aliyun.com

Keywords：

Complete concealed penis; pedicled skin flap of foreskin for phalloplasty; Sugita surgical method

DOI：

10.7507/1002-1892.202004165

Video：

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Objective To evaluate the effectiveness of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in the treatment of complete concealed penis.Methods The clinical data of 46 children with complete concealed penis between January 2016 and January 2018 were analyzed retrospectively. Among which, 25 cases were treated with pedicled skin flap of foreskin for phalloplasty (group A) and 21 cases were treated with Sugita surgical method (group B) with an average age of 4.7 years (range, 2 years and 8 months to 11 years). At 3 months after operation, the concealed penis recovery was scored from three aspects of postoperative penis length (the difference of the penis length between at 3 months after operation and before operation), penis appearance, and skin appearance (the total score was 10). And the parents evaluation of satisfaction degree of penis exposure, penis appearance, and foreskin appearance after surgical correction was collected.Results Eighteen cases (72.0%) in group A and 15 cases (71.4%) in group B were followed up with an average of 13 months (range, 3-36 months). The incisions healed well in both groups, and there was no flap dehiscence, infection, necrosis, and penile erectile dysfunction. The penile length of the two groups increased significantly at 3 months after operation (P<0.05); there was no significant difference between the two groups in terms of penis length and increased length at 3 months after operation and score of increase penis length after operation (P>0.05). No penile retraction occurred in the two groups. And there was no significant difference between the two groups in penis appearance score, but the penis appearance score, skin appearance score, and total score of group A were significantly better than those of group B (P<0.05). At 3 months after operation, the satisfaction rate of penis exposure in group A and group B was 88.9% and 80.0%, respectively, with no significant difference (χ²=0.50, P=0.48); the satisfaction rate of penis appearance was 72.2% and 53.3%, and the satisfaction rate of foreskin appearance was 94.4% and 53.3%, respectively, and the differences were significant (χ²=5.13, P=0.03; χ²=7.53, P=0.01).Conclusion Both surgical methods are suitable for correction of complete concealed penis, and the penile length gets a satisfactory recovery. However, the lymphedema of the prepuce after Sugita surgical method is serious, which can easily lead to poor appearance of the penis after operation. In general, the effectiveness of pedicled skin flap of foreskin for phalloplasty is better than that of the Sugita surgical method.

Citation： XU Ao, LI Xue, ZHANG Zhibo, ZENG Li, HUANG Yidong, MA Xue, HUANG Lugang. Comparison of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in treatment of complete concealed penis. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(11): 1423-1428. doi: 10.7507/1002-1892.202004165 Copy

1.	樊勝海. 隱匿陰莖研究進展. 中華男科學雜志, 2015, 21(9): 852-854.
2.	黃魯剛, 陳紹基, 王明和, 等. 兒童隱匿陰莖 (附 83 例報告). 中華泌尿外科雜志, 2001, 22(7): 410-412.
3.	Sugita Y, Ueoka K, Tagkagi S, et al. A new technique of concealed penis repair. J Urol, 2009, 182(4 Suppl): 1751-1754.
4.	黃魯剛, 曾莉. 兒童隱匿陰莖的診治現狀及最新進展. 臨床小兒外科雜志, 2018, 17(12): 886-890.
5.	Zeng L, Dan W, Huang GZ, et al. Pedicled skin flap of foreskin for phalloplasty in the management of completely concealed penis. J Pediatr Surg, 2012, 47(12): 2289-2293.
6.	聞竹, 曹永勝, 王永明. Sugita 術式治療兒童隱匿陰莖的臨床觀察. 安徽醫藥, 2017, 21(2): 309-311.
7.	楊華軍, 徐哲明, 唐達星, 等. Sugita 法治療重度隱匿陰莖. 中華小兒外科雜志, 2010, 31(6): 480-482.
8.	van der Toorn F, de Jong TP, de Gier RP, et al. Introducing the HOPE (Hypospadias Objective Penile Evaluation)-score: a validation study of an objective scoring system for evaluating cosmetic appearance in hypospadias patients. J Pediatr Urol, 2013, 9(6 Pt B): 1006-1016.
9.	陶暢, 唐達星, 徐珊, 等. 改良 Brisson 術治療小兒隱匿性陰莖的遠期隨訪結果. 中華小兒外科雜志, 2011, 32(11): 809-812.
10.	楊屹, 許卓凡. 隱匿陰莖手術治療爭議及隨訪研究進展. 臨床小兒外科雜志, 2018, 17(12): 881-885.
11.	Han DS, Jang H, Youn CS, et al. A new surgical technique for concealed penis using an advanced musculocutaneous scrotal flap. BMC Urol, 2015, 15: 54.
12.	Metcalfe PD, Rink RC. The concealed penis: management and outcomes. Curr Opin Urol, 2005, 15(4): 268-272.
13.	程帆, 張孝斌, 劉修恒, 等. 隱匿型陰莖的手術治療 (附 63 例報告). 中華男科學, 2004, 10(2): 100-102.
14.	唐達星. 關注小兒隱匿陰莖治療中的心理因素. 臨床小兒外科雜志, 2018, 17(12): 891-893.
15.	蘇春妹, 侍玲, 周云鳳, 等. 隱匿陰莖患兒心理狀態及家長疾病認知度的調查. 中西醫結合護理 (中英文), 2017, 3(10): 46-48.
16.	許麗彥, 遲志廣, 劉瑞, 等. 改良 Shiraki 術治療小兒完全型隱匿陰莖. 中外醫療, 2012, 31(25): 38-39.
17.	陳于明. 隱匿陰莖問題的再認識. 中華小兒外科雜志, 2000, 21(6): 379-380.
18.	張聰, 徐珊, 唐達星, 等. Brisson 術矯治小兒隱匿陰莖. 中華泌尿外科雜志, 2005, 26(8): 566-568.
19.	Spinoit AF, De Prycker S, Groen LA, et al. New surgical technique for the treatment of buried penis: results and comparison with a traditional technique in 75 patients. Urol Int, 2013, 91(2): 134-139.
20.	Redman JF. Buried penis: congenital syndrome of a short penile shaft and a paucity of penile shaft skin. J Urol, 2005, 173(5): 1714-1717.
21.	劉國昌, 柴成偉, 伏雯, 等. Sugita 手術治療小兒先天性隱匿陰莖. 中華小兒外科雜志, 2011, 32(11): 813-815.

1. 樊勝海. 隱匿陰莖研究進展. 中華男科學雜志, 2015, 21(9): 852-854.
2. 黃魯剛, 陳紹基, 王明和, 等. 兒童隱匿陰莖 (附 83 例報告). 中華泌尿外科雜志, 2001, 22(7): 410-412.
3. Sugita Y, Ueoka K, Tagkagi S, et al. A new technique of concealed penis repair. J Urol, 2009, 182(4 Suppl): 1751-1754.
4. 黃魯剛, 曾莉. 兒童隱匿陰莖的診治現狀及最新進展. 臨床小兒外科雜志, 2018, 17(12): 886-890.
5. Zeng L, Dan W, Huang GZ, et al. Pedicled skin flap of foreskin for phalloplasty in the management of completely concealed penis. J Pediatr Surg, 2012, 47(12): 2289-2293.
6. 聞竹, 曹永勝, 王永明. Sugita 術式治療兒童隱匿陰莖的臨床觀察. 安徽醫藥, 2017, 21(2): 309-311.
7. 楊華軍, 徐哲明, 唐達星, 等. Sugita 法治療重度隱匿陰莖. 中華小兒外科雜志, 2010, 31(6): 480-482.
8. van der Toorn F, de Jong TP, de Gier RP, et al. Introducing the HOPE (Hypospadias Objective Penile Evaluation)-score: a validation study of an objective scoring system for evaluating cosmetic appearance in hypospadias patients. J Pediatr Urol, 2013, 9(6 Pt B): 1006-1016.
9. 陶暢, 唐達星, 徐珊, 等. 改良 Brisson 術治療小兒隱匿性陰莖的遠期隨訪結果. 中華小兒外科雜志, 2011, 32(11): 809-812.
10. 楊屹, 許卓凡. 隱匿陰莖手術治療爭議及隨訪研究進展. 臨床小兒外科雜志, 2018, 17(12): 881-885.
11. Han DS, Jang H, Youn CS, et al. A new surgical technique for concealed penis using an advanced musculocutaneous scrotal flap. BMC Urol, 2015, 15: 54.
12. Metcalfe PD, Rink RC. The concealed penis: management and outcomes. Curr Opin Urol, 2005, 15(4): 268-272.
13. 程帆, 張孝斌, 劉修恒, 等. 隱匿型陰莖的手術治療 (附 63 例報告). 中華男科學, 2004, 10(2): 100-102.
14. 唐達星. 關注小兒隱匿陰莖治療中的心理因素. 臨床小兒外科雜志, 2018, 17(12): 891-893.
15. 蘇春妹, 侍玲, 周云鳳, 等. 隱匿陰莖患兒心理狀態及家長疾病認知度的調查. 中西醫結合護理 (中英文), 2017, 3(10): 46-48.
16. 許麗彥, 遲志廣, 劉瑞, 等. 改良 Shiraki 術治療小兒完全型隱匿陰莖. 中外醫療, 2012, 31(25): 38-39.
17. 陳于明. 隱匿陰莖問題的再認識. 中華小兒外科雜志, 2000, 21(6): 379-380.
18. 張聰, 徐珊, 唐達星, 等. Brisson 術矯治小兒隱匿陰莖. 中華泌尿外科雜志, 2005, 26(8): 566-568.
19. Spinoit AF, De Prycker S, Groen LA, et al. New surgical technique for the treatment of buried penis: results and comparison with a traditional technique in 75 patients. Urol Int, 2013, 91(2): 134-139.
20. Redman JF. Buried penis: congenital syndrome of a short penile shaft and a paucity of penile shaft skin. J Urol, 2005, 173(5): 1714-1717.
21. 劉國昌, 柴成偉, 伏雯, 等. Sugita 手術治療小兒先天性隱匿陰莖. 中華小兒外科雜志, 2011, 32(11): 813-815.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in treatment of complete concealed penis

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