Bladder mucosa method one-stage repair plasty

In 1947, Memmelaar first reported the use of the bladder mucosa for urethroplasty. By 1955 Marshall reported a two-stage method of bladder mucosal urethroplasty. However, due to the high failure rate and unsatisfactory postoperative results, this procedure has long been abandoned. In 1975 and 1980, Mei Lan reported a group of modified methods for bladder mucosal urethroplasty. The success rate of one-stage operation was 95.5%. This procedure is suitable for all types of hypospadias, with high success rate and good cosmetic effect. It has been widely used at home and abroad. Treatment of diseases: hypospadias of children with hypospadias Indication The "bladder mucosa" one-stage repair and prosthesis is suitable for all types of hypospadias. Preoperative preparation 1. If the penis is too small, the male hormone therapy should be applied appropriately. After the penis is developed, the operation is performed again. 2. Prophylactic use of broad-spectrum antibiotics 1d before surgery and continued until wound healing. 3. Wash the skin of the surgical field with a small irritating soap solution. Do not use any cleaning agent that stains the skin and confuses the blood vessels. 4. Patients with perineal hypospadias and patients with perineal urethral resection should be enema before surgery. 5. After anesthesia, separate the foreskin adhesion, expose the coronary sulcus, remove the accumulated smegma, and flush the urethra with 0.5% benzalkonium or dilute iodine to eliminate possible bacteria. Surgical procedure Continuous epidural block anesthesia, supine position or lithotomy position. 1. Correcting the lower penis: a needle is drawn at the head of the penis, and the penis skin is cut parallel to the coronal sulcus 0.3 to 0.5 cm from the outside of the penis, and the ventral urethral plate is bent to the proximal side, and the contralateral side is cut. The meeting meets. The proximal incision encircles the skin around the urethra. If the distal urethra has no corpus cavernosum, it should be opened to the developed part of the corpus cavernosum. The flaps in front of the urethral opening should be kept more for oblique anastomosis. From the lateral incision of the penis to the deep incision, until the plane of the white membrane, where the penis fascia and the tunica are easily recognized. Separate along the surface of the white membrane with a small curved forceps, cross the shallow urethral plate, and free the distal urethra 1 to 2 cm to make the penis completely straight. The separation of the dorsal side is performed on the superficial side of the penile fascia, taking care not to damage the dorsal neurovascular bundle. The standard for lower curvature correction is that the penis can naturally flatten the front of the pubic symphysis and no longer bounce back to the ventral side. An erection test can be performed if necessary. If there is still a penis lower, it needs to be loosened, and sometimes the cord between the sponges should be completely removed. Use a small scissors to separate the distal part of the urethral plate and the surface of the leucorrhea, and directly under the scalp of the penis, cut the skin here to form a tunnel wide enough for the new urethra to be placed into the stoma. 2. Cut the bladder mucosa: insert the catheter, inject the isotonic saline to the bladder filling state. Make a small incision in the middle of the lower abdomen or a small arc. Cut the white line of the abdomen in the midline and push the reflexed part of the peritoneum to reveal the bladder. Open the bladder muscle layer and open it with a curved forceps to reveal the underlying mucosa. The muscle layer is retracted with a leather forceps, and the small round knife is sharply separated between the mucosa and the muscle layer, or the blunt separation is performed with a small gauze ball, and a bladder mucosa which is slightly wider than the actual need is peeled off. Try to avoid pinching the mucosa during the stripping process to reduce damage to the tissue. A bladder mucosa was cut at 3 to 5 mm from the edge of the peeling edge, and the in situ mucosal wound edge was lifted while trimming, and fixed to the wound edge of the bladder muscle incision with a 5-0 absorbable line to reduce or eliminate the muscle wound. The bladder incision is not sutured. 3. Urethral formation: The free bladder mucosa is smoothed up and laid flat on the ventral side of the penis. The urethral caliber is designed according to the size of the penis. The proximal wound edge of the mucosa is firstly anastomosed with the urethral stump and fixed to the leucorrhea. The porous thin silicone tube is inserted into the bladder from the urethral opening, and is reserved for urethral stent drainage. The side hole portion of the tube should reach the middle of the penis. Then, the wound edges of both sides are closed to form a tubular shape, and the suture is continuously sutured by an absorbable thread, and the suture is passed through the white film at a certain distance to be fixed to the urethra. The new urethral edge was fixed to the white membrane with a number of intermittent sutures on the opposite side of the penis body. Pass the end of the urethra through the penis head. 4. Transfer and suture the penile flap: cut longitudinally on the dorsal midline of the foreskin, transfer the flaps on both sides to the ventral side, and suture the subcutaneous tissue corresponding to the flaps on both sides with absorbable fine lines. Cover the new urethra. Cut off the excess skin and suture the wound edges to form a penis with a near-normal appearance. The elastic mesh is slightly pressurized and the suture is fixed. The dressing should be from the base of the penis to the distal side of the coronal suture to avoid edema in the exposed part. The mesh yarn is fixed on the proximal and distal skin with a number of needle threads to prevent falling off. Plus gauze dressing. For patients with perineal hypospadias, it is advisable to wrap the gauze around the scrotum on both sides, and suture the scrotum close to each other in the midline, leaving it for 5-7 days to eliminate the dead space and accelerate healing.

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