total penisectomy

Total penile resection is used for the treatment of hermaphroditism. There are many types of congenital hermaphroditism, varying in degree. It is best to actively diagnose the diagnosis at birth, and to perform reasonable correction as soon as possible, not only to allow the gender to continue to develop healthily, but also to function or structure close to normal; and to avoid delaying the treatment, to change the original gender when adulthood Leading psychological and social barriers. Treatment of diseases: external genital malformations, pediatric hermaphroditism, male pseudohermaphroditism Indication There are many types of congenital hermaphroditism, varying in degree. It is best to actively diagnose the diagnosis at birth, and to perform reasonable correction as soon as possible, not only to allow the gender to continue to develop healthily, but also to function or structure close to normal; and to avoid delaying the treatment, to change the original gender when adulthood Leading psychological and social barriers. Unfortunately, the diagnosis and treatment of gender deformity in infants and young children has not been taken seriously. Most of them have found heterosexual symptoms or signs in adulthood and started to seek medical treatment. Some have delayed the timing of treatment and affected the therapeutic effect. The diagnosis and treatment of infantile malformations belong to the scope of pediatric and pediatric surgery, so I will not repeat them. In adulthood, surgery must be performed. Generally, there are three cases: 1. Female pseudohermaphroditism Also known as female masculinization syndrome, it is a kind of adrenal gland abnormal syndrome, which is an autosomal recessive genetic disease. Mainly due to the lack of 21-hydroxylase, resulting in the development of adrenal cortex and aldosterone, and the synthesis of androgen is too much, so that the girl has a clitoris hypertrophy, a beard and a rough voice. Corticosteroids should be given timely treatment. If the clitoris is too large, consider whether it is a clitoris resection. 2, male pseudohermaphroditism Also known as male feminization, or testicular feminization syndrome. Testosterone does not work for the target tissue in the reproductive organs lacking testosterone receptors, but it develops in the direction of women. Have a family history of genetics. There are ectopic testicles in the body (such as intra-abdominal testicles, inguinal or labial folds and inner testicles) and incompletely developed female vaginal, labia, and fallopian tubes, but no ovaries. Should be treated according to women, cut off ectopic testicles, expand the vagina or for vaginoplasty, according to female marriage. 3, true hermaphroditism There are two sets of gonads, testes and ovaries in the patient's body, which develop into two sets of reproductive organs. There are two secondary sexual characteristics during puberty. However, most male testes do not decline, which is ectopic abdominal testis, unilateral testis, or one or both ovarian testis, so the function is insufficient, male organs are often stunted and cannot be corrected to males. Therefore, more penile resection, abdominal test or egg testis resection, correction into women. After surgery, because there is no testicular androgen antagonism, women who retain the ovary and even a small part of the ovary are well developed. Contraindications Acute systemic diseases must be cured after remission or after remission; local inflammation; bleeding tendency. Preoperative preparation If menstruation should be cleaned 2 to 3 days after menstruation. The vulva is shaved and disinfected with the vulva surgery. 1 day pre-operative enema. Surgical procedure Before the surgical field is disinfected, the surgeon and assistant should perform a vulvar and pelvic examination to confirm the diagnosis. Then disinfect the vulva, and sterilize the towel with the vulva surgery routine. 1. Incision Cut the vulva skin from the root of the clitoris to the midline of the clitoris to the edge of the foreskin of the clitoris, deep into the skin. The clitoris head is separated and peeled off from both sides, and the clitoris ligament is cut off by separating the clitoris body on both sides. 2, stop bleeding Close to the clitoris fascia to separate the deep veins of the clitoris, the dorsal artery and nerves of the clitoris, clamp, cut, and ligature. 3, clitoral body resection Separate inward and downward along the surface of the white membrane of the clitoris, free the clitoris head, and the clitoris body reaches the bifurcation of the clitoris. Lift the clitoris, and cut the clitoris from the junction of the base of the clitoris. 4, stitching The incision at the intersection of the clitoris feet was sutured with 2-0 absorbable sutures or 2-0 guts for 2 to 3 needles. Trim the edge of the skin on both sides of the joint (should be close to the urethral opening on both sides of the labia after suturing to prevent contamination and discomfort during sexual intercourse). The skin was sutured with a thin silk thread or sutured continuously with a 3-0 absorbable suture, and the suture was not removed after surgery. Check for no bleeding, complete surgery. complication The main complications of small penile resection are mainly hemorrhage and postoperative subcutaneous hematoma of the labia, so it is necessary to handle the clitoris dorsal arteries. The clitoris head should be light and accurate when peeled off. Pay attention to wound pain and swelling after surgery. It can be eliminated by pressing and hot compressing. It is rare to cut the bleeding.

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