Epispadias Mitchell Correction

The external urethra is open to the dorsal side of the penis, and the distal mucosa of the urethra is cleft and is called a sulcus. It is a rare congenital malformation of the genitourinary organs. The cause of the disease is not clear, and may be related to the abnormal development of the cloaca at the 4th to 10th week of the embryo. The incidence is about 1 in 3 million, and men are four times more than women. The male urethral fissure is based on a surgical plan based on: 1 urethral opening position. 2 degree of separation of the corpus cavernosum and its relationship with the urethra. 3 with or without urinary incontinence. 4 There is no pubic bone separation and its extent. 5 with or without abdominal wall defects. Male urethral splitting is usually divided into three types according to the position of the urethra opening: 1. The penis head type urethral opening is open on the dorsal side of the penile coronal sulcus, and the penis head is split into a flat shape, generally without urinary incontinence. 2. The penis-type urethra is open on the dorsal side of the penis body, and the penis is flat and shovel-like, and it is deformed in the upper part, and some are accompanied by urinary incontinence of different degrees. 3. The pubic symphysis is also called the complete urethral fissure. The external urethra is located below the pubic symphysis, the urethra of the penis is completely open, the penis is flat and deformed, and the urethral opening is wide. This type of bladder neck muscle dysplasia causes urinary incontinence. A small number of complete urethral fissures and bladder valgus coexist, called the complex bladder valgus-exospadias complex with pubic symphysis separation. Zhang Fengxiang has proposed a classification method for treatment purposes, which is divided into: 1 incomplete type (penis head type and penis type), and penis straightening. 2 complete type, penile elongation and anti-urinary incontinence surgery. 3 complex (with bladder valgus), penile elongation and anti-urinary incontinence surgery and repair of bladder valgus and abdominal wall defects. Any type of male urethral fissure requires surgery. The age of surgery is 4 to 5 years old, the age is too small, and the effect of anti-urinary incontinence is poor. Surgical correction should achieve the following objectives: 1 correct urinary incontinence. 2 recovery of the urethral orifice in the orthodontic urination. 3 maintain normal sexual intercourse ability. Surgery indications against urinary incontinence should not be too strict, because the bladder neck and posterior urethra reconstruction in addition to anti-urinary incontinence, there is still anti-reverse ejaculation. A strict plan should be established before the urethral fissure, and it should be repaired in stages or in one stage. The upper urethral fissure without urinary incontinence can be considered for correction of penile malformation and urethroplasty. The urethral fissure with urinary incontinence is suitable for staged surgery. The first stage of bladder neck and posterior urethra reconstruction and penile extension is performed at the same time. The second stage of penile urethroplasty can improve the success rate of surgery. . For patients with stunted penis, testosterone or HCG can be given before surgery to promote their development. Treatment of diseases: upper urethra Indication Mitchell correction for urethra is suitable for penile-type urethral fissure, complex urethral fissure that has controlled urinary incontinence. Contraindications 1. Local skin has urinary dermatitis or infection. 2. Incontinence of urinary incontinence has not been completely cured. Surgical procedure 1. Urine circulatory and "U" shaped urethral stent tube placement: the 4th silk thread on the left and right sides of the penis head runs through a needle for traction, and the 12F metal probe is inserted into a 10F rubber catheter from the external urethra into the urethra, in the perineum. The skin is topped, the skin is cut open, the probe is ejected and the catheter is taken out, and the position of the catheter is adjusted to perform a urinary diversion of the perineal urethra. At the same time, a 10F porous silicone tube was introduced into the urethra through the probe to make a urethral "U" shaped stent drainage tube. 2. Free urethral mucosa plate, correction of upper curvature and prolongation of penis: make an incision along the junction of the mucosal bed of the urethra and the surrounding skin, the proximal end bypasses the outer urethra, and the distal end is to the tip of the penis, reaching the level of the anterior tunica. Close to the tunica mucosa of the urethra until the outer urethra, and free the normal proximal urethral sponge to the root of the penis. The incision is made around the coronary sulcus to the corpus cavernosum, and the cuff-like free penis skin reaches the root of the penis. Make a longitudinal incision of the dorsal skin of the penis to the pubic symphysis, so that the corpus cavernosum is fully exposed to the penile suspensory ligament. The dorsal fiber cord is removed to correct the upper curvature. The suspensory ligament is cut to extend the penis. If the prolongation is unsatisfactory, the corpus cavernosum can be peeled off from the pubic bone to partially extend away from the pubic bone. 3. Penile glans shaping and urethroplasty: the penis head is longitudinally cut open and the penis cavern is cut, so that the flat penis head and the corpus cavernosum are divided into two, and the penis sponge is separated. The free distal corpus cavernosum and urethral mucosa plate were transferred to the ventral side of the corpus cavernosum, and the urethral mucosa plate was wrapped around the inserted porous silicone tube, and the skin tube was sutured into a new urethra with a 5-0 absorbable wire. Thoroughly remove the fibrous cord tissue on the left and right corpus cavernosum, and then suture and tie the dorsal tunica on the dorsal tunica, and then combine them into one. Note that the needle on the lateral side of the left and right corpus cavernosum does not damage the dorsal vascular nerve bundle. After tightening, the corpus cavernosum becomes tubular from the frog belly. The new urethra was placed on the ventral side of the corpus cavernosum, and a few needles were fixed on the 3-0 silk thread, and the suture edge was placed close to the ventral side of the corpus cavernosum. At the distal end, the penis head that has been cut open is sutured around the distal new urethra, so that the outer urethra is just up to the tip of the penis and 6 needles are fixed. After suturing, the flat penis head becomes conical. If the urethra is too short, it can be extended with a pedicle flap. The method refers to the hypospadias. 4. Repair the penis wound: repair the free penis skin, wrap around the penis wound, compress the nylon mesh, and fix the pipes.

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