Pampered urethroplasty (denis-brown)

Hypospadias refers to the male urethral opening not at the forefront of the penis, but under the glans, the ventral side of the penis, the base of the penis or the perineum. Often accompanied by penile curvature and testicular insufficiency (cryptorchidism), some boys have to urinate in the squatting, and more difficult to distinguish between men and women, causing great suffering to the family. Hypospadias is not uncommon, with about one in every 300 boys. In addition to the opening of the glans, there is no need for surgical correction, and the rest, if not corrected, may affect penis development or cause infertility. Treatment of diseases: hypospadias of children with hypospadias Indication Lower urethra. Contraindications The patient is too old and should be filled with poor general condition. Preoperative preparation First, we must identify the gender. Secondly, the perineum should be cleaned with 1:1000 Xinjieer liquid on the 3rd day before surgery, once every night for 10 minutes. The area was shaved 1 day before surgery. It is necessary to perform bladder fistula, so that the urine flow can be diverted to avoid wet dressing and infection. Surgical procedure 1. Position: flat supine position, the legs can be slightly separated. 2. Incision: Two parallel incisions were made on both sides of the ventral midline of the penis, with a spacing of 1.0 to 2.0 cm. The upper end was from the coronal groove, and the lower end was bypassed 0.5 cm below the urethral opening and then connected to each other. In order to make the urethral opening reach the penis head, a triangular tissue can be cut off on both sides of the penis head to form a wound surface. 3. Forming the strips: respectively, the flaps are separated into the flaps outwardly, and the central portion is not separated to form a strip. 4. Close the wound: in two rows. In the first row, a 5-0 nylon thread or a silk thread was used to make a full-thickness suture, so that the flaps on both sides were facing each other. In the second row, the suture is sutured. On the outside of the first row, 5 to 6 sutures are made with the No. 0 silk thread. Each side wears a small piece of rubber tube, and the knot is not too tight to avoid edema, necrosis and pupil formation. Finally, the newly formed urethral orifice is placed with a rubber strip. The penis is fixed to the abdominal wall with a pulling wire or a thin steel wire. complication Because the flap is too thin, the blood supply is insufficient or the penis is small, and the foreskin is not enough, the tension after suturing the flap is too large or the pus in the urethral cavity is not cleared in time, and the wound infection can cause urethral fistula or wound collapse. If the wound infection is not well healed, the vaginal bladder mouth tube is delayed, the urine is not urinated, the secretion of the urethra is often removed, and physical therapy is performed. The small person has the possibility of self-healing. If after 3 to 4 weeks of treatment, the fistula still does not heal, the catheter can be removed, and after 3 to 6 months, the local scar tissue softens and repairs the fistula again. After the operation, the urethral opening is kept open, and the scarring is removed in time to ensure that the formed urethra can be circulated smoothly, which is essential for preventing infection and urinary fistula formation.

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