RU2371103C1 - Surgery technique for hypospadias - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly pediatric urology, can be used for treatment of patients suffering from hypospadias. A deficient site of urethral tube is formed while the latter is delivered to apex of balanus. Skin and balanus are restored. To restore skin of balanus, a pedicle graft is cut of internal petal of foreskin. The graft is moved onto the ventral surface of penis. The graft closes urethra and a defect between wings of balanus after suturing balanus thus forming meatus.

EFFECT: method allows eliminating of suturing of balanus, resistance to urine flowing in urination, is simple and can be used for all forms of hypospadias.

1 ex, 4 dwg

Description

The invention relates to medicine, in particular pediatric urology, and can be used to treat hypospadias patients.

There are currently many methods for surgical treatment of hypospadias in boys.

A high percentage of postoperative complications indicates the complexity of the treatment of this pathology and the imperfection of these methods.

A known method of surgical treatment of hypospadias in boys, including the simultaneous straightening of the corpora cavernosa, restoration of the missing section of the urethra using a skin flap of the dorsal surface of the trunk of the penis and foreskin stitched into the tube and moved to the ventral surface through the hole in the base of the flap (RF patent No. 2143853 by cell A61B 17/00 of March 30, 1999).

This method also includes cutting an additional flap from the scrotum skin, which is sutured into the tube to restore the integrity of the urethra, anastomosis is formed and the external opening of the urethra is created on top of the glans penis by cutting the tissue deeper into the depths using longitudinal incisions followed by laying the tube and stitching the head.

The disadvantage of this method is the difficulty of carrying out technological methods for creating the external opening of the urethra and, in addition, this method may not be used for all forms of hypospadias, which limits its capabilities.

The closest technical solution for the totality of essential features is a method of treating hypospadias in boys, including the formation of the missing section of the urethral tube with its output to the top of the glans penis and subsequent restoration of the skin and head of the penis (Snodgrass W .: Tubularized, incised plate urethroplastu for distal hypospadias J. Urol. 151 (2): 464-5, Feb. 1944).

The disadvantage of this method is that the distal part of the urethra, its capitate, and the spongy body of the urethra create additional resistance to urine flow during urination and the likelihood of developing meatostenosis increases. There may be a discrepancy of sutures on the glans penis due to the tension of the sutures, which ultimately reduces the effectiveness of surgical treatment of hypospadias.

The problem to which the claimed invention is directed, is to increase the effectiveness of surgical treatment of hypospadias in boys.

The problem is solved due to the fact that in the method of surgical treatment of hypospadias, including the formation of the missing section of the urethral tube with its output to the top of the glans penis with subsequent restoration of the skin and penis, to restore the skin of the glans penis from the inner lobe of the foreskin a flap on the feeding leg with its subsequent movement on the ventral surface and closing of the urethra with the formation of the anatomical structure of the head of the penis.

Figure 1-4 presents illustrations of a surgical operation for the treatment of hypospadias.

At the initial stage of the operation, a flap is cut from the inner leaf on the feeding leg and an urethral tube is formed, for example, according to the Duplay method (Fig. 1). Then, one suture is placed on the glans penis, limiting the meatus. The cut flap is moved to its ventral (front surface) and sewn to the glans penis, closing the formed urethra and forming the correct anatomical structure of the head (Fig. 2).

After this, the frenulum of the foreskin is formed by crimping the flap with U-shaped sutures with the subsequent restoration of the integument of the penis (Figs. 3 and 4).

An example of using the proposed method of surgical treatment of hypospadias.

03/14/08 in the hospital №9 named. G.N.Speransky, Moscow, a sick boy of 9 years old was admitted with a Diagnosis: Congenital malformation of the urinary system. Hypospadias, stem form.

After the study with ultrasound, a surgical operation was performed in which a platform including a hypospadias meatus and a glans penis was cut out on the ventral surface of the penis. The urethral tube is formed according to the Duplay principle on the urethral catheter Ball 8. Nodal sutures, PDS 6/0. Hemostasis is dry. The seam line is covered along the entire length with a displaced flap on the vascular pedicle from the subcutaneous tissues of the foreskin. The area of the formed urethra proximal to the coronary sulcus, including the area of the hypospadias meatus, is covered by a second layer of subcutaneous tissue of the skin of the penis. One nodal distal suture forming the meatus is applied to the glans penis. The defect between the wings of the head is closed by a displaced flap on the vascular pedicle from the inner leaf of the foreskin. Restoration of the skin with the removal of the remnants of the foreskin.

In the postoperative period, the patient received magnetotherapy for the penis. Urination is satisfactory. Uroflowmetry without deviation from the norm.

In contact with infections in the department was not. 04/25/08 was discharged home in satisfactory condition.

This method eliminates the divergence of sutures on the glans penis, as well as resistance to urine flow during urination, which ultimately increases the effectiveness of surgical treatment of hypospadias.

Claims (1)

A method of surgical treatment of hypospadias, including the formation of the missing section of the urethral tube with its output to the top of the glans penis with subsequent restoration of the skin and head of the penis, characterized in that to restore the skin of the glans penis from the inner lobe of the foreskin, a flap is cut out on the feeding leg with its subsequent movement on the ventral surface and closing of the urethra and defect between the wings of the head of the penis after applying one seam to the head of the penis, ph rheumatic meatus.

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