Comparison of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in treatment of complete concealed penis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Ao , LI Xue , ZHANG Zhibo , ZENG Li , HUANG Yidong , MA Xue ,  HUANG Lugang

Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

HUANG Lugang, Email: lugang992001@aliyun.com

Keywords：

Complete concealed penis; pedicled skin flap of foreskin for phalloplasty; Sugita surgical method

DOI：

10.7507/1002-1892.202004165

Video：

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Objective To evaluate the effectiveness of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in the treatment of complete concealed penis.Methods The clinical data of 46 children with complete concealed penis between January 2016 and January 2018 were analyzed retrospectively. Among which, 25 cases were treated with pedicled skin flap of foreskin for phalloplasty (group A) and 21 cases were treated with Sugita surgical method (group B) with an average age of 4.7 years (range, 2 years and 8 months to 11 years). At 3 months after operation, the concealed penis recovery was scored from three aspects of postoperative penis length (the difference of the penis length between at 3 months after operation and before operation), penis appearance, and skin appearance (the total score was 10). And the parents evaluation of satisfaction degree of penis exposure, penis appearance, and foreskin appearance after surgical correction was collected.Results Eighteen cases (72.0%) in group A and 15 cases (71.4%) in group B were followed up with an average of 13 months (range, 3-36 months). The incisions healed well in both groups, and there was no flap dehiscence, infection, necrosis, and penile erectile dysfunction. The penile length of the two groups increased significantly at 3 months after operation (P<0.05); there was no significant difference between the two groups in terms of penis length and increased length at 3 months after operation and score of increase penis length after operation (P>0.05). No penile retraction occurred in the two groups. And there was no significant difference between the two groups in penis appearance score, but the penis appearance score, skin appearance score, and total score of group A were significantly better than those of group B (P<0.05). At 3 months after operation, the satisfaction rate of penis exposure in group A and group B was 88.9% and 80.0%, respectively, with no significant difference (χ²=0.50, P=0.48); the satisfaction rate of penis appearance was 72.2% and 53.3%, and the satisfaction rate of foreskin appearance was 94.4% and 53.3%, respectively, and the differences were significant (χ²=5.13, P=0.03; χ²=7.53, P=0.01).Conclusion Both surgical methods are suitable for correction of complete concealed penis, and the penile length gets a satisfactory recovery. However, the lymphedema of the prepuce after Sugita surgical method is serious, which can easily lead to poor appearance of the penis after operation. In general, the effectiveness of pedicled skin flap of foreskin for phalloplasty is better than that of the Sugita surgical method.

Citation： XU Ao, LI Xue, ZHANG Zhibo, ZENG Li, HUANG Yidong, MA Xue, HUANG Lugang. Comparison of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in treatment of complete concealed penis. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(11): 1423-1428. doi: 10.7507/1002-1892.202004165 Copy

1.	樊胜海. 隐匿阴茎研究进展. 中华男科学杂志, 2015, 21(9): 852-854.
2.	黄鲁刚, 陈绍基, 王明和, 等. 儿童隐匿阴茎 (附 83 例报告). 中华泌尿外科杂志, 2001, 22(7): 410-412.
3.	Sugita Y, Ueoka K, Tagkagi S, et al. A new technique of concealed penis repair. J Urol, 2009, 182(4 Suppl): 1751-1754.
4.	黄鲁刚, 曾莉. 儿童隐匿阴茎的诊治现状及最新进展. 临床小儿外科杂志, 2018, 17(12): 886-890.
5.	Zeng L, Dan W, Huang GZ, et al. Pedicled skin flap of foreskin for phalloplasty in the management of completely concealed penis. J Pediatr Surg, 2012, 47(12): 2289-2293.
6.	闻竹, 曹永胜, 王永明. Sugita 术式治疗儿童隐匿阴茎的临床观察. 安徽医药, 2017, 21(2): 309-311.
7.	杨华军, 徐哲明, 唐达星, 等. Sugita 法治疗重度隐匿阴茎. 中华小儿外科杂志, 2010, 31(6): 480-482.
8.	van der Toorn F, de Jong TP, de Gier RP, et al. Introducing the HOPE (Hypospadias Objective Penile Evaluation)-score: a validation study of an objective scoring system for evaluating cosmetic appearance in hypospadias patients. J Pediatr Urol, 2013, 9(6 Pt B): 1006-1016.
9.	陶畅, 唐达星, 徐珊, 等. 改良 Brisson 术治疗小儿隐匿性阴茎的远期随访结果. 中华小儿外科杂志, 2011, 32(11): 809-812.
10.	杨屹, 许卓凡. 隐匿阴茎手术治疗争议及随访研究进展. 临床小儿外科杂志, 2018, 17(12): 881-885.
11.	Han DS, Jang H, Youn CS, et al. A new surgical technique for concealed penis using an advanced musculocutaneous scrotal flap. BMC Urol, 2015, 15: 54.
12.	Metcalfe PD, Rink RC. The concealed penis: management and outcomes. Curr Opin Urol, 2005, 15(4): 268-272.
13.	程帆, 张孝斌, 刘修恒, 等. 隐匿型阴茎的手术治疗 (附 63 例报告). 中华男科学, 2004, 10(2): 100-102.
14.	唐达星. 关注小儿隐匿阴茎治疗中的心理因素. 临床小儿外科杂志, 2018, 17(12): 891-893.
15.	苏春妹, 侍玲, 周云凤, 等. 隐匿阴茎患儿心理状态及家长疾病认知度的调查. 中西医结合护理 (中英文), 2017, 3(10): 46-48.
16.	许丽彦, 迟志广, 刘瑞, 等. 改良 Shiraki 术治疗小儿完全型隐匿阴茎. 中外医疗, 2012, 31(25): 38-39.
17.	陈于明. 隐匿阴茎问题的再认识. 中华小儿外科杂志, 2000, 21(6): 379-380.
18.	张聪, 徐珊, 唐达星, 等. Brisson 术矫治小儿隐匿阴茎. 中华泌尿外科杂志, 2005, 26(8): 566-568.
19.	Spinoit AF, De Prycker S, Groen LA, et al. New surgical technique for the treatment of buried penis: results and comparison with a traditional technique in 75 patients. Urol Int, 2013, 91(2): 134-139.
20.	Redman JF. Buried penis: congenital syndrome of a short penile shaft and a paucity of penile shaft skin. J Urol, 2005, 173(5): 1714-1717.
21.	刘国昌, 柴成伟, 伏雯, 等. Sugita 手术治疗小儿先天性隐匿阴茎. 中华小儿外科杂志, 2011, 32(11): 813-815.

1. 樊胜海. 隐匿阴茎研究进展. 中华男科学杂志, 2015, 21(9): 852-854.
2. 黄鲁刚, 陈绍基, 王明和, 等. 儿童隐匿阴茎 (附 83 例报告). 中华泌尿外科杂志, 2001, 22(7): 410-412.
3. Sugita Y, Ueoka K, Tagkagi S, et al. A new technique of concealed penis repair. J Urol, 2009, 182(4 Suppl): 1751-1754.
4. 黄鲁刚, 曾莉. 儿童隐匿阴茎的诊治现状及最新进展. 临床小儿外科杂志, 2018, 17(12): 886-890.
5. Zeng L, Dan W, Huang GZ, et al. Pedicled skin flap of foreskin for phalloplasty in the management of completely concealed penis. J Pediatr Surg, 2012, 47(12): 2289-2293.
6. 闻竹, 曹永胜, 王永明. Sugita 术式治疗儿童隐匿阴茎的临床观察. 安徽医药, 2017, 21(2): 309-311.
7. 杨华军, 徐哲明, 唐达星, 等. Sugita 法治疗重度隐匿阴茎. 中华小儿外科杂志, 2010, 31(6): 480-482.
8. van der Toorn F, de Jong TP, de Gier RP, et al. Introducing the HOPE (Hypospadias Objective Penile Evaluation)-score: a validation study of an objective scoring system for evaluating cosmetic appearance in hypospadias patients. J Pediatr Urol, 2013, 9(6 Pt B): 1006-1016.
9. 陶畅, 唐达星, 徐珊, 等. 改良 Brisson 术治疗小儿隐匿性阴茎的远期随访结果. 中华小儿外科杂志, 2011, 32(11): 809-812.
10. 杨屹, 许卓凡. 隐匿阴茎手术治疗争议及随访研究进展. 临床小儿外科杂志, 2018, 17(12): 881-885.
11. Han DS, Jang H, Youn CS, et al. A new surgical technique for concealed penis using an advanced musculocutaneous scrotal flap. BMC Urol, 2015, 15: 54.
12. Metcalfe PD, Rink RC. The concealed penis: management and outcomes. Curr Opin Urol, 2005, 15(4): 268-272.
13. 程帆, 张孝斌, 刘修恒, 等. 隐匿型阴茎的手术治疗 (附 63 例报告). 中华男科学, 2004, 10(2): 100-102.
14. 唐达星. 关注小儿隐匿阴茎治疗中的心理因素. 临床小儿外科杂志, 2018, 17(12): 891-893.
15. 苏春妹, 侍玲, 周云凤, 等. 隐匿阴茎患儿心理状态及家长疾病认知度的调查. 中西医结合护理 (中英文), 2017, 3(10): 46-48.
16. 许丽彦, 迟志广, 刘瑞, 等. 改良 Shiraki 术治疗小儿完全型隐匿阴茎. 中外医疗, 2012, 31(25): 38-39.
17. 陈于明. 隐匿阴茎问题的再认识. 中华小儿外科杂志, 2000, 21(6): 379-380.
18. 张聪, 徐珊, 唐达星, 等. Brisson 术矫治小儿隐匿阴茎. 中华泌尿外科杂志, 2005, 26(8): 566-568.
19. Spinoit AF, De Prycker S, Groen LA, et al. New surgical technique for the treatment of buried penis: results and comparison with a traditional technique in 75 patients. Urol Int, 2013, 91(2): 134-139.
20. Redman JF. Buried penis: congenital syndrome of a short penile shaft and a paucity of penile shaft skin. J Urol, 2005, 173(5): 1714-1717.
21. 刘国昌, 柴成伟, 伏雯, 等. Sugita 手术治疗小儿先天性隐匿阴茎. 中华小儿外科杂志, 2011, 32(11): 813-815.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in treatment of complete concealed penis

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