Operative Technique
Preoperative examination: chromosome, scrotum, groin, kidney, ureter, bladder, heart color ultrasound, liver and kidney function, electrocardiogram.Wash vulva area with running water 12 hours before surgery.Fasting 6-8 hours preoperatively and cefuroxime 30 minutes preoperatively.
In the supine position, 0.05% complexed iodine disinfects the skin, 0.05% complexed iodine disinfects the foreskin and urethral opening, F8 catheter is smoothly inserted into the bladder and left in, and 0.05% complexed iodine disinfects the foreskin. Suture No. 1 silk thread on the dorsal side of the glans as a traction line. Cut the inner plate of the foreskin to the albuginea layer at a distance of 0.5 cm from the coronal sulcus, and then sneak along the albuginea layer to the root of the penis(Fig1.B-C). Do a penile erection test with salt water to check that the flexion of the penis has been corrected. Measure the distance between the head of the penis and the ectopic urethral orifice as 4.1 cm. Take the joint flaps of the penis and scrotum with a continuous width of about 6mm along the inner foreskin on both sides of the ectopic urethral orifice, and cut the foreskin skin (the skin cannot be cut) at 12 o’clock on the back of the penis. (the skin cannot be cut), free the subcutaneous skin, pay attention to protect the blood supply of the skin flap, free the urethral plate along both sides of the ectopic urethral orifice, and the skin flap will become a sealed ”Y” shape, and the inner edges of the two arms of the sealed Y-shaped skin flap are intermittently sutured(Fig1.D-J). Make the sealed Y-shaped skin flap into a rectangular skin flap. The outer edge of the rectangular skin flap is intermittently sutured along the urethral catheter to form a urethral skin tube. A penis-sized hole is bluntly separated from the center of the urethral skin tube, and the penis is passed through the small Pull out the hole to transfer the urethral tube to the ventral side of the penis. Separate a tunnel into the cavernous tissue 0.5 cm below the ventral coronal sulcus of the head of the penis, cut the ventral side of the tunnel, and connect the distal end of the urethral tube to the head of the penis. 6-0 intermittent suture with absorbable thread to form a new urethral opening. An arc incision was made on the upper pole of the scrotum, the penis was lifted, the penile scrotal incomplete transposition was corrected, the excess foreskin was transferred from the dorsal side to the ventral side, and the new urethra was covered with intermittent suture with 6-0 absorbable thread(Fig1.K-N). Wrap the penile wound with petroleum jelly gauze, press the scrotum wound with petroleum jelly, use cefuroxime for 5 days after the operation, and remove the petroleum jelly gauze one week after the operation. The urinary catheter was pulled out 4 weeks after the operation, and the urination was observed.
Tips: 1. foreskin flap can only be cut to the skin layer, and the 12 o’clock dorsal foreskin incision can only cut the skin layer.
2. A vascular pedicle can be used to cover the urethra.
3. The thickness of tunnel and subcutaneous should not exceed 1.5mm.