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.