Repair of the Bulbospongiosus Muscle to Suspend the Penis to the Pubic Bones in Proximal Hypospadias

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-02-01 DOI:10.1016/j.jpedsurg.2024.162074

S. Hennayake , M. Gopal , H.M. Seleim , T. Cserni , P. Hajduk , A. Ajao , A. Bianchi

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引用次数: 0

Abstract

Background

In proximal hypospadias, ventral curvature is invariable and most have penoscrotal transposition, and we observed that the base of the penis (BOP) was located on the inferior aspect of the pubic bones in those, in contrast to the location of the BOP at the anterior end in normal penises. We also observed an unfused bulbospongiosus muscle (BSM) at surgery in those. The aim was to assess the impact of repairing the unfused BSM or transection and straightening of the urethral plate at the first operation on the low BOP.

Method

All consecutive proximal hypospadias operations from January 2021 to August 2023 that had a low BOP were retrospectively studied. At the first operation, some had urethral plate transection only, with no BSM repair. Some had BSM repair with or without plate transection. The BOP position was reassessed post-intervention.

Results

Thirty-three cases of proximal hypospadias with low BOP were studied. At the first operation, as the key distinguishing step, 18 had BSM repair and 15 urethral plate transections. BOP shifted to the anterior end of the pubic bones in all 18 patients following BSM repair but showed no change in the 15 without BSM repair (p < 0.01). Subsequent BSM repair, during the second stage, normalized BOP in those 15. Normalising the BOP corrected penoscrotal transposition because the anterior end of the scrotum was at the anterior end of the pubic bones.

Conclusion

Repairing BSM is essential for normalising the BOP, which results in a normal penoscrotal relationship and normal anterior penile projection.

Level of Evidence

IV.

Abstract Image

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尿道下裂近端阴茎悬吊至耻骨的球海绵肌修复。

背景：在尿道下裂近端，腹侧弯曲是不变的，大多数有阴茎阴囊转位，我们观察到阴茎基部（BOP）位于耻骨的下侧面，而正常阴茎的BOP位于前端。我们也在手术中观察到未融合的球海绵肌（BSM）。目的是评估在低BOP的首次手术中修复未融合的BSM或横断并拉直尿道板的影响。方法：回顾性研究2021年1月至2023年8月连续进行的低BOP的近端尿道下裂手术。在第一次手术中，一些患者只有尿道板横断，没有BSM修复。部分患者行椎板横断或不横断修复。干预后重新评估防喷器位置。结果：对33例低BOP的近端尿道下裂进行了分析。在第一次手术中，作为关键的区分步骤，18例行BSM修复，15例行尿道板横断。修复BSM后的18例患者BOP均移至耻骨前端，而未修复的15例患者BOP无变化(p)结论：修复BSM对BOP的正常化至关重要，这将导致正常的阴茎阴囊关系和正常的阴茎前投射。证据等级：四级。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.