Surgical Technique of Glans Wings Creation with Preservation of Glanular Vascular Arcade and Creating Flaps for Tension-Free Glansplasty in Hypospadias Repair.

IF 1 Q4 UROLOGY & NEPHROLOGY
Archika Gupta, S N Kureel, Gurmeet Singh, Survesh Kumar Gupta, Kanoujia Sunil
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引用次数: 0

Abstract

Objective: The objective of this study is to report the technical nuances of glans wings creation in anatomical plane facilitating liberal glans wings mobilization with preservation of glanular vessels for tension-free glansplasty in surgery of hypospadias in primary and redo cases.

Materials and methods: Eighty-six primary hyposapdias and 7 cases of distal hypospadias, operated elsewhere and presented with glans and urethroplasty dehiscence, undergoing tubularized-incised-plate (TIP) repair were included after ethical approval. Technical points of glans wings creation in the subfascial plane included (i) creation of Buck's fascia window, just proximal and lateral to the point of bifurcation of corpus spongiosum, (ii) creation of subfascial-pret unical plane on the tunica albuginea of corpora cavernosa up to ventral limit of laid open glanular meatus, (iii) release of pillars of corpus spongiosum off the glans base keeping the basal lamina propria covering the vascular arcade intact, (iv) release of glans base off the tip of corpora cavernosa and composite flap of corpus spongiosum pillars with Buck's fascia off the corpora cavernosa, (v) approximation of glans wings over the tubularized-incised-plate covered with dartos, and (vi) approximation of fasciospongioplasty flaps at hypospadiac meatus. Outcome measurement included (i) intra and postoperative problems and (ii) elimination of glans dehiscence.

Results: There occurred 1 injury to the tunica albuginea of ventral corpora cavernosa and 1 button-hole injury to subcoronal mucosal collars. Flaps for fasciospongioplasty were short in 11. One glans dehiscence occurred in flat glans.

Conclusions: This technique is effective in creating glans wings in the anatomical plane with the preservation of glanular vessels and flaps for fasciospongioplasty eliminating the possibility of glans dehiscence in both fresh and redo cases.

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尿道下裂无张力腺体成形术中保留腺体血管拱廊造翅及造皮瓣的手术技术
目的:本研究的目的是报告在解剖平面上形成龟头翼的技术上的细微差别,以便在原发性和复发性尿道下裂手术中自由的龟头翼活动并保留龟头血管以进行无张力的龟头成形术。材料与方法:本组86例原发性尿道下裂及7例远端尿道下裂经伦理批准行根管切开钢板(TIP)修补术。在筋膜下平面制造龟头翼的技术要点包括(i)在海绵体分叉点的近端和外侧制造Buck’s筋膜窗,(ii)在海绵体的白膜上制造筋膜下-龟头前平面,直至开放的腺体通道的腹侧极限,(iii)从龟头基部释放海绵体支柱,保持覆盖血管拱桥的基底固有层的完整。(iv)将龟头基部从海绵体顶端释放,并与巴克筋膜从海绵体上分离出海绵体柱复合瓣,(v)将龟头翼近似于覆盖有裂口的管状切口板上,(vi)近似于尿道下道处的筋膜海绵成形术瓣。结果测量包括(i)手术内和术后问题和(ii)龟头开裂的消除。结果:发生腹侧海绵体白膜损伤1例,冠下粘膜领扣孔损伤1例。11例筋膜海绵成形术皮瓣短。一个龟头开裂发生在扁平龟头。结论:该技术可有效地在解剖平面上形成龟头翼,保留龟头血管和皮瓣进行筋膜海绵成形术,消除了新鲜和重做病例龟头开裂的可能性。
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来源期刊
Turkish journal of urology
Turkish journal of urology Medicine-Urology
CiteScore
2.10
自引率
0.00%
发文量
53
期刊介绍: The aim of the Turkish Journal of Urology is to contribute to the literature by publishing scientifically high-quality research articles as well as reviews, editorials, letters to the editor and case reports. The journal’s target audience includes, urology specialists, medical specialty fellows and other specialists and practitioners who are interested in the field of urology.
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