Distal Hipospadias Cerrahisinde Daha İyi Bir Görünüme Yol Açan Modifikasyon: Frenuloplasti

Year 2021, Volume: 8 Issue: 3, 207 - 210, 28.12.2021

Alev Suzen , S. Cüneyt Karakuş

https://doi.org/10.47572/muskutd.952640

Abstract

Distal hipospadias cerrahisinde yaygın olarak kullanılan tekniklere eklediğimiz frenuloplasti modifikasyonu ile ilgili sonuçlarımızı sunmak. Haziran 2008 ile Aralık 2019 tarihleri arasında frenuloplasti ile modifiye edilmiş distal hipospadias cerrahisi uygulanan 306 çocuk geriye dönük olarak incelendi. Bizim tekniğimizde, üretral plağa kadar uzanan çepeçevre sünnet insizyonu yerine, koronal sulkusun yaklaşık 1 cm proksimalinden posterior ve lateralden insize edildikten sonra bu insizyon anteriorda oblik seyreden mukokutanöz bileşke boyunca devam ettirilerek frenular kanatlar oluşturuldu. Frenuloplasti modifikasyonunun başarılı bir şekilde uygulanması için glans yeterince disseke edildi. Üretroplasti sonrası glans kanatları ve frenular kanatlar gergin olmayacak şekilde yaklaştırıldı. Penis derisini ventralde glansın hemen altına dikmek yerine frenulum oluşturuldu ve sünnetli bir çocuğun penisine benzer bir görünüm elde edildi. Hastaların ortalama yaşı 3.93±3.3 yıl idi. Ortalama takip süresi 19±6.17 aydı. Hastaların 15'inde (%4.9) glanüler, 72'sinde (%23.5) koronal, 143'ünde (%46.7) subkoronal ve 67'sinde (%21.9) penil yerleşimli üretral meatus mevcuttu. Dokuz (%2.9) hastada megamatus ve intakt prepisyum tespit edildi. 16 (%5.2) olguda MAGPI, 264 hastada (%86.3) TIPU, 17 olguda üretral mobilizasyon/ilerletme ve 9 hastada GAP tekniği kullanıldı. 28 (%9.2) hastada komplikasyon meydana geldi. Hastaların 11’inde (%3.6) üretrokutanöz fistül oluşumu, 17’sinde (%5.6) meatal darlık ve 1 (%0.3) olguda onarımda ayrılma gözlendi. Meatusun yerinden ve kullanılan hipospadias onarım tekniğinden bağımsız olarak kullanılabilen frenuloplasti modifikasyonu, normal sünnetli penis görünümü oluşturarak tatmin edici kozmetik sonuçlar sağlamaktadır. 

Keywords

Frenulum, Glans, Hipospadias, Kozmetik Sonuçlar, Üretroplasti

Supporting Institution

yok

Modification in Distal Hypospadias Surgery That Leads to A Better Appearance: Frenuloplasty

Abstract

To present our results regarding the frenuloplasty modification, which we added to the techniques commonly used in distal hypospadias surgery. We retrospectively reviewed 306 children who underwent distal hypospadias surgery modified with frenuloplasty between June 2008 and December 2019. In our technique, the penis was incised approximately 1 cm proximal to the coronal sulcus posteriorly and laterally, and this incision was continued anteriorly along the oblique mucocutaneous junction to form frenular wings, instead of linear circumscribing incision joined the urethral plate. Glans wings must be dissected sufficiently for successful implementation of frenuloplasty modification. The glans wings and frenular wings were re-approximated without tension after uretroplasty. Instead of suturing the penile skin just to the end of the glans ventrally, the frenulum was formed, resulting in an appearance similar to the penis of a circumcised child. The mean age of the patients was 3.93±3.3 years. The mean follow-up was 19±6.17 months. Location of hypospadias was glanular in 15 (4.9%), coronal in 72 (23.5%), subcoronal in 143 (46.7%) and penil in 67 (21.9%) patients. Nine (2.9%) patients had megameatus intact prepuce. MAGPI was used in 16 (5.2%), TIPU in 264 (86.3%), urethral mobilization/advancement in 17, and GAP technique in 9 cases. The following complications occurred in 28 patients (9.2%): urethrocutaneous fistula formation in 11 (3.6 %), meatal stenosis in 17 (5.6 %) and dehiscence in one (0.3%). Frenuloplasty modification provides satisfactory cosmetic outcomes with the appearence of normal circumcised penis. It can be performed regardless of meatal location and technique used. 

Keywords

Cosmetic Outcomes, Frenulum, Glans, Hypospadias, Urethroplasty

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