Çocuklarda Konjenital İzole Penil Torsiyon ve Basit Cerrahi Onarımı

Yıl 2021, Cilt: 6 Sayı: 4, 542 - 547, 01.12.2021

Mehmet Arpacık , Hayriye Nihan Karaman Ayyıldız , Semih Lütfi Mirapoğlu , Ceyhan Şahin , Zekeriya İlce

https://doi.org/10.26453/otjhs.989316

Öz

Amaç: Amacımız konjenital izole penil torsiyon prevalansını saptamak ve basit bir teknik ile onarım sonuçlarını sunmaktır.

Materyal ve Metot: Kliniğimize sünnet istemiyle 2016 ile 2019 yılları arasında başvuran 2650 erkek çocuk konjenital izole penil torsiyon açısından değerlendirildi.Torsiyon derecesi ve yönüne göre sınıflandırıldı ve klinik bulguları incelendi. Torsiyon derecesi >45 derece olan hastalara sünnet ve degloving uygulandı. Raphe mevcut konumunda bırakılarak frenilum-cilt yeniden hizalama ile torsiyon düzeltildi. Sonuçlar değerlendirildi.

Bulgular: Çocukların %1,2 (n=32)’sinde >45° konjenital izole penil torsiyon tespit edildi. Torsiyon yönü %93,8 (n=30) hastada sola, %6,2 (n=2) hastada sağa idi. Hastaların %37,5 (n=12)’inde peniste eğrilik, okul çağındaki üç hastada peniste eğrilik ve yana işeme şikayeti vardı. Ameliyat sonrası hastaların %9,3 (n=3)’ünda kendiliğindendüzelen ekimoz görüldü. Hiçbir hastada rezidü torsiyon görülmedi.

Sonuç: Çocuklarda >45° izole penil torsiyon oranı %1,2 idi. Raphe mevcut konumunda bırakıldığında basit ve güvenli bir yöntem olan degloving-cilt yeniden hizalama ile tüm torsiyonlar düzeltilebilir.  

Anahtar Kelimeler

cerrahi onarım, çocuk, penil torsiyon, prevelans

Destekleyen Kurum

Herhangi bir kurumdan destek alınmamıştır

Congenital Isolated Penile Torsion and Simple Surgical Repair in Children

Öz

Objective: We aimed to determine the prevalence of congenital isolated penile torsion and to present the results of correction by a simple surgical technique.

Materials and Methods: Between 2016 and 2019, 2650 boys who presented circumcision request were evaluated in terms of congenital isolated penile torsion in our clinic.They were classified in terms of the degree and direction of torsion, and their clinical complaints were investigated. Circumcision and degloving were performed to patients that its had 45 degrees or more torsion. Raphe was left in its original position, and torsion was corrected by frenulum-skin realignment. Results were evaluated.

Results: Congenital isolated penile torsion of >45° was reported in 1.2% (n=32) boys. The direction of torsion was to the left in 93.8% (n=30) and to the right in 6.2% (n=2) patients. Moreover, 37.5% (n=12) patients had complaints of torsion in the penis, and three patients of school age had complaints of sideways-pointing urine stream. Ecchymosis, which resolved itself, was observed in 9.3% (n=3) of the postoperative patients. No patients had residual torsion.

Conclusion: The prevalence of congenital isolated penile torsion was in 1.2% (>45°) boys. The method of degloving and frenulum-skin realignment leaving the raphe in its original position is a safe and simple method that can be performed to correct all torsions. 

Anahtar Kelimeler

children, prevelans, surgical correction, penile torsiyon

Kaynakça

• Castagnetti M, Leonard M, Guerra L, Esposito C, Cimador M. Benign penile skin anomalies in children: A primer for pediatricians. World J Pediatr. 2015;11(4)316-323. doi:10.1007/s12519-015-0015-5
• Bıçakçı Ü, Issı Y, Yağız B, DemirelBD. Evaluation the outcome of two-stage repair in children with proximal hypospadias and severe chordee with hypospadias objective penile evaluation (HOPE) scoring. J Contemp Med 2019;9(4):373-377. doi:10.16899/jcm.561241
• Kestel M, Tarhan H, Şahin H. Male Circumcision. Medical Journal of Mugla Sitki Kocman University 2018;5(1):27-31.
• El Darawany HM, Al Damhogy ME, Kandil MS, Elkordi ME, Nagla SA, Taha MR. Procedures used for correction of isolated penile torsion: are they competitive or complementary? Int. Urol Nephrol. 2019;51(8):1313-1319. doi:10.1007/s11255-019-02163-9
• Elbakry A, Zakaria A, Matar A, El Nashar A. The management of moderate and severe congenital penile torsion associated with hypospadias: Urethral mobilisation is not a panacea against torsion. Arab J Urol. 2013;11(1):1-7. doi:10.1016/j.aju.2012.12.004
• Pişkin MM, Yılmaz K. Embrryology and developmental mechanisms of the male urogenital system (penis and urethra). Turk Urol Sem. 2011;2:170-172.
• Cunha GR, Baskin LS. Development of the external genitalia. Differentiation. 2020;112:7-9. doi:10.1016/j.diff.2019.10.008
• Jordan G, McCammon K. Surgery of the penis and urethra, Urology(10th edition), Walsh C, Philadelphia, USA; 2012: 177–189.
• Bhat A, Bhat M, Kumar V, Goyal S, Bhat A, Patni M. The incidence of isolated penile torsion in North India: A study of 5,018 neonates. J Pediatr Urol. 2017;13(5):491.e1-491.e6. doi:10.1016/j.jpurol.12.031
• Eroglu E, Gundogdu G. Isolated penile torsion in newborns. Can Urol Assoc J. 2015;9(11-12):805-807. doi:10.5489/cuaj.2833
• Fisher PC, Park JM. Penile torsion repair using dorsal dartos flap rotation. J Urol. 2004;171(5):1903-1904. doi:10.1097/01.ju.0000120148.79867.5c
• Aykaç A, Baran Ö, Yapıcı O, Aygün BA, Aydın C, Çakan M. Penil degloving and dorsal dartos flap rotation approach for the management of isolated penile torsion. Turk J Urol. 2016;42(1):27-31.
• Aldaqadossi HA, Elgamal SA, Seif Elnasr MK. Dorsal dartos flap rotation versus suturing tunica albuginea to the pubic periosteum for correction of penile torsion: a prospective randomize study. J Pediatr Urol. 2013;9(5)643-647. doi:10.1016/j.jpurol.2012.07.014
• Elbatarny AM, İsmail KA. Penile torsion repair in children following a ladder step: simple steps are usually sufficient. J Pediatr Urol. 2014;10(6):1187-1192. doi:10.1016/j.jpurol.2014.05.009
• Bhat A, Sabharwal K, Bhat M, Singla M, Kumar V, Upadhyay R. Correction of penile torsion and chordee by mobilization of urethra with spongiosium in chordiee without hipospadias. J Pediatr Urol. 2014;10(6)1238-1243. doi:10.1016/j.jpurol.2014.06.016
• Marret JB, Ravasse P, Raffoul L, Rod Jullian. The Fisher Technique for correction of penile torsion in children: Who are the candidates? Urology. 2017;104(6):179-182. doi:10.1016/j.urology.2017.02.038