Андрология и генитальная хирургия. 2024; 25: 55-63
Первичная реконструкция эписпадии при экстрофии: модифицированная техника Cantwell с наружной ротацией кавернозных тел
https://doi.org/10.62968/2070-9781-2024-25-4-55-63Аннотация
Цель исследования: представить модификацию техники реконструкции эписпадии по Cantwell, направленную на удлинение и выпрямление ствола полового члена.
Пациенты и методы: проведено проспективное наблюдение за всеми мальчиками с классической экстрофией, у которых применялась предложенная техника. Критериями включения были пациенты с экстрофией периодом послеоперационного наблюдения более 12 месяцев, имевшие уретральную пластинку длиной более 15 мм.
Результаты: в период с ноября 2021 г. по июнь 2023 г. реконструкция полового члена была выполнена 36 пациентам с экстрофией. Из этой когорты 14 мальчиков в возрасте от 12 до 47 месяцев соответствовали критериям включения и перенесли модифицированную реконструкцию. Операция и послеоперационный период не сопровождались серьезными осложнениями. В среднесрочном периоде оценивали внешний вид полового члена, форму при эрекции и мочеиспускание как в амбулаторных условиях, так и посредством фото- и видеофиксации.
Выводы: представленная методика, примененная в однородной группе пациентов с классической экстрофией мочевого пузыря, позволила добиться удлинения полового члена, улучшения внешнего вида, сохранения эрекции и устранения дорсального искривления.
Список литературы
1. Cantwell, F.V. (1895). I. Operative treatment of epispadias by transplantation of the urethra. Annals of surgery, 22(6), 689. https://doi.org/10.1097/00000658-189507000-00084
2. Diamond, D.A., & Ransley, P.G. (1995). Male epispadias. The Journal of urology, 154(6), 2150-2155. https://doi.org/10.1016/s0022-5347(01)66719-3
3. Mitchell, M.E., & Bagli, D.J. (1996). Complete penile disassembly for epispadias repair: the Mitchell technique. The Journal of urology, 155(1), 300-304. https://doi.org/10.1016/s0022-5347(01)66649-7
4. Braga, L.H., Lorenzo, A.J., Bägli, D.J., Khoury, A.E., & Pippi Salle, J.L. (2008). Outcome analysis of isolated male epispadias: single center experience with 33 cases. The Journal of urology, 179(3), 1107-1112. https://doi.org/10.1016/j.juro.2007.10.095
5. Morrill, C.C., Haffar, A., Harris, T.G., Crigger, C., & Gearhart, J.P. (2023). Current management of classic bladder exstrophy in the modern era. African Journal of Urology, 29(1), 27. https://doi.org/10.1186/s12301-023-00356-4
6. Reddy, S.S., Inouye, B.M., Anele, U.A., Abdelwahab, M., Le, B., Gearhart, J.P., & Rao, P.K. (2015). Sexual health outcomes in adults with complete male epispadias. The Journal of Urology, 194(4), 1091-1095. https://doi.org/10.1016/j.juro.2015.04.082
7. Baird, A.D., Gearhart, J.P., & Mathews, R.I. (2005). Applications of the modified Cantwell–Ransley epispadias repair in the exstrophy–epispadias complex. Journal of pediatric urology, 1(5), 331-336. https://doi.org/10.1016/j.jpurol.2005.02.003
8. Grady, R.W., & Mitchell, M.E. (2002). Management of epispadias. Urologic Clinics, 29(2), 349-360. https://doi.org/10.1016/s0094-0143(02)00027-7
9. Sholklapper, T., Crigger, C., Morrill, C., Harris, T. G., Haney, N., Lue, K., & Gearhart, J. P. (2023). Application of Tunica Vaginalis Flap for Epispadias Repair in the Epispadias-Exstrophy Complex. Urology, 171, 190-195. https://doi.org/10.1016/j.urology.2022.10.015
10. de Jesus, L. E., Dekermacher, S., & Pippi-Salle, J. L. (2022). Bladder exstrophy: We need to improve. A lot. Journal of Pediatric Urology, 18(1), 38-e1. https://doi.org/10.1016/j.jpurol.2021.11.007
11. Salle, J. P., Elifranji, M., Abbas, T., Alhadi, A., Elkadhi, A., Leslie, B., & Vallasciani, S. (2022). Technical details in the primary repair of male epispadias: Step by step video. Urology Video Journal, 13, 100127. https://doi.org/10.1016/j.urolvj.2022.100127
12. Gearhart, J. P., Sciortino, C., Ben-Chaim, J., Peppas, D. S., & Jeffs, R. D. (1995). The Cantwell-Ransley epispadias repair in exstrophy and epispadias: lessons learned. Urology, 46(1), 92-95. https://doi.org/10.1016/s0090-4295(99)80167-8
13. Perovic, S. V., Vukadinovic, V., Djordjevic, M. L., & Djakovic, N. G. (1999). Penile disassembly technique for epispadias repair: variants of technique. The Journal of urology, 162(3 Part 2), 1181-1184. https://doi.org/10.1016/s0022-5347(01)68122-9
14. Bar-Yosef, Y., Sofer, M., Ekstein, M. P., Binyamini, Y., & BenChaim, J. (2017). Results of epispadias repair using the modified cantwell-ransley technique. Urology, 99, 221-224. https://doi.org/10.1016/j.urology.2016.07.018
15. Woodhouse, C. R. J. (1986). The management of erectile deformity in adults with exstrophy and epispadias. The Journal of urology, 135(5), 932-935. https://doi.org/10.1016/s0022-5347(17)45927-1
16. Рудин, Ю.Э., Марухненко, Д.В., Алиев, Д.К., & Чекериди, Ю.Э. (2016). Комплексное этапное лечение порока полового члена у мальчиков с эписпадией и экстрофией мочевого пузыря. Экспериментальная и клиническая урология, (4), 128-135.
17. Nikolaev, V. V. (2019). A less invasive technique for delayed bladder exstrophy closure without fascia closure and immobilisation: can the need for prolonged anaesthesia be avoided?. Pediatric Surgery International, 35, 1317-1325. https://doi.org/10.1007/s00383-019-04530-0
18. Николаев В.В., Демин Н.В., Ладыгина Е.А. Отсроченное хирургическое лечение детей с экстрофией без аппроксимации лонных костей, использования перемещенных лоскутов и иммобилизации пациента // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2021. Т. 11, № 4. С. 445–454. DOI: https://doi.org/10.17816/psaic1031
19. Johnston, J. H. (1975). The genital aspects of exstrophy. The Journal of Urology, 113(5), 701-705. https://doi.org/10.1016/s0022-5347(17)59557-9
20. Perovic, S. V., & Djinovic, R. P. (2008). New insight into surgical anatomy of epispadiac penis and its impact on repair. The Journal of urology, 179(2), 689-696. https://doi.org/10.1016/j.juro.2007.09.105
21. Wood, D., Baird, A., Carmignani, L., De Win, G., Hoebeke, P., Holmdahl, G., ... & Tekgul, S. (2019). Lifelong congenital urology: the challenges for patients and surgeons. European Urology, 75(6), 1001-1007. https://doi.org/10.1016/j.eururo.2019.03.019
22. Lottmann, H. B., Yaqouti, M., & Melin, Y. (1999). Male epispadias repair: surgical and functional results with the Cantwell-Ransley procedure in 40 patients. The Journal of urology, 162(3 Part 2), 1176-1180. https://doi.org/10.1016/s0022-5347(01)68120-5
23. Fahmy, O., Khairul-Asri, M. G., Schwentner, C., Schubert, T., Stenzl, A., Zahran, M. H., & Gakis, G. (2016). Algorithm for optimal urethral coverage in hypospadias and fistula repair: a systematic review. European urology, 70(2), 293-298. https://doi.org/10.1016/j.eururo.2015.12.047
24. Koff, S. A., & Eakins, M. (1984). The treatment of penile chordee using corporeal rotation. The Journal of urology, 131(5), 931-931. https://doi.org/10.1016/s0022-5347(17)50716-8
Andrology and Genital Surgery. 2024; 25: 55-63
Primary reconstruction of epispadias in exstrophy: modified Cantwell technique with external rotation of the corpora cavernosa
https://doi.org/10.62968/2070-9781-2024-25-4-55-63Abstract
Objective: to present a modification of the Cantwell epispadias reconstruction technique aimed at lengthening and straightening the penile shaft.
Patients and methods: a prospective follow-up of all boys with classic exstrophy who underwent the proposed technique was conducted. Inclusion criteria were patients with exstrophy with a postoperative followup period of more than 12 months, who had a urethral plate longer than 15 mm.
Results: between November 2021 and June 2023, penile reconstruction was performed on 36 patients with exstrophy. Of this cohort, 14 boys aged 12 to 47 months met the inclusion criteria and underwent a modified reconstruction. The surgery and the postoperative period were not accompanied by serious complications. In the medium term, penile appearance, erectile shape, and urination were assessed both in an outpatient setting and by photo and video recording.
Conclusion: the presented technique, applied in a homogeneous group of patients with classic bladder exstrophy, allowed to achieve penile elongation, improved appearance, erectile function, and elimination of dorsal curvature.
References
1. Cantwell, F.V. (1895). I. Operative treatment of epispadias by transplantation of the urethra. Annals of surgery, 22(6), 689. https://doi.org/10.1097/00000658-189507000-00084
2. Diamond, D.A., & Ransley, P.G. (1995). Male epispadias. The Journal of urology, 154(6), 2150-2155. https://doi.org/10.1016/s0022-5347(01)66719-3
3. Mitchell, M.E., & Bagli, D.J. (1996). Complete penile disassembly for epispadias repair: the Mitchell technique. The Journal of urology, 155(1), 300-304. https://doi.org/10.1016/s0022-5347(01)66649-7
4. Braga, L.H., Lorenzo, A.J., Bägli, D.J., Khoury, A.E., & Pippi Salle, J.L. (2008). Outcome analysis of isolated male epispadias: single center experience with 33 cases. The Journal of urology, 179(3), 1107-1112. https://doi.org/10.1016/j.juro.2007.10.095
5. Morrill, C.C., Haffar, A., Harris, T.G., Crigger, C., & Gearhart, J.P. (2023). Current management of classic bladder exstrophy in the modern era. African Journal of Urology, 29(1), 27. https://doi.org/10.1186/s12301-023-00356-4
6. Reddy, S.S., Inouye, B.M., Anele, U.A., Abdelwahab, M., Le, B., Gearhart, J.P., & Rao, P.K. (2015). Sexual health outcomes in adults with complete male epispadias. The Journal of Urology, 194(4), 1091-1095. https://doi.org/10.1016/j.juro.2015.04.082
7. Baird, A.D., Gearhart, J.P., & Mathews, R.I. (2005). Applications of the modified Cantwell–Ransley epispadias repair in the exstrophy–epispadias complex. Journal of pediatric urology, 1(5), 331-336. https://doi.org/10.1016/j.jpurol.2005.02.003
8. Grady, R.W., & Mitchell, M.E. (2002). Management of epispadias. Urologic Clinics, 29(2), 349-360. https://doi.org/10.1016/s0094-0143(02)00027-7
9. Sholklapper, T., Crigger, C., Morrill, C., Harris, T. G., Haney, N., Lue, K., & Gearhart, J. P. (2023). Application of Tunica Vaginalis Flap for Epispadias Repair in the Epispadias-Exstrophy Complex. Urology, 171, 190-195. https://doi.org/10.1016/j.urology.2022.10.015
10. de Jesus, L. E., Dekermacher, S., & Pippi-Salle, J. L. (2022). Bladder exstrophy: We need to improve. A lot. Journal of Pediatric Urology, 18(1), 38-e1. https://doi.org/10.1016/j.jpurol.2021.11.007
11. Salle, J. P., Elifranji, M., Abbas, T., Alhadi, A., Elkadhi, A., Leslie, B., & Vallasciani, S. (2022). Technical details in the primary repair of male epispadias: Step by step video. Urology Video Journal, 13, 100127. https://doi.org/10.1016/j.urolvj.2022.100127
12. Gearhart, J. P., Sciortino, C., Ben-Chaim, J., Peppas, D. S., & Jeffs, R. D. (1995). The Cantwell-Ransley epispadias repair in exstrophy and epispadias: lessons learned. Urology, 46(1), 92-95. https://doi.org/10.1016/s0090-4295(99)80167-8
13. Perovic, S. V., Vukadinovic, V., Djordjevic, M. L., & Djakovic, N. G. (1999). Penile disassembly technique for epispadias repair: variants of technique. The Journal of urology, 162(3 Part 2), 1181-1184. https://doi.org/10.1016/s0022-5347(01)68122-9
14. Bar-Yosef, Y., Sofer, M., Ekstein, M. P., Binyamini, Y., & BenChaim, J. (2017). Results of epispadias repair using the modified cantwell-ransley technique. Urology, 99, 221-224. https://doi.org/10.1016/j.urology.2016.07.018
15. Woodhouse, C. R. J. (1986). The management of erectile deformity in adults with exstrophy and epispadias. The Journal of urology, 135(5), 932-935. https://doi.org/10.1016/s0022-5347(17)45927-1
16. Rudin, Yu.E., Marukhnenko, D.V., Aliev, D.K., & Chekeridi, Yu.E. (2016). Kompleksnoe etapnoe lechenie poroka polovogo chlena u mal'chikov s epispadiei i ekstrofiei mochevogo puzyrya. Eksperimental'naya i klinicheskaya urologiya, (4), 128-135.
17. Nikolaev, V. V. (2019). A less invasive technique for delayed bladder exstrophy closure without fascia closure and immobilisation: can the need for prolonged anaesthesia be avoided?. Pediatric Surgery International, 35, 1317-1325. https://doi.org/10.1007/s00383-019-04530-0
18. Nikolaev V.V., Demin N.V., Ladygina E.A. Otsrochennoe khirurgicheskoe lechenie detei s ekstrofiei bez approksimatsii lonnykh kostei, ispol'zovaniya peremeshchennykh loskutov i immobilizatsii patsienta // Rossiiskii vestnik detskoi khirurgii, anesteziologii i reanimatologii. 2021. T. 11, № 4. S. 445–454. DOI: https://doi.org/10.17816/psaic1031
19. Johnston, J. H. (1975). The genital aspects of exstrophy. The Journal of Urology, 113(5), 701-705. https://doi.org/10.1016/s0022-5347(17)59557-9
20. Perovic, S. V., & Djinovic, R. P. (2008). New insight into surgical anatomy of epispadiac penis and its impact on repair. The Journal of urology, 179(2), 689-696. https://doi.org/10.1016/j.juro.2007.09.105
21. Wood, D., Baird, A., Carmignani, L., De Win, G., Hoebeke, P., Holmdahl, G., ... & Tekgul, S. (2019). Lifelong congenital urology: the challenges for patients and surgeons. European Urology, 75(6), 1001-1007. https://doi.org/10.1016/j.eururo.2019.03.019
22. Lottmann, H. B., Yaqouti, M., & Melin, Y. (1999). Male epispadias repair: surgical and functional results with the Cantwell-Ransley procedure in 40 patients. The Journal of urology, 162(3 Part 2), 1176-1180. https://doi.org/10.1016/s0022-5347(01)68120-5
23. Fahmy, O., Khairul-Asri, M. G., Schwentner, C., Schubert, T., Stenzl, A., Zahran, M. H., & Gakis, G. (2016). Algorithm for optimal urethral coverage in hypospadias and fistula repair: a systematic review. European urology, 70(2), 293-298. https://doi.org/10.1016/j.eururo.2015.12.047
24. Koff, S. A., & Eakins, M. (1984). The treatment of penile chordee using corporeal rotation. The Journal of urology, 131(5), 931-931. https://doi.org/10.1016/s0022-5347(17)50716-8
