管理与Meatoplasty尿道外口狭窄的外科治疗

Published 11/30/2010
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Summary

Meatoplasty,尿道外口狭窄的手术管理。

Cite this Article

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Wang, M. Surgical Management of Meatal Stenosis with Meatoplasty. J. Vis. Exp. (45), e2213, doi:10.3791/2213 (2010).

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Abstract

包皮环切术后尿道狭窄是一种常见的的泌尿系统并发症。儿童目前他们的初级保健医生偏离尿流的投诉,难以目的,尿痛,尿频。临床检查发现一个精确的鼻道,如果孩子要小便,他通常也会有一个向上的,瘦的,偶尔有力的膀胱排空不全尿流。管理的主体是meatoplasty(重建远端尿道/鼻道)。这种教育视频将证明这是如何进行的。

Protocol

简介:

生殖器疾病是经常遇到的初级保健医生的办公室。尿道外口狭窄,尿道口(鼻道)的异常缩小包皮环切术后发生在9%-10%的男性是一种常见的并发症。这种疾病的特点是向上偏转,难以对目标流尿,排尿困难,尿急,频繁,长期排尿。如果不及时治疗,这可能会导致尿路感染和肾脏问题。手术meatotomy / meatoplasty有疗效。

治疗/诊断程序:

常规的尿液分析将排除尿路感染或糖尿病,尿频的潜在原因。

详细询问病史和体检,包括排尿的观察,确诊。

门诊手术/ meatoplasty有疗效。过程5-10分钟麻醉下进行。

术中准备包括手术放大镜放大,蚊子止血,细尖塑料显微剪刀,Castroviejo持针器,和7-0薇乔缝线;

  1. 孩子是摆在仰卧位。
  2. 最小的皮肤准备和悬垂性的生殖器。无需预防性使用抗生素。
    • 使用优碘聚维酮碘溶液擦洗生殖器区域,并允许保持大约3分钟前初始切口。
    • 阴茎应该用无菌毛巾披。
  3. 右手开站到左侧的耐心和良好的润滑蚊子止血颚头/腹侧尿道口深度约2-3毫米,然后将推出。腹侧组织关闭的止血,然后粉碎。总阻断时间为60秒。
  4. 粉碎腹侧组织阴刻大幅显微剪刀(图1)和内在的尿道粘膜和glanular组织reapproximated在中断方式使用7-0薇乔缝线(Castroviejo持针器图2)。

恢复时间是最小的,和孩子送到家庭与泰诺不适需要。凡士林是适用于伤口3-4x/day。

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Discussion

结果:

症状性尿道狭窄是令人沮丧的儿童和家庭。如果不及时治疗,有一个潜在的慢性膀胱排空不全,尿路感染和随后的肾功能损害的偶然发展。

重建meatoplasty治疗,可以做一个简短的麻醉下。

结论:

尿道外口狭窄是常见的并发症的割礼。一个彻底的历史和物理,就会发现尿道外口狭窄的诊断。手术治疗是根治性治疗。良好的执行meatoplasty,可以做到以最小的仪器。

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Disclosures

没有利益冲突的声明。

Acknowledgements

作者感谢约翰霍普金斯大学的手术室工作人员,并在约翰霍普金斯儿童医院的儿科部媒体关系。

Materials

Name Company Catalog Number Comments
Betadine
Mosquito hemostat
Microsurgical scissor
Castroviejo needle driver
7-0 vicryl suture Ethicon Inc.

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References

  1. Van Howe, R. S. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila). 45, (1), 49-54 (2006).
  2. Litvak, A. S., Morris, J. A., McRoberts, J. W. Normal size of the urethral meatus in boys. J Uro. 115, (6), 736-737 (1976).
  3. Brown, M. R., Cartwright, P. C., Snow, B. W. Common office problems in pediatric urology and gynecology. Pediatr Clin North Am. 44, (5), 1091-1115 (1997).
  4. Smith, C., Smith, D. P. Office pediatric urologic procedures from a parental perspective. Urology. 55, (2), 272-276 (2000).
  5. Frank, J. D., Pocock, R. D., Stower, M. J. Urethral strictures in childhood. Br J Urol. 62, (6), 590-592 (1988).
  6. Persad, R., Sharma, S., McTavish, J. Clinical presentation and pathophysiology of meatal stenosis following circumcision. Br J Urol. 75, (1), 91-93 (1995).
  7. Stenram, A., Malmfors, G., Okmian, L. Circumcision for phimosis: a follow-up study. Scand J Urol Nephrol. 20, (2), 89-92 (1986).
  8. Hinman, F., Baskin, L. Chapter 155. Hinman s Atlas of Pediatric Urologic Surgery. 2nd ed., 773-775 (2008).
  9. Belman, A. B., King, L. R., Kramer, S. A. Clinical Pediatric Urology. 4th ed, 214-215 (2002).
  10. Wein, A. J., Kavoussi, L. R., Novick, A. C., Partin, A. W., Peters, C. A. Campbell-Walsh Urology. 9th ed, 1044-1045 (2007).

Comments

2 Comments

  1. what is the incidence of glanular hypospadius post meatoplasty?

    Reply
    Posted by: Majed S.
    December 11, 2010 - 2:44 PM
  2. This should not occur, if only the ventral scar tissue is excised.

    It is possible hypospadias was missed on initial diagnosis.

    Reply
    Posted by: Anonymous
    December 12, 2010 - 9:45 PM

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