이물 육아종 제거 후 음낭 피판을 이용한 음경 재건

권순범,어수락,조상헌,이광수,이해원 동국대학교 의학연구소 2009 東國醫學 Vol.16 No.1

이물질 주사를 통한 음경 확대술은 비교적 흔히 행하여 지고 있는 시술로, 바셀린,실리콘과 파라핀 등이 주로 사용되고 있으며, 이로 발생하는 심각한후유증에 대한 경각심이 커짐에도 불구하고 음경의 둘레를 확대하기 위해 비의료인에 의해 행하여지고 있다. 합병증으로는 음경모양의 변형, 염증반응,피부괴사,육아종, 색전증과 악성 종양 등이 발생할 수 있다. 음경의 이물 육아종세 대한 치료는 이물질에 의하여 침윤된 피부,피하 조직의 완전한 제거와 다양한 국소 피판 또는 피부이식에 의한 음경 재피복으로 이루어 진다. 광범위한 음경 피부 결손의 경우 부분층 피부 이식이 우선 고려될 수 있으나, 음경해면체(corpora cavernosa)까지 이물질이 침윤한 경우 육아종의 완전한 제거가 불가능할 수 있으며, 수술 후 잔류 육아종은 피부이식의 생착을 어렵게 한다. 이러한 경우에는 안전한 음경 재피복을 위하여 음낭 피판을 사용할 수 있다. 음낭 피부는 이소성 모발성장을 보이는 경향에도 불구하고, 뛰어난 신축성과 풍부한 혈관 분포로 안해 마피 음경체(denuded penis)의 재피복을 위한 훌륭한 재료로 판단된다. 저자들은 음경의 이물 육아종 제거 후 발생한 광범위한 피부 결손이 었는 3명의 환자를 음낭 피판으로 치료하였다. 3명 모두에서 별다른 합병증 없이 만족스런 결과를 보였다. Penile augmentation with foreign body injection is a relatively common practice. Materials such as vaseline, silicone and paraffin are usually injected. Despite awareness of the potentially damaging effects of these practices, they are still being used by laymen in attempts to increase the circumference of the penile shaft. Penile deformity, inflammation, tissue necrosis, granuloma, embolism and malignant tumor are some of the complications that may follow. Treatment plan for patients with large penile foreign body granuloma include complete removal of foreign body infiltrated skin and subcutaneous tissue, followed by penile resurfacing with skin graft or various local flaps. Thick, nonmeshed, split-thickness skin grafts are preferred for extensive penile reconstruction. But, sometimes the foreign body infiltration of corpora cavernosa makes complete removal of foreign body granuloma impossible, and the remnant foreign body granuloma does not permit skin graft coverage. For patients with such problems, scrotal flaps can be utilized for safe coverage. The scrotal skin, with high elasticity and vascularity, has proven to be a good material for reconstruction of denuded penis, despite its hair bearing nature. We have treated 3 patients with penile foreign body granuloma using scrotal flaps. The postoperative course was uneventful. All flaps survived with no significant complications.

Total Urethra and Penile Shaft Reconstruction with Combined Pedicled Anterolateral Thigh Flap and Radial Forearm Free Flap after Total Penectomy

Pietro Giovanni di Summa,Gianluca Sapino,Olivier Bauquis 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.3

Total reconstruction of the penis (TPR) represents a challenge for urologists and plastic surgeons, especially when urethral length is severely reduced.We here describe, for the first time in an oncologic scenario, a double flap phalloplasty using a pedicled anterolateral thigh (ALT) flap for penile reconstruction and a radial forearm free flap (RFFF) for complete neourethra and glans reconstruction following penile amputation. A 48-year-old patient came to our department following a total penectomy with inferior urethral derivation. The indication for a double flap phalloplasty was posed as only way to fully reconstruct the urethra on its length avoiding possible complications of single flap reconstruction using tube-into-tube technique. Both flaps healed uneventfully with no neourethral strictures or fistulas described. At 18 months follow-up, the patient was extremely satisfied with the aesthetic result and was able to void in standing position. We think that a double free tissue transfer for TPR should be considered, particularly when a urethral length>14 cm needs to be reconstructed. While the pedicled ALT can be used to reconstruct a proper penile shaft with an easily concealed scar, the RFFF can provide adequate neourethra length with satisfactory sensory recovery at the neoglans.

변형 Biemer 방법에 의한 요골부위 전박 유리피판을 이용한 음경재건

김성덕,하범준,문구현,현원석,방사익,오갑성 大韓微細手術學會 2002 Archives of reconstructive microsurgery Vol.11 No.2

Concealed index for concealed penis in prepubertal children

Kobiljon Ergashev,정재민,이상돈 대한비뇨의학회 2021 Investigative and Clinical Urology Vol.62 No.2

Purpose: The concealed penis (CP) is a congenital or acquired genital anomaly that requires surgical correction. To construct an objective CP severity index, we compared the penile parameters of a CP with a normal penis (NP) and postoperative outcomes of CP patients. Materials and Methods: In this retrospective study, 391 boys under 14 years who visited our hospital between September 2017 and February 2020 were included. Among these boys, 105 patients had a CP and 286 boys had a NP without CP. The stretched penile length (SPL), penile circumference (PC), and penile length above baseline skin level (BPL) were measured using a ruler (cm), and the testicular volume was measured using an orchidometer (mL). We defined the concealed index according to SPL (CIs) as BPL/SPL and the concealed index according to circumference (CIc) as BPL/PC. A repair of the CP was performed in the CP patients. All parameters were measured before surgery and after three months. Results: The CP had significantly shorter SPL and BPL, and smaller CIs, and CIc than the NP. The cutoff values for the CIs and CIc were 0.68 and 0.58, respectively (sensitivity 86.7% and 86.7%; specificity 65.0% and 88.5%, respectively). After repair of the CP, all penile parameters were significantly improved. Conclusions: The CIs and CIc are useful and objective parameters for checking the severity of CP, and evaluating the postoperative outcome of CP repair. We newly introduced cutoff values for the CIs (0.68) and CIc (0.58) for diagnosing and evaluating CP repair.

Long-Term Results after Surgical Treatment of Congenital Penile Curvature Using a Modified Nesbit Technique

Ioannis Sokolakis,Petra Schönbauer,Ioannis Mykoniatis,Hubert Kübler,Jürgen Gschwend,Sven Lahme,Georgios Hatzichristodoulou 대한남성과학회 2020 The World Journal of Men's Health Vol.38 No.4

Purpose: Congenital penile curvature (CPC) is a rare condition with surgical correction being the standard therapy. In the current study, we report long-term results analyzing the surgical and functional outcomes using a modified Nesbit technique. Materials and Methods: Patients with CPC were included. After penile degloving and mobilization of the neurovascular bundle an artificial erection was performed. An ellipsoid part of the tunica albuginea was excised at the point of maximum curvature on the convex side of deviation. The tunical defect was then closed by interrupted absorbable sutures with inverted knots. Results of correction were documented intra- and postoperatively by artificial erection. Pre- and postoperative evaluation included measurement of penile length and curvature after pharmacological erection. Erectile function, alteration in glans sensation, palpable suture as well as short- and long-term complication were also recorded using validated questionnaires and objective examinations. Results: Fifty-five patients with mean age 26.93 years (14–66 years) and mean curvature 69.81° (25°–90°) were included in the study. Ventral or ventrolateral curvature was observed in 83.6%. Mean operative time was 106.8 minutes (55–169 minutes). Totally straightness of the penis was achieved in 51/55 patients (92.8%). After a mean long-term follow-up of 36.68 months (4–87 months), erectile function worsened in 3.6% of patients. Median penile length loss associated with this technique was 1.7 cm (0–3.0 cm). Conclusions: Surgical therapy of CPC using our modified Nesbit technique is feasible, safe and provides reliable long-term outcomes, representing an alternative for surgical correction of CPC.

Cell-based Approaches for Treating Erectile Dysfunction

배재현,James J. Yoo 대한남성과학회 2010 The World Journal of Men's Health Vol.28 No.1

Patients with erectile dysfunction (ED) often lose self-esteem, leading to severe psychological impairment. Although many forms of ED can be corrected with currently available therapeutic measures, several types of ED and its associated conditions may not be readily treated. Recently, the concept of cell transplantation has been applied to address ED with the goal of restoring normal anatomical tissue configuration and erectile function. This article provides an overview of the fundamental principles of these cell-based approaches and presents a framework that can be used to interpret current and future studies as well as to encourage further research into cell-based therapies.