PRIROĐENO SAVINUĆE PENISA (KORDA BEZ HIPOSPADIJE): KIRURŠKO LIJEČENJE SAVINUĆA PENISA I/ILI FORMIRANJE NOVE MOKRAĆNE CIJEVI SLOBODNIM TRANSPLANTATOM SLUZNICE USTA

IVAN KOLAR

Prikazali smo 19 dječaka s ventralnim savinućem penisa bez hipospadije. Prema jačini anomalije svrstali smo ih u tri skupine. U 1. skupini od 7 dječaka prednje savinuće penisa djelovalo je kao skraćenje frenuluma uz nabiranje kože. Riješili smo ga frenulotomijom, a kod 4 dječaka i prednjom »V« »Y«-plastikom kože penisa uz odličan kozmetski efekt. U 2. skupini od 10 dječaka postojala je očita korda. Kod 4 korda je bila tipa III po Devin-Hortonu. Učinjena je kordektomija s »V« »Y«-plastikom kože uz dobar rezultat. Preostalih 6 imali je tip II korde po D-H. Ovdje je učinjen isti kirurški zahvat, ali još i uz Nesbitovu plikaciju tunike albugineje kod njih 4 i uspješnost od 50% (3 od 6). U 3. skupini bilo je pet dječaka, i to tri neuspješno operirana iz 2. skupine i dva s »kožnom uretrom« tip korde I po D-H. Svim dječacima iz te skupine učinjena je plastika uretre tubularnim presatkom sluznice usta. Dobar rezultat postignut je kod 3 od 5 dječaka (60%). Uspješan rezultat postignut je kod oba slučaja s »kožnom uretrom« koji nisu prethodno operirani. Rezultati naših uretroplastika bukalnom sluznicom uklapaju se među rezultate u literaturi. Kod operacije korde bez hipospadije gdje je potrebno rekonstruirati mokraćnu cijev stalno se nameće problem nedostatka okolnog tkiva; mislimo da je tada bukalna sluznica dobar izbor.

Summary. Presented are the cases of 19 boys with ventral penile curvature without hypospadias. The cases were categorised into three groups according to the severity of the anomaly. In group I were 7 boys with ventral penile curvature affecting the shortening of the frenulum with skin tethering. The anomaly was corrected by fraenulotomy and, in 4 boys, by ventral »V« and »Y« penile skinplasty with excellent cosmetic results. In group II were 10 boys with an evident chordee. In 4 boys, the chordee was of type III according to Devin-Horton. A chordectomy was done with a »V« and »Y« skinplasty with very good result. The remaining 6 cases were chordee type II according to D-H. The same treatment was undertaken here, but with an additional Nesbit’s dorsal tunica albuginea plication in 4 boys and a 50% success (3 of 6). In group III were 5 boys, 3 previously failed chordectomy from group II and 2 with »skin urethra« type chordee I according to D-H. All boys in this group were treated for urethroplasty with autologous buccal mucosal graft. Good results were obtained in 3 of 5 (60%). Successful outcome was achieved in both cases with »skin urethra« not previously treated. The results of our urethroplasty with buccal mucosa agree with those in literature. In the treatment of chordee without hypospadias, where it was necessary to reconstruct the urethra there was a constant problem of the shortage of local tissue, so we believe that buccal mucosa is a good choice.