Objective:To evaluate the efficacy and safety of vacuum sealing drainage(VSD)and moist healing technology in the treatment of hypospadias of children.Methods:From January 2015 to January 2017, 80 cases of children with proximal hypospadias and moderate or severe penile curvature from 1.5 years to 12 years old who received hypospadias operation were assigned into the study group(SG)( n=40)and control group(CG)( n=40), based on simple randomization. 80 cases of children were done operation included correcting the penile curvature and urethroplasty(Duckett urethroplasty)by one surgeon, all of them were received the procedure covered the urethra by scrotal septum tissue. The cases of SG were installed VSD after covered soft polysilicone wound dressing (merlot), who underwent treatment of slowly flushing by saline solution(liquid drop, 7 drops/min)and attracting by negative pressure(negative pressure range, from -30 kpa to -20 kpa)for 7 days. The cases of CG were bound up the penis with merlot, gauze and self-adhesive elastic bandage for 7 days. All cases of two group were sterilize by iodophor after opening dressing, smeared erythromycin ointment and applied hydropathic compress by wet gauze to help blood scab accelerate to drop, when blood scab appeared. All cases were conventionally reserved with F8 catheter for 1 month. The standard of successful operation was that there was no complication, included urethral fistula, urethral stenosis, urethral dehiscence, urethrocele and dysuresia. Results:The children of SG were found to be well tolerated to VSD, there was no adverse reaction to VSD. 7 days after operation, incidence of blood scab(20%, 8/40)and rate of under-scab infection of SG(12.5%, 5/40) were lower than CG[42.5%(17/40), 32.5%(13/40)], the differences were statistically significant( χ2=4.713, P=0.030; χ2=4.588, P=0.032). 1 month postoperation, urethral fistula 5 cases, urethral stenosis 1 case were found in SG, otherwise CG complications included urethral fistula 9 cases, urethral dehiscence 1 case and urethral stenosis 1 case. The success rate of surgery of SG was higher than CG[85(34/40) vs 72.5%(29/40)%]. Conclusions:Applying VSD continuously slowly flushing and extracting by negative pressure to hypospadias treatment is effective and safe, which could effectively reduce the blood scab formation and the rate of under-scab infection, which can increase the success rate of hypospadias surgery.

例1 男 ,3岁 ,因左侧阴囊空虚入院 ,初诊为"左侧隐睾".体格检查时于左侧阴囊及腹股沟区未触及睾丸组织.超声检查示 :左侧阴囊空虚并左侧腹腔髂血管旁类睾丸样回声 ,左侧腹股沟杂乱回声(考虑腹股沟疝).实验室检查示性激素在正常参考值范围内.入院后拟行"左侧睾丸下降固定术+疝囊高位结扎术".术中于左侧睾丸引带处见一类睾丸样肿物(图1) ,大小约10 mm × 6 mm × 5 mm ,质软 ,包膜完整 ,表面光滑 ,肿物与同侧主睾丸、附睾及输精管分离 ,同侧主睾丸、附睾无明显异常 ,给予切除肿物 ,同时下拉固定左侧主睾丸 ,结扎疝囊.术后病理检查报告 :镜下见生精小管基底膜增厚 ,生精细胞及支持细胞减少 ,部分小管内生精细胞缺如 ,仅见少许支持细胞 ,睾丸间质增生 ,间质细胞减少 ,符合睾丸发育不良(图2).患儿术后3 d出院 ,术后1个月复诊双侧睾丸、附睾未见明显异常.

Objective To explore the treatment effect of pedicled myocutaneous island flap of anterolateral thigh muscle on the suprapubic defect caused by bladder exstrophy in children. Methods The clinical data of 3 adolescents with bladder exstrophy were analyzed. All 3 cases underwent one-stage Kelly procedure and received the treatment using pedicled myocutaneous island flap of anterolateral thigh muscle to repair the suprapubic defect. The bladder expansion was performed with ileal sarcoplasmic layer graft, and the Cohen ureteral reimplantation was performed as well, for 1 case 1, 1 year after the first operation. The others 2 patients didn′t receive the second operation. Results All operations were successful. The femoral donor regions were directly closed. Postoperative follow-up period was 1-7 years. The myocutaneous island flaps were survived and grew well. All incisions of the femoral donor region were primary healing without scar hypertrophy. Urinary continence was achieved in 2 cases, and partially achieved in 1 case. Recurrent urinary tract infection, recurrent fever or abdominal pain were not observed in all patients. Conclusions The pedicled anterolateral thigh myocutaneous island flap is an alternative way to repair suprapubic defect caused by bladder exstrophy.

Objective To explore the efficacy of superficial bladder neck incision (SBNI) plus urethral valve electrotomy (UVE) for posterior urethral valve (PUV).Methods A total of 36 PUV patients were retrospectively analyzed from April 2014 to April 2017.All diagnoses were confirmed preoperatively after the examinations of color Doppler ultrasound,voiding cystourethrogram (VCUG) and urodynamics test,etc.Twenty-one cases in group 1 underwent UVE through pediatric urethroscope from April 2014 to April 2016 while another 15 cases in group 2 SBNI plus UVE from May 2016 to April 2017.During a follow-up period of 3-6 months,reexaminations of color Doppler ultrasound,VCUG and urodynamic test were performed for analyzing the impact of different operative approaches on bladder function in PUV patients.Results After operation,statistical analysis was compared with the preoperative results of urodynamic data in two groups.In group one,no significant changes existed in maximal detrusor pressure (Pdetmax),uroflowmetry (UFM),maximum bladder capacity (MBC) and post voiding residual (PVR) urine while there were significant changes in bladder compliance (BC).In group two,significant changes existed in Pdetmax,UFM,MBC,BC and PVR while there was no significant change in UFM.Significant inter-group changes existed in Pdetmax,MBC,BC and PVR.Conclusions For PUV children,the combined approach of SBNI plus UVE may improve bladder compliance and reduce damaged degree in bladder wall.