Search

Objective: To investigate the efficacy and safety of oral testosterone therapy in individuals diagnosed with androgen insensitivity syndrome (AIS). Methods: A self-controlled study design was utilized, focusing on individuals with AIS who were genetically diagnosed at the Department of Endocrinology, Genetics, and Metabolism of Beijing Children's Hospital between 2009 and 2021. These patients underwent treatment involving the administration of testosterone. The primary observed indexes include the measurement of penis length, which should meet the minimal surgical standard (penis length≥2.5 cm) or greater than or equal to -2.5 s (lower limit of normal). Secondary observed indexes include penile length standard deviation score (PL-SDS), an increase in penis longitude (ΔPL), medication dosage, the course of therapy, and safety indicators, among others. There were 4 courses of treatment. After each course, patients were evaluated to determine whether termination of treatment was appropriate. Patients who exhibited inadequate post-treatment penile length growth were advised to continue with further treatment. The statistical methodology included t -test, and a Wilcoxon rank sum test to describe efficacy and safety. The patients were followed up until 2023. Results: The study comprised a total of 51 individuals with AIS, comprising 33 males and 18 females (gender of registered permanent residence). Among these patients, 10 were diagnosed with complete androgen insensitivity syndrome (CAIS) and 41 were diagnosed with partial androgen insensitive syndrome (PAIS). There were 2 children with CAIS were diagnosed by doctors and prescribed testosterone undecanoate, but the children did not really take medicine.The penile length of CAIS patients could not be measured (penile length<0.5 cm) before and after treatment. For PAIS patients, baseline penile length and PL-SDS were (2.3±0.6) cm and -3.7±1.3, respectively. The measurements for penile length and PL-SDS after each treatment course were recorded as follows: (2.7±0.8), (2.8±0.6), (2.6±0.4), (2.6±0.4) cm and -2.8±1.6, 2.5±1.6, 2.9±1.2, -3.2±0.9, respectively. Both penile length and PL-SDS interventions showed statistically significant gains when compared to the baseline performance of the 4 courses ( t =4.05、3.56、2.55、2.23 and 3.88、3.50、2.50、2.19, all P <0.05). Before treatment, 13 PAIS patients (32%) reached 2.5 cm and seven (17%) reached greater than or equal to -2.5 s . Following the initial, subsequent, third, and fourth therapeutic interventions, 18 cases (44%), 24 cases (59%), 25 cases (61%), and 26 cases (63%) reached 2.5 cm, respectively. Additionally, A total of 12 cases (29%), 15 cases (37%), 20 cases (49%), and 21 cases (51%), respectively, were found to reach greater than or equal to -2.5 s . The study involved the longitudinal monitoring of patients with the highest recorded age being 13.7 years. The weight, height, body mass index, bone age/age, cholesterol, hemoglobin and so on were all within the normal range and the difference were not statistically significant (all P >0.05). All 49 patients were no abnormalities in blood electrolyte, liver and kidney function and thyroid function and no changes in precocious puberty, pubic hair growth, aggressive behavior, vulvar skin darkening, diarrhea or other conditions. Conclusions: Testosterone undecanote in children with CAIS was no effective. The initial course of treatment for patients with PAIS demonstrates observable enhancements in penile length and PL-SDS. For patients with inadequate penile length growth, continued treatment in subsequent courses (such as the second, third, and fourth courses) is recommended toenhance outcomes gradually. Testosterone undecanoate was safe and effective for the majority of individuals with PAIS patients, with few adverse effects and good treatment tolerance.

Objective: To investigate the effectiveness of penile up transfer method in the treatment of penoscrotal transposition (PST) in children., Methods: A clinical data of 46 children with PST admitted between January 2015 and March 2021 and met selective criteria was retrospectively analyzed. The M-shaped scrotal flap method was adopted in 21 cases (group A), and the penile up transfer method was adopted in 25 cases (group B). There was no significant difference in age and PST typing between the two groups ( t =0.491, P =0.626; χ 2 =0.710, P =0.790). The operation time and postoperative complications of the two groups were recorded and compared, and the correction effect of PST was evaluated., Results: All operations were successfully completed, and no urethral injury occurred during operation. The operation time was significantly less in group B than in group A [(70.36±9.76) minutes vs . (96.62±13.18) minutes; t =7.553, P =0.000]. All children were followed up 6-33 months (mean, 13.2 months). There were 5 cases (23.8%) of skin necrosis and 6 cases (28.6%) of scar hyperplasia in group A, and 1 case (4.0%) of skin necrosis and 1 case (4.0%) of scar hyperplasia in group B. The incidence of complication was significantly lower in group B than in group A ( χ 2 =3.949, P =0.047; χ 2 =5.341, P =0.021). In the evaluation of PST correction at 6 months after operation, there were 15 cases of complete correction and 6 cases of incomplete correction in group A, 24 cases of complete correction and 1 case of incomplete correction in group B, and the difference was significant ( χ 2 =5.341, P =0.021)., Conclusion: The penis up transfer method is not only easy to correct PST, but also can correct scrotal separation at the same time, with fewer postoperative complications and satisfactory correction effect of penile scrotal appearance.

Objective: To explore the heterogeneity and correlation of clinical phenotypes and genotypes in children with disorders of sex development (DSD). Methods: A retrospective study of 1 235 patients with clinically proposed DSD in 36 pediatric medical institutions across the country from January 2017 to May 2021. After capturing 277 DSD-related candidate genes, second-generation sequencing was performed to analyzed the heterogeneity and correlation combined with clinical phenotypes. Results: Among 1 235 children with clinically proposed DSD, 980 were males and 255 were females of social gender at the time of initial diagnosis with the age ranged from 1 day of age to 17.92 years. A total of 443 children with pathogenic variants were detected through molecular genetic studies, with a positive detection rate of 35.9%. The most common clinical phenotypes were micropenis (455 cases), hypospadias (321 cases), and cryptorchidism (172 cases) and common mutations detected were in SRD5A2 gene (80 cases), AR gene (53 cases) and CYP21A2 gene (44 cases). Among them, the SRD5A2 mutation is the most common in children with simple micropenis and simple hypospadias, while the AMH mutation is the most common in children with simple cryptorchidism. Conclusions: The SRD5A2 mutation is the most common genetic variant in Chinese children with DSD, and micropenis, cryptorchidism, and hypospadias are the most common clinical phenotypes. Molecular diagnosis can provide clues about the biological basis of DSD, and can also guide clinicians to perform specific clinical examinations. Target sequence capture probes and next-generation sequencing technology can provide effective and economical genetic diagnosis for children with DSD.

Hypospadias is one of the common congenital malformations of the urogenital system in children, with a high incidence and an increasing trend. And the incidence rate of severe hypospadias is increasing year by year, which seriously affects the penile development of the patient. With deepened understanding of hypospadias, accumulated experience in its diagnosis and treatment, and continuous improvement of surgical strategies, the success rate of surgical repair of hypospadias has been elevated to a certain extent. However, quite a few problems remain to be studied, such as the high rate of complications, insufficient understanding of penile curvature, long-term follow-up recurrence of penile curvature, selection of strategic staged surgery, etc. This article analyzes the treatment of severe hypospadias and related problems, and provides some reference for clinicians in surgical repair of severe hypospadias.

Small penis is abnormal development of the male external genitalia with unknown etiology. It is closely related to abnormal endocrine or pubertal development, chromosomal or genetic abnormalities. Pubertal growth retardation and secondary hypogonadism are commonly complicated by small penis or small testis; primary hypogonadal lesion develops in the testis; testosterone deficiency often results in small penis and short stature; sexual dysfunction and male infertility tend to occur in adult men. Attention should be paid to the four aspects concerning the clinically standardized diagnosis and treatment of small penis, namely, accurate measurement of the stretched penile length, active screening of possible causes, diagnosis and differential diagnosis, and active and effective clinical interventions for the purpose of increasing the penile length and improving the prognosis, patient's quality of life, and natural pregnancy rate.

Objective To explore the operation points of the steps of "front -type" hypospadias operation in oral mucosa urethroplasty and scrubbed shaped urethra with meat membrane covering. Methods After correction of chordee of penis of 40 patients with "Front -type" hypospadias, oral mucosa was transplanted and fixed on albuginea surface at the one-third of ventral penile for all the patients to increase the width of the urethra and form the urethra with the selected appropriate size ureter. The skin of dorsal penile was transferred to ventral penile. After clearing the pedicled skin flap, the subcutaneous layer of meat was kept down, and stamped wholly on forming place of urethral reel (including both sides inferior of cut-off cavernous body of glans penis), forming the glans again. Results There was no ankylo-urethria among the 40 "front -type" hypospadias operation, ureteroscopy examination after two months of the operation showed that "all the transplanted oral mucosa survived", and the stamped subcutaneous layer of meat located at both sides inferior of cut-off cavernous body of glans penis adhered with satisfaction, no glans incision dehiscence, there occurred 2 cases of urinary fistula which had been cured by neoplasty, there was 1 case of transferred flap necrosis which had been cured after dressing change. 40 patients were satisfied with penis appearance after operation. Conclusion Following up the operation points of "front-type" hyospadias operation, the success rate of operation can be improverd obviously, the plastic effect is good, and the complications after operation can be reduced, stamped wholly on formed urethra. There is a small probability of incidence of urethral stenosis and urinary fistula after operation. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between micropenis and chromosomal karyotype abnormality., Methods: We collected the clinical data on 375 children with congenital micropenis treated in Wuhan Children's Hospital from July 2018 to April 2020, analyzed their chromosomal karyotype in the peripheral blood lymphocytes and investigated the correlation of chromosomal karyotype abnormality with micropenis., Results: Of the 375 cases of micropenis, 28 (7.5%) were found with chromosomal karyotype abnormality, including 21 cases of abnormal sex chromosomal karyotype (2 cases of 47,XXY, 1 case of 47,XYY, 1 case of 48,XXXY, 12 cases of 46,X,Yqh-, 4 cases of 46,X,Yqh+, and 1 case of 46,X,inv［Y］［p11q11］), accounting for 75% of the total cases of abnormal karyotype. Autosomal karyotype abnormality was detected in 7 cases, constituting 25% of the total cases of abnormal karyotype, including 2 cases of 46,XY,inv (9)(p12q13), 1 case of 46,XY,14pstk +, 1 case of 46,XY,15cenh +, 1 case of 46,XY,15ps +, 1 case of 46,XY,13pstk +, and 1 case of 46,XY,1qh +. The detection rate of abnormal sex chromosomal karyotype was significantly higher than that of autosomal abnormal karyotype., Conclusions: Chromosomal karyotype abnormality, especially the abnormal karyotype of sex chromosome, can cause the abnormality of the reproductive organ, which may be one of the important causes of micropenis.

Small penis is a disease of sexual dysplasia, which might be related to chromosome or genetic abnormalities, pubertal dysplasia, endocrine abnormality, and other factors. Hypogonadism is common in small penis. Children with small penis often have small testes, short stature, and male secondary sexual deficiencies, and the incidence of infertility is high in adulthood. Small penis can be early detected by accurately measuring the stretched penile length, screening the pathogenic causes, and differentiating it from buried or concealed penis. Once definite diagnosis is made, positive clinical intervention should be initiated. Early treatment can improve the prognosis of small penis, the patient's quality of life and the rate of natural pregnancy.

Objective: Human papilloma virus (HPV) is a necessary cause of cervical cancer and is also closely related to penile cancer, oropharyngeal cancer, and anal cancer in males. However, few studies are reported on male HPV. This study aimed to investigate HPV infection of the external genitalia in men whose female partners have cervical HPV infection., Methods: We collected the relevant data on the male outpatients whose partners had cervical HPV infection in our Department of Urology and Andrology from August to December 2016. We obtained samples with nylon swabs from the glans penis, corona, inner layer of the prepuce and penile body and detected different types of HPV infection using the Hybribio HPV typing kit, PCR and membrane hybridization., Results: Valid data were collected from 140 males, which showed 83.5% of HPV infection of the external genitalia, including 60 cases of HPV6 (43.2%), 27 cases of HPV16 (19.4%), 14 cases of HPV39 (10.1%), 13 cases of HPV18 (9.4%), 13 cases of HPV58 (9.4%), and 13 cases of HPV52 (9.4%). Redundant prepuce was found in 75.5% of the males, but there was no statistically significant difference in the incidence rate of HPV infection between the normal and redundant prepuce groups (P > 0.05)., Conclusions: Men who have the female partners with positive cervical HPV are at high risk of HPV infection and therefore need to be screened and treated so as to reduce HPV infection in both sexes.

Objective: To investigate the clinical effects of circumcision by surgical plane positioning with a disposable circumcision suture device in the treatment of phimosis and redundant prepuce., Methods: From September 2016 to June 2017, we treated 250 patients with phimosis or redundant prepuce, 127 by conventional circumcision (the control group) and the other 123 by surgical plane positioning with a disposable circumcision suture device (the observation group). We compared the operation time, intra-operative bleeding, preputial frenulum alignment, postoperative ecchymosis, and postoperative penile appearance between the two groups of patients., Results: Compared with the controls, the patients in the observation group showed significantly longer operation time (［4.48 ± 1.18］ vs ［7.17 ± 1.42］ min, P<0.05), lower rates of intra-operative frenulum bleeding (15.0% ［19/127］ vs 4.1% ［5/123］, P<0.05) and frenulum misalignment (26.8% ［34/127］ vs 0.8% ［1/123］, P<0.05), higher incidence of postoperative ecchymosis (41.7% ［53/127］ vs 21.1% ［26/123］, P<0.05), and higher satisfaction of the patients with the postoperative penile appearance (92.9% ［18/127］ vs 98.4% ［121/123］, P<0.05). However, no statistically significant difference was found between the control and observation groups in intra-operative non-frenulum bleeding (4.7% ［6/127］ vs 1.6% ［2/123］, P = 0.164)., Conclusions: Circumcision by surgical plane positioning with a disposable circumcision suture device can effectively avoid preputial frenulum misalignment, reduce intra-operative bleeding, and improve postoperative penile appearance.

Objective: To search for a safe and effective method of penoplasty with low incidence of complications for concealed penis by evaluating penoplasty with T-shaped incision and three-point fixation in comparison with modified Devine's technique., Methods: We retrospectively analyzed 169 cases of concealed penis treated in our center by penoplasty with T-shaped incision and three-point fixation (group A, n = 110) or modified Devine's surgery (group B, n = 59). We compared the operation time, postoperative complications, and recurrence rate between the two groups of patients., Results: Operations were successfully completed in all the cases, the urinary catheters removed at 3 days and the elastic bandages applied for 2 to 4 weeks. The patients were followed up for 4 to 12 months. The penis was satisfactorily exposed. The operative time was significantly shorter in group A than in B (［52.8 ± 6.9］ vs ［61.5 ± 10.6］ min, P < 0.001), the postoperative complication rate was obviously lower in the former than in the latter (prepuce edema: 17.27% ［19/110］ vs 33.89% ［20/59］, P = 0.021; bleeding: 0.90% ［1/110］ vs 3.38% ［2/59］, P = 0.552; skin necrosis: 0.90% ［1/110］ vs 5.08% ［3/59］, P = 0.123; skin infection: 0.90% ［1/110］ vs 5.08% ［3/59］, P = 0.123), and so was the recurrence rate (0.90% ［1/110］ vs 6.77% ［4/59］, P = 0.032)., Conclusions: Penoplasty with T-shaped incision and three-point fixation deserves to be popularized clinically for its advantages of minor invasion, clear exposure, reliable penile fixation, low incidence of postoperative complications and recurrence, and satisfactory outcomes.

Objective: To investigate the clinical effect of a novel disposable ring versus that of the suture device in circumcision for redundant prepuce and phimosis., Methods: We randomly assigned 470 male patients with redundant prepuce or phimosis to receive circumcision with a novel disposable ring (the DR group, n = 235) or the suture device (the SD group, n = 235) and compared the operation time, intraoperative blood loss, pain scores, wound healing time, and postoperative complications and penile appearance between the two groups of patients., Results: All the operations were completed smoothly. Compared with the SD group, the DR group showed significantly shorter operation time (［7.49 ± 1.84］ vs ［3.83 ± 0.42］ min, P <0. 05), less intraoperative blood loss (［3.34 ± 2.59］ vs ［2.41 ± 1.01］ ml, P <0.05), lower intraoperative pain score (0.57 ± 0.76 vs 0.20 ± 0.47, P <0.05) and 6-hour postoperative pain score (3.42 ± 1.12 vs 0.48 ± 0.94, P <0.05), shorter wound healing time (［12.05 ± 2.80］ vs ［7.79 ± 1.65］ d, P <0.05), lower incidence rates of postoperative glans congestion or edema (36.17% ［85/235］ vs 2.56% ［6/235］, P <0.05), dysuria or strenuous urination (34.04% ［80/235］ vs 2.13% ［5/235］, P <0.05) and bleeding or hematoma (5.11% ［12/235］ vs 1.28% ［3/235］, P <0.05), and higher satisfaction with postoperative penile appearance (90.6% ［213/235］ vs 95.8% ［228/235］, P <0.05). There were no statistically significant differences between the SD and DR groups in the pain scores at the sixth night after operation (1.31 ± 0.96 vs 1.34 ± 1.07, P >0.05) or while the staples scraping the underpants or at the ring removal (3.49 ± 1.22 vs 3.36 ± 1.41, P >0.05). No obvious postoperative infection or delayed healing was observed except for 3 cases of wound dehiscence (1 in the DR and 2 in the SD group) and 8 cases of delayed removal of the staples in the SD group., Conclusions: The novel disposable ring, with its advantages of short operation time, less bleeding and pain, good penile appearance, high safety, and simple operation, is obviously superior to the suture device in circumcision and deserves to be applied and popularized clinically. .

Objective: To compare the clinical effect of a novel disposable circumcision device Ring with that of conventional circumcision in the treatment of redundant prepuce and phimosis., Methods: Totally, 750 patients with redundant prepuce or phimosis underwent Ring circumcision (group A, n = 450) or conventional circumcision (group B, n = 300). We recorded the operation time, intraoperative blood loss, Visual Analogue Scale (VAS) intraoperative pain scores, postoperative complications, wound healing time, and patients' satisfaction with postoperative penile appearance, followed by comparison of the collected data between the two groups of patients., Results: All the operations were successfully completed. Group A, as compared with B, showed significantly shorter operation time (［3.78 ± 0.42］ vs ［26.24 ± 3.99］ min, P <0.05), less intraoperative blood loss (［2.39 ± 1.01］ vs ［10.80 ± 3.57］ ml, P <0.05), lower pain scores intraoperatively (0.14 ± 0.36 vs 2.30 ± 1.46, P <0.05), 6 hours postoperatively (0.32 ± 0.78 vs 3.03 ± 1.56, P <0.05) and at the ring removal (3.35 ± 1.42 vs 2.78 ± 1.43, P <0.05), shorter wound healing time (［7.61 ± 1.60］ vs ［8.57 ± 1.37］ d, P <0.05), higher satisfaction with postoperative penile appearance (97.8% ［440/450］ vs 86% ［258/300］, P <0.05), and lower incidence of postoperative bleeding or hematoma (0.89% ［4/450］ vs 3% ［9/300］, P <0.05). No statistically significant differences were observed between groups A and B in the nocturnal pain score before the ring removal (1.45±1.02 vs 1.38 ± 0.92, P >0.05) or the postoperative incidence rate of edema (0.89% ［4/450］ vs 2.33% ［7/300］, P >0.05). There were no significant postoperative infections or delayed incision healing except for 1 case of wound dehiscence in each group., Conclusions: Ring circumcision, with its advantages of shorter operation time, less blood loss and pain, higher safety, and better postoperative penile appearance, is easily accepted by the patients and deserves wide clinical application.

Objective: To assess the effect of traversing the vertical pedicle flap (TVPF) for the treatment of severely buried penis in children., Methods: Totally 43 children with severely buried penis underwentTVPF (n = 21)or modifiedShiraki surgery (control, n = 22) in our hospitalfrom February to December 2014. Wecompared the operation time, intra-operation blood loss, foreskin swelling time, and parents' satisfaction with penile appearance between the two groups., Results: No statistically significant differences were observed between the TVPFand control groups in the operation time (［45.0 ±6.8］ vs ［42.0 ±5.3］ min, P>0.05) or intra-operation blood loss(［5.0 ±1.2］ vs ［6.0 ±0.8］ ml, P>0.05). The average foreskin swelling time was markedly shorter in the TVPFgroup than in the control (［9.0 ±2.3］ vs ［15.0 ±4.8］ d, P<0.05)and the parents' satisfaction with penile appearancewas higher in the former than in the latter (95.23vs31.81 %, P<0.05). The elastic bandages were removedfor all the patientsat 3 days postoperatively, and 3 to 6-month follow-up revealed no penile retraction or relapse., Conclusions: The method of traversing the vertical pedicle flap is a feasible surgical option for the treatment of severely buried penis in children, which can make a rational use of the foreskin,remove the tight ring, and achieve a satisfactory appearance of the penis.

Objective: To evaluate the clinical effect of embedding sutures of single inner- and outer-prepuce flap in the treatment of concealed penis., Methods: This retrospective analysis included 37 cases of concealed penis treated by embedding sutures of single inner- and outer-prepuce flap between July 2011 and May 2015. Catheters were pulled out from the patients within 24 hours and the dressing removed about 1 week after surgery. All the patients were followed up for 12－24 months postoperatively for evaluation of the long-term outcomes of surgery., Results: One-stage wound healing was achieved in all the patients. No foreskin flap necrosis, inflammation, edema, voiding dysfunction, or painful erection was found during the follow-up. The penises were extended by 2－4 cm. No complications were observed axcept 8 cases of mild prepuce edema, which all subsided with 6 months postoperatively., Conclusions: Embedding sutures of single inner- and outer-prepuce flap, with the advantages of simple operation, rapid recovery and few complications, is a desirable surgical option for the treatment of concealed penis.

Objective: To investigate the plasty method for penoscrotal transposition and its efficacy., Methods: The adhesion between penis tunica albuginea and scrotum sheath capsule was separated to return the testis and their sheath capsule to the abdomen side of penis. Also, the scrotum skin was also transferred to the abdomen side of penis. The normal anatomic position of penis and scrotum was returned., Results: Between Jan 2004 to Oct 2015,34 cases were treated.5 scrotum fascia skin flaps underwent ischemia at the flap tip with delayed healing. All the other flaps survived with primary healing and good appearance., Conclusions: Adhesion between penis tunica albuginea and scrotum sheath capsule should be separated to return the testis and their sheath capsule, as well as scrotum skin to the abdomen side of penis. It' s an optional method for penoscrotal transposition.

Objective: To compare the clinical effects of circumcision and the foreskin-deglove plus shaft-fix (FDSF) procedure in the treatment of phimosis or redundant prepuce in obese adult males (body mass index [BMI] ≥ 28 kg/m²)., Methods: Forty-four obese adult men with phimosis or redundant prepuce underwent circumcision (n = 24) or FDSF (n = 20) according to their own wishes. The patients in the circumcision and FDSF groups were aged (26.38 ± 4.24) and (26.90 ± 3.14) years, with BMIs of (27.77 ± 0.77) and (28.07 ± 2.28) kg/m² and penis lengths of (3.51 ± 0.46) and (3.50 ± 0.59) cm, respectively. The operations were performed under local anesthesia with lidocaine plus ropivacaine mesylate., Results: The operation time of circumcision was (28.04 ± 2.65) min and that of FDSF was (45.45 ± 3.49) min. At 6 months after surgery, normal penile erection was found in all the patients, the penis length was significantly longer in the FDSF than in the circumcision group ([5.01 ± 0.73] vs [3.70 ± 0.47] cm) , and the rate of satisfaction with penile appearance was markedly higher in the former than in the latter group (3.25 ± 0.71 vs 2.83 ± 0.56)., Conclusion: The foreskin-deglove plus shaft-fix procedure under local anesthesia with lidocaine and ropivacaine mesylate may achieve desirable penile erection and appearance in the treatment of phimosis or redundant prepuce in obese adult patients.

Objective: To introduce the application of pedicled anterolateral thigh (ALT) flap for total penile reconstruction and to investigate its feasibility and effect., Methods: From May 2011 to May 2015, 12 male patients presented with absence of the penis or congenital malformation received phalloplasty with the pedicled ALT flap. Of them, the median age was 35 years old (range, 20-57 years). The size of the flaps ranged from 11 cm x 11 cm to 12 cm x 15 cm. 8 patients underwent urethra reconstruction with tube-in-tube flaps and other 4 patients with scrotal septal flaps. In this series, we performed one-stage urethral anastomosis in 4 cases and second-stage urethral anastomosis 6 months after the phalloplasty in 8 cases., Results: An acceptable reconstructed phallus was achieved in 10 patients. These flaps were primarily healed with satisfactory functional and cosmetic results. The reconstructed penis was completely necrosis because of the flap failure in one case. The distal half of the phallus was lost due to infection in one case. Both of them were treated with pedicled ALT flap from the other side. Reliable results were achieved. At a median follow-up of 1.5 year (range 1 to 4 years), 9 patients (90%) were fully satisfied with phallic cosmesis and size, and 4 patients who was married had successful sexual intercourse. 8 patients had normal urinate function. Fistula was developed in 2 patients (20%) which was treated with delayed repair at 6-12 months with local scrotal flaps., Conclusions: The pedicled ALT flap can be simply used to reconstruct an entire penis as well as a urethra. It has several advantages including a less conspicuous donor site, greater bulk, better color match and no necessary for microsurgery.

Objective: To investigate effectiveness of advanced skin flap and V-shaped ventral incision along the root of penile shaft for concealed penis in children., Methods: Between July 2007 and January 2015, 121 boys with concealed penis were treated with advanced skin flap and V-shaped ventral incision along the root of penile shaft. The age varied from 18 months to 13 years (mean, 7.2 years). Repair was based on a vertical incision in median raphe, complete degloving of penis and tacking its base to the dermis of the skin. Advanced skin flap and a V-shaped ventral incision along the root of penile shaft were used to cover the penile shaft., Results: The operation time ranged from 60 to 100 minutes (mean, 75 minutes). Disruption of wound occurred in 1 case, and was cured after dressing change; and primary healing of incision was obtained in the others. The follow-up period ranged from 3 months to 7 years (median, 24 months). All patients achieved good to excellent cosmetic results with a low incidence of complications. The results were satisfactory in exposure of penis and prepuce appearance. No obvious scar was observed. The penis had similar appearance to that after prepuce circumcision., Conclusion: A combination of advanced skin flap and V-shaped ventral incision along the root of penile shaft is a simple, safe, and effective procedure for concealed penis with a similar appearance result to the prepuce circumcision.

Concealed penis is usually found in children, which affects the patients both physiologically and psychologically. Some of the patients are wrongly treated by circumcision, which may bring about serious consequences to the sexual life of the patients in their adulthood. In the recent years, this disease has been receiving more and more attention from both doctors and parents. However, controversies remain as to its classification, pathogenesis, pathology, and treatment. This paper focuses on the understanding and advances in the studies of concealed penis.

One of the challenges in andrology nowadays is the diagnosis and treatment of external genital abnormalities and defects along with the consequent voiding, sexual, and reproductive dysfunctions, for which no guidelines are yet available. Hitherto, surgical repair and reconstruction are efficient for these diseases. The key to these operations is to individualize surgical strategies according to the specific local lesion and dysfunction, usually involving flap and graft techniques. This article presents our experience in the surgical treatment of penile and scrotal abnormalities and defects with urological and andrological techniques and microsurgical strategies, focusing on the external repair and functional reconstruction. Satisfactory treatment outcomes pivot on a precise evaluation of the disease, a rational design of surgical procedures, and an earnest communication with the patient. Some cases are rather complicated and challenging, usually with complications, and therefore deserve further researches for more effective treatment strategies in clinical practice.

Objective: To investigate the pathogenesis and treatment of penile necrosis resulting from microwave diathermy following circumcision., Methods: We retrospectively analyzed the clinical data about 9 cases of penile necrosis resulting from postoperative microwave diathermy following circumcision. The 9 males, aged 20 - 39 (mean 26) years, underwent traditional circumcision for redundant prepuce or phimosis in other hospitals, followed by microwave diathermy for 30 - 60 minutes daily, which resulted in penile necrosis. With no response to conservative therapy, the patients were referred to our hospital at 3 -30 days postoperatively. Of the 9 patients, 5 presented with dry gangrene and 4 with moist gangrene. Six of the patients underwent partial penectomy, including 1 that received penis lengthening.3 months later, while the other 3 underwent total penectomy for total penile necrosis followed by penile reconstruction 3 months later, with deep inferior epigastric perforator (DIEP) flaps and by implantation of the 12th costal cartilage in 2 cases and with epigastric groin island flaps and by urethroplasty in the other., Results: The patients were followed up for 2 - 8 years, and all could urinate smoothly in the standing position. Of the 6 men treated by partial penectomy, 1 received penis lengthening and achieved a penile length of 7 cm and 5 had the remaining penile length of 3 -5 cm, 4 with erectile function and the other 2 capable of sexual intercourse. The 3 men treated by total penectomy achieved nearly normal external appearance of the penis, with a finalized length of (11.7 ± 1.3) cm, a circumference of (11.4 ± 2.1) cm, and a normal feel of the skin. Of the 3 cases of penile reconstruction, 2 achieved sufficient erectile hardness of the penis (grade 3) for sexual intercourse, while the other 1 remained impotent., Conclusion: Post-circumcision microwave diathermy may result in penile necrosis, for the management of which, early debridement is necessitated and penile lengthening or reconstruction can be performed according to the severity of the lesion and needs of the patient.

Objective: To compare the clinical effects of the circumcision stapler, circumcision cerclage, and traditional circumcision in the treatment of phimosis and redundant prepuce., Methods: Using the circumcision stapler (group A), foreskin cerclage (group B), and traditional circumcision (group C), we treated 276 patients with phimosis or redundant prepuce. We made comparisons among the three groups in the operation time, intraoperative blood loss, intraoperative and 24-hour postoperative pain scores, and incidence of postoperative complications. Results: The operation time, intraoperative blood loss, and intraoperative pain score were (6.52 ± 2.45) min, (1.93 ± 0.82) ml, and 1.37 ± 0.68 in group A and (7.24 ± 1.86) min, (1.51 ± 0.72) ml, and 1.20 ± 0.79 in group B, all significantly lower than (28. 36 ± 4.22) min, (9.52 ± 3.29) ml, and 3.06 ± 0.75 in group C (P <0.05). The 24-hour postoperative pain score was remarkably higher in group B than in A and C (3. 18 ± 0. 82 vs 1. 85 ± 0. 63 and 1. 82 ± 0. 75, P <0. 05). The incidence rate of postoperative complications was markedly lower in group A than in B (5. 43% vs 14. 13%, P < 0.05), but with no significant differences between either A and C or B and C (P >0.05)., Conclusion: The circumcision stapler, with its advantages of simple operation, minimal invasiveness, fewer complications, and better cosmetic result, deserves a wider clinical application.

Objective: To observe the clinical effect and safety of circumcision stapler in the treatment of phimosis and redundant prepuce., Methods: We treated 120 patients with redundant prepuce or phimosis using circumcision stapler and another 60 by conventional dorsal-incision circumcision. We observed intraoperative blood loss, operation time, postoperative pain, wound healing time, cosmetic appearance of the penis, and postoperative complications and compared them between the two groups of patients., Results: Stapler circumcision showed obvious advantages over the conventional method in intraoperative blood loss ([2. 3 ± 1. 3] vs [15.6 ± 2.9] ml), operation time ([7.1 ± 1.4] vs [22.6 ± 4.6] min), wound healing time ([12.0 ± 2.9] as [16.3 ± 3. 1] d), postoperative pain score (1. 9 ± 1. 3 vs 5. 2 ± 1. 7), incision edema, and cosmetic appearance of the penis (all P <0. 05). Besides, stapler circumcision exempted the patients from stitch-removal pain. However, the incidence rate of postoperative local ecchymosis was significantly higher in the circumcision stapler group than in the conventional circumcision group (20. 8% vs 8. 3% , P <0. 05)., Conclusion: Circumcision stapler, with its advantages of easier manipulation, shorter operation time, better cosmetic penile appearance, less pain, and fewer complications, is superior to conventional circumcision in the treatment of phimosis and redundant prepuce.

Objective: To comparatively analyze the effect of one-stage nonstented tubularized incised plate urethroplasty (TIP) on operative pain and complication by comparing with urethral catheter and urethral stent drainages., Methods: Between March 2010 and June 2013, 214 cases of distal and mid-shaft hypospadias underwent TIP, and the clinical data were analyzed retrospectively. The patients were divided into 3 groups based on different urinary drainage techniques: indwelling urethral catheter was used in 68 cases (group A), indwelling urethral stent in 70 cases (group B), and nonstented drainage in 76 cases (group C). There was no significant difference in age, hypospadias type, and accompany malformation among 3 groups (P > 0.05). At 2 days after operation, Wong-Banker facial scale (WBS) and Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) were used for pain and praxiology assessment. The complications after operation also were observed and compared among 3 groups., Results: All patients were followed up 6-25 months (median, 11.8 months). At 2 days after operation, the median WBS scores were 4.0 (0-10), 3.5 (0-10), and 3.0 (0-10) in groups A, B, and C, respectively; median CHEOPS pain scores were 6.0 (1-13), 6.0 (1-13), and 4.0 (1-11), respectively. The WBS pain score and CHEOPS pain score in group C were significantly lower than those in groups A and B (P < 0.05), but there was no significant difference between group A and group B (P > 0.05). The postoperative complication occurred in 27 cases (39.7%) of group A, 29 cases (41.4%) of group B, and 13 cases (17.1%) of group C; two or more than two complications occurred in 14, 15, and 9 cases, respectively. There was significant difference in total incidence of postoperative complication among 3 groups (P < 0.05). The incidences of postoperative overactive bladder, bladder spasms, urinary tract infection, and fistula in group C were significantly lower than those in groups A and B (P < 0.05). There was no significant difference in incision infection, acute urinary retention, urinary extravasation, meatal stenosis, and urethral stricture among 3 groups (P > 0.05)., Conclusion: One-stage nonstented TIP is suitable for distal and mid-shaft hypospadias and could reduce postoperative pain and complications compared with the traditional postoperative indwelling urethral catheter and indwelling urethral stent.

Objective: To observe the clinical effects of the no-flip procedure with the Chinese Shang Ring when circumcising adult males with redundant prepuce or phimosis, and to discuss its advantages and disadvantages., Methods: Using the no-flip Shang Ring technique, we performed circumcision for 167 adult males aged 18 -72 (mean 27.8) years with redundant prepuce or phimosis, and analyzed the clinical data, including the operation time, postoperative complications, ring-removal time, and postoperative appearance of the penis., Results: Complete follow-up data of 94 cases (56.29%) were obtained. The mean operation time was (5.03 +/- 0.71) minutes and the average ring-removal time was (18.83 +/- 6.70) days. The primary postoperative complications were edema (35 cases [37.23%] at 2 weeks and 9 cases [9.57%] at 4 weeks), including 2 severe cases (2.13%), and infection (3 cases [3.19%]). The pain scores were 2.01 +/- 2.46 during the procedure and 4.52 +/- 2.53 at 24 hours postoperatively. Slipping of the outer ring occurred in 1 case, and delayed removal of the ring in 30 cases (31.91%)., Conclusion: Adult male circumcision with the no-flip Shang Ring technique is recommended for its short operation time, simple procedure, fewer postoperative complications, less pain, and better incision appearance.

Objective: To observe the clinical effects of two different circumcision procedures with the Shang Ring and compare their advantages and disadvantages., Methods: A total of 527 adult males with phimosis or redundant prepuce underwent Shang Ring circumcision by conventional outward replacement (n = 254) and inward placement (n = 273), respectively. We observed the in-ring nocturnal pain, complications, ring-removal pain, degree of edema, recovery time, and patients' satisfaction after surgery, and compared them between the two groups., Results: Compared with the conventional outward placement (5.9%) of the Shang Ring, the inward placement method showed the advantages of mild in-ring nocturnal pain, a low complication rate, significantly reduced ring-removal pain, and mild edema, but exhibited longer healing time., Conclusion: In Shang Ring circumcision for phimosis and redundant prepuce in adult males, each of the outward and inward placement methods has advantages and disadvantages of its own, but the latter is more advantageous and feasible.

Objective: To search for a simple and effective surgical approach to the management of moderate to severe pediatric concealed penis in children., Methods: We used Devine's technique via incision between the penis and scrotum in the treatment of 68 cases of moderate to severe pediatric concealed penis. The patients were aged 3 -13 (mean 6.5) years, 30 with moderate and 38 with severe pediatric concealed penis., Results: This strategy achieved good near- and long-term effects and satisfactory appearance of the penis, which was similar to that of circumcision. At 3 months after surgery, the penile length was 3 - 5.2 cm, averaging (2.35 +/- 0.35) cm., Conclusion: Devine's technique via incision between the penis and scrotum is a simple and effective surgical option for moderate to severe pediatric concealed penis in children.

Objective: To investigate the effectiveness of the penile ventral scrotum cohesion place wedge cutting and improved Brisson technique for congenital buried penis., Methods: Between March 2010 and June 2012, 68 boys with congenital buried penis were treated by the penile ventral scrotum cohesion place wedge cutting and improved Brisson technique, with a median age of 4 years and 10 months (range, 3 months-13 years). Of 68 cases, 14 were classified as phimosis type, 14 as rope belt type, 20 as moderate type, and 20 as severe type. The body of penis developed well and had no deformity. After operation, complications were observed, and the effectiveness was evaluated by the designed questionnaire., Results: Early postoperative complications occurred in 11 cases, including obvious adhesion of the outside wrapping mouth in 4 cases, scrotal skin bloat in 5 cases, and distal foreskin necrosis in 2 cases; long-term complications occurred in 9 cases, including abdominal incision scar formation in 4 cases, wrapping mouth scar stricture in 3 cases, and short penis in 2 cases. Primary healing of incision was obtained in the other boys. Fifty-four cases were followed up 6-12 months (mean, 8 months). According to the designed questionnaire, satisfaction rate with the overall view in parents was 77.78% (42/54); the clinical improvement rate was 85.19% (46/54); exposure of the penis was satisfactory in parents of 50 cases; and the parents had no psychological burden of penis exposure in 46 cases, which were significantly improved when compared with preoperative ones (P < 0.05). The boys had no psychological burden of penis exposure in 29 cases (53.70%) after operation, showing no significant difference when compared with preoperative one (18 cases, 33.33%) (chi2 = 1.22, P = 0.31)., Conclusion: Application of the penile ventral scrotum cohesion place wedge cutting and improved Brisson technique can effectively correct congenital buried penis.

Objective: To evaluate the histopathological characteristics and clinical implication of sarcolemma tissue in prepubertal concealed penis., Methods: After measurement of the penile length, 10 prepubertal children with congenital concealed penis underwent modified Devine's operation (treatment group), and another 10 normal prepubertal children received circumcision (control group). The anatomic features of the penile sarcolemma tissue was observed intraoperatively, and its fibrosis was evaluated by Masson trichrome staining., Results: The penile length of the treatment group was significantly shorter than that of the control group preoperatively ([1.49 +/- 0.17 ] cm vs [4.26 +/- 0.23 ] cm, P < 0.01). The degree of penile concealment was correlated with the distal point of the attachment of its sarcolemma fibrous tissue: the closer the distal attachment point was to the coronary ditch, the more serious was penile concealment. The proportion of the area of collagen fibers in the penile sarcolemma tissue was significantly higher in the treatment group than in the control ([65.6 +/- 6.9]% vs [37.1 +/- 4.7]%, P < 0.01)., Conclusion: Sarcolemma fibrosis was obvious in congenital concealed penis, and the key to its management is drastic removal of all the fibrous sarcolemma tissue.

Objective: To investigate the effectiveness of longitudinal preputial pedicled flap urethroplasty for chordee of Donnahoo IV type., Methods: Between June 1994 and October 2011, 30 patients with chordee (Donnahoo type IV) underwent longitudinal preputial pedicled flap urethroplasty. The patients' age ranged from 2 to 16 years (mean, 5.8 years). The morphology of the balanus-navicular fossa-external urethral orifice ranged normal; the penis length was 2.5-6.8 cm (mean, 4.3 cm); the penis bending angle was 35-70 degrees (mean, 40.1 degrees). Primary and secondary operation was 27 cases and 3 cases, respectively. The size of flap ranged from 1.5 cm x 1.3 cm to 4.0 cm x 2.0 cm., Results: After correction, the penis length was 3.0-8.5 cm (mean, 6.6 cm); the penis bending angle was 0-10 degrees (mean, 1.2 degrees). All patients were followed up 6 months to 12 years (mean, 33 months). No recurrence, stabbing pain of the balanus, or foreign body sensation occurred during follow-up. Of them, 4 patients (13.33%) had urinary fistular, they had satisfactory results after the second operation; 2 patients (6.67%) had urethral stricture 1 month after operation, they also had satisfactory results after arethral dilatation. The other patients showed no scattering urinary flow and good direction without complication. Six patients had satisfactory sexual function after puberty without erection disorder, pain, or dyspareunia., Conclusion: Longitudinal preputial pedicled flap urethroplasty can achieve maximum utilization of prepuce and aesthetic and functional improvement with less complication, so it is a relatively ideal mean for treating chordee of Donnahoo type IV.

Objective: To investigate the therapeutic effect of penoplasty with scrotal skin flap for the treatment of buried penis in children., Methods: The narrow ring was cut vertically at the ventral side of penis and the prepuce inner plate was circularly cut 0.5 cm from the coronary sulcus. The prepuce was degloved to the base of penis. The abnormal aponeurosis was removed completely. The prepuce was designed to cover the coronary sulcus. The scrotal flaps at both sides were formed and advanced to cover the penile base. Then the prepuce was sutured to reconstruct penile-scrotal angle and scrotum plasty was completed., Results: From March 2009 to July 2011, 24 children with buried penis were treated with scrotal flaps. Adhesion at external orifice of urethra was happened in two cases which recovered after urethra expansion. There was one case of necrosis at the distal end of prepuce. All the cases were followed up for 6 months to 2 years with no penile shrinkage. The penile appearance was good without rotation or lateral curvature during erection., Conclusions: The buried penis can be best corrected with scrotal flap. It is an ideal method with less complication.

Objective: To search for a simple surgical procedure for the treatment of concealed penis that may have better effect and less complications., Methods: We used a modified surgical method in the treatment of 58 patients with concealed penis aged from 3 to 15 (mean 6.8) years. The operation was simplified and involved the following steps: wholly unveiling the penis glans, half-degloving the foreskins, cutting off all the adhesive fibers up to the penile suspensory ligaments, and liberating the external penis., Results: The operation was successful in all the patients, with the operative time of 15 -45 (mean 33) minutes, hospital stay of 2 - 5 (mean 3.5) days, but no complications except mild foreskin edema in 5 cases. The external penis was prolonged from 0.5 - 2.8 (mean 1.4) cm preoperatively to 3.2 - 8.5 (mean 3.9) cm postoperatively. The patients were followed up for 1 -3 years, all satisfied with the length and appearance of the penis, and their sexual and reproductive functions were normal., Conclusion: The modified surgical procedure for concealed penis is simple and effective, with desirable outcomes, few postoperative complications and no damage to sexual and reproductive functions.

Objective: To investigate the localization and expression characteristics of androgen receptor (AR) in genital tissue of patients with congenital hypospadias and simple chordee., Methods: Between August 2005 and January 2007, dorsal prepuce, ventral perimeatal skin, and urethral plate were harvested from 25 patients with congenital hypospadias (aged from 1 year and 11 months to 19 years with an average of 3 years and 7 months) and 4 patients with simple chordee (aged from 3 years and 6 months to 16 years with an average of 7 years and 1 month). Prepuce by circumcision from 18 patients was used as control. The expression intensity and distribution of AR were assessed with immunohistochemistry., Results: AR was expressed in prepuce tissues from congentital hypospadias, simple chordee, and control. The AR positive cell rates were 62.94% +/- 5.40% and 62.87% +/- 5.33% in dorsal and ventral prepuce of control patients respectively, and were 59.00% +/- 3.75%, 58.46% +/- 4.14%, and 52.30% +/- 3.53% in dorsal prepuce, ventral perimeatal skin, and urethral plate of patients with congenital hypospadias respectively. AR positive cell rate was significantly lower in patients with congenital hypospadias than in control patients (P < 0.05), and in urethral plate than in dorsal prepuce and ventral perimeatal skin of patients with congenital hypospadias (P < 0.05), and no significant difference was detected between dorsal and ventral specimens (P > 0.05). Stratified analysis showed a similar expression mode in severe hypospadias group and severe chordee group (P < 0.05). In mild to moderate hypospadias group and mild to moderate chordee group, no significant difference was shown when dorsal and ventral skin specimens were compared to that in normal control (P > 0.05), with AR expression diminished in urethral plate (P < 0.05), and AR decrease was relative to severity of chordee (P < 0.05). The AR positive cell rates were 59.69% +/- 2.73%, 55.71% +/- 1.67%, and 51.92% +/- 1.87% in dorsal, ventral skin, and urethral plate of patients with chordee respectively. Reducing tendency of AR expression was observed., Conclusion: AR expression decreases in penile skin of patients with congenital hypospadias and simple chordee, especially in urethral plate.

Objective: To establish a model of individually forecasting the penile length gained after penis lengthening., Methods: A total of 322 patients were diagnosed congenital penile shortness and received partial suspensory ligament release in our department from Oct. 1988 to Apr. 2011. The patients were divide into two groups as Modeling Group (n = 200) and Checking Group (n = 122). Then a two-dimensional model of the suspensory-ligament-release penis lengthening is established. In the Modeling Group, a statistical analysis of the penile length in flaccid and erectile state before and after penis lengthening was carried out, and a forecasting predictive function of increased penile length was derived. Then the predictive accurate rate was tested in the Checking Group., Results: There was a significant linear correlation between the increased length in flaccid and erectile state (correlation coefficient = 0.921, P < 0.01), there was also a similar relationship between the extension rate of erection before and after the operation (correlation coefficient = 0.803, P < 0.01). According to the significant linear correlations showing above, two regression forecasting models were established. A predictive function of increased flaccid length was derived from the two regression forecasting models. The effectively forecasting rates were 84.5% (169/200, the Modeling Group) and 87.7% (107/122, the Checking Group) when the absolute value of forecasting error was less than 1.5 cm., Conclusions: The discovered significant correlation and the established forecasting function provide us a model of roughly and individually forecasting the penile length gained after penis lengthening.

Objective: To investigate the application of Koyanagi technique for repairing proximal hypospadias with penoscrotal transposition., Methods: Koyanagi procedure was used for repairing proximal hypospadias with penoscrotal transposition in 26 boys (mean age 4.2 years) between July 2005 and June 2010., Results: Primary healing was achieved in 22 cases. Three patients suffered from urinary fistula and the external urethral orifice in one patient was retracted to penis coronary sulcus, who were re-operated successfully. Two cases showed slight penile ventral curvature. Slight stricture of the urethral external orifice was noted in one case, which relieved after one to two times of urethral sounding every week for eight months. 20 patients were followed up for 6-36 months (mean 10.5 months) with good cosmetic result and normal urethra function. The penoscrotal transposition was also corrected., Conclusions: The original Koyanagi procedure might be one of the simple and effective method for repairing proximal hypospadias with penoscrotal transposition.

Objective: To investigate the clinical effect of Devine's technique with free skin grafting in the treatment of concealed penis with prepuce deficit., Methods: This study included 7 children with concealed penis, aged 6 - 15 (mean 8.6) years, 6 of them treated by circumcision previously. All the patients underwent Devine's operation to resect the inelasticity sarcolemma and lengthen the penis. The length of prepuce deficit ranged from 2 to 4 cm. Intermediate split thickness skin grafts of the corresponding length were taken from the femoribus internus to wrap up the tunica albuginea penis, followed by the procedures of saturation, encapsulation and fixation., Results: Surgery time ranged from 70 to 120 minutes, averaging 90.5 minutes. The penis was prolonged about 2 - 4 cm after surgery. A 6-month follow-up revealed desirable penile appearance and normal penile erection., Conclusion: Devine's technique with free skin grafting from the femoribus internus is an ideal treatment for concealed penis with prepuce deficit.

Objective: To explore various tunica albuginea plasty for penile curvature and their efficacies., Methods: From July 2005 to July 2008, there were a total of 8 patients with a mean age of 34 ± 9 years old (range: 23 - 47) undergoing corrective surgery for various types of penile curvature. Among them, 4 patients (3 with ventral curvature, 1 with lateral curvature) were treated by 16-dot plication technique, 2 patients of lateral curvature with tightening ring in tunica albuginea corrected by V-Y plasty and 2 patients (one caused by Peyronie's disease while the other by tunica scar contracture) repaired by venous graft patch. The pre-and post-operative levels of sexual satisfaction were evaluated by the International Index of Erectile Function (IIEF-5) scoring system., Results: All cases were followed up at 3, 6 & 9 months postoperatively. Their mean curvature at maximal erection was (58.2 ± 9.7)°. And a postoperative office assessment revealed a functional straight in all patients [mean degree (11 ± 4)°]. One patient (12.5%) reported penile shortening without dissatisfaction about it. No patients complained of anesthesia or other sensory abnormality on their penile skin. An improvement of IIEF-5 scores was noted (21 ± 3 vs 15 ± 5, P < 0.05) and all patients were satisfied with their outcomes. No complications, such as hematoma, infection or erectile dysfunction, occurred., Conclusion: To achieve a better penile morphology and functional outcomes with fewer complications, various arthroplasty should be adopted according to the cause, degree and direction of penile curvature.

Objective: To investigate the techniques of surgical correction of penoscrotal transposition with hypospadias., Methods: We retrospectively studied 83 cases of penoscrotal transposition with hypospadias treated by surgery from January 2003 to June 2009, and analyzed the surgical techniques and follow-up results., Results: The patients underwent urethroplasty with simultaneous or staged surgical correction of penoscrotal transposition. Postoperative follow-up was conducted for 0.5-5 years. Eighty-one of the patients were satisfied with the appearance of the reconstructed penis and scrotum, and satisfactory outcomes were achieved in the other 2 with severe hypospadias after a second surgical correction of penoscrotal transposition., Conclusion: Urethroplasty with simultaneous or staged surgical correction of penoscrotal transposition is recommendable for its resultant penile straightness, desirable penoscrotal appearance, good surgical prognosis and few postoperative complications.

Objective: To discuss the severity grading and procedure design of concealed penis., Methods: Between June 2004 and April 2008, 196 cases of concealed penis were surgically corrected. The age ranged from 1 year and 4 months to 44 years, with a median of 9 years. They presented with inconspicuous penis and abnormal cavernosa development. Four cases complicated by glanular hypospadias and 3 cases by penile epispadias. They were classified as mild in 49 cases, moderate in 109, and severe in 38 according to severity. Surgical procedures were selected based on varied anatomical changes in different categories., Results: All the patients got satisfactory appearance immediately after surgery. No voiding problem, wound infection, and skin necrosis were found. With 6 months to 48 months (mean 16 months) follow-up, most patients achieved good results and the penile appearance resembled that after circumcision. Mild penile retraction was noted in 1 moderate case and 1 severe case; and recurrence occurred in another one, the result was satisfactory after reoperation., Conclusion: Various surgical procedures can be adopted for concealed penis. The key point is to design procedures according to the anatomical abnormalities.

Objective: To introduce a modified penile elongation method and observe its postoperative complications., Methods: From January 1993 to December 2007, 130 patients with congenital short and small penis were divided into 2 groups: the routine group and the modified group, with 65 patients in each group. In the routine group, the patients were 18-55 years old (39.6 on average), and the penile length during erection was (4.9 +/- 1.4) cm. In the modified group, the patients were 20-56 years old (35.4 on average), and the penile length during erection was (5.0 +/- 1.5) cm. There was no significant difference between the two groups (P > 0.05). On the basis of scrotal flap which was transferred to cover the prolonged cavernous body of penis, the "+" shaped incision at the root of the penis was made in the routine group, and the incision was shifted upward by 1.5 cm in the modified group. And V-Y incision was made for the penises with more than 4 cm prolonged length. In order to compare the conditions in the two groups, no physical therapy was applied in 30 days after the operation., Results: All the 130 patients' incisions obtained healing by the first intention, and all flaps survived successfully. Postoperative hydrophallus appeared differently between both groups. In the routine group, obvious hydrophallus appeared on the 3rd day after the operation and lasted for (15.11 +/- 2.71) days, with 3 cases (4.62%) suffering from refractory hydrophallus. In the modified group, hydrophallus appeared on the 3rd day after the operation and lasted for (6.65 +/- 0.29) days without any refractory hydrophallus. There was significant difference between the two groups in the duration of hydrophallus (P < 0.05). All patients were followed up for 6-8 months. After the operation, the shape and function of the penis were found good. The prolonged length was (4.9 +/- 1.4) cm in the routine group and (5.0 +/- 1.5) cm in the modified group. There was no significant difference between the two groups (P > 0.05). The satisfaction rate (according to the patients' self-rating) was 95% and 98% in the routine group and the modified group, respectively., Conclusion: The method using the scrotal flap transferred to cover the prolonged cavernous body of the penis is safe and of low complication rate. The modified method is more effective to abate postoperative hydrophallus.

Objective: To explore the influence of buried penis on nitric oxide synthase (NOS) activity of the corpus cavernosum in rats., Methods: The experimental model of concealed penis was established by intra-pocket-suture of the root of the penis. Two hundred and forty rats were equally randomized into a 2, a 4 and a 6 months group, each further divided into a buried (n = 50), a sham operation (n = 15) and a normal subgroup (n = 15). The development of the corpus cavernosum was surveyed by measuring its weight and the ratio to the body weight, followed by determination of NOS activity in the corpus cavernosum by spectrophotometry., Results: No significant differences were found in the corpus cavernosum weight, the body weight and their ratio among the buried, sham operation and normal groups in any experimental stage (P > 0.05). Buried penis decreased NOS activity in the 4- and 6-month groups (P < 0.05 and P < 0.01) compared with the normal group, but effected no significant change in the 2-month group., Conclusion: Buried penis decreases the NOS activity of the corpus cavernosum in a positively time-related manner, but with no significant influence on its appearance and weight.

Objective: To recommend the successive "Z" incision and skin flaps as a method for repairing the wound in penile lengthening procedures., Methods: We performed penile lengthening surgery by successive "Z" incision for 5 patients complaining of short penis, who ranged in age from 16 to 34 years (22.4 +/- 7.2), and 3 of whom had a history of urethroplasty, circumcision and penile reconstruction, respectively. The superficial suspensory ligament and part of the deep suspensory ligament of the penis were exposed and severed to release the penis, and the "Z" skin flaps sutured in a tensionless state. Drainage was necessitated by exudation and the catheter removed in 24-48 hours. The penis was wrapped up by an elastic bandage, and the stitches taken out 8-10 days after the operation., Results: We achieved a mean erectile length of 8.4 cm (range 7.8-9.2 cm) after the operation, as compared with 4. 8 cm (range 4.0-5.8 cm) before the surgery. Two students of the patients obviously became active and confident. No penile contraction was noted during the 12-48 months follow-up, and both the patients and their family members were satisfied with the outcomes., Conclusion: Compared with the V-, M- and Z-incision, the successive "Z" incision and skin flaps can yield longer penile length, solve the problem of insufficient skin flap to cover the wound and reduce such complications as skin necrosis and infection. It is well worth recommending for patients complaining of short penis because of penile abnormality, post-operation scar on the penis or circumcision.

Objective: To search for a simple and effective surgical procedure for the treatment of the buried penis in children., Methods: We designed a new surgical procedure for the treatment of the buried penis, making a "V" incision in the venter of the radix penis, solving the superficial and deep fascia and the abnormal attachment of the dartos muscle, and fixing the left and right side of the radix penis respectively to 1 and 11 o'clock points in the fascia of the pubis nodus in the knee-chest position. A total of 38 children with the buried penis underwent the newly designed procedure and were followed up for 2-6 months., Results: All the patients were discharged with desirable cosmetic appearance of the penis and completely revealed penile shafts. Follow-up showed satisfactory penile shape in 35 cases (92.11%), slightly buried penis in 2 and cicatricial constriction of the ostium praeputiale in 1., Conclusion: The newly designed surgical procedure of solution and fixation of the penile venter is simple and effective for the treatment of the buried penis in children and well worthy to be introduced into clinical practice.

Objective: To establish a stable rat experimental model of concealed penis for studying the effect of buried penis on the structure and function of the corpus cavernosum., Methods: Ninety male SD rats, aged 2 weeks, were randomly divided into 3 groups (A, B and C) of equal number. Groups A and B underwent surgery with intra-purse suture of the penile root and folding suture of the prepuce, respectively, to bury the penis, while Group C were included as sham operation controls., Results: In Group A, death resulted in 4 cases from acute post-operative urine retention, failure in burying the penis occurred in 5 cases because of soft tissue ulceration around the urethral orifice and in another 3 due to loose concealment. In Group B, 1 died from deep anesthesia and 2 from acute post-operative urine retention. With the penile development and erection, 7 in Group A and 10 in Group B protruded the penis in different stages. In Group C, 1 died from deep anesthesia. The operations succeeded in all the other rats in Groups A and B, with the success rates of 36.7% and 56.7%, respectively. And the concealment could be relieved any time during the experiment., Conclusion: The experimental rat model of concealed penis can be successfully established by both intra-purse suture of the penile root and folding suture of the prepuce, which is stable and similar to the natural course of this disorder in human.

Objective: To discuss the diagnosis of pediatric concealed penis and evaluate the results after the correction of the pediatric concealed penis., Methods: Twenty patients with pediatric concealed penis were treated by using a modified Devine's technique., Results: The appearance with a straightening penile was achieved in all of the patients. All of the patients recovered well after the operation without any complications., Conclusions: The modified Devine' s technique could be a safe and effective method for the correction of the pediatric concealed penis with satisfactory outcome.

Objective: To investigate the surgical technic of re-shape penis and scrotum, as well as construct urethra in severe hypospadias patients., Methods: Twenty-two cases of perineal hypospadias with abnormal penis and scrotum were involved in operative repair. All the patients underwent two-stage of repair technic. The penis sponge were completely stretched out and uprighted in the first-stage. Foreskin and partial penis back skin was transferred into the ventral of penis and scrotum crack. At second-stage, urethroplasty was performed using bladder mucosa folded into half tube that sutured with urothra plate to reconstruct the urothra. The scrotum were re-shaped using foreskin and skinflap., Results: The operation's successful rate was 68% (15/22). There were 7 cases (32%) suffered from urethrocutaneous fistula and recovered after repair. Five cases (23%) occurred stricture of urethra and were treated by urethra dilatation. The appearance of penis and scrotum in 22 cases were satisfied., Conclusions: The operative methods should be made according to the type of hypospadias and of scrotum. The technic were effective on severe hypospadias with abnormal scrotum, even for the patients who need more than 10 cm urethra construct. The appearance of penis and scrotum were satisfied after following up.

Objective: To evaluate some currently used surgical approaches to the correction of congenital penile curvature., Methods: Seventy-six patients with congenital penile curvature underwent surgical correction, of whom 67 were accompanied with hypospadias, 5 with epispadias and 4 with normal urethral meatus. The methods for straightening the phallus included 5-week preoperative hCG treatment, complete degloving of penile skin, release of periurethral fibrous bands extending proximally to the meatus, plication of dorsal or ventral tunica albuginea, and embedding of dermis and tunica vaginalis grafts., Results: All the cases were followed up for 2 months to 2 years, and the mean follow-up time was 9.3 months. Satisfactory phallus straightening was achieved in 67 cases (88%), mild residual chordee remained in 6 (8%), which needed no reoperation for the time being unless warranted by follow-up, and relapse occurred in 3 (4%), which needed further operation., Conclusion: Most cases of congenital penile curvature can be corrected sufficiently with the above methods.

Objective: To observe the long-time results of the treatment of buried penis with fixation at the base of penis through pre-pubic route., Methods: From Aug 2002 to Dec 2003, the procedure was performed in 34 children without penile skin insufficiency. The major technique involved the release of hided penis shaft by partly shearing suspensory ligament, fixating the bucks fascia and tunica albuginea at 3 and 9 o'clock positions with the subcutaneous penile skin at the base of penis just under the pubic symphysis., Results: Twenty-one patients have been reviewed over one year with satisfactory appearance. Thirteen patients were lost to follow-up. No recurrence happened in our group., Conclusion: We compare this technique with major treatment methods for buried penis in children at present, and we conclude this technique is a reasonable, simplified and aesthetical method for the treatment of buried penis in children.