| Objective: To compare the clinical effects of scrotal progressive flap and dorsal transverse pedicled prepuce flap in the treatment of moderate to severe concealed penis in children.Methods: The clinical data were retrospectively analyzed for 72 children with moderate to severe concealed penis who underwent penile prepuplasty in the Department of Pediatric Surgery,Yijishan Hospital,Wannan Medical College from January 2020 to August 2022.The average age of 72 children was 78.5 months.Operation and postoperative follow-up was achieved by the same treatment group.They are divived into group A(45 cases)with progressive scrotal flap and group B(27 cases)with dorsal pedicled island flap.Clinical data were collected including perioperative general information,postoperative complications and family satisfaction 3 months after surgery.General conditions during perioperative period include age,Body mass index(BMI),operation time,penile length above baseline skin level(BPL)and stretched penile length(SPL)before and after operation,and concealed index according to circumference(CIs,BPL/SPL).Postoperative complications included postoperative bleeding,incision dehiscence,flap necrosis,refractory prepuce edema,and scar formation.The parents’ satisfaction survey was conducted using the relevant items in PPPS,including the score of penile appearance,prepuce appearance and penile exposure 3 months after the operation.Results: 1.All 72 cases were successfully operated and followed up for more than 3months.No serious complications such as penile torsion,penile head necrosis,residual prepuce narrow ring and urethral fistula occurred.2.The age of the children in the two groups was compared: group A(80.11±17.41)months and group B(75.70±23.49)months,with no statistical significance(t=0.910,P=0.366);The BMI of group A was(18.90±1.17)kg/m2 and that of group B was(18.34±1.30)kg/m2,showing no significant difference(t= 1.909,P= 0.060).The operation time of the two groups was compared: Group A(87.64±5.91),group B(112.67±6.37),the average time of group A was significantly shorter than group B,the difference was statistically significant(t=-16.884,P<0.001).The concealed index according to circumference before and after operation was0.46±0.13 and 0.75±0.06)in group A,,and0.44±0.13and0.74±0.05 in group B.There were statistically significant differences in intra-group comparison(P < 0.001).There were no significant differences among groups(P > 0.05).3.The incidence of postoperative complications was 33.33(15/45)in group A and 51.85(14/27)in group B,with no significant difference(χ2=2.406,P= 0.121).There was no significant difference in the incidence of postoperative bleeding and scar formation between the two groups(P=1.000).All the 7 cases of postoperative incision dehiscence occurred in group A,the difference was statistically significant(P=0.04).There were 3 cases of flap necrosis and6 cases of refractory prepuce edema in group B,but none of them occurred in group A,the differences were statistically significant(P=0.049,P=0.002).4.There were no significant differences in parents’ satisfaction scores,penile appearance,prepuce appearance,penile exposure and total score between the two groups 3 months after surgery(P > 0.05).Conclusion: Both the scrotal progressive flap technique and the dorsal transverse pedicled island flap technique can be used in the treatment of children’s moderate to severe concealed penis,and obtain satisfactory penis exposure effect.Compared with the latter,the operation of the former is simple,the learning curve is short,the operation time can be significantly shortened,and the relatives have high satisfaction on the appearance of the penile prepuce after the operation.The latter is suitable for children with large ventral prepuce defect,but the operation is complicated,the learning curve is long,postoperative prepuce edema and color difference may affect the appearance.Therefore,the scrotal progressive flap technology is more worthy of clinical promotion. |
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