Results
This cases preoperative bilateral urethral can void, Urodynamics revealed the left function is better than that the right, after closed pubic symphysis, we saw the right urethra is located in the middle through cystoscope, can smoothly entered into the bladder, the left urethral axis significantly deviate from the center line, with a 60 degree angle merge into the bladder, so we keep the right urethra, remove the left one. Azmy and TirtayasaPM report on the treatment of patients with repeated penis and pubic symphysis separation, only bladder, penile reconstruction surgery, not with pubic symphysis separation. Because the case should make the separation of the penis sponge to merge, and the penises were apart so far, if you don't closed pubic symphysis, bilateral corpus cavernosum may not be combined into a complete penis, so the pubic symphysis closure is the key to the success of the surgery.
Interpretation of results
The boy was 3 years old, the pelvis bone is hard enough, pelvic CT and 3D printing showed flat obvious, only posterior path bilateral iliac bone osteotomy is not enough, pelvic volume shrinking, bladder and rectum can't enter the pelvic cavity, pelvic also unable to achieve closed loop, so the operation design for double posterior path iliac bone osteotomy (longitudinal osteotomy) by the sacroiliac joint and bilateral Salter osteotomy. After four osteotomy, will soften the pelvis to closed loop, pelvic external fixation for 3 months, healed well, the pubic symphysis tightly closed. Also, the pubic symphysis closed not only make the abdominal wall achieve physiological closed, at the same time make anal muscle closed to pubic rectum muscle at the front, to re-establish urogenital diaphragm. The bladder neck and urethra cross the loops, closes the bladder neck tightly, can better control urination. His gait postoperative was significantly improved after joint of the pubic symphysis, was rotated to the medial side of the hip joint and the lower extremities. Therefore, no matter what type of repeat penis, especially combined with pubic symphysis, it is better to have the bladder and urethral reconstruction after the symphysis of the pubis.Anal rectal malformation is used to repeat rectum, repeat anal opening and rectal interlock. Repeat tube should be removed and anus molding. This example found repeated exist dysplasia outside around the anus sphincter, respectively pass through two external sphincter ring, and by using redundant seromuscular layer folding to form internal sphincter muscle layer, enhance bowel control. The treatment of repeated anal deformity of diphallia, no case had been reported. The treatment of repetitive penile and associated malformation is a series of sequential therapy, and one case of Smith is completed by 5 inpatient 7 surgeries. However, the patient with multiple malformations in this case have been able to complete the correction once to all with multiple disciplinary procedures, which have not been reported in the international community.
Concluding message
This procedure avoids repeatedly surgeries on the bottom of the pelvic floor, making the anatomical level unclear, increasing the difficulty of the operation and even causing the possibility of minor injury. Also relieve the suffering of the children with multiple surgery, and psychological impact on families and children, also greatly shorten the treatment time, can be more early gait, urine function rehabilitation training.
It is rare for us to repeat the clinical practice of the penis. We have only successfully treated one case, but there is still no large sample, multiple complicated abnormal statistics and diagnosis and treatment experience. The treatment of double penis is not only the treatment of physiological function, but appearance and psychotherapy are equally important. Therefore, it is necessary to make a comprehensive examination and make a reasonable treatment plan, which can obviously improve the quality of life of patients.