Anomaly External Genital in

Children

Randy Fauzan, MD
Urology Division, Raden Mattaher Hospital
School of Medicine ,Universitas Jambi
PHIMOSIS and PARAPHIMOSIS
 PHIMOSIS and PARAPHIMOSIS

The diagnosis of phimosis and paraphimosis

is made by physical examination
 Phimosis
(inability to retract the foreskin)

Physiologic phimosis Pathologic phimosis

Inflammatory and traumatic
injury → inelastic scar → prevent
retraction

• All children in the first year of life have

physiologic phimosis that requires no
treatment
• Forefull retraction of the foreskin maybe the
cause of pathologic phimosis
PHIMOSIS
 Phimosis
(inability to retract the foreskin)

• By 3 years of age → 90% of the foreskin can be

retracted
• Only 1 – 3 % of children after 3 years of age
would have true phimosis
• Topical steroid may be effective
 Terapi fimosis
• Tanpa komplikasi • Dengan komplikasi
 
- sirkumsisi plastik sirkumsisi segera
(frenuloplasti) atau tanpa melihat usia
radikal (tergantung
pilihan orang tua),
setelah usia 2 tahun
- Salep kortikoid 0.05 –
0,1%
 Paraphimosis

• Developed when the preputial aperture is

retracted proximal to the corona of the glans

• Edema → prevents replacement of the

aperture distal to the glans → pain → venous
congestion
Emergency case
PARAFIMOSIS
 Terapi parafimosis

• Kasus darurat

• Kompresi manual, bila gagal  dorsumsisi

atau sirkumsisi tergantung kondisi lokal
 Buried Penis (Concealed
Penis)
• Penis hidden by prominent prepubic fat pad

• Normal sized penis seen by compression of fat pad

• may resolve slowly with growth

• be very careful with circumcision

• surgery occasionally necessary

• fixation of penile skin to pubis and corpora (Redman,

1985)

• liposuction in severe cases (Maizels, 1986)

Buried penis after circumcision
Web penis

• The scrotal skin extends onto the ventrum of

the penis
• Abnormality of the attachment between
scrotum and penis
 Contra-indication to circumcise

• Abnormal penile development ( hypospadias,

chordee, micropenis, buried penis, ect)
• Bleeding disorder
• Prematurity
• Systemic illness
Penile amputation due to “laser” circumcision
Komplikasi
Smart klem
 Hypospadias
Hypospadias classification according to meatal location after
release of chordee
Anterior (60-70%): - glanular
- coronal
- distal penile shaft
Middle (10-15%): * middle penile shaft
Posterior (20%) : # proximal penile shaft
# penoscrotal
# scrotal
# perineal
HYPOSPADIAS

abnormal meatus
abnormal prepuce
abnormal ventral aspect
ventral curvature
abnormal meatus
abnormal prepuce
abnormal ventral aspect
ventral curvature
• Define anatomy well
• Choose the technique for the anatomy
 Hipospadia
Tujuan pembedahan

Usaha: fungsional dan kosmetik senormal mungkin

Eksisi/ release chordee  normal intercourse
Meatus lebih dekat glans bisa BAK berdiri
Penampilan phallus penis normal yg disunat
 Hipospadia

• Operasi bisa satu atau bbrp tahap

• Umur 2 th  diharapkan op sdh selesai

seluruhnya

• Inform consent untuk resiko operasi

Hipospadia

Diagnosis

• pemeriksaan fisik lengkap

• diskripsi temuan lokal
• anomali lain (mis UDT, hernia)
• hipospadia berat dengan transposisi skrotal
yang disertai UDT  px genetik
• urinalisa
• USG (?)
Hipospadia

• Indikasi pembedahan:
- hipospadia sedang dan berat
- bentuk distal dengan kurvatura / stenosis

Hipospadia distal sederhana, koreksi

kosmetik hanya dilakukan setelah diskusi
menyeluruh tentang aspek psikologis dan
pemastian adanya gangguan fungsional.
Hipospadia

Pilihan prosedur pembedahan

tergantung:
1. Chordee
2. Lokasi dan ukuran meatus
3. Banyaknya kulit dorsal penis
4. Urethral plate
Hipospadia

Penyebab kurvatura penis

• Chorde kulit
• Jaringan ikat chorde
• Disproporsi korporeal  orthoplasty
• Lempeng urethra (jarang)
Hipospadia

Concepts of the urethral plate

• Preservation when possible

1. allows onlay flaps reduces stenosis
2. incision and tubularization possible
3. rarely causes curvatura resection
Hipospadia

Prinsip-prinsip dasar operasi hipospadia

1. Chordectomi / orthoplasty
2. Urethroplasty
3. Meatoplasty
4. Glanuloplasty
5. Skin coverage
Hipospadia

Aspek bedah standard

- pakai pembesaran optik (loupe 3.5X)

- General, regional, caudal anesthesia
- Instrument opthalmic
- Kauter bipolar
- Benang  6-0 absorbable (catgut, chromic, vicryl,
Dexon, PDS)
- Silastic tubes dengan atau tanpa diversi urin
- Penile dressing  lebih simple (Op-Site)
- Antibiotika perioperatif
Hipospadia

Hasil yang ideal:

- penis tampak normal
- meatus terletak pada tip glans
- Saat BAK berdiri ----- pancaran lurus
- Penis lurus saat ereksi
Onlay island flap repair
Onlay island flap repair
Transverse Preputial Island Flap Repair
Transverse Preputial Island Flap Repair
Two-stage hypospadias repair
Hipospadia

Komplikasi

• Meatal stenosis : dilatasi

• Skar meatus : dilatasi tidak efektif utk jangka
panjang
• Fistula urethrokutan : repair setelah 6 bulan
• Kurvatur ringan yang tidak berpengaruh thp
fungsi : tidak perlu revisi
EPISPADIAS
Bladder Extrophy
Terima kasih