282 / 330
282
28
TH
CONGRESS OF THE ESPU
A pfannenstiel incision was used to mobilize the bladder and distal ureters. The ureters were
minimally dissected, taking care to avoid compromising the vascular supply, down to the level of
the bladder. The medial edges of the bilateral ureters were incised and brought together medially
with 6-0 PDS suture creating a Wallace anastomosis posteriorly. The lateral ureteral edges were
anastomosed to the posterior bladder wall using 4-0 vicryl suture creating the anterior plate of
the Wallace anastomosis. The patient had an uneventful postoperative course and discharged on
postop day two with prophylactic antibiotics. A foley catheter was left in place for four days.
CONCLUSIONS
This refluxing side-to side ureterovesicostomy is a useful technique for managing megaureter in
infants. It has the benefits of adequately draining the kidneys while preserving the distal ureters for
a future reimplantation, if necessary.
VS-4 (VS without presentation)
A SIMPLIFIED APPROACH TO CORRECTION OF PENILE
CONCEALMENT EMPLOYING SCROTAL MOBILIZATION
Gregory DEAN, Joshua JONES, Ziho LEE, Daniel PARKER, Jonathan ROTH
and Michael PACKER
Temple University, Urology, Philadelphia, USA
PURPOSE
Penile Concealment with inadequate shaft length can be challenging to manage, particularly when
a family desires circumcision. Traditional approaches for correction include techniques where shaft
lenth is achieved through excision of of peno-scrotal webbing followed by skin approximation. We
have devised an alternative approach which preserves the scrotal skin, yet provides good ventral
skin coverage.
MATERIAL AND METHODS
We demonstrate this approach in a boy with inadequate ventral shaft length whose family requested
circumcumcision. During the procedure we deglove the penis and free deep tethering bands at the
penopubic junction. We also incise the penile skin on the ventral surface from the coronal margin
to the penopubic junction and then retract the superficial scrotum posteriorly. Midline scrotal fat
is exposed and divided followed by posterior mobilization and re-positioning of the scrotum. This
permits ventral unfurling of the prepuce which provides shaft skin coverage.
RESULTS
This technique is easily performed in an ambulatory setting and has been widely applied to our
patients with penile concealment who are undergoing circumcision.
CONCLUSIONS
Penile concealment correction with scrotal mobilization provides excellent cosmetic results and is
well tolerated by patients. Preservation of the scrotal skin provides for a natural penoscrotal junction
with decreased wound healing requirements.