-
Journal of Surgical Case Reports Nov 2022We discuss a case report of a 38-year-old uncircumcised male on pre-exposure prophylaxis for human immunodeficiency virus who presents to the emergency department for...
We discuss a case report of a 38-year-old uncircumcised male on pre-exposure prophylaxis for human immunodeficiency virus who presents to the emergency department for painful lesions over his penile region following unprotected sexual intercourse. Following the development of these lesions he developed painless, itchy pustules over his bilateral arms and back. He also had extensive pain and swelling over his penile region, which prevented him from unretracting his foreskin. , Herpes simplex virus, and syphilis tests were negative. He was positive for orthopoxvirus using polymerase chain reaction. A diagnosis of paraphimosis as a complication of monkeypox infection was made.
PubMed: 36452291
DOI: 10.1093/jscr/rjac533 -
The Veterinary Clinics of North... Aug 2021Selected emergency conditions of male and female reproductive tracts in horses are described, including injuries affecting the external genitalia of male horses and... (Review)
Review
Managing Reproduction Emergencies in the Field: Part 1: Injuries in Stallions; Injury of the External Portion of the Reproductive Tract and Gestational Conditions in the Mare.
Selected emergency conditions of male and female reproductive tracts in horses are described, including injuries affecting the external genitalia of male horses and emergent conditions arising during gestation in mares. Conditions affecting male horses are discussed in the context of breeding stallions, but kicks or other mechanisms of trauma in the groin can also affect geldings. Priapism, paraphimosis, trauma to the scrotum and testicles, and penile injury are discussed. In mares, traumatic vestibular injury, placentitis, hydropsic conditions, prepubic tendon and abdominal wall compromise, and uterine torsion are included. Clinical recognition of the problem, diagnostic procedures, and treatments are summarized.
Topics: Animals; Breeding; Emergencies; Female; Genitalia, Female; Genitalia, Male; Horse Diseases; Horses; Male; Paraphimosis; Pregnancy; Priapism; Reproduction; Wounds and Injuries
PubMed: 34243877
DOI: 10.1016/j.cveq.2021.04.007 -
The American Journal of Emergency... Oct 2017Paraphimosis is an acute urologic emergency requiring urgent manual reduction, frequently necessitating procedural sedation (PS) in the pediatric population. The present... (Comparative Study)
Comparative Study
BACKGROUND
Paraphimosis is an acute urologic emergency requiring urgent manual reduction, frequently necessitating procedural sedation (PS) in the pediatric population. The present study sought to compare outcomes among pediatric patients undergoing paraphimosis reduction using a novel topical anesthetic (TA) technique versus PS.
METHODS
We performed a retrospective analysis of all patients <18years old, presenting to a tertiary pediatric ED requiring analgesia for paraphimosis reduction between October 2013 and September 2016. The primary outcome was reduction first attempt success; secondary outcomes included Emergency Department length of stay (ED LOS), adverse events and return visits. Dichotomous outcomes were analyzed by Chi-square testing and multivariate linear regression was used to compare continuous variables.
RESULTS
Forty-six patients were included; 35 underwent reduction using TA, 11 by PS. Patient age and duration of paraphimosis at ED presentation did not differ between groups. There was no difference in first attempt success between TA (32/35, 91.4%) and PS groups (9/11, 81.8%; p=0.37). Mean ED LOS was 209min shorter for TA patients (148min vs. 357min, p=0.001) and remained significantly shorter after controlling for age and duration of paraphimosis (adjusted mean difference -198min, p=0.003). There were no return visits or major adverse events in either group, however, among successful reduction attempts, PS patients more frequently experienced minor adverse events (7/9 vs. 0/32, p<0.001).
CONCLUSIONS
Paraphimosis reduction using TA was safe and effective. Compared to PS, TA was associated with a reduced ED LOS and fewer adverse events. TA could potentially allow more timely reduction with improved patient experience and resource utilization.
Topics: Anesthetics, Intravenous; Anesthetics, Local; Child; Child, Preschool; Emergency Service, Hospital; Humans; Hypnotics and Sedatives; Male; Paraphimosis; Retrospective Studies; Treatment Outcome
PubMed: 28416265
DOI: 10.1016/j.ajem.2017.04.015 -
Acta Neurologica Scandinavica Nov 2022Unverricht-Lundborg disease (EPM1) typically leads to accumulating disability. Disability may also be caused by comorbidities but there are no data available on these.
BACKGROUND
Unverricht-Lundborg disease (EPM1) typically leads to accumulating disability. Disability may also be caused by comorbidities but there are no data available on these.
AIMS OF THE STUDY
To investigate the frequency of comorbidities in EPM1.
METHODS
Comorbidity data of a previously described cohort of 135 Finnish patients with EPM1 were retrieved from neurological, surgical (including subspecialities), internal medicine (including subspecialities) and intensive care patient charts of the treating hospitals.
RESULTS
Mean follow-up time was 31.4 years (SD 12.4 years, range 6.8-57.8 years), during which at least one comorbidity was observed in 107 patients (79%) and three or more in 53 (39%). The most common diagnostic categories were external injuries, mental and behavioural disorders and endocrine, nutritional and metabolic diseases. The most common single comorbid diagnosis was a fracture of the ankle (in 19% of all patients). The second most common single comorbid diagnosis in the cohort was diabetes (in 13% of all patients), and the third was depression, recorded for 13% of the cohort. Malignancies and cardiovascular end-organ damage were rare, whereas phimosis/paraphimosis appeared more common than in general population.
CONCLUSIONS
Patients with EPM1 often have comorbidities. Trauma and mental health risks should be especially followed and acted upon. Further studies are needed to more accurately comorbidity risks, characteristics and patient needs.
Topics: Cohort Studies; Comorbidity; Finland; Humans; Male; Unverricht-Lundborg Syndrome
PubMed: 36097839
DOI: 10.1111/ane.13706 -
Military Medicine Mar 2023Military general surgeons commonly perform urologic procedures, yet, there are no required urologic procedural minimums during general surgery residency training.... (Review)
Review
BACKGROUND
Military general surgeons commonly perform urologic procedures, yet, there are no required urologic procedural minimums during general surgery residency training. Additionally, urologists are not included in the composition of forward operating surgical units. Urologic Care Army/Air Force/Navy Provider Education was created to provide military general surgeons with training to diagnose and treat frequently encountered urologic emergencies when practicing in environments without a urologist present.
STUDY DESIGN
A literature review and needs assessment were conducted to identify diagnoses and procedures to feature in the course. The course included a 1-hour didactic session and then a 2-hour hands-on simulated skills session using small, lightweight, cost-effective simulators. Using a pretest-posttest design, participants completed confidence and knowledge assessments before and after the course. The program was granted educational exemption by the institutional review board.
RESULTS
Twenty-seven learners participated. They demonstrated statistically significant improvement on the knowledge assessment (45.4% [SD 0.15] to 83.6% [SD 0.10], P < .01). On the confidence assessment, there were statistically significant (P ≤ .001) improvements for identifying phimosis, paraphimosis, and testicular torsion, as well as identifying indications for suprapubic catheterization, retrograde urethrogram, and cystogram. There were also statistically significant (P < .001) improvements for performing: suprapubic catheterization, dorsal penile block, dorsal slit, scrotal exploration, orchiopexy, orchiectomy, retrograde urethrogram, and cystogram.
CONCLUSION
We created the first-ever urologic emergencies simulation curriculum for military general surgeons that has demonstrated efficacy in improving the diagnostic confidence, procedural confidence, and topic knowledge for the urologic emergencies commonly encountered by military general surgeons.
Topics: Male; Humans; Education, Medical, Graduate; Military Personnel; Emergencies; Curriculum; Internship and Residency; Clinical Competence; Simulation Training
PubMed: 35043957
DOI: 10.1093/milmed/usac003 -
The Journal of Emergency Medicine Mar 2022Paraphimosis is an acute urological emergency occurring in uncircumcised males that can lead to strangulation of the glans and painful vascular compromise. Ketamine has...
BACKGROUND
Paraphimosis is an acute urological emergency occurring in uncircumcised males that can lead to strangulation of the glans and painful vascular compromise. Ketamine has been used in the emergency department (ED) as an anesthetic agent for procedural sedation, and when administrated in a sub-dissociative dose (low dose) at 0.1-0.3 mg/kg, ketamine has been utilized in the ED and prehospital settings for pain control as an adjunct and as an alternative to opioid, as well as for preprocedural sedation. This report details the case of a pediatric patient who presented to our Pediatric ED with paraphimosis and had his procedural pain treated with ketamine administrated via a breath-actuated nebulizer (BAN).
CASE REPORT
This case report illustrates the potential use of ketamine via BAN to effectively achieve minimal sedation for a procedure in pediatric patients in the ED. The patient was a 15-year-old boy admitted to the Pediatric ED complaining of groin pain due to paraphimosis. The patient was given 0.75 mg/kg of nebulized ketamine via BAN, and 15 min after the medication administration the pain score was reduced from 5 to 1 on the numeric pain rating scale. The patient underwent a successful paraphimosis reduction without additional analgesic or sedative agents 20 min after the administration of nebulized ketamine. The patient was subsequently discharged home after 60 min of monitoring, with a pain score of 0. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The use of nebulized ketamine via BAN might represent a viable, noninvasive way to provide a mild sedative and be an effective analgesic option for managing a variety of acute painful conditions and procedures in the pediatric ED.
Topics: Acute Disease; Adolescent; Analgesics; Anesthetics, Dissociative; Child; Emergency Service, Hospital; Humans; Hypnotics and Sedatives; Ketamine; Male; Pain; Paraphimosis
PubMed: 35094900
DOI: 10.1016/j.jemermed.2021.12.011 -
Cureus Apr 2022Paraphimosis is a urologic emergency that requires prompt diagnosis to avoid potential morbidity. Diagnosis is made clinically and imaging findings have not been...
Paraphimosis is a urologic emergency that requires prompt diagnosis to avoid potential morbidity. Diagnosis is made clinically and imaging findings have not been described. We will present the case of an 84-year-old man with a history of metastatic prostate cancer and prior pelvic external beam radiation therapy who presented to the emergency department with urinary retention. A urethral Foley catheter was placed for bladder decompression. He subsequently developed painful penile swelling and was found to have iatrogenic paraphimosis. Retrospective review of his contrast-enhanced CT of the abdomen and pelvis performed while in the emergency department before hospital admission revealed the relatively thickened, hypoattenuating prepuce located proximal to the corona of the glans penis, consistent with the clinical diagnosis. We will examine the imaging findings in this case and propose the novel "wet collar" sign to suggest the diagnosis of paraphimosis on CT.
PubMed: 35607539
DOI: 10.7759/cureus.24345 -
World Journal of Pediatrics : WJP Nov 2015Abnormalities involving the skin coverage of the penis are difficult to define, but they can significantly alter penile appearance, and be a cause of parental concern. (Review)
Review
BACKGROUND
Abnormalities involving the skin coverage of the penis are difficult to define, but they can significantly alter penile appearance, and be a cause of parental concern.
DATA SOURCES
The present review was based on a nonsystematic search of the English language medical literature using a combination of key words including "penile skin anomalies" and the specific names of the different conditions.
RESULTS
Conditions were addressed in the following order, those mainly affecting the prepuce (phimosis, balanitis xerotica obliterans, balanitis, paraphimosis), those which alter penile configuration (inconspicuous penis and penile torsion), and lastly focal lesions (cysts, nevi and vascular lesions). Most of these anomalies are congenital, have no or minimal influence on urinary function, and can be detected on clinical examination. Spontaneous improvement is possible. In the majority of cases undergoing surgery, the potential psychological implications of genital malformation on patient development are the main reason for treatment, and the age generally recommended for surgery is after 12 months of age.
CONCLUSION
This review provides the pediatrician with a handy tool to identify the most common penile skin anomalies, counsel parents adequately, make sensible and evidence based choices for management, and recognize complications or untoward outcomes in patients undergoing surgery.
Topics: Humans; Infant; Infant, Newborn; Male; Penile Diseases; Penis
PubMed: 25754752
DOI: 10.1007/s12519-015-0015-5 -
Annals of Dermatology Jun 2018
PubMed: 29853765
DOI: 10.5021/ad.2018.30.3.384