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Journal of the European Academy of... Oct 2016Eugène Follmann first described syphilitic balanitis as a manifestation of primary syphilis in 1948 and since then it has been known as syphilitic balanitis of Follmann... (Review)
Review
BACKGROUND
Eugène Follmann first described syphilitic balanitis as a manifestation of primary syphilis in 1948 and since then it has been known as syphilitic balanitis of Follmann (SBF). So far, SBF has rarely been described in literature.
OBJECTIVES
We are reporting five additional cases of SBF considering the broad differential diagnosis of balanitis.
METHODS
A review of the available literature of SBF was performed and five additional cases analyzed.
RESULTS
In our case series, the clinical appearance of SBF shows a heterogeneous spectrum varying from painful oedematous balanoposthitis with beginning paraphimosis to superficial erosive balanitis and even to painless induration of the glans.
CONCLUSIONS
SBF might be seen more frequently than has been described due to misinterpretation. Therefore primary syphilis should be included in the differential diagnosis of balanitis and balanoposthitis.
Topics: Adolescent; Humans; Male; Middle Aged; Penile Diseases; Syphilis; Young Adult
PubMed: 27421838
DOI: 10.1111/jdv.13802 -
Journal of the American Animal Hospital... 2017An 8 mo old intact male mixed-breed dog presented for diphallia with paraphimosis of the nonfunctional, accessory penis. Bloodwork, an abdominal ultrasound, and a...
An 8 mo old intact male mixed-breed dog presented for diphallia with paraphimosis of the nonfunctional, accessory penis. Bloodwork, an abdominal ultrasound, and a positive contrast retrograde urethrogram were performed and revealed no other structural abnormalities. Surgical excision of the accessory penis was elected. This is one of three reported cases of diphallia in the dog in the English literature, but this is the only case in which no other congenital abnormalities were identified. The authors also review diphallia in both the veterinary and human literature.
Topics: Animals; Contrast Media; Dog Diseases; Dogs; Female; Male; Penis; Urogenital Abnormalities
PubMed: 28792795
DOI: 10.5326/JAAHA-MS-6599 -
Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions.The Cochrane Database of Systematic... Mar 2021Medical circumcisions are among the most common surgical procedures performed in males. The usual indications are phimosis (inability to completely retract the foreskin... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Medical circumcisions are among the most common surgical procedures performed in males. The usual indications are phimosis (inability to completely retract the foreskin and expose the glans due to a congenital or acquired constriction of the prepuce), paraphimosis (when the foreskin is not pulled back over the glans after retraction resulting in a tight constricting band which causes swelling of the distal penis and acute discomfort), balanoposthitis (erythema and edema of the prepuce and glans) and balanitis (inflammation is confined to the glans; the foreskin is usually non-retractile). Circumcision devices have been developed to shorten the operative time, simplify techniques, and improve safety and cosmetic outcomes. The devices generally aim to crush the foreskin while simultaneously creating hemostasis, the foreskin is then excised or allowed to slough off. Their use is supposedly safer and easier to replicate than the standard dissection techniques. There are at least 20 devices for male circumcision on the market, yet their effectiveness has not been reviewed to date.
OBJECTIVES
To assess the effects of device-based circumcisions compared with standard surgical techniques in adolescent and adult males (10 years old and above).
SEARCH METHODS
We performed a comprehensive search with no restrictions to the language of publication or publication status. We searched the Cochrane Library, MEDLINE (PubMed), Embase, Web of Science, trials registries, grey literature sources and conference proceedings up to 16 April 2020.
SELECTION CRITERIA
We included randomized controlled trials of device-based circumcisions (crush or ligature circumcision devices) compared to standard surgical dissection-based circumcision conducted by health professionals in a medical setting.
DATA COLLECTION AND ANALYSIS
At least two review authors independently assessed study eligibility and extracted data from the included studies. We classified adverse events into serious, moderate or mild. We reported study results as risk ratios (RR) or mean differences (MD) using 95% confidence intervals (CI) and a random-effects model. We used the GRADE approach to evaluate the overall certainty of the evidence for each outcome.
MAIN RESULTS
Eighteen trials met the inclusion criteria. Trials were conducted in China, South Africa, Kenya and Zambia, Mozambique, Rwanda, Uganda and Zimbabwe. Primary outcomes Serious adverse events: there were no serious adverse events in either treatment arm (11 trials, 3472 participants). Moderate adverse events: there may be a slight increase in moderate adverse events when devices are used compared to standard surgical techniques (RR 1.31, 95% CI 0.55 to 3.10; I²= 68%; 10 trials, 3370 participants; low-certainty evidence); this corresponds to 8 more (ranging from 15 fewer to 84 more) moderate adverse events per 1000 participants. We downgraded the certainty of the evidence for study limitations and imprecision. Secondary outcomes Mild adverse events: we are uncertain about the difference in mild adverse events between groups when devices are used compared to standard surgical techniques (RR 1.09, 95% CI 0.44 to 2.72; I² = 91%; 10 trials, 3370 participants; very low-certainty evidence). We downgraded the certainty of the evidence for study limitations, imprecision and unexplained inconsistency. Operative time: operative time is probably about 17 minutes shorter when using a device rather than standard surgical techniques, which constitutes a clinically meaningful decrease in a procedure (MD -17.26 minutes, 95% CI -19.96 to -14.57; I² = 99%; 14 trials, 4812 participants; moderate-certainty evidence). We downgraded the certainty of the evidence for serious study limitations. The standard surgical technique generally takes about 24 minutes. There may be less postoperative pain during the first 24 hours when circumcision devices are used compared to standard surgical techniques (measured using a visual analog scale [VAS]; MD 1.30 cm lower, 95% CI 2.37 lower to 0.22 lower; I² = 99%; 9 trials, 3022 participants; low-certainty evidence). We downgraded the certainty of the evidence for study limitations and unexplained heterogeneity. There may be little or no difference in postoperative pain experienced during the first seven days when compared with standard surgical techniques (measured using a VAS; MD 0.11 cm higher, 95% CI 0.89 lower to 1.11 higher; I² = 94%; 4 trials, 1430 participants; low-certainty evidence). We downgraded the certainty of the evidence for study limitations and unexplained inconsistency. A higher score on the VAS indicates greater pain. Participants may slightly prefer circumcision devices compared to standard surgical techniques (RR 1.19, 95% CI 1.04 to 1.37; I² = 97%; 15 trials, 4501 participants; low-certainty evidence). We downgraded the certainty of the evidence for study limitations and unexplained inconsistency. We recorded satisfaction as a dichotomous outcome. Higher rates reflected greater satisfaction.
AUTHORS' CONCLUSIONS
We found that there were no serious adverse events reported when using a circumcision device compared to standard surgical techniques, but they may slightly increase moderate adverse effects, and it is unclear whether there is a difference in mild adverse effects. Use of circumcision devices probably reduces the time of the procedure by about 17 minutes, a clinically meaningful time saving. For patients, use of the circumcision device may result in lower pain scores during the first 24 hours and patients may be slightly more satisfied with it compared with standard surgical techniques. Clinicians, patients and policymakers can use these results in conjunction with their own contextual factors to inform the approach that best suits their healthcare settings. High-quality trials evaluating this intervention are needed to provide further certainty regarding the rates of adverse effects and postoperative pain of using devices compared to standard approaches.
Topics: Adolescent; Adult; Bias; Child; Circumcision, Male; Humans; Male; Middle Aged; Operative Time; Pain, Postoperative; Patient Preference; Randomized Controlled Trials as Topic; Young Adult
PubMed: 33786810
DOI: 10.1002/14651858.CD012250.pub2 -
The American Journal of Emergency... Jun 2015Adequate anesthesia for emergency department management of painful penile conditions such as paraphimosis or priapism is often both technically challenging and...
Adequate anesthesia for emergency department management of painful penile conditions such as paraphimosis or priapism is often both technically challenging and inconsistent using traditional landmark-based techniques of the dorsal penile block (DPB). The pudendal nerves branch to form the paired dorsal nerves of the penis providing sensory innervation to the skin of both the dorsal and ventral aspects of the penis. "Blind" DPB techniques tend to rely on subtle tactile feedback from the needle and visual landmark approximation to identify the appropriate subpubic fascial compartment for injection. The landmark-based DPB is not standardized with options including “10 o'clock and 2 o'clock” infrapubic injections with or without ventral infiltration or a ring block. Given the lack of standardization and inherent technical imprecision with the landmark-based DPB, large volumes of local anesthetic (up to 50 mL) are sometimes required to achieve a clinically adequate block. In addition, inadvertent injection into the corpora cavernosa may occur. More recently, an ultrasound-guided approach has been developed. Using ultrasound, the dorsal penile nerves can be precisely targeted in the fascial compartment just deep to Buck fascia, potentially increasing block success rate and reducing the need for large local anesthetic volumes. Herein, we report the first adult case of an ultrasound-guided dorsal penile nerve block performed in the emergency department for the reduction of a paraphimosis and review the relevant penile anatomy and technical details of the procedure.
Topics: Adult; Emergency Service, Hospital; Humans; Male; Nerve Block; Paraphimosis; Penis; Ultrasonography, Interventional
PubMed: 25605058
DOI: 10.1016/j.ajem.2014.12.041 -
Veterinary Surgery : VS Oct 2021To quantify cranial translation of the prepuce after elevating it from the ventral body wall and to compare it to the cranial translation achieved after each of two...
OBJECTIVE
To quantify cranial translation of the prepuce after elevating it from the ventral body wall and to compare it to the cranial translation achieved after each of two modifications expected to increase cranial translation.
STUDY DESIGN
Cadaveric study.
SAMPLE POPULATION
Ten male dogs.
METHODS
All procedures were performed with dogs in dorsal recumbency. A urinary catheter with an attached millimeter scale was secured in the urethra and the penis was sutured to the ventral body wall to eliminate relative movement between the penis and prepuce. Three preplaced sutures between the prepuce and linea alba, at increasing distances from the prepuce, were used to translate the prepuce cranially. The prepuce was tested after elevating it from the ventral body wall, and after sequentially releasing the skin caudal to the prepuce (modification 1) and the attachment of the lamina interna to the penis (modification 2). The preplaced sutures were tightened and loosened sequentially from caudal to cranial, and the location of the dorsal aspect of the preputial opening on the millimeter scale was noted prior to, and after tightening each of the sutures.
RESULTS
Maximum mean (range) cranial translation of the prepuce after elevating the prepuce, and after modifications 1 and 2, was 15 mm (5-26 mm), 25 mm (15-30 mm), and 37 mm (24-50 mm), respectively.
CONCLUSION
Modifications described increased cranial translation of the prepuce.
CLINICAL SIGNIFICANCE
Modifications described in this study may provide alternate strategies for the treatment of dogs with severe paraphimosis.
Topics: Animals; Cadaver; Dog Diseases; Dogs; Male; Penis; Skull; Urethra
PubMed: 34242410
DOI: 10.1111/vsu.13674 -
The Canadian Veterinary Journal = La... Jul 2023An 8-year-old intact male degu was examined with a 48-hour history of paraphimosis. The penis was devitalized and medical management was unsuccessful. A subtotal penile...
An 8-year-old intact male degu was examined with a 48-hour history of paraphimosis. The penis was devitalized and medical management was unsuccessful. A subtotal penile amputation was performed and a urethral-to-preputial anastomosis was created as part of a circumferential preputial urethrostomy. The immediate outcome in this case was good, with no complications. Key clinical message: Surgical intervention for paraphimosis in degus may be required in extreme cases of penile necrosis or due to an inability to replace the penis within the prepuce. Despite the degu's small size, surgery is feasible, as has been described in other species.
Topics: Male; Animals; Octodon; Paraphimosis; Penis; Urethra; Amputation, Surgical
PubMed: 37397699
DOI: No ID Found -
New Microbes and New Infections Mar 2023The presentation of mpox clade IIb during the 2022 outbreak overlaps with a range of other diseases. Understanding the factors associated with mpox is important for...
BACKGROUND
The presentation of mpox clade IIb during the 2022 outbreak overlaps with a range of other diseases. Understanding the factors associated with mpox is important for clinical decision making.
METHODS
We described the characteristics of mpox patients who sought care at Belgian sexual health clinic. Furthermore we compared their characteristics to those of patients with a clinical suspicion of mpox but who tested negative on polymerase chain reaction.
RESULTS
Between May 23 and September 20, 2022, 155 patients were diagnosed with mpox, and 51 patients with suspected symptoms tested negative. All mpox patients self-identified as men and 148/155 (95.5%) as gay or bisexual MSM. Systemic symptoms were present in 116/155 (74.8%) patients. All but 10 patients (145/155, 93.5%) presented with skin lesions. Other manifestations were lymphadenopathy (72/155, 46.5%), proctitis (50/155, 32.3%), urethritis (12/155, 7.7%), tonsillitis (2/155, 1.3%). Complications involved bacterial skin infection (13/155, 8.4%) and penile oedema with or without paraphimosis (4/155, 2.6%). In multivariable logistic regression models, the presence of lymphadenopathy (OR 3.79 95% CI 1.44-11.49), skin lesions (OR 4.35 95% CI 1.15-17.57) and proctitis (OR 9.41 95% CI 2.72-47.07) were associated with the diagnosis of mpox. There were no associations with age, HIV status, childhood smallpox vaccination, number of sexual partners and international travel.
CONCLUSIONS
The presence of proctitis, lymphadenopathies and skin lesions should increase clinical suspicion of mpox in patients with compatible symptoms.
PubMed: 36874154
DOI: 10.1016/j.nmni.2023.101093 -
Journal of Pediatric Surgery Aug 2017Circumcision has been found to be an effective strategy for lowering the transmission of HIV in Africa. The Luke Commission, a mobile hospital outreach program, has used...
BACKGROUND
Circumcision has been found to be an effective strategy for lowering the transmission of HIV in Africa. The Luke Commission, a mobile hospital outreach program, has used this information to decrease the rate of HIV in Swaziland by performing voluntary male medical circumcisions throughout the country. During many of these circumcisions, genital medical conditions and penile abnormalities are simultaneously discovered and corrected.
PURPOSE
The goal of our study was to evaluate the prevalence of penile abnormalities discovered and treated during voluntary male medical circumcisions performed by The Luke Commission (TLC) throughout rural Swaziland.
BASIC PROCEDURES
We completed a retrospective analysis of all male patients who underwent voluntary male medical circumcision performed by TLC during a period from June-August, 2014. The penile abnormalities included: phimosis, paraphimosis, epispadias, hypospadias, ulcers, balanitis, torsion, and foreskin adherent to the glans.
MAIN FINDINGS
Of 929 total circumcisions, 771 (83%) patients had at least one pre-existing penile abnormality identified during their examinations and procedures, totaling 1110 abnormalities. Three specific abnormalities were detected - phimosis, adherent foreskin, and hypospadias. The 6-12 and 13-19 age groups had adequate sample sizes to yield precise estimates of prevalence (age group 6-12: 87% (95% confidence interval [CI]=84-90%; age group 13-19: 79% (95% CI=74-84%).
PRINCIPLE CONCLUSIONS
The Luke Commission is improving the lives of children and adults with limited access to healthcare through regular preoperative evaluations during male circumcision, and the organization is setting an example for other international healthcare groups.
LEVEL OF EVIDENCE
Type of Study: Prognostic Study, Level II.
Topics: Adolescent; Adult; Child; Child, Preschool; Circumcision, Male; Cross-Sectional Studies; Eswatini; Humans; Male; Middle Aged; Penile Diseases; Penis; Preoperative Period; Prevalence; Retrospective Studies; Rural Population; Voluntary Programs; Young Adult
PubMed: 28088311
DOI: 10.1016/j.jpedsurg.2016.12.027 -
Indian Journal of Sexually Transmitted... 2023Gonococcal infection is known for complications, if not treated promptly and adequately. Although Tysonitis and Tyson's abscess are mentioned in textbooks, only few...
Gonococcal infection is known for complications, if not treated promptly and adequately. Although Tysonitis and Tyson's abscess are mentioned in textbooks, only few reports are available as complications of gonorrhea. Bilateral Tyson's abscess in acute gonorrhea is a rare entity when compared to other complications of gonorrhea. The patient responded well to treatment. Unless the physician is familiar with this condition, it may be mistaken for periurethral abscess or even as paraphimosis. Hence, this case is reported to alert the physicians.
PubMed: 37457517
DOI: 10.4103/ijstd.ijstd_97_22 -
Australian Veterinary Journal Nov 2014A 7-year-old neutered male Jack Russell terrier-cross was presented for signs of recurrent paraphimosis, despite previous surgical enlargement of the preputial ostium....
A 7-year-old neutered male Jack Russell terrier-cross was presented for signs of recurrent paraphimosis, despite previous surgical enlargement of the preputial ostium. Revision surgery was performed using a combination of preputial advancement and phallopexy, which resulted in complete and permanent coverage of the glans penis by the prepuce, and at 1 year postoperatively, no recurrence of paraphimosis had been observed. The combined techniques allow preservation of the normal penile anatomy, are relatively simple to perform and provide a cosmetic result. We recommend this combination for the treatment of paraphimosis in the dog, particularly when other techniques have failed.
Topics: Animals; Dog Diseases; Dogs; Male; Paraphimosis; Penis; Recurrence; Wound Healing
PubMed: 25348145
DOI: 10.1111/avj.12252