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MMW Fortschritte Der Medizin May 2021
Review
Topics: Child; Circumcision, Male; Humans; Male; Phimosis
PubMed: 34033050
DOI: 10.1007/s15006-021-9902-y -
Journal of Pediatric Urology Feb 2017In principle, the prepuce can be reconstructed during hypospadias repair, but the procedure has not gained wide acceptance and preputial reconstruction (PR) is... (Review)
Review
OBJECTIVE
In principle, the prepuce can be reconstructed during hypospadias repair, but the procedure has not gained wide acceptance and preputial reconstruction (PR) is surrounded by several controversies.
MATERIAL AND METHODS
A review is provided of the technique for PR, how PR combines with the other steps of hypospadias repair, the risks of complications related to the urethroplasty and specific to PR, and the results of PR with particular regard to the relevance for the patient and his family.
RESULTS
PR can be important for patients requiring hypospadias repair and their parents. It can be performed in almost all patients with distal hypospadias except perhaps those with the most asymmetrical prepuces or severe ventral skin deficiency. PR does not seem to increase urethroplasty complications, but combination of PR with tubularisation of the urethral plate urethroplasty seems to offer the best chance of success. Specific complications occur in around 8% of patients and include partial or complete dehiscence of the prepuce and secondary phimosis. To prevent the latter, the reconstructed prepuce should be easily retractile at the end of surgery. Technical modifications can help to achieve this goal. Cosmetically, reconstructed prepuces are not fully normal, but the abnormality could be less important for a patient and his parents that the complete absence of the prepuce.
CONCLUSION
On the basis of the evidence summarised above, an algorithm for PR in patients with distal hypospadias is proposed. PR can be offered to the vast majority of distal hypospadias patients, although some modification of the technique for hypospadias repair can be required. Retractility of the reconstructed prepuce at the end of surgery seems paramount for final success.
Topics: Foreskin; Humans; Hypospadias; Male; Plastic Surgery Procedures; Urologic Surgical Procedures, Male
PubMed: 27773620
DOI: 10.1016/j.jpurol.2016.07.018 -
Emergency Medicine Australasia : EMA Feb 2016
Review
Topics: Analgesia; Child; Child, Preschool; Conscious Sedation; Humans; Infant; Male; Paraphimosis
PubMed: 26781045
DOI: 10.1111/1742-6723.12532 -
American Journal of Ophthalmology Case... Dec 2020A 60year old male presented with insidious onset, gradually progressive, painless diminution of vision in the right eye since a year. He was operated for cataract about...
A 60year old male presented with insidious onset, gradually progressive, painless diminution of vision in the right eye since a year. He was operated for cataract about 7 years ago. However, details of surgery or intraocular lens (IOL) were unavailable. Fellow eye was unremarkable. Examination revealed a visual acuity of FC at 5 mts. Slit-lamp examination revealed a quiet anterior chamber without any cells-flare nor any posterior synechiae. Co-axial retro-illumination revealed an in-the-bag IOL, having both haptics folded on the optic with scarring and contraction of the capsular bag, most apparent in the centre. Fundus examination with indirect ophthamoloscopy was difficult owing to the media haze due to capsular scarring but retina was unremarkable as far as could be seen. A diagnosis of "Capsular Bag Phimosis"1,2,3,4 was made. An ASOCT demonstrated such severe moulding of the IOL that a simple YAG capsulotomy may have increased visual acuity but would have lead to severe image distortion, metamorphopsia and resultant aniseikonia. IOL was explanted alongwith the phimosed capsular bag and a Scleral-fixated IOL was placed to achieve a final BCVA 20/20P Snellen.
PubMed: 33319123
DOI: 10.1016/j.ajoc.2020.100999 -
Therapeutische Umschau. Revue... Jun 2020Urologic Emergencies: Paraphimosis Paraphimosis presents a rare but acute urological emergency whereby the foreskin becomes entrapped behind the coronary sulcus of the...
Urologic Emergencies: Paraphimosis Paraphimosis presents a rare but acute urological emergency whereby the foreskin becomes entrapped behind the coronary sulcus of the penis. Therapy is quick and feasible, even in an outpatient setting. In most cases compression of the preputial edema and subsequent reposition of the prepuce is sufficient. Rarely, surgical intervention in form of a dorsal incision of the constriction is required. With partial or full phimosis being the underlying condition, paraphimosis occurs predominantly in infants and toddlers. However, persistent or secondary phimosis can lead to paraphimosis in advanced age.
Topics: Child, Preschool; Emergencies; Emergency Service, Hospital; Humans; Male; Paraphimosis; Phimosis
PubMed: 32870094
DOI: 10.1024/0040-5930/a001182 -
BMJ (Clinical Research Ed.) Oct 2016
Topics: Adult; Humans; Male; Medical History Taking; Phimosis; Physical Examination
PubMed: 27707732
DOI: 10.1136/bmj.i4639 -
Der Urologe. Ausg. A Mar 2020Lichen sclerosus (LS) is a chronic inflammatory disease of the skin. It mainly affects the anogenital area. More knowledge of the disease is needed to avoid delay in... (Review)
Review
Lichen sclerosus (LS) is a chronic inflammatory disease of the skin. It mainly affects the anogenital area. More knowledge of the disease is needed to avoid delay in diagnosis as early treatment may cure the disease in some and reduce or prevent scarring. Initial treatment for girls and boys comprises the daily application of a potent cortisone ointment for 3 months. After remission the treatment should be continued long-term intermittently. If there is no complete remission in boys complete circumcision is recommended. LS usually cannot be healed but only well suppressed, and also after circumcision recurrences may occur years later. Therefore, patients have to be well informed and should be followed up long-term.
Topics: Anti-Inflammatory Agents; Child; Circumcision, Male; Cortisone; Female; Humans; Lichen Sclerosus et Atrophicus; Male; Skin; Treatment Outcome
PubMed: 32052167
DOI: 10.1007/s00120-020-01140-w -
Urology Aug 2022To provide a summary of surgical technique and outcomes for Heineke-Mikulicz preputioplasty (HMP), a foreskin-preserving surgical treatment for phimosis in the adult...
OBJECTIVE
To provide a summary of surgical technique and outcomes for Heineke-Mikulicz preputioplasty (HMP), a foreskin-preserving surgical treatment for phimosis in the adult population.
METHODS
We retrospectively reviewed 7 patients who underwent HMP by a single surgeon from May 2017 to May 2021. Variables included patient demographics, intraoperative considerations, and post-operative course. HMP is performed using a 2-3 cm vertical incision over the phimotic band on the dorsal surface to just above Buck's fascia. Additional incisions are made on the ventral surface if phimosis remains persistent after dorsal release. The incision is closed horizontally in 2 layers.
RESULTS
Seven patients underwent HMP. Median age was 47.3 and median BMI was 24.3. Five patients reported bothersome phimosis and 1 each reported paraphimosis and frenular tethering. Six patients requested foreskin sparing surgery as a personal preference and 1 patient was an intraoperative consult. Topical betamethasone was attempted in 3 of 7 patients. The median time from diagnosis to surgery was 2 months. Median operative time was 45.5 minutes and median estimated blood loss was 5 mL. Two patients required both dorsal and ventral incisions. No intraoperative complications were reported and all patients were discharged the same day. At median follow-up of 1.8 months, 1 patient reported bothersome phimosis secondary to scar formation treated successfully with triamcinolone.
CONCLUSION
HMP is a safe and effective method of treating even very significant phimosis in patients trying to avoid circumcision or intraoperative consults where preferences may be unclear. Our method takes less time than traditional circumcision with a comparable recovery and complication profile.
Topics: Adult; Circumcision, Male; Foreskin; Humans; Intraoperative Care; Male; Middle Aged; Penis; Phimosis; Retrospective Studies; Surgical Wound; Treatment Outcome
PubMed: 35430235
DOI: 10.1016/j.urology.2022.03.030 -
Der Urologe. Ausg. A Apr 2018Penile cancer is often an obvious visual diagnosis but histologic verification should be obtained prior to treatment. The clinical examination should determine the tumor... (Review)
Review
Penile cancer is often an obvious visual diagnosis but histologic verification should be obtained prior to treatment. The clinical examination should determine the tumor stage and whether it has infiltrated the cavernous bodies and/or the urethra and it should adequately assess the inguinal lymph nodes. Preoperative imaging of the lesion is only indicated in equivocal cases. Curative treatment requires the complete removal of the primary tumor and all metastatic lymph nodes. Lymph node management is the key prognostic factor in the treatment of penile cancer. No imagining technique such as the ultrasound, CT, MRI or PET/CT is able to adequately detect micrometastatic lymph nodes. Therefore, invasive (inguinal) lymph node diagnosis is indicated for all tumour stages from pT1G2. Over 90% of penile cancer cases can be cured with early diagnosis and adequate treatment if routine self-examination and physical examinations are regularly performed.
Topics: Adult; Aged; Carcinoma, Squamous Cell; Early Diagnosis; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Papillomavirus Infections; Penile Neoplasms; Penis; Phimosis; Risk Factors; Urethra
PubMed: 29523915
DOI: 10.1007/s00120-018-0602-x -
Turkish Journal of Urology Mar 2019Male circumcision is one of the most common surgical procedures worldwide. Although it is widely performed because of health issues, in Muslim-majority countries, the...
OBJECTIVE
Male circumcision is one of the most common surgical procedures worldwide. Although it is widely performed because of health issues, in Muslim-majority countries, the primary motivation yielding to male circumcision is religious. It is a relatively safe procedure with a low overall complication rate. We herein report an underrated complication of circumcision that can be termed as "secondary phimosis."
MATERIAL AND METHODS
The medical records of 25 boys with post-circumcision secondary phimosis were reviewed. Demographics of the patients, method of circumcision, type of provider, peroperative findings and comorbidities were recorded.
RESULTS
Between January 2005 and December 2016, 25 boys with post-circumcision secondary phimosis were treated surgically. The median age of the patients was 3 (2-5) years. The majority of the patients were circumcised by the Gomco clamp or Plastibell method (n=16). Of the patients' circumcisions, six were performed by the freehand method, and three by the dorsal slit method. In 15 boys, circumcision was performed by a traditional provider. Of the boys, seven were circumcised by a physician, and three were circumcised by a pediatric surgeon. All the patients were re-circumcised. The common peroperative finding was the redundant mucosal inner layer of the prepucium. Excess suprapubic fat was present in 12 patients.
CONCLUSION
Although circumcision is known as a minor surgical practice with low complication rate, it must be performed safely and especially by experienced physicians/surgeons. Secondary phimosis is a technical error that is caused by insufficient removal of the inner mucosal layer of the prepucium. Re-circumcision of the patient is inevitable, causing the patient second trauma.
PubMed: 30875291
DOI: 10.5152/tud.2018.94984