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International Journal of Women's Health 2020Vulvar lichen sclerosus (LS) is a chronic, inflammatory dermatosis that may lead to scarring of the vulva and sexual dysfunction. LS affects women of all ages and often... (Review)
Review
Vulvar lichen sclerosus (LS) is a chronic, inflammatory dermatosis that may lead to scarring of the vulva and sexual dysfunction. LS affects women of all ages and often goes unrecognized and underreported. Uncertainty continues to exist around its pathogenesis, histologic diagnosis, and treatment. However, there have been great advances in our understanding of autoimmunogenic targets in disease formation and progression. In addition, there has been recent investigation of potential non-steroid-based treatments, including platelet-rich plasma therapy and energy-based modalities such as the fractional CO laser, photodynamic therapy, and high intensity focused ultrasound. Refinement of surgical techniques for restoring vulvar anatomy and treating clitoral phimosis, introital stenosis, and vulvar granuloma fissuratum is leading to improved patient outcomes. This review summarizes current perspectives on the pathogenesis, symptomatology, diagnosis, and treatment for vulvar lichen sclerosus.
PubMed: 32021489
DOI: 10.2147/IJWH.S191200 -
American Family Physician Jun 2020Newborn male circumcision is a common elective surgical procedure for the removal of foreskin covering the glans penis. The American Academy of Pediatrics, the American... (Review)
Review
Newborn male circumcision is a common elective surgical procedure for the removal of foreskin covering the glans penis. The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians recognize that there are health benefits of newborn male circumcision but do not universally recommend the procedure. Performing male circumcision during the neonatal period has several advantages, including a lower risk of complications, faster healing, and lower cost. The three most common techniques for newborn male circumcision utilize the Mogen clamp, the Gomco clamp, or the Plastibell device. Complications are uncommon and can include bleeding, injury to the penis, adhesions, excessive skin removal, phimosis, and meatal stenosis. Anatomic and medical contraindications may require that the procedure be deferred beyond the neonatal period. Infants with anatomic abnormalities should be referred to a pediatric urologist. Physicians should present information about potential benefits and risks rather than withholding or recommending circumcision. Parents should weigh the health benefits and risks and consider their own religious, cultural, and personal preferences when making the decision.
Topics: Circumcision, Male; Humans; Infant; Infant, Newborn; Male; Penis
PubMed: 32463643
DOI: No ID Found -
Deutsches Arzteblatt International Sep 2018The incidence of penile cancer in Europe lies in the range of 0.9 to 2.1 cases per 100 000 persons per year. Carcinogenesis is associated with human papilloma virus...
BACKGROUND
The incidence of penile cancer in Europe lies in the range of 0.9 to 2.1 cases per 100 000 persons per year. Carcinogenesis is associated with human papilloma virus (HPV) infection and with chronic inflammation.
METHODS
This review is based on publications (2010-2017) retrieved by a selective search in PubMed and EMBASE and on the guidelines of the European Association of Urology, the European Society of Medical Oncology, the National Comprehensive Cancer Network, and the National Institute for Health and Care Excellence (NICE).
RESULTS
95% of cases of penile cancer are accounted for by squamous cell carcinoma, whose numerous subtypes have different clinical courses. Chronic preputial inflammation due to phimosis or lichen sclerosus is often associated with penile cancer. Circumcision lowers the risk of penile cancer (hazard ratio: 0.33). Maximally organ-preserving surgery with safety margins of no more than a few millimeters is the current therapeutic standard, because a local recurrence, if it arises, can still be treated locally with curative intent. Local radiotherapy can be performed in early stages. Lymphogenic metastasis must be treated with radical lymphadenectomy and adjuvant chemotherapy. Patients with clinically unremarkable inguinal lymph nodes nonetheless need invasive lymph node staging because of the high rate of lymphogenic micrometastasis.
CONCLUSION
Penile cancer is curable in all early stages with the appropriate treatment, but its prognosis depends crucially on the proper management of the regional (i.e., inguinal) lymph nodes. In many countries, the treatment of this rare disease entity has been centralized.
Topics: Carcinoma, Squamous Cell; Europe; Humans; Lymph Nodes; Male; Neoplasm Metastasis; Penile Neoplasms
PubMed: 30375327
DOI: 10.3238/arztebl.2018.0646