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Urology Oct 2021To describe a planned 2-staged metoidioplasty. Metoidioplasty is a genital gender-affirmation surgery aimed at creating a neophallus, scrotum (if desired), and flat...
OBJECTIVE
To describe a planned 2-staged metoidioplasty. Metoidioplasty is a genital gender-affirmation surgery aimed at creating a neophallus, scrotum (if desired), and flat male-type perineum (if desired) from natal tissues. It generally requires a planned second-stage to place testes prostheses, address complications, and perform additional surgical steps to maximally lengthen the phallus. The details of this procedure are sparsely mentioned in the literature. We found that phallus length can be optimized in the second-stage by applying surgical principles already established in the surgical treatment of adult acquired buried penis.
MATERIAL AND METHODS
We conducted a retrospective chart review of patients after metoidioplasty between August 2015 and June 2020, and isolated those that underwent second-stage metoidioplasty. Each procedure was done by 1 of 4 surgeons in a single practice in 2 locations, San Francisco, CA, and Austin, TX. Details of procedures required, complications, and demographic information were recorded.
RESULTS
Out of the 75 patients that had undergone metoidioplasty, 37 (37 of 75, 49%) underwent a second-stage metoidioplasty. Reduction of upper scrotal blocking tissue was the most common procedure performed during a second-stage metoidioplasty (31 of 37, 84%), followed by escutcheonectomy/penile lift (30 of 37, 81%), bilateral implant placement (20 of 37, 54%), chordee repair (13 of 37, 35%), and unilateral implant placement (1 of 37, 3%). 6 of the 37 patients (16%) developed major complications. 5 of the 37 (5 of 37, 15%) second-stage patients required a redo second-stage metoidioplasty.
CONCLUSION
Second-stage metoidioplasties are commonly performed on patients to optimize results of phallic lengthening and release, and to repair complications that arise after single-stage metoidioplasty. Escutcheonectomy/penile lift, placement of scrotal implants, repair of chordee, and upper scrotal blocking tissue reduction are procedures that are often performed during a second-stage metoidioplasty.
Topics: Adult; Humans; Male; Middle Aged; Penis; Perineum; Retrospective Studies; Scrotum; Sex Reassignment Surgery; Young Adult
PubMed: 34087313
DOI: 10.1016/j.urology.2021.04.045 -
Annales de Chirurgie Plastique Et... Aug 2023Necrotizing fasciitis is a severe bacterial infection characterized by involvement of all skin's layers, including the superficial fascia. Diagnosis and treatment must...
BACKGROUNDS
Necrotizing fasciitis is a severe bacterial infection characterized by involvement of all skin's layers, including the superficial fascia. Diagnosis and treatment must be as quick as possible. Once suspected, extensive surgical debridement is required.
METHODS
All necrotizing fasciitis, managed in our hospital in Dijon, during the period from January 2011 to May 2021, were retrospectively analyzed. Demographics characteristics of patients, biological parameters, and type of bacteria were collected. Statistical analysis was performed on the cost of hospitalization, as well as on the death rate between type I and II NF and the speed of management. Student's t-test and Chi test were performed with a significant level P<0.05.
FINDINGS
A total of 65 patients were included over the period. The mean age was 68.8 years. The average length of stay was 32.4 days, with an average cost of 79,305 €. The main locations were the lower limbs (57%) and the perineum (35%). Cost of hospitalization did not differ between type I and II (P=0.21), unlike mortality rate (P=0.003). Furthermore, the mortality rate according to the speed of management did not vary in our series (P=0.45).
CONCLUSION
Necrotizing fasciitis is quickly fatal if left untreated. Early diagnosis, combined with surgical debridement and probabilistic antibiotic therapy are required. Our study shows the impact of necrotizing fasciitis in terms of cost to society and the importance of prevention of certain risk factors. A global management of the patient is necessary to increase the survival rate.
Topics: Humans; Aged; Fasciitis, Necrotizing; Retrospective Studies; Debridement; Risk Factors; Perineum
PubMed: 35970651
DOI: 10.1016/j.anplas.2022.07.012 -
Archivio Italiano Di Urologia,... Jun 2022Cycling is a popular means of transport and recreational activity; bicycles are also a source of genitourinary injuries and there is the idea that cycling may have a...
INTRODUCTION
Cycling is a popular means of transport and recreational activity; bicycles are also a source of genitourinary injuries and there is the idea that cycling may have a significant impact on sexual function. The objective of this study was to evaluate the effect of amateur cycling on erectile function.
METHODS
We used a questionnaire comparing amateur cyclists (n = 199) and footballers (n = 43), regarding sexual related comorbidities and hours of practice per week. The cyclists were also characterized in terms of road vs cross-country, breaks during cycling, saddle, and shorts. To evaluate erectile function, the International Index of Erectile Function questionnaire was applied.
RESULTS
there was no difference in International Index of Erectile Function total score between groups. Age and presence of erectile dysfunction associated comorbidity were negative factors in the International Index of Erectile Function score in cyclists but not in the footballers.
CONCLUSIONS
Cycling is usually associated with perineal numbness, but that numbness did not lead to lower International Index of Erectile Function scores. In conclusion amateur cycling has no effect on EF.
Topics: Bicycling; Erectile Dysfunction; Humans; Hypesthesia; Male; Perineum; Surveys and Questionnaires
PubMed: 35775353
DOI: 10.4081/aiua.2022.2.232 -
Italian Journal of Pediatrics Mar 2022Median raphe cyst is usually benign and asymptomatic male genitalia lesions. Although uncommon, infection may be a complication.
BACKGROUND
Median raphe cyst is usually benign and asymptomatic male genitalia lesions. Although uncommon, infection may be a complication.
CASE PRESENTATION
We report the case of a 4-year-old child presented to the emergency department for a serpiginous and redness lesion extended from the basis of the penis until the perineum. An infected median raphe cyst was suspected, and the patient underwent surgical treatment and antibiotic therapy with complete resolution of symptoms. Liquid culture resulted positive for Serratia Marcescens.
CONCLUSION
Infection is a rare complication, especially in childhood. To prevent relapses and clinical symptoms, the majority of authors recommend surgical excision followed by primary closure. In case of infections caused by Serratia Marcescens, chronic granulomatous disease should always be rule out.
Topics: Anti-Bacterial Agents; Child, Preschool; Cysts; Humans; Male; Pelvis; Perineum; Scrotum
PubMed: 35241137
DOI: 10.1186/s13052-022-01224-7 -
Progres En Urologie : Journal de... Jun 2021To analyze the determinants and severity of perineal pain in the adventures of Tintin and Snowy.
AIMS
To analyze the determinants and severity of perineal pain in the adventures of Tintin and Snowy.
MATERIAL AND METHODS
All 23 adventures of Tintin and Snowy (Hergé, Moulinsart Ed.) were reviewed in order to determine the presence, causes and severity of perineal pain (PP) observed in the various heroes of this comic book. Several parameters were studied: the cause which could be either accidental or voluntary; the type of patient (good guys-bad guys); the hero concerned (Tintin, Captain Haddock, Thompson and Thomson, Snowy, Professor Calculus …); the duration of the pain (by the number of boxes where the subject was represented suffering from such pains); finally, the severity of these pains, by the number of stars or signs designating the region and stereotyping the importance of the pain. The Student and Chi tests were used to analyze these different qualitative and quantitative variables.
RESULTS
Five hundred and one traumas were found in the adventures of Tintin and Snowy, including 47 PP, 9.4% of cases compared to 299 head traumas (60% of cases). Six albums out of the 23 did not report any PP. PPs are usually traumatic either by a fall (68%) or by direct trauma (kick to the back 6%, spanking 4%) much more exceptionally by a bite (2 cases), a burn (2 cases), needles or arrows inserted in the bottom (5 cases) and a bullet wound (1 case). Tintin is the most concerned (19%) with Captain Haddock (23%), followed by Snowy (15%). The bad guys and the good guys don't share equally the perineal pain since the good guys are forgivably more exposed (79% vs. 21%). There is no correlation between head trauma and PP (r=0.117). The severity index for PP is 5.21 with a mean duration of 3.01 vs. 6.88 for severity and 3.2 for duration for head trauma, a highly significant difference in the Student test (P=0.00259). The total number of traumas per album progressively decreases over the albums (r=0.3111) with, for example, 38 for the first album (Tintin and the Soviets) and 4 for the last one (Tintin and the Picaros). This decrease in trauma is clearer for cephalic trauma (r=0.1436) than for PP (r=0.2189).
CONCLUSION
The frequency of traumatic PP in Tintin's adventures is important and is second only to head injuries. This frequency of PP traumas is undoubtedly linked to the hectic and adventurous life of Tintin and his acolytes exposed in all circumstances to all kinds of direct or indirect injuries. Future studies will have to specify the risk of after-effects and the psychological impact of PPs on the heroes concerned.
LEVEL OF PROOF
4.
Topics: Cartoons as Topic; France; Humans; Pain; Pain Measurement; Perineum; Wit and Humor as Topic
PubMed: 33849743
DOI: 10.1016/j.purol.2021.03.005 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Mar 2022Traumatic rectal injuries are uncommon and can originate due to various causes. Rectal injuries have a high mor-bidity, regardless of cause, and detection at the time of... (Review)
Review
BACKGROUND
Traumatic rectal injuries are uncommon and can originate due to various causes. Rectal injuries have a high mor-bidity, regardless of cause, and detection at the time of occurrence is important to prevent fistula formation and/or stoma. In this article, treatment approaches in patients with isolated rectovaginal septum injury without perineal and sphincter injury during sponta-neous vaginal delivery are presented and the current literature is reviewed.
METHODS
The records of spontaneous vaginal deliveries that resulted in live births between January 2015 and January 2020 were analyzed retrospectively at our center. The records of patients with isolated rectovaginal septum injury were evaluated in terms of demographic and obstetric data, trauma, classification of injury, and early and late results.
RESULTS
Isolated septum injuries were detected 12 women (0.06%). Of the isolated rectovaginal septum injuries, 9 (75%) were clas-sified as Type III, 2 (16.6%) as Type IV, and 1 (8.3%) as a Type V injury according to the Rosenshein classification. Transvaginal repair was performed because all of the injuries underwent early surgical intervention, were limited, and exploration through the vagina was possible.
CONCLUSION
Rectal examination should be performed simultaneously with a detailed perineal examination after vaginal delivery. For birth-related rectal injuries detected early in appropriate patients, a primary repair without diversion stoma may be the best option.
Topics: Abdominal Injuries; Delivery, Obstetric; Female; Humans; Parturition; Perineum; Pregnancy; Rectum; Retrospective Studies; Thoracic Injuries
PubMed: 35485555
DOI: 10.14744/tjtes.2020.26338 -
BMC Pregnancy and Childbirth Jun 2020Manual perineal protection (MPP) is an intrapartum intervention suggested to protect perineal integrity during childbirth. Proper execution of MPP is complex and...
BACKGROUND
Manual perineal protection (MPP) is an intrapartum intervention suggested to protect perineal integrity during childbirth. Proper execution of MPP is complex and evaluation of its true contribution is difficult in the clinical setting because of the large number of obstetric variables, some of which are hardly quantifiable. In this study we aimed to gather initial data on the forces executed by the accoucheur's thumb, index and middle fingers during MPP at the time of fetal head expulsion, quantify the duration of the intervention and investigate the timely interaction of the different components of MPP.
METHODS
Two bespoke right-handed measurement gloves (MG), with built in sensors, were designed and produced. The MG allowed the electronic real-time measurement of applied forces during MPP and transferred this data wirelessly to an integrated computer system. Sterile gloves were worn over the MG when used at the time of birth. The study was undertaken between January and December 2019. Singleton, term pregnant women having their first vaginal birth who provided a valid written consent were enrolled into this prospective pilot study. All deliveries were undertaken by one of two obstetricians experienced in MPP.
RESULTS
Twenty women were enrolled. The mean duration of execution of MPP during the last contraction was 13.6 s. In 20% it lasted < 5 s. The overall mean values of the average and maximum forces of the thumb, index and middle fingers were 26.7 N; 25.5 N; 20.2 N and 34.3 N; 32.6 N; and 27.6 N respectively. The onset of fingers and thumb activity was simultaneous in 13 cases (65%), while in seven (35%) deliveries the middle finger's force activity was initiated later.
CONCLUSIONS
MPP during fetal head expulsion happens over a short period of time. In the majority of cases the thumb and fingers actions started simultaneously. There were differences in the duration of application and the forces executed by the fingers and thumb between the two practitioners, however this was only significant for thumb measurements. The results obtained will aid in improving further MPP modeling studies to optimize the technique.
Topics: Adult; Benchmarking; Delivery, Obstetric; Female; Fingers; Head; Humans; Perineum; Pilot Projects; Pregnancy; Prospective Studies
PubMed: 32527247
DOI: 10.1186/s12884-020-03042-3 -
European Journal of Trauma and... Dec 2022Penetrating injuries to the perineum and associated pelvic organs have largely been reported in the military. Given the rarity of presentation and unique clinical... (Review)
Review
PURPOSE
Penetrating injuries to the perineum and associated pelvic organs have largely been reported in the military. Given the rarity of presentation and unique clinical characteristics of these injuries, we set out to address the gap in the literature in civilian settings.
METHODS
A systematic review of studies addressing penetrating perineal trauma from January 2000 to April 2021 was performed. Outcomes of interest were the epidemiology, associated injuries, management, follow-up, and patient outcomes.
RESULTS
26 studies were included in this review, reporting on a total of 2316 patients. Most injuries occurred in males (88.1%), with gunshot wounds (88.2%) representing the most common aetiology, followed by knife wounds (5.0%), impalement (3.1%), coital injuries/sexual assault (1.5%), and others (2.4%). Regarding associated injuries, anorectal (n = 1419, 69.4%), bladder (n = 351, 32.4%), penile (n = 282, 20.8%), scrotal (n = 375, 27.7%), and testicular (n = 229, 16.9%) occurred frequently. Bony injuries involved the pelvis (n = 88, 8.1%) and femoral fractures (n = 5, 0.5%), while soft-tissue injuries involved the inguinal region (n = 19, 1.6%) and buttocks (n = 14, 1.3%). Vascular injuries occurred in 79 (7.8%) patients. Regarding patient outcomes, 65 (4.8%) deaths were reported, and significant morbidity was detected with a mean injury severity score of 18.4 detected in the cohort. In terms of complications of injury, wound/infective complications (n = 135, 61.3%) and fistula formation/leakage (n = 16, 0.7%) featured prominently.
CONCLUSION
Penetrating perineal trauma in the civilian population poses a considerable challenge to clinicians, compounded by the potential for multisystem injury requiring involvement of different medical and surgical specialties.
Topics: Male; Humans; Wounds, Gunshot; Perineum; Wounds, Penetrating; Wounds, Stab; Injury Severity Score; Retrospective Studies
PubMed: 35262749
DOI: 10.1007/s00068-022-01908-z -
Annali Italiani Di Chirurgia 2022Aggressive angiomyxoma is a type of mesenchymal tumor occurring predominantly in the pelvic and perineal region. The aim of our study was to reveal our experience with... (Review)
Review
BACKGROUND
Aggressive angiomyxoma is a type of mesenchymal tumor occurring predominantly in the pelvic and perineal region. The aim of our study was to reveal our experience with gonadotropin-releasing hormone (GnRH) treatment in patients with angiomyxoma and provide a comprehensive review of management.
PATIENTS AND METHODS
This study is a case-series including seven female patients diagnosed with aggressive angiomyxoma from a single institution, between 2012 and 2020. Follow-up after surgery was ranged between 2-45 months with an average of 17.6 months. Resection was performed in all patients without any complications, and five had received GnRH analogue (Goserelin acetate) therapy after surgery. Immunohistochemistry analyses showed positivity for smooth muscle actin and desmin in all cases, while both estrogen receptor (ER) and progesterone receptor (PR) positivity were identified in 6 patients. None of the seven patients had recurrence during follow up period.
CONCLUSION
The mean treatment of aggressive angiomyxoma is surgery, and the use of GnHR analogues in cases with positive ER and PR may be effective in preventing recurrence.
KEY WORDS
Aggressive Angiomyxoma, Gonadotropin-Releasing Hormone, Soft Tissue Neoplasm.
Topics: Humans; Female; Myxoma; Receptors, Estrogen; Immunohistochemistry; Perineum; Gonadotropin-Releasing Hormone
PubMed: 36353852
DOI: No ID Found -
The Australian & New Zealand Journal of... Feb 2021Birth-related third- and fourth-degree perineal trauma is common and associated with short- and long-term complications. (Review)
Review
BACKGROUND
Birth-related third- and fourth-degree perineal trauma is common and associated with short- and long-term complications.
AIM
To conduct a review of clinical audits investigating management of women with perineal trauma.
MATERIALS AND METHODS
We identified all audits undertaken in eight New Zealand public hospitals between 2005 and 2014 that investigated whether women with birth-related third- and fourth-degree perineal trauma were receiving care according to clinical guidelines. We aggregated audit results and calculated the proportion of women receiving the recommended standard of care.
RESULTS
During the review period, 25 audits investigated intra-operative (n = 11), post-operative (n = 14) and outpatient care (n = 18). Baseline audits showed variation in care by site; intra-operative care (range 39-96% for repair conducted under anaesthesia, 60-96% for repair by or under supervision of a senior clinician, and 33-54% for completion of Accident Compensation Corporation forms); post-operative care (range 40-93% for prescribed antibiotics and 33-96% for stool softeners) and outpatient care (45-84% for referral to outpatient clinic and 54-78% for physiotherapy follow-up). Sustained high quality of care and improvements in adherence with recommendations were seen for most of the follow-up audits (eg 90% adherence for prescribed stool softeners over three audits; over 50% increase in prescribed antibiotics over seven years).
CONCLUSIONS
These clinical audits exemplify the need to measure patient care against standards, learn from the findings, implement changes to improve patient experience and reduce life-long sequelae from perineal trauma. This review showed some progress in some care services and highlighted where further changes are needed to close evidence-practice gaps.
Topics: Clinical Audit; Episiotomy; Humans; New Zealand; Parturition; Perineum; Standard of Care
PubMed: 33094500
DOI: 10.1111/ajo.13262