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South African Family Practice :... May 2023Voluntary medical male circumcision (VMMC) is a strategy used to try to limit new human immunodeficiency virus (HIV) infections, as it has the potential to reduce HIV...
BACKGROUND
Voluntary medical male circumcision (VMMC) is a strategy used to try to limit new human immunodeficiency virus (HIV) infections, as it has the potential to reduce HIV and/or AIDS transmission from women to men by up to 60%. However, in spite of efforts by the Ministry of Health and Social Services, only a few men in Namibia have been circumcised. The objective of this study was to explore and describe the facilitators of, and barriers to, medical male circumcision for HIV prevention in Kavango East, Namibia.
METHODS
A qualitative, explorative, descriptive and contextual design was employed. The accessible population in this study comprised 18 health professionals who were selected for the study using a purposive sampling technique.
RESULTS
Participants reported numerous barriers to VMMC in Namibia. Barriers to VMMC included 'myths' and misconceptions attached to VMMC, age limitations, fear of pain and stigma associated with HIV, small VMMC team and long distances from health facilities. Facilitators to VMMC included family support, having experienced genital sores and genital warts or phimosis and paraphimosis.
CONCLUSION
The study revealed that a number of barriers must be overcome before VMMC before the desired number of men take advantage of VMMC. Multiple factors act as constraints to VMMC, including fear, myths and misconceptions, small VMMC teams and the long distance between clients' homes and VMMC services.Contribution: The study's findings can be used to develop targeted interventions and strategies that can be used by VMMC providers to address the identified barriers.
Topics: Humans; Male; Female; Circumcision, Male; Namibia; HIV Infections; Condylomata Acuminata; Aizoaceae
PubMed: 37265134
DOI: 10.4102/safp.v65i1.5684 -
BMC Urology Jun 2024Circumcision is the most common surgical procedures performed in males. Medical circumcision is recommended for diseases such as phimosis, paraphimosis, balanoposthitis... (Comparative Study)
Comparative Study
PURPOSE
Circumcision is the most common surgical procedures performed in males. Medical circumcision is recommended for diseases such as phimosis, paraphimosis, balanoposthitis and common urinary tract infections, although there is no exact indication. Conversely, Jewish and Muslim individuals commonly undergo circumcision regardless of medical necessity. Circumcision devices are designed to shorten surgery time, achieve an aesthetic appearance and ensure safe surgery. The aim of this study is to evaluate the effectiveness of the NeoAlis clamp, a disposable circumcision device, by comparing it with the sleeve technique in children.
MATERIALS AND METHODS
Between 2017 and 2023, retrospective evaluation of 2626 patients who underwent circumcision using either the NeoAlis clamp (group 1) or the sleeve technique (group 2) was conducted. Operation time, results, cost, complications were compared between the two groups.
RESULTS
The study encompassed 2626 patients who fulfilled the inclusion criteria. Group 1 comprised 2403 patients, whereas Group 2 consisted of 223 patients. The overall complication rate, as denoted by n = 47, was 1.7%. Group 1 operation time was shorter than group 2. Bleeding, the most feared complication in the early period, was higher in the second group. No statistically significant difference was observed between the two groups regarding cost comparison.
CONCLUSION
The primary concern during circumcision is to avoid complications related to general anesthesia in newborns and infants. The use of disposable ring devices has been facilitated by the shorter operation time and the absence of the need for sutures when performing circumcision under local anesthesia. However, knowledge of advanced surgical circumcision techniques is necessary in cases of bleeding and inappropriate ring placement.
Topics: Circumcision, Male; Humans; Male; Retrospective Studies; Disposable Equipment; Child; Child, Preschool; Equipment Design; Infant; Operative Time; Adolescent; Postoperative Complications
PubMed: 38877524
DOI: 10.1186/s12894-024-01513-9 -
International Braz J Urol : Official... 2021The webbed penis represents a common genital abnormality consisting of penoscrotal transposition of various degrees, the presence of a skin fold tethering the ventral...
INTRODUCTION:
The webbed penis represents a common genital abnormality consisting of penoscrotal transposition of various degrees, the presence of a skin fold tethering the ventral penile shaft to the scrotum promoting the absence of a penoscrotal angle and an abnormally short ventral shaft. Besides, a stenotic ring of distal prepuce (phimosis or paraphimosis) is frequently found. We want in this video to illustrate the steps of this common procedure associated with an excellent cosmetic result and improvement of self-esteem.
PATIENTS AND METHODS:
Surgery consists of treating penoscrotal transposition when present by two inverted scrotal V-shaped skin flaps to be brought down to its natural position. The ventral penile shaft is detached from the scrotum, excising or dividing the fibrotic and fatty tissue. We dissect the skin and deglove the penis proximally almost reaching the pelvic floor, producing a release of the penile shaft and increase in size. After that, we suture the ventral penile skin at the lowest level of dissection by two 3.0 vycril sutures anchoring them to the Buck's fascia one at each side of the urethra. Subsequently, the circumcision is performed and the scrotum reconstructed with removal of redundant skin when necessary.
RESULTS:
Surgery produced improvement of ventral surface of the penis and better cosmetic appearance without any local complication
CONCLUSION:
The webbed penis is a frequently under-recognized abnormality by pediatricians, but a major cause of anxiety for parents. This technique can be regarded as an alternative to most webbed penis patients.
PubMed: 33047937
DOI: 10.1590/S1677-5538.IBJU.2019.0798 -
Veterinary Medicine and Science May 2022Aminogam gel is used in human patients to accelerate the post-surgical wound healing process of soft oral tissues (e.g. after teeth extraction or oral laser surgery)....
BACKGROUND
Aminogam gel is used in human patients to accelerate the post-surgical wound healing process of soft oral tissues (e.g. after teeth extraction or oral laser surgery). For this reason and because of the histological affinity between oral and genital mucosa, Aminogam Gel was applied on the dog's penile mucosa to evaluate wound healing after traumatic lesion.
OBJECTIVES
This study aimed to compare conventional therapy (using only oral medications) to topic application of 'Aminogam Gel' in order to determine which is better to accelerate the healing process of canine penis injuries.
METHODS
For this study, 12 male dogs with an injured penis and traumatic paraphimosis were selected. All patients had traumatic penis injuries due to unsuccessful mating attempts and consequent trauma (continuous licking). The dogs underwent surgical curettage of necrotic areas. The animals were randomly divided into two groups: a control group treated with routine therapy and a group treated with Aminogam Gel as an adjuvant for the scarring process. We assessed wound status and tracked healing using the Bates-Jensen Wound Assessment Tool.
RESULTS
Dogs treated with Aminogam Gel therapy healed faster than dogs treated with traditional therapy alone.
DISCUSSION
Aminogam Gel is a valid auxiliary drug to accelerate wound healing after penis surgery. This is especially important for breeding dogs, for whom rapid and complete healing of the penis is important for returning to normal reproductive activities.
Topics: Animals; Curettage; Dogs; Humans; Male; Penis; Wound Healing
PubMed: 35229984
DOI: 10.1002/vms3.769 -
Indian Journal of Urology : IJU :... 2021The health-care sector has been drastically overwhelmed in the wake of prevailing COVID-19 pandemic, hampering elective and emergency medical services alike. The...
The health-care sector has been drastically overwhelmed in the wake of prevailing COVID-19 pandemic, hampering elective and emergency medical services alike. The geriatric population is especially affected in this regard as they are the ones who need access to health care services the most, and unfortunately, they are the ones with the highest risk of cross infection and mortality with SARS-COV-2. Lockdown and public restrictions have made the accessibility even harder. Telemedicine has emerged as a useful tool that avoids the risk of cross infection during the face-to-face consultation. Numerous guidelines have been made regarding the implementation of teleconsultations during this pandemic. Through this report, we describe the "beyond guidelines" emergency management of paraphimosis in an aged, bedridden male with comorbidities, through teleconsultation amid the COVID-19 pandemic.
PubMed: 33850361
DOI: 10.4103/iju.IJU_405_20 -
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 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 -
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 -
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 -
IJU Case Reports Jul 2019Paraphimosis is a urologic emergency in which the foreskin of the penis becomes trapped behind the coronal sulcus and forms a tight band of constricting tissue. Surgical...
INTRODUCTION
Paraphimosis is a urologic emergency in which the foreskin of the penis becomes trapped behind the coronal sulcus and forms a tight band of constricting tissue. Surgical or conservative release of this constriction is required for the treatment. Delayed treatment will cause devastating outcomes, such as penile glans necrosis. A few studies have reported penile glans necrosis/gangrene, but long-term follow-up of the recovery from glans necrosis due to paraphimosis has not been previously reported.
CASE PRESENTATION
A 25-year-old man who experienced glans necrosis following paraphimosis was not treated promptly with circumcision. The patient underwent conservative treatment with debridement of necrotic tissue and cystostomy for urethral meatal necrosis. We were able to prevent partial penectomy. His penile glans was covered with healthy epithelium and retained its natural shape and voiding and erectile functions were normal 2 years after the treatment.
CONCLUSION
We report successful conservative management of penile glans necrosis.
PubMed: 32743402
DOI: 10.1002/iju5.12064