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Journal of Lower Genital Tract Disease Oct 2023Sexual gender minority (SGM) populations are at risk for human papillomavirus (HPV)-related cancers of the anogenital tract and oropharynx and often face barriers to... (Review)
Review
OBJECTIVES
Sexual gender minority (SGM) populations are at risk for human papillomavirus (HPV)-related cancers of the anogenital tract and oropharynx and often face barriers to health care. The goals of this document are to clarify language to provide inclusive care for SGM populations and to provide recommendations for screening and prevention of HPV-related cancers in SGM populations.
MATERIALS AND METHODS
An expert committee convened by the American Society for Colposcopy and Cervical Pathology performed a narrative review of the literature through February 2023. A comprehensive MEDLINE database search was performed for relevant studies. The literature review was divided into categories by organ/topic and by SGM population. Given the variability in available data for several of the categories, recommendations were made based on national guidelines where appropriate or expert opinion where there were less data to support risk-based guidelines.
RESULTS
Definitions and terminology relevant to SGM populations are presented. The authors advocate the adoption of sexual orientation gender identity data collection and an organ-based screening approach, which is possible with knowledge of patient anatomy, sexual behaviors, and clinical history. This includes screening for cervical cancer per national recommendations, as well as screening for anal, vulvar, vaginal, penile, and oral cancers based on risk factors and shared clinical decision making. The authors recommend consideration of HPV vaccination in all SGM individuals up to age 45 years old who are at risk.
CONCLUSIONS
An organ-based screening approach is part of a global strategy to create an inclusive care environment and mitigate barriers to screening and prevention of HPV-mediated cancers in SGM populations.
Topics: Female; Humans; Male; Middle Aged; Early Detection of Cancer; Gender Identity; Health Disparate Minority and Vulnerable Populations; Human Papillomavirus Viruses; Papillomavirus Infections; Sexual Behavior; Uterine Cervical Neoplasms; Adult
PubMed: 37729043
DOI: 10.1097/LGT.0000000000000763 -
Translational Andrology and Urology Apr 2024Implantation of a penile prosthesis is a reliable option for men with erectile dysfunction (ED) refractory to less invasive therapies. While the frequency of penile... (Review)
Review
BACKGROUND AND OBJECTIVE
Implantation of a penile prosthesis is a reliable option for men with erectile dysfunction (ED) refractory to less invasive therapies. While the frequency of penile prosthesis infections have decreased, they remain a devastating complication. Herein we discuss why immediate salvage surgery is an essential technique for the management of implant infections. We will also describe the relevant advancements to this technique.
METHODS
We conducted a narrative review via computer based search of PubMed for all relevant articles on penile prosthesis infection management, including guidelines, case series, reviews, and expert opinions. Search terms used included: "inflatable penile prosthesis", "IPP", "penile prosthesis", "salvage", "treatment", "delayed", "immediate". Only English peer-reviewed publications were included.
KEY CONTENT AND FINDINGS
Historically, patients who presented with penile prosthesis infections were exclusively managed with complete removal of the prosthesis without replacement. Although this strategy is safe, it hastens immediate ED and corporal fibrosis, resulting in loss of penile length and increased difficulty with subsequent prosthesis replacement. Previous case series have reported successful treatment of localized penile prosthesis infections with nonsurgical treatment, but the role of conservative treatment remains limited. The current standard of immediate salvage entails removal of the infected prosthesis and washout followed by immediate replacement with a new penile prosthesis. This technique has been demonstrated to be safe and effective, thus allowing patients to resume intercourse and maintain penile length.
CONCLUSIONS
Immediate salvage surgery is safe and effective, and has emerged as the preferred strategy for the management of most patients with a penile prosthesis infection.
PubMed: 38721291
DOI: 10.21037/tau-23-277 -
PloS One 2020The plenteous resistance to and undesirable consequences of the existing antipiroplasmic therapies have emphasized the urgent need for new chemotherapeutics and drug...
BACKGROUND
The plenteous resistance to and undesirable consequences of the existing antipiroplasmic therapies have emphasized the urgent need for new chemotherapeutics and drug targets for both prophylaxis and chemotherapy. Hydroxyurea (HYD) is an antineoplastic agent with antitrypanosomal activity. Eflornithine (α-difluoro-methyl ornithine, DFMO) is the best choice therapy for the treatment of late-stage Gambian human African trypanosomiasis.
METHODS
In this study, the inhibitory and combination efficacy of HYD and DFMO with existing babesicidal drugs (diminazene aceturate (DA), atovaquone (ATV), and clofazimine (CLF)) deoxyribonucleotide in vitro against the multiplication of Babesia and Theileria. As well as, their chemotherapeutic effects were assessed on B. microti strain that infects rodents. The Cell Counting Kits-8 (CCK-8) test was used to examine their cytotoxicity on human foreskin fibroblast (HFF), mouse embryonic fibroblast (NIH/3T3), and Madin-Darby bovine kidney (MDBK) cells.
FINDINGS
HYD and DFMO suppressed the multiplication of all tested species (B. bigemina, B. bovis, B. caballi, B. divergens, and T. equi) in a dose-related manner. HFF, NIH/3T3, or MDBK cell viability was not influenced by DFMO at 1000 μM, while HYD affected the MDBK cell viability at EC50 value of 887.5±14.4 μM. The in vitro combination treatments of DFMO and HYD with CLF, DA, and ATV exhibited synergistic and additive efficacy toward all tested species. The in vivo experiment revealed that HYD and DFMO oral administration at 100 and 50 mg/kg inhibited B. microti multiplication in mice by 60.1% and 78.2%, respectively. HYD-DA and DFMO-DA combined treatments showed higher chemotherapeutic efficacy than their monotherapies.
CONCLUSION
These results indicate the prospects of HYD and DFMO as drug candidates for piroplasmosis treatment, when combined mainly with DA, ATV, and CLF. Therefore, further studies are needed to combine HYD or DFMO with either ATV or CLF and examine their impact on B. microti infection in mice.
Topics: Animals; Antineoplastic Agents; Antiprotozoal Agents; Atovaquone; Babesia; Cell Survival; Clofazimine; Diminazene; Dogs; Eflornithine; Foreskin; Humans; Hydroxyurea; Male; Mice; NIH 3T3 Cells; Theileria
PubMed: 32053698
DOI: 10.1371/journal.pone.0228996 -
European Urology Oct 2021Urethral stricture disease (USD) is initially managed with minimally invasive techniques such as urethrotomy and urethral dilatation. Minimally invasive techniques are... (Meta-Analysis)
Meta-Analysis
CONTEXT
Urethral stricture disease (USD) is initially managed with minimally invasive techniques such as urethrotomy and urethral dilatation. Minimally invasive techniques are associated with a high recurrence rate, especially in recurrent USD. Adjunctive measures, such as local drug injection, have been used in an attempt to reduce recurrence rates.
OBJECTIVE
To systematically review evidence for the efficacy and safety of adjuncts used alongside minimally invasive treatment of USD.
EVIDENCE ACQUISITION
A systematic review of the literature published between 1990 and 2020 was conducted in accordance with the PRISMA checklist.
EVIDENCE SYNTHESIS
A total of 26 studies were included in the systematic review, from which 13 different adjuncts were identified, including intralesional injection (triamcinolone, n = 135; prednisolone, n = 58; mitomycin C, n = 142; steroid-mitomycin C-hyaluronidase, n = 103, triamcinolone-mitomycin C-N-acetyl cysteine, n = 50; platelet-rich plasma, n = 44), intraluminal instillation (mitomycin C, n = 20; hyaluronic acid and carboxymethylcellulose, n = 70; captopril, n = 37; 192-iridium brachytherapy, n = 10), application via a lubricated catheter (triamcinolone, n = 124), application via a coated balloon (paclitaxel, n = 106), and enteral application (tamoxifen, n = 30; deflazacort, n = 36). Overall, 13 randomised controlled trials were included in the meta-analysis. Use of any adjunct was associated with a lower rate of USD recurrence (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.27-0.50; p < 0.001) compared to no adjunct use. Of all the adjuncts, mitomycin C was associated with the lowest rate of USD recurrence (intralesional injection: OR 0.23, 95% CI 0.11-0.48; p < 0.001; intraluminal injection: OR 0.11, 95% CI 0.02-0.61; p = 0.01). Urinary tract infection (2.9-14%), bleeding (8.8%), and extravasation (5.8%) were associated with steroid injection; pruritis of the urethra (61%) occurred after instillation of captopril; mild gynaecomastia (6.7%) and gastrointestinal side effects (6.7%) were associated with oral tamoxifen.
CONCLUSIONS
Adjuncts to minimally invasive treatment of USD appear to lower the recurrence rate and are associated with a low adjunct-specific complication rate. However, the studies included were at high risk of bias. Mitomycin C is the adjunct supported by the highest level of evidence.
PATIENT SUMMARY
We reviewed studies on additional therapies (called adjuncts) to minimally invasive treatments for narrowing of the urethra in men. Adjuncts such as mitomycin C injection result in a lower recurrence rate compared to no adjunct use. The use of adjuncts appeared to be safe and complications are uncommon; however, the studies were small and of low quality.
Topics: Captopril; Humans; Injections, Intralesional; Male; Mitomycin; Recurrence; Tamoxifen; Triamcinolone; Urethra; Urethral Stricture
PubMed: 34275660
DOI: 10.1016/j.eururo.2021.06.022 -
The Canadian Journal of Urology Apr 2021Prostate abscess (PA) is an uncommon prostatic infection, with risk factors including indwelling catheters, acute or chronic prostatitis, bladder outlet obstruction,...
Prostate abscess (PA) is an uncommon prostatic infection, with risk factors including indwelling catheters, acute or chronic prostatitis, bladder outlet obstruction, voiding dysfunction, recent urologic instrumentation (especially transrectal prostate biopsy), chronic kidney disease (CKD), diabetes mellitus (DM), human immunodeficiency virus (HIV), intravenous drug use (IVDU), and hepatitis C. Treatment of PA consists of antibiotics and abscess drainage via transurethral resection (TUR) or image-guided transrectal or transperineal drainage. Numerous studies have demonstrated that TUR of PA has a higher success rate and shorter hospital length of stay when compared to image-guided drainage. Despite this, TUR of PA is a relatively uncommon surgery with few useful recommendations on how to best perform this procedure. We demonstrate the TUR surgical technique for drainage of a 6 cm loculated PA in a 44-year-old man with active IVDU and hepatitis C. The patient presented with progressive voiding symptoms, urinary retention, and leukocytosis. Given the size, loculated nature of the abscess, and its proximity to the prostatic urethra, we decided to proceed to the operating room for surgical drainage as opposed to image-guided transrectal drainage. Herein we describe the trans urethral technique. He clinically improved postoperatively and repeat imaging 4 days later showed decreased abscess size. Transurethral drainage of a PA is a safe, efficient, and effective treatment option. Treatment approach should depend on abscess size, location, and presence of loculations. Combining different endourologic techniques and instruments may be necessary.
Topics: Abscess; Adult; Humans; Male; Prostatic Diseases; Urethra; Urologic Surgical Procedures, Male
PubMed: 33872565
DOI: No ID Found -
PLoS Pathogens Mar 2022Transmission bottlenecks introduce selection pressures on HIV-1 that vary with the mode of transmission. Recent studies on small cohorts have suggested that stronger...
Transmission bottlenecks introduce selection pressures on HIV-1 that vary with the mode of transmission. Recent studies on small cohorts have suggested that stronger selection pressures lead to fitter transmitted/founder (T/F) strains. Manifestations of this selection bias at the population level have remained elusive. Here, we analysed early CD4 cell count measurements reported from ∼340,000 infected heterosexual individuals (HET) and men-who-have-sex-with-men (MSM), across geographies, ethnicities and calendar years. The reduction in CD4 counts early in infection is reflective of the virulence of T/F strains. MSM and HET use predominant modes of transmission, namely, anal and penile-vaginal, with among the largest differences in the selection pressures at transmission across modes. Further, in most geographies, the groups show little inter-mixing, allowing for the differential selection bias to be sustained and amplified. We found that the early reduction in CD4 counts was consistently greater in HET than MSM (P<0.05). To account for inherent variations in baseline CD4 counts, we constructed a metric to quantify the extent of progression to AIDS as the ratio of the reduction in measured CD4 counts from baseline and the reduction associated with AIDS. We found that this progression corresponding to the early CD4 measurements was ∼68% for MSM and ∼87% for HET on average (P<10-4; Cohen's d, ds = 0.36), reflecting the more severe disease caused by T/F strains in HET than MSM at the population level. Interestingly, the set-point viral load was not different between the groups (ds<0.12), suggesting that MSM were more tolerant and not more resistant to their T/F strains than HET. This difference remained when we controlled for confounding factors using multivariable regression. We concluded that the different selection pressures at transmission have resulted in more virulent T/F strains in HET than MSM. These findings have implications for our understanding of HIV-1 pathogenesis, evolution, and epidemiology.
Topics: Acquired Immunodeficiency Syndrome; Female; HIV Infections; HIV Seropositivity; HIV-1; Heterosexuality; Homosexuality, Male; Humans; Male; Sexual and Gender Minorities
PubMed: 35271687
DOI: 10.1371/journal.ppat.1010319 -
Ugeskrift For Laeger Jul 2021This is a case report of a 62-year-old male who had penile augmentation surgery performed in Turkey. The surgery was complicated by infection and necrosis of the penile...
This is a case report of a 62-year-old male who had penile augmentation surgery performed in Turkey. The surgery was complicated by infection and necrosis of the penile skin. The patient was treated with antibiotics, repeated wound debridement and a full thickness skin graft. Cosmetic penile surgery is considered controversial due to poor results and severe complications. Most men who seek surgery have normal penile size and may show signs of body dysmorphic disorder with avoidance behaviour and erectile dysfunction. These patients should be offered psychological treatment.
Topics: Erectile Dysfunction; Humans; Male; Middle Aged; Penis; Plastic Surgery Procedures; Skin Transplantation; Surgery, Plastic
PubMed: 34356009
DOI: No ID Found -
Anais Brasileiros de Dermatologia 2022Monkeypox is an emerging infection that has spread to all continents since May 2022. It is caused by the zoonotic monkeypox virus, consisting of double-stranded DNA,...
Monkeypox is an emerging infection that has spread to all continents since May 2022. It is caused by the zoonotic monkeypox virus, consisting of double-stranded DNA, belonging to the Orthopoxvirus genus of the Poxviridae family, which has high transmissibility, especially by contact with the skin, favoring its sexual transmission. This case report describes a same-sex male couple, both aged 28 years old, without comorbidities. In the index case, perioral and penile lesions started ten days before the consultation, with rapid progression and a high fever that started eight days after the appearance of the lesions. In the second case, the perioral lesions started three days after the partner; however, he remained afebrile. Both were isolated, treated with symptomatic measures, and, after ulceration, the lesions completely regressed in 14 days. Dermatologists should be aware of manifestations of monkeypox, which may include vesiculopustular lesions in areas of sexual contact, as well as oligosymptomatic cases or cases with few skin lesions.
Topics: Adult; Humans; Male; Mpox (monkeypox); Monkeypox virus; Skin
PubMed: 36137892
DOI: 10.1016/j.abd.2022.08.002 -
International Journal of Molecular... Jun 2022In the case of pediatric urology there are several congenital conditions, such as hypospadias and neurogenic bladder, which affect, respectively, the urethra and the... (Review)
Review
In the case of pediatric urology there are several congenital conditions, such as hypospadias and neurogenic bladder, which affect, respectively, the urethra and the urinary bladder. In fact, the gold standard consists of a urethroplasty procedure in the case of urethral malformations and enterocystoplasty in the case of urinary bladder disorders. However, both surgical procedures are associated with severe complications, such as fistulas, urethral strictures, and dehiscence of the repair or recurrence of chordee in the case of urethroplasty, and metabolic disturbances, stone formation, urine leakage, and chronic infections in the case of enterocystoplasty. With the aim of overcoming the issue related to the lack of sufficient and appropriate autologous tissue, increasing attention has been focused on tissue engineering. In this review, both the urethral and the urinary bladder reconstruction strategies were summarized, focusing on pediatric applications and evaluating all the biomaterials tested in both animal models and patients. Particular attention was paid to the capability for tissue regeneration in dependence on the eventual presence of seeded cell and growth factor combinations in several types of scaffolds. Moreover, the main critical features needed for urinary tissue engineering have been highlighted and specifically focused on for pediatric application.
Topics: Animals; Child; Humans; Male; Regenerative Medicine; Tissue Engineering; Urethra; Urethral Stricture; Urinary Bladder; Urology
PubMed: 35742803
DOI: 10.3390/ijms23126360 -
Medicina (Kaunas, Lithuania) Jun 2022To avoid complications related to mid-urethral slings (MUS), alternative procedures to treat stress urinary incontinence (SUI), such as urethral bulking agents (UBAs)... (Review)
Review
To avoid complications related to mid-urethral slings (MUS), alternative procedures to treat stress urinary incontinence (SUI), such as urethral bulking agents (UBAs) have been adopted. The aim of this review is to narratively report the efficacy and safety of UBAs for SUI treatment. For this review, research from PubMed and EMBASE was performed to evaluate relevant studies that were undertaken from January 2012 to January 2022. Nineteen prospective studies were included. Several definitions of subjective and objective success were adopted. At a follow-up of <24 months, significant improvement was widely observed, even if with a heterogeneous rate of success between 32.7−90%, and a reinjection rate of 8.3−77.3%. Compared with other procedures, MUS resulted as significantly superior to UBAs but was balanced by a higher complication rate. Acute urinary retention, urinary tract infection and de novo urgency, and other complications, such as injection site rupture, urethral erosion and particle migration have been described after UBAs. SUI after UBAs treatment resulted in improvements in all studies and can be considered a safe and effective option to treat SUI. However, homogenous and longer-term data lack, limiting general recommendations. Thus, larger RCTs evaluating long-term effects are required.
Topics: Female; Humans; Prospective Studies; Suburethral Slings; Treatment Outcome; Urethra; Urinary Incontinence, Stress
PubMed: 35744038
DOI: 10.3390/medicina58060775