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International Braz J Urol : Official... 2022To determine independent predictors of inguinal lymph node (ILN) metastasis in patients with penile cancer.
PURPOSE
To determine independent predictors of inguinal lymph node (ILN) metastasis in patients with penile cancer.
PATIENTS AND METHODS
We retrospectively analyzed all patients with penile cancer who underwent surgery at our medical center in the last ten years (n=157). Using univariate and multivariate logistic-regression models, we assessed associations with age, medical-history, phimosis, onset-time, number and maximum diameter of involved ILNs measured by imaging, pathological T stage, degree of tumor differentiation and/or cornification, lymphatic vascular infiltration (LVI), nerve infiltration, and ILN metastases. Interaction and stratified analyses were used to assess age, phimosis, onset time, number of ILNs, cornification, and nerve infiltration.
RESULTS
A total of 110 patients were included in the study. Multiple logistic regression analysis showed that the following factors were significantly correlated with ILN metastasis: maximum diameter of enlarged ILNs, T stage, pathological differentiation, and LVI. Among patients with a maximum ILN diameter ≥1.5cm, 50% had lymph node metastasis whereas 30.6% patients with a maximum ILN diameter <1.5cm showed LNM. Among 44 patients with stage Ta/T1, 10 showed ILN metastases, while 47.0% patients with stage T2 showed ILN metastases. Among 40 patients with highly differentiated penile-cancer, eight showed ILN metastasis, while 47.1% patients with low-to-middle differentiation showed ILN metastases. The rate of LNM was 33.3% in the LVI-free group and 64.3% in the LVI group.
CONCLUSION
Our single-center results suggested that maximum ILN diameter, pathological T stage, pathological differentiation, and LVI were independent risk factors for ILN metastases.
Topics: Cross-Sectional Studies; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Neoplasm Staging; Penile Neoplasms; Prognosis; Retrospective Studies; Risk Factors
PubMed: 35170892
DOI: 10.1590/S1677-5538.IBJU.2021.0613 -
PloS One 2022Although circumcision is the most commonly performed surgery in males, less is known about the incidence and indications of adult circumcision. In this study, we aim to...
PURPOSE
Although circumcision is the most commonly performed surgery in males, less is known about the incidence and indications of adult circumcision. In this study, we aim to present the incidence of adult circumcision across the United States.
METHODS
Using IBM MarketScan® Commercial Database from 2015 to 2018, we obtained claims for circumcision in men between 18 and 64 years of age. We calculated the incidence of adult circumcision over the study period and across the United States. We also collected data on indications for surgery using International Classification of Diseases codes.
RESULTS
We identified a total of 12,298 claims for adult circumcisions. The mean age was 39 (±12.9) years. The average incidence rates remained relatively constant from 98.1 per 100,000 person-years in 2015 to 98.2 per 100,000 person-years in 2018 (Δ+0.1%). The age-standardized incidence rates varied significantly across the United States (from 0 to 194.8 per 100,000 person-years) with South Dakota having the highest rate. The most common indications for adult circumcision were phimosis (52.5%), routine/ritual circumcision (28.7%), phimosis + balanitis/balanoposthitis (6.8%), balanitis (3.8%) and balanoposthitis (2.6%), and significantly varied by age groups.
CONCLUSION
This study suggested a wide geographic variation in rates of adult circumcision between states with highest incidences in the Northeast United States. Future studies can identify the underlying causes for the observed variations.
Topics: Adult; Balanitis; Ceremonial Behavior; Circumcision, Male; Humans; Incidence; Male; Phimosis; United States
PubMed: 36251658
DOI: 10.1371/journal.pone.0275207 -
Indian Pediatrics Dec 2019To evaluate the functional and cosmetic result of limited dorsal slit preputialplasty for surgical management of phimosis in children. (Observational Study)
Observational Study
OBJECTIVE
To evaluate the functional and cosmetic result of limited dorsal slit preputialplasty for surgical management of phimosis in children.
METHODS
This is a prospective cohort study (Jan 2010 to Dec 2019) of 246 children (age >5 y) who were unable to retract the foreskin and were symptomatic.
RESULTS
No intraoperative complications were encountered. Preputial edema was the most common (n=45, 18.2%) immediate postoperative occurrence. At one year follow-up, a total cosmetic score of 6 (considered optimal) was seen in 203 (91%) patients. A score of 5 was observed in 13 (5.9%) and the remaining 7 (3.1%) had a score of less than 4. All pubertal children, except one, could retract prepuce freely without discomfort.
CONCLUSIONS
This preputialplasty provides satisfactory cosmetic and functional result in phimosis, and is an acceptable alternative to circumcision.
Topics: Child; Circumcision, Male; Foreskin; Humans; Male; Patient Satisfaction; Phimosis; Postoperative Complications; Prospective Studies; Plastic Surgery Procedures
PubMed: 31884433
DOI: No ID Found -
Canadian Urological Association Journal... Dec 2019In Quebec, eight pediatric urologists practice in three tertiary centers covering large territories. To improve the availability of pediatric urology to distant families...
INTRODUCTION
In Quebec, eight pediatric urologists practice in three tertiary centers covering large territories. To improve the availability of pediatric urology to distant families and to reduce the economic burden on them, we examined the charts of all patients attending the pediatric urological outpatient clinic. Our objectives were to evaluate the distance travelled by each urological pediatric outpatient and to report the most frequent urological referral complaints.
METHODS
From July 2016 to June 2017, we retrospectively reviewed the charts of all the 3604 pediatric patients seen in the outpatient urological clinic of the CHU de Québec. We specifically focused on travel distance covered by families and the reason for referral.
RESULTS
Most patients were boys (78%) and the mean age was 7.2 years. The average one-way distance travelled by each family was 69 km. The patients came more frequently from Capitale-Nationale (63.7%) and Chaudière-Appalaches (21.9%), the closest regions. The most common reasons for consultations were postoperative followups (15%), phimosis and adhesions (14%), enuresias (14%), hydronephrosis (13%), micturition disorder (11%), and cryptorchidism and retractile testicles (8%). Of all patients seen for phimosis or cryptorchidism, only 24% and 36% of them, respectively, were scheduled for surgery.
CONCLUSIONS
Phimosis, cryptorchidism, and voiding disorders are the most frequent pediatric urological reasons for consultation; primary care continuing medical education seems worthwhile. It would, perhaps, be more beneficial for all to have the pediatric urologists travelling to perform clinics and surgeries in distant regions to save more than 300 km round trip to several families.
PubMed: 31799921
DOI: 10.5489/cuaj.5892 -
Cureus Apr 2024Preputial calculus is an infrequent manifestation of urolithiasis, primarily observed in ageing individuals with an uncircumcised penis and not maintaining proper...
Preputial calculus is an infrequent manifestation of urolithiasis, primarily observed in ageing individuals with an uncircumcised penis and not maintaining proper hygiene, which can further be complicated by co-morbidities such as phimosis. On the contrary, phimosis and other neurological/urological malformations have also been reported in children to cause preputial calculus. Overall clinical presentations include a palpable mass within the prepuce, dysuria, hematuria, obstructive uropathy, diminished urine flow, and malodorous discharge. This is a case of a 65-year-old male presented with a complaint of obstructed urinary flow. The patient was diagnosed with obstructive uropathy due to the presence of preputial stone/s. This case illustrates both singular and multiple stones in the affected patient. The patient was managed by surgical intervention by circumcision followed by calculus removal. As per the available published literature, this case can be noted as the first report of the largest preputial stone in an elderly in any rural setup of central India.
PubMed: 38800222
DOI: 10.7759/cureus.58968 -
Frontiers in Pediatrics 2020To evaluate the diagnosis and treatment methods of hypospadias with megameatus intact prepuce (MIP). A retrospective analysis was performed in 27 MIP children, 13 of...
To evaluate the diagnosis and treatment methods of hypospadias with megameatus intact prepuce (MIP). A retrospective analysis was performed in 27 MIP children, 13 of whom underwent tubularized incised plate urethroplasty (TIP procedure), 7 underwent the Duplay procedure, 5 underwent the Mathieu procedure, 1 underwent meatal advancement and glanuloplasty (MAGPI procedure), and 1 underwent the glans approximation procedure (GAP). The patients were followed for 6-36 months to evaluate the surgical outcomes by the Pediatric Penile Perception Score (PPPS). A total of 27 patients with a mean age of 8.12 ± 3.0 years were enrolled in this study, and 25 cases (25/27, 92.6%) were accidentally discovered during the first visit for phimosis. The patients had a formed urethra of 0.5 to 1.5 cm. Complications occurred in 4 of the 27 patients (14.81%): 2 patients with urethral fistula and 2 patients with meatal stenosis. One patient had a case of self-healed urethral fistula, and the remaining 3 patients underwent reoperation. The post-operative effect was satisfactory in all patients, and the urinary flow and stream during urination were normal. The overall average PPPS score of non-operative surgeons and parents was satisfactory. There were no significant differences in meatus appearance, glans appearance, skin appearance, and general appearance PPPS score among the Mathieu, TIP, and Duplay surgical procedures. MIP clinical manifestations are concealed and usually noted when circumcision is attempted. The suitable procedure for each patient should be tailored according to the anatomic features, and several techniques can be used with good functional and cosmetic results.
PubMed: 32296666
DOI: 10.3389/fped.2020.00128 -
The Veterinary Clinics of North... Aug 2021Selected emergency conditions of male and female reproductive tracts in horses are described, including injuries affecting the external genitalia of male horses and... (Review)
Review
Managing Reproduction Emergencies in the Field: Part 1: Injuries in Stallions; Injury of the External Portion of the Reproductive Tract and Gestational Conditions in the Mare.
Selected emergency conditions of male and female reproductive tracts in horses are described, including injuries affecting the external genitalia of male horses and emergent conditions arising during gestation in mares. Conditions affecting male horses are discussed in the context of breeding stallions, but kicks or other mechanisms of trauma in the groin can also affect geldings. Priapism, paraphimosis, trauma to the scrotum and testicles, and penile injury are discussed. In mares, traumatic vestibular injury, placentitis, hydropsic conditions, prepubic tendon and abdominal wall compromise, and uterine torsion are included. Clinical recognition of the problem, diagnostic procedures, and treatments are summarized.
Topics: Animals; Breeding; Emergencies; Female; Genitalia, Female; Genitalia, Male; Horse Diseases; Horses; Male; Paraphimosis; Pregnancy; Priapism; Reproduction; Wounds and Injuries
PubMed: 34243877
DOI: 10.1016/j.cveq.2021.04.007 -
Cureus May 2022Kindler syndrome is a rare autosomal recessive skin disorder. It results from mutation of the FERM domain containing kindlin-1 (FERMT1) that leads to loss of function of...
Kindler syndrome is a rare autosomal recessive skin disorder. It results from mutation of the FERM domain containing kindlin-1 (FERMT1) that leads to loss of function of kindlin-1, which plays a role in keratinocyte adhesion, polarization, proliferation, and migration. It is characterized by skin blistering, photosensitivity, progressive poikiloderma, and skin atrophy. The mucosae genitourinary system is commonly affected. The urological manifestations include meatal stenosis, urethral stricture, phimosis, and scarring of the glans penis. Skin biopsy with genetic analysis is the gold standard for diagnosis. Genetic counseling and a multidisciplinary approach are the mainstays of treatment.
PubMed: 35676982
DOI: 10.7759/cureus.24758 -
Journal of Clinical Medicine Oct 2022Traditional approaches for male circumcision are tedious and could lead to complications such as peri-/postoperative pain, bleeding, and infection. Thus, for the first...
Traditional approaches for male circumcision are tedious and could lead to complications such as peri-/postoperative pain, bleeding, and infection. Thus, for the first time, we investigated the surgical outcomes of recently the discovered Disposable Circumcision Anastomat Type A (Dongguan ZSR Biomedical Technology Company Ltd., China), a disposable circumcision suture device (DCSD), in terms of the operation time, surgical complexity, safety, satisfaction, and aesthetic outcomes and most importantly the prognostic factors for postoperative infection. A total of 394 individuals were circumcised, with a mean age, body mass index (BMI), stretched penile length (SPL), and penile circumference of 30.1 ± 7.05 years, 25.47 ± 4.73, 10.12 ± 1.61, and 7 ± 0.73 cm, respectively. Associated comorbidities included diabetes mellitus (6.09%), hypertension (2.03%), gout (1.02%), end-stage renal disease (ESRD, 0.25%), and HIV (0.25%). The mean operation time, average postoperative bleeding, and wound infection rate was 31.4 ± 9.96 min, 2.54%, and 9.39%, respectively. The mean VAS postoperative pain scores at D0 and D1 were 4.4 ± 2.4 and 1.9 ± 1.6, respectively. Moreover, 1.27% of subjects required reoperation, and a 2.03% rate of instrument malfunction was noted. The significant factors associated with the post-operative infection group were age (p = 0.0313), BW (p = 0.0081), BMI (p = 0.0026), penile circumference (p = 0.0343), and DM (p ≤ 0.001). Multivariate analyses revealed only DM as a statistically significant factor (p < 0.001). Our box−whisker plot revealed no significant difference between the HbA1c level of infection (Hb1Ac = 7.77 ± 1.39) and non-infection groups (Hb1Ac = 6.92 ± 1.84). However, a trend of higher glycemic index in the infection group was observed. Conclusively, DSCD could be an effective and safe alternative to performing circumcision. However, in the population with advanced aging, phimosis, elevated BMI, and DM (HbA1C > 9%), users should be highly cautious due to the increased risk of infection, dehiscence, and hematoma.
PubMed: 36294527
DOI: 10.3390/jcm11206206 -
Cirugia Pediatrica : Organo Oficial de... Apr 2020Balanitis xerotica obliterans (BXO) is a chronic inflammatory disease with a little known incidence in pediatric population. The objective of this work was to describe...
OBJECTIVES
Balanitis xerotica obliterans (BXO) is a chronic inflammatory disease with a little known incidence in pediatric population. The objective of this work was to describe our experience in the treatment of BXO.
MATERIALS AND METHODS
Retrospective study carried out in 419 patients undergoing circumcision surgery between January 2014 and January 2017. Demographic, clinical, therapeutic, and anatomical and pathological variables, as well as complications during follow-up, were analyzed.
RESULTS
Of the 419 patients, 41 (9.78%) were diagnosed with BXO. 6 patients were excluded owing to lack of follow-up, so 35 patients were analyzed. Mean age at diagnosis was 8.6 years. Suspicion diagnosis was clinical at physical exploration in 17 patients (48.6%), and at surgery in 18 patients (51.4%). Anatomical and pathological confirmation was performed in a total 35 patients (100%). During follow-up, 6 patients (17.14%) had lesions in the glans, 3 (8.57%) in the urethra, and 9 (25.71%) in both. 6 meatotomies (17.14%) and 5 new circumcisions (14.28%) had to be carried out. Mean recurrence time was 32.43 months. In 19 patients (54.28%), topical corticoids - ointment - were applied, and 1 patient (2.85%) received topical immunosuppressants.
CONCLUSIONS
A close follow-up of patients with clinical or anatomical and pathological diagnosis of BXO is required given its high morbidity. The complications described in pediatric population include meatal and urethral stenosis, as well as recurrent phimosis, unless a sufficient amount of foreskin is resected.
Topics: Adolescent; Balanitis Xerotica Obliterans; Betamethasone; Child; Child, Preschool; Circumcision, Male; Dexamethasone; Follow-Up Studies; Glucocorticoids; Humans; Male; Penis; Phimosis; Recurrence; Reoperation; Retrospective Studies; Tacrolimus
PubMed: 32250071
DOI: No ID Found