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Indian Journal of Sexually Transmitted... 2021Role of male circumcision (MC) as a tool to prevent sexually transmitted infections (STIs)/human immunodeficiency virus (HIV) was assessed. An attempt was made to search... (Review)
Review
Role of male circumcision (MC) as a tool to prevent sexually transmitted infections (STIs)/human immunodeficiency virus (HIV) was assessed. An attempt was made to search articles related to association between MC and STIs/HIV. A thorough search was carried out to find out quality articles published in indexed specialty journals. Centers for Disease Control and Prevention and World Health Organization (WHO) sites were also referred. Warm and moist environment of area under foreskin facilitates some pathogens to persist and replicate. Further, the thinness of foreskin predisposes it to minor trauma and abrasions that facilitate the entry of pathogens. MC reduces HIV infection risk by 50%-60% over time and reduces the risk of men acquiring herpes simplex virus-2 and human papillomavirus (HPV) that can cause penile and other anogenital cancers, by 30%. There is no significant reduction in risk of acquiring syphilis, but reduced risk of acquisition of is reported. MC is reported to be beneficial in conditions such as traumatic injury, Balanitis Xerotica Obliterans, refractory balanoposthitis, and chronic, recurrent urinary tract infections. MC also reduces the chances of penile carcinoma by facilitating improved penile hygiene, lowering HPV/HIV transmission rates, and reducing chronic inflammatory conditions such as phimosis and balanitis. MC has been recommended by the WHO and UNAIDS in 2007 as an additional HIV prevention intervention in settings of high HIV prevalence. MC is an important adjunct to safe sex education, condom use, and vaccination (HPV) in reducing the global burden of HIV/STIs-related morbidity and mortality.
PubMed: 34765930
DOI: 10.4103/ijstd.ijstd_20_21 -
BJU International Dec 2021To determine: (i) feasibility for a randomised controlled trial (RCT) comparing circumcision to preputioplasty and intralesional triamcinolone (PIT) to treat balanitis... (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVES
To determine: (i) feasibility for a randomised controlled trial (RCT) comparing circumcision to preputioplasty and intralesional triamcinolone (PIT) to treat balanitis xerotica obliterans (BXO) and (ii) patient outcomes to inform future study design.
PATIENTS AND METHODS
Approval was obtained from the UK Health Research Authority and local Research Ethics Committee (Reference 16/NW/0364) and the trial protocol registered with ClinicalTrials.gov (NCT02854995). A total of 20 boys (aged 2-16 years) with BXO were randomised to either circumcision or PIT (online parallel group 1:1 allocation, non-blinded). Exclusion criteria were: (i) previous penile surgery and (ii) contraindication for either treatment. Follow-up (including satisfaction questionnaire) was at 6 weeks, 3 and 12 months. Data are presented as median (interquartile range [IQR]), continuous variables were compared by t-test.
RESULTS
A total of 54 boys were approached over 18 months: 23 (45%) were recruited and randomised. The commonest reason for non-entry was treatment preference: 12 preferred circumcision, 18 preferred PIT. Four patients withdrew after randomisation, three did not want circumcision and one did not want PIT. The groups were similar in terms of age (median [IQR] 11 [6-12] vs 8 [7-10] years, P = 0.53) and duration of symptoms (median [IQR] 6 [6-15] vs 6 [2-24] months, P = 0.77). There were no protocol breaches, serious adverse events or postoperative meatal stenosis. There was one self-resolving haematoma after PIT and one suture granuloma after circumcision. Two boys went on to have a circumcision after PIT. Overall, satisfaction levels were high for both groups.
CONCLUSION
A definitive RCT of circumcision vs PIT for BXO appears feasible, with 39% of those approached completing the trial. More families preferred PIT. A robust comparison in the form of a multicentred RCT is required.
Topics: Adolescent; Anti-Inflammatory Agents; Balanitis Xerotica Obliterans; Child; Child, Preschool; Circumcision, Male; Combined Modality Therapy; Feasibility Studies; Foreskin; Humans; Injections, Intralesional; Male; Patient Satisfaction; Plastic Surgery Procedures; Triamcinolone
PubMed: 34110689
DOI: 10.1111/bju.15508 -
International Journal of STD & AIDS Sep 2021The role of circumcision in partially protecting against sexually transmitted infections (STIs) and other dermatoses has been documented. Neonatal circumcision is not... (Observational Study)
Observational Study
The role of circumcision in partially protecting against sexually transmitted infections (STIs) and other dermatoses has been documented. Neonatal circumcision is not routinely practiced in South America. Although it is logical to assume that male genital dermatoses are more prevalent in Hispanic men, they are underrepresented in the existing literature. Objective: To describe the epidemiological characteristics from our male genital dermatology unit in Montevideo (Uruguay), the diagnoses, and correlate them with circumcision status and comorbidities. Methods: A retrospective observational cohort study was conducted. A dermatologist and urologist evaluated all patients using standard questionnaires. In 3 years and 8 months, 269 patients were seen. Median age was 41, prevalence of neonatal circumcision was 0.7%, HIV was 4.2%, STIs were 24.9%, non-STIs were 63.9%, and both (STI + non-STI) were 11.2%. Most frequent entities: eczema/balanoposthitis (27.1%), condyloma (24.9%), and lichen sclerosus (15.6%). Data correlating circumcision and other diagnoses did not reach statistical significance. HIV was positively associated with other STIs ( < 0.05), and an association with balanoposthitis was seen; however, it did not reach statistical significance ( < 0.1). Main limitation was small sample size. This is the first study of its kind based on Hispanic patients. Collaboration between specialties proved to be fundamental. Further studies are needed in this demographic to find an association between circumcision, comorbidities, and genital dermatoses.
Topics: Adult; Circumcision, Male; Dermatology; Genitalia; Hispanic or Latino; Humans; Infant, Newborn; Male; Retrospective Studies
PubMed: 33914651
DOI: 10.1177/09564624211010056 -
World Journal of Urology Oct 2021To report long-term results and patient reported outcomes of staged anterior urethroplasties, and isolate risk factors for recurrence.
PURPOSE
To report long-term results and patient reported outcomes of staged anterior urethroplasties, and isolate risk factors for recurrence.
METHODS
We reviewed urethroplasty database for all patients who underwent staged urethroplasty from 2000 to 2017. Follow-up included a cystoscopy 4 months after their 2nd stage to assess early success, and then annual follow-up thereafter with post-void residual and symptom assessment. Stricture characteristics, etiology and graft type were analyzed with regards to success.
RESULTS
Forty-nine patients were eligible for inclusion. The median stricture length was 7 cm (3-17 cm). The early success rate demonstrated by cystoscopy at 4 months was 100%. Long-term success was 96.4% in buccal graft (BMG) only patients; however, long-term success fell considerably to 53% in patients requiring any use split thickness skin graft (STSG) in the first stage. Median follow up time was 57 months (6-240 months). On analysis, age, increased stricture length and especially the use of STSG all appeared to be associated with late recurrence. The recurrence group had longer stricture length and were more likely to be panurethral. All recurrences occurred after the initial 4-month cystoscopy with a median time to recurrence of 78 months.
CONCLUSION
Staged repairs that are amenable to BMG-only repairs have high long-term success rates. Increasing stricture length and the addition of split-thickness skin graft were associated with lower success rate in staged urethral reconstruction. Patients requiring staged repairs often experience recurrence in a very delayed fashion reinforcing the need for close, long-term follow up.
Topics: Adolescent; Adult; Aged; Balanitis Xerotica Obliterans; Follow-Up Studies; Humans; Hypospadias; Male; Middle Aged; Mouth Mucosa; Plastic Surgery Procedures; Recurrence; Risk Factors; Skin Transplantation; Urethral Stricture; Urologic Surgical Procedures, Male; Young Adult
PubMed: 33811511
DOI: 10.1007/s00345-021-03676-8 -
Asian Journal of Surgery May 2021
Topics: Balanitis Xerotica Obliterans; Child, Preschool; Foreskin; Hand, Foot and Mouth Disease; Humans; Male
PubMed: 33752984
DOI: 10.1016/j.asjsur.2021.02.014 -
BMC Infectious Diseases Mar 2021Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel hypoglycemic agents which reduce reabsorption of glucose at the renal proximal tubule, resulting in...
BACKGROUND
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel hypoglycemic agents which reduce reabsorption of glucose at the renal proximal tubule, resulting in significant glycosuria and increased risk of genital mycotic infections (GMI). These infections are typically not severe as reported in large systematic reviews and meta-analyses of the medications. These reviews have also demonstrated significant cardiovascular benefits through other mechanisms of action, making them attractive options for the management of Type 2 diabetes mellitus (T2DM). We present two cases with underlying abnormalities of the urogenital tract in which the GMI were complicated and necessitated cessation of the SGLT2 inhibitor.
CASE PRESENTATIONS
Both cases are patients with T2DM on empagliflozin, an SGLT2 inhibitor. The first case is a 64 year old man with Candida albicans balanitis and candidemia who was found to have an obstructing renal calculus and prostatic abscess requiring operative management. The second case describes a 72 year old man with Candida glabrata candidemia who was found to have prostatomegaly, balanitis xerotica obliterans with significant urethral stricture and bladder diverticulae. His treatment was more complex due to fluconazole resistance and concerns about urinary tract penetration of other antifungals. Both patients recovered following prolonged courses of antifungal therapy and in both cases the SGLT2 inhibitor was ceased.
CONCLUSIONS
Despite their cardiovascular benefits, SGLT2 inhibitors can be associated with complicated fungal infections including candidemia and patients with anatomical abnormalities of the urogenital tract may be more susceptible to these infections as demonstrated in these cases. Clinicians should be aware of their mechanism of action and associated risk of infection and prior to prescription, assessment of urogenital anatomical abnormalities should be performed to identify patients who may be at risk of complicated infection.
Topics: Aged; Benzhydryl Compounds; Candidiasis; Diabetes Mellitus, Type 2; Glucosides; Glycosuria; Humans; Hypoglycemic Agents; Male; Middle Aged; Pharmaceutical Preparations; Sodium-Glucose Transporter 2 Inhibitors
PubMed: 33743624
DOI: 10.1186/s12879-021-05982-3 -
Journal of Pediatric Urology Apr 2021Circumcision is a common procedure. Recently, tissue-sparing approaches have become a matter of interest, and a nerve-sparing approach is described in adults. Although...
BACKGROUND
Circumcision is a common procedure. Recently, tissue-sparing approaches have become a matter of interest, and a nerve-sparing approach is described in adults. Although circumcision is common in the practice, the nerve-sparing approach has not been evaluated in the pediatric age group.
OBJECTIVE
To give a contemporary evaluation of the preputium histology, challenge the phenomenon of a genuine nerve-sparing approach, and report the results of a prospective cohort contrasting the tissue-sparing fine dissection technique to the regular sleeve circumcision in the pediatric age group.
STUDY DESIGN
A total of 20 healthy children between 7 and 12 years of age were enrolled in the study. All circumcisions were carried out for religious purposes, and children with any anatomical anomaly, skin lesions, or Balanitis Xerotica Obliterans were not included in the study. The first 10 children underwent regular sleeve circumcision, while the latter 10 children underwent tissue-sparing fine dissection modification of the sleeve technique. All materials obtained from the circumcision were examined by a single pathologist, and relevant tissue structures were counted and compared between the groups.
RESULTS
Both techniques were satisfactory in terms of final cosmetic results, without significant complications, such as bleeding, massive edema, iatrogenic chordee, or unacceptable cosmetics. None of the children required readmission or medical intervention other than analgesics and topical moisturizing creams. Preservation of all nervous system structures, including the receptors, appeared to be not possible with macroscopic dissection techniques due to micrometer scale depth of the touch receptors. Nerve trunks were also located in less than 1-mm depth. The tissue-sparing technique could preserve significantly more vascular structures, nerve trunks, and Pacinian Corpuscles, which can be a matter of further long-term research.
CONCLUSION
We propose the term "tissue-sparing" instead of "nerve-sparing" for the available techniques. The tissue-sparing technique did not affect the clinical outcomes and the postoperative course in our study. However, it showed to be superior in terms of preserving the vascular structures, nerve trunks, and Pacinian Corpuscles.
Topics: Adult; Balanitis Xerotica Obliterans; Child; Circumcision, Male; Foreskin; Humans; Lichen Sclerosus et Atrophicus; Male; Prospective Studies
PubMed: 33339734
DOI: 10.1016/j.jpurol.2020.11.040 -
Surgery Journal (New York, N.Y.) Oct 2020Pediatric circumcision is a commonly performed operation, yet outcomes related to procedures performed for medical indications remain underreported. The aim of...
Pediatric circumcision is a commonly performed operation, yet outcomes related to procedures performed for medical indications remain underreported. The aim of this study was to report outcomes of therapeutic circumcision from our center. Prospective registry of elective circumcisions was maintained and analyzed at a single institution in the United Kingdom. Data collected included information on complications (early and late), emergency presentations, and referrals back from primary care services. Between August 2015 and June 2019, 300 patients (mean age: 9 years; range: 3-16 years) underwent therapeutic circumcision. The average length of follow-up data available was 2.1 years (range: 6 months to 4 years). The overall complication rate was 4.7% ( = 16). There were no unplanned admissions and no cases returned to the operating room as emergency. Only 1% ( = 3) of patients presented with an early complication (minor bleeding, pain, urinary retention), and 3.7% ( = 11) suffered a late complication (meatal stenosis [2.7%]). All cases of meatal stenosis had lichen sclerosus confirmed on histology. Cosmetic satisfaction was 99%. Therapeutic circumcision is an effective procedure in the pediatric population, which carries a low risk of early and late complications. Our study found that meatal stenosis only occurred in those patients with confirmed lichen sclerosus histology.
PubMed: 33335988
DOI: 10.1055/s-0040-1721430 -
International Journal of Dermatology May 2021Circumcision is one of the most frequently performed procedure by clinicians, yet its role and indication in clinical practice lacks consensus and remains unclear. We...
BACKGROUND
Circumcision is one of the most frequently performed procedure by clinicians, yet its role and indication in clinical practice lacks consensus and remains unclear. We sought to evaluate a collection of male circumcisions to determine the range of indications, histopathological diagnoses, and type of clinicians associated with circumcision.
METHODS
We performed a retrospective descriptive cohort study of male patients who received a circumcision reported by one major dermatopathology laboratory between January 2017 and December 2018. Data were extracted from the histological report of the pathologist for each case. Patient age, type of clinician, clinical notes, and histopathological diagnosis were evaluated.
RESULTS
"/> A total of 406 circumcisions were identified. The median age for circumcision was 36 (IQR 16-61). Boys less than 18 years of age made up 24% (98/406). Histological diagnoses included normal (43/406, 11%), nonspecific inflammation (82/406, 20%), inflammatory conditions (264/406, 65%), infections (9/406, 2.2%), benign neoplasms (5/406, 1.0%), and scar tissue (3/406, 0.7%). The most common diagnosis was balanitis xerotica obliterans (226/406, 56%). Rarely, genital infections and neoplastic lesions were identified. Circumcisions were performed by urologists (289/406, 71.2%), general practitioners (76/406, 18.7%), general surgeons (32/406, 8%), pediatric surgeons (5/406, 1%), and dermatologists (4/406, 1%). The main indications for circumcision were phimosis (110/202, 54%), suspected lichen sclerosus (28/202, 14%), and balanitis (15/202, 7%).
CONCLUSION
Circumcision was performed for a broad range of genital dermatoses across various medical and surgical specialties. Few studies have described these observations. We discuss the common pathological conditions leading to circumcision and its role in diagnosis and treatment.
Topics: Child; Circumcision, Male; Cohort Studies; Genitalia; Genitalia, Male; Humans; Male; Phimosis; Retrospective Studies; Specialties, Surgical
PubMed: 33319352
DOI: 10.1111/ijd.15359 -
Journal of the American Academy of... Jul 2021Demographic and clinical findings of patients with mucocutaneous morphea have not been well characterized, to our knowledge.
BACKGROUND
Demographic and clinical findings of patients with mucocutaneous morphea have not been well characterized, to our knowledge.
OBJECTIVE
To determine the demographic and clinical characteristics of morphea patients with mucocutaneous lesions who were enrolled in the Morphea in Adults and Children cohort.
METHODS
Cross-sectional study of 735 patients in the Morphea in Adults and Children cohort from 2007 to 2018.
RESULTS
A total of 4.6% of linear morphea patients had oral involvement versus 2.4% among the entire cohort, whereas 10.3% of generalized morphea patients had genital involvement versus 3.7% among the entire cohort. Patients with genital lesions were older at disease onset than those with oral morphea (57 versus 11.5 years; P < .001) and had more frequent extragenital lichen sclerosus et atrophicus (59.2% versus 5.6%; P = .004).
LIMITATIONS
Selection bias and limited number of affected subjects.
CONCLUSION
Oral morphea lesions predominate in younger patients with facial linear morphea, whereas genital lesions predominate in postmenopausal women with overlying extragenital lichen sclerosus et atrophicus.
Topics: Adolescent; Adult; Age Factors; Age of Onset; Balanitis Xerotica Obliterans; Child; Cross-Sectional Studies; Facial Hemiatrophy; Female; Humans; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Prospective Studies; Scleroderma, Localized; Severity of Illness Index; Vulvar Lichen Sclerosus; Young Adult
PubMed: 33249064
DOI: 10.1016/j.jaad.2020.10.093