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The Journal of Sexual Medicine Feb 2022Several treatment options for urethral complications following metoidioplasty in transmen are described in the literature, yet little is known with regard to the...
BACKGROUND
Several treatment options for urethral complications following metoidioplasty in transmen are described in the literature, yet little is known with regard to the surgical outcomes.
AIM
The aim of this study was to analyze the surgical outcomes after treatment of urethral strictures and urethral fistulas following metoidioplasty.
METHODS
A multicenter retrospective cohort study was conducted with transmen treated for strictures and fistulas after metoidioplasty in 3 tertiary referral centers.
OUTCOMES
The primary outcome was the recurrence-free rate after surgical treatment of urethral strictures and urethral fistulas over a time period of 3 years postoperatively.
RESULTS
Of 96 transmen included in this study with a urethral complication, 44 (46%) experienced a urethral fistula, 31 (32%) a urethral stricture, and 21 (22%) both complications simultaneously. The recurrence-free rate for urethral strictures following endoscopic management (ie, urethral dilation or direct visual internal urethrotomy) was 61% after 1, 50% after 2, and 43% after 3 years, compared to 82% following open treatment options after 1, 2, and 3 years (P = .002). Open treatment options were Heineke-Mikulicz procedure (7/9, 78% success), excision and primary anastomosis (3/3, 100%), 2-stage without graft (9/9, 100%), pedicled flap urethroplasty (1/1, 100%), and buccal mucosa graft urethroplasty (2/4 [50%] single-stage, 1/1 [100%] 2-stage). The recurrence-free rate for small urethral fistulas located at the pendulous urethra was 79% after 1, and 72% after 2 and 3 years, compared to 45% after 1, and 41% after 2 and 3 years for large fistulas, generally located at the urethral anastomoses of the fixed urethra. Treatment options for urethral fistulas were fistulectomy (26/48, 54%), fistulectomy & (redo) colpectomy (7/11, 64%), buccal mucosa graft urethroplasty (1/1, 100%), and retubularization of the urethral plate (3/4, 75%). A colpectomy before or during reoperation of a urethral fistula at the proximal urethral anastomosis showed higher success rates compared to without a colpectomy (7/11 [64%] vs 2/13 [15%] respectively, P = .03).
CLINICAL IMPLICATIONS
This study provides insight in the treatment possibilities and corresponding outcomes of urethral complications following metoidioplasty in transmen.
STRENGTHS & LIMITATIONS
Strengths were the relatively large sample size and the overview of multiple treatment options available. Limitations were the heterogeneity of the cohort, underexposure of some surgical modalities, and absence of patient-reported outcomes.
CONCLUSION
Open surgical techniques show better long-term outcomes in the management of urethral strictures compared to endoscopic options, and a colpectomy is beneficial before or during urethral fistula repair at the proximal urethral anastomosis. de Rooij FPW, Falcone M, Waterschoot M, et al. Surgical Outcomes After Treatment of Urethral Complications Following Metoidioplasty in Transgender Men. J Sex Med 2022;19:377-384.
Topics: Humans; Male; Mouth Mucosa; Retrospective Studies; Transgender Persons; Treatment Outcome; Urethra; Urethral Stricture; Urologic Surgical Procedures, Male
PubMed: 34974989
DOI: 10.1016/j.jsxm.2021.12.006 -
Poultry Science Feb 2022Pendulous crop (PC) in the turkey occurs when the crop distends from its normal position, thereby preventing the movement of feed and water from the crop down into the...
Pendulous crop (PC) in the turkey occurs when the crop distends from its normal position, thereby preventing the movement of feed and water from the crop down into the digestive system. This condition negatively impacts the turkey industry at both production and welfare levels. In this study, we estimated the genetic parameters for PC incidence and its genetic correlation with 5 production traits. Additionally, we evaluated the prediction accuracy and bias of breeding values for the selection candidates using pedigree (BLUP) or pedigree-genomic (ssGBLUP) relationships among the animals. A total of 245,783 turkey records were made available by Hybrid Turkeys, Kitchener, Canada. Of these, 6,545 were affected with PC. In addition, the data included 9,634 records for breast meat yield (BMY); 5,592 records for feed conversion ratio (FCR) and residual feed intake (RFI) in males; 170,844 records for body weight (BW) and walking score (WS) between 18 and 20 wk of age for males (71,012) and females (99,832), respectively. Among this population, 36,830 were genotyped using a 65K SNP Illumina Inc. chip. While all animals passed the quality control criteria, only 53,455 SNP markers were retained for subsequent analysis. Heritability for PC was estimated at 0.16 ± 0.00 and 0.17 ± 0.00 using BLUP and ssGBLUP, respectively. The incidence of PC was not genetically correlated with WS or FCR. Low unfavourable genetic correlations with BW (0.12 and 0.14), BMY (0.24 and 0.24) and RFI (-0.33 and -0.28) were obtained using BLUP and ssGBLUP, respectively. Using ssGBLUP showed higher prediction accuracy (0.51) for the breeding values for the selection candidates than the pedigree-based model (0.35). Whereas the bias of the prediction was slightly reduced with ssGBLUP (0.33 ± 0.05) than BLUP (0.30 ± 0.08), both models showed a regression coefficient lower than one, indicating inflation in the predictions. The results of this study suggest that PC is a heritable trait and selection for lower PC incidence rates is feasible. Although further investigation is necessary, selection for BW, BMY, and RFI may increase PC incidence. Incorporating genomic information would lead to higher accuracy in predicting the genetic merit for selection candidates.
Topics: Animals; Body Weight; Chickens; Female; Genomics; Genotype; Male; Models, Genetic; Pedigree; Phenotype; Turkeys
PubMed: 34954445
DOI: 10.1016/j.psj.2021.101601 -
World Journal of Plastic Surgery Sep 2021Macromastia in adolescent girls is a distressing condition. There is an increase in the number of patients opting for reduction mammoplasty in the late teens. The...
BACKGROUND
Macromastia in adolescent girls is a distressing condition. There is an increase in the number of patients opting for reduction mammoplasty in the late teens. The semicircular horizontal method of breast reduction, first described by Passot in 1925 has the advantage of being able to do larger reduction, particularly suitable for pendulous breasts and having a hidden scar in the inframammary fold.
METHODS
Eleven patients of adolescent macromastia were included in this study. It was conducted over a period of 4 years (2013-17) at two teaching institutions in Kolkata and Rishikesh, India. The mean age of the patients was 19.2 years. The Passot technique of reduction mammoplasty was performed in each case and the volume of resected breast tissue recorded by weighing the specimen. The aesthetic outcome was assessed by Lowery scale (volume, contour, placement of the breast mound and inframammary fold). Patient satisfaction was assessed after 6 months of follow up on a scale of 1 to 10, where 1-4 was poor, 5-6 fair, 7-8 good and 9-10 excellent.
RESULTS
Mean total reduction per breast was 856 gm. Patients reported a mean decrease of cup size by 1.5. The aesthetic outcome was excellent in 6 patients and good in 5 patients. Patient satisfaction was excellent in 9 patients and good in 2 patients.
CONCLUSION
Passot technique is a safe and effective technique of reduction mammoplasty and is especially useful in adolescent macromastia where the absence of visible scar on the breasts is very satisfying for the patients.
PubMed: 34912671
DOI: 10.29252/wjps.10.3.84 -
Animals : An Open Access Journal From... Nov 2021The study was conducted between March and September 2019 in six meat-type turkey flocks with similar management standard procedures using the transect walk method. The...
The study was conducted between March and September 2019 in six meat-type turkey flocks with similar management standard procedures using the transect walk method. The concept of the method is based on visual observation of the birds while slowly walking across the entire farm in predetermined transects. Each flock was evaluated at three different times during the fattening cycle: at 3 to 4, 12 to 13, and 19 to 20 weeks of age, and total number of males and females that were immobile or lame, had visible head, vent, or back wounds, were small, featherless, dirty, or sick, had pendulous crop, or showed aggression toward birds or humans were recorded. At each visit, NH and CO were measured within the facilities. In the first assessment, the most frequently observed welfare indicators were small size (0.87%) and immobility (0.08%). Males showed a significantly higher prevalence of small size ( < 0.01), sickness ( < 0.05), and dirtiness ( < 0.1) compared to females. In the second assessment, the most common findings in both sexes were dirtiness (1.65%) and poor feather condition (1.06%), followed by immobility (0.28%). Males were significantly dirtier ( < 0.001), had more immobile birds ( < 0.01) and birds with vent wounds ( < 0.1), but had fewer sick birds ( < 0.05). In the last assessment, an increase in immobile, lame, sick, and dead birds was recorded, indicating an increase in health problems. Higher CO (3000 and 4433 ppm) and NH (40 and 27.6 ppm) values were noted only at the first assessment in two facilities. Further analyses showed that slightly elevated NH and CO levels did not influence the occurrence of welfare indicators. This study is the first description of the welfare of commercial turkey flocks in Slovenia.
PubMed: 34827985
DOI: 10.3390/ani11113253 -
PhytoKeys 2021A new species of L. from northern Peru is described, illustrated, and compared with related species. This new species belongs to the Laxicaule Group and shares...
A new species of L. from northern Peru is described, illustrated, and compared with related species. This new species belongs to the Laxicaule Group and shares morphological characteristics with D.E. Benn & Christenson but differs in the shape and length of the dorsal sepal; the shape of the petals and the lip, ribs position of the lip, shape of the vesicle formed between the ovary and the column as well as the section of the stem.
PubMed: 34776732
DOI: 10.3897/phytokeys.184.70844 -
PeerJ 2021, a new species of Phyllanthaceae from Southeast Yunnan Province, China, is described. The phylogenetic position of the new species within the genus was analyzed based...
, a new species of Phyllanthaceae from Southeast Yunnan Province, China, is described. The phylogenetic position of the new species within the genus was analyzed based on nuclear ribosomal Internal Transcribed Spacer (nrITS) and plastid sequence data. The results show that is highly supported to be the sister of (P. T. Li) Voronts. & Petra Hoff., a species endemic to western Guangxi Province, China. Morphologically, the new species can be distinguished from all known congeneric taxa by its long and slim branches usually pendulous or procumbent, some of its leaf laminas up to 15 cm long and 7 cm wide. It further differs from its sister species by its hirsute stems, leaves and pedicel of female flowers, longer pedicel of male flowers, 3-locular ovary and three styles. A key to all 10 accepted species is provided.
PubMed: 34513329
DOI: 10.7717/peerj.11989 -
Journal of Clinical Medicine Aug 2021Urethral strictures are a common complication after genital gender-affirming surgery (GGAS) in transmasculine patients. Studies that specifically focus on the management... (Review)
Review
BACKGROUND
Urethral strictures are a common complication after genital gender-affirming surgery (GGAS) in transmasculine patients. Studies that specifically focus on the management of urethral strictures are scarce. The aim of this systematic review is to collect all available evidence on the management of urethral strictures in transmasculine patients who underwent urethral lengthening.
METHODS
We performed a systematic review of the management of urethral strictures in transmasculine patients after phalloplasty or metoidioplasty (PROSPERO, CRD42021215811) with literature from PubMed, Embase, Web of Science and Cochrane. Preferred Reporting Items for Systematic reviews and Meta-Analysis-(PRISMA) guidelines were followed, and risk of bias was assessed for every individual study using the 5-criterion quality appraisal checklist.
RESULTS
Eight case series were included with a total of 179 transmasculine patients. Only one study discussed the management of urethral strictures after metoidioplasty. Urethral strictures were most often seen at the anastomosis between the fixed and pendulous urethra. For each stricture location, different techniques have been reported. All studies were at a high risk of bias. The current evidence is insufficient to favor one technique over another.
CONCLUSIONS
Different techniques have been described for the different clinical scenarios of urethral stricture disease after GGAS. In the absence of comparative studies, however, it is impossible to advocate for one technique over another. This calls for additional research, ideally well-designed prospective randomized controlled trials (RCTs), focusing on both surgical and functional outcome parameters.
PubMed: 34501359
DOI: 10.3390/jcm10173912 -
Canine Medicine and Genetics Sep 2021Otitis externa is a commonly diagnosed disorder in dogs and can carry a high welfare impact on affected animals. This study aimed to report the prevalence and explore...
BACKGROUND
Otitis externa is a commonly diagnosed disorder in dogs and can carry a high welfare impact on affected animals. This study aimed to report the prevalence and explore the role of breed and aural conformation as predisposing factors for canine otitis externa in the UK. The study used a cohort design of dogs under UK primary veterinary care at clinics participating in the VetCompass Programme during 2016. Risk factor analysis used multivariable logistic regression modelling.
RESULTS
The study included a random sample of 22,333 dogs from an overall population of 905,554 dogs under veterinary care in 2016. The one-year period prevalence of otitis externa was 7.30% (95% confidence interval [CI]: 6.97 to 7.65). Breed and ear carriage were the highest ranked risk factors. Compared with crossbred dogs, sixteen breed types showed increased odds, including: Basset Hound (odds ratio [OR] 5.87), Chinese Shar Pei (OR 3.44), Labradoodle (OR 2.95), Beagle (OR 2.54) and Golden Retriever (OR 2.23). Four breeds showed protection (i.e. reduced odds) of otitis externa: Chihuahua (OR 0.20), Border Collie (OR 0.34), Yorkshire Terrier (OR 0.49) and Jack Russell Terrier (OR 0.52). Designer breed types overall had 1.63 times the odds (95% CI 1.31 to 2.03) compared with crossbred dogs. Compared with breeds with erect ear carriage, breeds with pendulous ear carriage had 1.76 times the odds (95% CI 1.48 to 2.10) and breeds with V-shaped drop ear carriage had 1.84 times the odds (95% CI 1.53 to 2.21) of otitis externa.
CONCLUSIONS
Breed itself and breed-associated ear carriage conformation are important predisposing factors for canine otitis externa. Greater awareness of these associations for both predisposed and protected breeds could support veterinary practitioners to promote cautious and low-harm approaches in their clinical advice on preventive care for otitis externa, especially in predisposed breeds.
PubMed: 34488894
DOI: 10.1186/s40575-021-00106-1 -
Practical Radiation Oncology 2021This pilot study (ClinicalTrials.gov NCT04543851) investigates a novel breast positioning device using a low density, high tensile carbon-fiber cradle to support the...
PURPOSE
This pilot study (ClinicalTrials.gov NCT04543851) investigates a novel breast positioning device using a low density, high tensile carbon-fiber cradle to support the breast, remove the inframammary fold, and reduce dose to organs at risk for whole breast radiation therapy in the supine position.
METHODS AND MATERIALS
Thirty patients with inframammary folds ≥1 cm or lateral ptosis in supine treatment position were planned with standard positioning and with a carbon-fiber Adjustable Reusable Accessory (CARA) breast support. Twenty patients received whole breast with or without regional nodal irradiation with 42.5 Gy in 16 fractions or 50 Gy in 25 fractions using CARA. Median body mass index was 32 in this study.
RESULTS
CARA removed all inframammary folds and reduced V20Gy V105%, and V50% , without compromising target coverage. Median (range) V20Gy for whole breast radiation therapy was 12.3% (1.4%-28.7%) with standard of care versus 10.9% (1.2%-17.3%) with CARA (Wilcoxon P = .005). Median V105% was 8.0% (0.0%-29%) with standard of care versus 4.0% (0.0%-23%) with CARA (P = .006) and median V50% was 3056 mL (1476-5285 mL) versus 2780 mL (1415-5123 mL) with CARA (P = .001). CARA was compatible with deep inspiration breath hold and achieved median V25Gy = 0.1% (range 0%-1.9%) for all patients with left breast cancer. Skin reactions with CARA were consistent with historical data and daily variation in treatment setup was consistent with standard supine positioning.
CONCLUSIONS
CARA can reduce V105%, lung and normal tissue dose, and remove the inframammary fold for breast patients with large or pendulous breasts and high body mass index treated in the supine position, without compromising target coverage. CARA will undergo further study in a randomized controlled trial.
Topics: Breast Neoplasms; Carbon Fiber; Female; Heart; Humans; Organs at Risk; Pilot Projects; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted
PubMed: 34303034
DOI: 10.1016/j.prro.2021.06.012 -
Technology in Cancer Research &... 2021To evaluate geometric and dosimetric effects of bra application during radiotherapy planning for breast cancer patients with large and pendulous breasts.
PURPOSE
To evaluate geometric and dosimetric effects of bra application during radiotherapy planning for breast cancer patients with large and pendulous breasts.
MATERIALS AND METHODS
Twenty patients with chest sizes >38 inches between April 2019 and July 2019 underwent radiotherapy planning with and without a radiation bra (Chabner XRT). Geometric and dosimetric parameters included the breast volume, superior-inferior (SI) distance, separation (S) as the distance of the longest diameter of the clinical target volume (CTV), conformity number (CN), and homogeneity index (HI) of CTV. The organs at risk (OARs) were defined as the lungs, heart, and liver.
RESULTS
The use of the radiation bra provided mean changes of -0.51 cm for S, -1.45 cm for SI, and -61.18 cc for breast volume (all < 0.05). Breast volume was correlated with bra-related changes in cross diameter (r = 0.641, = 0.002) and volume (r = 0.680, = 0.001). Significant dose reductions were observed for the lungs (mean V: 19.58 cc, V: 17.13 cc, D: 86.24 cGy) and heart (D: 170.23 cGy). No significant differences were observed for CN (0.62-0.67) and HI (0.19-0.20) of the CTV.
CONCLUSION
The application of a radiation bra was associated with better geometric and dosimetric planning parameters, with a smaller CTV and lower doses to the OARs (lungs and heart) in the radiotherapy field. In addition, we expect that bra use during radiotherapy would provide emotional benefits.
Topics: Adult; Aged; Breast; Breast Neoplasms; Clothing; Female; Heart; Humans; Liver; Lung; Middle Aged; Organ Size; Organs at Risk; Radiation Dosage; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Retrospective Studies
PubMed: 34180303
DOI: 10.1177/15330338211027909