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Access Microbiology 2023Non-typhoidal Salmonella (NTS) causes urinary tract infections infrequently and are usually associated with presence of genitourinary abnormalities.
INTRODUCTION
Non-typhoidal Salmonella (NTS) causes urinary tract infections infrequently and are usually associated with presence of genitourinary abnormalities.
CASE PRESENTATION
We report a case of immunocompetent male in his early 20 s with phimosis presented with history of dysuria and burning micturition for 4 months. A renal ultrasonography showed presence of bilateral intrarenal calculi. Urine analysis revealed presence of non-typhoidal Salmonella. Automated identification systems performed poorly in identification of serotype. On serotyping, it was identified as in the referral centre. The patient was managed with oral antibiotics.
CONCLUSION
This report highlights the issues of inaccurate identification of NTS even with advanced automated systems and early initiation of therapy based on the knowledge of local susceptibility patterns. UTI in immunocompetent individuals by non-typhoidal Salmonella should always be investigated further to rule out genitourinary abnormalities and appropriate antibiotics must be started to avoid chronicity and complications.
PubMed: 38188244
DOI: 10.1099/acmi.0.000610.v5 -
Journal of Pediatric Urology Jun 2024Surgical correction of hypospadias aims to achieve normal functionality and appearance. This entails foreskin reconstruction (FR) in countries where the uncircumcised...
INTRODUCTION
Surgical correction of hypospadias aims to achieve normal functionality and appearance. This entails foreskin reconstruction (FR) in countries where the uncircumcised penis constitutes the norm. Long-term data are however scarce.
OBJECTIVE
To investigate the long-term outcome of FR in cohort of patients operated for distal hypospadias combined with approximately 20 years after surgery.
METHODS
The hospital management system was searched for patients operated for distal hypospadias in conjunction with FR between 1997 and 2004. Prospective participants were invited to participate in an online questionnaire. Signed consent allowed for extended medical chart review, with regards to hypospadias grade, surgical procedure and complications.
RESULTS
Response rate of 44.6 %. For 113 participants, median age at primary surgery was 5.2 (1.0-15.5) years. Two-thirds had a distal meatus while the remaining, meatus was mid to distal shaft. Urethroplasties performed were mainly glanular approximation procedures and meatal based flap procedures in 85 %. Foreskin fistula developed in 15 % of cases. There was no significant relationship between urethroplasty procedure or meatal position and risk of foreskin complications. Three layer closure of foreskin resulted in significantly less complications than two layer closure. Twenty years on 95 % of the men still had an intact foreskin, of whom 16.8 % had received treatment for phimosis. Foreskin was retractable in 92.5 % and 74.7 % in the flaccid and erect states respectively. Ninety intact men had had their sexual debut and in those 23.3 % reported foreskin related issues with intercourse. Evolution of foreskin retractability can be seen in the figure.
DISCUSSION
Current results show that three layer FR in conjunction with hypospadias surgery is feasible and that short-term complication rates were comparable with what has previously been published in the literature. Long-term results indicate that FR is durable with regards to anatomical reconstruction however foreskin function especially in relation to sexual function was compromised in about 25 %. Foreskin retractability after surgery predicted retractability in adulthood for the flaccid but not erect penis. Limitations of this study include the retrospective nature of data collection, and that the questionnaire used was not validated. We however achieved a decent response rate and were able to capture important long-term data.
CONCLUSIONS
FR has an acceptable complication rate. Long-term results two decades on are remarkably durable with regards to the anatomical preservation of the prepuce, however functionality was compromised with regards to retractability and sexual function in approximately 25 %.
Topics: Humans; Male; Hypospadias; Foreskin; Child; Child, Preschool; Treatment Outcome; Adolescent; Plastic Surgery Procedures; Infant; Urologic Surgical Procedures, Male; Follow-Up Studies; Cohort Studies; Time Factors; Surveys and Questionnaires; Prospective Studies; Surgical Flaps; Postoperative Complications
PubMed: 38092584
DOI: 10.1016/j.jpurol.2023.11.047 -
Archivos Argentinos de Pediatria Jun 2024Introduction. The male genital exam is a simple and quick assessment to look for urogenital disease. Data on the prevalence of urogenital disease in male adolescents are...
Introduction. The male genital exam is a simple and quick assessment to look for urogenital disease. Data on the prevalence of urogenital disease in male adolescents are limited. Our objective was to describe the prevalence of urogenital disease in male adolescents. Population and methods. Descriptive, cross-sectional study conducted at the Department of Adolescence of a public hospital in the City of Buenos Aires. The medical records of male patients aged 9 to 20 years seen between 2008 and 2018 were retrospectively reviewed; all those with a genital exam were included. Data on age, pubertal stage, orchidometry, and urogenital disease before adolescence and at the time of consultation were recorded. The prevalence was described as percentage and 95% confidence interval (CI). As per estimations, 1167 medical records had to be included to establish the population sample. Results. A total of 2129 medical records were assessed and 1429 were included. No genital exam had been conducted in 686 cases. The median age of the population was 12 years (interquartile range: 11-14 years). Urogenital disease before adolescence was detected in 72 boys (5.7%; 95% CI: 4.5- 7.2). Urogenital disease was found in 272 adolescents (14.8%; 95% CI: 13.1-16.7); the most common conditions were balanopreputial adhesions in 5.3% (95% CI: 4.2-6.6), varicocele in 2.7% (95% CI: 2-3.7), and phimosis in 1.8% (95% CI: 1.2-2.6). Conclusions. A genital exam allowed to detect that 14.8% of adolescent boys had a urogenital disease. The most common conditions were balanopreputial adhesions, varicocele, and phimosis.
Topics: Humans; Male; Adolescent; Child; Varicocele; Cross-Sectional Studies; Retrospective Studies; Prevalence; Outpatients; Phimosis
PubMed: 37917038
DOI: 10.5546/aap.2023-10103.eng -
Cirugia Pediatrica : Organo Oficial de... Oct 2023Circumcision is one of the most common surgical procedures in pediatric surgery. Even though manual suture (MANS) is regarded as the gold standard technique, easy-to-use...
OBJECTIVE
Circumcision is one of the most common surgical procedures in pediatric surgery. Even though manual suture (MANS) is regarded as the gold standard technique, easy-to-use mechanical suture (MECS) devices have been recently developed, with better postoperative results in the adult population. The objective of our study was to compare the operating time and incidence of postoperative complications between both techniques in our environment.
MATERIALS AND METHODS
A retrospective study of patients undergoing circumcision in our institution from October 2021 to December 2022 was carried out. Operating time and complications observed in the first 14 postoperative days (edema, hematoma, dehiscence) were analyzed according to the technique used (MANS vs. MECS) and patient age (< 12 and ≥ 12 years old).
RESULTS
173 patients (147 MANS, 26 MECS) were included. Mean operating time was significantly lower in MECS patients, both in patients < 12 years old (16 min vs. 10 min, p= 0.002) and in patients ≥ 12 years old (23 min vs. 12 min, p< 0.001). Regarding complications, MECS patients ≥ 12 years old had a lower rate of suture dehiscence (23.5% vs. 0%, p< 0.001), with no significant differences in the younger group.
CONCLUSIONS
MECS circumcision is a simple and effective technique involving shorter operating times than MANS circumcision, regardless of age. It has a lower rate of complications in older children (≥ 12 years), which means it stands as a valid alternative to the conventional technique.
Topics: Child; Male; Adult; Humans; Phimosis; Retrospective Studies; Circumcision, Male; Postoperative Complications; Postoperative Period
PubMed: 37818898
DOI: 10.54847/cp.2023.04.12 -
Animal Reproduction 2023Acrobustitis is the inflammation of the distal prepuce, which can lead to a narrowing of the preputial ostium due to stenosis or growth of fibrous tissue after an...
Acrobustitis is the inflammation of the distal prepuce, which can lead to a narrowing of the preputial ostium due to stenosis or growth of fibrous tissue after an inflammatory reaction. This condition usually occurs in cattle with long prepuce, such as Zebu or Zebu's crossbreeds, leading the animal to Impotentia Coeundi, this condition is characterized by the bull's disability to copulate, that leads to lower herd fertility and consequent financial losses. Normally, corrective surgeries are performed on-farm and the animal is placed in a lateral recumbency. However, in some situations the animal is restrained with ropes and remains on the grass, dirt or even on uneven floors, which can cause neuropathies, bloat or hypoxia. Due to a series of complications that can occur in the postoperative period of surgery in the lateral recumbency, this article aims to describe the surgical technique for correcting acrobustitis with the animal in a standing position. Ten corrective surgeries for acrobustitis were performed in adult bulls between 4 and 8 years of age and predominantly of zebu or crossbreeds, with a total recovery of the animals for full reproductive activity.
PubMed: 37795197
DOI: 10.1590/1984-3143-AR2023-0047 -
Journal of Lower Genital Tract Disease Oct 2023Lichen sclerosus (LS) is a chronic inflammatory skin disease. In male patients, it usually involves the glans penis and foreskin and can cause phimosis or meatal...
OBJECTIVE
Lichen sclerosus (LS) is a chronic inflammatory skin disease. In male patients, it usually involves the glans penis and foreskin and can cause phimosis or meatal stenosis. The aim of this cross-sectional case-control study was to identify clinically important comorbidities in male patients with LS.
MATERIALS AND METHODS
By searching Turku University Hospital electronic health records, the authors identified 630 male patients diagnosed with LS between 2004 and 2020. To investigate possible comorbidities, the authors compared this patient group to a 10-fold larger control group.
RESULTS
The incidence of LS increased during the study period, from 5 to 27.5 per 100,000 men. Patients were most often diagnosed at 21 to 25 years of age. Patients with LS exhibited markedly increased risks of penile carcinoma (odds ratio [OR], 81.0; 95% CI = 10.82-3516.7; p < .001) and carcinoma in situ of the penis (OR = 60.5; 95% CI = 7.32-2738.9; p < .001). Patients also more commonly exhibited lichen planus (OR = 16.8; 95% CI = 8.97-32.39; p < .001), psoriasis (OR = 3.3; 95% CI = 1.80-5.70; p = .004), angina pectoris (OR = 1.8; 95% CI = 1.10-2.81; p = .013), obesity (OR = 2.6; 95% CI = 1.72-3.77; p < .001), type 2 diabetes (OR = 2.3; 95% CI = 1.74-3.09; p < .001), and hypertension (OR = 1.9; 95% CI = 1.53-2.37; p < .001). The most commonly performed urological procedures were operation for phimosis, uroflowmetry, and ultrasound measurement of residual urine.
CONCLUSIONS
Genital malignancies, other dermatological conditions, and diseases related to metabolic syndrome should be considered when treating patients with LS.
Topics: Humans; Male; Case-Control Studies; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Lichen Sclerosus et Atrophicus; Phimosis; Young Adult; Adult
PubMed: 37729047
DOI: 10.1097/LGT.0000000000000769 -
Translational Andrology and Urology Jul 2023At present, the only definitive treatment for adult phimosis is circumcision, which is a surgical removal of the prepuce. Novoglan is a novel device that could offer...
BACKGROUND
At present, the only definitive treatment for adult phimosis is circumcision, which is a surgical removal of the prepuce. Novoglan is a novel device that could offer patients with phimosis an alternative to surgery. It is based on application of custom-moulded balloons for gradual skin remodelling and prepuce dilatation. This open-label clinical trial aimed to investigate the safety, efficacy and tolerability of the Novoglan treatment.
METHODS
A prospective trial was conducted on 20 patients with adult phimosis recruited at Macquarie University Hospital and Princess Alexandra Hospital. After eligibility screening and enrolment, patients were provided with the Novoglan product and training. The treatment involved twice daily 10-minute applications for a duration of 4-8 weeks with patient's degree of phimosis assessed before and at 6-8 weeks after the initiation of the treatment. Participants were also asked to complete questionnaires aimed to assess the safety and tolerability of the Novoglan treatment.
RESULTS
The treatment was successful with improved foreskin retraction in 90% of patients and all patients achieving full foreskin retraction after the treatment. Ninety-five percent of patients reported reduced level of anxiety, and over 60% of patients reported reduced pain/discomfort during sexual activity or in general. Similarly, 95% of patients were moderately-to-very satisfied with the treatment and would recommend Novoglan to others. No adverse events were observed and only 15% of participants reported minor side effects.
CONCLUSIONS
The Novoglan-01 trial demonstrated high safety, efficacy and tolerability of the Novoglan treatment for adult phimosis and its high potential as a conservative alternative to circumcision or steroid cream treatment.
TRIAL REGISTRATION
The Novoglan-01 study has been registered with the Australia and New Zealand Clinical Trial Registry under the reference ACTRN 1262 10009 24853, dated 15 July 2021.
PubMed: 37554529
DOI: 10.21037/tau-23-91 -
Journal of Family & Reproductive Health Mar 2023A common genito-urinary infection known as Balanoposthitis presents with mild symptoms like itching or severe complications such as phimosis, ulceration of glans, and...
OBJECTIVE
A common genito-urinary infection known as Balanoposthitis presents with mild symptoms like itching or severe complications such as phimosis, ulceration of glans, and foreskin. It can result in four types of sexual dysfunction including Disorder of sexual desire, Disorder of erectile dysfunction, Disorder of satisfaction/premature ejaculation, and Disorder of orgasm.
MATERIALS AND METHODS
An observational clinic study including 50 patients diagnosed with Candidal Balanoposthitis based on KOH and clinical findings were recruited and evaluated for sexual function using a standardised questionnaire.
RESULTS
The results demonstrated that sexual dysfunction in patients with Candidal Balanoposthitis is a common entity encountered in STI clinics and should be addressed properly as any deficiency in any aspect of sexual health of a patient can lead to emotional and psychological disability impacting the overall quality of the life. The factors like advanced age, Diabetes Mellitus, and poor hygiene measures of genitalia can increase the incidence of candidal Balanoposthitis as well as sexual dysfunction.
CONCLUSION
Candidal Balanoposthitis, a common cause of sexual dysfunction in elderly population takes a toll on emotional and psychological health and certain modifiable factors like diabetic control and hygiene can prevent recurrent fungal infections.
PubMed: 37538229
DOI: 10.18502/jfrh.v17i1.11971