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BMC Urology Jan 2023Comparison between three different surgical techniques in the management of concealed penis. (Clinical Trial)
Clinical Trial
BACKGROUND
Comparison between three different surgical techniques in the management of concealed penis.
METHODS
This prospective interventional non-randomized study included 150 pediatric patients with a concealed penis. They were distributed equally into three groups; group A; patients treated by anchoring the penile skin dermis to Buck's fascia at the penile base at 3 and 9 o'clock points using PDS 5/0 (phallopexy), group B; patients treated by complete dissection and excision of dartos fascia and group C; patients treated by phallopexy as in group A after complete dissection and excision of dartos fascia. Follow-up at the end of the 1st post-operative week and then monthly for 6 months as regards penile skin congestion and/or necrosis, wound infection, edema, and/or re-retraction was carried out.
RESULTS
Penile edema and re-retraction have a statistically significant difference among the studied groups (p < 0.001 and p = 0.002 respectively). Penile re-retraction was noticed to be lowest in patients of group C, however penile edema was observed to be highest in patients of group B.
CONCLUSIONS
Phallopexy after complete dissection and excision of dartos fascia have better results than doing either phallopexy or dartos excision alone in the treatment of concealed penis.
CLINICAL TRIAL REGISTRATION
The manuscript was registered in ClinicalTrials.gov Protocol Registration and Results System.
CLINICALTRIALS
gov Identifier: NCT05565040. Our manuscript was registered on 4/10/2022.
Topics: Male; Child; Humans; Prospective Studies; Urologic Surgical Procedures, Male; Penis; Genital Diseases, Male; Penile Diseases
PubMed: 36631822
DOI: 10.1186/s12894-022-01169-3 -
Annals of Physical and Rehabilitation... Apr 2016Intermittent catheterization is considered the standard of care in most neurologic patients with lower urinary tract disorders. However, in this context, genitourinary... (Review)
Review
Intermittent catheterization is considered the standard of care in most neurologic patients with lower urinary tract disorders. However, in this context, genitourinary tract infection and urethral trauma represent specific challenges. Such conditions have been found to significantly deteriorate quality of life and complicate subsequent treatments. Only optimal prevention associated with appropriate treatment allows for the long-term continuation of such bladder management. Here, we discuss the diagnosis and therapeutic and preventive approaches associated with genitourinary tract infection and urethral trauma in this specific population. This "state-of-the-art" article results from a literature review (MEDLINE articles and scientific society guidelines) and the authors' experience. It was structured in a didactic way to facilitate comprehension and promote the implementation of advice and recommendations in daily practice. Genitourinary tract infection and urethral trauma associated with intermittent catheterization in neurologic patients should be managed with a global approach, including patient and caregiver education, optimal catheterization with hydrophilic-coated or pre-lubricated catheters and adequate use of antibiotic therapy.
Topics: Anti-Bacterial Agents; Humans; Intermittent Urethral Catheterization; Nervous System Diseases; Patient Education as Topic; Reproductive Tract Infections; Urethra; Urinary Tract Infections
PubMed: 27053002
DOI: 10.1016/j.rehab.2016.02.006 -
The American Journal of Surgical... Dec 2023Compared with vulva, precursor lesions of human papillomavirus (HPV)-independent invasive squamous cell carcinoma (SCC) of the penis are insufficiently characterized. We...
Compared with vulva, precursor lesions of human papillomavirus (HPV)-independent invasive squamous cell carcinoma (SCC) of the penis are insufficiently characterized. We analyzed the histologic and immunohistochemical characteristics of 70 peritumoral precursor lesions and correlated them with the histology and mutational profile of the adjacent HPV-negative invasive penile SCC. Atypical basal keratinocyte proliferation with variously elongated epithelial rete with premature squamatiziation, but regular superficial cornification, termed differentiated penile intraepithelial neoplasia (d-PeIN), were identified adjacent to 42/70 (60%) SCC (36/42 keratinizing ( P <0.001); 3 papillary, and 1 each verrucous, clear cell, sarcomatoid SCC). d-PeIN were associated with chronic inflammatory dermatoses (32/42; P <0.001), p53 overexpression (26/42; P <0.001), and hotspot mutations in TP53 (32/42; P <0.001), CDKN2A (26/42; P <0.001) or both (21/42; P =0.003) in the adjacent SCC. Cytoplasmic p16 ink4a overexpression in 5/42 d-PeIN correlated with CDKN2A missense mutations in the adjacent SCC. In all, 21/70 (30%) cornified verrucous or glycogenated verruciform precursors with minimal atypia and wild-type p53 (18/21; P <0.001) occurred adjacent to verrucous or papillary SCC (17/21; P <0.001) and keratinizing (4/21) SCC, which harbored mutations in HRAS and/or PIK3CA (12/21; P <0.004). Undifferentiated p16 ink4a -negative full-thickness precursors were identified in 7/70 (10%) SCC. Four histologically different HPV-independent penile precursor lesions can be assigned to 2 major genetic/biological pathways with characteristic highly differentiated precursors requiring different clinical management decisions. These include d-PeIN in chronic inflammatory dermatoses, with p53 overexpression and TP53/CDKN2A mutations, and the p53 wild-type verrucous and verruciform precursors unassociated with dermatoses, but with mutations in oncogenes PIK3CA and HRAS .
Topics: Male; Female; Humans; Papillomavirus Infections; Tumor Suppressor Protein p53; Human Papillomavirus Viruses; Skin Neoplasms; Carcinoma in Situ; Carcinoma, Squamous Cell; Penile Neoplasms; Penis; Papillomaviridae; Class I Phosphatidylinositol 3-Kinases; Vulvar Neoplasms
PubMed: 37768009
DOI: 10.1097/PAS.0000000000002130 -
BMC Urology Jul 2023Post-circumcision penile ischemia is a devastating complication. We will present our experience in managing children with various forms of penile ischemia. (Observational Study)
Observational Study
BACKGROUND
Post-circumcision penile ischemia is a devastating complication. We will present our experience in managing children with various forms of penile ischemia.
MATERIALS AND METHODS
This cohort prospective observational and interventional study was performed on all male children with post-circumcision penile ischemia between April 2017 and October 2021. A designed and approved protocol includes a combination of early pentoxifylline infusion, hyperbaric oxygen inhalation, early catheterization, and appropriate surgical debridement were applied for patients with deep ischemia 11/23, mainly the necrotic skin and subcutaneous tissues. Data of patient age, anesthesia method, monopolar diathermy usage, early presentation and positive wound culture were collected and analyzed statistically.
RESULTS
During the study period 3,382 children were circumcised for non-medical reasons; 23 children were diagnosed with penile ischemia (0.7%), among other complications (9%). Most of the penile ischemia is associated with the use of monopolar diathermy (74%). The use of compressive wound dressing to control post-circumcision bleeding and infections is also responsible for ischemia in 52.2% and 43.5% of the cases. Inexperienced physicians were commonly responsible for ischemia (73.9%). Patients managed at first 24 h had better outcomes than those who were presented later (p = 0.001).
CONCLUSION
In children with post-circumcision penile ischemia, a combination of hyperbaric oxygen therapy and pentoxifylline is especially effective for patients with skin and facial necrosis, this management reduces penile tissue loss.
Topics: Child; Humans; Male; Hyperbaric Oxygenation; Circumcision, Male; Pentoxifylline; Penis; Hyperthermia, Induced
PubMed: 37438810
DOI: 10.1186/s12894-023-01284-9 -
African Journal of Paediatric Surgery :... 2022Phimosis, a common paediatric condition, is defined as the inability to retract the preputial skin behind the glans. Current practice shows there is some confusion among...
BACKGROUND
Phimosis, a common paediatric condition, is defined as the inability to retract the preputial skin behind the glans. Current practice shows there is some confusion among the paediatricians towards this common condition and in differentiating it from the more common physiological preputial adhesion; leading to frequent referrals to a paediatric surgeon or a general surgeon, which can be addressed by the parents and the child physicians themselves.
AIM
To find out the awareness towards the management of phimosis among the paediatricians.
MATERIALS AND METHODS
A questionnaire on this topic was generated using 'Google Forms' and was circulated among junior and senior residents, faculty in various medical colleges and consultants in private practice all over India and their response was collected and analysed.
RESULTS
We received a total of 221 responses from all over India from paediatric medicine trainees and consultants. Among them, majority (48%) were senior residents. According to the survey participants, the most (46%) find inability to retract the prepuce as the major presenting complaint. A straight away reference to a paediatric surgeon was preferred by majority of paediatricians (62.9%), though most of them were aware of them were aware of physiological adhesions and conservative management (94.2%). There was a belief among 43% about counselling each and every patient presenting with phimosis for circumcision. Among the respondents, 60.2% advised ultrasound of kidneys, ureter, and bladder to their patients and believed that backpressure changes alter the management of the child. A urine routine examination was advised by 70.1% of participants, with 46.6% believing that the presence of urinary tract infection changes the management of phimosis. Waiting up to 1 year of age before going for surgery was advocated by 71.5%. A major proportion of respondents (76%) believed all cases of phimosis should be referred to a surgeon, only 58.8% would voluntarily follow them up. There is still a belief among 69.7% of participants that all cases of phimosis should be referred to a paediatric surgeon and only few of them, 5.4% feel referring only indicated cases.
CONCLUSION
Physiological phimosis is a common condition which can be addressed by the paediatricians themselves. Awareness is to be increased among them, especially during the training period regarding the proper management of this common condition, avoiding unnecessary circumcisions.
Topics: Child; Circumcision, Male; Foreskin; Humans; Male; Phimosis; Tissue Adhesions; Urinary Tract Infections
PubMed: 36018197
DOI: 10.4103/ajps.ajps_143_21 -
Genitourinary Medicine Apr 1988Fifty men whose sexual partners were 50 women with histologically proved cervical intraepithelial neoplasia (CIN) grade III (severe dysplasia or carcinoma in situ) were...
Fifty men whose sexual partners were 50 women with histologically proved cervical intraepithelial neoplasia (CIN) grade III (severe dysplasia or carcinoma in situ) were studied. A further 25 men whose current regular sexual partners were 25 women with chlamydial cervicitis were recruited as controls. If either of the partners in either group had genital condylomata acuminata or a known history of similar lesions, the couple was excluded from the study. Abnormal penile epithelium, which was detected by colposcopy after application of 5% acetic acid to the penile skin, was reported in 25 men in the study group compared with three in the control group. Histologically proved subclinical penile infection with human papillomavirus (HPV) was present in 23 men in the study group compared with three in the control group (p less than 0.01). Of the 50 men in the study group, four had histologically proved severe penile dysplasia or carcinoma in situ with evidence of HPV infection, the disease being subclinical in each case and diagnosed on histology of a specimen obtained by colposcopically directed biopsy. HPV DNA was detected on filter hybridisation of penile scrapes from 15 of the 23 men in the study group with histologically proved penile HPV infection, HPV16 DNA being detected in 10 of them. HPV DNA was detected on DNA-DNA hybridisation of biopsy material in seven of 18 men with histologically proved penile HPV infection. Five of these biopsy specimens were positive for HPV16 DNA. Only one man in the control group had HPV DNA detected in a penile scrape. This patient had histologically proved subclinical penile HPV infection. Such lesions may represent an important male reservoir of HPV types implicated in genital squamous carcinogenesis in both sexes.
Topics: Adult; Epithelium; Female; Humans; Male; Papillomaviridae; Penile Diseases; Penis; Sexual Partners; Tumor Virus Infections; Uterine Cervical Neoplasms
PubMed: 2838408
DOI: 10.1136/sti.64.2.90 -
Genitourinary Medicine Oct 1994To identify and study cases of mild balanoposthitis (MBP) with penile pathology among patients observed at a dermatology clinic over an 18-month period.
AIM
To identify and study cases of mild balanoposthitis (MBP) with penile pathology among patients observed at a dermatology clinic over an 18-month period.
MATERIALS
The study included 321 patients with penile pathology. The term MBP was used to describe balanoposthitis of a localised, inflammatory nature with few, non-specific symptoms and a tendency to become chronic or recur. Two hundred and seventy had diseases clearly identifiable by clinical examination or laboratory tests; 51 cases were diagnosed as MBP and these patients had blood tests (to evaluate immune status) and microbiological examination; when these proved negative, a series of patch tests was also used.
RESULTS
Of the 51 patients diagnosed as having MBP, the cause was ascertained in 34 cases (infection, mechanical trauma, contact irritation, contact allergy, etc.), whereas no specific aetiological factor was detected to explain the symptoms in the remaining 17 cases.
Topics: Adolescent; Adult; Aged; Balanitis; Child; Chronic Disease; Humans; Male; Middle Aged; Penile Diseases; Penis; Recurrence
PubMed: 8001949
DOI: 10.1136/sti.70.5.345 -
Indian Journal of Dermatology,... 2017
Topics: Condylomata Acuminata; Humans; Male; Penile Neoplasms; Penis; Young Adult
PubMed: 27647354
DOI: 10.4103/0378-6323.190869 -
World Journal of Urology Feb 2012Biofilm infections have a major role in implants or devices placed in the human body. As part of the endourological development, a great variety of foreign bodies have... (Review)
Review
PURPOSE
Biofilm infections have a major role in implants or devices placed in the human body. As part of the endourological development, a great variety of foreign bodies have been designed, and with the increasing number of biomaterial devices used in urology, biofilm formation and device infection is an issue of growing importance.
METHODS
A literature search was performed in the Medline database regarding biofilm formation and the role of biofilms in urogenital infections using the following items in different combinations: "biofilm," "urinary tract infection," "bacteriuria," "catheter," "stent," and "encrustation." The studies were graded using the Oxford Centre for Evidence-based Medicine classification.
RESULTS
The authors present an update on the mechanism of biofilm formation in the urinary tract with special emphasis on the role of biofilms in lower and upper urinary tract infections, as well as on biofilm formation on foreign bodies, such as catheters, ureteral stents, stones, implants, and artificial urinary sphincters. The authors also summarize the different methods developed to prevent biofilm formation on urinary foreign bodies.
CONCLUSIONS
Several different approaches are being investigated for preventing biofilm formation, and some promising results have been obtained. However, an ideal method has not been developed. Future researches have to aim at identifying effective mechanisms for controlling biofilm formation and to develop antimicrobial agents effective against bacteria in biofilms.
Topics: Biofilms; Catheters, Indwelling; Female; Foreign Bodies; Humans; Male; Prosthesis-Related Infections; Stents; Urethra; Urinary Tract Infections
PubMed: 21590469
DOI: 10.1007/s00345-011-0689-9 -
Urologia Internationalis 2021Infection by COVID-19, being a respiratory disease caused by SARS-CoV-2, can predispose to arterial and venous thrombotic disease, in response to excessive inflammation,...
Infection by COVID-19, being a respiratory disease caused by SARS-CoV-2, can predispose to arterial and venous thrombotic disease, in response to excessive inflammation, platelet activation, endothelial dysfunction, and venous stasis. During the COVID-19 pandemic period, the technological and resource availability for the care of these patients with thrombotic disease is critical, marking a factor of morbidity and poor prognosis in these cases. We describe a case of priapism in a patient with COVID-19, during the course of systemic inflammatory response syndrome and respiratory distress syndrome with a procoagulant state, seeking to relate the pathophysiological factors of ischemic priapism in patients with infection with SARS-Cov-2.
Topics: Adult; COVID-19; Fatal Outcome; Humans; Ischemia; Male; Penile Erection; Penis; Priapism; Regional Blood Flow
PubMed: 34107472
DOI: 10.1159/000514421