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Zhang HY, Zhao GG, Song YT, Xiao KB, Li HF, Cui J. Buried penis: a histological and histochemical study of dartos fascia. Asian J Androl 2023; 25:632-636. [PMID: 36930541 PMCID: PMC10521954 DOI: 10.4103/aja2022116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 01/15/2023] [Indexed: 03/18/2023] Open
Abstract
This study aimed to determine whether the abnormal deep layer of dartos fascia plays an important role in buried penis. Forty-nine patients with buried penis were treated with anatomical resection of the deep layer of dartos fascia under a microscope. Penile length was measured before and after completely resecting the deep layer to investigate the role of this layer in penile retraction. The superficial and deep layers of dartos fascia were collected from 49 patients with buried penis, the normal superficial layers were collected from 25 children/adults who underwent circumcision for nonmedical reasons, and the normal deep layers were collected from 20 adult cadavers. The penile fascia samples were stained with hematoxylin-eosin, Masson's trichrome, Sirius red, and Verhoeff's Van Gieson, and subjected to immunohistochemical examination and scanning electron microscopy. The penile shaft (mean ± standard deviation) was found to be significantly elongated after resecting the deep layer compared with that before resection (6.8 ± 1.9 cm vs 6.0 ± 1.6 cm, P < 0.001). An abnormal deep layer of dartos fascia characterized by disordered and fragmented elastic fibers was observed in 87.8% (43/49) of buried penis samples, whereas no abnormal deep layer was observed in normal penises from cadavers (0/20, P < 0.001). Thus, the abnormal deep layer of dartos fascia plays an important role in the buried penis. Its resection is helpful for avoiding recurrence.
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Affiliation(s)
- Hong-Yi Zhang
- Department of Urology, The First Affiliated Hospital of Xi’an Medical University, Xi’an 710000, China
- School of General Medicine of Xi’an Medical University, Xi’an 710000, China
| | - Gang-Gang Zhao
- Department of Urology, The First Affiliated Hospital of Xi’an Medical University, Xi’an 710000, China
- School of General Medicine of Xi’an Medical University, Xi’an 710000, China
| | - Yi-Ting Song
- Department of Urology, The First Affiliated Hospital of Xi’an Medical University, Xi’an 710000, China
- School of General Medicine of Xi’an Medical University, Xi’an 710000, China
| | - Ke-Bing Xiao
- Department of Urology, The First Affiliated Hospital of Xi’an Medical University, Xi’an 710000, China
- School of General Medicine of Xi’an Medical University, Xi’an 710000, China
| | - Hua-Feng Li
- Department of Urology, The First Affiliated Hospital of Xi’an Medical University, Xi’an 710000, China
- School of General Medicine of Xi’an Medical University, Xi’an 710000, China
| | - Jie Cui
- School of General Medicine of Xi’an Medical University, Xi’an 710000, China
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Pensabene M, Sergio M, Baldanza F, Grasso F, Serra G, Spataro B, Bonfiglio R, Patti M, Maggiore V, Cambiaso C, Giuffré M, Corsello G, Cimador M, Di Pace MR. Penile Length Assessment of Children Treated for Primary Buried Penis: Can Satisfying Penile Growth Always Be Achieved? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1254. [PMID: 37508751 PMCID: PMC10377962 DOI: 10.3390/children10071254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
Primary buried (BP) penis is describes as a small penis caused by a penile ligaments anomaly; it is unclear if a primary BP could reach a normal length. We selected 49 patients treated at our institution between 2015 and 2020 in order to post-operatively evaluate the SPL after one year. SPL was evaluated according to the PH Tanner staging system for pre-pubertal patients according to age-normalized values. A micropenis was detected if the SPL was below 2.5 SD. A normal SPL was found in thirty-two patients, eighteen were in PH Stage 1, four were in PH Stage 2, six were in PH Stage 3, and four were in PH Stage 5. Seventeen patients showed a reduced SPL; in seven of these (four in PH Stage 4 and three in PH Stage 5), their SPL was <2.5 ST. The difference in micropenis prevalence between the pre-pubertal and post-pubertal patients was significant (p = 0.038). A primary BP grows normally during the pre-pubertal period, where patients frequently showed a normal SPL, but it seems to be unable to reach a normal length in the higher PH stages, where the SPL is used to detect a micropenis. We suggest that a primary BP should be considered not as a simple defect of the penile ligaments and surrounding tissues, but as an incomplete manifestation of a micropenis due to a growth slowdown of the organ in late puberty.
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Affiliation(s)
- Marco Pensabene
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Maria Sergio
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Fabio Baldanza
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Francesco Grasso
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Gregorio Serra
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Benedetto Spataro
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Roberta Bonfiglio
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Maria Patti
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Valentina Maggiore
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Chiara Cambiaso
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Mario Giuffré
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Marcello Cimador
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Maria Rita Di Pace
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
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External phallopexy: A revisited technique and algorithm for simple management of buried penis. J Pediatr Surg 2023; 58:580-586. [PMID: 36002364 DOI: 10.1016/j.jpedsurg.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/05/2022] [Accepted: 07/29/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Buried penis (BP) is a distressing condition for both the child and his caregivers. A lot of techniques are available for the management of such condition. External phallopexy represents a simple technique designed for selected cases. This study aimed at reexploring the technique of "3 stitches phallopexy" in the context of correction of selected cases with BP, validating a prospectively designed algorithm for BP management, and detecting the parental satisfaction and possible complications of this technique. METHODS This was a prospective study performed over a 2 years' period on cases diagnosed with BP. Patients were excluded if they have previous urethral repair e.g., hypospadias or epispadias, BP with normal penopubic angle, micropenis, and insufficient skin coverage after phallopexy simulation test. A questionnaire with 0-12 points score was used for assessment of satisfaction by caregivers. RESULTS 28 cases were included, with a mean age at the procedure of 5.03±2.6 years. The mean BMI was 15.25±1.1. The intraoperative flaccid penile length measurement was 4.74±1.62 cm, and the mean gained extra-length with phallopexy simulation test was 1.8±0.63 cm. The mean operative time was 20±7 minutes. No wound infection was noted. 2 cases were concerned about the stitch marks at the penopubic junction skin. No recurrence of symptoms was reported after at least 6 months (mean11±4 months) follow up. The mean preoperative satisfaction score was 4.7±1.2, while at the 6 months follow up visit it rose to 10.8±0.67. CONCLUSIONS External phallopexy represents a simple technique for managing buried penis, with minimal complications during follow up period and satisfactory cosmetic outcome.
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Risk factors for surgical complications and short-term outcomes evaluation after novel method of buried penis correction: A single-center experience. J Pediatr Urol 2022; 18:677.e1-677.e11. [PMID: 35610128 DOI: 10.1016/j.jpurol.2022.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Buried penis is a condition that causes the penis to appear entrapped in the subcutaneous fatty tissues. Its significant impact on quality of life affects children as well as adults. This study aims to determine the risk factors for short-term surgical complications and assess patient and surgeon satisfaction after buried penis reconstruction using complete degloving and excision of dartos tissue technique without penile anchoring suture. METHODS A retrospective review was performed on all buried penis patients who underwent complete degloving and excision of dartos tissue by 3 different pediatric urologists at a single institution from July 2010-July 2020. The observation time point was taken from the last evaluation in the first 1 year postoperatively. Data were collected from questionnaires distributed to patients and surgeons. Patient demographics and perioperative data were extracted. Bivariate analyses were performed to identify the risk factors for short-term surgical complications. Patients' and surgeons' postoperative satisfaction was likewise assessed based on penis size, morphology, and voiding function. RESULTS One hundred and thirty-three patients of median age 12 (2-35) years with median follow-up of 6 (1-12) months were included. The median penis length were 2 (1-3.5) cm before surgery with 3 (0.5-7) cm postoperative penile length enhancement. The postoperative penis size were reported as "satisfied" or "very satisfied" by 99% of involved surgeons and 92% of patients. The morphology were reported as "satisfied" or "very satisfied" by 99% of involved surgeons and 88% of patients. Voiding function were reported as "satisfied" or "very satisfied" by 100% of involved surgeons and 99% of patients. Prolonged edema (19.5%) was reported as the most frequent complication. Poor skin gliding occurred in 10.5% of patients. Subjective penis pain was reported in 6% of patients. Five (3.8%) patients who reported being unsatisfied with their penis size had postoperative penile length enhancement of 2 (0.5-2.5) cm (p = 0.04). Trapped penis, uncorrected penile curvature, and dissatisfaction with the morphology were reported by one patient each. The uncorrected penile curvature has a correlation with the preoperative penile curvature (p = 0.02). CONCLUSION Buried penis reconstruction using complete dartos excision without penile anchoring suture is regarded safe and effective by both patients and surgeons. Prolonged edema is a reversible complication that can occur during early postoperative follow up (≤3 months) and obesity can be considered as one of the independent predictors for prolonged edema occurrence.
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Li Y, Feng D, Zhu X. Preliminary Study on the Application of Nanochitosan Film and Petrolatum Gauze in the Modified Devine Operation. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:9882966. [PMID: 35845736 PMCID: PMC9259251 DOI: 10.1155/2022/9882966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022]
Abstract
Although the use of sterile petroleum jelly gauze combined with nanochitosan film to wrap wounds has been proven to have good results, it has not been applied for modified Devine surgery. The use of sterile petroleum jelly gauze alone in the modified Devine surgery to treat concealed penis in children has different effects. In this study, the systematic evaluation of the effect of the modified Devine technique (Vaseline gauze bandaging the wound) in the treatment of concealed penis in children is conducted. Furthermore, the application of nanochitosan film and Vaseline gauze in the modified Devine technique is proposed. By analytical search in PubMed, China Knowledge Network (CKN), and other Chinese and foreign literature databases, there are 13 studies describing the development of the penis during the follow-up period with high satisfaction of patients and their family members. In addition, systematic evaluations have shown that the complete removal of the fibrotic penile sarcoid tissue is an important reason for the remarkable curative effect of the modified Devine surgery in the treatment of concealed penis in children.
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Affiliation(s)
- Yuan Li
- Department of Pediatric Urology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou 221006, China
| | - Dongchuan Feng
- Department of Pediatric Urology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou 221006, China
| | - Xiaoyu Zhu
- Department of Pediatric Urology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou 221006, China
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Negm M, Nagla S, Shalaby R, Halawa NA. Congenital webbed penis: Surgical outcomes of a simplified technique. J Pediatr Urol 2021; 17:813.e1-813.e8. [PMID: 34511377 DOI: 10.1016/j.jpurol.2021.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/15/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Webbed penis is a cause of concealed penis. It reflects abnormal attachment of the scrotal skin to different ventral penile shaft levels, possibly due to abnormal scrotal dartos insertion. Different techniques are available for correction of congenital webbed penis. However, there is no single one versatile for correction of different grades. OBJECTIVE To evaluate the surgical outcome of penile degloving, excision of abnormal dartos fascia with penoscrotal fixation sutures to correct different grades of congenital webbed penis. STUDY DESIGN This prospective study was conducted on boys with congenital webbed penis. Thorough clinical examination to determine the degree of webbed penis and associated anomalies were done. A technical modification of previously described technique by Frenkl et al. 2004 (22) was used. The principles include; complete penile degloving with excision of all abnormal scrotal dartos attached to the penile shaft, creation of a well-defined penoscrotal angle by penoscrotal fixation sutures and the short ventral skin was compensated from the prepuce with circumcision. Assessments of surgical outcomes and parents' satisfaction were done during follow up visits. RESULTS This study included 107 boys. The median age was 9 (range, 6-40) months, and the median operative time was 55 (range, 50-65) min. Five patients (4.7%) developed self-limited postoperative penile edema, two (1.9%) developed wound infections, and two (1.9%) had a self-limited scrotal hematoma. The median follow-up period was 19 months. At the 6 months follow-up, we had two patients with persistent mild grade I webs, with a success rate of 98.13%. Parental satisfaction was obtained for all patients. DISCUSSION Currently, there is no current single technique suitable for the correction of all grades of webbed penis. In this study, we presented a technical modification of previously described technique by Frenkl et al. 2004 (9), this modified technique is versatile for correction of different grades of congenital webbed penis without leaving a scar at the penoscrotal angle. But, absence of a comparative group is considered a limitation; however, the versatility of this technique overcomes this limitation. CONCLUSIONS This described technique is simple and feasible. It could correct all types of congenital webbed penis. Short term outcome showed good cosmetic and functional results with parental satisfaction.
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Affiliation(s)
- Mohamed Negm
- Pediatric Surgery Unit, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
| | - Salah Nagla
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Rafik Shalaby
- Pediatric Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Nezar Abo Halawa
- Pediatric Surgery Unit, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
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Ergashev K, Chung JM, Lee SD. Concealed index for concealed penis in prepubertal children. Investig Clin Urol 2021; 62:217-223. [PMID: 33660450 PMCID: PMC7940854 DOI: 10.4111/icu.20200401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/13/2020] [Accepted: 11/08/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The concealed penis (CP) is a congenital or acquired genital anomaly that requires surgical correction. To construct an objective CP severity index, we compared the penile parameters of a CP with a normal penis (NP) and postoperative outcomes of CP patients. MATERIALS AND METHODS In this retrospective study, 391 boys under 14 years who visited our hospital between September 2017 and February 2020 were included. Among these boys, 105 patients had a CP and 286 boys had a NP without CP. The stretched penile length (SPL), penile circumference (PC), and penile length above baseline skin level (BPL) were measured using a ruler (cm), and the testicular volume was measured using an orchidometer (mL). We defined the concealed index according to SPL (CIs) as BPL/SPL and the concealed index according to circumference (CIc) as BPL/PC. A repair of the CP was performed in the CP patients. All parameters were measured before surgery and after three months. RESULTS The CP had significantly shorter SPL and BPL, and smaller CIs, and CIc than the NP. The cutoff values for the CIs and CIc were 0.68 and 0.58, respectively (sensitivity 86.7% and 86.7%; specificity 65.0% and 88.5%, respectively). After repair of the CP, all penile parameters were significantly improved. CONCLUSIONS The CIs and CIc are useful and objective parameters for checking the severity of CP, and evaluating the postoperative outcome of CP repair. We newly introduced cutoff values for the CIs (0.68) and CIc (0.58) for diagnosing and evaluating CP repair.
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Affiliation(s)
- Kobiljon Ergashev
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Min Chung
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
| | - Sang Don Lee
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Manasherova D, Kozyrev G, Gazimiev M. Buried Penis Surgical Correction: Midline Incision Rotation Flaps. Urology 2020; 138:174-178. [PMID: 32007435 DOI: 10.1016/j.urology.2020.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/11/2020] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To improve cosmetic and functional results of buried penis correction in boys using a modified universal surgical approach - Midline Incision Rotation Flaps. MATERIALS AND METHODS We retrospectively analyzed results of 18 patients who underwent buried penis surgical treatment according to the Midline Incision Rotational Flaps technique from 2013 to 2016. The results were assessed by the surgeon 1, 3, 6 months after surgery, then yearly. Parents filled out postoperative survey after 1 month. The surgery commences with a midline longitudinal skin incision on the ventral surface. Following, a circumferential incision along the coronal edge allows to perform full degloving. Excessive subcutaneous fat tissues are removed from the peno-pubic area. Next stage is the formation of the peno-scrotal and peno-pubic angles by fixation of the skin at the base of the penis. Then, the edges of the skin flaps are opened, forming Byar's flaps. The skin defect along the ventral surface is covered with rotated triangular skin flaps with nourishing vessels. Uneven excessive skin is dissected and interrupted skin sutures are placed. RESULTS AND DISCUSSION The median age of patients was 1.4 years with a median follow-up of 56 months (range 36-72). 16 patients (89%) obtained good results, and 2 patients (11%) - satisfactory. The results showed that size and appearance are close to natural and satisfying to parents of the patients. CONCLUSION The suggested method of buried penis repair using Midline Incision Rotation Flaps technique allows to obtain the most satisfactory both cosmetic and functional results with minimal complication risk.
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Affiliation(s)
- Dina Manasherova
- Moscow State University, Faculty of Fundamental Medicine, Moscow, Russia.
| | - German Kozyrev
- Uroandrology Department of the Russian Children's Clinical Hospital of the Russian Ministry of Health, Moscow, Russia.
| | - Magomed Gazimiev
- Urology Department of Sechenov First Moscow State Medical University, Moscow, Russia
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Tack LJW, Praet M, Van Dorpe J, Haid B, Buelens S, Hoebeke P, Van Laecke E, Cools M, Spinoit AF. Androgen receptor expression in preputial dartos tissue correlates with physiological androgen exposure in congenital malformations of the penis and in controls. J Pediatr Urol 2020; 16:43.e1-43.e8. [PMID: 31810878 DOI: 10.1016/j.jpurol.2019.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/30/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The androgen receptor (AR) plays an important role in the development of male genitalia, and impaired androgen signalling has been hypothesised to underlie congenital penile malformations (CPM) such as hypospadias. Previous studies exploring the role of AR expression in the development of CPM have yielded conflicting results. OBJECTIVES To assess AR expression in human foreskin of boys/men born with hypospadias, buried penis versus controls. STUDY DESIGN Foreskin samples of 428 boys and men undergoing primary penile surgery (198 controls, 197 hypospadias, and 33 buried penis) were collected between October 2013 and July 2018. AR staining was performed in all samples and semi-quantitatively scored by two researchers independently, using a modified quick score (mQuicks) that assesses the proportion and intensity of AR staining in smooth muscle fibres. RESULTS The interobserver variability of the mQuicks had a high level of agreement for the total score, as well as for the subscores. Two phases of high AR expression were observed in all groups, the first following the postnatal gonadotropin surge (i.e., mini-puberty) and the second in (pre-) puberty. No differences in AR expression were found in hypospadias or buried penis cases as compared to controls matched for age at time of surgery. DISCUSSION This study describes the physiological evolution in AR expression in the human foreskin of boys with CPM and explains the cause of the previously reported, conflicting results. Despite the very large cohort, the limitations of this study are the low number of cases younger than six months at the time of surgery and the lack of Tanner stages to correlate with the mQuicks in adolescents. CONCLUSIONS The mQuicks is a straightforward and informative tool to semi-quantitatively assess AR expression in the dartos tissue. In this study, AR expression in human foreskin shows a bimodal distribution in boys with CMP and controls, following physiological androgen exposure. No statistically significant difference in AR expression could be found between both groups. Whether other local mechanisms are affected by these physiological changes is currently unclear. However, strict age-matching should be considered when exploring the mechanisms underlying disturbed penile and urethral development in CMP.
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Affiliation(s)
- L J W Tack
- Pediatric Endocrinology Service, Ghent University Hospital, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - M Praet
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - J Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - B Haid
- Department of Pediatric Urology Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz Austria & Department of Urology, Ludwig-Maximilian University of Munich, Germany
| | - S Buelens
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - P Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - E Van Laecke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - M Cools
- Pediatric Endocrinology Service, Ghent University Hospital, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent, Belgium.
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Bandini M, Sekulovic S, Stanojevic N, Spiridonescu B, Pesic V, Sansalone S, Slavkovic M, Briganti A, Salonia A, Montorsi F, Djinovic R. Prevalence and surgical management of pubic hypertrophy in hypospadias patients: results from a high-volume surgeon. Int Braz J Urol 2019; 45:1238-1248. [PMID: 31808413 PMCID: PMC6909876 DOI: 10.1590/s1677-5538.ibju.2019.0267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/19/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the outcomes associated with its surgical treatment. Material and methods: Within 266 hypospadias patients treated at our clinic, we assessed the prevalence of pubic hypertrophy, and we schematically described the surgical steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predictors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy. Results: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the location of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only significant predictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fistula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multivariable adjustment. Conclusions: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and severity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.
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Affiliation(s)
- Marco Bandini
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, BelMedic General Hospital, Belgrade, Serbia.,Division of Oncology and Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Sasha Sekulovic
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, BelMedic General Hospital, Belgrade, Serbia
| | - Nikola Stanojevic
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, BelMedic General Hospital, Belgrade, Serbia
| | - Bogdan Spiridonescu
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, BelMedic General Hospital, Belgrade, Serbia.,Clinical Institute Fundeni, Center for Uronephrology and Renal Transplantation, Bucharest, Romania
| | - Vladislav Pesic
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, BelMedic General Hospital, Belgrade, Serbia
| | - Salvatore Sansalone
- Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy
| | - Milan Slavkovic
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, BelMedic General Hospital, Belgrade, Serbia
| | - Alberto Briganti
- Division of Oncology and Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Division of Oncology and Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology and Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Rados Djinovic
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, BelMedic General Hospital, Belgrade, Serbia
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11
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Caione P, Cavaleri Y, Gerocarni Nappo S, Collura G, Capozza N. The concealed penis: the "two-corner" surgical technique. Minerva Urol Nephrol 2019; 73:122-127. [PMID: 31692304 DOI: 10.23736/s2724-6051.19.03532-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Concealed penis is an uncommon genital abnormality that requires surgical repair. Several techniques are offered but not fully accepted. We present a novel standardized approach that is suitable for concealed penis and penoscrotal webbing. METHODS From January 2005 to December 2013, patients presenting concealed penis were treated utilizing the "two corners" technique: through a midline penoscrotal incision, the superficial ventral chordee is removed, freeing the corpus spongiosum till the peno-scrotal angle. Circumferential degloving of the shaft is performed and the scrotal septum is separated from the urethra, allowing the penile shaft to pull out. The new peno-scrotal junction is rebuilt downwards, anchoring the peno-scrotal dartos corners to the peripubic tissue bilaterally and stabilizing the penile lengthening. Tension-free skin coverage is allowed by a series of Z-plasty at the penoscrotal angle avoiding circumcision if not needed. RESULTS Forty-nine patients aged 3-14 years (mean age 4.7 years) underwent correction of the concealed penis according to our technique. Of them, 26 were primary and 23 after previous to hypospadias repair or other genital surgery. Penile lengthening varied from 1 to 2.5 cm (median 1.8 cm). Hospital stay varied from 1 to 4 days (mean 1.6 days). Follow-up ranged from 4 to 14 years (median 7.3 years). Forty-five parents were satisfied with the results (92%), while the defect was judged imperfectly repaired in four patients. CONCLUSIONS The "two-corners" technique allows easy and effective correction of the concealed penis in both congenital and acquired conditions. It can be performed as outpatient procedure and results are stable at long-term follow-up.
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Affiliation(s)
- Paolo Caione
- Department of Urological Surgery, Bambino Gesù Children's Hospital and IRCCS, Rome, Italy -
| | - Yuri Cavaleri
- Unit of Urology, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Simona Gerocarni Nappo
- Department of Urological Surgery, Bambino Gesù Children's Hospital and IRCCS, Rome, Italy
| | - Giuseppe Collura
- Department of Urological Surgery, Bambino Gesù Children's Hospital and IRCCS, Rome, Italy
| | - Nicola Capozza
- Department of Urological Surgery, Bambino Gesù Children's Hospital and IRCCS, Rome, Italy
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13
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Early surgical correction of buried penis. ANNALS OF PEDIATRIC SURGERY 2018. [DOI: 10.1097/01.xps.0000521011.28670.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Lei J, Luo C, Cheng S, Yan W, Wang X, Su X. Longer length improvement and more covert incision: a single-center, prospective study of two innovative surgical methods "one stitch" and "four stitch" for pediatric buried penis. World J Urol 2018; 36:1275-1283. [PMID: 29549480 DOI: 10.1007/s00345-018-2243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND To introduce the detailed procedures of two innovative surgical options for pediatric buried penis and prospectively compare their efficacy and safety. METHODS A single-center, non-randomized, prospective study was conducted at the Zhongnan Hospital of Wuhan University, where patients were operated on using the so-called "one stitch" (OS) or "four stitch" (FS) methods. The operation time, adverse events, and satisfaction were recorded for both groups. RESULTS Finally, 156 patients underwent the so-called OS (n = 65) or FS (n = 91) method, with a follow-up rate of 86.5% (135/156). During the perioperative period, the FS group spent much longer in surgery (P < 0.001), had more blood loss (P < 0.001), and took longer to recover from edema (P < 0.001) than the OS group. In contrast to the satisfaction after 12 months' follow up, both the objective length improvement (2.5 ± 0.6 vs 3.8 ± 0.5 cm, P < 0.001) and subjective satisfaction percent (86 vs 95%, P = 0.678) in the FS group were superior to those in the OS group. No significant differences were detected in postoperative infection, stenosis circle, scar hyperplasia, and relapse. CONCLUSIONS In conclusion, the two surgical options for pediatric buried penis are both safe and effective. The OS method has a simple procedure, so with shorter operation time and faster postoperative recovery; though the FS method with more complex procedure, patients can acquire a satisfactory improvement of penile length almost 4 cm and more covert incision at the midline of the scrotum. We primarily recommend the FS method for patients with moderate or severe buried cases; but for mild cases, we preferred the OS method.
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Affiliation(s)
- Junhao Lei
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Donghu Road #169, Wuhan, 430071, China
| | - Chunhua Luo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Donghu Road #169, Wuhan, 430071, China.,Operating Room, Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Songtao Cheng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Donghu Road #169, Wuhan, 430071, China
| | - Wen Yan
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Donghu Road #169, Wuhan, 430071, China. .,Center for Evidence-based and Translational Medicine, Wuhan University, Wuhan, 430071, China.
| | - Xinjun Su
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Donghu Road #169, Wuhan, 430071, China.
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15
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Mühlstädt S, Anheuser P, Mohammed N, Bach AD. [Plastic surgery reconstruction of the adult buried penis : Option or obligation?]. Urologe A 2017; 56:1266-1273. [PMID: 28801716 DOI: 10.1007/s00120-017-0476-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The adult buried penis afflicts the patient with shame and is also potentially associated with considerable urogenital complications. Due to obesity, chronic urogenital lymphedema or subsequent inflammatory urogenital conditions, such as a lichen sclerosus et atrophicus, the clinical appearance of the adult buried penis is extremely variable. Epidemiological data are non-existent. Therapeutically, a combination of various plastic surgery procedures is often necessary for the best esthetic and functional results. The therapeutic strategy is highly individual and the therapy itself is interdisciplinary. This article provides an overview of the plastic surgery reconstruction of the adult buried penis.
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Affiliation(s)
- S Mühlstädt
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität Halle/Saale, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland.
| | - P Anheuser
- Klinik für Urologie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - N Mohammed
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität Halle/Saale, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland
| | - A D Bach
- Klinik für Plastische und Ästhetische Chirurgie - Handchirurgie - Wiederherstellungschirurgie, St. Antonius-Hospital Eschweiler, Aachen, Deutschland
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16
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Kankaka EN, Kigozi G, Kayiwa D, Kighoma N, Makumbi F, Murungi T, Nabukalu D, Nampijja R, Watya S, Namuguzi D, Nalugoda F, Nakigozi G, Serwadda D, Wawer M, Gray RH. Efficacy of knowledge and competence-based training of non-physicians in the provision of early infant male circumcision using the Mogen clamp in Rakai, Uganda. BJU Int 2016; 119:631-637. [PMID: 27753243 DOI: 10.1111/bju.13685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess acquisition of knowledge and competence in performing Early Infant Male Circumcision (EIMC) by non-physicians trained using a structured curriculum. SUBJECTS AND METHODS Training in provision of EIMC using the Mogen clamp was conducted for 10 Clinical Officers (COs) and 10 Registered Nurse Midwives (RNMWs), in Rakai, Uganda. Healthy infants whose mothers consented to study participation were assigned to the trainees, each of whom performed at least 10 EIMCs. Ongoing assessment and feedback for competency were done, and safety assessed by adverse events. RESULTS Despite similar baseline knowledge, COs acquired more didactic knowledge than RNMWs (P = 0.043). In all, 100 EIMCs were assessed for gain in competency. The greatest improvement in competency was between the first and third procedures, and all trainees achieved 80% competency and retention of skills by the seventh procedure. The median (interquartile range) time to complete a procedure was 14.5 (10-47) min for the COs, and 15 (10-50) min for the RNMWs (P = 0.180). The procedure times declined by 2.2 min for each subsequent EIMC (P = 0.005), and rates of improvement were similar for COs and RNMWs. Adverse events were comparable between providers (3.5%), of which 1% were of moderate severity. CONCLUSION Competence-based training of non-physicians improved knowledge and competency in EIMC performed by COs and RNMWs in Uganda.
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Affiliation(s)
| | | | | | | | - Frederick Makumbi
- Rakai Health Sciences Program, Kalisizo, Uganda.,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | | | - Daniel Namuguzi
- Rakai Health Sciences Program, Kalisizo, Uganda.,Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda.,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maria Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda.,Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ronald H Gray
- Rakai Health Sciences Program, Kalisizo, Uganda.,Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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17
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Benign penile skin anomalies in children: a primer for pediatricians. World J Pediatr 2015; 11:316-23. [PMID: 25754752 DOI: 10.1007/s12519-015-0015-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 09/20/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Abnormalities involving the skin coverage of the penis are difficult to define, but they can significantly alter penile appearance, and be a cause of parental concern. DATA SOURCES The present review was based on a nonsystematic search of the English language medical literature using a combination of key words including "penile skin anomalies" and the specific names of the different conditions. RESULTS Conditions were addressed in the following order, those mainly affecting the prepuce (phimosis, balanitis xerotica obliterans, balanitis, paraphimosis), those which alter penile configuration (inconspicuous penis and penile torsion), and lastly focal lesions (cysts, nevi and vascular lesions). Most of these anomalies are congenital, have no or minimal influence on urinary function, and can be detected on clinical examination. Spontaneous improvement is possible. In the majority of cases undergoing surgery, the potential psychological implications of genital malformation on patient development are the main reason for treatment, and the age generally recommended for surgery is after 12 months of age. CONCLUSION This review provides the pediatrician with a handy tool to identify the most common penile skin anomalies, counsel parents adequately, make sensible and evidence based choices for management, and recognize complications or untoward outcomes in patients undergoing surgery.
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18
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Cheng G, Liu B, Guan Z, Huang Y, Qin C, Song N, Wang Z. A modified surgical procedure for concealed penis. Can Urol Assoc J 2015; 9:E723-6. [PMID: 26664507 DOI: 10.5489/cuaj.3028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We described a modified surgical procedure for repairing a concealed penis and compared the efficacy and feasibility of modified repair with traditional repair. METHODS From March 2003 to December 2012, 96 patients with a concealed penis were recruited to undergo penile repair at our centre. Modified repair and traditional repair were performed respectively on 46 and 50 cases. We compared operative time, intraoperative blood loss, cosmetic result of operative scars, postoperative penile retraction, and complications. RESULTS All operations were completed successfully without serious complications. The mean operative time, intraoperative blood loss, and cosmetic result of the operative scar between the two surgical methods were similar. However, the postoperative penile retraction rate in patients undergoing modified repair decreased significantly than in the traditional repair. CONCLUSIONS Our modified surgical procedure is effective and feasible for a concealed penis. Although extra procedures were needed for the modified repair, the operative time, intraoperative blood loss and cosmetic result of operative scar between the two procedures were similar. Compared with traditional repair, modified repair has better clinical outcomes.
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Affiliation(s)
- Gong Cheng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210029, China
| | - Bianjiang Liu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210029, China
| | - Zhaolong Guan
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210029, China
| | - Yuan Huang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210029, China
| | - Chao Qin
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210029, China
| | - Ninghong Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210029, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210029, China
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