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Romero-Otero J, Manfredi C. Comment on "Complications and outcomes following injection of foreign material into the male external genitalia for augmentation: a single centre experience and systematic review". Int J Impot Res 2024; 36:541-542. [PMID: 37185980 DOI: 10.1038/s41443-023-00701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Javier Romero-Otero
- ROC Clinic, 28010, Madrid, Spain.
- Department of Urology, HM Hospitals (Montepríncipe, Puerta del Sur, Sanchinarro), 28660, Madrid, Spain.
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
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Susini P, Marcaccini G, Efica J, Giuffrè MT, Mazzotta R, Caneschi C, Cuomo R, Nisi G, Grimaldi L. Fournier's Gangrene Surgical Reconstruction: A Systematic Review. J Clin Med 2024; 13:4085. [PMID: 39064124 PMCID: PMC11278345 DOI: 10.3390/jcm13144085] [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: 06/06/2024] [Revised: 06/28/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Fournier's gangrene (FG) is a rare form of necrotizing fasciitis of the perineal, genital, or perianal region. It is characterized by an aggressive course and high mortality rate, over 20%. FG demands immediate treatment including resuscitation maneuvers, intravenous antibiotic therapy and early surgical debridement. Background/Objectives: The gold-standard treatment for FG is surgical reconstruction. However, up to date, no precise guidelines exist. Thus, we decided to systematically review the literature, focusing on FG contemporary approaches to reconstructive surgery, aiming to analyze the various reconstructive strategies and their specific indications. Methods: A systematic review was carried out according to the PRISMA statement by searching various databases from April 2014 to April 2024, using the terms ''Fournier Gangrene OR Fournier Gangrene Reconstruction OR Fournier Gangrene Treatment OR Fournier Gangrene Plastic Surgery OR Necrotizing Fasciitis OR Necrotizing Fasciitis AND Reconstruction". The eligibility criteria included original studies aimed at discussing FG reconstruction with at least three clinical cases. Results: The final synthesis included 38 articles, and 576 reconstructions were described. Of these, 77.6% were minimally invasive strategies (direct closure, secondary healing, grafts, and local random flaps), while more invasive reconstructions (loco-regional flaps based on known vascular anatomy) were adopted in 22.4%. No free flaps were reported. Conclusions: FG requires immediate medical interventions including broad-spectrum antibiotic therapy, surgical debridement, adjuvant therapies, and reconstructive surgeries. Taking into account the anatomical characteristics of the inguinal-crural region, skin grafts and local random flaps could offer versatile and effective reconstructions for most FG cases, while the more invasive strategies should be reserved for very few cases. Future research is warranted to define an FG dedicated reconstruction protocol.
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Affiliation(s)
- Pietro Susini
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
| | - Gianluca Marcaccini
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
| | - Jessica Efica
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
| | - Maria Teresa Giuffrè
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
| | - Ruggero Mazzotta
- Division of General Cardiology, Careggi University Hospital, 50134 Florence, Italy;
| | - Corso Caneschi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, 50134 Florence, Italy;
| | - Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
| | - Giuseppe Nisi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
| | - Luca Grimaldi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
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Wilkowski CM, Chang LW, Hill ST, Bordeaux JS. Repair of a Total Scrotal Defect Extending Into the Perianal Area. Dermatol Surg 2024; 50:283-285. [PMID: 37695679 DOI: 10.1097/dss.0000000000003941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
| | - Li-Wei Chang
- Department of Dermatology,University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sheena T Hill
- Department of Dermatology,University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology,University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Schifano N, Capogrosso P, Cakir OO, Dehò F, Garaffa G. Surgical tips in difficult penile prosthetic surgery: a narrative review. Int J Impot Res 2023; 35:690-698. [PMID: 36261536 DOI: 10.1038/s41443-022-00629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 11/08/2022]
Abstract
Penile prosthesis implantation continues to represent a reliable solution to address erectile dysfunction when oral medications fail, are not tolerated or are contraindicated, and most typically is associated with excellent satisfaction rates and durable results. Despite the dramatic improvements in the prostheses' design, in the surgical instruments and techniques over the years, certain categories of patients still pose a significant surgical challenge. The aim of the current review is to provide a quick and useful practical guidance based on our expertise in the identification and management of the difficult penile prosthesis implantation cases. A narrative review design was here preferred to fulfil our purpose. The search strategy included a range of terms, e.g. penile prosthesis, corporal fibrosis, infection, ischaemic priapism, Peyronie's disease, radical prostatectomy, pelvic surgery. Extensive corporal fibrosis after explantation of an infected device or after prolonged ischaemic priapism may represent the most difficult situations to deal with in penile prosthesis implantation surgery. Penile prosthesis implantation in patients with Peyronie's disease and in those who previously underwent radical prostatectomy also presents with an increased risk of complications. Experienced surgeons need to be able to recognise promptly and manage urethral perforation, cylinder crossover, tunical perforation and erosion, as these complications are more common when dealing with difficult penile prosthesis implantation cases. Applying penile lengthening techniques and principles can be useful in selected cases to ensure better postoperative satisfaction rates, especially in those patients who have experienced a more significant degree of loss of length preoperatively. High-volume-implanting surgeons should always be involved in complex cases to minimise the risk of complications. A thorough preoperative counselling can set realistic patients' expectations in this context, further contributing to postoperative satisfaction.
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Affiliation(s)
- Nicolò Schifano
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Paolo Capogrosso
- ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy
| | - Onur Omer Cakir
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | - Federico Dehò
- ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy
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Suleimanov V, Al Hawaj K, Al Rebh FN, Naser H, Al Noaim S. A Challenging Case of Fournier's Gangrene With Multiple Complications. Cureus 2023; 15:e48036. [PMID: 38034187 PMCID: PMC10688236 DOI: 10.7759/cureus.48036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Fournier's gangrene, a not-so-common urological emergency, is a fast-progressing necrotizing bacterial infection that affects the perineum and external genitalia and can be rapidly fatal unless diagnosed and aggressively managed promptly. Fever, erythematous edema of the scrotum, and palpation of classic scrotal crepitation are among the clinical symptoms. The treatment involves rapid administration of empirical broad-spectrum antibiotics with gram-positive, gram-negative, and anaerobic coverage and rigorous surgical debridement down to the bleeding tissues. The medium-term complications of this condition are primarily associated with extended stay in an intensive care unit and cardiorespiratory, thromboembolic, and cutaneous complications, whereas the long-term complications are mainly functional, aesthetic, and psychological. Also, there are complications inherent to ancillary interventions such as penectomy, orchidectomy, reconstructive surgery, and restoration of digestive continuity. Herein, we present the case of a 40-year-old diabetic male who was admitted with an initial diagnosis of scrotal abscess, which turned out to be Fournier's gangrene. Despite developing multiple complications and numerous surgeries, he made a full recovery and was discharged home after a prolonged hospital stay.
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Affiliation(s)
| | | | | | - Husain Naser
- General Surgery, Jubail General Hospital, Jubail, SAU
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History and future perspectives of male aesthetic genital surgery. Int J Impot Res 2022; 34:327-331. [PMID: 35538312 DOI: 10.1038/s41443-022-00580-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/08/2022]
Abstract
Since ancient times, men have tried to change the size and shape of their genitals. Bites from insects or poisonous snakes and weights were among the first methods used for this purpose. In the first half of the 1900s, the scientific push regarding male genital aesthetic surgery began. Scrotoplasty, penile suspensory ligament release, injection of hyaluronic acid as filler, use of several types of grafts, lipofilling, and liposuction are techniques currently used. The Penuma® implant has recently been described with promising results. We are living in the era of tailored surgery and regenerative medicine. Shortly the surgeons will have to know several surgical techniques and adapt them to the patient. New fillers with ideal characteristics, innovative prosthetic devices, and stem cells will probably be the protagonists of future aesthetic surgery. The main effort of the scientific community should be directed towards the design of new randomized controlled trials to increase the evidence on the efficacy and safety of the topic, with the ultimate aim of allowing clear recommendations from scientific societies.
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Serefoglu EC. New trend in medicine: aesthetic genital surgery. Int J Impot Res 2022; 34:325-326. [PMID: 35383341 DOI: 10.1038/s41443-022-00566-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 11/09/2022]
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Take-home messages on male genital aesthetic surgery. Int J Impot Res 2022; 34:404-405. [PMID: 35264743 DOI: 10.1038/s41443-022-00552-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/08/2022]
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