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Mirsadeghi SA, Aghaii M, Aghamir SMK. Using two “V” shaped flaps in penile torsion treatment. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820957548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Penile torsion is a congenital malformation that causes a rotational deformity of the penile shaft. Several techniques have been considered for penile torsion repair. In this study, we described our experience using two separate “V” dartos flaps, which leads to a more satisfying result. Patient and methods: Two young men with severe penile torsion aged 24 and 28 years old were candidates for surgery. During our novel method for penile torsion repair, we degloved the penis and dissected the dartos fascia from the penis shaft, then cut it distally from the sub-coronal region with a longitudinal cut to make two dartos flaps in a “V” shape. With these two flaps, we corrected penile torsion in a more satisfying way without crossing the urethra. Results: Penile torsion and concurrent chordee were completely corrected after surgery. Urine culture was sterile and uroflowmetry indicated a maximal urinary flow of 12 ml/s 3 months after the operation. Both patients were satisfied with ejaculation and their follow-up indicated complete resolution of penile torsion. Conclusions: Penile torsion is a challenging congenital anomaly. We used a two “V” shaped flap passage method to complete penile rotation and chordee correction without performing any plication techniques. Our penile torsion correction procedure resulted in the successful repair of torsion and excellent outcomes. Level of evidence: Not applicable for this multicenter audit.
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Zvizdic Z, Milisic E, Vranic S. Penile Degloving and Dorsal Dartos Flap Rotation Surgery in the Management of Severe Isolated Penile Torsion in a 6-Year-Old Boy. ACTA MEDICA (HRADEC KRÁLOVÉ) 2020; 63:52-54. [PMID: 32422117 DOI: 10.14712/18059694.2020.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Penile torsion is a rare congenital anomaly that is usually characterized by a counterclockwise rotation of the penile shaft or glans. Although several surgical techniques for its correction have been proposed, the consensus of choosing the most efficient technique remains controversial. Herein, we report our operational approach that successfully corrected a severe (>90 degrees) isolated penile torsion in the form of penile degloving and dorsal dartos flap rotation surgery.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Emir Milisic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Cassell A, Jalloh M, Mbodji MM, Ndoye M, Labou I, Niang L, Diallo Y, Diallo A, Gueye SM. 180° congenital penile torsion with distal hypospadias mistaken for an epispadias: Optimal outcome with tubularized incised plate urethroplasty and dartos flap rotation. IJU Case Rep 2019; 2:324-326. [PMID: 32743451 PMCID: PMC7292190 DOI: 10.1002/iju5.12120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/22/2019] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Severe penile torsion of 180° associated with hypospadias is a rare entity. Knowledge of penile anatomy and pathology are necessary as the diagnosis could be missed. CASE PRESENTATION We report a case of severe 180° penile torsion with distal hypospadias that was mistaken for an epispadias which was corrected with surgery. CONCLUSION Tubularized incised plate urethroplasty and dartos flap rotation provided satisfactory result for this association.
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Affiliation(s)
- Ayun Cassell
- Department of Urology and AndrologyHopital General de Grand YoffDakarSenegal
| | - Mohamed Jalloh
- Department of Urology and AndrologyHopital General de Grand YoffDakarSenegal
| | - Mouhamadou M Mbodji
- Department of Urology and AndrologyHopital General de Grand YoffDakarSenegal
| | - Medina Ndoye
- Department of Urology and AndrologyHopital General de Grand YoffDakarSenegal
| | - Issa Labou
- Department of Urology and AndrologyHopital General de Grand YoffDakarSenegal
| | - Lamine Niang
- Department of Urology and AndrologyHopital General de Grand YoffDakarSenegal
| | | | - Abdourahmane Diallo
- Department of Urology and AndrologyHopital General de Grand YoffDakarSenegal
| | - Serigne M Gueye
- Department of Urology and AndrologyHopital General de Grand YoffDakarSenegal
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Procedures used for correction of isolated penile torsion: are they competitive or complementary? Int Urol Nephrol 2019; 51:1313-1319. [PMID: 31073712 DOI: 10.1007/s11255-019-02163-9] [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: 03/09/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To report our experience in starting the correction of penile torsion, whatever its degree (moderate or severe) with one or more simple procedures either separately or complementary in the same session. PATIENTS AND METHODS Between 2013 and 2018, 62 patients who have significant isolated penile torsion (> 45°) were involved in this study. Those patients were subjected to either simple degloving with skin reposition, degloving with skin overcorrection and/or dartos flap procedures. Those procedures were performed either separately or complementarily. All patients were examined postoperatively after 7 days and followed up at 3, 6, and 9 months postoperatively. RESULTS 37 out of 62 patients had a moderate degree (45-90) of penile torsion; 21 of them were corrected using skin degloving-reattachment technique, 11 patients were corrected by degloving with skin overcorrection, and in the remaining 4 patients dartos flap technique was used for correction. In 25/62 patients who had severe degree (> 90°) of torsion; 9 patients were managed by degloving with skin overcorrection, while in 13 patients the procedure was shifted to dartos flap technique, and the remaining 3 patients, 2 of whom had 180° torsion, were managed by dartos flap with added skin overcorrection. CONCLUSION Performing degloving and skin reattachment with or without skin overcorrection procedure and dartos flap procedure either separately or complementarily in the same patient whatever the degree of torsion (moderate or severe) is associated with good results and can protect some patients from exposure to more difficult and extensive procedures as corporopexy and corporeal plication.
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The Fisher Technique for Correction of Penile Torsion in Children: Who Are the Candidates? Urology 2017; 104:179-182. [PMID: 28263821 DOI: 10.1016/j.urology.2017.02.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/20/2017] [Accepted: 02/24/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report our experience in the treatment of penile torsion with a special reference to the Fisher technique. PATIENTS AND METHODS We reviewed 30 cases of congenital penile torsion treated from 2009 to 2015 in a single center. Sixteen patients presented a moderate rotation of 45°-90° and 14 had a severe rotation with an angle greater than 90°. Chordee was present in 17 cases and distal glanular hypospadias in 15 cases. Median age at surgery was 10 months. In 14 cases, degloving along with skin realignment, alone, allowed correction of the torsion. In 16 cases, the Dartos flap (Fisher technique) was used. RESULTS Out of the 30 patients, 29 had a good result, with a complete correction of the torsion. Only 1 patient had a residual torsion of 30°. Complications were minor and consisted of skin excess in 11 patients; 1 single case needed to be reoperated for that skin complication. The need for the Dartos flap procedure was significantly correlated to the degree of torsion (P = .001): it was used in 4 out of 16 patients (25%) with a torsion of less than 90°, and in 12 out of 14 patients (86%) with a torsion of 90° or more. CONCLUSION Most of penile rotations less than 90° can be corrected by skin degloving and realignment. The Fisher technique is a simple and safe procedure for correction of persistent rotation after skin degloving; such cases have usually a penile rotation greater than 90°.
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Aykaç A, Baran Ö, Yapıcı O, Aygün BA, Aydın C, Çakan M. Penile degloving and dorsal dartos flap rotation approach for the management of isolated penile torsion. Turk J Urol 2016; 42:27-31. [PMID: 27011878 DOI: 10.5152/tud.2015.34651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Penile torsion is a counterclockwise rotational anomaly of the penile shaft or glans. We aimed to evaluate the outcomes of penile degloving and dorsal dartos flap rotation used for the repair of isolated penil torsion. MATERIAL AND METHODS During evaluation of the patients admitted to our polyclinic for circumcision between January 2013-December 2014, 5 cases of isolated penile torsion were determined. Following the circumcision procedure performed with bipolar cautery, patients undergoing penile degloving were checked whether penile torsion was relieved or not. In case of insufficient improvement, torsion was corrected with application of dorsal dartos flap. Penile torsion was corrected with dartos flap in 2, and penile degloving in 3 cases. RESULTS The mean age of the patients was 5.6 years (4-7), and the mean operative time 12 minutes (7-20), respectively. The mean operation time was 17.5 (15-20) minutes and 8.3 (7-10) minutes in the dorsal dartos flap and penile degloving groups, respectively. The preoperative mean degree of penile torsion was 50° (30°-70°). The mean degree of torsion was 65° and 40° in the dorsal dartos and penile degloving groups, respectively. During the postoperative follow up, 1 case of residual torsion (<10°) was observed in the dorsal dartos flap group. Residual torsion was not observed in other patients. CONCLUSION Exploration for isolated cases of penile torsion during the circumcision procedure should not be overlooked. Successful results can be obtained with penile degloving and dartos flap rotation in cases with low and moderate torsion.
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Affiliation(s)
- Aykut Aykaç
- Clinic of Urology, Orhangazi State Hospital, Bursa, Turkey
| | - Özer Baran
- Department of Urology, Karabük University Training and Research Hospital, Karabük, Turkey
| | - Onur Yapıcı
- Clinic of Urology, Şehit Kamil State Hospital, Gaziantep, Turkey
| | | | - Cemil Aydın
- Clinic of Urology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Murat Çakan
- Clinic of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Abstract
INTRODUCTION We reported on the incidence of isolated penile torsion among our healthy children and our approach to this anomaly. METHODS Between 2011 and 2014, newborn babies with penile torsion were classified according to the angle of torsion. Surgical correction (penile degloving and reattachment for moderate cases and dorsal dartos flap technique in case of resistance) after 6 months was advised to the babies with rotations more than 45°. RESULTS Among 1000 newborn babies, 200 isolated penile torsions were found, and among these, 43 had torsions more than 45°, and 4 of these had angles greater than 90°. The mean angle of the rotations was found 30.45° (median: 20°). In total, 8 children with 60° torsions were previously circumcised. Surgery was performed on 19 patients, with a mean patient age of 12 ± 2 months. Of these 19, 13 babies were corrected with degloving and reattachment. This technique was not enough on the remaining 6 patients; therefore, derotational dorsal dartos flap was added to correct the torsion. After a mean of 15.6 ± 9.8 months, residual penile rotation, less than 15°, was found only in 2 children. CONCLUSION The incidence of isolated penile torsion is 20% in newborns. However, rotation more than 45° angles are seen in 4.3% of male babies. Correction is not necessary in mild degrees, and penile degloving with reattachment is enough in most cases. If the initial correction is insufficient, dorsal dartos flap rotation is easy and effective. Prior circumcision neither disturbs the operative procedure nor affects the outcomes.
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Affiliation(s)
- Egemen Eroglu
- Department of Pediatric Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Gokhan Gundogdu
- Department of Pediatric Surgery, Koc University School of Medicine, Istanbul, Turkey
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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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Elbatarny AM, Ismail KA. Penile torsion repair in children following a ladder step: simpler steps are usually sufficient. J Pediatr Urol 2014; 10:1187-92. [PMID: 25012290 DOI: 10.1016/j.jpurol.2014.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/04/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the correction of different degrees of penile torsion following a ladder step so that simpler steps are used whenever possible. This can avoid the morbidity and complications of complex procedures. PATIENTS AND METHODS Cases of congenital and acquired penile torsion were repaired on a ladder step basis irrespective of the degree of torsion, starting with degloving and skin realignment, then a dorsal dartos flap and finally corporopexy. The torsion is checked with artificial erection after each step, and if corrected completely then the next step(s) is omitted. RESULTS Twenty-five cases of penile torsion (30-180°) were repaired over a 4-year period. Three cases were corrected by degloving only, 12 by degloving and skin realignment, five by a dartos flap and four required a corporopexy. Postoperative complications included five cases of penile edema, one case of hematoma and one case of dorsal skin gangrene. Residual torsion of <15° occurred in three cases. No cases required redo surgery. CONCLUSION A ladder step approach is a good option for penile torsion repair, starting with simpler techniques until complete correction is achieved. There is no need to plan a complex procedure in advance.
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Affiliation(s)
| | - Khalid Ahmed Ismail
- Department of Surgery, Tanta University Hospitals, Elgeish Road, Tanta, Egypt
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Elbakry A, Zakaria A, Matar A, El Nashar A. The management of moderate and severe congenital penile torsion associated with hypospadias: Urethral mobilisation is not a panacea against torsion. Arab J Urol 2013; 11:1-7. [PMID: 26579237 PMCID: PMC4442919 DOI: 10.1016/j.aju.2012.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 11/29/2022] Open
Abstract
Objectives To evaluate the effectiveness of urethral mobilisation for correcting moderate and severe penile torsion associated with distal hypospadias. Patients and methods Nineteen patients with distal hypospadias and congenital moderate and severe penile torsion were treated surgically. The hypospadias was at the distal shaft, coronal and glanular in seven, eight and four patients, respectively, and six had mild chordee. The mean (SD, range) angle of torsion was 94.7 (19.9, 75–160)°. The urethra was mobilised down to the perineum. If the urethral mobilisation was insufficient the right border of the tunica albuginea was anchored to the pubic periosteum. The hypospadias was repaired using the urethral mobilisation and advancement technique, with a triangular plate flap for meatoplasty. The patients were followed up for 12–18 months. Results All patients had a successful functional and cosmetic outcome, with no residual torsion. Two patients had a small subcutaneous haematoma that resolved after conservative treatment. Massive oedema occurred in three patients and was treated conservatively. Urethral mobilisation did not correct the penile torsion completely. Although the mean (SD, range) angle of torsion was reduced to 86.1 (14.3, 65–130)°, statistically significantly different (P = 0.001), it was not clinically important. The presence of chordee had no significant correlation with the reduction of penile torsion. Conclusion Urethral mobilisation cannot completely correct moderate and severe penile torsion but it might only partly decrease the angle of torsion. Periosteal anchoring of the tunica albuginea might be the most reliable manoeuvre for the complete correction of penile torsion.
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Affiliation(s)
- Adel Elbakry
- Department of Urology, Suez Canal University, Ismailia, Egypt
| | - Ahmed Zakaria
- Department of Urology, Suez Canal University, Ismailia, Egypt
| | - Adel Matar
- Department of Urology, Suez Canal University, Ismailia, Egypt
| | - Ahmed El Nashar
- Department of Urology, Suez Canal University, Ismailia, Egypt
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