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Badaoui A, Moulonguet I. A rare case of granular parakeratosis of the glans resembling genital psoriasis. Ann Dermatol Venereol 2024; 151:103268. [PMID: 38678769 DOI: 10.1016/j.annder.2024.103268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/02/2023] [Accepted: 03/04/2024] [Indexed: 05/01/2024]
Affiliation(s)
- A Badaoui
- Private Dermatologist, Paris, France; Dermatology Department, Military Teaching Hospital, Saint-Mandé, France.
| | - I Moulonguet
- Pathology Department XPath, Saint-Louis Hospital - APHP, Paris, France
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Hennayake S, Bianchi A. Response to the letter to the Editor "Further misconceptions in glans penis anatomy and hypospadias surgery". J Pediatr Urol 2023:S1477-5131(23)00196-1. [PMID: 37188602 DOI: 10.1016/j.jpurol.2023.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/17/2023]
Affiliation(s)
- S Hennayake
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
| | - A Bianchi
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
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Arredondo Montero J, Antona G, Ros Briones R, Bronte Anaut M, Bardají Pascual C. Glans Penis Ischemia after Circumcision in a 15-Year-Old Patient Managed with Intravenous Pentoxifylline: A Case Report and a Diagnostic-Therapeutic Guideline Proposal. Urol Int 2022; 107:105-110. [PMID: 36502804 DOI: 10.1159/000527642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/18/2022] [Indexed: 12/13/2022]
Abstract
Glans ischemia is an extremely infrequent complication characterized by a total or partial compromise in the penile arterial perfusion. A 15-year-old male patient suffered an episode of ischemia in the glans penis post-circumcision 24 h after surgery. Intravenous treatment with continuous perfusion of pentoxifylline was started for 4 days, with favorable evolution. Complete resolution was observed with no sequelae. There is no consensus on the best therapeutic management. The favorable evolution reported in most of the cases despite different therapeutic approaches leads us to think that the role of the treatments proposed so far is probably less than we believe. Additionally, we present a proposal for a diagnostic and therapeutic guide for this entity. Although the evidence in the literature is scarce and this guideline should be interpreted with caution, we believe that it can constitute a support resource for cases similar to ours.
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Affiliation(s)
| | - Giuseppa Antona
- Pediatric Surgery Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Raquel Ros Briones
- Pediatric Surgery Department, Hospital Universitario de Navarra, Pamplona, Spain
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Indriasari V, Alimoeddin PO, Pamungkas KO. Correlation between Glans, Meatus, Shaft Score, and Penile Perception after Hypospadias Repair. J Indian Assoc Pediatr Surg 2022; 27:585-587. [PMID: 36530828 PMCID: PMC9757774 DOI: 10.4103/jiaps.jiaps_231_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 06/17/2023] Open
Abstract
AIMS The aim is to analyze the correlation between the degree of hypospadias based on the Glans-Urethral Meatus-Shaft (GMS) score and penile perception after hypospadias repair using pediatric penile perception score (PPPS). SETTINGS AND DESIGN Analytic observational study with a cross-sectional design. SUBJECTS AND METHODS Thirty-two children with hypospadias were included in this study. The severity of hypospadias was assessed using GMS score. Postoperatively, PPPS was rated by two external pediatric surgeons. STATISTICAL ANALYSIS USED Correlation between GMS score and PPPS were analyzed using the Spearman test, P ≤ 0.05: Significant. RESULTS Mean-GMS was 8.69 ± 2.303 (mean-G 2.67 ± 0.858, mean-M 3.27 ± 0.942, mean-S 2.75 ± 1.055). Mean-PPPS was 10.19 ± 1.287. GMS score and PPPS had a very weak correlation (r = -0.227; P > 0.05). CONCLUSIONS There was no correlation between GMS score and penile perception according to PPPS after hypospadias repair.
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Affiliation(s)
- Vita Indriasari
- Department of Surgery, Division of Pediatric Surgery, Faculty of Medicine, Padjadjaran University, RSUP Dr. Hasan Sadikin, Bandung, Indonesia
| | - Patricia Okitaviani Alimoeddin
- Department of Surgery, Division of Pediatric Surgery, Faculty of Medicine, Padjadjaran University, RSUP Dr. Hasan Sadikin, Bandung, Indonesia
| | - Kurniawan Oki Pamungkas
- Department of Surgery, Division of Pediatric Surgery, Faculty of Medicine, Padjadjaran University, RSUP Dr. Hasan Sadikin, Bandung, Indonesia
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Sennert M, Wirmer J, Hadidi AT. Preoperative glans & penile dimensions in different hypospadias grades. J Pediatr Urol 2022; 18:47-53. [PMID: 34674950 DOI: 10.1016/j.jpurol.2021.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To report glans and penile dimensions in 1023 consecutive boys with hypospadias. PATIENTS & METHODS Boys admitted for hypospadias surgery between 2016 and 2018 were included in this study. Age ranged between 6 and 36 months. Boys who underwent previous surgery, received hormone therapy or older than 36 months were excluded. The hypospadias was classified according to ICD and WHO classification into glanular (Grade I), distal (Grade II), proximal (Grade III) and perineal (Grade IV). The flaccid penile length (PL), the dorsal glans length (DGL), the ventral glans length (VGL) and the glans width (GW) were measured in the operating room under anaesthesia just before operative correction. Small (GW) in this study was defined as less than 14 mm. RESULTS 1023 boys were included. 273 had glandular, 468 distal, 194 proximal and 88 perineal hypospadias. The mean glans width was 14 mm with a range of 8 to 20 mm. The mean glans width for glanular hypospadias was 14.0 mm (range 9-19 mm), 14.0 mm (range 10-20 mm) for distal hypospadias (p > 0.05), 13.1 mm (range 9-19 mm) for proximal hypospadias (p < 0.0001) and 11.1 mm (range 8-16 mm) for perineal hypospadias (p < 0.0001). 460 (45.0%) of all patients presented with a small glans width. In glanular hypospadias it was 99 (36.3%), 167 (35.7%) in distal hypospadias, 111 (57.5%) in proximal hypospadias and 83 (94.3%) in perineal hypospadias. There was no significant difference in the glans size between the age of 6 and 24 months (p > 0.2), but there was a difference when compared to patients older than 25 months (p < 0.05). CONCLUSIONS A small glans is found in about a third of distal, two thirds in proximal and more than 90% of perineal hypospadias.
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Affiliation(s)
- Michael Sennert
- Hypospadias Centre, Department of Pediatric Surgery, Emma Klinik Seligenstadt and Sana Klinikum Offenbach, Germany
| | - Johannes Wirmer
- Hypospadias Centre, Department of Pediatric Surgery, Emma Klinik Seligenstadt and Sana Klinikum Offenbach, Germany
| | - Ahmed T Hadidi
- Hypospadias Centre, Department of Pediatric Surgery, Emma Klinik Seligenstadt and Sana Klinikum Offenbach, Germany.
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Macedo A, Ottoni SL, Di Migueli RDD, de Mattos RM, Garrone G, Leal da Cruz M. A different approach to distal hypospadias repair: The GUD (glandular urethral disassembly) technique. J Pediatr Urol 2021; 17:690.e1-690.e6. [PMID: 34158249 DOI: 10.1016/j.jpurol.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Distal hypospadias represent the most frequent clinical presentation of hypospadias. In spite of more than 300 techniques available, there is not an ideal approach. We have proposed an alternative procedure based on the combination of minor urethral mobilization and major glans deconstruction and partial disassembly from the corpora, the GUD technique. We want to present our clinical experience with the procedure and describe it in detail. METHODS The technique consists of disconnecting the spongious tissue and the distal urethra from the corpora and detaching partially the glans as well, from 2 to 10 o'clock. The glans is opened in midline and the procedure combines cranially mobilization of urethra with caudal and medial rotation of glans wings to refurbish the glans correcting the hypospadia without urethroplasty. RESULTS We have treated 164 patients with distal hypospadia. Median age at the surgery was 22.4 months (1-184 months). The meatal position after penile degloving was coronal at 108 cases, subcoronal at 54 and 2 patients presented megameatus and intact foreskin. Three patients (1.8%) had mild penoscrotal transposition in addition to hypospadia. Twenty-eight patients were treated as a secondary repair (17%). We found complications in 6 patients (3.6%) consisting of five fistulas (3%) and three glans dehiscence (1.8%). Two patients had both complications. Follow up was 21 months (1-42 months) and the median follow-up time was 18 months. DISCUSSION We acknowledge that this procedure is intended only to distal hypospadias (coronal and subcoronal). We stress that the GUD procedure can be performed irrespectively of any urethral plate "quality" as it does not require a minimum glans width as the TIP repair. Moreover, there is no need for preoperative testosterone treatment. The absence of suture and urethroplasty minimizes the risk of coronal fistulas after surgery. CONCLUSIONS We believe that this procedure is a viable alternative to distal hypospadias repair.
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Affiliation(s)
- Antonio Macedo
- Department of Urology, CACAU-NUPEP, São Paulo, Brazil; Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
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Baazeem A. Solitary incidental primary Kaposi's sarcoma of the glans penis in a patient with no risk factors. Urol Ann 2020; 12:283-285. [PMID: 33100756 PMCID: PMC7546061 DOI: 10.4103/ua.ua_172_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/13/2020] [Indexed: 11/28/2022] Open
Abstract
Kaposi's sarcoma (KS) is an endothelial neoplasm, originally reported by Moritz Kaposi in 1872. It most commonly involves the lower extremities. Its clinical presentation and course can be quite variable. We present a rare case of solitary incidental primary KS of the glans penis in a circumcised, immunocompetent male who is human immunodeficiency virus seronegative. The lesion was discovered incidentally when the otherwise asymptomatic male presented to our outpatient department for an unrelated issue and was given a physical examination. To our knowledge, this is the first incidentally discovered case of primary penile KS.
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Affiliation(s)
- Abdulaziz Baazeem
- Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Liu X, Liu G, Shen J, Yue A, Isaacson D, Sinclair A, Cao M, Liaw A, Cunha GR, Baskin L. Human glans and preputial development. Differentiation 2018; 103:86-99. [PMID: 30245194 PMCID: PMC6234068 DOI: 10.1016/j.diff.2018.08.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 01/30/2023]
Abstract
The urethra within the human penile shaft develops via (1) an "Opening Zipper" that facilitates distal canalization of the solid urethral plate to form a wide urethral groove and (2) a "Closing Zipper" that facilitates fusion of the epithelial surfaces of the urethral folds. Herein, we extend our knowledge by describing formation of the human urethra within the glans penis as well as development of the prepuce. Forty-eight normal human fetal penile specimens were examined using scanning electron microscopy and optical projection tomography. Serial histologic sections were evaluated for morphology and immunohistochemical localization for epithelial differentiation markers: Cytokeratins 6, 7, 10, FoxA1, uroplakin and the androgen receptor. As the closing zipper completes fusion of the urethral folds within the penile shaft to form a tubular urethra (~ 13 weeks), canalization of the urethral plate continues in proximal to distal fashion into the glans penis to directly form the urethra within the glans without forming an open urethral groove. Initially, the urethral plate is attached ventrally to the epidermis via an epithelial seam, which is remodeled and eliminated, thus establishing mesenchymal confluence ventral to the glanular urethra. The morphogenetic remodeling involves the strategic expression of cytokeratin 7, FoxA1 and uroplakin in endodermal epithelial cells as the tubular glanular urethra forms. The most ventral epithelial cells of the urethral plate are pinched off from the glanular urethra and are reabsorbed into the epidermis ultimately losing expression of their markers, a process undoubtedly regulated by androgens. The prepuce initially forms on the dorsal aspect of the glans at approximately 12 weeks of gestation. After sequential proximal to distal remodeling of the ventral urethral plate along the ventral aspect of glans, the prepuce of epidermal origin fuses in the ventral midline.
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Taş S, Top H. Reconstruction of hypoplastic glans and subglanular stricture with fat transfer and release. J Plast Reconstr Aesthet Surg 2014; 67:1744-6. [PMID: 25163851 DOI: 10.1016/j.bjps.2014.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/03/2014] [Accepted: 07/26/2014] [Indexed: 11/28/2022]
Abstract
Circumcision is a common minor surgical procedure. However, if it is performed by untrained individuals, it may cause serious complications. In this case report, we describe an unusual circumcision complication with subglanular stricture and hypoplastic glans, which we named "exclamation mark deformity," its treatment that involved glans augmentation by fat injection, and results together with further treatment options.
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Affiliation(s)
- Süleyman Taş
- R.T.E. University Training & Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Rize, 53100, Turkey.
| | - Hüsamettin Top
- Trakya University Medicine Faculty, Department of Plastic, Reconstructive and Aesthetic Surgery, Edirne, 22030, Turkey
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Pippi Salle JL, Jesus LE, Lorenzo AJ, Romão RL, Figueroa VH, Bägli DJ, Reda E, Koyle MA, Farhat WA. Glans amputation during routine neonatal circumcision: mechanism of injury and strategy for prevention. J Pediatr Urol 2013; 9:763-8. [PMID: 23137994 DOI: 10.1016/j.jpurol.2012.09.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 09/13/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Glans injury during circumcision is an uncommon yet potentially devastating complication. Its mechanism remains poorly understood. Herein we critically evaluate a case series and, based on common characteristics, hypothesize the mechanism of injury as well as means to prevent it. METHODS Retrospective review of circumcision-related glans amputation cases referred for evaluation and management, focusing on detection of common history and presentation patterns in order to evaluate possible underlying mechanisms. RESULTS A neonatal elective circumcision was conducted using a Mogen clamp and an oblique injury to the ventro-lateral aspect of the glans was noted in 6 cases referred over a 5-year period, suggesting a similar trauma pattern. The urethra was consistently involved. The amputated segments were reattached as free composite grafts in 2/6 cases. Three patients underwent delayed glansplasty months after the trauma in an attempt to restore natural symmetry and cosmesis. In one case a buccal mucosa graft was employed to rebuild the ventral coronal sulcus. CONCLUSIONS Trauma pattern suggests that the ventral glans is at high risk for injury by traction on incompletely released ventral preputial adhesions with subsequent glans entrapment. Practitioners performing neonatal circumcisions, particularly with a Mogen clamp, should exercise adequate release of ventral adhesions to prevent this complication.
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Brecheteau F, Grison P, Abraham P, Lebdai S, Kemgang S, Souday V, Nedelcu C, Culty T, Larré S, Azzouzi AR, Bigot P. Successful medical treatment of glans ischemia after voluntary buprenorphine injection. J Sex Med 2013; 10:2866-70. [PMID: 23937228 DOI: 10.1111/jsm.12282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The diverted use of synthetic opioid buprenorphine by drug addicts can be responsible for serious ischemic and infectious complications, particularly in the case of intravenous injection. AIM We present a case of serious glans ischemia after buprenorphine injection directly into the deep dorsal vein of the penis. Analysis using new medical imaging techniques and treatments is detailed below. METHODS A 26-year-old male drug addict presented with glans pain 4 days after self-injection of buprenorphine into the deep dorsal vein of the penis. The patient was apyretic and presented a urethral discharge. His glans was blue without discoloration on digital pressure. Additionally, his biologic and serologic tests were normal while bacteriology showed the presence of Enterobacter cloacae urethritis. RESULTS After 48 hours of intravenous antibiotic treatment without improvement, a specific medical treatment using enoxaparin and ilomedin was initiated, with the assumption that there was an ischemic complication. Laser speckle contrast imaging allowed confirmation of the presence of distal penis ischemia and provided an accurate mapping of the ischemic zone. A 28-day treatment combining antibiotics, subcutaneous heparin at curative dose, antiplatelet drug, ilomedin, and hyperbaric oxygen therapy resulted in clinical improvement of the lesions with no functional complications. CONCLUSIONS To date, no consensus exists on the proper diagnostic and treatment approach to severe glans ischemia due to buprenorphine injection into the deep dorsal vein of the penis. The results of laser speckle contrast imaging were of real interest during the process of diagnosis. In addition, the combination of ilomedin with hyperbaric oxygen therapy and anticoagulant and antiplatelet drugs appeared to be an effective therapy.
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Abstract
A 32-year-old man presented with chemical burns to his penis following accidental application of depilatory cream to the area. The gentleman consequently sustained deep dermal burns to his penis, experiencing genital swelling and dysuria. This injury was managed conservatively in our burns unit and the patient was discharged shortly after. We present this unusual case of penile burns which has not previously been described in the literature despite depilatory creams being inexpensive and relatively easy to use, and subsequently popular choice amongst available hair removal options.
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Affiliation(s)
- Ian King
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, UK.
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