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Gondal MF, Saman R, Chaudhry AR, Aslam H, Qamar S, Sahi W. A case report of an epidermoid inclusion cyst following repair of hypospadias. Int J Surg Case Rep 2024; 118:109521. [PMID: 38564903 PMCID: PMC10999463 DOI: 10.1016/j.ijscr.2024.109521] [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: 11/19/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Epidermoid cysts also known as epidermal inclusion cysts are the most common type of cutaneous cysts. These are derived from ectoderm with a lining of stratified squamous epithelium. Penile epidermoid cysts however are very rare. We report a case of Fifteen years old male with complain of slow growing mass at ventral aspect of shaft of penis along with urethrocutaneous fistula following hypospadias surgery. Surgical excision was done of the cyst. Histopathology of the sample revealed an epidermoid cyst. CASE PRESENTATION We report a case of a Fifteen years boy who underwent midshaft hypospadias repair at the age of five years. During postoperative period stent was removed and one week after that he developed a urethrocutaneous fisula. At seven years of age patient reported a small swelling on the penile shaft which gradually increased in size over the years, however, he seeks no medical care for it. CLINICAL DISCUSSION At time of presentation swelling was separately appreciable from urehtrocuataneous fistula and extending from subcoroanal to midshaft of penis. We did excision of epidermal cyst and repair of urethrocutaneous fistula. CONCLUSIONS Epidermal inclusion cyst as a complication of hypospadias surgery is a very rare situation. The diagnosis is made histologically and surgical excision is sufficient for treatment.
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Affiliation(s)
| | - Rumaisaa Saman
- Neurosurgery Department, Holy Family Hospital, Rawalpindi, Pakistan
| | - Ali Raza Chaudhry
- Paediatric Surgery Department, Holy Family Hospital, Rawalpindi, Pakistan.
| | - Hasnain Aslam
- Paediatric Surgery Department, Holy Family Hospital, Rawalpindi, Pakistan
| | - Salman Qamar
- Paediatric Surgery Department, Holy Family Hospital, Rawalpindi, Pakistan
| | - Waqas Sahi
- Paediatric Surgery Department, Holy Family Hospital, Rawalpindi, Pakistan
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Caglar O, Kanat A, Aydin MD, Akca N, Ozmen S. First report of the histopathological effect of electrocautery using on the urethral taste rosea during glans penis injury by incision in rabbits. Asian J Urol 2024; 11:115-120. [PMID: 38312826 PMCID: PMC10837657 DOI: 10.1016/j.ajur.2022.03.004] [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: 06/27/2021] [Accepted: 11/04/2021] [Indexed: 10/18/2022] Open
Abstract
Objective Currently, electrocautery devices have frequently been used in penile surgical procedures. We hypothesized that electrocautery using during penile surgical procedures may harm the taste rosea and the dorsal nerve of the penis or clitoris. Methods Eighteen young age male New Zealand rabbits were studied: five in the control (Group I, n=5), five in the penile surgery without using electrocautery (sham group, Group II, n=5), eight in the monopolar cautery (study group, Group III, n=8) groups under general anesthesia. The animals were followed for 3 weeks and sacrificed. Penile tissue-pudendal nerve root complexes and dorsal root ganglion of sacral 3 level were examined using stereological methods. The results were compared statistically. Results The live and degenerated taste bud-like structures and degenerated neuron densities of pudendal ganglia (mean±standard deviation, n/mm3) were estimated as 198±24/mm3, 4±1/mm3, and 5±1/mm3 in Group I; 8±3/mm3, 174±21/mm3, and 24±7/mm3 in Group II; and 21±5/mm3, 137±14/mm3, and 95±12/mm3 in Group III, respectively. Neurodegeneration of taste buds and pudendal ganglia was significantly different between groups. Conclusion Intact spinal cord and normal parasympathetic and thoracolumbar sympathetic networks are crucial for human sexual function. The present study indicates that the glans penis injury by using electrocautery may lead to pudendal ganglia degeneration. Iatrogenic damage to taste rosea and retrograde degeneration of the pudendal nerve may be the cause of sexual dysfunction responsible mechanism.
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Affiliation(s)
- Ozgur Caglar
- Ataturk University, Medical Faculty, Department of Pediatric Surgery, Erzurum, Turkey
| | - Ayhan Kanat
- Recep Tayyip Erdogan University, Medical Faculty, Department of Neurosurgery, Rize, Turkey
| | - Mehmet Dumlu Aydin
- Ataturk University, Medical Faculty, Department of Neurosurgery, Erzurum, Turkey
| | - Nezih Akca
- Recep Tayyip Erdogan University, Medical Faculty, Department of Urology, Rize, Turkey
| | - Sevilay Ozmen
- Ataturk University, Medical Faculty, Department of Pathology, Erzurum, Turkey
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Ainayev Y, Zhanbyrbekuly U, Gaipov A, Suleiman M, Kissamedenov N, Zhaparov U, Urazova S, Rakhmetova N, Turebayev D, Keulimzhayev N, Zhankina R, Khairli G. Comparison of technical success and adverse events of plaque incision and grafting methods in patients with Peyronie's disease: Tunica vaginalis versus buccal mucosa. Urology 2022; 170:226-233. [PMID: 36115431 DOI: 10.1016/j.urology.2022.07.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/27/2022] [Accepted: 07/10/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the clinical outcomes of Peyronie's disease (PD) patients who were treated by plaque incision and grafting either with tunica vaginalis (TV) or buccal mucosa (BM) grafts. METHODS PD patients in BM (n=20) and TV group (n=20) were recruited between 2013 and 2020. Erectile dysfunction was assessed by short form of International Index of Erectile Function Questionnaire (IIEF-5). Technical success was defined as residual curvature ≤15°. Penile Doppler ultrasound was performed at baseline evaluation, 3-, and 24 months. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index were measured in erect penis. Erect penile length and curvature angle were measured at baseline and at 3, 12, and 24 months. RESULTS Mean age of the groups was comparable (47.2±10.8 years in TV vs 46.5±9.9 years in BM groups). Baseline mean penile curvature was 48.0±6.6° (TV) and 50.3±11.6° (BM) (p<0.001). Mean residual curvature at 24-months visits was 12.4±4.9° (TV) and 7.9±3.7° (BM), not significantly different. Technical success rate was 90% for both groups at 24 months. Surgery significantly increased erect penile length in both groups. Mean preoperative IIEF-5 scores were 18.4±2.5 and 17.5±2.2 in TV and BM groups, respectively. In both groups, IIEF-5 scores significantly improved after surgery with no intergroup IIEF-5 difference (20.6±2.6 in TV and 21.3±2.2 in BM). Mean postoperative PSV significantly increased, EDV significantly decreased in both groups, however, there was no significant intergroup difference. CONCLUSION Both grafting materials provided similar beneficial effects regarding technical success, erectile dysfunction, and penile length.
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Affiliation(s)
- Yernur Ainayev
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan
| | - Ulanbek Zhanbyrbekuly
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan
| | - Abduzhappar Gaipov
- Nazarbayev University, School of Medicine, Department of Medicine, Nur-Sultan, Kazakhstan
| | - Makhmud Suleiman
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan.
| | - Nurlan Kissamedenov
- JSC 'National Center of Neurosurgery', Department for Reception and Diagnosis, Nur-Sultan, Kazakhstan
| | - Ulan Zhaparov
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan
| | - Saltanat Urazova
- Astana Medical University, Department of General Medical Practice No. 3, Nur-Sultan, Kazakhstan
| | - Nurila Rakhmetova
- Astana Medical University, Department of microbiology and virology named after Sh. I. Sarbasova, Nur-Sultan, Kazakhstan
| | - Dulat Turebayev
- Astana Medical University, Department of Surgery with an angiosurgery and plastic surgery course, Nur-Sultan, Kazakhstan
| | - Nurbol Keulimzhayev
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan
| | - Rano Zhankina
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan
| | - Gafur Khairli
- Astana Medical University, Department of Urology and Andrology, Nur-Sultan, Kazakhstan
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Ainayev Y, Zhanbyrbekuly U, Gaipov A, Kissamedenov N, Zhaparov U, Suleiman M, Urazova S, Rakhmetova N, Turebayev D, Keulimzhayev N, Zhankina R, Khairli G. Autologous testicular tunica vaginalis graft in Peyronie's disease: a prospective evaluation. Int Urol Nephrol 2022. [PMID: 35503401 DOI: 10.1007/s11255-022-03223-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Peyronie's disease (PD) is a two-phase progressive condition characterized by inelastic plaques in the tunica albuginea of the penis, leading to curvature of the penis. Men with PD also suffer from psychological distress, and sexual life and overall quality of life. Although the preferred surgical treatment modality in Peyronie's disease is plaque incision and grafting, there is lack of studies assessing the erectile function and penile vasculature after the treatment. OBJECTIVES We aimed to evaluate the efficiency and safety of plaque incision and tunica vaginalis of testis grafting in PD. METHODS This was a prospective analysis. Erectile dysfunction was assessed via International Index of Erectile Function Questionnaire (IIEF-5). Penile Doppler ultrasound was performed to assess peak systolic velocity (PSV) and end-diastolic velocity (EDV). Postoperative follow-ups were scheduled at 3, 12, and 24 months. RESULTS Twenty patients (mean age 47.2 ± 10.8 years) were included. The mean preoperative penile curvature was 48 ± 6.6°. The technical success rate was 100% at 3 months and 90% at 24 months. At follow-up visits, mean erect penile length was no different from the baseline. The baseline mean IIEF-5 score was 18.4 ± 2.5. The mean IIEF-5 score was 20.6 ± 2.6 at 24-month visit (p < 0.0001). Mean PSV significantly increased, while EDV significantly reduced after surgery. There were no serious complications related to surgery. CONCLUSIONS We conclude that surgical reconstruction of penile curvature with tunica vaginalis grafting was a safe and effective procedure in PD.
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Ainayev Y, Zhanbyrbekuly U, Gaipov A, Suleiman M, Kadyrzhanuly K, Kissamedenov N, Zhaparov U, Akhmetov D, Khairli G. Surgical Reconstruction of Penile Curvature due to Peyronie's Disease by Plaque Incision and Buccal Mucosa Graft. J Sex Med 2021; 18:1308-16. [PMID: 34148821 DOI: 10.1016/j.jsxm.2021.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/06/2021] [Accepted: 04/16/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIM We aimed to evaluate the effectiveness and safety of penile plaque incision and buccal mucosa grafting in patients with stable-phase Peyronie's disease (PD). METHODS This was a prospective evaluation of patients with stable-phase PD who were treated by plaque incision and buccal mucosa grafting. Preoperative evaluation included International Index of Erectile Function Questionnaire (IIEF-5), measurement of erect penile length, and penile Doppler ultrasound during prostaglandin-induced erection. At 3- and 24-month follow-up visits, penile length and residual curvature were measured along with penile Doppler ultrasound and IIEF5 questionnaires. Patient and sexual partner satisfaction were also assessed at 24-month-visit. RESULTS The study was completed with 20 patients (mean age 46.5 ± 9.9 years). Dorsal curvature was the most frequent site of curvature (45%). The median curvature at preoperative evaluation was 45°(range 40-90°). The postoperative median curvatures were 5°(5-10, IQR) and 7°(5-10, IQR) at 3- and 24-month postoperatively, respectively. Success rate was 95% at 3-month and 90% at 24-month. There was no significant penile shortening. The mean IIEF-5 score was 17.5 ± 2.2 at preoperative evaluation. The median IIEF-5 scores were calculated as 20.1 ± 2.2 and 21.3 ± 2.2 at 3-month and 24-month visits, respectively (p<0.0001). Compared with baseline IIEF-5 score, both postoperative IIEF-5 scores were significantly higher. There was no de novo erectile dysfunction. There were no serious complications during and after the surgery. Ten percent of patients were poorly satisfied with the results of the surgery. CONCLUSION Corporoplasty with buccal mucosa graft led to excellent structural and functional results and patient satisfaction. Ainayev Y, Zhanbyrbekuly U, Gaipov A, et al. Surgical Reconstruction of Penile Curvature due to Peyronie's Disease by Plaque Incision and Buccal Mucosa Graft. J Sex Med 2021;18:1308-1316.
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Spinoit AF, Sinatti C, Lambert E, Pauwaert K, Verla W, Van Laecke E, Hoebeke P. How I do it: Buttonholing the preputial hood in hypospadias repair-related ventral skin shortage. J Pediatr Urol 2021; 17:332-4. [PMID: 33707131 DOI: 10.1016/j.jpurol.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/16/2020] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 11/20/2022]
Abstract
Gaining an esthetical skin coverage can be challenging in some hypospadias repair cases, especially in those with significant ventral skin paucity. A local institutional technique used to correct ventral skin paucity in hypospadias is described. It consists of a redistribution of the abundant dorsal skin and its hooded prepuce to the ventral side of the penis where skin shortage is observed. Reallocation of the skin is performed by buttonholing the dorsal skin to the ventral side. This versatile technique can be adapted to most penile surgeries where some ventral skin paucity is observed.
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Oetzmann von Sochaczewski C, Gödeke J, Muensterer OJ. Circumcision and its alternatives in Germany: an analysis of nationwide hospital routine data. BMC Urol 2021; 21:34. [PMID: 33678182 PMCID: PMC7938535 DOI: 10.1186/s12894-021-00804-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/08/2020] [Accepted: 02/26/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND/PURPOSE Circumcisions are among the most frequent operations in children. Health service data on circumcision in the United States has documented an increase in neonatal circumcisions since 2012. We investigated whether a similar effect could be found in Germany, which does not endorse neonatal circumcision. METHODS We analysed German routine administrative data for operations conducted on the preputium in order to analyse the frequency, age distribution, and time-trends in hospital-based procedures on a nationwide basis. RESULTS There were 9418 [95% confidence interval (CI) 8860-10,029] procedures per year, of which 4977 (95% CI 4676-5337) were circumcisions. Age distributions were highly different between both circumcisions (van der Waerden's χ² = 58.744, df = 4, P < 0.0001) and preputium-preserving operations (van der Waerden's χ² = 58.481, df = 4, P < 0.0001). Circumcisions were more frequent in the first 5 years of life and above 15 years of age, whereas preputium-preserving procedures were preferred in the age groups between 5 and 14 years of age. The number of circumcisions and preputium-preserving operations decreased in absolute and relative numbers. CONCLUSIONS The increasing trend towards neonatal circumcision observed in the United States is absent in Germany. The majority of patients were operated after the first year of life and absolute and relative numbers of hospital-based procedures were decreasing. Other factors such as increasing use of steroids for the preferred non-operative treatment of phimosis may play a role. As operations in outpatients and office-based procedures were not covered, additional research is necessary to obtain a detailed picture of circumcision and its surgical alternatives in Germany. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Christina Oetzmann von Sochaczewski
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany. .,Sektion Kinderchirurgie, Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany.
| | - Jan Gödeke
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Oliver J Muensterer
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany.,Kinderchirurgische Klinik und Poliklinik, Dr. von Haunersches Kinderspital der Ludwig- Maximilians-Universität München, Munich, Germany
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8
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El Khoury A, Jensen JC, Pacioles T. Neoadjuvant chemotherapy and penile conservation in the management of Buschke - Lowenstein tumor, a case report. Urol Case Rep 2020; 29:101111. [PMID: 31908967 PMCID: PMC6938808 DOI: 10.1016/j.eucr.2019.101111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/06/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 11/26/2022] Open
Abstract
Buschke-Lowenstein tumor is a rare form of low-grade penile cancer. Its low prevalence amongst the population bars the establishment of a standardized treatment algorithm. We present a case of BLT that was managed with neoadjuvant chemotherapy followed by phallic sparing surgery.
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Affiliation(s)
- Anthony El Khoury
- St. George's, University of London, UK.,Marshall University, Joan C. Edwards School of Medicine, USA
| | - James C Jensen
- Marshall University, Joan C. Edwards School of Medicine, USA.,Edwards Comprehensive Cancer Center, USA
| | - Tony Pacioles
- Marshall University, Joan C. Edwards School of Medicine, USA.,Edwards Comprehensive Cancer Center, USA
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Alyami F, Ferandez N, Koyle MA, Salle JP. Keloid formation after pediatric male genital surgeries: an uncommon and difficult problem to manage. J Pediatr Urol 2019; 15:48.e1-48.e8. [PMID: 30206024 DOI: 10.1016/j.jpurol.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/13/2018] [Accepted: 08/01/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Penile and genital keloids are uncommon despite frequent surgeries in the genital area. Keloid scar pathogenesis is not well understood, and a uniform effective therapeutic regimen for keloids has not yet been established. In the present study, the clinical features and subsequent management in cases of severe keloid formation after pediatric genital surgery are described. METHODS A retrospective review of keloid cases that had developed after genital procedures between 2000 and 2017 was conducted. Pre-operative characteristics, operative procedures, postoperative management, and follow-up were reviewed for each case. All cases were managed by a multidisciplinary team that included plastic surgeons and dermatologists. RESULT Six cases developed genital keloids. The mean age at surgery was 5.6 years (± standard deviation 4.6 years). Procedures included phalloplasties, penile curvature correction, penoscrotal transposition, redo hypospadias repair, and circumcision. Treatment options included excision of the keloid ± topical steroid injections and postoperative use of silicone gel. Two cases of severe keloid lesions developed after using posterior auricular grafts. Ultimately, a successful outcome was achieved in all cases. CONCLUSION Genital keloids are rare and difficult to treat. Many therapeutic options are available with varying degrees of proven clinical success. As a result, pediatric urologists must be aware of advances in other fields such as plastic surgery and dermatology to treat and ideally prevent the occurrence of this serious complication.
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Affiliation(s)
- F Alyami
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Urology Division, Department of Surgery, King Saud University, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia.
| | - N Ferandez
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - M A Koyle
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - J P Salle
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Division of Urology, Sidra Medical and Research Center, Doha, Qatar
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Guler Y, Tatar Z, Ucpinar B, Erbin A. An epidermal cyst of the penis after distal hypospadias surgery: a case report. J Med Case Rep 2018; 12:378. [PMID: 30580759 PMCID: PMC6304758 DOI: 10.1186/s13256-018-1930-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 09/25/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022] Open
Abstract
Background Epidermoid cyst is a benign tumor that can occur anywhere in the body but is rarely seen in the penis. Congenital and previous penile surgeries have been reported to be involved in the etiology of the disease, which is usually asymptomatic. Here we describe a case of a patient with a penile epidermoid cyst, which occurred in the circumcision line on the left side of his penis, and urethral dehiscence following hypospadias surgery. Case summary A 3-year-old white boy who underwent primary distal hypospadias surgery 1.5 years ago presented with a slowly growing mass in the left ventrolateral portion of the penile circumcision line and urethral dehiscence. The histology of the excised mass revealed an epidermal inclusion cyst. Since then, he has remained healthy. Conclusions Epidermal inclusion cyst as a complication of hypospadias surgery is a very rare situation. The diagnosis is made histologically and surgical excision is sufficient for treatment.
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Affiliation(s)
- Yavuz Guler
- Department of Urology, Safa Hospital, Istanbul, Turkey.
| | - Zeynep Tatar
- Department of Pathology, Patomer Pathological Cytological Research Center, Istanbul, Turkey
| | - Burak Ucpinar
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
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Abstract
INTRODUCTION With the growing shortage of pediatric urological surgeons, it was our aim to streamline our system to get patients with less complex penile procedures performed in a timely manner. To do this, an advanced practice provider (APP) was trained to perform minor penile procedures in children in the operating room(OR). OBJECTIVES The goal of our study was to show that with proper training an APP could safely perform a circumcision in the OR. STUDY DESIGN After approval of the study center's credentialing committee, a NP was trained to perform revisions and initial circumcisions in children in the OR. The process involved: (1) observation, (2) first assisting and (3) performing the procedure with direct, and later in-direct, supervision. The first 100 cases were evaluated for surgical complications, post-operative complications and return rates to the OR. RESULTS 100 independent cases were completed with 90 having only in-direct supervision. There were no operative complications, nor any documented emergency room or urgent care visits in the immediate post-operative period. There were no early returns to the OR and only 1 scheduled follow-up procedure for a penile skin bridge. DISCUSSION It was demonstrated that with proper training a NP can safely perform minor penile procedures in the OR. This allows us to free up our pediatric urology physicians to see and operate on more complex pediatric urology problems. In addition, it allows those with minor penile issues to be cared for more expeditiously. A concern related to training NPs to do circumcisions could be the loss of control by urologists. In this situation, the attending physician is ultimately responsible from a medico-legal standpoint. That would not be true if the NP was practicing independently. With a shortage of urologists, this significantly expands the ability to care for our patient population. In additional, attending surgeons will have a greater freedom to perform major procedures. A limitation of the study was that a patient satisfaction survey was not obtained to see if there were concerns over a APP doing their circumcision. Personal feedback on 30 of the patients that did not return for the follow-up visit was not obtained. The authors of the study are primary providers of pediatric urology care in the study region, thus any individual with concerns would have been referred. CONCLUSIONS It was demonstrated that a well-trained APP can safely perform minor penile procedures independently in the OR with indirect supervision.
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Affiliation(s)
- K M Giramonti
- Albany Medical Center Division of Urology, 23 Hackett Blvd, Albany, NY, 12208, USA.
| | - B A Kogan
- Albany Medical Center Division of Urology, 23 Hackett Blvd, Albany, NY, 12208, USA.
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Lightfoot MA, Kirsch AJ. Spiral nesbit plication: A simple method for simultaneous correction of penile torsion and chordee ("spiral chordee"). J Pediatr Urol 2018; 14:468-70. [PMID: 29936033 DOI: 10.1016/j.jpurol.2018.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/24/2018] [Accepted: 05/20/2018] [Indexed: 11/20/2022]
Abstract
Penile torsion and chordee may be corrected by a variety of techniques; however, when corporal body disproportion is involved plication may be necessary. Herein we describe a technique of placing oblique plication sutures to simultaneously correct both conditions, which we term "spiral chordee". The spiral Nesbit plication (SNP) has been performed on 21 boys at our institution. Median preoperative penile torsion and chordee were 49° (range 30-90°) and 35° (range 15-60°) respectively. Surgical success was 84.6% with two patients exhibiting mild residual chordee (15°) requiring no further treatment. This technique provides a simple and effective surgical option for correction of spiral chordee.
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Yao A, Ingargiola MJ, Lopez CD, Sanati-Mehrizy P, Burish NM, Jablonka EM, Taub PJ. Total penile reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2018; 71:788-806. [PMID: 29622476 DOI: 10.1016/j.bjps.2018.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 01/28/2018] [Accepted: 02/03/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Phalloplasty poses a unique challenge to the plastic and reconstructive surgeon. The development of advanced microsurgical techniques has greatly augmented the range of surgical approaches available. METHODS A systematic review of the MEDLINE and Cochrane databases was performed to identify clinical studies of total penile reconstruction published within the last 10 years using the search algorithm: "(phallus or penis or penile) and (reconstruction or phalloplasty or transplant)". RESULTS The primary literature search retrieved 1400 articles. After applying inclusion and exclusion criteria, 30 studies were selected for review. The radial forearm free flap is the preferred technique for total phalloplasty; however, other techniques including the fibular osteocutaneous flap, anterolateral thigh flap, latissimus dorsi flap, scapular free flap, and abdominal flap are described. Background, indications, and preoperative and postoperative care are also discussed. CONCLUSIONS Total penile reconstruction can provide functional, aesthetic, and psychosocial benefits to the patient. Use of the radial forearm free flap has been proposed as the gold standard; however, the wide range of potential complications associated with phalloplasty warrants an individualized approach to each patient.
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Affiliation(s)
- A Yao
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M J Ingargiola
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - C D Lopez
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - P Sanati-Mehrizy
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - N M Burish
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - E M Jablonka
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - P J Taub
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Boscarelli A, Frediani S, Ceccanti S, Cervellone A, Pesce MV, Cozzi DA. Fire in the Operating Room During Hypospadias Repair. Urol Case Rep 2017; 15:23-25. [PMID: 28924559 PMCID: PMC5591388 DOI: 10.1016/j.eucr.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/02/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
Fire in the operating room (OR) is a very distressful and shocking occurrence with potential dramatic consequences. Despite safety rules and rigorous recommendations, such unintentional events do occur every so often. Notably, the vast majority of cases have been reported in the adult population, with very few pediatric cases described to date. Herein, we report on a 16-month-old boy undergoing reconstructive surgery for penoscrotal hypospadias, who experienced an OR fire most likely related to the use of alcohol-based solution ignited by monopolar electrocautery.
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Affiliation(s)
- Alessandro Boscarelli
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM, 00161, Italy
| | - Simone Frediani
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM, 00161, Italy
| | - Silvia Ceccanti
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM, 00161, Italy
| | - Alice Cervellone
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM, 00161, Italy
| | - Maria Vittoria Pesce
- Department of Anesthesiology, Critical Care and Pain Medicine, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM, 00161, Italy
| | - Denis A Cozzi
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, RM, 00161, Italy
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