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Pang KH, Haider A, Freeman A, Hadway P, Bunker C, Muneer A, Alnajjar HM. A diagnosis of syphilis following a radical circumcision for suspected penile cancer. Ann R Coll Surg Engl 2024. [PMID: 38563065 DOI: 10.1308/rcsann.2022.0143] [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] [Indexed: 04/04/2024] Open
Abstract
We present a case of a 70-year-old gentleman who was referred to our tertiary 2-week-wait penile cancer clinic with a penile mass that was ulcerated, painful and discharging. This was suspicious for penile cancer and a radical circumcision was performed to remove the diseased foreskin en bloc with the lesion that was arising from the inner foreskin. Histopathology did not reveal cancer; however, we identified spirochaetes in keeping with syphilis. This was confirmed on serology. The patient was referred to the genitourinary medicine team and treated with antibiotics. This case demonstrates a rare presentation of genital syphilis in an elderly gentleman initially referred with concerns of penile cancer. Although, rare, especially in this age group, syphilis should be considered as a differential diagnosis in a patient presenting with an ulcerated, discharging, firm penile mass, especially given that the incidence of syphilis has been rising in recent years.
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Affiliation(s)
- K H Pang
- University College London Hospitals NHS Foundation Trust, UK
| | - A Haider
- University College London Hospitals NHS Foundation Trust, UK
- University College London, UK
| | - A Freeman
- University College London Hospitals NHS Foundation Trust, UK
- University College London, UK
| | - P Hadway
- University College London Hospitals NHS Foundation Trust, UK
- University College London, UK
| | - C Bunker
- University College London Hospitals NHS Foundation Trust, UK
| | - A Muneer
- University College London Hospitals NHS Foundation Trust, UK
- Division of Surgery and Interventional Science, University College London, UK
| | - H M Alnajjar
- University College London Hospitals NHS Foundation Trust, UK
- Division of Surgery and Interventional Science, University College London, UK
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Kravvas G, Muneer A, Watchorn R, Castiglione F, Haider A, Freeman A, Hadway P, Alnajjar H, Lynch M, Bunker C. 234 Male genital lichen sclerosus, micro incontinence and occlusion: Mapping the disease across the prepuce. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Schifano N, Castiglione F, Rewhorn M, Hadway P, Nigam R, Rees R, Alnajjar H, Muneer A. Inguinal lymphadenectomy for penile cancer using a fascial sparing technique -outcomes from a single centre. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00767-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wardak S, Castiglione F, Lindsay J, Alifrangis C, Walkden M, Hadway P, Nigam R, Rees R, Alnajjar H, Muneer A. Management of indeterminate Small Testis Masses (STMs): A 10-year single centre experience. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pozzi E, Cakir O, Castiglione F, Schifano N, Hadway P, Nigam R, Rees R, Albersen M, Parnham A, Lau M, Alnajjar H, Vijai S, Muneer A. Long term outcomes of Dynamic Sentinel Lymph Node Biopsy (DSNB) for clinically impalpable (cN0) penile cancer patients- an eUROGEN study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01044-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alnajjar H, Rewhorn M, Castiglione F, Cayetano Alcaraz A, Schifano N, Akers C, Haider A, Freeman A, Hadway P, Nigam R, Rees R, Mitra A, Alifrangis C, Muneer A. Long-term outcomes of Penile Squamous Cell Carcinoma (SCC) patients with sarcomatoid variant compared to non-sarcomatoid group - An eUROGEN study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Alifrangis C, Lee A, Fernando S, Cakir O, Koliou P, Lerner A, Forgenie J, Akers C, Harland S, Freeman A, Walkden M, Hadway P, Alnajjar H, Muneer A, Mitra A. 784P Perioperative multimodality treatment in high-risk node-positive penile cancer: A single institution study of patients treated in a supraregional centre. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pozzi E, Cakir O, Hadway P, Nigam R, Freeman A, Alnajjar H, Muneer A. Predictive factors for local recurrence (LR) and cancer-specific survival (CSS) – an eUROGEN risk stratification for grade 2 and grade 3 tumours. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32754-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Payne SR, Fowler S, Mundy AR, Alhasso A, Almallah Y, Anderson P, Andrich D, Baird A, Biers S, Browning A, Chapple C, Cherian J, Clarke L, Conn I, Dickerson D, Doble A, Dorkin T, Duggan B, Eardley I, Garaffa G, Greenwell T, Hadway P, Harding C, Hilmy M, Inman R, Kayes O, Kirchin V, Krishnan R, Kumar V, Lemberger J, Malone P, Moore J, Moore K, Mundy A, Noble J, Nurse D, Palmer M, Payne S, Pickard R, Rai J, Rees R, Roux J, Seipp C, Shabbir M, Saxby M, Sharma D, Sinclair A, Summerton D, Tatarov O, Thiruchelvam N, Venn S, Watkin N, Zacherakis E. The logistical management of tertiary urethral disease in the United Kingdom: Implications from an online audit of male reconstructive urethral surgery. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415819894182] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons. Methods: Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups. Results: More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures. Conclusion: Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology. Level of evidence: Level IV
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Affiliation(s)
| | - Sarah Fowler
- British Association of Urological Surgeons, London, UK
| | - Anthony R Mundy
- University College London Hospitals NHS Foundation Trust, London, UK
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Mount C, Muneer A, Hadway P, Akers C, Malone P. PS-7-2 Closure of Urethrocutaneous Fistulas Caused by Male Genital Piercing Using the PATIO Repair. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Barrett LK, Hadway P, Waghorn DJ. Urosepsis after transrectal ultrasonography-guided prostate biopsy: reaudit following a shortened antibiotic prophylaxis regimen. J Antimicrob Chemother 2013; 68:2959-60. [DOI: 10.1093/jac/dkt277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Williamson DA, Barrett LK, Rogers BA, Freeman JT, Hadway P, Paterson DL. Infectious Complications Following Transrectal Ultrasound-Guided Prostate Biopsy: New Challenges in the Era of Multidrug-Resistant Escherichia coli. Clin Infect Dis 2013; 57:267-74. [DOI: 10.1093/cid/cit193] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Blick C, Hadway P, Patel N, Lal S, Kelleher JP, Haldar N, Muneer A. The use of a multimodal enhanced recovery program for patients undergoing radical cystectomy. Journal of Clinical Urology 2013. [DOI: 10.1177/2051415813480776] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Radical cystectomy is a major oncological procedure, which is associated with a morbidity rate of 30% and a hospital stay of approximately 15 days. The aim of this study was to examine the effect of a multimodal enhanced recovery program on the post-operative recovery period. Patients: Forty-six patients underwent radical cystectomy for invasive or high-grade bladder cancer with curative intent at a single urology unit between June 2005 and March 2009. All patients were placed on an enhanced recovery pathway, which included a change in the surgical technique and alterations in pre-, peri- and post-operative management. The main outcome measures were length of stay, time to full diet, transfusion requirement, complications and readmission rates. Results: The median length of stay in this unit was reduced from 17 to eight days (range 6–22). There were five major complications and a readmission rate of 10.6%. Transfusion rates were not affected and there were no deaths within three months of surgery. Conclusions: We have demonstrated that this multimodal pathway, which also utilises a modification in the surgical technique, is both feasible and effective in order to improve the post-operative recovery and shorten hospital stay.
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Affiliation(s)
- C Blick
- Department of Urology, Wycombe General Hospital, UK
| | - P Hadway
- Department of Urology, Wycombe General Hospital, UK
| | - N Patel
- Department of Urology, Wycombe General Hospital, UK
| | - S Lal
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, UK
| | - JP Kelleher
- Department of Urology, Wycombe General Hospital, UK
| | - N Haldar
- Department of Urology, Wycombe General Hospital, UK
| | - A Muneer
- Department of Urology, University College London Hospitals NHS Foundation Trust, UK
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Crawshaw JW, Hadway P, Hoffland D, Bassingham S, Corbishley CM, Smith Y, Pilcher J, Allan R, Watkin NA, Heenan SD. Sentinel lymph node biopsy using dynamic lymphoscintigraphy combined with ultrasound-guided fine needle aspiration in penile carcinoma. Br J Radiol 2009; 82:41-8. [PMID: 19095815 DOI: 10.1259/bjr/99732265] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The purpose of this study was to assess the utility of sentinel lymph node lymphoscintigraphy (SLNL) and ultrasound-guided fine needle aspiration cytology (FNAC) in patients with penile carcinoma. A prospective study was undertaken of 64 patients with stage T1 (or greater) clinically N0 squamous cell carcinoma of the penis. Patients underwent SLNL and bilateral groin ultrasonography with or without FNAC. Following intradermal blue dye, patients underwent unilateral or bilateral sentinel lymph node excision biopsy (SNB). 17 patients had sentinel nodes that contained metastases (21 nodal basins). Lymphatic drainage was demonstrated in all patients by lymphoscintigraphy. Bilateral drainage was seen in 57/64 patients. 61/64 patients had ultrasonography of the inguinal basins on the same day as FNAC of 38 basins. FNAC showed malignancy in eight basins. FNAC was negative in six basins, which were subsequently shown to be positive following SNB. 82 inguinal basins did not warrant FNAC by ultrasound criteria, of which 5 contained metastases at SNB. The sensitivity and specificity of ultrasonography was 74% and 77%, respectively. The positive and negative predictive values were 37% and 94%, respectively. Two patients had a negative initial SNB; however, ultrasonography identified a metastatic node and re-evaluation of the sentinel node confirmed micro-metastases. There has been no evidence of recurrence in any patients with negative SNB (during 6-28 months' follow-up). In conclusion, when investigating clinically stage N0 penile cancer, the combination of SNB and groin ultrasonography, with or without FNAC, identifies accurately those with occult nodal metastases. Ultrasonography alone is not adequate as a staging technique, and SNB alone might miss between 5% and 10% of metastases.
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Affiliation(s)
- J W Crawshaw
- Department of Radiology, St George's Hospital, London, UK.
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Smith Y, Hadway P, Perry M, Corbishley C, Watkin N. MP-11.14. Urology 2006. [DOI: 10.1016/j.urology.2006.08.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Smith Y, Hadway P, Ahmed S, Perry M, Corbishley C, Watkin N. MP-11.12. Urology 2006. [DOI: 10.1016/j.urology.2006.08.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hadway P, Smith Y, Corbishley C, Heenan S, Perry M, Watkin N. MP-11.13. Urology 2006. [DOI: 10.1016/j.urology.2006.08.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hadway P, Lynch M, Corbishley CM, Mortimer PS, Watkin NA. Squamous Cell Carcinoma of the Penis in a Patient with Chronic Isolated Penile Lymphoedema. Urol Int 2006; 76:87-8. [PMID: 16401928 DOI: 10.1159/000089742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 04/26/2005] [Indexed: 11/19/2022]
Abstract
Squamous cell carcinoma arising in tissue affected by chronic lymphoedema is rare. We describe, to our knowledge, the first documented case of penile squamous cell carcinoma arising in a patient with a history of idiopathic chronic penile lymphoedema. Patients with chronic lymphoedema should be actively followed for possible malignant changes. We discuss the management and possible aetiology of this unusual case.
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Affiliation(s)
- P Hadway
- Department of Urology, St. George's Hospital, London, UK.
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Hadway P, Corbishley CM, Watkin NA. Re: Radiotherapy for basaloid carcinoma of the penis: a case report. J Urol 2005; 174:1501; author reply 1501-2. [PMID: 16145490 DOI: 10.1097/01.ju.0000173182.10232.f3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hadway P, Watkin NA. Re: How to avoid false-negative dynamic sentinel node procedures in penile carcinoma. J Urol 2005; 173:663; author reply 663. [PMID: 15643288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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