Appearance Of Penis Research Articles

Frenulum Protection Technique in Disposable Circumcision Suture Device for Adult Males.

To evaluate the efficacy of frenulum protection technique of the disposable circumcision suture device (DCSD) in adult males. Atotal of 53 adult males were diagnosed with redundant prepuce and underwent circumcision with DCSD using frenulum protection technique. The main preoperative and postoperative measure of the length of penile frenulum was evaluated. Other data such as edema rate, intraoperative blood loss, operation time, postoperative pain, staple falling off time, incision infection rate, and evaluation of satisfaction rate with penis appearance were documented in the study. There was no significant difference in preoperative and postoperative frenulum length for each patient. The mean length of the penile frenulum before and after surgery was 2.25 ± 0.36 cm and 2.23 ± 0.39 cm, respectively (p = .31). The rate of frenulum length preservation was 100%. All the patients had no excessive resection of the frenulum and no serious complication happened after surgery. The satisfaction rate of postoperative penis appearance from patients' evaluation was 98.1% (52/53). The frenulum protection technique was simple and operable, which could help the operator to accurately identify the most distal position of the frenulum and retain a sufficient length of frenulum during DCSD circumcision.

Male genital lichen sclerosus and associated symptoms range and severity: Results of a questionnaire study.

Male genital lichen sclerosus (MGLS) is a chronic inflammatory condition most often seen in uncircumcised men. It has an association with squamous cell carcinoma of the penis and causes significant morbidity in many men. It may present with a range of symptoms, notably male dyspareunia. The full range of symptoms in individuals has yet to be elucidated. To identify the range and severity of patient's symptoms using a questionnaire to quantify symptoms, including sexual function and urinary symptoms. Patients with MGLS were compared against patients diagnosed with other genital skin conditions (non-MGLS). Retrospective review of patients attending a specialist male genital skin clinic. A questionnaire, where symptoms were ranked between 0 (not present/no effect) and 10 (severe effect) was presented as part of the clinical assessment. Clinical diagnosis of MGLS or non-MGLS was made at the assessment. Sixty four patients attending the clinic completed the questionnaire, and 50 patients were diagnosed with MGLS. Splitting of skin (61.0%), soreness (61.0%), and unusual appearance or colour of penis (57.8%) were the most frequently reported physical symptoms in patients with MGLS. Non-MGLS patients reported these same symptoms in 35.7%, 35.7%, and 50.0% of cases respectively. Administering a simple numeric questionnaire for patients with MGLS has revealed multiple symptoms experienced by most patients. Scoring these symptoms allows the clinician to focus on the problems that most concern the individual patient, rather than just focussing on the physician's assessment of clinical disease.

Glans Anthropometry for Preputial Reconstruction in Hypospadias.

Cases of hypospadias present for poor stream or cosmetic appearance. The main aim is to provide a visibly normal phallus. Preputial reconstruction is technical. A properly planned reconstruction based on anthropometry may improve the result. We are presenting our experience of reconstruction based on glans anthropometry. The aim of the study was to evaluate the importance of glans anthropometry in preputial reconstruction in cases of hypospadias. All cases of hypospadias operated between June 2014 and March 2022 were included. Glans width was measured at the base. The marking sutures for preputial reconstruction were taken at distance thrice the glans width at base. Those requiring religious circumcision along with repair, associated significant chordee, catheter came out before 2 weeks, or history of any previous penile surgery were excluded. All the cases were subjected to urethroplasty, meatoplasty, and preputioplasty. The results obtained were analyzed. One hundred and forty-eight out of 159 cases formed the study group. There were 31 glanular, 42 distal penile, 58 mid-penile, and 17 proximal penile hypospadias. Mean glans width at base was 16 mm (range: 11-21 mm). Mean distance of marking suture at prepuce was 38 mm (range: 33-63 mm). Mean follow-up was 12 months (range: 1-36 months). Mean age at presentation was 23 months (range: 14-72 months). Mean operating time was 50 min (range: 45-60 min). Fistula at the base of preputioplasty was seen in four. Dehiscence of preputioplasty was seen in six. Meatal stenosis was seen in three cases. Preputial reconstruction improves the cosmetic appearance of the hypospadiac penis. Reconstruction based on glans anthropometry improves the result and avoids complications.

Fasciocutaneous foreskin twin flaps in hypospadias repair: Reconstructing a functional penis with freestyle design

Hypospadias is the most common congenital urological deformity in males; however, there is still no perfect solution or surgical method for one-stage operations to fix proximal hypospadias with ventral penile curvature (VPC). We developed a fasciocutaneous foreskin twin flap technique that can provide freestyle flap designs in hypospadias repair. A retrospective study including 26 patients was performed between January 2017 and June 2020. The surgical procedures included VPC correction, skin flap design, transfer and reconstruction. The urethra and shaft were reconstructed by twin flaps in one stage. All patients were followed up until 12 months. All VPC cases were corrected after the operation. The fistula rate was 11.5% (3/26). No meatal stenosis, urethral diverticulum, or stricture was observed. A total of 92.3% (24/26) of patients were satisfied with their penis appearance. The fasciocutaneous foreskin twin flaps provide freestyle designs in hypospadias repair, which can achieve a one-stage operation for proximal hypospadias with low fistula rates.

Update on the Penuma® an FDA-cleared penile implant for aesthetic enhancement of the flaccid penis.

The Penuma® implant is a medical-grade silicone implant surgically inserted subcutaneously to provide cosmetic improvement of the penile aesthetic. The principal author was invited to provide an update on the usage of the Penuma® implant for penile aesthetics. He collected as yet unpublished data, which is undergoing synchronous submission to Urologic meetings and peer-reviewed publications by a variety of authors for this communication. The objective of this article is to provide updated information regarding the Penuma® aesthetic penile implant. A new scrotal method of implantation named "concealed" is emerging. Through physician comparison of various factors prior to and after the scrotal method intervention, early findings suggest this approach seems to have less visible scar, is quicker and is followed by less seroma formation. As the device is now surgically implanted by surgeons other than its inventor, new developments have appeared authenticating the original published paper in 2018. Patients were contacted via phone and were asked five questions regarding satisfaction with the responses recorded. This new multicenter study shows findings of high patient and partner satisfaction coupled with acceptable adverse outcomes similar to the single-surgeon study. A new penile rehabilitation program has been developed with the aim for the penis appearance to be restored to its pre-operative state if the Penuma® is removed. 12 patients who underwent penile implant removal were followed for 6 months while participating in the penile rehabilitation program. The discipline worked in patients who desired removal for dissatisfaction and is currently under evaluation in patients who require device removal for medical reasons, e.g., infection or suture-related issues. Through new developments, the acceptance of Penuma® in the prosthetic community seems to be further solidified.

Comparison of Penile Appearance and Outcomes Between Prefabricated Urethra and Pre-implanted Urethral Plate for Treatment of Children With Severe Hypospadias: A Retrospective Study.

Objective: To compare the effect of prefabricated urethra and pre-implanted urethral plate in the treatment of severe hypospadias in children.Methods: We retrospectively analyzed the clinical data of 53 patients who diagnosed as severe hypospadias underwent staging urethroplasty from January 2015 to January 2018 in the Department of Pediatric Surgery, First People's Hospital, Zunyi City. The patients were divided into two groups: group A (n = 25) were treated with prefabricated urethra and group B (n = 28) were treated with pre-implanted urethral plate. After the second stage surgery, the ratios of complications such as urethral fistula, urethral stenosis, urethrocele, and recurrence chordee were compared. The penis was scored from meatus, glans, shaft skin, general appearance by the parents, blinded urologists according to The Pediatric Penile Perception Score, and the scores were compared too.Results: All patients were followed up after two stage operations for an average of 28 months. Glans dehiscence occurred in two patients (8%), urethral orifice stenosis occurred in one (4%) and urethral fistula occurred in three (12%) in group A. No urethral stenosis, urethrocele and recurrence chordee was observed. One patient presented urethral plate inactivation (3.6%), two patients presented urethral fistula (7.1%) and one patient presented urethral stenosis (3.6%) in group B. No urethrocele, glans dehiscence and recurrence chordee was observed. The total complication rate in group A was 24 and 14.3% in group B, respectively, and the difference was not statistically significant (P = 0.582). The differences between two groups scored by parents in glans (P = 0.030) was statistically significant. The differences between two groups scored by operators in meatus (P = 0.041), shaft skin (P = 0.000), glans (P = 0.001), and general appearance (P = 0.007) were statistically significant. The differences between two groups scored by counterparts in meatus (P = 0.006), shaft skin (P = 0.003), glans (P = 0.010), and general appearance (P = 0.014) were statistically significant.Conclusion: Both prefabricated urethra and pre-implanted urethral plate methods are suitable for correction of severe hypospadias as staging surgery in children. In general, pre-implanted urethral plate is more worthy of spread because it is much more applied in patients with small glans and achieve good appearance of penis.

The adolescent glans penis: Functional and aesthetic issues following childhood hypospadias repair

As children with childhood hypospadias repairs transition into adolescence, the function and appearance of the genitalia acquire greater importance. For some, the direction and shape of the urinary stream can be embarrassing if abnormal, and the appearance of the glans penis and meatus are a concern as they develop the capacity for self-awareness. Herein, we address the surgical correction and outcomes of urine spraying with or without fistulae, and cosmesis over 12 years. We also analyze if any specific prior repairs were more related to their complaints i.e. cosmesis, spraying, and/or fistulae. We retrospectively reviewed hypospadias revisions by a single surgeon over 12 years. We included adolescents and young adults who complained of abnormal urinary stream and/or aesthetic complaints. Patients then evaluated the post op result as very good, good, acceptable, or unsatisfactory. Of 542 patients who underwent revisionary procedures, 90 (16.6%) presented with complaints of urinary spraying, and appearance of the glans penis and/or meatus (see figure). Of these, 19 (21.1%) presented with aesthetic complaints alone, 37 (41.1%) presented with aesthetic complaints and spraying, and 34 (37.7%) presented with aesthetic concerns, spraying, and were noted to have urethral fistula either during preoperative examination or during surgery. 3/90 patients (3.3%) developed wound infection and dehiscence (one had a tubularized incised plate repair, another a Thiersch-Duplay repair, and the primary repair of the third patient was unknown). Adolescents and young adults who underwent hypospadias repair during childhood can return with concerns regarding functional and aesthetic abnormalities of the glans penis. Glans sculpting and meatal contouring may be utilized to normalize the urinary stream and achieve a normal aesthetic appearance of the glans penis. Surgeons should follow these patients through adolescence and into adulthood, because complications from hypospadias repairs acquire greater significance later and young adults seek to normalize their phalluses.

Penile Prosthesis Placement with Immediate Buried Penis Correction: A Retrospective Chart Review

Introduction: We present a case report on six patients who underwent a combined approach to improve the cosmetic appearance and functional performance of their buried penis. Aim: To report our combined approach to improve both buried penis and erectile dysfunction. Methods: In one surgery, we performed: a malleable penile prosthesis, ventral phalloplasty, and penile suspensory ligament release followed by a suprapubic lipectomy. Results: Postoperatively, all patients had an increase in penile length and were able to achieve successful penetrative intercourse. The average difference between the pre-operational and post-operational flaccid length of our six patients was 3.5 cm ± 1.38 (range, 1.9 to 5.08 cm). Conclusion: This case series serves as successful examples of using a combined approach in one stage to not only improve the cosmetic appearance of a buried penis but also address erectile dysfunction.

Comparison of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in treatment of complete concealed penis

To evaluate the effectiveness of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in the treatment of complete concealed penis. The clinical data of 46 children with complete concealed penis between January 2016 and January 2018 were analyzed retrospectively. Among which, 25 cases were treated with pedicled skin flap of foreskin for phalloplasty (group A) and 21 cases were treated with Sugita surgical method (group B) with an average age of 4.7 years (range, 2 years and 8 months to 11 years). At 3 months after operation, the concealed penis recovery was scored from three aspects of postoperative penis length (the difference of the penis length between at 3 months after operation and before operation), penis appearance, and skin appearance (the total score was 10). And the parents evaluation of satisfaction degree of penis exposure, penis appearance, and foreskin appearance after surgical correction was collected. Eighteen cases (72.0%) in group A and 15 cases (71.4%) in group B were followed up with an average of 13 months (range, 3-36 months). The incisions healed well in both groups, and there was no flap dehiscence, infection, necrosis, and penile erectile dysfunction. The penile length of the two groups increased significantly at 3 months after operation ( P<0.05); there was no significant difference between the two groups in terms of penis length and increased length at 3 months after operation and score of increase penis length after operation ( P>0.05). No penile retraction occurred in the two groups. And there was no significant difference between the two groups in penis appearance score, but the penis appearance score, skin appearance score, and total score of group A were significantly better than those of group B ( P<0.05). At 3 months after operation, the satisfaction rate of penis exposure in group A and group B was 88.9% and 80.0%, respectively, with no significant difference ( χ 2=0.50, P=0.48); the satisfaction rate of penis appearance was 72.2% and 53.3%, and the satisfaction rate of foreskin appearance was 94.4% and 53.3%, respectively, and the differences were significant ( χ 2=5.13, P=0.03; χ 2=7.53, P=0.01). Both surgical methods are suitable for correction of complete concealed penis, and the penile length gets a satisfactory recovery. However, the lymphedema of the prepuce after Sugita surgical method is serious, which can easily lead to poor appearance of the penis after operation. In general, the effectiveness of pedicled skin flap of foreskin for phalloplasty is better than that of the Sugita surgical method.

Peyronie’s Disease and the Female Sexual Partner: A Comparison of the Male and Female Experience

BackgroundPeyronie’s disease (PD) is characterized by penile pain, deformity, and sexual dysfunction, often resulting in an impaired sexual experience and significant psychological bother for the patient. However, there are limited data on the impact of PD on female sexual partners (FSPs). AimTo compare the psychosexual experience of men with PD and their FSPs. MethodsWe retrospectively reviewed all prospectively enrolled men and their FSPs who presented for initial PD evaluation to our sexual health clinic from July 2018 to February 2020. All men completed a PD-specific survey and the PD questionnaire (PDQ). If the patient was accompanied by an FSP during initial evaluation, she completed the PDQ for Female Sexual Partners and Female Sexual Function Index. We further queried our database that included information on patient demographics and clinical characteristics. OutcomesThe main outcome of this study is retrospective comparison of responses with the PDQ and PDQ for Female Sexual Partners. ResultsData were available for 44 men with PD (median age, 56 years; interquartile range, 49–63) and their FSPs (median age, 54 years; interquartile range, 50–61). The majority of men presented in the chronic phase (35 of 44, 79.5%), and median objective composite curvature was 75° (interquartile range, 50–90°). Owing to PD, female and male partners reported similar difficulty with vaginal intercourse (VI) (74.3% vs 81.5%, P = .555), decreased frequency of VI (70.6% vs 85.2%, P = .228), and at least moderate discomfort/pain with VI (48.6% vs 33.3%, P = .232). FSPs were “very” or “extremely” bothered by the appearance of their partner’s erect penis less often than male partners (20.0% vs 59.3%, P < .001). FSPs were “very” or “extremely” bothered by their partner’s PD during VI less often than men with PD (32.3% vs 65.2%, P = .017). Few FSPs (22.9%) had “severe” or “very severe” concern with damaging their partner’s penis during VI. Clinical ImplicationsThe sexual experience for men with PD and their FSPs differs, thus emphasizing the importance of active engagement of both men with PD and FSP during initial PD evaluation. Strengths and LimitationsThis initial study draws data from a single, high-volume men’s health clinic with a limited sample size. Survey responses may have been shared by patients with PD and their FSPs. ConclusionPD impacts the sexual experience for both men and FSPs. A similarly large proportion of men with PD and FSP noted decreased frequency of and difficulty with vaginal intercourse. Yet, FSPs were less bothered by the appearance of the erect penis and the deformity during VI compared with men.Farrell MR, Ziegelmann MJ, Bajic P, et al. Peyronie’s Disease and the Female Sexual Partner: A Comparison of the Male and Female Experience. J Sex Med 2020;17:2456–2461.

A prospective study comparing modified foreskin reconstruction versus circumcision with tubularized incised plate urethroplasty for distal and mid penile hypospadias

In Asian countries and the Hispanic populations, parents of many hypospadias patient demands prepuce to be saved. Foreskin reconstruction is a technique for achieving the nearly natural appearance of hypospadias penis. In most distal and selected mid-penile hypospadias it may be performed. Numerous specialists, however, support circumcision for the concern that foreskin reconstruction may endanger the repair of urethroplasty leading to the risk of formation of fistulas. To evaluate the surgical complications and outcome of modified foreskin reconstruction (MFR) versus circumcision with tubularized incised plate urethroplasty for distal and mid penile hypospadias. This prospective comparative study included 80 children with distal and mid penile hypospadias treated from 2017 to 2019 in tertiary referral hospital. Group 1, n=40 underwent TIPU and MFR, and Group 2 included 40 patients for TIPU with circumcision. In group 1, patients ranged from 2.2 to 6.5 years (mean 4.6±1.52 years) and in group 2 ranged 2.6-7 years (mean 4.59±1.43 years). Specific to group 1 preputial edema was seen in 29 patients at 2nd weeks, completely disappeared by 8thweek. Retraction of prepuce was possible in 18 patients by 21 days and all but one by 6 months Foreskin wound gaping was seen in 1at day 12 postoperatively and was repaired subsequently. Meatal stenosis was seen in one in both group, responded to urethral dilation by 6 weeks. Three patients from group 1 and 2 from group 2 developed urethral fistula which was subsequently closed. The complication rate was not statistically significant. Secondary phimosis was not seen in this study. A wide preputial opening was achieved during reconstruction in all patients in group 1. One of the notable features, the absence of the prepuce, makes the patient conscious of the surgical procedure they had undergone. The specific complication of the preputial reconstruction is the presence of a non-retractile prepuce at the end of the surgery, secondary phimosis, preputial wound gaping, and dehiscence. In some patients, the distal portion of the prepuce becomes narrow, after vertical reconstruction. To prevent phimosis, the technique was improvised by taking transverse sutures in the distal part combined with midline approximation of the foreskin. This widens the preputial ring enabling smooth retraction of the reconstructed prepuce. TIPU with MFR is an effective procedure for distal and selected mid penile hypospadias without increasing urethroplasty complications.

Efficacy and safety of DSA-guided percutaneous sclerotherapy for venous malformations of penile region in children

ObjectiveTo describe the effectiveness and security of DSA-guided percutaneous sclerotherapy for venous malformations of penile region in children. MethodsA total of 9 cases children with penile venous malformations treated by DSA-guided percutaneous sclerotherapy from January 2017 to June 2018 were enrolled in this study. Local angiography was performed under DSA fluoroscopy, and the shape, extent and venous drainage of the tumor nest were judged. Then sclerosing agents (Pingyangmycin and Polidocanol) were selected according to the flow rate of angiography and treated by percutaneous injection under DSA monitoring. Imaging examination (MRI) was performed to evaluate clinical improvement. ResultsA total of 26 interventional sclerotherapy sessions were performed in 9 children, with an average of (2.3±0.5) sessions per case. After a mean follow-up of 7.3 months, 6 cases were cured, and 3 cases were in basic remission. There were 9 cases of temporary edema secondary to the treatment site and 3 cases of mild pain. No serious complications such as ulceration, hemorrhage, infection and dysfunction occurred in any patients. ConclusionDSA-guided percutaneous sclerotherapy for venous malformations of penile region in children is safe and effective, does not affect the appearance and function of penis, and is worthy of clinical promotion. Type of studyTreatment Study. Level of evidenceLevel IV, Case series with no comparison group.

Anxiousness and Distractibility Strengthen Mediated Associations Between Men's Penis Appearance Concerns, Spectatoring, and Sexual Difficulties: A Preregistered Study.

Men with penis appearance concerns are more likely to experience sexual difficulties because they engage in spectatoring (i.e., negative self-critical attentional focus during sex). This preregistered study investigated whether anxious and distractible personality traits make men with penis appearance concerns more likely to engage in spectatoring and, in turn, experience sexual difficulties. In a sample of 858 sexually active men in predominantly mixed-gender relationships, we replicated previous findings that penis appearance concerns were associated with greater spectatoring, and in turn greater problems with erection and orgasm. Additionally, our novel hypotheses that anxiousness and distractibility would strengthen these associations were partially supported. Anxiousness strengthened associations between penis appearance concerns and sexual embarrassment, and in turn was associated with greater reports of erectile and orgasmic difficulties. However, anxiousness did not strengthen the mediated associations between penis appearance concerns, self-focus, and erectile and orgasmic difficulties. Distractibility strengthened associations between sexual embarrassment and erectile difficulties, and in turn strengthened the mediated associations between penis appearance concerns, sexual embarrassment, and erectile difficulties. However, distractibility did not strengthen associations between sexual embarrassment and orgasmic difficulties, between sexual self-focus and erectile difficulties, nor between sexual self-focus and orgasmic difficulties. Implications for therapeutic treatments are discussed.

Clinical study of concealed penis correction surgery based on principle of midline symmetry

To investigate the effectiveness of concealed penis correction surgery based on the principle of midline symmetry. Between January 2016 and September 2018, 18 children with concealed penis were treated with correction surgery based on the principle of midline symmetry. All children were 3-12 years old, with an average age of 8.3 years. Physical examination showed that the penis was short; the penis body could not be exposed or be exposed too limited; the corpus cavernosum developed well. The pressure dressing was removed at 3 days after operation and the urethral tube was removed. The color of the glans, the swelling and congestion of penis and scrotum, and the blood supple of the prepuce flap were observed. The operation time ranged from 47 to 54 minutes, with an average of 50 minutes. All children were followed up 3 months after operation. There was no hemorrhage and necrosis of the glans and no infection or ischemic necrosis of the flap. All patients had different degree of prepuce edema at 3 days after operation, 5 patients still had prepuce edema at 2 weeks, and the prepuce edema in all patients subsided at 3 months. All penises were exposed well after midline symmetric anastomosis with no bulky prepuce and scrotum. The correction surgery based on the principle of midline symmetry can be used to correct the appearance of the concealed penis effectively.

MP33-20 PEYRONIE′S DISEASE AND THE FEMALE SEXUAL PARTNER EXPERIENCE

INTRODUCTION AND OBJECTIVE: Peyronie′s disease (PD) can result in significant penile deformity and psychological bother that impacts the patient sexual experience. Little is known about the effect of PD on female sexual partners (FSP). We compare the impact of PD on men to that of FSP. METHODS: We reviewed data on all men and their FSP presenting for initial PD evaluation to our sexual health clinic from 7/2018-9/2019. All men completed a detailed PD-specific survey and the Peyronie’s Disease Questionnaire (PDQ). If the patient was accompanied by a FSP during initial evaluation, she completed the PDQ for Female Sexual Partners (PDQ-FSP) and Female Sexual Function Index (FSFI). RESULTS: Data was available for 36 men with PD (median age 55 years; range 38-69) and their FSPs (median age 55 years; range 49-62). The majority of men presented in the chronic phase (28/36, 77.8%) with median PD duration of 12 months (range 2-180). Penile shortening was reported in 69.4% (25/36) with median subjective length loss of 2.5 cm (range 1-12 cm). Subjective erectile dysfunction associated with PD was present in 44.4% (16/36). Median objective composite curvature was 75° (range 25-150°). Hinge effect or penile instability was noted in 61.1% (22/36). Due to PD, female and male partners reported similar difficulty with vaginal intercourse (VI) (78.6% vs 89.5%, p=0.444), decreased frequency of VI (70.4% vs 84.2%, p=0.320), and at least moderate discomfort/pain with VI (42.9% vs 39.3%, p=1.000) respectively. FSP were ″very″ or ″extremely″ bothered by the appearance of their partner′s erect penis less often than male partners (14.3% vs 57.9%, p<0.001). FSP were ″very″ or ″extremely″ bothered by their partner′s PD during VI less often than men with PD (26.9% vs 58.8%, p=0.027). The minority of FSP (25.0%) had ″severe″ or ″very severe″ concern with damaging their partner′s penis during VI, while 32.1% had ″moderate″ concern. There was no association between either hinge effect, worsening composite penile curvature, or stretched penile length and FSP bother with erect penile appearance, decreased frequency of VI due to PD, difficulty with VI, discomfort with VI due to PD, bother by partner′s PD during VI, and concern for damaging the male partner′s penis during VI (p>0.05). CONCLUSIONS: PD impacts the sexual experience for both men and FSP. A similarly large proportion of men with PD and FSP noted decreased frequency of and difficulty with VI. Yet, FSP were less bothered by the appearance of the erect penis and the deformity during VI compared to men. These data can be utilized when counseling men and their FSP who present for PD evaluation. Source of Funding: None

Clinical Outcomes And Risk Factors In Patients Circumcised By Chinese Shang Ring: A Prospective Study Based On Age And Types Of Penile Disease.

PurposesTo explore the efficacy of circumcision with Chinese Shang Ring (CSR) in the different cohorts so that can obtain the best applicable population and manage complications better.MethodsThis study consisted of 657 patients who were circumcised with CSR in our institute between August 2017 and August 2018. All cases were followed up at post-operation for 3 to 15 months. The surgery time (ST), wound healing time (WHT), satisfaction with the appearance of postoperative penis and complications were collected and comparatively analyzed. Multivariate analysis was used to determine the independent risk factors associated with efficacy, which were presented by odd ratios and its 95% confidence index.ResultsAll cases wore the CSR successfully. The ST and WHT respectively were 5.75 ± 2.27 mins and 21.15 ± 5.05 days. The long-term complications, total complications (TC), satisfaction and successful circumcision (SC) respectively were 5.30%, 11.70%, 97.70% and 94.70%. For TC and SC, there was a difference between phimosis and redundant foreskin (21.30% vs 6.20%, P<0.001 and 89.20% vs 97.8%, P<0.001, respectively). In terms of satisfaction and SC, adolescents were higher than children (98.70% vs 94.70%, P=0.035 and 96.80% vs 90.10%, P=0.024, respectively) but was similar to adults (98.70% vs 100.00%, P=0.071 and 96.80% vs 98.00%, P=0.257, respectively). The degree of pain and the incidence of wound dehiscence in adults was higher than adolescents (P<0.05). The phimosis (OR= 1.47, 95% CI=1.26–1.79, P<0.001) and childhood (OR= 1.13, 95% CI =1.06–1.36, P<0.001) were associated with poor efficacy.ConclusionThe curative effect of circumcision by CSR in adolescents was similar to adults, both higher than that of children. However, adults have more severe pain and a higher probability of wound dehiscence in the later stage than adolescents. So, adolescence is probably the best time to be circumcised with CSR.

Use of small intestinal submucosa for corporal body grafting in cases of epispadias and epispadias/exstrophy complex

Male epispadias is a rare congenital urogenital anomaly in which the meatus is ectopically located along the dorsal midline of the penile shaft. In cases associated with severe curvature, functional and cosmetic outcomes could be accomplished by lengthening the shorter dorsal surface with the use of corporal grafting. Various graft materials have been used in the past for hypospadias repair including tunica vaginalis, dermis, and small intestinal submucosa (SIS). The use of SIS grafting for corporoplasty during epispadias repair has rarely been described in the literature. To report the experience in the management of dorsal corporal body grafting using SIS in children with severe penile curvature due to epispadias. The authors retrospectively reviewed the charts of all patients with epispadias or bladder exstrophy/epispadias complex and severe dorsal chordee (>40°) who underwent epispadias repair with single-layer SIS for corporal body grafting. Clinical variables, surgical technique, and outcomes were analyzed. A total of nine consecutive patients underwent staged epispadias repair with dorsal corporal single-layer SIS grafting (summary figure). Of these, four (44.4%) had primary penopubic epispadias, one (11.1%) had mid-shaft epispadias, and four (44.4%) had bladder exstrophy/epispadias complex. The mean age at surgery was 13.4±6 months. After phalloplasty with SIS grafting, there were no reported complications related to the graft during the post-operative period or follow-up visits. Although traditional techniques for epispadias repair allow some degree of corporal lengthening, they also result in abrupt medial rotation of the corporal bodies leading to torqueing and potential unsatisfactory cosmetic results. In contrast, the authors use single-layer SIS for corporal body grafting, and this study technique results in a more gradual inward rotation thus allowing more anatomical accuracy. Furthermore, an advantage of the use of SIS over other grafting materials is that there is no need to harvest an autologous graft such as tunica vaginalis or dermis. Epispadias repair using single-layer SIS corporal body grafting is an effective, safe, and feasible method, which provides satisfactory cosmesis and correction of dorsal curvature in congenital epispadias in children. Furthermore, a more normal penis appearance, without a decrease in the corporal length or diameter, is achieved with this technique.

OUTCOME OF HYPOSPADIAS SURGERY IN CHILDREN;

Background: Hypospadias is a field of continuous evolving surgery. The aim of surgical treatment is to restore the normal appearance and function of Penis. The outcome of surgery largely varies and depends upon type and severity of anomaly, associated factors, type of surgery performed and skills of surgeon. Study Design: Descriptive, prospective study. Setting: Department of Pediatric Surgery, Military Hospital Rawalpindi and Combined Military Hospital Lahore. Period: 07 years, from October 2010 to October 2017. Methods: Report and analyze the types of hypospadias, choice of surgery along with outcome of surgical repair. All patients operated for Hypospadias surgery were divided in three groups according to age for the purpose of convenience of data collection. Results: A total of 142 surgeries were done on 131 patients were operated (In 09 patient’s stage 2 was performed). Distal penile hypospadias was the most common variety. One stage repair was performed in 83 patients. Two staged repair was decided in 59 patients. Among them 09 are done with second stage urethroplasty. Urethrocutanous fistula was the most common complication in 31 patients followed by bleeding, blocked tube, urine leakage from meatus, splayed stream, wound infection, disrupted glans, torsion of penile shaft and meatal stenosis. Conclusion: Hypospadias surgery is a continuous learning process, one should master in one or two techniques with its intricacies. Meticulous preoperative assessment of anomaly, accurate selection of surgical procedure, proper tissue handling and vigilant follow up are required for good outcome and least complications.

Subcutaneous tissue-sparing dorsal slit with new marking technique: A novel circumcision method.

Circumcision is a very common surgical procedure that is performed for medical and traditional purposes in the world. However, many technical of circumcision is needed to improve. Thus, this study introduced a novel method of circumcision that is a refined version of the sleeve technique, termed subcutaneous tissue sparing dorsal slit with new marking, and evaluated the safety and efficacy of this novel method of circumcision.The randomized clinical trial included 93 adult patients with redundant foreskin or phimosis treated from May 2015 to March 2017. Patients were randomly divided into the novel circumcision method (n = 45) or conventional dissection (n = 48). The groups were compared regarding rates of intraoperative hemorrhage, operative time, pain, healing, satisfaction with penis appearance, and relevant adverse events.No patient suffered any obvious complication. Compared with the patients given conventional dissection, the patients who underwent the new surgical device experienced significantly less wound healing time, scar width, and recovery time (P <.05). The new method resulted in greater intraoperative bleeding volume and surgical time (P <.05). The rate of satisfaction with appearance of the penis was significantly higher in the group treated with the novel technique. In addition, the cost of surgery of these 2 methods was similar.Based on the above research, we found that subcutaneous tissue-sparing dorsal slit with new marking technique was an effective and safe procedure for circumcision, and deserved further application in clinical practice.

Spectatoring Mediates the Association Between Penis Appearance Concerns and Sexual Dysfunction

Men with penis appearance concerns are more likely to experience sexual dysfunction, but the processes underlying this association are unknown. This study investigated whether spectatoring (i.e., negative self-directed attentional focus during sex) mediates the association between penis appearance concerns and sexual dysfunction. Men in romantic relationships (N = 512, in predominantly mixed-gender relationships) reported on sex they had with their partner in the previous month. Indirect effects indicated that penis appearance concerns predicted greater spectatoring, and in turn predicted greater erectile and orgasmic dysfunction. Results suggest that spectatoring is a conduit through which penis appearance concerns impede sexual function.