Dartos Research Articles

Correlation between histopathology properties of dartos tissue and the severity of penile curvature in hypospadias.

Hypospadias, one of the congenital anomalies commonly associated with some degrees of ventral penile curvature that may arise from malformation of dartos fascia, the chordee. Our study aims to determine the correlation between the histopathology properties of dartos fascia and the severity of ventral penile curvature in hypospadias. One hundred hypospadias patients with various degrees of ventral penile curvature were included in this cross-sectional analytical study from 2020 to 2022. During hypospadias repair, ventral dartos fascia was excised and analyzed for the degree of collagen thickness and the severity of the fibrotic condition. Out of 100 patients, the mean age was 6.58 + 4.28 years, who were classified as mild to moderate (66%) and severe (34%) ventral curvature cases. The analyses showed significant differences in the severity of fibrotic condition and collagen thickness of dartos fascia to the severity of penile ventral curvature with p-values of 0.002 and 0.017, respectively. The difference in histopathology properties of dartos fascia may affect the severity of penile curvature in hypospadias patients.

Reply to Editorial Comment on “Transsphincteric Repair of Rectourethral Fistulas in Combination With Dartos Muscle Flap Interposition Following Radical Prostatectomy”

Reply to Editorial Comment on “Transsphincteric Repair of Rectourethral Fistulas in Combination With Dartos Muscle Flap Interposition Following Radical Prostatectomy”

The effect of preoperative hormonal stimulation on the urethral plate; A histologic and histochemical study

Preoperative hormone stimulation (PHS) is used to increase the glans size and may improve the cosmetic appearance after hypospadias surgery. The exact effect of PHS on different penile tissues remains unclear and controversial. Previous studies showed that PHS increased vessel density in the foreskin. However, the effect of PHS on the urethral has never been studied before. In this study we examine the PHS effects on the urethral plate. Specimens of the urethral plate and the underlying tissue were excised to correct severe chordee in 16 children with proximal and perineal hypospadias with severe chordee in 2 groups. Group A consisted of 8 children received PHS prior to surgery. Group B included 8 children with proximal and perineal hypospadias with severe chordee who did not receive PHS and served as a control group. Specimens were examined blindly using hematoxylin-eosin and elastic van-Gieson stain as well as factor 8 and SMA antibodies. The median age of Group A was 13 (range 10-20) months. The median age of Group B (without prior PHS) was 17 (range 14-29) months (p=0,03). The median vessel-density in group A (82 vessels per mm2) was significantly higher than in Group B (65 per mm2), (p<0.05). The median vessel diameter was also significantly higher in Group A (13μm) than in Group B (11μm), (p<0.05). The median epithelial layer thickness in Group A was 110μm and in Group B 98μm, but showed no statistical significance (p=0,16). There was no significant change in dartos fascia layer thickness or androgen receptor expression. There was no visual change in the organization of elastic fibers. This study is the first study to document the effect of PHS on the urethral plate in hypospadias with severe chordee. PHS significantly increased the median vessel-density as well as median vessel diameter as compared to a matching control group. The findings of the study may justify PHS administration before the first operation to improve the vascularity and may reduce the severity of chordee.

Transsphincteric Repair of Rectourethral Fistulas in Combination With Dartos Muscle Flap Interposition Following Radical Prostatectomy

OBJECTIVETo present our experience with a novel technique that combines the York–Mason transsphincteric approach with dartos muscle flap interposition to treat rectourethral fistulas. METHODSWe extracted records from our prospectively kept database of 35 procedures conducted for treating rectourethral fistulas during 2002–2023; the York–Mason approach was combined with dartos muscle flap interposition in five cases, performed for treating rectourethral fistulas due to radical prostatectomy, all of which were referral cases. RESULTSAll five patients were successfully treated and followed up for a median of 70.0 months without recurrence. Before the fistula repair, all had a diverting stoma. In all cases, the first voiding cystourethrogram revealed a healed fistula. The posterior and the scrotal incisions healed uneventfully. All patients reported normal voiding and no urinary incontinence. To date, the stoma has closed in three patients, all of whom had intact fecal continence and no postoperative anal stenosis. CONCLUSIONThe transsphincteric modified York–Mason approach combined with dartos muscle flap interposition resulted in complete healing of rectourethral fistulas.

Observations on the anatomy of the funiculus spermaticus and the testis in Brachyteles sp. (SPIX, 1823) primates - Atelidae.

Analysing the literature about the reproductive anatomy on New World Primates, one can see the need of standardisation on the description methods and, more importantly, the lack of detailed information. The problem is aggravated by the difficult access to specimens of the endangered species such as Brachyteles sp. This paper's objective was to extend knowledge on the male reproductive anatomy of these primates. The testis and funiculus spermaticus of Brachyteles are described in detail. We utilised one individual of Brachyteles arachnoides, two hybrids (B. arachnoides × Brachyteles hypoxanthus) and photographs of the testis of a third fresh specimen of a hybrid individual. The septum formed by tunica dartos adheres to the testis and separates the scrotum in two testicular cavities. Passed the spermatic cord, the external spermatic fascia continues with the tunica dartos, covering the cranial half of the testis. The fascia cremasterica divides itself in bundles of fibres and forms loops around the testicles creating a sac like structure that seems to be unique among Neotropical Primates. The appendix testis is described for the first time in platyrrhini. It is presented as a sessile structure in the extremitas capitata of the testis. Previous literature on the reproductive anatomy of platyrrhini is limited. Despite that, it can be said that the large size and volume of the testis, and complex structure of the cremaster, could consist of a heat loss reduction strategy in cold and humid forest environments. Except for the larger size of the testicles in hybrid individuals, no other significant morphological differences were found between B. arachnoides and hybrids (B. arachnoides × B. hypoxanthus).

Result of simple versus layered repair of urethro-cutaneous fistula developing after hypospadias surgery

Background: Urethro-cutaneous fistula (UCF) after hypospadias surgery occurs regardless of the location of the meatus, procedure performed or experience of the surgeon. Hypospadias repair continues to be a singularly demanding form of surgical expression with considerable artistic latitude. The commonest complication of hypospadias surgery is fistula formation, which almost always requires repeat and similarly demanding surgery. Aims and Objectives: The aim of our study was to compare the result between simple and layered repair of UCF developing after hypospadias surgery. Materials and Methods: This comparative type of study was carried out in the Department of Paediatric Surgery, BSMMU, Dhaka from June 2015 to August 2016 for a period of 15 (fifteen) months. Forty (40) diagnosed cases of UCF were included in the study. All the participants were randomized into two groups named Group A &amp; Group B. Group A was assigned to the simple repair technique &amp; Group B was assigned to the layered repair technique. Relevant data were collected in a predesigned questionnaire. Results: The recurrent fistula formation rate was much higher in Group A (30%) than in Group B (05%), which was statistically significant in between the two groups. The majority of the fistulae recurred within a few days of the removal of the stent (from 7th to 10th POD). 6, out of 7 recurrent UCF were observed in this period. No recurrent fistula was observed beyond 4 weeks after operation. Conclusions: This study revealed that, the layered repair technique, with the addition of vascularized dorsal dartos fascia reduces the recurrent fistula formation rate in a significant number. Though more time consuming and technically difficult, we recommend wide application of layered repair technique in the management of post hypospadias UCF. Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 &amp; 2): 37-42

Fine scalpel surgery: preserving the dartos muscle in apatient with scrotal and perigenital giant Buschke-Löwenstein tumors.

Giant condyloma acuminatum (GCA), alternatively referred to as aBuschke-Löwenstein tumor (BLT), is an uncommon, benign, but locally aggressive form of verrucous carcinoma. The condition usually affects the male population under the age of50years; however, there have been rare reports of pediatric cases. Various risk factors such as smoking, diabetes, promiscuous behavior, poor hygiene, immunosuppression, and others are linked to the development of this condition. We present the case of a26-year-old male patient who came to the dermatology department with primary complaints of 10-year-old verrucous tumor formations located in the perigenital and perianal areas. Serological tests for AIDS, hepatitisB, hepatitisC, Chlamydia trachomatis, and syphilis were negative. The routine blood tests were slightly abnormal. Histological verification of condylomata acuminata of Buschke-Löwenstein was made. Given the sensitive areas, surgery was advised. With several fine undermining scalpel excisions, the lesions in the scrotal and perigenital areas were removed and the dartos muscle was preserved. Electrodissection and shave curettage were not performed. The postoperative period passed without complications and no recurrences in the perigenital area were reported. We believe that our case report represents the first documented surgical approach for scrotal Buschke-Löwenstein tumor using exclusively fine undermining scalpel surgery. Abrief literature review of the condition is presented, focusing on the currently available treatment options and highlighting the potential effectiveness of the surgical approach.

Evaluation of Smooth Muscle Myosin Heavy Chain Isoform Expressions in a Buried Penis

BackgroundA buried penis (BP) is rare in which the penile body is retracted into the prepubic adipose tissue. This research focuses on differences in smooth muscle myosin heavy chain (SMMHC) isoform expressions in the dartos fascia. MethodsA total of 82 children, 41 of whom had BPs, who applied for circumcision between May and November 2021, were included in the study. The cases were divided into four groups aged ≥6 years (NP6, n = 18) and aged ≤3 years (NP3, n = 17) with normal penile appearance, aged ≥6 years (BP6, n = 23) and aged ≤3 years (BP,n = 24) with a BP. SMMHC isoforms mRNA gene expression analyses were performed by quantitative PCR technique in dartos fascia obtained from foreskin removed by circumcision. ResultsCompared to the NP3 group, the SM1 mRNA expressed in the BP6 group was statistically significantly higher (p < 0.005). SM2 mRNA levels expressed in dartos fascia were considerably higher in NP6 and NP3 groups compared to BP6 and BP3 groups (p < 0.001). The SM2/SM1 ratio was 0.85 in the BP6 group and 1.46 in the NP6 group, which was statistically significant (p = 0.006) and increased from 0.87 in the BP3 group to 2.21 in the NP3 group (p < 0.001). ConclusionIn a buried penis, there is a difference in the expression of SMMHC isoforms. SM1 is highly expressed, while SM2 decreases, increasing the SM2/SM1 ratio. This causes increased contractility in the smooth muscle, leading to retraction of the penile body. The dartos fascia surrounding it resembles aberrant muscle tissue in boys with a BP. Level of EvidenceLevel III. Type of StudyCase-control study.

(170) Missed Urinary Leak During an Inflatable Penile Prosthesis Insertion Presenting as a Post-Operative Hydrocoele

Abstract Introduction This is a case of a revision of a three-piece penile prosthesis in a 53-year-old gentleman who had received an infrapubic implantable penile prosthesis (IPP) in Turkey over 12 months ago. He complained of an unsupported floppy shaft when the prosthesis was inflated, as well as a right hemi scrotal bulging which was exacerbated by activity but showed no signs of infection. A hydrocele had occurred 2 months following the IPP insertion and was confirmed on imaging. The MRI showed the pump within the hydrocele. He had previously had a laparoscopy gastric banding and a bilateral inguinal hernia repair with mesh. Objective Video to demonstrate the surgical case Methods This is a video demonstrating the steps of this operation. The procedure started with a transverse penoscrotal incision and dissection through the dartos muscle. The initial corporotomy allowed removal of the first cylinder of the prosthesis. Upon removing the right cylinder, the hydrocele was opened to reveal the presence of turbid fluid, 150ml of fluid was aspirated and sent for microbiology investigations. The next stage involved removal of the left cylinder and 7.5cm of rear-tip extenders (RTE) were subsequently removed intact, with further RTE from the right removed separately using a nasal speculum. Therefore, a 20cm IPP was removed with 7.5cm RTE on each side. An antibiotic salvage wash (Rifampicin/Gentamicin) was performed several times. At this point a 26cm + 1cm (13mm) malleable prosthesis was inserted as a spacer. The previous infrapubic wound was opened to remove the reservoir, 75ml of fluid was aspirated from around the reservoir prior to removal. Attempts are made to identify a possible fistula with flexible cystoscopy, but normal urethra, bladder neck and bladder are seen. Giving no evidence of any fistula into the abdominal cavity or urethral injury to explain fluid in the corporal cavities or around the components of the prosthesis. Methylene blue and distention were also used to attempt to identify a bladder leak, however this was also unremarkable. A suprapubic catheter was inserted to ensure the decompression of the urinary system to allow any small/undetected leaks to heal. This was done under direct vision using a cystoscope prior to being secured. Results The patient had a replacement of the inflatable penile prosthesis to a malleable prosthesis, a suprapubic catheter inserted and a drainage of his hydrocele. The patient recovered well from surgery and on examination the prosthesis tips were seated nicely in the glans. The fluid microbiology culture did not grow any organism. A subsequent cystogram showed no signs of any bladder leak. The patient was happy with the outcome and underwent a trial without catheter. He has a planned review and will be considered for an exchange to an inflatable device at this time. Conclusions This is an unusual presentation of a hydrocele, in the absence of any infective symptoms which is suggestive of a contained urine leak and even a missed bladder injury from the first prosthesis surgery. However, no fistula was found during the surgery or the post-operative cystogram. Disclosure No.

(188) Horizontal Plication and Reduction Corporoplasty for Penile Girth Discrepancy (Christmas Tree Deformity)

Abstract Introduction We present a case of severe Peyronie's Disease, described as the “Christmas tree deformity” due to its crescendo shaped proximal girth discrepancy. This very rare deformity and proposed surgical correction technique have only been described in the literature once beforehand. Objective To depict the surgical correction of the severe penile girth discrepancy in video format. Methods At the start of the case, artificial erection was performed, revealing significant girth discrepancy. The proximal base of the shaft measured 21.5 cm, mid shaft 18.5 cm, and distal shaft 12 cm (Image 1). A circumcising incision was made and a plane along Buck’s fascia developed. Using careful blunt and sharp dissection, left and right neurovascular bundles were carefully elevated and gently lifted to the midline to allow for plication suture placement laterally. An artificial erection was again created, revealing significant asymmetry with 9.5cm girth discrepancy between proximal and distal shaft. Plication sutures of 1-0 Ethibond were placed using a “1+1=2” dot horizontal plication pattern, starting at the base and progressing to mid shaft on both the left and right sides. Plication sutures were placed systematically until symmetric girth was confirmed using artificial erection. A TachoSil graft was then placed along the shaft to decrease likelihood patient would feel the numerous Ethibond sutures below and also improve hemostasis. Dartos fascia was then closed with a Vicryl suture and the circumcising incision closed in a running subcuticular fashion. Again, artificial erection showed drastic improvement in penile girth magnitude and symmetry. A penile block was performed and the penis was wrapped in Kerlix gauze and coban. Results The patient was discharged on the same-day of surgery with oral pain medications. He was seen back in follow-up at 8 weeks postoperatively at which time he endorsed an uneventful recovery and that he was once again able to have penetrative intercourse with his partner. Conclusions We are proud to report on the second known case of horizontal plication and reduction corporoplasty for correction of severe penile girth discrepancy, “Christmas tree deformity.” Despite a lack of available literature on the deformity and surgical technique, we believe it is a safe and effective treatment option for patients with this rare form of Peyronie's. Disclosure No.

Exploring Scrotal Leiomyomas, Unraveling the Mysteries of a Rare Tumor: A Case Report

Leiomyomas, originating from smooth muscle cells, are common in the uterus but rare in the scrotum, presenting a clinical challenge. Scrotal leiomyomas, first described in the 19th century, are characterized by benign pathology from the subcutaneous dartos muscle. We present two cases of middle-aged males with scrotal leiomyomas, detailing clinical presentations, histopathological findings, and immunohistochemistry results. The first involved a 48-year-old with a painless scrotal lump, excised to reveal well-circumscribed smooth muscle bundles. Immunohistochemistry confirmed vimentin, desmin, and smooth muscle actin (SMA) positivity, consistent with scrotal leiomyoma. The second case featured a 25-year-old with a painless scrotal swelling, histologically matching the features of scrotal leiomyoma. Accurate diagnosis is crucial for guiding appropriate management strategies. Clinicians often employ a combination of clinical evaluation, imaging studies, and histopathological examination to confirm the presence of scrotal leiomyomas. Ultrasound remains a valuable tool for assessing the size, location, and vascularity of the tumor, aiding in the formulation of a differential diagnosis. Definitive diagnosis, however, relies on histological examination, which typically reveals spindle-shaped smooth muscle cells arranged in interlacing bundles.

Correlation of Degrees Inflammation Tunica Dartos Chordae with Degrees for Penile Ventral Curvature in Hypospadias Patients

Correlation of Degrees Inflammation Tunica Dartos Chordae with Degrees for Penile Ventral Curvature in Hypospadias Patients

A comparative study on primary hypospadias repair using dartos fascia flap versus tunica vaginalis flap in paediatric age group

A comparative study on primary hypospadias repair using dartos fascia flap versus tunica vaginalis flap in paediatric age group

Surgical efficacy of tubularized incised plate urethroplasty applying for Buck's fascia coverage in the treatment of hypospadias

ObjectiveThe aim of this study was to compare the effectiveness of Buck's fascia and dartos fascia in covering the neourethra during tubularized incised plate urethroplasty (TIPU) for treating hypospadias in children. MethodsWe conducted a retrospective analysis of 100 cases of hypospadias treated with TIPU at the Department of Urology, Beijing Children's Hospital from January 2019 to September 2021. The cases were divided into two groups (A and B) based on the type of intraoperative neourethral covering used during surgery. Group A (n = 53) was covered with Buck's fascia, while group B (n = 47) was covered with dartos fascia. Two experienced surgeons performed the surgeries in their respective groups. We recorded general clinical data, intraoperative measurements, and postoperative follow-up data for both groups and analyzed the results statistically. ResultsThere were no significant differences in clinical data, such as mean age, urethral opening position, penile length, urethral plate width, urethral defect length, preoperative penile curvature and follow-up time (P > 0.05) between the two groups. However, group A had a wider glans and a lower proportion of dorsal tunica albuginea plication to correct penile curvature but a higher proportion of 6F catheters left in place (P < 0.05). c, group A reported 12 cases (22.6 %) of complications including eight cases (15.1 %) of urethral stricture and five cases (9.4 %) of urethral fistula; four cases were related to penile corporal fistula while one related to coronal fistula. On the other hand, group B reported 17 cases (36.2 %) of complications including three cases (6.4 %) of urethral stricture and fourteen cases (29.8 %) of urethral fistula; four cases were related to penile corporal fistula while one related to coronal fistula. A multifactorial analysis incorporating confounding factors revealed a lower incidence rate for urethral fistulas in group A compared to group B(P < 0 0.05). ConclusionThe application of Buck's fascia to cover the new urethra can effectively reduce the incidence of urethral fistula in TIPU, and the quality of Buck's fascia and suture tension should be taken into account to avoid the formation of urethral strictures.

(240) Penile Prosthesis Biofilms Harbor Bacteria, Viruses, and Protozoa, and Composition Differs by Device Type but Not Infection Status

Abstract Introduction The penile prosthesis is the gold standard surgical treatment for erectile dysfunction refractory to medical treatment, but a subset of individuals require device revision for mechanical failure, pain, erosion or infection. Clinical cultures have been used to demonstrate that both infected and non-infected explanted devices harbor bacteria. We hypothesized that penile prostheses generate complex adherent biological structures called biofilms that consistently harbor microbes, even in the absence of infection, and that their composition would differ by device type and infection status. Objective Using shotgun metagenomics, we sought to determine the biofilm composition of indwelling penile prostheses and compare them by device type and infection status. Methods Approval for this study was obtained from our institutional IRB, and informed consent was provided by all participants who underwent removal and replacement of a penile prosthesis for any indication. Prior to access of the device, the dartos fascia was swabbed as a control. Upon access of the device, instruments and gloves from the surgical team were changed to minimize contamination from the surrounding tissue. The device was explanted, and each component was analyzed in parallel. Device components were subjected to sonication, DNA extraction, and shotgun metagenomics. The curated reads were then compared to annotated databases of known bacterial, viral, fungal, and protozoal species. Metabolic pathway genes were identified and compared to KEGG pathways to generate a functional metabolic analysis. Results 19 devices (16 Boston Scientific; 3 Coloplast) were included in the study. Indications for removal were infection (n=4), pain (n=2), mechanical failure (n=11), and impending erosion (n=2). Of non-host derived reads, approximately 65% were prokaryotic, 15% viral, 15% protozoan, and no fungal in origin (Figure, left). Beta-diversity of bacteria (p=0.046, Figure, right), virus (p=0.04), non-human genes (p=0.02), and gene pathways differed by device type (p=0.04). Interestingly, none of these differed by infection status (p&amp;gt;0.05). Sulfur metabolism was commonly enriched throughout devices, indicative of anaerobic growth conditions. Sphingobacterium hotanense, and the flavin mononucleotide metabolism pathway, were enriched in the context of infection. After exclusion of the 4 devices explanted for infection, there were 16 differentially abundant prokaryotic taxa by device type including 4 Pseudomonas species. Biofilm and antibiotic resistance genes were commonly represented independent of device type or infection status. Conclusions Both non-infected and infected devices consistently harbored microbiota in the form of biofilms, which were rich in prokaryotic, viral, and protozoal taxa. Device type was a greater driver of variability than infection status. Our data suggest that different device types harbor variable affinity for microbiota. Mechanistic studies are needed to understand whether the identified microbiota might protect against or contribute to the risk of infection, pain or erosion. Disclosure No

Analysis of The Curative Effect of Tubularized Incised Plate Urethroplasty for Distal Hypospadias With The Dysplastic Corpus Spongiosum Covering Technique.

To investigate the use of tubularized incised plate (TIP) urethroplasty for distal second- and third-degree hypospadias to free the dysplastic forked corpus spongiosum and Buck's fascia, which are used as a covering material for the new urethra, thereby reducing the incidence of urinary fistula and other complications in the coronal sulcus. Clinical data of 113 patients with distal hypospadias treated with TIP urethroplasty from January 2017 to December 2020 were retrospectively analyzed. The study group comprised 58 patients (use of dysplastic corpus spongiosum and Buck's fascia to cover the new urethra), and the control group comprised 55 patients (use of dorsal Dartos fascia to cover the new urethra). All children were followed up for more than 12 months. In the study group, 4 patients developed urinary fistulas, 4 developed a urethral stricture, and no case developed glans fissure. In the control group, 11 patients developed urinary fistulas, 2 developed a urethral stricture, 3 developed a glans cracking. Using the dysplastic corpus spongiosum to cover the new urethra increases the amount of tissue in the coronal sulcus and reduces the incidence of urethral fistula, but it may increase the incidence of urethral stricture.

134 Late-gestation maternal overnutrition alters gene expression and histomorphology in neonatal foal testes

While obesity has deleterious effects on metabolism, performance, lameness, and health in mature horses, little is known about the impacts to reproductive health in foals from overfed dams. The objective of this study was to determine the effects of maternal overnutrition on neonatal foal testicular development. To test this, 16 Quarter horse mares were used in a completely randomized design and stratified by expected foaling date, body weight, and body condition score into one of 2 dietary treatments offered twice daily beginning on gestation d 235: control (CON; n = 8) fed to meet 100% of nutrient requirements and overfed (HIGH; n = 8) fed to 140% of nutrient requirements. At 5 h postpartum, foals were humanely euthanized, and testes were harvested, weighed, and stored for analyses. Testicular weight included the tunica dartos with the epididymis removed. RNA was extracted using the PureLink RNA Mini Kit (Life Technologies, Austin, TX) and submitted for RNA sequencing (Novogene, Sacramento, CA). Histomorphometric evaluations were performed using a hematoxylin and eosin stain. Ten 10X images per animal were analyzed using ImageJ software for individual seminiferous tubule (ST) area, ST number, and % area of STs per 10X field relative to interstitial tissue. Sertoli cell numbers were determined at 40X using 20 seminiferoustubules per animal. Data were analyzed using the MIXED procedure in SAS. Testes from HIGH male foals (n = 4; LSMeans ± SEM; 32.93 ± 1.93 g) were 61% larger than testes from CON male foals (n = 4; 20.50 ± 1.93 g; P < 0.01). RNA sequencing revealed 56 differentially expressed genes between HIGH and CON groups (P-adjusted <0.05). These genes represent biochemical pathways involved in oxidative phosphorylation, fatty acid metabolism, and thermogenesis, which are integral for testicular development and function. Gene ontology analyses revealed differential gene expression was associated with biological processes relevant to reproductive function and spermatogenesis, including cellular respiration and mitochondrial function. Histological analyses revealed no difference in individual ST area (P = 0.76) or Sertoli cell number within STs (P = 0.57); however, testes from CON foals had 2.3x more STs per 10X field (21.68 ± 2.48) than HIGH foals (9.35 ± 2.48; P = 0.01) along with STs representing a greater percentage of the image area relative to interstitial tissue (CON 3.66% ± 0.61%; HIGH 1.60% ± 0.61%; P = 0.05). These data from the neonatal foal indicate that late-gestation maternal overnutrition alters fetal testicular development with potential long-term implications.

Buried penis: a histological and histochemical study of dartos fascia.

This study aimed to determine whether the abnormal deep layer of dartos fascia plays an important role in buried penis. Forty-nine patients with buried penis were treated with anatomical resection of the deep layer of dartos fascia under a microscope. Penile length was measured before and after completely resecting the deep layer to investigate the role of this layer in penile retraction. The superficial and deep layers of dartos fascia were collected from 49 patients with buried penis, the normal superficial layers were collected from 25 children/adults who underwent circumcision for nonmedical reasons, and the normal deep layers were collected from 20 adult cadavers. The penile fascia samples were stained with hematoxylin-eosin, Masson's trichrome, Sirius red, and Verhoeff's Van Gieson, and subjected to immunohistochemical examination and scanning electron microscopy. The penile shaft (mean ± standard deviation) was found to be significantly elongated after resecting the deep layer compared with that before resection (6.8 ± 1.9 cm vs 6.0 ± 1.6 cm, P < 0.001). An abnormal deep layer of dartos fascia characterized by disordered and fragmented elastic fibers was observed in 87.8% (43/49) of buried penis samples, whereas no abnormal deep layer was observed in normal penises from cadavers (0/20, P < 0.001). Thus, the abnormal deep layer of dartos fascia plays an important role in the buried penis. Its resection is helpful for avoiding recurrence.

Concealed penis in pediatric age group: a comparison between three surgical techniques

BackgroundComparison between three different surgical techniques in the management of concealed penis.MethodsThis prospective interventional non-randomized study included 150 pediatric patients with a concealed penis. They were distributed equally into three groups; group A; patients treated by anchoring the penile skin dermis to Buck's fascia at the penile base at 3 and 9 o'clock points using PDS 5/0 (phallopexy), group B; patients treated by complete dissection and excision of dartos fascia and group C; patients treated by phallopexy as in group A after complete dissection and excision of dartos fascia. Follow-up at the end of the 1st post-operative week and then monthly for 6 months as regards penile skin congestion and/or necrosis, wound infection, edema, and/or re-retraction was carried out.ResultsPenile edema and re-retraction have a statistically significant difference among the studied groups (p < 0.001 and p = 0.002 respectively). Penile re-retraction was noticed to be lowest in patients of group C, however penile edema was observed to be highest in patients of group B.ConclusionsPhallopexy after complete dissection and excision of dartos fascia have better results than doing either phallopexy or dartos excision alone in the treatment of concealed penis.Clinical trial registration: The manuscript was registered in ClinicalTrials.gov Protocol Registration and Results System. ClinicalTrials.gov Identifier: NCT05565040. Our manuscript was registered on 4/10/2022.

Viabilidade da castração de cachaços por abordagem pré-escrotal: 30 casos

ABSTRACT: Since the first reports of boar castration, the anesthesia, surgery, and especially the restraint for surgical wound management of large and strong boars may be challenging. Most frequent complications include hemorrhage, excessive edema, infection, abscess, scirrhous cord, inguinal hernia, seroma, hematoma, and death. In order to diminish those complications, we hypothesized that the pre-scrotal approach would be a successful method for orchiectomy in boars and that the complication rate would be low, facilitating post-surgical handling on the commercial swine breeding farms by the owners or handlers. Therefore, the present study aimed to describe our experience performing castration in boars using a pre-scrotal approach on farm-setting. Thirty commercial-breed male boars (weighing 255-410kg) were submitted to dissociative anesthesia protocol and local anesthesia. An 8-10cm skin incision was made cranially to the hemiscrotum, and subcutaneous tissue was bluntly dissected, reaching the tunica dartos, fascia, and vaginal tunica. Mesorchium was bluntly dissected to separate, and a double size-0 transfixion ligature was placed around the spermatic cord that was sharply transected. The procedure was repeated on the contralateral testis using the same skin incision. Short-term complication was restricted to mild scrotal edema in 12 (40%) boars. No wound exudate, surgical site infection or death related to the surgery was recorded. On the long-term follow-up (≥4 months’ post-surgery), all owners stated that the boar was subsequently used as intended (slaughter after the proper boar taint withdrawal time) and their satisfaction with the low degree of difficulty in handling the post-operative care. Herein, the overall complication rate was considered low, the mortality rate was zero, and the pre-scrotal castration approach was successfully performed in all boars. These features confirm the technique as a safe procedure for orchiectomy in boars. Additionally, abolishing the daily dressing of surgical wounds required in open castration techniques, especially when surgical site infection occurs, may provide better welfare for the boars.