External Meatus Research Articles

Discrepancy of the location of depression on the soft tissue and the bone in isolated zygomatic arch fracture.

When performing reduction of zygomatic arch fractures, locating the inward portion of the fracture can be difficult. Therefore, this study investigated the discrepancy between the locations of the depression on the soft tissue and bone and sought to identify how to determine the inward portion of the fracture on the patient's face. We conducted a retrospective review of chart with isolated zygomatic arch fractures of type V in the Nam and Jung classification from March 2013 to February 2022. For consistent measurements, a reference point (RP), at the intersection between a vertical line passing through the end point of the root of the ear helix in the patient's side-view photograph and a transverse line passing through the longest horizontal axis of the external meatus opening, was established. We then measured the distance between the RP and the soft tissue depression in a portrait and the bone depression on a computed tomography (CT) scan. The discrepancy between these distances was quantified. Among the patients with isolated zygomatic arch fractures, only those with a fully visible ear on a side-view photograph were included. Twenty-four patients met the inclusion criteria. There were four types of discrepancies in the location of the soft tissue depression compared to the bone depression: type I, forward and upward discrepancy (7.45 and 3.28 mm), type II, backward and upward (4.29 and 4.21 mm), type III, forward and downward (10.06 and 5.15 mm), and type IV, backward and downward (2.61 and 3.27 mm). This study showed that discrepancy between the locations of the depressions on the soft tissue and bone exists in various directions. Therefore, applying the transverse and vertical distances measured from a bone image of the CT scan onto the patient's face at the indicated RP will be helpful for predicting the reduction location.

One-stage repair of proximal hypospadias by in situ tubularization of the transverse preputial island flap

PurposeThis study aimed to compare the efficacy of modified transverse preputial island flap (TPIF) repair with the traditional TPIF procedure and Byar’s two-stage procedure in proximal hypospadias repair, especially in the postoperative urethral stricture incidence rates.Materials and methodsPatients admitted for proximal hypospadias treated with modified TPIF repair, the traditional TPIF procedure, or Byar’s two-stage procedure at our institution from 2017 to 2021 were identified, and the incidence of postoperative complications among them was compared.ResultsIn total, 142 patients were included (modified TPIF group, 43; traditional TPIF group, 37; and Byar’s two-stage group, 62). The length of the neourethra was 4.21 ± 0.63 cm in the modified TPIF group, 4.18 ± 0.71 cm in the traditional TPIF group, and 4.20 ± 0.68 cm in the Byar’s two-stage group. The rate of urethral stricture in the modified TPIF group (two cases, 4.65%) was significantly lower than that in the traditional TPIF group (four cases, 10.81%) (P = 0.008). Seven (16.28%) cases of urethrocutaneous fistula occurred in the modified TPIF group, six (16.22%) in the traditional TPIF group, and eight (12.90%) in the two-stage group. Additionally, one case (2.33%) of urethral diverticulum occurred in the modified TPIF group, one (2.70%) in the traditional TPIF group, and three (4.84%) in Byar’s two-stage group.ConclusionsModified TPIF repair can ensure a wedge anastomosis between the proximal urethral meatus and the neourethra, provide support and blood supply for the neourethra. Furthermore, it extended the urethral plate width at the anastomosis and urethral meatus, effectively reducing the incidence of urethral strictures.

Evaluation of the optimal sampling approach for HPV genotyping in circumcised heterosexual men with genital warts

BackgroundHuman papillomavirus (HPV) causes a serious socioeconomic burden globally. However, there is currently no consensus on the optimal sampling method for HPVDNA genotyping in circumcised heterosexual men. This study aimed to determine the diagnostic efficacy of 6 different anatomic sampling sites in HPV DNA polymerase chain reaction (PCR) testing of circumcised heterosexual men with genital warts. MethodsThe study included circumcised heterosexual men who presented to our clinic with complaints of genital warts. Swab samples were obtained from the penile shaft (PS), scrotum, coronal sulcus (CS), and external urethral meatus (EUM). First-void urine (FVU) and genital wart biopsy (GWB) were also tested for HPV DNA by PCR. ResultsA total of 32 patients (mean age: 36.9 ± 6.9 years) were included. None of the six samples studied was sufficient on its own to reveal all HPV types detected in a patient. When the samples were analyzed individually, GWB detected an average of 49.5% of total HPV types in a patient. This rate was 50.5% for PS, 40.4% for CS, 31.6% for scrotum, 26.3% for EUM, and 15.8% for FVU samples. The detection rate increased to 75.8% with combined testing of GWB and PS samples, 83.2% with GWB/PS/CS, 90.5% with GWB/PS/CS/scrotum, and 98.9% with GWB/PS/CS/scrotum/EUM samples. ConclusionNo single anatomic region or sample type can detect all HPV types present in circumcised heterosexual men by PCR assay. The detection rate approaches 99% when wart biopsy is combined with swab sampling of the penile shaft, coronal sulcus, scrotum, and external urethral meatus.

Normal Glanular and Meatal Measurements in Boys and Men

ObjectiveTo determine the normal vertical urethral meatus length (ML), maximum glanular width (MGW), the glanular seam length (between the lowest edge of urethral meatus and the glans closure line corona) (GSL) and GSL/ML ratio in all age groups. Materials and MethodsConsecutive patients presented to urology and pediatric urology outpatient clinics were included in the study. Penile abnormalities, known endocrinological disorders, history of penile/urethral surgery were excluded. MGW, ML, and GSL were measured with a caliper. Glanular and meatal measurements were compared according to ages. ResultsA total of 1398 boys and men (380 (27.18%) prepubertal (1-12), 203 (14.52%) adolescent (13-19), and 815 (58.30%) postpubertal (19-93)) with a median age of 31 years (range: 1-93) were included in the study. In consecutive age groups, ML and GSL gradually increased and became steady between 16-19 & 20-30 age groups and 10-12 & 13-15 age groups, respectively. On the other hand, MGW gradually increased until 20 years of age and became steady at median of 35 mm over 20 years of age. Another interesting finding was a rather stable GSL/ML ratio in all age groups. Pairwise comparison of different age groups seemed to be similar and suggests a fixed ratio of 1.33 (IQR: 0.6). ConclusionThe normal glanular and meatal measurements may guide the surgeons for better cosmetic results during hypospadias repair. The GSL/ML ratio appears to be a stable measure for all ages to achieve better cosmetic results.

Pediatric penile biometry guides the surgical outcome following tubularised incised plate urethroplasty for hypospadias: a single centre study

Background: In hypospadias urethral meatus opens onto the ventral surface of the penis proximal to tip of glans and its surgery is challenging. Recent focus of hypospadias surgery is on reduction of postoperative complications and objective assessment of penile anthropometry which can affect outcome. Aim of study was to assess the surgical outcome of tubularised incised plate urethroplasty on penile biometric parameters among children with coronal, distal penile and mid penile hypospadias. Methods: Study was conducted in the department of pediatric surgery in IPGMER and SSKM Hospital in Kolkata during November 2019 to October 2021. Results: Among 42 boys mean urethral plate length is 4.286 (coronal), 7.643 (distal penile) and 8.846 (mid penile), mean urethral plate width is 3.321 (coronal), 5.786 (distal penile) and 5.923 (mid penile), mean diameter at mid glans level is 4 (coronal), 5.071 (distal penile) and 5.923 (mid penile), mean diameter at coronal level is 5.75 (coronal), 6.429 (distal penile) and 6.769 (mid penile), mean stretched penile length is 39.2143 (coronal), 41.857 (distal penile) and 40.308 (mid penile) hypospadias respectively. P value is less than 0.05 for all except urethral plate depth which has a non-significant p value. Conclusions: Urethral plate length, urethral plate width, mid glans diameter, glans diameter at coronal sulcus level and stretched penile length affect the outcome of the surgical process TIP urethroplasty in coronal, distal penile and mid penile type hypospadias but urethral plate depth does not.

Neural network non-linear modeling to predict hypospadias genotype–phenotype correlation

Hypospadias is an abnormal development of the urethral, ventral skin and corporeal bodies. Urethral meatus and ventral curvature have been historically the landmarks to define clinical severity. Genotyping has never been explored as a clinical predictor. Available reports have demonstrated a correlation between genetic mutations and syndromic hypospadias with poor surgical outcomes. We hypothesize that inclusion of genotyping can serve at classifying all types of hypospadias. We present the use of neural network algorithm to evaluate phenotype/genotype correlations and propose its potential clinical applicability. A systematic review was performed from January 1974 to June 2022. Literature was retrieved from Medline, Embase, Web of Science and Google Scholar. Included manuscripts were those that had an explicit anatomical description of hypospadias phenotype (urethral meatus location following an anatomical description) and a defined genotype (genetic mutation) description. Cases with more than one variant/mutation were excluded. A comprehensive phenotype-genotype statistical analysis using neural network non-linear data modeling SPSS™ was performed. Genotype-Phenotype analysis was performed on 1731 subjects. Of those, 959 (55%) were distal and 772 (45%) proximal. 49 genes with mutations were identified. Neural network clustering predicted better for coronal (90%) and glanular (80%), and lowest for midshaft (22%) and perineal (45%). Using genes as predictor factor only, the model was able to highly and more accurately predict the phenotype for coronal and glanular hypospadias. The following genotypes showed association to a specific phenotype: AR gene n.2058G>A for glanular (p<0.0001), n.480C>T for coronal (p=0.034), R840C for perineal (p=0.002), MAMLD1 gene c.2960C>T for coronal (p< 0.0001), p. G289S for glanular (p<0.0001), gene SRD5A2 607G>A for scrotal (p<0.0001), c16C>T for penoscrotal (p<0.0001), c59T>c for perineal (p=0.042), V89L for midshaft and scrotal (p<0.0001, p=0.041; respectively). Hypospadias phenotype has always been described from a purely anatomical perspective. Our results demonstrate that current phenotyping has poor correlation to the genotype. Higher genotype/phenotype correlation for distal hypospadias proves the clinical applicability of genotyping these cases. The concept and classification of differences in sexual development needs to be reconsidered given high positive yield reported for distal hypospadias. Given the better predictive value of genotyping in correlation to the phenotype, future efforts should be directed towards using the genotype. Hypospadias has poor phenotype/genotype correlation. Sequencing all hypospadias phenotypes may add clinical value if used in association to other predictive variables. Neural network analysis may have the ability to combine all these variables for clinical prediction.

Tips and Tricks in the Management of Megameatus Intact Prepuce Variant of Hypospadias: A Review Article

Introduction: Hypospadias is congenital anomalies with various spectrum and variants, presenting with abnormal urethral meatus short of the native tip of the glans. megameatus intact prepuce is a rare variant of glanular hypospadias seen in about 3-6 % of hypospadias cases. The main features of megameatus intact prepuce are large urethral external meatus with deep with deeply grooved glans penis and the preputial skin is usually present and intact with no chordae. Seven named procedures for megameatus intact prepuce were discussed. Methodology: We use the following search engines for out study where we found the following articles and reviews as follows in Scopus search, we found 26 articles, in AJOL we there were 7 articles and in PubMed Central Search we found 32 articles, then in Google scholar the search revealed 388 articles, 45 articles were reviewed and summarised and 7 established procedures were discussed. Results: Seven named established procedures for megameatus intact prepuce variant of hypospadias were summarized and discussed and include Pyramid Procedure, Glanular Approximation Procedure, Tubularised Urethral Plate Urethroplasty, Tubularised Incised Urethral Plate Procedure, Mathieu Technique, Cutaneous advancement procedure and The Inframeatal Vascularised Flap Procedure. DISCUSSION: The Surgical procedures for repair of megameatus intact prepuce is technically challenging not only for the surgeon but the anesthethiogist alike because the patients are paediatric with small organs, therefore appropriate instruments and proper timing of the surgical intervention is paramount. Duckett and Keating et al in their study identified the first challenge is to identify those patients who truly need surgical repair. In a study by Marc Cendron et al they found out that the features identified as important in the decision-making process were (1) meatal opening close to or below the coronal margin; (2) A deep glans cleft; (3) a wide, splayed-out glans; and (4) an abnormal urinary stream if witnessed. in a study by Duckett JW, Keating MA, Hatch DA et at and Austin Hill G, Wacksman J they reported a satisfactory outcome with the various described surgical procedures. Conclusion: The tip and tricks of the surgical procedures of megameatus intact prepuce rare variant of hypospadias is a review article to aimed to improve on the surgical outcome including normal conical appearance of the glans, a urethral meatus of normal caliber, and a single, normal urinary stream with no symptoms and to minimise the complications such as urethrocutenous fistula as extracted from the expert’s vast experience and modifications of the existing techniques, in our study we summarised the experts seven established techniques and the modifications to achieve the desired objectives.

Komplet üretra rüptürüyle birlikte olan penil fraktür

Penile fracture with complete urethral rupture OBJECTIVES: Penile fracture is a trauma that develops as a result of the rupture of the corpus cavernosum by forcing the erect penis to bend and twist and requires emergency surgery. Urethral trauma accompanies penile fracture in 1–40% of cases. In this study, we aimed to present a case of penile fracture with complete urethral rupture. CASE REPORT: A 51-year-old male patient presented to the emergency service with the complaints of sudden loss of erection, bruising and pain in the penile shaft after a cracking sound during coitus. Physical examination revealed limited ecchymosis and swelling in the penile shaft and hemorrhage in the external urethral meatus. Urethrography was performed on the patient due to urethrography. On urethrography, it was observed that there was contrast extravasation from the middle urethra. The patient was operated in the early period. In the midpenile region, it was observed that there were ruptures of approximately 1 cm in both corpus cavernosum and complete rupture in the urethra. Cavernosal ruptures and urethral rupture were repaired. At the postoperative 6th month follow-up, the patient had no erectile dysfunction and voiding symptoms. CONCLUSIONS: The “crackling sound” heard during coitus, severe pain and penile detumescence are typical clinical findings of penile fracture. If there are symptoms of bleeding in the meatus, hematuria and difficulty in voiding, urethral trauma should be considered. In these patients, urethral repair is also required during the operation. Keywords: penile fracture, urethral rupture, urethrorrhagia

Skene’s Duct Cyst in an Elderly Female: A Case Report

Paraurethral glands and ducts are the rudimentary female homologues of the prostate, which empty into the vaginal vestibule near the urethral meatus. The two largest ducts are referred to as Skene’s ducts. Skene’s duct cysts are rare across all age groups and are only noticed when they cause complications such as dysuria. The causes of Skene’s duct cysts include duct obstruction due to infection, inflammation, or cystic degeneration of embryonic remnants of the paraurethral glands. In this case report, the authors present the findings of a 50-year-old female who had a painless swelling in the left labial region for a duration of three years. Upon local examination, a pedunculated swelling measuring 6x2.8 cm was observed in the left labia minora. The entire swelling, including the pedicle, was excised under regional anaesthesia through a vertical elliptical incision. Histopathological examination confirmed the diagnosis, and the patient experienced complete satisfaction and relief from her symptoms.

EXPERIENCES OF CONTACT LASER VAPORIZATION OF THE PROSTATE (CVP) FOR TREATING BENIGN PROSTATIC HYPERPLASIA IN THE LOCAL HOSPITAL

(Objective) We started contact laser vaporization of the prostate (CVP) for treating benign prostatic hyperplasia at our hospital in July 2019. Forty-five patients were treated with CVP from July 2019 to April 2021. (Methods) Patients were assessed preoperatively and at one and three months after CVP treatment by using the International Prostate Symptom Score (IPSS), quality of life index (QOL index), peak urinary flow rate (Qmax), and postvoid residual urine volume (PVR). (Results) IPSS, QOL index, Qmax, and PVR significantly improved three months after CVP (p<0.05). Regarding adverse events, five patients developed early external urinary meatus strictures, two had postoperative bleeding, and three had temporary urinary retention. (Conclusions) In our hospital, elderly patients and patients who cannot discontinue an antithrombotic drug were treated by CVP for benign prostatic hyperplasia relatively safely.

PREVALENCE OF VANCOMYCIN RESISTANT ENTEROCOCCI FROM URINARY TRACT INFECTED PATIENTS

Urinary tract infections (UTIs) are one of the infectious diseases affecting humankind. The microbial agents that infect the tissues of the urinary tract from the renal cortex to the urethral meatus Enterococci are opportunistic pathogens that are found in the normal gut flora. Enterococci are the second leading cause of UTIs, accounting for 10% of all nosocomial UTIs. This species has become a major pathogen in the United States, Iran, Europe, and other parts of the world, including India. Antibiotic resistance is increasing, which slows the rate of progress in practical therapies, making susceptibility testing necessary. So, enterococci were isolated from urine samples of patients with UTI that were subjected to morphological characterization, biochemical assays, etc., The main aim of the study was to help in identifying resistance patterns and the dispersal of Enterococcus strains from various samples of urine to antibiotic agents like Penicillin G, Tetracycline, Teicoplanin, Norfloxacin, high-level Gentamycin, Linezolid, Nitrofurantoin, and with special emphasis on Vancomycin antibiotic. The greatest threat posed by Vancomycin-Resistant Enterococci (VRE) is its ability to transfer resistance genes to more dangerous gram-positive bacteria, potentially leading to truly terrifying pathogens in the future. A long stay in the hospital and the use of Vancomycin were connected to VRE-UTI and colonisation. Renal dialysis, renal failure, previous aminoglycoside, and third-generation cephalosporin use were all relevant hazard factors for VRE from UTI. The paper also underlines the importance of screening clinical samples for VRE and proposes that control measures be implemented to limit the spread of VRE.

The association of meatal stenosis and infant circumcision.

The association of meatal stenosis with age at circumcision is controversial. We noticed a high rate of meatal stenosis in a region where early circumcision is traditional. The aim of this study is to compare the age at circumcision between boys with or without meatal stenosis. After ethical approval, families of children with meatal stenosis were questioned about age at circumcision and reason for circumcision. Control group consisted of patients with diagnoses other than penile abnormalities, a normal urethral meatus, and having no symptoms about urination. Patients with a history of therapeutic circumcision were excluded from the study. Between November 2016 and November 2020, 115 patients with meatal stenosis were admitted. All were corrected with ventral meatotomy under general anesthesia. Median age at circumcision was 3 (min:0-max:111) monthsand age at admission was 74 (min:22-max:194) months. Control group consisted of 205 boys. Median age at circumcision was 5 (min:0-max:122) months and age at admission was 96 (13-202) months. There was a statistically significant difference between groups in terms of age at circumcision (p=0.024) but none for age at admission (p=0.356). There was a twofold increase in the meatal stenosis rate (39% vs. 23%) if circumcision was performed before age one (p=0.018). There was no difference between the patients circumcised in the newborn period and later (38% vs 36%, p=0.778). Our study supports the previous reports suggesting a relation of risk for meatal stenosis and age at circumcision and presents data that age one might be a cutoff for this risk.

Decellularization techniques of human foreskin for tissue engineering application.

The rapid development of tissue engineering (TE) and regenerative medicine brings an acute need for biocompatible and bioactive biological scaffolds to regenerate or restore damaged tissue. Great attention is focused on the decellularization of tissues or even whole organs, and the subsequent colonization of such decellularized extracellular matrices by recipient cells. The foreskin is an integral, normal part of the external genitalia that forms the anatomical covering of the glans penis and the urinary meatus of all human and non-human primates. It is mucocutaneous tissue that marks the boundary between mucosa and skin. In this work, we compared two innovative decellularization techniques for human foreskins obtained from donors. We compared the efficacy and feasibility of these protocols and the biosafety of prepared acellular dermal matrixes that can serve as a suitable scaffold for TE. The present study confirms the feasibility of foreskin decellularization based on enzymatic or detergent methods. Both techniques conserved the ultrastructure and composition of natural ECM while being DNA-free and non-toxic, making it an excellent scaffold for follow-up research and TE applications.

Management of Patients with Urinary Stone Obstruction a Single-Center Study

Aim: This study aims to characterize the clinical manifestations, location of the obstruction, and surgical intervention results of individuals with obstructive urethral stones. Study design: A single-center study Place and Duration: IKD Peshawar, Departboyst of Urology, from January 1, 2020, to January 1, 2021. Methods: 124 obstructive urethral stones were treated at IKD Peshawar. 4 to 14-year-old patients Obstructive urethral stones were treated surgically by removing the stone from the external urethral meatus (stone retrieval) with or without Meatotomy, retrograde manipulation (push back), and then cystolithoclasty or cystolitholapaxy, depending on the stone's position and size. Results: The mean age was 04±12.14 was between 10 and 12 years old. A total of 118 boys (98%), together with 06 girls (02%), were aged 13 and above. Sixty boys had stones in the proximal urethra (prostatic and membranous) or bulbar urethra, while 24 boys had stones in the external urethral meatus. Stones were found in the external urethral meatus of 60 boys individuals. Conclusion: For the most part, obstructive urethral stones may be managed with endoscopic therapy, but in certain situations, a minor operation like a meatotomy is necessary. Keywords: urethral obstruction, managment t, outcome, surgery, intervention

Penile Fractures: the Successful Outcome of Immediate Surgical Intervention

Aim: To determine the results of early surgical repair in patients who initially report with a penis fracture. Study design: Retrospective Study Place of study &amp; duration: General Surgery Department Hayatabad Medical Complex Peshawar from January 2020 to December 2021. Methodology: 42 patients with penile fractures who presented to the emergency room of the Hayatabad Medical Complex in Peshawar were included in this retrospective analysis. A clinical diagnosis was made. There was no radiological analysis done. All patients had primary suturing for the tunica tear and underwent postoperative monitoring for 4 months. Results: All patients underwent surgery within 24 hours of the injury. The most common cause of injury was sexual intercourse 35(83.3%) followed by 3(7.1%) masturbation, 2(4.8%) rolling over in bed and 2(4.8%) during “routine stretching.” Every patient consistently reported hearing a cracking sound along with a severe pain, erection loss, deformity, discolouration, and edoema. Only 3 patients had blood at the external meatus. No extravasation was detected by ascending urethrography. There were 20(47.6%) proximal injuries, 16(38%) midshaft injuries and 6(14.3%) distal injuries. Conclusion: An acceptable complication rate and satisfactory postoperative results are associated with early surgical intervention for penile fracture. Early diagnosis and surgical intervention are essential for a positive result and minimal complications. Keywords: Penile fracture, Tunica albugenia, corpus cavernosum

Primary Malignant Melanoma of the Bladder: A Rare Case Report

Background Primary malignant melanoma (PMM) of the bladder is a rare ailment and has a poor prognosis; only 40 cases of PMM reported in literature till date. In this case report we described a case of PMM of the bladder, treatment, and a review of the literature as the recommended treatment choices are not widely known. Case Presentation A 55-year-old Indian female came with a history of hematuria for two-months. Ultrasonography revealed a 18×16 mm size mass located in the antero-inferior wall of urinary bladder with involvement of bladder neck. She underwent transurethral resection of the bladder tumor outside and histologically reported to be malignant melanoma and confirmed on immunohistochemistry (IHC). No further primary sites of melanoma were found. Computed tomography (CT) showed an irregular enhancing mucosal thickening along internal urethral meatus and adjacent urinary bladder. The patient eventually underwent radical cystectomy with anterior pelvic exenteration with ileal conduit. Conclusion Primary bladder melanoma is very aggressive in nature. In most of the cases bladder malignant melanoma is secondary, so extensive search for any primary melanotic lesion is essential. It is often difficult to discriminate whether a bladder melanoma is primary or metastatic. Certain diagnostic features can be obtained through histopathological investigation, immuno-histochemistry, clinical history, and endoscopic evaluation. Despite a wide range of treatments, people with PMM still have a worst prognosis.

Evaluation of tunica vaginalis flap-covering combined with modified Glenn-Anderson in one-stage repair of proximal hypospadias with incomplete penoscrotal transposition.

To explore a novel repair method for proximal hypospadias with incomplete penoscrotal transposition in children and evaluate its safety and outcomes. A retrospective analysis of clinical data was conducted for 86 children with severe proximal hypospadias with incomplete penoscrotal transposition who were hospitalized in our department between June 2018 and February 2021. In total, 42 patients (Group A) underwent repair following a one-stage method in which tunica vaginalis flap-covering was combined with a modified Glenn-Anderson procedure, while 44 patients (Group B) underwent a two-step repair consisting of tunica vaginalis flap-covering using the Duplay technique and the modified Glenn-Anderson procedure. The two groups were compared on operation time, length of postoperative hospital stay, postoperative complications, and associated costs. All operations were successful in both groups. No statistical difference was observed between the two groups in incidence of stenosis of the urinary meatus (2.38% vs. 4.54%, P = 0.279), urethral stricture (2.38% vs. 2.27%, P = 0.948), urinary fistula (7.14% vs. 6.82%, P = 0.907), or urinary infection (7.14% vs. 4.55%, P = 0.309). Additionally, there was no statistical difference between the groups in operation time (63.21 ± 5.20 vs. 62.07 ± 4.47 min, P = 0.059), postoperative off-bed time (7.02 ± 1.32 vs. 6.84 ± 1.20 days, P = 0.456), or duration of hospitalization (10.55 ± 1.15 vs. 10.15 ± 1.45 days, P = 0.092). However, Group B patients underwent an additional second-stage operation, incurring extra costs. Three months after surgery, Group A were judged more positively on the PPPS (specifically receiving higher scores on shaft skin and general appearance) by both the parents (shaft skin: 2.10 ± 0.82 vs. 1.93 ± 0.62, P = 0.024; general appearance: 2.16 ± 0.91 vs. 1.93 ± 0.72, P = 0.042) and the surgeon (shaft skin: 2.42 ± 0.70 vs. 2.25 ± 0.58, P = 0.025; general appearance: 2.38 ± 0.69 vs. 2.29 ± 0.51, P = 0.041). In most cases, the parents and surgeon were satisfied with the appearance of the genitals after one-stage repair. The advantages of the novel repair technique include use of a single-stage operation, producing a better appearance at a lower cost. The tunica vaginalis flap-covering method is not only demonstrated to be safe and effective, but it is also a simpler method than the conventional operation.

Anatomical background of the sensory function in the urethra: involvement of endocrine paraneurons and afferent nerves in divergent urogenital functions. A review.

The urethra is ontogenetically derived from the cloaca together with distal parts of the large intestine, and serotonin cells are predominant among dispersed endocrine/paracrine cells in the epithelia of both tissues. Analysis of urethral endocrine cells thus helps us to understand the functions of gut endocrine cells and their communication with the nervous system, due to the fact that the urethra is a simple tubular organ, where only urine without microflora rapidly passes through. A certain number of urethral endocrine cells display unique, complicated shapes with dendritic processes, reminiscent of neurons. Characteristically, urethral endocrine cells-often called paraneurons-have direct contact with sensory nerves within the epithelium, unlike gut endocrine cells lacking in direct contact with nerves. These traits encourage us to focus on the urethral paraneurons as ideal endocrine/paracrine cells. A topographical complex of urethral paraneurons and afferent nerve fibers is sensitive to the passage of urine or the distention of the urethral lumen. The urethra-bladder excitatory reflex facilitates micturition via the release of serotonin from the paraneurons, ultimately ensuring complete voiding of the bladder. This reflex may also influence sexual behaviors such as ejaculation or the female orgasm. Urethral brush cells as well as paraneurons are responsible for continuous monitoring of the mucosal surface, especially for pathogens entering via the external urethral orifice.

Medical Device–related Pressure Injury Due to Urinary Catheterization: A Case Report

BACKGROUND: Urethral erosion secondary to a medical device–related pressure injury (MDRPI) is preventable, understudied, not well understood, and often overlooked. PURPOSE: This case report describes a patient who sustained an MDRPI secondary to indwelling urinary catheter placement for urinary retention. CASE STUDY: A 93-year-old man with prostate cancer and pneumonia received an indwelling urinary catheter for retention during a 2-week hospitalization. Upon his transfer to a rehabilitation facility, the patient’s daughter informed staff that she had observed a 1-cm urethral erosion on the urinary meatus. Within a week, the penile erosion worsened to encircle the urinary meatus to 1.5 cm, and clinical signs of infection were present. Eventually, the patient was transferred to a hospice facility where he died. CONCLUSION: This case study demonstrates the need for increased training of health care professionals in identifying risk factors for MDRPI and managing such injuries to limit their devastating impact on the patient and family members.

A comparative study of distal hypospadias repair combined with preputioplasty vs repair using conventional circumcision technique

Background: Hypospadias is one of the most common congenital anomalies characterised by underdevelopment of the ventral anatomical structures of the penis including skin, urethra, corpora spongiosum and prepuce and urethral opening can occur anywhere from the perineum to the ventral aspect of penis. This study evaluated and compared short-term cosmetic and functional outcomes and complications of distal hypospadias repair combined with preputioplasty with the repair using circumcision. Materials &amp; Methods: Patients were divided in two groups with 25 patients in either group. Group A patients underwent urethroplasty with circumcision whereas Group B patients were offered preputioplasty as an additional procedure. Clinical examination included location of the urethral meatus on the ventral aspect of the penis, presence or absence of associated chordee, stretched penile length, penile circumference, glans girth, depth of the navicular fossa or glans groove, urethral plate width, status of the preputial hood and testicular examination. Post-operatively, penis was examined for the location and shape of the neo-meatus, any complications in the form of meatal stenosis, urethrocutaneous fistula, preputial dehiscence and phimosis. Results: Both the groups were comparable with respect to the age at presentation and status of the urinary stream. Distal penile hypospadias predominated in both the groups and it was present in 21 patients in group A and 24 patients in group B. Rest of the babies had sub-coronal hypospadias. Preputial hood and navicular fossa/glans groove were good in either group. Mean stretched penile length in group A was 5.14 cm and it was 4.78 cm in group B children (p value- 0.141). Mean penile circumference of group A and group B patients ware 3.88 cm and 3.68 cm respectively (p value- 0.139). Girth of the glans and mean urethral plate width were also comparable (p values- 0.258 and 0.621 respectively). Final meatal appearance was slit shaped and wide in 22 patients in group A and 21 patients in group B. Urethro-cutaneous fistula was observed in two babies in group A and a single child in group B. One of the children was noted to have preputial dehiscence after two weeks. Prepuce was retracting well in 24 children during the 3rd follow up whereas one patient developed phimosis and thus results of the preputioplasty as an adjunct procedure were found to be satisfactory. Conclusion: Preputioplasty is a safe procedure and should be offered to all children undergoing single-stage distal penile hypospadias repair as it provides a near normal penile appearance at the cost of additional approximately 8% foreskin related complication rate.