Penile Region Research Articles

Migrating foreign bodies of penis: a case report and literature review

BackgroundOnly a few cases have been reported about active foreign body implantation in the cavernous body of the penis.Case presentationA 47-year-old man inserted two needles from the glans penis into the bilateral penile sponge body. Subsequently, two needles migrated through the penile cavernous body into the pelvic cavity. Attempts to remove the needles through the penis were unsuccessful. Eventually, after a duration exceeding one month, the displaced needles were removed in stages from the buttocks.ConclusionA few cases of intracavernosal-injection-therapy-associated needle breakage and retention have been reported globally. And this is the first case in China documenting the migration of foreign bodies within the penile region. In this condition, it is of utmost importance to engage the expertise of experienced andrologists to minimize the risk of excessive manipulation, thereby ensuring that inadvertent deep penetration of the needle into the penile tissue is prevented. In case the foreign body has migrated deeper into the tissues and the patient does not exhibit any specific symptoms or risks of macrovascular injury-related bleeding, close surveillance of its movement can be implemented. Surgical intervention can be initiated once the foreign body has reached a suitable position. Moreover, a psychiatric evaluation should be recommended for patient to discover any underlying mental health disorders.

Анализ результатов и осложнений после повторной пластики рецидивных стриктур уретры.

Introduction. Over the past 30 years in reconstructive urology there has been a tendency to reduce the frequency of use of minimally invasive methods of surgical treatment of urethral strictures of various localizations and the predominant use of reconstructive plastic interventions with the expansion of the narrowed area of the urethra using inserts from various tissues. Buccal dilation urethroplasty is currently recognized as the optimal treatment option for urethral strictures of various locations and of varying length. Thus, the issue of choosing the most appropriate method of surgical intervention for recurrent urethral strictures, in the context of a possible increase in the risk of complications, requires additional research. Purpose. To analyze and evaluate the results and complications after plastic surgery of recurrent urethral strictures using a free autograft of the buccal mucosa. Materials and methods. The analysis included data on 51 patients operated on at the Research Institute of Urology and Interventional Radiology named after. N.A. Lopatkina–branch of the Federal State Budgetary Institution National Medical Research Center of Radiology of the Ministry of Health of the Russian Federation for the period from 2014 to 2021 regarding recurrent urethral stricture. The average age of the patients was 36.2±1.6 years (from 18 to 58 years). The diagnosis of recurrent urethral stricture was confirmed by anamnesis, clinical and laboratory examination according to a standard protocol, and special examination methods (uroflowmetry, ultrasound examination of the bladder, retrograde or antegrade cystourethrography, voiding urethrography). According to indications, fibrourethrocystoscopy was performed. According to radiological research methods, the localization and extent of urethral stricture were determined. The functional state of the bladder and the severity of bladder outlet obstruction were determined by the volume of residual urine determined by ultrasound of the bladder, as well as by uroflowmetry data. Results. An analysis of the results and complications after plastic surgery of recurrent urethral strictures using a buccal flap was carried out after repeated operations. As the length of the stricture increases, the risk of its recurrence increases significantly. The most significant factors are the location of the stricture in the penile region and its extent. No other long-term complications (newly developed urinary incontinence/erectile dysfunction) were observed in any case in the analyzed group of patients. Conclusion. Repeated operations for recurrent urethral strictures can eliminate urinary disorders with an effectiveness close to (or equal to) that of primary operations. When choosing a method of surgical treatment of recurrent strictures, both the extent of the stricture and its location should be taken into account. The presence of an extended stricture of the penile urethra may be a risk factor for its recurrence. Complications that develop after repeated operations in the vast majority of cases are not life-threatening. The question of the effectiveness of different types of surgery requires additional research with the accumulation of clinical material.

Spontaneous Urethrocutaneous Fistula in Child with Spastic Cerebral Palsy: A Case Report

Urethrocutaneous fistulas are complications that usually seen after hypospadias repair. Spontaneous urethrocutaneous fistulas are extremely rare disorders unless related to the surgery of hypospadias. These fistulas are not associated with hypospadias repair, infection and trauma. While there are few cases reported in adults, there are no cases reported in children. Urethrocutaneous fistulas may rarely be encountered post-trauma, infection or due to weakness of spongious tissue of penis as well as. Children with spastic cerebral palsy often face various problems due to prolonged hospitalizations. Pressure ulcers are among the most common of these issues. Urinary catheterization is frequently performed in these patients for urine monitoring. A 6-year-old male patient with cerebral palsy developed a urethrocutaneous fistula while being monitored in the pediatric intensive care unit. Pre-existing unnoticed partial prepuce and weakness in the corpus spongiosum were present in the patient. We suspect that the development of the urethrocutaneous fistula is attributed to frequent urethral catheterization and the development of decubitus ulcer in the penile region. Since a similar case is not found in the pediatric literature, our aim is to present this case for reference.

Role of Shear Wave Elastography in the Diagnosis of Peyronie Disease.

The present study aims to explore the role of shear wave elastography (SWE) in the diagnosis of Peyronie disease (PD). A total of 59 PD patients and 59 age-matched healthy adult men were included in this study. The B-mode ultrasound (US) and SWE were performed for all subjects, and the Young modulus (YM) values of the corresponding regions of the penis in the PD and control groups were recorded and compared. The mean age of the included PD patients and age-matched controls was 53.81 years (SD 9.52, range 32-73). On B-mode US evaluation, 41 (69.5%) of 59 included PD patients were found to have penile plaques, and the remaining 18 (30.5%) patients had no evidence of penile plaque. After evaluation using SWE, the YM values in the penile plaque region of these 41 patients with penile dysplasia were found to be significantly higher (60.29 kPa ± 19.95) than those outside the plaque (in the same patient) (21.05 kPa ± 4.58) and in the same penile region of the control group (20.59 kPa ± 4.65) (P < .001). In the remaining 18 PD patients, the results showed that the YM value of the abnormal penile region in the PD patients (56.67 kPa ± 13.52) was significantly higher than the YM value outside the abnormal penile region in the same patients (22.79 kPa ± 4.31) and in the same penile region in the control group (19.87 kPa ± 3.48) (P < .001; P < .001). In conclusion, this study showed that SWE as a non-invasive technique is useful in identifying and differentiating penile plaques in PD patients and is a simple, rapid and complementary method to B-mode US.

Cavernosal abscess and primary scrotal calcinosis in the diabetic patient: A case report and review of literature

Abstract A cavernosal abscess is a rare urological condition to occur. It is classified as primary and secondary. The primary is mostly idiopathic, whereas the secondary is associated with some precipitating factors. Most of the cases were diagnosed clinically. In some cases, imaging such as an ultrasound of the local region or magnetic resonance imaging may be required. Cavernosal abscesses can be treated using a minimally invasive procedure such as image-guided drainage or incision and drainage along with systemic antibiotics. A 52-year-old uncircumscribed uncontrolled diabetic patient presented with a complaint of swelling in the penile region for the 1-week duration. He also complains of pain in the penile region for a 5-day duration. He is a known case of type 2 diabetes on oral hypoglycemic drugs for the past 2 years. Clinical examination confirmed the diagnosis of cavernosal abscess. The patient underwent circumcision with incision and drainage of abscess under higher antibiotic coverage (vancomycin and metronidazole). The patient underwent local excision of primary scrotal calcinosis after 1 month. The patient is followed up for more than 2 years without any evidence of recurrence or impotence. The cavernosal abscess is one of the rare urological conditions, which needs immediate surgical intervention to reduce future complications such as erectile dysfunction and recurrent abscess. Uncontrolled diabetes has a high chance of developing cavernosal abscesses even without precipitating factors.

Canine Cutaneous Extragenital Venereal Granuloma (CCEVG): Clinical and Pathological Features, Diagnostic Approach, and Treatment Strategies

Transmissible venereal tumor (TVT) is a contagious neoplasm affecting canines that is primarily transmitted through the transfer of malignant cells during coitus. TVT is a rare example of a naturally occurring allograft cancer, and studies have suggested that it may have originated from an individual dog or wolf that lived approximately 11,000 years ago (Murchison et al., 2014). The tumor is characterized by its predominantly extra-genital manifestations, which may develop from the implantation of neoplastic cells on exposed mucosae, as well as its unique genetic features. For instance, TVT has an unusual karyotype that is believed to have arisen from a rearrangement of the normal canine chromosomes, resulting in the maintenance of a stable tumor genome across the population of TVT cells (Bongiovanni et al., 2016). Young dogs, stray dogs and sexually active dogs are most regularly affected by this tumour (Nak et al., 2005). It is classified into two groups, genital TVT and extragenital TVT, depending upon the sites of the tumour mass is present (Das and Das, 2000). The most common site of TVT is the caudal penile region in male dogs and the posterior vagina region in female dogs, with the tumor frequently surrounding the urethral orifice and protruding from the vulva if located within the vagina. In rare cases, TVT may develop at extra-genital sites. Macroscopically, TVT lesions are often friable, with a low cohesion between the neoplastic cells, resulting in their propensity to hemorrhage. This tendency towards bleeding, in conjunction with the formation of nodular, granulomatous, or necrotic masses, typically forms the first clinical sign observed in affected animals. Diagnosis of TVT often involves a combination of clinical presentation, cytology, histopathology, and immunohistochemistry to differentiate it from other neoplasms. While TVT can cause significant morbidity, several chemotherapeutic agents have shown to be highly effective in treating it. Hence, this report describes canine cutaneous extragenital venereal granuloma (CCEVG) in three dogs: its clinical and pathological features, diagnostic approach, and treatment strategies.

Automated measurement of penile curvature using deep learning-based novel quantification method.

Develop a reliable, automated deep learning-based method for accurate measurement of penile curvature (PC) using 2-dimensional images. A set of nine 3D-printed models was used to generate a batch of 913 images of penile curvature (PC) with varying configurations (curvature range 18° to 86°). The penile region was initially localized and cropped using a YOLOv5 model, after which the shaft area was extracted using a UNet-based segmentation model. The penile shaft was then divided into three distinct predefined regions: the distal zone, curvature zone, and proximal zone. To measure PC, we identified four distinct locations on the shaft that reflected the mid-axes of proximal and distal segments, then trained an HRNet model to predict these landmarks and calculate curvature angle in both the 3D-printed models and masked segmented images derived from these. Finally, the optimized HRNet model was applied to quantify PC in medical images of real human patients and the accuracy of this novel method was determined. We obtained a mean absolute error (MAE) of angle measurement <5° for both penile model images and their derivative masks. For real patient images, AI prediction varied between 1.7° (for cases of ∼30° PC) and approximately 6° (for cases of 70° PC) compared with assessment by a clinical expert. This study demonstrates a novel approach to the automated, accurate measurement of PC that could significantly improve patient assessment by surgeons and hypospadiology researchers. This method may overcome current limitations encountered when applying conventional methods of measuring arc-type PC.

Single-stage combined urethroplasty for extended strictures of the anterior urethra of tuberculous origin

Background. Urethral strictures are currently one of the most complex pathologies in reconstructive urology. The most promising direction in this area is the development of single-stage surgical interventions that meets modern requirements for the quality of life of patients.The aim of the study. To evaluate the possibility and the effectiveness of surgical treatment of extended recurrent tuberculous urethral strictures in men using a combination of a skin flap and a buccal graft. In the literature, there is no description of the use of this technique in patients with urethral tuberculosis.Materials and methods. We observed 44 patients with urethral tuberculosis. Three men from this group of patients were diagnosed with tuberculous (post-tuberculous) extended recurrent stricture of the anterior urethra and they underwent combined single-stage urethroplasty with a ventral fasciocutaneous flap and a buccal graft using the inlay method in the penile region and with a buccal graft using the ventral onlay method in the bulbous urethra. Ultrasound of the urethra served as a method that determines the possibility of performing this surgery in case of maintaining a sufficient width of the urethral plate with a moderate degree of spongiofibrosis.Results. Patients were under observation for 34, 50 and 54 months and have good long-term functional results – all patients have unassisted urination and no residual urine. Post-micturition dribbling persists in 1 patient. The overall effectiveness of the treatment of these strictures, taking into account the treatment of repeated cases of the disease recurrence, is high.Conclusion. This technique demonstrates the possibility of performing a single-stage reconstruction of the anterior urethra in patients with extended recurrent tuberculous (post-tuberculous) urethral strictures and is also applicable for the surgical treatment of urethral strictures of other origins.

Penile Ewing's Sarcoma - A Rare Entity

Abstract Introduction/Objective Ewing sarcoma is a cancer involving the bones or the tissue around bones. It is the second most common malignant bone tumour comprising 10-15% of all primary bone tumours, most commonly affecting children and young adults. It can also be seen in adults also. Males are more commonly affected then females. Any bone can be affected but the lower extremity, the pelvis, upper extremity, axial skeleton and ribs, and face cases. Similar histology tumours when seen in soft tissue are peripheral primitive neuroectodermal tumour (pPNET), neuroepithelioma, and Askin tumour. It is always difficult to know the primary site when soft tissues are involved as it can be infiltration from bone or from soft tissue to bone. Penis is least common site involved with Ewing’s sarcoma in young male. Methods/Case Report This is a case report of a 22 year old male with penile lesion. He presented with the chief complaints of mass at the shaft of penis. The partial penectomy specimen was received along with the bilateral inguinal lymph node. On gross there was a ulcero-proliferative growth. Results (if a Case Study Enter NA) On histopathological examination showed small blue round cell tumour and further immunohistochemistry with CD99 and NKX2.2 revealed the diagnosis of Ewing’s sarcoma, however lymph nodes showed reactive lymphoid hyperplasia. Conclusion The Ewing sarcoma at the penile region is rarest entity. Only 7 cases are reported worldwide. The imaging modalities like CT or MRI can be used to know the extension. The diagnosis is primarily based on morphological features, immunohistochemical analysis and translocation analysis. However it is important to find out if any other soft tissue site is involved. The important prognostic markers are presence and absence of metastasis, size of tumour, necrosis and presence of fusion transcripts.

Paraphimosis as a complication of monkeypox infection

We discuss a case report of a 38-year-old uncircumcised male on pre-exposure prophylaxis for human immunodeficiency virus who presents to the emergency department for painful lesions over his penile region following unprotected sexual intercourse. Following the development of these lesions he developed painless, itchy pustules over his bilateral arms and back. He also had extensive pain and swelling over his penile region, which prevented him from unretracting his foreskin. Chlamydia trachomatis, Herpes simplex virus, Neisseria gonorrhoeae, and syphilis tests were negative. He was positive for orthopoxvirus using polymerase chain reaction. A diagnosis of paraphimosis as a complication of monkeypox infection was made.

Relationship among anogenital distance, adrenal gland volume, and penile length and width at 22-36weeks of pregnancy.

The subject of current work was to determine the relationship of fetal ultrasonographic biomarkers, including anogenital distance (AGD), adrenal gland volume, and penile length and width in mothers with male fetuses at 22-36weeks of gestation for the assessment of the effect of fetal adrenal gland producing androgens on the male anogenital structures that are exposed to androgen effects as anogenital region and penis. This study is a prospective cross-sectional study conducted in our hospital's outpatient perinatal care unit. One hundred and seventy pregnant women with a male fetus aged 22-36weeks of gestation were included in the study. The fetal adrenal gland length, width, and depth forthe calculation of adrenal volume, AGD, and penile lengthand width were measured for each participant. The Pearson coefficients were calculated to assess the correlation among these parameters. The adrenal gland volume had a meaningful, positive moderate relationship with both the AGD (r=0.60) and penile length and width (r=0.57 and r=0.59, respectively; p<0.001). The AGD had a positive, strong correlation with the penile length and width (r=0.74 and r=0.76, respectively; p<0.001). The fetal adrenal gland as one of the androgen sources of the fetus is an influencer of the development of the anogenital and penile region. The findings of the current study support that the adrenal gland considerably affects the masculinization of male fetuses, since there were remarkable correlations among the AGD, adrenal gland volume, and penile length and width.

Ectopic Vesicae in Adult : A Rare Case Report

Urinary bladder exstrophy is a relatively uncommon genitourinary malformation characterised by incomplete closure of the lower abdominal wall, resulting in bladder protrusion. Incidence is 3 to 5 per 1,00,000 births. It occurs as an isolated sporadic defect, but it has also been linked to other anomalies such as omphalocele, anal defect, neural tube defect, cleft lip/palate, preterm birth, and others. Adult presentation is unusual because it is usually surgically corrected in the neonatal period. The prognosis of such cases is determined by the level of continence achieved. We report a rare case of 23 years old patient with Ectopia Vesicae with the chief complaint of Dribbling of urine and using Diapers. On elaborating the history, the parents of the patient told that the condition was from birth. He had a history of incontinence noted soon after birth and a history of past surgical intervention at the age of 5 years. On physical examination revealed that the patient had a scar mark over the lower part of the abdomen and scar mark present over the penile region with excoriation of skin, extravasation of urine from opening over the penile shaft region, and doctors’ advice for Hospitalization. After admission patient undergone with various diagnostic investigations like CBC, LFT, KFT, ultrasonography, 2D ECHO, and patient undergone with cystoscopy. According to reviews, it suggests that this procedure can also benefit patients and is especially appropriate for adult patients with limited financial resources. This may open up new surgical options for patients suffering from bladder exstrophy.

Clinical results of PERICLES: A phase II trial investigating atezolizumab +/- radiotherapy for advanced squamous cell carcinoma of the penis.

3 Background: Patients (Pts) with advanced squamous cell carcinoma of the penis (aPeCa) have a poor prognosis (21% 2-year overall survival from moment of diagnosis) and high morbidity, due to progressive locoregional disease. Pre-clinical studies show high rates of infiltrating immune cells and high PD-L1 expression, suggesting that immunotherapy may be beneficial for these patients. In the PERICLES study, we assess the activity of atezolizumab (atezo) in aPeCa pts, with or without radiotherapy (RT) to control locoregional lymph node disease. Methods: A single-centre phase 2 study with two treatment arms (non-randomized) was conducted in 32 histologically confirmed aPeCa pts with a WHO performance status of 0-1 (NCT03686332). Any previous treatment except for immunotherapy was allowed. Study treatment consisted of atezo 1200 mg every 3 weeks (all pts). Pts expected to benefit from RT for locoregional disease control (cohort A) additionally received 33 fractions of 1.5 Gy (locoregional affected lymph node regions and penile region) and 1.8 Gy (macroscopic tumor + margin) irradiation. Response was evaluated with 12-weekly CT scans of the abdomen and thorax using RECIST1.1. Toxicity was scored by NCI-CTCAE V4. The primary endpoint was 1-year progression free survival (PFS) for the full cohort. Results: From Oct 2018 to Aug 2021, 20 pts were included in cohort A (RT + atezo) and 12 pts in cohort B (only atezo). Median follow-up was 22 months (interquartile range (IQR) 4.3-14). Median age was 67 years (IQR 60-72) and all patients had stage IV aPeCa. Pts received no prior treatment (25%), or prior RT (34%), chemoradiation (22%), chemotherapy (6%) or surgery (69%). An immunotherapy or radiotherapy-related grade 3-4 AE was observed in 3/32 (9.4%) and 1/20 (5.0%) patients, respectively. There were no grade 5 treatment-related AEs. One-year PFS was 12% (95% confidence interval (CI) 4.0-33), which did not meet the primary objective. The response rate of RECIST1.1 evaluable pts was 30% (see table). In two patients with pulmonary metastases, a complete response was observed. Initial responses with early progression were seen in 5 pts. Median overall survival (OS) was 12 months (95% CI 5.4-19). Conclusions: Anti-tumor activity of atezo was observed in aPeCa, including complete and durable responses. The trial failed to meet its primary objective (PFS). Our results suggest that a subset of aPeCa pts has incomplete immunological activity and/or early resistance to atezo. Analysis of tumor tissue collected in this trial (including on-treatment biopsies) could suggest new therapeutic strategies to overcome resistance and improve clinical outcome to immunotherapy in aPeCa. Clinical trial information: NCT03686332. [Table: see text]

A Malignant Melanoma of the Penile : A Very Rare Case Report and Literature Review

Background: Malignant melanoma of the penis is very rare, accounting for approximately 1.4% of all primary penile carcinomas. With a small prevalence of penile melanoma, there is lack of data about quality of the therapy. The primary treatment of melanoma of the penile is surgical, although there is a lack of consensus regarding the extent of treatment that is indicated.&#x0D; Case Report: A 60-year-old Caucasian man came to Division of Urology, Department of Surgery, Dr. Kariadi General Hospital Semarang with chief complaint painless and fast growing lesions on his penile. His general condition was fine, and has a normal vital signs. On the physical examination of penile region, there were found lesions on the ventral of the glans and penile foreskin and covered with blood and pus, with bilateral inguinal lymph nodes and lung metastasis from Multi Slice Computed Tomography. We already performed partial penectomy and bilateral inguinal lymph nodes dissection with histopathological results a malignant melanoma Clark IV. The final stage of penile melanoma was pT2N1M1. We follow-up the patient until 1 year after procedure, and there wasn’t any recurrence.&#x0D; Conclusion: Malignant melanoma of the penis is rare. Penile melanoma is highly treatable with surgical excision in its early stages because of resistant to both chemotherapy and radiotherapy. Delay in diagnosed and surgical treatment can lead to an adverse prognosis. The anamnesis, physical examination, and imaging studies must be done appropriately to improve the survival.

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.

Prevalence of human papillomavirus (HPV) in Brazil: A systematic review and meta-analysis.

ObjectivesThis study aimed to estimate the prevalence of genital, anal and oral HPV infection in Brazil through systematic review and meta-analysis.MethodsWe searched EMBASE, LILACS, MEDLINE, Web of Science and SciELO from inception to December 2018. Original research articles that assessed the prevalence of genital (i.e., cervical, penile), anal and oral HPV infection in Brazil were selected in pairs by independent authors. No sex, age, HPV vaccination, language or date restrictions were applied. HPV prevalence was estimated and stratified according to risk factors population and by geographic area throughout the country. The study prevalence was pooled using a random effects model. Analysis was performed using R (version 3.5.2), packages meta version 4.9–4 and metaphor 2.0–0. This review is registered on PROSPERO under protocol number CRD42016032751.ResultsWe identified 3,351 references. After the screening process, 139 of them were eligible for this systematic review (57,513 total participants). Prevalence of cervical HPV was 25.41% (95% CI 22.71–28.32). Additionally, prevalence was 36.21% (95% CI 23.40, 51.33) in the penile region, 25.68% (95%CI 14.64, 41.04) in the anal region, and 11.89% (95%CI 6.26, 21.43) in the oral region. Subgroup analysis showed prevalence in each anatomic site was higher in high-risk populations.ConclusionThe prevalence of HPV is high in the Brazilian population and varies by population risk and anatomic body site, with lower rates in the oral cavity compared to that in the cervical, penile and anal region. Studies on HPV have primarily been developed to evaluate infection and cancer in the cervical region. There is a profound lack of HPV data in many geographic regions of Brazil and for different anatomic sites.

Natural Infection by Trypanosoma cruzi in a Dog from Bahia State - Northeast of Brazil

Background: Chagas Disease (CD) is a parasitic anthropozoonosis caused by the Trypanosoma cruzi (T. cruzi), a protozoan transmitted by insects from the Reduviidae family. Several species of wild and domestic animals, humans included, are susceptible, developing acute clinical signals (myocarditis and cardiac arrhythmias) or chronic signals (drop on the performance and syncope) of the disease. In Brazil, the disease in dogs shows variable indexes of occurrence. The present paper describes the natural infection by T. cruzi in a canine living in the city of Barra, in the state of Bahia, Brazil, a region classified as high risk of vulnerability for the CD in the northeast of Brazil.Case: A 9-year-old male dog, non-specific breed, was referred to the clinic the Veterinary Clinic for Small Animals, at the Veterinary Medical Teaching Hospital), at the Federal University of the West of Bahia. Its owner reported the presence of bloody secretion in the penile region. During the physical exam it was possible to observe an increase in the volume of the penis base. All of the animal’s physiological parameters were within normal levels. Blood samples and cytological laminas from the lesioned area were collected and sent to the Laboratory of Veterinary Clinical Pathology in the same institution. The cytological exam showed monomorphic population of great round cells with a round nucleus, condensed chromatin and one to two prominent nucleolus, abundant and slightly basophilic cytoplasm, with multiple stippled vacuoles, thus confirming a Transmissible venereal tumor (TVT) case. With the blood exam one observed a thrombocytopenia, neutrophilia with a deviation on the left and the presence of a trypomastigote form of Trypanosoma sp. in the blood smears. A complete blood sample was sent to the Laboratory of Pathology and Molecular Biology from the Fiocruz-BA (Oswaldo Cruz Foundation in the State of Bahia), being identified by the PCR technique, T. cruzi.Discussion: During the complete blood count, specifically using the blood smear, the microscopic visualization of the trypomastigote form of the Trypanosoma sp., a hemoparasite of filiform aspect, with undulating membrane over the whole body and free flagellum, confirming a case of trypanosomiasis. Such diagnostics had not been considered up to this moment, as the animal did not present any clinic symptomatology that indicated the pathological condition. The high levels of parasitemia presented by the animal, confirmed by the presence of the protozoan in the blood smear, probably indicate the acute phase of the infection, period in which the multiplication and development of the agent is higher, consequently allowing the visualization of the hemoparasite in the lamina. Although the TVT had proved to be the main derogatory factor of sanity and wellbeing of the animal, one calls the attention in this case for the trypanosomiasis, a zoonosis that causes great risk to the sole health, highlighting that the canine species is taken as an important reservoir of T. cruzi, relevant for the maintenance and interaction among the domestic and wild cycles of the Chagas Disease. This is the first report of a canine naturally infected by T. cruzi in the west Region of the State of Bahia. It is, thus, important to emphasize its significance once dogs can be reservoirs of the protozoan, acting in their life cycle and epidemiological chain of the Chagas Disease, enabling the infection of triatomines and humans. Future studies should be done with the purpose of determining the predominance of the agent in the region of the city of Barra, in the State of Bahia.

Stepwise approach in the management of penile strangulation and penile preservation: 15-year experience in a tertiary care hospital

ABSTRACTObjective: To present our stepwise approach to the management of penile strangulation and penile preservation with 15 years’ experience in a tertiary care hospital, as penile strangulation is a rare urological emergency that requires immediate attention.Patients and methods: A prospective observational study was performed from March 2003 to December 2018 of patients presenting with penile strangulation to our hospital.Results: Nine patients with penile strangulation presented to us between March 2003 and December 2018. The most common motive for the application of a foreign body was sexual gratification (four patients). Three of the nine patients had a mental disorder. Objects used for strangulation included: metallic nut (three), metallic ring (two), plastic bottle (two), wooden hole (one), hammer head (one), and horse hair to control bleeding during circumcision (one). Most of the foreign bodies were located in the proximal penile region. The mean operative time was 38 min and three of the nine patients had complications.Conclusions: Penile strangulation is one of the rare urological emergencies experienced by a urologist. Removal of the foreign body can be difficult and there is no universal method of removal, as each case differs. So, following our stepwise approach can aid in removal of foreign body quickly and preserve the penis from fatal outcomes. Urologist should be aware of all the available armamentarium used for the removal of such foreign bodies.Abbreviation: SPC: suprapubic cystostomy

Tubular adenocarcinoma with squamous differentiation areas in a feline foreskin (Felis catus): A report of clinical-surgical, pathological, and therapeutic approach

Adenocarcinomas are malignant epithelial neoplasms of glandular nature and have been reported in many organs of companion animals including the lungs, thyroid, prostate, mammary glands, gallbladder, pancreas, esophagus, stomach, and intestine. In felines, reports of such neoplasms in the genitalia and associated glands are very rare and have a reserved prognosis. There are no reports in the veterinary literature describing this type of neoplasia affecting the foreskin of cats. Cytological analysis and histopathological evaluation of incisional or excisional biopsy samples can confirm the diagnosis of preputial neoplasms. The gold standard treatment consists of surgical excision of the neoplasm. In the present report, a 16-year-old male Brazilian shorthair feline was referred to the Surgical Clinic service of the Companion Animal Veterinary Hospital of UFRRJ, with a major complaint of increased volume and ulceration in the preputial and penile region with slow growth. The animal experienced dysuria, urinary retention, and pollakiuria. It had a history of recurrent urinary obstructions and urolithiasis. A penile urethrostomy was performed, and the mass was histopathologically and microbiologically analyzed due to a suspicion of fungal or neoplastic involvement. Histopathological examination showed the presence of tubular adenocarcinomas. Chemotherapy treatment was suggested in the immediate postoperative period, but it was not performed per the owner’s request. One year after the foreskin resection and creation of a new urethral stoma, a new mass was found in the perineal region, and the animal died one week later.

Tubular adenocarcinoma with squamous differentiation areas in a feline foreskin (Felis catus): A report of clinical-surgical, pathological, and therapeutic approach

Adenocarcinomas are malignant epithelial neoplasms of glandular nature and have been reported in many organs of companion animals including the lungs, thyroid, prostate, mammary glands, gallbladder, pancreas, esophagus, stomach, and intestine. In felines, reports of such neoplasms in the genitalia and associated glands are very rare and have a reserved prognosis. There are no reports in the veterinary literature describing this type of neoplasia affecting the foreskin of cats. Cytological analysis and histopathological evaluation of incisional or excisional biopsy samples can confirm the diagnosis of preputial neoplasms. The gold standard treatment consists of surgical excision of the neoplasm. In the present report, a 16-year-old male Brazilian shorthair feline was referred to the Surgical Clinic service of the Companion Animal Veterinary Hospital of UFRRJ, with a major complaint of increased volume and ulceration in the preputial and penile region with slow growth. The animal experienced dysuria, urinary retention, and pollakiuria. It had a history of recurrent urinary obstructions and urolithiasis. A penile urethrostomy was performed, and the mass was histopathologically and microbiologically analyzed due to a suspicion of fungal or neoplastic involvement. Histopathological examination showed the presence of tubular adenocarcinomas. Chemotherapy treatment was suggested in the immediate postoperative period, but it was not performed per the owner’s request. One year after the foreskin resection and creation of a new urethral stoma, a new mass was found in the perineal region, and the animal died one week later.