Pubic Skin Research Articles

(538) Penile Enlargement for Patient with Buried Penis: Pubic Dermolipectomy, Scrotoplasty and Mons Pubis Reconstruction

Abstract Introduction Acquired buried penis is a common condition in obese patients. Abnormal excess fat accumulation under the pubic skin leads to the partially or completely disappearance of the penis. This condition is related to voiding difficulties and sexual dysfunction. The goal of surgical treatment is to expose full penile lengthy by excising the adipose pubic tissue and part of excess pubic skin. Objective The aim of this kind of surgery is to make possible to have a normal sexual life to obese patients with buried penis. Methods We performed this technique for buried penis in 25 patients aged from 18 to 72 y (mean 48). Preoperatively, the patient is marked for the procedure in the standing position. Two transversal incisions are made on the pubis and joined laterally on both sides towards anterior iliac spines with the care taken to avoid the formation of "dog ears". The suprapubic fat is removed. Following the inner surface of the Scarpas fascia, the fat is also removed from the penoscrotal angle and from the scrotum as much as possible leaving exposed funiculus and testis on both sides. Suspensory ligament of the penis was incised. Penile skin redistribution leads to a better organ exposure. Postoperative vacuum erectile device was used in order to prevent penile retraction. Results Follow up was at 6 months. Early postoperative complications were hematoma (7pts), penile skin edema (5pts), seroma (5pts), wound infection (5pts), penile shaft retraction (3pts). Majority of pts (22pts) were satisfied good aesthetical and functional outcome. Conclusions Pubic dermolipectomy is a safe procedure with satisfactory results to treat men with buried penis. Surgical exposition of the penile shaft was accomplished in all patients. Disclosure No

Experiences with Surgical Reconstruction of Penoscrotal Extramammary Paget's Disease: A review of 21 cases

Penoscrotal extramammary Paget's disease is a rarely found intraepithelial adenocarcinoma in older male patients. The challenge for surgeons to perform high-quality post-surgery reconstruction is mostly case-dependent. Here, we present a review of post-surgical reconstruction practice in 21 cases using various scrotal skin flaps. During the 10-year study period (from 2008 to 2018), all 21 male patients diagnosed with penoscrotal extramammary Paget's diseases at Sun Yat-sen memorial hospital were enrolled in this study. All patients underwent expanding resections guided by frozen sections and penoscrotal reconstructions using various scrotal skin flaps alone or combined with pubic skin flaps and partial thickness skin graft depending on individual defects. The patient's clinical data, specifically the diagnosis, surgical outcome, and follow-up evaluation were retrospectively analyzed. The size of skin lesions ranged from 4 × 5 cm to 16 × 18 cm approximately. Out of 21 total cases, 13 patients received combined scrotal and pubic flaps, three patients received single scrotal flaps, and five patients received scrotal flaps and partial thickness skin grafts. Limited flap tip necrosis (two cases) and wound dehiscence (one case) were observed, and secondary resections were performed in four cases with positive post-operative pathological results. All patients experienced complete wound healing and had well-maintained penile morphology and function. Various scrotal skin flaps alone or combined with pubic skin flaps designed for individual lesion conditions in patients with penoscrotal extramammary Paget's disease are efficient for scrotal reconstruction. A good match of the local skin texture helps to maintain the morphology and function of the penis and scrotum.

ESTABLISHING NORMAL PENILE SKIN SENSATION USING TWO-POINT DISCRIMINATION TEST

Introductions: To many penile surgeries, degloving of the penis is a routine part. The effect of this on penile sensation is unknown. The Two-Point Discrimination test (TPD) is used in clinical practice to evaluate sensory nerve function. There is no normative data for two-point discrimination sensation in the penile skin in children. Methods: Participants were prospectively collected from the pediatric surgical clinic patients provided they were: 7 years or older, generally healthy with no known systemic or neurological disease, had no prior genitourinary surgery or trauma, and demonstrated understanding of the test principle on the fingers. Lowest TPD test was recorded for the following areas: dorsum of penis, ventral surface of penis, pubic skin, scrotum and medial thigh. The test was started at 5 mm and incrementally increased by 1-2 mm until the child could reliably feel two separate touch points by giving correct responses 4 out of 5 or 7 out of 10 times for each area. Data was analysed using mean +/- standard deviation. Results: 24 patients were enrolled during the study period August 2021 - October 2022, mean age 10 +/-2.1 years. TPD for dorsal and ventral penile skin was 8.5 +/-1 mm. For the scrotum, pubic skin and medial thigh; TPD was 9.9 +/-1.6, 10.3 +/-1.8 and 14 +/- 2.4 mm; respectively. Conclusion: Normal TPD for the penile skin is around 8 mm. This will aid in studying sensory effects of penile surgery, particularly degloving penile skin.

Simultaneous Suprapubic Lipectomy and Penile Prosthesis Implantation

IntroductionA shorter penis is a frequent complaint following penile prosthesis implantation (PPI), and a large redundant suprapubic fat pad can conceal the penis and possibly compromise patient and partner satisfaction with length. AimTo evaluate feasibility and outcome of same-session, same-incision, PPI and suprapubic lipectomy (SPL). MethodsIn 22 patients, SPL was performed through an abdominal crease incision. Through the same incision, the superficial perineal pouch was opened to gain access to the base of the penis. Penile prosthesis was implanted (semirigid in 16 patients and girth-expanding 3-piece inflatable in 6). Scarpa’s fascia, subcutaneous fat, and the abdominal crease skin incision were closed. Main Outcome MeasureEvaluation was in terms of implant survival, preoperative vs postoperative patient and partner satisfaction with penile length on a 5-point rating scale, subjective opinion over penile length postoperatively, compared with recall of erect length before erectile dysfunction (ED) had set in (longer, same, or shorter), and penile length with the implant rigid, compared in the supine and standing positions postoperatively (pubic skin to tip, using a rigid ruler). ResultsNo infections or extrusions or mechanical failures were encountered. There was a 53.3% increase in patient satisfaction with length comparing preoperative (2.55 ± 0.67) to postoperative (4.77 ± 0.43) ratings, P < .0001. Partner satisfaction showed a 40.2% increase, from 1.77 ± 0.61 to 4.41 ± 0.50, P < .0001. 19 of 22 patients reported that postoperative length was longer than their recall of erect length before ED had set in, and 3 patients reported that length was the same. With the implant rigid, there was no statistically significant difference in visible length between the supine and standing positions (14.1 cm ± 2.3 and 13.9 cm ± 2.3, respectively, P = .38). Clinical ImplicationsPatients with refractory ED and a concealed penis can be counseled as to the option of simultaneous SPL and PPI (SPL-PPI), a modification that may help avoid patient and partner dissatisfaction with length. Strength & LimitationsStrengths include objective evaluation of the efficacy of the procedure by comparing supine and standing penile length. Limitations of the current study include inability to evaluate erect length preoperatively owing to refractory ED, and subjectivity of patient and partner opinion. ConclusionSame-incision SPL-PPI appears to be a safe and effective procedure, with high patient and partner satisfaction rates.Shaeer O, Shaeer K, Abdel Rahman IF. Simultaneous suprapubic lipectomy and penile prosthesis implantation. J Sex Med 2018;15:1818–1823.

Dorsal phalloplasty accompanying penile prosthesis implantation minimizes penile shortening and improves patient satisfaction.

Many patients complain of shortened length following penile prosthesis implantation. Dorsal phalloplasty (DP) can accompany prosthesis placement to mitigate this complaint by resulting in more visible penis outside the plane of the patient's body. DP is done through the same incision. A nonabsorbable suture approximates the under surface of the skin where the penis meets the pubis to the periosteum of the pubic bone. This adjunctive procedure results in more visible proximal penile shaft. We compared penile visible length (pubic skin surface to tip) in patients who had the adjunctive procedure with prosthesis insertion to patients who had only the penile prosthesis. Totally, 66 patients had DP and 60 did not. All patients were operated through a penoscrotal incision. The tacking suture of # 5 nonabsorbable braided polyester was passed through the pubic periosteum then into the subcutaneous tissue and dermis of the under surface of the pubic skin. The suture was tied after prosthesis insertion. Efficacy of DP was evaluated by measured gain in erect visible length in the DP group, maintenance of that length gain until final follow up at 3 years, as well as by the difference in subjective evaluation criteria between both groups. The DP group had a 23% increase in visible length compared to pretacking (p < 0.0001) that was durable to 36 months. Subjectively, 80% of patients in the prosthesis alone group reported a shorter penis in contrast to 6.1% in the DP group. The DP group reported 28.4% higher satisfaction with length, compared to the control group (p < 0.0001). In conclusion, DP accompanying prosthesis insertion improved visible length, minimized the impression of shortening, and enhanced satisfaction with length.

AB030. Penile surgery for premature ejaculation and augmentation

Premature ejaculation (PE) is a male sexual dysfunction characterized by short duration of vaginal penetration and difficult to delay ejaculation with negative personal consequence. Current management of PE includes psycho-behavioral therapy and medication (oral or topical using). Unfortunately, not all patients are benefit or effective to these therapies. On the other hand, some patients are not satisfied with the dependent of medication. As a result, some patients seek for surgery to solve their PE problems. Penile augmentation is an actually need? Still, common sense doesn’t stop size-obsessed guys from trying very sketchy treatments on a vital part of their anatomy. The typical erect penis is usually 12.5 to 15 cm long with a circumference of 10 to 12.5 cm. There’s more variation in the size of flaccid penises. Some guys are genuinely smaller than that. In rare cases, genetics and hormone problems cause a condition called micropenis—an erect penis of under 7 cm. Penile augmentation is a surgical procedure included penile lengthening or via increase in girth, or both. The lengthening of the penis involves release of the suspensory ligament of the penis via an incision just above the shaft of the penis. The release allows the penis to be brought outward in a straighter path thereby increasing the external length of the penis. In order to gain length, this was accomplished by the advancement of a pubic skin flap (V-Y flap). The gain varies depending on penis size, body build, and the amount of post-operative stretching performed. In some cases, additional procedures such as the pubic fat pad reducing with pubic liposuction can be performed to enhance the results. As far as increasing girth, there is augmentation via patient’s himself tissue or via biomaterial implantation.

The Relative Effects of Manual Versus Automatic Exposure Control on Radiation Dose to Vital Organs in Total Hip Arthroplasty.

Technologic advances have reduced medical radiation exposure while maintaining image quality. The purpose of this study was to determine the effects of the presence of total hip arthroplasty implants, compared with native hips, on radiation exposure of the most radiosensitive organs when manual and automatic exposure control settings are used. Detection probes were placed at six locations (stomach, sigmoid colon, right pelvic wall, left pelvic wall, pubic symphysis, and anterior pubic skin) in a cadaver. Radiographs were obtained with the use of manual and automatic exposure control protocols, with exposures recorded. A total hip arthroplasty implant was placed in the cadaver, probe positioning was confirmed, and the radiographs were repeated, with exposure values recorded. The control probe placed at the stomach had values ranging from 0.00 mSv to 0.01 mSv in protocols with and without implants. With the manual protocol, exposures in the pelvis ranged from 0.36 mSv to 2.74 mSv in the native hip and from 0.33 mSv to 2.24 mSv after implant placement. The increases in exposure after implant placement, represented as relative risk, were as follows: stomach, 1.000; pubic symphysis, 0.818; left pelvic wall, 1.381; sigmoid colon, 1.550; right pelvic wall, 0.917; and anterior pubic skin, 1.015. With automatic exposure control, exposures in the pelvis ranged from 0.07 mSv to 0.89 mSv in the native hip and from 0.21 mSv to 1.15 mSv after implant placement. With automatic exposure control, the increases in exposure after implant placement, represented as relative risk, were as follows: stomach, 1.000; pubic symphysis, 1.292; left pelvic wall, 1.476; sigmoid colon, 2.182; right pelvic wall, 3.000; and anterior pubic skin, 1.378. The amount of radiation to which patients are exposed as a result of medical procedures or imaging, and whether exposure is associated with an increased risk of malignant transformation, are the subject of ongoing debate. We found that after insertion of a total hip arthroplasty implant, exposure values increased threefold at some anatomic locations and surpassed 1 mSv, the generally accepted threshold for concern. Radiation exposure to radiosensitive organs increased up to threefold after total hip implantation with automatic exposure control and up to approximately 1.5 times with the manual protocol. Doses were greater with manual exposures than with automatic exposure control (except at the control probe on the stomach, where exposure was negligible, as expected). However, after implant placement, doses increased more with automatic exposure control than with manual exposure. This difference can be attributed to increased scatter and the difficulty of dose modification because of the density of the implant. Current radiographic protocols should be reassessed to determine if the benefits of frequent radiographs outweigh the newly demonstrated risks.

Dorsal Phalloplasty to Preserve Penis Length after Penile Prosthesis Implantation.

Following penile prosthesis implantation (PPI), patients may complain of a decrease in visible penis length. A dorsal phalloplasty defines the penopubic junction by tacking pubic skin to the pubis, revealing the base of the penis. This study aimed to evaluate the efficacy of a dorsal phalloplasty in increasing the visible penis length following PPI. An inflatable penile prosthesis was implanted in 13 patients with severe erectile dysfunction (ED) at the Kamal Shaeer Hospital, Cairo, Egypt, from January 2013 to May 2014. During the surgery, nonabsorbable tacking sutures were used to pin the pubic skin to the pubis through the same penoscrotal incision. Intraoperative penis length was measured before and after the dorsal phalloplasty. Overall patient satisfaction was measured on a 5-point rating scale and patients were requested to subjectively compare their postoperative penis length with memories of their penis length before the onset of ED. Intraoperatively, the dorsal phalloplasty increased the visible length of the erect penis by an average of 25.6%. The average length before and after tacking was 10.2 ± 2.9 cm and 13.7 ± 2.8 cm, respectively (P <0.002). Postoperatively, seven patients (53.8%) reported a longer penis, five patients (38.5%) reported no change in length and one patient (7.7%) reported a slightly shorter penis. The mean overall patient satisfaction score was 4.9 ± 0.3. None of the patients developed postoperative complications. A dorsal phalloplasty during PPI is an effective method of increasing visible penis length, therefore minimising the impression of a shorter penis after implantation.

Effect of the surgical treatment on the keloid of mons pubis with postoperative radiotherapy

Objective To explore an effective surgical treatment to the keloid of mons pubis. Methods From March 2008 to January 2015, local flap and adjacent flap (including ilioinguinal flap and rectus abdominal musculocutaneous flap) were performed, and used to repair the defect after surgical removal of the keloid in 25 patients, and all the patients were received postoperative local radiotherapy, and then chi square test was applied to evaluate the effect in the six aspects, including perineal form, skin color, pubic hair distribution, satisfactory effect, skin texture and sense. Results The local flap group was better than the adjacent flap group in perineal form, skin color, pubic hair distribution, satisfactory effect, but there was no significant difference in skin texture and sense. Conclusions For the keloid of mons pubis, the first choice is local flap graft, which can maintain the normal mons pubis formation as most as possible, while the wound is so large that the local flap cannot work, and therefore the vascular pedicle axial flap should be used. Key words: Flap; Flap graft; Keloid; Mons pubis; Radiotherapy

A Combination of Penile Venous Stripping, Tunical Surgery and Varicocelectomy for Patients with Erectile Dysfunction, Penile Dysmorphology and Varicocele under Acupuncture-aided Local Anesthesia on Ambulatory Basis

Background: Since 1986, we have refined our combination of penile venous stripping, corporoplasty and varicocelectomy which has proven to be efficacious to patients who suffer from the combination of Erectile Dysfunction (ED), Penile Deviation (PD) and varicocele. It has been developed in tandem with the advances in our understanding of the penile venous, tunical and related anatomy. Herein we sought to report on an approach utilizing the combination of three surgeries for reversing ED, restoring libido and revitalizing the age-related decline in sexual performance. Materials and methods: From June 2010 to March 2012, a total of 35 men, aged from 41 to 49 years, with ED resulting from Veno-Occlusive Dysfunction (VOD), penile deviation and a varicocele. Twenty three (the surgical group) underwent a combination of penile venous stripping, morphological reconstruction and varicocelectomy. Twelve were assigned to the control group. The abridged five-item version of the International Index of Erectile Function (IIEF-5) was used to score the patients. Furthermore, a dual cavernosogram, a prostaglandin E-1 test and a life quality rating were used to assess patients at 6 month intervals. Under an innovative method of acupuncture-aided local anesthesia, and following a circumferential incision, the Deep Dorsal Vein (DDV) and Cavernosal Veins (CVs) were completely stripped and ligated, followed by a pubic median longitudinal skin incision for completing the venous vasculature removal. Tunical surgery was then performed for correcting penile shape. Finally, along the longitudinal pubic wound, a unilateral or bilateral varicocelectomy was performed via a subcutaneous tunnel. Results: The follow-up period ranged from 0.5 to 2.5 years. In the surgical group the average operation time was 4.8 ± 0.3 h. There was no postoperative infection. The preoperative IIEF-5 and the life quality ratings were 9.6 ± 2.1 and 27.3 ± 4.5%, which was increased postoperatively to 20.6 ± 2.3 and 80.8 ± 6.4% respectively (both p<0.001). Whereas in the control group the corresponding preoperative IIEF-5 and life quality ratings were 9.8 ± 2.5 and 29.4 ± 4.4% respectively, in the equivalent postoperative period these changed to 8.8 ± 2.7 and 20.8 ± 6.5% respectively (both p<0.01). The difference between the two groups (p<0.001) and within the group (p<0.01) was significant. A satisfactory penile shape was achieved in 21 (91.3%) patients with 2 men (8.7%) complaining of mild residual deviation of the penis (<10°). Postoperative frenulum edema was limited (3.2 ± 1.6 days). Cavernosograms also demonstrated the ideal milieu of the corpus cavernosum for retaining intracorporeal fluid/blood. Conclusion: A combination of penile venous stripping, penile morphological reconstruction and varicocelectomy provides a novel solution for reestablishing satisfactory and satisfying sexual functioning and performance.

Radiological evaluation by magnetic resonance of the ‘new anatomy’ of transsexual patients undergoing male to female sex reassignment surgery

Magnetic resonance (MR) is the best way to assess the new anatomy of the pelvis after male to female (MtF) sex reassignment surgery. The aim of the study was to evaluate the radiological appearance of the small pelvis after MtF surgery and to compare it with the normal women's anatomy. Fifteen patients who underwent MtF surgery were subjected to pelvic MR at least 6 months after surgery. The anthropometric parameters of the small pelvis were measured and compared with those of ten healthy women (control group). Our personal technique (creation of the mons Veneris under the pubic skin) was performed in all patients. In patients who underwent MtF surgery, the mean neovaginal depth was slightly superior than in women (P=0.009). The length of the inferior pelvic aperture and of the inlet of pelvis was higher in the control group (P<0.005). The inclination between the axis of the neovagina and the inferior pelvis aperture, the thickness of the mons Veneris and the thickness of the rectovaginal septum were comparable between the two study groups. MR consents a detailed assessment of the new pelvic anatomy after MtF surgery. The anthropometric parameters measured in our patients were comparable with those of women.

A role for B 12 in inflammatory bowel disease patients with suppurative dermatoses? An experience with high dose vitamin B 12 therapy

Background Inflammatory dermatoses in conjunction with inflammatory bowel disease (IBD) comprise a diverse range of disorders. Some but not all of these respond to conventional treatments for the underlying IBD, such as immunomodulating or antibiotic treatments. We describe our experience with high dose vitamin B 12, where conventional therapies have failed. Case reports The first case had pouchitis complicated by perianal abscesses and a recto-vaginal fistula. The second case had biopsy proven hidradenitis suppurativa affecting the perianal, inguinal and pubic skin. High dose vitamin B 12 appeared to be the major factor in preventing the recurrence of suppuration in both patients. Neither patient had vitamin B 12 deficiency. Open label experience: high dose vitamin B 12 treatment of a further 10 consecutive IBD patients with dermatoses was thought to provide benefit to six of them, but did not appear useful in four patients with perianal Crohn's disease with fistulae as the only manifestation of cutaneous disease. Conclusions There appears to be a subset of IBD patients with perianal and more distant inflammatory dermatoses, who benefit from high dose vitamin B 12 treatment. Clinical trials in IBD patients with biopsy-characterised suppurative dermatoses will be required in order to properly define the role of this safe and economical therapy.

Characterization of human epidermal neural crest stem cell (hEPI‐NCSC) candidate cells

We provide the first comprehensive characterization of hEPI‐NCSC candidate cells. Mouse EPI‐NCSC are multipotent remnants of the embryonic neural crest in a postnatal location, the bulge of hair follicles. Here, the bulge region of human anagen hair follicles was micro‐dissected from pubic skin that was procured with informed consent after elective Caesarean section. Emigrating cells were multipotent, as progeny of clone‐forming cells differentiated into smooth muscle cells, neuroblasts, and bone/cartilage cells. Gene expression profiling using the Illumina platform suggested that 17/18 mouse neural crest molecular signature genes identifiable in humans were also highly abundant in hEPI‐NCSC (PCBP4, MSX2, H1FX, PYGO2, THOP1, MYO10, ETS1, PYGO2, ADAM12, BEX1, VDAC1, CALR, CRYAB, PEG10 AGPAT6, CRMP1, UBE4B). Expression of eight of those genes, nestin and the neural crest marker SOX10, was validated by immunocytochemistry. Additional key neural crest‐characteristic genes included WNT1, SNAI2, MSX1, PAX9 and TNFRSF1B (p75NTR). The iPS genes MYC, KLF4, LIN28, and SOX2 were present at highly significant levels. Taken together, the data suggest that hEPI‐NCSC are multipotent cells of neural crest origin.

Development, Validation, and Field Use of a Novel Method for Extracting and Analyzing Organophosphate (OP) and Pyrethroid Pesticide Metabolites and Creatinine from Commercial Disposable Diapers

MAA4-PD-03 The ability to efficiently extract urine from disposable diapers ensures an easy-to-use urine collection protocol and ready compliance for caregivers of very young children. The use of disposable diapers is also desirable because of their high capacity-urine is retained effectively overnight (12–14 hours for young children), thus providing integration of excretion more than 50% of a day. Until now, no method has been developed to meet this challenge; urine collection for infants and toddlers in exposure studies has involved either expressing urine from cotton inserts in diapers or using spot urine collection into plastic bags attached to pubic skin. We report, for the first time here the development, the validation and use of a novel method that uses accelerated solvent extraction, C18 cleanup, and gas chromatography/mass spectroscopy (GC/MS) analysis for measuring pesticide metabolites and creatinine in the urine of infants and toddlers collected on commercial, disposable, acrylate gel diapers. A composite sample consisting of 6 clumps of swelled gel from a diaper is extracted under elevated temperature and pressure, hydrolyzed to deconjugate glucuronides, cleaned up on a solid phase extraction cartridge, split and derivatized using silylation and methylation reactions, and analyzed using GC/MS in the multiple ion detection mode. Recoveries of urinary TCPy (metabolite of chlorpyrifos), IMPy (metabolite of diazinon), 3PBA (from permethrin and cypermethrin), and 4F-3PBA (from cyfluthrin) were 92% to 102%; recovery of creatinine was 80%. Detection limits were comparable with conventional urine analysis methods (0.1–0.4 ng/ml), depending on the analyte. Method validation included evaluation of interferences and recoveries from different brands of diapers, variation in metabolite levels across diapers, effects of urine volume and multiple voids of differing concentrations, and the effects of room temperature and freezer storage. In all cases, the method was found to be robust, free of interferences, and stable during the 7-day period tested. This exposure assessment method is being used in a longitudinal birth cohort study of OP and pyrethroid pesticide exposures, where 200 maternal urines and 200 overnight urine diaper samples have been analyzed to date. Parents are asked to provide a wet and dry diaper (for total urine volume determination). Compliance has been 100%. Analyte ranges and ongoing QC results will be discussed. Acknowledgments: Although this work was reviewed by Environmental Protection Agency (EPA) and approved for publication, it may not necessarily reflect official Agency policy. This work has been supported under Contract 68-D-99-011 from the U.S. EPA and an EPA STAR Grant.

The medical and surgical therapy of pseudofolliculitis barbae.

Pseudofolliculitis barbae (PFB) is a common, chronic, inflammatory skin disorder seen mainly in individuals with curly hair. This condition is seen most frequently in black men who shave their beards but may also be seen in women of all races who wax or shave the axillary and pubic skin. The etiology of PFB is multifactorial, and heretofore a cure has been considered impossible for those desiring a clean-shaven face. The following article serves to discuss the current medical and surgical therapies available for this condition. Medical treatments for this condition include various combinations of topical antibiotics, corticosteroids, and retinoids. In the surgical arena, laser therapy has revolutionized the treatment of PFB and has enabled cure for the first time for those plagued by this disorder and for whom a beardless face is acceptable.

The pubic area skin and dermal graft donor site.

The pubic area skin and dermal graft donor site.

Buried penis release in adults with suction lipectomy and abdominoplasty.

The buried penis in adults who had substantial weight gain was treated with a combination of suction lipectomy of the abdomen and pubic area and the release of the suspensory ligament of the penis and with abdominoplasty with suture anchoring of the pubic and penile skin base dermis to the rectus fascia superiorly. This procedure was performed in 11 patients over the past 10 years with satisfactory results. One patient required additional excess skin excision from the side of the pubic and scrotal area to improve the results.

Transpubic herniation of the bladder: a sequel of traumatic pubic symphysis diastasis

If traumatic disruption of the pubic symphysis is not adequately reduced, an orifice may appear in the abdominal wall below the umbilicus, communicating with the perineal floor through the dislocated pubic symphysis. The bladder and sometimes intestinal structures then herniate beneath the pubic skin. If the diagnosis is established late, bone repair would be difficult since it would require a procedure of posterior pelvic osteotomy and difficult anterior osteosynthesis beneath thin skin liable to ulcerate. We therefore consider these herniations are better treated without mobilisation of bone. Placement of a mesh prosthesis makes it possible to reinforce the wall, but supplementary coverage is required at the level of the symphysis to strengthen the repair and isolate the prosthesis from the thin skin and scar tissue. This aim can be achieved by using a rectus abdominis muscular flap with an inferior pedicle to cover the prosthesis.

Point mutations in the steroid-binding domain of the androgen receptor gene of five Japanese patients with androgen insensitivity syndrome.

We analyzed the androgen receptor (AR) gene in five Japanese patients diagnosed with androgen insensitivity syndrome (AIS). All AR genes from the five patients had single-nucleotide substitutions, which introduced a premature termination codon in three patients (Gln640, Arg752, and Gln640 and Trp751), and a single amino acid substitution in two patients (Arg831 to Gln, and Leu812 to Phe). All the mutations occurred in the steroid-binding domain, comprising exons D through G. The three patients with the premature termination codon(s) and the one patient with Arg831Gln were clinically diagnosed as having complete AIS, while the patient with Leu812Phe had a partial form of AIS. Pubic skin fibroblasts from four of the five patients did not show detectable androgen binding. These data on mutations that have not been reported previously, provide valuable information for the further characterization of structural and functional relationships in the steroid-binding domain of the AR protein.

RECONSTRUCTION OF DEFORMITIES RESULTING FROM PENILE ENLARGEMENT SURGERY

Purpose More than 30 patients presented for reconstruction of penile deformities secondary to penile enlargement surgery performed by other physicians. Lengthening was performed by releasing the suspensory ligament of the penis and advancing pubic skin with a V-Y advancement flap. Girth was increased by injecting autologous fat. Specific complaints relating to the lengthening procedure involve hypertrophic and/or wide scars, a proximal penile hump from a thick, hair-bearing V-Y flap, and a low hanging penis. Complications relating to autologous fat injections include disappearance of fat, penile lumps and nodules, and shaft deformities. The repair of these deformities is described. Materials and Methods From 1994 through October 1996, 19 men underwent 24 various combinations of reconstructive operations, such as scar revisions, V-Y advancement flap reversal, and removal of fat nodules and asymmetrical fat deposits. Results Penile appearance and function were improved. Complications include 1 hematoma requiring drainage, minor wound complications and 1 inadequately reversed V-Y flap. Conclusions The methods of various repairs are discussed, including reconstructive limitations, timing and staging. Significant improvement can be achieved with proper reconstruction of penile deformities.