Penile Shaft Research Articles

Urethral complex thickness and thickness index are the independent risk factors for urethroplasty complications after tubularized incised plate hypospadias repair

In tubularized incised plate urethroplasty, the depth of the mid-line relaxing incision is the key factor for urethral plate tubularization without tension. The incision depths will be different from one case to the other even if they have been done by the same surgeon. This difference in depths resulted from the different thicknesses of the urethral plate and the underlying corpus spongiosum (urethral complex). To evaluate the urethral complex thickness and thickness index as risk factors for the complications of TIPU in penile shaft hypospadias repair. All primary penile shaft (distal and mid-penile) hypospadias (with or without mild penile chordee) were operated with TIPU between March 2018 and February 2021. We measured the urethral complex thickness in the hypospadiac and proximal normal parts of urethra pre-operatively with superficial U/S probe. Intraoperative, we measured the urethral plate width before and after the midline relaxing incision, calculate the relative increase in urethral plate width (RIUPW). Stepwise logistic regression assessed the effect of different variables on the complication rate. These variables include; urethral plate width before and after incision, urethral complex thickness, thickness index, RIUPW, site of hypospadiac meatus and patients ages. 10 cases had 11 complications (12.7%). Fistulae were the commonest complication (8.9%). Complication rate has significant negative correlations with many variables on Univariate analysis. Stepwise logistic regression shows that urethral plate thickness and thickness index are the independent risk factors for complications after TIPU in penile shaft hypospadias. Urethral plate width was suggested to be a risk factor for TIPU complications. In our study, Univariate analysis shows that complications were more with plate width ˂8mm but without significant difference (P=0.487). Also it shows that post incision width and RIUPW have significant negative correlation with complications rate. Multivariate analysis showed that the urethral complex thickness and thickness index are the independent risk factors for complications after TIPU hypospadias repair (AUC 0.94 95% CI 0.894-0.972P˂0.001 and 0.965 95% CI 0.921-0.996, respectively). The thickness of the urethral plate and the underlying spongiosum is the determining factor for TIPU success. We can use it as an objective reproducible assessment tool for urethral plate quality and to predict TIPU complications.

Technical note: Evaluation of a silicone-based custom bolus for radiation therapy of a superficial pelvic tumor.

PurposeUse of standard‐of‐care radiation therapy boluses may result in air‐gaps between the target surface and bolus, as they may not adequately conform to each patient's unique topography. Such air‐gaps can be particularly problematic in cases of superficial pelvic tumor radiation, as the density variation may result in the radiation delivered to the target site being inconsistent with the prescribed dose. To increase bolus fit and thereby dose predictability and homogeneity, we designed and produced a custom silicone bolus for evaluation against the clinical standard.MethodsA custom bolus was created for the pelvic regions of both an anthropomorphic phantom and a pelvic patient with squamous cell carcinoma of the penile shaft. Molds were designed using computed tomography (CT) scans, then 3D‐printed and cast with silicone rubber to yield the boluses. Air‐gap measurements were performed on custom and standard‐of‐care Superflab gel sheet boluses by analyzing total volume between the bolus and target surface, as measured from CT scans. Therapeutic doses of radiation were delivered to both boluses. Radiation dose was measured and compared to the expected dose using nine optically stimulated luminescent dosimeters (OSLDs) placed on the phantom.ResultsMean air‐gap volume between the bolus and phantom was decreased from 314 ± 141 cm3 with the standard bolus to 4.56 ± 1.59 cm3 using the custom device. In the case of the on‐treatment patient, air‐gap volume was reduced from 169 cm3 with the standard bolus to 46.1 cm3 with the custom. Dosimetry testing revealed that the mean absolute difference between expected and received doses was 5.69%±4.56% (15.1% maximum) for the standard bolus and 1.91%±1.31% (3.51% maximum) for the custom device. Areas of greater dose difference corresponded to areas of larger air‐gap.ConclusionsThe custom bolus reduced air‐gap and increased predictability of radiation dose delivered compared to the standard bolus. The custom bolus could increase the certainty of prescribed dose‐delivery of radiation therapy for superficial tumors.

Fluid-structure interaction: Advances on erectile functionality

In this work the interaction between the blood and the penile structures was treated in order to have an insight into erectile functionality. Coital consummation and, maybe, its concomitant tendency to procreate is only attainable when there exists a fluid-structure synergy. Remarkably, hemodynamic influence is the basis of the behaviour of the penile ‘utensils’ towards such consummation. The blood flow that induces penile engorgement that precedes vaginal intromission results in both tunical and vascular deformation, as was shown theoretically in this paper. The equations that govern blood flow and those that govern the penile structures’ response are derived. One of the results is the equation that furnishes the axial length of a penile shaft under axial displacement by using some tunical characteristics. Of much interest in erectile functionality is the concept of penile buckling. This was given attention here. Contrary to some insinuations occasioned by the treatment of the penile ‘shaft’ as a column subjected to axially compressive force that buckles under further application of a force, which was reported here, this work sees penile tissue detumescence resulting from the withdrawal of a force as the basis of penile axial buckling.

Spontaneous involvement of penile shaft (corpora cavernosa) by anal fistula.

ANZ Journal of SurgeryEarly View IMAGES FOR SURGEONS Spontaneous involvement of penile shaft (corpora cavernosa) by anal fistula Pankaj Garg MBBS, FASCRS, Pankaj Garg MBBS, FASCRS orcid.org/0000-0002-0800-3578 Department of General Surgery, Indus Super Specialty Hospital, Mohali, India Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, India Contribution: Conceptualization, Data curation, Formal analysis, ​Investigation, Methodology, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorVipul D. Yagnik MS, FMAS, FIAGES, FAIS, FISCP, Vipul D. Yagnik MS, FMAS, FIAGES, FAIS, FISCP orcid.org/0000-0003-4008-6040 Department of General Surgery, Nishtha Surgical Hospital and Research Center, Patan, Gujarat, India Contribution: Formal analysis, Methodology, Supervision, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorSushil Dawka MS, Sushil Dawka MS Department of General Surgery, SSR Medical College, Belle Rive, Mauritius Contribution: Formal analysis, Methodology, Validation, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this author Pankaj Garg MBBS, FASCRS, Pankaj Garg MBBS, FASCRS orcid.org/0000-0002-0800-3578 Department of General Surgery, Indus Super Specialty Hospital, Mohali, India Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, India Contribution: Conceptualization, Data curation, Formal analysis, ​Investigation, Methodology, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorVipul D. Yagnik MS, FMAS, FIAGES, FAIS, FISCP, Vipul D. Yagnik MS, FMAS, FIAGES, FAIS, FISCP orcid.org/0000-0003-4008-6040 Department of General Surgery, Nishtha Surgical Hospital and Research Center, Patan, Gujarat, India Contribution: Formal analysis, Methodology, Supervision, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorSushil Dawka MS, Sushil Dawka MS Department of General Surgery, SSR Medical College, Belle Rive, Mauritius Contribution: Formal analysis, Methodology, Validation, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this author First published: 19 January 2022 https://doi.org/10.1111/ans.17479 This manuscript is neither published nor under consideration for publication in any journals. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Partial Reconstruction with Thigh Skin Graft for Penile Cancer: Case Presentation, Description of Surgical Technique and Literature Review

<i>Background: </i>Penile cancer is a rare neoplasm, the most common variety is invasive squamous cell carcinoma or epidermoid carcinoma. Its incidence is very low in developed countries. Partial and radical penectomy has been the gold standard for the treatment of this disease. In recent decades, different reconstructive techniques have been developed with a much lower impact on the quality of life of the patient. <i>Objective</i>: describe a surgical technique to treat premalignant lesions and superficial malignant lesions of the penis, and review of the literature. <i>Method</i>: a description of the surgical technique regarding partial penile reconstruction using a thigh skin graft for the treatment of premalignant lesions and superficial penile cancer was done.<i> </i>The surgery is divided in 6 steps, which includes general preparation, cystoscopy,<i> </i>resection of lesions on the shaft of the penis and scrotum, estimation of graft size and graft taking, preparation and placement of the graft on the shaft of the penis and wound healing, urinary catheter placement and follow-up. <i>Results: </i>this<i> </i>surgery shows a good cosmetic result, without local progression of the underlying disease. <i>Conclusion</i>: Conservative surgical treatment is a possible option in premalignant and malignant penile lesions, as it allows a better quality of life for the patient without affecting overall survival.

Bluish-coloured Papule over the Penile Shaft.

Bluish-coloured Papule over the Penile Shaft.

Atrophic Lingual Plaque in Father-Son Duo.

Dear editor, A 24-year-old male presented with a tongue lesion present since adolescence. On examination, he had a single large, sharply demarcated, irregular, depressed plaque on the dorsum of the tongue. Blackish discoloration of the papillae within the lesion was noted. [Figure 1a]. Also, there were multiple, asymptomatic, annular plaques all over the body, slowly increasing in number and size with age. Most of these plaques had a hyperkeratotic double-edged border with a gutter in between with a thread-like margin with atrophy at the center in a few. Similar plaques were present in the buccal mucosa, hard palate, labial commissures, scrotum, glans, and penile shaft. His father also had multiple similar plaques on the tongue as the son, but the center was more atrophic and glazy [Figure 1c]. Furthermore, his father had similar lesions over the body and limbs [Figure 2].Figure 1: Shows (a) clinical picture of son showing a sharply demarcated large irregular plaque with bluish-grey papillae inside the border; (b) mucoscopy of the same lesion of the son with incomplete white peripheral keratotic tract with a double-free edge with few areas showing white radiating lines; (c) clinical picture of the father showing multiple sharply-demarcated plaques with atrophic papillae; (d) mucoscopic picture showing white peripheral keratotic tract with a double-free edge, dotted vessels in irregular distribution and clusters inside the plaque, loss of papillae with brown clods, and white lines in the centerFigure 2: Multiple large annular plaques with double-edged border of classic porokeratosis of Mibelli on back (a) and legs (b) and upper limb (c)Mucoscopy (DermLite DL4; Contact polarized; 10× magnification; ultrasound gel as interface media) of the tongue plaque of the son [Figure 1b] showed incomplete, peripheral, white, double-edged, keratotic tract with few areas showing white radiating lines and brown clods. In contrast, the father [Figure 1d] showed a white peripheral, double-edged, keratotic track with a center showing dotted vessels in irregular distribution and clusters inside the plaque, loss of papillae, brown clods, and white lines. Dermoscopy of the cutaneous lesion of both father and son showed the hyperkeratotic double-edged margin with the characteristic gutter in between and decreased skin markings at the center, which indicated a clinical diagnosis of classic porokeratosis of Mibelli (CPM). Biopsy and histopathological [Figure 3a and b] examination of the tongue lesion of the son showed moderately dense superficial perivascular patchy lichenoid lymphocytic infiltrate with focal interface vacuolar change. In a few places, the epidermis showed an invagination of the floor, which lacked a granular layer, whereas the walls showed hypergranulosis, and the center had a column of dyskeratotic and parakeratotic cells, the cornoid lamellae. It confirmed our clinical diagnosis of multifocal CPM.Figure 3: Showing histopathological findings {Hematoxylin and Eosin, 10 × (a) and 40 × (b)} – moderately dense superficial perivascular patchy lichenoid lymphocytic infiltrate with focal interface vacuolar change, the epidermis showed an invagination of the floor, which lacks granular layer, whereas the walls showed hypergranulosis, and the center had a column of dyskeratotic and parakeratotic cellsAlthough Pororkeratosis is clinically classified as localized and generalized, they are unified by a common histopathological finding of a column of parakeratotic cells with an absent granular layer at the base. Dermoscopy of cutaneous lesions helps diagnose as it accentuates the gutter as white track,[1] which is characteristic of porokeratosis, especially in CPM, as was seen in our case. Ahmed et al.[2] described 26 cases of primary genital porokeratosis in their review. Our literature search of PubMed and Google (till April 2021) and review of reported cases having mucosal porokeratosis [electronic supplement Table e-1] found 18 reports. Out of 21 cases, ten had labial lesions, nine cases had buccal mucosa lesions, and only six had lesions on their tongue (including the present report), making the tongue rarest of the three sites. Only labial porokeratosis was present in isolated form (seven cases), whereas the buccal mucosa lesions always presented with cutaneous lesions. In cases where the lesions were generalized with mucosal involvement (14 cases), buccal mucosal lesions were present in nine cases, six in the tongue, and only two on the lips, making buccal mucosa most common to be affected in generalized forms. Of these 14 cases, eight were of CPM, three each of disseminated superficial porokeratosis (DSP) and porokeratosis palmaris et plantaris disseminata (PPEPD). A total of six cases (including ours) had lingual porokeratosis. Previously, tongue plaque has been seen in two cases of CPM,[34] and one each in PPEPD,[5] and DSP.[6] Our case with widespread mucosal involvement is very rare. Furthermore, we could not find any literature describing the dermoscopic and histopathologic findings of lingual porokeratosis. The mucoscopic findings will help clinicians make outpatient-based spot diagnoses. Consent Consent for publication of the image is taken. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Supplement Table

Response of erectile dysfunction to extracorporeal shock wave therapy in type 2 diabetic men

IntroductionErectile dysfunction is a major complication of type 2 diabetes mellitus (T2DM). This study aimed to investigate the effect of active vs. sham low-intensity extracorporeal shock wave therapy (Li-ESWT) on erectile dysfunction in T2DM men.MethodsOverall, 40 married T2DM men aged 40–50 years with erectile dysfunction were assigned to the study and the control group. Besides a 12-week daily administration of a 5-mg tablet of phosphodiesterase-5 inhibitor (PDE5I) tadalafil in both groups, the control group (&lt;i&gt;n&lt;/i&gt; = 20) received sham Li-ESWT, while the study group (&lt;i&gt;n&lt;/i&gt; = 20) received 2 active Li-ESWT (on the penile shaft with 1800 pulses and intensity of 0.09 mJ/mm&lt;sup&gt;2&lt;/sup&gt;) sessions weekly for 3 consecutive weeks; then, the procedure was repeated for another 3 consecutive weeks, with a 3-week rest between the 2 procedures. Erectile dysfunction was assessed by the 5-item version of the International Index of Erectile Function (IIEF-5). Baseline, 1-month follow-up, 3-month follow-up, and 6-month follow-up IIEF-5 scores were documented.ResultsAfter 1- and 3-month follow-up, there was a significant difference between the active and sham groups in favour of the active Li-ESWT group (&lt;i&gt;p&lt;/i&gt;-value of 0.0001 and 0.01, respectively), but there was no significant difference between the groups at 6-month follow-up.ConclusionsLi-ESWT can increase the long-term efficacy of PDE5I in T2DM men with erectile dysfunction.

REMOVED: The Augmenta Implant: A Cadaver Model of a Novel Anatomic Subdermal Implant for Cosmetic Penile Enhancement.

IntroductionThere are limited options for cosmetic penile enhancement and the correction of structural penile deformities.AimWe present the Augmenta, an innovative, technologically advanced subcutaneous elastomer-silicone cosmetic penile implant (CPI), as evaluated by objective structural changes in a cadaveric model.MethodsFive fresh male cadaver pelves were utilized in this preclinical setting. Placement of a subcutaneous elastomer-silicone CPI was performed via a penoscrotal approach. Penile circumference was measured at the base and distal shaft before and after implant placement. Penile length was measured from the pubic bone to the tip of the glans penis before and after implantation of Augmenta.Main Outcome MeasureObjective outcomes included changes in penile circumference and shaft length in both the flaccid and erect state, both before and after CPI placement.ResultsIn 5 cadaver models, implantation of the Augmenta CPI increased flaccid penile shaft base circumference from an average of 8.7 cm to 12.0 cm after implantation (39.1% increase, P < .001). Flaccid distal circumference increased from 7.3 cm to 10.3 cm (41.8% increase, P = .020). During the erect state, penile base circumference increased from an average of 12.5 cm to 13.7 cm (6.3% increase, P = .273), while distal erect circumference changed from an average of 11.3 cm to 12.4 cm (9.7% increase, P = .298). Nonstretched flaccid shaft length increased from an average of 12.1 cm to 14 cm (15.2% increase, P = .073).Clinical ImplicationsThe Augmenta CPI could serve as alternative option for men seeking cosmetic penile enhancement.Strengths and LimitationsLimitations include a small number of cadavers which do not completely reproduce living physiologic function and the use of a single technical approach. However, a consistent and standardized surgical approach reduces operator-dependent outcomes. Another strength is the use of fresh human cadavers that most closely represent live models.ConclusionIn a cadaveric model, the Augmenta CPI demonstrates enhancements in penile girth in both the flaccid and erect state. The unique honeycomb technology, the embedded polyester mesh, and the antimicrobial hydrophilic coating of the Augmenta CPI may provide an advantage to currently available CPIs. Clinical trials will be needed to demonstrate both the safety and feasibility. Clavell-Hernández J, Tatem AJ, Lipshultz LI, et al. The Augmenta Implant: A Cadaver Model of a Novel Anatomic Subdermal Implant for Cosmetic Penile Enhancement. Sex Med 2021;9:100447.

1246 Partial Phalloplasty After Oncologic Resection: A Challenge for Health Centers in Remote Area of Indonesia

Abstract Background Restoring penile function for urination and sexual activity, and achieving cosmetic result, are the goals of penile reconstruction including in post-malignancy reconstruction. Lack of studies has reported the usage of radial forearm flap on partial phalloplasty. Case Presentation A 31-years old male presented with fragile, cauliflower-like mass sizing 6x8 cm. The tumor had covered whole glans until the middle shaft of the penis. Plan of treatment for this patient started with complete excision of the tumor (partial penectomy), continued with phalloplasty. Phalloplasty consisted of using radial forearm flap (RFF) for penile foreskin (including glans), reconstructing corporal bodies using sartorius muscle, reshaping the penile glans, and urethroplasty to correct the hypospadic-looking urethra. Radial forearm flap of the non-dominant arm was implanted on the remaining foreskin of the penis, continued with wound care. On the 7th day postoperatively, no signs of necrotic, wound dehiscence, nor pus were observed, with capillary refill time on the distal fingers shown less than 2 seconds. Further evaluation is scheduled. Conclusions Loss of physiologic function usually follows partial penilectomy, which could lead to decrease in psychological quality of life. The main goal of the reconstruction of penile foreskin (including glans) using RFF is to form a newly formed penile glans that would have a cosmetic appearance nearly similar to a normal glans, which could improve its physiologic function and benefit psychologically. A challenge for health care centers in remote is is how to monitor and maintain a viable flap after the reconstruction and to keep a regular evaluation from the patient.

Snodgrass procedure for distal penile and mid-shaft hypospadias repair in children

Introduction. Hypospadias is one of the most frequent penile malformations in newborn boys. Warren Snodgrass developed the «tubularized incised plate» (TIP) urethroplasty that is the most often procedure used in the surgical treatment of distal hypospadias for the last 20 years. Despite the great popularity of the technique, its no less famous Grafted TIP (GTIP) modification appeared. The technique is aimed at filling the defect in the urethral site with a foreskin free flap followed by tubularized urethroplasty.Purpose of the study. To compare the outcomes of TIP and GTIP procedures in our clinic which have been performed in the last 10 years.Materials and methods. One hundred-fourteen boys with hypospadias (aged 6 mo – 15 years) were operated on using the TIP technique and its modification GTIP during 2010 – 2020 (Sochi Center of Motherhood and Childhood Protection). The patients were: boys up to 1 year – 27 (23.7%), from 1 to 3 years – 57 (50%), 4 – 7 years – 19 (16.7%), from 8 to 14 years – 14 (12.3%). Primary repair was done in 112 cases (98.2%), the second procedure was done in 2 (1.8%) cases. There were 94 (82.5%) boys with distal hypospadias and 20 (17.5%) children with mid-shaft hypospadias. All patients were examined 3 and 12 months after surgery. We assessed the degree of skin scar process on the penile shaft, the location of the meatus and the quality of urination during the examination.Results. We observed 27 (23.7%) complications after urethroplasty out of 114 treated boys. There were 13 (11.4%) cases of urethral fistula, which were secondary repaired 6 months later. Meatal stenosis was observed in 2 (1.8%) cases, which required secondary meatoplasty. Repeat urethroplasty was done in 10 (8.7%) cases due to neourethral suture failure. There were also 2 (1.8%) cases of secondary penile curvature that required repeat surgery. The good cosmetical and functional results were achieved finally in all children.Conclusion. The analysis of our ten-year experience of using TIP-urethroplasty and its GTIP modification did not reveal significant differences in the overall incidence of postoperative complications. Yet, using the TIP procedure is associated with more fistulas. There were more cases of urethral suture failure in children whom the GTIP technique was performed. Our data suggest the need for a selective approach in the formation of indications for using TIP and GTIP procedures, along with research aimed at finding criteria for patient selection.

Novel Guidelines for Immunotherapeutic Treatment Options of Genital Warts: Review article Novel Guidelines for Immunotherapeutic Treatment Options of Genital Warts: Review article

Background: The appearance of genital warts varies. Flat or resembling raspberries or cauliflower, they can be found in a variety of shapes. They begin as little red or pink growths and can reach a diameter of four inches or more before interfering with sexual activity or delivery (in certain circumstances) (in some cases). The warts thrive in the vaginal area's moist tissues. On the external genitals and the walls of the cervix and urethra, in women, as well as on the shaft of the penis in males, they are found. Despite the availability of different therapeutic modalities, treating warts with immunotherapy is a tremendous benefit. HPV vaccination has shown promising efficacy in the treatment of genital warts. Objective: To hallmark the new guidelines of immunotherapeutic options for treatment of genital warts. Conclusion: Immunotherapy with HPV vaccines is an effective and safe treatment modality of anogenital warts.

Isolated penile Fournier’s: a caveat

Isolated penile Fournier’s gangrene is a rare condition causing significant morbidity to the patients. It occurs due to urinary tract infection or trauma. We describe an elderly male who presented with blackish discoloration of the skin of the penis with fever. Examination revealed a necrotic patch over the shaft of the penis without any other foci of infection around the perineum. Penis was debrided, and the antibiogram showed Escherichia coli sensitive to amikacin. He received seven days of antibiotics, and the wound granulated well. A split skin graft was used to cover the wound to prevent contraction. This unusual presentation requires expeditious management to prevent mortality and morbidity.

Hypospadias

Hypospadias

Повреждения головки полового члена при обрезании крайней плоти: причины, способы лечения и меры профилактики

INTRODUCTION Penile glans amputation during circumcision is a rare but potentially devastating complication. The mechanism and causes are poorly understood and incomprehensible. It is important to identify the causes of these complications, to suggest a mechanism and to propose prevention measures. MATERIALS Between 2005 and 2019, six patients with penile glans amputationafter circumcision were analyzed. All were operated without medical evidence, for religious reasons. THE RESULTS The operations were performed by local anesthesia, at home - in 5 patients, in 1 child - at polyclinic. All children were circumcised by scalpel with guillotine method, without visualization of glans. Partial amputation of penile glans was observed in 2 children (33.3%). Complete cut-off of the glans at the level of the coronal sulcus was revealed in 4 boys (66.6%). Meatoplasty with urethral mobilizations was performed 2 patients (33.3%) with partial amputation. The tops of corpus cavernous was covered of with the remnants of the skin of penile shaft in two boys (33.3%). Glansplasty was performed in 2 other patients (33/3%), using a labial mucosa graft to reconstruct the shape of glans and glanular groove. The follow up have showed meatostenosis in two boys (33.3%) in the first 2 months after surgery. One child required repeated meatoplasty (16.6%), another had a recovery of normal urine flow rates after urethral dilatation and stenting (4 weeks). CONCLUSION Visual control of the glans position during circumcision will prevent the amputation. Guillotine techniques including, Mogen clamp-type devices, are considered potentially dangerous. Circumcision in newborns, without general anesthesia, in the presence of swelling of the foreskin have an increased risk of glans damage. Preliminary examination of the glans and adequate release of preputial adhesions help to prevent complication of circumcision and to identify combined malformations (hypospadia, epispadia, concealed penis.).

TOTAL PENILE DEGLOVING INJURY RESURFACED WITH A SPLIT SKIN GRAFT – A CASE REPORT

Degloving injuries of the penis are a rare occurrence often requiring reconstruction. They are usually caused by industrial or agricultural machinery and tend to involve both the penile shaft and the scrotal skin with young adults being the usual victims. A penile degloving usually begins just proximal of the coronal line and progress down to the base of the shaft. Deep erectile tissue and the spermatic cord are usually undamaged and the endogenous skin of glans usually survives. The management requires thorough debridement and resurfacing the raw area by either using the degloved skin as a ap or a free skin graft, or by using a split skin or a full thickness skin graft. Here, we report a case of a total penile skin degloving managed with a split skin graft with satisfactory cosmetic result.

MP04-17 DERMAL FAT GRAFT FOR PENIS ENHANCEMENT—SINGLE CENTER RESULTS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-17 DERMAL FAT GRAFT FOR PENIS ENHANCEMENT—SINGLE CENTER RESULTS Borko Stojanovic, Marko Bencic, Marta Bizic, and Miroslav Djordjevic Borko StojanovicBorko Stojanovic More articles by this author , Marko BencicMarko Bencic More articles by this author , Marta BizicMarta Bizic More articles by this author , and Miroslav DjordjevicMiroslav Djordjevic More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The size of a penis is of great concern among men of all ages. Different methods for penile girth enhancement have been reported, and most of them are controversial and poorly evaluated. We assessed outcomes of penis enhancement surgery with autologous dermal fat graft in our center. METHODS: A total of 42 men with penile dysmorphophobia, with a mean age of 37 years (range 27-52) underwent penis enhancement surgery with dermal fat graft harvested from gluteal region from March 2015 to December 2019. Procedure included harvesting of the gluteal dermal fat graft, with the incision placed into the gluteal fold. Using circumcision incision, penile degloving is performed, while fat is trimmed, and graft is symmetrically placed around the penile shaft and fixed to the Bucks fascia close to the urethra with 4.0 polydioxanone interrupted sutures. Use of penile vacuum device was advised to the patients for the period of 6 months postoperatively. Girth measurements were taken in the flaccid and erect condition, preoperatively and 6 months postoperatively. RESULTS: Mean follow-up was 38 months (range from 14 to 71 months). Mean value of circumference gain after surgery was 1.23±0.24 cm (range from 0.62–2.53 cm). Postoperative complications included prolonged hematoma of the donor region, infection of the wound and partial necrosis of the penile shaft, in 3, 1 and 2 cases, respectively. All complications were successfully treated conservatively. Majority of patients (94%) were satisfied with the postoperative result, while 2 patients required additional penile enlargement and penile lengthening. CONCLUSIONS: Penis enhancement surgery with autologous dermal fat graft is safe procedure that provides good cosmetic outcome, and high rate of patient's satisfaction, with low complication rate. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e73-e73 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Borko Stojanovic More articles by this author Marko Bencic More articles by this author Marta Bizic More articles by this author Miroslav Djordjevic More articles by this author Expand All Advertisement Loading ...

V10-04 A BUCCAL MUCOSAL GRAFT SUB-CORONAL RESURFACING FOR TREATMENT OF RECURRENT PENILE ADHESIONS: THE BUCCAL BELT

You have accessJournal of UrologyLower Tract Reconstruction (V10)1 Sep 2021V10-04 A BUCCAL MUCOSAL GRAFT SUB-CORONAL RESURFACING FOR TREATMENT OF RECURRENT PENILE ADHESIONS: THE BUCCAL BELT Matthew Beamer, Javier Angulo, Leandro Capiel, Damian López-Alvarado, Erick Ramirez-Perez, Paksi Satyagraha, Daniel Zaccarini, and Dmitriy Nikolavsky Matthew BeamerMatthew Beamer More articles by this author , Javier AnguloJavier Angulo More articles by this author , Leandro CapielLeandro Capiel More articles by this author , Damian López-AlvaradoDamian López-Alvarado More articles by this author , Erick Ramirez-PerezErick Ramirez-Perez More articles by this author , Paksi SatyagrahaPaksi Satyagraha More articles by this author , Daniel ZaccariniDaniel Zaccarini More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002061.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrent penile adhesions often cause pain, post-coital bleeding, disfigurement and patient distress. Treatment options are limited and include topical steroids, lysis of adhesions and repeat circumcisions. Furthermore, adhesions are often associated with Lichen Sclerosus (LS) limiting the use of skin in any reconstruction. We present a novel surgical procedure using a sub-coronal buccal mucosal graft (BMG) resurfacing technique. METHODS: To perform the buccal belt procedure a sub-coronal segment of affected skin, approximately 1.5 cm in width, was circumferential excised. The circumference of the penile shaft was measured and an appropriately size buccal mucosal graft was harvested. The graft was placed sub-coronally and secured circumferentially with a proximal and distal anastomosis. Buck’s fascia was included in both the anastomosis and quilting sutures to allow for appropriate spread fixation of the graft. A vaseline gauze bolster was secured as a tie-over dressing. Patients were discharged with the bolster dressing and foley catheter. They were seen 7 days postoperatively for removal and then at 4-6 month intervals for follow-up. A retrospective, international multi-institutional review was conducted to include all patients treated with this technique. Surgical complications and evidence of recurrence were recorded. Patient-reported outcome measures including visual analog scale (VAS) and Global Response Assessment (GRA) questionnaires administered to measure functional and esthetic outcomes were also reviewed. RESULTS: Thirty-one men underwent the procedure across six institutions between 3/2014 and 9/2020. Mean age was 56.3 (32-77) and prior treatments included: topical agents 14 (45%) and circumcision 25 (81%). LS was seen in 23(74%) patients. Mean surgical time was 59 (25-95) minutes and mean hospital stay was 0.65(0-2) days. At the mean follow-up of 27 (4-79) months no patients developed recurrence. No patients reported painful erections. Mean VAS was 8.9 and 9.0 for esthetics and functional outcomes respectively. On GRA overall improvement was reported by all patients (61% +3; 25% +2; 14% +1). The majority saw improvement in esthetic appearance (46% +3; 39% +2; 7% +1; 4% 0; 4% -1) and improvement with post-coital bleeding (43% +3; 43% +2; 4% +1; 11% 0). Ninety-six percent would recommend the procedure to a friend. CONCLUSIONS: There are limited options for the treatment of recurrent penile adhesions, particularly in the setting of LS. A sub-coronal BMG resurfacing is feasible, with no recurrence and overall high satisfaction seen on an initial patient cohort. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e756-e756 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Beamer More articles by this author Javier Angulo More articles by this author Leandro Capiel More articles by this author Damian López-Alvarado More articles by this author Erick Ramirez-Perez More articles by this author Paksi Satyagraha More articles by this author Daniel Zaccarini More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement Loading ...

Traumatic penile partial amputation caused by rubber band a case report.

Introduction and importanceTraumatic amputation of the penis is a rare surgical emergency. Penile amputation is usually caused by self-mutilation, accidents, circumcision, assault and animal attacks. Accidental injury covers a large portion of external genitalia trauma because of its high prevalence and severity of this disease. Here, we report the case of a 21-year-old man who underwent replantation of his self-inflicted partial amputated penis.Case presentationWe report a case of traumatic penile partial amputation in a 21-year-old man with a history of mental retardation that presented with a one-day history of pain on the penile shaft due to tied penile shaft with a rubber band ten days prior. Genitalia examination showed a partial amputation at the penis shaft region. Reconstruction microsurgery and debridement on the penile shaft and urethral anastomosis were performed. This case highlights the management of traumatic penile partial amputation. The urethral anastomosis and penile replantation were successfully done.Clinical discussionPenile amputation is a rare urological emergency. Most of the cases reported with self-mutilation are a result of severe substance-induced psychosis or underlying psychiatric disorder. Factors that contribute to the successful penile replantation include the severity of the penile injury or amputation, type and mechanism of injury, team expertise available, duration of ischemia time, and use of a microscope at the time of neurovascular bundle repair.ConclusionA traumatic penile partial amputation is a rare urologic emergency. Self-inflicted amputation is often found in a patient with a history of psychological or mental illness. The limited data on detailed best surgical measures and outcomes is still a concern.

Staged penile skin reconstruction for sclerosing lipogranuloma

Subcutaneous injection of liquid fatty materials to enhance penile girth induce sclerosing lipogranuloma of the penis. In spite of its well known severe consequences there has been a persistent use of this practice in non-medical circumstances. The aim of this paper is to present our observations with staged penile skin reconstruction for sclerosing lipogranuloma and to evaluate postoperative complications in a retrospective manner. Between 2008 and 2020, 17 patients underwent surgery to treat sclerosing lipogranuloma of the penis by staged penile skin reconstruction at our department. Complete exscision of the involved tissue was performed, then the denuded penile shaft was inserted into a subcutaneous channel on the anterior side of the scrotum during the first stage. The second stage of reconstruction consisted of releasing the penile shaft from the scrotum. The second stage was performed merely on 9 in 17 patients. According to the Clavien-Dindo classification system, 3 grade I and 1 grade I complications occurred in the postoperative period after the first and second stage, respectively. Grade II-V complications were not observed. 7 of 9 patients who underwent both stages were satisfied with the final result, 2 patients had minor correction surgery 6 months and 9 years following the second stage. 1 of 8 patients who underwent only the first stage had minor correction surgery 4 months following the operation. In case of sclerosing lipogranuloma of the penis, excision of the affected tissue and reconstruction of the penile skin are indicated. Advantages of using scrotal skin flaps are that colour and elasticity of the scrotal skin are similar to penile skin, erogenous sensation of the scrotal flap remains intact. Applying staged penile skin reconstruction with scrotal skin flap has the advantage of few postoperative complications and it is easy to perform. Orv Hetil. 2021; 162(35): 1413-1417.