Shaft Skin Research Articles

Discussion of “Shielding Piles from Downdrag in Consolidating Ground” by S. Y. Lam, C. W. W. Ng, and H. G. Poulos

Discussion of “Shielding Piles from Downdrag in Consolidating Ground” by S. Y. Lam, C. W. W. Ng, and H. G. Poulos

Video presentation of the second stage of a two-stage repair for proximal hypospadias: A safe and reproducible technique

ObjectiveThe aims of proximal hypospadias repair are good cosmetic outcomes with low rates of complication, with a low number of operative exposures, before the age of genital difference realisation. Neo-urethral fistula and stenosis are well recognised complications; with international rates of 3.8–16% and 1.3–15.6% respectively. We present the key steps of the second of a two staged repair in video format. MethodVideo recording of the procedure performed on an 18-month-old with mid-penile hypospadias is presented. The steps are described; the importance of tension free tubularisation, layered urethral closure, suture technique, vascularised prepucal graft technique, optimal glanuloplasty, and penile shaft skin repair are highlighted. ResultThe child was brought back to the day ward for catheter removal at 7 days; follow-up in clinic showed good postoperative appearance. This technique has been performed on 31 boys with a fistula rate and stenosis rate favourable to the literature. ConclusionWe demonstrate a two-stage technique by video format for proximal hypospadias which is reproducible and gives results comparable to the literature.

Tunica Vaginalis Flap as a second layer for Tubularized incised plate urethroplasty (Snodgrass method) in reoperation for hypospadias

Purpose: Reoperation for failed hypospadias has been considered to be seriously bothersome because abundant penile skin doesn’t tend to remain for urethroplasty or for penile shaft skin coverage. In this study, the tubularization of incised urethral platewrapped by tunica vaginalis flap as the second layer to increase the success rate of operation and decrease the incidence of urethrocutaneous fistula.

DOuble LOngitudinal Megapreputium Incision TEchnique: The DOLOMITE

To present a straightforward, reproducible technique with the basic principle of preserving all available outer penile shaft skin and using this to cover the dorsal side of the penis. The DOuble LOngitudinal Megapreputium Incision TEchnique is presented in a step-by-step fashion. Six consecutive patients with a mean age of 13.3 months (range, 7-25) underwent this reconstruction between 2006 and 2011. The technique starts with 2 longitudinal incisions, the first on the ventral side, and the second on the dorsal side of the penis. After hinging the penile skin to the dorsal side, redundant inner preputial tissue is resected using diagonal incisions. Dartos is spared. A comparison with previously reported techniques and a concise review of existing literature are provided. The final cosmetic results, after an initial period of edematous swelling of the ventral aspect of the penis, were good in all patients. The bilateral diagonal scars on the penile shaft became inconspicuous over time. Voiding normalized. No complications occurred. The DOuble LOngitudinal Megapreputium Incision TEchnique provides a straightforward and reproducible surgical correction for congenital megaprepuce.

Dorsal inlay inner preputial graft for primary hypospadias repair.

The most commonly performed operation to repair distal hypospadias is the Tubularised incised plate (TIP) repair. The key step is midline incision of the urethral plate, which widens a narrow plate and converts a flat into a deep plate groove, ensuring a vertical, slit neomeatus and a normal-calibre neourethra. At times in cases of proximal hypospadias, the urethral plate is very narrow and needs to be augmented or substituted for further tubularisation. We report our experience with primary single stage dorsal inlay urethroplasty using preputial skin grafts. Children with proximal hypospadias with a narrow urethral plate formed the study group. Children needing transection of the urethral plate, having undergone circumcision/hypospadias repair previously or having an inadequate prepuce was excluded. Twelve children with a mean age of 48.83 months underwent primary dorsal inlay preputial graft urethroplasty for proximal hypospadias with a very narrow urethral plate. At an average follow-up of 42.16 months, 2 (16.66%) children had a breakdown of ventral shaft skin. None of the children had meatal stenosis, and none of these 12 children developed urethrocutaneous fistula. Primary dorsal inlay inner preputial graft urethroplasty successfully fulfills all traditional hypospadias repair criteria. It offers a viable, safe, rapid and easy option in the management of proximal hypospadias with a narrow urethral plate.

Effect of Surcharge Pressure on Pile Static Axial Load Test Results

AbstractThis paper presents the effect of surcharge support pressure on pile load–settlement response during static load testing. A three-dimensional nonlinear finite-element model is developed to investigate the loading sequences of an axial compressive static load test, using surcharge loads as the reaction system. Results of a static load test at a construction site for which the geotechnical data are available were used for verification of the numerical model. The results show that the surcharge pressure on supports has little impact on the ultimate capacity of the pile, as the shaft skin friction is slightly influenced by the surcharge and the effect on the tip resistance is negligibly small. The initial stiffness of the pile, however, might be considerably affected by the surcharge pressure distributed around the pile shaft. The influence on stiffness increases with increase in the pile diameter. The effect of surcharge pressure is more pronounced for piles embedded in frictional soils compared with...

Penetration and Removal of the Mooring Dolphin Platform With Three Caisson Foundations

Mooring dolphin platforms (MDPs) with three caisson foundations were installed in the ice-drifting Bohai Sea of China. Before installation, prototype tests of penetration and removal processing were conducted near the design site. To determine the lateral soil pressure and skin friction of the caisson, soil pressure and strain gauge transducers were fixed along the external skirt of caisson B of MDP1. The shaft skin friction was calculated from the strain difference between any two points of the strain gauges. The transducer results indicated that when the soil property determined by unconsolidated and undrained (UU) triaxial tests was used to calculate the unit skin friction resistance, a value of the adhesion factor α of 1.5–2.0 is recommended. The factor α is 1–0.4 during the suction-assisted penetration phase. The lateral earth pressure coefficient K decreased with penetration depth, most likely due to seepage caused by underpressure. In addition, the difference between the measured values obtained from the soil pressure transducers represented the small tilt of MDP1 during the installation phase. The skin friction and lateral earth pressure significantly decreased in the removal phase, 12 h after the penetration phase, mainly due to the soil disturbance caused by suction penetration around the caisson.

Cosmetic incision in boys for lower abdominal surgery

Editorial Comment: Skin coverage of the dorsum of the epispadiac penis during reconstruction is challenging. In this case the authors use a technique I have not seen before, namely preserving a ventral flap of coronal based tissue that becomes the ventral penile shaft skin. The remainder of the ventral skin is bisected with a reverse Byars flap to cover the dorsum after the urethroplasty. The postoperative images are convincing. Although we tend to use a ventral transverse island flap as a source of dorsal skin, this approach deserves consideration.

Fournier's Gangrene Associated with Intradermal Injection of Cocaine

Cocaine abuse is associated with a number of medical complications, most notably arrhythmias, myocardial infarction, and cerebral hemorrhages. The injection of cocaine in the penis has been predominantly recorded into the corpus cavernosae and is associated with priapism. Here we describe the injection of subcutaneous cocaine within the penile shaft skin producing ischemic necrosis and Fournier's gangrene. We sought to highlight the effects of cocaine use within the penis and emphasize the different effects that may ensue. We reviewed a recent clinical case and conducted a literature review on the use of cocaine within the penis. The use of cocaine has been reported previously within the literature and is mainly limited to case reports. Cocaine use within the corpora and the subcutaneous tissues produces significantly different consequences ranging from priapism to Fournier's gangrene. The case illustrates the growing use of cocaine and other illicit drugs and emphasizes the importance of this issue to all clinicians.

948 GLANS-PRESERVING SURGERY IN THE TREATMENT OF SUPERFICIAL PENILE CANCER

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease (III)1 Apr 2013948 GLANS-PRESERVING SURGERY IN THE TREATMENT OF SUPERFICIAL PENILE CANCER Ninghong Song, Peng-chao Li, Quan Li, Gong Cheng, Peng-fei Shao, and Chang-jun Yin Ninghong SongNinghong Song Jiangsu Province, China, People's Republic of More articles by this author , Peng-chao LiPeng-chao Li Nanjing, China, People's Republic of More articles by this author , Quan LiQuan Li Nanjing, China, People's Republic of More articles by this author , Gong ChengGong Cheng Nanjing, China, People's Republic of More articles by this author , Peng-fei ShaoPeng-fei Shao Nanjing, China, People's Republic of More articles by this author , and Chang-jun YinChang-jun Yin Nanjing, China, People's Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.527AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Discussion on the safety and feasibility of the glans-preserving surgery for superficial penile cancer. METHODS We retrospectively analyzed the clinical data of 21 patients who were treated with glans-preserving surgery for superficial penile cancer at our institution from January of 2003 to March of 2010. RESULTS The study included 21 patients, aged 36 to 57 years (median age 46), with superficial lesions involving the glans penis, coronary sulcus or shaft skin. After clinical staging and grading, those patients were offered a glans-preserving procedure to preserve the normal appearance and functional integrity of the glans penis. Of the 21 patients referred, the tumors were TaG1 in 6 patients, TaG2 in 5, TisG1 in 2, TisG2 in 4, T1G1 in 3, and T1G2 in 1. All patients returned to normal sexual activity 1 month postoperatively. Sexual function and sexual satisfaction were well maintained after operation. The 2 to 7 years (average 5) follow-up of 21 patients found recurrence in 2 cases of glans-preserving surgery with in 9 months, which were managed by second glans-preserving surgery without recurrence in the followed for 5 years. CONCLUSIONS Glans-preserving surgery is an effective method for superficial penile cancer. With proper selection of the patients, this procedure is technically safe, maximally preserves the penile appearance, and least affects the patients's sexual satisfication. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e389 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ninghong Song Jiangsu Province, China, People's Republic of More articles by this author Peng-chao Li Nanjing, China, People's Republic of More articles by this author Quan Li Nanjing, China, People's Republic of More articles by this author Gong Cheng Nanjing, China, People's Republic of More articles by this author Peng-fei Shao Nanjing, China, People's Republic of More articles by this author Chang-jun Yin Nanjing, China, People's Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Surgical Reconstruction for Male-to-Female Sex Reassignment

BackgroundThe primary challenge of male-to-female reassignment surgery is to create natural-appearing female genitalia with neovaginal dimensions adequate for intercourse, neoclitoris sensitivity, and minimal risk of complications. Surgical positioning is an important component of the procedure that successfully minimizes the risk of morbidity. ObjectiveWe modified various vaginoplasty techniques to better position the urethral neomeatus in the proper anatomic location to minimize the chance for complications and enhance aesthetic satisfaction. Design, setting, and participantsWe retrospectively reviewed data stored in a prospective database for 24 consecutive patients who underwent male-to-female gender reassignment at a German university clinic between January 2007 and March 2011. Surgical procedureFirst, orchiectomy and penile disassembly are performed with the patient in the supine position. Both corpora cavernosa are resected with the patient in the lithotomy position, and neovaginal construction is accomplished with the incorporation of the penile urethra into the penile shaft skin. The glans is preserved and resized to form the neoclitoris. The assembled neovagina is inverted, inserted into the expanded rectoprostatic space, and secured to the sacrospinous ligament. Scrotal skin is tailored to create the labia. Outcome measurements and statistical analysisComplications and patient satisfaction with neovaginal depth, appearance, neoclitoral sensation, and capacity for sexual intercourse were evaluated. Results and limitationsThe mean neovaginal depth was 11cm (range: 10–14cm); median follow-up was 39.7 mo (range: 19–69 mo). All patients reported satisfactory vaginal functionality. One patient noted stenosis after 4 yr that was histologically confirmed as lichen sclerosus. Neoclitoral sensation was good or excellent in 97% of patients; 33% reported regular intercourse. No major complications were observed. Because this is a retrospective review to describe a complex reconstructive surgery and illustrate these techniques in the accompanying intraoperative surgery-in-motion video, no control group was undertaken. ConclusionsGender reassignment can be performed with minimal complications using penile skin with incorporated penile urethra and intraoperative repositioning of the patient to achieve adequate neovaginal dimensions for intercourse and neoclitoral sensation.

The Penile Perception Score: An Instrument Enabling Evaluation by Surgeons and Patient Self-Assessment After Hypospadias Repair

Studies of the outcome of hypospadias repair must document quality, including assessment of complications and appraisal of appearance. To our knowledge the Pediatric Penile Perception Score is the first validated instrument for the outcome assessment of hypospadias repair in prepubertal males by surgeons and patients. We validated the instrument for adult genitalia. Standardized photographic documentation was prepared for 19 men after hypospadias repair and 3 with normal genitalia after circumcision. This was sent to 21 urologists, who rated the outcome with a questionnaire comprising items on the penile meatus, glans, shaft skin and general appearance. Each item was rated with a 4-point Likert scale. The Penile Perception Score is a sum score of all items. Patients were asked to provide a self-assessment with the same instrument. When calculated with the ICC and the rank correlation using Kendall W, concordance among urologist scores was fair and good (0.46 and 0.64, respectively, p <0.001). Instrument stability was 0.78, indicating good reproducibility. Using the Spearman rank correlation coefficient general appearance correlated well with single items, including the meatus (r = 0.93, p = 0.000), glans (r = 0.92, p = 0.000) and shaft skin (r = 0.89, p = 0.000). No significant differences were found between patient and urologist Penile Perception Scores. The Penile Perception Score is a reliable instrument for urologist assessment and self-assessment of postpubertal genitalia after hypospadias repair. The instrument can be recommended for all age groups because it was previously validated for the pediatric population.

Refinements in reconstruction of penile skin loss using intra-operative prostaglandin injections, postoperative tadalafil application and negative pressure dressings

Penile shaft skin defects represent demanding reconstructive tasks because a high degree of flexibility and stability of the skin grafts are essential to allow regular erections and sexual intercourse. A new concept of tailoring skin grafts to the erect penis by intra-operative application of prostaglandin E1 and postoperative stabilisation by negative-pressure wound therapy and pharmacological expansion by tadalafil was tested on four patients with penile shaft skin defects. Graft take, stability, pliability, softness and aesthetic results were evaluated up to at least 12 months postoperatively. The ratio of the skin transplanted area in the non-erect compared to the erect penis (non-erect/erect ratio) and the ratio of the skin transplanted area in the erect penis at 12 months compared to intra-operatively (Post/Pre ratio) was determined to define the amount of graft contraction and flexibility. International Index of Erectile Function (IIEF)-5 scores were evaluated postoperatively. There were no complications. Graft take was 97, 100, 100 and 100%. Stable skin grafts were achieved after 2 weeks. Sexual intercourse was possible at 2-3 months. The Post/Pre ratio was between 81 and 87% and proves comparably mild contracture rates. The non-erect/erect ratio of 50-72% shows how significantly undersized penile shaft skin grafts are when adjusted to the non-erect penis and that an adequate flexibility for erections can be reconstructed. IIEF-5 scores proved regular potency in three patients; one patient was no longer sexually active. With the new concept of tailoring the skin graft to the erect penis, pharmacological expansion and external stabilisation by vacuum-assisted closure (VAC) dressing the difficult task of penile skin reconstruction can be facilitated, accelerated and the functional and aesthetic outcome improved compared to earlier efforts or to results presented in the literature.

Glans‐Preserving Surgery for Superficial Penile Cancer

In this study, we investigated the safety and feasibility of glans-preserving surgery for superficial penile squamous cell carcinoma. Young patients with penile primary tumors exhibiting favorable histologic features were best suited for organ-sparing procedures, enabling them to avoid sexual disturbances. The study included 12 patients, 38-53 years of age (median age 46 years), with superficial lesions involving the glans penis, coronary sulcus, or shaft skin. After clinical staging and grading, those patients were offered a glans-preserving procedure to preserve the normal appearance and functional integrity of the glans penis. Of the 12 patients referred, the tumors were TaG1 in 4 patients, TaG2 in 3, TisG1 in 1, TisG2 in 1, T1G1 in 2, and T1G2 in 1. All patients returned to normal sexual activity 1 month postoperatively. Sexual function and sexual satisfaction were well maintained after surgery. The cosmetic results were considered satisfying/very satisfying by 83% (10 of 12 patients). Follow-up data were available on 12 patients at a mean follow-up of 62.5 months. Only 1 patient had recurrence 6 months after surgery, which was managed by a second glans-preserving surgery without recurrence. With careful patient selection and vigilant follow-up, anatomically suitable superficial penile cancer can be offered this glans-preserving surgery, while preserving function of the penis wherever possible.

Penile resurfacing for denuded penis following circumcision

Major loss of penile shaft skin following circumcision has been rarely reported in the paediatric literature and when it occurs is usually due to the injudicious use of monopolar diathermy, infection and poor surgical technique. We report the reconstruction of a penis following complete loss of penile skin due to circumcision. We employed a split-skin graft for the glans and full-thickness graft for the shaft to achieve a more natural cosmetic appearance. This approach has not been described previously in the paediatric literature and should be considered in the unfortunate event of significant penile skin loss.

Low-grade liquid silicone injections as a penile enhancement procedure: Is bigger better?

To report our experience with 5 cases of complications of penile enhancement procedures secondary to liquid silicone injections and our method of management of its debilitating effects. All five patients were treated with excision of penile shaft skin down to buck's fascia followed by resurfacing with split thickness skin grafting. We conclude that penile enhancement procedures with liquid silicone by non-medical personnel could result in devastating consequences. We also demonstrate that a simple method of excision of the entire penile shaft skin and resurfacing with split skin grafting showed improvement in cosmetic as well as functional outcome.

Simple Anchoring of the Penopubic Skin to the Prepubic Deep Fascia in Surgical Correction of Buried Penis

PurposeThe aim of this study was to categorize concealed penis and buried penis by preoperative physical examination including the manual prepubic compression test and to describe a simple surgical technique to correct buried penis that was based on surgical experience and comprehension of the anatomical components.Materials and MethodsFrom March 2007 to November 2010, 17 patients were diagnosed with buried penis after differentiation of this condition from concealed penis. The described surgical technique consisted of a minimal incision and simple fixation of the penile shaft skin and superficial fascia to the prepubic deep fascia, without degloving the penile skin.ResultsThe mean age of the patients was 10.2 years, ranging from 8 years to 15 years. The median follow-up was 19 months (range, 5 to 49 months). The mean penile lengths were 1.8 cm (range, 1.1 to 2.5 cm) preoperatively and 4.5 cm (range, 3.3 to 5.8 cm) postoperatively. The median difference between preoperative and postoperative penile lengths was 2.7 cm (range, 2.1 to 3.9 cm). There were no serious intra- or postoperative complications.ConclusionsWith the simple anchoring of the penopubic skin to the prepubic deep fascia, we obtained successful subjective and objective outcomes without complications. We suggest that this is a promising surgical method for selected patients with buried penis.

Proximal hypospadias with skin-covered shaft of penis and absent urethral plate: An unknown variant and its management

We report a case of proximal hypospadias with an absent urethral plate having intact ventral shaft skin with hooded dorsal prepuce and a good glans groove. Such a variant of hypospadias has not been reported in the literature.

Nicorandil‐induced penile ulcerations: a case series

To report on the largest series to date of ulceration of the external genitalia, related to treatment with nicorandil - a vasodilator for the prevention and long-term treatment of angina - and to review the literature on the subject, focusing on the clinical features and the pathogenesis of this rare, yet marked, side-effect. Three patients (aged 71-83 years) were referred for severe ulceration of the penis. A complete work-up was performed to exclude potential underlying causes, including malignancy and sexually transmitted diseases. After a careful review of the patients' medical history, a potentially causal relationship was noted; all patients had been taking nicorandil for at least 2 years before the development of penile ulceration. Penile ulcers associated with nicorandil are characteristically large, deep, painful and have punched-out edges. They usually involve the prepuce or the penile shaft skin. Higher doses of nicorandil (at least 40 mg daily) and surgical procedures seem to increase the risk for nicorandil-related ulceration. Response to topical steroids is poor, but complete healing is achieved by discontinuation of nicorandil, while surgical treatment should be discouraged. The growing body of literature showing the link between treatment with nicorandil and ulceration at multiple sites has led to the recognition of this side-effect by the World Health Organization. Nicorandil-related ulcers rarely involve the penile skin and constitute a diagnostic and therapeutic challenge. The pathogenesis of this rare side-effect is largely unknown, but mechanisms such as the 'vascular steal phenomenon' and the direct toxic effect of the drug or its metabolites have been implicated.

The Ventral V-plasty: a simple procedure for the reconstruction of a congenital megaprepuce

A buried penis secondary to a megaprepuce is defined clinically by a phimosis, failure of the corporal bodies to inhabit a variably deficient penile shaft skin and a basal hemispheric ballooning of the penis during micturition. Anatomically, it describes a condition in which a normal phallus is trapped within normal prepubic connective tissue by the excessive skin of a megaprepuce and a variable abundance of dartos fascia. Many surgical procedures have been described to correct this deformity, suggesting that no single method has a clear advantage. Most of them rely on relatively complex skin flaps or on the abnormal megapreputial tissue for reconstruction of the deficient ventral shaft skin. Herein, the authors describe an alternative technique for ventral skin coverage, the Ventral V-plasty. This surgical procedure allowed for the favorable reconstruction of 10 consecutive children with a buried penis secondary to a megaprepuce. This technique is distinguished by its simplicity and consistent, pleasing cosmetic results.