Ventral Aspect Of Penis Research Articles

Congenital anterior urethral valves and diverticula

Aims of StudyAnterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. The present study highlights the clinical approach in identifying the condition and its treatment options. MethodSingle centre, retrospective study of children. ResultOver a 16 year duration, 14 children were diagnosed with AUVs and diverticula with a mean age of 15 months. Clinical features included straining at micturation and a palpable penile swelling. Diagnosis was confirmed with voiding cystourethrogram and cystoscopy. An open surgical procedure was performed in 12 cases and endoscopic intervention done in one. On follow up 13 patients showed restoration of a normal voiding stream and normal renal function. One child died of chronic renal failure due to a delayed presentation, severe back-pressure changes, urinary ascites, and urosepsis. One patient developed a small urethrocutaneous fistula that healed spontaneously. ConclusionAUV, though rare, should be recognizable due to the combination of a poor urinary stream and visible swelling in the ventral aspect of penis. Open surgical excision is the method of choice, and the outcome is excellent. Level of EvidenceLevel IV.

The outcome of limited urethral mobilization urethroplasty for anterior hypospadias.

Objectives: Hypospadias, one of the most common genital anomalies, is characterized by an abnormal meatal opening on the ventral aspect of penis. Anterior hypospadias are the most common. Most of the surgical techniques involves the construction of neourethra with significant risk of urethrocutaneous fistula. Limited urethral mobilization technique involves the advancement of native urethra. Study Design: The objective of this study was to evaluate the outcome of Limited Urethral Mobilization Urethroplasty for Anterior Hypospadias. Setting: The study was conducted in the Department of Paediatric Surgery, DHQ teaching Hospital Sahiwal. Period: From January 2016 to December 2018. Material & Methods: A total number of 187 patients were included in this study. Limited urethral mobilization technique was used in all patients. Minimum age was 2.5 Years and maximum age was 12 years. Cosmetic appearance, functional outcome and complication rate were assessed. Results: Wound infection developed in 3.20 %( n=6) patients. Complete glanular disruption was seen in 2.13 %( n=4) patients. Partial disruption of glans with meatal retraction was observed in 1.60 %( n=3) patients. Post-operative haematoma was seen in 1.60 %( n=3) patients. Meatal stenosis in 1.06 %( n=2) patients. Post-operative bleeding and diverticula was observed in 0.5 %( n=1) patients each. Vertical oriented, slit like meatus at the tip of glans was achieved in 95.72 %( n=179) patients. Conclusion: Limited urethral mobilization urethroplasty is a technique with proven benefits and effectiveness in the terms of cosmesis and functional outcome with a minimal number of complications because of the usage of native elastic urethra.

Hypospadiac Duplication of Anterior Urethra—a Rare Congenital Anomaly

Duplication of the urethra is a complex and rarely seen congenital anomaly with three anatomic variants: epispadiac (dorsal), hypospadiac (ventral), and Y-type. We report here a case of hypospadiac duplication of anterior urethra with dorsal blind ending urethra in a 9-year-old boy who presented with complaint of passing urine from the ventral aspect of penis.

Fertility Potential in Adult Hypospadias.

Hypospadias is a congenital anomaly of the urogenital tract characterized by abnormal location of the external urethral meatus over ventral aspect of penis. The ideal time to correct primary hypospadias is when aged 6-12 months. However, in some developing countries, such as ours, this anomaly may be left untreated until adulthood. There are multiple risk factors responsible for development of this anomaly, out of which paternal sub fertility is one of them. As the child grows into adulthood, fertility status becomes an important issue, frequently raised by patients. To evaluate the fertility potential of adult hypospadiac patients and to rule out the effect of age of surgical correction over fertility potential. Seventy three adult patients of hypospadias were prospectively evaluated, out of which 43 were operated during adulthood. All patients underwent measurement of penile length and circumference in both flaccid and erect positions along with testicular volume, serum LH, FSH and testosterone and semen analysis. A set of questionnaire was given to all the patients which included assessment of erectile function (IIEF-5), ejaculatory function, strength of libido and level of satisfaction after sexual intercourse. Results were compared with an age matched control group of 70 healthy person. Out of 73 patients with a mean age of 23.73 years, 14(19.17%) had proximal and rest 59(80.82%) had distal type of hypospadias. Mean penile length in both type of hypospadiac patients under both flaccid and erect conditions (7.92±1.33 and 9.62±1.31cm) were significantly shorter than those of control (10.78±0.94 and 13.15±1.15 cm) (p<0.001). In spite of short penile length, the level of satisfaction of all patients and their partner after penetrating intercourse were comparable to control (p>0.05). The strength of libido (p>0.05) was comparable with control in both type of hypospadiac patients; however IIEF-5 scores was poor in the proximal type of hypospadias. Semen volume (ml), sperm concentration (mill/ml), active sperm motility (%), and normal sperm morphology were comparable between distal hypospadiac group and control (p>0.05), however these parameters were poor in proximal type. The serum FSH and LH levels were significantly higher and serum testosterone level was significantly lower in hypospadiac patients than control (p <0.001). However, no difference in testicular size was found. The patients who were operated during childhood had shorter penile length compared to patients operated during adulthood. Fertility potential parameters in distal type of hypospadias were comparable with control. However the proximal type had poor erectile function and semen quality. Patients operated in either childhood or in adulthood, there was no significant difference in fertility potential.

Congenital penile urethrocutaneous fistula: A rare anomaly and review of literature

Congenital penile urethrocutaneous fistula is described as an unusual developmental anomaly in children who present with an abnormal opening on the ventral aspect of penis with a normal foreskin and an absence of chordee and hypospadias. The authors present a discussion on the etiology, embryology, and management of this entity along with a description of three cases. We emphasize meticulous clinical examination for the diagnosis and to rule out other associated anomalies.

A new indication for tubularized incised plate urethroplasty: Isolated congenital penile urethrocutaneous fistula

Isolated congenital penile urethrocutaneous fistula is described as an unusual developmental anomaly in two infants who presented with an abnormal opening on the ventral aspect of penis with a normal foreskin and an absence of the chordee, hypospadias or other associated congenital anomalies. Tubularized incised plate urethroplasty augmented with dartos pedicle blanket wrap resulted in satisfactory recovery. Authors review their surgical experience with this new indication of tubularized incised plate urethroplasty in successful surgical repair of congenital penile urethrocutaneous fistula along with pertinent literature.

Outpatient catheterless Mathieu repair: how to cover ventral penile skin defect.

A modification of the Mathieu repair eliminating stenting has been described by Rabinowitz which makes the method more convenient for outpatient performance. We report on our experience with this modification with special emphasis on coverage of ventral penile skin defect. To cover the raw area formed on the ventral aspect of penis with the creation of meatal based flap Rabinowitz used Byar's flap. Two different flaps prepared from prepuce were used in this series. In some patients an island flap was used. In others the prepuce was incised transversally on its dorsal aspect and transferred to the ventral surface as a bipedicle visor flap, as described by Ombrédanne and popularized by Nesbit. Twenty-two patients ranging in age from one to twelve years (mean +/- 1SD = 6 +/- 3.28) were operated on using the technique. The meatus was glandular in two, coronal in twelve and distal penile in eight patients. Preputial flap was not used in one patient because the defect was small. Island flap was used in three and Ombrédanne-Nesbit's flap in 18 patients. Complete disruption of the repair occurred in one of the patients in whom an island flap was used. Among 18 patients in whom Ombrédanne-Nesbit's flap was used, one partial necrosis of the preputial flap was encountered which required revision and two urethrocutaneus fistulae occurred which healed spontaneously. The use of the present technique yields a good cosmetic result, a high success rate with minimal complications, and eliminates catheterization; hence, hospitalization is recommended.