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Su Q, Gao S, Lu C, Wu X, Zuo L, Zhang L. Clinical effect of Brisson operation modified by Y-shaped incision for treatment of concealed penis in adolescents. J Int Med Res 2021; 49:3000605211005951. [PMID: 33823633 PMCID: PMC8033467 DOI: 10.1177/03000605211005951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyze the clinical effect of the Brisson operation modified by a Y-shaped incision in treating adolescent concealed penis. METHODS We retrospectively analyzed clinical data of 27 adolescents with a concealed penis treated with the Brisson operation modified by a Y-shaped incision in our hospital from January 2017 to March 2020. RESULTS The operation went smoothly in all 27 patients. Postoperative foreskin edema occurred in 12 patients and spontaneously resolved within 1 month postoperatively. Two patients developed postoperative retropubic infection. After administering antibiotics and symptomatic treatment, both patients' conditions improved within 1 week. All operations obtained satisfactory results. Postoperatively, when the penis was in a non-erect state, it was clearly exposed without retraction or concealment; thus, demonstrating good surgical results. The prepuce was distributed naturally without obvious accumulation of redundant preputial tissue. The penile scar resembled that after circumcision. The postoperative follow-up period was 6 months, during which no patients developed recurrence. CONCLUSION The Brisson operation modified by a Y-shaped incision is effective for treating a concealed penis in adolescent patients. This technique may relieve the pathological abnormalities and retain the penile skin's integrity to the greatest extent with minimal scarring and a satisfactory appearance.
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Affiliation(s)
- Quanxin Su
- Department of Urology, The Affiliated Changzhou No. 2 People’s
Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
- Dalian Medical University, Dalian, Liaoning, China
| | - Shenglin Gao
- Department of Urology, The Affiliated Changzhou No. 2 People’s
Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Chao Lu
- Department of Urology, The Affiliated Changzhou No. 2 People’s
Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Xingyu Wu
- Department of Urology, The Affiliated Changzhou No. 2 People’s
Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Li Zuo
- Department of Urology, The Affiliated Changzhou No. 2 People’s
Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Lifeng Zhang
- Department of Urology, The Affiliated Changzhou No. 2 People’s
Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
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Ergashev K, Chung JM, Lee SD. Concealed index for concealed penis in prepubertal children. Investig Clin Urol 2021; 62:217-223. [PMID: 33660450 PMCID: PMC7940854 DOI: 10.4111/icu.20200401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/13/2020] [Accepted: 11/08/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The concealed penis (CP) is a congenital or acquired genital anomaly that requires surgical correction. To construct an objective CP severity index, we compared the penile parameters of a CP with a normal penis (NP) and postoperative outcomes of CP patients. MATERIALS AND METHODS In this retrospective study, 391 boys under 14 years who visited our hospital between September 2017 and February 2020 were included. Among these boys, 105 patients had a CP and 286 boys had a NP without CP. The stretched penile length (SPL), penile circumference (PC), and penile length above baseline skin level (BPL) were measured using a ruler (cm), and the testicular volume was measured using an orchidometer (mL). We defined the concealed index according to SPL (CIs) as BPL/SPL and the concealed index according to circumference (CIc) as BPL/PC. A repair of the CP was performed in the CP patients. All parameters were measured before surgery and after three months. RESULTS The CP had significantly shorter SPL and BPL, and smaller CIs, and CIc than the NP. The cutoff values for the CIs and CIc were 0.68 and 0.58, respectively (sensitivity 86.7% and 86.7%; specificity 65.0% and 88.5%, respectively). After repair of the CP, all penile parameters were significantly improved. CONCLUSIONS The CIs and CIc are useful and objective parameters for checking the severity of CP, and evaluating the postoperative outcome of CP repair. We newly introduced cutoff values for the CIs (0.68) and CIc (0.58) for diagnosing and evaluating CP repair.
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Affiliation(s)
- Kobiljon Ergashev
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Min Chung
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
| | - Sang Don Lee
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Huang W, Tang D, Gu W. The Characteristics and Distribution of Nerve Plexuses in the Dartos Fascia From Concealed Penis Children. Front Pediatr 2021; 9:705155. [PMID: 34422727 PMCID: PMC8374239 DOI: 10.3389/fped.2021.705155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/09/2021] [Indexed: 12/05/2022] Open
Abstract
The purpose of this study is to analyze the nerve plexus distribution in dartos fascia of concealed penis (CP). A total of 28 CP patients met ASA categories I and II were included, with median age of 3.5 years (8 months-5 years). During the surgery, tissue samples of dartos fascia at points 3, 6, 9, and 12 o'clock of the penile shaft were collected. Standard hematoxylin and eosin (H&E) staining and S-100 immunohistochemical staining were used to analyze the nerve plexus distribution among different positions. The number of nerve plexuses in superficial fascia collected at the 6 o'clock position of the penile shaft was the most abundant among four positions (median 7.25, range 1-24). The abundant nerve plexuses in the dartos fascia of CP patients, especially at the 6 o'clock position, indicate that the surgery on the preputial frenulum should avoid damage to the dartos fascia, as it might be related to maintain the erection and sexual function in adolescence.
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Affiliation(s)
- WenFang Huang
- Department of Anesthesiology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - DaXing Tang
- Department of Urology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - WeiZhong Gu
- Department of Pathology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Congenital Megaprepuce: Literature Review and Surgical Correction. Case Rep Urol 2019; 2019:4584609. [PMID: 31218089 PMCID: PMC6536951 DOI: 10.1155/2019/4584609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/05/2019] [Indexed: 12/01/2022] Open
Abstract
Congenital megaprepuce (CMP) is a type of buried penis characterized by extensive redundancy and ballooning of the inner prepuce as a result of preputial stenosis and phimosis. The malformation typically presents with difficulty voiding, often requiring manual expression of stagnant urine. Multiple techniques have been reported for the treatment of CMP with varying levels of positive outcomes. The authors provide a review of published literature, in addition to describing the procedure and results of our surgical technique in three children aged eleven months, two years, and twelve years. The literature review was conducted using PubMed with keywords “congenital megaprepuce,” “megaprepuce,” “buried penis,” “CMP,” and “correction.” Results were then differentiated based on presence or absence of true congenital megaprepuce and the surgical correction thereof. Regarding our cases, all patients completed the procedure with excellent cosmesis and without complication. Our technique is shown to provide consistent, excellent esthetic outcome across a wide range of ages and may be replicated by others.
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Rami M, Bakkaly AE, Bouljrouf J, Lafia T, Bouhafs MA, Belkacem R. [Congenital buried penis in the child: about a case]. Pan Afr Med J 2018; 28:296. [PMID: 29675129 PMCID: PMC5903706 DOI: 10.11604/pamj.2017.28.296.13864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/21/2017] [Indexed: 11/15/2022] Open
Abstract
La verge enfouie congénitale de l’enfant est une malformation congénitale dans laquelle le pénis semble être de petite taille, mais tous les constituants de la verge sont de taille normale (l’urètre, les corps érectiles et le gland). L’objectif de notre étude était de rapporter notre expérience dans le traitement chirurgical de cette anomalie. Il s’agit d’un nourrisson de 18 mois adressé initialement des urgences à notre service pour prise en charge d’une hydrocèle bilatérale. Cependant, l’examen clinique retrouve une verge enfouie avec un prépuce serré et une dilatation du réservoir préputial par les urines. L’intervention comprend plusieurs étapes: incision en Z, décalottage, libération de la verge par rapport aux adhérences entourant les corps caverneux et couverture cutanée ventrale sur sonde vésicale gardé une semaine pour protéger la cicatrisation. Les résultats esthétique et fonctionnel ont été satisfaisants chez notre patient après un an de recul. La verge enfouie congénitale reste un sujet très débattu. Notre technique était simple et facilement reproductible. Les difficultés mictionnelles, l’infection urinaire sont les indications principales de cette chirurgie.
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Affiliation(s)
- Mohamed Rami
- Service de Chirurgie Urologique Pédiatrique C, Hôpital d'Enfants, CHU Avicenne, Faculté de Médecine, Université Mohammed V, Rabat, Maroc
| | - Achraf El Bakkaly
- Service des Urgences Chirurgicales Pédiatriques, Hôpital d'Enfants, CHU Avicenne, Faculté de Médecine, Université Mohammed V, Rabat, Maroc
| | - Jaouad Bouljrouf
- Service des Urgences Chirurgicales Pédiatriques, Hôpital d'Enfants, CHU Avicenne, Faculté de Médecine, Université Mohammed V, Rabat, Maroc
| | - Toualouth Lafia
- Service de Chirurgie Urologique Pédiatrique C, Hôpital d'Enfants, CHU Avicenne, Faculté de Médecine, Université Mohammed V, Rabat, Maroc
| | - Mohammed Amine Bouhafs
- Service de Chirurgie Urologique Pédiatrique C, Hôpital d'Enfants, CHU Avicenne, Faculté de Médecine, Université Mohammed V, Rabat, Maroc
| | - Rachid Belkacem
- Service de Chirurgie Urologique Pédiatrique C, Hôpital d'Enfants, CHU Avicenne, Faculté de Médecine, Université Mohammed V, Rabat, Maroc
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Lei J, Luo C, Cheng S, Yan W, Wang X, Su X. Longer length improvement and more covert incision: a single-center, prospective study of two innovative surgical methods "one stitch" and "four stitch" for pediatric buried penis. World J Urol 2018; 36:1275-1283. [PMID: 29549480 DOI: 10.1007/s00345-018-2243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND To introduce the detailed procedures of two innovative surgical options for pediatric buried penis and prospectively compare their efficacy and safety. METHODS A single-center, non-randomized, prospective study was conducted at the Zhongnan Hospital of Wuhan University, where patients were operated on using the so-called "one stitch" (OS) or "four stitch" (FS) methods. The operation time, adverse events, and satisfaction were recorded for both groups. RESULTS Finally, 156 patients underwent the so-called OS (n = 65) or FS (n = 91) method, with a follow-up rate of 86.5% (135/156). During the perioperative period, the FS group spent much longer in surgery (P < 0.001), had more blood loss (P < 0.001), and took longer to recover from edema (P < 0.001) than the OS group. In contrast to the satisfaction after 12 months' follow up, both the objective length improvement (2.5 ± 0.6 vs 3.8 ± 0.5 cm, P < 0.001) and subjective satisfaction percent (86 vs 95%, P = 0.678) in the FS group were superior to those in the OS group. No significant differences were detected in postoperative infection, stenosis circle, scar hyperplasia, and relapse. CONCLUSIONS In conclusion, the two surgical options for pediatric buried penis are both safe and effective. The OS method has a simple procedure, so with shorter operation time and faster postoperative recovery; though the FS method with more complex procedure, patients can acquire a satisfactory improvement of penile length almost 4 cm and more covert incision at the midline of the scrotum. We primarily recommend the FS method for patients with moderate or severe buried cases; but for mild cases, we preferred the OS method.
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Affiliation(s)
- Junhao Lei
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Donghu Road #169, Wuhan, 430071, China
| | - Chunhua Luo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Donghu Road #169, Wuhan, 430071, China.,Operating Room, Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Songtao Cheng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Donghu Road #169, Wuhan, 430071, China
| | - Wen Yan
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Donghu Road #169, Wuhan, 430071, China. .,Center for Evidence-based and Translational Medicine, Wuhan University, Wuhan, 430071, China.
| | - Xinjun Su
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Donghu Road #169, Wuhan, 430071, China.
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de Luca U, Mangia G, Tesoro S, Martino A, Sammartino M, Calisti A. Guidelines on pediatric day surgery of the Italian Societies of Pediatric Surgery (SICP) and Pediatric Anesthesiology (SARNePI). Ital J Pediatr 2018. [PMID: 29530049 PMCID: PMC5848546 DOI: 10.1186/s13052-018-0473-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The Italian Society of Pediatric Surgery (SICP) together with The Italian Society of Pediatric Anesthesia (SARNePI) through a systematic analysis of the scientific literature, followed by a consensus conference held in Perugia on 2015, have produced some evidence based guidelines on the feasibility of day surgery in relation to different pediatric surgical procedures. The main aspects of the pre-operative assessment, appropriacy of operations and discharge are reported.
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Affiliation(s)
- Ugo de Luca
- Day Surgery Unit, Santobono-Pausilipon Pediatric Hospital, Napoli, Italy.
| | - Giovanni Mangia
- Department of Anesthesiology, San Camillo Forlanini Hospital, Roma, Italy
| | - Simonetta Tesoro
- Department of Anesthesiology, Perugia University, Perugia, Italy
| | | | - Maria Sammartino
- Department of Anesthesiology, Policlinico A. Gemelli, Roma, Italy
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