Venous malformation of the glans penis: efficacy of treatment with neodymium:yttruim-aluminum-garnet laser

Surgical Management of Arteriovenous Malformation of the Penis in an Adolescent Boy: A Case Report and Review of the Literature

Arteriovenous malformations (AVMs) are common benign lesions, present at birth. Although they may occur anywhere in the body, usually they are found on the head, the neck, and the extremities. AVMs of the glans penis are very rare. Only a few have been reported in the literature, and thus, a definitive treatment does not exist. We herein report our experience of treating an AVM of the glans penis with surgical excision and plastic reconstruction of the glans, with the application of transplant tissue from the inner skin of the prepuce.

Venous malformation of the penis treated with a combined Nd:YAG laser and sclerotherapy technique

Venous malformations are the commonest vascular anomalies and can be found everywhere in the body. Those of the external genitalia are quite rare. Although they can be small, they may give rise to psychological discomfort and functional impairment and their management can be delicate and challenging. We present a case of a large and infiltrating venous malformation of the glans penis successfully treated with a combined strategy using sclerotherapy and Nd:YAG laser.

Efficacy and safety of DSA-guided percutaneous sclerotherapy for venous malformations of penile region in children

OBJECTIVE

To describe the effectiveness and security of DSA-guided percutaneous sclerotherapy for venous malformations of penile region in children.

METHODS

A total of 9 cases children with penile venous malformations treated by DSA-guided percutaneous sclerotherapy from January 2017 to June 2018 were enrolled in this study. Local angiography was performed under DSA fluoroscopy, and the shape, extent and venous drainage of the tumor nest were judged. Then sclerosing agents (Pingyangmycin and Polidocanol) were selected according to the flow rate of angiography and treated by percutaneous injection under DSA monitoring. Imaging examination (MRI) was performed to evaluate clinical improvement.

RESULTS

A total of 26 interventional sclerotherapy sessions were performed in 9 children, with an average of (2.3±0.5) sessions per case. After a mean follow-up of 7.3 months, 6 cases were cured, and 3 cases were in basic remission. There were 9 cases of temporary edema secondary to the treatment site and 3 cases of mild pain. No serious complications such as ulceration, hemorrhage, infection and dysfunction occurred in any patients.

CONCLUSION

DSA-guided percutaneous sclerotherapy for venous malformations of penile region in children is safe and effective, does not affect the appearance and function of penis, and is worthy of clinical promotion.

TYPE OF STUDY

Treatment Study.

LEVEL OF EVIDENCE

Level IV, Case series with no comparison group.

Glanular Venous Malformation in Pediatric Age: An Uncommon Vascular Disorder

Glanular venous malformations are uncommon in pediatric patients. The diagnosis can be easily achieved by observation, even if color Doppler ultrasound is useful for a better characterization. Abdomino-pelvic MRI is necessary to assess the extension of complex lesions and check for associated anomalies. Several therapeutic options are reported in literature. We report 3 paediatric cases successfully treated by surgery with no complications and functional sequelae. Cosmetic results were satisfactory, with minimal surgical scarring. In our opinion, surgery for small glanular venous malformations is indicated within puberty to prevent traumatic bleeding and psychological impact.

A case series of genital vascular anomalies in children and their management: lessons learned

OBJECTIVE

To review our experience with genital vascular anomalies and discuss the management considerations for patients with associated genitourinary defects.

METHODS

We reviewed the presentation, course, management considerations, surgical treatment, and follow-up of all cases of genital vascular anomalies treated at a single institution from January 2008 to October 2011. The lesions were classified according to the International Society for the Study of Vascular Anomalies. All patients were boys <18 years old.

RESULTS

We identified 3 patients with genital vascular anomalies. Of these 3 patients, 2 had an infantile hemangioma and 1 had a venous malformation. All lesions were identifiable on physical examination, and 2 of the patients presented within a few months of birth. One patient had associated genitourinary abnormalities that complicated his treatment. Scrotal ultrasonography and pelvic magnetic resonance imaging consistently showed the vascular anomalies to be highly vascular and distinct from the underlying testes. Both intrascrotal lesions were excised, and the cutaneous lesion was excised as a part of a larger genitourinary reconstruction. At a mean follow-up of 33 months (range 23-42), the intrascrotal infantile hemangioma had recurred, requiring repeat intervention, but the cutaneous hemangioma had not.

CONCLUSION

Vascular anomalies of the male genitalia are rare. Pelvic magnetic resonance imaging is useful for characterizing the internal extent of vascular anomalies and ultrasonography is useful in monitoring these lesions over time. The timing of surgery and the high recurrence rate are important considerations when planning surgical resection of genital vascular anomalies, especially when associated with concomitant genitourinary defects.

Venous malformations of the genitals: a therapeutic dilemma

Venous malformations may occur anywhere in the body but are rare in the genitourinary tract and external genitalia. The authors report a case of a venous malformation in the glans penis and discuss the controversy over optimal management.

A review of pediatric glans malformations: a handy clinical reference

PURPOSE

Lesions of the pediatric glans penis are an uncommon but important aspect of pediatric urological care. We reviewed the available literature on this topic and did not identify a comprehensive reference resource. We compiled our multi-institutional experience with such conditions to prepare a handy clinical reference source.

MATERIALS AND METHODS

The diversity of pediatric glans penis lesions was documented by searching the English and nonEnglish literature as well as the archives at our institutions. Cases were included in the study if the patient(s) identified were younger than 18 years at initial presentation or documented to have first had a glans penis lesion when younger than 18 years. Hypospadiac-epispadiac anomalies of the glans were excluded.

RESULTS

From our institutions we identified 6 new cases of various pediatric glans lesions. Altogether the literature describes 137 distinct nondiphallia glans lesions and more than 100 cases of diphallia, including glans duplication. The nondiphallia reports consist of a total of 61 cystic lesions (44%), 33 vascular malformations (24%), 20 dermatological lesions (15%), 20 infectious lesions (15%) and 3 neurogenic lesions (2%). We did not identify a compact resource to compare these anomalies. Visual comparison permits structuring a differential diagnosis and determining urological treatment, which is typically excisional biopsy, laser treatment, sclerotherapy or topical steroid administration.

CONCLUSIONS

We present a visual reference of varied lesions of the pediatric glans penis, including 6 new cases, with urological significance. These lesions are always benign but they typically require surgical excision for a definitive pathological diagnosis.

Primary cavernous hemangioma of the glans penis: rare case report with a review of the literature

Hemangiomas of the urinary tract are rare lesions, and those of the glans penis are even rarer. A 23-year-old man with a hemangioma of the glans penis treated successfully with intralesional sclerotherapy is presented. Other options for the management of this disorder are discussed.

Laser Treatment of Venous Malformations

Venous malformations (VM) are developmental errors comprised of enlarged dysplastic blood vessels. Clinically they manifest as either a faint blue patch or a soft blue vascular mass. Treatment options include a sclerosing agent (such as alcohol or ethiblock), surgery or laser therapy. A review of the literature concerning VM and laser treatment yielded a few sporadic reports describing series of 3 to 46 cases. In this retrospective study we reviewed the files of the relevant cases. The data included the extent of the lesion, the different anatomical sites, age of patient and the extent of clearance of the lesion as the treatment's end point. This study includes 56 cases which makes it the largest series presented. The success rate of laser treatment was 92.8%. The immediate complication rate was very low (approximately 3.57%) including minimal scarring and deformity. No long term complications were noted. Our study concludes that treatment of VM is a difficult task due to the nature of the lesions. Laser treatment of these lesions enables one to obtain good results with a very low incidence of complications. Surgery and other treatment modalities are not always satisfactory, yield similar or less efficient results and have a higher complication rate. Laser treatment can play an important role in the treatment of VM and in fact may be the treatment of choice in some settings.

Sclerotherapy for venous malformations of the glans penis

OBJECTIVES

To retrospectively evaluate the safety and efficacy of percutaneous sclerotherapy with polidocanol in 9 patients with venous malformations of the glans penis. Vascular malformations of the external genitalia can be aesthetically and functionally disabling. These lesions are rare and their treatment is still controversial.

METHODS

Seven patients were asymptomatic, seeking advice for cosmetic reasons, and 2 patients had experienced several bleeding episodes during sexual intercourse. In all patients, Doppler ultrasound scanning was performed before treatment. All patients underwent direct intralesional injection of polidocanol. The concentration of the sclerosant varied from 1% to 3%, and the volume of the solution varied from 2 to 4 mL per injection. Four patients required multiple sclerotherapeutic sessions.

RESULTS

All patients experienced marked swelling after the injection and three developed cutaneous blistering. Neither cutaneous necrosis nor early or late major complications occurred. At a mean follow-up of 35.1 months, 7 patients were cured and 2 had marked improvement. No patients presented with signs of recurrence, and the outcome was overall cosmetically successful.

CONCLUSIONS

Sclerotherapy with polidocanol is a well-tolerated, safe, and effective treatment for venous malformations of the penis. In our opinion, it can be considered the treatment of choice.