Giant Fibroepithelial Polyp of the Penis

A fibroepithelial polyp (FEP) of the penis is a rare benign swelling and often under-recognised lesion that has the potential to become malignant in some cases. The pathogenesis is still unclear, but it is hypothesised to be due to chronic irritation most often associated with condom catheter use or phimosis. We describe a case of an FEP measuring 10 cm in largest diameter developing from the ventral prepuce with a longstanding post-radiation penoscrotal oedema. A 62-year-old male with a history of bladder cancer presented to the emergency department with abdominal distention, vomiting, and obstipation for three days to the emergency department. He had post-radiation penoscrotal edema for the last 10 years and penile tip growth for the last two years. Foley's catheter insertion was done through the urethra after dorsal slit of prepuce, and an incisional biopsy was sent, which was found to be an FEP.

Factors affecting the differential epithelial cell count in preputial cytology of healthy intact dogs

Information is limited on the factors that may affect the preputial differential epithelial cell count in healthy intact dogs. Our objectives were to establish RIs of the preputial differential epithelial cell count in dogs and investigate the potential impact of signalment, presence of gross preputial discharge or neutrophils, preputial cleaning, and normal estrogen variation on the differential cell count. We enrolled prospectively 50 client-owned, healthy dogs in our study. Preputial cytology smears were obtained, and we performed a 4-part (parabasal, intermediate, superficial, cornified) differential cell count, before and after gentle preputial cleaning. We found higher counts of fully cornified cells (median: 11-12%) compared to previous studies. The cleaning procedure significantly decreased the intermediate (p = 0.002) and increased the superficial (p = 0.006) cells. Age was positively associated with intermediate (p = 0.007) and negatively with superficial (p = 0.01) and cornified (p = 0.02) cells. The concentration of estrogens was negatively associated with the percentage of parabasal cells (p = 0.04). In healthy dogs, a variable impact may be expected in the preputial differential epithelial cell count, by the cleaning of the prepuce before sampling, the age of the dogs, and the normal variation of estrogen concentration.

Segmental Posthetomy in a Four Stallions Case Series

Simple Summary

The equine prepuce is characteristic for having two infoldings that allow for substantial accommodation of the penis during detumescence and permit erection. Segmental posthetomy of the equine prepuce is a well described technique indicated for penile sheath injuries or lesions (neoplasms, granulomas, or scar tissue) that do not involve the underlying penile tunics. This surgical technique can be performed with variable extent of excision (i.e., the Adam’s procedure or subtotal posthetomy). The authors describe their experiences and results with different levels of preputial resection for treating four Equidae stallion patients with different preputial/pathologies.

Abstract

Segmental posthetomy, also referred to as circumcision, reefing or posthioplasty, consists of removing a circumferential segment of the internal preputial lamina (internal preputial fold) followed by end-to-end anastomosis of skin edges. The purpose of this case series is to describe the successful outcome of segmental posthetomy for treating different diseases involving the internal or/and external preputial fold, while restoring the normal telescopic function. In this paper, we report the first case of complete degloving injury of the equine penis in the literature (case 1) and describe three different common lesions of the equine prepuce/penis (preputial scar tissue in case 2, preputial sarcoid in case 3 and penile/preputial wound in case 4). The amount of prepuce (safe minimums) that can be removed from a stallion without disrupting the proper telescopic function of the internal/external preputial fold and normal copulatory ability, has not been established. In this case series, all Equidae stallions maintained the telescopic function after preputial surgical resection. However, the surgeon must carefully evaluate every single case, especially when performing the Adam’s procedure.

Penile amputation and pre-scrotal urethrostomy in a male guinea pig (Cavia porcellus)

Male guinea pigs (Cavia porcellus), especially older animals, are prone to urethritis and posthitis. Severe, chronic balanoposthitis/posthitis can result in fibrosis, localised infection and the deposition of mineralised plaques in the prepuce. Severe cases may require surgical intervention, such as penile amputation and urethrostomy, to achieve resolution.

Penile Tuberculosis in a Bull

We describe a case of penile tuberculosis in a bull. The prepuce was thickened, firm and pale with multifocal to coalescent caseous nodules, and the inguinal and mesenteric lymph nodes were moderately enlarged. Lesions in the prepuce, penis and lymph nodes were characterized by multifocal to coalescent areas of caseous necrosis and marked granulomatous inflammation. Acid-fast bacilli were seen within necrotic foci and Langhans giant cells. Mycobacteriumtuberculosis var. bovis was identified in inguinal lymph nodes by the polymerase chain reaction technique and by bacterial isolation. Although rare, tuberculosis should be considered in the differential diagnosis of granulomatous lesions in the genital tract of bulls.

Applied anatomy, pathophysiology and a revised scoring system of bull sheaths

The sheath and prepuce are anatomically simple yet vital parts of the mating apparatus of the bull. They are also susceptible to a range of insults, and pathology of these structures is a common cause of infertility in both Bos taurus and Bos indicus bulls. Significant individual and breed-based variation occurs in the looseness of the skin, the presence and development of preputial muscles, the relative position of the opening to the cranial preputial muscles, the length of the prepuce, and the prominence of the umbilicus. Individual and breed-based susceptibility to different conditions is associated with these anatomical variations. Regardless of the cause, pathology of the prepuce generally results in sepsis, prolapse, stenosis or adhesions or a combination. Clinical examination should be aimed at determining the extent of these processes and the amount of healthy prepuce which would remain following successful treatment. The inclusion of evaluation of sheath conformation in the form of a sheath score is recommended. Current scoring systems do not reflect the diversity of predisposing factors to morbidity and may therefore fail to accurately reflect the risk of morbidity. A more detailed scoring system has been proposed. Further refinement of this system is outlined, consisting of a composite of scores for depth, umbilical skin fold, prepuce eversion, and distance from cranial muscle to opening (the 'Y' factor). Validation against actual bull performance is indicated to develop a valid and useful risk-management tool for use in evaluating sheath conformation.

Two case reports of unusual phimosis in rhesus monkeys (Macaca Mulatta)

Phimosis is the inability of the penis to protrude from the prepuce. In the present report, we present two cases of phimosis in two rhesus monkeys. Surgical enlargement of preputial orifice was performed for unrestricted movement of penis. The exact cause of this condition is unknown to us.

Vascularization of vessel pedicle in hypospadias and its relationship to near-period complications

The present study evaluated the relationship between the vascularization of vessel pedicle and the near-period complication by assessing the surgery effect and recognizing the blood supply of the material for urethra reconstruction and collected the follow-up of the hypospadias patients after the operation. We illuminated the prepuce by a lighting technique using cold light and then photographed, and recorded the distribution and the quantity of vessels. Then classified, analyzed and summarized the vascularization of vessel pedicle. Patients who were repaired by Duckett technique were followed up for 1-5 months after the operation. We classified vessel pedicle vascularization in hypospadias cases into four patterns based on the predominant blood vessels. The number of predominant vessels had no exact relationship to the meatal location. The incidence of fistula and stricture had no exact relationship to the number of predominant vessels. In conclusion, there is no exact congruent relationship between the types of vascularization with the meatal location. Vascularization of vessel pedicle had no exact relationship with urethral fistula or stricture.

Pagetoid Dyskeratosis of the Male Genitalia: Case Report and Review

Pagetoid dyskeratosis is a benign incidental pathologic finding that has been reported in many distinct skin lesions on various locations of the body. A man who had pagetoid dyskeratosis within lesions of the penile shaft is described and similar cases of pagetoid dyskeratosis in lesions of the male genitalia are reviewed. The patient was a 26-year-old healthy man who developed several asymptomatic penile papules that were refractory to topical imiquimod 5% cream and cryotherapy. Snip biopsies were performed and microscopic examination revealed pagetoid dyskeratosis. PubMed was searched for the following terms: cell, clear, dyskeratosis, genitalia, pagetoid, penile, penis, prepuce, scrotum, and shaft. The papers containing these terms and their references were reviewed. Pagetoid dyskeratosis has been observed in lesions on the prepuce and scrotum; this case report now expands the distribution of this finding to the penile shaft. Clinicians and pathologists should be aware of this intriguing potential incidental finding within skin lesions of the male genitalia.

Naturally acquired bovine besnoitiosis: Disease frequency, risk and outcome in an endemically infected beef herd

The recent spread of bovine besnoitiosis warrants further epidemiological investigations to improve the knowledge on disease development. Thus, a 4-year longitudinal open cohort study was conducted in the first German cattle herd naturally infected with Besnoitia besnoiti. At seven herd-visits between 2008 and 2012, fourteen breeding bulls (>1.5 years) and 131 females (>1 year) were examined clinically and serologically. In females, clinical and serological prevalences, incidence and remission rates were determined. In addition, the association of age, antibody levels and number of visible parasitic cysts with clinical and serological outcome was investigated. The seroprevalence (89.4%-100%) and serological incidence rate (140.5 per 100 animal-years) were considerably higher than the clinical prevalence (23.5%-36.6%) and clinical incidence rate (16.7 per 100 animal-years). Of 33 new clinical and 12 new serological cases, only 6.7% (3/45) attracted attention with clinical signs of acute bovine besnoitiosis. The apparent serological remission rate (1.9 per 100 animal-years) was considerably lower than the clinical remission rate (37.3 per 100 animal-years). A median cyst score of <1 and mean immunofluorescent antibody test (IFAT) titre of ≤1,600 over the entire observation period was significantly associated with a negative clinical outcome at the end. Overall cyst score was not significantly associated with serological outcome and age had no significant influence on clinical and serological outcome. Within 4 years, there was a significant reduction in cyst scores and IFAT titres in the same animals, leading to eight clinically and serologically negative animals in the end. Two initially negative animals achieved clinical and apparent serological remission in about 2.5 years. In bulls, the time between herd entry and seroconversion was 7-30 months and the serological incidence rate was nearly identical to the rate in females (142.0 per 100 animal-years). This shows that a high B. besnoiti prevalence leads to infection of bulls within a short time period.

Accessory fold of skin on the ventral surface of the penis: Is it a redundant prepuce?

Variations in the skin of the prepuce are very rare. We report here a variation of the penile skin as observed in an adult male cadaver aged approximately 65 years. The penis was covered by thin nonhairy skin. The glans was not covered with prepuce. There was no evidence of circumcision. The ventral surface of the penis, adjacent to the glans, had a huge fold of skin. This fold resembled the prepuce and had a hole in it. The glans penis had a normal urethral meatus. There was no evidence of hypospadias as the entire ventral surface of the penis was covered completely by the skin. We discuss the clinical importance of this accessory fold of skin.

Megaprepuce Reconstruction: A Single Center Experience

INTRODUCTION

Surgical treatment of congenital megaprepuce is challenging and controversial. We report our 10-year experience treating patients with this deformity using a standardized procedure that has similarities to a technique reported by Smeulders et al. (1). Our postoperative complications and mid-term follow-up cosmetic appearance of the genitalia after reconstruction are reviewed.

MATERIAL AND METHODS

Fifteen patients operated on between 2005 and 2015 were evaluated. Age at surgical repair ranged from 3 to 20 months (mean 9). Treatment included unfolding the preputial sac via a ventral approach, excision of redundant inner preputial skin, and ventral skin coverage with the outer preputial layer. Twelve patients presented associated partial scrotal engulfment, which was simultaneously treated. Mean follow-up was 4.6 years (range 2-7 years).

RESULTS

Short-term complications occurred in three patients: scrotal hematoma in one patient and small skin dehiscence at the penoscrotal junction in two patients. Skin disruption healed by secondary epithelial ingrowth. All cases resulted in a satisfactory genital cosmetic outcome. There were no late complications. All patients preserved normal external genitalia appearance.

CONCLUSION

Our experience is in agreement with reports of other authors; suggesting that excision of the inner preputial layer and using the external one for penile coverage provide good and durable mid-term esthetic results in megaprepuce reconstruction.

Comparative Morphology of the Penis and Clitoris in Four Species of Moles (Talpidae)

The penile and clitoral anatomy of four species of Talpid moles (broad-footed, star-nosed, hairy-tailed, and Japanese shrew moles) were investigated to define penile and clitoral anatomy and to examine the relationship of the clitoral anatomy with the presence or absence of ovotestes. The ovotestis contains ovarian tissue and glandular tissue resembling fetal testicular tissue and can produce androgens. The ovotestis is present in star-nosed and hairy-tailed moles, but not in broad-footed and Japanese shrew moles. Using histology, three-dimensional reconstruction, and morphometric analysis, sexual dimorphism was examined with regard to a nine feature masculine trait score that included perineal appendage length (prepuce), anogenital distance, and presence/absence of bone. The presence/absence of ovotestes was discordant in all four mole species for sex differentiation features. For many sex differentiation features, discordance with ovotestes was observed in at least one mole species. The degree of concordance with ovotestes was highest for hairy-tailed moles and lowest for broad-footed moles. In relationship to phylogenetic clade, sex differentiation features also did not correlate with the similarity/divergence of the features and presence/absence of ovotestes. Hairy-tailed and Japanese shrew moles reside in separated clades, but they exhibit a high degree of congruence. Broad-footed and hairy-tailed moles reside within the same clade but had one of the lowest correlations in features and presence/absence of ovotestes. Thus, phylogenetic affinity and the presence/absence of ovotestes are poor predictors for most sex differentiation features within mole external genitalia.

Zoon's balanitis treated with topical tacrolimus

Zoon's balanitis is an asymptomatic lesion that requires histopathological examination of involved tissue for confirmation of diagnosis. Till today, circumcision is considered as the treatment of choice as topical medical therapy is insufficient to cure the disease and also there was a risk of recurrence after discontinuation of therapy. Herein, we have treated the Zoon's balanitis with 0.1% topical tacrolimus with complete resolution of the lesion in 6 weeks. Hence, we think topical tacrolimus therapy should be considered as an alternative to circumcision in the treatment of Zoon's balanitis.

Solitary Angiokeratoma Presenting as Cutaneous Horn over the Prepuce: A Rare Appearance

We present a case of a 47-year-old man with 4 months history of conical growth on the prepuce with a progressive increase in size. The patient had been treated for seminoma a decade ago. Histopathology of the growth showed features of angiokeratoma. It is unusual for angiokeratoma to masquerade as a cutaneous horn.

Anatomy of mole external genitalia: Setting the record straight

Anatomy of male and female external genitalia of adult mice (Mus musculus) and broad-footed moles (Scapanus latimanus) was re-examined to provide more meaningful anatomical terminology. In the past the perineal appendage of male broad-footed moles has been called the penis, while the female perineal appendage has been given several terms (e.g. clitoris, penile clitoris, peniform clitoris and others). Histological examination demonstrates that perineal appendages of male and female broad-footed moles are the prepuce, which in both sexes are covered externally with a hair-bearing epidermis and lacks erectile bodies. The inner preputial epithelium is non-hair-bearing and defines the preputial space in both sexes. The penis of broad-footed moles lies deep within the preputial space, is an "internal organ" in the resting state and contains the penile urethra, os penis, and erectile bodies. The clitoris of broad-footed moles is defined by a U-shaped clitoral epithelial lamina. Residing within clitoral stroma encompassed by the clitoral epithelial lamina is the corpus cavernosum, blood-filled spaces and the urethra. External genitalia of male and female mice are anatomically similar to that of broad-footed moles with the exception that in female mice the clitoris contains a small os clitoridis and lacks defined erectile bodies, while male mice have an os penis and a prominent distal cartilaginous structure within the male urogenital mating protuberance (MUMP). Clitori of female broad-footed moles lack an os clitoridis but contain defined erectile bodies, while male moles have an os penis similar to the mouse but lack the distal cartilaginous structure.

Modified prepuce unfurling for buried penis: a report of 12 years of experience

BACKGROUND/OBJECTIVE

About 10 years ago, we started to correct buried penis using the technique of modified prepuce unfurling. We have made modifications in the years since our preliminary results were reported in 2002.

METHODS

One hundred and thirty-four patients received modified prepuce unfurling since 2000, with ages ranging from 2 months to 33 years. The surgical procedures included the removal of the narrowest part of the prepuce, dissection of the fibrotic tissue from the Buck's fascia, and unfurling the inner prepuce to cover the penis. Most patients had their procedures in day care service. No urinary catheter was needed. All patients were followed up for at least 2 months.

RESULTS

Most patients had satisfactory results. All patients had the glans exposed after surgery, although one patient needed reoperation for prolonged edema and two patients had wound infections.

CONCLUSION

Modified prepuce unfurling is a safe and effective method to correct buried penis.

Circumcision: experience at a private hospital in jos, Nigeria

Background:

Most circumcisions in our environment are carried out in children for religious and cultural reasons. The PlastiBell device has been used for several decades, though some complications have been associated with its use.

Aims and Objectives:

This study examines the safety and acceptability of the PlastiBell device, which was used in circumcision in the majority of patients studied.

Materials and Methods:

Fifty consecutive patients, who had circumcision at a private medical facility in Jos, Nigeria, over a 2 year period, were reported. Their ages, method of circumcision, size of PlastiBell device used, incidence of complications and acceptability of procedure to parents were documented.

Results:

In this study, all patients below 42 days old had their circumcision done with the PlastiBell device. Complications seen with this device included hemorrhage in one patient following a slipped out device. In 49 (98%) of the patients, the mothers were satisfied with the outcome of the procedures.

Conclusion:

The PlastiBell device can be safely used for circumcisions in children below 42 days old.

Frequency of different human mollicutes species in the mucosa of the oropharynx, conjunctiva, and genitalia of free-ranging and captive capuchin monkeys (Cebus spp.)

This study is the first to evaluate the occurrence of several Mollicutes species in Brazilian capuchin monkeys (Cebus spp.). Mollicutes were detected by culture and polymerase chain reaction (PCR) in samples of the oropharyngeal, conjuctiva, and genital mucosae of 58 monkeys. In the oropharynx, Mollicutes in general (generic PCR to the Class), and those of the genus Ureaplasma (genus PCR), were detected in 72.4% and 43.0% of the samples, respectively. The identified species in this site included: Mycoplasma arginini (43.1%), M. salivarium (41.4%), and M. pneumoniae (19.0%). Both Ureaplasma and Mycoplasma are genera of the order Mycoplasmatales. In the preputial/vaginal mucosa, PCR detected Mollicutes in general in 27.58% of the samples, the genus Ureaplasma in 32.7%, the species M. arginini in 8.6%, and Acholeplasma laidlawii of the order Acholeplasmatales in 1.7% In the conjunctiva, Mollicutes in general were detected in 29.3% of the samples, with 1.7% being identified as A. laidlawii. Culturing was difficult due to contamination, but two isolates were successfully obtained. The Mollicutes species of this study provided new insights into these bacteria in Brazilian Cebus. Studies are lacking of the actual risk of Mollicutes infection or the frequency at which primates serve as permanent or temporary reservoirs for Mollicutes. In the present study, the samples were collected from monkeys without clinical signs of infection. The mere presence of Mollicutes, particularly those also found in humans, nevertheless signals a need for studies to evaluate the impact of these microorganisms on the health of non-human primates (NHPs) and the possibility of cross-species transmission between NHPs and humans.

Modified Byars' flaps for securing skin closure in proximal and mid-penile hypospadias

OBJECTIVE

The objective of this study was to describe a modification for skin closure combined with tubularized incised plate (TIP) urethroplasty in the repair of proximal and mid-penile hypospadias.

PATIENTS AND METHODS

The study included 47 patients with nondistal hypospadias who underwent a primary TIP procedure from September 2007 to May 2010. Meatal position was mid-shaft (n = 20), penoscrotal (n = 20), and scrotal (n = 7). The patients in the study were divided into two groups according to a modification in the technique of skin closure, which involved incising the prepuce vertically into two halves, then harvesting the dartos flap for covering the repair from one half, leaving the other preputial half to reconstruct the ventral skin without compromising its blood supply.

RESULTS

In the standard procedure (n = 19 patients), complications included glanular dehiscence (10.5%), glanular fistula (5%), urethrocutaneous fistula (10.5%), and skin complications (21%). In the modified procedure (n = 28 patients), complications included glanular dehiscence (7%) and glanular fistula (3.6%), but no skin complications or urethrocutaneous fistulae occurred.

CONCLUSION

The modified Byars' flaps is a useful alternative for skin closure during proximal and mid-shaft TIP urethroplasty, with fewer complications and acceptable cosmetic outcome.

New insights on the morphology of adult mouse penis

The adult mouse penis represents the end point of masculine sex differentiation of the embryonic genital tubercle and contains bone, cartilage, the urethra, erectile bodies, several types of epithelium, and many individual cell types arrayed into specific anatomical structures. Using contemporary high-resolution imaging techniques, we sought to provide new insights to the current description of adult mouse penile morphology to enable understanding of penile abnormalities, including hypospadias. Examination of serial transverse and longitudinal sections, scanning electron microscopy, and three-dimensional (3D) reconstruction provided a new appreciation of the individual structures in the adult mouse penis and their 3D interrelationships. In so doing, we discovered novel paired erectile bodies, the male urogenital mating protuberance (MUMP), and more accurately described the urethral meatus. These morphological observations were quantified by morphometric analysis and now provide accurate morphological end points of sex differentiation of mouse penis that will be the foundation of future studies to identify normal and abnormal penile development.

Use of preputial skin for coverage of post-burn contractures of fingers in children

OBJECTIVE

Hand burns are common injuries. Children frequently sustain burn injuries, especially to their hands. Contractures are a common sequel of severe burns around joints. The prepuce, or foreskin, has been used as a skin graft for a number of indications. We conducted this study to evaluate the feasibility of utilising the preputial skin for the management of post-burn contractures of fingers in uncircumcised male children.

MATERIALS AND METHODS

Preputial skin was used for the coverage of released contractures of fingers in 12 patients aged 2-6 years. The aetiology of burns was "Kangri" burn in eight patients and scalding in four patients. Six patients had contracture in two fingers, four patients in one finger, and two patients had contractures in three fingers.

RESULTS

None of the patients had graft loss, and all the wounds healed within 2 weeks. All patients had complete release of contractures without any recurrence. Hyperpigmentation of the grafts was observed over a period of time, which was well accepted by the parents.

CONCLUSIONS

Preputial skin can be used successfully for male children with mild-to-moderate contractures of 2-3 fingers for restoration of the hand function, minimal donor site morbidity.

Removal of foreskin remnants in circumcised adults for treatment of premature ejaculation

Background and Aim:

Premature ejaculation (PE) is the most prevalent sexual dysfunction in every country. There are many types of treatment, but the main limitation of medical treatment for premature ejaculation is recurrence after withdrawal of medicine. The prepuce is a specific erogenous zone that contains a rich and complex network of nerves. Circumcision radically desensitizes the penis, but incomplete circumcision may cause premature ejaculation. We evaluate the effect of removal of foreskin remnants in adults on PE.

Materials and Methods:

The sensitive area of penile skin and the remaining parts of foreskin in adult men were recognized in 47 selective patients. Under local anesthesia, the remnant parts of foreskin were incised and removed. They were asked to fill the investigating questionnaire about the changes of intravaginal latency ejaculatory time (IVELT), patients and their sexual partners’ satisfaction with sexual life, control over ejaculation, and penile sensitivity, before and after treatment.

Results:

There were no signs of inflammation and no serious adverse reactions in all cases after operation. IVELT significantly increased from 64.25 before surgery to 731.49 sec after surgery (P<0.001). The percentage of postoperative satisfaction in both the patient and his partner significantly increased (P<0.001). After surgery, 95.7% of men had better control over their ejaculation. This surgery significantly decreased sensitivity of penis (P<0.001), but it did not change glans penis insensitivity.

Conclusions:

These results indicate that removal of foreskin remnants in adults is an effective modality in selective patients of PE.