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Cole RM, Andino JJ, Daignault-Newton S, Quallich SA, Hadj-Moussa M. Epididymectomy Is an Effective Treatment for Chronic Epididymal Pain. Urol Pract 2024; 11:409-415. [PMID: 38226929 DOI: 10.1097/upj.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Chronic scrotal pain is difficult to manage, and epididymectomy is a treatment option for a subset of men with pain localized to the epididymis. We sought to evaluate the efficacy of epididymectomy at our institution. METHODS Between 2000 and 2020, 225 men underwent epididymectomy at our institution for pain localized to the epididymis and not part of a greater constellation of pelvic pain or urinary symptoms. Our primary outcome measure was change in pain after epididymectomy, categorized as cured/improved or no change/worsened. Multivariable logistic regression compared the impact of pain duration, and surgical and psychiatric histories on postoperative pain. RESULTS Patients in both outcome categories-cured/improved and no change/worsened-were similar in age and BMI. Overall, 162 patients (72%) reported cured/improved pain at the last documented follow-up visit. Median follow-up time was 12 (IQR 1-364) weeks. About half of the cohort (n = 117, 52%) had a prior vasectomy, and there was no difference in outcome based on vasectomy history on multivariate analysis (OR 0.625, P = .3). Men with pain duration > 1 year (OR 0.46, P = .03), diagnosed psychiatric conditions (OR 0.44, P = .04), or prior scrotal/inguinal/abdominal surgeries other than vasectomy (OR 0.47, P = .03) had decreased odds of pain relief after epididymectomy. CONCLUSIONS This 20-year analysis is the largest review of postepididymectomy outcomes reported. Among carefully screened men, 72% had resolution or improvement of scrotal pain. Epididymectomy is most effective for men with < 1 year of focal epididymal pain, with no history of psychiatric conditions or scrotal/inguinal/abdominal surgery other than vasectomy.
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Affiliation(s)
- Renee M Cole
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Juan J Andino
- Department of Urology, University of California, Los Angeles, Santa Monica, California
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Sun JM, Yamamoto T. Genital elephantiasis: Surgical treatment and reconstruction. J Chin Med Assoc 2024; 87:142-147. [PMID: 37962359 DOI: 10.1097/jcma.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Genital elephantiasis is a severe form of lymphedema of the groin. It is characterized by progressive enlargement and distortion of the genitals, presenting significant physical, psychological, and social challenges to the affected individuals. Although pharmacological treatment of filariasis is well-established in the medical field, the surgical management of genital elephantiasis can be varied and confusing. This review article provides an in-depth analysis of the etiology, classification, severity grading, and various effective surgical treatment and reconstructive modalities commonly employed by surgeons since the early twentieth century. We also discuss how a combination approach of ablation, soft tissue coverage, and lymphatic reconstruction is viable for treating genital elephantiasis. By examining the literature, we hope to provide insights into how surgery plays a role in the holistic management of genital elephantiasis.
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Affiliation(s)
- Jeremy Mingfa Sun
- Department of Surgery, Plastic Reconstructive and Aesthetic Surgery Service, Changi General Hospital, Singapore
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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Koualla S, Bakhil A, Benbachir A, M'fa SK, Sabani H, Khalfi L, Hamama J, Ribag Y, El Khatib MK. Genital elephantiasis in men. ANN CHIR PLAST ESTH 2024; 69:92-96. [PMID: 37045654 DOI: 10.1016/j.anplas.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/23/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023]
Abstract
Penoscrotal elephantiasis (PSE) is defined as an increase, sometimes considerable, in the volume of the external genitalia, which will be responsible for an unsightly appearance, a sexological impact and a psychological harm. The cause may be primary or secondary to a parasitic disease (filarsiosis) or to intrinsic or extrinsic lymphatic obstruction. The diagnosis is essentially clinical, with penoscrotal involvement being the most frequent. The etiological research implies the realization of certain complementary examinations according to the circumstances. Surgical treatment ideally consists of excising the mass. followed by reconstruction using grafts or local flaps of healthy skin, which is an important way of restoring comfort to the patient. We report two cases of penoscrotal elephantiasis treated surgically with good functional and aesthetic results. We update, through our own experience, aspects of the diagnostic and therapeutic care of penoscrotal elephantiasis.
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Affiliation(s)
- Sara Koualla
- Burns and Reconstructive Surgery Department, Mohammed VI University Hospital, Oujda, Morroco.
| | - Ayoub Bakhil
- Maxillofacial and Plastic Surgery Department, Military Hospital of Instruction Mohammed V, Rabat, Morroco
| | - Adam Benbachir
- Maxillofacial and Plastic Surgery Department, Military Hospital of Instruction Mohammed V, Rabat, Morroco
| | - Sandy Keith M'fa
- Maxillofacial and Plastic Surgery Department, Military Hospital of Instruction Mohammed V, Rabat, Morroco
| | - Hicham Sabani
- Maxillofacial and Plastic Surgery Department, Military Hospital of Instruction Mohammed V, Rabat, Morroco
| | - Lahcen Khalfi
- Maxillofacial and Plastic Surgery Department, Military Hospital of Instruction Mohammed V, Rabat, Morroco
| | - Jalal Hamama
- Maxillofacial and Plastic Surgery Department, Military Hospital of Instruction Mohammed V, Rabat, Morroco
| | - Yassamina Ribag
- Maxillofacial and Plastic Surgery Department, Military Hospital of Instruction Mohammed V, Rabat, Morroco
| | - M Karim El Khatib
- Maxillofacial and Plastic Surgery Department, Military Hospital of Instruction Mohammed V, Rabat, Morroco
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Khan MM, Mirza ZR, Cheema FE, Shahzad R. Idiopathic Scrotal Calcinosis: A Case Report. J PAK MED ASSOC 2023; 73:2086-2088. [PMID: 37876077 DOI: 10.47391/jpma.6997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Idiopathic scrotal calcinosis is formation of calcium deposits in the dermal layers of the scrotum. It results in the formation of single or multiple nodular calcifications that vary in size and number. First reported in 1883, this condition is common in the third decade of life. The presenting complaints range from disfigurement to itching, leading to decreased quality of life. The diagnosis is usually made on a clinical basis and can be confirmed by the histopathology of the excised nodules. Surgical removal of the nodules is the generally recommended treatment. The surgery aims to eradicate the nodules leaving the scrotal skin enough for scrotoplasty. We present a case of idiopathic scrotal calcinosis in a 37 years old male who came for radiological examination.
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Affiliation(s)
| | | | | | - Rafia Shahzad
- Department of Radiology, INMOL Cancer Hospital, Lahore, Pakistan
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Fang C, Xu YK, DU QD, Fan XX, Yu Y. [Vacuum sealing drainage as an adjuvant treatment of severe scrotal infectious disease: Clinical analysis of 9 cases]. Zhonghua Nan Ke Xue 2023; 29:430-435. [PMID: 38602760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To evaluate the clinical effectiveness of vacuum sealing drainage (VSD) in the treatment of severe scrotal infectious diseases and to summarize the practical experience obtained during its implementation. METHODS Clinical data from 9 patients with severe scrotal infectious diseases were compiled. All patients underwent debridement assisted by a VSD device in addition to conventional treatment measures. RESULTS Following debridement with VSD device, combined with systemic anti-infection treatment and nutritional support, all patients exhibited favorable therapeutic outcomes, with no fatalities. The average duration of debridement was 81±27 minutes. One patient necessitated secondary debridement and skin grafting, while another was transferred to the ICU due to septic shock. CONCLUSIONS The application of VSD device can streamline the treatment process for severe scrotal infectious diseases, alleviate patient discomfort, and promote patient recovery.
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Affiliation(s)
- Cheng Fang
- Department of Urology, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang 315100,China
| | - Yang-Kai Xu
- Department of Urology, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang 315100,China
| | - Qi-Dan DU
- Department of Urology, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang 315100,China
| | - Xiao-Xiao Fan
- Department of Urology, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang 315100,China
| | - Yi Yu
- Department of Urology / Center of Reproductive Medicine, The First Affiliated Hospital of Ningbo University,Ningbo, Zhejiang 315100,China
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Sischka MF, Tentis ER, Helo S, Kohler TS, Collins CS, Ziegelmann MJ. Testicular Pain - Not Always What it Seems: A Cross-Sectional Assessment of Patients Presenting for Chronic Scrotal Content Pain at a Tertiary Care Center. Urology 2023; 174:18-22. [PMID: 36773956 DOI: 10.1016/j.urology.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/04/2023] [Accepted: 01/15/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To review historical and examination findings in patients presenting to a tertiary care center for evaluation of Chronic Scrotal Content Pain (CSCP) defined by persistent/bothersome pain present for > 3-months. METHODS We performed a retrospective chart review of all patients presenting to our medical center for evaluation of CSCP. Pertinent information collected included historical data, physical examination findings, laboratory and imaging results, and treatments recommended by the assessing physician. The data was summarized to present a cross-sectional representation of patients presenting for CSCP. RESULTS 110 patients were identified. 80 patients (73%) had seen at least one prior urologist. 26 patients (24%) had undergone a prior unsuccessful surgical intervention for CSCP. Reproducible tenderness was present in 67% of patients including testicular tenderness in 50 (45%), epididymal tenderness in 60 (55%), and spermatic cord tenderness in 31 patients (28%). 33% of patients did not have any reproductible scrotal content tenderness on physical examination. Surgery was recommended in 57/110 patients (52%), including microdenervation in 22%. Musculoskeletal etiologies were suspected based on specific aspects of the history and physical examination in 43 patients (39%), prompting additional evaluation and/or referrals. CONCLUSION CSCP presents with a wide array of symptoms and many patients do not have reproducible findings on examination, suggesting alternative sources of pain such as referred pain from musculoskeletal causes. The history and physical examination should include assessments for concurrent abdominal, back, hip, and other genital/pelvic pain that may suggest alternative diagnoses and referrals for appropriate treatment.
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Affiliation(s)
| | | | - Sevann Helo
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - C Scott Collins
- Department of Urology, Mayo Clinic, Rochester, MN; Department of Medicine, Mayo Clinic, Rochester, MN
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Xing Q, He L, Gao X, Zhang C, Luo X, Gao X, Wu Y, Zhang L, Guo F. Giant seminal vesicle cyst with hemorrhage in Zinner syndrome: A case report. Medicine (Baltimore) 2022; 101:e31577. [PMID: 36550832 PMCID: PMC9771240 DOI: 10.1097/md.0000000000031577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Zinner syndrome (ZS) is a rare congenital malformation of the urogenital tract that is associated with seminal vesicle cysts, ejaculatory duct obstruction, and ipsilateral renal agenesis. This unique condition was first reported by Zinner (1914). ZS is caused by malformation of the distal mesonephric duct during embryogenesis. To our knowledge, no giant seminal vesicle cysts with hemorrhage in ZS have been reported in the current study. PATIENT CONCERNS A 63-year-old man presented with chronic hypogastralgia with no history of lower urinary tract symptoms, hematuria, or trauma. Physical examination revealed no localized uplift or percussive pain in either kidney. No tenderness in the ureter stroke region, no localized eminence in the suprapubic region of the bladder, and no tenderness in the bladder region was observed. Digital rectal examination revealed a cystic mass with a smooth surface in the anterior wall of the rectum with no tenderness or unclear boundaries. No blood staining was observed in the finger sheaths. DIAGNOSES Computed tomography scan revealed that the right kidney was absent, with a mass similar to a cord above the right seminal vesicle cyst. Contrast-enhanced pelvic magnetic resonance imaging (MRI) confirmed a short T1 and T2 signal shadow similar to a cord above the right seminal vesicle cyst. The boundary was clear, with the upper part leading to the "renal region" and the lower part connecting to the right seminal vesicle cyst. Contrast-enhanced MRI showed local parenchymal cysts with cyst wall enhancement but no intrathecal enhancement. This suggested a hemorrhagic cyst. A diagnosis of Zinner syndrome was established. INTERVENTIONS The patient was diagnosed with a giant seminal vesicle cyst with hemorrhage in ZS. The patient had no obvious symptoms; therefore, regular follow-ups were performed. OUTCOMES MRI of the patient 1 month later showed that the hematoma in the seminal vesicle cyst was not absorbed. LESSONS Giant seminal vesicle cysts with hemorrhage in ZS are rare. To patients without symptom, regular follow-up can be adopted.
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Affiliation(s)
- Qingfei Xing
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, PR China
| | - Li He
- Department of Health, Shandong Province Hospital, Jinan, Shandong Province, PR China
| | - Xinghua Gao
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, PR China
| | - Chunling Zhang
- Department of Medical Imaging, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, PR China
| | - Xudong Luo
- Department of Medical Imaging, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, PR China
| | - Xiangqin Gao
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, PR China
| | - Yanlin Wu
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, PR China
| | - Longyang Zhang
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, PR China
- * Correspondence: Longyang Zhang and Feng Guo, Department of Urology, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Jinan, Shandong 250013, PR China (e-mail: , )
| | - Feng Guo
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, PR China
- * Correspondence: Longyang Zhang and Feng Guo, Department of Urology, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Jinan, Shandong 250013, PR China (e-mail: , )
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Kamalov AA, Karpov VK, Pshihachev AM, Andreytsev IL, Takhirzade TB, Ekhoyan MM, Gevorkyan ZA. [Surgical treatment of Zinner syndrome]. Urologiia 2022:60-62. [PMID: 36098592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Zinners syndrome (SC) is a rare congenital disease characterized by ejaculatory duct obstruction, seminal vesicle cyst in combination with ipsilateral renal agenesis. This syndrome is due to development arrest of the Wolffian duct (mesonephros). Before the onset of sexual activity, the disease is asymptomatic. The main symptoms are nonspecific, including dysuria, urinary frequency, perineal and scrotal pain after ejaculation. A clinical case with the presentation of our own experience of surgical robot-assisted treatment of a patient with Zinners syndrome is presented in the article.
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Affiliation(s)
- A A Kamalov
- Department of Urology and Andrology, Faculty of Fundamental Medicine of Moscow State University by Lomonosov, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- GBUZ GKB 31 of Moscow Healthcare Department, Moscow, Russia
| | - V K Karpov
- Department of Urology and Andrology, Faculty of Fundamental Medicine of Moscow State University by Lomonosov, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- GBUZ GKB 31 of Moscow Healthcare Department, Moscow, Russia
| | - A M Pshihachev
- Department of Urology and Andrology, Faculty of Fundamental Medicine of Moscow State University by Lomonosov, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- GBUZ GKB 31 of Moscow Healthcare Department, Moscow, Russia
| | - I L Andreytsev
- Department of Urology and Andrology, Faculty of Fundamental Medicine of Moscow State University by Lomonosov, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- GBUZ GKB 31 of Moscow Healthcare Department, Moscow, Russia
| | - T B Takhirzade
- Department of Urology and Andrology, Faculty of Fundamental Medicine of Moscow State University by Lomonosov, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- GBUZ GKB 31 of Moscow Healthcare Department, Moscow, Russia
| | - M M Ekhoyan
- Department of Urology and Andrology, Faculty of Fundamental Medicine of Moscow State University by Lomonosov, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- GBUZ GKB 31 of Moscow Healthcare Department, Moscow, Russia
| | - Z A Gevorkyan
- Department of Urology and Andrology, Faculty of Fundamental Medicine of Moscow State University by Lomonosov, Moscow, Russia
- Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
- GBUZ GKB 31 of Moscow Healthcare Department, Moscow, Russia
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Affiliation(s)
- Aman Najar Seyf
- Department of Dermatology and Venereology, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
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Xiao ZX, Xu D, He SH. [Modified Brisson surgery combined with skin flap clipping for the treatment of severe concealed penis in children]. Zhonghua Nan Ke Xue 2020; 26:820-825. [PMID: 33377707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the effect of modified Brisson surgery combined with the skin flap clipping technique in the treatment of severe concealed penis in children. METHODS We retrospectively analyzed the clinical data on 165 children with severely concealed penis treated in our hospital from January 2014 to January 2019, 105 by modified Brisson surgery combined with the skin flap clipping technique and the other 60 by modified Devine surgery, all the operations performed by the same surgeon. We compared the two surgical strategies concerning operation time, intraoperative blood loss, postoperative increase of penile exposure, preputial edema duration, flap necrosis and penile retraction, and satisfaction of the patients' parents with the overall surgical effect. RESULTS No injury of the dorsal nerve or urethra, nor postoperative refractory prepuce edema or painful erection was found in any of the cases. The patients treated by modified Brisson surgery, in comparison with those treated by modified Devine surgery, showed significantly less intraoperative blood loss ([8.4 ± 1.60] vs [12.6 ± 2.10] ml, P < 0.05), more postoperative increase of penile exposure ([2.7 ± 0.29] vs [2.3 ± 0.22] cm, P < 0.05), fewer cases of flap necrosis (1 vs 4, P < 0.05) and higher rate of satisfaction with the overall surgical effect (94.9% vs 84.5%, P < 0.05), but there were no statistically significant differences between the former and the latter groups in the operation time ([48.3 ± 4.1] vs [48.1 ± 5.0] min, P > 0.05) or the postoperative duration of prepuce edema ([3.3 ± 0.93] vs [3.2 ± 0.90] d, P > 0.05) or number of cases of penile retraction at 6 months (1 vs 1, P > 0.05). CONCLUSIONS Modified Brisson surgery combined with the skin flap clipping technique can achieve satisfactory results in the treatment of severe concealed penis in children and therefore deserves to be popularized in clinical application.
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Affiliation(s)
- Zhi-Xiang Xiao
- Department of Pediatric Surgery, Fujian Provincial Hospital / Provincial School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Di Xu
- Department of Pediatric Surgery, Fujian Provincial Hospital / Provincial School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Shao-Hua He
- Department of Pediatric Surgery, Fujian Provincial Hospital / Provincial School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian 350001, China
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Liang BB, Hu XZ, Lü KL, Zhang TB, Zheng T, Li HL, Zhang WX, Wang R. [Factors influencing recovery from childhood inguinal herniorrhaphy-induced vas deferens obstruction after microscopic vasovasostomy]. Zhonghua Nan Ke Xue 2020; 26:717-721. [PMID: 33377733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the factors influencing the recovery from childhood inguinal herniorrhaphy (IH)-induced vas deferens obstruction following microscopic vasovasostomy. METHODS We retrospectively analyzed the clinical data on 41 cases of microscopic vasovasostomy for obstructive azoospermia in our hospital from July 2015 to September 2018. All the patients had a history of inguinal hernia treated by IH in the childhood. We performed scrotal ultrasonography, semen analysis and seminal plasma biochemistry to confirm vas deferens obstruction preoperatively. If sperm was observed for ≥2 times in semen examination after vasovasostomy, we considered the vas deferens successfully unobstructed. RESULTS Microscopic vasovasostomy was successfully completed in 39 of the cases, of which2 were lost to follow-up, with a follow-up rate of 94.8% (37/39). The patients, at the mean age of (25.54 ± 2.85) years and with body mass index (BMI) of (24.92 ± 2.79) kg/m2 and post-IH time of (18.97 ± 2.58) years, were followed up for (13.05 ± 3.74) months. Successful recovery from vas deferens obstruction was observed in 78.4% (29/37) of the patients after IH, 80.0% (16/20) in the < 26-year-olds, 76.5% (13/17) in the ≥26-year-olds (P = 0.795), 75.0% (12/16) in those with BMI < 24.92 kg/m2 , 81.0% (17/21) in those with BMI ≥24.92 kg/m2 (P = 0.807), 78.6% (11/14) in those with post-IH time of < 19 years, 18.3% (18/23) in those with post-IH time of ≥19 years (P = 0.982), 60.0% (12/20) in those with sperm and 82.4% (14/17) in those without sperm found intraoperatively (P = 0.428), 42.9% (3/7) in those treated by unilateral and 82.4% (26/30) in those by bilateral vasovasostomy (P = 0.027). Multivariate logistic regression analysis showed a close correlation between the operation side and postoperative recovery from vas deferens obstruction (P = 0.022). CONCLUSIONS For male patients undergoing microscopic vasovasostomy for childhood IH-induced vas deferens obstruction, the operation side is an independent factor influencing postoperative recovery, while age, BMI, post-IH time, and intraoperative presence or absence of sperm are not significantly correlated with it.
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Affiliation(s)
- Bing-Bing Liang
- Research Institute of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Xiao-Zhe Hu
- Research Institute of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Kun-Long Lü
- Research Institute of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Tian-Biao Zhang
- Research Institute of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Tao Zheng
- Research Institute of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Hai-Lu Li
- Research Institute of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Wei-Xing Zhang
- Research Institute of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Rui Wang
- Research Institute of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
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12
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Malik MIK, Abbas J, Shuttleworth P, Qureshi N. Perforated necrotic appendix in Amyand's hernia treated with appendicectomy and simple suture repair of the inguinal hernia. BMJ Case Rep 2019; 12:e231765. [PMID: 31694829 PMCID: PMC6855868 DOI: 10.1136/bcr-2019-231765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2019] [Indexed: 11/04/2022] Open
Abstract
A 50-year-old man was referred to the emergency department by his general practitioner with a tender right-sided irreducible inguinal hernia (previously reducible), right-sided testicular pain and scrotal swelling. Clinical examination revealed a non-reducible, tender right inguinal-scrotal hernia and swollen right scrotum. Blood tests showed raised inflammatory markers. The patient went on to have a CT scan which was reported to show an indirect right inguinal-scrotal hernia possibly containing terminal ileum and small bowel mesentery. The scan also showed increased infiltrate changes within the hernia sac suggesting incarceration with possible early strangulation but no obvious evidence of bowel obstruction. The patient was taken to the operating theatre and found to have a large right inguinal-scrotal hernia containing pus and a perforated necrotic appendix. He went to have an appendicectomy and sutured repair of the hernia. Postoperatively, the patient made a good recovery and was discharged 2 days postsurgery.
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Affiliation(s)
| | - Joshua Abbas
- General Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Paul Shuttleworth
- General Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Nafees Qureshi
- General Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
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Ergin G, Kopru B, Ebiloglu T, Kirac M, Kibar Y, Fuat Cicek A, Biri H. Unusual intrascrotal lesions in adults in urological practice. ARCH ESP UROL 2019; 72:955-964. [PMID: 31697257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Unusual intrascrotal lesions in adults generally have been described as case reports in the medical literature. We present two lesions observed in two clinics over more than 28 years, with their radiological, pathological and clinical characteristics. METHODS Retrospective study preformed between 1989 and 2017 in 446 patients undergoing inguinal orchiectomy. Clinical data were obtained reviewing patient` s tables. All patients were evaluated with physical examination, medical history, serum tumor markers (alpha fetoprotein, beta human chorionic gonadotropin, LDH), and scrotal ultrasound in the perioperative period. RESULTS In 396 cases (88,78%) the diagnosis was germ cell or non-germ cell tumor and the remainder 50 patients (11.2%) presented 15 different intrascrotal lesions. These lesions were rhabdomyosarcoma (1 patient), intrascrotal cavernous hemangioma (1 patient), dermoid cyst (2 cases), epidermoid cyst (4 patients), paratesticular mesothelioma (1 case), parietal testicular tunica vaginalis cyst (2 patients), spermatic granuloma (3 cases). The number of patients with tuberculosis orchitis was 6 and granulomatous orchitis 8. There were 8 patients with fibrous pseudotumor. 1 patient presented testicular plasmocytoma. Metastatic involvement secondary to lymphoma and leukemia appeared in 4 cases. Brucella epididymitis-orchitis 7 cases. 2 cases of adult pure yolk sac testicular tumors. Additional evaluations and treatments were performed depending on histologic diagnosis. CONCLUSIONS The exact diagnosis of these lesions is difficult due to their rarity and they must always be considered for differential diagnosis.
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Affiliation(s)
- Giray Ergin
- Departamento de Urología. Hospital de la Universidad de Yüksek Ihtisas Koru Ankara. Ankara. Turquía
| | - Burak Kopru
- Departamento de Urología. Hospital de la Universidad de Yüksek Ihtisas Koru Ankara. Ankara. Turquía
| | - Turgay Ebiloglu
- Departamento de Urología. Hospital de formación e investigación de Gulhane. Ankara. Turquía
| | - Mustafa Kirac
- Departamento de Urología. Hospital de la Universidad de Yüksek Ihtisas Koru Ankara. Ankara. Turquía
| | - Yusuf Kibar
- Departamento de Urología. Hospital de la Universidad de Yüksek Ihtisas Koru Ankara. Ankara. Turquía
| | - Ali Fuat Cicek
- Departamento de Patología. Hospital de formación e investigación de Gulhane. Ankara. Turquía
| | - Hasan Biri
- Departamento de Urología. Hospital de la Universidad de Yüksek Ihtisas Koru Ankara. Ankara. Turquía
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Qian YT, Liu JW, Liu W, Ma DL. An Asymptomatic Verrucous Nodule on the Scrotum: A Quiz. Acta Derm Venereol 2019; 99:466-467. [PMID: 30673112 DOI: 10.2340/00015555-3127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yue-Tong Qian
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730 Beijing, China
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Perry TL, Kranker LM, Mobley EE, Curry EE, Johnson RM. Outcomes in Fournier's Gangrene Using Skin and Soft Tissue Sparing Flap Preservation Surgery for Wound Closure: An Alternative Approach to Wide Radical Debridement. Wounds 2018; 30:290-299. [PMID: 30299266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Fournier's gangrene (FG) remains a forbidding necrotizing soft tissue infection (NSTI) that necessitates early recognition, prompt surgical excision, and goal-directed antibiotic therapy. Traditionally, surgical management has included wide radical excision for sepsis control, but this management often leaves large, morbid wounds that require complex wound coverage, prolonged hospitalizations, and/or delayed healing. OBJECTIVE The purpose of this case series is to report the outcomes of FG using a surrogate approach of concurrent debridement of spared skin and soft tissue, negative pressure wound therapy (NPWT), and serial delayed primary closure (DPC). MATERIALS AND METHODS A retrospective review of 17 consecutive patients with FG treated with concurrent skin and soft tissue sparing surgery, NPWT, and serial DPC at Miami Valley Hospital Regional Adult Burn and Wound Center (Dayton, OH) between 2008 and 2018 was conducted. Patients were included if the following were noted: clinical suspicion of FG based on genital and perineal cellulitis, fever, leukocytosis, and confirmation of tissue necrosis upon surgical exploration. Patients not treated with skin sparing surgical debridement or wounds with an inability to maintain a NPWT dressing seal were excluded. RESULTS The mean number of total surgeries including simultaneous debridement and reconstruction was 5.5. The average intensive care unit and hospital length of stay was 3.2 and 18.9 days, respectively. The average number of days from initial consult to wound closure was 24.3. The need for colostomy and skin grafts were nearly eliminated with this surrogate approach. Using this reproducible technique, DPC was achieved in 100% of patients. Only 11.8% (2/17) required split-thickness skin grafting as part of wound closure. The majority (9/17; 52.9%) were partially managed as an outpatient during wound closure. During staged DPC, the mean number of outpatient management days was 16.0. There were no mortalities in this series of patients. CONCLUSIONS To the best of the authors' knowledge, this is the largest case series reported in the literature using skin and soft tissue sparing surgery for wound closure of a FG NSTI.
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Affiliation(s)
- Travis L Perry
- Miami Valley Hospital Regional Adult Burn and Wound Center, Dayton, OH; Wright State University, Boonshoft School of Medicine, Department of Surgery, Dayton, OH
| | - Lindsay M Kranker
- Wright State University, Boonshoft School of Medicine, Department of Surgery, Dayton, OH
| | - Erin E Mobley
- Miami Valley Hospital Regional Adult Burn and Wound Center, Dayton, OH
| | - Eileen E Curry
- Wright State University, Boonshoft School of Medicine, Division of Plastic Surgery, Dayton, OH
| | - R Michael Johnson
- Wright State University, Boonshoft School of Medicine, Division of Plastic Surgery, Dayton, OH
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16
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Solovev AE, Shatskii VA, Kulchitskii OA. [Congenital seminal vesicle cysts in children]. Urologiia 2018:126-128. [PMID: 30035432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The article reports two cases of seminal vesicle cysts with ipsilateral renal agenesis in children. The congenital nature of this condition, characteristic features of the clinical manifestation of seminal vesicle cysts makes it difficult to recognize this rare genitourinary disease. Using current methods of diagnosis and surgical treatment result in successful outcomes.
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Affiliation(s)
- A E Solovev
- Ryazan State I.P. Pavlov Medical University of Minzdrav of Russia, Ryazan, Russia
| | - V A Shatskii
- Ryazan State I.P. Pavlov Medical University of Minzdrav of Russia, Ryazan, Russia
| | - O A Kulchitskii
- Ryazan State I.P. Pavlov Medical University of Minzdrav of Russia, Ryazan, Russia
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17
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Spencer K, Mokhele I, Firnhaber C. Congenital genital abnormalities detected during routine circumcision at a South African institution: a retrospective record review. Afr Health Sci 2018; 18:352-358. [PMID: 30602962 PMCID: PMC6306973 DOI: 10.4314/ahs.v18i2.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Due to the reduction in HIV transmission through male medical circumcisions (MMC), numerous clinics throughout South Africa offer a voluntary free service to boys from the age of ten years and above. An examination prior to the procedure may detect congenital abnormalities missed after birth. OBJECTIVES The aim of this study was to measure the incidence of these abnormalities, determine the demographic and clinical characteristics of this group and determine what referral systems, interventions, and follow-up is available to them. METHODS The study was a descriptive, observational, retrospective analysis of de-identified medical records at a routine MMC service at a Johannesburg clinic in 2015. The participants were male patients between the ages of 10 - 49. RESULTS Out of 1548 participants, 91.0% (n=1409) had a normal genital examination while 3.7% (n=57) had an abnormal examination and 5.1% (n=79) had no examination recorded. Thirty five congenital anomalies were detected and only 2 patients (diagnosed with hypospadias) were seen at the urology out-patient's department. CONCLUSION The incidence of congenital genital abnormalities of males presenting for routine circumcision is low. Despite the low incidence the effect on fertility, sexuality, ability to urinate and on psychological wellbeing is significant. Referral services to the urology department should be restructured to improve all outcomes.
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18
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Nisar MU, Akhtar N, Gondal MF, Sikander S, Viqar S. Aphallia: A Very Rare Congenital Anomaly, With Associated Genitourinary And Ano-Rectal Malformation. J Ayub Med Coll Abbottabad 2018; 30:275-277. [PMID: 29938433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Aphallia or penile agenesis is very rare congenital anomaly of unknown cause occurring 1 in 30 million live births. Very little has been written in literature about aphallia. There is absent phallus and urethra may open abnormally in perineum or into rectum posing various surgical, social and psychological implications as the child grows. We are presenting 03 cases of aphallia with associated congenital anomalies such as unilateral renal agenesis, bilateral undescended testes, anorectal malformation and rectovasical fistula.
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Affiliation(s)
- Muhammad Umar Nisar
- Department of Paediatric Surgery, Children Hospital, PIMS, Islamabad, Pakistan
| | - Nadeem Akhtar
- Department of Paediatric Surgery, Children Hospital, PIMS, Islamabad, Pakistan
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19
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Fernández Bautista B, Parente Hernández A, Ortiz Rodríguez R, Burgos Lucena L, Angulo Madero JM. Endoscopic treatment of urethrodeferential reflux in children. Actas Urol Esp 2018; 42:133-136. [PMID: 28843475 DOI: 10.1016/j.acuro.2017.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Urethrodeferential reflux is an underdiagnosed condition, and there is no consensus on its treatment. Our objective is to show our experience in the minimally invasive treatment of this disease using endoscopy. MATERIAL AND METHODS We present 8 patients with recurrent suppurative orchitis due to urethrodeferential reflux treated endoscopically during the period 2008-2013. All patients presented unilateral orchitis. The minimum number of episodes of orchitis per patient prior to the operation was 3. The endoscopic treatment consists of ureteroscopy, locating the ejaculatory orifices and conducting an intraoperative contrast study to demonstrate the urethrodeferential reflux. Subejaculatory dextranomer/hyaluronic acid was subsequently injected in all the cases. RESULTS The mean surgical time was 15min, and the procedure was outpatient for all patients. There were no postoperative complications, and the patients had good clinical progression. Only one case required a second injection of dextranomer/hyaluronic acid. The follow-up of these patients showed a complete resolution of the epididymitis and good testicular development, with a follow-up longer than 4 years in all cases. CONCLUSION We propose this form of treatment as a minimally invasive, easily reproducible alternative that shows good long-term results in our small series of patients.
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Affiliation(s)
- B Fernández Bautista
- Departamento de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - A Parente Hernández
- Departamento de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Ortiz Rodríguez
- Departamento de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Burgos Lucena
- Departamento de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J M Angulo Madero
- Departamento de Urología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España
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20
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Lin JZ, Shi GD, Wu HF, Yu HB, Zhou HT, Hu X, Wang H. [Diagnosis and treatment of ejaculatory duct cyst: A report of 2 cases and review of the literature]. Zhonghua Nan Ke Xue 2018; 24:236-240. [PMID: 30161310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the diagnosis and treatment of ejaculatory duct cyst. METHODS This study included 2 male patients present at the hospital for hemospermia and abnormal sensation in the perineal region in July and August 2014. Both underwent transrectal ultrasonography, routine semen examination, CT, MRI, cystoscopy, and vesiculography before transurethral fenestration of the cysts and pathological examination of the cyst wall specimens. Analyses were made on the clinical presentations, imaging features, pathological characteristics, differential diagnosis and treatment of ejaculatory duct cyst and relevant literature was reviewed. RESULTS The cyst wall was mainly composed of smooth muscle, the inner wall lined with pseudostratified ciliated columnar epithelia, and with positive expressions of CD10 and Muc6 proteins on immunohistochemical staining, which indicated renal iatrogenic ejaculatory duct cyst. The patients were followed up for 18 and 20 months, respectively. All symptoms disappeared and no recurrence occurred after surgery. Routine semen examination for the two patients showed the semen volumes to be 3.5 and 3.1 ml, sperm concentrations 35 and 32 ×10⁶/ml, grade a sperm 32.0 and 26.0%, grade b sperm 18.0 and 31.0%, and semen liquidation time 30 and 34 minutes, respectively. CONCLUSIONS Pelvic cystic masses can be detected by transrectal ultrasonography, CT and MRI, but definite diagnosis relies on vesiculography, pathological examination and immunohistochemical staining. Transurethral fenestration is safe and effective for the treatment of ejaculation duct cyst.
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Affiliation(s)
- Jian-Zhong Lin
- Department of Urology, Nanjing BenQ Hospital, Nanjing Medical University, Nanjing, Jiangsu 210019, China
| | - Guang-Dong Shi
- Department of Surgery, Gaogang Hospital of Traditional Chinese Medicine, Taizhou, Jiangsu 225300, China
| | - Hong-Fei Wu
- Department of Urology, Nanjing BenQ Hospital, Nanjing Medical University, Nanjing, Jiangsu 210019, China
| | - Hong-Bo Yu
- Department of Urology, Nanjing BenQ Hospital, Nanjing Medical University, Nanjing, Jiangsu 210019, China
| | - He-Tong Zhou
- Department of Urology, Nanjing BenQ Hospital, Nanjing Medical University, Nanjing, Jiangsu 210019, China
| | - Xin Hu
- Department of Urology, Nanjing BenQ Hospital, Nanjing Medical University, Nanjing, Jiangsu 210019, China
| | - Hao Wang
- Department of Urology, Nanjing BenQ Hospital, Nanjing Medical University, Nanjing, Jiangsu 210019, China
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Perez TY, O'Hara BJ, Hirsch IH. Benign fibrous pseudotumor resulting in orchiectomy despite intraoperative frozen section. Can J Urol 2017; 24:9132-9136. [PMID: 29260641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Fibrous pseudotumors are rare benign lesions that originate within the paratesticular tissues. Local excision is the preferred method of treatment of these tumors over radical orchiectomy, however a definitive diagnosis must be made beforehand given the similarity of these tumors to malignant entities. We present a case of fibrous pseudotumor of the tunica vaginalis and cauda epididymis. A diagnosis of fibrous pseudotumor could not be established despite the use of intraoperative frozen section, therefore necessitating radical orchiectomy.
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Affiliation(s)
- Tomy Y Perez
- Department of Urology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
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22
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Tardáguila Calvo AR, Angulo Madero JM, Parente A, Romero RM, Rivas S. Genital reconstruction with Integra™ artificial dermis after radical resection in a boy with diffuse lymphangiomatosis. ARCH ESP UROL 2017; 70:847-851. [PMID: 29205164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Lymphangiomatosis is a rare disease affecting lymphatic vessels that causes a marked increase of them in the affected area. The final objective of treatment of the genital disease is to preserve sexual function and voiding with a satisfactory aesthetic result with the aim to minimize the emotional impact. METHODS For the first time in children, we report a case of local reconstruction using artificial dermis after the excision of a genital lymphatic malformation in an eight year old patient. RESULTS We performed surgical excision of the lymphatic malformation genital component and reconstruction of the scrotal and penile area in two steps, using an autologous graft over artificial dermis. No complications were registered. Both aesthetic and functional results were excellent, and spontaneous erections that were not present before, were also evidenced. No local recurrence was seen at two year follow up. CONCLUSION The use of artificial dermis for genital surface reconstruction enables radical excision of tissues involved by diffuse lymphangiomatosis in this location. Surgical technique is simple, postoperative care is easy, being ambulatory care feasible. Final result is an elastic, fine skin, very satisfactory aesthetically, and functionally normal, which even keeps local sensitivity. In the long term, this will benefit the sexual field, so damaged in this patients.
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Affiliation(s)
| | | | | | | | - Susana Rivas
- Hospital Universitario Gregorio Marañón. Madrid. España
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23
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Kikuchi I, Kimura T, Azuma S, Shimbo T, Wakabayashi T, Ota S, Sato T, Itoh S, Ishida T, Sageshima M. [A Case of Transverse Colon Cancer Metastasized to the Spermatic Cord after Resection of Peritoneal Dissemination]. Gan To Kagaku Ryoho 2017; 44:1290-1292. [PMID: 29394610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report a rare case of spermatic cord metastasis from colon cancer. A man in his 50s underwent extended right hemicolectomy for transverse colon cancer followed by resection of a peritoneal recurrence. After receiving adjuvant chemotherapy for 6 months, he became aware of a right inguinal mass. A spermatic cord tumor was noted on computed tomography(CT) and FDG/PET-CT. He underwent radical orchiectomy. The resected tumor was histologically compatible with the colon cancer. Although he received additional chemotherapy, right inguinal recurrence was resected 6 months after orchiectomy. Colon cancer is the second most common origin, after gastric cancer, of metastatic spermatic tumor. As several metastatic routes have been reported, peritoneal seeding is mostly suspected in this case.
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Wang Q, Liao LG, Li YF. [Seminal vesiculoscopy: Past, status quo, and prospects]. Zhonghua Nan Ke Xue 2017; 23:1038-1042. [PMID: 29738172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Seminal vesiculoscopy is a new technology in uro-andrology developed in recent 10 years, which is a set of clinical operational techniques for observing the ejaculatory duct, seminal vesicle, ampullar region of the vas deferens and their surrounding structure, determining the cause, location and degree of the disease, and accomplishing such treatment procedures as irrigation, resection, incision, fulguration, hemostasis, expansion, drainage, and removal of hematocele, stones or obstruction in the distal seminal duct region. Therefore, it is not only an etiologically diagnostic technique, but also a minimally invasive surgical approach to the management of common diseases of the distal seminal duct region. Seminal vesiculoscopy has irreplaceable advantages of safety, effectiveness, minimal invasiveness, rapid recovery, and few complications.
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Affiliation(s)
- Qi Wang
- Department of Urology, The Fifth People's Hospital of Chongqing, Chongqing 400021, China
| | - Liang-Gong Liao
- Department of Urology, Daping Hospital, Research Institute of Field Surgery, The Third Military Medical University, Chongqing 400042, China
| | - Yan-Feng Li
- Department of Urology, Daping Hospital, Research Institute of Field Surgery, The Third Military Medical University, Chongqing 400042, China
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Li Z, Li XP, Chen HX. [Diagnosis and treatment of ejaculatory duct obstruction: Current status and advances]. Zhonghua Nan Ke Xue 2017; 23:483-487. [PMID: 29722938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ejaculatory duct obstruction (EDO) is one of the obstructive factors for 1-5% of all cases of male infertility and it is, however, surgically correctable. Congenital developmental abnormality is a most common cause of EDO. The clinical manifestations of EDO are varied, typically with the decline of four semen parameters. Transrectal ultrasonography is an important imaging method for the diagnosis of EDO and guidance in its surgery. MRI provides high-resolution images of the reproductive system as evidence. Transurethral resection of the ejaculatory duct (TURED) is a classical operation, the application of transurethral seminal vesiculoscopy has become a new trend of minimally invasive surgery in the treatment of EDO, and the latest flexible vesiculovasoscopy (FVV) or vasoscopy techniques may further improve the diagnosis and treatment of EDO.
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Affiliation(s)
- Zheng Li
- Department of Andrology and Pelvic Floor Surgery, Urologic Medical Center, Center for Men's Health, Research Institute of Urology, Shanghai Key Lab of Reproductive Medicine, Shanghai Jiaotong University, Shanghai 200080, China
| | - Xiang-Ping Li
- Department of Andrology and Pelvic Floor Surgery, Urologic Medical Center, Center for Men's Health, Research Institute of Urology, Shanghai Key Lab of Reproductive Medicine, Shanghai Jiaotong University, Shanghai 200080, China
| | - Hui-Xing Chen
- Department of Andrology and Pelvic Floor Surgery, Urologic Medical Center, Center for Men's Health, Research Institute of Urology, Shanghai Key Lab of Reproductive Medicine, Shanghai Jiaotong University, Shanghai 200080, China
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Wang FR, Zhong HJ, Chen Y, Zhao JF, Li Y. [Ladder step strategy for surgical repair of congenital concealed penis in children]. Zhonghua Nan Ke Xue 2016; 22:984-990. [PMID: 29281205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the feasibility of the ladder step strategy in surgical repair of congenital concealed penis in children. METHODS This study included 52 children with congenital concealed penis treated in the past two years by surgical repair using the ladder step strategy, which consists of five main steps: cutting the narrow ring of the foreskin, degloving the penile skin, fixing the penile skin at the base, covering the penile shaft, and reshaping the prepuce. The perioperative data of the patients were prospectively collected and statistically described. RESULTS Of the 52 patients, 20 needed remodeling of the frenulum and 27 received longitudinal incision in the penoscrotal junction to expose and deglove the penile shaft. The advanced scrotal flap technique was applied in 8 children to cover the penile shaft without tension, the pedicled foreskin flap technique employed in 11 to repair the penile skin defect, and excision of the webbed skin of the ventral penis performed in another 44 to remodel the penoscrotal angle. The operation time, blood loss, and postoperative hospital stay were 40-100 minutes, 5-30 ml, and 3-6 days, respectively. Wound bleeding and infection occurred in 1 and 5 cases, respectively. Follow-up examinations at 3 and 6 months after surgery showed that all the children had a satisfactory penile appearance except for some minor complications (2 cases of penile retraction, 2 cases of redundant ventral skin, and 1 case of iatrogenic penile curvature). CONCLUSIONS The ladder step strategy for surgical repair of congenital concealed penis in children is a simple procedure with minor injury and satisfactory appearance of the penis.
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Affiliation(s)
- Fu-Ran Wang
- Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315031, China
| | - Hong-Ji Zhong
- Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315031, China
| | - Yi Chen
- Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315031, China
| | - Jun-Feng Zhao
- Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315031, China
| | - Yan Li
- Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315031, China
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Diao K, Ghosh A. Perforated Transverse Colon Cancer Presenting as an Incarcerated Inguinal Hernia. Am Surg 2016; 82:320-322. [PMID: 28206924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Kevin Diao
- Harvard Medical School, Cambridge Integrated Clerkship, Cambridge Health Alliance, Cambridge, Massachusetts, USA
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Abstract
Background and Aims: The aim of the study was to compare incidence, symptoms and signs of spermatic cord torsion to those of other conditions causing acute scrotum. Material and Methods: Records of 388 consecutive boys under 17 years of age treated for acute scrotum at The Hospital for Children and Adolescents in Helsinki in 1977–1995 were reviewed. During the period studied all patients with acute scrotum underwent urgent surgery to ensure accurate diagnosis and treatment. The duration and characteristics of the symptoms, clinical findings prior to operation and the age of the patients were registered. Results: Scrotal explorations revealed 100 cases (26%) of spermatic cord torsion (SCT), 174 cases (45%) of torsion of the testicular appendage (AT), 38 cases (10%) of epididymitis (ED), 32 cases (8%) of incarcerated inquinal hernias and 44 (11%) other conditions. During the first year of life SCT was the most common cause of acute scrotum, another peak incidence being in adolescence. Almost half of the boys with AT were nine to 12 years of age (median 11). Except for infants, the patients' acute symptoms were pain (SCT 88%, AT 94%, ED 76%). Swelling in the hemiscrotum was found in 44% of SCT, in 39% of AT and in 88% of ED cases. Epididymitis was also accompanied by erythema (37%), but infrequently with fever (in 16%). Erythema was found also in AT (32%), but the “blue dot sign” was found positive in only 17 (10%) of the boys with AT. Three quarters of the boys who were operated on within six hours from onset of symptoms had testicle torsion. All testicles were saved when detorsion was performed within six hours, but salvage was possible in only half of the cases when symptoms had lasted more than six but less than 12 hours. Conclusions: The high probability of SCT among those admitted to an emergency department within six hours from the onset of the symptoms justifies immediate surgical exploration.
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Affiliation(s)
- E Mäkelä
- Department of Paediatric Surgery, Paediatric Research Centre, Tampere University Hospital, Tampere, Finland.
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Mukudu H, Otwombe K, Laher F, Lazarus E, Manentsa M, Lebina L, Mapulanga V, Bowa K, Martinson N. A Cross Sectional Study of the Prevalence of Preputial and Penile Scrotal Abnormalities among Clients Undergoing Voluntary Medical Male Circumcision in Soweto, South Africa. PLoS One 2016; 11:e0156265. [PMID: 27253372 PMCID: PMC4890756 DOI: 10.1371/journal.pone.0156265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/11/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Medical device use is currently approved for males without preputial or major penile scrotal abnormalities for voluntary medical male circumcision (VMMC). We determined the prevalence of preputial abnormalities at a busy VMMC centre in Soweto, South Africa. METHODS This was a cross-sectional record review at a high-volume VMMC centre in South Africa. We collated pre-circumcision demographic and genital examination findings from clients 8 years and older who had undergone VMMC from 01 May 2013 to 30 April 2014. Logistic regression was used to determine factors associated with preputial abnormalities. FINDINGS During the review period, 6861 circumcisions were conducted and 37.1% (n = 2543) were 8-13 year olds. Median age was 15 years (IQR: 12-23 years). Fifteen percent (n = 1030) had preputial abnormalities or major penile scrotal abnormalities. Age-specific prevalence of preputial or major genital abnormalities were 27.3%, 10.6% and 6.0% in 8-13, 14-18 and > 18 year olds respectively. The odds of preputial or major penile scrotal abnormality were higher in younger clients aged 8-13 years (OR = 5.9; 95% CI = 4.8-7.1) and 14-18 years (OR = 1.9; 95% CI = 1.5-2.4) compared to older clients above18 years and in those testing for HIV outside our clinic network (OR = 1.9; 95% CI = 1.4-2.7). CONCLUSION The high prevalence of preputial and penile scrotal abnormalities observed suggests a need for VMMC sites to provide for both open surgical and devices methods in the provision of VMMC services. This is especially so among young male subjects presenting themselves for VMMC services at the various sites being developed in sub Saharan African countries.
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Affiliation(s)
- Hillary Mukudu
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fatima Laher
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Erica Lazarus
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mmatsie Manentsa
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Kasonde Bowa
- School of Medicine, Copperbelt University, Ndola, Zambia
| | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Lu Q, Jiang Z, Zhao Z, Wu L, Wu G, Suo S, Xu J. Assessment of The Lymphatic System of the Genitalia Using Magnetic Resonance Lymphography Before and After Treatment of Male Genital Lymphedema. Medicine (Baltimore) 2016; 95:e3755. [PMID: 27227943 PMCID: PMC4902367 DOI: 10.1097/md.0000000000003755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Treatment for chronic male genital lymphedema (GL) is limited. No standard treatment or validated instrument to assess GL is available. The aim of this study was to explore whether magnetic resonance lymphography (MRL) could be used to assess GL, select proper treatment for patients, and monitor postoperative progress.This is a retrospective analysis of a prospectively acquired cohort of men with GL presenting for MRL over a 7-year period. Thirty-six of 47 eligible men were included. All men were offered preoperative and postoperative MRL and assigned a morphology and function classification. Men with mild, moderate, and severe nodal dysfunction underwent complex decongestive physiotherapy (CDP), lymphoveneous microsurgery, and surgical excision, respectively. The volume reductions in the genitalia of patients with mild and moderate nodal dysfunction were recorded and compared using Student t test.The abnormal superficial and deep lymphatic vessels in the lymphedematous genitalia were detected by MRL, and inguinal lymph node dysfunction was classified by MRL. Seven patients with mild dysfunction who underwent CDP showed a more significant mean volume reduction in the genitalia than did 9 patients with moderate dysfunction. Three patients with hyperplasia and moderate dysfunction who underwent microsurgical operations and 17 patients with hypoplasia and moderate or severe nodal dysfunction who underwent surgical excision had excellent cosmetic results with no lymphedema at the 3- to 5-year follow-up.MRL can be used to assess morphological and functional lymphatic abnormalities in GL, preoperatively select appropriate treatment, and postoperatively evaluate treatment outcomes.
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Affiliation(s)
- Qing Lu
- From the Department of Radiology (QL, ZZ, LW, GW, SS, JX), Renji Hospital, School of Medicine, Shanghai Jiao Tong University; and Department of Plastic & Reconstructive Surgery (ZJ), Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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31
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Wang R, Zhang WX, Zhang TB, Li R, Wang CL, Song XH, Yang YL, Li XY. [Transurethral seminal vesiculoscopy for the treatment of vesiculitis with hemospermia:A report of 64 cases]. Zhonghua Nan Ke Xue 2016; 22:335-338. [PMID: 30088705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore the treatment of vesiculitis with hemospermia by transurethral seminal vesiculoscopy. METHODS We treated 64 cases of vesiculitis with hemospermia by transurethral seminal vesiculoscopy. During the operation,we removed the stones and inflammatory substances and collected seminal vesicle fluid to be cultured for bacteria,ureaplasma urealyticum(UU),chlamydia trachomatis(CT),and mycoplasma hominis(MH),followed by infusion of levofloxacin at 0. 3 g/100 ml into the seminal vesicle. Regular follow-up was conducted post-operatively. RESULTS All the operations were successfully accomplished, the operation time averaging(40 ± 15) min(25- 50 min). The ejaculatory duct opening was observed on the verumontanum surface in the posterior urethra in 2 cases, abnormal passages found in the prostatic utricle in 8 cases, and seminal vesicle fenestration from the prostatic utricle conducted in the other 54 cases(32 by seminal vesiculoscopy and 22 with holmium laser). Stones were seen in the prostatic utricle in 5 cases, in the seminal vesicle in 6 cases, and in both the prostatic utricle and seminal vesicle in 2 cases. Culture of the seminal vesicle fluid showed the acinetobacter to be positive in 1 case and UU, CT, and MH to be negative. At 3 months after surgery, hemospermia was cured in 52 cases, relieved in 8,and unimproved in 4. CONCLUSION Seminal vesicle fenestration drainage by transurethral seminal vesiculoscopy for the treatment of vesiculitis with hemospermia has the advantages of short operation time, high effectiveness and no obvious complications and can also be employed for the examination of the seminal vesicle as well as removal of stones and inflammatory substances.
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Tarcă E, Crişcov IG, Savu B, Aprodu SG. THE ACUTE SCROTUM IN CHILDREN. Rev Med Chir Soc Med Nat Iasi 2016; 120:90-99. [PMID: 27125078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The acute scrotum syndrome is a medical-surgical emergency and the recognition of this condition by both healthcare professionals and the general population may result into the patients' coming in earlier for medical examination and into the preservation of the gonad in case of torsion. The purpose of this retrospective analytical research is to point out specific epidemiological aspects in pediatric patients suffering from acute scrotum, and to review the existing diagnosis and treatment options. The study included 208 patients, of whom 16 with vanishing testis and 192 with acute scrotum (torsion of testis 25.5%, torsion of the hydatid of Morgagni 68.2%, epididymoorchitis 5.2%). The torsion of the hydatid of Morgagni occurs in boys with a mean age of 10 years and it involves both testes equally, whereas the torsion of testis usually occurs around the age of 13 and is twice more common in the left gonad. Another significant difference between the two conditions is the inflammatory syndrome, which occurs in 45.4% of the children with torsion of testis versus only 18.2% in the torsion of hydatid. Only one out of six testes torted during the neonatal period could be saved (16.6%); the gonad preservation rate was as high as 68.2% in the group of patients with testis torsion occurring outside the neonatal period. These alarming data are accounted for by the non-recognition of the severity of the condition and by the delayed surgical therapy, which occurs on the average 20 hours after the testis torsion has set in. If the asepsis and antisepsis standards are observed, patients with torsion of the hydatid of Morgagni or torsion of testis require neither fluid sampling from the tunica vaginalis for culture, nor antibiotic therapy.
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Gouvea JJ, Garrone G, da Cruz ML, Martins GMC, Parizi JLG, Oliveira DE, Ortiz V, Macedo A. Penile prosthesis implantation in a patient with congenital aphallia treated using the De Castro technique 10 years previously. Is it feasible? J Pediatr Urol 2015; 11:287-8. [PMID: 26231775 DOI: 10.1016/j.jpurol.2015.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/31/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Aphallia is a rare congenital abnormality with an incidence of 1 in 30 million births. In this video, we demonstrate implantation of a penile prosthesis in a neophallus performed 10 years previously in a patient aged 21. METHODS Through a midline perineal incision aiming to reach the inferior surface of the pubic arch, we created a 16-cm tunnel for prosthesis insertion into the neophallus. We dressed the prosthesis with a polypropylene mesh to give stability to the component and avoid its extrusion. We anchored the lateral mesh to the inferior aspect of the pubic arch with 2.0 vicryl sutures in both sides. RESULTS The patient had an excellent initial outcome, without any complaints of pain or other inflammatory findings. CONCLUSION We acknowledge limited clinical experience with this technique. Further psychological evaluation will confirm if patients can have pleasant sexual experiences.
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Cestaro G, De Rosa M, Gentile M, Massa S. A case of HPV and acquired genital lymphangioma: over-lapping clinical features. Ann Ital Chir 2015; 86:S2239253X15023695. [PMID: 25818349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lymphatic malformation or lymphangioma is a benign proliferation of the lymphatics accounting for 4% of all vascular malformations and 26% of all benign vascular tumors. There are several reports about genital lymphangiomas mimicking venereal lesions, such as genital warts. Hereby we described a case of a 24 year old man affected by multiple vesicles and warts in genital area. All hematological and biochemical parameters, Human Immunodeficiency Virus (HIV) and Treponema Pallidum tests, C1-Inhibitor and C1-Q values were within limits. An accurate fulguration and wide excision of bigger lesions were performed. Histological examination showed numerous dilated lymphatic vessels in the superficial dermis with infiltration of inflammatory cells, that is a histopathological picture compatible with genital lymphangioma. Considering our clinical suspicion of condylomatosis, HPV (Human Papilloma Virus) Polimerase Chain Reaction (PCR) Genotyping, named INNOLiPA test, was performed, that revealed a genital infection by HPV - genotype 6. We think that our case can be considered an example of HPV infection and acquired genital lymphangioma overlap clinical syndrome. The patient presented any lesions one year after the procedure at follow-up examination.
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35
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Nejmark BA, Kondrat'eva JS, Zologina VS, Torbik DV. [EFFECTIVENESS OF COMBINED TREATMENT OF HPV INFECTION]. Urologiia 2015:39-42. [PMID: 26237804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study evaluates the effectiveness of immunomodulating drug isoprinosine in a comprehensive treatment of genital warts in men. Most of the patients were aged 20-30 years. The combination therapy was found to have long term effectiveness. In the group of patients undergoing only destructive methods of treatment relapse after 8 month follow-up was diagnosed in 32% and in patients of the combination therapy group (destruction plus isoprinosine) - in 7% of patients. The pharmacological action of the drug (immunostimulating, antiviral) and the effectiveness of its combination with destructive therapies justify the use of inosine pranobex (isoprinosine) both in the complex therapy of genital warts and for the prevention of the disease recurrence.
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36
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Aworanti O, Awadalla S. An unusual cause of acute scrotum in a child. Ir Med J 2014; 107:327-328. [PMID: 25551901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Acute non-traumatic scrotal pain in children, commonly due to a torted testicular appendage (hydatid of Morgagni) or torted epididymal appendage is well described. These vestigial embryonal duct remnants are of Müllerian and Wolffian duct origin respectively. Very rarely, the other infrequently encountered Wolffian duct remnants known as the paradidymis or organ of Giraldés and the superior and inferior aberrant ducts known as the organs of Haller can become torted. We describe the presentation, management and diagnosis of a torted embryonal remnant arising from the distal spermatic cord.
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Affiliation(s)
- O Aworanti
- Children's University Hospital, Temple St, Dublin.
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37
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Köhn FM. [Scrotal calcinosis]. MMW Fortschr Med 2014; 156:54. [PMID: 25417476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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38
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McAdams S, Schomburg J, Sweet RM. Zinner's syndrome. Like sitting on a tennis ball for 20 years. Minn Med 2014; 97:40-41. [PMID: 25651636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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39
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Hsia LLB, Kuppalli S, Erdag GE, Wick MR, Patterson JW, Wilson BB. What is your diagnosis? verruciform xanthoma. Cutis 2014; 94:115-141. [PMID: 25279479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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40
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Matilsky D, Lewiss RE, Whalen M, Saul T. Fournier's gangrene. Case report. Med Ultrason 2014; 16:262-263. [PMID: 25110769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Fournier's gangrene is a condition marked by fulminant polymicrobial necrotizing fasciitis of the urogenital and perineal areas. We present a patient with Fournier's gangrene and describe the physical examination and bedside sonographic findings. These findings can assist in the evaluation of patients with concerning symptoms so there can be timely administration of antibiotics and specialist consultation when necessary.
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Affiliation(s)
- Danielle Matilsky
- Department of Emergency Medicine, Emergency Ultrasound Division, Mount Sinai St. Luke's Hospital, Mount Sinai Roosevelt Hospital, New York, USA.
| | - Resa E Lewiss
- Department of Emergency Medicine, Emergency Ultrasound Division, Mount Sinai St. Luke's Hospital, Mount Sinai Roosevelt Hospital, New York, USA
| | - Michael Whalen
- Department of Urology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, USA
| | - Turandot Saul
- Department of Emergency Medicine, Emergency Ultrasound Division, Mount Sinai St. Luke's Hospital, Mount Sinai Roosevelt Hospital, New York, USA
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López-Caballero I, Sánchez-Ruvalcaba I, Sánchez-Martinez LC, Hernández-Ordoñez O, Gómez-Lara M, Flores-Carrillo V. [Idiopathic scrotal elephantiasis. A case report]. Rev Med Inst Mex Seguro Soc 2014; 52:598-599. [PMID: 25301136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Penoscrotal lymphedema (scrotal elephantiasis) is a condition that has been described in areas in which filariasis is endemic. CASE REPORT This paper presents a case of a 45-year-old man with idiopathic lymphedema isolated to the scrotum. After acquired causes of lymphedema were ruled out, the patient was treated with scrotectomy and penoscrotal reconstruction. Currently, the patient is receiving follow-up care without evidence of recurrence. CONCLUSIONS Penoscrotal lymphedema may cause symptoms of weakness, immobility and emotional disturbance. Surgery procedure provides a satisfactory cosmetical and functional outcome.
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Affiliation(s)
- Ignacio López-Caballero
- Departamento de Urología, Hospital de Especialidades, Centro Médico Nacional La Raza, Distrito Federal, México.
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42
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Ząbkowski T, Wajszczuk M. Epidermoid cyst of the scrotum: a clinical case. Urol J 2014; 11:1706-1709. [PMID: 25015622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 04/06/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Tomasz Ząbkowski
- Urology Clinic of the Military Medical Institute, Szaserow 128, 00-909 Warsaw, Poland.
| | - Marcin Wajszczuk
- Urology Clinic of the Military Medical Institute, Szaserow 128, 00-909 Warsaw, Poland
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Yaghoobi R, Jalal Lotfi S, Pazyar N, Kazerouni A. Comparison of efficacy of 5% potassium hydroxide solution versus cryotherapy in the treatment of male genital wart: a randomized clinical trial. GIORN ITAL DERMAT V 2014; 149:149-150. [PMID: 24566576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- R Yaghoobi
- Department of Dermatology, Jundishapur University of Medical Sciences, Ahvaz, Iran -
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Uehara T, Takahashi S, Ichihara K, Hiyama Y, Hashimoto J, Kurimura Y, Masumori N. Surgical site infection of scrotal and inguinal lesions after urologic surgery. J Infect Chemother 2014; 20:186-9. [PMID: 24462435 DOI: 10.1016/j.jiac.2013.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 11/19/2022]
Abstract
To clarify the incidence of surgical site infection (SSI) after urological scrotal and inguinal surgical procedures and the preventive effect of antimicrobial prophylaxis for SSI, retrospective analysis was performed. The patients who underwent scrotal and inguinal operations from 2001 to 2010 were included in this analysis. A first or second generation cephalosporin was administered as antimicrobial prophylaxis just before the start of surgery and no additional prophylaxis was conducted. The surgery was classified into 76 (38%) cases with testicular sperm extraction (TESE), 72 (36%) with radical orchiectomy, 29 (14.5%) with bilateral orchiectomy (surgical castration) and 23 (11.5%) with other scrotal and inguinal operations. The median age and age range were 36 years and 18-81 years, respectively. SSI occurred in 7 (3.5%) cases. The frequencies of SSI were 6.5% in the patients with urological inguinal surgery and 1.6% in those with scrotal surgery. The frequency of SSI in the patients with urological inguinal surgery was not negligible even though it is considered a clean operation, and further analysis is warranted to prevent SSI.
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Affiliation(s)
- Teruhisa Uehara
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Takahashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Kohji Ichihara
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshiki Hiyama
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Jiro Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuichiro Kurimura
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Celik O, Ipekci T, Kazimoglu H. Idiopathic scrotal calcinosis. Saudi Med J 2013; 34:1294-1295. [PMID: 24343471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Idiopathic scrotal calcinosis is a rare scrotal benign disease. Its distinct features are painless, non-pruritic, semi-soft palpable calcific transdermal nodules. We report a 42-year-old-man with asymptomatic multiple calcified scrotal skin nodules for 10 years. Under spinal anesthesia, the affected scrotal skin was excised and the nodules removed. We aim to explain the etiology, pathophysiology, diagnosis, and treatment modalities of this rare disease.
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Affiliation(s)
- Orcun Celik
- Urology Clinic, Kirovasi Mevkii, Kemalpasa State Hospital, Kemalpasa, Izmir 35140, Turkey. Tel. +90 (232) 2853271. Fax. +90 (232) 8787519. E-mail:
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46
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Salvarci A, Altinay S. Relapsing idiopathic scrotal calcinosis. J PAK MED ASSOC 2013; 63:1433-1434. [PMID: 24392536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Idiopathic scrotal calcinosis is a rare and benign disease of the scrotum which is described in all age groups. It was initially first defined by Lewinski in 1883. Although many mechanisms have been proposed in the pathogenesis, underlying mechanisms are still controversial at the present time. Currently, the best therapeutic approach is the surgical removal of the scrotum without disrupting its integrity. Although it is indicated in literature that its recurrence is still controversial, we have observed relapse two times in our 41 year-old male patient following surgery at the 19th and 33rd months. We have confirmed recurrence with clinical and pathological assessments. Idiopathic scrotal calcinosis may recur both clinically and pathologically in the long-term follow up. Recurrence should be confirmed with post-surgical long-term follow up in larger series.
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Affiliation(s)
| | - Serdar Altinay
- Department of Pathology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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47
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Iorio ML, Rebowe RE, Hannan C. Morbidity after surgical treatment of hidradenitis suppurativa: reconstruction of severe genital lymphedema. Am Surg 2013; 79:e303-e304. [PMID: 24069969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Matthew L Iorio
- Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA
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48
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Scheinfeld N. Update on the treatment of genital warts. Dermatol Online J 2013; 19:18559. [PMID: 24011309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 06/15/2013] [Indexed: 06/02/2023] Open
Abstract
This review summarizes new treatments from the last seven years employed for the treatment of genital warts caused by human papillomavirus (HPV). Imquimod 3.75% is a new agent with fewer side effects and perhaps a better dosing schedule than imquimod 5%, but is not more effective. Sinecatechins/Polyphenon E 15%, a novel extract from green tea can be effective against genital warts but requires three times a day dosing and is not more effective than existing treatments; the treatment course is 12-16 weeks. Photodynamic therapy combined with other destructive modalities might increase the cure rate for genital warts. The quadrivalent vaccine against HPV 6, 11, 16, 18 is decreasing the incidence of warts in the western world but the evidence does not support vaccination as a treatment for those already infected by HPV. Hyperthermia and immunomodulators might be positive additions to the armamentarium of clinicians. In sum, there are new tools that physicians can use but none is really a great advance over what was available a decade ago.
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MESH Headings
- Abnormalities, Drug-Induced/etiology
- Adjuvants, Immunologic/therapeutic use
- Administration, Cutaneous
- Aminoquinolines/administration & dosage
- Aminoquinolines/adverse effects
- Aminoquinolines/therapeutic use
- Animals
- Carcinogenicity Tests
- Catechin/administration & dosage
- Catechin/adverse effects
- Catechin/analogs & derivatives
- Catechin/therapeutic use
- Clinical Trials as Topic
- Condylomata Acuminata/drug therapy
- Condylomata Acuminata/epidemiology
- Condylomata Acuminata/prevention & control
- Condylomata Acuminata/surgery
- Condylomata Acuminata/therapy
- Dermatologic Agents/administration & dosage
- Dermatologic Agents/adverse effects
- Dermatologic Agents/therapeutic use
- Electrocoagulation
- Female
- Genital Diseases, Female/drug therapy
- Genital Diseases, Female/epidemiology
- Genital Diseases, Female/prevention & control
- Genital Diseases, Female/surgery
- Genital Diseases, Female/therapy
- Genital Diseases, Male/drug therapy
- Genital Diseases, Male/epidemiology
- Genital Diseases, Male/prevention & control
- Genital Diseases, Male/surgery
- Genital Diseases, Male/therapy
- Glycyrrhizic Acid/administration & dosage
- Glycyrrhizic Acid/therapeutic use
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18
- Humans
- Hyperthermia, Induced
- Imiquimod
- Immunotherapy
- Incidence
- Male
- Mice
- Mice, Transgenic
- Papillomavirus Vaccines
- Photochemotherapy
- Phytotherapy
- Prevalence
- Secondary Prevention
- United States/epidemiology
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49
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Abstract
The evaluation and management of genitourinary emergencies is a fundamental component of the training and practice of emergency physicians. Urologic procedures are common in the emergency room. Emergency physicians play a vital role in the initial evaluation and treatment because delays in management can lead to permanent damage. This article discusses the most common urologic procedures in which emergency physicians must be proficient for rapid intervention to preserve function and avoid complications. An overview of each procedure is discussed as well as indications, contraindications, equipment, technique, and potential complications.
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Affiliation(s)
- Maria R Ramos-Fernandez
- Department of Emergency Medicine, University of Puerto Rico School of Medicine, 65th Infantry Avenue Km 3.8, Carolina, PR 00985, USA.
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50
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Mehta SD, Green SJ, Maclean I, Hu H, Bailey RC, Gillevet PM, Spear GT. Microbial diversity of genital ulcer disease in men enrolled in a randomized trial of male circumcision in Kisumu, Kenya. PLoS One 2012; 7:e38991. [PMID: 22848346 PMCID: PMC3407166 DOI: 10.1371/journal.pone.0038991] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 05/17/2012] [Indexed: 12/31/2022] Open
Abstract
Background Medical male circumcision (MMC) reduces the risk of genital ulcer disease (GUD) in men by 50%. In Ugandan and Kenyan trials, a sexually transmissible agent was not identified in 50–60% of GUD specimens by polymerase chain reaction (PCR) assay. We sought to better define the etiology of GUD in men participating in the Kenyan trial and examine how MMC affects GUD etiology. Methods We defined GUD of unknown etiology as negative for HSV (type 1 and type 2), T. pallidum, and H. ducreyi by PCR, and negative for HSV-2 and T. pallidum by serology. We identified bacterial microbiota in a subset of 59 GUD specimens using multitag pyrosequencing of the 16S rRNA gene, and compared results by unknown vs. STI-associated etiology. Statistical analysis employed Bray-Curtis similarity measure of bacterial community by etiology, hierarchical clustering and logistic regression. Results In 59 GUD specimens from 59 men, 23 (39%) had unknown etiology. Bacterial diversity was greater in GUD of unknown than STI etiology (p = 0.01). Fusobacteria (Fusobacterium spp. and Sneathia spp.) were more commonly detected in men with GUD of unknown etiology [adjusted OR = 5.67; 95% CI: 1.63–19.8] as were Oxobacter spp. and Anaerovorax spp. [adjusted OR = 3.12; 95% CI: 0.83–11.7]. Sequences from these four anaerobic bacterial taxa were more often detected in uncircumcised men than circumcised men (p<0.05). Conclusions Anaerobic bacteria are more common in genital ulcers of uncircumcised men. The specific anaerobic bacteria associated with GUD of unknown etiology have cytotoxic properties that can exacerbate epithelial disruptions leading to ulcer-like appearance. MMC may reduce GUD through a reduction in these anaerobic bacteria.
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MESH Headings
- Adolescent
- Adult
- Bacteria, Anaerobic
- Bacterial Infections/epidemiology
- Bacterial Infections/genetics
- Bacterial Infections/microbiology
- Bacterial Infections/surgery
- Circumcision, Male
- Female
- Genital Diseases, Male/epidemiology
- Genital Diseases, Male/genetics
- Genital Diseases, Male/microbiology
- Genital Diseases, Male/surgery
- Humans
- Kenya/epidemiology
- Male
- Polymerase Chain Reaction
- RNA, Bacterial/genetics
- RNA, Ribosomal, 16S/genetics
- Sequence Analysis, RNA
- Ulcer/epidemiology
- Ulcer/genetics
- Ulcer/microbiology
- Ulcer/surgery
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Affiliation(s)
- Supriya D Mehta
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, Illinois, United States of America.
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