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[Surgical procedures in penis cancer].

In the period of 1980-1999 (20 years) in Colentina Surgical Clinic were admitted and operated 16 patients with the diagnosis of pennial cancer (histopathology--squamocellular carcinoma), 13 of whom being from Colentina Dermatological Clinic. The mean age was about 64 years old, 10 cases presenting phimosis. Surgical procedures undergone were represented by partial pennial amputation with bilateral superficial inguinal lymphadenectomy (10 cases), total pennial amputation with superficial inguinal lymphadenectomy (4 cases), respectively emasculation with bilateral inguinal-iliopelvic lymphadenectomy (2 cases). In the postoperative period 3 patients presented lymphedema and lymphorrhagia, solved by conservative management. All the patients benefited of favorable evolution on the period they have responded to the controlled postoperative follow up (1-3 years).

Adult↗

The value of serological tests for syphilis in atypical genital ulcer disease.

A 45-year-old heterosexual man presented with phimosis three weeks after arriving in this country from India. Examination under anaesthesia and circumcision revealed a large ulcer on the ventral aspect of the penis around the fraenum. Histopathological examination of a biopsy taken from the ulcer revealed granulation tissue with inflammatory cell infiltrate. Specific and non-specific serological tests for syphilis carried out four weeks after the initial presentation showed high titres. The importance of serological tests for syphilis in genital ulcer disease, especially in atypical presentations, is discussed.

Humans↗

[Preputial development in Japanese boys].

The natural course of preputial development is still not clearly understood. The preputial retractability was evaluated in 242 Japanese boys. The incidence of having a retractable prepuce gradually increased with age from 0% at age 1 year to 77% by the age of 11 to 15 years. In 48 boys, preputial development was followed up for 2 to 10 years with the self-retract maneuver. Non-retractable prepuce was found in 9 boys, which then became retractable within 2-7 years. The prepuce became retractable in most of the boys with balanoposthitis. In conclusion, forced retraction or circumcision is unnecessary for phimosis in boys with or without balanoposthitis.

Adolescent↗

Inappropriate circumcision referrals by GPs.

One hundred and twenty boys were referred by GPs over a 12-month period to a paediatric urologist for circumcision. The reasons for referral were: ballooning in 36, non-retraction in 28, balanoposthitis in 36 or a combination in 15. On examination 53% had a retractile, 21% a partially retractile and 21% a non-retractile foreskin. Six patients had obvious balanitis xerotica obliterans. Only one quarter of the patients required a circumcision. The penis was not examined by the referring doctor in 15 patients. The implications of this survey are that a large proportion of general practitioners have difficulty in discriminating between a true phimosis and a developmentally non-retractile foreskin. This diagnostic inaccuracy was greatest when the referring doctor did not examine the patient.

Adolescent↗

Carcinoma penis.

In the present study 90 cases of carcinoma penis were studied. The disease is more common after the age of 40 years; phimosis was found to be most important predisposing factor. Most common presentation was proliferative lesion with commonest involvement of glans penis. All the cases were of squamous cell carcinoma except one case of malignant melanoma. Clinical determination of lymph node metastasis is falacious as there was discrepancy between clinical and histopathological stage of the disease in 26.67% of cases. Therefore lymph node biopsy at the time of primary surgery is advocated. The result of total amputation is better than other mode of treatment.

Adult↗

[Preputial sclero-atrophic lichen in children].

Clinicopathological findings and outcomes in ten pediatric cases of lichen sclerosus and atrophicus of the foreskin are reported. This well-defined entity usually presents as acquired sclerous phimosis. Diagnosis rests on histologic studies of biopsy specimens. Pathologic features change during the course of disease and are useful for selecting the most appropriate therapy. Local corticosteroid therapy may be helpful in early disease. However, circumcision is usually required for advanced disease, failure of medical therapy or prevention of squamous cell carcinoma. Pathophysiology is discussed. The incidence of this condition seems to be underestimated. Possible connections with diabetes mellitus and other conditions are reviewed.

Adolescent↗

An argument for circumcision. Prevention of balanitis in the adult.

A cross-sectional study and a retrospective study were performed to determine the frequency of balanitis in a randomly selected group of dermatology patients. A total of 398 subjects were included in the cross-sectional study, 213 (53.5%) of whom had been circumcised. Balanitis was diagnosed in 2.3% of circumcised men and in 12.5% of uncircumcised men. In patients with diabetes mellitus, balanitis occurred with a prevalence of 34.8% in the uncircumcised population, compared with 0% in the circumcised population. Balanitis did occur with increased frequency in the diabetic population (16%), regardless of circumcision status, compared with the nondiabetic population (5.8%). Of 63 circumcisions performed at our institution between 1987 and 1989, 28.6% were for the treatment of balanitis; 44.4%, for phimosis (which was probably induced by chronic balanitis); 19% in preparation for placement of penile prostheses; and 8% for miscellaneous reasons. No complications of circumcision were reported. In this group of patients, balanitis was more frequent in diabetic than in nondiabetic uncircumcised men (50% vs 15.4%).

Adult↗

[Sclerotic and atrophic lichen of the genitals in boys].

Sclerotic and atrophic lichen (LSA) is a rare condition in boys. A retrospective analysis of boys who underwent circumcision for medical reasons, revealed that nine out of 59 boys had histologically verified LSA. The condition thus appears to be a relatively frequent cause of phimosis in children.

Adolescent↗

Effects of hygiene among the uncircumcised.

Recommendations against routine neonatal circumcision are based on the assumption that good penile hygiene can offer the same advantages as this procedure. The purpose of this study was to investigate hygienic practices of uncircumcised subjects and the relationship of these practices to the condition of the prepuce and glans. Outcome was related to hygiene: subjects who retracted the foreskin when bathing were less likely to have smegma accumulation, inflammation, phimosis, or adhesions than those who did not. Significant correlations were also found between early instructions concerning hygiene and the type of hygiene practiced. These results support the recommendation that good hygiene can offer many of the advantages of circumcision and highlight the need for clear, early instructions on hygiene to uncircumcised patients.

Adolescent↗

Penile dorsal nerve block for penile surgery.

As pain is better prevented than relieved, 46 patients scheduled for phimosis operations, had for their pain control a penile dorsal nerve block: 37 children with additional inhalation anesthesia intraoperatively and 9 adults without any further analgesia. The technique used is described in detail. No untoward effects were recorded. It is concluded that penile dorsal nerve block offers such a simple, effective and reliable method of analgesia intra- and postoperatively that it should be an integral part of the anesthetic management of penile surgery.

Adolescent↗

A case of histoplasma posthitis.

The present report describes a case of disseminated histoplasmosis with involvement of the prepuce. Phimosis resulting from histoplasma posthitis is exceedingly rare and hence being documented.

Adult↗

[Prepuce plastic surgery, known as the Lille operation, in distal hypospadias. Apropos of 138 cases].

Distal hypospadias with meatus situated on the glans, in the balano-penile furrow, even on the distal part of the shaft, are the most frequent hypospadias. Without chordee, it's only a cosmetic handicap. The aim of surgery is to produce the esthetic appearance of a normal penis. In France, circumcision is not usual and most people prefer a child with prepuce. The best technique in this case is to keep the meatus in its hypospadial situation and get the prepuce circular with a ventral suture. It's an easy technique. The hospital stay is short, 2 or 3 days, without any diversion of the urine. This operation is made when the child is about 3 years. Saint-Aubert described this procedure in 1967. The authors present their technique and results. Since 1971, 138 boys underwent this operation with few complications: 2% of fistulas and 2% of phimosis on the last hundred of cases.

Child↗

Prepuceplasty: an alternative to circumcision.

The operation of prepuceplasty overcomes phimosis in children while conserving the foreskin. The narrowed preputial outlet is incised longitudinally and repaired transversely. When appropriate, this minor procedure produces lasting relief of the deformity, as shown in 55 patients followed for up to 20 years.

Adolescent↗

Topical clobetasol propionate compared with placebo in the treatment of unretractable foreskin.

OBJECTIVE: To assess whether it is the steroid alone or the gentle physical retraction combined with ointment that is responsible for the excellent results observed with topical steroid treatment of unretractable foreskin. DESIGN: Prospective, randomised, double-blind study. SETTING: University hospital, Sweden. SUBJECTS: 30 Boys randomised to be treated with clobetasol propionate (n = 15) or placebo (n = 15). INTERVENTIONS: The boys were examined 1, 2 and 6 months, respectively, after treatment. MAIN OUTCOME MEASURES: Comparison between the effects of clobetasol propionate and placebo. RESULTS: Two patients in the steroid group and one in the placebo group withdrew from the study. 10 Boys in the steroid group showed an improvement within 2 months. The remaining 3 boys had no effect and were circumcised. Histopathological examination showed lichen sclerosus et atrophicus. Seven boys in the placebo group improved. The 7 non-responders were prescribed clobetasol propionate ointment, and all 7 improved. CONCLUSION: 17 of 27 boys referred with "phimosis" were successfully treated with an ointment and gentle traction. When clobetasol propionate was given the non-responders success rate was increased to 24/27 (89%).

Administration, Topical↗

The tarsal strip procedure.

We have developed a procedure that is particularly useful for (1) paralytic or senile upper and lower eyelid laxity, (2) lateral canthal tendon laxity or malposition, and (3) iatrogenic phimosis associated with recurrent entropion or ectropion after traditional lid-shortening procedures. Lateral canthal tendon laxity or elongation is the primary problem in the majority of these cases, and eyelid tightening with use of lateral tarsal strips corrects this deformity. The midtarsal portion of the eyelid, which is usually resected in traditional lid-shortening procedures, is seldom elongated, and recurrences of laxity are common secondary to further stretching of lax tendons. The technique involves a lateral canthotomy and transection of the appropriate crus of the lateral canthal tendon. The eyelid is then split into anterior and posterior lamellae, and tarsal strips are fashioned from the posterior lamella. The tarsal strips are sutured to periosteum at the lateral orbital wall, adjusting the height and tension of the lateral canthus. This technique gives a normal appearance to the lateral canthal angle and has yielded good results in 51 cases.

Aged↗

Risk factors for penile cancer: results from a case-control study in China.

An epidemiologic study of penile cancer involving 141 cases and 150 community controls was undertaken in a high-risk area in China. Personal interviews, as well as physical examinations among the prospectively ascertained subjects, enabled evaluation of a variety of potential risk factors. Strongly related to risk were conditions restricting the motility of the foreskin, including phimosis or paraphimosis, particularly when so severe that circumcision was used for treatment. Poor hygiene practices also appeared to increase risk, particularly as evidenced by detection of smegma on physical examination, although it was difficult to decipher whether this association was etiologic or merely a consequence of disease. A sexual relationship outside of marriage was associated with a RR of 1.7, and appeared to be a more important discriminator than number of lifetime sexual partners. Risk was increased among subjects reporting previous genital conditions, particularly sexually transmitted diseases, and physical examinations revealed the appearance of genital warts among 13 cases vs. I control. Interviews with wives of study subjects failed to provide evidence of a "female factor" in the etiology of penile cancer. This study supports the need for further evaluation of the role of hygiene and sexually transmitted agents in the etiology of penile cancer.

Adolescent↗