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PubMed1989

Penis cancer: a review by the Joint Radiotherapy Committee of the European Organisation for Research and Treatment of Cancer (EORTC) Genitourinary and Radiotherapy Groups.

A review of the literature on penis cancer has been undertaken. The disease is rare and most of the cumulative experience is reported in retrospective series. Multi-institutional international collaboration will be needed to study prospectively facets of this disease where controversy presently exists. Suggested areas of research are in the treatment of early invasive tumours, the diagnosis and treatment of inguinal metastases, the improvement of radiotherapy techniques, and the development of effective chemotherapy and effective combinations of therapies. This will potentially lead to a greater degree of organ sparing. Studies of palliation, and aspects of quality of life, are also needed. Public education about the condition and genital hygiene, including the necessity for the early treatment of phimosis, may further reduce the incidence of penis cancer.

Aged↗
PubMed1992

Squamous cell carcinoma of the penis. Analysis of 24 cases.

The authors evaluated retrospectively 24 cases of spinocellular carcinoma of the penis, trying to detect aetiological carcinogenic factors of the disease. Phimosis persisting since childhood was reported by ten men, whereby in five of them circumcision was performed during puberty. The duration of symptoms up to the time of biopsy and histological verification of differentiated spinocellular carcinoma of the penis varied from one month to thirteen years. Eight patients (33.3%) belonged to category T1, 8 (33.3%) to T2 and 8 (33.3%) to T3. Fifteen tumours (62.5%) were G1, 5 (20.8%) G2 and 4 (16.7%) G3. In 5 men print cytology was negative.

Carcinoma, Squamous Cell↗
PubMed1998

Cardiovascular responses to tracheal extubation or LMA removal in children.

PURPOSE: This study was designed to investigate the cardiovascular effects related to tracheal extubation or laryngeal mask airway (LMA) removal in children. METHODS: Sixty children, ASA physical status 1, 4-10 yr of age, undergoing minor elective surgery (inguinal hernia and phimosis) were allocated randomly to have their surgery performed with endotracheal intubation (Group ET, n = 30) or LMA (Group LMA, n = 30) and were studied for cardiovascular responses related to extubation or LMA removal. Changes in heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured before and 1, 2, 3, 5, and 10 min after tracheal extubation or LMA removal when the patients were awake. RESULTS: The maximal changes in HR, SBP and DBP were less in Group LMA than in Group ET during the observation period (HR; 12 vs 26, SBP; 14 vs 28, DBP; 9 vs 13, median, P < 0.05). CONCLUSION: Laryngeal mask airway removal elicited less haemodynamic change than tracheal extubation in paediatric patients.

Blood Pressure↗
PubMed1998

Preputial intussusception or acquired megaprepuce.

Preputial intussusception, or acquired megaprepuce, is a clinical condition whose incidence is increasing. It results from infolding of the outer preputial skin, obstruction of urinary flow, and the development of a phimosis. With time the process continues, resulting in a distinctive clinical picture. Treatment by early circumcision cures the problem and allows resolution of the sequelae.

Humans↗
PubMed1999

Surgical correction of congenital megaprepuce.

Congenital megaprepuce (CMP) is a rare entity. Two infant boys presented with a tight congenital phimosis resulting in an excessively baggy, urine-filled prepuce and a swollen scrotum. Compression of the scrotum resulted in drainage of urine. We feel this to be a separate entity from a buried penis and recommend early surgery. The phimotic tip of the foreskin was excised and the inner layer preserved to cover the full length of the penile shaft. The outer layer of the foreskin, in reality the penoscrotal junction, was anchored to the base of the penile shaft. A V-shaped edge of ventral skin was excised and the edges approximated, giving the appearance of median raphe. The final appearance was that of a circumcised penis. A third patient awaits operation.

Humans↗
PubMed2006

Penis: an unusual site for pilonidal sinus.

Pilonidal sinus affects different regions of the body, gluteal cleft being the most common. This condition affecting the penis is extremely rare with only a few case reports around the world. It is prone for complications like infection, actinomycosis, abscess formation, erectile dysfunction and phimosis amongst others. We present a case of Pilonidal sinus of the penis where a pre-operative diagnosis was made and appropriate treatment in the form of circumcision prevented complications.

Adult↗
PubMed1995

A new approach to the surgical correction of buried penis.

Buried penis has been variously attributed to obesity with excessive suprapubic fat, severe phimosis with trapping of the penis within the prepubic tissues, and inadequate fixation of the penile shaft skin at the base resulting in tenting. Previous attempts at surgical correction, by excising suprapubic fat, fixing penile shaft skin to the base of the penis, and circumcising, have failed to give satisfactory results and, indeed, procedures like circumcision will make the condition even worse. The technique developed by the author is based on the recognition that this condition exists because of the displacement of the root of the penis below its normal position, resulting in the surrounding fat and dartos tissues enveloping the penile shaft. In this procedure, dissection at the root of the penis is carried out deep down to the corporal bodies. All fibrotic tissue that binds the penile shaft is excised. The lengthened penile shaft is anchored at its base by suturing the surrounding tissue onto the tunica. This technique has been applied in 22 patients ranging in age from 5 months to 11 years. Apart from two technical problems, all other patients had satisfactory correction with good functional results.

Child↗
PubMed1984

The effect of five synthetic progestational compounds on 5 alpha-reductase activity in genital skin fibroblast monolayers.

The suggestion has been made that prenatal exposure to synthetic progestogens contributes to an increased incidence of hypospadias. One potential mechanism for such an effect might be inhibition of 5 alpha-reductase, a key enzyme in normal male sexual differentiation. We have examined the effect of progesterone and of five synthetic progestogens upon 5 alpha-reductase activity in fibroblast monolayers from 12 genital skin cell lines obtained from normal newborn infants, boys with phimosis and hypospadias and a normal adult male. Basal enzyme activities ranged from 0.8-12.1 pmoles 5 alpha-reduced product/micrograms DNA/hour. Progesterone and norethindrone inhibited 5 alpha-reductase activity in a dose dependent manner to a maximum of 95% and 50% of basal levels respectively at 10(-5) M. Similar concentrations (10(-5) M) of norethynodrel, ethisterone, dl-norgestrel and d-norgestrel had little or no effect. Studies of cell viability showed that the effects of progesterone and norethindrone were specific for 5 alpha-reductase and not non-specific toxic effects.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1993

Microscopic features of lichen sclerosus et atrophicus in acrochordons: a clue to the cause of lichen sclerosus et atrophicus?

BACKGROUND: The cause of lichen sclerosus et atrophicus (LSA) is unknown, but on the penis it is associated with chronic occlusion, that is, phimosis. Microscopic changes of LSA were seen unexpectedly in two acrochordons. OBJECTIVE: Our purpose was to further characterize this phenomenon. METHODS: A total of 449 acrochordons examined in our histopathologic laboratory in the past 2 years were studied for changes of LSA, and clinical data were collected. RESULTS: Eight additional cases were found. All of the acrochordons exceeded 0.5 cm, and three were 1 cm or larger. At least six were under chronic occlusion or pressure. The dermal changes of LSA predominated over the epidermal changes. All showed collagenous homogenization, sclerosis, and inflammation. Elastic fibers were characteristically decreased. CONCLUSION: These observations strengthen the evidence that LSA in flaccid skin may be caused by chronic occlusion.

Adult↗
PubMed1995

De virginibus puerisque: the function of the human foreskin considered from an evolutionary perspective.

The functional significance of the human male foreskin is considered in evolutionary terms. It is postulated that there is a lifetime's reproductive advantage in delaying the age of first coitus, and hence of first childbirth, for some years after puberty, until the parents are better established as providers. Phimosis and preputial adhesions are common in human males because they have selective advantage, tending to impede and therefore delay the onset of sexual activity. The physical signs of female virginity have an analogous function, and have been selected for in the same way. This hypothesis also provides a consistent explanation for the worldwide tradition of circumcision and for the common practice of masturbation by human males.

Adolescent↗
PubMed2004

[Penis tumours: techniques and indications].

Although penis epidermoid carcinoma is a relatively rare tumour, early identification and treatment are necessary to avoid mutilating and sometimes morbid surgery. Awareness of disease epidemiology is mandatory for preventing the evolution of an underlying tumour (absent or insufficient hygiene, congenital or acquired phimosis, preepitheliomathous lesions such as Bowen's disease). Conservative surgical or radio-therapeutic techniques may be considered, provided the lesion is superficial and with a diameter < 30 mm. In all other cases, penis amputation is necessary. Penis epidermoid carcinoma spreads by vascular and lymphatic diffusion. Dynamic scintigraphy for the identification of a sentinel node and screening of subclinical metastasis is currently under evaluation. In case of palpable inguinal adenopathy, inguinal lymphadenectomy should be proposed if technically performable. Although superficial lymphadenectomy is associated with a low morbidity rate (about 3% of mild complications) deep inguinal Lymphadenectomy is far more morbid and disabling. Compliance with pre- and post-operative measures, and total patient compliance are necessary to minimize as far as possible such morbidity.

Amputation, Surgical↗
PubMed2005

Cancer of the penis.

Cancer of the penis is rare in Europe, accounting for less than 0.5% of all cancers. Phimosis and poor hygiene are strong risk factors whereas neonatal circumcision is a contributing factor in the prevention of this disease. More than 95% of penile carcinomas are squamous cell carcinomas. Early disease (stage I-II) is curable in most patients, who can be treated by conventional penile amputation or, in selected cases, by organ preserving techniques, including Moh's micrographic surgery, laser ablation or radiation therapy (external-beam, brachytherapy). For more advanced primary tumours, penile amputation is required. Survival of patients with penile cancer is strongly related to the presence and extent of nodal metastases. Bilateral inguinal lymphadenectomy is recommended for palpable lymph nodes that persist 3 or more weeks after removal of the primary tumour and a course of antibiotic therapy. In patients with proven inguinal lymph node metastases, bilateral ileoinguinal dissection should be performed. When the nodes are clinically negative, "prophylactic" inguinal lymphadenectomy may be a reasonable approach in patients with invasive tumours (T2 or greater), high grade tumours, or tumours exhibiting vascular invasion. The role of chemotherapy, as adjuvant and neoadjuvant or primary treatment in metastatic disease, needs to be further explored in prospective clinical trials.

Carcinoma, Squamous Cell↗
PubMed2004

Unstented tubularized incised plate urethroplasty combined with foreskin reconstruction for distal hypospadias.

BACKGROUND AND AIM: Urethral stent has recently been proven to be unnecessary for normal healing in an animal model of tubularized incised plate (TIP) urethroplasty. We report our experience with unstented TIP repair combined with foreskin reconstruction for distal hypospadias in children. PATIENTS AND METHODS: We retrospectively reviewed the records of 162 children consecutively treated by TIP urethroplasty for a distal or mid-shaft hypospadias without urethral stent over a 6 years period. The mean age +/- SEM at surgery was 15.7 +/- 1.2 months. A foreskin reconstruction was performed with the hypospadias repair in 136 boys (84%). One hundred thirty one children (81%) underwent this surgery as an outpatient procedure. RESULTS: With a mean follow-up of 12.4 +/- 1.0 months, urethrocutaneous fistula was observed in 9 children (5.6%), and meatal stenosis in 4 (2.5%). Postoperative urinary retention requiring suprapubic catheter insertion was observed in 4 cases (2.5%) without later complications. Cutaneous dehiscence of the reconstructed foreskin occurred in 6 children (4.4%) and phimosis in 13 (9.5%). CONCLUSIONS: Absence of urethral stent after TIP urethroplasty for distal hypospadias repair does not seem to increase postoperative complication rate. Foreskin reconstruction in distal hypospadias surgery has an acceptable complication rate.

Child↗
PubMed2004

Lymphedematous fibroepithelial polyps of the glans penis and prepuce: a clinicopathologic study of 7 cases demonstrating a strong association with chronic condom catheter use.

This report describes an underrecognized entity of the penis that is associated with chronic condom catheter use and phimosis. Our study group consisted of 7 patients who presented with polypoid or cauliflower-like masses that involved the glans penis or prepuce and that ranged in size from 2 to 7.5 cm in greatest dimension (median size, 2.5 cm). The majority of lesions affected the ventral surface of the glans, near the urethral meatus. The patients ranged in age from 25 to 58 years (median age, 40 years) at the time of initial surgical resection. The preoperative duration of the lesions ranged from 6 months to 10 years. Five patients had a history of long-term condom catheter use (duration: 5 to 21 years), and 1 patient had paraphimosis. The background history for 1 patient is unknown. Histologically, all specimens had a polypoid configuration and a keratinizing squamous epithelial surface. The underlying stroma was notably edematous, and there was vascular dilation of preexisting vessels, and in many instances, a focal mild small vessel proliferation. The stroma had mildly to moderately increased cellularity with mononucleated and multinucleated mesenchymal cells. A mild inflammatory infiltrate was often present. Two cases were examined with immunohistochemistry, and the stromal cells had limited immunoreactivity for muscle-specific actin, alpha-smooth muscle actin, and desmin and had no reactivity for S100 protein or CD34. Surgical intervention was local in all instances. Follow-up information was available for 5 of the 7 patients (71%), with a mean follow-up interval of 11 years 4 months. Two patients developed a local recurrence of the process at intervals of less than 1 years and 3 years 7 months. Both recurrent lesions were also managed by local excision.

Adult↗
PubMed2006

Foreskin preservation in penile surgery.

PURPOSE: Most hypospadias repairs performed in the United States involve the removal of any foreskin that is not used in the repair, resulting in a circumcised penis. Occasionally, the wishes of the parents or the child are for the final appearance to be that of a normal uncircumcised penis. We report our collective experience from 4 institutions in the reconstruction of the foreskin during penile surgery. MATERIALS AND METHODS: A total of 58 patients underwent penile surgery with reconstruction of the foreskin during a 6-year period. Of the patients 49 underwent hypospadias repair, 8 underwent phalloplasty for chordee correction without hypospadias and 1 underwent reconstruction of the foreskin for a dorsal hood without hypospadias or chordee. Of the 49 hypospadias repairs 46 were distal, 2 mid shaft and 1 proximal shaft. The technique for foreskin reconstruction consisted of a multilayered reapproximation of the lateral margins of the dorsal hood after completion of the urethroplasty and glanuloplasty. RESULTS: Among 49 hypospadias repairs 2 patients had dehiscence of the reconstructed foreskin, with development of a urethral fistula in 1. Of the 58 total patients undergoing penile surgery 56 had retractable foreskin, of whom 4 required postoperative steroid application. Three patients/parents requested a secondary circumcision, 2 for an unacceptable cosmetic result and 1 based on personal preference. CONCLUSIONS: Foreskin reconstruction in association with penile surgery can be performed safely and with a low complication rate in appropriately selected patients. Cases with a higher risk of complications include those involving more proximal hypospadias and those requiring complete degloving of the penile shaft. Of the reconstructions resulting in phimosis most can be salvaged with the application of steroids.

Child↗
PubMed2006

Technique for repair of minimal distal balanitic hypospadias.

OBJECTIVES: Although not pernicious, minimal distal hypospadias is frequently obvious to parents, whose concern that their child be completely normal prompts their request for repair. A simple technique for the repair of this anomaly that results in an elliptical meatus is presented. METHODS: A total of 28 boys ranging in age from 3 to 100 months (mean 21.8) underwent a surgical technique in which the distal urethral plate was excised, followed by advancement of the meatus into the defect thus created. Only 5 boys (17.8%) underwent hypospadias repair as an isolated procedure. Other concomitantly repaired anomalies included hooded prepuce, phimosis, redundant prepuce after neonatal circumcision, ventral penile curvature, inguinal hernia, undescended testis, penile torsion, and meatal stenosis. RESULTS: All patients had healed well at a follow-up of 3 to 4 months (mean 3.2) and uniformly had an excellent cosmetic appearance with an elliptical meatus. CONCLUSIONS: We recommend a technique for the repair of minimal distal hypospadias, consisting of excision of the distal urethral plate with advancement of the dorsal lip of the meatus into the created defect, for its simplicity and resultant elliptical meatus.

Child↗
PubMed1994

Subtle tubal abnormalities adversely affect gamete intrafallopian transfer outcome in women with endometriosis.

OBJECTIVES: To evaluate prospectively the impact of subtle tubal disorders on GIFT pregnancy rates in women with pelvic endometriosis. DESIGN: A prospective comparison of pregnancy rates in different stages of endometriosis while controlling for the presence of tubal abnormalities. INTERVENTIONS: A total of 146 patients with endometriosis underwent 201 GIFT procedures. During laparoscopy special attention was brought to the fallopian tubes and any anatomical disorders were recorded. Tubal abnormalities included tubal sacculations, diverticulae, convolutions, phimosis, fimbrial agglutination, and peritubal adhesions. Best tube was considered in the final analysis. RESULTS: The presence of tubal abnormalities significantly lowered the pregnancy rates in all stages of endometriosis. When we controlled for age, semen characteristics, number of mature oocytes transferred, and tubal status, the extent of anatomical tubal disorders was the most important prognostic factor in determining pregnancy outcome. CONCLUSION: The extent of tubal abnormalities rather than the stage of endometriosis seems to be an important prognostic factor in determining GIFT pregnancy rates. Couples should be counseled accordingly and accurate prognostic parameters should be explained before enrollment in a GIFT program.

Adult↗
PubMed1994

Pregnancy rates after operative endoscopic treatment of total (neosalpingostomy) or near total (salpingostomy) distal tubal occlusion.

OBJECTIVE: To determine the efficacy of the endoscopic treatment of complete distal tubal occlusion or moderate to severe tubal phimosis and to analyze outcome using contemporary statistical methodologies. DESIGN: Prospective cohort analysis. SETTING: Tertiary-care institution. PATIENTS: One hundred thirteen consecutive patients undergoing a neosalpingostomy or salpingostomy. INTERVENTIONS: KTP/532 laser (Laserscope, Santa Clara, CA) laparoscopy. Additional infertility factors were treated postoperatively. MAIN OUTCOME MEASURES: Crude pregnancy rate (PR), monthly fecundity rate, monthly probability of pregnancy, cure rate, and cumulative PRs. Outcome was compared on the basis of the surgical procedure performed. The impact of endometriosis as well as other fertility factors was analyzed. RESULTS: Twenty-three patients conceived yielding a crude PR of 20.4%, a monthly fecundity rate of 2.6%, a monthly probability of pregnancy of 6.4%, and a cure rate of 52.4%. There were six ectopic pregnancies (5.3%). A significant difference was found among the cumulative pregnancy curves. The cumulative pregnancy curve for unilateral salpingostomy differed significantly from that of unilateral neosalpingostomy. Patients with endometriosis and no other infertility factors had a significantly better cumulative pregnancy curve compared with patients without endometriosis or other factors as well as compared with patients with no endometriosis but with other infertility factors. Patients undergoing bilateral neosalpingostomy had a cure rate of 9.0% whereas patients undergoing bilateral salpingostomy had a cure rate of 34.2%. CONCLUSIONS: Operative endoscopy yields PRs that are comparable to those reported in the literature for laparotomy. The presence of complete bilateral distal tubal occlusion has a negative impact on outcome.

Adult↗