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PubMed2004

Significance of recent onset nocturnal enuresis in adult men: a prospective study.

INTRODUCTION: Although literature on childhood nocturnal enuresis and its persistence into adulthood is abundant, recent onset nocturnal enuresis in adults is a poorly studied symptom. OBJECTIVE: To determine the significance of recent onset nocturnal enuresis in adult males in relation to lower urinary tract pathology, and its treatment. METHODS: All men with recent onset nocturnal enuresis attending a urology unit over a period of 12 months were evaluated prospectively. Their treatment and outcome were recorded. RESULTS: There were 30 patients (mean age 64 years). Ultrasonography revealed upper urinary tract dilatation in 22 patients. Another six patients had post-void residual urine volume over 500 mL without upper tract dilatation. Only two patients did not have ultrasonographic evidence of bladder outflow obstruction. Elevated blood urea was noted in 14 patients. Twenty patients underwent transurethral resection of the prostate (TURP) and one patient with balanitis xerotica obliterans had circumcision and meatotomy. Three patients were taught clean intermittent self catheterisation, and three patients preferred indwelling urethral catheters. One patient while awaiting TURP died of a myocardial infarction. Eight patients, who were treated with alpha-adrenergic antagonists initially, required further intervention later as the response to medical therapy was poor. CONCLUSIONS: Recent onset nocturnal enuresis in adult males is a symptom closely associated with significant lower urinary tract pathology requiring early urological intervention. Considering its impact on management it is reasonable to classify recent onset nocturnal enuresis as a lower urinary tract symptom in adult men and including it in symptom scores used to assess bladder outflow obstruction.

Adult↗
PubMed2004

Struvite penile urethrolithiasis in a pygmy sperm whale (Kogia breviceps).

Massive urolithiasis of the penile urethra was observed in an adult pygmy sperm whale (Kogia breviceps) stranded on Topsail Island, North Carolina, USA. Calculi occupied the urethra from just distal to the sigmoid flexure to the tip of the penis for a length of 43 cm. A urethral diverticulum was present proximal to the calculi. The major portion of the multinodular urolith weighed 208 g and was 16 cm long x 3.7 cm diameter at the widest point. The urolith was composed of 100% struvite (magnesium ammonium phosphate) and on culture yielded Klebsiella oxytoca, a urease-positive bacterium occasionally associated with struvite urolith formation in domestic animals. Reaction to the calculi was characterized histologically by moderate multifocal to coalescing plasmacytic balanitis and penile urethritis. Role of the urethrolithiasis in the whale's stranding is speculative but could have involved pain or metabolic perturbations such as uremia or hyperammonemia.

Animals↗
PubMed1999

Adult circumcision.

Adult circumcision can be performed under local or regional anesthesia. Medical indications for this procedure include phimosis, paraphimosis, recurrent balanitis and posthitis (inflammation of the prepuce). Nonmedical reasons may be social, cultural, personal or religious. The procedure is commonly performed using either the dorsal slit or the sleeve technique. The dorsal slit is especially useful in patients who have phimosis. The sleeve technique may provide better control of bleeding in patients with large subcutaneous veins. A dorsal penile nerve block, with or without a circumferential penile block, provides adequate anesthesia. Informed consent must be obtained. Possible complications of adult circumcision include infection, bleeding, poor cosmetic results and a change in sensation during intercourse.

Adult↗
PubMed1999

An audit of diagnostic coding in genitourinary medicine clinics. Trent Region Genitourinary Medicine Audit Group.

The KC60 diagnostic code information provides an epidemiological monitor of sexually transmitted infection (STI) and a means of standardizing clinical workload in genitourinary medicine (GUM) departments. We aimed to assess the coding process and its uniformity within the Trent region by means of a confidential self-administered coding exercise with simulated case presentations. The correct coding for STIs ranged from 59.4% to 100% in different scenarios. Difficulty was identified in the coding of vulvitis and balanitis where no organism was isolated, as represented by a wide range of codes. HIV pre-test counselling without testing was coded by only 57.8% of respondents. Over 95% indicated correctly the first hepatitis B vaccine dose but 21% failed to code once only for the course. Coding practice also varied within individual sites with a 21-100% discordance. In parts diagnostic accuracy was good but there were areas of non-uniformity both within sites and cross-regionally. Regional discussions have resulted in increased training opportunities and guidelines have been developed to increase uniformity and achieve consensus in uncertain areas.

Female Urogenital Diseases↗
PubMed1999

Lateral preputioplasty for phimosis.

There exists a lack of understanding of normal preputial development which is reflected in the large numbers of inappropriate referrals for circumcision. While the scarred prepuce invariably responds best to formal circumcision a more conservative approach is recommended in those symptomatic patients with non-retractile foreskins. In this study, patients referred to the out-patient department with a phimosis were assessed. Those with a phimosis and secondary preputial scarring were listed for circumcision. Those with a narrowed foreskin and a history of recurrent balanitis or local symptoms such as fissuration, thought suitable for a more conservative approach, were listed for preputioplasty. Those with a phimosis but without local symptoms were reassured and discharged. Thirty patients were referred for preputioplasty. One patient developed a post-operative wound infection which settled with oral antibiotics prescribed by his general practitioner. This left him with further preputial adhesions and he later underwent circumcision. The remaining patients reported no post-operative problems at follow-up. Cosmesis was good with high levels of patient satisfaction expressed. All had easily retractile foreskins at follow-up. Large numbers of patients might reasonably benefit from a lateral preputioplasty when presenting with a symptomatic phimosis in the absence of significant scarring of the prepuce. It avoids the needless loss of the foreskin, the importance of which is only now beginning to emerge.

Adolescent↗
PubMed2001

[Mania during the use of a combination preparation with St. John's wort (Hypericum perforatum)].

A 23-year-old woman with no psychiatric history developed acute mania and psychosis while using St. John's wort at a high dosage (Valdispert 'balans', a combination of valerian extract and hypericin). She was diagnosed as having substance-induced mood disorder, with manic features (DSM-IV). Discontinuation of the use of the product and treatment with olanzapine led to complete recovery. No causal relationship between the use of the extract and the mania was established, but the course of the mania does suggest this association. St. John's wort is a popular herbal antidepressant. Hyperforin and hypericin, components of St. John's wort, inhibit synaptosomal serotonin, noradrenaline and dopamine uptake. The mechanism of action of St. John's wort is, however, not yet fully understood. St. John's wort should therefore be used with caution, especially in patients with a bipolar disorder.

Adult↗
PubMed2002

Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction.

PURPOSE: Evidence concerning the effect of circumcision on sexual function is lacking. Men circumcised as adults are potentially in a unique position to comment on the effect of a prepuce on sexual intercourse. We examine sexual function outcomes in men who have experienced sexual intercourse in the uncircumcised and circumcised states. MATERIALS AND METHODS: Men 18 years old or older when circumcised were identified by billing records during a 5-year period at an academic medical center. Medical charts were reviewed for confirmation of the procedure and to identify the indication(s). These men were surveyed to assess erectile function, penile sensitivity, sexual activity and overall satisfaction. Data were analyzed using paired t tests to compare category scores before and after circumcision. RESULTS: A total of 123 men were circumcised as adults. Indications for circumcision included phimosis in 64% of cases, balanitis in 17%, condyloma in 10%, redundant foreskin in 9% and elective in 7%. The response rate was 44% among potential responders. Mean age of responders was 42 years at circumcision and 46 years at survey. Adult circumcision appears to result in worsened erectile function (p = 0.01), decreased penile sensitivity (p = 0.08), no change in sexual activity (p = 0.22) and improved satisfaction (p = 0.04). Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised. CONCLUSIONS: Our findings may help urologists better counsel men undergoing circumcision as adults. Prospective studies are needed to better understand the relationship between circumcision and sexual function.

Adult↗
PubMed2002

[Skin changes of the penis. Differentiation between local findings and systemic diseases!].

In the event of diseases affecting the penis, both patient and doctor may first have to overcome a certain "threshold of inhibition". Since, however, the clinical examination of the genitals is uncomplicated and informative, the general practitioner should be familiar with the major pathological conditions that may affect the male organ. Diseases of the penis can take the form of a local condition or be part of a generalized cutaneous disease. Examples of the latter that frequently involve the penis are psoriasis and lichen planus. Infections are caused by bacteria, fungi, viruses or parasites, and Candida, streptococci and anaerobes need particular mention. Other major differential diagnoses are cutaneous drug reactions, contact dermatitis and neoplastic lesions. But, excessive hygiene may also cause problems ("over-treatment balanitis").

Diagnosis, Differential↗
PubMed2002

Topical steroid therapy for phimosis.

INTRODUCTION: Circumcision has been the traditional treatment for phimosis. Recent reports of medical management of phimosis with topical steroids quote success rates of 67%-95%. We present our results with topical steroid therapy for treatment of phimosis. MATERIALS AND METHODS: Retrospective review of 69 boys between the age of 3 and 13 years (average 7.4) who were referred to Urology clinic over a one year period (August 1999-2000) with phimosis. Boys without a distal preputial ring were excluded. A course of triamcinolone cream was prescribed and parents/patients were instructed to apply it to the preputial outlet twice daily for one month. Six weeks after treatment initiation patients were reassessed. Results were classified as follows: Full retraction (FR)-entire glans and coronal margin seen, Moderate retraction (MR)-proximal glans seen, residual preputial adhesions, Partial retraction (PR)-distal glans and meatus seen, and Failure (F)-no change. FR, MR, and PR were considered successful outcomes. Statistical analysis was performed with Splus software using the prop.test and ordinal logistic regression procedures. RESULTS: Follow-up ranged from 1-12 months, and 8 patients were lost to follow-up. Of the remaining 61 boys, 82% (12 FR, 26 MR, 12 PR) were successfully managed with topical steroid (95% confidence interval: 69%-90%). Scarring on examination was observed to negatively impact outcome (92% versus 67%) and was statistically significant using ordinal logistic regression (Chi square test=4.48, p-value=0.034). Two boys with severe balanitis xerotica obliterans (BXO) and two boys with buried penis and penoscrotal webbing failed treatment and required surgery. There was an association noted between older age and poorer outcome but this was not statistically significant. There were no local or systemic side effects noted. CONCLUSIONS: Local application of steroid cream to the phimotic foreskin may allow some degree of retraction and avert the need for circumcision. Although the length of follow-up is insufficient to decree ultimate success, topical steroid appears to be a safe and effective treatment for boys over three years of age with evidence of a tight preputial ring. Boys with severe BXO or buried penis and penoscrotal webbing should be considered primarily for surgery.

Administration, Topical↗
PubMed2002

[Should circumcision be performed in childhood?].

OBJECTIVE: To evaluate prepuce development and retractibility in a group of boys. To point out the value of circumcision and prepucial forced dilation during childhood. METHODS: Prepuce development and retractibility were evaluated in 400 boys ages between 0-16 year old. RESULTS: In boys under 1 year prepuce retractibility (assessed only in children who did not undergo forced dilation previously) was type I (non retractile) in 71.5% whereas type V (completely retractile) was only 5.5%. In adolescent boys type I prepuce was observed in 1 boy only, 1.6%, whereas type V was observed in 82.3%. Furthermore, it was observed that at the time of examination for the study 106 boys who had undergone forced dilation at an earlier age had balano-prepucial adhesions again, which demonstrates that prepuce adheres again to glans penis in many boys after a forced dilation is performed. Only 11 boys were considered in need for circumcision, three of them for prepucial orifice stenosis, which prevented normal micturition, causing a prepucial sac, one case due to a constrictive ring below the prepucial edge that would have prevented ulterior retractability, two cases with repetitive balanopostitis, and five cases secondary to xerosol balanitis, accounting for 2.7% of all examined boys. CONCLUSIONS: Incomplete separation between prepuce and glans penis is normal and common among new-borns, progressing until adolescence to spontaneous separation, at which time it is complete in the majority of boys. Accordingly to the criteria we have sustained for years and present study's findings, circumcision has few indications during childhood, as well as forced prepucial dilation.

Adolescent↗
PubMed2003

Circumcision for phimosis and other medical indications in Western Australian boys.

OBJECTIVE: To investigate the incidence rate of circumcision for phimosis and other medically indicated reasons in Western Australian boys from 1 January 1981 to 31 December 1999. DESIGN AND SETTING: A population-based incidence study using hospital discharge data of all circumcisions performed in all WA hospitals during the study period. MAIN OUTCOME MEASURES: Changes in the incidence rate of circumcision for medically indicated reasons. RESULTS: The rate of medically indicated circumcisions increased in boys aged less than 15 years during the study period. Phimosis was the most common medical indication for circumcision in all age groups. The rate of circumcision associated with phimosis was eight times that associated with balanoposthitis and 21 times that of balanitis xerotica obliterans. Boys aged less than five years had the highest rate of circumcision to treat phimosis, at 4.6 per 1000 person-years, representing about 300 circumcisions per year. Boys aged less than five years living in country areas were 1.5 times more likely to be circumcised for phimosis than boys living in metropolitan Perth. CONCLUSION: The rate of circumcision to treat phimosis in boys aged less than 15 years is seven times the expected incidence rate for phimosis. Many boys are circumcised before reaching five years of age, despite phimosis being rare in this age group.

Adolescent↗
PubMed2003

Reiter's syndrome.

Reiter's syndrome is a multisystem disease commonly triggered by a genitourinary infection or bacterial enteric infection. After a short latent period, ocular symptoms, oligoarthritis, and mucocutaneous involvement may occur. Classic cutaneous manifestations of Reiter's syndrome include keratoderma blennorrhagicum and balanitis circinata, both of which are microscopically similar to pustular psoriasis.

Adult↗
PubMedDate not supplied

[Epidemiology of urologic pediatric emergencies in our hospital, 1990].

The article's objective is to study the epidemiological patterns which define the paediatric urological emergencies within the area of influence of our hospital. To this end, 187 protocols of the paediatric emergencies attended by the urologist in 1990 were retrospectively reviewed. The most frequently observed pathologies were balanitis-phimosis, acute scrotum and genito-urinary injuries. A clear relationship of the type of disease to the patient's age and treatment, as well as some time-related variations were observed. About 40% of all cases could had been treated at a non-emergency outpatient clinic.

Adolescent↗
PubMed2003

[Clinical characteristics of children with enthesitis related arthritis].

OBJECTIVE: To study clinical characteristics of children with enthesitis related arthritis (ERA). METHODS: Twelve patients fulfilling the international league of associations for rheumatology (ILAR) criteria for classification of juvenile idiopathic arthritis (JIA) and ERA were referred to our department between August and November, 2002. Their gender, age, family history, clinical manifestations, imaging data, laboratory data and treatment regimens were analyzed retrospectively. RESULTS: Of the 12 patients, 11 were male, only one was female; their age ranged from 4 to 16 years, and the median age was 10.5 years. Ten (83%) of the patients were older than eight years. Among their first degree relatives, one had definite ankylosing spondylitis (AS), and 3 presented with a history of inflammatory low back pain. Enthesitis occurred in 9. Synovitis occurred in 11, most of which were oligoarthritis, predominantly affecting large joints of the lower limbs in an asymmetric pattern. Seven patients underwent CT scan, and only one had erosions of the sacroiliac joints to achieve a diagnosis of juvenile AS. Ten had fever at the onset, and one had a history of diarrhea preceding the symptoms of arthritis. Urethritis and balanitis circinata occurred in 3 cases fulfilling the classification criteria of Reiter's syndrome, with conjunctivitis in 2 and corneitis in one. Elevated inflammatory indicators such as white blood cell, neutrophil, platelet, erythrocyte sedimentation rate, C-reactive protein, immunoglobulins and serum complement C3 were common during the acute illness. Mild anemia was found in 4, and reactive hemophagocytosis in 4 bone marrow specimens. DNA of human parvovirus B19 was detected in sera of 2 cases. One had positive IgM antibody to coxsackie virus B. All 12 cases were rheumatoid factor negative and HLA-B27 positive. Nonsteroidal anti-inflammatory drugs and sulfasalazine were the mainstay of treatment. Corticosteroids were added in 3 cases as a "bridge" therapy due to the severe systemic inflammation. Methotrexate was used in 4 cases with refractory disease or with the hip involved, and in 2 of them cyclophosphamide was added. CONCLUSION: The clinical characteristics of ERA can facilitate an early diagnosis so as to avoid joint damage and disabilities.

Adolescent↗
PubMed1992

Premalignant and early carcinomas of the penis and scrotum.

Premalignant penile lesions are a spectrum of diseases ranging from those that are almost always benign to neoplasms that are carcinoma in situ. Balanitis xerotica obliterans is a localized variant of lichen sclerosus et atrophicus. The Buschke-Löwenstein tumor is a low-grade malignancy, whereas erythroplasia of Queyrat is a carcinoma in situ. Obtaining the correct diagnosis may challenge even the skilled clinician. It is increasingly likely that papillomaviruses play a role in the development of some cases of penile carcinoma. Scrotal cancer has both historical and current significance as an indicator of occupational health. Occasionally, extramammary Paget's disease presents as a primary scrotal neoplasm.

Carcinoma↗
PubMedDate not supplied

Juvenile onset Reiter's syndrome. A retrospective study of 26 patients.

Clinical, laboratory and radiological findings were evaluated in 26 children with Reiter's syndrome, all of whom met the 1982 diagnostic criteria of A. Calin. Twenty-two of the patients (85%) were male and 4 were female (15%); the mean age at onset was 10.5 years (range 4-15.5 yrs). Mean follow-up time was 28.6 months. Diarrhea prior to onset was observed in 18 cases (69%), but there was no report of venereal disease. The full classic triad was initially observed in only 9 patients (35%), urethritis alone in 6 (23%) and conjunctivitis alone in 4 (15%). Arthritis was present in all patients, with the lower limb joints involved in 25 cases (96%); the pattern was pauciarticular in 18 (69%), polyarticular in 7 (27%) and monoarticular in one (4%). There was complete remission in 15 out of the 26 patients (58%), while a sustained and fluctuating course was seen in 7 (27%) and 3 (11.5%) patients, respectively; a single patient showed a remitting course. Balanitis was present in 11 out of the 22 male (50%) cases. Twelve out of 18 patients tested (67%) proved to be HLA B27 positive and there was radiological evidence of sacroiliitis in 5 out of 24 patients (21%). Reiter's syndrome should be included in the differential diagnosis of the arthritic child. As a rule, the course of joint involvement is remittent and sequelae affecting functional capacity are indeed exceptional.

Adolescent↗
PubMed1992

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↗
PubMed2006

[Prospective study of sexually transmitted infections in Dakar, Senegal].

The objectives of this study conducted from January to December 2001 at our reference centre for sexualy transmitted infections (STI) were to determine the epidemiological profile of men who consulted our facility for symptomatic STI, describe the clinical manifestations of STI, and propose recommendations for improving therapeutic management of STI in tropical areas. A total of 100 men consulting for symptomatic STI were included over the one-year study period. In addition to administering a standardized questionnaire to each patient, a thorough clinical examination especially of the urogenital tract was performed and blood and urethral discharge specimens were obtained for analysis at the Reference STI laboratory of Institut d'Hygiène Sociale (IHS). Analysis of study data demonstrated that the mean age of patients was 25 years, that 52% were single, and that level of education was generally low (primary school for 37% and secondary school for 27%). However it should be pointed out that 12% of patients had a university level education. Most patients were Wolof people living in or around Dakar and working in the trades sector (shopkeeper, artists, tailors, drivers, and seamen). Thirty-seven percent of patients reported previous STI involving urethral discharge in 34% and genital ulcer in 3%. Risk factors included sex with random partners in 51% including 31% with prostitutes, more than two partners at the time of the study in 34%, and regular alcohol use in 44%. Neisseria gonorrhoea was by far the most frequent infectious agent found in urethral discharge specimens (52%). Genital ulcer was found in only 13 cases. Eight of 13 patients with genital ulcers had positive syphilis serology suggesting that syphilis was the most frequent aetiology. The other aetiologies were uncommon STI, ie., condyloma (n=3), balanitis (n=2), venereal lymphogranuloma (n=1) and secondary syphilis (n=1). Serology was positive for HIV in 4% of patients. The epidemiologic profile of the patients in our study was similar to those previously reported in the literature. However it is interesting to note the non-negligible number of cases of STI transmission involving illegal prostitution, the high incidence of mismanagement of STI by the health care workers who provided initial treatment, the poor availability of drugs used for treatment of STI therapy in the centre's Banako Initiative (BI) pharmacy, and the frequency of condom non-use by patients with STI.

Adult↗