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PubMed2006

Penile carcinoma arising in balanitis xerotica obliterans.

Squamous cell carcinoma of the penis is an uncommon cancer, though in one study it accounted for 90% of all penile cancers. Its association with balanitis xerotica obliterans (BXO) is a rare though recognized occurrence. We describe a case of a 46-year-old Caucasian male who first presented to our open-access clinic with a mild phimosis. An elective circumcision was performed and histological examination of the circumcision specimen showed BXO. He was lost to follow-up but re-presented three years later with a persistent tender penile ulcer which on biopsy showed no obvious sinister pathology. He returned a further two years later with a short history of bleeding from the ulcer, and another biopsy now confirmed penile squamous cell carcinoma. Our case emphasizes the importance of regular review of patients with BXO, in particular those with persistent symptoms.

Balanitis↗
PubMed2006

Is frenuloplasty worthwhile? A 12-year experience.

INTRODUCTION: Frenuloplasty is commonly performed. Its outcome has never been reported. PATIENTS AND METHODS: We have performed 213 frenuloplasties since 1992. Patients were sent a questionnaire regarding indication, treatment advised on presentation, anaesthetic, outcome (linear analogue satisfaction score), and further intervention required. RESULTS: Overall, 48 of 209 (23%) patients replied (median age of series, 27 years; range 16-78 years: and of respondents, 27 years; range, 17-78 years). Indications included tearing/bleeding of the foreskin (n = 32), balanitis (n = 3), pain on intercourse (n = 26), phimosis (n = 4), ejaculatory (n = 1) and hygiene (n = 1) problems. Twenty-five patients received general anaesthesia. Median satisfaction score was 8 (range, 1-10). Thirty-four patients would recommend frenuloplasty to another with similar symptoms. Three of nine patients initially advised to undergo circumcision later underwent circumcision (frenuloplasty satisfaction score, 1-3), 1 awaits circumcision (score, 5), 1 has a tight foreskin (score, 3), and 4 are satisfied (scores 6,9,10,10). In total, 23 of 209 patients (11%; median age, 27 years) underwent circumcision following frenuloplasty. Median time to circumcision was 11 months (range, 5-52 months). CONCLUSIONS: This is the only reported series of frenuloplasty. The response rate reflects a young mobile population. Most men are satisfied with the outcome, including some initially advised to undergo circumcision. The overall rate of circumcision following frenuloplasty is likely to be 15-20%.

Adolescent↗
PubMedDate not supplied

Chronic penile strangulation.

Chronic penile strangulation is exceedingly rare with only 5 cases previously reported. We report an additional case of progressive penile lymphedema due to chronic intermittent strangulation caused by a rubber band applied to the penile base for 6 years. A 49-year-old man presented incapacity to exteriorize the glans penis. For erotic purposes, he had been using a rubber-enlarging band placed in the penile base for 6 years. With chronic use, he noticed that his penis swelled. Physical examination revealed lymphedema of the penis, phimosis and a stricture in the penile base. The patient was submitted to circumcision and the lymphedema remained stable 10 months postoperatively. Chronic penile incarceration usually causes penile lymphedema and urinary disturbance. Treatment consists of removal of foreign devices and surgical treatment of lymphedema.

Journal Article↗
PubMedDate not supplied

Etiology of urinary tract infection in scholar children.

OBJECTIVE: To prospectively assess the prevalence of vesicourethral dysfunction in children over 3 years old, comparing it with the occurrence rate for other potential factors that cause urinary infection in this age range. MATERIALS AND METHODS: 36 girls and 9 boys were assessed, with mean age of 6.4 years, ranging from 3 to 13.9 years. These children were prospectively assessed regarding the presence of symptoms of lower urinary tract dysfunction. These data were compared with the retrospective assessment of other potential risk factors for urinary infection. Ultrasonography was performed in 28 children and voiding cystourethrogram was performed in 26 patients. RESULTS: Vesicourethral dysfunction was diagnosed in 39 (87%) of the 45 children with urinary infection. Among these 39 patients, all had voiding urgency, 30 (77%) had urinary incontinence, 12 (31%) pollakiuria and 3 (8%) presented infrequent voiding. Vaginal discharge was evidenced in 8 (22%) girls and phimosis in 2 (22%) boys. Obstipation was diagnosed in 10 (22%) cases. Significant post-voiding residue was detected in 4 (13%) of the 28 cases assessed. Vesicoureteral reflux was evidenced in 5 (19%) of the 26 patients who underwent voiding cystourethrogram. In only 2 (4%) cases there was not an apparent cause for the infection. CONCLUSION: Vesicourethral dysfunction is a major cause of urinary infection in children with ages above 3 years old. In cases where voiding dysfunction in not present, other predisposing factors must be assessed. However, only 4% of the patients did not present an apparent urologic cause for the infection.

Journal Article↗
PubMedDate not supplied

Urogenital involvement in the Klippel-Trenaunay-Weber syndrome. Treatment options and results.

OBJECTIVE: Klippel-Trenaunay-Weber syndrome (KTWS) is a congenital condition characterized by vascular malformations of the capillary, venous and lymphatic systems associated to soft tissue and bone hypertrophy in the affected areas. This syndrome may involve bladder, kidney, urethra, ureter and genitals. We report the treatment of 7 KTWS patients with urogenital involvement. MATERIALS AND METHODS: From 1995 to 2005, 7 patients with KTWS were evaluated and the charts of these patients were reviewed. RESULTS: Patients' median age was 19-years (range 4 to 46-years) and only 1 was female. The clinical presentation included genital deformities in 3 cases, hematuria in 2 and urethrorragia in 2, one of which associated with cryptorchidism and phimosis. Three patients had an association of pelvic and genital malformations, including 2 patients with hematuria due to vesical lesions and 1 patient with left ureterohydronephrosis due to a pelvic mass. Two patients had urethral lesions. Treatment included endoscopic laser coagulation for 1 patient with recurrent hematuria and 1 patient with urethrorrhagia, pelvic radiotherapy for 1 patient with hematuria and circumcision in 2 patients with genital deformities. One patient required placement of a double-J catheter to relieve obstruction. Hematuria and urethrorragia were safely and effectively controlled with laser applications. Circumcision was also effective. The patient treated with radiotherapy developed a contracted bladder and required a continent urinary diversion. CONCLUSIONS: Urogenital involvement in patients with KTWS is not rare and must be suspected in the presence of hematuria or significant cutaneous deformity of the external genitalia. Surgical treatment may be warranted in selected cases.

Adolescent↗
PubMed1978

Metabolism of androstenedione in skin and serum levels of gonadotrophins and androgens in prepubertal boys with hypospadias.

The metabolism of 4-[1,2-3H]androstene-3,17-dione in the prepuce, axillary skin and skin from the arm was investigated in 27 boys operated for phimosis (controls) and 13 unselected boys with hypospadias (a congenital defect of the male urethra). In all types of skin investigated, androstenedione was metabolized to 5alpha-androstane-3,17-dione, 3alpha-hydroxy-5alpha-androstan-17-one, 3beta-hydroxy-5alpha-androstan-17-one and testosterone. Conversion to testosterone was found in the prepuce of two out of 11 boys with hypospadias. Mild forms of hypospadias in the age group 1--4 years had a higher level of 5alpha-reductase activity in the prepuce than controls in the same age group (P less than 0.05); no such differences were found in the few severe cases of hypospadias in this group. No other differences in 5alpha-reductase activity were found between hypospadic boys and controls. The ratio of 5alpha-reductase activity in the prepuce: 5alpha-reductase activity in skin from the arm was significantly higher (P less than 0.05) in hypospadic boys than in controls in the age group 1--4 years. Serum levels of LH and FSH were the same in normal and hypospadic boys but the concentration of prolactin in the serum was lower in boys with hypospadias compared with control subjects in the age group 1--4 years (P less than 0.005). No differences were found in serum concentrations of androstenedione, testosterone, oestradiol and testosterone-binding globulin.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMedDate not supplied

Balanitis xerotica obliterans and its differential diagnosis.

BACKGROUND: Balanitis xerotica obliterans is a subcategory of lichen sclerosus et atrophicus limited to the male genitalia and is associated with destructive inflammation, phimosis, urethral stenosis, and squamous cell carcinoma. METHODS: The medical literature was searched from 1983-1998 using key words balanitis, lichen, and sclerosis using the MEDLINE system. RESULTS AND CONCLUSIONS: Balanitis xerotica obliterans can be distinguished from other genital dermatoses with similar characteristics through patient history, clinical findings, and laboratory evaluation.. Tzanck smear and cutaneous biopsy, along with a rapid protein reagin test, will provide a definitive diagnosis. Treatment with high-dose topical corticosteroids relieves symptoms, and therapy focuses on prevention of disease progression.

Administration, Topical↗
PubMed2006

[Our experience with the Nesbit technique for the treatment of Peyronie's disease].

OBJECTIVES: The Nesbit technique is the reference technique for the surgical correction of the penile incurvation of Peyronie's disease. We report our experience at the Centro Urológico San Ignacio. METHODS: 68 patients with stable penile incurvation who requested surgical correction. Correction of the curvature is defined as > or = 80% rectification of the pathologic angle. Mean patient age was 44 years (31-77). 53% of the patients presented difficulties for penetration, 20% partner's discomfort on intercourse, and 27% requested surgery for aesthetic reasons. Penile deviation was dorsal in 42% of the patients, to the left in 46% and to the right in 12%. The curvature angle was less than 30 degrees in 28%, between 30 degrees-45 degrees in 36%, between 45 degrees-60 degrees in 37% and > 60 degrees in 7%. RESULTS: Mean follow-up of the series was 36 months. 20% of the patients had a penile shortening longer than 1.5 cm. 85% of the patients are satisfied with the results. The most frequent complaint was penile shortening. Correction was achieved in 92% of the patients. Four patients were reoperated: two of them for significant phimosis three months after surgery, and the other two for curvature recurrence. CONCLUSIONS: The Nesbit technique is a simple technique, with a low complication rate, and good results both in curvature correction and patient satisfaction.

Adult↗
PubMed2003

Medical history and medical practice: persistent myths about the foreskin.

Although many 19th-century misconceptions about the foreskin have been dispelled since it was shown that infantile phimosis was not an abnormality, the ideas that ritual or religious circumcision arose as a hygiene measure, and that circumcision makes no difference to sexual response, have persisted. The first idea should be dismissed as a myth and the second has been seriously questioned by modern research.

Circumcision, Male↗
PubMed1989

[A study on genital skin androgen receptor by dispersed cell method].

We have measured androgen receptor in whole cell, cytosol and nuclear fractions of cultured skin fibroblasts originated from the genital area. Samples were obtained from the following patients: 10 boys with phimosis, 5 boys with cryptorchism, 4 boys and a man with hypospadia, 2 infertile men and 3 normal men. Androgen receptor was measured using methyltrienolone (R1881) as the ligand according to the assay technique of Eil et al. using dispersed cell method. The results were as follows: 1. There were no significant statistical differences in the dissociation constant among the diseases. 2. Hypospadia cases showed lower maximum binding capacities (Bmax) of whole cell than phimotic boys but the difference was not statistically significant. 3. The Bmax of normal men were statistically higher than those of phimotic boys and about 80% of these receptors were seen in the nuclear fraction. We also experienced low Bmax levels in an adult hypospadia case and two infertile men. These results suggest that this method is a simple and rapid method to study both nuclear and cytosol androgen receptor at the same time. It is also suggested that there are some cases with reduced androgen receptor levels in hypospadia and infertile cases.

Adolescent↗
PubMed1992

[A case of Noonan syndrome with neurogenic bladder].

We report a case of Noonan syndrome with neurogenic bladder. The patient was a 33-year-old man with a chief complaint of difficulty in urination, urinary frequency, and incontinence of urine. He had also various malformations, as deformities of the face, skull and hard palate, webbed neck, nail abnormality, edema of the lower extremities, contraction of visual field, deafness, malrotation of the intestine and so on. The case was diagnosed as Noonan syndrome because his karyotype of chromosome was 46, XY. Malformations of the urogenital organs were mild malrotation of bilateral kidneys, a right renal cyst, left cryptorchidism and pseudo phimosis. The uroflowmetrogram of the case showed a saw-like and flat pattern, with urination starting by tapping lower abdomen by himself. The cystometry and electromyogram of the external sphincter revealed neurogenic bladder with uninhibited contraction and detrusor-external sphincter dyssynergia. This is the first case of Noonan syndrome with neurogenic bladder.

Adult↗
PubMedDate not supplied

[The webbed penis. A report of a new case].

OBJECTIVE: To report an additional case of webbed penis or penis palmatus, an uncommon malformation caused by alterations that occur during the embryonic development of the external genitalia. METHODS: A 15-year-old by consulted for penile curvature. He was diagnosed as having webbed penis and phimosis, and was submitted to surgery. RESULTS/CONCLUSIONS: Z-plasty and circumcision achieved excellent results. He had no erectile anomalies following surgery.

Adolescent↗
PubMed1999

[Diagnostic and prognostic evaluations of sterility and the Sierre Hospital. 389 cases].

AIM OF THE STUDY: The management of infertile couples at regional hospital level is rarely reported and is generally less known, whereas the activity of university infertility clinics is usually the reference. We evaluate the diagnostic approach to infertile couples at the Regional Hospital of Sierre. METHOD: The medical charts of 389 couples presenting with infertility between 1989 and 1996 were reviewed. The investigations and interpretation of results were always performed by the same investigator. RESULTS: A lower pregnancy rate was observed in the case of a pathological postcoital test and when proximal tubal occlusion or phimosis were diagnosed by hysterosalpingography or laparoscopy. In our population, age of the female partner > 40 years, duration of infertility of more than 36 months and multifactorial, male and female, aetiology of infertility were significantly associated with a poor prognosis (p < 0.001). For the assessment of tubal patency, hysterosalpingography and laparoscopy with chromopertubation showed an acceptable level of agreement (kappa coefficient = 0.58). Hysterosalpingography does not provide a precise diagnosis in peritoneal and ovarian pathology (72.9% sensitivity, 55.7% specificity). A third of pregnancies were obtained without treatment during the diagnostic study of the menstrual cycle, or after hysterosalpingography and laparoscopy with chromopertubation. CONCLUSION: Most diagnostic procedures for infertility can be performed in a regional hospital by an infertility specialist collaborating closely with a university centre. When infertile couples are transferred to a university centre their evaluation is simplified, as they have already completed an initial systematic investigation and treatment plan at the regional hospital. This two-step approach may be beneficial in selecting couples who need specific treatment not available in a regional hospital.

Adult↗
PubMed1999

Diagnostic laparoscopy in infertile women with normal hysterosalpingograms.

OBJECTIVE: To assess the value of laparoscopy in infertile women with normal hysterosalpingograms, with and without risk factors suggesting pelvic disease. STUDY DESIGN: We retrospectively reviewed 1,022 consecutive charts from a tertiary infertility practice. In 265 women, laparoscopies were performed after normal hysterosalpingograms. RESULTS: Laparoscopies were normal in 136 (51%) women, whereas 129 (49%) had one or more abnormal laparoscopic findings, including minimal or mild endometriosis (n = 85), moderate or severe endometriosis (n = 11), adnexal adhesions (n = 27), subserosal myomas (n = 17), ovarian neoplasms (n = 5), distal phimosis (n = 1) and salpingitis isthmica nodosa (n = 1). Only 7% of cases had findings that might require standard operative laparoscopy or laparotomy, although not all were causally related to infertility. A history of dysmenorrhea or dyspareunia increased the likelihood of detecting endometriosis from 41% to 64% and 69%, respectively. The presence of both symptoms increased the likelihood to 83%. CONCLUSION: In the presence of a normal hysterosalpingogram, laparoscopy identified other pelvic disease in about half of patients. Because most abnormalities were mild, this knowledge can be used to plan a micro-laparoscopic approach for many women, reserving traditional or operative laparoscopy for women with an abnormal hysterosalpingogram or extensive disease following micro-laparoscopy. Alternately, knowledge of the nature and severity of the expected laparoscopic findings might lead to bypassing laparoscopy in favor of assisted reproduction when the perceived benefit of surgical intervention is small.

Adnexal Diseases↗
PubMedDate not supplied

[Gas-containing balano-preputial abscess; diagnostic and therapeutic approach].

OBJECTIVE: A case of balanopreputial abscess containing gas in a patient with adhesion of the glans penis to preputial mucosa is presented. METHODS: The clinical features, diagnostic methods (penile ultrasound) and treatment (debridement + step (staged?) circumcision) are described. RESULTS/CONCLUSIONS: Severe phimosis and balanopreputial adhesions can cause urological complications as shown in the case described. Ultrasound demonstrated the presence of abscess and gas.

Abscess↗
PubMed2000

[Epidermoid carcinoma of the penis].

OBJECTIVE: To analyze our series and review the prognostic factors in the treatment of epidermoid carcinoma of the penis. METHODS: Age, time to consultation, circumcision, form of presentation, local treatment, tumor stage and grade, lymph node involvement and outcome were analyzed in 27 cases of carcinoma of the penis diagnosed at our hospital from 1981 to 1999. RESULTS: The incidence rate was 1.8 cases/100,000 men/year. No patient had been circumcised, except one who was circumcised in the adult age. The median time to consultation was 24 months (interquartile range: 60-7.75). The median follow-up was 37 months (interquartile range: 84-12). All patients with pT1GI-II and pT2G-II primary tumor (n = 21; 78% of the series) and with no lymphadenopathy were disease-free at 6 months' minimum follow-up [17 of the 21 patients (81%) had more than 32 months' follow-up]. Only one patient with pT1-GII tumor, but with a vertical growth pattern, had positive inguinal lymph nodes (pN2). The remaining patients with lymph node involvement showed infiltration of the erectile tissue and moderately or poorly differentiated tumors. Only two prophylactic lymphadenectomy procedures were performed (pN0). Regardless of treatment, 5 of the 6 patients with lymph node involvement died within one year after diagnosis. CONCLUSIONS: Given the demonstrated relationship between carcinoma of the penis and hygiene, and phimosis which makes hygiene difficult, circumcision should be performed in childhood. Furthermore, circumcision at this age has been demonstrated to have a prophylactic value that disappears in the adult age.

Adult↗
PubMedDate not supplied

[Modification of meatoglanuloplasty (MAGPI-Duckett) for treatment of balanic and coronal forms of hypospadia in children].

14 boys with balanic hypospadia (BH) and 23 boys with coronal hypospadia (CH) aged 9 months to 15 years were operated in 1997-2000. For 13 boys this operation was meatoglanuloplasty (MAGPI) by J. Duckett. Complications occurred in 4 boys: retraction (downwards) of the meatus (n = 2), urethral stenosis and urinary fistula (n = 2). 24 boys have undergone modified MAGPI operation. The modification consists in extended mobilization of the lateral parts of the head with longitudinal consecutive incisions along the head margin into the spongy bodies. The head is closed by suturing its mobilized margins with two rows of interrupted monofilamentous (PDS, prolene) sutures above the urethra. A variant of saving foreskin is possible when partial separation of the internal and external layers is made bilaterally with consecutive circular closure of the preputial sac. Phimosis is prevented by a relief longitudinal incision along the internal foreskin and transverse suturing. The patients were followed up for 2 months to 1.5 years. The original operation MAGPI provided good cosmetic and functional results in 9 boys(69.2%), satisfactory in 2 boys(15.4%), unsatisfactory also in 2 boys(15.4%). The modified MAGPI operation provided only good cosmetic and functional results. Thus, the proposed modification (MAGPI-Duckett) ensures a more reliable variant of meatoglanuloplasty in balanic and coronal hypospadia irrespective of the size and shape of the head, presence of the scaphoid fossa or meatostenosis. These additional procedures helped to reduce the number of postoperative complications and improved cosmetic and functional results.

Adolescent↗
PubMed2001

Common urologic problems in children: guides to evaluation and referral, Part I.

A discussion of common urologic problems in children is presented to provide primary physicians with appropriate guidelines for evaluation and referrals. The problems will be discussed in two parts: Part I will cover urinary tract infections, voiding dysfunctions, hematuria and proteinuria. Part II will cover abnormalities found on antenatal renal ultrasonography, hypospadias and other penile anomalies, phimosis, undescended testes, inguinal hernia and hydrocele, and varicoceles. An adage states: "The questions in medicine never change over time--only the answers." Certainly the busy primary care physician may experience the frustration of changing evaluation guidelines established by narrow subspecialties. Guidelines for the evaluation of children with disorders of the genitourinary tract are no exception. The following presentation will address some of the most common childhood urologic problems with a brief discussion of how to evaluate and when to refer for pediatric urologic consultation or management.

Arkansas↗