Scrotal flap penoplasty of the paraffinomas penis: 15 years of experience.

A two-stage scrotal flap penoplasty was carried out on a paraffinomas penis. In the first stage, total excision of the penile paraffin-containing skin was performed; The denuded penis was embeded in the subcutaneous tunnel of the scrotal sac. A scrotal skin flap for covering the penile shaft was separated after four months. During the past 15 years, a study was undertaken on 174 patients with an average age of 44 years (figure I). A satisfactory result was found in 148 patients, with 26 cases having required minor corrective surgery (table 1). Satisfactory sexual function was found in 168 patients, mildly painful intercourse in four patients and impotency in two cases (table 2). The post operative complications (table 3) were mild graft infection in 32 patients, partial graft necrosis in 11 cases redundant penile skin in 16 cases and tortious shape of the scrotum in 15 cases. All the patients presented to the hospital, complaining of abnormal penile shape and unsuccessful sexual intercourse.

Current status of kidney transplantation in Thailand.

The first kidney transplantation in Thailand was done on March 3, 1972 at Chulalongkorn University Hospital in Bangkok. At present, twenty hospitals (both government and private) are performed this operation. The total number of transplant patients was reported (excluded 4 hospitals) for 750 patients up to September 1995. The average age was 38 years and the male to female ratio was 3:2 (450:300). The chronic glomerulonephritis is the leading cause of end stage renal diseases. Other causes were nephrosclerosis, stone, diabetes, polycystic kidney disease, IgA nephropathy and interstitial nephritis of unknown etiology. The replacement was CAPD and hemodialysis in an average ratio of 20:80. The donor were 86% cadaveric and 14% living related donors. The one year success rate was 95% with living donors and 87% with cadaveric donors; after five years was 82% with living and 64% with cadaveric donors. The major causes of graft loss were chronic rejection, infection and vascular complications (renal artery stenosis or renal vein thrombosis). The causes of death were studied in 122 patients. All of them survived more than five years. Forty percent (49 patients) died from infection; thirty nine percents (47) denied further dialysis treatments. The rest from other organ failure (11), heart diseases (3) and two were unknown cause. The sources of major infections were bacterial (23 patients), two of them were tuberculosis. The other were viral (HSV, HB and unknown) only two CMV were suspected and two were Cryptococcus infections. The urological complications were reported in 55 patients; forty percents (22) was urinary leakage. The immunosuppressive agents were prednisolone, cyclosporine A, azathioprine with occasionally ALG and OKT3. The double regimen of prednisolone + cyclosporine A accepted for more than 70%. The brain death criteria was submitted by the National Medical Board Meeting was accepted for our cadaveric donors.