Carcinoma de células escamosas (cce) em cão na região prepucial: relato de caso / Squamous cell carcinoma (scc) in dog in the preputial region: case report / Carcinoma de células escamosas (cce) en perro de la región prepucial: reporte de un caso

A expectativa de vida dos animais de companhia vem aumentando devido as mudanças comportamentais e de cuidados dos tutores. Em analogia, com as idades cada vez mais avançadas, é comum o desenvolvimento de doenças associadas, sendo o tumor o mais comum entre elas. Todavia, as neoplasias mais comuns na clínica de pequenos animais estão associadas ao sistema tegumentar. O carcinoma de células escamosas (CCE), ou carcinoma espinocelular, é uma neoplasia de epitélio, maligno, de crescimento lento e de baixo potencial metastático. Sua etiologia ainda não é precisamente conhecida e a causa exógena mais comum e descrita pela literatura é a exposição à luz ultravioleta, gerando consequentes lesões nas estruturas genéticas e imunogênicas na pele. Além disso, essas lesões apresentam-se de forma mais comum em animais de pelagem clara, com grande exposição solar e em área anatômicas hipopigmentadas. O prognóstico varia de acordo com a localização e o estágio clínico, sendo favorável o diagnóstico realizado precocemente, e o tratamento consiste na avaliação clínica seguida do protocolo adequado O presente relato de caso tem como objetivo principal reunir e discutir informações associadas sobre o carcinoma de células escamosas em caninos e felinos, abordando aspectos clínicos e patológicos, a fim de facilitar o raciocínio sobre o CCE, desde sua abordagem inicial, até seu diagnóstico final e estadiamento.(AU)

The life expectancy of companion animals has been increasing due to behavioral and care changes of the guardians. In analogy, with the increasingly advanced ages, the development of associated diseases is common, the tumor being the most common among them. However, the most common neoplasms in the small animal clinic are associated with the integumentary system. Squamous cell carcinoma (SCC), or squamous cell carcinoma, is a malignant, slow-growing, low-potential metastatic epithelial neoplasm. Its etiology is not yet precisely known and the most common exogenous cause described by the literature is exposure to ultraviolet light, generating consequent lesions on the genetic and immunogenic structures in the skin. In addition, these lesions are more common in light-haired animals, with high exposure to the sun, and in hypopigmented anatomical areas. The prognosis varies according to the location and clinical stage, being favorable to the early diagnosis, and the treatment consists in the clinical evaluation followed by the appropriate protocol. The present case report has as its main objective to gather and discuss associated information about squamous cell carcinoma in canines and cats, addressing clinical and pathological aspects, in order to facilitate the reasoning about the CCE, from its initial approach, to its final diagnosis and staging.(AU)

La esperanza de vida de los animales de compañía ha ido en aumento debido a los cambios de comportamiento y cuidado de los guardianes. Por analogía, con las edades cada vez más avanzadas, el desarrollo de enfermedades asociadas es común, siendo el tumor el más común entre ellos. Sin embargo, las neoplasias más comunes en la clínica de animales pequeños se asocian con el sistema tegumentario. El carcinoma epidermoide (CCE), o carcinoma epidermoide, es una neoplasia epitelial metastásica maligna de crecimiento lento y bajo potencial. Su etiología aún no se conoce con precisión y la causa exógena más común descrita por la literatura es la exposición a la luz ultravioleta, generando lesiones consecuentes en las estructuras genéticas e inmunogénicas de la piel. Además, estas lesiones son más comunes en animales de pelo claro, con alta exposición al sol, y en áreas anatómicas hipopigmentadas. El pronóstico varía según la localización y el estadio clínico, siendo favorable al diagnóstico precoz, y el tratamiento consiste en la evaluación clínica seguida del protocolo adecuado. El presente reporte de caso tiene como objetivo principal reunir y discutir información asociada sobre el carcinoma epidermoide en caninos y gatos, abordando aspectos clínicos y patológicos, con el fin de facilitar el razonamiento sobre el CCE, desde su abordaje inicial, hasta su diagnóstico final y estadificación.(AU)

Abordaje quirúrgico primario en un paciente con eritroplasia de Queyrat / Primary surgical approach to a patient with erythroplasia of Queyrat

Presentación del caso. Paciente masculino de 52 años que se presentó a la consulta de urología con historia de dos años de notar una lesión en el glande y el prepucio, de color rojo brillante, pruriginosa y dolorosa con aumento progresivo del tamaño que no mejoró con tratamientos antibióticos y anti fúngicos. Intervención terapéutica. Se realizó una glandectomía parcial con injerto de piel de muslo. Evolución clínica. Luego de un mes, el injerto presentó un 95 % de acoplamiento. No se observó recurrencia local de cáncer. El estudio histopatológico reportó un carcinoma escamoso invasor en la lesión del prepucio y en la piel del glande, con todos los márgenes quirúrgicos, limites laterales y profundos, negativos a malignidad. Luego de ocho meses posquirúrgicos, se observó el recubrimiento del glande con un adecuado resultado estético, con apariencia similar a la cubierta natural

Case presentation. A A 52-year-old male patient presented to the urology office with a two-year history of noticing a bright red, pruritic, and painful lesion on the glans and foreskin with a progressive increase in size that did not improve with antibiotic and antifungal treatments. Treatment. Partial glandectomy with thigh skin graft was performed. Outcome. After After one month, the graft presented a 95 % of coupling. No local recurrence of cancer was observed. The histopathological study reported invasive squamous cell carcinoma in the lesion of the foreskin and glans skin, with all surgical margins, lateral and deep limits, negative for malignancy. After eight months post-surgery, the covering of the glans was observed with an appropriate esthetic result, with a similar appearance to the natural covering

Why human prepuce is a valuable resource in science? Histological, ultrastructural, immunohistochemical and statistical analysis / ¿Por qué el prepucio humano es un recurso valioso en la ciencia? Análisis histológicos, ultraestructurales, inmunohistoquímicos y estadísticos

SUMMARY: This research was to examine the histological and ultrastructural characteristics of prepuce samples, as well as vimentin and S100 protein localization and statistical analysis. Urologists have long struggled with the prepuce, which is used to treat a variety of urethral problems. Skin biopsies were collected from the prepuce at the moment of circumcision and processed for light microscopy, electron microscope examination, immunohistochemical techniques, and statistical analysis in a total of six boys. Histologically, the prepuce epidermis displayed focal spiky ridges, which are saw-toothed interspersed with sulci, slight hyperpigmentation, looser connective tissue and plentiful vascular components. Immunohistochemically, the existence of melanocytes and Langerhans cells in the epidermis, as well as smooth muscles in the dermis, was stained positively for vimentin. Also, there was a positive reactivity of the Langerhans cells in the epidermis and around Meissner's corpuscles in the dermis for S100 protein staining. Ultrastructurally, the prepuce's intercellular gaps were widened, melanocytes rested on a folded basement membrane, and desmosomal content was reduced, with a prominent active euchromatic nucleus. Cytoplasmic projections were distended and elongated, and the interstitial blood vessels were surrounded by endothelial cells and rested on a basement membrane. There were also minimal collagen fibers in the interstitium. The prepuce's histological and ultrastructural features, as well as immunohistological studies using vimentin and S100 protein as intermediate filaments and statistical analysis, all demonstrated that it is a useful scientific resource.

RESUMEN: El presente trabajo de investigación se realizó para examinar las características histológicas y ultraestructurales de las muestras de prepucio, así como la localización y el análisis estadístico de la vimentina y la proteína S100. Los urólogos han intentado trabajar durante mucho tiempo con el prepucio, que se usa para tratar una variedad de problemas uretrales. Se recolectaron biopsias de piel del prepucio de seis niños en el momento de la circuncisión y se procesaron para microscopía óptica, examen con microscopio electrónico, técnicas inmunohistoquímicas y análisis estadístico. Histológicamente, la epidermis del prepucio mostraba crestas puntiagudas focales, intercaladas con surcos, hiperpigmentación leve, tejido conectivo más laxo y abundantes componentes vasculares. Inmunohistoquímicamente, la existencia de melanocitos y células dendríticas epidérmicas (células de Langerhans), así como músculo liso en la dermis, se tiñeron positivamente para vimentina. Además, hubo una reactividad positiva de las células dendríticas epidérmicas en la epidermis y alrededor de los corpúsculos del tacto (de Meissner) en la dermis para la tinción de la proteína S100. Ultraestructuralmente, los espacios intercelulares del prepucio se ensancharon, los melanocitos descansaban sobre una membrana basal plegada y el contenido desmosómico se redujo, con un núcleo eucromático activo prominente. Las proyecciones citoplasmáticas estaban distendidas y alargadas, y los vasos sanguíneos intersticiales estaban rodeados por células endoteliales y descansaban sobre una membrana basal. También había fibras de colágeno mínimas en el intersticio. Las características histológicas y ultraestructurales del prepucio, así como los estudios inmunohistológicos utilizando vimentina y proteína S100 como filamentos intermedios y el análisis estadístico, demostraron que es un recurso científico útil.

Padronização do exame ultrassonográfico do prepúcio e da parte livre do pênis em bovinos / Standardization of ultrasound examination of the prepuce and free end of the bovine penis

A ultrassonografia é um exame complementar não invasivo ainda pouco utilizado na avaliação prepucial e sem descrições detalhadas da parte livre do pênis (PLP) de bovinos. Este estudo objetivou padronizar a ultrassonografia prepucial em bovinos hígidos da raça Nelore com um ano de idade e, para tanto, descreveu o aspecto da lâmina interna prepucial (LIP) e da PLP, determinando as principais janelas acústicas, a viabilidade da utilização de contraste no lúmen da cavidade prepucial (LCP) e o melhor posicionamento do animal para a realização do exame. O escaneamento foi realizado com os animais na posição quadrupedal e em decúbito lateral direito. Foram determinadas cinco janelas acústicas a partir do óstio até a identificação do recesso prepucial. Os escaneamentos foram realizados nos planos longitudinais, transversais e dorsais, antes e após a infiltração de solução fisiológica a 0,9% no LCP. Como conclusões, o exame ultrassonográfico permitiu identificar a LIP e a PLP em todos os planos e em todas as janelas acústicas propostas. O melhor ponto de referência é a identificação da glande. O posicionamento quadrupedal é mais adequado para a realização do exame e o uso de contraste é recomendado para delimitação topográfica das estruturas.(AU)

Ultrasonography is a noninvasive complementary exam that is still rarely used in the preputial evaluation and without detailed descriptions of the bovine free end of the penis. The purpose of this study was to standardize preputial ultrasonography in one-year-old healthy Nelore cattle, describing the main acoustic windows, the viability of using contrast in the preputial cavity and the best positioning of the animal for performing the ultrasound examination. The scanning was performed with the animals in standing and decubitus position. Five acoustic windows were determined from the preputial ostium to the preputial fornix, at the free end of the penis. The scans were performed in longitudinal, transverse and dorsal planes, before and after infiltration of 0.9% saline solution into the preputial cavity. As conclusions, the ultrasound examination is able to identify the internal layer and the free part of the penis in all proposed planes and acoustic windows. The best landmark is the identification of the glans. Furthermore, standing positioning is the most appropriate to perform the exam and the use of contrast is recommended for topographic delimitation of the structures.(AU)

¿Qué factores se asocian con la reestrechez uretral en el paciente llevado a uretroplastia con o sin injerto? / Which Factors are Associated with Urethral re-Stricture in Patient Submitted to Urethroplasty with or without Grafting?

Objetivo Determinar los factores asociados a la reestrechez uretral en pacientes llevados a uretroplastia. Métodos Estudio observacional analítico retrospectivo. Se revisaron las historias clínicas de pacientes llevados a uretroplastia en el HSJ entre 2012-2017. Se realizó un análisis bivariado para estudiar las asociaciones entre la reestrechez uretral posterior a la uretroplastia y las caracteristicas preoperatorias, intraoperatorias y posoperatorias, así como un modelo de regresión logística múltiple. Resultados El total de pacientes llevados a uretroplastia fue de 82. La mediana de edad fue de 52 (RIQ = 35 -67) años. De todos los pacientes incluidos en el estudio 29 (36,2%) presentaron reestrechez. No se encontraron diferencias estadísticamente significativas en cuanto a los factores de riesgo en relación con reestrechez uretral en la población de estudio. Dentro de las técnicas quirúrgicas realizadas, los tipos de injerto utilizados en nuestros pacientes fueron la técnica con injerto de mucosa oral y con injerto de prepucio. De los pacientes a los cuales se les realizó uretroplastia con injerto de prepucio 13 (52%), presentaron reestrechez mostrando una diferencia estadísticamente significativa (p = 0,02). El tiempo quirúrgico fue mayor en los pacientes con reestrechez uretral (180 min RIQ = 120,0-189,0) comparado con los pacientes sin reestrechez (140 min RIQ = 120,0-198,0). En cuanto al modelo de regresión logística, pacientes llevados a uretroplastia con injerto de prepucio poseen más riesgo de presentar reestrechez uretral comparado con los pacientes a los cuales se les realizó la uretroplastia con otro tipo de injerto o con una tecnica terminoterminal sin injerto OR = 2,91 IC 95% (1,02-8,28). Conclusiones En nuestro estudio solo se encontró que el tipo de injerto utilizado es el único factor asociado al desarrollo de reestrechez uretral posterior a la realización de uretroplastia, otras variables clínicas descritas en la literatura no tuvieron asociación en nuestro estudio.

Objective To determine the association between risk factors, surgical procedure, and postoperative outcomes with stricture recurrence in patients who underwent urethroplasty. Methods An analytical observational study with retrospective data collection was conducted. We reviewed the medical records of all the patients who underwent urethroplasty at HSJ between the years 2012-2017. The analysis of the data included a bivariate model to study the association between the risk factors, surgical procedure, postoperative outcomes and stricture recurrence. Then, we used logistic regression analysis. Results 82 patients underwent urethroplasty: 29 (36.2%) presented stricture recurrence. The median age was 52 (IQR = 35-67) years old. There were no statistically significant differences between the risk factors, postoperative outcomes and stricture recurrence. In surgical technique we used buccal mucosal graft and penile skin graft. Stricture recurrence was observed in 13 patients who underwent penile skin graft urethroplasty showing a significant statistical difference (p = 0.02). The patients with stricture recurrence had longer operative time (180 minutes, IQR = 120.0-189.0) compared to patients without (140 minutes, IQR = 120-198). The logistic regression analysis showed that patients who underwent penile skin graft urethroplasty had a greater risk of stricture recurrence OR = 2,91 IC 95% (1,02-8,28). Conclusions The type of graft used is the only factor associated with the development of stricture recurrence after performing urethroplasty. Other clinical variables described in the literature have no association with our study.

Surgical plane positioning with a disposable circumcision suture device for the treatment of phimosis and redundant prepuce / 中华男科学杂志

<p><b>Objective</b>To investigate the clinical effects of circumcision by surgical plane positioning with a disposable circumcision suture device in the treatment of phimosis and redundant prepuce.</p><p><b>METHODS</b>From September 2016 to June 2017, we treated 250 patients with phimosis or redundant prepuce, 127 by conventional circumcision (the control group) and the other 123 by surgical plane positioning with a disposable circumcision suture device (the observation group). We compared the operation time, intra-operative bleeding, preputial frenulum alignment, postoperative ecchymosis, and postoperative penile appearance between the two groups of patients.</p><p><b>RESULTS</b>Compared with the controls, the patients in the observation group showed significantly longer operation time (［4.48 ± 1.18］ vs ［7.17 ± 1.42］ min, P<0.05), lower rates of intra-operative frenulum bleeding (15.0% ［19/127］ vs 4.1% ［5/123］, P<0.05) and frenulum misalignment (26.8% ［34/127］ vs 0.8% ［1/123］, P<0.05), higher incidence of postoperative ecchymosis (41.7% ［53/127］ vs 21.1% ［26/123］, P<0.05), and higher satisfaction of the patients with the postoperative penile appearance (92.9% ［18/127］ vs 98.4% ［121/123］, P<0.05). However, no statistically significant difference was found between the control and observation groups in intra-operative non-frenulum bleeding (4.7% ［6/127］ vs 1.6% ［2/123］, P = 0.164).</p><p><b>CONCLUSIONS</b>Circumcision by surgical plane positioning with a disposable circumcision suture device can effectively avoid preputial frenulum misalignment, reduce intra-operative bleeding, and improve postoperative penile appearance.</p>

HPV infection of the external genitalia in men whose female partners have cervical HPV infection / 中华男科学杂志

<p><b>Objective</b>Human papilloma virus (HPV) is a necessary cause of cervical cancer and is also closely related to penile cancer, oropharyngeal cancer, and anal cancer in males. However, few studies are reported on male HPV. This study aimed to investigate HPV infection of the external genitalia in men whose female partners have cervical HPV infection.</p><p><b>METHODS</b>We collected the relevant data on the male outpatients whose partners had cervical HPV infection in our Department of Urology and Andrology from August to December 2016. We obtained samples with nylon swabs from the glans penis, corona, inner layer of the prepuce and penile body and detected different types of HPV infection using the Hybribio HPV typing kit, PCR and membrane hybridization.</p><p><b>RESULTS</b>Valid data were collected from 140 males, which showed 83.5% of HPV infection of the external genitalia, including 60 cases of HPV6 (43.2%), 27 cases of HPV16 (19.4%), 14 cases of HPV39 (10.1%), 13 cases of HPV18 (9.4%), 13 cases of HPV58 (9.4%), and 13 cases of HPV52 (9.4%). Redundant prepuce was found in 75.5% of the males, but there was no statistically significant difference in the incidence rate of HPV infection between the normal and redundant prepuce groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Men who have the female partners with positive cervical HPV are at high risk of HPV infection and therefore need to be screened and treated so as to reduce HPV infection in both sexes.</p>

The Relationship between Neonatal Circumcision, Urinary Tract Infection, and Health

The risk-benefit profile of neonatal circumcision is not clear. Most studies have focused on urinary tract infections but other health sequelae have not been evaluated. While evidence supports benefits of circumcision, a lack of randomized trials has been cited as a weakness. National guidelines provide mixed recommendations regarding neonatal circumcision. We review the weight of evidence and utilize current statistical methodology on observational data to examine the risks and benefits of neonatal circumcision.

Pene no Conspicuo (Oculto) / Inconspicuous Penis

El término pene no conspicuo (oculto), agrupa las patologías en las que el pene adopta un tamaño aparentemente más pequeño, ya sea porque se oculta bajo el tejido cicatricial en caso del pene atrapado, cuando presenta un pliegue de piel que reduce el ángulo penoescrotal tratándose del pene en vela, o en los casos en los que el pene es cubierto por prepucio redundante produciendo un pene enterrado. Se realiza una revisión de la definición y terminología utilizada a través de la historia, clasificación actual, etiología, diagnóstico y técnica quirúrgica empleada para la corrección del pene no conspicuo (oculto).

Inconspicuous penis is referred conditions where the penis looks apparently small but is truely hidden under scarring tissue or under redundant mucosa or prepubic fat. These are all different pathologies that are surgically treated. Multiple techniques have been described. The aim of the present article is to review the state of the art in management throughout history, current classification, etiology, diagnosis and surgical techniques for correcting this pathology.

Glande Peneano ­ Teoría Integral y su Relación con la Triada Disfuncional (Glande Frío, Blando o Doloroso) / Penis Glans ­ Integral Theory and its Relationship with Dysfunctional Triad (Cold, Soft and Painful Glans)

El glande peneano forma parte de un ingenioso diseño evolutivo que convirtió el pene en una compleja maquina hidráulica bicameral para la intromisión exitosa en la vagina. El objetivo del glande es tener un extremo blando, recubierto con una piel de terminales altamente sensitivas que forma parte de un tercer cuerpo cilíndrico, que debe colaborar en la tumescencia peneana sin interferir ni en la eyección del semen, ni en la evacuación de la orina, al estar las funciones reproductivas y urinarias compartidas por el mismo órgano. Los cuerpos cavernosos y el esponjoso, incluyendo el glande, comparten anatomía y fisiología en lo referente a trabéculas, túnica albugínea y llenado de sangre, pero no son idénticos en función, por lo que conceptos como rigidez axial, distribución de receptores o venoclusión varían de una a otra cámara. Adicionalmente a su discreta colaboración en la erección, el glande es el origen del llamado reflejo eyaculatorio, que es básico en el proceso sexual humano. La disfunción de esa porción terminal, incluye tres situaciones patológicas que son el glande frío, blando o doloroso, con etiología común, relacionada con factores como trauma, disfunción eréctil o cirugías tales como prostatectomía radical o cirugía uretral, con muy pocos tratamientos específicos disponibles en la actualidad y que sin embargo deberán ir mejorando por la inusitada frecuencia de esos padecimientos

The glans arises from a clever evolving design through which that the penis was transformed into a complex bicameral hydraulic machine for successful intervention in the vagina; aiming to maintain a highly sensitive at soft end, being part of a third cylindrical body and functioning as an aid in the tumescence with no interference with the evacuation of urine or semen, as the reproductive and urinary functions are shared by the same body. The previous asseveration implies that corpora cavernosa and spongiosum, including glans, share anatomy and physiology, trabeculation, tunica albuginea and blood filled, although not identical in function yet concepts as axial rigidity, sensory receptors distribution or venoclussion, they are different from each other and dysfunction in this terminal portion, includes three pathological situations: cold, soft or painful glans, with common etiology related to factors such as trauma, erectile dysfunction and surgeries such as radical prostatectomy or urethral surgery, with few specific treatments currently available, yet they should be improving by the unusual frequency of these conditions.

Novas perspectivas no diagnóstico e tratamento da acropostite-fimose em touros / New perspectives in the diagnosis and treatment of acropostitis-phimosis of bulls

A acropostite-fimose é um processo inflamatório da extremidade do prepúcio, diagnosticada com frequência em touros. O presente estudo objetivou avaliar o exame ultrassonográfico na definição da viabilidade do folheto prepucial interno (FPI) e na evolução clínica do pós-operatório, após o emprego de fios de categute ou poliglactina na hemostasia e de algodão ou poliglactina na confecção de sutura padrão Donatti empregada para fixar o FPI à pele prepucial no transoperatório da acropostite-fimose em touros. A sutura utilizada foi captonada ou não captonada, e os animais submetidos ao procedimento cirúrgico apresentavam no mínimo dois terços do FPI viável. Os touros foram alocados, aleatoriamente, em quatro grupos contendo nove animais cada, de acordo com o fio empregado na hemostasia e na confecção da sutura padrão Donatti. O exame ultrassonográfico mostrou-se importante na indicação ou não do tratamento cirúrgico da acropostite-fimose e possibilitou localizar lesões, mensurar a área de reação tecidual e identificar lesões profundas e pontos de estreitamento do FPI. Os animais de GII apresentaram edema mais discreto, observando-se diferença significativa (P<0,05) entre GII e os grupos GI, GIII e GIV. A ocorrência de hiperemia no sétimo dia de pós-operatório também foi menor nos touros do grupo GII, ocorrendo diferença significativa (P<0,05) entre GII e os grupos GI e GIII. A sutura empregando o dispositivo de látex (cápton) e o emprego do fio de poliglactina apresentaram-se como medidas benéficas, resultando em menor número de complicações pós-operatórias.(AU)

Acropostitis-Phimosis is an inflammatory process of the extremity of the prepuce, frequently diagnosed in bulls. The present study aimed to evaluate ultrassound exams in the definition of viability of the internal layer of prepuce and the postoperative clinical evolution. This evaluation is after the employment of catgut or poliglactin threads in homeostasis, and cloth or polyglactin threads in confection of the standard suture, Donatti, used to fix the internal layer of prepuce to the preputial in the postoperative of acropostitis-phimosis in bulls. The suture was captonated and non-captonated and the animals conducted to the surgical procedure showed at least 2/3 of viability of the internal layer of prepuce. The bulls were randomly allocated in four groups, each one containing nine animals, according to the thread used in homeostasis and confection of the Donatti standard suture. Ultrassound was shown to be important in the indication or not of the surgical treatment of acropostitis-phimosis and allowed the identification of lesions, measurement of areas of tissue reaction and locate deep lesions and narrowing points of internal layer of prepuce. The employment of latex device (capton) in suture and the employment of polyglactin thread 910 were shown as beneficial measures, resulting in a lower number of postoperative complications.(AU)

Topical application of clobetasol propionate cream in the treatment of phimosis in prepubertal children: A report of 237cases / 中华男科学杂志

Objective@#To investigate the clinical effect of 0.02% clobetasol propionate cream (CPC) on phimosis in prepubertal children.@*METHODS@#We retrospectively analyzed the clinical data about 237 prepubertal children with phimosis present at the Outpatient Department from June 2012 to December 2015. The patients were aged 2－14 (mean 8.6) years, all treated by topical application of 0.02% CPC to the narrowed opening and adhered part of the foreskin twice a day, in the morning and evening respectively. At the time of CPC application, the foreskin was slightly retracted. We evaluated the therapeutic effect every week from the end of the first week of treatment.@*RESULTS@#Totally, 233 of the patients completed the 8-week treatment, of whom 181 (77.68%) showed full retraction of the foreskin, 28 (12.01%) experienced improvement (disappearance of the phimotic ring), and 24 (10.30%) failed to respond, with a total effectiveness rate of 89.70%. No significant local or systemic adverse reactions were observed during the treatment.@*CONCLUSIONS@#Topical application of 0.02% Clobetasol Propionate Cream is a safe, effective, painless, and inexpensive option for the treatment of phimosis in prepubertal chilodren.

Embedding sutures of single inner- and outer-prepuce flap for the treatment of concealed penis: A report of 37 cases / 中华男科学杂志

Objective@#To evaluate the clinical effect of embedding sutures of single inner- and outer-prepuce flap in the treatment of concealed penis.@*METHODS@#This retrospective analysis included 37 cases of concealed penis treated by embedding sutures of single inner- and outer-prepuce flap between July 2011 and May 2015. Catheters were pulled out from the patients within 24 hours and the dressing removed about 1 week after surgery. All the patients were followed up for 12－24 months postoperatively for evaluation of the long-term outcomes of surgery.@*RESULTS@#One-stage wound healing was achieved in all the patients. No foreskin flap necrosis, inflammation, edema, voiding dysfunction, or painful erection was found during the follow-up. The penises were extended by 2－4 cm. No complications were observed axcept 8 cases of mild prepuce edema, which all subsided with 6 months postoperatively.@*CONCLUSIONS@#Embedding sutures of single inner- and outer-prepuce flap, with the advantages of simple operation, rapid recovery and few complications, is a desirable surgical option for the treatment of concealed penis.

Risk factors for the complications of primary hypospadias urethroplasty with the urethral plate reserved / 中华男科学杂志

Objective@#To investigate the risk factors for the complications of urethroplasty in patients with primary hypospadias by postoperative follow-up observation.@*METHODS@#We retrospectively analyzed 110 cases of primary hypospadias repair performed from November 2010 to October 2015, including 70 cases of tubularized incised plate (TIP) urethroplasty and 40 cases of inlay internal preputial graft (IIPG) urethroplasty, all with the urethral plate reserved. We followed up the patients for 15.6－36 months, (27.3 ± 0.52) mo for those with and (26.9 ± 0.22) mo for those without complications. The mean age of the two groups of patients was (7.5 ± 0.2) and (7.0 ± 0.5) yr, respectively.@*RESULTS@#The follow-up data were collected from all the patients, 17 (15.5%) with and 93 (84.5%) without complications. The success rate of surgery was 84.5%. There were no statistically significant differences in the follow-up time and age between the two groups of patients (P >0.05). Single-factor analysis of variance showed significant differences between the complication and non-complication groups in the preoperative urethral opening (P <0.01), ventral penile curvature (P <0.01), and length of urethral defect (P = 0.04), while multiple linear regression analysis exhibited that only ventral curvature was associated with the postoperative complications of the patients (OR = 1.12, 95% CI: 1.06－1.19, P<0.01).@*CONCLUSIONS@#We chose single-stage urethroplasty with the urethral plate reserved for the treatment of primary hypospadias and achieved satisfactory outcomes. Ventral penile curvature is an independent risk factor for the complications of primary hypospadias, and a higher degree of curvature is associated with a higher incidnece of complications.

Frenulum identification positioning with a disposable suture device in circumcision to prevent postoperative penile frenulum malposition / 中华男科学杂志

Objective@#To investigate the effect of the frenulum identification positioning method with a disposable suture device in circumcision for the prevention of postoperative penile frenulum malposition.@*METHODS@#Totally 212 patients with phimosis or redundant prepuce underwent circumcision from March 2015 to September 2016, including 109 cases of conventional circumcision (the control group) and 103 cases treated by frenulum identification positioning with a disposable suture device (the observation group). We observed the postoperative position of the penile frenulum and median raphe and compared the deviation angles of the frenulum between the two groups of patients.@*RESULTS@#The median of penile frenulum deviation angle (interquartile range) was 0 (3.56) in the observation group, significantly smaller than 12.41 (19.59) in the control (P <0.001, P = 0.000). And the rate of frenulum deviation was remarkably lower in the former (8.74% ［9/103］) than in the latter group (66.06% ［72/109］) (P <0.01).@*CONCLUSIONS@#Circumcision using the frenulum identification positioning method with a disposable suture device can effectively avoid postoperative penile frenulum malposition. With the advantages of safety and easy operation, it deserves clinical application and popularization.

Traversing the vertical pedicle flap for the treatment of severely buried penis in children / 中华男科学杂志

Objective@#To assess the effect of traversing the vertical pedicle flap (TVPF) for the treatment of severely buried penis in children.@*METHODS@#Totally 43 children with severely buried penis underwentTVPF (n = 21)or modifiedShiraki surgery (control, n = 22) in our hospitalfrom February to December 2014. Wecompared the operation time, intra-operation blood loss, foreskin swelling time, and parents' satisfaction with penile appearance between the two groups.@*RESULTS@#No statistically significant differences were observed between the TVPFand control groups in the operation time (［45.0 ±6.8］ vs ［42.0 ±5.3］ min, P>0.05) or intra-operation blood loss(［5.0 ±1.2］ vs ［6.0 ±0.8］ ml, P>0.05). The average foreskin swelling time was markedly shorter in the TVPFgroup than in the control (［9.0 ±2.3］ vs ［15.0 ±4.8］ d, P<0.05)and the parents' satisfaction with penile appearancewas higher in the former than in the latter (95.23vs31.81 %, P<0.05). The elastic bandages were removedfor all the patientsat 3 days postoperatively, and 3 to 6-month follow-up revealed no penile retraction or relapse.@*CONCLUSIONS@#The method of traversing the vertical pedicle flap is a feasible surgical option for the treatment of severely buried penis in children, which can make a rational use of the foreskin,remove the tight ring, and achieve a satisfactory appearance of the penis.

Paraffin Granuloma Associated with Buried Glans Penis-Induced Sexual and Voiding Dysfunction

A paraffinoma is a type of inflammatory lipogranuloma that develops after the injection of an artificial mineral oil, such as paraffin or silicon, into the foreskin or the subcutaneous tissue of the penis for the purpose of penis enlargement, cosmetics, or prosthesis. The authors experienced a case of macro-paraffinoma associated with sexual dysfunction, voiding dysfunction, and pain caused by a buried glans penis after a paraffin injection for penis enlargement that had been performed 35 years previously. Herein, this case is presented with a literature review.

Comparative global immune-related gene profiling of somatic cells, human pluripotent stem cells and their derivatives: implication for human lymphocyte proliferation

Human pluripotent stem cells (hPSCs), including embryonic stem cells (ESCs) and induced PSCs (iPSCs), represent potentially unlimited cell sources for clinical applications. Previous studies have suggested that hPSCs may benefit from immune privilege and limited immunogenicity, as reflected by the reduced expression of major histocompatibility complex class-related molecules. Here we investigated the global immune-related gene expression profiles of human ESCs, hiPSCs and somatic cells and identified candidate immune-related genes that may alter their immunogenicity. The expression levels of global immune-related genes were determined by comparing undifferentiated and differentiated stem cells and three types of human somatic cells: dermal papilla cells, ovarian granulosa cells and foreskin fibroblast cells. We identified the differentially expressed genes CD24, GATA3, PROM1, THBS2, LY96, IFIT3, CXCR4, IL1R1, FGFR3, IDO1 and KDR, which overlapped with selected immune-related gene lists. In further analyses, mammalian target of rapamycin complex (mTOR) signaling was investigated in the differentiated stem cells following treatment with rapamycin and lentiviral transduction with specific short-hairpin RNAs. We found that the inhibition of mTOR signal pathways significantly downregulated the immunogenicity of differentiated stem cells. We also tested the immune responses induced in differentiated stem cells by mixed lymphocyte reactions. We found that CD24- and GATA3-deficient differentiated stem cells including neural lineage cells had limited abilities to activate human lymphocytes. By analyzing the transcriptome signature of immune-related genes, we observed a tendency of the hPSCs to differentiate toward an immune cell phenotype. Taken together, these data identify candidate immune-related genes that might constitute valuable targets for clinical applications.

Establishment of Immortalized Primary Human Foreskin Keratinocytes and Their Application to Toxicity Assessment and Three Dimensional Skin Culture Construction

In spite of frequent usage of primary human foreskin keratinocytes (HFKs) in the study of skin biology, senescence-induced blockage of in vitro proliferation has been a big hurdle for their effective utilization. In order to overcome this passage limitation, we first isolated ten HFK lines from circumcision patients and successfully immortalized four of them via a retroviral transduction of high-risk human papillomavirus (HPV) E6 and E7 oncogenes. We confirmed expression of a keratinocyte marker protein, keratin 14 and two viral oncoproteins in these immortalized HFKs. We also observed their robust responsiveness to various exogenous stimuli, which was evidenced by increased mRNA expression of epithelial differentiation markers and pro-inflammatory genes in response to three reactive chemicals. In addition, their applicability to cytotoxicity assessment turned out to be comparable to that of HaCaT cells. Finally, we confirmed their differentiation capacity by construction of well-stratified three dimensional skin cultures. These newly established immortalized HFKs will be valuable tools not only for generation of in vitro skin disease models but also for prediction of potential toxicities of various cosmetic chemicals.

Plasmocitoma extramedular em bulbo peniano de cão: relato de caso / Extramedullary plasmacytoma in the penile bulb of a dog: case report

O objetivo deste relato de caso é descrever a ocorrência de plasmocitoma em bulbo peniano de um cão, classificado como uma doença extramedular não cutânea de localização rara e casuística inédita. Um cão, sem raça definida, com sete anos de idade e pesando 15kg, não castrado, apresentou histórico clínico de anorexia, vômitos, anúria e constipação. Ao exame específico da genitália externa, foi encontrada uma massa em bulbo peniano durante a inspeção do prepúcio, aderida à pele e encapsulada, extremamente firme e arredondada, medindo cerca de 6cm de diâmetro. Por meio da ultrassonografia dessa estrutura, foi observado aumento do volume regional com ecotextura heterogênea e ecogenicidade mista, além de neovascularização tecidual ao Doppler colorido. Foi realizada biópsia da massa, sendo verificada a presença de neoplasia de células redondas. A caracterização do tumor foi realizada pela imuno-histoquímica, e as células neoplásicas foram imunoexpressas para CD79a e MUM1, indicando o diagnóstico de plasmocitoma extramedular. Embora os tumores penianos em cães sejam os predominantemente venéreos transmissíveis (TVT), e os plasmocitomas sejam neoplasias raras nessa localização, este relato de caso fornece com ineditismo a ocorrência de plasmocitoma extramedular em bulbo peniano de cão, condição ainda não descrita em veterinária.

Non-cutaneous extramedullary plasmacytomas are relatively rare in dogs, affecting mainly the oral cavity and bowel loops. The involvement of the penile bulb has not been described, a fact of great importance for obstetric and veterinary oncology. The aim of this case report is to describe the occurrence of plasmacytoma in a dog's penile bulb, classified as a non-cutaneous extramedullary disease of rare location and unpublished casuistry. A non castrated dog of undefined breed, with seven years of age and weighing 15kg, presented clinical history of anorexia, vomiting, anuria and constipation. By specific examination of the external genitalia, a penile bulb mass was found in the preputial inspection, which was adhered to the encapsulated skin, extremely firm and rounded, measuring approximately 6 cm in diameter. By ultrasound evaluation of the structure in the penile bulb an increase of regional volume with heterogeneous echotexture and mixed echogenicity and tissue neovascularization upon color Doppler was observed. Incisional biopsy of the mass was performed and showed the presence of neoplasia of round cells. The characterization of the tumor was performed by immunohistochemistry and the neoplastic immuno cells were expressed CD79a and MUM1, indicating the diagnosis of extramedullary plasmacytoma. Although the penile tumors in dogs are predominantly transmissible venereal tumors (TVT) and plasmocytomas are rare neoplasms in this location, this case report provides a novel occurrence of extramedullary plasmacytoma in the penile bulb of a dog, a condition not yet described in veterinary.