ABSTRACT
ABSTRACT Objective: to compare the postoperative esthetic and healing aspects of postectomy performed by different surgical techniques, based on the evaluation of different specialty expert professionals. Methods: prospective and randomized clinical trial enrolling 149 preschool children with a medical indication for circumcision, divided into three groups: postectomy with the hemostatic device Plastibell® (PB group), conventional technique (CV group) and conventional with subcuticular stitches (SC group). Pictures were taken from patients at pre-defined angles on the 30th and 60th postoperative days. Photos were evaluated by three specialists (dermatologist, pediatrician and plastic surgeon), who assigned scores from 1 to 5 regarding the esthetic and healing features at each moment. Grades 4 or 5 from all specialists characterized "best result". Data were analysed to compare the used surgical techniques, the judgments from specialties and postoperative complications. Results: most of the patients obtained the "best result" regarding healing (70%) and esthetics (56%). The final overall result showed the PB group as the best for healing (p=0.028) and the SC group as the best for esthetics (p=0.002). For the dermatologist, on the 60th postoperative day, the CV group presented the worst aesthetic result, whereas for the pediatrician and the plastic surgeon, the PB group presented the best healing result and the SC group had the best esthetic result. There was no difference between the groups regarding the presence of complications. Conclusion: the most common surgical techniques used to perform postectomy in children were differently assessed regarding healing and esthetic features by distinct medical professionals. The analysis of these two parameters among experts from related areas diverged among them and over time.
RESUMO Objetivo: analisar os aspectos estético e cicatricial pós-operatórios (PO) de pacientes submetidos a postectomia por diferentes técnicas cirúrgicas a partir da avaliação de profissionais experientes de áreas afins. Método: ensaio clínico prospectivo e randomizado, incluindo 149 meninos em idade pré-escolar com indicação médica de postectomia, divididos em três grupos: postectomia com dispositivo hemostático Plastibell® (grupo PB), técnica convencional (grupo CV) e convencional com pontos subcuticulares (grupo SC). Os pacientes foram fotografados em ângulos predefinidos no 30º e 60º dias de PO e as fotos avaliadas por três especialistas (dermatologista, pediatra e cirurgião plástico) que atribuíram notas entre 1 e 5, quanto aos aspectos estético e cicatricial em cada momento. Notas 4 ou 5 de todos os especialistas caracterizaram o "melhor resultado". Os dados foram submetidos à análise estatística para comparar as técnicas cirúrgicas, as avaliações dos especialistas e as complicações pós-operatórias. Resultados: a maioria dos pacientes obteve "melhor resultado" cicatricial (70%) e estético (56%). O resultado geral final apontou o grupo PB como superior quanto à cicatrização (p=0,028) e o grupo SC quanto ao aspecto estético (p=0,002). Para o dermatologista, na segunda avaliação, o grupo CV apresentou o pior resultado estético, enquanto para o pediatra e o cirurgião plástico, o grupo PB apresentou o melhor resultado cicatricial e o grupo SC o melhor resultado estético. Não houve diferença entre os grupos quanto à presença de complicações. Conclusão: as técnicas cirúrgicas mais empregadas para realizar postectomia em crianças foram avaliadas quanto aos resultados cicatricial e estético de distintas maneiras. A análise desses dois parâmetros entre especialistas de áreas afins divergiu entre eles e ao longo do tempo.
Subject(s)
Humans , Male , Child, Preschool , Child , Phimosis/surgery , Circumcision, Male/methods , Penis/pathology , Phimosis/pathology , Postoperative Complications , Postoperative Period , Wound Healing , Prospective Studies , Suture Techniques , Circumcision, Male/adverse effects , Circumcision, Male/instrumentation , Treatment Outcome , Esthetics , Intraoperative ComplicationsABSTRACT
ABSTRACT Introduction To evaluate the safety and efficacy of a novel penile circumcision suturing devices PCSD and Shang ring (SR) for circumcision in an adult population. Materials and Methods A total of 124 outpatients were randomly assigned to receive PCSD (n=62) or SR (n=62). Patient characteristics, operative time, blood loss, return to normal activities time (RNAT), visual analogue scale (VAS), scar width, wound healing time, cosmetic result, and complications were recorded. Results There were no significant differences in blood loss, RNAT, or complications between the two groups. There were no significant differences in the VAS scores at the operation, at 6 or 24 hours after surgery (P>0.05). The wound scar width was wider in the SR group than in the PCSD group (P<0.01). Patients in the SR group had significantly longer wound healing time compared with those in the PCSD group (P<0.01). Patients who underwent PCSD were significantly more satisfied with the cosmetic results (P<0.01). Conclusions SR and PCSD are safe and effective minimally invasive techniques for adult male circumcision. Compared with SRs, PCSDs have the advantages of faster postoperative incision healing and a good effect on wound cosmetics.
Subject(s)
Humans , Male , Adolescent , Adult , Aged , Young Adult , Phimosis/surgery , Suture Techniques/instrumentation , Circumcision, Male/instrumentation , Pain, Postoperative , Sutures , Prospective Studies , Circumcision, Male/methods , Treatment Outcome , Operative Time , Middle AgedABSTRACT
Objetivos: Diagnosticar e manejar patologias comuns do trato genital masculino. Métodos: Revisão da literatura do ano de 2011 ao 2017 em base de dados PubMed. Resultados: Hipospádia é a localização anômala do meato uretral. Seu diagnóstico é clínico. As indicações cirúrgicas são anormalidades funcionais e estéticas. Fimose é descrita como impossibilidade de retração do prepcio para exposição da glande peniana, sendo um evento fisiológico quando apresenta resolução espontânea. Nos casos patológicos, o tratamento é primeiramente realizado com corticoide tópico. Se falha, o tratamento é cirúrgico. Hidrocele é o acúmulo de líquido na bolsa escrotal. O diagnóstico é clínico e por transiluminação escrotal. A maioria dos casos regride espontaneamente até os 24-36 meses. A cirurgia é considerada padrão-ouro para hidrocele comunicante na criança. Criptorquidia é a falha na migração do testículo até a bolsa escrotal. Seu diagnóstico é clínico, através da palpação testicular bilateral. Caso os testículos não estejam presentes na bolsa escrotal até os 6 meses de idade, a cirurgia é imprescindível, pelo risco de infertilidade e malignização. Conclusões: É essencial que o médico generalista saiba reconhecer tais condições com o intuito de iniciar prontamente o tratamento adequado, evitando suas complicações.
Aims: Diagnose and manage common pathologies of the male genital tract. Methods: Literary review of the last 6 years in the PubMed database. Results: Hypospadia is an anomalous location of the urethral meatus. The diagnosis is clinical. Surgical indications are functional and aesthetic abnormalities. Fimosis is described as impossibility of retraction of the foreskin to expose the penile glans, it is a physiological event when it presents spontaneous resolution. In pathological cases, treatment is first performed with topical corticosteroids. If it fails, the treatment is surgical. Hydrocele is the accumulation of fluid in the scrotal sac. The diagnosis is clinical and scrotal transillumination. Most cases regress spontaneously up to 24-36 months. Surgery is considered gold standard in cases of communicant hydrocele in children. Cryptorchidism is the failure of the migration of the testis to scrotal sac. The diagnosis is clinical through bilateral testicular palpation. If the testicles are not present in the scrotal sac until 6 months of age, surgery is essential, due to the risk of infertility and malignancy. Conclusions: It is imperative that the general practitioner knows how to recognize such conditions in order to promptly initiate appropriate treatment, avoiding complications.
Subject(s)
Pediatrics , Genital Diseases, Male/surgery , Phimosis/surgery , Child , Cryptorchidism/surgery , Testicular Hydrocele/surgery , Hypospadias/surgeryABSTRACT
ABSTRACT Purpose: This study was to confirm the safety and efficacy of BC dressing when used in surgical male wound healing at the urogenital area. Methods: Open, non-controlled clinical study of phase II. A total of 141 patients, among those children, adolescents and adults with hypospadias (112), epispadias (04), phymosis (13) and Peyronie's disease (12) that had a BC dressing applied over the operated area after surgery. A written informed consent was obtained from all participants. Study exclusion criteria were patients with other alternative treatment indications due to the severity, extent of the injury or the underlying disease. The outcomes evaluated were efficacy, safe and complete healing. The costs were discussed. Results: In 68% patients, the BC dressing fell off spontaneously. The BC was removed without complications in 13% of patients at the outpatient clinic during the follow-up visit and 17% not reported the time of removal. In 3% of the cases, the dressing fell off early. Complete healing was observed between 8th and 10th days after surgery. The BC dressings have shown a good tolerance by all the patients and there were no reports of serious adverse events. Conclusion: The bacterial cellulose dressings have shown efficacy, safety and that can be considered as a satisfactory alternative for postoperative wound healing in urogenital area and with low cost.
Subject(s)
Humans , Male , Child, Preschool , Child , Adolescent , Penile Diseases/surgery , Penis/surgery , Polyurethanes/therapeutic use , Bandages , Urogenital Abnormalities/surgery , Wound Healing , Penile Induration/surgery , Phimosis/surgery , Postoperative Period , Epispadias/surgery , Treatment Outcome , Wound Closure Techniques , Hypospadias/surgery , Middle AgedABSTRACT
Epidermolysis bullosa (EB) is characterized by extreme fragility of the skin and mucosae. Anesthetic and surgical techniques have to be adapted to those children and routine practice may not be adequate. Urological problems are relatively common, but surgical techniques adapted to those children have not been well debated and only low evidence is available to this moment. Herein we discuss the specifics of anesthetic and surgical techniques chosen to treat a six year old EB male presenting with symptomatic phimosis.
Subject(s)
Child , Humans , Male , Anesthesia, General/methods , Epidermolysis Bullosa Dystrophica/surgery , Phimosis/surgery , Urologic Surgical Procedures, Male/methods , Epidermolysis Bullosa Dystrophica/complications , Phimosis/etiology , Surgical Fixation Devices , Treatment Outcome , Urologic Surgical Procedures, Male/instrumentationABSTRACT
The term phimosis is used when the prepuce cannot be reytracted behind the glans. This condition is present in almost all newborns, fulfilling mostly a protective function. In childhood, a gradual separation occurs, which is completed in adolescence. Through this process, complications may happen such as urinary tract infections, balanitis, or paraphimosis. Circumcision has been considered the treatment of choice, although some factors must be weighed: degree of narrowing, complications, opinión and religious beliefs of the parents. In the past 15 years, publications have suggested topical steroids as an alternative treatment, with variable success. Treatment of phimosis will continue to be controversial.
El término fimosis se utiliza cuando el prepucio no puede ser retraído por detrás del glande. Esta condición está presente en casi todos los recién nacidos cumpliendo una función principalmente protectora. Durante la infancia se produce una separación gradual del prepucio, que se completa, en la mayoría de los casos, al llegar la adolescencia. Mientras ocurre el proceso de desprendimiento pueden presentarse complicaciones como; infección del tracto urinario, balanitis o parafimosis. La circuncisión ha sido tradicionalmente el tratamiento de elección, sin embargo, se debe tener en cuenta diversos factores antes de tomar una decisión quirúrgica. Debe ser considerado: el grado de estrechez, las complicaciones, la opinión y las creencias religiosas de los padres. En los últimos 15 años se han publicado numerosos trabajos sobre el uso de esteroides tópicos como alternativa terapéutica, con resultados de éxito variable. El tratamiento de la fimosis seguirá siendo un tema controvertido.
Subject(s)
Humans , Child , Circumcision, Male , Phimosis/surgery , Phimosis/complications , Phimosis/diagnosis , Diagnosis, Differential , Phimosis/therapy , Patient SelectionABSTRACT
Purpose: To compare the efficacy and costs of circumcision versus topical treatment using a prospective pharmacoeconomic protocol. Materials and methods: We treated 59 patients (3-10 years of age) randomized into two groups: 29 underwent an 8-week course of topical treatment with 0.2 percent betamethasone-hyaluronidase cream twice a day; and 30 underwent circumcision. Topical treatment success was defined as complete exposure of the glans. In cases of treatment failure, circumcision was performed and its cost imputed to that of the initial treatment. The pharmacoeconomic aspects were defined according to the Brazilian National Public Health System database and the Brazilian Community Pharmacies Index. Results: The two groups were statistically similar for all clinical parameters evaluated. Topical treatment resulted in complete exposure of the glans in 52 percent of the patients. Topical treatment was associated with preputial pain and hyperemia. However, treatment suspension was unnecessary. Minor complications were observed in 16.6 percent of the surgical group patients. The mean cost per patient was US$ 53.70 and US$ 125.20, respectively, for topical steroid treatment (including the costs related to treatment failure) and circumcision. The total costs were US$ 2,825.32 and US$ 3,885.73 for topical treatment and circumcision, respectively. Conclusions: Topical treatment of phimosis can reduce costs by 27.3 percent in comparison with circumcision. Therefore, topical treatment of phimosis should be considered prior to the decision to perform surgery.
Subject(s)
Child , Child, Preschool , Humans , Male , Betamethasone/therapeutic use , Circumcision, Male/methods , Hyaluronoglucosaminidase/therapeutic use , Phimosis/drug therapy , Phimosis/surgery , Administration, Topical , Betamethasone/administration & dosage , Cost-Benefit Analysis , Circumcision, Male/economics , Hyaluronoglucosaminidase/administration & dosage , Prospective Studies , Phimosis/economics , Treatment OutcomeABSTRACT
Objective. To assess the trends and outcomes in referrals of ‘phimosis for circumcision’ to a tertiary care pediatric surgical department. Methods. This is a prospective study of 100 consecutive children of presumed phimosis referred for circumcision. They were assessed and classified by the senior author as having either preputial adhesions or phimosis. The patients in the former group underwent outpatient preputial adhesiolysis while those in the latter group were offered circumcision primarily. All were followed up till resolution. Results. All 100 were referred with a non-retractile prepuce and an additional reason – preputial ballooning at voiding, dysuria or suspect UTI. Eight (mean age -58 months, referred for preputial ballooning at voiding -6/8 and dysuria -2/8) had phimosis and were primarily offered circumcision. The remaining 92 (mean age – 22 months, referred for preputial ballooning at voiding -52/92, dysuria -28/92 and suspect UTI -12/92) had preputial adhesions. In the latter group, none has a documented urinary infection on specific investigations. These 92 underwent outpatient preputial adhesiolysis. Seventy three (79 %) required a single sitting, 11 (12%) required 2 -4 sittings and 4(4.5%) required 5-8 sittings over a follow up period of 1 -24 months (median -3 weeks). 4/92(4.5%) were deemed non-responders to adhesiolysis and were circumcised later. Conclusion. The majority of children referred with ‘phimosis for circumcision’ to this tertiary pediatric surgical centre were actually physiologic preputial adhesions that were managed with outpatient preputial adhesiolysis. This study underscores a lack of awareness amongst referring primary care physicians regarding preputial adhesions and the potential for an erroneous diagnosis of phimosis translating into unnecessary circumcisions in many young boys.
Subject(s)
Child, Preschool , Circumcision, Male , Humans , Infant , Male , Penis/surgery , Phimosis/surgery , Prospective Studies , Tissue Adhesions/surgery , Treatment OutcomeSubject(s)
Humans , Child , Genital Diseases, Male/surgery , Genital Diseases, Male/diagnosis , Genital Diseases, Male/physiopathology , Cryptorchidism/surgery , Cryptorchidism/diagnosis , Phimosis/surgery , Phimosis/physiopathology , Hernia, Inguinal/surgery , Hernia, Inguinal/complications , Incidence , Testicular HydroceleABSTRACT
Este estudo foi realizado com meninos de 3 a 6 anos de idade submetidos a cirurgia de postectomia, com os objetivos compreender o significado das interações vivenciadas por eles an pós-operatório de postectomia e identificar as suas estratégia enquanto vivenciam a experiência cirúrgica. O referencial teórico utilizado foi o Interacionismo Simbólico, e o metodológico a Teoria Fundamentada nos Dados. Devido às características desenvolvimento verbal desses meninos, a entrevista com eles intermediada pelo brinquedo terapêutico; suas mães também foram entrevistadas na qualidade de informantes da experiência de se filhos. Os dados foram analisados até a fase de categorização dos significados, permitindo a emergência de duas categorias conceituais: Entrando em Contato com uma Experiência Amedrontadora, que descreve a vivência do menino no período pré-operatório e Tentando Readquirir o Controle, que conta a sua vivência após a operação. compreensão desta experiência oferece subsídios importantes para repensar da assistência de enfermagem ao menino que vivencia postectomia e à sua família
Subject(s)
Child, Preschool , Pediatric Nursing , Phimosis/surgery , Play and PlaythingsABSTRACT
A fimose se caracteriza pela presença de uma constriçäo no extremo distal do prepúcio, que impede a retraçäo do prepúcio sobre a glande. Circuncisäo é o tratamento indicado em qualquer situaçäo; todavia, um importante indicador para a postectomia é quando o estreitamento do prepúcio causa obstruçäo urinária. Nos últimos 27 anos, tenho usado a técnica com plastibell, com resultados bastante satisfatórios. No entanto, ela näo está indicada naqueles pacientes em vigência de balanite ou com cicatriz disforme de prepúcio. Essa técnica é simples de executar e exige menos tempo do que a postectomia clássica. Com relaçäo aos aspectos funcional e estético do prepúcio, os resultados säo superiores. Concluo que me pareceu infinitas as discussöes sobre a indicaçäo da circuncisäo e também tenho a impressäo de que a mesma faz parte de nossa cultura e tradiçäo. Entretanto, sempre que for indicada, os pais deveräo ser bem informados dos motivos da indicaçäo, das desvantagens, vantagens e possíveis complicaçöes. Por outro lado, a postectomia é um procedimento cirúrgico que exige técnica cuidadosa e asséptica, cujo principal cuidado é evitar danos ao pênis e assim deverá sempre ser executada por um cirurgiäo-pediátrico experiente, como qualquer outra operaçäo
Subject(s)
Humans , Male , Child, Preschool , Child , Adolescent , Phimosis/surgery , Phimosis/classification , Phimosis/complications , Circumcision, Male/adverse effectsABSTRACT
Introducción. El desconocimiento del crecimiento y desarrollo normal del prepucio y de su función como protector del glande y zona erógena y de su retractibilidad durante el coito propicia que en muchas ocasiones, éste sea retirado innecesariamente mediante la circuncisión. Una alternativa en pacientes sintomáticos que presentan prepucio estenótico (apretado) pero sin cicatrización extensa, es la plastia de prepucio que permite facilitar su retracción y promover la higiene, manteniendo la aparencia normal del pene. Material y métodos. Se evaluaron las ventajas y desventajas de las plastias de uno, dos y tres cortes y zetoplastias realizadas entre los años de 1992 y 1996 en 41 pacientes asignados al azar a cada uno de los procedimientos. Resultados. Se logró retracción satisfactoria en 39 de 41 pacientes (95 por ciento), 4 (9.75 por ciento) presentaron complicaciones postoperatorias y 2 pacientes (4.8 por ciento) han sido destinados a reoperaciones. Conclusión. La plastia es un procedimiento efectivo para corregir la fimosis y consevar el prepucio con funciones
Subject(s)
Humans , Male , Infant , Child, Preschool , Child , Circumcision, Male , Phimosis/surgery , Postoperative ComplicationsABSTRACT
O autor discute as principais controversias sobre condutas em criancas com fimose bem como os problemas que podem decorrer da presenca do prepucio: acumulo de esmegma, infeccao urinaria, balano-postite e para-fimose. Sao abordados os criterios para a indicacao de postectomia: motivos de ordem medica, religiosos e culturais. Por fim discute-se o valor da postectomia rotineira na crianca, particularmente quanto a prevencao de afeccoes como balano-postites, cancer do penis e as doencas sexualmente transmissiveis, principalmente a sindrome da imunodeficiencia adquirida. A idade ideal para o procedimento cirurgico e em torno de um ano, em virtude da maior facilidade tecnica e do menor sofrimento pos-operatorio.
Subject(s)
Humans , Male , Child , Phimosis/surgery , Circumcision, Male/trends , Penis/surgery , Postoperative ComplicationsABSTRACT
Se hace una amplia descripción anatómica de las estructuras del pene, las indicaciones y contraindicaciones de la circuncición y de las técnicas quirúrgicas disponibles, con especial alternativa la sinequiotomía, que es la liberación del prepucio por despegamiento del glande; este procedimiento se puede efectuar después del cuarto o quinto mes de edad
Subject(s)
Infant, Newborn , Humans , Male , Penis/anatomy & histology , Penis/embryology , Phimosis/surgery , Surgical Procedures, Operative , Surgical Procedures, Operative , Circumcision, Male , Circumcision, Male , Circumcision, Male , Anesthesia, Local , Anesthesia, Local , Lidocaine/therapeutic useSubject(s)
Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Circumcision, Male , Phimosis/surgeryABSTRACT
O presente trabalho verificou a incidência de fimose em crianças de escolas públicas e particulares de Santa Maria, RS. Evidenciou-se: existência de 41% de meninos com fimose, 85,4% dos casos tratavam-se de fimoses fisiológicas, os restantes 14,5% eram de fimose congênitas. Näo observamos nenhum caso de fimose adquirida. Encontramos elevado número de fimose fisiológicas, com perspectiva de resoluçäo expontânea, acima da faixa etária considerada habitual pela maioria dos autores. O predomínio se fez na faixa etária dos 4 aos 5 anos, com diminuiçäo crescente a partir da idade de 6 anos. Observamos maior índice de correçöes cirúrgicas em estudantes de escolas particulares (50%), em relaçäo ás escolas públicas (6,45%)