Prevalence and surgical management of pubic hypertrophy in hypospadias patients: results from a high-volume surgeon

ABSTRACT Introduction: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the outcomes associated with its surgical treatment. Material and methods: Within 266 hypospadias patients treated at our clinic, we assessed the prevalence of pubic hypertrophy, and we schematically described the surgical steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predictors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy. Results: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the location of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only significant predictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fistula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multivariable adjustment. Conclusions: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and severity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.

Application of artificial ligament in treatment of lower abdominal wall reconstruction after pubic tumor resection / 北京大学学报(医学版)

OBJECTIVE@#For patients who had hemipelvectomies involving the resection of a portion or the whole of the pubis, bony reconstruction was not recommended commonly. However, the soft tissue reconstruction of the lower abdominal wall may benefit these patients. The object of the study was to determine the clinical effect of lower abdominal wall reconstruction with LARS ligament after pubic tumor resection interms of patient-reported and objective outcome.@*METHODS@#In this series, we reviewed twenty-five patients who underwent pubic tumor resection followed by reconstruction with LARS ligament between February 2012 and February 2018 retrospectively. We evaluated the clinical outcome and complication of this surgical treatment. The function outcome was evaluated according the musculoskeletal tumor society scores (MSTS) for all the patients at the end of the last follow-up.@*RESULTS@#All the patients were stable during the surgery. There were eight patients who underwent resection of superior ramus of pubis, five patients who had resection of inferior ramus of pubis, and twelve patients who received both superior and inferior ramus of pubis. For all the patients, the mean blood loss was (774±580) mL. The mean operation time was (138±25) min. The mean hospital stay was (19±6) d. For the patients who had resection of superior ramus, inferior ramus, as well as both superior and inferior ramus, the mean blood loss were (763±802) mL, (730±315) mL and (808±485) mL, respectively. The mean operation time were (133±27) min, (135±35) min and (143±20) min, respectively. The mean hospital stay were (18±5) d, (22±9) d and (19±6) d, respectively. The mean follow-up time was (37±21) months. Local recurrence was observed in one patient with chondrosarcoma. One patient with renal cancer metastasis died of the disease. No ligament infection, ligament related complication and incisional hernias were observed. Twenty-three patients could ambulate without assistive devices, and the remaining two could walk by crutches. Postoperative pain was reported as none in nineteen patients, mild in three, and moderate in three. From a functional point, the mean MSTS score was 87±4.@*CONCLUSION@#Lower abdominal wall reconstruction with LARS ligament after pubic tumor resection could have satisfactory clinical outcome. It could prevent the occurrence of herniation, decrease the infection rate by minishing the dead space, and achieve good patient-reported outcome.

Lifting do púbis após grande perda ponderal / Lifting of the mons pubis after massive weigth loss

This article describes the surgical planning, conducts pre and post operatively, results in the Lifting Pubic ex-obese patients submitted to gastroplasty or not, that feature large sagging skin and excess fat from the pubis. Method: Two hundred and eighteen patients underwent surgery from May 2005 to August 2012. The pubic lifting was held in conjunction with the Anchor Adbominoplasty. The pubis was raised through points positioned 2-3 cm above its original position in the aponeurosis of the muscles rectus abdominis. Traction lines were directed from the center to up and the sides of the pubis and abdominal flaps were pulled to the midline of the abdomen No significant complication was observed, which could compromise the final result. Results: The elevation of the pubis, the correct shape and resection of excess adipocutâneos were achieved in all cases, bringing satisfaction to patients. Conclusion: Considering the pubic deformity after massive weight loss, and the results obtained, the procedures adopted proved to be safe, easily reproducible and stable over the longterm...

O presente artigo descreve o planejamento cirúrgico, as condutasde pré e pós-operatório, e os resultados do lifting púbico em pacientes ex-obesos, submetidos ou não à Gastroplastia, que apresentavam grande flacidez cutânea e excesso adiposo do púbis Método: Duzentos e dezoito pacientes foram submetidos à cirurgia no período de maio de 2005 a agosto de 2012. O Lifting pubiano foi realizado conjuntamente com a Abdominoplastia em ãncora. O púbis foi elevado por meio de pontos posicionados 2 a 3 cm acima de sua posição original, na aponeurose dos retos abdominais. Vetores de tração foram direcionados do centro do púbis para cima e para os flancos e os retalhos abdominais foram tracionados para a linha média do abdome. Nenhuma complicação significativa foi observada que pudesse comprometer o resultado final. Resultados: A elevação do púbis, a correção do formato e a ressecção, dos excessos adipocutâneos, foram alcançadas em todos os casos, trazendo satisfação aos pacientes. Conclusão: Considerando-se a deformidade pubiana após grandes perdas ponderais e os resultados obtidos, os procedimentos adotados mostraram-se seguros, facilmente reproduzíveis e estáveis a longo prazo...

Plástica do púbis e da genitália externa: duas décadas de experiência / Plastic of the pubis and external genitalia: two decades of experience

Este artigo registra a experiência de duas décadas de cirurgias realizadas na região do púbis e da genitália externa em pacientes de ambos os sexos. A literatura apresenta limitadas contribuições sobre as alterações morfológicas que têm levado seus portadores a se submeterem a cirurgias para retornarem à normalidade anatômica, ao equilíbrio emocional e a recuperarem a autoestima. Método: Foram operados 513 pacientes com diferentes tipos de patologias nos genitais externos e no púbis, num período de vinte anos, sendo 469 (91,42%) do sexo feminino e 44(8,58%) do sexo masculino. A idade variou de 17 a 70 anos. No sexo feminino, as deformidades mais frequentes foram as distrofias do púbis, grandes e pequenos lábios, prepúcio sobre o clitóris, além das distorções secundárias decorrentes de cirurgias realizadas previamente nestas regiões. No sexo masculino, as afecções mais frequentes envolveram a região pubiana, hipotrofias penianas, sinéquias e ausência de testículos. Deformidades congênitas, além das descritas, não foram incluídas no presente artigo. Resultados: Durante o período de 1989 a 2010, os procedimentos aplicados nas disformias pubianas e nas genitálias beneficiaram pacientes física e psicologicamente, pela qualidade dos resultados e pelo baixo índice de complicações (2,31%). Conclusões: Apesar da limitada divulgação científica nas revistas da especialidade e nos eventos científicos, a importância destas patologias não tem limite nos seus portadores. Uma das razões da presente publicação baseia-se na experiência adquirida e a necessária divulgação aos especialistas que realizam estas cirurgias, face às consequências que determinam quando não executadas dentro da necessária realidade.

This article is the result of two decades of surgical experience in the pubic region for patients of both genders with the external genitalia dimorphic aspects. The literature presents limited contributions regarding the morphologic alterations of these regions, responsible for the patients be submitted to these surgeries to return to their normal anatomic aspects, to the emotional equilibrium and to the self-esteem. Methods: Patients of both genders, in a total of 513, with different types of pathologies of the external genitalia and the pubic regions were submitted to specific surgeries, where 469 (91.42%) were female and 44 (8.58%) were male. The age range was from 17 to 70 year old. In the female patients were included: dystrophies of the pubis, labia majora and minora, skin excess of the clitoris, and the treatment of other types of unacceptable results after previous surgical procedures. The male deformities included in this study were: penis hypotrophy, skin penis synechia, local angioma and the absence of congenital testicular glands. Congenital or acquired deformities out of the described were not included. Results: From 1989 to 2010, the procedures used in the genitalia and in the pubis dimorphisms brought psychological and physic benefic to the patients combined with low complication rate (2.31%). Conclusions: Despite of the limited scientific publications in the journals of the specialty and in the scientific meetings, the importance of these messages has no limits to their holders. One of reasons of this publicationis based in acquired experience and the necessary diffusion for those that perform these surgeries but still with negative results when not performed within the necessary level.

Aneurysmal bone cyst of pubis a rare presentation

Aneurysmal bone cyst is a benign usually expansile, solitary lytic lesion of bone; with blood filled cystic cavities, which tend to grow eccentrically. Such eccentric growth may, on occasion, attain considerable size before it is clinically recognized, particularly if the tumor arises in a deeply situated bone. Aneurysmal bone cyst of pubis is a rare entity. In the following case report, an aneurysmal bone cyst, originating from the superior pubic ramus, expanded into the groin and first manifested itself as a gradually increasing fullness in groin and pain especially with weight bearing. The size and location of this vascular tumor posed difficulties in treatment. It was managed by curettage with high speed burr and reconstruction of the defect with an iliac crest cancellous bone graft

Abnoplastia e lifting do púbis / Adnoplasty and public lifting

Introdução: O presente trabalho relata a conduta, planejamento, resultados e conclusões das abdominoplastias associadas ao lifting do púbis. Método: Foram analisados 120 pacientes, submetidos a cirurgia no período de maio de 2005 a junho de 2009. Resultados: Não foram observadas complicações significativas, que pudessem comprometer os resultados finais. Conclusão: Concluiu-se que os bons resultados foram decorrentes do adequado planejamento para cada caso em particular.

Introduction: The present paper relates the conduct, planning, results and conclusions about abdominoplasty associated to pubic lifting method. Methods: A hundred and twenty patients were submitted surgery between May 2005 to June 2009. No significant complications were observed, that they could pledge the final results. Conclusion: Good results were obtained due to adequate planning for each case in private.

Rejuvenescimento da região pudenta, associado ou não a dermolipectomia / Rejuvenation of the pudenta region, with or without abnoplasty

Introdução: Os autores propõem um método de simples compreensão e de fácil reprodução para a abordagem e tratamento da região pudenda, geralmente realizado no final de uma dermolipectomia abdominal. Método: A técnica consiste em lipectomia aberta com tesoura, podendo ser associada a lipoaspiração convencional e pexia com tracionamento cruzado da região pudenda, devolvendo as características de jovialidade à área em questão. Resultados: Pode-se constatar pelas fotografias, que houve estreitamento do triângulo e ainda elevação da rafe mediana, posicionada mais anatomicamente. Relatos foram obtidos quanto à melhora da qualidade e desempenho do ato sexual, tanto pelas pacientes quanto por seus parceiros. Discussão: Há dez anos, o autor principal aborda esta região, inicialmente utilizava lipoaspiração como ferramenta. Os resultados tornaram-se mais promissores quando foi iniciado o uso de pexia, anteriormente paralela e atualmente cruzada. Conclusão: Conclui-se que o método descrito, propõe e atinge os seus principais. Objetivos: tornar a região pudenda mais magra, estreita e harmoniosa. Por trazer benefícios para a paciente e para seu companheiro, a técnica poderá ser adicionada ao arsenal do cirurgião plástico brasileiro que tem como intuito uma melhora global no aspecto de sua cirurgia do contorno corporal.

Introduction: The authors propose a simple, comprehensive and easily reproducible method to suspend to thin and fixate the pubic region on a better position, usually in association with abdominoplasties. Method: The technique consists in approaching the pubic region with open defating associated or not with traditional liposuction and a cross traction with absorbable sutures, anchoring them in the anterior rectus apponeurosis. Results: Pictures will show the goal was achieved, with thinner, younger and more harmonious pudenda region obtained with the method. There are some reports of better performance during intercourse, probably because of the superficialization of the clitoris. Some mates also reported a better quality intercourse after the procedure. Discussion: The main author started to address this region with liposuction ten years ago, which is also a good option. However, in his hands the results became more promising when he began to use this traction at first a parallel traction and now a crossed one. Conclusion: With these results the authors were able to show that this method can be employed usually after an abdominoplasty to reach the main proposed objectives which are: a thinner, narrower and better looking pubic region.

Vesicocutaneous Fistula Presenting Groin Abscess and Chronic Osteomyelitis in Pubic Bone

The authors report a case of bladder fistula associated with a medial thigh cutaneous fistula and chronic osteomyelitis of the pubic bone 11 years after surgery for a pelvic bone fracture and bladder rupture. In the presenting case, despite the clinical suspicion, none of the diagnostic tools demonstrated the bladder fistula preoperatively. This case suggests that bladder repair should be prepared, even if the bladder fistula cannot be confirmed by imaging studies because the amount of urine leakage can be minimal or the fistula can close spontaneously.

Tratamento da região pubiana na abdominoplastia de pacientes após grande perda ponderal / Pubic region’s treatment in abdominoplasty of patients with great loss of weight

Introdução: Com base na angústia dos pacientes com grande perda ponderal em relação aoseu corpo, desenvolvemos uma nova tática para tratamento da ptose da região pubiana.Objetivos: Demonstrar tática cirúrgica para tratamento da região pubiana de pacientes comgrande perda ponderal e ptose importante dessa região. Método: Faz-se a marcaçãoconvencional da abdominoplastia com incisão pubiana mais baixa, a 5 cm da fúrcula vulvar,tracionando-se a pele para cima. Realiza-se a fixação mais cranial da fáscia de Scarpa naaponeurose com pontos simétricos em “U”, após seu descolamento, observando-seimediata melhora do aspecto dessa região. Resultados: Obtivemos satisfação de 100%entre os pacientes, por conseguirmos melhorar o aspecto da região pubiana sem aumentara cicatriz resultante e realizar uma retirada efetiva da redundância de pele e de tecido celularsubcutâneo. Conclusão: Trata-se de uma nova solução para melhora da região pubiana edo contorno corporal dos pacientes pós grande perda ponderal, apresentando baixamorbidade, sendo pouco invasiva, de fácil execução e de resultados agradáveis, comnenhuma cicatriz adicional ao paciente.

Introduction: Thinking about the affliction of the patients with great weight loss becauseof their bodies, we developed a new procedure to treat the pubic area in these patients.Objectives: To describe a new way to treat the pubic area in patients with great loss ofweight with an important pubic ptosis. Methods: The incision of the abdominoplasty isperformed a little bit lower in the pubic region, about 5cm from the vulvar fissure with theskin pulled up. Then, the Scarpa fascia is fixed more cranial in the aponeurosis after itsundermining, with symmetric nots. You can see a great improvement in this region as soonas you treat it. Results: We had an 100% satisfaction range among our patients, once wecould improve substantially the looking of this region without increasing the size of thescar, and could also make an effective resection of the excess of skin and fat tissue.Conclusion: This is a new solution to treat the ptotic pubic region in patients with greatloss of weight, improving their body contour. It showed to be a low morbidity technique,easy to performed, less invasive, giving great results and with no additional scars for thepatient.

Inferior pubectomy in management of post traumatic posterior urethral disruption

The aim of this work is to determine step wise procedures that would overcome long segment posterior defects and/or high prostatic apex in cases of post traumatic urethral defects. A total of 60 male patients presented with PUDD, a suprapubic tube was placed, and they were planned for delayed repair after 3 months. End to end anastomosis was contemplated after excision of all the scar tissue. In case the length of the defect, and the higher migration of the prostatic apex did not allow this tension free suturing the following maneuvers were undertaken: freeing the distal urethral segment till the penoscrotal junction, then development of the intercrural space, and if not sufficient, we utilized inferior pubectomy. After a mean follow up of 18 months [6-36], 60 patients were evaluated. Mean age was 43 years [27-68]. Twenty patients [group I] underwent end to end anastomosis [defect was <4cm]; 40 patients [group II] underwent end to end anastomosis with inferior pubectomy [defect > 4cm, or high riding prostate]. In group I, 14 out of 20 [70%] had a patent anastomosis and stricture recurred in 6 patients. In group II, 30 out of 40 [75%] had a patent anastomosis during follow-up. Of those 16 patients with recurrent stricture, 10 required visualized urethrotomy, and a redo anastomosis was done in 6 patients. Twelve [20%] developed new onset erectile dysfunction. Four patients had preoperative bladder neck insult, and suffered stress incontinence postoperatively. Four patients developed self limited local wound haematomas, one of them was infected and required drainage. AT could be cannluded that Shortening the distance between the distracted urethral ends can be achieved by inferior pubectomy that allows tension free anastomosis as well as smooth curved urethral pass from distal to proximal urethral ends. This procedure is preferred rather than using tissue transfer or difficult transpubic approach. Inferior pubectomy is indicated in case of long segment stricture posterior urethral defect and /or high prostate migration that will interfere with smooth pass of the urethra and results in urethral angulations