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1.
Int. braz. j. urol ; 47(3): 515-522, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1154487

ABSTRACT

ABSTRACT Purpose: To evaluate the erectile function in patients who underwent partial penectomy and identify factors associated with penile functional status. Materials and Methods: We identified patients who underwent partial penectomy due to penile cancer between 2009 and 2014. Clinical and pathological characteristics included patient age at the time of diagnosis, obesity, hypertension, dyslipidemia, diabetes, smoking, metabolic syndrome, Eastern Cooperative Oncology Group (ECOG) status, penile shaft length, tumor size, primary tumor stage (pT), clinical nodal status, and local recurrence. Erectile function was assessed prospectively with the International Index of Erectile Function (IIEF-5) at least 3 months after partial penectomy. Results: A total of 81 patients met analysis criteria. At the diagnosis, the median age was 62 years (range from 30 to 88). Median follow-up was 17 months (IQR 7-36). Of total patients, 37 (45%) had T2 or higher disease. Clinically positive nodes were present in 16 (20%) patients and seven (8.6%) developed local recurrence. Fifty patients (62%) had erectile dysfunction (ED) after partial penectomy, 30% had moderate or severe erectile dysfunction scores. Patients with ED versus without ED were similar in baseline characteristics except for age, penile shaft length, and presence of inguinal adenopathy (p <0.05). Multivariate analysis using logistic regression confirmed that older patients, shorter penile shaft length, and clinically positive lymph node were significantly associated with ED. Conclusion: Partial penectomy due to penile cancer provides adequate local control of the disease, however, proper counselling is important especially in relation to ED consequences. Preservation of penile length yields to more optimal erectile recovery.


Subject(s)
Humans , Male , Adult , Aged , Aged, 80 and over , Penile Neoplasms/surgery , Erectile Dysfunction/etiology , Penis/surgery , Penile Erection , Middle Aged , Neoplasm Recurrence, Local
4.
Rev. argent. cir. plást ; 27(1): 40-43, jan.-mar. 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1223887

ABSTRACT

Introducción. El pene oculto del adulto se presenta como una patología con prevalencia en ascenso, por el incremento de pacientes obesos y diabéticos. Representa un desafío para la reconstrucción en cirugía plástica y urología. El objetivo de este trabajo es describir la experiencia del Hospital Alemán de Buenos Aires en la resolución quirúrgica de esta patología. Métodos y resultados. Durante el año 2019 se realizaron dos cirugías reconstructivas de pacientes con pene oculto del adulto a cargo del Servicio de Cirugía Plástica del Hospital, en conjunto con el Servicio de Urología. El procedimiento fue segmentado en tres partes: Liberación del cuerpo peneano del panículo adiposo, dermolipectomía suprapúbica, y finalmente injerto del pene con piel de espesor total. El tiempo promedio de cirugía fue de 4 horas, sin complicaciones intraoperatorias. En ambos casos hubo prendimiento parcial del injerto, con la necesidad de tratamiento tópico con crema de colagenasa para estimular la cicatrización por segunda intención. La satisfacción funcional de los pacientes fue del 100% en ambos casos; la satisfacción estética fue incompleta. La recuperación de la erección y la función sexual fue completa para ambos. Conclusiones. La reconstrucción del pene oculto del adulto implica el trabajo multidisciplinario sobre una patología con resolución quirúrgica, con buenos resultados funcionales, aunque no exento de complicaciones estéticas.


Introduction. Adult buried penis represents a disease with increasing prevalence, after the ascending incidence of obese and diabetic patients. It represents an urologic and plastic surgery challenge. The aim of this paper is to describe the experience of German Hospital in Buenos Aires on the surgical resolution of this pathological entity. Methods and results. During year 2019 two adult buried penis surgeries were held by the Plastic Surgery service, with participation of the Urology service. The procedure was divided in three steps: Release of the penis from the adipose panicle; suprapubic dermolipectomy; and finally full-thickness skin graft on the penis body. The average surgery time was four hours. In both cases there was partial intake of the skin graft, which needed collagenase topical treatment to stimulate second intention healing. Functional satisfaction was 100% in both cases; aesthetical satisfaction was incomplete. Recovery of penile erection and sexual function was complete in both cases. Conclusions. Adult penis reconstruction implies an interdisciplinary work on a surgically correctable anomaly, with good functional results, although not exempt of aesthetical complications


Subject(s)
Humans , Male , Middle Aged , Aged , Penis/surgery , Penis/pathology , Reconstructive Surgical Procedures/methods , Obesity/pathology
5.
Int. braz. j. urol ; 47(2): 263-273, Mar.-Apr. 2021. graf
Article in English | LILACS | ID: biblio-1154477

ABSTRACT

ABSTRACT Vaginoplasty is a commonly performed surgery for the transfeminine patient. In this review, we discuss how to achieve satisfactory surgical outcomes, and highlight solutions to common complications involved with the surgery, including: wound separation, vaginal stenosis, hematoma, and rectovaginal fistula. Pre-operative evaluation and standard technique are outlined. Goal outcomes regarding aesthetics, creation of a neocavity, urethral management, labial appearance, vaginal packing and clitoral sizing are all described. Peritoneal vaginoplasty technique and visceral interposition technique are detailed as alternatives to the penile inversion technique in case they are needed to be used. Post-operative patient satisfaction, patient care plans, and solutions to common complications are reviewed.


Subject(s)
Humans , Male , Female , Transsexualism , Sex Reassignment Surgery , Penis/surgery , Gynecologic Surgical Procedures , Vagina/surgery
6.
Int. braz. j. urol ; 47(2): 388-394, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154447

ABSTRACT

ABSTRACT Purpose: To describe penile fracture (PF) findings with non-sexual etiology in a referral emergency hospital, with emphasis on demographic data, clinical and intraoperative findings and long-term outcomes. Materials and Methods: Patients with PF of non-sexual cause operated at our institution from January 2014 to January 2019 were submitted to surgical treatment and monitored for at least three months after surgery. Etiology of trauma, epidemiological and clinical presentation data, time to intervention and operative findings were reviewed retrospectively. The evaluation of postoperative erectile function was carried out by filling out the International Index of Erection Function - 5 (IIEF-5). The tool used to assess urinary function was the International Prostate Symptom Score (IPSS) questionnaire. Results: Of a total of 149 patients submitted to surgical treatment for PF, 18 (12%) reported non-sexual etiology. Twelve (66.6%) cases were due to penile manipulation through the act of bending the penis during morning erection, three (16.6%) when rolling over in bed with erect penis, one (5.5%) when embracing the wife during erection, one (5.5%) to laying on the partner with erect penis and the other (5.5%) when sitting on the toilet with an erection. Operative findings were unilateral corpus cavernosum injury in all cases. Only one (5.5%) patient had a partial urethral lesion. Follow-up time varied from 3 to 18 months (mean, 10.1 months). Three (16.6%) patients developed erectile dysfunction six months after surgery. However, all of them responded to treatment with IPDE-5 and reported improvement of erection, with no need for medication, on reevaluation after 18 months. One (5.5%) patient developed penile curvature < 30 degrees. Thirteen (72.2%) patients developed penile nodules. No patient presented voiding complaints during follow-up. Conclusions: PF is a rare urologic emergency, especially with the non-sexual etiology. However, PF should always be considered when the clinical presentation is suggestive, regardless of the etiology. Penile manipulation and roll over in bed were the most common non-sexual causes. These cases are related to low-energy traumas, usually leading to unilateral rupture of corpus cavernosum. Urethral involvement is uncommon but may be present. Early treatment has good long-term clinical outcome, especially when performed in specialized centers with extensive experience in FP.


Subject(s)
Humans , Male , Penile Diseases , Penis/surgery , Referral and Consultation , Rupture/surgery , Penile Erection , Retrospective Studies , Treatment Outcome , Hospitals
9.
Int. braz. j. urol ; 46(6): 1072-1074, Nov.-Dec. 2020. graf
Article in English | LILACS | ID: biblio-1134267

ABSTRACT

ABSTRACT Introduction We present an alternative procedure for distal hypospadias consisting of urethral mobilization and partial glandar disassembly, namely GUD (glandar urethral disassembly) technique. Materials and Methods A subcoronal circumcision exposes distal dysplastic urethra. We incise the Buck´s fascia on both sides of urethra releasing it partially from the corpora. We keep a thin bridge of urethral plate to the glans and disassembly almost completely the glans from the corpora, except for the bridge. The glans is incised creating two wide wings that are extremely mobile. The urethra is mobilized, advanced and sutured to the tip of the glans. The glans wings embrace the distal urethra producing a conical glans. Discussion The concept of urethral mobilization has been reported and popularized by Koff in the literature to correct distal hypospadias. One of the limitations of this procedure is the risk of urethral retraction due to extensive proximal dissection. We got inspiration from Mitchell and Bagli' s work of penile disassembly in epispadias to develop the GUD concept. We adopt minimal urethral mobilization mainly in glandar/proximal penile shaft and complete deconstruction of the glans, detaching the corpora from the glans and rotating the wide glans wings to embrace the urethra. Therefore we avoid suture urethroplasty and refurbish the glans to a better conical shape. Conclusion We are convinced that this operation can be regarded as a genuine alternative to distal hypospadias (coronal and subcoronal) but should not be addressed to midshaft forms.


Subject(s)
Humans , Male , Infant , Reconstructive Surgical Procedures , Hypospadias/surgery , Penis/surgery , Urologic Surgical Procedures, Male , Urethra/surgery
10.
Int. j. morphol ; 38(6): 1639-1644, Dec. 2020. graf
Article in English | LILACS | ID: biblio-1134491

ABSTRACT

SUMMARY: Previous studies from our group described the consequences of using ethanol on penile erection. Nevertheless, the molecular mechanisms surrounding microRNAs, apoptosis process and their relationship with erectile dysfunction associated with alcohol consumption are still poorly understood. The objective of this analysis was to evaluate the mechanism of apoptosis by the expression of AIF and PARP, as well as their regulatory microRNAs: miR-145, miR-210 and miR-486, in the corpus cavernosum of rats submitted to a semivoluntary alcoholism model. For this study 24 Wistar rats were divided into two groups: control (C) and treated with 20 % ethanol (A) for seven weeks. The corpus cavernosum samples were prepared for immunohistochemical analysis of AIF and PARP protein expression, and microRNAs miR-145, miR-210, miR-486 gene expression in cavernous tissue was performed by real time PCR. The immunohistochemical analysis showed little nuclear positive labeling for the protein PARP and AIF in the corpus cavernosum of control and ethanol treated animals. After analysis of miR-145, -210 and -486 microRNA expression in the 12 animals studied, no results were found with significant statistical difference between the control and alcoholized groups. The expression of AIF and PARP and their regulatory microRNAs involved in apoptotic process (miR-145, miR-210 and miR-486) were not altered in the corpus cavernosum of rats submitted to semivoluntary alcoholism.


RESUMEN: Estudios previos de nuestro grupo describieron las consecuencias del uso de etanol en la erección del pene. Sin embargo, los mecanismos moleculares que rodean a los microARN, el proceso de apoptosis y su relación con la disfunción eréctil asociada con el consumo de alcohol aún no se conocen bien. El objetivo de este análisis fue evaluar el mecanismo de apoptosis mediante la expresión de AIF y PARP, así como sus microARN reguladores: miR-145, miR-210 y miR-486, en el cuerpo cavernoso de ratas sometidas a un modelo de alcoholismo semivoluntario. Se dividieron 24 ratas Wistar en dos grupos: control (C) grupo de ratas tratadas con etanol al 20 % (A) durante siete semanas. Las muestras del cuerpo cavernoso se prepararon para el análisis inmunohistoquímico de la expresión de la proteína AIF y PARP, y la expresión del gen microRNAs miR-145, miR-210, miR-486 en tejido cavernoso se realizó por PCR en tiempo real. El análisis inmunohistoquímico mostró escaso etiquetado nuclear positivo para la proteína PARP y AIF en el cuerpo cavernoso de los animales de control y tratados con etanol. Después del análisis de la expresión de microARN miR-145, -210 y -486 no se encontraron resultados con diferencias estadísticas significativas entre los grupos control y alcoholizados. La expresión de AIF y PARP y sus microARN reguladores involucrados en el proceso apoptótico (miR-145, miR-210 y miR-486) no se alteraron en el cuerpo cavernoso de las ratas sometidas a alcoholismo semivoluntario.


Subject(s)
Animals , Rats , Apoptosis , Alcoholism/metabolism , Erectile Dysfunction/metabolism , Penis/physiopathology , Penis/chemistry , Immunohistochemistry , Rats, Wistar , MicroRNAs/analysis , MicroRNAs/genetics , MicroRNAs/metabolism , Disease Models, Animal , Alcoholism/physiopathology , Apoptosis Inducing Factor/analysis , Apoptosis Inducing Factor/genetics , Apoptosis Inducing Factor/metabolism , Real-Time Polymerase Chain Reaction , Erectile Dysfunction/physiopathology
11.
Rev. Assoc. Med. Bras. (1992) ; 66(9): 1180-1186, Sept. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136360

ABSTRACT

SUMMARY INTRODUCTION: The vascular evaluation of the erectile function through Color Duplex-Doppler Ultrasound (CDDU) of the penis can benefit the therapeutic decision-making process. Unfortunately, there is no standard procedure for CDDU conduction, a fact that results in high result-interpretation variability. OBJECTIVE: The aims of this review are to promote greater standardization during CDDU of the penis and discuss the fundamental principles for its accurate conduction. METHODS: CDDU is initially conducted with the penis in the flaccid state; the whole penis must be assessed (images at B mode) with a high-frequency linear transducer (7.5-18 MHz). Intracavernous injection of vasodilating agents (prostaglandin E1, papaverine, phentolamine) is performed to induce a rigid erection. Serial measurements at different times should be taken during the CDDU session and penile rigidity must be assessed in each evaluation. RESULTS: It is important to monitor the erection response after the vasoactive agent (hardness scale), and scanning during the best-quality erection should be contemplated. Manual self-stimulation, audiovisual sexual stimulation (AVSS), and vasoactive agent re-dosing protocols must be taken into account to reduce the influence of psychogenic factors and to help the patient to get the hardest erection possible. Such measurements contribute to the maximal relaxation of the erectile tissue, so the hemodynamic parameters are not underestimated. CONCLUSIONS: CDDU is a relevant specialized tool to assess patients with erectile dysfunction; therefore, this guideline will help to standardize and establish uniformity in its conduction and interpretation, taking into consideration the complexity and heterogeneity of CDDU evaluations of the penis.


RESUMO INTRODUÇÃO: A avaliação vascular da função erétil por meio da ultrassonografia com Doppler colorido do pênis (UDCP) pode trazer benefícios na tomada de decisão. Infelizmente, a falta de padronização na condução de UDCP resulta em alta variabilidade do exame, além de poder comprometer a interpretação dos resultados. OBJETIVO: Os objetivos desta revisão são promover uma maior padronização durante o UDCP e discutir os princípios fundamentais para sua correta condução e interpretação. MÉTODOS: O UDCP é conduzido inicialmente com o pênis no estado flácido; todo o pênis deve ser avaliado (imagens no modo B) com um transdutor linear de alta frequência (7,5-18 MHz). A injeção intracavernosa de agentes vasodilatadores (prostaglandina E1, papaverina, fentolamina) é realizada para induzir uma ereção rígida. Medições seriais em momentos diferentes podem ser realizadas durante a sessão da UDCP e a rigidez peniana deve ser estimada em cada avaliação. RESULTADOS: É importante monitorar a resposta da ereção após o agente vasoativo (escala de rigidez), bem como realizar avaliação hemodinâmica durante a ereção de melhor qualidade. Os protocolos de estimulação sexual manual e audiovisual (AVSS) e redosagem de agente vasoativo devem ser levados em consideração para reduzir a influência de fatores psicogênicos e ajudar o paciente a obter a ereção mais rígida possível. Tais medidas contribuem para o relaxamento máximo do tecido erétil, de modo que os parâmetros hemodinâmicos não são subestimados. CONCLUSÕES: O UDCP é uma ferramenta especializada relevante para avaliar pacientes com disfunção erétil; portanto, esta diretriz ajudará a padronizar e estabelecer uniformidade em sua condução e interpretação, se considerarmos a complexidade e a heterogeneidade das avaliações do pênis por UDCP


Subject(s)
Humans , Male , Penis , Penile Erection , Ultrasonography, Doppler, Color , Hemodynamics , Erectile Dysfunction
12.
Int. braz. j. urol ; 46(3): 409-416, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1090599

ABSTRACT

ABSTRACT Objective: To report our experience over the past 20 years in the diagnosis and surgical treatment of penile fracture (PF). Materials and methods: Between January 1997 and January 2017, patients with clinical diagnosis of PF were admitted to our facility and retrospectively assessed. Medical records were reviewed for clinical presentation, etiology and operative findings. Postoperative complications, sexual and urinary function were evaluated. Results: Sexual trauma was the main etiological factor, responsible for 255 cases (88.5%): 110 (43.1%) occurred with the "doggy style" position, 103 (40.3%) with "man on top" position, 31 (12.1%) with the "woman on top" position and 11 (4.3%) in other sexual positions. The most common findings in the clinical presentation were hematoma, in all cases and detumescence in 238 (82.6%). Unilateral corpus cavernosum injuries were found in 199 (69%) patients and bilateral in 89 (31%) patients. Urethral injuries were observed in 54 (18.7%) cases. Nine (14.7%) patients developed erectile dysfunction and eight (13.1%) had penile curvature. Only two (3.7%) patients had complications after urethral reconstruction. Conclusions: PF has typical clinical presentation and no need for additional tests in most cases. Hematoma and immediate penile detumescence are the most common clinical findings. Sexual activity was the most common cause. The 'doggy style' and 'man-on-top' was the most common positions and generally associated with more severe lesions. Concomitant urethral injury should be considered in cases of highenergy trauma. Surgical reconstruction produces satisfactory results, however, it can lead to complications, such as erectile dysfunction and penile curvature.


Subject(s)
Humans , Male , Female , Penile Diseases , Erectile Dysfunction , Penis , Rupture , Retrospective Studies
13.
Int. braz. j. urol ; 46(3): 436-443, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1090601

ABSTRACT

ABSTRACT Purpose: Spongioplasty (mobilization and midline approximation of the two branches of the bifid dysplastic distal corpus spongiosum) can form a covering layer for the neourethra to prevent urethrocutaneous fistula in hypospadias repair surgery. However, it remains unclear whether spongioplasty affects neourethral function. The objective of this study was to compare neourethral function after hypospadias repair with and without spongioplasty. Materials and Methods: Fourteen congenital hypospadiac New Zealand male rabbits were randomly allocated into two groups, seven animals underwent Duplay hypospadias repair and spongioplasty (experimental group), while seven underwent Duplay surgery alone (control group). Functional differences between groups were assessed by comparing neourethral compliance and flow rate. Two months after surgery, in vivo neourethral compliance was assessed by measuring intraluminal pressure with a digital pressure meter of an isolated neourethral segment, following progressive distension with 1, 2, and 3mL of air. Penises were harvested for uroflowmetry test using a simple device. Results: Postoperatively, fistula developed in one and zero rabbits in the control and experimental groups, respectively. Mean pressures tended to be higher in the experimental group than in the control group (82.14 vs. 69.57, 188.43 vs. 143.26, and 244.71 vs. 186.29mmHg for 1, 2, and 3mL of air, respectively), but the difference was not statistically significant. Mean flow rates also did not significantly differ between the experimental and control groups (2.93mL/s vs. 3.31mL/s). Conclusion: In this congenital rabbit model, no obvious functional differences were found between reconstructed urethras after hypospadias repair with and without spongioplasty.


Subject(s)
Humans , Animals , Male , Infant , Hypospadias , Penis , Rabbits , Urologic Surgical Procedures, Male , Surgical Flaps , Urethra , Random Allocation
16.
Arq. bras. med. vet. zootec. (Online) ; 72(2): 317-322, Mar./Apr. 2020. ilus
Article in English | ID: biblio-1128169

ABSTRACT

A 10-year-old male mixed-breed dog was admitted for recurrent signs of urinary tract infection (UTI). Urinary bladder ultrasonography revealed decreased thickness of its wall with floating hyperopic particles within its lumen. Ultrasonography revealed a structure invading the dorsal wall of the penile urethral lumen, located in a segment distal to the bladder. Radiographies showed bone resorption with proliferation at the caudal aspect of the penile bone, stricture of the final aspect of the penile urethra, and no radiopaque images compatible with a urethrolith. Computed tomography showed bone proliferation causing stricture of the urethral lumen at two different sites. Presumptive diagnosis of penile neoplasia was considered more likely and the dog underwent penectomy along with orchiectomy and scrotal urethrostomy. Enterobacter spp. was cultured from the urine sample and antibiotic sensitivity tests revealed that the bacterium was susceptible to amikacin, imipenem, and meropenem. Histopathology revealed severe suppurative urethritis, bone resorption, and hyperostosis, suggestive of osteomyelitis of the penile bone. Neoplastic cells were not observed at any part of the examined tissue. The findings in the present case suggest that osteomyelitis of the penile bone should be included in differential diagnosis for partial and complete urethral obstruction in dogs with recurrent UTI.(AU)


Um cão mestiço, com 10 anos, foi admitido por sinais recorrentes de infecção do trato urinário (ITU). A ultrassonografia da bexiga urinária revelou diminuição da espessura de sua parede com partículas flutuantes dentro de seu lúmen. A ultrassonografia demonstrou estrutura invadindo a parede dorsal do lúmen da uretra peniana, localizada em segmento distal à bexiga. Radiografias evidenciaram reabsorção óssea com proliferação no aspecto caudal do osso peniano, estenose do aspecto final da uretra peniana e ausência de imagens radiopacas compatíveis com uretrólito. Pela tomografia computadorizada, observou-se proliferação óssea causando estreitamento da luz uretral em dois locais diferentes. Diagnóstico presuntivo de neoplasia peniana foi considerado mais provável e o cão foi submetido à penectomia, juntamente com orquiectomia e uretrostomia escrotal. Enterobacter spp. foi cultivada da amostra de urina e testes de sensibilidade revelaram susceptibilidade ao amicacina, imipenem e ao meropenem. A histopatologia revelou uretrite supurativa grave, reabsorção óssea e hiperostose compatível com osteomielite do osso peniano. Células neoplásicas não foram observadas em nenhuma parte do tecido examinado. Os achados do presente caso sugerem que a osteomielite do osso peniano deve ser incluída no diagnóstico diferencial de obstrução uretral parcial e completa em cães com ITU recorrente.(AU)


Subject(s)
Animals , Male , Dogs , Osteomyelitis/veterinary , Penis , Urethritis/veterinary , Urinary Tract Infections/veterinary , Enterobacter , Bone and Bones , Bone Resorption , Tomography, X-Ray Computed
17.
Int. braz. j. urol ; 46(2): 152-157, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090594

ABSTRACT

ABSTRACT Objective To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. Materials and Methods We searched the Pubmed database between 1998 and 2019 using the following key words: "penile fracture", "fracture of penis", "trauma to penis", "rupture of corpora cavernosa", "urethral injury", "urethral rupture" and "urethral reconstruction". Results The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. Conclusion PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is mandatory and produces satisfactory results with low levels of complications.


Subject(s)
Humans , Male , Penile Diseases/surgery , Penile Diseases/diagnosis , Penile Diseases/etiology , Penis/injuries , Urethra/injuries , Urethral Diseases/etiology , Penis/surgery , Rupture/surgery , Rupture/diagnosis , Rupture/etiology , Urethra/surgery , Urethral Diseases/surgery
18.
Int. braz. j. urol ; 46(1): 83-89, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1056362

ABSTRACT

ABSTRACT Purpose: Obliterative urethral stenosis is a type of urethral lesion that compromises the whole corpus spongiosum's circumference. We present our experience in resolving complex long segment urethral obliteration in a single procedure using a combination of dorsal onlay oral mucosa graft (OMG) and ventral fasciocutaneous penile skin flap. Materials and methods: A prospectively maintained database was reviewed, which included data of men presenting long, obliterative strictures. Patients were excluded if they were lost to follow-up before one year. Failure was defined as need for further urethral instrumentation. The surgical technique used consisted on the fixation of OMG to the tunica albuginea of the corpus cavernosum, thus creating a new urethral plate. Penile or foreskin flaps were employed to complete the ventral aspect. Postoperative follow-up was done with a voiding cystourethrography at week 3. Results: A total of 21 patients were included with a median age of 49 years. Mean follow-up was 25 months. Failure was found for 3 patients (2 of them needing dilations and only one required a new urethral reconstruction). Conclusion: Single stage combination of dorsal OMG with ventral fasciocutaneous penile flap showed good results for selected patients affected with obliterative urethral stenosis.


Subject(s)
Humans , Male , Penis/surgery , Surgical Flaps/transplantation , Urethral Stricture/surgery , Reconstructive Surgical Procedures/methods , Mouth Mucosa/transplantation , Prospective Studies , Reproducibility of Results , Follow-Up Studies , Treatment Outcome , Kaplan-Meier Estimate , Operative Time , Middle Aged
19.
Arq. bras. med. vet. zootec. (Online) ; 72(1): 40-48, Jan.-Feb. 2020. tab, ilus
Article in Portuguese | ID: biblio-1088936

ABSTRACT

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)


Subject(s)
Animals , Male , Cattle , Penis/diagnostic imaging , Foreskin/diagnostic imaging , Ultrasonography/methods
20.
Article in English | WPRIM | ID: wpr-876111

ABSTRACT

@#Primary partial empty sella occurs when less than 50% of an enlarged or deformed sella turcica is filled with cerebrospinal fluid in the setting of unidentified etiologic pathological conditions. Prepubertal hypogonadotropic hypogonadism presenting as its main manifestation is rare since its peak incidence commonly occurs late at 30 to 40 years of age and has a sexual predilection for female. We described a case of 20-year-old male who presented with micropenis and absent secondary sex characteristics. Work up showed cranial MRI finding of partial empty sella, low testosterone, LH, FSH, Estradiol and Beta HCG levels. Sex hormone replacement may not improve fertility for this case but may help produce and maintain virilization and prevent future complications of hypogonadotropic hypogonadism.


Subject(s)
Genital Diseases, Male , Penis , Hypogonadism
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