ABSTRACT
Surgical resection is the standard treatment for the management of localized penile cancer and a neo-urethral meatus is generally created on the penile stump or perineum. Neo-urethral meatus is often stenosed and requires repeated transurethral manipulations such as dilation and urethrotomy. These procedures are generally futile and are associated with poor quality of life. Here, we report a case of penile cancer that developed a neo-meatal stenosis after total penectomy, which was subsequently salvaged by perineal urethrostomy using Blandy technique. A 72-year-old male who was diagnosed with localized penile cancer, underwent total penectomy and creation of neo-meatus on the perineum. Neo-meatus stenosis had developed in the patient and he received repeated urethral dilations without any success. Finally, when the patient was unable to void, he was referred to us for the amelioration of meatal stenosis through the placement of a suprapubic catheter. Because the condition of the residual bulbar urethra was adequate and its length was enough, we planned to create a non-transecting perineal urethrostomy by Blandy technique. An inverted U-shaped perineal incision was made, and a skin flap was created. The scarred neo-meatus and spongiofibrosis at the distal bulbar urethra were completely excised. The residual bulbar urethra was exposed, and a longitudinal ventral incision of 4 cm was made. The edge of the bare urethral mucosa and tunica albuginea of the corpus spongiosum were sutured by 4-0 PDS for hemostasis. The apex of the U-shaped skin flap was brought to the proximal margin of the urethrotomy and a tension-free anastomosis was created between the skin flap and the urethral plate. Thereafter, the skin of the perineum was sutured to the open longitudinal urethrotomy. The patient started to void on the 5th day post-surgery. The subject could void without the help of any intervention and did not require any instrument, sixteen weeks after the surgery.
ABSTRACT
We describe a case of tuberculous epididymitis following Bacillus Calmette-Guérin (BCG) instillation in a 79-year-old man. He had received transuretheral resection of bladder tumor in Sep 2009. Histopathological diagnosis was urothelial carcinoma, high grade, pTa and pTis. To prevent recurrence, he received maintenance therapy for Feb 2010-May 2011 after eight weekly intravesical instillation of BCG. Skin fistula with discharge in the left scrotum occurred in Sep 2011. Treatment with levofloxacin was not effective. Therefore, we performed bilateral orchiectomy (he had hormone therapy of prostate cancer) and left scrotal skin resection. Histopathological examine showed tuberculous epididymitis. He had no signs of recurrence 2 years postoperatively and has not received any anti-tuberculous chemotherapy.
