Paediatric preputial pathology: are we circumcising enough?
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INTRODUCTION: Preputial problems are a common reason for referral to the paediatric surgical out-patient department. Many boys referred do not need surgical intervention. One indication for intervention is balanitis xerotica obliterans (BXO), a potentially serious condition previously considered rare in childhood. PATIENTS AND METHODS: Consecutive boys referred to a paediatric general surgical out-patient department with problems relating to their prepuce during a period of 4 years were included. The out-patient diagnosis and management was recorded. All foreskins excised were sent for histological analysis. RESULTS: A total of 422 boys were referred, median age 6 years 2 months (range, 3 months to 16 years). Over half the boys referred simply required re-assurance that all was normal with their penis. However, 186 boys (44.1%) were listed for surgical procedures - 148 circumcision, 33 preputial adhesiolysis, and 5 frenuloplasty. There were histological abnormalities in 110 specimens (84.8%); chronic inflammation (n = 69; 46.6%), BXO (n = 51; 34.5%), and fibrosis (n = 4; 2.7%). Nineteen (12.8%) specimens were reported as histologically normal. The overall prevalence of BXO in the boys referred was 12.1%. CONCLUSIONS: In this series, the percentage of boys circumcised and the prevalence of BXO were both higher than in other published series. BXO may be more common and present at a younger age than previously thought. (+info)
Chordee without hypospadias: report of 79 Chinese prepubertal patients.
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A series of Chinese prepubertal patients with congenital chordee without hypospadias is presented and the clinical data described. From July 1999 to September 2006, 79 boys with congenital chordee without hypospadias were treated in the Department of Pediatric Surgery, West China Hospital of Sichuan University, China. The ages ranged from 21 months to 14 years, with a mean of 76.8 months (6.4 years). The patients were categorized according to structural defect into 4 groups, with the aid of intraoperative artificial erection. Group I included those with skin tethering (28 cases, 35.4%); group II, fascial chordee (22, 27.8%); group III, corporal disproportion (10, 12.7%); and group IV, urethral tethering (19, 24.1%). Chordee-related structural defect was considered the only criterion for classification, and urethral dysgenesis influenced the choice of surgical procedure. The chordee in group I patients was corrected with penile degloving; group II, release of dense fibrous tissue in addition; group III, dorsal-midline-plication-based correction; and group IV, longitudinal-island-flap-urethroplasty-based repair. At a mean follow-up of 14.8 months (range, 2 to 63), all patients had penile straightening except 1 group III patient with residual curvature that was managed upon reoperation. Glans dehiscence occurred in 1 group II patient who underwent a tubularized incised plate urethroplasty. Urethrocutaneous fistula and urethral stricture were found in 2 group IV patients who underwent island flap urethroplasty. With the categorization based on structural defect, chordee without hypospadias may be managed well with minimized complications. (+info)
Drug-resistant genital tuberculosis of the penis in a human immunodeficiency virus non-reactive individual.
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The genitourinary tract is the most common site for extrapulmonary tuberculosis (TB). Penile TB is extremely rare comprising less than 1 % of all genital TB cases in males. It most commonly presents either as a superficial ulcer on the glans or around the corona. Diagnosis of penile TB is often difficult because it can mimic numerous other diseases. The association of TB with AIDS, and the increasing incidence of multiple drug resistance has further compounded the problem. The case described herein involves a patient with multidrug-resistant smear-positive penile TB that was undiagnosed initially due to the lack of clinical suspicion of TB, and once diagnosed failed to respond to first line antitubercular drugs because of multiple drug resistance. (+info)
Penile necrosis by calciphylaxis in a diabetic patient with chronic renal failure.
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The patient was a 41-year-old man who had suffered from diabetes for 24 years and had been on insulin therapy for 17 years. The patient had commenced hemodialysis in 1999. Some of his toes on both feet had been amputated in 2000 due to diabetic gangrene. The patient was admitted to our hospital in early March 2005 complaining of a painful ulcer on the tip of the penis. At the time of admission, multiple ulcers and necrosis were observed on the prepuce and penis, as well as an ulcer on the left foot and gangrene of the left great toe. Imaging studies demonstrated severe arteriosclerosis with calcification of both large and small arteries. After penile amputation was performed because of severe pain, the wound became ulcerated, and a rectal ulcer as well as skin ulcers also developed in the bilateral inguinal regions. The penile necrosis, skin ulcers, and rectal ulcer were thought to have been caused by calciphylaxis. Calciphylaxis is a disorder in which necrosis occurs at sites of arterial obstruction and calcification, and the prognosis is poor. Seventeen patients with penile necrosis due to calciphyalxis, including our patient, have been reported in Japan. They all had a long history of diabetes, and 15 of the 17 patients were on dialysis. (+info)
Fracture penis: an analysis of 26 cases.
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The aim of this study was to review the pattern of penile fracture occurrence, its clinical presentation, diagnosis, management, and outcome at our center. A retrospective analysis of 26 patients with penile fractures treated at our hospital from January 1997 to January 2005 was carried out. We noted an incidence of 3.5 cases per year, occurring more commonly in unmarried men. Of our study group, 28 episodes of penile fractures occurred in 26 patients. Hospital presentation after trauma varied from 2 h to 21 days. Masturbation was the main initiating causative factor and penile hematoma was the most common clinical finding. Nearly 81% noticed the characteristic click prior to the fracture. Clinical diagnosis was adequate in a majority of the cases. Midshaft fractures with right-sided laterality were more frequent in this series. The tear size ranged from 0.5-2.5 cm with a mean of 1.1 cm. All cases, but one, were treated by surgical repair using absorbable sutures. Out of three cases treated conservatively, two failed to respond and had to be treated surgically. False fracture with dorsal vein tear was present in two cases. Involvement of bilateral corpora was seen in one patient. Infection was the most common early complication, while pain with deviation was the late complication. In our experience, clinical findings are adequate enough to diagnose fracture penis in a majority of cases. Surgical exploration with repair of the tear is recommended both in early and delayed presentations. There was no noticeable relationship to the time of initial presentation or with the size and site of tear to the final outcome. (+info)
Ciliated median raphe cyst of perineum presenting as perianal polyp: a case report with immunohistochemical study, review of literature, and pathogenesis.
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Median raphe cyst is a very rare, benign congenital lesion occurring mainly on the ventral aspect of the penis, but can develop anywhere in the midline between the external urethral meatus and anus. We report a case of median raphe cyst in the perineum presenting as a perianal polyp in a 65-year-old, English white male with exceptionally rare ciliated epithelium. According to our knowledge, this is the third such case of ciliated median raphe cyst in the English literature. This case, also the first case of ciliated median raphe cyst in the perineum location, focuses on pathogenesis of median raphe cyst. (+info)
Superficial granulomatous pyoderma gangrenosum of the penis: a case report.
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Classic type of pyoderma gangrenosum (PG) is an uncommon ulceronecrotic cutaneous disease of uncertain aetiology characterised by broad zones of confluent ulceration with violaceous undermined margins. Some 50% of cases are associated with systemic diseases. The superficial granulomatous variant of pyoderma gangrenosum (SGPG) of the external genitalia is extremely rare Patients with this condition develop single or multiple ulcerated skin lesions often with sinus tract formation. The majority of these lesions were found on the trunk and limbs. SGPG is less likely to be associated with underlying disease processes than classic PG. We present a 58 year-old with recalcitrant penile ulceration demonstrated to be SGPG on biopsy. Although rare and poorly recognised, the histological features are sufficiently typical to allow the correct diagnosis to be established. (+info)
First case of "bubonulus" in L2 lymphogranuloma venerum.
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Since 2003, an ongoing lymphogranuloma venereum (LGV) proctitis outbreak has been reported in industrialised countries with a new variant designated L2b. Only men who have sex with men (MSM) are affected and most are HIV co-infected; delayed or incorrect diagnoses are frequent. We report a rare clinical case of LGV primary stage called "bubonulus" with penile adenopathy and secondary local acute lymphoedema in an MSM seropositive man. This is the first case described of this clinical presentation with a L2b genovar strain, occurring immediately after use of a sex toy. It suggests that this presentation is favoured by host immunity and behavioural factors. These factors may also play a part in the new outbreak of LGV. (+info)