The Surgical Treatment of Adult Acquired Buried Penis Syndrome: A New Classification System.

BACKGROUND: Adult acquired buried penis syndrome may be associated with an inability to void, sexual dysfunction, and recurrent infection. Previously published classification systems rely on intraoperative findings, such as penile skin quality. OBJECTIVES: The purpose of this study was to evaluate outcomes after adult acquired buried penis repair and to develop a classification system based on preoperative assessment. METHODS: The authors reviewed data from patients who underwent buried penis reconstruction at a single institution. Patient history and physical examination guided the development of a classification system for surgical planning. RESULTS: Of the 27 patients included, the mean age was 56 ± 15 years and mean body mass index was 49 ± 14 kg/m2. Patients were classified into 4 groups based on examination findings: (I) buried penis due to skin deficiency, iatrogenic scarring, and/or diseased penile skin (n = 3); (II) excess abdominal skin and fat (n = 6); (III) excess skin and fat with diseased penile skin (n = 16); and (IV) type III plus severe scrotal edema (n = 2). Surgical treatment (eg, excision and grafting, mons suspension, panniculectomy, translocation of testes, and/or scrotectomy) was tailored based on classification. Complications included wound breakdown (n = 3), cellulitis (n = 4), and hematoma (n = 1). Nearly all patients (96%) reported early satisfaction and improvement in their symptoms postoperatively. CONCLUSIONS: Classifying patients with buried penis according to preoperative examination findings may guide surgical decision-making and preoperative counseling and allow for optimized aesthetics to enhance self-esteem and sexual well-being.

Classification and Treatment of the Adult Buried Penis.

In contrast to the concealed penis found in children, the adult buried penis (BP) is associated with obesity or found in patients after massive weight loss. Bariatric patients present with enormous prepubic fat masses into which the penile shaft retracts. As a consequence, urinating problems occur with wetting of the adjacent tissue. Many BP patients are circumcised with recurrence and worsening of the symptoms. In postbariatric patients, the penis is not engulfed into the prepubic tissue. In contrast to highly obese patients, the BP is covered underneath the cutaneous apron. Although all conditions are called BP, it is conceivable that plastic-surgical treatment differs. Hence, a novel classification for the adult BP was needed to adjust the procedures accordingly. We propose 3 types of the adult BP. The first type is termed "pseudo-BP." The penis is covered underneath the lax skin without signs of retraction. Here, an apronectomy and prepubic lift with tissue fixation are sufficient. The second type is the "intermediate-type BP" with partial penile invagination. After prepubic apronectomy, anchoring sutures secure the penile shaft from retraction. The third type is the "classical BP" seen in obese patients. The penile shaft is completely retracted into the prepubic fat. Often a stenotic scar tissue is found after previous circumcisions. The plastic-surgical reconstruction comprises scar excision, reduction of the prepubic fat masses with extraction of the penile shaft, anchoring sutures, and reconstruction of the penile envelope. In short, the etiology of the adult BP, a novel classification, and a treatment algorithm according to each type are presented in this comprehensive overview.

[Buried Penis: A Comprehensive Review on Aetiology, Classification and Plastic-Surgical Reconstruction]. / "Buried Penis": Aktuelle Übersicht über Ätiologie, Klassifikation und plastisch-chirurgische Rekonstruktion.

The buried penis, also called hidden or concealed penis, is associated with morbid obesity or seen after massive weight loss in adults. In highly obese, bariatric patients, the penile shaft invaginates into the pre-pubic fat masses, resulting in voiding problems and urine wetting of the surrounding tissue. This leads to infection, skin maceration, lichen sclerosus and eczema. Sole circumcision without mons pubis plasty or penile fixation does not suffice to alleviate the discomfort and leads to recurrence. In post-bariatric patients, penile retraction is only partially present or absent, but abundant pre-pubic skin tissue forms an apron covering the genitals with problems in hygiene and sexual intercourse. In these cases, plastic-reconstructive interventions include mons pubis plasty with or without penile fixation. This article provides a comprehensive overview on aetiology, a novel classification of the buried penis and plastic-surgical reconstructive interventions matched to the stages of the condition.

Incidence of genital warts in adolescents and young adults in an integrated health care delivery system in the United States before human papillomavirus vaccine recommendations.

BACKGROUND: Information on genital wart incidence in adolescents and young adults before human papillomavirus (HPV) vaccination is important for understanding the impact of the vaccine on the epidemiology of this early outcome of HPV infection. METHODS: The study population included 11- to 29-year-old enrollees of Northern California Kaiser Permanente between July 1, 2000, and July 1, 2005, before the availability of the HPV vaccine. We identified genital warts with an algorithm combining genital wart-specific International Classification of Diseases, Ninth Revision, Clinical Modification codes (078.10, 078.11, and 078.19) with physician-recorded anatomic locations. We calculated sex- and age-specific incidence rates of genital warts and described the specific anatomic location of presentation, as well as recurrences of genital warts. RESULTS: We identified 1,682 cases of genital warts among 181,264 individuals. The incidence rate was highest among women (6.3/1000 person-years) and men (2.9/1000 person-years) aged 20 to 24 years old. Among women (n = 96,792), 63.4% of the 1240 incident genital wart cases occurred on the vulva and 21.1% on the cervix. Among men (n = 84,472), 91.6% of the 442 incident genital wart cases did not have a specific anatomic location recorded. Most people with an incident genital wart diagnosis (87.2%) did not have a recurrence during the observation period. CONCLUSIONS: Our study found that the incidence of genital warts was highest among persons aged 20 to 24 years using a unique method to identify the location of the wart. Information on incidence of genital warts before vaccine use provides baseline data that can be used to measure HPV vaccine impact.

Mondor's disease: what's new since 1939?

Mondor's disease (MD) is a rare and self-limited benign disease first described in 1939. Originally its clinical presentation was a superficial vein thrombosis (SVT) without contiguous skin inflammation of the chest wall veins. Over time its definition has evolved and now also includes subcutaneous thrombosis of the dorsal vein of the penis but also retractile scarring of the fascia after breast surgery without concomitant SVT. In all cases clinical examination constitutes the first step of diagnostic management. It is followed by an ultrasound exploration (US) to search for a thrombus. In about half of all cases the disease is considered as idiopathic and cancer is rare. Whatever the location considered, the follow-up is usually uneventful with low rates of recurrence and of subsequent cancer. Treatment is debated and ranges from therapeutic abstention to anticoagulants or even surgery. It is likely that the new locations and mechanisms (without thrombosis) of the MD have lead to the constitution of a heterogeneous entity precluding from a consensual mode of care.

Male median raphe cysts: serial retrospective analysis and histopathological classification.

BACKGROUND: To review the clinical and pathological characteristics of median raphe cysts and to classify the lesions according to pathogenesis and histopathological findings. METHODS: The medical records of patients who were diagnosed with median raphe cysts between 2001 and 2010 were reviewed to document the clinical presentation and pathological findings of the cysts. RESULTS: Most patients were asymptomatic; however, 9 patients had inflammatory or infectious cysts that were tender or painful. Four patients who had cysts on the parameatus and distal prepuce had difficulty voiding. Hematuria and hematospermia were noted in 2 cases. Thirty-one cysts were lined with an urothelium-like epithelium, and a squamous epithelium lining was found in 3 cases. In 2 cases, a well-formed mucinous glandular structure was observed. The other 20 cysts consisted of mixed epithelia. After excision of the cysts under local or general anesthesia, an urethral fistula developed as a complication in only 1 case. CONCLUSIONS: Median raphe cysts are benign lesions formed due to tissue trapping during the development of urethral folds. The cysts can be defined into 4 types based on pathological findings: urethral, epidermoid, glandular, and mixed. The associated symptoms and signs should be taken into consideration when determining the treatment for the cysts. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http//http://www.diagnosticpathology.diagnomx.eu/vs/7727074877500751.

Noninfectious penile lesions.

Family physicians commonly diagnose and manage penile cutaneous lesions. Noninfectious lesions may be classified as inflammatory and papulosquamous (e.g., psoriasis, lichen sclerosus, angiokeratomas, lichen nitidus, lichen planus), or as neoplastic (e.g., carcinoma in situ, invasive squamous cell carcinoma). The clinical presentation and appearance of the lesions guide the diagnosis. Psoriasis presents as red or salmon-colored plaques with overlying scales, often with systemic lesions. Lichen sclerosus presents as a phimotic, hypopigmented prepuce or glans penis with a cellophane-like texture. Angiokeratomas are typically asymptomatic, well-circumscribed, red or blue papules, whereas lichen nitidus usually produces asymptomatic pinhead-sized, hypopigmented papules. The lesions of lichen planus are pruritic, violaceous, polygonal papules that are typically systemic. Carcinoma in situ should be suspected if the patient has velvety red or keratotic plaques of the glans penis or prepuce, whereas invasive squamous cell carcinoma presents as a painless lump, ulcer, or fungating irregular mass. Some benign lesions, such as psoriasis and lichen planus, can mimic carcinoma in situ or squamous cell carcinoma. Biopsy is indicated if the diagnosis is in doubt or neoplasm cannot be excluded. The management of benign penile lesions usually involves observation or topical corticosteroids; however, neoplastic lesions generally require surgery.

Surgical treatment of chordee without hypospadias.

OBJECTIVE: The aim of this study was to retrospectively assess the efficacy of the surgical techniques commonly used in three types of chordee without hypospadias (Devine and Horton classification). METHODS: Twenty-six patients, ranging in age from 3 to 14 years, had chordee without hypospadias and underwent Nesbit dorsal plication (9 cases out of 12, type III), associated extensive mobilization of the urethra (10 cases out of 10, type II), and vascularized neourethra (3 cases out of 4, type I). RESULTS: Eleven subjects undergoing follow-up investigation for the milder forms of chordee were satisfied with the outcome achieved; there was no impediment of any kind in the sex lives of 5 adult subjects. Of the 11 patients undergoing follow-up after more complex surgery for Devine and Horton type I-II chordee without hypospadias, a residual abnormal curvature was present in 4 subjects. These patients were submitted to one or more reoperations with outcomes defined as satisfactory. CONCLUSION: To avoid the risks of persistent chordee, the authors suggest more radical and accurate operations for the treatment of type I and II pseudohypospadias.

Patología no infecciosa de pene / Penile non infectious disease

En este trabajo se hace referencia particularmente a los distintos aspectos vinculados a las diversas patologías de estirpe no infecciosa que afectan el glande, pene y prepucio. Se realiza una revisión de la bibliografía

Common penile lesions.

We have briefly summarized some of the most common and confusing penile lesions likely to be seen by the urologist. We have discussed the clinical features, differential diagnosis, and treatment from the dermatologist's point of view. We have included the latest possible references, as many disorders discussed here are rapidly becoming better understood.

A group study for the classification of anorectal anomalies in Japan with comments to the International Classification (1970).

A study group was formed to undertake further investigation of the problems involved in the classification of anorectal anomalies. At first, a registration form including standardized techniques for clinical and roentogenologic investigation was defined, and then 254 cases were collected and analyzed by referring these materials to the International Classification by the Melbourne group in 1970. Our analysis disclosed: (1) It is imperative to establish a registration form with footnotes describing standardized techniques for clinical and roentogenologic investigations; (2) The rectourethral fistula has been classified simply as high type under the present International Classification, but differences in the levels of the rectal pouch and of the point of fistula, as observed in the collected materials, tends to show that further subdivision of this anomaly may be indicated; (3) An abnormal skin fold at the anal and/or perineal sites is not always diagnostic of low type, specifically of covered anus-complete. Conversely, some infants with high type anomaly had abnormal skin folds; and (4) Two types of anomaly, which have not been well described in the present classification, were detected. They were "rectal membraneous atresia" and "recto-penile fistula."

Multiple keratoacanthomata. A unique case and review of the current classification.

A case of multiple keratoacanthomata is described, with involvement of the palms and soles, and erosive lesions of the eyelids and penis. Several lesions healed spontaneously, leaving circular scars. Some were atypical clinically, taking the form of keratotic tumors. Methotrexate produced marked improvement of all lesions but had to be abandoned because of thrombocytopenia. The current classification of keratoacanthomata is reviewed.