Real-world practice in Peyronie's disease management: Results from a national survey of urologists.

BACKGROUND: Despite many available treatments for Peyronie's disease (PD), practice patterns of available therapeutics are not well characterized. OBJECTIVE: We conducted a national survey of urologists to characterize real-world practice patterns of PD management and to characterize the use of therapies discouraged by the American Urological Association guidelines on PD management. MATERIALS AND METHODS: A 34-item survey was distributed via RedCap to urologists who treat patients with PD in all American Urological Association sections. Questions elicited demographic information as well as practices in the diagnosis and treatment of PD. Comparisons were made with Pearson's chi-squared test. The primary outcome was reported use of therapies discouraged by the American Urological Association guidelines on PD. RESULTS: A total of 145 respondents completed the survey, of whom 19% were fellowship trained in andrology/sexual medicine, 36% practiced in an academic setting, and 50% had at least 20 years in practice. Only 60% of respondents reporting performing in-office curvature assessment prior to commencing intralesional injection or surgical treatment, with higher prevalence in andrology/sexual medicine fellowship-trained versus non-fellowship-trained urologists (85% vs. 54%, p = 0.003). The most popular treatment modalities were collagenase clostridium histolyticum (61% of respondents), phosphodiesterase-5 inhibitors (54%), and penile traction (53%). Twenty-one percent of respondents reported currently using a treatment that is explicitly discouraged by the American Urological Association guidelines (extracorporeal shockwave therapy for curvature, L-carnitine, omega-3 fatty acids, or vitamin E). DISCUSSION: Patients seeking PD treatment may be offered different therapies, some of which are not evidence-based, depending on the treating urologist. This study is limited by self-selection and response bias. Its strength is that it represents a cross-sectional overview of real-world practice patterns in PD management, which has not been previously described. CONCLUSIONS: A significant proportion of urologists reported PD management practices that are not evidence-based and not guideline-supported.

Genital Mutilation in Males.

PURPOSE OF THE REVIEW: Genital mutilation in males can range from minor injuries (cuts from a blade) to severe urological emergencies (testicular or penile amputation). Due to the rarity of these events, there is a lack of extensive reports, as most of the available literature is regarding single cases. Genital mutilation has been associated with psychotic and non-psychotic causes, psychiatric conditions, drug consumption, sexual practices, or even cultural or religious beliefs. It is crucial to perform a psychiatric evaluation of these patients to obtain the best therapeutic approach. This manuscript serves as a review of the currently available knowledge regarding male genital mutilation. RECENT FINDINGS: A great variety of reasons have been associated with genital mutilation. Previous authors have distinguished between those that present with a clear mental health precursor from cases with no psychotic background. Nevertheless, sometimes, it is difficult to make this distinction. Recently, reconstructive techniques for amputation cases have moved towards a microsurgical approach in order to improve outcomes. A holistic therapeutic approach must be performed to increase the chances of effective treatment. Close collaboration between urologists, psychiatrists, and emergency doctors is essential to ensure the best care for patients performing genital mutilation. Future publications must evaluate differences in treatment options and the impact that these have on the long-term well-being of patients undergoing genital self-mutilation.

Surgical treatment of a paraphimosis in a castrated alpaca secondary to a preputial avulsion.

A 4-year-old recently castrated male alpaca was referred for preputial prolapse of 4 d duration. Clinical findings upon admission were a 5 cm edematous preputial prolapse with the exposed preputial epithelium ulcerated and slightly necrotic. Initial therapy included NSAIDs and local treatment. A severe local inflammatory reaction with a consequent paraphimosis occurred on the penis and prepuce presumptively secondary to the use of a common compound ointment (i.e., tetracycline, scarlet oil, and lanolin) 24 h after its application. Medical treatment and local debridement were unsuccessful in reducing the paraphimosis. The prolapse was successfully reduced by traction of the penis through a para-preputial incision under general anesthesia. The alpaca was discharged after 22 d in hospital. The alpaca is still in the herd 24 mo after discharge with no prolapse recurrence.

Traitement chirurgical d'un paraphimosis chez un alpaga castré secondaire à une avulsion p réputiale. Un alpaga mâle de 4 ans récemment castré a été référé pour un prolapsus préputial d'une durée de 4 jours. Les signes cliniques à l'admission étaient un prolapsus préputial oedémateux de 5 cm avec l'épithélium préputial exposé ulcéré et légèrement nécrotique. Le traitement initial comprenait des AINS et un traitement local. Une réaction inflammatoire locale sévère avec un paraphimosis conséquent s'est produite sur le pénis et le prépuce, vraisemblablement secondaire à l'utilisation d'une pommade composée conventionnelle (i.e. tétracycline, huile scarlet et lanoline) 24 heures après son application. Le traitement médical et le débridement local n'ont pas réussi à réduire le paraphimosis. Le prolapsus a été réduit avec succès par traction du pénis à travers une incision parapréputiale sous anesthésie générale. L'alpaga est sorti après 22 jours d'hospitalisation. L'alpaga est toujours dans le troupeau 24 mois après sa sortie sans récidive de prolapsus.(Traduit par Dr Serge Messier).

Double penile fracture without urethral injury presenting after 7 days.

Penile fracture is the sudden rupture of the tunica albuginea of an erect penis due to blunt trauma. It is an uncommon uropathology which characteristically occurs when one or both of the turgid penile corpora cavernosa forcefully snap under an abrupt blunt trauma, usually during an aggressive sexual intercourse or noncoital manipulation. In the majority of cases, diagnosis is clinical. Surgical repair irrespective of the time of presentation results in accelerated recovery, reduced morbidity, and fewer short and long-term complication rates. We report the case of a 35-year-old banker who sustained a bilateral rupture of the tunica albuginea without urethral injury during a heterosexual intercourse. He presented 7 days after the trauma to our facility following the persistence of symptoms despite conservative management with herbal medicine. Following a clinical diagnosis of penile fracture, he had penile exploration under regional anesthesia using a degloving subcoronal incision. He subsequently had repair of both corporal tear after clot evacuation. The postoperative period was uneventful, and he was discharged on the 3rd day after the surgery. He had been followed up for 2 years with good erectile and functional outcomes. This case report reiterates the fact that late presentation is not a barrier to surgical management and good outcome.

Résumé La fracture pénile est la rupture soudaine de l'albuginea tunica d'un pénis en érection en raison d'un traumatisme contondant. C'est une uropathologie rare qui se produit typiquement quand un ou les deux de la cavernosa penile turgid de corpora s'enclenchent avec force sous un trauma émoussé brusque, habituellement pendant un rapport sexuel agressif ou une manipulation noncoital. Dans la majorité des cas, le diagnostic est clinique. La réparation chirurgicale indépendamment du temps de présentation a comme résultat le rétablissement accéléré, la morbidité réduite, et moins de taux à court et à long terme de complication. Nous rapportons le cas d'un banquier de 35 ans qui a soutenu une rupture bilatérale de l'albuginea de tunica sans blessure urétrale pendant des rapports hétérosexuels. Il s'est présenté 7 jours après le trauma à notre établissement suivant la persistance des symptômes en dépit de la gestion conservatrice avec la médecine de fines herbes. Après un diagnostic clinique de rupture pénienne, il a eu l'exploration pénienne sous l'anesthésie régionale utilisant une incision subcoronal degloving. Il a par la suite subi la réparation des deux déchirures corporelles après l'évacuation du caillot. La période postopératoire était calme, et il a été déchargé le 3ème jour après l'opération. Il avait été suivi pendant 2 années avec de bons résultats érectiles et fonctionnels. Ce rapport de cas réitère le fait que la présentation tardive n'est pas un obstacle à la gestion chirurgicale et au bon résultat. Mots-clés: Traumatisme contondant, fracture du pénis, rupture, tunica albuginea.

Penile injection of aedile silicone: A dangerous shortcut.

INTRODUCTION: The size of penis can cause concern in patients, even if the organ is clinically normal. Additionally, the cost of phosphodiesterase 5 inhibitors (iPDE5) and long waiting lists to access penile prosthesis placement can lead patients to resort to non-medical and potentially dangerous alternatives. One of these dangerous alternatives is the injection of building silicone at the level of the subcutis of the penis or the corpora cavernosa causing the formation of a granuloma that increases the girth and consistency of the penis. CASE REPORT: The article describes the case of a 43-year-old patient who self-injected aedile silicone at the level of his penis in an attempt to achieve greater penile size and greater rigidity. The patient reported that he could not economically afford the iPDE5.The persistence of severe pain in the penis forced the patient to go to a urological examination. The patient subsequently underwent the penile granuloma exeresis procedure and skin reconstruction with scrotal flap. CONCLUSION: The pursuit of sexual well-being can lead some patients to rely on unconventional and potentially harmful techniques. The role of the andrologist and of the scientific society should be to dissuade the patient from using these dangerous methods and to provide valid alternatives accessible to the patient. The economic difficulty in purchasing drugs that facilitate erection or the long waiting lists for the placement of penile prostheses can favor dangerous methods such as penile injection of silicon. There is therefore a clear need to facilitate access to drugs and surgical techniques that favor the patient's sexual well-being.

Management of post-circumcision necrosis of the penis: the medicolegal aspect.

PURPOSE: To perform a medical evaluation of penile necrosis causes and treatment approaches by examining patients who had penile necrosis after circumcision surgery. METHODS: A total of 24 patients with penile necrosis after circumcision surgery, who presented at various hospitals in Turkey between September 2003 and April 2013 and whose cases were being reviewed at the Institution of Forensic Medicine with regard to malpractice, were evaluated retrospectively. RESULTS: The mean age of the patients was 5 ± 3.7 years, and the mean time of the necrosis diagnosis after circumcision was 5.2 ± 6.3 days. In etiologic terms, the predictive factors were monopolar cautery use in ten (41.6%) patients, post-circumcision infection in eight (33.3%), compartment syndrome due to post-circumcision dressing in three (12.5%), local anesthetic agent used for dorsal nerve blockage in two (8.3%), and methemoglobinemia in one (4.1%) patient. The first approaches to necrosis treatment were surgical intervention in 15 (62.5%) patients, hyperbaric oxygen treatment (HBOT) in 6 (25%), the conservative approach in 2 (8.3%), and HBOT plus surgical intervention in 1 (4.1%) patient. CONCLUSION: Penile necrosis is a preventable complication that requires early intervention. The current study will be helpful in preventing penile necrosis and in guiding surgeons in approaches following its occurrence.

Successful replantation of amputated penis with adjuvant hyperbaric oxygen therapy.

Successful penile replantations are rarely reported in the literature and are associated with significant complications. We present a case of a patient who auto-amputated his penis. Delayed microvascular replantation was performed approximately 14 hours following injury. He was treated with a phosphodiesterase inhibitor postoperatively, and adjuvant hyperbaric oxygen (HBO2) therapy was started 58 hours after replantation; 20 treatments at 2.4 atmospheres absolute (ATA), twice daily for eight days, followed by once daily for four days. Perfusion of the replanted penis was serially assessed using fluorescent angiography. With some additional surgical procedures including a split- thickness skin graft to the shaft due to skin necrosis he has made a complete recovery with return of normal urinary and sexual function. This unusual case illustrates the potential benefit of HBO2 therapy in preserving viability of a severed body part. Fluorescent angiography may have potential utility in monitoring efficacy of HBO2.

Dorsal Penile Nerve Block via Perineal Approach, an Alternative to a Caudal Block for Pediatric Circumcision: A Randomized Controlled Trial.

BACKGROUND: General anesthesia combining with a caudal block (CB) has been commonly performed in pediatric patients undergoing circumcision surgeries. However, some severe complications have been suspected of a caudal block in the combined use. To avoid these issues of a caudal block, this study introduces a novel dorsal penile nerve block (DPNB) via perineum guided by ultrasound as an alternative to a caudal block in pediatric circumcision surgeries. METHODS: A total of 104 pediatric patients scheduled for circumcision surgeries were involved and randomly divided into 2 groups: the CB group (n=52) and the DPNB group (n=52). A laryngeal mask was inserted followed by induction and maintenance anesthesia of inhaled sevoflurane. In the DPNB group, a dorsal penile nerve block (DPNB) guided by a real-time ultrasonography was performed by a single injection via perineum of 0.25% ropivacaine plus 0.8% lidocaine with total injection volume of 3-5ml. In the CB group, a dose of 0.5 ml/kg was given via the caudal canal following the same general anesthesia with that of Group DPNB. The time to the first analgesic demand after surgery is the key data collected for comparing between the two study groups. Heart rates and respiratory rates changes before and during the surgical procedure, pain score when leaving the PACU, and the time taken for the first micturition after a surgery were also recorded to analyze the differences in analgesic effects between the CB and DPNB groups. RESULTS: No significant difference in heart rates and respiratory rates was found between the two groups before and during the surgery. Pain scores were similar before pediatric patients leave the PACU. However, the time taken for the first micturition after a surgery in Group DPNB is shorter than Group CB. The patients in Group DPNB asked for analgesics later than those in Group CB. Additionally, no significant differences in adverse effects were noted between two groups except the numbness of the lower limbs occurring less in Group DPNB. CONCLUSIONS: The ultrasound-guided dorsal penile nerve block via perineal approach can basically act as a safe and effective alternative to the caudal block in pediatric patients undergoing circumcision surgeries. Clinical Trials identifier is ChiCTR-IPR-15006670. Protocol is available at http://www.chictr.org.cn/showproj.aspx?proj=11319.

[Urological and psychological approach of secondary complications to penile aesthetic modifications]. / Abordaje urológico y psicológico de las complicaciones secundarias a las modificaciones estéticas peneanas.

OBJECTIVES: Due to the scarcity of scientific articles that review the technical alternatives available for aesthetic modifications in the penis that are the cause of subsequent uro-andrological problems, the existing literature is reviewed after the assistance of a penile infection by injection of subcutaneous hyaluronic acid with aesthetic purposes. MATERIAL AND METHODS: A 38-year-old male patient with no medical or psychiatric remarkable reports who came to the emergency room due to inflammation and abscess in penile skin after injection of hyaluronic acid. Surgical treatment was required and degloving and excision of affected skin was performed, with subsequent satisfactory evolution. The psychological analysis showed a narcissistic personality possibly secondary to traumas in childhood. We have reviewed the literature present in medical databases as well as information available on-line. RESULTS: Enlargement of the penis is an important cultural and social concern, so that there are different devices in the market to meet this demand, among them: herbal medicine, stretching exercises, weights, vacuum pumps or extensor devices. Among the surgical techniques, there have been described the pubic liposuction, the section of the suspensory ligament of the penis or the injection of autologous material or synthetic substances among others. As for the aesthetic modifications of the penis, there is a wide variety of genital piercings, tattoos and subcutaneous implants also called "pocketing" or "3D implants". All of these techniques or modifications are described in this article along with their possible associated more frequent urological complications. CONCLUSIONS: Aesthetic manipulations in the penis are becoming increasingly popular, and both its terminology and its medical implications should be known by urologists and andrologists. community.

CO2 laser treatment for pearly penile papules - personal experience.

Pearly penile papules (PPP) are physiological lesions in the epithelium of the corona of the glans penis which extend to its neck. These lesions may also appear on both sides of the frenulum. Although they are not pathological, the lesions frequently cause concern or embarrassment/discomfort in patients. They are the most common reason for seeing a dermatologist. There are several methods of treatment for PPP such as cryosurgery, electrocoagulation, treatment with CO2, Er:YAG, or pulsed dye lasers. This paper describes the authors' experience in removing PPP with a CO2 laser.

[Penile strangulation: about two patients living in rural areas]. / Strangulation du pénis: à propos de deux cas en milieu rural.

Penile strangulation is a clinical condition requiring emergency management. Several metallic or non-metallic objects can be placed around the penis to improve sexual performance or for auto-erotic purposes. We report the case of two schizophrenic patients aged 25 and 33years hospitalized in the Emergency Department due to penile strangulation by metal ring. The ring was placed at the level of the glans foreskin groove 3 days before in one case and at the level of the root of penis 2 days before in the other. There was no urinary disorder in both patients. Ring ablation was performed with taxis under local anesthesia in one case and under sedation followed by double ring section using an electric saw in the other case.

Priapism caused by "Rhino 7 Platinum 3000" an over-the-counter male enhancement supplement.

Male enhancement and erectile dysfunction supplements are typically non-Food and Drug Administration (FDA) approved and readily available for purchase by anyone. Longstanding priapism is a significant potential side effect. A 25-year-old man presented with a 48-h priapism after taking Rhino 7 Platinum 3000. He required bilateral corpo-glanular shunting to alleviate his priapism. On initial 2-week follow-up, he had significant fibrosis of the corporal bodies bilaterally and had been unable to achieve an erection. There are few studies performed and few case reports regarding the roles of various supplements in causing priapism. We are unaware of any studies regarding Rhino 7 Platinum 3000. Interestingly, since our initial contact with the FDA Safety Reporting Portal, multiple investigations of Rhino products have demonstrated that sildenafil is a non-labeled ingredient. Given the lack of FDA oversight of many other supplements similar to this one, patients must be wary that the ingredients listed may not be comprehensive and that serious side effects can occur.

Lymphangioma Circumscriptum Post Radiotherapy for Penile Cancer Treated with CO2 Laser.

Lymphangioma circumscriptum (LC) is a rare, benign condition, predominantly characterized by the malformation of lymphatic skin vessels. Its onset may be congenital or due to secondary causes such as radiotherapy, infections, or surgical procedures. We present the case of a 55-year-old patient with a pathologic history of squamous cell carcinoma of the penis followed by radical penectomy. Due to metastasis to the locoregional lymph nodes, the entire affected area was subsequently treated with radiation therapy, receiving a total dose of 55.8 Gray. Eight years after this treatment, translucent vesicles filled with a clear liquid appeared on the scrotum. Histopathology confirmed the diagnosis of LC and therapy with CO2 laser was applied, resulting in a favorable outcome. LC of the scrotum may present a long-term radiotherapy-induced complication of this site. Our clinical experience showed that the CO2 laser was the therapy of choice as the vesicles entirely disappeared and healed as white scar-like lesions.

Penile transplantation as an appropriate response to botched traditional circumcisions in South Africa: an argument against.

Traditional male circumcision is a deeply entrenched cultural practice in South Africa. In recent times, there have been increasing numbers of botched circumcisions by untrained and unscrupulous practitioners, leading to genital mutilation and often, the need for penile amputation. Hailed as a world's first, a team of surgeons conducted the first successful penile transplant in Cape Town, South Africa in 2015. Despite the euphoria of this surgical victory, concerns about the use of this costly intervention in a context of severe resource constraints have been raised. In this paper, we explore some of the ethical implications of penile transplants as a clinical and public health response to the adverse consequences of traditional male circumcision. Given the current fiscal deficits in healthcare and public health sectors, how can one justify costly, high-technology interventions for conditions affecting a small section of the population? Since botched traditional male circumcisions are preventable, is a focus on penile transplantation as a form of treatment reasonable? Finally, do such interventions create undue expectations and false hope among a highly vulnerable and stigmatised group of young men? In this paper, we argue that given limited healthcare resources in South Africa and competing healthcare needs, prevention is a more appropriate response to botched traditional circumcisions than penile transplants.

Differences in Survival Associated with Performance of Lymph Node Dissection in Patients with Invasive Penile Cancer: Results from the National Cancer Database.

PURPOSE: Inguinal lymphadenectomy remains under performed in patients with invasive penile cancer. Using a large national cancer registry we assessed temporal trends in inguinal lymphadenectomy performance and evaluated the impact of the procedure on survival in patients in whom inguinal lymphadenectomy was an absolute indication (T1b-4 N0/x-1) according to NCCN® (National Comprehensive Cancer Network®) Guidelines®. MATERIALS AND METHODS: We queried the National Cancer Database for all cases of nonmetastatic, T1b-4 N0/x-1 squamous cell carcinoma of the penis from 2004 to 2014. Multivariable logistic regression models adjusting for patient, demographic, and clinicopathological characteristics were used to examine the association between available covariates and receipt of inguinal lymphadenectomy. Cox proportional hazards regression analysis was then done to assess the impact of clinical and pathological variables on overall survival. Propensity score weighted analysis was performed to assess the effect of inguinal lymphadenectomy on overall survival. RESULTS: A total of 2,224 patients met analysis criteria, of whom 606 (27.2%) underwent inguinal lymphadenectomy. Following adjustment the procedure was more likely in younger patients, those who presented with palpable adenopathy (cN1), those treated at an academic facility and those with a more contemporary diagnosis. On survival analysis controlling for all known and measured confounders inguinal lymphadenectomy was associated with improved overall survival (HR 0.79, 95% CI 0.74-0.84, p <0.001). CONCLUSIONS: At hospitals that report to the National Cancer Database the overall rate of inguinal lymphadenectomy in patients with invasive penile cancer was only 27.2%. Inguinal lymphadenectomy was associated with increased overall survival, justifying the procedure as an important quality metric for performance reporting in patients with invasive penile cancer.

Current and emerging therapies in premature ejaculation: Where we are coming from, where we are going.

Premature ejaculation is the most common form of sexual dysfunction among men. The pathophysiology of premature ejaculation appears to be multifactorial, implicating the need for multimodal therapeutic regimens to successfully treat premature ejaculation. Multiple treatment regimens have been shown to be effective in extending the time between penetration and ejaculation. These treatment modalities include everything from behavioral modifications and medications to diet alterations and major surgery. The goal of the present article was to review the commonly used treatment regimens used in the treatment of premature ejaculation, as well as to introduce and discuss the newest treatment routines under study for the treatment of premature ejaculation.

Off-Target Effect of Sildenafil on Postsurgical Erectile Dysfunction: Alternate Pathways and Localized Delivery System.

INTRODUCTION: There is no consensus on the best oral phosphodiesterase type 5 inhibitor (PDE5I) for patients undergoing penile rehabilitation after surgical nerve injury. AIM: To determine the mechanism of PDE5I on cultured neuronal cells and the effectiveness of local drug delivery using nanospheres (NSPs) to sites of nerve injury in a rat model of bilateral cavernous nerve injury (BCNI). METHODS: The effects of sildenafil, tadalafil, and vardenafil on cyclic adenosine monophosphate, cyclic guanosine monophosphate, and cell survival after exposure to hypoxia and H2O2 were measured in PC12, SH-SY5Y, and NTERA-2 (NT2) cell cultures. The effects of phosphodiesterase type 4 inhibitor (PDE4I) and PDE5I on neuronal cell survival were evaluated. Male rats underwent BCNI and were untreated (BCNI), immediately treated with application of empty NSPs (BCNI + NSP), NSPs containing sildenafil (Sild + NSP), or NSPs containing rolipram (Rol + NSP). MAIN OUTCOME MEASURES: Viability of neuronal cells was measured. Intracavernous pressure changes after cavernous nerve electrostimulation and expression of neurofilament, nitric oxide synthase, and actin in mid-shaft of penis were analyzed 14 days after injury. RESULTS: Sildenafil and rolipram significantly decreased cell death after exposure to H2O2 and hypoxia in PC12, SH-SY5Y, and NT2 cells. PC12 cells did not express PDE5 and knockdown of PDE4 significantly increased cell viability in PC12, SH-SY5Y, and NT2 cells exposed to hypoxia. The ratio of intracavernous pressure to mean arterial pressure and expression of penile neurofilament, nitric oxide synthase, and actin were significantly higher in the Sild + NSP and Rol + NSP groups than in the BCNI and BCNI + NSP groups. Limitations included analysis in only two PDE families using only a single dose. CONCLUSION: Sildenafil showed the most profound neuroprotective effect compared with tadalafil and vardenafil. Sildenafil- or rolipram-loaded NSP delivery to the site of nerve injury prevented erectile dysfunction and led to increased neurofilament, nitric oxide synthase, smooth muscle content in rat penile tissue after BCNI.

Medical clowns reduce pre-operative anxiety, post-operative pain and medical costs in children undergoing outpatient penile surgery: A randomised controlled trial.

AIM: The aim of this paper is to investigate prospectively the potential benefits of the participation of the medical clowns in the outpatient paediatric penile surgery programme. METHODS: Eighty children undergoing meatotomy, age 2 to 16 years, were randomised into two groups (40 each). In the first group, the medical clown was an integral part of the medical team, and in the second group, the treatment was given without participation of the medical clown. The following parameters were measured: the level of pre-operative anxiety, the level of the post-operative pain, the amount of pain medication use in the first 24 h after surgery and the time needed to return to normal activities. The operating room time and hospital costs were calculated. RESULTS: The patients from the first group demonstrated a lower pre-operative anxiety index upon (P = 0.0319) and after surgery (P = 0.0042), required less induction time for anaesthesia (P < 0.001), spent overall less time in the operating room (P < 0.0001) and required less time to recover from the surgery and to be discharged (P = 0.0172). The overall OR time and post-operative unit care savings of 20 and 155 min, respectively, led to the cost savings of $467. CONCLUSION: Our data demonstrated that the use of the medical clown functioning as an integral part of the operating team reduces children pre-operative anxiety and leads to a shortening of the overall time in the hospital thereby reducing the overall medical cost justifying the participation of medical clown as an integral part of the health team in a paediatric urology outpatient surgical unit.

Cuerpos extraños en pene / Penile foreign bodies

No disponible

Medicinal Leech Therapy for Glans Penis Congestion After Primary Bladder Exstrophy-Epispadias Repair in an Infant: A Case Report.

Many postoperative complications have been reported after repair of classic bladder exstrophy. We present a case of medicinal leech therapy for glans penis congestion following exstrophy repair in an infant. A 2-week-old male with classic bladder exstrophy underwent complete primary repair. On postoperative day 1, he developed rapidly worsening glans penis venous congestion. Medicinal leech therapy was instituted with antibiotics and blood transfusions to maintain a hematocrit >30%. After 24 hours, venous congestion improved and therapy was discontinued. The patient's remaining hospital course was uncomplicated. Medicinal leeches are an effective therapy to relieve glans penis venous congestion.