Incidence and prevalence of multiple types of genital human papillomavirus (HPV) infection in men: a study in Poland.

OBJECTIVES: Infections with human papillomavirus (HPV) are sexually transmitted. Their prevalence in males is comparable to females, but infection in men is largely unknown. Since such information is needed to establish prevention strategies, the goal of our study was to estimate the incidence of type-specific genital HPV infection among men in Poland. MATERIAL AND METHODS: Within a multi-center clinical preventive trial, penile sampling of 826 (100%) uncircumcised and sexually active males (aged 25-69 yrs.) was studied. Peniscopy was performed in addition to routine clinical examination. DNA HPV in smears was detected by hybrid capture (HC2) and in the biopsy material by means of polymerase chain reaction (PCR). RESULTS: Twenty-three HPV types were detected, including 11 high-risk oncogenic (53-6.4% men) and in 65 (7.87%) individuals both oncogenic and nononcogenic simultaneously--altogether 118 (14.3%) and also 12 low-risk multiple nononcogenic types (248-30% men). Penile HPV prevalence was approximately 26.8%. In 53 (6.4%) cases we detected multiple oncogenic types (single HPV16 in only 17 cases--2.1%). Penile HPV DNA was detection did not appear to be associated with age. Our analyses also suggested a lower prevalence of HPV infection among male participants who reported consistent condom use and fewer sexual partners. In men with history of having more than 10 sexual partners over their lifetime increased the likelihood of detecting HPV DNA. CONCLUSIONS: Data from our study showing a high prevalence of HPV infection in the Polish population of men will be helpful for future studies on HPV transmission dynamics.

Proliferative and nonproliferative lesions of the rat and mouse male reproductive system.

The INHAND Project (International Harmonization of Nomenclature and Diagnostic Criteria for Lesions in Rats and Mice) is a joint initiative of the Societies of Toxicologic Pathology from Europe (ESTP), Great Britain (BSTP), Japan (JSTP), and North America (STP) to develop an internationally accepted nomenclature for proliferative and nonproliferative lesions in laboratory animals. The purpose of this publication is to provide a standardized nomenclature and differential diagnosis for classifying microscopic lesions observed in the male reproductive system of laboratory rats and mice, with color microphotographs illustrating examples of some lesions. The standardized nomenclature presented in this document is also available for society members electronically on the Internet (http://goreni.org). Sources of material included histopathology databases from government, academia, and industrial laboratories throughout the world. Content includes spontaneous and aging lesions as well as lesions induced by exposure to test materials. A widely accepted and utilized international harmonization of nomenclature for lesions of the male reproductive system in laboratory animals will decrease confusion among regulatory and scientific research organizations in different countries and provide a common language to increase and enrich international exchanges of information among toxicologists and pathologists.

Dysaesthetic penoscrotodynia: nomenclature, classification, diagnosis and treatment.

Male patients can present with a genital skin burning sensation that bears similarities to vulvodynia. The classification of vulvodynia by International Society for the Study of Vulvovaginal Disease of vulvodynia provides a blueprint for nomenclature and classification of Dysaesthetic penoscrotodynia (DPSD). Recognizing DPSD as generalized, localized, provoked, unprovoked and mixed will enable precise and objective communication between practitioners. Learning from research on the aetiology and management of vulvodynia can improve the care of patients suffering with DPSD. Scope remains for better acknowledgement of DPSD within the medical profession and improvement in its public profile in order to enhance patient care.

Hydrocele of the spermatic cord in infants and children: its particular characteristics.

BACKGROUND: The hydrocele of the spermatic cord (cord hydrocele) typically presents as a translucent swelling in the inguinal canal or upper scrotum, located above the testis. We report a case series and point out its distinctive characteristics. METHODS: From May 2008 to October 2009, 20 consecutive male infants or boys, ranging in age from 38 days to 54 months (mean age, 29.4 months), with cord hydrocele previously treated at our institution were retrospectively reviewed. There were 10 right and 10 left cord hydroceles. Surgery for 16 irreducible cord hydroceles was done via the open approach, whereas the remaining 4 were reducible and laparoscopy was performed. RESULTS: Five cord hydroceles were of encysted variety, and 7 were of funicular variety. The remaining 8 hydroceles, called mixed variety by the authors, had solitary or more than 1 wall-integrated cyst, but the proximal processus vaginalis remained patent. Of 4 patients with reducible cord hydrocele, 3 were of mixed variety and the remaining 1 was of funicular variety. Whether age and the hydrocele presented as reducible was similar among the 3 varieties (P = .099 and 0.232, respectively). CONCLUSIONS: Because the processus vaginalis remained patent in mixed variety, herniotomy is required to prevent later occurrence of an inguinal hernia. Laparoscopy may be an alternative therapeutic tool in patients with reducible funicular or mixed varieties.

[Lichen planus esophagitis without skin, genital or oral mucosa involvement]. / Lichenoide Osophagitis ohne Haut-, Genital- oder Mundschleimhautbeteiligung.

Lichen ruber planus is a common skin and mucosal disease, with very rare involvement of the esophagus. We report on a 68-year-old patient suffering from dysphagia, with a reduced general condition and weight loss of 12 kg in the past 6 months due to lichen planus of the esophagus. Treatment by bougienage was very successful. This case report describes a lichen ruber planus of the esophagus without involvement of skin, genital or oral mucosa.

Lymphedema of the external genitalia.

PURPOSE: This article presents a simple classification of lymphedema of the external genitalia, which is useful for selecting the appropriate therapy, and evaluates our experience with the various therapeutic options used to treat this disorder. MATERIALS AND METHODS: The literature was reviewed and the records of patients treated for the disorder were analyzed. RESULTS: A convenient classification of the disorder divides cases into congenital and acquired. Therapy is primarily dependent on whether the disease is self-limited and whether there has been any pathological change in the skin, lymphatics and subcutaneous tissue. For self-limited diseases in which no permanent pathological sequelae occur conservative therapy is appropriate. For most chronic conditions a surgical procedure is required. Excisional techniques are most effective for severe forms of the disease. In select cases subcutaneous tissue excision with preservation of the overlying skin is appropriate. However, for most patients excision of the skin and subcutaneous tissue with split-thickness grafting is most effective. CONCLUSIONS: When patients with lymphedema of the external genitalia require surgery and are properly selected for the appropriate procedure, the functional and cosmetic results are excellent and patient rehabilitation is likely.

[Intrascrotal epidermoid inclusion cyst. Report of a new case]. / Quiste epidermoide de inclusión intraescrotal. Aportación de un nuevo caso.

OBJECTIVES: We report a new case of intra-scrotal inclusion epidermoid cyst. METHODS: We describe the case of a 47-year-old male patient who referred an increase in size of the right hemiscrotum lasting seven months. Physical examination evidenced an intra scrotal mass of elastic consistency, which was confirmed by ultrasound. Testicular tumour markers were negative. Trans-scrotal excision of the lesion was performed. RESULTS: Pathology was compatible with inclusion epidermoid cyst. The patient remains asymptomatic on follow-up visits, without evidence of lesion relapse. CONCLUSIONS: We highlight the importance of establishing a nomenclature consensus for scrotal cystic lesions. We agree with other authors on the indication of simple excision of the lesion as a treatment with intention-to-cure. However, the limited number of cases makes the long-term follow-up of these patients recommendable.

Transurethral resection of the ejaculatory duct.

Complete bilateral ejaculatory duct obstruction has long been recognized as an uncommon, treatable form of male infertility. Partial ejaculatory duct obstruction reflects a disturbance of ejaculation where sperm quality is impaired during transit through the distal vas deferens and ejaculatory ducts. With the advent and increased use of high-resolution transrectal ultrasonography, abnormalities of the distal ejaculatory ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, several clinical findings are highly suggestive. In an infertile man with oligospermia or azoospermia with low ejaculate volume, normal secondary sexual characteristics, testes and hormonal profile and dilated seminal vesicles, midline cyst, or calcification on transrectal ultrasonography, ejaculatory duct obstruction is suggested. Of course, other causes of infertility may be concomitantly present and need to be searched for and treated as well. In selected cases, transurethral resection has resulted in marked improvement in semen parameters and pregnancies have been achieved. As is the case with all surgical procedures, proper patient selection and surgical experience are necessary to obtain optimal results. However, it appears that the treatments currently available for relief of ejaculatory obstruction are not optimally effective. Only approximately one half of treated patients will have an improvement in semen parameters and only about one quarter of treated patients will contribute to a pregnancy. What remains to be determined is how to manage the additional nearly 50% of patients who do not benefit from transurethral resection of ejaculatory obstruction. Based on my experience, I suggest that transrectal ultrasonography should be the first diagnostic procedure used when infertile men are suspected of having ejaculatory duct obstruction; however, vasography should still be considered for a more comprehensive diagnosis of ejaculatory duct obstruction. In patients showing atrophic seminal vesicles on transrectal ultrasonography and having a history of pulmonary tuberculosis, further study is not necessary and microscopic epididymal sperm aspiration is recommended for in vitro fertilization. Qualitative measurement of semen fructose may be helpful in the diagnosis of partial ejaculatory duct obstruction. Patients having midline cyst and being treated by transurethral resection are expected to have the best outcome.

Agenesis of the penis: patterns of associated malformations.

Agenesis of the penis is a rare malformation that occurs in otherwise normal males or together with other anomalies. In this article, we document unusual patterns of malformations in four such infants and analyze the nature and incidence of defects in 57 cases by clinical evaluation and numerical classification techniques. Although patients with this condition previously have been divided into groups based on the position of the urethral meatus in relation to the anus (presphincteric, postsphincteric, urethral atresia), our analyses suggest that most cases can be classified into either a severe form (16%) with renal aplasia or dysplasia and other caudal anomalies or a second group (72%) with low mortality and fewer additional malformations. The remaining cases in our group represented unique patterns stemming from a variety of causes, including etretinate embryopathy and the human homologue of the disorganization mutation. Agenesis of the penis occurs as a consequence of single gene disorders, teratogenic effects, or malformation sequences and associations and in unrecognized patterns of anomalies. It thus should be considered a developmental field defect. Its concurrence with scrotal hypoplasia, absent raphe, and anal anomalies implies a major disturbance of the caudal mesoderm. In such cases, severe renal defects are usually seen, and the prognosis is poor. When the patient has a patent urethra and normal scrotum, raphe, and testes, however, penile agenesis may be a localized malformation of the genital tubercle potentially related to penoscrotal transposition, a phylogenetic anomaly that is the normal genital arrangement in male marsupials, rabbits, and certain other mammals. Infants with isolated penile agenesis have generally done well. In the past, many were not treated; however, current recommendations are to use appropriate surgical and endocrine techniques to reassign female gender and enhance sexual and psychosocial functioning, though this approach is the subject of controversy.

[Attempted classification of scrotal contusions]. / Essai de classification des contusions scrotales.

We present a review of the literature and results of a survey involving 50 closed scrotal traumas. Based on this analysis, we propose an anatomoclinical classification of scrotal contusions based on what we consider to be the most appropriate therapeutic management.

[The clinical picture, classification and surgical treatment of paraffinomas of the external genitalia]. / Klinika, klassifikatsiia i operativnoe lechenie oleogranulem naruzhnykh polovykh organov.

Basing on operative data on 42 patients and literature data, the authors hold that clinical presentation of external genitalia paraffinomas varies depending on the quantity of the introduced emulsion, its chemical structure, site and depth of the injection, duration of the suspension stay in the tissues. Paraffinoma dissection within intact tissue is thought the only and radical treatment. The technique should be based on adequate classification of the disease taking into consideration clinical varieties, localization and extent of the process, involvement of the adjacent tissues, complications. Four forms of the disease are recognized: foreskin, stem, penile-scrotal, penile-pubic-scrotal. Etiological factors, spread of the disease, kind of complication are considered also. The classification permits unification of surgery, reliable comparison of the results from various institutions. In preputial complicated disease a simple policy is employed--circular dissection of the foreskin. Radical dissection of the affected skin with subcutaneous fat and plastic repair of the defect with a scrotal skin double-end graft according to Reich's technique in modification of the authors or replacement of the wound-adjacent triangle grafts according to A. A. Limberg. Utilization of this approach led to substantial improvement of end results in the treatment of 39 patients.

Urogenital sinus-ejaculatory duct cyst: a case report with a proposed clinical classification and review of the literature.

A 31-year-old infertile white man presented with difficulty with defecation secondary to a large urogenital sinus-ejaculatory duct cyst. Computerized axial tomography and ultrasound evaluation were accomplished before retroperitoneal transvesical surgical removal of the cyst. A computerized tomography scan detected a septum in the cyst. A clinical classification is presented of the various retrovesical cystic lesions in the male patient and the literature is reviewed.

Problem-orientated categorisation of "other conditions" seen in a genitourinary medicine clinic.

The case sheets of patients coded as D2 (other conditions requiring treatment) and D3 (other conditions not requiring treatment) in 1981 were reclassified on a problem-orientated basis. Ten discreet categories were delineated with ease. Women with non-specific vaginitis and men with Gardnerella vaginalis urogenital infection, usually coded D2 or C4, should be reclassified under the C group of conditions as, for example, "Gardnerella or other bacterial genital infections." It is suggested that codes D2 and D3 be replaced by the following nine categories: genital skin lesions or rashes; genitourinary symptoms; enteric conditions; other sexually transmitted infections; normal genital architecture, congenital conditions, or unconfirmed genital discharges; asymptomatic patients attending for routine examination; uninfected contacts of patients with sexually transmitted diseases; psychosexual problems; and others.

Cowper's syringocele: a classification of dilatations of Cowper's gland duct based upon clinical characteristics of 8 boys.

Lesions of Cowper's gland duct assume various appearances. A system to classify each of these appearances is offered to diagnose these lesions more precisely. The urethrographic and endoscopic characteristics of dilated Cowper's gland ducts noted in 8 boys are grouped as a simple classification. The dilated Cowper's duct is referred to as a syringocele (Greek syringo--tube plus cele--swelling). There are 4 groups of Cowper's syringoceles: 1) simple syringocele--a minimally dilated duct, 2) perforate syringocele--a bulbous duct that drains into the urethra via a patulous ostium and appears as a diverticulum, 3) imperforate syringocele--a bulbous duct that resembles a submucosal cyst and appears as a radiolucent mass, and 4) ruptured syringocele--the fragile membrane that remains in the urethra after a dilated duct ruptures. Marsupialization of the syringoceles cured urine infection and hematuria but voiding symptoms may persist.