The indications, complications and outcomes of dogs undergoing partial penile amputation: 10 cases (2014-2021).

OBJECTIVES: To report the signalment, indications for surgery, postoperative complications and medium-/long-term outcomes in dogs undergoing partial penile amputation. MATERIALS AND METHODS: Retrospective case series. The electronic medical records of a single small animal referral hospital were searched between January 2014 and January 2021 for dogs that underwent a partial penile amputation. Data collected included signalment, presenting clinical signs, indication for partial penile amputation, surgical technique, postoperative complications and outcome. RESULTS: Ten dogs were included in the study. Indications for surgery were treatment of preputial neoplasia (n=5), penile neoplasia (n=1), idiopathic paraphimosis (n=3) and chronic urethritis (n=1). Five of five preputial tumours were cutaneous mast cell tumours, and the penile tumour was a squamous cell carcinoma. All dogs recovered uneventfully from surgery with a median postoperative hospitalisation time of 28.8 hours. Two of the three dogs treated for paraphimosis had major postoperative complications requiring further resection of the tip of the penis at 2 weeks and 24 months. Four dogs had minor complications managed without surgical intervention. The outcome was good to excellent in nine of nine dogs for which medium- or long-term follow-up data were available. CLINICAL SIGNIFICANCE: In this group of dogs, partial penile amputation, performed with or without concurrent resection of the prepuce, was a well-tolerated surgical procedure with low intraoperative and postoperative complication rates and good functional outcomes. Partial penile amputation should be considered for conditions affecting the distal penis and prepuce.

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).

[Urologic Emergencies: Paraphimosis]. / Urologische Notfälle: Paraphimose.

Urologic Emergencies: Paraphimosis Abstract. Paraphimosis presents a rare but acute urological emergency whereby the foreskin becomes entrapped behind the coronary sulcus of the penis. Therapy is quick and feasible, even in an outpatient setting. In most cases compression of the preputial edema and subsequent reposition of the prepuce is sufficient. Rarely, surgical intervention in form of a dorsal incision of the constriction is required. With partial or full phimosis being the underlying condition, paraphimosis occurs predominantly in infants and toddlers. However, persistent or secondary phimosis can lead to paraphimosis in advanced age.

Circumcision: postoperative complications that required reoperation.

Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients' age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients' age did not influence in complications.

Combined caudal-superficial-epigastric axial pattern flap and full-thickness buccal mucosa graft for single-stage preputial reconstruction in six dogs.

OBJECTIVE: To describe the use of a caudal superficial epigastric flap in combination with a full-thickness oral mucosal/submucosal graft for single-stage reconstruction of extensive preputial defects in dogs. MATERIALS AND METHODS: Medical records of dogs with extensive preputial defects either of traumatic origin or derived from tumour excision were reviewed. In all dogs, the prepuce was reconstructed using a full-thickness oral mucosal/submucosal graft combined with a caudal superficial epigastric axial pattern flap during a single surgical procedure. Outcome was assessed by routine clinical examinations for 6 months postoperatively, and through telephone follow-up thereafter. RESULTS: Six dogs were included. The caudal superficial epigastric axial pattern flap healed without complications in all dogs, while the full-thickness oral mucosal/submucosal graft failed in one dog. In this individual the skin flap underwent contracture 30 days after surgery and preputial advancement was required. One dog showed postoperative discomfort during urination, which was successfully managed with a Foley catheter and analgesic administration. Three dogs developed paraphimosis at 30, 80 and 90 days, respectively, and required further surgery. Long-term results were good in all dogs. CLINICAL SIGNIFICANCE: The use of a full-thickness oral mucosal/submucosal graft combined with a caudal superficial epigastric axial pattern flap is feasible for single-stage preputial reconstruction in dogs. Attention should be paid to create a sufficiently large preputial opening, in order to prevent paraphimosis.

Circumcision: postoperative complications that required reoperation / Postectomia: complicações pós-operatórias necessitando reintervenção cirúrgica

ABSTRACT Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients' age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients' age did not influence in complications.

RESUMO Objetivo Avaliar as complicações pós-operatórias de postectomia que necessitaram de reintervenção cirúrgica. Métodos Estudo retrospectivo com análise de prontuários de pacientes submetidos à postectomia entre 1o de maio de 2015 a 31 de Maio de 2016. Resultados Foram realizadas 2.441 postectomias no período, sendo 501 utilizando a técnica clássica e 1.940 utilizando o dispositivo Plastibell. Apresentaram complicações que necessitaram reintervenção cirúrgica 3,27% dos pacientes. Quando separados por técnica operatória, 3,4% das postectomias com Plastibell foram reoperadas, comparando com 3% das postectomias convencionais (p=0,79). A estenose de prepúcio foi mais frequentemente encontrada na técnica clássica, com significância estatística (p<0,001). Sangramento foi mais frequente nos casos com uso do Plastibell, porém sem diferença significativa (p=0,37). A idade dos pacientes também foi avaliada para investigar se esta variável influenciou na taxa de complicações pós-operatórias, porém não houve diferença significativa. Conclusão Não houve diferença estatisticamente significativa quando comparadas as complicações entre as diferentes técnicas cirúrgicas utilizadas neste serviço. A estenose de prepúcio foi mais frequentemente encontrada nos pacientes operados pela técnica convencional enquanto demonstrou-se tendência a maior sangramento com uso do Plastibell. A idade dos pacientes não influenciou na presença de complicações.

Invasive Reduction of Paraphimosis in an Adolescent Male While in a Deployed Austere Environment.

Paraphimosis is a urologic emergency resulting in tissue necrosis and partial amputation, if not reduced. Paraphimosis occurs when the foreskin of the uncircumcised or partially circumcised male is retracted behind the glans penis, develops venous and lymphatic congestion, and cannot be returned to its normal position. Invasive reduction of paraphimosis requires minimal instruments and can be accomplished by experienced providers. This case describes a 10-year-old local national with paraphimosis over 10 days that required invasive reduction in a deployed austere environment in Africa.

Introducing the Quill™ device for modified sleeve circumcision with subcutaneous suture: a retrospective study of 70 cases.

OBJECTIVE: The purpose of the study was to evaluate the safety and feasibility of treatment for male circumcision using modified sleeve circumcision and subcuticular suture with the Quill™ device. METHODS: From May 2011 to March 2012, 70 consecutive cases of male circumcision were performed using an alternative technique with the Quill™ device by a single surgeon in our institution. The inclusion and exclusion criteria for the selection process of this procedure were the same as for conventional circumcision. We evaluated the indications and perioperative outcomes. The circumcisions were performed as day-case procedures under local anesthesia. RESULTS: All patients were followed up for a minimum of 3-6 months. The ages ranged from 8 to 68 (mean = 27.0 years, SD = 10). The indications for surgery were either cosmetic (n = 16, 22.9%) or medical [redundant prepuce (n = 36, 51.4%), phimosis (n = 5, 7.1%), paraphimosis (n = 2, 2.9%), balanoposthitis (n = 9, 12.9%), melanoma (n = 1, 1.4%), and condyloma acuminata (n = 1, 1.4%)] (n = 54, 77.1%). The mean operation time in this group was 29 min (19-38 min) when the Quill™ device was used. In all, 3 cases developed complications (4.3%). The final cosmetic result was satisfactory for both the patients and their spouses or parents. CONCLUSION: This study showed that modified sleeve circumcision and subcuticular suture were safe and reliable surgical methods of circumcision that provide a better cosmetic result.

Ultrasound-guided dorsal penile nerve block for ED paraphimosis reduction.

Adequate anesthesia for emergency department management of painful penile conditions such as paraphimosis or priapism is often both technically challenging and inconsistent using traditional landmark-based techniques of the dorsal penile block (DPB). The pudendal nerves branch to form the paired dorsal nerves of the penis providing sensory innervation to the skin of both the dorsal and ventral aspects of the penis. "Blind" DPB techniques tend to rely on subtle tactile feedback from the needle and visual landmark approximation to identify the appropriate subpubic fascial compartment for injection. The landmark-based DPB is not standardized with options including "10 o'clock and 2 o'clock" infrapubic injections with or without ventral infiltration or a ring block. Given the lack of standardization and inherent technical imprecision with the landmark-based DPB, large volumes of local anesthetic (up to 50 mL) are sometimes required to achieve a clinically adequate block. In addition, inadvertent injection into the corpora cavernosa may occur. More recently, an ultrasound-guided approach has been developed. Using ultrasound, the dorsal penile nerves can be precisely targeted in the fascial compartment just deep to Buck fascia, potentially increasing block success rate and reducing the need for large local anesthetic volumes. Herein, we report the first adult case of an ultrasound-guided dorsal penile nerve block performed in the emergency department for the reduction of a paraphimosis and review the relevant penile anatomy and technical details of the procedure.

Combined preputial advancement and phallopexy as a revision technique for treating paraphimosis in a dog.

A 7-year-old neutered male Jack Russell terrier-cross was presented for signs of recurrent paraphimosis, despite previous surgical enlargement of the preputial ostium. Revision surgery was performed using a combination of preputial advancement and phallopexy, which resulted in complete and permanent coverage of the glans penis by the prepuce, and at 1 year postoperatively, no recurrence of paraphimosis had been observed. The combined techniques allow preservation of the normal penile anatomy, are relatively simple to perform and provide a cosmetic result. We recommend this combination for the treatment of paraphimosis in the dog, particularly when other techniques have failed.

Primary cutaneous CD30+ T-cell lymphoproliferative disorder presenting as paraphimosis: a case report and review of the literature.

Primary cutaneous CD30+ T-cell lymphoproliferative disorders (PC-CD30+ LPD) as a group are one of the more common types of T-cell lymphoma. More specifically primary cutaneous anaplastic lymphoma (PC-ALCL), one of these lymphoproliferative disorders, is the second most common cutaneous T-cell lymphoma. We report an unusual presentation of PC-ALCL. A 90-year-old, uncircumcised male presented with a 3-week history of painful penile swelling and discharge. The patient was treated with cephalexin and underwent emergent circumcision for paraphimosis. The diagnosis of ALCL was made on microscopic evaluation of the foreskin along with follow-up staging studies. A literature review revealed 31 previously reported cases of penile lymphoma, one of which reported a primary penile CD30+ T-cell lymphoma similar to ours. Only one case report described a lymphoma presenting as paraphimosis. Our case is the second reported case of PC-ALCL of the penis and the first of its kind to present as paraphimosis. Lymphomas must be included in the differential diagnosis of penile lesions and paraphimosis. When present, clinicians should be able to differentiate primary cutaneous lymphoma from lymphomas with secondary skin involvement. All foreskins should be submitted to pathology for proper evaluation of penile lesions.

Use of a modified Vinsot technique for partial phallectomy in 11 standing horses.

CASE DESCRIPTION: 6 geldings and 5 stallions were evaluated from January 2007 through April 2009 for the following conditions requiring phallectomy: chronic paraphimosis (n = 7), squamous cell carcinoma of the penis (3), and priapism (1). CLINICAL FINDINGS: None of the 7 horses with paraphimosis was able to retract the penis. Chronicity of the paraphimosis in 6 horses ranged from 2 weeks to 2 months and was unknown in the seventh horse. Horses with paraphimosis had been medically treated without success. The horse with priapism had developed the condition secondary to acepromazine administration 2 days prior to referral and was unsuccessfully treated once by intracavernosal administration of phenylephrine and irrigation of the cavernosal tissues prior to surgery. The 3 horses with squamous cell carcinoma of the penis had had the condition for 2 years and had been treated by repeated application of a cryogen or chemotherapeutic agent to the lesions. TREATMENT AND OUTCOME: All 11 horses underwent a partial phallectomy by means of a modified Vinsot technique. Modifications to the original technique included creation of a linear urethrostomy, alteration of the location and shape of the urethrostomy, application of a latex tourniquet, concurrent castration of stallions, and use of the procedure in standing horses. The procedure was technically easy to perform, well tolerated by the horses, and cosmetically acceptable to the owners, and had minimal postoperative complications. Long-term follow-up information was obtained from owners of 10 horses a median of 454 days after surgery; 2 owners reported mild urine scalding as the only adverse effect. CONCLUSIONS AND CLINICAL RELEVANCE: The modified Vinsot technique of partial phallectomy was effective and may be useful for horses that are unsuitable candidates for general anesthesia because of medical or owner financial constraints.

[Foreskin surgery]. / Esinahan kirurgia.

Balanitis, phimosis and foreskin adhesions are common indications for foreskin surgery during childhood. In phimosis, the foreskin cannot be drawn behind the glans penis because of the narrow external opening of the former. It is important to be able to distinguish between physiologic and pathologic phimosis, since their treatment is different. In adulthood, the need for surgery can be caused by phimosis, a difficult sequel of paraphimosis, recurrent inflammations of the glans penis and foreskin, diseases and cancers of the skin as well as difficulties at intercourse due to the shortness of the frenulum of the prepuce of the penis.

Paraphimosis revisited: is chronic paraphimosis a predominantly third world condition?

Paraphimosis is an acute condition characterized by all the signs of inflammation. Here we describe a 'chronic' variant of paraphimosis where patients often present many days after the initial injury. The aim of this study is to identify and possibly classify this new variation of paraphimosis - the chronic condition. We studied 68 patients with this condition between 1997 and 2005. In all, the prepuce was fibrous and bunched up behind the glans penis and, in some cases, with ulcerations. All patients were treated by excision of the fibrous flap and circumcision, under local anaesthesia. Patients were discharged on the same day on which the excision was done. Follow-up was on the third, seventh and ninetieth days. Long-term follow-up was possible in only 22 patients. This technique of modified circumcision was effective in treating this condition and we think a new classification of paraphimosis is warranted - acute and chronic.

An unusual cause of paraphimosis: hemangioma of the glans penis.

Paraphimosis is a urologic emergency that occurs in uncircumcised boys. In untreated paraphimosis, increasing edema caused by vascular and lymphatic obstruction results in ominous sequelae such as penile gangrene, which leads to autoamputation in days or weeks. Most cases of paraphimosis are iatrogenic, but that condition has unusual causes as well. We present a very rare case of paraphimosis that occurred in a patient with a hemangioma of the glans penis. We suggest that the swelling of the hemangioma pushed the penile skin backward and caused paraphimosis. To our knowledge, such a presentation has not been previously reported in the English literature.

Treatment options for paraphimosis.

Paraphimosis is a frequently presented complaint in the emergency department. This review outlines the treatment options available for resolving this condition: manual reduction methods, osmotic methods, puncture and aspiration methods and treatments using sharp incision. The technique of penile block local anaesthesia is described. A technique sequence for treatment is suggested.

Paraphimosis and amputation in a Nile crocodile (Crocodylus niloticus).

A captive Nile crocodile (Crocodylus niloticus) developed recurrent episodes of paraphimosis over a 2-yr period, which eventually led to hemorrhage and obvious inflammation. Two months postsurgery, the crocodile remained clinically normal.