Haemophilus parainfluenzae-related cellulitis of the penis following tearing of a short frenulum.

INTRODUCTION: Infectious cellulitis is a common disease, mostly affecting the lower extremities and the face but only rarely the genitalia. OBSERVATION: A 24-year-old male patient presented with acute erythematous edema of the penile shaft and foreskin present for 48hours. Gentle retraction of the foreskin revealed a short frenulum with a small area (2-3mm) of erosion. He had had unprotected genital and orogenital sex three days before with his usual female partner and reported tearing of the frenulum during intercourse. Ampicillin-sensitive Haemophilus parainfluenzae was isolated from the swab taken from the erosion of the frenulum. Clinical remission was obtained following oral administration of amoxicillin and clavulanic acid. DISCUSSION: We describe not only the first case of Haemophilus parainfluenzae-associated cellulitis of the penis but also the first report of penile cellulitis following erosion of a short frenulum during sexual intercourse.

Ultrasound-guided dorsal penile nerve block performed in a case of zipper entrapment injury.

Injury to the penis resulting from zipper entrapment is a painful condition that presents a unique anesthetic challenge to the emergency physician and may even require procedural sedation for removal. In this case report, we describe successful removal of zipper entrapment from the penis of a 34-year-old patient after the application of an ultrasound-guided dorsal penile nerve block. We discuss the anatomy, sonographic features, and steps required for the nerve block procedure. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:589-591, 2017.

Hematoma prepucial: rotura de la vena superficial del pene / Foreskin hematoma: rupture of a superficial vein in the penis

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HIV prevalence is strongly associated with geographical variations in male circumcision and foreskin cutting in Papua New Guinea: an ecological study.

OBJECTIVE: To examine the correlation between HIV prevalence and male circumcision and other foreskin cutting practices across the four regions of Papua New Guinea (PNG). DESIGN: An ecological substudy using unique data from an interdisciplinary research programme to evaluate the acceptability, sociocultural context and public health impact of male circumcision for HIV prevention in PNG. METHODS: Published data describing (a) self-reported circumcision status by region from the 'Acceptability and Feasibility of Male Circumcision for HIV prevention in PNG' study and (b) HIV prevalence by region from PNG National Department of Health were used to correlate male circumcision and other foreskin cutting practices and HIV prevalence. Maps were constructed to visually represent variations across the four regions of PNG. RESULTS: Regions of PNG with the highest HIV prevalence had the lowest prevalence of male circumcision and other forms of foreskin cutting and vice versa. Male circumcision and dorsal longitudinal cuts were strongly associated with HIV prevalence and able to explain 99% of the observed geographical variability in HIV prevalence in PNG (p<0.01). CONCLUSIONS: The regional prevalence of HIV infection in PNG appears to be closely correlated with the regional distribution of male circumcision and dorsal longitudinal foreskin cuts. Further research is warranted to investigate causality of this correlation as well as the potential of dorsal longitudinal cuts to confer protection against HIV acquisition in heterosexual men.

Penile self-harm: a case report and concise clinical review.

Male genital self-mutilation is extremely rare and may be associated with severe psychopathology. This study reports the case of a 26-year-old man who presented after incising his prepuce with a knife and placing a rubber band around his foreskin. A plastic ring was also found underneath the prepuce. Clinical examination revealed a lateral preputial laceration with gross preputial oedema and dark red discoloration with a clear demarcation where the elastic band had been placed. A pelvic X-ray revealed no other foreign bodies. Following 72 h of observation he developed signs of preputial necrosis, which prompted urgent circumcision; this revealed a healthy underlying glans. In conclusion, male genital self-harm requires urgent urological and psychiatric assessments to prevent surgical and psychiatric sequelae including necrotizing fasciitis and suicide.

Removal of numerous vesical magnetic beads with a self-made magnetic sheath.

INTRODUCTION: Sexual curiosity and the quest for sexual excitement are the most frequent reasons for patients to introduce foreign bodies into the urethra or the bladder. Imagination and surgical skill are essential for urologists to retrieve such vesical foreign bodies. AIM: The aim of this study was to describe a novel method for retrieving vesical magnetic beads, which were inserted for autoeroticism by a male adolescent, with a self-made "magnetic sheath." METHODS: A 21-year-old young man inserted more than one hundred small magnetic beads into his urethra for sexual excitement, which lately caused symptoms of gross hematuria, frequent urination, and acute lower abdominal pain when walking or urinating. We invented a magnetic sheath by fixing a magnetic bead on the tip of an F9.5 ureteral access sheath to remove the foreign bodies in a minimally invasive way. MAIN OUTCOME MEASURE: The feasibility of using magnetic sheath to remove vesical foreign bodies; and operation duration. RESULTS: Under direct visualization of an F8/9.8 ureteroscope, the magnetic sheath could firmly attach to the magnetic bead inside the bladder and could easily pull out 5 to 15 beads each time. It took about 5 minutes to remove all of the 125 magnetic beads by utilizing our magnetic sheath. CONCLUSIONS: The self-made magnetic sheath can make the task of removal of magnetic foreign bodies easy to urologists, requiring less time and surgical skills. The new equipment provides a new method for urologists to deal with the challenging task of removing metal vesical foreign bodies which were self-inserted for masturbation.

Building social currency with foreskin cuts: a coping mechanism of Papua New Guinea health workers and the implications for new programmes.

BACKGROUND: Recent research as part of a multi-disciplinary investigation on the acceptability and impact of male circumcision for HIV prevention in Papua New Guinea (PNG) has shown that health workers (HWs) undertake unauthorized forms of penile cutting practices in public health facilities or in community settings, at times within a traditional context. Participation in these activities shares common features with coping mechanisms, strategies used by HWs to alleviate the burden of unsatisfactory living and working conditions. Coping mechanisms, however, are typically described as motivated by economic advantage, but in PNG evidence exists that the behaviours of HWs are also influenced by opportunities for social capital. METHODS: Twenty-five in-depth interviews (IDIs) were completed with a variety of HWs from 2009 until 2011 and were triangulated with findings from 45 focus group discussions and 82 IDIs completed with community members as part of a wider qualitative study. Thematic analysis examined HW participation in unauthorized penile cutting services. RESULTS: The emergence of unauthorized practices as a coping mechanism in PNG is compelled by mutual obligations and social capital arising from community recognition and satisfaction of moral, professional and cultural obligations. Using the example of unauthorized penile cutting practices amongst HWs in PNG, the research shows that although economic gains are not explicitly derived, evidence exists that they meet other community and socio cultural responsibilities forming a social currency within local traditional economies. CONCLUSIONS: Coping mechanisms create an opportunity to extend the boundaries of a health system at the discretion of the HW. Fragile health systems create opportunities for coping mechanisms to become institutionalized, pre-empting appropriate policy development or regulation in the introduction of new programmes. In order to ensure the success of new programmes, the existence of such practices and their potential implications must be addressed within programme design, and in implementation and regulation.

[Traumas to the scrotum or penis can be caused by "ordinary objects"]. / Skrotale og penile traumer kan forårsages af helt almindelige hverdagsting

In boys, most traumas to the scrotum result from sports or straddle injuries and do typically not inflict serious injury. Due to the small size and mobility of the prepubertal testicles, testicular injuries from penetrating trauma are less common in this age group. Penetrating scrotal injury, which poses a significant threat to testicular viability, is more prevalent among adolescents and young men. We describe two unusual genital injuries; one in childhood and the other in adulthood.

Optimum scratch assay condition to evaluate connective tissue growth factor expression for anti-scar therapy.

To evaluate a potential anti-scar therapy, we first need to have a reliable in vitro wound model to understand dermal fibroblast response upon cell injury and how cytokine levels are changed upon different wound heal phases. An in vitro wound model with different scratch assay conditions on primary human foreskin fibroblast monolayer cultures was prepared and cytokine levels and growth properties were evaluated with the aim of determining optimum injury conditions and observation time. Morphological characteristics of differently scratched fibroblasts from 0 to 36 h post injury (1 line, 2 lines and 3 lines) were investigated. The expression of connective tissue growth factor, CTGF, which is a key mediator in hyper-tropic scarring, and relative intensity of CTGF as a function of time were determined by western blot and gelatin Zymography. After injury (1 line), CTGF level was increased more than 2-fold within 1 h and continuously increased up to 3-fold at 6 h and was leveled down to reach normal value at 36 h, at which cell migration was complete. In more serious injury (2 lines), higher expression of CTGF was observed. The down regulation of CTGF expression after CTGF siRNA/lipofectamine transfection in control, 1 line and 2 lines scratch conditions were 40%, 75% and 55%, respectively. As a model anti-CTGF based therapy, CTGF siRNA with different ratios of linear polyethyleneimine (PEI) complexes (1:1, 1:5, 1:10, 1:20 and 1:30) were prepared and down-regulation efficacy of CTGF was evaluated with our optimized scratch assay, which is 1 line injury at 6 h post injury observation time. As the cationic linear PEI ratio increased, the down regulation efficacy was increased from 20% (1:20) to 55% (1:30). As CTGF level was increased to the highest at 6 h and leveled down afterwards, CTGF level at 6 h could provide the most sensitive response upon CTGF siRNA transfection. The scratch assay in the present study can be employed as a useful experimental tool to differentiate between anti-scar therapies for their down regulation efficacy of CTGF.

Possible function of the frenulum of prepuce in penile erection.

Fremulum of prepuce was the ruffle of foreskin while there was little about the function of fremulum. This study discusses the possible function of the frenulum of prepuce in penile erection. Twelve patients had premature ejaculation (PE) whose frenula were short. Two patients suffered unsatisfied intercourse whose frenula were damaged and departed 12 or 6 months earlier. We prolonged the short frenulum and reconstructed the ruptured frenulum. All patients reported satisfied sexual intercourse after 3-6 months. It is concluded that the frenulum is important in penile erection. PE might be treated by lengthening the frenulum.

Equine coital exanthema in a stallion / Herpesvirus equino 3 em um garanhão

Em agosto de 2008, um garanhão da raça Mangalarga Marchador, de quatro anos de idade, com histórico clínico de apatia, inapetência e edema de prepúcio e escroto, apresentou, ao exame clínico, exsudato purulento fluindo pelo óstio prepucial, prepúcio e mucosa peniana com inúmeras lesões circulares de bordos elevados e hiperêmicos, centro ulcerado recoberto por material amarelado de aspecto fibrinoso, com distribuição multifocal. Histologicamente, a mucosa peniana apresentou áreas de ulceração associadas a infiltrado inflamatório misto, com necrose multifocal e moderado acúmulo de fibrina, que se estendiam para o tecido conjuntivo adjacente. O diagnóstico morfológico foi de balanopostite ulcerativa fibrino-necrótica multifocal intensa, similar ao encontrado em casos de exantema coital equino (ECE), causado pelo herpesvírus equino 3 (EHV-3). Amostra de pele do prepúcio e sangue, colhido em EDTA, foram submetidos a ensaios de PCR específicos para EHV-3, observando-se a amplificação de um produto de tamanho esperado de 518pb. A detecção do EHV-3 foi confirmada por meio de seu sequenciamento, sendo a sequência de nucleotídeos depositada no GenBank sob o número GQ336877. As sequências de nucleotídeos e as de aminoácidos deduzidos apresentaram identidade de 99 por cento e 100 por cento, respectivamente, com a sequência de EHV-3 disponível no GenBank, número AF081188. Após 15 dias de tratamento, houve completa cicatrização das lesões, com despigmentação da pele, principalmente, no prepúcio e na bolsa escrotal. Com base nos achados clínicos, histopatológicos, PCR e sequenciamento, concluiu-se tratar de um caso de exantema coital equino, sendo o primeiro com confirmação definitiva do agente etiológico no Brasil.

"When I was circumcised I was taught certain things": risk compensation and protective sexual behavior among circumcised men in Kisumu, Kenya.

BACKGROUND: Male circumcision has been shown to reduce the transmission of HIV from women to men through vaginal sex by approximately 60%. There is concern that men may engage in risk compensation after becoming circumcised, diminishing the benefits of male circumcision. METHODS AND FINDINGS: We conducted qualitative interviews with 30 sexually active circumcised men in Kisumu, Kenya from March to November 2008. Most respondents reported no behavior change or increasing protective sexual behaviors including increasing condom use and reducing the number of sexual partners. A minority of men reported engaging in higher risk behaviors either not using condoms or increasing the number of sex partners. Circumcised respondents described being able to perform more rounds of sex, easier condom use, and fewer cuts on the penis during sex. CONCLUSIONS: Results illustrate that information about MC's protection against HIV has disseminated into the larger community and MC accompanied by counseling and HIV testing can foster positive behavior change and maintain sexual behavior.

Calcifilaxis de pene: nuestra experiencia en 5 años y revisión de la literatura científica / Penile calciphylaxis: 5-year experience and literature review

Introducción: La necrosis de pene es una entidad infrecuente, que puede ocurrir como diseminación de infecciones, desórdenes circulatorios, o incluso en pacientes con prótesis peneana. Se han descrito pocos casos en pacientes sometidos a diálisis, que suelen asociarse a diabetes mellitus, embolismos de colesterol y calcifilaxis. Casos clínicos: Exponemos los casos clínicos de 3 pacientes con esta entidad, manejados en nuestro hospital durante los últimos 5 años. Conclusiones: La calcifilaxis es una rara pero frecuentemente fatal condición en pacientes con fallo renal crónica, aproximadamente en el 1% de estos pacientes; se caracteriza por calcificación de arteriolas subcutáneas e infarto del tejido celular subcutáneo y la piel adyacente. Se asocia a una elevada morbimortalidad; el diagnóstico habitualmente es clínico. En lo referente al manejo, existe controversia, sobre todo en relación con la conducta quirúrgica que se debe seguir, que va desde falectomía hasta cuidados locales de la lesión, desbridación y antibiótico terapia (AU)

Introduction: Necrosis of the penis is a rare conditon that may occur as a result of infectious dissemination, circulatory disorders, or even in patients with penile prostheses. It has been reported in a few patients on dialysis, usually associated with diabetes mellitus, cholesterolembolism, and calciphylaxis. Case reports: Three patients with this condition seen at our hospital in the last 5 years are reported. Conclusions: Calciphylaxis is a rare but often fatal condition occurring in approximately 1% of patients with chronic renal failure. It is characterized by calcification of subcutaneous arteries and infarction of the subcutaneous cellular tissue and overlying skin. It is associated to a high morbidity and mortality, and diagnosis is usually based on clinical signs and symptoms. Management is controversial, particularly with regard to surgery, which may range from penectomy to local care of lesion, debridement, or antibiotic therapy (AU)

Surgery of the prepuce and penis.

Diseases involving the reproductive tract of bulls are a significant cause of economic and genetic loss to beef (eg, cow-calf units) and dairy (eg, bull studs) cattle producers. Injury or infectious disease may cause these abnormalities. Some injuries are amenable to surgical treatment. Surgical restoration of breeding bulls allows preservation of genetics and economic productivity for the owner of affected bulls. Accurate selection of surgical candidates is necessary to optimize prognosis.

Releasing of zipper-entrapped foreskin: a novel nonsurgical technique.

This report describes a novel technique of releasing the zipper-entrapped penile skin. The thin blade of a small screwdriver is inserted between the outer and inner faceplates of the zip fastener, and twisting movement is made toward the median bar. This will widen the gap between faceplates disengaging the prepuce. This technique was used in 12 children and was found to be safe, effective, simple, painless, and nontraumatic. This can be done by attending pediatrician even in nonhospital settings without resorting to surgical help.

[The management of a patient with foreskin strangulation by the pants zipper]. / Manejo de un paciente con estrangulación de prepucio por cremallera.

OBJECTIVE: To demonstrate that strangulation of the prepuce needs immediate specialist care. METHODS: Presentation of a 8-years-old boy case with on entrapped foreskin in his pant's zipper. RESULTS: After multiple attempts to remove the zipper under sedation, the case was referred to our service. The patient was surgically treated and his evolution was good. CONCLUSIONS: Immediate care, individualization of each case, as well as the experience of the treating physician will dictate the approach to follow in each patient. Medical personnel in adult as well as pediatric emergency departments must be aware that it is a problem that requires immediate care and avoid doing empirical and/or heroic treatments.

Bathing suit mesh entrapment: an unusual case of penile injury.

Penile injury is a rare chief complaint in the pediatric emergency department. The most common penile injuries are iatrogenic or postsurgical complications, blunt trauma, tourniquet injuries, fractures, and zipper injuries. We report a series of 3 cases of penile foreskin entrapment within the mesh lining of bathing suits as a new, recognized form of penile injury.