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1.
FP Essent ; 488: 11-15, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31894950

RESUMO

Circumcision is the surgical removal of some or all of the foreskin (ie, prepuce) of the penis. Among high-resource countries, the United States is the only country in which the majority of newborns are circumcised for nonreligious reasons. The rate of circumcision in the United States has been decreasing. Circumcised males have a lower risk of urinary tract infections, penile cancer, and several sexually transmitted infections. The benefit of circumcision is greater for males with certain urologic conditions, such as isolated hydronephrosis, vesicoureteral reflux, and ureteropelvic junction obstruction. Complications develop in approximately 1 of every 200 procedures. The American Academy of Pediatrics and the American Academy of Family Physicians recommend continued access to circumcision on an elective basis and conclude that the benefits outweigh the risks. However, they do not endorse routine neonatal circumcision. Local anesthesia should be used to decrease pain during the procedure. Three devices commonly are used. Each has risks and benefits, and no one device has been proven to be superior to another.


Assuntos
Circuncisão Masculina , Neoplasias Penianas , Doenças Sexualmente Transmissíveis , Infecções Urinárias , Criança , Humanos , Lactente , Recém-Nascido , Masculino , Neoplasias Penianas/prevenção & controle , Doenças Sexualmente Transmissíveis/prevenção & controle , Estados Unidos , Obstrução Ureteral , Infecções Urinárias/prevenção & controle
2.
Urology ; 135: 11-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605681

RESUMO

OBJECTIVE: To elucidate current understanding on the pathophysiological mechanism of genital lichen sclerosus (LS), urologic manifestations, and treatment options. MATERIALS AND METHODS: The Medline/PubMed and Embase databases were systematically reviewed for publications pertaining to LS. After applying inclusion and exclusion criteria, references were assessed for relevance to the pathophysiology, presentation, and treatment of LS by title and abstract review by 2 independent reviewers, yielding 186 articles for assessment. RESULTS: The contemporary understanding of the epidemiology and histology of LS is reviewed herein. Additionally, we explore in detail the 3 hypotheses regarding the pathophysiological mechanism contributing to disease presentation: infectious etiology, primary immune dysregulation, and the isotraumatopic response. We summarize the available biological evidence supporting each hypothesis. This discussion provides context for understanding LS morbidity and may spur new avenues of research. For the clinician, we review the clinical presentation of disease, including the risk of progression to squamous cell carcinoma. The current medical and surgical treatment options are also detailed. CONCLUSION: LS remains a potentially insidious disease which may lead to debilitating urinary and sexual dysfunction. Cross disciplinary research should aim for earlier detection, as well as more effective and durable treatment. The exact cause of LS remains unknown.


Assuntos
Balanite Xerótica Obliterante/diagnóstico , Líquen Escleroso e Atrófico/diagnóstico , Líquen Escleroso Vulvar/diagnóstico , Administração Tópica , Balanite Xerótica Obliterante/epidemiologia , Balanite Xerótica Obliterante/terapia , Biópsia , Circuncisão Masculina , Diagnóstico Diferencial , Progressão da Doença , Feminino , Glucocorticoides/uso terapêutico , Humanos , Líquen Escleroso e Atrófico/epidemiologia , Líquen Escleroso e Atrófico/terapia , Masculino , Pênis/patologia , Pênis/cirurgia , Prevalência , Resultado do Tratamento , Vulva/patologia , Líquen Escleroso Vulvar/tratamento farmacológico , Líquen Escleroso Vulvar/epidemiologia
3.
Medicine (Baltimore) ; 98(49): e18106, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804321

RESUMO

RATIONALE: Circumcision is one of the most frequently used surgical procedures worldwide. Extensive penile skin defects, which can occur as a rare but severe complication of circumcision, are serious and frustrating problems for patients who experience them. Procedures for correcting these problems can pose a challenge to plastic surgeons in the clinic. PATIENT CONCERNS: A 31-year-old man was admitted to our care with an extensive defect of the penile skin caused by a circumcision performed 20 days previously. PRIMARY DIAGNOSES: Infection, necrosis, and defects of the penile skin. INTERVENTIONS: A reverse bilateral anterior scrotal flap was used to correct complete penile skin loss following debridement of the infected and necrotic tissue. OUTCOMES: The patient experienced no complications during the 10-year follow-up period. The patient reported normal erectile function and the ability to perform intercourse. LESSONS: The reverse bilateral anterior scrotal artery flap is suitable for repairing skin defects of the penis and allows for satisfactory cosmetic and functional improvement following defects of the penile skin.


Assuntos
Circuncisão Masculina/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Dermatopatias/cirurgia , Adulto , Humanos , Masculino , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/terapia
4.
Pan Afr Med J ; 33: 212, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692651

RESUMO

Factor VII formerly known as proconvertin is a vitamin K-dependent coagulation factor involved in exogenous coagulation. Congenital factor VII deficiency is a very rare autosomal recessive hereditary disease. We report the case of a new-born of parents who had first-degree consanguinity, admitted to hospital on D10 of life with post-circumcision haemorrhagic syndrome. Laboratory tests showed decreased levels of prothrombin and normal activated partial thromboplastin time. Coagulation tests showed isolated factor VII deficiency to 18%. The new-born received transfusion of packed red blood cells and fresh frozen plasma in order to stop bleeding with favorable outcome. This study highlights the features of this rare deficit. Prognosis is linked to the risk of severe bleedings, such as brain bleeding occurring in the neonatal period as is the case with our patient. Hence the need to perform blood crasis assessment before circumcision.


Assuntos
Circuncisão Masculina/efeitos adversos , Deficiência do Fator VII/diagnóstico , Hemorragia/etiologia , Transfusão de Sangue/métodos , Deficiência do Fator VII/congênito , Humanos , Recém-Nascido , Masculino , Plasma , Prognóstico
5.
Afr J AIDS Res ; 18(3): 181-191, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31502923

RESUMO

Apart from its known association with short- and long-term adverse physical, psychological, and sexual sequelae, female genital mutilation/cutting (FGM/C) could be associated with increased susceptibility to HIV. Some experts propose that FGM/C increases risk of genital trauma and bleeding. Given the known protective effect for men of male circumcision against HIV and that, in some communities, male circumcision and FGM/C are thought of as "equivalent" or parallel procedures, there is an obvious need to more accurately determine the effects of FGM/C on HIV infection risk in women. This article reviewed current evidence of associations between FGM/C and HIV, drawing on evidence from peer-reviewed as well as grey literature. All studies evaluated were observational. This review investigated associations between FGM/C and HIV, not a causal relationship, and observational studies therefore sufficed. The final review included 14 studies from several African countries. The strength of the evidence overall was determined to be of low to moderate quality by Department for International Development criteria: conceptual framing, openness and transparency, cogency, appropriateness and rigour, validity, reliability, and cultural sensitivity. Findings were inconsistent: four studies found no association between FGM/C and HIV, six found a negative association, two found a positive association, and two found an indirect association. Many of the studies had significant deficiencies including insufficient statistical power, inadequate adjustment for potential confounders, and measurement of FGM/C status by self-reporting alone. The available evidence did not conclusively demonstrate the anticipated association between FGM/C and HIV. This review revealed the need for stronger study designs and outlines some considerations for future research.


Assuntos
Circuncisão Feminina/efeitos adversos , Infecções por HIV/etiologia , Adulto , África , Circuncisão Masculina , Suscetibilidade a Doenças/virologia , Feminino , HIV , Humanos , Masculino , Estudos Observacionais como Assunto , Reprodutibilidade dos Testes , Comportamento Sexual
6.
BMC Urol ; 19(1): 65, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296191

RESUMO

BACKGROUND: The past four years has seen a rapid roll-out of male medical circumcision services in South Africa in response to clinical trials showing circumcision prevents HIV acquisition in heterosexual men. Clinics conduct substantial numbers of circumcisions per day. We report three cases of glans amputation in adolescents attending high volume clinics where modified Models of Optimising Volume and Efficiency (MOVE) are implemented. CASE PRESENTATIONS: Three cases of glans amputation in young healthy men that presented for voluntary medical male circumcision. The procedures were performed by highly experienced medical officers in two cases. All these cases shared characteristics: younger males with immature genitalia, forceps guided circumcision, and likely operator fatigue. Voluntary male medical circumcision programs should include regular monitoring and evaluation and training of operators to ensure high quality surgical techniques such as working in clean areas and taking frequent breaks. CONCLUSION: Circumcision is a relatively simple medical procedure, however regular training and quality control in high volume Male Medical Circumcision sites is essential to prevent rare catastrophic adverse events.


Assuntos
Amputação Traumática/diagnóstico , Amputação Traumática/etiologia , Circuncisão Masculina/efeitos adversos , Pênis , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Adolescente , Criança , Humanos , Masculino , Instrumentos Cirúrgicos/efeitos adversos , Carga de Trabalho
7.
AIDS Behav ; 23(9): 2453-2466, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31321636

RESUMO

Voluntary medical male circumcision (VMMC) is an evidence-based biomedical HIV prevention but under-utilized by male sexually transmitted diseases patients (MSTDP) in China. A parallel-group, non-blinded randomized controlled trial was conducted. Participants were uncircumcised heterosexual MSTDP attending four sexually transmitted diseases (STD) clinics in three Chinese cities. A total of 244 MSTDP were randomized 1:1 into the intervention group (n = 108) and the control group (n = 136). In addition to the education booklet received by the control group, the intervention group watched a 10-min video clip and received a brief counseling delivered by clinicians in the STD clinics. The interventions were developed based on the Health Belief Model and the Theory of Planned Behavior. At Month 6, participants in the intervention group reported significantly higher uptake of VMMC (14.8% versus 2.9%; RR 5.03, 95% CI 1.73, 14.62, p = 0.001). The brief STD clinic-based intervention was effective in increasing VMMC uptake among MSTDP in China.Trial registry: This study is registered at ClinicalTrials.gov, number NCT03414710. https://clinicaltrials.gov/ct2/show/NCT03414710 .


Assuntos
Circuncisão Masculina/psicologia , Aconselhamento/métodos , Infecções por HIV/prevenção & controle , Promoção da Saúde/organização & administração , Heterossexualidade , Doenças Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto , China , Circuncisão Masculina/etnologia , Circuncisão Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
N Engl J Med ; 381(3): 230-242, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31314967

RESUMO

BACKGROUND: The feasibility of reducing the population-level incidence of human immunodeficiency virus (HIV) infection by increasing community coverage of antiretroviral therapy (ART) and male circumcision is unknown. METHODS: We conducted a pair-matched, community-randomized trial in 30 rural or periurban communities in Botswana from 2013 to 2018. Participants in 15 villages in the intervention group received HIV testing and counseling, linkage to care, ART (started at a higher CD4 count than in standard care), and increased access to male circumcision services. The standard-care group also consisted of 15 villages. Universal ART became available in both groups in mid-2016. We enrolled a random sample of participants from approximately 20% of households in each community and measured the incidence of HIV infection through testing performed approximately once per year. The prespecified primary analysis was a permutation test of HIV incidence ratios. Pair-stratified Cox models were used to calculate 95% confidence intervals. RESULTS: Of 12,610 enrollees (81% of eligible household members), 29% were HIV-positive. Of the 8974 HIV-negative persons (4487 per group), 95% were retested for HIV infection over a median of 29 months. A total of 57 participants in the intervention group and 90 participants in the standard-care group acquired HIV infection (annualized HIV incidence, 0.59% and 0.92%, respectively). The unadjusted HIV incidence ratio in the intervention group as compared with the standard-care group was 0.69 (P = 0.09) by permutation test (95% confidence interval [CI], 0.46 to 0.90 by pair-stratified Cox model). An end-of-trial survey in six communities (three per group) showed a significantly greater increase in the percentage of HIV-positive participants with an HIV-1 RNA level of 400 copies per milliliter or less in the intervention group (18 percentage points, from 70% to 88%) than in the standard-care group (8 percentage points, from 75% to 83%) (relative risk, 1.12; 95% CI, 1.09 to 1.16). The percentage of men who underwent circumcision increased by 10 percentage points in the intervention group and 2 percentage points in the standard-care group (relative risk, 1.26; 95% CI, 1.17 to 1.35). CONCLUSIONS: Expanded HIV testing, linkage to care, and ART coverage were associated with increased population viral suppression. (Funded by the President's Emergency Plan for AIDS Relief and others; Ya Tsie ClinicalTrials.gov number, NCT01965470.).


Assuntos
Antirretrovirais/uso terapêutico , Circuncisão Masculina , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Programas de Rastreamento , Adolescente , Adulto , Botsuana/epidemiologia , Circuncisão Masculina/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Incidência , Masculino , Administração Massiva de Medicamentos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , População Rural , Fatores Socioeconômicos , Carga Viral , Adulto Jovem
9.
Afr J AIDS Res ; 18(2): 158-167, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31282301

RESUMO

The study explored constructions of sexuality among young people of Venda in Limpopo, South Africa, and cultural practices that can be used to develop context-specific HIV prevention programmes. HIV prevention can be promoted by including some cultural practices in prevention programmes and changing some aspects of culture that may contribute negatively to health. Six focus group discussions were held with school-going young people (Grades 10 to 12) in urban and rural areas to explore their constructions of sexuality and HIV risk. Four focus group discussions were held with community leaders in the same areas to explore their constructions of young people's sexuality and cultural practices relevant to HIV prevention. Through discourse analysis, the following dominant discourses that influence young people's sexual risk behaviour were identified: rite of passage, the male sexual drive discourse (sex is natural and unavoidable); discourse of hegemonic masculinity (sex to prove masculinity); sex as a commodity; non-adherence to cultural practices; and HIV is normalised (AIDS is like flu). Some alternative constructions and shifts in gender norms were noticed, especially among female participants. The constructions of young people were not culture-specific but similar to those identified in other South African cultures. Community leaders identified a few cultural practices that could be considered in HIV prevention, for example, reinstating the rite of passage to provide age-appropriate sex and HIV education (behavioural intervention), and promoting traditional male circumcision (biological intervention). Cultural practices that contribute negatively to health should be challenged such as current constructions of gender roles (masculinity and femininity) and the practice that parents do not talk to young people about sex (both structural interventions).


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Sexualidade , Adolescente , Circuncisão Masculina , Feminino , Feminilidade , Grupos Focais/estatística & dados numéricos , Infecções por HIV/epidemiologia , Humanos , Masculino , Masculinidade , Fatores de Risco , Assunção de Riscos , Instituições Acadêmicas , Comportamento Sexual , África do Sul/epidemiologia
12.
AIDS Behav ; 23(Suppl 2): 195-205, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31214866

RESUMO

Voluntary Medical Male circumcision (VMMC) has been part of prevention in Namibia since 2009. Yet, as of 2013, VMMC coverage among 15- to 24-year-olds was estimated at less than 22%. Program data suggests uptake of VMMC below age 15 is lower than expected, given the age distribution of the eligible population. Nearly 85% of VMMCs were for males between ages 15 and 29, while boys 10-14 years were referred outside the program. This analysis uses the Decision Makers Program Planning Tool to understand the impact of age prioritization on circumcision in Namibia. Results indicate that circumcising males aged 20-29 reduced HIV incidence most rapidly, while focusing on ages 15-24 was more cost effective and produced greater magnitude of impact. Providing services to those under 15 could increase VMMC volume 67% while introducing Early Infant Medical Circumcision could expand coverage. This exercise supported a review of VMMC strategies and implementation, with Namibia increasing coverage among 10- to 14-year-olds nearly 20 times from 2016 to 2017.


Assuntos
Circuncisão Masculina/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Programas Voluntários/organização & administração , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Criança , Circuncisão Masculina/economia , Análise Custo-Benefício , Tomada de Decisões , Infecções por HIV/epidemiologia , Humanos , Incidência , Masculino , Namíbia/epidemiologia , Avaliação de Programas e Projetos de Saúde , Programas Voluntários/economia , Adulto Jovem
13.
Pediatr. aten. prim ; 21(82): e41-e45, abr.-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184585

RESUMO

Introducción: la realización de la circuncisión por motivos culturales o religiosos es una práctica cuya indicación no está bien definida dentro de nuestra práctica médica. El objetivo de nuestro trabajo es mostrar la diversidad de su práctica en España a fin de establecer un protocolo de actuación general con respecto a este tema. Material y métodos: se ha realizado una encuesta nacional en 49 centros públicos con disponibilidad de servicio de cirugía pediátrica, en la que se recogen datos epidemiológicos, descriptivos y de opinión tanto colectiva como del personal médico sobre las derivaciones recibidas para hacer circuncisión. Resultados: se enviaron 200 encuestas, de las que se obtuvieron un total de 142 respuestas, el 76,6% de los facultativos no realizan circuncisiones por motivo religioso en el ámbito público. El 89% de los pacientes vistos en consulta son derivados por su pediatra. Hasta el 65% de los médicos afirman que han tenido algún conflicto con la familia del paciente cuando rechazan la indicación de la circuncisión por esta razón. De los profesionales que aceptan la intervención, el 39% lo hace para evitar la cirugía en peores condiciones fuera del hospital. El 57% de los cirujanos desconoce si esta indicación está incluida en la cartera de servicios del Sistema Nacional de Salud. Conclusiones: en base a nuestra encuesta, la mayoría de los profesionales desconoce si esta indicación está dentro de la cartera de servicios y coinciden en la necesidad de tener un consenso de actuación. Es importante tener una actitud conjunta, conocer todas las opiniones, y crear un protocolo de manejo de esta situación


Introduction: the performance circumcision for cultural or religious reasons is a practice whose indication is not well defined within the scope of medical practice in Spain. The objective of this study was to illustrate the variability in its practice in Spain with the purpose of eventually establishing a general protocol on the subject. Material and methods: we conducted a nationwide survey of public hospitals with a paediatric surgery department to collect epidemiological and descriptive data and opinions, both general and from individual medical providers, on the referrals received for performance of circumcision. Results: we submitted 200 questionnaires and received 142 responses, and 76.6% of the responding physicians reported not performing circumcisions for religious reasons in their practice in the public health system. Of all patients seen for a consultation, 89% had been referred by their paediatricians. Up to 65% of doctors reported having conflict with families when they refused to perform circumcision for this indication. Of the professionals who agreed on religious reasons as an indication, 39% performed the surgery to prevent its being performed under poorer conditions outside a hospital. Of all paediatric surgeons, 57% did not know whether this indication is included among the services covered by the National Health System. Conclusions: based on our survey, most professionals do not know whether this indication is included in the services covered by the public health system and agree on the need of establishing a consensus guideline. We believe that it is important to have a homogeneous approach, to explore the opinions of the professional collective as a whole and to develop a general protocol for approaching this situation


Assuntos
Humanos , Masculino , Lactente , Circuncisão Masculina/estatística & dados numéricos , Religião e Medicina , Recusa Consciente em Tratar-se/estatística & dados numéricos , Fimose/cirurgia , Assistência à Saúde/tendências , Circuncisão Masculina/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos
14.
J Med Case Rep ; 13(1): 122, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31036080

RESUMO

BACKGROUND: Penile swellings are not very common. They usually present as an obvious lesion visible and palpable either on the penile shaft, glans, or prepuce. Rarely, benign swellings may be concealed by phimosis and can present as "club" penis. CASE PRESENTATION: We report the case of a 30-year-old Indian male man who presented with the complaint of difficulty in retracting his foreskin and a club-shaped distal penis. There were palpable lumps on either side of the glans penis which were concealed by the foreskin; hence, a proper preoperative clinical diagnosis was not possible. Circumcision revealed the presence of two discrete cystic swellings from inner prepuce which were excised. Histopathology was suggestive of epidermoid cysts. CONCLUSIONS: Although epidermoid cysts are common cutaneous swellings, they are rarely seen on the penis. They generally present as a small solitary swelling on the penile surface and occurrence at multiple sites is very rare. Epidermoid cysts arising from inner prepuce, hiding within and presenting as club penis have not been reported. Thus, benign lumps should be considered an etiology for phimosis.


Assuntos
Circuncisão Masculina/métodos , Cistos/cirurgia , Prepúcio do Pênis/cirurgia , Doenças do Pênis/patologia , Pênis/patologia , Fimose/cirurgia , Adulto , Humanos , Masculino , Doenças do Pênis/cirurgia , Pênis/cirurgia , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(16): e15322, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008987

RESUMO

Circumcision is a very common surgical procedure that is performed for medical and traditional purposes in the world. However, many technical of circumcision is needed to improve. Thus, this study introduced a novel method of circumcision that is a refined version of the sleeve technique, termed subcutaneous tissue sparing dorsal slit with new marking, and evaluated the safety and efficacy of this novel method of circumcision.The randomized clinical trial included 93 adult patients with redundant foreskin or phimosis treated from May 2015 to March 2017. Patients were randomly divided into the novel circumcision method (n = 45) or conventional dissection (n = 48). The groups were compared regarding rates of intraoperative hemorrhage, operative time, pain, healing, satisfaction with penis appearance, and relevant adverse events.No patient suffered any obvious complication. Compared with the patients given conventional dissection, the patients who underwent the new surgical device experienced significantly less wound healing time, scar width, and recovery time (P <.05). The new method resulted in greater intraoperative bleeding volume and surgical time (P <.05). The rate of satisfaction with appearance of the penis was significantly higher in the group treated with the novel technique. In addition, the cost of surgery of these 2 methods was similar.Based on the above research, we found that subcutaneous tissue-sparing dorsal slit with new marking technique was an effective and safe procedure for circumcision, and deserved further application in clinical practice.


Assuntos
Circuncisão Masculina/métodos , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Circuncisão Masculina/efeitos adversos , Prepúcio do Pênis/cirurgia , Humanos , Masculino , Fimose/cirurgia
16.
Biomed Res Int ; 2019: 6875756, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31032356

RESUMO

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.


Assuntos
Anestesia Geral/métodos , Circuncisão Masculina/métodos , Pênis/cirurgia , Nervo Pudendo/efeitos dos fármacos , Criança , Pré-Escolar , Humanos , Lidocaína/administração & dosagem , Masculino , Bloqueio Nervoso/métodos , Medição da Dor/métodos , Pênis/inervação , Ropivacaina/administração & dosagem
17.
Arch Ital Urol Androl ; 91(1): 25-29, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30932426

RESUMO

OBJECTIVE: The purpose of this study was to provide a detailed analysis of surgical and functional outcomes after correction of acquired buried penis in the adult. MATERIALS AND METHODS: From 2006 to 2016, we retrospectively reviewed 47 patients undergoing surgical treatment for the correction of buried penis. Functional and surgical outcomes, as well as patients' satisfaction were the main endpoints. RESULTS: The most common complains at presentation were recurrent uro-genital infections, sexual dysfunction, voiding dysfunction and Lichen Sclerosus (LS). Surgical management steps included: circumcision (27.66%), scrotoplasty (19.14%), V-Y skin plasty (4.25%), split thickness skin graft (STSG) 12.76%, full thickness skin graft (FTSG) 36.17%, suprapubic fat pad excision (57.44%), abdominoplasty (25.53%), division of the suspensory ligament (36.17%). Postoperative complications were recorded in 15% of patients. Vaginal penetration and erectile function ended up being more effective in 97.87% (46/47) and 42.55% (20/47) of patients. Improvement in penile erogenous sensation was in 6.38% (3/47). Aesthetic appearance of genitalia fully satisfied 36.17% of patients (17/47). Overall patients' satisfaction rate resulted 76.59% (36/47). CONCLUSION: Management of adult acquired buried penis still remains a challenging task to achieve, however excellent cosmetic results can be obtained by surgical reconstruction.


Assuntos
Satisfação do Paciente , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Idoso , Circuncisão Masculina/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/anormalidades , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Escroto/cirurgia , Transplante de Pele/métodos , Resultado do Tratamento
19.
Trials ; 20(1): 157, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832718

RESUMO

BACKGROUND: Complex health interventions must incorporate user preferences to maximize their potential effectiveness. Discrete choice experiments (DCEs) quantify the strength of user preferences and identify preference heterogeneity across users. We present the process of using a DCE to supplement conventional qualitative formative research in the design of a demand creation intervention for voluntary medical male circumcision (VMMC) to prevent HIV in Tanzania. METHODS: The VMMC intervention was designed within a 3-month formative phase. In-depth interviews (n = 30) and participatory group discussions (n = 20) sought to identify broad setting-specific barriers to and facilitators of VMMC among adult men. Qualitative results informed the DCE development, identifying the role of female partners, service providers' attitudes and social stigma. A DCE among 325 men in Njombe and Tabora, Tanzania, subsequently measured preferences for modifiable VMMC service characteristics. The final VMMC demand creation intervention design drew jointly on the qualitative and DCE findings. RESULTS: While the qualitative research informed the community mobilization intervention, the DCE guided the specific VMMC service configuration. The significant positive utilities (u) for availability of partner counselling (u = 0.43, p < 0.01) and age-separated waiting areas (u = 0.21, p < 0.05) led to the provision of community information booths for partners and provision of age-separated waiting areas. The strong disutility of female healthcare providers (u = - 0.24, p < 0.01) led to re-training all providers on client-friendliness. CONCLUSION: This is, to our knowledge, the first study documenting how user preferences from DCEs can directly inform the design of a complex intervention. The use of DCEs as formative research may help increase user uptake and adherence to complex interventions.


Assuntos
Comportamento de Escolha , Circuncisão Masculina/métodos , Ensaios Clínicos como Assunto/métodos , Conhecimentos, Atitudes e Prática em Saúde , Projetos de Pesquisa , Sujeitos da Pesquisa/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa Qualitativa , Estigma Social , Cônjuges/psicologia , Tanzânia , Volição , Adulto Jovem
20.
Urology ; 127: 97-101, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30817958

RESUMO

OBJECTIVE: To determine the safety and efficacy of advanced practice provider (APP)-performed newborn circumcisions (NBCs), we reviewed outcomes of NBCs performed by pediatric urologists and APPs. We hypothesize comparable clinical outcomes between the groups. METHODS: All urology performed NBCs during a 5-year period were reviewed, including time surrounding implementation of the APP-led clinic. Return to emergency department (ED) rates, return to operating room (OR) rates, and intraprocedure bleeding requiring intervention were reviewed. Fisher exact and Mann-Whitney testing were utilized. RESULTS: There were no statistically significant differences in rates of intraprocedure bleeding, return to ED in 30days, return to OR for revision or other related penile surgery, or the overall number of patients with complications between the groups. Thirteen patients had complications in the APP cohort, compared to 8 in the urologist cohort. There was a difference in age and weight, with urologists performing NBCs on older and heavier patients. There was no difference in clinical outcomes between children over and under 10 pounds (4.5 kg). There was a significant difference in the need for revision circumcision when comparing children older vs younger than 30days (1.9% vs 0%, P = 0.034). CONCLUSION: An APP-led NBC clinic is both safe and feasible. The widely used age and weight cutoffs for NBC need to be further evaluated, as there was no significant difference in clinical outcomes. This practice design provides pediatric urologists more time to focus on the most complex patients, both in the clinic and OR.


Assuntos
Instituições de Assistência Ambulatorial/normas , Procedimentos Cirúrgicos Ambulatórios/métodos , Circuncisão Masculina/métodos , Circuncisão Masculina/estatística & dados numéricos , Urologistas/normas , Fatores Etários , Circuncisão Masculina/etnologia , Estudos de Coortes , Pessoal de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/fisiopatologia , Segurança do Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Padrões de Prática Médica , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Resultado do Tratamento , Estados Unidos
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