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1.
Urology ; 137: 183-189, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31926195

RESUMO

OBJECTIVE: To characterize the bulbospongiosus muscle (BSM) in patients with bulbar urethral strictures. MATERIALS AND METHODS: We studied 21 patients divided into 2 groups: Stricture Group (n = 14; mean age = 62.00 years) with bulbar stricture submitted to open urethroplasty; and Control Group (n = 7; mean age = 60.14 years) with penile strictures (hypospadias cripples, penile cancer and/or penile infection) who were submitted to perineal urethrostomy. Samples of the BSM were dissected and histologic sections were stained by histochemical and immunohistochemical techniques. Histomorphometric analyzes were performed on photomicrographs. Means were statistically compared using the unpaired Student t test and the Mann-Whitney test (P <.05). RESULTS: The etiology of bulbar urethral stricture was idiopathic in 2 cases (14.29%), post-TURP in 6 (42.86%), post open radical prostatectomy in 5 (35.71%) and post open prostatectomy in 1 case (7.14%). The average length of the stricture was 2.08 cm. The only parameter analyzed with significant difference between the groups was the vessels (significant difference between the control group: 5.11 ± 1.98% and stricture group: 3.57 ± 1.32%, P = .0460). The quantitative analysis of collagen (Control Group: 10.63 ± 5.37% and Stricture Group: 10.83 ± 4.55%, P = .9296); diameter of BSM muscle fibers (Control Group: 41.71 ± 14.63 µm and Stricture Group: 40.11 ± 8.59 µm, P = .76 and elastic system fibers (Control Group; 3.83 ± 1.54% and Stricture Group: 5.43 ± 2.90%, P = .2601) showed no significant difference. CONCLUSIONS: Histologic analysis showed a significant decrease of the BSM vessels in urethral stricture, without changes in elastic fibers, collagen, nerves, and muscle fiber diameter. These findings show that the bulbar urethral stricture causes minimal alterations in the structure of the BSM.


Assuntos
Doenças do Pênis , Pênis , Complicações Pós-Operatórias , Uretra , Estreitamento Uretral , Procedimentos Cirúrgicos Urológicos , Pesos e Medidas Corporais/métodos , Brasil , Constrição Patológica , Correlação de Dados , Técnicas de Imagem por Elasticidade/métodos , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Pênis/patologia , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/irrigação sanguínea , Uretra/inervação , Uretra/patologia , Uretra/cirurgia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
2.
Ann R Coll Surg Engl ; 102(2): e36-e38, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31530167

RESUMO

Penile calciphylaxis or calcific uremic arteriolopathy is a rare urological condition often associated with patients undergoing renal dialysis for end-stage renal disease. The majority of cases are associated with systemic calciphylaxis. The pathophysiology, diagnosis and management of penile calciphylaxis as an individual entity has brought little attention. The rates of comorbidity and mortality of these patients are often particularly high. Early diagnosis and a multidisciplinary approach are therefore essential. We report a case of penile calciphylaxis in a 59-year-old man with end-stage renal failure on haemodialysis who was successfully managed conservatively.


Assuntos
Angioplastia/métodos , Calciofilaxia/terapia , Tratamento Conservador/métodos , Doenças do Pênis/terapia , Inibidores da Agregação de Plaquetas/uso terapêutico , Bandagens , Calciofilaxia/diagnóstico , Calciofilaxia/etiologia , Artéria Femoral/cirurgia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Pênis/irrigação sanguínea , Pênis/patologia , Diálise Renal/efeitos adversos , Resultado do Tratamento
3.
Urology ; 137: 146-151, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887351

RESUMO

OBJECTIVE: To explore a series of classic bladder exstrophy (CBE) cases referred to the authors' institution where primary closure with penile disassembly epispadias repair was complicated by penile injury. The penile disassembly technique is frequently combined with bladder closure in patients with CBE undergoing the complete primary repair of exstrophy (CPRE). Penile disassembly has been posited as a risk for penile injury by ischemic mechanisms. METHODS: A prospectively-maintained institutional database of 1337 exstrophy-epispadias complex patients was reviewed for CPRE cases referred to the authors' institution, and those with injury to the penis were identified. The location, extent of injury, and subsequent management is reported. RESULTS: One hundred and thirteen male CBE patients were referred after prior CPRE. Twenty-six (20%) were identified with penile loss and reviewed. Eighty-one percent were closed in the neonatal period, and 54% had a pelvic osteotomy. Median follow-up time was 9.9 years (range 0.6-21.3). Of 26 patients with penile loss, 77% had unilateral loss and in 23% had bilateral loss involving the glans and/or one or both corpora cavernosa. Three patients were successfully managed with myocutaneous neophalloplasty. CONCLUSION: Complete penile disassembly during bladder exstrophy closure may lead to penile injury. This major complication questions the continued application of complete penile disassembly in the reconstruction of bladder exstrophy.


Assuntos
Extrofia Vesical/cirurgia , Epispadia/cirurgia , Complicações Intraoperatórias , Doenças do Pênis , Pênis , Procedimentos Cirúrgicos Urológicos , Atrofia , Criança , Humanos , Recém-Nascido , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/cirurgia , Masculino , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Pênis/irrigação sanguínea , Pênis/lesões , Pênis/patologia , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Fatores de Risco , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
4.
Urology ; 133: 229-233, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369750

RESUMO

OBJECTIVE: To determine the prevalence of penile cancer in patients with adult acquired buried penis (AABP). Penile cancer is a rare but aggressive cancer. Several case reports have recently been published that indicate that AABP may increase the risk of penile cancer. MATERIALS AND METHODS: A retrospective review was conducted of adults diagnosed with AABP and penile cancer between January, 2008 and December, 2018 seen at a tertiary referral center. Demographics including age, BMI, comorbidities, etiology of AABP, smoking history, circumcision status, and premalignant lesions (condyloma, lichen sclerosus [LS] carcinoma in situ [CIS]) were recorded. For patients with penile cancer, AJCC staging, grade, TNM staging and treatments were recorded. Basic descriptive statistics were performed for the overall cohort. We used Chi-square tests and Fisher exact tests to compare differences between patients with benign pathology and patients with malignant or pre-malignant pathology. RESULTS: We identified 150 patients with the diagnosis of AABP. The prevalence of penile squamous cell carcinoma was 7%. There was a 35% rate of premalignant lesions. This study is limited by its retrospective and single-institution nature. CONCLUSION: AABP is a condition that incorporates multiple risk factors for penile cancer. The prevalence of penile cancer appears to be higher in patients with AABP; however, more data are needed to confirm these initial findings. Patients with AABP should be counseled on these risks and should be considered for buried penis repair if a physical examination cannot be performed.


Assuntos
Doenças do Pênis/complicações , Neoplasias Penianas/complicações , Neoplasias Penianas/epidemiologia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Doenças do Pênis/etiologia , Prevalência , Estudos Retrospectivos
5.
Andrologia ; 51(9): e13351, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31264245

RESUMO

Until now, no reliable method is recognised in treating buried penis. This study explored a new method of penile length augmentation using acellular dermal matrix filler in infrapubic space combined with liposuction and penile suspensory release. Patients with "small-sized penis" received penile length augmentation procedure including suprapubic liposuction, penile suspensory ligament release and insertion of folded acellular dermal matrix between corpora cavernosa and pubis symphysis. Their penile length from tip to skin was measured pre-operatively and post-operatively. The post-operative complications and patients' satisfaction were also recorded. Fifteen adult male patients were included with the mean age of 33.2 ± 4.6 years old and BMI of 28.9 ± 5.3 kg/m2 . The average amount of liposuction was 430 ± 90.0 ml. The average penile length measured pre-operatively and post-operatively (on table and 3 months afterwards) was 3.0 ± 1.3 cm, 7.3 ± 2.1 cm and 5.4 ± 1.8 cm. The penile length has significantly increased by 4.3 ± 1.6 cm (on table) and 2.4 ± 0.8 cm (3 months post-operatively; p < 0.05). The post-operative complications included oedema of penis, ecchymosis of lower abdomen and poor wound healing. No patient was dissatisfied with the appearance and function. The new method using acellular dermal matrix combined with liposuction and penile suspensory ligament release is safe and effective. The method could be applied to selected patients with buried penis.


Assuntos
Derme Acelular , Preenchedores Dérmicos/uso terapêutico , Lipectomia/métodos , Doenças do Pênis/cirurgia , Pênis/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Estudos de Viabilidade , Humanos , Ligamentos/cirurgia , Lipectomia/efeitos adversos , Masculino , Obesidade/complicações , Obesidade/terapia , Tamanho do Órgão , Satisfação do Paciente , Seleção de Pacientes , Doenças do Pênis/etiologia , Doenças do Pênis/patologia , Pênis/patologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
6.
Urology ; 131: e7-e8, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31132425

RESUMO

OBJECTIVE: To define clinical features and surgical management of urethro-cavernosal fistulas (UCF). METHODS: A literature search was performed using PubMed to identify publications with the key word urethro-cavernosal fistula. RESULTS: We herein describe surgical techniques and long-term outcomes for UCF repair. CONCLUSION: UCFs is a rare urological condition with only 9 cases reported to date. UCFs can be diagnosed with careful history, physical examination, and retrograde urethrography. Surgical management includes basic tenets of fistula repair, including adequate mobilization, tension-free but watertight approximation, multilayered closure with nonoverlapping suture lines, and maximal bladder drainage.


Assuntos
Fístula/etiologia , Fístula/cirurgia , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Uretra/lesões , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Adulto , Humanos , Masculino , Fatores de Tempo , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
7.
Cir Cir ; 86(1): 77-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30951036

RESUMO

Lymphedema is the result of an alteration of the lymphatic drainage, and its most common worldwide cause is filariasis. In our practice usually is associated to neoplasic, inflammatory and granulomatous processes, radiotherapy, hydroelectrolytic disbalances, and idiopathic. It can affect any part of the body, including the penis and scrotum. The genital lymphedema is a rare presentation, it corresponds to 0.6% of lymphedema. However, causes serious functional, social and emotional limitations for the patient. Too often have pain, recurrent infections, sexual dysfunction, cosmetic deformity, sometimes it limits mobility and ambulation. Although there are several treatment options, both medical and surgical, it has not been found ideal for this disease. We present a 43 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa, it limits his normal activity. The patient was referred to our center after unsuccessful medical treatment (doxycycline and clindamycin cycles). Surgical treatment consisted of total excision of the skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. The result was satisfactory both functionally and aesthetically.


Assuntos
Hidradenite Supurativa/complicações , Linfedema/etiologia , Doenças do Pênis/etiologia , Escroto , Adulto , Doenças dos Genitais Masculinos/etiologia , Doenças dos Genitais Masculinos/cirurgia , Humanos , Linfedema/cirurgia , Masculino , Doenças do Pênis/cirurgia
8.
Urology ; 129: e1, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31009741

RESUMO

Penetrating perineal trauma is an unusual urologic injury. Even less common is a delayed presentation. Herein we present the case of a patient with delayed development of a corporal cutaneous fistula 3 months following perineal trauma.


Assuntos
Fístula Cutânea/etiologia , Fístula/etiologia , Doenças do Pênis/etiologia , Períneo/lesões , Humanos , Masculino , Fatores de Tempo , Adulto Jovem
9.
Urology ; 129: 223-227, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31005654

RESUMO

OBJECTIVE: To evaluate the feasibility and outcomes of full thickness penile skin grafting (FTSG) for phalloplasty during acquired buried penis repair. MATERIALS AND METHODS: A retrospective cohort study of patients undergoing complex genital reconstruction for buried penis between January 2013 and April 2018 was performed. Patients undergoing FTSG were identified. All patients underwent escutcheonectomy, scrotoplasty, and penile skin grafting by a single Urologist (MM) and Plastic surgeon (JS). Escutcheon tissue was used for the FTSG. The primary outcome was graft take and the secondary outcome was recurrence requiring surgical revision. RESULTS: Thirteen patients were identified for inclusion in the study with average age of 43.4 and average BMI of 42. Median (range) follow-up for the cohort was 8 (3-44) months. Surgical indication was lymphedema in 6 (46.2%), morbid obesity in 6 (46.2%), and hidradenitis suppurativa in one (7.7%). Seven required concurrent urethromeatoplasty for meatal stenosis and fossa navicularis strictures. All grafts were successful. Two patients developed postoperative wound infections requiring antibiotics. One patient redeveloped lymphedema of the scrotum and required complete revision surgery although the FTSG remained intact. No patients had reburying of the penis. Minor outpatient surgical revision was performed for 2 patients for scarring and edema of the glans. CONCLUSION: Full thickness skin grafts provide a useful option for penile reconstruction during surgical management of buried penis. Patients had excellent graft acceptance and minimal wound complications. Further research and comparative cohorts are warranted to fully determine the role of FTSG in genital reconstruction.


Assuntos
Obesidade Mórbida/complicações , Doenças do Pênis/cirurgia , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Seguimentos , Humanos , Masculino , Doenças do Pênis/etiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
10.
Dermatol Online J ; 25(2)2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30865408

RESUMO

Calcific uremic arteriolopathy (CUA) or calciphylaxis is a syndrome characterized by calcification of vessels located in the dermis and adipose tissue. It commonly occurs in patients with diabetes mellitus, hypertension, and end-stage renal disease. Clinical presentation generally begins with severe pain, followed by the presence of liveloid or purpuric plaques. Later the formation necrotic ulcers occur. This condition is associated with a poor prognosis, with a high rate of mortality within months of the diagnosis. Penile involvement is an uncommon but severe manifestation. We present an 81-year-old man with a history of diabetes mellitus, hypertension, and end-stage renal disease with a one-month evolution of painful necrotic ulcers on his glans penis. He was diagnosed with CUA. Owing to infection complicated by sepsis; penectomy was performed. Unfortunately, the patient died of myocardial infarction during his hospitalization.


Assuntos
Calciofilaxia/complicações , Calciofilaxia/diagnóstico , Doenças do Pênis/etiologia , Dermatopatias Vasculares/complicações , Úlcera Cutânea/etiologia , Pele/patologia , Idoso de 80 Anos ou mais , Humanos , Falência Renal Crônica/complicações , Masculino , Necrose/etiologia , Doenças do Pênis/patologia , Dermatopatias Vasculares/diagnóstico , Uremia/complicações
13.
Int Braz J Urol ; 45(2): 384-391, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30785705

RESUMO

PURPOSE: To study the effect of penile constriction devices used on a large series of patients who presented at our emergency facility. We explored treatment options to prevent a wide range of vascular and mechanical injuries occurring due to penile entrapment. MATERIALS AND METHODS: Between January 2001 and March 2016, 26 patients with penile entrapment were admitted to our facility and prospectively evaluated. RESULTS: The time that elapsed from penile constrictor application to hospital admission varied from 10 hours to 6 weeks (mean: 22.8 hours). Non-metallic devices were used by 18 patients (66.6%) while the other nine (33.4%) had used metallic objects. Acute urinary retention was present in six (23%) patients, of whom four (66.6%) underwent percutaneous surgical cystotomy and two (33.4%) underwent simple bladder catheterization. The main reason for penile constrictor placement was erectile dysfunction, accounting for 15 (55.5%) cases. Autoerotic intention, psychiatric disorders, and sexual violence were responsible in five (18.5%), five (18.5%), and two (7.4%) cases, respectively. The mean hospital stay was 18 hours (range, 6 hours to 3 weeks). CONCLUSION: Penile strangulation treatment must be immediate through the extraction of the foreign body, avoiding vascular impairments that can lead to serious complications. Most patients present with low-grade injuries and use penile constrictors due to erectile dysfunction. Removal of constrictor device can be challenging. The use of specific tools for achieving penile release from constrictors is a fast, safe and effective method. Patients with urinary retention may require urinary diversion.


Assuntos
Corpos Estranhos/terapia , Doenças do Pênis/etiologia , Pênis/lesões , Comportamento Autodestrutivo/terapia , Adolescente , Adulto , Idoso , Amputação , Constrição Patológica , Corpos Estranhos/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/patologia , Pênis/patologia , Pênis/cirurgia , Comportamento Autodestrutivo/complicações , Comportamento Autodestrutivo/cirurgia , Comportamento Sexual , Adulto Jovem
15.
Pediatr Emerg Care ; 35(3): e59-e60, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29189594

RESUMO

Hirudin is a potent anticoagulant found in the salivary glands of several species of leeches. We report a case of direct hirudin exposure after suspected leech bite causing significant penile ecchymosis. Diagnosis was not apparent on initial evaluation but made after a thorough history was obtained and the leech was found in the lining of his swim trunks, which he left at home. Although this presentation mimics several other potentially serious conditions, treatment is largely observational with anticipated rapid improvement over the course of hours without intervention.


Assuntos
Mordeduras e Picadas/diagnóstico , Equimose/etiologia , Hirudinas/efeitos adversos , Doenças do Pênis/diagnóstico , Pênis/patologia , Animais , Mordeduras e Picadas/complicações , Criança , Diagnóstico Diferencial , Humanos , Sanguessugas , Masculino , Doenças do Pênis/etiologia , Remissão Espontânea
16.
Clin Exp Dermatol ; 44(1): 20-31, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30009576

RESUMO

BACKGROUND: Penile lymphoedema (with and without cellulitis) is a rare, often chronic, clinically heterogeneous entity with an uncertain pathogenesis and an important differential diagnosis. It creates significant physical and psychosexual morbidity, and presents considerable therapeutic challenges. The existing literature is limited. AIM: To describe and share our updated cumulative experience of a cohort of patients with penile lymphoedema. METHODS: This was a retrospective review of the case records of patients with chronic penile lymphoedema seen in two dedicated male genital dermatology clinics between January 2011 and July 2016. RESULTS: In total, 41 cases were identified. Over a third had Crohn disease (CD) (which was occult in one-third of these), and over a third had serological evidence of streptococcal infection. All patients responded to systemic antibiotics and specialized urological surgery circumcision and excision). CONCLUSIONS: Penile lymphoedema should be investigated to exclude underlying pathology especially CD and streptococcal infection. Treatment with antibiotics should be considered early and long term to try to preserve the foreskin: most patients are uncircumcised. Some patients may benefit from a course or courses of oral steroids. The development of gross dysfunction of the prepuce usually dictates circumcision and excision of lymphoedematous tissue once the situation is medically stabilized.


Assuntos
Antibacterianos/uso terapêutico , Circuncisão Masculina , Doença de Crohn/complicações , Linfedema/tratamento farmacológico , Doenças do Pênis/tratamento farmacológico , Infecções Estreptocócicas/complicações , Adolescente , Adulto , Idoso , Doença Crônica , Diagnóstico Diferencial , Humanos , Linfedema/etiologia , Linfedema/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Pênis/patologia , Estudos Retrospectivos , Infecções Estreptocócicas/tratamento farmacológico , Adulto Jovem
17.
Urology ; 123: 247-251, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30312674

RESUMO

OBJECTIVE: To demonstrate the safety and feasibility of outpatient surgical management for patients with acquired buried penis (ABP). METHODS: We conducted an Institutional Review Board approved review of patients who underwent surgical repair of ABP at a single institution from September 2014 to August 2017. Patient characteristics, operative details, and 30- and 90-day complications were assessed. RESULTS: Sixteen patients underwent surgical repair of ABP at the University of Kentucky during the study period. Mean age was 54 years (range 44-62). Median body mass index (BMI) was 47.7 (range 25.5-53.3). Patients largely underwent penile liberation, escutcheonectomy, and split thickness skin grafting. Concurrent scrotoplasty and urethroplasty were performed in select cases. The majority of patients 10/16 (62.5%) were discharged on the same day of surgery, while the remaining 6/16 (37.5%) were outpatient extended stay-and were discharged on postoperative day 1. The 30- and 90-day complications were 19% and 25% respectively, all were Clavien II. Split thickness skin graft take was 100%, and technical success was achieved in all patients. Patients with complications had higher BMIs, higher rates of diabetes, and higher rates of tobacco use, though only BMI reached statistical significance (P = .0150, P = .5846, and P = .0632) respectively. CONCLUSION: Multi component repair of adult ABP can be safely done on an outpatient basis without need for routine inpatient admission and complex algorithms. The most common complication is surgical site infection, which arose in the first 30 days postoperatively. Higher BMI was a significant risk factor for complications.


Assuntos
Doenças do Pênis/cirurgia , Adulto , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Doenças do Pênis/etiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
18.
J Sex Med ; 15(12): 1673-1677, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30446468

RESUMO

INTRODUCTION: Historically, contra-indications for immediate salvage of an infected penile prosthesis have included purulence on the device, purulent infections in diabetic patients, and severe diabetes. These clinical principles are from the 1990s to early 2000s and based on limited retrospective series or expert opinion. Since the publication of these contra-indications there have been improvements in device design, surgical technique, corporal washout protocols, and perioperative antibiotic prophylaxis that allow us to re-evaluate whether we can broaden the criteria for immediate salvage of an infected penile prosthesis. AIM: To report whether patients with severe diabetes can safely have a purulent inflatable penile prosthesis (IPP) immediately salvaged. METHODS: We considered a "severe diabetic" as a patient whose disease has progressed past diet control and oral medications and, therefore, has insulin-dependent type 2 diabetes mellitus (IDDM II). We retrospectively reviewed 6 consecutive patients with IDDM II and a purulent IPP who had been immediately salvaged from July 2011 to November 2017. In addition to immediate exchange, each received catheter-directed anti-microbial intracorporal irrigation and device culture. All patients were discharged home the next day with oral antibiotics. MAIN OUTCOME MEASURE: Outcomes included repeat penile prosthesis infection or any other complication following immediate salvage. RESULTS: All 6 patients have healed well and remained infection free at their 6- to 8-week post-operative follow-up appointment. 15-39 months after salvage, no patients have had a repeat infection or any other complication. 5 patients received a malleable replacement device and 1 patient was electively converted to an IPP 7 months after his salvage procedure. 1 patient received an IPP during salvage per patient preference. All patients are currently pleased with either their malleable penile prosthesis or IPP. CLINICAL IMPLICATIONS: Immediate salvage attenuates the morbidity associated with an infected penile prosthesis such as irreversible penile shortening and corporal fibrosis. Our findings suggest that more patients than originally thought may be a candidate for immediate salvage. STRENGTH & LIMITATIONS: To our knowledge, this is the first study evaluating outcomes after immediate salvage of a purulent IPP in patients with advanced diabetes. Limitations of the study include the small sample size and retrospective nature. CONCLUSION: Our results suggest that those with IDDM II who have a purulent penile prosthesis may be candidates for safe and effective immediate salvage. Peters CE, Carlos EC, Lentz AC. Purulent Inflatable Penile Prostheses Can Be Safely Immediately Salvaged in Insulin-Dependent Diabetics. J Sex Med 2018;15:1673-1677.


Assuntos
Diabetes Mellitus Tipo 2 , Prótese de Pênis/efeitos adversos , Implantação de Prótese/métodos , Terapia de Salvação/métodos , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Humanos , Insulinas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/etiologia , Infecções Relacionadas à Prótese/cirurgia , Estudos Retrospectivos
19.
J Sex Med ; 15(12): 1811-1817, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30446473

RESUMO

INTRODUCTION: The objective of genital enlargement surgery is to increase length and/or girth for cosmetic reasons; however, newer techniques have been recently reported to be associated with only minor complications in a small percentage of patients. AIM: We aim to report the severe complications of penile augmentation surgery seen at a referral center and describe their subsequent management. METHODS: Institutional review board approval was obtained. We reviewed our prospectively collected database for all patients who presented with complications of genital enlargement surgery from 2002-2016. MAIN OUTCOME MEASURE: Interventions following complications of genital enlargement surgery. RESULTS: 11 Patients were identified. Mean age was 47 (21-77) years. Prior procedures included subcutaneous injection of silicone outside a medical setting, girth enhancement procedures involving the subcutaneous placement or injection of substances including fat, other substances, or subcutaneous silicone implants. All patients who underwent subcutaneous penile implant underwent removal prior to presentation. Adverse changes included sexually disabling penile deformity and severe shortening, curvature, edema, subcutaneous masses, infection, non-healing wounds, and sexual dysfunction. 10 patients underwent corrective surgery, with 2 requiring multiple procedures and 3 requiring split-thickness skin grafting. All 10 patients had an improved cosmetic appearance and those who had disabling shortening had significantly improved functional length. CLINICAL IMPLICATIONS: Report of such adverse events should assist in appropriate perioperative counseling prior to genital enhancement surgery. STRENGTH & LIMITATIONS: Few reports of debilitating complications of penile enlargement exist in literature. However, without knowing the overall number of procedures performed, the true complication incidence is not known. CONCLUSION: Penile and scrotal enhancement surgery can be associated with major disabling complications, leading to deformity and functional compromise in men with prior normal anatomy and function. Patients should be aware of these risks. Furr J, Hebert K, Wisenbaugh E, et al. Complications of Genital Enlargement Surgery. J Sex Med 2018;15:1811-1817.


Assuntos
Doenças do Pênis/etiologia , Implante Peniano/efeitos adversos , Prótese de Pênis/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Implante Peniano/métodos , Pênis/cirurgia , Silicones/efeitos adversos , Procedimentos Cirúrgicos Urogenitais/efeitos adversos
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