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1.
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
2.
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
3.
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
4.
Int J Dermatol ; 58(7): 777-781, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30315576

RESUMO

Balanitis xerotica obliterans (BXO), or penile lichen sclerosus, is a progressive sclerosing inflammatory dermatosis of the glans penis and foreskin. It is associated with significant morbidity and may result in impaired urinary and sexual function. It was initially described by Stuhmer in 1928, named after its pathological features, and is considered the male equivalent of vulvar lichen sclerosis (LS).3,40 The etiology of BXO is uncertain; however, autoimmune disease, local trauma, and genetic and infective causes have been proposed. BXO occurs most commonly on the prepuce and glans penis. It is considered to have premalignant potential to transform into squamous neoplasia. This postulation rests on retrospective studies and parallels drawn with vulvar LS and squamous cell carcinoma (SCC) development. Histologically, BXO and vulvar LS are considered the same disease.41 There is a paucity of evidence-based guidelines to assist with appropriate follow-up for patients with BXO.


Assuntos
Balanite Xerótica Obliterante/terapia , Circuncisão Masculina , Glucocorticoides/administração & dosagem , Pênis/patologia , Lesões Pré-Cancerosas/terapia , Administração Tópica , Balanite Xerótica Obliterante/complicações , Balanite Xerótica Obliterante/diagnóstico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/prevenção & controle , Dermatologia/métodos , Dermatologia/normas , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Penianas/patologia , Neoplasias Penianas/prevenção & controle , Fimose/etiologia , Fimose/cirurgia , Guias de Prática Clínica como Assunto , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Transtornos Urinários/etiologia , Transtornos Urinários/prevenção & controle
6.
Bol. pediatr ; 59(247): 15-18, 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183163

RESUMO

La patología del pene y la vulvar en niñas es un motivo de consulta muy frecuente en urología pediátrica y suele ser origen hasta de consultas por problemas que no lo son, como las adherencias balanoprepuciales, la fimosis -fisiológica en el recién nacido y lactante- o el tamaño, que siempre preocupa por defecto. Describimos los principales procesos que solemos encontrar en consulta tanto de urología pediátrica como en atención primaria


The pathology of the penis as well as the vaginal pathology in girls are a very frequent presentation in pediatric Urology and usually comes from consultations for problems that are not, such as balanopreputial adhesions, phimosis, or the size of the penis that always worries about. We will describe the main processes that we find in consultation urology and primary care


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Doenças do Pênis/terapia , Doenças do Pênis/classificação , Doenças da Vulva/classificação , Doenças da Vulva/terapia , Fimose/cirurgia , Balanite (Inflamação)/terapia , Pênis/anormalidades , Hímen/anormalidades
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 32(12): 1581-1585, 2018 12 15.
Artigo em Chinês | MEDLINE | ID: mdl-30569687

RESUMO

Objective: To discuss the effectiveness of modified Brisson surgery in treatment of the severe and obviously obese concealed penis. Methods: A clinical data of 96 boys with severe concealed penis, of 53 cases combined with obviously obese, who were treated by modified Brisson surgery between January 2014 and August 2016, was retrospectively analysed. The children ranged in age from 1 year to 11 years and 9 months, with an average of 5 years and 3 months. The median longitudinal incision of the penis scrotum was used instead of the wedge-shaped skin incision at the junction of the penis and scrotum, which could completely expose the surgical field; fully release and removal of the abnormal meat membrane and fascia around the penis were performed; the propulsion and rotating flaps match the inner sheath of the foreskin was used to completely remove skin stenosis. Postoperative effectiveness was evaluated by Boemers standard. Results: All the incisions healed by first intention and no infection or necrosis of the foreskin flap occurred. Ninety-three cases were discharged from hospital after operation and followed up 1 year to 3 years and 6 months, with an average of 2 years and 4 months. Scrotal hematoma occurred in 2 cases within 48 hours, penile skin edema occurred in 5 cases, and scar hyperplasia in the penis scrotal corner incision occurred in 1 case at 1 month after operation. Postoperative exposure of the penis was good in 90 cases; there was no retraction of the penis in the upright position and sitting position; the family members were satisfied with the appearance of the penis. The penis were partially retracted in 3 cases, that affected the appearance of the penis during the sitting position. Conclusion: The modified Brisson surgery is one of the most effective methods to treat the severe and obviously obese concealed penis, with satisfactory effectiveness and less complication.


Assuntos
Prepúcio do Pênis , Pênis , Fimose , Procedimentos Cirúrgicos Urológicos Masculinos , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Doenças do Pênis , Pênis/cirurgia , Fimose/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
8.
Zhonghua Nan Ke Xue ; 24(5): 404-408, 2018 May.
Artigo em Chinês | MEDLINE | ID: mdl-30171754

RESUMO

Objective: To investigate the clinical effects of circumcision by surgical plane positioning with a disposable circumcision suture device in the treatment of phimosis and redundant prepuce. METHODS: From September 2016 to June 2017, we treated 250 patients with phimosis or redundant prepuce, 127 by conventional circumcision (the control group) and the other 123 by surgical plane positioning with a disposable circumcision suture device (the observation group). We compared the operation time, intra-operative bleeding, preputial frenulum alignment, postoperative ecchymosis, and postoperative penile appearance between the two groups of patients. RESULTS: Compared with the controls, the patients in the observation group showed significantly longer operation time (ï¼»4.48 ± 1.18ï¼½ vs ï¼»7.17 ± 1.42ï¼½ min, P<0.05), lower rates of intra-operative frenulum bleeding (15.0% ï¼»19/127ï¼½ vs 4.1% ï¼»5/123ï¼½, P<0.05) and frenulum misalignment (26.8% ï¼»34/127ï¼½ vs 0.8% ï¼»1/123ï¼½, P<0.05), higher incidence of postoperative ecchymosis (41.7% ï¼»53/127ï¼½ vs 21.1% ï¼»26/123ï¼½, P<0.05), and higher satisfaction of the patients with the postoperative penile appearance (92.9% ï¼»18/127ï¼½ vs 98.4% ï¼»121/123ï¼½, P<0.05). However, no statistically significant difference was found between the control and observation groups in intra-operative non-frenulum bleeding (4.7% ï¼»6/127ï¼½ vs 1.6% ï¼»2/123ï¼½, P = 0.164). CONCLUSIONS: Circumcision by surgical plane positioning with a disposable circumcision suture device can effectively avoid preputial frenulum misalignment, reduce intra-operative bleeding, and improve postoperative penile appearance.


Assuntos
Circuncisão Masculina/instrumentação , Pênis/anormalidades , Pênis/cirurgia , Fimose/cirurgia , Técnicas de Sutura/instrumentação , Equipamentos Descartáveis , Equimose/etiologia , Prepúcio do Pênis , Humanos , Incidência , Masculino , Duração da Cirurgia , Satisfação Pessoal , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório
9.
J Pediatr Urol ; 14(6): 545.e1-545.e4, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29909192

RESUMO

INTRODUCTION AND OBJECTIVES: The desire to preserve the prepuce is often based on cultural norms. Recently, the concept of "genital autonomy" has been invoked to delay circumcision (or any genital altering procedure) until the individual reaches maturity and can make his or her own decision. However, some uncircumcised boys develop one or more episodes of balanitis resulting in scarring of the prepuce and pathologic phimosis which is difficult to treat. Herein we report on the management of severe phimosis and preputial scarring using preputial Z-plasties. MATERIALS AND METHODS: We reviewed the records of 28 patients, aged 3-12 years who underwent prepuce-sparing surgery within the previous 5 years with a minimum follow-up of 6 months. All patients were uncircumcised, with severe phimosis defined as a tight, pinpoint opening. All patients failed to respond to 6-10 weeks of betamethasone treatment. All parents requested preservation of as much of the foreskin as possible. RESULTS: All patients healed satisfactorily, without infection, hematoma, or flap necrosis. One child developed mild scarring which responded to local steroid application. At follow-up evaluation, ranging from 6 to 24 months, the prepuce was fully retractable in all patients (Fig.). CONCLUSIONS: Excision of the scarred preputial ring results in a circular suture line, which is in essence a straight line, curved and connected at each end, and this is likely to contract over time. The principle of Z-plasty can be exploited to elongate and interrupt the straight line, preventing contracture thus widening and sparing the prepuce.


Assuntos
Cicatriz/cirurgia , Prepúcio do Pênis/cirurgia , Tratamentos com Preservação do Órgão/métodos , Doenças do Pênis/cirurgia , Fimose/cirurgia , Criança , Pré-Escolar , Humanos , Masculino , Índice de Gravidade de Doença , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
10.
Pediatr Surg Int ; 34(7): 803-806, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29845314

RESUMO

PURPOSE: Children with single ventricle physiology (SVP) have been shown to have a high morbidity and mortality after non-cardiac surgical procedures. Elective circumcision is one of the most common pediatric operations with low morbidity and mortality. The purpose of our study was to review our institutional experience with SVP children undergoing circumcisions to determine peri-operative course and outcomes. METHODS: We performed a retrospective review of children with SVP who underwent an elective circumcision from 2000 to 2017. Children with non-single ventricle physiology or children undergoing circumcision in combination with another case were excluded. Demographics, surgical characteristics, and outcomes were analyzed. Descriptive statistics were performed, all medians were reported with interquartile range. RESULTS: 15 males underwent elective circumcision with a median age at the time of surgery of 1.13 (1.03, 1.38) years. Eighty-four percent underwent their circumcision after their 2nd stage cardiac operation. Most common operative indication was uncomplicated phimosis. Median operative time was 20 (16, 27) mins. Median total length of stay was 229 (185, 242) mins with no admissions. Post-operative complications included two (16%) hematomas with one requiring surgical intervention. There were no deaths. CONCLUSION: Children with SVP who undergo elective circumcision may have a higher risk of bleeding.


Assuntos
Circuncisão Masculina , Cardiopatias Congênitas/complicações , Fimose/cirurgia , Circuncisão Masculina/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Ventrículos do Coração/anormalidades , Humanos , Lactente , Masculino , Fimose/complicações , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos
11.
BMJ Case Rep ; 20182018 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-29477995

RESUMO

A 70-year-old man was admitted to our hospital for a penile circumcision due to phimosis using continuous dose spinal anaesthesia. On postoperative day 10 he came to the emergency department with a superficial abscess localised at the injection site of the spinal catheter. He was treated with intravenous antibiotics for 10 days, and the superficial abscess was incised and drained. Ten days later, the patient was readmitted to the emergency department with complaints of back pain and fever. A repeat MRI scan of his lumbar sacral area was done and showed epidural abscesses without any compression of the medulla or the myelum. The patient did not have any signs of spinal cord or nerve root compression at that time. He was treated with intravenous antibiotics with resolution of symptoms.


Assuntos
Raquianestesia/efeitos adversos , Circuncisão Masculina , Abscesso Epidural/etiologia , Fimose/cirurgia , Complicações Pós-Operatórias/etiologia , Idoso , Antibacterianos/uso terapêutico , Drenagem , Abscesso Epidural/diagnóstico por imagem , Abscesso Epidural/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia
12.
J Clin Anesth ; 44: 91-96, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29161549

RESUMO

STUDY OBJECTIVE: The aim of this study was to compare the efficacies of ultrasound guided sacral hiatus injection and conventional sacral canal injection performed for caudal block in children. DESIGN: Randomized controlled clinical trial. SETTING: Operating rooms of university hospital of Erzurum, Turkey. PATIENTS: One hundred-thirty four children, American Society of Anesthesiologists I-II, between the ages of 5 and 12, scheduled for elective phimosis and circumcision surgery. INTERVENTIONS: Patients assigned to two groups for ultrasound guided caudal block (Group U, n=68) or conventional caudal block (Group C, n=66). Caudal solution was prepared as 0.125% levobupivacaine plus 10mcg/kg morphine (total volume: 0.5ml/kg), and was administered to both groups. MEASUREMENTS: The block performing time, the block success rate, the number of needle puncture, the success at first puncture and the complications were recorded. MAIN RESULTS: The block performing time and the success rate of block were similar between Group U and Group C (109.96±49.73s vs 103.17±45.12s, and 97% vs 93%, respectively p>0.05). The first puncture success rate was higher in Group U than in Group C (80% vs 63%, respectively p=0.026). No significant difference was observed between the groups with regard to the number of needle punctures (p=0.060). The rates of vascular puncture and subcutaneus bulging were higher in Group C than in Group U (8/66 vs 1/68, and 8/66 vs 0/68, respectively p<0.05). CONCLUSIONS: Despite the limitations in central neuroaxial anesthesia we recommend the use of ultrasound since it reduces the complications and increases the success rate of first puncture in pediatric caudal injection.


Assuntos
Anestesia Caudal/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Sacro/diagnóstico por imagem , Ultrassonografia de Intervenção , Variação Anatômica , Anestesia Caudal/métodos , Anestésicos Locais/administração & dosagem , Criança , Pré-Escolar , Circuncisão Masculina/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Humanos , Injeções Epidurais/efeitos adversos , Injeções Epidurais/métodos , Plexo Lombossacral/efeitos dos fármacos , Masculino , Fimose/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Sacro/anatomia & histologia , Resultado do Tratamento
13.
Urol Int ; 100(3): 361-363, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-26871688

RESUMO

Acute severe ischemia of glans penis after circumcision is a very rare event and, if not treated, can lead to irreversible necrosis with severe consequences such as loss of part of the penis. The possible causes for this condition could be blood-vessel binding or cauterization, dorsal penile nerve block (DPNB), local anesthesia with vasoconstricting agents and wound dressing compression. The aim of the treatment is to provide good blood supply and thus, oxygen delivery to the ischemic penis. The therapeutic options include hyperbaric therapy (HBOT), pentoxifylline (PTX), enoxaparina, iloprost, antiplatelet, corticosteroids and peridural anesthesia. We report the case of a 24-year-old male who developed an acute severe glans penis ischemia after circumcision done under DPNB. The patient was successfully treated with HBOT in combination with PTX.


Assuntos
Circuncisão Masculina/efeitos adversos , Oxigenação Hiperbárica , Pênis/irrigação sanguínea , Pênis/fisiopatologia , Pentoxifilina/uso terapêutico , Adulto , Anestesia Local/efeitos adversos , Bandagens , Humanos , Isquemia/cirurgia , Masculino , Necrose , Bloqueio Nervoso/efeitos adversos , Fimose/cirurgia , Vasoconstritores/efeitos adversos , Vasodilatadores/uso terapêutico
14.
Cir Pediatr ; 30(4): 211-215, 2017 Oct 25.
Artigo em Espanhol | MEDLINE | ID: mdl-29266891

RESUMO

AIM: Balanitis xerotica obliterans (BXO) is a disease of the skin and mucosa of male genitals of unknown etiology that may affect children of any age. It has a low incidence (9-19%) and in adults is considered a potential premalignant lesion. The aim of our study is to establish the incidence of BXO in our center and to determine its correlation between the clinical and immunohistochemical (IHC) findings. METHODS: Prospective cohort including all children < 14 years with foreskin pathology that required a circumcision between 2014-2016. Statistical analysis of the clinical characteristics, histological and IHC findings searching for inflammatory response, premalignant lesions and microbiological findings. RESULTS: A total of 176 boys with phimosis had circumcision with a mean age of 7 ± 3 years (Range 2-14). Presurgical diagnosis of BXO was suspected in 28.4% (n= 50) whereas the AP confirmed a total of 29.5% (n= 53) with a very good interobserver concordance (kappa= 0.81: p< 0.01). Previous treatment with corticoids in BXO was found in 63.5% (n= 33/52). Meatal stenosis was found in 7.69% (n= 4/52) requiring meatal/urethral dilations. Patients with BXO had a T-Lymphocytes CD3+ mediated inflammatory response with a positive correlation between tumor suppressing protein (p53) expression and chronic inflammation. CONCLUSIONS: BXO is a chronic inflammatory disease mediated by T-lymphocytes with an incidence greater than previously reported. Surgeons' criterion has a very good concordance with the AP findings. The elevation of p53 in children with BXO may indicate a plausible malignant potential that may require a surgical treatment (circumcision) and an adequate follow-up.


Assuntos
Balanite Xerótica Obliterante/diagnóstico , Circuncisão Masculina/métodos , Prepúcio do Pênis/cirurgia , Fimose/cirurgia , Adolescente , Balanite Xerótica Obliterante/epidemiologia , Balanite Xerótica Obliterante/cirurgia , Criança , Pré-Escolar , Estudos de Coortes , Prepúcio do Pênis/patologia , Humanos , Incidência , Inflamação/patologia , Masculino , Fimose/diagnóstico , Estudos Prospectivos , Linfócitos T/metabolismo , Proteína Supressora de Tumor p53/metabolismo
15.
Cuad. bioét ; 28(94): 303-316, sept.-dic. 2017.
Artigo em Inglês | IBECS | ID: ibc-167275

RESUMO

Preventive newborn male circumcision has been at the center of scientific debate for many years. The reason for promoting preventive newborn male circumcision is the reduction of the incidence of UTIs (in the first six months of life), penile cancer, transmission of STDs/HIV infection/AIDS. However preventive interventions in the newborn involving violations of bodily integrity elicit several ethical questions. In this article, we reviewed the literature regarding circumcision, the prevention of UTIs, penile cancer, transmission of STDs/HIV infection/AIDS and complications of this practice in the neonatal period. The very limited reduction of incidence of UTIs and the uncertain preventive role of newborn male circumcision towards penile cancer, STDs/HIV infection and AIDS, makes it difficult to justify male circumcision in newborns. Moreover, the challenge in obtaining a unanimous opinion on newborn male circumcision derives from the fact that, as a preventive intervention, it requires evaluation criteria that are not comparable to those of therapeutic treatments. Since preventive male circumcision determines permanent alteration of the body, some authors believe that it can be used only in subjects that are capable of giving their valid consent. In the case of a newborn, the "child’s best interest" should be used as a standard, but preventive newborn male circumcision does not satisfy it


La circuncisión masculina como tratamiento preventivo en recién nacidos ha estado en el centro del debate científico durante muchos años. Las razones para promover la circuncisión masculina preventiva en niños han sido la reducción de la incidencia de infecciones del tracto urinario (en los primeros seis meses de vida, UTIs), el cáncer de pene, la transmisión de VIH/SIDA y de otras enfermedades de transmisión sexual. Sin embargo, las intervenciones preventivas neonatales, que implican una violación de la integridad corporal del niño, presentan varias cuestiones éticas. En este artículo, revisamos la literatura con respecto a la circuncisión, la prevención de las UTIs, el cáncer de pene, la transmisión de VIH/SIDA y otras enfermedades de transmisión sexual y las complicaciones de esta práctica en el período neonatal. La muy limitada reducción de la incidencia de las UTIs y la incertidumbre en cuanto a la función preventiva de la circuncisión masculina en recién nacidos en relación con el cáncer de pene, la infección de VIH/SIDA y otras enfermedades de transmisión sexual, hace que sea difícil justificar la circuncisión masculina de tipo preventivo en neonatos. Por otra parte, los desafíos que aparecen en la obtención de una opinión unánime sobre la circuncisión masculina del recién nacido derivan del hecho que, como una intervención preventiva, se requieren criterios de evaluación que no son comparables a criterios de los tratamientos terapéuticos. Puesto que la circuncisión masculina preventiva determina una alteración permanente del cuerpo, algunos autores creen que puede ser utilizada sólo en los sujetos que son capaces de dar su consentimiento válido. En el caso de un recién nacido, "el mejor interés del niño" debe ser el estándar de referencia, pero la circuncisión masculina con carácter preventivo en niños recién nacidos no satisface este estándar


Assuntos
Humanos , Masculino , Recém-Nascido , Circuncisão Masculina/ética , Doenças Sexualmente Transmissíveis/prevenção & controle , Consentimento do Representante Legal/ética , Infecções por HIV/prevenção & controle , Neoplasias Penianas/prevenção & controle , Fimose/cirurgia , Medição de Risco
16.
Rev. int. androl. (Internet) ; 15(3): 108-118, jul.-sept. 2017. tab, ilus, graf
Artigo em Inglês | IBECS | ID: ibc-164828

RESUMO

Objective. To evaluate the clinic efficacy and safety of the disposable circumcision suture device (DCSD) and Shang ring circumcision (SRC) in the treatment of redundant prepuce or phimosis with a meta-analysis. Material and methods. Electronic databases including PubMed, Embase, Wan Fang, VIP, CNKI and CBM database were researched from inception to August 30, 2016 for relevant RCTs and prospective studies, the reference lists of the included studies were also searched manually. The risk ratios (RR) or mean difference (MD) with 95% confidence intervals (CI) as the effect sizes were calculated by the Revman 5.3 and stata 12.0 software. Results. Twelve RCTs or prospective studies were included with 3345 patients among which 1661 cases received DCSD treatment and 1684 SRC. Compared to the Shang ring circumcision treatment, the disposable circumcision suture device provided a significantly shorter operation time [MD=−0.94, 95%CI (-1.76, -0.12), P=0.02], lower pain scores [MD=-1.89, 95%CI (-2.72, -1.07), P<0.001], no stitch removal pain, better postoperative penile appearance [RR=1.10, 95%CI (1.04, 1.17), P=0.001], fewer complications [RR=0.42, 95%CI (0.32, 0.56), P<0.001] and shorter wound healing time [MD=-8.92, 95%CI (-10.79, -7.05), P<0.001]. Meanwhile, there is more intraoperative blood loss [MD=0.12, 95%CI (0.02, 0.22), P=0.02], and more treatment cost [MD=877.57, 95%CI (737.94, 1017.20); P<0.001]. Conclusions. Based on the results of our meta-analysis, DCSD is more effective and safer than SRC. Thus, it has the advantages of shorter operation time, lower pain scores, better postoperative penile appearance, fewer complication and shorter wound healing time. However, the results need additional high-quality multicenter RCTs to evaluate in the future (AU)


Objetivo. Evaluar la eficacia clínica y la seguridad en el tratamiento del prepucio redundante o fimosis con los dispositivos de sutura de circuncisión desechable (DCSD) y la circuncisión del anillo Shang (SRC). Material y métodos. Se investigaron las bases de datos en línea, como PubMed, Embase, Wan Fang, VIP, CNKI y CBM desde el inicio hasta el 30 de agosto de 2016 para ensayos controlados aleatorios y estudios prospectivos relevantes, así como las listas de referencias de los estudios incluidos. Las relaciones de riesgo (RR) o la diferencia de medias (MD) con intervalos de confianza (IC) del 95% (IC 95%) así como los tamaños del efecto se calcularon con el software Revman 5.3 y stata 12.0. Resultados. Se incluyeron 12 ECA o estudios prospectivos con 3.345 pacientes, de los cuales 1.661 fueron tratados con el DCSD y 1.684 con SRC. En comparación con el tratamiento con SRC, el DCSD proporcionó un tiempo de operación más corto (MD=-0,94; IC 95% [-1,76, -0,12], p=0,02), sin dolor al extraer las puntadas (MD=−1.89; IC 95% [-2,72, -1,07], p<0,001), y mejor recuperación después de la cirugía (RR=1,10; IC 95% [1,04; 1,17], p=0,001), menos complicaciones (RR=0,42; IC 95% [0,32; 0,56], p<0,001)] y menor tiempo de cicatrización (MD=-8,92; IC 95% (-10,79, -7,05), p<0,001]. Mientras tanto, hay más pérdidas sanguíneas intraoperatorias (MD=0,12; IC 95% [0,02; 0,22]; p=0,02) y más costo de tratamiento (MD=877,57, IC 95% [737,94; 1.017.20]; p<0,001). Conclusión. El DCSD es más eficaz y más seguro que SRC según el resultado del metaanálisis. Por lo tanto, tiene las ventajas de un menor tiempo de operación, menores puntuaciones de dolor, mejor aspecto postoperatorio del pene, menor complicación y menor tiempo de cicatrización de la herida. Se necesitan ECA multicéntricos adicionales de mejor calidad en la evaluación debido a los límites de esta revisión sistemática (AU)


Assuntos
Humanos , Masculino , Circuncisão Masculina/instrumentação , Suturas , Técnicas de Sutura/instrumentação , Cicatrização/fisiologia , Fimose/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Resultado do Tratamento , Estudos Prospectivos , Intervalos de Confiança , Cuidados Pós-Operatórios/métodos , Equipamentos Descartáveis , Complicações Pós-Operatórias/cirurgia
17.
Urol J ; 14(5): 5013-5017, 2017 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-28853107

RESUMO

PURPOSE: We evaluated the safety and efficacy of two different kinds of disposable circumcision suture devices in adult men. MATERIALS AND METHODS: Adult male patients (n = 179; mean age: 23.7 years) with redundant prepuce and/or phimosis were included in a clinical trial from July 2015 to August 2016. Patients were divided into 2 groups: group A using the Langhe disposable circumcision suture device (n = 89), and group B using the Daming disposable circumcision suture device (n = 94). RESULTS: Intraoperative and postoperative bleeding were more serious in the group A of disposable circumcision suture device compared with the group B of disposable circumcision suture device (4.21 ± 1.31 ml) versus (2.56 ± 1.45 ml). Patients in the group B of disposable circumcision suture device had a longer swelling time (group A versus group B: 11.7 ± 0.9 days versus 14.5 ± 1.4 days), the postoperative pain score in the 7 days after surgery (group A versus group B: 2.9 ± 0.9 versus 3.8 ± 1.5), and higher postoperative infection rate (group A versus group B: 4.7% versus 13.8%), the differences were statistically significant (p < 0.05). CONCLUSION: postoperative complications of the two kinds of disposable circumcision suture devices are different. We should pay attention to the risk of postoperative bleeding when the patients use the Langhe disposable circumcision suture device, while the patients who use the Langhe disposable circumcision suture device will have a longer healing time, and postoperative pain and the risk of infection cannot be ignored after the surgery.


Assuntos
Circuncisão Masculina/instrumentação , Edema/etiologia , Doenças do Pênis/etiologia , Hemorragia Pós-Operatória/etiologia , Técnicas de Sutura/instrumentação , Adulto , Perda Sanguínea Cirúrgica , Volume Sanguíneo , Circuncisão Masculina/efeitos adversos , Equipamentos Descartáveis , Humanos , Masculino , Dor Pós-Operatória/etiologia , Fimose/cirurgia , Adulto Jovem
18.
Eur Urol Focus ; 3(2-3): 149-150, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28753815

RESUMO

Circumcision can be a viable option for phimosis in a 10-yr-old boy, also if asymptomatic, in the presence of skin alterations or if the parents prefer avoid observation. Morbidity is minimal if the procedure is performed in a hospital setting.


Assuntos
Circuncisão Masculina , Fimose/complicações , Fimose/cirurgia , Criança , Circuncisão Masculina/efeitos adversos , Comunicação , Tomada de Decisões , Humanos , Masculino , Pais/educação , Participação do Paciente , Infecções Urinárias/etiologia
19.
Eur Urol Focus ; 3(2-3): 151-152, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28753818

RESUMO

In a 10-yr-old boy with no abnormalities or symptoms other than nonretractability of the foreskin, the foreskin should be preserved. If treatment is needed, local corticoid application should be used as first-line therapy, as it gives excellent results in up to 90% of cases, before removing this sensitive part of the body.


Assuntos
Circuncisão Masculina , Neoplasias Penianas/epidemiologia , Fimose/complicações , Fimose/cirurgia , Criança , Circuncisão Masculina/efeitos adversos , Comunicação , Humanos , Masculino , Pais/educação , Puberdade , Remissão Espontânea , Doenças Sexualmente Transmissíveis/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controle
20.
Int J Surg ; 43: 17-25, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28522221

RESUMO

BACKGROUND: Phimosis and redundant prepuce are defined as the inability of the foreskin to be retracted behind the glans penis in uncircumcised males. To synthesize the evidence and provide the hierarchies of different circumcisions for phimosis and redundant prepuce, we performed an overall network meta-analysis (NMA) based on their comparative efficacy and safety. MATERIAL AND METHODS: Electronic databases including PubMed, Embase, Wan Fang, VIP, CNKI and CBM database were researched from randomized controlled trials (RCTs) for redundant prepuce or phimosis. We conducted the direct and indirect comparisons by aggregate data drug information system (ADDIS) software. Moreover, consistency models were applied to assess the differences among the male circumcision practices, and the ranks based on probabilities of intervention for the different endpoints were performed. Node-splitting analysis was used to test inconsistency. RESULTS: Eighteen RCTs were included with 6179 participants. Compared with the conventional circumcision(CC), two new styles of circumcisions, the disposable circumcision suture device(DCSD) and Shang Ring circumcision(SRC), provided significantly shorter operation time[DCSD: standardized mean difference (SMD) = -20.60, 95% credible interval(CI) (-23.38, -17.82); SRC: SMD = -19.16, 95%CI (-21.86, -16.52)], shorter wound healing time [DCSD:SMD = -4.19, 95%CI (-8.24,-0.04); SRC: SMD = 4.55, 95%CI (1.62, 7.57); ] and better postoperative penile appearance [DCSD: odds ratios odds ratios (OR) = 11.42, 95%CI (3.60, 37.68); SRC: OR = 3.85,95%CI (1.29, 12.79)]. Additionally, DCSD showed a lower adverse events rate than other two treatments. However, no significant difference was shown in all surgeries for 24 h postoperative pain score. Node-splitting analysis showed that no significant inconsistency was existed (P > 0.05). CONCLUSIONS: Based on the results of NMA, DCSD may be a most effective and safest choice for phimosis and redundant prepuce. DCSD has the advantages of a shorter operation time, better postoperative penile appearance, fewer complication and shorter wound healing time. However, with the limitations of our study, additional multi-center RCTs are needed to evaluate the outcomes.


Assuntos
Circuncisão Masculina/métodos , Pênis/cirurgia , Fimose/cirurgia , Humanos , Masculino , Meta-Análise em Rede , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Pênis/anormalidades , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Suturas , Resultado do Tratamento , Cicatrização
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