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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.
Urology ; 135: 133-135, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31586472

RESUMO

Malignant peripheral nerve sheath tumors (MPNSTs) are soft tissue sarcomas that arise from peripheral nerve fibers and primarily occur in the setting of neurofibromatosis (NF1). MPNST arising from the penis is very rare and may require mutilating surgery to achieve surgical cure. We previously reported a case of MPNST involving the penis in a 14-month-old boy treated with neoadjuvant chemotherapy, total penectomy, and adjuvant radiation. Here we report intermediate follow-up of the same patient, describe his subsequent genitourinary reconstruction, and discuss management dilemmas that arise following treatment of penile MPNST.


Assuntos
Assistência ao Convalescente/métodos , Neoplasias da Bainha Neural/terapia , Neoplasias Penianas/terapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Criança , Humanos , Masculino , Terapia Neoadjuvante , Neoplasias da Bainha Neural/patologia , Neoplasias Penianas/patologia , Pênis/patologia , Pênis/cirurgia , Escroto/cirurgia , Resultado do Tratamento , Uretra/cirurgia
4.
Int Braz J Urol ; 46(1): 83-89, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31851463

RESUMO

PURPOSE: Obliterative urethral stenosis is a type of urethral lesion that compromises the whole corpus spongiosum's circumference. We present our experience in resolving complex long segment urethral obliteration in a single procedure using a combination of dorsal onlay oral mucosa graft (OMG) and ventral fasciocutaneous penile skin flap. MATERIALS AND METHODS: A prospectively maintained database was reviewed, which included data of men presenting long, obliterative strictures. Patients were excluded if they were lost to follow-up before one year. Failure was defined as need for further urethral instrumentation. The surgical technique used consisted on the fixation of OMG to the tunica albuginea of the corpus cavernosum, thus creating a new urethral plate. Penile or foreskin flaps were employed to complete the ventral aspect. Postoperative follow-up was done with a voiding cystourethrography at week 3. RESULTS: A total of 21 patients were included with a median age of 49 years. Mean follow-up was 25 months. Failure was found for 3 patients (2 of them needing dilations and only one required a new urethral reconstruction). CONCLUSION: Single stage combination of dorsal OMG with ventral fasciocutaneous penile flap showed good results for selected patients affected with obliterative urethral stenosis.


Assuntos
Mucosa Bucal/transplante , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/transplante , Estreitamento Uretral/cirurgia , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do Tratamento
5.
Int Braz J Urol ; 45(6): 1238-1248, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808413

RESUMO

INTRODUCTION: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the outcomes associated with its surgical treatment. MATERIAL AND METHODS: Within 266 hypospadias patients treated at our clinic, we assessed the prevalence of pubic hypertrophy, and we schematically described the surgical steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predictors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy. RESULTS: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the loca-tion of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only signifi cant pre-dictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fi stula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multi-variable adjustment. CONCLUSIONS: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and severity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.


Assuntos
Hipospadia/epidemiologia , Hipospadia/cirurgia , Lipectomia/métodos , Adolescente , Adulto , Humanos , Hipertrofia/epidemiologia , Hipertrofia/cirurgia , Modelos Logísticos , Masculino , Ilustração Médica , Pênis/cirurgia , Complicações Pós-Operatórias , Prevalência , Osso Púbico/cirurgia , Estudos Retrospectivos , Fatores de Risco , Sérvia/epidemiologia , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto Jovem
6.
Urologiia ; (5): 124-125, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808646

RESUMO

Diphallia is an uncommon deformity, with glans duplication being its rarest form. We discuss here a case of a 6-year-old boy who presented due to excess prepuce malformation that, on examination, revealed a "penile nodule" that proved to be glans duplication. Our patient had only one urethra present and no congenital anomalies. Surgical uneventful penile reconstruction involving radiofrequency ablation (RFA) resolved the issue.


Assuntos
Pênis/cirurgia , Ablação por Radiofrequência , Procedimentos Cirúrgicos Reconstrutivos/métodos , Criança , Humanos , Masculino , Pênis/anormalidades , Resultado do Tratamento , Uretra
7.
Pan Afr Med J ; 33: 257, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692822

RESUMO

Penile fracture is a rare urologic emergency, defined as a traumatic rupture of the tunica albuginea of the corpus cavernosum. It mainly affects the young subjects during sexual intercourse. The purpose of this study was to report treatment outcomes in 6 patients with penile fracture observed in the Department of Urology-Andrology, Souro Sanou University Hospital of Bobo-Dioulasso. The study involved six patients with an average age of 38.3 years admitted in the hospital with painful penile swelling (4 cases) and persistent urethrorragia (2 cases) after wrong coital movement or forced manipulation of the penis. Painful swelling of the penis with penis simulating the appearance of an aubergine was the main sign found. Treatment was based on evacuation of the intracavernous haematoma followed by albuginorraphy in 5 cases and conservative treatment in 1 case. All patients had an uneventful postoperative course.


Assuntos
Coito , Hematoma/etiologia , Pênis/lesões , Adulto , Burkina Faso , Hematoma/cirurgia , Hospitais Universitários , Humanos , Masculino , Pênis/cirurgia , Estudos Retrospectivos , Ruptura , Resultado do Tratamento
8.
Undersea Hyperb Med ; 46(5): 695-699, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683369

RESUMO

Successful penile replantations are rarely reported in the literature and are associated with significant complications. We present a case of a patient who auto-amputated his penis. Delayed microvascular replantation was performed approximately 14 hours following injury. He was treated with a phosphodiesterase inhibitor postoperatively, and adjuvant hyperbaric oxygen (HBO2) therapy was started 58 hours after replantation; 20 treatments at 2.4 atmospheres absolute (ATA), twice daily for eight days, followed by once daily for four days. Perfusion of the replanted penis was serially assessed using fluorescent angiography. With some additional surgical procedures including a split- thickness skin graft to the shaft due to skin necrosis he has made a complete recovery with return of normal urinary and sexual function. This unusual case illustrates the potential benefit of HBO2 therapy in preserving viability of a severed body part. Fluorescent angiography may have potential utility in monitoring efficacy of HBO2.


Assuntos
Oxigenação Hiperbárica , Pênis/cirurgia , Complicações Pós-Operatórias/terapia , Reimplante/métodos , Automutilação/cirurgia , Terapia Combinada , Desbridamento , Humanos , Masculino , Necrose , Pênis/irrigação sanguínea , Pênis/patologia , Fotografação , Adulto Jovem
9.
Nat Rev Urol ; 16(12): 734-744, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31649327

RESUMO

Penile wounds after traumatic and surgical amputation require reconstruction in the form of autologous tissue transfers. However, currently used techniques are associated with high infection rates, implant erosion and donor site morbidity. The use of tissue-engineered neocorpora provides an alternative treatment option. Contemporary tissue-engineering strategies enable the seeding of a biomaterial scaffold and subsequent implantation to construct a neocorpus. Tissue engineering of penile tissue should focus on two main strategies: first, correcting the volume deficit for structural integrity in order to enable urinary voiding in the standing position and second, achieving erectile function for sexual activity. The functional outcomes of the neocorpus can be addressed by optimizing the use of stem cells and scaffolds, or alternatively, the use of gene therapy. Current research in penile tissue engineering is largely restricted to rodent and rabbit models, but the use of larger animal models should be considered as a better representation of the anatomical and physiological function in humans. The development of a cell-seeded scaffold to achieve and maintain erection continues to be a considerable challenge in humans. However, advances in penile tissue engineering show great promise and, in combination with gene therapy and surgical techniques, have the potential to substantially improve patient outcomes.


Assuntos
Ereção Peniana , Pênis/cirurgia , Engenharia Tecidual , Animais , Células Cultivadas , Modelos Animais de Doenças , Humanos , Masculino , Pênis/fisiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Regeneração , Tecidos Suporte , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
11.
Urol Clin North Am ; 46(4): 511-525, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582026

RESUMO

Penile inversion vaginoplasty is a technique of gender-affirming genital surgery that uses primarily genital skin to construct the vulva and neovagina for patients assigned male sex at birth. This article presents present the authors' techniques and other contemporary techniques for this surgery, with particular attention to neovaginal canal construction, neoclitoral construction, and urethroplasty.


Assuntos
Pênis/cirurgia , Cirurgia de Readequação Sexual/métodos , Transexualismo , Vagina/cirurgia , Feminino , Humanos , Masculino , Cirurgia de Readequação Sexual/efeitos adversos , Transplante de Pele , Retalhos Cirúrgicos
12.
Urol Clin North Am ; 46(4): 527-539, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582027

RESUMO

"Surgical (re)construction of a vagina (vaginoplasty) is performed in biological women with congenital or postablative vaginal absence and in transgender women. Penile inversion vaginoplasty is the gold surgical standard for genital Gender Affirmation Surgery in transgender women. In absence of sufficient penoscrotal skin, due to penoscrotal hypoplasia, circumcision, penile trauma with loss of penile skin quantity and/or quality, or when primary vaginoplasty has failed, intestinal vaginoplasty can be performed. This article provides an update on surgical indications of intestinal vaginoplasty, operative technique, perioperative care, and short- and long-term postoperative issues. A review of recent literature is performed."


Assuntos
Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Cirurgia de Readequação Sexual/efeitos adversos , Cirurgia de Readequação Sexual/métodos , Transexualismo , Vagina/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Seleção de Pacientes , Pênis/cirurgia , Assistência Perioperatória
13.
Urol Clin North Am ; 46(4): 541-554, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582028

RESUMO

Improvements to vulvar aesthetics, particularly the clitoral complex and labia minora reconstruction, are difficult and remain the challenge of genital reconstructive surgeons. Various modifications of penile inversion technique have been introduced to improve vulvar aesthetics in recent years. Generally penile inversion vaginoplasty leaves limited penile tissue to reconstruct the natural labia minora. This article describes improvements made to overcome substantial limitations of the widely used traditional penile inversion vaginoplasty technique, with emphasis on creating a realistic vulvar aesthetic appearance in all respects, without compromising sexual sensation or vaginal depth.


Assuntos
Disforia de Gênero/cirurgia , Pênis/cirurgia , Cirurgia de Readequação Sexual , Transexualismo , Vagina/cirurgia , Vulva/cirurgia , Estética , Feminino , Humanos , Masculino
14.
Urol Clin North Am ; 46(4): 605-618, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582033

RESUMO

As more transgender patients undergo gender-affirming genital reconstructive surgery, such as vaginoplasty and phalloplasty, it is imperative for health care providers, including urologists, to understand the new anatomy and most common complications to diagnose and treat patients effectively. Although there have been several modifications to prior techniques as well as development of new techniques over the years, complications are still common after vaginoplasty and phalloplasty. This article focuses on the most common complications as well as the evaluation and management of those complications.


Assuntos
Disforia de Gênero/cirurgia , Pênis/cirurgia , Complicações Pós-Operatórias/terapia , Cirurgia de Readequação Sexual/efeitos adversos , Transexualismo , Vagina/cirurgia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Cirurgia de Readequação Sexual/métodos
15.
Urology ; 134: 217-220, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31542463

RESUMO

A case of accessory scrotum with duplicated penis (diphallia) in a male fetus is reported because of its rarity. This case is presented with proved negative androgen receptors in the accessory genitalia. The results of excisional surgery as well as immunostaining for androgen receptors in the resected specimens are presented as well. The outcomes of prenatal ultrasonography, clinical examination of the infant, and pathologic findings of the resected accessory genitalia are also discussed.


Assuntos
Pênis/anormalidades , Escroto/anormalidades , Ultrassonografia Pré-Natal , Adulto , Feminino , Humanos , Masculino , Pênis/diagnóstico por imagem , Pênis/cirurgia , Gravidez , Diagnóstico Pré-Natal , Escroto/diagnóstico por imagem , Escroto/cirurgia
16.
Schweiz Arch Tierheilkd ; 161(9): 553-557, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488396

RESUMO

INTRODUCTION: A 2-year-old Holstein Friesian bull with a penile tumour was referred to the University of Veterinary Medicine Hannover, Foundation, Germany, where the tumour was resected and diagnosed as a fibropapilloma. A urethral fistula was diagnosed eight days postoperatively and was present nine months later, although the bull had normal copulation behaviour and satisfactory fertility. Surgical removal of fibropapillomas in close proximity to the urethra is an effective treatment. A urethral fistula, which may occur as a postsurgical complication, did not have an adverse effect on copulation capacity and fertility of the bull.


Assuntos
Fístula/veterinária , Papiloma/veterinária , Animais , Bovinos , Doenças dos Bovinos/patologia , Doenças dos Bovinos/cirurgia , Fístula/etiologia , Fístula/patologia , Alemanha , Masculino , Papiloma/complicações , Papiloma/patologia , Papiloma/cirurgia , Pênis/patologia , Pênis/cirurgia , Uretra/patologia
19.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266281

RESUMO

PURPOSE: The aim of this article is to describe our modified surgical technique for the reconfiguration of the glans in the clitoris and the labia minora, known as the "M-shape neoclitorolabioplasty". METHODS: The glans with all its neurovascular bundle is isolated from the corpora cavernosa, incised in Y-shape mode and spread in order to obtain an M-shape glandular flap. The "belly" of the M-shape glans will constitute the triangular neoclitoris meanwhile the lateral flaps will constitute the labia minora. The inferior apex of the neoclitoris is fixed to the superior apex of the previously spatulated urethra. The two glans flaps are incised transversally to increase their length and sutured to the sides of the spatulated urethra forming the labia minora. Our technique permits to create an aesthetically pleasing neovagina preserving all the glandular erogenous sensitivity. RESULTS: 94 patients have been treated with our modified technique of male-to-female (MtoF) gender affirming surgery. At median follow-up of 27.57 months, 81 (86.1%) patients reported vaginal intercourse and 78 (82.9%) patients referred presence of erogenous sensitivity during dilatations, intercourse or masturbations. All the glandular tissue is preserved and reconfigured forming the neoclitoris and the labia minora. The M-shape reconfiguration permit to create an aesthetically pleasant neoclitoris. CONCLUSIONS: This technique could be applied safely and easily to patients undergoing gender affirming surgery, allowing the creation of a neovagina with the best possible erogenous sensitivity without losing aesthetical results.


Assuntos
Clitóris/cirurgia , Pênis/cirurgia , Cirurgia de Readequação Sexual/métodos , Vagina/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Retalhos Cirúrgicos , Uretra/cirurgia
20.
Urologiia ; (2): 64-66, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31162904

RESUMO

Lymphangioma circumscriptum (LC) is a rare, benign condition, predominantly characterized by the malformation of lymphatic skin vessels. The most common sites include the oral mucosa, tongue, skin of the extremities and torso. Lymphangioma of the penis is rare disease. In the paper a clinical case of cystic lymphangioma of the penis, which was initially diagnosed as herpes and human papillomavirus infection, is described. Early diagnosis of skin tumors of anogenital area allows to prescribe a timely therapy. After the CO2-laser vaporization there was no recurrence during the 6-month follow-up period.


Assuntos
Terapia a Laser/métodos , Lasers de Gás/uso terapêutico , Linfangioma Cístico/cirurgia , Neoplasias Penianas/cirurgia , Pênis/cirurgia , Diagnóstico Tardio , Humanos , Linfangioma Cístico/diagnóstico , Masculino , Neoplasias Penianas/diagnóstico
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