Subtotal penile amputation and preputial urethrostomy in a degu (Octodon degus).

An 8-year-old intact male degu (Octodon degus) was examined with a 48-hour history of paraphimosis. The penis was devitalized and medical management was unsuccessful. A subtotal penile amputation was performed and a urethral-to-preputial anastomosis was created as part of a circumferential preputial urethrostomy. The immediate outcome in this case was good, with no complications. Key clinical message: Surgical intervention for paraphimosis in degus may be required in extreme cases of penile necrosis or due to an inability to replace the penis within the prepuce. Despite the degu's small size, surgery is feasible, as has been described in other species.

Amputation pénienne subtotale et urétrostomie préputiale chez un degu (Octodon degus). Un degu mâle intact de 8 ans (Octodon degus) a été examiné avec une histoire de paraphimosis de 48 heures. Le pénis a été dévitalisé et la prise en charge médicale a échoué. Une amputation sous-totale du pénis a été réalisée et une anastomose urétral-préputial a été créée dans le cadre d'une urétrostomie préputiale circonférentielle. Le résultat immédiat dans ce cas a été bon, sans complications.Message clinique clé :Une intervention chirurgicale pour le paraphimosis chez le degu peut être nécessaire dans les cas extrêmes de nécrose pénienne ou en raison d'une incapacité à remplacer le pénis dans le prépuce. Malgré la petite taille du degu, la chirurgie est faisable, comme cela a été décrit chez d'autres espèces.(Traduit par Dr Serge Messier).

The indications, complications and outcomes of dogs undergoing partial penile amputation: 10 cases (2014-2021).

OBJECTIVES: To report the signalment, indications for surgery, postoperative complications and medium-/long-term outcomes in dogs undergoing partial penile amputation. MATERIALS AND METHODS: Retrospective case series. The electronic medical records of a single small animal referral hospital were searched between January 2014 and January 2021 for dogs that underwent a partial penile amputation. Data collected included signalment, presenting clinical signs, indication for partial penile amputation, surgical technique, postoperative complications and outcome. RESULTS: Ten dogs were included in the study. Indications for surgery were treatment of preputial neoplasia (n=5), penile neoplasia (n=1), idiopathic paraphimosis (n=3) and chronic urethritis (n=1). Five of five preputial tumours were cutaneous mast cell tumours, and the penile tumour was a squamous cell carcinoma. All dogs recovered uneventfully from surgery with a median postoperative hospitalisation time of 28.8 hours. Two of the three dogs treated for paraphimosis had major postoperative complications requiring further resection of the tip of the penis at 2 weeks and 24 months. Four dogs had minor complications managed without surgical intervention. The outcome was good to excellent in nine of nine dogs for which medium- or long-term follow-up data were available. CLINICAL SIGNIFICANCE: In this group of dogs, partial penile amputation, performed with or without concurrent resection of the prepuce, was a well-tolerated surgical procedure with low intraoperative and postoperative complication rates and good functional outcomes. Partial penile amputation should be considered for conditions affecting the distal penis and prepuce.

Surgical treatment of a paraphimosis in a castrated alpaca secondary to a preputial avulsion.

A 4-year-old recently castrated male alpaca was referred for preputial prolapse of 4 d duration. Clinical findings upon admission were a 5 cm edematous preputial prolapse with the exposed preputial epithelium ulcerated and slightly necrotic. Initial therapy included NSAIDs and local treatment. A severe local inflammatory reaction with a consequent paraphimosis occurred on the penis and prepuce presumptively secondary to the use of a common compound ointment (i.e., tetracycline, scarlet oil, and lanolin) 24 h after its application. Medical treatment and local debridement were unsuccessful in reducing the paraphimosis. The prolapse was successfully reduced by traction of the penis through a para-preputial incision under general anesthesia. The alpaca was discharged after 22 d in hospital. The alpaca is still in the herd 24 mo after discharge with no prolapse recurrence.

Traitement chirurgical d'un paraphimosis chez un alpaga castré secondaire à une avulsion p réputiale. Un alpaga mâle de 4 ans récemment castré a été référé pour un prolapsus préputial d'une durée de 4 jours. Les signes cliniques à l'admission étaient un prolapsus préputial oedémateux de 5 cm avec l'épithélium préputial exposé ulcéré et légèrement nécrotique. Le traitement initial comprenait des AINS et un traitement local. Une réaction inflammatoire locale sévère avec un paraphimosis conséquent s'est produite sur le pénis et le prépuce, vraisemblablement secondaire à l'utilisation d'une pommade composée conventionnelle (i.e. tétracycline, huile scarlet et lanoline) 24 heures après son application. Le traitement médical et le débridement local n'ont pas réussi à réduire le paraphimosis. Le prolapsus a été réduit avec succès par traction du pénis à travers une incision parapréputiale sous anesthésie générale. L'alpaga est sorti après 22 jours d'hospitalisation. L'alpaga est toujours dans le troupeau 24 mois après sa sortie sans récidive de prolapsus.(Traduit par Dr Serge Messier).

Paraphimosis Pain Treatment with Nebulized Ketamine in the Emergency Department.

BACKGROUND: Paraphimosis is an acute urological emergency occurring in uncircumcised males that can lead to strangulation of the glans and painful vascular compromise. Ketamine has been used in the emergency department (ED) as an anesthetic agent for procedural sedation, and when administrated in a sub-dissociative dose (low dose) at 0.1-0.3 mg/kg, ketamine has been utilized in the ED and prehospital settings for pain control as an adjunct and as an alternative to opioid, as well as for preprocedural sedation. This report details the case of a pediatric patient who presented to our Pediatric ED with paraphimosis and had his procedural pain treated with ketamine administrated via a breath-actuated nebulizer (BAN). CASE REPORT: This case report illustrates the potential use of ketamine via BAN to effectively achieve minimal sedation for a procedure in pediatric patients in the ED. The patient was a 15-year-old boy admitted to the Pediatric ED complaining of groin pain due to paraphimosis. The patient was given 0.75 mg/kg of nebulized ketamine via BAN, and 15 min after the medication administration the pain score was reduced from 5 to 1 on the numeric pain rating scale. The patient underwent a successful paraphimosis reduction without additional analgesic or sedative agents 20 min after the administration of nebulized ketamine. The patient was subsequently discharged home after 60 min of monitoring, with a pain score of 0. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The use of nebulized ketamine via BAN might represent a viable, noninvasive way to provide a mild sedative and be an effective analgesic option for managing a variety of acute painful conditions and procedures in the pediatric ED.

Managing Reproduction Emergencies in the Field: Part 1: Injuries in Stallions; Injury of the External Portion of the Reproductive Tract and Gestational Conditions in the Mare.

Selected emergency conditions of male and female reproductive tracts in horses are described, including injuries affecting the external genitalia of male horses and emergent conditions arising during gestation in mares. Conditions affecting male horses are discussed in the context of breeding stallions, but kicks or other mechanisms of trauma in the groin can also affect geldings. Priapism, paraphimosis, trauma to the scrotum and testicles, and penile injury are discussed. In mares, traumatic vestibular injury, placentitis, hydropsic conditions, prepubic tendon and abdominal wall compromise, and uterine torsion are included. Clinical recognition of the problem, diagnostic procedures, and treatments are summarized.

[Urologic Emergencies: Paraphimosis]. / Urologische Notfälle: Paraphimose.

Urologic Emergencies: Paraphimosis Abstract. Paraphimosis presents a rare but acute urological emergency whereby the foreskin becomes entrapped behind the coronary sulcus of the penis. Therapy is quick and feasible, even in an outpatient setting. In most cases compression of the preputial edema and subsequent reposition of the prepuce is sufficient. Rarely, surgical intervention in form of a dorsal incision of the constriction is required. With partial or full phimosis being the underlying condition, paraphimosis occurs predominantly in infants and toddlers. However, persistent or secondary phimosis can lead to paraphimosis in advanced age.

Penile Emergencies.

The penis is an organ of enormous importance and is vital for both excretory and reproductive function. The anatomy of the penis itself can lead to many of its emergent conditions and a thorough understanding of the anatomy and physiology is central to recognition of these conditions. Physicians should have a high clinical suspicion for penile emergencies and perform a thorough physical examination to make a proper diagnosis. Prompt diagnosis and proper management are essential for minimizing dysfunction of this vital organ.

Case Report: Penile necrosis associated to paraphimosis with calciphylaxis due to terminal chronic kidney disease.

Background: Penile necrosis is a rare condition that may present in patients with diabetes mellitus or chronic kidney disease (CKD). The recommended treatment is controversial. We report a case of penile necrosis in a diabetic patient caused by episode of paraphimosis associated with uremic arteriopathy treated with partial amputation. Clinical Case: A 53-year-old male with a background of arterial hypertension, diabetes mellitus and CKD in hemodialysis. The patient presented with paraphimosis and glans necrosis. An emergency circumcision was carried out. A doppler ultrasound found fluid collection in the left corpus cavernosum, parietal vascular calcifications and vascular insufficiency in the corpus cavernosum that suggested necrosis. A partial amputation of the penis was carried out. After three years of follow-up, the outcome has remained favorable. Conclusions: Penile necrosis is a rare but serious complication of terminal CKD. In these patients, systemic calciphylaxis is usually observed. The main take-away lesson is that a multidisciplinary approach is necessary.

Circumcision: postoperative complications that required reoperation.

Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients' age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients' age did not influence in complications.

Combined caudal-superficial-epigastric axial pattern flap and full-thickness buccal mucosa graft for single-stage preputial reconstruction in six dogs.

OBJECTIVE: To describe the use of a caudal superficial epigastric flap in combination with a full-thickness oral mucosal/submucosal graft for single-stage reconstruction of extensive preputial defects in dogs. MATERIALS AND METHODS: Medical records of dogs with extensive preputial defects either of traumatic origin or derived from tumour excision were reviewed. In all dogs, the prepuce was reconstructed using a full-thickness oral mucosal/submucosal graft combined with a caudal superficial epigastric axial pattern flap during a single surgical procedure. Outcome was assessed by routine clinical examinations for 6 months postoperatively, and through telephone follow-up thereafter. RESULTS: Six dogs were included. The caudal superficial epigastric axial pattern flap healed without complications in all dogs, while the full-thickness oral mucosal/submucosal graft failed in one dog. In this individual the skin flap underwent contracture 30 days after surgery and preputial advancement was required. One dog showed postoperative discomfort during urination, which was successfully managed with a Foley catheter and analgesic administration. Three dogs developed paraphimosis at 30, 80 and 90 days, respectively, and required further surgery. Long-term results were good in all dogs. CLINICAL SIGNIFICANCE: The use of a full-thickness oral mucosal/submucosal graft combined with a caudal superficial epigastric axial pattern flap is feasible for single-stage preputial reconstruction in dogs. Attention should be paid to create a sufficiently large preputial opening, in order to prevent paraphimosis.

Urologic Emergencies.

Urologic emergencies can involve the kidneys, ureters, bladder, urethra, penis, scrotum, or testicles. History and physical examination are essential to diagnosis, whereas imaging is increasingly used to confirm diagnoses. Acute urinary retention should be relieved with Foley placement. Penile emergencies include paraphimosis, which can be treated by foreskin reduction, whereas penile fracture and priapism require urologic intervention. Fournier gangrene and testicular torsion are scrotal emergencies requiring emergent surgery. Nephrolithiasis, although painful, is not an emergency unless there is concern for concomitant urinary tract infection, both ureters are obstructed by stones, or there is an obstructing stone in a solitary kidney.

Circumcision: postoperative complications that required reoperation / Postectomia: complicações pós-operatórias necessitando reintervenção cirúrgica

ABSTRACT Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients' age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients' age did not influence in complications.

RESUMO Objetivo Avaliar as complicações pós-operatórias de postectomia que necessitaram de reintervenção cirúrgica. Métodos Estudo retrospectivo com análise de prontuários de pacientes submetidos à postectomia entre 1o de maio de 2015 a 31 de Maio de 2016. Resultados Foram realizadas 2.441 postectomias no período, sendo 501 utilizando a técnica clássica e 1.940 utilizando o dispositivo Plastibell. Apresentaram complicações que necessitaram reintervenção cirúrgica 3,27% dos pacientes. Quando separados por técnica operatória, 3,4% das postectomias com Plastibell foram reoperadas, comparando com 3% das postectomias convencionais (p=0,79). A estenose de prepúcio foi mais frequentemente encontrada na técnica clássica, com significância estatística (p<0,001). Sangramento foi mais frequente nos casos com uso do Plastibell, porém sem diferença significativa (p=0,37). A idade dos pacientes também foi avaliada para investigar se esta variável influenciou na taxa de complicações pós-operatórias, porém não houve diferença significativa. Conclusão Não houve diferença estatisticamente significativa quando comparadas as complicações entre as diferentes técnicas cirúrgicas utilizadas neste serviço. A estenose de prepúcio foi mais frequentemente encontrada nos pacientes operados pela técnica convencional enquanto demonstrou-se tendência a maior sangramento com uso do Plastibell. A idade dos pacientes não influenciou na presença de complicações.

Balanopreputial Adhesion and Paraphimosis due to Lichen Sclerosus

No abstract available.

Comparison of outcomes for pediatric paraphimosis reduction using topical anesthetic versus intravenous procedural sedation.

BACKGROUND: Paraphimosis is an acute urologic emergency requiring urgent manual reduction, frequently necessitating procedural sedation (PS) in the pediatric population. The present study sought to compare outcomes among pediatric patients undergoing paraphimosis reduction using a novel topical anesthetic (TA) technique versus PS. METHODS: We performed a retrospective analysis of all patients <18years old, presenting to a tertiary pediatric ED requiring analgesia for paraphimosis reduction between October 2013 and September 2016. The primary outcome was reduction first attempt success; secondary outcomes included Emergency Department length of stay (ED LOS), adverse events and return visits. Dichotomous outcomes were analyzed by Chi-square testing and multivariate linear regression was used to compare continuous variables. RESULTS: Forty-six patients were included; 35 underwent reduction using TA, 11 by PS. Patient age and duration of paraphimosis at ED presentation did not differ between groups. There was no difference in first attempt success between TA (32/35, 91.4%) and PS groups (9/11, 81.8%; p=0.37). Mean ED LOS was 209min shorter for TA patients (148min vs. 357min, p=0.001) and remained significantly shorter after controlling for age and duration of paraphimosis (adjusted mean difference -198min, p=0.003). There were no return visits or major adverse events in either group, however, among successful reduction attempts, PS patients more frequently experienced minor adverse events (7/9 vs. 0/32, p<0.001). CONCLUSIONS: Paraphimosis reduction using TA was safe and effective. Compared to PS, TA was associated with a reduced ED LOS and fewer adverse events. TA could potentially allow more timely reduction with improved patient experience and resource utilization.

Invasive Reduction of Paraphimosis in an Adolescent Male While in a Deployed Austere Environment.

Paraphimosis is a urologic emergency resulting in tissue necrosis and partial amputation, if not reduced. Paraphimosis occurs when the foreskin of the uncircumcised or partially circumcised male is retracted behind the glans penis, develops venous and lymphatic congestion, and cannot be returned to its normal position. Invasive reduction of paraphimosis requires minimal instruments and can be accomplished by experienced providers. This case describes a 10-year-old local national with paraphimosis over 10 days that required invasive reduction in a deployed austere environment in Africa.

Urologic Emergencies.

The diagnosis and management of urologic emergencies are incorporated into the basic training of all urology residents. In institutions without access to urologic services, it is usually left to the General Surgeon or Emergency Medicine physician to provide timely care. This article discusses diagnoses that are important to recognize and treatment that is practically meaningful for the non-Urologist to identify and treat. The non-Urology provider, after reading this article, will have a better understanding and a higher comfort level with treating patients with urologic emergencies.