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1.
Childs Nerv Syst ; 40(1): 19-25, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37857859

RESUMO

OBJECTIVE: The incidence of scrotal migration of a ventriculoperitoneal shunt (VPS) catheter is rare and may lead to life-threatening visceral complications. Management requires prompt removal of the migrated portion of the shunt and closure of the scrotal sac. We report an interesting case of a young child who presented with asymptomatic unilateral swelling of his scrotum secondary to a migrated VPS catheter. A repeat X-ray prior to his surgery to remove the migrated catheter showed that the entire length of the distal VPS catheter was back in the peritoneal cavity. In view of this unusual phenomenon, the case is discussed in corroboration with published literature. METHODS AND RESULTS: A systematic search of publications in the English language is performed in PubMed and Google Scholar. Our findings show that there are 49 reported cases (including our patient) of scrotal migration of shunt catheters in patients less than 18 years old. There is only 1 other case of spontaneous resolution of shunt catheter from the scrotum. Favoured management of choice is repositioning the distal shunt catheter back into the peritoneal cavity and herniotomy in the same setting, if possible. Overall, the literature suggests this is a shunt-related complication that has a good prognosis if intervention is timely. CONCLUSION: Scrotal migration of a VPS catheter is a rare but potentially life-threatening complication in children. Our case report highlights the role of updated preoperative imaging and the need for consistent long-term shunt surveillance in children.


Assuntos
Migração de Corpo Estranho , Hidrocefalia , Masculino , Criança , Humanos , Adolescente , Escroto/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Peritônio , Remissão Espontânea , Hidrocefalia/cirurgia , Catéteres/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/cirurgia
2.
Urol Int ; 108(3): 264-271, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38368870

RESUMO

INTRODUCTION: Extramammary Paget's disease of the scrotum and penis is a relatively rare cutaneous malignant tumor. At present, its pathogenesis, and clinical and pathological characteristics are not very clear. This is controversial regarding surgical margin width to decrease the high recurrence rate. This paper aimed to report the case and review the literature of extramammary Paget's disease of scrotum and penis. CASE PRESENTATION: We presented the case of a 74-year-old male patient with the patchy erythema and pruritus in the perineum who was admitted to our department. Biopsy of the large plaque revealed Paget disease. Under the condition of ensuring negative surgical margins by rapid frozen pathology, a wide local excision of the lesion, bilateral orchiectomy, and adnexectomy were performed on the patient. Pathology revealed that many scattered vacuolated Paget cells were observed in the epidermal layer, and the diagnosis was Paget's disease of the scrotum and penis. The 2 cm outside the skin lesion was used as the initial surgical margin, and free skin flap transplantation was used to repair the surgical wound. The patient recovered well and was discharged 1 week after surgery. CONCLUSION: Currently, histopathologic biopsy is the most important diagnostic method for EMPD. Once confirmed, for patients eligible for surgical intervention, wide local excision of the lesion and rapid intraoperative frozen pathological examination should be performed as soon as possible. The skin flap transplantation is the first choice for the repair of large-scale wound after surgery.


Assuntos
Doença de Paget Extramamária , Neoplasias Penianas , Escroto , Humanos , Masculino , Doença de Paget Extramamária/cirurgia , Doença de Paget Extramamária/patologia , Doença de Paget Extramamária/diagnóstico , Escroto/patologia , Escroto/cirurgia , Idoso , Neoplasias Penianas/cirurgia , Neoplasias Penianas/patologia , Neoplasias dos Genitais Masculinos/cirurgia , Neoplasias dos Genitais Masculinos/patologia , Neoplasias dos Genitais Masculinos/diagnóstico , Biópsia , Resultado do Tratamento
3.
Urol Int ; 108(3): 259-263, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38290475

RESUMO

INTRODUCTION: Schwannomas originate from the peripheral nerve sheaths and are mainly detected in the head, neck, or extremities. They are rarely encountered in the penoscrotal region. CASE PRESENTATION: Herein, we present a case of a penoscrotal schwannoma diagnosed and successfully treated in our center. A 40-year-old patient with a history of resection of a dorsal penile schwannoma presented with multiple nodular lesions at the scrotum, penile shaft, and radix, which were first noticed 5 years before his current presentation. He complained about penile pain and dyspareunia. Magnetic resonance imaging was performed for preoperative diagnosis. All nodular lesions were resected while preserving the neurovascular structures. The histopathological examination revealed benign lesions. The patient's complaints were resolved, and there was no recurrence during the 1-year follow-up. CONCLUSION: The primary treatment is surgical excision. The patients need close follow-up regarding the risks of recurrence and malignant transformation.


Assuntos
Neurilemoma , Neoplasias Penianas , Escroto , Humanos , Neurilemoma/cirurgia , Neurilemoma/patologia , Neurilemoma/diagnóstico por imagem , Masculino , Adulto , Escroto/cirurgia , Escroto/patologia , Neoplasias Penianas/cirurgia , Neoplasias Penianas/patologia , Neoplasias dos Genitais Masculinos/cirurgia , Neoplasias dos Genitais Masculinos/patologia , Neoplasias dos Genitais Masculinos/diagnóstico , Imageamento por Ressonância Magnética , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Primárias Múltiplas/patologia , Resultado do Tratamento
4.
Int J Urol ; 31(8): 886-890, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38666362

RESUMO

OBJECTIVES: To describe a new penoscrotal reconfiguration technique, named "V-I penoscrotal reconfiguration" for the surgical reconstruction of a congenital webbed penis (CWP). METHODS: Twenty-one patients who underwent the "V-I penoscrotal reconfiguration technique" were included in this retrospective study. The CWP severity was assessed according to El-Koutby's classification. Demographic and clinical data, surgical data, and postoperative outcomes were scheduled and analyzed. Specifically, the postoperative follow-up included both physical and psychological assessments at 2 weeks, 1, 6, and 12 months after surgery. Parents' satisfaction degree was quantified by the Likert scale. RESULTS: CWP was grade 3 in 11 (52%) patients, 2 in five (24%), and 1 (24%) in five. Five (24%) CWP were isolated malformations, 11 (52%) were associated with phimosis, three (14%) with hypospadias, and two (10%) with hypospadias and phimosis. There were no postoperative complications and no cases of redo surgery. The cosmetic outcomes were excellent in all cases: the parents' satisfaction score was 4 in 17 (81%) cases and 3 (9%) in the other four cases. CONCLUSIONS: CWP may cause psychological distress and functional problems, especially during sexual intercourse. Its correction in childhood is advocated to prevent psychological and sexual issues. The "V-I reconfiguration technique" is simple, and easy with excellent cosmetic and functional outcomes.


Assuntos
Satisfação do Paciente , Pênis , Procedimentos de Cirurgia Plástica , Escroto , Procedimentos Cirúrgicos Urológicos Masculinos , Humanos , Masculino , Estudos Retrospectivos , Pênis/cirurgia , Pênis/anormalidades , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Escroto/cirurgia , Escroto/anormalidades , Pré-Escolar , Procedimentos de Cirurgia Plástica/métodos , Criança , Resultado do Tratamento , Lactente , Hipospadia/cirurgia , Hipospadia/psicologia , Seguimentos , Adolescente
5.
Pediatr Surg Int ; 40(1): 139, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38806810

RESUMO

PURPOSE: This study aimed to investigate the rate of re-ascent requiring re-operation after primary orchidopexy and to investigate eventual differences between the inguinal and scrotal approach as well as other potential predictors for re-ascent. METHODS: A retrospective cohort study of children treated for undescended testis (UDT) with orchidopexy between 2018 and 2022 was conducted. The primary outcome was re-ascent requiring re-operation, and the secondary outcome was atrophy rate. Independent variables were age, underlying conditions, side, surgical approach, operation time, bilaterality, congenital/ascended UDT, presence of scrotal hypoplasia, presence of a patent processus vaginalis, division of external oblique, and suture of the testis. Univariate and logistic regression were used to evaluate differences between groups and risk for re-ascent. RESULTS: A total of 662 testes in 554 patients were included. Re-operation occurred in 6% (7% with inguinal approach, 3% with scrotal approach, p = 0.04). Re-operation was associated with younger age, congenital UDT, and inguinal approach, but neither of these variables remained significant in multivariate analyses. Atrophy occurred in one testis. CONCLUSION: The rate of re-ascent was 6% and the atrophy rate was 0.15%. A larger study may find predictors for re-ascent but with very low absolute risk. The lower rate of re-ascent with the scrotal approach is probably due to selection bias.


Assuntos
Criptorquidismo , Orquidopexia , Reoperação , Humanos , Masculino , Criptorquidismo/cirurgia , Orquidopexia/métodos , Estudos Retrospectivos , Reoperação/estatística & dados numéricos , Lactente , Pré-Escolar , Criança , Testículo/cirurgia , Testículo/anormalidades , Resultado do Tratamento , Escroto/cirurgia
6.
Beijing Da Xue Xue Bao Yi Xue Ban ; 56(4): 741-744, 2024 Aug 18.
Artigo em Zh | MEDLINE | ID: mdl-39041574

RESUMO

The mesothelium, which consists of a monolayer of mesothelial cells, extends over the surface of the serosal cavities (pleura, pericardium, peritoneum and tunica vaginalis). Mesothelial tumours of the tunica vaginalis is rare compared with those arise from pleura or peritoneum. According to World Health Organization 2022 Classification of Urinary and Male Genital Tumours (5th edition), mesothelial tumours of the tunica vaginalis were categorized into adenomatoid tumour, well-differentiated papillary mesothelial tumour (WDPMT) and mesothelioma. Since WDPMT of tunica vaginalis was rare, there was no consensus concerning the treatment of it. In this case report, a 29-year-old man who had endured intermittent right scrotal pain for 8 months, aggravating scrotal pain for 2 weeks was admitted. No symptoms, such as frequent, urgent, or painful urination were shown. Physical examination revealed the enlargement and tenderness of right scrotum, with no signs of lifting pain. The most recent scrotal ultrasonography before surgery revealed right hydrocele with maximum depth of 4 centimeters and poor blood flow of right testis. Under the circumstance of patient' s chronic history of testicular hydrocele, he underwent an emergency operation of right scrotal exploration and hydrocelectomy under epidural anesthesia. After opening the vagina tunic cavity, spot-like bleeding was observed on the right testicle, epididymis and vaginalis surface. The vaginalis was obviously thickened and the inner and outer walls were smooth. The post-operative histopathology revealed a grayish-brown tissue with a thickness of 0.3-0.5 cm, smooth inner and outer walls, and a suspected WDPMT with a diameter of 1. 5 cm. Immunohistochemical staining showed positive for Calretinin, BAP1, WT-1, CK5/6, D2-40 and P16,which confirmed the diagnosis of WDPMT. To sum up, the purpose of this case report was to raise awareness of a rare disease WDPMT, which was usually asymptomatic and could be diagnosed by pathology and immunohistochemistry. The disease should be differentiated from testicular torsion, epididymitis, orchitis and oblique inguinal hernia in symptoms, and from malignant mesothelioma and adenomatoid tumour in pathology. Because of the rarity of the cases, there was no unified standard for the treatment of WDPMT at present. The common treatment methods reported in literature included orchidectomy and vaginectomy. Due to the lack of understanding of this disease, postoperative follow-up was still recommended for at least 5 years.


Assuntos
Neoplasias Testiculares , Humanos , Masculino , Adulto , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia , Neoplasias Testiculares/diagnóstico , Neoplasias Mesoteliais/patologia , Neoplasias Mesoteliais/diagnóstico , Escroto/patologia , Escroto/cirurgia , Hidrocele Testicular/cirurgia , Hidrocele Testicular/diagnóstico , Tumor Adenomatoide/patologia , Tumor Adenomatoide/cirurgia , Tumor Adenomatoide/diagnóstico
7.
Hinyokika Kiyo ; 70(5): 129-131, 2024 May.
Artigo em Japonês | MEDLINE | ID: mdl-38966923

RESUMO

The patient was a 71-year-old male whose chief complaint was a scrotum mass. The mass had gradually increased in size without any associated symptoms. The physical examination revealed a pedunculated, radish brown, and elastic soft tumor (4. 5×3. 5×3. 0 cm) in the right scrotum. Blood chemical analysis of HbA1c and squamous carcinoma antigen were 8. 3% and 38. 4 ng/ml (≦1. 5), respectively. This tumor was successfully treated with surgical resection. Histopathological examination showed condyloma acuminatum without malignant findings. Giant condyloma acuminatum commonly affects the genital and perianal areas. An immunocompromised state generally exists in the background of the patients.


Assuntos
Escroto , Humanos , Masculino , Idoso , Escroto/patologia , Escroto/cirurgia , Condiloma Acuminado/cirurgia , Condiloma Acuminado/patologia , Neoplasias dos Genitais Masculinos/patologia , Neoplasias dos Genitais Masculinos/cirurgia , Tumor de Buschke-Lowenstein/patologia , Tumor de Buschke-Lowenstein/cirurgia
8.
Hinyokika Kiyo ; 70(6): 185-188, 2024 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-38967032

RESUMO

A 70-year-old male came to our clinic with a high fever and left scrotal swelling. Following a diagnosis of left-side epididymitis, antibiotic treatment was started, though the swelling did not improve. Since an additional examination revealed an abscess in the left scrotum, scrotal incision and drainage were performed. Although the symptoms subsided, urine outflow from the incision was observed. The patient then noted that he had inserted a glass ball into the urethral meatus when he was about 30 years old. It was considered that an abscess and fistula had formed due to inflammation caused by the foreign body. Thus a transurethral surgical procedure was used for crushing and removal. The fistula disappeared within three months after the operation and the patient has not been affected by dysuria since that time. Symptoms may appear several years following insertion of a foreign body into the urethra. To the best of our knowledge, the present case is the longest term of indwelling, approximately 40 years, following insertion of a foreign body reported in Japan.


Assuntos
Abscesso , Corpos Estranhos , Escroto , Uretra , Humanos , Masculino , Idoso , Abscesso/cirurgia , Abscesso/diagnóstico por imagem , Escroto/cirurgia , Corpos Estranhos/cirurgia , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/complicações , Uretra/cirurgia , Uretra/lesões , Fístula Urinária/cirurgia , Fístula Urinária/diagnóstico por imagem , Doenças Uretrais/cirurgia , Doenças dos Genitais Masculinos/cirurgia , Doenças dos Genitais Masculinos/diagnóstico por imagem , Fatores de Tempo , Fístula/cirurgia , Fístula/etiologia
9.
Ann Chir Plast Esthet ; 69(4): 320-325, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38866679

RESUMO

INTRODUCTION: Fournier's gangrene, a rare infectious condition affecting the external genitalia, often requires aggressive medical-surgical interventions, resulting in variable scrotal tissue loss. Despite numerous proposed reconstruction techniques, achieving a consensus on the most effective approach that balances aesthetics and function remains elusive. This case report presents a one-year follow-up on scrotal reconstruction using a pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) propeller flap. CASE REPORT: A 56-year-old patient with significant scrotal tissue loss due to Fournier's gangrene underwent scrotal reconstruction using a pedicled SCIP propeller flap. Optimal placement was ensured through a subcutaneous tunnel, with a thin thigh skin graft applied to cover the penile skin defect. DISCUSSION: The SCIP flap is distinguished by its thin and pliable characteristics, rapid harvesting and featuring a discreet donor site. It stands as a compelling alternative to skin grafts, providing advantages in sensory restoration, color congruence, and resilience against tension. Considering the thickness of the reconstruction helps both in recovering testicular function and improving the appearance by restoring the natural contour. CONCLUSION: The utilization of the pedicled SCIP propeller flap for scrotal tissue loss resulting from Fournier's gangrene has demonstrated both aesthetic and functional success, underscoring its potential as an effective reconstructive option.


Assuntos
Gangrena de Fournier , Artéria Ilíaca , Retalho Perfurante , Escroto , Humanos , Masculino , Gangrena de Fournier/cirurgia , Escroto/cirurgia , Pessoa de Meia-Idade , Retalho Perfurante/irrigação sanguínea , Artéria Ilíaca/cirurgia , Procedimentos de Cirurgia Plástica/métodos
10.
Ann Chir Plast Esthet ; 69(3): 217-221, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-37429802

RESUMO

INTRODUCTION: Fournier's gangrene is a serious pathology with a high mortality rate. Treatment requires a large debridement of necrotized tissues, conducing to a skin loss, requiring a reconstruction, which may involve different surgical techniques, depending on the context as well as the size and location of the skin loss. The most common covering technique uses split-thickness skin grafting, which however presents a risk of contracture. CASE: Our 63 years old patient presented a Fournier's gangrene, leading to pubic and circular penile skin defects after multiple debridements. We decided to practice a right superficial circumflex iliac perforator (SCIP) pedicled flap to reconstruct the penile skin sheath. The flap was rotated 180 degrees and rolled around the penis. DISCUSSION: The inguinal pedicle flap is described for penile reconstruction, the SCIP flap for perineal reconstruction, and even bilateral SCIP flaps for performing phalloplasty, but SCIP pedicled flap is not already described for isolated penile skin sheath reconstruction. Skin loss in our patient was not extensive, permitting us to perform this surgical technique. To go further, note the possibility of carrying out this reconstruction by a super-thin SCIP flap, as a pure skin graft flap. CONCLUSION: The SCIP pedicled flap seems us to be a safe technique for penile skin reconstruction and a good alternative to the usual skin grafts, especially regarding the lower risk of contracture, and low donor-site morbidity.


Assuntos
Contratura , Gangrena de Fournier , Retalho Perfurante , Masculino , Humanos , Pessoa de Meia-Idade , Gangrena de Fournier/cirurgia , Gangrena de Fournier/patologia , Escroto/cirurgia , Retalho Perfurante/transplante , Pênis/cirurgia , Contratura/patologia , Artéria Ilíaca/cirurgia
11.
Ann Chir Plast Esthet ; 69(1): 92-96, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37045654

RESUMO

Penoscrotal elephantiasis (PSE) is defined as an increase, sometimes considerable, in the volume of the external genitalia, which will be responsible for an unsightly appearance, a sexological impact and a psychological harm. The cause may be primary or secondary to a parasitic disease (filarsiosis) or to intrinsic or extrinsic lymphatic obstruction. The diagnosis is essentially clinical, with penoscrotal involvement being the most frequent. The etiological research implies the realization of certain complementary examinations according to the circumstances. Surgical treatment ideally consists of excising the mass. followed by reconstruction using grafts or local flaps of healthy skin, which is an important way of restoring comfort to the patient. We report two cases of penoscrotal elephantiasis treated surgically with good functional and aesthetic results. We update, through our own experience, aspects of the diagnostic and therapeutic care of penoscrotal elephantiasis.


Assuntos
Elefantíase , Doenças dos Genitais Masculinos , Masculino , Humanos , Elefantíase/diagnóstico , Elefantíase/etiologia , Elefantíase/cirurgia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/cirurgia , Doenças dos Genitais Masculinos/complicações , Escroto/cirurgia , Retalhos Cirúrgicos , Genitália
12.
BMC Urol ; 23(1): 84, 2023 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-37149558

RESUMO

BACKGROUND: The purpose of this study was to investigate the clinical effect of laparoscopic assisted trans-scrotal orchiopexy versus traditional orchiopexy for inguinal cryptorchidism. METHODS: A retrospective analysis of cryptorchidism patients who were admitted to our hospital from July 2018 to July 2021. The patients were divided into the laparoscopic assisted trans-scrotal surgery group (n = 76) and the traditional surgery group (n = 78) according to the surgical method. RESULTS: All patients were successfully operated. There was no significant difference in operation time between the laparoscopic assisted trans-scrotal group and the traditional group (P>0.05). Although there was no significant difference in the postoperative hospital stay between the two groups, the time of postoperative hospital stay of the laparoscopic assisted trans-scrotal surgery group was lower than that in the traditional surgery group (P = 0.062). Additionally, there was no significant difference in discharge rate on the first day after surgery between the two groups, but the discharge rate on the first day after surgery was more than 90% in both groups. In terms of postoperative complications, there were no cases of testicular retraction, testicular atrophy, inguinal hernia, or hydrocele that occurred in both groups. There was no significant difference in the incidence of scrotal hematoma between the two groups(P>0.05). Although there was no significant difference in the incidence of poor wound healing between the two groups(P>0.05), the incidence in the laparoscopic assisted trans-scrotal surgery group was lower than that in the traditional surgery group (2.6% vs. 6.4%). CONCLUSION: Laparoscopic assisted trans-scrotal surgery is as safe and effective method as traditional surgery for patients with inguinal cryptorchidism, and could also provide a good appearance.


Assuntos
Criptorquidismo , Laparoscopia , Masculino , Humanos , Lactente , Criptorquidismo/cirurgia , Orquidopexia/métodos , Estudos Retrospectivos , Escroto/cirurgia , Resultado do Tratamento
13.
World J Surg Oncol ; 21(1): 226, 2023 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-37495989

RESUMO

Hemolymphangioma is an uncommon benign tumor type that commonly occurs in the head and neck. Primary spermatic cord hemolymphangioma (SCH) with only several reported, however, is extremely rare. Clinical diagnosis can be challenging because of its rarity. Although spermatic cord hemolymphangiomas are benign tumors, there is still a high recurrence rate in postoperative. A 15-year-old boy presented to our hospital with complaints of scrotal for 15 days and did not have other associated symptoms. The male genital color Doppler ultrasound revealed that a cystic echo in the left spermatic cord region and above the testes was about 32 mm × 20 mm × 14 mm. He underwent left en bloc scrotum tumor resection under general anesthesia, and pathologic examination showed SCH. He was discharged from the hospital in the second postoperative day. After 1-month follow-up, the patient recovered well without recurrence. The patient is currently in follow-up phase. Up to date, only a few cases have been reported in the literature about SCH. So, we hope to raise the awareness of the diagnosis of SCH in clinical practice although this case.


Assuntos
Neoplasias dos Genitais Masculinos , Hemangioma , Neoplasias Cutâneas , Cordão Espermático , Humanos , Masculino , Criança , Adolescente , Escroto/diagnóstico por imagem , Escroto/cirurgia , Escroto/patologia , Cordão Espermático/cirurgia , Cordão Espermático/patologia , Neoplasias dos Genitais Masculinos/cirurgia , Neoplasias dos Genitais Masculinos/diagnóstico , Neoplasias dos Genitais Masculinos/patologia , Neoplasias Cutâneas/patologia , Hemangioma/patologia
14.
Urol Int ; 107(5): 539-542, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37015202

RESUMO

Ectopic scrotum is an infrequent congenital scrotal anomaly. Different surgical methods of correcting ectopic scrotum have been used, but none have produced optimal cosmetic results for all types. We describe a case of left ectopic suprainguinal scrotum in a 14-month-old boy who had an undescended left testicle and a left-sided scrotal skin tag. Single-stage rotational flap scrotoplasty and unilateral orchiopexy were performed; however, we modified the surgical technique of scrotal rotation by excising the intervening longitudinal skin. Eight months after surgery, the repositioned scrotum had a better appearance, and the affected testicle was similar in size to the contralateral one. In comparison with other surgical methods, pedicle flap rotation of the ectopic scrotal skin with excision of the intervening longitudinal skin may produce a better cosmetic outcome.


Assuntos
Criptorquidismo , Procedimentos de Cirurgia Plástica , Masculino , Humanos , Lactente , Escroto/cirurgia , Escroto/anormalidades , Retalhos Cirúrgicos , Criptorquidismo/cirurgia
15.
Microsurgery ; 43(4): 316-324, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36420576

RESUMO

BACKGROUND: Reconstruction of penoscrotal defects resulted from margin-controlled excision of extramammary Paget's disease (EMPD) remains challenging, due to its unpredictably varying extents. The present study aimed to investigate outcomes of reconstruction of penoscrotal defects following radical excision of EMPD and to introduce a simplified algorithm for selecting reconstruction strategies. METHODS: Patients with penoscrotal EMPD who were treated with wide excision and subsequent reconstruction from 2009 to 2020 were reviewed. Their demographics, operation-related characteristics, and postoperative outcomes were evaluated. RESULTS: In total, 46 patients with a mean age of 64.9 years (range, 44-85 years) were analyzed. An average size of defects was 129.6 cm2 (range, 8-900 cm2 ). The most frequently involving anatomical subunit was scrotum, followed by suprapubic area and penile shaft. Twenty-six patients had defects spanning multiple subunits. The most commonly used reconstruction methods for each anatomical subunit were internal pudendal artery perforator (IPAP) flaps and/or scrotal flaps for scrotal defects, superficial external pudendal artery perforator (SEPAP) flaps for suprapubic defects, and skin grafts for penile defects. In all but four cases, successful reconstruction was achieved with combination of those reconstruction options. No major complications developed except for one case of marginal flap necrosis. All patients were satisfied with their aesthetic and functional results. CONCLUSIONS: Diverse penoscrotal defects following excision of EMPD could be solidly reconstructed with combination of several loco-regional options. A simplified algorithm using in combination of IPAP flap, SEPAP flap, scrotal flap, and skin graft may enable efficient and reliable reconstruction of penoscrotal EMPD defects.


Assuntos
Doença de Paget Extramamária , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Doença de Paget Extramamária/cirurgia , Escroto/cirurgia , Pênis/cirurgia , Retalho Perfurante/cirurgia
16.
J Pak Med Assoc ; 73(10): 2086-2088, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37876077

RESUMO

Idiopathic scrotal calcinosis is formation of calcium deposits in the dermal layers of the scrotum. It results in the formation of single or multiple nodular calcifications that vary in size and number. First reported in 1883, this condition is common in the third decade of life. The presenting complaints range from disfigurement to itching, leading to decreased quality of life. The diagnosis is usually made on a clinical basis and can be confirmed by the histopathology of the excised nodules. Surgical removal of the nodules is the generally recommended treatment. The surgery aims to eradicate the nodules leaving the scrotal skin enough for scrotoplasty. We present a case of idiopathic scrotal calcinosis in a 37 years old male who came for radiological examination.


Assuntos
Calcinose , Doenças dos Genitais Masculinos , Humanos , Masculino , Adulto , Doenças dos Genitais Masculinos/diagnóstico por imagem , Doenças dos Genitais Masculinos/cirurgia , Qualidade de Vida , Escroto/diagnóstico por imagem , Escroto/cirurgia , Escroto/patologia , Prurido , Calcinose/diagnóstico por imagem , Calcinose/cirurgia
17.
Medicina (Kaunas) ; 59(11)2023 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-38004047

RESUMO

Penile augmentation using filler injections is gaining popularity; however, complications such as foreign body reactions can arise, leading to issues like penile ulceration and necrosis, subsequently necessitating reconstruction. The existing method of the reconstruction of the penis is primarily aimed at filling the deficit. In this paper, we describe a case in which a scrotal flap and autologous augmentation were utilized to treat a soft tissue defect caused by a delayed infection following a penile filler injection. The patient, a 41-year-old male, had received an Aquafilling® (Biomedica, Prague, Czech Republic) filler injection seven years earlier and later developed a delayed infection. After debridement, the penile defect spanned the entire shaft, and the circumference of the flaccid penis was 7.5 cm. Using a bilateral scrotal flap technique, the lower margins of both flaps were rolled inward after de-epithelialization to achieve autologous augmentation. Over the three-month post-surgery follow-up, neither infections nor flap necrosis were observed. The penile circumference increased to 12 cm, and the patient reported high satisfaction with the outcome. This new surgical technique can be widely applied as treatment for a variety of penile defects.


Assuntos
Procedimentos de Cirurgia Plástica , Masculino , Humanos , Adulto , Retalhos Cirúrgicos/cirurgia , Pênis/cirurgia , Escroto/cirurgia , Necrose/etiologia , Necrose/cirurgia
18.
Folia Med Cracov ; 63(4): 49-55, 2023 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-38578344

RESUMO

Epididymal cysts are benign cystic formations of the epididymis that usually appear in adolescence or early adulthood. Their frequency doubles after the age of 14-15. Obstruction in the epididymal efferent ductules with subsequent prostenotic dilatation of them, as well as dysgenesis due to hormonal disorders during fetal or postnatal life, are possible. At the 1st Department of Pediatric Surgery of A.U.Th. we treated 11 cases of boys at the age of 11-16 who presented with acute scrotum because of an epididymal cyst. The diagnosis was confirmed by ultrasound scanning . Due to persistent symptomatology, patients underwent surgical exploration and removal of the cyst. The postoperative care of the patients was uncomplicated with immediate remission of symptoms. In one case, ipsilateral acute epididymitis occurred after 10 days, which was successfully treated with antibiotic therapy. It is reported that approximately 50% of epididymal cysts involute within an average of 17 months. In conclusion, using the data obtained from the review, of the small in number of international bibliography studies, it is proposed conservative treatment of asymptomatic cysts with diameter smaller than 1 cm and surgical excision [1] of large asymptomatic cysts with diameter greater than 1 cm, which do not regress after a follow-up of 24-48 months, cysts, regardless of their diameter, responsible for persistent symptoms and in the manifestation of acute scrotal symptoms due to inflammation, intravesical bleeding or secondarily torsion of the epididymis.


Assuntos
Cistos , Espermatocele , Masculino , Criança , Adolescente , Humanos , Adulto , Espermatocele/cirurgia , Epididimo/diagnóstico por imagem , Epididimo/cirurgia , Cistos/cirurgia , Escroto/cirurgia , Escroto/diagnóstico por imagem , Ultrassonografia
19.
Urologiia ; (2): 107-110, 2023 May.
Artigo em Russo | MEDLINE | ID: mdl-37401713

RESUMO

INTRODUCTION: Lymphangioma (lymphatic malformation) is a congenital malformation of lymphatic vessels. According to the classification of the International Society for the Study of the Vascular Anomalies, there are macrocystic, microcystic and mixed types of lymphatic malformations. The typical location of the lymphangiomas is the area of large lymphatic collectors (head, neck, axillary areas), while the scrotum is not frequently affected. AIM: To present a rare clinical case of lymphatic malformation of the scrotum with successful minimally invasive treatment (sclerotherapy). MATERIALS AND METHODS: A clinical observation of a 12-year-old child with a diagnosis of "Lymphatic malformation of the scrotum" is presented. From the age of 4, there was a large lesion in the left half of the scrotum. In other clinic, a surgical removal with a diagnosis of "left-sided inguinal hernia", "spermatic cord hydrocele", "isolated left-sided hydrocele" was performed. However, there was a recurrence after the procedure. When contacting the Clinic of pediatrics and pediatric surgery, scrotal lymphangioma was suspected. The diagnosis was confirmed by magnetic resonance imaging. The patient underwent minimally invasive sclerotherapy using the drug "Haemoblock". After 6 months of follow-up, no relapse was seen. CONCLUSION: Lymphangioma (lymphatic malformation) of the scrotum is a rare urological pathology that requires specific diagnosis, in-depth differential diagnosis and treatment by a multidisciplinary team of doctors, including a specialist in the treatment of vascular pathology.


Assuntos
Linfangioma , Anormalidades Linfáticas , Masculino , Criança , Humanos , Escroto/diagnóstico por imagem , Escroto/cirurgia , Linfangioma/diagnóstico por imagem , Linfangioma/cirurgia , Anormalidades Linfáticas/diagnóstico , Anormalidades Linfáticas/patologia , Anormalidades Linfáticas/terapia , Escleroterapia/métodos , Diagnóstico Diferencial , Resultado do Tratamento
20.
J Urol ; 208(1): 171-178, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35164523

RESUMO

PURPOSE: We introduce a new modified penile skin reconstruction technique to treat paraffin-induced sclerosing lipogranuloma of the penis. MATERIALS AND METHODS: From 2017 to 2020, 49 patients underwent the procedure. Complete removal of the lipogranuloma-involved penile skin was performed. A subcutaneous tunnel was then created between a horizontal scrotal incision and a proximal penile circumferential incision. The denuded penis was pulled through the tunnel, and a subcoronal and longitudinal dorsal penile suture line was made. An inverted V-shaped incision was made on the scrotum on the ventral side of the penis, followed by longitudinal closure. Outcomes and complications of the procedure were retrospectively studied. The long-term effect of surgery on sexual function and overall satisfaction was measured using a patient-reported questionnaire, which was completed by 30 patients. RESULTS: The overall complication rate was 26.5%. Clavien-Dindo grade 1, 2, 3a, 3b, 4 and 5 complications occurred in the postoperative period 5, 0, 8, 1, 0 and 0 times, respectively, in 13 patients. Surgery was successful in 27 (90%) patients according to the patient-reported questionnaire. Erectile dysfunction, pain/tension during erection, premature ejaculation and penile lymphedema were observed in 2, 3, 1 and 1 patients, respectively. All patients reported sexual intercourse ability. CONCLUSIONS: The type of penile skin reconstruction after the removal of sclerosing lipogranuloma of the penis is controversial. The reconstruction technique presented herein is an effective single-stage treatment option with a high success rate in patients with sclerosing lipogranuloma of the penis with intact scrotal skin.


Assuntos
Procedimentos de Cirurgia Plástica , Escroto , Humanos , Masculino , Parafina/efeitos adversos , Pênis/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Escroto/cirurgia
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