Unusual complication of male urethral catheterization: intussusception of prepuce into urethral meatus

We present a patient who experienced urinary retention with a comorbid phimosis and redundant prepuce, most likely complications of diabetes mellitus. Additionally, we report a rare complication of difficult catheterization, where the prepuce intussuscepted into the urethral meatus. Attempts to change the catheter with poor visualization of the external meatus secondary to diabetic phimosis resulted in telescoping of the prepuce into the urethra. Circumcision and meatotomy of the external meatus alleviated the acute issue and prevented potential problems with future catheterizations.     

两种包皮去除环在小儿包皮环切术中的应用体会

目的比较两种包皮去除环在小儿包皮环切术中的应用效果。方法回顾性分析425例患儿行圣环切除（A组）,445例患儿行CBV钟式包皮去除环切除（B组）的临床资料;对比两组患儿手术时间、术中术后出血量、术后并发症情况。结果两组患儿术中及术后出血量无统计学差异（P〉0.05）,B组在包皮环脱落时间、术后感染率、术后疼痛情况等方面优于A组（P〈0.05）,但其手术时间长于A组（P〈0.05）。结论在小儿包皮去除环中,CBV包皮去除环效果优于圣环,值得临床推广。     

Anterior Capsular Phimosis Occluding the Capsulorhexis Opening after Cataract Surgery in a Diabetic Patient with High Hemoglobin A1C

ABSTRACT

Purpose: To report a case of complete occlusion of the capsulorhexis opening in a DM patient with high hemoglobin A1C level. Methods: A 77-year-old woman with non-insulin-dependent diabetes underwent uncomplicated phacoemulsification in both eyes. One year later, she presented again because of reduced vision (best-corrected visual acuity of 16/20 in the right eye, 6/20 in the left eye). Dilated examination revealed marked anterior capsular contraction in the right eye and anterior capsular phimosis totally occluding the capsulorhexis opening in the left eye. Results: The severity of diabetic retinopathy and her fasting blood sugar (225?mg/dl) and hemoglobin A1C level (8.5%) increased during the previous year. Uncorrected visual acuity of 18/20 (OS) was achieved after a neodymium:YAG (Nd:YAG) radial anterior capsulotomy was performed. Conclusion: Microvascular complications such as diabetic retinopathy or diabetic iritis can occur in patient with uncontrolled diabetes mellitus. The pathophysiology of anterior capsular phimosis in this patient is probably increased vascular permeability chronically associated with diabetes.     

圣环包皮环切术与传统环切术、袖套状环切术临床疗效对比观察

目的比较圣环包皮环切术、袖套状包皮环切术及传统包皮环切术治疗包皮过长及包茎的临床疗效。方法对298例包皮过长及包茎患者分别行传统包皮环切术(剪刀法)86例(传统组)、袖套状包皮环切术82例(袖套组)、圣环包皮环切术130例(圣环组)。对比分析3组手术时间、术中出血量、术后疼痛持续时间、术后并发症、患者手术前后国际勃起功能评分-5(international index of erectile function,IIEF-5)和勃起功能障碍患者及性伴侣治疗满意度(treatment satisfaction scale,TSS)评分。结果传统组术后疼痛时间[(47.62±13.05)h]显著大于其他2组,术后切口感染率(6.9%)、血肿发生率(15.1%)和包皮畸形发生率(8.1%)显著高于其他2组(P<0.05),术后IIEF-5评分显著降低(P<0.05)而TSS评分无显著变化(P>0.05);袖套组手术时间[(44.21±10.55)min]和术中出血量[(11.02±2.44)ml]显著高于其他2组(P<0.05),术后TSS评分显著提高(P<0.05)而IIEF-5评分无显著变化(P>0.05);圣环组手术时间[(4.37±1.33)min]和术中出血量[(0.79±0.20)ml]显著低于其他2组(P<0.05)、术后阴茎水肿发生率(44.6%)显著高于其他2组(P<0.05),手术后TSS评分显著提高(P<0.05)而IIEF-5评分无显著变化(P>0.05)。结论圣环包皮术操作简单、快捷、安全,较传统术式和袖套状术式临床疗效佳。     

Conservative treatment of childhood phimosis with topical conjugated equine estrogen ointment

PURPOSE: To assess the application of topical conjugated equine estrogen for the treatment of boys with phimosis. METHODS: Fifteen boys with phimosis were included in the study. Conjugated equine estrogen (Premarin) 0.1% ointment was applied on the prepuce once daily. The treatment was continued until the prepuce was fully retractable. The patient was examined each second week up to a maximum treatment of 8 weeks. Retractability and the appearance of the foreskin were graded before and after treatment. RESULTS: Thirteen of 15 boys (87%) referred with phimosis were successfully treated with conjugated equine estrogen ointment. An adverse effect of gynecomastia was seen in one boy (7%). CONCLUSION: Conjugated equine estrogen ointment application for phimosis may be an alternative to surgery.     

Primary Malignant Melanoma of the Penis

A 50-year-old man had a primary malignant melanoma of the penis associated with granuloma telangiectaticum in the pigmented lesion. The patient had an operation for phimosis at the age of 20 and after the operation, he noticed a pigmented lesion at the operation site. We examined the literature and found 16 cases of primary malignant melanoma of the penis in Japan.     

Phimosis: Is circumcision necessary?

Abstract: Circumcision has been the traditional treatment for phimosis, but now is not the only management option, the best of which appears to be topical steroid application. Importantly, the literature suggests that phimosis probably is over-diagnosed, indicating that a prospective, randomized controlled study is needed to compare the non-circumcision options. Such a study would require consensus on the diagnostic criteria for phimosis; therefore, a more exacting definition would be needed and is suggested. Despite the non-controlled data on medical treatment of true phimosis, there seems little doubt that surgical intervention is not needed for all male infants with adherence of the foreskin to the glans, a non-retractable foreskin or, indeed, true phimosis.     

社区儿童包茎及并发包皮龟头炎相关因素分析

目的：分析社区儿童包茎及并发包皮龟头炎患病的相关因素。方法：回顾分析2013年11月—2014年11月在儿保门诊系统管理的男性儿童410人的资料。结果：410人男性儿童中1岁体检时患有包茎且并发包皮龟头炎273人,无包茎的137人。照看儿童人的年龄与儿童包茎及并发包皮龟头炎患病率有关,纸尿裤使用情况与儿童包茎及并发包皮龟头炎患病率有关,生殖器清洁护理情况与儿童包茎及并发包皮龟头炎患病率有关,无尿布疹儿童患包茎及并发包皮龟头炎患病率低。结论：应对照看儿童的家长加强健康教育,对儿童要进行科学的护理,降低儿童包茎及并发包皮龟头炎的发病率。