A rare complication after circumcision: Keloid of the penis

Keloids are benign hyperproliferative growths of dermal collagen that usually result from excessive tissue response to skin trauma. Although benign, they may be seen as a painful and/or pruritic lesions. A 15-year-young boy was admitted to our clinic with an enlarged scar and pain on the penis for about 1 year after a routine circumcision operation. Complete surgical resection of the lesion was done and histopathological examination revealed keloid of the penis. An erratum to this article can be found at     

阴囊皮瓣转移修复阴茎皮肤缺损

目的探讨一种操作简便而有效地修复阴茎皮肤缺损的手术方法.方法自1995年1月以来,应用阴囊皮瓣转移修复阴茎皮肤感染坏死所致皮肤缺损8例.其中6例为阴茎全周皮肤缺损,2例为2/3周皮肤缺损.手术切除创面肉芽组织,显露正常的阴茎海绵体或尿道海绵体筋膜,使阴茎充分伸展,设计、解剖、形成阴囊皮瓣,旋转转移至阴茎皮肤缺损区,边缘缝合固定.对阴囊皮肤缺损较大者,同期应用股内侧局部皮瓣转移修复阴囊皮肤缺损.结果本组8例手术全部成功,术后3～12个月随访,阴茎外形良好,生理功能恢复正常.结论阴囊皮瓣转移是一种较好的修复阴茎皮肤缺损的手术方法,具有操作简便、手术Ⅰ期完成、术后阴茎外形和生理功能恢复均佳的优点,值得推广应用.     

糖尿病和健康大鼠阴茎细胞凋亡的研究

目的 比较糖尿病和健康大鼠阴茎细胞调亡。方法 16只wister大鼠作为实验组,10只健康同期wister大鼠作对照组。注射链脲佐菌素(STZ,65mg/kg),建立糖尿病模型。8周后处死大鼠,测糖化血红蛋白(HBALC)并取阴茎。用流式细胞仪分析阴茎细胞凋亡。结果 流式细胞分析糖尿病组wister大鼠出现凋亡峰,同对照相比,二者有显著性差异(p<0.05)。结论 糖尿病大鼠阴茎细胞凋亡率显著高于正常健康大鼠阴茎细胞。     

阴茎离断再植成功一例报告并文献复习

报告一例阴茎离断病例，应用显微技术再植再功并复习文献，对阴茎离断的处理方法及术后并发症等进行讨论，认为成功的血管神经显微吻合是提高成活率，降低术后并发症的关键。     

Anomalies of the penis

Anomalies of the penis occur with regularity and cause much anxiety for parents of affected children. If left untreated, these problems may not only result in long-term physical sequelae, but also in poor psychosocial adjustment. This article describes the more commonly seen anomalies of the penis and their evaluation and treatment.     

成人阴茎的三维数字化图像分析

目的对成人阴茎进行三维数字化图像分析,为阴茎整形修复获得手术前后形变参数及手术方案的选择,提供精确的形态学数据。方法采用Angel数字快速测量诊断系统,分别测量200例正常成人阴茎安静状态和勃起时的长度、周长、以及勃起时角度与阴茎长度、周径的关系。结果随着年龄和身高增长,阴茎也随之增长;身高与阴茎长度不成正比;阴茎勃起时随着角度的增加硬度增强,但勃起硬度变化时阴茎体积无明显变化。结论从不同径线不同角度对阴茎进行计算机三维测量分析,为阴茎整形修复术前设计、术后效果评价提供重要的量化指标。     

Automutilation of the penis performed by the kitchen's knife

Automutilation of the penis performed by the kitchen's knife is described. Surgical techniques, the most important goals of therapy as well as psychiatric aspects of the automutilation are discussed.     

五种不同阴茎再造术应用体会

为进一步提高阴茎再造术的成活率和获得最佳外形效果 ,总结 12年采用 5种不同手术方法进行 2 0例阴茎再造的经验。下腹与大腿组合皮瓣法、脐旁皮瓣法、阴股沟皮瓣及前臂皮瓣法 ,均获得 10 0 %成活 ,下腹部皮瓣法仅 33.3%成活。认为阴茎全缺损者以脐旁皮瓣及阴股沟皮瓣为首选 ;阴茎大部缺损者以阴股沟皮瓣为首选 ;前臂皮瓣塑形最好 ,但需有显微外科技术为保证 ;下腹与大腿组合皮瓣法及下腹部皮瓣法应少用     

The CelluTome epidermal graft‐harvesting system: a patient‐reported outcome measure and cost evaluation study

Conventional split skin grafts (SSG) require anaesthesia, specialist equipment and can have high donor site (DS) morbidity. The CelluTome epidermal graft‐harvesting device is a novel alternative, providing pain‐free epidermal skin grafts (ESG) in the outpatient setting, with projected minimal DS trauma and improved patient satisfaction. This study aimed to compare ESG with SSG by evaluating patient‐related outcome measures (PROMs) and the cost implications of both. Twenty patients answered a graft satisfaction questionnaire that evaluated: donor/graft site noticeability, aesthetic concerns, adverse problems and patient satisfaction. Cost/patient was calculated based on total operative expenses and five clinic follow‐ups. In 100% of the ESG cases, there were no DS noticeability or adverse problems compared to 25% in the SSG group. Complete satisfaction with DS appearance was observed in 100% of the ESG cases (50% SSG). Noticeability, adverse problems and overall satisfaction were significantly better in ESG cases (P < 0.05). Graft site parameters were comparable with similar healing outcomes. The cost per patient for ESG was £431 and £1489 for SSG, with an annual saving of £126 960 based on 10 grafts/month. For the right patient, CelluTome provides comparable wound healing, with reduced DS morbidity and higher patient satisfaction.     

The impact of Improving Outcomes Guidance on the management and outcomes of patients with carcinoma of the penis

INTRODUCTION

The Improving Outcomes Guidance (IOG) for patients with carcinoma of the penis states that treatment should be provided supraregionally to populations of 4 million or greater who treat over 25 cases of penis cancer each year. This study assesses the impact of this guidance on the management and outcomes of patients with the disease in our region.

PATIENTS AND METHODS

We retrospectively compared the records of 44 patients with carcinoma of the penis treated in our institution between 1969 and 1990 with 101 patients treated between 2002 and 2006, i.e. after supraregional centralisation of the service.

RESULTS

There was no significant change in the stage or grade of the tumours. However, the results show that, in modern times, there was a significant increase in the amount of penis-preserving and nodal surgery as well as a fall in mortality. The improved survival is greatest in patients with poorly-differentiated disease who may, therefore, have benefited from aggressive nodal surgery.

CONCLUSIONS

The centralisation of surgery for carcinoma of the penis results in improved outcomes both in terms of preservation and improved survival and this supports the IOG guidance.     

Complications of circumcision

Circumcision remains the most common operation performed on males. Although, not technically difficult, it is accompanied by a rate of morbidity and can result in complications ranging from trivial to tragic. The reported incidence of complications varies from 0.1% to 35% the most common being infection, bleeding and failure to remove the appropriate amount of foreskin. Forty patients suffering from different degrees of circumcision complications and their treatment are presented. In all patients satisfactory functional and cosmetic results were achieved. Whether it is done for ritualistic, religious or medical reasons circumcision should be performed by a fully trained surgeon using a proper technique as follows 1) adequate use of antiseptic agents; 2) complete separation of inner preputial epithelium from the glans; 3) marking the skin to be removed at the beginning of operation; 4) careful attention to the baby’s voiding within the first 6 to 8 h after circumcision; 5) removal or replacement of the dressings on the day following circumcision. Received: 6 April 1998 / Accepted: 29 July 1998     

经包皮内板切口阴茎延长增粗术的研究

目的探讨经包皮内板切口阴茎延长增粗术的方法。方法通过阴茎包皮内板切口进行阴茎浅悬韧带和部分深悬韧带的切断,以及真皮脂肪游离移植的阴茎延长增粗术。结果本组12例患者行包皮内板切口阴茎延长术,其中3例同时行阴茎增粗术,阴茎静态长度增加2.0~3.5cm,静态周径增加1.5~2.5cm,术区无血供障碍,感觉良好,效果满意。结论经包皮内板切口的阴茎延长增粗术用于包皮过长的患者可以获得更佳的手术效果,且切口隐蔽,避免了耻骨区的瘢痕形成。     

正常成人阴茎及其毗邻组织结构的可视化研究

目的建立正常成人阴茎及其毗邻结构的数字化可视模型，为阴茎整形修复获得手术前后形变参数及手术方案的选择，提供形态学依据。方法采用第三军医大学解剖学教研室建立的数字化可视人体数据集（chinese visible human，CVH）部分连续图像，运用表面绘制的方法，对阴茎及其毗邻组织结构进行计算机三维重建和立体显示。结果可视化模型可清晰显示阴茎内部及毗邻结构的形态、分布特点和相互间的三维空间解剖关系。重建图像能单独或联合显示，并可进行任意径线和角度的适时三维测量。结论阴茎可视化模型能够准确反映出该区域复杂的解剖学特点及其内部空间毗邻关系，可为成人阴茎整形修复外科手术提供重要的形态学数据来源。     

阴茎包埋对海绵体结构和发育的影响

目的探讨阴茎包埋对海绵体结构和发育的影响。方法通过建立隐匿阴茎动物模型获得实验标本，分2个月组、4个月组和6个月组进行观测。检测海绵体质量和大鼠体重，观察发育情况；Masson染色分析海绵体内平滑肌和纤维结缔组织的含量来了解海绵体结构的变化。结果各阶段包埋组动物阴茎海绵体质量、体重及两者的比值与正常组和假手术组两两比较差异均无统计学意义（P〉0．05）；各阶段中包埋组的海绵体平滑肌面积下降（2个月组P〉0．05，4个月和6个月组P〈0．05），纤维结缔组织面积增加（2个月和4个月组P〉0．05，6个月组P〈0．05）血管窦的面积减少（2个月和4个月组P〉0．05，6个月组P〈0．05），且组织的正常形态发生改变。结论阴茎包埋可影响海绵体内平滑肌和纤维结缔组织的含量及组织排列的正常形态，且与包埋时间正相关，但对海绵体的大体观无明显影响。     

Severe ischemia of the glans penis following circumcision: A successful treatment via pentoxifylline

Severe ischemia or necrosis of glans penis is rare. We report the case of an 11-year-old boy with severe glanular ischemia occurring 24 h after circumcision. This was successfully treated with pentoxifylline injection for 5 days, and while the black color of the glans penis changed to brownish at 48 h, appearances were close to normal at 5 days. The patient did not require any surgical intervention, and was discharged without sequelae. We suggest that pentoxifylline might be considered as a treatment of choice for severe ischemia of glans penis.     

Subcutaneous granuloma annulare of the penis in 2 adolescents

Granuloma annulare (GA) is a benign inflammatory disorder of unknown etiology characterized histologically by dermal palisading granulomas with central degeneration of collagen (necrobiosis). There is a rare subcutaneous clinical variant, this occurring more frequently in children than in adults and very rarely involves the penis. We describe 2 cases of penile subcutaneous GA developing in adolescent boys who to our knowledge has not previously been described in literature. Both were initially treated with surgical excision. Circumcision was performed on one of the boys, with subsequent improvement with the resolution of most of the nodules. Granuloma annulare of the penis is very rare, with only 7 cases reported to date [Narouz N, Allan PS, Wade AH. Penile granuloma annulare. Sex Transm Infect 1999;75(3):186-7; Trap R, Wiebe B. Granuloma annulare localised to the shaft of the penis. Scand J Urol Nephrol 1993;27(4):549-51; Laird SM. Granuloma annulare of the penis. Genitourin Med 1992;68(4):277; Hillman RJ, Waldron S, Walker MM, et al. Granuloma annulare of the penis. Genitourin Med 1992;68(1):47-9; Kossard S, Collins AG, Wegman A, et al. Necrobiotic granulomas localised to the penis: a possible variant of subcutaneous granuloma annulare. J Cutan Pathol 1990;17(2):101-4] and no previous reports in children or adolescents to our knowledge. All except one of the cases reported so far were of the subcutaneous (nodular) form of GA.     

阴茎折断9例报告

目的 提高阴茎折断的诊治水平。方法 报告阴茎折断9例,并结合文献对其发病机理、病理、诊断和治疗进行讨论。结果 9例均采用纵形小切口行阴茎血肿清除加白膜修补术。随访8例,失访1例,随访时间3～96个月,1例阴茎勃起时轻度弯曲,但不影响性交,7例阴茎无弯曲、硬结,性功能正常。结论 阴茎折断手术疗效满意,应尽早手术治疗。纵形小切口手术简单,创伤小,适于临床应用。     

Successful microsurgical replantation of an amputated penis

Traumatic amputation of the penis is a rare condition. The paper presents a 22-year old man who suffered a complete penile amputation in a result of an unfortunate accident. Microsurgical replantation of the penis was performed in the case with a complete return of sensation, sexual function and physiologic miction. Microsurgical replantation is the treatment of choice for this injury.