penile reconstruction

阴茎重建
  • 文章类型: Systematic Review
    背景:阴茎癌治疗中的器官保留手术(OSS)旨在维持器官的形态和功能,并保持与健康相关的生活质量(HRQoL)。然而,缺乏探讨这些结局的综合证据.
    目的:目的试图审查HRQoL,功能,美学,OSS或根治性阴茎切除术治疗阴茎癌后的心理结果。
    方法:对MEDLINE和Cochrane数据库的系统评价包括报告功能的研究(性,泌尿或感觉),原发性阴茎癌手术治疗后的生殖器外观或HRQoL/心理健康。英文报告(2000-2022年),纳入患者报告或客观的临床结果指标,有资格。非手术治疗策略和转移性疾病的研究被排除在外。对数据进行汇编和分析。
    结果:纳入26项研究。性功能是研究最多的结果(754名受访者;19项研究),最常见的是原始的15项和删节的5项国际勃起功能指数。OSS后勃起功能的保存一般描述,引用的总体性满意度有所下降。对排尿功能的评估不均匀,术前评估很少,这使得研究间比较困难。大多数患者似乎能够在OSS之后从站立姿势中消失,喷药是最常见的症状。根治性腺体切除术后的裂层皮肤移植和尿道腺体成形术都描述了某些感觉功能的维持。有限的研究表明,患者对OSS后生殖器美容有合理的满意度。阴茎癌手术后的大多数研究都描述了对HRQoL的负面影响,与阴茎手术和淋巴结清扫术的侵袭性相关。焦虑,抑郁症,据报道,阴茎癌幸存者的自尊心降低。关系幸福感各不相同,一些幸存者报告说这一点没有改变。
    结论:OSS可以保留性元素,泌尿,和感觉功能,对符合条件的患者来说,支持优于根治性阴茎切除术的优势。然而,由于规模小,全面的理解仍然有限,异质患者队列,获取病前数据的挑战,和结果测量的可变性。OSS后患者报告结果的标准化是可取的。
    Organ-sparing surgery (OSS) in penile cancer management aspires to maintain organ form and function and preserve health-related quality of life (HRQoL), yet there is a lack of integrated evidence exploring these outcomes.
    The aim sought to review HRQoL, functional, aesthetic, and psychological outcomes following OSS or radical penectomy for penile cancer.
    A systematic review of MEDLINE and Cochrane databases included studies reporting on function (sexual, urinary or sensory), genital appearance or HRQoL/psychological well-being following surgical treatment of primary penile cancer. English-language reports (2000-2022), incorporating patient-reported or objective clinical outcome measures, were eligible. Studies of nonsurgical treatment strategies and those in the context of metastatic disease were excluded. Data were compiled and analyzed.
    Twenty-six studies were included. Sexual function was the most studied outcome (754 pooled respondents; 19 studies), most frequently with the original 15-item and abridged 5-item International Index of Erectile Function. Preservation of erectile function following OSS is generally described, with some reduction in overall sexual satisfaction cited. Heterogeneous assessment of voiding function with little preoperative evaluation render interstudy comparison difficult. Most patients appear able to void from a standing position following OSS, with spraying the most common symptom. Maintenance of some sensory function is described with both split-thickness skin grafting and urethral glanduloplasty following radical glansectomy. Limited studies suggest reasonable patient satisfaction with genital cosmesis post-OSS. A negative impact on HRQoL is described in most studies following penile cancer surgery, variably correlated with aggressiveness of penile surgery and addition of lymphadenectomy. Anxiety, depression, and reduced self-esteem have been reported in penile cancer survivors. Relationship well-being varies, with some survivors reporting this to be unchanged.
    OSS can preserve elements of sexual, urinary, and sensory function, supporting advantages over radical penectomy for eligible patients. However, a comprehensive understanding remains limited due to small, heterogeneous patient cohorts, challenges in obtaining premorbid data, and variability in outcome measures. Standardization of patient-reported outcomes following OSS is desirable.
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  • 文章类型: Case Reports
    BACKGROUND: Fournier's gangrene is necrotizing fasciitis of the genitalia, perineal and perianal region associated with a significant mortality rate. The potentially fatal disease is caused both by aerobic and anaerobic bacteria and primarily occurs in men. The majority of Fournier's gangrene cases is idiopathic or derived from perineal and genital skin infections. Early surgical debridement of necrotic tissues and antibiotics are fundamental.
    METHODS: We report a rare case of Fourniers gangrene of a 57-year-old man secondary to circumcision. The patient presented due to painful swelling of the scrotum and perineum associated with high-grade fever. The patient received broad-spectrum antibiotics and underwent immediate surgical debridement; a total of five other debridements were performed during the recovery until the wounds healed. On a second recovery phase, we performed a penile reconstruction with full thickness skin graft with satisfactory cosmetic and functional results.
    CONCLUSIONS: FG remains an urgent condition associated with a high mortality rate, requiring immediate treatment. More statistical reports and standard guidelines are necessary to improve the rate of its survival.
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  • 文章类型: Journal Article
    UNASSIGNED: : To review the literature on adult penile reconstruction due to Peyronie\'s disease, trauma and cosmesis, while emphasising specific surgical techniques and procedures such as phalloplasty, radial forearm free flap reconstruction, and penile transplant.
    UNASSIGNED: : A comprehensive review of the literature for the years 1992-2020 of the PubMed and SpringerLink databases was performed to identify articles on penile reconstruction. Search terms included \'penile reconstruction\', \'penile trauma\', \'phalloplasty\', \'penile transplant\', and \'treatment of Peyronie\'s\'. Relevant articles were selected. All included studies were performed on adults and written in English.
    UNASSIGNED: : We were able to identify 46 papers from PubMed and SpringerLink that included the research terms. From these, we included technical details of procedures and gleaned photographs of their works. Additionally, we included photographs from our institution\'s own plication surgery cases.
    UNASSIGNED: : The field of adult penile reconstruction is performed for a plethora of reasons. From cosmetic to urgent and from routine to complex, it is most certainly a growing subset of Urology that plays a vital role for the men who need it. To our knowledge, this is the most up-to-date review of adult penile reconstruction.
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  • 文章类型: Journal Article
    BACKGROUND: Penile denudation is a devastating condition often reconstructed with a split-thickness skin graft(STSG). As this kind of reconstruction is challenging, we present an non-invasive treatment using Manuka honey dressings with a satisfying result. This was performed as a salvage procedure after failed STSG.
    METHODS: A 55-year-old non-smoking male was admitted from his general practitioner with a newly onset of phimosis and lower urinary tract symptoms. Benign tumours complicated with infection were found on all segments of the penis causing dehiscence of the skin. After surgical removal of tumours and an unsuccessful STSG, Manuka honey dressings was used. Full sexual function was regained, and the patient was satisfied with the result.
    CONCLUSIONS: Alternatives to STSG are full-thickness skin graft using the inguinal or scrotal borrowing method, or using a dermal matrix before a STSG. A rediscovered method is using Manuka honey, with its unique combination of bactericidal, anti-inflammatory and healing-promoting properties. A wide range of wound types may benefit from Manuka honey dressings. A recent Danish in vitro study on honey derived from various Danish floras even shows high antibacterial effect superior to commercial medical grade honey. Considering a growing resistance to antibiotics, medical honey may contribute as a alternative to extensive wound care.
    CONCLUSIONS: We successfully treated a penile denudation with Manuka honey following a failed STSG. Wounds, ulcers, and burns may be infected, and can be challenging, time consuming, and expensive to treat. Manuka honey may be a good alternative to reconstructive surgery and can be managed on an out-patient basis.
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  • 文章类型: Case Reports
    完全阴茎发育不全(aphallia)是一种非常罕见的先天性异常。迄今为止,已报告约80例。这种罕见异常的诊断是通过临床检查得出的,但是对于治疗医生来说,治疗选择和性别分配的父母咨询是困难和具有挑战性的。我们报告了一例阴茎完全发育不全并伴有尿道瘘的婴儿,在生命的第六天被转介。这个婴儿出现了阻塞性尿路病,需要进行膀胱造口术。手术管理包括与父母详细讨论相关情况并接受他们的最终决定后的性别分配。
    Complete penile agenesis (aphallia) is a very rare congenital anomaly. Around 80 cases have been reported to date. Diagnosis of this rare anomaly is made by clinical examination, but treatment options and parental counselling for gender assignment is difficult and challenging for the treating doctor. We report a case of an infant with complete penile agenesis with recto-urethral fistula, who was referred on day 6 of life. This baby developed obstructive uropathy which required vesicostomy. Surgical management consists of gender assignment after discussing in detail the pertinent situation with the parents and accepting their final decision.
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