Dear Editor,We herein present three rare cases of penile keloids that formed after circumcision and were effectively treated with a combined modality. We also discuss their possible causes. The current complication rate for male circumcision is 2%-4%. 1 Hematoma, edema, infection and incision dehiscence are encountered more often, while keloid formation, a common complication after skin injury or surgery, is rarely seen after circumcision. This complication may result from improper circumcision and postoperative management.Penile keloids are more difficult to manage than those on other body sites because mechanical pressure and silicone sheeting, which comprise the normal treatment modality for keloids, are generally considered difficult to apply to the penis. 2-5 Using a novel dressing method that enabled the use of the normal treatment modality, three cases of penile keloids secondary to circumcision were effectively treated.All patients have given their informed consent prior to their inclusion in the study. One patient was a 32-year-old Chinese man who had a large, pruritic scar with pain on the penis. Two years prior, he underwent circumcision. Infection occurred on the third postoperative day and resulted in incision dehiscence. The wound healed in 1 month. Shortly before wound closure, the scar started to elevate and became hypertrophic and prominent; growth was slowly progressive for more than 16 months. Physical examination revealed a 2.5-cm-diameter circumferential scar cord with a colon-like, reddish surface along the coronal sulcus at the circumcision site. The patient also complained of embarrassment (such as that experienced in public lavatories and bathhouses) and the inability to have intercourse. He also had several hypertrophic scars on his lower abdominal wall and left deltoid region that had formed following dermatitis about 20 years prior. His 9-year-old son developed a hypertrophic scar after trauma. No additional family history was found. The scar on the deltoid region had been resected 5 years previously, but resulted in a much larger scar. He had undergone six intralesional steroid injections for the penile scar, but only minor regression was noted.The other two patients had a history of circumcision and incision infection. One was a 10-year-old Chinese boy who had a large, pruritic scar on the penis that had slowly developed over 2 years; the other was a 12-year-old boy whose penile scar had continued to grow for 10 months. Neither had a family history of keloids.None of the patients had any other physical diseases, and they underwent serial treatment. The entire scar was first excised, and an intradermal triamcinolone acetonide injection was administered at the incisal margin immediately after the excision (1 ml of 40 mg ml 21 triamcinolone acetonide mixed with 0.6 ml of 2% lidocaine hydrochloride injection, 0.1 ml mixture per centimeter of margin; the total length of the incisal margin in each case was 16, 9 or 12 cm). Injections were continued twice a month. Meanwhile, a well-fitting...
Objectives: To share our experience in hypospadias repair and discuss the clinical implications of our method, which consists of a combined buccal mucosa graft and local flap for urethroplasty. Patients and Methods: 1,394 cases (median age 11.3 years, age range 5 months to 53 years) of hypospadias which were repaired using our method between July 2000 and December 2010 in our department were included in this study. The patients who had a short penis or did not have chordee were excluded from the data. 588 cases (42.2%) had previously undergone surgery in other hospitals but failed; 806 (57.8%) cases had undergone the first treatment in our department. Results: Of the 806 cases which had undergone the first treatment in our department, we successfully reconstructed the urethra for 747 patients (92.3%), and 59 patients had complications (7.7%); of the 588 cases which had previously undergone surgery but failed, we successfully reconstructed the urethra for 522 patients (88.8%), and 66 patients had complications (11.2%). The most common complication was urethra fistula (70; 5%); other complications include necrosis of the skin flap and infection resulting in wound disruption (19; 1.4%), urethral diverticula (11; 0.8%) and urethral stricture (25; 1.8%). Conclusions: Our method appears to be a safe, simple and satisfactory surgical procedure and can provide relatively enough tissue to reconstruct the urethra with a higher success rate.
Objectives: To evaluate technical aspects and outcome of preventing urethrocutaneous fistula and calculi recurrence in surgical treatment of urethral calculi associated with hairballs after urethroplasty. Patients and Methods: Sixteen patients who had urethral calculi associated with hairballs after urethroplasty underwent urethrolithotomy and trimming and epilation of the neourethra. While operating, we made a staggered incision of the skin and urethra, carefully su-tured the urethral incision, and covered it by well-vascularized tissue. A tube-in-tube stent method was performed on the latter 12 patients for better drainage of the exudates that accumulated in the urethra. Results: All calculi were successfully removed. Surgical site infection occurred in the last one of the former 4 patients and resulted in an urethrocutaneous fistula. There were no other complications. All patients were followed up for 2-7 years; no urethral stenosis or recurrence of calculi was observed, and remarkable reduction of urethral hair was obtained. Conclusions: Urethrolithotomy and trimming and epilation of the neourethra seem to be appropriate treatments for urethral calculi associated with hairballs after urethroplasty. Full attention should be paid to fistula prevention.
Purpose: Spongioplasty (mobilization and midline approximation of the two branches of the bifi d dysplastic distal corpus spongiosum) can form a covering layer for the neourethra to prevent urethrocutaneous fi stula in hypospadias repair surgery. However, it remains unclear whether spongioplasty affects neourethral function. The objective of this study was to compare neourethral function after hypospadias repair with and without spongioplasty. Materials and Methods: Fourteen congenital hypospadiac New Zealand male rabbits were randomly allocated into two groups, seven animals underwent Duplay hypospadias repair and spongioplasty (experimental group), while seven underwent Duplay surgery alone (control group). Functional differences between groups were assessed by comparing neourethral compliance and fl ow rate. Two months after surgery, in vivo neourethral compliance was assessed by measuring intraluminal pressure with a digital pressure meter of an isolated neourethral segment, following progressive distension with 1, 2, and 3mL of air. Penises were harvested for urofl owmetry test using a simple device. Results: Postoperatively, fi stula developed in one and zero rabbits in the control and experimental groups, respectively. Mean pressures tended to be higher in the experimental group than in the control group (82.14 vs. 69.57, 188.43 vs. 143.26, and 244.71 vs. 186.29mmHg for 1, 2, and 3mL of air, respectively), but the difference was not statistically signifi cant. Mean fl ow rates also did not signifi cantly differ between the experimental and control groups (2.93mL/s vs. 3.31mL/s). Conclusion: In this congenital rabbit model, no obvious functional differences were found between reconstructed urethras after hypospadias repair with and without spongioplasty.
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