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The Neonate
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Laura De Angelis, Luca Ramenghi
Over 60% of the world male population is not circumcised, as this procedure is elective and tied in the past to religious practices and not scientific benefit or considerations. The health benefits to circumcision include prevention of urinary tract infection (from approximately 7–14/1000 to 1–2/1,000), penile cancer (about 1000 circumcisions needed to prevent one penile cancer), and transmission of sexually transmitted infections (about 15% decrease in lifetime HIV risk). In the United States, the benefits are not considered great enough to offer universal male circumcision. The AAP recommends that circumcision be chosen by parents after having received all the information about the risks and benefits associated with the procedure [11]. The World Health Organization suggests circumcision as a means to reduce the risk of acquiring HIV infection in high-risk populations [12]. Complications of the procedure have been reported to range from 0.3% to 20% and include excessive bleeding (1/100–1/1,000), infection (1–6/10,000), and penile injury (4/10,000).
Complications of Genitourinary Trauma
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Sean P. Elliott, Jack W. McAninch
All patients with penetrating penile injury should undergo urethrography and operative penile exploration, debridement, and suture repair of urethral and cavernosal injuries. Failure to do so leads to urethral stricture, hemorrhage from missed corporal injuries, and cavernosal-spongiosal fistula. Experience with the amputated penis is rare; however, prompt replantation with anastomosis of the urethra, tunica albuginea, cavernosal nerves, dorsal arteries and veins can be accomplished with few complications (51–54). Nonmicrosurgical replantation is associated with poorer outcomes (55). Penile engorgement due to poor venous and lymphatic drainage is common after replantation and responds to leech therapy (56).
Urologie Pain
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Hossein Sadeghi-Nejad, Carin V. Hopps, Allen D. Seftel
Fracture of the penis, faux pas du coit, was first reported by Abul Kasem in Cordoba more than 1,000 years ago and follows trauma to the erect penis during coitus or penile manipulation/masturbation (Eke, 2002). This acute condition is a medical emergency that presents with a sudden cracking sound (due to the rupture of the corpora cavernosa) that is accompanied by localized penile pain and immediate detumescence. Many patients present hours (or even days) after the actual injury due to embarrassment. Penile swelling due to hematoma formation at the site of rupture may result in voiding difficulties including possible urinary retention, as well as penile swelling, bruising, and deviation that is often described as an “eggplant” deformity (Cumming & Jenkins, 1991). Some reports have indicated that the condition may be as uncommon as 1 in 175,000 hospital admissions in the United States, but this is likely to be a low estimate due to the stigma associated with penile injury sustained during sexual activity (Farah, Stiles, & Cerny, 1978). Eke (2002) have reviewed a total of 183 publications pertaining to penile fracture from various countries and reported a total of 1,642 cases, but the condition is undoubtedly highly underreported and is commonly seen in most emergency rooms at least a few times per year.
Peyronie’s disease: new paradigm for the treatment of a unique cause of erectile dysfunction
Published in Postgraduate Medicine, 2020
While there have been many theories of the etiology of PD, most cases are idiopathic and not associated with other disease states. Trauma, either single or multiple small injuries are agreed upon as the primary etiology of PD. Many patients, however, do not recall a specific traumatic event. As a result, most feel that multiple small traumatic events in susceptible individuals is the most likely cause of PD. Trauma to the TA during intercourse may cause micro-hemorrhage, fibrin extravasation, cellular infiltration, and an inflammatory response, inducing deposition of abnormal extracellular matrix. PD patients may have genetic tendency for abnormal wound healing or have connective tissue vasculogenic aberrations or autoimmune disorders[10]. Family history of PD is reported in 2–4% of men and an association with Dupuytren’s contracture (DC) in 20% of patients [8]. Identical twins have been reported to have Peyronie’s disease. In a study of patients with Paget’s disease of bone, a condition characterized by abnormal bone turnover, 14–31% of the patients had PD and 23% had DC [11]. Age is a significant risk factor, with a prevalence of 1.5% in men aged 30–39 years and 6.5% in men older than 70 years [4]. Older men may be more susceptible to penile injury during coitus since erectile rigidity is decreased and the partially erect penis is more likely to buckle during coitus. Trauma to the penis is a common etiology of PD. There is a three-fold increased risk of PD in patients with prior genital or perineal trauma [4]. An association has been reported with urologic procedures including radical prostatectomy, urethral catheterization, and cystoscopy.
Co-culture of smooth muscle cells and endothelial cells on three-dimensional bioprinted polycaprolactone scaffolds for cavernosal tissue engineering
Published in The Aging Male, 2020
Kyung-Jin Oh, Ho Song Yu, Jinju Park, Hyun-Suk Lee, Su A. Park, Kwangsung Park
Congenital penile malformations, traumatic penile injury, corporal fibrosis, and severe erectile dysfunction may require surgical reconstruction. Reconstructive surgery may require adequate penile tissue, but this has remained a challenge because of limited availability [4,5]. Given the limitations of autologous tissue, intensive research is being conducted using regenerative medicine and tissue engineering techniques in urological fields [6]. Scaffold-based tissue engineering has led to significant improvements in various tissues and organs [7,8]. Functional tissue-engineered blood vessels can provide an alternative treatment approach to erectile dysfunction.
War-related penile injuries in Libya: Single-institution experience
Published in Arab Journal of Urology, 2018
Abdalla M. Etabbal, Fathi F. Hussain, Mohamed O. Benkhadoura, Abdalla M. Banni
The study was conducted in the Department of Urology at Benghazi Medical Center. This descriptive case series was carried out in a proactive manner by immediate registration of all operated cases sustaining shotgun, gunshot or explosive injuries to the penis from February 2011 to August 2017. The patient’s demographic data, cause of injury, site and severity of primary penile injuries, surgical management as well as the surgical outcome, postoperative complications, and hospital stay, were recorded. These data were collected prospectively and analysed retrospectively. Patients who arrived dead or died during surgery were not enrolled in the study. Penile injuries were classified according to the cause of the penile injury, whether gun/shotgun bullets or shrapnel of explosive devises/projectiles. The causes of penile injuries due to gunshots were sub-classified according to the velocity of bullets into: low-velocity gunshot injuries (<350 m/s), medium-velocity gunshot injuries (350–500 m/s), and high-velocity gunshot injuries (>600 m/s) [8]. Penile injuries due to explosions were classified as: IEDs, personal landmine or explosion of a projectile. The proper assessment of penile injuries depends on clinical findings and imaging studies results, as well as on operative findings. Imaging studies, e.g. plain X-ray, are required to identify foreign bodies and/or bone fractures; however, a retrograde urethrogram can only be done in cases of superficial penile injuries, in which urethral injuries are not obvious. CT is usually performed to assess patients who sustain multiple serious injuries. The management of penile injuries depends on the severity of the injury, physical findings and haemodynamic stability of the patient; however, patients in shock underwent immediate laparotomy without any diagnostic imaging studies to treat life-threatening injuries. The grades of the penile injuries were classified according to American Association for the Surgery of Trauma (AAST) Penis Injury Scale [9] (Table 1).