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Penoscrotal Pathology
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
General management of idiopathic ischaemic priapism:Full haematological and biochemical assessment including vasculitis screen to exclude any underlying cause.CT Chest-Abdo-Pelvis to exclude underlying malignancy.If due to metastases, radiotherapy or penectomy may be required.
Penile and urethral cancer
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Partial penectomy: Appropriate for smaller, more distal tumors2 cm proximal margin is requiredGoal if possible is to preserve ≥3 cm of penile shaft, which should preserve the ability to stand while urinating and maintain some sexual function.
Urethra and Penis
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Management is divided into treatment of the primary tumour and treatment of the inguinal nodes. For the primary tumour surgical excision is the mainstay of treatment, with the traditional view that a 2 cm margin of normal tissue be removed being superceded by a more recent, more conservative view, such that penile preserving surgery with excision of much lower margins of normal tissue are now accepted. Tumours affecting the glans penis require glansectomy, with more advanced tumours requiring partial penectomy. In advanced cases, total penectomy is required with formation of a perineal urethrostomy. Such surgery is indicated even in advanced metastatic disease for reasons of local control.
Penile calciphylaxis with extragenital gangrene
Published in Baylor University Medical Center Proceedings, 2021
Marcus Zaayman, Annika Silfvast-Kaiser, Edgar Rodriguez, Andrew J. DeCrescenzo, Alan Menter
Treatment for PC must consider noninvasive vs invasive approaches (Table 2).2,4–7,12 Three interventional approaches are supported in formal literature: excision of the affected tissue, revascularization, and parathyroidectomy.8,13,14 Yang et al6 found that 21 patients receiving partial or total penectomy showed no significant improvement in mortality rates over those with local wound care (42.9% vs 52%, respectively). Penectomy should be reserved for severe refractory pain or uncontrolled infection.6,8 Data concerning revascularization surgery are sparse. Successful revascularization from the left femoral artery to the deep dorsal penile vein and endovascular interventions have been separately reported.13,15 Parathyroidectomy for PC is controversial.6,8 In systemic calciphylaxis patients, the median survival time is increased by approximately 8 months with parathyroidectomy.14 Parathyroidectomy should only be considered in patients with concomitant severe hyperparathyroidism.
Ethical deliberation and management of attempted penile self-amputation in a male-to-female transgender person: case presentation and literature review
Published in Scandinavian Journal of Urology, 2019
Jacob T. Emerson, Alexander M. Geisenhoff, Alexander K. Chow, Lev Elterman
A conservative approach using primary repair should be elected in the acute setting provided there is adequate vascular supply to the penis and no evidence of necrotic tissue. This involves exploration of the wound with particular attention to the corporal bodies, followed by primary repair. Penectomy is an invasive, irreversible procedure with numerous medical and psychosocial implications. It should only be performed after much deliberation when the patient has a full understanding of these risks. Studies observing quality-of-life outcomes following penectomy primarily have involved patients in which the indication was penile cancer. Thus, much of the quality-of-life data regarding penectomy is difficult to translate to a case in which the patient is suffering from gender dysphoria. It should be noted that a recent study of health-related quality-of-life outcomes following partial penectomy for penile cancer demonstrated reasonably satisfactory scores in both physical functioning and global health status when compared to the general population, but significantly more concerns about appearance and life interferences [4,5]. Nonetheless, the majority of current literature indicates that MTF gender confirmation surgery leads to an improved quality-of-life for patients deemed appropriate candidates for gender confirmation surgery [6].
Neo-glans reconstruction for penile cancer: Description of the primary technique using autologous testicular tunica vaginalis graft
Published in Arab Journal of Urology, 2018
Peter Weibl, Christina Plank, Rudolf Hoelzel, Stefan Hacker, Mesut Remzi, Wilhelm Huebner
After general anaesthesia induction, the patient was placed supine and a tourniquet secured at the base of the penis. A circumferential skin incision was made ∼5 mm proximal to the coronary sulcus, followed by penis degloving to its base. The deep dorsal vein was isolated and secured with 3–0 polyglactin 910 suture (Vicryl®; Ethicon Inc., Somerville, NJ, USA) at the level of the primary incision. Then the meticulous dissection of the neurovascular bundle (NVB) was performed with full exposure of the tunica albuginea. After suturing the NVB, the transverse incision separated the NVB from the distal tips of the CC and the glans. Partial penectomy was completed and the specimen sent for frozen-section analysis. The resection margin of the CC, tunica albuginea, as well as the proximal margin of the urethra was negative.