Arry Rodjani

Diphallia with Associated Anomalies: A Case Report and Literature Review

Diphallia or penile duplication is an extremely rare congenital anomaly. It occurs once in every 5.5 million live births. The extent of penile duplication and the number of associated anomalies vary greatly, ranging from a double glans from a penis with no associated anomaly up to complete penile duplication associated with multiple anomalies. Here, we report a 12-year-old boy with complete bifid diphallia associated with bifid scrotum, epispadia, and pubic symphysis diastasis along with a review of the articles pertaining to this anomaly.

Zero ischaemia open partial nephrectomy using Thulium laser in pediatric renal tumor: A first experience

The management of localized kidney tumors has changed, resulting in a shift from radical nephrectomy toward more frequent use of partial nephrectomy (PN). For many patients with small clinical T1 renal tumors (< 7 cm) who are candidates for nephron-sparing surgery, PN is now the reference standard treatment. Laser technology, such as diode laser and holmium laser, has been reported in very selected series for PN since 1985. Thulium laser utilization in pediatrics partial nephrectomy has not been significantly evaluated. Therefore, we reported this study to know its affectivity and efficacy in open PN especially in pediatric patient.

Neo-glans reconstruction after glans amputation during circumcision using autologous buccal mucosal graft

Genitourinary trauma comprises 2e10% of all hospital admission, which external genitalia trauma is involved in 33e36% of the cases. Amongst external genitalia traumas, penile or glans amputation is very rare case.1 During circumcision, glans injury is mostly due to glans trapped in the circumcision clamp or while performing guillotine technique, which usually results in partial or total amputation of glans penis. After 24 hour of injury, it is not recommended to reattached the glans, penile lengthening can be performed using proximal lengthening using gracilis muscle, scrotal flap or distal lengthening using rectus abdominis fascial island flap covered by skin graft or scrotal flap. A few studies has report the use of buccal mucosal graft in glans reconstruction.2,3 In this study we describe this novel technique of neoglans reconstruction using autologous buccal mucosal graft in paediatric iatrogenic amputation during circumcision.

Abnormal dartos fascia in buried penis and hypospadias: Evidence from histopathology

INTRODUCTION The importance of the pathology of the dartos fascia in hypospadias and buried penis is still debatable. Understanding the properties of connective tissue of dartos fascia in hypospadias and buried penis may give a clue to the underlying mechanism. OBJECTIVE This study aimed to compare connective tissue and vascularization of dartos fascia between normal penis, buried penis, and hypospadias. STUDY DESIGN We conducted this prospective study from May 2013 to November 2016. We collected dartos fascia specimens from three groups: buried penis, hypospadias, and normal penis as control. All of the patients underwent primary surgery in all groups. Patients with penile abnormalities, such as phimosis or Balanitis Xerotica Obliterans (BXO) were excluded from the normal penis group. We compared the fibers between these groups using Masson trichrome histochemical staining, Gomoris silver impregnation staining, Weigert resorcin-fuchsin staining, and CD31 immunohistochemistry staining for evaluation of collagen fibers, reticulin fibers, elastin fibers, and endothelial cells of blood vessels, respectively. The collagen fibers, reticular fibers, elastic fibers, and vascular vessels were counted with ImageJ and manually calibrated and counted and were analyzed using the one-way ANOVA test. The assessment conducted by two pathologists was blinded, without knowing the clinical diagnosis of patients. RESULTS There was a total of 60 patients with 20 patients in each group. Collagen fibers for most cases of buried penis and hypospadias showed thicker but fewer collagen fibers than the normal penis. There was a reduction of total collagen and elastin of dartos fascia in hypospadias and buried penis cases. On the other hand, the ratio of reticulin fibers, which represents collagen type III to total collagen, was increased compared to normal penis. DISCUSSION Although the dartos fascia in buried penis and hypospadias is thick and inelastic when palpated or during traction/counter traction, it is well-vascularized tissue. This inelastic dartos fascia tissue is an abnormal tissue, but its characteristics are not similar to fibrotic tissue. However, further study with a larger sample is warranted and should differentiate the degree of chordee in patients with hypospadias and buried penis. CONCLUSIONS There was a difference between connective the tissue of dartos fascia in buried penis and patients with hypospadias compared with normal penis. Inelastic dartos fascia tissue in patients diagnosed with buried penis and hypospadias is an abnormal tissue. Therefore, it is suggested that this tissue is excised during reconstructive surgery. Further research is needed to unveil the pathophysiology of the condition.