Zsolt Kelemen

Long-term psychological and sexual outcomes of severe penile hypospadias repair

INTRODUCTION Hypospadias is the most common penis malformation, and there exist a variety of surgical approaches used to correct the abnormal position of the meatus. Although the long-term outcomes of surgery are considered important for psychosexual development, only a few attempts have been made to evaluate patient satisfaction. AIM The aim of our study was to evaluate surgical results and psychosocial adaptations in a homogeneous group of subjects with severe penile hypospadias who underwent the same types of surgical repairs during childhood and compare the results to data obtained from age-matched healthy controls. METHODS In this cross-sectional study, 104 men (between 24 and 42 years old) who underwent an uncomplicated two-stage hypospadias repair in their childhood and 63 age-matched healthy men without genital malformations completed the questionnaire. MAIN OUTCOME MEASURES   Difference in self-perception assessed by a 15-item questionnaire regarding psychosexual well-being and penile appearance between subjects with corrected hypospadias and healthy participants. RESULTS On average, subjects with a hypospadias repair were less satisfied with their genital appearance; however, they were more satisfied with their sex lives compared to healthy controls. The meatus distance was approximately 1.5 cm from the tip of the penis after surgical correction. None of the postoperative surgical results correlated with patient satisfaction. Furthermore, the small percentage of patients (11%) who were very unsatisfied with their surgical outcomes had no significant differences in surgical outcomes compared to satisfied patients. However, there was a significant difference between the two groups in almost all psychological outcome measures. CONCLUSIONS In adults who underwent an uncomplicated ventral repair of a severe penile hypospadias 20-30 years earlier, healthy psychosexual development was achieved despite the lack of a glanular meatus. Early identification of unsatisfied patients is important for appropriate long-term follow-up and counseling.

Treatment and outcome of vaseline-induced sclerosing lipogranuloma of the penis.

OBJECTIVES To study the treatment and short-term outcome of 16 consecutive cases of sclerosing lipogranuloma of penis developing after Vaseline inoculation for penile augmentation. METHODS After Vaseline inoculation, patient pain was related mainly to erection and severe phimosis. At surgical reconstruction complete and radical excision of the involved penile skin was performed, followed by skin substitution from the existing, saved coat of the penis. In most cases the stored, uninvolved inner preputial skin was used; less frequently scrotal flaps and in the least-favorable cases penis embedment in the scrotum was applied for coverage of the penis. RESULTS All 16 patients were cured, no matter how long after self-injection vaselinoma developed or which kind of surgery was performed. Histopathologic evaluation revealed different findings according to the time elapsed after Vaseline injection. CONCLUSIONS Early detection of patients with Vaseline penile augmentation and urgent surgery are essential because the best esthetic and functional results can be achieved in the acute period; this is when granuloma does not involve the subdermal but only the subcutaneous layer and local penile flaps can most commonly be used for reconstruction.

Management of Congenital Penile Curvature

PURPOSE The long-term results of the management in adulthood of congenital curvature of the penis (ventral, lateral and dorsal) without hypospadias using 3 different techniques are carefully evaluated based on our experience. MATERIALS AND METHODS A total of 116 patients were operated on for congenital curvature of the penis without hypospadias in adulthood between January 1985 and December 2004 of whom 87 (75%) (mean age 24 years) were available for evaluation by a telephone survey. A total of 54 ventral, 28 lateral and 5 dorsal penile curvatures were operated on with a mean followup of 89 months. Bend was managed with Nesbits procedure in 18, plication in 7 and the Heineke-Mikulitz technique in 62 men. RESULTS There were no significant intraoperative or postoperative complications. Overall 81 of the 87 patients (93.1%) were successfully treated with 1 operation. Curvature recurrence was less common in patients treated with the Heineke-Mikulitz technique. There were no complaints of de novo erectile dysfunction, but 15 men complained of shortening of the penis and 4 experienced decreased sensation of the glans. CONCLUSIONS Although feasible in cases of different types of congenital curvature, in our 20-year experience chordectomy always reduced the bend but patients could never completely straighten the penis by themselves. Surgical correction was reported by patients to be highly successful using the Heineke-Mikulitz technique, and statistical analysis revealed it to be significantly better than plication or the Nesbit procedure in terms of palpable nodules, recurrence and overall satisfaction.

Reconstructive surgery of penile deformities and tissue deficiencies

Penile deformities and tissue deficiencies can disturb sexual intercourse or make it impossible. The aim of the study is to summarize the different diseases according to their clinical appearance and pathological processes and to review operative methods and personal experiences. Surgical treatment of hypo- and epispadias is usually performed in childhood, but curvatures after unsuccessful operation can demand the reconstruction of urethra, skin and corpora cavernosa eventually. Peyronies disease and curvature after penile fracture desire the reconstruction of tunica albuginea. Plaque surgery used to be performed with dermal, tunica vaginalis or venous grafts, but best results are obtained by shortening procedure on the contralateral side according to the Heinecke-Mikulitz principle. Tissue deficiencies and curvatures were observed after necrotic inflammatory processes, like Fourniers gangrene or chronic dermatitis. Skin defects were cured by flaps and grafts. Abscesses of penis, severe tissue defects and also curvatures were observed after intracavernous injection in cases of erectile dysfunction. Possibilities of reconstruction seem to be very poor. Oil granuloma of penis presents a new task for penile reconstruction. The best results of skin replacement were achieved by temporary embedding of the penis in scrotum.

Penis covering and simultaneous urethral replacement by scrotal skin for severe penile and urethral necrosis

ObjectivesPenile strangulation with severe necrosis and concomitant significant tissue loss is a challenging problem for reconstructive surgery. Final reconstruction and tissue augmentation of the resected penis often require multi-step plastic reconstruction.MethodsSevere damage of the phallus with gangrene and septic complication caused by a bronze ring were first conservatively treated to achieve dry gangrene. The glans of the penis, the whole penile skin, and distal third of the corpus spongiosum with the urethra were lost to necrosis, resulting in a missing urethral segment on the penis. Surgery was performed 3 months after removing the metal ring; a one-step skin and urethral reconstruction was done.ResultsGood functional and esthetic results could be achieved by mid-term follow-up.ConclusionIn long-lasting penile strangulation with damaged blood supply, further surgery and treatment are needed in addition to immediate decompression. Most commonly in these situations, amputation seems to be the best and easiest action to be taken. However, our case shows that even in a most severe situation, careful conservative treatment allows preserving the phallus, and subsequently reconstruction enables reaching the best functional and esthetic results.

Renal tumor causing haematuria and sepsis

A 28 year old female patient developed hematuria in the 32th week of her pregnancy. She was given antibiotic treatment, since a urinary tract infection was suspected. After delivery symptoms of acute pyelonephritis, then sepsis developed, and conservative therapy had no effect. Ultrasound examination showed unusual renal destruction, so nephrectomy was performed. Surgical intervention revealed the presence of an advanced tumor of the kidney, while histological examination confirmed a Bellini duct carcinoma of the kidney.

Experiences in treatment and follow up of 50 patients with penile cancer

INTRODUCTION Malignant tumour of the penis is a rare disease. Although most of the cases are squamous cell carcinoma histologically, operation is managed by the urologist because of its location. AIM AND METHOD Experience with the treatment and attendance of penile cancer is presented by the author. Results were both retrospectively and prospectively worked up. RESULTS Between June 1996 and June 2006 there was operation performed in 50 patients. Mean age of men was 63.1 (31-83) years. Ninety-four percent of tumours were squamous cell carcinoma, 2 (4%) verrucosus carcinoma, in one case malignant melanoma. Pathological T stadium was T1 in 23 cases (46%), T2 in 19 (38%) patients, in 6 (12%) cases T3 and in 1 (2%) T4. Differentiation was grade 1 in 12 (24%), grade 2 in 27 (54%) and grade 3 in 10 (20%) cases. One side inguinal lymph node metastases were found in 11 (22%) and both side in 8 (16%) patients. In anamnesis 4 (8%) patients underwent circumcision because of phimosis, and 25 (50%) patients had had phimosis by identification of cancer. Seventeen patients (34%) were given chemotherapy after surgical treatment. Mean survival time of all patients was 31,4 (2-114) months. CONCLUSION Phimosis plays an important role in development of penile cancer, thats surgical treatment does not prevent the higher chance of incidence rate. The disease behaves aggressively, spreading through lymphatic vessels, where in advanced stadium, or in low differentiation cases it is already demonstrable by diagnosis. In the choice of therapy, stadium-oriented principle should be predominant. With early operation, long-term survival can be achieved.

Hímvessző-daganatos betegek kezelésével szerzett tapasztalataink@@@Experiences in treatment and follow up of 50 patients with penile cancer

INTRODUCTION Malignant tumour of the penis is a rare disease. Although most of the cases are squamous cell carcinoma histologically, operation is managed by the urologist because of its location. AIM AND METHOD Experience with the treatment and attendance of penile cancer is presented by the author. Results were both retrospectively and prospectively worked up. RESULTS Between June 1996 and June 2006 there was operation performed in 50 patients. Mean age of men was 63.1 (31-83) years. Ninety-four percent of tumours were squamous cell carcinoma, 2 (4%) verrucosus carcinoma, in one case malignant melanoma. Pathological T stadium was T1 in 23 cases (46%), T2 in 19 (38%) patients, in 6 (12%) cases T3 and in 1 (2%) T4. Differentiation was grade 1 in 12 (24%), grade 2 in 27 (54%) and grade 3 in 10 (20%) cases. One side inguinal lymph node metastases were found in 11 (22%) and both side in 8 (16%) patients. In anamnesis 4 (8%) patients underwent circumcision because of phimosis, and 25 (50%) patients had had phimosis by identification of cancer. Seventeen patients (34%) were given chemotherapy after surgical treatment. Mean survival time of all patients was 31,4 (2-114) months. CONCLUSION Phimosis plays an important role in development of penile cancer, thats surgical treatment does not prevent the higher chance of incidence rate. The disease behaves aggressively, spreading through lymphatic vessels, where in advanced stadium, or in low differentiation cases it is already demonstrable by diagnosis. In the choice of therapy, stadium-oriented principle should be predominant. With early operation, long-term survival can be achieved.

Hímvesszo-daganatos betegek kezelésével szerzett tapasztalataink

INTRODUCTION Malignant tumour of the penis is a rare disease. Although most of the cases are squamous cell carcinoma histologically, operation is managed by the urologist because of its location. AIM AND METHOD Experience with the treatment and attendance of penile cancer is presented by the author. Results were both retrospectively and prospectively worked up. RESULTS Between June 1996 and June 2006 there was operation performed in 50 patients. Mean age of men was 63.1 (31-83) years. Ninety-four percent of tumours were squamous cell carcinoma, 2 (4%) verrucosus carcinoma, in one case malignant melanoma. Pathological T stadium was T1 in 23 cases (46%), T2 in 19 (38%) patients, in 6 (12%) cases T3 and in 1 (2%) T4. Differentiation was grade 1 in 12 (24%), grade 2 in 27 (54%) and grade 3 in 10 (20%) cases. One side inguinal lymph node metastases were found in 11 (22%) and both side in 8 (16%) patients. In anamnesis 4 (8%) patients underwent circumcision because of phimosis, and 25 (50%) patients had had phimosis by identification of cancer. Seventeen patients (34%) were given chemotherapy after surgical treatment. Mean survival time of all patients was 31,4 (2-114) months. CONCLUSION Phimosis plays an important role in development of penile cancer, thats surgical treatment does not prevent the higher chance of incidence rate. The disease behaves aggressively, spreading through lymphatic vessels, where in advanced stadium, or in low differentiation cases it is already demonstrable by diagnosis. In the choice of therapy, stadium-oriented principle should be predominant. With early operation, long-term survival can be achieved.