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Background Objectives Materials and methods Results Conclusions Hypospadias with lichen sclerosus (LS) poses surgical challenges due to lack of materials for urethral reconstruction and coverage and the limited number of reports on this clinical condition.To report surgical strategies and outcomes for primary and redo hypospadias patients with LS.We conducted a retrospective observational descriptive study with 31 patients with primary/redo hypospadias and LS between 2013 and 2023. Of these patients, 9 had primary hypospadias with 7 distal types and 2 proximal types, and 22 were redo patients. Nineteen of the 31 patients underwent various surgical techniques, and 12 underwent the oral mucosa onlay procedure (OMOP). Postoperative uroflowmetry, hypospadias objective scoring evaluation (HOSE), and complications were evaluated.For primary distal hypospadias with LS‐affected skin, five patients underwent circumcision; these patients had normal postoperative urinary flow, and only one patient had an inconspicuous penis after surgery. For the patients with primary proximal hypospadias with an LS‐affected urethra, one patient required perineal urethrostomy following a modified Koyanagi procedure for recurrent stricture; the other patient underwent two‐stage transverse preputial island flap urethroplasty with no postoperative lower urinary tract symptoms (LUTS) and satisfactory aesthetic scores. In two remaining cases of primary distal hypospadias with meatus/urethral LS, no LUTS or postoperative complications occurred following meatoplasty/circumcision and penile basal fixation. During reoperations, compared with those of patients who underwent other redo procedures, twelve patients who underwent OMOP had better Qmax and uroflowmetry (p = 0.002) and higher HOSE scores (p = 0.01).For primary hypospadias patients with LS, enhanced exposure of the penile shaft and glans may benefit distal hypospadias, whereas staged surgery may be suitable for proximal hypospadias. The oral mucosa is favored for urethral augmentation in patients with redo hypospadias complicated with LS, and the OMOP can address neourethra coverage effectively. [ABSTRACT FROM AUTHOR]

Introduction: Vaginoplasty is performed to create a neovagina for transgender individuals who seek surgical transition or for cisgender individuals with congenital or acquired absence of a vagina (or "cisvagina"). The current knowledge of the bacterial microenvironment of the neovagina is limited. The objective of this study was to conduct a systematic review of current knowledge regarding the microbiome of the neovagina in transgender women. Methods: A systematic review of three medical databases (PubMed, MEDLINE, Web of Science) was performed in December 2021. Articles were included if they discussed the bacterial flora of the post-surgical neovagina in transgender women. Articles were excluded if their primary focus was pathogenic disease of the neovagina. Articles were summarized qualitatively and organized into a table. Results: Ten articles were identified for the review. Surgical techniques included penile inversion vaginoplasty (PIV) and intestinal/sigmoid vaginoplasty. PIV neovaginas were most similar to cisvaginas with bacterial vaginosis, whereas intestinal vaginoplasty resulted in microbiomes comparable to that of the colorectum. Oral probiotic supplements may be able to encourage the growth of Lactobacillus in the neovagina. Maintenance protocols relating to cleaning are largely surgeon- and institution-dependent, and evidence regarding the use of estrogen and its effect on the neovagina is limited. Conclusions: The microbiome of the neovagina is distinct from that of the cisvagina, and it differs based on surgical technique. Further research is warranted to better characterize the effect of different surgical techniques, patient characteristics, estrogen use, and cleaning habits on the health of the neovaginal microbiome. [ABSTRACT FROM AUTHOR]

Objectives: To describe a new penoscrotal reconfiguration technique, named "V‐I penoscrotal reconfiguration" for the surgical reconstruction of a congenital webbed penis (CWP). Methods: Twenty‐one patients who underwent the "V‐I penoscrotal reconfiguration technique" were included in this retrospective study. The CWP severity was assessed according to El‐Koutby's classification. Demographic and clinical data, surgical data, and postoperative outcomes were scheduled and analyzed. Specifically, the postoperative follow‐up included both physical and psychological assessments at 2 weeks, 1, 6, and 12 months after surgery. Parents' satisfaction degree was quantified by the Likert scale. Results: CWP was grade 3 in 11 (52%) patients, 2 in five (24%), and 1 (24%) in five. Five (24%) CWP were isolated malformations, 11 (52%) were associated with phimosis, three (14%) with hypospadias, and two (10%) with hypospadias and phimosis. There were no postoperative complications and no cases of redo surgery. The cosmetic outcomes were excellent in all cases: the parents' satisfaction score was 4 in 17 (81%) cases and 3 (9%) in the other four cases. Conclusions: CWP may cause psychological distress and functional problems, especially during sexual intercourse. Its correction in childhood is advocated to prevent psychological and sexual issues. The "V‐I reconfiguration technique" is simple, and easy with excellent cosmetic and functional outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Meatal stenosis and fossa navicularis strictures (FNSs) are commonly caused by lichen sclerosus and instrumentation. We present the technique and short-term functional outcomes of glans cap-preserving dorsal inlay-free graft augmentation for the reconstruction of meatal stenosis and FNS. Methods: This retrospective study analyzed patients with meatal stenosis and FNS who underwent glans cap-preserving dorsal inlay-free graft augmentation at our institute since 2019. The surgical technique included a ventral subcoronal approach, preservation and mobilization of the glans cap, a ventral midline urethrotomy incision over the stricture, and a dorsal midline meatotomy incision extending to the proximal normal urethral mucosa at the fossa navicularis, followed by dorsal inlay graft augmentation. During the follow-up, patients were periodically assessed for symptom scores, urinary flow rates (UFRs), and patient-reported outcomes. Results: A total of 26 patients with a mean age of 45 ± 15 years were assessed. The predominant cause of stricture was lichen sclerosus (n = 15; 58%). The mean stricture length was 3.8 ± 0.5 cm, 73% had a circumcised phallus, and an oral mucosa graft augmentation was performed in 22 (85%) patients. Notable postoperative complications included intractable meatal hemorrhage (n = 1) and glans suture granuloma (n = 1), which required intervention. At a mean follow-up of 40 months, there were four failures, of which one patient required redo-urethroplasty. The remaining patients (n = 22; 85%) showed improved symptom scores (P < 0.05), UFRs (P < 0.05), and satisfactory patient-reported outcomes. Conclusion: Glans cap-preserving dorsal inlay-free graft augmentation is a safe and feasible technique with satisfactory short-term functional outcomes for the management of meatal stenosis and FNS in carefully selected patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyze and explore the nursing effects of integrated medical and nursing care intervention in correction surgery for children with concealed penis. Methods: A total of 76 eligible patients with concealed penis were randomly divided into an observation group and a control group. The control group received conventional nursing care, while the observation group received integrated medical and nursing care intervention. Outcomes include pain levels, comfort status, incidence of complications, and nursing satisfaction were collected and analyzed to investigate the nursing effects of the integrated medical and nursing care model. Results: After 2/3 days of nursing intervention, the patients in the observation group had significantly lower pain scores (measured by FPS-R) compared to the control group (P < 0.05). The patients in the observation group also had significantly higher comfort scores (measured by Kolcabal) compared to the control group (P < 0.05). The incidence of complications in the observation group was significantly lower than that in the control group (2.63 vs. 23.68, P < 0.05). Parental satisfaction in the observation group was significantly higher than that in the control group (P < 0.05). Conclusion: The integrated medical and nursing care intervention in correction surgery for children with concealed penis demonstrated positive nursing effects. It effectively reduced pain, improved comfort, lowered the risk of complications, and increased parental satisfaction. This approach maximizes the role of nursing care and is recommended for clinical implementation. [ABSTRACT FROM AUTHOR]

Aim: Megameatus intact prepuce (MIP) is a rare form of hypospadias. Different meatal/urethral advancement and urethroplasty techniques are used in the treatment of MIP. This study aimed to evaluate the success of various surgical methods for the treatment of MIP. Materials and Methods: Patients who underwent circumcision, meatoplasty, and urethroplasty techniques due to MIP between 2011 and 2022 were included in this study. Surgical success was accepted as the absence of complications and/or the need for additional treatment. The statistical significance level was accepted as 0.05. Results: This study included 100 patients with a median age of 33 months. Of these, 94 patients were admitted to our center with untreated MIP, 5 presented after circumcision and 1 after MIP repair in another center. The urethral stent placement rate was significantly lower in those patients with a glanular meatus location as in patients who underwent the meatoplasty technique (p<0.001). The complication rate was significantly higher in the Duplay with Posterior Meatal Incision (DPMI) technique when compared to the other techniques (p=0.033). There were no significant differences between the meatoplasty, Duplay urethroplasty, Pyramid urethroplasty, and DPMI techniques in terms of the need for additional surgical intervention (p=0.102). None of the five previously circumcised patients who underwent Duplay urethroplasty experienced any complications. When the complication rates were compared between the patient group presenting with untreated MIP and those who underwent Duplay urethroplasty, no statistically significant difference was detected (p=0.534). Conclusion: According to the conclusions of this MIP series, prior circumcision or the preference for any specific surgical technique that preserves the urethral plate did not affect the success of MIP treatment. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between the quality of YouTube videos on penile enlargement surgery and the scholarly profiles of surgeons. Materials and Methods: A YouTube search was conducted using the keyword "penile enlargement surgery". Of the first 200 videos from the search results, 66 that met the study criteria were included in the analyses. Two urologists scored each video using the DISCERN score, the Journal of the American Medical Association (JAMA) score, and the global quality scale (GQS) in a double-blind manner. After the video quality scores were determined, the number of publications and h-indexes of surgeons were obtained from Google Scholar. Results: Of the videos, 31 (46.9%) were uploaded by plastic surgeons and 35 (53.1%) by urologists. The median duration of the videos was 4.1 min (interquartile range: 1-8.5) minutes. Eighteen (27.2%) videos had low quality, 9 (13.6%) had medium quality, and 39 (59.1%) had high quality. A statistically significant correlation was found between the h-index of surgeons and video quality scores (DISCERN, r=0.678; JAMA, r=0.646; GQS, r=0.689; p<0.0001). There was also a statistically significant correlation between the total publication counts of surgeons and the video quality scores (DISCERN, r=0.614; JAMA, r=0.569; GQS, r=0.607; p<0.0001). Lastly, a weak, statistically significant correlation was detected between the DISCERN scores of the videos and the number of likes (r=0.278, p=0.029). Conclusion: This study revealed a significant correlation between the quality of YouTube videos on penile enlargement surgery and the h-indexes and total publication counts of surgeons. This study was the first to analyze the relationship between the quality of YouTube videos on penile enlargement surgery and the scholarly profiles of surgeons. [ABSTRACT FROM AUTHOR]

In this paper, we present our experience with acute and chronic penile ulcers resulting from injection of an exogenous substance and their surgical treatment. [ABSTRACT FROM AUTHOR]

The care of skin grafts in the penile shaft is challenging because of its cylindrical shape and constantly changing length and lie, which makes it difficult to apply uniform compression and ensure immobilization during the critical period of skin graft take. These challenges are difficult to overcome with conventional dressings. The authors describe a technique of applying a double-opposing negative pressure dressing to sandwich the penile shaft following reconstruction with a skin graft, which is simple to apply and addresses these issues. Adoption of this technique may allow the reconstructive surgeon to manage skin grafts on the penile shaft with greater ease and confidence of optimum graft take. [ABSTRACT FROM AUTHOR]

An aesthetically and functionally pleasing phalloplasty is most commonly performed by a free radial forearm flap. However, the problem with donor site morbidity on the forearm remains unsolved. The aim of this study was to evaluate if the use of a dermal template such as MatriDerm® on the donor site significantly decreases the incidence of complications based on the Clavien–Dindo classification, such as wound healing disorders and reoperation rate, and if it could shortens the duration of hospital stay. A case series analysis was conducted at our institution. A total of 21 patients divided into two groups undergoing the phallic construction after the Gottlieb and Levine design in a single center underwent the donor site defect coverage either by MatriDerm® and split-thickness skin graft from the thigh or by full-thickness skin graft from the groin area. The use of MatriDerm® and split-thickness skin graft showed to have a statistically significant impact on the rate of complications (p = 0.008). Complications that were treated conservatively as well as that require surgical revision were significantly lower in the MatriDerm® group than in the full-thickness skin graft group (p = 0.002). Complications occurred not only at the forearm but also at the groin, where the full-thickness skin graft was harvested. The large dimension of the free radial forearm flap used for phalloplasty resulted in a significant donor site morbidity, leading to wound healing disorders, reoperations, and extended length of hospital stay. Therefore, we consider the use of dermal templates such as MatriDerm® as worth the additional effort and costs in this patient collective. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to share our outcomes, including complications and their management, of a "modified" penile inversion vaginoplasty (PIV) technique applied to transgender individuals, which we presume to be the first reported case series of a single center from Turkey. Methods: A cross-sectional study, including adult transgender cases who underwent male to female gender-affirming surgery in our institution, between January 2015 and December 2019, was planned. The same "modified" PIV technique, in which the spatulated urethra was incorporated to the penile skin flap, was applied to all cases. Demographic data including case characteristics, medical history with prior operative details, and complications detected during follow-up examination were collected prospectively. Results: The mean age of 30 cases included in the study was 31.03±7.05 years. The mean length of hospitalization after the surgical procedures was 10.13±2.24 days. The mean vaginal depth measured at postoperative 1st year follow-up examination was 14.2±2.95 cm. Satisfactory neovaginal moistening was reported by 24 (80%) cases. In 8 (26.6%) of 30 cases, no complication was reported at all. Intraoperative (rectal injury) and postoperative (meatal stenosis, vaginal narrowing, scars, infections, etc.) complications occurred in 22 (63.4%) cases. Postoperative satisfaction rates including mental, physical, and social health in general were found to be 81.84% (66–98%). Conclusion: The "modified" PIV can be used as a preferred technique showing high satisfactory outcomes, especially in cases with short penile skin or circumcision, due to the achievable lubricity and vaginal width/depth. [ABSTRACT FROM AUTHOR]

Objectives: Our study aimed to compare the efficacy of transdermal dihydrotestosterone and testosterone enanthate in treating idiopathic micropenis. Patients and methods: It's a comparative randomized study of 49 patients with idiopathic micropenis who are followed up in the Endocrinology-Diabetology and Nutrition Department of Mohammed VI University Hospital Center of Oujda, Morocco. The study was conducted from December 2019 to April 2021. All patients received a clinical examination including measurement of penis size before and after hormonal treatment. The patients were divided into two random groups, each group received a different drug, the first arm was treated with transdermal dihydrotestosterone (27 patients) and the second arm was treated with testosterone enanthate (22 patients). The Trial registration number was researchregistry7745. Results: The majority of the patients were children. The mean age was 9.7 ± 4.4 years. In the first arm, the mean penile size increased from −2.42 SD to −0.7 SD with a gain of 2.37 cm on average. In the second arm, the mean size increased from −2.48 SD to −0.69 SD, with a gain of 1.82 cm on average. The increase in penile size in the first arm was significantly greater than in the second arm (P =.008). No side effects were detected in both arms. Discussion and conclusion: In the present study, we demonstrated the superiority of transdermal DHT compared to injectable exogenous testosterone in the treatment of idiopathic micropenis. According to the age subgroups, there was no significant difference between the 2 treatments in each age group. [ABSTRACT FROM AUTHOR]

Background: Phalloplasty in transgender men is performed with or without Urethral Lengthening (UL). To create clear expectations in the choice of UL, an overview and comparison of outcomes is useful. Aims: To provide and compare surgical outcomes and urinary functioning after phalloplasty with versus without UL in transgender men. Methods: A single-center, retrospective chart review was conducted among transgender men who underwent phalloplasty with or without UL between 01-2013 and 10-2020. Primary outcomes were differences in complication and reoperation rates. Secondary outcomes were end-stages of voiding at last follow-up and differences in voiding analyses pre- and postoperatively. Results: Of 136 men, 91 (67%) underwent phalloplasty with, and 45 (33%) without UL. Wound infection (31 vs. 16%, p = 0.06) and partial flap loss (35 vs. 13%, p = 0.008) were predominately seen after UL. In the UL group, 43% urethral fistulas and 60% urethral strictures were observed, relative to one man without UL who had a urethral fistula (both p < 0.001). Meatal or perineal orifice stenosis was seen in 29% with versus 11% without UL (p = 0.02). Reoperation was needed in 81% with versus 27% without UL (p < 0.001). At follow-up, 80/91 (88%) after UL reached end-stage of voiding, with 60/80 (75%) able to void while standing and 20/80 (25%) having a definitive urethrostomy. The remaining 11/91 (12%) men were awaiting further treatment for urological complications. The men able to void while standing had a median of one reoperation (range 0–6), and a significant decrease in maximum flow rate on postoperative uroflowmetry (21.4 vs. 29.8 mL/s, p < 0.001). After phalloplasty without UL, all men had a definitive perineostomy without changes in voiding analyses. Discussion: The choice for or against UL during phalloplasty has become more relevant over the years. This comparison of surgical outcomes and urinary functioning can be useful in the shared decision-making process to come to the most suitable choice of phalloplasty. [ABSTRACT FROM AUTHOR]

Phalloplasties are one of the most performed genital surgeries in the treatment of gender dysphoria for transmasculine patients. Urethral lengthening is an essential component of phalloplasties. Few techniques have been described for the creation of this pars fixa urethra. The purpose of this article is to present the Montréal Classification for pars fixa urethral lengthening, to detail the surgical techniques and to report on clinical outcomes. All patients undergoing phalloplasty from November 2016 to February 2019 were included in this study. Patient demographics, type of surgery and urological complications were recorded. Statistics were performed using student's T-test, Chi-squared test, Fisher's exact test and One-way ANOVA. Patients underwent either type 1, type 2, or type 3 urethral reconstruction. Of the 84 total patients, 45 underwent type 1 lengthening, 28 type 2, and 11 type 3. Eighteen and 33 patients underwent single-stage and two stage anastomosis of the pars fixa to the pars pendulans neourethra, respectively. Thirty-three patients have not had any additional surgeries to date. Post-operative urological complications for immediate anastomosis and two-stage anastomosis were reported in 77.7% and 18.2% of patients, respectively. We propose a classification as well as a description of three types of urethral lengthening techniques. Over the last few years, we have shifted away from single-stage anastomosis and have adopted a two-stage anastomosis technique. Our experience allows us to classify urethral lengthening and to standardize care depending on patient characteristics, leading to excellent results. [ABSTRACT FROM AUTHOR]

A 3-year-old Lori-Bakhtiari ram with a history of a mass on the penis was referred to the veterinary teaching hospital of Shiraz University. The owner reported that the presence of the mass prevents the penis from returning to the prepuce. On physical examination, a 3.5cm x 2cm x 2cm mass on the penis was observed. After preparation, the mass was removed and its both sides were sutured. At this time, penis was simply returned into the prepuce and no recurrence was observed until seven months follow-up. No complication was noted in days after surgery. The removed mass was examined histopathologically. Microscopically, the mass was diagnosed to be a fibropapilloma. Although penile fibropapillomas have been described in bull and horse, to the best of authors' knowledge, no report was published about incidence of penile fibropapilloma in ram. Vaccines and immunization are crucial strategies to prevent and reduce the recurrence rate. [ABSTRACT FROM AUTHOR]

Nous présentons ici le cas d'un patient de 38 ans ayant bénéficié d'une phalloplastie faite par lambeau perforant thoracodorsal avec conformation par enroulement en double tube. Alors que la chirurgie de reconstruction de verge a vu une efflorescence de différentes techniques opératoires, la chirurgie de réassignation femme-homme qui en découle voit ces procédés se résumer a deux ou trois options. Si le temps préopératoire fait classiquement l'objet d'une discussion avec le patient d'un allongement des voies urinaires ou non ou encore d'une implantation secondaire ou non, le choix du site donneur reste trop systématisé. Le prélèvement d'un lambeau n'est pas sans risque. L'attention est trop souvent portée sur le site reconstruit au détriment du site prélevé. Dans le cas présent, la laxité de la région dorsale avec possibilité de fermeture directe nous a fait retenir le prélèvement d'un lambeau perforant thoraco dorsal. La fonction musculaire du site donneur est préservée et l'aspect esthétique affiné par fermeture directe. La finesse du lambeau obtenu a permis la conformation par enroulement en double tube tel que décrit par Chang. La revue de la littérature rapporte un cas de phalloplastie par lambeau perforant thoracodorsal avec allongement des voies urinaires par greffe. Aucun cas n'est décrit avec conformation en double tube à notre connaissance. This article deals with a clinical case of a tube in a tube TDAP phalloplasty in a 38 years old trans-man. While penis reconstruction surgery aroused an efflorescence of different operative techniques, the resulting female to male surgery sees these procedures boil down to two or three flaps. If we usually discuss before surgery about the way to lengthen the urinary tract, as the way to implant later for intercourse; the choice of the donor site remains too systematized. Surgeons commonly focus on the reconstructed site prior to the donor site. In this case, laxity in the back and reliability of direct closure make us harvest the thoracodorsal perforator flap. Dissection of perforators saves muscular function and direct closure afford an aesthetic result less visible than a graft on the forearm. The thin flap we harvest allows tube in tube phalloplasty so that phallus and urethra are being built in the same time. One case has been reported in the literature of thoracodorsal perforator flap phalloplasty with grafted urethra, but no case of tube within a tube TDAP phalloplasty. [ABSTRACT FROM AUTHOR]

Background The ongoing quest to surgically create the (nearly) ideal neophallus in transgender men has led to the continuous development of transgender medicine and the proposed introduction of penis transplantation. However, both technical and ethical issues arise when developing this treatment. Aim We sought to extract ethical considerations among different stakeholder groups regarding penile transplantation surgery in transgender men and to define preliminary clinical recommendations. Methods Three semistructured focus groups, consisting of different stakeholders, were organized to participate in discussions of ethical considerations retrieved from the ethics literature of transplantation and transgender medicine. Analysis of the results was performed according to empirical ethics. Outcomes Study outcomes were the identification of qualitative themes describing ethical considerations pertaining to penile transplantation in transgender men. Results Nineteen people participated in this qualitative study. The main domains that emerged included arguments in favor of and arguments against penile transplantation. Although the participants expressed positive attitudes toward developing this care, with acknowledgement of the current limitations stakeholders of all groups were reluctant to endorse the introduction of penile transplantation for transgender men at this point. Clinical Implications Under the present circumstances, all groups expressed both a wide variety of ethical considerations as well as a tendency to prefer developing alternative treatment options or improving the results of currently available treatments in relation to penile transplantation for transgender men. Strengths and Limitations This study was the first (empirical) study to focus on this topic and included a diversity of stakeholder perspectives. Limitations included the hypothetical nature of the discussion as well as the clinical setting in which the topic has been studied. Conclusion Introducing penile transplantation for transgender men, under the current circumstances, comes with a wide range of ethical considerations, which deal with personal identity, autonomy, medical risks, risk for transgender support and donor willingness, and issues regarding equality. Despite the present hesitancy to use penile transplantation, should the technical side of this treatment option develop, further research in the ethical field of penile transplantation for transgender men is recommended. [ABSTRACT FROM AUTHOR]

Background: Men of various ages feel that an increase in penile size would give them and their sexual partners an increased confidence. There are a variety of methods for increasing penile girth, such as injection therapies and surgery. All of these methods have a high complication rate which must be emphasized to the patients. In this article, the techniques used for increasing penile girth using dermofat grafts and SEPA (superior external pudendal artery) flaps are highlighted along with their complications and their management thereof. Patients and Methods: Ten patients were operated for penile girth augmentation between June 2016 and March 2022. Of these, six patients had augmentation using dermofat grafts and four patients had SEPA flaps. Patients were chosen as per the Augmentation Phalloplasty Patient Selection and Satisfaction Inventory (APPSSI) score which was between 2 and 6 in the preoperative period. The age range of the patients were between 25 and 57 years. The mid-penile girth in the flaccid state ranged from 8.8 to 12.3 cm. Results: Post-operatively, after 6 months, the final girth increase varied from 1.9 to 2.6 cm. The complication rate was 50% and included skin loss, urinary obstruction, fat necrosis, and so on. The post-operative APPSSI score ranged from 2 to 12. Complications were more in uncircumcised patients and in those who desired excessive augmentation. Conclusion: Penis girth augmentation using SEPA flaps and dermofat grafts is indicated in patients who fulfill the criteria and give appreciable girth increase, but patients need to be aware of the potential complications of these surgeries. [ABSTRACT FROM AUTHOR]

Primary buried (BP) penis is describes as a small penis caused by a penile ligaments anomaly; it is unclear if a primary BP could reach a normal length. We selected 49 patients treated at our institution between 2015 and 2020 in order to post-operatively evaluate the SPL after one year. SPL was evaluated according to the PH Tanner staging system for pre-pubertal patients according to age-normalized values. A micropenis was detected if the SPL was below 2.5 SD. A normal SPL was found in thirty-two patients, eighteen were in PH Stage 1, four were in PH Stage 2, six were in PH Stage 3, and four were in PH Stage 5. Seventeen patients showed a reduced SPL; in seven of these (four in PH Stage 4 and three in PH Stage 5), their SPL was <2.5 ST. The difference in micropenis prevalence between the pre-pubertal and post-pubertal patients was significant (p = 0.038). A primary BP grows normally during the pre-pubertal period, where patients frequently showed a normal SPL, but it seems to be unable to reach a normal length in the higher PH stages, where the SPL is used to detect a micropenis. We suggest that a primary BP should be considered not as a simple defect of the penile ligaments and surrounding tissues, but as an incomplete manifestation of a micropenis due to a growth slowdown of the organ in late puberty. [ABSTRACT FROM AUTHOR]

Erectile dysfunction (ED) is a common condition that has a substantial impact on quality of life. It is described as the continuous inability to develop or maintain sufficient stiffness of the penis to allow satisfactory sexual performance. Early detection and treatment of ED and comorbidities associated with ED, such as hypertension, diabetes mellitus, and hyperlipidemia, can significantly improve the quality of life for men and their partners. About 35.6% of Indonesian adults have ED. The bulk of ED treatments now on the market are pharmacological and surgical procedures. Even though there has been substantial progress, it seems that the aforementioned treatment has a high dropout rate due to cultural restrictions and taboos. These patients would then look for herbal nutritional supplements like ginseng as an alternative. This systematic review evaluates the current evidence for the effectiveness of red ginseng in managing erectile dysfunction. We performed systematic review conducted from MEDLINE, ScienceDirect, ProQuest. The authors screened the articles based on inclusion criteria: (1) Mild-to-moderate erectile dysfunction; (2) Ginseng as interventional therapy; (3) Human studies that have IIEF score as an outcome; (4) Written in English. Four randomized control trials (RCT) using keywords "((Erectile Dysfunction) AND (Korean Ginseng) AND (Ginseng))" were included. Three randomized control trials (RCT) study involving 454 male patients with mild to moderate erectile dysfunction, aged from 20 to 70 years old. Our findings support that the mean in International Index of Erectile Function scores were significantly higher in patients treated with Korean ginseng than in those who received placebo. Korean ginseng could be an effective alternative treatment for male erectile dysfunction if more research with larger-scale clinical trials and higher standards is done in the future on the safety and effectiveness of ginseng. [ABSTRACT FROM AUTHOR]

Surgeons often encounter patients with realistic goals yet who desire unrealistic means of achieving them. This tension is compounded when surgeons consult with patients eager to revise a prior gender-affirming procedure completed by another surgeon. Two key factors of ethical and clinical relevance are that (1) a consulting surgeon's job is complicated when a population-specific evidence base is lacking and (2) a patient's marginalization is exacerbated by their having suffered the downstream effects of compromised initial access to comprehensive, realistic surgical care. This case commentary about revision of gender-affirming phalloplasty canvasses the pitfalls of a limited evidence base and focuses on strategies surgeons can use to help guide consultation. In particular, informed consent discussion may need to reframe a patient's expectations about clinical accountability for irreversible interventions. [ABSTRACT FROM AUTHOR]

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Background & Objectives: Caudal epidural and dorsal nerve penile blockade are commonly used for analgesia during and after hypospadias repair in children. Comparative studies to recommend the most effective block are in dearth. This study aims to compare penile block versus caudal block with bupivacaine for hypospadias repair in children in terms of post-operative effectiveness, pain management, and complications. Methodology: The study was conducted on 60 male children, aged 1-9 years, undergoing hypospadias surgery under general anesthesia. The subjects were randomly divided into two groups: (A: caudal block, n=30, and B: penile block, n=30). A postoperative pain assessment was conducted using FLACC scale until 24 hours post-surgery. Results: The patients from the A and B groups were comparable in age, weight, and ASA classification. All patients in the 2 groups did not feel pain post-operatively throughout the first 6 hours. One patient (3.4%) from each of the A and B groups started to feel pain 6 hours, and 9 hours, respectively after surgery. Eight patients (26.7%) in group A and 6 patients (20%) in group B felt pain throughout 6 to 24 hours after surgery. Four patients from group A and 1 patient from group B developed nausea and vomiting during the first 24 hours post-surgery. Conclusion: The penile blockade proved to be more effective in lowering postoperative pain scores, with fewer side effects, thereby decreasing the need for rescue analgesia. [ABSTRACT FROM AUTHOR]

Ritual circumcision in children remains a trivialized procedure in some countries, especially in rural areas. It is often performed by unqualified paramedical personnel, or even by religious workers whose notions of surgery and asepsis are uncertain. Although it is thought to be a minor procedure, major complications with sexual or even life-threatening prognosis can occur. Amputation of the glans during circumcision is a rare incidence secondary to poor application of operating principles. We report the case of a 1 1/2-year-old boy who underwent a progressive amputation of the glans after a ritual circumcision by a religious worker. The child was brought 10 days after the procedure with totally amputated, nonsalvageable glans. A urethral meatoplasty was performed to enable proper voiding and prevent meatal stenosis. The child has been in follow-up for the past 6 months without any urinary symptoms. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Penile inversion vaginoplasty (PIV) remains the gold standard technique for vaginoplasty, a gender-affirming feminizing surgery, but has been associated with urinary complications; however, there is little literature synthesizing urinary complications after PIV surgery, and there is a need to compile these complications to counsel patients pre- and postoperatively on managing surgical expectations. In this systematic review, we summarize the prevalence of urinary complications following PIV. METHODS: We searched the MEDLINE, EMBASE, CINAHL, and Scopus databases in July 2020. The primary outcome was the prevalence of urinary and surgical complications in patients after penile inversion vaginoplasty. Pooled prevalence was determined from extrapolated data. ROBINS-I tool was used to assess study quality. The study was prospectively registered on PROSPERO (CRD42020204139). RESULTS: Of 843 unique records, 27 articles were pooled for synthesis, with 3388 patients in total. Overall patient satisfaction ranged from 80-100%. The most common urological complications included poor/splayed stream (11.7%, 95% confidence interval [CI] 5.7-19.3), meatal stenosis (6.9%, 95% CI 2.7-12.7), and irritative symptoms (frequency, urgency, nocturia) (11.5%, 95% CI 2.6-25.1). Other urinary complications included retention requiring catheterization (5.1%, 95% CI 0.3-13.8), incontinence (8.7%, 95% CI 3.4-15.6), urethral stricture (4.6%, 95% CI 1.2-9.8), and urinary tract infection (5.6%, 95% CI 2.7-9.4). Most pooled studies had moderate risk of bias. CONCLUSIONS: The available evidence suggests that there is a low prevalence of urinary complications following PIV. Overall, there is a need for standardization of data in transgender surgical care to better understand surgical outcomes and improve postoperative management. [ABSTRACT FROM AUTHOR]

Background: The current war in Ukraine is associated with frequent applications of multiple-launch rocket systems and cruise missiles as well as other various high-energy weapons to cause severe injuries in military personnel including abdomen wounds, vascular injury, and limb amputations as well as genitourinary trauma. The aim of this report is to demonstrate a case of successful penile salvage by restoring its function in a combat patient with gunshot genitourinary trauma in conditions of an interrupted supply of medical equipment. Case presentation: We describe a case of a 48-year-old male patient with a combined shrapnel gunshot wound to the penis with damage to the urethra and combined injury to the soft tissues of the left thigh. Several hours after the injury, the patient underwent primary surgical debridement of the left thigh, ligation of the great saphenous vein of the thigh, primary sutures on the penile urethra and navicular fossa, suturing of the rupture of the head and penis, drainage of the wound, catheterization of the bladder, and epicystostomy. An artificial erection was performed intraoperatively. The urethral catheter was removed 3 weeks after urethral suturing (May 4, 2022). The epicystostomy was removed 5 months after the injury (August 4, 2022) and 2 days after the restoration of spontaneous urination. At the follow-up of 7 months after the injury, the patient has normal urination with minor urinary dribbling, sufficient erection, and ejaculation. Conclusions: We have shown that in a case of gunshot wounds to the penis and hanging part of the urethra, even in the presence of combined severe purulent lesions of non-urological localizations, it is possible to perform a primary reconstruction of urogenital injuries using a primary urethral suture and applying a negative pressure device. Findings from this case report shed new light on the management of penile gunshot injury in ongoing warfare as well as provide evidence of the possibility to perform adequate management for penile injury in conditions of limited medical resources, violation of international humanitarian law, and under frequent strikes of high-energy weapons. [ABSTRACT FROM AUTHOR]

The comment by Daniel Barth discusses the difficulties Elisabeth Imhorst faces in analyzing trans patients. A 15-year-old girl who is undergoing analysis does not want breasts or testosterone, but also does not want a penis plastic surgery. She explains that she does not want to be a girl or a boy, but would rather be a cat in order to avoid dealing with her own identity. The author discusses the creation of identity as an important task of adolescence and emphasizes that the question of gender is closely related to identity formation. He notes that there are different views on trans people in psychoanalysis and that Imhorst takes a third path by focusing on psychoanalytic technique and attitude. The author also refers to the authors François Jullien and Erika Kittler to discuss the concept of distance and the double origin of the subject. The text addresses the formation of identity and the challenges faced by trans people. It emphasizes that identity requires boundaries and that understanding the other is not always helpful. Adolescents draw attention to the impossibility of definitive answers and communicate their distress through projective identification. The text concludes with the importance of dialogue between patient and therapist in allowing for distress. It is also mentioned that a cat serves as the analysand and has discovered the value of encountering others. [Extracted from the article]

Background: The penis has always been considered the symbol of masculinity, and the sexual potency and even the reproductive capacity of men are often mistakenly associated with its size. Traditionally, penis enlargement procedures have been reserved for patients with true congenital micropenis or an acquired reduction in penile size. Procedures involving injections and surgery are commonly used to increase penile circumference and length in hospital settings. Aim: To review the literature to synthesize clinical evidences related to techniques for penile enlargement. Methods: This is an exploratory study, based on the literature review method with evidence synthesis. The database chosen for the selection of papers was PUBMED, using the following search strategy: (penis[title] OR penile[title]) AND (enlargement[title] OR enhancement[title]). After reading the titles and abstracts, studies that did not address penile enlargement techniques were excluded from the study. Results: Initially, 23 studies were identified that met the previously established search strategy. After reading the titles and abstracts, it was found that 10 were suitable for this review. Conclusion: Techniques for both stretching and increasing the circumference of the penis were evaluated. In addition, three new techniques have been described, with good aesthetic and functional results. [ABSTRACT FROM AUTHOR]

The article presents two case studies of 54-year-old patient and 32-year-old male, with penile fractures repaired under conscious sedation. Topics discussed include the etiology of penile fractures, delayed surgical management in rural areas, and the potential benefits of performing the procedure under conscious sedation, such as cost savings and improved patient outcomes.

Introduction: The objective of this article is to describe surgical techniques for the management of localized penile cancer concurrent with adult acquired buried penis. Penile cancer, while rare, invariably impacts quality of life as the primary surgical management ranges from local excision to total penectomy. Penile cancer has recently been linked to adult acquired buried penis (AABP) with the hypothesis that chronic inflammation of the penis contributes to risk of penile malignancy. Buried penis reconstruction is now a well-described procedure involving escutcheonectomy and split thickness skin grafting which has been shown to improve quality of life in individuals with adult acquired buried penis.Technical Considerations: This report describes a patient with AABP requiring partial penectomy and inguinal node dissection who also underwent adult acquired buried penis repair during his procedure. A review of cases of buried penis cases was carried out and four other cases of penile cancer were identified who were managed with penile preserving procedures.Conclusions: This combination of surgical techniques strives to improve quality of life and facilitate cancer surveillance without compromising oncologic outcomes. [ABSTRACT FROM AUTHOR]

Background: Two stage urethroplasty for proximal penile hypospadias is time consuming, expensive and; traumatic both for parents and phallus. On the other hand, single stage procedure technically demanding. We would like to describe Extended Ulaanbaatar Procedure (EUP) which is not a two stage procedure. Rather, might be called as 'extended single stage' procedure. In EUP we have done orthoplasty along with urethroplasty with preputial skin graft at same sitting as primary procedure keeping urination diverted through proximal hypospadiac meatus as "controlled fistula" which was closed after six months as secondary procedure. Methods: We operated on 35 patients of proximal penile hypospadias with moderate to severe chordee. Chordee was excised till correction of curvature. Two distracted cut ends of native plate was bridged with preputial skin graft (PSG) in between. Following that, silastic tube was placed over glandular plate as scaffold, on both cut ends of native plate and PSG. All the urethral plates and PSG were buried with tunica vaginalis flap before glanuloplasty. After six months, proximal "controlled fistula" was closed with scrotal dartos fascia and skin to join distal to proximal urethra. Results: Vertical meatus in glans was found in 32 patients. One patient had glans dehiscence, two patients had medium sized fistula, another two patients had stenosis in neourethra and six had suture track fistula. Twenty-nine patients had satisfactory curve with good flow in uroflowmetry as per nomogram at sixth month of follow up. Conclusion: In classic Ulaanbaatar procedure authors do distal urethroplasty and glanuloplsaty in 1st stage following orthoplasty to avoid repeat trauma in glans in repeat procedures. Left over urethroplasty in classic Ulaanbaatar was done in 2nd stage. However, in EUP; we did urethroplasty for full length following orthoplasty as primary procedure. This procedure is less invasive than two staged as we avoided repeat degloving and repeat dissection on operated tissues. Urethroplasty done as primary procedure shunned the need of repeat degloving, decreased the period of morbidity, stay, and cost of surgery. We also avoided problems of urination through not matured, long, neo-urethra. Similarly complications i.e disruption, stenosis in neo-urethra can be managed utilizing the advantages of urinary diversion. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate the parents' view of the cosmetic outcome after hypospadias surgery. Materials and Methods: Between January 2017 and December 2020, 70 patients aged between 2 and 7 years underwent surgical correction of hypospadias. Group 1 had 35 patients (coronal: 6, distal: 19, and mid-penile: 10) assigned for tubularized incised plate urethroplasty (TIPU) with modified foreskin reconstruction. Group 2 had 35 patients (coronal: 4, distal: 22, and mid-penile: 9) assigned for TIPU and circumcision. Parents were assessed with the Pediatric Penile Perception Score (PPPS). Results: Parent satisfaction for the position and shape of the urethral opening, shape of the glans, penile skin, and length exhibited no statistically relevant difference between the group. Parent satisfaction with the appearance of the genitals in Group 1 was relatively high 2.60 ± 0.55, as compared to Group 2 1.77 ± 0.49 which is statistically significant (P < 0.00028). Conclusion: Our experience shows good early cosmetic results of foreskin reconstruction and high parental satisfaction. Foreskin reconstruction should constitute a key element of the final result to restore a penis with an appearance as normal as possible. [ABSTRACT FROM AUTHOR]

Background: Gender-affirming surgery leads to high satisfaction for patients; however, patients often require revision surgery. Revision labiaplasty is one of the most common surgeries following vaginoplasty. The labia minora commonly become incorporated into the labia majora and lose definition even after revision leading to patient dissatisfaction. Description of Technique: We propose a technique of incorporating cadaveric costal cartilage allograft into the revised labia minora to increase the definition. Patient and Methods: The procedure was demonstrated in a 38-year-old MTF patient who had previously undergone inversion vaginoplasty. The cartilage allograft was incorporated within the labia minora flaps during labiaplasty. Results: The patient had lasting definition of her labia minora post-operatively at 6 weeks without adverse effects. Conclusion: We believe that this technique may be effective and safe in patients requesting more defined labia minora after vaginoplasty. [ABSTRACT FROM AUTHOR]

Introduction: In pediatric surgery, proxy decision-makers are frequently involved in treatment planning and may experience decisional conflict (DC). Shared decision-making (SDM) approaches may be effective to remedy DC. This study investigates DC and SDM involvement in elective pediatric penile surgery. Methods: Forty-four parents of children aged <8 years undergoing elective penile surgery consultations at a tertiary pediatric hospital were prospectively enrolled. Patient and physician questionnaires were used to assess the SDM process and the SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) screening test was used to assess DC. Results: Thirty-seven (84.1%) mothers and seven (15.9%) fathers were enrolled for circumcision (n=33, 75.0%) and distal hypospadias repair (n=11, 25.0%) consultations, with 21 (47.7%) choosing to proceed with surgery. Seven (15.9%) participants experienced clinically significant DC. Participant gender was not associated with higher levels of DC (p=0.318). The average patient and physician SDM scores were 88.2±10.0 and 85.3±7.4, respectively, with no correlation found between participant and physician perception of SDM involvement (p=0.168, p=0.276). DC was significantly associated with lower participant and physician ratings of SDM. Conclusions: There was a high perception of SDM involvement by both parents and pediatric urologists regarding elective penile surgery. Of the 15% of parents experiencing DC, there was an association with lower participant and physician levels of SDM involvement. Despite high SDM scores overall, discrepancies exist between the perceived physician and participant SDM involvement. [ABSTRACT FROM AUTHOR]

Penetrating trauma to male external genitalia is a rare trauma case. It accounts for 20% of all genitourinary trauma cases, and penile involvements are presented between 10-16% of all cases. Male genital trauma is considered a urological emergency due to the high risk of infection, sexual dysfunction, and infertility. In this work, a 17-year-old male patient presented with scrotal and penile injuries due to a low-velocity gunshot wound. Genital examination revealed tissue loss in the foreskin, glans, anterior urethra (distal third), cavernous corpora, and total loss of right testis with a scrotal laceration. The patient was treated with partial penectomy, penile reconstruction, and urethral repair with an excellent uneventful postoperative cosmetic and functional outcome. In conclusion, penetrating male external genital injuries are rare with extremely serious consequences due to the functional, psychological, and aesthetic consequences. The best treatment with penile reconstruction and urethral and cavernous corpora repair may be achieved. [ABSTRACT FROM AUTHOR]

Background: A thorough evaluation of the functional outcomes resulting from supra-pubic phalloplasty (SPP) assessing different aspects of the phalloplasty technique has not been reported., Purpose of the Study: To report the outcomes on sexuality, urinary function, satisfaction, and regrets following SPP performed at our centre., Subjects Studied: All consecutive patients who underwent the three-step technique of pre-expanded SPP between 2007 and 2018 and who had at least one year of follow-up., Methods: Questionnaires were sent to analyse several domains of penile reconstruction: sexuality, urinary function, perceived sensitivity, and satisfaction. Sexuality was evaluated using the Self-Esteem And Relationship (SEAR) questionnaire. Urinary function was analysed based on the urethral stricture surgery patient-reported outcome measures (USS-PROM) questionnaire., Main Findings: A total of 77 patients were included, 92.2% were transmen, and 33 (42.9%) responded to the questionnaire. Urethral lengthening (UL) was performed in 28 (36.4%) procedures, and erectile prosthesis was implanted in 42 patients (54.5%). The mean length of the neophallus was 15.3 cm (standard deviation [SD] 2.6), and the mean girth was 11.8 cm (SD 2.1). The mean total SEAR score (/100) was 73.8 (SD 26.7). The mean six-item lower urinary tract symptom score (/24) was 8.4 (SD 4.6). The standing position was the usual voiding position reported by 11 patients (73.3%)., Conclusion: Pre-expanded SPP is a robust technique that can achieve substantial flap dimensions, leading to high satisfaction with neophallus appearance and the choice of the phalloplasty technique. Overall, sexual outcomes are mostly favourable. UL is feasible and effective in terms of voiding in a standing position., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: To prospectively assess surgical outcomes, complications, and patient-reported tolerability of invasive scrotal surgeries under local anesthesia (LA) alone, without sedation, compared to tolerability of penile procedures commonly performed in this manner., Methods: Adult patients undergoing penile and scrotal surgeries under LA only were enrolled from August 2022 to June 2023 (NCT05617261). Demographics, surgeon-perceived and patient-reported pain, and surgical variables were collected. Tolerability to the procedures and future anesthetic choice for a repeat procedure was assessed on follow-up. Complication data were collected, including recurrence, infection, excessive pain, and emergency room and family physician visits., Results: Hundred and seven patients were enrolled with a mean age ± SD of 42.2 ± 16.4 years. There was a 100% procedural success rate and no cases of perioperative complications or escalation of anesthetic. Around 92.4% (n = 97) of patients indicated they would opt for LA only for a hypothetical repeat procedure. Of the minority opting for general anesthetic, most indicated discomfort or preferring an element of amnesia. No differences between intraoperative pain or tolerability scores of invasive scrotal procedures compared to penile procedures were observed. On univariate analysis, longer procedure duration (P = .003), cannabis use (P = .01), and higher intra-operative pain (P = .005) was associated with lower tolerability., Conclusion: LA alone in an office-based setting is promising for scrotal surgeries. It offers similarly high patient tolerability compared to procedures that are routinely performed under LA, with the preservation of outcomes. Adopting this method has the potential for substantial cost savings, reduced wait times, enhanced accessibility, and improved surgical efficiency., Competing Interests: Declaration of Competing Interest Premal Patel—consultant for Boston Scientific Corporation; the remaining author declares that they have no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Nesbit's procedure remains a cornerstone in surgical management of Peyronie's disease, despite the subjective loss of penile length. This retrospective study demonstrates that the perceived length loss has already occurred prior to surgery and that the Nesbit's procedure does not produce additional loss of length. Ninety-one patients who had undergone Nesbit's procedure between 2017 and 2022 at the Department of Urology of the University of Trieste were enrolled in the study. Preoperative stretched penile length and postoperative stretched penile length were measured. The curvature was uniplanar in 78 patients and biplanar in the remainder. Mean degree of the main curvature was 52.58° ± 14.13° and mean number of plications was 2.42 ± 1.07. Analysis revealed that the median of the differences between preoperative stretched penile length and postoperative stretched penile length was not significant (p = 0.466). According to our results, no significant penile shortening occurs as immediate consequence of Nesbit's procedure, as length is defined by the shorter side of the shaft affected by Peyronie's disease. Hence the length loss should have to be attributed to Peyronie's disease itself and could have been accurately predicted preoperatively allowing for a more accurate counseling of patients. Further studies are pending to assess potential postoperative loss of length due to scarring contracture., Competing Interests: Competing interests: The authors declare no competing interests. Ethics approval: This is a prospective non-interventional study conducted on patients treated by the law and the national and European ethical guidelines. All Authors ensured that their institutions and their clinical behavior are complying with the specific requirements of the Country. Informed consent statement: Informed consent was obtained from all subjects involved in the study. The informed consent as well as the consent for the use of personal data were regularly collected from all the subjects involved in the study. Signed informed consent forms are stored in an appropriate repository., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Patient satisfaction after inflatable penile prosthesis (IPP) has been linked to preexisting curvature; however the association with intraoperative asymmetric corporal measurements (ACM) has not been well described. We sought to identify incidence of ACM during IPP surgery, and relationship to penile curvature. A retrospective review of all patients undergoing primary IPP placement between 6/2019 and 6/2021 was performed. Logistic regression analysis was performed to identify factors associated with ACM and need for adjunct straightening techniques. A total of 273 patients underwent primary IPP. 27.8% had Peyronie's disease (PD) diagnosed preoperatively or detected intraoperatively. ACM was identified in 20.1% (55/273) patients. There was no significant difference in ACM in PD versus non-PD patients (p = 0.55). Most patients with ACM (78.2%, 43/55) underwent placement of asymmetric device. ACM did not predict need for invasive straightening maneuvers (p = 0.12). However ACM patients were significantly more likely to have mild residual curvature than those with symmetry (p < 0.0001). Our study is first to address management of idiopathic ACM and association with curvature, providing new insight into a common situation. While ACM was detected in 20%, it did not predict need for adjunct straightening techniques. Our findings may provide reassurance to urologists troubleshooting idiopathic ACM during corporal dilation during IPP surgery., Competing Interests: Competing interests: The authors declare no competing interests., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Caudal anesthesia alleviates the strong pain endured by children during surgical treatment for concealed penis. In the traditional method, anesthesiologists identify the puncture point using the 'blind probe' method, which leads to anesthesia induction failure in children. Ultrasound has recently gained wide attention for its guidance in peripheral nerve block analgesia. However, the clinical significance of wireless ultrasound - guided caudal anesthesia technology in children remains unexplored. This study investigated the clinical value of wireless ultrasound - guided caudal anesthesia in children undergoing concealed penis surgery. From April 2022 to August 2022, 120 pediatric patients aged 3-10 years were selected for concealed penis surgery. They were divided into the wireless ultrasound - guided sacral block group (group A) and the traditional sacral block group (group B), with 60 children in each group. Children in group A and group B underwent wireless ultrasound - guided caudal anesthesia and traditional caudal anesthesia, respectively. The success rates of the first puncture and total punctures, time taken for the punctures, and number of punctures were compared between the groups. The success rates of the first puncture (95% vs 68.3%) and total puncture (100% vs 90%) were significantly higher in group A than in group B (P<0.05). The average puncture time and the average number of punctures were, respectively, significantly shorter and lesser in group A than in group B (both P<0.05). Compared with the traditional method, wireless ultrasound visualization technology can effectively improve the success rate of sacral block puncture and reduce puncture time, which is worthy of clinical application.

Purpose: To explore the efficacy of active fistulation in the treatment of proximal hypospadias in children by comparing one-stage and two-stage Duckett procedure., Materials and Methods: A total of sixty-seven children who were diagnosed with proximal hypospadias and underwent Duckett operation at our hospital between January 2013 and January 2021 were selected for this study. These subjects were divided into two groups: the research group (n = 36), using two-stage Duckett procedure with active fistulation, and the control group (n = 31), using one-stage Duckett procedure. The incidence of postoperative complications and the score of pediatric penile perception Scale were compared between the two groups., Results: The research group exhibits a significantly lower incidence rate of urethral fistula (8.3% Vs 16.1%) and urethral stricture (5.6% Vs 12.9%) in comparison to the control group (P < 0.01). Furthermore, the analysis of Pediatric Penile Perception Scale scores indicates that the research group achieves significantly higher scores in terms of urethral shape, penile skin shape, and overall appearance than the control group (P < 0.05)., Conclusion: In the treatment of proximal hypospadias in children, active fistulation within the two-stage Duckett procedure significantly reduces the rate of stage 1 postoperative complications and improves parental satisfaction. Active fistulation may offer a more promising option for the treatment of proximal hypospadias in children.

Introduction: Distal anterior urethral strictures (DAUS) affect the meatus, navicular fossa (NF) and penile urethra (PU). The main causes are inflammatory (lichen sclerosous [LS]), traumatic iatrogenic, or idiopathic. Post-hypospadias stenosis is common and constitutes a separate entity, dealt with in a separate article., Method: A summary of North American, European and French recommendations was drawn up, supplemented by a literature search from December 2020 to December 2023, to provide a current overview of strategies adapted to DAUS., Results: Stricture limited to the meatus without LS can be dilated once. From the 1st recurrence or in the presence of LS, only a ventral or dorsal meatoplasty will be effective. In cases of Navicular involvement, an augmentation urethroplasty, respecting the glans penis (aesthetic preservation) will be preferred. Severe cases or recurrences may require replacement urethroplasty in two or more stages. PU stricture should not be treated by endoscopic urethrotomy but by urethroplasty in all cases. A one-stage augmentation technique will be discussed with a staged (2 stages most often) urethroplasty depending on the severity of the obstruction, stricture length, recurrent nature and the presence of LS. Buccal mucosa (jugal, lingual) is the most commonly used material in the form of a free graft. The most complex cases may require a perineal urethrostomy., Conclusion: DAUS present in a variety of ways. They are mainly managed surgically, in one or more stages. It is necessary to master several techniques to adapt to their heterogeneity., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Aim: Genital burns are rare injuries. Reconstruction of penile skin defects should consider cosmetic and functional outcomes. Skin grafts can develop scar contractures and carry hair follicles, causing unwanted results. These downsides remain unsolved issues. This work aimed to describe a new foreskin advancement flap method for completely reconstructing penile shaft skin defects in severely burned patients., Materials and Methods: From 2021 to 2023, four patients with third-degree burns in the genital area were enrolled in this investigation. We describe a series of cases with deep burns to the penile shaft and surrounding area that needed debridement and reconstruction using a novel technique called "reverse circumcision," which consists of tangential excision of the penis and a foreskin advancement flap without longitudinal cuts with less morbidity, preservation of function, and a better aesthetic appearance. The patients had an average follow-up of nine months., Results: The reverse circumcision technique was established for patients with severe burns in the genital area. The four patients were satisfied with the postoperative results and the aesthetic results of the procedure without reporting any complications. No scarring or contractures were observed on the glans or penile shaft after surgery., Conclusions: Compared with other flap methods, the use of a reverse circumcision foreskin advancement flap was more straightforward, feasible, and effective. In adults, the foreskin tissue completely covers the penile shaft skin defect. It is a viable reconstructive surgical technique that is easily reproducible and has excellent aesthetic and functional results. For this surgical technique, tissue transfers, bulky regional flaps, or skin grafts were not needed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Tissue Viability Society / Society of Tissue Viability. Published by Elsevier Ltd. All rights reserved.)

Objective: To describe a new technique or adjunct-telescoping the dorsal hood-with a view to banking excess skin on the penile shaft in hypospadias surgery. This would help if redo surgery, not a rare occurrence, is required in the future., Method: A review of a prospectively maintained database of hypospadias surgeries conducted between 1997 and 2023 by a single surgeon. After the hypospadias repair, instead of excising the dorsal hood and suturing the ventral penile skin in the usual way, a skin hook is applied on the ventral penile skin in the midline. As the skin hook is pulled down towards the scrotum, anywhere from 1 to 4cm, it telescopes the dorsal hood down the penile shaft and also pulls in dorsal skin ventrally. (Technique described more fully in the manuscript) RESULTS: Around 1084 patients were operated for hypospadias over these 27 years. Telescoping of the dorsal hood was used in all patients, and in the 126 with proximal hypospadias, none had any skin of the dorsal hood excised! Sixty-two patients presented later with 73 fistulae which were operated on. Of note, no patient needed more than 2 surgical attempts for a cure., Conclusion: The dorsal hood is a useful source of not only skin but also underlying vascularised soft tissue. In hypospadias surgery where redo-operations are a predictable reality, preserving any excess skin on the phallus seems sensible. Our innovation of telescoping the dorsal hood achieves this goal nicely and takes only a few minutes to perform., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To introduce the Penile Trauma Score (PTS), a new statistically driven classification system aimed at enhancing the management of penile trauma by providing clinically relevant treatment protocols., Methods: A retrospective review was conducted of 34 men with penetrating penile injuries at the Elvis Presley Level 1 Trauma Center, Memphis, from January 2014 to December 2016. Variables assessed included injury mechanism, location, depth, and follow-up outcomes related to voiding and erectile function. Odds ratios were calculated using superficial penile injury as the control group., Results: Based on physical examination findings and odds ratios calculated, the PTS was developed. Results indicated that higher PTS scores necessitated surgical intervention, while lower scores could be managed nonoperatively. Follow-up showed no missed injuries or reported dysfunctions, validating the PTS's effectiveness., Conclusion: The PTS represents an important modification in the classification and management of penile trauma. By integrating practical, easily identifiable injury characteristics, the PTS facilitates more streamlined surgical decision-making and potentially reduces unnecessary diagnostic procedures. However, further prospective studies with larger sample sizes and longer follow-up are needed to fully validate the PTS's clinical utility., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Primary phalloplasty in transgender men can be performed using a single or double free or pedicled flap to reconstruct the shaft and, if desired, the urethra. Vascular complications may result in total or partial loss of the used flap(s). Surgical management after flap loss in primary phalloplasty presents a challenge to the reconstructive surgeon., Aim: To describe our experience with surgical reconstructive management after primary phalloplasty flap loss in transgender men and report on the clinical and participant-reported outcomes., Methods: All transgender men who underwent a secondary reconstructive procedure after failure of the primary procedure between January 1989 and December 2023, at our institution, were identified. A retrospective chart review was conducted, recording relevant demographic and clinical data. In addition, participants were invited to complete a non-validated questionnaire consisting of questions regarding surgical outcomes, (sexual) functionality, and sexuality., Outcomes: Surgical outcomes, flap failure, and self-reported outcomes., Results: Eighteen individuals were included in this study, who underwent flap reconstruction of the phalloplasty shaft (n = 7), the urethra (n = 4), or both (n = 7). Primary phalloplasty was performed with urethral lengthening (UL) in 16 (89%) and without in 2 (11%). There were no redo phalloplasty flap failures. In those with UL 13/16 (81%) were able to void while standing. Eleven individuals completed the follow-up questionnaire. Most participants were "satisfied" (45%) or "very satisfied" (27%) with the appearance of their penis. All participants (strongly) agreed that when looking back, they would undergo the surgery all over again., Clinical Implications: Practical surgical tips, deducted from our experiences, are provided for gender surgeons performing (revision) phalloplasty and urethroplasty., Strengths and Limitations: Strengths are the unique set of surgical reconstruction cases that has taught us valuable lessons. Data from this study can be used to optimize pre-operative counseling regarding flap loss complications and the outcomes of the subsequent management. Weaknesses comprise the retrospective nature, the low number of included individuals, and use of non-validated questionnaires for self-reported outcomes., Conclusion: Flap loss after primary phalloplasty in transgender men is a serious complication. Successful secondary reconstruction of the phalloplasty can be performed using a new pedicled or free flap., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Hypospadias is a common congenital anomaly characterized by the displacement of the urethral opening to the ventral side of the penis. Surgical correction is often necessary for functional and psychological reasons. The etiology involves genetic and environmental factors, and chordee, a downward curvature of the penis, is a common complication. Proteins such as fibulin-1, elastin, matrix metalloproteinase-1, basic fibroblast growth factor, and α-smooth muscle actin play roles in hypospadias development., Objective: The study's aim is to investigate the differences in messenger RNA (mRNA) expression of fibulin-1, elastin, matrix metalloproteinase-1, basic fibroblast growth factor, and α-smooth muscle actin between the ventral and dorsal tunica dartos in patients with hypospadias and chordee., Methods: This prospective cohort study aims to investigate differences in mRNA expression of the abovementioned proteins between the ventral and dorsal tunica dartos in patients with hypospadias and chordee. Ethics approval has been obtained, and consent from parents will be obtained before data collection. Eligible participants are aged 6-18 months, diagnosed with hypospadias and chordee, and planned for urethroplasty. Tissue samples will be collected from both aspects of the tunica dartos and analyzed using real-time quantitative reverse transcription-polymerase chain reaction. Data analysis will involve statistical tests and normalization of housekeeping genes., Results: This study is at the protocol development stage. A pilot study regarding its feasibility has been ongoing as of August 2023. The study results are expected to be available by the end of 2024., Conclusions: The study of mRNA expressions of various proteins in the tunica dartos of patients with hypospadias and chordee is expected to improve the understanding and expand the knowledge of the pathophysiology of hypospadias and chordee., International Registered Report Identifier (irrid): DERR1-10.2196/52282., (©Joko Pitoyo, Alvarino, Eryati Darwin, Yanwirasti. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 30.10.2024.)

Urethroplasty for the management of long-segment urethral strictures associated with lichen sclerosus presents considerable clinical challenges. Oral mucosal grafts are commonly employed but are vulnerable to posttransplantation infection and recurrent stricture formation. Furthermore, the necessity for anesthesia and oral graft harvesting restricts their application in primary healthcare settings. The single layer of flattened epithelium of the tunica vaginalis can serve as a potential alternative to oral mucosa. Animal experiments have demonstrated that the tunica vaginalis can readily form a tight connection with the multilayered urothelium of the urethra. Utilizing the tunica vaginalis as a scaffold for urethral re-epithelialization may help reduce the risk of recurrence of urethral stricture after surgery. Over a 19 year period, pedicled tunica vaginalis urethroplasty has been used for successfully treating 86 cases. The surgical procedure involves dorsally incising the urethral stricture segment, then covering it with a pedicled tunica vaginalis patch followed by suturing. Postoperatively, the pedicled tunica vaginalis graft exhibits good vascularization and take rate, facilitating urethral re-epithelialization. The surgical procedure is conducted in a sterile environment to mitigate the potential for infectious complications. Moreover, the operation can be executed under spinal anesthesia, which facilitates its implementation in primary healthcare settings.