Unusual presentation of penile giant condyloma acuminatum with spontaneous prepuce perforation: A case report

BACKGROUND Giant condyloma acuminatum(GCA)is an uncommon condition affecting the anogenital area.CASE SUMMARY Here,we report an 88-year-old male patient who presented with a 5-year history of a progressive appearance of multiple cauliflower-like warts over his penile shaft,pubis region,and groin as well as urine leakage along the distal penile shaft.Physical examination revealed an ulcerative skin perforation with pus discharge under the distal prepuce base,which was initially suspected to be a urethral fistula.However,during surgery,it was discovered that the perforation was caused by a giant condyloma lesion that had obliterated the prepuce opening,with infection and high pressure causing subsequent skin perforation.He underwent circumcision and wide excision with electrocauterization of the warts.He was discharged after the surgery,and the residual lesion was treated with imiquimod and low-dose oral tegafur-uracil.CONCLUSION Penile GCA can cause prepuce perforation and can be postoperatively treated with imiquimod and low-dose oral tegafur-uracil.

Redundant prepuce increases the odds of chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）

Some published evidence has revealed that the dendritic cells can interact with pathogens that exist in the inner foreskin. This information provides a new vision that pathogens could play a role through the redundant prepuce; numerous studies have failed to find pathogens in prostates of patients who had chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）. However, no studies have reported an association between foreskin length and CP/CPPS. Hence, we conducted a retrospective case-control study of clinical data from 322 CP/CPPS patients （case group） and 341 nonCP/CPPS patients （control group）. Demographic characteristics, lifestyle factors, and foreskin lengths were collected and analyzed. Multivariate logistic regression was adopted to calculate the odds of foreskin length for CP/CPPS. According to the multivariate logistic regression results, when the foreskin length covered up more than half of the glans penis, the odds for CP/CPPS were higher with an increased foreskin （odds ratio （OR）： 1.66, 95% confidence interval （CI）： 1.04-2.66）. In comparison, when the glans penis was completely covered by the foreskin, the OR value increased to 1.86 （95% CI, 1.2-2.88）. The study results showed an association between foreskin length and the odds of CP/CPPS. When the foreskin length covered up more than half of the glans penis, there were greater odds for CP/CPPS. This possible mechanism might result from interaction between pathogens and DCs in the inner foreskin, consequently activating T-cells to mediate allergic inflammation in the prostate and producing the autoimmunizations causing CP/CPPS.

Possible Function of Frenulum of Prepuce in Penile Erection

Objective To discuss the possible function of frenulum of prepuce in penile erection. Methods Nine patients had premature ejaculation whose frenula were short. Two patients suffered unsatisfied intercourse whose frenula were injured and departed 12 and 6 months ago. Three males endured premature ejaculation whose frenula were hurt in coition 30 min ago.We prolonged short frenulum and reconstructed the ruptured frenulum. To the fresh wound,we debrided the cut,then sutured the injured frenulum vertically. Results Investigated 3 to 6 months,all patients got satisfied sexual intercourse. Conclusion Frenulum is important in erecting time.

Safety and Efficacy of Circumcision Stapler in the Treatment for Children with Phimosis and Redundant Prepuce

Objective: To observe the clinical effect and safety of circumcision stapler in children with phimosis and redundant prepuce. Methods: From July 2013 to July 2017, 40 children were prospectively randomized and assigned to experiment group (circumcision stapler n = 20) or control group (conventional circumcision, n = 20). Outcomes were operation time, intraoperative blood loss and postoperative complications. Results: There was significant difference between the two groups for operation time (5.35 min vs 30.30 min, P < 0.05) and intraoperative blood loss (2.56 ml vs 10.40 ml, P < 0.05) respectively. Conclusion: Circumcision staplers are superior to conventional circumcision for the advantages of shorter operation time and fewer blood losses.

Epispadias in a Child with Intact Prepuce: A Rare Congenital Abnormality

Epispadias is a rare genitourinary malformation, more so is epispadias with intact prepuce. Incidence of epispadias with intact prepuce is not known however, there are few case reports and a case series. We present a 5-year-old boy brought to our facility by his parent for circumcision. Further evaluation revealed a short penis with broad base and intact prepuce. The preputial slit was dorsally oriented. On retracting the prepuce, there was corona epispadias with wide and healthy urethral plate. No meatal stenosis or chordee noticed. Other findings were normal. He had epispadias repair. The postoperative period was uneventful. Three months after operation, the prepuce was easily retractable over the penis and the penis was cosmetically acceptable.

Use of a disposable circumcision suture device versus conventional circumcision： a systematic review and meta-analysis

This systematic review assessed the safety and efficacy of the disposable circumcision suture device （DCSD） and conventional circumcision （CC） in the treatment of redundant prepuce and phimosis. Two independent reviewers conducted a literature search for randomized controlled trials （RCTs） using the DCSD and CC for the treatment of redundant prepuce or phimosis in China and abroad. Nine RCTs （1898 cases） were included. Compared with the CC group, the DCSD group had a shorter operative time （standardized mean difference [SMD] = -21.44; 95% confidence intervals [95% CIs] [-25.08, -17.79]; P 〈 0.00001）, shorter wound healing time （SMD = -3.66; 95% CI [-5.46, -1.85]; P 〈 0.0001）, less intraoperative blood loss （SMD = -9.64; 95% CI [-11.37, -7.90]; P 〈 0.00001）, better cosmetic penile appearance （odds ratio [OR] =8.77; 95% CI [5.90, 13.02]; P 〈 0.00001）, lower intraoperative pain score, lower 24-h postoperative pain score, lower incidence of infection, less incision edema, and fewer adverse events. There were no differences between the CC and DCSD groups in the incidences of dehiscence, or hematoma. The results of this meta-analysis indicate that the DCSD appears to be safer and more effective than CC. However, additional high-quality RCTs with larger study populations are needed.

Circumcision with ＂no-flip Shang Ring＂ and ＂Dorsal Slit＂ methods for adult males： a single-centered, prospective, clinical study

This paper was aimed to compare the clinical effectiveness and safety of adult male circumcision using the Shang RingTM （SR） with the no-flip technique compared with Dorsal Slit （DS） surgical method, A single-centered, prospective study was conducted at the West China Hospital, where patients were circumcised using the no-flip SR （n = 408） or the DS （n = 94） procedure. The adverse events （AEs） and satisfaction were recorded for both groups, and ring-removal time and percentage of delayed removals were recorded for the SR group. Finally, complete follow-up data were collected for 76.1% of patients （SR： n = 306; DS： n = 76）. The average ring-removal time for the SR group was 17.62 ± 6.30 days. The operation time （P 〈 0.001）, pain scores during the procedure （P 〈 0.001） and at 24 h postoperatively （P 〈 0.001）, bleeding （P = 0.001）, infection （P = 0.034）, and satisfaction with penile appearance （P 〈 0.001） in the SR group were superior to those in the DS group. After two postoperative weeks, the percentage of patients with edema in the SR group （P = 0.029） was higher but no differences were found at 4 weeks （P = 0, 185） between the two groups. In conclusions, the no-flip SR method was found to be superior to the DS method for its short operation time （〈5 min）, involving less pain, bleeding, infection, and resulting in a satisfactory appearance. However, the time for recovery from edema took longer, and patients may wear device for 2-3 weeks after the procedure.