Successful microsurgical replantation of an amputated penis

ABSTRACTPenile amputation is an uncommon injury for which immediate surgical replantation is warranted. Microsurgical replantation is the “standard” method for penile replantation. Early replantation yields a high success and low complication rate. We report a case of a 34-year-old male who presented with amputation at the proximal penile shaft which was successfully replanted using microsurgical techniques. Minor skin necrosis was noted post-operatively which was debrided and covered with skin graft. Follow-up at 6 months showed satisfactory cosmetic appearance, normal voiding, return of sensations and erectile function. The level of evidence was V.

Download Full-text

Penile Reconstruction for a Case of Genital Lymphoedema Secondary to Proteus Syndrome

ISRN Urology ◽

10.5402/2011/431536 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3

Author(s):

F. Ashouri ◽

J. Manners ◽

R. Rees

Keyword(s):

Urinary Catheter ◽

Sexual Debut ◽

Proteus Syndrome ◽

Main Concern ◽

Penile Skin ◽

Penile Shaft ◽

Cosmetic Appearance ◽

Minimal Scarring ◽

Thickness Skin

To our knowledge penile lymphoedema secondary to Proteus syndrome has not previously been reported. Hence we report a case of a 16-year-old male who was referred with features of right hemi-hypertrophy and severe lymphoedema affecting his scrotum and penis. He had previously undergone scrotal reduction surgery at the age of 13, but had since developed worsening penile oedema. His main concern was that of cosmetic appearance prior to sexual debut, and he also complained of erectile dysfunction. An MRI confirmed gross oedema of the penile skin, but normal underlying cavernosal structure, and no other anatomical abnormality. Under general anaesthesia, the entire diseased penile skin was excised. Two full thickness skin grafts were harvested from the axillae, and grafted onto the dorsal and ventral penile shaft respectively. A compressive dressing and urinary catheter was applied for 7 days. Follow-up at 4 months confirmed complete graft take with minimal scarring, and the patient was very satisfied with the cosmetic outcome. He had also noticed a recovery in erectile activity, and feels psychologically and physically more prepared for sexual relations.

Download Full-text

Using two “V” shaped flaps in penile torsion treatment

Journal of Clinical Urology ◽

10.1177/2051415820957548 ◽

2020 ◽

pp. 205141582095754

Author(s):

Seyed Amin Mirsadeghi ◽

Maryam Aghaii ◽

Seyed Mohammad Kazem Aghamir

Keyword(s):

Complete Resolution ◽

Urine Culture ◽

Urinary Flow ◽

Rotational Deformity ◽

Penile Shaft ◽

Level Of Evidence ◽

Novel Method ◽

Coronal Region ◽

Successful Repair

Introduction: Penile torsion is a congenital malformation that causes a rotational deformity of the penile shaft. Several techniques have been considered for penile torsion repair. In this study, we described our experience using two separate “V” dartos flaps, which leads to a more satisfying result. Patient and methods: Two young men with severe penile torsion aged 24 and 28 years old were candidates for surgery. During our novel method for penile torsion repair, we degloved the penis and dissected the dartos fascia from the penis shaft, then cut it distally from the sub-coronal region with a longitudinal cut to make two dartos flaps in a “V” shape. With these two flaps, we corrected penile torsion in a more satisfying way without crossing the urethra. Results: Penile torsion and concurrent chordee were completely corrected after surgery. Urine culture was sterile and uroflowmetry indicated a maximal urinary flow of 12 ml/s 3 months after the operation. Both patients were satisfied with ejaculation and their follow-up indicated complete resolution of penile torsion. Conclusions: Penile torsion is a challenging congenital anomaly. We used a two “V” shaped flap passage method to complete penile rotation and chordee correction without performing any plication techniques. Our penile torsion correction procedure resulted in the successful repair of torsion and excellent outcomes. Level of evidence: Not applicable for this multicenter audit.

Download Full-text

Identifying complications and failure modes of innovative growing rod configurations using the (hybrid) magnetically controlled growing rod (MCGR) and the spring distraction system (SDS)

Spine Deformity ◽

10.1007/s43390-021-00378-4 ◽

2021 ◽

Author(s):

Justin V. C. Lemans ◽

Casper S. Tabeling ◽

René M. Castelein ◽

Moyo C. Kruyt

Keyword(s):

Cost Effectiveness ◽

Complication Rate ◽

Failure Modes ◽

Complication Rates ◽

Level Of Evidence ◽

Free Survival ◽

Growing Rods ◽

Growing Rod ◽

Group 5

Abstract Background Magnetically controlled growing rods (MCGRs) offer non-invasive distractions in Early-Onset Scoliosis (EOS). However, implant-related complications are common, reducing its cost-effectiveness. To improve MCGRs functionality and cost-effectiveness, we often combine a single MCGR with a contralateral sliding rod (hybrid MCGR). Recently, we developed the spring distraction system (SDS) as an alternative, which provides continuous distraction forces through a helical spring. This study aims to identify complication rates and failure modes of EOS patients treated with either of these innovative systems. Methods This single-centre retrospective study included EOS patients treated with a (hybrid) MCGR or SDS between 2013 and 2018. Baseline demographics, and data regarding complications and implant growth were measured. Complication rate, complication profile, complication-free survival and implant growth were compared between groups. Results Eleven hybrid- and three bilateral MCGR patients (4.1-year follow-up) and one unilateral, eleven hybrid and six bilateral SDS patients (3.0-year follow-up) were included. Groups had similar age, sex, aetiology distribution, and pre-operative Cobb angle. Complication rate was 0.35 complications/patient/year for MCGR patients and 0.33 complications/patient/year for SDS patients. The most common complications were failure to distract (MCGR-group; 8/20 complications) and implant prominence (SDS-group; 5/18 complications). Median complication-free survival was 2.6 years, with no differences between groups (p = 0.673). Implant growth was significantly higher in the SDS-group (10.1 mm/year), compared to the MCGR-group (6.3 mm/year). Conclusion (Hybrid) MCGR and SDS patients have similar complication rates and complication-free survival. Complication profile differs between the groups, with frequent failure to distract leading to significantly reduced implant growth in (hybrid) MCGR patients, whereas SDS patients frequently exhibit implant prominence and implant kyphosis. Level of evidence III.

Download Full-text

Spectacularly Successful Microsurgical Penile Replantation in an Assaulted Patient: One Case Report

Case Reports in Urology ◽

10.1155/2011/865489 ◽

2011 ◽

Vol 2011 ◽

pp. 1-2

Author(s):

Mohammed Fadl Tazi ◽

Youness Ahallal ◽

Abdelhak Khallouk ◽

Mohammed Jamal Elfassi ◽

Moulay Hassan Farih

Keyword(s):

Emergency Department ◽

Wound Healing ◽

Case Report ◽

Erectile Function ◽

Rare Condition ◽

Urinary Function ◽

Penile Amputation ◽

Penile Replantation

Penile amputation is a rare condition for which immediate surgical replantation is warranted. We present herein one case of a 27-year-old male who presented to the Emergency Department after his wife cut his penis. The penis was replanted microsurgically. The deep dorsal penile veins and superficial veins were anastomosed. Although we could not reanastomose the arteries, wound healing occurred without any problem one week postoperatively and the patient regained erectile function 4 weeks after surgery. At 1-year follow-up examinations he reported on restored erectile function and a normal urinary function.

Download Full-text

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

European Spine Journal ◽

10.1007/s00586-019-06253-1 ◽

2019 ◽

Vol 29 (4) ◽

pp. 904-913 ◽

Cited By ~ 9

Author(s):

Amer Sebaaly ◽

Martin Gehrchen ◽

Clément Silvestre ◽

Khalil Kharrat ◽

Tanvir Johanning Bari ◽

...

Keyword(s):

Complication Rate ◽

Adult Spinal Deformity ◽

Spine Deformity ◽

Mechanical Complication ◽

Level Of Evidence ◽

Multicentric Study ◽

Mechanical Complications ◽

Roussouly Classification ◽

Normal Shape

Abstract Purpose To evaluate the incidence of mechanical complications in patients with adult spine deformity (ASD) treated by restoring the normal shape according to the Roussouly classification. Methods This is a retrospective multicentric study with a minimum follow-up of 2 years. Patients operated on with fusion for ASD (minimum performed fusion: L2 to sacrum) were included. Patients with a history of previous spinal fusion of more than three levels were excluded. Spinal and pelvic parameters were measured on the preoperative and the immediate postoperative follow-up. All mechanical complications were recorded. Results A total of 290 patients met the criteria of inclusion with a minimum follow-up of 2 years. Mechanical complications occurred in 30.4% of the cohort. The most common complication was PJK with an incidence of 18% while nonunion or instrumentation failure (rod breakage, implant failure) occurred in 12.4%. 66% of the patients were restored to the normal shape according to the Roussouly classification based on their PI and had a mechanical complication rate of 22.5%, whereas the remaining 34% of patients had a complication rate of 46.8% (p < 0.001). The relative risk for developing a mechanical complication if the algorithm was not met was 3 (CI 1.5–4.3; p < 0.001) Conclusion In the recent literature, there are no clear guidelines for ASD correction. Restoring the sagittal spinal contour to the normal shapes of Roussouly according to the PI could serve as a guideline for ASD treatment. Ignoring this algorithm has a threefold risk of increased mechanical complications. We recommend this algorithm for treatment of ASD. Level of evidence IV cross-sectional observational study. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

Download Full-text

Latarjet Procedure for Anterior Glenohumeral Instability: Early Postsurgical Complications for Primary Coracoid Transfer Versus Revision Coracoid Transfer After Failed Prior Stabilization

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120924628 ◽

2020 ◽

Vol 8 (6) ◽

pp. 232596712092462

Author(s):

Gary F. Updegrove ◽

Patrick S. Buckley ◽

Ryan M. Cox ◽

Stephen Selverian ◽

Manan S. Patel ◽

...

Keyword(s):

Revision Surgery ◽

Complication Rate ◽

Primary Group ◽

Complication Rates ◽

Latarjet Procedure ◽

Glenohumeral Instability ◽

Level Of Evidence ◽

Coracoid Transfer ◽

Primary Surgery

Background: The Latarjet procedure (coracoid transfer) is often used to successfully treat failed instability procedures. However, given the reported increased complication rates in primary Latarjet surgery, there is a heightened concern for complications in performing the Latarjet procedure as revision surgery. Purpose: To evaluate the early outcomes and complications of the Latarjet procedure as primary surgery compared with revision surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 157 patients were included and retrospectively reviewed: 103 patients in the revision group and 54 patients in the primary group. Patients were evaluated by physical examination findings as well as by documentation of complications and reoperations extracted from their electronic medical records. Results: The mean follow-up was 7.8 ± 11.0 months for the primary group and 7.0 ± 13.2 months for the revision group. There were no significant differences in overall complication rates between the primary and revision groups (16.7% vs 8.7%, respectively; P = .139). The complication rate was significantly higher in patients in the revision group who had undergone a prior open procedure compared with those who had undergone only arthroscopic procedures (30.0% vs 4.1%, respectively; P < .001). Of those patients who sustained a complication, 7 of the 9 underwent a reoperation in the primary group (13.0%), and 7 of the 9 did so in the revision group (6.8%); the risk of reoperations was not different between groups ( P = .198). There were 4 patients in the primary group (7.4%) and 5 patients in the revision group (4.9%) who experienced recurrent dislocations during the follow-up period ( P = .513). There was no difference in postoperative range of motion. Conclusion: The Latarjet procedure is a reasonable option for the treatment of failed arthroscopic instability repair with an early complication rate similar to that found in primary Latarjet surgery.

Download Full-text

Comparison of Lateralized Versus Medialized Reverse Total Shoulder Arthroplasty: A Systematic Review and Meta-analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211063922 ◽

2022 ◽

Vol 10 (1) ◽

pp. 232596712110639

Author(s):

Sung-Hyun Cho ◽

Hyo-Jin Lee ◽

Osama R. Aldhafian ◽

Yang-Soo Kim

Keyword(s):

Systematic Review ◽

Pain Score ◽

Complication Rate ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Level Of Evidence ◽

Scapular Notching ◽

Functional Scores ◽

Reverse Total Shoulder

Background: Reverse total shoulder arthroplasty (rTSA) is an established procedure for cuff tear arthropathy. More lateralized prostheses have been designed to overcome the reported adverse outcomes of Grammont-style rTSA. Purpose: To compare the clinical and radiological outcomes of medialized and lateralized center of rotation (COR) in rTSA. Study Design: Systematic review; Level of evidence, 3. Methods: This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were studies with a level of evidence ≥3 that compared medialized and lateralized rTSA with a minimum follow-up of 12 months. Functional scores including the American Shoulder and Elbow Surgeons (ASES) score and Constant score (CSS), range of motion at final follow-up, gain of external rotation (ER), visual analog scale (VAS) pain score, scapular notching, and heterotopic ossification (HO) were compared. Data were analyzed using random-effects or fixed-effects models in accordance with heterogeneity. Results: Five retrospective cohort studies and 1 randomized controlled study (n = 594 patients) were included. Lateralized rTSA resulted in greater improvement in ER degree ( P < .001), a lower VAS pain score (standardized mean difference [SMD], –0.39; P = .002), and a lower rate of scapular notching (risk ratio [RR], 0.40; P < .001) and HO (RR, 0.52; P < .001). Final forward flexion (SMD, –0.14; P = .629) and ER (SMD, 0.21; P = .238) did not differ significantly between the 2 groups. Overall functional scores, including ASES score (SMD, 0.22; P = .310) and CSS (SMD, 0.37; P = .077), also did not differ significantly (SMD, 0.28; P = .062). The overall complication rate did not differ significantly between the 2 groups (RR, 0.71; P = .339). Conclusion: Compared with medialized rTSA, lateralized COR rTSA results in greater improvement in ER and the VAS pain score, decreased rates of scapular notching and HO, and no significant changes in functional outcome scores or the complication rate.

Download Full-text

A Comparison of Nonoperative and Operative Treatment of Type 2 Tibial Spine Fractures

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120975410 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097541

Author(s):

◽

Niyathi Prasad ◽

Julien T. Aoyama ◽

Theodore J. Ganley ◽

Henry B. Ellis ◽

...

Keyword(s):

Range Of Motion ◽

Complication Rate ◽

Cruciate Ligament ◽

Complication Rates ◽

Spine Fractures ◽

Level Of Evidence ◽

Tibial Spine ◽

Nonoperative Group

Background: Tibial spine fractures (TSFs) are typically treated nonoperatively when nondisplaced and operatively when completely displaced. However, it is unclear whether displaced but hinged (type 2) TSFs should be treated operatively or nonoperatively. Purpose: To compare operative versus nonoperative treatment of type 2 TSFs in terms of overall complication rate, ligamentous laxity, knee range of motion, and rate of subsequent operation. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed 164 type 2 TSFs in patients aged 6 to 16 years treated between January 1, 2000, and January 31, 2019. Excluded were patients with previous TSFs, anterior cruciate ligament (ACL) injury, femoral or tibial fractures, or grade 2 or 3 injury of the collateral ligaments or posterior cruciate ligament. Patients were placed according to treatment into the operative group (n = 123) or nonoperative group (n = 41). The only patient characteristic that differed between groups was body mass index (22 [nonoperative] vs 20 [operative]; P = .02). Duration of follow-up was longer in the operative versus the nonoperative group (11 vs 6.9 months). At final follow-up, 74% of all patients had recorded laxity examinations. Results: At final follow-up, the nonoperative group had more ACL laxity than did the operative group ( P < .01). Groups did not differ significantly in overall complication rate, reoperation rate, or total range of motion (all, P > .05). The nonoperative group had a higher rate of subsequent new TSFs and ACL injuries requiring surgery (4.9%) when compared with the operative group (0%; P = .01). The operative group had a higher rate of arthrofibrosis (8.9%) than did the nonoperative group (0%; P = .047). Reoperation was most common for hardware removal (14%), lysis of adhesions (6.5%), and manipulation under anesthesia (6.5%). Conclusion: Although complication rates were similar between nonoperatively and operatively treated type 2 TSFs, patients treated nonoperatively had higher rates of residual laxity and subsequent tibial spine and ACL surgery, whereas patients treated operatively had a higher rate of arthrofibrosis. These findings should be considered when treating patients with type 2 TSF.

Download Full-text