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Objective: Report a case of a scrotum-perinea lGranular Cell Tumor (GCT) in pediatric age., Methods: To report a case., Results: A 12 years old men with a multiple GCT history, located in both extremities, abdomen and scrotum perineal region. Surgical excision of all lesions and a genetic studyare performed to rule out Noonan syndrome., Conclusion: GCT or Abrikossoff tumor is a tumor witha very low incidence, especially in pediatric age. The most frequent form of presentation a solitary nodule and the most common behavior is in the form of a benign tumor. Immunohistochemistryis crucial for its diagnosis, the main characteristicis positivity for the S100 protein. Although scrotal location is very rare, it must be considered in the differential diagnosis of scrotal mass. Surgical excision is the treatment of choice.

Lymphedema is the result of an alteration of the lymphatic drainage, and its most common worldwide cause is filariasis. In our practice usually is associated to neoplasic, inflammatory and granulomatous processes, radiotherapy, hydroelectrolytic disbalances, and idiopathic. It can affect any part of the body, including the penis and scrotum. The genital lymphedema is a rare presentation, it corresponds to 0.6% of lymphedema. However, causes serious functional, social and emotional limitations for the patient. Too often have pain, recurrent infections, sexual dysfunction, cosmetic deformity, sometimes it limits mobility and ambulation. Although there are several treatment options, both medical and surgical, it has not been found ideal for this disease. We present a 43 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa, it limits his normal activity. The patient was referred to our center after unsuccessful medical treatment (doxycycline and clindamycin cycles). Surgical treatment consisted of total excision of the skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. The result was satisfactory both functionally and aesthetically., (Copyright: © 2018 Permanyer.)

Objective: Lymphangiomatosis is a rare disease affecting lymphatic vessels that causes a marked increase of them in the affected area. The final objective of treatment of the genital disease is to preserve sexual function and voiding with a satisfactory aesthetic result with the aim to minimize the emotional impact., Methods: For the first time in children, we report a case of local reconstruction using artificial dermis after the excision of a genital lymphatic malformation in an eight year old patient., Results: We performed surgical excision of the lymphatic malformation genital component and reconstruction of the scrotal and penile area in two steps, using an autologous graft over artificial dermis. No complications were registered. Both aesthetic and functional results were excellent, and spontaneous erections that were not present before, were also evidenced. No local recurrence was seen at two year follow up., Conclusion: The use of artificial dermis for genital surface reconstruction enables radical excision of tissues involved by diffuse lymphangiomatosis in this location. Surgical technique is simple, postoperative care is easy, being ambulatory care feasible. Final result is an elastic, fine skin, very satisfactory aesthetically, and functionally normal, which even keeps local sensitivity. In the long term, this will benefit the sexual field, so damaged in this patients.

Objective: To describe the anatomical characteristics and vascularization of the biaxial hair free scrotal flap (BAES-flap) and to detail its surgical application to reconstruction of the more complex urethral strictures., Methods: We performed macro and micro anatomical dissections of the scrotum in 15 cryopreserved cadavers for the study of the arterial microvascularization of the BAES flap, and this anatomical knowledge has been implemented with the aim to improve the anterior and posterior urethra reconstructive surgical technique. For scrotal skin conditioning we performed definitive hair removal with the alexandrite laser., Results: The BAES flap, thanks to its rich biaxial vascularization, its anatomical disposition over the urethral axis, and the suitable characteristics of hair free scrotal skin, has allowed us to perform successful one-step urethral reconstruction in complex cases such as panurethral disease, multioperated hypospadias, failed urethroplasties and obliterative stenosis., Conclusions: Detailed study of scrotal skin arterial vascularization is essential to design reliable and versatile genital skin flaps that result appropriate for the most complex reconstructive urethral surgery. The BAES scrotal flap complies with these requirements offering the patient a one step reconstructive option with a very satisfactory surgical experience over more than 20 years.

Purpose: There is a controversy concerning infant testicular prosthesis. The problem is that this may necessitate further surgery to insert a larger prosthesis when the child gets older. An alternative strategy is to delay the placement of the definitive prosthesis until the child reaches adolescence. However, the underdeveloped scrotum may fail to accommodate the desired sized testicular prosthesis. We present scrotoplasty using hyaluronic acid gel injection as a minimally-invasive alternative to enhance the volume of scrotum until puberty., Material and Methods: A prospective report of 35 boys younger than seven years old with monorchia underwent injection of hyaluronic acid for scrotal filling. Mean follow-up of 24 months (range 12-48 months)., Results: The only complication was early resorption in 2 patients at 8 and 10 months after implantation, respectively. In long-term followup 100 per cent of the families rated the cosmetic appearance as good and 95 per cent were content with the decision regarding placement of a testicular implant irrespective of whether they had been retreated., Conclusions: It shows that hyaluronic acid gel scrotal injection can provide satisfactory improvement in enhance the volume of scrotum. It is associated with high family and patient satisfaction, and provides a long-lasting result. This technique makes placement of prosthetic testis a very simple procedure that can be performed at the time of diagnostic exploration or orchiectomy, increasing scrotal space until post pubertal definitive prosthesis.

Objective: To report one case of advanced fibrous pseudotumour., Methods: A 34-year-old patient presented with a painless lump on the right side of the scrotum. Examination revealed a hard tissue thickening attached to the tail and body of the right epididymis. The results of the ultrasound study were not clear and multiple differential diagnosis were considered. The lesion was surgically removed by partial right epididymectomy and resection of the affected tunica vaginalis and ductus deferens for anatomopathological study., Results: The histopathological study revealed an evolved fibrous pseudotumour with bone metaplasia., Conclusion: Fibrous pseudotumour is a benign paratesticular lesion that grows slowly and painlessly. It is usually diagnosed by chance or in associated processes such as hydrocele. Differential diagnosis with malignant tumors avoids unnecessary radical treatment.

Objective: To describe one case of hematocele secondary to rupture of an abdominoscrotal hydrocele in an adult patient., Methods and Results: We report a huge hematocele in a patient with this unusual type of hydrocele that suffered a minimal scrotal trauma. It was a hydrocele that extended through the inguinal canal to the retroperitoneal space., Conclusions: Abdominoscrotal hydrocele is a rare condition in children and even rarer in adults. The presence of a hematocele requires early surgical treatment.

Objective: To report a case of a mesothelioma of the tunica vaginalis and to review the published literature. METHODS / RESULTS: A 61-year-old patient complained of one-month increase of right scrotum size with pain. An ultrasound showed a right hydrocele with a mass attached to the tunica vaginalis. He didn't refer any urological history or known exposure to asbestos. Blood levels of tumor markers (alpha-fetoprotein and beta-HCG) were within normal limits. We performed a radical inguinal orchiectomy with an en-bloc resection of the tunica vaginalis. The pathology described a potentially malignant biphasic mesothelioma. The patient has remained asymptomatic with negative extension studies after 10 years of follow up., Conclusions: Paratesticular mesotheliomas are rare tumors (approximately 250 cases reported )with uncertain etiology (only 30-40% are associated with asbestos exposure). The age range is between 50-70 years. Its presentation is usually as a scrotal mass with recurrent reactive hydrocele, which may delay early diagnosis. During surgery, intraoperative biopsy is recommended. It is important to do a differential diagnosis with other benign diseases. Treatment is only curative in early stages with radical orchidectomy and resection in-block of the tunica vaginalis. Despite being multidisciplinary, it is not curative in most cases due to rapid local and distant spread.

Objective: To report a clinical case of testicular rupture and review of the literature published., Method: A 15 years old male with a testicular rupture after a sports injury was diagnosed by Doppler ultrasound., Results: Surgical exploration was performed and the tear was repaired. He had a benign postoperative course. The patient presents a normal size testicle after a year of follow-up., Conclusions: Testicular rupture is an uncommon but important entity that may occur. It is essential early diagnosis and e management to avoid orchiectomy.

Objective: Mondor's disease is a superficial thrombophlebitis and usually occurs in the anterior and lateral chest. The scrotal vein thrombosis is a fairly rare disease., Methods: Thirty-four year old male who consulted for inguinal tumor and pain in the postoperative period of an umbilical hernia repair, which resulted in a subsequent scrotal vein thrombosis treated conservatively., Results: It was resolved with conservative treatment, with recanalization of the scrotal veins., Conclusion: Mondor's disease is a rare entity, related to multiple etiological factors. The diagnosis is made easily with Doppler ultrasound and most resolve with conservative treatment.

Objective: To report a rare case of penile paraffinoma caused by the subcutaneous or intra-urethral injection of foreign substances containing long-chain saturated hydrocarbons. These were injected in order to increase the penis size which generated a chronic granulomatous inflammatory reaction. This is a rare practice in the western world., Methods: We present the case of a 32-year-old Bulgarian male who presented with a two-year history of elastic, slightly painful penis swelling after subcutaneous liquid paraffin injection. The proposed treatment was excision of the affected tissue and penile reconstruction in a two-stage procedure., Results: The operative procedure was successful and the patient had good aesthetic and functional results. Paraffin and other materials injected into the penis can produce many complications. Foreign body granuloma, skin necrosis, penile deformity, chronic and unhealed ulcer, painful erection, and the inability to achieve a satisfactory sexual relationship are some of the resulting complications. Intralesional or systemic steroids have been used in primary sclerosing lipogranuloma resulting in the disappearance of the granuloma, but in our opinion the treatment of choice should be radical excision, and, if necessary, secondary reconstruction of the penis., Conclusion: The injection of foreign substances to enhance penis size is currently an unjustifiable practice. However, it is still carried out, especially in Eastern Europe and Asia. In most cases surgical treatment is needed to treat the complications and the best modality seems to be radical excision together with follow-up.

Moderate-severe urinary incontinence and refractory-to-treatment erectile dysfunction after radical prostatectomy are two entities causing an important loss of quality of life to patients. The double implant of penile prosthesis and artificial urinary sphincter is a safe and effective option in these cases. This article describes preoperative considerations and the most important technical steps to do it satisfactorily.

Objective: To report the case of a patient with long-term giant genital lymphedema as a consequence of partial penectomy with bilateral inguinal lymphadenectomy 26 years before., Methods: 58-year-old male patient consulting for genital volume increase (penis and scrotum). Diagnostic tests were performed and surgery was indicated., Results: Complete bilateral scrotal excision including testicles and complete amputation of the penile remnant were carried out. Urethra was anastomosed to skin in the root of the scrotum. Post-operative outcome was satisfactory., Conclusions: Genital lymphedema is a disease associated with severe aesthetic and psychological disorders. The present case demonstrates that these patients may be rehabilitated.

Penoscrotal lymphedema is a rare disease in the developed countries, although it is relatively frequent in tropical countries. The most common cause is filariasis, although in our practice usually is associate to neoplasic and inflammatory processes, surgery, radiotherapy, hidroelectrolitic disbalances and idiopathic. We present a 22 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa. After unsuccessful medical treatment, was performed a total excision of the penile skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. Even medical management of penoscrotal lymphedema is not effective for most patients, surgery is a safe and effective procedure that gives excellent functional and cosmetic results.

Objectives: To report a new case of giant scrotal lymphedema due to Milroy's disease, its treatment and outcome., Methods: A 27-year-old man with generalized congenital lymphedema presented with a giant scrotal mass which interfered with his daily activities and physiological necessities. Physical examination showed a scrotal mass 40 x 40 cm in size and a normal penis. CT scan showed a homogeneous mass, thickened vaginal tunica, and bilateral hydrocele., Results: A surgical procedure was performed including mass resection (5.6 kg), and bilateral hydrocelectomy. Skin defect was covered with skin grafts., Conclusions: Several therapeutic alternatives have been suggested for Milroy's disease with genital involvement. Nevertheless, when complications are as severe as in the present case, the only valid therapy is surgery.

It is discussed a dermoid cyst case that depends on paratesticular structures, clinical entity which has low frequency of presentation. It is analyzed the controversial terminology of this tumours and are established anatomopathological criteria for this disease.

Objective: To present two cases of intrascrotal lithiasis associated with hydrocele and the results of the crystallographic study., Methods: Three intrascrotal calculi in two patients aged 72 and 75 years that underwent surgery for hydrocele were analyzed. Two 2-mm. calculi were incidentally discovered during surgery for a right hydrocele in one patient. An ultrasound scan of the other patient showed a left hydrocele with a free-floating, round, hyperechoic, 6-mm. calculus, with posterior acoustic shadow. None of the patients had a previous history of trauma. The 3 calculi were white and smooth, but turned yellow and rough after removal. Scanning electron microscopy and x-ray dispersion studies were performed., Results: All 3 calculi had a center comprised of hydroxyapatite and white organic matter, and an exterior of yellow organic matter. The mineral portion of the center of the 6-mm. calculus and one of the 2-mm. calculi was composed of 33% phosphorus and 67% calcium, and the other 2-mm. calculus contained 32% phosphorus and 68% calcium by x-ray dispersion analysis., Conclusions: Intrascrotal lithiasis is rare. In the two cases described herein, we observed abundant organic matter, particularly on the stone surface, and hydroxyapatite, particularly in the center. Among the possible etiologic causes, the deposit of organic matter in the presence of high oversaturation of calcium phosphates and absence of crystallization inhibitors, can initiate calcification and the subsequent collection of organic matter makes the process irreversible.

We present the clinicoepidemiological and therapeutic characteristics of 12 patients with Fournier's gangrene. The mean age of the patients was 66 years and all had a known predisposing factor for the disease. In all cases there was a predominance of mixed flora (four Gram-positive cocci, nine Gram-negative bacilli and ten anaerobic pathogens), with only one case of bacteremia reported. Initial surgery was conducted and was complemented by antimicrobial administration (imipenem, cefotaxime, clindamycin, penicillin and gentamicin alone and in combination) and local treatment with sugar and povidone-iodine. Hyperbaric oxygen was not used in any cases. At the end of treatment a mesh graft could be applied in 11 patients, all of whom showed an excellent functional and aesthetic recovery. The mean time of hospital stay was lengthy (49 days). The good evolution of the lesions after starting the local treatments with the sugar povidone-iodine combination should be emphasized.

Many surgical techniques, using different tissues, have been performed to repair the scrotal hypospadias in this century, but none of them has been completely effective. The use of autologous buccal mucosa as a free graft for urethral replacement was introduced in 1989. The reported results have been encouraged since then. Twenty three patients with scrotal hypospadias, have been treated from 1991 to 1998. These patients underwent a 2-stage surgical replacement. The first stage of the procedure included correction of the penile curvature and advancement of preputial flaps ventrally as described by Byras. The second stage of the procedure was the urethroplasty. The neourethra was made of a tubularized buccal mucosa graft. The mucosa was harvested from the inner surface of the lower lip. The first stage was performed at a mean age of 20 months old, and the second stage at a mean age of 32 months old. Micropenis was detected in 26% of patients. All of them were treated with topic testosterone before the second stage. The follow-up reflected that 7 out of 23 patients (30.4%) had not complications, while 16 patients (69.5%) developed urethro-cutaneous fistula. Six of them (26%) required only one surgical closure and the other 10 patients required more than one surgical procedure to correct several complications. One patient presented complications in both the recipient and the donor areas. Nowadays, cosmetic and functional results are good in 22 patients.

Objective: To report a case of urethral carcinoma presenting as scrotal abscess., Methods: A 53-year-old man presented with swelling, redness and pain in the scrotum. He had a history of urethral stricture and multiple scrotal abscesses. Incision and drainage were performed and the patient was treated with antibiotics without improvement. Incision and drainage were repeated and a biopsy of the tissue edges of the abscess were performed., Results: Histopathological analysis disclosed a squamous cell carcinoma arising from the urethra., Conclusion: Patients with a history of urethral stricture should be followed closely. A scrotal biopsy should be performed in patients who do not improve with antibiotic therapy.

We report a case of simple epidermoid cyst of the scrotum. Complete excision was performed transcrotally and the presence of epidermoid cyst confirmed by histopathological examination. Epidermoid cyst of the scrotum is a rare disease and only 10 cases have been reported. Simple excision was sufficient for treatment of this very rare lesion. The patient is now in the follow-up period.

Objective: To analyze the incidence and the clinical and histopathological features of non-inflammatory scrotal lesions with special reference to the non-neoplastic lesions, which are the most common., Methods: The cases of scrotal surgical pathology of the Hospital Nuestra Señora del Pino from 1988-1997 were reviewed. Skin biopsies for dermatological conditions, Fournier's gangrene, inflammatory-infectious lesions, hydroceles, lesions that could cause secondary involvement of the scrotal wall (e.g., spermatoceles) and invasive lesions from adjacent tumors were excluded from the study., Results: 14 cases (4 neoplastic and 10 non-neoplastic lesions) were specifically analyzed. Of these 10 non-neoplastic lesions, 7 were epidermoid cysts (3 multiple) and 3 idiopathic calcinosis. The latter, which are discussed at length, presented in middle-aged patients (56, 45 and 42 years) as multiple nodules that had gradually appeared over several years (20 years in one of the cases) and had been invariably diagnosed as "sebaceous scrotal cysts". Their form of presentation and treatment are similar to those of true scrotal epidermoid cysts, with which they might be related., Conclusions: In our series, the most common primary scrotal lesions were non-neoplastic and comprised two types whose pathogenic relationship has as yet not been elucidated: simple epidermoid or epidermal cysts (half of which were multiple lesions) and less frequently idiopathic calcinosis of the scrotum.

Objective: To report an additional case of webbed penis or penis palmatus, an uncommon malformation caused by alterations that occur during the embryonic development of the external genitalia., Methods: A 15-year-old by consulted for penile curvature. He was diagnosed as having webbed penis and phimosis, and was submitted to surgery., Results/conclusions: Z-plasty and circumcision achieved excellent results. He had no erectile anomalies following surgery.

Objective: To describe a simple method of depilation of scrotal skin and the advantages of utilizing scrotal skin flaps for urethroplasty in the postpubertal male., Methods: Depilation of the scrotal flap is achieved by electrocoagulating the dermal papillae with a needle specifically designed for scrotal hair. The frequency and the number of depilations are determined by the hair biological cycle., Results: Scrotal hair is removed with no injury to tissue or changes in the characteristics of scrotal skin. This method of depilation is well-tolerated and no complication has been observed., Conclusion: The scrotal skin depilated provides excellent flaps for reconstructive surgery of complex urethral strictures, specially those extending beyond the penoscrotal angle up to the membranous and prostatic inframontanum portion.

An efficient compression can reduce the complications of an inadequate hemostasis following scrotal surgery. The main difference between the "sumo" and previously described compressive methods lies in the use of both pelvic brims as main loading points for the dressing. Similar features are provided by standard scrotal supports but the compression they are able to achieve is minimal compared to that of "sumo" dressing.

We report on a patient who underwent scrotal reconstruction by cutaneous expansion, a new technique utilized to repair the male genital area. The tissue obtained with this technique permits creating a scrotal pouch and completely free movement of the testes. Unlike the other methods, sufficient skin can be obtained with the exparsion technique. The morphological result achieved with this technique is clearly superior. The absence of scars is underscored.

We present a boy 6 years old, with a penoscrotal hypospadias and perineal urethrostomy, with several unsuccessful attempts at hypospadias repair in other hospital. Autologous buccal mucosa was used as a free graft for urethral reconstruction. The clinical result was excellent, with a functioning urethra of good caliber throughout the entire length of the penis, without voiding difficulties. A proximal fistula that closed spontaneously 20 days postoperatively was the only complication. We present this technique as an elective option for severe hypospadias repair.

We report a case of granulomatous reaction to intrascrotal foreign body (vegetable fibers) that presented as an inguinal mass in a patient who had been treated for perforation of the jejunum loop incarcerated in inguinal hernia. To our knowledge a similar case has not been reported in the literature.

Scrotal trauma has increase in frequency during recent years, largely as the result of sporting activities, physical aggressions and road accidents. Its importance lies in the likelihood of associated lesions of the testis and the spermatic cord. We report 41 cases of scrotal trauma. Thirty-seven cases were non-penetrating and four were penetrating (including a case of traumatic rupture of the testis). Nonsurgical treatment was applied in 30 cases (73.1%) and surgical treatment in 11 (26.8%). The diagnostic techniques employed included ultrasonography in 19 cases, gammagraphy in 10 cases, Doppler-effect ultrasonography in 2 cases and CAT in 2 cases. The decision to operate should be based on the clinical findings. Follow-up studies over 8-60 months were satisfactory in all cases, with no cases of testicular atrophy detected.

Appearance of haemorrhages and bruises after surgery of scrotal bags contents is one of the most frequent complications in Urology. Presentation of results obtained in a prospective study carried out on 86 patients who had underwent surgery due to intrascrotal disease. In all of them and regardless of the approach used (inguinal or scrotal), suspension of bags to hypogastrium using suture traction was performed by Oesterling technique in combination to Joseph and O'Boyle's technique. Drainage was not used in any case. The article explains the characteristics of undergoing pathologies' surgical indications, describing both the technique used and the results obtained. It concludes by stating this is a useful method to prevent routine complications in scrotal surgery.

Fournier's gangrene is an uncommon pathological condition that affects the perineoscrotal region. Its course is fulminant and it carries a high mortality. We present 6 cases that had been treated over a period of 24 months. The mortality rate was 33.3%. The mean patient age was 53 years. The clinical and therapeutic aspects are discussed. The need to perform wide repeated debridement and the usefulness of the epidural catheter are underscored.

Herein we report on a 70-year-old patient with invasive angiomyxoma of the scrotum that had evolved for more than 30 years. The tumor's enormous size (4.225 gms.), its rarity and clinical behaviour are highlighted. There was no distant metastasis and tumor recurrence was by local infiltration. Its histologic features, which are like those of myxomatous tumors, are described.

A case of a child with complete penoscrotal transposition is presented. Surgical correction was performed in two stages. First, we performed penile elongation with scrotoplasty and partial perineal urethroplasty with the Thiersch Duplay technique, followed by Byars urethroplasty. The surgical techniques commonly used to correct this anomaly and their indications are reviewed. Currently, we recommend correction of hypospadias and transposition in a single stage procedure whenever possible.