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Masushi Kohta, Junko Sugama Research Center for Implementation Nursing Science Initiative, Fujita Health University, Toyoake, Aichi, JapanCorrespondence: Junko Sugama, Research Center for Implementation Nursing Science Initiative, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan, Tel +81 562 93 2504, Fax +81 562 93 4593, Email junko.sugama@fujita-hu.ac.jpPurpose: Elevated skin pH facilitates the number of pathogenic bacteria increase, leading to the skin barrier dysfunction. This phenomenon is typically observed in individuals with Incontinence-associated dermatitis (IAD), which imposes a substantial physical and psychological burden on the afflicted individuals. We evaluated the association between the development of IAD in community-dwelling women with urinary incontinence and cutaneous urease-producing bacteria, as these bacteria may be involved in elevating skin pH by chemical reaction with urea in urine.Patients and Methods: This was a cross-sectional study of 114 community-dwelling women with urinary incontinence who had registered for a survey campaign of a company. Swabs collected from genital skin were cultured in urea agar medium. The presence of urease-producing bacteria was determined by visually observing the change in the color of the culture medium caused by alkalization. The medium pH and total bacteria count were measured. Bacterial species were isolated and identified using a selective agar medium and simple identification kits. The participants were asked the presence of IAD by a self-administered questionnaire, and outcomes were compared between the IAD and no-IAD groups. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline.Results: IAD was present in 31.6% (36/114) of participants. The detection rate of urease-producing bacteria and the medium pH was significantly higher in the IAD group than in the no-IAD group; however, the total number of bacteria was not significantly different. There were no significant between-group differences regarding the bacterial species identified.Conclusion: The presence of urease-producing bacteria was associated with the development of IAD in community-dwelling women with urinary incontinence. Alkalization of the genital skin surface because of the contact between urine and urease-producing bacteria may compromise skin homeostasis. The bacterial species specifically involved in the development of IAD could not be determined.Keywords: microorganism, perineal, pH, skin care, women’s health

Background: Squamous cell carcinoma (SCC) in domestic cattle is an economically significant malignant neoplasm and has been documented primarily in ocular and periocular tissues, vulva and perineum. SCCs are often slow-growing and locally invasive, but metastasis is uncommon. Increased risk of developing SCC has been predominantly associated with high levels of sunlight exposure and hypopigmentation (skin and conjunctiva). This manuscript reports a case of ocular and perineal SCC in a Holstein Friesian cow with maxillary sinusitis secondary to tumor invasion. Case Description: An approximately 17-year-old Holstein Friesian cow was presented with a swollen, closed left eye and slow-growing perineal masses. The left eye was exenterated after showing poor response to anti-inflammatory and antimicrobial therapies, and the largest perineal mass was excised. Twelve months later, the cow developed purulent nasal discharge and dyspnea. The animal was euthanized for postmortem investigation due to health deterioration, advanced age, and suspected tumor metastasis. Conclusion: Ocular and perineal SCCs were diagnosed on biopsy and confirmed with immunohistochemistry. Postmortem gross and histological evaluations confirmed SCC invasion in the left maxillary sinus, with a secondary Trueperella pyogenes infection confirmed on aerobic culture. Histological evaluation of the enlarged lymph nodes revealed reactive lymphoid hyperplasia without evidence of tumor metastasis. [Open Vet J 2024; 14(11.000): 3113-3119]

Burns that involve the perineum, buttocks and genitals (PBG) have been associated with more challenging therapeutic needs and worse clinical outcomes. We aimed to investigate whether PBG burns are an independent predictor for mortality, morbidity and complications in a large, heterogenous patient collective and in comparison to patients without PBG burns. Patients admitted to a level one burn center between August 2014 and July 2022 were included and stratified based on the presence of PBG burns on admission (PBG & control group = CTR). Demographic baseline data, burn aetiology, inhalation trauma (IHT), full-thickness burns (FT), number of operations (NOR), mortality, length of ICU stay (LOS-ICU), length of in-hospital stay (LOHS) and bacteraemia were assessed to compare key clinical characteristics and outcomes between the groups. Multivariate regression analyses and a 1:1 propensity score matching were conducted for key clinical outcomes. A total of 1024 patients were included in the analysis (PBG: n = 227; CTR: n = 797). PBG burns were older (median (IQR) 54 (34−72) vs. 44, (30−61) years, p < 0.0001), more frequently female (35% vs. 23%, p = 0.002) presented with larger total body surface area (TBSA) burns overall (27 (32−39) vs. 10 (13−15) %, p < 0.0001) and sustained FT burns more frequently (69% vs. 26% p < 0.0001). Scald burns were more frequently the cause of PBG burns (45% vs. 15%, p < 0.0001), PBG patients needed twice as many surgical procedures (Mean (SD) 2 (2.84) vs. 1 (1.6), p < 0.0001) as CTR. In multivariate analyses, a significant correlation was identified between length of ICU stay and presence of PBG burns. Following strict cohort matching to account for sex, age, cause of burn, TBSA %, presence of FT burn, inhalation trauma and bacteraemia, PBG burns were an independent predictor for mortality (p = 0.0003). PBG burns are at risk for prolonged intensive care, hospitalization and complications during treatment. Furthermore, the presence of PBG burns appears to be a risk factor for mortality, irrespective of patient age, TBSA affected and other relevant covariates. • Patients with PBG burns are at risk for complications and prolonged hospitalisation. • PBG burns are an independent risk factor for mortality. • PBG burns often occur in (near) isolation to elderly people. [ABSTRACT FROM AUTHOR]

Background: Vaginismus, a prevalent genito-pelvic pain/penetration disorder in the Middle East, often leads to unconsummated marriages, with a significant impact on marital and social well-being. Traditional treatments have shown limited success in refractory cases. Objective: To evaluate the effectiveness of an integrated treatment program, including Botulinum Toxin A (BTXA) injections, gradual vaginal introitus dilation, and psychological support, in treating refractory vaginismus in Egyptian women. Patients and Methods: This retrospective case series analyzed 1,400 women with refractory vaginismus, treated between January 2013 and 2023. The program comprised BTXA injections in the perineal muscles, followed by guided physiotherapy for muscle dilation and psychological counseling. Success was defined as painless vaginal penetration. Results: Of the initial 1,512 cases, 1,400 completed the program. The average age of participants was 28 years. Most patients (93%) had tried conventional treatments without success. Post-treatment, 92.6% (1,288/1,400) achieved painless penetration. The majority required 3 to 5 dilatation treatment sessions for success. Mild adverse effects were reported in 28% of cases. Conclusion: The integrated treatment program, combining BTXA injections, gradual dilation, and psychological support, is highly effective in managing refractory vaginismus in Egyptian women, with a success rate of over 90%. This approach offers a promising solution for couples facing unconsummated marriages due to vaginismus. [ABSTRACT FROM AUTHOR]

Objective: The objective of study is to investigate the effects of radical retropubic and perineal prostatectomy methods in addition to the effect of pelvic lymph node dissection on perioperative morbidities, oncological outcomes and 1-year quality of life in patients with clinically local stage prostate cancer. Material and methods: Patients admitted to our clinic between January 2013 and March 2015 and diagnosed with clinically localized stage prostate cancer were included. A total of 103 patients were randomized into 3 groups in which 38 patients received radical perineal prostatectomy(RPP), 31 had radical retropubic prostatectomy(RRP), and 34 RRP with pelvic lymph node dissection(PLND). Age, comorbidities, preoperative Gleason scores and serum prostate-specific antigen(PSA) data as well as the surgical parameters, clinical and pathological stages, and 1-year follow-up data were recorded for each patient."Extended prostate cancer index composite (EPIC)" and "SF-12v2™ Health Survey(Version 2.0)" questionnaires were used for overall and disease-specific quality of life at month 0, 1, 6 and 12 visits. Results: No difference was found between the groups with regard to preoperative data such as age, serum PSA levels, clinical stage, biopsy Gleason score and Charlson comorbidity index while intraoperative data for the amount of bleeding and the average amount of transfusion were significantly lower in RPP group(RPP:645cc, RRP:960cc, RRP+PLND:890cc).1-year recurrencefree survivals for RPP, RRP, and RRP+PLND groups were 9.9 months, 11.2 months and 10.2 months, respectively, with no significant difference. Overall and prostate cancer-specific quality of life was similar for all 3 groups. No additional benefit with nerve-sparing surgery was shown in any of the groups in terms of incontinence and erectile functions. Conclusion: Perineal dissection is beneficial in terms of the amount of bleeding and blood transfusion while prolonged postoperative drainage and wound infection rates are higher compared to retropubic approach. All 3 groups were similar in urinary, sexual, gastrointestinal and hormonal functions as well as the quality of life. [ABSTRACT FROM AUTHOR]

Objective: In the last 10 years, robotic platforms allowed to resume of some alternative surgical approaches, including perineal robot-assisted radical prostatectomy (p-RARP). Herein, we present in detail the oncological and functional outcomes of patients who underwent p-RARP with a median follow-up of 30 months. Methods: Patients presenting low- or intermediate-risk prostate cancer and prostate volume up to 60 mL who underwent p-RARP between November 2018 and November 2022 were selected. Baseline, intraoperative, pathological, and postoperative data were collected and then analyzed. Results: Thirty-seven p-RARP cases were included. Such patients presented mean age of 62 years and a mean Charlson comorbidity index of 4. Body mass index of ≥25 kg/m2 was reported by 24 (64.9%) patients, as well as 7 (18.9%) patients reported a past surgical history. Mean prostate volume and median prostate-specific antigen were 41 mL and 6.2 ng/mL, respectively. The median operative time was 242 min. The positive surgical margin rate was 45.9%. In terms of postoperative complications, 10 patients reported complications with any grade; however, a single case (2.7%) of major (Clavien-Dindo grade ≥3) complication was observed. No patient with biochemical recurrence or distant metastasis was reported at 2 years of follow-up. Recovery of continence rates were 67.6%, 75.7%, and 92.9%, at 6 months, 12 months, and 24 months after surgery, respectively. Conclusion: p-RARP is a challenging but safe minimally invasive approach for selected patients with prostate cancer suitable for radical prostatectomy, showing outstanding functional recovery. Despite positive surgical margin rates being relatively high, no cases of biochemical recurrence or distant metastasis were reported after a median follow-up of 30 months.

Fibrous hamartoma of infancy is a rare benign tumor that’s mainly detected in the upper trunk. In this study authors report a 1-year-old case of perianal fibrous hamartoma which was successfully managed without need to orchidectomy or urethral manipulation.

Flap reconstruction is often required after pelvic tumor resection to reduce wound complications. The use of perforator flaps has been shown to reduce donor site morbidity. The purpose of this study was to evaluate the outcomes of pedicled deep inferior epigastric perforator (pDIEP) flap reconstruction. This was a retrospective multicenter study of patients who underwent immediate pDIEP flap reconstruction for a pelvic or perineal defect after tumor resection between November 2012 and June 2022. The primary outcome was abdominal donor site morbidity, and the secondary outcome was perineal morbidity. Thirty-four patients (median age, 57.5 years) who underwent pelvic exenteration (n = 31), extralevator abdominoperineal excision (n = 2), or extended vaginal hysterectomy (n = 1) were included. The most common indications were recurrent cervical (n = 19) and anal (n = 4) squamous cell carcinoma. Twenty-nine patients (85%) had a history of radiotherapy. Only one patient (3%) had major (Clavien-Dindo ≥ III) donor site complications (surgical site infection due to tumor recurrence). Eleven patients (32%) had at least one major recipient site complication (surgical site infection [n = 1], total [n = 2] or partial [n = 1] flap loss, perineal dehiscence [n = 2], hematoma [n = 1], fistula [n = 5]). No incisional or perineal hernias were observed during follow-up. Ninety-day survival was 100%. Pedicled DIEP flap reconstructions performed by experienced surgical teams had good outcomes for perineal or vaginal reconstruction, with low abdominal morbidity, in patients with advanced pelvic malignancies who had undergone median laparotomy. The risks and benefits of this procedure should be carefully evaluated preoperatively using clinical and imaging data. [ABSTRACT FROM AUTHOR]

Background: There are many ways to treat prostatic hyperplasia; these are currently more inclined to minimally invasive treatment. We mainly compared the differences between two treatment methods， ultrasound-guided transperineal laser ablation (US-TPLA) and prostatic artery embolization (PAE). Purpose: To evaluate the efficacy and safety of US-TPLA and PAE in the treatment of benign prostatic hyperplasia (BPH). Material and Methods: The clinical information for 40 patients with BPH admitted to our hospital between June 2018 and January 2021 were retrospectively analyzed. The changes in International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate volume (PV), and the incidence of complications were compared between groups. Results: The IPSS (P < 0.001; P < 0.001), QoL (P < 0.001; P < 0.001), Qmax (P < 0.001; P < 0.001), PVR (P < 0.001; P < 0.001), and PV (P < 0.001; P < 0.001) at three and six months after US-TPLA and PAE improved with respect to those before surgery. There was no significant difference in IPSS (P = 0.235; P = 0.151), QoL (P = 0.527; P = 0.294), Qmax (P = 0.776; P = 0.420), PVR (P = 0.745; P = 0.607), and PV (P = 0.527; P = 0.573) between the groups at three and six months after surgery. No serious complications occurred in either group. Conclusion: US-TPLA and PAE seem to have a similar short-term efficacy. The efficacy of the two procedures is comparable, and neither is associated with serious complications. US-TPLA and PAE are both effective complementary measures for the treatment of BPH. [ABSTRACT FROM AUTHOR]

Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Radical prostatectomy (RP) represents the standard of care for the treatment of patients with organ-confined prostatic cancer. Historically, perineal RP has been described as the first surgical approach for the complete removal of the prostatic gland. In the past years, robotic techniques provided some technical advantages that allow resuming alternative approaches, such as robotic radical perineal prostatectomy (r-RPP). Objective: To present in detail the technique of Xi nerve-sparing r-RPP and to report perioperative, oncological, and functional outcomes from a European tertiary center. Design, setting, and participants: Patients with low- or intermediate-risk prostatic cancer not suitable for active surveillance and prostate volume up to 60 ml who underwent r-RPP between November 2018 and December 2020 were identified. Surgical procedure: All patients underwent Xi nerve-sparing r-RPP. Measurements: Baseline characteristics and intraoperative, pathological, and postoperative data were collected and analyzed. The complications were reported according to the standardized methodology to report complications proposed by European Association of Urology guidelines. Results and limitations: Overall, our series included 26 patients who underwent r-RPP. Patients’ median age was 62.5 yr. Thirteen (50%) and eight (30.7%) patients showed a body mass index (BMI) of 25–30 and >30, respectively. A history of past surgical procedures was present in seven (26.8%) patients. The median prostate volume was 40 (interquartile range [IQR]: 28–52) ml. The median operative time and blood lost were 246 (IQR: 230–268) min and 275 (IQR: 200–400) ml, respectively. Overall, four (15.4%) patients reported intraoperative complications and five (19.2%) reported postoperative complications, with one (3.8%) reporting major complications (Clavien-Dindo ≥3). No patient with biochemical recurrence (BCR) was reported at 1 yr of follow-up. Continence rates were 73.0%, 84.6%, and 92.3%, respectively, at 3, 6, and 12 mo after surgery. Erectile potency recovery rates were 57.1%, 66.6%, and 80.9% at 3, 6, and 12 mo of follow-up, respectively. Conclusions: Xi r-RPP is a challenging but safe minimally invasive approach for selected patients. No patient reported BCR at 12 mo. The choice of the surgical approach for RP is likely to be based on the patient’s characteristics as well as the surgeon’s preferences. Patient summary: Our study suggests that Xi radical perineal prostatectomy is a safe minimally invasive approach for patients with low- or intermediate-risk prostatic cancer, and complex abdominal surgical history or comorbidities.

Background: Perineal reconstruction following recurrent lower rectal and anal carcinoma can represent a challenge to reconstructive surgeons owed to the variability and complexity of the size of the defects, availability of donor sites, biomechanical strain, and patient factors. Historically, these wounds have been managed with very little consensus surrounding the best reconstructive surgical approach and options. Methods: We propose a reconstructive algorithm based on a case series from January 2014 to July 2021 of 63 patients. In our algorithm, we have included four surgical reconstructive options; de-epithelialised buttock closure (DEBC), bilateral buttock rotation flaps (BBRF), V–Y advancement flaps, and pedicled vertical rectus myocutaneous flaps (VRAM) and its modified version. Results: The majority of patients over 90% had a successful outcome, and only a few less than 10% had postoperative complications classed as minor related to reconstruction, which did not require further surgery. The majority, 41 patients received de-epithelialised buttock closure of which two patients (4.9%, p = 0.0476) had postoperative complications. Ten patients had bilateral buttock rotation flaps of which one (10%, p = 0.1642) had complications. Six patients V–Y advancement buttock flaps, one patient (16.7%, p = 0.5031) had postoperative complication. Finally, six patients had VRAM flaps; there was one (16.7%, p = 0.4636) complication. When comparing all four reconstructive modalities, there was no significant difference between the number of complications (p = 0.0576). Conclusions: This cohort has shown that any approach to perineal reconstruction can be tailored to the patient's need rather than one reconstructive choice to fits all defects. This algorithm based on the pinch test to assess the availability of local options and the integrity of the internal iliac blood supply to provide durable and reliable soft-tissue reconstruction is very reliable and reproducible. Level of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

The perineal presentation of plexiform neurofibroma is exceptional, with only two cases reported to date. We present an 8-year-old African male with a large perineal tumor of years of evolution. He had no associated symptoms. Café au lait stains were observed on examination, without other findings of relevance. The patient had no preoperative radiological studies. Partial excision of the lesion was performed. Histopathological study of the specimen revealed a plexiform neurofibroma. The lack of diagnostic suspicion due to the atypical nature of the location, the anatomical complexity of surgical resection and the potential urological and rectal involvement make this lesion a diagnostic-therapeutic challenge. Among the differential diagnoses, schwannoma, congenital lipoma, hamartoma and lipoblastoma should be considered. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the safety, oncologic, surgical, and functional outcomes of RPP and RRP for localized prostate cancer (Pca), especially focusing on RPP. Materials and methods: From March 2005 to January 2021, we retrospectively reviewed the records of 685 patients undergoing RPP (n = 320) or RRP (n = 365) for localized Pca. Surgical and functional outcomes, and complications were compared. Oncological outcomes were also compared using Kaplan-Meier survival analysis. Results: A higher biochemical recurrence rate were noted in RRP than in RPP group (28.8% vs 21.6%, respectively; p = 0.03). A local recurrence was detected in a few numbers of patients (4.4%) with no statistically significant differences by surgical groups (p = 0.71). No significant differences were observed in the cancer-specific survival and the overall survival according to the surgical approach. Positive surgical margins were similar in the two techniques. In comparison to RRP, patients undergoing RPP have less postoperative pain, decreased transfusion rate, and less catheterization time. Complete continence was achieved in 96.9% of the RPP group at 18 and 24 months versus 91.8% and 92.3% in the RRP group at 18 and 24 months, respectively (p = 0.005 and p = 0.01, respectively). At 18 months of follow-up, the nerve-sparing technique was performed equally between the two groups, the mean of erectile function domain improved more in RPP than RRP (12.71 vs 10.42 respectively, p < 0.001). Medical and surgical complication rates were higher for RRP than RPP. Conclusions: RPP showed acceptable oncologic outcomes and excellent functional outcomes when compared to RRP. [ABSTRACT FROM AUTHOR]

Copyright of Yeni Üroloji Dergisi is the property of Ali Ihsan Tasci and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: This study involves the use of a new multifunctional prosthetic mesh for treatment of perineal hernia without complications. The prosthetic mesh is a hybrid platform of both synthetic and natural materials with its backbone consisting of a synthetic commercial polyester fabric (CPF) to deliver the required mechanical integrity. The CPF mesh was coated by a natural biodegradable, biocompatible and antimicrobial layer of chitosan (CS) incorporating phenytoin (PH)-loaded pluronic nanomicelles for healing promotion, and ciprofloxacin (CPX)-alginate polyelectrolyte complex-based microparticles as antibacterial agent. Aim: The aim this study is to evaluate the new developed multifunction polyester-based hybridmesh to repair perineal hernias clinical cases in dogs. Methods: The used multifunctional prosthetic mesh is a hybrid of the natural biodegradable, biocompatible and antimicrobial materials was used in 6 case of perineal hernia Results: The prosthetic polyester-based hybrid mesh was found very helpful for repairing clinical cases of perineal hernias in 6 dogs without unwarranted other surgical procedures or complications. The developed mesh proved its feasibility in terms of efficient biocompatibility, stability, sterilizability and low cost. Conclusions: The prosthetic commercial polyester-based mesh provided the ideal and feasible alternative prothesis with many advantages.

Copyright of Medical Journal of Ankara Training & Research Hospital is the property of Medical Journal of Ankara Training & Research Hospital and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The use of prophylactic negative pressure wound therapy (NPWT) postoperatively is reported to assist with closure and prevent wound breakdown. However, studies using NPWT on perineal wounds following abdominal perineal excision have been inconclusive. In this non-randomised study we examined the outcomes (measured by days to healing) in patients who did and did not have prophylactic NPWT immediately postoperatively. Results: Low risk ethics was obtained through South Eastern Sydney HRECLNR 2020/ETH0058. There were 40 patients in our cohort. A total of 22 did not have a NPWT dressing applied and 18 did. The dressings were of varying brands and were what the hospital stocked at the time. There was no difference between the groups at baseline. Those with NPWT had a median healing time of 29.5 days vs 43.5 days in those without NPWT. This was not statistically significant. The use of the PICO dressing (Smith+Nephew) appeared to trend toward a shorter healing period but again this was not statistically significant. Conclusion: These data indicate that NPWT may be useful in reducing days to healing. However, a properly powered, well designed randomised controlled trial is required to assess if these expensive dressings are worthwhile in improving healing in these difficult wounds. [ABSTRACT FROM AUTHOR]

Fibrous hamartoma of infancy is a rare benign tumor that's mainly detected in the upper trunk. In this study authors report a 1-year-old case of perianal fibrous hamartoma which was successfully managed without need to orchidectomy or urethral manipulation. [ABSTRACT FROM AUTHOR]

Purpose: To describe clinical features, risk factors, and outcomes of patients with perineal and perianal rhabdomyosarcoma., Methods: The records of 51 patients (38 perineal and 13 perianal) enrolled on Children's Oncology Group clinical trials between 1997 and 2012 were reviewed., Results: At presentation, 53% were female, 65% were older than 10 years of age, 76% were alveolar histology, 76% were more than 5 cm, 84% were invasive, 65% were regional node positive by imaging, 49% were metastatic, only 16% were grossly resected upfront, and 25% of patients had a delayed excision. At a median follow-up of 6.13 years, estimated 5-year event-free survival (EFS) was 38% [22.17%-53.38%], and overall survival (OS) was 42% [26.66%-58.21%]. The rates of local, regional, and distant failure were 15.6%, 13.7%, 43.1%, respectively; all failures ultimately died. By univariate analysis, only age more than 10 years negatively impacted 5-year EFS (p = .023) and OS (p = .09), and IRS Group also impacted OS (p = .043). In Cox proportional hazards model, neither of these variables were significant after adjusting for other factors., Conclusion: Patients with perineal and perianal rhabdomyosarcoma have a poor overall prognosis, probably related to poor patient and disease characteristics at presentation., (© 2024 Wiley Periodicals LLC.)

A small subset of males presenting with cryptorchidism are found to have ectopic testes. The most common location for an ectopic testicle is the superficial inguinal pouch, but there are several other possibilities, necessitating a thorough physical exam.A 4-month-old term male presented for evaluation of a nonpalpable right testicle. Examination revealed an ectopic right testicle located in the perineum. The patient underwent successful right orchiopexy.Ectopic testes are rare but remain in the differential diagnoses for patients with cryptorchidism. Patients should undergo prompt orchiopexy to avoid potential complications and allow maximal preservation of testicular function.

Purpose: To compare infectious complications after transrectal systematic prostate biopsy (SB) and magnetic resonance imaging (MRI)-targeted biopsy (TB) in a large retrospective cohort to assess whether one technique is superior to the other regarding infectious complications. Methods: A total of 4497 patients underwent 5288 biopsies, 2875 (54%) SB and 2413 (46%) MRI-TB only. On average, 12 SB cores and 3.7 MRI-TB cores were taken per biopsy session during the study period. Infection-related complications within 30 days were compared. The primary endpoint was a positive urine culture. Secondary endpoints were positive blood cultures, urine tests with elevated leukocytes ≥ 100 E6/L and elevated C-reactive protein (CRP) ≥ 100 mg/L. Chi-square test was used to compare the cohorts. Results: Positive urine cultures were found in 77 (2.7%) after SB and in 42 (1.7%) after MRI-TB (p = 0.022). In total, 46 (0.9%) blood culture positive infections were found, 23 (0.9%) occurred after SB and 23 (1.0%) after MRI-TB, (p = 0.848). Urine tests with elevated leukocytes ≥ 100 E6/L were found in 111 (3.9%) after SB and in 61 (2.5%) after MRI-TB (p = 0.006). Elevated CRP ≥ 100 mg/L was found in 122 (4.2%) after SB and in 72 (3.0%) after MRI-TB (p = 0.015). Blood cultures were drawn more often after SB than after MRI-TB, but the difference was not statistically significant. However, urine cultures and CRP were taken more often after SB than MRI-TB. Conclusion: Blood culture positive infections were equally rare after SB and MRI-TB. However, all other infectious complications were more common after SB than MRI-TB. [ABSTRACT FROM AUTHOR]

Maternal mortality remains public health issue. One of its leading causes is postpartum haemorrhage. The aim of this study is to test the relationship between haemoglobin levels, perineal tear, retained placenta, uterine atony, and maternal mortality from postpartum haemorrhage in Jember district, Indonesia. This case-control study comprised 43 mothers died from postpartum haemorrhage (cases), and 43 mothers survived from postpartum haemorrhage (controls) between from January 2017 and December 2019. Data were obtained from maternal verbal autopsies, complemented by birth registrations and medical records in 26 community health centres across Jember district. The chi-square, and multivariate logistic regression were administered to test the hypothesis. The results of this study indicate that Haemoglobin levels (p = 0.032, OR 6.372, 95% CI 1.172 - 34.626), retained placenta (p = 0.033, OR 4.578 95% CI 1.128 – 18.587), and atonia utery (p= 0.014, OR 4.578 95% 1.364 – 16.502) had significant relationship with maternal deaths from postpartum haemorrhage. However, perineal tear (p= 0.155, OR 0.347 95% 0.081 – 1.490) had no significant relationship with maternal deaths from postpartum haemorrhage. The conclusion in this study is Identifying obstetric factors are important. Therefore, conducting early detection screening during pregnancy is encouraged to reduce postpartum haemorrhage maternal death. [ABSTRACT FROM AUTHOR]

Introducción: los quistes de rafe medio (QRM) son lesiones infrecuentes del aparato genital masculino, pueden localizarse desde la parte distal del pene hasta la zona perianal. Se deben a defectos del cierre del rafe medio durante el desarrollo embrionario. Objetivo: presentar un lactante con el diagnóstico de QRM, discutir el diagnóstico, tratamiento y seguimiento. Caso clínico: niño de 1 año y 3 meses de edad con 7 lesiones quísticas de 0.5 cm cada una en el rafe medio escrotal desde el nacimiento, la ecografía de partes blandas reporta imagen sólida hipoecogénica de borde definidos y sin vascularización al doppler. Se realizó exéresis quirúrgica y la patología confirmó el diagnóstico de quiste de rafe medio perineal, con buena evolución en el seguimiento. Discusión: 75% de los casos de los QRM son asintomáticos es por ello que muchas veces su diagnóstico es tardío, además su desconocimiento produce confusión con patologías quísticas o tumorales similares. El diagnóstico es clínico, aunque la ecografía puede ayudar para excluir otras anomalías como las vasculares. El tratamiento de elección debe ser la extirpación quirúrgica para evitar episodios de sobreinfección o molestias locales derivadas de su localización y tamaño. Conclusión: debido a lo infrecuente de esta patología es importante darla a conocer. Se recomienda realizar la valoración integral del paciente pediátrico para lograr un adecuado diagnóstico, ofrecer el mejor tratamiento y brindar información adecuada a los padres.

Perineal hernias are protrusions of intra-abdominal contents resulting from weakness of the pelvic floor muscles. They are an uncommon complication after ultraradical pelvic surgeries, with no established gold standard for surgical treatment. This case describes a rare anterior perineal hernia that developed after radical surgery for bladder carcinoma. A 77-year-old Caucasian woman presented with a painful 10 cm bulge in the perineal region. The hernial sac involved the entire left labia majora and developed 4 years after radical surgery for bladder carcinoma. She had been misdiagnosed twice in the past with vaginal prolapse, leading to two unsuccessful vaginoplasty procedures due to recurrence. She underwent hernia repair with perineal approach and polypropylene mesh placement. The postoperative period was uncomplicated, and the patient was discharged after five days, with histology showing no malignancy. Perineal hernias are protrusions of intra- or extraperitoneal contents into the perineum due to a defect in the pelvic musculature. Various surgical modalities exist for perineal hernia repair, which adhere to the fundamental principles of hernia surgery: sac mobilization, precise incision, sac debridement and excision, and defect repair. Here, we successfully applied the perineal approach in a complicated case of a misdiagnosed perineal hernia after radical surgery. The perineal approach for hernia repair, involving an implantation of a polypropylene mesh and tissue flap was successfully applied, confirming its main place in the surgical treatment of perineal hernias. During the two-year follow-up no postoperative complications or recurrence hernia were registered. • A rare case of an anterior perineal hernia after radical surgery for bladder carcinoma • A perineal approach with implantation of polypropylene synthetic mesh and tissue flap cover • Recurrent misdiagnosed perineal hernia, treated twice with vaginoplasty procedures [ABSTRACT FROM AUTHOR]

Abstract Background Perianal/perineal rhabdomyosarcomas (PRMS) are easily misdiagnosed soft tissue tumours with a poor prognosis. This study was designed to analyze the clinical, diagnostic, pathological and prognostic features of PRMS, and to explore currently available therapeutic modalities. Methods Clinical data of PRMS patients admitted to the Sixth Affiliated Hospital and the Cancer Center of Sun Yat-sen University and from related Chinese literature published from 1987 to 2018 were collected and analyzed. The Chi-square test was used to evaluate the differences between each group. The Kaplan–Meier methods were applied to estimate and compare survival rates. Results A total of 35 patients were included in this study; 20 identified within related Chinese literatures and 15 from our center admitted during the period of 1997–2019. Out of these cases, 34 presented with perianal masses and the remaining one manifested as an inguinal mass. Moreover, 20 patients complained of pain and 16 of them were misdiagnosed as perianal abscesses, in which the presence of pain contributed to the misdiagnosis (p

Perineal trauma in children are rare, but they can be life-threatening and surgically challenging conditions in the absence of a standardized therapeutic approach. Colostomy remains important and plays an essential role in minimizing the frequency of perineal wound infections but has known complications. Here, we describe a case of a 7-year-old boy who was a victim of a road traffic accident polytrauma and sustained severe perineal injury. The patient was managed primarily without stoma creation and achieved complete wound healing and continence. This case highlights that selection of primary repair without colostomy must be meticulous and individualized.

To report glans and penile dimensions in 1023 consecutive boys with hypospadias. Boys admitted for hypospadias surgery between 2016 and 2018 were included in this study. Age ranged between 6 and 36 months. Boys who underwent previous surgery, received hormone therapy or older than 36 months were excluded. The hypospadias was classified according to ICD and WHO classification into glanular (Grade I), distal (Grade II), proximal (Grade III) and perineal (Grade IV). The flaccid penile length (PL), the dorsal glans length (DGL), the ventral glans length (VGL) and the glans width (GW) were measured in the operating room under anaesthesia just before operative correction. Small (GW) in this study was defined as less than 14 mm. 1023 boys were included. 273 had glandular, 468 distal, 194 proximal and 88 perineal hypospadias. The mean glans width was 14 mm with a range of 8 to 20 mm. The mean glans width for glanular hypospadias was 14.0 mm (range 9–19 mm), 14.0 mm (range 10–20 mm) for distal hypospadias (p > 0.05), 13.1 mm (range 9–19 mm) for proximal hypospadias (p < 0.0001) and 11.1 mm (range 8–16 mm) for perineal hypospadias (p < 0.0001). 460 (45.0%) of all patients presented with a small glans width. In glanular hypospadias it was 99 (36.3%), 167 (35.7%) in distal hypospadias, 111 (57.5%) in proximal hypospadias and 83 (94.3%) in perineal hypospadias. There was no significant difference in the glans size between the age of 6 and 24 months (p > 0.2), but there was a difference when compared to patients older than 25 months (p < 0.05). A small glans is found in about a third of distal, two thirds in proximal and more than 90% of perineal hypospadias. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: This study involves the use of a new multifunctional prosthetic mesh for treatment of the perineal hernia without complications. The prosthetic mesh is a hybrid platform of both synthetic and natural materials, mainly consisting of a synthetic commercial polyester fabric (CPF) to deliver the required mechanical integrity. The CPF mesh was coated by a natural biodegradable, biocompatible, and antimicrobial layer of chitosan incorporating phenytoin-loaded pluronic nanomicelles for healing promotion and ciprofloxacin-alginate polyelectrolyte complexbased microparticles as antibacterial agent. Aim: To evaluate the new developed multifunction polyester-based hybridmesh to repair perineal hernia clinical cases in dogs. Methods: The used multifunctional prosthetic mesh is a hybrid of the natural biodegradable, biocompatible, and antimicrobial material used in six cases with perineal hernia. Results: The prosthetic polyester-based hybrid mesh was found very helpful in repairing clinical cases of perineal hernias in six dogs without unwarranted other surgical procedures or complications. The developed mesh proved its feasibility in terms of efficient biocompatibility, stability, sterilizability, and low cost. Conclusion: The prosthetic commercial polyester-based mesh provided the ideal and feasible alternative prosthesis with many advantages. [ABSTRACT FROM AUTHOR]

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BackgroundPatients with rectal prolapse often have significant comorbidities that lead surgeons to select a perineal resection for treatment despite a reported higher recurrence rate over abdominal approaches. There is a lack of data to support this practice in the laparoscopic era. The objective of this study was to evaluate if risk-adjusted morbidity of perineal surgery for rectal prolapse is actually lower than laparoscopic surgery.DesignA retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database as performed for patients undergoing surgical treatment of rectal prolapse between 2005 and 2011. Outcomes were analyzed according to procedure-type: laparoscopic rectopexy (LR), laparoscopic resection/rectopexy (LRR), open rectopexy (OR), open resection/rectopexy (ORR), and perineal resection (PR). A multivariate logistic regression was used to compare risk-adjusted morbidity and mortality between each procedure. Main outcome measures were 30-day morbidity and mortality.ResultsAmong 3,254 cases sampled, a laparoscopic approach was used in 22 %, an open abdominal approach in 30 %, and PR in 48 %. Patients undergoing PR were older (76) and had a higher ASA (3) compared to laparoscopic (58, 2) and open abdominal procedures (58, 2). Risk-adjusted mortality could not be assessed due to a low overall incidence of mortality (0.01 %). Overall morbidity was 9.3 %. ORR was associated with a higher risk-adjusted morbidity compared to PR (OR: 1.89 CI (1.19-2.99), p = 0.03). There were no significant differences in risk-adjusted morbidity found between LR and LRR compared to PR (OR 0.44 CI (0.19-1.03), p = 0.18; OR 1.55 CI (0.86-2.77), p = 0.18). Laparoscopic cases averaged 27 min longer than open cases (p < 0.001).ConclusionLaparoscopic rectal prolapse surgery has comparable morbidity and mortality to perineal surgery. A randomized trial is indicated to validate these findings and to assess recurrence rates and functional outcomes.

BACKGROUND: We hypothesized that knowledge regarding obstetric anal sphincter injuries amongst healthcare workers in our setting is limited. A lack of knowledge would result in worsened clinical outcomes and proving this knowledge deficiency would allow us to institute educational programs to improve outcomes. OBJECTIVE: This study aimed to assess the knowledge and perceptions of healthcare workers regarding obstetrical anal sphincter injuries in a resource-limited setting. STUDY DESIGN: Questionnaires assessing the knowledge in classification, diagnosis, and management of obstetrical anal sphincter injuries were completed by 290 doctors and nurses involved in conducting vaginal deliveries at various levels of care (primary, district, regional, tertiary) in a resource-limited setting. Moreover, confidence in managing obstetrical anal sphincter injuries was assessed. RESULTS: Although the healthcare workers’ knowledge of anatomy was poor, most healthcare workers knew how to define obstetrical anal sphincter injuries and classify these injuries. Most healthcare workers considered obstetrical anal sphincter injuries serious complications and perceived that patients with obstetrical anal sphincter injuries were best managed at a regional- or tertiary-level hospital. There was variation in choice of suture material and methods of repair, with most healthcare workers lacking confidence in managing obstetrical anal sphincter injuries and 96.9% of healthcare workers indicating a need for further training. Most healthcare workers felt that perineal support was the best intrapartum preventative strategy against obstetrical anal sphincter injuries. CONCLUSION: Here, it was likely that knowledge and confidence in managing obstetrical anal sphincter injuries in most resource-limited settings were suboptimal, highlighting a need for ongoing training.

Somatosensory feedback from peripheral receptors dynamically interacts with networks located in the spinal cord and brain to control mammalian locomotion. Although somatosensory feedback from the limbs plays a major role in regulating locomotor output, those from other regions, such as lumbar and perineal areas also shape locomotor activity. In mammals with a complete spinal cord injury, inputs from the lumbar region powerfully inhibit hindlimb locomotion, while those from the perineal region facilitate it. Our recent work in cats with a complete spinal cord injury shows that they also have opposite effects on cutaneous reflexes from the foot. Lumbar inputs increase the gain of reflexes while those from the perineal region decrease it. The purpose of this review is to discuss how somatosensory feedback from the lumbar and perineal regions modulate the spinal locomotor central pattern generator and reflex circuits after spinal cord injury and the possible mechanisms involved. We also discuss how spinal cord injury can lead to a loss of functional specificity through the abnormal activation of functions by somatosensory feedback, such as the concurrent activation of locomotion and micturition. Lastly, we discuss the potential functions of somatosensory feedback from the lumbar and perineal regions and their potential for promoting motor recovery after spinal cord injury.

Somatosensory feedback from peripheral receptors dynamically interacts with networks located in the spinal cord and brain to control mammalian locomotion. Although somatosensory feedback from the limbs plays a major role in regulating locomotor output, those from other regions, such as lumbar and perineal areas also shape locomotor activity. In mammals with a complete spinal cord injury, inputs from the lumbar region powerfully inhibit hindlimb locomotion, while those from the perineal region facilitate it. Our recent work in cats with a complete spinal cord injury shows that they also have opposite effects on cutaneous reflexes from the foot. Lumbar inputs increase the gain of reflexes while those from the perineal region decrease it. The purpose of this review is to discuss how somatosensory feedback from the lumbar and perineal regions modulate the spinal locomotor central pattern generator and reflex circuits after spinal cord injury and the possible mechanisms involved. We also discuss how spinal cord injury can lead to a loss of functional specificity through the abnormal activation of functions by somatosensory feedback, such as the concurrent activation of locomotion and micturition. Lastly, we discuss the potential functions of somatosensory feedback from the lumbar and perineal regions and their potential for promoting motor recovery after spinal cord injury. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Several studies have assessed birth-related deformations of the levator ani muscle (LAM) and perineum on models that depicted these elements in isolation. The main aim of this study was to develop a complex female pelvic floor computational model using the finite element method to evaluate points and timing of maximum stress at the LAM and perineum in relation to the birth process. Methods: A three-dimensional computational model of the female pelvic floor was created and used to simulate vaginal birth based on data from previously described real-life MRI scans. We developed three models: model A (LAM without perineum); model B (perineum without LAM); model C (a combined model with both structures). Results: The maximum stress in the LAM was achieved when the vertex was 9 cm below the ischial spines and measured 37.3 MPa in model A and 88.7 MPa in model C. The maximum stress in the perineum occurred at the time of distension by the suboocipito-frontal diameter and reached 86.7 MPa and 119.6 MPa in models B and C, respectively, while the stress in the posterior fourchette caused by the suboccipito-bregmatic diameter measured 36.9 MPa for model B and 39.8 MPa for model C. Conclusions: Including perineal structures in a computational birth model simulation affects the level of stress at the LAM. The maximum stress at the LAM and perineum seems to occur when the head is lower than previously anticipated. [ABSTRACT FROM AUTHOR]

Abstract Background The surgical strategy for congenital perineal lipoma varies depending on the size, location, and accompanying congenital anomalies, with the optimum approach remaining to be determined. We herein report a case of congenital perianal lipoma that was first detected by prenatal ultrasound and review the literature. Case presentation A female neonate was referred to us for the evaluation of a perianal mass. She had been considered to be male prenatally because fetal ultrasound showed a perineal mass similar to a scrotum and penis. A postnatal examination revealed an appropriate-for-age neonate with a soft round mass 1.5 cm in diameter just to the left of the anal verge. She passed urine and stool smoothly, and contrast enema confirmed no anorectal malformation. Magnetic resonance imaging showed that the lesion had a signal intensity consistent with fat located close to the anal sphincter, and no spinal anomaly (e.g., spina bifida) was identified. We excised the lesion (pathologically confirmed to be lipoma) simply at 2 months old, taking care to avoid damaging the anal sphincter by using a muscle stimulator. She has been doing well with good bowel movement and satisfactory cosmetic results for a follow-up period of one and a half years. Our literature search revealed 49 cases of perineal lipoma reported in English in the last 25 years, and 74% of them—including ours—had other congenital anomalies, the breakdown of which was anorectal malformation in 40% of cases, labioscrotal fold or accessory scrotum in 28%, and urogenital malformation, congenital pulmonary airway malformation, and disorder of sex differentiation. The prenatal detection of the lesion, as in our case, was quite rare. Conclusion A thorough physical examination after birth, magnetic resonance imaging and contrast enema to identify the nature of the perineal lipoma and accompanying anomalies are crucial for planning the surgical strategy. The lesion may be deeply interspersed between the sphincter muscle, especially when it accompanies anorectal anomaly. A muscle stimulator is useful for preserving and repairing the sphincter muscles during resection in order to ensure satisfactory bowel movement.

Endometriosis is the presence of endometrial tissue in abnormal locations outside the uterine cavity. These locations are usually the ovaries, the peritoneum, and the uterine ligaments. Less frequently, the endometrial tissue can affect the perineum especially after surgical procedures or obstetric lesions. In this case report, we describe the case of a patient suffering from pain and swelling, with a sizeable nodule in an old episiotomy scar. Clinical examination, ultrasonography (USG) and magnetic resonance imaging (MRI) helped evoke the diagnosis of perineal endometriosis, and there were no signs of other endometriosis locations. Hormonal treatment was provided at first, but there was no clinical improvement after three months, so the treatment had to be surgical. Histopathological examination of the endometriotic mass confirmed the diagnosis. There were no immediate postoperative complications, and no clinical symptoms or recurrence signs six months and one year after.

Background: Perianal/perineal rhabdomyosarcomas (PRMS) are easily misdiagnosed soft tissue tumours with a poor prognosis. This study was designed to analyze the clinical, diagnostic, pathological and prognostic features of PRMS, and to explore currently available therapeutic modalities.Methods: Clinical data of PRMS patients admitted to the Sixth Affiliated Hospital and the Cancer Center of Sun Yat-sen University and from related Chinese literature published from 1987 to 2018 were collected and analyzed. The Chi-square test was used to evaluate the differences between each group. The Kaplan-Meier methods were applied to estimate and compare survival rates.Results: A total of 35 patients were included in this study; 20 identified within related Chinese literatures and 15 from our center admitted during the period of 1997-2019. Out of these cases, 34 presented with perianal masses and the remaining one manifested as an inguinal mass. Moreover, 20 patients complained of pain and 16 of them were misdiagnosed as perianal abscesses, in which the presence of pain contributed to the misdiagnosis (p < 0.05). The average time interval between symptom onset and pathological diagnosis was 3.1 months. Next, 13 cases were classified into IRS group III/IV and 20 cases into stages 3/4. Additionally, 14 and 9 cases received the pathological diagnoses of embryonal rhabdomyosarcoma and alveolar rhabdomyosarcoma, respectively. Regarding the patients' survival rates, five patients survived for more than 2 years, and three of them survived for more than 5 years. The overall 2 years and 5 years survival rates were 32% and 24%, respectively. The symptom of pain and misdiagnosis both contributed to the poor prognosis in these patients (p < 0.05). MRI showed that the PRMS were closely related to external anal sphincter in 10 cases.Conclusion: PRMS are easily misdiagnosed lesions, which often leads to an unfavourable outcome in affected patients. Patients with painful perianal masses should be evaluated to exclude PRMS. MRI revealed that PRMS are closely related to the external anal sphincter. Multidisciplinary management is recommended in the treatment of PRMS. [ABSTRACT FROM AUTHOR]

Urethral sphincter insufficiency following radical prostatectomy (RP) is a common cause of non-neurogenic stress urinary incontinence (SUI). Artificial urinary sphincter (AUS) insertion remains the standard of care for fit patients with SUI refractory to non-operative interventions. The proximal urethra is a common location for uncomplicated AUS placement. However, previous failed AUS, urethroplasty, or pelvic radiotherapy (RT) may compromise urethral tissue requiring technique modifications that optimise outcomes. In these situations, transcorporal cuff (TC) placement has been well described to facilitate continence restoration in men where there is no other feasible option other than urinary diversion or permanent incontinence. In the traditional TC approach, the procedure may be complicated by haematoma due to difficulty in completely closing the corporal defects behind the urethra. This narrated video demonstrates the tunical flap (TF) modification for transcorporal AUS implantation via a perineal and penoscrotal approach in patients with prior failed AUS placements secondary to urethral erosion. The TF technique for transcorporal AUS insertion provides circumferential reinforcement with tunica albuginea from the corpora cavernosa. Here, we show how this technique provides additional urethral support for compromised urethral tissue to help prevent cuff erosion. The TF preserves the corporal volume and does not limit candidacy for future penile prosthesis implantation. In our early results, there have been no postoperative haematoma formation with this technique., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-23-641/coif). The authors have no conflicts of interest to declare., (2024 Translational Andrology and Urology. All rights reserved.)