Penile Curvature Incidence in Hypospadias: Can It Be Determined?

The aim was to retrospectively determine the real incidence of congenital penile curvature in various forms of hypospadias, in order to indicate intraoperative assessment and correction of curvature. We analyzed 842 patients with hypospadias who underwent surgery from 2003 to 2010, classified into two groups. First group was intraoperatively checked for curvature as a routine procedure, while a curvature in the second group was assessed mostly in severe hypospadias. Results are analyzed using Fisher's and chi-square tests. In total, 238 cases (28.3%) of associated curvature were confirmed. Curvature was significantly more frequent in the first group, regarding hypospadias in general (P<0.01), as well as distal (P<0.05) and midshaft forms (P<0.01). Penile curvature is common figure in hypospadias, including distal types. Intraoperative testing for associated curvature should be considered as a routine procedure in hypospadias repair

Adult non-urethral complications after hypospadias repair in childhood: presentation, treatment and outcomes

PurposeThis study aimed to evaluate a group of adult patients with non-urethral complications after hypospadias repair in childhood, their surgical treatment, and outcomes.Materials and methodsWe analyzed 97 patients, mean age 22.5 years, who were treated in our center between January 2009 and December 2020, for non-urethral complications after previous hypospadias repair in childhood. Non-urethral complications were defined as glans deformity, residual curvature and trapped penis due to insufficient penile skin. A radical surgical approach was used to correct all deformities, in a one-stage or a two-stage procedure. A successful outcome was defined as a straight penis with good length, anatomically regular glans, and cosmetically acceptable appearance, without need for additional surgeries. Sexual function was evaluated using International Index of Erectile Function.ResultsMean follow-up was 75 months (ranged from 24 to 168 months). One-stage and two-stage repair were performed in 85.5% and 14.5% of cases, respectively. A higher success rate was noted after one-stage repair (94% compared to 86%). Complications included four cases of penile curvature with late onset, one case of glans dehiscence and partial skin necrosis. Erectile dysfunction was determined in 24% of patients.DiscussionNon-urethral complications may occur many years after primary hypospadias repair, with a strong impact on the quality of life. Treatment is individualized and usually involves a radical surgical approach to correct all associated deformities and to achieve successful cosmetic and psychosexual outcomes

Effectiveness of Wharton’s jelly stem cells in gastroschisis repair using the inner surface of the umbilical cord as a patch: Long-term results

Objective This retrospective study was designed to assess and compare the anatomical, functional, and esthetic appearance of the umbilical area in patients after repair of gastroschisis using the inner surface of the umbilical cord (UC) and in patients with omphalocele conservatively treated.Background Our procedure transformed gastroschisis into an ‘artificial–surgical omphalocele’ in which the prolapsed intestine was covered with an umbilical patch, the inner surface of which contained Wharton’s jelly (WJ).Methods We have summarized an experience of 17 years in repairing gastroschisis using the inner surface of the UC. From 1986 to 2003, 21 infants with gastroschisis and one with a ruptured omphalocele were treated with this technique. We used Eagle’s medium to prove the validity of the umbilical stump and the duration of its viability. The inner surface of the umbilical patch is a ‘live’ structure with WJ, which contains mucoid connective tissue and fibroblast-like cells – that is, stem cells producing cutis, adipose, and connective tissue.Results Using our method, early control assessment of 18 of 21 patients with gastroschisis, at intervals of 1–3 months, showed good functional and esthetic results. Clinical long-term results in terms of anatomical, clinical, and functional findings were excellent. Besides clinical testimony, we used high-frequency ultrasonography to make an appraisal of the effectiveness of WJ stem cells in the repair of gastroschisis, and compared our results with healthy volunteers and patients with  omphalocele conservatively treated.Conclusion This paper describes the effect of the local application of WJ – that is, mesenchymal stromal cells derived from the inner surface of the umbilical stump – and its influence on the healing process of the birth defect and wound. Keywords: gastroschisis, high frequency ultrasound imaging, inner surface of umbilical patch, ruptured omphalocele, Wharton’s jell

Branding of protected areas and National Parks: A case study of Montenegro.

Protected areas with their beauty, richness and diversity represent the core value and one of the most important natural values of every country. Protected areas represent not only important instruments for preserving biodiversity, but they also contain enormous potential for social and economic development. However, these potentials are not yet sufficiently recognized. Nowadays, the key issue in managing protected natural areas is to define and choose the most favorable natural resource management strategy that will at the same time satisfy all development criteria. In that sense, the marketing issue is one of the most crucial ones, having in mind the fact that protected areas represent very specific tourist destinations that have to be adequately preserved, protected, valorized and promoted. This paper focuses on the results of the research that was carried out in Montenegro in order to improve the process in the branding of national parks and protected areas in Montenegro and to promote and valorize them in an appropriate manner based on the critically important principles of sustainable development. Any sustainable tourism development guidelines and management practices should also be applicable to all forms of tourism and in a wide variety of destinations, including mass tourism and the various niche tourism segments. Sustainability is critical as it denotes the environmental, economic, and socio-cultural facets of tourism development, and thus it is vital that a suitable balance must be established amongst its various dimensions so as to assure its enduring sustainability. This implies that optimum use be made of environmental resources that constitute a significant components in tourism development, and which preserve indispensable ecological processes which support the conservation of natural heritage and wide range of biodiversity

Gender Dysphoria: Bioethical Aspects of Medical Treatment

Gender affirmation surgery remains one of the greatest challenges in transgender medicine. In recent years, there have been continuous discussions on bioethical aspects in the treatment of persons with gender dysphoria. Gender reassignment is a difficult process, including not only hormonal treatment with possible surgery but also social discrimination and stigma. There is a great variety between countries in specified tasks involved in gender reassignment, and a complex combination of medical treatment and legal paperwork is required in most cases. The most frequent bioethical questions in transgender medicine pertain to the optimal treatment of adolescents, sterilization as a requirement for legal recognition, role of fertility and parenthood, and regret after gender reassignment. We review the recent literature with respect to any new information on bioethical aspects related to medical treatment of people with gender dysphoria

The Role of Clitoral Anatomy in Female to Male Sex Reassignment Surgery

Introduction. Controversies on clitoral anatomy and its role in female sexual function still make clitoral reconstructive surgery very challenging. We evaluated the role of clitoral anatomic features in female to male sex reassignment surgery. Material and Methods. The study included 97 female transsexuals, aged from 18 to 41 years, who underwent single stage metoidioplasty between March 2008 and January 2013. The operative technique involved vaginectomy, the release of clitoral ligaments and urethral plate, urethroplasty by combining buccal mucosa graft and genital flaps, and scrotoplasty with insertion of testicle prostheses. Postoperative questionnaire was used to evaluate aesthetic, functional, and sexual outcome. Results. The mean followup was 30 months. The mean length of the neophallus was 7 cm, compared to mean preoperative length of the hypertrophied clitoris of 3.3 cm. Complications occurred in 27.84% of all patients, related mostly to urethroplasty. Voiding while standing was achieved in all cases. None of the patients had problems in sexual arousal, masturbation, or orgasms. Conclusion. Accurate knowledge of the clitoral anatomy, physiology, and neurovascular supply is crucial for a successful outcome of female to male sex reassignment surgery. Our approach appears to ensure overall satisfaction and high quality of sexual life

Combined grafts and flaps in urethral stricture repair

Although urethral strictures have been known since antiquity, the surgical management of urethral strictures has undergone a great (re)evolution over the last six decades, both in the perception of the disease and in the surgical repair techniques, always presenting itself as a challenge for the surgeon and patient. Reconstruction of urethral stricture disease involving a combination of grafts and flaps consists of a group of complex procedures with specific clinical indications. The knowledge of these procedures by reconstructive urologists is both necessary and relevant. A thorough understanding of the anatomy, including blood supply, is a crucial proviso for the correct evaluation and successful management of urethral stricture disease. We discuss the main techniques and indications in combined graft and flap urethroplasties

Metoidioplasty as a one-stage phallic reconstruction in transmen

Gender dysphoria is a condition where there is a discrepancy between the gender assigned at birth and the desired gender, leading the patient to pursue surgical intervention. Reconstruction of the neophallus for transmen is still challenging, even though there are many surgical techniques with satisfying results. The aim of neophallic reconstruction in gender affirmation surgery (GAS) for transmen is to provide stand-up voiding, erotic sensation, orgasm and penetration ability, and acceptable donor site morbidity with minimal scarring and complications. Metoidioplasty as a variant of phalloplasty for transmen is a one-stage procedure that results in male-like external genitals, with minimal scarring, ability of standing micturition, and full erogenous sensation with the ability to achieve orgasm during sexual intercourse. Metoidioplasty is a method of choice for those transmen who wish to have GAS in one procedure without multi-staged procedures to create the adult-male-sized neophallus