Query: Penile swelling in children

title: Granulomatous lymphangitis of the penile skin as a cause of penile swelling in children.
abstract: Genital edema in children is a rare entity which is usually idiopathic and self limiting. However, in occasional cases that required surgery at our institution the skin specimen showed granulomatous lymphangitis, suggesting a possible association with Crohn's disease. We review our experience with 1 previously reported case1 and 2 additional cases of genital lymphedema associated with granuloma formation.

title: Urinary retention secondary to acute vasculitic penile swelling in a pediatric patient
abstract: Acute urinary retention secondary to vasculitic penile swelling in children is extremely rare. Henoch Schonlein purpura is a self limiting IgA mediated cutaneous vasculitis, which can cause soft tissue edema. Acute urinary retention requires urgent intervention to prevent obstructive uropathy. Suprapubic catheterization provides an effective management strategy in the emergency setting.

title: Unusual presentation of Crohn's disease in a boy with penile swelling
abstract: Crohn's disease is one of the three subtypes of inflammatory bowel disease, with regional, transmural, and granulomatous inflammation. The present study is a case report on an 11 year old boy who was referred to the hospital due to penis swelling and pain since a year ago, the patient sometimes complained of pain when urinating, he was having a severe painful swelling in the penis shaft; however, his scrotum was completely normal. He was diagnosed with crohn's disease, thus was placed on azathioprine therapy which eradicated his pain after 3 months, and thus, his skin lesion became much smaller. Crohn's disease, especially in children, should be considered in patient with unknown skin complications, and, if clinically suspected, biopsy examination should be performed. The diagnosis of crohn's disease may be delayed in extradigestive cases. This disease occurs when associated with skin manifestations, which is uncommon. We reported a case with penile crohn's disease, of which few cases have been reported in children to date.

title: Acute penile pain and swelling in a 4 year old child with Henoch Schonlein purpura
abstract: Henoch Schonlein purpura (HSP) is the most common vasculitis found in children. It usually affects the small vessels of the skin, joints, gastrointestinal tract and, more rarely, kidneys, brain, lungs and genitalia. Apart from classical presentation with purpuric rashes around buttocks and lower extremities, features such as arthralgia, abdominal pain, haematuria and proteinuria as well as scrotal swelling have been described in the literature. Penile involvement is rare and is not commonly described. We describe a child with HSP who developed penile involvement. We review the literature of all the cases reported in detail, in order to highlight useful clinical presentation, management and prognosis of this rare manifestation.

title: Penile and Scrotal Swelling: An Underrecognized Presentation of Crohn's Disease
abstract: Penile and scrotal swelling can occur as an extraintestinal manifestation of Crohn's disease (CD) and is thought to be an uncommon form of metastatic CD (MCD) Because of the rarity of this manifestation, much is unknown concerning the presentation, treatment, and response to therapy in children with genital MCD.  Boys ages 1 to 17 years presenting with genital edema and a confirmed diagnosis or strong suspicion of CD who were evaluated at the Mayo Clinic between 1996 and 2014 were included for review. We sought to characterize the clinical and pathologic features of genital MCD and response to treatment in our cohort of patients.  Eight patients with genital MCD were identified from our institution (mean age 11.4 yrs, range 7 16yrs) Seven (88% patients experienced cutaneous symptoms before a formal diagnosis of CD was made, and two of the seven had no adverse gastrointestinal symptoms at that time. Patients were prescribed an average of 3.4 medications (topical and systemic) for management of their gastrointestinal CD and MCD.  Penile and scrotal swelling can occur as an extraintestinal manifestation of CD and is thought to be an uncommon form of MCD. In boys, genital swelling typically precedes intestinal CD. Treatment of the underlying CD with systemic medications was most helpful in this series. An evaluation for CD is necessary in all patients presenting with unexplained genital swelling.

title: [Traversing the vertical pedicle flap for the treatment of severely buried penis in children]
abstract: To assess the effect of traversing the vertical pedicle flap (TVPF) for the treatment of severely buried penis in children.  Totally 43 children with severely buried penis underwentTVPF (n 21)or modifiedShiraki surgery (control, n 22) in our hospitalfrom February to December 2014. Wecompared the operation time, intra operation blood loss, foreskin swelling time, and parents' satisfaction with penile appearance between the two groups.  No statistically significant differences were observed between the TVPFand control groups in the operation time [45.0 6.8] vs [42.0 5.3] min, P>0.05) or intra operation blood loss([5.0 1.2] vs [6.0 0.8] ml, P>0.05) The average foreskin swelling time was markedly shorter in the TVPFgroup than in the control [9.0 2.3] vs [15.0 4.8] d, P<0.05)and the parents' satisfaction with penile appearancewas higher in the former than in the latter (95.23vs31.81 P<0.05) The elastic bandages were removedfor all the patientsat 3 days postoperatively, and 3 to 6 month follow up revealed no penile retraction or relapse.  The method of traversing the vertical pedicle flap is a feasible surgical option for the treatment of severely buried penis in children, which can make a rational use of the foreskin,remove the tight ring, and achieve a satisfactory appearance of the penis.

title: Case Report: Penile Strangulation Secondary to Hair Tourniquet
abstract: Penile strangulation is a rare condition in children caused by circumferential constriction of the coronal sulcus by constricting material, commonly thin maternal hair. Vague presenting symptoms often makes diagnosis difficult, but delay in diagnosis can lead to a variety of severe complications including urethral injury and penile necrosis. Providers must have a high index of suspicion and carry out a careful examination to identify maternal hair strands that may bury deep within penile edema. We describe two cases of penile strangulation secondary to maternal hair strands that were successfully treated with thorough examination and division of the constricting hair in the emergency department. In both cases, presentation involved penile swelling and erythema which was noticed by caregivers. Once the diagnosis has been made, urgent treatment using depilatory cream or mechanical removal must occur, with urgent referral to specialists if unable to remove to constricting material. Caregivers must also be counseled on appropriate steps to prevent penile hair tourniquet syndrome. Devastating complications can be avoided by early recognition and proper management of the syndrome, but providers must have knowledge of the condition and a high index of suspicion.

title: Congenital Anterior Urethral Diverticulum in Children: A Case Report and Review
abstract: Congenital anterior urethral diverticulum (CAUD) is an uncommon condition in children. We describe 2 patients of CAUD who presented with ventral penile swelling; in one, the site of swelling was just proximal to corona which is quite rare. The diagnosis was made on USG and MCU. Both patients had normal renal function. Open diverticulectomy and primary repair was done in both patients.

title: Henoch Schonlein purpura: ultrasonography of scrotal and penile involvement
abstract: Testicular or scrotal involvement has been reported in children with Henoch Schonlein purpura (HSP) but there are very few reports on penile involvement. We report the initial and follow up ultrasonographic findings of scrotal and penile involvement of HSP in a 5 year old boy. On ultrasonography, scrotal soft tissue thickening and epididymal swelling with increased vascularity were noted, and on the penis, a focal mass like lesion appeared on the dorsal surface of the distal penis, having a hypoechoic mass like appearance without visible vascular flow on a Doppler study. After 2 days of treatment, follow up ultrasonography showed normal scrotum and penis with a resolved soft tissue mass like lesion. Therefore, we think that HSP ultrasonographic findings involving the scrotum and penis might help to diagnose scrotal and penile involvement in a case of HSP and to avoid unnecessary medication and/or surgical procedures.

title: Successful penile reconstruction after multimodal therapy in patients with primitive neuroectodermal tumor originating from the penis
abstract: We herein present an extremely rare case of primitive neuroectodermal tumor originating in the penis. A 16 year old male adolescent presented with painful penile swelling. Pathological, immunohistochemical and cytogenetical examinations of the specimens obtained from total penectomy confirmed the diagnosis of primitive neuroectodermal tumor. After total penectomy, the patient received adjuvant chemotherapy with ifosfamide based regimen for 48 weeks. As a series of therapies, the patient underwent penile reconstruction surgery after completing adjuvant chemotherapy. The patient has not shown any evidence of recurrence for the 7 years after penile reconstruction surgery, and voiding function is completely normal. A favorable outcome was observed by multimodal therapy including aggressive resection for local control, intensive adjuvant chemotherapy, and penile reconstruction with cosmetic and functional success. Similar therapeutic approaches might be selected for children with primary malignant tumors of the penis.