urogenital reconstructive surgery: GREEK PAGE

urogenital reconstructive surgery: GREEK PAGE: "Δρ. Δημήτριος Μπορούσας . Ο Δημήτριος Μπορούσας του Ματθαίου, γεννήθηκε στις 23 Μαρτίου 1966 , στην Αθήνα. Είναι Χειρουργός Ουρολόγος,..."

Circumcision

Circumcision is the surgical removal of the skin covering the tip of the penis. Circumcision is fairly common for newborn boys in certain parts of the world, including the United States — making it the most common surgical procedure in newborn males worldwide. Circumcision after the newborn period is a more complicated procedure that may require general anesthesia.
For some families, circumcision is a religious ritual. Circumcision can also be a matter of family tradition, personal hygiene or preventive health care. For others, however, circumcision seems unnecessary or disfiguring. After circumcision, it isn't generally possible to re-create the appearance of an uncircumcised penis.
Circumcision is a religious or cultural ritual for many Jewish and Islamic families, as well as certain aboriginal tribes in Africa and Australia. Circumcision can also be a matter of family tradition, personal hygiene or preventive health care. Sometimes there's a medical need for circumcision, such as when the foreskin is too tight to be retracted over the glans. In other cases, particularly in certain parts of Africa, circumcision is recommended for older boys or men to reduce the risk of certain sexually transmitted infections.
The American Academy of Pediatrics (AAP) policy statement on newborn circumcision says the benefits of circumcision aren't strong enough to recommend routine circumcision for all male newborns. The AAP leaves the circumcision decision up to parents — and supports use of anesthetics for infants who have the procedure.
Circumcision may have various health benefits, including:
 Easier hygiene. Circumcision makes it easier to wash the penis — although washing beneath the foreskin of an uncircumcised penis isn't generally difficult.
 Decreased risk of urinary tract infections. The overall risk of urinary tract infections in males is low, but these infections may be more common in uncircumcised males. Severe infections early in life can lead to kidney problems later on.
 Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis may be difficult or impossible to retract (phimosis). This can also lead to inflammation of the foreskin or head of the penis.
 Decreased risk of penile cancer. Although cancer of the penis is rare, it's less common in circumcised men. In addition, cervical cancer is less common in the female sexual partners of circumcised men.
 Decreased risk of sexually transmitted infections. Safe sexual practices remain essential, but circumcised men may have a lower risk of certain sexually transmitted infections — including HIV, the virus that causes AIDS.
Circumcision may not be an option if certain blood-clotting disorders or penis abnormalities are present. In addition, circumcision may not be appropriate for premature babies who still require medical care in the hospital nursery.
Circumcision doesn't affect fertility, nor is circumcision generally thought to enhance or detract from sexual pleasure for men or their partners.

Varicocele

A varicocele is a collection of enlarged (dilated) veins (blood vessels) in the scrotum. It occurs next to and above one or both of the testes (testicles).

The affected veins are those that travel in the spermatic cord. The spermatic cord is like a 'tube' that goes from each testis up towards the lower abdomen. You can feel the spermatic cord above each testis in the upper part of the scrotum. The spermatic cord contains the vas deferens (the tube that carries sperm from the testes to the penis), blood vessels, lymphatic vessels, and nerves.

Normally, you cannot see or feel the veins in the spermatic cord that carry the blood from the testes. If you have a varicocele, the veins become bigger (they enlarge or dilate) and this makes them more prominent. It is similar to varicose veins of the legs. The size of a varicocele can vary. A large varicocele is sometimes said to look and feel like 'a bag of worms' in the scrotum.

Who gets a varicocele?

Varicoceles are common. About 1 in 7 men develop a varicocele - usually between the ages of 15 and 25. In about half of cases the varicocele is on the left hand side. In just under half of cases there is one on both sides. In a small number of cases it is just on the right side. The reason why most occur on the left side is because of the different route the left veins take out of the scrotum compared to the right.

What are the symptoms of a varicocele?

Varicoceles are usually painless and usually cause no symptoms. A small number of affected men notice a 'dragging' feeling or slight discomfort from their varicocele. This may only occur at the end of a day, especially if you are on your feet all day. The size of a varicocele varies from case to case. Some cannot be seen, only felt. Some are large and can be easily seen. If you lie down, the blood from the veins drains away and the varicocele may seem to disappear. On standing, gravity will cause the blood to pool again and the varicocele reappears.

Are varicoceles serious?

Usually not. In themselves they are usually harmless. Causes of concern include the following:   

• Possible cause of infertility .Studies have shown that there is a higher rate of infertility in men with a varicocele compared to those who do not have a varicocele. It is thought that the pooled blood causes a slightly higher temperature in the scrotum than normal. This may reduce the number and quality of sperm made by the testis which can reduce fertility. Even if you have a varicocele only on one side, both testes can be warmed by the increased amount of blood pooled in the enlarged veins. However, most men with varicoceles are not infertile. It is just that the chance of being infertile is increased if you have a varicocele.
• Small testis .If a large varicocele develops in a teenager, the testis on the side of the varicocele may not develop as much as would be expected. The testis may end up being smaller than normal. This may contribute to infertility too.
• Sudden onset of a varicocele in an older man
• Rarely, a varicocele quickly develops as a symptom of a blockage of a larger vein in the abdomen (see below). This would normally only occur in men over the age of 40.

What causes varicoceles?

In most cases, the reason why the veins become larger is because the valves of the small veins in the scrotum do not function well. There are one-way valves at intervals along the veins. The valves open to allow blood to flow towards the heart, but close when blood flow slows to stop blood flowing backwards.

If these valves do not work well, blood can flow backwards (due to gravity) and pool in the lower parts of the vein to form a varicocele. (This is similar to how varicose veins form in legs.)

It is not clear why the valves do not work well.

Rarely, a varicocele may develop if there is a blockage of larger veins higher in the abdomen. This puts back-pressure on the smaller veins in the scrotum which then enlarge. This is only likely to occur in men older than 40. For example, if a varicocele suddenly develops in an older man, it may indicate a tumour of the kidney has developed which is pressing on veins.

But it must be stressed, the vast majority of varicoceles develop in teenagers and young men and are not due to a serious condition.

Do I need any tests?

Usually not. Most varicoceles occur in young healthy men. The diagnosis is made by a doctor's examination. A varicocele is associated with some cases of infertility. Therefore, a semen test may be asked for if you are part of a couple that is being investigated for infertility. In the rare situation of a varicocele first developing in a man over 40, then tests to check out a possible underlying cause may be advised. Also, a solitary right-sided varicocele is unusual. If this occurs you may need some tests to rule out any unusual cause.

What is the treatment for varicoceles?

No active treatment is needed in most cases

If a varicocele is causing no symptoms or problems, then it is best left alone. If there is just mild discomfort then supportive underpants (rather than boxer shorts) may help to ease or prevent discomfort. If a varicocele develops in a teenager, then your doctor may wish to monitor the growth of the testes. For example, an annual measurement of the testes may be advised. This may help to clarify if a testis is not growing to its full size.

Treatment may be advised in certain situations

For example, treatment may be a advised if you have persistent discomfort. Also, treatment may be advised if a testis is not growing properly in a teenager with a varicocele.

Treatment involves tying off the veins that are enlarged. Another method of treatment is to use a special substance injected into the veins to block them. Both methods are usually successful. Your surgeon will advise on the pros and cons of the different techniques.

However, after successful treatment, some men have a recurrence of a varicocele months or years later. This is because the veins left behind to do the job of taking the blood from the testes may themselves enlarge or dilate with the extra blood they will now have to carry. A recurrence can be treated in the same way as the first time.

Is treatment for varicocele a possible cure for male infertility?

Probably not. For many years it was thought that treating a varicocele in an infertile man would increase his chance of becoming fertile again. Studies have shown that after treatment, the sperm count may improve. This was assumed to increase the chance of fertility. Some studies did indicate that fertility may be increased with treatment.

However, a recent large analysis (meta-analysis) of studies looking at this issue found that there was no good evidence to say that fertility is increased by treatment. Some experts are critical of this analysis and maintain that more research is needed to clarify whether treating a varicocele improves fertility. If you are infertile, your specialist will advise on current research related to this issue. But remember, most men with a varicocele are not infertile.

  

Penis Enlargement Surgery: Everything You Need to Know

Penis enlargement surgery for men without erectile dysfunction has long been the most popular elective surgical procedure performed by the surgical specialists of the Sava Perovic Foundation. But surgery to create larger male genitals and a larger than average penis comprises only about 5% of the 74 complex uro-genital procedures & urologic
However, most international medical tourism to Serbia is for complex, non-elective surgery by the Sava Perovic Foundation Surgical Team, led by Dr Djinovic. About 95% of our urology operations are unrelated to penile enlargement and penis sizes.
Regardless, inquiries about penis girth enlargement using tissue engineering have long dominated all inquiries about penis surgery of any type and consume a disproportionate amount of the case manager's time. This page aims to answer all your questions proactively so the only remaining questions will be:
• are you a suitable candidate?
• when can you get the surgery?
• exactly how much will it cost you?
To be fair to the 95% of our other 20,000+ patients who need complex, life-changing, non-elective surgery, starting in the second quarter of 2010, the case manager will no longer provide by email any penis enlargment surgery information already published here or from any of the pages to which we have provided links here. Peform your due diligence and read the information we have already provided to you before asking any questions.
Dr Djinovic and the Surgical Team of the Sava Perovic Foundation are taking his techniques, procedures and philosophy to the next level. That means they are busier than you can possibly imagine. Many patients came from around the world for Dr Perovic to correct mistakes, failures and bad penis enlargment surgery and the Sava Perovic Foundation Surgical Team continues to provide that service. More than a few guys are waiting for their medical situation to stabilize so Dr Djinovic can undo the damage done by other surgeons attempting girth enhancement using tissue engineering.Other times it’s Alloderm or FFT gone wrong or the unfortunate result of other inadvisable procedures. The Sava Perovic Foundation Surgical Team will fix the penile enhancement problem but do not ask them to comment about the surgery or the surgeon because invariably Dr Djinovic's answer will be: “No comment.”
Perovic penile girth enhancement using autologous tissue engineering with biodegradable scaffolds is very safe with a 100% success rate after more than 300 operations and an average girth increase in both flaccid and erect states of approximately 30% in the initial pilot study done a decade ago
• [mean value flaccid girth gain 3.15 cm (0.42, range 1.9 to 4.1 cm)]
• [mean value erect girth gain 2.47 cm (0.49, range 1.8 to3.0 cm)] 
Substantial but not massive size increase is the trade-off for the safety, success, permanency, and rare, minor complications of tissue engineering such as inflammation that
You can calculate the approximate immediate increase in your girth after tissue engineering surgery using the formulas:
•  [Circumference = π • Diameter] and
• [Diameter = Circumference / π]
• π (pi) = 3.14
… because the scaffolds are exactly 4mm thick which means an instant 8 mm increase in diameter:
•  [(original penile diameter + 8 mm) • 3.14].
How that evolves into penile augmentation over the subsequent months varies from person to person. You can find your current penile diameter using your current circumference.
Penis girth enhancement surgery takes less than 2 hours of surgery, requires 1-2 days hospital stay and 3-4 days in Belgrade total time. A standard schedule:
• Day One: arrive, have consultation and pre-op exam, give blood, check into medical facility & stay night;
• Day Two: surgery, stay night at medical facility;
• Day Three: post-op exam, nursing care, check-out of medical facility, check into hotel (or stay at medical facility for Euros 50 to 60 per night);
• Day Four: physical exam then departure.
A number of men have come back for a second and a third enhancement because the results are cumulative. Penile girth enhancement surgery repeated by the Sava Perovic Foundation Surgical Team a second time costs about 38% less than the first procedure. Girth enhancement by the Team a third time is discounted more than 53%.
Penile lengthening using ligamentolysis (optional) which can provide gains in penile length ranging from ½ cm erect to as much as 4 cm longer flaccid  would cost an addition Euros €1000, if wanted. This procedure is more penile plastic surgery than urology and provides primarily aesthetic benefits
 •  [mean value of flaccid length gain 3.45 cm (0.52, range 2.1 to 4.5 cm) , mean value of erect length gain 0.65 cm (0.32, range 0.5 to 1.0 cm)]
 Pubic area liposuction (optional) at the same time as penis enhancement adds 30 minutes to the entire time in the operating room and an additional Euros €1000 to the total cost.
Gynecomastia and/or nipple reduction (optional) at the same time as penis enlargement surgery cost an additional Euros €1500.
Patients who believe scrotal cell culture for seeding the scaffolds (full tissue culture) may get them better girth gains than blood serum, and who are willing to visit Belgrade twice to do so, are welcome to choose that option. It costs an additional Euros 350 during your first visit for the tissue culture.
During the past four decades, Dr Perovic developed many secret “tips and tricks” while doing surgery on his 20,000 patients. More than 10,000 of those persons needed the most complex uro-genital surgery done anywhere. Those “tips and tricks” used by the Sava Perovic Foundation Surgical Team mean complications are extremely rare and the ones that occur are very minor — and patients get aesthetically pleasing as well as very functional surgical results.
Dr Djinovic puts tremendous importance on attention to detail and that is a big part of their often amazing results.
 We also recommend you take a few minutes to read this article about the risks and complications of any surgery in addition to doing research about the specifics of the procedure you are considering. Get all the answers and information you need to get the surgery abroad you want by doing all of the following:
• 1) inform us of the date you most prefer to have your surgery performed (you will need to arrive in Belgrade the day before);
•  2) submit your medical history (optional but advisable
• 3) send digital photos of your penis from left, right, center, above and below in flaccid and erect states.
• In 2009, Dr Perovic revised post-operative physiotherapy for penile girth enhancement patients, saying: “Regarding postoperative physiotherapy it is best is to start with an ANDROPENIS stretcher (Euros 250) about two weeks post¬
• “Using a vacuum device (Euros 150) is better postponed until about four weeks after surgery with the same protocol as published online.”
Starting 1 May 2010, both the Andronpenis device and the vacuum device are included in surgical package fee. The package price has remained the same since 2007. No increase in price.
[Note: Falling asleep for a long period of time while using an Andropenis device can result in permanent, total loss of tactile and erogenous sensation in the user's penis. Use only as prescribed by your doctor. These are NOT for penis lengthening.] Dr Djinovic does not use fat, lipofilling, Alloderm, silicone or any other substance to create penile girth enhancement in men able to have natural erections unaided. He uses only tissue
engineering and biodegradable scaffolds

urethral stricture

 

Urethral Stricture

Understanding the urethra

The urethra is the tube that urine flows out from the bladder. It passes through the penis in men. The urethra is much shorter in women and ends just above the vagina. (In men, semen is also ejaculated through the urethra.)

What is a urethral stricture?

A stricture occurs when a part of the urethra becomes narrowed. Any section of the urethra may be affected. There is usually some scar tissue around the affected part of the urethra that causes the narrowing. The length of strictures vary from less than 1 cm to the full length of the urethra. The diagram below illustrates a fairly long and severe stricture, but many are shorter than this. Urethral stricture is uncommon in men and rare in women.

What causes a urethral stricture?

�    Injury or damage to the urethra can heal with scar tissue that may cause a stricture. There are various types of injury that can damage the urethra. For example: an injury may occur during medical procedures to look into the bladder via the urethra; radiotherapy treatment may damage the urethra; a "fall astride" on to the frame of a bike can cause damage.

�    Infection of the urethra is another cause. For example:         Sexually transmitted infections such as gonorrhoea or chlamydia.         Infection as a complication of long-term use of a catheter to drain the bladder.

Infection may cause inflammation in the tissues in and around the urethra. These infections usually clear with treatment but may leave some scar tissue at the site of the inflammation which can cause a stricture. Note: most urethral infections do not cause a stricture. A stricture is just one possible complication from a urethral infection.

Page 2 of 3

Congenital - some babies are born with a urethral stricture.                 Cancer - very rarely, a cancer of the urethra can be the cause of a stricture.

What are the symptoms of a urethral stricture?

There may not be any symptoms initially. However, the following symptoms may occur which are likely to worsen with time:

Reduced urine flow is the usual first symptom. Straining to pass urine is common but a complete blockage of urine flow is rare.                 Spraying of urine or a 'double stream' may occur.                 Dribbling of urine for a while after going to the toilet to pass urine.                 Frequency sometimes occurs (needing to pass urine more often than normal).                 Urine infections.                 You may have a reduced force of ejaculation.                 Mild pain on passing urine sometimes occurs.

What are the possible complications?

More pressure is needed from the bladder muscle to pass urine out through a stricture (it acts like a bottleneck). Not all urine in the bladder may be passed when you go to the toilet. Some urine may pool in the bladder. This 'residual' pool of urine is more likely to become infected. This makes you more prone to bladder, prostate and kidney infections. An abscess (ball of infection) above the stricture may also develop. This can cause further damage to the urethra and tissues below the bladder. Cancer of the urethra is a rare complication of a longstanding stricture.

Are any tests needed?

Tests to determine the flow rate of urine are usually advised if a urethral stricture is suspected. This involves passing urine and measuring how much is passed per second. The flow rate is much reduced if you have a stricture.                 A look into the urethra by a special thin telescope will be needed to assess the stricture.                 Special X-rays may be taken whilst you pass urine which can show the site and severity of a stricture.

What is the treatment for urethral stricture?

Treatment is usually advised to improve the flow rate of urine, ease symptoms and to prevent possible complications. A specialist surgeon called a urologist advises on treatment. (A urologist treats problems of the urinary tract - such as prostate, bladder, kidney and penis problems.) Treatment options include the following. The one advised by your specialist will depend on factors such as the site and length of your stricture, and also your age and general wellbeing.

Dilatation (widening) of the stricture

This is usually done by passing a thin plastic rod (boogie) into the urethra. This procedure may be done either under a local or a general anaesthetic. Rods of increasing thickness are gently inserted to gradually widen (dilate) the narrowed stricture. The aim is to stretch and widen the stricture without causing additional scarring. However, a stricture often tends gradually to narrow again after each dilation. Therefore, a repeat dilation is commonly needed every so often when symptoms recur. (Some people are given a self-lubricating catheter which they insert themselves regularly to keep a stricture dilated.)

As a rule, the shorter the stricture, the greater the chance of a cure with dilation. It is a relatively easy procedure to do and so may be tried first.

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Urethrotomy

In this procedure a thin telescope is passed into the urethra to see exactly where the stricture is. This is done during a general anaesthetic. A tiny knife is then passed down the telescope to cut along the stricture. This widens the narrowed stricture. You will get some relief of symptoms from this procedure. About one in three cases are 'cured' for good. However, like dilation, the stricture may re-form and the procedure may have to be repeated from time to time in some cases.

Generally, the shorter the stricture, the greater the chance of a cure with this procedure. For example, one research study found that when a urethrotomy was done for a stricture less than 2 cm, there was a recurrence of symptoms within 12 months in about 4 in 10 cases. However, there was a recurrence in 8 in 10 cases within 12 months when the stricture was greater than 4 cm.

Surgery

A corrective operation may be an option if the above do not work. Various techniques are used. For example, a short stricture can be cut out and the two ends of the healthy urethra stitched together.

If the stricture is longer, then one kind of operation is similar to 'skin grafting' the inside lining of the urethra. A graft is usually used from the inside of your cheek to form the new section of your urethra. Techniques continue to improve and your specialist will advise if an operation is likely to be successful, and which operation is best for the length and site of your stricture. As a rule, there is a high success rate in curing symptoms with these operations.

Antibiotics

A long course of antibiotics may be advised to prevent urine infections until a stricture has been widened.

Peyronies

Disease  

Treatment

Bent Penis Surgery & Penis Curvature Correction

Peyronie's Disease Treatment

There are two principal ways of correcting penile deformity. The first one is plication technique, a procedure that shortens the longer side of the penis that has normal length by means of tucks in the walls done by cutting out healthy tissue opposite the plaque — straighter but shorter. This is frequently referred to as the the Nesbit procedure.

In cases such as dorsal curvature, when viewed from the side, the penis will normally have a concave dorsal side with an inward curve and a convex ventral side. Plication technique simply shortens normal penile length 2-3 cm (1 inch) or more to equalize it with the already deformed dorsal side.

Dr Perovic has done this procedure only a few times in recent years on patients with a very mild degree of curvature so there was insignificant loss of length. Otherwise, he almost never performs it because how many man choose to have a drastically shorter penis? Professor Perovic has also noticed that after plication, recurrence of Peyronies disease is much more common after

http://www.peyronies-surgery.com/peyronies-treatment.htm

plication than after using his grafting procedure, the second principal way of correcting bent penis disease.

Dr Perovic's standard technique is a radical and exact grafting procedure which restores shape and length of the tunica albuginea that existed before onset of Peyronies disease. It is done by geometrical calculation of the defect in a very logical and simple mathematical way.

The Perovic Procedure is complex and difficult but removes the plaque causing your bent penis and replaces it with a healthy tissue graft

— the exact opposite of plication which cuts out healthy tissue and leaves all the diseased tissue.

About 85-90% of Dr Perovic's Peyronies disease patients do not develop erectile dysfunction after surgery. When ED occurs a penile prosthesis implant will be needed to achieve or keep an erection.

Correction procedures have two basically different results: Nesbit and plication give you a shorter penis; grafting gives you a longer, larger penis.

Perovic Peyronie's Treatment differs from almost all other bent penis correction surgery techniques in the world in that very exact measurements of the penile defects are taken and

appropriate grafting done to restore its original shape prior to Peyronie's disease. Few surgeons in the world are able to perform the Perovic Peyronie's Procedure and most of them learned it directly from Professor Perovic.

majority of other surgical centers, they do only empirical grafting and their penis surgery does not re-establish penile shape exactly. In the majority of cases, there remains residual penile curvature after bent penis correction.

Starting in 2006, Dr Perovic also started restoring penile girth in Peyronie's Disease patients. In addition to transversal grafting of the penis, the Perovic Team also began doing longitudinal grafting to widen it. Penile girth enhancement is also based on geometrical calculation of the defect and of the graft that should be inserted.

During the same period, the Sava Perovic Team also introduced the regular use of InteXen® LP™ (lyophilized [freeze-dried] porcine), the acellular collagen dermal matrix graft material of American Medical Systems (AMS) Holdings Inc of Minnesota, USA. This soft, pliable biomaterial (harvested from animals) is the best grafting material the surgical team has found so far in his more than 36 years of practice. This proprietary biomaterial facilitates tissue integration and cellular remodeling, conforms to patient anatomy, has good hardness, promotes early vascularization, improves early cellular infiltration, promotes collagen rebuilding, maintains graft integrity and has many other good characteristics and gets excellent results. It is very similar to tunica albuginea and semi-resorbable which means that after several months the surrounding tissue grows into it.

http://www.peyronies-surgery.com/peyronies-treatment.htm

26/9/2009

The United Statest Department of Agriculture (USDA) regulates the facilities where the grafts are made according to Food and Drug Administration (a federal agency of the USA Department of Health and Human Services) and ISO 9001 standards.

Surgery normally takes 2½-3 hours and sometimes up to four hours if the grafts are big.

In patients who require a penile implant, very exact grafting is performed first, as with other Peyronie's patients, completely re-establishing penile structure and shape, then penile implant surgery is done with either a semi-rigid or inflatable prosthesis.

In a small percentage of patients (10-15%) there is post-operative progression of the disease. Nobody in the world can predict or estimate who will experience progression of the disease or who will not. The great thing about penile implant surgery for Peyronie's disease patients is that it ALWAYS stops the disease. The disease is completely beaten. When post-operative progression of Peyronie's occurs, the only proper solution is immediate penile prosthesis implantation in a second surgery.

For patients who have erectile dysfunction, we immediately implant a penile prosthesis and there is no re-occurence of disease in these patients. Both semi-rigid and inflatable prostheses can be implanted during surgery. We have no special preference and none of them have any special advantage.

This procedure is very radical but safe and effective. It is always done simultaneously with mobilization, complete penile disassembly — disassembly of the penis into it's basic parts — mobilization of the neurovascular bundle. Depending on whether the curvature is ventral or lateral, we also mobilize the urethra. After grafting, all penile parts are re-assembled again.

The procedure is not popularly performed in many surgical centers because penile disassembly is a little bit risky and results in complications if the surgeons are not experienced. However, Dr Perovic and the other surgeons comprisng his Team have performed this procedure for a very long time, even in small babies, without ANY complications to date (30 April 2009).