Evolution of penile prosthetic devices

PubMed Central

Burnett, Arthur L.

2015-01-01

Penile implant usage dates to the 16th century yet penile implants to treat erectile dysfunction did not occur until nearly four centuries later. The modern era of penile implants has progressed rapidly over the past 50 years as physicians' knowledge of effective materials for penile prostheses and surgical techniques has improved. Herein, we describe the history of penile prosthetics and the constant quest to improve the technology. Elements of the design from the first inflatable penile prosthesis by Scott and colleagues and the Small-Carrion malleable penile prosthesis are still found in present iterations of these devices. While there have been significant improvements in penile prosthesis design, the promise of an ideal prosthetic device remains elusive. As other erectile dysfunction therapies emerge, penile prostheses will have to continue to demonstrate a competitive advantage. A particular strength of penile prostheses is their efficacy regardless of etiology, thus allowing treatment of even the most refractory cases. PMID:25763121

Evolution of penile prosthetic devices.

PubMed

Le, Brian; Burnett, Arthur L

2015-03-01

Penile implant usage dates to the 16th century yet penile implants to treat erectile dysfunction did not occur until nearly four centuries later. The modern era of penile implants has progressed rapidly over the past 50 years as physicians' knowledge of effective materials for penile prostheses and surgical techniques has improved. Herein, we describe the history of penile prosthetics and the constant quest to improve the technology. Elements of the design from the first inflatable penile prosthesis by Scott and colleagues and the Small-Carrion malleable penile prosthesis are still found in present iterations of these devices. While there have been significant improvements in penile prosthesis design, the promise of an ideal prosthetic device remains elusive. As other erectile dysfunction therapies emerge, penile prostheses will have to continue to demonstrate a competitive advantage. A particular strength of penile prostheses is their efficacy regardless of etiology, thus allowing treatment of even the most refractory cases.

[Repair and functional reconstruction of the penis (a report of 62 cases)].

PubMed

Wang, Zhong; Cai, Zhi-Kang; Cheng, Kai-Xiang; Da, Jun; Jiang, Yue-Qing; Lu, Mu-Jun; Ren, Xiao-Min; Zhang, Ke; Xu, Ming-Xi; Yao, Hai-Jun; Chen, Qi; Wang, Hao; Dong, Guo-Qin

2009-08-01

To investigate the effects of surgery treatment on serious penile lesions and malformation. Sixty-two patients, aged from 19 to 63 years old (mean 35 ys), were included in the study. Among them, 4 patients suffered from penis partial defection were respectively treated with restoring defective penis, penis lengthening and urethroplasty; three patients with penis completely missing were treated with penis reconstruction surgery; 22 cases with serious penile curvature were treated with the 16-dot plication technique (Lue's procedure); 15 cases with penile fracture were treated with conservative treatment for 1 case and with patch penis, corpus spongiosum, and deep penile dorsal vein ligation for 14 cases; 5 cases with post-operative complications of 3-pieces of penile prosthesis, including the prosthesis perforating to the urethra, water pump failure, broken connection tube, erection angle < 60 degrees and failure to expansion the corpus cavernosum, were treated by taking out prostheses, urethral repair cracks, replacement of the prostheses, excision of fibrosis scar and re-implantation prostheses respectively. Four cases with penis complete amputation were treated with the penis replantation; three cases of avulsion injury were treated with the replantation and free flap skin; 6 with Paget's disease of penises were treated with the lesion free skin buried in the scrotum and penis. All these patients were followed up for 3 months to 4 years, with the average of 9 months. Among the 4 cases of penis partial defection, 2 patients were satisfied with the penile appearance and sexual function; 1 got some satisfactory and 1 was unsatisfied. Three cases with the loss of the penis completely were satisfied with both the postoperative appearance and urination, and 1 was not satisfied. Twenty-two cases of penile curvature deformities were corrected, and one case was recurrence. Fourteen of the 15 patients with penile fracture were followed, and all got the restoration of sexual function. Among them, 5 cases with post-operative complications, including mild bending, algopareunia, subcutaneous induration, poor hardness and poor sexual pleasure, were not further treated, and another case lost; Five cases with post-operative complications of three-pieces penile prosthesis were treated successfully, and 4 of their spouses were satisfied with their sexual function after operation, only 1 of their spouse not satisfied. Among four cases with complete amputation of penis, two cases of penis were replanted successfully while two necrosis. Three cases with avulsion were treated with skin grafting successfully. All 6 cases with penile Paget's disease were followed for 2 -4 years, and free skin grafts were all survival. One patient died of brain metastases 18 months after operation and five cases were disease-free survival. The patients should be treated based on the procedure of andrological and urological surgery, together with microsurgical, flap or skin graft technique. The urologist should design personalized surgical procedure. Most of the patient's penis shape and erectile dysfunction can be reconstructed by our procedures, but some patients can not achieve the desired appearance or function of penis. New approaches of the treatment ought to be developed to restore both of the shape and function for those severe injury of the penis.

Erectile Dysfunction: A Review of Historical Treatments With a Focus on the Development of the Inflatable Penile Prosthesis

PubMed Central

Gurtner, Kristen; Saltzman, Amanda; Hebert, Kristi; Laborde, Eric

2015-01-01

Erectile dysfunction has been a concern for men since the beginning of written history. For many men it can lead to severe psychological distress and humiliation. The treatment of erectile dysfunction has advanced significantly over the past 200 years. Men today are presented with many more viable therapy options leading to improved efficacy and more satisfactory sex lives. The objective of this article is to explore historical options for the treatment of erectile dysfunction, with particular emphasis on the development and progression of the inflatable penile prosthesis. PMID:26206161

Trends in Penile Prosthetics: Influence of Patient Demographics, Surgeon Volume, and Hospital Volume on Type of Penile Prosthesis Inserted in New York State.

PubMed

Kashanian, James A; Golan, Ron; Sun, Tianyi; Patel, Neal A; Lipsky, Michael J; Stahl, Peter J; Sedrakyan, Art

2018-02-01

Penile prostheses (PPs) are a discrete, well-tolerated treatment option for men with medical refractory erectile dysfunction. Despite the increasing prevalence of erectile dysfunction, multiple series evaluating inpatient data have found a decrease in the frequency of PP surgery during the past decade. To investigate trends in PP surgery and factors affecting the choice of different PPs in New York State. This study used the New York State Department of Health Statewide Planning and Research Cooperative (SPARCS) data cohort that includes longitudinal information on hospital discharges, ambulatory surgery, emergency department visits, and outpatient services. Patients older than 18 years who underwent inflatable or non-inflatable PP insertion from 2000 to 2014 were included in the study. Influence of patient demographics, surgeon volume, and hospital volume on type of PP inserted. Since 2000, 14,114 patients received PP surgery in New York State; 12,352 PPs (88%) were inflatable and 1,762 (12%) were non-inflatable, with facility-level variation from 0% to 100%. There was an increasing trend in the number of annual procedures performed, with rates of non-inflatable PP insertion decreasing annually (P < .01). More procedures were performed in the ambulatory setting over time (P < .01). Important predictors of device choice were insurance type, year of insertion, hospital and surgeon volume, and the presence of comorbidities. Major influences in choice of PP inserted include racial and socioeconomic factors and surgeon and hospital surgical volume. Use of the SPARCS database, which captures inpatient and outpatient services, allows for more accurate insight into trends in contrast to inpatient sampling alone. However, SPARCS is limited to patients within New York State and the results might not be generalizable to men in other states. Also, patient preference was not accounted for in these analyses, which can play a role in PP selection. During the past 14 years, there has been an increasing trend in inflatable PP surgery for the management of erectile dysfunction. Most procedures are performed in the ambulatory setting and not previously captured by prior studies using inpatient data. Kashanian JA, Golan R, Sun T, et al. Trends in Penile Prosthetics: Influence of Patient Demographics, Surgeon Volume, and Hospital Volume on Type of Penile Prosthesis Inserted in New York State. J Sex Med 2018;15:245-250. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Penile lengthening and widening without grafting according to a modified 'sliding' technique.

PubMed

Egydio, Paulo H; Kuehhas, Franklin E

2015-12-01

To present the feasibility and safety of penile length and girth restoration based on a modified 'sliding' technique for patients with severe erectile dysfunction (ED) and significant penile shortening, with or without Peyronie's disease (PD). Between January 2013 and January 2014, 143 patients underwent our modified 'sliding' technique for penile length and girth restoration and concomitant penile prosthesis implantation. It is based on three key elements: (i) the sliding manoeuvre for penile length restoration; (ii) potential complementary longitudinal ventral and/or dorsal tunical incisions for girth restoration; and (iii) closure of the newly created rectangular bow-shaped tunical defects with Buck's fascia only. In all, 143 patients underwent the procedure. The causes of penile shortening and narrowing were: PD in 53.8%; severe ED with unsuccessful intracavernosal injection therapy in 21%; post-radical prostatectomy 14.7%; androgen-deprivation therapy, with or without brachytherapy or external radiotherapy, for prostate cancer in 7%; post-penile fracture in 2.1%; post-redo-hypospadias repair in 0.7%; and post-priapism in 0.7%. In patients with ED and PD, the mean (range) deviation of the penile axis was 45 (0-100)°. The mean (range) subjective penile shortening reported by patients was 3.4 (1-7) cm and shaft constriction was present in 53.8%. Malleable penile prostheses were used in 133 patients and inflatable penile prostheses were inserted in 10 patients. The median (range) follow-up was 9.7 (6-18) months. The mean (range) penile length gain was 3.1 (2-7) cm. No penile prosthesis infection caused device explantation. The average International Index of Erectile Function (IIEF) score increased from 24 points at baseline to 60 points at the 6-month follow-up. Penile length and girth restoration based on our modified sliding technique is a safe and effective procedure. The elimination of grafting saves operative time and, consequently, decreases the infection risk and costs associated with surgery. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Manual Ventilation and Sustained Lung Inflation in an Experimental Model: Influence of Equipment Type and Operator’s Training

PubMed Central

Mascaretti, Renata Suman; Vale, Luciana Assis; Haddad, Luciana Branco

2016-01-01

Aim To compare the influence of devices for manual ventilation and individual experience on the applied respiratory mechanics and sustained lung inflation. Methods A total of 114 instructors and non-instructors from the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics participated in this study. Participants ventilated an intubated manikin. To evaluate respiratory mechanics and sustained lung inflation parameters, a direct comparison was made between the self-inflating bag and the T-shaped resuscitator (T-piece), followed by an analysis of the effectiveness of the equipment according to the participants’ education and training. Results A difference between equipment types was observed for the tidal volume, with a median (interquartile range) of 28.5 mL (12.6) for the self-inflating bag and 20.1 mL (8.4) for the T-piece in the instructor group and 31.6 mL (14) for the self-inflating bag and 22.3 mL (8.8) for the T-piece in the non-instructor group. Higher inspiratory time values were observed with the T-piece in both groups of professionals, with no significant difference between them. The operator’s ability to maintain the target pressure over the 10 seconds of sustained lung inflation was evaluated using the area under the pressure-time curve and was 1.7-fold higher with the use of the T-piece. Inspiratory pressure and mean airway pressure applied during sustained lung inflation were greater with the self-inflating bag, as evaluated between the beginning and the end of the procedure. Conclusion The T-piece resulted in lower tidal volume and higher inspiratory time values, irrespective of the operator’s experience, and increased the ease of performing the sustained lung inflation maneuver, as demonstrated by the maintenance of target pressure for the desired period and a higher mean airway pressure than that obtained using the self-inflating bag. PMID:26859896

Total phallic reconstruction using radial forearm free flap after iatrogenic penile amputation.

PubMed

Angulo, J C; Arance, I; Gómez-Llorens, C; Esquinas, C; Gómez-Martín, C; Fernández-Cañamaque, J L

2017-09-01

The iatrogenic loss of the penis is a rare situation. We present a challenging case of deferred total penile reconstruction in a genetic male. A 57-year-old man with the loss of the penis due to a penile abscess and necrosis secondary to penile curvature surgery. The reconstruction was performed over several operations using a radial forearm free flap (RFFF) and placement of a customised inflatable prosthesis a year later. During the first operation, the penile abscess was drained, the necrotic residues were debrided and placement of hypogastric drainage. Seven weeks later, phalloplasty was performed with RFFF and a tube-in-tube neourethra was constructed. Multiple microsurgical anastomosis was performed, and the donor site was coated with a skin graft from the thigh of partial thickness. The surgery lasted 10hours and had the complication of hair growth in the neourethra, which required mechanical endoscopic depilation on repeated occasions. The patient regained penile sensitivity. Eighteen months after the phalloplasty, a Zephyr single-body inflatable prosthesis (Geneva, Switzerland) was implanted, using the tunica albuginea of the proximal corpus cavernosum. The patient was satisfied with the aesthetics and urinary and sensory function. Four months later, the patient is gaining confidence to consider penetration. Despite the risk of postoperative complications and the need for multiple operations, phallic reconstruction with RFFF and the placement of a customised prosthetic implant can improve urinary and sexual function secondary to the loss of the penis. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Pseudo-malfunction of the Coloplast Titan Inflatable Penile Prosthesis One-Touch Release Pump.

PubMed

Garber, Bruce B; Khurgin, Jacob L; Stember, Doron S; Perito, Paul E

2014-10-01

To define and describe a type of pseudo-malfunction of the Coloplast Titan Inflatable Penile Prosthesis (IPP) One-Touch Release (OTR) pump (Coloplast Corp, Minneapolis, MN). We retrospectively reviewed a consecutive series of 550 patients with refractory organic erectile dysfunction who were implanted with a Coloplast Titan IPP with the OTR pump during a period of approximately 4 years. All patients were implanted using standard techniques through an infrapubic or penoscrotal approach. Twenty-nine patients (5.3%) complained that their IPP would not inflate and that the pump bulb felt "hard." Examination revealed that their IPP was working normally; however, the inflate/deflate valve disc had become stuck in the deflate position. Very firm pressure had to be applied to the pump bulb to move the valve disc into the inflate position. Once this was accomplished, the device inflated and deflated normally. Another 14 patients (2.5%) reported this phenomenon to us but were able to apply enough pressure on the pump bulb to rectify it. The inflate/deflate valve disc in the Coloplast Titan OTR pump can occasionally become stuck in the deflate position (7.8% of patients in our experience). Patients may be unable to inflate the device and return for evaluation. In all cases we have encountered, firm pressure on the pump bulb caused the valve to shift into the inflate position, and the device worked properly thereafter. Patients and implanting urologists should be aware of this issue and of the way in which it can be rectified. Copyright © 2014 Elsevier Inc. All rights reserved.

Comparison of devices for newborn ventilation in the delivery room.

PubMed

Szyld, Edgardo; Aguilar, Adriana; Musante, Gabriel A; Vain, Nestor; Prudent, Luis; Fabres, Jorge; Carlo, Waldemar A

2014-08-01

To evaluate the effectiveness and safety of a T-piece resuscitator compared with a self-inflating bag for providing mask ventilation to newborns at birth. Newborns at ≥26 weeks gestational age receiving positive-pressure ventilation at birth were included in this multicenter cluster-randomized 2-period crossover trial. Positive-pressure ventilation was provided with either a self-inflating bag (self-inflating bag group) with or without a positive end-expiratory pressure valve or a T-piece with a positive end-expiratory pressure valve (T-piece group). Delivery room management followed American Academy of Pediatrics and International Liaison Committee on Resuscitation guidelines. The primary outcome was the proportion of newborns with heart rate (HR)≥100 bpm at 2 minutes after birth. A total of 1027 newborns were included. There was no statistically significant difference in the incidence of HR≥100 bpm at 2 minutes after birth between the T-piece and self-inflating bag groups: 94% (479 of 511) and 90% (466 of 516), respectively (OR, 0.65; 95% CI, 0.41-1.05; P=.08). A total of 86 newborns (17%) in the T-piece group and 134 newborns (26%) in the self-inflating bag group were intubated in the delivery room (OR, 0.58; 95% CI, 0.4-0.8; P=.002). The mean±SD maximum positive inspiratory pressure was 26±2 cm H2O in the T-piece group vs 28±5 cm H2O in the self-inflating bag group (P<.001). Air leaks, use of drugs/chest compressions, mortality, and days on mechanical ventilation did not differ significantly between groups. There was no difference between the T-piece resuscitator and a self-inflating bag in achieving an HR of ≥100 bpm at 2 minutes in newborns≥26 weeks gestational age resuscitated at birth. However, use of the T-piece decreased the intubation rate and the maximum pressures applied. Copyright © 2014 Elsevier Inc. All rights reserved.

21 CFR 876.3350 - Penile inflatable implant.

Code of Federal Regulations, 2010 CFR

2010-04-01

... implanted in the penis, connected to a reservoir filled with radiopaque fluid implanted in the abdomen, and... rigidity to the penis. This device is used in the treatment of erectile impotence. (b) Classification...

21 CFR 876.3350 - Penile inflatable implant.

Code of Federal Regulations, 2014 CFR

2014-04-01

... implanted in the penis, connected to a reservoir filled with radiopaque fluid implanted in the abdomen, and... rigidity to the penis. This device is used in the treatment of erectile impotence. (b) Classification...

21 CFR 876.3350 - Penile inflatable implant.

Code of Federal Regulations, 2011 CFR

2011-04-01

... implanted in the penis, connected to a reservoir filled with radiopaque fluid implanted in the abdomen, and... rigidity to the penis. This device is used in the treatment of erectile impotence. (b) Classification...

21 CFR 876.3350 - Penile inflatable implant.

Code of Federal Regulations, 2013 CFR

2013-04-01

... implanted in the penis, connected to a reservoir filled with radiopaque fluid implanted in the abdomen, and... rigidity to the penis. This device is used in the treatment of erectile impotence. (b) Classification...

21 CFR 876.3350 - Penile inflatable implant.

Code of Federal Regulations, 2012 CFR

2012-04-01

... implanted in the penis, connected to a reservoir filled with radiopaque fluid implanted in the abdomen, and... rigidity to the penis. This device is used in the treatment of erectile impotence. (b) Classification...

Implantation of AMS 700 LGX penile prosthesis preserves penile length without the need for penile lengthening procedures

PubMed Central

Augusto Negro, Carlo Luigi; Paradiso, Matteo; Rocca, Alessandro; Bardari, Franco

2016-01-01

Implantation of an inflatable penile prosthesis (IPP) is a well-established definitive solution for erectile dysfunction when conservative treatments fail. Penile implants may shorten the penis. The AMS 700 LGX IPP is in common use but reports on its mechanical reliability, medium-term postsurgical patient satisfaction, and mean penile length preservation are lacking. We investigate the mean penile length, mechanical reliability, and patient satisfaction at 6 and 12 months after implantation of the AMS 700 LGX. This prospective study consecutively enrolled men undergoing first-time IPP implant surgery from February 2009 to April 2012. Stretched flaccid penile length, penile length at 50% and 100% of stiffness (P50 and P100) and International Index of Erectile Function (IIEF) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores, were measured at 6 and 12 months postsurgery. Of 45 patients who underwent AMS 700 LGX implantation (median age 61 years) and completed 6 months’ follow-up, 36 (80%) completed the study. A significant difference in stretched flaccid penile length was seen between 6 and 12 months (P = 0.033). P100 was also significantly increased at 6 and 12 months, with a mean 10% increase (1.3 ± 0.4 cm) from baseline to 12 months. Differences in mean IIEF scores at 6 and 12 months were significant for the desired domain (P = 0.0001) and for overall satisfaction (P = 0.002); however, mean EDITS scores at 6 and 12 months were not significantly improved. AMS 700 LGX is a powerful tool for preserving penile length in men undergoing penile prosthesis implantation. PMID:26112480

Erectile Dysfunction: MedlinePlus Health Topic

MedlinePlus

... Men's Health (Hormone Health Network) Also in Spanish Sex and the Man With Cancer (American Cancer Society) Also in Spanish Specifics Bent Penis (Mayo Foundation for Medical Education and Research) Videos and Tutorials Simultaneous Inflatable Penile Prosthesis (IPP) and ...

T-piece resuscitator versus self-inflating bag for preterm resuscitation: an institutional experience.

PubMed

Jayaram, Archana; Sima, Adam; Barker, Gail; Thacker, Leroy R

2013-07-01

Manual ventilation in the delivery room is provided with devices such as self-inflating bags (SIBs), flow-inflating bags, and T-piece resuscitators. To compare the effect of type of manual ventilation device on overall response to resuscitation among preterm neonates born at < 35 weeks gestation. Retrospective data were collected in 2 time periods. Primary outcome was overall response to resuscitation, as measured by Apgar score. Secondary outcomes were incidence of air leaks, need for chest compressions/epinephrine, need for intubation, and surfactant use. We identified 294 resuscitations requiring ventilation. SIB was used for 135 neonates, and T-piece was used for 159 neonates. There was no significant difference between the 1-min and 5-min Apgar scores between SIB and T-piece (P = .77 and P = .11, respectively), nor were there significant differences in secondary outcomes. The rate of rise of Apgar score was higher, by 0.47, with T-piece, compared to SIB (95% CI 0.08-0.87, P = .02). Although some manikin studies favor T-piece for providing reliable and consistent pressures, our experience did not indicate significant differences in effectiveness of resuscitation between the T-piece and SIB in preterm resuscitations.

The hydrophilic-coated inflatable penile prosthesis: 1-year experience.

PubMed

Wolter, Christopher E; Hellstrom, Wayne J G

2004-09-01

Penile prosthesis infections are a devastating complication for both patient and surgeon. Efforts to reduce the risk of infection from these elective procedures are a major focus of research and development by the major prosthesis companies. The Titan inflatable penile prosthesis (Mentor Corporation, Santa Barbara, CA) is coated with polyvinylpyrrolidone (PVP), a hydrophilic substance that reduces bacterial adherence and absorbs and elutes the antibiotics the device is immersed in intraoperatively. The Titan device was introduced to the American market in September 2002. This study reports the 1-year experience in the U.S. with the Titan and compares infection rates with the noncoated Alpha-1 IPP made by Mentor. Two thousand three hundred and fifty-seven Titan prostheses were implanted in the U.S. from September 2002 to August 2003, compared with the 482 noncoated Alpha-1 IPPs implanted over the same time period. Infection rates were compared, along with bacterial culture data. All data were collected from Mentor's internal database, as generated from the FDA's mandatory reporting of explanted medical devices, and available on the internet. The infection rate for the coated Titan IPP was 1.06% (25/2,357). During the same time period, the infection rate for the Alpha-1 noncoated prosthesis was 2.07% (10/482). Staphylococcus species predominated in both groups (9/25 Titan, 6/10 Alpha-1). At 1 year of follow-up, the data demonstrate that the hydrophilic coating on the Titan IPP confers a significant advantage in reducing the rate of infection over the noncoated device. Long-term follow-up on this first year database is needed before this innovation is accepted as the standard of care for prosthetic surgery. Nevertheless, the theoretical reduction in bacterial adhesion conferred by the hydrophilic PVP surface and the ability to choose which antibiotic the device is immersed in intraoperatively gives the implanting surgeon distinct advantages with this new product.

The Evolution and Utility of the Small-Carrion Prosthesis, Its Impact, and Progression to the Modern-Day Malleable Penile Prosthesis.

PubMed

Martinez, Daniel R; Terlecki, Ryan; Brant, William O

2015-11-01

Erectile dysfunction has plagued humanity for millennia. For years, treatment had been in the hands of mental health professionals. It was not until the 1970s that urologists created a modality that was marketable, reproducible, and consistently successful at treating impotence, the Small-Carrion Penile Prosthesis. We present the evolution of the malleable/semi-rigid penile prosthesis, concentrating our efforts reviewing and critiquing the pivotal article published by Drs. Michael P. Small, Hernan M. Carrion, and Julian A. Gordon. We then discuss its continued advancement, current-day utilization, and the future of the malleable prosthesis. From the early 1900s, surgeons have been toying with the idea of creating a penile implant. These initial attempts utilized rib cartilage, and eventually synthetic materials, including acrylic, silicone, and polyethylene. In 1975, Drs. Carrion and Small presented their initial experience of 31 patients utilizing their silicone implant. In their manuscript titled, "The Small-Carrion Penile Prosthesis: New Implant for the Management of Impotence," they discuss their technique, perioperative management of complications, and results. The malleable penile prosthesis continued to evolve throughout the years to the current day Genesis and Spectra. Although the current market is dominated by the inflatable penile prosthesis, there are specific situations where the malleable is ideally utilized. The pivotal article by Drs. Carrion and Small helped pave the way for the "New Era" of penile prosthetics and still remains one of the most impactful contributions to the management of erectile dysfunction. © 2015 International Society for Sexual Medicine.

Preoperative counseling and expectation management for inflatable penile prosthesis implantation.

PubMed

Narang, Gopal L; Figler, Bradley D; Coward, Robert M

2017-11-01

The inflatable penile prosthesis (IPP) is the gold standard surgical treatment for medical refractory erectile dysfunction (ED). While the modern IPP has enjoyed high satisfaction rates as a product of its continued innovation, reliability, and performance, patient dissatisfaction can still occur. IPP implantation restores physiologic function with cosmetic and psychological consequences, both of which place inherent emphasis on preoperative counseling and expectation management. This review aims to highlight the complex nature of such counseling and provide practitioners with a roadmap to navigate the landscape. Preoperative counseling begins with appropriate patient selection and identification of those patients who are at risk for dissatisfaction as a result of personality characteristics. The informed consent provides a natural framework to discuss the host of complications and risks that are associated with surgery, including infection, device malfunction, damage to nearby structures, and device erosion. Device selection is a nuanced process that merges patient preference with clinical factors and consideration. We address device selection through a description of cylinder construction, pump design, and reservoir placement in the context of preoperative counseling. Lastly, we draw attention to expectation management with a specific focus on possible post-operative changes to penile length and sensation as well as partner involvement. The modern IPP provides excellent results with high patient and partner satisfaction. Ultimately, satisfaction is dependent on multiple factors, but providing accurate, realistic counseling and expectation management prepares patients for the best possible outcomes.

Thulium-yttrium-aluminium-garnet (Tm:YAG) laser treatment of penile cancer: oncological results, functional outcomes, and quality of life.

PubMed

Musi, Gennaro; Russo, Andrea; Conti, Andrea; Mistretta, Francesco A; Di Trapani, Ettore; Luzzago, Stefano; Bianchi, Roberto; Renne, Giuseppe; Ramoni, Stefano; Ferro, Matteo; Matei, Deliu Victor; Cusini, Marco; Carmignani, Luca; de Cobelli, Ottavio

2018-02-01

To evaluate the oncological and functional outcomes of patients diagnosed with penile cancer undergoing conservative treatment through thulium-yttrium-aluminium-garnet (Tm:YAG) laser ablation. Twenty-six patients with a penile lesion underwent ablation with a RevoLix 200 W continuous-wave laser. The procedure was carried out with a pen-like laser hand piece, using a 360 μm laser fiber and 15-20 W of power. Median (IQR) follow-up time was 24 (15-30) months. Recurrence rate and post-operative sexual function were assessed. Median age at surgery was 61 years. Median (inter quartile range) size of the lesions was 15 [10-20] mm. Overall, 11 (47.8%) and 12 (52.2%) at the final pathology presented in situ and invasive squamous cell carcinoma (SCC), respectively. The final pathological stage was pTis, pT1a, pT2, and pT3 in 11 (47.8%), 7 (30.4%), 3 (13.0%), and 2 (8.7%) patients, respectively. Moreover, four (17.4%) patients had a recurrence of which three (13.0%) and one (4.3%) patients developed an invasive or in situ recurrence, respectively. After treatment 6 (26.1%) patients reported a conserved penile sensitivity, while 13 (56.5%) and 4 (17.4%) patients experienced a better or worse sensitivity after ablation, respectively. Post-treatment sexual activity was achieved within the first month after laser ablation in 82.6% of the patients. Early stage penile carcinomas can be effectively treated with an organ preservation strategy. Tm:YAG conservative laser treatment is easy, safe and offers good functional outcome, with a minor impact on patient's quality of life.

Fifteen years experience of penile prosthesis insertion.

PubMed

Burns-Cox, N; Burston, A; Gingell, J C

1997-12-01

To review the outcome and patient satisfaction of penile prosthesis insertion over a 15 y period. We reviewed the notes of 172 patients who underwent penile prosthesis insertion between January 1980 and May 1995. From the notes information was determined on age of the patient, type of prosthesis, surgical approach and length of stay. Also noted were risk factors for erectile dysfunction and the aetiology. Twenty patients were known to have died or moved away. To assess the impact the operation had on quality of life, 152 questionnaires were sent of which 103 were returned (67%). The questionnaire gained information about sexual activity, before and after the operation and the overall satisfaction of the patient and his partner and whether they felt the operation was a success. Overall 149 patients were known to have had malleable prostheses inserted and 23 had inflatables. The commonest organic groups were vascular disease, diabetes and Peyronies disease. Fifteen patients had two procedures. Four patients required revision of the prosthesis due to erosion, and there was one death due to pulmonary embolism. One hundred and three completed questionnaires have been returned to date the median time since operation was 4 y, the range being six months to 16 y and 78% thought the operation was a success. The insertion of malleable prostheses is associated with low complication rates, good patient satisfaction and improved quality of life for the couple. Concealment was not a major problem.

Penile enhancement using a porcine small intestinal submucosa graft in a rat model.

PubMed

Leungwattanakij, S; Pummangura, N; Ratana-Olarn, K

2006-01-01

Several biodegradable materials have been experimented for penile enhancement, but none show the potential for clinical use. This study was designed to use porcine small intestinal submucosa (SIS) augmenting the normal tunica albuginea to increase the functional girth of the rat penis. In all, 20 adult male Sprague-Dawley rats constituted the study population. The animals were divided into two groups: group 1 consisted of the control (n=10) and group 2 (n=10) consisted of rats that underwent penile enhancement by a longitudinal I-shaped incision of the tunica albuginea on both sides, and the dissection of the plane between tunica albuginea and cavernosal tissue was carried out (n=10). The incision was then patched with a 3 x 10 mm2 piece of SIS, using a 6/0 nylon suture material. The penile length and mid-circumference were then measured using a Vernier Caliper before and 2 months after surgery. All rat penises underwent histological examination using Masson's trichome and Verhoff's van Giesen's stain for collagen and elastic fibers. The penile length, mid-circumference and degree of fibrosis score were expressed as mean+/-s.e. (standard error) and analyzed using a Wilcoxon rank-sum test. A statistical significance was accepted at P-value < or =0.05. Our results showed similar preoperative penile length and circumference in both groups. However, 2 months after the surgery, the mean penile circumference of the SIS group has grown significantly larger than the control group, while the mean penile length remained unchanged. The histological study of the rat penises revealed minimal amounts of fibrosis under the graft, and the elastic fibers of the graft showed orientation in a circular manner. In conclusion, SIS appears promising for material use in a penile enhancement.

Augmented reality assisted surgery: a urologic training tool

PubMed Central

Dickey, Ryan M; Srikishen, Neel; Lipshultz, Larry I; Spiess, Philippe E; Carrion, Rafael E; Hakky, Tariq S

2016-01-01

Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass® optical head-mounted display to train urology residents in how to place an inflatable penile prosthesis. We use the phrase Augmented Reality Assisted Surgery to describe this novel application of augmented reality in the setting of surgery. The application demonstrates the steps of the surgical procedure of inflatable penile prosthesis placement. It also contains software that allows for detection of interest points using a camera feed from the optical head-mounted display to enable faculty to interact with residents during placement of the penile prosthesis. Urology trainees and faculty who volunteered to take part in the study were given time to experience the technology in the operative or perioperative setting and asked to complete a feedback survey. From 30 total participants using a 10-point scale, educational usefulness was rated 8.6, ease of navigation was rated 7.6, likelihood to use was rated 7.4, and distraction in operating room was rated 4.9. When stratified between trainees and faculty, trainees found the technology more educationally useful, and less distracting. Overall, 81% of the participants want this technology in their residency program, and 93% see this technology in the operating room in the future. Further development of this technology is warranted before full release, and further studies are necessary to better characterize the effectiveness of Augmented Reality Assisted Surgery in urologic surgical training. PMID:26620455

Augmented reality assisted surgery: a urologic training tool.

PubMed

Dickey, Ryan M; Srikishen, Neel; Lipshultz, Larry I; Spiess, Philippe E; Carrion, Rafael E; Hakky, Tariq S

2016-01-01

Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass ® optical head-mounted display to train urology residents in how to place an inflatable penile prosthesis. We use the phrase Augmented Reality Assisted Surgery to describe this novel application of augmented reality in the setting of surgery. The application demonstrates the steps of the surgical procedure of inflatable penile prosthesis placement. It also contains software that allows for detection of interest points using a camera feed from the optical head-mounted display to enable faculty to interact with residents during placement of the penile prosthesis. Urology trainees and faculty who volunteered to take part in the study were given time to experience the technology in the operative or perioperative setting and asked to complete a feedback survey. From 30 total participants using a 10-point scale, educational usefulness was rated 8.6, ease of navigation was rated 7.6, likelihood to use was rated 7.4, and distraction in operating room was rated 4.9. When stratified between trainees and faculty, trainees found the technology more educationally useful, and less distracting. Overall, 81% of the participants want this technology in their residency program, and 93% see this technology in the operating room in the future. Further development of this technology is warranted before full release, and further studies are necessary to better characterize the effectiveness of Augmented Reality Assisted Surgery in urologic surgical training.

Penile Prosthesis Implantation in Patients with a History of Total Phallic Construction.

PubMed

Zuckerman, Jack M; Smentkowski, Katherine; Gilbert, David; Storme, Oscar; Jordan, Gerald; Virasoro, Ramon; Tonkin, Jeremy; McCammon, Kurt

2015-12-01

Outcomes following penile prosthesis implantation in patients with a history of total phallic construction are not well described. The aim of this study was to evaluate outcomes following neophallus penile prosthesis placement. Retrospective review penile prosthesis placement in patients with prior total phallic construction. GORE-TEX® (Gore Medical, Flagstaff, AZ) sleeve neotunica construction was utilized in all patients. Success defined as patient sexual activity with a functioning prosthesis. Thirty-one patients underwent neophallic prosthesis implantation at a mean 35.6 years of age. Prosthesis placement occurred at an average 56.3 months following phallic construction and follow-up was a mean of 59.7 months. Malleable prostheses were placed in 21 patients and inflatable in 10; implants were bilateral in 94%. Six percent experienced operative complications including a bladder injury (1) and phallic flap arterial injury (1). Postoperative complications occurred in 23% at a median 5.5 months following placement. Five prostheses were explanted secondary to infection or erosion and two additional required revisions. Of the explanted prosthesis two were later replaced without further complication. Eighty-one percent of patients were sexually active following prosthesis placement. Penile prosthesis placement is possible in patients with prior penile reconstruction/phallic construction. Although complications rates appear to be elevated in this population compared with historic controls of normal anatomic men, the majority of patients in this series were sexually active following prosthesis placement. This demonstrates the utility of prosthesis implantation in these difficult patients. © 2015 International Society for Sexual Medicine.

[Reconstruction of penile function with tissue engineering techniques].

PubMed

Song, Lu-jie; Pan, Lian-jun; Xu, Yue-min

2007-04-01

Tissue engineering techniques, with their potential applied value for penile reconstruction, are of special interest for andrologists. The purpose of this review is to appraise the recent development and publications in this field. In the past few years, great efforts have been made to develop corpus cavernosum tissues by combining smooth muscle and endothelial cells seeded on biodegradable polyglycolic acid polymer (PGA) or acellular corporal collagen matrices scaffolds. Animal experiment demonstrated that the engineered corpus cavernosum achieved adequate structural and functional parameters. Engineered cartilage rods as an alternative for the current clinical standard of semirigid or inflatable penile implants could be created by seeding chondrocyte cylindrical PGA. A series of studies showed that, compared to commercially available silicone implants, the engineered rods were flexible, elastic and stable. Besides, a variety of decellularized biological materials have been used as grafts not only for substitution of tunica albuginea but also for penile enhancement, with promising results. For treating erectile dysfunction, a new approach to recovering erectile function by cell-based therapy could be the injection of functional cells into corpus cavernosum, which seemed to be promising when combined with cell manipulation by gene therapy prior to cell transfer.

Three-component hydraulic penile prosthesis malfunction due to penile fibrolipoma secondary to augmentative phalloplasty: A case report.

PubMed

Antonini, Gabriele; Vicini, Patrizio; De Berardinis, Ettore; Pacchiarotti, Arianna; Gentile, Vincenzo; Perito, Paul

2016-01-14

Fibrolipomas are an infrequent type of lipomas. We describe a case of a man suffering from subcutaneous penile fibrolipoma, who twelve months earlier has been submitted to augmentative phalloplasty due to aesthetic dysmorphophobia. The same patient three years earlier has been submitted to three-component hydraulic penile prostheses implantation due to erectile dysfunction. After six months from removing of the mass, the penile elongation and penile enlargement were stable, the prostheses were correctly functioning and the patient was satisfied with his sexual intercourse and life. The diagnostics and surgical characteristics of this case are reported.

Peyronie's disease: lights and shadows.

PubMed

Sasso, F; Gulino, G; Falabella, R; D'Addessi, A; Sacco, E; D'Onofrio, A; Bassi, P F

2007-01-01

Peyronie's disease (PD) is characterized by the onset of fibrous plaque inside the tunica albuginea of the penile corpora cavernosa that can cause pain and bending during the erection, making intercourse difficult or impossible. Evidence of the literature supports the autoimmune etiology of PD and suggests genetic and familiar conditions, penile traumatisms, and a history of genital tract diseases as risk factors, but no definitive conclusions arise about the pathogenesis of the disease. Few randomized trials demonstrated that medical therapies, such as vitamin E, colchicine, potassium aminobenzoate, tamoxifen, and injection therapy with verapamil, can stabilize the acute phase of the disease. Extracorporeal shock wave therapy and iontophoresis cannot be considered first-line or gold standard therapies. Satisfactory results have been published with the Nesbit operation in large series with low-stage disease, whereas plication procedures have shown significant relapse rates. A high incidence of long-term penile retractions has been reported in high-stage disease treated with plaque incision and simple graft insertion. Malleable, soft, or inflatable prostheses combined with graft implantation have given the best results in terms of penile straightening and lengthening and patient satisfaction. In conclusion, the etiopathogenesis of PD is not yet clearly understood, no medical therapy is fully effective, and surgery remains the gold standard in patients with severe deformity and/or erectile dysfunction.

Expert training with standardized operative technique helps establish a successful penile prosthetics program for urologic resident education.

PubMed

King, Ashley B; Klausner, Adam P; Johnson, Corey M; Moore, Blake W; Wilson, Steven K; Grob, B Mayer

2011-10-01

The challenge of resident education in urologic surgery programs is to overcome disparity imparted by diverse patient populations, limited training times, and inequalities in the availability of expert surgical educators. Specifically, in the area of prosthetic urology, only a small proportion of programs have full-time faculty available to train residents in this discipline. To examine whether a new model using yearly training sessions from a recognized expert can establish a successful penile prosthetics program and result in better outcomes, higher case volumes, and willingness to perform more complex surgeries. A recognized expert conducted one to two operative training sessions yearly to teach standardized technique for penile prosthetics to residents. Each session consisted of three to four operative cases performed under the direct supervision of the expert. Retrospective data were collected from all penile prosthetic operations before (February, 2000 to June, 2004: N = 44) and after (July, 2004 to October, 2007: N = 79) implementation of these sessions. Outcomes reviewed included patient age, race, medical comorbidities, operative time, estimated blood loss, type of prosthesis, operative approach, drain usage, length of stay, and complications including revision/explantation rates. Statistical analysis was performed using Student's t-tests, Fisher's tests, and survival curves using the Kaplan-Meier technique (P value ≤ 0.05 to define statistical significance). Patient characteristics were not significantly different pre- vs. post-training. Operative time and estimated blood loss significantly decreased. Inflatable implants increased from 19/44 (43.2%, pre-training) to 69/79 (87.3%, post-training) (P < 0.01). Operations per year increased from 9.96 (pre-training) to 24 (post-training) (P < 0.01). Revision/explantation occurred in 11/44 patients (25%, pre-training) vs. 7/79 (8.9%, post-training) (P < 0.05). These data demonstrate that yearly sessions with a recognized expert can improve surgical outcomes, type, and volume of implants and can reduce explantation/revision rates. This represents an excellent model for improved training of urologic residents in penile prosthetics surgery. © 2011 International Society for Sexual Medicine.

Time to adjust to changes in ventilation settings varies significantly between different T-piece resuscitators, self-inflating bags, and manometer equipped self-inflating bags.

PubMed

Hartung, Julia C; Dold, Simone K; Thio, Marta; tePas, Arjan; Schmalisch, Gerd; Roehr, Charles Christoph

2014-06-01

Resuscitation guidelines give no preference over use of self-inflating bags (SIBs) or T-piece resuscitators (TPR) for manual neonatal ventilation. We speculated that devices would differ significantly regarding time required to adjust to changed ventilation settings. This was a laboratory study. Time to adjust from baseline peak inflation pressure (PIP) (20 cmH2O) to target PIP (25 and 40 cmH2O), ability to adhere to predefined ventilation settings (PIP, PEEP, and inflation rate [IR]), and the variability within and between operators were assessed for a SIB without manometer, SIB with manometer (SIBM), and two TPRs. Adjustment time was significantly longer with TPRs, compared with SIB and SIBM. The SIBM and TPRs were < 5% (median) off target PIP, and the SIB was 14% off target PIP. Significant variability between operators (interquartile range [IQR]: 71%) was seen with SIBs. PIP adjustment takes longer with TPRs, compared with SIB/SIBM. TPRs and SIBM allow satisfactory adherence to ventilation parameters. SIBs should only be used with manometer attached. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

How Big is Too Big? The Girth of Bestselling Insertive Sex Toys to Guide Maximal Neophallus Dimensions.

PubMed

Isaacson, Dylan; Aghili, Roxana; Wongwittavas, Non; Garcia, Maurice

2017-11-01

In our practice we have encountered 4 female-to-male transgender patients seeking neophallus revision surgery for girth precluding penetrative vaginal or anal intercourse. Despite this, there is little evidence available to guide transitioning patients in neophallus sizing. In this work we examined the dimensions of bestselling realistic dildos, presuming that the most popular dimensions would reflect population preferences for penetrative toys and phalluses. To determine a maximal upper limit for girth compatible with penetrative intercourse based on measurements of bestselling realistic dildos and published erect penile dimensions. We collected measurements for "realistic dildos" designated as bestsellers for the top 5 Alexa.com-rated online adult retailers in the United States and for Amazon.com. We compared these with measurements of dildos available at Good Vibrations in San Francisco and with studies of erect natal dimensions. We compared all data with measurements of 4 index patients whose neophallus girth prevented penetrative intercourse. Length and circumference of overall bestselling and largest bestselling realistic dildos as reported on top websites and measured by investigators. The average insertive length of the compiled dildos (16.7 ± 1.6 cm) was 1 SD longer than natal functional erect penile length as reported in the literature (15.7 ± 2.6 cm); however, their average circumference (12.7 ± 0.8 cm) mirrored natal erect penile girth (12.3 ± 1.3). The average girth of vendors' top 3 largest-girth dildos was 15.1 ± 0.9 cm, 2 SD wider than natal erect penile girth. Index patients had an average length of 16.3 ± 3.2 cm and an average girth of 17.6 ± 1.3 cm. Index patient girth was 4 to 5 SD wider than the average natal erect girth. Based on our data, we suggest that a surgically created neophallus should have a girth no wider than 15.1 cm after implantation of an inflatable penile prosthesis. This corresponds to 2 SD wider than the average natal man's erect girth. Strengths include in-person measurements of patients whose girth prevented penetrative intercourse, the large number of dildos assessed, and correlations with in-person measurements. Limitations include the inability to account for the pliability of different materials, whether dildos were used for vaginal and/or anal insertion, the limited sample of 4 transmen for in-person measurement, and the absence of implanted inflatable penile prostheses in index neophalluses. Neophallus girth wider than 15.1 cm could lead to difficulty in penetrative intercourse for many individuals. A conservative recommendation for neophallus girth is 13 to 14 cm, or 0.5 to 1.5 SD wider than natal erect penile girth. Isaacson D, Aghili R, Wongwittavas N, Garcia M. How Big is Too Big? The Girth of Bestselling Insertive Sex Toys to Guide Maximal Neophallus Dimensions. J Sex Med 2017;14:1455-1461. Copyright © 2017. Published by Elsevier Inc.

The PICS Technique: A Novel Approach for Residual Curvature Correction During Penile Prosthesis Implantation in Patients With Severe Peyronie's Disease Using the Collagen Fleece TachoSil.

PubMed

Hatzichristodoulou, Georgios

2018-03-01

Correction of residual curvature during inflatable penile prosthesis (IPP) implantation in patients with Peyronie's disease (PD) by plaque incision and grafting is a common approach. To present a novel technique for residual curvature correction during IPP implantation using collagen fleece (TachoSil, Baxter Healthcare Corp, Deerfield, IL, USA). After the IPP (Titan Touch, Coloplast, Minneapolis, MN, USA) is placed, the implant is inflated maximally. When residual curvature exceeds 40°, the PICS (penile implant in combination with the Sealing technique) technique is performed. The device is deflated, and a circumcising skin incision and penile degloving are performed. After elevation of the neurovascular bundle, the device is reinflated maximally. Plaque incision is performed at the point of maximum curvature using electrocautery. This leads to penile straightening because the tension is removed. In the next step, the defect of the tunica is closed with collagen fleece, which sticks to the tunica and defect without any sutures needed. The neurovascular bundle is reapproximated and the Buck fascia is closed. This is followed by closure of penile skin. Primary outcome measurements were straightening rates, operative times, 5-item International Index of Erectile Function (IIEF-5) scores at follow-up, immediate and late complications, and patient satisfaction. The PICS technique was applied to 15 patients. Mean patient age was 61.7 years (52-79 years). Mean residual curvature after IPP was 66.7° (50-90°). Mean operative time was 117.3 minutes (100-140 minutes). Mean follow-up was 15.1 months (1-29 months). 12 of 15 patients (80%) showed a totally straight penis. 3 patients (20%) had residual curvature of 10° at follow-up, which did not interfere with sexual intercourse. Mean IIEF-5 score at follow-up was 24.2 (22-25). No immediate or late complications occurred. All patients were satisfied with the surgical outcomes. This novel technique prevents puncture or injury of the device, because the collagen fleece does not require suture fixation into the defect after plaque incision. This technique can be applied to patients with severe PD who display residual curvature greater than 40° after IPP placement. It is a fast approach with low complication rates. Limitations include the small patient population and short follow-up. The PICS technique represents a safe and time-saving approach for residual curvature correction during IPP placement in patients with PD and prevents device puncture. Hatzichristodoulou G. The PICS Technique: A Novel Approach for Residual Curvature Correction During Penile Prosthesis Implantation in Patients With Severe Peyronie's Disease Using the Collagen Fleece TachoSil. J Sex Med 2018;15:416-421. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Preoperative clinical and diagnostic characteristics of patients who require delayed IPP after primary Peyronies repair.

PubMed

Alphs, Hannah H; Navai, Neema; Köhler, Tobias S; McVary, Kevin T

2010-03-01

Penile vascular abnormalities occur in a high proportion of patients with Peyronie's disease (PD). Penile duplex ultrasonography (PDU) and dynamic infusion cavernosometry and cavernosography (DICC) are tools that can be used to help tailor individualized treatment for patients undergoing surgical intervention for their PD. However, precisely which parameters can be used to predict those patients with PD at risk for developing erectile dysfunction (ED) after intervention without inflatable penile prosthesis (IPP) has not been previously elucidated. To evaluate preoperative vascular parameters that predispose PD patients for developing ED after intervention without IPP. Twenty-six patients receiving surgical intervention for their PD at a single center were retrospectively identified. Of these, 11 (42.3%) opted for primary repair without placement of an IPP. Three (27.2%) of these 11 patients went on to develop ED postoperatively. We compared various demographic, PDU, and DICC parameters between patients who did and did not fail primary repair of their PD. Mean age and follow-up of patients who went on to develop ED after repair of PD without IPP were not significantly different (P < 0.05). Resistive index (RI) and end diastolic volume were significantly different between these two groups (P < 0.05), while peak systolic volume, flow to maintain, and pressure decay were not significantly different. An RI cutoff of <0.80 was found to identify all patients who would later develop ED and fail primary repair without IPP. Penile vascular assessment can aid in counseling patients about their risk of developing delayed ED after primary repair of PD. In our cohort of patients, PDU provided preoperative risk stratification for postoperative erectile dysfunction in men undergoing Peyronie's repair without IPP. We propose the prospective study of an RI cutoff to identify patients at risk of failing primary PD repair without IPP.

16 CFR § 1117.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Definitions. (a) Small part means any part, component, or piece of a toy or game, which, when tested in... term “ball” includes any spherical, ovoid, or ellipsoidal object that is designed or intended to be... consisting of a latex bag that is designed to be inflated by air or gas. The term does not include inflatable...

16 CFR 1117.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Definitions. (a) Small part means any part, component, or piece of a toy or game, which, when tested in... term “ball” includes any spherical, ovoid, or ellipsoidal object that is designed or intended to be... consisting of a latex bag that is designed to be inflated by air or gas. The term does not include inflatable...

16 CFR 1117.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Definitions. (a) Small part means any part, component, or piece of a toy or game, which, when tested in... term “ball” includes any spherical, ovoid, or ellipsoidal object that is designed or intended to be... consisting of a latex bag that is designed to be inflated by air or gas. The term does not include inflatable...

16 CFR 1117.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Definitions. (a) Small part means any part, component, or piece of a toy or game, which, when tested in... term “ball” includes any spherical, ovoid, or ellipsoidal object that is designed or intended to be... consisting of a latex bag that is designed to be inflated by air or gas. The term does not include inflatable...

[Peyronie's disease: state of the art and future perspectives].

PubMed

Gulino, G; Sasso, F; Falabella, R; Racioppi, M; Sacco, E; D'Onofrio, A; Bassi, P F

2007-01-01

Peyronie's disease (PD) is characterized by the onset of a fibrous plaque within the tunica albuginea of the penile corpora cavernosa, resulting in pain and bending during the erection, which can make the intercourse difficult or impossible. Evidence from literature supports the autoimmune etiology of PD, and suggests genetic and familiar conditions, penile traumatisms and history of genital tract diseases as risk factors, even though no definitive conclusions arise about the pathogenesis of the disease. Few randomized trials demonstrated that medical therapies, such as Vitamin E, Colchicine, Potassium amminobenzoate, Tamoxifen and injection therapy with Verapamil are effective in stabilizing the acute phase of the disease. Extracorporeal shock wave therapy (ESWT) and ionophoresis cannot be considered as first line or gold standard therapies. Satisfactory results have been published about Nesbit operation in large number of cases with low-stage disease, whereas plication procedures have shown significant rates of relapse. High incidence of long-term penile retraction have been reported in high-stage disease treated with plaque incision and simple graft insertion. Malleable, soft or inflatable prostheses combined with graft implant have given the best results in terms of penile straightening and lengthening and patients' satisfaction. In conclusion, the PD etiopathogenesis hasn't been clearly understood-yet, no medical therapy is fully effective; surgery remains therefore the gold standard in case of severe deformity and/or erectile dysfunction.

Assessment of psychosexual adjustment after insertion of inflatable penile prosthesis.

PubMed

Tefilli, M V; Dubocq, F; Rajpurkar, A; Gheiler, E L; Tiguert, R; Barton, C; Li, H; Dhabuwala, C B

1998-12-01

To evaluate the psychosexual benefit obtained from multicomponent penile implant surgery in patients with erectile dysfunction. A psychosexual questionnaire was given to 35 patients undergoing penile prosthesis implantation before surgery and at 3 months, 6 months, and 1 year after surgery. The questionnaire consisted of 13 questions scored on a scale from 1 through 5. Results of the questionnaire were statistically analyzed for differences among the preoperative, 3-month postoperative, 6-month postoperative, and 1-year postoperative period. The general linear model evaluation showed a significant difference for each overall combination of the following pairs: preoperative versus 3 months postoperative (P=0.0005) and 3 months postoperative versus 6 months postoperative (P=0.002). There was no overall difference between psychosexual total score at 6 months after surgery and 1 year after prosthesis implantation (P=0.85). The patients perceived improvement in their erectile ability and libido. Concern about obtaining and maintaining an erection during intercourse was significantly alleviated. There was an increase in the frequency of sexual activity and an improvement in satisfaction with sex life. A decrease in feelings of sadness, depression, anxiety, anger, frustration, and embarrassment related to sexual activity was also noted. The current study demonstrates significant improvement in the psychosexual well being of multicomponent penile implant recipients, with attainment of a high level of patient satisfaction up to 1 year after surgery.

Non-Abelian S-term dark energy and inflation

NASA Astrophysics Data System (ADS)

Rodríguez, Yeinzon; Navarro, Andrés A.

2018-03-01

We study the role that a cosmic triad in the generalized SU(2) Proca theory, specifically in one of the pieces of the Lagrangian that involves the symmetric version Sμν of the gauge field strength tensor Fμν, has on dark energy and primordial inflation. Regarding dark energy, the triad behaves asymptotically as a couple of radiation perfect fluids whose energy densities are negative for the S term but positive for the Yang-Mills term. This leads to an interesting dynamical fine-tuning mechanism that gives rise to a combined equation of state parameter ω ≃ - 1 and, therefore, to an eternal period of accelerated isotropic expansion for an ample spectrum of initial conditions. Regarding primordial inflation, one of the critical points of the associated dynamical system can describe a prolonged period of isotropic slow-roll inflation sustained by the S term. This period ends up when the Yang-Mills term dominates the energy density leading to the radiation dominated epoch. Unfortunately, in contrast to the dark energy case, the primordial inflation scenario is strongly sensitive to the coupling constants and initial conditions. The whole model, including the other pieces of the Lagrangian that involve Sμν, might evade the recent strong constraints coming from the gravitational wave signal GW170817 and its electromagnetic counterpart GRB 170817A.

Long-term Treatment Outcomes Between Surgical Correction and Conservative Management for Penile Fracture: Retrospective Analysis.

PubMed

Yamaçake, Kleiton Gabriel Ribeiro; Tavares, Alessandro; Padovani, Guilherme Philomeno; Guglielmetti, Giuliano Betoni; Cury, José; Srougi, Miguel

2013-07-01

Early surgical management is the standard of care for penile fracture. Conservative treatment is an option with recent reports revealing lower success rates. We reviewed the data and long-term outcomes of patients with penile injury submitted to surgical or conservative treatment. Between January 2004 and February 2012, 42 patients with penile blunt trauma on an erect penis were admitted to our center. We analyzed the following variables: age, etiology, symptoms and signs, diagnostic tests, treatment used, complications and erectile function during the follow-up. One patient was excluded due to missing information. Thirty-five patients underwent surgical repair and 6 patients were submitted to conservative management. Mean follow-up was 19.2 months (range, 7 days to 72 months). The mean elapsed time from trauma to surgery was 21.3±12.5 hours. Trauma during sexual relationship was the main cause (80.9%) of penile fracture. Urethral injury was present in five patients submitted to surgery. Dorsal vein injury occurred in three patients with false penile fracture and concomitant spongious corpus lesion was present in three patients. During follow-up, 31 cases (88.6%) of the surgical group and four cases (66.7%) of the conservative group reported sufficient erections for intercourse, with no voiding dysfunction and no penile curvature. However, the remaining two patients (33.3%) from the conservative group developed erectile dysfunction and three patients (50%) developed penile deviation. Surgical approach provides excellent functional outcomes and lower complications. Early surgical management of penile fracture provides superior results and conservative approach should be avoided.

Long-term Treatment Outcomes Between Surgical Correction and Conservative Management for Penile Fracture: Retrospective Analysis

PubMed Central

Tavares, Alessandro; Padovani, Guilherme Philomeno; Guglielmetti, Giuliano Betoni; Cury, José; Srougi, Miguel

2013-01-01

Purpose Early surgical management is the standard of care for penile fracture. Conservative treatment is an option with recent reports revealing lower success rates. We reviewed the data and long-term outcomes of patients with penile injury submitted to surgical or conservative treatment. Materials and Methods Between January 2004 and February 2012, 42 patients with penile blunt trauma on an erect penis were admitted to our center. We analyzed the following variables: age, etiology, symptoms and signs, diagnostic tests, treatment used, complications and erectile function during the follow-up. One patient was excluded due to missing information. Thirty-five patients underwent surgical repair and 6 patients were submitted to conservative management. Results Mean follow-up was 19.2 months (range, 7 days to 72 months). The mean elapsed time from trauma to surgery was 21.3±12.5 hours. Trauma during sexual relationship was the main cause (80.9%) of penile fracture. Urethral injury was present in five patients submitted to surgery. Dorsal vein injury occurred in three patients with false penile fracture and concomitant spongious corpus lesion was present in three patients. During follow-up, 31 cases (88.6%) of the surgical group and four cases (66.7%) of the conservative group reported sufficient erections for intercourse, with no voiding dysfunction and no penile curvature. However, the remaining two patients (33.3%) from the conservative group developed erectile dysfunction and three patients (50%) developed penile deviation. Conclusions Surgical approach provides excellent functional outcomes and lower complications. Early surgical management of penile fracture provides superior results and conservative approach should be avoided. PMID:23878691

Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin.

PubMed

Wilson, S K; Carson, C C; Cleves, M A; Delk, J R

1998-05-01

Elevation of glycosylated hemoglobin above levels of 11.5 mg.% has been considered a contraindication to penile prosthesis implantation in diabetic patients. We determine the predictive value of glycosylated hemoglobin A1C in penile prosthesis infections in diabetic and nondiabetic patients to confirm or deny this prevalent opinion. We conducted a 2-year prospective study of 389 patients, including 114 diabetics, who underwent 3-piece penile prosthesis implantation. All patients had similar preoperative preparation without regard to diabetic status, control or glycosylated hemoglobin A1C level. Risk of infection was statistically analyzed for diabetics versus nondiabetics, glycosylated hemoglobin A1C values above and below 11.5 mg.%, insulin dependent versus oral medication diabetics, and fasting blood sugars above and below 180 mg.%. Prosthesis infections developed in 10 diabetics (8.7%) and 11 nondiabetics (4.0%). No increased infection rate was observed in diabetics with high fasting sugars or diabetics on insulin. There was no statistically significant increased infection risk with increased levels of glycosylated hemoglobin A1C among all patients or among only the diabetics. In fact, there was no meaningful difference in the median or mean level of glycosylated hemoglobin A1C in the infected and noninfected patients regardless of diabetes. Use of glycosylated hemoglobin A1C values to identify and exclude surgical candidates with increased risk of infections is not proved by this study. Elevation of fasting sugar or insulin dependence also does not increase risk of infection in diabetics undergoing prosthesis implantation.

The Mulcahy Salvage: Past and Present Innovations.

PubMed

Mellon, Matthew J; Broghammer, Joshua R; Henry, Gerard D

2015-11-01

Inflatable penile implants are a mainstay for the surgical correction of erectile dysfunction. For the last 40 years they have provided reliable outcomes with durable patient satisfaction. Infection of the implant continues to remain the primary surgical concern, despite the advent of antibiotic-coated devices and improved skin preparation solutions. In this article, we review and evaluate the published literature for important contributions surrounding the various salvage techniques and washout strategies. In addition, the role of biofilm in prosthetic infection will be discussed. First described by Mulcahy for instances of device infection, the salvage or rescue procedure was established to avoid complete removal and staged replacement. This approach, with its avoidance of difficult revision surgery, penile shortening and patient discomfort, has produced success as high as 84%. Mulcahy's innovative approach at salvage or rescue reimplantation has proven to be a highly successful approach to this difficult surgical problem. Without question, the report of the long-term results of his salvage patients has directly influenced a generation of prosthetic surgeons. © 2015 International Society for Sexual Medicine.

Cancer of the penis associated with HIV: a report of three cases presenting at the CHU cocody, ivory coast.

PubMed

Konan, P G; Vodi, C C; Dekou, A H; Fofana, A; Gowé, E E; Manzan, K

2015-11-16

We describe three cases of advanced penile cancer associated with HIV infection. Advanced penile cancer associated with VIH infection were discovered in three patients aged respectively 47, 56 and 40. The prognosis was extremely poor. Two patients died without receiving any treatment and one patient was lost to follow-up after refusing all treatment proposed. There appears to be a link between HIV infection and penile cancer with concomitant HIV infection worsening the prognosis of the disease.

Penile prostheses and the litigious patient: a legal database review.

PubMed

Sunaryo, Peter L; Colaco, Marc; Terlecki, Ryan

2014-10-01

Erectile dysfunction (ED) is a common problem with significant impact on patient quality of life. Penile prosthesis implantation provides an effective treatment for ED but as an invasive procedure carries with it an increased risk of medicolegal liability. To investigate factors associated with malpractice litigation surrounding penile prosthesis implantation. The Westlaw legal database was used to perform an advanced search for case reports using the term "medical malpractice" in combination with "penile" or "penis" and "prosthesis" or "implant" with dates between the January 1990 and December 2013. Each report was examined for trial information including patient demographics, device model and indications, alleged breach of duty, alleged damages, progression to trial, case outcome, and plaintiff award(s). The initial search yielded 76 cases that were narrowed to 40 after exclusions. There were 23 (57.5%) cases that were found in favor of the defendant, while 17 (42.5%) cases led to indemnity payment to the plaintiff including two cases (5.0%) that were settled out of court and 15 (37.5%) favoring the plaintiff in front of a jury. The mean settlement received was $335,500 compared with the mean indemnity award of $831,050 for verdicts decided in favor of the plaintiff (P = 0.68). The most common breach of duty was error in surgical decision making, present in 20 cases (48.8%). Informed consent was an issue in 13 filings (31.7%), and postoperative infection was seen in 13 cases (31.7%). In cases that identified the type of implant used, 58.3% were malleable implants, and 41.7% were inflatable devices. The main issues involved in malpractice litigation for penile prosthesis implants included surgical performance, informed consent, and postoperative management. Urologists must be aware of these potential issues in order to minimize their malpractice liability. © 2014 International Society for Sexual Medicine.

Penile sclerosing lipogranulomas and disfigurement from use of "1Super Extenze" among Laotian immigrants.

PubMed

Manny, Ted; Pettus, Joseph; Hemal, Ashok; Marks, Malcolm; Mirzazadeh, Majid

2011-12-01

Subcutaneous penile injection of various oils for penile augmentation has been described among men in Laos. We have now treated three Laotian immigrants with penile disfigurement secondary to sclerosing lipogranulomas, also known as paraffinoma, induced by injection of a mineral oil compound marketed as "1Super Extenze," which they purchased in the United States. This series describes the clinical course and management of complications associated with the use of "1Super Extenze" in three Laotian men. Surgeons excised all grossly affected tissue and performed reconstruction using skin grafting, Z-plasty, and tissue advancement, respectively. Tissue from the penile shaft of each patient and a local lymph node in one patient was examined microscopically. Mass spectroscopy was performed on an aliquot of "1Super Extenze." Urinary function, sexual function, and cosmesis of the three reported cases, chemical composition of "1Super Extenze," and microscopic analysis of penile and regional lymphatic tissue. Short-term cosmetic and functional outcomes were acceptable after surgical intervention. Histologic findings consistent with sclerosing lipogranulomas were seen in specimens from affected subcutaneous and lymphatic tissue. "1Super Extenze" proved to be composed of mineral oil with tocopherol acetate (vitamin E). Injection of "1Super Extenze" into the penile shaft results in sclerosing lipogranulomas, which can cause severe sexual and urinary complications. Surgical resection of all grossly involved tissue with appropriate reconstruction can mitigate these problems. This series supports previous recommendations in the literature that men should avoid the use of non-medical foreign bodies and fillers as means of penile augmentation. © 2010 International Society for Sexual Medicine.

Characterization of bulbospongiosus muscle reflexes activated by urethral distension in male rats.

PubMed

Tanahashi, Masayuki; Karicheti, Venkateswarlu; Thor, Karl B; Marson, Lesley

2012-10-01

The urethrogenital reflex (UGR) is used as a surrogate model of the autonomic and somatic nerve and muscle activity that accompanies ejaculation. The UGR is evoked by distension of the urethra and activation of penile afferents. The current study compares two methods of elevating urethral intraluminal pressure in spinalized, anesthetized male Sprague-Dawley rats (n = 60). The first method, penile extension UGR, involves extracting the penis from the foreskin, so that urethral pressure rises due to a natural anatomical flexure in the penis. The second method, penile clamping UGR, involves penile extension UGR with the addition of clamping of the glans penis. Groups of animals were prepared that either received no additional treatment, surgical shams, or received bilateral nerve cuts (4 nerve cut groups): either the pudendal sensory nerve branch (SbPN), the pelvic nerves, the hypogastric nerves, or all three nerves. Penile clamping UGR was characterized by multiple bursts, monitored by electromyography (EMG) of the bulbospongiosus muscle (BSM) accompanied by elevations in urethral pressure. The penile clamping UGR activity declined across multiple trials and eventually resulted in only a single BSM burst, indicating desensitization. In contrast, the penile extension UGR, without penile clamping, evoked only a single BSM EMG burst that showed no desensitization. Thus, the UGR is composed of two BSM patterns: an initial single burst, termed urethrobulbospongiosus (UBS) reflex and a subsequent multiple bursting pattern (termed ejaculation-like response, ELR) that was only induced with penile clamping urethral occlusion. Transection of the SbPN eliminated the ELR in the penile clamping model, but the single UBS reflex remained in both the clamping and extension models. Pelvic nerve (PelN) transection increased the threshold for inducing BSM activation with both methods of occlusion but actually unmasked an ELR in the penile extension method. Hypogastric nerve (HgN) cuts did not significantly alter any parameter. Transection of all three nerves eliminated BSM activation completely. In conclusion, penile clamping occlusion recruits penile and urethral primary afferent fibers that are necessary for an ELR. Urethral distension without significant penile afferent activation recruits urethral primary afferent fibers carried in either the pelvic or pudendal nerve that are necessary for the single-burst UBS reflex.

Artificial urinary sphincter

PubMed Central

Martins, Francisco E.

2017-01-01

Although currently still the gold standard treatment for post-prostatectomy urinary incontinence, the artificial urinary sphincter (AUS) (AMS800) is an invasive procedure with associated risks factors. In this paper, we aim to outline what the scientific literature and what we personally believe are the factors that are useful and/or necessary to mitigate these risks, including both patient factors and surgeon factors. We also review special populations, including transcorporal (TC) AUS approach, AUS with inflatable penile prosthesis, AUS after male urethral sling, AUS erosion management, and AUS after orthotopic urinary diversion. PMID:28904901

Sustained versus intermittent lung inflation for resuscitation of preterm infants: a randomized controlled trial.

PubMed

El-Chimi, Mohamed S; Awad, Hisham A; El-Gammasy, Tarek M; El-Farghali, Ola G; Sallam, Mohamed T; Shinkar, Dina M

2017-06-01

To evaluate efficacy and safety of delivery room (DR) sustained lung inflation (SLI) in resuscitation of preterm neonates. Randomized Controlled Trial including 112 preterm infants randomized to either SLI (n = 57) using T-piece resuscitator [maximum three inflations with maximum pressure of 30 cmH 2 O for 15 s followed by continuous positive airway pressure (CPAP) of 5-7 cmH 2 O] or conventional bag/mask inflation (CBMI) (n = 55) using traditional self-inflating bag (maximum pressure of 40 cmH 2 O at a rate of 40-60 per min). Failure was defined as the need for DR or first 72 h intubation. Cord and 2-h post-resuscitation blood samples were collected to measure interleukin (IL)-1β and tumor necrosis factor-α levels before and after intervention. SLI was associated with significantly higher success rate compared to CBMI [75.4 versus 54.5%; p = 0.017], lower need for DR intubation [5.3% versus 23.6%; (X 2  =   7.7; p = 0.005)], higher 5-min-Apgar score (median 8 versus 7; p = 0.018), shorter duration on nasal-CPAP (p = 0.017), and non-significantly different air leak (7% versus 11%; p = 0.3) and bronchopulmonary dysplasia rates among survivors (2% versus 11%; p = 0.09). Post-resuscitation IL-1β plasma levels increased significantly in CBMI (p = 0.009) and not in SLI group. Delivery room SLI is more effective than intermittent bag and mask inflation for improving short-term respiratory outcome in preterm infants, without significant adverse effects.

Penile Prosthesis Surgery: Current Recommendations From the International Consultation on Sexual Medicine.

PubMed

Levine, Laurence A; Becher, Edgardo; Bella, Anthony; Brant, William; Kohler, Tobias; Martinez-Salamanca, Juan Ignacio; Trost, Landon; Morey, Allen

2016-04-01

Penile prosthesis implantation has emerged as a definitive treatment to restore sexual function to the motivated man with erectile dysfunction. Substantial improvements in the design of inflatable devices have been made since they first became available more than four decades ago. To review the history of the penile prosthesis, the indications, preoperative evaluation, and patient and partner satisfaction. The current approaches to addressing intra- and postoperative complications, provide an understanding of prosthesis infection, and placement of these devices will be reviewed. A committee of worldwide experts in this field was assembled during the 2015 International Consultation on Sexual Medicine (ICSM) and performed a systematic review of the peer-reviewed published medical literature pertaining to penile prosthesis. Particular attention was given to higher level trials when available. Recommendations are based upon the Oxford Criteria. Unfortunately there is limited level 1 and 2 evidence, and where expert opinion was utilized, the decision was unanimous within the committee with a goal of presenting a clinically relevant guideline pertaining to penile prostheses. Penile prosthesis has undergone an evolution over the past 40 years resulting in a more effective and reliable treatment for advanced erectile dysfunction not responding to less invasive methods including oral treatment with PDE5 inhibitors, vacuum erection device, and intracorporal injection therapy. It should be considered an appropriate treatment option for the man who wishes to restore erectile function and who understands the potential risk of mechanical failure and infection, both of which are less common now as a result of improvements made in device design as well as surgical protocols adhered to in the operating room. Patients must be clearly informed of the risks associated with penile prosthesis including mechanical failure, infection, shortening of the penis, change in sensation and configuration of the penis, as well as injury to local structures. Intraoperative complications are unusual but do occur and can usually be addressed intraoperatively to allow placement of the device at the time of initial surgery. Postoperative complications may also be addressed when they occur but may require more advanced reconstructive surgical techniques. Men with Peyronie's disease, corporal fibrosis due to infection, trauma, prior prosthesis explantation, priapism, and men who have undergone construction of a neophallus may require additional advanced maneuvers to obtain optimum results with a penile prosthesis. Penile prosthesis remains as an important, viable, and effective treatment for male erectile dysfunction that does not respond to other less invasive approaches or when these approaches are contraindicated or not acceptable to the patient. These devices provide the patient with the ability to engage in penetrative sexual activity without interfering with urination, ejaculation, sensation, or orgasm. Although mechanical failure can occur, the current devices are more reliable as a result of design modifications. Infection remains the most dreaded complication but since the introduction of antibiotic and hydrophilic coatings, infection is less common. Overall, patient and partner satisfaction appear to be reasonably high when a penile prosthesis is used to restore erectile function. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Myriad presentations of penile fracture: report of three cases and review of literature

PubMed Central

Faridi, M. S.; Agarwal, Nitin; Saini, Pradeep; Kaur, Navneet; Gupta, Arun

2015-01-01

Penile fracture is an unusual though not a rare condition but underreported. It is defined classically as the disruption of the tunica albuginea with rupture of the corpus cavernosum. Penile fracture can be misdiagnosed with rupture of corpus spongiosum clinically. Therefore, we are presenting three cases due to its varied clinical presentation and management. In first patient, there was a tear in the corpus spongiosum and a partial tear in the ventral urethra. Both defects were repaired with interrupted sutures. In the second patient, there was a rupture of corpus cavernosum, which was primarily repaired. After 1-year of primary surgery, patient again came with similar complaints, and diagnosis of scar dehiscence was made. Patient was treated conservatively with satisfactory results on follow-up. Third patient came with a history of 1-week. Intra-operative findings revealed only hematoma without any defect in corpora cavernosum, corpus spongiosum, and urethra. Only evacuation of hematoma was done. Early surgical treatment of penile fracture is advantageous. In recurrent penile fracture, if no penile deformity or any reasonable clinical and radiological evidence, then conservative management is advocated. Even when presentation is delayed up to 1-week, operative management has shown good results. PMID:25949981

Myriad presentations of penile fracture: report of three cases and review of literature.

PubMed

Faridi, M S; Agarwal, Nitin; Saini, Pradeep; Kaur, Navneet; Gupta, Arun

2015-01-01

Penile fracture is an unusual though not a rare condition but underreported. It is defined classically as the disruption of the tunica albuginea with rupture of the corpus cavernosum. Penile fracture can be misdiagnosed with rupture of corpus spongiosum clinically. Therefore, we are presenting three cases due to its varied clinical presentation and management. In first patient, there was a tear in the corpus spongiosum and a partial tear in the ventral urethra. Both defects were repaired with interrupted sutures. In the second patient, there was a rupture of corpus cavernosum, which was primarily repaired. After 1-year of primary surgery, patient again came with similar complaints, and diagnosis of scar dehiscence was made. Patient was treated conservatively with satisfactory results on follow-up. Third patient came with a history of 1-week. Intra-operative findings revealed only hematoma without any defect in corpora cavernosum, corpus spongiosum, and urethra. Only evacuation of hematoma was done. Early surgical treatment of penile fracture is advantageous. In recurrent penile fracture, if no penile deformity or any reasonable clinical and radiological evidence, then conservative management is advocated. Even when presentation is delayed up to 1-week, operative management has shown good results.

A Preliminary Report on Combined Penoscrotal and Perineal Approach for Placement of Penile Prosthesis with Corporal Fibrosis

PubMed Central

Brusky, John P.; Tran, Viet Q.; Rieder, Jocelyn M.; Aboseif, Sherif R.

2008-01-01

Purpose. This paper aims at describing the combined penoscrotal and perineal approach for placement of penile prosthesis in cases of severe corporal fibrosis and scarring. Materials and methods. Three patients with extensive corporal fibrosis underwent penile prosthesis placement via combined penoscrotal and perineal approach from 1997 to 2006. Follow-up ranged from 15 to 129 months. Results. All patients underwent successful implantation of semirigid penile prosthesis. There were no short- or long-term complications. Conclusions. Results on combined penoscrotal and perineal approach to penile prosthetic surgery in this preliminary series of patients suggest that it is a safe technique and increases the chance of successful outcome in the surgical management of severe corporal fibrosis. PMID:19043562

A penal problem: the increasing incidence of implantation of penile foreign bodies.

PubMed

Flynn, Ryan M; Mostafa, Hesham I; Khan, Omar A; Haselhuhn, Gregory D; Jain, Samay

2014-12-01

Our objective is to describe a novel presentation of subcutaneous penile insertion of foreign bodies. This is a practice performed globally and mostly has been reported outside of the United States. We present three cases of incarcerated males that implanted sculpted dominos into the penile subcutaneous tissue. The patients presented with erosion of the foreign bodies through the skin without evidence of infection. We believe that insertion of foreign bodies into penile subcutaneous tissue by incarcerated American males for sexual enhancement is more widespread than previously reported. Erosion is a novel presentation.

Subcutaneous Penile Insertion of Domino Fragments by Incarcerated Males in Southwest United States Prisons: A Report of Three Cases

PubMed Central

Hudak, Steven J.; McGeady, James; Shindel, Alan W.; Breyer, Benjamin N.

2013-01-01

Introduction Self-insertion of penile foreign bodies is performed worldwide, largely due to a perception that it will enhance sexual performance and virility. There are relatively few cases reported in the United States. Aim We report three cases of Hispanic men incarcerated in separate southwest United States prisons who utilized a similar technique to insert foreign bodies fabricated out of dominos into the subcutaneous tissues of the penis. Methods Details of the three cases were retrospectively reviewed. Main Outcome Measure Resolution of the case. Results In each case, an incarcerated Hispanic male or fellow inmate filed a domino into a unique shape for placement under the penile skin. Utilizing the tip of a ballpoint pen or a sharpened shard of plastic to create a puncture wound, each man inserted the domino fragment into the subcutaneous tissue of the penis. All three men presented with infection requiring operative removal. Conclusions Incarcerated males put themselves at risk for injury and infection when attempting penile enhancement with improvised equipment. PMID:22081893

Subcutaneous penile insertion of domino fragments by incarcerated males in southwest United States prisons: a report of three cases.

PubMed

Hudak, Steven J; McGeady, James; Shindel, Alan W; Breyer, Benjamin N

2012-02-01

Self-insertion of penile foreign bodies is performed worldwide, largely due to a perception that it will enhance sexual performance and virility. There are relatively few cases reported in the United States. We report three cases of Hispanic men incarcerated in separate southwest United States prisons who utilized a similar technique to insert foreign bodies fabricated out of dominos into the subcutaneous tissues of the penis. Details of the three cases were retrospectively reviewed. Resolution of the case. In each case, an incarcerated Hispanic male or fellow inmate filed a domino into a unique shape for placement under the penile skin. Utilizing the tip of a ballpoint pen or a sharpened shard of plastic to create a puncture wound, each man inserted the domino fragment into the subcutaneous tissue of the penis. All three men presented with infection requiring operative removal. Incarcerated males put themselves at risk for injury and infection when attempting penile enhancement with improvised equipment. © 2011 International Society for Sexual Medicine.

Flutamide-induced hypospadias in rats: A critical assessment.

PubMed

Sinclair, Adriane Watkins; Cao, Mei; Pask, Andrew; Baskin, Laurence; Cunha, Gerald R

This paper provides the first detailed description of flutamide-induced hypospadias in the rat based upon wholemount, histologic, three-dimensional reconstruction, scanning electron microscopic, and immunocytochemical analysis. The penile malformations elicited by this potent anti-androgen include a substantial proximal shift in the urethral meatus that clearly conforms to the definition of hypospadias based upon specific morphological criteria for this malformation. Through examination of the normal penile development and flutamide-induced abnormal penile development observed in prenatally oil- and flutamide-treated rats, our analysis provides insights into the morphogenetic mechanism of development of hypospadias. In this regard, a common theme in normal penile development is midline fusion of epithelia followed by removal of the epithelial seam and establishment of midline mesenchymal confluence during development of the penile urethra and prepuce, processes which are impaired as a result of prenatal flutamide treatment. The developmental processes occurring in normal penile development, through comparison with development of female external genitalia and those impaired due to prenatal flutamide treatment, are consistent with critical role of androgen receptors in normal penile development in the rat, and the specific penile abnormalities embodied in flutamide-induced rat hypospadias. Copyright © 2016 International Society of Differentiation. Published by Elsevier B.V. All rights reserved.

No evidence of depression, anxiety, and sexual dysfunction following penile fracture.

PubMed

Penbegul, N; Bez, Y; Atar, M; Bozkurt, Y; Sancaktutar, A A; Soylemez, H; Ozen, S

2012-01-01

There is a gap in the literature about psychological status of patients following penile fracture surgery. We aimed to assess the long-term psychological status of penile fracture patients who have been treated by immediate surgical repair. A total of 32 patients with penile fracture have been treated surgically at our center. These 32 patients and 30 healthy control subjects were included in the study. All participants have completed the Hospital Anxiety and Depression Scale (HADS), Glombok-Rust Inventory of Satisfaction Scale (GRISS), and the premature ejaculation diagnostic tool (PEDT). The mean age of patients was 30.4 years and the mean body mass index was 27.3 kg m(-2). Sexual intercourse was the most common cause of the fracture. Immediate surgical repair was performed in all cases using a circumferential subcoronal incision and none of the patients had urethral injury intraoperatively. All tears were unilateral with a mean size of 1.5 cm. Only two patients had superficial dorsal vein rupture. At the day of assessment, the mean time elapsed after penile trauma was 15.9±6.3 months (range: 6-23). Only three patients had complications due to penile fracture including minimal penile curvature, penile nodule, and penile pain during intercourse. The mean scores obtained from PEDT, HADS, and GRISS did not show any statistically significant difference between groups. Anxiety, depression, premature ejaculation, and sexual dyssatisfaction levels were similar in both penile fracture patients who underwent immediate surgical repair and healthy control subjects. Immediate surgical repair of corporal ruptures have not shown any harmful psychogenic sequelae on patients with penile fracture.

Trends in penile cancer: a comparative study between Australia, England and Wales, and the US.

PubMed

Sewell, James; Ranasinghe, Weranja; De Silva, Daswin; Ayres, Ben; Ranasinghe, Tamra; Hounsome, Luke; Verne, Julia; Persad, Raj

2015-01-01

To investigate and compare the trends in incidence and mortality of penile cancer between Australia, England and Wales, and the US, and provide hypotheses for these trends. Cancer registry data from 1982 to 2005 inclusive were obtained from Australia, England and Wales, and the United States. From these data, age-specific, -standardised and mortality:incidence ratios were calculated, and compared. The overall incidence of penile cancer in England and Wales (1.44 per 100,000 man-years) was higher than in Australia (0.80 per 100,000), and the US (0.66 per 100,000). Incidence of penile cancer in all three countries has remained relatively stable over time. Similarly, although the mortality rates were also higher in England and Wales (0.37 per 100,000 man-years) compared to Australia (0.18 per 100,000) and the US (0.15 per 100,000), the mortality/incidence ratios were similar for all three countries. Penile cancer incidence is low, affecting mainly older men. Rates differ between the three countries, being twice as common in England and Wales as in the other studied regions. Circumcision rates have a potential influence on these rates but are not the sole explanation for the variation.

Penile fracture at LAUTECH Teaching Hospital, Osogbo.

PubMed

Aderounmu, A O A; Salako, A A; Olatoke, S A; Eziyi, A K; Agodinrin, O

2009-09-01

We have seen three cases of penile fracture presenting in diverse ways in our teaching hospital. We want to highlight the difficulties of management when patients present late. Three case reports of young men whose ages range between 22-32 years and who presented at 1 year 6 months, four weeks, and 3 hours respectively, following penile fracture. The patient that presented within 3 hours had immediate exploration and primary repair with good results while the one that presented after four weeks is still being followed up. The patient that presented very late has been lost to follow up after he was told that he would require surgery. Early surgical intervention in penile trauma still gives the best result and is hereby advocated. Decision to operate or not should also be based on the empirical finding of size of tear if there is no associated urethra injury.

The Outcome of Multiple Slit on Plaque with Plication Technique for the Treatment of Peyronie's Disease

PubMed Central

Shin, Su Hwan; Jeong, Hyeong Guk; Park, Jong Jin; Chae, Ji Yun; Kim, Jong Wook; Oh, Mi Mi; Park, Hong Seok; Kim, Je Jong

2016-01-01

Purpose To evaluate the postoperative outcome of the multiple slit on plaque plication technique for the treatment of Peyronie's disease. Materials and Methods We retrospectively evaluated 22 patients who underwent plaque incision with penile plication for the surgical treatment of Peyronie's disease, who had failed medical treatment between 2009 and 2014. Patients were grouped by preoperative degree of penile curvature into Group I: mild (n=5, 22.7%), Group II: moderate (n=11, 50.0%), and Group III: severe (n=6, 27.3%). After a thorough review of the medical records, we evaluated (a) the correction of the curvature; (b) sexual function; and (c) any penile shortening or other complications. Results The mean postoperative follow-up period was 39 months. Complete correction of the curvature was attained in 21 patients (95.5%). As an inevitable complication, minimal penile shortening (<1.5 cm) was reported by 14 patients (82.4%) but did not adversely affect sexual intercourse (0%), and all patients found the extent of penile shortening to be acceptable. Nineteen patients had good erectile function (International Index of Erectile Function >21). The most frequent complication was subcutaneous penile edema in three patients (13.6%), which was resolved within about 3 months following surgery. Conclusions As a modified technique, multiple slit on plaque with plication is a simple, minimally-invasive and effective technique for correcting penile curvature regardless of curvature severity. The degree of penile curvature does not significantly predict the amount of penile length loss. PMID:27169125

Dorsal Phalloplasty to Preserve Penis Length after Penile Prosthesis Implantation

PubMed Central

Shaeer, Osama; Shaeer, Kamal; Rahman, Islam A.

2017-01-01

Objectives Following penile prosthesis implantation (PPI), patients may complain of a decrease in visible penis length. A dorsal phalloplasty defines the penopubic junction by tacking pubic skin to the pubis, revealing the base of the penis. This study aimed to evaluate the efficacy of a dorsal phalloplasty in increasing the visible penis length following PPI. Methods An inflatable penile prosthesis was implanted in 13 patients with severe erectile dysfunction (ED) at the Kamal Shaeer Hospital, Cairo, Egypt, from January 2013 to May 2014. During the surgery, nonabsorbable tacking sutures were used to pin the pubic skin to the pubis through the same penoscrotal incision. Intraoperative penis length was measured before and after the dorsal phalloplasty. Overall patient satisfaction was measured on a 5-point rating scale and patients were requested to subjectively compare their postoperative penis length with memories of their penis length before the onset of ED. Results Intraoperatively, the dorsal phalloplasty increased the visible length of the erect penis by an average of 25.6%. The average length before and after tacking was 10.2 ± 2.9 cm and 13.7 ± 2.8 cm, respectively (P <0.002). Postoperatively, seven patients (53.8%) reported a longer penis, five patients (38.5%) reported no change in length and one patient (7.7%) reported a slightly shorter penis. The mean overall patient satisfaction score was 4.9 ± 0.3. None of the patients developed postoperative complications. Conclusion A dorsal phalloplasty during PPI is an effective method of increasing visible penis length, therefore minimising the impression of a shorter penis after implantation. PMID:28417025

Effect of penile-extender device in increasing penile size in men with shortened penis: preliminary results.

PubMed

Nikoobakht, Mohammadreza; Shahnazari, Alireza; Rezaeidanesh, Maedeh; Mehrsai, Abdolrasoul; Pourmand, Gholamreza

2011-11-01

It has been suggested that the application of penile-extender devices increases penile length and circumference. However, there are a few scientific studies in this field. The aim of this study was to assess the efficacy of a penile-extender (Golden Erect(®) , Ronas Tajhiz Teb, Tehran, Iran) in increasing penile size. This prospective study was performed on subjects complaining about "short penis" who were presented to our clinic between September 15, 2008 and December 15, 2008. After measuring the penile length in flaccid and stretched forms and penile circumference, patients were instructed to wear Golden Erect(®) , 4-6 hours per day during the first 2 weeks and then 9 hours per day until the end of the third month. The subjects were also trained how to increase the force of the device during determined intervals. The patients were visited at the end of the first and third months, and penile length and circumference were measured and compared with baseline. The primary end point of the study was changes in flaccid and stretched penile lengths compared with the baseline size during the 3 months follow-up. Twenty-three cases with a mean age of 26.5 ± 8.1 years entered the study. The mean flaccid penile length increased from 8.8 ± 1.2 cm to 10.1 ± 1.2 cm and 10.5 ± 1.2 cm, respectively, in the first and third months of follow-up, which was statistically significant (P < 0.05). Mean stretched penile length also significantly increased from 11.5 ± 1.0 cm to, respectively, 12.4 ± 1.3 cm and 13.2 ± 1.4 cm during the first and second follow-up (P < 0.05). No significant difference was found regarding proximal penile girth. However, it was not the same regarding the circumference of the glans penis (9.3 ± 0.86 cm vs. 8.8 ± 0.66 cm, P < 0.05). Our findings supported the efficacy of the device in increasing penile length. Our result also suggested the possibility of glans penis girth enhancement using penile extender. Performing more studies is recommended. © 2010 International Society for Sexual Medicine.

[Penile injury caused by a Moulinette. Result of autoerotic self-mutilation].

PubMed

Lehsnau, M

2007-07-01

Autoerotic manipulations of external male genitals resulting in mutilation with different degrees of severity are rare. We report the clinical case of a 12-year-old boy who injured his glans, left corpus cavernosum and corpus spongiosum with opened urethra as a consequence of autoerotic genital self-mutilation. According to our knowledge of the current literature this is the first description of autoerotic genital self-mutilation with a Moulinette. A Moulinette is a kitchen tool with an electric engine and an extremely fast rotary double knife, which is used to reduce food into small pieces, especially vegetables and fruits.

The World Health Organisation 2016 classification of penile carcinomas: a review and update from the International Society of Urological Pathology expert-driven recommendations.

PubMed

Cubilla, Antonio L; Velazquez, Elsa F; Amin, Mahul B; Epstein, Jonathan; Berney, Daniel M; Corbishley, Cathy M

2018-05-01

The International Society of Urological Pathology (ISUP) held an expert-driven penile cancer conference in Boston in March 2015, which focused on the new World Health Organisation (WHO) classification of penile cancer: human papillomavirus (HPV)-related tumours and histological grading. The conference was preceded by an online survey of the ISUP members, and the results were used to initiate discussions. Because of the rarity of penile tumours, this was not a consensus but an expert-driven conference aimed at assisting pathologists who do not see these tumours on a regular basis. After a justification for the novel separation of penile squamous cell carcinomas into HPV-related and non-HPV-related-carcinomas, the histological classification of penile carcinoma was proposed; this system was also accepted subsequently by the WHO for subtyping of penile carcinomas (2016). A description of HPV-related neoplasms, which may be recognised by their histological features, was presented, and p16 was recommended as a surrogate indicator of HPV. A three-tier grading system was recommended for penile squamous carcinomas; this was also adopted by the WHO (2016). Many of the distinctive histological subtypes of squamous cell carcinoma of the penis are associated with distinct grades, based on the squamous cell carcinoma subtype histological features. © 2017 John Wiley & Sons Ltd.

Three-Dimensional Photography for Quantitative Assessment of Penile Volume-Loss Deformities in Peyronie's Disease.

PubMed

Margolin, Ezra J; Mlynarczyk, Carrie M; Mulhall, John P; Stember, Doron S; Stahl, Peter J

2017-06-01

Non-curvature penile deformities are prevalent and bothersome manifestations of Peyronie's disease (PD), but the quantitative metrics that are currently used to describe these deformities are inadequate and non-standardized, presenting a barrier to clinical research and patient care. To introduce erect penile volume (EPV) and percentage of erect penile volume loss (percent EPVL) as novel metrics that provide detailed quantitative information about non-curvature penile deformities and to study the feasibility and reliability of three-dimensional (3D) photography for measurement of quantitative penile parameters. We constructed seven penis models simulating deformities found in PD. The 3D photographs of each model were captured in triplicate by four observers using a 3D camera. Computer software was used to generate automated measurements of EPV, percent EPVL, penile length, minimum circumference, maximum circumference, and angle of curvature. The automated measurements were statistically compared with measurements obtained using water-displacement experiments, a tape measure, and a goniometer. Accuracy of 3D photography for average measurements of all parameters compared with manual measurements; inter-test, intra-observer, and inter-observer reliabilities of EPV and percent EPVL measurements as assessed by the intraclass correlation coefficient. The 3D images were captured in a median of 52 seconds (interquartile range = 45-61). On average, 3D photography was accurate to within 0.3% for measurement of penile length. It overestimated maximum and minimum circumferences by averages of 4.2% and 1.6%, respectively; overestimated EPV by an average of 7.1%; and underestimated percent EPVL by an average of 1.9%. All inter-test, inter-observer, and intra-observer intraclass correlation coefficients for EPV and percent EPVL measurements were greater than 0.75, reflective of excellent methodologic reliability. By providing highly descriptive and reliable measurements of penile parameters, 3D photography can empower researchers to better study volume-loss deformities in PD and enable clinicians to offer improved clinical assessment, communication, and documentation. This is the first study to apply 3D photography to the assessment of PD and to accurately measure the novel parameters of EPV and percent EPVL. This proof-of-concept study is limited by the lack of data in human subjects, which could present additional challenges in obtaining reliable measurements. EPV and percent EPVL are novel metrics that can be quickly, accurately, and reliably measured using computational analysis of 3D photographs and can be useful in describing non-curvature volume-loss deformities resulting from PD. Margolin EJ, Mlynarczyk CM, Muhall JP, et al. Three-Dimensional Photography for Quantitative Assessment of Penile Volume-Loss Deformities in Peyronie's Disease. J Sex Med 2017;14:829-833. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Methotrexate in the treatment of penile carcinoma.

PubMed

Sklaroff, R B; Yagoda, A

1980-01-15

Eight patients with epidermoid carcinoma of the penis received methotrexate, five with high-dose methotrexate, 250--1500 mg/m2 with citrovorum rescue Q 2--4 weeks, and three with low-dose methotrexate, 0.5--3.0 mg/kg weekly. Three (38%) patients achieved a complete or partial remission which persisted for 11, 3 and 2 months, respectively. Methotrexate appears to be an active agent in the treatment of advanced penile cancer.

Short-term results of incremental penile girth enhancement using liquid injectable silicone: words of praise for a change.

PubMed

Yacobi, Yacov; Tsivian, Alexander; Grinberg, Roman; Kessler, Oded

2007-05-01

To report our experience with penile girth augmentation using liquid injectable silicone. Between August 2003 and July 2006, 324 men (mean age 35 years, range 19-65 years) received a series of liquid silicone subcutaneous injections between the penile skin and the corpora cavernosa on the dorsal and lateral aspects of the penile shaft, under local anesthesia. Digital photographs taken pre- and post-procedure (n = 324), and penile contour measurements (n = 30) yielded objective results. Subjective results were derived from patient and partner testimony of satisfaction. Follow-up averaged 20 months (range 1-36 months). Three hundred and twenty-four procedures were primary augmentations. Most men (61%) were married, 7% were accompanied by their partners, and 93% were circumcised. The mean measured penile circumference was 9.5 cm (7.5-11.5 cm) pretreatment and 12.1 cm (10.3-15.3 cm) post-treatment (mean increase of 27% in circumference and 0.84 cm in diameter). Patient and partner satisfaction was already expressed after the first two treatments. Sexual activity could be resumed after 8 h. Complications (mild bruising) were easily resolved. Penile girth augmentation using liquid injectable silicone yields very satisfactory short-term results with no immediate or short-term complications.

The incidence of isolated penile torsion in North India: A study of 5,018 male neonates.

PubMed

Bhat, Amilal; Bhat, Mahakshit; Kumar, Vinay; Goyal, Suresh; Bhat, Akshita; Patni, Madhu

2017-10-01

Congenital penile torsion is a three-dimensional deformity with helical rotation of the distal corporal bodies with the penile crurae remaining fixed to the pubic rami. The first case of congenital penile torsion (hypospadias) was described in 1857. Isolated penile torsion is an under-reported anomaly. The reported incidence of isolated penile torsion is 1.7-27% and severe torsion is 0.7%. There are no studies available from Indian subcontinent on the incidence of isolated penile torque. The objective of this study was to determine the overall incidence of isolated penile torque in a north Indian population. A prospective study of deliveries of male children was conducted at our institute between April 2014 and June 2015. Penile torsion was measured using a small protractor either by the deviation of the median raphae or the direction of the meatus. Data were collected on the incidence of congenital isolated penile torsion, including the degree and direction (left or right) of torsion. Torsion was classified as mild (<450), moderate (450-900), and severe (>900). Statistical analysis was done using the chi-square test with variables of age and parity of the mother and weight of the child. There were 99 cases of isolated penile torque among 5018 male neonates assessed for penile torque. The incidence of isolated penile torque was 19.7 per 1000 births. The degree of torsion varied from 30 to 110° (average 51.46°). Seventy-nine percent (79%) of them had left side and 21% had right side torque (4:1). The degree of torsion was mild in 30%, with 20% having left side torque and 10% having right side torque (2:1). A moderate degree of torsion was seen in 69%: 84% of them had left torque and only 16% had right sided torque (5:1). Only one patient had severe left torque. The incidence of isolated congenital penile torsion was highest in the maternal age group of >30 years followed by the 26-30-year age group, and was lowest in 21-25 year age group. In multiparous women, the incidence of isolated congenital penile torsion was highest (2.54%), and it was lowest in primiparous women (1.36%). The incidence of isolated penile torsion was 1.97% and the left-to-right ratio was 3:1, but for moderate torque it was 5:1. There was a strong association between incidence of penile torque with the age of the mother (p = 0.012) and parity (p = 0.008) but not with the weight of the baby (p = 0.415). Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Low-Intensity Extracorporeal Shock Wave as a Novel Treatment for Erectile Dysfunction.

PubMed

Pan, Michael M; Raees, Ayman; Kovac, Jason R

2016-03-01

The paradigm of erectile dysfunction (ED) treatment was fundamentally altered following the introduction of oral phosphodiesterase type 5 inhibitors. Unfortunately, a significant number of men exhibit a suboptimal response and require additional management strategies. One of the novel, minimally invasive strategies being developed is low-intensity extracorporeal shock wave therapy. Used in the hope of delaying placement of an inflatable penile prosthesis, the final phase of ED treatment, low-intensity extracorporeal shock wave therapy is a unique application of an established technology that may hopefully one day expand the medical options for patients with ED. This commentary will highlight the physiology underlying this technique and summarize the most recent studies. © The Author(s) 2015.

Experimental investigation of the structural behavior of equine urethra.

PubMed

Natali, Arturo Nicola; Carniel, Emanuele Luigi; Frigo, Alessandro; Fontanella, Chiara Giulia; Rubini, Alessandro; Avital, Yochai; De Benedictis, Giulia Maria

2017-04-01

An integrated experimental and computational investigation was developed aiming to provide a methodology for characterizing the structural response of the urethral duct. The investigation provides information that are suitable for the actual comprehension of lower urinary tract mechanical functionality and the optimal design of prosthetic devices. Experimental activity entailed the execution of inflation tests performed on segments of horse penile urethras from both proximal and distal regions. Inflation tests were developed imposing different volumes. Each test was performed according to a two-step procedure. The tubular segment was inflated almost instantaneously during the first step, while volume was held constant for about 300s to allow the development of relaxation processes during the second step. Tests performed on the same specimen were interspersed by 600s of rest to allow the recovery of the specimen mechanical condition. Results from experimental activities were statistically analyzed and processed by means of a specific mechanical model. Such computational model was developed with the purpose of interpreting the general pressure-volume-time response of biologic tubular structures. The model includes parameters that interpret the elastic and viscous behavior of hollow structures, directly correlated with the results from the experimental activities. Post-processing of experimental data provided information about the non-linear elastic and time-dependent behavior of the urethral duct. In detail, statistically representative pressure-volume and pressure relaxation curves were identified, and summarized by structural parameters. Considering elastic properties, initial stiffness ranged between 0.677 ± 0.026kPa and 0.262 ± 0.006kPa moving from proximal to distal region of penile urethra. Viscous parameters showed typical values of soft biological tissues, as τ 1 =0.153±0.018s, τ 2 =17.458 ± 1.644s and τ 1 =0.201 ± 0.085, τ 2 = 8.514 ± 1.379s for proximal and distal regions respectively. A general procedure for the mechanical characterization of the urethral duct has been provided. The proposed methodology allows identifying mechanical parameters that properly express the mechanical behavior of the biological tube. The approach is especially suitable for evaluating the influence of degenerative phenomena on the lower urinary tract mechanical functionality. The information are mandatory for the optimal design of potential surgical procedures and devices. Copyright © 2017 Elsevier B.V. All rights reserved.

Penile fracture: long-term results of surgical and conservative management.

PubMed

Gamal, Wael M; Osman, Mahmoud M; Hammady, Ahmed; Aldahshoury, M Zaki; Hussein, Mohamed M; Saleem, Mohamed

2011-08-01

Penile fracture usually results from direct trauma to the erected penis. We evaluate the outcomes of surgical and conservative treatment. Between February 2000 and February 2007, 77 patients with mean age 29 ± 2.5 years (range, 20-57 years) with penile fracture were evaluated retrospectively. A total of 56 patients (group A) were treated with immediate surgical repair and 21 patients (group B) were treated conservatively as they refused surgical intervention. Data on erectile function and any penile sequel were obtained during follow-up using the International Index of Erectile Function (IIEF-15) questionnaire, local examination, and color Doppler ultrasonography reports. Only 69 patients were available for median follow-up period of 20.8 months (range, 17-30 months), 51 patients of the group A and 18 of the group B. Injury involved unilateral and bilateral corporeal rupture in 50 and 6 cases, respectively. Concomitant urethral injury was detected in three cases. During follow-up, 49 cases (96%) of the surgical group (A) and 9 cases (50%) of the conservative group (B) reported erection adequate for intercourse, with no voiding dysfunction and no penile curvature. However, the remaining nine patients (50%) from the conservative group (B) reported erectile dysfunction and penile deviation. Immediate surgical repair of the penile fracture gave good results and is superior to conservative treatment; however, we cannot distinguish false from true penile fracture accurately to determine on whom we can use the conservative treatment.

New perspectives of penile enhancement surgery: tissue engineering with biodegradable scaffolds.

PubMed

Perovic, Sava V; Byun, Jae-Sang; Scheplev, Peter; Djordjevic, Miroslav L; Kim, Jin-Hong; Bubanj, Tatjana

2006-01-01

To evaluate in a multicenter, prospective study preliminary aesthetic and functional results of autologous ex-vivo tissue engineering for penile girth enhancement. From July 1999 to January 2004, 204 men of mean age 26.77 (range 19-54 years) underwent this procedure. Indications for penile girth enhancement were penile dysmorphic disorder and previous failed surgery for penile girth enhancement. Fibroblast cells harvested from 1 cc of biopsied scrotal dermal tissue were expanded in culture until the total cell number of at least 2x10(7) was reached. Suspended cells in culture medium were then seeded on pretreated tube-shaped PLGA scaffolds and incubated for 24 hours. After penile degloving, scaffolds were shape adjusted and transplanted between dartos and Buck's fascia when the skin was compliant or under the neurovascular bundle when the skin was not compliant. A total of 84 randomly selected patients were followed 1 to 5 years postoperatively (median 24 months). The gain in girth ranged from 1.9 to 4.1cm (mean 3.15 cm). Postoperative complications occurred as infection in three, penile skin pressure necrosis in two and seroma formation in five patients and were all treated conservatively. Surgical intervention was appraised by patients on a scale from 1 to 5 as follows: the best mark (5) was given by 44.05%, very good (4) by 36.90%, good (3) by 19.05% and only one patient gave the mark 2 judging general penile appearance as dissatisfactory; mean score was 4.25. Autologous tissue engineering by using biodegradable scaffolds as a carrier is a new and safe therapeutic approach for penile girth enhancement. The outcome of this study points out the necessity for its expanded clinical applicability in the future.

Concealed epispadias associated with a buried penis.

PubMed

Sol Melgar, Ricardo; Gorduza, Daniela; Demède, Delphine; Mouriquand, Pierre

2016-12-01

The aim was to describe the clinical presentation and the surgical management of penile epispadias associated with a buried penis in five children. This is a 5-year retrospective review of patients presenting with a buried penis, a congenital defect of the penile skin shaft associated with an unretractable foreskin for whom a penile epispadias was found at the time of surgery. All had undergone surgery combining a Cantwell-Ransley procedure and refashioning of the penile skin following the authors' technique. Three children had a glanular epispadias and two had a midshaft epispadias. Four had a satisfactory outcome, and one required a complementary urethroplasty for glanular dehiscence. Buried penis and epispadias are usually isolated congenital anomalies, although they can be associated. It is therefore recommended to warn parents about the possibility of underlying penile anomaly in children with buried penises and unretractable foreskin. Careful palpation of the dorsum of the glans through the foreskin looking for a dorsal cleft could indicate an associated epispadiac urethra. Surgical correction of both anomalies can be done at the same time. Parents of boys with buried penises should be warned that underlying penile anomaly may exist. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

The effect of condoms on penile vibrotactile sensitivity thresholds in young, heterosexual men

PubMed Central

Hill, Brandon J.; Janssen, Erick; Kvam, Peter; Amick, Erick E.; Sanders, Stephanie A.

2013-01-01

Introduction Investigating the ways in which barrier methods such as condoms may affect penile sensory thresholds has potential relevance to the development of interventions in men who experience negative effects of condoms on sexual response and sensation. A quantitative, psychophysiological investigation examining the degree to which sensations are altered by condoms has, to date, not been conducted. Aim The objective of this study was to examine penile vibrotactile sensitivity thresholds in both flaccid and erect penises with and without a condom, while comparing men who do and those who do not report condom-associated erection problems (CAEP). Methods Penile vibrotactile sensitivity thresholds were assessed among a total of 141 young, heterosexual men using biothesiometry. An incremental two-step staircase method was used and repeated three times for each of four conditions. Intra-class correlation coefficients (ICC) were calculated for all vibratory assessments. Penile vibratory thresholds were compared using a mixed-model Analysis of Variance (ANOVA). Main Outcome Measures Penile vibrotactile sensitivity thresholds with and without a condom, erectile function measured by International Index of Erectile Function Questionnaire (IIEF), and self-reported degree of erection. Results Significant main effects of condoms (yes/no) and erection (yes/no) were found. No main or interaction effects of CAEP were found. Condoms were associated with higher penile vibrotactile sensitivity thresholds (F(1, 124)=17.11, p<.001). Penile vibrotactile thresholds were higher with an erect than with a flaccid penis (F(1, 124)=4.21, p=.042). Conclusion The current study demonstrates the feasibility of measuring penile vibratory thresholds with and without a condom in both erect and flaccid experimental conditions. As might be expected, condoms increased penile vibrotactile sensitivity thresholds. Interestingly, erections were associated with the highest thresholds. Thus, this study was the first to document that erect penises are less sensitive to vibrotactile stimulation than flaccid penises. PMID:24168347

Neopuff T-piece resuscitator mask ventilation: Does mask leak vary with different peak inspiratory pressures in a manikin model?

PubMed

Maheshwari, Rajesh; Tracy, Mark; Hinder, Murray; Wright, Audrey

2017-08-01

The aim of this study was to compare mask leak with three different peak inspiratory pressure (PIP) settings during T-piece resuscitator (TPR; Neopuff) mask ventilation on a neonatal manikin model. Participants were neonatal unit staff members. They were instructed to provide mask ventilation with a TPR with three PIP settings (20, 30, 40 cm H 2 O) chosen in a random order. Each episode was for 2 min with 2-min rest period. Flow rate and positive end-expiratory pressure (PEEP) were kept constant. Airway pressure, inspiratory and expiratory tidal volumes, mask leak, respiratory rate and inspiratory time were recorded. Repeated measures analysis of variance was used for statistical analysis. A total of 12 749 inflations delivered by 40 participants were analysed. There were no statistically significant differences (P > 0.05) in the mask leak with the three PIP settings. No statistically significant differences were seen in respiratory rate and inspiratory time with the three PIP settings. There was a significant rise in PEEP as the PIP increased. Failure to achieve the desired PIP was observed especially at the higher settings. In a neonatal manikin model, the mask leak does not vary as a function of the PIP when the flow rate is constant. With a fixed rate and inspiratory time, there seems to be a rise in PEEP with increasing PIP. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Blood transfusion and resuscitation using penile corpora: an experimental study.

PubMed

Abolyosr, Ahmad; Sayed, M A; Elanany, Fathy; Smeika, M A; Shaker, S E

2005-10-01

To test the feasibility of using the penile corpora cavernosa for blood transfusion and resuscitation purposes. Three male donkeys were used for autologous blood transfusion into the corpus cavernosum during three sessions with a 1-week interval between each. Two blood units (450 mL each) were transfused per session to each donkey. Moreover, three dogs were bled up until a state of shock was produced. The mean arterial blood pressure decreased to 60 mm Hg. The withdrawn blood (mean volume 396.3 mL) was transfused back into their corpora cavernosa under 150 mm Hg pressure. Different transfusion parameters were assessed. The Assiut faculty of medicine ethical committee approved the study before its initiation. For the donkey model, the mean time of blood collection was 12 minutes. The mean time needed to establish corporal access was 22 seconds. The mean time of blood transfusion was 14.2 minutes. The mean rate of blood transfusion was 31.7 mL/min. Mild penile elongation with or without mild penile tumescence was observed on four occasions. All penile shafts returned spontaneously to their pretransfusion state at a maximum of 5 minutes after cessation of blood transfusion. No extravasation, hematoma formation, or color changes occurred. Regarding the dog model, the mean rate of transfusion was 35.2 mL/min. All dogs were resuscitated at the end of the transfusion. The corpus cavernosum is a feasible, simple, rapid, and effective alternative route for blood transfusion and venous access. It can be resorted to whenever necessary. It is a reliable means for volume replacement and resuscitation in males.

Overall satisfaction, sexual function, and the durability of neophallus dimensions following staged female to male genital gender confirming surgery: the Institute of Urology, London U.K. experience

PubMed Central

Christopher, Nim A.; De Luca, Francesco; Spilotros, Marco; Ralph, David J.

2014-01-01

Background and purpose What factors influence transgender men’s decisions to undergo (and to not undergo) specific genital gender confirming surgeries (GCS) has not been described in the literature. Sexual function outcomes related to clitoral transposition and penile prosthesis placement is also not well described. Durability of neophallus dimensions after phalloplasty has not been described. A better understanding of these factors is necessary for pre-op counseling. We sought to assess patient genital-GCS related satisfaction, regret, pre/post-op sexual function, genital preferences, and genital measurements post-op. Materials and methods We evaluated ten female to male transgender patients who had previously undergone suprapubic pedicle-flap phalloplasty [suprapubic phalloplasty (SP); N=10] and 15 who had undergone radial artery forearm-flap phalloplasty [(RAP); N=15; 5/15 without and 10/15 with cutaneous nerve to clitoral nerve anastomosis] at our center (UK). We queried patients’ surgery related preferences and concerns, satisfaction, and sexual function pre/post-surgery, and accounted for whether patients had undergone clitoral transposition and/or cutaneous-to-clitoral nerve anastomosis. We measured flaccid and (where applicable) erect length and girth using a smart-phone app we designed. Results Mean age at surgery and follow-up for those that underwent SP was 35.1 and 2.23 years, and 34 and 6.8 for those that underwent RAP. Mean satisfaction scores were 9.1/10 and 9/10 for those that underwent SP and RAP, respectively. No patient (0%) regretted starting genital-GCS surgery. All (100%) patients that could achieve orgasm before GCS with clitoral transposition could achieve orgasm after surgery, and the vast majority reported preserved quality of erogenous sensation by our transposition technique. All (100%) RAP and 9/10 SP patients reported masturbation with their phallus. Inflatable penile prosthesis placement was not associated with decreased erogenous sensation/orgasm. Penile dimensions were relatively stable through follow-up for both groups. Our App length measurements correlated with a ruler within ±<4.5%. Conclusions Female-to-male genital-GCS offered in 3-stages was associated with high overall satisfaction and no regret among our sample. Sexual function appears to be preserved after both clitoral transposition and inflatable prosthesis placement, and consolidation of erogenous sensation to the phallus was described as important to all subjects. Discussion of patient’s pre-op sexual function, as well as specific concerns and preferences related to specific genital-GCS surgeries is important. PMID:26816764

The History of Nontraditional or Ectopic Placement of Reservoirs in Prosthetic Urology.

PubMed

Perito, Paul; Wilson, Steven

2016-04-01

Reservoir placement during implantation of prosthetic urology devices has been problematic throughout the history of the surgical treatment of erectile dysfunction and urinary incontinence. We thought it would be interesting to review the history of reservoir placement leading up to current surgical techniques. To provide an overview of the past and present techniques for reservoir placement and discuss the evolutionary process leading to safe and effective placement of prosthetic reservoirs. We reviewed data pertaining to inflatable penile prosthesis (IPP) reservoirs and pressure-regulating balloons (PRB) in a chronological fashion, spanning 25 years. Main outcomes included a historical review of techniques for IPP reservoir and PRB placement leading to the subsequent incremental improvements in safety and efficacy when performing penile implants and artificial urinary sphincters. Prosthetic urologic reservoirs have traditionally been placed in the retropubic space. Over the years, urologists have attempted use of alternative spaces including peritoneal, epigastric, "ectopic," posterior to transversalis, and high submuscular. Current advances in prosthetic urologic reservoir placement allow safe and effective abdominal wall placement of reservoirs. These novel approaches appear to be so effective that urologists may now be able to cease using the traditional retropubic space for reservoir placement, even in the case of virgin pelves. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Is V-Y plasty necessary for penile lengthening? Girth enhancement and increased length solely through circumcision: description of a novel technique.

PubMed

Mertziotis, Nikos; Kozyrakis, Diomidis; Bogris, Elias

2013-11-01

Our objective is to describe a novel ligamentolysis approach using a subcoronal incision technique and to determine its safety and efficacy. During the last 7 years, 82 consecutive patients had penile augmentation surgery. Ligamentolysis, through a lower abdominal incision (V-Y plasty) in the first 35 males, was performed (Group A), followed by circumcision ligamentolysis in the next 47 males (Group B). The operation time, complications, and the preoperative and postoperative values of penile length and girth along with the self-esteem and relations questionnaire score as well as satisfaction score was calculated before and after the surgery, and a comparison was conducted between the groups. The mean age at presentation was 32 years (range: 18-56 years). Seventy-nine patients suffered from penile dysmorphophobia, and three patients had micropenises (length <7.5 cm). The mean surgical times were 150.7 and 125.2 min for Groups A and B, respectively (P=0.005). Postoperatively, four Group A patients and three Group B patients (11% versus 6%, respectively) experienced penile retraction (P=0.453). Hypertrophic scars were observed in 18 men (51%) in the former [corrected] group. In the circumcision group, no major wound complications were recorded. The length and girth improvements between the groups were similar. In terms of satisfaction and SEAR improvement, the resulting difference for both variables favored the circumcision group (P=0.007 and <0.001, respectively). With strict selection criteria, the circumcision ligamentolysis procedure compared to the V-Y plasty demonstrated improved results in terms of safety, operation time, retraction rate and cosmetic appearance without any compromise in the gained penile size.

Penile size and penile enlargement surgery: a review.

PubMed

Dillon, B E; Chama, N B; Honig, S C

2008-01-01

Penile size is a considerable concern for men of all ages. Herein, we review the data on penile size and conditions that will result in penile shortening. Penile augmentation procedures are discussed, including indications, procedures and complications of penile lengthening procedures, penile girth enhancement procedures and penile skin reconstruction.

Postnatal penile growth concurrent with mini-puberty predicts later sex-typed play behavior: Evidence for neurobehavioral effects of the postnatal androgen surge in typically developing boys.

PubMed

Pasterski, Vickie; Acerini, Carlo L; Dunger, David B; Ong, Ken K; Hughes, Ieuan A; Thankamony, Ajay; Hines, Melissa

2015-03-01

The masculinizing effects of prenatal androgens on human neurobehavioral development are well established. Also, the early postnatal surge of androgens in male infants, or mini-puberty, has been well documented and is known to influence physiological development, including penile growth. However, neurobehavioral effects of androgen exposure during mini-puberty are largely unknown. The main aim of the current study was to evaluate possible neurobehavioral consequences of mini-puberty by relating penile growth in the early postnatal period to subsequent behavior. Using multiple linear regression, we demonstrated that penile growth between birth and three months postnatal, concurrent with mini-puberty, significantly predicted increased masculine/decreased feminine behavior assessed using the Pre-school Activities Inventory (PSAI) in 81 healthy boys at 3 to 4years of age. When we controlled for other potential influences on masculine/feminine behavior and/or penile growth, including variance in androgen exposure prenatally and body growth postnally, the predictive value of penile growth in the early postnatal period persisted. More specifically, prenatal androgen exposure, reflected in the measurement of anogenital distance (AGD), and early postnatal androgen exposure, reflected in penile growth from birth to 3months, were significant predictors of increased masculine/decreased feminine behavior, with each accounting for unique variance. Our findings suggest that independent associations of PSAI with AGD at birth and with penile growth during mini-puberty reflect prenatal and early postnatal androgen exposures respectively. Thus, we provide a novel and readily available approach for assessing effects of early androgen exposures, as well as novel evidence that early postnatal aes human neurobehavioral development. Copyright © 2015. Published by Elsevier Inc.

Penile strangulation by hair.

PubMed

Acimi, Smail

2014-07-01

To know the causes and results of treatment of complications from a penile strangulation by hair in seven boys. From April 2000 to December 2012, seven boys presenting serious penile complications by hair strangulation have been operated in two centers. All seven boys had transection of the urethra at the coronal level. And none of our patients were at the stage of necrosis or amputation of the glans. The age of the patients at surgery ranged from 34 to 134 months (mean 96 months). Four children presented urethrocutaneous fistulas (57% of cases), and the innervation and vascularization of the glans remained poor after repair in three patients. The penile strangulation by hair was due to a simple accident. However, several predisposing factors were discovered in our patients: lack of cleanliness; a moist environment with nocturnal enuresis; the presence of pubic hair in young children reported in the four children, and a coronal sulcus not covered by the foreskin in circumcised children.

Cis-diamminedichloride platinum II (DDP) in the treatment of penile carcinoma.

PubMed

Sklaroff, R B; Yagoda, A

1979-11-01

Cis-diamminedichloride platinum II (DDP) was administered to eight patients with epidermoid carcinoma of the penis. Three of six adequately treated patients had an objective response: one patient achieved complete remission of 7 months duration and 2 patients had partial remissions of 8 and 2 months, respectively. DDP appears to be an active agent in the treatment of penile carcinoma.

Penile Girth Enhancement With Polymethylmethacrylate-Based Soft Tissue Fillers.

PubMed

Casavantes, Luis; Lemperle, Gottfried; Morales, Palmira

2016-09-01

An unknown percentage of men will take every risk to develop a larger penis. Thus far, most injectables have caused serious problems. Polymethylmethacrylate (PMMA) microspheres have been injected as a wrinkle filler and volumizer with increasing safety since 1989. To report on a safe and permanently effective method to enhance penile girth and length with an approved dermal filler (ie, PMMA). Since 2007, the senior author has performed penile augmentation in 752 men mainly with Metacrill, a suspension of PMMA microspheres in carboxymethyl-cellulose. The data of 729 patients and 203 completed questionnaires were evaluated statistically. The overall satisfaction rate was 8.7 on a scale of 1 to 10. After one to three injection sessions, average girth increased by 3.5 cm, or 134% (10.2 to 13.7 cm = 134.31%). Penile length also increased by weight and stretching force of the implant from an average of 9.8 to 10.5 cm. Approximately half the patients perceived some irregularities of the implant, which caused no problems. Complications occurred in 0.4%, when PMMA nodules had to be surgically removed in three of the 24% of patients who had a non-circumcised penis. After 5 years of development, penile augmentation with PMMA microspheres appears to be a natural, safe, and permanently effective method. The only complication of nodule formation and other irregularities can be overcome by an improved injection technique and better postimplantation care. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

The treatment of loss of penile rigidity associated with Peyronie's disease.

PubMed

Krane, R J

1996-01-01

Patients with Peyronie's Disease on occasion present with loss of rigid erections. A full evaluation is required to determine the presence or absence of arterial insufficiency or corporal veno-occlusive dysfunction. Treatment for these patients include intracavernosal pharmacotherapy, a vacuum/constrictor device, venous ligation surgery or a penile prosthesis. Whatever the therapeutic approach, the angulation produced by the Peyronie's plaque must be taken into account. Patients with Peyronie's Disease will present to their physicians with a variety of clinical scenarios. They may merely be concerned with the presence of an asymptomatic penile plaque and will simply require reassurance. More typically, however, penile curvature, pain, and/or difficulty with sexual relations will prompt the desire for medical advice. Treatment of penile pain which usually abates with time and attempts at non surgically treating the Peyronies plaque will not be discussed in this paper. Patients with penile plaque and curvature present in three distinct ways: a. penile rigidity preserved and the ability to continue sexual relations; b, penile rigidity preserved and the inability to continue with sexual relations because of significant angulation; c. the inability to have rigid erections. The patient who is able to continue sexual relations with preserved penile rigidity and the lack of significant penile angulation requires no treatment. However, the patient who has lost his ability to have sexual relations because of significant angulation is a candidate for penile straightening surgery (e.g. graft) (1, 11). It is the last group of patients. Namely those who are not able to maintain penile rigidity because of their Peyronie's Disease that will be addressed in this paper. Patients who present with impotence (i.e. loss of penile rigidity) and Peyronie's disease should be evaluated in a similar manner as patients who present with erectile dysfunction and do not have Peyronie's Disease. The standard approach would therefore include a detailed medical and sexual history, a measurement of penile arterial pressure or flow to determine adequate arterial inflow (5,8), a measurement of penile sensation (10) to determine if an underlying neurological problem is present and lastly an evaluation of the veno-occlusive mechanism (12,17). In addition, the presence of penile curvature and plaque may cause significant and disturbing psychological manifestations and it is advisable that these patients undergo a psychological interview to determine the presence or absence of psychiatric influences. Obviously, many older patients with Peyronie's Disease may suffer concomitant arterial insufficiency leading to loss of rigidity and impotence. An evaluation of arterial input into the penis by penile Doppler studies, duplex ultrasound, or cavernosal occlusion pressures is required to determine the presence of arterial insufficiency. Patients who are found to have significant decreases in arterial flow and/or pressure would therefore become candidates for either self-injection with vasoactive agents or a vacuum constrictor device. It is our feeling in general that these nonsurgical therapies should be tried prior to considering the implantation of a penile prosthesis in any patient who presents with erectile dysfunction. It should be noted, however, that many patients with Peyronie's Disease who present with loss of penile rigidity will have an underlying veno-occlusive dysfunction secondary to the plaque itself. Normally, venules draining the corpora are passively compressed between the expanding corporal tissue and the tunica albugince (6). When a Peyronie's plaque is present compliance of the underlying corporal smooth musculature may be decreased thus preventing venous compression. In a recent evaluation of 92 patients who presented in this manner 87% were noted to have veno-occlusive dysfunction as determined by dynamic cavernosometry and cavernosography (3)...

Aesthetic neo-glans reconstruction after penis-sparing surgery for benign, premalignant or malignant penile lesions

PubMed Central

Palminteri, Enzo; Fusco, Fernando; Berdondini, Elisa; Salonia, Andrea

2011-01-01

Purpose To describe the technique and results of penis-sparing surgery combined with a cosmetic neo-glans reconstruction for benign, pre-malignant or malignant penile lesions. Patients and methods Twenty-one patients (mean age 61 years) with penile lesions with a broad spectrum of histopathology underwent organ-sparing surgery with neo-glans reconstruction, using a free split-thickness skin graft harvested from the thigh. Three patients were treated by glans-skinning and glans-resurfacing, 10 by glansectomy and neo-glans reconstruction, four by partial penectomy and a neo-glans reconstruction, and four by neo-glans reconstruction after a traditional partial penectomy. Results The mean follow-up was 45 months; all patients were free of primary local disease. All patients were satisfied with the appearance of the penis after surgery, and recovered their sexual ability, although sensitivity was reduced as a consequence of glans/penile amputation. Conclusion In benign, premalignant or malignant penile lesions, penis-sparing surgery combined with a cosmetic neo-glans reconstruction can be used to assure a normally appearing and functional penis, while fully eradicating the primary local disease. PMID:26579279

Penile intraepithelial neoplasia and other premalignant lesions of the penis.

PubMed

Crispen, Paul L; Mydlo, Jack H

2010-08-01

Invasive penile cancer is an aggressive malignancy that often requires partial or complete penile amputation. Premalignant penile lesions, such as penile intraepithelial neoplasia, will have been present prior to the development of invasive disease in a substantial percentage of patients. Early detection and treatment of premalignant penile lesions may prevent malignant progression while avoiding penile amputation. This review focuses on premalignant penile lesions and the associations of these lesions with the development of invasive penile cancer. Copyright 2010 Elsevier Inc. All rights reserved.

Penile abscess and necrotizing fasciitis secondary to neglected false penile fracture

PubMed Central

Al-Reshaid, Reshaid Abdullah; Madbouly, Khaled; Al-Jasser, Abdullah

2010-01-01

Penile infection and abscess formation have been described in association with priapism, cavernosography, intracavernosal injection therapy, trauma and penile prosthesis. We report a case of penile abscess and necrotizing fasciitis of penile skin in a 37-year-old male, presented 3 weeks after neglected false penile fracture. PMID:20882163

Infection rates of rifampin/gentamicin-coated Titan Coloplast penile implants. Comparison with Inhibizone-impregnated AMS penile implants.

PubMed

Dhabuwala, Chirpriya; Sheth, Sheila; Zamzow, Brent

2011-01-01

It is a common practice to soak Titan(®) Coloplast penile implants in antibiotic solution prior to implantation. Experience with Inhibizone impregnation suggests that rifampin coating significantly reduces infection rates of penile implant surgery. In this article we describe the results of coating Titan Coloplast penile implants with rifampin/gentamicin solution. To compare infection rates of Titan(®) Coloplast penile implants coated with vancomycin/gentamycin, rifampin/gentamicin, and Inhibizone-impregnated American Medical Systems (AMS) penile implants. Chart review was done for all Mentor/Coloplast and AMS implant surgeries performed at our center between the dates January 1, 2002 and February 8, 2010. Infection rates for Titan(®) Coloplast penile implants coated with vancomycin/gentamycin, rifampin/gentamicin, and Inhibizone-impregnated (AMS) penile implants were compared. Infection rates for penile implants coated with different antibiotics. Infection rates for Titan(®) Coloplast penile implants coated with vancomycin/gentamycin and Inhibizone-impregnated (AMS) penile implants was 4.4% and 1.3%, respectively (P = 0.05). None of the rifampin/gentamicin-coated Titan(®) Coloplast penile implants have developed infection. Rifampin is the common antibiotic both in rifampin/gentamicin-coated Coloplast implants and Inhibizone(®) . The infection rate in this combined rifampin/gentamicin-coated Titan Coloplast implants and Inhibizone-coated AMS implants group was 0.63% (P = 0.03). Both rifampin/gentamicin-coated Titan(®) Coloplast penile implants and Inhibizone-impregnated (AMS) penile implants appear to have lower infection rates compared with vancomycin/gentamycin-coated Titan(®) Coloplast penile implants The present study does not suggest superiority of rifampin/gentamicin-coated Titan(®) Coloplast penile implants or Inhibizone-impregnated (AMS) penile implants but we strongly suggest that all Titan(®) Coloplast penile implants should be coated with rifampin/gentamicin solution. © 2010 International Society for Sexual Medicine.

Erect penile dimensions in a cohort of 778 Middle Eastern men: establishment of a nomogram.

PubMed

Habous, Mohamad; Tealab, Alaa; Williamson, Ben; Binsaleh, Saleh; El Dawy, Sherif; Mahmoud, Saad; Abdelwahab, Osama; Nassar, Mohammed; Mulhall, John P; Veale, David; Muir, Gordon

2015-06-01

Accurate data regarding the size of the erect penis are of great importance to several disciplines working with male patients, but little high-quality research exists on the subject, particularly in different ethnic groups and for erect penis size. The aim of this study was to create a nomogram of erect penile dimensions in a large sample of Middle Eastern men. A retrospective cohort study of 778 men (mean age 43.7; range 20-82) attending urological outpatient clinics in Saudi Arabia was conducted. Exclusion criteria were age under 18 years, a presenting complaint of small or short penis, Peyronie's disease or complaint of congenital curvature, clinical hypogonadism, and previous penile surgery or trauma. Three erect penile dimensions following induction of erection using intracavernosal injection of Quadrimix. Mean patient body mass index (BMI) was 29.09 (standard deviation [SD] 5.76). The mean suprapubic skin-to-penile tip erect length was 12.53 cm (SD 1.93); the mean erect length from the symphysis pubis to the penile tip was 14.34 cm (SD 1.86); and the mean erect shaft circumference was 11.50 cm (SD 1.74). A nomogram was constructed and statistical analysis performed, demonstrating a weak negative correlation between BMI and erect penile length measured from the suprapubic skin (r = -0.283, P < 0.000) but not from bone to tip, and a weak negative correlation between age and both erect penile length measurements (skin to tip r = -0.177, P < 0.0005; bone to tip r = -0.099, P = 0.006). A nomogram for Middle Eastern men can be used as a standard when advising men with small penis anxiety. The importance of measuring erect size and allowing for infra-pubic fat interference in measurement is emphasized. We envisage that this tool can be used to educate and reassure concerned men about the size of their penises. © 2015 International Society for Sexual Medicine.

Inflating the Life Rafts of NCLB: Making Public School Choice and Supplemental Services Work for Students in Troubled Schools

ERIC Educational Resources Information Center

Hess, Frederick M.; Finn, Chester E., Jr.

2004-01-01

To no one's surprise, the No Child Left Behind (NCLB) Act has become a political football in this election season. Amidst the heated rhetoric and impassioned claims, it can be easy to forget that NCLB is no one thing but rather an awkward compendium of many disparate pieces. While public officials are pressed to render absolute judgments--that…

Prognostic value of CD44 expression in penile squamous cell carcinoma: a pilot study.

PubMed

Minardi, Daniele; Lucarini, Guendalina; Filosa, Alessandra; Zizzi, Antonio; Simonetti, Oriana; Offidani, Anna Maria; d'Anzeo, Gianluca; Di Primio, Roberto; Montironi, Rodolfo; Muzzonigro, Giovanni

2012-10-01

Several studies have reported on the prognostic value of molecular markers for metastasis risk and survival in penile squamous cell carcinoma (SCC) patients. The usefulness of CD44 expression as such a marker has been studied in different tumors, but not in penile SCC. Our aim was to determine whether CD44 expression may serve as a prognostic marker for lymph node metastasis and survival in penile SCC patients. CD44 immunoistochemical expression was investigated in tissue specimens from 39 patients with penile SCC. CD44 cell positivity, staining intensity and distribution were analyzed and correlated with tumor stage, grade, lymph node status and disease-specific survival. CD44 expression was detected in epithelial cells of both intratumoral and normal tissues with different intensities and staining distributions. In normal tissues CD44 protein was mainly detected in cell membranes, whereas in the tumor compartments it was found in both the cell membranes and the cytoplasm. The intensities and percentages of CD44 expressing cells did not correlate with tumor stage and/or grade. Seventy-three percent of the patients with lymph node metastasis showed high intensities of CD44 staining, as compared to 44% of the patients without lymph node metastasis (P = 0.03). Lymph node-positive patients showed both cytoplasmic and membranous CD44 expression. High CD44 expression was found to be significantly correlated with a decreased 5 year overall survival (P = 0.01). CD44 levels and patterns of expression can be considered as markers for penile SCC aggressiveness and, in addition, may serve as predictive markers for lymph node metastasis, also in patients with clinically negative lymph nodes. CD44 expression may provide prognostic information for penile SCC patients, next to classical clinical-pathological factors.

Shortened penis post penile prosthesis implantation treated with subcutaneous soft silicone penile implant: case report.

PubMed

Shirvanian, V; Lemperle, G; Araujo Pinto, C; Elist, J J

2014-01-01

Penile prosthesis surgery for erectile dysfunction has the highest satisfaction rates among all treatment options but is often associated with subjective and objective loss of penile length and girth following surgery. To present a novel technique using a subcutaneous soft silicone implant for reversal of penile shortening and narrowing after prosthesis surgery, with additional gains in overall penile length and girth. Nine patients were treated with the insertion of a subcutaneous soft silicone penile implant. All patients had previously reported a loss in penile length (0.5-2 cm), and seven of nine patients also reported a loss in penile girth (0.5-2.6 cm) after penile prosthesis surgery. During a follow-up period of 4-24 months, penile length and girth measurements showed a mean increase in length of 2.4 cm (±0.75 cm) and a mean increase in girth of 3.4 cm (±0.94 cm). The additional insertion of a subcutaneous soft silicone implant in patients with decreased penile length and girth after penile prosthesis surgery is an effective treatment option that provides reversal of lost penile length and girth.

Penile fracture seems more likely during sex under stressful situations.

PubMed

Kramer, Andrew C

2011-12-01

The unusual event of penile fracture occurs when there is a disruption of the tunica albuginea surrounding engorged erectile tissue during aggressive sexual behavior. There is often an audible crack and rapid detumescence with subcutaneous hemorrhage that follows. Medical literature has described the etiology and treatment of penile fracture. We report the remarkably unusual social situations of a series of patients who sustained this unique injury. We conducted a retrospective chart review of 16 patients whose injury was severe enough to require surgical repair at the University of Maryland between 2007 and 2011. Particular attention was paid to the intake interview in the emergency department and the postoperative chart notes by the attending urologist to ascertain out-of-the-ordinary social situations in which the injury was sustained. The occurrence of penile fracture is sufficiently rare that the author was able to interact personally with most of the patients. The patients were remarkably forthcoming with the personal social dynamics of the sexual encounter. Half of these penile fracture patients sustained the injury during an extramarital affair. Only three patients sustained the injury in a bedroom; the remainder was in out-of-the-ordinary locations for sexual intercourse, e.g., cars, elevator, the workplace, and public restrooms. Penile fracture patients appear to be a unique population of men who are having sexual intercourse under stressful situations. Extramarital affairs and out-of-the-ordinary locations appear common in patients sustaining this relatively rare injury. © 2011 International Society for Sexual Medicine.

Unreliability of modified inguinal lymphadenectomy for clinical staging of penile carcinoma.

PubMed

Lopes, A; Rossi, B M; Fonseca, F P; Morini, S

1996-05-15

In 1988, Catalona proposed a modified bilateral inguinal lymphadenectomy for staging of lymph node metastasis from penile carcinoma. All three patients with penile carcinoma submitted to this procedure and without histologically confirmed metastases were free of disease within a mean follow-up time of 14.6 months. In a prospective study, the authors evaluated thirteen patients staged by the TNM system and submitted to modified bilateral inguinal lymphadenectomy. None of the patients had histologic metastases in the medial quadrant lymph nodes. Two of these patients developed regional lymph node metastases within 13.2 months (mean follow-up time). Catalona's procedure was not reliable. We therefore recommend standard inguinal lymphadenectomy as the minimal treatment for patients with infiltrating carcinoma of the penis.

Managing the difficult penile prosthesis patient.

PubMed

Trost, Landon W; Baum, Neil; Hellstrom, Wayne J G

2013-04-01

Inflatable penile prostheses (IPPs) are associated with excellent long-term outcomes and patient/partner satisfaction. A small percentage of patients remain dissatisfied, despite acceptable surgical results. This study aims to evaluate factors associated with patient satisfaction and dissatisfaction, define patient characteristics, which may identify elevated risk of postoperative dissatisfaction, and describe management strategies to optimize functional and psychological patient outcomes. A review of urologic and non-urologic cosmetic surgery literature was performed to identify factors associated with patient satisfaction/dissatisfaction. Emphasis was placed on articles defining "high risk" or psychologically challenging patients. Preoperative factors associated with patient satisfaction/dissatisfaction and character traits, which may identify elevated risk of postoperative dissatisfaction or otherwise indicate a psychologically challenging patient. Contemporary patient and partner satisfaction rates following IPP are 92-100% and 91-95%, respectively. Factors associated with satisfaction include decreased preoperative expectations, favorable female partner sexual function, body mass index ≤30, and absence of Peyronie's disease or prior prostatectomy. Determinants of dissatisfaction include perceived/actual loss of penile length, decreased glanular engorgement, altered erectile/ejaculatory sensation, pain, diminished cosmetic outcome, difficulty with device function, partner dissatisfaction and perception of unnatural sensation, complications, and extent of alternative treatments offered. Personality characteristics which may indicate psychologically challenging IPP patients include obsessive/compulsive tendencies, unrealistic expectations, patients undergoing revision surgery, those seeking multiple surgical opinions, feeling of entitlement, patients in denial of their prior erectile/sexual function and current disease status, or those with other psychiatric disorders. The mnemonic CURSED Patient is presented: "Compulsive/obsessive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric." Although the majority of IPP patients experience excellent, durable satisfaction and outcomes, a challenging subset of patients may be at increased risk of postoperative dissatisfaction. Appropriate recognition/prevention and management of this cohort may help to establish and strengthen relationships, reduce physical, emotional, and legal risk, and ultimately enhance patient satisfaction. © 2013 International Society for Sexual Medicine.

Modeling zero-modified count and semicontinuous data in health services research part 2: case studies.

PubMed

Neelon, Brian; O'Malley, A James; Smith, Valerie A

2016-11-30

This article is the second installment of a two-part tutorial on the analysis of zero-modified count and semicontinuous data. Part 1, which appears as a companion piece in this issue of Statistics in Medicine, provides a general background and overview of the topic, with particular emphasis on applications to health services research. Here, we present three case studies highlighting various approaches for the analysis of zero-modified data. The first case study describes methods for analyzing zero-inflated longitudinal count data. Case study 2 considers the use of hurdle models for the analysis of spatiotemporal count data. The third case study discusses an application of marginalized two-part models to the analysis of semicontinuous health expenditure data. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Surfactant and pulmonary blood flow distributions following treatment of premature lambs with natural surfactant.

PubMed Central

Jobe, A; Ikegami, M; Jacobs, H; Jones, S

1984-01-01

Prematurely delivered lambs were treated with radiolabeled natural surfactant by either tracheal instillation at birth and before the onset of mechanical ventilation, or after 23 +/- 1 (+/- SE) min of mechanical ventilation. Right ventricular blood flow distributions, left ventricular outputs, and left-to-right ductal shunts were measured with radiolabeled microspheres. After sacrifice, the lungs of lambs receiving surfactant at birth inflated uniformly with constant distending pressure while the lungs of lambs treated after a period of ventilation had aerated, partially aerated, and atelectatic areas. All lungs were divided into pieces which were weighed and catalogued as to location. The amount of radiolabeled surfactant and microsphere-associated radioactivity in each piece of lung was quantified. Surfactant was relatively homogenously distributed to pieces of lung from lambs that were treated with surfactant at birth; 48% of lung pieces received amounts of surfactant within +/- 25% of the mean value. Surfactant was preferentially recovered from the aerated pieces of lungs of lambs treated after a period of mechanical ventilation, and the distribution of surfactant to these lungs was very nonhomogeneous. Right ventricular blood flow distributions to the lungs were quite homogeneous in both groups of lambs. However, in 8 of 12 lambs, pulmonary blood flow was preferentially directed away from those pieces of lung that received relatively large amounts of surfactant and toward pieces of lung that received less surfactant. This acute redirection of pulmonary blood flow distribution may result from the local changes in compliances within the lung following surfactant instillation. PMID:6546766

Penile Analogue of Stratified Mucin-Producing Intraepithelial Lesion of the Cervix: The First Described Case. A Diagnostic Pitfall.

PubMed

Michal, Michael; Michal, Michal; Miesbauerova, Marketa; Hercogova, Jana; Skopalikova, Barbora; Kazakov, Dmitry V

2016-05-01

The authors report a case where undifferentiated (classic) penile intraepithelial neoplasia was associated with the presence of goblet cells throughout the full epithelial thickness and which later progressed into an invasive carcinoma. The lesion evolved in three consecutive biopsies from only surface epithelium occupying numerous goblet cells in the first to variably sized solid nodules in the dermis composed of atypical squamous and/or basaloid cells intermixed with numerous goblet cells in the third biopsy. Both cellular components expressed CK7 and p16 protein. Human Papillomavirus (HPV) genotyping revealed high risk HPV type 16. To the best of our knowledge, this is the first description of such a lesion occurring on the penis, which can be considered the penile analogue of cervical stratified mucin-producing intraepithelial lesion (SMILE). The correct diagnosis was rendered retrospectively, after recognition of the existence of a vulvar lesion resembling cervical SMILE. The initial biopsy was misinterpreted as extramammary Paget disease, which also constitutes the main pitfall in the differential diagnosis. Another important differential diagnosis is penile/vulvar mucinous metaplasia. The finding of atypical squamous epithelial cells positive for p16 associated with mucinous cells present throughout the full epithelial thickness is a clue to the diagnosis of penile SMILE.

Detection of HPV-DNA, p53 alterations, and methylation in penile squamous cell carcinoma in Japanese men.

PubMed

Yanagawa, Naoki; Osakabe, Mitsumasa; Hayashi, Masahiro; Tamura, Gen; Motoyama, Teiichi

2008-08-01

Penile carcinoma is a rare disease, accordingly there are few studies on molecular changes, and these results also vary greatly. A total of 26 penile squamous cell carcinomas in Japanese men were studied with respect to HPV, p53 alterations, and methylation of gene promoter region. HPV-DNA was detected in three of 26 patients (11.5%). Overexpression of p53 was observed in 13 of 26 patients (50%), and p53 gene mutations were detected in four of 26 patients (15.4%). The frequency of methylation was as follows: DAPK, 26.9% (7/26); FHIT, 88.4% (23/26); MGMT, 19.2% (5/26); p14, 3.8% (1/26); p16, 23.1% (6/26); RAR-beta, 23.1% (6/26); RASSF1A, 11.5% (3/26); and RUNX3, 42.3% (11/26). As for correlation between HPV and p53 alterations, and methylation status, mutations of the p53 gene were detected only in HPV-negative patients, and methylation was more frequently found in HPV-negative than in HPV-positive patients. The present results suggest that the majority of penile squamous cell carcinomas in Japanese men are unrelated to HPV, and gene alterations accumulate more frequently in HPV-unrelated penile carcinomas.

Evolution in the concept of erection anatomy.

PubMed

Awad, Ayman; Alsaid, Bayan; Bessede, Thomas; Droupy, Stéphane; Benoît, Gérard

2011-05-01

To review and to summarize the literature on anatomy and physiology of erection in the past three decades, especially the work done in our institution. A search of the PubMed database was performed using keywords erection, anatomy and erectile dysfunction (ED). Relevant articles were reviewed, analyzed and summarized. Penile vascularisation and innervation vary substantially. Internal pudendal artery is the major source of penile blood supply, but a supralevator accessory pudendal artery that may originate from inferior vesical or obturator or external iliac arteries is not uncommon. Section of this artery during radical prostatectomy (RP) may adversely affect postoperative potency. Anastomoses between the supra and the infralevator arterial pathways are frequent. The cavernous nerves (CNs) contain parasympathetic and sympathetic nerve fibers and these nerves lie within leaves of the lateral endopelvic fascia. Anastomoses between the CNs and the dorsal nerve of the penis are common. Nitric oxide released from noradrenergic, noncholinergic neurotransmission of the CN and from the endothelium is the principal neurotransmitter-mediating penile erection. Interactions between pro-erectile and anti-erectile neurotransmitters are not completely defined. Finally, medial preoptic area and paraventricular nucleus are the key structures in the central control of sexual function and penile erection. The surgical and functional anatomy of erection is complex. Precise knowledge of penile vascularisation and innervation facilitates treatment of ED especially after RP.

Limited experience, high body mass index and previous urethral surgery are risk factors for failure in open urethroplasty due to penile strictures.

PubMed

Ekerhult, Teresa O; Lindqvist, Klas; Peeker, Ralph; Grenabo, Lars

2015-01-01

The aim of this study was to evaluate outcomes and possible risk factors for failure of open urethroplasty due to penile urethral strictures. A retrospective chart review was undertaken of 90 patients with penile stricture undergoing 109 open urethroplasties between 2000 and 2011. In 80 urethroplasties, a one-stage procedure was performed: 68 of these had a pediculated penile skin flap, nine had a free buccal mucosal graft and three had a free skin graft. A two-stage procedure using buccal mucosa was performed in 29 urethroplasties. Failure was defined as when further urethral instrumentation was needed. The mean age in the one-stage and two-stage groups were 50 and 54 years, respectively. The success rates in the corresponding groups were 65% and 72%, with follow-up times of 63 and 40 months, respectively. Multivariable analyses disclosed body mass index (BMI) and previous urethral surgery to be significant risk factors for failure in the one-stage group. Failure over time significantly decreased during the study period. Both one- and two-stage penile urethroplasty demonstrated success rates in line with previous reports. Limited experience, high BMI and previous urethral surgery appear to be associated with less favourable outcome.

Antifibrogenic role of valproic acid in streptozotocin induced diabetic rat penis.

PubMed

Kutlu, O; Karaguzel, E; Gurgen, S G; Okatan, A E; Kutlu, S; Bayraktar, C; Kazaz, I O; Eren, H

2016-05-01

We investigated the therapeutic effects of valproic acid (VPA) on erectile dysfunction and reducing penile fibrosis in streptozocin (STZ)-induced diabetic rats. Eighteen male rats were divided into three experimental groups (Control, STZ-DM, STZ-DM plus VPA) and diabetes was induced by transperitoneal single dose STZ. Eight weeks after, VPA and placebo treatments were given according to groups for 15 days. All rats were anesthetised for the measurement of in vivo erectile response to cavernous nerve stimulation. Afterward penes were evaluated histologically in terms of immune labelling scores of endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF) and transforming growth factor-β1 (TGF-β1). Slides were also evaluated in terms of collagen/smooth muscle ratio and penile apoptosis. After the treatment with VPA, erectile responses were found as improved when compared with STZ-DM rats but not statistically meaningful. eNOS and VEGF immune expressions diminished in penile corpora of STZ-DM rats and improved with VPA treatment. VPA led to decrease in TGF-β1 expression and collagen content of diabetic rats' penes. Penile apoptosis was not diminished with VPA. In conclusion, VPA treatment seems to be effective for reducing penile fibrosis in diabetic rats and more prolonged treatment period may enhance erectile functions. © 2015 Blackwell Verlag GmbH.

Brachytherapy for conservative treatment of invasive penile carcinoma in older patients: Single institution experience.

PubMed

Escande, Alexandre; Maroun, Pierre; Dumas, Isabelle; Schernberg, Antoine; Bossi, Alberto; De Crevoisier, Renaud; Deutsch, Eric; Haie-Meder, Christine; Chargari, Cyrus

2018-05-01

No study has examined the possibility to perform an organ sparing strategy in older patients with penile carcinoma, and amputation is frequently proposed. We report our experience of interstitial brachytherapy for the conservative treatment of penile carcinoma confined to the glans in patients aged of 70years and more. A total of 55 patients candidates to conservative brachytherapy were identified. Median age was 73.8years (range: 70-95years). Patients underwent a circumcision then 3-4weeks later, an interstitial brachytherapy was delivered, median dose of 65Gy (range 55-74Gy). Salvage surgery was discussed in patients with histological confirmation of residual/relapsed tumor. With median follow-up of 9.0years, eight patients (14.5%) experienced a relapse, including five patients with local relapse. Three patients with local relapse only underwent salvage penile surgery, including two partial glansectomies and one total penectomy, and were in second complete remission at last follow-up. Among 55 patients analyzed for late side effects, seven patients (13.0%) presented pain or ulceration, 12 (22.2%) experienced urethral or meatal stenosis requiring at least one dilatation, two patients (3.7%) experienced both ulcerations and urethral complication. Three patients (5.5%) needed partial glansectomy for focal necrosis. At five years, estimated overall survival rate was 74.5% (95%CI: 62.0-87.0%) and local relapse free rate was 91.0% (95%CI: 82.6-99.4%). Brachytherapy is feasible in selected older patients with penile carcinoma, with efficacy and toxicity rates comparable to that of other series in younger patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Penile Cancer—Health Professional Version

Cancer.gov

Penile cancer is most commonly squamous cell carcinoma. When diagnosed early, penile cancer is highly curable. Some studies suggest an association between human papillomavirus (HPV) infection and penile cancer. Find evidence-based information on penile cancer treatment.

Penile Cancer—Patient Version

Cancer.gov

Penile cancer usually forms on or under the foreskin. Human papillomavirus (HPV) causes about one-third of penile cancer cases. When found early, penile cancer is usually curable. Start here to find information on penile cancer treatment and research.

Injection of Vaseline under Penis Skin for the Purpose of Penis Augmentation.

PubMed

Karakan, Tolga; Ersoy, Erim; Hasçiçek, Metin; Ozgür, Berat Cem; Ozcan, Serkan; Aydın, Arif

2012-01-01

Penile foreign body injection is an uncommon entity produced by penile paraffin, mineral oil, and vaseline injections for the purpose of penile enlargement. Generally, penile subcutaneous and glandular injections for penile augmentation are performed by a nonmedical person, under unacceptable conditions. It will be an aim to share our experiences about penile vaseline injection.

Penile fracture: surgical repair and late effects on erectile function.

PubMed

Ateyah, Ahmed; Mostafa, Taymour; Nasser, Taha Abdel; Shaeer, Osama; Hadi, Ahmed Abdel; Al-Gabbar, Mohammed Abd

2008-06-01

Penile fracture is described as a traumatic rupture of the tunica albuginea because of blunt injury of an erect penis. To assess the etiology, treatment maneuvers, and late effects of penile fractures treated by surgical repair. Thirty-three patients diagnosed provisionally as having fractured penises. Thirty patients were managed by immediate surgical repair and three by delayed repair. International Index of Erectile Function-5 for married cases and Single-question Self-report of Erectile Dysfunction questionnaires and recording complications after 2, 3, and 6 months. The most common cause of fracture penis is self-inflicted acute bending (54.5%). The tear was visualized by ultrasound in 20/30 patients (66.7%) mostly on the right proximal third of the penis. All tears were unilateral with mean length 2.0 +/- 0.9 cm (range 0.5-4 cm). All patients who completed their follow-up after 6 months (N = 24) were able to achieve an adequate erection except two married cases who felt mild erectile dysfunction. Penile nodules were the most common postoperative complication (41.7%) after 6 months' follow-up. Patients treated with immediate or delayed repair had comparable complications. Fracture penis is not uncommon as an emergency that must be repaired either immediately or delayed. Clinical diagnosis is more predictive than ultrasound in diagnosis and determining the site of the tear. Ultrasound may be of value in patients where there is clinical doubt.

Preputial skin free graft as dorsal onlay urethroplasty: Our experience of 73 patients.

PubMed

Bapat, Shivadeo S; Padhye, Abhijit S; Yadav, Pushkaraj B; Bhave, Ashish A

2007-10-01

To present the outcome of dorsal onlay urethroplasty in 73 patients for stricture urethra over a period of eight years. Seventy-three patients of stricture urethra have undergone dorsal onlay urethroplasty from July 1998 to February 2006. Age distribution: 14-58 years. Trauma 20/73 (27.39%), Balanitis Xerotica Obliterans 2/73 (2.73%), Iatrogenic 26/73(35.61%), Infection 3/73 (4.10%), Idiopathic 22/73 (30.13%). Site: Penobulbar-25/73, bulbar-38/73, membranous-8/73 and long length-2/73. Suprapubic catheter was inserted preoperatively: 21/73 patients. Preputial / distal penile skin was used in all patients. Buccal mucosa was not used in any patient. Hospitalization was for four to five days. Catheter was removed after 21 days. All patients had their first endoscopic checkup after three months. Subsequently they were followed up by uroflometry. Routine imaging of urethra for follow-up was not carried out. 63/73 (86.30%) patients had satisfactory outcome not requiring any further treatment, 8/73 (10.95%) developed anastomotic stricture (3/8-optical internal urethrotomy, 5/8 dilatation alone). 2/73 (2.75%) developed external meatal stenosis. None had urinary fistula and required repeat urethroplasty. Follow-up ranged from three months to eight years. Dorsal onlay urethroplasty using preputial/distal penile skin is a satisfactory procedure. Preputial/distal penile skin is devoid of hair and fat and hence an ideal graft material. Even in circumscribed patients distal penile skin can be harvested. Long-term follow-up is required in judging results of patients with stricture urethra.

Metastatic prostate adenocarcinoma to the penis: a series of 29 cases with predilection for ductal adenocarcinoma.

PubMed

Ellis, Carla L; Epstein, Jonathan I

2015-01-01

Twenty-nine men with metastatic prostate adenocarcinoma to the penis were identified at our institution between 1993 and 2013. Of the 29 patients, 19 had a prior history of adenocarcinoma of the prostate, and 8 of those had ductal features in the primary lesion. Sixteen of 29 revealed ductal features in the metastasis. Seven of the 8 cases with ductal features in the primary had ductal features in the penile metastasis. Seven penile metastases were proven to be of prostatic origin solely by immunohistochemistry. Three cases were originally misdiagnosed as urothelial carcinoma upon review of the penile lesion. Other variant morphologies in the metastases included sarcomatoid carcinoma, small cell carcinoma, and adenosquamous carcinoma. In summary, prostate carcinoma involving the penis displays ductal features considerably more often than prostate cancer in general. Features that can cause difficulty in recognizing metastatic prostate adenocarcinoma to the penis include the unusual anatomic site for prostate cancer, poor differentiation, an increased prevalence of variant morphology, a long interval from the primary lesion, and, in some cases, no documented history of a primary prostatic lesion. Immunohistochemical analysis should be performed to rule out prostate carcinoma in penile/penile urethral tumors with morphology that differs from typical squamous or urothelial carcinoma. Even in the setting of metastatic disease, there is a critical need for an accurate diagnosis so that the appropriate therapy can be initiated, symptomatic relief can be provided, and long-term survival achieved in some cases, while at the same time avoiding penectomy for a misdiagnosis of a primary penile cancer.

Penile sparing surgical approaches for primary penile tumors: preserving function and appearance

PubMed Central

Baumgarten, Adam S.; Fisher, John S.; Lawindy, Samuel M.; Pavlinec, Jonathan G.; Carrion, Rafael E.

2017-01-01

Penile cancer is a rare and potentially disfiguring disease. There are multiple treatment options for primary penile lesions. Penile sparing approaches offer an attractive option as they can provide several quality of life benefits without detrimental oncologic outcomes. With appropriate diagnostic evaluation and staging, penile sparing techniques provide proper cancer control with improved cosmetic and functional results. Regardless of the chosen treatment modality, a commitment to close follow-up remains a critical component of all treatment considerations. The goal of this review is to provide an overview of the multiple treatment strategies for primary penile tumors with a focus on penile sparing surgical approaches. PMID:29184777

Sexual function and tunica albuginea wound healing following penile fracture: An 18-year follow-up study of 352 patients from Kermanshah, Iran.

PubMed

Zargooshi, Javaad

2009-04-01

We present a study on the experiences of penile fracture in an Iranian population. Aim. To determine the long-term outcome of penile fracture. Between April 1990 and May 2008, 373 patients presented with clinical features suggestive of penile fracture. Of these, 11 declined surgery. The remaining 362 were operated upon using a degloving incision. Ten patients had venous injury and 352 had penile fracture. At follow-up visits, in addition to answering our questionnaire, the patients completed the International Index of Erectile Function (IIEF), Erection Hardness Grading Scale (EHGS), and global self-assessment of potency (GSAP). To enhance documentation and to promote transparency, with the patients' permission, their full name and hospital chart number was sent to the journal. Clinical findings and IIEF and EHGS scores. Mean patients' age was 29.6 years. Mean duration of follow-up was 93.6 months. Diagnosis was solely clinical. At presentation, 278 (78.9%) reported no pain. Cavernosography, ultrasonography, or magnetic resonance imaging was not used in any of the patients. Penile fracture was due to taqaandan in 269 patients (76.4%). Patients were treated with surgical exploration and repair within 24 hours of admission, regardless of delay in presentation. A nodule was found at follow-up in 330 patients (93.7%). The painless, mostly proximal nodule was palpated at the floor of the corpora cavernosa, in a deep midline position above the corpus spongiosum. The non-expansive nodule was not associated with erectile dysfunction (ED) or Peyronie's disease. Postoperative complications included mild penile pain in cold weather (two patients), transient wound edema (one patient), mild chordee (four patients), and occasional instability of the erect penis (one patient). Postoperatively, of the 217 patients who had partners, 214 (98.6%) were potent. Mean IIEF ED domain score was 29.8 +/- 1.1. The EHGS score was 4 in 203 and 3 in 11. The GSAP score was 0 in 204, 1 in 8, and 2 in 2. ED in the remaining three could not be explained by penile fracture. Of 10 nonoperated patients, eight (80%) developed ED. Pain is rare in penile fracture. Postoperatively, almost all patients develop a permanent, inconsequential, fibrotic nodule. Our time-tested approach provided excellent long-term sexual function.

Physiology of Penile Erection—A Brief History of the Scientific Understanding up till the Eighties of the 20th Century

PubMed Central

2015-01-01

Abstract Introduction Understanding the physiology of penile erection is important for all who work in the field of sexual medicine. Aim The aim of this study was to highlight and analyze historical aspects of the scientific understanding of penile erection. Methods (i) Review of the chapters on the physiology of erection out of the author's collection of books dealing with male sexual functioning published in the German, French, Dutch, and English language in between 1780 and 1940. (ii) Review of the topic “physiology of penile erection” of relevant chapters of C lassical writings on erectile dysfunction. A n annotated collection of original texts from three millennia, including the study of all relevant references mentioned in these books. Main Outcome Measure The main outcome measure used for the study was the scientific understanding of the physiology of penile erection. Results In Antiquity, Galen considered penile erection as the result the accumulation of air. His ideas so dominated medieval medicine that nearly everyone then alive was a Galenist. The beginning of the Renaissance shows meaningful examples of experimental scientific work on the penis. Da Vinci correctly concluded that erections were caused by blood, and in the 18th century, Von Haller from Switzerland was the first who explained that erections were under the control of the nervous system. In the 19th century, a mindset that emphasized on experimentation determined a new direction, namely experimental physiology. Animal studies clarified that stimulation of the nervi erigentes‐induced small muscle relaxation in the corpora cavernosa. Nearly all were published in the German language. That may be one of the reasons that the existence of the concept of smooth muscle relaxation remained controversial until the first World Congress on Impotence in 1984 in Paris. Conclusions As the Renaissance's innovative research defined neural and vascular physiologic phenomena responsible for penile erection. The concepts from animal experimentations in Europe in the 19th century significantly contributed to the current understanding of penile erection. van Driel MF. Physiology of penile erection—a brief history of the scientific understanding up till the eighties of the 20th century. Sex Med 2015;3:343–351. PMID:26797073

Penile suspensory ligament division for penile augmentation: indications and results.

PubMed

Li, Chi-Ying; Kayes, Oliver; Kell, Phillip D; Christopher, Nim; Minhas, Suks; Ralph, David J

2006-04-01

This study assessed the management of patients requesting penile length enhancement by division of the penile suspensory ligament. From September 1998 to January 2005, 42 patients with a variety of etiologies were included; all underwent division of the penile suspensory ligament. The outcome was assessed objectively based on increase in flaccid stretched penile length (SPL) and subjectively using the rates of patient satisfaction. The mean increase in SPL was 1.3+/-0.9 cm (range, -1 to +3 cm), with the addition of a silicone spacer placed between the pubis and penis giving a better outcome (p<0.05). The overall patient satisfaction rate was 35% but lower in the group with penile dysmorphic disorder at 27%. Division of the penile suspensory ligament or other augmentation techniques may increase penile length but usually not to a degree that satisfies the patient. Men with penile dysmorphic disorder often have unrealistic expectations regarding the outcome of surgical intervention and should be encouraged to seek psychological help primarily, with surgery reserved as the last resort.

Human papillomavirus and penile cancers in Rio de Janeiro, Brazil: HPV typing and clinical features.

PubMed

Scheiner, Marcos A; Campos, Mercia M; Ornellas, Antonio A; Chin, Eduardo W; Ornellas, Maria H; Andrada-Serpa, Maria J

2008-01-01

To determine the prevalence of human papillomavirus (HPV) DNA in penile cancers in Rio de Janeiro, Brazil. We studied, prospectively, 80 consecutive cases of patients with penile cancers who underwent surgical treatment at three different Hospitals in Rio de Janeiro between March 1995 and June 2000. Of these patients, 72 were diagnosed with invasive squamous cell carcinoma and 8 patients with verrucous carcinoma. The following parameters were observed: presence or absence of HPV DNA viral type, histological subtypes, clinical stage and overall survival. HPV DNA was detected in 75% of patients with invasive carcinomas and in 50% of patients with verrucous carcinomas. High risk HPVs were detected in 15 of 54 (27.8%) patients with HPV positive invasive tumors and in 1 of 4 (25%) patients with HPV positive verrucous tumors. HPV 16 was the most frequent type observed. No correlation was observed between HPV status and histological subtype (p = 0.51) as well as HPV status and stage stratification (p = 0.88). HPV status was also not significantly associated with the presence of regional metastases (p = 0.89). The overall survival was related to the presence of lymph node metastases (p < 0.0001). HPV infection may have contributed to malignant transformation in a large proportion of our penile cancer cases but only inguinal metastasis was a prognostic factor for survival in these patients with penile carcinoma.

Penile injuries: A 10-year experience

PubMed Central

Krishna Reddy, S.V.; Shaik, Ahammad Basha; Sreenivas, K.

2014-01-01

We report our 10-year experience with penile injuries. We retrospectively reviewed the records of 156 cases of male external genitalia injuries between May 2002 and December 2012. Of these, only 26 patients presented without urethral injuries and were included in this study. Patients were divided into 4 groups: Group 1 (n = 12) with patients with penile fractures injuries; Group 2 (n = 5) with patients with penile amputation injuries; Group 3 (n = 2) with patients with penile penetrating injuries; and Group 4 (n = 7) with patients with penile soft tissue injuries. Grading of injury was done using the American Association for the Surgery of Trauma (AAST)-Organ injury scale of penile injury. Penile injuries without urethral injuries are urological emergencies which require immediate attention. PMID:25295134

Ultrasound diagnosis of penile fracture.

PubMed

Nomura, Jason T; Sierzenski, Paul R

2010-04-01

Rupture of the corpus cavernosum, penile fracture, is an uncommon occurrence. Diagnosis is straightforward when classical historical and physical examination findings are present. However, atypical presentations can make the diagnosis difficult. Review the literature supporting use of ultrasound for the diagnosis of penile fracture. Review of the ultrasonographic findings in patients with penile fracture. A 32-year-old man presented with penile ecchymosis after sex but lacking several historical and physical examination elements for a diagnosis of penile fracture. Ultrasound performed by the treating physician revealed rupture of the tunica albuginea and presence of a hematoma, leading to a diagnosis of penile fracture. Ultrasound is a simple, efficient, and non-invasive imaging method to assist in the diagnosis of penile fracture. Copyright 2010 Elsevier Inc. All rights reserved.

False penile fracture: report of 16 cases.

PubMed

Feki, W; Derouiche, A; Belhaj, K; Ouni, A; Ben Mouelhi, S; Ben Slama, M R; Ayed, M; Chebil, M

2007-01-01

We determined the value of diagnostic and therapeutic approaches of false penile fractures and the outcome of treatment. We retrospectively reviewed 16 cases of presumed penile fracture with a negative surgical exploration. Clinical presentation, technique of treatment and outcome were noted. The mean age was 39 years (17-64). Nine patients were injured during sexual intercourse. All the patients presented with the presumptive diagnosis of penile fracture. False penile fracture was evoked in one patient presenting a new erection. Surgical penile exploration was carried out for all the patients without any radiological explorations. It revealed nonspecific dartos bleeding in 10 cases and avulsed superficial dorsal vein in six cases requiring venous ends ligation. All the patients regained penile appearance and potency. We can hardly distinguish false penile fracture from 'true' penile fracture with certainty either clinically or radiologically, thus, surgical exploration is mostly necessary. The prognosis is excellent.

The Ethics of Penile Transplantation: Preliminary Recommendations.

PubMed

Caplan, Arthur L; Kimberly, Laura L; Parent, Brendan; Sosin, Michael; Rodriguez, Eduardo D

2017-06-01

For men with significant genitourinary injury, penile transplantation is being considered as an option when reconstruction is not feasible or proves unacceptable to the injured patient. A review of the literature was conducted to assess the current state of penile reconstruction and transplantation options, as well as to evaluate scholarly research addressing the ethical dimensions of penile transplantation. The state of penile transplantation is elementary. If reconstruction is not a possibility, proceeding ethically with research on penile vascularized composite allotransplantation will require the articulation of guidelines. To date, very little has been published in the scholarly literature assessing the ethics of penile transplantation. Guidelines should be developed to address penile transplantation and must cover the donation of tissue, consent, subject selection, qualifications of the surgical team, and management of both failure and patient dissatisfaction. Unless guidelines are established and disseminated, penile transplants should not be undertaken. The preliminary recommendations suggested in this article may help to inform development of guidelines.

Successful Treatment of Residual Curvature in Peyronie Disease in Men Previously Treated With Intralesional Collagenase Clostridium Histolyticum.

PubMed

DeLay, Kenneth; Diao, Linley; Nguyen, Hoang Minh Tue; Zurawin, Jonathan; Libby, Russell; Yafi, Faysal; Hellstrom, Wayne J G

2017-12-01

To determine the success and feasibility of surgically correcting residual curvature after intralesional collagenase clostridium histolyticum (CCH) for the treatment of Peyronie disease (PD). We performed a retrospective analysis of patients who had intralesional CCH treatment for PD and who subsequently underwent penile plication (PP), plaque incision and grafting (PIG), or inflatable penile prosthesis (IPP) placement. Ten men who underwent PP, PIG, or IPP for the treatment of residual curvature after intralesional CCH were identified. Six patients underwent PP; 1 patient underwent PIG; and 3 patients underwent IPP with ancillary straightening maneuvers. The mean time from the last CCH injection to surgical correction was 150.9 days, or 5 months. The mean pre-CCH curvature was 67 degrees and the mean post-CCH curvature was 51 degrees. Eight of 10 patients had no residual curvature after surgical treatment. The mean postprocedure curvature was 4.5 degrees. The mean operative time was 72.1 minutes. The mean estimated blood loss was 20 mL. Increased fibrosis with increased surgical difficulty was noted in 3 (all <6 months post CCH treatment) of 10 patients. No postoperative complications were noted. The surgical treatment of PD after intralesional CCH is safe and effective. If surgery is considered, this should be performed at least 6 months after the last CCH injection, given the potential for an increased inflammatory reaction in this area. Copyright © 2017 Elsevier Inc. All rights reserved.

The Inflatable Poster

NASA Astrophysics Data System (ADS)

Tackley, P. J.

2004-12-01

Inflatable devices are frequently used in advertising in order to grab the attention of consumers: one sees, for example, 20 foot tall inflatable drink containers, inflatable cell phones, inflatable bubble gum packets, as well as blimps wafting majestically over major sports events. More usefully, inflatable representations of scientifically-interesting items are widely available, including astronauts, space shuttles, dinosaurs and globes and can help to build and inspire the interest of the general public, and in particular children, in such ideas. How can such concepts be adapted to improve poster presentations? Possibility one is to use relevant existing commercially-available inflatables to dress the poster: skeletons, astronauts, globes and so forth. More exciting is to develop custom inflatables that represent three-dimensional renderings of objects that the poster is describing. Examples of individual objects might be an inflatable slab, inflatable avalanche, inflatable plume, or it's larger cousin, the 10 foot high inflatable superplume or 20 foot high inflatable megaplume. More elaborately, inflatables might represent isosurfaces in three-dimensional spherical convection, although other fabrication methods may be more suitable. More simply, inflatable spheres could be imprinted with the planform of convection, geoid, or other spherical fields of geophysical interest. Finally, it should be possible to put an entire poster on an inflatable object, possibly small ones (balloons) to hand out. A major concern, however, is that the presenter may use such techniques to inflate their scientific findings, or to present overblown ideas.

False fracture of the penis: Different pathology but similar clinical presentation and management.

PubMed

Kurkar, Adel; Elderwy, Ahmad A; Orabi, Hazem

2014-01-01

Penile fracture is the most common presentation of acute penis. Rupture of the superficial dorsal penile vein (s) may mimic penile fractures with similar clinical presentation but with intact corporeal bodies. Our aim of the study is to highlight superficial dorsal penile vein (s) injury as true emergency with better prognosis. Sixty-eight patients with suspected penile fractures presented to our hospital between June 2007 and January 2013. Out of these, 11 patients showed intact tunica albuginea on exploration with injured dorsal penile vein (s) identified. Records of such 11 cases were reviewed regarding age, etiology, symptoms, physical signs, findings of surgical exploration and post-operative erectile function. All 11 patients were injured during sexual intercourse and presented with penile swelling and ecchymosis and gradual detumescence. Mild penile pain was encountered in 5 cases and the "snap" sound was noted in 2 cases. Examination revealed no localized tenderness, or tunical defect. All the patients regained penile potency without deformity after surgical ligation of the severed vessels. One patient developed penile hypoesthesia. Although the classic "snap" sound and immediate detumescence are usually lacking in the symptomology of dorsal penile vein rupture, its clinical presentation can be indistinguishable from true penile fracture. Surgical exploration is still required to avoid missing tunical tear with possible future complications. The long-term outcome and prognosis are excellent.

False fracture of the penis: Different pathology but similar clinical presentation and management

PubMed Central

Kurkar, Adel; Elderwy, Ahmad A.; Orabi, Elderwy

2014-01-01

Introduction: Penile fracture is the most common presentation of acute penis. Rupture of the superficial dorsal penile vein (s) may mimic penile fractures with similar clinical presentation but with intact corporeal bodies. Our aim of the study is to highlight superficial dorsal penile vein (s) injury as true emergency with better prognosis. Subjects and Methods: Sixty-eight patients with suspected penile fractures presented to our hospital between June 2007 and January 2013. Out of these, 11 patients showed intact tunica albuginea on exploration with injured dorsal penile vein (s) identified. Records of such 11 cases were reviewed regarding age, etiology, symptoms, physical signs, findings of surgical exploration and post-operative erectile function. Results: All 11 patients were injured during sexual intercourse and presented with penile swelling and ecchymosis and gradual detumescence. Mild penile pain was encountered in 5 cases and the “snap” sound was noted in 2 cases. Examination revealed no localized tenderness, or tunical defect. All the patients regained penile potency without deformity after surgical ligation of the severed vessels. One patient developed penile hypoesthesia. Conclusion: Although the classic “snap” sound and immediate detumescence are usually lacking in the symptomology of dorsal penile vein rupture, its clinical presentation can be indistinguishable from true penile fracture. Surgical exploration is still required to avoid missing tunical tear with possible future complications. The long-term outcome and prognosis are excellent. PMID:24669117

Overexpression of ANXA1 in penile carcinomas positive for high-risk HPVs.

PubMed

Calmon, Marilia Freitas; Mota, Mânlio Tasso de Oliveira; Babeto, Érica; Candido, Natália Maria; Girol, Ana Paula; Mendiburu, Carlos Fabian; Bonilha, Jane Lopes; Silvestre, Rodrigo Vellasco Duarte; Rosa, Bruno Miziara; Thomé, Jorge Alberto; Medeiros, Gustavo Hernandez Américo; Soares, Fernando Augusto; Guimarães, Gustavo Cardoso; de Arruda, José Germano Ferraz; Oliani, Sonia Maria; Villa, Luisa Lina; Vassallo, José; Rahal, Paula

2013-01-01

The incidence of penile cancer varies between populations but is rare in developed nations. Penile cancer is associated with a number of established risk factors and associated diseases including phimosis with chronic inflammation, human papillomavirus (HPV) infection, poor hygiene and smoking. The objective of this study was to identify genes related to this type of cancer. The detection of HPV was analyzed in 47 penile squamous cell carcinoma samples. HPV DNA was detected in 48.9% of penile squamous cell carcinoma cases. High-risk HPV were present in 42.5% of cases and low-risk HPV were detected in 10.6% of penile squamous cell carcinomas. The RaSH approach identified differential expression of Annexin A1 (ANXA1), p16, RPL6, PBEF1 and KIAA1033 in high-risk HPV positive penile carcinoma; ANXA1 and p16 were overexpressed in penile squamous cells positive for high-risk HPVs compared to normal penile samples by qPCR. ANXA1 and p16 proteins were significantly more expressed in the cells from high-risk HPV-positive penile carcinoma as compared to HPV-negative tumors (p<0.0001) independently of the subtype of the carcinoma. Overexpression of ANXA1 might be mediated by HPV E6 in penile squamous cell carcinoma of patients with high-risk HPVs, suggesting that this gene plays an important role in penile cancer.

Overexpression of ANXA1 in Penile Carcinomas Positive for High-Risk HPVs

PubMed Central

Calmon, Marilia Freitas; Mota, Mânlio Tasso de Oliveira; Babeto, Érica; Candido, Natália Maria; Girol, Ana Paula; Mendiburu, Carlos Fabian; Bonilha, Jane Lopes; Silvestre, Rodrigo Vellasco Duarte; Rosa, Bruno Miziara; Thomé, Jorge Alberto; Medeiros, Gustavo Hernandez Américo; Soares, Fernando Augusto; Guimarães, Gustavo Cardoso; de Arruda, José Germano Ferraz; Oliani, Sonia Maria; Villa, Luisa Lina; Vassallo, José; Rahal, Paula

2013-01-01

The incidence of penile cancer varies between populations but is rare in developed nations. Penile cancer is associated with a number of established risk factors and associated diseases including phimosis with chronic inflammation, human papillomavirus (HPV) infection, poor hygiene and smoking. The objective of this study was to identify genes related to this type of cancer. The detection of HPV was analyzed in 47 penile squamous cell carcinoma samples. HPV DNA was detected in 48.9% of penile squamous cell carcinoma cases. High-risk HPV were present in 42.5% of cases and low-risk HPV were detected in 10.6% of penile squamous cell carcinomas. The RaSH approach identified differential expression of Annexin A1 (ANXA1), p16, RPL6, PBEF1 and KIAA1033 in high-risk HPV positive penile carcinoma; ANXA1 and p16 were overexpressed in penile squamous cells positive for high-risk HPVs compared to normal penile samples by qPCR. ANXA1 and p16 proteins were significantly more expressed in the cells from high-risk HPV-positive penile carcinoma as compared to HPV-negative tumors (p<0.0001) independently of the subtype of the carcinoma. Overexpression of ANXA1 might be mediated by HPV E6 in penile squamous cell carcinoma of patients with high-risk HPVs, suggesting that this gene plays an important role in penile cancer. PMID:23341933

Vasomotor tone does not affect perfusion heterogeneity and gas exchange in normal primate lungs during normoxia

NASA Technical Reports Server (NTRS)

Glenny, R. W.; Robertson, H. T.; Hlastala, M. P.

2000-01-01

To determine whether vasoregulation is an important cause of pulmonary perfusion heterogeneity, we measured regional blood flow and gas exchange before and after giving prostacyclin (PGI(2)) to baboons. Four animals were anesthetized with ketamine and mechanically ventilated. Fluorescent microspheres were used to mark regional perfusion before and after PGI(2) infusion. The lungs were subsequently excised, dried inflated, and diced into approximately 2-cm(3) pieces (n = 1,208-1,629 per animal) with the spatial coordinates recorded for each piece. Blood flow to each piece was determined for each condition from the fluorescent signals. Blood flow heterogeneity did not change with PGI(2) infusion. Two other measures of spatial blood flow distribution, the fractal dimension and the spatial correlation, did not change with PGI(2) infusion. Alveolar-arterial O(2) differences did not change with PGI(2) infusion. We conclude that, in normal primate lungs during normoxia, vasomotor tone is not a significant cause of perfusion heterogeneity. Despite the heterogeneous distribution of blood flow, active regulation of regional perfusion is not required for efficient gas exchange.

Penile fracture: preoperative evaluation and surgical technique for optimal patient outcome.

PubMed

Kamdar, Ciamack; Mooppan, Unni M M; Kim, Hong; Gulmi, Frederick A

2008-12-01

To review the preoperative diagnostic evaluation and surgical treatment of penile fracture, as the condition is a urological emergency that requires immediate surgical exploration and repair. Between January 2003 and October 2007 eight patients presented to the emergency department with penile fracture after sexual intercourse. The clinical presentation, preoperative evaluation and imaging, surgical technique, and postoperative care were assessed to determine the optimal patient outcome. Seven of the eight patients were treated surgically and one refused surgical intervention. Four cases involved unilateral corporal injury, two involved unilateral corporal injury with an associated urethral injury, and one involved bilateral corporal injury with an associated urethral injury. Although retrograde urethrogram were taken of all three urethral injuries, none of them revealed the injury. Diagnostic cavernosography or magnetic resonance imaging were not used in any of the patients. No complications occurred in the patients treated surgically. Preoperative imaging should not delay surgical repair. If an associated urethral injury is suspected, flexible cystoscopy is recommended in the operating room, as opposed to a retrograde urethrogram. A subcoronal circumcising incision is recommended to deglove the entire penile shaft and have complete access to all three corporal bodies, as well as the neurovascular bundle. Saline mixed with indigo carmine can be injected both into the corpora cavernosum or corpus spongiosum via the glans penis, after a tourniquet is placed at the base of the penis, to evaluate the surgical repair and to determine if there are any missed injuries.

Human papillomavirus-associated increase in p16INK4A expression in penile lichen sclerosus and squamous cell carcinoma.

PubMed

Prowse, D M; Ktori, E N; Chandrasekaran, D; Prapa, A; Baithun, S

2008-02-01

Human papillomaviruses (HPVs) are sexually transmitted human carcinogens that may play a role in the oncogenesis of penile cancer. To investigate the role of HPV infection and expression of the tumour suppressor protein p16INK4A in the pathogenesis of penile cancer. By means of polymerase chain reaction amplification and reverse hybridization line probe assay to detect HPV infection, and immunohistochemical staining for p16INK4A and Ki67, we analysed 26 penile squamous cell carcinomas (SCCs) and 20 independent penile lichen sclerosus (LS) lesions from 46 patients. HPV DNA was found in 54% of penile SCCs and 33% of penile LS cases in single and multiple infections. High-risk HPV 16 was the predominant HPV type detected. No relationship between Ki67 expression and HPV infection was observed. Strong immunostaining for p16INK4A correlated with HPV 16/18 infection in both penile LS and penile SCC. In our penile SCC series the cancer margins were also associated with penile LS in 13 of 26 lesions, and HPV was detected in seven of the 13 SCC cases associated with LS and in six of the 11 SCC lesions not involving LS. Our study shows a high prevalence of HPV 16 and p16INK4A expression in penile lesions, consistent with an active role for HPV in interfering with the retinoblastoma pathway. High-risk HPV infection could be involved in the tumorigenic process in 50% of penile cancers, and the use of prophylactic HPV vaccines has the potential to prevent these cancers.

Comparison of efficacy and satisfaction profile, between penile prosthesis implantation and oral PDE5 inhibitor tadalafil therapy, in men with nerve-sparing radical prostatectomy erectile dysfunction.

PubMed

Megas, Georgios; Papadopoulos, Georgios; Stathouros, Georgios; Moschonas, Dimitrios; Gkialas, Ioannis; Ntoumas, Konstantinos

2013-07-01

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Erectile dysfunction after nerve-sparing radical retropubic prostatectomy constitutes a challenge to the urologist. The mainstay of medical treatment after radical prostatectomy to restore spontaneous erectile function remains phosphodiesterase (PDE5) inhibitors, despite the fact that data from animal studies suggesting that PDE5 inhibitors can prevent smooth muscle apoptosis and fibrosis have not yet been extrapolated to humans because of a lack of standardized protocols. If the above treatment fails, second-line therapies such as intraurethral prostaglandins, penile injection therapy and vacuum devices are offered. When less invasive therapies are ineffective, interventions that preserve sexual function such as penile prosthesis implantation become the treatment of choice. Our study reveals the alternative of penile prosthesis implantation as first-line treatment in erectile dysfunction after nerve-sparing radical prostatectomy. It also highlights its superiority to the oral PDE5 inhibitor treatment, regarding the erection, frequency, firmness, maintenance and penetration ability. This suggests that a concept of an early penile intervention in the future would be promising for those patients who wish to remain sexually active without depending on oral formulations with doubtful and delayed results. To evaluate the outcome of penile prosthesis surgery in comparison to oral phosphodiesterase type 5 (PDE5) inhibitor administration, in men with erectile dysfunction after nerve-sparing radical prostatectomy, as early penile intervention therapy. A total of 174 patients treated by nerve-sparing retropubic radical prostatectomy (RRP) for clinically localized prostate cancer, between January 2006 and September 2009 enrolled in the study, 153 patients fulfilled the inclusion criteria, and 69 (45%) patients presented with post-RRP erectile dysfunction 6 months after primary surgery. Fifty-four patients were disease-free and subdivided into two arms according to treatment modality, either tadalafil three times/week or penile prosthesis implantation. All patients were evaluated using the International Index of Erectile Function (IIEF) questionnaire preoperatively and at 6, 12 and 24 month postoperatively. Repeated measurements analysis of variance was conducted to evaluate the effect of time and group on IIEF total score. There was a significant reduction in IIEF score from preoperative values to the first measurement after surgery in both treatment groups. The overall degree of change from the first time point immediately after surgery to 2 years was greater in the penile prosthesis group than the tadalafil group (20.4 ± 1.3 vs 8.1 ± 2.4, P < 0.001). The efficacy and satisfaction results of both treatment types are considered acceptable. However, regarding the erection frequency, firmness, penetration ability, maintenance and erection confidence it seems that penile prosthesis implantation is superior to oral treatment. The concept of early penile intervention should be considered and is promising for all patients with post-RRP erectile dysfunction. © 2012 BJU International.

Bathing suit mesh entrapment: an unusual case of penile injury.

PubMed

Hoppa, Eric C; Wiley, James F

2006-12-01

Penile injury is a rare chief complaint in the pediatric emergency department. The most common penile injuries are iatrogenic or postsurgical complications, blunt trauma, tourniquet injuries, fractures, and zipper injuries. We report a series of 3 cases of penile foreskin entrapment within the mesh lining of bathing suits as a new, recognized form of penile injury.

Penile Dislocation with Inversion: A Rare Complication of Blunt Pelvic Injury

PubMed Central

Sahadev, Ravindra; Jadhav, Vinay; Munianjanappa, Narendra Babu; Shankar, Gowri

2018-01-01

Penile injuries in children are usually uncommon and are predominantly associated with pelvic trauma or as postcircumcision injuries. The authors present a rare case of penile dislocation with penile inversion in a 5-year-old child occurring due to blunt pelvic injury. The child presented 3 months after pelvic injury with a suprapubic catheter for urinary diversion and absent penis with only penile skin visible. The presence of dislocated penile body was detected on magnetic resonance imaging, which was subsequently confirmed intraoperatively. During the surgery, the dislocated penis was identified and mobilized into its normal anatomical position within the remnant penile skin. Very few cases of penile dislocation have been reported in the literature. Pubic fracture with pulling of suspensory ligament resulting in dislocation of the penis would have been the probable mechanism of injury. PMID:29681700

Superficial Dorsal Venous Rupture of the Penis: False Penile Fracture That Needs to be Treated as a True Urologic Emergency.

PubMed

Truong, Hong; Ferenczi, Basil; Cleary, Ryan; Healy, Kelly A

2016-11-01

A 38-year-old man with history of repaired penile fracture presented with rapid detumescence, penile pain, and ecchymosis during vaginal sexual intercourse concerning for recurrent fracture. Surgical exploration revealed ruptured superficial dorsal vein of the penis, which was subsequently ligated. Patients with traumatic penile vascular injuries often present with clinical features indistinguishable from a true penile fracture. Gradual detumescence and an absence of characteristic popping sound may indicate a vascular injury but they cannot safely rule out a true penile fracture. Both true and false penile fractures require emergent surgical exploration and repair to prevent long-term complications. Copyright © 2016 Elsevier Inc. All rights reserved.

Defining a glycated haemoglobin (HbA1c) level that predicts increased risk of penile implant infection.

PubMed

Habous, Mohamad; Tal, Raanan; Tealab, Alaa; Soliman, Tarek; Nassar, Mohammed; Mekawi, Zenhom; Mahmoud, Saad; Abdelwahab, Osama; Elkhouly, Mohamed; Kamr, Hatem; Remeah, Abdallah; Binsaleh, Saleh; Ralph, David; Mulhall, John

2018-02-01

To re-evaluate the role of diabetes mellitus (DM) as a risk factor for penile implant infection by exploring the association between glycated haemoglobin (HbA1c) levels and penile implant infection rates and to define a threshold value that predicts implant infection. We conducted a multicentre prospective study including all patients undergoing penile implant surgery between 2009 and 2015. Preoperative, perioperative and postoperative management were identical for the entire cohort. Univariate analysis was performed to define predictors of implant infection. The HbA1c levels were analysed as continuous variables and sequential analysis was conducted using 0.5% increments to define a threshold level predicting implant infection. Multivariable analysis was performed with the following factors entered in the model: DM, HbA1C level, patient age, implant type, number of vascular risk factors (VRFs), presence of Peyronie's disease (PD), body mass index (BMI), and surgeon volume. A receiver operating characteristic (ROC) curve was generated to define the optimal HbA1C threshold for infection prediction. In all, 902 implant procedures were performed over the study period. The mean patient age was 56.6 years. The mean HbA1c level was 8.0%, with 81% of men having a HbA1c level of >6%. In all, 685 (76%) implants were malleable and 217 (24%) were inflatable devices; 302 (33.5%) patients also had a diagnosis of PD. The overall infection rate was 8.9% (80/902). Patients who had implant infection had significantly higher mean HbA1c levels, 9.5% vs 7.8% (P < 0.001). Grouping the cases by HbA1c level, we found infection rates were: 1.3% with HbA1c level of <6.5%, 1.5% for 6.5-7.5%, 6.5% for 7.6-8.5%, 14.7% for 8.6-9.5%, 22.4% for >9.5% (P < 0.001). Patient age, implant type, and number of VRFs were not predictive. Predictors defined on multivariable analysis were: PD, high BMI, and high HbA1c level, whilst a high-volume surgeon had a protective effect and was associated with a reduced infection risk. Using ROC analysis, we determined that a HbA1c threshold level of 8.5% predicted infection with a sensitivity of 80% and a specificity of 65%. Uncontrolled DM is associated with increased risk of infection after penile implant surgery. The risk is directly related to the HbA1c level. A threshold HbA1c level of 8.5% is suggested for clinical use to identify patients at increased infection risk. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

20-year experience with iatrogenic penile injury.

PubMed

Amukele, Samuel A; Lee, Gene W; Stock, Jeffrey A; Hanna, Moneer K

2003-10-01

We review our experience with the management of iatrogenic penile injuries. Apart from circumcision, serious damage to the penis can occur following hypospadias repair, surgery for priapism or total loss of the penis following surgical repair of bladder exstrophy. A retrospective analysis of patients with iatrogenic penile amputation referred to us between 1980 and 2000 was undertaken. Causes of injury and choice of management were reviewed. Of the 13 cases treated during the 20-year period mechanism of primary injury was circumcision in 4, hypospadias repair in 6, priapism in 1, bladder exstrophy repair in 1 and penile carcinoma in 1. A variety of techniques were used for phallic reconstruction. Penile degloving, division of suspensory ligament and rotational skin flaps achieved penile augmentation and enhancement. Reasonable cosmesis and penile length were achieved in all cases. In indicated cases microsurgical phalloplasty was technically feasible. However long-term followup showed various complications including erosions from the use of a penile stiffener. The ultimate goal of reconstructive surgery is to have a penis with normal function and appearance. The management of penile injury requires a wide variety of surgical techniques that are tailored to the individual patient. Expedient penile reconstruction is successful and therapeutic delay is associated with complications.

Safety Profile of Collagenase Clostridium Histolyticum Stratified by Degree of Penile Curvature in Patients With Peyronie Disease.

PubMed

Hellstrom, Wayne J G; Tan, Ronny B W; Liu, Genzhou

2017-08-01

To examine the safety of collagenase clostridium histolyticum (CCH) in adult men with penile curvature deformity <30°. CCH is indicated for treatment of Peyronie disease in adult men with palpable plaque and a penile curvature deformity ≥30° at start of therapy; however, during treatment, patients may receive CCH injections when penile curvature deformity is <30°. Patients who received ≥2 CCH treatment cycles in 2 phase 3 studies (Investigation for Maximal Peyronie's Reduction Efficacy and Safety Studies I and II) were included. All patients had penile curvature ≥30° at the beginning of treatment and could receive up to 4 treatment cycles. The rate and number of treatment-related adverse events (TRAEs) with CCH treatment were compared between patients with penile curvature deformity ≥30° and penile curvature <30°. The number of CCH treatment cycles included in the current analysis totaled 1204 and 289 cycles in patients with penile curvature deformity ≥30° and <30°, respectively. The incidence of most TRAEs was similar between groups. Rates of penile swelling (21.1% vs 14.5%, P = .007), penile hemorrhage (12.8% vs 8.9%; P = .046), and skin hyperpigmentation (1.0% vs 0.1%; P = .025) were significantly higher in the <30° group. The occurrence of serious TRAEs was similar between groups. No clinically meaningful differences were observed with TRAE rates when CCH injections were administered at penile curvature deformity ≥30° vs CCH injections at penile curvature deformity <30°. These findings highlight the safety of continued CCH injections for patients who have achieved penile curvature deformity <30° after an initial treatment cycle of CCH. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Penile erection responses of Nigella sativa seed extract on isolated rat corpus cavernosum

NASA Astrophysics Data System (ADS)

Aminyoto, M.; Ismail, S.

2018-04-01

Nigella sativa L. (NS) from Ranunculaceae family is known as black cumin in Indonesia. The seed has been used as an aphrodisiac in ethnobotanical studies and reported to have pharmacological activities such as antihypertensive through the relaxant effect of vascular smooth muscles but the direct effect to the blood vessels of the corpus cavernosum is still unknown. The purpose of this study was to examine the response of NS seed extract on penile erection in vitro. NS seeds were macerated in ethanol solvent for three days in room temperature and repeated for two times. Penile erection responses was assessed using isolated rat corpus cavernosum in Krebs-Henseleit solution, temperature 37°C, pH 7.4, aerated with carbogen gas. After acclimation, corpus cavernosum was contracted with a phenylephrine solution. Ethanolic extract of NS seeds or control solution were given after reaching the plateu phase of the highest contraction. This study showed that the contraction response of the corpus cavernosum decreased after addition of NS extract and this action was increased with the addition of the extract concentration. This study concluded that NS seed ethanol extract affects the penile erection response directly through the relaxation of blood vessels in the corpus cavernosum.

Bladder outlet obstruction treated with transurethral ultrasonic aspiration

NASA Astrophysics Data System (ADS)

Malloy, Terrence R.

1991-07-01

Fifty-nine males with bladder outlet obstruction were treated with transurethral ultrasonic aspiration of the prostate. Utilizing a 26.5 French urethral sheath, surgery was accomplished with a 10 French, 0-700 micron vibration level ultrasonic tip with an excursion rate of 39 kHz. Complete removal of the adenoma was accomplished, followed by transurethral electrocautery biopsies of both lateral lobes to compare pathologic specimens. One-year follow-up revealed satisfactory voiding patterns in 57 of 59 men (96%). Two men developed bladder neck contractures. Pathologic comparisons showed 100% correlation between aspirated and TUR specimens (56 BPH, 3 adeno-carcinoma). Forty-sevel men were active sexually preoperatively (6 with inflatable penile prostheses). Post ultrasonic aspiration, 46 men had erectile function similar to preoperative levels with one patient suffering erectile dysfunction. Forty men (85%) had antegrade ejaculation while 7 (15%) experienced retrograde or retarded ejaculation. No patients were incontinent.

Diagnosis and management of premalignant penile lesions

PubMed Central

Shabbir, Majid; Minhas, Suks; Muneer, Asif

2011-01-01

Diagnosing premalignant penile lesions from benign penile dermatoses presents a unique challenge. The rarity of these conditions and the low incidence of penile cancer mean that the majority of our knowledge is based on small, non-randomized, retrospective studies. The introduction of specialist penile cancer centres in the UK has resulted in the centralization of expertise and resources, and has furthered our understanding of the biological behaviour and management of this rare malignancy. We review the current trends in the approach to diagnosing and treating various premalignant penile conditions. PMID:21904571

Dorsal vein rupture after practice of taqaandan, necrotising cavernositis, penile reconstruction, urethroplasty and penile prosthesis implantation.

PubMed

Faydaci, G; Ozgul, A; Kuyumcuoglu, U; Aktoz, T; Oder, M

2012-05-01

Penile fracture is an uncommon and emergent urologic condition defined as traumatic rupture of the corpus cavernosum secondary to a blunt trauma of the erect penis. Tunica albuginea is thinned and stretched in the erect state, and a transverse tear in the corpus cavernosums may occur by a buckling force. However, penile dorsal vein tears may mimic penile fracture. Also, corporeal infection and purulent cavernositis are associated with trauma, cavernosography, priapism, intracavernosal injection therapy and penile prosthesis. © 2011 Blackwell Verlag GmbH.

T-piece resuscitators: how do they compare?

PubMed

Hinder, Murray; McEwan, Alistair; Drevhammer, Thomas; Donaldson, Snorri; Tracy, Mark Brian

2018-05-04

The T-piece resuscitator (TPR) has seen increased use as a primary resuscitation device with newborns. Traditional TPR design uses a high resistance expiratory valve to produce positive end expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) at resuscitation. A new TPR device that uses a dual flow ratio valve (fluidic flip) to produce PEEP/CPAP is now available (rPAP). We aimed to compare the measured ventilation performance of different TPR devices in a controlled bench test study. Single operator provided positive pressure ventilation to an incremental testlung compliance (Crs) model (0.5-5 mL/cmH 2 O) with five different brands of TPR device (Atom, Neopuff, rPAP, GE Panda warmer and Draeger Resuscitaire). At recommended peak inflation pressure (PIP) 20 cmH 2 O, PEEP of 5 cmH 2 O and rate of 60 inflations per minute. 1864 inflations were analysed. Four of the five devices tested demonstrated inadvertent elevations in mean PEEP (5.5-10.3 cmH 2 O, p<0.001) from set value as Crs was increased, while one device (rPAP) remained at the set value. Measured PIP exceeded the set value in two infant warmer devices (GE and Draeger) with inbuilt TPR at Crs of 0.5 (24.5 and 23.5 cmH 2 O, p<0.001). Significant differences were seen in tidal volumes across devices particularly at higher Crs (p<0.001). Results show important variation in delivered ventilation from set values due to inherent TPR device design characteristics with a range of lung compliances expected at birth. Device-generated inadvertent PEEP and overdelivery of PIP may be clinically deleterious for term and preterm newborns or infants with larger Crs during resuscitation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Toward inflation models compatible with the no-boundary proposal

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hwang, Dong-il; Yeom, Dong-han, E-mail: dongil.j.hwang@gmail.com, E-mail: innocent.yeom@gmail.com

2014-06-01

In this paper, we investigate various inflation models in the context of the no-boundary proposal. We propose that a good inflation model should satisfy three conditions: observational constraints, plausible initial conditions, and naturalness of the model. For various inflation models, we assign the probability to each initial condition using the no-boundary proposal and define a quantitative standard, typicality, to check whether the model satisfies the observational constraints with probable initial conditions. There are three possible ways to satisfy the typicality criterion: there was pre-inflation near the high energy scale, the potential is finely tuned or the inflationary field space ismore » unbounded, or there are sufficient number of fields that contribute to inflation. The no-boundary proposal rejects some of naive inflation models, explains some of traditional doubts on inflation, and possibly, can have observational consequences.« less

Use of penile extender device in the treatment of penile curvature as a result of Peyronie's disease. Results of a phase II prospective study.

PubMed

Gontero, Paolo; Di Marco, Massimiliano; Giubilei, Gianluca; Bartoletti, Riccardo; Pappagallo, Giovanni; Tizzani, Alessandro; Mondaini, Nicola

2009-02-01

Pilot experiences have suggested that tension forces exerted by a penile extender may reduce penile curvature as a result of Peyronie's disease. To test this hypothesis in a Phase II study using a commonly marketed brand of penile extender. Peyronie's disease patients with a curvature not exceeding 50 degrees with mild or no erectile dysfunction (ED) were eligible. Fifteen patients were required to test the efficacy of the device assuming an effect size of >0.8, consistent with an "important" reduction in penile curvature. Changes in penile length over baseline and erectile function (EF) domain scores of the International Index of Erectile Function (IIEF) constituted secondary end points. Patients were counselled on the use of the penile extender for at least 5 hours per day for 6 months. Photographic pictures of the erect penis and measurements were carried out at baseline, at 1, 3, 6, and 12 months (end of study). The IIEF-EF domain scores were administered at baseline and at the end of study. Treatment satisfaction was assessed at end of study using a nonvalidated institutional 5-item questionnaire. Penile curvature decreased from an average of 31 degrees to 27 degrees at 6 months without reaching the effect size (P = 0.056). Mean stretched and flaccid penile length increased by 1.3 and 0.83 cm, respectively at 6 months. Results were maintained at 12 months. Overall treatment results were subjectively scored as acceptable in spite of curvature improvements, which varied from "no change" to "mild improvement." In our study, the use of a penile extender device provided only minimal improvements in penile curvature but a reasonable level of patient satisfaction, probably attributable to increased penile length. The selection of patients with a stabilized disease, a penile curvature not exceeding 50 degrees, and no severe ED may have led to outcomes underestimating the potential efficacy of the treatment.

Applying extender devices in patients with penile dysmorphophobia: assessment of tolerability, efficacy, and impact on erectile function.

PubMed

Nowroozi, Mohammad Reza; Amini, Erfan; Ayati, Mohsen; Jamshidian, Hassan; Radkhah, Kayvan; Amini, Shahab

2015-05-01

Most men seeking penile enhancement techniques have a normal penile size. They are either misinformed or suffer from penile dysmorphophobia and should be discouraged from undergoing invasive procedures. Less invasive techniques including penile extenders are not associated with major complications and may be beneficial from a psychological perspective. We conducted this study to assess the efficacy and safety of AndroPenis (Andromedical, Madrid, Spain) penile extender. Between December 2010 and December 2013, 163 men presented to our institution complaining of small penile length and/or girth. All patients received structured psychosexual counseling. Fifty-four patients were willing to use the AndroPenis penile extender after counseling. Patients with major psychiatric disorders were excluded from enrollment. The patients were instructed to wear the device between 4 and 6 hours per day for 6 months. Penile dimensions including flaccid stretched and erected lengths were measured at baseline and after 1, 3, 6, and 9 months. Erectile function was assessed at baseline and 9 months after treatment using the simplified International Index of Erectile Function (IIEF-5). An institutional nonstandardized questionnaire was used to evaluate patient satisfaction at the end of study. Penile length and girth enhancement as well as satisfaction rate and improvement in erectile function were assessed during follow-up. At 6-month follow-up, a mean gain of 1.7 ± 0.8, 1.3 ± 0.4, and 1.2 ± 0.4 cm was noted for the flaccid, stretched, and erected penile lengths, respectively (all P values < 0.001). During the off treatment period, there were no significant changes in penile lengths. No effect on penile girth was observed. Patient satisfaction survey revealed modest satisfaction. From 13 patients with mild baseline erectile dysfunction, nine patients reported normal erectile function after 9 months. Penile extender as a minimally invasive technique is safe and provides modest benefits and patient satisfaction. © 2015 International Society for Sexual Medicine.

Reinnervating the penis in spina bifida patients in the United States: ilioinguinal-to-dorsal-penile neurorrhaphy in two cases.

PubMed

Jacobs, Micah A; Avellino, Anthony M; Shurtleff, David; Lendvay, Thomas S

2013-10-01

Penile sensation is absent in some patients with myelomeningocele owing to the dysfunction of the pudendal nerve. Here, we describe the introduction of penile sensation via ilioinguinal-to-dorsal-penile neurorrhaphy in two patients with penile anesthesia due to neural tube defects. To establish penile sensation via ilioinguinal-to-dorsal-penile-nerve neurorrhaphy. A 20-year-old and a 35-year-old male with L5/S1 myelomeningocele were both highly functioning and ambulatory, with intact ilioinguinal nerve distribution sensation but anesthesia of the penis and glans. They were sexually active and able to ejaculate antegrade. Both had high International Index of Erectile Function scores for confidence to achieve erection sufficient for intercourse. An incision was made from anterior superior iliac crest to the glans penis to expose the inguinal canal and ilioinguinal nerve. The ilioinguinal and dorsal penile nerve were transected and anastomosed. The anastomotic site was then wrapped in a hemostatic agent and a drain was left in place. For penile rehabilitation, both patients were instructed to stimulate the penis while looking at the genitalia to encourage redistribution of perceived sensation. Presence of erogenous penile sensation was tested by neurologic examination and patient feedback, and patients completed sexual health questionnaires. Both patients reported paresthesias of the groin with penile stimulation 1 month after surgery. Both patients are now 24 months postoperative and have erogenous sensation on the ipsilateral glans and shaft during intercourse. Neither patient has difficulty achieving or maintaining erections. We present two patients with dorsal penile reinnervation via the ilioinguinal nerve. Although nerve reinnervation has been used in urological procedures, this is the first description of an attempt to resupply penile sensation via the dorsal penile nerve in the United States with a minimum of 18 months follow-up. Early follow-up suggests successful neuronal remapping and regained sensation of the penis. © 2013 International Society for Sexual Medicine.

Study of penile circulation before and after radiation in patients with prostate cancer and its effect on impotence

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mittal, B.

1985-06-01

Decrease in penile blood flow has been implicated as the cause of erectile impotence in patients receiving pelvic irradiation. To determine any changes in the penile circulation secondary to pelvic irradiation, the authors measured the penile blood flow before and 6-9 months following completion of irradiation in six patients with prostate cancer. None of these patients had hormonal manipulation. The non-invasive techniques of Penile Brachial Index (PBI) and Penile Flow Index (PFI) were used to study penile circulation. Two patients developed impotence 2 to 4 1/2 months following completion of irradiation. There was no significant change in penile blood flowmore » following irradiation in any of the six patients studied. The etiology of post-irradiation impotence is probably multifactorial and it may be an oversimplification to attribute it to a single organic cause.« less

Long-term penile morphometric alterations in patients treated with robot-assisted versus open radical prostatectomy.

PubMed

Capogrosso, P; Ventimiglia, E; Cazzaniga, W; Stabile, A; Pederzoli, F; Boeri, L; Gandaglia, G; Dehò, F; Briganti, A; Montorsi, F; Salonia, A

2018-01-01

Neglected side effects after radical prostatectomy have been previously reported. In this context, the prevalence of penile morphometric alterations has never been assessed in robot-assisted radical prostatectomy series. We aimed to assess prevalence of and predictors of penile morphometric alterations (i.e. penile shortening or penile morphometric deformation) at long-term follow-up in patients submitted to either robot-assisted (robot-assisted radical prostatectomy) or open radical prostatectomy. Sexually active patients after either robot-assisted radical prostatectomy or open radical prostatectomy prospectively completed a 28-item questionnaire, with sensitive issues regarding sexual function, namely orgasmic functioning, climacturia and changes in morphometric characteristics of the penis. Only patients with a post-operative follow-up ≥ 24 months were included. Patients submitted to either adjuvant or salvage therapies or those who refused to comprehensively complete the questionnaire were excluded from the analyses. A propensity-score matching analysis was implemented to control for baseline differences between groups. Logistic regression models tested potential predictors of penile morphometric alterations at long-term post-operative follow-up. Overall, 67 (50%) and 67 (50%) patients were included after open radical prostatectomy or robot-assisted radical prostatectomy, respectively. Self-rated post-operative penile shortening and penile morphometric deformation were reported by 75 (56%) and 29 (22.8%) patients, respectively. Rates of penile shortening and penile morphometric deformation were not different after open radical prostatectomy and robot-assisted radical prostatectomy [all p > 0.5]. At univariable analysis, self-reported penile morphometric alterations (either penile shortening or penile morphometric deformation) were significantly associated with baseline international index of erectile function-erectile function scores, body mass index, post-operative erectile function recovery, year of surgery and type of surgery (all p < 0.05). At multivariable analysis, robot-assisted radical prostatectomy was independently associated with a lower risk of post-operative penile morphometric alterations (OR: 0.38; 95% CI: 0.16-0.93). Self-perceived penile morphometric alterations were reported in one of two patients after radical prostatectomy at long-term follow-up, with open surgery associated with a potential higher risk of this self-perception. © 2017 American Society of Andrology and European Academy of Andrology.

Factors affecting post-pubertal penile size in patients with hypospadias.

PubMed

Moriya, Kimihiko; Nakamura, Michiko; Nishimura, Yoko; Kitta, Takeya; Kanno, Yukiko; Chiba, Hiroki; Kon, Masafumi; Shinohara, Nobuo

2016-09-01

To evaluate actual post-pubertal penile size and factors affecting it in hypospadias patients, we retrospectively reviewed medical charts. Hypospadias patients whose external genitalia were categorized into Tanner stage 5, and whose stretched penile length was evaluated at 15 years old or older from April 2008 to April 2015, were enrolled in the present study. Stretched penile length was measured by a single examiner. Actual post-pubertal stretched penile length and factors affecting the post-pubertal stretched penile length were estimated. Statistical analysis was performed using Mann-Whitney U test and univariate and multivariate linear regression models for the determination of independent factors. Thirty patients met the inclusion criteria. Median age at evaluation was 17.2 years. Thirteen and 17 had mild and severe hypospadias, respectively. Endocrinological abnormality was identified in 5. Multivariate analysis showed that the severity of hypospadias and endocrinological abnormality were significant factors affecting stretched penile length. Stretched penile length in 25 patients without endocrinological abnormality was significantly longer than that in those with endocrinological abnormality (p = 0.036). Among patients without endocrinological abnormality, stretched penile length in 13 with severe hypospadias was significantly shorter than that in 12 with mild hypospadias (p = 0.004). While the severity of hypospadias and endocrinological abnormality at post-pubertal evaluation were factors affecting post-pubertal penile size, stretched penile length in patients with severe hypospadias was shorter even in cases without endocrinological abnormality. These results suggest that severe hypospadias is not only a disorder of urethral development, but also a disorder of penile development.

Tolerability and efficacy of newly developed penile injection of cross-linked dextran and polymethylmethacrylate mixture on penile enhancement: 6 months follow-up.

PubMed

Yang, D Y; Lee, W K; Kim, S C

2013-05-01

Cross-linked dextran and polymethylmethacrylate mixture (Lipen-10) is newly developed tissue filler. The purpose of this study was to evaluate tolerability and efficacy of Lipen-10 on penile enhancement. Twenty adult males were included in this study. Lipen-10 was injected into the subcutaneous tissue of the penile shaft. The penile girth and length were measured in the flaccid state, before and 1, 3 and 6 months after the injection. The circumference increased by 3.7±1.2 cm (50.8%, P<0.0001) at penile base, 4.2±0.9 cm (59.0%, P<0.001) at mid-shaft, and 3.8±1.0 cm (53.2%, P<0.0001) at distal shaft and the length increased by 2.3±1.4 cm (63.2%, P<0.001). There was, however, no significant difference between 3 and 6 months post-treatment in girth and length (P-values: 0.796, 0.498, 0.600 and 0.084 for penile base, mid- and distal-shaft and length, respectively). The complications were only one mild asymmetry of penile shape and one 5-mm-sized nodule in the injected site. There were no clinically significant adverse events in all subjects. Penile injection of Lipen-10 led to a significant increase in penile size, showed a good durability and was well-tolerated, without serious adverse events. These results suggest that penile injection of Lipen-10 may be a new effective method for penile enhancement.

The natural history of penile length after radical prostatectomy: a long-term prospective study.

PubMed

Vasconcelos, Juliana Souza; Figueiredo, Rui Teófilo; Nascimento, Fabio Luis Branco; Damião, Ronaldo; da Silva, Eloisio Alexsandro

2012-12-01

To describe the penile length after radical prostatectomy (RP) in a long-term follow-up. We evaluated prospectively the penile length of 105 patients with localized prostate cancer treated by open RP. Participants using therapy for penile rehabilitation were excluded from statistical analysis. Measurements of the stretched penis were taken preoperatively and at 3, 6, 12, 24, 36, 48, and 60 months postoperatively. The International Index of Erectile Function-Erectile Function (IIEF-EF) questionnaire was used to evaluate erectile function. The penile anthropometric measure used was the stretched length of the flaccid penis, from the pubopenile skin angle to the end of the glans, after the prepubic fat was depressed under maximum manual traction. The mean stretched penile length 3 months after RP decreased an average of 1 cm from baseline (P <.001). This mean difference persisted until 24 months. At 36 months, the penile length differed 0.6 cm. At 48 months (-0.3 cm) and 60 months (+0.4 cm), the mean differences in penile length before and after RP were not significant (P = .080 and P = .065, respectively). Erectile function was a predictor for early return of penile length. Nearly 1 cm of penile shortening after RP may be expected up to 12 months. However, a trend toward recovery of penile length occurs after 24 months of follow-up and is completely re-established after 48 months. The preserved erectile function after RP is a predictor for penile length recovery. Copyright © 2012 Elsevier Inc. All rights reserved.

Traumatic penile injuries: Mechanisms and problems of treatment in a tertiary institution in Nigeria.

PubMed

Oranusi, C K; Nwofor, Ame

2014-01-01

Penile injuries are uncommon. The more severe injuries are often difficult to manage. We report our experience with penile injuries from different causes and treatment options available. We analyzed retrospectively 23 cases of penile injuries presenting to the Urology Unit of a tertiary hospital in the Southeastern part of Nigeria from January 2007 to December 2012. The management for each patient varied depending on the nature and extent of the injury. The mean age of the patients was 28.9 ± 14.4 years (range 3 weeks to 43 years). The mean duration before presentation was 22.7 ± 17.8 h (range 1-168 h). The causes of penile injuries were categorized as follows: Postcircumcision 3 (13.0%), genital mutilation (self-inflicted injury/attacks by assailants) 6 (26.1%), accident 4 (17.4%), penile fracture 8 (34.8%), and gunshot injury 2 (8.6%). Isolated blunt injuries to the corporal tissues as occurs in penile fractures was managed successfully with early exploration and closure of the tunical tear, while injuries to the penile skin was managed with dressing and secondary closure. Severe penile injuries resulting in partial or total phallic loss presented the most challenge to treatment. Traumatic penile injuries are not common. Severe penile injuries could be challenging because of the nature of the injuries, delayed presentation and unavailability of modern technological tools and experience required for the treatment of such severe injuries. Expertise in the use of flaps for a neophallus are still been developed, and penile prosthetic devices are not readily available in our setting.

77 FR 16907 - Special Conditions: Embraer S.A., Model EMB 505; Inflatable Side-Facing Seat Three-Point...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-23

... inflatable portion of the restraint system will rely on sensors to electronically activate the inflator for... inflatable restraint system relies on sensors to electronically activate the inflator for deployment. These sensors could be susceptible to inadvertent activation, causing deployment in a potentially unsafe manner...

Penile Abscess Secondary to Neglected Penile Fracture after Intracavernosal Vasoactive Drug Injection

PubMed Central

Song, Wan; Ko, Kwang Jin; Shin, Seung Jea

2012-01-01

Penile abscesses are rare, but can develop after trauma, injection therapy, or surgery of the penis, or as an unusual presentation of sexually transmitted diseases. We report a case of penile abscess in a 51-year-old diabetic man, presented 9 days after neglected penile fracture following intracavernosal injection therapy and sexual intercourse. Penile ultrasonography and surgical exploration confirmed the physical examination findings of involvement of the corpus cavernosum. The pus culture from the abscess revealed Enterococcous faecalis. The patient was successfully treated by surgical drainage of the abscess and primary closure of the ruptured tunica albuginea. PMID:23596611

Penile abscess secondary to neglected penile fracture after intracavernosal vasoactive drug injection.

PubMed

Song, Wan; Ko, Kwang Jin; Shin, Seung Jea; Ryu, Dong Soo

2012-12-01

Penile abscesses are rare, but can develop after trauma, injection therapy, or surgery of the penis, or as an unusual presentation of sexually transmitted diseases. We report a case of penile abscess in a 51-year-old diabetic man, presented 9 days after neglected penile fracture following intracavernosal injection therapy and sexual intercourse. Penile ultrasonography and surgical exploration confirmed the physical examination findings of involvement of the corpus cavernosum. The pus culture from the abscess revealed Enterococcous faecalis. The patient was successfully treated by surgical drainage of the abscess and primary closure of the ruptured tunica albuginea.

Simple, safe, and satisfactory secondary penile enhancement after near-total oncologic amputation.

PubMed

Hage, J Joris

2009-06-01

After oncologic penile amputation, the penile stump may prove of insufficient length, causing poor personal hygiene and scrotal excoriation and an inability to void while standing. In these cases, penile enhancement by uncovering its subcutaneous parts may offer a simple and satisfactory solution.From August 2003 to August 2007, penile enhancement was performed in 6 patients with a mean age of 63 years (range, 51-69 years) and only 1 cm (range, 0-1.5 cm) of remaining penile length when standing up.The skin on the penile stump was used to recreate a neoglans. The subcutaneously covered penile shaft was dissected deep to Buck's fascia up into the deep suspensory ligament. Ventrally, the bulbospongeous muscle was laid bare over 1 to 2 cm. After resection of pubic subcutaneous fat, the pubic and scrotal skin edges were anchored to the suspensory ligament, bulbospongious fascia, and tunica albuginea. The resulting bare surface of the penile shaft was covered by a skin graft.Partial neoglandular skin slough was observed in 2 patients and could be treated conservatively in both. Penile lymphedema was observed in the 1 patient whom had previously undergone radiotherapy. This was treated by secondary subcutaneous resection and skin tightening. At a mean follow-up of 2.5 years (range, 1-5 years), the cosmetic appearance was acceptable in all patients and their penile length ranged from 7.5 to 9 cm. All were able to void while standing without soiling themselves.

Plication procedures—excisional and incisional corporoplasty and imbrication for Peyronie’s disease

PubMed Central

Chen, Roger; McCraw, Casey

2016-01-01

Plication procedures for the correction of Peyronie’s disease (PD) curvature are management options for PD patients. There are basically three types of procedures: excisional corporoplasty, incisional corporoplasty, and plication-only. This review is a compilation of English literature, peer-reviewed, published articles addressing these types of operations for Peyronie’s curvature correction, not congenital curvature. According to the urology literature, this surgical type was initially used for correction of curvature associated with hypospadias repair or congenital penile curvature. The procedures also, for the most part, historically became an alternative for plaque excision and graft repair, because of the difficulty with such repairs and the often-resultant erectile dysfunction (ED). A brief section traces some of the origins of these various repairs, followed by a brief section on the selection criteria for these types of surgery for the patient with PD penile curvature. We also review the significant articles in which the three types were presented with modifications. Finally, several articles that compare the various surgical repairs are summarized in the order that they appear in the literature. These types of surgery have become a mainstay for the surgical correction of penile curvature due to PD. PMID:27298779

Dorsal vein injuries observed during penile exploration for suspected penile fracture.

PubMed

Bar-Yosef, Yuval; Greenstein, Alexander; Beri, Avi; Lidawi, Ghalib; Matzkin, Haim; Chen, Juza

2007-07-01

Penile fracture is a rare injury, bearing potential impairment of erectile function if not treated. Patients with clinical presentation of a penile fracture commonly undergo early surgical exploration with the intention to repair a tunica albuginea tear. We present a group of men who presented with a penile hematoma following trauma to the erect penis. Exploration revealed an intact tunica albuginea and a dorsal vein tear. Eighteen men (mean age 38 years, range 20-55) presented with suspected penile fracture during an 8-year period. One man presented twice. Two of the patients were managed expectantly and the remaining 16 patients underwent 17 immediate surgical explorations. Explorations were performed under general anesthesia, using a circumferential subcoronal incision and degloving of the penile skin. The tunica albuginea of both penile sides as well as the penile urethra were examined for injuries. Medical records were retrospectively reviewed for etiology, symptoms, signs of physical examination, and information on findings of surgical exploration. Data on erectile function, medical treatment for erectile dysfunction, and penile curvature were obtained during follow-up. In nine of the 17 procedures the tunica albuginea was intact and the only pathological finding was a ruptured dorsal vein. One procedure was negative for both tunical and vascular injury. A tunical tear was detected in the remaining seven procedures. At a mean follow-up of 40 months (range 4-91), five patients required medical treatment for erectile dysfunction, including the two who were managed expectantly, two with a tunical tear, and one with a venous tear. Dorsal vein tears may mimic penile fracture. Suggestive findings following trauma to the erect penis prompted exploration for suspected tunica albuginea tear. In less than half of the men was the diagnosis of penile fracture established and treated at surgery.

Modified Penile Augmentation by Dermal-Fat Graft in Post-Hypospadias Adults.

PubMed

Xu, Lisi; Zhao, Muxin; Yang, Zhe; Chen, Wen; Li, Yangqun; Ma, Ning; Wang, Weixin; Feng, Jun; Liu, Qiyu; Ma, Tong

2016-02-01

Although a considerable part of patients desire further improvement in penile size after hypospadias repairs, penile augmentation is only considered in patients with congenital penile hypoplasia or acquired penile retraction. Modified penile augmentation by free dermal-fat graft is introduced to satisfy these patients and improve surgical safety. From April 2012 to December 2014, a total of 15 male adults after hypospadias repairs, aged 18-24 years, underwent modified penile augmentation which involved girth enhancement by a free dermal-fat graft and penile elongation (suprapubic skin advancement-ligamentolysis). A specially designed tunneling instrument was introduced to facilitate pericavernous thickening without degloving. Outcome evaluation was mainly based on objective penile measurements and results of the Male Genital Image Scale. With 6 months' follow-up, all patients had achieved excellent cosmetic results, with a significant average dimensional increase of 1.53 ± 0.23 cm in flaccid girth and 1.67 ± 0.24 cm in flaccid length. No erection deficiencies or urinary fistula occurred. Patients' perception of male genitalia improved postoperatively, with the average MGIS score rising from 31.73 ± 4.86 to 40.20 ± 4.54. This modified technique is safe and effective in enlarging penile size. The use of the specially designed tunneling instrument simplifies penile girth enhancement, avoiding unnecessary trauma to the neo-urethra and neurovascular bundle. It is confirmed that physical dimensional enhancement does contribute to improving their underestimation of penile size. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Magnetic resonance imaging of penile cancer.

PubMed

Gupta, Sumit; Rajesh, Arumugam

2014-05-01

Penile cancer is a rare neoplasm that, although rare in the developed world, has devastating physical and psychological consequences for the patient. Novel MR imaging techniques such as lymphotropic nanoparticle-enhanced MR imaging may help identify metastatic lymph node disease. This article reviews the normal penile anatomy and MR imaging techniques and features of primary and metastatic penile cancer. Recent advances in penile cancer imaging are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

Penile carcinogenesis in a low-incidence area: a clinicopathologic and molecular analysis of 115 invasive carcinomas with special emphasis on chronic inflammatory skin diseases.

PubMed

Mannweiler, Sebastian; Sygulla, Stephan; Beham-Schmid, Christine; Razmara, Yas; Pummer, Karl; Regauer, Sigrid

2011-07-01

Human papillomavirus (HPV) infections account worldwide for 50% of penile cancers. The role of lichen sclerosus and lichen planus in penile carcinogenesis needs further investigation. Archival formalin-fixed high-grade penile intraepithelial neoplasias, differentiated penile intraepithelial neoplasias, and invasive carcinomas from a single pathology institution in a low-incidence area for penile cancer were analyzed for 28 HPV low-risk and HPV high-risk genotypes, p16 overexpression, presence of peritumoral lichen sclerosus, lichen planus, precursor lesions, and monoclonal rearrangement of the T-cell receptor γ locus. A total of 29 penile intraepithelial neoplasias (100%) and 69 of 115 (60%) invasive cancers contained HPV high-risk genotypes with a single HPV high-risk genotype (80% HPV16, 6% HPV33, 2% HPV45 and HPV18, 1% HPV73). Multiple HPV high-risk genotypes were identified in 4% with and in 5% without HPV16/18. p16 overexpression correlated in all but 1 case of HPV high-risk 45 cancer. No p16 overexpression and HPV genotype was found in 6 differentiated penile intraepithelial neoplasias and 46 of 115 (40%) invasive cancers, 30% of which were pT2/pT3 cancers. For 35 cancers, peritumoral tissue was available for analysis. Advanced lichen sclerosus was identified in 26, lichen planus in 9, and differentiated penile intraepithelial neoplasia in 18 carcinomas. Dense T-cell-dominant lymphocytic infiltrates were identified in 22 of 46 carcinomas and in 3 of 6 differentiated penile intraepithelial neoplasias, with 6 of 13 analyzed carcinomas/penile intraepithelial neoplasias showing a monoclonal rearrangement of the T-cell receptor γ locus. The prevalence of HPV high-risk in penile cancers from a low-incidence area was slightly higher than the global distribution. HPV-negative carcinomas were associated with advanced lichen sclerosus and lichen planus, differentiated penile intraepithelial neoplasia, and accumulation of T lymphocytes with monoclonal rearrangement of the T-cell receptor γ locus.

Do adult men with untreated ventral penile curvature have adverse outcomes?

PubMed

Menon, Vani; Breyer, Benjamin; Copp, Hillary L; Baskin, Laurence; Disandro, Michael; Schlomer, Bruce J

2016-02-01

Congenital ventral penile curvature without hypospadias is often treated surgically in childhood. The history of untreated ventral curvature is unknown. This study's aim was to examine the association of untreated ventral penile curvature with various sexual and psychosexual outcomes. An electronic survey was advertised to men older than 18 years on Facebook. Men with possible ventral penile curvature identified themselves by choosing sketches that most closely represented their anatomy. Outcomes assessed included: Sexual Health Inventory for Men, difficulty of intercourse because of curvature, International Prostate Symptom Score, Penile Perception Score, psychosexual milestones, paternity, infertility, sitting to urinate, and the CDC HRQOL-4 module. Among participants, 81 out of 684 men (11.8%) reported untreated ventral penile curvature. Participants with self-reported curvature noted more difficulty with intercourse because of curvature (4.5 vs 4.9, p < 0.001), more unhealthy mental days (8.6 vs 6.2, p = 0.02), and increased dissatisfaction with penile self-perception compared with men without reported curvature (8.6 vs 9.5, p < 0.001). Men with possible untreated ventral curvature reported worse penile perception scores, more mentally unhealthy days, and increased difficulty with intercourse secondary to curvature compared with men without curvature. A limitation to this study is selection bias; responses collected were self-reported from survey volunteers. Additionally, the question identifying ventral penile curvature is not validated but performed well in pretesting. Most questions were from validated surveys, but some were modeled after validated surveys and/or contained high face validity types of questions. Men with possible untreated ventral penile curvature reported more dissatisfaction with penile appearance, increased difficulty with intercourse, and more unhealthy mental days. Given high success rates, low complications, and improved outcomes after surgical correction of penile curvature reported in the literature, our results support correction of congenital penile curvature in childhood. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Do adult men with untreated ventral penile curvature have adverse outcomes?

PubMed Central

Menon, Vani; Breyer, Benjamin; Copp, Hillary L.; Baskin, Laurence; Disandro, Michael; Schlomer, Bruce J.

2016-01-01

Summary Introduction Congenital ventral penile curvature without hypospadias is often treated surgically in childhood. The history of untreated ventral curvature is unknown. Objective This study’s aim was to examine the association of untreated ventral penile curvature with various sexual and psychosexual outcomes. Study design An electronic survey was advertised to men older than 18 years on Facebook. Men with possible ventral penile curvature identified themselves by choosing sketches that most closely represented their anatomy. Outcomes assessed included: Sexual Health Inventory for Men, difficulty of intercourse because of curvature, International Prostate Symptom Score, Penile Perception Score, psychosexual milestones, paternity, infertility, sitting to urinate, and the CDC HRQOL-4 module. Results Among participants, 81 out of 684 men (11.8%) reported untreated ventral penile curvature. Participants with self-reported curvature noted more difficulty with intercourse because of curvature (4.5 vs 4.9, p < 0.001), more unhealthy mental days (8.6 vs 6.2, p = 0.02), and increased dissatisfaction with penile self-perception compared with men without reported curvature (8.6 vs 9.5, p < 0.001). Discussion Men with possible untreated ventral curvature reported worse penile perception scores, more mentally unhealthy days, and increased difficulty with intercourse secondary to curvature compared with men without curvature. A limitation to this study is selection bias; responses collected were self-reported from survey volunteers. Additionally, the question identifying ventral penile curvature is not validated but performed well in pretesting. Most questions were from validated surveys, but some were modeled after validated surveys and/or contained high face validity types of questions. Conclusion Men with possible untreated ventral penile curvature reported more dissatisfaction with penile appearance, increased difficulty with intercourse, and more unhealthy mental days. Given high success rates, low complications, and improved outcomes after surgical correction of penile curvature reported in the literature, our results support correction of congenital penile curvature in childhood. PMID:26776946

HEART Aerothermodynamic Analysis

NASA Technical Reports Server (NTRS)

Mazaheri, Alireza

2012-01-01

This paper presents an assessment of the aerothermodynamic environment around an 8.3 meter High Energy Atmospheric Reentry Test (HEART) vehicle. This study generated twelve nose shape configurations and compared their responses at the peak heating trajectory point against the baseline nose shape. The heat flux sensitivity to the angle of attack variations are also discussed. The possibility of a two-piece Thermal Protection System (TPS) design at the nose is also considered, as are the surface catalytic affects of the aeroheating environment of such configuration. Based on these analyses, an optimum nose shape is proposed to minimize the surface heating. A recommendation is also made for a two-piece TPS design, for which the surface catalytic uncertainty associated with the jump in heating at the nose-IAD juncture is reduced by a minimum of 93%. In this paper, the aeroshell is assumed to be rigid and the inflatable fluid interaction effect is left for future investigations.

High-Energy Atmospheric Reentry Test Aerothermodynamic Analysis

NASA Technical Reports Server (NTRS)

Mazaheri, Alireza

2013-01-01

This paper presents an assessment of the aerothermodynamic environment around an 8.3 meter High Energy Atmospheric Reentry Test (HEART) vehicle. This study generated twelve nose shape configurations and compared their responses at the peak heating trajectory point against the baseline nose shape. The heat flux sensitivity to the angle of attack variations are also discussed. The possibility of a two-piece Thermal Protection System (TPS) design at the nose is also considered, as are the surface catalytic affects of the aeroheating environment of such configuration. Based on these analyses, an optimum nose shape is proposed to minimize the surface heating. A recommendation is also made for a two-piece TPS design, for which the surface catalytic uncertainty associated with the jump in heating at the nose-IAD juncture is reduced by a minimum of 93%. In this paper, the aeroshell is assumed to be rigid and the inflatable fluid interaction effect is left for future investigations

Superficial dorsal vein injury/thrombosis presenting as false penile fracture requiring dorsal venous ligation.

PubMed

Rafiei, Arash; Hakky, Tariq S; Martinez, Daniel; Parker, Justin; Carrion, Rafael

2014-12-01

Conditions mimicking penile fracture are extremely rare and have been seldom described. To describe a patient with false penile fracture who presented with superficial dorsal vein injury/thrombosis managed with ligation. A 33-year-old male presented with penile swelling and ecchymosis after intercourse. A penile ultrasound demonstrated a thrombosed superficial dorsal vein but also questionable fracture of the tunica albuginea. As the thrombus was expanding, he was emergently taken to the operating room for exploration and required only dorsal venous ligation. Postoperatively, patient's Sexual Health Inventory for Men score was 23, and he had no issues with erections or sexual intercourse. Early exploration of patients with suspected penile fracture provides excellent results with maintenance of erectile function. Also, in the setting of dorsal vein thrombosis, ligation preserves the integrity of the penile tissues and avoids unnecessary complications from conservative management. Rafiei A, Hakky TS, Martinez D, Parker J, and Carrion R. Superficial dorsal vein injury/thrombosis presenting as false penile fracture requiring dorsal venous ligation.

Advances in Surgical Reconstructive Techniques in the Management of Penile, Urethral, and Scrotal Cancer.

PubMed

Bickell, Michael; Beilan, Jonathan; Wallen, Jared; Wiegand, Lucas; Carrion, Rafael

2016-11-01

This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each organ system is examined individually. Techniques and discussion for penile cancer reconstruction include Mohs surgery, glans resurfacing, partial and total glansectomy, and phalloplasty. Included in the penile cancer reconstruction section is the use of penile prosthesis in phalloplasty patients after penectomy, tissue engineering in phallic regeneration, and penile transplantation. Reconstruction following treatment of primary urethral carcinoma and current techniques for scrotal cancer reconstruction using split-thickness skin grafts and flaps are described. Copyright © 2016 Elsevier Inc. All rights reserved.

Management and outcomes of penile fracture: 10 years' experience from a tertiary care center.

PubMed

Özorak, Alper; Hoşcan, Mustafa Burak; Oksay, Taylan; Güzel, Ahmet; Koşar, Alim

2014-03-01

To evaluate our experience on diagnosis and management of penile fractures. This retrospective study included 31 patients who were treated for penile fracture between 2002 and 2012. We analyzed the etiology of penile fracture, concomitant pathologies such as urethral injury, deep or superficial dorsal vein ruptures, treatment modalities (surgery or conservative treatment) and complications of treatment modalities. The mean age of the patients was 32 years (range, 23-47 years). In 27 patients (87%), the cause of penile fracture was sexual intercourse. Patients presented with swelling, pain and popping or cracking sound in penis. The diagnosis of penile fracture was established clinically in all of the patients. There were no urethral injuries or dorsal vein ruptures. Ten patients who refused surgical treatment were treated conservatively and remaining 21 patients with early surgical intervention. Among conservatively treated patients, two suffered from erectile dysfunction, two from painful erection and another two from penile curvature. No serious complications such as erectile dysfunction, penile curvature or painful erection were observed in surgically treated patients. Penile fracture can be diagnosed easily with history and physical examination, and favorable functional results can be achieved with early surgical repair.

[Penile dimensions in type 2 diabetes].

PubMed

Belousov, I I; Kogan, M I; Ibishev, H S; Vorobyev, S V; Khripun, I A; Gusova, Z R

2015-12-01

The current literature provides a wide range of publications on the anthropometry of the penis specifying the relationship between penile dimensions and sex hormones, weight, height and erectile function. But most of the studies involved healthy volunteers or young patients with erectile dysfunction. Our study was conducted in patients with type 2 diabetes. Penile measurements obtained in the present study were compared those of the average Russian man. The patients were divided into groups with preserved and impaired erectile function. Erectile function was also studied relative to the variability of penile dimensions. The effect of DM duration on erectile function was defined. Comparative analysis revealed the relationship between penile anatomical dimensions and erectile function. We studied the effect of type 2 diabetes on the anatomical dimensions and elasticity of the penis, established the relationship between penile dimensions and elasticity of the penis. The correlation between the severity of erectile dysfunction and serum testosterone levels on one side, and penile dimensions on the other was found. The effect of penile dimensions on erectile function in DM patients was also examined. Determining penile dimensions and their variability due to various pathological conditions or processes, may eventually lead to better result of ED management.

21 CFR 876.5020 - External penile rigidity devices.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External penile rigidity devices. 876.5020 Section 876.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... maintain sufficient penile rigidity for sexual intercourse. External penile rigidity devices include vacuum...

21 CFR 876.5020 - External penile rigidity devices.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false External penile rigidity devices. 876.5020 Section 876.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... maintain sufficient penile rigidity for sexual intercourse. External penile rigidity devices include vacuum...

21 CFR 876.5020 - External penile rigidity devices.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false External penile rigidity devices. 876.5020 Section 876.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... maintain sufficient penile rigidity for sexual intercourse. External penile rigidity devices include vacuum...

21 CFR 876.5020 - External penile rigidity devices.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External penile rigidity devices. 876.5020 Section 876.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... maintain sufficient penile rigidity for sexual intercourse. External penile rigidity devices include vacuum...

21 CFR 876.5020 - External penile rigidity devices.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false External penile rigidity devices. 876.5020 Section 876.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... maintain sufficient penile rigidity for sexual intercourse. External penile rigidity devices include vacuum...

Role of ultrasonography with color-Doppler in the emergency diagnosis of acute penile fracture: a case report.

PubMed

Buyukkaya, Ramazan; Buyukkaya, Ayla; Ozturk, Beyhan; Kayıkçı, Ali; Yazgan, Ömer

2014-03-01

Penile fracture is the rupture of tunica albuginea, typically resulting from blunt trauma, intercourse, or penile manipulation. Diagnosis is made clinically. Ultrasound is not used frequently in diagnosis of penile fracture but it provides a fast, non-invasive alternative to more often used MRI and cavernography. We aimed to present diagnostic ultrasound and color Doppler images of a patient with acute penile fracture in conjunction with literature.

Penile Doppler sonographic and clinical characteristics in Peyronie's disease and/or erectile dysfunction: an analysis of 1500 men with male sexual dysfunction.

PubMed

Chung, Eric; Yan, Hanmu; De Young, Ling; Brock, Gerald B

2012-10-01

What's known on the subject? and What does the study add? Penile colour Doppler ultrasonography (CDU) can be an invaluable investigative tool to characterize penile abnormalities to complement clinical history and physical examination in the evaluation of men with Peyronie's disease (PD) and/or erectile dysfunction (ED). Although CDU findings between men with PD and those with ED were not markedly different, subtle differences were observed. The classic penile CDU findings in men with PD comprise tunical thickening, intracavernosal fibrosis, septal fibrosis and intracavernosal calcification, while, in men with ED, low peak systolic velocity and high end-diastolic velocity are found on penile haemodynamics. Previously published studies have focused predominantly on either ED or PD exclusively, or examine the risk of progression to ED in the PD population. To our knowledge, this is the largest and most comprehensive analysis of penile CDU and clinical findings in men with PD and/or ED. The large sample size and multivariable analysis allow meaningful interpretation of the results. This study has found some substantial differences in the penile CDU findings of men with PD and/or ED that have not previously been reported. Although the risk factors of ED may be greater than those for PD, there is crossover in age, cardiovascular risk factors, trauma and penile CDU findings in men with PD and/or ED. To explore the differences in penile colour Doppler ultrasonography (CDU) findings between men with Peyronie's disease (PD) and those with erectile dysfunction (ED). Patients presenting with PD and/or ED who underwent penile CDU were recruited to the study. Patient demographics, comorbidities, International Index of Erectile Function-5 scores, previous therapies and physical findings were documented. Penile curvature, presence of tunical thickening, septal fibrosis, intracavernosal fibrosis and calcification, and cavernosal vascular status were recorded. A total of 1500 men underwent penile CDU during the 10-year period. Of these men, 891 men presented with PD and 609 men had ED only. Men with ED had higher rates of diabetes and coronary artery disease (P < 0.05). Isolated tunical thickening was more common in older men and in the PD cohort. The presence of intracavernosal fibrosis correlated strongly with difficulty maintaining erection (P < 0.05). Impaired cavernosal arterial flow was observed in men with decrease penile rigidity and penile pain, while higher end-diastolic velocities were found in men with difficulty maintaining erection and tunical thickening on penile CDU. Men with PD and ED had many similarities and differences on penile CDU. Penile CDU continues to be an invaluable clinical tool in the management of men with male sexual dysfunction. © 2012 BJU INTERNATIONAL.

Penile manipulation: The most common etiology of penile fracture at our tertiary care center.

PubMed

Rahman, Md Jawaid; Faridi, M S; Mibang, Naloh; Singh, Rajendra Sinam

2016-01-01

Penile fracture is the disruption of the tunica albuginea with rupture of the corpus cavernosum secondary to blunt trauma to the erect penis. It is an unusual condition, usually underreported. According to the published literature, vigorous vaginal intercourse with women on top position is the most common etiology across the globe including India with Middle Eastern countries being the exception. A total of seven patients of penile fracture presented in emergency in the last 6 months. The etiology was penile manipulation at the time of sexual excitement in six out of seven patients of penile fracture, which was contrary to the literature published except in Middle Eastern countries. All the patients were managed by emergency exploration and repair. Thus, the incidence and etiologies of penile fracture vary according to geographic region, sexual behavior, marital status, and culture.

Dynamic Deployment Simulations of Inflatable Space Structures

NASA Technical Reports Server (NTRS)

Wang, John T.

2005-01-01

The feasibility of using Control Volume (CV) method and the Arbitrary Lagrangian Eulerian (ALE) method in LSDYNA to simulate the dynamic deployment of inflatable space structures is investigated. The CV and ALE methods were used to predict the inflation deployments of three folded tube configurations. The CV method was found to be a simple and computationally efficient method that may be adequate for modeling slow inflation deployment sine the inertia of the inflation gas can be neglected. The ALE method was found to be very computationally intensive since it involves the solving of three conservative equations of fluid as well as dealing with complex fluid structure interactions.

Increase in fracture of the penis in south-west Nigeria.

PubMed

Tijani, Kehinde H; Ogo, Chidiebere N; Ojewola, Rufus W; Akanmu, Nurudeen O

2012-12-01

To present our recent experience in the management of penile fracture. We present 21 cases of penile fracture managed at the two Federal-owned tertiary hospitals in two neighbouring states in south-west Nigeria between 2001 and 2011. The diagnosis was based mainly on a clinical evaluation. The treatment was surgical in patients who presented within 2 weeks of the fracture. The emphasis during the follow-up was on erectile function and micturition. Seventeen patients presented within 48 h, two presented after a week, while two reported months later with penile deviation. The mean age of the patients was 26.4 years. The cause of fracture was sexual intercourse in 11 (52%) patients and forceful manipulation of the erect penis in 10 (48%). Thirteen (62%) of all injuries occurred in the last 2 years of the study, of which eight men were injured during rear entry with the woman on top (reverse coital) position. Six of the patients with reverse coital injuries reported trying the position after watching it on the Internet, specifically on their cellular phones. Eighteen patients had surgical treatment, with a satisfactory outcome. Two of the other three patients had penile deviation during erection. The incidence and causes of penile fracture appear to have changed drastically over the last 2 years in our environment. The rapid demographic changes in south-west Nigeria are probably responsible. There appears to be a relationship between the cause of fracture and the use of the Internet, although that might be coincidental. Surgical repair, irrespective of the delay before intervention, usually offers a satisfactory outcome.

HPV infection and immunochemical detection of cell-cycle markers in verrucous carcinoma of the penis.

PubMed

Stankiewicz, Elzbieta; Kudahetti, Sakunthala C; Prowse, David M; Ktori, Elena; Cuzick, Jack; Ambroisine, Laurence; Zhang, Xiaoxi; Watkin, Nicholas; Corbishley, Catherine; Berney, Daniel M

2009-09-01

Penile verrucous carcinoma is a rare disease and little is known of its aetiology or pathogenesis. In this study we examined cell-cycle proteins expression and correlation with human papillomavirus infection in a series of 15 pure penile verrucous carcinomas from a single centre. Of 148 penile tumours, 15 (10%) were diagnosed as pure verrucous carcinomas. The expression of the cell-cycle-associated proteins p53, p21, RB, p16(INK4A) and Ki67 were examined by immunohistochemistry. Human papillomavirus infection was determined by polymerase chain reaction to identify a wide range of virus types. The expression of p16(INK4A) and Ki67 was significantly lower in verrucous carcinoma than in usual type squamous cell carcinoma, whereas the expression of p53, p21 and RB was not significantly different. p53 showed basal expression in contrast to usual type squamous cell carcinoma. Human papillomavirus infection was present in only 3 out of 13 verrucous carcinomas. Unique low-risk, high-risk and mixed viral infections were observed in each of the three cases. In conclusion, lower levels of p16(INK4A) and Ki67 expressions differentiate penile verrucous carcinoma from usual type squamous cell carcinoma. The low Ki67 index reflects the slow-growing nature of verrucous tumours. The low level of p16(INK4A) expression and human papillomavirus detection suggests that penile verrucous carcinoma pathogenesis is unrelated to human papillomavirus infection and the oncogenes and tumour suppressor genes classically altered by virus infection.

Prevalence of preoperative penile abnormalities among voluntary male medical circumcision patients in Swaziland.

PubMed

Oddo, Anthony R; Ruedrich, Elizabeth; Zust, Christopher; Marugg, Lindsey; VanderWal, Echo; VanderWal, Harry; Sartori, Rebekah; Markert, Ronald; McCarthy, Mary C

2017-08-01

Circumcision has been found to be an effective strategy for lowering the transmission of HIV in Africa. The Luke Commission, a mobile hospital outreach program, has used this information to decrease the rate of HIV in Swaziland by performing voluntary male medical circumcisions throughout the country. During many of these circumcisions, genital medical conditions and penile abnormalities are simultaneously discovered and corrected. The goal of our study was to evaluate the prevalence of penile abnormalities discovered and treated during voluntary male medical circumcisions performed by The Luke Commission (TLC) throughout rural Swaziland. We completed a retrospective analysis of all male patients who underwent voluntary male medical circumcision performed by TLC during a period from June-August, 2014. The penile abnormalities included: phimosis, paraphimosis, epispadias, hypospadias, ulcers, balanitis, torsion, and foreskin adherent to the glans. Of 929 total circumcisions, 771 (83%) patients had at least one pre-existing penile abnormality identified during their examinations and procedures, totaling 1110 abnormalities. Three specific abnormalities were detected - phimosis, adherent foreskin, and hypospadias. The 6-12 and 13-19 age groups had adequate sample sizes to yield precise estimates of prevalence (age group 6-12: 87% (95% confidence interval [CI]=84-90%; age group 13-19: 79% (95% CI=74-84%). The Luke Commission is improving the lives of children and adults with limited access to healthcare through regular preoperative evaluations during male circumcision, and the organization is setting an example for other international healthcare groups. Type of Study: Prognostic Study, Level II. Copyright © 2017 Elsevier Inc. All rights reserved.

Restoring tactile and erogenous penile sensation in low-spinal-lesion patients: procedural and technical aspects following 43 TOMAX nerve transfer procedures.

PubMed

Overgoor, Max L E; de Jong, Tom P V M; Kon, Moshe

2014-08-01

The "TOMAX" (TO MAX-imize sensation, sexuality, and quality of life) procedure restores genital sensation in men with low spinal lesions, improving sexual health, as shown previously. It connects the dorsal nerve of the penis to the intact ipsilateral ilioinguinal nerve, unilaterally or bilaterally. This study reports on the technical aspects based on 43 TOMAX nerve transfers. In 40 patients with no penile but intact groin sensation, 43 nerve transfers were performed. Data on patient selection, surgical history, anatomy of the ilioinguinal nerve and dorsal nerve of the penis, unilateral or bilateral surgery, surgical technique, complications, and patient information were collected prospectively. Regardless of origin, all patients with no penile but good groin sensation are eligible for the procedure, provided the ilioinguinal nerve is not damaged because of former inguinal surgery or absent because of anatomical variations. Selection of a unilateral or bilateral procedure depends on the presence or absence of reflex erections and bulbocavernosus reflex. Preliminary experience with the first three bilateral cases shows that it is technically feasible, with encouraging results. The surgical technique has evolved (described in detail, including video) to enhance outcome and reduce complications. Patients are better informed, resulting in realistic expectations. This article synthesizes the procedural and technical experience of 43 TOMAX nerve transfers. Anyone skilled in peripheral nerve surgery and microsurgery can adopt this concept and further develop it. The TOMAX procedure can then be used to restore erogenous penile sensation and improve the quality of sexual health in patients with absent penile but good groin sensation.

Interactions between dopamine and oxytocin in the control of sexual behaviour.

PubMed

Baskerville, Tracey A; Douglas, Alison J

2008-01-01

Dopamine and oxytocin are two key neuromodulators involved in reproductive behaviours, such as mating and maternal care. Much evidence underlies their separate roles in such behaviours, but particularly in sexual behaviour. It is generally believed that central dopaminergic and oxytocinergic systems work together to regulate the expression of penile erection, but relatively little is known regarding how they interact. Thus, this review aims to discuss neuroanatomical proof, neuromodulator secretory profiles in the hypothalamus and behavioural pharmacological evidence which support a dopamine-oxytocin link in three hypothalamic nuclei that have been implicated in sexual behaviour, namely the medial preoptic nucleus, supraoptic nucleus and paraventricular nucleus (PVN). We also aim to provide an overview of potential dopamine-mediated transduction pathways that occur within these nuclei and are correlated with the exhibition of penile erection. The PVN provides the most convincing evidence for a dopamine-oxytocin link and it is becoming increasingly apparent that parvocellular oxytocinergic neurons in the PVN, in part, mediate the effects of dopamine to elicit penile erection. However, while we show that oxytocin neurons express dopamine receptors, other evidence on whether dopaminergic activation of PVN oxytocin cells involves a direct and/or indirect mechanism is inconclusive and further evidence is required to establish whether the two systems interact synergistically or sequentially in the regulation of penile erection.

Penile necrosis secondary to purpura fulminans: a case report and review of literature.

PubMed

Hogarth, David B; Cheon, Paul M; Kassam, Javeed; Seal, Alexander E; Kavanagh, Alexander G

2017-02-01

We report the case of a 60-year-old Hispanic male with widespread necrotic purpuric lesions involving the penile, suprapubic, inguinal and hip dermis due to purpura fulminans. Purpura fulminans describes a rare syndrome involving intravascular thrombosis and hemorrhagic infarction of the skin; this rapidly progressing syndrome features vascular collapse and disseminated intravascular coagulation. This patient's penile necrosis involved the majority of the penile shaft and glans penis, and ultimately required partial glansectomy and repeated debridement for treatment. Subsequently, full thickness skin grafting was completed for reconstruction with good effect. While reports of penile necrosis secondary to various causes are documented in the literature, no prior reports describe penile necrosis secondary to purpura fulminans.

Penile enlargement surgery.

PubMed

Alter, G J

1998-06-01

Aesthetic surgery to improve the appearance of the penis, scrotum, and pubic region has successfully evolved. Penile lengthening is performed by releasing the suspensory ligament of the penis followed by use of penile weights. Girth is increased by wrapping a dermal-fat graft around the penile circumference. The choice of surgery is determined by the patient's anatomy and desires.

Penile fracture and penile reconstruction.

PubMed

Garaffa, Giulio; Raheem, Amr Abdel; Ralph, David John

2011-12-01

The past decade has seen a significant development in penile reconstruction techniques, and the management of penile fracture has progressively shifted from a conservative approach to early surgical repair. The radial artery-based free flap phalloplasty now represents the gold-standard procedure for total phallic reconstruction both in men and in female-to-male transsexuals.

Delayed surgical repair of penile fracture under local anesthesia.

PubMed

Nasser, Taha Abdel; Mostafa, Taymour

2008-10-01

Penile fracture is a traumatic rupture of the tunica albuginea because of blunt injury of an erect penis. To assess the efficacy of a simple delayed surgical repair of penile fracture after a conservative treatment under local anesthesia in patients presented after 24 hours. Twenty-four patients with penile fracture presented after 24 hours were subjected to history taking, clinical examination, urine analysis, and penile ultrasound. They underwent conservative treatment for 7-12 days, and then a surgical repair under local anesthesia was carried out. A follow-up for 6 months for sexual activity and any associated complaints in addition to local examination. All cases were presented with unilateral single tear, and the main cause of penile fracture was sexual intercourse. No intraoperative or postoperative complications were encountered. They regained their sexual activity 4-6 weeks after the repair. One case developed a mild penile deviation that did not interfere with sexual relation after the 6-month follow-up. Surgical repair of penile fracture after a conservative treatment is an effective method for patients with delayed presentation devoid of urethral involvement.

Superficial Dorsal Vein Injury/Thrombosis Presenting as False Penile Fracture Requiring Dorsal Venous Ligation

PubMed Central

Rafiei, Arash; Hakky, Tariq S; Martinez, Daniel; Parker, Justin; Carrion, Rafael

2014-01-01

Introduction Conditions mimicking penile fracture are extremely rare and have been seldom described. Aim To describe a patient with false penile fracture who presented with superficial dorsal vein injury/thrombosis managed with ligation. Methods A 33-year-old male presented with penile swelling and ecchymosis after intercourse. A penile ultrasound demonstrated a thrombosed superficial dorsal vein but also questionable fracture of the tunica albuginea. As the thrombus was expanding, he was emergently taken to the operating room for exploration and required only dorsal venous ligation. Results Postoperatively, patient's Sexual Health Inventory for Men score was 23, and he had no issues with erections or sexual intercourse. Conclusion Early exploration of patients with suspected penile fracture provides excellent results with maintenance of erectile function. Also, in the setting of dorsal vein thrombosis, ligation preserves the integrity of the penile tissues and avoids unnecessary complications from conservative management. Rafiei A, Hakky TS, Martinez D, Parker J, and Carrion R. Superficial dorsal vein injury/thrombosis presenting as false penile fracture requiring dorsal venous ligation. PMID:25548650

A comprehensive, prospective study of penile dimensions in Chinese men of multiple ethnicities.

PubMed

Chen, X B; Li, R X; Yang, H N; Dai, J C

2014-01-01

This study aimed to establish a reference range of penile length and circumference of adult males in China, and to compare the penile dimensions of different ethnical backgrounds. To do this, penile length and circumference measurements were obtained from 5196 healthy males attending the Urology Counseling Clinic. The mean value of penile dimensions was a flaccid length of 6.5 ± 0.7 cm, a stretched length of 12.9 ± 1.2 cm and a flaccid circumference of 8.0 ± 0.8 cm. In the subgroup of 311 males, the mean erectile length was 12.9 ± 1.3 cm and the mean erectile circumference was 10.5 ± 0.9 cm, the mean flaccid and erectile glans lengths were 2.7 ± 0.3 and 3.4 ± 0.4 cm, respectively, and the mean flaccid and erectile glans diameters were 2.6 ± 0.2 and 3.4 ± 0.4 cm, respectively. We found that flaccid penile length and circumference varied among different ethnicities. This study established a reference range for penile dimensions, which will help when counseling patients worried about their penile size or seeking penis enlargement surgery. We also found that penile dimensions are different in different ethnicities, but further investigations are needed to validate this.

External Mechanical Devices and Vascular Surgery for Erectile Dysfunction.

PubMed

Trost, Landon W; Munarriz, Ricardo; Wang, Run; Morey, Allen; Levine, Laurence

2016-11-01

The field of sexual medicine is continuously advancing, with novel outcomes reported on a regular basis. Given the rapid evolution, updated guidelines are essential to inform practicing clinicians on best practices. To summarize the current literature and provide clinical guidelines on penile traction therapy, vacuum erection devices, and penile revascularization. A consensus panel was held with leading sexual medicine experts during the 2015 International Consultation on Sexual Medicine (ICSM). Relevant literature was reviewed and graded based on Oxford criteria to develop evidence-based guideline and consensus statements. The development of clinically relevant guidelines. Penile traction therapy is a viable therapy to modestly improve penile length as a primary therapy, before penile prosthesis placement in men with decreased penile length or after surgery for Peyronie's disease. It also might have a role in the acute phase of Peyronie's disease but has inconsistent outcomes in the long-term phase. Vacuum erection devices are effective in creating an erection satisfactory for intercourse, even in difficult-to-treat populations. They also might be used in the post-prostatectomy setting to maintain penile length but have insufficient evidence as a penile rehabilitation therapy. For vasculogenic erectile dysfunction, men with suspected arterial insufficiency can be evaluated with penile Duplex Doppler ultrasonography and confirmatory angiography. Penile revascularization procedures have consistently demonstrated benefits in very select patient populations; however, inadequate data exists to suggest the superiority of one technique. Men with vascular risk factors are likely poor candidates for penile revascularization, although veno-occlusive dysfunction and age are less significant. Therapies for treating primary veno-occlusive dysfunction are not recommended and should be reserved for clinical trials. Since the prior ICSM meeting, multiple developments have occurred in external mechanical devices and penile revascularization for the treatment of erectile and sexual dysfunction. Sexual medicine clinicians are encouraged to review and incorporate recommendations as applicable to their scope of practice. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

EAU guidelines on penile curvature.

PubMed

Hatzimouratidis, Konstantinos; Eardley, Ian; Giuliano, François; Hatzichristou, Dimitrios; Moncada, Ignacio; Salonia, Andrea; Vardi, Yoram; Wespes, Eric

2012-09-01

Penile curvature can be congenital or acquired. Acquired curvature is secondary due to La Peyronie (Peyronie's) disease. To provide clinical guidelines on the diagnosis and treatment of penile curvature. A systematic literature search on the epidemiology, diagnosis, and treatment of penile curvature was performed. Articles with the highest evidence available were selected and formed the basis for assigning levels of evidence and grades of recommendations. The pathogenesis of congenital penile curvature is unknown. Peyronie's disease is a poorly understood connective tissue disorder most commonly attributed to repetitive microvascular injury or trauma during intercourse. Diagnosis is based on medical and sexual histories, which are sufficient to establish the diagnosis. Physical examination includes assessment of palpable nodules and penile length. Curvature is best documented by a self-photograph or pharmacologically induced erection. The only treatment option for congenital penile curvature is surgery based on plication techniques. Conservative treatment for Peyronie's disease is associated with poor outcomes. Pharmacotherapy includes oral potassium para-aminobenzoate, intralesional treatment with verapamil, clostridial collagenase or interferon, topical verapamil gel, and iontophoresis with verapamil and dexamethasone. They can be efficacious in some patients, but none of these options carry a grade A recommendation. Steroids, vitamin E, and tamoxifen cannot be recommended. Extracorporeal shock wave treatment and penile traction devices may only be used to treat penile pain and reduce penile deformity, respectively. Surgery is indicated when Peyronie's disease is stable for at least 3 mo. Tunical shortening procedures, especially plication techniques, are the first treatment options. Tunical lengthening procedures are preferred in more severe curvatures or in complex deformities. Penile prosthesis implantation is recommended in patients with erectile dysfunction not responding to pharmacotherapy. These European Association of Urology (EAU) guidelines summarise the present information on penile curvature. The extended version of the guidelines is available on the EAU Web site (www.uroweb.org/guidelines/). Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

[Surgical or conservative treatment of penile fracture].

PubMed

Nale, Dj; Nikić, P; Vuković, I; Djordjević, D; Vuksanović, A

2008-01-01

Penile fracture presents with rupture of corpora cavernosa. It is not rare but is remarkable. Treatment options are controversial. To establish the incidence, what are early and late complications in patients treated surgically or with conservative treatment options (prospective/retrospective and randomized analysis). To find out what therapy verified as superior. The total of 32 patients with typical acute penile fracture were analyzed. The patients were between 20 and 56 years of age (Mean age 40+/-7.25 SD). A total of 11 patients that presented up to 48h after the rupture of tunica albuginea (34.37%) were operated, while 9 patients (28.13%) were conservatively treated. 12 patients (37.5%) reported to andrology consulting room due to penile fibrous alterations and/or erectile dysfunction 6 to 14 months after the anamnesticaly established, typical penile fracture ("primary latent penile fracture"). Both groups of patients were strictly clinically followed 3, 6, 9 and 12 months after the penile fracture. Eventual development of late complications (erectile dysfunction ED, penile curvature, induratio, caverno-urethral fistula and urethral stenosis) was also recorded. Etiology of ED was investigated: anamnesticaly, by hormone and laboratory analysis, using penodynamic test (PGE1), Duplex Doppler echosonography, and dynamic cavernosography. In the operated group of patients, (11 pts, 34.37%) preserved erectile capacity was recorded and no penile deformity or plaque lesions on the site of suture, after the patients were recommended to have 4 weeks of sexual abstinence. The rupture of tunica albuginea was always transversal in relation to penile axis i.e. in relation to axial force against which the penis acts during the intercourse. The rupture is always on the basis or mid penile portion . Out of 21 (65.63%) conservatively treated patients in 13 (61.9%) plaque lesions (longitudinal diameter 2 cm) was recorded, while sexual dysfunction was established in 13 patients (12 with ED and 1 patient with incapability for vaginal penetration). Evaluation of post therapeutical complications in relation to type of treatment, significantly higher frequency was recorded in the group of conservatively treated patients (p<0.01). Penile veno-oclusive dysfunction was registrated as significantly most frequent cause of ED (in 10-76.92% out of 13 patients). All patients with ED had palpable fibrous lesion similar to Peyrone's plaque, while the degree of penile deviation correlated to the size of plaque lesion. The late complications of penile fracture were significantly more frequently recorded in the group of conservative treated patients (p<0.01) which proves that this lesion presents as urgent urological entity. The penile rupture is always transversal, and most probable place of rupture is physiological penile curve since this is the site of weakened structural integrity.

Penile necrosis secondary to purpura fulminans: a case report and review of literature

PubMed Central

Cheon, Paul M.; Kassam, Javeed; Seal, Alexander E.; Kavanagh, Alexander G.

2017-01-01

Abstract We report the case of a 60-year-old Hispanic male with widespread necrotic purpuric lesions involving the penile, suprapubic, inguinal and hip dermis due to purpura fulminans. Purpura fulminans describes a rare syndrome involving intravascular thrombosis and hemorrhagic infarction of the skin; this rapidly progressing syndrome features vascular collapse and disseminated intravascular coagulation. This patient’s penile necrosis involved the majority of the penile shaft and glans penis, and ultimately required partial glansectomy and repeated debridement for treatment. Subsequently, full thickness skin grafting was completed for reconstruction with good effect. While reports of penile necrosis secondary to various causes are documented in the literature, no prior reports describe penile necrosis secondary to purpura fulminans. PMID:28479975

[Human papillomavirus and penile cancer : Thinking about measures for prevention].

PubMed

Schneede, P; Schlenker, B

2018-04-01

Two major pathways of penile carcinogenesis are known: human papillomavirus (HPV)-induced penile cancer and HPV-negative cancers associated with chronic dermatoses. Therefore, modern measures for prevention of penile cancer may for example include prophylactic HPV vaccination. The resulting B‑cell-mediated immunity to HPV capsid proteins is effective protection against future HPV infections. Contrarily when treating existing HPV infections or HPV-associated cancers an antigen-specific T‑cell immunity is necessary. To date, screening and treatment of precancerous lesions to prevent penile cancer are not established in the German health care program and the highly expected therapeutic HPV vaccines are still on the horizon. In this article, we focus on possible strategies to prevent HPV-related penile cancer on different levels of carcinogenesis.

Penile blood flow by xenon-133 washout

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haden, H.T.; Katz, P.G.; Mulligan, T.

1989-06-01

Penile erectile failure is often attributed to abnormalities of vascular supply or drainage, but few direct measurements of penile blood flow have been made. We describe the xenon washout method for measurement of penile blood flow, and present the results obtained in a group of normal and impotent subjects. The procedure was performed with standard nuclear imaging equipment. Flaccid-state penile blood flow in the impotent patients studied was not significantly different from the normal group, suggesting that flaccid-state measurements may not be helpful in evaluation of erectile failure. However, this method can be used to measure penile venous outflow withmore » stimulated or induced erection, and may provide a method for detecting abnormal venous leakage.« less

Instructional control of an autonomic sexual response1

PubMed Central

Laws, D. R.; Rubin, H. B.

1969-01-01

Four of seven human male subjects developed full penile erections when exposed to erotically stimulating motion pictures. Changes in penile size were detected by a mercury strain gauge transducer and automatically recorded on a continuous paper record. When instructed to inhibit penile erection in the presence of such effective stimulus films, every subject was able to reduce his erection by at least 50%. This inhibition was apparent as long as the instructions were in effect; when the instructions were removed and the film reshown, the erection returned almost to its maximum state. This was true whether the films were presented as few as three or as many as nine times in succession. When instructed to develop an erection in the absence of a film, every subject was able to do so, each reaching a peak of about 30% of his maximum. Such erections had longer latencies to the peak produced and lower maximum levels than those elicited by a film. PMID:16795214

New Insights on the Morphology of Adult Mouse Penis1

PubMed Central

Rodriguez, Esequiel; Weiss, Dana A.; Yang, Jennifer H.; Menshenina, Julia; Ferretti, Max; Cunha, Tristan J.; Barcellos, Dale; Chan, Lok Yun; Risbridger, Gail; Cunha, Gerald R.; Baskin, Laurence S.

2011-01-01

ABSTRACT The adult mouse penis represents the end point of masculine sex differentiation of the embryonic genital tubercle and contains bone, cartilage, the urethra, erectile bodies, several types of epithelium, and many individual cell types arrayed into specific anatomical structures. Using contemporary high-resolution imaging techniques, we sought to provide new insights to the current description of adult mouse penile morphology to enable understanding of penile abnormalities, including hypospadias. Examination of serial transverse and longitudinal sections, scanning electron microscopy, and three-dimensional (3D) reconstruction provided a new appreciation of the individual structures in the adult mouse penis and their 3D interrelationships. In so doing, we discovered novel paired erectile bodies, the male urogenital mating protuberance (MUMP), and more accurately described the urethral meatus. These morphological observations were quantified by morphometric analysis and now provide accurate morphological end points of sex differentiation of mouse penis that will be the foundation of future studies to identify normal and abnormal penile development. PMID:21918128

Functional outcomes following immediate repair of penile fracture: a tertiary referral centre experience with 76 consecutive patients.

PubMed

De Luca, Francesco; Garaffa, Giulio; Falcone, Marco; Raheem, Amr; Zacharakis, Evangelos; Shabbir, Majed; Aljubran, Abdelkareem; Muneer, Asif; Holden, Fiona; Akers, Claire; Christopher, Nim; Ralph, David J

2017-04-01

The aim of this study was to report surgical and functional outcomes in patients who underwent immediate penile fracture repair following location of the tunical tear with ultrasonography. Patients' clinical notes from September 2005 to October 2015 were reviewed. The inclusion criteria were the documented presence of an albugineal laceration at the preoperative ultrasonography and during surgical exploration. In total, 76 patients were enrolled in the study. The aetiology, presentation, imaging results, intraoperative findings, functional outcomes and complications of surgical repair were retrospectively extrapolated from the clinical notes. Patients were questioned about their erectile and urinary function 12 months after the traumatic event. Validated questionnaires were administered to enquire about sexual and urinary function. Finally, the accuracy of the ultrasound in detecting the site of the tunical defect was evaluated. The mean age was 39.5 years (range 21-72 years) and the median follow-up was 13 weeks. The aetiology of the fracture was sexual intercourse in 70 patients, the taqaandan manoeuvre in three and trauma while sleeping in three. The intraoperative findings showed a ventral and transverse tear in 93.5% of cases. Urethral injuries were evident in one-quarter of the patients. Ultrasonographic findings were confirmed intraoperatively in all patients. Worsening of the quality of erections was reported by 5% of patients, and 5.2% reported a penile curvature postoperatively. Penile fracture is a rare urological emergency and requires early surgical exploration and repair. Ultrasonography is a cheap and readily available investigation that allows confirmation of the diagnosis, and identification of the location of the tear and the associated urethral injury.

Reversal Surgery in Regretful Male-to-Female Transsexuals After Sex Reassignment Surgery.

PubMed

Djordjevic, Miroslav L; Bizic, Marta R; Duisin, Dragana; Bouman, Mark-Bram; Buncamper, Marlon

2016-06-01

Sex reassignment surgery (SRS) has proved an effective intervention for patients with gender identity disorder. However, misdiagnosed patients sometimes regret their decision and request reversal surgery. This review is based on our experience with seven patients who regretted their decision to undergo male-to-female SRS. To analyze retrospectively seven patients who underwent reversal surgery after regretting their decision to undergo male-to-female SRS elsewhere. From November 2010 through November 2014, seven men 33 to 53 years old with previous male-to-female SRS underwent reversal phalloplasty. Preoperatively, they were examined by three independent psychiatrists. Surgery included three steps: removal of female genitalia with scrotoplasty and urethral lengthening, total phalloplasty with microvascular transfer of a musculocutaneous latissimus dorsi flap, and neophallus urethroplasty with penile prosthesis implantation. Self-reported esthetic and psychosexual status after reversion surgery and International Index of Erectile Function scores for sexual health after phalloplasty and penile prosthesis implantation. Follow-up was 13 to 61 months (mean = 31 months). Good postoperative results were achieved in all patients. In four patients, all surgical steps were completed; two patients are currently waiting for penile implants; and one patient decided against the penile prosthesis. Complications were related to urethral lengthening: two fistulas and one stricture were observed. All complications were repaired by minor revision. According to patients' self-reports, all patients were pleased with the esthetic appearance of their genitalia and with their significantly improved psychological status. Reversal surgery in regretful male-to-female transsexuals after SRS represents a complex, multistage procedure with satisfactory outcomes. Further insight into the characteristics of persons who regret their decision postoperatively would facilitate better future selection of applicants eligible for SRS. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Comparison of the patient and partner satisfaction with 700CX and Titan penile prostheses.

PubMed

Otero, Javier Romero; Cruz, César Rojas; Gómez, Borja García; Geli, Joaquim Sarquella; Polo, Jose Medina; Castañé, Eduard Ruiz; Antolín, Alfredo Rodríguez

2017-01-01

Most widespread three-component penile prosthesis models are 700CX™ and Titan ® . Our purpose is to assess patient and partner satisfaction after the first implant. This is a multicenter, retrospective, nonrandomized study in which all patients who met the inclusion criteria between 2009 and 2013 were included. In total, 248 patients agreed to participate. To evaluate patient satisfaction, a validated but modified 11-question questionnaire was completed (EDITS); and a nonvalidated two-item questionnaire was given to the partner. Statistical analysis used an ordinal logistic regression model. Two hundred and forty-eight patients (194 with 700CX™ vs 54 with Titan®) and 207 couples completed the questionnaire (165 with 700CX™ vs 42 with Titan®). Overall satisfaction was high. Both showed great reliability for sexual intercourse and high compliance with prior expectations. Most patients were able to manage the penile prosthesis correctly within 6 months. Postoperative penile shortening led to some dissatisfaction in 42% and 46% of cases (700CX™ /Titan®). Significant differences were found in three questions of patients' questionnaire. There were more patients satisfied with the 700CX™ (P = 0.0001). No patient with Titan® implant took longer than 6 months to optimal management. Only 4% of patients with 700CX™ implant were dissatisfied with the deflation, in contrast to 24% with the Titan® (P = 0.0031). Of the two partners' questions, one showed a statistically significant difference (P = 0.0026). It seems that group 700CX™ would recommend to re-implant the prosthesis with a greater tendency. The overall satisfaction was very high for both prostheses. The final aspect of the erected and flaccid penis was satisfactory, but both groups showed significant discontent with its final size. Partners' overall satisfaction was high.

Functional restoration of penis with partial defect by scrotal skin flap.

PubMed

Zhao, Yue-Qiang; Zhang, Jie; Yu, Mo-Sheng; Long, Dao-Chou

2009-11-01

We investigated a reconstructive method with better sensory and erectile function for partial penile defects and report our long-term results of surgical correction using scrotal skin flaps. We retrospectively analyzed the records of 18 patients with penile defects referred to us between 1992 and 2007. All cases were treated with a scrotal skin flap initially to repair the secondary defect after penile elongation. Of the 18 cases treated during the 15-year period the mechanism of primary injury was circumcision in 3, animal bite in 9 and penile tumor dissection in 6. Penile elongation, division of the suspensory ligament and scrotal skin flaps achieved penile augmentation and enhancement. Six cases were treated with a bilateral scrotal skin flap supplied by the anterior scrotal artery and 12 were repaired with a total anterior scrotal skin flap supplied by the anterior and posterior scrotal arteries. Penile length in the flaccid and erectile states was obviously increased postoperatively (p <0.05). All patients were followed 1 to 9 years (mean 2.3) postoperatively. Deep and superficial sensation recovered and erectile function was retained. Of the 18 patients 15 reported satisfied sexual intercourse during the 0.5 to 5-year followup. The method of correcting partial penile defect using scrotal skin flaps is effective and simple according to our long-term experience. This method achieves reasonable cosmesis and penile length in most cases with better sensory and erectile function.

Obesity is associated with increased risk of invasive penile cancer.

PubMed

Barnes, Kerri T; McDowell, Bradley D; Button, Anna; Smith, Brian J; Lynch, Charles F; Gupta, Amit

2016-07-13

To validate the association between obesity and penile cancer at a population level, we conducted a matched case-control study linking the Iowa Department of Motor Vehicles Drivers' License Database (DLD) with cancer surveillance data collected by the State Health Registry of Iowa (SHRI). All men diagnosed with invasive penile squamous cell carcinoma from 1985 to 2010 were identified by SHRI. Two hundred sixty-six cancer cases and 816 cancer-free male controls, selected from the Iowa DLD, were matched within 5-year age and calendar year strata. Body mass index (BMI) was calculated using self-reported height and weight from the DLD. Conditional logistic regression was used to evaluate the association between BMI and the risk of developing invasive penile cancer. Obesity was significantly associated with an increased risk of developing penile cancer. For every five-unit increase in BMI the risk of invasive penile cancer increased by 53 % (OR 1.53, 95 % CI 1.29-1.81, p < 0.0001). We previously reported an association between obesity and higher risk of invasive penile cancer and advanced cancer stage at diagnosis in a hospital-based retrospective study. This population-based study confirms an association between obesity and invasive penile cancer.

Penile epidermal inclusion cyst: a late complication of penile girth enhancement surgery.

PubMed

Park, Hyun Jun; Park, Nam Cheol; Park, Sung Woo; Jern, Tae Kyung; Choi, Kyung-Un

2008-09-01

Epidermal inclusion cysts are benign lesions that can develop in any part of the body. However, the finding of an epidermal inclusion cyst in the penis is rare. The aim of this article was to present the management of a case of a penile epidermal inclusion cyst that occurred because of late complications of a penile girth enhancement surgery. A 52-year-old man presented with a painless, slowly growing mass in the penis, which was first noted after a penile girth enhancement surgery 20 years ago. A cystic mobile mass about 2 cm in depth was found surrounding the coronal sulcus. Excision of the mass was performed for diagnosis and treatment. There was no communication with the urethra. The pathological diagnosis was an epidermal inclusion cyst of the penis. A penile epidermal inclusion cyst in adult men is rare. It can develop after an inadequate procedure for penile girth enhancement, and should be treated by complete resection.

Insight into novel biomarkers in penile cancer: Redefining the present and future treatment paradigm?

PubMed

Zargar-Shoshtari, Kamran; Sharma, Pranav; Spiess, Philippe E

2017-11-02

Biomarkers are increasingly used in the diagnosis and management of various malignancies. Selected biomarkers may also play a role in management of certain cases of penile carcinoma. In this article, we provide an overview of the clinical role of such markers in the management of penile cancer. This is a nonsystematic review of relevant literature assessing biomarkers in penile carcinoma. Evidence of infections with human papillomavirus and its surrogate markers may have important prognostic value in patients with localized or metastatic penile cancer. Squamous cell carcinoma antigen, p53, C-reactive protein, Ki-67, proliferating cell nuclear antigen, cyclin D1, as well as other markers have been studied with various degree of evidence in support of clinical utility in penile cancer. No single marker may have all the answers, and future research should focus on genomic analysis of individual penile tumors, attempting to identify specific targets for treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

Penile fracture: experience at Ayub Teaching Hospital.

PubMed

Khan, Raza Muhammad; Malik, Masud Akhtar; Jamil, Muhammad; Khan, Delawar; Shah, Iftikhar Hussain

2008-01-01

Penile fracture is a relatively rare traumatic rupture of the tunica albuginea of one or both corpora cavernosa of an erect penis. It is a real urological emergency which needs early assessment and surgical management. Twelve (12) cases of penile fracture were reviewed from July, 1997 to July, 2007 in the Department of Urology, Ayub Teaching Hospital Abbottabad. All cases presented with classical history of penile fracture and the diagnosis was made on the basis of history and clinical examination only. All the patients underwent immediate surgical repair with well preserved potency and excellent overall results. Penile fracture has typical signs. Standard treatment consists of immediate surgical repair of penile fracture with a low incidence of late complications. Post op complications including urethral strictures and erectile dysfunction should be ruled out by regular follow-up.

The status of penile enhancement procedures.

PubMed

Vardi, Yoram; Gruenwald, Ilan

2009-11-01

Most men who request surgical penile enhancement have a normal-sized and fully functional penis but visualize their penises as small (psychological dysmorphism). This fact by itself leads to controversy regarding the true indications for penile enhancement procedures in men without micropenis. One of the typical aspects of penile enhancement is the lack of true methodological evaluation of the more commonly performed procedures. Even recently, only few solid scientific studies are available which can shed some light on results and outcome of these controversial procedures. Although some additional data has emerged during the past year, there is still no consensus in regard to indications and surgical techniques used for penile augmentation or penile girth enhancement. There is further need for more studies to provide a better overview of the value and worthiness of these procedures.

Value of p16(INK)⁴(a) in the pathology of invasive penile squamous cell carcinomas: A report of 202 cases.

PubMed

Cubilla, Antonio L; Lloveras, Belén; Alejo, Maria; Clavero, Omar; Chaux, Alcides; Kasamatsu, Elena; Monfulleda, Núria; Tous, Sara; Alemany, Laia; Klaustermeier, Joellen; Muñoz, Nubia; Quint, Wim; de Sanjose, Silvia; Bosch, Francisco Xavier

2011-02-01

One third to one half of penile squamous cell carcinomas (SCCs) are related to human papillomavirus (HPV) infection. Viral detection is usually carried out by polymerase chain reaction (PCR) or other molecular methods. In this study, we evaluated p16(INK)⁴(a) immunohistochemical expression, which is simpler and less costly, as a potential marker of high-risk HPV (HR-HPV) infection in penile SCC. We pathologically classified 202 invasive penile carcinomas and performed HPV genotyping by short PCR fragment (SPF)₁₀ PCR and p16(INK)⁴(a) immunohistochemistry. We also evaluated HPV and p16(INK)⁴(a) according to the histologic subtypes of penile SCC. Tumors depicting continuous p16(INK)⁴(a) immunostain in all neoplastic cells were considered positive. HPV and p16(INK)⁴(a) status were compared using classifier performances and concordance indexes. Evidence of HPV (low-risk and high-risk genotypes) was found in 63 cases (31%) by PCR. Fifty-three p16(INK)⁴(a)-positive cases were identified (26%). Overexpression of p16(INK)⁴(a) had a sensitivity of 67% and a specificity of 91% for defining the HPV status. Concordance indexes between p16(INK)⁴(a) and HPV status were high (≥78%) in general cases and in all histologic subtypes of penile SCC. The stain was useful in the differential diagnosis of basaloid and low-grade warty carcinomas. Low-risk HPV genotypes were found in 5 tumors, 4 of which were p16(INK)⁴(a) negative. Basaloid and nonbasaloid high-grade (grade 3) SCCs were more likely to be HR-HPV positive when compared with grades 1 to 2 tumors (P<0.000001 and 0.0417, respectively). p16(INK)⁴(a) overexpression was found to be a reliable marker for HR-HPV and a helpful tool in the differential diagnosis of low-grade verruciform and high-grade solid penile tumors. SCC variants depicting basaloid features were more likely to be HPV and p16(INK)⁴(a) positive than low-grade, keratinizing lesions. We also observed a tendency toward HPV positivity in high-grade nonbasaloid tumors. Our results indicated a concordance between HPV and p16(INK)⁴(a) status and this observation may have diagnostic and prognostic implications.

Successful removal of strangulating metal penile ring using a dental handpiece.

PubMed

Etetafia, Mabel Okiemute; Nwajei, Charles Onochie

2014-07-11

Under emergency conditions, the dental handpiece can be a useful tool for removing a strangulating penile ring. To report the successful use of a dental handpiece (dental drill) to remove a strangulating penile ring in an emergency. A case report of a strangulating metal penile ring in a psychiatric patient who presented at the accident and emergency unit of Delta State University Teaching Hospital. The metal ring was removed using a diamond bur in a dental handpiece. In case of emergency, the dental handpiece is a useful tool for removing a strangulating penile ring. 2014 BMJ Publishing Group Ltd.

Primary prevention and vaccination for penile cancer

PubMed Central

Barod, Ravi; Hegarty, Paul K.; Minhas, Suks

2013-01-01

The outcome of penile cancer is proportional to the stage at presentation. Strategies aimed at primary prevention would have a clear advantage, both for the individual and in terms of health economics. A number of preventative measures could be employed, including circumcision, smoking cessation, education on hygiene and human papillomavirus (HPV) prevention. There is a high prevalence of HPV infection associated with penile cancer worldwide. The recent development of HPV vaccines has facilitated interest in their use for the prevention of penile cancer. In this article we review the literature surrounding penile cancer prevention and HPV vaccination in men. PMID:23730331

The effect of vacuum devices on penile hemodynamics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Katz, P.G.; Haden, H.T.; Mulligan, T.

1990-01-01

External vacuum devices are being used increasingly for the management of erectile dysfunction. There is limited information regarding the effect of vacuum devices on penile blood flow and potential for ischemic penile injury. The penile xenon washout rate was measured before and after application of 2 vacuum systems in 15 subjects. Compared to flaccid state measurements the xenon washout rate did not change significantly with the Synergist Erection System but it was significantly reduced with the Osbon ErecAid System. However, the degree and duration of decrease in penile blood flow that may result in ischemic changes are unknown.

Face mask ventilation--the dos and don'ts.

PubMed

Wood, Fiona E; Morley, Colin J

2013-12-01

Face mask ventilation provides respiratory support to newly born or sick infants. It is a challenging technique and difficult to ensure that an appropriate tidal volume is delivered because large and variable leaks occur between the mask and face; airway obstruction may also occur. Technique is more important than the mask shape although the size must appropriately fit the face. The essence of the technique is to roll the mask on to the face from the chin while avoiding the eyes, with a finger and thumb apply a strong even downward pressure to the top of the mask, away from the stem and sloped sides or skirt of the mask, place the other fingers under the jaw and apply a similar upward pressure. Preterm infants require continuous end-expiratory pressure to facilitate lung aeration and maintain lung volume. This is best done with a T-piece device, not a self-inflating or flow-inflating bag. Copyright © 2013 Elsevier Ltd. All rights reserved.

Penile fracture and its treatment: is retrograde urethrograghy necessary for management of penile fracture?

PubMed

Ahmadnia, Hassan; Younesi Rostami, Mehdi; Kamalati, Ali; Imani, Mohammad Mehdi

2014-01-01

Penile fracture, being defined as rupture of the tunica albuginea of the corpus cavernosum, is uncommon. Here, we analyze findings on our patients during a 10-year period and evaluate the role of retrograde urethrography. From February 2002 to April 2012, 116 patients were admitted with penile fracture at Ghaem Medical Center. Patient history and physical examination were taken at their admittance to detect probable urethral injury. Before surgery, retrograde urethrography was performed in all patients. The size and site of the tunical rupture were recorded. Then the rupture of tunica albuginea was sutured with nonabsorbable (3-0 nylon) sutures and the ties were placed on the internal surface (continuous method). All patients were followed up for 12 months. Patients' mean age was (32.78 ± 10.61) years and ranged (16-62) years. The mechanism of trauma was sexual intercourse in 103 patients (89%) and masturbation in 13 patients (11%). The most common site of injury found after exploration was right (55%) and lateral (74%) of the corpus cavernosum. The size of the tunical rupture was from 0.5 to 3.0 cm (mean 1.88 ± 0.72). Three of the patients had Marphan's syndrome. Urethral injury was detected by retrograde urethrography in 4 patients (3%) who had macroscopic hematuria and urethrorrhagia. During 12 months follow-up, no complication was seen. There is no need to perform retrograde urethrography unless the patients have gross hematuria or urethrorrhagia. The key to success in treatment of penile fracture is to achieve a rapid diagnosis based on history and a physical examination, avoid unnecessary imaging tests and perform immediate surgery to reconstruct the site of injury.

Predictive factors for erectile dysfunction in men with prostate cancer after brachytherapy: Is dose to the penile bulb important?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Macdonald, A. Graham; Keyes, Mira; Kruk, Alexandra

2005-09-01

Purpose: To determine predictive factors for postimplant erectile dysfunction (ED) in a cohort of patients, according to prospectively collected data; specifically, to assess the impact of penile bulb volume and D50 and D95 (dose covering 50% and 95% of the penile bulb volume, respectively) on ED. Methods and Materials: Three hundred forty-two patients were identified who were potent before implant and who had at least 2 years' follow-up. Patient, tumor, treatment, and dosimetric data were collected on all patients. Postimplant ED was defined according to both physician-documented and patient-documented outcome data. Binary logistic regression analysis was used to create multivariablemore » models of predictors for ED at 1, 2, and 3 years after implant. Results: Physician-documented rates of ED were 57%, 48%, and 38% at 1, 2, and 3 years after implant, respectively. Patient-documented rates of ED were 70% and 66% at 1 and 2 years, respectively. Multivariable analyses revealed age and degree of preimplant erectile function to be consistently significant predictors of ED. Use of hormones was significant at the 1-year physician-documented ED endpoint but not thereafter, in keeping with the time course of testosterone recovery. Penile bulb volume, D50, and D95 were not found to be predictive for ED at any time point, in contrast to previous studies. In addition, planning ultrasound target volume, number of needles, and institutional case sequence number were significant predictors of ED at various time points, consistent with a traumatic etiology of ED. Conclusions: We found no evidence to support penile bulb dosimetry as an independent predictive factor for ED after implant, using physician-documented or patient-documented outcomes.« less

Risk Group Systems for Penile Cancer Management: A Study of 203 Patients With Invasive Squamous Cell Carcinoma.

PubMed

Chaux, Alcides

2015-10-01

To evaluate the accuracy of previously published risk group systems for predicting inguinal nodal metastases in patients with penile carcinoma. Two hundred three cases of invasive penile squamous cell carcinomas (SCC) were stratified using the following systems: Solsona et al (J Urol 2001;165:1509), Hungerhuber et al (Urology 2006;68:621), and the system proposed by the European Association of Urology (EAU; Eur Urol 2004;46:1). Receiver operating characteristic (ROC) analysis was carried out to compare accuracy in predicting final nodal status and cancer-related death. Most of cases were pT2/pT3 high-grade tumors with a small percentage of low-grade pT1 carcinomas. The metastatic rates for the Solsona et al, EAU, and Hungerhuber et al systems in the high-risk category were 15 of 73 (21%), 16 of 103 (16%), and 10 of 35 (29%) in patients with clinically negative inguinal lymph nodes and 52 of 75 (69%), 55 of 93 (59%), and 34 of 47 (72%) in patients with palpable inguinal lymph nodes, respectively. Performance by ROC analysis showed a low accuracy for all stratification systems although the Solsona et al and the Hungerhuber et al systems performed better than the EAU system. Patients in intermediate-risk categories and with clinically palpable inguinal lymph nodes were more likely to have nodal metastasis than patients with clinically negative lymph nodes in the same category. These stratification systems may be useful for patients with low-grade superficial tumors and less accurate for evaluating patients with high-grade locally advanced penile carcinomas. These data may be useful for therapeutic planning of patients with penile SCC. Copyright © 2015 Elsevier Inc. All rights reserved.

Management of penile defects: a review.

PubMed

Guizhong, Li; Feng, He; Guangling, Huang; Libo, Man; Kun, Liu; Yuming, Shen

2012-06-01

Penile amputation is a rare injury. Although, in principle, penile replantation can be performed using a variety of methods, few, if any, standardized procedures exist to deal with this medical emergency. The value of the various microsurgical techniques for replantation of the penis remains uncertain. This article provides a review of the management of penile defects and complications. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Penile Reconstruction

PubMed Central

Salgado, Christopher J.; Chim, Harvey; Tang, Jennifer C.; Monstrey, Stan J.; Mardini, Samir

2011-01-01

A variety of surgical options exists for penile reconstruction. The key to success of therapy is holistic management of the patient, with attention to the psychological aspects of treatment. In this article, we review reconstructive modalities for various types of penile defects inclusive of partial and total defects as well as the buried penis, and also describe recent basic science advances, which may promise new options for penile reconstruction. PMID:22851914

Signs, symptoms and treatment of penile fracture.

PubMed

Bhoil, Rohit; Sood, Dinesh

2015-10-01

Penile fracture is an uncommon injury and requires urgent treatment, therefore emergency nurses should be aware of the signs and symptoms and understand the importance of immediate surgical referral. This article describes the anatomy and physiology of penile erection and the ways in which penile fracture can occur. It also outlines the management of patients and includes a case study of a fracture caused by vigorous masturbation.

Ruptured superficial dorsal vein of the penis masquerading as a penile fracture: case report.

PubMed

Perlmutter, Adam E; Roberts, Lawrence; Farivar-Mohseni, Hesam; Zaslau, Stanley

2007-08-01

Acute onset of pain, swelling, and ecchymosis of the penis during sexual intercourse indicate a penile fracture until proven otherwise. However, there have been few case reports of isolated injuries to the dorsal penile artery or dorsal vein mimicking a penile fracture. Presented herein is a rare case of a patient who ruptured his superficial dorsal vein during intercourse.

Corpus cavernosum abscess after Winter procedure performance

PubMed Central

Paladino, Joao Roberto; Nascimento, Fabio Jose; Gromatsky, Celso; Pompeo, Antonio Carlos Lima

2014-01-01

A 23-year-old male patient with sickle-cell disease reported his third episode of priapism complicated by the presence of a corpus cavernosum abscess after the performance of a Winter procedure 20 days prior to his presentation. While in hospital for 11 days, two penile needle aspirations and three surgical drainages were performed with associated antibiotic therapy. He evolved with erectile dysfunction refractory to drug therapy and his infectious condition improved. An early penile prosthesis implantation followed after the use of a vacuum pump in an attempt to decrease the fibrotic process of the corpora cavernosa. Final results were positive. PMID:24515231

Human papillomavirus-16 is the predominant type etiologically involved in penile squamous cell carcinoma.

PubMed

Heideman, Daniëlle A M; Waterboer, Tim; Pawlita, Michael; Delis-van Diemen, Pien; Nindl, Ingo; Leijte, Joost A; Bonfrer, Johannes M G; Horenblas, Simon; Meijer, Chris J L M; Snijders, Peter J F

2007-10-10

Human papillomavirus (HPV) infections are suggested to be involved in the development of penile squamous cell carcinoma (SCC), but comprehensive studies to define the association are limited. Therefore, we performed molecular and serologic analyses for a broad spectrum of HPV types on a large series of 83 penile SCCs, and we compared serological findings to those of age-matched male controls (N = 83). Penile SCCs were subjected to detection and typing assays for mucosal and cutaneous HPVs and to subsequent, type-specific viral load and viral gene expression assays. Sera of patients and of controls were analyzed for type-specific mucosal and cutaneous HPV L1, E6, and/or E7 antibodies using bead-based, multiplex serology. HPV DNA of mucosal and/or cutaneous types was found in 46 of 83 (55%) penile SCCs. HPV16 was the predominant type, appearing in 24 (52%) of 46 of penile SCCs. The majority of HPV16 DNA-positive SCCs (18 of 24; 75%) demonstrated E6 transcriptional activity and a high viral load. Additionally, HPV16 molecular findings were strongly associated with HPV16 L1-, E6-, and E7-antibody seropositivity. Furthermore, serologic case-control analyses demonstrated that, in addition to the association of HPV16 with penile SCC, seropositivity against any HPV type was significantly more common in patients compared with in controls. HPV18 and HPV6 seropositivity were associated with HPV16-negative SCCs but were not correlated to molecular findings. HPV16 is the main HPV type etiologically involved in the development of penile SCC. Although individuals who develop penile SCC show a greater prior exposure to a broad spectrum of HPV types, insufficient evidence was found to claim a role for HPV types other than HPV16 in penile carcinogenesis.

Centralization of Penile Cancer Management in the United States: A Combined Analysis of the American Board of Urology and National Cancer Data Base.

PubMed

Matulewicz, Richard S; Flum, Andrew S; Helenowski, Irene; Jovanovic, Borko; Palis, Bryan; Bilimoria, Karl Y; Meeks, Joshua J

2016-04-01

To assess the potential benefit of centralization of care in penile cancer. Centralization of care in other disease processes standardizes treatment and improves outcomes. Because penile cancer is a rare malignancy with unchanged mortality rates over the last two decades, we hypothesize that there may be a benefit to centralization. We identified surgeon, patient, and hospital characteristics captured by the National Cancer Data Base (1998-2012) and American Board of Urology case logs (2003-2013) for all penile cancer cases and procedures. Differences in patient demographics, stage of disease, referral patterns, and surgical quality indicators were assessed between academic and community hospitals. Using case logs to evaluate the distribution of penile cancer care, we found that only 4.1% of urologists performed a penile surgery and 1.5% performed a lymph node dissection (LND). Academic centers treated higher-stage cancers and saw more cases/year than community centers, suggesting informal centralization. Two guideline-based quality indicators demonstrated no difference in use of penile-sparing surgery but a higher likelihood of having an LND performed at an academic center (48.4% vs 26.6%). The total lymph node yield was significantly greater at academic centers (18.5 vs 12.5). Regression modeling demonstrated a 2.29 increased odds of having an LND at an academic center. Our data provide the first evidence for centralization of penile cancer in the US. At the time of diagnosis, equal number of patients is treated with penile-sparing surgery but there is greater use of LND and higher lymph node yield at academic centers. Ultimately, longer follow-up is necessary to determine if this improves survival of patients with penile cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

[Regional anatomy of the dorsal penile nerve and its clinical significance].

PubMed

Zhang, Chun-Ying; Li, Xing-Hua; Yuan, Tan; Zhang, Hai-Feng; Liu, Ji-Hong; Ye, Zhang-Qun

2009-02-01

To investigate the number, course and distribution of normal dorsal penile nerves and their clinical significance for selective neurectomy of the dorsal penile nerve in the treatment of primary premature ejaculation. We dissected 38 cadaveric adult penises and recorded the number, course and distribution of the dorsal penile nerves. A total of 314 cases of primary premature ejaculation underwent selective neurectomy of the dorsal penile nerve. The patients ranged between 20 and 45 years in age and from 1 to 22 years in disease course. The dorsal penile nerves were distributed in parallel bilaterally in all the cadaveric penises and branched into the ventral side in 4 of them. The total number of dorsal penile nerves was (3.6 +/- 1.2) in the 38 cadaveric penises, 7 in 1 case, 6 in 1 case, 5 in 6 cases, 4 in 9 cases, 3 in 14 cases and 2 in 7 cases, while that of the 314 patients with primary premature ejaculation was (7.0 +/- 1.9), 5 in 64 cases, 6 in 56 cases, 7 in 52 cases, 8 in 40 cases, 9 in 33 cases, 10 in 28 cases, 11 in 25 cases, 12 in 11 cases and 13 in 5 cases. Selective neurectomy of the dorsal penile nerve achieved an intravaginal ejaculation latency of (4.31 +/- 1.87) minutes and sexual satisfaction rate of (61 +/- 17) %, significantly different from those before the operation ([1.24 +/- 0.32] min, [23 +/- 6] %; all P < 0.01). The abnormal increase of dorsal penile nerves possibly lies at the bottom of the pathogenesis of primary premature ejaculation. Selective neurectomy of the dorsal penile nerve is safe and effective for the treatment of primary premature ejaculation.

Penile artery shunt syndrome: a novel cause of erectile dysfunction after penile revascularization surgery.

PubMed

Pavlinec, Jonathan G; Hakky, Tariq S; Yang, Christopher; Massis, Kamal; Munarriz, Ricardo; Carrion, Rafael E

2014-09-01

Penile revascularization is a surgical treatment option for erectile dysfunction (ED) in healthy individuals due to a focal arterial occlusion in the absence of generalized vascular disease. Most described failures have been attributed to graft stenosis or disruption of the anastomosis. We report a novel phenomenon called Penile Artery Shunt Syndrome that contributed to persistent ED in a patient after penile microvascular arterial bypass surgery. A 26-year-old man presented for evaluation of long-standing ED, which was attributed to trauma sustained 12 years earlier. He had difficulty obtaining and maintaining erections despite oral pharmacotherapy. Clinical data related to the case were studied, analyzed, and reviewed with urologic and radiologic specialists at multiple centers that collaborated in the care of this patient. Penile duplex ultrasound peak systolic velocities and five-item International Index for Erectile Function questionnaire scores were the main outcome measures. Initial diagnostic workup of the patient confirmed severe insufficiency of the left cavernosal artery, with no evidence of venous leak. The patient underwent penile microvascular arterial bypass surgery with anastomosis of the left inferior epigastric artery to the left dorsal penile artery. The patient had persistence of severe ED despite patent anastomosis by penile duplex ultrasound. Subsequent arteriography revealed an arterial shunt due to an aberrant obturator artery arising from the donor inferior epigastric artery. The patient underwent embolization of the aberrant obturator artery, with resolution of the shunt and marked improvement in erectile function. The presence of an aberrant obturator artery arising from the inferior epigastric artery may predispose to persistent ED after revascularization due to the creation of a shunt phenomenon. Pelvic arteriography may be useful in identifying anomalous anatomic considerations prior to penile revascularization and to evaluate patients with persistent postoperative ED. © 2014 International Society for Sexual Medicine.

[Medical and surgical treatments of congenital and acquired penile curvatures: a review].

PubMed

Guillot-Tantay, C; Phé, V; Chartier-Kastler, E; Mozer, P; Bitker, M-O; Rouprêt, M

2014-03-01

The aim of the current study was to provide an overview about the surgical and medical management of acquired and congenital penile's curvature. [corrected] A systematic review of the literature was done from the PubMed database by searching the following keywords alone or in combination: Congenital penile curvature; Congenital penile deviation; Acquired penile curvature; Acquired penile deviation; Peyronie's disease. The treatment of congenital curvature is only surgical. The most common technique is the Nesbit's technique which consists in making elliptical excisions of the tunica albuginea. There are also incison or plication procedures which are efficient as well. Acquired curvature is most of the time represented by the Peyronie's disease or is post-traumatic. Among oral treatments available, the Potaba is the only drug which has proved a significant reduction in penile plaque size. Injections of interferon and nicardipine have also shown their efficacy. Ionotophoresis and extracorporeal shock-wave therapy may be beneficial for penile pain. Other therapies (vacuum, traction devices, topical Verapamil) can be interesting but other studies are necessary to recommend them. Surgical treatment is recommended during the fibrotic phase. The most common technique is also the Nesbit's technique. In case of severe curvature (curve superior to 60°), small penis, major deformations, graft techniques can be used. Moreover, if there is a sexual dysfunction, penile prosthesis is recommended. Other studies are necessary to prove the efficacy of most of the drugs already available in the treatment of the penile curvature. It seems to be interesting to combine the different treatments to improve the results of those therapies. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Three cases of subcutaneous granuloma annulare of the penis: a rare presentation of a common disease.

PubMed

Toepfer, Nicholas J; Wessner, Scott R; Elston, Dirk M; Simmons, Jennifer; Sumfest, Joel M

2011-09-01

To describe three patients who presented to a single institution within four years of each other with isolated granuloma annulare of the penis. Granuloma annulare is an inflammatory disease of the dermis that can affect men of any age including childhood. Granuloma annulare of the penis is a remarkably uncommon presentation with only 12 cases previously reported. A retrospective review of pathologic records was conducted confirming three cases of penile granuloma annulare diagnosed at our institution. The three cases are described in detail including the history, presentation, histological findings and treatment of each patient. The clinical variants, characteristic histology, classic clinical presentation, differential diagnosis and recurrence following surgery of granuloma annulare are reviewed. We describe three individuals from a single institution with isolated granuloma annulare of the penis suggesting this condition is more common than previously thought. Patients with penile granuloma annulare may present to practicing urologists and it is important to be familiar with this idiopathic subcutaneous disorder in order to avoid unnecessary aggressive surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

General Information about Penile Cancer

MedlinePlus

... Research Penile Cancer Treatment (PDQ®)–Patient Version General Information About Penile Cancer Go to Health Professional Version ... the PDQ Adult Treatment Editorial Board . Clinical Trial Information A clinical trial is a study to answer ...

Penile enlargement with methacrylate injection: is it safe?

PubMed

Torricelli, Fabio Cesar Miranda; Andrade, Enrico Martins de; Marchini, Giovanni Scala; Lopes, Roberto Iglesias; Claro, Joaquim Francisco Almeida; Cury, Jose; Srougi, Miguel

2013-01-01

CONTEXT Penis size is a great concern for men in many cultures. Despite the great variety of methods for penile augmentation, none has gained unanimous acceptance among experts in the field. However, in this era of minimally invasive procedure, injection therapy for penile augmentation has become more popular. Here we report a case of methacrylate injection in the penis that evolved with penile deformity and sexual dysfunction. This work also reviews the investigation and management of this pathological condition. CASE REPORT A 36-year-old male sought medical care with a complaint of penile deformity and sexual dysfunction after methacrylate injection. The treatment administered was surgical removal. Satisfactory cosmetic and functional results were reached after two months. CONCLUSIONS There is a need for better structured scientific research to evaluate the outcomes and complication rates from all penile augmentation procedures.

Primary Undifferentiated Pleomorphic Sarcoma of the Penis

PubMed Central

Yoo, Hyung Sun; Satti, Suma

2017-01-01

Background: Primary penile sarcoma is a rare disease that affects men of all ages. Different subtypes of primary penile sarcoma exist, with the rarest being pleomorphic sarcoma. Delays in presentation and diagnosis of primary penile sarcoma have been reported because of its benign-appearing presenting features and rarity. If penile sarcoma is left untreated, the clinical consequence is metastasis that is fatal in most cases. Case Report: We report an extremely rare case of undifferentiated pleomorphic sarcoma of the penis in a 59-year-old patient who initially presented with a slow-growing penile nodule. The tumor was surgically excised, but the patient experienced local recurrence and, despite receiving chemotherapy and surgery, died of metastatic disease 15 months after initial presentation. Conclusion: Vigilance regarding biopsy and intervention for penile nodules may lead to early diagnosis and improved clinical outcomes. PMID:29230132

APOBEC3A Expression in Penile Squamous Cell Carcinoma.

PubMed

Heller, Martina; Prigge, Elena-Sophie; Kaczorowski, Adam; von Knebel Doeberitz, Magnus; Hohenfellner, Markus; Duensing, Stefan

2017-11-23

APOBECs (apolipoprotein B mRNA-editing catalytic polypeptides) are cytidine deaminases that have been implicated in the host defense against viruses by blocking viral replication. They have also been shown to play a role in genome hypermutation in several human cancers. An APOBEC3 hypermutation signature has been discovered in cervical cancer, which is intimately associated with infection by high-risk human papillomaviruses (HPVs). At the same time, HPV genomes themselves are subject to DNA editing by APOBECs. Similar to cervical cancer, a proportion of penile squamous cell carcinomas (SCCs) is etiologically driven by high-risk HPVs, but very little is known about the role of APOBECs in penile SCC development and progression. A series of 34 penile SCCs was analyzed for the expression of APOBEC3A protein by immunohistochemistry. HPV genotyping was carried out using a bead-based multiplex hybridization assay preceded by BSGP5+6+ primer-based amplification. We found a frequent reduction of APOBEC3A protein expression in the invasive parts of the majority of HPV-negative penile SCCs. In contrast, the majority of HPV-positive penile SCCs retained APOBEC3A expression during malignant progression. Our results suggest that APOBEC3A expression is downregulated during progression towards invasiveness in HPV-negative penile SCC, but maintained in HPV-positive penile SCC. How high-risk HPV-infected tumor cells tolerate high APOBEC3A, which appears to exert tumor suppressive functions in HPV-negative penile SCCs, remains to be elucidated. © 2017 S. Karger AG, Basel.

The prevalence of human papillomavirus genotypes in penile cancers from northern Thailand.

PubMed

Senba, Masachika; Kumatori, Atsushi; Fujita, Shuichi; Jutavijittum, Prapan; Yousukh, Amnat; Moriuchi, Toshiyuki; Nakamura, Tsuyoshi; Toriyama, Kan

2006-10-01

The highest frequency of penile cancer occurs in Asia, Africa, and Latin America, and there have been a few reports concerning the association of penile cancer with human papillomavirus (HPV) infection in these areas. The objective of this study was to determine the relation between penile cancer and the prevalence of HPV genotypes in northern Thailand. Eighty-eight specimens of penile tissue (65 malignant, 1 pre-malignant, and 22 benign cases) were examined to determine the association of HPV infection. An in situ hybridization (ISH) method was used to detect and localize HPV-DNA. Sensitive HPV polymerase chain reaction (PCR) procedure was used for detection of HPV-DNA, and DNA sequencing was used to identify the HPV genotype. HPV-DNA was detected in 53.8% and 81.5% of cases of penile cancer, using ISH and PCR, respectively. The high-risk HPV-16, most commonly associated with penile cancer in previous reports, was found in only one case in this study. The most prevalent genotype was the high-risk HPV-18, found in 55.4% of the cases (32.3% single and 23.1% multiple infection) followed by the low-risk HPV-6, found in 43.1% of the cases (24.6% single and 18.5% multiple infection). In this study, penile cancer was found to be highly correlated with HPV-DNA. Specifically, infection with both the low-risk HPV-6 and the high-risk HPV-18 is the characteristic prevalence of HPV genotypes in penile cancer in this area.

Women's partnered orgasm consistency is associated with greater duration of penile-vaginal intercourse but not of foreplay.

PubMed

Weiss, Petr; Brody, Stuart

2009-01-01

It has been asserted that women's likelihood or consistency of partnered orgasm (her orgasm as a result of sexual activities with a partner) is determined by duration of foreplay, but not by duration of penile-vaginal intercourse. The objective was to examine the extent to which women's likelihood or consistency of partnered orgasm is associated with duration of foreplay, duration of penile-vaginal intercourse, and age. In a representative sample of the Czech population, 2,360 women reported their consistency of orgasm with a partner (from "never" to "almost every time"), and estimates of their typical durations of foreplay and of penile-vaginal intercourse. The association of consistency of partnered orgasm with typical durations of both foreplay and penile-vaginal intercourse. In univariate analyses, consistency of partnered orgasm was more associated with penile-vaginal intercourse duration than with foreplay duration (consistency also correlated negatively with age). In multivariate analysis, foreplay ceased to be a significant correlate of partnered orgasm consistency (the exclusion of respondents reporting a penile-vaginal intercourse duration of 1 minute or less did not alter the results). When both sexual activity categories are examined in tandem on a population level, women's likelihood or consistency of partnered orgasm is associated with penile-vaginal intercourse duration, but not with foreplay duration. In contrast to the assumptions of many sex therapists and educators, more attention should be given to improve the quality and duration of penile-vaginal intercourse rather than foreplay.

Penile embryology and anatomy.

PubMed

Yiee, Jenny H; Baskin, Laurence S

2010-06-29

Knowledge of penile embryology and anatomy is essential to any pediatric urologist in order to fully understand and treat congenital anomalies. Sex differentiation of the external genitalia occurs between the 7th and 17th weeks of gestation. The Y chromosome initiates male differentiation through the SRY gene, which triggers testicular development. Under the influence of androgens produced by the testes, external genitalia then develop into the penis and scrotum. Dorsal nerves supply penile skin sensation and lie within Buck's fascia. These nerves are notably absent at the 12 o'clock position. Perineal nerves supply skin sensation to the ventral shaft skin and frenulum. Cavernosal nerves lie within the corpora cavernosa and are responsible for sexual function. Paired cavernosal, dorsal, and bulbourethral arteries have extensive anastomotic connections. During erection, the cavernosal artery causes engorgement of the cavernosa, while the deep dorsal artery leads to glans enlargement. The majority of venous drainage occurs through a single, deep dorsal vein into which multiple emissary veins from the corpora and circumflex veins from the spongiosum drain. The corpora cavernosa and spongiosum are all made of spongy erectile tissue. Buck's fascia circumferentially envelops all three structures, splitting into two leaves ventrally at the spongiosum. The male urethra is composed of six parts: bladder neck, prostatic, membranous, bulbous, penile, and fossa navicularis. The urethra receives its blood supply from both proximal and distal directions.

Penile bulb dose and impotence after three-dimensional conformal radiotherapy for prostate cancer on RTOG 9406: Findings from a prospective, multi-institutional, phase I/II dose-escalation study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roach, Mack; Winter, Kathryn; Michalski, Jeffrey M.

2004-12-01

Purpose: To assess the relationship between the dose to the bulb of the penis and the risk of impotence in men treated on Radiation Therapy Oncology Group (RTOG) 9406. Methods and materials: Men enrolled on a Phase I/II dose-escalation study, RTOG 9406, who were reported to be potent at entry and evaluable (n = 158) were selected for inclusion. Follow-up evaluations were scheduled every 3, 4, and 6 months for the first, second, and the third through fifth years, then annually. At each follow-up visit an assessment of potency status was made. Penile structures were defined by a single observermore » blinded to the potency status, using Web-based, on-line software. The dosimetry for penile structures was calculated at the Quality Assurance Center at Washington University and provided to RTOG Statistical Headquarters to determine whether there was a relationship between dose and impotence. Results: Patients whose median penile dose was {>=}52.5 Gy had a greater risk of impotence compared with those receiving <52.5 Gy (p = 0.039). In a multivariate analysis neither age, the dose to the prostate, nor the use of hormonal therapy correlated with the risk of impotence. Conclusions: Dose to the bulb of the penis seems to be associated with the risk of radiation-induced impotence.« less

Penile Embryology and Anatomy

PubMed Central

Yiee, Jenny H.; Baskin, Laurence S.

2010-01-01

Knowledge of penile embryology and anatomy is essential to any pediatric urologist in order to fully understand and treat congenital anomalies. Sex differentiation of the external genitalia occurs between the 7and 17 weeks of gestation. The Y chromosome initiates male differentiation through the SRY gene, which triggers testicular development. Under the influence of androgens produced by the testes, external genitalia then develop into the penis and scrotum. Dorsal nerves supply penile skin sensation and lie within Buck's fascia. These nerves are notably absent at the 12 o'clock position. Perineal nerves supply skin sensation to the ventral shaft skin and frenulum. Cavernosal nerves lie within the corpora cavernosa and are responsible for sexual function. Paired cavernosal, dorsal, and bulbourethral arteries have extensive anastomotic connections. During erection, the cavernosal artery causes engorgement of the cavernosa, while the deep dorsal artery leads to glans enlargement. The majority of venous drainage occurs through a single, deep dorsal vein into which multiple emissary veins from the corpora and circumflex veins from the spongiosum drain. The corpora cavernosa and spongiosum are all made of spongy erectile tissue. Buck's fascia circumferentially envelops all three structures, splitting into two leaves ventrally at the spongiosum. The male urethra is composed of six parts: bladder neck, prostatic, membranous, bulbous, penile, and fossa navicularis. The urethra receives its blood supply from both proximal and distal directions. PMID:20602076

Fracture of the penis: management and long-term results of surgical treatment. Experience in 300 cases.

PubMed

El Atat, Rabii; Sfaxi, Mohamed; Benslama, Mohamed Riadh; Amine, Derouiche; Ayed, Mohsen; Mouelli, Sami Ben; Chebil, Mohamed; Zmerli, Saadedine

2008-01-01

Herein, we present the largest series of penile fracture ever published. We evaluate the clinical presentation, the outcome of the treatment and the prognosis. We retrospectively studied patients with penile fracture treated from 1975 to 2005. Three hundred patients were included in this study. The mean patient age was 30 years (range, 18-68 years). Out of these patients, 57 (19%) patients were injured during sexual intercourse, whereas 180 (60%) patients were injured during masturbation. The mean time from injury to presentation was 26 hours. The diagnosis was clinical in all cases. No further investigation was needed for confirming the diagnosis. Five patients had urethral bleeding with urethral lesion. All patients were treated by immediate surgery. All of the patients had a tunica albuginea tear that was promptly repaired. At follow-up (mean time of 7 years), 14 patients presented mild curvature, which had not hindered intercourse in 10 patients. The Nesbit intervention was performed in four patients. Penile pain at intercourse developed in four patients (1.3%) and at erection in six patients (2%). Erectile dysfunction was observed in two cases (0.6%). Penile fracture has typical clinical signs. Early surgical treatment is associated with a low incidence of late complications. The high frequency in our area is neither because of physical nor genetic particularities. It is probably because of sociocultural characteristics.

Effect of sustained inflation duration; resuscitation of near-term asphyxiated lambs.

PubMed

Klingenberg, Claus; Sobotka, Kristina S; Ong, Tracey; Allison, Beth J; Schmölzer, Georg M; Moss, Timothy J M; Polglase, Graeme R; Dawson, Jennifer A; Davis, Peter G; Hooper, Stuart B

2013-05-01

The 2010 ILCOR neonatal resuscitation guidelines do not specify appropriate inflation times for the initial lung inflations in apnoeic newborn infants. The authors compared three ventilation strategies immediately after delivery in asphyxiated newborn lambs. Experimental animal study. Facility for animal research. Eighteen near-term lambs (weight 3.5-3.9 kg) delivered by caesarean section. Asphyxia was induced by occluding the umbilical cord and delaying ventilation onset (10-11 min) until mean carotid blood pressure (CBP) was ≤22 mm Hg. Animals were divided into three groups (n=6) and ventilation started with: (1) inflation times of 0.5 s at a ventilation rate 60/min, (2) five 3 s inflations or (3) a single 30 s inflation. Subsequent ventilation used inflations at 0.5 s at 60/min for all groups. Times to reach a heart rate (HR) of 120 bpm and a mean CBP of 40 mm Hg. Secondary outcome was change in lung compliance. Median time to reach HR 120 bpm and mean CBP 40 mm Hg was significantly shorter in the single 30 s inflation group (8 s and 74 s) versus the 5×3 s inflation group (38 s and 466 s) and the conventional ventilation group (64 s and 264 s). Lung compliance was significantly better in the single 30 s inflation group. A single sustained inflation of 30 s immediately after birth improved speed of circulatory recovery and lung compliance in near-term asphyxiated lambs. This approach for neonatal resuscitation merits further investigation.

Comparison of decentration and tilt between one piece and three piece polymethyl methacrylate intraocular lenses

PubMed Central

Hayashi, K.; Hayashi, H.; Nakao, F.; Hayashi, F.

1998-01-01

BACKGROUND—The extent of the decentration and tilt was prospectively compared between one piece polymethyl methacrylate (PMMA) and three piece PMMA intraocular lenses (IOLs) which were implanted in the capsular bag after performing continuous curvilinear capsulorhexis.
METHODS—91 patients underwent a one piece PMMA IOL implantation in one eye as well as the implantation of the three piece PMMA IOL with polyvinylidene fluoride loops in the opposite eye. The length of the lens decentration and the angle of the tilt were quantitated using the anterior eye segment analysis system (EAS-1000) at 1 week as well as 1, 3, and 6 months postoperatively.
RESULTS—The mean length of the decentration in the one piece IOL was smaller than that in the three piece IOL at 1 week (p=0.0092), 1 month (p=0.0044), 3 months (p=0.0069), and 6 months (p=0.0010) postoperatively. However, no significant difference was found in the degree of the tilt between the two types of IOLs throughout the observation periods.
CONCLUSION—These results clarified that the one piece PMMA IOL with rigid PMMA haptics implanted in the capsular bag provides a better centration than the three piece PMMA IOL with flexible haptics, whereas the tilt was the same between the two types of IOLs.

 Keywords: intraocular lens; decentration; tilt; continuous curvilinear capsulorhexis PMID:9640193

[Penile torsion. Case report].

PubMed

Arch Canas, Albert; Gutiérfz del Pozo, Rafael

2006-01-01

To report the clinical characteristics and therapeutic options of penile torsion. We report the case of a male with asymptomatic penile torsion as an incidental finding after consultation for other reasons. The patient was treated conservatively because it was not an important aesthetic trouble and it was asymptomatic. Penile torsion is rare. Surgical treatment is reserved for very important degrees of torsion, symptomatic patients or, when patient feels discomfort with the aesthetic alteration.

Relationship between penile fracture and Peyronie's disease: a prospective study.

PubMed

Acikgoz, A; Gokce, E; Asci, R; Buyukalpelli, R; Yilmaz, A F; Sarikaya, S

2011-01-01

Peyronie's disease is postulated to be initiated by repetitive minor traumas to the fully or partially erect penis. We investigated Peyronie's disease prospectively in cases treated for penile fracture (PF) within the last 20 years. Medical records of 63 cases treated for PFs were reviewed. Subjects were required to self-assess their current penile morphologies and sexual functions. Penile nodules and Peyronie's plaques were also evaluated with physical examination, ultrasonography and magnetic resonance imaging (MRI), and penile curvatures with auto-photography, and sexual function with international erectile function index (IIEF). Of the 63 cases (mean age 37 years), 46 who had mean follow-up of 63 months were re-evaluated. The mean IIEF-5 score was 23.2±3.1. Painful erections (n=5), penile nodules (n=5) and also penile curvatures <20° (n=2) were investigated. No Peyronie's plaque was palpated in any of the cases. Ultrasound and MRI showed fibrotic nodules of 5 mm in diameter, which extended into the subtunical area in the rupture site in 54% of the cases, although any thickening and Peyronie's plaque were not found in the tunica albuginea and intracavernosal septum of the cases examined. In PF patients treated surgically, the erectile function and penile morphology were preserved. In our cases PFs did not induce the development of Peyronie's disease.

Successful removal of strangulating metal penile ring using a dental handpiece

PubMed Central

Etetafia, Mabel Okiemute; Nwajei, Charles Onochie

2014-01-01

Background Under emergency conditions, the dental handpiece can be a useful tool for removing a strangulating penile ring. Objective To report the successful use of a dental handpiece (dental drill) to remove a strangulating penile ring in an emergency. Method A case report of a strangulating metal penile ring in a psychiatric patient who presented at the accident and emergency unit of Delta State University Teaching Hospital. Result The metal ring was removed using a diamond bur in a dental handpiece. Conclusions In case of emergency, the dental handpiece is a useful tool for removing a strangulating penile ring. PMID:25015321

Penile herpes zoster: an unusual location for a common disease.

PubMed

Bjekic, Milan; Markovic, Milica; Sipetic, Sandra

2011-01-01

Herpes zoster is a common dermatological condition which affects up to 20% of the population, most frequently involving the thoracic and facial dermatomes with sacral lesions occurring rarely and only a few reported cases of penile shingles. We report two cases of unusual penile clinical presentations of varicella zoster virus infection in immunocompetent men. The patients presented with grouped clusters of vesicles and erythema on the left side of penile shaft and posterior aspect of the left thigh and buttock, involving s2-s4 dermatomes. The lesions resolved quickly upon administration of oral antiviral therapy. Penile herpes zoster should not be overlooked in patients with unilateral vesicular rash.

Penile Cancer Treatment (PDQ®)—Health Professional Version

Cancer.gov

Penile cancer treatment options include surgery and radiation therapy depending upon tumor size, location, invasiveness, and stage. Get detailed information about the treatment of newly diagnosed and recurrent penile cancer in this summary for clinicians.

Penile agenesis and congenital hypertrophic pyloric stenosis: an association or a random coexistence?

PubMed

Yagmurlu, Aydin; Vargun, Rahsan; Gollu, Gulnur; Gokcora, I Haluk

2004-01-01

A neonate with penile agenesis and congenital hypertrophic pyloric stenosis is presented. The patterns of associated anomalies with penile agenesis, and those of congenital hypertrophic pyloric stenosis are discussed.

Microvascular temporalis fascia transfer for penile girth enhancement.

PubMed

Küçükçelebi, A; Ertaş, N M; Aydin, A; Eroğlu, A; Ozmen, E; Velidedeoğlu, H

2001-07-01

The authors report a 44-year-old man with inadequate penile girth that caused psychological problems. Using microvascular temporalis fascia transfer, they achieved satisfactory penile girth enhancement based on reliable vascularity in a single stage.

Reconstruction of deformities resulting from penile enlargement surgery.

PubMed

Alter, G J

1997-12-01

More than 30 patients presented for reconstruction of penile deformities secondary to penile enlargement surgery performed by other physicians. Lengthening was performed by releasing the suspensory ligament of the penis and advancing pubic skin with a V-Y advancement flap. Girth was increased by injecting autologous fat. Specific complaints relating to the lengthening procedure involve hypertrophic and/or wide scars, a proximal penile hump from a thick, hair-bearing V-Y flap, and a low hanging penis. Complications relating to autologous fat injections include disappearance of fat, penile lumps and nodules, and shaft deformities. The repair of these deformities is described. From 1994 through October 1996, 19 men underwent 24 various combinations of reconstructive operations, such as scar revisions, V-Y advancement flap reversal, and removal of fat nodules and asymmetrical fat deposits. Penile appearance and function were improved. Complications include 1 hematoma requiring drainage, minor wound complications and 1 inadequately reversed V-Y flap. The methods of various repairs are discussed, including reconstructive limitations, timing and staging. Significant improvement can be achieved with proper reconstruction of penile deformities.

Penile length and circumference: an Indian study.

PubMed

Promodu, K; Shanmughadas, K V; Bhat, S; Nair, K R

2007-01-01

Apprehension about the normal size of penis is a major concern for men. Aim of the present investigation is to estimate the penile length and circumference of Indian males and to compare the results with the data from other countries. Results will help in counseling the patients worried about the penile size and seeking penis enlargement surgery. Penile length in flaccid and stretched conditions and circumference were measured in a group of 301 physically normal men. Erected length and circumference were measured for 93 subjects. Mean flaccid length was found to be 8.21 cm, mean stretched length 10.88 cm and circumference 9.14 cm. Mean erected length was found to be 13.01 cm and erected circumference was 11.46 cm. Penile dimensions are found to be correlated with anthropometric parameters. Insight into the normative data of penile size of Indian males obtained. There are significant differences in the mean penile length and circumference of Indian sample compared to the data reported from other countries. Study need to be continued with a large sample to establish a normative data applicable to the general population.

Radioisotope penile plethysmography: A technique for evaluating corpora cavernosal blood flow during early tumescence

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schwartz, A.N.; Graham, M.M.; Ferency, G.F.

1989-04-01

Radioisotope penile plethysmography is a nuclear medicine technique which assists in the evaluation of patients with erectile dysfunction. This technique attempts to noninvasively quantitate penile corpora cavernosal blood flow during early penile tumescence using technetium-99m-labeled red blood cells. Penile images and counts were acquired in a steady-state blood-pool phase prior to and after the administration of intracorporal papaverine. Penile counts, images, and time-activity curves were computer analyzed in order to determine peak corporal flow and volume changes. Peak corporal flow rates were compared to arterial integrity (determined by angiography) and venosinusoidal corporal leak (determined by cavernosometry). Peak corporal flow correlatedmore » well with arterial integrity (r = 0.91) but did not correlate with venosinusoidal leak parameters (r = 0.01). This report focuses on the methodology and the assumptions which form the foundation of this technique. The strong correlation of peak corporal flow and angiography suggests that radioisotope penile plethysmography could prove useful in the evaluation of arterial inflow disorders in patients with erectile dysfunction.« less

Complete Penile Duplication with Structurally Normal Penises: A Case Report.

PubMed

Karagözlü Akgül, Ahsen; Uçar, Murat; Çelik, Fatih; Kırıştıoğlu, İrfan; Kılıç, Nizamettin

2018-03-28

Diphallia is a very rare anomaly and seen once in every 5.5 million live births. True diphallia with normal penile structures is extremely rare (1,2,3,4,5,6,7). We present the surgical management of a 4-year-old patient with complete penile duplication without any penile or urethral pathology. The patient's first physical examination revealed complete penile duplication, urine flow from both penises, meconium flow from right urethra, and anal atresia. Further evaluations showed double colon and rectum, double bladder, and large recto-vesical fistula. Two cavernous bodies and one spongious body were detected in each penile body. Surgical treatment plan consisted of right total penectomy and end-to-side urethra-urethrostomy. No postoperative complications and no voiding dysfunction were detected during the 18 months follow-up. Penile duplication is a rare anomaly, which presents differently in each patient. Because of this, the treatment should be individualized and end-to-side urethra-urethrostomy may be an alternative to removing posterior urethra. This approach eliminates the risk of damaging prostate gland and sphincter.

Penile rehabilitation following prostate cancer treatment: review of current literature

PubMed Central

Clavell-Hernandez, Jonathan; Wang, Run

2015-01-01

Radical prostatectomy (RP) and radiotherapy (RT) are highly effective in improving prostate cancer survival. However, both have a detrimental effect on erectile function (EF). Penile rehabilitation consists of understanding the mechanisms that cause erectile dysfunction (ED) and utilizing pharmacologic agents, devices or interventions to promote male sexual function. For the past decade, many researchers have pursued to define effective treatment modalities to improve ED after prostate cancer treatment. Despite the understanding of the mechanisms and well-established rationale for postprostate treatment penile rehabilitation, there is still no consensus regarding effective rehabilitation programs. This article reviews a contemporary series of trials that assess penile rehabilitation and explore treatment modalities that might play a role in the future. Published data and trials related to penile rehabilitation after RP and RT were reviewed and presented. Although recent trials have shown that most therapies are well-tolerated and aid in some degree on EF recovery, we currently do not have tangible evidence to recommend an irrefutable penile rehabilitation algorithm. However, advancements in research and technology will ultimately create and refine management options for penile rehabilitation. PMID:25851656

The role of Nesbit's procedure in surgical reconstruction of penile deviation

PubMed Central

Martenstein, Christian; Peruth, Julia; Hamza, Amir

2012-01-01

Objective: We review our results after surgical reconstruction with the Nesbit’s procedure for congenital or acquired penile deviation. Patients and methods: Etiology of penile deviation, surgical outcome for straightening the penis, postoperative patient satisfaction and clinical findings were evaluated for 5 patients undergoing Nesbit’s procedure followed by a Medline review of contemporary literature regarding alternative surgical techniques. Follow-up included clinical examination, self-photography on erection and a standardized interview with erectile dysfunction assessment using IIEF-5 questionnaire. Results: Overall patient satisfaction was 100% in two patients, 2 patients were partly satisfied and 1 patient reported no satisfaction because of severe penile shortening with insufficiency for sexual intercourse postoperatively. Preoperative mean angulation of the penis was 42°. Four patients had Peyronie’s disease and 1 patient’s curvature resulted from an untreated penile fracture during sexual intercourse. Conclusion: The Nesbit technique can give satisfactory results for mild and moderate penile curvature. However, each technique for the reconstruction of penile deviation has its own advantages and disadvantages. Therefore proper patient selection has a major impact on further outcome. PMID:26504690

The electromyographic activity of the external and internal urethral sphincters and urinary bladder on vaginal distension and its role in preventing vaginal soiling with urine during sexual intercourse.

PubMed

Shafik, Ahmed; Shafik, Ali A; Shafik, Ismail A; El Sibai, Olfat

2008-03-01

We investigated the hypothesis that external (EUS) and internal (IUS) urethral sphincters and urinary bladder (UB) respond to penile thrusting (PT) of vagina in a way that prevents urinary leakage during coitus. Vaginal condom was inflated with air in increments of 50-300 ml and EMG of EUS and IUS and vaginal pressure were recorded; test was repeated after anesthetization of vagina, UB, EUS, and IUS. Vaginal distension effected reduction of vesical pressure but increase of IUS EMG until the 150 ml distension was reached, beyond which more vaginal distension caused no further effect; EUS EMG showed no response. Vaginal distension while vagina, UB, EUS, and IUS had been separately anesthetized, produced no change. Vaginal balloon distension appears to effect vesical relaxation and increased IUS tone. This seems to provide a mechanism to avoid urine leakage during coitus and to occur through a reflex we term 'vagino-urethrovesical reflex'.

78 FR 17642 - Determination Under the Textile and Apparel Commercial Availability Provision of the Dominican...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... Agreements (``CITA'') has determined that certain piece dyed three-thread fleece fabric, as specified below... behalf of Garan Manufacturing, Inc. for certain piece dyed three-thread fleece fabric, as specified below... Commercial Availability proceedings. SPECIFICATIONS: Certain Piece Dyed Three-thread Fleece Fabric HTS: 6001...

[Penile augmentation using acellular dermal matrix].

PubMed

Zhang, Jin-ming; Cui, Yong-yan; Pan, Shu-juan; Liang, Wei-qiang; Chen, Xiao-xuan

2004-11-01

Penile enhancement was performed using acellular dermal matrix. Multiple layers of acellular dermal matrix were placed underneath the penile skin to enlarge its girth. Since March 2002, penile augmentation has been performed on 12 cases using acellular dermal matrix. Postoperatively all the patients had a 1.3-3.1 cm (2.6 cm in average) increase in penile girth in a flaccid state. The penis had normal appearance and feeling without contour deformities. All patients gained sexual ability 3 months after the operation. One had a delayed wound healing due to tight dressing, which was repaired with a scrotal skin flap. Penile enlargement by implantation of multiple layers of acellular dermal matrix was a safe and effective operation. This method can be performed in an outpatient ambulatory setting. The advantages of the acellular dermal matrix over the autogenous dermal fat grafts are elimination of donor site injury and scar and significant shortening of operation time.

[Idiopathic elephantiasis of the penis: a case report].

PubMed

Yamamoto, Keisuke; Matsuoka, Yasuhiro; Takao, Tetsuya; Tsujimur, Akira; Okuyama, Akihiko; Kubo, Tateki; Hosokawa, Kou; Kakuta, Yoichi; Yamaguchi, Seiji

2009-03-01

We report a case of idiopathic elephantiasis of penis. A 41-year-old man was refered to our hospital with a painful penile swelling and severe miction pain. He had no particular past or familial history, and had never been to tropical or semitropical region. Physical examination showed a prominent swelling and flection of his penis. Magnetic resonance imaging revealed a significant thickening of the penile skin and subcutaneous tissue. Due to the difficulty of voiding, an urethral catheter was placed. The penile skin biopsy showed no malignancy. Under the diagnosis of penile elephantiasis, the resection of abnormal penile skin and penile plasty with the split skin graft from his thigh was performed. Histopathological findings showed nonspecific inflammation. The skin graft was successfully adapted. He could urinate smoothly without pain after the urethral catheter was removed. There has been no recurrence 6 months after the operation. He recovered normal micturition and sexual function.

Therapeutic strategies for patients with micropenis or penile dysmorphic disorder.

PubMed

Kayes, Oliver; Shabbir, Majid; Ralph, David; Minhas, Suks

2012-09-01

Micropenis in adults is defined as a stretched length of <7.5 cm. Many aetiologies exist, including congenital and endocrinological causes as well as pathological conditions, such as penile lichen sclerosus, trauma and genital cancer. The resulting reduction in functional penile length can lead to considerable psychosexual morbidity. Furthermore, the subset of patients with micropenis who also suffer from penile dysmorphic disorder require careful and intensive psychological counselling. Corrective surgery for micropenis can be performed in patients with realistic expectations. Total phalloplasty using radial-artery-based forearm skin flaps can offer restoration of normal penile length in selected patients. More-conservative surgical techniques to improve length or girth are limited by minimal enhancement but associated with a significantly lower rate of complications and comorbidity compared to total phalloplasty. Emerging tissue engineering techniques might represent a suitable alternative to penile replacement surgery in the future.

Anatomic Basis for Penis Transplantation: Cadaveric Microdissection of Penile Structures.

PubMed

Tiftikcioglu, Yigit Ozer; Erenoglu, Cagil Meric; Lineaweaver, William C; Bilge, Okan; Celik, Servet; Ozek, Cuneyt

2016-06-01

We present a cadaveric dissection study to investigate the anatomic feasibility of penile transplantation. Seventeen male cadavers were dissected to reveal detailed anatomy of the dorsal neurovascular structures including dorsal arteries, superficial and deep dorsal veins, and dorsal nerves of the penis. Dorsal artery diameters showed a significant decrease from proximal to distal shaft. Dominance was observed in one side. Deep dorsal vein showed a straight course and less decrease in diameter compared to artery. Dorsal nerves showed proximal branching pattern. In a possible penile transplantation, level of harvest should be determined according to the patient and the defect, where a transgender patient will receive a total allograft and a male patient with a proximal penile defect will receive a partial shaft allograft. We designed an algorithm for different levels of penile defect and described the technique for harvest of partial and total penile transplants.

What is the cause of confidence inflation in the Life Events Inventory (LEI) paradigm?

PubMed

Von Glahn, Nicholas R; Otani, Hajime; Migita, Mai; Langford, Sara J; Hillard, Erin E

2012-01-01

Briefly imagining, paraphrasing, or explaining an event causes people to increase their confidence that this event occurred during childhood-the imagination inflation effect. The mechanisms responsible for the effect were investigated with a new paradigm. In Experiment 1, event familiarity (defined as processing fluency) was varied by asking participants to rate each event once, three times, or five times. No inflation was found, indicating that familiarity does not account for the effect. In Experiment 2, richness of memory representation was manipulated by asking participants to generate zero, three, or six details. Confidence increased from the initial to the final rating in the three- and six-detail conditions, indicating that the effect is based on reality-monitoring errors. However, greater inflation in the three-detail condition than in the six-detail condition indicated that there is a boundary condition. These results were also consistent with an alternative hypothesis, the mental workload hypothesis.

Sexual Function and Quality of Life Before and After Penile Prosthesis Implantation Following Radial Forearm Flap Phalloplasty.

PubMed

Young, Ezekiel E; Friedlander, Daniel; Lue, Kathy; Anele, Uzoma A; Khurgin, Jacob L; Bivalacqua, Trinity J; Burnett, Arthur L; Redett, Richard J; Gearhart, John P

2017-06-01

To provide sexual function and quality of life outcomes in patients with severe penile deficiency who underwent radial forearm flap phalloplasty with and without penile prosthesis implantation. Patients with history of severe penile deficiency who underwent microsurgical radial forearm flap phalloplasty with and without penile prosthesis implantation between 2007 and 2014 were identified. They completed a set of web-based validated questionnaires including the International Index of Erectile Function, the Pediatric Penile Perception Score, the Sexual Quality of Life for Men, and several items addressing general quality of life. Outcomes were compared between groups. Nine of the 12 identified patients who had prosthesis after phalloplasty and 4 out of the 7 phalloplasty-only patients completed the survey, resulting in an overall response rate of 68%. Among the phalloplasty-prosthesis patients, 66% reported current sexual activity and 78% reported regular masturbation, whereas 1 of the 4 phalloplasty-only patients reported both. Prosthesis patients scored notably higher in all domains of the International Index of Erectile Function except for sexual desire. In contrast, they demonstrated similar scores of penile perception, as well as general and sexual quality of life. Among patients who have undergone flap phalloplasty, the subsequent placement of penile prosthesis appears to effectively allow for both intercourse and masturbation, resulting in measurable improvements in orgasmic function, intercourse satisfaction, and overall sexual satisfaction. Despite these important benefits, prosthesis placement does not appear to result in improvements in penile perception scores, or general or sexual quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

[Ladder step strategy for surgical repair of congenital concealed penis in children].

PubMed

Wang, Fu-Ran; Zhong, Hong-Ji; Chen, Yi; Zhao, Jun-Feng; Li, Yan

2016-11-01

To assess the feasibility of the ladder step strategy in surgical repair of congenital concealed penis in children. This study included 52 children with congenital concealed penis treated in the past two years by surgical repair using the ladder step strategy, which consists of five main steps: cutting the narrow ring of the foreskin, degloving the penile skin, fixing the penile skin at the base, covering the penile shaft, and reshaping the prepuce. The perioperative data of the patients were prospectively collected and statistically described. Of the 52 patients, 20 needed remodeling of the frenulum and 27 received longitudinal incision in the penoscrotal junction to expose and deglove the penile shaft. The advanced scrotal flap technique was applied in 8 children to cover the penile shaft without tension, the pedicled foreskin flap technique employed in 11 to repair the penile skin defect, and excision of the webbed skin of the ventral penis performed in another 44 to remodel the penoscrotal angle. The operation time, blood loss, and postoperative hospital stay were 40－100 minutes, 5－30 ml, and 3－6 days, respectively. Wound bleeding and infection occurred in 1 and 5 cases, respectively. Follow-up examinations at 3 and 6 months after surgery showed that all the children had a satisfactory penile appearance except for some minor complications (2 cases of penile retraction, 2 cases of redundant ventral skin, and 1 case of iatrogenic penile curvature). The ladder step strategy for surgical repair of congenital concealed penis in children is a simple procedure with minor injury and satisfactory appearance of the penis.

Impact of penile rehabilitation with low-dose vardenafil on recovery of erectile function in Japanese men following nerve-sparing radical prostatectomy

PubMed Central

Nakano, Yuzo; Miyake, Hideaki; Chiba, Koji; Fujisawa, Masato

2014-01-01

Erectile dysfunction (ED) is a major complication after radical prostatectomy (RP); however, debate continues regarding the efficacy of penile rehabilitation in the recovery of the postoperative erectile function (EF). This study included a total of 103 consecutive sexually active Japanese men with localized prostate cancer undergoing nerve-sparing RP, and analyzed the postoperative EF, focusing on the significance of penile rehabilitation. In this series, 24 and 79 patients underwent bilateral and unilateral nerve-sparing RPs, respectively, and 10 or 20 mg of vardenafil was administered to 35 patients at least once weekly, who agreed to undergo penile rehabilitation. Twelve months after RP, 48 (46.6%) of the 103 patients were judged to have recovered EF sufficient for sexual intercourse without any assistance. The proportion of patients who recovered EF in those undergoing penile rehabilitation (60.0%) was significantly greater than that in those without penile rehabilitation (38.2%). Of several parameters examined, the preoperative International Index of Erectile Function-5 (IIEF-5) score and nerve-sparing procedure were significantly associated with the postoperative EF recovery rates in patients with and without management by penile rehabilitation, respectively. Furthermore, univariate analysis identified the preoperative IIEF-5 score, nerve-sparing procedure and penile rehabilitation as significant predictors of EF recovery, among which the preoperative IIEF-5 score and nerve-sparing procedure appeared to be independently associated with EF recovery. Considering these findings, despite the lack of independent significance, penile rehabilitation with low-dose vardenafil could exert a beneficial effect on EF recovery in Japanese men following nerve-sparing RP. PMID:24994781

A review of penile elongation surgery

PubMed Central

Gillis, Joshua

2017-01-01

Penile elongation surgery is less commonly performed in the public sector, but involves a collaborative approach between urology and plastic surgery. Congenital and acquired micropenis are the classic surgical indications for penile elongation surgery. The goal of intervention in these patients is to restore a functional penis size in order to allow normal standing micturition, enable satisfying sexual intercourse and improve patient quality of life. Many men seeking elongation actually have normal length penises, but perceive themselves to be small, a psychologic condition termed ‘penile dysmorphophobia’. This paper will review the anatomy and embryology of congenital micropenis and discuss both conservative and surgical management options for men seeking penile elongation therapy. PMID:28217452

Penile Enhancement Procedures with Simultaneous Penile Prosthesis Placement

PubMed Central

Hakky, Tariq S.; Suber, Jessica; Henry, Gerard; Smith, David; Bradley, Paul; Martinez, Daniel; Carrion, Rafael E.

2012-01-01

Here we present an overview of various techniques performed concomitantly during penile prosthesis surgery to enhance penile length and girth. We report on the technique of ventral phalloplasty and its outcomes along with augmentation corporoplasty, suprapubic lipectomy, suspensory ligament release, and girth enhancement procedures. For the serious implanter, outcomes can be improved by combining the use of techniques for each scar incision. These adjuvant procedures are a key addition in the armamentarium for the serious implant surgeon. PMID:22811703

Which is guilty in self-induced penile fractures: marital status, culture or geographic region? A case series and literature review.

PubMed

Al Ansari, A; Talib, R A; Shamsodini, A; Hayati, A; Canguven, O; Al Naimi, A

2013-01-01

Penile fracture is a well-recognized and relatively uncommon clinical entity. It was previously reported that the incidence of penile fracture varies according to various geographic regions. In order to determine whether marital status or culture other than geographic region is involved in the etiology of penile fracture in our country, the charts of 122 men diagnosed with penile fracture were retrospectively reviewed. Detailed history including cause, symptoms, country of origin and a single-question self-report of erectile dysfunction was used for all cases. Diagnosis of our cases was mainly based on history and physical examination and ultrasonography. Immediate or delayed surgical repair of penile fracture included a degloving circumferential, and an additional direct incision, if the site of the tear could not be reached via degloving, was performed. The patients were evaluated after 1 week and 1, 3, and 6 months follow-up by penile examination, recording complications, and with a single-question self-report questionnaire after 3 and 6 months. The most common cause of penile fracture was manual bending of the erected penis in 66 out of 122 (54.1%) of our study patients. In our study, we believe that the prime causes of bending the penis are single status and culture, which are influencing factors irrespective of the geographic distribution.

Increased incidence of penile cancer and high-grade penile intraepithelial neoplasia in Denmark 1978-2008: a nationwide population-based study.

PubMed

Baldur-Felskov, Birgitte; Hannibal, Charlotte Gerd; Munk, Christian; Kjaer, Susanne K

2012-02-01

To assess the trends in incidence of penile cancer during 1978-2008 and high-grade penile intraepithelial neoplasia (PIN2/3) during 1998-2008 in Denmark. Using two nationwide registries, we estimated age- and period-specific incidence rates. Log-linear Poisson regression analysis was used to estimate average annual percentage change (AAPC) and 95% confidence intervals (CI). We identified 1,488 men with penile cancer and 285 men with PIN2/3. The incidence of penile cancer increased from 1.0 to 1.3 per 100,000 men-years in 1978-1979 to 2006-2008; this represented an AAPC of 0.8% (95% CI: 0.17-1.37). Squamous cell carcinoma (SCC) was the most common histological type (91.7%). The median age at diagnosis was 67 years, and the age-specific incidence rate of penile SCC increased with increasing age. The incidence rate of PIN2/3 increased significantly (0.5 to 0.9 per 100,000 men-years) in 1998-1999 to 2006-2008, and this represented an AAPC of 7.1% (95% CI: 3.30-11.05). The incidence of penile cancer increased in 1978-2008 in Denmark, and the same applied to PIN2/3 in 1998-2008. A high prevalence of human papillomavirus (HPV) and a low circumcision rate in Denmark may partly explain our results.

Detection and typing of human papillomavirus DNA in penile carcinoma: evidence for multiple independent pathways of penile carcinogenesis.

PubMed

Rubin, M A; Kleter, B; Zhou, M; Ayala, G; Cubilla, A L; Quint, W G; Pirog, E C

2001-10-01

To clarify the role of human papillomavirus (HPV) in penile cancer we evaluated the prevalence of HPV DNA in different histological subtypes of penile carcinoma, dysplasia, and condyloma using a novel, sensitive SPF10 HPV polymerase chain reaction assay and a novel genotyping line probe assay, allowing simultaneous identification of 25 different HPV types. Formalin-fixed, paraffin-embedded tissue samples were collected from the United States and Paraguay. HPV DNA was detected in 42% cases of penile carcinoma, 90% cases of dysplasia, and 100% cases of condyloma. There were significant differences in HPV prevalence in different histological cancer subtypes. Although keratinizing squamous cell carcinoma and verrucous carcinoma were positive for HPV DNA in only 34.9 and 33.3% of cases, respectively, HPV DNA was detected in 80% of basaloid and 100% of warty tumor subtypes. There was no significant difference in HPV prevalence between cases from Paraguay and the United States. In conclusion, the overall prevalence of HPV DNA in penile carcinoma (42%) is lower than that in cervical carcinoma (approximately 100%) and similar to vulvar carcinoma (approximately 50%). In addition, specific histological subtypes of penile cancer--basaloid and warty--are consistently associated with HPV, however, only a subset of keratinizing and verrucous penile carcinomas is positive for HPV DNA, and thus these two tumor groups seem to develop along different pathogenetic pathways.

A new surgical method for penile girth enhancement.

PubMed

Li, Xiaoge; Tao, Ling; Cao, Chuan; Shi, Haishan; Li, Le; Chen, Liang; Li, Shirong

2015-01-01

We developed a new surgical model of penile girth enhancement in dog, with minimal damage, fewer complications, and high success rate, to enable the experimental investigation of penile implants. We obtained materials for penile girth enhancement by processing the pericardium and blood vessel wall collected from pigs. Incisions were made at the penile bulb for the implantation of the materials, and facilitate observation and data collection, based on the anatomical features of dog's penis. We measured the girth of the flaccid penis before and after the operation, and erectile function at 1-month postoperation. In addition to evaluation of recovery from the incision and local pathological changes, ultrasonic examination was performed to monitor the long-term changes associated with implantation. The mean girth of the flaccid penis significantly increased from 7.37±0.40 cm before the operation, to 8.70±0.56 cm postoperation. Dogs resumed normal mating at 1 month after the operation, without any significant change in the mating time. Ultrasonic examination clearly illustrated the implants, and helped in the measurement of the distance between the materials and the baculum. Chinese Rural dog is a promising animal model for penile girth enhancement surgery. The findings demonstrated that surgical implantation into penile bulb was associated with less damage, faster postoperative recovery, and higher success. For the first time, ultrasonic examination provided objective data on the surgical outcomes of penile girth enhancement.

War-related penile injuries in Libya: Single-institution experience.

PubMed

Etabbal, Abdalla M; Hussain, Fathi F; Benkhadoura, Mohamed O; Banni, Abdalla M

2018-06-01

To report on our initial experience in the management of war-related penile injuries; proper diagnosis and immediate treatment of penile injuries is essential to gain satisfactory results. Besides treating primary wounds and restoring penile function, the cosmetic result is also an important issue for the surgeon. The study was conducted in the Department of Urology at Benghazi Medical Center and comprised all patients who presented with a shotgun, gunshot or explosive penile injury between February 2011 and August 2017. The patient's age, cause of injury, site and severity of injuries, management, postoperative complications, and hospital stay, were recorded. In all, 29 males with war-related penile injuries were enrolled in the study. The mean (SD) age of these patients was 31.3 (10.5) years. The glans, urethra, and corporal bodies were involved in four (13.7%), 10 (34.4%), and 20 (68.9%) of the patients, respectively. According to the American Association for the Surgery of Trauma Penis Injury Scale, Grade III penile injuries were the most common (11 patients, 37.9%). The most common post-intervention complications were urethral stricture with or without proximal urethrocutaneous fistula (eight patients, 27.5%), followed by permanent erectile dysfunction (five patients, 17.2%). In patients who sustain war-related penile injuries the surgeon's efforts should not only be directed to restoring normal voiding and erectile function but also on the cosmetic appearance of the penis.

Penile Inflammatory Skin Disorders and the Preventive Role of Circumcision

PubMed Central

Morris, Brian J.; Krieger, John N.

2017-01-01

Penile inflammatory skin conditions such as balanitis and posthitis are common, especially in uncircumcised males, and feature prominently in medical consultations. We conducted a systematic review of the medical literature on PubMed, EMBASE, and Cohrane databases using keywords “balanitis,” “posthitis,” “balanoposthitis,” “lichen sclerosus,” “penile inflammation,” and “inflammation penis,” along with “circumcision,” “circumcised,” and “uncircumcised.” Balanitis is the most common inflammatory disease of the penis. The accumulation of yeasts and other microorganisms under the foreskin contributes to inflammation of the surrounding penile tissue. The clinical presentation of inflammatory penile conditions includes itching, tenderness, and pain. Penile inflammation is responsible for significant morbidity, including acquired phimosis, balanoposthitis, and lichen sclerosus. Medical treatment can be challenging and a cost burden to the health system. Reducing prevalence is therefore important. While topical antifungal creams can be used, usually accompanied by advice on hygiene, the definitive treatment is circumcision. Data from meta-analyses showed that circumcised males have a 68% lower prevalence of balanitis than uncircumcised males and that balanitis is accompanied by a 3.8-fold increase in risk of penile cancer. Because of the high prevalence and morbidity of penile inflammation, especially in immunocompromised and diabetic patients, circumcision should be more widely adopted globally and is best performed early in infancy. PMID:28567234

A critical analysis of penile enhancement procedures for patients with normal penile size: surgical techniques, success, and complications.

PubMed

Vardi, Yoram; Har-Shai, Yaron; Harshai, Yaron; Gil, Tamir; Gruenwald, Ilan

2008-11-01

Most men who request surgical penile enhancement have a normal-sized and fully functional penis but visualize their penises as small (psychological dysmorphism). The aim of this review is to describe the various reported techniques and to provide the available scientific data on the success and complication rates of penile enhancement procedures. We performed an extensive systematic review based on a search of the MEDLINE database for articles published between 1965 and 2008. The following key words were used: penis, enhancement, enlargement, phalloplasty, reconstruction, girth, lengthening, and augmentation. Only English-language articles that were related to penile surgery and dysmorphobia were sought. We excluded articles in which fewer than five cases were described and articles in which the type of surgical treatment and the outcome were not clear. Of the 176 papers found, 34 were selected and critically analyzed. We found only a small number of well-designed and comprehensive studies, and most of the published articles reported data that were obtained from small cohorts of patients. The more recently published studies presented better methodologies and descriptions of the surgical techniques than did the older publications. In general, penile enhancement surgery can cause a 1-2-cm increase in penile length and a 2.5-cm augmentation of penile girth. Unwanted outcomes and complications, namely penile deformity, paradoxical penile shortening, disagreeable scarring, granuloma formation, migration of injected material, and sexual dysfunction were reported frequently in these studies. Disappointing short- and long-term patient satisfaction rates following these procedures were also reported in most studies. To date, the use of cosmetic surgery to enlarge the penis remains highly controversial. There is a lack of any standardization of all described procedures. Indications and outcome measures are poorly defined, and the reported complications are unacceptably high. In our opinion, until new, reliable, and more objective and reproducible data are available, these procedures should be regarded as investigational and patients should be discouraged from undergoing these invasive treatments.

Surgical management of penile fracture and long-term outcome on erectile function and voiding.

PubMed

Hatzichristodoulou, Georgios; Dorstewitz, Annika; Gschwend, Jürgen E; Herkommer, Kathleen; Zantl, Niko

2013-05-01

Penile fracture is an emergency in urology. Surgical management is recommended, but objective data of postoperative long-term effects, especially regarding voiding and erectile function, vary. To assess long-term results of patients undergoing surgical therapy for penile fracture. Patients presenting with suspicion of penile fracture were included in this study. Diagnosis of penile fracture was made by clinical assessment and surgery performed thereafter. The defect of the tunica albuginea was closed by absorbable suture. In case of concomitant urethral lesion, the defect was repaired simultaneously. Voiding and erectile function were evaluated at long-term follow-up by mail. Patients' status before penile fracture was assessed retroactively. Erectile function was assessed by the International Index of Erectile Function questionnaire and voiding function by the International Prostate Symptom Score questionnaire. N = 34 patients were included. Penile fracture was suspected in 28/34 (82.4%) patients. Twenty-six of the 28 (92.9%) patients underwent surgery. Only less than half of confirmed fracture patients presented with the classical triad of an audible crack, detumescense, and hematoma. Fourteen of the 26 (53.8%) patients after surgery were available for follow-up. Mean follow-up was 45.6 months (range: 3.6-128.4). In 13/14 (92.9%) patients, penile fracture was confirmed by surgery. At follow-up, 7/13 (53.8%) patients had impaired erectile function, with 3/13 (23.1%) patients needing medical treatment. Four of the 13 (30.8%) patients showed deterioration of voiding including occurrence of urethral fistula. Penile fracture is an emergency for which surgery should be offered. Clinical suspicion of fracture should be high even with hematoma alone. Concomitant urethral injury is common, particularly with bilateral corporal rupture and/or initial hematuria. Preoperative counseling should include discussion of long-term erectile and voiding dysfunction, penile deformity, and urethral fistula both with and without surgery. Close patient follow-up is required. © 2013 International Society for Sexual Medicine.

Erectile hydraulics: maximizing inflow while minimizing outflow.

PubMed

Meldrum, David R; Burnett, Arthur L; Dorey, Grace; Esposito, Katherine; Ignarro, Louis J

2014-05-01

Penile rigidity depends on maximizing inflow while minimizing outflow. The aim of this review is to describe the principal factors and mechanisms involved. Erectile quality is the main outcome measure. Data from the pertinent literature were examined to inform our conclusions. Nitric oxide (NO) is the principal factor increasing blood flow into the penis. Penile engorgement and the pelvic floor muscles maintain an adequate erection by impeding outflow of blood by exerting pressure on the penile veins from within and from outside of the penile tunica. Extrinsic pressure by the pelvic floor muscles further raises intracavernosal pressure above maximum inflow pressure to achieve full penile rigidity. Aging and poor lifestyle choices are associated with metabolic impediments to NO production. Aging is also associated with fewer smooth muscle cells and increased fibrosis within the corpora cavernosa, preventing adequate penile engorgement and pressure on the penile veins. Those same penile structural changes occur rapidly following the penile nerve injury that accompanies even "nerve-sparing" radical prostatectomy and are largely prevented in animal models by early chronic use of a phosphodiesterase type 5 (PDE5) inhibitor. Pelvic floor muscles may also decrease in tone and bulk with age, and pelvic floor muscle exercises have been shown to improve erectile function to a similar degree compared with a PDE5 inhibitor in men with erectile dysfunction (ED). Because NO is critical for vascular health and ED is strongly associated with cardiovascular disease, maximal attention should be focused on measures known to increase vascular NO production, including the use of PDE5 inhibitors. Attention should also be paid to early, regular use of PDE5 inhibition to reduce the incidence of ED following penile nerve injury and to assuring normal function of the pelvic floor muscles. These approaches to maximizing erectile function are complementary rather than competitive, as they operate on entirely different aspects of erectile hydraulics. © 2014 International Society for Sexual Medicine.

Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture.

PubMed

El-Assmy, A; El-Tholoth, H S; Abou-El-Ghar, M E; Mohsen, T; Ibrahiem, E H I

2012-01-01

This study was conducted to determine the preoperative and intraoperative risk factors of ED and the underlying penile vascular abnormalities among patients with penile fracture treated surgically. In all, 180 patients with penile fracture were treated surgically and followed up in one center. None of our patients had ED before the penile trauma and only two of them had risk factors for systemic vascular diseases, such as diabetes mellitus (one patient) and hypertension (one patient). After a mean follow-up of 106 months, 11 patients (6.6%) developed ED, 7 had mild ED and 4 had moderate ED. The main risk factors for subsequent ED were aging, >50 years, and bilateral corporal involvement. Among the 11 patients with ED, color Doppler ultrasonography (CDU) showed normal Doppler indices in 4 (36.4%), veno-occlusive dysfunction in 4 (36.4%) and arterial insufficiency in the remaining 3 (27.2%) patients. CDU assessments from the injured and intact sides were comparable. ED of either a psychological or vascular origin can be encountered as a long-term sequel of surgical treatment of penile fracture. Aging, >50 years, at presentation and bilateral corporal involvement is the main risk factors for subsequent development of ED.

[Penile augmentation and elongation using autologous dermal-fat strip grafting].

PubMed

Yang, Zhe; Li, Yang-qun; Tang, Yong; Chen, Wen; Li, Qiang; Zhou, Chuan-de; Zhao, Mu-xin; Hu, Chun-mei

2012-05-01

To investigate the effect of autologous dermal-fat strip grafting in penile augmentation and elongation. From May 2004 to December 2010, 24 patients underwent penile enhancement with free dermal-fat strip grafting. Through suprapubic incision, the superior suspensory ligament and part deep suspensory ligament are cutted off to lengthen the penis. The resulted dead space is filled with the autologous dermal-fat strip (6.0-9.5 cm in length, 1.2-1.5 cm in width and 0.6-0.8 cm in depth) to enhance the penis. Primary healing was achieved in 23 cases. Incisional fat liquefaction happened in one case which healed after dressing change. The penile appearance was satisfactory both at rest or erection. The penile length and circumference increased by 2.5-4.8 cm (average, 3.2 cm) and 1.8-3.0 cm (average, 2.4 cm), respectively. 18 patients were followed up for 3 months to 5 years. All the patients were satisfactory on the cosmetic and functional results. No complication happened. It is safe and effective for penile augmention and elongation with autologous dermal-fat strip grafting and disconnection of penile suspensory ligament.

Topical Therapy for non-invasive penile cancer (Tis)-updated results and toxicity.

PubMed

Manjunath, Aditya; Brenton, Thomas; Wylie, Sarah; Corbishley, Catherine M; Watkin, Nick A

2017-10-01

Penile cancer is a rare malignancy estimated to affect 26,000 men globally each year. The association with penile cancer, in particular non-invasive disease, and human papilloma virus (HPV) is well known. Ninety-five percent of cases of penile cancer are squamous cell carcinoma (SCC), which are staged using the TNM staging system. Terminology describing the histological appearance of non-invasive penile cancer has changed with all cases grouped under the umbrella term of penile intraepithelial neoplasia (PeIN); either undifferentiated or differentiated. This replaces previous terms such as carcinoma in situ (CIS) and eponymous names such as Bowen's disease. This change is recognised by the World Health Organisation (WHO). The topical treatments most commonly used for PeIN are 5-fluorouracil (5-FU) and imiquimod (IQ). Other treatments such as photodynamic therapy (PDT) are used but to a lesser degree. The evidence for all of these treatments is heterogenous with no randomised data available. Overall up to 57% complete response has been reported with a low number of serious adverse events. In this article, we aim to review the available evidence for the topical treatment of non-invasive penile cancer specifically regarding its efficacy and toxicity.

Topical Therapy for non-invasive penile cancer (Tis)—updated results and toxicity

PubMed Central

Brenton, Thomas; Wylie, Sarah; Corbishley, Catherine M.; Watkin, Nick A.

2017-01-01

Penile cancer is a rare malignancy estimated to affect 26,000 men globally each year. The association with penile cancer, in particular non-invasive disease, and human papilloma virus (HPV) is well known. Ninety-five percent of cases of penile cancer are squamous cell carcinoma (SCC), which are staged using the TNM staging system. Terminology describing the histological appearance of non-invasive penile cancer has changed with all cases grouped under the umbrella term of penile intraepithelial neoplasia (PeIN); either undifferentiated or differentiated. This replaces previous terms such as carcinoma in situ (CIS) and eponymous names such as Bowen’s disease. This change is recognised by the World Health Organisation (WHO). The topical treatments most commonly used for PeIN are 5-fluorouracil (5-FU) and imiquimod (IQ). Other treatments such as photodynamic therapy (PDT) are used but to a lesser degree. The evidence for all of these treatments is heterogenous with no randomised data available. Overall up to 57% complete response has been reported with a low number of serious adverse events. In this article, we aim to review the available evidence for the topical treatment of non-invasive penile cancer specifically regarding its efficacy and toxicity. PMID:29184776

A smooth exit from eternal inflation?

NASA Astrophysics Data System (ADS)

Hawking, S. W.; Hertog, Thomas

2018-04-01

The usual theory of inflation breaks down in eternal inflation. We derive a dual description of eternal inflation in terms of a deformed Euclidean CFT located at the threshold of eternal inflation. The partition function gives the amplitude of different geometries of the threshold surface in the no-boundary state. Its local and global behavior in dual toy models shows that the amplitude is low for surfaces which are not nearly conformal to the round three-sphere and essentially zero for surfaces with negative curvature. Based on this we conjecture that the exit from eternal inflation does not produce an infinite fractal-like multiverse, but is finite and reasonably smooth.

A review of penile metastasis

PubMed Central

Mearini, Luigi; Colella, Renato; Zucchi, Alessandro; Nunzi, Elisabetta; Porrozzi, Carlo; Porena, Massimo

2012-01-01

Penile cancer as primary disease is relatively rare in developed countries. The penis is a rare site of metastases in spite of its rich vascularization. Approximately 500 cases have been reported in the literature; almost 70% of primary lesions are of pelvic origin (from genitourinary or recto-sigmoid primary tumors). We describe a case of penile metastasis from lung cancer. The rarity of the event prompted us to also explore related reviews and discuss the incidence, physiopathology, diagnosis and therapy of penile secondary cancer. PMID:25992200

Ultrasound Diagnosis of Penile Fracture.

PubMed

Nizamani, Waseem Mehmood; Ali, Syed Imtiaz; Vaswani, Aneel Kumar; Shahani, Bhesham Kumar

2015-10-01

A rare but possibly underreported urological emergency is penile fracture which results from tear in the tunica albuginea of the penis. The proposed etiology is forceful manipulation of an erect penis or secondary to blunt trauma. We would like to report a case of young patient presenting with large penile shaft hematoma and deformity. The patient did not provide obvious history of trauma or sexual intercourse. The ultrasound of penis was performed which suggested the diagnosis of penile fracture and ultrasound findings were correlated with peroperative findings.

The development of inflatable array antennas

NASA Technical Reports Server (NTRS)

Huang, J.

2001-01-01

Inflatable array antennas are being developed to significantly reduce the mass, the launch vehicle's stowage volume, and the cost of future spacecraft systems. Three inflatable array antennas, recently developed for spacecraft applications, are a 3.3 m x 1.0 m L-band synthetic-aperture radar (SAR) array, a 1.0 m-diameter X-band telecom reflectarray, and a 3 m-diameter Ka-band telecom reflectarray. All three antennas are similar in construction, and each consists of an inflatable tubular frame that supports and tensions a multi-layer thin-membrane RF radiating surface with printed microstrip patches. The L-band SAR array achieved a bandwidth of 80 MHz, an aperture efficiency of 74%, and a total mass of 15 kg. The X-band reflectarray achieved an aperture efficiency of 37%, good radiation patterns, and a total mass of 1.2 kg (excluding the inflation system). The 3 m Ka-band reflectarray achieved a surface flatness of 0.1 mm RMS, good radiation patterns, and a total mass of 12.8 kg (excluding the inflation system). These antennas demonstrated that inflatable arrays are feasible across the microwave and millimeter-wave spectrums. Further developments of these antennas are deemed necessary, in particular, in the area of qualifying the inflatable structures for space-environment usage.

Cross-sectional analysis of penile length in males 13 to 15 years old according to pubertal development stages.

PubMed

Soydan, Hasan; Akyol, İlker; Ates, Ferhat; Yilmaz, Omer; Dursun, Furkan; Baykal, Kadir

2012-10-01

Genital development is affected by pubertal process to a great extent, and puberty is a complex phenomenon that is influenced by multiple factors resulting in individual differences. We studied penile length and its relationship to pubertal stage in boys 13 to 15 years old. Healthy boys who were candidates for military high school were evaluated between June and July 2011. Age, residence and body mass index were recorded. Stretched penile length was measured. Pubic hair was assessed according to Tanner and Marshall staging. Genital puberty stage was defined by measurement of testicular volume with Prader orchidometer. Relationship of penile length to age, residence, pubertal stages and body mass index was evaluated statistically. A total of 1,539 boys were included in the study. Mean ages and number of patients according to genital stage were as follows. Mean age was 14 years for genital stage 1 (5 patients), 13.9 years (range 13 to 15) for stage 2 (194), 14.07 years (13 to 15) for stage 3 (965) and 14.11 years (13 to 15) for stage 4 (375). Linear regression analysis revealed a significant effect of body mass index, genital stage and pubic hair stage on penile length (p <0.001) but no significant effect of age or residence. Mean penile length was significantly different among different age groups and among pubertal stages. However, mean penile lengths of different age groups within the same pubertal stage were similar. Penile length during puberty should be evaluated individually according to the current pubertal stage. Our study offers a reliable reference table of penile length for pubertal age group. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Can Eosinophil Count, Platelet Count, and Mean Platelet Volume Be a Positive Predictive Factor in Penile Arteriogenic Erectile Dysfunction Etiopathogenesis?

PubMed Central

Sönmez, Mehmet Giray; Göğer, Yunus Emre; Sönmez, Leyla Öztürk; Aydın, Arif; Balasar, Mehmet; Kara, Cengiz

2016-01-01

Blood count parameters of patients referring with erectile dysfunction (ED) were examined in this study and it was investigated whether eosinophil count (EC), platelet count (PC), and mean platelet volume values among the suspected predictive parameters which may play a role in especially penile arteriogenic ED etiopathogenesis had a contribution on pathogenesis. Patients referring with ED complaint were evaluated. Depending on the medical story, ED degree was determined by measuring International Index of Erectile Function. Penile Doppler ultrasonography was taken in patients suspected to have vasculogenic ED. According to penile Doppler ultrasonography result, patients with arterial deficiency were included in the penile arteriogenic ED group and the patients with normal results were included in the nonvasculogenic ED group. A total of 36 patients participated in the study from the penile arteriogenic ED group and 32 patients from the nonvasculogenic ED group. Compared with the nonvasculogenic ED group, the penile arteriogenic ED group’s low International Index of Erectile Function score, high EC, mean platelet volume and PC values were detected to be statistically significant (p < .001, p = .021, p = .018, p = .034, respectively). No statistically significant difference was observed among the two groups when age, white blood cells, red blood cells, and hemoglobin values were considered. Pansystolic volume velocities were detected as statistically significantly low compared with the nonvasculogenic ED group in the measurements made in 5th, 10th, 15th, and 20th minutes on the right and left sides in the penile arteriogenic ED group. High MPV value and PC is a significant predictive factor for penile arteriogenic ED and vasculogenic ED and high EC is specifically predictive of arteriogenic ED. PMID:27895254

Reference standard of penile size and prevalence of buried penis in Japanese newborn male infants.

PubMed

Matsuo, Nobutake; Ishii, Tomohiro; Takayama, John I; Miwa, Masayuki; Hasegawa, Tomonobu

2014-01-01

The present study set forth the reference values for penile size and determined the prevalence of buried penis in Japanese full-term newborns. The stretched penile length was measured and the presence of buried penis was assessed at 1-7 days of age in 547 Japanese full-term newborn infants born between 2008 and 2012 in Tokyo. The stretched penile lengths were compared at 1-12 hours and 1-7 days of age in 63 infants and by two observers in 73 infants to estimate postnatal changes and interobserver variation, respectively. The mean stretched penile length was 3.06 cm (SD, 0.26; 95% confidence interval [CI], 3.04-3.08) and the mean ratio of penile length to body length was 6.24 × 100(-1) (SD, 0.55 × 100(-1)), both of which were significantly smaller than those in Caucasian newborn infants. Buried penis was identified in 20 of 547 infants (3.7%; 95% CI, 2.1-5.2%). The first measurements of penile length at 1-12 hours were significantly smaller than the next measurements at 1-7 days (95% CI of the difference, 0.22-0.34). The 95% CI for the limits of agreement in the penile lengths measured by the two observers was -0.58 to -0.40 for the lower limit and 0.33 to 0.51 for the upper limit. These findings indicate that the penile length should be assessed after 24 hours of age by the reference standard of the same ethnicity for identifying micropenis and that buried penis is not uncommon in Japanese full-term newborns.

Item Description: ISS TransHab Restraint Sample and Photo Documentation

NASA Technical Reports Server (NTRS)

Adams, Constance

2000-01-01

The yellow strap seen in the display is a piece of the main restraint layer of a test article for the ISS TransHab spacecraft, First conceived as a technology which is capable of supporting a [human] crew of six on an extended space journey such as the six-month trip to Mars, TransHab (short for "Transit habitat") is the first space inflatable module ever designed. As this text is written it is being considered as a replacement for the Habitation module on the International Space Station (ISS). It constitutes a major breakthrough both in technology and in tectonics: capable of tight packaging at light weight for efficient launch, the vehicle can then be inflated to its full size on orbit via its own inflation tanks. This is made possible by the separation of its main structural elements from its pressure-shell. In other words, all spacecraft flown to date have been of an exoskeletal type---i.e., its hard outer shell acts both as a pressure container and as its main channel for structural loading This includes the ISS, which is currently under construction in Low Earth Orbit [275 miles above the Earth]. By contrast TransHab is the first endoskeletal space Habitat, consisting of a dual system: a light, reconfigurable central structure of graphite composite and a multilayered, deployable pressure shell.

A novel technique for repair of mid-penile hypospadias using a preputial skin flap: results of 110 patients.

PubMed

Elmoghazy, Hazem; Hussein, Mohamed M; Mohamed, Elnisr; Badawy, Abdelbasset; Alsagheer, Gamal; Abd Elhamed, Ahmed Mamdouh

2016-12-01

Several techniques have been used to repair mid-penile hypospadias; however, high failure rates and major complications have been reported. In this study, we describe a novel technique using a well-vascularized flap of the inner and outer preputial skin. A total of 110 male children with hypospadias underwent repair by our technique between 2008 and 2015. The inclusion criteria were children with mid-penile or slightly more proximal hypospadias, with or without ventral chordae, and an intact prepuce of the cobra eyes variety. Recurrent cases, patients with other preputial types, and circumcised children were excluded from this study. The prepared flap was sutured in its natural longitudinal orientation to the created urethral plate strip to form a neo-urethra over a urethral catheter. Outcome measures included surgical success without the formation of a urethra-cutaneous fistula, no ischaemia of the flaps, glans dehiscence or infection and functional outcome and cosmetic appearance. The median follow-up duration was 3.3 years. There were 63 cases of mid-penile hypospadias (57.3 %), and in 47 cases (42.7 %), the meatus was slightly more proximal. The age of the patients ranged from 1.1 to 8.0 years, with a mean age of 4.6 ± 1.2 years. Surgery was successful in 106 (96.4 %) cases. Minor complications occurred in 11 patients (10 %) and included oedema of glans in ten patients and bluish discoloration on the ventral aspect of the glans close to the suture line in three patients. All patients improved within 2 weeks after surgery. Long-term follow-up revealed a properly functioning urethra with a forward, projectile, single, compact, and rifled urinary stream of adequate calibre and cosmetically acceptable repair. No cases of meatal retraction, meatal stenosis, urethral stricture, or acquired urethral diverticulum occurred. Our technique is different from the split prepuce in situ technique. We create a narrow strip of the urethral plate that facilitates glanular closure, and we use the inner and adjacent outer skin in a vertical manner to preserve excess skin for penile coverage. Prepuce is split at midline to preserve more preputial skin with favourable dartos tissue for penile skin coverage. The glans is closed using a stitch-by-stitch method that has not been described previously. This study presents a novel technique for mid-penile hypospadias repair using a preputial skin flap with excellent results in terms of short- and long-term outcomes.

An unusual course after injection of industrial silicone for penile augmentation.

PubMed

Shin, Yu Seob; You, Jae Hyung; Choi, Hwang; Zhang, Li Tao; Zhao, Chen; Choi, In Sung; Park, Jong Kwan

2015-01-01

A 48-year-old male patient had an injection of industrial silicone under the penile skin for augmentation by non-medical practitioners a week before. There was complete necrosis of the dorsal part of the penile skin and soft tissue. In a penile magnetic resonance image, big masses of silicone under the penile skin were found and a part of the silicone was partially exposed. Debridement of the necrotic tissue was done. As the right side of the tunica albuginea was thin-walled, a silicone-induced infection developed. Because of this, the wet dressing was done daily without closing the wound for the next 23 days. Finally, both scrotal skins were drawn and sutured to the dorsal glandular skin after the total penile skin was completely removed and sutured with T-style anastomosis. The ventral flap was anastomosed to the ventral glandular skin with the end-to-end technique with inverted V incision at 1 cm proximal from the sutured margin. Flaps survived completely without skin necrosis or dehiscence.

Penile Mondor's disease in a patient treated with radical chemoradiation for anal cancer

PubMed Central

Pittaka, Maria; Fotiou, Eleni; Dionysiou, Margarita; Polyviou, Petros; Eracleous, Eleni; Andreopoulos, Demetris

2017-01-01

Abstract Penile Mondor's disease is a rare condition characterized by sclerosing thrombophlebitis of the superficial dorsal penile vein. Usually its causes are benign, but it is also evident in cancer patients. We report the case of a 62-year-old man with a cT4 anal cancer (infiltration of corpora spongiosa and penile bulb), associated with extensive loco-regional lymphadenopathy, who developed painful lumps in the midline of the anterior penile surface while receiving radical chemoradiotherapy. Physical examination revealed two palpable cord-like swellings located 2 cm from the pubic symphysis. Color Doppler ultrasound established the diagnosis of Mondor's disease. The patient was successfully managed with non-steroidal anti-inflammatory drugs. The causative factors were pelvic malignancy and radiotherapy. The diagnosis was challenging since Mondor's disease is a rare condition and the differential diagnosis included malignancy progression. This is the first case report describing penile Mondor's disease in a patient with anal cancer under chemoradiotherapy. PMID:29383260

Establishment and characterization of a penile cancer cell line, penl1, with a deleterious TP53 mutation as a paradigm of HPV-negative penile carcinogenesis.

PubMed

Chen, Jieping; Yao, Kai; Li, Zaishang; Deng, Chuangzhong; Wang, Liangjiao; Yu, Xingsu; Liang, Peili; Xie, Qiankun; Chen, Peng; Qin, Zike; Ye, Yunlin; Liu, Zhuowei; Zhou, Fangjian; Zhang, Zhenfeng; Han, Hui

2016-08-09

To establish penile cancer (PeCa) cell lines for the study of molecular mechanisms of carcinogenesis and testing therapeutic reagents. We successfully established two PeCa cell lines from fresh tumor tissues from 21 cases. One cell line named Penl1 was isolated from a lymph node metastasis (LNM) of penile squamous cell carcinoma (PeSCC), usual type and comprehensively characterized here. Our in-depth characterization analysis of the Penl1 cell line included morphology, tumorigenicity, genetic characteristics, protein expression, biology, and chemosensitivity. Penl1 was authenticated by single tandem repeat (STR) DNA typing. Comparative histomorphology, genetic characteristics, and protein expression patterns revealed essential similarities between the cell line and its corresponding LNM. In-depth characterization analysis of Penl1 cell line revealed tumorigenicity in immunodeficient mice, negative human papilloma virus (HPV) and mycoplasma infection, TP53 mutations and sensitivity to cisplatin and epirubicin. STR DNA typing did not match any cell lines within three international cell banks. The limitation of this study is that one patient cannot represent the complete heterogeneity of PeCa, especially primary tumor. We established and characterized an HPV-negative and moderately differentiated PeCa cell model with a TP53 missense mutation from a PeSCC, usual type patient. A preliminarily study of carcinogenesis and chemosensitivity suggests that this cell model carries a tumor suppressor gene mutation and is sensitive to chemotherapy drugs.

Establishment and characterization of a penile cancer cell line, penl1, with a deleterious TP53 mutation as a paradigm of HPV-negative penile carcinogenesis

PubMed Central

Li, Zaishang; Deng, Chuangzhong; Wang, Liangjiao; Yu, Xingsu; Liang, Peili; Xie, Qiankun; Chen, Peng; Qin, Zike; Ye, Yunlin; Liu, Zhuowei; Zhou, Fangjian; Zhang, Zhenfeng; Han, Hui

2016-01-01

Purpose To establish penile cancer (PeCa) cell lines for the study of molecular mechanisms of carcinogenesis and testing therapeutic reagents. Materials and Methods We successfully established two PeCa cell lines from fresh tumor tissues from 21 cases. One cell line named Penl1 was isolated from a lymph node metastasis (LNM) of penile squamous cell carcinoma (PeSCC), usual type and comprehensively characterized here. Our in-depth characterization analysis of the Penl1 cell line included morphology, tumorigenicity, genetic characteristics, protein expression, biology, and chemosensitivity. Penl1 was authenticated by single tandem repeat (STR) DNA typing. Results Comparative histomorphology, genetic characteristics, and protein expression patterns revealed essential similarities between the cell line and its corresponding LNM. In-depth characterization analysis of Penl1 cell line revealed tumorigenicity in immunodeficient mice, negative human papilloma virus (HPV) and mycoplasma infection, TP53 mutations and sensitivity to cisplatin and epirubicin. STR DNA typing did not match any cell lines within three international cell banks. The limitation of this study is that one patient cannot represent the complete heterogeneity of PeCa, especially primary tumor. Conclusions We established and characterized an HPV-negative and moderately differentiated PeCa cell model with a TP53 missense mutation from a PeSCC, usual type patient. A preliminarily study of carcinogenesis and chemosensitivity suggests that this cell model carries a tumor suppressor gene mutation and is sensitive to chemotherapy drugs. PMID:27351128

Human papillomavirus DNA in the urogenital tracts of men with gonorrhoea, penile warts or genital dermatoses.

PubMed Central

Hillman, R J; Ryait, B K; Botcherby, M; Taylor-Robinson, D

1993-01-01

OBJECTIVE--To assess the presence of human papillomavirus (HPV) DNA in urethral and urine specimens from men with and without sexually transmitted diseases. DESIGN--Prospective study. SETTING--Two London departments of genitourinary medicine PATIENTS--100 men with urethral gonorrhoea, 31 men with penile warts and 37 men with genital dermatoses. METHODS--Urethral and urine specimens were taken, HPV DNA extracted and then amplified using the polymerase chain reaction. HPV types 6, 11, 16, 18, 31 and 33 were identified using Southern blotting followed by hybridisation. RESULTS--HPV DNA was detected in 18-31% of urethral swab specimens and in 0-14% of urine specimens. Men with penile warts had HPV detected in urethral swabs more often than did men in the other two clinical groups. "High risk" HPV types were found in 71-83% of swab specimens and in 73-80% of urine specimens containing HPV DNA. CONCLUSIONS--HPV is present in the urogenital tracts of men with gonorrhoea, penile warts and with genital dermatoses. In men with urethral gonorrhoea, detection of HPV in urethral specimens is not related to the number of sexual partners, condom usage, racial origin or past history of genital warts. HPV DNA in the urethral swab and urine specimens may represent different aspects of the epidemiology of HPV in the male genital tract. The preponderance of HPV types 16 and 18 in all three groups of men may be relevant to the concept of the "high risk male". Images PMID:8392967

Penile Reconstruction with Skin Grafts and Dermal Matrices: Indications and Management

PubMed Central

Triana Junco, Paloma; Dore, Mariela; Nuñez Cerezo, Vanesa; Jimenez Gomez, Javier; Miguel Ferrero, Miriam; Díaz González, Mercedes; Lopez-Pereira, Pedro; Lopez-Gutierrez, Juan Carlos

2017-01-01

Introduction  The penis eventually needs specific cutaneous coverage in the context of reconstructive procedures following trauma or congenital anomalies. Local flaps are the first choice but are not always available after multiple previous procedures. In these cases, skin graft and dermal matrices should be considered. Materials and Methods  This study was a retrospective review of the past 4 years of four patients with severe loss of penile shaft skin who underwent skin reconstruction. Dermal matrices and skin grafts were utilized. Dermal matrices were placed for a median of 4.5 weeks (3.0–6.0 weeks). The skin graft was harvested from the inner thigh region for split-thickness skin graft (STSG) and the inguinal region for full-thickness skin graft (FTSG). Results  The four patients presented with complete loss of skin in the penile shaft. One patient had a vesical exstrophy, one had a buried penis with only one corpus cavernosum, one had a wide congenital lymphedema of the genitalia, and one had a lack of skin following circumcision at home. They underwent reconstruction with three patients undergoing split-thickness skin graft; two dermal matrices; and one full-thickness graft, respectively, thereby achieving a good cosmetic and functional result. There were no complications, and all the patients successfully accepted the graft. Conclusion  Dermal matrices and skin grafts may serve as effective tools in the management of severe penile skin defects unable to be covered with local flaps. PMID:28868232

Male circumcision for HIV prevention in Papua New Guinea: a summary of research evidence and recommendations for public health following a national policy forum.

PubMed

Vallely, A; MacLaren, D J; Kaleva, W; Millan, J; Tommbe, R; Marape, W; Manineng, C; Buchanan, H; Amos, A; Frank, R; Kelly, A; Kupul, M; Aeno, H; Trowalle, E; John, L N; Redman-Maclaren, M L; Ryan, C; Browne, K; Tynan, A; Hill, P S; Gray, R T; Murray, J; Wilson, D P; Law, G; Siba, P; McBride, W J H; Farley, T; Kaldor, J M

2011-01-01

In 2005, a clinical trial in South Africa found that circumcision of young men could reduce their risk of acquiring HIV (human immunodeficiency virus) infection by over 60%. In the following year, two more trials in Africa confirmed this finding, leading the World Health Organization to recommend male circumcision as a public health strategy for HIV prevention in high-incidence countries. In order to inform public health policy in Papua New Guinea (PNG), two major research projects were initiated with the goals of investigating the status of penile cutting practices and assessing understandings, acceptability, feasibility and cost-effectiveness of male circumcision for HIV prevention. In addition, behavioural surveillance surveys systematically asked questions on penile cutting practices and an ethnographic literature review informed historical perspectives of penile cutting in PNG. Key findings from these research activities were presented at a National Policy Forum on Male Circumcision for HIV Prevention held in Port Moresby in November 2011. The Forum made three key recommendations: (1) the formation of a joint National Department of HealthlNational AIDS Council Secretariat Policy Committee on male circumcision; (2) the establishment of an integrated harm reduction program; and (3) that future policy on wide-scale roll-out of male circumcision for HIV prevention in PNG be informed by a combination of data from (a) male circumcision intervention pilot programs and (b) research on the potential protective effect of other forms of penile cutting.

Contemporary management of penile cancer: greater than 15 year MSKCC experience.

PubMed

Moses, Kelvin A; Winer, Andrew; Sfakianos, John P; Poon, Stephen A; Kent, Matthew; Bernstein, Melanie; Russo, Paul; Dalbagni, Guido

2014-04-01

Penile cancer is a rare malignancy, and few guidelines are available to define treatment paradigms. For greater understanding of the natural history of surgically treated penile cancer, we analyzed the experience at our institution. Using an institutional database, we identified 127 patients treated for squamous cell carcinoma of the penis from 1995-2011. Cancer-specific survival (CSS) was calculated using the Kaplan-Meier method. Survival data were compared using the log-rank test. The difference in risk of cancer-specific death by lymph node status and histological grade was determined by univariate Cox regression analysis. Five year CSS for pTis, pT1, pT2, and pT3/4 was 100%, 84% (95% CI 58%-95%), 54% (95% CI 33%-71%), and 54% (95% CI 25%-76%), respectively (p ≤ .005). Three year CSS for patients with N0, N+, and Nx disease was 90% (95% CI 47%-99%), 65% (95% CI 47%-79%), and 86% (95% CI 73%-93%), respectively (p = .03). The receipt of neoadjuvant chemotherapy did not change per 5 year period over the 16 years of our study. Median follow up was 2.8 years. Penile cancer patients with advanced disease had poor survival. Tumor stage and nodal status were significant predictors of CSS. Penis-sparing approaches may be considered for most patients; however, pathological stage and grade dictate the management and ultimate outcome. Further studies are necessary to clarify the benefits of chemotherapy in this disease.

Role of Human Papillomavirus in Penile Carcinomas Worldwide.

PubMed

Alemany, Laia; Cubilla, Antonio; Halec, Gordana; Kasamatsu, Elena; Quirós, Beatriz; Masferrer, Emili; Tous, Sara; Lloveras, Belén; Hernández-Suarez, Gustavo; Lonsdale, Ray; Tinoco, Leopoldo; Alejo, Maria; Alvarado-Cabrero, Isabel; Laco, Jan; Guimerà, Nuria; Poblet, Enrique; Lombardi, Luis E; Bergeron, Christine; Clavero, Omar; Shin, Hai-Rim; Ferrera, Annabelle; Felix, Ana; Germar, Julieta; Mandys, Vaclav; Clavel, Christine; Tzardi, Maria; Pons, Luis E; Wain, Vincent; Cruz, Eugenia; Molina, Carla; Mota, Jose D; Jach, Robert; Velasco, Julio; Carrilho, Carla; López-Revilla, Ruben; Goodman, Marc T; Quint, Wim G; Castellsagué, Xavier; Bravo, Ignacio; Pawlita, Michael; Muñoz, Nubia; Bosch, F Xavier; de Sanjosé, Silvia

2016-05-01

Invasive penile cancer is a rare disease with an approximately 22 000 cases per year. The incidence is higher in less developed countries, where penile cancer can account for up to 10% of cancers among men in some parts of Africa, South America, and Asia. To describe the human papillomavirus (HPV) DNA prevalence, HPV type distribution, and detection of markers of viral activity (ie, E6*I mRNA and p16(INK4a)) in a series of invasive penile cancers and penile high-grade squamous intraepithelial lesions (HGSILs) from 25 countries. A total of 85 penile HGSILs and 1010 penile invasive cancers diagnosed from 1983 to 2011 were included. After histopathologic evaluation of formalin-fixed paraffin-embedded samples, HPV DNA detection and genotyping were performed using the SPF-10/DEIA/LiPA25 system, v.1 (Laboratory Biomedical Products, Rijswijk, The Netherlands). HPV DNA-positive cases were additionally tested for oncogene E6*I mRNA and all cases for p16(INK4a) expression, a surrogate marker of oncogenic HPV activity. HPV DNA prevalence and type distributions were estimated. HPV DNA was detected in 33.1% of penile cancers (95% confidence interval [CI], 30.2-36.1) and in 87.1% of HGSILs (95% CI, 78.0-93.4). The warty-basaloid histologic subtype showed the highest HPV DNA prevalence. Among cancers, statistically significant differences in prevalence were observed only by geographic region and not by period or by age at diagnosis. HPV16 was the most frequent HPV type detected in both HPV-positive cancers (68.7%) and HGSILs (79.6%). HPV6 was the second most common type in invasive cancers (3.7%). The p16(INK4a) upregulation and mRNA detection in addition to HPV DNA positivity were observed in 69.3% of HGSILs, and at least one of these HPV activity markers was detected in 85.3% of cases. In penile cancers, these figures were 22.0% and 27.1%, respectively. About a third to a fourth of penile cancers were related to HPV when considering HPV DNA detection alone or adding an HPV activity marker, respectively. The observed HPV type distribution reinforces the potential benefit of current and new HPV vaccines in the reduction of HPV-related penile neoplastic lesions. About one-third to one-quarter of penile cancers were related to human papillomavirus (HPV). The observed HPV type distribution reinforces the potential benefit of current and new HPV vaccines to prevent HPV-related penile neoplastic lesions. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

A new surgical method for penile girth enhancement

PubMed Central

Li, Xiaoge; Tao, Ling; Cao, Chuan; Shi, Haishan; Li, Le; Chen, Liang; Li, Shirong

2015-01-01

Objective: We developed a new surgical model of penile girth enhancement in dog, with minimal damage, fewer complications, and high success rate, to enable the experimental investigation of penile implants. Methods: We obtained materials for penile girth enhancement by processing the pericardium and blood vessel wall collected from pigs. Incisions were made at the penile bulb for the implantation of the materials, and facilitate observation and data collection, based on the anatomical features of dog’s penis. We measured the girth of the flaccid penis before and after the operation, and erectile function at 1-month postoperation. In addition to evaluation of recovery from the incision and local pathological changes, ultrasonic examination was performed to monitor the long-term changes associated with implantation. Results: The mean girth of the flaccid penis significantly increased from 7.37±0.40 cm before the operation, to 8.70±0.56 cm postoperation. Dogs resumed normal mating at 1 month after the operation, without any significant change in the mating time. Ultrasonic examination clearly illustrated the implants, and helped in the measurement of the distance between the materials and the baculum. Conclusion: Chinese Rural dog is a promising animal model for penile girth enhancement surgery. The findings demonstrated that surgical implantation into penile bulb was associated with less damage, faster postoperative recovery, and higher success. For the first time, ultrasonic examination provided objective data on the surgical outcomes of penile girth enhancement. PMID:26379868

Approach to management of penile fracture in men with underlying Peyronie's disease.

PubMed

Minor, Thomas X; Brant, William O; Rahman, Nadeem U; Lue, Tom F

2006-10-01

To report on a series of patients with Peyronie's disease (PD) who experienced a penile fracture, examining the history, presentation, and management. Additionally, we describe an unreported surgical technique implementing combined fracture repair and tunica plication. PD is an acquired inflammatory condition of the penis that can cause fibrotic, nonexpansile thickening of the tunica albuginea, resulting in a focal bend or narrowing on erection. From October 1999 to July 2003, 4 patients with nonsurgically treated PD had a penile fracture during sexual activity. The mean patient age was 43 years (range 29 to 52), with an average of 5.5 days (range 3 to 8) transpiring from the time of penile trauma to surgery in the men presenting early. Penile ultrasonography was used to locate the site of tunica laceration. Either circumcising or ventral midline incisions were selected to treat these patients. During penile exploration, the tunica defect in the corpus cavernosum was identified and closed with 2-0 Maxon suture. Subsequent artificial erection displayed penile curvature in 3 patients, and plication was then performed to straighten the tunica angulation using 2-0 TiCron suture. The fourth patient had a minimal bend with slight waisting, not requiring plication. No perioperative complications occurred. These 4 patients regained their preoperative level of erectile rigidity with lasting nonpainful correction of their deformity. Patients with PD who have a penile fracture are candidates for combined fracture repair and tunica plication at the same setting.

Human papillomavirus prevalence and type distribution in penile carcinoma.

PubMed

Miralles-Guri, C; Bruni, L; Cubilla, A L; Castellsagué, X; Bosch, F X; de Sanjosé, S

2009-10-01

Penile carcinoma is an uncommon and potentially mutilating disease with a heterogeneous aetiology. Several risk factors have been established for its development. Human papillomavirus (HPV) infection seems to play an important role in the development of a subset of these carcinomas and its presence is thought to be related to the histological type. HPV prevalence in penile tumours is reported to be associated to a variety of morphological changes. Its determination will provide a better estimate for HPV related cancer burden and its preventable fraction. A systematic and comprehensive literature review of the major penile cancer studies published from 1986 until June 2008 evaluating the HPV prevalence among the different histological types was carried out. 31 studies including 1466 penile carcinomas were reviewed. Global HPV prevalence was 46.9%. Relative contribution was: HPV-16 (60.23%), HPV-18 (13.35%), HPV-6/11 (8.13%), HPV-31 (1.16%), HPV-45 (1.16%), HPV-33 (0.97%), HPV-52 (0.58%), other types (2.47%). Assessment of multiple infections contribution is limited due to study design. Basaloid and warty squamous cell carcinomas were the most frequent HPV-related histological types, but keratinising and non-keratinising subtypes also showed prevalence rates of around 50%. About half of the penile tumours were associated with HPV 16-18 with little presence of other genotypes. Research on the mechanisms behind penile carcinogenesis is warranted. Available HPV vaccines are likely to be effective in penile tumours.

Human Papillomavirus Genotype Prevalence in Invasive Penile Cancers from a Registry-Based United States Population

PubMed Central

Hernandez, Brenda Y.; Goodman, Marc T.; Unger, Elizabeth R.; Steinau, Martin; Powers, Amy; Lynch, Charles F.; Cozen, Wendy; Saber, Maria Sibug; Peters, Edward S.; Wilkinson, Edward J.; Copeland, Glenn; Hopenhayn, Claudia; Huang, Youjie; Watson, Meg; Altekruse, Sean F.; Lyu, Christopher; Saraiya, Mona

2013-01-01

Background: Human papillomavirus (HPV) is estimated to play an etiologic role in 40–50% of penile cancers worldwide. Estimates of HPV prevalence in U.S. penile cancer cases are limited. Methods: HPV DNA was evaluated in tumor tissue from 79 invasive penile cancer patients diagnosed in 1998–2005 within the catchment areas of seven U.S. cancer registries. HPV was genotyped using PCR-based Linear Array and INNO-LiPA assays and compared by demographic, clinical, and pathologic characteristics and survival. Histological classification was also obtained by independent pathology review. Results: HPV DNA was present in 50 of 79 (63%) of invasive penile cancer cases. Sixteen viral genotypes were detected. HPV 16, found in 46% (36/79) of all cases (72% of HPV-positive cases) was the most prevalent genotype followed equally by HPV 18, 33, and 45, each of which comprised 5% of all cases. Multiple genotypes were detected in 18% of viral positive cases. HPV prevalence did not significantly vary by age, race/ethnicity, population size of geographic region, cancer stage, histology, grade, penile subsite, or prior cancer history. Penile cases diagnosed in more recent years were more likely to be HPV-positive. Overall survival did not significantly vary by HPV status. Conclusion: The relatively high prevalence of HPV in our study population provides limited evidence of a more prominent and, possibly, increasing role of infection in penile carcinogenesis in the U.S. compared to other parts of the world. PMID:24551592

[Buccal mucosa transplant the concept of ideal graft in surgical management of peyronies disease].

PubMed

Kotov, S V; Yusufov, A G; Semenov, M K

2017-09-01

Surgical techniques in managing Peyronies disease include plication corporoplasty, plaque incision, grafting and penile prosthesis implantation. The question of an ideal transplant for corporoplasty remains open. To evaluate the effectiveness of the substitution corporoplasty using buccal mucosa transplant (BMT) in treating Peyronies disease. From January 2011 to February 2016, 28 patients with stable stage Peyronies disease underwent substitution coroproplasty using BMT (incision and grafting). The mean age of patients was 54.8+/-6.2 years. All patients completed an IIEF-5 questionnaire and underwent a standard preoperative examination: anamnesis, physical examination, penile duplex pharmaco-ultrasonography and penile fixation photography to assess the type and angle of curvature. The average angle of penile curvature was 82.8 (45-120). All patients underwent incision and grafting using BMT; in 5 patients additionally the plication of the penile tunica albuginea was performed. Follow-up examinations were concluded at 3, 6 and 12 months and more after surgery. Median follow-up was 30 months. Postoperative penile straightening was achieved in 93% of patients. The duplex peak systolic velocity of the right and left cavernosal arteries improved from 42.59 to 45.64 cm/s and from 34.55 to 43.48 cm/s, respectively (p less or equal 0.05). Penile corproroplasty using BMT is a safe and effective method of treating patients with Peyronies disease. Follow-up clinical and instrumental examination showed no impairment of the erectile function or penile hemodynamics.

Effect of mechanical behaviour of the brachial artery on blood pressure measurement during both cuff inflation and cuff deflation.

PubMed

Zheng, Dingchang; Pan, Fan; Murray, Alan

2013-10-01

The aim of this study was to investigate the effect of different mechanical behaviour of the brachial artery on blood pressure (BP) measurements during cuff inflation and deflation. BP measurements were taken from each of 40 participants, with three repeat sessions under three randomized cuff deflation/inflation conditions. Cuff pressure was linearly deflated and inflated at a standard rate of 2-3 mmHg/s and also linearly inflated at a fast rate of 5-6 mmHg/s. Manual auscultatory systolic and diastolic BPs, and pulse pressure (SBP, DBP, PP) were measured. Automated BPs were determined from digitally recorded cuff pressures by fitting a polynomial model to the oscillometric pulse amplitudes. The BPs from cuff deflation and inflation were then compared. Repeatable measurements between sessions and between the sequential order of inflation/deflation conditions (all P > 0.1) indicated stability of arterial mechanical behaviour with repeat measurements. Comparing BPs obtained by standard inflation with those from standard deflation, manual SBP was 2.6 mmHg lower (P < 0.01), manual DBP was 1.5 mmHg higher (P < 0.01), manual PP was 4.2 mmHg lower (P < 0.001), automated DBP was 6.7 mmHg higher (P < 0.001) and automatic PP was 7.5 mmHg lower (P < 0.001). There was no statistically significant difference for any automated BPs between fast and standard cuff inflation. The statistically significant BP differences between inflation and deflation suggest different arterial mechanical behaviour between arterial opening and closing during BP measurement. We have shown that the mechanical behaviour of the brachial artery during BP measurement differs between cuff deflation and cuff inflation.

21 CFR 876.3630 - Penile rigidity implant.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Penile rigidity implant. 876.3630 Section 876.3630 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Prosthetic Devices § 876.3630 Penile rigidity implant. (a...

Load Asymmetry Observed During Orion Main Parachute Inflation

NASA Technical Reports Server (NTRS)

Morris, Aaron L.; Taylor, Thomas; Olson, Leah

2011-01-01

The Crew Exploration Vehicle Parachute Assembly System (CPAS) has flight tested the first two generations of the Orion parachute program. Three of the second generation tests instrumented the dispersion bridles of the Main parachute with a Tension Measuring System. The goal of this load measurement was to better understand load asymmetry during the inflation process of a cluster of Main parachutes. The CPAS Main parachutes exhibit inflations that are much less symmetric than current parachute literature and design guides would indicate. This paper will examine loads data gathered on three cluster tests, quantify the degree of asymmetry observed, and contrast the results with published design guides. Additionally, the measured loads data will be correlated with videos of the parachute inflation to make inferences about the shape of the parachute and the relative load asymmetry. The goal of this inquiry and test program is to open a dialogue regarding asymmetrical parachute inflation load factors.

Distinctive signatures of space-time diffeomorphism breaking in EFT of inflation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bartolo, Nicola; Cannone, Dario; Ricciardone, Angelo

2016-03-01

The effective field theory of inflation is a powerful tool for obtaining model independent predictions common to large classes of inflationary models. It requires only information about the symmetries broken during the inflationary era, and on the number and nature of fields that drive inflation. In this paper, we consider the case for scenarios that simultaneously break time reparameterization and spatial diffeomorphisms during inflation. We examine how to analyse such systems using an effective field theory approach, and we discuss several observational consequences for the statistics of scalar and tensor modes. For example, examining the three point functions, we showmore » that this symmetry breaking pattern can lead to an enhanced amplitude for the squeezed bispectra, and to a distinctive angular dependence between their three wavevectors. We also discuss how our results indicate prospects for constraining the level of spatial diffeomorphism breaking during inflation.« less

Dyadic Aspects of Sexual Well-Being in Men with Laser-Treated Penile Carcinoma.

PubMed

Skeppner, Elisabet; Fugl-Meyer, Kerstin

2015-06-01

Coping with cancer, its treatment and recovery are dyadic processes within a relationship. Sexual dysfunctions and problems of penile cancer may add to the demands of coping. The prospective study aimed to describe the dyadic aspects of sexual well-being and life satisfaction before and 1 year after organ-sparing laser treatment of penile carcinoma. A consecutive series of 29 patients with penile carcinoma suitable for laser treatment were included together with their partners, median age 60 (37-73) years and 57 (30-72) years, respectively. Median length of relationship was 29 years (1-54 years). The participants completed structured interviews before treatment, at 6 months' and 12 months' follow-up. The interview addressed sexual activities, sexual functions, verbal (sexual) communication, and life satisfaction. Three well-validated instruments were included: Hospital Anxiety and Depression Scale, International Index of Erectile Function-5, and Life Satisfaction checklist, LiSat-11. The interviews contained the same questions for patients and partners at all three measuring points. There was a high level of within-couple agreement on sexual activities, sexual function, and life satisfaction before and after organ-sparring treatment. No significant differences between interview data at 6 and 12 months' follow-up occurred. Before treatment, sexual dysfunctions were common among men, especially decreased sexual interest and dyspareunia. At follow-up, increased sexual function was found, with the exception of erectile function and women's orgasm. A rather high proportion was being unsatisfactory sexually inactive. Few had an ongoing verbal (sexual) mutual communication. Couples with an active sexual life at follow-up showed coherence in high satisfaction with life as a whole. A high level of within-couple agreement concerning sexuality and life satisfaction points to the necessity of including an adequate sexological case history, counseling, and treatment for this group of patients and their partners.

An Easy-to-Assemble Three-Part Galvanic Cell

ERIC Educational Resources Information Center

Eggen, Per-Odd; Skaugrud, Brit

2015-01-01

The galvanic cell presented in this article is made of only three parts, is easy to assemble, and can light a red light emitting diode (LED). The three cell components consist of a piece of paper with copper sulfate, a piece of paper with sodium sulfate, and a piece of magnesium ribbon. Within less than 1 h, students have time to discuss the…

Penile surgery and reconstruction.

PubMed

Perovic, Sava V; Djordjevic, Miroslav L J; Kekic, Zoran K; Djakovic, Nenad G

2002-05-01

This review will highlight recent advances in the field of penile reconstructive surgery in the paediatric and adult population. It is based on the work published during the year 2001. Besides the anatomical and histological studies of the penis, major contributions have been described in congenital and acquired penile anomalies. Also, a few new techniques and modifications of old procedures are described in order to improve the final functional and aesthetic outcome. The techniques for penile enlargement present a trend in the new millennium, but are still at the stage of investigation.

Focal Urethral Stricturing Following Intraurethral Mitomycin-C Gel and the Use of a Penile Clamp

PubMed Central

Stanford, Richard F. J.; Thomas, Stephen A.

2012-01-01

We present a case of a 51-year-old gentleman, previously diagnosed with high-grade superficial transitional cell carcinoma of the bladder and treated with intravesical mitomycin C and BCG, who developed serial recurrences in the prostatic urethra. This was resected and treated further with intraurethral mitomycin-C gel. He subsequently developed an almost impassable distal penile urethral stricture, corresponding to the site of penile clamp application which we hypothesise is secondary to a combination of the mitomycin-C gel and penile clamp pressure. PMID:22830069

Focal urethral stricturing following intraurethral mitomycin-C gel and the use of a penile clamp.

PubMed

Stanford, Richard F J; Thomas, Stephen A

2012-01-01

We present a case of a 51-year-old gentleman, previously diagnosed with high-grade superficial transitional cell carcinoma of the bladder and treated with intravesical mitomycin C and BCG, who developed serial recurrences in the prostatic urethra. This was resected and treated further with intraurethral mitomycin-C gel. He subsequently developed an almost impassable distal penile urethral stricture, corresponding to the site of penile clamp application which we hypothesise is secondary to a combination of the mitomycin-C gel and penile clamp pressure.

Dislocation of the penis: a rare complication after traumatic pelvic injury

PubMed Central

Lim, Mei Chin; Srinivasan, Sivasubramanian; Teh, Hui Seong; Teo, Chang Peng Colin

2015-01-01

Traumatic injury to the male external genitalia is frequently encountered, but acute traumatic dislocation of the penile structure is extremely rare, with only a few reports found in the literature. We herein report the case of a 21-year-old man who sustained blunt trauma to the pelvis following a motor vehicle accident, and had features suspicious of penile dislocation. With the use of computed tomography and bedside ultrasonography, a diagnosis of penile dislocation was made, which was subsequently confirmed intraoperatively. Immediate surgical intervention via gentle manipulation of the penile tissue back to its native position was performed in order to restore normal anatomy. The exact mechanism of penile dislocation is not known. However, circumferential laceration around the foreskin causing degloving injury of the penis is suggested in our patient. PMID:25640107

Advances in understanding of mammalian penile evolution, human penile anatomy and human erection physiology: Clinical implications for physicians and surgeons

PubMed Central

Hsieh, Cheng-Hsing; Liu, Shih-Ping; Hsu, Geng-Long; Chen, Heng-Shuen; Molodysky, Eugen; Chen, Ying-Hui; Yu, Hong-Jeng

2012-01-01

Summary Recent studies substantiate a model of the tunica albuginea of the corpora cavernosa as a bi-layered structure with a 360° complete inner circular layer and a 300° incomplete outer longitudinal coat spanning from the bulbospongiosus and ischiocavernosus proximally and extending continuously into the distal ligament within the glans penis. The anatomical location and histology of the distal ligament invites convincing parallels with the quadrupedal os penis and therefore constitutes potential evidence of the evolutionary process. In the corpora cavernosa, a chamber design is responsible for facilitating rigid erections. For investigating its venous factors exclusively, hemodynamic studies have been performed on both fresh and defrosted human male cadavers. In each case, a rigid erection was unequivocally attainable following venous removal. This clearly has significant ramifications in relation to penile venous surgery and its role in treating impotent patients. One deep dorsal vein, 2 cavernosal veins and 2 pairs of para-arterial veins (as opposed to 1 single vein) are situated between Buck’s fascia and the tunica albuginea. These newfound insights into penile tunical, venous anatomy and erection physiology were inspired by and, in turn, enhance clinical applications routinely encountered by physicians and surgeons, such as penile morphological reconstruction, penile implantation and penile venous surgery. PMID:22739749

Risk factors for squamous cell carcinoma of the penis--population-based case-control study in Denmark.

PubMed

Madsen, Birgitte Schütt; van den Brule, Adriaan J C; Jensen, Helle Lone; Wohlfahrt, Jan; Frisch, Morten

2008-10-01

Few etiologic studies of squamous cell carcinoma (SCC) of the penis have been carried out in populations where childhood circumcision is rare. A total of 71 patients with invasive (n=53) or in situ (n=18) penile SCC, 86 prostate cancer controls, and 103 population controls were interviewed in a population-based case-control study in Denmark. For 37 penile SCC patients, tissue samples were PCR examined for human papillomavirus (HPV) DNA. Overall, 65% of PCR-examined penile SCCs were high-risk HPV-positive, most of which (22 of 24; 92%) were due to HPV16. Penile SCC risk was positively associated with measures of early and high sexual activity, including lifetime number of female sex partners, number of female sex partners before age 20, age at first intercourse, penile-oral sex, a history of anogenital warts, and never having used condoms. Histories of phimosis and priapism at least 5 years before diagnosis were also significant risk factors, whereas alcohol abstinence was associated with reduced risk. Our study confirms sexually transmitted HPV16 infection and phimosis as major risk factors for penile SCC and suggests that penile-oral sex may be an important means of viral transmission. The association with priapism was unexpected and needs replication.

CSN1 Somatic Mutations in Penile Squamous Cell Carcinoma.

PubMed

Feber, Andrew; Worth, Daniel C; Chakravarthy, Ankur; de Winter, Patricia; Shah, Kunal; Arya, Manit; Saqib, Muhammad; Nigam, Raj; Malone, Peter R; Tan, Wei Shen; Rodney, Simon; Freeman, Alex; Jameson, Charles; Wilson, Gareth A; Powles, Tom; Beck, Stephan; Fenton, Tim; Sharp, Tyson V; Muneer, Asif; Kelly, John D

2016-08-15

Other than an association with HPV infection, little is known about the genetic alterations determining the development of penile cancer. Although penile cancer is rare in the developed world, it presents a significant burden in developing countries. Here, we report the findings of whole-exome sequencing (WES) to determine the somatic mutational landscape of penile cancer. WES was performed on penile cancer and matched germline DNA from 27 patients undergoing surgical resection. Targeted resequencing of candidate genes was performed in an independent 70 patient cohort. Mutation data were also integrated with DNA methylation and copy-number information from the same patients. We identified an HPV-associated APOBEC mutation signature and an NpCpG signature in HPV-negative disease. We also identified recurrent mutations in the novel penile cancer tumor suppressor genes CSN1(GPS1) and FAT1 Expression of CSN1 mutants in cells resulted in colocalization with AGO2 in cytoplasmic P-bodies, ultimately leading to the loss of miRNA-mediated gene silencing, which may contribute to disease etiology. Our findings represent the first comprehensive analysis of somatic alterations in penile cancer, highlighting the complex landscape of alterations in this malignancy. Cancer Res; 76(16); 4720-7. ©2016 AACR. ©2016 American Association for Cancer Research.

Gravitational waves from warm inflation

NASA Astrophysics Data System (ADS)

Li, Xi-Bin; Wang, He; Zhu, Jian-Yang

2018-03-01

A fundamental prediction of inflation is a nearly scale-invariant spectrum of gravitational wave. The features of such a signal provide extremely important information about the physics of the early universe. In this paper, we focus on several topics about warm inflation. First, we discuss the stability property about warm inflation based on nonequilibrium statistical mechanics, which gives more fundamental physical illustrations to thermal property of such model. Then, we calculate the power spectrum of gravitational waves generated during warm inflation, in which there are three components contributing to such spectrum: thermal term, quantum term, and cross term combining the both. We also discuss some interesting properties about these terms and illustrate them in different panels. As a model different from cold inflation, warm inflation model has its individual properties in observational practice, so we finally give a discussion about the observational effect to distinguish it from cold inflation.

The effect of platelet rich fibrin on growth factor levels in urethral repair.

PubMed

Soyer, Tutku; Ayva, Şebnem; Boybeyi, Özlem; Aslan, Mustafa Kemal; Çakmak, Murat

2013-12-01

Platelet rich fibrin (PRF) is an autologous source of growth factors and promotes wound healing. An experimental study was performed to evaluate the effect of PRF on growth factor levels in urethral repair. Eighteen Wistar albino rats were included in the study. Rats were allocated in three groups (n:6): control (CG), sham (SG), and PRF (PRFG). In SG, a 5 mm vertical incision was performed in the penile urethra and repaired with 10/0 Vicryl® under a microscope. In PRFG, during the urethral repair as described in SG, 1 cc of blood was sampled from each rat and centrifuged for 10 minutes at 2400 rpm. PRF obtained from the centrifugation was placed on the repair site during closure. Penile urethras were sampled 24 hours after PRF application in PRFG and after urethral repair in SG. Transforming growth factor beta receptor (TGF-β-R-CD105), vascular endothelial growth factor (VEGF) and its receptor (VEGF-R), as well as endothelial growth factor receptor (EGFR), were evaluated in subepithelia of the penile skin and urethra. Groups were compared for growth factor levels and growth factor receptor expression with the Kruskal Wallis test. TGF-β-R levels were significantly decreased in SG when compared to CG (p<0.05). In PRFG, TGF-β-R was increased in both subepithelia of penile skin and urethra with respect to SG (p<0.05). When VEGF levels and its receptor expression were compared between SG and PRFG, VEGF levels were found to be increased in penile skin subepithelium, whereas VEGF-R expressions were decreased in urethral subepithelia in PRFG (p<0.05). There was no difference between groups for EGFR levels (p>0.05). Use of PRF after urethral repair increases TGF-β-R and VEGF expressions in urethral tissue. PRF can be considered as an alternative measure to improve the success of urethral repair. © 2013.

Efficacy and safety evaluation of pentoxifylline associated with other antioxidants in medical treatment of Peyronie’s disease: a case-control study

PubMed Central

Paulis, Gianni; Barletta, Davide; Turchi, Paolo; Vitarelli, Antonio; Dachille, Giuseppe; Fabiani, Andrea; Gennaro, Romano

2016-01-01

Peyronie’s disease (PD) is a chronic disorder involving the tunica albuginea surrounding the corpora cavernosa of the penis. A conservative treatment is indicated in the first stage of disease. The aim of this study was to assess the therapeutic impact and possible side effects of treatment with pentoxifylline (PTX) in combination with other antioxidants in 307 patients with early-stage PD. Patients were subdivided into three groups: A, B, and C. Both groups, A and B, comprising of 206 patients, underwent treatment, whereas Group C was the control group (n=101). Treatment lasted 6 months and included the following: Group A: PTX 400 mg twice a day + propolis 600 mg/d + blueberry 160 mg/d + vitamin E 600 mg/d + diclofenac 4% gel twice/a day + PTX 100 mg via perilesional penile injection/every other week (12 injections in all); Group B: the same treatment as Group A except for the penile PTX injections. After the 6-month treatment course, we obtained the following results: actual mean decrease in plaque volume −46.9% and −24.8% in Group A and B, respectively (P<0.0001); mean curvature reduction −10.1° and −4.8°, respectively (P,0.0001); resolution of pain in 67.6% and 67.2% of cases, respectively (P=0.961); recovery of normal penile rigidity in 56.09% and 23.5% of cases, respectively (P=0.005). After 6 months, progression of disease was observed in all patients belonging to Group C: plaque volume +123.3%; curvature +15.7°; no recovery of penile rigidity. The statistically significant results of our study show that multimodal treatment with PTX in association with other antioxidants and topical diclofenac is efficacious in treating early-stage PD. Furthermore, treatment proved to be more effective when PTX was administered both orally and by penile injection. No serious adverse effects occurred. PMID:26770906

Excision and Patch Grafting of a Lateral Peyronie's Plaque-Utilizing a Longitudinal "Window" Approach.

PubMed

Lue, Kathy; Emtage, Justin B; Martinez, Daniel R; Yang, Christopher; Carrion, Rafael

2015-06-01

Peyronie's disease (PD) is a debilitating disorder in which collagen deposition, fibrosis, and plaques in the tunica albuginea result in penile curvature, shortening, and pain. For severe curvatures requiring plaque incision or excision with grafting (PIEG), a subcoronal circumcising incision with penile degloving has historically been used. The aim of this study was to report our unique approach to PIEG via a longitudinal "window" incision for the correction of PD, minimizing the surgical manipulation and dissection accompanying the traditional circumcising incisional approach that may lead to increased postoperative edema, pain, and prolonged healing time. A patient presented with a stable, painless, 90-degree midshaft leftward curvature causing penetration difficulties and painful intercourse for his partner. His Sexual Health Inventory for Men (SHIM) score was 23. The patient opted for surgical correction with plaque excision and grafting via a 4-cm longitudinal incision overlying the point of maximal curvature along the left lateral penile shaft. This direct access to the left corpus cavernosum and plaque, along with dissecting skin, dartos, and Buck's fascia, created a window with sufficient exposure for excision and patch grafting. The main outcome measures were objective data and subjective data in men undergoing PIEG via lateral longitudinal "window" incision for PD repair. The plaque was excised and a porcine small intestinal submucosa graft was sewn in. Intraoperative artificial tumescence at the end of surgery revealed complete correction of the curvature. The patient experienced painless rigid erections by postoperative day three with minimal penile edema. By postoperative week four, he could successfully partake in coitus. His SHIM score remained unchanged. At maximum follow-up 6 months postoperatively, he still endorsed excellent cosmetic and functional outcomes with spontaneous unassisted erections and no recurrence of his curvature. A lateral longitudinal incision for PIEG is a feasible technique and may reduce the postoperative morbidity and dissection required with traditional circumcising incision with penile degloving. Larger comparative studies are necessary for further evaluation.

Current Management of Penile Fracture: An Up-to-Date Systematic Review.

PubMed

Falcone, Marco; Garaffa, Giulio; Castiglione, Fabio; Ralph, David J

2018-04-01

Because of the low incidence of penile fracture, many aspects of the diagnostic process and of the surgical and functional outcomes are rarely reported. To systematically review the current literature on the surgical management of penile fracture, focusing on etiology, diagnosis, functional outcomes, and postoperative complications. The present review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration standards for systematic reviews. A systematic search for the terms penile fracture, fracture of penis, trauma of penis, rupture of corpora cavernosa, and immediate management of penile fracture was been carried out in the PubMed, EMBASE, Cochrane, SCOPUS, and Science Citation Index databases. Etiology of penile fracture, clinical presentation, types of radiologic investigations and their accuracy, surgical approach, suture material used for tunica repair, timing of surgical exploration, intraoperative findings, surgical complications, and functional outcomes. The total number of patients analyzed was 438, and the patients' an average age was 36 years. The most frequent reported cause of penile fracture was sexual intercourse (80% of cases). The most common finding at examination was a penile hematoma (97.5%). Although operator dependent, in experienced hands, ultrasonography was found to be a useful tool in confirming the location of the albuginea tear and identifying the presence of any concomitant urethral injury, helping the surgeon to choose the best surgical approach. Early surgical repair of a penile fracture was found to be a safe procedure, although long-term complications are not uncommon. Tertiary referral centers that managed a larger number of cases seemed to obtain more satisfactory long-term results with a significantly smaller number of complications. A low incidence of postoperative complications and full satisfactory functional outcomes are reported when early repair is performed in high-volume centers. Falcone M, Garaffa G, Castiglione F, Ralph DJ. Current Management of Penile Fracture: An Up-to-Date Systematic Review. Sex Med Rev 2018;6:253-260. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Burden of invasive squamous cell carcinoma of the penis in the United States, 1998-2003.

PubMed

Hernandez, Brenda Y; Barnholtz-Sloan, Jill; German, Robert R; Giuliano, Anna; Goodman, Marc T; King, Jessica B; Negoita, Serban; Villalon-Gomez, Jose M

2008-11-15

Invasive squamous cell carcinoma (SCC) of the penis is rare in the United States. Although human papillomavirus (HPV) infection is an established etiologic agent in at least 40% of penile SCCs, relatively little is known about the epidemiology of this malignancy. Population-based data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, the Centers for Disease Control and Prevention's National Program for Cancer Registries, and the National Center for Health Statistics were used to examine invasive penile SCC incidence and mortality in the United States. SEER data were used to examine treatment of penile SCC. From 1998 to 2003, 4967 men were diagnosed with histologically confirmed invasive penile SCC in the United States, representing less than 1% of new cancers in men. The annual, average age-adjusted incidence rate was 0.81 cases per 100,000 men, and rates increased steadily with age. Overall, penile SCC incidence was comparable in whites and blacks, but approximately 2-fold lower in Asians/Pacific Islanders. Rates among Hispanics were 72% higher compared with non-Hispanics. Blacks compared with whites and Asians/Pacific Islanders and Hispanics compared with non-Hispanics were diagnosed at significantly younger ages. Higher rates of mortality were also observed among blacks compared with whites and Hispanics compared with non-Hispanics. Penile SCC incidence and mortality were elevated in Southern states and in regions of low socioeconomic status (SES). Some histologic and anatomic site differences were observed by race and ethnicity. Treatment of penile SCC varied with age, stage, and other tumor characteristics. There are considerable disparities in invasive penile cancer incidence and mortality in the United States. Key risk factors for excess incidence include Hispanic ethnicity and residence in the South and in low SES regions. Risks for excess mortality include these factors in addition to black race. Decreases in penile cancer incidence and mortality in the United States may be realized in the future as the indirect result of prophylactic HPV vaccination of females. Further research is needed to better understand the epidemiology of penile cancer including the role of HPV.

Burden of Invasive Squamous Cell Carcinoma of the Penis in the United States, 1998–2003

PubMed Central

Hernandez, Brenda Y.; Barnholtz-Sloan, Jill; German, Robert R.; Giuliano, Anna; Goodman, Marc T.; King, Jessica B.; Negoita, Serban; Villalon-Gomez, Jose M.

2009-01-01

BACKGROUND Invasive squamous cell carcinoma (SCC) of the penis is rare in the United States. Although human papillomavirus (HPV) infection is an established etiologic agent in at least 40% of penile SCCs, relatively little is known about the epidemiology of this malignancy. METHODS Population-based data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, the Centers for Disease Control and Prevention's National Program for Cancer Registries, and the National Center for Health Statistics were used to examine invasive penile SCC incidence and mortality in the United States. SEER data were used to examine treatment of penile SCC. RESULTS From 1998 to 2003, 4967 men were diagnosed with histologically confirmed invasive penile SCC in the United States, representing less than 1% of new cancers in men. The annual, average age-adjusted incidence rate was 0.81 cases per 100,000 men, and rates increased steadily with age. Overall, penile SCC incidence was comparable in whites and blacks, but approximately 2-fold lower in Asians/Pacific Islanders. Rates among Hispanics were 72% higher compared with non-Hispanics. Blacks compared with whites and Asians/Pacific Islanders and Hispanics compared with non-Hispanics were diagnosed at significantly younger ages. Higher rates of mortality were also observed among blacks compared with whites and Hispanics compared with non-Hispanics. Penile SCC incidence and mortality were elevated in Southern states and in regions of low socioeconomic status (SES). Some histologic and anatomic site differences were observed by race and ethnicity. Treatment of penile SCC varied with age, stage, and other tumor characteristics. CONCLUSIONS There are considerable disparities in invasive penile cancer incidence and mortality in the United States. Key risk factors for excess incidence include Hispanic ethnicity and residence in the South and in low SES regions. Risks for excess mortality include these factors in addition to black race. Decreases in penile cancer incidence and mortality in the United States may be realized in the future as the indirect result of prophylactic HPV vaccination of females. Further research is needed to better understand the epidemiology of penile cancer including the role of HPV. PMID:18980292

Seventeen years' experience of penile fracture: conservative vs. surgical treatment.

PubMed

Yapanoglu, Turgut; Aksoy, Yilmaz; Adanur, Senol; Kabadayi, Bariş; Ozturk, Gurkan; Ozbey, Isa

2009-07-01

Penile fracture is the rupture of the tunica of one or both corpora cavernosa due to direct blunt trauma to the erected penis. Partial or complete rupture of the urethra or injury to the deep dorsal vein may accompany penile fracture. To compare conservative and surgical treatment modalities in terms of duration of hospitalization, early and late complications such as penile nodule and curvature, erectile dysfunction, and painful erection. Treatment results and complications in two groups were evaluated with history and physical examination, and International Index of Erectile Function-5 Questionnaire was used for erectile function assessment. Methods. The charts of 42 men diagnosed with penile fracture were retrospectively reviewed, and two treatment modalities were compared: conservative (Group I) and surgical (Group II). Results. Between 1991 and 2008, a total of 42 patients with penile fracture were followed in our clinic for a mean of 18 months (range: 6-30 months). Five men who refused surgical treatment were treated conservatively, and the other 37 patients underwent surgical treatment. In Group II, the most common complication was painful erection (in 4 of 37 patients, 10.8 %), whereas in Group I, 80 % (4/5 patients) suffered complications such as wound infection, painful erection, penile nodule and curvature, and erectile dysfunction. Conclusion. Diagnosis of penile fracture can be based on history and physical examination; diagnostic tests such as ultrasonography and magnetic resonance imaging are generally not required. Fractures must be repaired either immediately or delayed. Because management with emergency surgical repair is the most effective approach, with the lowest complication rate, surgical treatment should be preferred compared to a conservative approach.

False penile fracture: value of different diagnostic approaches and long-term outcome of conservative and surgical management.

PubMed

El-Assmy, Ahmed; El-Tholoth, Hossam S; Abou-El-Ghar, Mohamed E; Mohsen, Tarek; Ibrahiem, El Housseiny I

2010-06-01

We determined the value of clinical and radiological findings in diagnosis of false penile fracture. Also, the long-term outcome of conservative and surgical treatment of such patients was evaluated. Seventeen patients with false penile fracture were treated conservatively (3 patients) and surgically (14 patients) at our center. Medical records were retrospectively reviewed for etiology, symptoms, signs of physical examination, and information on findings of surgical exploration. Data on erectile function and penile sequelae were obtained during follow-up using the Sexual Health Inventory for Men (SHIM) questionnaire and local examination. The most common cause of false penile fracture is sexual intercourse (76.5%). False fracture was suspected in 3 patients who presented with small hematoma and slow post-trauma detumescence; intact tunicas were diagnosed by magnetic resonance imaging (MRI) in all of them and were managed conservatively. Surgical penile exploration was performed in 14 cases, in whom preoperative ultrasound was done in 6, and it was false positive for presence of tunical tear in 50%. Exploration revealed nonspecific dartos bleeding in 9 cases and avulsed superficial dorsal vein in 5. Long-term follow-up (mean=93 months) was available for 16 patients, among whom there was no complications. In most cases, false penile fracture is indistinguishable from true penile fracture either clinically or radiologically. In atypical cases, MRI seems to be a promising modality for diagnosis of such patients. The long-term outcome of conservative and surgical treatment is excellent. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Prevalence of human papillomavirus and Epstein-Barr virus DNA in penile cancer cases from Brazil.

PubMed

Afonso, Larissa Alves; Moyses, Natalia; Alves, Gilda; Ornellas, Antônio Augusto; Passos, Mauro Romero Leal; Oliveira, Ledy do Horto dos Santos; Cavalcanti, Silvia Maria Baeta

2012-02-01

Penile cancer is a potentially mutilating disease. Although its occurrence is relatively rare worldwide, penile cancer rates can be high in developing countries. A few studies have been conducted on the involvement of human papillomavirus (HPV) in penile carcinoma, which have found HPV present in 30-70% of penile malignant lesions, with a higher prevalence of HPV 16 and 18. It has been assumed that cofactors, such as Epstein-Barr virus (EBV) infections, may play a role in the progression of penile neoplasia. The aim of this study was to determine HPV and EBV prevalence in 135 penile malignant lesions from Brazilian men through the use of MY09/11 polymerase chain reaction (PCR), type-specific PCR and restriction fragment length polymorphism analysis. HPV prevalence among the men tested was 60.7%. Of the men who tested positive, 27 presented with HPV 16 (29.7%), five with HPV 18 (5.5%), 21 with HPV 45 (23.1%) and nine with HPV 6 (9.9%). Seven mixed infections were detected (9.2%), while 11 cases remained untyped (13.4%). Regarding EBV positivity, 46.7% of the samples contained EBV DNA with EBV-1 as the most prevalent type (74.6%). More than 23% of the men were co-infected with both HPV and EBV, while 35% presented exclusively with HPV DNA and 20% presented only with EBV DNA. Penile carcinoma aetiology has not been fully elucidated and the role of HPV and EBV infections individually or synergistically is still controversial. Hence, more studies are needed to determine their possible role in carcinogenesis.

Blunted non-nitric oxide vasodilatory neurotransmission in penile arteries from renal hypertensive rats.

PubMed

Martínez, Ana Cristina; Stankevicius, Edgaras; Jakobsen, Preben; Simonsen, Ulf

2006-05-01

The present study was designed to explore whether there are any effects on neurogenic responses in penile small arteries during the development of hypertension in a one-kidney, one-clip (1K1C) model, a non-renin-dependent model of renovascular hypertension. Five weeks after surgery, male Sprague-Dawley rats were given vehicle, bendroflumethiazide (7.5 mg/kg/day), or L-arginine (2 g/kg/day) in their drinking water for five weeks. Experiments were performed on penile small artery rings (150-200 microm) mounted on microvascular myographs for electrical field stimulation (EFS), and erectile tissue was processed for immunohistochemistry. Maximal neurogenic contractions were unmodified in penile preparations. Relaxations induced by EFS were reduced in the presence of ADMA. In 1K1C rats, neurogenic vasorelaxation mediated by nitric oxide (NO) was unaltered, while relaxation resistant to NO synthase inhibition was blunted. L-arginine and bendroflumethiazide lowered blood pressure in 1K1C rats, but vasodilation was still blunted in the penile arteries. Immunoreactivity for factor VIII and neuronal NO synthase was unaltered in penile arteries from 1K1C animals. Endothelium-dependent vasorelaxation evoked by acetylcholine was also blunted in preparations from 1K1C rats, while exogenous NO relaxation was unaffected. Plasma concentrations and urinary excretion of ADMA did not differ among the experimental animals. Our findings indicate that the reduced release of a non-NO vasodilatory neurotransmitter accounts for the impaired neurogenic vasodilation of the penile arteries. Although ADMA inhibits penile vasorelaxation, it is unlikely to affect erectile function in 1K1C rats.

Modified 16-Dot plication technique for correction of penile curvature: prevention of knot-related complications.

PubMed

Salem, Emad A

2018-05-08

Penile curvature is a common urological disease. Tunical plication for correction of penile curvature has been much popularized being simpler, adjustable to avoid overcorrection, less bleeding, and less postoperative erectile dysfunction. This study aims to assess the results of modified 16-dot plication technique for correction of congenital and acquired penile curvature and avoidance of knot-associated complications. Eighteen patients underwent correction of their penile curvature using the modified 16-dot plication technique between January 2014 and October 2015. Patients' pre and postoperative data were analyzed. The mean age of patients is 44 years old. Of the patients 15 who were available for follow-up, 8 patients had congenital penile curvature (CPC) and 7 had Peyronie's disease (PD). The angle of deviation ranged from 30° to 90°. Erectile function (EF) was assessed preoperative by IIEF score and duplex ultrasound. Postoperative follow-up at 3 and 6 months revealed straight erect penis in all patients. Longer follow-up at 1 to 2 years, 2 patients complained from slight recurrence of curve (<20°) and 2 patients complained of worsening of their erectile function. Penile shortening was noted by 6 patients. None of our patients stated any knot complication or bothersome, nor do hematomas, numbness, or painful erections. The modified 16-dot plication technique for correction if penile curvature is a safe and effective method. This modification allowed the knots to be tucked in the plicate tunical tissue avoiding knot-associated complications. More investigation on a large scale of patients or multicenter studies is recommended.

Isolated penile torsion in newborns.

PubMed

Eroglu, Egemen; Gundogdu, Gokhan

2015-01-01

We reported on the incidence of isolated penile torsion among our healthy children and our approach to this anomaly. Between 2011 and 2014, newborn babies with penile torsion were classified according to the angle of torsion. Surgical correction (penile degloving and reattachment for moderate cases and dorsal dartos flap technique in case of resistance) after 6 months was advised to the babies with rotations more than 45°. Among 1000 newborn babies, 200 isolated penile torsions were found, and among these, 43 had torsions more than 45°, and 4 of these had angles greater than 90°. The mean angle of the rotations was found 30.45° (median: 20°). In total, 8 children with 60° torsions were previously circumcised. Surgery was performed on 19 patients, with a mean patient age of 12 ± 2 months. Of these 19, 13 babies were corrected with degloving and reattachment. This technique was not enough on the remaining 6 patients; therefore, derotational dorsal dartos flap was added to correct the torsion. After a mean of 15.6 ± 9.8 months, residual penile rotation, less than 15°, was found only in 2 children. The incidence of isolated penile torsion is 20% in newborns. However, rotation more than 45° angles are seen in 4.3% of male babies. Correction is not necessary in mild degrees, and penile degloving with reattachment is enough in most cases. If the initial correction is insufficient, dorsal dartos flap rotation is easy and effective. Prior circumcision neither disturbs the operative procedure nor affects the outcomes.

Penile length of term newborn infants in multiracial Malaysia.

PubMed

Ting, T H; Wu, L L

2009-08-01

Micropenis may be an important sign of underlying hypogonadism or pituitary hypofunction in the neonatal period. Penile lengths of normal newborns have been reported in many Western populations. However, the data may not be applicable in the Asian or the multiracial Malaysian population. Our study aimed to establish the normal penile length and testicular volume in term newborn infants in the major ethnic groups in Malaysia. The stretched penile length and testicular volume were measured in 340 normal term newborn infants (195 Malays, 129 Chinese and 16 Indians). The mean penile length in Malay term newborn infants was 35 +/- 4 mm, which was similar to Chinese infants. The mean testicular volume was 2.5 +/- 0.6 ml in Malay and 2.4 +/- 0.5 ml in Chinese infants. There was no significant difference between the groups. The sample size for the Indian group during the study period was inadequate. Using -2.5 standard deviations as the cut-off for micropenis, a Malay or Chinese newborn infant in Malaysia with a penile length of less than 25 mm is considered to have a micropenis and further evaluation is warranted.

Incidence and predictive factors of isolated neonatal penile glanular torsion.

PubMed

Sarkis, Pierrot E; Sadasivam, Muthurajan

2007-12-01

To determine the incidence of isolated neonatal penile glanular torsion, describe the basic characteristics, and explore the relationship between foreskin and glans torsion. A prospective survey was conducted of all male newborns admitted to nursery after delivery, or neonates less than 3 months presenting for circumcision. Cases with associated genital malformations were excluded. The incidence of isolated neonatal penile torsion was 27% (95% CI: 22.2%-31.84%), to the left in 99% of cases. In 3.5% of cases, the penis had an angle <10 degrees, and 9.5% >20 degrees. Using Spearman's correlational coefficient, deviation of penile raphe from the midline at the foreskin tip had a better correlation with glans torsion than deviation of raphe at the coronal sulcus (0.727 vs 0.570; both significant at p<0.01). Isolated neonatal penile torsion is more common than reported. The median raphe of the penis may be normal and mask unexpected glans torsion. Median raphe torsion at foreskin tip can be used as a predictor for glans torsion. Clinical significance and relation to adult penile torsion are beyond the scope of the study.

Homosexual Behavior Between Male Spider Monkeys (Ateles geoffroyi).

PubMed

Busia, Laura; Denice, Anthony R; Aureli, Filippo; Schaffner, Colleen M

2018-05-01

Homosexual behavior is defined as genital contact or genital manipulation between same-sex individuals. In nonhuman primates, it may regulate social relationships by serving as a means of reconciliation, tension alleviation, or alliance formation. Grappling is a rare and complex behavior, which most frequently occurs between same-sex individuals of the genus Ateles and can include mutual manipulation of the genitalia. Here we report three cases of penile-anal intromission during grappling between wild male spider monkeys living in the natural protected area of Otoch Ma'ax Yetel Kooh, Mexico. In all the observed cases, the same adult male was the actor. To our knowledge, this is the first report of penile-anal intromission between males in any New World primate species.

How to deal with penile carcinoma inguinal metastases invading femoral vessels.

PubMed

Fodor, Marius; Petrut, Bogdan; Fodor, Lucian

2017-01-01

Penile cancer accounts for 1-10% of men neoplastic diseases and 30-60% of patients have inguinal metastases at the time of diagnosis. Inguinal metastases of penile cancer with femoral vessel involvement could lead to vascular fistula and hemorrhagic shock. We present 3 consecutive patients with inguinal metastases of penile cancer complicated by infection and hemorrhage from femoral vessels invaded by the tumor. Simultaneous extra-anatomical axillo-femoral bypass graft, wide excision of tumor and groin defect reconstruction was used to achieve "tumor-free" oncologic aim and to save the lower limb. We consider the extra-anatomic axillo-femoral bypass associated with wide inguinal tumor excision and defect covering a feasible surgical solution for improving the life quality and extend life expectancy in patients with lymph node metastasis of penile cancer complicated by necrosis, infection and femoral vessel involvement.

Buried penis: An unrecognized risk factor in the development of invasive penile cancer.

PubMed

Abdulla, Alym; Daya, Dean; Pinthus, Jehonathan; Davies, Timothy

2012-10-01

One of the documented benefits of neonatal circumcision is protection against invasive penile cancer. To date there have been a handful of published cases of invasive penile cancer in men circumcised as neonates. We report a case of a 73-year-old man, with a history of neonatal circumcision with no evidence of previous human papillomavirus exposure, who developed a buried penis secondary to obesity. He was diagnosed with Grade 2, pT3N0 squamous cell carcinoma of the penis. This report suggests that buried penis may pose a risk factor for the development of penile cancer despite the protective effects of neonatal circumcision. Thus periodic examination of a buried penis is warranted even in patients with no risk factors for penile cancer. A review of the literature is provided.

Trends in incidence, mortality and survival of penile squamous cell carcinoma in Norway 1956-2015.

PubMed

Hansen, Bo T; Orumaa, Madleen; Lie, A Kathrine; Brennhovd, Bjørn; Nygård, Mari

2018-04-15

We examine trends in incidence, mortality and survival of penile squamous cell carcinoma (SCC) in Norway over 60 years. Data on all cases of penile cancer diagnosed in Norway during 1956-2015 were obtained from the Cancer Registry of Norway. Trends in age-standardized rates of penile SCC incidence, mortality and 5-year relative survival were assessed by the annual percentage change statistic and joinpoint regression. A total of 1,596 penile cancer cases were diagnosed during 1956-2015, among which 1,474 (92.4%) were SCC. During 2011-2015, the age-standardized incidence and mortality of penile SCC were 0.91 (95% confidence interval (CI): 0.78; 1.05) and 0.50 (0.42; 0.60) per 100,000, respectively, and the 5-year relative survival was 61.6% (41.9; 76.4). The incidence of SCC increased during 1956-2015, with an average annual percentage change (AAPC) of 0.80% (0.46; 1.15). The increase was strongest among men diagnosed at a relatively early age (age<=64 years; AAPC: 1.47% (0.90; 2.05)). Mortality also increased over the study period (AAPC: 0.47% (0.10; 0.85)), whereas 5-year relative survival did not change (AAPC: 0.08% (-0.19; 0.36)). We conclude that the incidence of penile SCC has increased at a moderate and constant rate during 1956-2015, and that the most consistent increase occurred among younger men. Mortality also increased during the study period. However, survival did not change, thus changes in diagnostics and treatment had little impact on survival from penile SCC. Since a substantial proportion of penile SCC is caused by human papillomavirus (HPV), the incidence increase may in part be attributed to increased exposure to HPV in the population. © 2017 The Authors International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

Trends in incidence, mortality and survival of penile squamous cell carcinoma in Norway 1956–2015

PubMed Central

Orumaa, Madleen; Lie, A. Kathrine; Brennhovd, Bjørn; Nygård, Mari

2017-01-01

We examine trends in incidence, mortality and survival of penile squamous cell carcinoma (SCC) in Norway over 60 years. Data on all cases of penile cancer diagnosed in Norway during 1956–2015 were obtained from the Cancer Registry of Norway. Trends in age‐standardized rates of penile SCC incidence, mortality and 5‐year relative survival were assessed by the annual percentage change statistic and joinpoint regression. A total of 1,596 penile cancer cases were diagnosed during 1956–2015, among which 1,474 (92.4%) were SCC. During 2011–2015, the age‐standardized incidence and mortality of penile SCC were 0.91 (95% confidence interval (CI): 0.78; 1.05) and 0.50 (0.42; 0.60) per 100,000, respectively, and the 5‐year relative survival was 61.6% (41.9; 76.4). The incidence of SCC increased during 1956–2015, with an average annual percentage change (AAPC) of 0.80% (0.46; 1.15). The increase was strongest among men diagnosed at a relatively early age (age<=64 years; AAPC: 1.47% (0.90; 2.05)). Mortality also increased over the study period (AAPC: 0.47% (0.10; 0.85)), whereas 5‐year relative survival did not change (AAPC: 0.08% (−0.19; 0.36)). We conclude that the incidence of penile SCC has increased at a moderate and constant rate during 1956–2015, and that the most consistent increase occurred among younger men. Mortality also increased during the study period. However, survival did not change, thus changes in diagnostics and treatment had little impact on survival from penile SCC. Since a substantial proportion of penile SCC is caused by human papillomavirus (HPV), the incidence increase may in part be attributed to increased exposure to HPV in the population. PMID:29205336

mTOR signaling pathway in penile squamous cell carcinoma: pmTOR and peIF4E over expression correlate with aggressive tumor behavior.

PubMed

Ferrandiz-Pulido, Carla; Masferrer, Emili; Toll, Agustin; Hernandez-Losa, Javier; Mojal, Sergio; Pujol, Ramon M; Ramon y Cajal, Santiago; de Torres, Ines; Garcia-Patos, Vicente

2013-12-01

Penile squamous cell carcinoma is a rare neoplasm associated with a high risk of metastasis and morbidity. There are limited data on the role of the mTOR signaling pathway in penile squamous cell carcinoma carcinogenesis and tumor maintenance. We assessed a possible role for mTOR signaling pathway activation as a potential predictive biomarker of outcome and a therapeutic target for penile cancer. A cohort of 67 patients diagnosed with invasive penile squamous cell carcinoma from 1987 to 2010 who had known HPV status were selected for study. Tissue microarrays were constructed with 67 primary penile squamous cell carcinomas, matched normal tissues and 8 lymph node metastases. Immunohistochemical staining was performed for p53, pmTOR, pERK, p4E-BP1, eIF4E and peIF4E. Expression was evaluated using a semiquantitative H-score on a scale of 0 to 300. Expression of pmTOR, p4E-BP1, eIF4E and peIF4E was increased in penile tumors compared with matched adjacent normal tissues, indicating activation of the mTOR signaling pathway in penile tumorigenesis. Over expression of pmTOR, peIF4E and p53 was significantly associated with lymph node disease. peIF4E and p53 also correlated with a poor outcome, including recurrence, metastasis or disease specific death. In contrast, pERK and p4E-BP1 were associated with lower pT stages. pmTOR and intense p53 expression was associated with HPV negative tumors. Activation of mTOR signaling may contribute to penile squamous cell carcinoma progression and aggressive behavior. Targeting mTOR or its downstream signaling targets, such as peIF4E, may be a valid therapeutic strategy. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Inflammatory mechanisms and oxidative stress in Peyronie's disease: therapeutic "rationale" and related emerging treatment strategies.

PubMed

Paulis, Gianni; Brancato, Tommaso

2012-02-01

Peyronie's disease (PD) is a connective tissue disorder characterized by a fibrous plaque involving the tunica albuginea of the penis. The inelastic fibrous plaque leads to a penile curvature. Several Authors have suggested an immunological genesis of this disease, others have linked PD with Dupuytren's contracture. Signs of this disease are curvature, penile pain, penile deformity, difficulty with coitus, shortening, hinging, narrowing and erectile dysfunction. The natural history of PD and the clinical course can develop from spontaneous resolution of symptoms to progressive penile deformity and impotence. Surgical treatment is indicated when patients fail the conservative medical treatment and however, only in case of disease stabilization with a condition of impossibility of penetration. The medical treatment is indicated in the development stage of PD for at least one year after diagnosis and whenever in case of penile pain. Current non-surgical therapy includes vitamin-E, verapamil, para-aminobenzoate, propoleum, colchicine, carnitine, tamoxifen, interferons, collagenase, hyaluronidase, cortisone, pentoxifylline, superoxide dismutase, iontophoresis, radiation, extracorporeal shock wave therapy (ESWT) and the penile extender. The etiology of this fibrotic disease is not widely known, although in recent years pathophysiological knowledge has evolved and new studies propose the penile trauma as cause of the disease. The penile trauma results in a delamination of the tunica albuginea with a consequent small hematoma, then the process evolves as an inflammation with accumulation of inflammatory cells and production of reactive oxygen species (ROS). In the course of the inflammation, Peyronie's disease occurs due to the activation of nuclear factor kappa-B, that induces the production of inducible nitric oxide synthase (iNOS), with an increase of nitric oxide, leading to increased production of peroxynitrite anion. All these processes result in the proliferation of fibroblasts and myo-fibroblasts and excessive production of collagen between the layers of the tunica albuginea (penile plaque). Referring to the current knowledge of inflammatory and oxidative mechanisms of PD, a possible therapeutic strategy is then analyzed. © 2012 Bentham Science Publishers

Low-Mass Inflation Systems for Inflatable Structures

NASA Technical Reports Server (NTRS)

Thunnissen, Daniel P.; Webster, Mark S.; Engelbrecht, Carl S.

1995-01-01

The use of inflatable space structures has often been proposed for aerospace and planetary applications. Communication, power generation, and very-long-baseline interferometry are just three potential applications of inflatable technology. The success of inflatable structures depends on the development of an applications of inflatable technology. This paper describes two design studies performed to develop a low mass inflation system. The first study takes advantage of existing onboard propulsion gases to reduce the overall system mass. The second study assumes that there is no onboard propulsion system. Both studies employ advanced components developed for the Pluto fast flyby spacecraft to further reduce mass. The study examined four different types of systems: hydrazine, nitrogen and water, nitrogen, and xenon. This study shows that all of these systems can be built for a small space structure with masses lower than 0.5 kilograms.

The impracticality of MRI for the diagnosis of atypical penile fracture in the emergency setting.

PubMed

Maurice, Matthew J; Spirnak, J Patrick

2014-05-01

We report the case of a patient who presented to the emergency department with a history suspicious for penile fracture without typical physical exam findings. A small penile fracture was present on MRI, but the diagnosis was missed, and surgery was withheld owing to this misinformation. Despite its technical accuracy, MRI may be impractical for the diagnosis of penile fracture in the emergency setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Current Treatment Options for Penile Fractures

PubMed Central

Jack, Gregory S; Garraway, Isla; Reznichek, Richard; Rajfer, Jacob

2004-01-01

The diagnosis of “penile fracture” describes the traumatic rupture of the tunica albuginea of an erect penis. Penile fractures typically occur when the engorged penile corpora are forced to buckle and literally “pop” under the pressure of a blunt sexual trauma. Patients typically describe immediate detumescence, severe pain, and swelling as a result of the injury. Prompt surgical exploration and corporal repair is the most efficacious therapy. Although a majority of cases can be diagnosed from the history and physical examination alone, radiographic studies, including retrograde urethrography and corporal cavernosography can aid in the diagnosis of unusual cases. PMID:16985591

Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review

PubMed Central

Hoag, Nathan A.; Hennessey, Kiara; So, Alan

2011-01-01

Penile fracture is a rare injury most commonly sustained during sexual intercourse. We report the case of a 35-year-old man who presented with bilateral rupture of the corpora cavernosa and complete disruption of the urethra. A review of the literature on penile fracture is also presented. Urgent surgical exploration was performed and the injuries repaired primarily. In follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early surgical repair and evaluation for concomitant urethral injuries in cases of penile fracture. PMID:21470546

Penile hair tourniquet resulting in hypospadias failure

PubMed Central

Jesus, Lisieux E.; Bragança, Jailma J.; Rocha, Julia M.; Dekermacher, Samuel; Anderson, Kleber M.

2014-01-01

Penile hair tourniquet (PHT) is a painless form of penile ischemia, typically seen in toddlers with long-haired mothers, caused by entanglement of hair on the balano-prepucial sulcus, normally associated with circumcision. Its association with hypospadias has been reported only once. A school-aged boy admitted for surgery to treat hypospadias failure was incidentally detected to have PHT and severe hourglass deformity of the penis. Urethral anastomosis and glanuloplasty were done after removal of the constricting ring, without complications. Normal erections were reported during follow up. Treatment may involve urethral reconstruction and penile reimplantation in extreme cases. PMID:25097325

The management of the acute ischemic priapism: A state of the art review.

PubMed

Falcone, M; Gillo, A; Capece, M; Raheem, A; Ralph, D; Garaffa, G

2017-12-01

To review the current literature on early penile prosthesis implantation in patients with refractory ischemic priapism (IP). A systematic search for the terms "penile prosthesis", "priapism", "impotence", "fibrosis", "downsized prosthesis cylinders", and "patient satisfaction" has been carried out in PubMed, EMBASE, Cochrane, SCOPUS and Science Citation Index databases. Cavernosal tissue damage in IP is time related. Conservative measures and aspiration with or without intracorporeal instillation of α-adrenergic agonists are usually successful in the early stages. Shunt surgery in patients remains debatable, as the lack of response to aspiration and instillation of α-adrenergic agonists indicates that irreversible changes in the cavernosal smooth muscle are likely to have already occurred. Immediate penile prosthesis implantation in patients with refractory IP settles the priapic episode, maintains the long term rigidity necessary to engage in penetrative sexual intercourse and prevents the otherwise inevitable penile shortening. Although complication rates after penile prosthesis implantation in acute priapism are higher than in virgin cases, they are still lower than after implantation in patients with severe corporal fibrosis due to chronic priapism. Regardless of the complication rates, penile prosthesis implantation in refractory IP should be preferred as it allows the preservation of penile length, which is one of the main factors influencing postoperative patient's satisfaction following surgery. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Invasive squamous cell carcinoma originating from a giant penile condyloma.

PubMed

Sir, Emin; Gungor, Melike; Ucer, Oktay; Kebat, Tulu

2017-05-01

In this case study, we present an unusual case with squamous cell carcinoma originating from a giant condyloma acuminata completely surrounding the penis. A 57-year-old circumcised heterosexual male patient presented with a penile lesion existing for 20 years. Incisional biopsy revealed acanthosis of the squamous epithelium. The patient was operated on under spinal anaesthesia. The lesion was resected circumferentially with macroscopic clearance, resulting in complete degloving of the penile shaft. Neurovascular bundles were preserved. The penile skin was constructed with a split thickness skin graft. Histopathological analysis of the lesion revealed an invasive and well-differentiated squamous cell carcinoma arising on a condyloma, and the surgical margins were free from tumour. The patient was staged as G2 T1 N0 M0 and was followed for one year. He did not have any erectile dysfunction and could engage in intercourse. Pelvic tomographic and physical examination findings did not reveal any episode of recurrence or metastasis. When encountering patients with giant condyloma acuminata, it should not be forgotten that it may be accompanied by squamous cell carcinoma. In addition, tissue excision should be as extensive as possible while keeping in mind the importance of the function. This is the first case of a penile-degloving surgery for giant penile condyloma, supporting conservative and preserving penile surgery for such tumours.

Genital HPV infection and related lesions in men

PubMed Central

Anic, Gabriella M.; Giuliano, Anna R.

2012-01-01

Human papillomavirus (HPV) is highly prevalent in men and there is an interest in further understanding the relationship between HPV infection and disease in men, including the development of genital warts, penile intraepithelial neoplasia and invasive penile carcinomas. Genital warts are caused by HPV 6/11 and are the most common clinical manifestation of HPV in men. Though they are benign and not associated with mortality, they are a source of psychosocial distress and physical discomfort. HPV infection can also develop into invasive penile carcinoma which is associated with morbidity and mortality. Approximately 40% of invasive penile carcinomas are attributable to HPV with HPV 16, 18, and 6/11 being the genotypes most commonly detected in penile tumors. Penile carcinomas of the basaloid and warty histologic subtypes are most likely to test positive for HPV. In addition to HPV infection, the risk factors most strongly associated with penile cancer are lack of neonatal circumcision, phimosis (the inability of uncircumcised men to fully retract the foreskin), and anogenital warts. Male vaccination with the quadrivalent HPV vaccine that protects against HPV 6/11/16/18 has been shown to significantly reduce HPV-associated anogenital infection and disease in men. If the quadrivalent vaccine is successfully disseminated to large segments of the young male population, there is the potential for substantial reduction in genital HPV infection and related lesions in men. PMID:21962470

Auditing for Score Inflation Using Self-Monitoring Assessments: Findings from Three Pilot Studies

ERIC Educational Resources Information Center

Koretz, Daniel; Jennings, Jennifer L.; Ng, Hui Leng; Yu, Carol; Braslow, David; Langi, Meredith

2016-01-01

Test-based accountability often produces score inflation. Most studies have evaluated inflation by comparing trends on a high-stakes test and a lower stakes audit test. However, Koretz and Beguin (2010) noted weaknesses of audit tests and suggested self-monitoring assessments (SMAs), which incorporate audit items into high-stakes tests. This…

Using eye tracking to identify faking attempts during penile plethysmography assessment.

PubMed

Trottier, Dominique; Rouleau, Joanne-Lucine; Renaud, Patrice; Goyette, Mathieu

2014-01-01

Penile plethysmography (PPG) is considered the most rigorous method for sexual interest assessment. Nevertheless, it is subject to faking attempts by participants, which compromises the internal validity of the instrument. To date, various attempts have been made to limit voluntary control of sexual response during PPG assessments, without satisfactory results. This exploratory research examined eye-tracking technologies' ability to identify the presence of cognitive strategies responsible for erectile inhibition during PPG assessment. Eye movements and penile responses for 20 subjects were recorded while exploring animated human-like computer-generated stimuli in a virtual environment under three distinct viewing conditions: (a) the free visual exploration of a preferred sexual stimulus without erectile inhibition; (b) the viewing of a preferred sexual stimulus with erectile inhibition; and (c) the free visual exploration of a non-preferred sexual stimulus. Results suggest that attempts to control erectile responses generate specific eye-movement variations, characterized by a general deceleration of the exploration process and limited exploration of the erogenous zone. Findings indicate that recording eye movements can provide significant information on the presence of competing covert processes responsible for erectile inhibition. The use of eye-tracking technologies during PPG could therefore lead to improved internal validity of the plethysmographic procedure.

Penile fracture: role of ultrasound

PubMed Central

Gupta, Nishant; Sharma, Komal; Bansal, Itisha; Gupta, Sonali; Li, Shuo; Zinn, Kenneth; Kumar, Yogesh

2017-01-01

Penile fracture is a rare surgical emergency which requires prompt diagnosis and immediate surgical repair. In most cases the diagnosis is clinical however, in equivocal cases ultrasound examination can help in establishing the diagnosis by demonstrating the site and extent of tunica albuginea disruption. In this article, we are presenting sonographic findings in two cases of penile fractures. PMID:28725601

Use of point-of-care ultrasound to evaluate for penile fracture in a child.

PubMed

Lam, Samuel H F

2015-02-01

Penile fracture is a urologic emergency requiring prompt surgical intervention. Ultrasound may help clarify the diagnosis in cases of uncertain history and physical examination. The author presents a case of suspected pediatric penile fracture, in which point-of-care ultrasound helped to rule out the condition and facilitated disposition of the patient.

Hidden penile fracture: An unusual presentation and review of literature

PubMed Central

Sabharwal, Sagar; George, Arun Jacob Philip; Singh, J. Chandra

2015-01-01

Penile fractures, a not so uncommon urological emergency, mostly present with a characteristic history and physical examination. Here, we present an atypical case where even in the absence of physical findings, a characteristic history led us to penile exploration and timely repair, highlighting the importance of careful history-taking in these cases. PMID:25836974

Longitudinal cleavage of the penis in chronic spinal cord injury: two case reports

PubMed Central

Mansoor, Sahibzada Nasir; Ayaz, Saeed Bin; New, Peter

2016-01-01

Context Penile cleavage is a rare complication of spinal cord injury (SCI) in patients with a chronic indwelling catheter. We report two cases of chronic SCI who developed penile urethral cleavage after prolonged use of an indwelling catheter for bladder management. Findings A 25-year-old wheelchair mobile male with T7 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade A paraplegia developed a 4 × 1.5 cm ventral urethral cleavage after using an indwelling catheter for four months with inadequate care. He had an associated urinary tract infection and undiagnosed diabetes mellitus. A suprapubic catheter was inserted and surgical repair recommended after resolution of UTI and adequate control of his diabetes mellitus. After initial treatment he was lost to follow-up. The second patient was a 15-year-old male with AIS grade B tetraplegia who presented with a 2.5 cm cleavage on the ventral aspect of penis for the preceding three months. He had been using an indwelling catheter for bladder management for the previous 18 months. He had modified Ashworth scale grade III spasticity in lower limbs resistant to conservative management. There was no history of trauma, infection or diabetes mellitus. The patient was advised penile urethral repair surgery but was lost to follow-up. Conclusion Penile cleavage is a rare complication of neurogenic bladder in SCI patients. Patients and care givers should be trained in proper bladder management techniques during the hospital stay, counseled regarding the need for regular follow up, and be taught identification and prevention of common complications. PMID:26108452

Longitudinal cleavage of the penis in chronic spinal cord injury: two case reports.

PubMed

Mansoor, Sahibzada Nasir; Ayaz, Saeed Bin; Rathore, Farooq Azam; New, Peter

2016-05-01

Penile cleavage is a rare complication of spinal cord injury (SCI) in patients with a chronic indwelling catheter. We report two cases of chronic SCI who developed penile urethral cleavage after prolonged use of an indwelling catheter for bladder management. A 25-year-old wheelchair mobile male with T7 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade A paraplegia developed a 4 × 1.5 cm ventral urethral cleavage after using an indwelling catheter for four months with inadequate care. He had an associated urinary tract infection and undiagnosed diabetes mellitus. A suprapubic catheter was inserted and surgical repair recommended after resolution of UTI and adequate control of his diabetes mellitus. After initial treatment he was lost to follow-up. The second patient was a 15-year-old male with AIS grade B tetraplegia who presented with a 2.5 cm cleavage on the ventral aspect of penis for the preceding three months. He had been using an indwelling catheter for bladder management for the previous 18 months. He had modified Ashworth scale grade III spasticity in lower limbs resistant to conservative management. There was no history of trauma, infection or diabetes mellitus. The patient was advised penile urethral repair surgery but was lost to follow-up. Penile cleavage is a rare complication of neurogenic bladder in SCI patients. Patients and care givers should be trained in proper bladder management techniques during the hospital stay, counseled regarding the need for regular follow up, and be taught identification and prevention of common complications.

The value of magnetic resonance imaging in the diagnosis of penile fracture.

PubMed

Guler, Ibrahim; Ödev, Kemal; Kalkan, Havva; Simsek, Cihan; Keskin, Suat; Kilinç, Mehmet

2015-01-01

We studied the use of magnetic resonance imaging in the diagnosis of penile fracture. Between 1997 and 2012, fifteen patients (age range 17-48 years, mean age 37 years) with suspected penile fracture underwent MRI examinations. Ten patients were injured during sexual intercourse, whereas four patients were traumatized by non-physiological bending of the penis during self manupilation, one patient was traumatized falling from the bed. Investigations were performed with 1.5 T MR unit. With the patient in the supine position, the penis was taped against the abdominal wall and surface coil was placed on the penis. All patients were studied with axial, coronal, sagittal precontrast and postcontrast T1-weighted TSE(TR/TE:538/13 msn) and T2-weighted TSE(5290/110 msn) sequences. All patient underwent surgical exploration. The follow-up ranged from 3 months to 72 months. Clinically all patients showed normal healing process without complications. In 11 patients a shortening and thickening of tunica albuginea was observed. Three patients have post traumatic erectile disfunction. In all patient corpus cavernosum fractures were clearly depicted on a discontinuity of the low signal intensity of tunica albuginea. These findings were most evident on T1WI and also depicted on T2W sequences. Images obtained shortly after contrast medium administration showed considerable enhancement only in rupture site. Subcutaneous extratunical haematoma in all patients were also recognizable on T2 WI. MRI findings were confirmed at surgery. Magnetic resonance imaging is of great value for the diagnosis of penile fracture. Furthermore this method is well suited for visualising the post-operative healing process.

Partial penectomy and penile reconstruction. Initial surgical management of localized penile cancer.

PubMed

Pérez-Niño, J; Fernández, N; Sarmiento, G

2014-01-01

Surgical management for penile carcinoma is mutilating and affects significantly quality of life. Hereby we present our experience on penile reconstruction (PR) immediately after oncologic resection. We included all patients from January 2007 until April 2012 who underwent PR after partial penectomy (PP). Patients included in the study were seen at four different hospitals. All procedures were done by the same surgeon. Information included were: oncological status at the moment of surgery, surgical technique used for reconstruction. Each case was also registered photographically. On follow-up visits data about outcome and patient's satisfaction were registered. During the study period 15 patients underwent PR. Average age at the moment of surgery was 49 years. Average follow-up was 15 months. In 12 patients PR was made at the same time as PP. Of those, four cases underwent glans resurfacing, 2 glandectomy, 6 partial penectomy, and the remaining 3 have had PP in a different time in the past. Every case underwent a split thickness graft procedure. Only 2 patients had postoperative complications. One of them presented urethral stricture and the other graft ischemia. Three patients had positive nodes at the moment of PP and two during the follow-up. None of the cases have presented local recurrence and only one died. On follow-up the remaining patients refer a good quality of life and felt happy with aesthetic results. Given the results presented hereby we propose that PR must be part of the same procedure as the PP. Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.

Fracture penis: an analysis of 26 cases.

PubMed

Pandyan, G V Soundra; Zaharani, Ahmed Bakeet; Al Rashid, Mohammed

2006-01-29

The aim of this study was to review the pattern of penile fracture occurrence, its clinical presentation, diagnosis, management, and outcome at our center. A retrospective analysis of 26 patients with penile fractures treated at our hospital from January 1997 to January 2005 was carried out. We noted an incidence of 3.5 cases per year, occurring more commonly in unmarried men. Of our study group, 28 episodes of penile fractures occurred in 26 patients. Hospital presentation after trauma varied from 2 h to 21 days. Masturbation was the main initiating causative factor and penile hematoma was the most common clinical finding. Nearly 81% noticed the characteristic click prior to the fracture. Clinical diagnosis was adequate in a majority of the cases. Midshaft fractures with right-sided laterality were more frequent in this series. The tear size ranged from 0.5-2.5 cm with a mean of 1.1 cm. All cases, but one, were treated by surgical repair using absorbable sutures. Out of three cases treated conservatively, two failed to respond and had to be treated surgically. False fracture with dorsal vein tear was present in two cases. Involvement of bilateral corpora was seen in one patient. Infection was the most common early complication, while pain with deviation was the late complication. In our experience, clinical findings are adequate enough to diagnose fracture penis in a majority of cases. Surgical exploration with repair of the tear is recommended both in early and delayed presentations. There was no noticeable relationship to the time of initial presentation or with the size and site of tear to the final outcome.

Gravitational waves and large field inflation

NASA Astrophysics Data System (ADS)

Linde, Andrei

2017-02-01

According to the famous Lyth bound, one can confirm large field inflation by finding tensor modes with sufficiently large tensor-to-scalar ratio r. Here we will try to answer two related questions: is it possible to rule out all large field inflationary models by not finding tensor modes with r above some critical value, and what can we say about the scale of inflation by measuring r? However, in order to answer these questions one should distinguish between two different definitions of the large field inflation and three different definitions of the scale of inflation. We will examine these issues using the theory of cosmological α-attractors as a convenient testing ground.

Clear Cell Carcinoma of the Penis: An HPV-related Variant of Squamous Cell Carcinoma: A Report of 3 Cases.

PubMed

Sanchez, Diego F; Rodriguez, Ingrid M; Piris, Adriano; Cañete, Sofía; Lezcano, Cecilia; Velazquez, Elsa F; Fernandez-Nestosa, Maria J; Mendez-Pena, Javier E; Hoang, Mai P; Cubilla, Antonio L

2016-07-01

Penile clear cell carcinoma originating in skin adnexal glands has been previously reported. Here, we present 3 morphologically distinctive penile tumors with prominent clear cell features originating not in the penile skin but in the mucosal tissues of the glans surface squamous epithelium. Clinical and pathologic features were evaluated. Immunohistochemical stains were GATA3 and p16. Human papilloma virus (HPV) detection by in situ hybridization was performed in 3 cases, and whole-tissue section-polymerase chain reaction was performed in 1 case. Patients' ages were 52, 88, and 95 years. Tumors were large and involved the glans and coronal sulcus in all cases. Microscopically, nonkeratinizing clear cells predominated. Growth was in solid nests with comedo-like or geographic necrosis. Focal areas of invasive warty or basaloid carcinomas showing in addition warty or basaloid penile intraepithelial neoplasia were present in 2 cases. There was invasion of corpora cavernosa, lymphatic vessels, veins, and perineural spaces in all cases. p16 was positive, and GATA3 stain was negative in the 3 cases. HPV was detected in 3 cases by in situ hybridization and in 1 case by polymerase chain reaction. Differential diagnoses included other HPV-related penile carcinomas, skin adnexal tumors, and metastatic renal cell carcinoma. Features that support primary penile carcinoma were tumor location, concomitant warty and/or basaloid penile intraepithelial neoplasia, and HPV positivity. Clinical groin metastases were present in all cases, pathologically confirmed in 1. Two patients died from tumor dissemination at 9 and 12 months after penectomy. Clear cell carcinoma, another morphologic variant related to HPV, originates in the penile mucosal surface and is probably related to warty carcinomas.

Penile warty mucoepidermoid carcinoma with features of stratified mucin-producing intra-epithelial lesion and invasive stratified mucin-producing carcinoma.

PubMed

Yorita, Kenji; Kuroda, Naoto; Naroda, Takushi; Tamura, Masato; Ohe, Chisato; Divatia, Mukul; Amin, Mahul B; Cubilla, Antonio L; Kazakov, Dimitry V; Hes, Ondrej; Michal, Michael; Michal, Michal

2018-04-01

Stratified mucin-producing intra-epithelial lesion (SMILE) and invasive stratified mucin-producing carcinoma (ISMC) are recently described cervical and penile lesions. We report an unusual case of mixed variant of penile squamous cell carcinomas with warty, usual and mucoepidermoid SMILE/ISMC features. A 62-year-old Japanese man had a glans penis lesion of one-and-a-half years' duration, suggesting malignancy. Partial penectomy and left inguinal lymphadenectomy were performed. Pathological evaluation revealed a mixed squamous cell carcinoma with warty, mucinous and usual features. The mucinous component resembled mucoepidermoid carcinoma (MEC) and SMILE/ISMC. Glandular differentiation was absent. All the diverse tumour components were negative for p16, which was confirmed by negative human papillomavirus (HPV) genotyping. The mucinous component was diffusely positive for cytokeratin 7 and largely negative for cytokeratin 5 and p63. Fluorescence in-situ hybridisation did not detect rearrangement in the MAML2 or EWSR1 genes. The tumour was pathological stage pT2, pN1 (AJCC prognostic stage group IIIA) and was disease-free 26 months after surgery. The lack of glands in the mucinous areas suggested that MEC should be separated from adenosquamous carcinoma (ASC). Penile SMILE/ISMC may occur without dependence upon HPV status. Further studies will be necessary to determine the pathogenesis and definition of penile SMILE/ISMC, the presence of true MEC arising from the glans penis and the clinicopathological differences of penile ASC, MEC and SMILE/ISMC. Herein, we refer to the SMILE-like penile lesion as 'mucinous penile intra-epithelial neoplasia'. © 2017 John Wiley & Sons Ltd.

Oral treatment with herbal formula B401 alleviates penile toxicity in aging mice with manganism.

PubMed

Hsu, Chih-Hsiang; Lin, Ching-Lung; Wang, Sheue-Er; Sheu, Shuenn-Jyi; Chien, Chiang-Ting; Wu, Chung-Hsin

2015-01-01

The present study aims to elucidate the roles of nitric oxide synthase activity, oxidative stress, inflammation, and apoptosis in penile toxicity of aging mice associated with excess manganese (Mn) treatment and to investigate the effect of oral treatment with the herbal formula B401 in this respect. ICR strain mice were divided into two groups: the vehicle (sham group) and the B401 (50 mg/kg) group. The mice were orally treated for 5 days; then a high single dose of MnCl2 (100 mg/kg) was given by intraperitoneal injection to the mice. One day after MnCl2 treatment, corpora cavernosal tissues of both Mn-treated mice and their controls were simultaneously sampled to examine their immunohistochemical staining and Western blot analysis. Nitric oxide (NO) production, levels of neuronal nitric oxide synthase (nNOS) and endothelial nitric oxide synthase (eNOS), expression levels of factors governing angiogenesis (vascular endothelial growth factor), oxidative stress (catalase, superoxide dismutase 2,4-hydroxynonenal), inflammation (tumor necrosis factor alpha), apoptosis (B-cell lymphoma 2 [Bcl-2], Bcl-2-associated X protein [Bax], cleaved poly(adenosine diphosphate-ribose) polymerase [c-PARP], cytochrome C, caspase-12, and caspase-3) were evaluated in penile corpus cavernosum of the mice. We found that penile toxicity in the mice was enhanced under excess Mn treatment through reduction of NOS activity and increase in oxidative stress, inflammation, and apoptosis in the penile cavernous tissue. Furthermore, the penile toxicity in mice with manganism was alleviated by oral B401 treatment through enhancement of both nitric oxide synthesis and angiogenesis, with simultaneous reduction of oxidative stress, inflammation, and apoptosis in penile corpus cavernosum. We suggest that the herbal formula B401 may serve as a potential dietotherapeutic supplement for penile toxicity or dysfunction in aging males.

Efficacy of magnetic resonance imaging for diagnosis of penile fracture: A controlled study

PubMed Central

Tarhan, Fatih; Hamarat, Mustafa B.; Can, Utku; Coskun, Alper; Camur, Emre; Sarica, Kemal

2017-01-01

Purpose To evaluate the diagnostic value of magnetic resonance imaging (MRI) in patients with suspected penile fracture. Materials and Methods A total of 122 patients admitted to our inpatient clinic with a suspicion of penile fracture following a recent history of penile trauma and who underwent surgical exploration were included this study. A thorough physical examination, a detailed medical history, description of the trauma, and preoperative International Index of Erectile Function (IIEF) scores were obtained for each patient prior to surgery. Thirty-eight of these patients were evaluated with MRI before the surgical exploration. Intraoperative findings were also recorded. Physical findings and IIEF scores were also recorded at postoperative 6 months. Results The mean age of our patient group was 36.5±12.3 years. Penile fracture was detected in 105 of 122 patients in whom surgical exploration was performed owing to a suspected diagnosis. The mean time interval from penile trauma to hospital admittance was 9.9±15.1 hours. No cavernosal defect was detected in 9 of 84 patients (10.7%) who were not evaluated with MRI prior to surgery. Compared with surgical exploration, MRI findings showed 100% (30 of 30) sensitivity and 87.5% (7 of 8) specificity in the diagnosis of penile fracture. MRI had a high negative predictive value of 100% (7 of 7) and a positive predictive value of 96.7% (30 of 31) with just 1 misdiagnosed patient. Conclusions MRI is a reliable diagnostic tool in the diagnosis of penile fractures. Compared to history and physical findings taken all together, the high sensitivity and specificity of this imaging technique can decrease the number of unnecessary surgical explorations. PMID:28681035

Efficacy of magnetic resonance imaging for diagnosis of penile fracture: A controlled study.

PubMed

Saglam, Erkin; Tarhan, Fatih; Hamarat, Mustafa B; Can, Utku; Coskun, Alper; Camur, Emre; Sarica, Kemal

2017-07-01

To evaluate the diagnostic value of magnetic resonance imaging (MRI) in patients with suspected penile fracture. A total of 122 patients admitted to our inpatient clinic with a suspicion of penile fracture following a recent history of penile trauma and who underwent surgical exploration were included this study. A thorough physical examination, a detailed medical history, description of the trauma, and preoperative International Index of Erectile Function (IIEF) scores were obtained for each patient prior to surgery. Thirty-eight of these patients were evaluated with MRI before the surgical exploration. Intraoperative findings were also recorded. Physical findings and IIEF scores were also recorded at postoperative 6 months. The mean age of our patient group was 36.5±12.3 years. Penile fracture was detected in 105 of 122 patients in whom surgical exploration was performed owing to a suspected diagnosis. The mean time interval from penile trauma to hospital admittance was 9.9±15.1 hours. No cavernosal defect was detected in 9 of 84 patients (10.7%) who were not evaluated with MRI prior to surgery. Compared with surgical exploration, MRI findings showed 100% (30 of 30) sensitivity and 87.5% (7 of 8) specificity in the diagnosis of penile fracture. MRI had a high negative predictive value of 100% (7 of 7) and a positive predictive value of 96.7% (30 of 31) with just 1 misdiagnosed patient. MRI is a reliable diagnostic tool in the diagnosis of penile fractures. Compared to history and physical findings taken all together, the high sensitivity and specificity of this imaging technique can decrease the number of unnecessary surgical explorations.

How to deal with penile carcinoma inguinal metastases invading femoral vessels

PubMed Central

FODOR, MARIUS; PETRUT, BOGDAN; FODOR, LUCIAN

2017-01-01

Penile cancer accounts for 1–10% of men neoplastic diseases and 30–60% of patients have inguinal metastases at the time of diagnosis. Inguinal metastases of penile cancer with femoral vessel involvement could lead to vascular fistula and hemorrhagic shock. We present 3 consecutive patients with inguinal metastases of penile cancer complicated by infection and hemorrhage from femoral vessels invaded by the tumor. Simultaneous extra-anatomical axillo-femoral bypass graft, wide excision of tumor and groin defect reconstruction was used to achieve “tumor-free” oncologic aim and to save the lower limb. We consider the extra-anatomic axillo-femoral bypass associated with wide inguinal tumor excision and defect covering a feasible surgical solution for improving the life quality and extend life expectancy in patients with lymph node metastasis of penile cancer complicated by necrosis, infection and femoral vessel involvement. PMID:29151798

Penile paraffinoma and ulcers of penis.

PubMed

Bobik, O; Bobik, O

2011-01-01

The authors describe a case of 33 year old Caucasian married man with an irregular 6 cm penile mass associated with multiple penile ulcers. He reluctantly admitted that 10 years ago he had multiple mineral oil (Vaseline) self injections into the penis, for penile enlargement purposes. The patient had a surgical intervention 10 years ago, but he has recurrent ulcers on his penis. We have administered an intravenous antibiotic therapy combined with local therapy. The term paraffinoma describes a distinct histopathological finding that results from the injection of foreign oily substances into the skin. Although such procedure may be considered rare, they are still performed in some countries. The major point we want emphasis is following: a lot of people seek penile augmentations, it is necessary to remind physicians and the public that nonscientific and inadequate procedure such as Vaseline may lead to debilitating and destructive consequences (Tab. 1, Ref. 12).

SURGICAL TREATMENT AND COMPLICATIONS OF PENILE FRACTURES

PubMed Central

Kulovac, Benjamin; Aganović, Damir; Junuzović, Dželaludin; Prcić, Alden; Hadžiosmanović, Osman; BazardžAnović, Mustafa; Hodžić, Harun

2007-01-01

Paper goal is to determine complications after urgent surgical treatment of patient with penile fractures, by using circumferential-degloving technique (degloving penile skin to root of penis). In period between 1998-2006 year, 23 patients have been treated as urgent cases with clinically proven penis fracture, age between 18 and 35. Patients were treated in 3 medical centers in Bosnia and Herzegovina(Sarajevo, Tuzla and Zenica). All 23 (100%) patients were injured during sexual intercourse. In the case of 20 (86,9%) patients partial rupture of corpus cavernosum was verified. Two (8,6%) patients had a complete rupture of urethra and it was primary sutured. In 22 cases (95,6%) spontaneous erection appeared, and in the case of 2 (8,6%) patients penile curvature was verified. Urgent surgical treatment is the best therapy choice, which enables preservation of erection in great number of cases in patients with penile fracture. PMID:17489766

Microbubble-enhanced ultrasound to demonstrate urethral transection in a case of penile fracture.

PubMed

Czarnecki, Oliver; von Stempel, Conrad Brice; Sangster, Pippa; Walkden, Miles

2017-09-23

A 47-year-old man attended the emergency department following trauma during sexual intercourse after which he developed penile swelling and haematuria several hours later. A penile fracture was suspected but given the slightly atypical history, ultrasound was performed to look for a fracture. Given the history of haematuria, both a standard Doppler ultrasound and a microbubble-enhanced retrograde ultrasound urethrogram were performed. The Doppler confirmed the suspected diagnosis of penile fracture, and microbubble urethrogram demonstrated a urethral injury. This facilitated prompt surgical treatment and helped guide the surgical approach. Retrograde microbubble enhanced ultrasound urethrogram is a novel technique that can be used in conjunction with standard ultrasound to confirm the presence of a concurrent urethral rupture in penile fracture. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Compulsive masturbation and chronic penile lymphedema.

PubMed

Calabrò, Rocco Salvatore; Galì, Alessandro; Marino, Silvia; Bramanti, Placido

2012-06-01

Chronic penile lymphedema arises from the abnormal retention of lymphatic fluid in the subcutaneous tissues and may be secondary to local and systemic medical conditions such as sexually transmitted diseases, filariasis, malignancy, local radiotherapy, and surgery. This case report aims to consider compulsive masturbation as a possible cause of chronic penile edema. A 40-year-old man was referred to our institute for behavioral disturbance, including compulsive masturbation. Neuropsychiatric evaluation showed moderate mental retardation, mild dysarthria and limb incoordination, anxiety, depressed mood, and impulse dyscontrol. Brain MRI pointed out diffuse white matter lesions. Urogenital examination revealed an uncircumcised penis with non-tender edema of the shaft and prepuce with areas of lichenification. Since the most common local and systemic causes of edema were excluded, chronic penile edema due to compulsive masturbation was diagnosed and the compulsive behavior treated with an antidepressant and low-dose neuroleptics. Compulsive masturbation should be taken into account when counselling patients with penile edema.

Nonthermal gravitino production in tribrid inflation

NASA Astrophysics Data System (ADS)

Antusch, Stefan; Dutta, Koushik

2015-10-01

We investigate nonthermal gravitino production after tribrid inflation in supergravity, which is a variant of supersymmetric hybrid inflation where three fields are involved in the inflationary model and where the inflaton field resides in the matter sector of the theory. In contrast to conventional supersymmetric hybrid inflation, where nonthermal gravitino production imposes severe constraints on the inflationary model, we find that the "nonthermal gravitino problem" is generically absent in models of tribrid inflation, mainly due to two effects: (i) With the inflaton in tribrid inflation (after inflation) being lighter than the waterfall field, the latter has a second decay channel with a much larger rate than for the decay into gravitinos. This reduces the branching ratio for the decay of the waterfall field into gravitinos. (ii) The inflaton generically decays later than the waterfall field, and it does not produce gravitinos when it decays. This leads to a dilution of the gravitino population from the decays of the waterfall field. The combination of both effects generically leads to a strongly reduced gravitino production in tribrid inflation.

78 FR 55629 - Special Conditions: Cirrus Design Corporation, Model SF50; Inflatable Three-Point Restraint...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-11

...-0781; Special Conditions No. 23-261-SC] Special Conditions: Cirrus Design Corporation, Model SF50... conditions are issued for the Cirrus Design Corporation (Cirrus), model SF50. This airplane will have novel and unusual design features associated with installation of an inflatable three-point restraint safety...

Modeling zero-modified count and semicontinuous data in health services research Part 1: background and overview.

PubMed

Neelon, Brian; O'Malley, A James; Smith, Valerie A

2016-11-30

Health services data often contain a high proportion of zeros. In studies examining patient hospitalization rates, for instance, many patients will have no hospitalizations, resulting in a count of zero. When the number of zeros is greater or less than expected under a standard count model, the data are said to be zero modified relative to the standard model. A similar phenomenon arises with semicontinuous data, which are characterized by a spike at zero followed by a continuous distribution with positive support. When analyzing zero-modified count and semicontinuous data, flexible mixture distributions are often needed to accommodate both the excess zeros and the typically skewed distribution of nonzero values. Various models have been introduced over the past three decades to accommodate such data, including hurdle models, zero-inflated models, and two-part semicontinuous models. This tutorial describes recent modeling strategies for zero-modified count and semicontinuous data and highlights their role in health services research studies. Part 1 of the tutorial, presented here, provides a general overview of the topic. Part 2, appearing as a companion piece in this issue of Statistics in Medicine, discusses three case studies illustrating applications of the methods to health services research. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Penile Fracture Following a Fall in a 7-Year-Old Male.

PubMed

Meenakshi-Sundaram, Bhalaajee; Coco, Caitlin T; Furr, James R; Shaw, Marshall D; Frimberger, Dominic C

2017-08-01

We report a rare case of isolated penile fracture in a prepubescent male caused by an accidental fall. The patient presented with swelling and ecchymosis on the base of the penis and along the penile shaft. A flexible cystoscopy was performed, which did not reveal any concomitant urethral injury. The penis was degloved and the corporal tear was closed with absorbable suture. Due to the location of the injury, ventral mobilization of the urethra was required. The pathophysiology of penile fracture as well as the diagnosis and management of this rare injury are discussed in this report. Copyright © 2017 Elsevier Inc. All rights reserved.

The relation between sexual orientation and penile size.

PubMed

Bogaert, A F; Hershberger, S

1999-06-01

The relation between sexual orientation and penile dimensions in a large sample of men was studied. Subjects were 5122 men interviewed by the Kinsey Institute for Research in Sex, Gender, and Reproduction from 1938 to 1963. They were dichotomously classified as either homosexual (n = 935) or heterosexual (n = 4187). Penile dimensions were assessed using five measures of penile length and circumference from Kinsey's original protocol. On all five measures, homosexual men reported larger penises than did heterosexual men. Explanations for these differences are discussed, including the possibility that these findings provide additional evidence that variations in prenatal hormonal levels (or other biological mechanisms affecting reproductive structures) affect sexual orientation development.

The diagnosis and treatment of penile fracture: our 19-year experience.

PubMed

Gedik, Abdullah; Kayan, Devrim; Yamiş, Sait; Yılmaz, Yakup; Bircan, Kamuran

2011-01-01

The aim of this study was to retrospectively evaluate our approach to the diagnosis and treatment of penile fracture. We retrospectively evaluated the results of 107 patients with penile fracture treated in our clinic between January 1990 and January 2009. Patient age, etiology of each fracture, history, physical examination results, radiologic findings, type of treatment, and postoperative complications were recorded. In 5 cases cavernosography was performed and in 8 cases retrograde urethrography. The most common etiologies of penile fracture were coitus and manually bending the penis for detumescence. Diagnoses were made based on history and physical examination in 102 patients and cavernosography in 5 patients. In order to evaluate urethral injury in 8 cases, retrograde urethrography was performed. Rupture was repaired surgically in 101 patients, but 6 patients were treated conservatively. Among the 6 conservatively treated patients, 3 developed penile curvature 6 months post-treatment; no complications occurred in the surgically treated patients. Cavernosography should be performed only when history and physical examination are insufficient for diagnosis, and retrograde urethrography should be performed when urethral injury is suspected. In order to prevent the development of penile curvature and to ensure rapid recovery, early surgical repair is advised.

Alteration in the etiology of penile fracture in the Middle East and Central Asia regions in the last decade; a literature review.

PubMed

Majzoub, Ahmad A; Canguven, Onder; Raidh, Talib A

2015-01-01

Penile fracture is a well-recognized, relatively uncommon medical condition and its etiology differs according to geographic area. In this review article, we evaluated literature reported in the past decade, aiming to verify whether there has been any change in the etiology of this condition. A literature review was done for studies published in the past 10 years and focusing on the etiology of penile fracture. Inclusion criteria comprised articles in English language, of sample size more than 10 patients and originating from the Middle East and Central Asia. Data relating to the studied population, etiology of penile fracture, clinical presentation, investigations, management, and outcome was analyzed. One thousand six hundred and twenty-nine patients from 21 original articles were included in the study. The mean age ± standard deviation of the patients was 33.3 ± 3.23 years. Etiologies of penile fracture were vigorous sexual intercourse, manual bending of erect penis, vigorous masturbation, rolling over in bed and blunt trauma in 41%, 29%, 10%, 14% and 6% patients, respectively. Treatment choices were surgery and conservative, in 1580 (95%), 83 (5%) patients, respectively. A higher incidence of complications was found in conservatively treated patients. As a conclusion, in the last 10 years, vigorous sexual intercourse was the commonest etiology of penile fracture in the Middle East and Central Asia regions. Surgery remains the preferred treatment option for patients diagnosed with penile fracture.

Alteration in the etiology of penile fracture in the Middle East and Central Asia regions in the last decade; a literature review

PubMed Central

Majzoub, Ahmad A.; Canguven, Onder; Raidh, Talib A.

2015-01-01

Penile fracture is a well-recognized, relatively uncommon medical condition and its etiology differs according to geographic area. In this review article, we evaluated literature reported in the past decade, aiming to verify whether there has been any change in the etiology of this condition. A literature review was done for studies published in the past 10 years and focusing on the etiology of penile fracture. Inclusion criteria comprised articles in English language, of sample size more than 10 patients and originating from the Middle East and Central Asia. Data relating to the studied population, etiology of penile fracture, clinical presentation, investigations, management, and outcome was analyzed. One thousand six hundred and twenty-nine patients from 21 original articles were included in the study. The mean age ± standard deviation of the patients was 33.3 ± 3.23 years. Etiologies of penile fracture were vigorous sexual intercourse, manual bending of erect penis, vigorous masturbation, rolling over in bed and blunt trauma in 41%, 29%, 10%, 14% and 6% patients, respectively. Treatment choices were surgery and conservative, in 1580 (95%), 83 (5%) patients, respectively. A higher incidence of complications was found in conservatively treated patients. As a conclusion, in the last 10 years, vigorous sexual intercourse was the commonest etiology of penile fracture in the Middle East and Central Asia regions. Surgery remains the preferred treatment option for patients diagnosed with penile fracture. PMID:26229311

Inflation from extra dimensions

NASA Astrophysics Data System (ADS)

Levin, Janna J.

1995-02-01

A gravity-driven inflation is shown to arise from a simple higher-dimensional universe. In vacuum, the shear of n > 1 contracting dimensions is able to inflate the remaining three spatial dimensions. Said another way, the expansion of the 3-volume is accelerated by the contraction of the n-volume. Upon dimensional reduction, the theory is equivalent to a four-dimensional cosmology with a dynamical Planck mass. A connection can therefore be made to recent examples of inflation powered by a dilaton kinetic energy. Unfortunately, the graceful exit problem encountered in dilaton cosmologies will haunt this cosmology as well.

Stability issues of nonlocal gravity during primordial inflation

NASA Astrophysics Data System (ADS)

Belgacem, Enis; Cusin, Giulia; Foffa, Stefano; Maggiore, Michele; Mancarella, Michele

2018-01-01

We study the cosmological evolution of some nonlocal gravity models, when the initial conditions are set during a phase of primordial inflation. We examine in particular three models, the so-called RT, RR and Δ4 models, previously introduced by our group. We find that, during inflation, the RT model has a viable background evolution, but at the level of cosmological perturbations develops instabilities that make it nonviable. In contrast, the RR and Δ4 models have a viable evolution even when their initial conditions are set during a phase of primordial inflation.

A Focus on Cryogenic Engineering for the Primordial Inflation Polarization Explorer (PIPER) Mission

NASA Technical Reports Server (NTRS)

Rosas, Rogelio; Weston, Amy

2011-01-01

Cryogenic engineering involves design and modification of equipment that is used under boiling point of nitrogen which is 77 K. The focus of this paper will be on the design of hardware for cryogenic use and a retrofit that was done to the main laboratory cryostat used to test flight components for the Primordial Inflation Polarization Explorer balloon-borne mission. Data from prior tests showed that there was a superfluid helium leak and a total disassemble of the cryostat was conducted in order to localize and fix the leak. To improve efficiency new fill tubes and clamps with modifications were added to the helium tank. Upon removal of the tank, corrosion was found on the flange face that connects to the helium cold plate and therefore had to be fully replaced and copper plated to prevent future corrosion. Indium seals were also replaced for the four fill tubes, a helium level sensor, and the nitrogen and helium tanks. Four additional shielded twisted pairs of cryogenic wire and a wire harness for the Superconducting Quantum Interference Devices (SQUIDs) were added. Finally, there was also design work done for multiple pieces that went inside the cryostat and a separate probe used to test the SQUIDs. Upon successful completion of the cryostat upgrade, tests were run to check the effectiveness and stability of the upgrades. The post-retrofit tests showed minor leaks were still present and due to this, superfluidity has still not been attained. As such there could still be a possibility of a superfluid leak appearing in the future. Regardless, the copper plating on the helium tank has elongated the need to service it by three to five years.

Congenital penile curvature: update and management.

PubMed

Makovey, Iryna; Higuchi, Ty T; Montague, Drogo K; Angermeier, Kenneth W; Wood, Hadley M

2012-08-01

Congenital penile curvature results from disproportionate development of the tunica albuginea of the corporal bodies and is not associated with urethral malformation. Patients usually present after reaching puberty as the curvature becomes more apparent with erections, and severe curvature can make intercourse difficult or impossible, at which point surgical repair is recommended. Excellent outcomes can be expected with surgical intervention. The three most commonly used repair techniques are the original Nesbit procedure, modified Nesbit procedure, and plication. Nesbit and modified Nesbit techniques require that an incision is made in the tunica albuginea while plication techniques utilize plicating sutures without an incision. While Nesbit and modified Nesbit techniques are more complex operations, these generally result in less recurrences and more satisfactory outcomes as opposed to the quicker and simpler plication technique.

The use of human chorionic gonadotropin (HCG) for penile reconstruction in bladder exstrophy and total epispadias patients.

PubMed

Makedonsky, I A

2006-12-01

The effect of intramuscular human chorionic gonadotropin (HCG) administration on penile enlargement before genital surgery, its influence on penile skin histology and testicular descent were investigated. We examined 45 male patients (median age, 8 months; range 3-28) with total epispadias and classic bladder exstrophy, combined with cryptorchidism. 30 patients were administered 250-500 IU HCG intramuscularly 2 times per week for 3 weeks before reconstructive surgery. Skin biopsies were obtained for human epidermal growth factor (EGF) and human epidermal growth factor receptor (Her2/neu) determination. Skin specimens of the prepuce of 18 circumcised patients were used as controls. Post treatment testicle position was evaluated. HCG caused a mean increase in penile length of 1.8 cm (p < 0.01) and in circumference of 1.2 cm (p < 0.05) as well as improved local vascularity in all patients. Compared to the controls, the penile skin of exstrophy/epispadias patients showed a significant decrease in the average amount per field of EGF and Her2/neu positive material (controls 81% [mean 79, SE 2.3] vs. 31% [mean 28, SE 3.6; p < 0.001]). Treatment with HCG led to an increase in average EGF and Her2/neu positive material by 10% (mean 8, SE 2; p < 0.05). The potential side effects of HCG treatment were monitored 3 to 6 months postoperatively. Basal testosterone and LH levels were obtained in patients before and during therapy and postoperatively. Testicular descent was achieved in 21 patients (70%). No significant side effects or complications were encountered in any of our patients. Mean EGF and Her2/neu values are decreased in the penile skin of exstrophy/epispadias patients. The use of preoperative HCG administration leads to an increase in EGF and Her2/neu values and significantly contributes to successful reconstruction in these patients, especially in cases with a paucity of penile skin and in patients who have undergone previous repairs. Temporary penile stimulation by HCG in patients with bladder exstrophy combined with cryptorchidism allows the penile operation to be carried out earlier and contributes to testicular descent while demonstrating negligible side effects.

Congenital completely buried penis in boys: anatomical basis and surgical technique.

PubMed

Liu, Xing; He, Da-wei; Hua, Yi; Zhang, De-ying; Wei, Guang-hui

2013-07-01

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Surgical correction of the congenital completely buried penis (CCBP) is a difficult challenge and there is no unanimous consensus about the surgical 'gold standard' and patient eligibility for surgery. In the present study, dysgenetic fundiform ligaments were found to be attached to the distal or middle shaft of the penis. This abnormality can be successfully corrected by releasing the fundiform ligament and mobilising the scrotal skin to cover the length of the penile shaft. The study shows that the paucity and traction of the penile skin and an abnormal fundiform ligament are important anatomical defects in CCBP. Dorsal curve and severe shortage of penile skin in erectile conditions are the main indications for surgical correction. To present our experience of anatomical findings for congenital completely buried penis (CCBP), which has no unanimous consensus regarding the 'gold standard' for surgical correction and patient eligibility, by providing our surgical technique and illustrations. Between February 2006 and February 2011, 22 children with a median (range) age of 4.2 (2.5-5.8) years, with CCBP underwent surgical correction by one surgeon. Toilet training and photographs of morning erections by parents were advised before surgery. The abnormal anatomical structure of buried penis during the operation was observed. The technique consisted of the release of the fundiform ligament, fixation of the subcutaneous penile skin at the base of the degloved penis, penoscrotal Z-plasty and mobilisation of the penile and scrotal skin to cover the penile shaft. In reflex erectile conditions, CCBP presents varying degrees of dorsal curve and shortage of penile skin. Dysgenetic fundiform ligaments were found to be attached to the distal or middle shaft of the penis in all patients. All wounds healed well and the cosmetic outcome was good at 6-month follow-up after the repair. The appearance of the dorsal curve in CCBP mainly results from the traction of penile dorsal skin and the abnormal attachment of the fundiform ligament to the shaft. This abnormality can be successfully corrected by releasing the abnormal fundiform ligament and mobilising scrotal skin to cover the length of the penile shaft. © 2013 BJU International.

Archeological Testing of the North Bend Site (16SMY132) and Survey of the Todd Area Levee, St. Mary Parish, Louisiana

DTIC Science & Technology

1993-07-01

borings and from the drilling of vibracore or hand auger holes for a specific project. The terrane is the unit used to map the subsurface distribution...three pieces of amethyst glass and a piece of dark green bottle glass. Two pieces of coal, one indeterminate nail fragment and a 12- gauge shotgun shell...and three pieces of indeterminate iron. Also recovered were a 12- gauge shotgun shell base, and one brick fragment. Based on the stratigraphy all were

[Four cases of penile fracture].

PubMed

Ohtake, Shinji; Nakaigawa, Noboru; Kubota, Yoshinobu

2013-04-01

Penile fracture is not common but is an emergency disease. We report 4 cases of penile fracture treated at the Department of Urology, Yokohama City University between 2005 and 2012. The age of the patients ranged between 26 and 67 years (mean age, 41.5 years). Of the patients in our series, 3 sustained injury during sexual intercourse, and 1 while rolling over in bed. All patients were treated surgically and cured without any functional disturbance after treatment. Reports before 2002 and 99 cases after 2002 were also reviewed. The number of patients between 40 and 60 years was increasing. Magnetic resonance imaging was useful to detect the site of penile fracture and immediate surgical treatment was important.

[A simple model for describing pressure-volume curves in free balloon dilatation with reference the dynamics of inflation hydraulic aspects].

PubMed

Bloss, P; Werner, C

2000-06-01

We propose a simple model to describe pressure-time and pressure-volume curves for the free balloon (balloon in air) of balloon catheters, taking into account the dynamics of the inflation device. On the basis of our investigations of the flow rate-dependence of characteristic parameters of the pressure-time curves, the appropriateness of this simple model is demonstrated using a representative example. Basic considerations lead to the following assumptions: (1) the flow within the shaft of the catheter is laminar, and (ii) the volume decrease of the liquid used for inflation due to pressurization can be neglected if the liquid is carefully degassed prior to inflation, and if the total volume of the liquid in the system is less than 2 ml. Taking into account the dynamics of the inflation device used for pumping the liquid into the proximal end of the shaft during inflation, the inflation process can be subdivided into the following three phases: initial phase, filling phase and dilatation phase. For these three phases, the transformation of the time into the volume coordinates is given. On the basis of our model, the following parameters of the balloon catheter can be determined from a measured pressure-time curve: (1) the resistance to flow of the liquid through the shaft of the catheter and the resulting pressure drop across the shaft, (2) the residual volume and residual pressure of the balloon, and (3) the volume compliance of the balloon catheter with and without the inflation device.

Steatocystoma simplex in penile foreskin: a case report.

PubMed

de Lima, Mário Maciel; de Lima, Mário Maciel; Granja, Fabiana

2016-03-08

Steatocystoma simplex is an uncommon skin lesion with a histological pattern that is identical to that of steatocystoma multiplex. We are reporting this case of steatocystoma simplex for its uncommon location in the penile foreskin, and its occurrence in a Wapishana man. A 56-year-old man of Wapishana ethnicity presented with complaints of referred penile discomfort and pain during sexual intercourse for 5 years. A physical examination revealed a mobile, compressible subcutaneous non-tender mass of 4 cm diameter located on the left-side of his penile foreskin. There were no signs of inflammation, no grip on the penile shaft, and no urethral discharge or enlargement of lymph nodes. We found no evidence of other cysts on cutaneous examination. We performed classical excision of the lesion under local anesthesia and confirmed the diagnosis of steatocystoma with the pathological report. As there were no complications, we discharged him the same day. Steatocystoma can be considered a differential diagnosis for cystic lesions on and around the penis.

Concordance of Penile and Oral Human Papillomavirus Infections Among Men in the United States

PubMed Central

Patel, Eshan U.; Rositch, Anne F.; Gravitt, Patti E.

2017-01-01

Abstract This study examined the concordance of penile and oral human papillomavirus (HPV) infections in the United States. A total of 1683 men aged 18–59 years who participated in the 2013–2014 National Health and Nutrition Examination Survey and had results of oral and penile HPV DNA testing were examined. The prevalence of any HPV genotype was 45.3% on the penis, 11.2% in the oral cavity, and 8.8% at both sites. The prevalence of HPV in the oral cavity was higher among those with than among those without penile HPV infection (19.3% vs 4.4%; prevalence ratio, 4.37 [95% confidence interval, 2.66–7.16]). The prevalence of ≥1 genotype-concordant HPV infection was 3.2% and was associated with sexual behavior, independent of demographic characteristics and smoking status. Sexual behavior may partly explain the observed association between penile and oral HPV infections. PMID:28329127

Penile squamous cell carcinoma: a review of the literature and case report treated with Mohs micrographic surgery.

PubMed

Marchionne, Elizabeth; Perez, Caroline; Hui, Andrea; Khachemoune, Amor

2017-01-01

The majority of penile carcinoma is squamous cell carcinoma. Although uncommon in the United States, it represents a larger proportion of cancers in the underdeveloped world. Invasive squamous cell carcinoma may arise from precursor lesions or de novo , and has been associated with lack of circumcision and HPV infection. Early diagnosis is imperative as lymphatic spread is associated with a poor prognosis. Radical surgical treatment is no longer the mainstay, and penile sparing treatments now are often used, including Mohs micrographic surgery. Therapeutic decisions should be made with regard to the size and location of the tumor, as well as the functional desires of the patient. It is critical for the dermatologist to be familiar with the evaluation, grading/staging, and treatment advances of penile squamous cell carcinoma. Herein, we present a review of the literature regarding penile squamous cell carcinoma, as well as a case report of invasive squamous cell carcinoma treated with Mohs micrographic surgery.

Recurrent Penile Fracture-Case Report and Alternative Surgical Approach.

PubMed

Nascimento, Bruno; Guglielmetti, Giuliano B; Miranda, Eduardo P; Ivanovic, Renato F; Batagello, Carlos A; Nahas, William C; Srougi, Miguel; Cury, José

2018-05-03

Penile refracture is an exceedingly rare event, with very few published studies. To the best of our knowledge, this is the first documented case in the literature of penile fracture with 3 same-site recurrences. To describe the case of a 25-year-old Caucasian man with recurrent penile fracture ultimately treated with resuture and patch reinforcement. Patient history (clinical and surgical) and literature review. After the 3rd same-site recurrence, patch reinforcement over the sutured area was performed. The patient had an uneventful recovery and no recurrences to date. There is no evidence indicating the superiority of non-absorbable sutures. Bovine pericardium reinforcement over the sutured area was used to minimize the chance of another recurrence. More studies are necessary to investigate its safety and efficacy in this scenario. Nascimento B, Guglielmetti GB, Miranda EP, et al. Recurrent Penile Fracture-Case Report and Alternative Surgical Approach. Sex Med 2018;X:XX-XX. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Penile skin bridges: causes and prevention.

PubMed

Kamal, Baher A

2009-01-01

The pathogenesis and methods of prevention of penile skin bridges are discussed, with a review of the literature. This was a retrospective study on 57 adult men who presented with penile skin bridges at King Fahd University Hospital, Khobar, Saudi Arabia, over a period of approximately 22 years. All patients gave a history of circumcision during the first month after birth. The bridges were surgically excised. The skin bridges were single (23 patients) or multiple (34 patients). Their edges were attached to the distal penile shaft proximally and the glans distally. Their width varied from 1 mm to 3 cm. They were all successfully excised under local or general anesthesia. Penile skin bridges are a rare complication of neonatal circumcision. They are caused by skin adhesions that occur during childhood. With aging, the adhesions separate partially at the corona to form bridges. Careful suturing and good dressing at the time of circumcision are simple procedures that can prevent adherence of the distal prepetual skin flap to the glans penis.

Comparison of oxidative/antioxidative status of penile corpus cavernosum blood and peripheral venous blood.

PubMed

Yeni, E; Gulum, M; Selek, S; Erel, O; Unal, D; Verit, A; Savas, M

2005-01-01

The aim of the study is to determine and to compare the oxidative and antioxidative status of penile corpus cavernosum and peripheral venous blood. A total of 28 adult healthy males were included in the study. Whole blood was simultaneously withdrawn from penile corpus cavernosum and the cubital vein and their plasma separated. Total antioxidant capacity (TAC), vitamin C, total protein, albumin, uric acid, bilirubin and total peroxide (TP) levels of both plasma samples were measured and compared. While TAC, total protein, albumin, bilirubin and uric acid levels were higher, vitamin C levels were lower in cavernosal blood than that of peripheral blood. On the other hand, TP level was found to be higher in penile blood samples than that of peripheral blood. We thought that the normal erectile process of the penile cavernosal body leads to increased production of oxidants as in the mechanism of ischaemia-reperfusion; however, the increase of TAC can prevent development of oxidative injury.

Penile Fracture: Our Experience in a Tertiary Care Hospital.

PubMed

Mahapatra, Rajkumar Singha; Kundu, Anup Kumar; Pal, Dilip Kumar

2015-08-01

Penile fracture is rare, but it is a urological emergency that always requires immediate attention. Moreover, penile fracture has been reported more frequently in recent years. It may have devastating physical, functional, and psychological consequences if not properly managed in time. The objective of this study was to highlight the causes, clinical presentation, and outcomes of cases of penile fracture. This was a prospective observational study extending from November 2012 to November 2014. Each patient underwent a thorough clinical evaluation and received proper treatment. Twenty patients with penile fracture, aged 19 to 56 years (mean, 28 years) were evaluated in this study. Vaginal intercourse was the most common mechanism of injury. Most of the patients (95%) were diagnosed clinically with a proper history and clinical examination. Nineteen patients were treated surgically. The patients underwent six months of follow-up, and were evaluated with local examinations, questionnaires, and colour Doppler ultrasonography as necessary. Although penile fracture is an under-reported urological emergency, its incidence is increasing. It is usually diagnosed based on a clinical examination, but ultrasonography can be very helpful in diagnosis. Especially in cases where treatment is delayed, surgery is preferable to conservative management, because it is associated with better outcomes and fewer long-term complications.

Penile Fracture: Our Experience in a Tertiary Care Hospital

PubMed Central

Mahapatra, Rajkumar Singha; Kundu, Anup Kumar

2015-01-01

Purpose Penile fracture is rare, but it is a urological emergency that always requires immediate attention. Moreover, penile fracture has been reported more frequently in recent years. It may have devastating physical, functional, and psychological consequences if not properly managed in time. Materials and Methods The objective of this study was to highlight the causes, clinical presentation, and outcomes of cases of penile fracture. This was a prospective observational study extending from November 2012 to November 2014. Each patient underwent a thorough clinical evaluation and received proper treatment. Results Twenty patients with penile fracture, aged 19 to 56 years (mean, 28 years) were evaluated in this study. Vaginal intercourse was the most common mechanism of injury. Most of the patients (95%) were diagnosed clinically with a proper history and clinical examination. Nineteen patients were treated surgically. The patients underwent six months of follow-up, and were evaluated with local examinations, questionnaires, and colour Doppler ultrasonography as necessary. Conclusions Although penile fracture is an under-reported urological emergency, its incidence is increasing. It is usually diagnosed based on a clinical examination, but ultrasonography can be very helpful in diagnosis. Especially in cases where treatment is delayed, surgery is preferable to conservative management, because it is associated with better outcomes and fewer long-term complications. PMID:26331126

Penile prosthesis implantation compares favorably in malpractice outcomes to other common urological procedures: findings from a malpractice insurance database.

PubMed

Chason, Juddson; Sausville, Justin; Kramer, Andrew C

2009-08-01

Some urologists choose not to offer penile prostheses because of concern over malpractice liability. The aim of this study was to assess whether urologists performing penile prosthesis surgery are placed at a greater malpractice risk. Percentage of malpractice suits from prosthesis surgery and other urological procedures that result in payment, average resulting payout from these cases, and category of legal issue that ultimately resulted in payout. A database from the Physician Insurers Association of America, an association of malpractice insurance companies covering physicians in North America, was analyzed to quantitatively compare penile implant surgery to other urological procedures in medicolegal terms. Compared to other common urological procedures, penile implant is comparable and on the lower end of the spectrum in terms of both the percentage of malpractice suits that result in payment and the amount ultimately paid in indemnity from those cases. Additionally, issues of informed consent play the largest role in indemnities for all urological procedures, whereas surgical technique is the most important issue for prosthesis surgery. Urologists who are adequately trained in prosthetic surgery should not avoid penile implant procedures for fear of malpractice suits. A focus on communication and informed consent can greatly reduce malpractice risk for urological procedures.

Structural testing and analysis of a braided, inflatable fabric torus structure

NASA Astrophysics Data System (ADS)

Young, Andrew C.; Davids, William G.; Whitney, Daniel J.; Clapp, Joshua D.; Goupee, Andrew J.

2017-10-01

Inflatable structural members have military, disaster relief, aerospace and other important applications as they possess low mass, can be stored in a relatively small volume and have significant load-carrying capacity once pressurized. Of particular interest to the present research is the Hypersonic Inflatable Aerodynamic Decelerator (HIAD) structure under development by NASA. In order to make predictions about the structural response of the HIAD system, it is necessary to understand the response of individual inflatable tori composing the HIAD structure. These inflatable members present unique challenges to structural testing and modeling due to their internal inflation pressure and relative compliance. Structural testing was performed on a braided, inflatable, toroidal structural member with axial reinforcing cords. The internal inflation pressure, magnitude of enforced displacement and loading methodology were varied. In-plane and out-of-plane experimental results were compared to model predictions using a three dimensional, corotational, flexibility-based fiber-beam finite element model including geometric and material nonlinearities, as well as the effects of inflation pressure. It was found that in order to approximate the load-deformation response observed in experimentation it is necessary to carefully control the test and model boundary conditions and loading scheme.

Ground and Flight Evaluation of a Small-Scale Inflatable-Winged Aircraft

NASA Technical Reports Server (NTRS)

Murray, James E.; Pahle, Joseph W.; Thornton, Stephen V.; Vogus, Shannon; Frackowiak, Tony; Mello, Joe; Norton, Brook; Bauer, Jeff (Technical Monitor)

2002-01-01

A small-scale, instrumented research aircraft was flown to investigate the night characteristics of innersole wings. Ground tests measured the static structural characteristics of the wing at different inflation pressures, and these results compared favorably with analytical predictions. A research-quality instrumentation system was assembled, largely from commercial off-the-shelf components, and installed in the aircraft. Initial flight operations were conducted with a conventional rigid wing having the same dimensions as the inflatable wing. Subsequent flights were conducted with the inflatable wing. Research maneuvers were executed to identify the trim, aerodynamic performance, and longitudinal stability and control characteristics of the vehicle in its different wing configurations. For the angle-of-attack range spanned in this flight program, measured flight data demonstrated that the rigid wing was an effective simulator of the lift-generating capability of the inflatable wing. In-flight inflation of the wing was demonstrated in three flight operations, and measured flight data illustrated the dynamic characteristics during wing inflation and transition to controlled lifting flight. Wing inflation was rapid and the vehicle dynamics during inflation and transition were benign. The resulting angles of attack and of sideslip ere small, and the dynamic response was limited to roll and heave motions.

[Cosmetic surgery of the male genitalia].

PubMed

Chevallier, D; Haertig, A; Faix, A; Droupy, S

2013-07-01

To describe the indications and results of techniques to change the appearance of the penis for aesthetic reasons. Provide recommendations concerning cosmetic surgery of the male genitalia. We have selected from Medline Database, articles published between 1990 and 2011. Forty articles have been selected excluding papers reporting populations less than five cases per type of procedure. There is no consensus on the size below which it is justifiable to accept or attempt to modify the size of the penis. Length of the penis in maximal tension less than 9.5 cm or 10 cm in erection can be considered as an acceptable limit, in a patient who suffers from it. The assessment of men asking for penile enlargement must include a psychosexological or psychiatric evaluation, looking for a dysmorphophobia or another psychiatric condition. Penile extenders under medical control must be the first-line treatment option for patient seeking penile lenghtening procedure when justified. In case of failure, three techniques can be used alone or in combination: penile lengthening by section of the suspensory ligaments and suprapubic skin advancement, lipectomy of Mons pubis and scrotal webbing section. The results are modest, the rate of complications significant and satisfaction low. Girth enlargement techniques by injection of autologous fat give inconsistent aesthetic results and satisfaction rates are low. All other techniques remain experimental. Cosmetic surgery of the penis is associated with a high risk of forensic exposure and surgery should be only proposed after a multidisciplinary consensus, followed by a time of reflection given to the patient after full disclosure. Applications for the purpose of reconstruction surgery after trauma or consequences of cancer treatment are justified. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

P16INK4A immunohistochemistry for detection of human papilloma virus-associated penile squamous cell carcinoma is superior to in-situ hybridization.

PubMed

Aumayr, K; Susani, M; Horvat, R; Wrba, F; Mazal, P; Klatte, T; Koller, A; Neudert, B; Haitel, A

2013-01-01

We evaluated p16INK4A as a reliable option to detect human papilloma virus (HPV) DNA in penile tumor specimens. Formalin-fixed paraffin embedded samples of 26 patients with penile cancer and another 18 cases with non-tumorigenic lesions were stained by three different widely used commercially available chromogenic in-situ hybridization assays high-risk HPV CISH Y1443 (Genpoint, DAKO), pan HPV CISH Y1404 (Genpoint, DAKO), INFORM HPV III (Ventana, Tucson, Arizona) and p16INK4A immunohistochemistry, then compared to the known gold standard polymerase chain reaction detecting HPV 16, 18, 31, and 33. Immunoreactivity for p16INK4A was evaluated by using a 4-tiered (0, 1, 2, and 3) pattern based system. 19 cases were positive for p16INK4A, 13 of which showed a continuous transepithelial staining (pattern 3). Pan HPV ISH showed positivity in 9 cases, high-risk HPV ISH in 7 cases and INFORM HPVIII ISH in 7 cases. p16INK4A IHC pattern 3 versus pattern 0, 1 and 2 exhibited a specificity and positive predictive value of 100 percent, with a sensitivity and negative predictive value of 72 and 62 percent, respectively, which was much better than all HPV in-situ hybridization methods referred to polymerase chain reaction. p16INK4A seems to be a superior marker for the detection of HPV-associated penile squamous cell carcinoma compared to CISH tests, but is not recommend for the detection of non-tumorigenic lesions, where PCR should be used for the initial assessment.

The value of magnetic resonance imaging in the diagnosis of penile fracture

PubMed Central

Guler, Ibrahim; Ödev, Kemal; Kalkan, Havva; Simsek, Cihan; Keskin, Suat; Kilinç, Mehmet

2015-01-01

Purpose We studied the use of magnetic resonance imaging in the diagnosis of penile fracture. Materials and Methods Between 1997 and 2012, fifteen patients (age range 17-48 years, mean age 37 years) with suspected penile fracture underwent MRI examinations. Ten patients were injured during sexual intercourse, whereas four patients were traumatized by non-physiological bending of the penis during self manupilation, one patient was traumatized falling from the bed. Investigations were performed with 1.5T MR unit. With the patient in the supine position, the penis was taped against the abdominal wall and surface coil was placed on the penis. All patients were studied with axial, coronal, sagittal precontrast and postcontrast T1-weighted TSE(TR/TE:538/13 msn) and T2-weighted TSE(5290/110 msn) sequences. All patient underwent surgical exploration. The follow-up ranged from 3 months to 72 months. Clinically all patients showed normal healing process without complications. In 11 patients a shortening and thickening of tunica albuginea was observed. Three patients have post traumatic erectil disfunction. Results In all patient corpus cavernosum fractures were clearly depicted on a discontinuity of the low signal intensity of tunica albuginea. These findings were most evident on T1WI and also depicted on T2W sequences. Images obtained shortly after contrast medium administration showed considerable enhancement only in rupture site. Subcutaneous extratunical haematoma in all patients were also recognizable on T2 WI. MRI findings were confirmed at surgery. Conclusions Magnetic resonance imaging is of great value for the diagnosis of penile fracture. Furthermore this method is well suited for visualising the post-operative healing process PMID:26005975

Re-establishing safer medical-circumcision-integrated initiation ceremonies for HIV prevention in a rural setting in Papua New Guinea. A multi-method acceptability study

PubMed Central

MacLaren, David; Baigry, Maggie; Trowalle, Emil; Muller, Reinhold; Vallely, Andrew; Gesch, Patrick; Hombhanje, Francis; McBride, William John

2017-01-01

Background Efforts to stem the spread of Human Immunodeficiency Virus (HIV) in Papua New Guinea (PNG) are hampered by multiple interrelated factors including limited health services, extreme diversities in culture and language and highly prevalent gender inequity, domestic violence and poverty. In the rural district of Yangoru-Saussia, a revival of previously ceased male initiation ceremonies (MICs) is being considered for a comprehensive approach to HIV prevention. In this study, we explore the local acceptability of this undertaking including replacing traditional penile cutting practices with medical male circumcision (MMC). Methods A multi-method study comprising three phases. Phase one, focus group discussions with male elders to explore locally appropriate approaches to HIV prevention; Phase two, interviews and a cross-sectional survey with community men and women to assess views on MICs that include MMC for HIV prevention; Phase three, interviews with cultural leaders and a cross sectional survey to assess the acceptability of replacing traditional penile bleeding with MMC. Results Cultural leaders expressed that re-establishing MICs was locally appropriate for HIV prevention given the focus on character building and cultural preservation. Most surveyed participants (81.5%) supported re-establishing MICs and 92.2% supported adapting MICs with MMC. Changes to penile bleeding emerged as a contentious and contested issue given its cultural significance in symbolizing initiates’ transition from childhood to adulthood. Participants were concerned about potential clash with modern education, introduced religious beliefs and limited government support in leadership and funding. Conclusions Most people in this study in Yangoru-Saussia support re-establishing MICs and replacing traditional penile bleeding with MMC. This culturally-sensitive alignment of MMC (and HIV prevention) with revived MICs responds to a national health priority in PNG and acts as an example of providing culturally-sensitive male circumcision for HIV prevention recommended by WHO/UNAIDS. However, the implementation of this undertaking will require considerable effort, especially when modern pursuits in education and religion must be factored and when there is expectation for local authorities to lead and provide funding. PMID:29117244

Re-establishing safer medical-circumcision-integrated initiation ceremonies for HIV prevention in a rural setting in Papua New Guinea. A multi-method acceptability study.

PubMed

Manineng, Clement Morris; MacLaren, David; Baigry, Maggie; Trowalle, Emil; Muller, Reinhold; Vallely, Andrew; Gesch, Patrick; Hombhanje, Francis; McBride, William John

2017-01-01

Efforts to stem the spread of Human Immunodeficiency Virus (HIV) in Papua New Guinea (PNG) are hampered by multiple interrelated factors including limited health services, extreme diversities in culture and language and highly prevalent gender inequity, domestic violence and poverty. In the rural district of Yangoru-Saussia, a revival of previously ceased male initiation ceremonies (MICs) is being considered for a comprehensive approach to HIV prevention. In this study, we explore the local acceptability of this undertaking including replacing traditional penile cutting practices with medical male circumcision (MMC). A multi-method study comprising three phases. Phase one, focus group discussions with male elders to explore locally appropriate approaches to HIV prevention; Phase two, interviews and a cross-sectional survey with community men and women to assess views on MICs that include MMC for HIV prevention; Phase three, interviews with cultural leaders and a cross sectional survey to assess the acceptability of replacing traditional penile bleeding with MMC. Cultural leaders expressed that re-establishing MICs was locally appropriate for HIV prevention given the focus on character building and cultural preservation. Most surveyed participants (81.5%) supported re-establishing MICs and 92.2% supported adapting MICs with MMC. Changes to penile bleeding emerged as a contentious and contested issue given its cultural significance in symbolizing initiates' transition from childhood to adulthood. Participants were concerned about potential clash with modern education, introduced religious beliefs and limited government support in leadership and funding. Most people in this study in Yangoru-Saussia support re-establishing MICs and replacing traditional penile bleeding with MMC. This culturally-sensitive alignment of MMC (and HIV prevention) with revived MICs responds to a national health priority in PNG and acts as an example of providing culturally-sensitive male circumcision for HIV prevention recommended by WHO/UNAIDS. However, the implementation of this undertaking will require considerable effort, especially when modern pursuits in education and religion must be factored and when there is expectation for local authorities to lead and provide funding.

The Influence of Presession Factors in the Assessment of Deviant Arousal

ERIC Educational Resources Information Center

Reyes, Jorge R.; Vollmer, Timothy R.; Hall, Astrid

2011-01-01

Three adult male sex offenders with developmental disabilities participated in an evaluation of presession factors that may influence levels of sexual arousal measured with a penile plethysmograph. We evaluated the effects of presession masturbation (1 participant) and arousal-suppression strategies (2 participants). Results showed that presession…

The Genetic Basis of Peyronie Disease: A Review.

PubMed

Herati, Amin S; Pastuszak, Alexander W

2016-01-01

Peyronie disease (PD) is a progressive fibrotic disorder of the penile tunica albuginea that results in fibrotic penile plaques and can lead to penile deformity. Characterized by aberrant fibrosis resulting in part from the persistence of myofibroblasts and altered gene expression, the molecular factors underpinning PD and other related fibrotic diatheses are just being elucidated. A genetic link to PD was first identified three decades ago using pedigree analyses. However, the specific genetic factors that predispose patients to aberrant fibrosis remain unknown, and the relations between these fibrotic conditions and other heritable diseases, including malignancy, are uncharacterized. To review the current landscape linking molecular and genetic factors to aberrant fibrosis in PD and related fibrotic diatheses, including Dupuytren disease. Review and evaluation of the literature from 1970 to the present for genetic factors associated with PD were performed. Data describing the genetic factors associated with PD were obtained. We describe the known structural chromosomal abnormalities and single-nucleotide polymorphisms associated with fibrotic diatheses and discuss the spectrum of differential gene expression data comparing normal tissues with those derived from men with PD or Dupuytren disease. We discuss epigenetic mechanisms that might regulate gene expression and alter predisposition to fibrosis. Although the current understanding of the genetic factors associated with PD is limited, significant advances have been made during the past three decades. Further research is necessary to provide a more comprehensive understanding of the landscape of genetic factors responsible for the development of PD. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Penile fracture: outcomes of early surgical intervention.

PubMed

Swanson, Daniel E W; Polackwich, A Scott; Helfand, Brian T; Masson, Puneet; Hwong, James; Dugi, Daniel D; Martinez Acevedo, Ann C; Hedges, Jason C; McVary, Kevin T

2014-11-01

To report a series of penile fractures, describing preoperative evaluation, surgical repair, and long-term outcomes. Medical records from Northwestern Memorial Hospital and Oregon Health & Science University from 2002 to 2011 were reviewed. Clinical presentation, preoperative evaluation, time from injury, mechanism and site of injury, and presence of urethral injury were assessed. Outcomes including erectile dysfunction, penile curvature, and voiding symptoms were evaluated using International Prostate Symptom Score and International Index of Erectile Function scores. Twenty-nine patients with 30 separate episodes of penile fractures presenting to the emergency room were identified. Mean patient age was 43 ± 9.6 years. The time from presentation to the initiation of surgery was 5.5 ± 4.4 hours. Mechanism of injury was intercourse in 26 of 30 fractures with the remaining attributed to masturbation or "rolling over." Immediate surgical repair was offered to all patients. Twenty-seven patients underwent surgery. Urethral injury was noted in 5 of the 27. The site of fracture was at the proximal shaft in 11, mid shaft in 12, and distal shaft in 4 patients. The mean follow-up period was 14.3 ± 15.8 weeks. Nine patients reported new mild erectile dysfunction or penile curvature. One patient reported new irritative voiding symptoms. The most common mechanism of penile fracture was from sexual intercourse, and frequent concomitant urethral injuries were observed. The frequency of concomitant urethral injury was higher than in previous studies. Although we observed high incidence of erectile dysfunction or penile curvature with early surgical repair, we retain it as the favored approach. Copyright © 2014 Elsevier Inc. All rights reserved.

Outcome of penile revascularization for arteriogenic erectile dysfunction after pelvic fracture urethral injuries.

PubMed

Zuckerman, Jack M; McCammon, Kurt A; Tisdale, Britton E; Colen, Larry; Uroskie, Ted; McAdams, Paul; Jordan, Gerald H

2012-12-01

To review our experience with penile revascularization for patients with bilateral occlusion of the deep internal pudendal arteries after pelvic fracture urethral injury (PFUI). We identified 17 patients who had undergone penile revascularization with end-to-side anastomosis of the deep inferior epigastric artery to the dorsal penile artery from July 1991 to December 2010. Success was defined as achieving erections sufficient for intercourse with or without pharmacologic assistance. All patients had had a PFUI causing arterial insufficiency and erectile dysfunction not responsive to pharmacologic intervention. Of the 17 patients, 4 (24%) underwent revascularization before and 13 (76%) after PFUI repair. The mean age at revascularization was 32.7 years (range 17-54). At an average follow-up of 3.1 years, the surgery was successful in 14 of the 17 patients (82%). In patients with erectile dysfunction as an indication for surgery, successful erections were achieved in 11 of 13. For those who underwent revascularization to prevent ischemic stenosis of the urethral repair, 3 of 4 achieved successful erections, and all subsequent urethral surgeries were successful. The penile duplex ultrasound parameters showed clinically and statistically significant improvements after revascularization. No operative complications developed. The average hospital length of stay was 4.7 days. Four patients experienced early postoperative complications, including an abdominal wall hematoma requiring evacuation in one, penile edema in two, and a superficial surgical site infection in one. No late complications occurred. Penile arterial revascularization in select patients can allow for successful treatment of PFUIs and the refractory erectile dysfunction caused by them. Copyright © 2012 Elsevier Inc. All rights reserved.

Penile Dimensions of Diabetic and Nondiabetic Men With Erectile Dysfunction: A Case-Control Study.

PubMed

Salama, Nader

2018-05-01

This study aimed to report penile dimensions in diabetic and nondiabetic men with erectile dysfunction (ED) and correlate their dimensions with other study variables. A case-control study was designed through retrospective data analysis of diabetic and nondiabetic patients consulting for ED and a control group ( n = 105, each group). Study data retrieved included history, clinical evaluation, and penile dimensions (pendulous length [PL], total length [TL], and circumference [CF]) at flaccid and erect states. Results identified that patients had lower values (mean, cm) for almost all penile dimensions. The diabetic patients identified significant differences in most dimensions, whether in flaccid (PL: 7.46 vs. 7.51 and 7.81, p = .11; TL: 11.8 vs. 12.77 and 12.88, p = .000; CF: 8.84 vs. 9.1 and 9.14, p = .016) or erect state (PL: 9.66 vs. 9.61 and 10, p = .092; TL: 13.96 vs. 14.88 and 15.04, p = .000; CF: 11.56 vs. 12.06 and 11.92, p = .018) as compared with the nondiabetic patients and controls, respectively. No significant correlation was detected between the dimensions and age, durations of diabetes and ED, or erectile function scores. In conclusion, diabetic and nondiabetic patients with ED presented, in varying degrees, significant decline in their penile dimensions, and this was more prevalent in diabetic patients. As changes in penile size could be a silent corollary of comorbidities, monitoring the changes in penile dimensions should be an important component of the clinical checkup of any patient with ED, especially a diabetic patient.

Penile Dimensions of Diabetic and Nondiabetic Men With Erectile Dysfunction: A Case–Control Study

PubMed Central

Salama, Nader

2015-01-01

This study aimed to report penile dimensions in diabetic and nondiabetic men with erectile dysfunction (ED) and correlate their dimensions with other study variables. A case–control study was designed through retrospective data analysis of diabetic and nondiabetic patients consulting for ED and a control group (n = 105, each group). Study data retrieved included history, clinical evaluation, and penile dimensions (pendulous length [PL], total length [TL], and circumference [CF]) at flaccid and erect states. Results identified that patients had lower values (mean, cm) for almost all penile dimensions. The diabetic patients identified significant differences in most dimensions, whether in flaccid (PL: 7.46 vs. 7.51 and 7.81, p = .11; TL: 11.8 vs. 12.77 and 12.88, p = .000; CF: 8.84 vs. 9.1 and 9.14, p = .016) or erect state (PL: 9.66 vs. 9.61 and 10, p = .092; TL: 13.96 vs. 14.88 and 15.04, p = .000; CF: 11.56 vs. 12.06 and 11.92, p = .018) as compared with the nondiabetic patients and controls, respectively. No significant correlation was detected between the dimensions and age, durations of diabetes and ED, or erectile function scores. In conclusion, diabetic and nondiabetic patients with ED presented, in varying degrees, significant decline in their penile dimensions, and this was more prevalent in diabetic patients. As changes in penile size could be a silent corollary of comorbidities, monitoring the changes in penile dimensions should be an important component of the clinical checkup of any patient with ED, especially a diabetic patient. PMID:26130730

Estrogen-Induced Developmental Disorders of the Rat Penis Involve Both Estrogen Receptor (ESR)- and Androgen Receptor (AR)-Mediated Pathways1

PubMed Central

Goyal, H.O.; Braden, T.D.; Williams, C.S.; Williams, J.W.

2009-01-01

This study tested the hypothesis that the estrogen receptor (ESR) pathway, androgen receptor (AR) pathway, or both mediate estrogen-induced developmental penile disorders. Rat pups received diethylstilbestrol (DES), with or without the ESR antagonist ICI 182,780 (ICI) or the AR agonist dihydrotestosterone (DHT) or testosterone (T), from Postnatal Days 1 to 6. Testicular T concentration, penile morphology and morphometry, and/or fertility was determined at age 7, 28, or 150 days. DES treatment alone caused 90% reduction in the neonatal intratesticular T surge; this reduction was prevented by ICI coadministration, but not by DHT or T coadministration. Unlike the T surge, coadministration of ICI and coadministration of DHT or T mitigated penile deformities and loss of fertility. Generally, ICI, DHT, or T treatment alone did not alter penile morphology; however, fertility was 20% that of controls in ICI-treated rats vs. 70%–90% in DHT- or T-treated rats. The lower fertility in the rats treated with ICI alone could be due to altered sexual behavior, as these males did not deposit vaginal plugs. In conclusion, observations that both an ESR antagonist and AR agonists prevent penile deformities and infertility suggest that both pathways are involved in estrogen-induced penile disorders. Observations that coadministration of ICI, but not DHT or T, prevents the DES-induced reduction in the neonatal T surge suggest that, although ICI exerts its mitigating effect both at the level of Leydig cells and penile stromal cells, DHT and T do so only at the level of stromal cells. PMID:19420389

Complications of penile augmentation by use of nonmedical industrial silicone.

PubMed

Shamsodini, Ahmad; Al-Ansari, Abdulla A; Talib, Raidh A; Alkhafaji, Haidar M; Shokeir, Ahmed A; Toth, Csaba

2012-12-01

Penile augmentation has been reported in the literature by injecting various materials by nonmedical persons. This study aims to present our experience in management of penile augmentation complications associated with injection or implantation of industrial silicone by lay persons. Early surgical intervention can lead to faster recovery and better cosmetic and functional outcome. Two patients had injection of industrial silicone paste, and the other two had industrial silicone ring implantation. All the patients except one were presented after 13 months of the procedure. Patients with industrial silicone ring presented with multiple sinuses of penile skin in one, and abscess discharge pus from the site of implanted ring in the other. Both patients with injected silicone paste presented with swelling and deformity of the penis that interfered with their intercourse. Silicone ring patients underwent skin incision and drainage of the infected materials and extraction of the implants with delayed skin closure. The two patients with silicone paste injection underwent two-stage penile reconstructions using scrotal flap. Patients with extracted rings had smooth recovery with acceptable cosmetic outcome. One of them was not initially satisfied with the length of his penis that was overcome by short-term use of vacuum device. One of the patients with silicone paste injection had wound infection that was successfully treated with local wound care. Both had satisfactory penile length and acceptable cosmetic outcome. All patients had normal erectile function postoperatively. Complications of using industrial silicone injection can be drastic, and awareness of the public can avoid using of this material for penile augmentation. © 2011 International Society for Sexual Medicine.

Identifying Psychosocial Distress and Stressors Using Distress-screening Instruments in Patients With Localized and Advanced Penile Cancer.

PubMed

Dräger, Désirée Louise; Protzel, Chris; Hakenberg, Oliver W

2017-10-01

We examined the effects of treatment on the psychological well-being of patients with localized or advanced penile cancer using screening questionnaires to determine the consecutive need for psychosocial care. Penile cancer is a rare, but highly aggressive, malignancy. The psychological stress of patients with penile cancer arises from the cancer diagnosis per se and the corresponding consequences of treatment. In addition, cancer-specific distress results (eg, fear of metastasis, progression, relapse, death). Studies of the psychosocial stress of penile cancer patients are rare. We undertook a prospective analysis of the data from patients with penile cancer who had undergone surgery or chemotherapy from August 2014 to October 2016 at our department. Patients were evaluated using standardized questionnaires for stress screening and the identification for the need for psychosocial care (National Comprehensive Cancer Network Distress Thermometer and Hornheider screening instrument) and by assessing the actual use of psychosocial support. The average stress level was 4.5. Of all the patients, 42.5% showed increased care needs at the time of the survey. Younger patients, patients undergoing chemotherapy, and patients with recurrence were significantly more integrated with the psychosocial care systems. Finally, 67% of all patients received inpatient psychosocial care. Owing to the potentially mutilating surgery, patients with penile cancer experience increased psychological stress and, consequently, have an increased need for psychosocial care. Therefore, the emotional stress of these patients should be recognized and support based on interdisciplinary collaboration offered. Copyright © 2017 Elsevier Inc. All rights reserved.

The transverse penile pedicled flap urethroplasty: description of a simplified technique for the dissection of the Fascio-cutaneous flap.

PubMed

Shittu, O B; Sotunmbi, P T

2015-06-01

Urethroplasty is often required for long urethral strictures or urethral strictures that have recurred after repeated urethral dilatations or urethrotomy. The transvers penile skin pedicled flap is very versatile for the reconstruction of long urethral stricture. However the meticulous sharp dissection required to develop it takes a long time to do and may be associated with button hole injuries to the vascular pedicle and the penile skin. We describe a simplified technique of raising the flap which does not require sharp dissection and is very quick to accomplish. Technique involves using a circumcising distal penile shaft skin incision to de-glove the penis by blunt dissection. The skin substitute, adequate to give appropriate urethra calibre is similarly dissected bluntly along with its vascular pedicle from the proximal penile skin. The techniques used to facilitate successful blunt dissection are described. In 9 adults with long, multiple urethral strictures, the average time to develop the flap was 15 minutes and complication have been limited to temporary urethro-cutaneous fistula at the ventral part of the circular skin closure. These fistulae closed on conservative treatment. No patient suffered button-hole injuries to either the vascular pedicle or the penile skin. This modification to the standard sharp dissection is very quick to accomplish. It also avoids the creation of button-hole injuries to either the vascular pedicle or the penile skin. It should make the use of this versatile flap more attractive in the reconstruction of long urethral strictures in those who may wish to use this option for reconstruction of long urethral strictures.

The application of color Doppler flow imaging in the diagnosis and therapeutic effect evaluation of erectile dysfunction

PubMed Central

Xuan, Xu-Jun; Bai, Gang; Zhang, Cai-Xia; Xu, Chao; Lu, Fu-Ding; Peng, Yang; Ma, Gang; Han, Cong-Hui; Chen, Jun

2016-01-01

We aim to investigate the correlations between hemodynamic parameters, penile rigidity grading, and the therapeutic effects of phosphodiesterase type 5 inhibitors using color Doppler flow imaging after intracavernosal injection in patients with erectile dysfunction. This study involved 164 patients. After intracavernosal injection with a mixture of papaverine (60 mg), prostaglandin E1 (10 μg), and lidocaine (2%, 0.5–1 ml), the penile vessels were assessed using color Doppler flow imaging. Penile rigidity was classified based on the Erection Hardness Score system as Grades 4, 3, 2 or 1 (corresponding to Schramek Grades V to II). Then, the patients were given oral sildenafil (50–100 mg) and scored according to the International Index of Erectile Function (IIEF-5) questionnaire. The number of patients with penile rigidities of Schramek Grades II to V was 14, 18, 21, and 111, respectively. The IIEF-5 score was positively correlated with the refilling index of the penile cavernosal artery (r = 0.79, P < 0.05), the peak systolic velocity (r = 0.45, P < 0.05), and penile rigidity (r = 0.75, P < 0.05), and was negatively correlated with the end diastolic velocity (r = −0.74, P < 0.05). For patients with erectile dysfunction, both the IIEF-5 score after sildenafil administration, which is correlated with penile rigidity, and the hemodynamic parameters detected using color Doppler flow imaging may predict the effects of phosphodiesterase type 5 inhibitor treatment and could provide a reasonable model for the targeted-treatment of erectile dysfunction. PMID:25994651

Excision and Patch Grafting of a Lateral Peyronie’s Plaque—Utilizing a Longitudinal “Window” Approach

PubMed Central

Lue, Kathy; Emtage, Justin B; Martinez, Daniel R; Yang, Christopher; Carrion, Rafael

2015-01-01

Introduction Peyronie’s disease (PD) is a debilitating disorder in which collagen deposition, fibrosis, and plaques in the tunica albuginea result in penile curvature, shortening, and pain. For severe curvatures requiring plaque incision or excision with grafting (PIEG), a subcoronal circumcising incision with penile degloving has historically been used. Aims The aim of this study was to report our unique approach to PIEG via a longitudinal “window” incision for the correction of PD, minimizing the surgical manipulation and dissection accompanying the traditional circumcising incisional approach that may lead to increased postoperative edema, pain, and prolonged healing time. Methods A patient presented with a stable, painless, 90-degree midshaft leftward curvature causing penetration difficulties and painful intercourse for his partner. His Sexual Health Inventory for Men (SHIM) score was 23. The patient opted for surgical correction with plaque excision and grafting via a 4-cm longitudinal incision overlying the point of maximal curvature along the left lateral penile shaft. This direct access to the left corpus cavernosum and plaque, along with dissecting skin, dartos, and Buck’s fascia, created a window with sufficient exposure for excision and patch grafting. Main Outcome Measures The main outcome measures were objective data and subjective data in men undergoing PIEG via lateral longitudinal “window” incision for PD repair. Results The plaque was excised and a porcine small intestinal submucosa graft was sewn in. Intraoperative artificial tumescence at the end of surgery revealed complete correction of the curvature. The patient experienced painless rigid erections by postoperative day three with minimal penile edema. By postoperative week four, he could successfully partake in coitus. His SHIM score remained unchanged. At maximum follow-up 6 months postoperatively, he still endorsed excellent cosmetic and functional outcomes with spontaneous unassisted erections and no recurrence of his curvature. Conclusion A lateral longitudinal incision for PIEG is a feasible technique and may reduce the postoperative morbidity and dissection required with traditional circumcising incision with penile degloving. Larger comparative studies are necessary for further evaluation. PMID:26185673

What is a Good Looking Penis? How Women Rate the Penile Appearance of Men with Surgically Corrected Hypospadias.

PubMed

Ruppen-Greeff, Norma Katharina; Weber, Daniel M; Gobet, Rita; Landolt, Markus A

2015-08-01

Some men with corrected hypospadias perceive their penile appearance to be abnormal, although health professionals consider these results satisfactory. The aim of this study was to investigate how relevant women consider single aspects of penile appearance to be. Moreover, we studied whether women perceive hypospadias-affected surgically repaired genitals (HASRGs) to be as normal-looking as circumcised genitals and identified the most relevant predictors that influence whether a penis is perceived as normal. In this cross-sectional study, 105 women in different age groups (age range: 16-20, 25-30, and 40-45 years) completed a standardized questionnaire. Participants had to rate the importance of eight penile aspects and to indicate how normal they found the appearance of standardized photos of 10 HASRGs and of 10 circumcised genitals. Furthermore, they were asked about demographic characteristics and their sexuality. Results showed that women considered the position and shape of the meatus as the least important penile aspect. Furthermore, results showed that HASRGs with distal hypospadias were perceived to be as normal-looking as circumcised genitals, whereas genitals with more proximal hypospadias were perceived as significantly less normal. However, the difference need not be considered clinically relevant, as the effect size was small. Observer-related predictors of a more positive perception of HASRGs were higher age, higher sexual interest, and perceiving the general cosmetic penile appearance as more important and penile length as less important. Overall, women were found to consider the "position and shape of the meatus" as the least important penile aspect. These findings may stimulate reflections regarding the relevance of surgical correction of the meatus in minor forms of hypospadias. In addition, this study indicates that women perceived genitals of men with distal operated hypospadias (which represents the majority of hypospadias) to be as normal as nonaffected, circumcised genitals. © 2015 International Society for Sexual Medicine.

Acute penile trauma and associated morbidity: 9-year experience at a tertiary care center.

PubMed

Phillips, Elizabeth A; Esposito, Anthony J; Munarriz, Ricardo

2015-05-01

Penile fracture is an uncommon urologic emergency, defined as traumatic rupture of the tunica albuginea of the corpus cavernosum. It occurs mainly in young adults during sexual activity. In the United States, urethral injury is associated with 10-38% of all penile fractures. Diagnosis can be made clinically with the classic triad of an audible crack, detumescence, and appearance of hematoma. We sought to identify characteristics associated with true penile fracture vs. other diagnoses, and determine associated morbidity and risk factors for complications. Retrospective operative chart review identified 39 patients (mean age 39.4 years) with clinical features of penile fracture presenting to Boston Medical Center from June 2004 to May 2013. Average time from injury to presentation was 76 h (range 0.5 h-9 days) and the mechanism of injury was coital in 32 (82%) patients. Thirty-two patients (82%) had confirmed penile fracture, 7 (18%) had isolated vascular injury. Of confirmed fractures, 4 (13%) had bilateral corporal injury and associated urethral injury. Imaging was utilized in a total of 21 cases, penoscrotal ultrasound (US) in 17 cases, retrograde urethrogram (RUG) in 3 cases, and magnetic resonance imaging (MRI) in 1 case. Penile exploration was carried out via degloving (n = 5, 13%) or penoscrotal (n = 34, 87%) incisions. At follow-up, six patients (15%) had complications: 2 wound infections, 2 new-onset erectile dysfunction (ED), 1 urethral stricture, 1 fistula and 1 wound dehiscence. Urethral injury increased the risk of post-operative complications (p = 0.015). Penile fracture is primarily a clinical diagnosis, however imaging may be helpful if diagnosis is uncertain. Urethral injury should be suspected in cases of bilateral corporal injury and may be associated with increased morbidity. Surgical approach does not affect morbidity, but may facilitate surgical repair. © 2015 American Society of Andrology and European Academy of Andrology.

Critical androgen-sensitive periods of rat penis and clitoris development.

PubMed

Welsh, Michelle; MacLeod, David J; Walker, Marion; Smith, Lee B; Sharpe, Richard M

2010-02-01

Androgen control of penis development/growth is unclear. In rats, androgen action in a foetal 'masculinisation programming window' (MPW; e15.5-e18.5)' predetermines penile length and hypospadias occurrence. This has implications for humans (e.g. micropenis). Our studies aimed to establish in rats when androgen action/administration affects development/growth of the penis and if deficits in MPW androgen action were rescuable postnatally. Thus, pregnant rats were treated with flutamide during the MPW +/- postnatal testosterone propionate (TP) treatment. To assess penile growth responsiveness, rats were treated with TP in various time windows (late foetal, neonatal through early puberty, puberty onset, or combinations thereof). Phallus length, weight, and morphology, hypospadias and anogenital distance (AGD) were measured in mid-puberty (d25) or adulthood (d90) in males and females, plus serum testosterone in adult males. MPW flutamide exposure reduced adult penile length and induced hypospadias dose-dependently; this was not rescued by postnatal TP treatment. In normal rats, foetal (e14.5-e21.5) TP exposure did not affect male penis size but increased female clitoral size. In males, TP exposure from postnatal d1-24 or at puberty (d15-24), increased penile length at d25, but not ultimately in adulthood. Foetal + postnatal TP (e14-postnatal d24) increased penile size at d25 but reduced it at d90 (due to reduced endogenous testosterone). In females, this treatment caused the biggest increase in adult clitoral size but, unlike in males, phallus size was unaffected by TP during puberty (d15-24). Postnatal TP treatment advanced penile histology at d25 to more resemble adult histology. AGD strongly correlated with final penis length. It is concluded that adult penile size depends critically on androgen action during the MPW but subsequent growth depends on later androgen exposure. Foetal and/or postnatal TP exposure does not increase adult penile size above its 'predetermined' length though its growth towards this maximum is advanced by peripubertal TP treatment.

Penile Cancer: Contemporary Lymph Node Management.

PubMed

O'Brien, Jonathan S; Perera, Marlon; Manning, Todd; Bozin, Mike; Cabarkapa, Sonja; Chen, Emily; Lawrentschuk, Nathan

2017-06-01

In penile cancer, the optimal diagnostics and management of metastatic lymph nodes are not clear. Advances in minimally invasive staging, including dynamic sentinel lymph node biopsy, have widened the diagnostic repertoire of the urologist. We aimed to provide an objective update of the recent trends in the management of penile squamous cell carcinoma, and inguinal and pelvic lymph node metastases. We systematically reviewed several medical databases, including the Web of Science® (with MEDLINE®), Embase® and Cochrane databases, according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines. The search terms used were penile cancer, lymph node, sentinel node, minimally invasive, surgery and outcomes, alone and in combination. Articles pertaining to the management of lymph nodes in penile cancer were reviewed, including original research, reviews and clinical guidelines published between 1980 and 2016. Accurate and minimally invasive lymph node staging is of the utmost importance in the surgical management of penile squamous cell carcinoma. In patients with clinically node negative disease, a growing body of evidence supports the use of sentinel lymph node biopsies. Dynamic sentinel lymph node biopsy exposes the patient to minimal risk, and results in superior sensitivity and specificity profiles compared to alternate nodal staging techniques. In the presence of locoregional disease, improvements in inguinal or pelvic lymphadenectomy have reduced morbidity and improved oncologic outcomes. A multimodal approach of chemotherapy and surgery has demonstrated a survival benefit for patients with advanced disease. Recent developments in lymph node management have occurred in penile cancer, such as minimally invasive lymph node diagnosis and intervention strategies. These advances have been met with a degree of controversy in the contemporary literature. Current data suggest that dynamic sentinel lymph node biopsy provides excellent sensitivity and specificity for detecting lymph node metastases. More robust long-term data on multicenter patient cohorts are required to determine the optimal management of lymph nodes in penile cancer. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Biometry of the hypospadic penis after hormone therapy (testosterone and estrogen): A randomized, double-blind controlled trial.

PubMed

Paiva, Kelly Christina de Castro; Bastos, André Netto; Miana, Laura Pimenta; Barros, Eveline de Souza; Ramos, Plínio Santos; Miranda, Lara Meneguelli; Faria, Natália Maia; Avarese de Figueiredo, André; de Bessa, José; Netto, José Murillo B

2016-08-01

The use of preoperative hormonal stimulation before hypospadias surgery aims to increase penile size and achieve better surgical results; however, the rules are not clear in the literature. We evaluated the effects of topical testosterone and estrogen in the hypospadic penis regarding biometric measures, side effects, and serum hormonal levels. To our knowledge, this is the first study using estradiol prior to hypospadias surgery. Sixty-nine children with hypospadias were randomly divided into three study groups: a control group (CG) of 17 children given placebo cream; a testosterone group (TG) of 28 children who used 1% testosterone propionate; and an estradiol group (EG) of 24 children using 0.01% estradiol. All subjects applied the topical ointment on the entire penis, twice daily for 30 days before surgical correction. Biometric evaluation of the penis included penile length and diameter, glans diameter, distance from the urethral meatus to the tip, and the width of the urethral plate. These measurements as well as serum hormone level, and side effects were evaluated prior to hormone use, and 30 and 90 days after. After 30 days an increase in penile diameter and length and diameter of the glans were observed in TG (p < 0.05). The width of the urethral plate and distance from meatus to the tip increased in TG, although not significantly. The most frequent side effects were appearance of pubic hair and darkening of the genital skin, mainly in TG, but these were transient and disappeared after 90 days of treatment. No significant variations were seen in serum hormonal levels (Table). As in previous studies, an increase in penile length and diameter, and glans diameter was observed with the use of testosterone. Proximal urethral plate width and distance from the meatus to the tip of the penis had a tendency to increase also in TG. Estradiol did not change biometric measure of the penis. Few side effects occurred after both hormones, and any that did improved after 90 days follow-up and did not change hormone serum levels. Preoperative use of topical testosterone increases penile size, diameter of the penis and glans. The use of estradiol does not change penile biometry. Side effects occur mainly with the use of testosterone and are transient. No significant and persistent hormonal changes were observed. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

A New Technique to Map the Lymphatic Distribution and Alignment of the Penis.

PubMed

Long, Liu Yan; Qiang, Pan Fu; Ling, Tao; Wei, Zhang Yan; Long, Zhang Yu; Shan, Meng; Rong, Li Shi; Li, Li Hong

2015-08-01

The present study was to examine the distribution of lymphatic vessels in the penis of normal adult males, which could provide an anatomical basis for improvement of incisions in penile lengthening surgery, and may also help to prevent postoperative refractory edema. Thirteen normal adult male volunteers were recruited for this study. Contrast agent was injected subcutaneously in the foreskin of the penis, and after two minutes magnetic resonance lymphangiography (MRL) was performed. The acquired magnetic resonance images were analyzed to determine the changes in the number and diameter of lymphatic vessels in different parts of the penis. Maximum intensity projections (MIP) and materializes interactive medical image control system (MIMICS) were applied to analyze the overall distribution of lymphatic vessels in the penis. Magnetic resonance imaging (MRI) showed that the lymphatic vessels were in conspicuous contrast with surrounding tissues and could be clearly identified. Penile lymphatic vessels were clearly visible in the root of the penis. At the junction of the penis and the abdominal wall, all lymphatic vessels were found to be concentrated in the dorsal part of the penis. MIP two-dimensional reconstruction showed that the overall distribution of relatively large lymphatic vessels in the dorsal and ventral parts of the penis could be seen clearly on bilateral 45° position, but not inside the abdominal wall because some of lymphatic vessels were overlapped by other tissues in the abdomen. MIMICS three-dimensional reconstruction was able to reveal the overall spatial distribution of lymphatic vessels in the penis from any angle. The reconstruction results showed that there were 1-2 main lymphatic vessels on the root of dorsal penis, which coursed along the cavernous to the first physiological curvature of the penis. Lymphatic vessels merged on both sides of the ventral penis. At the root of the penis, lymphatic vessels gradually coursed to the dorsal surface of the penis and folded at the abdominal wall to the outside, and finally merged into the inguinal lymph nodes. The changes in distribution, number and diameter of the lymphatic vessels in the penis were observed by MRI. MIP and MIMICS reconstructions directly revealed the anatomical features of penile lymphatic vessels such as spatial distribution, overall alignment, and the relations to adjacent structures, drainage and reflux. The study will provide the anatomical basis for penile surgery, penile lymphatic reflux disorders caused by trauma or lymphatic vessels obstruction, and lymph node metastasis in penile cancer. © 2014 Wiley Periodicals, Inc.

The deployable, inflatable wing technology demonstrator experiment aircraft looks good during a flig

NASA Technical Reports Server (NTRS)

2001-01-01

The deployable, inflatable wing technology demonstrator experiment aircraft looks good during a flight conducted by the NASA Dryden Flight Research Center, Edwards, California. The inflatable wing project represented a basic flight research effort by Dryden personnel. Three successful flights of the I2000 inflatable wing aircraft occurred. During the flights, the team air-launched the radio-controlled (R/C) I2000 from an R/C utility airplane at an altitude of 800-1000 feet. As the I2000 separated from the carrier aircraft, its inflatable wings 'popped-out,' deploying rapidly via an on-board nitrogen bottle. The aircraft remained stable as it transitioned from wingless to winged flight. The unpowered I2000 glided down to a smooth landing under complete control.

Deployment Simulation of Ultra-Lightweight Inflatable Structures

NASA Technical Reports Server (NTRS)

Wang, John T.; Johnson, Arthur R.

2002-01-01

Dynamic deployment analyses of folded inflatable tubes are conducted to investigate modeling issues related to the deployment of solar sail booms. The analyses are necessary because ground tests include gravity effects and may poorly represent deployment in space. A control volume approach, available in the LS-DYNA nonlinear dynamic finite element code, and the ideal gas law are used to simulate the dynamic inflation deployment process. Three deployment issues are investigated for a tube packaged in a Z-fold configuration. The issues are the effect of the rate of inflation, the effect of residual air, and the effect of gravity. The results of the deployment analyses reveal that the time and amount of inflation gas required to achieve a full deployment are related to these issues.

Histopathological effects of fibrin glue on penile fracture in a rat model.

PubMed

Tasdemir, Cemal; Samdanci, Emine T; Turtay, Muhammet G; Firat, Cemal; Oguzturk, Hakan; Ozdemir, Hulya

2011-12-01

To evaluate both histopathological effects and potential clinical application of fibrin glue on the penile cavernosal tissue. Experimental penile fracture was formed by incising from the proximal dorsal side of the penis in 32 Wistar Albino rats. The rats were randomly assigned to four main groups of eight animals each. In the control group, the incision was not repaired and it was left to secondary healing. In the primary repair group, the incision was primarily repaired. In the fibrin glue group, glue was applied only to the incision. In the final group, fibrin glue was applied to the incision following primary repair. Three weeks later, penectomy tissue was examined histopathologically. When the control group was compared with primary repair+fibrin glue group, the differences in cavernous tissue healing with fibrosis and inflammation were statistically significant (p = 0.04 and 0.01, respectively). The primary repair+fibrin glue group, showed the best cavernous healing with fibrosis observed in only one rat. . There was no significant difference between the control group and the other groups according to cavernous tissue healing with fibrosis and inflammation (p = 0.11 and 0.12). Hyperemia was observed in the all groups of rats. Fibrin glue can be used in cavernoseal surgeries due to its adhesive and potentially anti-inflammatory features.

Biomechanical evaluation of one-piece and two-piece small-diameter dental implants: In-vitro experimental and three-dimensional finite element analyses.

PubMed

Wu, Aaron Yu-Jen; Hsu, Jui-Ting; Chee, Winston; Lin, Yun-Te; Fuh, Lih-Jyh; Huang, Heng-Li

2016-09-01

Small-diameter dental implants are associated with a higher risk of implant failure. This study used both three-dimensional finite-element (FE) simulations and in-vitro experimental tests to analyze the stresses and strains in both the implant and the surrounding bone when using one-piece (NobelDirect) and two-piece (NobelReplace) small-diameter implants, with the aim of understanding the underlying biomechanical mechanisms. Six experimental artificial jawbone models and two FE models were prepared for one-piece and two-piece 3.5-mm diameter implants. Rosette strain gauges were used for in-vitro tests, with peak values of the principal bone strain recorded with a data acquisition system. Implant stability as quantified by Periotest values (PTV) were also recorded for both types of implants. Experimental data were analyzed statistically using Wilcoxon's rank-sum test. In FE simulations, the peak value and distribution of von-Mises stresses in the implant and bone were selected for evaluation. In in-vitro tests, the peak bone strain was 42% lower for two-piece implants than for one-piece implants. The PTV was slightly lower for one-piece implants (PTV = -6) than for two-piece implants (PTV = -5). In FE simulations, the stresses in the bone and implant were about 23% higher and 12% lower, respectively, for one-piece implants than those for two-piece implants. Due to the higher peri-implant bone stresses and strains, one-piece implants (NobelDirect) might be not suitable for use as small-diameter implants. Copyright © 2016. Published by Elsevier B.V.

Safe emergency department removal of a hardened steel penile constriction ring.

PubMed

Peay, Jeremy; Smithson, James; Nelson, James; Witucki, Peter

2009-10-01

Penile constriction devices are used for the enhancement of sexual performance. These devices have the potential to become incarcerated, leading to necrosis and amputation if not removed promptly. This article presents a step-by-step approach for the safe removal of a hardened steel penile constriction device using somewhat unorthodox tools found in a hospital. We present a case of an incarcerated hardened steel penile constriction ring that was not able to be removed with conventional techniques. We describe a novel technique using an electric grinder and laryngoscope blade. The technique described in this article is a valuable and relatively safe technique for the Emergency Physician to facilitate the timely removal of a hardened steel constriction device.

[Urethroplasty in hypoplastic-dysplastic corpus spongiosum and short urethra].

PubMed

Vitarelli, Antonio; Divenuto, Lucia; Altomare, Mauro; Masiello, Giuseppe; Pagliarulo, Arcangelo

2013-01-01

Congenital penile curvature and chordee are a rare malformative condition most frequently associated with hypospadias, but varying degrees of penile curvature are observed with an orthotopic meatus. Disease becomes evident after puberty, when curvature becomes more apparent with erection. We present a case of a young man (16 years old), with ventral congenital penile curvature without hypospadias and with hypoplastic-dysplastic corpus spongiosum and short urethra, who could not have normal sexual intercourses. The patient underwent first-stage urethroplasty with urethral opening and graft of buccal mucosa and creation of a temporary hypospadic meatus. No post-operative complications were observed. There were no residual penile curvatures. Results are promising and satisfactory after the first surgical stage and provide a solid ground for the final reconstruction.

Management of High-Grade Penile Curvature Associated With Hypospadias in Children

PubMed Central

Moscardi, Paulo R. M.; Gosalbez, Rafael; Castellan, Miguel Alfedo

2017-01-01

Penile curvature is a frequent feature associated with hypospadias with also a great variability of severity among each patient. While the low-grade curvature (<30°) can be relatively easily corrected by simple techniques like penile degloving and dorsal plication, severe cases often demand more complex maneuvers to manage it. A great number of surgical techniques have been developed to adequately correct curvatures greater than 30°; however, each one of them should be individualized to different patients and local conditions encountered. In this article, we will review the evaluation of the pediatric patient with penile curvature associated with hypospadias with a special attention to high-grade cases, their management, indications for surgical treatment, and several surgical options for their definitive treatment. PMID:28929092

Wrinkling and collapse of mesh reinforced membrane inflated beam under bending

NASA Astrophysics Data System (ADS)

Tao, Qiang; Wang, Changguo; Xue, Zhiming; Xie, Zhimin; Tan, Huifeng

2016-11-01

A novel concept of mesh reinforced membrane (MRM) is proposed in this paper. The tensile collapse mechanism of MRM is elucidated based on three obvious deformed stages. An improved Shell-Membrane model is used to predict the wrinkling and collapse of MRM inflated beam which is verified by a non-contact experiment based on the digital image correlation technique. Further the wrinkling details including the wrinkling evolution, pattern, shape, stress distribution are simulated to evaluate the functions of MRM for loading-carrying capacity of inflated beam. Pressure resistant performance of inflated beam was studied at last. The results revealed that MRM shows a great improvement on the collapse moment of inflated beam. MRM contributes to restrain wrinkling evolution by changing the transfer path of loadings which results from dispersing stress distribution and changing wrinkling pattern. The results show good references to the wrinkling control and the improvement of load-carrying capacity of inflated beam.

Testing hypotheses of bat baculum function with 3D models derived from microCT

PubMed Central

Herdina, Anna Nele; Kelly, Diane A; Jahelková, Helena; Lina, Peter H C; Horáček, Ivan; Metscher, Brian D

2015-01-01

The baculum (os penis) has been extensively studied as a taxon-specific character in bats and other mammals but its mechanical function is still unclear. There is a wide consensus in the literature that the baculum is probably a sexually selected character. Using a novel approach combining postmortem manipulation and three-dimensional (3D) imaging, we tested two functional hypotheses in the common noctule bat Nyctalus noctula, the common pipistrelle Pipistrellus pipistrellus, and Nathusius’ pipistrelle Pipistrellus nathusii: (i) whether the baculum can protect the distal urethra and urethral opening from compression during erection and copulation; and (ii) whether the baculum and corpora cavernosa form a functional unit to support both the penile shaft and the more distal glans tip. In freshly dead or frozen and thawed bats, we compared flaccid penises with artificially ‘erect’ penises that were inflated with 10% formalin. Penises were stained with alcoholic iodine and imaged with a lab-based high-resolution x-ray microtomography system. Analysis of the 3D images enabled us to compare the changes in relative positions of the baculum, corpora cavernosa, urethra, and corpus spongiosum with one another between flaccid and ‘erect’ penises. Our results support both functional hypotheses, indicating that the baculum probably performs two different roles during erection. Our approach should prove valuable for comparing and testing the functions of different baculum morphologies in bats and other mammals. Moreover, we have validated an essential component of the groundwork necessary to extend this approach with finite element analysis for quantitative 3D biomechanical modeling of penis function. PMID:25655647

A Novel Collaborative Protocol for Successful Management of Penile Pain Mediated by Radiculitis of Sacral Spinal Nerve Roots From Tarlov Cysts.

PubMed

Goldstein, Irwin; Komisaruk, Barry R; Rubin, Rachel S; Goldstein, Sue W; Elliott, Stacy; Kissee, Jennifer; Kim, Choll W

2017-09-01

Since 14 years of age, the patient had experienced extreme penile pain within seconds of initial sexual arousal through masturbation. Penile pain was so severe that he rarely proceeded to orgasm or ejaculation. After 7 years of undergoing multiple unsuccessful treatments, he was concerned for his long-term mental health and for his future ability to have relationships. To describe a novel collaboration among specialists in sexual medicine, neurophysiology, and spine surgery that led to successful management. Collaborating health care providers conferred with the referring physician, patient, and parents and included a review of all medical records. Elimination of postpubertal intense penile pain during sexual arousal. The patient presented to our sexual medicine facility at 21 years of age. The sexual medicine physician identifying the sexual health complaint noted a pelvic magnetic resonance imaging report of an incidental sacral Tarlov cyst. A subsequent sacral magnetic resonance image showed four sacral Tarlov cysts, with the largest measuring 18 mm. Neuro-genital testing result were abnormal. The neurophysiologist hypothesized the patient's pain at erection was produced by Tarlov cyst-induced neuropathic irritation of sensory fibers that course within the pelvic nerve. The spine surgeon directed a diagnostic injection of bupivacaine to the sacral nerve roots and subsequently morphine to the conus medullaris of the spinal cord. The bupivacaine produced general penile numbness; the morphine selectively decreased penile pain symptoms during sexual arousal without blocking penile skin sensation. The collaboration among specialties led to the conclusion that the Tarlov cysts were pathophysiologically mediating the penile pain symptoms during arousal. Long-term follow-up after surgical repair showed complete symptom elimination at 18 months after treatment. This case provides evidence that (i) Tarlov cysts can cause sacral spinal nerve root radiculitis through sensory pelvic nerve and (ii) there are management benefits from collaboration among sexual medicine, neurophysiology, and spine surgery subspecialties. Goldstein I, Komisaruk BR, Rubin RS, et al. A Novel Collaborative Protocol for Successful Management of Penile Pain Mediated by Radiculitis of Sacral Spinal Nerve Roots From Tarlov Cysts. Sex Med 2017;5:e203-e211. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

National Patterns of Urethral Evaluation and Risk Factors for Urethral Injury in Patients With Penile Fracture.

PubMed

Pariser, Joseph J; Pearce, Shane M; Patel, Sanjay G; Bales, Gregory T

2015-07-01

To examine the epidemiology and timing of penile fracture, patterns of urethral evaluation, and risk factors for concomitant urethral injury. The National Inpatient Sample (2003-2011) was used to identify patients with penile fractures. Clinical data included age, race, comorbidity, insurance, hospital factors, timing, hematuria, and urinary symptoms. Rates of formal urethral evaluation (cystoscopy or urethrogram) and urethral injury were calculated. Multivariate logistic regression was used to identify predictors of urethral evaluation and risk factors for urethral injury. A weighted population of 3883 patients with penile fracture was identified. Presentations during weekends (37%) and summers (30%) were overrepresented (both P <.001). Urethral evaluation was performed in 882 patients (23%). Urethral injury was diagnosed in 813 patients (21%) with penile fracture. There was an increased odds of urethral evaluation with hematuria (odds ratio [OR] = 2.99; 95% confidence interval [CI], 1.03-8.73; P = .045) and a decrease for Hispanics (OR = 0.42; 95% CI, 0.22-0.82; P = .011). Older age (32-41 years: OR = 1.84; 95% CI, 1.07-3.16; P = .027; >41 years: OR = 2.25; 95% CI, 1.25-4.05; P = .007), black race (OR = 1.93; 95% CI, 1.12-3.34; P = .018), and hematuria (OR = 17.03; 95% CI, 3.20-90.54; P = .001) were independent risk factors for urethral injury. Penile fractures, which occur disproportionately during summer and weekends, were associated with a 21% risk of urethral injury. Urethral evaluations were performed in a minority of patients. Even in patients with hematuria, 55% of patients underwent formal urethral evaluation. On multivariate analysis of patients with penile fracture, hematuria as well as older age and black race were independently associated with concomitant urethral injury. Copyright © 2015 Elsevier Inc. All rights reserved.

FRACTURE OF THE PENIS IN THE NIGER DELTA REGION OF NIGERIA.

PubMed

Ekeke, O N; Eke, N

2014-01-01

Penile fracture is a surgical emergency which often frightens the patient and partner. Varying incident rates, precipitating mechanisms and outcomes of treatment have been reported from different parts of the world. To determine clinical presentation, aetiological factors and outcome of treatment of penile fracture in Port Harcourt, Niger Delta region of Nigeria. This was a retrospective study of all patients who presented with penile fracture to our institution from 2007 and 2015. Data on age of patient, events leading to the injury, mode and time of presentation, mode and outcome and complications of treatment were collected and analysed with SPSS 20.0 software. Twenty one patients with a median age of 34.0 years (21-45) were treated within the study period. Nine patients (42.9%) were married. Overenthusiastic/ vigorous sex-related events were responsible for penile fracture in 17 patients (81.0%). Seven injuries were self inflicted while in 14 patients (66.7%), partners were involved. All the patients presented with pain, swelling, sudden detumescence and deviation of the penis. The right side was affected in 61.9% of the cases. The penile mid-shaft was the site of injury in 57.1% of cases. Six patients (28.6%) had associated urethral injuries. Eighteen patients (85.7%) had immediate surgery, 2 patients (9.5%) refused surgery and were treated conservatively. One patient who presented late was also managed conservatively. All but one patient had satisfactory penile erections with no significant complications. Overenthusiastic and vigorous sexual activities were the most common causes of penile fracture in this study. A third of the patients had associated urethral injuries. Early surgical repair led to satisfactory outcome.

Epigenetics markers of metastasis and HPV-induced tumorigenesis in penile cancer.

PubMed

Feber, Andrew; Arya, Manit; de Winter, Patricia; Saqib, Muhammad; Nigam, Raj; Malone, Peter R; Tan, Wei Shen; Rodney, Simon; Lechner, Matthias; Freeman, Alex; Jameson, Charles; Muneer, Asif; Beck, Stephan; Kelly, John D

2015-03-01

Penile cancer is a rare malignancy in the developed world with just more than 1,600 new cases diagnosed in the United States per year; however, the incidence is much higher in developing countries. Although HPV is known to contribute to tumorigenesis, little is known about the genetic or epigenetic alterations defining penile cancer. Using high-density genome-wide methylation arrays, we have identified epigenetic alterations associated with penile cancer. Q-MSP was used to validate lymph node metastasis markers in 50 cases. A total of 446 head and neck squamous cell carcinoma (HNSCC) and cervical squamous cell carcinoma (CESCC) samples were used to validate HPV-associated epigenetic alterations. We defined 6,933 methylation variable positions (MVP) between normal and tumor tissue, which includes 997 hypermethylated differentially methylated regions associated with tumor supressor genes, including CDO1, AR1, and WT1. Analysis of penile cancer tumors identified a 4 gene epi-signature which accurately predicted lymph node metastasis in an independent cohort (AUC of 89%). Finally, we explored the epigenetic alterations associated with penile cancer HPV infection and defined a 30 loci lineage-independent HPV specific epi-signature which predicts HPV status and survival in independent HNSCC, CESC cohorts. Epi-signature-negative patients have a significantly worse overall survival [HNSCC P = 0.00073; 95% confidence interval (CI), 0.021-0.78; CESC P = 0.0094; HR = 3.91, 95% CI = 0.13-0.78], HPV epi-signature is a better predictor of survival than HPV status alone. These data demonstrate for the first time genome-wide epigenetic events involved in an aggressive penile cancer phenotype and define the epigenetic alterations common across multiple HPV-driven malignancies. ©2014 American Association for Cancer Research.

Growth and development of male external genitalia: a cross-sectional study of 6200 males aged 0 to 19 years.

PubMed

Tomova, Analia; Deepinder, Fnu; Robeva, Ralitsa; Lalabonova, Hristina; Kumanov, Philip; Agarwal, Ashok

2010-12-01

To provide estimates of normal variations in penile measurements and testicular volumes, and to establish reference ranges for clinical use. Cross-sectional, population-based study. Schools, kindergartens, and child care centers in different parts of Bulgaria. A population of 6200 clinically healthy white males aged 0 to 19 years. The study physician chose schools, kindergartens, and child care centers randomly and examined children at random until he reached the required number. Each of the 20 age groups (age range, 0-19 years) had an equal number of males (ie, 310). The mean (SD) values and fifth, 50th, and 95th percentiles of height (Siber Hegner anthropometer), weight (beam balance), testicular volume (Prader orchidometer), penile length (rigid tape), and penile circumference (measuring tape) from birth to 19 years of age. Testes did not show any increase in size until the onset of puberty at age 11 years, whereas penile growth was gradual after birth. However, both penile and testicular development demonstrated peak growth from 12 to 16 years of age, which coincided with the maximal male pubertal growth spurt. Data indicate an earlier pubertal development for this study population than that for a similar population several decades ago. Significant differences between urban and rural populations regarding penile length were also noticed. Our study provides the contemporary reference range values for height, weight, testicular volume, and penile length and circumference of males aged 0 to 19 years. Our data show that, even by the end of 20th century, there is still some acceleration of male pubertal development. For the first time are reported somatic differences in genitalia within a population between urban and rural representatives.

[Trans-scrotal penile degloving, a new procedure for corporoplasties].

PubMed

Austoni, Edoardo; Altieri, Vincenzo Maria; Tenaglia, Raffaele

2012-07-01

The subcoronal approach is the most widely used skin degloving procedure for corporoplasty. Although it is relatively easy and it fully exposes the corpora cavernosa, it is not free from several complications (subcoronal lymphedema, decrease of glans sensitivity, paraphimosis, distal skin necrosis), which sometimes require a postoperative circumcision, or a preoperative prophylactic circumcision. To describe our own degloving approach, the "Trans-scrotal Penile Degloving (TPD)", that is suitable for most corporoplasties, and to present the outcomes. This is a retrospective analysis conducted on 89 patients (pts) presenting with different penile diseases, and submitted to the TPD during Corporoplasty, from February 2008 to July 2010: Congenital curvature (26 pts); Peyronie's Disease (PD) with penile curvature (18 pts); PD with erectile dysfunction and curvature (25 pts); Redo surgery with complex tunica albuginea remodeling and prosthesis implant (20 pts). The TPD approach calls for a 5 cm incision to be placed ventrally on the scrotal raphe at the penile base: penile degloving is then easily carried out up to the coronal line. Subsequently, the dorsal neurovascular bundle is normally isolated and all types of different corporoplasties can be carried out. Any complication occurring during or after surgery has been registered. Patient follow-up controls were performed on day 7, month 1 and month 3 post-surgery: -No pre- or post-operative circumcision procedures were required; -There was no evidence of post-operative preputial edema or penile skin necrosis or loss of glans sensitivity; -In 6 patients, we noted a mild scrotal sub-dartos hematoma, which reabsorbed spontaneously. TPD, which represents an evolution of our previous combined subcoronal-trans-scrotal approach, may be advantageously performed in most corporoplasties with optimal aesthetic and functional outcomes, and may replace in many cases the subcoronal approach without its associated complications.

Desire for penile girth enhancement and the effects of the self-injection of hyaluronic Acid gel.

PubMed

Coskuner, Enis Rauf; Canter, Halil Ibrahim

2012-07-01

Penile girth enhancement is a controversial subject but demands for enhancement are increasing steadily. Although various fillers have been widely used for soft tissue augmentation, there is no reliable material for this particular situation. Here we report a case of an acute hypersensitivity reaction in a man after his first self-injection of a filler material, which, he claimed, was hyaluronic acid gel for penile girth enhancement and glans penis augmentation.

Penile vascular indices in surgically treated and conservatively treated penile fracture: does conventional immediate repair matter?

PubMed

Safarinejad, Mohammad Reza; Lashkari, Mohammad Hossein; Babaei, Alireza; Dadkhah, Farid; Kolahi, Ali Asghar

2012-12-01

To investigate the impact of immediate surgical repair and conservative treatment of penile fracture (PF) on penile vascular indices. The study includes 146 surgically treated (group 1), and 56 conservatively treated patients (group 2). All of the participants underwent penile duplex Doppler ultrasonography (PDDU), and Doppler parameters including the peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured in both corpora at baseline and after intracavernosal injection of 20 μg prostaglandin E1. Univariable and multivariable Cox regression analysis addressed study variables. An increased number of men in group 2 (25.0%) compared with men in group 1 (19.2%) reported ED, but the difference did not reach statistical significance (P=0.06). In patients with ED the mean PSV did not differ significantly between the group 1 (30.1±4.02 cm/s) and group 2 (30.1±4.02 cm/s) (P=0.32). Also, in patients without ED, the mean PSV for group 1 (82.4±24.1 cm/s) subjects did not differ significantly from the means for the group 2 patients (79.4±27.2 cm/s) (P=0.21). Vascular hemodynamics in fractured corpus cavernosum did not differ significantly between two groups (P=0.08). Current method of surgical treatment does not provide better outcome in terms of erectile function and penile vascular hemodynamics.

HPV- and non-HPV-related subtypes of penile squamous cell carcinoma (SCC): Morphological features and differential diagnosis according to the new WHO classification (2015).

PubMed

Sanchez, Diego F; Cañete, Sofía; Fernández-Nestosa, María José; Lezcano, Cecilia; Rodríguez, Ingrid; Barreto, José; Alvarado-Cabrero, Isabel; Cubilla, Antonio L

2015-05-01

The majority of penile carcinomas are squamous cell carcinomas originating in the squamous mucosa covering the glans, coronal sulcus, or inner surface of the foreskin, the 3 latter sites comprising the penile anatomical compartments. There is a variegated spectrum of subtypes of penile squamous cell carcinomas according to recent classification schemes. Currently, because of etiological and prognostic considerations, 2 morphologically and molecularly distinctive groups of subtypes of penile SCCs based on the presence of HPV were delineated. The predominant cell composition of tumors associated with HPV is the basaloid cell, which is the hallmark and best tissue marker for the virus. Tumors negative for the virus, however, are preferentially of lower grade and keratinizing maturing neoplasms with the exception of sarcomatoid carcinoma. HPV is detected in research studies by PCR or in situ hybridization (ISH) technologies, but p16 immunohistochemical stain is an adequate and less-expensive surrogate that is useful in the routine practice of pathology. The aim of this review is to demonstrate the variable morphological phenotypic expression of penile tumors separating non-HPV- and HPV-related neoplasms and to add morphological information that will justify subclassifying squamous cell carcinomas in a number of special subtypes. A brief discussion of the differential diagnosis in each category is also provided. Copyright © 2015 Elsevier Inc. All rights reserved.

MYC copy number gains are associated with poor outcome in penile squamous cell carcinoma.

PubMed

Masferrer, Emili; Ferrándiz-Pulido, Carla; Lloveras, Belén; Masferrer-Niubò, Magalí; Espinet, Blanca; Salido, Marta; Rodríguez-Rivera, María; Alemany, Laia; Placer, Jose; Gelabert, Antoni; Servitje, Octavi; García-Patos, Vicenç; Pujol, Ramon M; Toll, Agustí

2012-11-01

We determined MYC gene numerical aberrations and protein expression at different stages of penile squamous cell carcinoma carcinogenesis. We correlated these findings with clinicopathological parameters and HPV infection. We evaluated 79 cases of penile squamous cell carcinoma, including 11 in situ and 68 invasive carcinomas. The MYC cytogenetic profile was evaluated by fluorescence in situ hybridization. HPV was detected by polymerase chain reaction amplification. MYC gains were identified in 4 of 11 in situ carcinomas (36%) and 50 of 68 invasive penile squamous cell carcinomas (73%). A significant association between MYC gains, and tumor progression and poor outcome was demonstrated (p <0.05). HPV DNA was detected in 32 of 79 penile squamous cell carcinomas (39%). High risk type 16 was the most prevalent type. MYC numerical aberrations did not correlate with HPV status. A significant association between HPV and MYC protein over expression was noted. In HPV negative cases MYC gains correlated with MYC over expression. MYC gains progressively increased during penile squamous cell carcinoma progression from in situ samples to metastases. MYC gains were an independent factor for poor prognosis. These findings were independent of HPV infection. MYC expression was increased in samples with HPV infection, probably reflecting direct activation of MYC. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

[Five-year survival analysis in patients with penile cancer].

PubMed

Montiel-Jarquín, Álvaro José; Contreras-Díaz, Antonio Jesús; Vázquez-Cruz, Eduardo; Chopin-Gazga, Marco Antonio; Romero-Figueroa, María Socorro; Etchegaray-Morales, Ivet; Alvarado-Ortega, Ivan

2017-01-01

Short-term survival of penile cancer is poor. The objective was to describe the 5-years penile cancer survival. Retrospective cohort study. We included patients with penile cancer managed surgically from 2010 to 2014. Descriptive statistics were used for socio-demographic variables and the Kaplan-Meier estimator for survival function. We studied 22 patients with a mean age of 64.95 years and a time of evolution of 25 months after the diagnosis. 68.2% of patients smoked or had human papillomavirus (HPV); they all presented phimosis; 72.7% had pain in the penis and the groin area; 81.8% had palpable lymph nodes and 45.5% lesions ≥ 3 cm; 86.3% were diagnosed in clinical stage IIIa. 59.1% underwent partial penectomy and 86.4% had squamous cell variety. 40.9% of patients died six months after the surgery. 66% of the smokers presented metastasis; all of the patients that smoked and had HPV infection had neurovascular invasion and died; 83.3% of the patients (n = 6) who underwent partial penectomy and positive lymph node dissection due to metastases died. The 5-years mortality of patients with penile cancer was 40.9%. Tobacco use and HPV increase morbidity and mortality in patients with penile cancer; lesions greater than 5 cm are more common in smokers. The size of the lesion increases with the delay in treatment.

Long-term Results of Ventral Penile Curvature Repair in Childhood.

PubMed

Golomb, Dor; Sivan, Bezalel; Livne, Pinhas M; Nevo, Amihay; Ben-Meir, David

2018-02-01

To assess the postpubertal outcome of ventral penile curvature repaired in infancy in terms of recurrence and aesthetics. Postpubertal patients treated for hypospadias and ventral penile curvature in infancy at a tertiary medical center were invited to undergo assessment of the quality of the repair. Findings were compared between patients with a straight penis after skin release and patients who required dorsal plication. The cohort included 27 patients of mean age 16.5 years who were reported with straight penis after surgery. Postpubertal curvature was found in 6 of 14 patients (43%) successfully treated by skin release and 10 of 13 patients (77%) who underwent dorsal plication (P = .087). Significant curvature (≥30 degrees) was found in 1 of 14 patients in the skin-release group and 4 of 13 in the dorsal plication group (P = .16). Rates of redo urethroplasty were 2 of 14 (14%) and 5 of 10 (50%), respectively. Patient satisfaction with the appearance of the penis did not differ significantly. Ventral penile curvature repaired in infancy often recurs after puberty. The need for dorsal plication has a trend-level association with recurrence of penile curvature in puberty. It might also be related to the degree of postpubertal penile curvature and the need for redo urethroplasty. Procedure type does not affect patient satisfaction with the postpubertal appearance of the penis. Copyright © 2017 Elsevier Inc. All rights reserved.

Position paper: Management of men complaining of a small penis despite an actually normal size.

PubMed

Ghanem, Hussein; Glina, Sidney; Assalian, Pierre; Buvat, Jacques

2013-01-01

With the worldwide increase in penile augmentation procedures and claims of devices designed to elongate the penis, it becomes crucial to study the scientific basis of such procedures or devices, as well as the management of a complaint of a small penis in men with a normal penile size. The aim of this work is to study the scientific basis of opting to penile augmentation procedures and to develop guidelines based on the best available evidence for the management of men complaining of a small penis despite an actually normal size. We reviewed the literature and evaluated the evidence about what the normal penile size is, what patients complaining of a small penis usually suffer from, benefits vs. complications of surgery, penile stretching or traction devices, and outcome with patient education and counseling. Repeated presentation and detailed discussions within the Standard Committee of the International Society for Sexual Medicine were performed. Recommendations are based on the evaluation of evidence-based medical literature, widespread standards committee discussion, public presentation, and debate. We propose a practical approach for evaluating and counseling patients complaining of a small-sized penis. Based on the current status of science, penile lengthening procedure surgery is still considered experimental and should only be limited to special circumstances within research or university institutions with supervising ethics committees. © 2012 International Society for Sexual Medicine.

Down-regulation of Toll-like Receptor TLR4 Is Associated with HPV DNA Integration in Penile Carcinoma.

PubMed

Damasdi, Miklos; Kovacs, Krisztina; Farkas, Nelli; Jakab, Ferenc; Kovacs, Gyula

2017-10-01

Development of penile cancers is attributed to HPV-related carcinogenesis. Our aim was to analyze HPV positivity and TLR4, p16 ink4a and p53 expression. HPV presence was assessed with virus-specific TaqMan PCR and HPV Genotyping Test in 31 penile cancers. Immunohistochemistry was carried out on tissue microarray. TLR4 expression was detected in 4 of the 16 HPV positive and 13 of the 15 HPV negative tumors. We found a significant inverse correlation between HPV positivity and TLR4 expression (p=0.0006). Ten of the 16 HPV-positive but none of the 15 HPV-negative tumors expressed p16INK4a. A significant correlation was seen between p53 expression and lack of HPV DNA (p=0.0191) as well as between TLR4 and p53 expression (p=0.0198) in penile cancers. Our findings suggest a protective role of TLR4 expression against HPV DNA integration and the viral and non-viral carcinogenesis of penile cancer. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Personal series with clinical review of fracture penis.

PubMed

Bhuiyan, Z H; Khan, S A; Tawhid, M H; Islam, M F

2007-07-01

Penile fracture is an uncommon Urological emergency. In flaccid state it allows significant degree of deformation without any injury to the vital structures but in erected state it is vulnerable to blunt injury. The tumescent corpora cavernosa may have got injured due to nonphysiological bending of penile shaft. The true incidence of penile fracture is not known even in western countries. It is either under reported or hidden for potential social embracement. We have reviewed all of our cases of penile fracture and has been conducted a retrospective study in the Department of Urology, Bangladesh Medical College, Dhaka. The study period was from October 2001 to January 2006. The sample size was 23. All patients have got classical history of penile fracture. The time between the onset of symptom and seeking of medical care ranges from 02 hours to 07 days. The diagnosis was made on the basis of history and clinical examination only. All the patients were underwent surgery. The potency was well preserved in all of our patients. The local tissue healing process is better among the patients, reported earlier. The overall result is excellent.

Cabozantinib-s-malate and Nivolumab With or Without Ipilimumab in Treating Patients With Metastatic Genitourinary Tumors

ClinicalTrials.gov

2018-04-02

Clear Cell Renal Cell Carcinoma; Metastatic Malignant Neoplasm in the Bone; Metastatic Penile Carcinoma; Renal Pelvis Urothelial Carcinoma; Squamous Cell Carcinoma of the Penis; Stage III Bladder Adenocarcinoma AJCC v6 and v7; Stage III Bladder Squamous Cell Carcinoma AJCC v6 and v7; Stage III Bladder Urothelial Carcinoma AJCC v6 and v7; Stage III Penile Cancer AJCC v7; Stage III Renal Cell Cancer AJCC v7; Stage III Renal Pelvis Cancer AJCC v7; Stage III Ureter Cancer AJCC v7; Stage III Urethral Cancer AJCC v7; Stage IIIa Penile Cancer AJCC v7; Stage IIIb Penile Cancer AJCC v7; Stage IV Bladder Adenocarcinoma AJCC v7; Stage IV Bladder Squamous Cell Carcinoma AJCC v7; Stage IV Bladder Urothelial Carcinoma AJCC v7; Stage IV Penile Cancer AJCC v7; Stage IV Renal Cell Cancer AJCC v7; Stage IV Renal Pelvis Cancer AJCC v7; Stage IV Ureter Cancer AJCC v7; Stage IV Urethral Cancer AJCC v7; Ureter Urothelial Carcinoma; Urethral Urothelial Carcinoma

The structural characteristics of inflatable beams

NASA Astrophysics Data System (ADS)

Wicker, William J.

1992-08-01

Two inflatable beams are designed and fabricated from polyethylene of ultrahigh molecular weight, and the structures are tested against similar composite and metal-alloy tubes. Specific attention is given to the choice of material that insures material stiffness, good strength-to-weight ratio, creep resistance, and durability. A cloth beam is built from a commercial extended-chain polyethylene fiber, and the inflated beams are tested by means of three- and four-point loading to measure bending and shear deformation. Comparing geometrically similar structures shows that the fabric beams can be about 35 percent as stiff as aluminum for small deflections. The inflatable beams have elastic stiffness coefficients five and two times higher than those for nylon and polyester tubes, respectively. Inflatable structures are concluded to hold promise for lightweight aerospace applications which demand small storage areas.

Engineers Jim Murray and Joe Pahle prepare a deployable, inflatable wing technology demonstrator exp

NASA Technical Reports Server (NTRS)

2001-01-01

Engineers Jim Murray and Joe Pahle prepare a deployable, inflatable wing technology demonstrator experiment flown by the NASA Dryden Flight Research Center, Edwards, California. The inflatable wing project represented a basic flight research effort by Dryden personnel. Three successful flights of the I2000 inflatable wing aircraft occurred. During the flights, the team air-launched the radio-controlled (R/C) I2000 from an R/C utility airplane at an altitude of 800-1000 feet. As the I2000 separated from the carrier aircraft, its inflatable wings 'popped-out,' deploying rapidly via an on-board nitrogen bottle. The aircraft remained stable as it transitioned from wingless to winged flight. The unpowered I2000 glided down to a smooth landing under complete control.

The I2000, a deployable, inflatable wing technology demonstrator experiment aircraft, leaves the gro

NASA Technical Reports Server (NTRS)

2001-01-01

The deployable, inflatable wing technology demonstrator experiment aircraft leaves the ground during a flight conducted by the NASA Dryden Flight Research Center, Edwards, California. The inflatable wing project represented a basic flight research effort by Dryden personnel. Three successful flights of the I2000 inflatable wing aircraft occurred. During the flights, the team air-launched the radio-controlled (R/C) I2000 from an R/C utility airplane at an altitude of 800-1000 feet. As the I2000 separated from the carrier aircraft, its inflatable wings 'popped-out,' deploying rapidly via an on-board nitrogen bottle. The aircraft remained stable as it transitioned from wingless to winged flight. The unpowered I2000 glided down to a smooth landing under complete control.

An innovative methodology for measurement of stress distribution of inflatable membrane structures

NASA Astrophysics Data System (ADS)

Zhao, Bing; Chen, Wujun; Hu, Jianhui; Chen, Jianwen; Qiu, Zhenyu; Zhou, Jinyu; Gao, Chengjun

2016-02-01

The inflatable membrane structure has been widely used in the fields of civil building, industrial building, airship, super pressure balloon and spacecraft. It is important to measure the stress distribution of the inflatable membrane structure because it influences the safety of the structural design. This paper presents an innovative methodology for the measurement and determination of the stress distribution of the inflatable membrane structure under different internal pressures, combining photogrammetry and the force-finding method. The shape of the inflatable membrane structure is maintained by the use of pressurized air, and the internal pressure is controlled and measured by means of an automatic pressure control system. The 3D coordinates of the marking points pasted on the membrane surface are acquired by three photographs captured from three cameras based on photogrammetry. After digitizing the markings on the photographs, the 3D curved surfaces are rebuilt. The continuous membrane surfaces are discretized into quadrilateral mesh and simulated by membrane links to calculate the stress distributions using the force-finding method. The internal pressure is simplified to the external node forces in the normal direction according to the contributory area of the node. Once the geometry x, the external force r and the topology C are obtained, the unknown force densities q in each link can be determined. Therefore, the stress distributions of the inflatable membrane structure can be calculated, combining the linear adjustment theory and the force density method based on the force equilibrium of inflated internal pressure and membrane internal force without considering the mechanical properties of the constitutive material. As the use of the inflatable membrane structure is attractive in the field of civil building, an ethylene-tetrafluoroethylene (ETFE) cushion is used with the measurement model to validate the proposed methodology. The comparisons between the obtained results and numerical simulation for the inflation process of the ETFE cushion are performed, and the strong agreements demonstrate that the proposed methodology is feasible and accurate.

Adolescent Sexual Behavior in Two Ethnic Minority Groups: A Multisystem Perspective.

ERIC Educational Resources Information Center

Miller, Kim S.; Forehand, Rex; Kotchick, Beth A.

2000-01-01

Black and Hispanic adolescents (N=907) and their mothers were interviewed concerning the adolescents' experiences with penile-vaginal intercourse. Factors from three systems (self, family, and extrafamilial) that are influential in the lives of adolescents were evaluated using four outcome measures. Factors from most or all systems emerged as…

Penile Implants

MedlinePlus

... ED that's situational, the result of a relationship conflict or potentially reversible An infection, such as a ... your partner in the discussion with your doctor. Types of penile implants There are two main types ...

Rectal adenocarcinoma infiltrating the bulbar urethra and metastasising to the penis

PubMed Central

James, Mathews; Amaranathan, Anandhi; Nelamangala Ramakrishnaiah, Vishnu Prasad; Toi, Pampa Chakrabarty

2016-01-01

Secondary penile tumours from rectal carcinoma is a known clinical entity but can be missed unless carefully evaluated. We report a case of rectal adenocarcinoma with synchronous painless penile nodules. A patient presented with constipation and rectal bleeding. He had an anorectal growth as well as palpable nodules on his penis. Rectal biopsy yielded adenocarcinoma. Imaging revealed direct infiltration of tumour into the bulb of the penis as well as distal shaft lesions. Fine-needle aspiration cytology of the penile nodule showed metastatic adenocarcinoma. Diversion colostomy was performed and the patient referred for chemoradiation. Since he did not have any urinary symptoms, the penile lesions were left unaltered. Repeat imaging after concurrent chemoradiotherapy showed no response. The prognosis was explained and the patient was given palliative clinic care. PMID:27312852

Technical considerations to minimize complications of inguinal lymph node dissection

PubMed Central

Gupta, Manik K.; Patel, Amar P.

2017-01-01

Penile cancer is a rare malignancy with a high propensity for regional dissemination. Current guidelines recommend inguinal lymphadenectomy in patients with penile cancer for palpable inguinal lymph nodes or in certain cases of nonpalpable inguinal lymph nodes. For many years, this procedure was performed with a traditional open approach and carried significant morbidity due to severe lymphedema, flap necrosis, wound infections, and seroma formation. The evolution of inguinal lymphadenectomy surgery for patients with penile cancer to a more minimally invasive approach has greatly reduced the morbidity of the procedure. Complications of inguinal lymphadenectomy can be minimized with modifications in surgical approach with the use of endoscopic, robotic, and various reconstructive methods. This review focuses on various intraoperative techniques to reduce morbidity in inguinal lymphadenectomies for penile cancer. PMID:29184778

[Two Cases of Penile Fracture Diagnosed by Magnetic Resonance Imaging].

PubMed

Kuribayashi, Sohei; Takao, Tetsuya; Yamamichi, Gaku; Kawamura, Masataka; Nakano, Kosuke; Kishimoto, Nozomu; Tanigawa, Go; Tsutahara, Koichi; Yamaguchi, Seiji

2016-09-01

We report two cases of penile fracture. Case 1 was in a 22-year-old male. He heard a cracking sound during urination and experienced acute penile pain and detumescence. He was admitted to our hospital on that day. Case 2 was in a 52-year-old male. He heard a cracking sound during sexual intercourse and experienced detumescence. He was admitted to our hospital on the next day. In both cases, magnetic resonance imaging (MRI) showed disruption of the tunica albuginea. We performed immediate surgical repair through localized incision. They had no perioperative complications. Several months after surgery, they reported subjectively good erection without penile curvature or pain. We found that MRI is a useful tool for the assessment of location of the tunica rupture and minimization of the surgical incision.

No-scale ripple inflation revisited

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Tianjun; Li, Zhijin; Nanopoulos, Dimitri V., E-mail: tli@itp.ac.cn, E-mail: lizhijin@physics.tamu.edu, E-mail: dimitri@physics.tamu.edu

We revisit the no-scale ripple inflation model, where no-scale supergravity is modified by an additional term for the inflaton field in the Kähler potential. This term not only breaks one SU(N,1) symmetry explicitly, but also plays an important role for inflation. We generalize the superpotential in the no-scale ripple inflation model slightly. There exists a discrete Z{sub 2} symmetry/parity in the scalar potential in general, which can be preserved or violated by the non-canonical nomalized inflaton kinetic term. Thus, there are three inflation paths: one parity invariant path, and the left and right paths for parity violating scenario. We showmore » that the inflations along the parity invariant path and right path are consistent with the Planck results. However, the gavitino mass for the parity invariant path is so large that the inflation results will be invalid if we consider the inflaton supersymmetry breaking soft mass term. Thus, only the inflation along the right path gives the correct and consistent results. Notably, the tensor-to-scalar ratio in such case can be large, with a value around 0.05, which may be probed by the future Planck experiment.« less

Individuality in harpsichord performance: disentangling performer- and piece-specific influences on interpretive choices

PubMed Central

Gingras, Bruno; Asselin, Pierre-Yves; McAdams, Stephen

2013-01-01

Although a growing body of research has examined issues related to individuality in music performance, few studies have attempted to quantify markers of individuality that transcend pieces and musical styles. This study aims to identify such meta-markers by discriminating between influences linked to specific pieces or interpretive goals and performer-specific playing styles, using two complementary statistical approaches: linear mixed models (LMMs) to estimate fixed (piece and interpretation) and random (performer) effects, and similarity analyses to compare expressive profiles on a note-by-note basis across pieces and expressive parameters. Twelve professional harpsichordists recorded three pieces representative of the Baroque harpsichord repertoire, including three interpretations of one of these pieces, each emphasizing a different melodic line, on an instrument equipped with a MIDI console. Four expressive parameters were analyzed: articulation, note onset asynchrony, timing, and velocity. LMMs showed that piece-specific influences were much larger for articulation than for other parameters, for which performer-specific effects were predominant, and that piece-specific influences were generally larger than effects associated with interpretive goals. Some performers consistently deviated from the mean values for articulation and velocity across pieces and interpretations, suggesting that global measures of expressivity may in some cases constitute valid markers of artistic individuality. Similarity analyses detected significant associations among the magnitudes of the correlations between the expressive profiles of different performers. These associations were found both when comparing across parameters and within the same piece or interpretation, or on the same parameter and across pieces or interpretations. These findings suggest the existence of expressive meta-strategies that can manifest themselves across pieces, interpretive goals, or expressive devices. PMID:24348446

Urethral Foreign Bodies: Clinical Presentation and Management.

PubMed

Palmer, Cristina J; Houlihan, Matthew; Psutka, Sarah P; Ellis, K Alexandria; Vidal, Patricia; Hollowell, Courtney M P

2016-11-01

To review a single institution's 15-year experience with urethral foreign bodies, including evaluation, clinical findings, and treatment. In total, 27 patients comprising 35 episodes of inserted urethral foreign bodies were reviewed at Cook County Hospital between 2000 and 2015. Retrospective chart review was performed to describe the clinical presentation, rationale for insertion, management, recidivism, and sequelae. Median patient age was 26 (range 12-60). Twenty-six patients (97 %) were male, 1 was female (3%). Items inserted included pieces of plastic forks, spoons, metal screws and aluminum, pieces of cardboard or paper, staples, writing utensils such as pens and pencils, as well as coaxial cable and spray foam sealant. Reported reasons for insertion were self-stimulation, erectile enhancement, and attention seeking. Presenting symptoms included dysuria, gross hematuria, urinary retention, urinary tract infection, and penile discharge. The most common technique for removal was manual extraction with extrinsic pressure (n = 19, 54%). Other methods include endoscopic retrieval (n = 8, 23%), open cystotomy (n = 1, 3%), and voiding to expel the foreign body (n = 7, 20%). Postremoval complications included urinary tract infection (n = 7), sepsis (n = 4), urethral false passage (n = 5), laceration (n = 5), and stricture (n = 1). We present the largest single-institutional series of urethral foreign bodies to date. Urethral foreign body insertion is a relatively rare occurrence and, commonly, is a recurrent behavior. Urethral trauma related to foreign body insertion is associated with significant risk of infection and urethral injury with long-term sequelae. Copyright © 2016 Elsevier Inc. All rights reserved.

Desire for Penile Girth Enhancement and the Effects of the Self-Injection of Hyaluronic Acid Gel

PubMed Central

Coskuner, Enis Rauf; Canter, Halil Ibrahim

2012-01-01

Penile girth enhancement is a controversial subject but demands for enhancement are increasing steadily. Although various fillers have been widely used for soft tissue augmentation, there is no reliable material for this particular situation. Here we report a case of an acute hypersensitivity reaction in a man after his first self-injection of a filler material, which, he claimed, was hyaluronic acid gel for penile girth enhancement and glans penis augmentation. PMID:23112518

Balloon-Inflated Catheters for Enteral Feeding: a Word of Caution.

PubMed

Dash, Nihar Ranjan; Singh, Anand Narayan; Kilambi, Ragini

2018-02-01

Catheters with inflatable balloons such as a Foley catheter may be used for feeding gastrostomy/jejunostomy. The incorrect or improper use of these catheters can have serious consequences. We report 13 cases of feeding jejunostomy with balloon-inflated catheter's malfunction, some referred to our centre and others operated here over a period of 8 years. The most dramatic consequence of such improper use led to rupture of the small intestine due to inadvertent over-inflation (over 100 ml) of the balloon of the catheter during a contrast study. The patient required a laparotomy with resection and anastomosis of the bowel. Three other patients had similar over-inflation of the balloon leading to severe pain and discomfort. In all three patients, timely deflation of the balloon was sufficient to relieve the symptoms. One patient had intussusception with the inflated balloon acting as a lead point. The patient underwent resection of the small bowel with end jejunostomy and distal mucous fistula. All other patients presented with abdominal pain and distension and intestinal obstruction and were managed non-operatively with deflation of balloon either by aspiration, cutting the balloon port or ultrasound-guided puncture of balloon. Healthcare personnel dealing with patients with indwelling catheters must be educated to suspect, detect and manage such problems. The best measure for such unusual complications of otherwise safe devices would be prevention by training and generation of awareness.

Development of Inflatable Entry Systems Technologies

NASA Technical Reports Server (NTRS)

Player, Charles J.; Cheatwood, F. McNeil; Corliss, James

2005-01-01

Achieving the objectives of NASA s Vision for Space Exploration will require the development of new technologies, which will in turn require higher fidelity modeling and analysis techniques, and innovative testing capabilities. Development of entry systems technologies can be especially difficult due to the lack of facilities and resources available to test these new technologies in mission relevant environments. This paper discusses the technology development process to bring inflatable aeroshell technology from Technology Readiness Level 2 (TRL-2) to TRL-7. This paper focuses mainly on two projects: Inflatable Reentry Vehicle Experiment (IRVE), and Inflatable Aeroshell and Thermal Protection System Development (IATD). The objectives of IRVE are to conduct an inflatable aeroshell flight test that demonstrates exoatmospheric deployment and inflation, reentry survivability and stability, and predictable drag performance. IATD will continue the development of the technology by conducting exploration specific trade studies and feeding forward those results into three more flight tests. Through an examination of these projects, and other potential projects, this paper discusses some of the risks, issues, and unexpected benefits associated with the development of inflatable entry systems technology.

Computerized methodology for micro-CT and histological data inflation using an IVUS based translation map.

PubMed

Athanasiou, Lambros S; Rigas, George A; Sakellarios, Antonis I; Exarchos, Themis P; Siogkas, Panagiotis K; Naka, Katerina K; Panetta, Daniele; Pelosi, Gualtiero; Vozzi, Federico; Michalis, Lampros K; Parodi, Oberdan; Fotiadis, Dimitrios I

2015-10-01

A framework for the inflation of micro-CT and histology data using intravascular ultrasound (IVUS) images, is presented. The proposed methodology consists of three steps. In the first step the micro-CT/histological images are manually co-registered with IVUS by experts using fiducial points as landmarks. In the second step the lumen of both the micro-CT/histological images and IVUS images are automatically segmented. Finally, in the third step the micro-CT/histological images are inflated by applying a transformation method on each image. The transformation method is based on the IVUS and micro-CT/histological contour difference. In order to validate the proposed image inflation methodology, plaque areas in the inflated micro-CT and histological images are compared with the ones in the IVUS images. The proposed methodology for inflating micro-CT/histological images increases the sensitivity of plaque area matching between the inflated and the IVUS images (7% and 22% in histological and micro-CT images, respectively). Copyright © 2015 Elsevier Ltd. All rights reserved.

Critical androgen-sensitive periods of rat penis and clitoris development

PubMed Central

Welsh, Michelle; MacLeod, David J; Walker, Marion; Smith, Lee B; Sharpe, Richard M

2010-01-01

Androgen control of penis development/growth is unclear. In rats, androgen action in a foetal ‘masculinisation programming window’ (MPW; e15.5–e18.5)’ predetermines penile length and hypospadias occurrence. This has implications for humans (e.g. micropenis). Our studies aimed to establish in rats when androgen action/administration affects development/growth of the penis and if deficits in MPW androgen action were rescuable postnatally. Thus, pregnant rats were treated with flutamide during the MPW ± postnatal testosterone propionate (TP) treatment. To assess penile growth responsiveness, rats were treated with TP in various time windows (late foetal, neonatal through early puberty, puberty onset, or combinations thereof). Phallus length, weight, and morphology, hypospadias and anogenital distance (AGD) were measured in mid-puberty (d25) or adulthood (d90) in males and females, plus serum testosterone in adult males. MPW flutamide exposure reduced adult penile length and induced hypospadias dose-dependently; this was not rescued by postnatal TP treatment. In normal rats, foetal (e14.5–e21.5) TP exposure did not affect male penis size but increased female clitoral size. In males, TP exposure from postnatal d1–24 or at puberty (d15–24), increased penile length at d25, but not ultimately in adulthood. Foetal + postnatal TP (e14–postnatal d24) increased penile size at d25 but reduced it at d90 (due to reduced endogenous testosterone). In females, this treatment caused the biggest increase in adult clitoral size but, unlike in males, phallus size was unaffected by TP during puberty (d15–24). Postnatal TP treatment advanced penile histology at d25 to more resemble adult histology. AGD strongly correlated with final penis length. It is concluded that adult penile size depends critically on androgen action during the MPW but subsequent growth depends on later androgen exposure. Foetal and/or postnatal TP exposure does not increase adult penile size above its ‘predetermined’ length though its growth towards this maximum is advanced by peripubertal TP treatment. PMID:19656234

Delaying Surgical Treatment of Penile Fracture Results in Poor Functional Outcomes: Results from a Large Retrospective Multicenter European Study.

PubMed

Bozzini, Giorgio; Albersen, Maarten; Otero, Javier Romero; Margreiter, Markus; Cruz, Eduard Garcia; Mueller, Alexander; Gratzke, Christian; Serefoglu, Ege Can; Salamanca, Juan Ignacio Martinez; Verze, Paolo

2018-01-01

Penile fracture is a rare clinical entity that represents a urologic emergency. It involves traumatic rupture of the tunica albuginea of the corpora cavernosa due to twisting or bending of the penile shaft during erection. To determine the differences in preoperative diagnostic evaluation patterns and outcomes of penile fracture patients to investigate the impact of surgical delay on functional outcomes. A retrospective analysis was performed using data obtained from 137 patients presenting with penile fracture at seven different European academic medical centers between 1996 and 2013. Age, imaging modalities used, timing of surgical intervention, length of tunica albuginea defect, and surgical technique were recorded. Postoperative erectile function outcomes were assessed with the International Index of Erectile Function (IIEF-5), and the presence of postoperative penile curvature was noted. The association between timing of surgical intervention and postoperative IIEF-5 results was evaluated with discriminant function analysis. The median age of the patients was 34.50 yr (interquartile range [IQR]: 28.0-46.5 yr). Of the 137 patients, 82 (59.85%) underwent penile Doppler ultrasound, and 5 patients (3.64%) were evaluated with magnetic resonance imaging. All patients were treated surgically, and the duration between emergency room admission and surgical intervention was 5.0h (IQR: 3.6-8.0h). The median length of tunica albuginea defect was 10mm (IQR: 8-20mm). Postoperative IIEF-5 scores were 21 (IQR: 12-23) and 23 (IQR: 15-24) at the first and third postoperative months, respectively. Discriminant function analysis revealed that if the surgical intervention was performed >8.23hours after emergency room admission, postoperative erectile function was significantly worse (p=0.0051 at first month and p=0.0057 at third month postoperatively). Our multicenter study showed that delaying surgical intervention results in significantly impaired erectile function. Surgical treatment must be planned as soon as possible to avoid postoperative erectile dysfunction. We looked at sexual outcomes following the repair of penile fracture in a large European population. We found that outcomes worsened if surgical repair was delayed. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

40 CFR Table 2 to Subpart Kkkk of... - Emission Limits for Existing Affected Sources

Code of Federal Regulations, 2010 CFR

2010-07-01

... coating a. Two-piece beverage cans—all coatingsb. Two-piece food cans—all coatings c. One-piece aerosol.... Three-piece can assembly a. Inside spray 0.29 (2.43). b. Aseptic side seam stripes on food cans 1.94 (16.16). c. Nonaseptic side seam stripes on food cans 0.79 (6.57). d. Side seam stripes on general line...

Drugs Approved for Penile Cancer

Cancer.gov

This page lists cancer drugs approved by the Food and Drug Administration (FDA) for penile cancer. The list includes generic names and brand names. The drug names link to NCI’s Cancer Drug Information summaries.

Use of negative-pressure dressings and split-thickness skin grafts following penile shaft reduction and reduction scrotoplasty in the management of penoscrotal elephantiasis.

PubMed

Stokes, Tracey H; Follmar, Keith E; Silverstein, Ari D; Weizer, Alon Z; Donatucci, Craig F; Anderson, Everett E; Erdmann, Detlev

2006-06-01

From 1988 to 2005, 8 men who presented with penoscrotal elephantiasis underwent penile shaft degloving and reduction scrotoplasty, followed by transplantation of a split-thickness skin graft (STSG) to the penile shaft. The etiology of elephantiasis in these patients included self-injection of viscous fluid and postsurgical obstructive lymphedema. In the 6 most recent cases, negative-pressure dressings were applied over the STSG to promote graft take, and STSG take rate was 100%. The results of our series corroborate those of a previous report, which showed circumferential negative-pressure dressings to be safe and efficacious in bolstering STSGs to the penile shaft. Furthermore, these results suggest that the use of negative-pressure dressings may improve graft take in this patient population.

Radiation Dose-Volume Effects and the Penile Bulb

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roach, Mack, E-mail: mroach@radonc.ucsf.ed; Nam, Jiho; Gagliardi, Giovanna

2010-03-01

The dose, volume, and clinical outcome data for penile bulb are reviewed for patients treated with external-beam radiotherapy. Most, but not all, studies find an association between impotence and dosimetric parameters (e.g., threshold doses) and clinical factors (e.g., age, comorbid diseases). According to the data available, it is prudent to keep the mean dose to 95% of the penile bulb volume to <50 Gy. It may also be prudent to limit the D70 and D90 to 70 Gy and 50 Gy, respectively, but coverage of the planning target volume should not be compromised. It is acknowledged that the penile bulbmore » may not be the critical component of the erectile apparatus, but it seems to be a surrogate for yet to be determined structure(s) critical for erectile function for at least some techniques.« less

Complete penile corporeal septation: evaluation with contrast enhanced US.

PubMed

Bertolotto, Michele; Bucci, Stefano; Quaia, Emilio; Coss, Matteo; Liguori, Giovanni

2008-01-01

Complete penile corporeal septation is a rare malformation in which the corpora cavernosa are completely isolated. We describe a new method to reach the diagnosis of this malformation using contrast enhanced US. Two patients with complete penile corporeal septation underwent color Doppler and contrast enhanced US after bilateral cavernosal injection of 10 microg prostaglandin E1. Contrast enhanced US was performed using a contrast specific software (Contrast-Tuned imaging, EsaOte, Genoa, Italy) and a linear transducer designed to evaluate superficial structures. Microbubbles of SonoVue (Bracco, Milan, Italy) were injected in one corpus cavernosum. After cavernosal injection of microbubbles no adverse events were observed. Contrast enhanced US showed unilateral enhancement of the corpus cavernosum in which microbubbles were injected. Cavernosography confirmed unilateral corporeal opacification. Contrast enhanced US can be used effectively to diagnose complete penile corporeal septation.

Fracture of the penis with urethral rupture.

PubMed

Roy, Mk; Matin, Ma; Alam, Mm; Suruzzaman, M; Rahman, Mm

2008-01-01

We report a rare case of penile fracture with incomplete urethral rupture in a 25 years old male who sustained the injury during sexual intercourse. He presented with a tense haematoma on the ventral aspect of the penile shaft, associated with urethral bleeding. Per urethral catheterization was possible though it was painful. Exploration and repair of the penile fracture and urethra were performed within 16 hrs. The patient made an uneventful recovery with good erectile and voiding function. This case illustrates the value of early surgical repair of the fracture in order to prevent complications. The true incidence of penile fracture is not known even in the Western countries because it is under reported or hidden for social embracement and even it is reported to physicians it remains undiagnosed or mismanaged. Very rarely it is associated with urethral rupture.

Epithelial-to-mesenchymal transition in penile squamous cell carcinoma.

PubMed

Masferrer, Emili; Ferrándiz-Pulido, Carla; Masferrer-Niubò, Magalí; Rodríguez-Rodríguez, Alfredo; Gil, Inmaculada; Pont, Antoni; Servitje, Octavi; García de Herreros, Antonio; Lloveras, Belen; García-Patos, Vicenç; Pujol, Ramon M; Toll, Agustí; Hernández-Muñoz, Inmaculada

2015-02-01

Epithelial-to-mesenchymal transition is a phenomenon in epithelial tumors that involves loss of intercellular adhesion, mesenchymal phenotype acquisition and enhanced migratory potential. While the epithelial-to-mesenchymal transition process has been extensively linked to metastatic progression of squamous cell carcinoma, studies of the role of epithelial-to-mesenchymal transition in squamous cell carcinoma containing high risk human papillomaviruses are scarce. Moreover, to our knowledge epithelial-to-mesenchymal transition involvement in human penile squamous cell carcinoma, which can arise through transforming HPV infections or independently of HPV, has not been investigated. We evaluated the presence of epithelial-to-mesenchymal transition markers and their relationship to HPV in penile squamous cell carcinoma. We assessed the expression of E-cadherin, vimentin and the epithelial-to-mesenchymal transition related transcription factors Twist, Zeb1 and Snail by immunohistochemical staining in 64 penile squamous cell carcinoma cases. HPV was detected by polymerase chain reaction amplification. Simultaneous loss of membranous E-cadherin expression and vimentin over expression were noted in 43.5% of penile squamous cell carcinoma cases. HPV was significantly associated with loss of membranous E-cadherin but not with epithelial-to-mesenchymal transition. Recurrence and mortality rates were significantly higher in cases showing epithelial-to-mesenchymal transition. Our findings indicate that in penile squamous cell carcinoma epithelial-to-mesenchymal transition is associated with poor prognosis but not with the presence of HPV. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

An unanswered question in pediatric urology: the post pubertal persistence of prepubertal congenital penile curvature correction by tunical plication

PubMed Central

Ozkuvanci, Ünsal; Ziylan, Orhan; Dönmez, M. Irfan; Yucel, Omer Baris; Oktar, Tayfun; Ander, Haluk; Nane, Ismet

2017-01-01

ABSTRACT Objective: The aim of this study is to analyze post pubertal results of pre pubertal tunica albuginea plication with non-absorbable sutures in the correction of CPC. Materials and Methods: The files of patients who underwent tunica albuginea plication without incision (dorsal/lateral) were retrospectively reviewed. Patients younger than 13 years of age at the time of operation and older than 14 years of age in November 2015 were included. Patients with a penile curvature of less than 30 degrees & more than 45 degrees and penile/urethral anomalies were excluded. All of the patients underwent surgery followed by circumcision. Results: The mean age of patients at the time of the operation was 9.7 years (range, 6-13 years). The mean degree of ventral penile curvature measured during the operation was 39 degrees while it was 41 degrees in the lateral curvatures. All of the patients were curvature-free at the end of the operation. At the time of the follow-up examination, the mean age was 16.7 years (range, 14-25 years). Six patients had a straight (0-10 degrees) penis during erection and seven patients had recurrent penile curvatures ranging from 30 to 50 degrees. Conclusion: Pre pubertal tunica albuginea plication of congenital penile curvature (30-45 degrees) with non-absorbable sutures performed without incision is a minimal invasive method especially when performed during circumcision. However, recurrence might be observed in half of the patients after puberty. PMID:28727375

An unanswered question in pediatric urology: the post pubertal persistence of prepubertal congenital penile curvature correction by tunical plication.

PubMed

Ozkuvanci, Ünsal; Ziylan, Orhan; Dönmez, M Irfan; Yucel, Omer Baris; Oktar, Tayfun; Ander, Haluk; Nane, Ismet

2017-01-01

The aim of this study is to analyze post pubertal results of pre pubertal tunica albuginea plication with non-absorbable sutures in the correction of CPC. The files of patients who underwent tunica albuginea plication without incision (dorsal/lateral) were retrospectively reviewed. Patients younger than 13 years of age at the time of operation and older than 14 years of age in November 2015 were included. Patients with a penile curvature of less than 30 degrees & more than 45 degrees and penile/urethral anomalies were excluded. All of the patients underwent surgery followed by circumcision. The mean age of patients at the time of the operation was 9.7 years (range, 6-13 years). The mean degree of ventral penile curvature measured during the operation was 39 degrees while it was 41 degrees in the lateral curvatures. All of the patients were curvature-free at the end of the operation. At the time of the follow-up examination, the mean age was 16.7 years (range, 14-25 years). Six patients had a straight (0-10 degrees) penis during erection and seven patients had recurrent penile curvatures ranging from 30 to 50 degrees. Pre pubertal tunica albuginea plication of congenital penile curvature (30-45 degrees) with non-absorbable sutures performed without incision is a minimal invasive method especially when performed during circumcision. However, recurrence might be observed in half of the patients after puberty. Copyright® by the International Brazilian Journal of Urology.

[EFFECTIVENESS OF ADVANCED SKIN FLAP AND V-SHAPED VENTRAL INCISION ALONG THE ROOT OF PENILE SHAFT FOR CONCEALED PENIS].

PubMed

Lin, Junshan; Li, Dumiao; Zhang, Jianxing; Wu, Qiang; Xu, Yali; Lin, Li

2015-09-01

To investigate effectiveness of advanced skin flap and V-shaped ventral incision along the root of penile shaft for concealed penis in children. Between July 2007 and January 2015, 121 boys with concealed penis were treated with advanced skin flap and V-shaped ventral incision along the root of penile shaft. The age varied from 18 months to 13 years (mean, 7.2 years). Repair was based on a vertical incision in median raphe, complete degloving of penis and tacking its base to the dermis of the skin. Advanced skin flap and a V-shaped ventral incision along the root of penile shaft were used to cover the penile shaft. The operation time ranged from 60 to 100 minutes (mean, 75 minutes). Disruption of wound occurred in 1 case, and was cured after dressing change; and primary healing of incision was obtained in the others. The follow-up period ranged from 3 months to 7 years (median, 24 months). All patients achieved good to excellent cosmetic results with a low incidence of complications. The results were satisfactory in exposure of penis and prepuce appearance. No obvious scar was observed. The penis had similar appearance to that after prepuce circumcision. A combination of advanced skin flap and V-shaped ventral incision along the root of penile shaft is a simple, safe, and effective procedure for concealed penis with a similar appearance result to the prepuce circumcision.

A nonimaging scintillation probe to measure penile hemodynamics.

PubMed

Zuckier, L S; Korupolu, G R; Gladshteyn, M; Sattenberg, R; Goldstein, R; Ricciardi, R; Goodwin, P; Melman, A; Blaufox, M D

1995-12-01

We have developed a penile nonimaging scintillation (PNIS) probe consisting of a plastic well-type scintillation crystal interfaced to a portable computer and acquisition board. This report describes the design of the PNIS probe, performance characteristics, mode of usage and illustrative results which demonstrate its capabilities. With the PNIS probe, penile blood-pool studies were performed in nine patients utilizing 3.7 MBq (100 microCi) autologous 99mTc-labeled red blood cells (RBCs). Venous blood standards were assayed to enable conversion of the count rate to volummetric measurements. Washin of peripherally administered 99mTc-RBCs was mathematically analyzed to estimate penile blood volume and cavernosal flow rate in the flaccid state. The rate of change of penile blood volume after intracavernosal vasodilators was used to generate measures of stimulated flow. A major advantage of this device over the gamma-camera is a 3300-fold increase in count rate sensitivity, which allows for markedly improved temporal resolution while significantly reducing the radiopharmaceutical dosage. Additionally, the PNIS probe is portable, economical and is not dependent on operator-defined regions of interest. Count rate sensitivity is relatively constant within the bore, with the exception of the proximal region adjacent to the opening, where geometric efficiency is reduced. The PNIS probe is an effective device for measuring penile activity in radionuclide studies, allowing for acquisition of time-activity curves of the penis during flaccid washin of peripherally labeled red blood cells and after pharmacologic stimulation to induce erection.

The interactive bending wrinkling behaviour of inflated beams

PubMed Central

Liu, Y. P.; Tan, H. F.; Wadee, M. K.

2016-01-01

A model is proposed based on a Fourier series method to analyse the interactive bending wrinkling behaviour of inflated beams. The whole wrinkling evolution is tracked and divided into three stages by identifying the bifurcations of the equilibrium path. The critical wrinkling and failure moments of the inflated beam can then be predicted. The global–local interactive buckling pattern is elucidated by the proposed theoretical model and also verified by non-contact experimental tests. The effects of geometric parameters, internal pressure and boundary conditions on the buckling of inflated beams are investigated finally. The results reveal that the interactive buckling characteristics of an inflated beam under bending are more sensitive to the dimensions of the structure and boundary conditions. We find that for beams which are simply supported at both ends or clamped and simply supported, boundary conditions may prevent the wrinkling formation. The results provide significant support for our understanding of the bending wrinkling behaviour of inflated beams. PMID:27713665

Operating characteristics of a three-piece-inner-ring large-bore roller bearing to speeds of 3 million DN

NASA Technical Reports Server (NTRS)

Schuller, F. T.

1984-01-01

A 118 mm bore roller bearing with a three piece inner ring ran successfully at 300,000 DN for 20 hr. Provisions were made for lubrication and cooling through the inner ring. In some tests the outer ring was also cooled. Power loss within the bearing increased with both speed and total oil flow rate to the inner ring. Outer ring temperature decreased by as much as 22 K (40 F) when outer ring cooling was employed whereas inner ring temperature remained essentially constant. Cage slip was greatly reduced or even eliminated by using a bearing with a very tight clearance at operating speed. A three piece inner ring bearing had higher inner ring temperatures and less temperature difference between the inner and outer rings than a conventional one piece inner ring bearing.

Historical Inflation Program. A Computer Program Generating Historical Inflation Indices for Army Aircraft. Revision.

DTIC Science & Technology

1984-01-01

data comes in three published formats: (1) a cumulative history coverina past years on a monthly basis, 5 (2) yearly supplements (such as wage and...all fisca. ea’r :. ma. Outzu: _ dNx’resse as monthly, quarterly, fiscal vear, and .-r ear 4n- :~n.e (in calen- dar year 1967 base) and inflation faCt...These indices and factors provide a means of adjusting historical cost data for the procurement of Army aircraft to constant year dollars. Additional

The Effect of High Versus Low Teacher Affect and Passive Versus Active Student Activity During Music Listening on Preschool Children's Attention, Piece Preference, Time Spent Listening, and Piece Recognition.

ERIC Educational Resources Information Center

Sims, Wendy L.

1986-01-01

Small-group listening lessons and subsequent individual posttests were used to judge 94 three- through five-year-old subjects' attention, paired-comparison piece preference, time spent listening, and piece recognition. Research procedures included a modified multiple baseline design and split-screen video taping of instructional sessions.…

Penile Traumatic Neuroma: A Late Complication of Penile Dorsal Neurotomy to Treat Premature Ejaculation.

PubMed

Park, Hyun Jun; Kim, Tae Nam; Baek, Seung Ryong; Lee, Kyung Min; Choi, Kyung-Un; Park, Nam Cheol

2016-09-01

Traumatic neuroma is a reactive process caused by the regeneration of an injured nerve that usually forms a nodular proliferation of small nerve bundles. Penile traumatic neuroma is rare; only a few cases related to circumcision have been reported. To report on a case of traumatic neuroma in the penis after selective dorsal neurotomy (SDN) to treat premature ejaculation. The penile traumatic neuroma was successfully removed by excision and confirmed by histopathology. A 55-year-old man who had had several painless, slow-growing nodules on his penis for 2 years presented to our hospital. He had no history of genital trauma, urinary tract infection, or penile surgery, except SDN to treat premature ejaculation. The nodules were excised and the final diagnosis was traumatic neuroma. No recurrence has been detected during 1 year of follow-up. The main complications of SDN are recurrence of premature ejaculation, pain or paresthesia on the glans penis, and erectile dysfunction. However, no traumatic neuroma has been reported as a complication. We report that a traumatic neuroma can occur after SDN. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Dysfunctional penile cholinergic nerves in diabetic impotent men

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blanco, R.; Saenz de Tejada, I.; Goldstein, I.

1990-08-01

Impotence in the diabetic man may be secondary to a neuropathic condition of the autonomic penile nerves. The relationship between autonomic neuropathy and impotence in diabetes was studied in human corporeal tissue obtained during implantation of a penile prosthesis in 19 impotent diabetic and 15 nondiabetic patients. The functional status of penile cholinergic nerves was assessed by determining their ability to accumulate tritiated choline (34), and synthesize (34) and release (19) tritiated-acetylcholine after incubation of corporeal tissue with tritiated-choline (34). Tritiated-choline accumulation, and tritiated-acetylcholine synthesis and release were significantly reduced in the corporeal tissue from diabetic patients compared to thatmore » from nondiabetic patients (p less than 0.05). The impairment in acetylcholine synthesis worsened with the duration of diabetes (p less than 0.025). No differences in the parameters measured were found between insulin-dependent (11) and noninsulin-dependent (8) diabetic patients. The ability of the cholinergic nerves to synthesize acetylcholine could not be predicted clinically with sensory vibration perception threshold testing. It is concluded that there is a functional penile neuropathic condition of the cholinergic nerves in the corpus cavernosum of diabetic impotent patients that may be responsible for the erectile dysfunction.« less

Nonoperative treatment of patients with presumed penile fracture.

PubMed

Mydlo, J H; Gershbein, A B; Macchia, R J

2001-02-01

Immediate surgical intervention is the basis for treatment of penile fractures due to the high risk of complications associated with conservative management. Unfortunately, patient refusal to undergo surgery has led to conservative treatment of a small group of patients with presumed penile fractures at our institution. We followed these patients in regard to clinical outcome. Between 1992 and 1999, 5 patients were evaluated after blunt trauma to an erect penis. Patient age at presentation ranged from 19 to 31 years (mean 25). The interval from time of injury to presentation was 24 to 72 hours. Of these patients 4 had been injured during sexual intercourse, while 1 had been injured during masturbation. All 5 patients refused immediate surgical exploration for presumed penile fracture. No patient had any immediate complications. At 6 and 12-month followup all patients reported erections adequate for intercourse without associated pain. One patient reported only mild curvature for which he did not seek treatment. We report on a subset of young males with presumed penile fracture who refused diagnostic evaluation and therapy, and were able to maintain normal erectile and voiding function. However, longer followup and radiographic evidence will be necessary to corroborate or refute these initial observations.

[Magnetic resonance imaging of the penis. Its normal anatomy].

PubMed

Banchik, E L; Mineev, N I; Mitusov, V V; Dombrovskiĭ, V I; Kogan, M I

2012-01-01

To estimate the capabilities of magnetic resonance imaging (MRI) to identify penile anatomic structures and their topographic relationships. Penile MRI results were analyzed in 52 men of different ages who had no history, clinical, laboratory, and radiological data in favor of diseases of this organ. Penile imaging technology and its algorithm, including patient preparation and posi-tioning and a list of impulse sequences and their parameters, are proposed. Penile MRI and anatomy are described in detail; magnetic resonance signal characteristics of the main structural elements of the organ and its adjacent tissues on T1- and T2-weighted images are specified. The MRI morphometry results of the cavernous and spongy bodies, urethra, and penis as a whole, which agree well with the similar known literature data, are given. The investigation has provided evidence for the high informative value of the technique in recognizing the relatively small anatomic structures of the penis, which is comparable with that of the morphological study of a gross specimen of this organ, which in turn predetermines a further investigation of the capabilities of MRI to diagnose penile diseases and to estimate the quality of their treatment.

Pathological Fracture of the Femur by Metastatic Carcinoma Penis-a Rare Presentation.

PubMed

Hussain, Shabbir; Solanki, Fanindra Singh; Sharma, Deepti B; Sharma, Dhananjay

2016-04-01

We report herein a clinical case of a patient with femur fracture due to metastasis from penile squamous cell carcinoma. A young man, who was treated for carcinoma penis, presented with pathological fracture of femur and lung metastasis from metastatic carcinoma penis after 18 months. Long bone metastasis from penile cancer is extremely rare, to the best of our knowledge; this is the first report of a patient with penile cancer spread to the femur from primary squamous cell carcinoma of the penis.

Femoral Metastasis from Penile Carcinoma: Report of 2 Cases

PubMed Central

Braumann, Laura; Tsagozis, Panagiotis; Wedin, Rikard; Brosjö, Otte

2015-01-01

Purpose. Penile cancer rarely gives symptomatic skeletal metastases. Methods. We present 2 patients with squamous carcinoma of the penis who were surgically treated for metastases in the femur. Results. Both patients had pathological fractures and were operated on. In one case, the skeletal metastasis preceded any lymphatic spread of the disease, suggesting early haematogenous dissemination. Conclusions. Endoprosthetic reconstruction resulted in pain relief and restored the ambulatory capacity. Clinicians should be aware of the possibility for symptomatic bone metastases with a risk for pathological fracture in patients with penile cancer. PMID:26579327

Application of computerised penile arterial waveform analysis in the diagnosis of arteriogenic impotence. An initial study in potent and impotent men.

PubMed

Desai, K M; Gingell, J C; Skidmore, R; Follett, D H

1987-11-01

A new method is described for evaluating arteriogenic impotence by means of noninvasive quantification of penile Doppler arterial waveforms using computerised analysis based on the Laplace Transform model. The haemodynamic changes occurring during a papaverine-induced erection in healthy potent volunteers have been recorded by this technique, which has also been shown to be capable of discriminating between a normal and an abnormal penile arterial supply in an initial study of potent and impotent men.