-
International Journal of Impotence... Sep 2022Severe Peyronie's disease (PD) and concomitant erectile dysfunction (ED) may require plaque incision/excision and grafting (PIG) as an adjunct to penile prosthesis... (Review)
Review
Severe Peyronie's disease (PD) and concomitant erectile dysfunction (ED) may require plaque incision/excision and grafting (PIG) as an adjunct to penile prosthesis implantation (IPP). Currently, there is no available consensus on the best graft material to use. Our aim was to systematically review graft materials used as patches following PIG + IPP. Literature search was performed in March 2021. Only original articles in English with a series of 10 or more patients were included. Overall, a total of 17 studies were included, corresponding to a cohort of 662 patients. The mean age ranged from 45 to 65 years and most patients had curvatures >45°. Average penile lengthening ranged from 1 to 3.5 cm, average residual curvatures from 0 to 20% and decreased glans sensitivity from 0 to 20%. Eighty to 100% of patients were satisfied with cosmetic and functional results. PIG + IPP with the use of various grafts offers promising results for the treatment of patients suffering from severe PD with concomitant ED. Unfortunately, the absence of high quality and comparative studies makes it difficult to establish the optimum graft. Therefore, the level of experience of the surgical team with one or more methods should guide their choice.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penile Induration; Penile Prosthesis; Penis
PubMed: 34718344
DOI: 10.1038/s41443-021-00479-8 -
International Braz J Urol : Official... 2021Squamous cell carcinoma (SCC) of the penis is a rare disease in developed countries but is associated with significant morbidity and mortality. A crucial prognostic... (Review)
Review
PURPOSE
Squamous cell carcinoma (SCC) of the penis is a rare disease in developed countries but is associated with significant morbidity and mortality. A crucial prognostic factor is the presence of inguinal lymph node metastases (ILNM) at the time of diagnosis. At least 25% of cases have micrometastases at the time of diagnosis. Therefore, we performed a literature review of studies evaluating factors, both clinical and pathological, predictive of lymph node metastases in penile SCC.
MATERIALS AND METHODS
Studies were identified using PubMed and search terms included the following: penile cancer, penile tumor, penile neoplasm, penile squamous cell carcinoma, inguinal lymph node metastasis, lymph node metastases, nodal metastasis, inguinal node metastasis, inguinal lymph node involvement, predictors, and predictive factor. The number of patients and predictive factors were identified for each study based on OR, HR, or RR in multivariate analyses, as well as their respective significance values. These were compiled to generate a single body of evidence supportive of factors predictive of ILNM in penile SCC.
RESULTS
We identified 31 studies, both original articles and meta-analyses, which identified factors predictive of metastases in penile SCC. The following clinical factors were predictive of ILNM in penile SCC: lymphovascular invasion (LVI), increased grade, increased stage (both clinical and pathological), infiltrative and reticular invasion, increased depth of invasion, perineural invasion, and younger patient age at diagnosis. Biochemically, overexpression of p53, SOD2, Ki-67, and ID1 were associated with spread of SCC to inguinal lymph nodes. Diffuse PD-L1 expression, increased SCC-Ag expression, increased NLR, and CRP >20 were also associated with increased ILNM.
CONCLUSIONS
A multitude of factors are associated with metastasis of SCC of the penis to inguinal lymph nodes, which is associated with poor clinical outcomes. The above factors, most strongly LVI, grade, and node positivity, may be considered when constructing a nomogram to risk-stratify patients and determine eligibility for prophylactic inguinal lymphadenectomy.
Topics: Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Penile Neoplasms; Prognosis
PubMed: 33650835
DOI: 10.1590/S1677-5538.IBJU.2020.0959 -
Endocrinology, Diabetes & Metabolism Apr 2021Fibrosis is characterized by dysregulation and accumulation of extracellular matrix. Peyronie's disease and Dupuytren disease are fibroproliferative disorders of the...
INTRODUCTION
Fibrosis is characterized by dysregulation and accumulation of extracellular matrix. Peyronie's disease and Dupuytren disease are fibroproliferative disorders of the tunica albuginea of the penis and fascia of the hand, respectively. Chronic hyperglycaemia due to diabetes mellitus can also lead to tissue injury and fibrosis. A meta-analysis has shown a relationship between Dupuytren disease and diabetes (overall odds ratio, 3.1; 95% confidence interval, 2.7-3.5). This review explores commonalities in the pathogenesis of Peyronie's disease, Dupuytren disease and diabetes.
METHODS
A search of the PubMed database was conducted using the search terms "diabetes" AND "Peyronie's disease"; and "diabetes" AND "Dupuytren."
RESULTS
Genome-wide association and gene expression studies conducted with tissue from people with Peyronie's disease or Dupuytren disease identified signalling pathways associated with wingless-type mammary-tumour virus integration site signalling, extracellular matrix modulation and inflammation. Biochemical studies confirmed the importance of these pathways in the pathogenesis of fibrosis with Peyronie's disease and Dupuytren disease. Dysregulation of matrix metalloproteinase activity associated with extracellular matrix breakdown was implicated in fibroproliferative complications of diabetes and in the aetiology of Peyronie's disease and Dupuytren disease. A notable percentage of people with diabetes have comorbid Peyronie's disease and/or Dupuytren disease.
CONCLUSIONS
Studies have not been performed to identify fibroproliferative pathways that all 3 conditions might have in common, but data suggest that common pathways are involved in the fibroproliferative processes of Peyronie's disease, Dupuytren disease, and diabetes.
Topics: Chronic Disease; Diabetes Complications; Diabetes Mellitus; Dupuytren Contracture; Extracellular Matrix; Fascia; Female; Fibrosis; Genome-Wide Association Study; Hand; Humans; Hyperglycemia; Male; Matrix Metalloproteinases; Penile Induration; Penis; Signal Transduction
PubMed: 33855203
DOI: 10.1002/edm2.195 -
International Journal of Molecular... Jan 2023Current literature has indicated that Peyronie's disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted... (Review)
Review
Current literature has indicated that Peyronie's disease (PD) could be initiated by microtrauma and the subsequent inflammation episodes that follow. PD could be sorted into acute or chronic status, and it can differ when selecting the clinical therapeutics. PD would cause pain and penile deformity to diseased men and impair their erectile function. Occasionally, surgical revision of the penis might be needed to correct the penile curvature. We find that there are limited effective options of intra-lesion injections for the PD plaques. By searching the databases and screening the literature with the PRISMA 2020 guideline, we observed that several preclinical studies that applied stem cell therapy in treating PD were fruitful in the acute phase. Although in the chronic phase of PD, erectile parameters were not significantly improved, and therefore, future studies might be better elevated in certain aspects, such as the sites selected for harvesting stem cells or changing the centrifugation forces. In this review, we concluded the contemporary understanding of inflammatory microenvironments in PD, the stem cell therapy in PD, and our perspectives on future studies. We concluded that there may be great potential in stem cell therapy for treating both acute and chronic phases PD.
Topics: Male; Humans; Penile Induration; Penis; Penile Erection; Injections; Stem Cells
PubMed: 36614220
DOI: 10.3390/ijms24010777 -
AJR. American Journal of Roentgenology Jul 2022Treatment recommendations of penile cancers are determined primarily by the local extent of the primary tumor. Clinical palpation is used for local staging. We... (Meta-Analysis)
Meta-Analysis Review
Treatment recommendations of penile cancers are determined primarily by the local extent of the primary tumor. Clinical palpation is used for local staging. We reviewed diagnostic performance of MRI in local staging of penile cancer in three clinical scenarios (questions [Qs] 1 through 3, Q1-Q3) and one imaging scenario (Q4). Q1 asked whether MRI reliably distinguishes ≤ T1 from ≥ T2 disease. Q2 asked whether clinical staging reliably identifies ≤ T1 versus ≥ T2 disease and how clinical staging compares to MRI. Q3 asked if MRI is accurate for diagnosis of T3 disease. Q4 asked if artificial erection (by intracavernosal injection of prostaglandin E) improved accuracy of MRI in T categorization. MEDLINE, EMBASE, and Cochrane Library databases were searched through September 13, 2021, for studies evaluating local staging of penile cancer using MRI with surgical pathology as the reference standard. Diagnostic accuracy was calculated using a bivariate random-effects model and hierarchic summary ROC mode Meta-regression was performed to test for covariate effects of MRI and artificial erection in Q3 and Q4, respectively. Eight studies and 481 patients were included. The sensitivity and specificity of MRI for Q1 were 86% (95% CI, 73-94%) and 89% (95% CI, 77-95%), respectively. AUC for MRI (0.94; 95% CI, 0.92-0.96) did not differ from clinical staging (0.87; 95% CI, 0.84-0.90; = .83). For Q3, MRI had sensitivity and specificity of 80% (95% CI, 70-87%) and 96% (95% CI, 85-99%), respectively. For Q4, sensitivity and specificity for MRI with versus without artificial erection were 85% (95% CI, 71-92%) and 93% (95% CI, 77-98%) versus 86% (95% CI, 68-95%) and 84% (95% CI, 70-93%), respectively ( = .50). MRI staging of penile cancer may be considered for ≤ T1 versus ≥ T2 disease but did not appear more accurate than clinical staging. High specificity of MRI for diagnosis of ≥ T3 disease suggests that MRI may be useful when organ-sparing approaches are planned. MRI with and without artificial erection showed similar accuracy in local staging. MRI, with or without artificial erection, may be valuable in routine preoperative evaluation of local staging of penile cancer, particularly when organ-sparing options are considered.
Topics: Humans; Magnetic Resonance Imaging; Male; Neoplasm Staging; Penile Neoplasms; Preoperative Care; Sensitivity and Specificity
PubMed: 35195435
DOI: 10.2214/AJR.21.27063 -
International Braz J Urol : Official... 2024Penile fracture (PF) affects 1,14 to 10,48 men in every 100.000 men in East Asia, and the primary aetiology is sexual intercourse, but the knowledge regarding the most... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Penile fracture (PF) affects 1,14 to 10,48 men in every 100.000 men in East Asia, and the primary aetiology is sexual intercourse, but the knowledge regarding the most dangerous sexual position is not well explained. This study compares three sexual positions: man on top position (MTP), woman on top position (WTP), and doggy style position (DSP), leading to PF potential.
MATERIALS AND METHODS
A search of sexual position-related PF in Google Scholar, PubMed, Cochrane, and PMC Europe was performed. Criteria inclusion was the full text of relevant articles which describ the number of sexual positions. It was analyzed by odds ratio, random model effect, and the OR and 95%CI were calculated.
RESULTS
12 relevant papers involving 490 patients comprised 169 MTP, 120 WTP, 158 DSP, and 43 no intercourse cases. Meta-analysis of all sexual positions was a MTP P= 0,04, WTP P=0,49, and DSP P=0,0005.
CONCLUSION
The man-dominant positions (MTP and DSP) were significantly potential for PF, which speculated that when a man is dominant and very excited, intercourse may become highly vigorous and impact trauma. This study found that man's dominant position consists of DSP and the MTP significantly lead to PF.
Topics: Male; Female; Humans; Penis; Sexual Behavior; Penile Diseases; Coitus
PubMed: 38166220
DOI: 10.1590/S1677-5538.IBJU.2023.0419 -
Research and Reports in Urology 2020Erectile dysfunction (ED) is a common clinical condition with limited treatment options. The main aim of the present systematic review was to synthesize information on... (Review)
Review
BACKGROUND
Erectile dysfunction (ED) is a common clinical condition with limited treatment options. The main aim of the present systematic review was to synthesize information on Rho-kinase as a novel therapeutic approach for the treatment of ED.
METHODS
We performed a systematic literature study in PubMed, Google Scholar and Scopus. Included studies were original articles studied the role of Rho-kinase in the pathogenesis and/or new treatment approach for ED in animal models and clinical studies, published between 2014 and 2019. Data derived from each study were study design used, interventions applied and main treatment outcomes. The quality of the selected articles was assessed by CAMARADES criteria and data were analyzed using descriptive statistics.
RESULTS
A total of 1067 original articles were retrieved in the given period and eighteen papers met our inclusion criteria. Five articles explain the role of Rho-kinase in ED pathogenesis using different models such as cavernous nerve crush injury, heart failure-induced ED, vasculogenic and post-radical prostatectomy ED, diabetes-induced ED and age-related ED. Other ten papers explain the role of novel drugs evaluated for ED treatment by targeting Rho-kinase as a new approach for ED therapy. The rest three papers discuss the role of plant extracts used by traditional society for the treatment of ED and assess their potential function in targeting Rho-kinase in animal models. The penile erectile functional index has shown that the ratio of intracavernosal pressure to mean arterial pressure (ICP/MAP) was decreased due to age and various chronic diseases. Whilst, ROCK I and ROCK II expression were increased. Western blot findings have also shown that ROCK II and MYPT-1 phosphorylation rates increased in cavernous tissue after ED induction. Besides, compounds which can inhibit the action of Rho-kinase activity showed relaxation of the corpus cavernosum, decrease in corporal fibrosis, and alleviate increased apoptosis and caspase-3 activity in an NO-independent manner. Moreover, histological and molecular dysregulation have been improved by inhibition of Rho-kinase.
CONCLUSION
Targeting Rho-kinase may be a possible target for the treatment of ED secondary to specific causes, and Rho-kinase inhibitors may be a new drug family for the treatment of ED. However, this requires further studies for in-depth understanding.
PubMed: 32766173
DOI: 10.2147/RRU.S255743 -
Indian Journal of Urology : IJU :... 2022The management options for regional lymph nodes (LNs) in men with penile cancer include surveillance, surgery, and chemotherapy. The use of radiotherapy (RT) for nodal... (Review)
Review
INTRODUCTION
The management options for regional lymph nodes (LNs) in men with penile cancer include surveillance, surgery, and chemotherapy. The use of radiotherapy (RT) for nodal disease follows tradition and single-institution policies. We aimed to analyse the existing evidence regarding the management of penile cancer patients with suspected or known metastatic pelvic LNs using pelvic LN dissection (PLND) with RT versus PLND or RT alone.
METHODS
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with no filters for language or time. The search was conducted in EMBASE, MEDLINE/PubMed, and Cochrane Library. Inclusion criteria were adult men with penile cancer and suspected metastatic pelvic LNs, undergoing PLND with or without RT or RT alone. Primary outcomes included disease-specific survival and locoregional recurrence. Secondary outcomes included overall survival and complications of therapy.
RESULTS
A total of 552 articles were identified. Only eight retrospective studies were eligible for inclusion (including 406 patients). All studies had a high risk of bias. None of the studies reported the use of neoadjuvant RT. Indications for PLND varied but were usually two or more clinically positive inguinal nodes with or without extracapsular extension. Adjuvant RT was mainly used in positive pelvic LNs or pN2/pN3 stages. The rate of locoregional recurrence following adjuvant RT was 70%. Complications of treatment were reported in two studies only.
CONCLUSIONS
There is insufficient evidence to recommend the use of adjuvant RT following PLND in penile cancer patients. The quality of evidence is low due to the retrospective design and high risk of bias. Randomized clinical trials are required to assess the efficacy and safety of adjuvant RT and PLND.
PubMed: 35400869
DOI: 10.4103/iju.iju_453_21 -
Seminars in Oncology Nursing Jun 2022To investigate the contemporary rates of 30-day complications after surgery for penile cancer and to discuss the currently used preventative and therapeutic practices...
OBJECTIVES
To investigate the contemporary rates of 30-day complications after surgery for penile cancer and to discuss the currently used preventative and therapeutic practices aimed at mitigation of these postoperative adverse events.
DATA SOURCES
A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed, and studies reporting on the contemporary rates, nature, or management of acute complications following primary penile surgery or inguinal lymph node dissection for penile cancer were abstracted. Medline (PubMed) and EMBASE libraries were used to retrieve the articles published between January 1984 and December 2021 (n = 170 articles). Ultimately, 38 articles were included. The primary outcome of interest was 30-day (acute) postoperative complications, stratified by those associated with treatment of the primary penile lesion and those with inguinal lymph node dissection. Risk of bias assessment was undertaken. Special attention was paid to studies reporting management strategies for these complications.
CONCLUSION
This comprehensive review revealed that the quality of existing studies reporting on complications is poor and the risk of bias is high. Within these studies, the rates of acute complications following primary penile surgery and inguinal lymph node dissection ranged between 0% and 29.4% and 6% and 90%, respectively. More than 50% of these complications were wound related. Over the past two decades, several studies have reported on improved surgical techniques and protocolized postsurgical care pathways. Although the newer techniques have been associated with improved outcomes, the absolute rates of complications have remained high even in the most contemporary series. Therefore, there is an urgent need for health care providers and stakeholders to reach consensus regarding preoperative workup and medical optimization goals, stage appropriate therapies, and postoperative care pathways, as has been done for other malignancies associated with high morbidity.
IMPLICATIONS FOR NURSING PRACTICE
Penile cancer is a disease of the elderly, and surgical management of the primary lesion or the groins is associated with a high rate of complications. Most complications are wound related. Meticulous surgical technique and careful postoperative monitoring with early intervention are keys to mitigating surgery-related morbidity. However, equally important is dissemination and adoption of these principles by all health care workers universally.
Topics: Aged; Carcinoma; Humans; Inguinal Canal; Lymph Node Excision; Lymphatic Metastasis; Male; Penile Neoplasms
PubMed: 35597731
DOI: 10.1016/j.soncn.2022.151285 -
European Urology Focus Sep 2020The genesis of neurogenic sexual dysfunction (NSD) can be central, peripheral, or both. The correct stratification of the level of sexual dysfunction allows the...
CONTEXT
The genesis of neurogenic sexual dysfunction (NSD) can be central, peripheral, or both. The correct stratification of the level of sexual dysfunction allows the clinician to choose the best type of treatment, in order to reduce sexual complaints.
OBJECTIVE
The aim of our review is to focus on the management of NSD due to central nervous system disorders and peripheral neuropathy.
EVIDENCE ACQUISITION
A systematic review of the English-language literature was completed until July 2019 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The following terms were included: [(neurogenic sexual dysfunction) OR neurogenic erectile dysfunction)] AND (treatment OR management). An Excel file was created respecting the following criteria: participants, interventions, comparators, outcomes, and study design (PICOS).
EVIDENCE SYNTHESIS
Overall, from 505 identified records, 52 full-text articles were assessed for eligibility. Finally, 46 original researches were included in quantitative analysis.
CONCLUSIONS
The phosphodiesterase type 5 inhibitors sildenafil, tadalafil, and vardenafil were proved to be effective and safe in first-line therapy of erectile dysfunction caused by neurogenic disorders. In addition, intracavernous injections of prostaglandin E1, papaverine, or phentolamine and vacuum systems have been a mainstay of second-line treatment for NSD, extremely successful in the spinal cord injury population. Surgical therapy via penile prosthesis implantation remains a viable alternative as a third-line approach and may also be utilised to assist men with bladder management, despite higher complication rates of infections. Despite poor evidence, a better understanding of female sexual dysfunction due to neurological complaints is needed, in order to find more efficacious therapies for intercourse and orgasmic phase. Further prospective studies are required to better clarify the more successful treatment in improving sexual function and quality of life of these patients.
PATIENT SUMMARY
Management of neurogenic sexual dysfunction includes phosphodiesterase type 5 inhibitors, intracavernous injections/vacuum devices, and penile prosthesis implantation. Female sexual dysfunction due to neurological disease needs to be better investigated.
Topics: Central Nervous System Diseases; Female; Humans; Male; Peripheral Nervous System Diseases; Sexual Dysfunction, Physiological
PubMed: 31879263
DOI: 10.1016/j.euf.2019.12.002