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Nature Reviews. Disease Primers Feb 2021Penile squamous cell carcinoma (PSCC) is a rare cancer with orphan disease designation and a prevalence of 0.1-1 per 100,000 men in high-income countries, but it... (Review)
Review
Penile squamous cell carcinoma (PSCC) is a rare cancer with orphan disease designation and a prevalence of 0.1-1 per 100,000 men in high-income countries, but it constitutes up to 10% of malignancies in men in some African, Asian and South American regions. Risk factors for PSCC include the absence of childhood circumcision, phimosis, chronic inflammation, poor penile hygiene, smoking, immunosuppression and infection with human papillomavirus (HPV). Several different subtypes of HPV-related and non-HPV-related penile cancers have been described, which also have different prognostic profiles. Localized disease can be effectively managed by topical therapy, surgery or radiotherapy. As PSCC is characterized by early lymphatic spread and imaging is inadequate for the detection of micrometastatic disease, correct and upfront surgical staging of the inguinal lymph nodes is crucial in disease management. Advanced stages of disease require multimodal management. Optimal sequencing of treatments and patient selection are still being investigated. Cisplatin-based chemotherapy regimens are the mainstay of systemic therapy for advanced PSCC, but they have poor and non-durable responses and high rates of toxic effects, indicating a need for the development of more effective and less toxic therapeutic options. Localized and advanced penile cancers and their treatment have profound physical and psychosexual effects on the quality of life of patients and survivors by altering sexual and urinary function and causing lymphoedema.
Topics: Carcinoma, Squamous Cell; Humans; Lymph Nodes; Male; Papillomaviridae; Penile Neoplasms; Quality of Life
PubMed: 33574340
DOI: 10.1038/s41572-021-00246-5 -
Journal of the European Academy of... Jun 2023This guideline is an update to the 2014 edition of the European guideline for the management of balanoposthitis. Balanoposthitis describes inflammation of the glans... (Review)
Review
BACKGROUND
This guideline is an update to the 2014 edition of the European guideline for the management of balanoposthitis. Balanoposthitis describes inflammation of the glans penis and prepuce and is caused by a range of disparate conditions including infection, dermatoses and premalignancy.
OBJECTIVE
The main objectives of this guideline are to aid recognition of the symptoms and signs and complications of penile skin conditions and to offer recommendations on the diagnostic tests and treatment for a selected group of these conditions.
METHODS
The previous guideline was updated following a literature review and priority was given to randomized controlled trial and systematic review evidence.
RESULTS
The updated guideline includes amended management for infective balanitis to provide clear guidance for Group A streptococcal infections, management of on going Lichen sclerosus (to include circumcision and supportive management to reduce the recurrence of genital herpes and warts), additional regimens for Zoonoid change, use of calcineurin inhibitors in management and risk of premalignancy and change of nomenclaturefrom Premalignant conditions to Penile Intraepithelial neoplasia (PeIN).
CONCLUSION
Balanoposthitis has a widerange of causes high quality evidence specific to the management of penile disease is not available for all the conditions described.
Topics: Humans; Male; Balanitis; Circumcision, Male; Penile Diseases; Penile Neoplasms; Penis; Precancerous Conditions
PubMed: 36942977
DOI: 10.1111/jdv.18954 -
The Canadian Journal of Urology Aug 2020Peyronie's disease is a common, benign condition characterized by an acquired penile abnormality due to fibrosis of the tunica albuginea. This may lead to penile... (Review)
Review
INTRODUCTION
Peyronie's disease is a common, benign condition characterized by an acquired penile abnormality due to fibrosis of the tunica albuginea. This may lead to penile curvature, deformity, discomfort, pain, and erectile dysfunction, resulting in emotional and psychosocial effects on patients. Therefore, it is important for urologists to thoroughly evaluate the extent of the patient's bother and discuss treatment goals, therapeutic options, and expectations.
MATERIALS AND METHODS
We provide a review of the current landscape for the diagnosis, management, and treatment of Peyronie's disease, including oral, topical, intralesional, external energy, and surgical therapies.
RESULTS
The hallmark of managing Peyronie's disease is attentive patient counseling. Patients may be hesitant to discuss their symptoms unless inquired directly and may not be aware that treatments exist. It is not uncommon for Peyronie's disease to be diagnosed incidentally during a routine or unrelated healthcare visit, with reported rates of incidental diagnosis as high as 16%. Treatment options are stratified by disease phase which is defined by whether symptoms (e.g. penile deformity and discomfort) are actively changing or have stabilized. Conservative therapy is the most common recommendation during the active phase with more invasive treatments reserved for the passive phase. Conservative therapy may include oral or topical medication, intralesional injection, and external energy therapy. These treatments may also have a role in improving symptoms during the passive phase prior to undergoing more definitive surgical treatment. Surgical interventions include tunical plication, plaque incision or excision with or without grafting, and penile prosthesis implantation. Despite the variety of treatment options available to patients, each has a distinct efficacy and adverse effect profile, warranting thorough discussion to meet patients' goals and manage expectations.
CONCLUSION
Peyronie's disease is a common condition that is underdiagnosed and undertreated. Patients with Peyronie's disease will benefit from a comprehensive evaluation and in-depth counseling so that they may become familiar with the natural disease course and have appropriate expectations of each treatment option.
Topics: Humans; Male; Penile Induration
PubMed: 32875997
DOI: No ID Found -
Urology Aug 2021A 66-year-old male presented with five days of penile pain and ulceration. The patient had a history of stage 5 chronic kidney disease and repeatedly declined...
A 66-year-old male presented with five days of penile pain and ulceration. The patient had a history of stage 5 chronic kidney disease and repeatedly declined hemodialysis. Wound and urine cultures were unrevealing. CT of the abdomen and pelvis did not reveal any evidence of Fournier's gangrene but identified diffuse severe calcific vasculopathy. Urology and dermatology agreed on the diagnosis of penile calciphylaxis. While diagnosis of calciphylaxis often includes histologic evidence of obstructive vasculopathy, biopsy of penile calciphylaxis is contraindicated due to increased morbidity and mortality. Management focuses wound care and correction of electrolyte abnormalities responsible for calcium deposition.
Topics: Aged; Calciphylaxis; Humans; Male; Penile Diseases
PubMed: 34097941
DOI: 10.1016/j.urology.2021.05.040 -
European Urology Focus Sep 2019Penile paraffinoma is a rare cause of penile mass that can occur following injection of liquid paraffin, performed illicitly for penile augmentation. Over the past 2 yr,... (Review)
Review
Penile paraffinoma is a rare cause of penile mass that can occur following injection of liquid paraffin, performed illicitly for penile augmentation. Over the past 2 yr, we have observed an increasing number of cases presenting with the complications of penile paraffinoma; three patients of central European origin have required inpatient treatment at our institution and posed a significant management dilemma. This mini-review aims to review the literature on the aetiopathogenesis, clinical features, diagnosis, and management of penile paraffinoma. A systematic search of PubMed and Scopus was performed with 10 case series and 26 case reports identified between 1956 and 2017. A total of 124 cases, with a mean age of 36.29 yr, were identified. The majority originated in Korea, and the most common injected material was liquid paraffin (80.6%). Patients presented with pain/swelling, ulceration/fistulae, and penile deformity. The majority required surgical excision of paraffinoma followed by reconstruction with a variety of procedures including split skin grafting, scrotal skin flap reconstruction, and prepuce grafting. Mean duration of follow-up was 15.8 mo. Penile paraffinoma remains a rare presentation; however, it can present management difficulties. We have had an increase in cases, with three patients presenting with complications following injection of paraffin in our unit in the past 2 yr. Definitive management includes surgical excision and reconstruction as required with early involvement of plastic surgeons. There may be a role for conservative management; however, long-term outcomes are unclear. There may be a need for targeted preventative measures through public health agencies in communities where the practice is more prevalent. PATIENT SUMMARY: Penile paraffinoma can occur following injection of liquid paraffin or similar substances, generally used by non-healthcare personnel for the purpose of penile augmentations, and can cause significant pain, ulceration, and penile deformity. Definitive management includes surgical excision with reconstruction as required. Prevention of its use through awareness and education may be required in communities where the practice is more common.
Topics: Body Modification, Non-Therapeutic; Foreign Bodies; Humans; Injections; Male; Paraffin; Penile Diseases
PubMed: 30007541
DOI: 10.1016/j.euf.2018.06.013 -
Emergency Medicine Clinics of North... Nov 2019The penis is an organ of enormous importance and is vital for both excretory and reproductive function. The anatomy of the penis itself can lead to many of its emergent... (Review)
Review
The penis is an organ of enormous importance and is vital for both excretory and reproductive function. The anatomy of the penis itself can lead to many of its emergent conditions and a thorough understanding of the anatomy and physiology is central to recognition of these conditions. Physicians should have a high clinical suspicion for penile emergencies and perform a thorough physical examination to make a proper diagnosis. Prompt diagnosis and proper management are essential for minimizing dysfunction of this vital organ.
Topics: Emergencies; Humans; Male; Paraphimosis; Penile Diseases; Penis; Phimosis; Priapism
PubMed: 31563196
DOI: 10.1016/j.emc.2019.07.001 -
Revista Internacional de Andrologia 2021A fifty-year-old healthy, Portuguese male, with prior history of paraffin injections into the penis 30 years ago, was referred for urological consultation because of a...
A fifty-year-old healthy, Portuguese male, with prior history of paraffin injections into the penis 30 years ago, was referred for urological consultation because of a large, hardened ulcerated mass on the base of the penis causing deformity and pain. The patient underwent a biopsy that showed a benign granulomatous lesion, and then excision of the mass and penile plasty with a scrotum flap in the same surgical time. Histology confirmed the diagnosis of paraffinoma. Three months after surgery, the patient is satisfied with the functional (urinary function and erectile function) and aesthetic results. Penile paraffinoma is a rare disease (most common in Asia and Eastern Europe) and results from an inflammatory response to the subcutaneous injection of paraffin, Vaseline or other mineral oils. Treatment is usually surgery.
Topics: Granuloma; Humans; Injections, Subcutaneous; Male; Middle Aged; Paraffin; Penile Diseases; Penis; Plastic Surgery Procedures; Skin Ulcer; Surgical Flaps; Treatment Outcome
PubMed: 32778451
DOI: 10.1016/j.androl.2020.01.006 -
British Journal of Hospital Medicine... Oct 2021A penile fracture is a traumatic rupture of the tunica albuginea of the corpora cavernosa in an erect penis, usually as a result of blunt trauma during sexual activity....
A penile fracture is a traumatic rupture of the tunica albuginea of the corpora cavernosa in an erect penis, usually as a result of blunt trauma during sexual activity. The aetiology varies with geographical region, with the USA and Europe having a higher incidence of sexual trauma and the Middle East having a higher rate of self-manipulation. Diagnosis is usually clinical, but numerous imaging modalities have been used to confirm the fracture site and to help plan appropriate surgical management. Clinical examination will find a detumescent penis with a diffuse penile swelling and ecchymosis: the classic eggplant sign. The penis will often deviate away from the side of the injury. A history of the patient's inability to pass urine after the injury or of blood at the urethral meatus suggests an associated urethral injury. Immediate surgical management is the mainstay of treatment, with many surgeons favouring a degloving approach. Penile fractures also carry a risk of urethral tears and urethral repair may be necessary. This article describes the aetiology, presentation and management of penile fractures to enable identification and treatment in daily clinical practice.
Topics: Humans; Male; Penile Diseases; Penis; Rupture; Urethra; Urethral Diseases
PubMed: 34726937
DOI: 10.12968/hmed.2020.0715 -
Cancer Radiotherapie : Journal de La... 2022Penile cancers are uncommon and should be treated in expert center. Radiotherapy indications are mainly limited to exclusive brachytherapy for early stage penile glans...
Penile cancers are uncommon and should be treated in expert center. Radiotherapy indications are mainly limited to exclusive brachytherapy for early stage penile glans cancer. Brachytherapy yields to excellent outcome for disease control and organ and function preservation. Only scarce data are available for external beam radiation therapy. It could be considered as palliative setting for irradiation of the primary tumor. For lymph node irradiation, external beam radiation therapy (with or without chemotherapy) could be discussed either as neoadjuvant approach prior to surgery for massive inguinal lymph node invasion or as adjuvant approach in case of high-risk of relapse. However, these cases should be discussed on an individual basis, as the level of evidence is poor. We present the recommendations of the French Society of Oncological Radiotherapy on the indications and techniques for external beam radiotherapy and brachytherapy for penile glans cancer.
Topics: Brachytherapy; Chemoradiotherapy; Dose Fractionation, Radiation; France; Humans; Inguinal Canal; Lymph Nodes; Lymphatic Irradiation; Male; Neoplasm Staging; Organ Sparing Treatments; Palliative Care; Penile Neoplasms; Radiation Oncology; Radiotherapy, Adjuvant
PubMed: 34953715
DOI: 10.1016/j.canrad.2021.10.001 -
The Pan African Medical Journal 2022
Topics: Calciphylaxis; Humans; Male; Penile Diseases; Penis
PubMed: 35480413
DOI: 10.11604/pamj.2022.41.124.33602