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European Urology Focus May 2020There is considerable interest in understanding the genetics of erectile dysfunction (ED) and Peyronie's disease (PD) in an effort to identify novel therapeutic and... (Review)
Review
There is considerable interest in understanding the genetics of erectile dysfunction (ED) and Peyronie's disease (PD) in an effort to identify novel therapeutic and preventative targets. Initial support for a genetic component of ED and PD was derived from familial aggregation studies. Candidate gene studies have suggested an association between polymorphisms of eNOS and ED and between TGF-β1 and PD. More recently, several genome-wide association studies have suggested an association between single-nucleotide polymorphisms of the SIM1 gene and ED. The development of models and functional assays that are able to explore these potential pathways implicated in ED and PD is pivotal for future studies. We highlight the current literature that supports a genetic component for ED and PD. PATIENT SUMMARY: There is great interest in understanding the genetic underpinnings of erectile dysfunction and Peyronie's disease. Candidate gene studies and genome-wide association studies have set a foundation for future work; however, we have yet to determine a true genetic cause. A better understanding of the genetics of these conditions will help advance novel therapeutics and preventative strategies.
Topics: Erectile Dysfunction; Humans; Male; Penile Induration
PubMed: 31474580
DOI: 10.1016/j.euf.2019.08.006 -
The Journal of Sexual Medicine Mar 2023Priapism, a urologic emergency, has known associations with certain medical conditions. Many cases are idiopathic, suggesting an opportunity to identify novel risk...
BACKGROUND
Priapism, a urologic emergency, has known associations with certain medical conditions. Many cases are idiopathic, suggesting an opportunity to identify novel risk factors.
AIM
We sought to identify medical conditions and pharmaceutical treatments that are associated with priapism using data-mining techniques.
METHODS
Using deidentified data in a large insurance claims database, we identified all men (age ≥20 years) with a diagnosis of priapism from 2003 to 2020 and matched them to cohorts of men with other diseases of male genitalia: erectile dysfunction, Peyronie disease, and premature ejaculation. All medical diagnoses and prescriptions used prior to first disease diagnosis were examined. Predictors were selected by random forest, and conditional multivariate logistic regressions were applied to assess the risks of each predictor.
OUTCOMES
We identified novel relationships of HIV and some HIV treatments with priapism and confirmed existing associations.
RESULTS
An overall 10 459 men with priapism were identified and matched 1:1 to the 3 control groups. After multivariable adjustment, men with priapism had high associations of hereditary anemias (odds ratio [OR], 3.99; 95% CI, 2.73-5.82), use of vasodilating agents (OR, 2.45; 95% CI, 2.01-2.98), use of HIV medications (OR, 1.95; 95% CI, 1.36-2.79), and use of antipsychotic medications (OR, 1.90; 95% CI, 1.52-2.38) as compared with erectile dysfunction controls. Similar patterns were noted when compared with premature ejaculation and Peyronie disease controls.
CLINICAL IMPLICATIONS
HIV and its treatment are associated with priapism, which may affect patient counseling.
STRENGTHS AND LIMITATIONS
To our knowledge, this is the first study to identify risk factors for priapism utilizing machine learning. All men in our series were commercially insured, which limits the generalizability of our findings.
CONCLUSION
Using data-mining techniques, we confirmed existing associations with priapism (eg, hemolytic anemias, antipsychotics) and identified novel relationships (eg, HIV disease and treatment).
Topics: Male; Humans; Young Adult; Adult; Priapism; Erectile Dysfunction; Premature Ejaculation; Penile Induration; HIV Infections; Anemia
PubMed: 36881738
DOI: 10.1093/jsxmed/qdad017 -
Journal of Cutaneous Medicine and... 2024
Topics: Humans; Male; Penis; Penile Diseases
PubMed: 38323555
DOI: 10.1177/12034754241229337 -
Current Urology Reports Feb 2021The goal of this paper is to understand the reasons behind penile length and girth issues after penile prosthesis surgery and review the literature for current... (Review)
Review
PURPOSE OF REVIEW
The goal of this paper is to understand the reasons behind penile length and girth issues after penile prosthesis surgery and review the literature for current strategies employed to decrease these issues.
RECENT FINDINGS
Measurement inconsistencies triggering further studies have shown there is a real loss of penile length and girth after prosthesis surgery. There have been varying hypotheses of why this happens, and numerous approaches have been proposed to help combat this in the preoperative, intraoperative, and postoperative settings. Erectile dysfunction prevalence is expected to increase; therefore it is important for urologists to understand the treatment options, including prosthesis surgery. Numerous techniques have been hypothesized and studied in smaller settings in the preoperative, intraoperative, and postoperative settings with regard to prosthetics surgery. However, larger studies are still needed to confirm these findings in order to help to counsel and educate patients preoperatively in addition to employing tactics to help minimize penile shortening.
Topics: Body Weights and Measures; Erectile Dysfunction; Humans; Male; Organ Size; Penile Diseases; Penile Erection; Penile Implantation; Penile Prosthesis; Penis; Postoperative Period
PubMed: 33533997
DOI: 10.1007/s11934-021-01032-2 -
The Urologic Clinics of North America Aug 2022In this article, the authors discuss the epidemiology, pathophysiology, and initial work-up for men with adult-acquired buried penis syndrome (AABP). Given the... (Review)
Review
In this article, the authors discuss the epidemiology, pathophysiology, and initial work-up for men with adult-acquired buried penis syndrome (AABP). Given the significant heterogeneity of AABP, a classification system is proposed which classifies the condition by the status of the abdominal pannus, the escutcheon, the penile skin and the scrotal skin, and their respective fascial attachments. Classification is achieved by a uniform assessment of anatomy using the proposed standardized preoperative photos. Various surgical strategies to repair AABP are proposed which, importantly, should be in line with the patient-centered goals and also differ widely with the condition.
Topics: Adult; Fascia; Humans; Male; Penile Diseases; Penis; Plastic Surgery Procedures; Scrotum
PubMed: 35931438
DOI: 10.1016/j.ucl.2022.04.009 -
Orvosi Hetilap May 2023Epithelioid hemangioma is a benign vascular tumor. Complete surgical excision is curative, there is no tendency to recurrence or metastasize. Its penile occurrence is...
Epithelioid hemangioma is a benign vascular tumor. Complete surgical excision is curative, there is no tendency to recurrence or metastasize. Its penile occurrence is extremely rare, only 33 cases have been reported in English literature. A patient with epithelioid hemangioma of the deep dorsal vein of the penis is reported. To our knowledge, this is the first report of penile epithelioid hemangioma in Hungarian literature. The 64-year-old patient presented to our department with painful erection caused by a palpable penile mass. Physical examination revealed a mobile subcutaneous nodule on the dorsum of the penis. Penile ultrasound showed a 10 mm homogeneous, well circumscribed lesion superficial to the tunica albuginea of the corpora cavernosa without intralesional blood flow. Local excision was performed through a dorsal longitudinal penile incision. The deep dorsal vein was dissected circumferentially, then the lesion was removed following ligation of the vein proximal and distal to the mass. Histopathological examination revealed epithelioid hemangioma. At three months after surgery, the patient reported complete resolution of pain, his International Index of Erectile Function Score was 21. At four years after the operation, there were no signs of recurrence or metastasis. Successful treatment of epithelioid hemangioma of the penis requires in-depth knowledge of processes resulting in penile subcutaneous masses, therefore the differential diagnosis is detailed in discussion. Orv Hetil. 2023; 164(21): 836-840.
Topics: Male; Humans; Middle Aged; Penis; Penile Neoplasms; Hemangioma; Pain; Vascular Neoplasms
PubMed: 37245208
DOI: 10.1556/650.2023.32777 -
International Braz J Urol : Official... 2022Total corpora mobilization (TCM) is a novel technique that is used for penile reconstruction in cases of micropenis and penile amputation. Its principle is based on...
PURPOSE
Total corpora mobilization (TCM) is a novel technique that is used for penile reconstruction in cases of micropenis and penile amputation. Its principle is based on Kelly's procedure for bladder exstrophy (1). In contrast to the Kelly procedure, TCM is performed entirely through the perineum with the patient in the lithotomy position.
MATERIALS AND METHODS
TCM was performed on three patients. The first was a boy who suffered trauma from a dog bite at an age of eight months. At 23 years old he underwent TCM. The second patient had genital self-amputation induced by psychiatric disorder. After treatment, at 27 years old, he desired surgery for penile reconstruction. The third patient had partial androgen insensitivity syndrome (PAIS) with a micropenis and at 23 years old had TCM procedure. The patients were placed in the lithotomy position with a perineal incision in the midline. A subperiosteal incision was made and the corpora cavernosa were detached from the pubic arch and the ischial rami. The periosteum and the neurovascular bundles were preserved. Subsequently the corpora cavernosa was mobilized upward and the periosteum that was left attached to them was sutured to the pubis.
RESULTS
At twenty-four, nine, and six months, respectively, in the follow-up process, all patients expressed satisfaction with the final cosmetic appearance, penile length, and erectile function.
CONCLUSION
TCM may prove to be an alternative for patients with a functional disturbance because of small penile length, though a higher number of cases and a more extended follow-up are needed to draw a more definitive conclusion.
Topics: Animals; Bladder Exstrophy; Dogs; Genital Diseases, Male; Humans; Male; Penile Diseases; Penile Erection; Penis
PubMed: 35838516
DOI: 10.1590/S1677-5538.IBJU.2022.0177 -
The Journal of Sexual Medicine Feb 2021Peyronie's disease (PD) is a challenging clinical entity. To assist clinicians with diagnosis and management, four separate organizations have published PD guidelines... (Review)
Review
BACKGROUND
Peyronie's disease (PD) is a challenging clinical entity. To assist clinicians with diagnosis and management, four separate organizations have published PD guidelines over the past five years, but there remains a lack of consensus and data-driven recommendations for many aspects of diagnosis and treatment.
AIM
To compare and contrast PD guidelines, highlighting key similarities and differences among the guideline panel recommendations and identify areas for further research.
METHODS
We performed an extensive review to compare and contrast diagnosis and treatment recommendations from publically available published PD guidelines from four different organizations: American Urological Association, European Association of Urology, Canadian Urologic Association, and the International Society of Sexual Medicine.
OUTCOMES
Key similarities and differences with regards to definition, evaluation, nonsurgical and surgical treatments were compared.
RESULTS
Points of general consensus among the guideline panels included: History is adequate for diagnosis of PD, and intracavernosal injection is a gold standard to evaluate penile deformity prior to invasive intervention. Careful counseling with shared decision-making is required prior to treatment. In general, plication and incision and/or grafting surgery is reserved for patients with preserved erectile function whereas penile prosthesis implantation is the only surgical option for PD patients with erectile dysfunction. Overall, nonsurgical treatments have inferior evidence of efficacy with these being the main area of controversy; however, all societies recognize that intralesional injections may be used. 0Further research into the pathophysiology of PD may direct novel treatments targeted towards early intervention and rigorous outcomes research may direct best practices for the surgical treatment of PD in the future.
CLINICAL IMPLICATIONS
PD is a challenging clinical entity. Direct comparison of the published PD guidelines highlights clear standards of care as well as areas where more research is needed to promote higher levels of evidence-based practice.
STRENGTHS & LIMITATIONS
To our knowledge this is the first report to directly compare and contrast published guidelines pertaining to the diagnosis and management of PD. Limitations include the lack of evidence-quality review pertaining to individual guideline recommendations, although this was not the aim of this review.
CONCLUSION
We highlight consensus of major urologic societies on many aspects of work up and management of PD with notable exceptions which may guide further research. Manka MG, White LA, Yafi FA, et al. Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. J Sex Med 2021;18:363-375.
Topics: Canada; Consensus; Humans; Male; Penile Implantation; Penile Induration; Penis
PubMed: 33423972
DOI: 10.1016/j.jsxm.2020.11.013 -
JAMA Dermatology Oct 2023
Topics: Male; Humans; Foscarnet; Penile Diseases; Antiviral Agents; Ulcer; Skin Diseases; Penis
PubMed: 37647057
DOI: 10.1001/jamadermatol.2023.2592 -
The Surgeon : Journal of the Royal... Jun 2022Penile cancer is a rare malignancy, with a reported incidence of 1.5/100,000 males in the Republic of Ireland in 2015. The aim of this study was to perform the first... (Review)
Review
OBJECTIVE
Penile cancer is a rare malignancy, with a reported incidence of 1.5/100,000 males in the Republic of Ireland in 2015. The aim of this study was to perform the first national review and to evaluate clinicopathological factors affecting survival.
SUBJECTS AND METHODS
All cases of penile cancer in Ireland between 1995 and 2010 were identified through the National Cancer Registry Ireland (NCRI) and analysed to identify factors affecting survival.
RESULTS
360 cases of penile cancer were identified, with a mean age at diagnosis of 65.5 years and 88% (n = 315) of cases occurred in those over 50. 91% (n = 328) of cases were squamous cell carcinomas (SCC). The majority of patients were treated surgically (n = 289), with 57% (n = 206) and 24% (n = 87) undergoing partial penectomy and total penectomy respectively. Only 18% (n = 65) received radiotherapy, and 8% (n = 27) received chemotherapy. Mean overall survival (OS) was 113 months, and five year disease specific survival (DSS) was 70% (95%CI: 59.1-77.8%). Age at diagnosis, nodal status and presence of metastatic disease were independent prognostic markers on multivariate analysis.
CONCLUSION
This study represents the first national review of penile cancer in Ireland. The annual incidence and survival rates are comparable to European figures, though superior DSS has previously been reported from our institution, highlighting the role for centralisation of care in Ireland.
LEVEL OF EVIDENCE
2b.
Topics: Carcinoma, Squamous Cell; Humans; Ireland; Male; Penile Neoplasms; Penis; Survival Rate
PubMed: 34034967
DOI: 10.1016/j.surge.2021.04.004