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The American Journal of Case Reports May 2024BACKGROUND High-flow (non-ischemic) priapism is a rare urological condition usually related to blind trauma to the penis or perineum causing an arterial-lacunar fistula....
BACKGROUND High-flow (non-ischemic) priapism is a rare urological condition usually related to blind trauma to the penis or perineum causing an arterial-lacunar fistula. It can be treated conservatively, but in some cases when conservative treatment fails, the interventional approach is indicated. In the past, only surgical treatment was available, which was associated with a significant risk of complications. Endovascular techniques use a novel approach and offer clinical benefits for the patient. CASE REPORT A 51-year-old man was admitted to the hospital after referral from the urology department with high-flow priapism related to blunt trauma. Angio-computed tomography showed extravasation of contrast medium to the corpus cavernosum, and angiography revealed a fistula between the distal segment of the left internal pudendal artery and corpora cavernosa. A successful endovascular microembolization of the arterial-lacunar fistula with the use of microcoils was performed. The postprocedural period was uneventful and the patient was discharged. Despite incomplete angiographic follow-up at 6 months, the initial symptoms were fully resolved with the absence of any erectile dysfunction and no recurrence of priapism occurred. CONCLUSIONS Post-traumatic high-flow priapism can be safely and effectively treated by endovascular means. Microembolization has proven to be successful and beneficial to preserve sexual functions.
Topics: Humans; Male; Priapism; Middle Aged; Embolization, Therapeutic; Penis; Endovascular Procedures; Wounds, Nonpenetrating
PubMed: 38689468
DOI: 10.12659/AJCR.943467 -
World Journal of Urology Apr 2024About 10% of Peyronie's patients are complex cases with severe curvature (>60 degrees), ventral plaque, multiplanar curvature, hour-glass/hinge deformity, notching... (Review)
Review
PURPOSE
About 10% of Peyronie's patients are complex cases with severe curvature (>60 degrees), ventral plaque, multiplanar curvature, hour-glass/hinge deformity, notching deformity, and ossified plaque. In patients with complex Peyronie's disease (PD), different techniques (shortening procedures, lengthening procedures, and penile prosthesis implantation (IPP)) may be necessary to achieve successful result. This review aims to analyze the various surgical techniques employed in the management of Peyronie's disease, with a specific focus on patients with complex deformity.
METHODS
Articles focusing on the surgical management of complex curvature in Peyronie's disease were searched in MEDLINE and PubMed published between 1990 and 2023.
RESULTS
Shortening procedures are linked to penile shortening and are not recommended for complex cases such as notching, hour-glass deformity, or ossified plaque. Lengthening procedures are suitable for addressing complex curvatures without erectile dysfunction (ED) and are a more appropriate method for multiplanar curvatures. Penile prosthesis implantation (IPP), with or without additional procedures, is the gold standard for patients with ED and Peyronie's disease. IPP should also be the preferred option for cases of penile instability (hinge deformity) and has shown high satisfaction rates in all complex cases.
CONCLUSION
While surgical interventions for complex curvature in Peyronie's disease carry inherent risks, careful patient selection, meticulous surgical techniques, and post-operative care can help minimize complications and maximize positive outcome.
Topics: Humans; Penile Induration; Male; Urologic Surgical Procedures, Male; Penile Implantation; Penis; Penile Prosthesis
PubMed: 38689034
DOI: 10.1007/s00345-024-04936-z -
JACC. Case Reports Jun 2024A young patient, recently treated for squamous cell penile carcinoma, presented with acute myocardial infarction and severe heart failure. Despite repeatedly ruling out...
A young patient, recently treated for squamous cell penile carcinoma, presented with acute myocardial infarction and severe heart failure. Despite repeatedly ruling out metastatic disease on imaging, surgery for a mechanical assist device revealed unexpected squamous cell metastasis in the pericardium. Consequently, palliative care was initiated.
PubMed: 38680131
DOI: 10.1016/j.jaccas.2024.102350 -
International Journal of Surgery Case... Jun 2024Bowen's disease (BD) represents an in situ squamous cell carcinoma that can progress to an invasive one without treatment. Various options for Bowen's disease have been...
INTRODUCTION
Bowen's disease (BD) represents an in situ squamous cell carcinoma that can progress to an invasive one without treatment. Various options for Bowen's disease have been delineated, each with its set of advantages and disadvantages.
CASE PRESENTATION
We report the case of a 60-year-old patient with a history of chronic smoking and a background of multiple partners and recurrent urethritis. The patient presented with a maculopapular lesion on the lateral aspect of the penis, evolving for 5 years. A biopsy confirmed the diagnosis of Bowen's disease. The patient underwent an excision of the lesion which the histology showed an infiltrating basosquamous cell carcinoma.
DISCUSSION
The diagnosis of Bowen's disease requires a biopsy and is based on histological examination. Only surgical treatment allows for the identification, through histological analysis of the excised specimen, of any potential invasive area that may not have been identified in the biopsy. Nonsurgical therapies are also an option with high recurrence rates.
CONCLUSION
Bowen's disease management requires a personalized approach, considering factors like lesion characteristics, patient-related variables and treatment efficacy. An adapted follow-up is recommended due to the recurrence risk associated with various treatments.
PubMed: 38678992
DOI: 10.1016/j.ijscr.2024.109662 -
Urology Apr 2024To quantify the incremental downstream revenue generated from subsequent treatment of men who received an inflatable penile prosthesis (IPP) to treat erectile...
OBJECTIVE
To quantify the incremental downstream revenue generated from subsequent treatment of men who received an inflatable penile prosthesis (IPP) to treat erectile dysfunction (ED), compared to men without ED.
METHODS
The 100% Medicare Standard Analytic Files were used to conduct a retrospective claims analysis of the 5-year revenue generated by patients receiving IPP to treat their ED, compared to a propensity-matched cohort of men without ED. Men aged 65 years or older with ED who underwent IPP implantation (Current Procedural Terminology 54405) in a hospital outpatient setting between January 1, 2016 and December 31, 2021, and who had continuous Medicare Parts A and B enrollment for 12 months pre-index IPP and 5 years post-index IPP discharge date were included in the study. Men without ED but with comparable characteristics were identified and used as a comparator group. Revenue received by hospitals from Medicare was defined as the sum of payments for patient services, other payor-paid amounts, patient deductibles, copayments, and coinsurance. Revenue was inflated to 2022 US dollars. The mean values and their corresponding standard deviations (SD) are reported.
RESULTS
After matching, there were 2905 men with ED who received an IPP and 7462 men without ED. The IPP cohort showed a significantly higher 5-year cumulative revenue (mean=$34,571 [SD=$50,234]) compared to the men without ED (mean=$3189 [SD=$11,527]). When stratified by diagnosis type, the differences in revenue were $10,258 for circulatory disease, $2646 for diabetes, $2013 for urology, and $1043 for prostate cancer. Significantly more IPP patients had at least 1 health encounter for these conditions over the 5-year follow-up period than their matched controls (55.0% vs 7.8% for circulatory, 46.7% vs 16.8% for urology, 19.3% vs 3.6% for diabetes, and 19.0% vs 3.0% for prostate cancer).
CONCLUSION
Men with ED who received IPP generated substantially higher revenue for the healthcare system over a 5-year period, nearly 10 times as much, compared to men without ED, excluding the initial cost of the IPP procedure. The presence of ED, coupled with IPP usage, is associated with significantly increased healthcare revenue across a range of medical conditions compared to men without ED. These findings emphasize the financial implications for advanced ED programs to improve access to necessary care for these patients. Healthcare facilities may leverage these insights to effectively allocate resources to deliver critical healthcare to men with ED.
PubMed: 38677374
DOI: 10.1016/j.urology.2024.04.018 -
Genes Mar 2024Rare sarcomas present significant treatment challenges compared to more prevalent soft tissue sarcomas due to limited treatment options and a poor understanding of their...
Rare sarcomas present significant treatment challenges compared to more prevalent soft tissue sarcomas due to limited treatment options and a poor understanding of their biology. This study investigates a unique case of penile sarcoma, providing a comprehensive morphological and molecular analysis. Through the creation of experimental patient-derived models-including patient-derived xenograft (PDX), 3D, and monolayer primary cultures-we successfully replicated crucial molecular traits observed in the patient's tumor, such as smooth muscle actin and CD99 expression, along with specific mutations in genes like and . These models are helpful in assessing the potential for an in-depth exploration of this tumor's biology. This comprehensive approach holds promise in identifying potential therapeutic avenues for managing this exceedingly rare soft tissue sarcoma.
Topics: Animals; Humans; Male; Mice; Mutation; Penile Neoplasms; Sarcoma; Tuberous Sclerosis Complex 2 Protein; Middle Aged
PubMed: 38674359
DOI: 10.3390/genes15040424 -
Medicina (Kaunas, Lithuania) Mar 2024Metastasis to the penis from renal cell carcinoma (RCC) or any other primary cancer site is unusual; when it does occur, it often involves multiple organs. A 75-year-old... (Review)
Review
Metastasis to the penis from renal cell carcinoma (RCC) or any other primary cancer site is unusual; when it does occur, it often involves multiple organs. A 75-year-old man presented with penile pain and swelling. Three months earlier, he had open radical nephrectomy with thrombectomy and was diagnosed with clear-cell RCC with tumor thrombosis in the inferior vena cava. The follow-up imaging indicated metastasis to the penis, prompting a total penectomy due to worsening pain. The excised mass displayed features consistent with metastatic RCC. This case underscores the need to consider rare metastatic sites, such as the metastasis of RCC to the penis, in RCC patients.
Topics: Humans; Male; Carcinoma, Renal Cell; Aged; Penile Neoplasms; Kidney Neoplasms; Nephrectomy; Neoplasm Metastasis; Penis
PubMed: 38674200
DOI: 10.3390/medicina60040554 -
Journal of Radiology Case Reports Nov 2023High-flow priapism is rare, uncontrolled arterial inflow, preceded by penile or perineal trauma and arterial-lacunar fistula. There are several ways to treat high-flow...
INTRODUCTION
High-flow priapism is rare, uncontrolled arterial inflow, preceded by penile or perineal trauma and arterial-lacunar fistula. There are several ways to treat high-flow priapism, i.e., conservative management, the use of ice packs, mechanical decompression, surgery, and super-selective arterial embolization. Embolization is currently widely accepted in patients who fail from conservative management. This study aimed to report the use of Gelfoam and microcoil embolization in recurrent high-flow priapism compared to PVA embolization.
CASE STUDY
A 36-year-old man complained of prolonged erection. The erection occurred three days before admission while waking up in the morning, not accompanied by either sexual stimulation or pain. There was a history of fall four days ago in the afternoon, with the patient's groin hitting a rocky ground. Physical examination revealed an erect penis, which felt warm, with an EHS of 4. Blood gas analysis of the corpus cavernosum showed bright red blood with a pH of 7.47, pCO of 23.6, pO of 145, HCO of 17.3, BE of -6, and SaO of 99%. Doppler ultrasound examination of the penis showed high-flow priapism. Embolization with PVA was performed, and there were decreased complaints. A few hours later, the erection occurred. Reevaluation was then performed and continued with embolization using Gelfoam and microcoil. There were immediate successful results (EHS of 3) accompanied by a decrease in symptoms. Long-term follow-up has shown a return to normal erectile function six months following the injury.
CONCLUSION
Priapism may happen due to various etiologies. Differentiating high-flow and low-flow is paramount during the acute phase because of different treatment strategies. Conservative management may be applied to high-flow priapism. If conservative management fails, embolization may be attempted. The choice of embolization agent must be taken into account.
Topics: Male; Humans; Adult; Priapism; Penis; Penile Erection; Arteries; Embolization, Therapeutic; Fistula
PubMed: 38638553
DOI: 10.3941/jrcr.v17i11.5230 -
Journal of Medical Economics Apr 2024Human papilloma virus (HPV) is a common cause of several types of cancer, including head and neck (oral cavity, pharynx, oropharynx, hypopharynx, nasopharynx, and...
BACKGROUND
Human papilloma virus (HPV) is a common cause of several types of cancer, including head and neck (oral cavity, pharynx, oropharynx, hypopharynx, nasopharynx, and larynx), cervical, vulval, vaginal, anal, and penile cancers. As HPV vaccines are available, there is potential to prevent HPV-related disease burden and related costs.
METHOD
A model was developed for nine Central Eastern European (CEE) countries (Bulgaria, Croatia, Czechia, Hungary, Poland, Romania, Serbia, Slovakia, Slovenia). This model considered cancer patients who died from 11 HPV-related cancers (oropharynx, oral cavity, nasopharynx, hypopharynx, pharynx, anal, larynx, vulval, vaginal, cervical, and penile) in 2019. Due to data limitations, Bulgaria only included four cancer types. The model estimated the number of HPV-related deaths and years of life lost (YLL) based on published HPV-attributable fractions. YLL was adjusted with labor force participation, retirement age and then multiplied by mean annual earnings, discounted at a 3% annual rate to calculate the present value of future lost productivity (PVFLP).
RESULTS
In 2019, there were 6,832 deaths attributable to HPV cancers resulting in 107,846 YLL in the nine CEE countries. PVFLP related to HPV cancers was estimated to be €46 M in Romania, €37 M in Poland, €19 M in Hungary, €15 M in Czechia, €12 M in Croatia, €10 M in Serbia, €9 M in Slovakia, €7 M in Bulgaria and €4 M in Slovenia.
CONCLUSIONS
There is a high disease burden of HPV-related cancer-related deaths in the CEE region, with a large economic impact to society due to substantial productivity losses. It is critical to implement and reinforce public health measures with the aim to reduce the incidence of HPV-related diseases, and the subsequent premature cancer deaths. Improving HPV screening and increasing vaccination programs, in both male and female populations, could help reduce this burden.
Topics: Humans; Papillomavirus Infections; Female; Male; Cost of Illness; Europe, Eastern; Neoplasms; Middle Aged; Efficiency; Life Expectancy; Adult; Europe; Aged; Models, Econometric; Human Papillomavirus Viruses
PubMed: 38638098
DOI: 10.1080/13696998.2024.2341572