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British Medical Journal (Clinical... Nov 1982
Topics: Erectile Dysfunction; Humans; Male; Penile Diseases; Penis; Radiography
PubMed: 6814592
DOI: 10.1136/bmj.285.6353.1443 -
Minerva Urology and Nephrology Feb 2021Concealed penis is an uncommon genital abnormality that requires surgical repair. Several techniques are offered but not fully accepted. We present a novel standardized...
BACKGROUND
Concealed penis is an uncommon genital abnormality that requires surgical repair. Several techniques are offered but not fully accepted. We present a novel standardized approach that is suitable for concealed penis and penoscrotal webbing.
METHODS
From January 2005 to December 2013, patients presenting concealed penis were treated utilizing the "two corners" technique: through a midline penoscrotal incision, the superficial ventral chordee is removed, freeing the corpus spongiosum till the peno-scrotal angle. Circumferential degloving of the shaft is performed and the scrotal septum is separated from the urethra, allowing the penile shaft to pull out. The new peno-scrotal junction is rebuilt downwards, anchoring the peno-scrotal dartos corners to the peripubic tissue bilaterally and stabilizing the penile lengthening. Tension-free skin coverage is allowed by a series of Z-plasty at the penoscrotal angle avoiding circumcision if not needed.
RESULTS
Forty-nine patients aged 3-14 years (mean age 4.7 years) underwent correction of the concealed penis according to our technique. Of them, 26 were primary and 23 after previous to hypospadias repair or other genital surgery. Penile lengthening varied from 1 to 2.5 cm (median 1.8 cm). Hospital stay varied from 1 to 4 days (mean 1.6 days). Follow-up ranged from 4 to 14 years (median 7.3 years). Forty-five parents were satisfied with the results (92%), while the defect was judged imperfectly repaired in four patients.
CONCLUSIONS
The "two-corners" technique allows easy and effective correction of the concealed penis in both congenital and acquired conditions. It can be performed as outpatient procedure and results are stable at long-term follow-up.
Topics: Adolescent; Child; Child, Preschool; Follow-Up Studies; Humans; Hypospadias; Length of Stay; Male; Penis; Plastic Surgery Procedures; Scrotum; Treatment Outcome; Urethra; Urologic Surgical Procedures, Male
PubMed: 31692304
DOI: 10.23736/S2724-6051.19.03532-X -
Sexual Development : Genetics,... 2021Erectile dysfunction (ED) is one of the most prevalent chronic conditions affecting men. ED can arise from disruptions during development, affecting the patterning of... (Review)
Review
Erectile dysfunction (ED) is one of the most prevalent chronic conditions affecting men. ED can arise from disruptions during development, affecting the patterning of erectile tissues in the penis and/or disruptions in adulthood that impact sexual stimuli, neural pathways, molecular changes, and endocrine signalling that are required to drive erection. Sexual stimulation activates the parasympathetic system which causes nerve terminals in the penis to release nitric oxide (NO). As a result, the penile blood vessels dilate, allowing the penis to engorge with blood. This expansion subsequently compresses the veins surrounding the erectile tissue, restricting venous outflow. As a result, the blood pressure localised in the penis increases dramatically to produce a rigid erection, a process known as tumescence. The sympathetic pathway releases noradrenaline (NA) which causes detumescence: the reversion of the penis to the flaccid state. Androgen signalling is critical for erectile function through its role in penis development and in regulating the physiological processes driving erection in the adult. Interestingly, estrogen signalling is also implicated in penis development and potentially in processes which regulate erectile function during adulthood. Given that endocrine signalling has a prominent role in erectile function, it is likely that exposure to endocrine disrupting chemicals (EDCs) is a risk factor for ED, although this is an under-researched field. Thus, our review provides a detailed description of the underlying biology of erectile function with a focus on the role of endocrine signalling, exploring the potential link between EDCs and ED based on animal and human studies.
Topics: Adult; Androgens; Animals; Endocrine Disruptors; Erectile Dysfunction; Humans; Male; Penile Erection; Penis
PubMed: 34134123
DOI: 10.1159/000516600 -
Asian Journal of Andrology Jan 2013Peyronie's disease (PD) is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating... (Review)
Review
Peyronie's disease (PD) is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 70° without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems.
Topics: Algorithms; Erectile Dysfunction; Fibrosis; Humans; Male; Penile Induration; Penile Prosthesis; Penis; Postoperative Care; Postoperative Complications
PubMed: 23178395
DOI: 10.1038/aja.2012.92 -
Asian Journal of Andrology Nov 2010This article provides an overview of the ethical issues associated with penile transplantation, a form of composite tissue allografting. There is only one reported case... (Review)
Review
This article provides an overview of the ethical issues associated with penile transplantation, a form of composite tissue allografting. There is only one reported case of human penile transplantation, and, as such, this technique is considered to be experimental. The ethical issues at stake involve both the graft donor and the graft recipient. With regard to the recipient, there are significant concerns relating to surgical risks and benefits, informed consent, body image (including surgical expectations and outcomes) and compliance. Donor issues may include family consent and privacy, as well as graft harvesting (leaving the donor cadaver without a penis). Many of these ethical issues can be explored during the recipient's assessment and consent process. Because no medium-term or long-term outcome data for this procedure exist-only one such operation has ever been performed-the burdens and ethical issues concerning penile transplantation remain unknown.
Topics: Humans; Informed Consent; Male; Penis; Privacy; Replantation; Tissue Donors; Transplantation, Homologous; Penile Transplantation
PubMed: 20835258
DOI: 10.1038/aja.2010.88 -
BioMed Research International 2014The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish... (Review)
Review
The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish a strategy of treatment; however, to date there has been less effort to make a classification for trauma of external genitalia. The classification of external trauma in male could be established by the nature of injury mechanism or anatomic site: accidental versus self-mutilation injury and penis versus penis plus scrotum or perineum. Accidental injury covers large portion of external genitalia trauma because of high prevalence and severity of this disease. The aim of this study is to summarize the mechanism and treatment of the traumatic injury of penis. This study is the first review describing the issue.
Topics: Amputation, Traumatic; Bites and Stings; Circumcision, Male; Clothing; Humans; Male; Penis; Plastic Surgery Procedures; Wounds, Nonpenetrating
PubMed: 25250318
DOI: 10.1155/2014/375285 -
Asian Journal of Andrology Jan 2008To present a simple technique during penile prosthesis implantation that promotes the perception of increased phallic length.
AIM
To present a simple technique during penile prosthesis implantation that promotes the perception of increased phallic length.
METHODS
The penoscrotal web is defined. A "check mark" incision is made with excision of scrotal tissue. Excellent exposure is provided for implantation of the cylinders, pump and reservoir. Wound closure is performed longitudinally.
RESULTS
This technique is a modified extension of surgeries described in the pediatric literature for webbed penis. Loss of penile length following penile implantation surgery is worrisome for patients suffering from erectile dysfunction (ED). This technique helps with patient satisfaction, cosmetic results, and improves perception of penile length.
CONCLUSION
Ventral phalloplasty is a safe, technically simple procedure that may be performed in concert with penile prosthesis implantation or as a stand alone procedure under certain circumstances.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penis
PubMed: 18087655
DOI: 10.1111/j.1745-7262.2008.00365.x -
International Braz J Urol : Official... 2020To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. (Review)
Review
OBJECTIVE
To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury.
MATERIALS AND METHODS
We searched the Pubmed database between 1998 and 2019 using the following key words: "penile fracture", "fracture of penis", "trauma to penis", "rupture of corpora cavernosa", "urethral injury", "urethral rupture" and "urethral reconstruction".
RESULTS
The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula.
CONCLUSION
PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is man-datory and produces satisfactory results with low levels of complications.
Topics: Humans; Male; Penile Diseases; Penis; Rupture; Urethra; Urethral Diseases
PubMed: 31961620
DOI: 10.1590/S1677-5538.IBJU.2020.99.02 -
ANZ Journal of Surgery Sep 2022Diphallia occurs once in 5-6 million births, with no two patients presenting with the same anatomical variation. Here we discuss a review of diphallia case reports, as... (Review)
Review
BACKGROUND
Diphallia occurs once in 5-6 million births, with no two patients presenting with the same anatomical variation. Here we discuss a review of diphallia case reports, as well as present a new surgical classification system based on the soft tissue composition of the two phalluses, the anatomy of the urethra present within the most normal phallus and the bladder configuration.
METHODS
Eighty-seven diphallia case reports were collected and analysed, excluding those presented in animals and articles that were non-English, with the results compiled to provide an in-depth reference of the specific anatomy found in diphallia patients and the associated abnormalities.
RESULTS
Our proposed classification system was then applied to each patient and the most common configuration base on our classification system presented, along with commonly seen associated anomalies.
CONCLUSION
The reviewed cases represent a subset of the most unique diphallia patients; thus, several cases may be left unreported. Future reports can then be categorized, aiding as a reference, and potentially building on the classification, should the patient not fit into a specific group, leading to an expansion of the classification system.
Topics: Animals; Male; Penis; Urethra; Urinary Bladder
PubMed: 35678221
DOI: 10.1111/ans.17846 -
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