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Lammers RJM, Tsachouridis G, Andersson MK, Dormeus S, Ekerhult TO, Frankiewicz M, Gunn CJ, Matuszewski M, de Mooij KL, Schroeder RPJ, Wyndaele MIA, Xing Z, De Kort LMO, de Graaf P. What should be next in lifelong posterior hypospadias: Conclusions from the 2023 ERN eUROGEN and EJP-RD networking meeting. Neurourol Urodyn 2024; 43:1097-1103. [PMID: 38289328 DOI: 10.1002/nau.25305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND A congenital disease is for life. Posterior hypospadias, the severe form of hypospadias with a penoscrotal, scrotal, or perineal meatus, is a challenging condition with a major impact on lifelong quality of life. AIM Our network meeting is aimed to identify what is currently missing in the lifelong treatment of posterior hypospadias, to improve care, quality of life, and awareness for these patients. METHODS The network meeting "Lifelong Posterior Hypospadias" in Utrecht, The Netherlands was granted by the European Joint Programme on Rare Diseases-Networking Support Scheme. There was a combination of interactive sessions (hackathons) and lectures. This paper can be regarded as the last phase of the hackathon. RESULTS Surgery for hypospadias remains challenging and complications may occur until adulthood. Posterior hypospadias affects sexual function, fertility, and hormonal status. Transitional care from childhood into adulthood is currently insufficiently established. Patients should be more involved in defining desired treatment approach and outcome measures. For optimal outcome evaluation standardization of data collection and registration at European level is necessary. Tissue engineering may provide a solution to the shortage of healthy tissue in posterior hypospadias. For optimal results, cooperation between basic researchers from different centers, as well as involving clinicians and patients is necessary. CONCLUSIONS To improve outcomes for patients with posterior hypospadias, patient voices should be included and lifelong care by dedicated healthcare professionals guaranteed. Other requirements are joining forces at European level in uniform registration of outcome data and cooperation in basic research.
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Affiliation(s)
- Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - George Tsachouridis
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatric Urology, Wilhemina Kinderziekenhuis, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
| | - Marie K Andersson
- Department of Pediatric Surgery, Sahlgrenska Academy, Women's and Children's Health, Queen Silvia's Children's Hospital, Gothenburg, Sweden
| | - Sarah Dormeus
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Teresa O Ekerhult
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Callum J Gunn
- Department of Bioethics and Health Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Keetje L de Mooij
- Department of Pediatric Urology, Wilhemina Kinderziekenhuis, Utrecht, The Netherlands
| | - Rogier P J Schroeder
- Department of Pediatric Urology, Wilhemina Kinderziekenhuis, Utrecht, The Netherlands
| | - Michel I A Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Zhentao Xing
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
| | - Laetitia M O De Kort
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
| | - Petra de Graaf
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
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Wei L, Zheng L, Jiang H, Jiang T. Differences between the glans and shaft of the penis: a review. Sex Med Rev 2024:qeae019. [PMID: 38600708 DOI: 10.1093/sxmrev/qeae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION The penis serves as a vital receptor in men, playing a significant role in sexual intercourse. While there are discernible disparities between the glans penis and the penile shaft, a comprehensive and detailed analysis of these distinctions is currently lacking. OBJECTIVES This study aimed to review the existing literature on the variances between the glans penis and the penile shaft, providing a systematic examination of their anatomical and histological dissimilarities. METHODS Our investigation encompassed a thorough search of the published literature, including original articles, reviews, letters to the editor, and case reports focused on the penis. We conducted a comprehensive review of the anatomical and histological dissimilarities between the glans penis and the penile shaft. RESULTS The following key differences were identified. First, regarding innervation, the glans penis and the penile shaft possess distinct neural pathways. The glans penis exhibits a 3-dimensional structure, while the penile shaft exhibits a 2-dimensional distribution. Notably, the nerves of the penile shaft extend penetrating branches into the corpus cavernosum. Furthermore, there are variations in nerve-specific antibodies between the 2 regions. Second, regarding composition, the glans penis and the penile shaft consist of dissimilar cavernous bodies. The glans penis contains unique epithelial structures and receptors, setting it apart from the penile shaft. Third, regarding the veins, there are disparities in the venous systems of the glans penis and the penile shaft. Fourth, regarding biothesiometry, variances in biothesiometry research have been observed between the 2 regions. CONCLUSION There are differences between the glans and the shaft. To further advance our understanding, future research should delve deeper into the discrepancies between the glans penis and the penile shaft. Additionally, a more specialized subdivision of the glans penis and the penile shaft would facilitate more precise and tailored treatments.
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Affiliation(s)
- Letian Wei
- Department of Andrology and Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
- Institution of Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
| | - Lei Zheng
- Department of Andrology and Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
- Institution of Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
| | - Hui Jiang
- Department of Andrology, Peking University First Hospital, Beijing 100191, China
| | - Tao Jiang
- Department of Andrology and Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
- Institution of Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
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Zheng L, Wei LT, Song-Chunli, Liu WR, Jiang H, Jiang T. The effect of local anesthetic on the hypersensitive and nonsensitive areas of the penis is different in primary premature ejaculation: a pilot study. Sex Med 2024; 12:qfae020. [PMID: 38586249 PMCID: PMC10997408 DOI: 10.1093/sexmed/qfae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/30/2023] [Accepted: 02/19/2024] [Indexed: 04/09/2024] Open
Abstract
Background Penile hypersensitivity is not the whole penis, but rather only a part of the penis. Though local anesthetic can prolong intravaginal ejaculation latency time by reducing penile hypersensitivity, the effect on the hypersensitive and nonsensitive areas of penis is still unclear. Aim The study aimed to explore whether the effect of local anesthetic on the hypersensitive and nonsensitive areas of the penis is different in premature ejaculation. Methods Penile neurophysiological tests were performed on 290 patients with primary premature ejaculation. The sensory threshold, latency, and amplitude were recorded before and after the topical application of a local anesthetic (lidocaine cream) on the penis. Outcomes Local anesthetics increased the sensory thresholds of hypersensitive and nonsensitive areas of the penis without difference but only prolonged the latency of the hypersensitive areas. Results According to the neurophysiological results, 149 of 290 patients with primary premature ejaculation had normal penile sensitivity and 141 had penile hypersensitivity. While penile hypersensitivity does not necessarily mean that the whole penis is hypersensitive, and may be that only a part of the penis is hypersensitive, and we examined the following hypersensitivities: glans hypersensitivity only (14 cases), shaft hypersensitivity only (77 cases), and whole penis hypersensitivity (50 cases). Local anesthetics (lidocaine cream) increased the sensory thresholds of hypersensitive and nonsensitive areas of the penis without difference (P < .001) but only prolonged the latency of the hypersensitive areas (P < .001), and the latency of the nonsensitive areas was not different (P > .05). Clinical Implications The present discovery implies that it is possible to improve ejaculation by applying local anesthetics externally to the hypersensitive areas of the penis to reduce the afferent local sensory signals, and improve intravaginal ejaculation latency time through accurately decreasing penile sensibility. Strengths & Limitations This is the first large-sample study to explore the difference of local anesthetics' effects on the hypersensitive and nonsensitive areas of the penis by means of neurophysiological methods in premature ejaculation. Our study exclusively examines alterations in penile evoked potential following electrical stimulation, which may not entirely encompass shifts in penile receptivity during sexual activity. Conclusion The effects of local anesthetics on the same penis varied with penile sensitivity, and can only prolong the latency of hypersensitive area of the penis. The effect of local anesthetic on the hypersensitive and nonsensitive areas of the penis is different in premature ejaculation.
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Affiliation(s)
- Lei Zheng
- Department of Andrology and Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
- Institution of Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
| | - Le-Tian Wei
- Department of Andrology and Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
- Institution of Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
| | - Song-Chunli
- Department of Neuroelectrophysiology, The First Hospital of Dalian Medical University, Dalian 116000, China
| | - Wen-Rong Liu
- Department of Andrology and Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
- Institution of Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
| | - Hui Jiang
- Department of Andrology, Peking University First Hospital, Beijing 100191, China
| | - Tao Jiang
- Department of Andrology and Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
- Institution of Sexual Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, China
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Abbas TO, Parangusan H, Yalcin HC, Hassan M, Zakrif L, Zandi N, Pennisi CP. Trilayer composite scaffold for urethral reconstruction: in vitroevaluation of mechanical, biological, and angiogenic properties. Biomed Mater 2024; 19:025022. [PMID: 38194708 DOI: 10.1088/1748-605x/ad1c9c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 01/11/2024]
Abstract
Regeneration of damaged urethral tissue remains a major challenge in the field of lower urinary tract reconstruction. To address this issue, various synthetic and natural biodegradable biomaterials are currently being explored for the fabrication of scaffolds that promote urethral regeneration and healing. In this study, we present an approach to fabricate a trilayer hybrid scaffold comprising a central layer of poly(lactic acid) (PLA) between two layers of chitosan. The chitosan/PLA/chitosan (CPC) scaffolds were fabricated by a sequential electrospinning process and their properties were evaluated for their suitability for urethral tissue engineering. The physical and biological properties of the CPC scaffolds were evaluated in comparison to electrospun PLA scaffolds and acellular dermis (Alloderm) as controls for a synthetic and a natural scaffold, respectively. Compared to the controls, the CPC scaffolds exhibited higher elastic modulus and ultimate tensile strength, while maintaining extensibility and suture retention strength appropriate for clinical use. The CPC scaffolds displayed significant hydrophilicity, which was associated with a higher water absorption capacity of the chitosan nanofibres. The degradation products of the CPC scaffolds did not exhibit cytotoxicity and promoted wound closure by fibroblastsin vitro. In addition, CPC scaffolds showed increased growth of smooth muscle cells, an essential component for functional regeneration of urethral tissue. Furthermore, in a chicken embryo-based assay, CPC scaffolds demonstrated significantly higher angiogenic potential, indicating their ability to promote vascularisation, a crucial aspect for successful urethral reconstruction. Overall, these results suggest that CPC hybrid scaffolds containing both natural and synthetic components offer significant advantages over conventional acellular or synthetic materials alone. CPC scaffolds show promise as potential candidates for further research into the reconstruction of the urethrain vivo.
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Affiliation(s)
- Tariq O Abbas
- Regenerative Medicine Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Pediatric Surgery Department, Hamad General Hospital, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
- Urology Division, Urology Department, Sidra Medicine, Doha, Qatar
| | | | - Huseyin C Yalcin
- Biomedical Research Centre, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Mohamed Hassan
- Centre for Advanced Materials, Qatar University, Doha, Qatar
| | - Lubna Zakrif
- Biomedical Research Centre, Qatar University, Doha, Qatar
| | - Nooshin Zandi
- Regenerative Medicine Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Cristian P Pennisi
- Regenerative Medicine Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Filipoiu FM, Ion RT, Filipoiu ZF, Tulin AD, Enciu O, Enyedi M. Suspension of the penis - dissection, anatomical description and highlighting of anatomical risks in sectioning the suspensory ligaments. Basic Clin Androl 2023; 33:26. [PMID: 37872528 PMCID: PMC10594829 DOI: 10.1186/s12610-023-00202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/17/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The suspension of the penis is provided by two ligaments: fundiform and suspensory. These ligaments are sectioned during some augmentative surgical procedures. The structure, the relations and the variability of these ligaments have been demonstrated. The penile neurovascular bundle and its relationships have also been emphasized. A clear knowledge of these details should ensure a reduction of the risk of surgical injury during augmentation procedures. RESULTS We dissected the ligaments providing the suspension of the penis in 7 formalized corpses. We identified, for each of the ligaments, the origin, the insertion and the relations. The dissection pieces were photographed and the images obtained were discussed upon. We described the variability of the anatomical distribution and highlighted the relations with the vascular and nervous structures for each of these ligaments. The anatomical variability of the fascia and the relations with the base of the penis were also emphasized. For the suspensory ligament, we identified three groups of fibers through which it is attached to the penile body. CONCLUSIONS The dissections were conducted in layers, corresponding to the operative steps for the penile augmentation procedures. We believe that our study highlights the anatomical basis necessary to safely perform these surgeries. The study contributes to the description of the anatomical variability of the ligaments and logically presents details that contribute to preventing most surgical incidents.
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Affiliation(s)
- Florin-Mihail Filipoiu
- Morphological Sciences Department, Anatomy Discipline, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania
| | - Radu-Tudor Ion
- Doctoral School of the University of Medicine and Pharmacy "Carol Davila" Bucharest, Eroii Sanitari Blvd, no.8, Bucharest, 050474, Romania.
| | - Zoran Florin Filipoiu
- Doctoral School of the University of Medicine and Pharmacy "Carol Davila" Bucharest, Eroii Sanitari Blvd, no.8, Bucharest, 050474, Romania
| | - Adrian-Daniel Tulin
- Morphological Sciences Department, Anatomy Discipline, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania
| | - Octavian Enciu
- Surgery Department, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania
| | - Mihaly Enyedi
- Morphological Sciences Department, Anatomy Discipline, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania
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Modekwe VI, Ugwu JO, Ekwunife OH, Maduba CC, Nnadozie UU, Nwankwo EU. Anthropometric Predictors of Appropriate-Sized Plastibell for Neonatal Circumcision. Ethiop J Health Sci 2023; 33:689-694. [PMID: 38784201 PMCID: PMC11111189 DOI: 10.4314/ejhs.v33i4.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/11/2023] [Indexed: 05/25/2024] Open
Abstract
Background Using anthropometric parameters to determine the appropriate Plastibell size before circumcision ensures that cumbersome carrying of all the sizes before each procedure is eliminated and also complications reduced. Methods Male neonates who presented for routine circumcision by Plastibell method were recruited. Collected on a proforma were their age in days, weight in Kg, stretched penile length (SPL) in cm, penile diameter (PD) in cm and the Plastibell size used by the "circumciser". The routine circumcision was carried out for each neonate according to protocol. P value was set at <0.05. Results There were 231 neonates who had Plastibell circumcision. Their mean age, weight, SPL and PD were 15.6(±5.73) days, 3.7(±0.58) Kg, 3.66 (±0.58) cm and 3.79 (±0.64) cm, respectively. Plastibell size 1.3 is the most used (53.6%). There was a positive correlation between weight, SPL, PD, on one hand and Plastibell size , on the other hand with P-values of <0.001, <0.001 and <0.001 respectively. The weight was a weak determinant for Plastibell sizes 1.1 and 1.3: (OR 7.104; 95% CI 1.108 - 45.559; P = .039) and (OR 2.044; 95% CI 1.054 - 3.963; P = .034) respectively. The SPL is also a weak predictor for Plastibell sizes 1.2 and 1.5: (OR 2.176; 95% CI 1.136 -4.136; P = .019) and (OR .043; 95% CI .072 - .984; P = .047), respectively. Conclusion The anthropometric parameters correlate well with Plastibell sizes. However, they are not effective in predicting the appropriate sized Plastibell for neonatal circumcision.
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Affiliation(s)
- Victor Ifeanyichukwu Modekwe
- Department of Surgery, Nnamdi Azikiwe University Awka
- Paediatric Surgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Jideofor Okechukwu Ugwu
- Department of Surgery, Nnamdi Azikiwe University Awka
- Paediatric Surgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Okechukwu Hyginus Ekwunife
- Department of Surgery, Nnamdi Azikiwe University Awka
- Paediatric Surgery Unit, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Charles Chidiebele Maduba
- Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Ugochukwu Uzodimma Nnadozie
- Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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S H, F A, A A, A B. Post-pubertal functional outcomes of one-stage anatomical reconstruction of the corpus spongiosum, bulbo-spongiosus muscle and dartos in 46 children with proximalhypospadias. J Pediatr Urol 2023:S1477-5131(23)00110-9. [PMID: 37012103 DOI: 10.1016/j.jpurol.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/03/2023] [Accepted: 03/16/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Anatomical studies of hypospadias show failure of zipping-up of histologically normal urethral plate and corpus spongiosum. With the commonly utilized substitution urethroplasties for proximal hypospadias, a reconstructed urethra of just an "epithelial-lined tube" with no spongiosal support, is apt to long-term urinary and ejaculatory dysfunctions. We completed a one-stage anatomical reconstruction in children with proximal hypospadias whenever the ventral curvature could be reduced to <30° and evaluated the post-pubertal outcomes. METHOD This is a retrospective analysis of prospectively maintained data on one-stage anatomical repair of proximal hypospadias between 2003 and 2021. In children with proximal hypospadias, the corpus spongiosum, bulbo-spongiosus muscle (BSM), Bucks', and Dartos' layers of the shaft were anatomically re-aligned prior to assessing the ventral curvature visually. When the curvature was >30°, the urethral plate was divided at the glans for a 2-stage procedure, and those patients were excluded from the study. Otherwise, the anatomical repair was continued (this series). The Hypospadias Objective Scoring Evaluation (HOSE) and the Paediatric Penile Perception Score (PPPS) were used for post-pubertal assessment. RESULTS Prospective records provided details of 105 patients with proximal hypospadias who had complete primary anatomical repair. The median age at surgery was 1.6 years, and 15.9 years at the post-pubertal assessment. Forty-one (39%) had complications that necessitated re-operations. Thirty-five (33.3%) patients had complications involving the urethra. For fistula and diverticula, eighteen cases required only one corrective procedure, while one required two. Other 16 patients required an average of 1.78 corrective operations for severe chordee and/or breakdown, with 7 requiring Bracka's 2-stage procedure. RESULTS OF PUBERTAL REVIEW Fifty patients (47.6%) were over 14 years old; 46 (92.0%) had pubertal reviews and scoring, while four were lost to follow-up. The mean HOSE score was 14.8/16, and the mean PPPS score was 17.8/18. Five patients had residual curvature of >10°. 17 and 10 patients, respectively, were unable to comment on glans firmness and ejaculation quality. During erections, 26/29 (89.7%) patients reported a firm glans, and 36/36 (100%) reported normal ejaculations. CONCLUSION This study proves the need for reconstruction of normal anatomy for normal post-pubertal function. In all proximal hypospadias, we strongly recommend anatomical reconstruction (zipping up) of the corpus spongiosum and BSM. When the curvature can be reduced to <30°, a complete one-stage reconstruction is possible; otherwise, anatomical reconstruction of the bulbar and proximal penile urethra is recommended, reducing the length of the epithelial-lined substitution tube for the distal shaft and glans.
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Affiliation(s)
- Hennayake S
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom.
| | - Almutairi F
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom.
| | - Ajao A
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom.
| | - Bianchi A
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom.
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Lopez CD, Girard AO, Lake IV, Oh BC, Brandacher G, Cooney DS, Burnett AL, Redett RJ. Lessons learned from the first 15 years of penile transplantation and updates to the Baltimore Criteria. Nat Rev Urol 2023; 20:294-307. [PMID: 36627487 PMCID: PMC9838304 DOI: 10.1038/s41585-022-00699-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/11/2023]
Abstract
Since 2006, five penis transplants have been performed worldwide. Mixed outcomes have been reported, and two of the five penile transplants have required explantation. However, the long-term outcomes have been encouraging when compliance is implemented, whether standard induction and triple therapy maintenance, or single therapy maintenance. Follow-up monitoring of transplant recipients has enabled a synthesis of technical considerations for surgical success and has shown stable leukocyte counts and renal function after a donor bone-marrow-based immunomodulatory regimen followed by tacrolimus monotherapy as long as 3 years post-transplant, as well as continuous nerve regeneration of penile allografts 3 years post-transplant. Areas of uncertainty include the ethics of donor-recipient colour mismatch, surveillance for sexually transmitted infections and how to optimize patient compliance. Questions also remain with respect to the long-term immunological sequelae of penile tissue, functional outcomes, psychosocial implications and patient selection. Patient counselling should be modified to mention the possibility of long-term improvement in nerve regeneration and sufficient renal function with single-therapy maintenance, and to build a longitudinal dialogue and partnership between the patient and the multidisciplinary care team regarding the risks of sexually transmitted infection instead of surveillance.
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Affiliation(s)
- Christopher D. Lopez
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Alisa O. Girard
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Isabel V. Lake
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Byoung Chol Oh
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Gerald Brandacher
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Damon S. Cooney
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Arthur L. Burnett
- grid.21107.350000 0001 2171 9311Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Richard J. Redett
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
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Pregnancy outcomes following maternal macrolide use: A systematic review and meta-analysis. Reprod Toxicol 2023; 115:124-146. [PMID: 36549458 DOI: 10.1016/j.reprotox.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/04/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
To determine whether gestational use of all or specific macrolides (azithromycin, clarithromycin, roxithromycin or erythromycin) lead to an increase in rates of overall major congenital malformations, organ-specific malformations, and other adverse pregnancy outcomes in infants. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials and Reprotox® databases were searched. Dichotomous outcomes or calculated log odds ratios and standard errors from observational studies are combined using the random-effects method in Review Manager 5.3. No significant increased risks for major congenital malformation (OR 1.06 [95% CI 0.99, 1.13]) and congenital heart defect (OR 1.05 [95% CI 0.92, 1.19]) following all macrolides use during the first trimester were detected. Prenatal azithromycin use was associated with a significantly increased risk of major congenital malformations in the analysis of cohort studies (OR 1.21 [95% CI 1.08-1.36]). This significance was also present in the sensitivity analysis. There were no statistically significant associations between the risk of organ specific malformations and all or specific macrolide exposures except for the decreased risk in hypospadias following erythromycin use in the meta-analysis of case-control studies (OR 0.38 [95% CI 0.18, 0.81]. Also, a significant 1.5-fold increased risk for spontaneous abortion following macrolide use was detected. A slight yet significantly increased rate of major congenital malformation with azithromycin exposure during pregnancy may be associated with maternal confounders. Nevertheless, level II ultrasound can be suggested following maternal azithromycin use during the first trimester. Future studies should take into account the inclusion of a disease-matched control group and accurate classification of the malformations.
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Rohrer GE, Premo H, Lentz AC. Current Techniques for the Objective Measures of Erectile Hardness. Sex Med Rev 2022; 10:648-659. [PMID: 37051971 DOI: 10.1016/j.sxmr.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/12/2022] [Accepted: 05/10/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION One of the most discussed topics in the urology provider's office is that of the male penile erection. Moreover, this is also a frequent basis for consultation by primary care practitioners. As such, it is essential that urologists are familiar with the various means by which the male erection may be evaluated. OBJECTIVES This article describes several techniques presently available that may serve to objectively quantify the rigidity and hardness of the male erection. These techniques are meant to bolster information gathered from the patient interview and physical examination to better guide patient management. METHODS An extensive literature review was performed examining publications in PubMed on this subject, including corresponding contextual literature. RESULTS While validated patient questionnaires have been routinely employed, the urologist has many additional means available to uncover the extent of the patient's pathology. Many of these tools are noninvasive techniques that involve virtually no risk to the patient and take advantage of pre-existing physiologic properties of the phallus and its blood supply to estimate corresponding tissue stiffness. Specifically, Virtual Touch Tissue Quantification which precisely quantifies axial and radial rigidity, can provide continuous data on how these forces change over time, thus providing a promising comprehensive assessment. CONCLUSION Quantification of the erection allows for the patient and provider to assess response to therapy, aids the surgeon in choice of appropriate procedure, and guides effective patient counseling regarding expectation management. Rohrer GE, Premo H, Lentz AC. Current Techniques for the Objective Measures of Erectile Hardness. Sex Med Rev 2022;XX:XXX-XXX.
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Affiliation(s)
- Gabrielle E Rohrer
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Hayley Premo
- Duke University School of Medicine, Durham, NC, USA
| | - Aaron C Lentz
- Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
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Endocrine outcome and seminal parameters in young adult men born with hypospadias: A cross-sectional cohort study. EBioMedicine 2022; 81:104119. [PMID: 35759917 PMCID: PMC9249999 DOI: 10.1016/j.ebiom.2022.104119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 04/18/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hypospadias affects around 1/200 newborn males. Intrauterine testicular dysfunction may underlie a subset of cases. The long-term endocrine and reproductive outcomes in these men remain largely unknown. METHODS Cross-sectional study in Ghent and Vienna University Hospitals to assess the endocrine and seminal parameters of young adult men (16-21 years) born with non-syndromic hypospadias (NSH) (n = 193) compared to healthy typical males (n = 50). Assessments included physical exam, semen analysis, hormone assays and exome-based gene panel analysis (474 genes). FINDINGS All participants had experienced a spontaneous puberty, in spite of higher LH and INSL3 levels than typical males. Oligo- or azoospermia was observed in 32/172 (18·6%; 99%-CI: 12·2-27·4%) of NSH men; but in 5/16 (31·3%; 99%-CI: 11·1;62·4%) of complex NSH men and in 13/22 (59·1%; 99%-CI: 33·2-80·7%) of those born small for gestational age (SGA). No (likely) pathogenic coding variants were found in the investigated genes. Suboptimal statural growth affected 8/23 (34·8%; 99%-CI: 15·4-61·0%) of men born SGA with NSH. INTERPRETATION Spermatogenesis is significantly compromised in NSH men, especially in those born SGA or those with complex NSH. Long-term andrological follow-up is recommended, including end-pubertal semen analysis. No clear monogenic causes could be demonstrated in our cohort even in proximal or complex NSH. Being born SGA with NSH is frequently associated with poor catch-up growth, requiring growth hormone therapy in some. FUNDING Research grants from the European Society of Paediatric Endocrinology, the Belgian Society of Pediatrics, the Belgian Society of Pediatric Endocrinology and Diabetology and the Research Foundation Flanders (FWO).
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Gallo CBM, Sampaio FJB, Pires RDS, Viana HM, Logsdon NT, Favorito LA. STUDY OF PENIS STRUCTURE AND DEVELOPMENT IN FETUS WITH PRUNE BELLY SYNDROME. Urology 2022; 166:283-288. [PMID: 35523289 DOI: 10.1016/j.urology.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the influence of prune belly syndrome (PBS) on the development of penises in human fetuses. METHODS We studied 39 human fetuses (including 4 with PBS) aged 11-22 weeks post conception. We measured the length and width of the free portion and penis root and the penis total length (PTL). In 21 fetuses of the control group and in 3 with PBS we analyze the penile with histochemical and immunohistochemical methods. The total penile area, area of corpora cavernosa, area of corpus spongiosum, and thickness of tunica albuginea were measured by stereological method. Means were compared using the Kolmogorov-Smirnov and ANOVA test (p<0.05). RESULTS We did not observe difference in PTL (p=0.999) when we compared the control group (4.69 to 29.77 mm, mean=16.2 mm; SD=6.34 mm) with the PBS (12.23 to 23 mm, mean=16.16; SD=4.99). The total penile area (p=0.002), the area of corpora cavernosa (p=0.023) and the area of corpus spongiosum (p=0.004) had a significant increase when comparing the PBS with the control group. CONCLUSIONS In fetuses with PBS there is no change in the length of the penis but we observed a low rate of growth in all the other histologic parameters analyzed, suggesting that PBS impacts the penile development.
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Affiliation(s)
| | | | | | - Heloana M Viana
- Urogenital Research Unit - State University of Rio de Janeiro - Brazil
| | - Natasha T Logsdon
- Urogenital Research Unit - State University of Rio de Janeiro - Brazil
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Sonkodi B, Kopa Z, Nyirády P. Post Orgasmic Illness Syndrome (POIS) and Delayed Onset Muscle Soreness (DOMS): Do They Have Anything in Common? Cells 2021; 10:cells10081867. [PMID: 34440637 PMCID: PMC8392034 DOI: 10.3390/cells10081867] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 12/16/2022] Open
Abstract
Post orgasmic illness syndrome is a rare, mysterious condition with an unknown pathomechanism and uncertain treatment. The symptoms of post orgasmic illness syndrome last about 2–7 days after an ejaculation. The current hypothesis proposes that the primary injury in post orgasmic illness syndrome is an acute compression proprioceptive axonopathy in the muscle spindle, as is suspected in delayed onset muscle soreness. The terminal arbor degeneration-like lesion of delayed onset muscle soreness is theorized to be an acute stress response energy-depleted dysfunctional mitochondria-induced impairment of Piezo2 channels and glutamate vesicular release. The recurring symptoms of post orgasmic illness syndrome after each ejaculation are suggested to be analogous to the repeated bout effect of delayed onset muscle soreness. However, there are differences in the pathomechanism, mostly attributed to the extent of secondary tissue damage and to the extent of spermidine depletion. The spermidine depletion-induced differences are as follows: modulation of the acute stress response, flu-like symptoms, opioid-like withdrawal and enhanced deregulation of the autonomic nervous system. The longitudinal dimension of delayed onset muscle soreness, in the form of post orgasmic illness syndrome and the repeated bout effect, have cognitive and memory consequences, since the primary injury is learning and memory-related.
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Affiliation(s)
- Balázs Sonkodi
- Department of Health Sciences and Sport Medicine, University of Physical Education, 1123 Budapest, Hungary
- Correspondence:
| | - Zsolt Kopa
- Department of Urology, Semmelweis University, 1082 Budapest, Hungary; (Z.K.); (P.N.)
| | - Péter Nyirády
- Department of Urology, Semmelweis University, 1082 Budapest, Hungary; (Z.K.); (P.N.)
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Huang W, Tang D, Gu W. The Characteristics and Distribution of Nerve Plexuses in the Dartos Fascia From Concealed Penis Children. Front Pediatr 2021; 9:705155. [PMID: 34422727 PMCID: PMC8374239 DOI: 10.3389/fped.2021.705155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/09/2021] [Indexed: 12/05/2022] Open
Abstract
The purpose of this study is to analyze the nerve plexus distribution in dartos fascia of concealed penis (CP). A total of 28 CP patients met ASA categories I and II were included, with median age of 3.5 years (8 months-5 years). During the surgery, tissue samples of dartos fascia at points 3, 6, 9, and 12 o'clock of the penile shaft were collected. Standard hematoxylin and eosin (H&E) staining and S-100 immunohistochemical staining were used to analyze the nerve plexus distribution among different positions. The number of nerve plexuses in superficial fascia collected at the 6 o'clock position of the penile shaft was the most abundant among four positions (median 7.25, range 1-24). The abundant nerve plexuses in the dartos fascia of CP patients, especially at the 6 o'clock position, indicate that the surgery on the preputial frenulum should avoid damage to the dartos fascia, as it might be related to maintain the erection and sexual function in adolescence.
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Affiliation(s)
- WenFang Huang
- Department of Anesthesiology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - DaXing Tang
- Department of Urology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - WeiZhong Gu
- Department of Pathology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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15
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Lee SH, Koh KS, Song WC. Macro/microscopic distribution of the dorsal nerve of penis in human glans penis. J Anat 2020; 237:849-853. [PMID: 32683709 DOI: 10.1111/joa.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/07/2020] [Accepted: 06/01/2020] [Indexed: 11/27/2022] Open
Abstract
This study aimed to elucidate the macroscopic and microscopic distributions of the dorsal nerve of penis (DNP) that provides the greatest sensitivity over the glans penis. The glandes of 23 penises of formalin-embalmed cadavers were investigated to confirm the macroscopic and microscopic distributions of the DNP within the glans penis by whole-mount Sihler's staining and histological sectioning. Superficial regions of the mid-glans were reconstructed in three dimensions to define the microstructure of terminal branches of the DNP that project towards the skin surface. A mean of 6.7 bundles of the DNP consisting of several nerve fibres converged linearly towards the distal end of the penis, rather than diverging laterally as they travelled. Lateral branches of the DNP extended linearly to the distal end with ramifications, while dorsomedial branches of the DNP gave off nerve fibres to the dorsum of the mid-glans and the corona. The intrastromal ramifications of the DNP were more developed in the distal half of the glans penis than the proximal glans containing the corpus cavernosum. These ramifications gave rise to radial nerve fibres that project towards the skin surface to form a plexiform network of terminal branches in the dermis. Linear projections of the main branches of the DNP throughout the glans and fine networks of terminal branches in the dermis were distinctly visualized in the human penis.
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Affiliation(s)
- Shin-Hyo Lee
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Ki-Seok Koh
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Wu-Chul Song
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
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16
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Mukendi AM, Doherty SW. Dorsal penile frenulum a rare congenital abnormality. AFRICAN JOURNAL OF UROLOGY 2019. [DOI: 10.1186/s12301-019-0001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Dorsal penile frenulum is noted to be an extremely rare congenital penile abnormality. Only two cases have been reported in the literature.
Case presentation
A 31-year-old male was involved in a motor vehicle accident and sustained a pelvic fracture and a scrotal laceration which was the main reason for urology consult. Genital examination revealed a circumcised penis, the presence of two frenula and a right scrotal laceration. Scrotal laceration was cleaned and closed. Orthopaedic surgeon took over the patient for the pelvic fracture.
Conclusion
This is the third reported case of a dorsal penile frenulum incidentally found in a circumcised male and completely asymptomatic. A brief review of relevant embryology and anatomy is herein discussed.
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Kaplan YC, Richardson JL, Keskin-Arslan E, Erol-Coskun H, Kennedy D. Use of ondansetron during pregnancy and the risk of major congenital malformations: A systematic review and meta-analysis. Reprod Toxicol 2019; 86:1-13. [PMID: 30849498 DOI: 10.1016/j.reprotox.2019.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 12/31/2022]
Abstract
AIMS To investigate whether ondansetron use during pregnancy is associated with increased rates of major or subgroups of malformations. METHODS PubMed/MEDLINE, Cochrane and Reprotox® databases were searched. Observational studies comprising an exposed and control group (healthy and/or disease-matched) were included. RESULTS No significant increased risk for major malformations, heart defects, orofacial clefts, genitourinary malformations or hypospadias were identified in our primary analysis. A significant heterogeneity existed for isolated cleft palate. Elevated point estimates and altered statistical significances were present for some of the outcomes among secondary analyses. CONCLUSIONS Ondansetron use during pregnancy was not associated with a significant increase in rate of major or selected subgroups of malformations in our primary analysis. However, results of the secondary analyses warrant the need for continued surveillance. These results may be reassuring for pregnant women in whom ondansetron use is clinically indicated since the absolute risks of possible concerns appear to be low.
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Affiliation(s)
- Yusuf Cem Kaplan
- Terafar - Izmir Katip Celebi University Teratology Information, Training and Research Center, Izmir, Turkey; Izmir Katip Celebi University School of Medicine, Department of Pharmacology Izmir, Turkey
| | - Jonathan Luke Richardson
- The UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
| | - Elif Keskin-Arslan
- Terafar - Izmir Katip Celebi University Teratology Information, Training and Research Center, Izmir, Turkey; Izmir Katip Celebi University School of Medicine, Department of Pharmacology Izmir, Turkey
| | - Hilal Erol-Coskun
- Terafar - Izmir Katip Celebi University Teratology Information, Training and Research Center, Izmir, Turkey; Izmir Katip Celebi University School of Medicine, Department of Pharmacology Izmir, Turkey
| | - Debra Kennedy
- Mothersafe, The Royal Hospital for Women, Sydney, New South Wales, Australia; School of Women's and Children's Health University of New South Wales, Australia
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Lee SH, Ha TJ, Koh KS, Song WC. Ligamentous structures in human glans penis. J Anat 2018; 234:83-88. [PMID: 30450557 DOI: 10.1111/joa.12896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 01/29/2023] Open
Abstract
The corpus spongiosum reportedly occupies a larger proportion of the human glans penis than does the penile body, embedding the end of the corpus cavernosus (CC). However, anatomic descriptions about the fibrous structures of glans penis in the literature cause confusion during dissection and reconstructive surgery. Forty-five penises of formalin-embalmed cadavers were dissected sagittally along the course of the distal urethra and observed macroscopically. Dense connective tissues adjacent to the fossa navicularis and spongiosum parts of the glans were cropped, and underwent Masson's trichrome and Verhoeff-Van-Gieson staining. Most (55.5%) of the specimens had distinct fibrous bands toward the distal tips of the glans penis, which elongated from the tunica albuginea of the CC. They comprised longitudinal collagen bundles continuous to the outer longitudinal layer of the tunica albuginea covering the CC and were intermingled with sparse elastic fibres. This architecture either did not reach the distal end of the glans penis (35.5% of cases), or was obscure or dispersed in all directions (9.0% of cases). The structural dimorphism and the variations in the ratio of dense connective tissue components of the fibrous skeleton are considered to contribute to the varying degrees of flexibility, distensibility and rigidity of the human glans penis.
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Affiliation(s)
- Shin-Hyo Lee
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Tae-Jun Ha
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Ki-Seok Koh
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Wu-Chul Song
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
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Abstract
BACKGROUND To investigate the efficacy of acellular dermal matrix in penis augmentation (ADMPA) for premature ejaculation (PE). METHODS A total of 39 patients treated with ADM in penis augmentation from June 2014 to December 2017 were evaluated. Detailed evaluations on PE were conducted before operation and at the 6-month and 2-year follow-up visits after operation. Self-estimated intravaginal ejaculatory latency time (IELT) and 5-item version of the International Index of Erectile Function (IIEF-5) were used to measure the ejaculation and the erectile function for all subjects. RESULTS Compared to the baseline data, the IELT and IIEF-5 scores were increased, and PE was relieved at 6 months and 2 years after operation. No major complications occurred in the series. Minor complications were resolved with conservative treatment within 3 weeks. The psychosexual impact of the operation was beneficial in the majority of cases. CONCLUSION Our survey systematically evaluated the effects of ADMPA for PE. ADMPA might be an optional surgical method in patients with PE, especially for those who seek penile augmentation. However, given the small amount of cases involved in this study, further studies on the effect of ADMPA for PE were still needed.
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Affiliation(s)
- Xiaowei Zhang
- Department of Urology, Peking University People's Hospital
| | - Yuanyi Wu
- Department of Urology, First Affiliated Hospital of PLA General Hospital
| | - Min Zhang
- Department of Urology, Chengdu Kowloon Hospital, Southwest Institute of Sexual and Health Medicine, Chengdu, China
| | - Huaqi Yin
- Department of Urology, Peking University People's Hospital
| | - Qing Li
- Department of Urology, Peking University People's Hospital
| | - Wenjun Bai
- Department of Urology, Peking University People's Hospital
| | - Tao Xu
- Department of Urology, Peking University People's Hospital
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20
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Punjani N, McGarry P, Brock G. Successful Use of an Inflatable Penile Prosthesis for the Treatment of Distal Deficiency of the Tunica Albuginea and Cavernous Tissue. Sex Med 2018; 6:356-359. [PMID: 30078732 PMCID: PMC6302149 DOI: 10.1016/j.esxm.2018.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/16/2018] [Accepted: 06/21/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Congenital hypoplasia of the distal half of the tunica albuginea has not been previously described. Aim To review a patient presenting with erectile dysfunction secondary to congenital penile hypoplasia. Methods History, physical exam and penile Doppler ultrasound of the patient, followed by a discussed of treatment options and definitive management. Results Successful operative treatment of our patient with insertion of an inflatable penile prosthesis. Conclusion We present a case of congenital hypoplasia of the distal tunica albuginea and a successful treatment strategy. We highlight the need for further study of penile embryology. Punjani N, McGarry P, Brock G. Successful Use of an Inflatable Penile Prosthesis for the Treatment of Distal Deficiency of the Tunica Albuginea and Cavernous Tissue. Sex Med 2018;6:356–359.
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Affiliation(s)
- Nahid Punjani
- Divison of Urology, Western University, London, Ontario, Canada.
| | - Patrick McGarry
- Divison of Urology, Western University, London, Ontario, Canada
| | - Gerald Brock
- Divison of Urology, Western University, London, Ontario, Canada
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21
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Comelis MT, Bueno LM, Góes RM, Taboga S, Morielle-Versute E. Morphological and histological characters of penile organization in eleven species of molossid bats. ZOOLOGY 2018; 127:70-83. [DOI: 10.1016/j.zool.2018.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/14/2017] [Accepted: 01/27/2018] [Indexed: 11/24/2022]
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Wollina U, Schönlebe J, França K, Tchernev G, Lotti T. Idiopathic Scrotal Calcinosis - A Case Report. Open Access Maced J Med Sci 2018; 6:108-109. [PMID: 29484000 PMCID: PMC5816274 DOI: 10.3889/oamjms.2018.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/23/2017] [Accepted: 09/24/2017] [Indexed: 11/05/2022] Open
Abstract
Idiopathic scrotal calcinosis is a rare disorder presenting with firm and painless nodules on the scrotal skin. The most common site is the frontal aspect of the scrotum whereas the dorsal aspect with the transition to the perineum is rarely involved. Surgery is the gold standard of treatment.
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Affiliation(s)
- Uwe Wollina
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Jacqueline Schönlebe
- Städtisches Klinikum Dresden - Center of Physical and Rehabilitative Medicine, Dresden, Germany
| | - Katlein França
- Department of Dermatology and Cutaneous Surgery, Department of Psychiatry & Behavioral Sciences; Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria.,Onkoderma, Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - Torello Lotti
- University of Rome, Institute of Deramtology, Rome, Italy
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Vocht DE, Kemp V, Iljas J, Bosch JR, Kort LM, Graaf P. A systematic review on cell‐seeded tissue engineering of penile corpora. J Tissue Eng Regen Med 2017; 12:687-694. [DOI: 10.1002/term.2487] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 04/20/2017] [Accepted: 05/19/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Dorien E.C.M. Vocht
- Department of UrologyUniversity Medical Centre Utrecht Utrecht The Netherlands
| | - Vincent Kemp
- Department of UrologyUniversity Medical Centre Utrecht Utrecht The Netherlands
| | - J.D. Iljas
- Department of UrologyUniversity Medical Centre Utrecht Utrecht The Netherlands
| | - J.L.H. Ruud Bosch
- Department of UrologyUniversity Medical Centre Utrecht Utrecht The Netherlands
| | - Laetitia M.O. Kort
- Department of UrologyUniversity Medical Centre Utrecht Utrecht The Netherlands
| | - Petra Graaf
- Department of UrologyUniversity Medical Centre Utrecht Utrecht The Netherlands
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Chung E. Translating Penile Erectile Hydraulics to Clinical Application in Inflatable Penile Prosthesis Implant. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0107-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Shen Q, Li J, Zheng D, Lv L, Yang G, He Q. Doppler Characteristics of Cavernosal-Spongiosal Communications in Patients with Erectile Dysfunction. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:159-166. [PMID: 26493238 DOI: 10.1016/j.ultrasmedbio.2015.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 08/28/2015] [Accepted: 09/04/2015] [Indexed: 06/05/2023]
Abstract
The goal of this work was to characterize the blood flow in cavernosal-spongiosal communications (CSCs) in patients with erectile dysfunction using color Doppler ultrasound. Peak systolic velocity was measured in the CSCs, cavernosal artery and urethral artery in 72 erectile dysfunction patients of the Han ethnic group in southern China. Blood in the CSCs was observed to flow from the cavernosal artery to the urethral artery in all except 5 patients with arteriogenic insufficiency whose blood flow was bidirectional. Peak systolic velocity in erectile dysfunction patients with normal vascular function or veno-occlusive dysfunction was significantly lower in the CSCs than in the cavernosal artery (p < 0.01), but significantly higher than in the urethral artery (p < 0.05). Peak systolic velocities in CSCs in patients with arteriogenic insufficiency were significantly lower than those in the cavernosal (p < 0.01) and urethral (p < 0.01) arteries. The direction of blood flow in the CSCs is determined by the pressure gradient between the cavernosal and urethral arteries.
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Affiliation(s)
- Qiang Shen
- Department of Ultrasonography, Second Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Jinbing Li
- Department of Ultrasonography, Second Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China.
| | - Dequan Zheng
- Andrology Center, Second Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Liguo Lv
- Andrology Center, Second Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Gewen Yang
- Department of Ultrasonography, Second Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Qingkun He
- Department of Ultrasonography, Second Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
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Otero HJ, Rubio E, Blask A. Ovary and testicle and everything in between: lesions and imaging in the newborn. Semin Ultrasound CT MR 2015; 36:178-92. [PMID: 26001946 DOI: 10.1053/j.sult.2015.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Assessment of the neonatal reproductive tract requires an understanding of embryology, awareness of common clinical presentations, and familiarity with normal newborn variation. This review of the neonatal reproductive tract emphasizes the use of sonography in the evaluation of developmental, acquired, and neoplastic conditions in male and female newborns. Anchored in embryologic origins, the discussion also includes descriptions of findings that may be encountered in prenatal imaging. Comments on clinical correlation are included to guide appropriate triaging of these complex cases. Imaging pearls and pitfalls are incorporated into this review, including the recognized effects of maternal hormones in female infants.
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Affiliation(s)
- Hansel J Otero
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.
| | - Eva Rubio
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC
| | - Anna Blask
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC
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27
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Microsurgical Penile Replantation after Self-inflicted Amputation in a Schizophrenic Patient: 5-year Follow-up. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e319. [PMID: 25878930 PMCID: PMC4387141 DOI: 10.1097/gox.0000000000000172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/10/2014] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. In this article, we report on the long-term follow-up of a microvascular penile replantation resulting from self-inflicted amputation in a schizophrenic patient. An interdisciplinary approach with the involvement of urology, plastic surgery, endocrinology, and psychiatry is imperative for optimal treatment of these catastrophic injuries.
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28
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Wollina U, Steinbach F, Verma S, Tchernev G. Penile tumours: a review. J Eur Acad Dermatol Venereol 2014; 28:1267-76. [DOI: 10.1111/jdv.12491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 03/03/2014] [Indexed: 12/13/2022]
Affiliation(s)
- U. Wollina
- Department of Dermatology and Allergology; Academic Teaching Hospital Dresden-Friedrichstadt; Dresden Germany
| | - F. Steinbach
- Department of Urology; Academic Teaching Hospital Dresden-Friedrichstadt; Dresden Germany
| | - S. Verma
- Nirvana Clinic; Vadodara; Gujarat India
| | - G. Tchernev
- Policlinic for Dermatology and Venerology; Saint Kliment Ohridski University; University Hospital Lozenetz; Sofia Bulgaria
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29
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Renfree MB, Chew KY, Shaw G. Inducing sex reversal of the urogenital system of marsupials. Differentiation 2014; 87:23-31. [DOI: 10.1016/j.diff.2013.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/20/2013] [Indexed: 11/29/2022]
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30
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Hoyt BS, Cohen PR. Reply to: a rare case of vulvar skin metastasis of rectal cancer after operation. Int J Dermatol 2013; 53:e339-40. [PMID: 24261652 DOI: 10.1111/ijd.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Brian S Hoyt
- Medical School, University of Texas Medical School at Houston, Houston, TX, USA
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31
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Hakky TS, Ferguson D, Spiess PE, Bradley P, Lue TF, Carrion RE. Three-dimensional mapping and comparative analysis of the distal human corpus cavernosum and the inflatable penile prosthesis. Asian J Androl 2013; 15:567-70. [PMID: 23542138 DOI: 10.1038/aja.2012.172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/16/2012] [Accepted: 01/20/2013] [Indexed: 11/09/2022] Open
Abstract
The intricate anatomy of the corpus cavernosum in both the flaccid and tumescent state has not been fully elucidated. We report our experience using a three-dimensional (3D) scanner to reconstruct cadaveric casts and compare them with 3D images of two prototypes of penile prosthesis. Two different models of the Titan Coloplast inflatable penile prosthesis were analyzed using a 3D scanner. The first was the standard model and the second was a newer model with a rounder silicone tip. Two cadaveric phalluses were harvested using Smooth-Cast 300Q polyurethane molding. The molds were excised and scanned along side the penile prosthesis. 3D scans were completed and analyzed using Leios Mesh software, and GOM Inspect software. The 3D scans demonstrated the mean human corporal radii 2 mm from the distal tip to be 36.51 mm (36.01-37.0 mm), which is an obtuse angle. The standard Titan penile prosthesis spherical radius at the same level was 202.52 mm, while the new silicone tip prosthesis had a radius of 139.33 mm. 3D mapping further demonstrated the trajectory of the cavernosa appeared curvilinear and the distal ends appeared blunt. The use of cadaveric cavernosal molds in combination with the 3D scanner allowed us to accurately image the corpus cavernosum for the first time. Our findings suggest that anatomically accurate corporal tips appear to be relatively blunt and that the new Titan silicone tip penile prosthesis more closely resembles the human corporal tip.
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Affiliation(s)
- Tariq S Hakky
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL 33602, USA
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32
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Schlomer BJ, Feretti M, Rodriguez E, Blaschko S, Cunha G, Baskin L. Sexual differentiation in the male and female mouse from days 0 to 21: a detailed and novel morphometric description. J Urol 2013; 190:1610-7. [PMID: 23473905 DOI: 10.1016/j.juro.2013.02.3198] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE We hypothesized that a significant portion of sexual differentiation of mouse external genitalia occurs postnatally. To establish a baseline of normal development to which genital abnormalities could be compared, we determined morphometric measurements and morphological descriptions of the postnatal period of sexual differentiation in mice from birth to 21 days postnatally. MATERIALS AND METHODS The external genitalia of male and female CD-1® mice were serially sectioned for histological staining. Mice were studied by age group, including ages 0 to 1, 2 to 3, 4 to 5, 10 and 21 days. Three-dimensional reconstructions were created to visually compare differences. Morphometric measurements were made of the distal mouse external genitalia and compared across age groups, and between males and females. RESULTS The morphology of male and female mouse external genitalia is similar at 0 to 1 days but undergoes dramatic changes during 21 days. The changes include the development of mesenchymal extensions, which in males form the male urogenital mating protuberance and erectile bodies, as well as comparable structures in females. Differences in morphometric measurements in homologous males and females became pronounced during 0 to 21 days, serving as a baseline for recognizing the genesis of malformations of the mouse external genitalia. CONCLUSIONS Male and female mouse external genitalia are similar morphologically and morphometrically at birth but achieve dramatic differences by age 21 days, suggesting that a significant portion of sexual differentiation in the mouse occurs after birth. We described these changes using novel, accurate morphometric measurements and 3-dimensional reconstruction. These results will be useful for studying abnormal sexual development of the mouse external genitalia.
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Affiliation(s)
- Bruce J Schlomer
- Department of Urology, University of California-San Francisco, San Francisco, California
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33
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Bronselaer GA, Schober JM, Meyer-Bahlburg HF, T'Sjoen G, Vlietinck R, Hoebeke PB. Male circumcision decreases penile sensitivity as measured in a large cohort. BJU Int 2013; 111:820-7. [DOI: 10.1111/j.1464-410x.2012.11761.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology; Ghent University Hospital; Ghent; Belgium
| | - Robert Vlietinck
- Department of Human Genetics; University of Leuven; Leuven; Belgium
| | - Piet B. Hoebeke
- Department of Urology; Ghent University Hospital; Ghent; Belgium
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34
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Hoyt BS, Cohen PR. Cutaneous scrotal metastasis: origins and clinical characteristics of visceral malignancies that metastasize to the scrotum. Int J Dermatol 2013; 52:398-403; quiz 403-5. [PMID: 23331276 DOI: 10.1111/j.1365-4632.2012.05717.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cutaneous metastases occur in about 10% of patients with cancer, occasionally presenting as the initial sign of internal malignancy. Most often cutaneous metastases are an indicator of advanced cancer and are associated with a poor prognosis. The scrotum is a rare site of cutaneous metastasis, and metastatic tumor to the scrotum can be mistaken for other skin lesions. We reviewed the published literature regarding patients who developed cutaneous metastasis to the scrotum. We summarized the clinical characteristics of these men, including primary tumor sites, age at diagnosis, treatment regimens, interval between diagnosis of primary tumor and subsequent metastasis, and outcomes. We extensively searched the PubMed medical database for papers on visceral malignancies with metastasis to the scrotum. We limited our definition to solid organ tumors; thus lymphomas, sarcomas, and melanomas of the scrotum were excluded. We identified 29 patients who developed scrotal metastases from visceral cancers. The colon/rectum (34%), prostate (28%), and lung (14%) were the most frequent sites of tumor origin. The prognosis for these patients is poor: mean patient survival was only four months after diagnosis of metastatic skin lesions. Cutaneous metastasis to the scrotum is a rare manifestation of internal malignancies that most often represents an advanced and/or progressive cancer associated with a poor prognosis. Treatment is often unsuccessful, and the mean patient survival following scrotal metastasis is <4 months.
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Affiliation(s)
- Brian S Hoyt
- Medical School, University of Texas Medical School at Houston, Houston, TX, USA
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35
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Li M, Qiu L, Lin T, He D, Hua Y, Yuan X, Liu X, Wei G. c-Jun N-Terminal Kinase is Upregulated in Patients With Hypospadias. Urology 2013; 81:178-83. [DOI: 10.1016/j.urology.2012.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/29/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
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36
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Okumu LA, Bruinton S, Braden TD, Simon L, Goyal HO. Estrogen-induced maldevelopment of the penis involves down-regulation of myosin heavy chain 11 (MYH11) expression, a biomarker for smooth muscle cell differentiation. Biol Reprod 2012; 87:109. [PMID: 22976277 DOI: 10.1095/biolreprod.112.103556] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Cavernous smooth muscle cells are essential components in penile erection. In this study, we investigated effects of estrogen exposure on biomarkers for smooth muscle cell differentiation in the penis. Neonatal rats received diethylstilbestrol (DES), with or without the estrogen receptor (ESR) antagonist ICI 182,780 (ICI) or the androgen receptor (AR) agonist dihydrotestosterone (DHT), from Postnatal Days 1 to 6. Tissues were collected at 7, 10, or 21 days of age. The smooth muscle cell biomarker MYH11 was studied in depth because microarray data showed it was significantly down-regulated, along with other biomarkers, in DES treatment. Quantitative real time-PCR and Western blot analyses showed 50%-80% reduction (P ≤ 0.05) in Myh11 expression in DES-treated rats compared to that in controls; and ICI and DHT coadministration mitigated the decrease. Temporally, from 7 to 21 days of age, Myh11 expression was onefold increased (P ≥ 0.05) in DES-treated rats versus threefold increased (P ≤ 0.001) in controls, implying the long-lasting inhibitory effect of DES on smooth muscle cell differentiation. Immunohistochemical localization of smooth muscle alpha actin, another biomarker for smooth muscle cell differentiation, showed fewer cavernous smooth muscle cells in DES-treated animals than in controls. Additionally, DES treatment significantly up-regulated Esr1 mRNA expression and suppressed the neonatal testosterone surge by 90%, which was mitigated by ICI coadministration but not by DHT coadministration. Collectively, results provided evidence that DES treatment in neonatal rats inhibited cavernous smooth muscle cell differentiation, as shown by down-regulation of MYH11 expression at the mRNA and protein levels and by reduced immunohistochemical staining of smooth muscle alpha actin. Both the ESR and the AR pathways probably mediate this effect.
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Affiliation(s)
- L A Okumu
- Department of Biomedical Sciences, Tuskegee University, Tuskegee, Alabama 36088, USA
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37
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Nemec SF, Nemec U, Brugger PC, Bettelheim D, Weber M, Graham JM, Rimoin DL, Prayer D. Male genital abnormalities in intrauterine growth restriction. Prenat Diagn 2012; 32:427-31. [PMID: 22495637 DOI: 10.1002/pd.3831] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Previous studies have shown a correlation between hypospadias and intrauterine growth restriction (IUGR), suggesting an association between placental insufficiency and abnormal genital development. This study sought to analyze the association of IUGR and genital abnormalities apparent on fetal magnetic resonance imaging (MRI). METHODS This retrospective study included 22 MRI scans of 20 male fetuses between 20 and 35 weeks of gestation presenting with IUGR. On MRI, penile length and testicular descent were evaluated. Student's t-testing and analysis of covariance were used to compare MRI penile length measurements with published normative data obtained from fetal ultrasonography (US) and MRI. McNemar testing was used to evaluate testicular descent in IUGR, compared with reported fetal MRI normative data. RESULTS The penile length in IUGR fetuses was shorter than in normal fetuses (p<0.001). Furthermore, six of 20 fetuses presented with a micropenis (2.5 SD below the mean value for age). Undescended testes were significantly more frequent in IUGR fetuses than in normal fetuses (p=0.004). CONCLUSION Our data confirm that abnormal fetal growth may be associated with penile shortening and, potentially, also undescended testes.
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Affiliation(s)
- Stefan F Nemec
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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38
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Shahid SK. Phimosis in children. ISRN UROLOGY 2012; 2012:707329. [PMID: 23002427 PMCID: PMC3329654 DOI: 10.5402/2012/707329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/19/2011] [Indexed: 11/23/2022]
Abstract
Phimosis is nonretraction of prepuce. It is normally seen in younger children due to adhesions between prepuce and glans penis. It is termed pathologic when nonretractability is associated with local or urinary complaints attributed to the phimotic prepuce. Physicians still have the trouble to distinguish between these two types of phimosis. This ignorance leads to undue parental anxiety and wrong referrals to urologists. Circumcision was the mainstay of treatment for pathologic phimosis. With advent of newer effective and safe medical and conservative surgical techniques, circumcision is gradually getting outmoded. Parents and doctors should a be made aware of the noninvasive options for pathologic phimosis for better outcomes with minimal or no side-effects. Also differentiating features between physiologic and pathologic phimosis should be part of medical curriculum to minimise erroneous referrals for surgery.
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Affiliation(s)
- Sukhbir Kaur Shahid
- Consultant Pediatrician and Neonatologist, Shahid Medical Centre, Mumbai-400 077, India
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