Periurethral abscess in corpus spongiosum caused by urinary tract infection: A case report and review of literature

Penile abscesses are rare and mainly interest the corpora cavernosa or soft tissue of the external genitalia, while involvement of the corpus spongiosum is unusual, with only a few cases published in the literature. We report the case of an abscess of the corpus spongiosum secondary to a documented urinary tract infection in a young immunocompetent patient with no particular pathological history. To our knowledge this is the first case reported in this context.

Post-pubertal functional outcomes of one-stage anatomical reconstruction of the corpus spongiosum, bulbo-spongiosus muscle and dartos in 46 children with proximalhypospadias

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.

Anatomy of the bulbus vestibuli: A cadaveric study

BACKGROUND

To describe the BV anatomy in detail, to compare previous BV descriptions and illustrations to the current study's findings and photograms, to show the BV topographic relation of the BV to the urethral meatus, to document the BV anatomy using photograms.

METHODS

Ten fresh human female adult cadavers were used. Stratum-by-stratum anatomical dissections in sagittal, transverse, and coronal planes were performed. The BV was dissected-off from the original location of the posterior-distal vaginal wall and the anterior anal wall.

RESULTS

The BV was located within the posterior-distal vagina and composed of two vertical legs, which fused to one another. The inferior pars intermedia fused both descending legs to the anterior-proximal perineal urethral wall, and BV embraced the anterior-proximal urethra. The superior pars intermedia connects the BV to the posterior-distal clitoral body. The BV legs traversed parallel to and aside from the vaginal introitus and the lateral urethra and not crossing the anterior-distal urethra. The tile-end was a tapered end which terminates in the vicinity of Bartholin glands. Laterally, the BV legs outspread to the medial labia minora and attach to the ischiopubic ramus. The anatomical site-specific defect (s) occurs within the BV.

CONCLUSIONS

The present study resolves the BV anatomical controversy and shows that the BV runs parallel to and aside from the anterior-distal urethra and the BV. The site-specific defect(s) can occur within the BV. This study provides important information for anatomy educators and surgeons.

Penile metastases of rectal adenocarcinoma after abdominoperineal resection: a case report

BACKGROUND

Penile metastases are very rare and arise most frequently from genitourinary cancers. Penile metastases from rectal adenocarcinoma are less common.

CASE PRESENTATION

We report the case of a 47-year-old North Afican man with penile metastases from a rectal adenocarcinoma, which was discovered 4 months after abdominoperineal resection. A penile biopsy was carried out and established the metastatic nature. He underwent palliative chemotherapy treatment. He was still alive 4 months after diagnosis of penile metastases.

CONCLUSION

The prognosis of metastasis to the penis is very poor; the best results have been achieved with surgery but only for lesions where metastasis is limited to the penis.

Penile Metastasis from Rectal Carcinoma: Case Report and Review of the Literature

Background

Metastasis of rectal cancer to the penis is a very rare condition with less than 40 cases found in the literature.

Case Report

We here report a case of a 41-year-old man who was diagnosed with rectal cancer which later metastasized to the penis. The patient was treated with neoadjuvant radiotherapy, underwent rectal resection, had adjuvant chemotherapy, and, despite that, had penile metastasis 2 years later. Palliative penectomy as well as bilateral orchiectomy with suprapubic cystostomy were performed. The patient died 2 months after the diagnosis. All the previous cases mentioned in the literature are reviewed as well.

Conclusion

The prognosis of penile metastasis from rectal cancer is poor and life expectancy is short. The mechanism of rectal cancer metastasis spread to the penis is unknown. The most acceptable theory is retrograde venous spread. There are several treatment options; however, no single treatment option is associated with superior results.

Isolated penile urethral injury: A rare case following male coital trauma

Penile fractures are an uncommon urological emergency. Typically, penile fractures involve the corpus cavernosum and are sometimes associated with urethral injury. Isolated corpus spongiosum and urethral injuries without concomitant corpus cavernosum injury are, however, rare. With proper knowledge of the management of penile fractures and urethral injuries, this distinct entity can be diagnosed, assessed and managed successfully without complications.

Myriad presentations of penile fracture: report of three cases and review of literature

Penile fracture is an unusual though not a rare condition but underreported. It is defined classically as the disruption of the tunica albuginea with rupture of the corpus cavernosum. Penile fracture can be misdiagnosed with rupture of corpus spongiosum clinically. Therefore, we are presenting three cases due to its varied clinical presentation and management. In first patient, there was a tear in the corpus spongiosum and a partial tear in the ventral urethra. Both defects were repaired with interrupted sutures. In the second patient, there was a rupture of corpus cavernosum, which was primarily repaired. After 1-year of primary surgery, patient again came with similar complaints, and diagnosis of scar dehiscence was made. Patient was treated conservatively with satisfactory results on follow-up. Third patient came with a history of 1-week. Intra-operative findings revealed only hematoma without any defect in corpora cavernosum, corpus spongiosum, and urethra. Only evacuation of hematoma was done. Early surgical treatment of penile fracture is advantageous. In recurrent penile fracture, if no penile deformity or any reasonable clinical and radiological evidence, then conservative management is advocated. Even when presentation is delayed up to 1-week, operative management has shown good results.

Metachronous penile metastasis from rectal cancer after total pelvic exenteration

Despite its abundant vascularization and extensive circulatory communication with neighboring organs, metastases to the penis are a rare event. A 57-year-old male, who had undergone total pelvic exenteration for rectal cancer sixteen months earlier, demonstrated an abnormal uptake within his penis by positron emission tomography/computed tomography. A single elastic nodule of the middle penis shaft was noted deep within Bucks fascia. No other obvious recurrent site was noted except the penile lesion. Total penectomy was performed as a curative resection based on a diagnosis of isolated penile metastasis from rectal cancer. A histopathological examination revealed an increase of well differentiated adenocarcinoma in the corpus spongiosum consistent with his primary rectal tumor. The immunohistochemistry of the tumor cells demonstrated positive staining for cytokeratin 20 and negative staining for cytokeratin 7, which strongly supported a diagnosis of penile metastasis from the rectum. The patient is alive more than two years without any recurrence.