Partial Amputation of the Penis with Total Rupture of the Urethra: About a Case in the Urology Department of the Bonamoussadi District Medical Center

Penis amputations are rare, they are most often observed in a criminal context or in the context of self-mutilation. We present the case of a partial amputation of the shaft in the context of a domestic accident. This is a 53-year-old patient received in the emergency department for partial amputation of the penis occurred, whose mechanism of occurrence would be the fall of a sheet metal from the roof of his house, with reception on the proximal end of the shaft leading to a partial rupture of it—here, with total urethral section. He has no medical-surgical history. The physical examination finds a good general condition, a partial tearing of the ventral face of the penis associated with a total rupture of the urethra followed by a hemorrhage, the rest of the examination was without particularity. The emergency assessment carried out was without particularity. The treatment consisted initially of catheterizing the urethra by a urinary tube ch 20, then a urethral replacement, followed by a Peno plastie. The surgical suites were enamelled with parietal suppuration plus necrosis at J 14 post-operative. A more bidaily dressing debridement followed with a favorable evolution at 2 months. Subsequently, a penile graft was performed more urethrolastic, with removal of the flap on the inner side of the thigh, the surgical suites were favorable on the sexual plane gradual resumption of night erections.

Reawakened Sexual Interest: The Result of Surgical Correction of Concealed Penis

Concealed penis (CP) is a developmental anomaly in which the penis is hidden in the skin of the abdomen, thigh or scrotum. As a result of this, the penis appears shortened in length. It was first described by Keyes Jr. E.L. in 1919. It can be associated with voiding problem and in adults, sexual issues, among others. Objective: To show that surgery can reverse celibacy induced by CP and highlight the need for an interdisciplinary approach to correction of this anomaly. Patient and Method: A thirty-one-year male patient who had a surgical release of his buried penis by two surgeons in 2019 in a private hospital. The case note was reviewed, the data obtained analyzed and the results including photographs, were presented. The patient was followed up. Result: A 10 cm length of penis and a hundred percent (100%) take of sheet of split skin graft used to resurface the denuded penis were achieved using combined spinal and epidural anesthesia. The patient, his mother and the surgeons were satisfied with the outcome. Consequently, he resolved to marry a wife after all. Conclusion: Concealed penis can now be regarded as a known cause of celibacy and surgical correction can reverse the celibate state.

Severe Coital Accident: A Rare Case of Simultaneous Fracture of the Penis and a Complete Urethral Rupture at the University Hospital of Bouake

Cavernous body fracture is a rare urological emergency. Its association with complete rupture of the urethra remains exceptional. This is a report of simultaneous penile fracture and complete rupture of the urethra following a misstep in coitus. It is about a 41-year-old young adult, admitted to the surgical emergency department of the University Hospital of Bouaké on March 2, 2020 for penile pain associated with acute retention of urine. The clinical examination confirmed the diagnosis of a corpus cavernosa fracture associated with a ruptured urethra. The patient underwent cystostomy, right cavernoraphy and urethrorrhaphy. The postoperative follow-up was straightforward and the patient was discharged from the hospital on D3 postoperatively. The urethral catheter was removed on D21 postoperatively. With a follow-up of 1 year, the patient presents a good erection and does not report any voiding disorder.

Strangulation of the Penis by a Ring in Children: About a Case

Strangulation of the penis by a ring is a rare but quite common event in children and is potentially serious. We found it important to report this case in order to share our experience on the management of penis rings. It was a 9-year-old child, with no particular medical-surgical history, nor any notion of known family defect, brought to the emergency room by his parents for intense pain in the penis associated with incessant crying. In front of which a clinical examination made it possible to conclude with penile strangulation by a metal ring. Our course of action was the ablation of the ring with non-medical forceps associated with local and general care. No complications were observed during treatment. The immediate consequences were simple and the patient was followed for 4 months.

Bilateral ureteral reimplantation in a patient with an intraperitoneal ectopic bipenis:A case report

BACKGROUND Diphallia is a highly uncommon congenital urogenital abnormality and a few connected reports have been published.However,no case of intraabdominal heterotopic diphallus has been documented to date.In the present study,we present a rare case of intraperitoneal ectopic bipenis.CASE SUMMARY A 49-year-old man was hospitalized with the chief complaint of hydronephrosis of both kidneys,which was discovered three days earlier through regular physical examination performed using urological ultrasound without significant lumbar or abdominal pain or bladder irritation.Physical examination showed normal external penile development,bilateral testes located on the left side of the scrotum,and a fused epididymis.Urological plain and enhanced computed tomography suggested bilateral hydronephrosis,bilateral ureters opened to the left side of the bladder wall;an intrapelvic soft tissue shadow on the left side of the bladder was considered a germline malformation called bipenis(hidden penis in the abdominal cavity).Based on the urological plain and enhanced computed tomography results,a 49-year-old man was diagnosed with bipenis(one hidden in the abdominal cavity).Ectopic penile compression produced bilateral ureteral dilatation and hydronephrosis.The ectopic penis was amputated and partially removed during surgery,and bilateral ureteral replantation was successfully performed.At a 2-mo follow-up,the patient was very satisfied with the operation,there was no significant hydronephrosis in both kidneys,and urination and erectile function were normal.CONCLUSION To our knowledge,this is the first report of diphallia with an intraperitoneal ectopic penis.Computed tomography or magnetic resonance imaging can be used to assess the associated internal anomalies before surgery.Postoperative pathological findings are the gold standard for the diagnosis.

Clinical Characteristics and Difficulties in the Management of Cancer of the Penis

Introduction: Penile cancer is a rare primary malignancy that occurs in patients in their 60s and 70s. The aim of the study was to describe the anatomical aspects of penile cancer and to report the difficulties of its management. Materials and Methods: This was a retrospective descriptive study of patients with penile tumors from January 2007 to December 2019. Patients of sexual age with an ulcerated lesion of the penis, who came to our department and whose clinical and paraclinical workup led to the diagnosis of penile cancer, were included. The variables studied were clinical, paraclinical and therapeutic. Results: In 12 years, we diagnosed and managed 8 patients with penile cancer, an incidence of 0.7 per year. The reason for consultation was the chronic ulcerating wound of the penis with a “cauliflower” aspect. The first medical consultation was late (n = 8) after a long latency period lost to traditional healers. The lesion was located in the glans penis (n = 6) and/or in the corpus cavernosum (n = 2). Histological analysis of the cores concluded to a squamous cell carcinoma. Patients were classified as T2N+M+ (n = 3) and T2N0M0 (n = 5). One patient had accepted partial amputation of the penis. Conclusion: Penile cancer is a rare tumor. Partial amputation of the penis is the only alternative in our practice context, an alternative often refuted.

Preliminary study on androgen dependence of calcitonin gene-related peptide in rat penis

Aim: To study the androgen dependence of the neurotransmitter, calcitonin gene-related peptide (CGRP) in rat penis. Methods: Forty-four Sprague-Dawley rats were randomly divided into Group A (intact controls), Group B (castrated) and Group C (gavaged with finasteride 4.5 mg·kg^(-1).day^(-1)). Four and ten weeks later respectively, half of rats in each group were anaesthetized. Blood samples were taken for the measurement of serum testosterone and dihydrotestosterone (DHT) by means of radioimmunoassay. Penile samples were harvested for the investigation of calcitonin gene related peptide (CGRP)-immunoreactive nerve fibers with immunohistochemistry. The computer-assisted imaging analysis system was applied to calculate the area proportion of the CGRP-positive nerve fibers (CGRP-PNF) in each group. Results: 1) Both 4 and 10 weeks later, testosterone and DHT levels in Group B decreased significantly compared with those in Group A, (P < 0.05, P < 0.01, respectively); DHT level in Group C was also significantly decreased in comparison with that in Group A for both 4- and 10- week animals (P < 0.05); 2) There was no significant differences in area proportion of CGRP-PNF among Groups A, B and C 4 weeks after treatments (P > 0.05); However, 10 weeks later, the proportion of CGRP-PNF in Groups B and C was significantly less than that in Group A (P < 0.01);3) The proportion of CGRP-PNF of 4-week animals in Groups B and C was significantly higher than that of 10-week animals (P < 0.05). Conclusion: The expression of neurotransmitter, CGRP may depend on androgens, including testosterone and DHT in rat penis.

Coagulation of a giant hemangioma in glans penis with holmium laser

A 21-year-old man presented with an enlarged giant hemangioma on glans penis which also causes an erectile dysfunction （ED） that partially responded to the intracavernous injection stimulation test. Although the findings in magnetic resonance imaging （MRI） indicated a glandular hemangioma, penile colored Doppler ultrasound revealed an invaded cavernausal hemangioma to the glans. Surgical excision was avoided according to the broad extension of the gland lesion. Holmium laser coagulation was applied to the lesion due to the cosmetically concerns. However, the cosmetic results after holmium laser application was not impressive as expected without an improvement in intracavernous injection stimulation test. In conclusion, holmium laser application should not be used to the hemangiomas of glans penis related to the corpus cavernosum, but further studies are needed to reveal the effects of holmium laser application in small hemangiomas restricted to the glans penis.

Festosterone regulates keratin 33B expression in rat penis growth through androgen receptor signaling

Androgen therapy is the mainstay of treatment for the hypogonadotropic hypogonadal micropenis because it obviously enhances penis growth in prepubescent microphallic patients. However, the molecular mechanisms of androgen treatment leading to penis growth are still largely unknown. To clarify this well-known phenomenon, we successfully generated a castrated male Sprague Dawley rat model at puberty followed by testosterone administration. Interestingly, compared with the control group, testosterone treatment stimulated a dose-dependent increase of penis weight, length, and width in castrated rats accompanied with a dramatic recovery of the pathological changes of the penis. Mechanistically, testosterone administration substantially increased the expression of androgen receptor （AR） protein. Increased AR protein in the penis could subsequently initiate transcription of its target genes, including keratin 33B （Krt33b）. Importantly, we demonstrated that KRT33B is generally expressed in the rat penis and that most KRT33B expression is cytoplasmic. Furthermore, AR could directly modulate its expression by binding to a putative androgen response element sequence of the Krt33b promoter. Overall, this study reveals a novel mechanism facilitating penis growth after testosterone treatment in precastrated prepubescent animals, in which androgen enhances the expression of AR protein as well as its target genes, such as Krt33b.

Ischemic glans penis after circumcision

A 33-year-old male receiving dorsal penile nerve block (DPNB) for circumcision exhibited a postoperative ischemic change over the glans penis. The event occurred nearly 24 hours after the procedure. The patient was treated with intravenous pentoxifyllin and hyperbaric oxygenation. Total reverse of the ischemia was observed. The complications associated with circumcision and DPNB were reviewed and discussed.

Extraskeletal Osteosarcoma of Penis: A Case Report

Extraskeletal osteosarcoma （EOS） is rare and commonly arises in the retroperitoneum, limbs, head and neck. There is no significant difference between EOS and other malignant tumors in soft tissue. Localized pain and swelling are the common presenting symptoms. Clinical diagnosis of EOS is difficult, imaging techniques may be helpful and careful, and the histopathological analysis is necessary. The common histological variants of EOS include： osteoblastoma, chondroblastoma, and fibroblastoma, and other unusual subtypes were reported occasionally. It should be distinguished with myositis ossificans, malignant mesenchymoma, giant cell tumor and parosteal osteosarcoma. We present an EOS arising in the penis. The primary site and histological category of the tumor were extremely rare. We hope the case will be helpful to the recognition of clinical signs, iconography and histopathology of EOS.

Penile aseptic abscess in the cavernous body at the base of the penis:a case report

We report a case of aseptic abscess in the cavernous body at the base of the penis.In our clinical observation,the patient underwent puncture and drainage of the corpus cavernosum abscess,followed by surgical resection of the abscess wall,with the incisions closed layer by layer with primary suture.In addition,we paid attention to strengthening the postoperative management by using elastic bandages to wrap the penis intermittently to prevent edema;the incision would not be covered with dressings from the third day after the operation,so as to keep the incision site dry in an open way.During the period of indwelling of the catheter after the operation,we noticed the care of the external orifice of the urethra to reduce the occurrence of catheter-related infections.Finally,the patient was diagnosed with a penile aseptic abscess in the cavernous body at the base of the penis.The patient recovered well after surgery and was discharged 1 week later.At 1.5 years after the operation,the shape of the penis returned to normal,and the erectile function was normal.It was seen that good nursing concept is of great help for prognosis,which could avoid infection and edema,and is conducive to wound healing.

CLINICOPATHOLOGICAL AND SURGICAL STUDY OF VERRUCOUS CARCINOMA OF PENIS

Fifty-nine cases of resected verrucous carcinoma of penis are analysed. They account for 46 percent of the hospitalized patients with carcinoma of penis in the same time (1966--1990). Among them, 54 cases were diagnosed originally as squamous cell carcinoma.Surgical treatment included total amputation of the penis, urethral transplantation (23 cases), excision of testis (15 cases) and resection of the regional lymph nodes (25 cases). Our study demonstrates that the malignant degree of verrucous carcinoma of penis is low and it should be differentiated from squamous cell carcinoma in diagnosis and treatment. It is preferable that local tumour resection or partial amputation of penis should be carried out.

Effect of Topical Steroid Treatment for Concealed Penis: Is It Managed Conservatively?

Purpose: Phimosis can be treated using topical steroid treatment effectively. Meanwhile, concealed penis has been required surgical correction because it was considered stubborn to conservative treatment. But there were few reports of conservative treatment using topical steroid treatment for concealed penis. The aim of the present study was to evaluate the effects of topical steroid treatment for concealed penis. Materials and Methods: From December 2006 to December 2011, 30 patients (mean age 9.3 years) with concealed penis were treated with topical 0.12% bethamethasone valerate cream. Patients or their parents continued to retract the prepuce gently without causing pain and to apply a topical 0.12% bethamethasone valerate cream to the prepuce twice daily for 6 weeks. When topical steroid treatment was ineffective, patients were surgically corrected. Results: The success rate of topical steroid treatment was low (10%). 27 of 30 patients required surgical repair. No patients showed complications associated with topical steroid or surgical intervention. Conclusions: Concealed penis is highly resistant to topical steroid treatment and should be corrected surgically.

The Use of Bovine Collagen and Skin Graft for Reconstruction of the Glans Penis Following Cancer Resection

Penile reconstruction following cancer resection has long been a challenge due to demand for both aesthetic and functional preservation. Although various methods have attempted to achieve both goals, none have succeeded entirely. In this report, we introduce a novel reconstructive technique on a 64-year-old patient with squamous cell carcinoma of the glans penis. The technique consisted of two staged procedures. First, a dermal substitute, consisting of bovine collagen, was sutured onto the defect after partial glansectomy and three weeks later, the integrated dermis was covered with autologous non-meshed partial thickness skin graft. Use of this dermal substitute in a staged fashion allowed for ability to await final pathologic margins prior to definitive reconstruction and increased dermal thickness. After 9-month follow-up, sexual function returned within 3 months and the patient remained healed. We found this technique to be useful in concurrently preserving penile function and cosmesis. Future studies should include more patients and longer follow-up.

Management of Post-Circumcision Trapped Penis with Glanular Amputation

A phenomenon known as trapped penis has numerous origins, including injudicious circumcision. Materials and Methods: Surgery for trapped penis with glanular amputation was performed for 5 children. The surgical policy in these cases included complete penile degloving, excising the scarring due to circumcission, fixing the penile skin at the penopubic and penoscrotal angles and reconstructing the penile skin with full thickness skin graft. Results: Improvement was noted in all cases. Conclusion: Surgery for hidden penis using full thickness skin graft achieves very satisfactory aesthetic and functional improvement.

Penis Cancer: About Three (03) Observations at the University Hospital of Bouake

Objective: To report the diagnostic aspects and the therapeutic difficulties of this disease, to contribute to the prevention and screening of this cancer and propose a diagnostic, therapeutic and psychological management of penile cancer of patients at Bouaké University Hospital Center based on a short series of three (03) observations. Patients and Method: Over a period of five years (January 2012 to December 2017), we collected three (03) cases of cancer of the penis. Results: A total of three (03) cases of epidermoidal carcinoma of the penis were diagnosed. The average age of the patients is [52 years], all of them of low socio-economic level. Two (02) patients (n = 2) categorically refused surgical treatment (penile amputation) and one (01) patient was lost to follow-up. Two patients are currently deceased. Conclusion: Penile cancer has been an aggressive tumor with a pejorative prognosis, due to the delay of consultation in our underdeveloped countries. Patients consult late but above all refuse any idea of surgical treatment on the penis. The effort to be made is to insist on the prevention and screening of penile precancerous lesions by an adequate training of urban medical staff by a squad of specialists (urologists, oncologists and dermatologists).

Fracture of the Penis: About a Case of Delay in Management at the Nianankoro Fomba Hospital in Segou-Mali

Introduction: Fracture of the penis is a rare uro-andrological emergency defined as the rupture of the tunica albuginea of the erect penis most often during sexual intercourse. Surgical exploration and repair of the albuginea breach as soon as possible are the standard treatment. However, in our African context, early diagnosis and management are negatively influenced by the delay in consultation due to modesty. Our objective was to describe the clinical and therapeutic aspects of the fracture of the penis seen late in the African context and to compare it with the literature review. Presentation of the case: Our aim was to report our experience in the management of late-onset fracture of the penis, after more than 48 hours of evolution, by reporting the observation of a 54-year-old patient, who had a false coitus, treated in the urology department of the Nianankoro Fomba Hospital. The physical examination revealed a deformation of the penis following the formation of a large hematoma with a characteristic eggplant appearance. Therapeutically, a suture of the albuginea was performed with simple follow-up. Conclusion: This case study shows a delay in the management of this emergency due to the reluctance of the patient to be consulted as soon as possible for reasons of modesty. A delayed emergency surgical management was the only therapeutic alternative and the coronal incision with degloving was the only way to approach the voluminous hematoma related to the delay in management.

Sarcomatoid carcinoma of the penis

We encountered a 63-year-old male with a sarcomatoid carcinoma of the penis accompanied by metastasis to the bilateral inguinal lymph nodes and lungs. He noticed a penile mass, but neglected it. The mass rapidly increased in size, forming an ulcer, and began to disintegrate. He visited our hospital 4 months after noticing the mass. After cystostomy and blood transfusion, surgical resection was performed. A diagnosis of a squamous cell carcinoma with a sarcomatoid carcinoma of the penis was made. After the operation, best supportive care (BSC) was selected. We made efforts to maintain his quality of life (QOL), and he died 3 months after the operation.