Electrophysiological evaluation of alterations in penile sensation due to penile prosthesis implantation in patients with erectile dysfunction

Objective The present study was aimed to determine the effect of penile prosthesis implantation(PPI)surgery on penile sensation by evaluating the penile electromyography(EMG)variables.Methods The research was designed as a prospective study.Thirty patients who were diagnosed with organic erectile dysfunction and had underwent PPI surgery between January 2017 and January 2018 in the Urology Clinic of Antalya Training and Research Hospital were included in this study.Penile sensory EMG was performed on each patient 1 day prior to the surgery by the Physical Therapy and Rehabilitation clinic.Additionally,the control EMG study was also performed in the 3rd and 6th postoperative months.Results We included 27 patients in this study who attended regular follow-ups and had complete EMG results.Out of the 27 patients,23(85.2%)patients had received malleable(ProMedon)penile prosthesis,one(3.7%)patient had received a two-piece inflatable(Ambicor)penile prosthesis,and three(11.1%)patients had received a three-piece inflatable(AMS 700 CXR)penile prosthesis.The mean nerve conduction value(NCV)of the patients was 29.85(standard derivation:22.54;range:0-78.4)m/s during the preoperative period,whereas it was 27.64(standard derivation:24.72;range:0-83.3)m/s in the 3rd postoperative month and 24.80(standard derivation:22.31;range:0-88.4)m/s in the 6th postoperative month.There was no significant difference between preoperative NCV and 3rd postoperative month NCV(p=0.607).Similarly,no significant difference was observed between preoperative NCV and 6th postoperative month NCV(p=0.276).Additionally,the change between NCV values at postoperative 3rd and 6th months was not statistically significant(p=0.553).Conclusion Significant loss of penile sensation does not occur in patients who undergo PPI surgery.

Penile and scrotal strangulation by stainless steel rings in an human immunodeficiency virus positive man: A case report

BACKGROUND Penoscrotal constriction devices are either used as autoerotic stimuli or to increase sexual pleasure or performance by maintaining an erection for a longer period,and a variety of metallic and non-metallic objects are used.On the other hand,penile strangulation is a rare urologic emergency that requires prompt evaluation and intervention to prevent long-term complications.The goal of treating penile incarceration is to remove the foreign object as soon as possible.On the other hand,removal can be very challenging,and often requires resourcefulness and a multidisciplinary approach.CASE SUMMARY A 47-year-old man who has sex with men was transferred to our hospital for persistent phallodynia and scrotal pain,accompanying swelling due to strangulation by stainless steel rings.His medical history included acquired immunodeficiency syndrome.One day prior,he had put three stainless steel rings on his penis and scrotum before sexual intercourse.After sexual intercourse,he was unable to remove them,due to swelling of his penis and scrotum.The swelling persisted,and he felt pain in the affected area the next day,then he was transferred to our hospital by ambulance.The emergency department found that his penis and scrotum were markedly engorged and swollen.We established a diagnosis of penile and scrotal strangulation by stainless steel rings.We unsuccessfully attempted to cut the rings using a cutter,then requested a rescue team via emergency medical service.They cut through each ring in two places,using an electric-powered angle grinder,and successfully removed all of the pieces.Finally,he was discharged and went home.CONCLUSION We report the first case of penile and scrotal strangulation by stainless steel rings in an human immunodeficiency virus positive person.

Traumatic Penile Amputation Post Circumcision: A Series of 3 Cases

Circumcision remains a frequently performed surgical procedure and could be associated with various complications, ranging from mild to catastrophic. Penile amputation is a rare and severe complication usually complex and challenging to manage. We describe three cases of penile amputation injuries following circumcision referred within a week at the urological service of the Yaoundé Central Hospital. The first case was a 5-year-old who had complete penile amputation during circumcision by a nurse assistant at a rural health center. The second was a 7-year-old boy who sustained total penile glans amputation while undergoing circumcision by a nurse under local anesthesia at a rural health facility. The third involved a 6-year-old who had total penile amputation with loss of the amputated stump during circumcision by a traditional practitioner at home. Non-microsurgical penile re-implantations were done with diverse outcomes. The preservation of the amputated stump, the ischemic time and the severity of injury are factors affecting surgical outcome. The aim of this study is to evaluate our management experience and outcome of penile amputation injuries in resource-limited settings. Microsurgical replantation remains the gold standard in the management of penile amputation injuries. However, in resource-limited settings macroscopic replantation could be used as an alternative remedy to salvage the amputated penis.

Updates in the use of radiotherapy in the management of primary and locally-advanced penile cancer

Objective:Penile cancer is a rare malignancy in most developed countries,but may represent a significant oncologic challenge in certain African,Asian,and South American regions.Various treatment approaches have been described in penile cancer,including radio-therapy.This review aimed to provide a synopsis of radiotherapy use in penile cancer management and the associated toxicities.In addition,we aimed to discuss palliative radiation for metastases to the penis and provide a brief overview of how tumor biology may assist with treatment decision-making.Methods:Peer-reviewed manuscripts related to the treatment of penile cancer with radio-therapy were evaluated by a PubMed search(1960-2021)in order to assess its role in the definitive and adjuvant settings.Selected manuscripts were also evaluated for descriptions of radiation-related toxicity.Results:Though surgical resection of the primary is an excellent option for tumor control,select patients may be treated with organ-sparing radiotherapy by either external beam radiation or brachytherapy.Data from randomized controlled trials comparing radiotherapy and surgery are lacking,and thus management is frequently determined by institutional practice patterns and available expertise.Similarly,this lack of clinical trial data leads to divergence in opinion regarding lymph node management.This is further complicated in that many cited studies evaluating lymph node radiotherapy used non-modern radiotherapy delivery techniques.Groin toxicity from either surgery or radiotherapy remains a challenging problem and further risk assessment is needed to guide intensification with multi-modal therapy.Intrinsic differences in tumor biology,based on human papillomavirus infection,may help aid future prognostic and predictive models in patient risk stratification or treatment approach.Conclusion:Penile cancer is a rare disease with limited clinical trial data driving the majority of treatment decisions.As a result,the goal of management is to effectively treat the disease while balancing the importance of quality of life through integrated multidisciplinary discussions.More international collaborations and interrogations of penile cancer biology are needed to better understand this disease and improve patient outcomes.

Thedual pathogenesisofpenileneoplasia: The heterogeneous morphology of human papillomavirus-relatedtumors

Objective:Penile neoplasia,usually of squamous histogenesis,is currently classfied into human papillomavirus(HPV)-related or-dependent and non-HPV-related or-indepen dent.There are distinct morphological differences among the two groups.New research studies on penile cancer from Northern countries showed that the presence of HPV is corre lated with a better prognosis than virus negative people,while studies in Southern countries had not confirmed,perhaps due to differences in staging or treatment.Methods:We focused on the description of the HPV.related carcinomas of the penis.The approach was to describe common clinical features followed by the pathological features of each entity or subtype stressing the characteristics for differential diagnosis,HPV genotypes,and prognostic features of the invasive carcinomas.Similar structure was followed for penile intraepithelial neoplasia,except for prognosis because of the scant evidence available.Results:Most of HPV-related lesions can be straightforwardly recognized by routine hematoxylin and eosin stains,but in some cases surrogate p16 immunohistochemical staining or molecular methods such as in situ hybridization or polymerase chain reaction can be utilized.Currently,there are eight tumor invasive variants associated with HPV,as follows:basaloid,warty,warty-basaloid,papillary basaloid,clear cell,medullary,lymphoepithelioma-like,and giant condylomas with malignant transformation.Conclusion:This review presents and describes the heterogeneous clinical,morphological,and genatypic features of the HPV-related subtypes of invasive and non-invasive penile neoplasia.

Advances in penile-sparing surgical approaches

Objective:Penile cancer(PeCa)is a rare disease with a global incidence of 36068 new cases in 2020.This accounts for 0.4%of all male malignancies.The surgical management of PeCa depends on the location of the tumour and depth of invasion.Here,we review the oncological and functional outcomes of penile-preserving surgery(PPS).Methods:A PubMed search until July 2021 on PPS for PeCa was conducted;a narrative review on different penile-sparing approaches and outcomes was performed.Results:PPS is now the standard of care in specialist centres for distal tumours not involving the corpus cavernosa.Laser therapy,glans resurfacing,and wide local excision are options for superficial lesions,whilst glansectomy is required for lesions invading into the corpus spongiosum.Conclusion:PPS aims to preserve urinary and sexual function without compromising oncological outcomes.

Penile Fracture at the Department of Urology and Andrology, University Hospital, Brazzaville

Objective: The objectives of this study, was to analyze epidemiological diagnosis, therapeutic option and evolutionary aspects. Materials and methods: This is a retrospective study regarding clinical data of nine penile fracture patients who have been admitted in the department of urology (university hospital, Brazzaville) from January 2006 to December 2018. The study parameters were: epidemiological, diagnosis, operative details, outcomes after treatment, and sexual disorders. Results: The mean age was 46.3 ± 14 years, ranged from 25 to 73 years. The etiology of penile fracture was coitus in 5 cases, masturbation in 3 cases and rolling of the penis on the bed in one case. 8 patients were managed surgically. The complications noticed in the postoperative period and during the follow-up visits were penile curvature in 2 cases, and erectyl dysfunction in 2 cases. Conclusion: The diagnosis of penile fracture remains clinic. Immediate surgical management is necessary for good functional result.

A review of regenerative therapies as penile rehabilitation in men following primary prostate cancer treatment:Evidence for erectile restoration and cavernous nerve regeneration

Objective:The following article explores our evolving understandings of the role of regenerative technology as an effective penile rehabilitation tool in men with erectile dysfunction(ED)in the setting of prostate cancer(PCa)treatment and PCa survivorship.Methods:This narrative clinical review paper summarizes what is currently known about various modalities of regenerative therapy in restoring spontaneous erectile function(EF)in men following PCa treatment with an emphasis on penile rehabilitation strategies.Results:Conventional medical therapy often does not reverse underlying endothelial dysfunction or promote neuro-vasculogenesis to preserve penile health in men with ED.Over the past decade,there has been considerable interest in the role of regenerative therapy to restore endothelial dysfunction and ED without future dependency on medical therapy.Regenerative therapy can be classified into cellular-based(immunomodulators,stem cells,and platelet-rich plasma),biomaterials(nerve graft transfer),and device-related technology(low-intensity shockwave).Although published literature shows early promise in the role of regenerative technology for ED,there is a paucity of high-quality clinical trials in the setting of penile rehabilitation and PCa survivorship to support their use as standard care and be adopted in clinical guidelines.

Penile cancer:Updates in systemic therapy

Penile cancer is a rare genitourinary malignancy with a greater incidence in parts of Asia,South America,and Africa.Outcomes are very poor in patients with advanced disease and in those who do not respond to frstine mutimodal therapy.Among systemic therapy options,platinum-based chemotherapy is used in the frst line;however,approximately half of patients do not benefit.Response rates to systeric therapy as subsequent line treatment are historically dismal.There is also a paucity of prognostic and predictive tools within the context of penile cancer.As such,there remains an urgent need to expand systemic treatment options for patients with advanced penile cancer.The purpose of this review is to summarize the existing evidence for standard-of-care lines of systemic treatment,examine the potential of novel lines of systemic therapy,and provide an update as to the status of these new therapies within the context of penile cancer.

Initial experience of a single center with the use of ZSI 475 penile prosthesis

Objective:To evaluate surgical outcomes after implantation of the Zephyr ZSI 475 inflatable penile prosthesis(IPP)and patients’quality of life.Methods:From December 2014 to September 2018,15 patients underwent prosthesis implantation with ZSI 475.A retrospective review of clinical data was performed.Patients’quality of life after implantation was investigated with Quality of Life and Sexuality with Penile Prosthesis(QoLSPP)questionnaire.Results:The median age of patients was 57 years and the average follow-up time was 22 months.Twelve patients received a standard implantation due to severe erectile dysfunction(ED);three patients also presented penile curvature and additional corporoplasty with grafting was necessary.Three procedures had to be interrupted due to defects of the insertion tools.In one case a manufacturing defect resulted in a pump leak.In one case,a severe postoperative complication occurred,which requested explanation of the device.During the follow-up,four patients experienced mechanical failure of the prosthesis.Results of QoLSPP questionnaire at 12 months were skewed toward the positive end of the scale in all domains.Conclusion:In our initial experience,ZSI 475 suffered a high rate of mechanical failures;on the other hand,the company showed great commitment in order to improve the quality and reliability of the device.The lower cost of ZSI 475 may add to the chances of the product to become a cost-effective alternative to treat those patient who need a IPP.

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.

Penile metastasis from rectal carcinoma: A case report

BACKGROUND Metastasis to the penis is an unusual event,and penile metastasis from rectal carcinoma(PMRC)is extremely rare and associated with a dismal prognosis.Thus far,approximately 80 cases have been reported.CASE SUMMARY Herein,we report the case of a 49-year-old man with PMRC.The patient presented to the urology clinic with a complaint of penile pain during urination.The patient underwent the Dixon operation for rectal carcinoma 2 mo before the presentation.During hospitalisation,abdominal computed tomography revealed a nodular lesion on the left penis.The postoperative pathological examination revealed a typical intestinal-type adenocarcinoma.Previous cases of PMRC were retrieved from PubMed to characterise the clinicopathological features and identify the prognostic factors of PMRC.CONCLUSION The analysis suggested that approximately 24 mo is the median time to metastasis occurrence and 150 d is the survival time after diagnosis.Furthermore,poor pathological differentiation,lymph node involvement of the primary RC,metastasis time<6 mo,penile metastatic nodule diameter>1 cm,and treatment abandonment are negative predictors of survival outcomes.Close follow-up,surgical resection,chemotherapy,and radiotherapy may potentially improve the prognosis of patients.

Conversion therapy for advanced penile cancer with tislelizumab combined with chemotherapy:A case report and review of literature

BACKGROUND Locally advanced penile squamous cell carcinoma with unresectable inguinal lymph node metastasis has a poor prognosis,and surgical treatment alone offers limited benefits.Effective conversion therapy regimens are urgently needed.CASE SUMMARY We describe a locally advanced penile squamous cell carcinoma patient with bulky,fixed inguinal lymph node metastasis complicated with genital skin ulcers who underwent inguinal lymph node dissection and achieved a pathological complete response with conversion therapy comprising immunotherapy plus chemotherapy.CONCLUSION For unresectable locally advanced penile squamous cell carcinoma,neoadjuvant immunotherapy combined with chemotherapy is a potential treatment approach.Biomarkers of immunotherapy efficacy need to be explored,and clinical trials are needed to test these strategies.

Diagnosis and Treatment of Penile Fractures: A Single Center Series

Objectives: The aim of this study is to review the diagnostic work-up, treatment methods and outcomes in patients treated for penile fractures. Methods: Thirty-one patients were treated for penile fracture during the period 2006-2014. Data were retrieved from patients’ journals and analyzed retrospectively. Follow-up data were available for 23 patients. Results: Twenty-eight patients (90%) experienced immediate pain at incidence;29 (94%) experienced immediate swelling;23 (74%) heard a cracking sound;20 (65%) observed a blue discoloration immediately afterwards and 20 (65%) got immediate detumescence. Magnetic Resonance Imaging was used preoperatively in 10 patients and demonstrated the side and localization of the rupture in tunica albuginea in all cases. A longitudinal incision over the suspected site of the rupture was used in 20 patients and a sub-coronal de-gloving incision of the penile skin was used in 10 patients. The average operation time with longitudinal incision method and de-gloving was 43 minutes and 57 minutes, respectively. Short term complications were seen in four patients and long term complications were seen in 14 patients of which deviation of penis during erection was most common. Conclusions: Immediate pain, swelling and hearing a cracking sound are predominant features in the history of patients with penile fracture. Magnetic Resonance Imaging is recommended for localizing the rupture site. A longitudinal incision over the rupture site means significantly shorter operation time than de-gloving.

Surgical Treatment of Penile Deformity Due to Curvature Using a Subcutaneous Soft Silicone Implant: Case Report

Introduction: Congenital and acquired penile curvature has a negative impact on penile aesthetics, sexual capabilities, and male psychology. Surgical procedures yield satisfactory correction of curvature, but are usually associated with penile shortening and palpable suture material and nodules under the skin, resulting in patient dissatisfaction. Aims: To present a novel technique using a subcutaneous soft silicone implant for surgical treatment of penile soft tissue deformities with curvature, with prevention of surgery-associated penile shortening and subcutaneous “bumps”, and with additional gains in overall penile length and girth. Method: 3 patients who complained about congenital, post-traumatic, and post-penile surgery associated penile curvature, with concerns about their penile aesthetics and associated negative psychosocial effects, were treated with the insertion of a subcutaneous soft silicone penile implant. Results: During a follow up period of 2 - 12 months (mean: 6.7 ± 3.6 months) all three patients expressed objective and subjective satisfaction regarding the corrective results of the surgery. Penile length and girth measurements during follow-up showed a mean increase in length of 4.3 cm (±1.4 cm) and a mean increase in girth of 3.0 cm (±1.0 cm). Conclusion: The insertion of the subcutaneous soft silicone implant in addition to corporeal fibrotic tissue removal in patients with congenital or acquired penile curvature is an effective option that provides the patient with aesthetic improvements by correcting penile deviation, preventing post-surgical subcutaneous nodule formation that results from the technique and suture material used, and adding penile length and girth. Further prospective studies are required to validate our initial experience.

Dartos Fascio-Myo-Cutaneous Flap for Penile Skin Loss: A Simple Flap with an Immense Potential

Introduction: Penile skin loss poses a particular challenge for reconstruction to the plastic surgeon. These defects, depending on their size, have been reconstructed using skin grafts or regional flap. Patients & Methods: Ten patients with variable sized penile skin defects were included in this work. Scrotal fascio-myo-cutaneous (Dartos) flap was harvested and used for penile shaft resurfacing. Results: All harvested flaps were successful. None of them showed any ischemic manifestations. Discussion: Despite being a simple and robust flap, its use for resurfacing of moderate to extensive penile skin defects isn’t popular. We propose the use of Dartos flap as a good alternative for challenging moderate to extensive penile skin losses.

The “Kiel Knots” Technique for Treatment of Congenital and Acquired Penile Deviation

Objectives: We propose a surgical correction of the penile curvature applying a technique based on the 16-dot plication technique modified by burying the knots in a shallow trough of incised tunica. We entitle this modification the “Kiel Knots”. Material and methods: 20 patients with a penile deviation, average age 36.8 years (24 - 52) were operated. Follow-up time was 26 months. In 8 patients the deviation was congenital, in 12 patients it was an acquired deviation. The deviation was >30? in all patients. Surgical technique: A circumcising incision was made and the penis was degloved. Buck’s fascia was incised exposing the tunica albuginea opposite the curvature. 8 dots were marked bilaterally on the tunica albugineaand a5 mmincision along the marks was made without cutting into the Corpus cavernosum. Instead of plicating with one suture for 4 dots, our modification uses one suture for two dots with the knot buried in a shallow trough created by a scalpel. Results: The average operation time was 64 minutes. We observed a loss of penile length in 30% of the patients (0.5 - 1 cm). There were no problems with erectile function. In a follow-up of 2 years, 90% of the patients remained without recurrence of deviation. None of patients reported problems with the suture knots. Conclusion: Our technique achieves penile straightening with minimal loss of length and no erectile dysfunction.

Blunt Trauma to the Penis Post Penile Augmentation Surgery: Case Report

Introduction: Blunt trauma to the penis is a rare but potentially serious injury that can occur by various mechanisms (e.g., kicks, accidents, sexual activity, and falls). The most common clinical presentation is sudden pain, swelling, and discoloration. Depending on the type and severity of injury, management can include conservative treatment or surgery, with the ultimate goal being the prevention of delayed complications. Case presentation: A 30-year-old male presented with penile pain, swelling, and redness as a result of blunt trauma to his penis 1 week after penile enhancement surgery using a subcutaneous soft silicone implant. Once the patient’s blood pressure was stabilized, surgical management consisted of exploration with evacuation of a large hematoma and removal of the subcutaneous penile implant to avoid further perioperative and postoperative bleeding. Discussion: Postoperative bleeding is a risk factor associated with almost all types of surgical procedures, and its prevention is best achieved by identification and elimination of potential causes pre- and postoperatively. Hypertension is another risk factor for excessive postsurgical bleeding, particularly bleeding associated with prosthetic implant surgeries, and should be considered for any potential surgical patient. Conclusion: With penile prosthesis and implant surgery, hypertension is an especially serious risk factor. Early surgical management is warranted in cases involving a major hematoma and swelling. Even cases with minimal bleeding should be evaluated in a timely manner, with surgical treatment indicated, rather than watchful waiting, to prevent further damage to the penis.

Infrapubic versus Penoscrotal Approaches for Implantation of Semi-Rigid Penile Prosthesis

Background: Modification of surgical techniques to minimize wound infections in penile implant surgery using malleable prosthesis which is easy to use, of very low risk of mechanical failure and is financially suitable to improve outcome and ensures less complications. The aim of the study is to compare infrapubic approach and Penoscrotal approach in penile semi-rigid prosthesis implantation surgery. Patients and methods: Fifty patients were randomly divided into two groups and each group underwent one approach. Results: No statically significant differences were found between both groups in terms of operative time. Corporeal cross over was the most common intraoperative complications, 3 cases in IP approach and 6 cases in PS but not statistically significant. Peyronie’s disease patients underwent penile implant through infrapubic approach in 3 cases and PS in 4 cases with one recorded complication of keloid formations with IP. Urethral false passage reported only in one case with PS approach without affecting the procedure. Only minor complications including superficial wound infection which was significantly more with PS, 6/25 (24%) and IP 1/25 (4%), p value = 0.041. Penile and scrotal edema was common with IP approach (92%) in comparison with PS approach (60%). The urethral catheter can be abandoned with IP to avoid the risk of catheterizations. No significant relation between diabetes and infections and no erosions were encountered. Conclusion: Through this research work, infrapubic approach is better than Penoscrotal approach even if it is not commonly used by surgeon.

Vacuum Preparation, Optimization of Cylinder Length and Postoperative Daily Inflation Reduces Complaints of Shortened Penile Length Following Implantation of Inflatable Penile Prosthesis

Introduction: The inflatable penile prosthesis (IPP) has been used to treat erectile dysfunction for 40 years. Loss of penile length following IPP remains the single biggest patient complaint. We describe a preoperative and postoperative patient preparation protocol to assist in setting realistic patient expectations and decreasing the complaint of reduced penile length. Materials & Methods: 750 Patients are instructed to use a vacuum erection device for 10 minutes each day for up to 2 months prior to IPP implant. After two months, maximization of cylinder length is accomplished regardless of IPP manufacturer. Cylinders are left partially inflated in the post-operative period and daily inflation for 3 months immediately upon patient tolerance. The average implanted cylinder length has increased dramatically with the preoperative vacuum usage when compared to the authors’ previous implantations and when compared to the national average of implanted cylinders obtained from one manufacturer. Results: Preoperative use of the vacuum device has allowed maximization of cylinder length. After the vacuum program, patients tend to experience less pain following implantation allowing earlier device instruction cycling and use. The average implanted cylinder length continued to increase annually for the first 5 years as the protocol evolved and seems to have remained stable for the last five years. Conclusions: Preoperative vacuum usage and postoperative capsule management has nearly eliminated patient complaints of reduced penile length. We believe this to be the result of larger size cylinders being implanted when compared to our previous implantations absent of the patient participation protocol.