Changes In Penile Length Research Articles

Absolute heat sources as a method to check the accuracy of temperature prediction in underground structures within cryolithozone

The appearance of the penis is often an important aspect for men, and dissatisfaction with it distorts the perception of their body and makes them seek surgical help.The approach to this problem should be based on the objective needs of patients, assessed after analysis of their requests, anamnesis, emotional background and anatomical features. A non-systematic literature review was conducted using PubMed and Scopus to search for papers on penile aesthetic surgery published in the last 15 years.The main parameters evaluated were changes in penile length and girth, and postoperative complications.

Extratunical grafting for minimally invasive management of complex Peyronie's disease deformities.

Penile deformities due to Peyronie's Disease (PD) often significantly impair men's sexual health and quality of life. In this article we discuss the extratunical graft (ETG) procedure as a management strategy for PD patients with hourglass or indent penile deformities. We compiled descriptions of surgical techniques and performed a review of the literature regarding ETG for PD. The ETG procedure appears to have promising results in the management of indent/hourglass deformity of PD. The findings of this review of the literature demonstrate that ETG is a safe and effective reconstructive technique for penile deformity with minimal side effects. We recommend utilizing ETG with or without plication for PD patients with indent or hourglass deformities. Strengths of ETG are the improvement in patients with tunical indents and hourglass deformities secondary to PD. Additionally, patients who underwent ETG maintained sexual function given no significant change in penile length and intact erectile function. Limitations, however, are that the procedure is relatively new, and data are limited to small cohorts. The ETG procedure is a safe and effective for management of complex PD in the short- and intermediate-term follow-up cohort.

Penile length changes after penile implant surgery.

Penile length changes after penile implant surgery.

Outcomes of surgical correction of Peyronie's disease with plaque excision and grafting: Comparison of testicular tunica vaginalis graft versus bovine pericardium graft

ObjectivePeyronie's disease (PD) is an abnormal wound healing in the penile tunica albuginea. After fibrotic plaque excision, different graft materials have been used to repair the defects, but the optimal graft remains unknown. This study aimed to compare the functional outcomes of testicular tunica vaginalis grafts and bovine pericardium grafts in patients with severe PD. MethodsA retrospective comparative study was conducted on 33 PD patients undergoing partial plaque excision and grafting from September 2015 to May 2021. The patients were divided into two groups depending on the type of graft used. For 15 patients in Group B, testicular tunica vaginalis grafts were used to repair the defect, while for 18 patients in Group A, bovine pericardium grafts were used. Data of the patient's age, comorbidities, sexual function, penile curvature, postoperative complications, need for further treatment, change in penile length, and satisfaction were gathered and compared between the groups. Sexual function was evaluated using the 5-item version of the International Index of Erectile Function (IIEF-5), and a functional less than 20-degree penile curvature after surgery was considered a successful intervention. ResultsThere was no difference in age, comorbidities, degree of curvature, perioperative IIEF-5, operative time, plaque size, or complication rates. After surgery, a statistically significant improvement in curvature degree (p<0.05) and satisfactory penile appearance (p<0.05) were seen in both groups without any superiority between the two groups (p=0.423 and p=0.840, respectively). With a 30-month follow-up, the IIEF-5 was consistent in both groups, with no statistical significance between the groups (p=0.492). The main change in penile length during the operation was increased and still positive in the last follow-up in both groups without statistical significance (p=0.255 and p=0.101, respectively). ConclusionPartial plaque excision and corporoplasty with both testicular tunica vaginalis or bovine pericardium grafts are equally effective in treating males with clinically significant PD.

The Effect of Spinal Anesthesia on Penile Length and Erectile Function in Patients Underwent Endoscopic Urological Surgeries: A Double-Blinded Randomized Clinical Trial

Background: Evidence shows that spinal anesthesia can alter the penile length and penile engorgement and the fact that patients undergoing spinal anesthesia may experience erectile dysfunction. We hypothesized that spinal anesthesia would not result in altered penile length; however, it can lead to temporary erectile dysfunction. Methods: A total of 73 patients referred to our hospital for endoscopic urological surgeries underwent either spinal anesthesia (SA, n = 37) or general anesthesia (GA, n = 36). We measured patients’ penile length in both stretched and flaccid states during surgery and compared changes in penile length between the SA and GA groups. We assessed erectile function in patients through a standard questionnaire one month and three months after the surgery. Results: No significant difference was observed in penile length during and two weeks after surgery between the SA and GA groups (P &gt; 0.05). Regarding erectile function, we observed a significant difference in the international index of erectile function (IIEF)-5 score between the two study groups one-month after surgery (P &lt; 0.05). However, there was no significant difference between the SA and GA groups three months after the surgery. Spinal anesthesia had no significant effect on penile length during and two weeks after surgery compared to general anesthesia. Conclusions: Patients undergoing SA may experience transient erectile dysfunction one month after surgery; however, they may develop transient erectile dysfunction, which is recovered three months after surgery.

Delineating Which Patient-reported Symptoms Are Associated with Satisfaction After Urethroplasty

To determine which patient-reported symptoms are associated with satisfaction after urethroplasty. From 2011 to 2018, patients were offered enrollment in a prospective study assessing patient-reported outcomes after urethroplasty. Outcomes were assessed preoperatively and 6-months postoperatively including patient satisfaction, voiding function (International Prostate Symptom Score), erectile function (International Index of Erectile Function 5) and ejaculatory function (ejaculatory component of brief sexual function inventory). Additionally, penile curvature/appearance, genitourinary pain, postvoid dribbling, and standing voiding function were also evaluated using either 3 or 5 point Likert scales. Stricture recurrence was defined as the inability to easily pass a 16Fr flexible videocystoscope. Multivariable binary logistic regression was used to examine the associations between outcomes and patient satisfaction. A total of 387 patients completed the study with a mean age of 49.5 years and a mean stricture length of 4.5 cm. Location was bulbar (59.4%), penile (19.6%), posterior (13.7%) and pan-urethral (7.2%). At 6-months, 96.1% of patients were stricture-free, 81.6% reported being satisfied with surgery and 8% were unsatisfied. On multivariable binary logistic regression, improvement in International Prostate Symptom Score (odds ratio [OR]: 1.1, 95% confidence interval [CI]: 1.1-1.2, P=.04), new erectile dysfunction (OR: 0.5, 95% CI: 0.2-0.9, P=.04), new penile curvature (OR: 0.4, 95% CI: 0.2-0.9, P=.03) and improved standing voiding function (OR: 1.3, 95% CI: 1.1-1.5, P=.004) were associated with patient satisfaction. Cystoscopic success (P=.60), change in pain score (P=.14), postvoid dribbling (P=.69), change in penile length (P=.44), and ejaculatory dysfunction (P=.51) were not. Improved voiding function, patient-reported penile curvature, new erectile dysfunction and improved standing voiding are independently associated with patient satisfaction after urethroplasty and should be incorporated into any patient-centered approach to urethral stricture management.

Functional Penile Length After Penile Plication: “Empha-sizing” What Matters

ObjectiveTo reassess penile length changes after penile plication (PP), we defined a novel measurement of functional penile length (FPL) and compared preoperative and postoperative measurements. PP reduces penile curvature in Peyronie's Disease (PD) patients, but is traditionally thought to reduce overall penile length. However, the literature on PD lacks a standardization for penile length measurement techniques, leading to high inter-study variability. MethodsA prospectively maintained database of PD patients who underwent PP from 2018-2021 was queried. FPL was obtained by measuring the erect penis from the base of the pubis to the tip of the glans, as a straight line disregarding any curvature. Intraoperative assessment of FPL was performed before incision and immediately after surgical correction. ResultsOf 28 patients included, the average age was 59, average SHIM was 17, and average PDQ was 9. Curvature was unidirectional in 16 patients (57%) and bidirectional in 12 (43%). Dorsal curvature was most common (71%). The average curve severity was 37 ± 8.6 degrees. Mean FPL pre-operatively was 11.1 ± 1.4 cm and 12.5 ± 1.3 cm post-operatively. This represented an average 12.8% ± 6.6% increase in FPL following plication. All 28 patients reported subjective improvement in their curvature. ConclusionFunctional penile length is a useful primary surgical outcome when describing post-operative expectations for penile plication. We report an increase in FPL achieved for PD treated with PP despite conventionally being considered a shortening procedure. This can be an invaluable tool for preoperative counseling and setting expectations for penile length.

Penile skin length can be predicted before frenuloplasty during routine circumcision.

One of the restricting factors for surgical treatment of congenital anatomical pathologies of the penis is the skin structure. Thanks to its structure, the penis is a flexible organ structure, and the treatment can be completed without the need for a free tissue graft. Length changes are obtained on the ventral side of the penis by frenuloplasty. Our study aims to attain an objective formula that could noninvasively predict these changes on the ventral side before the procedure. In our study, 52 patients who were admitted for routine religious circumcision were included, and penile ventral and dorsal skin and inner mucosa lengths were measured before and after frenuloplasty, which is a part of the normal routine circumcision procedure and performed via the "pull and burn" method. Stitches were done to prevent scar formation in the frenuloplasty area. The results were used to estimate the length changes to be obtained on the ventral side by performing a regression analysis of the patient's weight, height, ventral and dorsal inner mucosa, and outer skin lengths. Result: Following frenuloplasty, an increase was detected in the ventral surface ranging from 20% to 177%. This increase was found to be predictable with 62.5% precision (P < 0.01) using the formulation established by assessing the ventral inner mucosa length from pre-procedure values. No significant result was determined in the regression analysis of the patients' other measurements (P > 0.05). Penile length changes that would occur following frenuloplasty can be calculated using a noninvasive method. Frenuloplasty, which would be performed without any vascular change, could be helpful in the surgical planning of some penile surgeries. More studies should be conducted on older boys, in anatomic deviations, and moreover, to establish a reliable formulation.

The SAPOC technique: A novel approach utilizing multiple slices around point of maximal curvature for the correction of penile curvature at the time of penile prosthesis placement in patients with severe Peyronie's Disease

ABSTRACT Introduction Placement of an inflatable penile prosthesis (IPP) is indicated for patients with severe Peyronie's disease (PD) and erectile dysfunction (ED) that do not respond to medications. When utilizing plaque incision and graft placement, most surgeons perform an incision at the point of maximal curvature. In most cases of severe PD, this incision results in a large defect that requires placement of a large graft while postoperative penile shortening remains a concern among patients. Objective To present a novel technique for the treatment of severe PD and ED during IPP implantation, in which multiple relaxing incisions are made around the point of maximal curvature. This technique minimizes the size or even the need of a graft and maximizes length restoration. Methods A total of 35 patients with PD and severe ED underwent IPP placement with penoplasty by a single surgeon from October 2018 to March 2021. 27 of these patients underwent the SAPOC technique at the time of IPP placement through a non-degloving approach. This technique involves elevation of the neurovascular bundle for dorsal or lateral curvatures along with elevation of the urethra for ventral curvatures. After the point of maximal curvature is identified, 2 to 4 transverse relaxing incisions (slices) are made around the point of curvature approximately 1 to 1.5cm apart in order to minimize the size of the defect, and hence the size of the graft, while allowing for maximal restoration of length. Primary outcome measurements included straightening rates, patient satisfaction, change in penile length, immediate and late complications. Results The SAPOC technique was applied to 27 patients. Mean patient age was 58.2. Mean preoperative curvature was 71.9 degrees. Mean pre-operative stretched penile length at the time of surgery was 14.18 cm. Mean increase in erect penile length after IPP with SAPOC technique was 0.94 cm (p=0.006) (range 0 to 2.5 cm). A total of 12 patients (44.4%) did not require graft placement. After a mean follow-up of 13.5 months, 23 of 27 (85.2%) patients had a totally straight penis. 4 patients (14.8%) had less than 20 degrees residual curvature which was sufficient for penetrative intercourse. 26 patients (96.2%) were satisfied with their postoperative result. Complications included delayed ejaculation (n=4, 11%, all of which resolved within 12 months), device malfunction (n=1) after 2 years of initial surgery which was revised successfully, device infection at 6 weeks (n=1) and intractable pain 2 years after implantation (n=1), both of which required removal of the prosthesis. Conclusion The SAPOC technique at the time of IPP placement is a novel, safe and feasible technique for the management of complex Peyronie's disease and erectile dysfunction. This technique allows the surgeon to complete the procedure without graft placement in some occasions which theoretically will decrease operative time. It also provides for length restoration which will increase patient satisfaction. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Consultant for Coloplast and Boston Scientific).

Patient Perception of Penile Size and Device after Penile Implant Revision for Mechanical Failure

ABSTRACT Introduction IPP revision after implant malfunction yields rare insight into patient preference and perception of penile implant variations in brand and size. Objective To assess patients’ perception of their penile implant after IPP revision. Methods Retrospective review of all patients undergoing revision surgery for purely mechanical malfunction (fluid leak) at our institution since 2017. Patients with greater than 6 months follow-up after revision were contacted to comment on changes in penile size and device preference. Patients were asked 1. “Did you notice any change in penile length or girth after your last surgery, explain, and 2. “Please describe your preference (if any) of implant and why”. We utilize the Coloplast Titan with “classic” (genesis) pump in most cases, with AMS Cx cylinders being used in cases with attenuated corpora (aneurysm). Results 21 patients were identified that met criteria with an average age of 70. 15/21 were successfully contacted. 9 Coloplast, 2 Mentor, and 12 AMS devices (Cx =7, LGX =4, Ultrex =1) were revised. Device brand used to replace the broken IPP was n= 19 for Coloplast and n=3 for AMS (Cx =2, Lgx =1). Mean and median time to revision was 9 years overall (2-26) and was similar between Coloplast and AMS. Fluid leak location showed no discernable pattern. Total average implant length increased 2.2 cm from 20.6 cm to 22.8 cm. 8/10 patients were reached that had had both AMS and Coloplast devices (all AMS initially). 12 patients stayed within the manufacturer. Despite change in implanted length, most patients did not discern a definitive change in penile length unless cylinders increased by &amp;gt; 3 cm (perhaps reflecting under-sizing of initial implant). All patients correctly described improvement or no change in penile girth when compared to actual cylinder sizes. Patients preferred Coloplast (6 – girth/erection quality/pump), AMS (1 pump/flaccidity) and undecided (1). Several patients felt consistently cycling the device after revision led to relative length improvement and ease of use. Conclusions Our small cohort of IPP revision patients for mechanical failure reveals that revision often requires longer cylinders but this is often imperceptible to the patient. Increased cylinder girth was a key factor in driving device preference. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Senior author consultant for Coloplast

The SAPOC Technique: A Novel Approach Utilizing Multiple Slices Around Point of Maximal Curvature for the Correction of Penile Curvature at the Time of Penile Prosthesis Placement in Patients with Severe Peyronie's Disease

ABSTRACT Introduction Placement of an inflatable penile prosthesis (IPP) is indicated for patients with severe Peyronie's disease (PD) and erectile dysfunction (ED) that do not respond to medications. When utilizing plaque incision and graft placement, most surgeons perform an incision at the point of maximal curvature. In most cases of severe PD, this incision results in a large defect that requires placement of a large graft while postoperative penile shortening remains a concern among patients. Objective To present a novel technique for the treatment of severe PD and ED during IPP implantation, in which multiple relaxing incisions are made around the point of maximal curvature. This technique minimizes the size or even the need of a graft and maximizes length restoration. Methods A total of 35 patients with PD and severe ED underwent IPP placement with penoplasty by a single surgeon from October 2018 to March 2021. 27 of these patients underwent the SAPOC technique at the time of IPP placement through a non-degloving approach. This technique involves elevation of the neurovascular bundle for dorsal or lateral curvatures along with elevation of the urethra for ventral curvatures. After the point of maximal curvature is identified, 2 to 4 transverse relaxing incisions (slices) are made around the point of curvature approximately 1 to 1.5cm apart in order to minimize the size of the defect, and hence the size of the graft, while allowing for maximal restoration of length. Primary outcome measurements included straightening rates, patient satisfaction, change in penile length, immediate and late complications. Results The SAPOC technique was applied to 27 patients. Mean patient age was 58.2. Mean preoperative curvature was 71.9 degrees. Mean pre-operative stretched penile length at the time of surgery was 14.18 cm. Mean increase in erect penile length after IPP with SAPOC technique was 0.94 cm (p=0.006) (range 0 to 2.5 cm). A total of 12 patients (44.4%) did not require graft placement. After a mean follow-up of 13.5 months, 23 of 27 (85.2%) patients had a totally straight penis. 4 patients (14.8%) had less than 20 degrees residual curvature which was sufficient for penetrative intercourse. 26 patients (96.2%) were satisfied with their postoperative result. Complications included delayed ejaculation (n=4, 11%, all of which resolved within 12 months), device malfunction (n=1) after 2 years of initial surgery which was revised successfully, device infection at 6 weeks (n=1) and intractable pain 2 years after implantation (n=1), both of which required removal of the prosthesis. Conclusions The SAPOC technique at the time of IPP placement is a novel, safe and feasible technique for the management of complex Peyronie's disease and erectile dysfunction. This technique allows the surgeon to complete the procedure without graft placement in some occasions which theoretically will decrease operative time. It also provides for length restoration which will increase patient satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for Coloplast, Boston Scientific, and Endo Pharmaceuticals

Obesity Is Strongly Associated With Low Testosterone and Reduced Penis Growth During Development.

Growth of male genitalia represents an important marker of sexual development. Testicle size is the primary measure and little is known regards penile length changes during puberty. This work aims to assess penis growth and testosterone levels in obese vs normal-weight children and adolescents, to evaluate a possible influence of obesity on genital development in boys, and to establish a new method for measuring penis length that allows comparison of normal-weight and overweight boys. We assessed anthropometric and genital development in 1130 boys from birth to age 20 years. Testosterone levels were also measured. A new method for penile length measurement was employed to minimize errors when comparing obese and nonobese children. Penis length was measured with a gentle, painless, straight positioning on a centimetric ruler without stretching, which is doable from the first years of life until the end of adolescence. Penis length and testosterone are strongly related in children during puberty. Penile length growth is significantly decreased (by about 10%) in obese boys when compared to normal-weight boys, with concomitantly reduced testosterone levels, across puberal phases. Childhood obesity represents an important determinant of lower testosterone level and reduced penis development. A new method should be employed to improve penis measurement in normal-weight and overweight/obese boys. The possible significance of these observations for adult genital development and reproductive potential will require large longitudinal studies.

Sexual function following pelvic fracture urethral injury and posterior urethroplasty.

BackgroundTo evaluate erectile and sexual function after pelvic fracture urethral injury (PFUI) by performing a retrospective review of a large multi-center database. We hypothesized that most men will have erectile dysfunction (ED) and poor sexual function following PFUI, which will remain after posterior urethroplasty.MethodsUsing the Trauma and Urologic Reconstructive Networks of Surgeons (TURNS) database, we identified PFUI patients undergoing posterior urethroplasty. We excluded patients with incomplete demographic, surgical and/or questionnaire data. Sexual Health Inventory of Men (SHIM), Male Sexual Health Questionnaire (MSHQ), and subjective changes in penile curvature were collected before urethroplasty surgery and at follow-up. We performed descriptive statistics for erectile and ejaculatory function using STATA v12.ResultsWe identified 92 men meeting inclusion criteria; median age was 41.7 years and BMI was 26.5. The mechanism of injury was blunt in all patients, and average distraction defect length was 2.3 cm (SD 1.0 cm). In the 38 patients who completed both pre and post-operative SHIM questionnaires, the mean SHIM score was 10.5 (SD 7.0), with 63% having severe ED (SHIM <12). The median follow-up was 5.6 months and the mean post-operative SHIM was 9.3 (SD 6.5), with 68% having severe ED. The mean change in SHIM score was −1.18 (SD 6.29) with 6 (16%) patients reporting de novo ED (≥5 point decrease in score). Of the men with pre-operative MSHQ data, 46/74 (62.1%) had difficulty with ejaculation, 25/35 (71%) had change in penile length, and 6/33 (18%) reported penile curvature. In men with post-operative MSHQ, 19/44 (43%) expressed difficulty with ejaculation, 23/32 (72%) had change in penile length, and 9/33 (27%) reported penile curvature.ConclusionsThere is a high rate of severe ED, both following PFUI and remaining after posterior urethroplasty. Additionally, rates of ejaculatory difficulty and patient perceived changes in penile length and curvature underscore the complex nature of the impact of these injuries on sexual function beyond simple erectile function.

Comparing Outcomes of Grafts Used in Peyronie’s Disease Surgery: a Systematic Review

Peyronie’s disease (PD) is a scarring condition of the tunica albuginea. Various graft materials are used to fill defects following plaque incision (PIG) or partial excision (PEG), but the optimal graft material remains unknown. This systematic review compares outcomes of different grafts, performed with or without concurrent penile prosthesis implantation (PPI). Studies reported quantitative curvature assessment, with adequate follow-up to assess straightening, change in penile length, postoperative erectile dysfunction (ED), and patient satisfaction. From a total of 41 study arms, 1732 patients underwent PEG/PIG without and 302 with PPI. For PIG/PEG without PPI, the most frequently used grafts are cadaveric human pericardium (38.3%), autologous saphenous vein (21.2%), and porcine small intestinal submucosa (13.5%) with reported mean preoperative curvature of 69.3° and curvature recurrence ≥ 30° in 6.6%, 5.4%, and 15.4%, respectively. Grafts used most commonly with PPI include hemostatic patches (36.4%), bovine pericardium (34.8%), with similar mean preoperative curvature of 70.0° (p < 0.01). Satisfaction rates for PIG/PEG without PPI ranged from 70 to 100% with lowest satisfaction rates associated with dermis (70%) and human pericardium (73.4%). In the prosthesis cohort, satisfaction rates exceeded 88% with all grafts. Human pericardium seems to be the most commonly used graft when PPI is not indicated, with low rates of curvature recurrence, an acceptable rate of ED and satisfaction. Hemostatic patches are the most favorable graft choice with concurrent PPI. In general, the PD treatment literature is limited to low evidence grade retrospective studies, and further prospective investigation is warranted.

MP60-08 FURTHER DEFINING WHICH OUTCOMES ARE ASSOCIATED WITH PATIENT SATISFACTION AFTER URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (MP60)1 Apr 2020MP60-08 FURTHER DEFINING WHICH OUTCOMES ARE ASSOCIATED WITH PATIENT SATISFACTION AFTER URETHROPLASTY Jordan Bekkema* and Keith Rourke Jordan Bekkema*Jordan Bekkema* More articles by this author and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000929.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Outcomes after urethroplasty can be assessed by multiple measures both surgeon-reported and patient-reported. Our objective is to determine which clinical outcomes are associated with patient satisfaction after urethroplasty. METHODS: From 2012-2018, 387 patients enrolled in this prospective single-center study. Patient reported outcomes were assessed preoperatively and 6 months postoperatively including patient satisfaction, voiding function, erectile function, ejaculatory function, penile curvature/appearance, genitourinary pain, post-void dribbling, and standing voiding function. Voiding function was assessed with the IPSS, erectile function was assessed with the IIEF-5 and ejaculatory function was scored with a hybrid of the brief sexual function inventory. The remaining measures were assessed using literature derived 3 or 5 point Likert scales. Urethroplasty success was defined as the easy passage of a 16Fr flexible cystoscope. Descriptive statistics were used to summarize findings while multivariate binary logistic regression was used to determine the association between outcomes and patient satisfaction. RESULTS: Of the 387 patients, mean age was 49.5 years with a mean stricture length of 4.5cm. Urethroplasty techniques included buccal mucosa graft onlay (51.7%), anastomotic (30.7%) or staged (12.1%) reconstruction. At 6-months follow-up 96.1% of patients were stricture free on cystoscopy while 81.7% reported being satisfied. On multivariate binary logistic regression, improvement in IPSS (O.R. 1.1, 95% CI 1.1-1.2, p=0.04), de novo erectile dysfunction (O.R. 0.5, 95% CI 0.2-0.9, p=0.04), de novo penile curvature (O.R. 0.4, 95% CI 0.2-0.9, p=0.03) and improved standing voiding function (O.R. 1.3, 95% CI 1.1-1.5, p=0.004) were associated with patient satisfaction. However, cystoscopic success (p=0.60), change in pain score (p=0.14), post-void dribbling (p=0.69), change in penile length (p=0.44), and ejaculatory dysfunction were not (p=0.51). CONCLUSIONS: Improved voiding function, patient reported penile curvature, de novo erectile dysfunction and improved standing voiding function are independently associated with patient satisfaction after urethroplasty and should likely be incorporated into any patient centered approach to urethral stricture. While perhaps important to surgeons, cystoscopic success is not associated with patient satisfaction. Source of Funding: Dr. Rex Boake Studentship in Urology © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e892-e892 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jordan Bekkema* More articles by this author Keith Rourke More articles by this author Expand All Advertisement PDF downloadLoading ...

Factors Associated With Patient-Reported Penile Length Loss After Radical Cystoprostatectomy in Male Patients With Bladder Cancer

BackgroundThe perception of penile length loss is common in male patients undergoing radical prostatectomy; however, this has not been described after radical cystoprostatectomy (RC). AimTo evaluate perceptions of penile length loss in male patients after RC and contributing factors. MethodsPatients completed an institutional review board–approved questionnaire comprised the International Index of Erectile Function (IIEF-5) and supplemental questions including perceived changes in penile length after RC. Multivariable analysis was performed to determine associations between the perception of penile length loss and the amount of length lost with patient and surgery-specific factors. OutcomesThe rate of patient-reported penile length loss and factors contributing to this perception was the outcome of this study. ResultsFrom October 2017 to January 2019, 151 patients completed the questionnaire. The median age at cystectomy was 66.1 years (interquartile range [IQR]: 59.4–73.3), and the median duration of follow-up was 28.3 months (IQR: 13–74.1). Preoperative IIEF-5 was available in 55 patients with a median score of 14 (IQR: 3–20). The median IIEF-5 score at time of survey completion was 3 (IQR: 1–18). The majority of patients (55.1%) reported a perceived loss of penile length, 20.4% reported no loss, and 24.5% were unsure. Of those who quantified their loss in penile length, 54.6% reported losses of an inch or more. Neurovascular preservation was not found to protect against penile length loss but did correlate with a reduction in the amount reported lost (P = .008). Multivariable logistic regression analysis identified increasing IIEF-5 score at time of survey completion to protect against a perceived loss in penile length (odds ratio: 0.924, 95% confidence interval: 0.878–0.973, P = .0025), whereas increasing body mass index was associated with a loss in perceived penile length (odds ratio: 1.198, 95% confidence interval: 10.53–1.383, P = .0060). Clinical ImplicationsThe perception of penile length loss is a commonly held belief in patients after RC, and many patients will perceive losses that exceed 1 inch (2.54 cm). Strengths and LimitationsThis study is the first series to describe the perception of penile length loss after RC. It is strengthened by the study population's size, heterogeneity, and patient-reported results. It is limited by lack of objective measurements of stretched penile length. ConclusionsRC can result in significant sexual dysfunction including the perceived loss of penile length.Loh-Doyle JC, Han J, Ghodoussipour S. Factors Associated With Patient-Reported Penile Length Loss After Radical Cystoprostatectomy in Male Patients With Bladder Cancer. J Sex Med 2020;17:957–963.

Adding a vacuum erection device to regular use of Tadalafil improves penile rehabilitation after posterior urethroplasty.

This study aimed to evaluate whether adding a vacuum erection device (VED) to regular use of Tadalafil could achieve better penile rehabilitation following posterior urethroplasty for pelvic fracture-related urethral injury (PFUI). Altogether, 78 PFUI patients with erectile dysfunction (ED) after primary posterior urethroplasty were enrolled and divided into two treatment groups: VED combined with Tadalafil (Group 1, n = 36) and Tadalafil only (Group 2, n = 42). Changes in penile length, testosterone level, International Index of Erectile Function-5 (IIEF-5) questionnaire, Quality of Erection Questionnaire (QEQ), and nocturnal penile tumescence (NPT) testing were used to assess erectile function before and after 6 months of ED treatment. Results showed that the addition of VED to regular use of Tadalafil preserved more penile length statistically (0.4 ± 0.9 vs −0.8 ± 0.7 cm, P < 0.01). IIEF-5 score and QEQ score in Group 1 were higher than Group 2 (both P < 0.05). After treatment, 21/36 (58.3%) Group 1 patients and 19/42 (45.2%) Group 2 patients could complete vaginal penetration. Group 1 patients also had markedly improved testosterone levels (P = 0.01). Unexpectedly, there was no significant difference in NPT testing between two therapies. For PFUI patients with ED after posterior urethroplasty, the addition of VED to regular use of Tadalafil could significantly improve their conditions – improving erection and increasing penile length – thus increasing patient satisfaction and confidence in penile rehabilitation.

Grower or shower? Predictors of change in penile length from the flaccid to erect state.

In colloquial English, a "grower" is a man whose phallus expandssignificantly in length from the flaccid to the erect state; a "shower" is a man whose phallus does not demonstrate such expansion. We sought to investigate various factors that might predict a man being either a grower or a shower. A retrospective review of 274 patients who underwent penile duplex Doppler ultrasound (PDDU) for erectile dysfunction between 2011 and 2013 was performed. Penile length was measured, both in the flaccid state prior to intracavernosal injection (ICI) of a vasodilating agent (prostaglandin E1), and at peak erection during PDDU. The collected data included patient demographics, vascular, and anatomic parameters. The median change in penile length from flaccid to erect state was 4.0 cm (1.0-7.0), and was used as a cut-off value defining a grower (≥4.0 cm) or a shower (4.0 cm). A total of 73 men (26%) fit the definition of a grower (mean change in length of 5.3 cm [SD 0.5]) and 205 (74%) were showers (mean change in length of 3.1 cm [SD 0.9]). There were no differences between the groups with regards to race, smoking history, co-morbidities, erectile function, flaccid penile length, degree of penile rigidity after ICI, or PDDU findings. Growers were significantly younger (mean age 47.5 vs. 55.9 years, p < 0.001), single (37% vs. 23%, p = 0.031), received less vasodilator dose (10.3 mcg vs. 11.0 mcg, p = 0.038) and had a larger erect phallus (15.5 cm vs. 13.1 cm, p < 0.001). On multivariate analysis, only younger age was significantly predictive of being a grower (p < 0.001). These results suggest that younger age and single status could be predictors of a man being a grower, rather than a shower. Larger, multicultural and multinational studies are needed to confirm these results.

Multi-institutional Prospective Analysis of Intralesional Injection of Collagenase Clostridium Histolyticum, Tunical Plication, and Partial Plaque Excision and Grafting for the Management of Peyronie's Disease

ObjectiveTo compare in a prospective nonrandomized fashion, the outcomes of collagenase clostridium histolyticum (CCH) and surgical interventions (tunical plication [TP] and partial plaque excision and grafting [PEG]) in patients with Peyronie's disease (PD). Intralesional injection of CCH is the only Food and Drug Administration-approved nonsurgical intervention for PD. Materials and MethodsBetween June 2015 and January 2017, 57 patients with PD and dorsal, dorsolateral, and/or lateral penile curvatures 30°-90° were included in this study. Patients with ventral curvature, hourglass deformity, and previous surgery for PD were excluded. All patients completed questionnaires and underwent penile measurements and penile vascular studies prior to and after completion of treatment, and were followed for at least 6 months. ResultsCCH was administered to 18 patients, TP performed in 14, and PEG in 25. The median follow-up for the whole cohort was 12 months (6-28). Mean changes in curvature after treatment were 23.3° (34.4%) for CCH, 72.0° (92.2%) for TP, and 71.8 ° (94.9%) for PEG, P<.001. Mean changes in International Index of Erectile Function-5 scores were +5.7 for CCH, +4.9 for TP, and +2.2 for PEG, P = .395. Mean penile length changes were −0.2 cm for CCH, −1.0 cm for TP, and +0.9 cm for PEG, P<.001. Three patients in the CCH group had bothersome residual curvature and underwent uneventful TP. ConclusionSurgical options are associated with superior curvature correction. CCH is an effective and safe option for motivated patients who prefer to avoid surgery. PEG is associated with a small stretched penile length gain.

Surgical Outcomes of Plaque Excision and Grafting and Supplemental Tunica Albuginea Plication for Treatment of Peyronie's Disease With Severe Compound Curvature

BackgroundThere are limited data in the literature that describe the management of Peyronie's disease (PD) with severe compound curvature, which often requires additional straightening procedures after plaque excision and grafting (PEG) to achieve functional penile straightening (<20 degrees). AimThis study highlights the clinical distinction and our experience with men with PD and severe compound curvature treated with PEG and supplemental tunica albuginea plication (TAP). MethodsWe performed a retrospective chart review of patients with PD and acute angulation who underwent PEG (group 1) and patients with compound curvature who underwent PEG with TAP (group 2) between 2007 and 2016. OutcomesPrimary post-operative outcomes of interest include change in penile curvature, change in measured stretched penile length, and subjective report on penile sensation and sexually induced penile rigidity. Results240 Men with PD were included in the study, of which 79 (33%) patients in group 1 underwent PEG and 161 (67%) in group 2 underwent PEG and TAP. There was no difference in associated PD co-morbidities including age, hypertension, hyperlipidemia, hypogonadism, diabetes, or tobacco use. After artificial induction of erection with intracorporal trimix injection, the average primary curvature was 73 (range, 20–120) degrees for group 1 compared to 79 (range, 35–140) degrees for group 2 (P = .01). Group 2 had an average secondary curvature of 36 (20–80 degrees). After completion of PEG, men in group 2 had an average residual curvature of 30 (range, 20–50) degrees which required 1–6 TAPs to achieve functional straightness (<20 degrees). At an average follow-up of 61 months, there was no difference for group 1 and group 2, respectively, for recurrent curvature (11.4% vs 12.4%, P = .33), change in penile length (+0.57 vs +0.36 cm, P = .27) or decreased penile sensation (6% vs 13%, P = .12). In all, 81% of group 1 and 79% of group 2 were able to engage in penetrative sex after penile straightening with or without pharmacotherapy (P = .73). Clinical TranslationOur review shows promising surgical outcomes for the use of PEG and supplemental TAP for this subtype of complex PD. Strengths and LimitationsThis article reports the largest experience with treatment of PD with compound curvature to date. Limitations of this study include the retrospective nature of the analysis as well as the lack of a validated objective measurement of erectile function after penile straightening. ConclusionOur study found no baseline difference in underlying co-morbidities in men with severe compound curvature compared with men with acute severe angulated curvature. Men with severe compound curvature represent a severe and under-recognized population of men with PD who can be surgically corrected with PEG and supplemental TAP(s) when needed without an increased risk of loss of penile length, recurrent curvature, decreased penile sensation, or erectile dysfunction when compared to men treated with PEG alone.Chow AK, Sidelsky SA, Levine LA. Surgical Outcomes of Plaque Excision and Grafting and Supplemental Tunica Albuginea Plication for Treatment of Peyronie's Disease With Severe Compound Curvature. J Sex Med 2018;15:1021–1029.