Complex Penile Research Articles

Reproductive strategy of two deep-sea scalpellid barnacles (Crustacea: Cirripedia: Thoracica) associated with decapods and pycnogonids and the first description of a penis in scalpellid dwarf males

We investigated the sexual system in two pedunculate barnacles of the family Scalpellidae. Both inhabit deep water and are attached to mobile arthropod hosts. Verum brachiumcancri was attached to the majid crab Rochinia hertwigi, and Weltnerium nymphocola to the pycnogonidan sea spider Boreonymphon rubrum. Both barnacles have separate sexes and females almost always carry two dwarf males that are almost fully embedded in a pair of symmetrically situated receptacles inside the rim of the mantle cavity. The dwarf males of V. brachiumcancri have a complex penile structure extending into the female mantle cavity. This is the first time a copulatory structure has been described in detail for a dwarf male of a scalpellid barnacle. Both species lack free nauplii and their larvae are released as cyprids; the brood size is small. This is probably an adaptation for settling close to the parent population. We compare reproductive strategies among scalpellids and suggest that the present males are highly specialized and that the females are allocating resources to few offspring.

Penile Plication Without Degloving Enables Effective Correction of Complex Peyronie's Deformities

To present our initial experience with extended plication repair for men with severe and/or biplanar penile curvature. A review of men who underwent plication repair for complex penile deformity (biplanar curvature or curvature ≥ 60°) was performed. All patients underwent tunical plication via a 2-cm penoscrotal incision mobilized distally along the penile shaft without degloving. Angle of curvature, direction(s), stretched penile length (SPL), and number of sutures were recorded. Among 102 patients treated with plication surgery, 43 (44%) had complex penile deformity. Among 11 men with biplanar curvature, median angle in the primary plane of curvature was corrected from 45° to 10° and secondary plane was corrected from 35° to 5° using an average of 7 sutures (5° correction per suture). Among 32 men with severe curvature, median angle of curvature was corrected from 70° to 15° using an average of 11 sutures (6° correction per suture). SPL was unchanged in 29 (69%), increased an average of 0.65 cm in 7 (16%), and decreased 0.5 cm in only 6 (14%) patients. At a mean follow-up of 15.3 months, repeat plication was required in 2 patients and 2 required penile prosthesis. Penile plication without degloving appears to be safe and effective for correction of complex penile curvature without significant impact on penile length.

Matriderm and vac: A case of complex penile reconstruction

Matriderm and vac: A case of complex penile reconstruction

Editorial Comment

Lumen et al. present a retrospective 2-year series of 7 patients with penile insufficiency who were reconstructed using free microvascular tissue phalloplasty. All patients had loss of functional penile tissue from surgery for bladder exstrophy or hypospadias, repeat placement of penile prosthesis, or amputation from trauma or cancer. Four of the patients underwent reconstruction for a congenital anomaly. Six of the patients were reconstructed with a radial forearm free flap and 1 with an anterolateral thigh flap. Flap survival was 100%. All 7 patients had low self-esteem, which improved after penile reconstruction. Cosmetic results were excellent. The authors should be commended for their work with complex penile reconstruction in this challenging group of patients.

Plaque incision and grafting represents the best surgical approach to the Peyronie’s disease patient: Pro

Various surgical modalities have been utilized for the treatment of penile tortuosity caused by Peyronie’s disease. However, the ideal surgical procedure has not yet been developed. Because plaque incision and grafting does not cause penile shortening, it is the best approach, particularly in cases of severe and complex penile curvature. Additionally, if the graft is nonsynthetic, neither inflammatory nor anomalous scarring will develop over time. This review suggests crural corpora cavernosa as the graft of choice, because it more closely resembles the incised area both anatomically and functionally.

An Approach for Using Full Thickness Skin Grafts for Complex Penile Surgeries in Children

Many problems in pediatric urology derive from a paucity of penile skin resulting from prior surgical interventions. While hypospadias surgery is most often responsible for creating this problem, excessive circumcision also can leave a patient with too little skin to cover the penis. To our knowledge we describe the first series of pediatric patients in whom FTSGs were used in a variety of difficult circumstances where penile skin was lacking. We retrospectively studied a cohort of 11 children 2 to 13 years old who underwent urethral repair and adjunctive skin grafting due to circumcision injuries (4 patients), traumatic urethral injury (1) or congenital lymphangiectasis (1), or for congenital hypospadias with previous failed surgery (5). In our patients available penile skin was used to reconstruct the urethra, while full thickness inguinal skin grafts were fashioned to resurface the denuded penis following reconstruction. All patients underwent successful reconstruction and grafting. There were no intraoperative complications. There was 100% take of the grafts. Average followup was 23 months (range 3 weeks to 8.6 years). One patient had slight chordee at 6 years postoperatively, and 1 had development of a urethrocutaneous fistula at 8.6 years. All patients reported normal caliber urinary streams. Use of full thickness inguinal skin grafts to resurface the penis provided patients with an esthetically acceptable result, and where necessary allowed penile skin to be used for urethroplasty. This technique is useful and justifies consideration in appropriately selected patients.

Critical analysis of surgery for Peyronieʼs disease

This review focuses on the surgical management of Peyronie's disease in the light of recent published reports from 2003 and 2004. Although there have been a number of non-surgical innovations in this field, the surgical treatment of Peyronie's disease still remains the only alternative for patients not responding to other therapies. Various surgical modalities have recently been promulgated, however the ideal surgical procedure is still not perfected, particularly in cases of severe and complex penile curvature. The recent results of various surgical approaches have engendered concern about their long term benefits. The initial management of the acute presentation of Peyronie's disease is conservative and non-surgical. Surgery for Peyronie's disease is contemplated only after stabilization of the fibrotic process, and is generally reserved for men with severe penile deformities that impede satisfactory sexual intercourse. If there is ample penile length and the deformity is mild to moderate in severity, a variety of plication techniques may be considered to provide a straight and functional penis. In patients with larger plaques, severe curvature, complete or hourglass deformities, then incision or excision of the plaque and the placement of a graft are recommended. Most authorities currently favor non-synthetic graft materials whose properties resemble the anatomy and functionality of the tunica albuginea. The implantation of a penile prosthesis, with or without excision/incision of the diseased tunica albuginea, is reserved for patients with erectile dysfunction who have not responded to medical therapies. Manual modeling of the deformed penis over a penile prosthesis may prevent some patients from needing more complex surgical grafting procedures.

Long-Term Results of Plaque Thinning with Carbide Burs, Small Incisions and Venous Grafting for Correcting Complex Penile Curvature in Peyronie’s Disease: Poor Results of an “Ideal” Approach

We evaluated the long-term results of plaque thinning by carbide burs, small transverse incisions and venous grafting for correcting complex penile curvature in patients with Peyronie's disease. A total of 13 patients with Peyronie's disease and complex penile curvature received plaque thinning by carbide burs equipped with a fraise, small plaque incision and venous grafting. All patients were available for long-term followup at a mean of 29 months. Preoperatively the mean dorsal curvature angle was 73 degrees with an additional malrotation in 4 patients. Followup consisted of a standardized interview and 3-dimensional photo documentation during erection. Although penile straightening was achieved intraoperatively, dorsal curvature (mean 35 degrees) recurred in 8 men, of whom 3 noticed this deterioration after a longer period. Penile shortening (mean 3.3 cm.) occurred in 7 patients, and decreased rigidity during intercourse occurred in 4. Hypothetically, a combined technique of thinning, incision and grafting seems to be an ideal surgical approach for correction of complex penile curvatures in Peyronie's disease without plaque excision. Although the penis had been completely straightened intraoperatively, severe dorsal curvatures recurred and significant penile shortening became obvious in more than half of the patients. Manipulation of the plaque may be associated with activation of the disease, with all of the risks of recurrence and deterioration. Due to the poor results of the thinning procedures, we stopped using this surgical approach and now prefer a combination of small incisions and grafting only.

Long-Term Results of Plaque Thinning with Carbide Burs, Small Incisions and Venous Grafting for Correcting Complex Penile Curvature in Peyronie???s Disease: Poor Results of an ???Ideal??? Approach

Long-Term Results of Plaque Thinning with Carbide Burs, Small Incisions and Venous Grafting for Correcting Complex Penile Curvature in Peyronie???s Disease: Poor Results of an ???Ideal??? Approach

Correction of complex penile deformities by modified Nesbit procedure asymmetric tunica albuginea excision

Correspondence to Mr Christopher R. Chapple, Urology Research Department, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. Tel: +44 114 271 2791; fax: +44 114 279 8318

Correction of Complex Penile Deformities by Modified Nesbit Procedure Asymmetric Tunica albuginea Excision

Purpose: Penile angulation combined with penile torsion is an uncommon finding in case of congenital or acquired penile curvature. We describe our technique for treatment of complex penile curvature by the excision of asymmetric ellipses of tunica albuginea.Materials and Methods: During the last 4 years, 4 patients with complex penile curvature underwent surgical correction by the excision of asymmetric ellipses of tunica albuginea. 3 patients had Peyronie’s disease and 1 had congenital penile deviation. They ranged in age from 27 to 63 years.Results: Convalescence was uneventful with good cosmetic correction of the penile torsion and lateral curvature in all patients. 1 patient reported shortening of the penis of about 2 cm, postoperatively. 2 patients reported decreased penile sensation, which resolved after 3 months. Erectile failure did not occur postoperatively in any case.Conclusions: During the last years many Authors have modified the original surgical procedure in an attempt to correct penile deformity. Unfortunately there are very few reports about correction of penile deformities combined with penile torsion. Our modified Nesbit surgical technique for complex deformities differs from the others with regard to the shape of the incision. In this manner, by shortening the longer corporeal body and creating a torque on the penis, it is possible to correct both problems: penile angulation and torsion. The technique is simple, bloodless, safe and reliable. In our experience good cosmetic and functional results have been achieved without complicated surgical interventions.

VENOUS PATCH GRAFT FOR PEYRONIE'S DISEASE. PART I: TECHNIQUE

Purpose We describe our technique of plaque incision and venous patch grafting to correct complex penile deformity associated with Peyronie's disease. Materials and Methods Graft material is obtained from the lower and upper saphenous and deep dorsal veins. The configuration, size and number of tunical incisions depend on the site and size of the lesion. In most cases an H-shaped tunical incision is adequate to release the contracture. With the aid of a vascular stapler several vein segments can be assembled easily into 1 piece to cover the defect. Results The incidence of penile shortening and erectile dysfunction, following other corrective procedures, is lessened with the tunical incision and venous grafting technique. Conclusion The venous graft provides an anatomical and functional tunical substitute. Results in correction of Peyronie's disease are highly encouraging.

Venous patch graft for Peyronie's disease. Part I: technique.

We describe our technique of plaque incision and venous patch grafting to correct complex penile deformity associated with Peyronie's disease. Graft material is obtained from the lower and upper saphenous and deep dorsal veins. The configuration, size and number of tunical incisions depend on the site and size of the lesion. In most cases an H-shaped tunical incision is adequate to release the contracture. With the aid of a vascular stapler several vein segments can be assembled easily into 1 piece to cover the defect. The incidence of penile shortening and erectile dysfunction, following other corrective procedures, is lessened with the tunical incision and venous grafting technique. The venous graft provides an anatomical and functional tunical substitute. Results in correction of Peyronie's disease are highly encouraging.

Fascia Lata in Penile Reconstructive Surgery: A Reappraisal of the Fascia Lata Graft

Various surgical techniques and innovations have been applied to manage complex penile deformities. As an adjunct to penile reconstructive surgery, use of fascia lata, the superficial connective tissue structure of the thigh, may also be considered. Herein, four case reports are described in which fascia lata was applied: penile deformity associated with multiple unsuccessful penile prosthesis surgeries; penile prosthesis migration alter phalloplasty ; partial penile loss after ablative penile cancer surgery: and penile fibromatosis (Peyronie's disease). Fascia lata was autogenously obtained from the lateral thigh in all cases and used for, respectively, corporoplasty, penile prosthesis fixation, penile elongation, and tunica albuginea grafting. Surgeries were successful in every instance, and each patient reported satisfactory neophallic appearance and function postoperatively. The functional anatomy of the fascia lata was investigated further with lower extremity cadaveric dissections. For penile reconstructive surgery, fascia lata offers an autogenous source, it can be expeditiously obtained causing minimal morbidity, and it serves as a viahle graft material with good tensile strength. Its application derives from, and may extend to, other reconstructive surgeries.

Complete Lower Urinary Tract Duplication With True Diphallia Presenting as a Rare Covered Exstrophy Variant

No AccessJournal of UrologyPediatric Urology1 May 1997Complete Lower Urinary Tract Duplication With True Diphallia Presenting as a Rare Covered Exstrophy Variant Steven D. Rock and John P. Gearhart Steven D. RockSteven D. Rock More articles by this author and John P. GearhartJohn P. Gearhart More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64899-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Complete Lower Urinary Tract Duplication With True Diphallia Presenting as a Rare Covered Exstrophy Variant." The Journal of Urology, 157(5), pp. 1907–1908 References 1 : Variants of the exstrophic complex. Urol. Clin. N. Amer.1980; 7: 493. Google Scholar 2 : Covered exstrophy and visceral sequestration with complete double bladder. J. Urol.1994; 151: 455. Abstract, Google Scholar 3 : Duplication of bladder and urethra and associated anomalies. Urology1973; 1: 71. Google Scholar 4 : Duplication of entire colon, bladder, and urethra. Surgery1953; 34: 843. Google Scholar From the James Buchanan Brady Urological Institute and Division of Pediatric Urology, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byDJORDJEVIC M and PEROVIC S (2018) COMPLEX PENILE JOINING IN A CASE OF WIDE PENILE DUPLICATIONJournal of Urology, VOL. 173, NO. 2, (587-588), Online publication date: 1-Feb-2005. Volume 157Issue 5May 1997Page: 1907-1908 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information Steven D. Rock More articles by this author John P. Gearhart More articles by this author Expand All Advertisement PDF downloadLoading ...

Sexual selection, genital morphology, and copulatory behavior in male Galagos

Variations in penile morphology among galago species are pronounced and complex. Comparative studies of galagos and other primate species show that elongation of the baculum (os penis)is associated with copulatory patterns involving a prolonged period of intromission. The enlarged penile “spines” of male galagos may be important in maintaining a genital “lock” during copulation. In primate species where females mate with a number of partners, sexual selection may have favored the rapid evolution of such features of penile morphology and masculine copulatory behavior. It is suggested that evolution of complex penile morphologies in galagos has been influenced by sexual selection and that such morphological variations are extremely useful in taxonomic studies.