Corpus Spongiosum Research Articles

Non-transecting dorsal mucosal anastomosis plus ventral oral graft for the treatment of urethral bulbar strictures: single surgeon experience.

To report our experience with the non-transecting dorsal mucosal anastomosis plus ventral oral graft urethroplasty (NTAVOG) for the repair of tight bulbar urethral strictures. Data of 68 men with tight bulbar strictures underwent NTAVOG urethroplasty between 2012 and 2019 were retrospectively revised. The urethra was opened ventrally; the dorsal scarred mucosa was excised preserving the spongiosum; the mobilized mucosal edges were anastomosed to recreate the dorsal urethral plate; the repaired urethral plate was augmented by the ventral oral graft and the spongiosum was closed over it. Successful urethral reconstruction was defined as normal voiding without the need for any postoperative procedure. Sexual function was investigated using a validated questionnaire. Median follow-up was 58months (IQR 38-63) and mean stricture length was 1cm (IQR 1-1.5). Of 68 cases, 56 (82.4%) were successful and 12 (17.6%) were failures requiring re-treatment. At multivariable analysis, no preoperative factor was significantly associated with recurrence. None of the preoperatively sexually active 53 patients reported postoperative erectile impairment and all were satisfied with their sexual life. The main limitation is the retrospective design. In cases of tight bulbar stricture, the NTAVOG urethroplasty provides adequate urethral augmentation by preserving the spongiosum and avoiding postoperative sexual complications. We presented a series of patients undergone non-transecting dorsal anastomosis plus ventral oral graft urethroplasty for tight bulbar stricture. This treatment seems to be safe and with limited postoperative complications thanks to the preservation of the corpus spongiosum.

Penile Myointimoma: A Clinicopathologic Study of 4 Tumors.

Penile myointimoma is a rare, benign tumor occurring within the corpus spongiosum vasculature of the glans penis. Thus far, there have been twenty-three reported tumors in the literature. We present four additional tumors of this unique myointimal proliferation. Patients ranged in age from 20 to 68 years and presented with a firm mass on the glans penis. All four tumors displayed distinctive morphologic features consisting of a myointimal proliferation with plexiform architecture of bland myofibroblastic cells in a myxoid background in the corpus spongiosum vasculature. Characteristic cytoplasmic immunoreactivity of lesional cells with smooth muscle actin in addition to a desmin positive collarette of native vessel smooth muscle was seen in all four tumors. No disease was reported in any of the patients at last clinical follow-up (9 months to 15 years) after biopsy or excision. Myointimoma is part of a rare group of mesenchymal tumors that has been recently classified by its distinctive location, morphology, and immunohistochemical reactivity. For any nodular, spindle cell lesion of the corpus spongiosum, myointimoma should be included in the differential diagnosis given its unique characteristics and favorable clinical outcome.

Phenotypic modulation of vascular smooth muscle cells in the corpus spongiosum surrounding the urethral plate in hypospadias.

Hypospadias is an abnormal ventral development of the penis caused by incomplete virilization of the male genital tubercle. This study investigated the phenotypic modulation of vascular smooth muscle cells (VSMCs) in the corpus spongiosum surrounding the urethral plate in hypospadias. The urethral corpus spongiosum tissue was collected for HE, Masson and α-SMA immunohistochemical staining. Spongiosum VSMCs were cultured and identified by α-SMA fluorescence. qRT-PCR and Western blotting and fluorescence were performed. The results showed that the vascular lumen of the corpus spongiosum around the urethral plate was larger and that the vascular smooth muscle layer was thicker in hypospadias. The expression of the contractile markers α-SMA and Calponin 1 in VSMCs was decreased, the expression of the synthetic marker OPN was increased, and the transcription of the phenotypic switching factors SRF and MYOCD was decreased. The expression of Ki67, PCNA and BAX was increased, and the expression of Bcl-2 was decreased. The phenotype of corpus spongiosum VSMCs in hypospadias changed from the contractional type to the synthetic type. This phenotypic modulation was associated with increased proliferation and apoptosis rates. SRF and MYOCD may be the main factors mediating the phenotypic modulation of urethral corpus spongiosum VSMCs.

Ultrasonographic Evaluation of the Hypospadiac Penis in Children.

IntroductionIdentifying key anatomical features of the hypospadiac penis is crucial to better understanding this pathology and guiding surgical reconstruction plans, thereby achieving superior functional and cosmetic outcomes.ObjectiveTo Assess the feasibility and precision of penile ultrasonography (PUG) in determining key structural features for hypospadias cases (including distal extent of the spongiosal component of the urethral plate, to elucidate the healing process following tubularised incised-plate urethroplasty).Patients and MethodsTwenty-five children with hypospadias were assessed using PUG prior to surgical repair and then again under general anesthesia. Preoperative images were acquired using ultrasonography in sagittal and transverse planes, then later compared with anatomical findings obtained during surgical repair of urethral hypoplasia.ResultsMedian patient age was 1.2 years (range 0.5–12) and hypospadias types included coronal 17/25 (68%), mid-penile 5/25 (20%), and proximal penile 3/25 (12%). Distinct layers of the corpus spongiosa and mucosal layer, Buck fascia, tunica albuginea, glans, corpora cavernosa, and penile skin were delineated so that their spatial inter-relationship could be assessed. Distal extent of the spongiosal component of the urethral plate was determined by the mid-glans B-B line. The extent of urethral hypoplasia identified by PUG was relatively similar to measurements obtained intraoperatively.ConclusionPUG is a feasible and accurate approach to evaluating penile configuration in children with hypospadias. Distal extent of the spongiosal component of the urethral plate was accurately determined, hence PUG could potentially be used to improve surgical planning and appraisal of current repair procedures.

A rare case report of tricorpora penile fracture associated with urethral disruption.

Penile fracture is defined as a tear of tunica albuginea that covers the corpus cavernosum during an erection. It is a rare finding that both the corpora cavernosum and corpora spongiosum are involved in penile fracture. Herewith, we reported a rare case of 44 years old presented with penile fracture during woman on top sex position with both corpora cavernosum and corpus spongiosum rupture with urethral disruption. On clinical examination, the penis was swollen, and there was a sudden loss of erection and ecchymosis. Cystoscopy examination revealed urethral rupture. Emergent surgical repair was then performed. During emergency surgery, we found a defect of 3 cm in bicorporal cavernosa with urethral and corpus spongiosum disruption. The penis was degloved, and debridement with water-tight suturing of tunica albuginea was performed to repair the tear in corpora cavernosa. End-to-end anastomosis urethroplasty with spatulation was also performed to repair the urethra. After 21 days following surgery, erectile function was good and no difficulties in voiding function as shown in uroflowmetry result with Qmax >15 mL/s. The patient had a favorable recovery. This was a rare case report, and with early and prompt surgical intervention, this case could result in a good outcome in preserving erectile function and voiding function.

ISCHEMIC PRIAPISM: A STARTLING THROMBOEMBOLIC COMPLICATION OF COVID-19

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: The coronavirus disease-2019 (COVID-19) is known to cause severe systemic inflammation leading to thrombotic complications. Deep vein venous thrombosis, pulmonary embolism and stroke are some of the most commonly reported. However, ischemic priapism has been rarely documented as a thromboembolic consequence. CASE PRESENTATION: A 39-year-old man with a history of hypertension and type 2 diabetes mellitus presented with a painful irreducible erection of six-hour duration. Physical exam revealed tachycardia and a tender, rigid penile shaft, with an engorged glans and corpus spongiosum. He denied prior episodes or penile trauma. Laboratory-work revealed an elevated D-Dimer and inflammatory markers, as well as a positive COVID PCR test. Further investigations showed no previous hematological diseases or medications with an elevated thromboembolic risk. He received epinephrine irrigation and cavernosal blood aspiration which resolved the priapism. Nonetheless, the erection recurred a few hours later and a heparin infusion was started. Despite being on heparin for 24 hours, the erection persisted, requiring surgical intervention via a corpora cavernosa - penis glans fistula. The erection resolved and he was discharged home. DISCUSSION: Priapism is a prolonged penile erection of more than four hours without sexual stimulation. Interestingly, COVID-19 induces thrombosis by the hypercoagulability, hyperviscosity, and endothelial dysfunction after the massive inflammatory response and free radical damage. Ischemic priapism is a medical emergency that prompts treatment with a-agonists and corporal blood aspiration if needed. Detumescence can be achieved surgically if the initial measures fail. CONCLUSIONS: This case highlights a rare complication of COVID-19. Early recognition and medical treatment can prevent irreversible complications. DISCLOSURE: Nothing to declare. KEYWORD: COVID-19 Ischemic Priapism

Primary solitary neurofibroma of penis in a child: case report and review

BackgroundGenital involvement in neurofibromas is rare and can involve both the clitoris and penis; in the latter, it usually accompanies a systemic pathology. Isolated penile neurofibroma is anecdotal. This report presents an unusual solitary penile neurofibroma in a child, discusses its surgical management and reviews the literature.Case presentationA 6-year child presented with history of swelling on the undersurface of his penis and obstructive voiding symptoms since 18 months of age. He underwent a partial excision at 5 years of age elsewhere which recurred. The swelling was a 3 × 2 cm, firm, midline, smooth surfaced, longitudinally oblong mass over the ventral penis extending from root to mid shaft with restricted mobility. There was no inguinal lymphadenopathy. Ultrasonography and cystoscopy characterized it to be a corpus spongiosal soft tissue mass encasing and indenting the contained penile urethra. The mass was completely excised along with involved urethra and corpus spongiosa and a penoscrotal urethrostomy created. Histopathological analysis revealed it to be a benign nerve sheath tumor/neurofibroma. He had no stigmata of neurofibromatosis and the ophthalmologic examination was unremarkable. At 2-year follow-up, he is well, has normal glanular sensation and erectile function and awaits urethral reconstruction.ConclusionPrimary solitary penile neurofibroma in children is extremely rare. This report details the presentation and management of a ventral penile neurofibroma involving the adjacent urethra/corpora spongiosa.

Epidemiological, pathological and statistical analysis of penis cancer in Espírito Santo - analysis of 79 cases / Análise epidemiológica, patológica e estatística do cancro do pénis no Espírito Santo - análise de 79 casos

Purpose: To determine the epidemiological and pathological characteristics of penile cancer (PeCa) and to verify the independence between two statistical variables of patients with PeCa treated at the Urology Service of the Cassiano Antônio de Moraes University Hospital (HUCAM), Vitória, ES, Brazil .Patients and Methods: Between 2010 and 2020, 79 patients with histologically confirmed PeCa were evaluated in our institution considering age, birthplace, ethnicity, marital status, practice of circumcision, histological type, growth pattern, site of tumor, tumor size, grade tumor, Chaux index, vascular invasion, lymphatic invasion, perineural invasion and pathologic stage (TNM staging). For the statistical treatment of square-data with p-value by Monte Carlo statistical calculations, in order to verify the independence between two variables, being the following: Degree of Pathological - TNM, Chaux Index, Lymphatic Invasion, Vascular Invasion and Perineural Invasion, with the patient's race and age group.Results: The ages ranged from 25 to 87 years, with an average of 62 years. Of the 79 patients, 36 (45,56%) were from the metropolitan region, 07 (8,86%) were from the north, 14 (17,72%) were from the northwest and 22 (27,86%) from the south of the Espírito Santo state. Most patients were brown 45 (56,96%), married 51 (64,55%) and had not completed primary school 59 (74,68%). Of the 79 patients, only 4 (6,32%) circumcised. Grade I tumors were present in 35 (44,30%) of the patients, grade II in 32 (40,50%) and grade III in 10 (12,65%). Vascular invasion was observed in 13 (16,45%) and lymphatic in 7 (8,86%) patients. Regarding Chaux Index, 16 patients (20,25%) had Index 2, 19 (24,05%) had Index 3, 13 (16,45%) had Index 4, 19 (24,05%) had Index 5, 9 (11,39%) had Index 6, 1 (1,26%) had Index 7 and 2 (2,53%) were not evaluated. Of the total, 20 (25,31%) had corpora cavernosa and 24 (30,37%) corpus spongiosum infiltration. According to the statistical analysis, there is evidence to reject the null hypothesis, that is, vascular invasion is related to the patient's age group, as p-value = 0.00449 p-value =0.05.Conclusion: Considering that the majority of penile cancer cases in the state of Espírito Santos are treated at the Department of urology of HUCAM, it can be concluded hat all patients in the study were residents of the state of Espírito Santo and had a low socioeconomic status. Most were brown hemones, married with low schooling and an average age of 62 years. The majority of cases have already been diagnosed with advanced disease. And after performing the chi-square tests and calculating the p value, we were able to conclude with statistical significance (p0.05) the relationship between age group and vascular invasion, which may justify a worse prognosis the more the age group.

An objective hypospadias classification system

Current approaches to classifying hypospadias severity are based on meatus position. These classification tools lack precise reflection on the degree of urethral hypoplasia and extent of urethral underdevelopment hence are not good representative of hypospadias severity. Here, an alternative classification system is introduced that objectively reflects the developmental pathology underlying this condition. The study goal was to appraise location of bifurcation in the corpus spongiosum (BCS) relative to the penile shaft as an indicator of hypospadias severity. Patients aged <18 years with primary hypospadias were included in the study. Urethral defect ratio (UDR) was calculated by dividing the extent of urethral defect (distance between the glandular knobs and BCS) relative to stretched penile length (SPL). Hypospadias severity was then categorized into three distinct grades (UDR <0.5, 0.5-0.99, ≥1.0). The Inter-Class Correlation (ICC) was evaluated to assess the intra- and inter-rater agreement between the reviewers of UDC ratio. Linear regression analysis was performed to estimate the correlation between UDC ratios and either plate objective scoring tool (POST) and Curvature degrees. A total of 67 patients aged 12.3±3.7 months with primary hypospadias were enrolled. UDR ranged between 0.2 and 1.3. A significant difference in hypospadias level was observed between UDR grades, which further correlated degree of curvature (P<0.0001), urethral plate quality (P<0.0001), and associated anomalies (P<0.05). The Inter-Class Correlation (ICC) value to examine the intra- and inter-rater agreement between the two reviewers in UDC ratio was 0.998 (95% CI 0.998, 0.999). Regression analysis revealed that UDR and both POST and Curvature degree were significantly associated (P<0.001). A hypospadias severity scoring system based on embryological etiology and urethral hypoplasia and assessed relative to the penile shaft represents an objective, feasible, and consistent tool. These results clearly indicate that the reviewers have had excellent consistency/reliability across their consecutive readings. This new system can facilitate objective description of hypospadias-spectrum anomalies and thus support precise communication between individual surgeons and centers.

Study of Penis Structure and Development in Fetus With Prune Belly Syndrome

To evaluate the influence of prune belly syndrome (PBS) on the development of penises in human fetuses. We studied 39 human fetuses (including 4 with PBS) aged 11-22 weeks post conception. We measured the length and width of the free portion and penis root and the penis total length (PTL). In 21 fetuses of the control group and in 3 with PBS we analyze the penile with histochemical and immunohistochemical methods. The total penile area, area of corpora cavernosa, area of corpus spongiosum, and thickness of tunica albuginea were measured by stereological method. Means were compared using the Kolmogorov-Smirnov and ANOVA test (P <.05). We did not observe difference in PTL (P=.999) when we compared the control group (4.69-29.77 mm, mean=16.2 mm; SD=6.34 mm) with the PBS (12.23-23 mm, mean=16.16; SD=4.99). The total penile area (P=.002), the area of corpora cavernosa (P=.023) and the area of corpus spongiosum (P=.004) had a significant increase when comparing the PBS with the control group. In fetuses with PBS there is no change in the length of the penis but we observed a low rate of growth in all the other histologic parameters analyzed, suggesting that PBS impacts the penile development.

MP08-07 LONG TERM CONSEQUENCES OF FAILURE TO REPAIR CORPUS SPONGIOSUM IN DISTAL HYPOSPADIAS

You have accessJournal of UrologyCME1 May 2022MP08-07 LONG TERM CONSEQUENCES OF FAILURE TO REPAIR CORPUS SPONGIOSUM IN DISTAL HYPOSPADIAS David Ali, and Moneer Hanna David AliDavid Ali More articles by this author , and Moneer HannaMoneer Hanna More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002530.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Several surgical techniques have been described in the repair of hypospadias; however, none mention the role of repairing the corpus spongiosum. Herein we review our experience with adolescents who underwent hypospadias repair during childhood and their main complaints were partially or totally related to spongiosum defects. Their surgical outcomes are also discussed. METHODS: Between 2007 and 2017, 26 patients aged between 13 and 28 years of age (median 19 years) were operated upon to repair of the deficiency or absence of corpus spongiosum. The primary hypospadias repairs included meatal advancement and glanduloplasty (MAGPI) repair (N=10); tubularized incised plate (TIP) (N=9), and in 7 patients the primary repair was unknown. RESULTS: The main complaints were urinary infections (N=5), spraying of the urinary stream and dripping of urine (N=10) and distal urethral swelling during voiding (N=15). In 5 patients, the urethral wall was thin and covered with adherent epidermis only. In 14 patients, the laterally displaced spongiosum pillars were mobilized and approximated using interrupted log lasting absorbable sutures. Four patients had significant spongiosum deficiency and urethral swelling during urination resulting in mild diverticulum formation. In 2 patients the spongiosum pillars were fixed and could not be mobilized to provide a tension-free closure, a thick Dartos scrotal flap was used to cover the plicated urethral wall. 12 out of 25 patients underwent glandular contouring and/or meatoplasty simultaneously to improve the penile esthetics. The median follow-up period was 4 years. 6 patients were excluded from this series due to no follow-up. 18 out of 19 patients reported normal and steady urinary stream, absence of urethral swelling during voiding and no postvoid dripping. One patient developed glans dehiscence and is voiding through a coronal meatus; he declined further surgery. None developed urinary infection. The mild curvature was corrected successfully in all 4 patients. CONCLUSIONS: Failure to recognize and/or repair the corpus spongiosum defect during childhood distal hypospadias repair may become symptomatic during adolescence however, the abnormality can be corrected successfully. Source of Funding: No source of funding was provided for this study © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e127 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Ali More articles by this author Moneer Hanna More articles by this author Expand All Advertisement PDF DownloadLoading ...

Correcting gender dysphoria –the anatomical changes with male to female gender reassignment surgery

ABSTRACT Introduction &amp; Objectives Increased Global acceptance of transgender communities, gender-affirming genital reconstructive surgery is becoming more prominent. Formalised education and training however has not quite entered the curriculum of many surgical training programs yet it remains imperative we have an understanding of modified anatomy in out patients. We demonstrate anatomical reconstruction during the transition between male to female anatomy. Methods Patient consent was obtained to take a series of photographs during gender affirming surgery from male to female. Results Contemporary patients receive both spinal and general anaesthesia prior to positioning in standard lithotomy. A perineal incision of approximately 10cm in the midline raphae exposes the corpora and spongiosum. A simple bilateral orchidectomy was performed at the level of the external inguinal ring. A neovaginal cavity was created by firstly dividing the bulbospongiosus attachments to the perineal body and the space is both blunt and sharply dissected. Further dissection is carried out in the avascular perirectal fat plant anterior to the Denonvilliers fascia. During this dissection a 18-22Fr urethral sound is used to apply downward traction on the rectum. A sterile ultrasound sleeve is placed in the rectum to allow bimanual palpation to confirm intact rectal mucosa. A circumferential incision proximal to the glans is performed to aide degloving of the penis. Bucks fasica is left intact and distal penile skin will later be used to form the clitoral hood. The dorsal neurvascular bundle is raised off the corporal bodies but an attachment to the glans remains. A triangular section of dorsal glans is preserved and dissected off the tips of corpora. The penile tissue is then disassembled separating the corpus spongiosum from the corporal bodies. The corpora are amputated at the level of the pubis, remaining erectile tissue destroyed and oversewn for haemostasis. The Urethra is shortened to an appropriate length to allow the dorsal aspect to align between the neoclitoris and neomeatus. The ventral aspect is spatulated to expose the neomeatus. The penile skin flap is invaginated within the neovaginal space and the skin incised to expose the neoclitoris and neomeatus. The penile skin is then anastomosed to the neoclitoris and neomeatus The distal end of the penile skin flaps is oversewn to create a blind ending tube and thus creating the neovagina. Labia Majora are formed by excising excess scrotal skin to create an appropriate contour. This form of neovagina is compared to methods that involve intestinal and peritoneal lining transfer. Conclusions We have outline the stepwise transition of male to female anatomy with a conventional contemporary technique. Creation of a neovagina with penile inversion has become common practice in gender affirming surgery. However there are other means of creating genitalia with alternative tissues, which subspecialised practitioners should be aware. Disclosure Work supported by industry: no.

Female sexual medicine: What are students learning in undergraduate medical education?

ABSTRACT Introduction In the United States, medical education on sexual medicine varies throughout the country and between institutions. With limited standardization, medical students and subsequent trainees have little to no training in how to approach a patient with concerns surrounding their sexual health. In 2018, half of the medical institutions in the United States required formal instruction in sexual medicine. Of those institutions that do include didactic material on sexual medicine, most of the material is dedicated to anatomy, physiology, and sexually transmitted infections, with limited or no information on sexual dysfunction and sexual history taking. Therefore, we identified a need to determine which components of sexual medicine, particularly female sexual medicine, are currently being covered in undergraduate medical education with the goal of proposing and developing standardized curriculum materials to be utilized by medical students during their preclinical education. Objective The aim of this study is to examine current preclinical curricula at all seven medical schools, including six allopathic and one osteopathic institution, in the Chicago, Illinois area to investigate which aspects of female sexual anatomy, physiology, pathology and pharmacology are being taught to medical students. Methods Curriculum materials on female sexual anatomy, physiology and pathology were collected from all seven medical schools in Chicago, Illinois. Courses covering topics on female sexual medicine varied between institutions due to differences in preclinical curriculum and coursework. To standardize our needs assessment, we utilized previous literature to identify specific components of anatomy, physiology, pathology, pharmacology, social sciences, and history and physical exam skills. Upon reviewing each institution's preclinical educational materials, we assessed curriculum content for saturation of specific concepts within each of the above areas. Results Curriculum materials were collected from seven (n=7) total medical schools in the surrounding Chicago, Illinois area. Out of the 7 institutions, 4/7 discussed clitoral anatomy, with 6/7 mentioning the glans, 1/7 mentioning the corona, 2/7 mentioning the clitoral hood, 6/7 mentioning the corpora cavernosa, 4/7 mentioning the corpus spongiosum, 6/7 mentioning the crus, 6/7 mentioning the bulb and 5/7 detailing the clitoral neurovasculature. In addition to the anatomy, 4/7 discussed the physiology of the female orgasm, 3/7 highlighted the rate and epidemiology of female sexual dysfunction (FSD), 3/7 included information on treatment for FSD, 1/7 taught a genitourinary physical exam specific to assessing FSD (external exam, internal exam, pelvic floor assessment), and 6/7 institutions included information on how to take a sexual history asking about sexual function, pleasure, and satisfaction. Conclusion Overall, our focused needs assessment of both allopathic and osteopathic medical schools in the Chicago, Illinois area highlights the need for restructuring of curriculum as it pertains to female sexual medicine and FSD in undergraduate medical education. Next steps include proposing individual curricular recommendations to institutions, due to the variation in current curriculum design, as to how they can better teach on areas surrounding FSD, while also aiming to standardize what medical students are learning during their preclinical years. Disclosure Work supported by industry: no.

Effect of long-term administration of Tadalafil on arteriosclerosis: A prospective cohort study

ABSTRACT Introduction Tadalafil is a phosphodiesterase type 5 (PDE-5) inhibitor, and it is used globally as a highly effective and safe drug for the treatment of erectile dysfunction (ED) and lower urinary tract symptom (LUTS). Tadalafil relieve ED or LUTS by relaxing vascular smooth muscle and increasing blood flow to the lower urinary tract tissue. PDE is distributed in pelvic organs, including the corpus spongiosum of the penis and the urethra and prostate, as well as in the lung, heart, and vascular smooth muscle. In other words, PDE is distributed throughout the body. Thus, we hypothesized that the administration of tadalafil might reduce not only systemic arteriosclerosis but also ischemia of the lower urinary tract. Objective To prospectively investigate whether the long-term administration of tadalafil, which is commonly used for erectile dysfunction, could reduce arteriosclerosis. Methods This study included 85 patients who presented to one of three hospitals with lower urinary tract symptoms. Tadalafil was administered daily (5 mg/d), and pulse wave velocity was measured before administration and at weeks 12, 24, 36, and 48. The International Prostate Symptom Score, Overactive Bladder Symptom Score, and Erection Hardness Score were simultaneously assessed at the same time points. Further sub analyses were performed in patients with a high risk of cardiovascular events, those aged 75 years or older, and those younger than 75 years. The Wilcoxon signed rank test was used for statistical analysis. Results Compared with pretreatment values, the pulse wave velocity did not show any statistically significant decrease at any time point. However, the three aforementioned scores significantly improved compared. The group at high risk of cardiovascular events showed significant improvement at weeks 24 and 36, whereas the 75 years or older group showed significant improvement at only week 24. Conclusions The long-term administration of tadalafil (5 mg daily) reduced arteriosclerosis or inhibited its progression, and relieved dysuria and improved erectile function. In particular, the drug was revealed to be more effective in patients at a high risk of cardiovascular events and those aged 75 years or older. Hence, tadalafil may have the potential to be used as an anti-aging medicine, although further studies with longer observation periods are needed to confirm its effectiveness and safety. Disclosure Work supported by industry: no.

Epidemiological, pathological and statistical analysis of penis cancer in Espírito Santo - analysis of 79 cases / Análise epidemiológica, patológica e estatística do cancro do pénis no Espírito Santo - análise de 79 casos

To determine the epidemiological and pathological characteristics of penile cancer (PeCa) and to verify the independence between two statistical variables of patients with PeCa treated at the Urology Service of the Cassiano Antônio de Moraes University Hospital (HUCAM), Vitória, ES, Brazil.Patients and Methods: Between 2010 and 2020, 79 patients with histologically confirmed PeCa were evaluated in our institution considering age, birthplace, ethnicity, marital status, practice of circumcision, histological type, growth pattern, site of tumor, tumor size, grade tumor, Chaux index, vascular invasion, lymphatic invasion, perineural invasion and pathologic stage (TNM staging). For the statistical treatment of square-data with p-value by Monte Carlo statistical calculations, in order to verify the independence between two variables, being the following: Degree of Pathological - TNM, Chaux Index, Lymphatic Invasion, Vascular Invasion and Perineural Invasion, with the patient's race and age group.Results: The ages ranged from 25 to 87 years, with an average of 62 years. Of the 79 patients, 36 (45,56%) were from the metropolitan region, 07 (8,86%) were from the north, 14 (17,72%) were from the northwest and 22 (27,86%) from the south of the Espírito Santo state. Most patients were brown 45 (56,96%), married 51 (64,55%) and had not completed primary school 59 (74,68%). Of the 79 patients, only 4 (6,32%) circumcised. Grade I tumors were present in 35 (44,30%) of the patients, grade II in 32 (40,50%) and grade III in 10 (12,65%). Vascular invasion was observed in 13 (16,45%) and lymphatic in 7 (8,86%) patients. Regarding Chaux Index, 16 patients (20,25%) had Index 2, 19 (24,05%) had Index 3, 13 (16,45%) had Index 4, 19 (24,05%) had Index 5, 9 (11,39%) had Index 6, 1 (1,26%) had Index 7 and 2 (2,53%) were not evaluated. Of the total, 20 (25,31%) had corpora cavernosa and 24 (30,37%) corpus spongiosum infiltration. According to the statistical analysis, there is evidence to reject the null hypothesis, that is, vascular invasion is related to the patient's age group, as p-value = 0.00449 &lt; p-value =0.05.Conclusion: Considering that the majority of penile cancer cases in the state of Espírito Santos are treated at the Department of urology of HUCAM, it can be concluded hat all patients in the study were residents of the state of Espírito Santo and had a low socioeconomic status. Most were brown hemones, married with low schooling and an average age of 62 years. The majority of cases have already been diagnosed with advanced disease. And after performing the chi-square tests and calculating the p value, we were able to conclude with statistical significance (p&lt;0.05) the relationship between age group and vascular invasion, which may justify a worse prognosis the more the age group.

Mucosal-sparing augmented non-transected anastomotic (MsANTA) urethroplasty: a step forward in ANTA urethroplasty.

The surgical advancement of urethral reconstruction is a rapidly moving field. In the last decade, the technique for bulbar urethroplasty has evolved towards less invasive approaches with minimal transection and more tissue sparing in order to increase the patency rate. In this study, we provide a step forward in the augmented non‐transected anastomotic (ANTA) urethroplasty proposed in 2012, with a true mucosa‐sparing modification of the technique. In detail, the bulbar urethral lumen is approached with either a ventral or dorsal urethrotomy. Differently from previous techniques, the native urethral mucosa is neither transected nor resected but is reconstructed with a direct mucosa‐to‐mucosa anastomosis. This allows a complete sparing of communicant vessels that come from the corpus spongiosum to the urethral mucosa. The technique aims to preserve the native vascularity of the urethral mucosa by enlarging the native urethral plate with a direct anastomosis at the level of the stricture, and without the need for resection. In our hands the technique was easy and reproducible, and it carried promising results in the preliminary cohort where it was applied.

Early Data Supporting Ventral Onlay Pseudospongioplasty for Penile Urethral Strictures

ABSTRACT Introduction Augmented urethroplasty with buccal mucosal graft remains one of the mainstays of urethral stricture management, and location of graft placement depends on surgeon preference as well as patient-specific factors. Historically, ventral graft placement has been preferred in the bulbar urethra due to a robust blood supply provided by a thicker corpus spongiosum at the bulb. While, in the penile urethra, dorsal placement is traditionally preferred due to limited spongiosum in this location and concern for poor graft take. Some have advocated for ventral onlay placement in the penile urethra, arguing this placement decreases dissection thereby preserving vascularization of the urethra. We present promising results and outcomes for ventral onlays in the penile urethra, which we cover with periurethral vascularized tissue as a “pseudospongioplasty” to provide a supportive, vascular bed for graft survival. Objective We aimed to assess the efficacy of ventral buccal mucosal graft positioning for treatment of penile urethral strictures using the pseudospongioplasty technique. Methods We retrospectively reviewed clinical and procedural characteristics for all patients that underwent urethroplasty at our institution from August 2016 through February 2021. Patients were divided into one of three groups based on their operative approach: (1) pseudospongioplasty in the penile urethra, (2) spongioplasty in the bulbar urethra, (3) and bulbopenile strictures requiring a combined approach. Key outcomes variables included recurrence rates and complication rates. Results 50 patients fit our inclusion criteria. We identified 18 patients that underwent isolated spongioplasty in the bulbar urethra, 19 patients that underwent isolated pseudospongioplasty in the penile urethra, and 13 patients with bulbopenile strictures that had simultaneous spongioplasty and pseudospongioplasty. All procedures used buccal mucosa as a ventral onlay. Median stricture length (cm) for spongioplasty, pseudospongioplasty and both were 4.0 (3-5) and 4.25 (3.5-6) and 8 (6-10), respectively. There were three 30-day complications in each group. Figure 1 shows the Kaplan Meier curves for recurrence in the three study groups, rates were not statistically different using spongioplasty as a reference group (p=0.83 and p=0.72 for pseudospongioplasty and combined, respectively). When compared to spongioplasty, the relative risk of recurrence in pseudospongioplasty and combined were 0.41 (0.05-2.44, p=0.344) and 1.56 (0.30-8.21, p=0.593), respectively. Meanwhile the relative risk for complications were 0.94 (0.15-5.77, p=0.942) and 1.5 (0.24-9.61, p=0.657), for pseudospongioplasty and combined respectively. Conclusions Supporting recent literature concerning ventral onlay graft positioning in the penile urethra, a pseudospongioplasty appears to provide enough of a supportive vascular bed for graft survival. There are few published series demonstrating its effectiveness; however, we show that pseudospongioplasty in the penile urethra has comparable outcomes to conventional spongioplasty in the bulbar urethra. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific

Corporal Excavation and Grafting for Inflatable Penile Prosthesis Implantation in Severe Corporal Fibrosis

ABSTRACT Introduction Inflatable Penile Prosthesis (IPP) insertion becomes substantially more difficult in men with severe corporal fibrosis due to the need for dilation through scar tissue and decreased diameter of the corporal bodies. In this setting, traditional strategies of dilation have increased risk of urethral and glanular perforation given obliteration of normal dilation planes. This is a rare, but significant surgical challenge whose body of evidence contains few studies with small cohorts. Objective To describe and analyze our institution's experience with complex IPP placement in patients with severe corporal fibrosis using corporal excavation and/or grafting. Methods We performed a retrospective review of all patients with severe corporal fibrosis who underwent IPP placement using a technique of corporal excavation and/or grafting between 01/2006—05/2021. Corporal excavation involved a penoscrotal incision extending the full length of penile shaft for complete exposure of the corpus spongiosum and direct excision of the entire central fibrotic core. Corporal grafting involved sewing grafts in areas of the corporal implant bed that remained severely narrowed after excavation to accommodate the IPP cylinder(s). Our two primary outcomes were (1) post-operative complications and (2) surgical success, which was defined as erections sufficient for intercourse in the absence of post-operative complication requiring re-operation. Results Ten cases meeting inclusion criteria were identified with 1 involving corporal excavation only, 4 involving grafting only, and 5 involving corporal excavation and grafting. In all cases, severe fibrosis was due to trauma (n=3), priapism requiring corporal shunting (n=3) or prior IPP infection and explant (n=4). All were implanted with an AMS-700 three-piece IPP and five patients required insertion of a reduced diameter IPP. Five out of 9 (55.6%) cases involving grafting used a Tutoplast pericardium allograft and 4/9 (44.4%) cases used a Gore-Tex synthetic graft. When graft was used, the median area used was 10.0 centimeters (IQR 4.5-11.8). Median operative duration was 315 minutes (IQR 243.75-370.5). Median post-operative hospital stay was 1 day. Post-operative complications included 2 (20%) cases of infection requiring antibiotics and 1 (10%) case of post-operative neuropathic pain/distal glans numbness. Median follow-up duration was 3.8 months (IQR 1.5-65.7) across all groups, with surgical success seen in 3/4 (75%) grafting cases, 1/1 (100%) excavation cases, and 5/5 (100%) simultaneous excavation and grafting cases. Failure was seen in one case due to penile shortening that required a penile lengthening procedure and IPP upsizing 10 months post-operatively. Conclusions IPP insertion in the setting of corporal fibrosis is complex. Downsized cylinders may be required due to contracture of the tunica albuginea. However, patients with corporal fibrosis may safely undergo IPP placement with good intermediate term outcomes using corporal excavation and/or grafting. Disclosure No

Complete diphallia: How to proceed?

Diphallia is a rare anomaly. It has a range of appearances from a small accessory penile to complete duplication. We present a 2 year-old boy with complete penile duplication. The left penile was the largest. NMR (Nuclear Magnetic Resonance) suggested one corporal body for each penile and VCUG (Voiding Cystourethrogram) showed a normal urethra in the right penile and stricture at glandular and mid penile urethra of the left penis. A Y confluence to bulbar urethra was observed confirming only one prostate and bladder. The cystoscopy through the right penile identified the urethral confluence in the bulbar area. We performed a meatotomy in the left penile to insert the cystoscope and confirmed the blind ending urethra. We decided to remove this penile. The penile was degloved entirely and clamped and took out the corpora at the base. Diphallia can have three presentations: only glans duplication, bifid diphallia and complete diphallia (two corpora cavernosa and a corpus spongiosum for each penile). In our case, each penile presented only one corpora cavernosa and the decision taken was based on urethral patency. The treatment should always be planned individually whereas associated anomalies with the goal of attaining satisfactory functional and cosmetic results.

Racial differences in survival outcomes for early-stage (T1 tumor) penile cancer: Analysis from the Surveillance, Epidemiology, and End Results (SEER) database.

5 Background: Penile cancer is a rare malignancy that accounts for less than 1% of male cancers in the United States. Localized disease, particularly T1 tumors (no invasion the corpora spongiosum, corpora cavernosa or adjacent structures using the AJCC 7th edition staging system) are potentially curable with local surgery. We present the racial differences in survival outcomes for T1, penile cancer from the SEER database. Methods: From 2004 to 2016, we identified all patients with T1 (coded as T1, T1a, T1b),N0,M0 penile cancer in the SEER-18 database were included. Univariate Kaplan-Meier analysis and multivariable (adjusting for age, year of diagnosis, race, socioeconomic status, primary tumor site and type of surgery) Cox-Regression analysis were conducted to investigate prognostic variables for cancer specific survival (CCS). Results: A total of 4,406 patients were identified with penile cancer; 1,941 patients had T1 disease and were further evaluated (Table). On multivariable analysis, Black (HR: 1.72, CI 1.01- 2.94; p=0.046) and Hispanic individuals (HR: 2.15, CI 1.36- 3.40; p= 0.001) had worse CSS compared to the White men with T1 disease. Logistic regression analysis shows no difference in the application of primary surgical resection by race (p=0.065). In the univariate analysis, patients who underwent primary site surgery had better 5-year CSS (HR: 0.36, CI 0.22-0.60; p &lt;0.001). Among those undergoing primary surgery, the 5-year CSS was superior with excisional biopsy (HR: 0.22, CI 0.12-0.40; p &lt; 0.001) compared to simple/partial removal of the primary tumor. Conclusions: Significant racial disparities in CSS exist in early-stage penile cancer patients. CSS is worse in Black and Hispanic T1 penile cancer patients compared to White patients. CSS is also decreased in those without any primary surgery and in those treated with simple/partial surgical removal compared to excisional biopsy. Further research on the cause of racial disparity outcomes in penile cancer is needed.[Table: see text]