Decrease In Penile Length Research Articles

1070 USE OF LENGTH EXPANSION INFLATABLE PENILE PROSTHESES IN MEN WITH ERECTILE DYSFUNCTION SECONDARY TO PEYRONIE'S DISEASE

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Peyronie's Disease/Surgical Therapy I1 Apr 20101070 USE OF LENGTH EXPANSION INFLATABLE PENILE PROSTHESES IN MEN WITH ERECTILE DYSFUNCTION SECONDARY TO PEYRONIE'S DISEASE Benjamin Whittam, Todd Doran, Melissa Kaufman, and Douglas Milam Benjamin WhittamBenjamin Whittam More articles by this author , Todd DoranTodd Doran More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , and Douglas MilamDouglas Milam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2229AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Implantation of an inflatable penile prosthesis (IPP) with molding is an effective and durable treatment for erectile dysfunction (ED) and moderate penile curvature due to Peyronie's disease (PyD). Current literature and dogma support use of the American Medical Systems (AMS) CX model or the Mentor Alpha 1 IPP because lengthening capacity of other models is thought to prohibit adequate rigidity for molding and straightening, however, these devices may result in the perception of decreased penile length. Herein we report our experience with placement of length expansion IPP models in the Peyronie's population. METHODS Retrospective review of medical records was performed for patients with ED and penile curvature that had undergone AMS Ultrex or LGX IPP implantation from January 2004 to February 2009. Charts were evaluated for demographics, perioperative curvature, voiding symptoms, erectile function, outcomes, and complications. RESULTS Forty-nine patients underwent AMS Ultrex or LGX implantation for ED associated with PyD. Mean patient age at time of surgery was 60 years (range 45 – 79 years). All patients presented with ED and penile curvature with an average penile curve of 52.9 degrees. Postoperatively, of the 40 patients with sufficient follow-up, 22 had no residual curve and the 18 had an average residual curve of 17.7 degrees. Sexual Health Inventory for Men scores increased from a preoperative mean of 6.97 to 18.54 postoperatively (p=0.0001). AUA-SS mean scores remained stable from 9.11 preoperatively to 7.77 at last follow-up (p=0.80). Excluding 2 patients not sexually active, 87% reported satisfaction with their IPP, while the percentage able to have intercourse increased from 30.8% preoperatively to 97.3% postoperatively. 31 patients underwent molding at time of operation, with no reported cases of aneurysmal dilatation. There were no device infections, one hematoma and one revision due to reduced glans support. No devices were explanted secondary to issues with penile length. CONCLUSIONS Even in patients with severe curvature and ED secondary to PyD, implantation of the AMS Ultrex or LGX IPP results in substantial improvements in curvature, erectile function and sexual health. This data expands current clinical strategies for treatment of this complex patient population by demonstrating the AMS Ultrex and LGX devices are viable therapeutic options for PyD, providing substantial resolution of penile deformities without perceived loss of length and accompanied by an acceptable morbidity profile Nashville, TN© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e417 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Whittam More articles by this author Todd Doran More articles by this author Melissa Kaufman More articles by this author Douglas Milam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impaired Reproductive Development in Sons of Women Occupationally Exposed to Pesticides during Pregnancy

ObjectivesThe aim of this prospective study was to investigate whether occupational pesticide exposure during pregnancy causes adverse effects on the reproductive development in the male infants.Design and measurementsPregnant women employed in greenhouses in Denmark were consecutively recruited, and 113 mother–son pairs were included. The mothers were categorized as occupationally exposed (91 sons) or unexposed (22 sons) to pesticides during pregnancy. Testicular position and volume, penile length, and position of urethral opening were determined at 3 months of age using standardized techniques. Concentrations of reproductive hormones in serum from the boys were analyzed.ResultsThe prevalence of cryptorchidism at 3 months of age was 6.2% [95% confidence interval (CI), 3.0–12.4]. This prevalence was considerably higher than among Danish boys born in the Copenhagen area (1.9%; 95% CI, 1.2–3.0) examined by the same procedure. Boys of pesticide-exposed mothers showed decreased penile length, testicular volume, serum concentrations of testosterone, and inhibin B. Serum concentrations of sex hormone-binding globulin, follicle-stimulating hormone, and the luteinizing hormone:testosterone ratio were increased compared with boys of nonexposed mothers. For individual parameters, only the decreased penile length was statistically significant (p = 0.04). However, all observed effects were in the anticipated direction, and a joint multivariate test showed that this finding had a p-value of 0.012.ConclusionsOur findings suggest an adverse effect of maternal occupational pesticide exposure on reproductive development in the sons despite current greenhouse safeguards and special measures to protect pregnant women.

Effect of Ascertainment and Genetic Features on the Phenotype of Klinefelter Syndrome

To describe the Klinefelter Syndrome (KS) phenotype during childhood in a large cohort. Clinical assessment, measurement of hormonal indices of testicular function, and parent of origin of extra X chromosome were assessed in a cross-sectional study of 55 boys with KS, aged 2.0 to 14.6 years, at an outpatient center. Mean height and body mass index SD scores (SDS +/- SD) were 0.9 +/- 1.3 and 0.4 +/- 1.4, respectively. Mean penile length and testicular volume SDS were -0.5 +/- 0.9 and -0.9 +/- 1.4. Testosterone levels were in the lowest quartile of normal in 66% of the cohort. Other features included clinodactyly (74%), hypertelorism (69%), elbow dysplasia (36%), high-arched palate (37%), hypotonia (76%), and requirement for speech therapy (69%). Features were similar in boys in whom the diagnosis was made prenatally versus boys in whom the diagnosis was made postnatally. There was no evidence for a phenotypic effect of parent of origin of the extra X chromosome. Boys with KS commonly have reduced penile length and small testes in childhood. The phenotype in boys with KS does not differ according to ascertainment or origin of the extra X chromosome. Boys with KS may be identified before puberty by tall stature, relatively decreased penile length, clinodactyly, hypotonia, and requirement for speech therapy.

ORIGINAL RESEARCH—SURGERY: Concomitant Ventral Phalloplasty During Penile Implant Surgery: A Novel Procedure That Optimizes Patient Satisfaction and Their Perception of Phallic Length After Penile Implant Surgery

ABSTRACT Introduction Despite previous reports showing consistently elevated patient satisfaction with penile implantation, it is our impression that patients who have had a prosthesis placed often complain of penile shortening postoperatively. Aim We sought to evaluate if the release of the penoscrotal web would optimize patient perception and satisfaction regarding penile length after such procedure. Main Outcome Measure Utilizing a questionnaire, we evaluated patient satisfaction, focusing on phallic size. Methods Ninety patients (mean age 62) underwent penile prosthesis placement during a 17-month period. Forty-three were carried out with takedown of penoscrotal web during a 17-month period (group 1). Of group 1, 39 patients had an inflatable implant placed (inflatable penile prosthesis) and 4 had a semirigid implant. The patients were directly inquired with a seven-item questionnaire 3 months after the procedure. These results were then compared to a group of 37 patients that had penile implants placed without release of the penoscrotal web (group 2). All the patients involved in the study had a high insertion of the scrotum ventrally (penoscrotal web). Results Of the patients, 42/43 (98%) (group 1) reported good overall satisfaction of the surgical procedure; 36/43 (84%) reported some degree of increase in penile length; 5/43 (12%) reported no significant change in their perception of penile length postoperatively. The remaining two patients reported a decreased penile length. The clinical records from group 2 demonstrated 31/37 (84%) of the patients complained of penile shortening, and only one patient reported an increase in penile length. Postoperative complications in group 1 consisted of wound hematoma (2/43) and focal superficial wound dehiscence (3/43). The operative time for group 1 patients was approximately 12 minutes (mean 11.7) longer. Conclusions Release of penoscrotal web is a simple, safe, and reproducible procedure that can enhance patient perception of penile length and further improve satisfaction.

Penile Length Changes in Men Treated With Androgen Suppression Plus Radiation Therapy for Local or Locally Advanced Prostate Cancer

We determined penile length alterations in men treated with androgen suppression plus radiation therapy for local or locally advanced prostate cancer. From November 2000 to November 2005, 47 patients were enrolled in this prospective study. After clinical staging all patients received hormonal therapy (luteinizing hormone releasing agonist, leuprolide acetate or goserelin every 3 months for a total of 3 injections) and at month 7 of hormonal therapy radiation therapy was begun (total 70 Gy) for 7 weeks. Stretched penile length measurements were performed before starting androgen suppression therapy and every 3 months thereafter with a paper ruler. With the initiation of therapy a gradual decrease in stretched penile length was observed. Penile shortening was statistically significant at a mean followup of 18 months (mean 14.2 to 8.6 cm, p <0.001). Our findings support observations of decreased penile length after neoadjuvant hormonal therapy plus external beam radiation therapy for local or locally advanced prostate cancer. Patients should be counseled before therapy that penile shortening may occur.

Penile Length Alterations Following Penile Prosthesis Surgery

ObjectiveDetermine the impact of penile prosthetic surgery on penile length. MethodsStretched flaccid penile length was measured in men undergoing first-time penile implant surgery. Measurements were done before implantation and at 1 and 6 mo postoperatively. Patients were evaluated by the International Index of Erectile Function (IIEF) preoperatively and the IIEF and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) at 6 mo postoperatively. Patients also provided subjective assessment of penile changes at 6 mo postoperatively. Preoperative and postoperative IIEF and EDITS scores were compared as were the patients who complained of penile length loss with those who did not. ResultsOf the 56 patients, 50% were diabetic and 28.5% had previous radical prostatectomy; 78% of the implants were three-piece (Alpha-1, Mentor) and 22% were two-piece (Ambicor, American Medical Service). There were no statistically significant differences in penile length after the surgery compared to preoperative measurements. Forty of 56 patients (72%) reported a decrease in penile length, 10 of 50 (19%) reported no change, and 6 of 56 (9%) had a slight increase. Subjective penile length loss was more common in patients who had undergone radical prostatectomy before prosthesis implantation (32%). No statistical difference in EF domain scores occurred between patients who complained of penile length loss and those who did not; however, men complaining of length loss had lower IIEF satisfaction domain and EDITS scores. ConclusionPenile prostheses do not have a negative impact on measured stretched flaccid penile length. Treatment satisfaction scores do not depend on subjective penile length loss.

Endocrine disrupters and human puberty

In this overview of the literature, epidemiological research studying the effect of endocrine disrupters on the onset of puberty is summarized. In girls, earlier age at menarche was reported after exposure to polychlorinated biphenyls (PCBs), polybrominated biphenyls (PBBs), persistent pesticides [dichlorodiphenyltrichloroethane (DDT)] and phthalate esters. However, several other studies found no effect of these compounds on age at menarche or pubertal Tanner stages. One study reported a delaying effect of dioxin-like compounds on breast development. In boys, exposure to PCBs, PCDFs or the pesticide endosulfan was associated with delayed puberty or decreased penile length. Much of the results found in population studies are in accordance with experimental studies in animals. However, the mixture of different components with antagonistic effects (oestrogenic, anti-oestrogenic, anti-androgenic) and the limited knowledge about the most critical window for exposure (prenatal, peri-natal and pubertal) may hamper the interpretation of results.

Early use of vacuum constriction device following radical prostatectomy facilitates early sexual activity and potentially earlier return of erectile function

To assess the efficacy of vacuum constriction devices (VCD) following radical prostatectomy (RP) and determine whether early use of VCD facilitates early sexual activity and potentially earlier return of erectile function. This prospective study consisted of 109 patients who underwent nerve-sparing (NS) or non-nerve-sparing (NNS) RP between August 1999 and October 2001 and developed erectile dysfunction following surgery. The patients were randomized to VCD use daily for 9 months (Group 1, N=74) or observation without any erectogenic treatment (Group 2, N=35). Treatment efficacy was analyzed by responses to the Sexual Health Inventory of Men (SHIM) (abridged 5-item International Index of Erectile Function (IIEF-5)), which were stratified by the NS status. Patient outcome regarding compliance, change in penile length, return of natural erection, and ability for vaginal intercourse were also assessed. The mean patient age was 58.2 years, and the minimum follow-up was 9 months. Use of VCD began at an average of 3.9 weeks after RP. In Group 1, 80% (60/74) successfully used their VCD with a constriction ring for vaginal intercourse at a frequency of twice/week with an overall spousal satisfaction rate of 55% (33/60). In all, 19 of these 60 patients (32%) reported return of natural erections at 9 months, with 10/60 (17%) having erections sufficient for vaginal intercourse. The abridged IIEF-5 score significantly increased after VCD use in both the NS and NNS groups. After a mean use of 3 months, 14/74 (18%) discontinued treatment. In Group 2, 37% (13/35) of patients regained spontaneous erections at a minimum follow-up of 9 months after surgery. However, only four of these patients (29%) had erections sufficient for successful vaginal intercourse and rest of patients (71%) sought adjuvant treatment. Of the 60 successful users, 14 (23%) reported a decrease in penile length and circumference at 9 months (range, 4-8 months) compared to 12/14 (85%) among the nonresponders. However, in control group 22/35 reported decrease in penile length and circumference. Early use of VCD following RP facilitates early sexual intercourse, early patient/spousal sexual satisfaction, and potentially an earlier return of natural erections sufficient for vaginal penetration.

Treatment of penile curvature with Essed-Schröder tunical plication: aspects of quality of life from the patients' perspective.

To investigate retrospectively the long-term functional results and quality of life of patients undergoing the Essed-Schröder procedure (a simple plication of the tunica albuginea) to correct penile deviation, using a standardized questionnaire. Between 1998 and 2001, 59 patients had surgery in our hospital to correct penile deviation (mean age 40 years at the time of surgery; mean follow-up 30 months for this study). All 59 patients received a standardized questionnaire via mail, of which 50 could be assessed as valid. Of the 50 patients, 22 had a congenital penile deviation and 28 Peyronie's disease. In all patients the penis was completely straightened. The proportion of patients capable of sexual intercourse was significantly higher after surgery (90%) than before (62%). The frequency of pain during intercourse was halved. Of the 50 patients, 60% would have the same operation again, 32% were undecided and 8% would not; 22% were dissatisfied with the results. None of the patients had complete erectile dysfunction after surgery; 74% reported a decrease in penile length and 78% of the patients' partners were satisfied with the outcome. The tunical plication procedure is simple and minimally invasive for correcting penile deviation. In the opinion of most patients the Essed-Schröder method provides a significant improvement in sexual function and quality of life with maximum protection of erectile function.

A Prospective Study Measuring Penile Length in Men Treated With Radical Prostatectomy for Prostate Cancer

Some patients report that the penis is smaller after radical retropubic prostatectomy for prostate cancer. We performed a prospective study which measured penile length before and after radical retropubic prostatectomy. A total of 124 men consented to penile measurements before radical prostatectomy performed by the same surgeon. Repeat measurements were performed at 3-month intervals following surgery. Penile measurements (cm.) consisted of flaccid length, stretched length, depth of prepubic fat pad and circumference. Statistical analysis of penile measurements was performed using the paired samples and independent Student's t test, Pearson's correlation and analysis of variance. Mean patient age was 59.1 (range 42 to 76). No patient had a penile abnormality, for example Peyronie's disease, or history of penile or urethral surgery. The size of the penis was significantly smaller after prostatectomy, and there was a significant difference for flaccid (p <0.001), stretched (p <0.001), prepubic fat pad (p = 0.02) and circumference measurements (p <0.01). Twelve patients (19%) had a 15% or greater decrease in stretched penile length. When dichotomizing groups at the cut point of 15% decrease, the independent t test of prostate size was not significant (t[df 36.7] = -1.83, p = 0.076). Nerve sparing was not significant in relation to change in penile stretched length, (F[df 2, 62] = 0.501, p = 0.609). Our findings support observations of decreased penile length after radical prostatectomy. Men should be counseled before radical prostatectomy that penile shortening may occur.