Penile Body Research Articles

Evaluation of Smooth Muscle Myosin Heavy Chain Isoform Expressions in a Buried Penis

BackgroundA buried penis (BP) is rare in which the penile body is retracted into the prepubic adipose tissue. This research focuses on differences in smooth muscle myosin heavy chain (SMMHC) isoform expressions in the dartos fascia. MethodsA total of 82 children, 41 of whom had BPs, who applied for circumcision between May and November 2021, were included in the study. The cases were divided into four groups aged ≥6 years (NP6, n = 18) and aged ≤3 years (NP3, n = 17) with normal penile appearance, aged ≥6 years (BP6, n = 23) and aged ≤3 years (BP,n = 24) with a BP. SMMHC isoforms mRNA gene expression analyses were performed by quantitative PCR technique in dartos fascia obtained from foreskin removed by circumcision. ResultsCompared to the NP3 group, the SM1 mRNA expressed in the BP6 group was statistically significantly higher (p < 0.005). SM2 mRNA levels expressed in dartos fascia were considerably higher in NP6 and NP3 groups compared to BP6 and BP3 groups (p < 0.001). The SM2/SM1 ratio was 0.85 in the BP6 group and 1.46 in the NP6 group, which was statistically significant (p = 0.006) and increased from 0.87 in the BP3 group to 2.21 in the NP3 group (p < 0.001). ConclusionIn a buried penis, there is a difference in the expression of SMMHC isoforms. SM1 is highly expressed, while SM2 decreases, increasing the SM2/SM1 ratio. This causes increased contractility in the smooth muscle, leading to retraction of the penile body. The dartos fascia surrounding it resembles aberrant muscle tissue in boys with a BP. Level of EvidenceLevel III. Type of StudyCase-control study.

The Efficacy and Safety of Low‐Intensity Pulsed Ultrasound Therapy for the Treatment of Peyronie’s Disease (A Report of 106 Cases): A Retrospective Study

Objective: To evaluate the efficacy and safety of low‑intensity pulsed ultrasound (LIPUS) for the treatment of Peyronie’s disease (PD).Methods: To analyze the treatment effect of 106 PD patients, 56 patients treated with LIPUS as therapy group and 50 patients with oral L‐carnitine and vitamin E as control group. 56 patients were treated with LIPUS three times per week for four consecutive weeks (12 times totally). Penile erectile pain, erectile function, the size of penile plaques, and penile curvature were assessed for all of these 106 PD patients before treatment and at 4‐ and 24‐week follow‐ups to evaluate the treatment effect. Erectile pain was assessed by visual analog scale (VAS), while erectile function using the International Index of Erectile Function scale (IIEF‐5), and penile plaque size was measured by ultrasound. After alprostadil was injected into the penile body to induce a full erection, the penis was measured with a protractor at the maximum bending degree.Results: After 4‐weeks follow‐up, the VAS scores of the LIPUS group were significantly lower than the baseline (P &lt; 0.01), while no significant differences were found in the control group (P &gt; 0.05). After 24‐weeks follow‐up, the VAS scores of the control group reduced significantly but also were significantly higher than the LIPUS group (P &lt; 0.01). The IIEF‐5 scores of the LIPUS group were significantly higher than the baseline (P &lt; 0.01). While the IIEF‐5 scores of the control group showed no significant differences both after 4‐ and 24‐weeks follow‐up (P &gt; 0.05). The penile plaque size showed no significant differences after 4‐ and 24‐weeks follow‐up both in the LIPUS group and the control group (P &gt; 0.05). The penile curvature degrees showed a significant reduction after 4‐weeks follow‐up in LIPUS group (P &lt; 0.01). While the penile curvature degrees of the control group showed no significant differences both after 4‐ and 24‐weeks follow‐up (P &gt; 0.05). No complications, such as penile pain, hematoma, or skin ecchymosis, were observed during the entire process of LIPUS treatment, nor did they appear during follow‐up.Conclusions: In patients with acute PD, LIPUS could relieve erectile pain and improve erectile dysfunction. Moreover, it appears not to reduce plaque size and not to have a clinically significant effect on penile curvature. Furthermore, LIPUS also shows a good safety profile during the management of PD and should be recommended for the clinical management of PD.

(388) Primary Penile Squamouse Cell Cancer Related Malignant Priapism In A Cystectomized Patient: A Case Report

Abstract Introduction Priapism is a prolonged (&amp;gt; 4 hours) and unintended erection without sexual stimulation or sexual desire. Priapism due to neoplasms is called malignant priapism, which is a rare condition that tends to occur with corporeal metastasis of other pelvic area malignancies. Priapism due to primary penile malignancies is extremely rare. Objective In this article, we present the case of a patient who underwent total penectomy and bilateral inguinal lymphadenectomy due to malignant priapism related to primary penile squamous cell cancer (SCC), and who also underwent radical cystectomy (RC) and total urethrectomy due to urothelial carcinoma 19 and 2 years prior, respectively. Methods We prepared the patient's information to present. Results An 82-year-old male patient presented to an outpatient clinic with unintended erection and penile pain of about 48 hours’ duration and was on follow-up in our clinic because of urothelial carcinoma history. The patient’s history indicated that he underwent RC and orthotopic neobladder due to muscle-invasive urothelial cancer (UC) in the bladder. No tumor was observed in the final cystectomy pathology; therefore, no adjuvant therapy was given. Seventeen years after the RC operation, he presented with hematuria and a papillary lesion detected in the mid-urethra during cystourethroscopy. Since the biopsy result from this region was compatible with high-grade UC, he underwent total urethrectomy, neobladder resection, and ileal conduit. Urethrectomy pathology results were reported as UC invading the subepithelial stroma and lymphovascular area. Adjuvant MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) chemotherapy was administered. On follow-up 2 years after the urethrectomy operation, he presented with prolonged priapism. On examination, a cold and erect penis with a 1 cm diameter ulcerated lesion on the glans penis were observed. Hypoxia and hypercarbia were observed on the cavernosal blood gas examination, which was compatible with ischemic priapism. The hemogram was normal. On the emergent penile duplex Doppler ultrasound showed decreased blood flow and a mass on the proximal part of the penis. Subsequently, pelvic magnetic resonance imaging was performed and a mass was observed that was fully destructive to the cavernosal bodies and had irregularly circumscribed borders (Figure 1). Afterward, the patient underwent a total penectomy and bilateral inguinal lymphadenectomy. The pathology report from the penectomy material suggested that the tumor was compatible with moderately differentiated SCC. No sign of metastasis was observed in the lymph nodes. Extensive sampling of the tumor did not reveal any UC in situ, nor SCC in situ. The penis shaft was fully infiltrated by the tumor, with SCC morphology starting from the surgical margin and damaging all the structures of the penile body (Figure 2). The patient was transferred to the oncology clinic for additional treatment planning. Conclusions Despite being the most common primary malignancy of the penis, to the best of our knowledge priapism due to primary penile SCC has been reported only once in the literature. Although metastatic disease is typically thought to be the cause, when a patient with a history of pelvic malignancy presents with malignant priapism, it should be kept in mind that primary malignancies of the penis may also cause this condition. Disclosure No

PROGNOSTIC FACTORS FOR LYMPH NODE INVOLVEMENT, DISEASEFREE SURVIVAL AND OVERALL SURVIVAL IN PENILE CANCER

Background Penile Cancer (PC) is a rare neoplasm. The most important PC prognostic factor is inguinal lymph node (ILN) involvement (pN+). Inguinal lymphadenectomy (ILND) is the most accurate method for ILN staging. Due to high morbidity and quality of life impairment, alternative staging modalities have been researched. This epidemiological study aims to assess risk factors to determine prognosis in PC patients. A retrospective review was Methods conducted on 84 PC patients. Mean age was 58.68 (12.98) years. Thirty-Eight (45.3%) patients underwent ILND. The main reasons were primary tumor staging (pT2 and up) and palpable nodes (cN+) in physical examination. For pN+ risk, cN+, tumor inltration of penile body, dartos, spongios Results um and corpora cavernosa, as well as perineural and lymph vascular invasion (LVI) were signicant. For recurrence and metastasis, cN+, penile body invasion, LVI, corpora cavernosa invasion and pN+ showed statistical signicance. In overall survival (OS) evaluation, cN+, LVI, penile body, dartos, spongiosum and corpora cavernosa invasion, pT and pN+ presented worst prognosis. In multivariate analysis, cN+ was a risk factor for pN+. Cox regression analysis was also performed. Factors that decreased disease-free survival (DFS), were cN+, penile body, dartos or corpora cavernosa invasion and pN+. When applied to OS, cN+, penile body invasion, LVI, dartos invasion, pT and pN+ were related to worst survival. Most patients (67.5%) stayed disease free. Recurrence was more common on ILN (14.3%). When metastatic (10.7%), mortality was 55.6%. Conclusion This study conrmed several risk factors for pN+, DFS and OS on PC patients.

Commentary to: Sutureless circumcision using monopolar diathermy and 2-octyl cyanoacrylate is safe and effective in a cohort of 634 post-neonatal prepubescent boys

In the late ’90s, a paediatric surgical resident was called to the emergency department to examine a neonate for a potential complication after ritual circumcision. The resident confirmed complete gangrene of the penile body following the application of an unconfirmed chemical substance to stop bleeding. Complete amputation of the penile body occurred a few days later. The circumcision was performed by a physician who seemed to be a relative to the child. This resident was me. Similar cases of penile gangrene after circumcision are reported in the literature [ 1 Rizvi S.A. Naqvi S.A. Hussain M. Hasan A.S. Religious circumcision: a Muslim view. BJU Int. 1999; 83: 13-16 Google Scholar , 2 Altokhais T.I. Electrosurgery use in circumcision in children: is it safe?. Urol Ann. 2017; 9: 1-3 Google Scholar , 3 Seleim H.M. Elbarbary M.M. Major penile injuries as a result of cautery during newborn circumcision. JPS. 2016; 51: 1532-1537 Google Scholar ]. Sutureless circumcision using monopolar diathermy and 2-octyl cyanoacrylate is safe and effective in a cohort of 634 post-neonatal prepubescent boysJournal of Pediatric UrologyVol. 18Issue 6PreviewCircumcision is the most commonly performed surgical procedure in the world, with one-third of males circumcised globally. Post-neonatal, prepubescent sutured circumcision demonstrates complication rates ranging from 1.7% to 9.1%. We have previously reported that 2-octyl cyanoacrylate (2-OCA, Dermabond, Ethicon) primary circumcision (PC) and circumcision revision (CR) in prepubescent children demonstrated superior cosmesis, shorter operating room (OR) times and cost savings. Full-Text PDF Response to commentary re no instruments, no sutures, no worries: Circumcision using monopolar diathermy and 2-octyl cyanoacrylate is safe and effective in a cohort of 634 post-neonatal prepubescent boysJournal of Pediatric UrologyVol. 18Issue 6PreviewJust as there is debate about whether to perform circumcision, so too are there opinions about how to do them. Sadly, the reviewer witnessed a devastating complication following a circumcision. This anecdotal experience may have blinded their view of circumcision in general. However, we must remember that electrocautery and chemical cautery are two distinct entities. The reader of our manuscript should be reassured that the procedure we describe is both safe and effective when performed by trained experts. Full-Text PDF

LBA02-12 RBFOX2 COPY NUMBER VARIATION VITIATES URETHRAL CLOSURE CAUSING HYPOSPADIAS

You have accessJournal of UrologyCME1 May 2022LBA02-12 RBFOX2 COPY NUMBER VARIATION VITIATES URETHRAL CLOSURE CAUSING HYPOSPADIAS Victor Ruthig, Fredi Ruiz Rojano, Jeffrey White, Marisol O'Neill, and Dolores Lamb Victor RuthigVictor Ruthig More articles by this author , Fredi Ruiz RojanoFredi Ruiz Rojano More articles by this author , Jeffrey WhiteJeffrey White More articles by this author , Marisol O'NeillMarisol O'Neill More articles by this author , and Dolores LambDolores Lamb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002670.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The dosage-sensitive gene, RBFOX2, encodes a RNA binding protein that is a regulator of alternative mRNA splicing. Copy number variations (CNVs) in RBFOX2 cause birth defects in the cardiac and nervous systems. A subset of patients were identified in public databases with genitourinary birth defects, including hydronephrosis and hypospadias, associated with RBFOX2 CNVs. RBOX2 CNVs are more common in patients with GU and CAKUT anomalies (2.4 % of non-syndromic patients with GU birth defects, 0% of our control patients with no GU anomalies and 0.11% of subjects in the general population (Database of Genomic Variants) and 0.06% of patients with anomalies in DECIPHER (p<0.00001; ANOVA). Work by others posited that RBFOX2-mediated splicing is integral in the mesenchymal-to-epithelial transition pathway. In support of this hypothesis, our RNA-sequencing analysis with postnatal penises from Rbfox2-knockout mice, that exhibit CAKUT and/or hypospadias, identified disruption of this pathway. Sequencing analysis revealed evidence of RBFOX2 interaction with sex hormone signal pathways. METHODS: We tested the hypothesis that the developmental origins of a subset of hypospadias is due to RBFOX2 CNVs. Whole exome sequencing identified patients with RBFOX2 CNVs and SNPs. To define the cell type specific expression ofRbfox2, spatiotemporal expression was defined over a fetal time course of mouse penises before and after sex determination of the genital tubercle. Fluorescent in situ hybridization and immunofluorescent whole mount samples were imaged using confocal microscopy. RESULTS: Whole exome sequencing data confirmed in patients with RBFOX2 CNV and damaging SNPs, that these variants were a root cause for lower tract genitourinary anomalies, as well as CAKUT, cardiac defects, intellectual disabilities and head deformities. Imaging experiments defined Rbfox2 expression after sex determination of the murine male genital tubercle. Rbfox2 expression is first confined to the peri-urethral space of the developing penis. In this region, the most abundant urethral RBFOX2 protein signal travels distally starting at the base of the penis as a urethral ring of signal that halts at the junction of the penile body and glans. The glans is encased with an epithelial layer of cells that are strongly RBFOX2-positive. These cells aggregate at the site of glandular urethra formation. Most RBFOX2-positive glandular epithelial cells co-express androgen receptor. The preputial folds have a similar epithelial net of RBFOX2- and androgen receptor-positive cells. CONCLUSIONS: The coincident locations of RBFOX2 signal during urethral formation and development of hypospadias when Rbfox2 is deleted, implicate RBFOX2 as a molecular player in the double zipper mechanism of urethral formation and closure. The more peripheral co-expression of RBFOX2 and androgen receptor in the glandular and preputial epithelium may be part of a RBFOX2-mediated balancing of androgen and estrogen signaling. The hypospadias that is observed when Rbfox2 is deleted would then, at least partly, be due to resultant favoring of the feminization pathway. Source of Funding: AUA/UCF Research Scholar Award to JW; NIH-R01DK078121 and Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust to DJL; NIH-T32DK007763 to DJL for MO © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1046 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Victor Ruthig More articles by this author Fredi Ruiz Rojano More articles by this author Jeffrey White More articles by this author Marisol O'Neill More articles by this author Dolores Lamb More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP20-16 CLINICAL TRANSLATION OF ENGINEERED PENILE TISSUE

You have accessJournal of UrologyCME1 May 2022MP20-16 CLINICAL TRANSLATION OF ENGINEERED PENILE TISSUE Sita Somara, Teresa Burnette, Namrata Sangha, Lindsey Creahan, Tsghe Abraha, Kathryn Krupp, Tiana Stewart, Torie Westendorf, Brad Damratoski, Lisa Hinshaw, Todd Meinecke, Darren Hickerson, Cynthia Wilkins-Port, Ryan Terlecki, James Yoo, Julie Allickson, Anthony Atala, and John Jackson Sita SomaraSita Somara More articles by this author , Teresa BurnetteTeresa Burnette More articles by this author , Namrata SanghaNamrata Sangha More articles by this author , Lindsey CreahanLindsey Creahan More articles by this author , Tsghe AbrahaTsghe Abraha More articles by this author , Kathryn KruppKathryn Krupp More articles by this author , Tiana StewartTiana Stewart More articles by this author , Torie WestendorfTorie Westendorf More articles by this author , Brad DamratoskiBrad Damratoski More articles by this author , Lisa HinshawLisa Hinshaw More articles by this author , Todd MeineckeTodd Meinecke More articles by this author , Darren HickersonDarren Hickerson More articles by this author , Cynthia Wilkins-PortCynthia Wilkins-Port More articles by this author , Ryan TerleckiRyan Terlecki More articles by this author , James YooJames Yoo More articles by this author , Julie AllicksonJulie Allickson More articles by this author , Anthony AtalaAnthony Atala More articles by this author , and John JacksonJohn Jackson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002553.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Loss or damage of penile tissue due to trauma and disease are life-defining injuries for those affected. Restoration of sexual function is necessary to support recovering psychologically and reestablish the prospect of leading a full and productive life. Recently, the concept of tissue engineering has been proposed to address the goal of restoring normal anatomical tissue configuration and erectile function. METHODS: A penile construct has been engineered by seeding autologous, ex vivo-expanded smooth muscle and endothelial cells seeded onto a naturally derived acellular corporal tissue matrix that possesses the same architecture as native corpora. The proposed clinical indication for the engineered product was for treatment of damaged penile corpora cavernosa. Autologous endothelial cells (EC) and smooth muscle cells (SMC) were isolated from a biopsy obtained from the patient’s cavernosum. Scaffolding was generated by decellularizing a donor penile body. This acellular scaffold was seeded with cells isolated and expanded from the patient’s biopsy. Once seeded, the engineered penile tissue construct was matured in a bioreactor. RESULTS: A robust process, developed in WFIRM RMCC Process Development, is being translated into GMP Manufacturing for the production of a clinical grade engineered penile tissue construct. In-process and release testing procedures have been established for the utilization of autologous cells and decellularized donor scaffold, to deliver a sterile engineered penile tissue final product. Cells were characterized by studying growth kinetics, identity and purity through immunophenotyping and viability assessments. Decellularized scaffolds are evaluated for acellularity through the absence of DNA and cell nuclei. The final product construct has been characterized for cell viability and distribution on the donor scaffold. CONCLUSIONS: Processes for isolating and expanding the cells, decellularization of a donor penile body and production of a final product construct is currently being been optimized and validated to conform to FDA requirements. An investigational New Drug (IND) application for the project has been approved from the Food and Drug Administration (FDA) for carrying out Phase I safety study for this engineered penile tissue product. Source of Funding: This work was supported by the Army, Navy, NIH, Air Force, VA and Health Affairs to support the AFIRM II effort, under Award No. W81XWH-13-2-0052. The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e324 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sita Somara More articles by this author Teresa Burnette More articles by this author Namrata Sangha More articles by this author Lindsey Creahan More articles by this author Tsghe Abraha More articles by this author Kathryn Krupp More articles by this author Tiana Stewart More articles by this author Torie Westendorf More articles by this author Brad Damratoski More articles by this author Lisa Hinshaw More articles by this author Todd Meinecke More articles by this author Darren Hickerson More articles by this author Cynthia Wilkins-Port More articles by this author Ryan Terlecki More articles by this author James Yoo More articles by this author Julie Allickson More articles by this author Anthony Atala More articles by this author John Jackson More articles by this author Expand All Advertisement PDF DownloadLoading ...

A rare complication of circumcision due to monopolar cauterization: Penile necrosis

Penile necrosis due to monopolar cauterization during circumcision is a rare complication and may cause organ loss. When monopolar cauterization applied on an end-organ, current flows through the organ and, causes disruption of blood flow and oxidative stress. Penile injury may include skin, glans and cavernous bodies. Injury can be limited with the help of medical treatment and hyperbaric oxygen treatment, but eventually the need for reconstruction arises. Some case reports of application of feminizing genitoplasty after total organ loss are present on the literature. However, lengthening of penis via dissection of cavernous bodies and application of skin graft seems more appropriate as a method of reconstruction. At this case report, three-year old male who had penile necrosis after having circumcised at another center will be discussed under the light of current literature. As soon as the patient was hospitalized, medical treatment and hyperbaric oxygen treatment started. However circulation of the necrotic tissue didn’t improve and necrotic part of the penile skin, glans and cavernous bodies were debrided. After the debridement, two centimeters of cavernous body remained. Once tissues recovered, as a second operation, cavernous bodies were dissected through pubic arms and skin graft was applied. As a result, five centimeters of penile body was achieved. Post-operatively no problem was encountered and patient was discharged 23 days after circumcision.

A rare complication of circumcision due to monopolar cauterization: Penile necrosis

Penile necrosis due to monopolar cauterization during circumcision is a rare complication and may cause organ loss. When monopolar cauterization applied on an end-organ, current flows through the organ and, causes disruption of blood flow and oxidative stress. Penile injury may include skin, glans and cavernous bodies. Injury can be limited with the help of medical treatment and hyperbaric oxygen treatment, but eventually the need for reconstruction arises. Some case reports of application of feminizing genitoplasty after total organ loss are present on the literature. However, lengthening of penis via dissection of cavernous bodies and application of skin graft seems more appropriate as a method of reconstruction. At this case report, three-year old male who had penile necrosis after having circumcised at another center will be discussed under the light of current literature. As soon as the patient was hospitalized, medical treatment and hyperbaric oxygen treatment started. However circulation of the necrotic tissue didn’t improve and necrotic part of the penile skin, glans and cavernous bodies were debrided. After the debridement, two centimeters of cavernous body remained. Once tissues recovered, as a second operation, cavernous bodies were dissected through pubic arms and skin graft was applied. As a result, five centimeters of penile body was achieved. Post-operatively no problem was encountered and patient was discharged 23 days after circumcision.

Epidemiological Analysis of Penile Neoplasms in Brazil and Its Social Determinants

Introduction: Penile neoplasms, although preventable, are frequent even among young persons. Penile neoplasms have a high risk of not only morbidity and mortality but also important psychosocial repercussions.Objective: To describe the epidemiology of penile neoplasms in Brazil. Method: This was an epidemiological, descriptive and cross-sectional study. Data on all the notified cases of penile neoplasms in Brazil between 1985 and 2015 were obtained from RCPBP/INCA and DATASUS databases.Results: Of 9 625 notified cases of penile neoplasms, a higher proportion of cancer patients was observed among patients aged between 40 and 70 years (63.5%) and among smokers (21%), in Brown and Caucasian patients (80%), those who were married (54.2%), had high alcohol intake levels (16%) and with lower levels of education: illiterate people (21.5%), those with incomplete elementary school education (36.6%) and those with complete elementary school education (10.3%). The lesions were located in the glans (22.6%), prepuce (7.5%) and the penile body (7.5%). Higher mortality rates were observed in the age-group 50 to 80 years and in among patients from the Northeast (31.4%) and Southeast (39.2%) regions of the country.Conclusion: Penile neoplasms, which mainly affect young people that are economically active, are prevalent in Brazil and the majority of patients present with an advanced stage of the disease. They are Brown and Caucasian, married, with poor education and live in the Northeast and Southeast regions of the country.

Características clínico-patológicas del cáncer de pene: experiencia actual de un centro hospitalario de tercer nivel en México

Introducción: El carcinoma epidermoide de pene se considera una enfermedad rara en países desarrollados, representando el 0.4-0.6% de las neoplasias malignas en los hombres, sin embargo, en los países en vías de desarrollo representa el 10-20% de las neoplasias malignas. El 95% de los casos corresponde a carcinoma epidermoide, los factores de riesgo que destacan son fimosis, tabaquismo e infección por virus del papiloma humano.&#x0D; Objetivo: Describir las características clínicas y patológicas de pacientes con diagnóstico de cáncer de pene.&#x0D; Material y métodos: Se realizó un estudio retrospectivo, retrolectivo y descriptivo de expedientes clínicos físicos y electrónicos de los pacientes atendidos en servicio de Urología y Oncología del Hospital General de México en un periodo de 5 años de enero 2015 a enero 2020.&#x0D; Resultados: Se incluyeron datos de 93 pacientes con edad promedio de 57.87 años (23-86), tabaquismo en el 55.9%. Comorbilidades en el 50%. El grado de escolaridad primaria, secundaria o analfabeta en el 65.6%, 20.4 y 7.5%, respectivamente. Se identificó fimosis en el 74.2%. Los sitios más frecuentes de localización del cáncer fueron Glande, glande-prepucio o cuerpo en el 40.9%, 33.5% y 23.7%, respectivamente. Coilocitosis en el 17.2%. Identificamos invasión linfovascular en el 18.3%, perineural en el 19.4%.&#x0D; Conclusiones: En nuestro hospital contamos con casos de cáncer de pene frecuentemente, está incluido en los 20 principales diagnósticos anuales, en su mayoría de tipo escamoso, moderadamente diferenciado, de presentación ulceroso, estadio T3, estadio clínico N0.

Clinical and pathologic characteristics of penile cancer: current experience at a tertiary care hospital center in Mexico

Background: Squamous cell carcinoma of the penis is considered a rare disease in developed countries, accounting for 0.4-0.6% of the malignant tumors in men, but the figure increases to 10-20% in developing countries. Ninety-five percent of penile cancers correspond to squamous cell carcinoma and the outstanding risk factors are phimosis, smoking, and human papillomavirus infection.&#x0D; Objective: To describe the clinical and pathologic characteristics of patients diagnosed with penile cancer.&#x0D; Materials and methods: A retrospective, retrolective, and descriptive study was carried out utilizing the physical and electronic case records of patients treated at the Urology and Oncology Service of the Hospital General de México over the 5-year period of January 2015 to January 2020.&#x0D; Results: Data on 93 patients were included. Mean age of the patients was 57.87 years (23-86), 55.9% were smokers, and 50% had comorbidities. A total of 65.6% of the patients had a primary school education, 20.4% had a secondary school education, and 7.5% were illiterate. Phimosis was identified in 74.2% and the most frequent penile cancer sites were the glans penis (40.9%), the glans penis-prepuce (33.5%), or the penile body (23.7%). Koilocytosis was present in 17.2%, lymphovascular invasion in 18.3%, and perineural invasion in 19.4%.&#x0D; Conclusions: Cases of penile cancer are frequent at our hospital and the disease is one of the 20 principal diagnoses made annually. The majority of cases are ulcerous, moderately differentiated, stage T3, clinical stage N0, squamous cell carcinoma.

High levels of androgens cause chondrocyte accumulation and loss of smooth muscle in the mouse penile body†

Androgens are essential for penile development and for maintaining penile structural and functional integrity. Loss of androgen levels or function results in a decrease in smooth muscle content, accumulation of adipocytes in the corpora cavernosa, and inhibition of erectile function. Our previous studies with a mouse model (KiLHRD582G) of constitutive luteinizing hormone receptor activity also showed structural abnormalities in the penis caused by a decrease in smooth muscle content, accumulation of chondrocytes, and sexual dysfunction. As KiLHRD582G mice exhibit very high levels of testosterone at all postnatal ages, the goal of this study was to determine if the elevated androgen levels were responsible for the morphological changes in the penis. Implantation of testosterone capsules in wild-type mice at neonatal (2weeks) and postpubertal (5weeks) ages resulted in the accumulation of chondrocytes in the corpora cavernosa of the adult animals. Mice implanted with testosterone capsules at 2weeks of age exhibited a 4-fold increase in serum testosterone with a 1.5-fold loss of smooth muscle at 24weeks of age. Collagen content was unchanged. Only 57% of testosterone implanted mice were fertile at 24weeks of age. Mice implanted with testosterone capsules at 5weeks of age showed no decrease in smooth muscle content at 24weeks, although serum testosterone levels were elevated 5-fold. Implantation with dihydrotestosterone also resulted in chondrocyte accumulation and a 2-fold loss in smooth muscle content. Together, these studies demonstrate that supraphysiological levels of androgens cause structural changes in the penile corpora cavernosa and impair fertility.

Clinicopathological Presentation and Management of Penile Schwannoma

Patients with penile schwannoma are rare and usually with variant presentations. No evidence-based clinical guideline exists for diagnosis or treatment. To put schwannoma into differential diagnoses of benign soft tissue lesions in the penis is important. To analyze and categorize clinical, histopathological, and radiological presentations and apply possible explanation on several fields of penile schwannoma. We collected the English literature through the PubMed database of the National Library of Medicine up to October 2019. A newly diagnosed case in Chang Gung Memorial Hospital, Taiwan, was also included. This study categorized lesion locations into the penile body or shaft, glans, or penile root, dorsal or ventral. The main outcome measure was to demonstrate clinical, pathological, ultrasonography, and MRI manifestations of penile schwannoma and perform immunohistochemistry staining that has not been performed among penile schwannomas. We collected 40 cases. Data were arranged in tables. Clear descriptions were added on several fields of penile schwannoma in detail in Discussion. Penile schwannomas are mostly located at the penile shaft and dorsum of the penis. Dyspareunia is the most reported complaint for sexual dysfunction. This study is the first study in the world to document the expressions of calretinin, SOX10, glial fibrillary acid protein, D2-40 (podoplanin), and cytokeratin AE1/AE3 in penile schwannoma and claims magnetic resonance imaging and pathologic presentations of penile schwannomas are synonymous with schwannomas from head to toe. The current patient may be the first to present with penile schwannoma with schwannomatosis. Huang LC, Wang HZ, Chu YC, etal. Clinicopathological Presentation and Management of Penile Schwannoma. Sex Med Rev 2020;8:615-621.

Spongiosum combined glanuloplasty reduces glanular complications after proximal hypospadias repair

To reduce the incidence of complication after hypospadias repair, we designed a modified glanuloplasty maneuver that made the corpus spongiosa connecting to the glans when creating the glanular wings. Patients with proximal hypospadias between 2014 and 2016 were reviewed and divided into new maneuver group or control group. The incidence of complications was compared between two groups. In the new maneuver group, dysplastic spongiosum on both sides of the urethral plate were mobilized to glans with Buck’s fascia (3-4mm wide) together to form glanular wings and covering neo-urethra. In the control group, the new urethral was only covered with superficial fascia under the coronal sulcus. 47 patients in the new maneuver group (32.65±15.75 months) and 28 patients in the control group (32.05±17.26 months). In the new maneuver group, the length of neo-urethra was 3.95±1.04cm. In the control group, the length of the neo-urethra was 4.11±1.26cm. Follow-up (20.36±6.29 months) was conducted for 75 patients. In the new maneuver group, there were 10 cases (21.28%) of urinary fistula (2 at coronal sulcus(4.26%), 4 at penile body (8.51%), and 4 at penile root (8.51%)), 2 cases of urethral stricture 2 (4.26%, all at penile root), 4 cases of diverticulum (8.51%) and no glans dehiscence. In the control group, there were 15 cases (53.57%) of urinary fistula (8 at coronal fistula (28.57%), 3 at penile body 3 (10.71%), 4 at penile root (14.29%)), 2 cases of glans dehiscence (7.14%), 4 cases of urethral stricture (14.29%, 2 at penile root, 2 at coronal sulcus), 1 case of diverticulum (3.57%), and 1 case of penile curvature recurrence (3.57%). The new maneuver group had much lower incidences of coronal fistula (P<0.001), glans dehiscence (P=0.033), urethral stricture (P=0.008) and higher incidence of diverticulum (P=0.040). Spongiosum combined glanuloplasty can increase the amount of the glans tissue, reduce the incidences of complications effectively.

About malpraxis, with love

About malpraxis, with love

The sentinel lymph node biopsy in penile carcinoma guided by multispectral separate-merge guided surgery device

Objective To explore the method and clinical value of sentinel lymph node biopsy for penile carcinoma guided by multispectral separate-merge guided surgery device(MGS). Methods The clinical data of 7 patients with sentinel lymph node biopsy of penile cancer guided by MGS from April 2017 to April 2018 were analyzed retrospectively at First Hospital of Shanxi Medical University. They were 62-78 years old, with an average age of 65 years. All of carcinoma was located in the glans or coronal sulcus, which diameter was 1.0-3.5 cm, with an average of 2.5 cm. Three cases of inguinal lymph nodes could be non-palpable and the others palpable. All patients were injected 0.25 ml (2.5 mg/ml) of indocyanine green solution with 1 ml syringe at 12, 4, 6 and 9 points in the proximal normal skin of penile tumors. Immediately, the imaging probe was aligned with the injection point to observe the dynamic changes of fluorescence image on MGS display. Results There were 14 sides of groin in 7 patients, except for 1 side without images, other 13 sides developed well. The images displayed by MGS include visible image, fluorescent image and merged image, and the merged image was green pseudo color. According to the dynamic changes of the image, it could be divided into five parts: injection point, penile body, pubic symphysis, inguinal region and sentinel lymph node. In 13 well-developed sides, fluorescence gradually disappeared in other parts about 15 minutes after injection, and the location of sentinel lymph nodes was determined in vitro by gradually consolidating and fixing the fluorescence images in the inguinal region. The lymph node-like tissue with strong fluorescence intensity was observed immediately after the skin incision. There was a clear boundary between the lymph node-like tissue and the surrounding tissue. Along this boundary, lymph nodes were separated, ligated, excised. No lymph nodes were found on the undetected side. Postoperative pathology confirmed that lymph nodes were located by fluorescence imaging in vitro and traced by fluorescence imaging in vivo, the coincidence rate was 100%. There were residual fluorescent tissues on three sides and lymphatic vessels were removed. Conclusions MGS-assisted intraoperative fluorescence imaging could improve the doctor's visual depth so that physicians can real-time, dynamic, accurate in vitro location and in vivo tracking of sentinel lymph nodes of penile cancer. Key words: Penile carcinoma; Sentinel lymph node biopsy; Fluorescence image; Indocyanine green; Image guided

Ligamentous structures in human glans penis.

The corpus spongiosum reportedly occupies a larger proportion of the human glans penis than does the penile body, embedding the end of the corpus cavernosus (CC). However, anatomic descriptions about the fibrous structures of glans penis in the literature cause confusion during dissection and reconstructive surgery. Forty-five penises of formalin-embalmed cadavers were dissected sagittally along the course of the distal urethra and observed macroscopically. Dense connective tissues adjacent to the fossa navicularis and spongiosum parts of the glans were cropped, and underwent Masson's trichrome and Verhoeff-Van-Gieson staining. Most (55.5%) of the specimens had distinct fibrous bands toward the distal tips of the glans penis, which elongated from the tunica albuginea of the CC. They comprised longitudinal collagen bundles continuous to the outer longitudinal layer of the tunica albuginea covering the CC and were intermingled with sparse elastic fibres. This architecture either did not reach the distal end of the glans penis (35.5% of cases), or was obscure or dispersed in all directions (9.0% of cases). The structural dimorphism and the variations in the ratio of dense connective tissue components of the fibrous skeleton are considered to contribute to the varying degrees of flexibility, distensibility and rigidity of the human glans penis.

Constitutive luteinizing hormone receptor signaling causes sexual dysfunction and Leydig cell adenomas in male mice.

The luteinizing hormone receptor (LHCGR) is necessary for fertility, and genetic mutations cause defects in reproductive development and function. Activating mutations in LHCGR cause familial male-limited precocious puberty (FMPP). We have previously characterized a mouse model (KiLHRD582G) for FMPP that exhibits the same phenotype of precocious puberty, Leydig cell hyperplasia, and elevated testosterone as boys with the disorder. We observed that KiLHRD582G male mice became infertile by 6 months of age, although sperm count and motility were normal. In this study, we sought to determine the reason for the progressive infertility and the long-term consequences of constant LHCGR signaling. Mating with superovulated females showed that infertile KiLHRD582G mice had functional sperm and normal accessory gland function. Sexual behavior studies revealed that KiLHRD582G mice mounted females, but intromission was brief and ejaculation was not achieved. Histological analysis of the reproductive tract showed unique metaplastic changes resulting in pseudostratified columnar epithelial cells with cilia in the ampulla and chondrocytes in the penile body of the KiLHRD582G mice. The infertile KiLHRD582G exhibited enlarged sinusoids and a decrease in smooth muscle content in the corpora cavernosa of the penile body. However, collagen content was unchanged. Leydig cell adenomas and degenerating seminiferous tubules were seen in 1-year-old KiLHRD582G mice. We conclude that progressive infertility in KiLHRD582G mice is due to sexual dysfunction likely due to functional defects in the penis.

Application of vascularized tunica vaginalis flap technique in repairing recurrent urethrocutaneous fistula following hypospadias surgery

0bjective To investigate the feasibility and efficacy of tunica vaginalis flap cover in treatment of recurrent urethrocutaneous fistula (UCF). Methods We reviewed the clinical datas of 25 cases of UCF after urethroplasty of hypospadias from January 2011 to January 2015. The mean age of the patients was 6.2 years(range 1.6 -14.0 years). All patients had undergone previous hypospadias repair and at least one previous failed attempt to close the urethrocutaneous fistulae. There were 5 cases of fistula in the coronary sulcus, 6 cases of fistula in the penile body and 14 cases of fistula at the junction of penis and scrotum.The diameter of urethrocutaneous fistulae were 3-10 mm. Single fistula was present in all patients. 16 cases had undergone UCF repair for two times, 9 cases had undergone UCF repair for more than two times. After closing the fistula with inverting running stitch, a tunica vaginalis flap was mobilized to cover the repair site through a subcutaneous tunnel and the skin closed. Results The mean follow-up time was 2.1 years(range 0.5- 4 years). The overall success rate was 96%(24/25). Penile cosmesis was excellent. There was no evidence of recurrent fistulas or urethral strictures. All parents reported a straight penis when erected, and one patient in whom there was leak from the fistula site because of local wound infection. No postoperative complication was encountered in the testis. The testis was of normal size and position, and the ultrasound findings were normal. Conclusions Repairment of recurrent urethrocutaneous fistulas with a tunica vaginalis flap could be effective regardless of fistula location. The technique is simple to improve the success rate of the repair of UCF effectively and reduce the occurrence of postoperative complications. Key words: Vascularized tunica vaginalis flap; Hypospadias; Urethrocutaneous fistula