Penile Diameter Research Articles

Recording method of nocturnal penile tumescence to evaluate the efficacy of X-ray endovascular treatment of vasculogenic erectile dysfunction

Background. The vasculogenic form of erectile dysfunction (ED) is the most widespread of all forms of ED. As a rule, young men in the initial stages of the disorder are not ready to accept phalloprosthetics, making it a relevant concern to search for alternative ways of their sexual rehabilitation, including X-ray endovascular surgery. No less relevant is further improvement of the quality assessment methods for erectile dysfunction both for diagnostic purposes and for determining of efficacy of the treatment provided.Aim. To assess the quality of erectile function by monitoring nocturnal penile tumescence (NPT) in patients after X-ray endovascular treatment of vasculogenic ED.Materials and methods. Over 560 patients with suspected vasculogenic erectile disorder have been examined since 2012, with X-ray endovascular treatment provided to 121 patients with confirmed veno-occlusive ED. To assess the quality of erectile function in patients, we monitored NPT using an Androscan MIT registrar from January 2022 to September 2023, in each case one month before and after the surgical treatment of vasculogenic ED. Included in the study were 40 patients who underwent surgery with us, aged 25 to 48 years old (34.3 ± 7.4 years on average) and having vasculogenic ED, including those with veno-occlusive erectile disorders (n = 33), arterial insufficiency of the cavernous bodies (n = 5), hemodynamic and clinical signs of arteriovenous ED in the subcompensation stage (n = 2). Data were compared on changes in the penile diameter and duration of rigidity during NPT, reflecting the main hemodynamic indicators of the penile blood flow.Results. In the compensated stage of ED, the increase in the penile diameter during NPT was 20–30 %, with duration of tumescence being 43.2 ± 20 min; in the subcompensated stage, 10–30 % and 23 ± 21 min respectively. One month after treatment, these indicators were 45 ± 15 % and 76.3 ± 21 min respectively. After surgery, all patients demonstrated a recovery of the erectile function, and the linear and angle-independent blood flow indicators tended to normalize. The data obtained from the monitoring of NPT helped identify a correlation between the linear blood flow indicators, their derivatives, as well as the time and character of penile rigidity during NPT, making it possible to differentiate the types of vasculogenic ED and the criteria for its clinical compensation.Conclusion. At present, the instrumental diagnostics of ED is limited to the Doppler sonography of the penile vessels, which does not consider the multifactorial nature of the causes of erectile disorders in men of various ages. Registration of NPT using a standalone device allowing to reconduct the examination and to record the results graphically as erectograms can be used for minimally invasive objectification to confirm the recovery of the erectile function in the event of compensated and subcompensated stages of vasculogenic ED. However, further research is required into vasculogenic erectile disorders and the capacities for their assessment using NPT monitoring.

Efficacy and complications of hyaluronic acid and polylactic acid for penile augmentation: a systematic review and meta-analysis.

Penile size is considered a symbol of manhood and is a subjective problem for men, especially those with small penis syndrome. Penile augmentation was introduced to correct penile size problems from a medical, psychological, or esthetic point of view. Hyaluronic acid (HA) and polylactic acid (PLA) are two types of augmentation agents that are popularly used today. However, no systematic studies and meta-analyses have compared these two modalities as penile augmentation agents. This study aimed to analyze the efficacy and safety of penile filler injections with HA compared to PLA. This study was based on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Articles examining the differences in efficacy and adverse events of the administration of HA and PLA in patients undergoing penile augmentation were systematically reviewed from the PubMed, Proquest, Web of Science, and Scopus databases. An odds ratio with a 95% CI was applied to measure the study outcome. The analysis was performed with RevMan 5.4 software. The risk of bias for each study was evaluated using the Risk of Bias v2 instrument from Cochrane. This research protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) registry. Four articles consisting of 283 research subjects were included in this study. The meta-analysis for penile girth enhancement after penile augmentation found significant results in the HA group compared to the PLA group (P=0.01). There was no difference in the level of satisfaction with penile appearance 4 weeks after penile augmentation in the HA group compared to the PLA group (P=0.79). HA was significantly superior in sexual satisfaction 12 weeks postpenile augmentation (P=0.0004). There was no difference in the incidence of pain after penile augmentation in the HA group compared to the PLA group (P=0.33). In the postaugmentation penile inflammation, there was no difference (P=0.98) in the HA group compared to the PLA group. There are differences in the efficacy of penile augmentation with the superiority of HA in increasing penile diameter and postaugmentation sexual satisfaction compared to PLA. There was no difference in the incidence of complications between using HA and PLA.

Anthropometric Predictors of Appropriate-Sized Plastibell for Neonatal Circumcision.

Using anthropometric parameters to determine the appropriate Plastibell size before circumcision ensures that cumbersome carrying of all the sizes before each procedure is eliminated and also complications reduced. Male neonates who presented for routine circumcision by Plastibell method were recruited. Collected on a proforma were their age in days, weight in Kg, stretched penile length (SPL) in cm, penile diameter (PD) in cm and the Plastibell size used by the "circumciser". The routine circumcision was carried out for each neonate according to protocol. P value was set at <0.05. There were 231 neonates who had Plastibell circumcision. Their mean age, weight, SPL and PD were 15.6(±5.73) days, 3.7(±0.58) Kg, 3.66 (±0.58) cm and 3.79 (±0.64) cm, respectively. Plastibell size 1.3 is the most used (53.6%). There was a positive correlation between weight, SPL, PD, on one hand and Plastibell size , on the other hand with P-values of <0.001, <0.001 and <0.001 respectively. The weight was a weak determinant for Plastibell sizes 1.1 and 1.3: (OR 7.104; 95% CI 1.108 - 45.559; P = .039) and (OR 2.044; 95% CI 1.054 - 3.963; P = .034) respectively. The SPL is also a weak predictor for Plastibell sizes 1.2 and 1.5: (OR 2.176; 95% CI 1.136 -4.136; P = .019) and (OR .043; 95% CI .072 - .984; P = .047), respectively. The anthropometric parameters correlate well with Plastibell sizes. However, they are not effective in predicting the appropriate sized Plastibell for neonatal circumcision.

Parenteral testosterone therapy’s effect on penile size before hypospadias surgery

Objectives: The purpose of this study was to see the effect of parenteral testosterone injection on penile length, glans diameter, and diameter at the base of the penis in hypospadias patients before surgery. Material and Methods: The study was conducted from September 2019 to March 2021. This study comprised a total of 20 hypospadias patients. At a dose of 2 mg/kg body weight, an injection testosterone propionate was administered deep intramuscularly in three doses with a 3-week gap before reconstructive surgery. Before surgery, the penile length, glans diameter, and penile diameter at the base of the penis were all measured. Results: The mean increase in penile length, glans diameter, and diameter at the base of penis following parenteral testosterone therapy was 1.07 ± 0.23 cm (P &lt; 0.001), 1.01 ± 0.46 cm (P &lt; 0.001), and 0.92 ± 0.12 cm (P &lt; 0.001), respectively. All three measurements were statistically significant. Conclusion: Intramuscular testosterone increased penis size, glans diameter, and penile diameter without causing any notable side effects. Development of fine pubic hair, acne, and aggressiveness is minor adverse effects.

Penile diameter during puberty in boys: aretrospective analysis of longitudinally obtained data.

Tanner staging is the standard for rating sexual maturation (SMR) in boys (pubic hair (PH) and genital (G)development). G staging is tripartite innature and is prone to ambiguity because it is based upon somewhat vague visual cues that may lead to erroneous assessments and medical errors. Measurement of penile growth (penile girth or diameter) may provide an additional tool (in addition to the orchidometer) to make Gstaging more valid. Although studies on penile growth (either circumference of width) have been reported, none were longitudinal. Therefore, our objective was to compare penile development in boys- measured as penile diameter (PD)- to PH stage and testicular volume (TV) and secondarily to G stage; moreover, to do so on a longitudinal basis. Charts of 61 boys, ages 6-21years of age, who were seen longitudinally, were reviewed. Each boy had his PD and TV measured along with his PH and G stage assessed on a quarterly to semi-annual basis. PD increased significantly among PH stages II, III, and IV only. PD increased significantly among G stages I, II, III and IV only. PD correlated well with TV. There were significant correlations between PD and TV in all PHstages. However, for G stage correlations were not significant for stages II, III, and IV. PH stage was a better predictor of PD than G stage. Measuring PD may be another tool to help in objectifying male SMR during puberty and overcome the vagueness encountered with the visual SMR G stage scales.

Evaluation of a New Tubular Finger Oxygen-Enriched Oil Inside-Coated Dressing Device in Pediatric Patients Undergoing Distal Hypospadias Repair: A Prospective Randomized Clinical Trial Part II.

Background: This study was the second part of a prospective randomized clinical trial and aimed to evaluate the use of a tubular finger oxygen-enriched oil inside-coated dressing device and its effect on the post-operative outcome of children undergoing distal hypospadias repair.Methods: A prospective single-blinded randomized clinical trial was carried out between September 2019 and September 2020. We included all patients with distal hypospadias, who received Snodgrass urethroplasty and preputioplasty. The patients were randomized in two groups according to the type of dressing: tubular finger oxygen-enriched oil inside-coated device (G1) and elastic net bandage with application of oxygen-enriched oil-based gel (G2). The patients were evaluated at 7, 14, 21, 30, and 60 post-operative day (POD).Results: Sixty-four patients (median age 14 months) were included in the study and randomized in two groups, each of 32 patients. Post-operative preputial edema rate was significantly lower in G1 (3/32, 9.3%) compared with G2 (10/32, 31.2%) (p = 0.001). The median duration of preputial edema was significantly shorter in G1 compared with G2 (6 vs. 10.5 days) (p = 0.001). Penile diameter measurements at 4th, 7th, 14th POD proved that entity and duration of post-operative swelling were objectively decreased using the new dressing. The wound healing was significantly faster in G1 compared with G2 (14.2 vs. 18.5 days) (p = 0.001). The post-operative complications rate was significantly lower in G1 (0%) compared with G2 (3/32, 9.3%) (p = 0.001). Foreskin dehiscence occurred in two G2 patients (6.2%) whereas, breakdown of urethroplasty and preputioplasty occurred in one G2 patient (3.1%) due to scratching injuries. The dressing management was subjectively assessed by nurses to be easier in G1 patients compared with G2 ones (median score 1.2 vs. 3.5) (p = 0.001). The median treatment costs were significantly lower in G1 compared with G2 (55 vs. 87 eur) (p = 0.001). No adverse skin reactions occurred.Conclusions: Post-operative dressing using tubular finger oxygen-enriched oil inside-coated device was highly effective, easy to manage, cheaper and associated with a lower rate of foreskin and urethral complications compared with the standard dressing method in pediatric patients undergoing distal hypospadias repair. It was also clinically safe without allergy or intolerance to the product.

PS-07-010 Psychological survey and medical form to establish objective evaluation criteria of outcome about phalloplasty in pediatric age

The problem of objective assessment about aesthetic/functional Results and psychological implication after male external genitalia reconstructive surgery is yet known in the literature. To establish objective evaluation criteria of outcome about De Castro’s neo-phalloplasty in children, we created a psychological survey submitted to patients/parents and a form with medical parameters evaluated from the surgeon Medical form is divided in subjective and objective parameters. Subjective (surgeons’, parents’ and patients’ estimations) parameters are: overall appearance of external genitalia, look of penis - scrotum - penile scars - abdominal scars and look/position of the umbilicus; scored as extremely-poor, poor, acceptable, good, excellent or better in a ranking from 0 to 10. Objective parameters are: Tanner scale, Faisal external and internal masculinization score, sex hormones attitude, length of the ventral and dorsal aspect of penis and difference between the two, penile diameter, location of the urethral ending, urinary continence/voiding, patient’s position during micturition, presence of penile erection – masturbation - erogenous areas - sexual intercourse – insertion of penile prosthesis. The survey evaluate patients and parents psychological/sexual aspects and quality of life post-phalloplasty. Tests used: Child Behaviour Checklist, Parenting Stress Index, Children Global Assessment Scale, Body Uneasiness Test, Revised Children’s Manifest Anxiety Scale, Beck Depression Inventory, Beck Anxiety Inventory, Multi-Attitude Suicide Tendency Scale, Gender Identity/Gender Dysphoria Questionnaire, Duss Tales, Utrecht Gender Dysphoria Scale, Body Image Scale, Recalled Childhood Gender Identity Scale

MON-LB051 Non-inferiority Clinical Trial on Gonadotropinversus Pulsatile Gonadotropin-releasing Hormone Infusion Therapy in Male Adolescent Patient with Congenital Hypogonadotropic Hypogonadism

Context We investigate the efficacy and safety of non-inferiority clinical trial for human chorionic gonadotropin/ human menopausal gonadotropin (HCG/HMG) versus pulsatile gonadotropin-releasing hormone (GnRH) which has not been evaluated on non-inferiority clinical trial in puberty boys with CHH. Objective To compare the efficacy and security of two different treatments in male adolescent patient with congenital hypogonadotropic hypogonadism (CHH) . To explore the standardization of early treatment and it is possible clinical recommended regimen. Methods For this prospective cohort nonrandomized controlled study, male adolescent CHH patients were recruited and categorized into HCG/HMG(group 1) and GnRH (group 2) groups. All patients were treated for 3-12months. The study was divided into research period (3 months of treatment) and extension period (3 to 12 months of treatment). Testicular volume (TV), penile length(PL), blood sex hormones levels, height, body weight, and other related laboratory indices were measured and evaluated. In this study, we observe the therapeutic effect within 3 months and also collect partial extended period data for providing further research experience. Results All CHH patients were treated for over 3 months. At the beginning, the average age of patients, the testicular volume, penile length, penile diameter in group 1 and group 2 were 15.3±1.9 years VS 14.2±1.5 years, 2.5±1.4ml VS 2.7±1.5ml, 4.8±1.3cm VS 4.2±1.4cm and 1.6±0.4cm VS 1.5±0.4cm. The difference of two groups was not statistically significant. After 3 months treatment, the testicular volume, penile length, penile diameter, the growth of testicular volume, the growth of penile length and the growth of penile diameter in group 1 and group 2 were 5.1±2.7ml VS 4.6±2.7ml , 6.9±1.7cm VS 5.1±1.6cm, 2.5±0.5cm VS 1.9±0.6cm,2.0±1.6 cm 和1.0±0.8cm, 0.9±0.5cmand0.3±0.4cm. The difference of two groups was not statistically significant. There was no significant difference in height, body weight, or BMI between the two treatments. Based on the principles of hypothesis-test, mean value M-0.25625, standard error(SE) = 0.69319,M±1.96, Se=-0.25625±1.3586524,(-1.161,1.10). The growth differential of testicular volume between group 1 and group 2 was less than 2ml in (P<0.05) . It can be inferred that group 1 is not inferior to group 2. There was no significant difference in efficacy comparison in some of the patients were treated after 6-12 months in both groups. There was no significant difference in side effects in both groups. Conclusions In this clinical trial, 3 months was an observation period. Short-term therapeutic indicated adolescent patients with CHH were effectively treated with HCG/HMG and GnRH. We discovered that the effect of HCG/HMG was as good as GnRH in treating adolescent boys with CHH. This therapeutic schedule can be used in more patients. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Male external genitalia growth curves and charts for children and adolescents aged 0 to 17 years in Chongqing, China.

Genital size is a crucial index for the assessment of male sexual development, as abnormal penile or testicular size may be the earliest visible clinical manifestation of some diseases. However, there is a lack of data regarding penile and testicular size measurements for Chinese boys at all stages of childhood and puberty. This cross-sectional study aimed to develop appropriate growth curves and charts for male external genitalia among children and adolescents aged 0–17 years in Chongqing, China. A total of 2974 boys were enrolled in the present study. Penile length was measured using a rigid ruler, penile diameter was measured using a pachymeter, and testicular volume was determined using a Prader orchidometer. Age-specific percentile curves for penile length, penile diameter, and testicular volume were drawn using the generalized additive models for location, scale, and shape. Very similar growth curves were found for both penile length and penile diameter. Both of them gradually rose to 10 years of age and then sharply increased from 11 to 15 years of age. However, testicular volume changed little before the age of 10 years. This study contributes to the literature covering age-specific growth curve and charts about male external genitalia in Chinese children and adolescents. These age-related values are valuable in evaluating the growth and development status of male external genitalia and could be helpful in diagnosing genital disorders.

Curative effectiveness of human chorionic gonadotropin treatment on hypospadias with micropenis

Objective To evaluate the curative effectiveness and safety of human chorionic gonadotropin(HCG) treatment on children with microphallic hypospadias. Methods A total of 48 consecutive children with microphalic hypospadias were enrolled in the study, and the children were randomized into the experiment group(HCG treatment) and the control group with the research randomizer.The patients in experiment group were treated with HCG prior to surgery, and the control group did not received any hormone therapy preoperatively.All children in the experiment group and the control group underwent hypospadias repair by using transverse preputial island flap (Duckett technique) urethroplasty.Penile length, diameter of glans penis, bone age, serum testosterone level, and secondary effects were recorded before and after therapy in the experiment group.Postoperative complications were assessed with respect to fistulas, urethral strictures, diverticula, meatal stenosis, and glanular dehiscence in both groups. Results (1)Mean penile length and diameter of the experiment group increased significantly by (1.08±0.47) cm (t=-5.196, P<0.05) and (0.31±0.06) cm and there was a significant difference between before and after treatment (t=-5.080, P<0.05). (2)Urethrocutaneous fistulas were observed in 8 patients in the control group compared to 2 patients in the experiment group with a statistically significant difference (χ2=4.547, P<0.05). There was a significant difference between the overall reoperation rates of control group (9 patients) and the experiment group (3 patients, χ2=4.000, P<0.05). The penile tissue of the patients in the experiment group was soft and able to be easily separated and released during the operation and the flap had more blood supply. Conclusions Pretreatment with HCG therapy prior to hypospadias repair is beneficial to children with microphallic hypospadias.Significant penile growth was seen in the children treated with HCG and there was no obvious side effect.Moreover, pretreatment with HCG is beneficial to decrease the complications and reoperation rates of hypospadias repair which proves to be effective and safe. Key words: Human chorionic gonadotropin; Hypospadias; Micropenis; Curative effect

Testosterone replacement maintains smooth muscle content in the corpus cavernosum of orchiectomized rats

ObjectiveTo evaluate the effects of testosterone (T) on the maintenance of corpus cavernosum (CC) structure and apoptosis. MethodsAnimals were divided into three groups: sham operation group (n = 8) underwent sham operation; Orchiectomized (Orchiec)+ oily vehicle group (n = 8) underwent bilateral orchiectomy and received a single dose of oily vehicle by intramuscular injection (i.m.) 30 days after orchiectomy; and Orchiec + T group (n = 8) underwent bilateral orchiectomy and received a single dose of T undecanoate 100 mg/kg i.m. 30 days after the surgery. Animals were euthanized 60 days after the beginning of the experiment with an anesthetic overdose of ketamine and xylazine. Blood samples and penile tissue were collected on euthanasia. Azan's trichrome staining was used to evaluate smooth muscle, Weigert's Fucsin-Resorcin staining was used to evaluate elastic fibers and Picrosirius red staining was used to evaluate collagen. Apoptosis was evaluated using TUNEL technique. ResultsT levels decreased in Orchiec + oily vehicle when compared to sham operation and Orchiec + T groups (p < 0.001). T deprivation reduced trabecular smooth muscle content and penile diameter and T replacement maintained both parameters (p = 0.005 and p = 0.001, respectively). No difference was observed in the content of sinusoidal space (p = 0.207), elastic fibers (p = 0.849), collagen (p = 0.216) and in apoptosis (p = 0.095). ConclusionNormal testosterone levels maintain CC smooth muscle content and do not influence elastic fibers, collagen content and apoptotic index. Further studies should be performed in order to investigate the mechanisms by which androgen mediates its effects on CC structure.

Biometry of the hypospadic penis after hormone therapy (testosterone and estrogen): A randomized, double-blind controlled trial

The use of preoperative hormonal stimulation before hypospadias surgery aims to increase penile size and achieve better surgical results; however, the rules are not clear in the literature. We evaluated the effects of topical testosterone and estrogen in the hypospadic penis regarding biometric measures, side effects, and serum hormonal levels. To our knowledge, this is the first study using estradiol prior to hypospadias surgery. Sixty-nine children with hypospadias were randomly divided into three study groups: a control group (CG) of 17 children given placebo cream; a testosterone group (TG) of 28 children who used 1% testosterone propionate; and an estradiol group (EG) of 24 children using 0.01% estradiol. All subjects applied the topical ointment on the entire penis, twice daily for 30 days before surgical correction. Biometric evaluation of the penis included penile length and diameter, glans diameter, distance from the urethral meatus to the tip, and the width of the urethral plate. These measurements as well as serum hormone level, and side effects were evaluated prior to hormone use, and 30 and 90 days after. After 30 days an increase in penile diameter and length and diameter of the glans were observed in TG (p<0.05). The width of the urethral plate and distance from meatus to the tip increased in TG, although not significantly. The most frequent side effects were appearance of pubic hair and darkening of the genital skin, mainly in TG, but these were transient and disappeared after 90 days of treatment. No significant variations were seen in serum hormonal levels (Table). As in previous studies, an increase in penile length and diameter, and glans diameter was observed with the use of testosterone. Proximal urethral plate width and distance from the meatus to the tip of the penis had a tendency to increase also in TG. Estradiol did not change biometric measure of the penis. Few side effects occurred after both hormones, and any that did improved after 90 days follow-up and did not change hormone serum levels. Preoperative use of topical testosterone increases penile size, diameter of the penis and glans. The use of estradiol does not change penile biometry. Side effects occur mainly with the use of testosterone and are transient. No significant and persistent hormonal changes were observed.

Inguinal lymph node dissection for penile cancer: Predictors of lymph node metastasis.

386 Background: Inguinal lymph node dissection (ILND) for lymph node metastasis (LNM) of squamous cell carcinoma of the penis (SCCP) can be a curative surgical treatment. Having the potential to identify clinical and pathological factors that predict LNM is important because of the poor prognosis this diagnosis carries. Methods: A retrospective review of 51 patients that underwent inguinal plus pelvic lymph node dissection from 1999 to 2012 was preformed. Age, race, body mass index (BMI), significant lymphadenopathy on preoperative imaging (nodes &gt; 1 cm), palpable lymphadenopathy, and pathologic depth of invasion and diameter of the primary penile tumor along with associated lymphovascular invasion (LVI) were recorded and analyzed as potential predictors of LNM. Results: Median patient age was 65 and the median BMI was 29.3. Thirty-nine patients (76.5%) were white, 3 (5.9%) African American, and 9 (17.6%) were Hispanic. Median primary penile tumor diameter was 3.2 cm with 7, 29, and 15 patients having well, moderate, and poorly differentiated tumors. Pre-operatively, 32 patients (62.7%) had palpable lymphadenopathy on physical exam and 26 (51.0%) had significant lymphadenopathy on imaging (93% CT, 7% MRI), with 24 (47.1%) having both findings. Thirty-one patients (60.8%) who underwent ILND had pathological LNM. On univariate analysis, palpable nodes (p &lt; 0.001), nodes on imaging (p &lt;0.001), having both palpable nodes and nodes on imaging (p &lt; 0.001), age (p = 0.02), and LVI (p = 0.04), were significantly associated with LMN. On multivariate analysis, having nodes on imaging (p = 0.001) and age &lt; 65 years (p = 0.049) were significant for predicting LNM. Conclusions: In evaluation of patients with T1-T3 penile cancer, multiple factors were predictive of LNM in our series: palpable and radiographic nodes, younger than age 65 and LVI. Inguinal adenopathy defined as more than 1 cm appears to better predict occult nodal metastasis, however, this must be weighed in terms of the additional cost and clinical yield provided by widespread adoption of pelvic (CT or MRI) imaging in all patients with aggressive primary penile tumor phenotypes.

Surgical Outcomes and Patients' Satisfaction with Suprapubic Phalloplasty

Many techniques, specifically forearm free flap phalloplasty, are used in penile reconstructive surgery. Although satisfying, a major disadvantage is the large, stigmatizing scar on the donor site, which leads many patients to explore alternatives. The aim of this study is to assess the outcomes and satisfaction of patients offered the choice between metaidioplasty, forearm free flap, and suprapubic phalloplasty. Medical outcomes from the three-stage surgery were collected from the hospital files of 24 patients, who were also interviewed to assess their satisfaction, sexual function, and psychosexual well-being. Medical complications, anthropometric measures, and interviewing questionnaire on satisfaction with appearance, sexual function, and psychological variables. Duration of surgery and of hospital stay was relatively short in the first (1 hour 30 minutes; 3 days) and last (1 hour 40 minutes; 3 days) stage of surgery involving tissue expansion and neophallus release. These two stages were associated with few complications (17% and 4% minor complications respectively, 12% additional complications with hospitalization for the first stage). The second stage involving tubing was associated with longer surgery and hospital stay (2 hour 15 minutes; 5 days) and had more complications (54% minor complications and 29% requiring hospitalization) although fewer than one-step surgery. No loss of neophallus was reported. Overall, 95% of patients were satisfied with their choice of phalloplasty, 95% with the appearance, 81% with the length (Mean = 12.83 cm), and 71% with the circumference (Mean = 10.83 cm) of their neophallus. Satisfactory appearance was significantly correlated (P < 0.01) with penile length (r = 0.69) and diameter (r = 0.77). Sexual satisfaction was significantly correlated with penile diameter (r = 0.758), frequency of orgasm (r = 0.71), perceived importance of voiding while standing (r = 0.56), presurgery satisfaction with sexuality (r = 0.58), current masculine-feminine scale (r = 0.58), attractive-unattractive scale (r = 0.69), and happy-depressed scale (r = 0.63). Suprapubic phalloplasty, despite the lack of urethroplasty, offers an interesting alternative for patients concerned with the stigmatizing scar on the donor site.

Functional anatomy and ultrasound examination of the canine penis

The aim of this study was to identify the functional–anatomical structures of the canine penis during and after erection to demonstrate the respective changes to provide a basis for further examinations of pathological conditions like priapism. Additionally, a gray-scale analysis was performed to quantify results from the ultrasound examination. In total, 80 dogs were examined. In group (Gr.) A, 44 intact or castrated dogs were examined, and in Gr. B, 36 dogs were examined during erection and after complete detumescence of the penis. The following parameters were assessed: (1) using physical measurements: length of the Pars longa glandis [Plg] and length of the Bulbus glandis [Bg]; and (2) using ultrasound: total penile diameter, width of the erectile tissue of the Plg, diameter of the Corpus spongiosum [Cs] including the penile bone and urethra, vertical diameter, circumference of the penis, cross-sectional area, and area of the Cs including the urethra. The mentioned parameters could be assessed in all dogs of Gr. A and Gr. B with the only exception being the urethra that could be visualized using ultrasound in some dogs only and predominantly in the erected penis (Gr. B). Concomitantly, the erectile tissue of the Plg and the Cs was more heterogenous and hypo- to anechoic during erection compared with dogs in Gr. A and Gr. B after detumescence. Comparing the results in Gr. B, the length of the Plg and the Bg were decreased approximately 40.6% and 38.0%, the total width of the penis 40.5%, the total width of the erectile tissue of the Plg 48.0%, and the width of the Cs 15.6% during detumescence compared with erection. Comparing the decrease in size at the different locations (apex penis, middle of Plg, middle of Bg) for vertical diameter, total circumference, and cross-section area, it was largest at the Bg. B-mode ultrasound is a suitable tool to investigate not only the morpho–functional structures of the resting canine penis, but also of the erected and detumescent penis, and to investigate the underlying changes during erection and detumenscence.

Penile rehabilitation with a vacuum erectile device in an animal model is related to an antihypoxic mechanism: blood gas evidence

Our previous study showed that vacuum erectile device (VED) therapy has improved erectile function in rats with bilateral cavernous nerve crush (BCNC) injuries. This study was designed to explore the mechanism of VED in penile rehabilitation by analyzing cavernous oxygen saturation (SO2) and to examine the effect of VED therapy on preventing penile shrinkage after BCNC. Thirty adult Sprague-Dawley rats were randomly assigned into three groups: group 1, sham surgery; group 2, BCNC; and group 3, BCNC+VED. Penile length and diameter were measured on a weekly basis. After 4 weeks of therapy, the penile blood was extracted by three methods for blood gas analysis (BGA): method 1, cavernous blood was aspirated at the flaccid state; method 2, cavernous blood was aspirated at the traction state; and method 3, cavernous blood was aspirated immediately after applying VED. SO2 values were tested by the blood gas analyzer. The results showed that VED therapy is effective in preventing penile shrinkage induced by BCNC (Penile shortening: BCNC group 1.9±1.1 mm; VED group 0.3±1.0 mm; P<0.01. Penile diameter reduction: BCNC group 0.28±0.14 mm; VED group 0.04±0.14 mm; P<0.01). The mean SO2±s.d. values were increased by VED application (88.25%±4.94%) compared to the flaccid (76.53%±4.16%) or traction groups (78.93%±2.56%) (P<0.05). The calculated blood constructs in the corpus cavernosum right after VED application were 62% arterial and 38% venous blood. These findings suggest that VED therapy can effectively preserve penile size in rats with BCNC injury. The beneficial effect of VED therapy is related to antihypoxia by increasing cavernous blood SO2.

Sonographic measurement of corpus spongiosum in male fetuses

To establish a nomogram of the corpus spongiosum dimensions in male fetuses and to evaluate its correlation with penile length. These references can be useful when fetal genital anomalies are suspected, particularly to distinguish micropenis from concealed penis cases. A cross-sectional prospective study was conducted on 486 fetuses of normal singleton pregnancies between 18 and 40 weeks. Corpus spongiosum length, penile length, penile diameter and scrotal diameter were measured by one operator. All measurements were analyzed according to gestational age. The four measurements were studied as a function of gestational age. Median values, 3(rd) and 97(th) percentiles were determined using regression curves. A correlation between penile length and corpus spongiosum length (r(2) = 0.845) was observed. We established measurements of the length of fetal corpus spongiosum and a correlation between the former and the penile length. These references can be useful when fetal genital anomalies are suspected.

Penile erectile responses to cavernous nerve stimulation in rats are not affected by nitrate tolerance

The aim of this study was to elucidate whether penile erection induced by electrical stimulation of the cavernous nerve was affected in male rats with nitrate tolerance. Nitrate tolerance to nitroglycerin was induced by oral administration of isosorbide dinitrate (ISDN) at 1000 mg/kg to rats, once or twice a day for 5 or 6 days. The rats were anesthetized with sodium pentobarbital 18–24 h after the last dosing with ISDN or its vehicle. Penile erection induced by electrical stimulation was monitored by measuring the penile diameter sonomicrometrically. After measurement of the penile erectile response, nitroglycerin (3–300 μg/kg) was intravenously (i.v.) injected into eight rats treated with the vehicle or ISDN to examine its hypotensive effect. In the vehicle-treated rats, the maximal developed penile diameter ( D-max) and the duration of penile erection ( T50%, period of time from the maximum erection to its 50% decline) produced by electrical stimulation were 509±47 μm and 14.2±1.7 s, respectively. On the other hand, neither D-max nor T50% in ISDN-treated rats (509±36 μm and 13.1±1.3 s, respectively) was different from those in the vehicle-treated rats. However, the hypotensive effects of i.v. injected nitroglycerin were significantly attenuated in the ISDN-treated group as compared with the vehicle-treated group. It is concluded that nitrate tolerance fails to influence penile erection induced by cavernous nerve electrical stimulation in rats.

Evaluation of erectile response by continuous measurement of penile diameter in rats

The present study was performed to determine whether measurement of penile diameter in an in vivo rat model is useful for pharmacologic and physiologic investigations on penile erection. Penile erection induced by electrical stimulation of the cavernous nerve was monitored by measuring the penile diameter sonomicrometrically with a pair of 10-MHz piezoelectric crystals glued to the opposite surfaces of the adventitia of the penile erectile chamber in anesthetized rats. Using this method, we examined the effects of a nitric oxide (NO) synthase inhibitor, N ω-nitro-L-arginine methyl ester (L-NAME), and a well-known phosphodiesterase 5 (PDE5) inhibitor, zaprinast, on the maximal developed penile diameter (D-max) and the time from the maximum response to 50% recovery (T50%) of the maximum response as an index of the duration of penile erection. An intravenous injection of L-NAME at a dose of 10 mg/kg significantly inhibited D-max produced by cavernous electrical stimulation at 5 to 50 V, without affecting T50%. Sequential intravenous infusions of 10, 30, 100, and 300 μg/kg/min of zaprinast at 30-min intervals did not show any effect on D-max, heart rate, and systolic arterial pressure, although doses of 100 and 300 μg/kg/min significantly prolonged T50% and the maximum dose decreased diastolic arterial pressure. Moreover, zaprinast produced a more prominent increase in cyclic guanosine monophosphate (cGMP) levels than cyclic adenosine monophosphate levels in the plasma taken at the end of the maximum dose infusion. Measurement of murine penile diameter with a sonomicrometrical device, indicating that a NO-cGMP-PDE5 pathway plays a pivotal role in the penile diameter increase and its maintenance, would be useful for pharmacologic and physiologic investigations on penile erection.

Intracellular mechanism of penile erection in monkeys

To elucidate the sequence of events between the release of neurotransmitters and cavernous smooth muscle relaxation in erection, we studied the role of the cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) systems. In a well-established simian model, the effects of specific agonists and antagonists of the intracellular sequence for smooth muscle relaxation and potassium channel openers on the intracavernous pressure were examined. Sodium nitroprusside (10(-3) M), a nitric oxide releaser and thus a stimulant of the cGMP system, caused an increase in the intracavernous pressure from 82 to 115 cm H2O for 7 to 19 min and penile diameter from 24.8 +/- 2.28 to 43 +/- 4.87 mm. When nitroprusside was injected after methylene blue (10(-3) M), a specific antagonist of the enzyme guanylate cyclase, intracavernous pressure rise decreased significantly, but cromakalin, a potassium channel opener, provoked excellent increases after the block. A smaller dose of sodium nitroprusside (10(-4) M) caused an increase in intracavernous pressure from 35 to 85 cm H2O for 7 to 11.5 min. When nitroprusside was injected after zaprinast, a phosphodiesterase inhibitor, the increase in pressure ranged from 80 to 116 cm H2O for 15 to 30 min. Prostaglandin E1, an activator of the cAMP system, caused an increase in the intracavernous pressure of 20-80 cm H2O for 5 to 10 min, and an increase in penile diameter from 25 +/- 2.22 to 35 +/- 3.48 mm. The erectile response to PGE1, but not to cromakalin, was nearly abolished by ethylmaleimide, an adenylate cyclase blocker. The response to nitroprusside was significantly greater (P < 0.05) than to PGE1. Both systems, cAMP and cGMP, may be involved in cavernous smooth muscle relaxation, and cGMP is probably the predominant intracellular second messenger in penile erection in monkeys. Stimulants of the cGMP system, such as nitric oxide releasers, could represent a more physiological and effective approach in the treatment of erectile dysfunction.