Penile Ischemia Research Articles

Penile and Testicular Incarceration with a Metal Foreign Body - Full Recovery of Erectile Function after 4 Days of Entrapment.

Penile incarceration with a foreign body is a rare urological emergency necessitating prompt intervention. We present a 59-year-old patient who entrapped penis and right testicle with metal thread reducer for sexual arousal four days prior to admission to Emergency room. Ultrasound revealed significantly reduced Color Doppler signal in right testicle and completely absent signal in penile artery. After admission metal reducer was removed using a hacksaw in analgosedation. Magnetic resonance imaging showed penile ishemic changes. Patient had reduction of penile swelling and parts of the skin highly suspected of necrosis recovered fully with preserved sensations. Despite penile ischemia on magnetic resonance imaging patient had full recovery obtaining normal erections. Patient was discharged six days after admission, presenting with normal International Index Erectile Function on follow up exam.

Management of penile post-circumcision ischemia by pentoxifylline infusion and hyperbaric oxygen therapy

BackgroundPost-circumcision penile ischemia is a devastating complication. We will present our experience in managing children with various forms of penile ischemia.Materials and methodsThis cohort prospective observational and interventional study was performed on all male children with post-circumcision penile ischemia between April 2017 and October 2021. A designed and approved protocol includes a combination of early pentoxifylline infusion, hyperbaric oxygen inhalation, early catheterization, and appropriate surgical debridement were applied for patients with deep ischemia 11/23, mainly the necrotic skin and subcutaneous tissues. Data of patient age, anesthesia method, monopolar diathermy usage, early presentation and positive wound culture were collected and analyzed statistically.ResultsDuring the study period 3,382 children were circumcised for non-medical reasons; 23 children were diagnosed with penile ischemia (0.7%), among other complications (9%). Most of the penile ischemia is associated with the use of monopolar diathermy (74%). The use of compressive wound dressing to control post-circumcision bleeding and infections is also responsible for ischemia in 52.2% and 43.5% of the cases. Inexperienced physicians were commonly responsible for ischemia (73.9%). Patients managed at first 24 h had better outcomes than those who were presented later (p = 0.001).ConclusionIn children with post-circumcision penile ischemia, a combination of hyperbaric oxygen therapy and pentoxifylline is especially effective for patients with skin and facial necrosis, this management reduces penile tissue loss.

What do we know about Treatment of Post Circumcision Penile Ischemia. Case report and Review of Literature

What do we know about Treatment of Post Circumcision Penile Ischemia. Case report and Review of Literature

Extrinsic Compression of Inflatable Penile Prosthesis Secondary to Prone Positioning for COVID-19 Pneumonia: A Case Series of Two Patients

IntroductionComplications of extrinsic compression on an inflatable penile prosthesis (IPP) due to prone positioning for COVID-19 pneumonia have not been described. Patients with an IPP present a unique challenge for managing compression injuries secondary to proning due to the dependent position of the penis and ability of the device to restrict blood flow to the distal penis when externally compressed for long periods of time. We present two patients with previous IPP placement who experienced glans and penile ischemia secondary to extrinsic compression of the penis from proning, who were monitored conservatively and avoided urgent explantation.ObjectiveTo describe two patients with IPPs who were intubated and proned for COVID-19 pneumonia who experienced IPP-related complications due to pressure injury, one of whom survived for follow-up.MethodsTwo male patients, ages 68 and 74 years, who developed penile injury following proning for COVID-19 pneumonia. The first patient presented with skin breakdown of the ventral aspect of the penis and scrotum without exposed implant. The second patient presented with a pale and dusky glans.ResultsThe first patient was managed by scrotal elevation with bacitracin application to the wound twice daily. There was no surgical intervention or debridement of the penile and scrotal wounds. The patient was then followed on an outpatient basis without need for explantation at 4-months from initial consultation (Figure 1). He underwent a CT of the abdomen and pelvis as well as a CT Urogram as an outpatient that confirmed appropriate positioning of all components of the device without evidence of underlying infection. On exam, the penile prosthesis was well-positioned and cycled normally, with a freely mobile pump within the scrotum. The second patient expired during hospitalization from COVID-19 respiratory failure, but was monitored for six days without glans necrosis (Figure 2) once external pressure was removed.ConclusionsPatients with IPPs who require prone positioning are a unique population that are at risk for extrinsic compression injury of the penis. In contrast to ischemia related to instrinsic compression, such as with the sliding technique, which results in glans necrosis and necessitates urgent explantation, conservative treatment and serial examination in the setting of external compression from prone intubation was a viable and safe option to immediate explantation in these patients. Prevention, in the form of proper padding and minimization of external compression, remains paramount as we obtain more long term data from this unique patient population.DisclosureNo

Clinical and penile Doppler outcomes using a modified, tourniquet free, Nesbit plication for severe Peyronie's disease.

BackgroundPenile curvature (PC) can be surgically corrected by plication techniques or Nesbit corporoplasty. These shortening techniques can be complicated by post-operative: penile shortening, recurrent PC, palpable suture knots and erectile dysfunction. Furthermore, Nesbit procedures require the use of a penile tourniquet to avoid intraoperative bleeding. This observational study aims to assess the results of Nesbit modified corporoplasty, avoiding intraoperative use of tourniquet without risk of bleeding. The objective is to reduce penile ischemic anatomical and functional damages such as long-term erectile dysfunction.MethodsBetween January 2010 and March 2019, a total of 64 patients with congenital penile curvature (CPC) and Peyronie’s disease (PD) underwent surgical correction with a Nesbit modified technique first time described by Rolle et al., with minimal technical differences. The operation notes were retrospectively reviewed. In particular, we evaluated pre- and post-operative erectile functions using IIEF-5 score, penile Doppler ultrasonography and overall patient satisfaction.ResultsDuring operations, no intraoperative bleeding was noted, and no short-term complications such as hematomas or neurovascular bundle lesions were reported. At 6 months, no palpable subcutaneous indurations and no sensory change were detected. Post-operative penile shortening was reported in 38 (59.4%) patients (mean 0.83±0.79 cm), but it did not influence the high overall satisfaction rate of 91.4%. Only 2 patients reported a slightly partial recurrence of curvature (<15%) with no need for a redo surgery. Mean IIEF-5 score increased from 17.1±5.2 to 20.8±3.9 at 6 months and 21.8±3.4 at 12 months (P<0.001 in both cases). Mean PSV also significantly increased at the end of follow-up (28.5±6.1 at baseline vs. 31.0±7.1 at 12 months, P=0.03).ConclusionsConsidering the optimal results in terms of erectile functions increasing and absence of PC recurrence (>15°), we think that Nesbit modified corporoplasty without tourniquet application during reconstruction is a safe and effective surgical procedure for all kind of shortening corporoplasty to reduce the time of penile ischemia, preventing even serious consequences for the normal physiology of erection.

Sonourethrography With Pharmaco-Penile Doppler in Penile Fractures: A Complete and Productive Imaging Combination

Penile fracture is a rare urological emergency requiring prompt diagnosis and management. The role of high-resolution ultrasonography is established in detecting a tear, in the tunica albuginea. The late complications of penile fracture are distressing and may manifest as asymmetrical and insufficient penile tumescence, penile ischemia, and sometimes urethral stenosis. The current case series demonstrates the combined role of post-papaverine penile Doppler duplex ultrasonography and sonourethrography techniques in assessing the late presenting cases of penile fractures. The combination of these two techniques was found to be a useful comprehensive imaging tool. This combination can be employed in clinical practice to define the extent of trauma and penile insufficiency, in an efficient manner.

Penile Ischemia for Hypospadias Repair and The Patients and Surgeons Reported Outcomes

Penile Ischemia for Hypospadias Repair and The Patients and Surgeons Reported Outcomes

Commentary to 'Modified staged repair of bladder exstrophy: a strategy to prevent penile ischemia while maintaining advantage of the complete primary repair of bladder exstrophy'

Commentary to 'Modified staged repair of bladder exstrophy: a strategy to prevent penile ischemia while maintaining advantage of the complete primary repair of bladder exstrophy'

Modified staged repair of bladder exstrophy: a strategy to prevent penile ischemia while maintaining advantage of the complete primary repair of bladder exstrophy

Penile ischemic injury is a reported catastrophic complication after complete primary repair of exstrophy (CPRE). Aiming to improve the bladder exstrophy-epispadias repair outcomes, the study institution adopted a modified staged exstrophy repair to incorporate the advantages of CPRE by avoiding concurrent epispadias repair and adding bilateral ureteral re-implantation and bladder neck tailoring (staged repair of bladder exstrophy with bilateral ureteral re-implantation [SRBE-BUR]) at the initial repair. It was hypothesized that such modifications minimize penile complications and prevent upper tract deterioration while enhancing bladder resistance and consequent capacity. Here, a comparative series of outcomes between CPRE and SRBE-BUR is reported. A retrospective cohort study including all exstrophy-epispadias male neonates managed in the study institution from January 2000 to December 2014 was performed. Patients were divided into those who underwent CPRE-BUR (group 1) and SRBE-BUR (group 2) (Figure). Baseline characteristics, peri-operative data, and long-term surgical outcomes were collected and analyzed for between-group comparison. Fisher exact and Mann-Whitney U tests were performed for statistical analysis. A total of 21 eligible patients were included: 10 in group 1 and 11 in group 2. Baseline characteristics were comparable. Two patients in group 1 had intra-operative penile ischemic injury (one with subsequent penile tissue loss), whereas none of the group 2 patients had intra-operative complications. No significant difference between the groups was noted for operative time; however, significantly lesser blood loss was noted in group 2. Comparable long-term surgical outcomes such as additional surgical intervention, urinary continence, bladder capacity, vesicoureteral reflux, hydronephrosis and recurrent urinary tract infections (UTIs) were noted. In addition, although subjective, better penile length and cosmesis were achieved by staging the repair (Figure). The SRBE with bilateral ureteral re-implantation is a safe alternative for the repair of the exstrophy-epispadias repair as it prevents the catastrophic complication of penile tissue loss, while having comparable long-term outcomes with the CPRE. Delaying epispadias repair avoids penile injury besides possible improvement of its overall cosmesis.

AB092. Surgical techniques and experience sharing of replantation of complete penile fracture

Penile amputation is a kind of rare urological condition with was firstly described in 1929, the common etiologies include emotional and family dispute, self-mutilation, trauma, and so on. In the early stage, traditional surgery is the only way to accomplish the replantation for penile amputation, but in recent years, microscopic surgery became the main treatment. In this study, we reported two cases of penile amputation and microsurgical replantation performed in our hospital in August 2016. In the first case, the patient was injured by sharp scissors due to family conflict, while in the second case, it was a mechanical injury. For both cases, the penile ischemia time exceeded 10 hours, and microsurgical approaches were adopted. After the microsurgical replantation, both the patients recovered well and showed normal urination, erectile function, return of sensations and satisfactory cosmetic appearance. With the development of microsurgical techniques, the successful re-anastomosis of blood vessel and nerve can increase the survival and functional recovery of the penis even in cases exceeding 10 hours of ischemia. This provides greater possibility of graft survival with minimum complication.

MP25-02 PENILE DISASSEMBLY IN EXSTROPHY: TIME TO REEVALUATE?

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II1 Apr 2018MP25-02 PENILE DISASSEMBLY IN EXSTROPHY: TIME TO REEVALUATE? Matthew Kasprenski, Mahir Maruf, John Jayman, Karl Benz, Jason Michaud, Emily Dunn, and John Gearhart Matthew KasprenskiMatthew Kasprenski More articles by this author , Mahir MarufMahir Maruf More articles by this author , John JaymanJohn Jayman More articles by this author , Karl BenzKarl Benz More articles by this author , Jason MichaudJason Michaud More articles by this author , Emily DunnEmily Dunn More articles by this author , and John GearhartJohn Gearhart More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.839AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Epispadias repair, using the complete penile disassembly technique, is frequently combined with primary bladder closure in patients with classic bladder exstrophy (CBE). Yet, penile disassembly has been posited as a risk for penile injury by ischemic mechanisms. Herein, the authors present all CBE cases referred to their institution where primary closure with penile disassembly epispadias repair was complicated by penile injury. METHODS A prospectively-maintained institutional database of 1311 exstrophy-epispadias complex patients was reviewed for complete primary repair of CBE cases referred to the authors' institution, and those with injury to the penis were identified. The location, extent of injury, and subsequent management is reported. Triplanar magnetic resonance imaging (MRI) of the pelvis with volumetric analysis was used for penile compartment quantification. RESULTS Of the 170 CBE patients referred after a prior complete primary repair, 22 (13%) were identified with penile loss. A majority (82%) were closed in the neonatal period, and 55% had a pelvic osteotomy. Eight patients (38%) had a failed primary closure. Median follow-up time was 10 years (range 3-21). Penile injury was often unilateral (82%), and involved the glans and/or corpora cavernosa. MRI of the pelvis confirmed anterior corporal deficiency that resulted from primary closure. Three patients were successfully managed with myocutaneous neophalloplasty between the ages of 15 and 16 years old. CONCLUSIONS As a part of the primary bladder closure, penile disassembly for epispadias repair may lead to penile ischemia. In addition to reconstructive planning, MRI may be used to quantify penile injury. CBE patients with penile injury can be managed with myocutaneous phalloplasty. Because of the soft tissue loss with complete penile disassembly, it may be time to reevaluate the application of this technique in the reconstruction of bladder exstrophy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e326 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Matthew Kasprenski More articles by this author Mahir Maruf More articles by this author John Jayman More articles by this author Karl Benz More articles by this author Jason Michaud More articles by this author Emily Dunn More articles by this author John Gearhart More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP43-07 PROTECTIVE EFFECT OF TADALAFIL IN A NOVEL RAT MODEL OF CHRONIC PENILE ISCHEMIA

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research I1 Apr 2014MP43-07 PROTECTIVE EFFECT OF TADALAFIL IN A NOVEL RAT MODEL OF CHRONIC PENILE ISCHEMIA Norifumi Sawada, Masanori Nomiya, Mona Zarifpour, Masayuki Takeda, and Karl-Erik Andersson Norifumi SawadaNorifumi Sawada More articles by this author , Masanori NomiyaMasanori Nomiya More articles by this author , Mona ZarifpourMona Zarifpour More articles by this author , Masayuki TakedaMasayuki Takeda More articles by this author , and Karl-Erik AnderssonKarl-Erik Andersson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1164AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Oxidative stress induced by atherosclerosis accelerates ischemia and structural damage of penile corporal tissue and may produce erectile dysfunction. We tested the protective effects of tadalafil in a novel rat model of chronic penile ischemia. Methods Adult male Sprague-Dawley rats were divided into three groups (control, arterial injury: AI; AI with tadalafil treatment: AI-tada). The AI and AI-tada groups underwent endothelial bilateral injury of the iliac arteries and received a 2% cholesterol diet. Tadalafil (2 mg/kg/day) was administered for 8 weeks. The control group received a regular diet. After 8 weeks, apomorphine test was performed in each group. Corporal tissues were then processed for histological, pharmacological, and immunohistochemical studies. Results The iliac arteries from the AI showed neo-intimal proliferation and vascular occlusion. This was not prevented by tadalafil treatment. Erectile responses in AI group were significantly reduced, but were normalized in the in AI-tadalafil group (Figure 1AB). The percentage of collagen was significantly increased in AI the group but was almost normalized in the AI-tada group. (Figure 2AB) Electrical field stimulation-induced relaxation was decreased in AI group, but improved significantly in the AI-tada group (P < 0.05). (Figure 3) Conclusions Arterial occlusive disease caused chronic penile ischemia and resulted in reduced erectile function and structural changes in corporal tissue. These changes could be prevented by tadalafil treatment. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e479 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Norifumi Sawada More articles by this author Masanori Nomiya More articles by this author Mona Zarifpour More articles by this author Masayuki Takeda More articles by this author Karl-Erik Andersson More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Technique of traction-free nerve-sparing robotic prostatectomy: delicate tissue handling by real-time penile oxygen monitoring

It is postulated that intraoperative injury to the cavernosal nerves results in hemodynamic and histologic changes within the penis, which manifest clinically as ED. We hypothesize that non-neuronal cause, such as vascular insults due to intraoperative tissue handling, may also have a minor but definite role in penile ischemia and consequent postoperative sexual dysfunction. Between May 2008 and July 2008, 64 patients were enrolled in the study (group 1). Following sterilization, the Odissey Tissue Oximeter probe was placed on the shaft of the penis, 2 cm from its base. The patient underwent continuous penile tissue saturation monitoring. Surgical dissection was altered whenever the oxygen saturation alarm went off until it was restored to 85%. In addition, 192 patients, matched for age, preoperative prostate-specific antigen, clinical stage, baseline sexual function, Charlson comorbidity index and nerve-sparing status operated between October 2007 and July 2008, formed the control group (group 2). These patients did not have any intraoperative tissue oxygenation monitoring. Opening of the endopelvic fascia and steps of nerve sparing were associated with significant drops in oxygen levels, especially if done using torque. Drop in oxygen levels were also noted whenever excessive traction was applied on the Foley catheter, seminal vesicles or prostate during apical dissection. We deliberately modified our surgical steps to make surgery more traction free. A significantly higher percentage of group 1 patients with bilateral nerve sparing had no ED compared with group 2 patients at 6 weeks (24.5% vs 10.4%; P=0.014) and 52 weeks (83.7% vs 68%; P=0.029). Overall, 93.9% of patients in study group had Sexual Health Inventory for Men (SHIM) score of 17 (mild to no ED) at 1 year compared with 78.4% of patients in the control group. We demonstrated that avoidance of ischemic stress, aided by intraoperative penile oxygenation monitoring, may help surgeons improve their technique and thus functional outcomes in patients.

Penile Arterial Waveform Analyzer for Assessing Penile Vascular Function in Young Adults

Not only does erectile dysfunction (ED) reflect penile vascular disorder in the majority of patients, but it also implicates their high systemic cardiovascular risk. Based on the principle of reactive hyperemia after a brief period of penile ischemia, in this study, we tested the validity of a new Penile Arterial Waveform Analyzer (PAWA) in assessing the relative increase in post-ischemic penile perfusion. Twenty young adult males (mean age 24.24 ± 2.45) without known history of cardiovascular diseases were recruited, whose anthropometric characteristics were recorded and their serum testosterone levels as well as biochemical profiles were determined. A penile cuff was applied to each subject, with cuff pressure being increased from 80 to 250 mmHg, each for 4 min, followed by reperfusion for 7 min. By dividing the area under waveform contour of hyperemic and baseline signals after Ensemble Empirical Mode Decomposition (EEMD), a Penile Perfusion Index (PPI) was calculated. Penile Brachial Index (PBI) was also obtained for comparison. The results not only showed a significant agreement between PPI and serum testosterone levels, but also a superiority of PPI to PBI in distinguishing the high- and low-risk groups for potential ED (PPI: p = 0.039 vs. PBI: p = 0.147). PPI was also demonstrated to show significant correlations with waist circumference (p < 0.001), body mass index (p = 0.005), body weight, total triglyceride, high-density lipoprotein, and systolic and diastolic pressures (all p < 0.05). In conclusion, we proposed a portable and easy-to-operate system in assessing the relative increase in penile perfusion after brief ischemia. The PPI thus obtained correlated significantly with serum testosterone levels as well as key anthropometric and serum biochemical parameters even in apparently healthy young adults, suggesting its potential as a sensitive tool in monitoring penile vascular function and risk for ED.

Strangulation of Penis by a Ball Bearing Device

Penile strangulation is rare and usually results following placement of constricting objects to enhance sexual stimulation. It requires urgent treatment as delay may lead to irreversible penile ischemia and gangrene. Various objects causing penile strangulation have been reported. Nonmetallic and thin metallic objects can be removed easily as compared to heavy metallic objects. Cutting is the commonest method described, although procuring special cutting tools may be difficult and the process of cutting may be tedious with the possibility of iatrogenic penile injury. To present a simple, safe, minimally invasive, effective, and feasible technique for removing heavy metallic objects constricting the penis. The published English literature (PubMed™) was searched for cases of "penile strangulation" using the keywords penile strangulation, penile injury, penile trauma, penile constriction, penile entrapment, and penile incarceration. The described treatment modalities were carefully reviewed and studied. Reviewed published English literature on the various causes of penile incarceration and the various techniques used for their extrication. Search results yielded several cases of penile strangulation caused by a variety of metallic and nonmetallic objects. Various modalities have been described in the English literature for their safe removal, each with its own merits and demerits. Penile strangulation should be viewed and managed as an emergency in order to prevent penile necrosis and urethral injury and to preserve erectile function. The modified method described herein for managing penile strangulation due to heavy metallic rings is minimally invasive, safe, effective, does not require any special cutting instrument(s) or skill, and is free of causing iatrogenic collateral thermal or mechanical damage to the penile organ. A stepwise algorithm depicting a rational and comprehensive approach to the diagnosis and management of penile incarceration is also suggested for the clinicians.

Penile Ischemia and Loss Due to Warfarin-induced Skin Necrosis

A 30-year-old man with a history of bilateral deep vein thromboses and recurrent penile ischemic episodes presented for distal penile amputation and skin graft. Despite suspicion, serologies indicated no hypercoagulable disorder. After surgery, the patient was bridged from enoxaparin to warfarin. Nine days after initiation of warfarin therapy, he developed necrotic arm ulcers, which were subsequently proved to be secondary to warfarin-induced skin necrosis.

Penile ischemic injury in the exstrophy/epispadias spectrum: New insights and possible mechanisms

Partial or complete penile loss following bladder exstrophy and/or epispadias repair has been reported in the literature progressively more frequently. The authors report new cases of penile injury following bladder exstrophy and/or epispadias repair referred to their centers and not previously published. They review the literature on this subject and offer an explanation as to the likely mechanism for the penile injury and recommendations to avoid this complication. Seven new cases of partial or complete penile loss following bladder exstrophy or epispadias repair have been recently referred to the authors' institutions. Twenty-one patients have previously been reported in the literature. Altogether, 24 cases occurred after bladder exstrophy closure: 23 after complete primary repair of exstrophy (Mitchell repair) and one after first-stage radical soft-tissue mobilization (Kelly repair). Nineteen of 24 patients did not have a pelvic osteotomy at the time of primary closure. Four cases occurred after epispadias repair: two following the second-stage radical soft-tissue mobilization (Kelly repair) and two following penile disassembly epispadias repair (Mitchell repair). Exstrophy closure combined with epispadias repair can be followed by ischemic penile injury, particularly when osteotomy is not performed. Compression of the pudendal vessels after pubic apposition and/or direct injury to the pudendal vessels play an important role in the pathogenesis of this complication.

T-Shaped Shunt and Intracavernous Tunneling for Prolonged Ischemic Priapism

Conservative management of prolonged ischemic priapism is rarely effective. Interventions include corporal aspiration/irrigation, injection of vasoconstrictive agents or surgical procedures. We describe a technique that fulfills several important criteria in the surgical management of ischemic priapism in that immediate resolution of ischemic pain is achieved, a wide area, reliably patent shunt is created, the procedure is technically simple and it may be performed with the patient under a local anesthetic. We reviewed the records of 13 patients treated with the T-shunt for whom followup, including erectile function, was available. Records were available for review for 13 men who underwent the T-shunt procedure from April 2006 to January 2008. In most cases priapism had lasted for more than 24 hours and previous irrigation/intracorporal administration of sympathomimetics had been unsuccessful. Of these 13 men 6 had undergone unsuccessful distal or proximal shunt procedures before presentation to our service. All procedures were performed using local anesthetic only. Cavernous blood flow was restored in all but 1 patient and another required a second procedure. T-shunts resulted in resolution of penile pain in all patients and all but 2 had recovery of erectile function. The T-shunt technique results in immediate resolution of ischemic penile pain and rigidity. Ultrasonography confirms that blood flow is usually restored to the previously ischemic corpora cavernosa after the procedure. The T-shaped shunt is simple and reliable, and access also allows for proximal trans-shunt dilation. We observed surprisingly excellent recovery of erectile function. This procedure may facilitate recanalization of corporal circulation and could make proximal shunts obsolete.

Management of Ischemic Penile Gangrene: Prompt Partial Penectomy and Other Treatment Options

Penile gangrene is a rare but troublesome problem with high mortality rates. The etiologies could be infectious, traumatic, or vasculogenic. The treatment algorithm is controversial because of limited case numbers. To describe our experiences in treating the patients with ischemic penile gangrene, to review the related literatures, and to try to summarize a practical algorithm for penile gangrene. We retrospectively reviewed the medical records of five patients with penile gangrene treated between 1996 and 2006. Data obtained include the patients' ages initial presentation, detailed histories, comorbidity, renal status, other vascular diseases, coagulation profile, treatment course, histology presentations, and prognosis were obtained. Comparison of the patients' ages, presentations, underlying diseases, the duration of conservative treatments, surgical options, resected penile length, and prognosis. All of the five patients underwent partial penectomy. One patient underwent immediate surgery while the other four had delayed partial penectomy because of progressive distal penile gangrenous change. There was no postoperative wound infection noted in any of the five patients and all had survived after 1 year follow-up. Three of them could void independently with a neourethra meatus. Two of them kept suprapubic cystostomy as a result of bladder outlet obstruction caused by an enlarged prostate and bed-ridden status. Penile dry gangrene is an irreversible process. Early partial penectomy and correction of the underlying disease can prevent wound liquefaction, preserve more penile length, and improve quality of life.

Complications of radical soft-tissue mobilization procedure as a primary closure of exstrophy

Purpose The radical soft-tissue mobilization procedure was developed as a component of the staged closure of classical bladder exstrophy to improve continency rates without having to perform pelvic osteotomies. The authors describe complications following this procedure and discuss possible etiologies and subsequent management. Materials and methods We extracted from an institutionally approved exstrophy database the records of patients evaluated for complications following radical soft-tissue mobilization repair from 1999 to 2002. Results Four patients were referred to our institution following closure of exstrophy with the radical soft-tissue mobilization technique; two boys and two girls. Complications included ischemic penile injuries in both males, failed exstrophy closure in one female, incontinence with need for bladder neck transection and diversion in two patients, and upper tract deterioration in two patients of whom one required cystectomy and incontinent diversion. Conclusions Omission of osteotomies when employing the radical soft-tissue mobilization repair appears to result in complications that could otherwise be prevented. Additionally, the complex dissection of the pelvic musculature, innervation and vasculature performed during radical mobilization has great potential to injure the pelvic structures and genitalia, as has been seen with the cases presented herein.