Penile Nerve Research Articles

Role of pericytes in regulating penile angiogenesis and nerve regeneration.

Pericytes are multifunctional mural cells that surround the abluminal wall of endothelial cells and are associated with vascular development, vascular permeability, and angiogenesis. Additionally, pericytes demonstrate stem cell-like properties and contribute to neuroinflammatory processes. Pericytes have been extensively studied in the central nervous system. However, specific mechanisms underlying its involvement in various physiological and pathological conditions, especially in erectile dysfunction (ED), remain poorly understood. Advancements in in vitro and in vitro techniques, such as single-cell RNA sequencing, are expanding our understanding of pericytes. Recent studies have shown that pericyte dysfunction is considered an important factor in the pathogenesis of vascular and neurological ED. Therefore, this study aims to analyze the specific role of pericytes in ED, focusing on diabetic and neurogenic ED. This article provides a comprehensive review of research findings on PubMed from 2000 to 2023, concerning pericyte dysfunction in the process of ED, offering valuable insights, and suggesting directions for further research.

Alisklamp versus Conventional Dorsal Slit Circumcision: A Multicentric Randomized Controlled Trial.

Background: There are numerous methods of circumcision performed worldwide, typically classified into two main groups: conventional surgical techniques and various device-assisted techniques. Each method has its own advantages, limitations, and potential complications. The aim of this study was to compare outcomes of the Alisklamp technique versus the dorsal slit technique in male circumcision procedures. Method: This multicenter RCT compared the dorsal slit and Alisklamp techniques for circumcision, assessing patient demographics and intraoperative and postoperative outcomes. All patients, under local anesthesia via dorsal penile nerve block, were discharged on the same day and followed up at 24-48 h, 1 week, and 1 month. Results: A total of 180 patients enrolled, and 166 patients were included. The study compared postoperative outcomes between the Alisklamp (AK) and dorsal slit (DS) circumcision techniques in 166 patients. Key findings included significantly higher penile edema in the DS group (19%) compared to the AK group (2.4%) (p < 0.001), with severe edema occurring only in the DS group. Wound gaping was more common in the AK group (8.3%) compared to the DS group (1.2%) (p = 0.030). Skin tunnels were observed only in the DS group (9.5%) (p = 0.004). There were no significant differences in nausea, vomiting, bleeding, necrosis, infection, wound dehiscence, chordee, rotational anomalies, or secondary phimosis between the groups. Mean operation time was lower in the AK group than the DS group (7.8 min vs. 15.5 min; p < 0.001). Conclusions: The Alisklamp technique is recommended as the preferred method for circumcision because it minimizes complications, shortens the procedure time, and is easy to apply.

A case of a lidocaine intoxication of a 12 week old boy due to a circumcision in a domestic setting - clinical, toxicological and forensic aspects.

Lidocaine is a local anaesthetic commonly used during circumcision for dorsal penile nerve block (DPNB). We describe a case of a 12-week-old infant who presented generalized seizures due to local anesthetic systemic toxicity after Lidocaine administration for circumcision in a non-hospital setting. Serum concentrations of Lidocaine (16.4mg/L) and its main active metabolite monoethylglycinexylidide (MEGX, 1.36mg/L) were determined by HPLC-DAD, in a sample collected shortly after administration, which were higher than in comparable cases reported in literature. The reason for the overdose was assumed to be accidental systemic application. Due to suspicion of an improperly performed circumcision and bodily harm, police was involved and a clinical forensic examination was carried out. Here, we present analytical, clinical and forensic aspects of this case.

Comparison of Post-Operative Analgesia of Caudal versus Dorsal Penile Nerve Blocks for Pediatric Patients Undergoing Hypospadias Repair

Abstract Background Hypospadias is the second most common congenital disorder in males after cryptorchidism, but it is the most common penile congenital malformation. It is an abnormality of anterior urethral and penile development in which the urethral opening is ectopically located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is splayed open. The urethral opening may be located as far down as in the scrotum or perineum. The penis is more likely to have associated ventral shortening and curvature, called chordee, with more proximal urethral defects. Aim of the Work The aim of this study is to compare the effectiveness of penile block versus caudal block using bupivacaine on the quality of analgesia after hypospadias repair in pediatrics. Methodology This prospective randomized comparative clinical study was conducted in Ain Shams University Hospitals; Pediatric Surgery Unit. It included 30 male patient aged (1–8) years, ASA I or II patients undergoing hypospadias (distal penile and mid penile) repair. They were divided into two groups: Group P: Penile block (n = 15) received dorsal penile nerve block by using the subpubic approach technique. Group C: Caudal block (n = 15) received caudal epidural block using a 22-G needle in the lateral decubitus position. Results There was statistically high significant difference between the two groups in postoperative MAP and HR (p value &amp;lt;0.001) but no statistically significant difference between them in Spo2. FLACC pain scores were significantly lower in group C compared with group P at PACU and 3 hours postoperative (p value &amp;lt;0.001) but no statistically significant difference between them at 6, 9 and 12 hours postoperative. Also, The time for first rescue analgesia was significantly longer in caudal group compared with penile group (P &amp;lt; 0.001) and the total analgesia consumption was also significantly lower (P &amp;lt; 0.001) in group C compared with group P. Postoperative time of ambulation was significantly lower (P &amp;lt; 0.001) in group P compared with group C. Conclusion The current study revealed that Caudal block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and prolonged time of ambulation as compared with Penile block in pediatric patients undergoing hypospadias repair.

Feasibility of partial penectomy under local anesthesia: a case–control study

BackgroundTo assess the feasibility of partial penectomy under local anesthesia and penile nerve blocks.MethodsA total of 45 patients underwent partial penectomy under local anesthesia over the last 15 years at our institute. These patients were included in group A. We took 45 age-matched controls for comparison in group B. All patients underwent partial penectomy with the standard technique. The control group underwent partial penectomy under general or spinal anesthesia, and the intervention group underwent partial penectomy under local anesthesia. Patients’ tolerance to anesthesia and surgery was compared, and postoperative pain and other complications were assessed.ResultsMean age was 53.5 years in group A (case) and 52.8 years in group B (controls). Out of 45 patients in group A, 9 were ASA I, 16 were ASA II, 8 were ASA III, and 12 were ASA IV patients. Out of control patients, 35 underwent surgery under spinal and 10 underwent surgery under general anesthesia. All patients tolerated the anesthesia and surgery well. The duration of anesthesia and surgery was shorter in group A (p < 0.05). Postoperative pain scores between the two groups were comparable after 6 h. Postoperative recovery was comparable in both groups, and hospital stays were shorter in local anesthesia/nerve block group but were statistically insignificant. There was no positive margin in any group.ConclusionPartial penectomy under local anesthesia is a satisfactory alternative in selected cases or with limited availability of anesthesia services.

(063) Effect of Phosphodiesterase Type 4 Inhibitor on Erectile Function Recovery and Nerve Regeneration After Cavernous Nerve Injury in Rats

Abstract Introduction There is no consensus on the best treatment regimen for recovery of erectile function (EF) after radical prostatectomy (RP). Although many pharmacological interventions can improve EF in rats, there is still a lack of studies evaluating strategies that promote nerve regeneration of the cavernous nerve (CN). Phosphodiesterase type 4 inhibitors (PDE4Is), such as rolipram, have shown a neuroprotective effect after spinal cord injury in mice, facilitating functional recovery. It has also been suggested that the neuroprotective property of sildenafil is probably attributed to its effect on phosphodiesterase type 4. Objective Our aim was to evaluate the role of rolipram and its association with tadalafil in EF recovery and nerve regeneration after bilateral CN crush injury (BCNI) in rats. Methods Thirty-five male Wistar rats were randomly divided into four groups: (i) sham (no CN lesion); (ii) control (no treatment after BCNI); (iii) BCNI + tadalafil; (iv) BCNI + rolipram and (v) BCNI + tadalafil + rolipram. The initial laparotomy was performed and the CN were crushed with a hemostatic clamp. The animals in groups (iii) and (iv) received tadalafil (5mg/kg/d) or rolipram (1mg/kg/d) orally for 14 days, respectively. The animals in group (v) received tadalafil + rolipram at the same doses. Then, the animals were submitted to CN stimulation at frequencies 4, 8 and 16 Hz, with recording of mean arterial pressure (MAP) and intracavernosal pressure (ICP). EF was represented by the measurement of maximum ICP normalized to MAP (ICP/MAP ratio) and total normalized area under the curve (AUC) of ICP. The penises and CN of the animals were sent for structural evaluation with the immunohistochemical markers S100 and Ki-67. Results In the functional analysis, BCNI resulted in worse EF when compared to sham. This was observed when considering the maximum ICP/MAP and when analyzing normalized AUC of ICP for 4Hz and 8Hz. The different treatments were able to increase the ICP/MAP ratio after stimulation with 4Hz (p = 0.04) and 8Hz (p = 0.01). When considering normalized AUC of ICP, the different drugs (tadalafil, rolipram or tadalafil + rolipram) showed a significant improvement in EF in two of the three frequencies analyzed (4Hz and 8Hz) (figure 1). For 16hz, although it did not reach a statistical difference, a trend of improvement was observed after the different treatments (p = 0.08). With regard to immunohistochemical analysis, the tadalafil group had a higher expression of S100 in the dorsal penile nerve compared to the control group (p = 0.01). The rolipram group had a lower expression of Ki-67 in the CN compared to the control group (p = 0.03). Conclusions The combination of tadalafil and rolipram was associated with a functional improvement in EF in the experimental model with rats. The present study also suggests that rolipram may have a neuroprotective effect according to the structural evaluation of the CN. Disclosure No.

(243) Frenular Delta Excision with Neurectomy of Ventro – Lateral Branches of Penile Dorsal Nerves (Alaa Aglan4 Operation)

Abstract Introduction Neurectomy is one of the surgical options used for treatment of premature ejaculation, variable degrees of neurectomy could be done, aggressive neurectomy may cause severe demenishion in sensations as occurs in cases of perovic technique for penis elongation or in cases of sliding techniques used in treatment of peyronie`s disease also it increases the risk of erectile dysfunction. In our old trials in phalloplasty and penile implantation we were doing neurectomy routinely with few exceptions, the success rate at that time was 78% and some side effects were reported e.g neuroma, numbness, and recurrence. After application of prediction test (spraying local anesthesia procomail at frenular area (temporary excision) and local injection around the chosen nerve/s) the picture has been changed. as we could predict the expected gained time post-surgery. The classic neurectomy is related to neural supply of glans. once we was doing classic Alaa Aglan operation (cutting bulbospongiosus muscles bilaterally plus frenular delta excision) but we found the muscles congenitally absent so we excised part of frenular delta with neurectomy to neural supply to the same area (i.e. ventro – lateral branches of dorsal nerves) the results were satisfactory to the patient. Many patients were afraid of muscles cutting at our early trials, so this operation was the alternative option, dorsal neurectomy could be done with it according to prediction tests in some cases (usually with implants). Objective Presentation of new operation for treatment of premature ejaculation (Alaa Aglan4). Methods Study was done between 3/12/2011 – 8/2/2017 (5 years following up), 247 patients were operated (after prediction test), partial excision of frenular delta plus neurectomy to ventral branches of RT and LT penile dorsal nerves. Neurectomy was done at middle third of penile shaft before branching. Dissection of proximal part till penis root and retraction of the proximal end and placing it at penis root area (to avoid reunion or recurrence). Results Numbness was reported in 13 patients disappeared within 3 months, neuroma was obvious in 7 patients treated by vitamin B injection in 5 patient’s. Re-excision of 2mm of proximal neural end (under local anesthesia) in 3 patients. No recurrence was reported. The dissection of nerves and covering the proximal end with inverted skin graft or silicone cap as a barrier between the nerves ends to prevent reunion and recurrence was done outside this study, but this technique is simple and easy. Erectile dysfunction was not reported in all patients. after 4 months all patients were satisfied by the ejaculation time. Conclusions Alaa Aglan4 operation is simple, effective, safe and permanent treatment for premature ejaculation guided by prediction test. Disclosure No.

Analgesia for Infant Circumcision: Eutectic Mixture of Local Anesthetic (EMLA) Cream versus Dorsal Penile Nerve Block using Bupivacaine

Context: Circumcision is a painful procedure; thus, analgesia for neonatal circumcision is advocated for every male infant, and its use is considered essential by the American Academy of Pediatrics. Aim: This study aimed to compare the analgesic, hemodynamic effects, and complications of an eutectic mixture of a local anesthetic cream versus dorsal penile nerve block using bupivacaine for infants coming for circumcision. Materials and Methods: This was a prospective randomized interventional study involving 64 infants scheduled for circumcision at the Jos University Teaching Hospital. Infants were randomized into one of two groups through allocation concealment technique. Group I received dorsal penile nerve block with plain bupivacaine 0.5 mL/kg of 0.25%, while group II received 1 g of an eutectic mixture of a local anesthetic cream (EMLA). Circumcision started 5 minutes after penile block for group I and 1 hour after EMLA cream application for group II. Pain levels using CRIES scale, hemodynamic parameters, duration of surgery, and postoperative complications were noted and documented. Data were analyzed using SPSS version 23. A P value of less the 0.05 was considered statistically significant. Results: The study groups were comparable in demographic characteristics (P = 0.054). Less infants had CRIES scores of &gt;4 in the DPNB group up to 2 hours postoperative period. Hemodynamic parameters were within normal ranges but higher in the EMLA group. No complication was noted in both study groups. Conclusion: Dorsal penile nerve block with bupivacaine provided better analgesia in infants undergoing circumcision than EMLA.

Ultrasound-Guided Dorsal Penile Nerve Block in Children: An Anatomical-Based Observational Study of a New Anesthesia Technique.

Dorsal penile nerve block stands out as one of the commonly employed regional anesthetic techniques in children. Despite the large body of experience, failure rates are still significant. We included 20 children (median (SD) age of 73 (31) months) scheduled for circumcision without general anesthesia and secondary airway manipulation in a consecutive case series. Under ultrasound guidance and utilizing an in-plane needle guidance technique, the dorsal penile nerve block was administered with slight sedation, and spontaneous respiration was maintained in all cases. To investigate the underlying anatomy for dorsal penile nerve blockade, we dissected three cadavers. The primary study endpoint was the success rate of surgical blockade, meaning that the surgical procedure could be performed without additional general anesthesia and invasive airway management. The secondary endpoint was the requirement of analgesics until discharge from the post-anesthesia care unit. The primary endpoint was successfully met in all patients according to our strict definition without additional general anesthesia or airway manipulation. In addition, no child received analgesics until discharge from the recovery room. The anatomical investigation clarified the specific anatomy as baseline knowledge for an ultrasound-guided dorsal penile nerve blockade and enabled successful performance in 20 consecutive children where penile surgery was possible in light sedation without additional airway manipulation.

Pediatric ultrasound-guided dorsal penile nerve block and sedation in spontaneous breathing: a prospective observational study.

Worldwide, one of the most common surgical procedures in the pediatric population is circumcision. There is no consent on the best anesthesiologic approach. This study aimed to investigate ultrasound-guided dorsal penile nerve block (DPNB) plus sedation in spontaneous breathing as a time-saving, safe, effective, and opioid-sparing technique. The primary outcome was the assessment of the time from the end of surgery and the discharge to the post-anesthesia care unit. Secondary outcomes were to evaluate the cumulative dosages of opioids, differences in pain levels between the two groups, and complications at the awakening, 4 h and 72 h after surgery, respectively. This was a prospective study with a retrospective control group, approved by the Friuli-Venezia Giulia Ethics Committee. Children in the intervention group received an ultrasound-guided DPNB under sedation and spontaneous breathing. With the probe positioned transversally at the base of the penis using an in-plane approach with a modified technique, local anesthetic was injected under the deep fascia of the penis. We recruited 70 children who underwent circumcision at the University Hospital of Udine, Italy, from 1 January 2016 to 1 October 2021: 35 children in the ultrasound-guided DPNB group and 35 children in the control group. Children who received ultrasound-guided DPNB had a statistically significant lower time to discharge from the operating room, did not require mechanical ventilation, maintained spontaneous breathing at all times, received fewer opioids, had lower mean intraoperative arterial pressures, and lower pain levels immediately after surgery. Ultrasound-guided DPNB associated with sedation and spontaneous breathing is a time-saving, opioid-sparing, safe, and effective strategy for the management of intraoperative and postoperative pain in children undergoing circumcision.Clinical trial registration: ClinicalTrial.gov (NCT04475458, 17 July 2020).

Efficacy of adjuvant dexmedetomidine on penile block for pediatric hypospadias repair

The management of postoperative pain, particularly in younger children, presents a challenge due to their limited ability to articulate the intensity of pain, lower pain threshold, and restricted availability of approved analgesics for pediatric use. Peripheral nerve blocks may be favored over neuraxial blocks because they allow quicker mobilization after surgery. The present study aims to investigate the potential impact of adding dexmedetomidine to a local anesthetic (bupivacaine) on the analgesic efficacy in dorsal penile nerve block in hypospadias repair surgery. In this prospective double-blinded clinical trial, 50 children aged between 6 months and 6 years old undergoing hypospadias repair surgery participated. Analgesia was administered through a dorsal penile nerve block (DPNB) at the end of surgery. Participants were divided into two groups; one received bupivacaine alone, and the other received dexmedetomidine and bupivacaine in DPNB. Pain and sedation levels were assessed with FLACC score and MOAA/S score, respectively, at 0,1,2 and 4h after surgery. Vital signs and adverse effects were also recorded, including hemodynamic changes, nausea, and vomiting. There was no statistically significant difference in demographic variables. As illustrated in Figure, the median of FLACC score in group BD was significantly lower compared to group B at every measured time point. MOAA/S score was significantly lower in group BD than in group B (p<0.001), indicating a higher sedation level. None of the participants in either group experienced any adverse effect except for vomiting, which was not statistically significant (8% in group B vs. 4% in group BD, p>0.999). Several studies have documented the supplementary analgesic properties of dexmedetomidine when used in conjunction with local anesthetic during various surgical procedures and nerve blocks. The present study provides evidence for the additional analgesic efficacy of dexmedetomidine and bupivacaine in the context of dorsal penile nerve block during hypospadias repair surgery while not yielding any significant adverse outcomes. Although the patients in our study were monitored for 4h in the postanesthesia care unit (PACU), conducting a more comprehensive assessment of patients is advisable. The findings of our study indicate that incorporating dexmedetomidine alongside bupivacaine in dorsal penile nerve block during hypospadias repair surgery may lead to enhanced management of postoperative pain. The lack of adverse effects implies it may be a potentially safe supplementary pain reliever for surgical procedures.

Dimethyl fumarate ameliorates erectile dysfunction in bilateral cavernous nerve injury rats by inhibiting oxidative stress and NLRP3 inflammasome-mediated pyroptosis of nerve via activation of Nrf2/HO-1 signaling pathway

ObjectiveTo investigate the therapeutic potential of dimethyl fumarate (DMF) in improving erectile function of bilateral cavernous nerve injury (BCNI) rats, along with elucidating its underlying mechanisms. MethodsA BCNI rat model was established by clamping bilateral cavernous nerve (CN). DMF was given by gavage at low (20 mg/kg/day) and high (40 mg/kg/day) dosages for a duration of 4 weeks. Erectile function was assessed by electrical stimulation of CN. Penis and CN tissues were collected for subsequent analysis. Additionally, PC-12 cell line was used to verify the mechanism of DMF in vitro. Nfe2l2 or Ho-1 gene knockdown PC-12 cell lines were constructed by lentiviral transfection, respectively. A damaged cell model was induced using H2O2. And then molecular biological methods were employed to analyze cellular molecules and proteins. ResultsDMF administration for 4 weeks led to improvements in erectile function, reduced fibrosis of penis corpus cavernosum in BCNI rats. The morphology of CN was improved and the number of nerve fibers increased. Furthermore, the levels of nNOS, NO, and cGMP were increased, while Ca2+ was decreased in penis corpus cavernosum. Notably, the levels of ROS, 3-NT and NLRP3 inflammasomes production were reduced, alongside increased expression of Nrf2 and HO-1 proteins in the dorsal penile nerve (DPN) and CN. In vitro, DMF increased cell viability, reduced ROS level, promoted SOD, diminished 3-NT, MDA and DNA damage markers, and inhibited the activation of NLRP3 inflammasomes in H2O2 induced PC-12 cells. Nfe2l2 knockdown and Ho-1 knockdown significantly attenuated the protective effect of DMF, respectively. Furthermore, inhibition of ROS production by N-acetylcysteine led to a reduction in NLRP3 inflammasome activation in H2O2 induced PC-12 cells. ConclusionsDMF improved erectile function of BCNI rats by protecting nerves through inhibiting oxidative stress and the activation of NLRP3 inflammasome-mediated pyroptosis via activation of Nrf2/HO-1 pathway.

Low Dose Caudal vs Dorsal Penile Nerve Block for Postoperative Analgesia after Circumcision

Abstract Background Circumcision is a painful surgery that is mostly performed under general anesthesia in order to eliminate fear and anxiety. Regional techniques are more effective than systemic opioids, non steroidal anti-inflammatory drugs, and acetaminophen for postoperative analgesia in circumcision, The most preferred techniques are dorsal penile nerve block and caudal block. Objective To investigate the effectiveness of post operative analgesia and complications among dorsal penile nerve block, caudal block and the combination of both. Patients and Methods Our study was carried out to compare the effectiveness, duration of postoperative analgesia, and the complications among dorsal penile nerve block (DPNB), caudal nerve block (CNB) and the combination of both. This study was carried out on 81 male patients, aged from 3-12 years old &amp; undergoing circumcision. The patients were divided into 3 groups, each is composed of 27 patients; group 1 including DPNB patients, group 2 including CNB patients and group 3 for combined block. This study compared between the three groups regarding the intraoperative vital data (HR,BP), post-operative VAS scores and the complications (nausea, vomiting, urinary retention, itching, constipation &amp; CNS depression). Results The demographic data (age, weight &amp; height) does not differ between the three groups of the study. There is difference in the VAS score post operatively, being significantly less in the CNB group. There was no significant difference in the percentage of complications between the groups, except for urinary retention being slightly increased in the CNB group. Conclusion Our results showed that, CNB is superior to DPNB in intraoperative and postoperative analgesia after circumcision as regarding pain control. However CNB is associated with more complications compared to the DPNB. Also, the results showed that there‟s no need to combine both blocks as it gave the same results as with the CNB alone.

Low androgen levels induce ferroptosis of rat penile cavernous endothelial cells.

Endothelial dysfunction caused by low androgen levels in penile tissue can lead to erectile dysfunction. The exact mechanism of endothelial dysfunction has not been thoroughly studied. The study sought to verify whether low androgen levels induce ferroptosis of endothelial cells in rat penile tissue. Rat penile cavernous endothelial cells (CP-R133) were divided into a no-androgen group (Dihydrotestosterone (DHT): 0nmol/L), very low-androgen group (DHT: 0.1nmol/L), low-androgen group (DHT: 1nmol/L), DHT = 10nmol/L group, DHT (0nmol/L) + ferrostatin-1 (Fer-1) group, DHT (0.1nmol/L) + Fer-1 group, DHT (1nmol/L) + Fer-1 group, DHT (10nmol/L) + Fer-1 group. Cell viability, intracellular ferrous ion (Fe2+), malondialdehyde (MDA), GSH into oxidized glutathione (GSSG), reactive oxygen species (ROS), nitric oxide (NO), transferrin receptor 1 protein (TfR1), solute carrier family 7 member 11 (SLC7A11), glutathione peroxidase 4 (GPX4), acyl-CoA synthetase long-chain family member 4 (ACSL4), endothelial nitric oxide synthase (eNOS), and phospho-eNOS (p-eNOS) were detected. Low androgen levels could induce ferroptosis of rat penile cavernous endothelial cells in vivo by upregulating the expressions of TfR1 and ACSL4 and downregulating the expressions of SLC7A11 and GPX4. Cell viability, the levels of glutathione (GSH), NO, SLC7A11, GPX4, and p-eNOS/eNOS in the DHT = 0nmol/L group were lower than those in the other groups (P < .05). The levels of Fe2+, ROS, MDA, GSSG, TfR1, and ACSL4 in the DHT = 0nmol/L group were higher than those in the other groups (P < .05). Cell viability and the levels of GSH, NO, SLC7A11, GPX4, and p-eNOS/eNOS in the DHT = 1nmol/L group were lower than those in the DHT (1nmol/L) + Fer-1 group, DHT = 10nmol/L group, and DHT (10nmol/L) + Fer-1 group (P < .05). The levels of Fe2+, ROS, MDA, GSSG, TfR1, and ACSL4 in the DHT = 1nmol/L group were higher than those in the DHT (1nmol/L) + Fer-1 group, DHT = 10nmol/L group, and DHT (10nmol/L) + Fer-1 group (P < .05). A ferroptosis inhibitor might be a novel drug for treating erectile dysfunction caused by low androgen level. The results of this study need to be further confirmed in in vitro and in human studies. Meanwhile, further investigation is needed to clarify whether low androgen levels affect ferroptosis of rat penile cavernous smooth muscle and nerve cells. Low androgen levels can induce ferroptosis of endothelial cells in rat penile tissue. Inhibition of ferroptosis can reverse endothelial dysfunction caused by low androgen levels.

Radiofrequency pulse modulation of the penile dorsal nerve for the treatment of premature ejaculation: evaluation of effectiveness

Introduction. Premature ejaculation (PE) is the second most common male sexual dysfunction with a significant negative impact on quality of life. A significant number of conservative and surgical methods for the treatment of PE are proposed, but their effectiveness and, in some cases, safety, remain the subject of discussion.Objective. To study the effectiveness of pulsed radiofrequency impulse neuromodulation (RPN) with different modes on the penile dorsal nerve in treatment of patients with premature ejaculation.Materials &amp; methods. Two groups of PE-patients participated in a prospective multicenter study: Group 1 — 11 patients aged 22 – 34 years; Group 2 — 12 patients aged 23 – 34 years. Group 1 received pulsed RPN at a temperature of 42°C, a stimulation frequency of 2 Hz, 45 V, and a duration of 180 seconds; in Group 2 — pulsed RPN at a temperature of 50 °C and the same frequency and duration of stimulation as Group 1. All patients before and after treatment measured intravaginal ejaculation latency time (IELT) and completed a premature ejaculation profile (PEP). The results were evaluated after 30 days.Results. In both groups, there was a statistically significant increase in IEDT and PEP. Thus, in Group 1, IELT increased from 58 to 101.9 seconds, PEP from 3.8 to 12.6 points. In Group 2, IELT increased from 66.5 to 210.9 seconds, PEP from 3.2 to 12.6 points. At the same time, in Group 2, IELT increased by 107% more than in Group 1. No significant side effects were observed in both groups.Conclusion. RPN appears to be a very promising treatment for premature ejaculation, as it is a minimally invasive, safe, and reversible procedure. The technique of influencing the penile dorsal nerve at an electrode temperature of 50 °C compared to 42 °C seems to be more effective, however, additional studies are needed.

Fiber counts and architecture of the human dorsal penile nerve

The human penis transmits behaviorally important sensory information via the dorsal penile nerve, which is required for initiation and maintenance of erection. The human penis differs from the penes of other hominids. The lack of a baculum makes the human penis dependent on erectile tissue, which is under control of neural signals activated by tactile stimulation. Accordingly, the penile sensory innervation is crucial for human sexual behavior. To clarify penile innervation, we analyzed the architecture of the dorsal penile nerve of five male subjects who donated their body. We stained the sensory fibers in the penile dorsal nerve with anti-neurofilament H antibody, and identified myelinated axons with Luxol fast blue staining. Furthermore, we visualized nerve bundles as they travel along the shaft of the penis by performing microfocus computed tomography scans after counterstaining penes with iodine. Our results show that the dorsal penile nerve is organized in 25–45 loosely packed nerve bundles, running mediodorsally in the shaft of the penis. This organization corresponds to that in penes of other mammalian species, but differs from the organization of the other peripheral sensory nerves. Around half of the dorsal penile nerve fibers were myelinated and a human hemipenis contained a total of 8290 ± 2553 (mean ± SD) axons. Thus, the number of sensory axons in the human dorsal penile nerve is higher than in other species described so far. The large fraction of unmyelinated nerve fibers suggests that the conduction speed is not a crucial aspect of penile sensory transmission.

(199) Anterolateral Thigh Flap Phalloplasty for Micropenis

Abstract Introduction Congenital micropenis is defined as a normally formed penis with a stretched penile length less than 2.5 standard deviations below the mean for that man’s age and ethnicity. Micropenis may present as an isolated condition or with other genital or multi-system abnormalities. Penile reconstruction or phalloplasty may be required where topical and systemic hormonal treatment have failed. The most common flap used for phalloplasty is the radial artery forearm free flap phalloplasty. Other alternatives include the anterolateral thigh (ALT), musculocutaneous latissimus dorsi and abdominal flaps. Objective The aim of this video is to illustrate the technique for penile reconstruction using a pedicled ALT flap without integrated urethra. Methods A 21-year-old man with micropenis and hypospadias from a disorder of sexual differentiation (46XY) presents for penile reconstruction following multiple failed attempts at hypospadias repair. He requested an ALT flap without integrated urethra because he is dependent on a long-term suprapubic catheter due to a hypocontractile bladder. Intraoperative vascular doppler identified 3 perforators from the descending branch of the lateral circumflex iliac artery of the left leg. The flap was designed centred on the perforators with dimensions of 14cm (length), 13cm (width at base) and 12cm (width at tip). The flap was raised carefully and transferred to the recipient groin. The neophallus was constructed and microsurgical anastomosis of the lateral cutaneous of the thigh to one of the dorsal penile nerves with 8/0 nylon was completed. The partially divided left vastus lateralis muscle was re-approximated and the skin edges drawn in and flattened. The left thigh was then resurfaced with a 14/1000 of an inch split-thickness skin graft from the contralateral thigh. All wounds were dressed. Results The man had an uneventful post-operative course with careful vascular monitoring, and he was discharged on day 10. He is currently awaiting glans-sculpting and will eventually proceed with insertion of an inflatable erectile device. Conclusions Penile reconstruction using an ALT flap can be offered to a well-informed and motivated man with a micropenis following appropriate assessment. As shown, the technique requires careful dissection of the perforator vessels and can usually be transferred as a pedicled flap. Pedicled flaps do not require microvascular anastomosis and therefore have a lower risk of vascular compromise. Further esthetic and functional refinements like the insertion of an erectile device are possible in later stages, if desired. Disclosure No

(520) The Use of Gracilis Muscle Flap in Radial Forearm Free Flap Phalloplasty to Decrease Urethral Fistula Rate: Initial Outcome

Abstract Introduction `- Chang and Hwang, in 1984, described the technique of Radial Forearm Free Flap Phalloplasty (RFFFP). It is now considered to be the standard surgery for phallic reconstruction. Urethral fistula is the most common complication reported in RFFFP and may reach up to 60-70%. Most commonly, the fistula site is at the anastomosis between the native urethra and the neo-urethra. Objective `- to study the impact of gracilis muscle flap wrapping around the native urethra/neo-urethral anastomosis on decreasing the fistula rate. Methods `- A prospective study was conducted at our urology department, from January 2018 till December 2020. - Patients presenting with a micropenis (Stretched penile length &amp;lt;7 cm) underwent RFFFP with gracilis muscle flap wrapping. - The free-flap was harvested from the non-dominant forearm. Under microscopic guidance, the radial artery was anastomosed with the inferior epigastric artery, the cephalic vein with the great saphenous vein, and the medial and lateral antecubital nerves with the ilio-inguinal and the dorsal penile nerves respectively. - A pedicled gracilis muscle flap was then wrapped around the neo-urethera/native urethral anastomosis to assess its possible role in decreasing the postoperative urinary fistula rate. Results `- Nineteen patients were included in the study with a median age of 26 years (16 - 43) and a BMI of 24 (22-25). The median hospital stay of 14 days (14 - 21) and the median follow-up was 11 months (4 - 13). The median cold ischemia time was 90 mins (70 - 100), estimated blood loss was 500 cc (400 - 500) and operative time was 11 hrs (10 - 12). - A viable phallus was achieved in 13 patients (overall free flap survival 68.4%). - Of the successfully viable phallus cases, 8 cases (42.1%) were complicated by complete disruption of the urethra and the remaining five cases (26.3%) had complete urethral tube. - One case of them developed a fistula at the neo-urethera/native urethral anastomosis, one case had a distal fistula and one case had a ring stricture at the site of anastomosis. - The gracilis muscle flap prevented urethral fistula formation in 4 out of 5 cases (80%) with complete urethral tube. Conclusions `- The use of pedicled garcilis muscle flap wrapping around the neo-urethra/native urethral anastomosis during RFFP might be helpful in reducing the urinary fistulae rates at this site. However, larger comparative studies are needed. Disclosure No

MP02-01 CADAVERIC PENILE DISSECTION AND ITS IMPACT ON LIVE DONOR PENILE TRANSPLANTATION: A PRELIMINARY STUDY

You have accessJournal of UrologyCME1 Apr 2023MP02-01 CADAVERIC PENILE DISSECTION AND ITS IMPACT ON LIVE DONOR PENILE TRANSPLANTATION: A PRELIMINARY STUDY Borko Stojanovic, Bojana Radnic, Marta Bizic, Milenko Bogdanovic, Sinisa Ducic, Vesna Popovic, Tatjana Atanasijevic, and Miroslav Djordjevic Borko StojanovicBorko Stojanovic More articles by this author , Bojana RadnicBojana Radnic More articles by this author , Marta BizicMarta Bizic More articles by this author , Milenko BogdanovicMilenko Bogdanovic More articles by this author , Sinisa DucicSinisa Ducic More articles by this author , Vesna PopovicVesna Popovic More articles by this author , Tatjana AtanasijevicTatjana Atanasijevic More articles by this author , and Miroslav DjordjevicMiroslav Djordjevic More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile transplantation presents an ideal treatment for penile agenesis, traumatic penile amputation, penile cancer or gender dysphoria in transmen. Until now, all four reported cases underwent cadaveric penile transplantation. We evaluated possibilities for using all penile entities after their removal in transfemale gender affirming surgery for live donor penile transplantation. Main goal of this cadaveric study was to develop techniques for anatomical harvesting of the penile entities (corpora cavernosa with distal urethra and glans) that could be used for safe and successful donor penile transplantation. METHODS: Between January and September 2022, penile dissection was performed in 18 male cadavers, aged from 19 to 51 years (mean 38.5 years). Dissection was based on penile disassembly principles: corpora cavernosa with urethra, glans with neurovascular bundle and penile skin. Penile skin with small piece of the glans and proximal urethra were separated as a tissue for creating the female genitalia. This way completely preserved cavernosal bodies, distal urethra and largest part of the glans were precisely measured with associated blood vessels and nerves. RESULTS: Mean penile length was 10.5 cm (from 6 to 13 cm) in flaccid and 15 cm (from 12 to 18 cm) in stretched state, and mean circumference 8 cm (from 7 to 9 cm). Neurovascular bundle had regular anatomy in 16 cases, while in remaining 2 anatomical variations were detected: single penile artery in one and a common trunk of both penile arteries in another case. Mean diameters of deep dorsal vein, right and left left artery were measured 2.9 mm, 2.5 mm and 2.2 mm, respectively. Penile nerves were found in all cases with anatomical distribution. A circumflex branches and perforators of the blood vessels were detected in all cases. Mean length and girth of cavernosal bodies were 20 cm (from 18 to 24 cm), and 7.4 cm (from 6.5 to 11 cm), respectively. Both crural arteries are identified in all cases. Mean length of the distal urethra was 11.4 cm (from 9.5 to 14 cm) without registered anomalies. The mean volume of the remaining glans after creation of the neoclitoris was 87% (from 85 to 90%). All dissections were finished successfully, and all entities were joined again in all cadavers. CONCLUSIONS: Preliminary results of cadaveric penile dissection confirm feasibility of using all remaining entities such as corpora cavernosa, minimally reduced glans, distal urethra and preserved neurovascular elements during transfemale gender affirming surgery for possible penile transplantation. Surgical technique is suggested and will be established with further research. Source of Funding: Science Fund of the Republic of Serbia, Project IDEAS © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e10 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Borko Stojanovic More articles by this author Bojana Radnic More articles by this author Marta Bizic More articles by this author Milenko Bogdanovic More articles by this author Sinisa Ducic More articles by this author Vesna Popovic More articles by this author Tatjana Atanasijevic More articles by this author Miroslav Djordjevic More articles by this author Expand All Advertisement PDF downloadLoading ...

V11-03 PENILE RECONSTRUCTION FOR CONGENITAL MICROPENIS WITH THE ANTEROLATERAL THIGH PEDICLED FLAP

You have accessJournal of UrologyCME1 Apr 2023V11-03 PENILE RECONSTRUCTION FOR CONGENITAL MICROPENIS WITH THE ANTEROLATERAL THIGH PEDICLED FLAP Aurélie Schirmann, Nim Christopher, David Ralph, and Wai Gin Lee Aurélie SchirmannAurélie Schirmann More articles by this author , Nim ChristopherNim Christopher More articles by this author , David RalphDavid Ralph More articles by this author , and Wai Gin LeeWai Gin Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Congenital micropenis is defined as a normally formed penis with a stretched penile length less than 2.5 standard deviations below the mean for that man’s age and ethnicity. Micropenis may present as an isolated condition or with other genital or multi-system abnormalities. Penile reconstruction or phalloplasty may be required where topical and systemic hormonal treatment have failed. The most common flap used for phalloplasty is the radial artery forearm free flap phalloplasty. Other alternatives include the anterolateral thigh (ALT), musculocutaneous latissimus dorsi and abdominal flaps.The aim of this video is to illustrate the technique for penile reconstruction using a pedicled ALT flap without integrated urethra. METHODS: A 21-year-old man with micropenis and hypospadias from a disorder of sexual differentiation (46XY) presents for penile reconstruction following multiple failed attempts at hypospadias repair. He requested an ALT flap without integrated urethra because he is dependent on a long-term suprapubic catheter due to a hypocontractile bladder.Intraoperative vascular doppler identified 3 perforators from the descending branch of the lateral circumflex iliac artery of the left leg. The flap was designed centred on the perforators with dimensions of 14cm (length), 13cm (width at base) and 12cm (width at tip). The flap was raised carefully and transferred to the recipient groin. The neophallus was constructed and microsurgical anastomosis of the lateral cutaneous of the thigh to one of the dorsal penile nerves with 8/0 nylon was completed. The partially divided left vastus lateralis muscle was re-approximated and the skin edges drawn in and flattened. The left thigh was then resurfaced with a 14/1000 of an inch split-thickness skin graft from the contralateral thigh. All wounds were dressed. RESULTS: The man had an uneventful post-operative course with careful vascular monitoring, and he was discharged on day 10. He is currently awaiting glans-sculpting and will eventually proceed with insertion of an inflatable erectile device. CONCLUSIONS: Penile reconstruction using an ALT flap can be offered to a well-informed and motivated man with a micropenis following appropriate assessment. As shown, the technique requires careful dissection of the perforator vessels and can usually be transferred as a pedicled flap. Pedicled flaps do not require microvascular anastomosis and therefore have a lower risk of vascular compromise. Further aesthetic and functional refinements like the insertion of an erectile device are possible in later stages, if desired. Source of Funding: None declared © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e999 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aurélie Schirmann More articles by this author Nim Christopher More articles by this author David Ralph More articles by this author Wai Gin Lee More articles by this author Expand All Advertisement PDF downloadLoading ...