Penile Numbness Research Articles

Does the suturing technique (barbed continuous versus conventional interrupted) impact the outcome of anastomotic urethroplasty?

To evaluate and compare continuous suture (CS) and interrupted suture (IS) techniques applied in excision and primary anastomosis (EPA) urethroplasty in terms of surgical success and complication rates. A retrospective evaluation was conducted on patients with bulbar urethral strictures measuring ≤ 2.5cm who underwent EPA between April 2020 and December 2022. Patients with a history of urethral reconstruction, multiple strictures, a history of pelvic radiotherapy, a diagnosis of Lichen sclerosis, a history of surgery due to congenital penile curvature or Peyronie's disease, and a follow-up period of less than 12months were excluded. The patients were divided into two groups according to the suture technique used (CS or IS), and the groups were compared for demographic and perioperative data. A total of 97 patients (CS n = 52, IS n = 55) were included in the sample. The mean age of the entire patient group was calculated to be 56.2years and the mean stricture length was 19.3mm. Operation time and postoperative catheter time were shorter in the CS group (94.7 ± 7.3 vs. 117.2 ± 5.7min and 9.9 ± 1.6 vs. 15.8 ± 1.9min, p < 0.001, respectively). The groups were similar regarding anatomical success, stress urinary incontinence, penile numbness, curvature, and postoperative infection (p > 0.05). No significant difference was observed in terms of success or complications between the CS and IS techniques employed during EPA urethroplasty. However, in addition to reducing the operation time, the CS technique offers the advantage of safely removing the urethral catheter earlier.

Outcome of Malleable Penile Implant and End Stage of Erectile Dysfunction Single Centre Experience

Background: The inflatable penile prosthesis (IPP) is typically the preferred implant for Peronei’s disease (PD) and malleable penile prostheses (MPPs) have been discouraged.&#x0D; Objective: To share experience of malleable penile implant in younger patients at institute of kidney disease Peshawar in a developing country.&#x0D; Materials and Methods: Total of 24 Patients were included in this study who underwent malleable penile prosthesis surgery from July 2017 till June 2020 were included. They all counseled thoroughly regarding procedure, success statistics, possible complications and post-operative follow up. During follow up any problem if occurred and satisfaction documented. Data analysis done with SPSS version 22.&#x0D; Results: mean age of 31.7 (27-65) years were included. The most common etiology of ED was vasculogenic (n=10, 41.7%). The comorbidities found were diabetes mellitus and hypertension in 12.5% each (n=3), these patients had no comorbidities (n=18, 75%). The mean size of penile prosthesis was 11.79mm (ranged from 9.5-13mm). We had four patients (16.7%) with unconsummated marriage due to ED. The post-operative problems noted were penile numbness (n=4, 16.7%), retarded ejaculation (n=4, 16.7%), penile pain (n=3, 12.55), hematoma (n=1, 4.2%) and lower urinary tract symptoms (n=1, 4.2%). Most of these patients were fully satisfied (n=15, 62.5%), some were partially satisfied (n=7, 29.2%), only two patients were not satisfied (8.3%) while all patients had their partner satisfaction with malleable penile prosthesis. Inappropriately, patients had presented initially to urologist, rest of all 24 patients were initially treated by quacks, general practitioners, homeopaths, spiritual healers, dermatologists, gynecologists and psychiatrists. All patients had no sense about erectile dysfunction. Patients have idea about discussion of specific field consultant. Their doctor only deal with urology, kidney and bladder pathologies.&#x0D; Conclusion: Malleable penile prosthesis has great success rate in end point erectile dysfunction with acceptable complication rate. E.D is a global problem. There has been an incredible ignorance in the public about proper referral and management of Sexual dysfunction. Herbal medications are marginally effective and management of erectile dysfunction.

Penil Plikasyon Cerrahisinde Minimal İnvaziv H-İnsizyon Tekniği Komplikasyonları Azaltmaktadır: Retrospektif Kohort Çalışması

Objective: To compare the long-term results and complications of minimally invasive H-incision complete burying-knot technique and modified Nesbit procedure in penile curvature surgery. Material and Methods: The data of 53 patients who underwent penile curvature surgery in our clinic for Peyronie's disease were retrospectively analyzed. While 27 (50.9%) of the patients had excisional modified Nesbit procedure (Group 1), 26 (49.1%) were applied minimally invasive H-incision complete burying-knot technique (Group 2). The postoperative results and complications of the groups were compared. Results: The mean age of groups was similar (p=0.369). There was no significant difference between the groups in terms of mean operating times (Group 1=41.92±6.93 minute vs Group 2=43.14±6.81 minute, p=0.520). The mean postoperative penile shorthening was 1.07±1.77 cm in Group 1, while it was 0.84±1.59 cm in Group 2 (p=0.625). Mean postoperative palpable suture knots, penile pain and penile numbness were found to be significantly lower in Group 2 (p=0.011, p=0.005, p=0.011 respectively). The mean postoperative International Index of Erectile Function scores were similar in both groups (Group 1=20.14±1.58 vs Group 2=19.73±1.84, p=0.249). Conclusion: Minimally invasive H-incision complete burying-knot technique provides similar success rates with lower postoperative complication compared to the modified Nesbit procedure in penile curvature surgery.

The Association Between Pelvic Discomfort and Erectile Dysfunction in Adult Male Bicyclists

BackgroundBicycle riding's impact on erectile function remains a topic of great interest given cycling's popularity as a mode of transportation and exercise. AimWe evaluated risk factors for sexual dysfunction in male cyclists with the primary intention of determining if genital/pelvic pain and numbness are associated with erectile dysfunction (ED). MethodsWe surveyed male cyclists using an online anonymous questionnaire. Cyclists were queried on their demographics, cycling experience, and sexual function using the Sexual Health Inventory for Men (SHIM). ED was diagnosed when a completed SHIM score was <22. Regression analysis was used to evaluate the risk of ED in men with genital/pelvic pain or numbness after riding. The survey was designed in the United States. OutcomesQuantitative characterization of cycling habits, onset and timing of genital pain and numbness, and SHIM score. ResultsA total of 1635 participants completed the survey. A majority of men were over the age of 50 (58%, 934/1,607), Caucasian (88%, 1,437/1,635), had been active cyclists for over 10 years (63%, 1,025/1,635) and used road bikes (97%, 1,578/1,635). Overall, 22%, 30%, and 57% of men reported ED, genital pain, and genital numbness, respectively. While controlling for cohort demographics, body mass index, cycling intensity and equipment, and medical comorbidities, no saddle characteristics were associated with the risk of developing genital numbness. However, men reporting penile numbness were at higher risk of reporting ED (odds ratio [OR] = 1.453, P = .048). In addition, quicker onset of numbness and resolution of numbness within a day was associated with impaired erectile function. For example, numbness occurring less than 1 hour after cycling had greater odds of leading to ED than numbness after 5 hours (OR = 2.002, P = .032). Similarly, genital pain occurring less than 1 hour (OR = 2.466, P = .031) after cycling was associated with higher ED risk. Strengths & LimitationsStrengths include a large sample size of high-intensity cyclists and validated questionnaire use. Limitations include reliance on anonymous self-reported survey data and minimal inquiry into the riding preferences and terrain traversed by cyclists. ConclusionsPelvic pain and numbness are common complaints among male riders in the United States. Men with such complaints are more likely to also report ED especially if it occurs earlier in the ride. Although direction of causality and temporality are uncertain, alleviation of factors resulting in pelvic discomfort may reduce cycling's impact on sexual function. Such interventions are critical given that cycling for both active travel and aerobic exercise confers numerous health benefits.Balasubramanian A, Yu J, Breyer BN, et al. The Association Between Pelvic Discomfort and Erectile Dysfunction in Adult Male Bicyclists. J Sex Med 2020;17:919–929.

130 Evaluation of Bothersome/Distressing Penile Numbness with Orgasmic Dysfunction: Role of Neuro-Genital Testing to Localize the Site of Neurologic Pathology

Penile numbness is an unusual, troubling symptom that may cause delayed/muted orgasm. The afferent neurologic pathway (S2, 3, 4) to the brain passes along dorsal/pudendal nerves, in the cauda equina along sacral spinal nerve roots, and along the spinal cord to the brain. Penile numbness causing orgasm dysfunction can be caused by different pathologies and locations within this pathway. Reduced genital sensation/orgasm dysfunction may follow end organ injuries such as dorsal nerve damage during penile implant surgery especially with the infra-pubic approach; pudendal nerve injury such as during a straddle/fall onto the perineum or pudendal neuropathy from diabetes; radiculopathy of sacral afferent roots within the cauda equina such as from lumbar disc disease; spinal cord pathology such as spinal cord injury or multiple sclerosis; or lesions in the brain such as aneurysms as examples. The purpose of this retrospective chart review was to utilize objective assessments to determine the location of pathology in neurologic pathways of penile sensation from penis to brain so as to better manage patients.

Successful Treatment of Penile Numbness and Erectile Dysfunction Resulting From Pudendal Nerve Entrapment

Pudendal nerve decompression surgery has not been studied or reported for the treatment of penile numbness in the absence of pain. Herein, we report a case of a male patient with chronic numbness of the penis and erectile dysfunction in the absence of pelvic pain who was found to have pudendal nerve entrapment. This patient was treated with surgical decompression of the pudendal nerves that resulted in the return of genital sensation and erections. Thus, we propose that pudendal nerve entrapment may be considered as a cause of penile numbness and that pudendal nerve decompression surgery in these patients may be effective.

210 Distressing Penile Numbness Following Infrapubic Approach for Penile Implant Insertion: Medical Malpractice Case and Role of Post-operative Neuro-Genital Testing in Understanding Pathophysiology

210 Distressing Penile Numbness Following Infrapubic Approach for Penile Implant Insertion: Medical Malpractice Case and Role of Post-operative Neuro-Genital Testing in Understanding Pathophysiology

A Novel Collaborative Protocol for Successful Management of Penile Pain Mediated by Radiculitis of Sacral Spinal Nerve Roots From Tarlov Cysts.

IntroductionSince 14 years of age, the patient had experienced extreme penile pain within seconds of initial sexual arousal through masturbation. Penile pain was so severe that he rarely proceeded to orgasm or ejaculation. After 7 years of undergoing multiple unsuccessful treatments, he was concerned for his long-term mental health and for his future ability to have relationships.AimTo describe a novel collaboration among specialists in sexual medicine, neurophysiology, and spine surgery that led to successful management.MethodsCollaborating health care providers conferred with the referring physician, patient, and parents and included a review of all medical records.Main Outcome MeasureElimination of postpubertal intense penile pain during sexual arousal.ResultsThe patient presented to our sexual medicine facility at 21 years of age. The sexual medicine physician identifying the sexual health complaint noted a pelvic magnetic resonance imaging report of an incidental sacral Tarlov cyst. A subsequent sacral magnetic resonance image showed four sacral Tarlov cysts, with the largest measuring 18 mm. Neuro-genital testing result were abnormal. The neurophysiologist hypothesized the patient's pain at erection was produced by Tarlov cyst-induced neuropathic irritation of sensory fibers that course within the pelvic nerve. The spine surgeon directed a diagnostic injection of bupivacaine to the sacral nerve roots and subsequently morphine to the conus medullaris of the spinal cord. The bupivacaine produced general penile numbness; the morphine selectively decreased penile pain symptoms during sexual arousal without blocking penile skin sensation. The collaboration among specialties led to the conclusion that the Tarlov cysts were pathophysiologically mediating the penile pain symptoms during arousal. Long-term follow-up after surgical repair showed complete symptom elimination at 18 months after treatment.ConclusionThis case provides evidence that (i) Tarlov cysts can cause sacral spinal nerve root radiculitis through sensory pelvic nerve and (ii) there are management benefits from collaboration among sexual medicine, neurophysiology, and spine surgery subspecialties.Goldstein I, Komisaruk BR, Rubin RS, et al. A Novel Collaborative Protocol for Successful Management of Penile Pain Mediated by Radiculitis of Sacral Spinal Nerve Roots From Tarlov Cysts. Sex Med 2017;5:e203–e211.

Painless Multidermatomal Herpes Zoster in an Immunocompetent Elderly Male: a Case Report

Abstract The varicella-zoster virus is the cause of both varicella and herpes zoster. The primary infection of varicella includes viremia and a widespread eruption, after which the virus persists in nerve ganglion cells, usually sensory. Herpes zoster is the result of reactivation of this residual latent virus. The first manifestation of zoster is usually pain, which may be severe and accompanied by fever, headache, malaise and tenderness localized to one or more nerve roots. The lymph nodes draining the affected area are enlarged and tender. Occasionally, the pain is not followed by eruption (zoster sine herpete). We hereby report an 85-year-old otherwise healthy male patient with a 3-day history of a non-painful rash on the left side of abdomen, pubic and penile regions, left groin and the left leg. He denied any pain and/or abnormal sensations before the rash onset. On examination, there were closely grouped multiple vesicles over the anterior left abdominal wall, left groin, thigh, knee and left upper quarter of penis, involving the left T12, L1-L4 and S2 dermatomes. The patient reported no pain, fever, rigor or any other symptoms; he had no associated cervical, axillary or inguinal lymphadenopathy. He denied any abdominal pain, nausea, vomiting, any weakness or sensory changes in the limbs. There was no history of penile numbness, urinary retention, and increased frequency of micturition or constipation. The varicella-zoster virus serology test performed by Calbiotech VZV IgG ELISA Kit (Calbiotech, Spring Valley, Canada) was strongly positive. The human immunodeficiency virus serology test, as well as herpes simplex virus type 1 and type 2 serology tests performed by ELISA were all negative. The Tzanck smear, stained with Giemsa, demonstrated multinucleated giant cells. The patient responded well to valacyclovir with complete clearance of lesions within one week. An extensive PubMed search revealed only few reports of painless herpes zoster. We present a rather peculiar case of painless herpes zoster in an elderly patient with no apparent systemic immunosuppression, with severe involvement affecting multiple adjacent and one remote dermatome. We hereby propose the term ”herpes zoster sine algesia” in cases where eruption is not followed by pain.

A Practical Solution for Dyspareunia in Breast Cancer Survivors: A Randomized Controlled Trial.

Dyspareunia is common in breast cancer survivors because of low estrogen. This study explored whether dyspareunia is introital pain, preventable with analgesic liquid. In a randomized, controlled, double-blind trial, estrogen-deficient breast cancer survivors with severe penetrative dyspareunia applied either saline or 4% aqueous lidocaine to the vulvar vestibule for 3 minutes before vaginal penetration. After a 1-month blinded trial of patient-assessed twice-per-week tampon insertion or intercourse, all patients received lidocaine for 2 months in an open-label trial. The primary outcome was patient-related assessment of penetration pain on a scale of zero to 10. Secondary outcomes were sexual distress (Female Sexual Distress Scale), sexual function (Sexual Function Questionnaire), and resumption of intercourse. Comparisons were made with the Mann-Whitney U and Wilcoxon signed rank test with significance set at P < .05. In all, 46 patients, screened to exclude those with pelvic muscle and organ pain, uniformly had clinical evidence of severe vulvovaginal atrophy, dyspareunia (median pain score, 8 of 10; interquartile range [IQR], 7 to 9), increased sexual distress scores (median, 30.5; IQR, 23 to 37; abnormal, > 11), and abnormal sexual function. Users of lidocaine reported less pain during intercourse in the blinded phase (median score of 1.0 compared with saline score of 5.3; P = .007). After open-label lidocaine use, 37 (90%) of 41 reported comfortable penetration. Sexual distress decreased (median score, 14; IQR, 3 to 20; P < .001), and sexual function improved in all but one domain. Of 20 prior abstainers from intercourse who completed the study, 17 (85%) had resumed comfortable penetrative intimacy. No partners reported penile numbness. Breast cancer survivors with menopausal dyspareunia can have comfortable intercourse after applying liquid lidocaine compresses to the vulvar vestibule before penetration.

A case of almost painless herpes zoster presenting with symptoms of cystitis, penile numbness, and acute vestibular failure.

Herpes zoster (shingles) is an acute, painful, vesicular, and cutaneous eruption caused by varicella zoster virus, the same virus which causes chicken pox. It is due to the reactivation of the virus which remains dormant in sensory ganglions following chicken pox. It is usually confined to a single dermatome but may involve 2-3 dermatomes. Typically, it is a unilateral lesion which can affect both cranial and peripheral nerves. It is usually a self-limiting disease; however, it may cause significant morbidity especially in the elderly. It is more common in older people and individuals with immunocompromised conditions. Antiviral drugs can shorten the duration and the severity of the illness and need to be started as soon as possible after the appearance of the rash. Gabapentin and tricyclic antidepressant are effective in postherpetic neuralgia. Vaccine can reduce the risk of infection and its associated pain. Typically, it occurs once in a lifetime, but some individuals may have more than one episode.

Subacute penile numbness after brachytherapy for prostate cancer

Purpose Penile numbness is a rare complication of permanent prostate brachytherapy, and optimal clinical management remains unclear. We present such a case and discuss pathophysiology and clinical management strategies. Methods and Materials A 68-year-old male presented with a serum prostate-specific antigen level of 6.9 ng/mL, Gleason score of 7 (3 + 4), and clinical T1c adenocarcinoma of the prostate. After a permanent prostate brachytherapy implant with 125I monotherapy to a dose of 145 Gy, the patient developed complete penile numbness postoperatively on the third day. Results The patient experienced complete restoration of penile sensation and function by postoperative day 9 with conservative management. Conclusions Subacute penile shaft numbness after brachytherapy is rare and is caused by dorsal penile nerve compression. Over the course of a week, the restoration of penile sensation is likely to occur with conservative management.

Dengue Hemorrhagic Fever Complicated with Acute Idiopathic Scrotal Edema and Polyneuropathy

We report a case of an adult with dengue hemorrhagic fever who developed acute idiopathic scrotal edema and glove-and-stocking polyneuropathy. A 54-year-old man who had fever, chills, bone pain, and skin rash for 4 days was admitted. We diagnosed dengue hemorrhagic fever because of fever, gum bleeding, thrombocytopenia, and hemoconcentration, and confirmed the diagnosis by serology. The patient had scrotal and penile edema and distal limb numbness with a glove-and-stocking distribution. After supportive care, the scrotal edema and other symptoms subsided. Patients with dengue hemorrhagic fever may develop scrotal edema caused by plasma leakage.

A novel technique of bulbourethral sling for post-prostatectomy incontinence

The treatment of post-prostatectomy incontinence (PPI) can be challenging. Although many injectable materials have been used to treat this problem, the results are at best unsatisfactory. Fixation of an artificial urinary sphincter has been the gold standard of care for patients with PPI for many years. In the last decade there has been a revival of male sling techniques, involving either a fixed or dynamic compressive effect. Herein, a technique for the correction of PPI is described which involves minimal incursion of exogenous material and has excellent cost-effectiveness. A total of 23 patients underwent a bulbourethral sling procedure using mesh suspended from the anterior abdominal wall for the management of PPI. The technique is performed under spinal anesthesia and utilizes knitted polypropylene mesh, which is fastened by three pairs of sutures. A modified Stamey needle is used for transferring nylon sutures to the suprapubic wound. The sutures are tied in front of the rectus sheath, utilizing intraoperative urodynamic guidance. A 12 F suprapubic tube is utilized as a pressure channel for monitoring vesical pressure and sling tension. Twenty patients were completely dry at the last follow-up, one was greatly improved and in two the treatment was considered a failure. The median follow-up period was 9 months (range 6-24 months). No urethral erosion has been reported thus far. Morbidity in the form of perineal pain and limited ambulation in the first few days after surgery were reported. Five patients had scrotal and penile numbness which continued for an average of 3 months. The mesh sling technique described herein is efficient and cost-effective. It yielded promising results in this study, which involved a short-term follow-up period and a limited number of patients. More cases are being enrolled and a study involving a longer follow-up period is underway.

Arterial priapism and cycling: a new worrisome reality?

Arterial priapism is a rare condition caused by the traumatic formation of an arteriolacunar fistula. We report 2 cases of arterial priapism after cycling injuries. Both patients sustained a violent perineal trauma against the top tube on the bicycle. In both cases, penile detumescence was obtained by superselective arteriographic embolization of the fistula with gelatin sponge or microcoil. The fistula was monolateral in the first case and bilateral in the second. Cycling should be considered a possible risk factor for arterial priapism as it is for urethritis, prostatitis, hematuria, testicular torsion, scrotal and penile numbness, and erectile dysfunction.

Erectile Dysfunction in Cyclists

Objective: Perineal compression during bicycling appears to be responsible for some cases of erectile dysfunction. Material and Methods: In 46 healthy athletic men transcutaneous penile oxygen pressure (tpO₂) at the glands of the penis was measured, using a transcutaneous measurement device. It has been shown that the tpO₂ levels measured at the glans correlate with the penile blood flow. Our measurements were performed before, during and after cycling in an upright and a reclining position in a crossover study. Results: The mean transcutaneous pO₂ at the glans in a standing position before biking was 60.5±8.1 mm Hg. It decreased after sitting on the saddle in an upright position to 17.9±3.9 mm Hg. Continued cycling in a seated upright position showed pO₂ levels of 18.3±5.2 mm Hg, with a full return to normal pO₂ values after a 10–min recovery period in a standing position. Cycling in a reclining position resulted in pO₂ levels of 59.4±4.2 mm Hg, a similar level to that obtained before exercising. Conclusions: The results of the present study demonstrated that there is a defiency in penile perfusion caused by perineal arterial compression. Cycling in a reclining position – in which no perineal compression was seen – caused no alteration in penile blood flow during exercising. Therefore, we suggest cycling in a reclining position to avoid health hazards – such as penile numbness and hypoxygenation of the corpora cavernosa, which can result in impotency.

PUDENDAL NERVE INJURY ASSOCIATED WITH AVID BICYCLING

Perineal and penile numbness is a frequent complaint of avid male bicyclists. It is currently believed to be caused by cycling induced transient ischemia from pressure on perineal neurovasculature while riding, which results in temporary numbness. We report electromyographic evidence of bilateral pudendal nerve injury associated with excessive bicycling. This condition may be associated with male erectile dysfunction if the penile blood supply is compromised.

Impotence and nerve entrapment in long distance amateur cyclists.

To assess the frequency and duration of symptoms suggesting peripheral nerve compression after long distance cycling. A questionnaire based cross sectional study among 260 participants in a Norwegian annual bicycle touring race of 540 km. Thirty-five of 160 responding males (22%) reported symptoms from the innervation area of the pudendal or cavernous nerves. Thirty-three had penile numbness or hypaesthesia after the tour. In 10, the numbness lasted for more than one week. Impotence was reported by 21 (13%) of the males. It lasted for more than one week in 11, and for more than one month in three. Both genital numbness and impotence were correlated with weakness in the hands after the ride, a complaint reported by 32 (19%) of all 169 respondents. Forty-six cyclists (30%) indicated paraesthesia or numbness in the fingers, half of them from the ulnar nerve area only. The frequency of impotence, numbness of the penis, hand weakness and sensory symptoms from the fingers in bicycle sport may be higher than hitherto recognized. It afflicts both experienced cyclists and novices. In some, the complaints may last up to eight months. Besides changing the hand and body position on the bike, restricting the training intensity, and taking ample pauses may also be necessary in prolonged and vigorous bicycle riding to prevent damage to peripheral nerves.