Penile Edema Research Articles

MP36-10 SAFETY AND FEASIBILITY OF PLATELET-RICH PLASMA INJECTIONS FOR PEYRONIE DISEASE: A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED CROSS-OVER STUDY

You have accessJournal of UrologyCME1 Apr 2023MP36-10 SAFETY AND FEASIBILITY OF PLATELET-RICH PLASMA INJECTIONS FOR PEYRONIE DISEASE: A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED CROSS-OVER STUDY Braian Ledesma, Manuel Molina, Kevin Chu, Thomas Masterson, Isaac Zucker, Emad Ibrahim, and Ranjith Ramasamy Braian LedesmaBraian Ledesma More articles by this author , Manuel MolinaManuel Molina More articles by this author , Kevin ChuKevin Chu More articles by this author , Thomas MastersonThomas Masterson More articles by this author , Isaac ZuckerIsaac Zucker More articles by this author , Emad IbrahimEmad Ibrahim More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The only FDA-approved medical therapy for Peyronie’s Disease involves use of intralesional collagenase injection. Platelet-derived therapies have acquired increased popularity in different areas in medicine due to their potential ability in tissue regeneration. In PD, autologous platelet rich plasma (PRP) may be an emerging viable treatment. Our hypothesis is that PRP can be safely used in PD, with minimal adverse events. Therefore, we are conducting a randomized, placebo controlled, cross over study to test it. METHODS: We analyzed data of a cohort of men from the ongoing trial treated with PRP vs placebo at our center from Apr-2021 to Oct-2022. Patients received two 0.5 ml injections of PRP obtained using an autologous platelet separator (Arthrex Angel, Arthrex Inc.) or placebo directly into the dominant plaque, separated by two weeks. Patients were examined immediately after the procedure and assessed with Visual Analogue Pain Scale, and at follow-up for complications. Patients are then followed three-months post-injections, at which point they cross over into the other treatment arm for two more injections. Patients undergo goniometer measurement, IIEF-15 and PDQ questionnaire assessment, prior to crossover. (NCT04512287) RESULTS: We report data from the 29 men who completed all injections. No minor or major adverse events such as penile bruising, swelling, edema, allergy, or penile fracture were reported. No patients experienced complications at follow-up. No worsening curvature was seen in men at later evaluations. CONCLUSIONS: From our data accumulated thus far in our ongoing randomized placebo-controlled trial with PRP for PD, PRP appears to be a safe and feasible treatment modality. Our study is the first one in the USA evaluating men with PRP for PD and we believe data from our study will be important for evaluating PRP as an additional medical treatment modality for PD. Source of Funding: This work was supported by NIH Grant R01 DK130991 and Clinician Scientist Development Grant from the ACS to RR, as well as SMSNA Research Grant to KC © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e483 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Braian Ledesma More articles by this author Manuel Molina More articles by this author Kevin Chu More articles by this author Thomas Masterson More articles by this author Isaac Zucker More articles by this author Emad Ibrahim More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

MP15-01 THE NEW PANDEMIC: MONKEYPOX AND ITS UROLOGICAL PRESENTATIONS

You have accessJournal of UrologyCME1 Apr 2023MP15-01 THE NEW PANDEMIC: MONKEYPOX AND ITS UROLOGICAL PRESENTATIONS Alex Murray, Piotr Śluzar, Anna Daunt, Aatish Patel, Nori Achyuta, Geraldine O'Hara, and Tet Yap Alex MurrayAlex Murray More articles by this author , Piotr ŚluzarPiotr Śluzar More articles by this author , Anna DauntAnna Daunt More articles by this author , Aatish PatelAatish Patel More articles by this author , Nori AchyutaNori Achyuta More articles by this author , Geraldine O'HaraGeraldine O'Hara More articles by this author , and Tet YapTet Yap More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Monkeypox (MPX) is a zoonotic virus, endemic to Central and Western Africa. Since early May 2022, there has been an outbreak of the virus with 3,548 confirmed cases in the UK for 2022, predominantly affecting men who have sex with men (MSM). Due to the virus’ capacity to transmit via exchange of bodily fluids, colonisation of the genitalia is not uncommon. Despite this, there is a paucity of available literature concerning urological manifestations. This case series seeks to elucidate the natural history of MPX from a urological perspective. METHODS: We reviewed all MPX antigen-positive cases at Guy’s & St Thomas’ NHS Trust, and affiliated sexual health centres in south London, between May and October 2022. Patients that presented with penile lesions were identified — of those, cases that required specialist urological input were selected. RESULTS: 199 men with Monkeypox were identified. Of those, 10% (19/199) presented with penile lesions and required treatment in an isolation ward with full personal protection equipment; 4% (8/199) required input from the urology team. Their average age was 41.6 (±7.1) years. 62.5% (5/8) of these patients were HIV positive but only one was poorly controlled (>200 copies/mL). 75% (6/8) of patients experienced penile oedema and 50% (3/6) of these patients experienced paraphimosis. One patient experienced paraphimosis without oedema, another experienced penile cyanosis concomitant with severe distal oedema. Rarely, urinary insufficiency will develop. The average number of penile lesions was 6 (range: 1-14, s.d. ±5.4). Lesions demonstrated a range of presentations — some initially appeared as pustules and papules, while more severe cases developed extensive, wet ulcerations; in some cases secondary infections were superimposed on the lesions, leading to necrosis. All lesions, however, were painful and required analgesia. On average, patients would present to health services 5.4 (±1.6) days after onset of symptoms, and would take 21 (±7.9) days for all lesions to heal. CONCLUSIONS: MPX urological presentations seem to observe a continuum of severity. Currently, the long-term urological sequelae of MPX are unknown but small lesions seem to heal without issue. By assessing the number of penile lesions and the presence of/potential for superimposed infections, a clinical picture for the course of the infection can be constructed and be used to inform management. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e191 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Murray More articles by this author Piotr Śluzar More articles by this author Anna Daunt More articles by this author Aatish Patel More articles by this author Nori Achyuta More articles by this author Geraldine O'Hara More articles by this author Tet Yap More articles by this author Expand All Advertisement PDF downloadLoading ...

Characteristics of confirmed mpox cases among clinical suspects: A prospective single-centre study in Belgium during the 2022 outbreak

BackgroundThe presentation of mpox clade IIb during the 2022 outbreak overlaps with a range of other diseases. Understanding the factors associated with mpox is important for clinical decision making. MethodsWe described the characteristics of mpox patients who sought care at Belgian sexual health clinic. Furthermore we compared their characteristics to those of patients with a clinical suspicion of mpox but who tested negative on polymerase chain reaction. ResultsBetween May 23 and September 20, 2022, 155 patients were diagnosed with mpox, and 51 patients with suspected symptoms tested negative. All mpox patients self-identified as men and 148/155 (95.5%) as gay or bisexual MSM. Systemic symptoms were present in 116/155 (74.8%) patients. All but 10 patients (145/155, 93.5%) presented with skin lesions. Other manifestations were lymphadenopathy (72/155, 46.5%), proctitis (50/155, 32.3%), urethritis (12/155, 7.7%), tonsillitis (2/155, 1.3%). Complications involved bacterial skin infection (13/155, 8.4%) and penile oedema with or without paraphimosis (4/155, 2.6%). In multivariable logistic regression models, the presence of lymphadenopathy (OR 3.79 95% CI 1.44–11.49), skin lesions (OR 4.35 95% CI 1.15–17.57) and proctitis (OR 9.41 95% CI 2.72–47.07) were associated with the diagnosis of mpox. There were no associations with age, HIV status, childhood smallpox vaccination, number of sexual partners and international travel. ConclusionsThe presence of proctitis, lymphadenopathies and skin lesions should increase clinical suspicion of mpox in patients with compatible symptoms.

Two levels vs. one level of phallopexy in the treatment of concealed penis in patients in pediatric age group.

Concealed penis, which is the congenital type of buried penis, is a condition in which a normal-sized penis is totally or partially hidden by pubic, scrotal, or thigh skin. Several procedures had been described for its correction including phallopexy, that is, fixation of penile Buck's fascia to the sub-dermis. Our work aims to study the difference in outcome between performing phallopexy at one level and at two levels. Our study included 180 uncircumcised patients who had a concealed penis while having an average length of an outstretched penis. These patients were divided into two groups: the first one was treated with one level of phallopexy at the 3 and 9 o'clock points, while the second group was treated with the same procedure in addition to another level of stitches at the mid-penile level. The follow-up was carried out for one post-operative year regarding penile skin edema, infection, congestion, necrosis, and/or re-retraction. The overall success rate was 96.1% for a normally-looking penis without post-operative re-retraction. Re-retraction developed in two patients (2.2%) of those who had one-level phallopexy and in five patients (5.6%) of those who had two-level phallopexy without statistical significance (FE p = .444). Penile skin edema developed in 76 patients (42.2%) being significantly lower in patients with lower body weight (p = .030*). Phallopexy could be performed safely in the case of the concealed penis with satisfactory results. Two levels of phallopexy did not add any advantage to the post-operative results besides the fact that this may be demanding, time-consuming, and may require higher resources, so we recommend the easier one-level phallopexy in the treatment of such conditions with satisfactory results.

Concealed penis in pediatric age group: a comparison between three surgical techniques

BackgroundComparison between three different surgical techniques in the management of concealed penis.MethodsThis prospective interventional non-randomized study included 150 pediatric patients with a concealed penis. They were distributed equally into three groups; group A; patients treated by anchoring the penile skin dermis to Buck's fascia at the penile base at 3 and 9 o'clock points using PDS 5/0 (phallopexy), group B; patients treated by complete dissection and excision of dartos fascia and group C; patients treated by phallopexy as in group A after complete dissection and excision of dartos fascia. Follow-up at the end of the 1st post-operative week and then monthly for 6 months as regards penile skin congestion and/or necrosis, wound infection, edema, and/or re-retraction was carried out.ResultsPenile edema and re-retraction have a statistically significant difference among the studied groups (p < 0.001 and p = 0.002 respectively). Penile re-retraction was noticed to be lowest in patients of group C, however penile edema was observed to be highest in patients of group B.ConclusionsPhallopexy after complete dissection and excision of dartos fascia have better results than doing either phallopexy or dartos excision alone in the treatment of concealed penis.Clinical trial registration: The manuscript was registered in ClinicalTrials.gov Protocol Registration and Results System. ClinicalTrials.gov Identifier: NCT05565040. Our manuscript was registered on 4/10/2022.

Dasatinib induced penile and scrotal edema a case report

Dermatologist’s opinion is often sought for various types of drug reactions/side effects-specially, if the effects are on skin, mucous membranes or genitals. Updating their knowledge about newer molecules (drugs) and their side effects,thus become a necessity. Dasatinib is a new USFD approved Tyrosine kinase inhibitor for the treatment of those Chronic Myeloid Leukemias patients who cannot tolerate Imatinib or are resistant to imatinib. Dasatinib can cause fluid retention in some patients,which can lead to peripheral edema and pleural effusion. Penile and scrotal edema are unusual manifestation of that fluid retention and very few cases have so far been reported to my knowledge of this side effect. We reporting a case of scrotal and penile edema, who had a transitory relief on stoppage of drug, restricting fluid intake and vitamin E. Recognising this side effect could have prevented many investigations and various specialist consultations and nine months of agony in my case.

Surgical management of genital lymphoedema: experience and critical considerations from a tri-center study

Aim: Genital lymphoedema (GL) is a chronic and debilitating disease, which can severely affect the patient’s quality of life with significant socio-economic impact. Nowadays, no gold standard algorithm exists for GL from diagnosis to treatment. This study proposes our therapeutic flowchart based on the three senior consultants’ experience in lymphatic surgery. Methods: A retrospective investigation was conducted on a prospectively maintained database (2018-2022). Inclusion criteria involved all patients who underwent surgical procedures for treating GL in three plastic surgery departments (Lausanne, Bari, and Genova). Outcomes were assessed in terms of oedema reduction, stage regression, and functional reported outcomes. Results: 16 patients with GL were included: 50% underwent debulking surgery, 18.8% microsurgery, and 31.2% debulking + microsurgery. We recorded a significant regression of the GL stage: 62.5% shifted from stage II/III to postoperative stage I. Similarly, we found an infection recurrency resolution in 50%, a scrotal oedema reduction in 62.5%, and a scrotal oedema resolution in 37.5% of the patients treated. While almost half of the patients (53.3%) with associated penile oedema described persistent postoperative penile oedema, only two patients complained of persistent lymphorrhea. Conclusion: According to our clinical experience, preoperative and postoperative physical functional therapy is always recommended. For stages I and IIA, after the failure of the conservative treatment, lymph-venous shunts and lymph node transplantation surgery are proposed at the early time. When GL is already diagnosed at stages IIB and III, the debulking surgery, together with functional procedures, represents our first approach.

Role of radiotherapy in the treatment of locally advanced penile cancer

Penile cancer is a rare but aggressive tumor, most commonly squamous cell carcinoma. Treatment modalities depend on the stage of the disease, but the backbone of treatment is surgical resection of the primary tumor and regional lymph nodes with the use of neoadjuvant/adjuvant chemotherapy and radiotherapy. Our case report is about a 59-year-old patient which was presented with bilateral inguinal lymphadenitis, scrotal and penile edema. A biopsy of the change in the penis confirmed squamous cell carcinoma. Partial amputation of the penis and an excisional biopsy of the inguinal lymph nodes was performed, which confirmed the metastasis to the lymph nodes. Diagnostic imaging revealed bilateral enlarged inguinal lymph nodes which were later surgically removed. Postoperative CT scan showed three suspected lung metastases. The patient was then treated with polychemotherapy. Follow-up CT scan showed complete regression of metastatic changes in the lungs but also showed local recurrence in the area of the penile root. Radiotherapy with concomitant administration of cisplatin was conducted. Penile cancer is an aggressive disease that can be cured at an early stage if adequate treatment is applied. We highlight the importance of a multimodal and multidisciplinary approach consisting of polychemotherapy, surgical treatment, and radiotherapy.

Severe mpox (formerly monkeypox) disease in five patients after recent vaccination with MVA-BN vaccine, Belgium, July to October 2022.

Vaccination is important in containing the 2022 mpox (formerly monkeypox) epidemic. We describe five Belgian patients with localised severe symptoms of proctitis and penile oedema, occurring between 4 and 35 days after post-exposure preventive vaccination or after one- or two-dose off-label pre-exposure preventive vaccination with MVA-BN vaccine. Genome sequencing did not reveal evidence for immune escape variants. Healthcare workers and those at risk should be aware of possible infections occurring shortly after vaccination and the need for other preventive measures.

Post-circumcision penile skin loss: reporting the outcome of one-stage anterolateral scrotal based flaps in children

ABSTRACT Introduction Improper penile assessment, together with carrying out circumcision by an inexperienced person, results in major complications. One of the complex complications is the complete or sub-complete penile skin loss, which in many cases, necessitates one or staged repair. Purpose To evaluate modified one-stage bilateral anterolateral scrotal-based flaps to compensate for penile skin loss after circumcision. Methods This study was performed on patients with almost penile skin loss after circumcision from February 2013 to July 2021. In all cases, one-stage modified bilateral anterolateral scrotal skin flaps were used to compensate for penile skin loss. The modification includes scrotal skin flap fashioning in a novel way, in addition to the use of penodermal fixation sutures at the penoscrotal junction, to create a stable penoscrotal junction and new penile skin coverage. Patients were discharged from the hospital on the same day of surgery. The dressing was left for 5 days. Follow-up visits were scheduled weekly in the first month, 3 and 6 months later, then annually. Results Forty-six children were included in this study. Their mean age was 4.5 ± 1.5 years. The mean operative time was 139.6 ± 11.5 min. No flap ischemia or necrosis was reported. One case (2.2%) developed a scrotal hematoma managed conservatively. Three (6.5%) cases presented with wound dehiscence at the penoscrotal angle. Three (6.5%) cases had self-limited penile edema. Two (4.3%) cases had dorsal midline hypertrophic scar; one improved after treatment with triamcinolone acetonide ointment, and the other needed scar revision. The mean follows up was 23.33 ± 9.13 months. Conclusion The modified scrotal skin flap technique provides a good substitution for stable penile skin coverage and a one-stage reconstruction of penile skin loss. It results in good parents’ satisfaction with acceptable complications.

Two Case Reports about Prostatitis and Penile Edema as Allergic Reaction to Pfizer-Biontech Covid19 Vaccine

Penile edema is a condition of fluid accumulation in the intracellular spaces of the penile soft tissues, often associated with sexually transmitted diseases, but can have different causes, such as allergic reactions [1,2]. Prostatitis is an inflammatory condition of the prostate which is classified by the NIH as acute bacterial prostatitis, chronic bacterial prostatitis, chronic non bacterial prostatitis-Chronic Pelvic Pain Syndrome (CPPS) and asymptomatic prostatitis [3]. There are also described, in the scientific literature, cases of allergic prostatitis [4]. We report the clinical case of a prostatitis and penile edema as allergic reaction to Pfizer-BioNTech COVID19 vaccine for which there is still insufficient scientific literature

Genitourinary Lesions Due to Monkeypox

BackgroundSince May 2022, 31 000 cases of monkeypox infection have been reported in nonendemic areas. ObjectiveTo describe a series of cases of monkeypox with genitourinary involvement. Design, setting, and participantsThis was a prospective observational study of men diagnosed with monkeypox disease with genitourinary involvement. Results and limitationsA total of 14 patients were recruited. The median age was 42 yr. Of these patients, 43% sought a consultation for genitourinary symptomatology, and 71% had engaged in sex with other men. Eight patients (57%) were positive for human immunodeficiency virus, one diagnosed synchronously; the remainder had a median CD4 count of 663/μl. Six patients (43%) had a different sexually transmitted disease. Penile oedema was present in 43% of patients and two patients required surgical exploration. ConclusionsGenitourinary involvement is frequent in monkeypox disease and is often the reason for the consultation visit. Patients summaryIn this report we looked at how monkeypox disease can affect the genitourinary area, causing swelling of the penis or skin lesions.

Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study

BackgroundIn May, 2022, several European countries reported autochthonous cases of monkeypox, which rapidly spread globally. Early reports suggest atypical presentations. We aimed to investigate clinical and virological characteristics of cases of human monkeypox in Spain.MethodsThis multicentre, prospective, observational cohort study was done in three sexual health clinics in Madrid and Barcelona, Spain. We enrolled all consecutive patients with laboratory-confirmed monkeypox from May 11 to June 29, 2022. Participants were offered lesion, anal, and oropharynx swabs for PCR testing. Participant data were collected by means of interviews conducted by dermatologists or specialists in sexually transmitted infections and were recorded using a standard case report form. Outcomes assessed in all participants with a confirmed diagnosis were demographics, smallpox vaccination, HIV status, exposure to someone with monkeypox, travel, mass gathering attendance, risk factors for sexually transmitted infections, sexual behaviour, signs and symptoms on first presentation, virological results at multiple body sites, co-infection with other sexually transmitted pathogens, and clinical outcomes 14 days after the initial presentation. Clinical outcomes were followed up until July 13, 2022.Findings181 patients had a confirmed monkeypox diagnosis and were enrolled in the study. 166 (92%) identified as gay men, bisexual men, or other men who have sex with men (MSM) and 15 (8%) identified as heterosexual men or heterosexual women. Median age was 37·0 years (IQR 31·0–42·0). 32 (18%) patients reported previous smallpox vaccination, 72 (40%) were HIV-positive, eight (11%) had a CD4 cell count less than 500 cells per μL, and 31 (17%) were diagnosed with a concurrent sexually transmitted infection. Median incubation was 7·0 days (IQR 5·0–10·0). All participants presented with skin lesions; 141 (78%) participants had lesions in the anogenital region, and 78 (43%) in the oral and perioral region. 70 (39%) participants had complications requiring treatment: 45 (25%) had a proctitis, 19 (10%) had tonsillitis, 15 (8%) had penile oedema, six (3%) an abscess, and eight (4%) had an exanthem. Three (2%) patients required hospital admission. 178 (99%) of 180 swabs from skin lesions collected tested positive, as did 82 (70%) of 117 throat swabs. Viral load was higher in lesion swabs than in pharyngeal specimens (mean cycle threshold value 23 [SD 4] vs 32 [6], absolute difference 9 [95% CI 8–10]; p<0·0001). 108 (65%) of 166 MSM reported anal-receptive sex. MSM who engaged in anal-receptive sex presented with proctitis (41 [38%] of 108 vs four [7%] of 58, absolute difference 31% [95% CI 19–44]; p<0·0001) and systemic symptoms before the rash (67 [62%] vs 16 [28%], absolute difference 34% [28–62]; p<0·0001) more frequently than MSM who did not engage in anal-receptive sex. 18 (95%) of 19 participants with tonsillitis reported practising oral-receptive sex. The median time from onset of lesions to formation of a dry crust was 10 days (IQR 7–13).InterpretationIn our cohort, monkeypox caused genital, perianal, and oral lesions and complications including proctitis and tonsillitis. Because of the variability of presentations, clinicians should have a low threshold for suspicion of monkeypox. Lesion swabs showed the highest viral loads, which, combined with the history of sexual exposure and the distribution of lesions, suggests close contact is probably the dominant transmission route in the current outbreak.FundingNone.

Sexual behaviours and clinical course of human monkeypox in Spain

Sexual behaviours and clinical course of human monkeypox in Spain

Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series

ObjectiveTo characterise the clinical features of monkeypox infection in humans.DesignDescriptive case series.SettingA regional high consequences infectious disease centre with associated primary and secondary care referrals, and affiliated sexual health centres...

Sexual and Functional Outcomes after Penile cancer treatment-perspective from a tertiary cancer care hospital in Nepal

Background: The mainstay of treatment for penile cancer is Penectomy with inguinal lymph node dissection following risk stratification followed by chemo-radiotherapy. Despite satisfactory oncological result, penile surgery has significant impact on patient’s functional and sexual quality of life. This retrospective analysis is to evaluate sexual and functional outcome of patient after curative treatment and its possible associations with clinic-pathological characteristics. Methods: This is a retrospective study conducted at Bhaktapur Cancer Hospital from January 2011 to December 2015 of histologically confirmed cases of carcinoma penis. Clinical and pathological characteristic data included age, history of smoking, clinical presentation, anatomical site, presence of lymph nodes or distant metastasis, primary tumor size (pT ) and TNM staging, surgery involved, length of remaining penile shaft, histopathological type, chemotherapy and radiotherapy patient received and follow ups time. International Index of Erectile Function (IIEF-5) questionnaire was used to assess sexual function which encompasses five questions and addresses the relevant domains of male sexual function respectively erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction and Urinary function were noted during follow up . Result: Among the cases, 64 cases were pathologically proven for penile cancer. The age of patient entering the study group included from 22 years to 88 years with mean age of 58.75±12.30 years. All patients except one were married and sexually active prior to treatment. Vast majority of the patients 63 (98.4%) were not circumcised and majority of cases 42 (65.64%) were smoker. The mean size of the tumor was 3.25±1.208 cm. Majority of patients 54(84.4%) underwent partialam putation of penis while 2(3.1%) patients had undergone total amputation of penis. The multivariate analysis of different factors showed that T staging ≥ T2 and penile shaft(cm) &lt;3cm were independent risk factors for sexual dysfunctions (odds ratio = 13.64; 95% confidence interval = 1.02-181.005), and (odds ratio = 0.03; 95% confidence interval = 00-0.05) respectively. Out of 56 cases, 33(58.9%) had different grades of sexual dysfunction where 15(26.8%) cases were severe, 5(8.9%) cases were moderate, 8(14.3%) cases were mild to moderate and 5(8.9%) cases were mild. 23 (41.1%) cases who did not have any form of sexual dysfunction. One (1.8%) case had urethral stricture, 3(5.4%) cases had meatal stenosis, 2(3.6%) cases had penile edema and 4 (7.1%) cases had penile discoloration. Conclusions: Amputation of penis with inguinal lymph node dissection which is necessary for curative intent of the disease is disfiguring and has a profound and lasting sexual dysfunction, voiding problems, penile appearance and cosmetic problems, all of which may adversely affect the patient’s quality of life. Emphasis on preventive aspects and early detection should be emphasized to get rid of this disease.

The Efficacy of Suspensory Ligament Release and Pubic Lipectomy Via Penopubic Z Plasty During Penile Prosthesis Implantation in Improving Sexual Satisfaction: A Prospective Randomized Controlled Trial

The utility of penile suspensory ligament release (SLR) in the setting of penile prosthesis implantation (PPI) has received limited attention in the literature. To assess the efficacy and safety of penile SLR release, pubic lipectomy (PL), and the utility of penopubic Z-plasty (ZP) during malleable PPI in improving sexual satisfaction compared to that achieved with the conventional method. Between August 2018 and April 2020, 61 patients with refractory erectile dysfunction were prospectively randomized into 2 groups; group A included 31 patients who underwent PPI with SLR and PL via ZP, and group B included 30 patients who underwent conventional PPI via a penoscrotal incision. Penile length was assessed at 3 months, and sexual satisfaction was assessed up to 1 year after PPI using both validated and non-validated tools. The median operative time was higher in group A than in group B (170 min; interquartile range [IQR] [160-190] vs 97.5 min; IQR [90-110] P < .001).The median pre- to postoperative differences in functional and visible penile lengths for group A were 1.5 cm; IQR [0-2] and 2.5 cm; IQR [1-3.5], respectively, while those in group B were both 0 cm; IQR [-1 to 0] P < .001). Group A patients reported higher scores in the International Index of Erectile Function satisfaction domains than the group B patients did (13; IQR [12-14] and 9; IQR [8-10] vs 11; IQR [9.5-12] and 8; IQR [6.5-8.5], respectively, P < .001). Moreover, the postoperative Erectile Dysfunction Inventory of Treatment Satisfaction score was higher in group A than that in group B (95.40; IQR [91-97.7] vs 85.20; IQR [72.7-91], respectively, P < .001). Common complications in group A were penile edema (77.4%), penile instability (9.7%) and glans numbness (9.7%). The benefit in patient satisfaction following SLR and PL via ZP during PPI may outweigh the incremental increase in complications. To our knowledge, this is the first prospective randomized controlled study to evaluate the efficacy and safety of SLR, PL, and ZP during PPI. However, because an optimal tool for assessing sexual satisfaction after PPI is lacking at this time, we alternatively adopted the most used assessment tools. Further, our data applies only to malleable penile prosthesis. SLR and PL via ZP during PPI resulted in a substantial improvement of the patients' sexual satisfaction without serious complications.

Safety and Feasibility of Platelet-Rich Plasma Injections for Peyronie's Disease: Update From a Single-center Double-blind Placebo-controlled Randomized Trial

ABSTRACT Introduction Peyronie's Disease (PD) is prevalent in approximately 7.1% of the general population. Current treatment approaches include medical therapy and surgical intervention, and intervention only occurs once the disease process has entered the chronic, stable phase. The only FDA-approved medical therapy involves use of intralesional collagenase clostridium histolyticum injection and surgical interventions include tunica albuginea plication, plaque excision without grafting, or placement of penile prothesis. Additional PD therapies are needed as current treatment modalities have limited efficacy and considerable side effects. Platelet-derived therapies have seen increased use across various specialties in medicine, especially in orthopedics, due to their potential ability in wound healing and tissue regeneration. As calcified scar plaques are frequently identified in PD patients, autologous platelet rich plasma (PRP) may prove to be a viable treatment for this patient population. Objective We reviewed an initial series of patients receiving PRP vs placebo for PD to assess safety and feasibility among men recruited in a double-blind placebo controlled single-center clinical trial. Methods We reviewed data for men recruited into the clinical trial treated with PRP vs placebo at our center from April 2021 to July 2021. Patients were observed immediately post-injection and at follow-up for complications and tolerability. Where applicable, International Index of Erectile Function (IIEF-5) scores were reviewed before and after injections for PD. Results We report data from the men who have completed 2 completed injections (PRP or placebo). No post-procedural minor adverse events were seen in any of the men. None of them reported adverse effects such as penile bruising, swelling, edema, allergy, penile fracture, or mild pain at injection site. No patients experienced complications at follow-up. No worsening curvature was observed in men completing pre/post evaluations. Conclusions PRP appears to be a safe and feasible treatment modality in patients with PD from our limited data accumulated thus far in our ongoing randomized placebo-controlled trial with PRP for PD. Our study is the first study in the USA accruing men with PRP for PD and believe that safety and efficacy data accumulated from our study will be important for patient counseling. Disclosure No

Comparison of Outcomes of Circumcisions among Children 0-4 years by using Gomco Versus Plastibell Techniques

Objective: We aimed to compare the rate of complications of Gomco and Plastibell circumcision techniques ininfants. Study design:Prospective Randomized Clinical TrialStudy. Place and duration of study:Department of Pediatric Surgery, Sheikh Zayed Hospital, Rahim Yar Khanfor six months from August 2020 to July 2021. Patients and method: A total of 80 patients were enrolled in the study, equally divided into two groups. Group 1 included patients undergoing circumcision via the Gomco technique, while group 2 circumcised with the Plastibell method. All healthy male patients aged one day old to 4 years of age were included. Patients with any congenital abnormalities, e.g., urethral or penile shaft abnormality, local infection, hypospadias. Jaundice and bleeding disorders were excluded. All procedures weredone under local anesthesia, postoperatively topical antibiotic was prescribed to each patient. Data was entered and analyzed using SPSS 25.0. Frequencies and percentages were expressed for qualitative variables like gender and postoperative outcomes, i.e., bleeding, penile edema, and redundant skin. Mean ± S.D represented quantitative variables like age, weight, and BMI. A Chi-square test was used to compare the complication rate between both groups. A p-value ≤0.05 was considered significant. Results: In the Gomco technique, there was no Penile edema, surgical site infection, hematoma, and need for Repeat surgery/manipulation. We found that bleeding was more common in Gomco compared to Plastibell. On the other hand, penile edema, reductant skin, slipped ring, and the need for repeated surgery/manipulation was more often in the Plastibell technique. Conclusion: We propose using the Gomco method for circumcision because of its lower rate of complication and better aesthetic outcome than the Plastibell method. Keywords: Circumcision, Gomco, Infant, Plastibell.

Temsirolimus (T) in patients (pts) with colorectal cancer (CRC) with PIK3CA mutation: Results from the Targeted Agent and Profiling Utilization Registry (TAPUR) study.

106 Background: TAPUR is a phase II basket study evaluating anti-tumor activity of commercially available targeted agents in pts with advanced cancers with genomic alterations. Results in a cohort of CRC pts with PIK3CA mutation treated with T are reported. Methods: Eligible pts had advanced CRC with PIK3CA mutation reported by a genomic test performed in a CLIA-certified, CAP-accredited site selected lab, no standard treatment options, measurable disease, ECOG performance status (PS) 0-2, and adequate organ function. Use of T was approved by the TAPUR Molecular Tumor Board in each case. After antihistamine pre-treatment, T was administered at 25 mg IV over 30-60 minutes weekly until disease progression. Primary endpoint was disease control (DC), defined as complete (CR) or partial (PR) response per RECIST v. 1.1, or stable disease at 16+ weeks (SD 16+). Simon 2-stage design tested the null DC rate of 15% vs. 35% (power = 0.85; α = 0.10). If ≥2 of 10 pts in stage 1 has DC, 18 more pts are enrolled; otherwise, the study stops for futility. If ≥7 of 28 pts has DC, the null DC rate is rejected. Secondary endpoints were progression-free survival (PFS), overall survival (OS) and safety. Results: 10 pts (60% male) with CRC with PIK3CA mutation were enrolled from November 2017 to May 2020. All were eligible for efficacy and toxicity. Demographics and outcomes are summarized in Table. No objective responses (OR) were observed. 1 pt had SD of 16.1 wks duration for a DC rate of 10% (95% CI: 0%, 45%); the null DC rate of 15% was not rejected (p=0.80). 6 pts had at least one grade 3-4 adverse or serious adverse event (AE/SAE) at least possibly related to T, including acute kidney injury, dehydration, decreased platelet count hypertriglyceridemia, mucositis, neutropenia, and scrotal and penile edema. Conclusions: Monotherapy T does not have sufficient clinical activity in CRC pts with PIK3CA mutation for continued evaluation in this pt population. Other treatments should be considered for these pts, including treatments offered in clinical trials. Clinical trial information: NCT02693535. [Table: see text]