Penile Sensitivity Research Articles

118 The Penile Sensitivity Ratio: A Novel Application of Biothesiometry to Assess Changes in Penile Sensitivity

118 The Penile Sensitivity Ratio: A Novel Application of Biothesiometry to Assess Changes in Penile Sensitivity

Penile sensory thresholds in subtypes of premature ejaculation: implications of comorbid erectile dysfunction.

Penile hypersensitivity plays an important role in premature ejaculation (PE), but differences in penile sensitivity among subtypes of PE are unknown. Therefore, we compared penile sensory thresholds in PE subtypes of lifelong and acquired PE, PE with and without erectile dysfunction (ED), PE with an intravaginal ejaculation latency time ≤1 min and >1 min, and PE with and without orgasmic pleasure perceptual dysfunction. During August 2014 to January 2016, 136 patients with PE were included. Penile warm, cold, and vibratory thresholds were measured. Data of clinical characteristics, sexual life, Premature Ejaculation Diagnostic Tool (PEDT) score, and the 5-item version of the International Index of Erectile Function (IIEF-5) score were collected. Vibratory thresholds of the PE with ED group were higher in the right coronal sulcus (median amplitude: 4.92 vs 3.65 μm, P = 0.02) and the right penile shaft (median amplitude: 3.87 vs 3.30 μm, P = 0.03), while differences in penile sensory thresholds between other subtypes were not significant. The median PEDT score was lower in the PE without ED group (12 vs 14, P < 0.001). The IIEF-5 and PEDT scores were negatively correlated (r = −0.29, P < 0.001). Patients with orgasmic pleasure perceptual dysfunction had a lower median IIEF-5 score (20 vs 21, P = 0.02). Patients with PE and ED had lower penile sensitivity, and ED was associated with more severe symptoms and weaker orgasmic pleasure perception. In men with PE, management of comorbid ED is necessary. In case of side effects in erectile function, topical anesthetics should be cautiously used in men with PE and ED.

Thulium-yttrium-aluminium-garnet (Tm:YAG) laser treatment of penile cancer: oncological results, functional outcomes, and quality of life.

To evaluate the oncological and functional outcomes of patients diagnosed with penile cancer undergoing conservative treatment through thulium-yttrium-aluminium-garnet (Tm:YAG) laser ablation. Twenty-six patients with a penile lesion underwent ablation with a RevoLix 200W continuous-wave laser. The procedure was carried out with a pen-like laser hand piece, using a 360μm laser fiber and 15-20W of power. Median (IQR) follow-up time was 24 (15-30) months. Recurrence rate and post-operative sexual function were assessed. Median age at surgery was 61years. Median (inter quartile range) size of the lesions was 15 [10-20] mm. Overall, 11 (47.8%) and 12 (52.2%) at the final pathology presented in situ and invasive squamous cell carcinoma (SCC), respectively. The final pathological stage was pTis, pT1a, pT2, and pT3 in 11 (47.8%), 7 (30.4%), 3 (13.0%), and 2 (8.7%) patients, respectively. Moreover, four (17.4%) patients had a recurrence of which three (13.0%) and one (4.3%) patients developed an invasive or in situ recurrence, respectively. After treatment 6 (26.1%) patients reported a conserved penile sensitivity, while 13 (56.5%) and 4 (17.4%) patients experienced a better or worse sensitivity after ablation, respectively. Post-treatment sexual activity was achieved within the first month after laser ablation in 82.6% of the patients. Early stage penile carcinomas can be effectively treated with an organ preservation strategy. Tm:YAG conservative laser treatment is easy, safe and offers good functional outcome, with a minor impact on patient's quality of life.

Total phallic reconstruction using radial forearm free flap after iatrogenic penile amputation

IntroductionThe iatrogenic loss of the penis is a rare situation. We present a challenging case of deferred total penile reconstruction in a genetic male. Material and methodsA 57-year-old man with the loss of the penis due to a penile abscess and necrosis secondary to penile curvature surgery. The reconstruction was performed over several operations using a radial forearm free flap (RFFF) and placement of a customized inflatable prosthesis a year later. ResultsDuring the first operation, the penile abscess was drained, the necrotic residues were debrided and placement of hypogastric drainage. Seven weeks later, phalloplasty was performed with RFFF and a tube-in-tube neourethra was constructed. Multiple microsurgical anastomosis was performed, and the donor site was coated with a skin graft from the thigh of partial thickness. The surgery lasted 10h and had the complication of hair growth in the neourethra, which required mechanical endoscopic depilation on repeated occasions. The patient regained penile sensitivity. Eighteen months after the phalloplasty, a Zephyr single-body inflatable prosthesis (Geneva, Switzerland) was implanted, using the tunica albuginea of the proximal corpus cavernosum. The patient was satisfied with the esthetics and urinary and sensory function. Four months later, the patient is gaining confidence to consider penetration. ConclusionsDespite the risk of postoperative complications and the need for multiple operations, phallic reconstruction with RFFF and the placement of a customized prosthetic implant can improve urinary and sexual function secondary to the loss of the penis.

A prospective evaluation of penile measures and glans penis sensory changes after penile prosthetic surgery.

BackgroundWith better designed devices and lower infection rates, satisfaction with inflatable penile prosthesis (IPP) placement is increasingly high. However, dissatisfaction is still present and there is disagreement regarding length and sensation changes after the IPP placement. The aim of this study was to evaluate changes in penile length, girth and sensitivity after IPP placement.MethodsFrom August 2012 to January 2013 all patients undergoing “de novo” IPP surgery were invited to participate in this study. Eighty six patients met inclusion criteria while 62 agreed to participate in this observational study. A week before surgery, penile length and circumference, and glans/elbow biothesiometer readings were recorded 15 minutes after Trimix induced erection. Same measures were taken at postoperative week 6 and month 6.ResultsAmperage from Glans biothesiometer readings showed statistically significant shorter readings than elbow biothesiometer preoperatively, 6 weeks and 6 months after surgery (P<0.001 each). No significant sensory difference in the glans penis after IPP was noted. However, compared to preoperative Trimix induced erections, penile length and circumference were greater after IPP placement (P=0.04 and P=0.001, respectively).ConclusionsWe observed statistically significant increase in penile length and girth after IPP placement without significant changes in sensory conduction.

MP79-20 RISK STRATIFICATION FOR ERECTILE DYSFUNCTION AFTER PELVIC FRACTURE URETHRAL INJURIES: A PILOT STUDY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I1 Apr 2017MP79-20 RISK STRATIFICATION FOR ERECTILE DYSFUNCTION AFTER PELVIC FRACTURE URETHRAL INJURIES: A PILOT STUDY Paul H Chung, Cody Gehring, Reza Firoozabadi, and Bryan B Voelzke Paul H ChungPaul H Chung More articles by this author , Cody GehringCody Gehring More articles by this author , Reza FiroozabadiReza Firoozabadi More articles by this author , and Bryan B VoelzkeBryan B Voelzke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2504AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pelvic fractures with associated urethral injuries are associated with a high risk of erectile dysfunction (ED) perhaps due to the proximity of the cavernosal nerve to the bulbomembranous junction. We sought to compare the frequency and severity of new onset ED in pelvic fracture patients with and without urethral injuries and to identify potential risk factors for ED in the setting of pelvic injury. METHODS A retrospective analysis was conducted evaluating male patients treated for pelvic fractures with and without urethral injury at a level 1 trauma center between 2005 and 2016. The International Index of Erectile Function (IIEF) questionnaire was administered by telephone to assess post-injury ED. Additional questions regarding pre-injury sexual function, glans vascular symptoms, glans sensitivity, and an updated past medical history were also administered. A diagnosis of new onset ED was defined as the patient having no recollection of ED prior to injury and subsequently having an IIEF score of <22 after injury. Glans vascular symptoms were defined as having a cold glans during an erection. Penile sensitivity was described as either decreased or increased sensitivity of the glans penis. RESULTS Of the 118 patients, 42% (50/118) patients responded to the questionnaire: 21 (42%) with pelvic fracture urethral injuries (PFUI) and 29 (58%) with pelvic fractures alone. We observed a numerical increase in new-onset ED in the PFUI group (n=12, 57%) when compared to the pelvic fracture alone group (n=11, 38%, p=0.29). The mean post-injury IIEF score was higher for the PFUI group (18 ± 7.6) than the pelvic fracture alone group (13 ± 8.7, p=0.05), with the PFUI patients more frequently developing severe ED (IIEF <7) (p<0.05). There were no significant differences in glans vascular symptoms (p=0.33) or penile sensitivity (p=0.17) between the two groups. Age, comorbidities, concomitant injuries, pelvic fracture pattern, and need for pelvic angioembolization were not risk factors for developing ED in either cohort. CONCLUSIONS ED was more severe in patients with PFUI compared to patients with pelvic fractures alone. Based on our results, a larger prospective analysis is warranted to better characterize ED in pelvic fracture patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1080 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Paul H Chung More articles by this author Cody Gehring More articles by this author Reza Firoozabadi More articles by this author Bryan B Voelzke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Sexual Pleasure and Function, Coital Trauma, and Sex Behaviors After Voluntary Medical Male Circumcision Among Men in the Dominican Republic

BackgroundVoluntary medical male circumcision (VMMC) is effective in decreasing the risk of HIV acquisition. As men resume sexual activity after circumcision, it will be important to study their satisfaction with the procedure, sexual pleasure and function, coital trauma, and risk compensation (RC), which can hamper or facilitate the long-term success of VMMC programs. AimTo assess men's satisfaction with VMMC, sexual pleasure and function, coital trauma, and RC after VMMC. MethodsThis is a cohort study of circumcised men who presented for follow-up 6 to 24 months after VMMC. Logarithmic binomial regression was performed to explore factors associated with any increase in the number of sex partners after VMMC as a measurement of RC. Main Outcome Measures(i) Men's satisfaction with their VMMC; (ii) sexual pleasure and function after VMMC; (iii) coital trauma; and (iv) RC. ResultsOf 454 circumcised men, 362 (80%) returned for a follow-up visit 6 to 24 months after VMMC. Almost all (98%) were satisfied with the outcome of their VMMC; most (95%) reported that their female partners were satisfied with their circumcision. Two thirds (67%) reported enjoying sex more after VMMC and most were very satisfied or somewhat satisfied (94%) with sexual intercourse after VMMC. Sexual function improved and reported sex-induced coital injuries decreased significantly in most men after VMMC. There was an increase in the proportion of men who reported at least two sexual partners after VMMC compared with baseline. In multivariate analysis, having sex with a woman they met the same day (adjusted relative risk = 1.7, 95% CI = 1.2–2.4) and having at least two sexual partners at baseline (adjusted relative risk = 0.5, 95% CI = 0.3–0.8) were associated with the outcome of any increase in the number of partners after VMMC. Clinical ImplicationsVMMC can be offered to Dominican men for HIV prevention without adversely affecting sexual pleasure or function. The procedure substantially reduces coital trauma. Strengths & LimitationsThis is the first report of long-term overall satisfaction, sexual pleasure/function and sex behaviors in the context of VMMC outside of Africa. Limitations of the study included the reliance on self-reported sex behaviors, the lack of physiologic measurement of penile sensitivity and the lack of follow up data beyond 24 months, which precludes the assessment of longer term RC. ConclusionThe study confirmed men's long-term satisfaction with the outcome of their VMMC. VMMC improved sexual pleasure and function for most men and significantly decreased coital injuries. There was mixed evidence of RC.Brito MO, Khosla S, Pananookooln S, et al. Sexual Pleasure and Function, Coital Trauma, and Sex Behaviors After Voluntary Medical Male Circumcision Among Men in the Dominican Republic. J Sex Med 2017;14:526–534.

Reconstrucción fálica total con colgajo libre antebraquial radial tras amputación peneana iatrogénica

IntroductionThe iatrogenic loss of the penis is a rare situation. We present a challenging case of deferred total penile reconstruction in a genetic male. Material and methodsA 57-year-old man with the loss of the penis due to a penile abscess and necrosis secondary to penile curvature surgery. The reconstruction was performed over several operations using a radial forearm free flap (RFFF) and placement of a customised inflatable prosthesis a year later. ResultsDuring the first operation, the penile abscess was drained, the necrotic residues were debrided and placement of hypogastric drainage. Seven weeks later, phalloplasty was performed with RFFF and a tube-in-tube neourethra was constructed. Multiple microsurgical anastomosis was performed, and the donor site was coated with a skin graft from the thigh of partial thickness. The surgery lasted 10hours and had the complication of hair growth in the neourethra, which required mechanical endoscopic depilation on repeated occasions. The patient regained penile sensitivity. Eighteen months after the phalloplasty, a Zephyr single-body inflatable prosthesis (Geneva, Switzerland) was implanted, using the tunica albuginea of the proximal corpus cavernosum. The patient was satisfied with the aesthetics and urinary and sensory function. Four months later, the patient is gaining confidence to consider penetration. ConclusionsDespite the risk of postoperative complications and the need for multiple operations, phallic reconstruction with RFFF and the placement of a customised prosthetic implant can improve urinary and sexual function secondary to the loss of the penis.

Infant circumcision and adult penile sensitivity: implications for sexual experience

A recent study reported that neonatal circumcision is not associated with changes in adult penile sensitivity, leading to viral coverage in both traditional and online media. In this commentary the author questions the conclusions drawn from the study and explores the relationship between objective assessments of penile sensitivity and subjective sexual experience and satisfaction. The author concludes with suggestions for improving future research.

MP81-07 PATIENT-REPORTED ASSESSMENT OF ANATOMICAL, NEUROLOGICAL AND FUNCTIONAL CHANGES OF THE GENITALIA AFTER ANTERIOR URETHROPLASTY: INCIDENCE AND RECOVERY OF FUNCTION

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease II1 Apr 2016MP81-07 PATIENT-REPORTED ASSESSMENT OF ANATOMICAL, NEUROLOGICAL AND FUNCTIONAL CHANGES OF THE GENITALIA AFTER ANTERIOR URETHROPLASTY: INCIDENCE AND RECOVERY OF FUNCTION Christopher Tam, Maria Voznesensky, Benjamin Breyer, Sean Elliott, Christopher McClung, Jeremy Myers, Alex Vanni, Bryan Voelzke, and Bradley Erickson Christopher TamChristopher Tam More articles by this author , Maria VoznesenskyMaria Voznesensky More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Sean ElliottSean Elliott More articles by this author , Christopher McClungChristopher McClung More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Alex VanniAlex Vanni More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2060AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Anterior urethroplasty is thought to cause erectile dysfunction in only a small percentage of patients, but little is known about how the patient perceives other changes to their genitalia after surgery. The purpose of this study was to evaluate patient-reported post-operative anatomical, neurological and functional changes after urethroplasty. We hypothesized higher rates of dysfunction and slower recovery in patients with longer strictures and those undergoing penile urethroplasty. METHODS We retrospectively reviewed a multi-institutional urethroplasty database for patients that completed a post-operative sexual function questionnaire assessing patient-reported penile anatomical changes. The questionnaire was given routinely at 3 months and then again at all subsequent post-operative visits. Predictors of initial sexual dysfunction were analyzed using logistic regression; recovery of function was assessed with Kaplan-Meier estimations. RESULTS A total of 392 men completed at least two post-operative questionnaires. Rates of initial (3 mo) sexual dysfunction were high with 31% of subjects reporting alteration of sexual intercourse (relative to pre-op), 20% reporting de novo penile curvature, 37% noticing loss of penile length, and 22% experiencing decreased penile sensitivity. Partner-reported erectile dysfunction was similar to patient reported rates at 32%. Patients undergoing penile urethroplasty were significantly more likely to report penile curvature (OR 3.65, 95% CI 1.67-7.97) and penile sensation loss (OR 2.86, 1.27-6.44) versus bulbar repair at early follow-up. Stricture length or repair type (excisional versus buccal) did not independently predict post-operative sexual dysfunction. Recovery of function was predicted for most patients by 3 years (Figure 1), though significantly slower rates of recovery of penile length (HR 1.38), penile curvature (HR 1.41) and penile sensation (HR 1.42) were seen in penile repairs as compared to bulbar repairs. CONCLUSIONS Patient-reported rates of genital sensory and anatomical alteration after anterior urethroplasty are high. Recovery is common but can take many years, with higher rates of dysfunction and slower recovery in men undergoing penile urethroplasty. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1055 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Christopher Tam More articles by this author Maria Voznesensky More articles by this author Benjamin Breyer More articles by this author Sean Elliott More articles by this author Christopher McClung More articles by this author Jeremy Myers More articles by this author Alex Vanni More articles by this author Bryan Voelzke More articles by this author Bradley Erickson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Jun 2016This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.03.071AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : The accuracy of references in The Journal of Urology®. J Urol2016; 195: 1952. Abstract, Google Scholar 2 : Safety and efficacy of ureteral stent placement at the bedside using local anesthesia. J Urol2016; 195: 1886. Abstract, Google Scholar 3 : Validation of a genomic classifier for predicting post-prostatectomy recurrence in a community based health care setting. J Urol2016; 195: 1748. Link, Google Scholar 4 : Laparoscopic nephrectomy as outpatient surgery. J Urol2016; 195: 1671. Link, Google Scholar 5 : Preoperative International Prostate Symptom Score predictive of inguinal hernia in patients undergoing robotic prostatectomy. J Urol2016; 195: 1744. Link, Google Scholar 6 : Standardizing the definition of biochemical recurrence after radical prostatectomy—what prostate specific antigen cut point best predicts a durable increase and subsequent systemic progression?. J Urol2016; 195: 1754. Link, Google Scholar 7 : More favorable pathological outcomes in men with low risk prostate cancer diagnosed on repeat versus initial transrectal ultrasound guided prostate biopsy. J Urol2016; 195: 1767. Abstract, Google Scholar 8 : Critical analysis of early recurrence after laparoscopic radical cystectomy in a large cohort by the ESUT. J Urol2016; 195: 1710. Abstract, Google Scholar 9 : Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing. J Urol2016; 195: 1848. Abstract, Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 195Issue 6June 2016Page: 1633-1635 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Examining Penile Sensitivity in Neonatally Circumcised and Intact Men Using Quantitative Sensory Testing

Little is known about the long-term implications of neonatal circumcision on the penile sensitivity of adult men, despite recent public policy endorsing the procedure in the United States. In the current study we assessed penile sensitivity in adult men by comparing peripheral nerve function of the penis across circumcision status. A total of 62 men (age 18 to 37 years, mean 24.2, SD 5.1) completed study procedures (30 circumcised, 32 intact). Quantitative sensory testing protocols were used to assess touch and pain thresholds (modified von Frey filaments) and warmth detection and heat pain thresholds (a thermal analyzer) at a control site (forearm) and 3 to 4 penile sites (glans penis, midline shaft, proximal to midline shaft and foreskin, if present). Penile sensitivity did not differ across circumcision status for any stimulus type or penile site. The foreskin of intact men was more sensitive to tactile stimulation than the other penile sites, but this finding did not extend to any other stimuli (where foreskin sensitivity was comparable to the other sites tested). Findings suggest that minimal long-term implications for penile sensitivity exist as a result of the surgical excision of the foreskin during neonatal circumcision. Additionally, this study challenges past research suggesting that the foreskin is the most sensitive part of the adult penis. Future research should consider the direct link between penile sensitivity and the perception of pleasure/sensation. Results are relevant to policy makers, parents of male children and the general public.

Higher Frequency of Unprotected Insertive Anal Sex Among Young Black MSM Who are Circumcised

I read with great interest the recent paper by Crosby et al., in which the authors failed to find any significant difference in the prevalence of HIV (or other sexually transmitted infections) between circumcised and intact young black men who have sex with men (MSM) in the United States [1]. Their findings are in line with those of a 2011 Cochrane review showing no significant association overall between circumcision/foreskin status and HIV infection in MSM, although a subanalysis suggested a possible reduction in HIV risk among circumcised MSM who predominantly take the insertive role during anal sex [2]. However, a subsequent British study found no evidence that circumcision is protective against HIV among MSM who predominantly engage in anal sex as the insertive partner [3]. Crosby et al. highlight an additional, potentially noteworthy finding in their article’s abstract [1]. They report that ‘‘The mean frequency of unprotected insertive anal sex for circumcised men was about twice as high compared to those intact (P = .04).’’ This finding is consistent with evidence from another recent study by Feldblum et al. [4], which pointed to reduced condom use following adult circumcision among a large sample of Kenyan men. Unfortunately, Crosby et al. make no mention anywhere in the main text about this statistically significant finding. Perhaps the authors considered it to be a chance finding because, apparently, it was the only statistically significant result in their study. However, there are reasons why this finding may actually deserve some attention. First, such a result is plausible on anatomical and behavioral grounds. Since circumcision removes the adult equivalent of approximately 50 cm of touch-sensitive tissue (see below), one might expect an overall reduction in penile sensitivity as a function of the surgery. Since condoms tend to decrease penile sensitivity [5], circumcised men may have conscious or unconscious motivations to avoid any further desensitization during sex, which could explain their reduced condom use. Laboratory investigations have sought to determine whether the foreskin is a particularly sensitive penile structure, and have produced conflicting results. Some researchers have provided evidence that the foreskin is the most sensitive part of the penis [6], while others fail to confirm such findings [7]. However, regardless of whether sensitivity per square centimeter is actually higher in the foreskin compared to other parts of the penis, or the foreskin is merely as sensitive as other parts of the sexual organ, the overall sensory input from a circumcised penis during sex will be reduced in a manner that plausibly depends—at least to some extent—on the amount of foreskin removed. The obvious reason for this is that any sensation that would be experienced in the foreskin itself is necessarily eliminated by circumcision [8]. The adult foreskin—with its rich supply of nerve endings and specialized sensory structures [9]—may comprise up to 100 cm, with reported average values between 30 and 50 cm [10, 11]. The contribution of this motile sleeve of erogenous tissue to overall penile sensitivity is not known with certainty. However, any specific qualitative sensation elicited by the mechanical rolling and gliding movements of the foreskin during sexual activity will in fact be absent or reduced in circumcised men [8]. & Morten Frisch mfr@ssi.dk

Editorial Comment

This is a multicenter collaborative study about sexual and ejaculatory function after staged penile urethroplasty. As Patel et al 1 Patel D.P. Elliott S.P. Voelzke B.B. et al. Patient-reported sexual function after staged penile urethroplasty. Urology. 2015; 86: 395-400 Abstract Full Text Full Text PDF Scopus (24) Google Scholar note, surgical success following staged penile urethroplasty with oral mucosa grafts has been well described; however, little is known about how the surgery affects sexual function. Patient-Reported Sexual Function After Staged Penile UrethroplastyUrologyVol. 86Issue 2PreviewTo evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG). Full-Text PDF ReplyUrologyVol. 86Issue 2PreviewWe thank Dr. Buckley1 for her thoughtful editorial comments. Our analyses are likely underpowered to detect a change in preoperative vs postoperative Sexual Health Inventory for Men (SHIM) and Male Sexual Health Questionnaire Ejaculatory Domain (MSHQ-EjD) scores, given the small sample size and limited questionnaire completion. However, our results do add to the current literature to help guide reconstructive urologists when counseling patients considering staged penile urethroplasty. Importantly, a significant percentage of patients reported a change in penile curvature, length, and/or sensitivity on our nonvalidated posturethoplasty questionnaire. Full-Text PDF

Patient-Reported Sexual Function After Staged Penile Urethroplasty

To evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG). We identified men with completed staged penile urethroplasty with OMG from the Trauma and Urologic Reconstruction Network of Surgeons database between January 1, 2010 and May 1, 2014. Our primary outcome was change in total Sexual Health Inventory for Men (SHIM) and total Male Sexual Health Questionnaire Ejaculatory Domain (MSHQ-EjD) Short Form at baseline vs after the second stage of the procedure. Second, we assessed subjective changes in penile curvature, length, and sensation. Thirty-three patients were included with a mean age of 45years and mean body mass index of 27.6kg/m(2). Urethral strictures arose from failed hypospadias repair in 52% and lichen sclerosus in 27%. Fifty-two percent of patients reported a previous urethroplasty. The median follow-up time between the second stage procedure and postoperative questionnaires was 6.3months (interquartile range: 3.5-13.3). There was no significant change in the total SHIM (Δ0.64, 95% confidence interval [CI]:-3.00∼1.72) and MSHQ-EjD (Δ1.55, 95% CI:-1.53∼4.63) scores preoperatively vs postoperatively. In addition, 32% reported improved and 52% no change in satisfaction with sexual intercourse (SHIM Q5). Forty percent of patients reported reduced and 45% no change in bother with ejaculation after surgery (MSHQ-EjD Q4). Men reported new penile curvature (23%), loss of penile length (55%), and altered penile sensitivity (45%) after surgery. Patients undergoing staged penile urethroplasty with OMG are likely to have minimal changes in erectile and ejaculatory function postoperatively, although many may experience new penile curvature, reduced penile length, and/or reduced penile sensitivity.

Histological Correlates of Penile Sexual Sensation: Does Circumcision Make a Difference?

IntroductionThe question of whether removal of sensory receptors in the prepuce by circumcision affects sensitivity and/or sexual pleasure is often debated.AimsTo examine histological correlates relevant to penile sensitivity and sexual pleasure.MethodsSystematic review of the scientific literature on penile structures that might affect sensitivity and sexual sensation. Articles were included if they contained original data on human male penile histology or anatomy. Individual articles, including reference lists, were evaluated. They were then considered in relation to physiological data from articles retrieved by a previous systematic review.ResultsWe retrieved 41 publications on penile structure. Considered in the light of 12 reporting physiological measurements, our evaluation finds that sexual response is unlikely to involve Meissner’s corpuscles, whose density in the prepuce diminishes at the time of life when male sexual activity is increasing. Free nerve endings also show no correlation with sexual response. Because tactile sensitivity of the glans decreases with sexual arousal, it is unrelated to sexual sensation. Thermal sensitivity seems part of the reward mechanism of intercourse. Vibrational sensitivity is not related to circumcision status. Observations that penile sexual sensation is higher post circumcision are consistent with greater access of genital corpuscles to sexual stimuli after removal of the prepuce. This is based on the distribution of these corpuscles (which are located in the glans) and, in uncircumcised men, the position of the retracted prepuce during intercourse, rather than any change in the number of genital corpuscles. The scientific literature suggests that any sexual effect of circumcised men may depend solely on exposure of the glans and not on the absence of the prepuce.ConclusionBased on histological findings and correlates of sexual function, loss of the prepuce by circumcision would appear to have no adverse effect on sexual pleasure. Our evaluation supports overall findings from physiological measurements and survey data.

Anastomotic Repair versus Free Graft Urethroplasty for Bulbar Strictures: A Focus on the Impact on Sexual Function

Objectives. To evaluate alterations in sexual function and genital sensitivity after anastomotic repair (AR) and free graft urethroplasty (FGU) for bulbar urethral strictures. Methods. Patients treated with AR (n = 31) or FGU (n = 16) were prospectively evaluated before, 6 weeks and 6 months after urethroplasty. Evaluation included International Prostate Symptom Score (IPSS), 5-Item International Index of Erectile Function (IIEF-5), Ejaculation/Orgasm Score (EOS), and 3 questions on genital sensitivity. Results. At 6 weeks, there was a significant decline of IIEF-5 for AR (−4.8; p = 0.005), whereas there was no significant change for FGU (+0.9; p = 0.115). After 6 months, differences with baseline were not significant overall and among subgroups. At 6 weeks, there was a significant decline in EOS for AR (−1.4; p = 0.022). In the FGU group there was no significant change (+0.6; p = 0.12). Overall and among subgroups, EOS normalized at 6 months. After 6 weeks and 6 months, respectively, 62.2 and 52% of patients reported alterations in penile sensitivity with no significant differences among subgroups. Conclusions. AR is associated with a transient decline in erectile and ejaculatory function. This was not observed with FGU. Bulbar AR and FGU are likely to alter genital sensitivity.

Post Traditional Circumcision Penile Skin Degloving in a Five Year Old Boy: Short Discussion

Circumcision is the surgical removal of the prepucial skin of the penis, some of the complications of traditional circumcision includes; sepsis, genital mutilation, redundant prepuce, gangrene of penis, excessive bleeding, penile amputation or urinary retention, others include loss of penile sensitivity, metal stenosis, and urethrocuteneous fistula. Among the documented complications we did not come across complete degloving of the penile skin, as we found in this 5-year-old patient, who had traditional circumcision with application of some concoction on the penis leading to sloughing of the entire penile skin. A case report of 5-year-old Hausa Muslim boy who after penis skin avulsion presented with a 5 days history of a penile swelling and pain with discharge of purulent material, following a traditional circumcision and application of a concoction on the penis. Examination revealed acutely ill looking boy who was crying warm to touch, he has a degloved penis with sloughs and purulent discharge, the external urethral meatus was partly covered by crust and blood clots, no active bleeding and a diagnosis of post-circumcision degloved penis was made and patient was admitted. Patient was planned for reconstruction and penile coverage with split thickness skin grafting which he had on 5th day of admission, he was placed on parenteral antibiotics, analgesic, and intravenous fluids and graft site was dressed with Vaseline gauze and he was discharged on 7th day post-operative.

Penile anesthesia in Post SSRI Sexual Dysfunction (PSSD) responds to low-power laser irradiation: A case study and hypothesis about the role of transient receptor potential (TRP) ion channels

Treatment of paroxetine-induced penile anesthesia in Post SSRI Sexual Dysfunction (PSSD) by Low-power Laser Irradiation (LPLI) is unknown in medical literature. The aim of the current article is to report partial efficacy of LPLI for paroxetine-induced persistent penile anesthesia. We report on a male patient who presented with a history of reversible loss of smell, taste and skin sensitivity occurring within a week after start of 20mg/day paroxetine-hemihydrate for a depressive period. Concurrently, patient suffered from penile anesthesia, scrotum hypesthesia, anejaculation and erectile difficulties with normal sexual desire. During 2.5 years of paroxetine treatment and throughout 2 years after paroxetine discontinuation, genital and sexual complaints persisted. Penile anesthesia was treated by LPLI with single and multi diode pulsed laser probes. After 20 LPLI-treatment sessions of 15min each, patient reported partial return of penile touch and temperature sensation. Clinical improvement of glans penis sensitivity was reported to 20% and 40%, compared to pre-paroxetine treatment penile sensitivity during erect and flaccid states, respectively. However, anejaculation and erectile difficulties remained unchanged. Briefly, in the current patient with early onset of PSSD, LPLI treatment reduced paroxetine-induced penile anesthesia. It is hypothesized that SSRI treatment induces disturbances of transient receptor potential (TRP) ion channels of mechano-, thermo- and chemosensitive nerve endings and receptors resulting in the penile anesthesia in PSSD. It is further hypothesized that there are two types of PSSD, one of which occurs soon after the start of SSRI treatment.

A Review of the Current State of the Male Circumcision Literature

Male circumcision is one of the most commonly performed surgical procedures worldwide and a subject that has been the center of considerable debate. Recently, the American Association of Pediatrics released a statement affirming that the medical benefits of neonatal circumcision outweigh the risks. At present, however, the majority of the literature on circumcision is based on research that is not necessarily applicable to North American populations, as it fails to take into account factors likely to influence the interpretability and applicability of the results. The purpose of this review is to draw attention to the gaps within the circumcision literature that need to be addressed before significant changes to public policy regarding neonatal circumcision are made within North America. A literature review of peer-reviewed journal articles was performed. The main outcome measure was the state of circumcision research, especially with regard to new developments in the field, as it applies to North American populations. This review highlights considerable gaps within the current literature on circumcision. The emphasis is on factors that should be addressed in order to influence research in becoming more applicable to North American populations. Such gaps include a need for rigorous, empirically based methodologies to address questions about circumcision and sexual functioning, penile sensitivity, the effect of circumcision on men's sexual partners, and reasons for circumcision. Additional factors that should be addressed in future research include the effects of age at circumcision (with an emphasis on neonatal circumcision) and the need for objective research outcomes. Further research is needed to inform policy makers, health-care professionals, and stakeholders (parents and individuals invested in this debate) with regard to the decision to perform routine circumcision on male neonates in North America.