Adult Penis Research Articles

Iatrogenic Trapped Penis in Adults: New, Simple 2-Stage Repair

We present a new, 2-stage functional and cosmetic reconstruction of concealed penis in adults with short-term subjective outcomes. Patients with excess penile skin removal, shaft tissue scarring and penile retraction with poor functional and cosmetic results underwent 2-stage repair. At stage 1 after a coronal incision and penile degloving an intrascrotal tunnel was formed and the penis was transposed through the scrotum. Three or 4 zero or 2-zero nonresorbable sutures were applied ventral to the penis, crossing through the entire scrotum to ensure complete scrotal skin adhesion to the penis (penile scrotalization). At stage 2 after 6 to 12 weeks the scrotal skin at the penile base was incised bilaterally to separate the skin around the penis from the remaining scrotal skin (penile descrotalization). Evaluation was scheduled 3, 6 and 9 months postoperatively, and annually thereafter. Ten men with concealed penis underwent this 2-stage penile repair, including 8 who were circumcised and 2 who underwent conservative surgery for penile cancer. Mean +/- SD operative time was 75 +/- 15 minutes for stage 1 and 45 +/- 10 minutes for stage 2. No major intraoperative or perioperative complications occurred except superficial scrotal hematoma in 1 patient. At a median followup of 20 months (range 6 to 72) all men were in satisfactory clinical condition and the median patient satisfaction visual analog score was 97 (range 85 to 100). All patients recovered normal spontaneous erection with regular sexual intercourse 4 to 8 weeks after operation 2. This simple, new 2-stage technique seems feasible and effective, and it is well accepted by patients. Further studies are mandatory to confirm preliminary results.

The Role of Hedgehog-Interacting Protein in Maintaining Cavernous Nerve Integrity and Adult Penile Morphology

IntroductionSonic hedgehog (SHH) is an essential regulator of smooth muscle apoptosis in the penis that has significant clinical potential as a therapy to suppress post-prostatectomy apoptosis, an underlying cause of erectile dysfunction (ED). Thus an understanding of how SHH signaling is regulated in the adult penis is essential to move the field of ED research forward and to develop new treatment strategies. We propose that hedgehog-interacting protein (HIP), which has been shown to bind SHH protein and to play a role in SHH regulation during embryogenesis of other organs, is a critical regulator of SHH signaling, penile morphology, and apoptosis induction. AimsWe have examined HIP signaling in the penis and cavernous nerve (CN) during postnatal differentiation of the penis, in CN-injured, and a diabetic model of ED. MethodsHIP localization/abundance and RNA abundance were examined by immunohistochemical (IHC) analysis and real-time reverse transcriptase-polymerase chain reaction (RT-PCR) in Sprague-Dawley rats between the ages of 7 and 92 days old, in CN-injured Sprague-Dawley rats and in BioBreeding/Worcester diabetic rats. HIP signaling was perturbed in the pelvic ganglia and in the penis and TUNEL assay was performed in the penis. CN tie, lidocaine, and anti-kinesin experiments were performed to examine HIP signaling in the CN and penis. ResultsIn this study we are the first to demonstrate that HIP undergoes anterograde transport to the penis via the CN, that HIP perturbation in the pelvic ganglia or the penis induces apoptosis, and that HIP plays a role in maintaining CN integrity, penile morphology, and SHH abundance. ConclusionsThese studies are significant because they show HIP involvement in cross-talk (signaling) between the pelvic ganglia and penis, which is integral for maintenance of penile morphology and they suggest a mechanism of how nerves may regulate target organ morphology and function. Angeloni NL, Bond CW, Monsivais D, Tang Y, and Podlasek CA. The role of hedgehog-interacting protein in maintaining cavernous nerve integrity and adult penile morphology. J Sex Med 2009;6:2480–2493.

Revealing the Buried Penis in Adults

Several surgical solutions have been proposed for resolving penile concealment with successful outcomes. Those include liposuction, adhesiolysis, and suprapubic lipectomy through the abdominal crease. Nevertheless, some limitations exist and compromise the results of surgical correction. This work presents our technique for revealing the hidden penis, addressing the limitations of existing methods for surgical correction. Sixty-four adult males with buried penis were operated upon. The penis was revealed by the combination of adhesiolysis, suprapubic and lateral lipectomy, anchoring the penoscrotal and penopubic junctions, and skin coverage by a local flap. Penile length in the flaccid and erect states. Average postoperative length in the flaccid state was approximately 7 cm +/- 1.3 (a 293% increase) and in the erect state was 18.4 cm +/- 2.9 (185.7% increase), compared with preoperative length of 1.8 cm +/- 0.4 in the flaccid state and 6.4 cm +/- 1.6 in the erect state. Minor complications occurred. There was no deterioration in sexual function. Revealing the concealed penis is a complicated procedure. The outcome may be improved by implementing a radical approach to tissue excision, providing adequate skin coverage, and anchoring the penile shaft, skin, and subcutaneous tissues in the revealed state to prevent relapse.

Sonic Hedgehog, Apoptosis, and the Penis

Smooth muscle apoptosis in the penis is common in prostatectomy patients and animal models of erectile dysfunction (ED). A critical regulator of smooth muscle apoptosis in the penis is the secreted protein Sonic hedgehog (SHH). Since SHH protein treatment of the penis prevents cavernous nerve (CN) injury-induced apoptosis, SHH has the potential to treat post-prostatectomy apoptosis. However, little is known about how SHH signaling is regulated in the adult penis. The goal of this review is to examine what is known about SHH signaling in the penis, to offer insight as to how SHH inhibition induces apoptosis in penile smooth muscle, and to define the role of the SHH pathway in maintaining CN integrity. Information presented in this review was derived from a literature search using the National Library of Medicine PubMed Services. Search terms included SHH, apoptosis, smooth muscle, penis, ED, pelvic ganglia, corpora cavernosa, CN, regeneration, Schwann cell, neural activity, and transport. In this review, we have discussed the role of the CN in regulation of SHH abundance and apoptosis induction in the penis, and have examined the function and localization of SHH signaling in the CN. There is substantial potential to develop SHH for delivery to the penis of prostatectomy patients at the time of surgery in order to prevent apoptosis induction and long-term ED development. Studies are in progress that will identify if SHH may be used as a regenerative therapy to speed CN regeneration.

BURIED PENIS IN ADULTS

You have accessJournal of Urology1 Apr 2008BURIED PENIS IN ADULTS Timothy O Davies, Uri Gur, Kurt A McCammon, Steven M Schlossberg, David R Gilbert, and Gerald H Jordan Timothy O DaviesTimothy O Davies More articles by this author , Uri GurUri Gur More articles by this author , Kurt A McCammonKurt A McCammon More articles by this author , Steven M SchlossbergSteven M Schlossberg More articles by this author , David R GilbertDavid R Gilbert More articles by this author , and Gerald H JordanGerald H Jordan More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60033-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "BURIED PENIS IN ADULTS." The Journal of Urology, 179(4S), p. 10 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 10 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Timothy O Davies More articles by this author Uri Gur More articles by this author Kurt A McCammon More articles by this author Steven M Schlossberg More articles by this author David R Gilbert More articles by this author Gerald H Jordan More articles by this author Expand All Advertisement PDF downloadLoading ...

Torsion of the Penis in Adults: Prevalence and Surgical Correction

Torsion of the penis is a condition where the penis rotates around its longitudinal axis, whether congenital or acquired. Extreme degrees may provoke a cosmetic complaint. We describe surgical correction of congenital torsion of the penis in adults, and its prevalence among a special patient group. Success and ease of surgical repair. Sixteen cases with congenital torsion were operated upon, by counter-rotation, using a dartos flap in eight cases, and skin realignment in the other eight. The prevalence of congenital torsion was examined in 12,307 patients attending two andrology clinics. Full correction was achieved in all cases. Skin realignment was easier and faster than dartos flap, and was equally effective. Congenital torsion was present in 11.993% of the epidemiologic study group, mild in 80%, moderate in 15%, and severe in 5%. Only 2.2% was bothered by the condition. Torsion of the penis is not uncommon but rarely provokes a complaint. Surgical repair by degloving and skin realignment is effective and easy. Dartos flap technique may be utilized if the former is inadequate.

Neural Influences on Sonic Hedgehog and Apoptosis in the Rat Penis1

The role of sonic hedgehog (SHH) in maintaining corpora cavernosal morphology in the adult penis has been established; however, the mechanism of how SHH itself is regulated remains unclear. Since decreased SHH protein is a cause of smooth muscle apoptosis and erectile dysfunction (ED) in the penis, and SHH treatment can suppress cavernous nerve (CN) injury-induced apoptosis, the question of how SHH signaling is regulated is significant. It is likely that neural input is involved in this process since two models of neuropathy-induced ED exhibit decreased SHH protein and increased apoptosis in the penis. We propose the hypothesis that SHH abundance in the corpora cavernosa is regulated by SHH signaling in the pelvic ganglia, neural activity, or neural transport of a trophic factor from the pelvic ganglia to the corpora. We have examined each of these potential mechanisms. SHH inhibition in the penis shows a 12-fold increase in smooth muscle apoptosis. SHH inhibition in the pelvic ganglia causes significantly increased apoptosis (1.3-fold) and decreased SHH protein (1.1-fold) in the corpora cavernosa. SHH protein is not transported by the CN. Colchicine treatment of the CN resulted in significantly increased smooth muscle apoptosis (1.2-fold) and decreased SHH protein (1.3-fold) in the penis. Lidocaine treatment of the CN caused a similar increase in apoptosis (1.6-fold) and decrease in SHH protein (1.3-fold) in the penis. These results show that neural activity and a trophic factor from the pelvic ganglia/CN are necessary to regulate SHH protein and smooth muscle abundance in the penis.

Corrigenda

BJU InternationalVolume 100, Issue 2 p. 481-481 Free Access corrigenda First published: 04 July 2007 https://doi.org/10.1111/j.1464-410X.2007.07066_1.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In [1], the following error was present in the submitted manuscript and subsequently appeared in the print issue BJU99:4. PAGE 867 Table 3. In Table 3, following the two instances of “Circumcision” in the first column, the numbers in the second column should read “+0.1554” and “+0.161” in place of “−0.1554” and “−0.161”, respectively. REFERENCE 1 Sorrells ML et al. Fine-touch pressure thresholds in the adult penis. BJU Int 2007; 99: 864– 9 Volume100, Issue2August 2007Pages 481-481 ReferencesRelatedInformation

Fine‐touch pressure thresholds in the adult penis

To map the fine-touch pressure thresholds of the adult penis in circumcised and uncircumcised men, and to compare the two populations. Adult male volunteers with no history of penile pathology or diabetes were evaluated with a Semmes-Weinstein monofilament touch-test to map the fine-touch pressure thresholds of the penis. Circumcised and uncircumcised men were compared using mixed models for repeated data, controlling for age, type of underwear worn, time since last ejaculation, ethnicity, country of birth, and level of education. The glans of the uncircumcised men had significantly lower mean (sem) pressure thresholds than that of the circumcised men, at 0.161 (0.078) g (P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity. There were significant differences in pressure thresholds by location on the penis (P < 0.001). The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds than the ventral scar of the circumcised penis. The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.

Buried Penis Release in Adults with Suction Lipectomy and Abdominoplasty

The buried penis in adults who had substantial weight gain was treated with a combination of suction lipectomy of the abdomen and pubic area and the release of the suspensory ligament of the penis and with abdominoplasty with suture anchoring of the pubic and penile skin base dermis to the rectus fascia superiorly. This procedure was performed in 11 patients over the past 10 years with satisfactory results. One patient required additional excess skin excision from the side of the pubic and scrotal area to improve the results. (Plast. Reconstr. Surg. 106: 840, 2000.)

Buried penis release in adults with suction lipectomy and abdominoplasty.

The buried penis in adults who had substantial weight gain was treated with a combination of suction lipectomy of the abdomen and pubic area and the release of the suspensory ligament of the penis and with abdominoplasty with suture anchoring of the pubic and penile skin base dermis to the rectus fascia superiorly. This procedure was performed in 11 patients over the past 10 years with satisfactory results. One patient required additional excess skin excision from the side of the pubic and scrotal area to improve the results.

Congenital hypogonadotropic hypogonadism and micropenis: Effect of testosterone treatment on adult penile size—Why sex reversal is not indicated

Micropenis is commonly due to fetal testosterone deficiency. The clinical management of this form of micropenis has been contentious, with disagreement about the capacity of testosterone treatment to induce a functionally adequate adult penis. As a consequence, some clinicians recommend sex reversal of affected male infants. We studied 8 male subjects with micropenis secondary to congenital pituitary gonadotropin deficiency from infancy or childhood to maturity (ages 18 to 27 years). Four patients were treated with testosterone before 2 years of age (group I) and four between age 6 and 13 years (group II). At presentation, the mean penile length in group I was 1.1 cm (–4 SD; range, 0.5 to 1.5 cm) and in group II it was 2.7 cm (–3.4 SD; range, 1.5 to 3.5 cm). All patients received one or more courses of 3 intramuscular injections of testosterone enanthate (25 or 50 mg) at 4-week intervals in infancy or childhood. At the age of puberty the dose was gradually increased to 200 mg monthly and later to an adult replacement regimen. As adults, both group I and II had attained a mean final penile length of 10.3 cm ± 2.7 cm with a range of 8 to 14 cm (mean adult stretched penile length for Caucasians is 12.4 ± 2.7 cm). Six of 8 men were sexually active, and all reported normal male gender identity and psychosocial behavior. We conclude that 1 or 2 short courses of testosterone therapy in infancy and childhood augment penile size into the normal range for age in boys with micropenis secondary to fetal testosterone deficiency; replacement therapy at the age of puberty results in an adult size penis within 2 SD of the mean. We found no clinical, psychologic, or physiologic indications to support conversion of affected male infants to girls. Further, the results of this study do not support the notion, derived from data in the rat, that testosterone treatment in infancy or childhood impairs penile growth in adolescence and compromises adult penile length. (J Pediatr 1999;134:579-83)

A NEW TECHNIQUE FOR CORRECTION OF THE HIDDEN PENIS IN CHILDREN AND ADULTS

A phenomenon known as hidden penis has numerous origins, including congenital buried penis and obesity with descent of the escutcheon. No previous report to our knowledge mentions abnormal hypermobility of ventral skin and dartos fascia, which is a major cause of surgical treatment failures. Because the skin and dartos fascia are inadequately attached to Buck's fascia, the corporeal bodies telescope proximally inside the scrotum and pubis. Therefore, the subdermis of the penoscrotal junction must also be tacked to the tunica albuginea ventrally to stabilize the proximal penile skin and prevent the penis from retracting into the scrotum. The surgical technique for correction of the hidden penis in adult and pediatric patients with adequate penile shaft skin is described. Surgery for hidden penis from multiple causes was performed in 6 adults and 7 children. Tacking sutures were taken from the subdermis of the ventral penoscrotal junction to the tunica albuginea in all cases. A combination procedure with either suprapubic dermatolipectomy, tacking of the penopubic subdermis to the rectus fascia, penoscrotal Z plasty, circumcision revision or lateral penile shaft Z plasty also was performed in some patients. Improvement was noted in all cases. One child requires suprapubic lipectomy for optimal improvement and 3 minor wound problems occurred. Surgery for hidden penis achieves marked aesthetic and often functional improvement. Surgical failure can be diminished by placing ventral tacking sutures from the tunica albuginea to the subdermis of the penoscrotal junction.

The condom: an effective penile dressing.

An effective penile dressing should support the wound, prevent contamination, and minimize edema and hematoma formation. Traditional penile dressings are cumbersome to apply and hard to secure. This report describes use of a condom to provide support after operations on the adult penis. After surgery, the penis is loosely wrapped with sterile gauze and a condom is rolled down over the dressing to the base of the penis. The tip of the condom is cut off and the ring of latex at its base is divided to prevent constriction. Patients can urinate through the excised tip. In 12 patients who received this regimen, the dressing remained in place for the desired duration and condom removal was painless. The most common indication for use of this dressing has been Nesbit's procedure.

Urethral advancement for distal hypospadias: 14 years' experience.

76 patients with distal hypospadias were operated on with this technique. The technique is first shortly described. A modification of the meatal reconstruction prevents the uncosmetic flattening of the glans. The overall results were excellent. In 40 cases (23 adults and 17 adolescents) we were able to judge the appearance and function of their adult penis in a follow-up of at least 5-14 years after the operation. We conclude that the fear of ischemia and retraction or even necrosis, with secondary late chordee, after extensive urethral mobilization is unjustified.

Expression of the Androgen Receptor Gene in Rat Penile Tissue and Cells during Sexual Maturation*

The cessation of rat and human penile growth at completion of sexual maturation appears to be related to a tissue-specific decrease in the number of androgen receptors (AR) in the penis. To find out whether this is due to either transcriptional or translational regulation of the AR gene, we determined the levels of AR mRNA by Northern blots in the corpora cavernosa from groups of 16-, 19-, 22-, 27-, 52-, and 90-day-old rats. The AR mRNA rapidly decreases with age and is nearly undetectable in the 52- and 90-day-old rats, paralleling the decline in AR number. The persistence of a low amount of AR mRNA in the adult penis was confirmed by reverse transcription/polymerase chain reaction amplification of total RNA, and its level was estimated by a semiquantitative modification of this procedure at less than 1/25th of that found in the youngest rats. Smooth muscle cells derived from the 16- and 90-day-old corpora cavernosa express in the AR gene in vitro in approximately the same levels, suggesting that there are factors in culture that up-regulate the AR mRNA. Our results are compatible with the assumption that the age-dependent decrease in AR in the rat penis is due to transcriptional regulation, although they do not exclude the less likely alternative of a selective effect on AR mRNA stability and support the use of this model for studying tissue-specific factors controlling the developmental expression of the AR gene.

Micropenis: Gender, erotosexual coping strategy, and behavioral health in nine pediatric cases followed to adulthood

In nine cases of micropenis followed from pediatric age until adulthood (aged 22 to 31) the adult penis size was 2.5 SD below the mean or smaller, with one exception. Pubertal virilization was inadequate in six cases, in five of which there was also a history of neglecting follow-up and androgen-replacement therapy. In six cases there was a low incidence of erotosexual activity. In three there was a long-term pair-bonded attachment. There was one case of homosexual hustling, one of homosexual pair-bondedness, and one of homosexual attraction frustrated by the concealment of a skin-grafted phalloplasty. In the latter two cases, there was a history of agonizing over the option of possible sex reassignment and contemplating death by suicide. In one other case there was a history of paraphilic sadomasochism, in fantasy only, with a woman victim. The juvenile experience of micropenis in the family, the clinic, and the community may dislocate what should be the normal juvenile erotosexual rehearsal play and fantasy of uncomplicated heterosexual differentiation.

Micropenis: adult follow-up and comparison of size against new norms.

In eight cases of micropenis, the follow-up period was from childhood through adulthood (age range 22 to 31). Topical treatment of the penis with testosterone propionate in childhood increased its size relative to the rest of the body before adolescence. In adolescence and adulthood, the penis with a prior history of treatment with testosterone (N = 5) had no size advantage over the untreated one (N = 3). Topical testosterone postponed the age of developing a coping strategy, but not the necessity of developing one. New data (N = 65) for the stretched length of the adult penis give a M +/- SD of 16.69 +/- 1.90 cm, or 6.57 +/- .75 inches.

Aesthetic Aspects of Post-Traumatic Nasal Reconstruction: A Case Study

Acquired buried penis (ABP) is a urologic condition that has significant morbidity and negative effect on quality of life, including but not limited to sexual function, hygiene, micturition, and self-image. This disease process is characterized by a wide degree of variability and severity that requires a patient-specific approach and significant flexibility on the surgeon’s behalf.To review and present the current evaluation and surgical management of this rare and complex patient population.A structured review of the English language literature from 1970 to June 2018 was performed using the PubMed and MEDLINE medical databases. Queried terms included “buried penis,” “concealed penis,” “hidden penis,” “adult buried penis,” “cicatricial penis,” “trapped penis,” “inconspicuous penis,” “scrotoplasty and obesity,” “penile release,” “penile skin graft,” “penile reconstruction,” and “pubic lift.” Papers were individually reviewed for their utility and applicability to the management of adult ABP. Manuscripts focusing on pediatric patients were excluded.Current surgical management options for adult ABP are heterogenous but focus on preserving shaft length while improving cosmesis and voiding function.Surgical versatility remains critical for successful outcomes. However, recent advances in surgical techniques for correction of adult ABP focus on the use of skin grafting to cover the shaft, along with lipectomy and/or scrotoplasty to further aid penile exposure. Collaboration with multiple surgical services is often required to achieve optimal outcomes.ABP is a complex urologic condition with equally complex surgical treatment options. Care must be taken when planning a surgical intervention, and support from plastic or general surgery may be required. However, with careful selection, surgical correction frequently leads to significant improvement in function and quality of life.Smith-Harrison LI, Piotrowski J, Machen GL, et al. Acquired Buried Penis in Adults: A Review of Surgical Management. Sex Med Rev 2020;8:150–157.

Identification, partial characterization and age-related changes of a cytoplasmic androgen receptor in the rat penis

A cytoplasmic androgen receptor has been identified in the penis of the immature rat utilizing a dextran-coated charcoal assay and sucrose density gradient centrifugation. The receptor sediments at 8S, is specific for androgens and binds with high affinity to 5α-dihydrotestosterone, K d = 5.52 × 10 −1U M. In addition, this penile receptor is found in very high concentration in the immature period and decreases with aging to reach almost undetectable levels at adulthood. This diminution in the concentration of the penile receptor from birth to adulthood appears to be consistent with the clinical and experimental observation that the maximum androgen-induced response in the penis occurs during the immature period while the penis is relatively unresponsive to androgenic stimulation at adulthood. The identification of an androgen receptor in the penis should provide an important probe into the elucidation of the endocrine events that govern the ultimate size of the adult penis.