Suspensory Ligament Research Articles

Should sacrouterine plication be added to lateral suspension surgery? A prospective study.

Laparoscopic lateral suspension is a novel approach for repairing anterior and apical pelvic organ prolapse (POP). According to integral theory, urinary symptoms and pelvic pain are believed to originate from suspensory ligaments. We aimed to investigate the objective and subjective outcomes of adding sacroterine plication to apical prolapse surgery. Sixty patients with Grade 2 or higher symptomatic apical POP were included in the study. The study sample was categorized into two groups: Group 1 underwent lateral suspension and Group 2 underwent lateral suspension and sacroterine plication. Anatomical cure was defined separately for the apical and anterior compartments as POP-Q scores for sites C and Ba of less than -1 cm for each compartment. A subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia, and constipation were assessed. In Group 1, anatomical cure rates for apical and anterior prolapse were 100% and 70%, respectively (p <0.001). In Group 2, these rates were 100% for apical prolapse and 73.3% for anterior prolapse (p <0.001). The subjective cure was 96.6% in both groups. Furthermore, improvement in sexual and urinary symptoms was more significant in the group that underwent sacroterine plication (p <0.001). The additional sacroterine plication (shortening) procedure with lateral suspension proved to be an effective and successful surgical approach for apical prolapse. Its routine addition to existing lateral suspension surgery can contribute significantly to the improvement of urinary and prolapse symptoms.

A brief physiology and pathophysiology of the bladder.

The remit of this review is confined to experimental works and publications relevant to the integral theory of female urinary incontinence (IT). Since its first publication in 1990, the IT has challenged the general view that the pathogenesis of overactive bladder (OAB) (urge, frequency, nocturia) is unknown and there is no cure. According to the IT, normal function bladder control is binary, either closed or open. Control is cortical via a peripheral feedback component: oppositely acting reflex striated pelvic muscles contract against suspensory ligaments to close the urethra for continence, open it prior to evacuation, and stretch the vagina like a trampoline to prevent excess impulses from the urothelial stretch receptors which may cause unwanted urgency at low bladder volumes (OAB). The pathogenesis of female urinary incontinence is from outside the bladder, mainly weak ligaments or vagina, due to collagen deficiency. Damage in childbirth (collagen depolymerization) and age (collagen loss) make ligaments vulnerable to damage. With weak ligaments, muscles contracting against them weaken: the muscles cannot close the urethra (manifested as stress incontinence), open it (manifested as emptying problems or retention) or stretch the vagina to prevent the urothelial stretch receptors firing off prematurely (manifested as urge incontinence). Weak pubourethral ligaments can cause stress urinary incontinence (SUI), or SUI plus urge (mixed incontinence). Weak uterosacral ligaments (USLs) can cause urge, frequency, nocturia and emptying difficulties. Treatment consisting of surgical/non-surgical strengthening of ligaments can cure or improve SUI, OAB, and emptying dysfunctions. In summary, bladder control is from outside the bladder, binary, with cortical and peripheral components. A small change in definition, from "overactive" to "overactivated" is consistent with this concept, retains the acronym "OAB", and opens the door to probability of cure and a massive increase in research endeavours.

(019) Penile Augmentation by Division of the Suspensory Ligament of the Penis and Autologous Fat Injection

Abstract Introduction Penile size dissatisfaction is a problem which is more prevalent than what is perceived, it is not taken seriously by healthcare professionals. It is reported that 45% of men are unhappy with their penile size. Most men are too ashamed to seek professional help so they go to online sites that promote fake pills, creams, lotions, or try to solve the problem themselves (DIY Penile enlargement) which causes significant complications or undergo high risk procedures without proper counselling. Objective The aim of this study was to evaluate the outcome of penile augmentation surgery by division of the suspensory ligament of the penis with insertion of silicon buffer for flaccid length enhancement plus liposuction and autologous fat injection for penile girth enhancement. Methods A retrospective audit of patient outcomes after surgical Penile Augmentation (PA) at one centre, over a 5.5 year period. 560 patients had division of the suspensory ligament of the penis with insertion of silicon buffer with liposuction and autologous fat injection. The following data was collected: - Pre and post-operative flaccid penile length and girth. - Patient reported satisfaction rates. - Complications. Results 560 patients were included in this study, the mean patient age was 38 (24–72). The Mean follow up duration was 6 (3-12) months. The mean increase in flaccid length was 3.8 (1.5-6) cm. The mean increase in girth was 4.2 (2.5-5.5) cm. The patient reported satisfaction rates were 85%. No serious adverse events were encountered; the following complications were recorded: partial fat absorption occurred in 120 patients (21.4%) and was managed by fat top up. Phimosis occurred in 20 patients (3.5%) and was manged conservatively in all but 2 patients who required a circumcision, hard fat lumps occurred 30 patients (5.3%) and was managed by in office needling. Migration of fat in the scrotum occurred in 40 patients (7.1%) and was managed conservatively in all but 5 patients who required surgical removal of the fat lumps, infection of the silicon buffer occurred in 6 patients (1.07%) and was managed by removal of the silicon buffer, discomfort from the silicon buffer occurred in 5 patients (0.89%) and was managed by removal of the silicon buffer. Conclusions Penile enlargement by division of the penile suspensory ligament and injection of autologous fat is a safe and effective procedure which is associated with high patient-satisfaction rates. Disclosure No.

(219) Lengthening Phalloplasty: Combined Technique of a Urologist and a Plastic Surgeon

Abstract Introduction Lengthening phalloplasty is an operation that aims at increasing the length of the penile shaft. This procedure has been gaining popularity with different surgical techniques being described and possible suboptimal patient satisfaction rate that can be optimized. The most popular surgical method used for penile lengthening is release of the suspensory ligament. Our technique differs as it involves a combination of urological and plastic surgical steps to achieve the maximum length with the safest optimum outcome. Objective We are advocating the above unique modified surgical technique aiming to achieve the desired results with higher satisfaction rate. Methods A retrospective study including consecutive male patients presenting for penile lengthening over the last 6years. Patients underwent pre-operative andrology and psychological evaluation. All procedures were performed by the same urologist and plastic surgeon simultaneously. A successful surgical outcome is defined as: achieving a lengthening equal to or more than 2cm. Results A total of 82 married male patients were included. The age ranged from 26 to 40 years with a median of 33years. They had normal sexual activity with no psychiatric nor behavioural disturbance. The average pre-operative penile length was: 9.75 cm. the average additional penile lengthening achieved post-operatively was: 3.7 cm. with a range of 2.8 to 4.7 cm. There was no major complications or failure of the procedure observed. One patient suffered from partial wound dehiscence following return to sexual activity two week after surgery. Patients satisfaction with the outcome 6 months following surgery reached 31/32 with a single case of dissatisfaction owing to the residual scar (success rate of 97%). Conclusions We have concluded that using our multimodality technique that this type of phalloplasty is a safe procedure with 100% anatomical surgical success rate in achieving the desired length gain and overall patient satisfaction rate of 97% which has not been reported using the standard procedure. Disclosure No.

(110) Evaluation of Penile Anatomy with MRI

Abstract Introduction Penile enlargement interventions have become increasingly popular in recent years. The common lengthening procedure involves dividing the fundiform and suspensory ligaments to enable the outward movement of the concealed part of the penis. Nevertheless, the outcomes of these surgeries can vary, and clear patient selection criteria have yet to be established. Objective In this study, our objective was to assess penile anatomy using MRI and to identify penile anatomical variations that can aid in the selection of patients for penile enlargement surgeries. Methods We conducted a retrospective study to assess penile anatomy in the context of lengthening surgery. Pelvic MRIs taken for various reasons were evaluated, and the angle between the penile shaft and the symphysis pubis (a), as well as the distance from the pubis to the skin (b), were measured. Patients were categorized into three groups (I, II, III) based on the highest point of the penis relative to the symphysis pubis in the sagittal plane (Figure 1). Results A total of 519 pelvic MRIs were initially reviewed, and 344 met the protocol's eligibility criteria. The participants had a median age of 53 years (IQR 38-65) and a median body mass index of 26 (IQR 24-29). The median angle between the penile shaft and pubis was 23 degrees, with a pubis-skin distance of 38 mm. Age was significantly correlated with the angle between the penile shaft and pubis (r=0.61, p&amp;lt;0.01). Patient distribution across the groups based on penis highest point and pubis location was as follows: 36.1% in Group I, 47.4% in Group II, and 16.5% in Group III. Additionally, a significant positive correlation existed between BMI and suprapubic fat thickness (r=0.65, p&amp;lt;0.01). The analysis unveiled noteworthy variations in penile anatomy, suprapubic fat distribution, peno-pubic angle, and the anchoring point of the fundiform ligament to the penis. Some penises also displayed an S-shaped anatomy. Figure 2 visually illustrates the range of observed penile anatomical variations. Conclusions Our study revealed a significant variability in penile anatomy. The distinctions among patients should be carefully considered when planning any penile enhancement intervention. Disclosure No.

The prognosis for return to athletic function for Thoroughbred racehorses in Hong Kong with injuries to the palmaroproximal aspect of the metacarpus diagnosed using low-field magnetic resonance imaging.

To evaluate and compare the prognosis for Thoroughbred racehorses to return to galloping and racing with injuries to the palmaroproximal metacarpus diagnosed with MRI. 29 flat racing Thoroughbreds at the Hong Kong Jockey Club that underwent MRI between 2014 and 2022. Clinical, radiographic, ultrasonographic, and MRI reports were collected from veterinary clinical records, and these were combined with training and racing data. Horses were categorized on the basis of MRI diagnosis: (1) proximal suspensory ligament (PSL) involvement only, (2) PSL and concurrent proximal third metacarpal (MC3) bone involvement, and (3) proximal MC3 bone involvement only. The following were compared for prognosis for return to athletic function: return to galloping or racing, and reinjury. Overall, the prognosis for return to athletic function was fair, with 92% (22/24; P = .53) and 67% (16/24; P = .73) of horses returning to galloping and racing, respectively. There was a relatively low reinjury rate, with 18% (4/22) of horses reinjuring. Horses with concurrent injury to both the PSL and proximal MC3 bone (Category 2) took longer to return to gallop (median, 116; IQR, 100.5 to 160), when compared with horses having only PSL injury (median, 69; IQR, 43 to 80; P = .04). Of the 4 horses that reinjured, 3 (75%) were horses in Category 2. The findings from this study suggest that injuries involving both PSL and proximal MC3 bone concurrently require a longer rehabilitation period than those with PSL involvement alone.

Safety assessment of equine allogeneic tenogenic primed mesenchymal stem cells in horses with naturally occurring tendon and ligament injuries.

Mesenchymal stem cells provide a valuable treatment option in orthopedic injuries in horses. The aim of this study was to evaluate the hematological, biochemical, immunological and immunomodulatory parameters following intralesional treatment with tenogenic primed equine allogeneic peripheral blood-derived mesenchymal stem cells (tpMSCs) in client-owned horses with naturally occurring superficial digital flexor tendon (SDFT) and suspensory ligament (SL) injuries. The immunogenicity and immunomodulatory capacities of tpMSCs were assessed in a modified mixed lymphocyte reaction, including peripheral blood mononuclear cells (PBMCs) of 14 horses with SDFT and SL injuries after treatment with tpMSCs. In a second study, 18 horses with SDFT and SL injuries received either an intralesional injection with tpMSCs (n = 9) or no treatment (n = 9). The tpMSCs did not provoke a cellular immune response (p < 0.001) and were able to immunomodulate stimulated T lymphocytes (p < 0.001) in vitro. Therapeutic use of tpMSCs did not result in relevant hematologic or biochemical abnormalities. Both studies had a small sample size. No statistical analyses were performed in the second study. Fibrinogen was only analyzed in a single horse prior to treatment. Co-incubation of tpMSCs and PBMCs of horses that have been previously exposed to tpMSCs did not elicit a cellular immune response and tpMSCs were able to immunomodulate stimulated T lymphocytes. Intralesional treatment with tpMSCs did not provoke abnormal changes in hematological and biochemical parameters.

Sentinel Node Mapping in Ovarian Tumors: A Study Using Lymphoscintigraphy and SPECT/CT.

Ovarian cancer in the early stage requires a complete surgical staging, including radical lymphadenectomy, implying subsequent risk of morbidity and complications. Sentinel lymph node (SLN) mapping is a procedure that attempts to reduce radical lymphadenectomy-related complications and morbidities. Our study evaluates the feasibility of SLN mapping in patients with ovarian tumors by the use of intraoperative Technetium-99m-Phytate (Tc-99m-Phytate) and postoperative lymphoscintigraphy using tomographic (single-photon emission computed tomography/computed tomography (SPECT/CT)) acquisition. Thirty-two patients with ovarian mass participated in this study. Intraoperative injection of the radiopharmaceutical was performed just after laparotomy and before the removal of tumor in utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum. Subsequently, pelvic and para-aortic lymphadenectomy was performed for malignant masses, and the presence of tumor in the lymph nodes was assessed through histopathological examination. Conversely, lymphadenectomy was not performed in patients with benign lesions or borderline ovarian tumors. Lymphoscintigraphy was performed within 24 hr using tomographic acquisition (SPECT/CT) of the abdomen and pelvis. Final pathological examination showed 19 patients with benign pathology, 5 with borderline tumors, and 6 with malignant ovarian tumors. SPECT/CT identified SLNs in para-aortic-only areas in 6 (20%), pelvic/para-aortic areas in 14 (47%), and pelvic-only areas in 7 (23%) cases. Notably, additional unusual SLN locations were revealed in perirenal, intergluteal, and posterior to psoas muscle regions in three patients. We were not able to calculate the false negative rate due to the absence of patients with involved lymph nodes. SLN mapping using intraoperative injection of radiotracers is safe and feasible. Larger studies with more malignant cases are needed to better evaluate the sensitivity of this method for lymphatic staging of ovarian malignancies.

Factor analysis for udder and teat type traits in Sahiwal and Karan Fries cows

Selecting female cows for productivity based on udder and teat traits is essential in field due to lack of available records. The objective of the present study was to reduce the dimensionality of the 17 udder and teat traits and to analyse their impact on milk productivity. The data on 256 cattle comprising 133 Sahiwal and 123 Karan Fries cows were used in this study over the years 2017-2019 from Livestock Research Centre (LRC) of ICAR-National Dairy Research Institute, Karnal. The 17 udder and teat traits were fore udder attachment (FUA), rear udder width (RUW), rear udder height (RUH), udder balance (UB), udder depth (UD), udder length (UL), udder width (UW), udder circumference (UC), central ligament/udder cleft (CL), teat circumference (TC), fore teat length (FTL), rear teat length (RTL), distance between fore and rear teat (DFR), distance between left and right teat (DLR), shortest distance from floor to fore teat (SDFT), shortest distance from floor to rear teat (SDRT) and teat diameter (TD). In the factor analysis, first five latent factors accounted for 62.22% of total variance in udder and teat measurements for Sahiwal cows and 65.67% in Karan Fries (KF) cows, respectively. In Sahiwal cows F1 represented better udder support and wideness (wide udders, udders were supported by strong suspensory ligament), whereas in KF cows, first factor reflected better udder dimension and distance between teats (longer length, width of udder and well placed teats). Factor analysis could reduce the multicollinearity of the data. It can be concluded that inclusion of udder and teat measurements in selection index can be a reliable criteria for selecting cows for higher milk yield.

(052) Penile Length Enhancement with Suspensory Ligament Release, Corporal Advancement, and Periosteal Stabilization

Abstract Introduction Penile shortening is a common complaint with multiple etiologies. To date, safe and efficacious options have been limited. Release of the penile suspensory ligament has been described for penile augmentation with a reported increase in penile length, However, a simple release of the suspensory ligament sacrifices the stability of the erect penis. We propose a novel technique of dividing the penile suspensory ligament while simultaneously advancing the corporal bodies and maintaining penile stability with periosteal anchoring of the corpora to the pubic symphysis. Objective We demonstrate a method to increase penile length by releasing the suspensory ligament while simultaneously performing corporal body advancement and anchoring of the corpora to the periosteum of the pubic symphysis. Methods An IRB protocol was submitted to the State University of New York at Buffalo IRB committee. The project was found to be IRB-exempt. A test procedure was performed on a male cadaver. A 3cm transverse infrapubic incision was made one fingerbreadth superior to the dorsal aspect of the penis. Scarpa’s fascia and the fundoform ligament were dissected to expose the suspensory ligament and dorsal phallus. Stretched penile length was measured. The suspensory ligament of the penis was released and the corporal bodies were advanced. A 2-0 Ethibond suture was placed through the periosteum of the inferior aspect of the pubic symphysis and tunica albuginea bilaterally in an intervascular manner. Stretched length was again measured with an increase of approximately four centimeters observed. Results In our cadaveric model, simultaneous penile suspensory ligament with corporal advancement and reattachment resulted in a four-centimeter increase in stretched penile length. Conclusions Simply releasing the suspensory ligament may lead to penile instability, scar tissue formation, and retraction of gained penile length. In this cadaveric model, we demonstrate suspensory ligament release with stabilization of the phallus is viable and may offer a method to increase stretched penile length. Disclosure No.

(057) Destabilising Evidence: A Micro-Anatomical Investigation of Penile Suspensory Ligaments (PSL) Using Epoxy Sheet Plastination and Confocal Microscopy

Abstract Introduction Precise anatomy of the PSL remains controversial. It is routinely described as having 3 components: The fundiform (FL), Suspensory (SL) and Arcuate Ligaments (AL). Proponents of penile enlargement surgery (PES) ensure that division of the “superficial” PSL (FL, SL), allows desired distraction between phallus and pubic symphysis (PS) without risking instability. Seemingly in support of this rationale, many publications imply the FL and SL provide less structural integrity as they connect only superficial fascias (Origin: Scarpa’s fascia or linea alba; Insertion: Penile Dartos or Buck’s fascia). AL is reported to be the primary support structure as it connects the corporal tunica albuginea (TA) directly to the bone and preserved in PES given its deeper location. Despite this, significant sexual dysfunction (SD) from PSL deficiency after PES has been reported. An improved understanding of this anatomy is paramount for quality surgical care in both pre-operative counselling and rectification of adverse functional outcomes. Objective (1) To present initial findings of the in-situ PSL anatomy (2) To propose a new anatomical classification system Methods Data from six male cadavers (46-87 years; mean 75) were used in present study. There was no history of genitourinary operations and cause of death were either respiratory or vascular. Following deep-freeze and 0.9mm whole-mount sectioning, specimens were impregnated with epoxy-resin mixture (E12/E1/AE10/AE30). Without specific labelling, this process allows endogenous autofluorescence of collagen/elastin/myofilaments when excited using 488nm-confocal-laser microscope. Select areas were examined using stereoscopic microscopy and scanned at high-resolution. This technique ensures preservation of anatomy in-situ and allowed enhanced examination at both macroscopic and microscopic levels (Figure 1). Results Proposed classification divides PSL by anatomical location: Prepubic, Subpubic, Retropubic. While corresponding to the same distinct structures, it avoids the misnomers and discrepancies that are embedded in existing nomenclature. Findings are summarised in Table 1. The AL does not appear to the PSL apparatus. It fuses with the interosseus fibrocartilaginous lamina deep to it and attaches laterally to the inferior pubic rami. Inferiorly, its semicircular free edge rounds off the apex of the pubic arch but has no corporal attachment. Conclusions Findings of the present study do not support an anatomical rationale for PES, without risking instability. Contrary to previous reports, the subpubic PSL (or suspensory ligament) is the only component that directly connects TA with PS. The purported role of AL appears unfounded. Furthermore, perpendicular fibrous orientation of the subpubic and retropubic PSL suggests a dynamic support mechanism, not dissimilar to the knee’s cruciate ligaments. To the author’s knowledge, this is the first description of the musculotendinous origin of the retropubic PSL, whose fibres extend anteriorly from the urogenital diaphragm. Further studies are required to better characterise the retropubic PSL insertion and may lead to new insights into the origin and architecture of deep penile fascia. Based on present findings, the TA likely consists of multiple fibrous components originating from the musculotendinous aponeuroses of superficial perineal musculature. Disclosure No.

(062) The Physiological Health of the Penile Fibro-Vascular Assembly Requires the Integrity of Ten Fibro-ligaments in the Human Penis

Abstract Introduction Although the human penis has existed on earth for 3000 centuries and extensive studies have been conducted for many recent centuries, there is still room for improvement, particularly in the fibro-ligaments' role in maintaining physiological sexual health. Thus far, there needs to be more interpretation concerning these ligaments. Objective We aimed to explore the penile fibrous ligaments thoroughly to fill this research gap. Methods We excluded cadaveric penises that had both sides of the corpora cavernosa (CC) and corpus spongiosum (CS) damaged. However, penises with one undamaged side of the CC, including the Colles' fascia and the corpus spongiosum, were included. A total of 15 out of 46 penises were meticulously examined. Dissection findings were supplemented with 101 cadaveric photos and data from 263 penile vascular surgeries, 11 CT imaging scans, 8 MRI imaging scans, eight hypospadias surgeries, and eight penile elongation surgeries performed elsewhere internationally. Results Bilaterally, the penile CC is primarily anchored to the pelvis wall through the unilateral cavernosal ligament bilaterally (CL=2), while the CS is connected to the urinary sphincter. The suspensory, fundiform, and arcuate pubic ligament (two anatomically and one functionally) assist in stabilizing and holding the penile shaft to the pelvic wall. Distally, a distal ligament (DL=1) and spongiosal ligament (SL=1) extend the CC and CS to the glans penis and frenulum, ensuring urethra patency when required. The CC is encircled by a bi-layered tunica consisting of a 360° inner circular tunica and a 300° outer longitudinal coat. The ischiocavernosus muscle wraps around the penile crus and envelops the CL connecting to the ischial tuberosity. The CS is partially secured by the bulbospongiosus muscle proximally and receives the SL distally. The entire penis interconnects with the skeletal muscle of the urogenital diaphragm eventually. Conclusions The physiologically sexual health of the human penis's hydraulic system relies on the integrity of ten anatomically and six functionally fibro-muscular ligaments. Disclosure No.

(229) A Pilot Study of a Novel PRP Protocol to Increase Penile Length, Girth, and Function

Abstract Introduction A study of a novel PRP protocol to increase penile length, girth, and function Intro: Various solutions have been utilized to increase penis size, including fillers, fat transfers, traction devices, suspensory ligament ligation, and silicon augmentation. None of these improve length, girth, function and are completely safe. PRP is an autologous source of growth factors. The RestoreX is a well-studied traction device. Vacuum erection devices provide a stimulus for circumferential penile growth. Nitric Oxide boosters improve blood flow and nighttime erections. Objective The P-Long Study aims to find a safe and reproducible way to increase the length, girth, and function of a normal male penis. Methods The study is IRB approved and patient consented. Inclusion criteria: healthy men aged 20 to 55 with normal erectile function (SHIM greater than 22) and no Peyronie’s Disease, previous penile interventions, or congenital penile issues. Measurement of penile length and girth were performed by the patient on an erect penis during self-stimulation at full tumescence with standard protocol and measuring instruments (transparent rigid ruler and flexible tape measure) and documented with digital images. No PDE-5 inhibitors or Trimix were used. Measurements were taken at baseline and once a month for six months. PRP was administered in the right and left corpora under ultrasound guidance once a month for six months using PureSpin double spin system (60cc blood drawn) Centrifuge technical data show an average platelet recovery of 84% and average concentration of 6.6 times that of the whole blood sample. Using this data, the injection of 10cc of PRP, assuming a starting platelet count of 250K/microliter, would contain approximately 1.65 billion platelets. Traction with RestoreX 20 minutes bid and suction with Joel Kaplan penis pump (pressure 5-10 for 12 minutes bid (1 minute x 2 and 5 minutes x 2.) Nitric Oxide boosting supplement (trade name AFFIRM) with a dose of 3 gm L-Citrulline and 1 gm beet extract (nitrate). Results 29 men have completed treatment. The mean age was 32 and mean baseline erect penile length was 5.70 and girth was 5.25. Erect penis length was 0.805 inch greater after six months from baseline (N=29, paired t-test t=13.641 p value=0.000). Circumference was 0.469 inch greater (N=29, paired t-test t=13.498 p value=0.000). Using a Likert scale, all participants reported better erectile function. Conclusions The P-Long Protocol is potentially a safe way to improve erect penile length 0.81 inches and girth 0.47 inches over a period of six months and subjectively improve function in a healthy penis. The P-Long Protocol does not require any synthetic injectables or foreign bodies or extensive penile traction. The P-Long Protocol ultrasound-guided PRP injection can be taught to urologists and sexual medicine practitioners. It does not preclude additional augmentation procedures and is potentially an acceptable first option for men interested in penile enhancement. This study provides a guide for expectations for growth for men using the protocol. The slope of the growth curve indicates possible continued growth with additional treatments. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: AFFIRM Science.

(043) Tensile Contention: A Novel Reconstructive Technique for Unstable Erections Secondary to Penile Suspensory Ligament (PSL) Deficiency

(043) Tensile Contention: A Novel Reconstructive Technique for Unstable Erections Secondary to Penile Suspensory Ligament (PSL) Deficiency

Morphometric Predictors of Penile Length Increase After Division of its Suspensory Ligament

IntroductionDivision of the suspensory ligament of the penis has emerged as a popular surgical approach for penile lengthening, but accurate preoperative predictions of lengthening outcomes remain elusive. This study aimed to identify readily measurable anatomical parameters associated with post-ligamentolysis penile length gain, facilitating more reliable preoperative estimations.MethodsAn experimental cross-sectional study was performed on 16 adult cadavers. Data collected before dissection included: age at death, ethnicity, height, length of the penis before dissection and width of the suspensory ligament of penis. Following the complete dissection of the suspensory ligament of penis, the depth of the pubic symphysis and the penile length after the procedure were measured. The absolute and relative length differences pre- and post-ligamentolysis were calculated. Correlation coefficients were used to study relations between these variables.ResultsPenile length increased uniformly after complete division of the suspensory ligament (average gain: 26.38 mm, SD = 14.83 mm; range 4–60 mm). Pearson correlation revealed a significant negative correlation between pre-ligamentolysis penile length and post-ligamentolysis increase (r = − 0.601; p = 0.014), suggesting greater gains in individuals with shorter pre-ligamentolysis lengths. Age, ligament width, and pubic arch depth showed no significant correlations. Ethnicity did not impact post-ligamentolysis length increase (t = − 0.135; p = 0.894).ConclusionsThis study highlights the potential to predict penile length gain post-ligamentolysis through measurable anatomical parameters. The ability to anticipate the outcome of this procedure could empower surgeons to provide informed counseling, potentially elevating patient satisfaction.An experimental cross-sectional study was performed to investigate the outcomes of penile lengthening surgeryPenile lengthening was achieved in all subjects via complete dissection of the suspensory ligament of the penisPenile length increase may be predicted preoperatively using easily measurable anatomical parametersNo Level AssignedThis journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Fratura in uterus de metacarpo em neonato bovino

Long bone fractures are common in juvenile cattle, however, cases of fractures occurring in the intrauterine environment during pregnancy are rare. The objective of this report is to present a case of an open consolidated fracture of the metacarpal that occurred in uterus, in a newborn calf, in which the surgical approach used was successful. A 48-hour-old female bovine was treated at the Veterinary Hospital of Paranaense University, who presented a complete, open and poorly consolidated transverse diaphyseal fracture in uterus during the gestational period on clinical and radiographic examination. As a therapeutic approach, open reduction was chosen, with ostectomy followed by stabilization with type IA external skeletal fixator. Four 4mm transcortical pins were positioned proximally and distally to the newly formed fracture line, followed by two more pins in the proximal phalanges region, seeking to stabilize the metacarpophalangeal joint, since flexural deformity of that joint was observed after the realignment of the longitudinal axis of the metacarpal, even after the section of the superficial and deep digital flexor tendons and suspensory ligament. The ESF was removed after 32 days, when radiographic signs of neoproliferation and bone consolidation were observed. In a last evaluation 15 months after the surgical correction, a complete and satisfactory recovery was observed regarding the development and well-being of the animal.

Topographic and Structural Anatomy of the Suspensory Ligament of the Penis: Implications for Phalloplasty.

The suspensory ligamentous system of the penis supports the penis when erect and plays a key role during coitus. These ligaments, which are prone to injury during coitus, are clinically important in penile reconstruction procedures. The current study investigated the macro- and microanatomy of the suspensory ligamentous system of the penis to determine the origin, course, insertion, dimensions, and tissue composition of these ligaments, knowledge of which is vital for successful penile reconstruction procedures. The study utilized a total of 49 cadavers. Gross anatomy dissection, MRI, and histological staining were performed to elucidate the topography, dimensions, and tissue composition of the suspensory ligaments of the penis. Three ligaments were observed to form the suspensory ligamentous system of the penis. The most superficial is the fundiform ligament, which consists of superficial bundles and deep median bundles, with the former arising from the Scarpa's fascia and the latter arising from the linea alba of the anterior abdominal wall; both inserted into the superficial fascia of the penis. The suspensory ligament of the penis arose from the pubic symphysis and inserted into the deep fascia (Buck's fascia) of the penis. The arcuate ligament arose from the body of the pubis and pubic symphysis and inserted into the Buck's fascia. The ligaments were determined to consist of adipose tissue, collagen fibers, elastic fibers and reticular fibers, in varying proportions. The suspensory ligaments of the penis exhibit a fan-like structure on the penis that allows the forward movement of the penis as a result of engorgement of the erectile bodies while simultaneously offering support.

Evaluation of surgical and functional outcome of penile lengthening surgery with or without suspensory ligament release in adult buried penis

Evaluation of surgical and functional outcome of penile lengthening surgery with or without suspensory ligament release in adult buried penis

Concentrations of Selected Adipocytokines in the Blood Plasma in Proximal Suspensory Desmopathy of Horses, with a Focus on Their Physical Activity-A Pilot Study.

Chronic tendon and ligament diseases are commonly encountered in both athletic humans and animals, especially horses. Distal limb diseases, including suspensory ligament (SL) pathology due to anatomical, histological, and biomechanical properties, can be considered a model for tendon and ligament pathologies in humans. The appropriate selection of therapy is often crucial in optimising the healing process. One decisive factor influencing the possibility of returning to pre-disease training levels appears to be the utilisation of physical activity, including controlled movement, during the rehabilitation process. In the pathogenesis of musculoskeletal diseases and rehabilitation, adipocytokines play diverse roles. However, it is unclear what significance they hold in horses and in specific disease entities as well as the consequences of their mutual interactions. Recent studies indicate that in the pathogenesis of diseases with varied aetiologies in humans, their value varies at different stages, resulting in a diverse response to treatment. The results of this study demonstrate lower resistin concentrations in the venous blood plasma of horses with proximal suspensory desmopathy (PSD), while higher levels were observed in regularly trained and paddocked animals. The horses investigated in this study showed higher concentrations of resistin and IL-8, particularly in paddocked horses as well as in the working group of horses. The results suggest that these concentrations, including resistin in blood plasma, may be clinically significant. This attempt to explore the aetiopathogenesis of the processes occurring in the area of the proximal attachment of the suspensory ligament may optimise the procedures for the treatment and rehabilitation of horses.

Anatomical relations of the recurrent laryngeal nerve in thyroid dissection

Introduction: Recurrent laryngeal nerve (RLN) palsy is one of the major complications thyroidectomy. Visualization of the anatomical relations of the RLN with branches of the inferior thyroid artery (ITA) remains essential for preservation of RLNs. Suspensory ligament of Berry, inferior horn of the thyroid cartilage is considered as other important landmarks for safe thyroidectomy. The objective of this study was to describe the various anatomical relations of the RLN during thyroid dissection.Methods: An observation cadaveric study was conducted by simple random sampling of 35 cadavers with a total of 70 RLNs over a one-year period, from June 2022 to June 2023. The cadavers that had thyroidotomies and goitres were excluded from the study.Results: The majority of RLNs in this series had a retrovascular course (with respect to the ITA or its branches): 57% on the right and 68.6% on the left. The course of 64/70 of the dissected nerves was posteromedial to the suspensory ligament of Berry, while the other 6 nerves passed between the fibres of this ligament. All RLNs penetrated the larynx by passing posteriorly to the inferior horn of the thyroid cartilage on both sides. No case of non-recurrent laryngeal nerve was observed.Conclusion: This preliminary study illustrates the numerous anatomical variants of the RLN with respect to the ITA and its branches. The RLN mainly has a retrovascular course on both the right and the left sides.