Ventral Penile Research Articles

Recurrent ventral curvature after corporoplasty with tunica vaginalis flap

Optimal means to correct ventral curvature (VC) is debated. Our preferred technique for curvature greater than 45° is corporoplasty using tunica vaginalis flap (TVF). We describe our complications with TVF for ventral lengthening. Forty-four boys who underwent ventral lengthening with a corporoplasty with TVF were identified in a prospective database for proximal hypospadias repair by a single surgeon from 2008 to 2021. Corporotomy was performed by incising the tunica albuginea of the corpora cavernosa transversely at the point of maximum curvature. Harvested TVF was tailored to the size of the corporotomy and anastomosed to the edges of the tunica albuginea and on laid to the corporal defect with the mesothelial side of the TVF abutting the erectile tissue. Median age at surgery was 1.0 years (IQR 0.72-1.82). Median follow-up time was 4.9 years (IQR 2.6-8.0). Thirteen patients (27%) were older than 10 years of age at last follow up (median 13.3, range 10-20). Twenty-two boys (50%) received preoperative testosterone. The most common location of the meatus after degloving was penoscrotal (41%). Median VC after degloving was 90° (IQR 80-100). The urethral plate was transected in 43/44 (98%) of boys, improving median VC to 60° (IQR 40-60). After corporotomy, the median longitudinal distracted distance was 15mm (IQR 12-17). Urethral reconstruction was most commonly achieved with the transverse island preputial flap technique or its modifications (39/44; 89%). Erections were reported in 42 boys (95%). None developed corporal diverticula, and two patients (4.5%) had ascended testis associated with TVF harvest. Seven percent of boys had recurrent ventral curvature (RVC; 3/44). Median RVC was 30° (IQR 30-45). One patient had RVC at the penoscrotal junction (not at site of prior corporoplasty) identified 11 years post operatively at age 15, and underwent dorsal plication. The other 2 patients were diagnosed less than 1 year post operatively. Both patients received testosterone due to small glans size, had double-face tubularized transverse island preputial flap as urethral and ventral skin coverage, and had endocrine and genetic consultation. Both had scarring of the preputial flap and of the corporoplasty. Scar excision and superficial transverse incisions on the tunica albuginea corrected RVC. The five-year outcome of ventral penile lengthening using TVF for corporoplasty is favorable with 7% of boys with RVC, and 4.5% with ascended testes associated with TVF harvest. None developed corporal diverticula.

Primary solitary neurofibroma of penis in a child: case report and review

BackgroundGenital involvement in neurofibromas is rare and can involve both the clitoris and penis; in the latter, it usually accompanies a systemic pathology. Isolated penile neurofibroma is anecdotal. This report presents an unusual solitary penile neurofibroma in a child, discusses its surgical management and reviews the literature.Case presentationA 6-year child presented with history of swelling on the undersurface of his penis and obstructive voiding symptoms since 18 months of age. He underwent a partial excision at 5 years of age elsewhere which recurred. The swelling was a 3 × 2 cm, firm, midline, smooth surfaced, longitudinally oblong mass over the ventral penis extending from root to mid shaft with restricted mobility. There was no inguinal lymphadenopathy. Ultrasonography and cystoscopy characterized it to be a corpus spongiosal soft tissue mass encasing and indenting the contained penile urethra. The mass was completely excised along with involved urethra and corpus spongiosa and a penoscrotal urethrostomy created. Histopathological analysis revealed it to be a benign nerve sheath tumor/neurofibroma. He had no stigmata of neurofibromatosis and the ophthalmologic examination was unremarkable. At 2-year follow-up, he is well, has normal glanular sensation and erectile function and awaits urethral reconstruction.ConclusionPrimary solitary penile neurofibroma in children is extremely rare. This report details the presentation and management of a ventral penile neurofibroma involving the adjacent urethra/corpora spongiosa.

Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis.

Immunohistological patterns of density and distribution of neural tissue in the human penis, including the prepuce, are not fully characterized, and effects of circumcision (partial or total removal of the penile prepuce) on penile sexual sensation are controversial. This study analyzed extra- and intracavernosal innervation patterns on the main penile axes using formalin-fixed, paraffin-embedded human adult and fetal penile tissues, single- and double-staining immunohistochemistry and a variety of neural and non-neural markers, with a special emphasis on the prepuce and potential sexual effects of circumcision. Immunohistochemical profiles of neural structures were determined and the most detailed immunohistological characterizations to date of preputial nerve supply are provided. The penile prepuce has a highly organized, dense, afferent innervation pattern that is manifest early in fetal development. Autonomically, it receives noradrenergic sympathetic and nitrergic parasympathetic innervation. Cholinergic nerves are also present. We observed cutaneous and subcutaneous neural density distribution biases across our specimens towards the ventral prepuce, including a region corresponding in the adult anatomical position (penis erect) to the distal third of the ventral penile aspect. We also describe a concept of innervation gradients across the longitudinal and transverse penile axes. Results are discussed in relation to the specialized literature. An argument is made that neuroanatomic substrates underlying unusual permanent penile sensory disturbances post-circumcision arerelated to heightened neural levels in the distal third of the ventral penile aspect, which could potentially be compromised by deep incisions during circumcision.

Extratunical Grafting and Penile Plication for Peyronie's Disease

ABSTRACT Introduction Extratunical grafting is a surgical option for men with Peyronie's disease who have an hourglass deformity or indentation defect. Rather than necessitating neurovascular bundle elevation and tunical incision, the procedure can be done without mobilization of the bundle. This benefit limits the risk of de novo erectile dysfunction and glans hypoesthesia. Here we present a case of a penile plication combined with extratunical grafting for a man with dorsal curvature and a right sided indentation defect. Objective To present a video presentation of extratunical grafting during penile plication for Peyronie's disease Methods An artificial erection is done to confirm the location and extent of the penile deformity and curvature. A midline ventral penile incision is made and carried down to the tunica albunigea as is standard for a penile plication. A penile plication is performed with 2-0 polyester suture to correct the dorsal curvature. At the site of the indentation defect, a pericardium allograft is doubly-folded on itself and sewn to the tunica albuginea. The indentation repair is demonstrated, and the surgical site is closed. Results The patient reports high satisfaction with the indentation correction and improvement in dorsal curvature with no new erectile dysfunction or hypoesthesia. Conclusions Extratunical grafting is a viable, straightforward option for men with Peyronie's disease and indentation defects or an hourglass deformity that can be combined with penile plication to treat symptomatic men. Disclosure No

Effect of surgical steps in primary hypospadias repair on penile length

To document the effect of surgical steps, including penile degloving, plate transection, dorsal plication, and fasciocutaneous coverage, in primary hypospadias repair on penile length. A consecutive series of 209 prepubertal boys with primary hypospadias repair was included with the age ranged from 10 to 97 months (mean, 31.7 months). Intraoperative stretched penile length (SPL) was measured before operation ( n=209), and after each step, namely penile degloving ( n=152), plate transection ( n=139), dorsal plication ( n=170), and fasciocutaneous coverage ( n=209). SPLs before and after each steps or the entire operation were analyzed. The SPL was compared between plate transection group and plate preservation group, dorsal plication group and non-plication group, and plate preservation with plication group and plate preservation without plication group, respectively. Differences of SPL between before and after each steps were analyzed with factors including neourethra length, rest dorsal penile length, rest ventral penile length, preoperative SPL, and the degree of penile curvature after penile degloving, with multivariate linear regression analysis. All the four steps resulted in SPL difference. The SPL increased after penile degloving and plate transection ( P<0.05), and decreased after dorsal plication and fasciocutaneous coverage ( P<0.05). The SPL increased after all steps were completed ( P<0.05). In patients with plate transection, postoperative SPL increased when compared with that before operation ( P<0.05). No significant difference was noted in patients without plate transection ( P>0.05). And there was significant difference in the increased length of SPL between patients with and without plate transection ( P<0.05). In patients with dorsal plication, a significant increase of postoperative SPL ( P<0.05) was noted. No significant difference was noted in patients without dorsal plication ( P>0.05). And there was no significant difference in increased length between patients with and without dorsal plication ( P>0.05). When patients with plate transection were excluded, dorsal plication resulted in no significant difference on postoperative SPL ( P>0.05). The increased length of SPL after penile degloving, dorsal plication, or cutanofascial coverage was not related to the neourethra length, the rest dorsal penile length, the rest ventral penile length, the preoperative SPL, and the degree of penile curvature ( P>0.05). However, the neourethra length and preoperative SPL were the influencing factors for the increased length of SPL after plate transection ( P<0.05). The main steps in primary hypospadias repair can change SPL. The lengthening effect of plate transection would not be counteracted by dorsal plication. Dorsal plication makes no significant difference on postoperative SPL.

Partial mobilisation of the neurovascular bundle for ventral penile curvature correction: A proof-of-concept study

Background: To lift the neurovascular bundle (NVB) is a critical step during dorsal plications for ventral penile curvature correction. Indeed, this procedure may hesitate in nerves and vascular damage. Herein, we present a revolutionary approach of partial NVB mobilisation that avoids dissection among 10 and 2 o’clock positions decreasing the risk of injuring nerves and vessels. Methods: We assessed ventral penile curvature after penile degloving, marking the level of maximal bending. Bilateral para urethral incisions were made and the Buck’s fascia carefully mobilised from the tunica albuginea. The mobilisation of NVB was carried until 10 and 2 o’clock, avoiding the area between 10 and 2 o’clock positions, where nerves and vessels are more concentrated. The 10 and 2 o’clock positions correspond also to the dorsal edges of the two cavernosa cylinders, where plications are more effective. Penile straightening after surgery was defined as residual curvature less than 10 degrees. Results: Between 2016 and 2020, we have operated 33 men and 32 boys with ventral penile curvature. The severity of penile curvature was mid (&lt;30 degrees) in 13 (20%) patients, moderate (30–60 degrees) in 33 (51%) patients, and severe (&gt; 60 degrees) in 19 (29%) patients. Penile straight was achieved for all patients. We recorded three haematoma, three glans skin erosion, and one curvature recurrence after 13 months of follow-up. No patient reported erectile dysfunction. Conclusion: This proof-of-concept study shows that partial NVB mobilisation is technically easier and safer compared to complete NVB mobilisation, without compromising the success of surgery. Level of evidence: Not applicable

DORSAL Plication Technique for the Treatment of Congenital Ventral Penile Curvature: Long-Term Outcomes of 72 Cases

A total of 78 patients aged 11 to 17 years were diagnosed with congenital ventral penile curvature and underwent surgery with the dorsal plication technique between 2005 and 2014. To investigate the long-term outcomes of 72 patients who underwent dorsal penile plication for the treatment of congenital ventral penile curvature without hypospadias. In all cases, the intervascular space between the deep dorsal vein and dorsal artery was dissected, and tunical plication was carried out with non-absorbable 3-0 polyamide sutures and the complication and satisfaction rates of the patients were determined in the postoperative seventh year. At the final postoperative follow-up, the patients' satisfaction with the operation was found to be 95.8%. Shortening of the penis (0.5-1 cm) in five cases, recurrence with less than a 20-degree curvature in two cases, palpable sutures in two cases was observed and no patients reported erectile dysfunction. The limitations of our study can be considered as the absence of pharmacological erection in the preoperative evaluation, failure to evaluate penile length at the last postoperative follow-up due to the continued development of the penis, inability to evaluate erectile function at the beginning, postoperative erectile capacity being assessed in only some of the operated cases, all operations being performed by a single surgeon in the same center, and the absence of standardized questionnaires for postoperative satisfaction or adverse events. According to the results of this study, dorsal plication is a relatively simple method with a low risk and high success rate for the treatment of congenital ventral penile curvatures.

MP04-15 PARTIAL MOBILIZATION OF THE NEUROVASCULAR BUNDLE (NVB) FOR VENTRAL PENILE CURVATURE CORRECTION: A PROOF OF CONCEPT STUDY

INTRODUCTION AND OBJECTIVE:Lifting the NVB is required any time we perform dorsal plications for ventral penile curvature, regardless the etiology of the penile bending. However, this procedure may...

V07-09 PENILE PROSTHESIS IMPLANTATION AND PEYRONIE'S DISEASE: HOW TO APPROACH THE RESIDUAL CURVATURE; A DETAILED DEMONSTRATION OF MOULDING TECHNIQUE AND GRAFTING PROCEDURE

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-09 PENILE PROSTHESIS IMPLANTATION AND PEYRONIE'S DISEASE: HOW TO APPROACH THE RESIDUAL CURVATURE; A DETAILED DEMONSTRATION OF MOULDING TECHNIQUE AND GRAFTING PROCEDURE Giovanni Chiriaco, Enya Maher, Wai Gin Lee, and David Ralph Giovanni ChiriacoGiovanni Chiriaco More articles by this author , Enya MaherEnya Maher More articles by this author , Wai Gin LeeWai Gin Lee More articles by this author , and David RalphDavid Ralph More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Insertion of a penile prosthesis is the treatment of choice in men with Peyronie’s disease and concomitant erectile dysfunction. The aim of surgery is to straighten the penis and allow adequate rigidity for sexual intercourse. A conundrum arises when there is residual curvature during device testing. This video highlights strategies that will aid the implanter when faced with these intraoperative challenges. METHODS: This video illustrates three different scenarios and suggests strategies that can be used when there is a residual penile curvature following inflatable penile prosthesis insertion: 1) Manual moulding – In this scenario, a persistent left lateral curvature is successfully straightened by moulding the plaque following device insertion. The cylinders are fully inflated and the tubes to the pump are double clamped. One hand is positioned distal to the apex of the curvature while the other is proximal. The penis is manipulated in the opposite direction to the curvature. 2) Residual curvature after manual moulding – The plaque can be incised at the point of maximal curvature and grafted If there is a significant persistent curvature (>30°) following moulding. TachoSil sealant matrix was used in this patient and it offers a quick and effective choice for grafting the tunical defect. 3) Upfront plaque incision and grafting - Some patients are not suitable for moulding following penile prosthesis insertion. Examples include ventral penile curvature and ossified plaques. In this patient with a ventral curvature, the plaque was incised and the tunical defect grafted with bovine pericardial graft prior to corporal dilatation. RESULTS: All three patients had an uneventful post-operative outcome. They were encouraged to cycle the device from 3 weeks and allowed to commence sexual intercourse after 6 weeks post-surgery. CONCLUSIONS: Manual moulding is a safe and effective first line option for residual penile curvature following inflatable penile prosthesis insertion. Plaque incision and grafting can be considered if moulding fails or where manual moulding is contraindicated. There are several choices for graft material including TachoSil or bovine pericardium. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e553-e553 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Chiriaco More articles by this author Enya Maher More articles by this author Wai Gin Lee More articles by this author David Ralph More articles by this author Expand All Advertisement Loading ...

The perils of penile enhancement: case report of a fulminant penile infection

BackgroundPenile enhancement with injectable agents is a rising trend and yet has received little scientific attention despite the potential for serious complications. These include cosmetic, functional and systemic complications that may require complex penile reconstructive surgery. We report a case of delayed severe infection following penile filler insertion leading to multi-organ failure and intensive care support.Case presentationA 31-year-old man presented with fevers and progressive pain and swelling of the penile shaft, 3 days after unprotected sexual intercourse. The patient received subcutaneous hyaluronic filler injections at a cosmetic clinic for penile enlargement two months prior to presentation. Relevant social history include polysubstance abuse and multiple sexual partners. Physical examination revealed gross penile oedema and erythema, with a ventral curvature of the penile shaft and a superficial abrasion on the distal ventral penile shaft. Within 24 h the patient developed septic shock with anuria, hypotension and fevers to 40 °C, requiring transfer to the Intensive Care Unit (ICU) for vasopressor and inotropic support. Intraoperative penile exploration revealed multiple pus stained fillers which were drained and grew Streptococcus Pyogenes on cultures. There was no abscess or evidence of necrotising fasciitis intraoperatively. The patient improved with intravenous antibiotics and was stepped down from the ICU after four days and discharged on day eight. One month post admission there was significant superficial skin loss to both ventral and lateral aspect of the penis, with healthy granulation tissue at the base. The patient opted for conservative management with regular dressings. He reported normal sexual and urinary function three months post admission.ConclusionThis is the first published case of sepsis from a penile infection in the context of hyaluronic acid penile fillers. In an era of escalating demand for penile cosmetic procedures, there is an increasing need for early recognition and appropriate management of penile filler infections. We report an unusual case of a localised penile infection rapidly progressing to sepsis with multi-organ failure requiring intensive care support. The case demonstrates early surgical intervention with targeted antimicrobials can result in successful eradication of infection, with satisfactory cosmetic and functional outcomes for patients.

Congenital webbed penis: Surgical outcomes of a simplified technique

Webbed penis is a cause of concealed penis. It reflects abnormal attachment of the scrotal skin to different ventral penile shaft levels, possibly due to abnormal scrotal dartos insertion. Different techniques are available for correction of congenital webbed penis. However, there is no single one versatile for correction of different grades. To evaluate the surgical outcome of penile degloving, excision of abnormal dartos fascia with penoscrotal fixation sutures to correct different grades of congenital webbed penis. This prospective study was conducted on boys with congenital webbed penis. Thorough clinical examination to determine the degree of webbed penis and associated anomalies were done. A technical modification of previously described technique by Frenkl etal. 2004 (22) was used. The principles include; complete penile degloving with excision of all abnormal scrotal dartos attached to the penile shaft, creation of a well-defined penoscrotal angle by penoscrotal fixation sutures and the short ventral skin was compensated from the prepuce with circumcision. Assessments of surgical outcomes and parents' satisfaction were done during follow up visits. This study included 107 boys. The median age was 9 (range, 6-40) months, and the median operative time was 55 (range, 50-65) min. Five patients (4.7%) developed self-limited postoperative penile edema, two (1.9%) developed wound infections, and two (1.9%) had a self-limited scrotal hematoma. The median follow-up period was 19 months. At the 6 months follow-up, we had two patients with persistent mild grade I webs, with a success rate of 98.13%. Parental satisfaction was obtained for all patients. Currently, there is no current single technique suitable for the correction of all grades of webbed penis. In this study, we presented a technical modification of previously described technique by Frenkl etal. 2004 (9), this modified technique is versatile for correction of different grades of congenital webbed penis without leaving a scar at the penoscrotal angle. But, absence of a comparative group is considered a limitation; however, the versatility of this technique overcomes this limitation. This described technique is simple and feasible. It could correct all types of congenital webbed penis. Short term outcome showed good cosmetic and functional results with parental satisfaction.

Creation of Tissue-Engineered Urethras for Large Urethral Defect Repair in a Rabbit Experimental Model

Introduction: Tissue engineering is a potential source of urethral substitutes to treat severe urethral defects. Our aim was to create tissue-engineered urethras by harvesting autologous cells obtained by bladder washes and then using these cells to create a neourethra in a chronic large urethral defect in a rabbit model.Methods: A large urethral defect was first created in male New Zealand rabbits by resecting an elliptic defect (70 mm2) in the ventral penile urethra and then letting it settle down as a chronic defect for 5–6 weeks. Urothelial cells were harvested noninvasively by washing the bladder with saline and isolating urothelial cells. Neourethras were created by seeding urothelial cells on a commercially available decellularized intestinal submucosa matrix (Biodesign® Cook-Biotech®). Twenty-two rabbits were divided into three groups. Group-A (n = 2) is a control group (urethral defect unrepaired). Group-B (n = 10) and group-C (n = 10) underwent on-lay urethroplasty, with unseeded matrix (group-B) and urothelial cell-seeded matrix (group-C). Macroscopic appearance, radiology, and histology were assessed.Results: The chronic large urethral defect model was successfully created. Stratified urothelial cultures attached to the matrix were obtained. All group-A rabbits kept the urethral defect size unchanged (70 ± 2.5 mm2). All group-B rabbits presented urethroplasty dehiscence, with a median defect of 61 mm2 (range 34–70). In group-C, five presented complete correction and five almost total correction with fistula, with a median defect of 0.3 mm2 (range 0–12.5), demonstrating a significant better result (p = 7.85 × 10−5). Urethrography showed more fistulas in group-B (10/10, versus 5/10 in group-C) (p = 0.04). No strictures were found in any of the groups. Group-B histology identified the absence of ventral urethra in unrepaired areas, with squamous cell metaplasia in the edges toward the defect. In group-C repaired areas, ventral multilayer urothelium was identified with cells staining for urothelial cell marker cytokeratin-7.Conclusions: The importance of this study is that we used a chronic large urethral defect animal model and clearly found that cell-seeded transplants were superior to nonseeded. In addition, bladder washing was a feasible method for harvesting viable autologous cells in a noninvasive way. There is a place for considering tissue-engineered transplants in the surgical armamentarium for treating complex urethral defects and hypospadias cases.

Устранение вентрального искривления полового члена у детей с гипоспадией

OBJECTIVE Our study aims to improve hypospadias in children by successfully correcting ventral penile curvature. MATERIALS AND METHODS From 2014 to 2018, 424 patients with ventral penile curvature of 15-60 degrees were treated. All patients were divided into 3 groups depending on the form of hypospadias: Group I consists of 303 patients with subcoronal and midshaft hypospadias; Group II - 48 patients with midshaft hypospadias who earlier underwent urethroplasty; Group III - 73 patients with chordee without hypospadias. To correct ventral curvature in all cases - STAGE technique was applied. RESULTS No recurrence of penile curvature was noted in any of the three groups in the early and late post-operative follow-up of up to 1 year. CONCLUSIONS Ventral curvature penile correction is important for the future sexual life of the patient. Attention should be paid to this stage of the hypospadias repair. STAGE technique allows to correct ventral curvature of 15 - 60 degrees with minimal number of complications.

Protective effects of hydrogen rich saline solution on ventral penile mathieu type flap with penile tourniquet application in rats

Penile tourniquet (Pt) application aims to work in a bloodless field in penile surgery. When the tourniquet is released, reperfusion injury occurs with the resumption of blood flow. Molecular hydrogen can easily attach to biomembranes and enter cytosol, mitochondria and other organelles of the cell and convert the formed OH- to H₂O to prevent cell and tissue damage. We investigated the effects of hydrogen rich saline solution (HRSS) on penile Mathieu type flap tissue with Pt application in rats. Thirty-six Wistar-albino male rats were randomly divided into six groups. No operations were performed in the Sham group. Ventral penile Mathieu type flap was prepared and Pt was applied to the root of the penis with a plastic band in other groups. Pt was applied 10 and 30min in the PT1⁰ and PT³⁰ groups. HRSS was injected intraperitoneally (ip) 5ml/kg just before Pt was released in the HRSS1⁰ and HRSS³⁰ groups. In the HRSSB group, HRSS was injected 1h before 10min of Pt application. At the 4th hour of experiments the rats were sacrificed and tissue samples were taken for biochemical and histopathological studies. Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), myeloperoxidase (MPO), malondialdehyde (MDA) and glutathione (GSH) levels were determined in the penile tissue. The results were analyzed with one-way ANOVA and Pearson's Chi-Squared test. Tissue MDA, MPO, IL-6 and TNF-α values were significantly lower in all HRSS groups compared to PT1⁰ and PT³⁰ groups. Tissue GSH levels of HRSS groups were higher compared to PT groups. Histopathologically, inflammation was found to be higher in PT groups compared to HRSS groups. Interestingly, in the HRSSB group with HRSS administration prior to Pt, the damage was less in grade, but not statistically different than the other HRSS groups (p>0.05). In previous studies, damage in histopathological examinations after Pt could only be demonstrated long after tourniquet applications such as 24h and with longer duration of Pt such as 30min. Structural changes in different Pt application times could be demonstrated at 60min by electron microscopy and 48h by light microscopy. In this study, the histopathological effect of Pt application could be demonstrated at the 4th hour after release and HRSS was observed to reduce the damage histopathologically as well as biochemically with its anti-inflammatory and antioxidant effects. It was observed that administration of HRSS either before or following Pt did not cause an alteration statistically. HRSS reduces tissue oxidative stress and inflammation on the flap tissue and has a protective effect in Pt applied to the hypospadias model created with a penile flap.

Giammusso corporoplasty for the treatment of isolated congenital ventral penile curvature: Results and long-term follow-up.

The aim was to retrospectively evaluate our experience in a large series of patients affected by isolated congenital ventral penile curvature, surgically treated using a previously described modified incisional corporoplasty. Two hundred and six patients with isolated congenital ventral penile curvature underwent a modified incisional corporoplasty. Mean age at surgery was 20.7±5.5years, and degree of ventral curvature was 60±23°. After the point of maximum convexity identification, Buck's fascia was vertically opened along the deep dorsal vein, which was partially ligated, resected and removed. Tunica albuginea was then longitudinally incised and transversally closed. Post-operative follow-up examination was performed at 2weeks, 6, 12 and 24months and then annually. Surgical time was 79±12min. At follow-up, 189 out of 198 patients (95%) were completely satisfied, four patients (2%) complained a recurrence of penile curvature, and 6 (3%) complained about shortening of the penis. None of the patients had any interference with sexual activity. One patient (0.5%) showed erectile dysfunction 5years after surgery, but there was no organic dysfunction during examination. The proposed technique allows correction of ventral congenital penile curvature without dorsal neurovascular bundle manipulation, resulting in minimum trauma of the erectile tissue, without injury to nerve fibres.

Preoperative topical testosterone for penile hypospadias repair `a comparative study`

BackgroundAlthough the outcome of hypospadias repair has much improved, repair of a small-sized phallus is still challenging. Whether preoperative hormonal therapy is beneficial remains controversial.In this report, we prospectively conducted a clinical trial comparing two groups of patients regarding the effect of preoperative topical testosterone application on the outcome of primary hypospadias repair.ResultsThe study included 40 cases of primary hypospadias with a small glans. Their age ranged from 6 months to 3 years. Patients were divided into two equal groups. Group A were treated by local application of testosterone topical gel 1% for 30–40 days and stopped one month before operation, while cases in group B did not receive preoperative hormonal treatment. Genital skin biopsies were taken for histopathological examination. For group A, penile measurements were documented before and after hormonal therapy.There was a significant increase in all penile parameters after hormonal stimulation in group A. Interestingly, the ventral penile length proximal to the meatus showed more growth in response to hormonal stimulation compared to ventral penile length distal to meatus.We did not find significant difference between both groups regarding the rate of postoperative complications. Also, the cosmesis and parent satisfaction were ‘more or less’ similar. On the histopathological level, we could not detect a difference between both groups regarding micro-vessel density using CD31, which is a vascular marker indicating neovascularization supposed to play a fundamental role in the healing process.ConclusionThe use of preoperative topical testosterone significantly increases the size of the hypospadiac phallus. However, this increase in size appears to be disproportionate on the ventral penile surface and has not been reflected on improving the surgical outcome.Level of evidenceThis is a case control study (level III evidence).

Коррекция стенозов уретры после оперативных вмешательств по поводу проксимальных форм гипоспадии у детей

Aim Urethral stenosis is one of the serious complications after proximal hypospadias repair. A variety of techniques has been suggested for its correction, such as urethral dilation using bougies, endoscopic incisions and one- or two-staged urethroplasty with buccal mucosa. The aim of our study was to improve results of urethral stenosis correction in children after multiple proximal hypospadias repairs. Materials and methods A total of 24 patients with urethral stenosis after proximal hypospadias repairs underwent treatment in the Department of Uroandrology of the Russian Childrens Clinical Hospital from 2015 to 2019. The age of the patients was from 3-17 years (average - 4.2) with penoscrotal form of hypospadias in 12, scrotal in 8, and perineal in 4 patients. All children previously underwent 2-8 hypospadias repairs. Patients were divided into 2 groups. In group I, 16 patients had urethral stenosis from the glans of the penis to the penoscrotal area, urethral diameter of 3-4 Ch and ventral penile curvature of 45-60o. These patients were treated with a two-staged urethroplasty, similar to Brackas technique. In group II, 8 patients with urethral stenosis in the penile shaft area, urethral diameter of 6 Ch, without penile curvature were included. They underwent to a one-stage urethroplasty with buccal mucosa graft, which was sutured on the dorsolateral aspect of the urethra, with a formation of the age-appropriate urethra (Dorsolateral Inlay). Results All patients in both groups had successful results with flow rate of 8-12 ml/sec. Conclusions The correction of urethral stenosis in children after proximal hypospadias repairs can be performed using buccal mucosa. In cases of long urethral stenosis, urethral diameter of 3-4 Ch, penile curvature, and scarring of the penile skin, a two-staged urethroplasty is recommended. In patients with stenosis of the penile shaft, urethral diameter of 6 Ch and lack of penile curvature, a one-stage urethroplasty with buccal mucosa fixation on the dorsolateral aspect of the urethra (Dorsolateral Inlay) allows to achieve successful results.

Measurement accuracy of 3-Dimensional mapping technologies versus standard goniometry for angle assessment

A specific aspect of the hypospadias phenotype that may contribute to long-term outcomes is the presence of ventral penile curvature and the adequacy of its surgical correction. The current gold standard to assess this angle is intraoperative goniometry of an erect penis. 3-dimensional (3D) mapping technologies may overcome the limitations of these traditional methods through their combination of digital image and geometric replication to produce consistent 3D digital forms of a physical structure. The aim of this study is to evaluate the measurement accuracy and reliability of handheld 3D mapping technologies versus standard goniometry for angle assessment in a laboratory setting. Blocks with specified angles (10-45°) were printed using a Zortrax M200 3D printer (±0.2% accuracy). Following the completion of standardized training, blinded participants measured each block angle using a baseline digit goniometer. Additionally, complete digital models of the blocks were created using 3D mapping technologies. Structured light scanning was completed using an Artec Space Spider and Artec Studio 13. Traditional photogrammetry was completed using a Canon Eos Rebel T5i DSLR camera and Agisoft Metashape Pro. Photogrammetry with a 3D camera was completed using the VECTRA H1 and VECTRA Analysis Module. All 3D models were imported into the software Autodesk Inventor in which automated angle measurements through the central plane were obtained. Statistical analysis was performed to determine the accuracy, precision and reliability of each modality using SAS 9.4 software. The reliability of goniometry and each mapping technology was evaluated using two-way random effect models with absolute agreement. Six 3D printed blocks were evaluated. 5 digital models per block were created using each of the 3 mapping technologies. Inter-rater reliability of goniometry was moderate (ICC 0.76, 95% CI 0.46, 0.92), whereas all mapping technologies demonstrated excellent test-retest reliability: structured light scanning (ICC 0.99; 95% CI 0.999, 0.999); traditional photogrammetry (0.99; 0.99, 0.99); 3D camera (0.99; 0.99, 0.99). Mean angle measurements and standard error for each angle and modality are provided in the table. This study demonstrated excellent accuracy, precision and reliability of off-the-shelf, handheld 3D mapping technologies and moderate reliability for goniometry when applied to measurements of angulation in a laboratory setting. The described methods developed in the laboratory for optimization of angle analysis from 3D models are an important step toward reliable, reproducible phenotypic analysis of congenital genitourinary conditions in future intraoperative and database development applications.

Study on the effect of simple incision of ventral tunica albuginea on the correction of penile curvature in hypospadias

Objective: To investigate the therapeutic effect of simple tunica albugineaincision and ventral penile lengthening surgery on the correction of penile curvature due to asymmetry of the cavernous bodies in hypospadias. Methods: A retrospective analysis was performed in 39 children with hypospadias who underwent simple tunica albuginea incision and ventral penile lengthening surgery for correcting asymmetry of the cavernous bodies from January 2016 to December 2018(36 of them were from Department of Pediatric Urology surgery, The Children's Hospital, Zhejiang University School of Medicine, and 3 from Department of Urology surgery, Affiliated Hospital ofJiaxing University), all of whom aged from 0.5 to 5, with a median age of 1.1 years. During the first stage of the operation, firstly penile skin and sarcoma was released by completely degloving the skin and fascia of penis, secondly the factor of short urethral plate was solved by transection of urethral plate, and then the dorsal length of penis (A), the ventral length of the penis before and after straightening by incision of tunica albuginea (B and C) were measured and recorded; onto the second stage of the operation, an artificial erection test was performed to observe the curvature of the penis, the dorsal and ventral length of the penis (D and E) were measured. The dorsal and ventral length of the penis before and after straightening were compared. Results: The dorsal length of penis (A) was 33-39(35.6±3.2) mm, the length of ventral length of penis before straightening (B) was 28-35 (29.8±2.8) mm and the length of ventral length of penis after straightening (C) was 32-38 (34.3±2.1) mm, which were measured during the first stage of operation, and the difference between B and C was statistically significant (P<0.05), while the difference between A and C was not statistically significant (P>0.05). The dorsal length of penis (D) was34-41 (36.4±2.5) mm and the ventral length of penis (E) was 33-40 (35.7±3.6) mm, which were measured during the second stage of operation, and there was no significant difference between D and E (P>0.05). The degree of penile curvature at the time of erection was less than 15° by measuring with the side photos in all patients during 0.5 to 2.5 years of follow-ups with an average of 1.7 years. Conclusions: Penile curvature due to the asymmetry of the cavernous bodies could be effectively corrected by simple incision of ventral tunica albuginea, which showed a good result of early follow-up. The effect of this surgery on ventral penile straightening could be verified by measuring and comparing the ventral and dorsal length of penis during surgery.

Ventral penile curvature estimation using an app

The assessment of penile curvature is a key component of hypospadias surgery, as it often determines if a 1 or 2-stage procedure should be done. The objective of this study was to test the accuracy of penile curvature measurements using an App-based method among non-urologists. Lateral pictures of six plastic 3-dimensional penile models representing each decile of curvature from 20 to 70° were obtained and stored on the research project iPad. Each picture was labeled with a name (i.e. Jim). Non-urology medical professionals were recruited to estimate the curvature of the six pictures with an App-based method consisting of the Photoblend Pro App and 9 provided graded 2-dimensional penile curvature images (representing each decile of curvature from 10 to 90°). Curvature estimations were done by merging the picture of the 3-dimensional penile model with one of the 9 provided graded 2-dimensional penile curvature images inside the App in an iterative process until the penile model picture matched the graded image (see figure). A research associate taught the research subjects the App-based method and then the subjects were asked to estimate the ventral penile curvature of each of the six penile model pictures. Measurement error was calculated as the absolute difference in between the measured value and the true value for the 6 models. A comparison was then made with previous research where pediatric urologists used either a goniometer or unaided visual inspection (UVI) to measure the ventral curvature of the same plastic 3-dimensional penile models used for the pictures of this study. Twenty-one subjects were recruited, and all completed the study. Mean errors using the App ranged from 1.9° to 7.1°, compared to 6.5°-15° for UVI and 4.4°-15.9° for goniometry. The median error for the App was 0° compared to 5-10° for both UVI and goniometry. Mean errors were significantly lower (p<0.05) when using the app compared to UVI/goniometry for all except the 30° and 50° models. Assuming patients with VC≤30° would have had a one stage repair versus a 2-stage repair if curvature was >30°, the number of measurements that could have resulted in the unintended operation was calculated. There was a statistically significant difference in number of potential unintended surgeries in between App (17%) versus UVI+Goniometer (37%) (p=0.0133). This pilot study demonstrated better penile curvature estimations using the App compared to the two most common methods currently used by pediatric urologists. Plastic models provide an avenue to test and compare penile curvature measurement techniques.