Aim: To clarify the ultrastructural changes of penile tunica albuginea (TA) in streptozotocin (STZ)-induced diabetic rats. Methods: Intraperitoneal injection of STZ was used to induce diabetes mellitus (DM) in 12 Spra...Aim: To clarify the ultrastructural changes of penile tunica albuginea (TA) in streptozotocin (STZ)-induced diabetic rats. Methods: Intraperitoneal injection of STZ was used to induce diabetes mellitus (DM) in 12 Sprague Dawley rats. Ten rats (age and weight-matched) were used as control. Blood samples from the tail snips of the rats were used for the determination of serum glucose levels with SureStep Plus Blood Meter. At week 4 and 10 after the injection, half of the rats in each group were sacrificed and penile samples were obtained from the middle third of the penile shaft for the examination of TA under scanning electron microscopy. Results: In the diabetic group, the serum glucose levels were higher (P<0.01 at both time points) and the TA were thinner (P<0.05) than those of the controls. In the control group, the fibers of TA were rich and arranged regularly and undulated, while in the diabetic group, the fibers were diminished, lost the undulations and were arranged irregularly. Conclusion: In rats, DM appeared to impair the penile TA ultrastructures and this impairment could contribute to diabetic erectile dysfunction in part by impairing the veno-occlusive function.展开更多
We evaluated penile prosthesis implantation with tunica albuginea-relaxing incisions without grafting in the treatment of Peyronie＇s disease associated with erectile dysfunction. Between April 2005 and June 2011, 62 ...We evaluated penile prosthesis implantation with tunica albuginea-relaxing incisions without grafting in the treatment of Peyronie＇s disease associated with erectile dysfunction. Between April 2005 and June 2011, 62 patients underwent surgery due to severe Peyronie＇s disease associated with erectile dysfunction. Malleable and inflatable penile prostheses were inserted in 49 and 13 cases, respectively. Penile prostheses were inserted into the corpora cavernosa using the standard ventral approach. After lifting the neurovascular bundle, the tunica albuginea was incised and opened at the plaque region to correct the deformities and to lengthen the penis. Subsequently, the wide neurovascular bundle was replaced, and all incisions of the tunica albuginea were covered to prevent corporal grafting. In the median follow-up of 35 months （range 14-82 months）, the penis was completely straightened in 59 （95%） patients. Numbness of the glans, which the patients found initially upsetting, decreased or disappeared spontaneously 3-6 months later. Penile prosthesis implantation with tunica albuginea incisions is a viable alternative in the treatment of Peyronie＇s disease because the extensive dissection of the neurovascular bundle allows a good approach to the plaque and provides excellent covering of the incised tunica albuginea without additional grafting.展开更多
Several andrological diseases require surgical repair or reconstruction of tunica albuginea, which envelops the corpora cavernosa penis. Despite intense research efforts involving a variety of biological materials, su...Several andrological diseases require surgical repair or reconstruction of tunica albuginea, which envelops the corpora cavernosa penis. Despite intense research efforts involving a variety of biological materials, such as skin, muscle aponeurosis, human dura mater, tunica vaginalis, and pericardium, engineered tunica albuginea suitable for graft use is yet to be obtained. The study investigates microsurgical tunica albuginea allotransplantation in an animal model with the purpose of creation of an organ-specific tissue bank to store penile tissue, from cadaveric donors and male-to-female trans-sexual surgery, for allogeneic transplantation. Materials were tunica albuginea tissue explanted from 15 donor rats, cryopreserved at -80~C, gamma-irradiated, and implanted in 15 recipient rats, of which three rats were used as controls. Penile grafts were explanted at different time intervals; after macroscopic evaluation of the organ, the grafts were processed to morphological, histochemical, and immunohistochemical examinations by light microscopy. Detection of pro-inflammatory cytokines was also performed. Examination of the tunica albuginea allografts collected 1, 3, or 6 months after surgery and of control tunica albuginea fragments showed that tunica albuginea implants achieved biointegration with adjacent tissue at all-time points. The integration of cryopreserved rat tunica albuginea allografts, documented by our study, encourages the exploration of tunica albuginea allotransplantation in humans. In conclusion, the effectiveness and reliability of the tunica albuginea conditioning protocol described here suggest the feasibility of setting up a tunica albuginea bank as a further tissue bank.展开更多
This study aimed to explore whether and how anti-lysyl oxidase(anti-LOX)combined with a vacuum device(VD)could promote penile lengthening and to evaluate the effect on erectile function.This study was performed on fou...This study aimed to explore whether and how anti-lysyl oxidase(anti-LOX)combined with a vacuum device(VD)could promote penile lengthening and to evaluate the effect on erectile function.This study was performed on four groups of adult rats:control,anti-LOX,VD(negative pressure value of-300 mmHg),and anti-LOX+VD.Penile length was measured by a modified VD method and verified on exposed length data.Intracavernous pressure(ICP)and maximum ICP/mean arterial pressure(MAP)ratio were recorded to assess erectile function.For corpus cavernosum,LOX activity and concentrations of pyridinoline,desmosine,hydroxyproline,and elastin were analyzed;transmission electron microscope and Hart’s elastin staining were performed to monitor microstructural changes.Anti-LOX and VD significantly lengthened the penis by 10.8%(3.75 mm)and 8.2%(2.48 mm)compared with the control group,respectively,while anti-LOX+VD achieved the longest penile size(40.58±0.40 mm)which was 17.4%longer than the control group(34.58±0.54 mm).After 1-week washout,no penile retraction was observed.Meanwhile,exposed penile length data confirmed that the penis in the anti-LOX+VD group was also significantly longer.Anti-LOX inhibited LOX activity to reduce pyridinoline level,which led the penile tunica albuginea remodeling.However,it had no effect on hydroxyproline,desmosine,and elastin levels.Moreover,anti-LOX had no impact on erectile function,which was determined by ICP and ICP/MAP ratio.These results suggest that anti-LOX elongates the penis by reducing pyridinoline,which induces tunica albuginea remodeling.This lengthening effect was more obvious when combined with a VD.All procedures had no impact on erectile function.展开更多
Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclu...Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclusion criteria were randomised into two groups:TAU(Group A)and BMG urethroplasty(Group B).Surgical outcome was evaluated with pre-and post-operative work-up involving retrograde urethrogram,voiding cystourethrogram,uroflowmetry,and urethroscopy.Patients were followed up till 1 year.Results:Mean duration of surgery was statistically significant between two groups(p=0.0005).Maximum urine flow rate was comparable when compared between two groups(p=0.22)but statistically significant when compared pre-and post-operatively(p<0.001).At follow-up of 1 year,the successful outcomes were 80% in Group A and 87%in Group B.A total of five patients who had unsuccessful results required redo urethroplasty.Complications were minimal in both the groups.Conclusion:TAU provides outcomes equivalent to those of BMG urethroplasty.TAU has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.展开更多
Background:Numerous surgical techniques are available for the correction of isolated ventral congenital penile curvature(IVCPC).This study aimed to assess the outcomes and predictors of IVCPC treatment in adults using...Background:Numerous surgical techniques are available for the correction of isolated ventral congenital penile curvature(IVCPC).This study aimed to assess the outcomes and predictors of IVCPC treatment in adults using an incisionless plication technique.Materials and methods:This prospective case series examined patients with IVCPC who were treated in our hospital between October 2017 and February 2020 using incisionless plication of the tunica albuginea(Essed-Schroeder technique)with a covering pair of absorbable sutures.The primary outcomes were successful correction(defined as a residual curvature≤15 degrees)and patient satisfaction.Postoperative follow-ups were performed at 3,6,and 12 months.Results:A total of 23 patients were treated for IVCPC with a mean(range)age of 25.3(18-31)years.Eighteen patients(78.3%)were single with cosmetic complaints,whereas the other 5 patients(21.7%)were married and presented with a difficult vaginal intromission.The mean(range)curvature,length,and operative time were 40(30-50)degrees,15(10-19)cm,and 82(65-100)minutes,respectively.Postoperative penile pain and numbness occurred in 13 patients(56.5%)and 7 patients(30.4%)only within the first month,respectively.Palpable suture knots were reported in 15 patients(65.5%)without being bothersome up to 12 months.The postoperative means(ranges)of penile curvature and length were significantly different from that of the preoperative values at 3(5[0-20]degrees and 14.5[9-18.5]cm),6(5[0-20]degrees and 14.5[9-18.5]cm),and 12 months(5[0-30]degrees and 14.5[9-18.5]cm;all p<0.001).Age,preoperative penile curvature,penile length,postoperative pain,wound infections,and knot palpation insignificantly affected curvature recurrence.Seventeen patients(73.9%)were very satisfied with their surgical outcomes.Conclusions:Incisionless plication of the tunica albuginea is effective and safe for the correction of IVCPC in adults with high success and patient satisfaction rates.展开更多
Background: Peyronie’s disease is characterized by fibrous plaque formation in the tunica albuginea, leading to penile curvature and sexual dysfunction. Surgical correction is often required in cases of severe deform...Background: Peyronie’s disease is characterized by fibrous plaque formation in the tunica albuginea, leading to penile curvature and sexual dysfunction. Surgical correction is often required in cases of severe deformity or significant functional impairment. Aim: To present the case of a patient with severe Peyronie’s disease who underwent surgical correction using an autologous fascia lata graft. Case Presentation: We report the case of a 77-year-old Black-African gentleman with Peyronie’s disease, presenting with a self-reported penile curvature of 70 degrees and significant sexual frustration. He was managed surgically with plaque excision followed by a tunica albuginea patch using a subcutaneously harvested autologous fascia lata graft, all performed in a single surgical session. Conclusion: This case highlights the importance of individualized surgical planning and patient-specific considerations in achieving optimal outcomes in the management of Peyronie’s disease, particularly in cases requiring grafting for severe curvature.展开更多
目的:观察低温等离子扁桃体切除术治疗慢性扁桃体炎患者的效果。方法:选择2022年1—12月莆田九十五医院收治的85例慢性扁桃体炎患者作为研究对象,根据手术方式将患者分为低温等离子组(n=43,低温等离子扁桃体切除术)和常规组(n=42,常规...目的:观察低温等离子扁桃体切除术治疗慢性扁桃体炎患者的效果。方法:选择2022年1—12月莆田九十五医院收治的85例慢性扁桃体炎患者作为研究对象,根据手术方式将患者分为低温等离子组(n=43,低温等离子扁桃体切除术)和常规组(n=42,常规扁桃体切除术)。比较两组围手术期指标、创面白膜形成情况、视觉模拟评分法(VAS)评分、并发症。结果:低温等离子组术后恢复正常饮食时间、手术时间、白膜形成时间、开始脱落时间和完全脱落时间短于常规组,术中出血量少于常规组,术后创面白膜形成情况优于常规组,术后1 d、3 d、7 d VAS评分低于常规组,差异有统计学意义(P<0.05);低温等离子组术后并发症发生率为6.98%,与常规组的16.67%比较,差异无统计学意义(P>0.05)。结论:低温等离子扁桃体切除术能缩短慢性扁桃体炎患者手术时间,减少术中出血量和缩短术后疼痛时间,促进术后创面白膜形成。展开更多
<abstract>Aim: To investigate the ultrastructural changes of penile corpus cavernosum and tunica albuginea in rats treated with castration or finasteride. Methods: Eighteen male Sprague-Dawley rats of nine weeks...<abstract>Aim: To investigate the ultrastructural changes of penile corpus cavernosum and tunica albuginea in rats treated with castration or finasteride. Methods: Eighteen male Sprague-Dawley rats of nine weeks old were randomly divided into three groups with 6 rats each. Group A served as the control, Group B was castrated and Group C, treated with finasteride. Four weeks later, rats were anesthetized and blood samples obtained for the determination of serum testosterone (T) and dihydrotestosterone (DHT) levels; penile tissues were taken for scanning electron microscopy. Results: The T, free T and DHT levels in Group B and the DHT level in Group C were significantly lower than those in Group A (P<0.05). The tunica albuginea was significantly thinner in Group B than that in Group A (P<0.05), but there was no significant difference between Group C and Group A (P>0.05). Elastic fibers in the tunica albuginea of Group A were very rich and arranged regularly and undulatedly, but in Group B, most of the elastic fibers were replaced by collagenous fibers. In Group C, the tunica albuginea was mainly composed of thick and irregular-arranged collagenous fibers. In Group A, there were abundant smooth muscle fibers in the trabeculae of corpus cavernosum, but they were much less in Group C and scarce or even disappeared in Group B. In Groups B and C, the diminished/disappeared smooth muscle fibers were replaced by irregularly arranged collagenous fibers. Conclusion: In rats, androgen is essential for maintaining the normal structure of penile tunica albuginea and corpus carvenosum.展开更多
Peymnie＇s disease （PD） is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvatu...Peymnie＇s disease （PD） is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 70° without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems.展开更多
Aim： To discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyro...Aim： To discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyronie＇s disease. Methods： Recent advances in approaches to Peyronie＇s disease are discussed based on the literature and personal experiences. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed. Lengthening procedures on the convex side of the penile curvature by means of grafting offer the best possible gain from a reconstruction standpoint. Penile rectification and rigidity are required to achieve a completely functional penis. Most patients experience associated erectile dysfunction （ED）, and penile straightening alone may not be enough to restore complete function. Twenty-five patients were submitted to total penile reconstruction on length and girth with concomitant penile prosthesis implant. The maximum length restoration was possible and limited by the length of the dissected neurovascular bundle. The mean age was 55.4 years （32-69 years） and the mean angle of curvature 74.2± 22.4° （0-100°）. Pericardial grafting was used to cover the defect. The mean follow-up time was 11.2 ± 5.9 months （3-22 months）. Results： Mean functional penile length gain was 3.40 ＋ 0.73 cm （2-5 cm）. Penile prosthesis maintained the penis straight. No infections occurred. Sexual intercourse was restored in all patients and all reported recovered self-esteem. Conclusion： Improving patient satisfaction with the surgical treatment includes proper preoperative evaluation on stable disease, penile shortening, vascular and erectile status, patient decision and selection as well as extensive discussion on surgical technique for restoring functional penis （length and rigidity）. Length and girth restoration is very important for self-esteem and patient satisfaction.展开更多
Aim： To identity proteins that are differentially expressed in cells derived from normal and diseased tunica albuginea （TA） as related to Peyronie＇s disease （PD）. Methods： Cells with characteristics of fibrobla...Aim： To identity proteins that are differentially expressed in cells derived from normal and diseased tunica albuginea （TA） as related to Peyronie＇s disease （PD）. Methods： Cells with characteristics of fibroblasts were isolated from two tissue sources. Those from the plaque of patients with PD were designated as PT cells, and those from the normally- appearing TA of the same patients were designated as NT cells. Messenger RNAs of these cells were analyzed by real-time polymerase chain reaction （RT-PCR） for the expression of monocyte chemoattractant protein 1 （MCP-1）. Crude protein lysates were analyzed by surface-enhanced laser desorption/ionization mass spectrometry （SELDI-MS） with IMAC30-Cu, CM10, and H50 chips. Each lysate was then separated into six fractions, which were further analyzed by SELDI-MS. Results： RT- PCR analysis showed that PT cells expressed higher levels of MCP-1 than their counterpart NT cells. SELDI-MS analysis showed that the crude protein lysates of all four cell strains produced similar and reproducible protein profiles on IMAC30-Cu and CM 10 chips. Additional SELDI-MS analyses with the fractionated lysates detected three proteins of 11.6 kDa, 14.5 kDa, 22.6 kDa that were upregulated in PT cells and two proteins of 6.3 kDa and 46,9 kDa that were downregulated in PT cells. Conclusion： MCP-1, which is often involved in tissue fibrosis, was expressed at higher levels in PT than that in NT cells. Five potential biomarkers for PD were identified by SELDI-MS analysis. （Asian J Androl 2005 Sep; 7： 237-243）展开更多
文摘Aim: To clarify the ultrastructural changes of penile tunica albuginea (TA) in streptozotocin (STZ)-induced diabetic rats. Methods: Intraperitoneal injection of STZ was used to induce diabetes mellitus (DM) in 12 Sprague Dawley rats. Ten rats (age and weight-matched) were used as control. Blood samples from the tail snips of the rats were used for the determination of serum glucose levels with SureStep Plus Blood Meter. At week 4 and 10 after the injection, half of the rats in each group were sacrificed and penile samples were obtained from the middle third of the penile shaft for the examination of TA under scanning electron microscopy. Results: In the diabetic group, the serum glucose levels were higher (P<0.01 at both time points) and the TA were thinner (P<0.05) than those of the controls. In the control group, the fibers of TA were rich and arranged regularly and undulated, while in the diabetic group, the fibers were diminished, lost the undulations and were arranged irregularly. Conclusion: In rats, DM appeared to impair the penile TA ultrastructures and this impairment could contribute to diabetic erectile dysfunction in part by impairing the veno-occlusive function.
文摘We evaluated penile prosthesis implantation with tunica albuginea-relaxing incisions without grafting in the treatment of Peyronie＇s disease associated with erectile dysfunction. Between April 2005 and June 2011, 62 patients underwent surgery due to severe Peyronie＇s disease associated with erectile dysfunction. Malleable and inflatable penile prostheses were inserted in 49 and 13 cases, respectively. Penile prostheses were inserted into the corpora cavernosa using the standard ventral approach. After lifting the neurovascular bundle, the tunica albuginea was incised and opened at the plaque region to correct the deformities and to lengthen the penis. Subsequently, the wide neurovascular bundle was replaced, and all incisions of the tunica albuginea were covered to prevent corporal grafting. In the median follow-up of 35 months （range 14-82 months）, the penis was completely straightened in 59 （95%） patients. Numbness of the glans, which the patients found initially upsetting, decreased or disappeared spontaneously 3-6 months later. Penile prosthesis implantation with tunica albuginea incisions is a viable alternative in the treatment of Peyronie＇s disease because the extensive dissection of the neurovascular bundle allows a good approach to the plaque and provides excellent covering of the incised tunica albuginea without additional grafting.
文摘Several andrological diseases require surgical repair or reconstruction of tunica albuginea, which envelops the corpora cavernosa penis. Despite intense research efforts involving a variety of biological materials, such as skin, muscle aponeurosis, human dura mater, tunica vaginalis, and pericardium, engineered tunica albuginea suitable for graft use is yet to be obtained. The study investigates microsurgical tunica albuginea allotransplantation in an animal model with the purpose of creation of an organ-specific tissue bank to store penile tissue, from cadaveric donors and male-to-female trans-sexual surgery, for allogeneic transplantation. Materials were tunica albuginea tissue explanted from 15 donor rats, cryopreserved at -80~C, gamma-irradiated, and implanted in 15 recipient rats, of which three rats were used as controls. Penile grafts were explanted at different time intervals; after macroscopic evaluation of the organ, the grafts were processed to morphological, histochemical, and immunohistochemical examinations by light microscopy. Detection of pro-inflammatory cytokines was also performed. Examination of the tunica albuginea allografts collected 1, 3, or 6 months after surgery and of control tunica albuginea fragments showed that tunica albuginea implants achieved biointegration with adjacent tissue at all-time points. The integration of cryopreserved rat tunica albuginea allografts, documented by our study, encourages the exploration of tunica albuginea allotransplantation in humans. In conclusion, the effectiveness and reliability of the tunica albuginea conditioning protocol described here suggest the feasibility of setting up a tunica albuginea bank as a further tissue bank.
基金the National Nature Science Foundation of China(No.81871147 and No.81671453)Sichuan Science and Technology Program(No.2018SZ0019 and No.2018TJPT0018).
文摘This study aimed to explore whether and how anti-lysyl oxidase(anti-LOX)combined with a vacuum device(VD)could promote penile lengthening and to evaluate the effect on erectile function.This study was performed on four groups of adult rats:control,anti-LOX,VD(negative pressure value of-300 mmHg),and anti-LOX+VD.Penile length was measured by a modified VD method and verified on exposed length data.Intracavernous pressure(ICP)and maximum ICP/mean arterial pressure(MAP)ratio were recorded to assess erectile function.For corpus cavernosum,LOX activity and concentrations of pyridinoline,desmosine,hydroxyproline,and elastin were analyzed;transmission electron microscope and Hart’s elastin staining were performed to monitor microstructural changes.Anti-LOX and VD significantly lengthened the penis by 10.8%(3.75 mm)and 8.2%(2.48 mm)compared with the control group,respectively,while anti-LOX+VD achieved the longest penile size(40.58±0.40 mm)which was 17.4%longer than the control group(34.58±0.54 mm).After 1-week washout,no penile retraction was observed.Meanwhile,exposed penile length data confirmed that the penis in the anti-LOX+VD group was also significantly longer.Anti-LOX inhibited LOX activity to reduce pyridinoline level,which led the penile tunica albuginea remodeling.However,it had no effect on hydroxyproline,desmosine,and elastin levels.Moreover,anti-LOX had no impact on erectile function,which was determined by ICP and ICP/MAP ratio.These results suggest that anti-LOX elongates the penis by reducing pyridinoline,which induces tunica albuginea remodeling.This lengthening effect was more obvious when combined with a VD.All procedures had no impact on erectile function.
文摘Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclusion criteria were randomised into two groups:TAU(Group A)and BMG urethroplasty(Group B).Surgical outcome was evaluated with pre-and post-operative work-up involving retrograde urethrogram,voiding cystourethrogram,uroflowmetry,and urethroscopy.Patients were followed up till 1 year.Results:Mean duration of surgery was statistically significant between two groups(p=0.0005).Maximum urine flow rate was comparable when compared between two groups(p=0.22)but statistically significant when compared pre-and post-operatively(p<0.001).At follow-up of 1 year,the successful outcomes were 80% in Group A and 87%in Group B.A total of five patients who had unsuccessful results required redo urethroplasty.Complications were minimal in both the groups.Conclusion:TAU provides outcomes equivalent to those of BMG urethroplasty.TAU has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.
文摘Background:Numerous surgical techniques are available for the correction of isolated ventral congenital penile curvature(IVCPC).This study aimed to assess the outcomes and predictors of IVCPC treatment in adults using an incisionless plication technique.Materials and methods:This prospective case series examined patients with IVCPC who were treated in our hospital between October 2017 and February 2020 using incisionless plication of the tunica albuginea(Essed-Schroeder technique)with a covering pair of absorbable sutures.The primary outcomes were successful correction(defined as a residual curvature≤15 degrees)and patient satisfaction.Postoperative follow-ups were performed at 3,6,and 12 months.Results:A total of 23 patients were treated for IVCPC with a mean(range)age of 25.3(18-31)years.Eighteen patients(78.3%)were single with cosmetic complaints,whereas the other 5 patients(21.7%)were married and presented with a difficult vaginal intromission.The mean(range)curvature,length,and operative time were 40(30-50)degrees,15(10-19)cm,and 82(65-100)minutes,respectively.Postoperative penile pain and numbness occurred in 13 patients(56.5%)and 7 patients(30.4%)only within the first month,respectively.Palpable suture knots were reported in 15 patients(65.5%)without being bothersome up to 12 months.The postoperative means(ranges)of penile curvature and length were significantly different from that of the preoperative values at 3(5[0-20]degrees and 14.5[9-18.5]cm),6(5[0-20]degrees and 14.5[9-18.5]cm),and 12 months(5[0-30]degrees and 14.5[9-18.5]cm;all p<0.001).Age,preoperative penile curvature,penile length,postoperative pain,wound infections,and knot palpation insignificantly affected curvature recurrence.Seventeen patients(73.9%)were very satisfied with their surgical outcomes.Conclusions:Incisionless plication of the tunica albuginea is effective and safe for the correction of IVCPC in adults with high success and patient satisfaction rates.
文摘Background: Peyronie’s disease is characterized by fibrous plaque formation in the tunica albuginea, leading to penile curvature and sexual dysfunction. Surgical correction is often required in cases of severe deformity or significant functional impairment. Aim: To present the case of a patient with severe Peyronie’s disease who underwent surgical correction using an autologous fascia lata graft. Case Presentation: We report the case of a 77-year-old Black-African gentleman with Peyronie’s disease, presenting with a self-reported penile curvature of 70 degrees and significant sexual frustration. He was managed surgically with plaque excision followed by a tunica albuginea patch using a subcutaneously harvested autologous fascia lata graft, all performed in a single surgical session. Conclusion: This case highlights the importance of individualized surgical planning and patient-specific considerations in achieving optimal outcomes in the management of Peyronie’s disease, particularly in cases requiring grafting for severe curvature.
文摘目的:观察低温等离子扁桃体切除术治疗慢性扁桃体炎患者的效果。方法:选择2022年1—12月莆田九十五医院收治的85例慢性扁桃体炎患者作为研究对象,根据手术方式将患者分为低温等离子组(n=43,低温等离子扁桃体切除术)和常规组(n=42,常规扁桃体切除术)。比较两组围手术期指标、创面白膜形成情况、视觉模拟评分法(VAS)评分、并发症。结果:低温等离子组术后恢复正常饮食时间、手术时间、白膜形成时间、开始脱落时间和完全脱落时间短于常规组,术中出血量少于常规组,术后创面白膜形成情况优于常规组,术后1 d、3 d、7 d VAS评分低于常规组,差异有统计学意义(P<0.05);低温等离子组术后并发症发生率为6.98%,与常规组的16.67%比较,差异无统计学意义(P>0.05)。结论:低温等离子扁桃体切除术能缩短慢性扁桃体炎患者手术时间,减少术中出血量和缩短术后疼痛时间,促进术后创面白膜形成。
文摘<abstract>Aim: To investigate the ultrastructural changes of penile corpus cavernosum and tunica albuginea in rats treated with castration or finasteride. Methods: Eighteen male Sprague-Dawley rats of nine weeks old were randomly divided into three groups with 6 rats each. Group A served as the control, Group B was castrated and Group C, treated with finasteride. Four weeks later, rats were anesthetized and blood samples obtained for the determination of serum testosterone (T) and dihydrotestosterone (DHT) levels; penile tissues were taken for scanning electron microscopy. Results: The T, free T and DHT levels in Group B and the DHT level in Group C were significantly lower than those in Group A (P<0.05). The tunica albuginea was significantly thinner in Group B than that in Group A (P<0.05), but there was no significant difference between Group C and Group A (P>0.05). Elastic fibers in the tunica albuginea of Group A were very rich and arranged regularly and undulatedly, but in Group B, most of the elastic fibers were replaced by collagenous fibers. In Group C, the tunica albuginea was mainly composed of thick and irregular-arranged collagenous fibers. In Group A, there were abundant smooth muscle fibers in the trabeculae of corpus cavernosum, but they were much less in Group C and scarce or even disappeared in Group B. In Groups B and C, the diminished/disappeared smooth muscle fibers were replaced by irregularly arranged collagenous fibers. Conclusion: In rats, androgen is essential for maintaining the normal structure of penile tunica albuginea and corpus carvenosum.
文摘Peymnie＇s disease （PD） is most simply referred to as a fibrotic wound-healing disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, hinging, narrowing and shortening, which may compromise sexual function. Although a variety of non-surgical treatments have been suggested, none to date offer a reliable and effective correction of the penile deformity. As a result, surgery remains the gold standard treatment option, offering the most rapid and reliable treatment which will be the focus of this article. We review the preoperative evaluation, surgical algorithm, graft materials and postoperative management of PD. Outcomes for tunical shortening, tunical lengthening and penile prosthesis placement for penile straightening are reviewed. Tunica albuginea plication is the preferred method of straightening for men with adequate rigidity and less severe disease defined as curvature less than 70° without narrowing/hinging. Men who have more severe, complex deformity, but maintain strong preoperative erectile function should be considered candidates for straightening with plaque incision or partial excision and grafting. Finally, for those men who have inadequate rigidity and PD, penile prosthesis placement with straightening is the best approach to address both problems.
文摘Aim： To discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyronie＇s disease. Methods： Recent advances in approaches to Peyronie＇s disease are discussed based on the literature and personal experiences. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed. Lengthening procedures on the convex side of the penile curvature by means of grafting offer the best possible gain from a reconstruction standpoint. Penile rectification and rigidity are required to achieve a completely functional penis. Most patients experience associated erectile dysfunction （ED）, and penile straightening alone may not be enough to restore complete function. Twenty-five patients were submitted to total penile reconstruction on length and girth with concomitant penile prosthesis implant. The maximum length restoration was possible and limited by the length of the dissected neurovascular bundle. The mean age was 55.4 years （32-69 years） and the mean angle of curvature 74.2± 22.4° （0-100°）. Pericardial grafting was used to cover the defect. The mean follow-up time was 11.2 ± 5.9 months （3-22 months）. Results： Mean functional penile length gain was 3.40 ＋ 0.73 cm （2-5 cm）. Penile prosthesis maintained the penis straight. No infections occurred. Sexual intercourse was restored in all patients and all reported recovered self-esteem. Conclusion： Improving patient satisfaction with the surgical treatment includes proper preoperative evaluation on stable disease, penile shortening, vascular and erectile status, patient decision and selection as well as extensive discussion on surgical technique for restoring functional penis （length and rigidity）. Length and girth restoration is very important for self-esteem and patient satisfaction.
文摘Aim： To identity proteins that are differentially expressed in cells derived from normal and diseased tunica albuginea （TA） as related to Peyronie＇s disease （PD）. Methods： Cells with characteristics of fibroblasts were isolated from two tissue sources. Those from the plaque of patients with PD were designated as PT cells, and those from the normally- appearing TA of the same patients were designated as NT cells. Messenger RNAs of these cells were analyzed by real-time polymerase chain reaction （RT-PCR） for the expression of monocyte chemoattractant protein 1 （MCP-1）. Crude protein lysates were analyzed by surface-enhanced laser desorption/ionization mass spectrometry （SELDI-MS） with IMAC30-Cu, CM10, and H50 chips. Each lysate was then separated into six fractions, which were further analyzed by SELDI-MS. Results： RT- PCR analysis showed that PT cells expressed higher levels of MCP-1 than their counterpart NT cells. SELDI-MS analysis showed that the crude protein lysates of all four cell strains produced similar and reproducible protein profiles on IMAC30-Cu and CM 10 chips. Additional SELDI-MS analyses with the fractionated lysates detected three proteins of 11.6 kDa, 14.5 kDa, 22.6 kDa that were upregulated in PT cells and two proteins of 6.3 kDa and 46,9 kDa that were downregulated in PT cells. Conclusion： MCP-1, which is often involved in tissue fibrosis, was expressed at higher levels in PT than that in NT cells. Five potential biomarkers for PD were identified by SELDI-MS analysis. （Asian J Androl 2005 Sep; 7： 237-243）
