Objective The aim of this study was to investigate the value of the 8th American Joint Committee on Cancer(AJCC)anatomic and prognostic stage groups for penile cancer patients and explore whether there is room for imp...Objective The aim of this study was to investigate the value of the 8th American Joint Committee on Cancer(AJCC)anatomic and prognostic stage groups for penile cancer patients and explore whether there is room for improvement.Methods The clinical and histopathologic data from 16 centers between January 2000 and December 2021 were assessed according to the 8th AJCC anatomic and prognostic stage groups.Kaplan–Meier plots were used to estimate the disease-specific survival(DSS)of the patients.The accuracy of the staging systems was investigated using the Harrell's concordance index(C-index).Results According to the 8th AJCC anatomic and prognostic stage groups,the 5-year DSS rates for patients with stages 0is/a,I,IIA,IIB,IIIA,IIIB,and IV disease were 100%,99%,86%,81%,66%,34%,and 23%,respectively(p_(0is/a–I)=0.8,p_(I–IIA)<0.001,p_(IIA–IIB)=0.5,p_(IIB–IIIA)<0.001,p_(IIIA–IIIB)<0.001,p_(IIIB–IV)=0.004,and p_(Total)<0.001).According to the modified model 1 system,the 5-year DSS rates without survivorship overlap for patients with stages 0is/a,I,II,IIIA,IIIB,and IV disease were 100%,99%,88%,66%,34%,and 23%,respectively(p_(0is/a–I)=0.8,p_(I–II)<0.001,p_(II–IIIA)=0.002,p_(IIIA–IIIB)<0.001,p_(IIIB–IV)=0.004,and p_(Total)<0.001).Similarly,according to the modified model 2 system,the 5-year DSS rates without survivorship overlap for patients with stages 0is/a,I,II,IIIA,IIIB,and IV disease were 100%,99%,86%,66%,34%,and 23%,respectively(p_(0is/a–I)=0.8,p_(I–II)<0.001,p_(II–IIIA)=0.008,p_(IIIA–IIIB)<0.001,p_(IIIB–IV)=0.004,and p_(Total)<0.001).The C-index scores of the simple modified staging systems were not inferior to those of the AJCC anatomic and prognostic stage groups.These results were confirmed by the bootstrap internal validation.Conclusion There is still room for improvement about the 8th AJCC anatomic and prognostic stage groups.The improved models,which are more concise and convenient,have similar prediction accuracy.展开更多
Penile fracture is a rare clinical entity that occurs secondary to direct trauma to an erect penis,most commonly during sexual intercourse.Specifically,increased pressure within the corpus cavernosa results in rupture...Penile fracture is a rare clinical entity that occurs secondary to direct trauma to an erect penis,most commonly during sexual intercourse.Specifically,increased pressure within the corpus cavernosa results in rupture of the tunica albuginea.Occasionally,these injuries extend to the urethra and very rarely cause a complete urethral avulsion.Emergent exploration improves posttraumatic erectile function,penile curvature,and prevents painful erections.The traditional approach is a subcoronal circumcising incision to allow for adequate visualization.We present an uncircumcised male with bilateral corporal injuries and complete urethral avulsion who underwent a ventral midline approach for successful foreskin preservation.展开更多
BACKGROUND The incidence of colon cancer has been progressively increasing over time,whereas penile metastasis of colon cancer has remained exceedingly uncommon.Since the prognosis for colon cancer with BRAF_(V600E)mu...BACKGROUND The incidence of colon cancer has been progressively increasing over time,whereas penile metastasis of colon cancer has remained exceedingly uncommon.Since the prognosis for colon cancer with BRAF_(V600E)mutation is relatively unfavorable,further exploration and investigation are still required to develop treatment strategies for such rare cases.CASE SUMMARY About one year after surgery and chemotherapy,a 50-year-old patient with sigmoid colon cancer developed a mass at the base of the patient's penis,accompanied by severe tenderness and pain during urination.With disease progression,multiple metastatic nodules also emerged in other regions of the penis,including the coronal sulcus.The nodules located in the coronal sulcus were excised for histopathological examination.The histopathological findings revealed that the nodules were metastases originating from the sigmoid colon cancer,with a BRAF V600E mutation detected.This prompted a modification of the therapy regimen of cetuximab,dabrafenib and trametinib,which effectively held back the progression of penile metastasis in the patient.CONCLUSION Combining the BRAF/MEK-targeted therapy with cetuximab demonstrates a favorable therapeutic response in BRAF_(V600E)-mutated colon cancer with penile metastasis.展开更多
Inflatable penile prosthesis(IPP)implantation is the gold standard treatment for patients with erectile dysfunction who are refractory to medical therapy.The standard placement of the reservoir in the space of Retzius...Inflatable penile prosthesis(IPP)implantation is the gold standard treatment for patients with erectile dysfunction who are refractory to medical therapy.The standard placement of the reservoir in the space of Retzius(SOR)may be contraindicated in patients with prior pelvic or abdominal surgery due to altered anatomy and increased risk of complications.This has led to the development of alternative ectopic reservoir placement techniques.In this narrative review,we summarize the literature on various ectopic reservoir approaches,including low and high submuscular placements,submuscular techniques with counter incisions or transfascial fixation,midline submuscular placement,subcutaneous placement,and lateral retroperitoneal approaches.We describe the surgical methods,outcomes,and complication rates associated with each technique.While most methods demonstrate low complication and revision rates,direct comparisons remain limited due to heterogeneity and lack of prospective data.This review highlights the importance of individualized technique selection based on prior surgical history,body habitus,and surgeon experience.As ectopic placement becomes more widely adopted,familiarity with multiple approaches is essential for prosthetic surgeons.展开更多
Penile prosthesis surgery is a definitive treatment for erectile dysfunction(ED).The two categories of penile prosthesis are endorsed by professional guidelines,inflatable penile prosthesis(IPP)and malleable penile pr...Penile prosthesis surgery is a definitive treatment for erectile dysfunction(ED).The two categories of penile prosthesis are endorsed by professional guidelines,inflatable penile prosthesis(IPP)and malleable penile prosthesis(MPP).Each modality of penile prosthesis offers distinct advantages and incorporates specific design features,allowing for personalized device selection that aligns with individual needs and preferences.While the overall complication rate of penile implant surgery remains low,surgeons should maintain a high index of suspicion for complications in the perioperative time period.Multimodal analgesic regimens including nerve blocks and narcotic-free pathways should be administered to manage perioperative pain.Finally,the high patient satisfaction after penile prosthesis surgery underscores the success of this ED treatment option.展开更多
Implantation of an inflatable penile prosthesis （IPP） is a well-established definitive solution for erectile dysfunction when conservative treatments fail. Penile implants may shorten the penis. The AMS 700 LGX IPP ...Implantation of an inflatable penile prosthesis （IPP） is a well-established definitive solution for erectile dysfunction when conservative treatments fail. Penile implants may shorten the penis. The AMS 700 LGX IPP is in common use but reports on its mechanical reliability, medium-term postsurgical patient satisfaction, and mean penile length preservation are lacking. We investigate the mean penile length, mechanical reliability, and patient satisfaction at 6 and 12 months after implantation of the AMS 700 LGX. This prospective study consecutively enrolled men undergoing first-time IPP implant surgery from February 2009 to April 2012. Stretched flaccid penile length, penile length at 50% and 100% of stiffness （PSO and P100） and International Index of Erectile Function （IIEF） and Erectile Dysfunction Inventory of Treatment Satisfaction （EDITS） scores, were measured at 6 and 12 months postsurgery. Of 45 patients who underwent AMS 700 LGX implantation （median age 61 years） and completed 6 months＇ follow-up, 36 （80%） completed the study. A significant difference in stretched flaccid penile length was seen between 6 and 12 months （P= 0.033）. P100 was also significantly increased at 6 and 12 months, with a mean 10% increase （1.3 ±0.4 cm） from baseline to 12 months. Differences in mean IIEF scores at 6 and 12 months were significant for the desired domain （P = 0.0001） and for overall satisfaction （P = 0.002）; however, mean EDITS scores at 6 and 12 months were not significantly improved. AMS 700 LGX is a powerful tool for preserving penile length in men undergoing penile prosthesis implantation.展开更多
Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie’s disease.Currently,there is a variety of options for the correction of residual curvature,i...Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie’s disease.Currently,there is a variety of options for the correction of residual curvature,including penile modeling,plication techniques,as well as tunical incision/excision with or without grafting.A literature search of PubMed and Medline databases was conducted from 1964 until 2020,using search terms for all articles in the English language.In this article,we provide a review of the techniques and the outcomes,according to the published literature.展开更多
Objective:Penile cancer is a rare malignancy in most developed countries,but may represent a significant oncologic challenge in certain African,Asian,and South American regions.Various treatment approaches have been d...Objective:Penile cancer is a rare malignancy in most developed countries,but may represent a significant oncologic challenge in certain African,Asian,and South American regions.Various treatment approaches have been described in penile cancer,including radio-therapy.This review aimed to provide a synopsis of radiotherapy use in penile cancer management and the associated toxicities.In addition,we aimed to discuss palliative radiation for metastases to the penis and provide a brief overview of how tumor biology may assist with treatment decision-making.Methods:Peer-reviewed manuscripts related to the treatment of penile cancer with radio-therapy were evaluated by a PubMed search(1960-2021)in order to assess its role in the definitive and adjuvant settings.Selected manuscripts were also evaluated for descriptions of radiation-related toxicity.Results:Though surgical resection of the primary is an excellent option for tumor control,select patients may be treated with organ-sparing radiotherapy by either external beam radiation or brachytherapy.Data from randomized controlled trials comparing radiotherapy and surgery are lacking,and thus management is frequently determined by institutional practice patterns and available expertise.Similarly,this lack of clinical trial data leads to divergence in opinion regarding lymph node management.This is further complicated in that many cited studies evaluating lymph node radiotherapy used non-modern radiotherapy delivery techniques.Groin toxicity from either surgery or radiotherapy remains a challenging problem and further risk assessment is needed to guide intensification with multi-modal therapy.Intrinsic differences in tumor biology,based on human papillomavirus infection,may help aid future prognostic and predictive models in patient risk stratification or treatment approach.Conclusion:Penile cancer is a rare disease with limited clinical trial data driving the majority of treatment decisions.As a result,the goal of management is to effectively treat the disease while balancing the importance of quality of life through integrated multidisciplinary discussions.More international collaborations and interrogations of penile cancer biology are needed to better understand this disease and improve patient outcomes.展开更多
Penile cancer is an uncommon malignancy. Surgical treatment is inevitably mutilating. Considering the strong impact on patients＇ sexual life we want to evaluate sexual function and satisfaction after partial penectom...Penile cancer is an uncommon malignancy. Surgical treatment is inevitably mutilating. Considering the strong impact on patients＇ sexual life we want to evaluate sexual function and satisfaction after partial penectomy. The patients in this study （n = 25） represented all those who attended our institutions and were diagnosed and treated for penile cancer from October 2011 to November 2013. All patients underwent partial penectomy and followed-up （mean： 14 months; range： 12-25）. Sexual presurgical baseline was estimated using the International Index of Erectile Dysfunction 15 （IIEF-15）. Sexual outcomes of each patient were estimated considering four standardized and validated questionnaires. We analyzed the means and ranges of IIEF-15 including erectile function （IIEF-1-5 and -15）, orgasmic function （IIEF-9 and -10）, sexual desire （IIEF-11 and -12）, intercourse satisfaction （IIEF-6-8）, and overall satisfaction （IIEF-13 and -14）. Then, we also used Quality of Erection Questionnaire （QEQ）, Erectile Dysfunction Inventory of Treatment Satisfaction （EDITS） and Self-Esteem and Relationship （SEAR） to evaluate the sexual function and satisfaction of our patients. The final results showed that penile cancer leads to several sexual and psychosexual dysfunctions. Nevertheless, patients who undergo partial penectomy for penile cancer can maintain the sexual outcomes at levels slightly lower to those that existed in the period before surgery.展开更多
During the most recent years, a variety of new techniques of penile reconstruction have been described in the literature. This paper focuses on the most recent advances in male genital reconstruction after trauma, exc...During the most recent years, a variety of new techniques of penile reconstruction have been described in the literature. This paper focuses on the most recent advances in male genital reconstruction after trauma, excision of benign and malignant disease, in gender reassignment surgery and aphallia with emphasis on surgical technique, cosmetic and functional outcome.展开更多
Aim: To investigate the flaccid and stretched penile sizes of young Korean men and their complexes or pride about their penile size. Methods: After an explanation and agreement to the purpose and methods of this study...Aim: To investigate the flaccid and stretched penile sizes of young Korean men and their complexes or pride about their penile size. Methods: After an explanation and agreement to the purpose and methods of this study, 123 Korean men in their early 20's visiting the Jinhae Military General Hospital were included in the study. The flaccid penile length, flaccid mid-shaft circumference, stretched length and pre-pubic bone fat pad depth were measured in a warm comfortable environment. The accuracy the subjects assessed their penile size was investigated by asking them to rate their penile size, as 'very small', 'small', 'normal', 'large' or 'very large'. All subjects were asked to complete the Minnesota multiphasic personality inventory (MMPI) test. Results: The mean flaccid length, flaccid circumference, stretched length and fat pad depth of the 123 subjects were (6.9 ± 0.8) cm, (8.5 ±1.1) cm, (9.6 ± 0.8) cm and (1.1 ± 0.4) cm, respectively. The answer distribution on penile size was 1 (0.8 %) 'very small', 29 (23.6 %) 'small', 86 (69.9 %) 'normal', 6 (4.9 %) 'large' and 1 (0.8 %) 'very large'. Subjects who underestimated their penile size showed significantly higher scores on the hypochondriasis (Hs), depression (D) and psychasthenia (Pt) subscales of the MMPI than those in the Unbiased Group (P<0.05). Conclusion: In consultation, with a patient requesting penile augmentation, the urologist should consider the psychologic attitude of the patient to his penile size.展开更多
The pathophysiology of LaPeyronie＇s disease （PD） is considered to be multifactorial, involving genetic predisposition, trauma, inflammation and altered wound healing. However, these factors have not yet been valida...The pathophysiology of LaPeyronie＇s disease （PD） is considered to be multifactorial, involving genetic predisposition, trauma, inflammation and altered wound healing. However, these factors have not yet been validated using animal models. In this study, we have presented a new model obtained by tunica albuginea allograft. A total of 40, 16-week-old male rats were used. Of these, 8 rats served as controls and underwent a 10 × 2-mm-wide tunical excisionwith subsequent autografting, whereas the remaining 32 underwent the same excision with grafting of the defect with another rat＇s tunica. Morphological and functional testing was performed at 1, 3, 7 and 12 weeks after grafting. Intracavernous pressure, the degree of penile curvature and elastic fiber length were evaluated for comparison between the allograft and control groups. The tissues were obtained for histological examination. The penile curvature was significantly greater in the allografted rats as compared with the control rats. The erectile function was maintained in all rats, except in those assessed at 12 weeks. The elastin fiber length was decreased in the allografted tunica as compared to control. SMAD2 expression was detected in the inner part of the allograff, and both collagen-Ⅱ- and osteocalcin-positive cells were also noted. Tunica albuginea （TA） allograft in rats is an excellent model of PD. The persistence of curvature beyond 12 weeks and the presence of ossification in the inner layer of the TA were similar to those observed in men with PD. Validation studies using this animal model would aid understanding of the PD pathophysiology for effective therapeutic interventions.展开更多
A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement techniq...A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique （NLMT） coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfact on and erectile peni e measurements Th s is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, With new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer （30.8%） or the same （46.2%） as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject （96.5%） was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.展开更多
Erectile dysf un ction and penile shri nkage are the comm on complications after radical prostatectomy.Penile rehabilitati on is widely applied after the surgery.Vacuum therapy is one of the three penile rehabilitatio...Erectile dysf un ction and penile shri nkage are the comm on complications after radical prostatectomy.Penile rehabilitati on is widely applied after the surgery.Vacuum therapy is one of the three penile rehabilitation methods used in the clinical setting,but its mechanism is not well known.This study was designed to investigate whether vacuum erectile device(VED)can prevent corporeal veno-occlusive dysfunction and penile shrinkage in the bilateral cavernous nerve crush(BCNC)rat model.Adult male Sprague-Dawley rats were randomly assigned into three groups:sham group,BCNC group,and BCNC+VED group.After 4 weeks,penile length and intracavernosal pressure(ICP)were measured,and then the middle part of the penis was harvested after dynamic inf usion caver no sometry to complete the followi ng items:smooth muscle/collage n ratios and collagenⅠ/Ⅲratios;ultramicrostructure of the tunica albuginea,endothelial cell,and smooth muscle cell;and the expression of calponin・l and osteopontin.The penile shortening,peak ICP and ICP drop rate after alprostadil injection were significantly improved with vacuum therapy after 4-week treatme nt.Compared with BCNC group,VED sign ifica ntly in creased smooth muscle/collagen ratios,decreased collagenⅠ/Ⅲratios,and preserved the ultramicrostructure of the tunica albuginea,endothelial cell,and smooth muscle cell.The data also showed that an imals exposed to VED could partially reverse the expression of calp onin・l and osteop ontin induced by BCNC.In conclusion,vacuum therapy is effective to prevent penile shrinkage and veno-occlusive dysfunction in penile rehabilitation,which may be associated with well-preserved structure and function of the tunica albuginea,endothelial cell,and smooth muscle cell.展开更多
The second to fourth digit ratio （2D：4D） has been proposed as a putative biomarker for prenatal testosterone and covaries with the sensitivity of the androgen receptor （AR）. Both prenatal testosterone and the AR ...The second to fourth digit ratio （2D：4D） has been proposed as a putative biomarker for prenatal testosterone and covaries with the sensitivity of the androgen receptor （AR）. Both prenatal testosterone and the AR play a central role in penile growth. In this study, we investigated the relationship between digit ratio and penile length. Korean men who were hospitalized for urological surgery at a single tertiary academic centre were examined in this study, and 144 men aged 20 years or older who gave informed consent were prospectively enrolled. Right-hand second- and fourth-digit lengths were measured by a single investigator prior to measurement of penile length. Under anaesthesia, flaccid and stretched penile lengths were measured by another investigator who did not measure nor have any the information regarding the digit lengths. Univariate and multivariate analysis using linear regression models showed that only height was a significant predictive factor for flaccid penile length （univariate analysis： r=0. 185, P=-0.026; multivariate analysis： r=-0.172, P=0.038） and that only digit ratio was a significant predictive factor for stretched penile length （univariate analysis： r=-0.216, P=0.009; multivariate analysis： r=-0.201, P=0.024; stretched penile length=-9.201 xdigit ratio ＋ 20.577）. Based on this evidence, we suggest that the digit ratio can predict adult penile size and that the effects of prenatal testosterone may in part explain the differences in adult penile length.展开更多
We aimed to evaluate ten-year outcomes of penile prosthesis(PP)implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection(EPI).We identified 549 men who underwent 576...We aimed to evaluate ten-year outcomes of penile prosthesis(PP)implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection(EPI).We identified 549 men who underwent 576 PP placements between 2008 and 2018.Univariate and multivariate analyses were used to identify potential predictors of EPI.An EPI predictive nomogram was developed.Thirty-five(6.1%)cases of EPI were recorded with an explant rate of 3.1%.In terms of satisfaction,82.0%of the patients defined themselves as“satisfied,”while partner’s satisfaction was 88.3%.Diabetes(P=0.012),longer operative time(P=0.032),and reinterventions(P=0.048)were associated with EPI risk,while postoperative ciprofloxacin was inversely associated with EPI(P=0.014).Rifampin/gentamicin-coated 3-piece inflatable PP(r/g-c 3IPP)showed a higher EPI risk(P=0.019).Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients,redo surgeries,or when a r/g-c 3IPP was used(all P<0.03).We showed that diabetes,longer operative time,and secondary surgeries were the risk factors for EPI.Postoperative ciprofloxacin was associated with a reduced risk of EPI,while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant.After further validation,the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.展开更多
Most widespread three-component penile prosthesis models are 700CXTM and Titan~. Our purpose is to assess patient and partner satisfaction after the first implant. This is a multicenter, retrospective, nonrandomized s...Most widespread three-component penile prosthesis models are 700CXTM and Titan~. Our purpose is to assess patient and partner satisfaction after the first implant. This is a multicenter, retrospective, nonrandomized study in which all patients who met the inclusion criteria between 2009 and 2013 were included. In total, 248 patients agreed to participate. To evaluate patient satisfaction, a validated but modified 11-question questionnaire was completed （EDITS）; and a nonvalidated two-item questionnaire was given to the partner. Statistical analysis used an ordinal logistic regression model. Two hundred and forty-eight patients （194 with 700CXTM vs 54 with Titan） and 207 couples completed the questionnaire （165 with 700CXTM vs 42 with Titan）. Overall satisfaction was high. Both showed great reliability for sexual intercourse and high compliance with prior expectations. Most patients were able to manage the penile prosthesis correctly within 6 months. Postoperative penile shortening led to some dissatisfaction in 42% and 46% of cases （700CX/Titan）. Significant differences were found in three questions of patients＇ questionnaire. There were more patients satisfied with the 700CXTM （P= 0.0001）. No patient with Titan implant took longer than 6 months to optimal management. Only 4% of patients with 700CXTM implant were dissatisfied with the deflation, in contrast to 24% with the Titan （P = 0.0031）. Of the two partners＇ questions, one showed a statistically significant difference （P = 0.0026）. It seems that group 700CX＂ would recommend to re-implant the prosthesis with a greater tendency. The overall satisfaction was very high for both prostheses. The final aspect of the erected and flaccid penis was satisfactory, but both groups showed significant discontent with its final size. Partners＇ overall satisfaction was high.展开更多
Penile reconstruction still represents a formidable challenge for the urologist. In this review, the most recent advances in penile reconstruction after trauma, excision of benign and malignant disease and in patients...Penile reconstruction still represents a formidable challenge for the urologist. In this review, the most recent advances in penile reconstruction after trauma, excision of benign and malignant disease and in patients with micropenis, aphallia or female to male gender dysphoria are reported.展开更多
Aim： To report our experience with penile girth augmentation using liquid injectable silicone. Methods： Between August 2003 and July 2006, 324 men （mean age 35 years, range 19-65 years） received a series of liquid...Aim： To report our experience with penile girth augmentation using liquid injectable silicone. Methods： Between August 2003 and July 2006, 324 men （mean age 35 years, range 19-65 years） received a series of liquid silicone subcutaneous injections between the penile skin and the corpora cavernosa on the dorsal and lateral aspects of the penile shaft, under local anesthesia. Digital photographs taken pre- and post-procedure （n = 324）, and penile contour measurements （n = 30） yielded objective results. Subjective results were derived from patient and partner testimony of satisfaction. Follow-up averaged 20 months （range 1-36 months）. Results： Three hundred and twenty-four procedures were primary augmentations. Most men （61%） were married, 7% were accompanied by their partners, and 93% were circumcised. The mean measured penile circumference was 9.5 cm （7.5-11.5 cm） pretreatment and 12.1 cm （10.3-15.3 cm） post-treatment （mean increase of 27% in circumference and 0.84 cm in diameter）. Patient and partner satisfaction was already expressed after the first two treatments. Sexual activity could be resumed after 8 h. Complications （mild bruising） were easily resolved. Conclusion： Penile girth augmentation using liquid injectable silicone yields very satisfactory short-term results with no immediate or short-term complications.展开更多
Penile length shortening and erectile dysfunction are common complications after radical prostatectomy.Various methods have been used to maintain erectile function,but less attention has been paid to preserving penis ...Penile length shortening and erectile dysfunction are common complications after radical prostatectomy.Various methods have been used to maintain erectile function,but less attention has been paid to preserving penis length.N-acetylcysteine(NAC)has the effect of antioxidation and antifibrotic,which may be beneficial to improve those postoperative complications.This study investigated the effect of NAC on maintaining the penile length and the erectile function after bilateral cavernous nerve crush(BCNC)and its underlying mechanism.Twenty-four male rats were randomly divided into three groups:control group,BCNC group,and BCNC+NAC group.NAC or equal volume of saline was daily administrated by intragastric gavage for 4 weeks.The initial and end penile lengths were measured.Intracavernosal pressure/mean arterial pressure(ICP/MAP)ratio was calculated to assess erectile function.Hematoxylin-eosin staining,Masson's trichrome staining,immunohistochemistry,and Western blot were performed to explore cellular and molecular changes of the penis.Compared to the BCNC group,the penile length,ICP/MAP ratio and smooth muscle/collagen ratio in the BCNC+NAC group were improved significantly(all P<0.05),and the expressions of endothelial nitric oxide synthase,α-smooth muscle actin,glutathione,and glutathione peroxidase 1 were significantly increased after NAC treated(all P<0.05),along with the decreased expressions of hypoxia-inducible factor-1α,transforming growth factor-β1,collagen I,collagen III,collagen IV,malonaldehyde,and lysine oxidase(all P<0.05).This study demonstrated that NAC could maintain penile length and partly improve erectile function.Possible mechanism is directly and/or indirectly related to antihypoxic and antifibrosis.展开更多
基金supported by the Guangdong Province Nature Foundation of China Project (No. 2022A1515012200 to Li Z)Shenzhen Science and Technology Program (No. RCYX20221008093032008 to Li Z)Shenzhen People's Hospital Clinician Scientist Training Program (No. SYWGSJCYJ202405 to Li Z).
文摘Objective The aim of this study was to investigate the value of the 8th American Joint Committee on Cancer(AJCC)anatomic and prognostic stage groups for penile cancer patients and explore whether there is room for improvement.Methods The clinical and histopathologic data from 16 centers between January 2000 and December 2021 were assessed according to the 8th AJCC anatomic and prognostic stage groups.Kaplan–Meier plots were used to estimate the disease-specific survival(DSS)of the patients.The accuracy of the staging systems was investigated using the Harrell's concordance index(C-index).Results According to the 8th AJCC anatomic and prognostic stage groups,the 5-year DSS rates for patients with stages 0is/a,I,IIA,IIB,IIIA,IIIB,and IV disease were 100%,99%,86%,81%,66%,34%,and 23%,respectively(p_(0is/a–I)=0.8,p_(I–IIA)<0.001,p_(IIA–IIB)=0.5,p_(IIB–IIIA)<0.001,p_(IIIA–IIIB)<0.001,p_(IIIB–IV)=0.004,and p_(Total)<0.001).According to the modified model 1 system,the 5-year DSS rates without survivorship overlap for patients with stages 0is/a,I,II,IIIA,IIIB,and IV disease were 100%,99%,88%,66%,34%,and 23%,respectively(p_(0is/a–I)=0.8,p_(I–II)<0.001,p_(II–IIIA)=0.002,p_(IIIA–IIIB)<0.001,p_(IIIB–IV)=0.004,and p_(Total)<0.001).Similarly,according to the modified model 2 system,the 5-year DSS rates without survivorship overlap for patients with stages 0is/a,I,II,IIIA,IIIB,and IV disease were 100%,99%,86%,66%,34%,and 23%,respectively(p_(0is/a–I)=0.8,p_(I–II)<0.001,p_(II–IIIA)=0.008,p_(IIIA–IIIB)<0.001,p_(IIIB–IV)=0.004,and p_(Total)<0.001).The C-index scores of the simple modified staging systems were not inferior to those of the AJCC anatomic and prognostic stage groups.These results were confirmed by the bootstrap internal validation.Conclusion There is still room for improvement about the 8th AJCC anatomic and prognostic stage groups.The improved models,which are more concise and convenient,have similar prediction accuracy.
文摘Penile fracture is a rare clinical entity that occurs secondary to direct trauma to an erect penis,most commonly during sexual intercourse.Specifically,increased pressure within the corpus cavernosa results in rupture of the tunica albuginea.Occasionally,these injuries extend to the urethra and very rarely cause a complete urethral avulsion.Emergent exploration improves posttraumatic erectile function,penile curvature,and prevents painful erections.The traditional approach is a subcoronal circumcising incision to allow for adequate visualization.We present an uncircumcised male with bilateral corporal injuries and complete urethral avulsion who underwent a ventral midline approach for successful foreskin preservation.
基金National Natural Science Foundation of China,No.81871981Natural Science Foundation of Guangdong Province,No.2022A1515012348 and No.2023A1515010457.
文摘BACKGROUND The incidence of colon cancer has been progressively increasing over time,whereas penile metastasis of colon cancer has remained exceedingly uncommon.Since the prognosis for colon cancer with BRAF_(V600E)mutation is relatively unfavorable,further exploration and investigation are still required to develop treatment strategies for such rare cases.CASE SUMMARY About one year after surgery and chemotherapy,a 50-year-old patient with sigmoid colon cancer developed a mass at the base of the patient's penis,accompanied by severe tenderness and pain during urination.With disease progression,multiple metastatic nodules also emerged in other regions of the penis,including the coronal sulcus.The nodules located in the coronal sulcus were excised for histopathological examination.The histopathological findings revealed that the nodules were metastases originating from the sigmoid colon cancer,with a BRAF V600E mutation detected.This prompted a modification of the therapy regimen of cetuximab,dabrafenib and trametinib,which effectively held back the progression of penile metastasis in the patient.CONCLUSION Combining the BRAF/MEK-targeted therapy with cetuximab demonstrates a favorable therapeutic response in BRAF_(V600E)-mutated colon cancer with penile metastasis.
文摘Inflatable penile prosthesis(IPP)implantation is the gold standard treatment for patients with erectile dysfunction who are refractory to medical therapy.The standard placement of the reservoir in the space of Retzius(SOR)may be contraindicated in patients with prior pelvic or abdominal surgery due to altered anatomy and increased risk of complications.This has led to the development of alternative ectopic reservoir placement techniques.In this narrative review,we summarize the literature on various ectopic reservoir approaches,including low and high submuscular placements,submuscular techniques with counter incisions or transfascial fixation,midline submuscular placement,subcutaneous placement,and lateral retroperitoneal approaches.We describe the surgical methods,outcomes,and complication rates associated with each technique.While most methods demonstrate low complication and revision rates,direct comparisons remain limited due to heterogeneity and lack of prospective data.This review highlights the importance of individualized technique selection based on prior surgical history,body habitus,and surgeon experience.As ectopic placement becomes more widely adopted,familiarity with multiple approaches is essential for prosthetic surgeons.
文摘Penile prosthesis surgery is a definitive treatment for erectile dysfunction(ED).The two categories of penile prosthesis are endorsed by professional guidelines,inflatable penile prosthesis(IPP)and malleable penile prosthesis(MPP).Each modality of penile prosthesis offers distinct advantages and incorporates specific design features,allowing for personalized device selection that aligns with individual needs and preferences.While the overall complication rate of penile implant surgery remains low,surgeons should maintain a high index of suspicion for complications in the perioperative time period.Multimodal analgesic regimens including nerve blocks and narcotic-free pathways should be administered to manage perioperative pain.Finally,the high patient satisfaction after penile prosthesis surgery underscores the success of this ED treatment option.
文摘Implantation of an inflatable penile prosthesis （IPP） is a well-established definitive solution for erectile dysfunction when conservative treatments fail. Penile implants may shorten the penis. The AMS 700 LGX IPP is in common use but reports on its mechanical reliability, medium-term postsurgical patient satisfaction, and mean penile length preservation are lacking. We investigate the mean penile length, mechanical reliability, and patient satisfaction at 6 and 12 months after implantation of the AMS 700 LGX. This prospective study consecutively enrolled men undergoing first-time IPP implant surgery from February 2009 to April 2012. Stretched flaccid penile length, penile length at 50% and 100% of stiffness （PSO and P100） and International Index of Erectile Function （IIEF） and Erectile Dysfunction Inventory of Treatment Satisfaction （EDITS） scores, were measured at 6 and 12 months postsurgery. Of 45 patients who underwent AMS 700 LGX implantation （median age 61 years） and completed 6 months＇ follow-up, 36 （80%） completed the study. A significant difference in stretched flaccid penile length was seen between 6 and 12 months （P= 0.033）. P100 was also significantly increased at 6 and 12 months, with a mean 10% increase （1.3 ±0.4 cm） from baseline to 12 months. Differences in mean IIEF scores at 6 and 12 months were significant for the desired domain （P = 0.0001） and for overall satisfaction （P = 0.002）; however, mean EDITS scores at 6 and 12 months were not significantly improved. AMS 700 LGX is a powerful tool for preserving penile length in men undergoing penile prosthesis implantation.
文摘Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie’s disease.Currently,there is a variety of options for the correction of residual curvature,including penile modeling,plication techniques,as well as tunical incision/excision with or without grafting.A literature search of PubMed and Medline databases was conducted from 1964 until 2020,using search terms for all articles in the English language.In this article,we provide a review of the techniques and the outcomes,according to the published literature.
文摘Objective:Penile cancer is a rare malignancy in most developed countries,but may represent a significant oncologic challenge in certain African,Asian,and South American regions.Various treatment approaches have been described in penile cancer,including radio-therapy.This review aimed to provide a synopsis of radiotherapy use in penile cancer management and the associated toxicities.In addition,we aimed to discuss palliative radiation for metastases to the penis and provide a brief overview of how tumor biology may assist with treatment decision-making.Methods:Peer-reviewed manuscripts related to the treatment of penile cancer with radio-therapy were evaluated by a PubMed search(1960-2021)in order to assess its role in the definitive and adjuvant settings.Selected manuscripts were also evaluated for descriptions of radiation-related toxicity.Results:Though surgical resection of the primary is an excellent option for tumor control,select patients may be treated with organ-sparing radiotherapy by either external beam radiation or brachytherapy.Data from randomized controlled trials comparing radiotherapy and surgery are lacking,and thus management is frequently determined by institutional practice patterns and available expertise.Similarly,this lack of clinical trial data leads to divergence in opinion regarding lymph node management.This is further complicated in that many cited studies evaluating lymph node radiotherapy used non-modern radiotherapy delivery techniques.Groin toxicity from either surgery or radiotherapy remains a challenging problem and further risk assessment is needed to guide intensification with multi-modal therapy.Intrinsic differences in tumor biology,based on human papillomavirus infection,may help aid future prognostic and predictive models in patient risk stratification or treatment approach.Conclusion:Penile cancer is a rare disease with limited clinical trial data driving the majority of treatment decisions.As a result,the goal of management is to effectively treat the disease while balancing the importance of quality of life through integrated multidisciplinary discussions.More international collaborations and interrogations of penile cancer biology are needed to better understand this disease and improve patient outcomes.
文摘Penile cancer is an uncommon malignancy. Surgical treatment is inevitably mutilating. Considering the strong impact on patients＇ sexual life we want to evaluate sexual function and satisfaction after partial penectomy. The patients in this study （n = 25） represented all those who attended our institutions and were diagnosed and treated for penile cancer from October 2011 to November 2013. All patients underwent partial penectomy and followed-up （mean： 14 months; range： 12-25）. Sexual presurgical baseline was estimated using the International Index of Erectile Dysfunction 15 （IIEF-15）. Sexual outcomes of each patient were estimated considering four standardized and validated questionnaires. We analyzed the means and ranges of IIEF-15 including erectile function （IIEF-1-5 and -15）, orgasmic function （IIEF-9 and -10）, sexual desire （IIEF-11 and -12）, intercourse satisfaction （IIEF-6-8）, and overall satisfaction （IIEF-13 and -14）. Then, we also used Quality of Erection Questionnaire （QEQ）, Erectile Dysfunction Inventory of Treatment Satisfaction （EDITS） and Self-Esteem and Relationship （SEAR） to evaluate the sexual function and satisfaction of our patients. The final results showed that penile cancer leads to several sexual and psychosexual dysfunctions. Nevertheless, patients who undergo partial penectomy for penile cancer can maintain the sexual outcomes at levels slightly lower to those that existed in the period before surgery.
文摘During the most recent years, a variety of new techniques of penile reconstruction have been described in the literature. This paper focuses on the most recent advances in male genital reconstruction after trauma, excision of benign and malignant disease, in gender reassignment surgery and aphallia with emphasis on surgical technique, cosmetic and functional outcome.
文摘Aim: To investigate the flaccid and stretched penile sizes of young Korean men and their complexes or pride about their penile size. Methods: After an explanation and agreement to the purpose and methods of this study, 123 Korean men in their early 20's visiting the Jinhae Military General Hospital were included in the study. The flaccid penile length, flaccid mid-shaft circumference, stretched length and pre-pubic bone fat pad depth were measured in a warm comfortable environment. The accuracy the subjects assessed their penile size was investigated by asking them to rate their penile size, as 'very small', 'small', 'normal', 'large' or 'very large'. All subjects were asked to complete the Minnesota multiphasic personality inventory (MMPI) test. Results: The mean flaccid length, flaccid circumference, stretched length and fat pad depth of the 123 subjects were (6.9 ± 0.8) cm, (8.5 ±1.1) cm, (9.6 ± 0.8) cm and (1.1 ± 0.4) cm, respectively. The answer distribution on penile size was 1 (0.8 %) 'very small', 29 (23.6 %) 'small', 86 (69.9 %) 'normal', 6 (4.9 %) 'large' and 1 (0.8 %) 'very large'. Subjects who underestimated their penile size showed significantly higher scores on the hypochondriasis (Hs), depression (D) and psychasthenia (Pt) subscales of the MMPI than those in the Unbiased Group (P<0.05). Conclusion: In consultation, with a patient requesting penile augmentation, the urologist should consider the psychologic attitude of the patient to his penile size.
文摘The pathophysiology of LaPeyronie＇s disease （PD） is considered to be multifactorial, involving genetic predisposition, trauma, inflammation and altered wound healing. However, these factors have not yet been validated using animal models. In this study, we have presented a new model obtained by tunica albuginea allograft. A total of 40, 16-week-old male rats were used. Of these, 8 rats served as controls and underwent a 10 × 2-mm-wide tunical excisionwith subsequent autografting, whereas the remaining 32 underwent the same excision with grafting of the defect with another rat＇s tunica. Morphological and functional testing was performed at 1, 3, 7 and 12 weeks after grafting. Intracavernous pressure, the degree of penile curvature and elastic fiber length were evaluated for comparison between the allograft and control groups. The tissues were obtained for histological examination. The penile curvature was significantly greater in the allografted rats as compared with the control rats. The erectile function was maintained in all rats, except in those assessed at 12 weeks. The elastin fiber length was decreased in the allografted tunica as compared to control. SMAD2 expression was detected in the inner part of the allograff, and both collagen-Ⅱ- and osteocalcin-positive cells were also noted. Tunica albuginea （TA） allograft in rats is an excellent model of PD. The persistence of curvature beyond 12 weeks and the presence of ossification in the inner layer of the TA were similar to those observed in men with PD. Validation studies using this animal model would aid understanding of the PD pathophysiology for effective therapeutic interventions.
文摘A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique （NLMT） coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfact on and erectile peni e measurements Th s is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, With new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer （30.8%） or the same （46.2%） as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject （96.5%） was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.
基金The authors would like to thank Dorothy Stradinger for her editing assistance.This work was supported by the Natural Science Foundation of China(No.81671453 and No.81871147)the Sichuan Science and Technology Program(No.2018SZ0019 and No.2018TJPT0018).
文摘Erectile dysf un ction and penile shri nkage are the comm on complications after radical prostatectomy.Penile rehabilitati on is widely applied after the surgery.Vacuum therapy is one of the three penile rehabilitation methods used in the clinical setting,but its mechanism is not well known.This study was designed to investigate whether vacuum erectile device(VED)can prevent corporeal veno-occlusive dysfunction and penile shrinkage in the bilateral cavernous nerve crush(BCNC)rat model.Adult male Sprague-Dawley rats were randomly assigned into three groups:sham group,BCNC group,and BCNC+VED group.After 4 weeks,penile length and intracavernosal pressure(ICP)were measured,and then the middle part of the penis was harvested after dynamic inf usion caver no sometry to complete the followi ng items:smooth muscle/collage n ratios and collagenⅠ/Ⅲratios;ultramicrostructure of the tunica albuginea,endothelial cell,and smooth muscle cell;and the expression of calponin・l and osteopontin.The penile shortening,peak ICP and ICP drop rate after alprostadil injection were significantly improved with vacuum therapy after 4-week treatme nt.Compared with BCNC group,VED sign ifica ntly in creased smooth muscle/collagen ratios,decreased collagenⅠ/Ⅲratios,and preserved the ultramicrostructure of the tunica albuginea,endothelial cell,and smooth muscle cell.The data also showed that an imals exposed to VED could partially reverse the expression of calp onin・l and osteop ontin induced by BCNC.In conclusion,vacuum therapy is effective to prevent penile shrinkage and veno-occlusive dysfunction in penile rehabilitation,which may be associated with well-preserved structure and function of the tunica albuginea,endothelial cell,and smooth muscle cell.
文摘The second to fourth digit ratio （2D：4D） has been proposed as a putative biomarker for prenatal testosterone and covaries with the sensitivity of the androgen receptor （AR）. Both prenatal testosterone and the AR play a central role in penile growth. In this study, we investigated the relationship between digit ratio and penile length. Korean men who were hospitalized for urological surgery at a single tertiary academic centre were examined in this study, and 144 men aged 20 years or older who gave informed consent were prospectively enrolled. Right-hand second- and fourth-digit lengths were measured by a single investigator prior to measurement of penile length. Under anaesthesia, flaccid and stretched penile lengths were measured by another investigator who did not measure nor have any the information regarding the digit lengths. Univariate and multivariate analysis using linear regression models showed that only height was a significant predictive factor for flaccid penile length （univariate analysis： r=0. 185, P=-0.026; multivariate analysis： r=-0.172, P=0.038） and that only digit ratio was a significant predictive factor for stretched penile length （univariate analysis： r=-0.216, P=0.009; multivariate analysis： r=-0.201, P=0.024; stretched penile length=-9.201 xdigit ratio ＋ 20.577）. Based on this evidence, we suggest that the digit ratio can predict adult penile size and that the effects of prenatal testosterone may in part explain the differences in adult penile length.
文摘We aimed to evaluate ten-year outcomes of penile prosthesis(PP)implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection(EPI).We identified 549 men who underwent 576 PP placements between 2008 and 2018.Univariate and multivariate analyses were used to identify potential predictors of EPI.An EPI predictive nomogram was developed.Thirty-five(6.1%)cases of EPI were recorded with an explant rate of 3.1%.In terms of satisfaction,82.0%of the patients defined themselves as“satisfied,”while partner’s satisfaction was 88.3%.Diabetes(P=0.012),longer operative time(P=0.032),and reinterventions(P=0.048)were associated with EPI risk,while postoperative ciprofloxacin was inversely associated with EPI(P=0.014).Rifampin/gentamicin-coated 3-piece inflatable PP(r/g-c 3IPP)showed a higher EPI risk(P=0.019).Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients,redo surgeries,or when a r/g-c 3IPP was used(all P<0.03).We showed that diabetes,longer operative time,and secondary surgeries were the risk factors for EPI.Postoperative ciprofloxacin was associated with a reduced risk of EPI,while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant.After further validation,the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.
文摘Most widespread three-component penile prosthesis models are 700CXTM and Titan~. Our purpose is to assess patient and partner satisfaction after the first implant. This is a multicenter, retrospective, nonrandomized study in which all patients who met the inclusion criteria between 2009 and 2013 were included. In total, 248 patients agreed to participate. To evaluate patient satisfaction, a validated but modified 11-question questionnaire was completed （EDITS）; and a nonvalidated two-item questionnaire was given to the partner. Statistical analysis used an ordinal logistic regression model. Two hundred and forty-eight patients （194 with 700CXTM vs 54 with Titan） and 207 couples completed the questionnaire （165 with 700CXTM vs 42 with Titan）. Overall satisfaction was high. Both showed great reliability for sexual intercourse and high compliance with prior expectations. Most patients were able to manage the penile prosthesis correctly within 6 months. Postoperative penile shortening led to some dissatisfaction in 42% and 46% of cases （700CX/Titan）. Significant differences were found in three questions of patients＇ questionnaire. There were more patients satisfied with the 700CXTM （P= 0.0001）. No patient with Titan implant took longer than 6 months to optimal management. Only 4% of patients with 700CXTM implant were dissatisfied with the deflation, in contrast to 24% with the Titan （P = 0.0031）. Of the two partners＇ questions, one showed a statistically significant difference （P = 0.0026）. It seems that group 700CX＂ would recommend to re-implant the prosthesis with a greater tendency. The overall satisfaction was very high for both prostheses. The final aspect of the erected and flaccid penis was satisfactory, but both groups showed significant discontent with its final size. Partners＇ overall satisfaction was high.
文摘Penile reconstruction still represents a formidable challenge for the urologist. In this review, the most recent advances in penile reconstruction after trauma, excision of benign and malignant disease and in patients with micropenis, aphallia or female to male gender dysphoria are reported.
文摘Aim： To report our experience with penile girth augmentation using liquid injectable silicone. Methods： Between August 2003 and July 2006, 324 men （mean age 35 years, range 19-65 years） received a series of liquid silicone subcutaneous injections between the penile skin and the corpora cavernosa on the dorsal and lateral aspects of the penile shaft, under local anesthesia. Digital photographs taken pre- and post-procedure （n = 324）, and penile contour measurements （n = 30） yielded objective results. Subjective results were derived from patient and partner testimony of satisfaction. Follow-up averaged 20 months （range 1-36 months）. Results： Three hundred and twenty-four procedures were primary augmentations. Most men （61%） were married, 7% were accompanied by their partners, and 93% were circumcised. The mean measured penile circumference was 9.5 cm （7.5-11.5 cm） pretreatment and 12.1 cm （10.3-15.3 cm） post-treatment （mean increase of 27% in circumference and 0.84 cm in diameter）. Patient and partner satisfaction was already expressed after the first two treatments. Sexual activity could be resumed after 8 h. Complications （mild bruising） were easily resolved. Conclusion： Penile girth augmentation using liquid injectable silicone yields very satisfactory short-term results with no immediate or short-term complications.
基金This work was supported by the Natural Science Foundation of China(No.81671453 and No.81871147)the Sichuan Science and Technology Program(No.2018SZ0019 and No.2018TJPT0018)。
文摘Penile length shortening and erectile dysfunction are common complications after radical prostatectomy.Various methods have been used to maintain erectile function,but less attention has been paid to preserving penis length.N-acetylcysteine(NAC)has the effect of antioxidation and antifibrotic,which may be beneficial to improve those postoperative complications.This study investigated the effect of NAC on maintaining the penile length and the erectile function after bilateral cavernous nerve crush(BCNC)and its underlying mechanism.Twenty-four male rats were randomly divided into three groups:control group,BCNC group,and BCNC+NAC group.NAC or equal volume of saline was daily administrated by intragastric gavage for 4 weeks.The initial and end penile lengths were measured.Intracavernosal pressure/mean arterial pressure(ICP/MAP)ratio was calculated to assess erectile function.Hematoxylin-eosin staining,Masson's trichrome staining,immunohistochemistry,and Western blot were performed to explore cellular and molecular changes of the penis.Compared to the BCNC group,the penile length,ICP/MAP ratio and smooth muscle/collagen ratio in the BCNC+NAC group were improved significantly(all P<0.05),and the expressions of endothelial nitric oxide synthase,α-smooth muscle actin,glutathione,and glutathione peroxidase 1 were significantly increased after NAC treated(all P<0.05),along with the decreased expressions of hypoxia-inducible factor-1α,transforming growth factor-β1,collagen I,collagen III,collagen IV,malonaldehyde,and lysine oxidase(all P<0.05).This study demonstrated that NAC could maintain penile length and partly improve erectile function.Possible mechanism is directly and/or indirectly related to antihypoxic and antifibrosis.
