Various techniques have been described for reconstructing the skin of the penile shaft;however,no universally accepted standard exists for correcting buried penis in adults.We aimed to describe a new technique for cor...Various techniques have been described for reconstructing the skin of the penile shaft;however,no universally accepted standard exists for correcting buried penis in adults.We aimed to describe a new technique for correcting an adult-acquired buried penis through a diamond-shaped incision at the penopubic junction.We retrospectively analyzed data from patients treated with our technique between March 2019 and June 2023 in the Department of Andrology,Nanjing Drum Tower Hospital(Nanjing,China).Forty-two adult males with buried penises,with a mean(±standard deviation[s.d.])age of 26.6(±6.6)years,underwent surgery.All patients were obese,with an average(±s.d.)body mass index of 35.56(±3.23)kg m^(-2).In addition to phalloplasty,32 patients concurrently underwent circumcision,and 28 underwent suprapubic liposuction.The mean(±s.d.)duration of the operation was 98.02(±13.28)min.The mean(±s.d.)duration of follow-up was 6.71(±3.43)months.The length in the flaccid unstretched state postoperatively was significantly greater than that preoperatively(mean±s.d:5.55±1.19 cm vs 1.94±0.59 cm,P<0.01).Only minor complications,such as wound disruption(7.1%)and infection(4.8%),were observed.The mean(±s.d.)score of patient satisfaction was 4.02(±0.84)on a scale of 5.This technique provides excellent cosmetic and functional outcomes with a minimal risk of complications.However,additional clinical studies are needed to evaluate the long-term effects of this procedure.展开更多
To evaluate the therapeutic effect of a modified Devine procedure with a subcutaneous sliding fixation method for the treatment of congenital concealed penis,we retrospectively selected 45 patients with congenital con...To evaluate the therapeutic effect of a modified Devine procedure with a subcutaneous sliding fixation method for the treatment of congenital concealed penis,we retrospectively selected 45 patients with congenital concealed penises who were admitted to General Hospital of Ningxia Medical University(Yinchuan,China)between September 2020 and November 2023.In all cases,the penis was observed to be short,and retracting the skin at the base revealed a normal penile body,which immediately returned to its original position upon release.All patients underwent the modified Devine procedure with subcutaneous sliding fixation and completed a 12-week postoperative follow-up.A statistically significant increase in penile length was observed postoperatively,with the median length increasing from 4.0(interquartile range[IQR]:3.5–4.8;95%confidence interval[CI]:3.9–4.4)cm to 8.0(IQR:7.8–8.0;95%CI:7.7–7.9)cm,with P<0.001.The parents were satisfied with the outcomes,including increased penile length,improved hygiene,and enhanced esthetics.Except for mild foreskin edema in all cases,no complications(such as infections,skin necrosis,or penile retraction)were observed.The edema was resolved within 4 weeks after the operation.This study demonstrates that the modified Devine procedure utilizing the subcutaneous sliding fixation method yields excellent outcomes with minimal postoperative complications,reduced penile retraction,and high satisfaction rates among patients and their families.展开更多
BACKGROUND Diphallia is a highly uncommon congenital urogenital abnormality and a few connected reports have been published.However,no case of intraabdominal heterotopic diphallus has been documented to date.In the pr...BACKGROUND Diphallia is a highly uncommon congenital urogenital abnormality and a few connected reports have been published.However,no case of intraabdominal heterotopic diphallus has been documented to date.In the present study,we present a rare case of intraperitoneal ectopic bipenis.CASE SUMMARY A 49-year-old man was hospitalized with the chief complaint of hydronephrosis of both kidneys,which was discovered three days earlier through regular physical examination performed using urological ultrasound without significant lumbar or abdominal pain or bladder irritation.Physical examination showed normal external penile development,bilateral testes located on the left side of the scrotum,and a fused epididymis.Urological plain and enhanced computed tomography suggested bilateral hydronephrosis,bilateral ureters opened to the left side of the bladder wall;an intrapelvic soft tissue shadow on the left side of the bladder was considered a germline malformation called bipenis(hidden penis in the abdominal cavity).Based on the urological plain and enhanced computed tomography results,a 49-year-old man was diagnosed with bipenis(one hidden in the abdominal cavity).Ectopic penile compression produced bilateral ureteral dilatation and hydronephrosis.The ectopic penis was amputated and partially removed during surgery,and bilateral ureteral replantation was successfully performed.At a 2-mo follow-up,the patient was very satisfied with the operation,there was no significant hydronephrosis in both kidneys,and urination and erectile function were normal.CONCLUSION To our knowledge,this is the first report of diphallia with an intraperitoneal ectopic penis.Computed tomography or magnetic resonance imaging can be used to assess the associated internal anomalies before surgery.Postoperative pathological findings are the gold standard for the diagnosis.展开更多
<strong>Introduction:</strong> Penile cancer is a rare primary malignancy that occurs in patients in their 60s and 70s. The aim of the study was to describe the anatomical aspects of penile cancer and to r...<strong>Introduction:</strong> Penile cancer is a rare primary malignancy that occurs in patients in their 60s and 70s. The aim of the study was to describe the anatomical aspects of penile cancer and to report the difficulties of its management. <strong>Materials and Methods:</strong> This was a retrospective descriptive study of patients with penile tumors from January 2007 to December 2019. Patients of sexual age with an ulcerated lesion of the penis, who came to our department and whose clinical and paraclinical workup led to the diagnosis of penile cancer, were included. The variables studied were clinical, paraclinical and therapeutic. <strong>Results:</strong> In 12 years, we diagnosed and managed 8 patients with penile cancer, an incidence of 0.7 per year. The reason for consultation was the chronic ulcerating wound of the penis with a “cauliflower” aspect. The first medical consultation was late (n = 8) after a long latency period lost to traditional healers. The lesion was located in the glans penis (n = 6) and/or in the corpus cavernosum (n = 2). Histological analysis of the cores concluded to a squamous cell carcinoma. Patients were classified as T2N+M+ (n = 3) and T2N0M0 (n = 5). One patient had accepted partial amputation of the penis. <strong>Conclusion:</strong> Penile cancer is a rare tumor. Partial amputation of the penis is the only alternative in our practice context, an alternative often refuted.展开更多
Aim: To study the androgen dependence of the neurotransmitter, calcitonin gene-related peptide (CGRP) in rat penis. Methods: Forty-four Sprague-Dawley rats were randomly divided into Group A (intact controls), Group B...Aim: To study the androgen dependence of the neurotransmitter, calcitonin gene-related peptide (CGRP) in rat penis. Methods: Forty-four Sprague-Dawley rats were randomly divided into Group A (intact controls), Group B (castrated) and Group C (gavaged with finasteride 4.5 mg·kg^(-1).day^(-1)). Four and ten weeks later respectively, half of rats in each group were anaesthetized. Blood samples were taken for the measurement of serum testosterone and dihydrotestosterone (DHT) by means of radioimmunoassay. Penile samples were harvested for the investigation of calcitonin gene related peptide (CGRP)-immunoreactive nerve fibers with immunohistochemistry. The computer-assisted imaging analysis system was applied to calculate the area proportion of the CGRP-positive nerve fibers (CGRP-PNF) in each group. Results: 1) Both 4 and 10 weeks later, testosterone and DHT levels in Group B decreased significantly compared with those in Group A, (P < 0.05, P < 0.01, respectively); DHT level in Group C was also significantly decreased in comparison with that in Group A for both 4- and 10- week animals (P < 0.05); 2) There was no significant differences in area proportion of CGRP-PNF among Groups A, B and C 4 weeks after treatments (P > 0.05); However, 10 weeks later, the proportion of CGRP-PNF in Groups B and C was significantly less than that in Group A (P < 0.01);3) The proportion of CGRP-PNF of 4-week animals in Groups B and C was significantly higher than that of 10-week animals (P < 0.05). Conclusion: The expression of neurotransmitter, CGRP may depend on androgens, including testosterone and DHT in rat penis.展开更多
A 21-year-old man presented with an enlarged giant hemangioma on glans penis which also causes an erectile dysfunction （ED） that partially responded to the intracavernous injection stimulation test. Although the fin...A 21-year-old man presented with an enlarged giant hemangioma on glans penis which also causes an erectile dysfunction （ED） that partially responded to the intracavernous injection stimulation test. Although the findings in magnetic resonance imaging （MRI） indicated a glandular hemangioma, penile colored Doppler ultrasound revealed an invaded cavernausal hemangioma to the glans. Surgical excision was avoided according to the broad extension of the gland lesion. Holmium laser coagulation was applied to the lesion due to the cosmetically concerns. However, the cosmetic results after holmium laser application was not impressive as expected without an improvement in intracavernous injection stimulation test. In conclusion, holmium laser application should not be used to the hemangiomas of glans penis related to the corpus cavernosum, but further studies are needed to reveal the effects of holmium laser application in small hemangiomas restricted to the glans penis.展开更多
There is no well-established procedure for the management of small penis syndrome(SPS),especially when psychological interventions fail.This study aimed at systematically evaluating the physical and psychological bene...There is no well-established procedure for the management of small penis syndrome(SPS),especially when psychological interventions fail.This study aimed at systematically evaluating the physical and psychological benefits of penile augmentation(PA)using injectable hyaluronic acid(HA)gel.Thirty-eight patients receiving PA with HA gel from January 2017 to March 2020 were included and followed up for 1 year.Penile size,erectile function,and psychological burden measured by the Index of Male Genital Image(IMGI),Index of International Erectile Function(lIEF),and Beliefs about Penis Size(BPAS),respectively,were assessed at the beginning and at 1,3,6,and 12 months postinjection.The volume of HA gel injected was 21.5±3.7 ml.Compared to baseline data,flaccid penile girth and length significantly increased by 3.41±0.95 cm(P<0.01)and 2.55±0.55 cm(P<0.01)at the 1^(st)month postinjection,respectively.At the endpoint,despite attenuations,statistically significant improvements in flaccid penis size were still obtained,namely 2.44±1.14 cm in girth(P<0.01)and 1.65±0.59 cm in length(P<0.01).Similarly,erectile penile girth statistically increased by 1.32±1.02 cm(P<0.01)at the 1^(st)month but were only 0.80±0.54 cm bigger than baseline(P<O.01)at the endpoint.At the 1^(st)month,the average score of IMGI and the mean score of IIEF statistically increased by 46.2±10.5(P<0.01)and 7.6±6.2(P<0.01),respectively;the score of BAPS significantly decreased by 18.3±4.5(P<0.01).These alterations remained steady during follow-up.Considering the significant penile size improvement,lasting psychological benefit,and low complication rate,PA with HA might serve as an appropriate alternative for patients with SPS.展开更多
For many years,surgical treatment of buried penis in children has been researched by several scholars,and numerous methods exist.This study aimed to explore the clinical effect of a modified fixation technique in trea...For many years,surgical treatment of buried penis in children has been researched by several scholars,and numerous methods exist.This study aimed to explore the clinical effect of a modified fixation technique in treating buried penis in children.Clinical data of 94 patients with buried penis who were treated using the modified penile fixation technique from March 2017 to February 2019 in Fujian Maternity and Child Health Hospital(Fuzhou,China)were retrospectively collected,compared,and analyzed.Clinical data of 107 patients with buried penis who were treated using traditional penile fixation technique from February 2014 to February 2017 were chosen for comparison.The results showed that at 6 months and 12 months after surgery,the penile lengths in the modified penile fixation group were longer than those in the traditional penile fixation group(both P<0.05).The incidence of postoperative skin contracture and penile retraction in the modified penile fixation group was less than that in the traditional penile fixation group(P=0.034 and P=0.012,respectively).When the two groups were compared in terms of parents'satisfaction scores,the scores for penile size,penile morphology,and voiding status in the modified penile fixation group were higher than those in the traditional penile fixation group at 2-week,6-month,and 12-month follow-ups after surgery(all P<0.05).We concluded that the modified penile fixation technique could effectively reduce the incidence of skin contracture and penile retraction and improve the penile length and satisfaction of patients'parents.展开更多
Androgen therapy is the mainstay of treatment for the hypogonadotropic hypogonadal micropenis because it obviously enhances penis growth in prepubescent microphallic patients. However, the molecular mechanisms of andr...Androgen therapy is the mainstay of treatment for the hypogonadotropic hypogonadal micropenis because it obviously enhances penis growth in prepubescent microphallic patients. However, the molecular mechanisms of androgen treatment leading to penis growth are still largely unknown. To clarify this well-known phenomenon, we successfully generated a castrated male Sprague Dawley rat model at puberty followed by testosterone administration. Interestingly, compared with the control group, testosterone treatment stimulated a dose-dependent increase of penis weight, length, and width in castrated rats accompanied with a dramatic recovery of the pathological changes of the penis. Mechanistically, testosterone administration substantially increased the expression of androgen receptor （AR） protein. Increased AR protein in the penis could subsequently initiate transcription of its target genes, including keratin 33B （Krt33b）. Importantly, we demonstrated that KRT33B is generally expressed in the rat penis and that most KRT33B expression is cytoplasmic. Furthermore, AR could directly modulate its expression by binding to a putative androgen response element sequence of the Krt33b promoter. Overall, this study reveals a novel mechanism facilitating penis growth after testosterone treatment in precastrated prepubescent animals, in which androgen enhances the expression of AR protein as well as its target genes, such as Krt33b.展开更多
There is no safe and effective standard method for glans penis augmentation. Furthermore, there has been scant research on glans penis augmentation due to a poor understanding of glans anatomy, technical difficulty, a...There is no safe and effective standard method for glans penis augmentation. Furthermore, there has been scant research on glans penis augmentation due to a poor understanding of glans anatomy, technical difficulty, and a lack of suitable substances for augmentation. Cross-linked dextran gel is a newly developed filler for soft-tissue augmentation. We evaluated the efficacy and safety of using a novel technique to inject cross-linked dextran gel for glans penis augmentation during a 24-week follow-up study. This prospective, single-arm, multicenter study enrolled twenty healthy adult men who underwent glans penis augmentation between June and August 2013. Cross-linked dextran gel was injected into the glans penis using a simple and easy technique. The sizes of the glans penis and individual satisfaction were assessed. Any adverse event was also reported. A total of 18 individuals were analyzed; two of them were lost to follow-up. The mean procedure time and injected volume were about 30 rain and 6.6 ＋- 0.9 ml, respectively. The mean surface areas of the glans at baseline and 24 weeks were 20.0 _＋ 3.5 cm2 and 33.6 -＋ 5.4 cm2, respectively, representing a mean increase of 68.7% _＋ 14.0% （P 〈 0.001）. Sixteen individuals （88.9%） were satisfied with the outcomes, and none were dissatisfied. There were no serious adverse events during the study. Cross-linked dextran gel injection for glans penis augmentation was easy and showed a significant augmentative effect on the glans penis, good durability, and was well tolerated without serious adverse events. Therefore, cross-linked dextran gel injection may be an effective, new technique for glans penis augmentation.展开更多
A 33-year-old male receiving dorsal penile nerve block (DPNB) for circumcision exhibited a postoperative ischemic change over the glans penis. The event occurred nearly 24 hours after the procedure. The patient was tr...A 33-year-old male receiving dorsal penile nerve block (DPNB) for circumcision exhibited a postoperative ischemic change over the glans penis. The event occurred nearly 24 hours after the procedure. The patient was treated with intravenous pentoxifyllin and hyperbaric oxygenation. Total reverse of the ischemia was observed. The complications associated with circumcision and DPNB were reviewed and discussed.展开更多
Extraskeletal osteosarcoma （EOS） is rare and commonly arises in the retroperitoneum, limbs, head and neck. There is no significant difference between EOS and other malignant tumors in soft tissue. Localized pain and...Extraskeletal osteosarcoma （EOS） is rare and commonly arises in the retroperitoneum, limbs, head and neck. There is no significant difference between EOS and other malignant tumors in soft tissue. Localized pain and swelling are the common presenting symptoms. Clinical diagnosis of EOS is difficult, imaging techniques may be helpful and careful, and the histopathological analysis is necessary. The common histological variants of EOS include： osteoblastoma, chondroblastoma, and fibroblastoma, and other unusual subtypes were reported occasionally. It should be distinguished with myositis ossificans, malignant mesenchymoma, giant cell tumor and parosteal osteosarcoma. We present an EOS arising in the penis. The primary site and histological category of the tumor were extremely rare. We hope the case will be helpful to the recognition of clinical signs, iconography and histopathology of EOS.展开更多
This study aimed to determine whether the abnormal deep layer of dartos fascia plays an important role in buried penis.Forty-nine patients with buried penis were treated with anatomical resection of the deep layer of ...This study aimed to determine whether the abnormal deep layer of dartos fascia plays an important role in buried penis.Forty-nine patients with buried penis were treated with anatomical resection of the deep layer of dartos fascia under a microscope.Penile length was measured before and after completely resecting the deep layer to investigate the role of this layer in penile retraction.The superficial and deep layers of dartos fascia were collected from 49 patients with buried penis,the normal superficial layers were collected from 25 children/adults who underwent circumcision for nonmedical reasons,and the normal deep layers were collected from 20 adult cadavers.The penile fascia samples were stained with hematoxylin-eosin,Masson’s trichrome,Sirius red,and Verhoeff’s Van Gieson,and subjected to immunohistochemical examination and scanning electron microscopy.The penile shaft(mean±standard deviation)was found to be significantly elongated after resecting the deep layer compared with that before resection(6.8±1.9 cm vs 6.0±1.6 cm,P<0.001).An abnormal deep layer of dartos fascia characterized by disordered and fragmented elastic fibers was observed in 87.8%(43/49)of buried penis samples,whereas no abnormal deep layer was observed in normal penises from cadavers(0/20,P<0.001).Thus,the abnormal deep layer of dartos fascia plays an important role in the buried penis.Its resection is helpful for avoiding recurrence.展开更多
We report a case of aseptic abscess in the cavernous body at the base of the penis.In our clinical observation,the patient underwent puncture and drainage of the corpus cavernosum abscess,followed by surgical resectio...We report a case of aseptic abscess in the cavernous body at the base of the penis.In our clinical observation,the patient underwent puncture and drainage of the corpus cavernosum abscess,followed by surgical resection of the abscess wall,with the incisions closed layer by layer with primary suture.In addition,we paid attention to strengthening the postoperative management by using elastic bandages to wrap the penis intermittently to prevent edema;the incision would not be covered with dressings from the third day after the operation,so as to keep the incision site dry in an open way.During the period of indwelling of the catheter after the operation,we noticed the care of the external orifice of the urethra to reduce the occurrence of catheter-related infections.Finally,the patient was diagnosed with a penile aseptic abscess in the cavernous body at the base of the penis.The patient recovered well after surgery and was discharged 1 week later.At 1.5 years after the operation,the shape of the penis returned to normal,and the erectile function was normal.It was seen that good nursing concept is of great help for prognosis,which could avoid infection and edema,and is conducive to wound healing.展开更多
Fifty-nine cases of resected verrucous carcinoma of penis are analysed. They account for 46 percent of the hospitalized patients with carcinoma of penis in the same time (1966--1990). Among them, 54 cases were diagnos...Fifty-nine cases of resected verrucous carcinoma of penis are analysed. They account for 46 percent of the hospitalized patients with carcinoma of penis in the same time (1966--1990). Among them, 54 cases were diagnosed originally as squamous cell carcinoma.Surgical treatment included total amputation of the penis, urethral transplantation (23 cases), excision of testis (15 cases) and resection of the regional lymph nodes (25 cases). Our study demonstrates that the malignant degree of verrucous carcinoma of penis is low and it should be differentiated from squamous cell carcinoma in diagnosis and treatment. It is preferable that local tumour resection or partial amputation of penis should be carried out.展开更多
Purpose: Phimosis can be treated using topical steroid treatment effectively. Meanwhile, concealed penis has been required surgical correction because it was considered stubborn to conservative treatment. But there we...Purpose: Phimosis can be treated using topical steroid treatment effectively. Meanwhile, concealed penis has been required surgical correction because it was considered stubborn to conservative treatment. But there were few reports of conservative treatment using topical steroid treatment for concealed penis. The aim of the present study was to evaluate the effects of topical steroid treatment for concealed penis. Materials and Methods: From December 2006 to December 2011, 30 patients (mean age 9.3 years) with concealed penis were treated with topical 0.12% bethamethasone valerate cream. Patients or their parents continued to retract the prepuce gently without causing pain and to apply a topical 0.12% bethamethasone valerate cream to the prepuce twice daily for 6 weeks. When topical steroid treatment was ineffective, patients were surgically corrected. Results: The success rate of topical steroid treatment was low (10%). 27 of 30 patients required surgical repair. No patients showed complications associated with topical steroid or surgical intervention. Conclusions: Concealed penis is highly resistant to topical steroid treatment and should be corrected surgically.展开更多
Penile reconstruction following cancer resection has long been a challenge due to demand for both aesthetic and functional preservation. Although various methods have attempted to achieve both goals, none have succeed...Penile reconstruction following cancer resection has long been a challenge due to demand for both aesthetic and functional preservation. Although various methods have attempted to achieve both goals, none have succeeded entirely. In this report, we introduce a novel reconstructive technique on a 64-year-old patient with squamous cell carcinoma of the glans penis. The technique consisted of two staged procedures. First, a dermal substitute, consisting of bovine collagen, was sutured onto the defect after partial glansectomy and three weeks later, the integrated dermis was covered with autologous non-meshed partial thickness skin graft. Use of this dermal substitute in a staged fashion allowed for ability to await final pathologic margins prior to definitive reconstruction and increased dermal thickness. After 9-month follow-up, sexual function returned within 3 months and the patient remained healed. We found this technique to be useful in concurrently preserving penile function and cosmesis. Future studies should include more patients and longer follow-up.展开更多
A phenomenon known as trapped penis has numerous origins, including injudicious circumcision. Materials and Methods: Surgery for trapped penis with glanular amputation was performed for 5 children. The surgical policy...A phenomenon known as trapped penis has numerous origins, including injudicious circumcision. Materials and Methods: Surgery for trapped penis with glanular amputation was performed for 5 children. The surgical policy in these cases included complete penile degloving, excising the scarring due to circumcission, fixing the penile skin at the penopubic and penoscrotal angles and reconstructing the penile skin with full thickness skin graft. Results: Improvement was noted in all cases. Conclusion: Surgery for hidden penis using full thickness skin graft achieves very satisfactory aesthetic and functional improvement.展开更多
基金supported by Jiangsu provincial key R&D plan special fund(Social Development)project in China(No.BE2019606)a funding for Clinical Trials from the Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University(Nanjing,China,2024-LCYJ-PY-65).
文摘Various techniques have been described for reconstructing the skin of the penile shaft;however,no universally accepted standard exists for correcting buried penis in adults.We aimed to describe a new technique for correcting an adult-acquired buried penis through a diamond-shaped incision at the penopubic junction.We retrospectively analyzed data from patients treated with our technique between March 2019 and June 2023 in the Department of Andrology,Nanjing Drum Tower Hospital(Nanjing,China).Forty-two adult males with buried penises,with a mean(±standard deviation[s.d.])age of 26.6(±6.6)years,underwent surgery.All patients were obese,with an average(±s.d.)body mass index of 35.56(±3.23)kg m^(-2).In addition to phalloplasty,32 patients concurrently underwent circumcision,and 28 underwent suprapubic liposuction.The mean(±s.d.)duration of the operation was 98.02(±13.28)min.The mean(±s.d.)duration of follow-up was 6.71(±3.43)months.The length in the flaccid unstretched state postoperatively was significantly greater than that preoperatively(mean±s.d:5.55±1.19 cm vs 1.94±0.59 cm,P<0.01).Only minor complications,such as wound disruption(7.1%)and infection(4.8%),were observed.The mean(±s.d.)score of patient satisfaction was 4.02(±0.84)on a scale of 5.This technique provides excellent cosmetic and functional outcomes with a minimal risk of complications.However,additional clinical studies are needed to evaluate the long-term effects of this procedure.
基金supported by the National Natural Science Foundation of China(No.81860268,and No.82201000)Ningxia Natural Science Foundation(No.2021AAC02025)+2 种基金Ningxia science and technology innovation leading talent training project(No.2020GKLRLX06 and No.2020GKLRLX11)Ningxia Medical University research project(No.XTJKF240315)Ningxia Key Research and Development Project(No.2023BEG03021 and No.2021BEB04034).
文摘To evaluate the therapeutic effect of a modified Devine procedure with a subcutaneous sliding fixation method for the treatment of congenital concealed penis,we retrospectively selected 45 patients with congenital concealed penises who were admitted to General Hospital of Ningxia Medical University(Yinchuan,China)between September 2020 and November 2023.In all cases,the penis was observed to be short,and retracting the skin at the base revealed a normal penile body,which immediately returned to its original position upon release.All patients underwent the modified Devine procedure with subcutaneous sliding fixation and completed a 12-week postoperative follow-up.A statistically significant increase in penile length was observed postoperatively,with the median length increasing from 4.0(interquartile range[IQR]:3.5–4.8;95%confidence interval[CI]:3.9–4.4)cm to 8.0(IQR:7.8–8.0;95%CI:7.7–7.9)cm,with P<0.001.The parents were satisfied with the outcomes,including increased penile length,improved hygiene,and enhanced esthetics.Except for mild foreskin edema in all cases,no complications(such as infections,skin necrosis,or penile retraction)were observed.The edema was resolved within 4 weeks after the operation.This study demonstrates that the modified Devine procedure utilizing the subcutaneous sliding fixation method yields excellent outcomes with minimal postoperative complications,reduced penile retraction,and high satisfaction rates among patients and their families.
文摘BACKGROUND Diphallia is a highly uncommon congenital urogenital abnormality and a few connected reports have been published.However,no case of intraabdominal heterotopic diphallus has been documented to date.In the present study,we present a rare case of intraperitoneal ectopic bipenis.CASE SUMMARY A 49-year-old man was hospitalized with the chief complaint of hydronephrosis of both kidneys,which was discovered three days earlier through regular physical examination performed using urological ultrasound without significant lumbar or abdominal pain or bladder irritation.Physical examination showed normal external penile development,bilateral testes located on the left side of the scrotum,and a fused epididymis.Urological plain and enhanced computed tomography suggested bilateral hydronephrosis,bilateral ureters opened to the left side of the bladder wall;an intrapelvic soft tissue shadow on the left side of the bladder was considered a germline malformation called bipenis(hidden penis in the abdominal cavity).Based on the urological plain and enhanced computed tomography results,a 49-year-old man was diagnosed with bipenis(one hidden in the abdominal cavity).Ectopic penile compression produced bilateral ureteral dilatation and hydronephrosis.The ectopic penis was amputated and partially removed during surgery,and bilateral ureteral replantation was successfully performed.At a 2-mo follow-up,the patient was very satisfied with the operation,there was no significant hydronephrosis in both kidneys,and urination and erectile function were normal.CONCLUSION To our knowledge,this is the first report of diphallia with an intraperitoneal ectopic penis.Computed tomography or magnetic resonance imaging can be used to assess the associated internal anomalies before surgery.Postoperative pathological findings are the gold standard for the diagnosis.
文摘<strong>Introduction:</strong> Penile cancer is a rare primary malignancy that occurs in patients in their 60s and 70s. The aim of the study was to describe the anatomical aspects of penile cancer and to report the difficulties of its management. <strong>Materials and Methods:</strong> This was a retrospective descriptive study of patients with penile tumors from January 2007 to December 2019. Patients of sexual age with an ulcerated lesion of the penis, who came to our department and whose clinical and paraclinical workup led to the diagnosis of penile cancer, were included. The variables studied were clinical, paraclinical and therapeutic. <strong>Results:</strong> In 12 years, we diagnosed and managed 8 patients with penile cancer, an incidence of 0.7 per year. The reason for consultation was the chronic ulcerating wound of the penis with a “cauliflower” aspect. The first medical consultation was late (n = 8) after a long latency period lost to traditional healers. The lesion was located in the glans penis (n = 6) and/or in the corpus cavernosum (n = 2). Histological analysis of the cores concluded to a squamous cell carcinoma. Patients were classified as T2N+M+ (n = 3) and T2N0M0 (n = 5). One patient had accepted partial amputation of the penis. <strong>Conclusion:</strong> Penile cancer is a rare tumor. Partial amputation of the penis is the only alternative in our practice context, an alternative often refuted.
文摘Aim: To study the androgen dependence of the neurotransmitter, calcitonin gene-related peptide (CGRP) in rat penis. Methods: Forty-four Sprague-Dawley rats were randomly divided into Group A (intact controls), Group B (castrated) and Group C (gavaged with finasteride 4.5 mg·kg^(-1).day^(-1)). Four and ten weeks later respectively, half of rats in each group were anaesthetized. Blood samples were taken for the measurement of serum testosterone and dihydrotestosterone (DHT) by means of radioimmunoassay. Penile samples were harvested for the investigation of calcitonin gene related peptide (CGRP)-immunoreactive nerve fibers with immunohistochemistry. The computer-assisted imaging analysis system was applied to calculate the area proportion of the CGRP-positive nerve fibers (CGRP-PNF) in each group. Results: 1) Both 4 and 10 weeks later, testosterone and DHT levels in Group B decreased significantly compared with those in Group A, (P < 0.05, P < 0.01, respectively); DHT level in Group C was also significantly decreased in comparison with that in Group A for both 4- and 10- week animals (P < 0.05); 2) There was no significant differences in area proportion of CGRP-PNF among Groups A, B and C 4 weeks after treatments (P > 0.05); However, 10 weeks later, the proportion of CGRP-PNF in Groups B and C was significantly less than that in Group A (P < 0.01);3) The proportion of CGRP-PNF of 4-week animals in Groups B and C was significantly higher than that of 10-week animals (P < 0.05). Conclusion: The expression of neurotransmitter, CGRP may depend on androgens, including testosterone and DHT in rat penis.
文摘A 21-year-old man presented with an enlarged giant hemangioma on glans penis which also causes an erectile dysfunction （ED） that partially responded to the intracavernous injection stimulation test. Although the findings in magnetic resonance imaging （MRI） indicated a glandular hemangioma, penile colored Doppler ultrasound revealed an invaded cavernausal hemangioma to the glans. Surgical excision was avoided according to the broad extension of the gland lesion. Holmium laser coagulation was applied to the lesion due to the cosmetically concerns. However, the cosmetic results after holmium laser application was not impressive as expected without an improvement in intracavernous injection stimulation test. In conclusion, holmium laser application should not be used to the hemangiomas of glans penis related to the corpus cavernosum, but further studies are needed to reveal the effects of holmium laser application in small hemangiomas restricted to the glans penis.
基金supported by grant from the Beijing Municipal Natural Science Foundation(No.7194327).
文摘There is no well-established procedure for the management of small penis syndrome(SPS),especially when psychological interventions fail.This study aimed at systematically evaluating the physical and psychological benefits of penile augmentation(PA)using injectable hyaluronic acid(HA)gel.Thirty-eight patients receiving PA with HA gel from January 2017 to March 2020 were included and followed up for 1 year.Penile size,erectile function,and psychological burden measured by the Index of Male Genital Image(IMGI),Index of International Erectile Function(lIEF),and Beliefs about Penis Size(BPAS),respectively,were assessed at the beginning and at 1,3,6,and 12 months postinjection.The volume of HA gel injected was 21.5±3.7 ml.Compared to baseline data,flaccid penile girth and length significantly increased by 3.41±0.95 cm(P<0.01)and 2.55±0.55 cm(P<0.01)at the 1^(st)month postinjection,respectively.At the endpoint,despite attenuations,statistically significant improvements in flaccid penis size were still obtained,namely 2.44±1.14 cm in girth(P<0.01)and 1.65±0.59 cm in length(P<0.01).Similarly,erectile penile girth statistically increased by 1.32±1.02 cm(P<0.01)at the 1^(st)month but were only 0.80±0.54 cm bigger than baseline(P<O.01)at the endpoint.At the 1^(st)month,the average score of IMGI and the mean score of IIEF statistically increased by 46.2±10.5(P<0.01)and 7.6±6.2(P<0.01),respectively;the score of BAPS significantly decreased by 18.3±4.5(P<0.01).These alterations remained steady during follow-up.Considering the significant penile size improvement,lasting psychological benefit,and low complication rate,PA with HA might serve as an appropriate alternative for patients with SPS.
文摘For many years,surgical treatment of buried penis in children has been researched by several scholars,and numerous methods exist.This study aimed to explore the clinical effect of a modified fixation technique in treating buried penis in children.Clinical data of 94 patients with buried penis who were treated using the modified penile fixation technique from March 2017 to February 2019 in Fujian Maternity and Child Health Hospital(Fuzhou,China)were retrospectively collected,compared,and analyzed.Clinical data of 107 patients with buried penis who were treated using traditional penile fixation technique from February 2014 to February 2017 were chosen for comparison.The results showed that at 6 months and 12 months after surgery,the penile lengths in the modified penile fixation group were longer than those in the traditional penile fixation group(both P<0.05).The incidence of postoperative skin contracture and penile retraction in the modified penile fixation group was less than that in the traditional penile fixation group(P=0.034 and P=0.012,respectively).When the two groups were compared in terms of parents'satisfaction scores,the scores for penile size,penile morphology,and voiding status in the modified penile fixation group were higher than those in the traditional penile fixation group at 2-week,6-month,and 12-month follow-ups after surgery(all P<0.05).We concluded that the modified penile fixation technique could effectively reduce the incidence of skin contracture and penile retraction and improve the penile length and satisfaction of patients'parents.
文摘Androgen therapy is the mainstay of treatment for the hypogonadotropic hypogonadal micropenis because it obviously enhances penis growth in prepubescent microphallic patients. However, the molecular mechanisms of androgen treatment leading to penis growth are still largely unknown. To clarify this well-known phenomenon, we successfully generated a castrated male Sprague Dawley rat model at puberty followed by testosterone administration. Interestingly, compared with the control group, testosterone treatment stimulated a dose-dependent increase of penis weight, length, and width in castrated rats accompanied with a dramatic recovery of the pathological changes of the penis. Mechanistically, testosterone administration substantially increased the expression of androgen receptor （AR） protein. Increased AR protein in the penis could subsequently initiate transcription of its target genes, including keratin 33B （Krt33b）. Importantly, we demonstrated that KRT33B is generally expressed in the rat penis and that most KRT33B expression is cytoplasmic. Furthermore, AR could directly modulate its expression by binding to a putative androgen response element sequence of the Krt33b promoter. Overall, this study reveals a novel mechanism facilitating penis growth after testosterone treatment in precastrated prepubescent animals, in which androgen enhances the expression of AR protein as well as its target genes, such as Krt33b.
文摘There is no safe and effective standard method for glans penis augmentation. Furthermore, there has been scant research on glans penis augmentation due to a poor understanding of glans anatomy, technical difficulty, and a lack of suitable substances for augmentation. Cross-linked dextran gel is a newly developed filler for soft-tissue augmentation. We evaluated the efficacy and safety of using a novel technique to inject cross-linked dextran gel for glans penis augmentation during a 24-week follow-up study. This prospective, single-arm, multicenter study enrolled twenty healthy adult men who underwent glans penis augmentation between June and August 2013. Cross-linked dextran gel was injected into the glans penis using a simple and easy technique. The sizes of the glans penis and individual satisfaction were assessed. Any adverse event was also reported. A total of 18 individuals were analyzed; two of them were lost to follow-up. The mean procedure time and injected volume were about 30 rain and 6.6 ＋- 0.9 ml, respectively. The mean surface areas of the glans at baseline and 24 weeks were 20.0 _＋ 3.5 cm2 and 33.6 -＋ 5.4 cm2, respectively, representing a mean increase of 68.7% _＋ 14.0% （P 〈 0.001）. Sixteen individuals （88.9%） were satisfied with the outcomes, and none were dissatisfied. There were no serious adverse events during the study. Cross-linked dextran gel injection for glans penis augmentation was easy and showed a significant augmentative effect on the glans penis, good durability, and was well tolerated without serious adverse events. Therefore, cross-linked dextran gel injection may be an effective, new technique for glans penis augmentation.
文摘A 33-year-old male receiving dorsal penile nerve block (DPNB) for circumcision exhibited a postoperative ischemic change over the glans penis. The event occurred nearly 24 hours after the procedure. The patient was treated with intravenous pentoxifyllin and hyperbaric oxygenation. Total reverse of the ischemia was observed. The complications associated with circumcision and DPNB were reviewed and discussed.
文摘Extraskeletal osteosarcoma （EOS） is rare and commonly arises in the retroperitoneum, limbs, head and neck. There is no significant difference between EOS and other malignant tumors in soft tissue. Localized pain and swelling are the common presenting symptoms. Clinical diagnosis of EOS is difficult, imaging techniques may be helpful and careful, and the histopathological analysis is necessary. The common histological variants of EOS include： osteoblastoma, chondroblastoma, and fibroblastoma, and other unusual subtypes were reported occasionally. It should be distinguished with myositis ossificans, malignant mesenchymoma, giant cell tumor and parosteal osteosarcoma. We present an EOS arising in the penis. The primary site and histological category of the tumor were extremely rare. We hope the case will be helpful to the recognition of clinical signs, iconography and histopathology of EOS.
文摘This study aimed to determine whether the abnormal deep layer of dartos fascia plays an important role in buried penis.Forty-nine patients with buried penis were treated with anatomical resection of the deep layer of dartos fascia under a microscope.Penile length was measured before and after completely resecting the deep layer to investigate the role of this layer in penile retraction.The superficial and deep layers of dartos fascia were collected from 49 patients with buried penis,the normal superficial layers were collected from 25 children/adults who underwent circumcision for nonmedical reasons,and the normal deep layers were collected from 20 adult cadavers.The penile fascia samples were stained with hematoxylin-eosin,Masson’s trichrome,Sirius red,and Verhoeff’s Van Gieson,and subjected to immunohistochemical examination and scanning electron microscopy.The penile shaft(mean±standard deviation)was found to be significantly elongated after resecting the deep layer compared with that before resection(6.8±1.9 cm vs 6.0±1.6 cm,P<0.001).An abnormal deep layer of dartos fascia characterized by disordered and fragmented elastic fibers was observed in 87.8%(43/49)of buried penis samples,whereas no abnormal deep layer was observed in normal penises from cadavers(0/20,P<0.001).Thus,the abnormal deep layer of dartos fascia plays an important role in the buried penis.Its resection is helpful for avoiding recurrence.
文摘We report a case of aseptic abscess in the cavernous body at the base of the penis.In our clinical observation,the patient underwent puncture and drainage of the corpus cavernosum abscess,followed by surgical resection of the abscess wall,with the incisions closed layer by layer with primary suture.In addition,we paid attention to strengthening the postoperative management by using elastic bandages to wrap the penis intermittently to prevent edema;the incision would not be covered with dressings from the third day after the operation,so as to keep the incision site dry in an open way.During the period of indwelling of the catheter after the operation,we noticed the care of the external orifice of the urethra to reduce the occurrence of catheter-related infections.Finally,the patient was diagnosed with a penile aseptic abscess in the cavernous body at the base of the penis.The patient recovered well after surgery and was discharged 1 week later.At 1.5 years after the operation,the shape of the penis returned to normal,and the erectile function was normal.It was seen that good nursing concept is of great help for prognosis,which could avoid infection and edema,and is conducive to wound healing.
文摘Fifty-nine cases of resected verrucous carcinoma of penis are analysed. They account for 46 percent of the hospitalized patients with carcinoma of penis in the same time (1966--1990). Among them, 54 cases were diagnosed originally as squamous cell carcinoma.Surgical treatment included total amputation of the penis, urethral transplantation (23 cases), excision of testis (15 cases) and resection of the regional lymph nodes (25 cases). Our study demonstrates that the malignant degree of verrucous carcinoma of penis is low and it should be differentiated from squamous cell carcinoma in diagnosis and treatment. It is preferable that local tumour resection or partial amputation of penis should be carried out.
文摘Purpose: Phimosis can be treated using topical steroid treatment effectively. Meanwhile, concealed penis has been required surgical correction because it was considered stubborn to conservative treatment. But there were few reports of conservative treatment using topical steroid treatment for concealed penis. The aim of the present study was to evaluate the effects of topical steroid treatment for concealed penis. Materials and Methods: From December 2006 to December 2011, 30 patients (mean age 9.3 years) with concealed penis were treated with topical 0.12% bethamethasone valerate cream. Patients or their parents continued to retract the prepuce gently without causing pain and to apply a topical 0.12% bethamethasone valerate cream to the prepuce twice daily for 6 weeks. When topical steroid treatment was ineffective, patients were surgically corrected. Results: The success rate of topical steroid treatment was low (10%). 27 of 30 patients required surgical repair. No patients showed complications associated with topical steroid or surgical intervention. Conclusions: Concealed penis is highly resistant to topical steroid treatment and should be corrected surgically.
文摘Penile reconstruction following cancer resection has long been a challenge due to demand for both aesthetic and functional preservation. Although various methods have attempted to achieve both goals, none have succeeded entirely. In this report, we introduce a novel reconstructive technique on a 64-year-old patient with squamous cell carcinoma of the glans penis. The technique consisted of two staged procedures. First, a dermal substitute, consisting of bovine collagen, was sutured onto the defect after partial glansectomy and three weeks later, the integrated dermis was covered with autologous non-meshed partial thickness skin graft. Use of this dermal substitute in a staged fashion allowed for ability to await final pathologic margins prior to definitive reconstruction and increased dermal thickness. After 9-month follow-up, sexual function returned within 3 months and the patient remained healed. We found this technique to be useful in concurrently preserving penile function and cosmesis. Future studies should include more patients and longer follow-up.
文摘A phenomenon known as trapped penis has numerous origins, including injudicious circumcision. Materials and Methods: Surgery for trapped penis with glanular amputation was performed for 5 children. The surgical policy in these cases included complete penile degloving, excising the scarring due to circumcission, fixing the penile skin at the penopubic and penoscrotal angles and reconstructing the penile skin with full thickness skin graft. Results: Improvement was noted in all cases. Conclusion: Surgery for hidden penis using full thickness skin graft achieves very satisfactory aesthetic and functional improvement.
