RESUMO
Premature ejaculation (PE) is the most common self-reported male sexual disorder estimated to occur in approximately 5% of men in the general community. Penile hypersensitivity is thought to be an etiologic factor of lifelong PE. The role of glans penis augmentation using injectable hyaluronic acid (HA) for the treatment of PE is debatable and remains to be confirmed. The creation of a barrier at the level of the glans, by the bulking agent blocking accessibility and inhibiting the tactile stimuli to reach the dorsal nerve of the penis (branch of the pudendal nerve) receptors, is the theory behind the effectiveness of HA in the field of PE. We reviewed the literature using PubMed and searched for the following keywords: premature ejaculation, glans penis and HA, over the last 20 years. Five studies were found. These studies showed that HA injection could significantly increase IELT (2.43- to 4.46-fold), and this increase could persist for long term (up to 5 years). No serious adverse reactions were reported besides transient discoloration and swelling of the glans that recovered to normal within 2 weeks. Many techniques were discussed, their effectiveness remains to be proved. However, proper patient selection and mastering the esthetics of the technique, by adequate surgical training, is necessary in order to achieve the optimal results.
RESUMO
Duplex collecting systems are seen in 0.7% of the population and its association with an ectopic ureter (specifically in the ejaculatory duct) is even less common. We presented a 57 year-old male with an elevated PSA and suspicious findings on a multiparametric MRI (mpMRI) who underwent transrectal ultrasound (TRUS) guided biopsies. The procedure led to an infection of the upper moiety of the duplicated left collecting system with ectopic ureter draining into the ejaculatory duct. CT-scan was used for the diagnosis and an urgent surgical treatment was performed. To our knowledge, no such case has ever been reported.