RESUMEN
Background: Previous studies of the cortical suspensory button (CSB) implant have analyzed fixation strength as a function of suture type and surgical technique, but knot configuration remains an area of interest. This study investigates 4-strand knot configurations in CSB suspensory fixation, specifically comparing the use of 2 separate knots with a single knot. We hypothesize that using 2 knots on the distal side of the CSB with #2 suture will yield the strongest and stiffest suspensory fixation. Methods: Two types of knot configurations were compared: a single knot with all 4 suture strands versus 2 independent knots with 2 suture strands each (1 knot from inner strands and 1 knot from outer strands). They were tested using #2 or 2-0 suture, and at distal (on top of the button) or proximal (underneath the button) knot positions. Mechanical testing on the Instron measured ultimate failure load, elongation at failure, and stiffness. Statistical analyses (Shapiro-Wilk, unpaired Student's t-tests, and Chi-square tests) assessed differences in strength, stiffness, elongation, and failure mode between knot configurations within each CSB construct combination. Results: With #2 suture, 2 knots across the CSB resulted in higher load to failure compared to 1 knot in both proximal (467.00 N vs. 554.66 N, P = .026) and distal (395.18 N vs. 526.51 N, P < .001) locations. Furthermore, 2 knots provided higher stiffness than 1 knot in both proximal (53.24 N/mm vs. 67.89 N/mm, P < .001) and distal (47.08 N/mm vs. 56.73 N/mm, P = .041) knot locations. However, using 2-0 suture showed no significant differences in failure load and stiffness regardless of knot location. Conclusion: Using #2 suture and tying 2 independent knots across the CSB increased load to failure and stiffness compared to using only 1 knot regardless of knot position. Thus, if using #2 suture, it is recommended to tie 2 knots to enhance construct strength. However, with 2-0 suture, the number of knots did not impact construct strength. Therefore, if using 2-0 suture, 1 knot can be used to save time. Knot position did not significantly affect the strength or stiffness of the CSB construct, emphasizing the importance of considering knot prominence and surgical approach for determining knot location.
RESUMEN
Erection transforms the penis from a safe, flaccid organ to a susceptible one. During an erection, the thick tunica albuginea thins and becomes fracturable. Penile fracture (PF) is a very uncommon ailment produced by a blow to the erect penis. Unphysiological bending of the erect penis during sexual activity or masturbation is the most often reported mechanism of trauma. The penis is made up of three columns of erectile tissue: one ventral corpus spongiosum and two dorsolateral corpora cavernosa, each enclosed by the tunica albuginea. The tunica albuginea is a bilaminar structure composed of collagen and elastin. The outer layer of the tunica determines its strength and thickness. It varies in several locations across the shaft and is thinnest ventrally. It has high tensile strength and can sustain rupture at intra-cavernous pressures of up to 1500 mmHg. The tunica albuginea's thickness decreases from 2 mm to 0.25 mm while the penis is erect, and a trauma-induced rise in intracorporeal pressure during an erection might easily cause rupture. PF with urethral bleeding is a very rare urological emergency. One of the common causes of PF includes vigorous sexual intercourse. Symptoms include a cracking, snapping, or clicking sound followed by an instantaneous detumescence. Additionally, the penis may exhibit acute discomfort, significant ecchymosis, rapid swelling, and noticeable eggplant deformity. This is a case report of a 30-year-old male who presented with a history of penile swelling and ecchymosis during sexual intercourse. There was blood spotted at the urethral meatus. A retrograde urethrogram showed complete disruption at the proximal third of the urethra. The patient was immediately taken for surgery, and extensive exploration was done. There was a significant defect of the tunica albuginea of the corpora cavernosa on the ventral side of the penis. Along with the defect and the PF, there was a sizeable urethral injury as well. The defect of the tunica albuginea of the corpora cavernosa was repaired with a Prolene 2.0 suture (Johnson & Johnson, New Brunswick, New Jersey, United States), and urethral reconstruction was done with Vicryl 3.0 interrupted suture (Johnson & Johnson, New Brunswick, New Jersey, United States) over a 14-Foley catheter. Ultrasonography (USG) can be used to assess patients who have suffered penile injuries as well as to determine the sort of incision that is necessary, saving time by preventing needless waiting. This instance emphasises the value of early diagnosis in cases of unique presentation and early surgical treatment for improved results.