Development of nerves and vessels in the penis during the human fetal period.

INTRODUCTION: Although nerves and vessels of the penis play important role in erection, there are few studies on their development in human fetus. Therefore, the objective of the present study is to analyze, quantitatively, in the corpora cavernosa and corpus spongiosum, the development of the nerves and vessels in the fetal penis at different gestational ages. MATERIAL AND METHODS: Fifty-six fresh, macroscopically normal human fetuses aged from 13 to 36 weeks post-conception (WPC) were used. Gestational age was determined by the foot length criterion. Penises were immediately fixed in 10% formalin, and routinely processed for paraffin embedding, after which tissue sections from the mid-shaft were obtained. We used immunohistochemical staining to analyze the nerves and vessels in the corpus cavernous and in the corpus spongiosum. These elements were identified and quantified as percentage by using the Image-J software. RESULTS: The quantitative analysis showed that the percentage of nerves varied from 3.03% to 20.35% in the corpora cavernosa and from 1.89% to 23.88% in the corpus spongiosum. The linear regression analysis indicated that nerves growth (incidence) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.9421, p<0.0001) and (r2=0.9312, p<0.0001), respectively, during the whole fetal period studied. Also, the quantitative analysis showed that the percentage of vessels varies from 2.96% to 12.86% in the corpora cavernosa and from 3.62% to 14.85% in the corpus spongiosum. The linear regression analysis indicated that vessels growth (appearance) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.8722, p<0.0001) and (r2=0.8218, p<0.0001), respectively, during the whole fetal period studied. In addition, the linear regression analysis demonstrated a more intense growth rate of nerves in the corpus spongiosum during the 2nd trimester of gestation, when compared with nerves in the corpora cavernosa. In addition, the linear regression analysis demonstrated a more intense growth rate of vessels in the corpus spongiosum when compared with the corpora cavernosa, during the whole fetal period studied. CONCLUSIONS: In the fetal period, the human penis undergoes major developmental changes, notably in the content and distribution of nerves and vessels. We found strong correlation between nerves and vessels growth (amount) with fetal age, both in the corpora cavernosa and corpus spongiosum. There is significant greater proportional number of nerves than vessels during the whole fetal period studied. Also, nerves and vessels grow in a more intense rate than that of the corpora cavernosa and corpus spongiosum areas.

Modified penile reconstruction in classic bladder exstrophy: Can complete corporal covering of the urethral closure be achieved using incomplete disassembly technique?

PURPOSE: To answer the question of whether it is possible to achieve complete corporal covering of the urethral closure using incomplete penile disassembly in classic bladder exstrophy. We hypothesize that mobilization of the corpora under Buck's fascia, their dorsal translocation through the incisions in Buck's fascia and suturing corporal convex sides above the urethra would allow extend corporal covering of the urethra, reducing the risk of urethra-cutaneous fistula formation. MATERIALS AND METHODS: A prospective follow-up on all boys who underwent the modified Cantwell-Ransley primary penile reconstruction was conducted. Inclusion criteria comprised bladder exstrophy closure in our institution, ensuring a postoperative follow-up period of no less than 24 months. The key innovation of the technique lies in a deep dissection of the dependent corpora under Buck's fascia, followed by their dorsal relocation through extended dorsal incisions in Buck's fascia, and limited external corporal rotation 90 degrees only at the base of the penis. RESULTS: Between November 2019 and March 2022, 18 boys aged 11 to 35 months met the inclusion criteria and underwent the modified penile reconstruction. Surgical procedures and postoperative period did not include any major complications. Total corporal covering of the urethral sutures was achieved in 15 of 18 patients. No urethra-cutaneous fistulas were observed within 2 years of follow-up. All individuals demonstrated spontaneous erections, and the absence of dorsal curvature was documented. CONCLUSION: The modified technique of incomplete penile disassembly applied in a homogenous group of patients with classic bladder exstrophy allows penile shaft elongation, improved aesthetic outcomes, preserved erections, and eliminates dorsal curvature. The technique demonstrated feasibility and reliability while maintaining positive effects on tissue circulation. The absence of urethra-cutaneous fistulae is attributed to the complete corporal covering of the urethral sutures and supports the initial hypothesis.

A comprehensive review of current knowledge on penile squamous cell carcinoma.

Neoplasm of the penis is relatively rare in most regions representing 0-2% of cancers worldwide. While the penis can be affected by sarcomas, basal cell carcinomas or even melanoma, Penile Squamous Cell Carcinoma (PSCC) represents approximately 95% of all penile neoplasms. Despite its rarity and most common presentation at later decades of life most individuals diagnosed with PSCC are faced with significant decrease in quality of life. The prevalence and incidence vary among different regions and populations, but a common trend is for diagnosis to occur late (stage 4). Underdeveloped countries are traditionally reported to have higher incidence rates; however, rates may vary significantly between urban and rural areas even in developed countries. Age adjusted rates are on the rise in some countries that used to have incidence rates of 1:100 000 or less. The list of associated risk factors is long and includes among others, lack of neonatal circumcision, poor genital hygiene, socioeconomic status, history of human papillomavirus (HPV) infection and penile intraepithelial neoplasia (PeIN). Many risk factors are widely debated among experts however HPV and PeIN are indisputable risk factors, and both also form part of the classification system for PSCC. Both conditions may have occurred in the past or be present at the time of diagnosis and identifying them plays a major role in management strategies. For such a rare condition PSCC can present in many different forms clinically making diagnosis no easy feat. Diagnosis of PSCC is done through clinical examination, including lymph node palpation, followed by a biopsy, which is essential for the classification. Lymph node involvement is a common finding at first presentation and investigation of spread to deep nodes is important and can be done with the aid of PET-CT. Treatment options for PSCC include surgery, chemotherapy, and radiation therapy. Surgical removal of the tumor is considered the most effective however can lead to severe decrease of quality of life. Chemotherapy is used in the case of fixed or bulky lymph nodes, where surgery is not indicated, and for distant metastasis. Radiation therapy is particularly effective in the case of HPV-positive PSCC.

Keloids in male genitalia-Systematic review and illustrative case report.

Keloid is the maximum expression of pathological fibroproliferative skin wound healing, whose pathophysiology is not yet fully understood. Its occurrence in the perineum and genitalia is uncommon. A systematic review was carried out regarding the occurrence and treatment of keloids on the penis. An illustrative case was also reported. The review used the PRISMA checklist and was registered in PROSPERO. The entire literature period up to April 2023 was searched in the EMBASE/Elsevier, Cochrane, Scopus, Medline, BVS, SciELO, and Lilacs databases. The inclusion criteria embraced primary studies, clinical trials, prospective or retrospective cohorts, case series, case-control studies and case reports. Three hundred and sixty-one studies were found and 12 of them were included, consisting of 9 case reports and 3 case series. The most common triggering factor for keloid formation was circumcision, in 11 of the cases, of which more than half occurred in prepubescent children. Several therapies, associated or isolated, were used to treat the cases. Only one of the reported patients had scar recurrence after surgical treatment. Studies with better scientific evidence are needed to understand the involvement of keloids in male genitalia. However, keloid formation in this topography is rare, making it difficult to carry out more elaborate studies.

What is the most dangerous sexual position that caused the penile fracture? A systematic review and meta-analysis.

PURPOSE: Penile fracture (PF) affects 1,14 to 10,48 men in every 100.000 men in East Asia, and the primary aetiology is sexual intercourse, but the knowledge regarding the most dangerous sexual position is not well explained. This study compares three sexual positions: man on top position (MTP), woman on top position (WTP), and doggy style position (DSP), leading to PF potential. MATERIALS AND METHODS: A search of sexual position-related PF in Google Scholar, PubMed, Cochrane, and PMC Europe was performed. Criteria inclusion was the full text of relevant articles which describ the number of sexual positions. It was analyzed by odds ratio, random model effect, and the OR and 95%CI were calculated. RESULTS: 12 relevant papers involving 490 patients comprised 169 MTP, 120 WTP, 158 DSP, and 43 no intercourse cases. Meta-analysis of all sexual positions was a MTP P= 0,04, WTP P=0,49, and DSP P=0,0005. CONCLUSION: The man-dominant positions (MTP and DSP) were significantly potential for PF, which speculated that when a man is dominant and very excited, intercourse may become highly vigorous and impact trauma. This study found that man's dominant position consists of DSP and the MTP significantly lead to PF.

What is the most dangerous sexual position that caused the penile fracture? A systematic review and meta-analysis

ABSTRACT Purpose: Penile fracture (PF) affects 1,14 to 10,48 men in every 100.000 men in East Asia, and the primary aetiology is sexual intercourse, but the knowledge regarding the most dangerous sexual position is not well explained. This study compares three sexual positions: man on top position (MTP), woman on top position (WTP), and doggy style position (DSP), leading to PF potential. Materials and methods: A search of sexual position-related PF in Google Scholar, PubMed, Cochrane, and PMC Europe was performed. Criteria inclusion was the full text of relevant articles which describ the number of sexual positions. It was analyzed by odds ratio, random model effect, and the OR and 95%CI were calculated. Results: Twelve relevant papers involving 490 patients comprised 169 MTP, 120 WTP, 158 DSP, and 43 no intercourse cases. Meta-analysis of all sexual positions was a MTP P= 0,04, WTP P=0,49, and DSP P=0,0005. Conclusions: The man-dominant positions (MTP and DSP) were significantly potential for PF, which speculated that when a man is dominant and very excited, intercourse may become highly vigorous and impact trauma. This study found that man's dominant position consists of DSP and the MTP significantly lead to PF.

A new treatment of concealed penis: symmetrical pterygoid flap surgery

ABSTRACT Purpose: Considerable controversy exists regarding the surgery for concealed penis. We describe a new technique for repairing concealed penis by symmetrical pterygoid flap surgery. Methods: From January 2016 to July 2022, we evaluated 181 cases of concealed penis that were surgically treated using the symmetrical pterygoid flap surgery. We measured the penile size preoperative and 2, 4, 12 weeks, and 1 year postoperative to confirm the improvement. A questionnaire was administered to the patients and parents to assess satisfaction regarding penile size, morphology, and hygiene. Result: The perpendicular penile length was1.59±0.32cm preoperative and 3.82±1.02 cm after the procedure (p < 0.05), and 4.21±1.91cm after one year of postoperative (p < 0.05). The overall satisfaction of patients was 97.89%, while the overall satisfaction of older children patients (age>7) was 75.24%. Parents focus more on the penile exposure size, while patients focus more on the penile morphology. Almost every patient had postoperative penile foreskin edema. However, this symptom had spontaneously resolved by 4-6 weeks. The complications such as skin necrosis, tissue contracture, or wound infection were 4.42%. Conclusion: The symmetrical pterygoid flap surgery is an effective surgical technique for the management of concealed penis in children producing predictable results and excellent satisfaction of the parents and patients.

A new treatment of concealed penis: symmetrical pterygoid flap surgery.

PURPOSE: Considerable controversy exists regarding the surgery for concealed penis. We describe a new technique for repairing concealed penis by symmetrical pterygoid flap surgery. METHODS: From January 2016 to July 2022, we evaluated 181 cases of concealed penis that were surgically treated using the symmetrical pterygoid flap surgery. We measured the penile size preoperative and 2, 4, 12 weeks, and 1 year postoperative to confirm the improvement. A questionnaire was administered to the patients and parents to assess satisfaction regarding penile size, morphology, and hygiene. RESULT: The perpendicular penile length was1.59±0.32cm preoperative and 3.82±1.02 cm after the procedure (p < 0.05), and 4.21±1.91cm after one year of postoperative (p < 0.05). The overall satisfaction of patients was 97.89%, while the overall satisfaction of older children patients (age>7) was 75.24%. Parents focus more on the penile exposure size, while patients focus more on the penile morphology. Almost every patient had postoperative penile foreskin edema. However, this symptom had spontaneously resolved by 4-6 weeks. The complications such as skin necrosis, tissue contracture, or wound infection were 4.42%. CONCLUSION: The symmetrical pterygoid flap surgery is an effective surgical technique for the management of concealed penis in children producing predictable results and excellent satisfaction of the parents and patients.

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer

ABSTRACT Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.

Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction - a narrative review

ABSTRACT Objectives: To provide an overview of low-intensity extracorporeal shockwave therapy (LIEST) for erectile dysfunction (ED), pointing out which concepts are already consolidated and which paths we still need to advance. Materials and Methods: We performed a narrative review of the literature on the role of shockwave therapies in erectile dysfunction, selecting publications in PUBMED, including only relevant clinical trials, systematic reviews and meta-analyses. Results: We found 11 studies (7 clinical trials, 3 systematic review and 1 meta-analysis) that evaluated the use of LIEST for the treatment of erectile dysfunction. One clinical trial evaluated the applicability in Peyronie's Disease and one other clinical trial evaluated the applicability after radical prostatectomy. Conclusions: The literature presents little scientific evidence but suggests good results with the use of LIEST for ED. Despite a real optimism since it is a treatment modality capable of acting on the pathophysiology of ED, we must remain cautious, until a larger volume of higher quality studies allows us to establish which patient profile, type of energy and application protocol will achieve clinically satisfactory results.

Effects of comfort food diet on the penile morphology of stressed rats.

Purpose: To investigate the effects of chronic stress, associated or not with comfort food, on the morphology of the penis. Materials & methods: Thirty-two adult Wistar rats were divided into four experimental groups: Control group (C), receiving standard rat chow, and under normal conditions; Stressed group (S), receiving standard chow, and submitted to stressful situations; Control + comfort food group (C + CF), receiving standard chow and comfort food, and under normal conditions; and Stressed + comfort food group (S + CF), receiving standard chow and comfort food, and submitted to stressful situations. At 10 weeks of age, food supply and stress were initiated. All groups had ad libitum access to standard chow and water, and groups receiving comfort food also had access to Froot Loops®. Chronic stress was induced by restriction, animals were contained daily in polypropylene tubes for 2 h, for eight weeks. After eight weeks all animals were killed; penises were removed for histomorphometric analysis. Results: Body mass was similar among the groups. Food intake in S + CF group was lower than in other groups. Concerning food preference, groups C + CF and S + CF preferred comfort food over the standard chow, with this preference being higher in S + CF than in C + CF. The area of the corpora cavernosa without tunica albuginea was lower in group S + CF than in group C. Most interestingly, the surface density of connective tissue in the corpora cavernosa was higher in groups S and S + CF compared to group C. In contrast, smooth muscle surface density was markedly lower in S + CF compared to groups C and C + CF, while group S also had reduced smooth muscle in comparison to group C. Conclusion: Chronic stress caused a morphological alteration on penile histomorphometry. Also, stress increased the preference for comfort foods which caused more deleterious effects in some parameters.

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer.

OBJECTIVE: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). MATERIALS AND METHODS: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. RESULTS: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. CONCLUSION: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.

Detailed anatomy of the corpora-glans ligament via the P45 plastination method / Anatomía detallada de los ligamentos cuerpo cavernoso-glande mediante el método de plastinación P45

SUMMARY: The corporo-glans ligament is the ligament connecting the corpus cavernosum and the glans of the penis. The anatomical description of the corporo-glans ligaments shape is still uncertain, this knowledge affects penile reconstructive procedures. The anatomy of the corporo-glans ligament was analyzed and recorded via observing sagittal sections of 10 different penile P45 plastination sections. According to the P45 plastination sections, the corporo-glans junction displayed a fibrous tissue band connecting the distal ends of the two corpus cavernous (CC) with the glans penis (GP). The fibrous band was a round-obtuse shape and ran deep into the glans of the penis and occupied about 2/3 of the whole GP. The original end was laid in a socket embedded in the GP. The density of the fibers of the ligament at the original end close to the tunica albuginea was less than that of the other parts. The fibers originating from the tunica albuginea, directly extended to the blind end of the two CC, covering the distal end of the two CC.

El ligamento cuerpo cavernoso-glande es el ligamento que conecta el cuerpo cavernoso y el glande del pene. La descripción anatómica de la forma de los ligamentos cuerpo cavernoso -glande aún es incierta; este conocimiento afecta los procedimientos reconstructivos del pene. La anatomía del ligamento cuerpo cavernoso-glande se analizó y registró mediante la observación de 10 secciones sagitales diferentes del pene a través de plastinación P45. Según las secciones de plastinación, la unión cuerpo-glande mostraba una banda de tejido fibroso que conectaba los extremos distales de los dos cuerpos cavernosos con el glande del pene. La banda fibrosa tenía una forma redonda y obtusa y se adentraba profundamente en el glande del pene ocupando alrededor de 2/3 de él. En su origen se coloca en un espacio profundo en el glande del pene. La densidad de las fibras del ligamento cuerpo cavernoso-glande en su origen cercano a la túnica albugínea era menor que el de las otras partes. Las fibras que se originan en la túnica albugínea, se extienden directamente hasta el extremo ciego de los dos cuerpos cavernosos, cubriendo el extremo distal de estos.

Some technical contributions to the treatment of buried penis.

Buried penis is a rare condition in which the preputial skin and the fat in the hypogastric area cause the body of the organ to be involved in such a way as to convey the impression that the patient has a micro penis. We present a few technical contributions to the surgical treatment of buried penis, suggesting modifications that may be of help in the treatment of those patients.

Producción científica en investigación sobre avances terapéuticos de la Enfermedad de Peyronie durante los últimos 62 años. Un análisis bibliométrico / Scientific production on research on therapeutic advances in Peyronie's Disease during the last 62 Years. A bibliometric analysis / Produção científica em pesquisa sobre avanços terapêuticos na Doença de Peyronie nos últimos 62 anos. Uma análise bibliométrica

Introducción. La enfermedad de Peyronie es una malformación adquirida del pene, originada por la deposición de placas fibróticas en la túnica albugínea. La prevalencia en Estados Unidos oscila entre el 0.39% y 11.8%, en Europa 8.9%, en Latinoamérica no existe un porcentaje puntual de prevalencia actual debido a la escasez de reportes de esta patología. Este análisis bibliométrico busca describir la evolución terapéutica de la Enfermedad de Peyronie en la literatura de los últimos 62 años, así como la distribución geográfica de estas publicaciones. Metodología. Estudio observacional, descriptivo, un análisis bibliométrico desde 1957 hasta 2019, utilizando GoPubMed y FABUMED. Resultados. Se obtuvieron 721 referencias sobre tratamiento quirúrgico en enfermedad de Peyronie, con un aumento de la producción científica a lo largo del periodo de estudio. The Journal of Urology fue la revista con mayor cantidad de publicaciones, el 57.9% dentro de la categoría de artículo científico. El país líder fue Estados Unidos con 191 publicaciones. Discusión. Existe poca literatura sobre los avances terapéuticos para el tratamiento de enfermedad de Peyronie, lo que dificulta la comparación de las investigaciones a lo largo de los años en diferentes zonas del mundo. La investigación en Latinoamérica es escasa. Conclusión. La investigación sobre el tratamiento quirúrgico en enfermedad de Peyronie muestra un patrón ascendente en la productividad científica durante los años estudiados. Los países con mayores ingresos económicos son de mayor desarrollo en el tema y en menor medida regiones con recursos limitados. El análisis evidencia la importancia de aumentar producción científica en Colombia, así como estimular la investigación sobre este tema, ya que existen muy pocas publicaciones sobre la evolución del tratamiento quirúrgico para esta enfermedad. Palabras clave: Induración Peniana; Enfermedades del Pene; Bibliometría; Fibrosis; Erección Peniana

Introduction. Peyronie's disease is an acquired malformation of the penis, caused by the deposition of fibrotic plaques in the tunica albuginea. The prevalence in the United States ranges between 0.39% and 11.8%, in Europe 8.9%, in Latin America there is no specific percentage of current prevalence due to the scarcity of reports of this pathology. This bibliometric analysis seeks to describe the therapeutic evolution of Peyronie's Disease in the literature over the last 62 years, as well as the geographic distribution of these publications. Methodology. This is an observational, descriptive study, with a bibliometric analysis from 1957 to 2019, using GoPubMed and FABUMED. Results. 721 references on surgical treatment in Peyronie's disease were obtained, with an increase in scientific production throughout the study period. The Journal of Urology was the journal with the highest number of publications, 57.9% within the scientific article category. The leading country was the United States with 191 publications. Discussion. There is a limited amount of literature on therapeutic advances for the treatment of Peyronie's disease, which makes it difficult to compare research over the years in different areas of the world. Research in Latin America is scarce. Conclusion. Research on surgical treatment in Peyronie's disease shows an increasing pattern in scientific productivity over the years. Countries with higher economic income have greater development in the subject and to a lesser extent regions with limited resources. The analysis shows the importance of increasing scientific production in Colombia, as well as stimulating research on this topic, since there are few publications on the evolution of surgical treatment for this disease. Keywords: Penile Induration; Penile Diseases; Bibliometrics; Fibrosis; Penile Erection

Introdução. A doença de Peyronie é uma malformação adquirida do pênis, causada pela deposição de placas fibróticas na túnica albugínea. A prevalência nos Estados Unidos varia entre 0.39% e 11.8%, na Europa 8.9%, na América Latina não existe um percentual específico de prevalência atual devido à escassez de relatos desta patologia. Esta análise bibliométrica tem como objetivo descrever a evolução terapêutica da Doença de Peyronie na literatura dos últimos 62 anos, bem como a distribuição geográfica destas publicações. Metodologia. Estudo observacional, descritivo, análise bibliométrica de 1957 a 2019, utilizando GoPubMed e FABUMED. Resultados. Foram obtidas 721 referências sobre tratamento cirúrgico na doença de Peyronie, com aumento da produção científica ao longo do período do estudo. The Journal of Urology foi o periódico com maior número de publicações, 57.9% dentro da categoria artigo científico. O país líder foram os Estados Unidos com 191 publicações. Discussão. Há pouca literatura sobre avanços terapêuticos para o tratamento da doença de Peyronie, o que dificulta a comparação de pesquisas ao longo dos anos em diferentes partes do mundo. As pesquisas na América Latina são escassas. Conclusão. As pesquisas sobre o tratamento cirúrgico da doença de Peyronie mostram um padrão crescente de produtividade científica ao longo dos anos estudados. Os países com maior rendimento económico são mais desenvolvidos no assunto e, em menor medida, regiões com recursos limitados. A análise mostra a importância de aumentar a produção científica na Colômbia, bem como estimular a pesquisa sobre o tema, uma vez que existem poucas publicações sobre a evolução do tratamento cirúrgico desta doença. Palavras-chave: Induração Peniana; Doenças do Pênis; Bibliometria; Fibrose; Ereção Peniana

Administration with L-glutamine and L-glutathione protects the nitrergic innervation of the penile tissue of diabetic rats

Erectile dysfunction is caused due to neuropathy, resulting from a high oxidative stress, in this way treatment with antioxidants may be promising. Aim of this work was toinvestigate the effects of the administration of 2% L-glutamine and 1% L-glutathione on the penile tissue of diabetic rats analyzing the nerve fibers that expressing Nitric Oxide Synthase Neuronal (nNOS). Forty-eight male Wistar rats distributed into six groups were used: normoglycemic, diabetic, normoglycemic administered with 2% L-glutamine, normoglycemic administered with 1% L-glutathione, diabetic administered with 2% L-glutamine, and diabetic administered with 1% L-glutathione. After a 120 days experimental period, the animals were euthanized, and the penile tissues were collected and processed for the subsequent immunohistochemical procedure (nNOS) and posterior varicosities morphometry analysis. Diabetic rats administered with L-glutamine and with L-glutathione displayed larger varicosity areas of 14 and 15% compared to the diabetic group (p < 0.05). On the other hand, the administration of 2% L-glutamine and 1% L-glutathione in normoglycemic animals promoted a reduction of 3.3% and 2.4% compared to the normoglycemic group (p < 0.05). We concluded that both L-glutamine and L-glutathione administrations exerted a protective effect on the penile nitrergic innervation of diabetic rats, which can have a positive impact on the erectile function and thattheir use in normoglycemic animals should be better investigated.(AU)

Epidemiological study of penile cancer in a northeastern state - Brazil / Estudo epidemiológico do câncer de pênis em um estado do Nordeste - Brasil

ABSTRACT Objective: to trace the clinical and epidemiological profile of penile cancer in Rio Grande do Norte/Brazil and relate them to data published in the literature. Methods: a cross-sectional study was conducted with 94 patients diagnosed with penile cancer in 2011-2018, treated at the Liga Norte Riograndense Contra o Cancer. Results: all patients were diagnosed with squamous cell carcinoma, mainly aged over 50 years, from the states interior, brown, illiterate, or with incomplete primary education. At diagnosis, 68% of patients were classified as having tumors =T2, and 30% had lymph node involvement. Distant metastases were detected in 2.1% of patients at diagnosis. Most patients received the diagnosis in the initial phase of the disease, but 20.2% were diagnosed in stage IV. Partial penectomy was the most performed surgery, and 10% of patients relapsed, mainly in the lymph nodes (87.5%). The mean follow-up of the patients was 18 months, with an estimated overall survival at five years of 59.1%. However, 25% of patients were followed up for up to 3 months, losing follow-up. Conclusion: the State of Rio Grande do Norte has a high incidence of penile cancer with a high frequency of locally advanced tumors at diagnosis and in younger patients younger than 50. Furthermore, socioeconomic factors interfere with early diagnosis and hinder access to specialized services.

RESUMO Objetivo: traçar o perfil clínico e epidemiológico do câncer de pênis no Rio Grande do Norte/Brazil e relacioná-los com dados publicados na literatura. Métodos: realizou-se estudo transversal de 94 pacientes diagnosticados com câncer de pênis no período de 2011-2018, tratados na Liga Norte Riograndense Contra o Câncer. Resultados: todos os pacientes foram diagnosticados com carcinoma espinocelular, principalmente com idade acima dos 50 anos, provenientes do interior do estado, pardos, analfabetos ou com ensino fundamental incompleto. Ao diagnóstico, 68% dos pacientes foram classificados com tumores =T2 e 30% possuiam envolvimento linfonodal. Metástases à distância foram detectadas em 2,1% dos pacientes ao diagnóstico. A maioria dos pacientes recebeu o diagnóstico na fase inicial da doença, mas 20,2% foram diagnosticados em estádio IV. Penectomia parcial foi a cirurgia mais realizada e 10% dos pacientes recidivaram, principalmente para linfonodos (87,5%). A média de seguimento dos pacientes foi de 18 meses, apresentando estimativa de sobrevida global em 5 anos de 59,1%. No entanto, 25% dos pacientes foram acompanhados por até 3 meses, perdendo o seguimento. Conclusão: o Estado do Rio Grande do Norte apresenta elevada incidência de câncer de pênis com alta frequência de tumores localmente avançados ao diagnóstico, assim como em pacientes mais jovens, menores que 50 anos de idade. Outrossim, o fator socioeconômico interfere no diagnóstico precoce e dificulta o acesso a serviços especializados. .

Foreskin leiomyosarcoma: a case report. / [Leiomiosarcoma de prepucio: reporte de un caso]

Introduction: Primary skin leiomyosarcomas are infrequent neoplasms. They correspond to 2-3% of skin sarcomas and are most frequently located on the lower extremities, trunk and genitals. Methods: We present a case of a 73-year-old man with a 4-month evolution of foreskin leiomyosarcoma. The lesion was biopsied for histopathological study with HE and immunohistochemistry with smooth muscle actin, specific muscle actin, CD34, p63 and S-100 (-). Results: We observed a leiomyosarcoma of high histological grade and mitotic count. It was positive by immunohistochemistry for smooth muscle actin, while the other markers were negative. Surgical limits were compromised so a reoperation with wide margins of healthy tissue was necessary. Conclusion: The skin lesions should be removed all, without exception, since they can be neoplasms of variable biological behavior. The histological study must be complemented with immunohistochemistry to differentiate them from other neoplasms. For the prognosis, the histological grade, size, location and the possibility of resection with wide margins must be taken into account.

Introducción: Los leiomiosarcomas primarios de piel son neoplasias infrecuentes. Corresponden al 2-3 % de los sarcomas cutáneos y se localizan con mayor frecuencia en las extremidades inferiores, tronco y genitales. Método: Presentamos un caso de un varón de 73 años con un leiomiosarcoma en prepucio de 4 meses de evolución. Se le practicó biopsia excisional de la lesión para estudio histopatológico con HE e inmunohistoquímica con actina de músculo liso, actina muscular específica, CD34, p63 y S-100 (-). Resultados: Observamos un leiomiosarcoma de alto grado histológico y recuento mitótico. Presentó positividad por inmunohistoquímica para actina de músculo liso, en tanto que los otros marcadores fueron negativos. Los límites quirúrgicos estuvieron comprometidos por lo que fue necesaria una reintervención con amplios márgenes de tejido sano. Conclusión: Las lesiones de piel deben extirparse todas, sin excepción, ya que pueden tratarse de neoplasias de conducta biológica variable. El estudio histológico debe complementarse con inmunohistoquímica para diferenciarlas de otras neoplasias. Para el pronóstico se debe tener en cuenta el grado histológico, el tamaño, la localización y la posibilidad de resección con amplios márgenes.

Correção cirúrgica de pênis embutido com utilização de enxertia: relato de caso / Surgical correction of buried penis with a skin graft: case report

Introdução: Pênis embutido é uma patologia rara relacionada à redução do comprimento peniano. É descrita com maior incidência em crianças, porém acomete também adultos. Nesta população está associado principalmente a obesidade e acúmulo de gordura em região suprapúbica, sendo considerada uma afecção de difícil manejo e tratamento. A intervenção cirúrgica é a base do tratamento e o objetivo principal é o retorno da função urinária e sexual. Múltiplas técnicas cirúrgicas são descritas para reconstrução em pacientes com pênis embutido e devem ser adaptadas para as características apresentadas pelo paciente. Relato de Caso: Nesse artigo é relatada a abordagem de um paciente com pênis embutido, utilizando-se da técnica cirúrgica de lipoaspiração superficial e dermolipectomia associada à fixação da base do pênis em sínfise púbica com o uso de enxerto de pele parcial. Conclusão: A técnica apresentada demonstrou bons resultados funcionais pós-operatórios, devido apresentar melhora clínica das queixas iniciais do paciente, e estéticos, verbalizados pelo paciente e pela responsável legal em virtude do baixo nível cognitivo do paciente.

Introduction: Buried penis is a rare pathology related to the reduction of penile length. It is described with a higher incidence in children, but it also affects adults. This population is mainly associated with obesity and fat accumulation in the suprapubic region, being considered a pathology that is difficult to manage and treat. Surgical intervention is the basis of treatment, and the main objective is the return of urinary and sexual function. Multiple surgical techniques are described for reconstruction in patients with buried penis and must be adapted to the characteristics presented by the patient. Case Report: This article reports the surgical technique of dermolipectomy associated with the fixation of the base of the penis in pubic symphysis and a partial skin graft to approach a patient with a buried penis. Conclusion: The presented technique showed good functional postoperative results due to clinical improvement of the patients' initial complaints and aesthetic ones, verbalized by the patient and the legal guardian due to the patient's low cognitive level.

Reconstrução total da cobertura cutânea do pênis com retalho miocutâneo: relato de caso / Total reconstruction of the skin coverage of the penis with myocutaneous flap: case report

Introdução: O pênis é uma importante estrutura do corpo masculino, sendo sua reconstrução um desafio. Existem diversas doenças e deformidades que acometem este órgão, sendo necessário, em certos casos, a reconstrução total da cobertura cutânea do pênis, tendo já sido descritas na literatura diversas técnicas, tais como o uso de enxertos totais, retalho escrotal, retalhos miocutâneos da fáscia lata e outros. Relato de Caso: Neste relato é apresentada uma reconstrução da cobertura total do pênis por meio do uso de retalho miocutâneo do músculo cremaster com pele da bolsa escrotal, conseguindo prover uma boa vascularização e mantendo a permeabilidade uretral. Conclusão: Tal técnica não foi encontrada em nenhuma das bases de dados pesquisadas no trabalho, apenas semelhantes, e mostrouse como uma boa opção para a reconstrução total da cobertura cutânea peniana.

Introduction: The penis is an important structure of the male body, and its reconstruction is a challenge. Several diseases and deformities affect this organ, being necessary, in certain cases, for the total reconstruction of the cutaneous coverage of the penis, having already been described in the literature several techniques, such as the use of total grafts, scrotal flap, myocutaneous flaps of the fasciae latae and others. Case Report: In this report, a reconstruction of the total coverage of the penis is presented using a myocutaneous flap of the cremaster muscle with skin from the scrotum, achieving good vascularization and maintaining urethral permeability. Conclusion: This technique was not found in any of the databases researched in this study, only similar ones, and it proved to be a good option for the total reconstruction of penile skin coverage.