Long-term outcomes of penile squamous cell carcinoma in men age ≤50 years old compared with men >50 years old from a single tertiary referral centre: a propensity score matched analysis.

Penile cancer (PeCa) is rare, and the oncological outcomes in younger men are unclear. We aimed to analyse and compare oncological outcomes of men age ≤50 years (y) and >50 years with PeCa. A retrospective analysis of men ≤50 y with penile squamous cell carcinoma managed at a tertiary centre was performed. A propensity score matched cohort of men >50 y was identified for comparison. Matching was according to tumour, nodal stage and the types of primary surgery. Overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and metastasis-free survivals (MFS) were estimated using Kaplan-Meier plots and compared using log-rank tests. Between 2005-2020, 100 men ≤50 y (median (IQR) age, 46 y (40-49)) were identified and matched with 100 men >50 y (median (IQR) age, 65 y (59-73)). 10, 24, 32, 34 men age ≤50 y were diagnosed in 2005-2007, 2008-2012, 2013-2016 and 2017-2020 respectively. Median (IQR) follow-up was 53.5 (18-96) months. OS at 2 years: ≤50 y, 86%>50 y, 80.6%; 5 years: ≤50 y, 78.1%, >50 y, 63.1%; 10 years: ≤50 y, 72.3%, >50 y, 45.6% (p = 0.01). DSS at 2 years: ≤50 y, 87.2%>50 y, 87.8%; 5 years: ≤50 y, 80.9%>50 y, 78.2%; 10 years: ≤50 y, 78%, >50 y, 70.9% (p = 0.74). RFS was 93.1% in the ≤50 y group (vs. >50 y, 96.5%) at 2 year, and 90% (vs. >50 y, 88.5%) at 5 years, p = 0.81. Within the ≤50 y group, 2 years and 5 years MFS was 93% (vs. >50 y, 96.5%), and 89.5% (vs. >50 y, 92.7%) respectively, (p = 0.40). There were no statistical significance in DFS, RFS and MFS in men age ≤50 y and >50 y. PeCa in younger patients is fatal, public awareness and patient education are crucial for early detection and management.

Primary penile melanoma and genital lichen sclerosus.

Background: There is a well-established association between squamous cell cancer and genital lichen sclerosus (GLSc). Although there have been several reported cases of vulval melanoma (MM) associated with LSc, particularly in the paediatric population, fewer cases of male genital (M) GLSc and penile (Pe)MM have been published. Objectives: The aim of this study was to explore further the relationship between PeMM and MGLSc by reviewing all the cases managed by our multidisciplinary service over a finite period. Methods: All patients known to our tertiary urology and male genital dermatology service with a diagnosis of PeMM and where histology was available for review were identified over an 11-year period (2011-2022). The histology was reviewed by two independent, mutually 'blinded' histopathologists. Photographs and clinical notes, where available, were retrospectively reviewed by two independent dermatologists for signs or symptoms of LSc. Results: Eleven patients with PeMM were identified for review. Histopathological examination found evidence of LSc in nine patients, and review of clinical photos corroborated the presence of LSc in three. Overall, features of LSc were present in nine out of eleven cases (82%). Conclusion: The presence of LSc in 9 out of 11 cases of PeMM is suggestive of a causative relationship between LSc and PeMM. This may be due to chronic melanocytic distress created by chronic inflammation secondary to LSc.

Primary squamous cell carcinoma of the scrotum: Outcomes from a specialist center.

BACKGROUND: Squamous cell carcinoma (SCC) of the scrotum is a rare and aggressive cancer. There are no established guidelines on the management of scrotal SCC. OBJECTIVE: To analyze the clinical management and outcomes of scrotal SCC. PATIENTS AND METHODS: A retrospective analysis of patients diagnosed with primary scrotal SCC over a 10-year period was performed. The type of surgery, tumor stage and histological subtypes, recurrence rate and metastases, cancer-specific mortality (CSM), and other-cause mortality (OCM) were analyzed. RESULTS: Between 2012 and 2022, a total of 10 men were identified with primary scrotal SCC. The median (interquartile, IQR) age was 65.5 (55-77) years. Wide local excision was performed in 9 patients and 1 patient underwent a total scrotectomy. The pathological T-stage was: pT1, n = 3; pT2, n = 1; pT3, n = 5 (50%); pT4, n = 1. Four patients had pathologically positive inguinal lymph nodes and 2 had distant metastatic disease at presentation. At a median (IQR) follow-up of 10.5 (4-31) months 5 patients died, of which 3 died from scrotal SCC. CONCLUSION: Scrotal SCC is extremely rare in the UK with only 10 primary cases identified in our center over the past 10 years. Surgical resection of the tumor and appropriate inguinal node staging are required due to a high proportion of cases which metastasize to the inguinal lymph nodes. PATIENT SUMMARY: Scrotal cancer is rare. 10 cases were diagnosed over 10 years at a single center. Around half had disease spread to the groin nodes or distant organs at presentation. Surgical resection was required in all patients. At the time of analysis, half of the patients are alive. Due to the rarity and aggressiveness of the cancer, management should be carried out within a specialist center.

Outcomes of penile sarcomatoid squamous cell carcinoma from a single tertiary referral centre: a matched cohort study.

OBJECTIVE: To report the oncological survival outcomes of men with penile sarcomatoid squamous cell carcinoma (sSCC). PATIENTS AND METHODS: A retrospective analysis of men with penile sSCC diagnosed between January 2010 and January 2020 in a single centre was conducted. Disease-specific (DSS), recurrence-free (RFS) and metastasis-free (MFS) survival were evaluated. Outcomes were compared with a non-sarcomatoid penile SCC cohort matched to age, type of surgery and tumour stage. Kaplan-Meier plots were used to estimate survival outcomes. RESULTS: In all, 1286 men were diagnosed with penile SCC during the study period and of these 38 (3%) men had sSCC. The median (interquartile range) age and follow-up was 70 (57-81) years and 16 (7-44) months, respectively. Operations performed included: circumcision, one (2.6%); wide local excision, four (10.5%); glansectomy, 11 (29%); partial penectomy, 10 (26%); subtotal/total penectomy, 12 (32%). The Kaplan-Meier estimated 12-, 24- and 36-month DSS was 62% (vs non-sarcomatoid, 67%), 43% (vs non-sarcomatoid, 67%) and 36% (vs non-sarcomatoid, 67%), respectively (P = 0.03). The Kaplan-Meier estimated 12- and 24-month RFS was 47% (vs non-sarcomatoid, 60%) and 28% (vs non-sarcomatoid, 55%), respectively (P = 0.01). The MFS was 52% (vs non-sarcomatoid, 62%) at 12 months and 37% (vs non-sarcomatoid, 57%) at 24 months (P = 0.04). CONCLUSIONS: Sarcomatoid differentiation was associated with a lower DSS, RFS and MFS. Due to the rarity of its incidence and aggressiveness, expert histological review and multidisciplinary management is required in a specialist penile cancer centre.

Genital lichen sclerosus and melanoma; a systematic review.

Background: Lichen sclerosus (LSc) is a chronic, inflammatory, destructive skin disease with a predilection for the genitalia (GLSc). An association with vulval (Vu) and penile (Pe) squamous carcinoma (SCC) is now well established but melanoma (MM) has only rarely been reported complicating GLSc. Methods: We have performed a systematic literature review of GLSc in patients with genital melanoma (GMM). Only articles that mentioned both GMM and LSc affecting either the penis or vulva were included. Results: Twelve studies with a total of 20 patients were included. Our review shows that an association of GLSc with GMM has been more frequently reported in women and female children than men viz, 17 cases compared with three. It is notable that five of the cases (27.8%) concerned female children aged under twelve. Discussion: These data suggest a rare association between GLSc and GMM. If proven, there arise intriguing questions about pathogenesis and consequences for counselling of patients and follow-up.

Complications and outcomes following injection of foreign material into the male external genitalia for augmentation: a single-centre experience and systematic review.

Injection of exogenous material into the penis and scrotum has been performed for augmentation purposes. Complications include cosmetic dissatisfaction, penile necrosis and lymphoedema. We report the complications and outcomes from a single centre with an updated systematic review of the literature. A retrospective review of all cases presenting with foreign substance injection into the genitalia, over a 10-year period was performed. Thirty-five patients with a mean (standard deviation (SD); range) age of 36.9 (±9.1; 22-61) years at presentation were included. The mean (SD; range) time between injection and presentation was 7.8 (±5.8; 1 day-20 years) years. The most common injected substance was silicone (n = 16, 45.7%) and liquid paraffin (n = 8, 22.9%). The penile shaft (94.3%) was the most injected site. The most common presentations were cosmetic dissatisfaction (57.1%) and pain and/or swelling (45.7%). Surgery was required in 32 (91.4%) cases. Primary procedures included local excision and primary closure (n = 19, 59.4%), circumcision (n = 5, 15.6%), excision with a split skin graft or a scrotal flap reconstruction (n = 5, 15.6%). Three (8.6%) patients presented with necrosis and required acute debridement. Overall, 18 patients had more than 1 procedure, and 8 patients required 3 or more procedures. A systematic search of the literature identified 887 articles of which 68 studies were included for analysis. The most common substance injected was paraffin (47.7%), followed by silicone (15.8%). The majority of patients (77.9%) presented with pain, swelling or penile deformity. 78.8% of the patients underwent surgical treatment, which included excision and primary closure with or without the use of skin grafts (85.1% of all procedures), the use of flaps (12.3%) and penile amputation (n = 2). Complications of foreign body injection into the male genitalia can be serious resulting in necrosis and autoamputation. Surgical intervention is often required to excise abnormal tissue to manage pain and improve cosmesis.

Videoendoscopic Inguinal Lymphadenectomy Versus Radical Open Dissection (VELRAD) in Patients with Male Genital Cancer: A Clinical Trial Update.

VELRAD is the first multicentre feasibility randomised controlled trial comparing videoendoscopic radical inguinal lymphadenectomy versus open dissection for male genital cancer. We have randomised nine patients so far in our attempt to identify the best approach to inguinal lymph node dissection.

Treatment of Persistent or Recurrent Varicoceles: A Systematic Review.

CONTEXT: The outcomes and morbidity following treatment for persistent or varicocele recurrence remain controversial. OBJECTIVE: To conduct a systematic review relating to the outcomes following treatment (any surgical or radiological) for varicocele persistence/recurrence. EVIDENCE ACQUISITION: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Prospective and retrospective observational or interventional studies were included until March 2022. Outcomes were pregnancy rate, improvements in semen parameters after treatment compared with those at baseline, pain control, complication rates, and repeat treatment approach. Men of any age with any-grade persistent/recurrent varicoceles were included. EVIDENCE SYNTHESIS: Of 913 articles identified, 18 with 1073 patients were eligible for inclusion. The mean time between the first and repeat treatment ranged between 5.3 and 73.3 months. The indication for repeat treatment was infertility in eight and pain control in six out of 18 studies, whereas four did not provide details for the indication. Of the patients with recurrent/persistent varicoceles initially treated using a radiological intervention, 83.8% underwent another radiological procedure, whereas 16.2% underwent a surgical procedure. Of those initially treated with a surgical procedure, 77.8% underwent a further surgical procedure, whereas 22.2% underwent a radiological procedure. The rate of success of repeat treatment was 60-100%. The reported complications were as follows: hydrocele (up to 16%), testicular atrophy (up to 2%), scrotal hematoma (up to 1.6%), wound infection (up to 6.6%), chronic pain (up to 2.9%), injury to other organs (up to 10%), and thrombophlebitis (up to 5.8%). The rate of symptom resolution was >90% for pain control. Pregnancy rates were 17-58% at 12-month follow-up. Semen parameters improved after repeat treatment compared with that at baseline in 87.5% of studies. The main limitations are the high risk of bias according to the Newcastle and Ottawa Scale, heterogeneity of the included studies, and small simple size. CONCLUSIONS: Treating any grade of persistent/recurrent varicoceles has a good rate of success, pregnancy, and pain control, but there is still a risk of complications. Repeat treatment with the same interventional modality is feasible. The level of evidence is overall low. PATIENT SUMMARY: In this systematic review on persistent or recurrent varicoceles, we showed that repeat treatment with radiological or surgical procedures was feasible, with good success, pregnancy, and pain control rates at follow-up. However, repeat treatment was associated with a higher risk of complications than reported in the published literature relating to patients having their first intervention.

A systematic review of non-surgical management in Peyronie's disease.

The efficacy of many non-surgical treatments for Peyronie's disease is unclear. This systematic review aims to critically assess the currently available options and provide a recommendation for treatment based on this. A systematic literature search utilising the Medline (Pubmed), Embase, global health and Cochrane library databases was conducted up to May 2021. All randomised controlled trials assessing non-surgical treatment modalities for Peyronie's Disease were included. Individual study risk of bias was evaluated using the Cochrane tool and GRADE was used to assess evidence strength. Outcome measures were the change in penile curvature (degrees), plaque size (volume or size), International Index of Erectile Function score, pain scores and change in penile length. Prospero registration number: CRD42017064618. Amongst the 5549 articles identified, 41 studies (42 reports) were included. Seven different oral treatment options including vitamin E supplementation showed evidence for improving outcomes such as penile curvature and plaque size. Of the intralesional treatments, Collagenase Clostridium Histolyticum showed evidence for improving penile curvature (Range: 16.3-17 degrees, moderate level certainty of evidence). Intralesional Interferon demonstrated some improvement in curvature (Range: 12-13.5 degrees), plaque size (Range: 1.67-2.2 cm2) and pain, whilst intralesional calcium channel blockers such as Verapamil showed variable evidence for changes in the plaque size and pain. Extracorporeal Shockwave Therapy consistently demonstrated evidence for improving penile pain in stable disease, and two mechanical traction devices improved curvature. Iontophoresis, topical medications, and combination therapies did not demonstrate any consistent improvements in outcome measures. Intralesional options demonstrate the best potential. Overall, results varied with few high-quality randomised trials present.

Diagnostic Accuracy of Dynamic Sentinel Lymph Node Biopsy for Penile Cancer: A Systematic Review and Meta-analysis.

CONTEXT: A dynamic sentinel lymph node biopsy (DSNB) is used for inguinal lymph node staging in patients presenting with primary penile cancer with clinically impalpable inguinal lymph nodes (cN0). Further completion radical inguinal lymph node dissection (RLND) is offered to patients diagnosed with metastatic inguinal nodes following a DSNB. OBJECTIVE: To identify the diagnostic accuracy of a DSNB and RLND to detect lymph node metastasis. EVIDENCE ACQUISITION: A systematic literature search was performed on PubMed Medscape, EMBASE, Google Scholar, and Cochrane database for relevant studies between January 1, 2000 and April 30, 2022. Studies were included if a DSNB was offered to cN0 patients and if RLND was offered to patients with positive histology at the DSNB. Risk of bias and confounding assessments were performed. Diagnostic odds ratio, pooled sensitivity/specificity, and heterogeneity analyses were displayed. EVIDENCE SYNTHESIS: Overall, 2893 patients in the 28 studies analysed underwent a DSNB. Twenty-one studies reported patients undergoing RLND for a positive DSNB. A DSNB showed pooled weighted sensitivity of 0.87 (95% confidence interval [CI]: 0.82-0.91) and pooled log diagnostic odds ratio of 6.17 (95% CI: 5.47-6.87). A DSNB showed pooled weighted sensitivity of 0.50 (95% CI: 0.24-0.59), specificity of 0.82 (95% CI: 0.78-0.87), and a log diagnostic odds ratio of 1.18 (95% CI: 0.29-2.97) for detecting further positive lymph nodes at RLND. High heterogeneity, mostly caused by study design, characteristics of the included patients, DSNB technique used, surgical experience/centre case volumes, and follow-up schedule, represents the main limitation of this meta-analysis. Several sensitivity analyses to address these issues support our findings. CONCLUSIONS: A positive DSNB is poorly able to discriminate which patients will have further metastatic involvement at completion RLND. Better stratification of these patients would avoid unnecessary overtreatment and possible postoperative comorbidities. PATIENT SUMMARY: This analysis of the data from the published literature provides evidence that the diagnostic accuracy of a dynamic sentinel lymph node biopsy (DSNB) requires further improvement. Moreover, a high proportion of patients with a positive DSNB undergo unnecessary radical lymph node dissection; better stratification of these patients might help determine avoidable overtreatment and postoperative comorbidities.

Are finasteride-related penile curvature/Peyronie's disease Adverse Event Reports worthy of further clinical investigation? Disproportionality analysis based on both the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) pharmacovigilance databases.

A limited number of studies have described patients on finasteride showing findings which were consistent with Peyronie's disease (PD). We aimed to detect a pharmacovigilance signal of possible association between finasteride and PD-related clinical features. The Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database was queried to identify the ten drugs which were associated the most with the adverse drug reactions (ADRs) recorded as "penile curvature" and/or "Peyronie's disease". A similar analysis, including the same drugs, was carried out for the EMA (European Medicines Agency) EudraVigilance (EV) database. Descriptive data have been analyzed, and Proportional Reporting Ratios (PRRs) have been computed against the other nine drugs of the database. Overall, 860 reports of "penile curvature" and/or "Peyronie's disease", were identified in the FAERS database, 214 of which (24.9%) were associated with finasteride. Most reports (56.9%) were submitted by healthcare professionals. Where a treatment-indication was stated, the vast majority of reports (176/210; 83.8%) were associated with androgenetic alopecia. The outcome of most ADRs was "serious" (82.2%), with 96 ADRs resulting in levels of permanent disability. For 97/214 individual cases, penile curvature/PD reports were not part of a syndromic cluster suggestive of post-finasteride syndrome (PFS). The PRR resulted 6.6 (95% CI: 5.6-7.8) and 11.8 (95% CI: 9.08-15.33), respectively, in the FAERS and in the EV databases. Notwithstanding the related limitations and biasing factors of pharmacovigilance studies based on spontaneous reporting, the PRR values here identified should be interpreted as strong signals of disproportionality. These findings, per se, are however not useful to confirm any causal association. Clinical studies are needed to investigate on the possible role for finasteride in causing PD-related clinical features, an hypothesis which remains highly speculative due to the very questionable quality of present data.

Management of small testicular masses: outcomes from a single-centre specialist multidisciplinary team.

OBJECTIVES: To report the management outcomes of men with ≤20-mm small testicular masses (STMs) and to identify clinical and histopathological factors associated with malignancy. PATIENTS AND METHODS: A retrospective analysis of men managed at a single centre between January 2010 and December 2020 with a STM ≤20 mm in size was performed. RESULTS: Overall, 307 men with a median (interquartile range [IQR]) age of 36 (30-44) years were included. Of these, 161 (52.4%), 82 (26.7%), 62 (20.2%) and 2 men (0.7%) underwent surveillance with interval ultrasonography (USS), primary excisional testicular biopsy (TBx) or primary radical orchidectomy (RO), or were discharged, respectively. The median (IQR) surveillance duration was 6 (3-18) months. The majority of men who underwent surveillance had lesions <5 mm (59.0%) and no lesion vascularity (67.1%) on USS. Thirty-three (20.5%) men undergoing surveillance had a TBx based on changes on interval USS or patient choice; seven (21.2%) were found to be malignant. The overall rate of malignancy in the surveillance cohort was 4.3%. The majority of men who underwent primary RO had lesions ≥10 mm (85.5%) and the presence of vascularity (61.7%) on USS. Nineteen men (23.2%) who underwent primary TBx (median lesion size 6 mm) had a malignancy confirmed on biopsy and underwent RO. A total of 88 men (28.7%) underwent RO, and malignancy was confirmed in 73 (83.0%) of them. The overall malignancy rate in the whole STM cohort was 23.8%. Malignant RO specimens had significantly larger lesion sizes (median [IQR] 11 [8-15] mm, vs benign: median [IQR] 8 [5-10] mm; P = 0.04). CONCLUSIONS: Small testicular masses can be stratified and managed based on lesion size and USS features. The overall malignancy rate in men with an STM was 23.8% (4.3% in the surveillance group). Surveillance should be considered in lesions <10 mm in size, with a TBx or frozen-section examination offered prior to RO in order to preserve testicular function.

Advances in penile-sparing surgical approaches.

Objective: Penile cancer (PeCa) is a rare disease with a global incidence of 36 068 new cases in 2020. This accounts for 0.4% of all male malignancies. The surgical management of PeCa depends on the location of the tumour and depth of invasion. Here, we review the oncological and functional outcomes of penile-preserving surgery (PPS). Methods: A PubMed search until July 2021 on PPS for PeCa was conducted; a narrative review on different penile-sparing approaches and outcomes was performed. Results: PPS is now the standard of care in specialist centres for distal tumours not involving the corpus cavernosa. Laser therapy, glans resurfacing, and wide local excision are options for superficial lesions, whilst glansectomy is required for lesions invading into the corpus spongiosum. Conclusion: PPS aims to preserve urinary and sexual function without compromising oncological outcomes.

Recent advances in understanding and treating priapism.

Priapism is a rare condition that can lead to long-term erectile dysfunction if left untreated. It is one of the few urological emergencies that require prompt medical intervention. Priapism refers to a penile erection that lasts for more than 4 hours and is unrelated to sexual stimulation or orgasm. The aims of immediate intervention for ischaemic priapism are to resolve the painful erection and preserve the cavernosal smooth muscle function. The aim of this review is to evaluate the latest advances in the management of priapism. Despite the continuous challenge in providing an optimal treatment for this rare urological condition, our understanding and management of it have been advanced by decades of clinical and basic science research. Proximal shunts (Quackels or Grayhack) are no longer routinely performed. Distal shunt procedures are currently the most commonly used techniques. A novel penoscrotal decompression technique has recently been described. Ischaemic priapism can be managed conservatively in most cases with the preservation of erectile function. In cases where ischaemic priapism has persisted for more than 36 hours, the majority will develop erectile dysfunction. Early penile prosthesis with thorough patient counselling should be considered in such cases. In some cases of long-standing non-ischaemic priapism, patients can develop fibrosis within the distal corpora, and, therefore, early treatment with super-selective embolisation is required to prevent this.

Detection rates of urogenital cancers and benign pathology in men presenting with hematospermia.

Background: Hematospermia, although often found to be a benign condition, can be an alarming sign. Consequently, patients can undergo multiple investigations with no current standardized pathway based on data from large series. The aim of this study was to evaluate the incidence of an underlying pathology and the value of diagnostic investigations performed in patients presenting with hematospermia. Materials and methods: A retrospective review of 393 consecutive men who underwent investigations for hematospermia was performed in a single tertiary center. Patient demographics, radiological and microbiological results were recorded together with symptoms of concomitant hematuria and clinical outcomes. Results: In this cohort, the overall prostate cancer detection rate was 5.3% and 7.2% in the ≥40 years group. One patient was diagnosed with testicular seminoma detected on scrotal ultrasound scan and one with G1pTa urothelial carcinoma of the bladder detected on flexible cystoscopy. In addition, 5.6% of patients were found to have a significant benign pathology for which intervention was proposed. A total of 288 patients underwent a transrectal ultrasound scan and 58.7% (n = 169) of these patients were found to have a positive finding. One hundred ten patients underwent a multiparametric magnetic resonance imaging and 73.6% (n = 81) had a positive finding. Conclusions: Apart from transrectal ultrasound and multiparametric magnetic resonance imaging, the remaining investigations have a low diagnostic yield. Prostate cancer detection was 5.3%; 7.2% in the ≥40 years group, and two further patients were diagnosed with testicular and bladder malignancy. Based on our results, we propose an algorithm for the management of hematospermia to limit unnecessary investigations with the majority requiring reassurance.

Medications mostly associated with priapism events: assessment of the 2015-2020 Food and Drug Administration (FDA) pharmacovigilance database entries.

A range of drugs have a direct role in triggering ischaemic priapism. We aimed at identifying: a) which medications are associated with most priapism-reports; and, b) within these medications, comparing their potential to elicit priapism through a disproportionality analysis. The FDA Adverse Event Reporting System (FAERS) database was queried to identify those drugs associated the most with priapism reports over the last 5 years. Only those drugs being associated with a minimum of 30 priapism reports were considered. The Proportional Reporting Ratios (PRRs), and their 95% confidence intervals were computed. Out of the whole 2015-2020 database, 1233 priapism reports were identified, 933 of which (75.7%) were associated with 11 medications with a minimum of 30 priapism-reports each. Trazodone, olanzapine and tadalafil showed levels of disproportionate reporting, with a PRR of 9.04 (CI95%: 7.73-10.58), 1.55 (CI95%: 1.27-1.89), and 1.42 (CI95%: 1.10-1.43), respectively. Most (57.5%) of the reports associated with the phosphodiesterase type 5 inhibitors (PDE5Is) were related with concomitant priapism-eliciting drugs taken at the same time and/or inappropriate intake/excessive dosage. Patients taking trazodone and/or antipsychotics need to be aware of the priapism-risk; awareness among prescribers would help in reducing priapism-related detrimental sequelae; PDE5I-intake is not responsible for priapism by itself, when appropriate medical supervision is provided.

A Systematic Review of Penile Prosthesis Insertion in Patients With Spinal Cord Injury.

INTRODUCTION: A penile prosthesis (PP) may be inserted for erectile dysfunction (ED) and/or urinary management in men with spinal cord injury (SCI). This group of patients is considered high risk for complications due to their reduced mobility and sensation. OBJECTIVES: To identify the complication and satisfaction rates following PP insertion in patients with SCI. METHODS: A systematic review of the literature was performed according to the PRISMA checklist. The Medline/PubMed and EMBASE databases were searched up to July 27th 2021. Studies on men ≥18 years who had a PP inserted for ED secondary to SCI were included. Two reviewers independently screened all articles, assessed for risk of bias and performed data extraction. RESULTS: Eleven studies including 475 men with SCI were included for analysis. The overall complication rate was 4.2-61.1%. Specific complications included infection, 0-16%; erosion, 3.7-11.1% and mechanical failure, 0-16.7%. The explantation rate was 2.1-16.7% and the revision rate was 2.7-44.4%. Overall, 79.2-92.9% of men were satisfied with their PP and, 36-86.1% were having satisfactory sexual intercourse. In those who used the PP for urinary management ± ED, 86.5--92.8%% were satisfied. Men with SCI had higher rates of complications compared to those without SCI (infection, 2.1-9.1% vs non-SCI, 0.8-5.7%; erosion, 2.1-8.3% vs non-SCI, 0%; explanation, 2.1-8.3% vs non-SCI, 0.8-5.7%). CONCLUSION: PP is an option for SCI patients for the management of end-stage ED or urinary function, but the rate of infection, erosion and implant explantation is higher compared with men without SCI. Inflatable penile prosthesis (IPP) is the preferred PP due to the lower risk of erosion, however, they are prone to mechanical failure and require good hand dexterity. A thorough pre-operative counselling is essential. Pang KH, Muneer A, Alnajjar HM, et al. A Systematic Review of Penile Prosthesis Insertion in Patients With Spinal Cord Injury. Sex Med Rev 2022;10:461-470.

Surgical technique and outcomes following coronal-sparing glans resurfacing for benign and malignant penile lesions.

The aim of this study is to describe the outcomes for a modified glans-resurfacing technique for benign and malignant penile conditions in which the uninvolved glans corona is preserved in order to maintain glans erogenous sensation. A total of 13 patients underwent coronal-sparing glans resurfacing (CSGR), with follow-up every 3 months for ≥2 years. Positive surgical margin and local recurrence (LR) rates were evaluated. Surgical complications and cosmetic outcomes were also recorded. Patients were asked to complete the International Index of Erectile Function-5 (IIEF-5) questionnaire starting 12 months after the surgery. The median (interquartile range [IQR]) age and follow-up periods were 63 (53-68) years and 29 (14-38) months, respectively. Eight patients were diagnosed with primary penile squamous cell carcinoma (SCC), three had refractory lichen sclerosus, and two had penile intraepithelial neoplasia (PeIN). No surgical complications were recorded. All patients had a complete graft take and reported satisfactory cosmetic results with preserved erogenous sensation. Two cancer patients developed LR which was managed with further penile preserving surgery. The median (IQR) postoperative IIEF-5 value was 20 (17-23). This modified coronal-sparing technique was suitable for glans lesions that spare the coronal ridge and coronal sulcus. Preservation of the coronal ridge helps maintain sexual function and provides excellent cosmetic outcomes.