Tratamiento de las pápulas perladas peneanas mediante uso de láser de dióxido de carbono fraccionado / Treatment of pearly penile papules using fractionated carbon dioxide laser

Las pápulas perladas del pene son angiofibromas acrales, lesiones asintomáticas benignas, no infecciosas, ubicadas alrededor del glande masculino. Debido su aspecto suelen causar angustia, disminución de autoestima y dificultades en la intimidad sexual. Todo esto lleva a un deterioro de la calidad de vida sexual. Métodos. Se incluyeron pacientes varones con pápulas perladas peneanas que recibieron tratamiento con láser de dióxido de carbono fraccionado entre diciembre de 2023 y abril de 2014. Se trataron en total 75 pacientes. Previo al tratamiento se les realizó una encuesta para saber si había realizado consulta previa con especialista y los motivos para realizar el tratamiento. Se les realizó el primer control postratamiento entre 10 a 15 días post tratamiento. En caso de presentar pápulas perladas peneanas residuales se procedió a un segundo o tercer tratamiento. Se les realizó segundo y tercer control postratamiento entre 10 a 15 días postratamiento. En dicho segundo o tercer control se les realizó encuesta de satisfacción. Resultados. Todos los pacientes incluidos en nuestro estudio informaron que se lograron eliminar sus pápulas perladas peneanas: 13% (10 pacientes) en primera sesión, 82% (62 pacientes) en segunda sesión y solo 4% (3 pacientes) requirieron una tercera sesión. Conclusiones. Las pápulas perladas peneanas, aun siendo de etiología benigna y no contagiosa, reducen significativamente la calidad de vida sexual de los varones, especialmente los jóvenes, y merecen de un tratamiento médico. El tratamiento de las pápulas perladas peneanas mediante uso de láser de dióxido de carbono fraccionado demostró ser un tratamiento rápido, seguro y eficaz

Pearly penile papules are acral angiofi bromas, benign, non-infectious, asymptomatic lesions around the male glans. Due to their appearance, they often cause distress, decreased self-esteem, and difficulties in sexual intimacy. All this leads to a deterioration in the quality of sexual life. Methods. Male patients with pearly penile papules who received fractionated carbon dioxide laser treatment between December 2023 and April 2014 were included. A total of 75 patients were treated. Before the treatment, a survey was conducted to fi nd out if they had previously consulted with a specialist and what motivated them to undergo the treatment. They underwent their first post-treatment control between 10 to 15 days after treatment. If residual pearly penile papules were present, a second or third treatment was performed. A second and third post-treatment control was carried out between 10 to 15 days after treatment. In said second or third control, a satisfaction survey was carried out. Results. All patients included in our study reported that their pearly penile papules were eliminated: 13% (10 patients) in the fi rst session, 82% (62 patients) in the second session, and only 4% (3 patients) required a third session. Conclusions. Pearly penile papules, even though they are of benign and non-contagious etiology. They signifi cantly reduce the quality of sexual life of men, especially young men, and deserve medical treatment. The treatment of pearly penile papules using fractionated carbon dioxide laser proved to be fast, safe, and effective.

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.

Penile fractures in young bulls raised in feedlots in Southern Brazil

Background: Penile fracture is a pathology of young cattle that perform precocious and disordered breeding. The incompatibility of height between males and females and sodomy between males cause a great pressure on the sigmoid flexure and retractor muscle of the penis, which are the main causes and sites of organ injury. This study aimed to describe the epidemiological and pathological aspects of penile fractures observed in young bulls raised in pre-export feedlots (PEFs) in southern Brazil. Cases: In 2 PEFs located in the municipalities of Pelotas (property 1) and Capão do Leão (property 2), 3 male cattle [1 from property 1 and 2 from property 2] presented subcutaneous edema in the foreskin and perineum, associated with dysuria. The evolution of the clinical picture was approximately 20 days in all cases, with evolution to death. The bovine necropsied on property 1 had an increased volume and inguinal edema, involving the penis and scrotal sac. Necrosis of the subcutaneous tissue and local musculature was also observed. The testicles were surrounded by the necrotic tissue, and the right testis was swollen, with flaccid parenchyma adhering to the tunica albuginea. In the necropsy of 1 bull from property 2, an increase in the inguinal volume was observed, with an extensive area of necrosis and edema extending from the prepuce to the caudal musculature of the scrotal sac. There were also marked varicosis in the sigmoid flexure and necrosis of the adjacent region, without the involvement of the corpus cavernosum. During the necropsy of the 2 young bulls, fragments of organs from the abdominal, thoracic, and brain cavities were collected and fixed in 10% buffered formalin. From the bull of the property 2, an anatomical piece consisting of the penis, prepuce, and testicles was also collected and fixed in 10% buffered formalin. After 48 h, the tissue samples were cleaved, embedded in paraffin, cut into 3-µm-thick sections, and stained using hematoxylin and eosin (HE). A histological evaluation of the penile lesions in both cattle revealed intense hemorrhage, congestion, and necrosis of the muscles and tissues adjacent to the corpus cavernosum. In addition to areas of dystrophic calcification, neutrophil and macrophage infiltration was also observed. In the bull from the property 1, an intense edema and proliferation of fibrous tissue surrounding the urethra were noted. There were also marked tubular degeneration and intense infiltration of neutrophils, lymphocytes, and macrophages in the inner portion of the tunica albuginea. Discussion: In the present cases, the diagnosis was based on epidemiological data associated with clinical signs and pathology. The macroscopic lesions observed were probably due to the involvement of blood vessels adjacent to the penis, which suffered trauma during sodomy mating among cattle. These lesions have been described in other reports of this pathology and in diseases, such as acropostitis-phimosis, fibropapilloma of the glans, preputial abscess, and urolithiasis, and the differential diagnosis of these diseases must be carried out, as they have different etiologies. In the bulls of the present study, no lesions were observed in the corpus cavernosum, and this condition was attributed to the presence of varicosis and accumulation of urine in the prepuce, due to the difficulty in exposing the penis. Histologically, there were intense hemorrhage, congestion, and necrosis of the muscles and tissues adjacent to the corpus cavernosum, with the infiltration of neutrophils and macrophages, and areas of dystrophic calcification. The presence of necrotic lesions in tissues adjacent to the penis may be related to hypoxia, vascular lesions, or the action of chemical elements present in the urine. In both cases, vascular lesions were present, which were attributed to the main triggering factor for the disease.

Enfermedad de Mondor del pene en un paciente joven / Mondor disease of the penis in a young patient

Se presenta el caso clínico de un paciente de 21 años de edad, con antecedente de herniorrafia inguinal derecha, quien asistió a consulta de control y refirió presentar una induración y dolor en la región dorsal del pene con 4 días de evolución, que había comenzado después de una relación sexual en la cual consumió marihuana. En el examen físico se encontró la vena dorsal del pene engrosada, dura y dolorosa a la palpación. Se le diagnosticó una enfermedad de Mondor del pene. La ecografía Doppler confirmó la tromboflebitis de esta vena. El paciente recibió tratamiento médico y evolucionó satisfactoriamente.

The case report of a 21 years patient with history of right inguinal herniorrhaphy is presented, who attended control visit and he made reference to an induration and pain in the dorsal region of the penis with 4 days of evolution that had begun after a sexual relationship in which he consumed marihuana. In the physical exam the penis dorsal vein was found thicken, hard and painful to the palpation. He was diagnosed a Mondor disease of the penis. The Doppler scanning confirmed the thrombophlebitis of this vein. The patient received medical treatment and had a favorable clinical course.

Bloqueo del nervio dorsal del pene en la analgesia postoperatoria en la cirugía de fimosis. Hospital Pediátrico Hermanos Cordové. Abril 2017-2018 / Dorsal nerve block of the penis in postoperative analgesia in phimosis surgery. Hermanos Cordové Pediatric Hospital. April 2017 - 2018

Introducción: lograr una adecuada analgesia posoperatoria en la cirugía pediátrica se ha convertido en uno de los objetivos más importantes de la anestesia contemporánea, para lo cual se emplean diferentes métodos, entre estos el bloqueo de los nervios sensitivos. Objetivo: describir los resultados del bloqueo del nervio dorsal del pene para la analgesia posoperatoria de la cirugía de fimosis. Método: se realizó un estudio descriptivo comparativo prospectivo en el Hospital Pediátrico Hermanos Cordové de la ciudad de Manzanillo en el periodo comprendido desde abril 2017 a 2018, cuyo universo estuvo conformado por 80 pacientes ingresados e intervenidos quirúrgicamente de forma electiva en cirugía de fimosis, divididos aleatoriamente en dos grupos a los cuales se les aplicó la técnica de anestesia general y bloqueo del nervio dorsal del pene y a otro grupo se le aplicó la técnica anestesia general combinada con opioides. Resultados: el grupo etáreo que más incidencia de casos tuvo fue el de 4-6 años en el grupo estudio para un 52.5 por ciento y en el grupo control de 7-9 años para 47.5 por ciento. El promedio de edad en el grupo de estudio fue de 4.77 con una DE+_1.95 y en el grupo de control se constató una media de 5.95 con una DE+_ 2.16, no se presentaron complicaciones relacionadas con la técnica y 36 pacientes no tuvieron dolor (90 por ciento). Conclusiones: podemos considerar que es una técnica anestésica con mínimas complicaciones, favoreciendo la recuperación anestésica a corto plazo, lo que se refleja en el alta temprana, disminuyendo la estancia hospitalaria y reduce los costos familiares e institucionales(AU)

Introduction: Achieving adequate postoperative analgesia in pediatric surgery has become one of the most important objectives of contemporary anesthesia, for which different methods are used, including blocking sensitive nerves. Objective: to describe the results of the dorsal nerve blockage of the penis for postoperative analgesia of phymosis surgery. Method: A prospective comparative descriptive study was carried out at the Hermanos Cordové Pediatric Hospital in the city of Manzanillo in the period from April 2017 to 2018, whose universe consisted of 80 patients entered and surgically surgically surgery electively in phymosis surgery, randomly divided into two groups to which the technique of general anesthesia and block age of the dorsal nerve of the penis was applied and another group was given the general anesthesia technique combined with opioids. Results: the ethereal group that had the highest incidence of cases was the 4-6 year in the study group for 52.5 percent and in the control group of 7-9 years for 47.5 percent. The average age in the study group was 4.77 with a DE+_1.95 and the control group found an average of 5.95 with a DE+_ 2.16, no complications related to the technique and 36 patients had no pain (90 percent). Conclusions: we can consider it to be an anesthetic technique with minimal complications, favoring short-term anesthetic recovery, which is reflected in early discharge, reducing hospital stay and reducing family and institutional costs(EU)

Urethral injury in penile fracture: a narrative review

ABSTRACT Objective To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. Materials and Methods We searched the Pubmed database between 1998 and 2019 using the following key words: "penile fracture", "fracture of penis", "trauma to penis", "rupture of corpora cavernosa", "urethral injury", "urethral rupture" and "urethral reconstruction". Results The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. Conclusion PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is mandatory and produces satisfactory results with low levels of complications.

Urethral injury in penile fracture: a narrative review.

OBJECTIVE: To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. MATERIALS AND METHODS: We searched the Pubmed database between 1998 and 2019 using the following key words: "penile fracture", "fracture of penis", "trauma to penis", "rupture of corpora cavernosa", "urethral injury", "urethral rupture" and "urethral reconstruction". RESULTS: The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. CONCLUSION: PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is man-datory and produces satisfactory results with low levels of complications.

Can the snapping sound discriminate true from false penile fractures? Bayesian analysis of a case series of consecutively treated penile fracture patients.

Some patients with clinically diagnosed penile fracture actually have a false fracture (no tunica albuginea tear found at surgery). Although previous reports indicate that these patients often do not report hearing a snapping sound (henceforth sound) at injury, there are no studies of the sound's role in this differential diagnosis. To assess if the sound's absence increased the likelihood of intraoperatively diagnosing a false fracture, we retrospectively analyzed 65 consecutive clinically diagnosed penile fracture patients between January 2008 and December 2017, using surgical diagnosis of penile fracture as outcome variable and sound as main predictor, including as covariates age, presentation delay, immediate detumescence after injury, and whether injury occurred during sexual intercourse. Fifty-six patients had penile fracture (86.2%), and most (40, 71.4%) reported the sound, whereas two of the nine patients with false fracture reported the sound (22.2%, p = 0.007, Fisher's exact test). Bayesian logistic regression revealed that the sound was associated with surgical diagnosis of penile fracture (relative odds ratio = 4.25), and the probability of penile fracture fell from 92 to 74% when the sound was not reported among patients injured during intercourse experiencing immediate detumescence. This study followed PROCESS (Preferred Reporting of Case Series in Surgery) guidelines.

Chronic alcoholism associated with diabetes induced apoptosis in the corpus cavernosum of rats

Purpose To evaluate the effects of alcohol exposure and diabetes on apoptotic process in the corpus cavernosum. Methods Forty eight male Wistar rats were divided into four groups: control, diabetic, alcoholic and diabetic-alcoholic. Samples of the corpus cavernosum were prepared to study protein expression of apoptotic genes (Caspases-3 and 9) by immunohistochemistry and Real-Time PCR. Results The immunoreactivity of Caspases-3 and -9 was diffuse and higher in the treated groups though there was no significant difference between the experimental groups, only when compared with the control group. An increase was observed in the gene expression of Caspases-9 in the diabetic and ethanol-diabetic groups when compared with control and ethanol groups. Conclusions The association of these factors (ethanol and diabetes) probably can affect the apoptosis mechanism in lesions of the cavernous tissue in the rat penis. Both gene and protein expression of Caspase-9 in diabetic and ethanol-diabetic groups suggest the involvement of the apoptosis cascade from this study model.(AU)

Effects of tadalafil to prevent injury on corpus cavernosum after vascular or nervous peri-prostatic bundle injury. Experimental model in rats

Purpose:To evaluate the effects of tadalafil (TD) in preventing histological alterations of the corpus cavernosum caused by isolated lesions of cavernous nerve (ILCN) and artery (ILCA) in rats.Methods:Fifty male Wistar rats were randomly assigned in five groups: G1: control; G2: bilateral ILCN; G3: bilateral ILCA; G4: ILCN+TD; G5: ILCA+TD. The cavernous bodies were submitted to histomorphometry, immunohistochemistry and biochemical analysis.Results:Nerve density was significantly higher in G2 and G4 compared to control (22.62±2.84 and 19.53±3.47 vs. 15.72±1.82; respectively, p<0.05). Smooth muscle density was significantly lower in G2 and G3 in comparison to G1 (12.87±1.90 and 18.93±1.51 vs. 21.78±1.81, respectively; p<0.05). A significant decrease in the sinusoidal lumen area was observed in G2 compared to controls (5.01±1.62 vs. 9.88±3.66, respectively; p<0.05) and the blood vessel density was increased in G2 and G3 (29.32±4.13 e 20.80±2.47 vs. 10.13±2.71, p<0.05). Collagen density was higher in G3 compared to G1 (93.76±15.81 vs. 64.59±19.25; p<0.05).Conclusions:Histomorphometric alterations caused by ILCN were more intense than those produced by vascular injury, but the collagen analyses showed more fibrosis in animals with ILCA. TD was effective in preventing the majority of the alterations induced by the periprostatic bundle injury.(AU)

Perfil clínico de pacientes com Síndrome de Fournier em um hospital terciário / Clinical profile of patients with Fournier's Syndrome in a tertiary hospital

INTRODUÇÃO: A Síndrome de Fournier consiste em uma fasciite necrosante que afeta tecido subcutâneo e pele do períneo e genitais externos. Caracterizada como uma urgência cirúrgica, seu tratamento é baseado em três pilares: debridamento de tecidos necróticos e infectados; controle sistêmico e antibioticoterapia; e reparação dos tecidos afetados. OBJETIVO: Identificar o perfil clínico de pacientes diagnosticados com Síndrome de Fournier em um hospital de urgências. MÉTODOS: Trata-se de um estudo descritivo, retrospectivo e de abordagem quantitativa. A amostra consistiu de pacientes diagnosticados com Síndrome de Fournier acompanhados pela comissão de curativos do hospital no período de agosto de 2016 a agosto de 2017, que receberam alta ou foram a óbito. RESULTADOS: A amostra do estudo foi composta por 14 pacientes, sendo em sua totalidade pacientes do sexo masculino, entre 21 e 82 anos e idade média de 55 anos. Em 50% dos casos, foi necessário internação em Unidade de Terapia Intensiva (UTI). Quanto ao desfecho, 78,6% (11) receberam alta hospitalar e 21,4% (3) evoluíram para óbito. CONCLUSÃO: A assistência a pacientes com Síndrome de Fournier ocorre de forma despadronizada, o que ocasiona altas taxas de mortalidade. A elaboração de protocolos específicos é necessária.

INTRODUCTION: Fournier's Syndrome consists of a necrotizing fasciitis that affects subcutaneous tissue and skin of the perineum and external genitalia. Characterized as a urological urgency, its treatment is based on three pillars: debridement of necrotic and infected tissues; systemic control and antibiotic therapy; and repair of the affected tissues. OBJECTIVE: To identify the clinical profile of patients diagnosed with Fournier's Syndrome in an emergency hospital. METHODS: This is a descriptive, retrospective and quantitative study. The sample consisted of patients diagnosed with Fournier's Syndrome and attended by the hospital curative committee from August 2016 to August 2017, who were discharged or died. RESULTS: The study sample consisted of 14 medical records, all of them were male, aged between 21 and 82 years and mean age of 55 years. In 50% of the cases admittance to the Intensive Care Unit (ICU) was necessary. Regarding the outcome, 78.6% (11) were discharged from hospital and 21.4% (3) died. CONCLUSION: Assistance to patients with Fournier Syndrome is poorly standardized, resulting in high mortality rates. Development of specific protocols is necessary.

Treatment options and outcomes of penile constriction devices

ABSTRACT Purpose: To study the effect of penile constriction devices used on a large series of patients who presented at our emergency facility. We explored treatment options to prevent a wide range of vascular and mechanical injuries occurring due to penile entrapment. Materials and Methods: Between January 2001 and March 2016, 26 patients with penile entrapment were admitted to our facility and prospectively evaluated. Results: The time that elapsed from penile constrictor application to hospital admission varied from 10 hours to 6 weeks (mean: 22.8 hours). Non-metallic devices were used by 18 patients (66.6%) while the other nine (33.4%) had used metallic objects. Acute urinary retention was present in six (23%) patients, of whom four (66.6%) underwent percutaneous surgical cystotomy and two (33.4%) underwent simple bladder catheterization. The main reason for penile constrictor placement was erectile dysfunction, accounting for 15 (55.5%) cases. Autoerotic intention, psychiatric disorders, and sexual violence were responsible in five (18.5%), five (18.5%), and two (7.4%) cases, respectively. The mean hospital stay was 18 hours (range, 6 hours to 3 weeks). Conclusion: Penile strangulation treatment must be immediate through the extraction of the foreign body, avoiding vascular impairments that can lead to serious complications. Most patients present with low-grade injuries and use penile constrictors due to erectile dysfunction. Removal of constrictor device can be challenging. The use of specific tools for achieving penile release from constrictors is a fast, safe and effective method. Patients with urinary retention may require urinary diversion.

Treatment Options and Outcomes of Penile Constriction Devices.

PURPOSE: To study the effect of penile constriction devices used on a large series of patients who presented at our emergency facility. We explored treatment options to prevent a wide range of vascular and mechanical injuries occurring due to penile entrapment. MATERIALS AND METHODS: Between January 2001 and March 2016, 26 patients with penile entrapment were admitted to our facility and prospectively evaluated. RESULTS: The time that elapsed from penile constrictor application to hospital admission varied from 10 hours to 6 weeks (mean: 22.8 hours). Non-metallic devices were used by 18 patients (66.6%) while the other nine (33.4%) had used metallic objects. Acute urinary retention was present in six (23%) patients, of whom four (66.6%) underwent percutaneous surgical cystotomy and two (33.4%) underwent simple bladder catheterization. The main reason for penile constrictor placement was erectile dysfunction, accounting for 15 (55.5%) cases. Autoerotic intention, psychiatric disorders, and sexual violence were responsible in five (18.5%), five (18.5%), and two (7.4%) cases, respectively. The mean hospital stay was 18 hours (range, 6 hours to 3 weeks). CONCLUSION: Penile strangulation treatment must be immediate through the extraction of the foreign body, avoiding vascular impairments that can lead to serious complications. Most patients present with low-grade injuries and use penile constrictors due to erectile dysfunction. Removal of constrictor device can be challenging. The use of specific tools for achieving penile release from constrictors is a fast, safe and effective method. Patients with urinary retention may require urinary diversion.

[Rotura inusual de cuerpo cavernoso: resultados del manejo quirúrgico oportuno]. / Unusual cavernous body break: results of timely surgical management.

BACKGROUND: The rupture of the cavernous body (faux pas du coit) refers to the solution of continuity in its surrounding tunica albuginea. It occurs in one of 175,000 hospital admissions, accounting for 58% of penile lesions. When the erect penis flexes abnormally, the abrupt increase in intracavernous pressure exceeds the tensile strength of the tunica albuginea and often determines transverse laceration of the proximal body of the penis. CLINICAL CASE: A 29-year-old male patient presented to the emergency department for an 8-h course of evolution characterized by detumescence, lateral deviation, violet coloration and penile pain, following the introduction of the erect penis into his underwear. The patient was taken as soon as possible to surgical exploration and a 1 × 1 cm continuity solution was repaired in the right corpus cavernosum. CONCLUSION: The fracture of the penis is a rare disease and a urological emergency. Immediate repair of the rupture of the penis has a low complication rate, shorter hospital stay and better long-term results.

ANTECEDENTES: La rotura del cuerpo cavernoso (faux pas du coit) se refiere a la solución de continuidad en su túnica albugínea circundante. Se presenta en una de 175,000 admisiones hospitalarias, representando el 58% de las lesiones peneanas. Cuando el pene erecto se dobla anormalmente, el incremento abrupto de la presión intracavernosa excede la fuerza tensional de la túnica albugínea y determina a menudo la laceración transversal del cuerpo proximal del pene. CASO CLÍNICO: Paciente masculino de 29 años de edad que se presentó al servicio de urgencias por un padecimiento de 8 horas de evolución caracterizado por detumescencia, desviación lateral, coloración violácea y dolor peneanos, posterior a la introducción del pene erecto en su ropa interior. Se llevó al paciente lo antes posible a exploración quirúrgica y se realizó reparación de una solución de continuidad de 1 × 1 cm en el cuerpo cavernoso derecho. CONCLUSIÓN: La fractura del pene es una patología poco frecuente y una emergencia urológica. La reparación inmediata de la rotura del pene tiene una baja tasa de complicaciones, menor estancia hospitalaria y mejores resultados a largo plazo.

Impact of Surgical Treatment of Penile Fracture on Sexual Function.

OBJECTIVE: To conduct a comprehensive assessment of sexual function of patients undergoing surgical treatment of penile fracture (PF), covering psychological aspects related to trauma. METHODS: Patients undergoing surgical treatment of PF from January 2014 to August 2017 were followed-up in our department for at least 6 months. The patients underwent a detailed clinical follow-up, including physical examination and were interviewed about any evidence of erectile dysfunction, penile nodules, or curvature acquired after surgery, besides psychological sexual problems. RESULTS: A total of 58 patients conducted the follow-up. The mean age was 38.5 years (range: 18-66 years). Eight (13.7%) patients complained of penile curvature after surgery. Postoperative erectile function was recovered after 6 months in 50 (86.2%) cases. After the last evaluation at 18 months, only 1 patient developed persistent erectile dysfunction (ED) and color duplex Doppler ultrasound excluded a vascular etiology. Psycho-sexual evaluations showed that 45 (77.5%) patients feared a new episode of PF. Changes in sexual habits, such as avoiding vigorous sexual intercourse, was reported by 40 (68.9%) patients. Finally, patients with performance anxiety and those who reported a negative impact on sexual life were more susceptible to the development of ED (P = .0337 and P = .0418, respectively). CONCLUSION: Sexual complications after surgical treatment of PF are unusual but may occur in the late postoperative period and should be treated. Psychological sequela is very common, causing fear of recurrence and psychogenic ED, resulting in negative impact on the sexual life of these patients, which should be monitored closely.

CT-guided minimally-invasive penile fracture repair

ABSTRACT We present the case of a 28 year old patient with an incomplete tear of the tunica albuginea occurred after having sexual intercourse in the female superior position. The diagnostic assessment was performed first clinically, then with CT, owing to its high resolution, allowed to exactly detect the tear location leading to precise preoperative planning. After adequate diagnosis through imaging and proper planning, the patient was performed a selective minimally invasive surgical approach to repair the lesion. The patient had good erection with no angular deformity or plaque formation after a 3-month follow-up.

CT-guided minimally-invasive penile fracture repair.

We present the case of a 28 year old patient with an incomplete tear of the tunica albuginea occurred after having sexual intercourse in the female superior position. The diagnostic assessment was performed first clinically, then with CT, owing to its high resolution, allowed to exactly detect the tear location leading to precise preoperative planning. After adequate diagnosis through imaging and proper planning, the patient was performed a selective minimally invasive surgical approach to repair the lesion. The patient had good erection with no angular deformity or plaque formation after a 3-month follow-up.

Penile refracture: a preliminary report

ABSTRACT Objective: To report our institutional experience with penile refracture, including demographic data, recurrence time, etiology and operative findings in the first and second episodes. Materials and methods: Between January 1982 and September 2017, 281 patients underwent surgical treatment for penile fracture (PF) at our institution. Demographic data, clinical presentation, besides operative findings and follow-up of patients with relapsed PF were retrospectively assessed by reviewing medical records. Results: Of a total of 281 cases of PF operated at our institution, 3 (1.06%) patients experienced two episodes of trauma. Age ranged from 38 - 40 years (mean: 39.3). The recurrence time varied from 45 to 1560 days (mean: 705). Two patients presented the new fracture episode at the same site of the previous lesion, while in the other case the lesion was observed at another site. Conclusion: Recurrent FP is an extremely rare entity. The risk factors for its occurrence are still unknown. Although the lesion of the corpus cavernosum ipsilateral to the scar tissue of the prior FP is more common, contralateral rupture may be present. Nevertheless, prospective studies with larger samples should be conducted.

Sexual complications of penile frature in men who have sex with men

ABSTRACT Objectives: Evaluate the demographic data, etiology, operative findings and results of surgical treatment of penile fracture (PF) in men who have sex with men(MSM) with emphasis on sexual complications. Materials and Methods: We studied 216 patients underwent surgical correction of PF at our hospital. Patients self-identified as MSM were followed for at least 6 months. Demographic data, presentation, operative findings, International Index of Erection Function - 5 (IIEF-5) and the Premature Ejaculation Diagnostic Tool. Results: Of 216 PF cases, 4 (1.8%) were MSM. All cases resulted from sexual activity and all patients reported using the "doggy style" position during anal intercourse. Unilateral or bilateral injury of corpus cavernosum was found in 2 patients each. One (25%) patient had complete urethral injury associated with bilateral corpus cavernosum lesion. During the follow-up period, all patients developed some type of sexual complication. One patient reported penile pain during intercourse. Another patient experienced low sexual desire and premature ejaculation. This patient was also dissatisfied with the aesthetic result of the surgical scar and complained about decreased penis size after surgery. The third case developed delayed ejaculation. The fourth patient experienced mild to moderate erectile dysfunction. This same patient presented with penile curvature. Finally, palpable fibrotic nodules in the operative area were observed in all cases. Conclusions: Sexual activity in the "doggy style" position was the commonest cause of PF in MSM. Sexual dysfunction is always present in gay man after surgery for PF. However, additional studies with larger samples should be coinducted.