Plexiform Schwannoma of the Penis: A Rare Subtype of Genital Schwannoma.

Schwannomas are benign, encapsulated neurogenic tumors which present in diverse histological subtypes despite the limited variety of their cellular constituents. These include the cellular, ancient, cystic, epithelioid, melanotic, psammomatous, schwannoma with pseudoglandular elements, and plexiform varieties. The plexiform schwannoma (PS) represents 4.3% of all schwannomas. These lesions are commonly encountered in the head and neck region and are extremely rare in the penis. To the best of our knowledge only 34 cases of penile schwannomas have been reported and this is the 3rd case of plexiform penile schwannoma. A 39-year-old patient presented to our andrology outpatient clinic complaining for two painful penile nodules. The lesions were located on the dorsum of the penile shaft. His medical history was insignificant for penile trauma and sexual transmitted diseases. The masses measured 2x1 cm and 0.5x1 cm. After sonographic and magnetic resonance evaluation the patient was admitted to theatre and underwent topical resection of the lesions. Histopathology revealed plexiform schwannoma. Postoperatively, penile tenderness and hyperesthesia ensued which was managed with pregabalin administration and topical corticosteroids. Plexiform schwannomas are rare in the penile region. Surgical excision is inevitably the only way to diagnose and treat the lesions. They must be differentiated by a variety of malignant and benign clinical conditions. Topical excision suffices for oncological control and allows for acceptable functional outcomes.

Current role of local treatments for erectile dysfunction in the real-life setting.

PURPOSE OF REVIEW: Local treatments for erectile dysfunction include intraurethral alprostadil as well as topical alprostadil cream. They are alternative treatment options to oral or intracavernosal treatments that could overcome unmet needs in patient treatment. RECENT FINDINGS: Intraurethral and topical alprostadil are two local methods of delivering an erectogenic drug to the patient. They have an established efficacy and a safety profile without important systemic adverse events. Efficacy data show that they result in significantly improved erections sufficient for sexual intercourse compared with placebo. Comparative efficacy data to other treatments are very limited. There are no specific contraindications to other drugs. They can be offered to patients who do not tolerate or do not respond to oral treatment. They can be also combined to oral treatment as a salvage therapy before proceeding to intracavernosal injections. The major advantages of them are the patient-friendly modality of delivering and the presence of minor local adverse events that are self-limited and mild in nature. Priapism or prolonged erections are very rare with local treatments. SUMMARY: Local treatments can have an important role as a first-line treatment for erectile dysfunction or in drug combinations mainly because of their excellent safety profile.

Presence of a sexual problem may not affect women's satisfaction from their sexual function.

INTRODUCTION: It has been proposed that women's sexual problems/dysfunctions, in the absence of personal and interpersonal distress, may have little clinical importance, as they may not necessarily affect women's sexual satisfaction. However, data are missing to support such interpretation. AIM: The objective of the present study was to examine whether the presence of a sexual problem necessary affects women's satisfaction with sexual function. METHOD: The study included 164 women who visited a general hospital because of symptoms not related to their sexual function and were asked to complete voluntarily and anonymously demographic data and two questionnaires. MAIN OUTCOME MEASURES: Women completed the Female Sexual Function Index (FSFI)--an instrument which evaluates women sexual function--and the Symptom Checklist of Sexual Function-women version (SCSF-w), a screening tool of women's self-perception of sexual function. RESULTS: Mean patients' age was 43 +/- 12.6 (18-72) years. According to the FSFI, 48.8% of the participants had a sexual dysfunction. However, based on their self-perception of sexual function (SCSF), 80.5% of the sample declared to be satisfied with their sexual function, despite the fact that 69.5% of them reported at least one sexual problem. Of all women, only 26.2% would like to talk about their sexual problem(s) with a doctor (57.4% of those who are "bothered" by their sexual symptoms). Logistic regression analysis revealed no association between any sexual dysfunction and women's satisfaction from their sexual function. CONCLUSION: Despite the presence of sexual problem(s), women may be satisfied with their sexual function, but half of those who are bothered would like to talk about it with their doctor. The presence of a sexual problem or its severity is not a determinant of women's help-seeking behavior. Such data strongly support current definitions of women's sexual dysfunction, where the presence of personal distress has been included as a crucial dimension.

Removal of a detached head of the Brooks dilator from the corpora cavernosa during penile prosthesis implantation.

INTRODUCTION: Several complications during and after penile implantation have been reported. The most difficult part of the procedure seems to be the dilatation of the corpora, especially in fibrotic cases. AIM: To report a rare intraoperative complication during dilatation of the corpora and its management. METHODS: During dilation of the corpora cavernosa with Brooks dilators for the implantation of penile prosthesis, its head was detached and stuck at the tip of the corpus cavernosum. Several trials to remove the head of the dilator using different kinds of clamps were unsuccessful. Finally, an incision was performed to the distal lateral part of the corpora cavernosa and the head of the dilator was removed. Implantation was completed uneventfully. RESULTS: The patient instructed to inflate the prosthesis and use it for sexual intercourse after 6 weeks. Follow-up was 14 months and the patient is using properly the prosthesis. CONCLUSIONS: Although this is a very rare complication not previously described, we recommend examination of the dilators before use.

Moderate and severe erectile dysfunction equally affects life satisfaction.

PURPOSE: To explore the life satisfaction of patients with erectile dysfunction (ED) and to examine the relation between severity of ED and life satisfaction. MATERIALS AND METHODS: The study sample was recruited from patients who presented in an andrologic outpatient clinic complaining of ED. All patients underwent the basic clinical evaluation and were assessed by the International Index of Erectile Dysfunction (IIEF) and the Life Satisfaction Inventory (LSI). RESULTS: The study included 69 patients with ED (age range 22-71 years, mean 49.5, SD 13.7). The LSI appeared to have satisfactory internal consistency (Cronbach's alpha = 0.82). Men with ED had significantly lower satisfaction with their sexual life (t = -13.756, d.f. = 68, P = 0.000), but also significantly lower total score of satisfaction with their life (t = -2.793, d.f. = 68, P = 0.007) compared with available normative data from healthy population. However, when compared with controls, men with ED showed significantly higher satisfaction scores on their financial status (t = 5.075, d.f. = 68, P = 0.000) and on their leisure time activities (t = 4.029, d.f. = 68, P = 0.000). Regarding ED severity, mild ED affects patients' satisfaction with sexual life less than do moderate and severe ED. Interestingly, no difference was identified between moderate and severe ED groups. CONCLUSIONS: Men who seek help for ED have lower satisfaction with sexual life and lower satisfaction with their overall life compared with healthy people. Severity of ED seems to be an important factor, as men with moderate ED perceive the impact of ED on their life satisfaction equally with those with severe ED. ED patients gain more satisfaction from other domains of their life, provided they adopt coping behaviors that help compensate for their low overall life satisfaction. Furthermore, as ED patients do not differ from healthy people in their expressed subjective rating of quality of life (QoL), life satisfaction may be more sensitive than QoL assessment in the evaluation of the impact of ED on our patients' life.

Educating physicians to treat erectile dysfunction patients: development and evaluation of a course on communication and management strategies.

PURPOSE: To describe the development and assess the outcome of a workshop on erectile dysfunction (ED) management based on participating physicians evaluations. METHOD: The study involved physicians who attended a workshop offered throughout the country, during a 3-year period. The workshop included tutorials, video-based dramatizations, and role-play sessions. A pilot study investigated the workshop's impact on physicians' attitudes toward patient-centeredness and sexual behavior issues; Patient-Practitioner Orientation Scale (PPOS) and Cross Cultural Attitude Scale (CCAS) were administered before and after the course. New knowledge acquisition, quality of presentation, and workshop's usefulness in their clinical practice were the dimensions used for workshop's evaluation. Analysis used quantitative and qualitative methods. RESULTS: A total of 194 questionnaires were administered during the pilot study and the response rate was 53.6%. A shift in attitudes toward patient-centeredness and less judgmental attitude toward patients' sexual attitudes were revealed (total PPOS score and Sharing subscale: P < 0.05, CCAS: P < 0.001). Six hundred physicians were asked to evaluate the workshops and the response rate was 62.3%. The tutorial session for "medical treatment of ED" (P < 0.001) and the role-play on sexual history taking (P < 0.05) received higher evaluation scores. Qualitative analysis showed that the most frequently reported category referred to the appropriateness of role-play as a teaching and awareness-raising technique (31.25%); a need for changes in clinical practice and communication patterns was identified by 20% of the participants who stressed the necessity for multidisciplinary approach, as well as the adoption of a nonjudgmental attitude toward patients. CONCLUSION: Training courses on ED management, using a combination of tutorial and interactive sessions, constitute an effective way of providing knowledge, enhancing physicians' communication skills with ED patients, and influencing attitudes toward patient-centeredness in sexual issues. Such results strongly support the establishment of sexual medicine courses at continuing medical education curricula.