Clinical efficacy and safety of hyaluronic acid gel injection in the glans penis for treatment of premature ejaculation: systematic review and meta-analysis.

BACKGROUND: In recent years, there has been growing interest in the use of hyaluronic acid (HA) for the treatment of premature ejaculation (PE). The efficacy of this treatment is quite controversial. AIM: This study intended to evaluate the efficacy and safety of glans penis augmentation with HA gel for PE. METHODS: This systematic review includes randomized controlled trials (RCTs), primary clinical trials, prospective and retrospective studies, case series, and case reports. Searches in Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov were performed blindly by 2 reviewers. OUTCOMES: Intravaginal ejaculation latency time (IELT), questionnaires about PE, glans circumference (millimeters), and adverse events. RESULTS: Thirteen studies were included in the evaluation: 4 RCTs, 8 prospective observational studies, and 1 restrospective study. The number of patients who received HA gel on the glans penis was 706. According to the results of 2 placebo-controlled RCTs, HA gel treatment significantly improved IELT at the end of the first month (mean difference [MD], 65.44 seconds). In the first month after the HA gel injection procedure, IELT increased vs before the procedure (MD, 176.18 [95% CI, 146.89-205.48]; P < .001, I2 = 83%). When the IELT values ​​were compared at 6 months after HA gel application, IELT improved vs before the procedure (MD, 143.93 [95% CI, 124.78-163.09]; P < .001, I2 = 82). The glans circumference expanded by approximately 1.5 cm after the procedure (MD, 14.82 mm [95% CI, 12.75-16.90]; P < .001, I2 = 65%). When the side effect profile of other studies was examined, side effects were observed in 91 patients after HA gel injection applied to 598 patients (15.22%). Among these side effects, the most common were pain (n = 46, 7.69%), bulla/nodule formation (n = 25, 4.18%), and ecchymosis (n = 20, 3.34%). CONCLUSION: While HA shows promise as a therapeutic option for PE, ongoing research is essential to elucidate its clinical utility, mechanisms of action, and comparative efficacy.

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.

Comparing GPT-4 and Human Researchers in Health Care Data Analysis: Qualitative Description Study.

BACKGROUND: Large language models including GPT-4 (OpenAI) have opened new avenues in health care and qualitative research. Traditional qualitative methods are time-consuming and require expertise to capture nuance. Although large language models have demonstrated enhanced contextual understanding and inferencing compared with traditional natural language processing, their performance in qualitative analysis versus that of humans remains unexplored. OBJECTIVE: We evaluated the effectiveness of GPT-4 versus human researchers in qualitative analysis of interviews with patients with adult-acquired buried penis (AABP). METHODS: Qualitative data were obtained from semistructured interviews with 20 patients with AABP. Human analysis involved a structured 3-stage process-initial observations, line-by-line coding, and consensus discussions to refine themes. In contrast, artificial intelligence (AI) analysis with GPT-4 underwent two phases: (1) a naïve phase, where GPT-4 outputs were independently evaluated by a blinded reviewer to identify themes and subthemes and (2) a comparison phase, where AI-generated themes were compared with human-identified themes to assess agreement. We used a general qualitative description approach. RESULTS: The study population (N=20) comprised predominantly White (17/20, 85%), married (12/20, 60%), heterosexual (19/20, 95%) men, with a mean age of 58.8 years and BMI of 41.1 kg/m2. Human qualitative analysis identified "urinary issues" in 95% (19/20) and GPT-4 in 75% (15/20) of interviews, with the subtheme "spray or stream" noted in 60% (12/20) and 35% (7/20), respectively. "Sexual issues" were prominent (19/20, 95% humans vs 16/20, 80% GPT-4), although humans identified a wider range of subthemes, including "pain with sex or masturbation" (7/20, 35%) and "difficulty with sex or masturbation" (4/20, 20%). Both analyses similarly highlighted "mental health issues" (11/20, 55%, both), although humans coded "depression" more frequently (10/20, 50% humans vs 4/20, 20% GPT-4). Humans frequently cited "issues using public restrooms" (12/20, 60%) as impacting social life, whereas GPT-4 emphasized "struggles with romantic relationships" (9/20, 45%). "Hygiene issues" were consistently recognized (14/20, 70% humans vs 13/20, 65% GPT-4). Humans uniquely identified "contributing factors" as a theme in all interviews. There was moderate agreement between human and GPT-4 coding (κ=0.401). Reliability assessments of GPT-4's analyses showed consistent coding for themes including "body image struggles," "chronic pain" (10/10, 100%), and "depression" (9/10, 90%). Other themes like "motivation for surgery" and "weight challenges" were reliably coded (8/10, 80%), while less frequent themes were variably identified across multiple iterations. CONCLUSIONS: Large language models including GPT-4 can effectively identify key themes in analyzing qualitative health care data, showing moderate agreement with human analysis. While human analysis provided a richer diversity of subthemes, the consistency of AI suggests its use as a complementary tool in qualitative research. With AI rapidly advancing, future studies should iterate analyses and circumvent token limitations by segmenting data, furthering the breadth and depth of large language model-driven qualitative analyses.

Fixed Drug Eruption on the Penis Due to Trimethoprim-Sulfamethoxazole: A Case Report.

A fixed drug eruption (FDE) is a common dermatological drug side effect but can go unnoticed. It is characterized by an oval-circular erythematous patch, sometimes with itching and burning pain localized in many parts of the body, such as the face, lips, torso, limbs, and anogenital area. Its diagnosis is generally clinical, but it can be mistaken for other dermatological diseases seen in primary care, like balanitis, genital herpes, and lichen planus. It can be a diagnostic challenge for primary care physicians when it is not considered. We present a 26-year-old man who developed an FDE in the penis with intense itching and burning pain during his labor hours after 15 minutes of consuming an oral dose of trimethoprim-sulfamethoxazole for a gastrointestinal infection. The patient was treated with topical corticosteroids twice per day and educated to avoid the use of the antibiotic again. In the next few days, the symptoms fully resolved, and he developed post-inflammatory hyperpigmentation in the area. The primary management of an FDE is immediate discontinuation of the offending drug and use of topical corticosteroids to prevent possible generalized reactions and recurrence of lesions. Therefore, the primary care physician should consider this condition in his or her diagnosis when new dermatologic lesions occur after exposure to a new drug.

Comment to: "The Role of Suprapubic Fascial System Reconstruction During Repair of Adult-Acquired Buried Penis".

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Improvising on the Fly: Comparison of a Novel Technique for Emergent Zipper Release to a Well-Established Technique in a Simulated Setting.

BACKGROUND: Penile skin zipper entrapment is an emergent medical condition in which the penile skin, scrotal skin, or foreskin gets caught within the teeth of a zipper or the slider itself. This can lead to complications such as urethral involvement, skin loss, or tissue necrosis. We propose a novel technique to aid in the release of entrapped skin utilizing wire cutters directed at the inferior portion of the zipper pull. OBJECTIVES: To describe a novel technique to free entrapped penile skin and compare its performance to the well-established median bar technique in a simulated setting. METHODS: A randomized cross-over design was used to compare techniques on successful release, time to release and tissue injury using an animal model of raw chicken skin entrapped in a zipper. Statistical significance was assessed at p < 0.05. RESULTS: Twenty-two participants were included. There was no statistically significant difference between the novel technique and the median bar technique regarding successful release (100% vs 95.5%, respectively), median time to release (29.1 vs 26.4 seconds, respectively), or frequency of tissue injury (22.7% vs 27.3%). CONCLUSION: Performance using our novel technique for removal of penile skin from a zipper is similar to the median bar release technique regarding. Our novel technique may be a valid treatment option for the release of entrapped penile skin in a zipper mechanism in the emergency department setting.

First report of a neurofibrosarcoma in the penis of a bull.

Reproductive problems in cattle are frequent and have an important impact on production. In addition, inflammatory, traumatic and other diseases may be followed by the development of tumours, which are a cause of culling of breeding males. The main types of tumours diagnosed in the bull penis are fibropapilloma and squamous cell carcinoma. The aim of this study was to characterize a case of a tumour in the glans penis of a bull from a dairy farm in Santa Fe, Argentina. The neoplastic tissue was stained with haematoxylin and eosin and then analysed by immunohistochemistry to reveal its characteristic phenotype. Results showed positivity to vimentin, neuron specific enolase, proliferating cell nuclear antigen, S100 and glial fibrillary acidic protein. This suggested that the tumour was a neoplasm of neural origin, classified as neurofibrosarcoma, a peripheral nerve sheath tumour, here reported in the penis of a bull for the first time.

Comparing Penile Problems in Circumcised vs. Uncircumcised Boys: Insights From a Large Commercial Claims Database With a Focus on Provider Type Performing Circumcision.

OBJECTIVES: To compare penile problems in circumcised relative to uncircumcised boys, and to determine which providers performing the circumcision have fewer post-circumcision problems. METHODS: CPT codes in the 2011-2020 MarketScan database were used to identify boys who had a circumcision. Uncircumcised control subjects of the same age, state of residence, and insurance type were selected. The primary outcome was a penile problem, defined as penis-specific infection, inflammation, and urethral stricture/stenosis, among others. The secondary outcomes were procedure-related complications limited to 28 days after circumcision, and whether post-circumcision problems varied by the clinician performing the procedure. ICD-9/10 diagnostic codes were used to identify these problems. RESULTS: We identified ∼850,000 cases and ∼850,000 matched controls. Overall, the rate of penile problems within the first five years of life was 1.7% in circumcised boys versus 0.5% in uncircumcised boys (p < 0.05). Multivariable regression models showed that the risk of penile problems was 2.9-fold higher among circumcised compared to uncircumcised males (95%CI [2.8-3], p < 0.001). Compared to males circumcised by pediatricians, those circumcised by surgeons had 2.1-fold higher penile problems in the year after circumcision (95% CI [2-2.3], p < 0.001). Procedure-related complications within 28 days of circumcision were infrequent (0.5%), with the most common being penile edema (0.2%). CONCLUSIONS: Penile problems are very infrequent in boys in the first five years of life. However, when they occur, they are 3x more likely to occur in circumcised boys relative to uncircumcised boys. Penile problems are more likely to occur in boys circumcised by surgeons. LEVELS OF EVIDENCE: Level II. TYPE OF STUDY: Prognosis study.

Technical nuances of the concealed penis repair.

Circumcision is commonly performed but anatomic variants occur and can affect outcomes if not addressed properly. The combination of concealed penis and penoscrotal webbing is fairly common and presents across a spectrum of severity. If not repaired, this can result in a buried penis that can cause penile adhesions, wound healing concerns, and make the penis appear shorter secondary to a retracted position. We present our technique that is reproducible and highly successful in addressing both of these concerns. The paraphimotic band approach is performed more commonly and is able to reliably correct webbing and concealment without an incision at the penoscrotal junction. When more severe defect is present, a Y shaped incision is made at the penoscrotal junction to mobilize skin flaps to correct the deficit. In our cohort of 885 patients, 736 were corrected using the paraphimotic band technique while 149 underwent a complex scrotoplasty. None of the patients required a secondary surgery for complications.

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.

Superficial circumflex iliac artery perforator propeller flap for penoscrotal extramammary Paget's disease.

BACKGROUND: Extramammary Paget's disease (EMPD) is a rare intra-epidermal adenocarcinoma, and reconstruction of the penoscrotal region remains a clinical challenge. The superficial circumflex iliac artery perforator (SCIP) flap has been successfully used as a free flap, while its application as a propeller flap in the reconstruction of penoscrotal EMPD defect is rarely reported. The objective was to evaluate the safety and efficacy of the SCIP propeller flap in the reconstruction of penoscrotal defects in EMPD. METHODS: Between September 2010 and August 2022, consecutive patients diagnosed with penoscrotal EMPD were enrolled. All patients underwent penoscrotal EMPD excision and reconstruction with SCIP propeller flap combined with other flaps or skin grafts on individual defects. Demographic information, surgical parameters, postoperative complications, patient satisfaction, and recurrence rates were analyzed. RESULTS: Twenty-four patients (mean age, 73 ± 8.8 years; mean BMI, 23.98 ± 3.62 kg/m2) with 33 SCIP propeller flaps (mean size 120.1 cm2; range, 24-208 cm2) were included, and the mean defect size was 67.4 cm2 (range, 12-255 cm2). The mean operative duration was 385.4 ± 146.8 min. Fifteen patients received autologous full-thickness skin grafts, and four received other flaps simultaneously. All flaps survived without total or partial loss, and all donor sites achieved primary closure, though local hematoma (one case) and limited skin graft necrosis (two cases) were observed. All patients experienced complete wound healing and maintained penoscrotal morphology and function without recurrent lesions over a mean follow-up of 59 months. CONCLUSIONS: The SCIP propeller flap seems a safe and effective reconstructive method for penoscrotal EMPD. LEVEL OF EVIDENCE: IV.

Traumatic Penile Injury: An Analysis of the Patient Age with Aetiological Type and Injury Severity in a Single Centre.

BACKGROUND: Penile trauma is associated with debilitating complications. Apart from its sparse literature, contextually relevant evidence on aetiology and standardized severity grading, and its stratification by legal age are needed. This study aimed to describe the frequency, aetiology and injury severity grade of patients, and explore the association of specific factors by legal age. SUBJECTS, MATERIALS AND METHODS: A single-centre retrospective cross-sectional study was conducted in our centre. Male patients with penile trauma managed by urologists were included. Data on age, year of presentation, aetiology, penile injury extent and co-existing genitourethral injuries were obtained. Descriptive and inferential statistics were undertaken using SPSS and MedCalc. Pvalue < 0.05 was considered significant. RESULTS: Forty-two patient records were analyzed. The median age and interquartile range for legal minors and legal adults were 9.5 (5.0-14.8) years and 31.0 (22.5-41.0) years, and they constituted 28.6% (n=12) and 71.4% (n=30) of the study population respectively. Penile trauma was isolated in 26.2% (n=11) of the total population.Its annual frequency was below the median volume between 2001 and 2008 but shifted to a rate above the average level between 2017 and 2021. The rate of conveyor belt-related aetiology and high-grade trauma was 41.7% and 75.0% in legal minors while it was 26.1% and 53.3% respectively in legal adults. CONCLUSIONS: Grade IV trauma was the most predominant while conveyor belt injury was the most common cause of the injury. Albeit limitations of statistical comparison, the rate of conveyor belt injury and high-grade trauma was numerically high in legal minors.

CONTEXTE: Les traumatismes du pénis sont associés à des complications débilitantes. Outre la rareté de la littérature, des preuves contextuel l ement per tinentes sur l ' étiol ogie et l a classification standardisée de la gravité, ainsi que leur stratification par âge légal, sont nécessaires. Cette étude visait à décrire la fréquence, l'étiologie et le degré de gravité des blessures des patients, et à explorer l'association de facteurs spécifiques par âge légal. SUJETS, MATÉRIELS ET MÉTHODES: Une étude rétrospective transversale monocentrique a été réalisée dans notre centre. Les patients masculins ayant subi un traumatisme pénien pris en charge par des urologues ont été inclus. Les données sur l'âge, l'année de présentation, l'étiologie, l'étendue de la blessure pénienne et les blessures génito-urétrales coexistantes ont été obtenues. Des statistiques descriptives et inférentielles ont été réalisées à l'aide de SPSS et MedCalc. Une valeur de p < 0,05 a été considérée comme significative. RÉSULTATS: Quarante-deux dossiers de patients ont été analysés. L'âge médian et l'intervalle interquartile pour les mineurs légaux et les adultes légaux étaient de 9,5 (5,0-14,8) ans et 31,0 (22,5-41,0) ans, représentant respectivement 28,6 % (n=12) et 71,4 % (n=30) de la population étudiée. Le traumatisme pénien était isolé chez 26,2 % (n=11) de la population totale. Sa fréquence annuelle était inférieure au volume médian entre 2001 et 2008, mais a dépassé le niveau moyen entre 2017 et 2021. Le taux d'étiologie liée aux tapis roulants et de traumatismes graves était de 41,7 % et 75,0 % chez les mineurs légaux, contre 26,1 % et 53,3 % respectivement chez les adultes légaux. CONCLUSIONS: Le traumatisme de grade IV était le plus prédominant, tandis que les blessures causées par les tapis roulants étaient la cause la plus courante de lésion. Bien que limitées par des comparaisons statistiques, les taux de blessures par tapis roulant et de traumatismes graves étaient numériquement élevés chez les mineurs légaux. MOTS-CLÉS: Facteurs d'âge, Étiologie, Score de gravité des blessures, Pénis.

Peno-scrotal metastasis of colorectal adenocarcinoma: A case report and review of the literature.

INTRODUCTION: Colorectal cancer is the second most common cause of death worldwide and may present as metastatic disease involving the liver, lungs and bones, and pelvic organs. Penile and scrotal metastasis may occur secondary to primary tumors originating from the genito-urinary tract. CASE PRESENTATION: We present a case of rectal adenocarcinoma metastatic to the penis and scrotum s/p chemotherapy and radiotherapy. His metastatic involvement was complicated by infections, necrosis and growth of maggots. Patient underwent wide excision and debridement of the metastatic deposits in the pubic, penile, scrotal and perineal region in addition to split-tissue skin graft from the right anterior thigh to cover the pubic region, the remainder of the penile shaft, and the scrotum. CLINICAL DISCUSSION: Peno-scrotal metastasis secondary to rectal adenocarcinoma is a rare condition. It may present as malignant priapism, hematuria, obstructive urinary symptoms occurring when there is urethral involvement. The mechanism of metastasis may be due to retrograde venous flow from the vesical, pudendal, hemorrhoidal plexuses, and the prostatic venous plexus draining the cavernosal veins of the penis. Additionally, lymphatic involvement and spread may play an important role in the spread of the disease. Treatment of such conditions relies on chemotherapy and radiotherapy and surgery for local control and symptomatic treatment. CONCLUSION: This article describes the rare occurrence of peno-scrotal metastasis of rectal adenocarcinoma and provides an overview on diagnosis, etiology, and management of the disease.

The impact of male genital self-image on depression, anxiety and sexual functions.

AIM: This study aims to examine the relationship between male genital self-perception and sexual functioning and depression anxieties. METHOD: The study included male patients who were referred to the andrology outpatient clinic between March 2022 and June 2022. Demographic data of the patients were recorded. Cigarette and alcohol consumption was also noted. The Male Genital Self Image Scale (MGSIS) questionnaire was used for the Genital Self Image(GSI) assessment, which consists of 7 questions. The International Index of Erectile Function (IIEF), composed of 15 questions, was used to evaluate sexual function. STAI-I, STAI-II, and BECK scales were used for depression and anxiety. The penis size of the patients was measured in a flask and stretched condition, and the midpenile circumference was recorded. Patients were compared with respect to GSI, depression, anxiety, and sexual functioning. RESULTS: A total of 75 patients were included in the study. The mean age of the patients was 46.69 ± 11.32 (26-72), and the mean BMI was 27.82 ± 3.79 (22.46-40.40) kg/m2. A slightly positive correlation was found between the patients' flask penis size and MGSIS-total scores (r = 0.260, p = .024) and IIEF-SF scores (r = 0.240, p = .038). There was a moderately positive correlation between the stretched penis size and IIEF-OS (r = 0.403, p < .001) and IIEF-SF (r = 0.354, p = .002). While the MGSIS-total score and the STAI-I and STAI-II scores had a moderate negative correlation, there was an advanced negative correlation between the MGSIS-total score and the BECK score. CONCLUSION: Disruption of men's genital self-perception is moderately related to their susceptibility to depression and anxiety. This situation affects the person's sexual performance and causes orgasm problems to increase.

A low androgenic state inhibits erectile function by suppressing endothelial glycosides in the penile cavernous tissue of rats.

Background: The endothelial glycocalyx is an important barrier that protects the structure and function of endothelial cells. Androgen deficiency is a common factor that causes structural and functional impairment of endothelial cells. Aim: To investigate changes in the endothelial glycocalyx in the penile corpus cavernosum of the rat with low androgen status and its relationship with erection function. Methods: Eighteen 10-week-old Sprague-Dawley male rats were randomly divided into 3 groups (n = 6 each): sham operation, castration, and castration + testosterone replacement. The maximum intracavernosal pressure/mean arterial pressure of the penis was measured after modeling for 4 weeks. The expression levels of endothelial nitric oxide synthase (eNOS), phospho-eNOS, syndecan 1, heparanase, and nitric oxide in penile cavernous tissue and the serum levels of heparan sulfate, hyaluronic acid, tumor necrosis factor α, and interleukin 6 were determined. Transmission electron microscopy was used to observe the ultrastructure of the endothelial glycocalyx in penile tissue. Outcomes: The thickness of the endothelial glycocalyx in the penile corpus cavernosum of castrated rats was significantly lower than that of the control group. Results: In the castrated rats, the endothelial glycocalyx thickness, syndecan 1 level, ratio of phospho-eNOS to eNOS, nitric oxide level, and maximum intracavernosal pressure/mean arterial pressure (3 V, 5 V) were significantly lower than those in the sham group (P < .05). The expression of heparanase and the serum levels of tumor necrosis factor α and interleukin 6 were significantly higher in the castrated group than in the sham group (P < .05). Clinical Translation: Upregulating the expression of the endothelial glycocalyx in the penile corpus cavernosum may be a new method for treating erectile dysfunction caused by low androgen levels. Strengths and Limitations: This study confirms that low androgen status promotes the breakdown of the endothelial glycocalyx. However, further research is needed to determine whether androgens are related to the synthesis of the endothelial glycocalyx. Conclusion: Low androgen status may suppress the level of nitric oxide in the cavernous tissue of the penis via impairment of the endothelial glycocalyx, resulting in inhibited erection function in rats.

The Role of Suprapubic Superficial Fascial System Reconstruction During Repair of Adult-Acquired Buried Penis.

BACKGROUND: Adult-Acquired Buried Penis is a disorder associated with systemic obesity that confers increased risks of malignancy, sexual dysfunction, urinary abnormalities, and psychological distress. Surgical correction improves patient-reported functional and psychological outcomes and often requires collaboration between plastic and urologic surgeons. To improve postoperative cosmetic outcomes and decrease wound complications following adult-acquired buried penis repair, we performed an anatomic and histologic study of the superficial fascial layers providing support to the external male genitalia and describe our approach for fascial reconstruction. METHODS: We characterized the superficial fascial anatomy in three patients undergoing adult-acquired buried penis repair, including two patients with Wisconsin Type II disease and one patient with Wisconsin Type IV disease. Gross specimens were sent from two patients histologic analysis using H&E and elastin-specific stains to characterize the identity of the superficial fibrofatty tissue. RESULTS: In all three patients, the fundiform ligament overlying the suspensory ligament was identified, isolated, and transected for removal with the suprapubic specimen. We found that reapproximation of this ligament following transection at the time of escutcheonectomy provided significant lift to the penis and genitals via improved support of dartos fascia. Histologic analysis of the superficial fibrofatty tissue located beneath the dermis revealed histologic similarities with the superficial fascial system described previously in abdominal and breast tissue. CONCLUSIONS: Reapproximation of the fundiform ligament and superficial fascial tissue following suprapubic/lower abdominal fat pad removal during adult-acquired buried penis may improve postoperative cosmesis by reducing strain on the dermal closure. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

High-risk human papilloma virus status & outcomes for penile squamous cell carcinoma: A single institution experience.

OBJECTIVES: There is a paucity of data on North American cohorts of patients with penile squamous cell carcinoma (pSCC). Herein, we aimed to assess the sensitivity of various modalities to identify human papillomavirus (HPV) status, determine the prevalence of high-risk HPV-positivity, and evaluate the prognostic impact of relevant clinicopathologic variables. METHODS: Patients with pSCC (n = 121) consecutively treated with partial/total penectomy (2000-2022) at a single institution were included. HPV status (based on immunohistochemistry [IHC], in situ hybridization [ISH], and panviral metagenomic sequencing [PMS]), histologic features, and outcomes were reviewed. Outcome events included death due to disease and progression. RESULTS: The majority of patients were white (105/121, 86.8%). Thirty-seven (30.6%) were high-risk HPV-positive, and morphologic evaluation had a sensitivity of 97.3% (95% confidence interval [CI], 86.2-99.5) for predicting high-risk HPV status compared to IHC/ISH/PMS. Disease progression was more common among high-risk HPV-negative compared to high-risk HPV-positive patients (HR 2.74, CI 1.12-8.23, P = 0.03). Moreover, among high-risk HPV-negative patients, those with moderate-poorly differentiated tumors had increased disease-specific mortality (32.6%, CI 17.1-48.1) compared to those with well-differentiated tumors (0%). Among high-risk HPV-positive patients, those with basaloid morphology had lower disease-specific mortality (0% vs 14.4%, CI 0.0-33.1). CONCLUSIONS: We demonstrate high-risk HPV-positivity in approximately one-third of patients with pSCC. Morphologic evaluation alone had a high sensitivity in correctly determining HPV status. Our results suggest that high-risk HPV status and morphologic features (differentiation in high-risk HPV-negative, and basaloid subtype in high-risk HPV-positive pSCC) may have prognostic value.

The gross reproductive morphology of the male Temminck's pangolin Smutsia temminckii (Smuts, 1832).

The Temminck's pangolin (Smutsia temminckii) is one of eight pangolin species worldwide and the only pangolin present in southern Africa. Historically, pangolins have not been able to reproduce successfully in captivity and this may be in part due to the lack of knowledge and understanding with regards to the pangolin reproductive system (anatomy, physiology, biology) in all eight species. This original study describes the gross anatomy of the male Temminck's pangolin from three adult individuals investigated. The male Temminck's pangolin presented a short, conical penis with ascrotal (internal) testes, similar to many other myrmecophagous mammals such as the aardvark (Orycteropus sp.) and anteaters (suborder: Vermilingua). However, the orientation of the penis of the Temminck's pangolin differed in that it was oriented cranioventrally, in contrast to the caudal orientation of the giant anteater. The testes were found to be bilaterally flattened with an elongate oval shape, similar to the aardvark. The specific characteristics of the reproductive tract of the male Temminck's pangolins are thought to be adaptations to their peculiar lifestyle as the male portrays characteristics that indicate adaptation to a lower basal metabolic rate and body temperature as well as to their defensive mechanism of rolling up into a ball. Our study suggests the male Temminck's pangolin reproductive anatomy is most similar and comparable to the Xenarthrans and the aardvark that display the same fossorial activities as pangolins, and the male morphology is not comparable to the phylogenetically closely-related Carnivora.

The co-design and acceptability of a genital body image educational video for people with a penis.

Within body image research, genital body image has not received significant attention. This project aimed to explore how positive genital body image could be fostered among people with a penis by co-designing and developing an educational resource. Participants were 22 people in Australia who identified as having a penis and were involved in three phases of co-design focus groups. Thematic and content analyses were used to generate themes across the data with each phase informing the next, culminating in a prototype resource being shown to participants in the final phase. Amongst the predominantly cisgender men sample, there was consensus that a brief, animated, educational video could have potential in promoting a positive genital body image in people with a penis. For video content, participants were not supportive of challenging societal messaging around penis size that "bigger is better". Instead, participants supported the inclusion of information about the range of penile functions, promoting acceptance of penile size/appearance and that fulfilling intimate relationships were possible irrespective of penis size. The feedback was positive overall for the final prototype video. To our knowledge, we describe the first co-designed educational resource for people with a penis and contribute to the understanding of this understudied topic.