Penile calciphylaxis in a patient with concurrent haemodialysis and Coumadin treatment.

A man in his 30s, with a medical history of end-stage renal disease on haemodialysis three times a week after kidney transplant rejection, anaemia of inflammatory disease, hypertension, atrial fibrillation, hyperlipidaemia, subtotal parathyroidectomy and aortic valve replacement on Coumadin treatment, presented to our institution with glans penis pain. Examination of the penis revealed a painful black eschar with ulceration on the glans penis with surrounding erythema. CT scan of the abdomen and pelvis and penile Doppler ultrasound revealed calcifications of the abdominal, pelvic and penile blood vessels. He was diagnosed with penile calciphylaxis, a very rare manifestation of calciphylaxis characterised by penile blood vessel calcification leading to occlusion, ischaemia and necrosis. Treatment with low calcium dialysate and sodium thiosulfate was initiated with haemodialysis. Five days after the treatment started, the patient's symptoms improved.

What We Know About Penile Mondor's Disease.

INTRODUCTION: Penile Mondor's Disease (PMD) is a rare illness that causes thrombophlebitis in the superficial veins of the penis that is manifested by transient pain and swelling. PMD often is associated with trauma to the penis, prolonged or vigorous sexual intercourse, and has been linked to genetics. OBJECTIVES: Our aim is to review the current literature on PMD. METHODS: A comprehensive literature search of English and Turkish publications on PMD was found through PubMed and Web of Science using various keywords. It is a systematic review. RESULTS: PMD might be an uncommon, harmless condition that normalizes with moderate therapy or potentially clinical therapy. Its pathogenesis has not yet been completely explained; however, different etiological variables are known. The current studies on PMD are summarized. CONCLUSION: Analyses are frequently made with a fair history and actual assessment. In any case, education on the illness is needed. Furthermore, the identification should be supported by ultrasonography. In a greater part of the patients, results are acquired with 2 months of clinical treatment. In exceptionally uncommon cases, careful thrombectomy or expulsion of the superficial vein is required. Özkan B, Coskuner ER. What We Know About Penile Mondor's Disease. Sex Med Rev 2022;10:396-401.

A rare case of successful percutaneous drainage of a methicillin-resistant Staphylococcus aureus prostatic abscess extending into the penis and revealing diabetes mellitus.

In the postantibiotic era, prostatic abscesses (PAs) are rare, affecting primarily immunocompromised men and/or caused by atypical drug-resistant pathogens, raising both diagnostic and management challenges. PA caused by methicillin-resistant Staphylococcus aureus (MRSA) is an uncommon condition and also a primary source of bacteremia. Nevertheless, the continued pattern of increase in reported cases, due especially to community-associated strains, is a growing concern regarding the significant morbidity and mortality. Besides proper antibiotics, drainage of a PA may be required, which is usually transrectal or transurethral. Herein, we describe the case of MRSA PA extending into the penis with concomitant MRSA bacteremia of unknown origin, whereupon diabetes mellitus was newly diagnosed in a previously healthy man residing in a community setting, and managed successfully by a transperineal drainage with good outcome. This case also highlights that individuals diagnosed with such rare deep-seated MRSA infections should be assessed for undiagnosed comorbidities. To the best of our knowledge, this is the first reported case of percutaneous drainage of a PA by using a double-lumen catheter.

Can malleable penile prosthesis implantation improve voiding dysfunction in men with concurrent erectile dysfunction and buried penis?

PURPOSE: A buried penis causes voiding dysfunction and limits penetrative sexual intercourse. This pilot study evaluates the urinary outcomes in men with buried penis following insertion of malleable penile implants. MATERIALS AND METHODS: Men with buried penis and co-existing urinary problems and erectile dysfunction underwent malleable penile prosthesis implantation were reviewed in a prospective ethics approved database. Patient demographics, flow rate (Qmax), International Prostate Symptom Score (IPSS), Patient Global Impression of Improvement (PGI-I) score, International Index of Erectile Function (IIEF)-5 score, Sexual Encounter Profile (SEP) and overall satisfaction score (on a 5-point scale) were recorded. RESULTS: A total of 12 men (age 55 to 72 years) were reviewed, and the average gain in penile length post-implant, as measured from the pubis to the tip of the glans penis, was 6.8 (3 to 8) cm. There was a significant improvement in IIEF-5 score (8.2 vs. 22.5; p=0.029) post-implant, and more than half of patients were able to resume normal sexual intercourse and positive SEP-2 and SEP-4 were reported in 9 (75%) and 8 (67%) patients. There were no significant intraoperative or postoperative complication. Significant improvement in Qmax (8.4 ml/s vs. 18.6 ml/s; p=0.042) and IPSS (24.5±5.5 vs 15.5±3.5; p=0.038) were observed. More than two-thirds (83%) reported PGI-I score at 1 or 2, while 9 (75%) patients scored a 5/5 in overall satisfaction rate. CONCLUSIONS: Malleable penile implants increases penile length and improves urinary function in a highly select group of men with a buried penis and erectile dysfunction.

A Review on Penile Length and Girth Issues in Penile Prosthetic Surgery.

PURPOSE OF REVIEW: The goal of this paper is to understand the reasons behind penile length and girth issues after penile prosthesis surgery and review the literature for current strategies employed to decrease these issues. RECENT FINDINGS: Measurement inconsistencies triggering further studies have shown there is a real loss of penile length and girth after prosthesis surgery. There have been varying hypotheses of why this happens, and numerous approaches have been proposed to help combat this in the preoperative, intraoperative, and postoperative settings. Erectile dysfunction prevalence is expected to increase; therefore it is important for urologists to understand the treatment options, including prosthesis surgery. Numerous techniques have been hypothesized and studied in smaller settings in the preoperative, intraoperative, and postoperative settings with regard to prosthetics surgery. However, larger studies are still needed to confirm these findings in order to help to counsel and educate patients preoperatively in addition to employing tactics to help minimize penile shortening.

The Management of Penile Fracture: a Review of the Literature with Special Consideration for Patients Undergoing Collagenase Clostridium Histolyticum Injection Therapy.

PURPOSE OF REVIEW: To review the current literature on acute management of traumatic penile fracture, with a specific discussion of those injuries following collagenase clostridium histolyticum (CCH) injections for the treatment of Peyronie's disease. RECENT FINDINGS: The immediate repair of traumatic penile fracture injury is associated with significantly better prognosis for long-term sexual health. Corporal disruption following CCH administration has several distinct features, and the trend is to manage these patients conservatively in the absence of urethral injury. Traumatic penile fracture repair continues to have excellent results when performed immediately following injury. The post-CCH treatment setting portends increased difficulty during surgical management and can be successfully managed in most cases by conservative measures.

Sexual Dysfunction Among Men Who Have Sex with Men: a Review Article.

PURPOSE OF REVIEW: The goal of this review article is to evaluate sexual dysfunction among men who have sex with men (MSM). RECENT FINDINGS: Men who have sex with men are commonly affected by sexual dysfunction. Often sexual dysfunction in MSM will significantly impact their psychological well-being perhaps even more than their heterosexual counterparts. Despite the frequency and high impact of sexual dysfunction in MSM, access to appropriate care may be limited. It is important for urologists, especially sexual medicine clinicians, to be aware of and comfortable with differences in sexual practices of MSM. Penile pathology in this patient population will negatively affect their quality of life and well-being. Therefore, it is important to properly assess and treat these patients.

Management of Urologic Conditions in Small Ruminants.

Small ruminants frequently experience urologic conditions, such as obstructive urolithiasis, posthitis, vulvitis, and urinary tract infections. Urologic conditions are more common in male small ruminants, especially castrated males, primarily due to their anatomy. Traditionally, urologic conditions warranted culling from the herd without significant efforts in treatment. However, more goats and sheep are now being kept as pets. Small ruminant owners have strong emotional attachments to their animals and are more likely to seek treatment of medical disorders, including urologic conditions. Surgical or medical treatments are available. Conditions also may be avoided through hydration, diet, hygiene, and other means.

Fatal infections in andrology. Atypical clinical presentation of a Fournier's disease.

BACKGROUND: Fournier disease (FD) is a worrisome infection of genital area caused by a polimicrobial infection and characterized by a rapid progression to necrosis. Scrotum, perineum and lower abdomen represent the primary sites of origin. Clinical presentation and laboratory strongly suggest FD, but if not precociously diagnosed, it may quickly evolve into septic syndrome and patient's death. CASE REPORT: A 62 years old Caucasian male presented for fever and penile gross oedema recently occurred. No history of previous urinary tract infection, hematuria or genital trauma was referred. He did not complain any storage or voiding low urinary tract symptom (LUTS); no foci of infection in genitoperineal area was observed nor urethral discharge. The ultrasound (US) revealed a disomogeneous broad thickening of subcutaneous tissues with increased vascularity on Color-Doppler. When the penis was manipulated in order to reduce oedema, retract foreskin and evaluate the glans, clinical parametres rapidly worsened and the patient developed a septic shock with blood pressure falling down, dyspnoea and tachyarrhythmia, and he was fastly sent to Intensive Care Unit where it has been hemodynamically stabilized and subjected to antibiotic therapy. Considering the clinical absence of gangrene's foci, we opted for a conservative treatment by maintaining bladder catheter and drug therapy.

An Overview of Penile and Scrotal Dermatoses.

There are a number of dermatoses that manifest in the genital region. Urologists are often the first point of contact for patients with such disorders. These can be isolated genital conditions or manifestations of a more widespread cutaneous disease. Though similar appearing, there are often key clinical findings that aid in in diagnosis. In general, genital dermatoses can be classified as physiologic variants, inflammatory, neoplastic, or infectious in etiology. This article provides a broad overview for urologists in addressing both common and rarer penile and scrotal dermatoses. Emphasis is placed on characteristic clinical findings to aid in diagnosis. Recommendations for diagnostic evaluation, treatment, and appropriate follow-up are discussed.

[Long term results of congenital penile curvature treated with cavernosa corpora rotation.] / Seguimiento a largo plazo de la incurvación peneana congénita tratada mediante rotación de los cuerpos cavernosos.

INTRODUCTION: Congenital penile curvature (PCC) is a disorder caused by an alteration in the embryonic development of the urethra and the corporacavernosa, which causes difficulty in penetration, requiring surgical correction when inter course is impossible. OBJECTIVE: To analyze the results of the surgical treatment of the IPC by means of rotation of the corpora cavernosa (RCC) described and modified by Shaeer. PATIENTS AND METHODS: Ten patients diagnosed with PCC with impossibility to inter course, were operated in a period of 36 months. Prior to the intervention,we applied the IIEF-5 questionnaire, measured the length of the penis and the angle of curvature throughself-photographs in three projections. By subcoronal approach,we perform denudation of the penis. On both sides of the urethra we incised Buck's fascia and released the neurovascular bundle from the ventral to the dorsal side. We generate an artificial erection evidencing the curvature. On the dorsal aspect of both corpora cavernosa, we made two incisions in the external longitudinal layer of the tunica albuginea. We sutured the internal and external edges of both incisions together with a 4/0 non-reabsorbable monofilament continuous suture, checking the correction of the curvature by means of an artificial erection. The patients were discharged the day after the intervention. The penile length and curvature were determined in the sixth month, and the IIEF-5 questionnaire. For the comparison of means we used the Mann-Whitney U test.  RESULTS: The mean age was 26.8 years. The average follow-up was 20.7 months (12-31) and the median was 24. Before the intervention, the average curvature was 68.5° (50-90°); the average length 14.2 cm (10-18) and the IIEF-5 of 21. After surgery, the average length was 13.7 cm, the residual curvature the IIEF-5 of 25. There were no statistically significant differences between pre and postoperative penile length,(p=0.08). Nine patients assured that they would under go the same intervention again. CONCLUSIONS: RCC is an effective therapeutic alternative to the techniques of plication or lengthening of the tunica albuginea for the treatment of PCC, main tainingits long-term results.

INTRODUCCIÓN: La incurvación peneana congénita (IPC) es un trastorno originado por una alteración en el desarrollo embrionario de la uretra y los cuerpos cavernosos, que condiciona dificultad para la penetración, precisando corrección quirúrgica cuando imposibilita el coito. OBJETIVO: Analizar los resultados del tratamiento quirúrgico de la IPC mediante rotación de los cuerpos cavernosos(RCC) descrita y modificada por Shaeer. PACIENTES Y MÉTODOS: Diez pacientes diagnosticados de IPC con imposibilidad para el coito, fueron intervenidos en un período de 36 meses. Previo a la intervención aplicamos el cuestionario IIEF-5, medimos la longitud del pene y el ángulo de incurvación mediante autofotografías en tres proyecciones. Mediante abordaje subcoronal realizamos el denudamiento del pene. A ambos lados de la uretra incidimos la fascia de Buck y liberamos el paquete vasculonervioso desde la cara ventral hasta dorsal. Generamos una erección artificial evidenciando la incurvación. En la cara dorsal deambos cuerpos cavernosos realizamos dos incisiones longitudinales en la capa longitudinal externa de la túnica albugínea. Suturamos los bordes internos y externosde ambas incisiones entre sí con una sutura continuade monofilamento irreabsorbible de 4/0, comprobando mediante una erección artificial la corrección de la incurvación. Los pacientes fueron dados de alta al día siguiente de la intervención. Al sexto mes se determinaron la longitud e incurvación peneanas, y el cuestionario IIEF-5. Para la comparación de medias utilizamos el test de la U de Mann-Whitney. RESULTADOS: La edad media fue 26,8 años. El seguimiento promedio fue 20,7 meses (12-31) y la mediana 24. Antes de la intervención la incurvación media fue 68,5° (50-90°); la longitud media 14,2 cm (10-18) yel IIEF-5 de 21. Tras la intervención la longitud media fue 13,7 cm, la incurvación residual 25. No existieron diferencias estadísticamente significativas entre la longitud peneana pre y postquirúrgica,(p=0,08). Nueve pacientes aseguraron que volverían asometerse a la misma intervención. CONCLUSIONES: La RCC constituye una alternativa terapéutica eficaz a las técnicas de plicatura o alargamiento de la túnica albugínea para el tratamiento de la IPC, manteniendo sus resultados a largo plazo.

Seguimiento a largo plazo de la incurvación peneana congénita tratada mediante rotación de los cuerpos cavernosos / Long term results of congenital penile curvature treated with cavernosa corpora rotation

INTRODUCCIÓN: La incurvación peneana congénita (IPC) es un trastorno originado por una alteración en el desarrollo embrionario de la uretra y los cuerpos cavernosos, que condiciona dificultad para la penetración, precisando corrección quirúrgica cuando imposibilita el coito. OBJETIVO: Analizar los resultados del tratamiento quirúrgico de la IPC mediante rotación de los cuerpos cavernosos (RCC) descrita y modificada por Shaeer. PACIENTES Y MÉTODOS: Diez pacientes diagnosticados de IPC con imposibilidad para el coito, fueron intervenidos en un período de 36 meses. Previo a la intervención aplicamos el cuestionario IIEF-5, medimos la longitud del pene y el ángulo de incurvación mediante autofotografías en tres proyecciones. Mediante abordaje subcoronal realizamos el denudamiento del pene. A ambos lados de la uretra incidimos la fascia de Buck y liberamos el paquete vasculonervioso desde la cara ventral hasta dorsal. Generamos una erección artificial evidenciando la incurvación. En la cara dorsal deambos cuerpos cavernosos realizamos dos incisiones longitudinales en la capa longitudinal externa de la túnica albugínea. Suturamos los bordes internos y externosde ambas incisiones entre sí con una sutura continuade monofilamento irreabsorbible de 4/0, comprobando mediante una erección artificial la corrección de la incurvación. Los pacientes fueron dados de alta al día siguiente de la intervención. Al sexto mes se determinaron la longitud e incurvación peneanas, y el cuestionario IIEF-5. Para la comparación de medias utilizamos el test de la U de Mann-Whitney. RESULTADOS: La edad media fue 26,8 años. El seguimiento promedio fue 20,7 meses (12-31) y la mediana 24. Antes de la intervención la incurvación media fue 68,5° (50-90°); la longitud media 14,2 cm (10-18) yel IIEF-5 de 21. Tras la intervención la longitud media fue 13,7 cm, la incurvación residual 25. No existieron diferencias estadísticamente significativas entre la longitud peneana pre y postquirúrgica, (p = 0,08). Nueve pacientes aseguraron que volverían asometerse a la misma intervención. CONCLUSIONES: La RCC constituye una alternativa terapéutica eficaz a las técnicas de plicatura o alargamiento de la túnica albugínea para el tratamiento de la IPC, manteniendo sus resultados a largo plazo

INTRODUCTION: Congenital penile curvature (PCC) is a disorder caused by an alteration in the embryonic development of the urethra and the corporacavernosa, which causes difficulty in penetration, requiring surgical correction when inter course is impossible. OBJECTIVE: To analyze the results of the surgical treatment of the IPC by means of rotation of the corpora cavernosa (RCC) described and modified by Shaeer. PATIENTS AND METHODS: Ten patients diagnosed with PCC with impossibility to inter course, were operated in a period of 36 months. Prior to the intervention,we applied the IIEF-5 questionnaire, measured the length of the penis and the angle of curvature throughself-photographs in three projections. By subcoronal approach,we perform denudation of the penis. On both sides of the urethra we incised Buck’s fascia and released the neurovascular bundle from the ventral to the dorsal side. We generate an artificial erection evidencing the curvature. On the dorsal aspect of both corpora cavernosa, we made two incisions in the external longitudinal layer of the tunica albuginea. We sutured the internal and external edges of both incisions together with a 4/0 non-reabsorbable monofilament continuous suture, checking the correction of the curvature by means of an artificial erection. The patients were discharged the day after the intervention. The penile length and curvature were determined in the sixth month, and the IIEF-5 questionnaire. For the comparison of means we used the Mann-Whitney U test. RESULTS: The mean age was 26.8 years. The average follow-up was 20.7 months (12-31) and the median was 24. Before the intervention, the average curvature was 68.5° (50-90°); the average length 14.2 cm (10-18) and the IIEF-5 of 21. After surgery, the average length was 13.7 cm, the residual curvature the IIEF-5 of 25. There were no statistically significant differences between pre and postoperative penile length, (p = 0.08). Nine patients assured that they would under go the same intervention again. CONCLUSIONS: RCC is an effective therapeutic alternative to the techniques of plication or lengthening of the tunica albuginea for the treatment of PCC, main tainingits long-term results

Penile calciphylaxis: a conservative approach.

Penile calciphylaxis or calcific uremic arteriolopathy is a rare urological condition often associated with patients undergoing renal dialysis for end-stage renal disease. The majority of cases are associated with systemic calciphylaxis. The pathophysiology, diagnosis and management of penile calciphylaxis as an individual entity has brought little attention. The rates of comorbidity and mortality of these patients are often particularly high. Early diagnosis and a multidisciplinary approach are therefore essential. We report a case of penile calciphylaxis in a 59-year-old man with end-stage renal failure on haemodialysis who was successfully managed conservatively.

Management of Pearly Penile Papules: A Review of the Literature.

Pearly penile papules (PPPs) are benign, dome-shaped lesions found around the corona of the penis. Despite being asymptomatic and benign in nature, the appearance of PPPs may cause a great deal of psychological distress to both the patient and their sexual partner. While patient reassurance may be the first-line treatment, several other treatment modalities including cryotherapy, electrodessication and curettage, and laser therapy have all been used to treat PPPs in order to achieve a cosmetic outcome that satisfies the patient. Based on the evaluation of the existing literature, ablative laser therapies offer satisfactory cosmetic outcomes with good long-term results.

A Nonspecific Penile Ulcer Leading to the Diagnosis of Wegener's Granulomatosis.

The presented case describes a 53-year-old male who had been treated for non-specific cutaneous lesions for two months without any improvement. He was referred to our department after developing an erosive penile ulcer. Investigation for sexually transmitted diseases and Mycobacterium tuberculosis ended with negative results. Penile ulcer biopsy suggested the diagnosis of Wegener's granulomatosis (WG). The patient presented with upper respiratory tract symptoms during this period. Measuring antineutrophil cytoplasmic antibodies (c-ANCA), confirmed the diagnosis. Immunosuppressive therapy was initiated and resulted in a favorable response.

Penile Emergencies.

The penis is an organ of enormous importance and is vital for both excretory and reproductive function. The anatomy of the penis itself can lead to many of its emergent conditions and a thorough understanding of the anatomy and physiology is central to recognition of these conditions. Physicians should have a high clinical suspicion for penile emergencies and perform a thorough physical examination to make a proper diagnosis. Prompt diagnosis and proper management are essential for minimizing dysfunction of this vital organ.

Hookworm-related cutaneous larva migrans of the penis successfully treated with topical ivermectin.

Hookworm-related cutaneous larva migrans is an infestation of the skin caused by nematodes. Involvement of genitals is extremely rare. We report the case of a child with this infestation on the penis who cleared rapidly with topical ivermectin.