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1.
Urologiia ; (6): 124-126, 2021 Dec.
Artigo em Russo | MEDLINE | ID: mdl-34967173

RESUMO

Gangrene of the penis is a rare condition manifesting with purulent necrotization of penile tissues and systemic inflammatory response. In more than 90% of cases, the cause of the development of the penile and scrotal gangrene is rapidly progressive necrotizing fasciitis of polymicrobial etiology, which predominantly affected the external genital organs. Isolated cases of penile gangrene development when using the restraining rings of the penis are described in literature (condom urine collection bag, rings for erection, etc.). Cases of penile and scrotum gangrene, when treatment with bilateral orchiectomy and penectomy is required are quite rare. We present the case of penlie and scrotum gangrene in an 86-year-old patient with mental disorders. The cause of gangrene was long-term forced position of the patient with infringement of the penis and scrotum by the thighs. Active intensive therapy, surgical removal of the penis, scrotum and testicles and urine diversion by the imposition of a trocar cystostomy saved the patients life and he was discharged from the hospital in a satisfactory condition.


Assuntos
Doenças dos Genitais Masculinos , Doenças do Pênis , Idoso de 80 Anos ou mais , Gangrena/cirurgia , Humanos , Masculino , Doenças do Pênis/cirurgia , Pênis/cirurgia , Escroto/cirurgia
2.
Br J Hosp Med (Lond) ; 82(10): 1-9, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34726937

RESUMO

A penile fracture is a traumatic rupture of the tunica albuginea of the corpora cavernosa in an erect penis, usually as a result of blunt trauma during sexual activity. The aetiology varies with geographical region, with the USA and Europe having a higher incidence of sexual trauma and the Middle East having a higher rate of self-manipulation. Diagnosis is usually clinical, but numerous imaging modalities have been used to confirm the fracture site and to help plan appropriate surgical management. Clinical examination will find a detumescent penis with a diffuse penile swelling and ecchymosis: the classic eggplant sign. The penis will often deviate away from the side of the injury. A history of the patient's inability to pass urine after the injury or of blood at the urethral meatus suggests an associated urethral injury. Immediate surgical management is the mainstay of treatment, with many surgeons favouring a degloving approach. Penile fractures also carry a risk of urethral tears and urethral repair may be necessary. This article describes the aetiology, presentation and management of penile fractures to enable identification and treatment in daily clinical practice.


Assuntos
Doenças do Pênis , Doenças Uretrais , Humanos , Masculino , Doenças do Pênis/diagnóstico , Doenças do Pênis/epidemiologia , Doenças do Pênis/etiologia , Pênis/cirurgia , Ruptura , Uretra
3.
Hinyokika Kiyo ; 67(8): 399-401, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34472324

RESUMO

A 65-year-old man visited us with a painful penis after receiving an injection of hyaluronic acid into the penis for male genital augmentation. On admission, physical examination revealed black necrotic lesions and ulcerations on his glans penis. We performed partial penectomy to remove the necrotic tissues. Histopathological examination showed necrosis with severe inflammatory infiltration in the dermis and subcutis. Glans penile necrosis due to hyaluronic acid injected into the glans penis for male genital augmentation is exceedingly rare. This case is reported herein along with a review of the Japanese literature.


Assuntos
Ácido Hialurônico , Doenças do Pênis , Idoso , Humanos , Ácido Hialurônico/efeitos adversos , Injeções , Masculino , Necrose/induzido quimicamente , Doenças do Pênis/induzido quimicamente , Doenças do Pênis/tratamento farmacológico , Doenças do Pênis/cirurgia , Pênis/cirurgia
4.
Med J Malaysia ; 76(5): 774-776, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34508395

RESUMO

Penile self-injections are performed with the purpose of increasing the size of the penis. Commonly, mineral oils or mineral oil-like substances are used for this purpose. However, there are very few publications describing on the complications from vegetable oil injections especially olive oil. Following the injection, the resulting deformity of the male genitalia is described as penile paraffinomas lipogranuloma of the penis. We would like to report a case of penis augmentation by a 50-year-old gentleman using olive oil injections that caused a massive, severely deformed of the penis and scrotum. Surgical excision and reconstruction was done. The patient was discharged after five days postoperatively, with full graft take. Injecting any oily substances into the human body is hazardous. The differential diagnosis of nodules following injections should be kept in mind and in doubtful cases, biopsy should be done. Regular follow-up is essential to prevent the further inflammatory event. Safe and legal procedures should be implemented for penile enlargement so as to avoid self-injections and in the prevention of such debilitating problems.


Assuntos
Doenças do Pênis , Pênis , Granuloma , Humanos , Masculino , Pessoa de Meia-Idade , Azeite de Oliva , Doenças do Pênis/induzido quimicamente , Doenças do Pênis/cirurgia , Pênis/cirurgia , Escroto/cirurgia
5.
Urologiia ; (4): 79-86, 2021 09.
Artigo em Russo | MEDLINE | ID: mdl-34486279

RESUMO

INTRODUCTION: Penile glans amputation during circumcision is a rare but potentially devastating complication. The mechanism and causes are poorly understood and incomprehensible. It is important to identify the causes of these complications, to suggest a mechanism and to propose prevention measures. MATERIALS: Between 2005 and 2019, six patients with penile glans amputationafter circumcision were analyzed. All were operated without medical evidence, for religious reasons. THE RESULTS: The operations were performed by local anesthesia, at home - in 5 patients, in 1 child - at polyclinic. All children were circumcised by scalpel with guillotine method, without visualization of glans. Partial amputation of penile glans was observed in 2 children (33.3%). Complete cut-off of the glans at the level of the coronal sulcus was revealed in 4 boys (66.6%). Meatoplasty with urethral mobilizations was performed 2 patients (33.3%) with partial amputation. The tops of corpus cavernous was covered of with the remnants of the skin of penile shaft in two boys (33.3%). Glansplasty was performed in 2 other patients (33/3%), using a labial mucosa graft to reconstruct the shape of glans and glanular groove. The follow up have showed meatostenosis in two boys (33.3%) in the first 2 months after surgery. One child required repeated meatoplasty (16.6%), another had a recovery of normal urine flow rates after urethral dilatation and stenting (4 weeks). CONCLUSION: Visual control of the glans position during circumcision will prevent the amputation. "Guillotine" techniques including, Mogen clamp-type devices, are considered potentially dangerous. Circumcision in newborns, without general anesthesia, in the presence of swelling of the foreskin have an increased risk of glans damage. Preliminary examination of the glans and adequate release of preputial adhesions help to prevent complication of circumcision and to identify combined malformations (hypospadia, epispadia, concealed penis.).


Assuntos
Circuncisão Masculina , Doenças do Pênis , Amputação , Criança , Circuncisão Masculina/efeitos adversos , Prepúcio do Pênis , Humanos , Recém-Nascido , Masculino , Doenças do Pênis/etiologia , Doenças do Pênis/prevenção & controle , Doenças do Pênis/cirurgia , Pênis/cirurgia
6.
Ann R Coll Surg Engl ; 103(10): e330-e334, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34414780

RESUMO

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.


Assuntos
Abscesso/terapia , Complicações do Diabetes/microbiologia , Staphylococcus aureus Resistente à Meticilina , Doenças do Pênis/microbiologia , Doenças Prostáticas/microbiologia , Infecções Estafilocócicas/terapia , Abscesso/complicações , Abscesso/microbiologia , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/complicações , Doenças do Pênis/terapia , Doenças Prostáticas/complicações , Doenças Prostáticas/terapia , Infecções Estafilocócicas/complicações
8.
Scand J Urol ; 55(5): 422-426, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34286674

RESUMO

An 8-year-old boy presented with a duplicated penis and urinary incontinence. He had a history of a perineal teratoma which was removed during his first week of life. Examination revealed a large prepuce, 90-degree counter clockwise rotation of the penis, an orthotopic megalomeatus and an additional smaller glans dorsally. Cystourethroscopy and artificial erection showed a wide-open bladder neck and deviation of the penis(es) to the right. There were two cavernosae in the orthotopic penis and one in the duplicated rudimentary penis. The patient was subjected to Young-Dees bladder neck reconstruction and two years later, excision of the rudimentary penis. A satisfactory cosmetic result was achieved, the patient is voiding normally, and urinary incontinence improved. Penile duplication is a rare anomaly, which presents differently in each patient. Therefore, treatment should be individualized, and the goal of surgery being to achieve as a near normal cosmetic and functional result as possible.


Assuntos
Doenças do Pênis , Teratoma , Criança , Humanos , Recém-Nascido , Masculino , Pênis/cirurgia , Teratoma/cirurgia , Uretra , Bexiga Urinária
9.
Pan Afr Med J ; 38: 265, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34122692

RESUMO

Penile paraffinoma is a rare condition after penile injection of liquid paraffin or other mineral oils, with well-documented debilitating complications. Nevertheless, such injections are still performed by people of Eastern European and Asian descent for cosmetic penile augmentation. We report a case of penile paraffinoma in an otherwise healthy, 30-year-old male, with obstructive lower urinary tract symptoms (LUTS) as the sole complaint at presentation in the emergency department and a conservative approach. This case report describes an unusual presentation of penile paraffinoma in a young man and aims to raise public and physician awareness regarding disease manifestation to prevent high morbidity from delayed diagnosis and treatment.


Assuntos
Granuloma de Corpo Estranho/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Doenças do Pênis/diagnóstico , Adulto , Diagnóstico Tardio , Granuloma de Corpo Estranho/patologia , Humanos , Masculino , Doenças do Pênis/patologia
11.
BMC Urol ; 21(1): 94, 2021 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-34176473

RESUMO

BACKGROUND: Collagenase Clostridium histolyticum (CCH), also know as Xiaflex, with penile modeling is considered to be the gold standard non-surgical option for management of Peyronie's disease and is known to be safe and efficacious. Corporal rupture is a rare but known adverse event of CCH treatment, however there are limited studies describing corporal herniation without rupture. Here we present a patient who experienced a rare complication following CCH injections for Peyronie's disease: lateral herniation of the tunica albuginea in the setting of a dorsal penile plaque. CASE PRESENTATION: A 58-year-old male presented to our clinic seeking treatment for Peyronie's disease. On exam, he was found to have a palpable dorsal plaque and > 30 degrees leftward curvature of the penis. He was deemed an appropriate candidate for and patient decided to proceed with CCH and modeling. He received 2 cycles of CCH injections (4 total CCH injections) with in-office and at-home penile modeling, per manufacturer's protocol. Two weeks following in-office modeling during his second CCH cycle, the patient reported a painless, soft swelling involving the left side of his penile shaft only occurring with erection. Exam and history were suggestive of lateral herniation rather than corporal rupture. CCH was discontinued. Patient declined further evaluation with penile ultrasound. CONCLUSIONS: This is the first case report detailing lateral herniation with CCH injections. Symptoms and exam that should raise suspicion of corporal herniation are a soft, painless mass with erection.


Assuntos
Hérnia/induzido quimicamente , Colagenase Microbiana/efeitos adversos , Doenças do Pênis/induzido quimicamente , Induração Peniana/tratamento farmacológico , Humanos , Masculino , Colagenase Microbiana/uso terapêutico , Pessoa de Meia-Idade
12.
Diagn. tratamento ; 26(2): 79-84, abr.-jun. 2021.
Artigo em Português | LILACS | ID: biblio-1280729

RESUMO

A doença de Peyronie, notória desde 1743, segue sendo um grande desafio na prática médica, com prevalência relevante e grande impacto na vida sexual dos casais. O tratamento cirúrgico é a principal modalidade terapêutica capaz de restabelecer a vida sexual nos pacientes com doença de Peyronie significativa. A escolha do momento de implementação do tratamento cirúrgico, bem como a escolha da técnica a ser empregada, varia de acordo com três pontos centrais: a fase da doença, a deformidade apresentada e a função erétil. Estes pilares para a decisão terapêutica do paciente com doença de Peyronie possuem nuances, não sendo simples a caracterização destes fatores em muitos casos. Uma avaliação pré-operatória criteriosa, fundamental para a melhor escolha terapêutica, exige experiência e um conhecimento aprofundado sobre o tema. O objetivo do presente artigo é promover uma ampla discussão acerca de fatores primordiais da avaliação pré-operatória de pacientes com doença de Peyronie.


Assuntos
Doenças do Pênis , Induração Peniana , Cuidados Pré-Operatórios , Implante Peniano , Disfunção Erétil
13.
J Sex Med ; 18(6): 1099-1103, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33935017

RESUMO

BACKGROUND: Whilst there is a trend away from aggressive nonorgan sparing surgical treatments for malignant penile disease, a variety of penile preservation options exist but functional outcomes and patient reported outcomes (PROs) in this area are poorly reported to date. AIM: The aim of this study is to report functional outcomes and PROs of total glans resurfacing (TGR) in a consecutive series of patients with lichen sclerosis (LS) or localized penile cancer (PC). METHODS: From 2004 to 2018 a consecutive series of patients underwent TGR for the management of LS or localized PC in a tertiary referral network. Patient clinical records and operative notes were retrospectively reviewed. Statistical analysis was conducted with Stata 12. OUTCOMES: Urinary and sexual outcomes were recorded utilizing both the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) validated questionnaires while PROs were extrapolated from a 5-item "ad hoc" telephone questionnaire administered at 1 year post procedure. RESULTS: 37 consecutive patients were enrolled. Histology results demonstrated LS in 16 patients, with the remaining 21 having a diagnosis of PC. The most common reasons for patient presentation were local pain (32.4%), pruritus (37.8%) and bleeding (29.7%). Median follow-up was 22 (IQR 13-77) months. Median age was 62 (IQR 55-68). Neither of the questionnaires assessing urinary and sexual function showed any significant deterioration after surgery. Glans sensitivity was fully maintained in 89.2% of cases. 94.5% of patients reported to be fully satisfied with the aesthetic appearance of the penis and would consider undergoing the same procedure again if necessary. 91.9% of patients would recommend the same procedure to someone else. An overall improvement of the quality of life was reported by 86.4% of patients. CLINICAL IMPLICATIONS: TGR should be considered a treatment of choice for selected cases of benign or malignant penile lesions STRENGTHS AND LIMITATIONS: Our study has some limitations, the first being its retrospective nature. Furthermore, despite being one of the largest series to date, follow-up duration is somewhat limited and a control group is lacking. CONCLUSION: TGR represents an excellent surgical option ensuring satisfactory voiding and sexual function, as well as cosmesis for selected cases of penile lesions. M. Preto, M. Falcone, G. Blecher, et al. Functional and Patient Reported Outcomes Following Total Glans Resurfacing. J Sex Med 2021;18:1099-1103.


Assuntos
Doenças do Pênis , Qualidade de Vida , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Pênis/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
14.
Dermatol Online J ; 27(3)2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33865284

RESUMO

Report _Case Presentation X Photo Vignette _Letter Authors declare that the contents of this article are their own original unpublished findings. Title: Cutaneous calciphylaxis of the glans penis presenting as a gangrenous ulceration Authors: Marie Danset, Cécile Lesort, Denis Jullien, Jean Kanitakis Affiliations: Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France Corresponding Author: Jean Kanitakis, Department of Dermatology, Edouard Herriot Hospital Group, 69437 Lyon Cedex 03, France, Tel: 33-472110301, Email: jean.kanitakis@univ-lyon1.fr Abstract: Calciphylaxis is a rare microvascular disorder causing necrotic skin ulcers. It is characterized by deposits of calcium within vascular walls but its precise pathogenesis remains poorly understood. A major risk factor is end-stage renal disease on dialysis. We report a 67-year-old man with calciphylaxis revealed by an unusual necrotic ulcer of the glans penis. The patient also presented with bilateral panniculitis of the thighs and a calf ulcer. All those lesions were painful, highlighting the value of pain as a diagnostic clue. Penile involvement of calciphylaxis is rare and biopsy is often avoided in this area. However, rapid diagnosis of calciphylaxis is important because early treatment has a better chance of being successful. Our patient's condition deteriorated rapidly with development of bilateral retinal artery occlusion and he died shortly thereafter. This case further highlights the fact that calciphylaxis is a systemic vascular disease with an ominous prognosis.


Assuntos
Calciofilaxia/patologia , Doenças do Pênis/patologia , Pênis/patologia , Idoso , Calciofilaxia/complicações , Evolução Fatal , Gangrena/etiologia , Gangrena/patologia , Humanos , Masculino , Dor Intratável/etiologia , Doenças do Pênis/complicações , Oclusão da Artéria Retiniana/etiologia , Sepse/etiologia , Úlcera Cutânea/etiologia , Úlcera Cutânea/patologia
15.
J Pediatr Urol ; 17(4): 566.e1-566.e12, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33849793

RESUMO

INTRODUCTION: From 2000 to 2019, the De Castro's neo-phalloplasty was used in 47 patients with congenital and acquired penile loss. PURPOSE: Herein, the technical aspects of penile reconstruction and the outcomes in 17 children and adolescents treated for total or sub-total acquired penile loss are reported. MATERIAL AND METHODS: The median age at the time of injury was 3 months (range: 2 days-15 years). Twelve patients were born with normal penis but suffered injuries (11) or underwent surgical resection of the penis (1). The remaining 5, affected by bladder exstrophy (2) or cloacal exstrophy (3), had penile loss due to surgical complications. RESULTS: The median age at the time of surgery was 5 years (range: 2-20 years). The median length of the procedure was 5 h (range 4-8 h). Skin expander were inserted in preparation of phalloplasty in 9 patients. Corpora-cavernosa remnants were found and incorporated in the neophallus in 12 patients. In 7 patients, urethral remnants were also incorporated into the repair, placing the meatus at the tip of the neophallus. In the remaining patients the urethra was left in the acquired position after penile loss creating a perineal (2), scrotal (3), peno-scrotal (3), or posterior penile (1) urethrostomy. The first patient of this series was the only patient to receive simultaneously phalloplasty and total urethroplasty, with failure of urethral reconstruction. The median follow-up was 2 years (range 1-11 years). The overall complication rate was about 47%. All of the complications were late and required surgical revision. The results were assessed regarding overall functionality (voiding, erection/erogenous areas, masturbation/sexual intercourse) and aesthetic outcome using subjective and objective parameters. Psychological evaluation for both patient and parents was performed in 4 cases. DISCUSSION: There are no specific guidelines for treating significant penile injuries in the pediatric population. We do not think secondary severe penile impairments should wait until adult age for repair. In this specific subgroup of patients technical aspects differ from phalloplasty done for congenital aphallia, due to the possible presence of corpora-cavernosa/urethral remnants and the feasibility to perform a "functional phalloplasty" with very encouraging results. CONCLUSION: The De Castro's neo-phalloplasty remains one of the few techniques available for total penile reconstruction in pediatric age group. Data demonstrate that this technique for acquired aphallia is feasible and reproducible, however, it is a challenging procedure with a high complication rate and likelihood of revisions.


Assuntos
Extrofia Vesical , Doenças do Pênis , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Adulto , Extrofia Vesical/cirurgia , Criança , Humanos , Masculino , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Pênis/cirurgia , Uretra/cirurgia
16.
J Pediatr Urol ; 17(3): 422-423, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33716000

RESUMO

INTRODUCTION: We present a different salvage procedure for penile prosthesis implantation in a De Castro neophallus. METHODS: A patient with congenital aphallia had been operated at the age of 11. Ten years later he had two non successful attempts of prosthesis implantation. Surgery consisted of adapting the implants into the aortic graft and folding it in the middle over the cylinders to reinforce its strength. RESULTS: Patient had a successful postoperative course and has now 6 months of follow-up. DISCUSSION: In a systematic review of penile prosthetic outcomes and complications in gender-affirming surgery, most of the prostheses were inflatable (83.6%) and single-cylinder (61.0%). At a mean follow-up of 3.0 years: 36.2% of prosthesis complications, 60.0% of patients had their original implant present and 83.9% reported achieving penetration. We decided to use vascular grafts as a scaffold because of former non successful attempts. CONCLUSION: The use of vascular prosthesis as a device to implant the penile prosthesis seems to be a safe and effective alternative in an attempt to offer erectile function to the neophallus in case of congenital aphallia.


Assuntos
Disfunção Erétil , Doenças do Pênis , Implante Peniano , Prótese de Pênis , Cirurgia de Readequação Sexual , Humanos , Masculino , Satisfação do Paciente , Pênis/cirurgia , Implantação de Prótese
17.
Pediatr Surg Int ; 37(6): 815-825, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33760967

RESUMO

Megaprepuce (MP) is a rare and challenging condition characterised by an excessive inner prepuce, paucity of penile skin and an extremely narrow phimotic ring. The aetiological factors leading to its development are poorly understood. A variety of surgical techniques have been described in the last 26 years mostly with small number of patients and short follow-up. It is also highly likely that some series have in the past included different variants of inconspicuous penis combining concealed penis, MP and webbed penis. This article is a systematic review of the literature on Megaprepuce; in particular the embryology, history, aetiology, and the surgical techniques available for the correction of this unique penile anomaly will be presented and discussed in this study.


Assuntos
Doenças do Pênis/cirurgia , Pênis/cirurgia , Fimose/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Prepúcio do Pênis/cirurgia , Humanos , Masculino , Doenças Raras
18.
Rev. int. androl. (Internet) ; 19(1): 25-33, ene.-mar. 2021. tab, graf, ilus
Artigo em Inglês | IBECS | ID: ibc-201667

RESUMO

INTRODUCTION AND OBJECTIVE: Erectile dysfunction's physiopathology in uremia is complex and multifactorial, involving a combination of classical risk factors and specific uremia-related risk factors such as increased oxidative stress, endothelial dysfunction and inflammation. The aim of the study is to investigate the effect of chronic kidney disease (CKD) on vascular calcification and endothelial function of cavernosal bodies in apolipoprotein E deficient (apoE−/−) mice, a well known model of erectile dysfunction. MATERIALS AND METHODS: Eight-week-old male apoE−/− mice were randomly assigned to the following 3 groups: (I) subtotally nephrectomised (SNX apoE−/−, 12 mice), (II) uninephrectomised (UNX apoE−/−, 11 mice) or (III) sham operated (sham-op apoE−/−, 15 mice). At 16 weeks after surgery, aortas and penile erectile tissues were harvested for histological studies to assess atherosclerosis, vascular calcification, nitrotyrosine staining, total collagen content and macrophage staining. RESULTS: At sacrifice, SNX and UNX mice had significantly higher serum urea, total cholesterol, and triglyceride concentrations than sham-op controls. Atherosclerotic lesions in thoracic aorta were significantly larger in uremic apoE−/− mice than in controls. There were no atheromatous lesions in cavernosal bodies or penile artery observed in any group. However, SNX and UNX animals showed a significant increase in calcification score, collagen content and nitrotyrosine staining in cavernosal bodies when compared with controls. The degree of macrophage infiltration was comparable between the 3 groups. CONCLUSION: In conclusion, even mild renal dysfunction, i.e., after uninephrectomy increases calcification score and aggravates endothelial function of cavernosal bodies in apoE−/− mice and this effect might be linked to increased oxidative stress in penile endothelium


INTRODUCCIÓN Y OBJETIVOS: La fisiopatología de la disfunción eréctil en la uremia es compleja y multifactorial, e incluye una combinación de factores de riesgo clásicos y factores específicos asociados a la uremia, como el aumento del estrés oxidativo, la disfunción endotelial y la inflamación. El objetivo de este trabajo es examinar el efecto de la enfermedad renal crónica (ERC) sobre la calcificación vascular y la función endotelial de los cuerpos cavernosos en caso de deficiencia de apolipoproteína E en ratones (ratones ApoE−/−), un modelo bien conocido de disfunción eréctil. MATERIALES Y MÉTODOS: Los ratones machos de 8 semanas de edad con «ApoE−/−mice» se distribuyen aleatoriamente en 3 grupos: 1) con heminefrectomía (SNX ApoE−/−), 12 ratones; 2) con nefrectomía única (UNX ApoE−/−), 11 ratones, y 3) operación de placebo (sham-op ApoE−/−), 15 ratones. Dieciséis semanas después de la cirugía, se retiraron los tejidos eréctiles de la aorta y el pene para realizar estudios histológicos con el fin de evaluar la aterosclerosis, la calcificación vascular, las sombras de nitrotirosina, el contenido de colágeno total y las sombras de macrófagos. RESULTADOS: Durante el sacrificio, los ratones con SNX y UNX reflejaron valores de urea sérica, colesterol total y concentración de triglicéridos significativamente más elevados, en comparación con los casos controlados con placebo. Las lesiones ateroscleróticas en la aorta torácica fueron mucho mayores en los ratones urémicos «ApoE−/−» en comparación con los controles. No hubo lesiones ateromatosas en los cuerpos cavernosos ni en la arteria del pene en ninguno de los grupos. Sin embargo, los animales con nefrectomía seminal y única mostraron un aumento significativo en la calcificación, presencia de colágeno y manchas de nitrotirosina en cuerpos cavernosos en comparación con los controles. El grado de infiltración de macrófagos fue comparable entre los 3 grupos. CONCLUSIÓN: Se ha concluido que incluso una disfunción renal menor, es decir, tras una nefrectomía única, aumenta la calcificación y exacerba la función endotelial de los cuerpos cavernosos en ratones «ApoE−/−», y este efecto puede estar asociado a un aumento del estrés oxidativo en el endotelio del pene


Assuntos
Animais , Masculino , Camundongos , Doenças do Pênis/veterinária , Disfunção Erétil/fisiopatologia , Calcinose/diagnóstico , Apolipoproteínas E/deficiência , Aterosclerose/diagnóstico , Disfunção Erétil/veterinária , Calcinose/terapia , Calcinose/veterinária , Apolipoproteínas E/administração & dosagem , Modelos Animais , Aterosclerose/veterinária
19.
Int. braz. j. urol ; 47(2): 388-394, Mar.-Apr. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1154447

RESUMO

ABSTRACT Purpose: To describe penile fracture (PF) findings with non-sexual etiology in a referral emergency hospital, with emphasis on demographic data, clinical and intraoperative findings and long-term outcomes. Materials and Methods: Patients with PF of non-sexual cause operated at our institution from January 2014 to January 2019 were submitted to surgical treatment and monitored for at least three months after surgery. Etiology of trauma, epidemiological and clinical presentation data, time to intervention and operative findings were reviewed retrospectively. The evaluation of postoperative erectile function was carried out by filling out the International Index of Erection Function - 5 (IIEF-5). The tool used to assess urinary function was the International Prostate Symptom Score (IPSS) questionnaire. Results: Of a total of 149 patients submitted to surgical treatment for PF, 18 (12%) reported non-sexual etiology. Twelve (66.6%) cases were due to penile manipulation through the act of bending the penis during morning erection, three (16.6%) when rolling over in bed with erect penis, one (5.5%) when embracing the wife during erection, one (5.5%) to laying on the partner with erect penis and the other (5.5%) when sitting on the toilet with an erection. Operative findings were unilateral corpus cavernosum injury in all cases. Only one (5.5%) patient had a partial urethral lesion. Follow-up time varied from 3 to 18 months (mean, 10.1 months). Three (16.6%) patients developed erectile dysfunction six months after surgery. However, all of them responded to treatment with IPDE-5 and reported improvement of erection, with no need for medication, on reevaluation after 18 months. One (5.5%) patient developed penile curvature < 30 degrees. Thirteen (72.2%) patients developed penile nodules. No patient presented voiding complaints during follow-up. Conclusions: PF is a rare urologic emergency, especially with the non-sexual etiology. However, PF should always be considered when the clinical presentation is suggestive, regardless of the etiology. Penile manipulation and roll over in bed were the most common non-sexual causes. These cases are related to low-energy traumas, usually leading to unilateral rupture of corpus cavernosum. Urethral involvement is uncommon but may be present. Early treatment has good long-term clinical outcome, especially when performed in specialized centers with extensive experience in FP.


Assuntos
Humanos , Masculino , Doenças do Pênis , Pênis/cirurgia , Encaminhamento e Consulta , Ruptura/cirurgia , Ereção Peniana , Estudos Retrospectivos , Resultado do Tratamento , Hospitais
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