Incarceration of the penis with a heavy metallic object

OBJECTIVE: To report an additional case of incarceration of the penis by a heavy metallic object. METHODS/RESULTS: A case of incarceration of the penis by a heavy metallic object (3400 gm) that was resolved by multiple puncture of the glans penis is described. After release, no complications were observed; penile morphology was completely recovered, erectile function was preserved and micturition was normal. CONCLUSION: Multiple puncture of the glans penis was demonstrated to be useful in the management of this case of penile incarceration.     

Re-intervention in the anal region

In 29 rats, responses evoked by pelvic and hypogastric nerve stimulation were recorded from postganglionic nerves to bladder and penis (clitoris). Responses to pelvic nerve stimulation had nonsynapsing and synapsing components. The nonsynapsing component was relatively large in main nerve to penis and small in lateral nerve to penis and nerves to bladder. Pelvic nerve fiber synapsing on pelvic ganglion neurons to bladder had a large subliminal fringe, while fibers synapsing on neurons supplying penis (clitoris) had a small subliminal fringe. Recruitment was greater in nerves to bladder and lateral nerve to penis (clitoris) compared to main nerve to penis (clitoris), indicating more synapsing fibers in the former nerves. Almost all hypogastric fibers to bladder were direct. A small subliminal fringe was demonstrated for hypogastric fibers synapsing on neurons supplying penis. No subliminal fringe was evident for the bladder. Pelvic and hypogastric nerve interaction on pelvic ganglion neurons could not be demonstrated with either single shock or tetanic trains of conditioning stimuli. With antidromic stimulation, conduction velocities of afferent fibers in pelvic nerve ranged from 0.15 m per sec to 2.9 m per sec. In hypogastric nerve they ranged from 0.35 m per sec to 2.8 m per sec.     

Anatomical alignment for the correction of buried penis

PURPOSE: We report a straightforward surgical technique for the correction and anatomical alignment of the skin in patients with various degrees of buried penis. MATERIALS AND METHODS: A combined series of 74 patients 7 months to 10 years old who were treated for buried penis at 2 institutions during a 7-year period. Patients presented with various symptoms, including balanitis, urinary tract infection, painful voiding, ballooning of the foreskin and urinary retention. In 29 patients (38%) trapped penis was due to previous circumcision. In our estimation the major anatomical defect in buried penis is an insufficient attachment of the dartos fascia and penile skin to Buck's fascia. Our technique involves making a circumferential incision of the inner preputial skin layer proximal to the corona, unfurling it from the shaft skin and leaving a coronal collar of approximately 1 cm. The annular band that usually constricts the corpora on retraction of the penile skin is incised, and the remaining proximal penile skin and dartos fascia are dissected off Buck's fascia proximally to the base of the penis. The penile dermis is sutured to the lateral aspect of the tunica albuginea at the penopubic junction and mid shaft of the penis. This technique restores normal anatomical relationships with excellent cosmetic results and negligible complications. RESULTS: At a median 5-year followup cosmesis was excellent in all cases. Two patients with micropenis who required revision responded to endocrine therapy. CONCLUSIONS: Excellent cosmetic results were obtained in all cases using this surgical technique.     

Pneumocystis carinii pneumonia in mutant mice deficient in both TCRalphabeta and TCRgammadelta cells: cytokine and antibody responses

PURPOSE: A phenomenon known as hidden penis has numerous origins, including congenital buried penis and obesity with descent of the escutcheon. No previous report to our knowledge mentions abnormal hypermobility of ventral skin and dartos fascia, which is a major cause of surgical treatment failures. Because the skin and dartos fascia are inadequately attached to Buck's fascia, the corporeal bodies telescope proximally inside the scrotum and pubis. Therefore, the subdermis of the penoscrotal junction must also be tacked to the tunica albuginea ventrally to stabilize the proximal penile skin and prevent the penis from retracting into the scrotum. The surgical technique for correction of the hidden penis in adult and pediatric patients with adequate penile shaft skin is described. MATERIALS AND METHODS: Surgery for hidden penis from multiple causes was performed in 6 adults and 7 children. Tacking sutures were taken from the subdermis of the ventral penoscrotal junction to the tunica albuginea in all cases. A combination procedure with either suprapubic dermatolipectomy, tacking of the penopubic subdermis to the rectus fascia, penoscrotal Z plasty, circumcision revision or lateral penile shaft Z plasty also was performed in some patients. RESULTS: Improvement was noted in all cases. One child requires suprapubic lipectomy for optimal improvement and 3 minor wound problems occurred. CONCLUSIONS: Surgery for hidden penis achieves marked aesthetic and often functional improvement. Surgical failure can be diminished by placing ventral tacking sutures from the tunica albuginea to the subdermis of the penoscrotal junction.     

Surgical correction of torsion of the penis

Torsion of the penis is a rare anomaly, believed to be due to abnormal skin attachment and not to any structural abnormality of the corpora. The rotation is usually to the left in a counter-clockwise fashion. The urethral meatus is placed in a oblique position and the median raphe makes a spiral curve from the base of the penis towards the meatus. Three boys with congenital torsion of the penis are reported. A corrective operative for this condition is described. Penile torsion was first described by Verneuil in 1857, but in the past no operative correction was recommended, since attempts to move the skin around were believed not to correct the spiral alignment of the corpora cavernosa.     

A rare and little known variant of hypospadias

Hypospadia is a congenital defect presenting as different variants of dysplasia of the distal urethra with ectopy of the urethral external orifice and distortion of the penis. A variant of hypospadia not yet described in Russian medical literature was observed in a newborn boy. He had normal penis and scrotum, but on the under-side of the penis there was a site of thin skin protruding as a resonance bag in urination. At the site of the thin skin the back urethral wall was absent with a cavity covered by the thin skin. In urination urine filled the cavity blowing up the skin above it to the form of the resonance bag. This variant of hypospadia was designated as segmental urethral hypoplasia.     

Nd:YAG laser in the treatment of superficial lesions of the penis

In surgical treatment of benign and malignant lesions of the penis in addition to radicality also the demand of a favourable cosmetic result is stressed. The presented paper evaluates experience with the use of a Nd:YAG laser in condylomata acuminata and carcinoma of the penis. The author operated 51 men with condylomata acuminata of the glans, in 32 the external orifice of the urethra was affected. Treatment was successful in all patients with very good cosmetic results, relapses occurred in 11 patients. The author treated successfully also five patients with carcinoma of the penis classified as TIS and T1. In none of the patients a relapse was observed after a mean follow-up period of 15.4 months.     

Venous wall graft in Peyronie's disease (author's transl)

One patient with Peyronie's disease (induratio penis plastica) was treated utilizing plastic surgery to correct the penile curvature. The plaques which invaded the corpora were transversely incised and a section of the greater saphenous vein was sewn into the gap. Postoperatively, the penis is quite straight and the patient has resumed normal sexual intercourse.     

Effects of hydroxocobalamin on nitrergic transmission in rat anococcygeus and bovine retractor penis muscles: sensitivity to light

Hydroxocobalamin inhibited nitrergic nerve-induced relaxations in rat anococcygeus and bovine retractor penis muscles in a concentration-dependent manner. In the rat anococcygeus muscle, the inhibition was greater in light than in dark conditions, whereas in the bovine retractor penis the inhibition was similar under both conditions.     

Management of the buried penis in adults

PURPOSE: Buried penis, most commonly seen in children, is particularly debilitating in adults, resulting in the inability to void standing and it affects vaginal penetration. The pathophysiology, including scar contracture of the distal soft tissue and skin envelope with concurrent descent of the abdominal fat pad, represents a surgical challenge. We developed a management algorithm to evaluate and treat adults with buried penis. MATERIALS AND METHODS: From January 1, 1994 to May 1, 1996, 7 patients 23 to 66 years old presented with buried penis. Diabetes mellitus, a common co-morbid condition, was present in 5 patients, and 5 of 7 were morbidly obese. RESULTS: Surgical correction was performed in 5 patients with excellent results in 3. Resection of scar contracture was sufficient to provide adequate length and none required release of the suspensory ligament. Panniculectomy was performed in 1 patient. One man requiring a graft to achieve adequate penile coverage required reoperation. This patient had undergone a previous attempted repair with extensive contracture. All patients regained potency postoperatively. CONCLUSIONS: With appropriate planning and adherence to basic reconstructive surgical principles, correction of the buried penis can yield a high success rate.     

The penile disassembly technique in hypospadias repair

OBJECTIVE: To report experience and results with penile disassembly in hypospadias repair. PATIENTS AND METHODS: From November 1995 to May 1997 penile disassembly was used in 92 patients aged from 9 months to 32 years. The indications for operation were hypospadias with severe penile curvature (especially with curvature in the distal third of the corpora cavernosa), chordee without hypospadias, and small penis with hypospadias. The technique involves separating the penis into its component parts, i.e. the glans cap with neurovascular bundle dorsally, together with the undivided or divided urethra and urethral plate ventrally, and the corpora cavernosa. The manoeuvre allows any curvature to be corrected, especially when in the distal third of the corporal bodies, glans tilt to be rectified, and the penis to be enlarged, particularly elongated, which is a significant gain in small penises with hypospadias. RESULTS: The patients were followed for 3-20 months (mean 14); the penis was straightened in all cases, with no recurrence of curvature. In 37 patients (40%) penile disassembly combined with extensive urethral mobilization resolved the hypospadiac meatus with no need to form a neourethra; the penis was larger after surgery. Complications were related to urethroplasty and included four urethral stenoses, two fistulae and three diverticula. There was no injury to the neurovascular bundle and urethra; sensitivity and erection were preserved in all patients. CONCLUSION: The penile disassembly technique is most effective for hypospadias with severe curvature, especially for glans tilt and curvature located distally. Penile augmentation is possible using this technique.     

Fracture of the penis: two new cases. Review of the literature. Usefulness of echography

OBJECTIVE: To analyze the diagnostic and therapeutic difficulties in rupture of the albuginea penis and review the literature. METHODS/RESULTS: Two additional cases of penile rupture are described. Penile ultrasound evaluation disclosed a hematoma in the corpus cavernosum in one case and hematoma and a probable rupture of the albuginea penis in the other case. Treatment was by immediate surgery which achieved good cosmetic and functional results. CONCLUSIONS: Penile fracture is an uncommon condition which occurs when the penis is in erection. Ultrasound is useful in its diagnosis, but MRI is more precise. Treatment is by immediate surgery to avoid sequelae, which are common in cases treated conservatively.     

SRY and karyotypic status of one abnormal and two intersexual marsupials

An intersexual agile wallaby (Macropus agilis) with a penis, a pouch and four teats had a sex-chromosome constitution of XXY in lymphocytes and cultured fibroblasts; the sex-determining region Y (SRY) gene was present, consistent with the presence of a testis. An intersexual eastern grey kangaroo (Macropus giganteus) with a small empty scrotum and no penis, and an abnormal red kangaroo (Macropus rufus) with no penis, pouch or teats, both had XX sex-chromosome complements; the SRY gene was not present, consistent with testis absence. The agile wallaby and grey kangaroo described here provide further evidence that scrotal development in marsupials is independent of the Y chromosome. The cause of the abnormalities in the XX individuals cannot be determined until candidate genes are identified. These animals provide a basis for further genetic studies into marsupial intersexuality and sex differentiation.     

Visualization of the human cavernosum penis by using 99mTc-labeled autologous red blood cells

Penial scintiphoto-images were obtained by using 99mTc-labeled autologous red blood cells in three functionally impotent patients. The cavernosum penis was clearly pictured disclosing no organic abnormalities in these three patients' penises. This method enables one to present clear macroscopic images of the cavernosum penis without causing pain to the patient, and it may be recommended for clinical use as an alternative to cavernosography.     

Fixed drug eruption from amoxycillin

We present a case of fixed drug eruption on the genital mucosa induced by amoxycillin. Topical provocation was carried out, applying amoxycilin (10% pet) on the glans penis. No reaction was observed. Oral challenge with amoxycillin was followed by pruritic erythema on the glans penis 6 hours after the intake of 125 mg. The study of cross-reactivity to other betalactams showed good tolerance of phenoxymethyl-penicillin, which shares an identical nuclear structure with amoxycillin. The patient also tolerated cephadroxil, a cephalosporin with a side chain identical to that of amoxycillin. On reviewing the literature we have only found three reports of fixed drug eruption fue to amoxycillin.     

Squamous cell carcinoma of the penis and of the cervix, vulva and vagina in spouses: is there any relationship? An epidemiological study from Norway, 1960-92

Four hundred and twenty-three wives of 671 men with cancer of the penis were compared with 444 wives of 569 men who did not have this disease. The risk among the wives of patients with cancer of the penis of preinvasive and invasive cancer of the neck of the uterus was 1.75 (95% CI 0.42-7.37).     

Epidermal cyst of median raphe

Cysts of the penis are rare and references to them in standard textbooks are sketchy. A case report of a congenital epidermal cyst of the median raphe of the penis is presented; therapy involved excision of the mass. Review of the literature is given.     

Report of a case of traumatic avulsion of the penile skin with amputation of the glans

OBJECTIVES: A case of traumatic avulsion of penile skin with amputation of the penis and sectioning of the urethra is described. METHODS/RESULTS: Surgical management included embedding the penis without scrotal skin and subsequent reconstruction utilizing scrotal skin. The patient has recovered sexual activity, although sensitivity has been reduced as a consequence of penile amputation. Six months postoperatively, the patient has reported orgasm during intercourse. CONCLUSIONS: The surgical technique of embedding the penis is safe and preserves elasticity for subsequent reconstruction of the urethral meatus.     

The "small penis": considerations about subjective penile deficiency

In sexology clinical practice you can see quite frequently patients who make complaints about their penis not being big enough. The Authors suggest that the subjective feeling of penis deficiency is a symptom which needs to be properly diagnosed and understood, in order to be able to make effective therapeutic interventions, from a psychotherapeutic, psychopharmacologic or surgical point of view.