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At least 343 records · Page 19Linked to original sources
PubMed1997

Regional anaesthesia for circumcision. Subcutaneous ring block of the penis and subpubic penile block compared.

In this prospective study techniques for the subcutaneous ring block of the penis and subpubic block of the penis for analgesia after circumcision were compared. Forty-five boys having circumcision as day-case patients were allocated randomly to have either a subcutaneous ring block or a subpubic penile block. The blocks were inserted after induction of anaesthesia but before surgery. Pain scores at 15, 30, 45 and 60 min post-operatively were recorded. Side effects and analgesic requirements in hospital were recorded post-operatively. Analgesia (morphine, paracetamol or diclofenac) was given depending on the pain score. One patient was withdrawn from the study. Four of the 24 boys who had subpubic penile blocks and nine of the 16 boys who had subcutaneous ring blocks were given morphine for post-operative pain (P = 0.015). The surgeons complained about oedematous tissues in three patients, all of whom had had subcutaneous ring blocks. The subpubic penile block provided significantly better analgesia than the subcutaneous ring block of the penis.

Child, Preschool↗
PubMed1996

The prepuce: specialized mucosa of the penis and its loss to circumcision.

OBJECTIVE: To assess the type and amount of tissue missing from the adult circumcised penis. MATERIALS AND METHODS: The gross and histological features of the prepuces of 22 adults obtained at autopsy were assessed, primarily focusing on the inner or mucosal surface of the prepuce. RESULTS: Skin and mucosa sufficient to cover the penile shaft was frequently missing from the circumcised penis. Missing tissue included a band of ridged mucosa located at the junction of true penile skin with smooth preputial mucosa. This ridged band contains more Meissner's corpuscles than does the smooth mucosa and exhibits features of specialized sensory mucosa. CONCLUSION: The amount of tissue loss estimated in the present study is more than most parents envisage from pre-operative counselling. Circumcision also ablates junctional mucosa that appears to be an important component of the overall sensory mechanism of the human penis.

Adult↗
PubMed1997

Neuroanatomical ontogeny of the human fetal penis.

OBJECTIVE: To determine the development of the human penis, and hence the cause of congenital anomalies, using an immunohistochemical analysis of fetal penile ontogeny. MATERIALS AND METHODS: In 25 human fetal penile specimens (gestational age 8 to 23 weeks) various tissues were localized immunohistochemically using stains for alpha-actin (smooth muscle), cytokeratin 8 and 14 (epithelium) and protein gene-product (PGP) 9.5 (neurons). RESULTS: Nerves were identified in the penis with anti-PGP in specimens of all ages, prominent dorsally at the 11 and 1 o'clock positions but also extending around the tunica to the junction of the corpus spongiosum and corpora cavernosa, suggesting that these structures may be injured in procedures which straighten the penis. The nerves continued into the glans on the dorsal aspect, suggesting that glans reduction in feminizing genitoplasties should be performed on the ventral aspect. Smooth muscle was first noted at 10 weeks' gestation, with epithelial differentiation occurring in the earliest specimens studied (8 weeks' gestation). With time, smooth muscle density was highest in the corpus spongiosum, especially between it and the corpora cavernosa. Smooth muscle also developed close to the urethral epithelium. The tunica albuginea showed consistent variations in thickness, with the mid-dorsal 12 o'clock position being the thickest, followed by the 5 and 7 o'clock periurethral positions. CONCLUSION: A better knowledge of penile development and of the relationship of the nerves to the corpora cavernosa is useful in the strategic design of penile straightening procedures and feminizing genitoplasties.

Actins↗
PubMed1998

Neuroanatomy of the penile portion of the human dorsal nerve of the penis.

OBJECTIVE: To determine the distribution of the dorsal nerve of the penis (DNP), the principal somatosensory nerve innervating the phallus, along the penile shaft and within the glans penis. MATERIALS AND METHODS: The DNP was dissected in human autopsy specimens, using low magnification, following the course of the nerve from the symphysis pubis into the glans penis. RESULTS: The shaft and glans were innervated by separate populations of axons. The lateral and ventral portions of the penile shaft were innervated by branches arcading from the dorsal midline radiating toward the ventral surface. These branches were very variable and some were seen to penetrate the corpus spongiosum. The axons innervating the glans were constant in a dorsal, midline location along most of the penile shaft, and once within the glans, there was abundant branching. Undulations in the nerves were noted along the penile shaft. CONCLUSIONS: The lateral arcading branches of the DNP provide a sensory pathway on the ventral and lateral penile shaft, and the termination of the fibres at the corpus spongiosum is consistent with pudendal innervation of the penile urethra. The distinct pattern of innervation of the glans emphasizes the role of the glans as a sensory structure. These findings may aid in planning penile surgical procedures.

Aged↗
PubMed2000

The histological extent of the local spread of carcinoma of the penis and its therapeutic implications.

OBJECTIVE: To explore the possibility of reducing the margin of clearance at surgery for carcinoma of the penis without causing an increase in the incidence of local tumour recurrence, so that the functional and cosmetic compromise associated with penectomy might be minimized. PATIENTS AND METHODS: Sixty-four patients underwent partial or total penectomy based on the extent of tumour. The specimens were evaluated histologically for grade and for proximal microscopic extensions beyond the grossly visible tumour margin, by examining serial proximal 5 mm sections. The histological grade of the lesion was correlated with its clinical site, morphology and proximal microscopic spread. Differences were assessed using the chi-squared test. RESULTS: Of 64 tumours, 31% were grade 1, 50% grade 2 and the remaining 19% grade 3. Higher grade lesions were more likely to involve the penile shaft. The maximum proximal histological extent was 5 mm for grades 1 and 2, and 10 mm for grade 3 tumours; there was no discontinuous spread. CONCLUSIONS: Histological grading is mandatory in the management of carcinoma of the penis. A 10-mm clearance is adequate for grade 1 and 2 lesions, and 15 mm for grade 3 tumours. This approach would qualify more patients for partial rather than total amputation; the residual length of the penis would then be cosmetically and functionally more acceptable.

Humans↗
PubMed1999

Peyronie's disease--incision and dorsal vein grafting combined with contralateral plication in straightening the penis.

OBJECTIVES: To evaluate the effectiveness of incisions of Peyronie's plaque and vein grafting combined with contralateral plication to straightening the penis. PATIENTS AND METHODS: Twenty-four patients with Peyronie's disease were treated surgically with a vein patch grafting technique to correct penile curvature. Median penile deviation was 70 degrees (range 60-90 degrees ), in 1 patient curvature was 30 degrees and all were unable to have normal sexual intercourse. The deep dorsal vein was excised and opened longitudinally. Transverse relaxing incisions about 1-2 cm long were made on the plaques at the point of maximal curvature, then, two other lateral incisions were made on both ends at 3 and 9 o'clock. The endothelial side of the harvested vein was placed in contact with the cavernous tissue to cover the defect created. Application of the contralateral surface of the tunica albuginea was performed in 21 cases to straighten the penis. RESULTS: After a median follow-up of 24 months, 19 patients were able to perform sexual intercourse, 3 patients who required intracavernous injection to maintain erection presented pre-operative adverse factors affecting erectile function. One patient returned to baseline pre-operative curvature. Twelve patients reported penile shortening, although only 5 patients were concerned about it. None of the patients permanently lost sensation in the glans of the penis. Palpable knots on the site of plication were reported in 5 patients. CONCLUSIONS: Plaque incision and placement of a deep dorsal vein patch graft, combined with contralateral corporeal plication, is a relatively simple, safe and effective alternative to correct angulations greater than 60 degrees.

Adult↗
PubMed1983

Microsurgical replantation of a completely amputated penis.

Replantation of a penis with microsurgical repair of vessels and nerves can restore normal genitourinary function. A case is presented of an amputated penis that was ischemic for sixteen hours before being microsurgically revascularized. The patient has at all times appreciated having an intact penis despite the fact that the injury was self-inflicted. Self-mutilation is not considered to be an absolute contraindication to replantation.

Adult↗
PubMed1986

Fournier's gangrene of the penis: a report of two cases.

Fournier's gangrene is a rare disease involving the scrotum and penis with occasional extension up the abdominal wall. Both of our cases were unusual in that only the penis was involved. In addition, the occurrence of squamous cell carcinoma in an area previously affected by Fournier's gangrene has never been reported. The usual organism is an anaerobic streptococcus synergistic with some second organism. Early therapy is key, including debridement of the entire shaft of the penis distal to the devastated area, intravenous broad-spectrum antibiotics, and skin grafting.

Carcinoma, Squamous Cell↗
PubMed1990

Axial flaps for treatment of penis lesions due to granulomas.

Granulomas can result from subcutaneous injection of ointment into the penis to augment its bulk. Rigid, infiltrated granulomatous and scar tissue prevents coitus, often ulcerates, and must be excised. Large segmental or circumferential defects of the penile integument must be covered with soft, pliable skin. We describe our experience with axial skin-fat flaps taken for this purpose from the groin region. There are two well-known vascular bundles, the arteria circumflexa ilium superficialis (ACIS) and arteria epigastrica superficialis (AES). Both were used successfully (the ACIS in 3 patients and the AES in 1) to provide island skin territories sufficient for resurfacing even a completely degloved penis (1 patient) with primary donor wound closure and rapid healing. In addition, a new flap, based on the arteria pudenda externa, was designed and implemented in 1 patient. The donor potential of the groin and lower abdominal region amply meets the requirements for penis reconstruction. Therefore, it is surprising that axial flaps have not yet become broadly accepted.

Adult↗
PubMed1994

An empirical study of Freud's penis-baby equation.

One hypothesis of traditional psychoanalytic theory holds that a cardinal aspect of the "natural" development of femininity involves the woman's substitution of the wish for a baby in place of her original wish for a penis. The current study modified and extended earlier research examining the validity of Freud's this "penis-baby" theory. College-aged women and men were presented with either subliminal or supraliminal auditory messages concerned with either pregnancy or penetration themes. Subjects' written responses to Holtzman ink-blots, obtained both before and after exposure to an auditory message, were content-coded for phallic imagery and sexual imagery. Consistent with Freud's speculations about the phallic significance of pregnancy for women, female subjects who were exposed to the subliminal pregnancy message produced significantly more phallic imagery responses to ink-blots than did women in any of the other experimental conditions (p < .01). The phallic imagery production of males did not vary significantly as a function of message condition. Implications of these findings are discussed in the context of modern revisions to Freud's psychology of women and the current psychoanalytic conceptualization of penis envy as a highly condensed mental product with many layers of meaning.

Adolescent↗
PubMed1995

Management of gunshot injuries to the penis and anterior urethra.

OBJECTIVE: To verify the appropriate methods of diagnosis and treatment of gunshot injuries to the penis and anterior urethra. DESIGN: Retrospective study. MATERIALS AND METHODS: Fourteen patients presented over 5 years with gunshot wounds to the male genitalia with injuries involving the penis and or the anterior urethra. All patients underwent a full physical examination and retrograde urethrogram to fully stage suspected injuries. RESULTS: Of the nine patients sustaining penile wounds, four were superficial, requiring only debridement, and five involved the corpus cavernosum, necessitating formal repair. Physical findings of an expanding hematoma, a palpable corporeal defect, and excessive bleeding via the wounds were indicative of cavernosal injury and warranted a penile exploration. All patients were potent in follow-up, although two patients with extensive injuries did complain of curvatures. Retrograde urethrograms noted anterior urethral injuries in eight patients, three of whom also had sustained cavernosal injuries. Five were repaired primarily, and three were treated by urinary diversion via a suprapubic tube. Three patients developed urethral strictures: one in the primary repair group and two in the diversion group. CONCLUSIONS: The preferred method of handling low-velocity gunshot wounds to the penis and anterior urethral includes debridement of superficial wounds, repair of cavernosal defects, and primary repair of urethral injuries wherein tissue loss is not extensive to result in high-potency rates and lower rates of urethral stricture disease.

Adolescent↗
PubMed1996

An unusually avulsed penis successfully replanted by using microsurgical technique.

An unusually avulsed penis and its successful microsurgical replantation is reported. The penis was self-avulsed between the superficial fascia of the shaft, and the shaft was cut distally, just proximal to the glans, with the whole glans and a short part of the shaft hanging in the avulsed skin of the penis. According to our search in the literature, this is the first successful replantation of such a case by microsurgery. The blood circulation of the replant was reestablished, after 15 hours of tissue ischemia, by means of microsurgical vascular anastomosing of the minimal subcutaneous vessels in the skin. Both the skin and the glans survived, indicating the alternative possibility of replantation of avulsed penile skin by microsurgery, rather than by skin grafting.

Adult↗
PubMed1997

Cheng's method for reconstruction of a functionally sensitive penis.

This article introduces a new surgical method for one-stage reconstruction of the penis. It is applied to the reconstruction of the microphallus as well as to traumatic cases with the residual stump of the amputated penis not less than 3 cm long. By transferring the original glans or the residual penile stump to the anterior portion of the newly reconstructed penile body with microsurgical techniques, we have thus rebuilt a penis with more satisfactory results in both appearance and erotic sensation. Seven patients are reported here who were operated on by this method and who have been followed up for 18 months to 10 years. The good results achieved and the method's advantages over other methods are demonstrated and discussed.

Adolescent↗
PubMed2000

Modified penis lengthening surgery: review of 52 cases.

A modified surgical method for penis lengthening was, for the first time, set up in this laboratory. The procedure involves covering the dissected corpus cavernosum with either a scrotal flap or a skin graft after releasing the superficial ligament and even some deep suspensory ligament. The advantage of the scrotal flap is emphasized to cover the wound, and a V-Y suture was made to avoid the traction. The results, both in appearance and increased length, were satisfactory in 52 cases. Among the 52 patients, 39 suffered from congenital short penis and 13 from traumatic injuries. The significance and the blood supply of the penis are discussed.

Adult↗
PubMed2006

Potential HIV-1 target cells in the human penis.

OBJECTIVES: To study the distribution of HIV-1 receptors and degree of keratinization in the human penis. DESIGN: Formalin-fixed penises were obtained from nine uncircumcised cadavers. Foreskins were obtained from 21 healthy adult men undergoing elective circumcision for social reasons. Uncircumcised penises were obtained within 24 h of death from eight men. All tissues were stained for keratin and HIV-1 receptors. METHODS: Penises from nine formalin fixed cadavers aged 64-80 years were obtained from the Department of Anatomy, University of Melbourne. Foreskins were obtained from 21 men aged 18-64 years following circumcision performed at either the Freemason's or Mercy Private Hospitals, Melbourne, Australia. Fresh penile necropsy specimens from eight uncircumcised men aged 23-63 years were obtained from the Victorian Institute of Forensic Medicine, Melbourne. The degree of keratinization was scored, and the distribution of HIV-1 susceptible cells was mapped in the glans penis, penile urethra, urethral meatus, frenulum and foreskin. RESULTS: Cells with HIV-1 receptors were present in all penile epithelia, but Langerhans' cells were most superficial in the inner foreskin and frenulum. The inner foreskin had a significantly thinner keratin layer (1.8 +/- 0.1 units), than the outer foreskin (3.3 +/- 0.1), or glans penis (3.3 +/- 0.2), P < 0.05. CONCLUSIONS: Superficial Langerhans' cells on the inner aspect of the foreskin and frenulum are poorly protected by keratin and thus could play an important role in primary male infection. These findings provide a possible anatomical explanation for the epidemiologically observed protective effect of male circumcision.

Adolescent↗
PubMed2005

Split-thickness skin graft for the management of concealed penis.

PURPOSE: We review the use of split-thickness skin grafting in children with concealed penis. MATERIALS AND METHODS: Medical records were retrospectively reviewed for all patients younger than 20 years seen at our institution from 1995 to 2003 with a diagnosis of concealed penis. Patients were separated into "primary" and "secondary" groups based on the cause of concealment. Primary factors were prominent prepubic fat pad, dysgenetic dartos fascia or both. Secondary factors were post-circumcision phimosis and overzealous circumcision. RESULTS: A total of 26 patients 1 month to 19 years old were treated. In the primary group of 23 patients 11 underwent lysis of dartos fascia. Four of these 11 patients had insufficient skin, and split-thickness skin grafting was necessary to resurface the penile shaft. Five of the patients underwent excision of the fat pad only, and 2 underwent excision of the fat pad and lysis of fascia. Five patients are being observed. Of the 3 patients in the secondary group 1 underwent manual reduction of post-circumcision phimosis, 1 underwent scrotal flaps and 1 is being observed. Followup ranged from 2 weeks to 46 months (mean 13 months). Of 20 surgically repaired patients 19 (95%) had an excellent cosmetic result, were satisfied with penile length and reported no voiding complaints. CONCLUSIONS: The surgical approach for correcting concealed penis varies, depending on the cause. Of our 26 patients 4 (15%) had insufficient penile skin to resurface the penile shaft. In these select children split-thickness skin grafting provided a good cosmetic appearance and functional result.

Adolescent↗
PubMed2005

The concealed penis: management and outcomes.

PURPOSE OF REVIEW: Management of the concealed penis continues to evolve, with several manuscripts having been published over the last several years. Each describes a novel surgical approach, as well as outcome data. Recently a non-surgical, conservative, approach has also been published. Our goal with this review is to examine the most recent work, highlight the commonalities and differences in technique and compare their results. RECENT FINDINGS: The surgical techniques all adhere to several common principles, and all accompany excellent results. The different manuscripts highlight the importance of classification based upon the underlying cause, as this directs surgical technique. The recent report by Radhakrishnan et al. is the first to describe the successful use of conservative management in select cases, a very appealing approach. SUMMARY: Appropriate management requires a solid understanding of the variable causes of the concealed penis. This allows a more tailored surgical approach and improved outcomes. Accordingly, the management of concealed penis can include a successful non-surgical approach.

Humans↗
PubMed2006

Reconstructive surgery of the penis.

PURPOSE OF REVIEW: Diseases of the penis are common, and the aim now is the preservation of function and cosmesis of the penis using modern penile reconstructive techniques. Penile cancer, Peyronie's disease and trauma are the three pathologies assessed. RECENT FINDINGS: Modern conservative organ-sparing surgery in penile cancer has shown that good oncological control can be gained by 2 mm margins that allow preservation of sexual function. Early intervention in the traumatic penis gives better results whereas the Nesbit operation is still the gold standard for Peyronie's disease as the quest for an alternative graft to saphenous vein continues. SUMMARY: The current operations of choice in penile reconstruction are glansectomy and skin grafting to fashion a neoglans in penile cancer and the Nesbit operation or saphenous grafting for Peyronie's disease.

Humans↗