Carcinoma of the penis. Partial amputation of the penis.
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Aged↗
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[Cancer of the penis: report of 2 cases and statistical studies of cancer of the penis observed at our clinic for the past 11 years].
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Adult↗
Ultrasound-guided injection of contrast medium into the crus penis for diagnosis of erection failure in bulls.
The objectives of this study were to demonstrate the ability to cannulate the crurae of the bull's penis under ultrasound guidance, to demonstrate contrast medium injected by this route in the distal penis, and to confirm the technique to be safe and repeatable. Five adult bulls with normal serving ability were used, one being subjected to the procedure twice. The procedure was performed with the bulls under general anesthesia and in lateral recumbency. A spinal needle was passed through the skin and into the crus penis under ultrasound guidance and two syringes containing an iodine-based contrast medium were connected to it. Stimulation using an electro-ejaculator with a rectal probe was initiated, and when the penis started developing an erection, 50-100 ml of contrast medium was injected. Lateral and ventro-dorsal radiographs were taken of the extended penis during, and at intervals after, injection. After a rest period of 5 min, clearance of the contrast medium was confinned and the procedure was repeated on the other crus penis. Each case therefore, contained two attempts. Successful cannulation of the crus penis was confirmed by observing indentation of its fibrous wall by the needle, free flow of blood, lack of resistance to the injection of air, which could be seen in the crus, and fluctuation of resistance to injection in synchrony with the pulsation of the electroejaculator. Contrast medium was demonstrated in the mid or distal portion of the penis in all six cases, or on 9 of the 12 attempts. Attainment of penile erection, a larger volume of contrast medium, and the order of cannulation all enhanced flow of contrast medium to the distal portion of the penis, with the first crus giving better results. On one occasion the needle worked out of the crus penis during stimulation, resulting in injection of contrast medium into the corpus spongiosum penis. All bulls recovered uneventfully and returned to normal serving ability. It is concluded that ultrasound-guided cannulation of the crus penis is a safe and successful method for the injection of contrast medium for contrast studies of the penis, and is less invasive than the surgical method.
Animals↗
The inconspicuous penis.
OBJECTIVE: To describe the etiology and management of the group of abnormalities referred to as the inconspicuous penis. DESIGN: Analysis of 19 cases seen over a period of 2 years by chart review. SETTING: Children's hospital in a major metropolitan area. PATIENTS: Nineteen boys referred to two pediatric urologists over a period of 2 years with penises that appeared abnormally small, but on palpation and measurement, were found to have a normal shaft with a normal stretched length. Diagnoses included were buried penis, webbed penis, and trapped penis. Patients ages ranged from 1 week to 13 years. FINDINGS: There were eight patients (42%) with trapped penis, and all were complications of circumcision (age 1 week to 7 months). Of nine (47%) patients with buried penis, two had been circumcised prior to diagnosis. One (5%) patient had webbed penis and one (5%) had combined buried and webbed penis. INTERVENTION: Six trapped penises were surgically repaired, and two resolved spontaneously. Five patients with buried penis had surgical repair, and two are being followed up for probable repair at age 9 to 12 months. Two were not repaired because of medical conditions or parental concerns. The webbed penis was surgically repaired as was the combined buried and webbed penis. The repair were all successful and had no complications. CONCLUSIONS: Inconspicuous penis encompasses a group of conditions in which the penis appears small but the shaft can be normal or abnormal in size. Circumcision is contraindicated in these patients until they have been evaluated by a urologist. Further study is needed to determine the natural history of these disorders and to better define which patients will benefit from surgical intervention and at what age.
Adolescent↗
[Research advances in the diagnosis and treatment of inconspicuous penis of children].
Inconspicuous penis is a group of symptoms that can make penis body not be showed normally instead of a kind of simple disease. They are presented with conclude concealed penis, buried penis, webbed penis and trapped penis. Most of them are resulting from congenital abnormality except the trapped penis. The diminutive penis caused by hypospadia and intersex and micropenis resulted from endocrine disease does not belong to this category. Pathological changes of concealed penis, buried penis and webbed penis are congenital but trapped penis is caused by acquired reasons. It's not difficult to make the diagnosis by the pathological and clinical manifestations. According to different age's indication, type and severity of the disease, corresponding surgery method ought to be chosen and the curative effect can be obtained.
Child↗
What importance do women attribute to the size of the penis?
OBJECTIVE: A great deal of men consider that the size of the penis is directly proportional to its sexual power. Some men, who are worried that their penis is too small, wish to be considered for surgical lengthening or thickening procedures. The argumentation for this chiefly points in the direction of women. However, have women actually been asked about the extent to which they consider the size of the penis to be of importance from a sexual point of view? Or asked what they think about ideas surrounding the size of the penis in relation with actual sexual functioning? PATIENTS AND METHODS: To address these questions, 375 sexually active women who had recently given birth at the University Hospital Groningen were asked a number of questions about sexual functioning and the importance they attach to the size of their partner's penis. RESULTS: A total of 170 questionnaires were returned (response rate 45%); 20% of the women found the length of the penis important and 1% very important; 55% and 22% of the women found the length of the penis unimportant and totally unimportant, respectively. Opinions about the girth of the penis followed the same trend. Length was less important than girth: 21% and 32%, respectively. The women who found the girth of the penis important had the same opinion about the length of the penis (correlation 0.71, p=-0.001). Median division into two subgroups (girth important/unimportant; t-test) did not reveal any significant differences in relation with demographic data. Correlation analysis did not reveal any significant correlation between sexual functioning (measured with the NSF) and opinions about the girth of the penis. CONCLUSION: Although clearly in the minority, a nevertheless considerable percentage of the women respondents attached substantial importance to the size of the male sexual organ.
Anthropometry↗
Long-term outcome of the surgical treatment of concealed penis.
PURPOSE: The term concealed penis describes a spectrum of disorders ranging from penoscrotal webbing to a completely buried penis. A number of surgical procedures have been described to correct this condition but little has been written about long-term results. We report our long-term results of the surgical correction of concealed penis based on a survey of parents. MATERIALS AND METHODS: A retrospective review of patients treated from 1995 to 1999 identified 18 males with a minimum of 21 months of followup whose parents were available for evaluation via telephone interview. The parents were questioned about the initial problems that they associated with concealed penis, such as appearance and accessibility of the penis, ease of hygiene, severity of concealment and negative feelings about the appearance of the penis. Parents were also questioned about the results of surgery and how the surgical result improved or failed to improve their concerns. Specifically, they were questioned about whether the surgery helped to alleviate negative concerns, improve hygiene and make the penis more assessable. RESULTS: Of the 18 patients 14 were infants/toddlers (group 1) and 4 were adolescents (group 2). Group 1 patients with a mean age of 2 years were evaluated at a mean of 41.7 (range 21 to 76) months and group 2 patients with a mean age of 12 years were evaluated at a mean of 38.8 (25 to 63) months after surgery. Before surgery 57% of patients in group 1 and 50% in group 2 complained of difficulty with hygiene. Of the parents 64% of group 1 and 75% of group 2 described their child as having a completely hidden penis. On the other hand, only 57% of parents in group 1 expressed negative feelings about the appearance of the penis compared to all parents in group 2. Following surgery group 1 patients fared better reporting improvements in hygiene (87%), accessibility (86%) and improved appearance of the penis (100%). Results from surgical intervention were less successful in group 2, with improved hygiene in 50%, improved penile accessibility in 75% and improved appearance in 50% of patients. Interestingly, all group 2 parents would still recommend the same surgery to a friend with the same problem despite less than perfect results compared to 79% of group 1 parents who would recommend surgery to others. CONCLUSIONS: Our long-term outcome survey data demonstrate that surgical correction of concealed penis addresses an array of presenting complaints. According to the parents of patients surgery is almost uniformly successful in toddlers and less often successful in adolescents. However, despite its limited success in older patients, most parents thought that surgery was a positive intervention and would recommend it to a friend with a similar condition.
Adolescent↗
[Penis deviation correction using Schröder's method and patients' postoperative quality of life].
Most frequent methods of penis deviation operative treatment are penis corporoplastics after Schröder and Nesbit. The penis corporoplastics can be followed by early complications (bleeding from the penis, recrudescent deviation due to suture cut-out, reduced or extinct sensitivity of the penis head as a result of n. dorsalis penis injury, etc.) or tardy ones (scarring phymosis, recrudescent deviation due to the scar, etc.). The objective of the study is to assess the quality of the patients' life after the operation (penis corporoplastics after Schröder) and any possible post-operative complications. The medical documentation of twelve patients, who were operated in the aforesaid manner at Kaunas 2(nd) Clinical Hospital and Kaunas Clinics of General Medical Practice in 1994-2001, was checked. Before the operation all the patients had penis deviation diagnosed (two ventral, two lateral and five mixed) resulting from congenital penis curvature. The indication for the operation of all the patients was aggravated intercourse. None of the patients showed early post-operative complications. When the patients were checked 6 months and 1 year later there were no tardy post-operative complications, either. All the patients were satisfied with the quality of life after the operation - there was no deviation, the erection and intercourse were normal. Penis corporoplastics after Schröder is a proper method to be used for correction of inherent penis deviations.
Adult↗
Vascularization of the male penis.
PURPOSE: The study of the features of the blood supply of a penis of the man. MATERIAL AND METHODS: Macromicropreparation, angiography, corrosion method, morphometry, statistical method. RESULTS: The penis has three venous collector-executing outflow of blood. First of them is submitted surface dorsal vein, which is shaped from small-sized venous vessels of skin, subcutaneous fat and surface fascia of penis. The beginning deep dorsal vein, which will derivate second venous collector, gives veniplex of head of the penis. The spongy veins outstanding as third venous collector, reach the bulb of penis, where they receive small-sized bulbar vein. The arterial blood supply of penis happens at the expense of external and internal pudendal arteries. The external pudendal artery starts from an internal wall of femoral artery on 2.5-2.7 cm below inguinal ligament. In some cases (8%) the artery starts by two trunks--forward and back. The internal pudendal artery is main source of blood supply of penis of the man. It removes from forward trunk of internal iliac artery independently in 50% of cases. In remaining cases it or removes from this artery by one trunk with lower gluteal (36%), common trunk with the upper and lower gluteal arteries (4%), or with upper gluteal (8%), or with obturator artery (2%). Besides in the arterial blood supply of penis take part bulbar, urethral, dorsal and deep arteries of penis. CONCLUSIONS: The penis receives blood from external and internal pudendal arteries, which are very variable. The venous blood of the penis flows off in three types of veins.
Adult↗
Proximal-distal sequence of development of the skeletal tissues in the penis of rat and the inductive effect of epithelium.
The penis of adult rats comprises the corpus cavernosum penis and the proximal and distal segments of os penis which are situated proximal-distally in this order. Androgens are necessary for the phenotypic differentiation of these tissues. In the present study, genital tubercular mesenchyme of foetal rats was recombined with or without homologous or heterologous epithelia and transplanted beneath the kidney capsule of syngeneic adult male rats, and the development of the corpus cavernosum penis and the os penis in the transplants was examined. Only in the presence of epithelia can the genital tubercular mesenchyme acquire the capacity for differentiation into the corpus cavernosum penis, the proximal segment of os penis, and the distal segment of os penis in this chronological order. The inductive effect of epithelium is a permissive step in the differentiation of the os penis of rat. The epithelium seems to be necessary for the process of rudiment formation of the os penis and the corpus cavernosum penis.
Animals↗
Impotence in the boar: angioarchitecture and venous drainage of the penis in normal boars.
Twenty penis from normal boars were injected with various media at known reservoir pressures and examined by radiography, dissection, maceration, clearing and sectioning. Injections into the corpus spongiosum penis (csp) produced dorsal deviation and clockwise spiral twisting. The ccp was traversed by a system of large longitudinal cavernous spaces. The csp consisted of one large vascular space, its walls joined by trabeculae which were close together ventrally and further apart dorsally. The corpus spongiosum glandis (csg) was a vascular network within the penile integument communicating with the csp by fine vascular spaces around the urethral orifice. The penile arteries and veins were supplied and drained by the internal pudendal vessels. The ccp was drained from its crura by the v profunda penis but no venous drainage of this cavernous body was demonstrated within the body of the penis. The csp was drained from its bulb by the v bulbi penis; its distal extremity was drained by two large veins which ran proximally enclosed by the tunica albuginea of the csp. The right vein was always much larger than the left vein and at the sigmoid flexure the two united to form the right tributary of the v dorsalis penis. The csg and the entire penile integument were drained by the left tributary of the v dorsalis penis; the csg was also drained by one or both of the ventral veins of the csp. Blood from the scrotum was drained by the v circumflexa perinealis and v perinealis ventralis into the v dorsalis penis and v penis. A large dorsal lymphatic vessel drained lymph from the body of the penis into the pelvic lymph nodes. No connections with the superficial inguinal lyphocentres were identified.
Animals↗
Peripheral distribution of the human dorsal nerve of the penis.
PURPOSE: The integrity of the dorsal nerve of the penis is crucial for normal erectile and ejaculatory function. To our knowledge a description of this nerve along the phallus has not been formally described. We illustrate the distribution of the dorsal nerve of the penis to the penile shaft, anterior urethra and glans. MATERIALS AND METHODS: Neuroanatomical dissections were performed on 28 cadaver penis specimens. Electrodiagnostic testing was conducted on 10 healthy male subjects to confirm the anatomical findings. RESULTS: The dorsal nerve of the penis consists of 2 populations of axons, one to innervate the penile shaft and urethra, and the other to innervate the glans. Stimulation of the urethra resulted in responses recorded in the main trunk of the dorsal nerve of the penis and stimulation of the nerve evoked responses within the urethra. Bulbocavernosus muscle contraction was elicited following urethral stimulation. CONCLUSIONS: Urethral innervation by the dorsal nerve of the penis supports the view that urethral afferent impulses are a component of reflex ejaculatory activity. The pattern of glanular innervation by the dorsal nerve of the penis identifies the glans as a sensory end organ for sexual reflexes. The undulating character of the dorsal nerve of the penis is a mechanism by which the nerve can accommodate to significant changes in penile length with erection. Electrodiagnostic studies of the dorsal nerve of the penis should be modified to consider the anatomical findings.
Adult↗
Results of a simplified technique for buried penis repair.
PURPOSE: The buried penis can cause secondary phimosis, recurrent balanitis and social embarrassment. We report our results using a simplified technique for repair. MATERIALS AND METHODS: A retrospective chart review of 83 consecutive patients undergoing buried penis repair between March 1995 and March 2001 was performed. Indications for surgery included recurrent balanitis, secondary phimosis, difficulty holding the penis during voiding, spraying of the urinary stream, or parental or patient concern for social embarrassment. The technique involves fixation of the subcutaneous penile skin at the base of the degloved penis to Buck's fascia of the penile shaft at the 3 and 9 o'clock positions. RESULTS: For the 79 patients included in the study average followup was 4.4 years. Group 1 consisted of 26 patients who underwent circumcision at the time of buried penis repair. Six patients had hypospadias and 13 had penoscrotal webbing that was repaired simultaneously. Three patients (11.5%) had recurrent buried penis that required a repeat procedure and 1 (3.8%) required revision of the circumcision only. Three patients (11.5%) with penoscrotal webbing had mild recurrence requiring no further treatment. Group 2 consisted of 49 patients who underwent revision of the circumcision at the time of buried penis repair. Seven patients (14.3%) had mild recurrence that did not require further treatment. Group 3 consisted of 4 patients who underwent liposuction at the time of buried penis repair. One patient experienced lymphedema of the ventral distal shaft skin, which required subsequent excision. CONCLUSIONS: The buried penis repair is a simple and effective outpatient procedure with few complications and recurrences. It can be used as a primary or secondary procedure and affords good cosmetic results.
Adolescent↗
[The microvascularization of the penis of the steer (Bos taurus)].
The blood supply and the microvascularization of the bovine penis (Bos taurus) were demonstrated using the scanning electron microscope. The Corpus cavernosum penis of the bull consists of a surprisingly well-developed mesh of small to intermediate vessels. The architecture of the cavernous body is largely determined by trabeculae of connective tissue, the extent of which varies between penis segments. The Corpus cavernosum is arranged primarily as a ring around the trabeculae of connective tissue. Chambers of large bore are found in the central portions of the Corpus cavernosum penis, whereas a relatively fine vascular network predominates in the periphery. Vessels in the cavernous body of the urethra, on the other hand, show strictly parallel orientation to the urethra, which they surround like a sleeve. They also stand in close association with vessels in the outer layer of the Tunica albuginea. The vascular systems of the Corpus cavernosum penis and the Corpus spongiosum penis are not connected with one another. The vascular architecture of the Glans penis is characterized by the inclusion of well-developed vascular arcades at regular intervals. These course through a connective tissue matrix rich in glycoproteins and stretch to just under the skin of the penis, where they are intimately associated with a subpapillary network of arteries and veins. The venous legs of the vascular arcades are supplied by this network of veins. The Glans penis of the bull is considered to represent a specialization of the penile integument.
Animals↗
[Reparative treatment of urethral defect in adult penis].
OBJECTIVE: To summarize the methods of repairing the urethral defect in the penis of an adult and the clinical application of the island skin flaps of the scrotum septum to the reparative treatment. METHODS: From January 2000 to November 2005, twenty-six cases of urethral defect in penis, including 16 cases of congenital urethral defect, 6 cases of traumatic urethral defect in middle penis, and 4 cases of distal urethral defect, were repaired by the local penis fascia flaps. The island skin flaps of the scrotum septum were transferred to cover the penis wound. The pedicle contained the artery of the posterior scrotum and the artery of the anterior scrotum. The flap taken from the scrotum septum was 2.5 cm x 5.5 cm in area. RESULTS: After a follow-up of 7 months to 4 years, all the 26 patients had the healing of the first intention without urethral fistula, urethral narrowness or penis curvature, except 4 patients who developed infection and leakage of urine, but the wounds healed spontaneously 2-4 weeks after operation. CONCLUSION: The penis fascia flaps and the island skin flaps of the scrotum septum can be used to repair the urethral defect in the penis of an adult. The blood supply to the flaps is sufficient and all the flaps can survive well. A good shape and function of the penis can be obtained.
Adolescent↗
The penis morphology of the four-eyed opossum Philander opossum.
The penis of the Philander opossum is found in post-scrotal position and attached to the schiatic arch by means of a suspensory ligament. The bulk of the penile musculature is formed by the ischio-cavernosus (IC) and bulbo-spongiosus (BS) muscles, which converge caudo-medially to join the radix penis. The paired levator penis muscles are encaised in the radix and fuse to each other ventrally to the urethra forming a long tendon. The erectile tissue arisen from the BS forms the corpus spongiosum of the urethra and the corpus cavernosum starts within the IC. The urethral mucosa is longitudinally folded and lined with transitional epithelium. The body of the penis shows a pronounced sigmoid flexure which runs ventro-dorsally, with ventral, intermediate and dorsal segments. The retractor penis (RP) muscles insert in both sides of the penile dorsal curvature. The fascia of the penis is thick and surrounds the corpus cavernosum, the corpus spongiosum of the urethra and the final part of the levator penis muscles. The body-glans transition initiates with the formation of a mid- ventral groove which progressively reaches the urethral lumen; the mid-dorsal groove initiates farther distally and also reaches the urethra. The transition of urethra into urethral grooves is characterized by the modification of transitional into stratified squamous epithelium. The glans penis is bifid and has slender tips. Each urethral groove are situated on the medial-ventral surface of each glands tip. The penis in the non-erect state is partially situated in the preputial cavity; when erected, projects through the cloaca, unfolding the sigmoid flexure. The preputial sac is formed by the lamina externa (without hair follicles but having preputial glands), the lamina interna (which shows cornified areas and delimit externally the opening of the preputial cavity) and the visceral lamina, very folded and with numerous cornified spicules.
Animals↗
The diagnosis of short penis as a cause of impotentia coeundi in bulls.
Short penis condition was diagnosed as the cause of impotentia coeundi in 10 bulls, aged 2.5 to 5 yr. The diagnosis was based on observation of service attempts, measurement of the extended penis, and elimination of other causes of impotence. Measurements of the penis were made under general inhalation anesthesia or pudendal nerve block. These measurements were then compared with those of 10 control bulls, matched for age and breed and having no history of impotence; the latter measurements were likewise obtained under general anesthesia, pudendal nerve block or sedation. with propionyl promazine. Similar measurements were obtained from 10 yearling bulls under propionyl promazine sedation. Measurements obtained under general anesthesia or pudendal nerve block in the same bull were usually similar and repeatable, while phenothiazine tranquillization produced incomplete and variable relaxation of the retractor penis muscles. The dimension best correlated with impotence due to short penis was the distance from the tip of the extended penis to the preputial orifice in its resting position. In 10 bulls in which short penis was diagnosed, this distance was 10 to 22 cm, while in 10 control bulls with no history of impotence it was 25 to 42 cm. The distances from the tip of the extended penis to the preputial reflection (fornix) and to the neck of the scrotum were also shorter in affected than in control bulls. Although observation of service ability remains the cornerstone of diagnosis of short penis, a presumptive diagnosis can be made if penile protrusion of less than 25 cm can be obtained in an adult bull under general anesthesia or pudendal nerve block. Phenothiazine tranquillization is suitable for screening examinations but not for definitive diagnosis.
Journal Article↗
Blood flow to the corpus cavernosum penis in the bull and goat buck during penile quiescence.
Bulls and bucks were used to study the blood flow into and out of the corpus cavernosum penis (CCP) during the non-erect state of the penis. When contrast medium was injected into the dorsal artery of the penis in a bull cadaver and into surgically implanted catheters of anesthetized bucks, it flowed into the cavernous spaces of the CCP via the penetrating arteries. When contrast medium was injected directly into the CCP of the bull and buck there was no evidence of vascular exits along the body of the penis. The only venous outlets from the CCP were in the crus penis area. In the non-erect penis the vascular pressure within the CCP was 17.8 mm Hg higher in the bull and 8.3 mm Hg higher in the buck at the glans area than the crus area. During the non-erect state of the penis most of the blood flow to the CCP is from the dorsal artery of the penis via the penetrating arteries. The results showed that the pressure gradient provides the means for flow of blood from the glans area toward the base or crus penis area. This flow prevents platelet aggregation and clot formation and provides nutrition to local tissue during the long periods of non-erection.
Journal Article↗