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Crohn's disease is a chronic granulomatous disorder, which may involve any segment of the gastrointestinal tract from the mouth to the anus. Although extraintestinal manifestations are frequent, involvement of skin distant to the gastrointestinal tract is uncommon. We report a case of Crohn's disease affecting penile and scrotal skin.
Cavernous body radiography is of great importance in the diagnosis of penile disorders. An exact localisation of structural changes of the cavernous bodies is possible and also identification of venous leaks causing erectile dysfunction.
Using computerized image analysis the percentage of smooth muscle fibers was measured in several biopsies of the penis from 10 cadavers and 5 patients with vascular impotence. No significant difference was observed between the proximal and distal areas, and/or between the peripheral and central areas in 1 corpus cavernosum, and between the 2 corpora cavernosa for each patient or cadaver. The percentage of smooth muscle fibers was less in impotent patients in comparison with the cadavers, in which the erectile status was not known, and this reduction occurred throughout both cavernous bodies. Vascular impotence is a diffuse penile disease. Therefore, a cavernous body biopsy can be used to study the penile structure in the assessment of vascular impotence.
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MR imaging has been successfully applied to a variety of diseases involving the scrotum, testes and penis. It offers superior contrast resolution and multiplanar imaging capability. This article discusses MR imaging features of normal and pathologic conditions.
PURPOSE: This study was performed to determine whether patients with penile fracture or a long history of forcefully bending the erect penis (taqaandan), as models of acute and chronic penile trauma, had an increased rate of Peyronie's disease (PD). MATERIALS AND METHODS: The study included 193 surgical cases of penile fracture (average followup 85 months), 150 cases of long history of taqaandan, and 50 cases of PD. All 3 groups of patients were interviewed and physically examined. RESULTS: Signs of PD were found in only 1 case of long-term taqaandan and in no case of penile fracture. None of the 50 cases of PD had a history of penile fracture. CONCLUSIONS: Severe, acute trauma of penile fracture and moderate, chronic buckling injury of taqaandan are not associated with later development of PD. These findings question whether the hypothesis that trauma, trauma-induced smoldering inflammatory cascade and aberrant wound healing are the main causes of PD. Alternative, plausible, evidence based explanations should be sought for the etiology of PD. Any theory on the etiology of PD should provide an explanation for total lack of occurrence of PD following the trauma of penile fracture.
Sildenafil is frequently the first-line treatment for post-radical retropubic prostatectomy (RRP) erectile dysfunction (ED) with maximum treatment satisfaction rates of 43%-80%. The etiology of erectile dysfunction after RRP has been attributed to psychogenic, vascular, veno- occlusive or nerve injury causes. The purpose of this study was to gain insight into the penile duplex Doppler arterial parameters in men with ED after RRP who failed sildenafil. The purpose was to assess whether sildenafil failure after RRP is associated with underlying corporal arterial disease. A total of 174 consecutive men presenting with sildenafil refractory ED after nerve-sparing RRP underwent color duplex penile Doppler evaluation with vasoactive injection. Mean age was 59.6 y and mean time from surgery was 11.6 months. Some 81% (141/174) of the men had no pre-operative ED (PED). Significant differences in penile duplex Doppler parameters for arterial disease were seen between men with and without PED. In men without PED, 19% (27/141) manifested arterial insufficiency. However, in men with PED, 50% (16/33) demonstrated arterial disease. Nerve sparing status did not affect the presence of arterial disease. Sildenafil refractory erectile dysfunction after RRP in men without PED is not predominantly associated with penile Doppler parameters consistent with arterial insufficiency.
Penile erections were regularly induced by intermittent subcutaneous injections of apomorphine in five patients with Parkinson's disease (PD) complicated by motor fluctuations. Four of the patients reported erectile dysfunction before beginning apomorphine and two of these report a significant improvement in their sexual function resulting from apomorphine use. Animal studies suggest central D2-type dopamine receptor stimulation and oxytocin release from the paraventricular nucleus of the hypothalamus mediate the effect. Erections reported with other dopamine agonists and levodopa are probably mediated by the same mechanism. Apomorphine-induced erections in PD are probably more common than previously thought. The benefit of apomorphine on sexual function in some patients suggests a possible role in the treatment of impotence in PD.
Peyronie's disease is a common malady affecting men mostly between the ages of 40 and 60. When penile curvature and erectile softening are present and the erectile dysfunction does not respond to Viagra a penile implant will strengthen and usually straighten the penis. If curvature persists after implant placement 'modeling' the erect penis will successfully achieve straightening in most patients. Plaque incision and grafting or a Nesbit procedure are rarely necessary to straighten the penis but will afford excellent results when employed. A thorough explanation of the pathogenesis of Peyronie's disease and effects of the disease and treatment on penile size will help avoid some of the disappointment seen when a shorter erection occurs.
Erectile dysfunction (ED) may be an early sign or symptom of cardiovascular disease (CVD). We examined the relation of traditional and emerging risk factors for CVD to the severity of penile vascular disease in men with ED and without clinical coronary artery disease (CAD). In total, 137 men with ED were evaluated for penile vascular disease severity by penile Doppler ultrasound. These men were divided into the following groups based on ultrasound results: normal, cavernous venous occlusive disease, mild arterial insufficiency, and severe arterial insufficiency. Traditional (fasting lipid panel, fasting glucose, age, BMI, smoking, Framingham coronary artery disease risk score) and emerging (C-reactive protein, Lp(a), homocysteine) risk factors for CVD were correlated to severity of penile vascular disease in men with ED and without clinical CAD. Using univariate analysis, penile Doppler groups showed significant positive correlation to CRP (r=0.21; < or = 0.05) and age (r=0.30; < or = 0.01). For CRP, this correlation remained significant even when adjusted for age (< or = 0.05). Men displaying evidence of penile arterial disease (mild and severe arterial insufficiency) were characterized by elevated CRP levels (0.17 mg/dl) compared to men with no evidence of arterial abnormalities in the penis (0.04 mg/dl). CRP levels correlate significantly with increasing severity of penile vascular disease as measured by penile Doppler.
Genital cutaneous involvement with Crohn disease is an uncommon complication which has been described only recently. A case is presented of a young man with Crohn disease involving the penile and scrotal skin four years after total colectomy for Crohn disease. The histopathology and management are discussed. While the complications of Crohn disease vary in the literature, we believe involvement of the skin of the genitalia is uncommon.
In the period between December 1989 and December 1991, penile duplex sonography was performed, mostly after intracavernous injection of prostaglandin E1 in more than 1000 patients with erectile dysfunction or other penile disorders (Peyronie's disease, penile deviations, priapism). The most reliable evaluation criterion was the assessment of the peak flow velocity. Values of more than 25-30 cm/s with reference to the deep penile artery and more than 35-40 cm/s with reference to the dorsal artery indicated the integrity of the penile arteries. The assessment of the resistancy index has not proved to be a useful criterion because of its dependence on diastolic blood flow and therefore on the erection state, especially in cases of so-called cavernous insufficiency. Similar observations were made concerning the assessment of the increase in diameter of the deep penile arteries after intracavernous application of vasoactive drugs. Based on the fact that the increase in diameter is more dependent on the relaxation capacity of the cavernous smooth musculature and not on the actual blood flow, the measured values may be equal both in normal and in clearly disturbed blood circulation. In conclusion, duplex sonography is at present, together with color Doppler imaging, the most reliable vascular diagnostic tool and has clearly proved its superiority both to conventional penile Doppler imaging and penile angiography.
OBJECTIVE: To report the aetiological, diagnostic and therapeutic aspects of penile Mondor's disease treated with non-steroidal anti-inflammatory drugs (NSAIDs) or surgery. PATIENTS AND METHODS: During the last 3 years, 10 patients (mean age 35 years, range 20-57) were treated for superficial penile vein thrombophlebitis. The main aetiological factors were prolonged and excessive sexual intercourse, operations for inguinal hernia and deep vein thrombosis. All patients had noticed sudden and almost painless cord-like induration on the penile dorsal surface. Doppler ultrasonography was useful in both diagnosis and follow-up. Eight patients were treated with NSAIDs and platelet drugs. RESULTS: The mean interval to resolution of symptoms was 3 weeks. Two patients who did not respond to drug therapy underwent surgery (dorsal vein resection). CONCLUSION: Medical therapy and, when indicated, vein resection are successful and effective in treating penile Mondor's disease.
Many dermatoses become manifest in the genital region. Some of them are specific for this anatomical site; other lesions of the penis are associated with systemic dermatological diseases. Medical history, clinical inspection of the whole integument and optional microbiological or histological examination of the lesions will lead to a correct diagnosis. Dermatoses of the penis (glans penis and/or prepuce) may be symptoms of general diseases or specific alterations of the genital region. The differential diagnoses of penile dermatoses include infections, balanitides, neoplastic diseases, trauma, papulosqamous or systemic diseases, fixed drug reactions, allergic or irritant contact dermatitis and miscellaneous lesions. Since andrologists pay special attention to the inspection and palpation of the male genital region, they should possess knowledge of dermatologically relevant penile lesions.
A 34-year old man was admitted to us with a mild painful cord-like induration on the left dorsal side of the penis extending from corona of the glans to the base of the penis. The patient was treated with anti-inflammatory and anticoagulan agents. Cord-like-induration resolved and recanalized in 4th week, and venous flow was detected in Doppler examination.
PURPOSE: We determined the effect of incision and saphenous vein grafting on penile length, erectile function and overall sexual satisfaction in men with Peyronie's disease. MATERIALS AND METHODS: A total of 24 consecutive men underwent plaque incision and saphenous vein grafting with postoperative daily use of a vacuum erection device. Erect penile length, pain, curvature and erectile function were assessed before and after surgery, and overall sexual satisfaction was scored from 1 to 5 by a validated instrument. RESULTS: Of the 22 patients in whom adequate followup data were available mean penile length was increased 2.1 cm. as a result of surgery (p <0.001). Median score of overall satisfaction with sex life was 4 or moderately satisfied. Of the 86% of men who achieved sexual intercourse after surgery 54% used no erectile aids and 32% required sildenafil or intracavernous injection. Complete erectile dysfunction was present in 14% of cases. Patients who reported erectile difficulty preoperatively were significantly more likely to have erectile dysfunction postoperatively that required erectile aids. Arterial insufficiency on duplex Doppler ultrasound was associated with a higher likelihood of complete erectile dysfunction. Complications in 33% of patients included complete erectile dysfunction in 3 and significant persistent penile curvature in 1. CONCLUSIONS: Incision and venous grafting of plaque leads to statistically and clinically significant increases in penile length in men with Peyronie's disease. Preoperative erectile dysfunction and cavernous arterial insufficiency were associated with a higher risk of postoperative erectile dysfunction. Nevertheless, patients reported a high degree of satisfaction with their overall sex life.
In a patient with diabetic microangiopathy and renal disease, penile necrosis occurred in connection with clean intermittent catheterization. Microangiopathy of the urethral and penile arteries presumably lowered the local defences, so that the catheterization initiated penile necrotic changes by introducing bacteria and traumatizing the poorly vascularized urethral epithelium.
Implantation of bilateral prostheses was used to treat Peyronie's disease in 69 patients. A circumferential approach was used in 46 patients and, more recently, a prepubic approach was used in 23. In addition, plaque removal was performed by a transcavernous route in 29 patients. Penile lengthening was performed in 49 patients and the glans was repositioned in 14. In 4 patients it became necessary to remove the implants. The best results without complications were observed when the prepubic approach was used for implants and lengthening of the penis, without removal of the plaque. This technique provides a penile length gain of about 3 cm. and generally does not obviate additional normal erection.