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At least 127 records · Page 7Linked to original sources
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↗
PubMed2004

The management of Peyronie's disease.

Peyronie's disease has no known cause; recent understanding of the molecular mechanisms involved and the development of an animal model will aid the medical management of early disease. The medical management of chronic disease is futile as the delicate tunical architecture cannot regenerate. Surgical correction of the penile deformity is required in a minority of patients, and a choice lies between a Nesbit operation and a plaque incision and venous patch in patients who are concerned with penile shortening.

4-Aminobenzoic Acid↗
PubMed2004

Penile prosthetic surgery for Peyronie's disease: defining the need for intraoperative adjuvant maneuvers.

INTRODUCTION: There are a number of accepted approaches to the patient with Peyronie's disease and erectile dysfunction (ED), including penile prosthesis surgery. During prosthesis surgery for Peyronie's disease some men are left with residual curvature upon maximum device inflation. This analysis was undertaken to define how often and in which patients, intra-operative adjuvant maneuvers are required. METHODS: Men undergoing penile prosthesis surgery for combined Peyronie's disease/ED constituted the study population. Residual curvature >10 degrees was deemed to warrant the use of a secondary maneuver to correct curvature. In this analysis, plaque release incisions were utilized and grafting was performed only if there was overt exposure of the prosthesis. RESULTS: 36 men were included in the analysis. All patients with preoperative curvatures 45 degrees curvature preoperatively, 86% needed plaque incision to achieve adequate penile straightening. Grafting was required in only 5.5% patients and both of these patients had preoperative curvature >60 degrees . CONCLUSIONS: In 61% of patients with combined Peyronie's disease/ED in this study, the placement of a three-piece inflatable penile prosthesis alone corrected the penile curvature. 86% of patients requiring plaque incision had preoperative curvatures >45 degrees . This information should enable surgeons to plan such operations more effectively and to counsel patients more comprehensively prior to operative intervention.

Erectile Dysfunction↗
PubMed2004

Peyronie's disease.

INTRODUCTION: Peyronie's disease is a sexual medicine condition that may adversely affect male sexual function. AIM: To provide expert opinions/recommendations concerning state-of-the-art knowledge for the pathophysiology, diagnosis and treatment of Peyronie's disease. METHODS: An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a scientific and debate process. Concerning the Peyronnie's disease committee, there were 10 experts from six countries. MAIN OUTCOME MEASURE: Expert opinions/recommendations are based on grading of evidence-based medical literature, extensive internal committee discussion over 2 years, public presentation and deliberation. RESULTS: Peyronie's disease is characterized by an inflammatory response beneath the tunica albuginea with fibroblast proliferation forming a thickened fibrous plaque that may cause penile pain, penile curvature and erectile dysfunction. Medical treatments have been described but few prospective controlled trials have revealed significant clinical benefits. Surgical treatments (penile plication, Nesbit excision, plaque incision and grafting and penile prosthesis insertion) should be considered after Peyronie's disease has stabilized. Surgical outcome studies reveal that a stable deformity is best corrected with the least postoperative ED by a Nesbit procedure. Plaque incision and grafting should be reserved for men with good erectile function and marked penile shortening although there is a higher prevalence of postoperative ED. Implantation of a penile prosthesis is an excellent option for men with an accompanying erectile deficit. CONCLUSIONS: Safe and effective treatments for Peyronie's disease examined by prospective, placebo-controlled, multi-institutional clinical trials are needed.

Consensus↗
PubMed2005

A surgical algorithm for men with combined Peyronie's disease and erectile dysfunction: functional and satisfaction outcomes.

INTRODUCTION: Men with Peyronie's disease who also have erectile dysfunction represent a challenge to the urologist. Historically, penile prosthesis surgery has been the management strategy of choice for this population. This study was undertaken to define the outcomes of a penile reconstructive surgery algorithm in men with Peyronie's disease and concomitant erectile dysfunction (ED). METHODS: Patients presenting with combined Peyronie's disease and erectile dysfunction were treated with vasoactive therapy initially. All patients underwent dynamic infusion cavernosometry and cavernosography. Nonresponders to erectogenic pharmacotherapy were advised to undergo penile prosthetic surgery. Responders to erectogenic therapy were considered candidates for either corporoplasty or plaque incision and grafting. The International Index of Erectile Function (IIEF) questionnaire was used to compare erectile function and satisfaction profiles serially pre- and postoperatively between the patients in the three groups. RESULTS: Sixty-two patients constituted the study population. Eighty-one percent of the patients responded to erectogenic pharmacotherapy. Postoperative IIEF erectile function domain scores were statistically higher for implant patients and lower for plaque incision and grafting patients compared to preoperative scores. Postoperative IIEF satisfaction domain scores were higher for corporoplasty and implant patients and lower for plaque incision and grafting patients compared to preoperative scores. CONCLUSIONS: The surgical algorithm used in this study leads to excellent IIEF erectile function and satisfaction scores for corporoplasty and implant patients; however, plaque incision and grafting patients had poor functional and satisfaction outcomes. These data support the concept that not all men with combined ED and Peyronie's disease require penile prosthetic surgery, and furthermore, plaque incision and grafting surgery is a poor option for men with combined disease.

Adult↗
PubMed2006

Determinants of patient satisfaction following penile prosthesis surgery.

PURPOSE: Penile prosthetic surgery is associated with satisfaction rates >90% for the general penile implant population. It is suggested that satisfaction rates may be lower in certain populations. This study was undertaken to define potential predictors of satisfaction. METHODS: Patients undergoing penile prosthesis surgery completed the International Index of Erectile Function (IIEF) prior to surgery, and the IIEF and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires at least 6 months postoperatively accompanied by a Global Satisfaction Question (GSQ). RESULTS: A total of 114 patients constituted the study population. Subgroups evaluated included patients with Peyronie's disease (PD), body mass index (BMI) > 30 kg/m2, radical prostatectomy (RP), and patient age > 70 years. The mean patient age and duration of ED were 59 +/- 14 and 3.2 +/- 1.9 years, respectively. All groups demonstrated statistically significant differences between pre- and postoperative scores for the IIEF and EDITS. Patients with PD, a history of RP, and BMI > 30 kg/m2 had significantly lower scores on the GSQ, IIEF satisfaction domain, and EDITS compared with the general implant population. Only PD impacted negatively on the postoperative IIEF erectile function domain score. On the multivariate analysis, factors associated with >or=5-point difference in the IIEF satisfaction domain score compared with the general implant population were PD (RR = 4.2), RP (RR = 2.2), and BMI > 30 (RR = 1.8). CONCLUSIONS: These data suggest that men diagnosed with PD, BMI > 30, or previous RP undergoing penile prosthesis surgery have lower satisfaction rates than the general penile implant population.

Adult↗
PubMed2006

Corporoscopic excavation of the fibrosed corpora cavernosa for penile prosethesis implantation: optical corporotomy and trans-corporeal resection, Shaeer's technique.

INTRODUCTION: Implantation of a penile prosthesis in cases of neglected or resistant ischemic priapism, or delayed re-implantation following prosthesis infection and extraction, is usually a difficult and risky procedure due to fibrosis of the corpora cavernosa. Among the common complications are perforation of the urethra, tunica albuginea, and infection. The complications are usually due to the use of blind force against resistance. AIM: We propose the techniques of Trans-Corporeal Resection and Optical Corporotomy as adjuvant measures for excavating the fibrosed corpora cavernosa under vision, without the use of force against resistance. METHODS: Six patients with diffuse fibrosis of the corpora cavernosa were operated on. The instruments and technique are the same as for optical urethrotomy and transurethral resection. Optical Corporotomy was started with, where the corpora are incised from within. After establishment of a satisfactory passage, Trans-Corporeal Resection followed to scrape the fibrous tissue. Implantation of penile prosthesis was completed as usual. The procedure was performed through 1.5 cm incision in the tunica albuginea. MAIN OUTCOME MEASURES: Length, girth, and straightness in the erect position, as well as the incidence of complications. RESULTS: Operative time was an average of 90 minutes. No difficulty was encountered during the procedure. No complications were noted through 1 year of follow-up. CONCLUSION: Optical Corporotomy and Trans-Corporeal Resection allow for force-free, visually monitored excavation of the fibrosed corpora cavernosa, aiming at safer penile prosthesis implantation.

Erectile Dysfunction↗
PubMed1988

Normal penile anatomy and abnormal penile conditions: evaluation with MR imaging.

The appearance of the normal penis and of a variety of penile abnormalities on magnetic resonance (MR) images was studied in 55 patients with either medium (0.35 T) or high (1.5 T) magnetic field strengths. Penile morphologic characteristics with anatomic detail of the corpora cavernosa and corpus spongiosum were demonstrated in each patient. MR images clearly displayed congenital anomalies (n = 6), penile prostheses (n = 7), fibrous tissue or hematoma due to trauma (n = 8), and fibrous plaque in Peyronie disease (n = 3). MR imaging also demonstrated urethral (n = 6) and penile (n = 5) neoplasms and allowed tumor staging, thus facilitating the surgical approach.

Adolescent↗
PubMed1999

Penile prosthesis implantation and couple's satisfaction.

OBJECTIVE: Implant surgery is the most acceptable curative choice for patients with erectile dysfunction and their partners, since the results are excellent with regard to the couple's pleasure and the materials used are extremely manageable. MATERIALS AND METHODS: We performed 46 prosthesis implantations in patients with erectile dysfunction: in 22 patients we implanted soft prostheses; in 20 malleable prostheses; in 1 a mono-component prosthesis, and in 3 patients a tri-component model. All patients and partners were evaluated using a questionnaire. RESULTS: We obtained a degree of satisfaction equal to 82% against 18% dissatisfaction due to a sensation of 'unnaturalness' report by the partner, with low perioperative and postoperative complications. CONCLUSION: In our opinion the degree of satisfaction of the patient is currently the only legitimate indicator to establish the effectiveness of therapy.

Erectile Dysfunction↗
PubMed1991

Surgical treatment of Peyronie's disease.

Surgical measures usually represent the last step in the treatment of Peyronie's disease. Straightening of the penile shaft and relief of pains during erection are the main goals of the operation. From December 1987 to April 1990, 11 patients with a mean age of 58.3 years underwent surgical treatment. Three of them complained of erectile dysfunction prior to surgery. The plaques were located distally in 8 patients, proximally in 1 patient and in the middle of the shaft in 2 patients. Complete resection was performed and defects of the tunica albuginea were closed by means of running sutures (3 patients) or grafts of autologous skin (5 patients) and lyophilized dura mater (3 patients), respectively. After a mean follow-up of 21 months, 6 patients reported spontaneous erections, whereas 3 patients needed corpus cavernosum autoinjection therapy. In 2 cases implantation of a penile prosthesis was necessary. Surgical treatment of Peyronie's disease yields satisfactory results if conservative therapy proves unsuccessful. However, diagnostic evaluation of erectile dysfunction should precede operative treatment and if present, be treated accordingly.

Humans↗
PubMed1997

Implant surgery in Peyronie's disease.

The etiology and evolution of Peyronie's disease are not well known, and this certainly affects patient management. If spontaneous regression or stabilization of the disease is lacking, actually all therapies, except surgery, seem to be only partially successful. We attended 88 patients affected by Peyronie's disease, and 21 patients (23.6%) were referred for surgery and penile implantation; plaque excision was necessary in 8 patients (38.1%). We implanted 10 malleable prostheses and 11 soft prostheses. So far, potency has been the only parameter for evaluating the results of surgery, but in our view both the patient and his partner should be satisfied aesthetically and functionally.

Erectile Dysfunction↗
PubMedDate not supplied

Fine needle aspiration cytology of penile tumors.

OBJECTIVE: Penile tumors are unusual and can represent neoplastic or inflammatory processes. We report a series of penile tumors diagnosed by fine needle aspiration (FNA) cytology. STUDY DESIGN: Files from the Division of Clinical Cytology, Karolinska Hospital, were searched, and cases of FNA cytology of the penis selected. Clinical information and cytologic diagnoses were recorded and observations from aspiration smears made. RESULTS: Eleven patients had presented to Karolinska Hospital for FNA cytology of the penis. They ranged from 46 to 89 years of age; all were uncircumcised. Tumors were present in various locations, including the glans and shaft. Five patients had squamous cell carcinoma (SCCA) of the penis; three were primary, one locally recurrent and one metastatic from primary lung SCCA. There were three carcinomas metastatic from primary colon, prostate and bladder tumors. There was one each of locally recurrent malignant melanoma, locally metastatic testicular mesothelioma and Peyronie's disease. Discomfort associated with the procedure was tolerable, there were no complications, and each biopsy provided sufficient material for a cytologic diagnosis. CONCLUSION: FNA cytology of penile tumors is a successful, well-tolerated procedure capable of providing a cytologic diagnosis and useful information for patient management.

Adenocarcinoma↗
PubMedDate not supplied

Surgical management of erectile dysfunction.

Since the introduction of sildenafil citrate, oral systemic therapy has become the first line of therapy for men with erectile dysfunction (ED). Men who are not candidates for or who fail treatment with an oral agent may choose second-line therapies such as intraurethral prostaglandins, penile injection therapy, sex therapy, or a vacuum erection device. These secondline therapies may be unpalatable or inadequate for some men, and these men constitute the candidates for surgical intervention for ED. This article reviews surgical management of vascular ED, surgical management of Peyronie's disease, and penile prosthesis implantation. At the current time, the appropriate candidate for penile revascularization is a young man with proven arterial insufficiency resulting from pelvic trauma. Results in other populations are disappointing. Peyronie's disease with curvature significant enough to interfere with intercourse may be managed with tunical lengthening or shortening procedures in potent men and with prosthetic implantation in men with ED. Modern three-piece penile prostheses are associated with excellent device reliability, high rates of patient satisfaction, and acceptably low complication rates.

Equipment Design↗
PubMed1997

Secondary penile carcinoma originated from pancreas.

Secondary penile cancers are rarely seen and most of them are originated from genitourinary and gastrointestinal tract. But metastatic penile cancer originated from pancreas are extremely rare and two cases have been reported in the literature, only one of them was pathological proven in autopsy. We report a case of secondary penile carcinoma originated from the pancreas as the primary site which was pathologically proven.

Adenocarcinoma↗