Carcinoma of the penis. Partial amputation of the penis.
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[Cancer of the penis and its treatment].
It had been believed that carcinoma of the penis was rather rare in the developed countries comparing with that in the under-developing countries, however, the recent epidemiological studies failed to reveal any clear difference of the incidence of carcinoma of the penis all over the world. In these days so called successful treatment is coming to be evaluated by the quality of life (QOL) after surgical or nonsurgical treatment (especially sexual function tended to be considered very important factors altering QOL). I want to emphasize the following issues in this report. 1. Erythroplasia of Queyrat and Bowen's disease are carcinoma in situ and should be dealt as carcinoma of the penis. 2. relation of human papilloma virus and carcinoma of penis. 3. usefulness of TNM classification over Jackson's classification. 4. SCC antigen is a reliable tumor marker of carcinoma of the penis? 5. effectiveness of chemotherapy based on BLM combined with radiation therapy for carcinoma of the penis. 6. usefulness of Mohs microscopically controlled surgery and modified groin dissection. It is generally accepted that since carcinoma of the penis is a rare disease and for one institution up to 50 cases can be experienced during 20 years in Japan, there exist no integrated study involving a large number of institutions. I really wish a certain form of group study to be completed and the results from this study utilized to overcome the present problems for the treatment of carcinoma of the penis.
Antibiotics, Antineoplastic↗
Effect of local anesthesia of the penis and dorsal penile neurectomy on the mating ability of bulls.
Eleven bulls were used to study the effect of the loss of nerve sensitivity in the free portion of the penis and glans penis on their ability to copulate. The loss of sensitivity was induced by topical anesthesia, infiltration anesthesia, and dorsal penile neurectomy. Topical anesthesia of the glans penis reduced the ability of the bulls to search for and to locate the vagina and to complete copulation; however, all bulls eventually copulated. Topical anesthesia of the free portion of the penis and glans penis blocked the ability of all bulls to copulate. Infiltration of the glans penis with lidocaine resulted in bulls failing to ejaculate, indicating the need for input from deep nerve receptors. Ten of the eleven bulls with unilateral neurectomy were able to copulate, but a longer time was required. In the one bull that failed to complete intromission and ejaculation, the sectioned nerve made up 75% of the nerve mass to the distal end of the penis, leaving only a small number of functional fibers. With this small number of fibers, there may have been insufficient sensory input to elicit the thrusting responses and to cause the animal to ejaculate. Bulls with bilateral neurectomy were unable to copulate.
Anesthesia, Local↗
Innervation of pelvic viscera in the rat. Evoked potentials in nerves to bladder and penis (clitoris).
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.
Animals↗
Reconstruction of the penis following necrosis from circumcision used high frequency cutting current.
Penis necrosis secondary to circumcision by an electrical scalpel in a 2 years and 2 months-old boy occurred. After healing of the electric burn only stumps of the erectile bodies and strictured urethral meatus remained. The penis shaft reconstruction by corpora mobilisation and by detachment of the crura from the pubo-ischial rami was effected. This procedure gained 6 cm of a new length of the penis. To prevent readhesions to the puboischial rami the penis was buried in a scrotal tunnel. Six months later the denuded shaft was resurfaced with one split thickness skin graft and a zigzag seam on the ventral side was made. The patient voids with good stream, has spontaneous erections and nocturnal emissions. During 10-years follow-up after the reconstruction two complications, namely a stricture of the urethra and a slight dorsal tethering of the penis caused by a scarred pubic skin were treated. The problems of the a reconstruction type and resurfacing of the penis in childhood are discussed.
Child, Preschool↗
Reconstruction of the penis following necrosis from circumcision used high frequency cutting current.
Penis necrosis secondary to circumcision by an electrical scalpel in a 2 years and 2 months-old boy occurred. After healing of the electric burn only stumps of the erectile bodies and strictured urethral meatus remained. The penis shaft reconstruction by corpora mobilisation and by detachment of the crura from the pubo-ischial rami was effected. This procedure gained 6 cm of a new length of the penis. To prevent readhesions to the puboischial rami the penis was buried in a scrotal tunnel. Six months later the denuded shaft was resurfaced with one split thickness skin graft and a zigzag seam on the ventral side was made. The patient voids with good stream, has spontaneous erections and nocturnal emissions. During 10-years follow-up after the reconstruction two complications, namely a stricture of the urethra and a slight dorsal tethering of the penis caused by a scarred pubic skin were treated. The problems of the a reconstruction type and resurfacing of the penis in childhood are discussed.
Circumcision, Male↗
Os penis of the rat. II. Morphology of the mature bone.
A morphological description of the mature os penis and its related structures in the rat is presented. The description aims at being a natural introduction to studies of histomorphological and histochemical events during the development of the bone. The causal interest of this topic is due to a recently published observation of a rare reaction for presence of alkaline phosphatase in the proximally positioned growth cartilage of os penis. The study, thus, presents a systematical description of the position of os penis in relation to the soft tissue structures of glans penis, of gross morphology of the bone, of its periosteal covering and of the distribution of the bone types, which together form the mature bone. The observations result in an introduction of a systematical terminology, based on the Latin language. Furthermore, certain phenomena concerning a distally positioned cartilagenous process, and the distribution of bone tissue types in os penis are observed and discussed. Together with the phenomenon earlier mentioned these phenomena need further attention in future studies of the bone.
Animals↗
The effect of neonatal treatment of male mice with antiandrogens and of females with androgens on the development of the os penis and os clitoridis.
The os penis in mice and rats is composed of a proximal intramembranous and endochondral osseous element and a distal cartilaginous, ossifying element. Female mice, but not rats, have a small os clitoridis which corresponds to the intramembranous part of the proximal element of the os penis. In mice of either sex a dense mesenchymatous formation ventral to the urethra is the anlage for the bones of the external genitalia. In the early postnatal period the proximal part of the os penis develops as bone at the outer and as cartilage at the basal end of the anlage, while in females a minute focus of ossification differentiates into the small os clitoridis without passing through a cartilaginous phase. The distal element of the os penis is formed later than the proximal rod and grows at a slower rate. Neonatal treatment with an antiandrogen inhibits the increase in size and calcification of the os penis. Neonatal castration is an even more effective inhibitor. Neonatal treatment with testosterone or dihydrotestosterone, but not with oestradiol, stimulates the growth of the bony proximal os clitoridis, but induces only a rudimentary collagenous distal element. The differences between mice and rats in the response of the tissues of the clitoris to androgenic treatment are discussed, particularly as regards the differentiation of proximal and distal elements.
Androgens↗
On the classification of penis carcinoma and its 10-year survival.
With respect to the primary tumor there is no difference between the proposal of the UICC and the Heidelberg version for TNM classification of the penis carcinoma. Clinically the Heidelberg scheme seems more practical, but there were no statistical differences between them. With respect to the prognosis for the patient, the size and localization of the primary tumor are of secondary importance. What is important is the degree of tumor spreading in the lymph system. From this point of view, one needs only to differentiate between T1 (tumor restricted to the penis) and T2 (tumor extending the bounds of the penis). On the other hand, size, localization, and degree of infiltration of penis carcinoma do have different therapeutic consequences, so from this point of view the differentiation of the primary tumor from T1 up to T4 should be retained. With respect to the classification of the state of the corresponding lymph system it is our opinion that the UICC proposal is too differentiated and has little meaning. In its stead, the Heidelberg scheme is clear and simple. Any examiner can complete it. With the help of life tables extending beyond 10 years after diagnosis we were able to determine that 5 years is not a sufficiently long time to clsoe a case of penis cancer. Even with proper treatment, the patient may suffer up to 10 years or more from the disease. In patients aged between 50 and 59 years of age the cancer seems to grow faster; in spite of proper and intensive treatment those patients had a clearly limited life expectancy. In patients aged 60-69 and more so in those between 70 and 79 years of age the tumor seemed to grow slowly and often had no effect on the survival rate.
Follow-Up Studies↗
Penis envy: from childhood wish to developmental metaphor.
Two phases of penis envy are considered. The first regularly occurs early in development and is registered as a narcissistic injury which can be resolved under optimal conditions and can contribute to female psychosexual development. If, however, it is not favorably resolved or, even more significantly, if the basic character disorder is of a narcissistic type, the awareness of the genital difference becomes one of many narcissistic traumas. A later phase of penis envy usually represents a regressive effort to resolve oedipal conflicts. In the past, these two phase-oriented forms of penis envy have not been adequately distinguished. Two clinical examples are presented in which the envy of men was only part of a tendency to envy in a narcissistic character disorder. In the analysis, the interpretation of the penis envy offered a metaphor around which all of the "free-floating" envy could coalesce. The cases illustrate the necessity to consider penis envy as the manifest content of a symptom that needs analysis, rather than as "bedrock" or ultimate conflict.
Adult↗
[Malignant melanoma of penis].
Two cases of malignant melanoma of the penis are reported. A further case report of a naevus caeruleus of the glans penis is presented with regard to the differential diagnosis of malignant melanoma of the penis. A comprehensive review of the literature has revealed 41 case reports of malignant melanoma of the penis. A brief characterisation of malignant melanoma of the penis is given.
Adult↗
Angiography of the crus penis in the ram and buck during erection.
Serial angiography was used to determine blood flow patterns to the penis of rams and bucks. Animals were anesthetized and the internal pudendal artery was catheterized so that contrast medium could be injected toward the crus penis area. By comparing vascular patterns of the ram and buck during erection, it was found that flow patterns of the corpus cavernosum penis (CCP) and corpus spongiosum penis (CSP) were similar for both species. Contraction of the ischiocavernosus muscles occluded the arterial inflow and venous outflow to the CCP, making it a closed system during peak erection. However, during erection, the contrast medium continued to flow into the CSP, showing that it is not a closed system. In the vasodilatation phase, the CSP usually filled before and more intensely than did the CCP.
Angiography↗
Metastasis to the penis from malignant melanoma: case report and review of the literature.
A case of metastatic malignant melanoma to the shaft of the penis is described and the literature reviewed to collate the incidence of primary sites which metastasize to the penis. Less than 260 cases of metastasis to the penis have been reported. Of these, 76% are from genitourinary primary sites and 17% are from gastrointestinal primary sites but only one case of metastatic melanoma to the penis has been previously reported. The described case presented with painful priapism while receiving combination chemotherapy for metastatic disease. A CT scan demonstrated a deposit in the left corpora cavernosa and needle aspiration cytology of a plaque attached to the shaft confirmed malignant melanoma cells. Palliation of the painful priapism was achieved by treatment with radiotherapy using large doses per fraction. Retrograde venous or lymphatic spread may have been the cause of a metastasis at this site. Prognosis is very poor.
Adult↗
Primary malignant melanoma of the penis. Two cases and a review of the literature.
Two cases of primary malignant melanoma of the penis are reported and 35 cases from the world literature are reviewed. The tumour most commonly started in the glans penis and less frequently from the prepuce. The microscopic appearances were identical with those of tumours arising elsewhere in the skin. A comparison is made between the incidence of melanoma of the penis and melanoma occurring elsewhere on the body surface. Evaluation of the best treatment was difficult because the total number of cases was small and the methods of treatment and results so variable. It would seem that the prognosis of malignant melanoma of the penis is generally poor, although there are sufficient examples of long-term survival after total amputation in Stage I disease to suggest that this radical treatment is justified.
Adult↗
Ectopic lesion of schistosomiasis of the penis simulating an early carcinoma.
A case of ectopic lesion of Schistosoma haematobium of the penis with extensive tissue destruction, simulating an early carcinoma of the penis and almost resulting in an autoamputation of the crown of the penis, is presented. The penis was surgically repaired and the patient treated with ambilhar. In schistosoma endemic area, it is important to think of ectopic schistosoma lesion by such a presentation. Existing theories to explain the presence of schistosoma eggs in locations outside the portal-caval system were reviewed and another one was advanced: its being sexually transmitted.
Adult↗
Parental mislabeling of female genitals as a determinant of penis envy and learning inhibitions in women.
A survey of sex education literature confirms parents' self-reports regarding sex information imparted to their children. With relatively few exceptions, young children (and even teenagers) are taught that "boys have a penis and girls have a vagina," without further linguistic distinctions made regarding the sensitive external genitals of the female child. It is suggested that this incomplete, undifferentiated, and often inaccurate picture of female genitals prevents the growing girl from achieving pride in femininity, and may lead to anxiety and confusion regarding her sexuality. A case is presented in which the failure to label the girl's external genitals was a contributing factor to penis envy, as well as to conflicts about "looking" which led to symptomatic learning inhibitions. It is suggested that the ubiquity of the female "castration complex" may not stem primarily from the fact that the clitoris is a smaller (and thus inferior) organ compared to the penis. Rather, the girl's feeling of being "cheated" may reflect parental failure to explicitly acknowledge that the vulva (especially the clitoris) is an important aspect of "what girls have." Because visible and sensitive aspects of the girl's genitals are not labeled for her, the girl may feel that she does not have "permission" to develop into a sexually responsive and complete woman. As in the case presented, penis envy may be a symptom expressing the wish to have one's female sexuality "validated," but which also serves to block this forbidden wish by inhibiting sexual responsiveness and pride in femininity.
Achievement↗
[Skin replacement on the penis (author's transl)].
For skin replacement on the penis and scrotum, only a free split-skin graft (about 0.45 mm in thickness) can be considered in cases where local flaps are not available. The transplant is fixed on the denuded penis with a special thermoplast splint, which ensures healing in. Additional sedation is necessary. Pedicle flaps taken from some distance away are too voluminous for the penis and not adequate. Cases with eschars and granulation tissue must be carefully cleaned to avoid hypertrophic scars. Covering can also be achieved with mesh-grafts in these cases.
Humans↗
A possible neural source of nitric oxide in the rat penis.
NADPH diaphorase staining was used to indicate the presence of nitric oxide synthase (NOS) in whole mounts of rat major pelvic ganglion (MPG) and sections of rat penis. Many stained neurons were observed in the MPG and were distributed in a manner identical to that of retrogradely labelled penile neurons described previously. Staining was also observed within many axons of the penile (cavernous) nerve and in varicose terminals associated with various tissues of the penis. The results suggest that many, if not all, penile neurons of the MPG contain NOS and that a neural source of NO within the penis is likely.
Animals↗