Shaeer's Glans Augmentation Technique: A Pilot Study

IntroductionAugmentation of the glans penis may be indicated for cosmetic reasons, lack of glans tumescence following implantation of a penile prosthesis, or asymmetry following girth augmentation of the shaft. Many augmentation techniques have been offered to increase the length and girth of penile shaft, but not the glans penis, with the exception of hyaluronic acid gel injection that is known to decrease sensitivity of the glans and is restricted for cases with premature ejaculation.AimThis work is the first report on glans augmentation by grafting.Main Outcome MeasuresMaximum circumference of the glans, self‐reported impression of the augmented volume and glans sensitivity.MethodsTen males requesting augmentation of the glans were selected for the study after failing counseling, with normal erectile function and ejaculatory control. Two ventral incisions were cut along the ventral aspects of the coronal sulcus, one on either side of the frenulum. Lateral glans flaps were dissected on either side. The urethra was circumvented, creating a plane all around it. A dermal fat graft was inserted into the space created. The flaps were closed by simple absorbable sutures.ResultsMaximum circumference of the glans increased by 16.6%, declining to 14.2% by the last follow‐up visit (10–12 months), a 2.3% decline. Self‐reported impression of the augmented volume was high and well maintained over the follow‐up period. Glans sensation, engorgement, erectile function, and ejaculatory control were preserved.ConclusionThis pilot study on glans augmentation by grafting reports promising results with retention of the added volume at 1‐year follow‐up, preservation sensitivity and engorgement, and no adverse effects on erectile function or ejaculatory control. Shaeer O. Shaeer's glans augmentation technique: A pilot study. J Sex Med 2012;9:3264–3269.     

The surgical management of lichen sclerosus of the glans penis: our experience and review of the literature

IntroductionLichen sclerosus (LS) of the glans penis is a chronic, progressive, scleroatrophic inflammatory process of unknown etiology affecting the glans penis, prepuce, and urethra and may lead to severe impairment of sexual and urinary function.AimsTo report our experience of surgical management of LS of the glans penis.Main Outcome MeasuresComplications, patients’ satisfaction, cosmesis, resolution of pain and puritus, and postoperative sexual function and were recorded retrospectively.MethodsThe surgical outcome of the 31 patients who have undergone resurfacing of the glans penis with the use of skin grafting for the management of genital LS in our institute is reported.ResultsAfter a median follow‐up of 12.8 months, 26 patients (84%) were fully satisfied with cosmetic and functional results, and 71% of them have resumed sexual activity.ConclusionsResurfacing of the glans penis represents a simple and reproducible technique for the management of LS and yields excellent functional and cosmetic results. Garaffa G, Shabbir M, Christopher N, Minhas S, and Ralph DJ. The surgical management of Lichen Sclerosus of the glans penis: Our experience and review of the literature. J Sex Med 2011;8:1246–1253.     

Restoration of the penis following amputation at circumcision: Shaeer's A-Y plasty

IntroductionMale circumcision is one of the most commonly performed procedures worldwide. It has an estimated complication rate ranging from 0.1% to 35%. Amputation of the shaft is one of the most devastating complications reported, resulting from entrapment of the phallus between the blades of the clamp or from thermal injury due to the application of unipolar diathermy.AimIn this work, I describe the guidelines I adopted in the management of 32 male patients afflicted with amputation of the shaft of the penis upon circumcision.Methods“Shaeer's A-Y plasty” was performed for all patients, whereby the proximal corpora and crura were released from their attachment to the pubis and were advanced forward by insetting a specially configured fat flap into the resultant cavity. Skin grafts were used to cover the released penis.ResultsIn all 32 cases, the released penis was within the normal range of penile length, and was cosmetically and functionally acceptable.Conclusions“Shaeer's A-Y plasty” is capable of restoring the native phallus following amputation, with preservation of both gender identity and physiological characteristics of the penis to a large extent. Shaeer O. Restoration of the penis following amputation at circumcision: Shaeer's A-Y plasty.     

Delayed Complications of Gel Injection for Penile Girth Augmentation

IntroductionPenile girth augmentation is a domain of extensive controversy and debate. A variety of methods is available for the choice of the surgeon including dermal-fat grafts and flaps. The need for a simple procedure with minimal donor site has lead to proposing injection therapy for penile augmentation, whether by fat or synthetic materials.AimThis work reports on a male patient suffering a deforming subcutaneous mass in the penis following penile girth augmentation by injection therapy using synthetic material, and describes its management, and pathologic analysis of the extracted tissue.MethodsThe mass was excised through a circumferential subcoronal incision while maintaining skin vascularity and integrity of the corpora. The excised tissue was microscopically examined.Main Outcome MeasuresCosmetic and functional results of surgical correction.ResultsCosmetic and functional outcome were acceptable. Pathology examination revealed features of foreign body granuloma.ConclusionInjection of fillers for girth augmentation of the penile shaft may result in delayed complications including migration, granulomatous reaction, and resorption that may occur beyond the follow-up span of the currently available study that recommends its use. Shaeer O, and Shaeer K. Delayed complications of gel injection for penile girth augmentation. J Sex Med 2009;6:2072–2078.     

Revealing the Buried Penis in Adults

IntroductionSeveral surgical solutions have been proposed for resolving penile concealment with successful outcomes. Those include liposuction, adhesiolysis, and suprapubic lipectomy through the abdominal crease. Nevertheless, some limitations exist and compromise the results of surgical correction.AimThis work presents our technique for revealing the hidden penis, addressing the limitations of existing methods for surgical correction.MethodsSixty-four adult males with buried penis were operated upon. The penis was revealed by the combination of adhesiolysis, suprapubic and lateral lipectomy, anchoring the penoscrotal and penopubic junctions, and skin coverage by a local flap.Main Outcome MeasuresPenile length in the flaccid and erect states.ResultsAverage postoperative length in the flaccid state was approximately 7 cm ± 1.3 (a 293% increase) and in the erect state was 18.4 cm ± 2.9 (185.7% increase), compared with preoperative length of 1.8 cm ± 0.4 in the flaccid state and 6.4 cm ± 1.6 in the erect state. Minor complications occurred. There was no deterioration in sexual function.ConclusionRevealing the concealed penis is a complicated procedure. The outcome may be improved by implementing a radical approach to tissue excision, providing adequate skin coverage, and anchoring the penile shaft, skin, and subcutaneous tissues in the revealed state to prevent relapse. Shaeer O, and Shaeer K. Revealing the buried penis in adults. J Sex Med 2009;6:876–885.     

Central Somatosensory Networks Respond to a De Novo Innervated Penis: A Proof of Concept in Three Spina Bifida Patients

IntroductionSpina bifida (SB) causes low spinal lesions, and patients often have absent genital sensation and a highly impaired sex life. TOMAX (TO MAX‐imize sensation, sexuality and quality of life) is a surgical procedure whereby the penis is newly innervated using a sensory nerve originally targeting the inguinal area. Most TOMAX‐treated SB patients initially experience penile stimulation as inguinal sensation, but eventually, the perception shifts to penis sensation with erotic feelings. The brain mechanisms mediating this perceptual shift, which are completely unknown, could hold relevance for understanding the brain's role in sexual development.AimThe aim of this study was to study how a newly perceived penis would be mapped onto the brain after a lifelong disconnection.MethodsThree TOMAX‐treated SB patients participated in a functional magnetic resonance imagery experiment while glans penis, inguinal area, and index finger were stimulated with a paint brush.Main Outcome MeasureBrush stimulation‐induced activation of the primary somatosensory cortex (SI) and functional connectivity between SI and remote cerebral regions.ResultsStimulation of the re‐innervated side of the glans penis and the intact contralateral inguinal area activated a very similar location on SI. Yet, connectivity analysis identified distinct SI functional networks. In all three subjects, the middle cingulate cortex (MCC) and the parietal operculum‐insular cortex (OIC) were functionally connected to SI activity during glans penis stimulation, but not to SI activity induced by inguinal stimulation.ConclusionsInvestigating central somatosensory network activity to a de novo innervated penis in SB patients is feasible and informative. The consistent involvement of MCC and OIC above and beyond the brain network expected on the basis of inguinal stimulation suggests that these areas mediate the novel penis sensation in these patients. The potential role of MCC and OIC in this process is discussed, along with recommendations for further research. Kortekaas R, Nanetti L, Overgoor MLE, de Jong BM and Georgiadis JR. Respond to a de novo innervated penis: a proof of concept in three spina bifida patients. J Sex Med 2015;12:1865–1877.     

Reconstructive Surgery for Female Genital Mutilation Starts Sexual Functioning in Sudanese Woman: A Case Report

IntroductionFemale genital mutilation (FGM) involves the partial or complete removal of the external female genitalia and/or other injury to the female genital organs whether for cultural or other nontherapeutic reasons.AimsThe study aims to describe the method of and findings from reconstructive surgery for FGM victims.MethodsWe present a case of a 24-year-old Sudanese female, who had undergone ritual FGM type III as a young girl. She had suffered from a large, vulval mass for the last 6 years and came to the clinic because of apareunia. We performed mass excision and reconstructive surgery of the mutilated genital tissue.ResultsThe giant mass was successfully removed. Remaining genital tissues were approximated and sutured, with hemostasis assured for the reconstructed organs on each side.ConclusionReconstructive surgery for women who suffer sexual consequences from FGM is feasible, with a high degree of client acceptance and satisfaction. It restores some of women's natural genital anatomy, and offers the potential for improved female sexuality. Fazari ABE, Berg RC, Mohammed WA, Gailii EB, and Elmusharaf K. Reconstructive surgery for female genital mutilation starts sexual functioning in S udanese woman: A case report. J Sex Med 2013;10:2861–2865.     

ORIGINAL RESEARCH—MEN'S SEXUAL HEALTH: Botulinum Toxin A (Botox) for Relieving Penile Retraction

IntroductionThe flaccid penis undergoes retraction upon contraction of the dartos muscle. These contractions are most pronounced in the situations of cold, stress, and upon exercising, and can be the source of embarrassment to those who have a hyperactive retraction reflex, especially when exposed to their partners or to others in showers and dressing rooms, despite a normal and satisfactory length in the erect state.AimIn this work, we propose an alternative to surgery and penile extenders for alleviating penile retraction, by injection of botulinum toxin into the dartos to induce muscle relaxation. This is the first report of the technique.MethodsTen male patients complaining of a short penis exclusively in the flaccid state, despite normal and satisfactory erect and outstretched lengths, were selected for the study. One hundred units of BOTOX were injected into the dartos muscle.Main Outcome MeasuresFrequency and amplitude of penile retraction, flaccid unstretched length, and patient satisfaction.ResultsSeven out of 10 cases (70%) subjectively reported a decrease in the frequency and amplitude of penile retraction, as well as improvement in flaccid length. Clinical measurements were less pronounced but still showed an improvement that was mainly in terms of less retraction rather than more length. No side effects were reported. Improvement faded completely by the 6th month.ConclusionThis preliminary report of botulinum toxin A (Botox) injection into the dartos muscle shows that Botox may have a potential effect in temporarily decreasing penile retractions in terms of frequency and amplitude. Shaeer O, Shaeer K, and Shaeer A. Botulinum toxin A (Botox) for relieving penile retraction. J Sex Med 2009;6:2788–2794.     

Shaeer’s Punch Technique: Transcorporeal Peyronie’s Plaque Surgery and Penile Prosthesis Implantation

BackgroundPenile prosthesis implantation in cases of severe Peyronie’s disease may require plaque excision/incision and grafting, which may require mobilization of the neurovascular bundle or urethra, posing the risks of penile hyposensitivity or urethral injury, and is time-consuming, possibly increasing infection risk.AimEvaluating transcorporeal debulking of Peyronie’s plaques by “Shaeer’s punch technique.”MethodsPenile prosthesis implantation and punch technique (PPI-Punch) was performed for 26 patients. After corporotomy and dilatation, Peyronie’s plaques were punched out from within the corpora cavernosa using the punch forceps, and then a penile prosthesis was implanted. Comparison to a matching retrospective group of 18 patients operated upon by plaque excision-grafting and penile prosthesis implantation was performed.OutcomesThe study outcomes were straightness of the erect penis, complication, satisfaction with length on a 5-point scale, the International Index of Erectile Function-5, and the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire.ResultsAverage preoperative curvature angle was 58.1 ± 11.7 in the Punch group and 58 ± 14.8 in the excision-grafting group, p=0.99. After surgery, all patients had a straight penis. No tunical perforations, urethral injuries, or extrusions were noted. Average additional operative time for Punch technique ranged from 5 to 10 minutes (7.3 ± 1.7), in contrast to the excision-grafting group where plaque surgery duration was 50.8 minutes ± 11.1, an 85% difference, p < 0.0001. Septal plaques in the latter group could not be removed. In the PPI-Punch group, penile sensitivity was preserved in all patients, compared with the excision/grafting group, with 7 of 18 patients reporting hyposthesia of the glans. Infection occurred in 1 of 26 patients in the PPI-Punch group, compared with 2 of 18 patients in the excision/grafting group. Satisfaction with length on a 5-point scale was 3.8 ± 0.9 in the punch group, versus 3.1 ± 1.1 in the excision-grafting group, p=0.009.Clinical ImplicationsThe proposed technique is minimally invasive and prompt, possibly decreasing the known complications of plaque surgery and PPI including sensory loss.Strengths & LimitationsOne limitation is the inability to accurately measure preoperative erect length in patients with erectile dysfunction with poor response to intracavernous injections.ConclusionShaeer’s punch technique is a minimally invasive procedure for transcorporeal excavation of Peyronie’s plaques before penile prosthesis implantation, omitting the need for mobilization of the neurovascular bundle or spongiosum, and hence, there is low or no risk for nerve or urethral injury and brief plaque surgery time.Shaeer O, Soliman Abdelrahman IF, Mansour M, et al. Shaeer’s Punch Technique: Transcorporeal Peyronie’s Plaque Surgery and Penile Prosthesis Implantation. J Sex Med 2020;17:1395–1399.     

Consequences of Female Genital Mutilation on Women’s Sexual Health – Systematic Review and Meta-Analysis

BackgroundFemale genital mutilation (FGM) can leave a lasting mark on the lives and minds of those affected.AimTo assess the consequences of FGM on women’s sexual function in women who have undergone FGM compared to women who have not undergone FGM.MethodsA systematic review and meta-analysis were conducted from 3 databases; inclusion and exclusion criterions were determined. Studies included adult women having undergone FGM and presenting sexual disorders assessed by the Female Sexual Function Index (FSFI).ResultsOf 129 studies, 5 that met the criteria were selected. The sexual function of mutilated women, based on the FSFI total score and its different domains, was compared to the sexual function of non-mutilated women. There was a significant decrease in the total FSFI scores of mutilated women compared to non-mutilated women. However, the results obtained for the different domains were not the same for all authors. The meta-analysis highlighted a high heterogeneity with inconsistency and true variance in effect size between-studies.ConclusionAnalysis of studies showed that there is a significant decrease in the total FSFI score, indicating that FGM of any type may cause impaired sexual functioning. But a firm conclusion on this topic is not yet achievable because the results of this analysis do not allow to conclude a cause and effect relationship of FGM on sexual function.Nzinga A-M, De Andrade Castanheira S, Herklmann J, et al. Consequences of Female Genital Mutilation on Women’s Sexual Health – Systematic Review and Meta-Analysis. J Sex Med 2021;18:750–760.     

Pleasure and orgasm in women with Female Genital Mutilation/Cutting (FGM/C)

IntroductionFemale genital mutilation/cutting (FGM/C) violates human rights. FGM/C women's sexuality is not well known and often it is neglected by gynecologists, urologists, and sexologists. In mutilated/cut women, some fundamental structures for orgasm have not been excised.AimThe aim of this report is to describe and analyze the results of four investigations on sexual functioning in different groups of cut women.Main Outcome MeasureInstruments: semistructured interviews and the Female Sexual Function Index (FSFI).MethodsSample: 137 adult women affected by different types of FGM/C; 58 young FGM/C ladies living in the West; 57 infibulated women; 15 infibulated women after the operation of defibulation.ResultsThe group of 137 women, affected by different types of FGM/C, reported orgasm in almost 86%, always 69.23%; 58 mutilated young women reported orgasm in 91.43%, always 8.57%; after defibulation 14 out of 15 infibulated women reported orgasm; the group of 57 infibulated women investigated with the FSFI questionnaire showed significant differences between group of study and an equivalent group of control in desire, arousal, orgasm, and satisfaction with mean scores higher in the group of mutilated women. No significant differences were observed between the two groups in lubrication and pain.ConclusionEmbryology, anatomy, and physiology of female erectile organs are neglected in specialist textbooks. In infibulated women, some erectile structures fundamental for orgasm have not been excised. Cultural influence can change the perception of pleasure, as well as social acceptance. Every woman has the right to have sexual health and to feel sexual pleasure for full psychophysical well-being of the person. In accordance with other research, the present study reports that FGM/C women can also have the possibility of reaching an orgasm. Therefore, FGM/C women with sexual dysfunctions can and must be cured; they have the right to have an appropriate sexual therapy. Catania L, Abdulcadir O, Puppo V, Baldaro Verde J, Abdulcadir J, and Abdulcadir D. Pleasure and orgasm in women with female genital mutilation/cutting (FGM/C).     

Functional and Patient Reported Outcomes Following Total Glans Resurfacing

BackgroundWhilst there is a trend away from aggressive nonorgan sparing surgical treatments for malignant penile disease, a variety of penile preservation options exist but functional outcomes and patient reported outcomes (PROs) in this area are poorly reported to date.AimThe aim of this study is to report functional outcomes and PROs of total glans resurfacing (TGR) in a consecutive series of patients with lichen sclerosis (LS) or localized penile cancer (PC).MethodsFrom 2004 to 2018 a consecutive series of patients underwent TGR for the management of LS or localized PC in a tertiary referral network. Patient clinical records and operative notes were retrospectively reviewed. Statistical analysis was conducted with Stata 12.OutcomesUrinary and sexual outcomes were recorded utilizing both the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) validated questionnaires while PROs were extrapolated from a 5-item “ad hoc” telephone questionnaire administered at 1 year post procedure.Results37 consecutive patients were enrolled. Histology results demonstrated LS in 16 patients, with the remaining 21 having a diagnosis of PC. The most common reasons for patient presentation were local pain (32.4%), pruritus (37.8%) and bleeding (29.7%). Median follow-up was 22 (IQR 13–77) months. Median age was 62 (IQR 55–68).Neither of the questionnaires assessing urinary and sexual function showed any significant deterioration after surgery. Glans sensitivity was fully maintained in 89.2% of cases. 94.5% of patients reported to be fully satisfied with the aesthetic appearance of the penis and would consider undergoing the same procedure again if necessary. 91.9% of patients would recommend the same procedure to someone else. An overall improvement of the quality of life was reported by 86.4% of patients.Clinical ImplicationsTGR should be considered a treatment of choice for selected cases of benign or malignant penile lesionsStrengths and LimitationsOur study has some limitations, the first being its retrospective nature. Furthermore, despite being one of the largest series to date, follow-up duration is somewhat limited and a control group is lacking.ConclusionTGR represents an excellent surgical option ensuring satisfactory voiding and sexual function, as well as cosmesis for selected cases of penile lesions.M. Preto, M. Falcone, G. Blecher, et al. Functional and Patient Reported Outcomes Following Total Glans Resurfacing. J Sex Med 2021;18:1099–1103.     

Skin Reduction Technique for Correction of Lateral Deviation of the Erect Straight Penis

IntroductionLateral deviation of the erect straight penis (LDESP) refers to a penis that despite being straight in the erect state, points laterally, yet can be directed forward manually without the use of force. While LDESP should not impose a negative impact on sexual function, it may have a negative cosmetic impact.AimThis work describes skin reduction technique (SRT) for correction of LDESP.MethodsCounseling was offered to males with LDESP after excluding other abnormalities. Surgery was performed in case of failed counseling. In the erect state, the degree and direction of LDESP were noted. Skin on the base of the penis on the contralateral side of LDESP was excised from the base of the penis and the edges approximated to correct LDESP. Further excision was repeated if needed. The incision was closed in two layers.Main Outcome MeasureLong‐term efficacy of SRT was the main outcome measure.ResultsOut of 183 males with LDESP, 66.7% were not sexually active. Counseling relieved 91.8% of cases. Fifteen patients insisted on surgery, mostly from among the sexually active where the complaint was mutual from the patient and partner. SRT resulted in full correction of the angle of erection in 12 cases out of 15. Two had minimal recurrence, and one had major recurrence indicating re‐SRT.ConclusionsLDESP is more common a complaint among those who have not experienced coital relationship, and is mostly relieved by counseling. However, sexually active males with this complaint are more difficult to relieve by counseling. A minority of patients may opt for surgical correction. SRT achieves a forward erection in such patients, is minimally invasive, and relatively safe, provided the angle of erection can be corrected manually without force. Shaeer O. Skin reduction technique for correction of lateral deviation of the erect straight penis. J Sex Med 2014;11:1863–1866.     

Extracorporeal Transseptal Penile Prosthesis Implantation for Extreme Cases of Corporeal Fibrosis: Shaeer Implantation Technique

Background

Penile prosthesis implantation into scarred corporeal bodies is one of the most challenging procedures in prosthetic urologic surgery, especially following infection and extrusion of a penile implant. Several instruments and techniques have been used for making dilatation of scarred corporeal bodies easier and safer in expert hands. Nevertheless, in some cases, implantation is not possible.

Successful Medical Treatment of Glans Ischemia after Voluntary Buprenorphine Injection

IntroductionThe diverted use of synthetic opioid buprenorphine by drug addicts can be responsible for serious ischemic and infectious complications, particularly in the case of intravenous injection.AimWe present a case of serious glans ischemia after buprenorphine injection directly into the deep dorsal vein of the penis. Analysis using new medical imaging techniques and treatments is detailed below.MethodsA 26‐year‐old male drug addict presented with glans pain 4 days after self‐injection of buprenorphine into the deep dorsal vein of the penis. The patient was apyretic and presented a urethral discharge. His glans was blue without discoloration on digital pressure. Additionally, his biologic and serologic tests were normal while bacteriology showed the presence of Enterobacter cloacae urethritis.ResultsAfter 48 hours of intravenous antibiotic treatment without improvement, a specific medical treatment using enoxaparin and ilomedin was initiated, with the assumption that there was an ischemic complication. Laser speckle contrast imaging allowed confirmation of the presence of distal penis ischemia and provided an accurate mapping of the ischemic zone. A 28‐day treatment combining antibiotics, subcutaneous heparin at curative dose, antiplatelet drug, ilomedin, and hyperbaric oxygen therapy resulted in clinical improvement of the lesions with no functional complications.ConclusionsTo date, no consensus exists on the proper diagnostic and treatment approach to severe glans ischemia due to buprenorphine injection into the deep dorsal vein of the penis. The results of laser speckle contrast imaging were of real interest during the process of diagnosis. In addition, the combination of ilomedin with hyperbaric oxygen therapy and anticoagulant and antiplatelet drugs appeared to be an effective therapy. Brecheteau F, Grison P, Abraham P, Lebdai S, Kemgang S, Souday V, Nedelcu C, Culty T, Larré S, Azzouzi AR, and Bigot P. Successful medical treatment of glans ischemia after voluntary buprenorphine injection. J Sex Med 2013;10:2866–2870.     

Penile prosthesis implantation in cases of fibrosis: ultrasound-guided cavernotomy and sheathed trochar excavation

IntroductionImplantation of a penile prosthesis into fibrosed corpora cavernosa is a difficult and risky procedure. Specialized instruments that assist safer and more efficient excavation include Otis Urethrotome and various cavernotomes, all of which operate underneath the tunica albuginea, out of sight. The blind use of such instruments can result in perforation of the tunica albuginea or injury to the urethra.AimThis work describes the utility of ultrasonography for adding visual monitoring to any of the above-mentioned instruments, maintaining them in the mid-corpus cavernosum position to avoid perforation, and describes the application of alternative sheathed, sharp instruments that allow fast, efficient, and visually monitored drilling into fibrous tissue.Main Outcome MeasuresClinical outcome data were examined.MethodsSurgery was performed on five cases with extensive fibrosis of the penis. Initial blunt dilatation by Hegar dilators faced considerable resistance. An ultrasound probe was applied to the ventral aspect of the penis. A laparoscopy sheath was advanced under ultrasound guidance up to the fibrous tissue. A sharp laparoscopy trochar was inserted through the sheath. Its tip was oriented in the mid-corpus cavernosum by longitudinal and transverse sonography sections, as it drilled into the fibrous tissue. Laparoscopy scissors were used in the same fashion to cut fibrous tissue lumps. After full excavation, penile prosthesis was implanted.ResultsAll implants survived adequately. No complications occurred following implantation. Operative time ranged from 50 to 60 minutes. No difficulty was encountered at excavation.ConclusionUltrasound guidance can be a handy adjunct to any of the available techniques developed for excavating the fibrosed corpora cavernosa, with a possible decrease in difficulty and complication rate of the procedure. Utility of sheathed, sharp instruments guided by sonography is an alternative to the cavernotomes, allowing fast and efficient drilling into fibrous tissue. Shaeer O. Penile prosthesis implantation in cases of fibrosis: Ultrasound-guided cavernotomy and sheathed trochar excavation.     

High Grade Gynecomastia: Surgical Correction and Potential Impact on Erectile Function

IntroductionGynecomastia denotes benign enlargement of the male breast. It is a common belief that gynecomastia is stigmatizing and may frequently cause social embarrassment and psychological stress. It is possible that this may reflect on erectile function of the afflicted. High grade gynecomastia requires radical breast tissue excision and skin reduction ending up in aesthetically unappealing scars.AimThe purpose of this study is to evaluate the reduction mammaplasty using no vertical scar technique in males with high grade gynecomastia; as regards technical refinements and outcome in the hope of providing a cosmetically appealing solution to this condition. This study also reports on the effect of high grade gynecomastia on erectile function, as well as the effect of surgery.MethodsFifteen male patients with gynecomastia underwent breast reduction using the “no vertical scar reduction mammaplasty.” Erectile function was evaluated before and after surgery.Main Outcome MeasuresSurgical outcome and erectile function.ResultsAll patients but one were satisfied with the outcome. Complications were minimal and manageable. Eleven out of 15 patients had a preoperative International Index of Erectile Function (IIEF) score less than 20 denoting erectile dysfunction. All but one (n = 10) showed improvement in their IIEF score following surgery. The difference between pre-operative IIEF (average 17.8) and postoperative (average 23.5) was statistically significant.ConclusionsThe “no vertical scar reduction mammaplasty” is a reliable technique in cases with gynecomastia and significant ptosis. It has the added benefits of avoiding the vertical scar, hiding the transverse scar in the shadow of the inferior aspect of the breast, with minimal complications. Gynecomastia as a condition causing a feminized outlook may have a negative impact on self confidence and body image. We suggest that this may have a potential negative effect on erectile function, that can be improved by adequate surgical correction. El Noamani S, Thabet AM, Enab AA, Shaeer O, and El-Sadat A. High grade gynecomastia: Surgical correction and potential impact on erectile function.