Evaluation of penile hemodynamic status and adjustment of treatment alternatives in Peyronie's disease

Aim: Erectile dysfunction may be observed in up to 80% of patients with Peyronie's disease. An objective evaluation of the erectile function is attempted to work out in patients with Peyronie's disease. Methods: Penile deformity, sexual function and penile vascular status were analyzed in 123 patients with Peyronie's disease, who had not received any pertinent treatment. Results: Penile deformity, palpable plaque and pain on erection were seen in 112 (91%), 97(78.8%) and 27 (21.9%) of the 123 patients, respectively. Of the 76 patients evaluated by color Doppler ultrasounography, veno-occlusive dysfunction as the vascular component for erectile dysfunction was found in 17 (22.3%), arterial insufficiency in 10(13.1%) and a mixed picture in 23 (30.2%). Conclusion: The documentation of penile erectile function and the determination of the vascular status using color Doppler ultrasonography can guide the appropriate therapeutic choice.     

Evaluation of penile hemodynamic status and adjustment of treatment alternatives in Peyronis‘s disease

Aim:Erectile dysfunction may be observed in up to 80%of patients with Peyronis‘s disease.An objective evaluation of the erectile function is attempted to work out in patients with Peyronie‘s disease.Methods:Penile deformity,sexual function and penile vascular status were analyzed in 123patients with Peyronis‘s disease,who had not received any pertinent treatment.Results:Penile edformity,palpable plaque and pain on erection were seen in112(91%),97(78.8%)and27(21.9%)of the123patients,respectively.Of the 76patients evaluated by color Doppler ultrasounography,veno-occlusive dysfunction as the vascular component for erectile dysfunction was found in 17(22.3%),arterial insufficiency in10(13.1%)and a mixed picture in 23(30.2%).Conclusion:The documentation of penile erectile function and the determination of the vascular status using color Doppler ultrasonography can guide the appropriate therapeutic choice.     

大鼠阴茎组织NOS活性对雄激素的依赖性

目的探讨ＮＯＳ活性与雄激素在阴茎勃起中的关系。方法将３０只成年雄性大白鼠随机分为去势组,替代组及对照组,去势组与替代组分别切除双侧睾丸,其中替代组在切除睾丸后给予睾酮替代。于术后１周取阴茎组织,用紫外分光光度法检测其ＮＯＳ活性。结果去势组ＮＯＳ活性较对照下降７０％（Ｐ＜０．０１）,睾酮替代组和对照组ＮＯＳ活性差异无显著性（Ｐ＞０．０５）。结论雄激素可能通过调节ＮＯＳ活性而在阴茎勃起中发挥重要作用。     

Risk of connective—tissue disease in men with testicular or penile prostheses：a preliminary study

AIM: To help clarifying the possibility of connective-tissue diseases in men with penile or testicular prostheses. METHODS: Eight patients underwent inflatable penile prostheses and 15, testicular prostheses consented to the study. Their medical records were reviewed and a follow-up interview and physical and serological examinations were performed. RESULTS: In patients with penile prostheses, there was no abnormal antinuclear antibody (ANA) or IgM elevation. The serum levels of the rheumatoid factor (RF), C4, IgA and IgG were abnormal in one patient, and the levels of erythrocyte sedimentation rate (ESR) and C3, abnormal in two. Four had elevated IgE. In patients with testicular prostheses, there was no abnormal RF, ANA or IgM. The serum levels of ESR and IgA were abnormal in two, and three had abnormal C4, ten abnormal C3, and eleven decreased IgG. All had increased IgE. Men with penile prostheses had higher serum levels of IgG and IgM than those with testicular prostheses (P=0.001, P=0.016, respectively). The rates of abnormal values of IgE and IgG were higher in men with testicular prostheses than in men with penile prostheses (P=0.008, P=0.009, respectively). Physical examination was normal in all patients and nobody had documented symptoms pertinent to connective-tissue diseases. CONCLUSION: Our findings suggest that the risk of connective-tissue diseases is not higher in patients wearing prostheses as the ANA is negative and there is no apparent manifestation suggestive of connective-tissue diseases.     

大鼠阴茎组织中NOS表达及增龄的影响

为探讨大鼠阴茎组织中一氧化氮合酶分布及增龄对其的影响。本文采用ＮＡＤＰＨｄ组化对不同月龄大鼠阴茎组织进行染色。结果显示ＮＯＳ主要分布于大鼠阴茎组织平滑肌细胞,而内皮和社会纤维含量较少;随年龄增加,阴茎组织中ＮＯＳ表达逐渐减弱,各月龄组间差别明显。     

The rat as a model for the study of penile erection

A model has been developed for the study of penile erection in the Sprague-Dawley rat. Anatomical dissections demonstrate a bilateral ganglion lateral to the prostate called the major pelvic ganglion. This ganglion receives input from the pelvic and hypogastric nerves and innervates the pelvic viscera. A large fiber from the major pelvic ganglion courses along the urethra and innervates the corpus cavernosum, the cavernous nerve. In 40 animals, electrical stimulation of either the cavernous nerve or the pelvic nerve resulted in reproducible repetitive tumescence of the corpora cavernosum. Following ablation of the cavernous nerve, electrical stimulation failed to produce erections. Standard mating behavior tests of mounting, intromission and ejaculation in 38 rats showed that surgical ablation of the cavernous nerve resulted in a decrease in the rate of intromissions and ejaculations compared with sham operated controls. Present models for the study of erection have been limited to the dog, monkey and cat. The rat model presented here offers several advantages over these existing models: 1) the cavernous nerve is easily identified, 2) electrical stimulation is easily accomplished and reproducible, 3) behavioral and neurophysiological studies are possible, and 4) animal purchase, housing, and maintenance costs are low. These advantages make this model a uniquely useful tool in the further study of penile erection.     

Antimicrobial tissue penetration in a rat model of E. coli epididymitis

Following induction of unilateral epididymitis by intratesticular injection of E. coli, a single intraperitoneal dose of amdinocillin, ampicillin, doxycycline, tobramycin, or trimethoprim/sulfamethoxazole was administered to five groups of rats. The animal was sacrificed serially and concentrations of antibiotic in serum, infected epididymides, and non-infected epididymides were determined by high performance liquid chromatography. The ratio of infected to non-infected tissue area under the curve values was 1.05 for trimethoprim, 1.58 for sulfamethoxazole, 1.67 for amdinocillin, 2.01 for tobramycin, 2.25 for doxycycline, and 2.58 for ampicillin. Except for trimethoprim, infected tissue concentrations were significantly greater than compared to uninfected epididymal levels (p less than 0.05). Antibiotic concentrations in infected epididymides compared to serum revealed overall penetration of 34% for amdinocillin, 66% for sulfamethoxazole, 70% for ampicillin, 76% for tobramycin, 256% for trimethoprim, and 257% for doxycycline. In a rat model of epididymitis, trimethoprim and doxycycline demonstrated the greatest degree of epididymal penetration compared to serum. All antibiotics except trimethoprim had significantly greater penetration into infected tissue when compared to non-infected epididymal tissue.     

A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision

Study Type – Aetiology (case series)
Level of Evidence 4

OBJECTIVE

To determine the sensory innervation of the penis, as regional anaesthesia is often used either for postoperative analgesia or as the sole anaesthetic technique for circumcision. Since first described in 1978 the dorsal penile nerve block has become the standard technique, but some blocks are ineffective; a better understanding of the sensory innervation of the penis might improve the efficacy of the dorsal penile block technique.

PATIENTS AND METHODS

In 13 men undergoing circumcision with local anaesthetic, cutaneous sensation was tested before and after infiltration of the dorsal aspect of the penis, and then again after infiltration of the ventral aspect. The area of anaesthesia was mapped using pin‐prick sensation.

RESULTS

Ten of the 13 patients showed a similar pattern of sensory distribution. After the dorsal block, the dorsal aspect of the shaft of the penis and glans penis became insensate. The ventral aspect of the shaft remained sensate up to and including the frenulum. After successful ventral infiltration all sensate areas became insensate and circumcision proceeded. In one case the frenulum and distal ventral foreskin was anaesthetized after the dorsal block and ventral infiltration was not required. No patient experienced pain during circumcision.

CONCLUSION

For consistently successful regional anaesthesia of the foreskin in circumcision, a dorsal block must be used. This should be combined with ventral infiltration at the site of incision. This method will avoid inconsistencies and allow pain‐free circumcision using local anaesthesia in most men.     

Surgical debridement of mineral pitch and nonviable penile tissue using water‐jet power: a preliminary report

OBJECTIVE

To report our experience of debriding genital wounds embedded with mineral pitch (MP) from asphalt, using a water jet‐powered surgical tool, the Versajet Hydrosurgery System (VHS, Smith and Nephew, Key Largo, FL) before reconstruction.

PATIENTS AND METHODS

We used the VHS for penile debridement in two patients. The first was 42‐year‐old Hispanic man involved in a truck‐bike accident, who was dragged ≈60 m after the collision. He presented with 25% body‐surface abrasion impregnated with MP. The scrotal soft tissue had been lost and both testicles were exposed and ruptured, with no viable tissue. Moreover, the distal two‐thirds of the penile urethra and the ventral glans were completely damaged and his penis entirely degloved. Several procedures were required for surgical debridement and reconstruction, including the skin grafting to 25% of his body surface. All surgical debridement was done with the VHS. A modified Thiersch‐Duplay urethroplasty was used over a 16 F Foley catheter to reconstruct the missing urethra. The second patient was a 32‐year‐old man with no previous medical history, who presented with Fournier’s gangrene after a penile abrasion following unprotected sexual intercourse. He required several surgical debridements. The VHS was applied to an 8 × 10 cm area, followed by a free‐radial graft to the inferior epigastric.

RESULTS

The clinical follow‐up was 9 and 6 months, respectively; both patients had satisfactory granulation tissue and proper wound healing. Neither of the patients had infection after surgical debridement with the VHS, even when used in the case of Fournier’s gangrene.

CONCLUSION

The VHS appears to be effective for genital soft‐tissue surgical debridement even when the tissue is impregnated with MP or infected, without causing any spread of infection. Larger series and a longer follow‐up are needed to validate the effectiveness of the VHS in managing complex genital wounds.     

Regional and systemic prophylaxis with teicoplanin in total knee arthroplasty: a tissue penetration study

Five patients undergoing total knee arthroplasty (TKA) received 800 mg intravenous teicoplanin systemically 2.5 hours before surgery and 15 patients received 200 mg teicoplanin into a foot vein in the leg to be treated. Samples of bone, synovia, subcutaneous tissue, and skin were collected at 20, 40, and 60 minutes after tourniquet inflation and at the end of surgery. None of the study subjects experienced adverse effects, adverse events, or infections during the postoperative and follow-up period. Mean teicoplanin concentration in the collected tissue ranged from 1.52 to 5.81 mg/L after regional prophylaxis and from 0.9 to 2.94 mg/L after systemic prophylaxis. Bone and soft tissue penetration of teicoplanin after regional prophylaxis with 200 mg is at least comparable with that achieved after systemic prophylaxis with 800 mg. Regional prophylaxis in TKA appears to be safe and valuable. Higher dosages of teicoplanin seem to be needed to ensure coverage against coagulase negative staphylococci.     

Diffusion tensor imaging in evaluating testicular injury after unilateral testicular torsion and detorsion in rat model: A preliminary study

Diffusion tensor imaging (DTI) is a functional magnetic resonance sequence based on the movement of water molecules. This study attempted to investigate the feasibility of DTI in evaluating testicular injury after testicular torsion and detorsion. Seventy-two rats were randomly divided into the sham group, torsion group and detorsion group. The left testis in the sham group was brought out through a scrotal incision for 1 hr, and that of the torsion group was twisted 720^o clockwise for 1 hr and fixed to the scrotum, while the detorsion group was restored after being twisted 720° for 1 hr. Rats were further divided into four subgroups according to the set time, then performed DTI and histology analysis. The mean diffusion of the torsion and detorsion groups increased within 24 hr (p <.01), while it in the detorsion-1-week-group was lower than that in the detorsion-24-hr-group (p <.05). The fraction anisotropy of both experimental groups decreased in the acute phase (p <.01), while that of the detorsion-1-week-group increased (p <.01). Cosentino score in both experimental groups showed an increasing trend (p <.05). Besides, the spermatogenic ability of the detorsion-1-week-group decreased (p <.05). In conclusion, DTI was able to evaluate the injury after testicular torsion and detorsion.     

Proteomic analysis of rat penile tissue in a model of erectile dysfunction after radical prostatectomy

OBJECTIVE: To identify differential protein expression in penile tissue in a rat model of erectile dysfunction (ED) at an early stage after bilateral cavernosal nerve (CN) neurectomy, using proteomic techniques. MATERIALS AND METHODS: Twelve male adult Sprague-Dawley rats were randomly divided into two equal groups, one having bilateral CN resection and one a control group. The penises were harvested 7 days after CN resection. Total protein was separated into >1250 protein spots by two-dimensional electrophoresis using pH 3-10 nonlinear immobilized pH gradient strips. Differential expression of proteins was analysed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and database searching. RESULTS: Thirty-two proteins were significantly changed in the denervated penis, of which 25 (including nine up-regulated and 16 down-regulated) with cytoskeletal functions, and pathophysiological functions related to energy metabolism and oxidative stress, were identified. Examples include transgelin, creatine kinase B, annexin-1 and galactin-7. CONCLUSIONS: The expression of several important proteins participating in pathophysiological processes of penile tissue are changed early after bilateral CN neurectomy. These changes might give new insights into the cellular and molecular mechanisms involved in neurogenic ED development, and indicate potential therapeutic targets.     

高脂血症对大鼠阴茎海绵体中NOS及CO含量影响的研究

目的 探讨高脂血症对大鼠阴茎海绵体中一氧化氮合成酶(NOS)活性及一氧化碳(CO)浓度的影响及两者之间的关系.方法 将32只雄性wistar大鼠随机分为2组:高脂血症组和正常对照组,每组各16只大鼠.通过建立大鼠高脂血症模型,于实验开始后10d和20d,分别随机取各组1/2大鼠观察其勃起功能;用分光光度法分别测定海绵体匀浆中NOS活性和CO浓度.结果 在第10天及第20天,高脂血症组和正常对照组相比,大鼠阴茎海绵体内NOS活性、CO浓度及阴茎勃起次数差异均有统计学意义(P<0.05);而且第20天高脂血症组NOS活性、CO浓度及阴茎勃起次数,均明显低于第10天,两两比较差异均有统计学意义(P<0.05).结论 高脂血症大鼠阴茎海绵体中NOS及CO下降,这可能是高脂血症引起勃起功能障碍的发病机制之一.     

Collagen crosslinked N-telopeptides as markers for evaluating particulate osteolysis: a preliminary study.

The purpose of this study was to determine whether a marker of bone resorption could be used noninvasively to diagnose and assess treatment of periprosthetic osteolysis. The crosslinked N-telopeptide marker of osteoclast-mediated bone resorption potentially has the sensitivity to detect periprosthetic osteolysis. Second-morning urine specimens were obtained from (a) seven age-matched controls, (b) eight patients who had a hip arthroplasty, hybrid implants at least 1 year after surgery, and no osteolysis, (c) 11 patients who had a hip arthroplasty and osteolysis, and (d) 10 patients who had a hip arthroplasty and with osteolysis before and after 6 weeks of oral Fosamax (alendronate) treatment. The Fosamax treatment consisted of one 10-mg dose per day for 6 weeks. Men and young women (less than 40 years old) were chosen for this study to avoid bone resorption enhanced after menopause as a possible confounder. An enzyme-linked immunosorbent assay technique for quantifying crosslinked N-telopeptides of type-I collagen was performed on all specimens. The patients with osteolysis had significantly elevated levels of N-telopeptide compared with the implant control group. In addition, levels of N-telopeptide were significantly lowered after Fosamax treatment. These findings indicate that a systemic bone-resorption marker (N-telopeptide) can be used to evaluate local particulate-induced osteolysis and its treatment. The study also provides clinical evidence that osteolysis is associated with increased osteoclast-mediated bone resorption and that this locally induced bone resorption can be suppressed by certain bisphosphonates (Fosamax). These insights have potential value in the understanding and clinical management of aseptic loosening.     

衰老对大鼠阴茎组织NO-cGMP通路及端粒酶活性的影响研究

目的探讨衰老对大鼠阴茎组织结构、NO(nitric oxide)-cGMP(cvclic Guanosine Monophosphate)通路及端粒酶活性的影响作用。方法本课题以不同月龄大鼠阴茎组织及培养的平滑肌细胞为研究对象,检测不同月龄大鼠阴茎组织中NO量、NOS(Nitric Oxide Synthase)活性、cGMP量、端粒酶活性及海绵体结构的变化,并比较大鼠、人阴茎组织及大鼠原代海绵体平滑肌细胞的端粒酶活性。结果(1)大鼠阴茎组织中NO量、NOS活性均先升高后降低,各月龄组间有显著差异。阴茎组织cGMP含量逐渐降低,各月龄组间差别显著；(2)随龄增加,平滑肌纤维逐渐减少,胶原纤维增多,粗大成团,窦状隙变少、变窄：(3)大鼠阴茎组织端粒酶活性以2月龄活性最高,随龄增加逐渐下降。人阴茎组织中无端粒酶活性。结论(1)衰老对大鼠阴茎组织结构、NO．cGMP通路及端粒酶活性有显著影响,提示衰老与ED关系密切；(2)大鼠阴茎组织有端粒酶活性,可作为研究细胞衰老与ED关系有关端粒酶的模型。     

Phalloplasty and urethroplasty in children with penile agenesis: preliminary report

PURPOSE: Female gender has been assigned to 46,XY newborns affected by aphallia, possibly resulting in subsequent gender dysphoria. Prenatal and postnatal effects of the androgens on the brain and sexual orientation cannot be modified later. Therefore, patients affected by aphallia should be raised as males. Because definitive forearm flap phalloplasty is generally not recommended before puberty, we performed a preliminary penile reconstruction during childhood in 4 patients. MATERIALS AND METHODS: Four patients with aphallia who had no sex reassignment at birth were treated at age 9, 17 and 36 months, and 12 years in a single operation. The urethral channel was dissected through an anterior-sagittal-transanorectal approach, and then phalloplasty and urethroplasty were carried out using an abdominal skin flap and a bladder/buccal mucosa free graft. RESULTS: Immediate postoperative outcome was excellent in all the patients. One patient had excellent functional and cosmetic results at 5 years, while 2 had a partial dorsal urethral dehiscence resulting in an epispadiac urethra at 2 years, and 1 had necrosis of the distal urethra and was voiding through a scrotal urethrostomy at 9 months postoperatively. Phalloplasty survived and provided an adequate male appearance in all patients. CONCLUSIONS: Opposite gender should not be assigned in patients affected by penile agenesis, who are better raised according to their karyotype and hormonal production. Definitive phalloplasty in adults may achieve good results. Nevertheless, this procedure is generally performed in postpubertal boys and it is not easily available everywhere. Therefore, we believe that social and psychological concerns justified this type of phalloplasty as a palliative preliminary procedure in 3 of our patients. In those countries where definitive forearm phalloplasty is not available our method may also be justified in older children (as in 1 of our patients) as an attempt at a definitive procedure.     

Evaluation of biocompatibility and biodegradability of a new auto-derived injectable soft tissue filler: a preliminary report

Although a wide range of materials has been used as implants in reconstructive or cosmetic surgery, many implant materials proved to be of limited usefulness due to lack of stability or result in host immune response. The purpose of this study is to explore a new autogenous injectable soft-tissue filler derived from hair and evaluate the possible use of this potential filling agent. Hair fibers after bleaching were processed into different size particles by a ball mill or hair keratin gel, respectively. The microstructure of material was observed under electron microscopy. General toxic tests in vitro or in vivo include MTT assay, acute toxicity, and the micronucleus were used to evaluate the biocompatibility of this material. Animal subcutaneous implant models were employed to investigate the immune reaction, absorption, and maintenance of the augmentation effect. Hair-derived material after processing showed an intrinsic capacity with preferable fluidity and glutinousness for injection. General toxic evaluation revealed a good biocompatibility and an absence of cytotoxicity or mutagenicity. Animal subcutaneous implant models did not show local or systemic adverse reactions in the observation period. Hair fiber particles showed preferable augmentation effect which preserved at least 50% of original volume during the observation period compared to hair keratin gel. The optimal size of the particle is about 120 μm. The autogenous hair material directly processed by the ball mill after bleaching is easy to obtain and shows biocompatibility and biodegradability well. It may become a prospective filling agent in reconstructive or cosmetic surgery.