Ultrastructural changes of penile tunica albuginea in diabetic rats

Aim: To clarify the ultrastructural changes of penile tunica albuginea (TA) in streptozotocin (STZ)-induced diabetic rats. Methods: Intraperitoneal injection of STZ was used to induce diabetes mellitus (DM) in 12 Sprague Dawley rats. Ten rats (age and weight-matched) were used as control. Blood samples from the tail snips of the rats were used for the determination of serum glucose levels with SureStep Plus Blood Meter. At week 4 and 10 after the injection, half of the rats in each group were sacrificed and penile samples were obtained from the middle third of the penile shaft for the examination of TA under scanning electron microscopy. Results: In the diabetic group, the serum glucose levels were higher (P<0.01 at both time points) and the TA were thinner (P<0.05) than those of the controls. In the control group, the fibers of TA were rich and arranged regularly and undulated, while in the diabetic group, the fibers were diminished, lost the undulations and were arranged irregularly. Conclusion: In rat     

Effect of aging on penile ultrastructure

Aim: To clarify whether there are anatomical changes in tunica albuginea and corpora cavernosa in aged rats. Meth-ods: Seventeen male Sprague-Dawley rats were divided into three groups based on age. Group A consisted of youngrats (9 weeks), Group B, middle aged rats (14 weeks) and Group C, old rats (62 weeks). The penile samples wereobtained and observed under a scanning electron microscope. Results: The thickness (mean ± SD) of the tunica al-buginea was 0.14±0.02, 0.16±0.03 and 0.06±0.02 mm in Groups A, B and C, respectively. The tunica albug-inea of group C was significantly thinner than those of the other two groups (P < 0.05) and the elastic fibers were di-minished in the old rats. In the corpora cavernosa of old rats, the intracavernous pillars were irregular, in which manylarge collagen fibers could be observed, and the smooth muscle and elastic fibers were reduced. Conclusion; In oldrats, the tunica albuginea became thinner with diminished elastic fibers; the collagen fibers of corpora cavern     

Effects of extra—corporeal shock waves on penile hemodynamics and histopathology in rats

Aim: To study the effect of extra-corporeal shock wave (ESW) on the penile hemodynamics and histopathology in rats. Methods: Adult male Sprague-Dawley rats were divided at random into 3 groups. ESW application was performed with a Siemens Lithostar with the rats under anesthesia lying prone on the balloon probe. Rats in Group Ⅰ received a total of 1000 shocks at 18 kV and immediately underwent hemodynamic evaluation performed by direct electrostimulation of the cavernous nerve and measurement of intracavernous pressure (ICP). Rats in Group Ⅱ received 3 times 1000 shocks at 18 kV at weekly intervals and hemodynamic evaluation was performed 1 month after the last ESW application. Group Ⅲ served as the control. Histopathological examinations of penile tissues were done on Masson's trichrome and hematoxylin and eosin stained sections. Results: Penile hemodynamic evaluation showed a trend toward a diminished mean maximal ICP, duration of erection, ICP during the plateau phase and maximal ICP/blood pressur     

Infiltration of inflammatory factors induced penile damage in chronic prostatitis

The present study aimed to investigate the mechanism of penile damages in experimental autoimmune prostatitis (EAP) rat models to reveal the potential pathological mechanism of the relationship between CP and penile damages. Sprague–Dawley (SD) rats were administered with different concentrations of prostate tissue homogenate supernatant (PTHS) by multipoint subcutaneous injection to establish EAP models. IHC staining was done to assess the expression of inflammatory cytokines in prostate tissues and the corpus cavernosum of penis. Masson and Tunel staining was conducted to observe the fibrosis and apoptosis in the corpus cavernosum. Finally, the functional changes of corpus cavernosum were assessed by WB and IHC staining. The results revealed that EAP rats with different prostatitis severity were successfully established by PTHS. The expression of IL-1β, IL-6 and TNF-α in prostate tissues increased with the concentration of PTHS. The results of Masson and Tunel staining indicated fibrosis and apoptosis gradually aggravated in corpus cavernosum among different subgroups. The function of cavernosum impaired by prostatitis from WB and IHC results and positively with the severity. In conclusion, there existed the infiltration of inflammatory factors and impaired function in the corpus cavernosum of EAP rats’ penis and positively correlated with the severity of prostatitis.     

Penoscrotal plication as a uniform approach to reconstruction of penile curvature

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

OBJECTIVE

To present our 4‐year experience of using a minimally invasive technique, penoscrotal plication (PSP), as a uniform treatment for men with debilitating penile curvature resulting from Peyronie’s disease.

PATIENTS AND METHODS

In 48 men (median age 58.7 years) with penile curvature the penis was reconstructed by imbricating the tunica albuginea opposite the curvature with multiple nonabsorbable sutures. All patients, regardless of the degree or direction of curvature, were approached through a small penoscrotal incision made without degloving the penis. Detailed measurements of penile shaft angle and stretched penile length were recorded and analysed before and after reconstruction, and the numbers of sutures required for correction were documented.

RESULTS

Nearly all patients had dorsal and/or lateral deformities that were easily corrected via a ventral penoscrotal incision. The median (range) degree of correction was 28 (18–55)° and number of sutures used was 6 (4–17). Stretched penile length measurements before and after plication showed no significant difference. A single PSP procedure was successful in 45/48 (93%) patients; two were dissatisfied with the correction, one having repeat plication and the other a penile prosthesis; one other required a suture release for pain.

CONCLUSIONS

PSP is safe and effective and should be considered even for cases with severe or biplanar curvature.     

Pattern of presentation and surgical management of penile fractures in a semi-urban African teaching hospital: Case reports and literature review

Introduction

Penile fracture is relatively rare and also under-reported in our environment. There seem to be a gradual change in this pattern however, as we managed six patients over a two-year period.

Effect of castration on penile erection in the dog

The reduction in sexual activity in hypogonadal men is at least partially due to a decrease in sexual interest, but it may also involve peripheral mechanisms. In the present experiments, the effects of castration on penile erection in dogs was investigated. The pressure within the corpus cavernosum was measured in intact anaesthetized dogs and in dogs castrated 2 weeks or more than 6 months previously. It was found that there was no significant difference between intact and castrated dogs in the magnitude or time course of increase in corpus cavernosal pressure induced by pelvic nerve stimulation or in the inhibitory effects of simultaneous stimulation of the sympathetic chain. Furthermore, the mean ED₅₀ value for contraction to phenylephrine of isolated strips of erectile tissue from the corpus cavernosum was not significantly different between groups. This suggests that the mechanism of penile erection is not affected by reducing the levels of testosterone.     

Recent insights into androgen action on the anatomical and physiological substrate of penile erection

Erectile response is centrally and peripherally regulated by androgens.The original insights into the mechanismsof action of androgens were that androgens particularly exert effects on libido and that erections in response to eroticstimuli were relatively androgen-independent.It was shown that sexual functions in men required androgen levels atthe low end of reference values of testosterone.So it seemed that testosterone was not useful treatment for men witherectile difficulties,particularly following the advent of the phosphodiesterase type 5(PDE5)inhibitors.However,approximately 50% of those treated with PDE5 inhibitors discontinue their treatment.A number of recent develop-ments shed new light on testosterone treatment of erectile dysfunction(ED)in aging men.(1)A recent insight is that,in contrast to younger men,elderly men might require higher levels of testosterone for normal sexual functioning.(2)Several studies have indicated that PDE5 inhibitors are not always sufficient to restore erectile potency in men,andthat testosterone improves the therapeutical response to PDE5 inhibitors considerably.(3)There is growing insightthat testosterone has profound effects on tissues of the penis involved in the mechanism of erection and that testoster-one deficiency impairs the anatomical and physiological substrate of erectile capacity,reversible upon androgenreplacement.The synthesis of PDE5 is upregulated by androgens,and the arterial inflow into the penis is improved bygiving androgen.The above invites a re-examination of the merits of giving testosterone to aging men with ED.Thebeneficial effects of PDE5 inhibitors may only be optimally expressed in a eugonadal environment.(Asian J Androl2006 Jan;8:3-9)     

Leiomyoma of the corpus cavernosum of the penis

While soft tissue tumors can occur in the penis, corpus cavernous tumors are rare. Reported cases of corpus cavernous tumors are from metastases of advanced malignancy, such as cancers of the bladder, prostate, rectosigmoid colon, kidney, pancreas, liver, testis and nasopharynx. Primary corpus cavernous tumors are extremely rare and have possibly never been reported before. Herein, we report a case of leiomyoma of the corpus cavernosum. After the diagnosis of leiomyoma was established, total excision of the tumor was not attempted and the tumor remained unchanged in size and shape over a follow-up period of 15 months.     

Effect of sildenafil citrate on penile erection of rhesus macaques

Aim: To examine the effect of sildenafil citrate on penile erection of male rhesus macaque. Methods:Twenty Macaca mulatta were divided into the sildenafil treated and the control groups of l0 animals each. The penile size, the corpus cavernosal electromyogram (EMG) and the intra-corpus cavernosal pressure (ICP) were determined. Results: The diameter of penis and the ICP were significantly increased and the corpus cavernosal EMG significantly reduced in the sildenafil group. Conclusion: Sildenafil citrate increases the penile size and ICP and reduces the corpus cavernosal EMG in male rhesus macaque. (Asian J Androl 2004 Sep; 6: 233-235)     

外伤性阴茎海绵体破裂的诊断与治疗（附12例报告）

目的：总结外伤性阴茎海绵体破裂的诊断与治疗经验。方法：回顾性分析2001年1月～2010年1月收治的12例阴茎海绵体破裂患者的临床资料：12例患者年龄28～47岁,平均36．5岁。致伤原因为粗暴性交9例,硬物砸伤1例,骑跨伤1例,斗殴致伤1例。12例均急诊行阴茎折断修补手术,结果：术后随访2～26个月,发生1例阴茎勃起后疼痛,1例尿道狭窄,1例勃起功能障碍,均经恰当的治疗后在不同的时间内恢复。结论：急诊手术是外伤性阴茎海绵体破裂的恰当治疗方法。     

阴茎包埋对海绵体形态结构的影响

目的:探讨阴茎包埋对大鼠阴茎海绵体形态结构的影响。方法:通过建立隐匿阴茎大鼠模型获得实验标本,分2月组、4月组进行观测,每组25只大鼠。各阶段又分包埋组(15只)、正常组(10只),光镜和电镜下观察海绵体形态结构的改变。结果:阴茎包埋2月组海绵体形态结构无明显变化,4月组病理改变较为明显,光镜下见大鼠阴茎海绵体平滑肌细胞,内皮细胞分布杂乱,细胞间大量间质组织增生,海绵窦狭窄;电镜下见阴茎海绵体平滑肌细胞及内皮细胞萎缩、线粒体退变、内质网扩张,致密体及收缩纤维减少,脂滴增加,空泡形成。包埋组与正常组阴茎海绵体在外观和重量上无明显差异(P>0.05)。结论:阴茎包埋对海绵体外观和重量无明显影响,但随着包埋时间的延长,海绵体组织发生超微结构上的病理改变。     

大鼠糖尿病模型中阴茎白膜超微结构的改变

目的 阐明糖尿病大鼠阴茎白膜超微结构的改变.方法 实验组(DM)链脲佐菌素(STZ)诱导糖尿病的雄性SD大鼠18只,对照组(AMC)年龄相同雄性SD大鼠10只.分别十处理后5、10周测定两组大鼠血糖,并作统计学分析;5周后测量海绵体内压(ICP):两组人鼠于5、10周分别处死半数,取阴茎组织,作电镜观察.结果 处理5、10周后,DM组人鼠血糖水平明显高于AMC,P＜0.01.5周后,DM组ICP明显低于AMC组,P＜0.01.处理周后,DM和AMC阴茎白膜厚度分别为(0.05±0.01)mm和(0.12±0.02)mm;处理10周后DM和AMC阴茎白膜厚度分别为(0.08±0.02)mm和(0.13±0.03)mm.两组分别在5周后和10周后阴茎白膜厚度比较,差异均有统计学意义P＜0.05;另外可见白膜弹性纤维减少,组织紊乱,结构松驰,胶原纤维失去波形等.结论 阴茎白膜超微结构改变可能损害了白膜静脉阻闭功能而导致阴茎勃起功能障碍(ED).     

The management of penile fracture based on clinical and magnetic resonance imaging findings

OBJECTIVE: To present our experience with repairing penile fracture, based on clinical and magnetic resonance imaging (MRI) findings. PATIENTS AND METHODS: Between December 2002 and October 2004, 14 men (19-64 years old) presented to our centre with a penile fracture. Two patients had urethral bleeding. MRI was used before surgery in all patients, and the repair comprised a localized longitudinal penile incision in 13 men. This incision was designed according to the tunical tear site and size already depicted by MRI. One case was managed conservatively, as MRI confirmed an intercavernosal haematoma with no tunical tear. The follow-up was 4-21 months. RESULTS: The tear involved one corpus cavernosum in 11 patients; two were associated with urethral injury. The course after repair was uneventful in all men; the follow-up showed no erectile dysfunction in any. The patients reported neither pain nor penile curvature during erection. CONCLUSION: MRI is a simple and informative investigation for evaluating and documenting a penile fracture, and it improves the management plan.     

Tunica Albuginea Reefing: A Novel Technique for the Treatment of Erectile Dysfunction

ABSTRACT

Background: “Tunica albuginea (TA) reefing” is a modification of Shafik's “TA overlapping” operation. Both techniques are based on the fact that in venogenic erectile dysfunction patients, the TA exhibits degenerative and atrophic collagen and elastic fibers causing its subluxation and flabbiness. This had led to loss of the veno-occlusive mechanism of the TA and venous leakage during erection. Aim: Reefing of the redundant tissue by bilateral excision of an ellipse of the TA provides a more effective correction of the TA and achieves a good support of the corpora cavernosa during tumescence. Material and Methods: The study included 24 patients with a mean age of 33.5 ± 1.7 SD years. Intracorporal pressure was measured preoperatively and postoperatively. After penile degloving, an ellipse was excised from both lateral aspects of the penile shaft, extending from the glans penis to its root, and the two edges of each wound were reefed by continuous Dexon suture. Results: The TA ellipses were taken as biopsies and revealed degenerative changes when stained with hematoxylin and eosin and Masson's trichrome stain. Postoperatively, there was an intracorporal pressure increase (p < .01) in 20 out of 24 patients of the study and a decrease in 4 out of 24. Six months after operation, the patients showed significantly (p < .01) improved scores for the domain of erectile function over the preoperative scores. Conclusion: The reefing operation corrects the TA flabbiness to a greater extent, lends more support to corporal tissue, and improves the veno-occlusive mechanism.     

Tunica‐sparing ossified Peyronie’s plaque excision

Study Type – Diagnostic (non‐consecutive series) Level of Evidence 3b What’s known on the subject? and What does the study add? Peyronie’s disease with heterotopic, ossified plaques require surgical removal. While conventional tunical excision techniques risk erectile and sensory compromise, we describe a tunical‐sparing technique which maintains potency with durable results.

OBJECTIVE

Ossified Peyronie’s plaques may require surgical excision because of the palpable problems and penile curvature that result. As tunical excision can result in impotence and decrease penile sensation, we describe a novel method of tunical preserving excision of such lesions.

PATIENTS AND METHODS

We evaluated 12 men with dorsal penile curvature between 10° and 90°. Penile plaque size ranged from 1 to 5 cm. 80% had painful erections. An artificial erection was induced with intracavernous injection of papaverine to assess penile deformity. Via a circumcising or ventral incision, plication sutures were placed to correct penile curvature. A lateral longitudinal corporotomy was made and the calcified/ossified portion was dissected free from the tunica albuginea/plaque of the corpora cavernosa. Watertight tunical closure was then performed.

RESULTS

Postoperatively, 80% of men reported erections always adequate for intercourse and normal sensation with a mean follow‐up of 7 months (range 2.1–14.5 months). All patients required simultaneous penile plication to ensure a straight phallus. Pathologic evaluation of plaque specimens all showed bone fragments.

CONCLUSION

Tunica‐sparing excision of the ossified/calcified portion of Peyronie’s plaques shows a durable benefit for large, ossified lesions and maintains potency and penile sensation.     

Fibrin glue for the suture-less correction of penile chordee: a pilot study in a rabbit model

OBJECTIVE: To evaluate the use of fibrin glue as a scaffold for patching defects in the tunica albuginea in a rabbit model for a future application in correcting chordee. MATERIALS AND METHODS: Nine New Zealand white male rabbits were utilized. All had a 15 x 5-mm defect created in the ventral tunica albuginea. Fibrin glue (1 mL) was applied to cover the defect in tunica albuginea and the penile skin closed with a continuous 5/0 chromic catgut suture. Animals were killed in groups of three at 2, 6 and 12 weeks afterward. The evaluation included an artificial erection test with intracavernosal injection of prostaglandin E1 (5 microg), cavernosography and histopathological examination of sections of the penis stained with haematoxylin and eosin or Masson trichrome. RESULTS: None of the rabbits died during the procedure or developed bleeding or haematoma afterward. All animals had straight erections on testing with prostaglandin (5 microg). There was no evidence of corporal narrowing or venous leakage on cavernosography. Histopathological evaluation showed evidence of the fibrin sealant layer, with angiogenesis and a cell infiltrate at 2 weeks. At 6 and 12 weeks there was completely normal regeneration of the tunica albuginea. CONCLUSIONS: In this pilot study in a rabbit model the haemostatic effect of fibrin glue was confirmed on covering a defect in the tunica albuginea. Moreover, there was regeneration of normal tunica albuginea with no scarring at 6 weeks and maintained at 12 weeks. Further well-controlled studies are required before using fibrin glue for corporal body grafting to treat chordee.     

Identification of potential biomarkers of Peyronie＇s disease

Aim： To identity proteins that are differentially expressed in cells derived from normal and diseased tunica albuginea （TA） as related to Peyronie＇s disease （PD）. Methods： Cells with characteristics of fibroblasts were isolated from two tissue sources. Those from the plaque of patients with PD were designated as PT cells, and those from the normally- appearing TA of the same patients were designated as NT cells. Messenger RNAs of these cells were analyzed by real-time polymerase chain reaction （RT-PCR） for the expression of monocyte chemoattractant protein 1 （MCP-1）. Crude protein lysates were analyzed by surface-enhanced laser desorption/ionization mass spectrometry （SELDI-MS） with IMAC30-Cu, CM10, and H50 chips. Each lysate was then separated into six fractions, which were further analyzed by SELDI-MS. Results： RT- PCR analysis showed that PT cells expressed higher levels of MCP-1 than their counterpart NT cells. SELDI-MS analysis showed that the crude protein lysates of all four cell strains produced similar and reproducible protein profiles on IMAC30-Cu and CM 10 chips. Additional SELDI-MS analyses with the fractionated lysates detected three proteins of 11.6 kDa, 14.5 kDa, 22.6 kDa that were upregulated in PT cells and two proteins of 6.3 kDa and 46,9 kDa that were downregulated in PT cells. Conclusion： MCP-1, which is often involved in tissue fibrosis, was expressed at higher levels in PT than that in NT cells. Five potential biomarkers for PD were identified by SELDI-MS analysis. （Asian J Androl 2005 Sep; 7： 237-243）     

The use of high‐resolution magnetic resonance imaging in the management of patients presenting with priapism

Study Type – Diagnosis (exploratory cohort)
Level of Evidence 2b OBJECTIVE To investigate the use of magnetic resonance imaging (MRI) of the penis during an episode of priapism and assess the viability of the corpus cavernosum (CC) smooth muscle, as prolonged ischaemic priapism is associated with a high rate of long‐term erectile dysfunction (ED), and the viability of CC smooth muscle influences the subsequent management in ischaemic priapism. PATIENTS AND METHODS The study was set in a single centre based in a large university teaching hospital. We investigated the correlation of T2‐weighted gadolinium‐ enhanced MRI with the histology from CC biopsies in the same patients. In all, 38 patients (mean age 42 years) presenting with priapism over a 3‐year period had MRI of the penis. The scans were reported by two dedicated uro‐radiologists who graded the MR images as showing viable or nonviable erectile tissue. One pathologist assessed the CC biopsies for necrosis. The findings were then correlated. Where no biopsies were taken a clinical follow‐up was used to assess erectile function. RESULTS In 23 patients undergoing both a CC biopsy and MRI, the sensitivity of MRI in predicting nonviable smooth muscle was 100%. In a further 10 patients MRI showed nonviable CC smooth muscle, but no biopsy was taken in these patients; on clinical follow‐up all of these patients subsequently developed ED. In a further five patients the imaging showed viable smooth muscle and these patients subsequently maintained erectile function on clinical follow up. CONCLUSIONS Penile MRI provides an accurate imaging method to assess smooth muscle viability in patients presenting with priapism.