Primary and secondary malignancies of the penis: ultrasound features

Cancer of the penis is a rare neoplasm in developed countries but worldwide represents a significant health problem. In this study, the ultrasonographic features of primary and secondary malignant lesions of the penis are described. Squamous cell carcinoma usually presents as a hypoechoic lesion with heterogeneous appearance. Invasions of the corpora cavernosa and the corpus spongiosum are appreciable. B-cell lymphoma presents as well-vascularized mass, a plaque, or ulcers in the penile skin. Penile metastases results from hematogenous or lymphatic spreading of distant tumors or, more frequently, as penile infiltration by tumors from adjacent organs. Diffuse corporeal or nodular involvement can result.     

Penile paraffinoma

This case study presents the case of a patient self‐injecting Vaseline into the penile skin to increase the size of the penis. The history of this procedure, complications and management options are presented.     

HADM"隐痕"阴茎增粗延长术

目的探讨HADM(脱细胞异体真皮)"隐痕"阴茎增粗延长术的操作要点和临床效果.方法从本手术项目组2018年1月至2019年12月期间阴茎整形案例中,随机选择50例HADM"隐痕"阴茎增粗延长术作为研究对象.均采用阴茎冠状沟切口,在Buck's筋膜浅面分离脱套至阴茎根部,离断阴茎浅悬韧带、部分深悬韧带;距冠状沟l.5-2.0cm处环形切开Buck's筋膜,将HADM补片前部植于Buck's筋膜与白膜间,后部植于Dartos筋膜与Buck's筋膜间,缝合Dartos筋膜及皮肤切口.测算平均手术时间;观察术前、术后即刻疲软状态下阴茎周径、长度,计算阴茎增粗及延长数值;观察术后并发症及其发生率;术后3月随访求美就医者对手术效果和性生活改善的满意度.结果本组50例阴茎短小综合征实施了HADM"隐痕"阴茎增粗延长术,平均手术时间50min;与术前比较,术后疲软状态阴茎周径平均增加了2.5cm、阴茎长度平均增加3.0cm;术后5例早期出现包皮水肿;未发生阴茎包皮肤坏死、补片外露等并发症;术后3月随访,均对阴茎外形和性生活改善比较满意.结论HADM"隐痕"阴茎增粗延长的关键操作在于选用阴茎冠状沟切口、离断阴茎浅悬韧带和部分深悬韧带、HADM补片前部植于Buck's筋膜与白膜间而后部植于Dartos筋膜与Buck's筋膜间;该术式阴茎增粗、延长效果确切,具有安全性高、植入材料易于获得、手术可操作性强等优势,值得临床推广应用.     

阴茎疣状癌的临床诊断和治疗

目的探讨阴茎疣状癌的诊断和治疗。方法回顾性分析6例阴茎疣状癌患者的诊治资料。患者平均年龄45岁。肿瘤均为菜花状、外生型,最大径2～6cm,局限于阴茎头4例,侵犯至冠状沟近侧2例。3例在术前经病理活检确诊,另3例为术后病检证实。2例肿瘤侵犯冠状沟近侧者和2例位于阴茎头肿瘤较大者行阴茎部分切除术,1例局限于阴茎头与冠状沟之间者给予包皮环切术,1例局限于阴茎头者行肿瘤局部切除术。结果病理检查见肿瘤细胞分化好,标本切缘均阴性。6例术后随访2～4年,无肿瘤复发或转移。结论6例阴茎疣状癌以局部侵袭性生长为主,未发生区域性淋巴结转移或远处转移,选择手术方式合理,预后良好。     

腹股沟前哨淋巴结活检在阴茎癌治疗中的价值

目的探讨腹股沟前哨淋巴结活检在阴茎癌手术治疗及二期髂腹股沟淋巴结清扫的意义。方法对阴茎癌患者在手术切除原发病灶的同时,行双侧腹股沟淋巴结活检,以确定其性质。结果46例阴茎癌患者中,高分化鳞癌25例,中分化鳞癌18例,低分化鳞癌3例。其中42例行前哨淋巴结活检,20例活检阳性,二期行髂腹股沟淋巴结清扫术;另22例阴性,其中淋巴结炎症及反应性增生者16例,密切观察随访。结论对阴茎癌患者手术切除原发病灶,同时作双侧腹股沟前哨淋巴结活检,对确定其有无转移及进一步对活检阳性者行髂腹股沟淋巴结清扫术具有重要的价值。     

Penile emergencies

The penis is a very sensitive organ and even minor injury or discomfort may cause a patient to seek emergency evaluation. Emergency practitioners must be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis, namely ischemic priapism, paraphimosis, and entrapment injury. Any penile trauma should be considered an emergency until proven otherwise. This article discusses emergent penile complaints in adults, with emphasis on the most serious and common conditions.     

Ultrasound‐guided dorsal penile nerve block performed in a case of zipper entrapment injury

Injury to the penis resulting from zipper entrapment is a painful condition that presents a unique anesthetic challenge to the emergency physician and may even require procedural sedation for removal. In this case report, we describe successful removal of zipper entrapment from the penis of a 34‐year‐old patient after the application of an ultrasound‐guided dorsal penile nerve block. We discuss the anatomy, sonographic features, and steps required for the nerve block procedure. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45 :589–591, 2017     

Sonographic evaluation of penile trauma.

OBJECTIVE: The purpose of this presentation is to illustrate the normal sonographic anatomy of the penis and various imaging manifestations of penile trauma. METHODS: Penile trauma cases were collected and reviewed retrospectively from our archive. RESULTS: The normal sonographic anatomy of the penis and various pathologic conditions of patients with penile trauma are discussed. CONCLUSIONS: Sonography (especially with color Doppler sonography) is a useful imaging method for evaluating penile anatomy and various pathologic features in patients with penile trauma.     

大隐静脉在阴茎离断再植术血管吻合中的应用

目的：探讨提高阴茎再植术的成功率的方法。方法：回顾性分析本院3例运用显微外科技术行吻合血管神经的阴茎离断再植术的临床资料。结果：3例病例采用大隐静脉自体移植修复阴茎背动脉并吻合阴茎静脉和神经,全部再植成功。3例均有勃起功能。结论：阴茎背动脉,阴茎背深静脉以及阴茎背神经的相继处理以及术中高度精细的无创操作技术是决定手术成败的关键之一。     

阴茎部分切除术后阴茎勃起功能状态的评价

目的分析阴茎癌患者行阴茎部分切除术后的勃起功能状态。方法20例阴茎癌患者在我院施行了阴茎部分切除术，术前和术后6个月采用勃起功能国际问卷一5（IIEF5）进行评分。依据评分高低将患者分为正常勃起、轻度障碍、中度障碍和重度障碍四级。结果术前有12例患者勃起功能正常，术后仅有4例。12例（60％）患者手术后的勃起功能评级明显下降。术前正常勃起组出现分级下降的患者比例更高，达67％。术前本组无重度勃起功能障碍者，但术后出现2例重度障碍。针对IIEF一5问卷的5个问题，问题1、2、5的评分下降最为明显。结论阴茎部分切除对于患者的勃起功能状态有着显著影响。在保证无瘤切缘和严密随访的情况下，可以有选择的施行保留阴茎的手术。     

Penile adhesion: the hidden complication of circumcision

A penile or prepuce adhesion can occur after a circumcision if the remaining skin is not retracted after the circumcision has healed. When a circumcision is done, tissue which would normally be intact is split. Unless proper care is taken, the epithelium of the inner prepuce at the point where the foreskin was removed can reattach to the epithelium of the glans. The result of this is a penile adhesion. Usually the adhesions can be released by simple retraction. Sometimes, however, the fusion is so complete that simple retraction will not work, and the child must be referred to a urologist. Another problem is that smegma or bacteria can collect under the adhesion if it covers the preputial cavity and cause infection. Professionals must look for this problem, and parents must be taught how to care for the normal circumcised penis so that penile adhesions do not develop. This article discusses the formation and identification of penile adhesions, the process by which adhesions can be released, when a referral to a urologist is necessary and the proper care for the circumcised penis.     

Traumatic thrombophlebitis of the superficial dorsal vein of the penis: An occupational hazard

Several cases of thrombophlebitis of the superficial dorsal vein of the penis (TSDVP) have been reported in the literature. Etiologies may include any of the following: trauma associated with vigorous sexual intercourse; penile strangulation caused by a multitude of entities; penile injection; infection; neoplasm; or surgery. We report a rare case of traumatic TSDVP in a cab driver following repeated injury to the penis by a coin-filled pouch. We review the etiologies, mechanism, and treatment of traumatic TSDVP, and attempt to identify men who may be at similar occupational risk.     

背侧横行带蒂岛状包皮内板转移术矫治中重型隐匿阴茎

目的探讨背侧横行带蒂岛状包皮内板转移术矫治中、重型隐匿阴茎的临床应用。方法回顾性分析我院2010年9月至2011年6月收治的34例采用背侧横行带蒂岛状包皮内板转移术矫治的中、重型隐匿阴茎患者的临床资料及其术后1周、3周、3个月和6个月复查时皮瓣存活及阴茎外形情况。结果本组全部病例均顺利完成手术。术后32例皮瓣存活良好,2例内板部边缘小片缺血坏死,约1个月后自行修复形成接近正常的皮肤外观。阴茎皮肤和皮瓣肿胀在术后1～3周基本消退,末见慢性水肿形成。全部病例阴茎外显良好,无回缩,无皮肤缩窄环。14例皮瓣外观接近正常阴茎皮肤,皮瓣-皮肤交界部痕迹不明显,15例皮瓣内板部与阴茎皮肤外观差异明显但阴茎整体外观轮廓良好,5例可见内板与阴茎皮肤交界部轻度线状凹陷瘢痕。结论采用背侧横行带蒂岛状包皮内板转移术矫治中、重型隐匿阴茎可以充分保留局部皮肤材料、充分矫正包皮狭窄环、获得并维持良好阴茎显露,阴茎外观良好,少数病例存在较明显的皮肤异质性问题。     

非穿透性阴茎损伤的超声表现

目的 观察非穿透性阴茎损伤的声像图特点。方法 回顾性分析我院经手术病理及临床随访证实的21例非穿透性阴茎损伤患者的超声表现。结果 14例阴茎折断,超声可见其中13例阴茎白膜破裂;1例白膜周边低回声区,未见明确白膜连续性中断。1例尿道海绵体破裂并尿道断裂及尿道海绵体动静脉破裂,超声可见阴茎尿道线状高回声连续性中断。1例阴茎海绵体血肿,超声可见双侧海绵体内大小不等、边缘不规则的高回声区。2例阴茎背深静脉损伤,超声可见阴茎白膜与Buck筋膜之间均匀低回声区。3例阴茎海绵体动脉假性动脉瘤,超声可见一侧阴茎海绵体内不规则无回声区。结论 超声不仅可评价阴茎折断、阴茎海绵体和尿道海绵体损伤,还能检测阴茎血管损伤,为非穿透性阴茎损伤选择临床治疗方案提供依据。     

Cavernosal arterial anatomic variations and its effect on penile hemodynamic status.

OBJECTIVE: With continuous improvements in ultrasound technology, small vessels with remarkably slow blood flow that may not be assessed by color Doppler ultrasonography, can be evaluated using power Doppler ultrasonography. In the present study, penile arterial anatomic variations were determined with power Doppler ultrasonography and its impact on penile hemodynamic status. METHODS: A total of 54 patients with erectile dysfunction were evaluated with power Doppler ultrasonography. The effects of vascular anatomic variations and the structure of the corpora cavernosa and tunica albuginea on vascular status were assessed on both sides. RESULTS: A normal penile vascular system was observed in 35.2% and 25% of 54 patients (mean age: 46.6+/-11.5 years) at the radix and mid-shaft of the penis, respectively. Pure arterial component was observed in 40.7% (22/54) and 47.2% (17/36) of the patients at the base and mid-shaft of the penis, respectively. Penile arterial insufficiency was severe in 9.2 and 5.5% of the patients at the base and mid-shaft of the penis, respectively, whereas intrapenile truncus was found in six patients (5.5%), the ratio of single cavernosal artery, intrapenile and extrapenile bifurcations were 69.4, 7.4 and 12.0%, respectively. Twenty (18.5%) dorso-cavernosal perforators, 15 (13.9%) cavernoso-dorsal and 30 (27.8%) intercavernosal branches were found. Peak systolic blood flow velocity values were decreased in 12 of 36 patients (33.3%) distally, while increased blood flow was observed in 11 (30.5%). CONCLUSIONS: Hemodynamic parameters might be variable at either side of the penis and depend on intrapenile arterial anatomic variations. Parameters determined using power Doppler ultrasonography should be evaluated from the proximal to distal side of the penis to obtain reliable and standard results. However, variations of penile arterial anatomy and its effect on penile hemodynamic changes should not be overlooked especially in the patients who are candidates for penile reconstructive or vascular surgery.     

Imaging of Penile Neoplasm

Penile malignancies are rare, accounting for less than 1% of all male malignancy in the United States. The diagnosis can be very devastating psychologically to patients and often presents a challenge for physicians to accurately diagnose and treat these neoplasms. Clinical examination is known to have certain limitations and cross-sectional imaging techniques are increasingly utilized. Knowledge in imaging characteristics of the normal anatomy of the penis, vascular supply, lymphatic drainage, and pathology of penile malignancy is essential for an accurate staging. In this article, normal anatomy of the penis is briefly discussed and is followed by a review of multiple imaging approaches for characterization of the primary tumor and nodal staging.     

阴茎尖锐湿疣并发阴茎癌临床分析（附17例报告）

目的探讨阴茎尖锐湿疣并发阴茎癌之间的关系。方法对我院2003年1月至2011年6月间收治的阴茎尖锐湿疣并发阴茎癌患者的临床资料进行回顾性分析。结果 17例患者临床表现为阴茎头、冠状沟处不规则形淡红色或暗红色较大、柔软或成簇的乳头状或菜花样肿块,基底较宽,局部有糜烂,其中11例有恶臭。17例患者均在术前取小块肿瘤组织送病理活检,病理结果提示16例为尖锐湿疣并鳞状上皮细胞癌,1例为尖锐湿疣（巨块型）。17例均采用阴茎部分切除术,术后患者全部顺利康复出院。术后病理证实17例均为尖锐湿疣并鳞状上皮细胞癌。结论阴茎尖锐湿疣（巨块型）并发鳞状上皮细胞癌较为常见,治疗上以采用阴茎部分切除术为宜。     

Embolization for massive urethral hemorrhage

Priapism is the term given to a prolonged, painful penile erection, unaccompanied by sexual desire. Most cases of priapism occur as a result of engorgement of the cavernous body of the penis due to intrinsic or extrinsic venous outflow obstruction, which is termed veno-occlusive priapism. However, in a small number of patients, the cause is related to uncontrolled arterial inflow due to trauma and resultant laceration of cavernosal arteries. This form of disease has been termed high-flow priapism and usually occurs in association with genitoperineal trauma. Most incidents of high-flow arteriogenic priapism result from genitoperineal trauma, such as that caused by sliding on a wooden bar or falling astride a ladder. We experienced a patient with a high-flow priapism due to urethral trauma caused by a misplaced Foley catheter. The treatment consisted of superselective arterial embolization of the bilateral internal pudendal arteries using metallic microcoils, which resulted in the subsequent detumescence of the penis with no complications. This case showed that bilateral arteriocavernosal fistulae can be successfully treated by superselective arterial embolization.     

Penile fracture: A case report from Nepal

Penile fractures are clinically diagnosed with eggplant‐like deformity of the penis (aubergine sign). Surgical repair immediately following the penile fracture is the standard of care, which usually heals with minimal or no complications.     

Fetal penile length.

OBJECTIVE: To construct a reference range for fetal penile length. METHODS: The length of the penis was measured during ultrasound assessment of 95 structurally normal male fetuses of gestational ages 16-38 weeks. Two fetuses with bladder outflow obstruction were also examined. RESULTS: Fetal penile length increases significantly with gestational age, from a mean value of 6.0 mm at 16 weeks to 26.4 mm at 38 weeks. One fetus with urethral agenesis had a penile length on the 0.3rd centile. CONCLUSIONS: Measurement of the fetal penis is easy and not time-consuming. In cases of bladder outflow obstruction, assessment of penile length assists in the differentiation between urethral agenesis and posterior urethral valves.