Diagnostic value of radionuclide phallography with intravenous vasodilator stress in the evaluation of arteriogenic impotence

Arteriogenic impotence is a major cause of organic erectile dysfunction. We evaluated the diagnostic value of quantitative radionuclide phallography with intravenous pharmacological stress in screening impotent patients for penile arterial inadequacy. Using technetium-99m labelled autologous erythrocytes, dynamic scintigraphy of the penile blood pool was performed. Penile haemodynamic changes following intravenous injection of the vasodilator isoxsuprine hydrochloride were assessed by quantitation of penile blood flow and volume. Forty-seven impotent patients (11 psychogenic, 24 arteriogenic, 10 venogenic, 2 endocrine) were studied. Arteriogenic impotent patients demonstrated a lesser degree of increase in penile blood flow and volume than impotent patients with uncompromised penile arterial inflow. Quantitation of penile blood flow and volume yielded a high diagnostic accuracy (>90%). Radionuclide phallography with intravenous vasodilator stress forms a simple and accurate method for evaluating the functional integrity of penile arterial inflow.     

Pulsed and color Doppler sonographic findings of penile Mondor's disease.

This report describes the color and pulsed Doppler US findings of penile Mondor's disease. The pulsed Doppler US findings of penile Mondor's disease have not been previously published, so we report here for the first time on the cavernosal arterial flow signal pattern of penile Mondor's disease. Penile Mondor's disease is rare disease that's characterized by thrombosis in the dorsal vein of the penis. The previous reports on penile Mondor's disease are concerned with the color Doppler US finding without the flow signals in this area, but these findings are insufficient to understand the hemodynamics in penile Mondor's disease. We report for the first time on a cavernosal artery flow signal pattern of low peak systolic velocity and high-resistance.     

Penile blood flow by xenon-133 washout

Penile erectile failure is often attributed to abnormalities of vascular supply or drainage, but few direct measurements of penile blood flow have been made. We describe the xenon washout method for measurement of penile blood flow, and present the results obtained in a group of normal and impotent subjects. The procedure was performed with standard nuclear imaging equipment. Flaccid-state penile blood flow in the impotent patients studied was not significantly different from the normal group, suggesting that flaccid-state measurements may not be helpful in evaluation of erectile failure. However, this method can be used to measure penile venous outflow with stimulated or induced erection, and may provide a method for detecting abnormal venous leakage.     

不同月龄大鼠阴茎组织中一氧化氮合成酶的含量比较

 目的比较2月龄及18月龄Wister大鼠阴茎海绵体组织中一氧化氮合成酶(Nitrie oxide synthase,NOS)的含量,讨论其生理意义并对阴茎勃起功能障碍发病的年龄依赖性作出相应的解释。方法使用NADPH-d脱氢酶组织化学染色方法观察并进行图像分析。结果发现阴茎海绵体组织中NOS阳性成分是普遍存在的,特别是在阴茎动脉外膜层周围及血窦内皮细胞系统中的含量较多。18月龄大鼠阴茎海绵体组织总体NOS染色水平下降,进一步行图像分析,测定阴茎海绵体组织中NOS的含量,结果显示18月龄大鼠阴茎海绵体组织中NOS含量明显低于2月龄大鼠。结论 阴茎海绵体组织中NOS含量下降是阴茎勃起功能障碍(Erectile dysfunction,ED)年龄依赖性的原因之一。     

Quantitation of pharmacologically-induced penile erections: the value of radionuclide phallography in the objective evaluation of erectile haemodynamics

This study combines the pharmacologically-induced penile erection (PIPE) technique with radionuclide phallography (RNP) for the non-invasive study of penile haemodynamic changes during erection. Penile erections produced by the intracavernosal injections of two different vasoactive drugs, prostaglandin E1 (PGE1) and papaverine HCl (PPV) were assessed by quantitation of the dynamic RNP and parameters of erection were defined and compared. PGE1 intracavernosal injections were seen to elicit a better erectile response than PPV. Dynamic radionuclide phallography was performed using 99Tcm-labelled autologous RBCs in five normally potent volunteers, sixteen patients with psychogenic impotence, seven patients with vasculogenic impotence (three arteriogenic, four venous leakage) and one patient with neurogenic impotence. Physical parameters of erection including the penile length and circumference changes during erection and the erectile angle were compared with the indices of penile blood flow and volume derived through quantitation of the RNP. There was a close correlation between the penogram index (an index of penile blood volume) and penile circumference increase during erection (r = 0.77, p less than 10(-6). The erectile angle, a measure of penile rigidity, correlated strongly (r = 0.82, p less than 10(-6) with the flow index, a measure of penile blood volume. Patterns specific to various categories of impotence were observed and these aided in the diagnosis, especially in equivocal cases with a suboptimal clinical response to the intracavernosal injection. Quantitative RNP offers a non-invasive method which allows direct objective assessment of the erectile response providing several quantitative parameters for analysis.     

Impotence and genital numbness in cyclists.

Cyclists often complain of genital numbness and even of impotence. The purpose of this study was to determine if perineal compression during cycling causes changes in the penile blood supply, impotence and penile numbness. Forty healthy athletic men with a mean age of 30 +/- 5.3 years took part in the study. Transcutaneous penile oxygen pressure was obtained using a device consisting of a modified Clark pO2 electrode, attached to the glans of the penis. All men were measured in a standing position before, in a seated and standing position during and in a standing position after cycling. Additionally, a detailed interview was carried out with each man. The penile blood supply--which correlates with the transcutaneous PO2 at the glans-- decreased significantly in over 70% of the test subjects during cycling in a seated position. Cycling in a standing position did not show any alteration in the penile blood supply as compared to the values measured before exercising. Numbness of the genital region was reported by 61% of the cyclists. 19% of cyclists who had a weekly training distance of more than 400 km complained of erectile dysfunction. The results of the present study showed that there is a deficiency in penile perfusion due to perineal arterial compression. This could be a reason for penile numbness and impotence in long-distance cyclists. Therefore, we suggest restricting the training distance, and taking sufficient pauses during the course of prolonged and vigorous bicycle riding, in order to avoid penile numbness and impotence.     

阴茎组织中一氧化氮合成酶的分布及生理意义

 目的观察大鼠阴茎组织中一氧化氮合成酶(Nitric Oxide Synthase,NOS)的分布,并就其生理意义进行讨论.方法NADPH-d脱氢酶组织化学染色方法.结果发现大鼠阴茎海绵体及尿道海绵体中均含有NOS阳性染色神经纤维,海绵体平滑肌小梁内分布有NOS阳性神经纤维,阴茎动脉外膜层环绕着阳性染色神经纤维,而阴茎静脉外膜则无阳性染色神经纤维环绕.血窦内皮细胞系统及血管内皮细胞均呈阳性染色.阴茎勃起组织内未见NOS阳性染色神经元.结论一氧化氮(Nitric Oxide,NO)可能是调节阴茎勃起的生理性介质之一.     

Sparing of the penile bulb and proximal penile structures with intensity-modulated radiation therapy for prostate cancer

Quality of life is an important consideration in the treatment of early prostate cancer. Laboratory and clinical data suggest that higher radiation doses delivered to the bulb of penis and proximal penile structures correlates with higher rates of post-radiation impotence. The goal of this investigation was to determine if intensity-modulated radiation therapy (IMRT) spares dose to the penile bulb while maintaining coverage of the prostate. 10 consecutive patients with clinically organ confined prostate cancer were planned with 3D conformal radiation therapy (3D-CRT) or IMRT to give a dose of 74 Gy without specifically constraining the plans to spare the penile bulb. All 10 patients were ultimately treated with IMRT. Dose-volume histograms were evaluated and the doses to prostate, rectum, bladder and penile bulb were compared. IMRT reduced the mean penile bulb doses compared with 3D-CRT (33.2 Gy vs 48.9 Gy, p<0.001), the percentage of penile bulb receiving over 40 Gy (37.7% vs 67.2%, p<0.001) and the dose received by >95% of penile bulb (5.3 Gy vs 11.7 Gy, p=0.003). Maximum penile bulb doses were higher with IMRT (81.2 Gy vs 73.1 Gy, p<0.001) although the volume of this high dose region was small. Both methods resulted in similar coverage of the prostate. The volume of rectum receiving 70 Gy was significantly reduced with IMRT (18.4% vs 21.9%, p=0.003) but the volumes of bladder receiving 70 Gy were similar (p=0.3). IMRT may potentially reduce long term sexual morbidity by reducing the dose to the majority of the penile bulb.     

New oral cut-off time limits in NSW

Standard collection procedure for the investigation of allegations of penile - oral assault has traditionally been the oral swab. Review of both the literature and NSW forensic laboratory results from oral swabbing has highlighted the sub-optimal nature of this method for the recovery of both sperm and offender DNA.554 oral swabs, collected in NSW from 2010 to 2015, were analysed. Sperm detection occurred in only 4.2%. In the same period there was analysis of 104 oral rinses (of which 16.4% were positive for sperm) and 71 peri-oral samples (of which 18.3% were positive for sperm).As a result, a decision was made to revise forensic collection guidelines for sample collection in cases of penile - oral assault. Oral swabbing is no longer recommended. Current NSW forensic collection guidelines recommend the collection of both an oral rinse and a peri-oral (lip) swab. Samples are to be taken in the first 12 h after a penile - oral assault in all cases where there is a suspicion of oral assault. Oral collections may be extended to 24 h post penile - oral assault in those cases where there is either a clear recollection of ejaculation into the mouth (or ejaculation elsewhere prior to penile penetration of the mouth) or in those cases where a complainant is clear that there had been penile penetration of the mouth but is unable to recall whether or not ejaculation has taken place.     

Ultrasound in penile cancer

Ultrasonography clearly visualized the extent of primary tumor and the presence or absence of inguinal node metastases in two patients with penile cancer. These findings enabled us to decide an appropriate level for penile amputation and the indication for lymphadenectomy.     

Magnetic resonance angiography findings of penile Mondor's disease

A 53‐year‐old male was admitted to our Emergency Department affected by a contemporary high‐flow priapism and induration on the dorsal penile surface, in consequence of a prior transrectal prostate biopsy performed 2 weeks earlier on the basis of a suspicion of prostate cancer. We describe a penile Mondor's disease (penile superficial dorsal vein thrombosis) of uncertain pathogenesis involving the penile superficial vein, and employing a careful diagnostic pathway by using magnetic resonance angiography (MRA). In the literature many reports described pulsed‐ and color‐Doppler ultrasonography classical findings about penile Mondor's disease. For the first time we report the pathognomonic features of penile Mondor's disease on MRA, which may be considered a useful and comprehensive tool to deepen the analysis only in the case of a complex clinical picture such as the one presented. J. Magn. Reson. Imaging 2009;30:407–410. © 2009 Wiley‐Liss, Inc.     

MRI of the Penis: Indications,Anatomy, and Pathology

The purpose of this review is to discuss the role of magnetic resonance imaging (MRI) in the evaluation of penile pathology. Normal penile anatomy as well as the appearance of neoplastic and non-neoplastic entities on MRI will be reviewed. While ultrasound remains the first line imaging modality in evaluating most penile pathology, MR imaging has specific advantages owing to improved soft tissue resolution, ability to evaluate less accessible or complex anatomy (such as at the base of the penis), and the ability to detect subtle enhancement. Therefore, MRI is useful for when ultrasound and/or clinical findings are equivocal or incongruent. In addition, MR imaging is essential for preoperative surgical planning and is the imaging modality of choice in evaluating penile prostheses. The added value of MRI in these settings makes it an integral component to the management of many pathological entities affecting the penis.     

Forensic value of the Lugol's staining method: further studies on glycogenated epithelium in the male urinary tract

This study presents findings from a series of investigations on the presence of glycogenated epithelium in the male urinary tract and on the penile surface in order to assess the forensic value of the Lugol's method for the identification of vaginal cells. Direct smears obtained from the urethral opening, glans penis, and penile shaft, along with post-mortem samples of the fossa navicularis, and histological sections of the penis were examined. The presence of polygonal, glycogenated, Lugol-positive epithelium cells in the male urinary tract was found to be common. Our results suggest that these cells originate from the fossa navicularis. Because of the possibility of exfoliation of glycogenated male cells and transfer to the penile surface a Lugol-positive reaction in epithelial cells on penile swabs can no longer be assumed to prove the presence of vaginal cells.     

Intracavernosal injection of prostaglandin E1 as an alternative for papaverine in penile angiography

Arteriography of the penile vasculature was performed after intracavernous injection of prostaglandin E1 in five patients. Penile tumescence was obtained in three patients with a dose of 10 micrograms and in the other two patients with a dose of 20 micrograms. Mean duration of penile tumescence was 1 h 36 min. Visualization of the penile vasculature was adequate in all patients. Local pain was a minor side effect in one patient. These preliminary results suggest that prostaglandin E1 might represent an alternative for papaverine in the angiographic study of male impotence.     

Examination of regional limph nodes in penile carcinoma by 99M Tc-MIBI scintigraphy

99mTc-MIBI scintigraphy has proven utility as a clinically valuable technique for the diagnosis of various primary and recurrent malignant lesions. We report the case of a 65 year old man with penile squamous cell carcinoma and clinically questionable bilateral inguinal lymph nodes. 99mTc-MIBI scan shows increased focal uptake in both groins and in the right iliac region. The patient underwent penile amputation with bilateral lymphadenectomy. Histopathologic report revealed metastatic lymph nodes in all lymphatic basins seen with 99mTc-MIBI. We conclude that this technique has the potential of supplying clinically relevant information for the diagnosis of regional extension of patients with penile carcinoma.     

阴茎背神经离断术联合α1受体阻断药治疗早泄的疗效

目的探讨阴茎背神经离断术联合高选择性α1受体阻断药治疗早泄的疗效。方法对89例早泄患者随机分为3组:单纯药物治疗组、单纯阴茎背神经离断组、联合治疗组,每组给予相应治疗,观察阴道内射精潜伏期的变化。结果联合治疗组阴道内射精潜伏期(160.4±57.7 s)较单纯药物α1受体阻断药治疗组(64.3±23.2 s)和单纯阴茎背神经离断组(106.5±41.4 s)明显延长(P<0.01)。结论阴茎背神经离断术联合高选择性α1受体阻断药治疗早泄效果明显。     

阴茎鳞癌中survivin和caspase-3蛋白的表达及其与腹股沟淋巴结转移的关系

目的：探讨阴茎鳞癌中survivin和caspase-3蛋白的表达及其与肿瘤细胞凋亡和腹股沟淋巴结转移的关系。方法：用免疫组化SP法检测survivin和caspase-3蛋白在31例阴茎鳞癌组织（其中腹股沟淋巴结转移14例）及15例正常阴茎组织的表达情况。结果：阴茎鳞癌组织中survivin的表达显著高于正常阴茎组织（P〈0.01）;而caspase-3在阴茎鳞癌组织中表达显著低于正常阴茎组织（P〈0.05）;survivin表达与临床分期和淋巴结转移有关（P〈0.01和P〈0.05）;与年龄、病理分级无关（P〉0.05）。survivin与caspase-3表达呈负相关（P〈0.01）。结论：survivin、caspase-3可能参与了阴茎鳞癌的发生发展。     

Imaging review of penile pathologies encountered in the emergency department

Emergency Radiology - While penile pathology is uncommon, prompt diagnosis and treatment of emergent and urgent penile pathology are necessary to prevent complications. This paper will review the...     

阴茎癌MRI表现 (附20例分析)

目的探讨阴茎癌的MRI影像学特点。方法选取我院确诊的20例阴茎癌影像学资料并分析其影像学特点。结果20例阴茎癌,病理均为鳞癌,4例(4/20,20%)位于阴茎头,10例(10/20,50%)位于冠状沟,4例(4/20,20%)位于包皮,2例(2/20,10%)位于双侧阴茎海绵体。2例(2/20,10%)广泛转移(包括腹股沟转移),4例(4/20,20%)可见腹股沟转移无其他部位转移。MRI主要表现为阴茎肿块,增强扫描肿瘤强化不规则。结论阴茎癌影像学表现为阴茎肿块,强化不均,主要转移为腹股沟淋巴结转移,可为临床提供更多诊疗信息。