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Bass D, Clancy K, Gupta A, Dogra V. Penile Evaluation: An Illustrated Review. Ultrasound Q 2024; 40:32-38. [PMID: 38015246 DOI: 10.1097/ruq.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT High-frequency ultrasound is the imaging modality of choice for evaluating penile pathology because of its easy access, low cost, and patient tolerance ( The Penis, Diagnostic Ultrasound, second edtion . Boca Raton: CRC Press; 2007:957-978). This pictorial review will illustrate the sonographic features of emergent and nonemergent penile conditions such as penile fracture, spongial tear, urethral injury, various types of priapism, erectile dysfunction, penile abscess, and Mondor disease.
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Affiliation(s)
- David Bass
- Imaging Sciences Department, University of Rochester, Rochester, NY
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Xu AJ, Mishra K, Zhao LC. Heineke-Mikulicz Preputioplasty: Surgical Technique and Outcomes. Urology 2022; 166:271-276. [PMID: 35430235 DOI: 10.1016/j.urology.2022.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To provide a summary of surgical technique and outcomes for Heineke-Mikulicz preputioplasty (HMP), a foreskin-preserving surgical treatment for phimosis in the adult population. METHODS We retrospectively reviewed 7 patients who underwent HMP by a single surgeon from May 2017 to May 2021. Variables included patient demographics, intraoperative considerations, and post-operative course. HMP is performed using a 2-3 cm vertical incision over the phimotic band on the dorsal surface to just above Buck's fascia. Additional incisions are made on the ventral surface if phimosis remains persistent after dorsal release. The incision is closed horizontally in 2 layers. RESULTS Seven patients underwent HMP. Median age was 47.3 and median BMI was 24.3. Five patients reported bothersome phimosis and 1 each reported paraphimosis and frenular tethering. Six patients requested foreskin sparing surgery as a personal preference and 1 patient was an intraoperative consult. Topical betamethasone was attempted in 3 of 7 patients. The median time from diagnosis to surgery was 2 months. Median operative time was 45.5 minutes and median estimated blood loss was 5 mL. Two patients required both dorsal and ventral incisions. No intraoperative complications were reported and all patients were discharged the same day. At median follow-up of 1.8 months, 1 patient reported bothersome phimosis secondary to scar formation treated successfully with triamcinolone. CONCLUSION HMP is a safe and effective method of treating even very significant phimosis in patients trying to avoid circumcision or intraoperative consults where preferences may be unclear. Our method takes less time than traditional circumcision with a comparable recovery and complication profile.
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Affiliation(s)
- Alex J Xu
- Department of Urology, NYU Langone Health, New York, NY.
| | | | - Lee C Zhao
- Department of Urology, NYU Langone Health, New York, NY
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Chandra Mohan V, Ramakrishna P, Siddalinga Swamy P, Panda R, Ganesan S, Anandan H. Occult penile fracture: An atypical presentation. Urol Case Rep 2021; 40:101933. [PMID: 34917477 PMCID: PMC8645441 DOI: 10.1016/j.eucr.2021.101933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Penile fracture is a urological emergency. Most cases are under reported due to social stigma. It is caused by rupture of the tunica -albuginea of corpora cavernosa. Here we present an atypical case of penile fracture, with normal physical examination findings. But characteristic history and ultrasonography, led us to penile exploration and timely repair. Delay in diagnosis and treatment could have led to complications. Objective of our case report is to raise suspicion of fracture penis in patients with typical history, even without physical findings with normal appearing penis. This helps in early repair and prevent complications.
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Abstract
The penis is an organ of enormous importance and is vital for both excretory and reproductive function. The anatomy of the penis itself can lead to many of its emergent conditions and a thorough understanding of the anatomy and physiology is central to recognition of these conditions. Physicians should have a high clinical suspicion for penile emergencies and perform a thorough physical examination to make a proper diagnosis. Prompt diagnosis and proper management are essential for minimizing dysfunction of this vital organ.
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Paonam S, Kshetrimayum N, Rana I. Penile strangulation by iron metal ring: A novel and effective method of management. Urol Ann 2017; 9:74-76. [PMID: 28216935 PMCID: PMC5308044 DOI: 10.4103/0974-7796.198873] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Penile strangulation by metal ring is a rare urological emergency situation which requires urgent decompression of the penis to avoid adverse effect. It is usually associated with an attempt to improve sexual act and/or to prolong erection. But sometimes, cutting of the ring to decompress the penis safely is a very difficult task particularly when the strangulating object is a hard metal object as in our case. Here, we present a case which was managed by cutting in a novel way with the help of dental micromotor with wheel shape bur.
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Affiliation(s)
- Somorendro Paonam
- Department of Urology and Renal Transplant Surgery, Shija Hospitals and Research Institute, Langol, Imphal, Manipur, India
| | | | - Indrajit Rana
- Department of General Surgery, Shija Hospitals and Research Institute, Langol, Imphal, Manipur, India
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Abstract
In addition to practitioners who care for male patients, with the increased use of high-resolution anoscopy, practitioners who care for women are seeing more men in their practices as well. Some diseases affecting the penis can impact on their sexual partners. Many of the lesions and neoplasms of the penis occur on the vulva as well. In addition, there are common and rare lesions unique to the penis. A review of the scope of penile lesions and neoplasms that may present in a primary care setting is presented to assist in developing a differential diagnosis if such a patient is encountered, as well as for practitioners who care for their sexual partners. A familiarity will assist with recognition, as well as when consultation is needed.
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Abstract
The diagnosis and management of urologic emergencies are incorporated into the basic training of all urology residents. In institutions without access to urologic services, it is usually left to the General Surgeon or Emergency Medicine physician to provide timely care. This article discusses diagnoses that are important to recognize and treatment that is practically meaningful for the non-Urologist to identify and treat. The non-Urology provider, after reading this article, will have a better understanding and a higher comfort level with treating patients with urologic emergencies.
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Affiliation(s)
- Adam E Ludvigson
- Division of Urology, Maine Medical Center, 100 Brickhill Ave., South Portland, Maine 04106, USA
| | - Lisa T Beaule
- Division of Urology, Maine Medical Center, Tufts University School of Medicine, 100 Brickhill Ave., South Portland, Maine 04106, USA.
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Bone Cutting Forceps: A Safe Approach for Saving Strangulated Penis. Case Rep Med 2016; 2016:1274124. [PMID: 27239200 PMCID: PMC4864529 DOI: 10.1155/2016/1274124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/05/2016] [Indexed: 12/03/2022] Open
Abstract
Penile strangulation is considered a rare andrological emergency that may lead to a wide range of complications. Penile strangulation may be related to mental retardation in children or hypersexuality, abnormal sexual preferences in adults. This case report shows a 23-year-old male who presented to the emergency room with agonizing pain related to a metallic ring placed at the base of the penis for more than 8 hours during an attempt of masturbation. Removing this metallic ring and saving the patient's penis from gangrene without causing injury were very challenging. Patient was successfully managed and had an uneventful recovery.
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Valderrama-Illana P, Abad-Menor F, Puche-Sanz I, Pareja-Vilchez M, Cozar-Olmo JM. Penile Strangulation Caused by a Seal Ring. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:3-4. [PMID: 26502282 DOI: 10.1007/s10508-015-0649-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Rajih E, Alenizi A, El-Hakim A. Penile fracture with two ipsilateral corporal tears and delayed presentation: A case report. Can Urol Assoc J 2015; 9:E741-3. [PMID: 26664512 DOI: 10.5489/cuaj.2959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although penile fracture is an infrequent injury, it is a well-described urologic emergency. It results from the rupture of the tunica albuginea of corpora cavernosa by blunt strain that mandates immediate surgical exploration. Reported cases are usually single tear unless contralateral corporal tear is present. We present a case of 56-year-old with intraoperative findings of two separate tears in the same corpus cavernosum. Clinical presentation was also delayed for 4 days post-injury and repair was performed on day 7. This case accentuates the need for a high index of suspicion to rule out concomitant ipsilateral tear. Delayed repair was possible, and full recovery ensued.
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Affiliation(s)
- Emad Rajih
- Department of Urology, Taibah University, Madinah, Saudi Arabia
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Waseem M, Upadhyay R, Kapoor R, Agyare S. Fracture of the penis: an atypical presentation. Int J Emerg Med 2013; 6:32. [PMID: 23941195 PMCID: PMC3765379 DOI: 10.1186/1865-1380-6-32] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fracture of the penis is an uncommon injury presenting to the emergency department (ED). Personal embarrassment and social scenarios associated with this condition may result in underreporting. Patients often delay seeking medical attention, and even when they do, as in our case report, they may withhold the condition for a significant time. ED physicians need to be aware of the social inhibitions and the need for early diagnosis and prompt treatment. A delay in treatment increases the risk of complications such as ischemia, necrosis and penile deformity.Fracture of the penis is caused by rupture of the tunica albuginea of one or both corpora cavernosa by a blunt trauma to the erect penis. Diagnosis is usually clinical as evident by the characteristic history and clinical presentation. Diagnostic modalities aid in the management of the fracture and associated injuries if present. But promptness in the recognition and initiation of treatment can significantly reduce the chances of post-injury complications. FINDINGS We present a case of penile fracture in a young male who presented to the ED with abdominal pain, but careful history and physical examination revealed penile fracture. A delay in diagnosis could have led to complications. CONCLUSION Our case report is an attempt to emphasize the need to suspect injury to the penis in a young adult who might present to the emergency department with an entirely different complaint and also to treat any penile trauma as an emergency. This report provides evidence of an uncommon and underreported clinical entity. A review of the pertinent literature is included.
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Affiliation(s)
- Muhammad Waseem
- Lincoln Medical & Mental Health Center, 234 East 149th Street, Bronx, NY 10451, USA.
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Alhalbouni S, Deem S, Abu-Halimah S, Sadek BT, Mousa A. Atypical Presentation of Priapism in a Patient With Acute Iliocaval Deep Venous Thrombosis Secondary to May-Thurner Syndrome. Vasc Endovascular Surg 2013; 47:488-92. [PMID: 23843289 DOI: 10.1177/1538574413493680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report on a 42-year-old male who presented with priapism, severe scrotal swelling, and left lower extremity pain and swelling. Initial management of priapism failed, and he was noted to have both cavernosal and glandular venous obstruction. Computed tomography (CT) was performed and identified extensive acute thrombosis involving the distal inferior vena cava and the left iliac veins. Pharmacomechanical thrombolysis (PMT) was started over the course of two days. At completion of thrombolysis, the culprit lesion in the left common iliac vein was treated with angioplasty and stenting. His postoperative course was uneventful, and his priapism as well as the scrotal and leg swelling improved. He was discharged home on full anticoagulation. To our knowledge, this is the first available description of this rare presentation along with a literature review of the underlying vascular etiology for priapism.
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Affiliation(s)
- Saadi Alhalbouni
- Department of Vascular Surgery, Charleston Area Medical Center, West Virginia University, Charleston, WV, USA
| | - Samuel Deem
- Department of Urology, Charleston Area Medical Center, West Virginia University, Charleston, WV, USA
| | - Shadi Abu-Halimah
- Department of Urology, Charleston Area Medical Center, West Virginia University, Charleston, WV, USA
| | - Betro T. Sadek
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Albeir Mousa
- Department of Vascular Surgery, Charleston Area Medical Center, West Virginia University, Charleston, WV, USA
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