1
|
Gossadi H, Abu Eishah H, Autwdi A, Abualgasem M. Isolated Penile Fracture and Complete Urethral Injury After a Motorcycle Accident: A Case Report and Literature Review. Cureus 2024; 16:e55535. [PMID: 38576651 PMCID: PMC10993025 DOI: 10.7759/cureus.55535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Tri-tubular penile fracture (PF) is a rare urological subdivision of PFs commonly caused by a blow to the erect penis during sexual intercourse or aggressive manipulation. PF associated with complete urethral injury and bleeding is an extremely rare presentation. This is a case report of a healthy 20-year-old male who presented to the emergency room after a motorcycle accident, experiencing rapid penile swelling and urethral bleeding. The accident happened while he was riding his motorcycle with a full erection. The patient reported a tearing sensation, immediate detumescence, and excruciating penile pain. A clinical diagnosis of PF was made, and the patient was immediately taken to the operating room for surgical intervention. At the three-month follow-up, the patient reported satisfactory erections and good voiding function. This case highlights the importance of immediate surgical intervention and urethral evaluation to avoid PF complications.
Collapse
Affiliation(s)
| | | | - Ali Autwdi
- Department of Urology, Sabia General Hospital, Jazan, SAU
| | | |
Collapse
|
2
|
Hardesty J, Burns RT, Soyster ME, Mellon M, Bernie HL. A review of the literature and proposed algorithm for penile fracture management. Sex Med Rev 2023; 12:100-105. [PMID: 37786337 DOI: 10.1093/sxmrev/qead041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/13/2023] [Accepted: 08/28/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION In the management of penile fractures, immediate surgical repair has resulted in better outcomes when compared with a conservative approach; however, there is currently no consensus on the treatment of patients presenting beyond the immediate period (>24 hours) following injury. OBJECTIVES To examine the latest literature on management strategies in penile fracture and propose an optimal algorithm for the treatment of patients with delayed presentation. METHODS A comprehensive search was conducted following the PRISMA-P 2020 guidelines. A search was performed in several databases with the following strategy: ("Penile fracture" OR "fracture of penis" OR "rupture of corpora cavernosa" OR "rupture of tunica albuginea") AND (management OR treatment OR surgery OR "surgical reconstruction" OR "surgical repair"). This resulted in 108 relevant articles. Two independent reviewers screened these articles according to the inclusion criteria. Full-text review of 56 articles was performed, and ultimately 20 studies were selected. Measures included the use of diagnostic imaging, timing of surgical repair (immediate, <24 hours after injury; delayed, >24 hours), surgical approach, and long-term complications (ie, erectile dysfunction and penile curvature). RESULTS The review highlighted the benefits of immediate surgical repair in penile fractures, demonstrating improved patient outcomes. Furthermore, it found that surgical repair should be considered even in cases with delayed presentation (>24 hours after injury). To better evaluate the long-term impact of delayed surgical intervention on patient outcomes, we recommend standardized postoperative follow-up, with routine assessments of erectile function and penile curvature. CONCLUSION Contemporary literature suggests that immediate and delayed surgical repair of penile fractures leads to adequate postoperative outcomes, and patients presenting >24 hours after injury should still be considered for surgery.
Collapse
Affiliation(s)
- Juliet Hardesty
- School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Ramzy T Burns
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Mary E Soyster
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Matthew Mellon
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Helen L Bernie
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| |
Collapse
|
3
|
Blondeau A, Grandmougin A, Larose C, Mazeaud C. First Two Cases of Conservative Treatment for Extreme Proximal Penile Fracture of the Corpora Cavernosa. Case Rep Urol 2023; 2023:5706109. [PMID: 37333788 PMCID: PMC10276763 DOI: 10.1155/2023/5706109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Penile fracture is a urological emergency, and surgery is usually recommended to prevent complications. However, proximal locations are scarce and not well investigated. We present two rare penile fractures involving the proximal corpora cavernosa with an original conservative strategy to manage this clinical presentation. Twenty-five- and thirty-eight-year-old men with no previous medical history were admitted to the emergency room for penile trauma during sexual intercourse a few months apart. Both presented with "butterfly pattern" ecchymosis with a palpable hematoma on the perineum. They had no hematuria or voiding dysfunction. Ultrasound found a hematoma and a tear of the proximal corpus cavernosum for the younger one. Then, an MRI confirmed a longitudinal fracture of the right corpus cavernosum for the first patient and left for the second, without urethral injury. In agreement with the patients facing this atypical presentation, we proposed a conservative treatment with analgesics, monitoring, and advice to stop sexual activity for three weeks. After six weeks and four weeks, respectively, we performed a clinical evaluation and a second MRI that found no residual tear or hematoma. The IIEF-5 questionnaire was 24/25 and 25/25. The patients were clinically symptom-free at 8 and 11 months of follow-up. Extreme proximal fracture of the corpus cavernosum can be managed conservatively in selected situations. MRI is useful for decision-making by confirming the diagnosis and location to avoid surgery.
Collapse
Affiliation(s)
| | | | - Clément Larose
- Department of Urology, Nancy University Hospital, France
| | | |
Collapse
|
4
|
Shebl SE. The presentation and outcomes of penile fracture with associated urethral injury: A systematic literature review. Arch Ital Urol Androl 2023:11082. [PMID: 37259814 DOI: 10.4081/aiua.2023.11082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/07/2023] [Indexed: 06/02/2023] Open
Abstract
PURPOSES Penile fracture (PF) with associated urethral injury has been described as a rare condition yet a serious urological emergency. We conducted this systematic review to address the current literature concerning the etiology, presentations, intra-operative findings, site of injury, and complications of PF with associated urethral injury, Materials and Methods: The present systematic review was limited to human-based studies published in English language, and reporting clinical data on PF cases with associated urethral injuries. A comprehensive search of the literature was conducted on five electronic databases from their inception to May 2022: Medline via PubMed, Web of Science, Google Scholar, Scopus, and EBSCO host. RESULTS A total of 15 studies were included encompassing 1671 patients with PF. Out of 1665 patients with PF retrieved from the case series studies, 65 patients had associated urethral injuries giving a point prevalence of 3.9%. The vast majority of the patients had blood on the meatus and hematuria suggestive of urethral injury (57/59; 96.6%). Forty patients had partial urethral disruption and the rest of the patients had a complete rupture. All patients received primary urethroplasty as the main modality of treatment. The median hospital stay was two days and the median duration of transurethral catheterization was 21 days. Five patients (8.5%) developed urethral stricture; other complications included penile curvature (6.7%), palpable fibrosis (6.7%), and erectile dysfunction (3.4%). CONCLUSIONS Urethral injuries are uncommon, but serious findings, in patients with PF. Primary urethroplasty appears to achieve satisfactory outcomes with a low incidence of short and long-term complications.
Collapse
Affiliation(s)
- Salah E Shebl
- Urology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo.
| |
Collapse
|
5
|
Taskin B, Kloth C, Hechler V, Benz T, Beer M, Vogele D. [Rare variant of a sexual intercourse injury]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:43-45. [PMID: 36469050 DOI: 10.1007/s00117-022-01091-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Billurvan Taskin
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Christopher Kloth
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Veronika Hechler
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, Ulm, Deutschland
| | - Tobias Benz
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Meinrad Beer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Daniel Vogele
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| |
Collapse
|
6
|
KASAP Y, CEVİZ K, POLAT ME, BOYACI Lİ, ÇELİK M, ŞENEL S, UZUN E. Surgical and conservative treatment results of penile fracture: single-center experience. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1139262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Amaç: Bu çalışmada penil fraktürde cerrahi tedavinin komplikasyon olarak daha avantajlı olduğu ancak cerrahi sonrasında da özellikle ikinci kez cerrahi gerektirecek kadar ciddi komplikasyonların görülebileceğini göstermek amaçlandı.
Gereç ve Yöntem: 05.04.2019 ve 28.07.2021 tarihleri arasında penil fraktür tanısı konulan 31 hastanın verileri retrospektif olarak değerlendirildi. 3 hasta verilerine ulaşılamaması nedeni ile dışlandı. Penil fraktür onarımı yapılan 21 hasta grup 1 ve cerrahi istemediğinden konservatif olarak izlenen 7 hasta grup 2 olarak iki gruba ayrıldı. Penil fraktür nedenleri, acil servise başvuru süreleri, ultrasonografik (USG) görüntülemeleri incelendi. Tüm hastalar cerrahi veya konservatif tedavinin altıncı ayında IIEF-15 formu ile değerlendirildi. Ayrıca operasyondan sonra penil nodül ve kurvatür, ağrılı ereksiyon açısından değerlendirildi.
Bulgular: Grup 1 için median yaş 43±14,52 Grup 2 için 47±14,71 idi. Grup 1 hastalar için tunika defekti 7,02±3,26, grup 2 için 6,85±4,98 idi. İki grup arasında komplikasyon ve erektil disfonkisyon (ED) varlığı karşılaştırıldığında Grup 2 de anlamlı olarak daha fazla komplikasyon geliştiği ve daha fazla ED’ ye neden olduğu saptandı.
Sonuç: Penil fraktürün komplikasyon olarak daha az olan tedavisi cerrahi tedavidir ancak cerrahi tedavinin de ikinci kez cerrahi müdahale gerektirecek komplikasyonlara neden olabileceği unutulmamalıdır.
Collapse
|
7
|
Long term complications of penile fracture repair: Erectile dysfunction and penile curvature. Rev Int Androl 2022; 20:116-120. [PMID: 35339402 DOI: 10.1016/j.androl.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/27/2020] [Accepted: 12/06/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the factors that cause erectile dysfunction and penile curvature after repair of penile fracture (PF). METHODS Data from 25 patients who underwent PF repair was retrospectively analyzed. PF was diagnosed by examining patients' medical histories and performing physical examinations. All patients underwent immediate PF repair. All patients filled out the International Index of Erectile Function (IIEF-5) form and penile curvature was examined. RESULTS The median age of patients at the time of surgery and the median follow-up duration were 46 years (22-60 years) and 95 months (12-156 months), respectively. Two of the patients had concomitant urethral injury. At the final follow up, erectile dysfunction (ED) was present in 13 patients (52%). Among these patients, 9 patients (36%) had mild ED and 4 patients (16%) had moderate ED. With a univariate analysis, age and penile curvature were significantly associated with ED (p=0.008 and p=0.039, respectively). With a multivariate analysis, age was independently associated with ED (p=0.048, odds ratio=1.104, 95% confidence interval 1.000-1.218). The IIEF-5 scores correlated with age (p=0.009, r=0.510). Seven patients (28%) had penile curvature and one patient underwent penile plication surgery. CONCLUSION After PF repair, age is the only risk factor for ED and penile curvature rarely requires surgical treatment.
Collapse
|
8
|
Bulbul E, Gultekin MH, Citgez S, Derekoylu E, Demirbilek M, Akkus E, Ozkara H. Penile fracture: Tertiary care center experience and long-term complications after immediate repair. Andrology 2021; 10:560-566. [PMID: 34939748 DOI: 10.1111/andr.13148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/07/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the literature, there is not sufficient data on factors affecting the development of complications in patients with penile fracture after early surgical intervention. OBJECTIVES To investigate the predictors of long-term complications in patients who underwent immediate surgical repair for penile fracture. MATERIALS/METHODS This clinical study included a total of 31 cases of penile fracture in which surgical treatment was performed within the first 24 hours and penile fracture was confirmed during the operation. The patients with and without late complications were compared in terms of parameters such as age, tear size of the tunica albuginea of the penis, bilateral involvement of the corpora cavernosa involvement, urethral injuries, and duration from penile fracture to surgery. RESULTS The median age of the patients was 42 (interquartile range [IQR]: 34-51) years. The median time from penile fracture to surgery was 13 (8-18) hours. The median tear size was 16 (11-21) mm. Late complications were seen in 13 (41.9%) patients in the postoperative period. Erectile dysfunction (ED) developed in five (16.1%) patients in the postoperative period. There was no statistically significant relationship between age, tear size, time from penile fracture to surgery, and bilateral corporeal involvement in terms of ED development. Painful erections, penile deviations, urethral strictures, tunical scars, and re-fracture were the other late complications. There was a significant relationship between the development of any complication and time from penile fracture to surgery (p = 0.028) and tear size (p = 0.031). In the receiver operating characteristic analysis of complication development, the cut-off value for the time from penile fracture to surgery was 13.5 hours. DISCUSSION AND CONCLUSION We found that the longer time interval between penile fracture and surgery worsened the patient outcomes. In addition, tear size was determined to be a predictor for long-term complications. In our opinion, early treatment of penile fracture can prevent severe complications in these cases. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Emre Bulbul
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| | - Mehmet Hamza Gultekin
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| | - Sinharib Citgez
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| | - Engin Derekoylu
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| | - Muhammet Demirbilek
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| | - Emre Akkus
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| | - Hamdi Ozkara
- University of Istanbul-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Urology, Turkey
| |
Collapse
|
9
|
Abstract
Penile fracture is a urologic injury with an etiology that varies based on the cultural milieu. Diagnosis can be made based on history and physical examination alone. Patients should be evaluated with RUG or cystoscopy when urethral injury is suspected. Ultrasound or MRI is a helpful adjunct when the diagnosis is unclear, and can assist in identifying the location of the rupture. Surgical management is favored over conservative measures to improve outcomes. Delayed surgical repair may not be inferior to immediate intervention.
Collapse
Affiliation(s)
- Allen Simms
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Nima Baradaran
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Tom F Lue
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
| |
Collapse
|
10
|
Rezaee ME, Gross MS. The pelvic pop: an extremely rare case of internal penile fracture presenting with scrotal hematoma and review of the literature. Asian J Androl 2021; 23:116-117. [PMID: 32367836 PMCID: PMC7831833 DOI: 10.4103/aja.aja_14_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Michael E Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Martin S Gross
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| |
Collapse
|
11
|
Sharma KL, Bole R, Yang D, Alom M, Savage J, Ziegelmann M, Trost L. Conservative management of suspected fractures in men undergoing collagenase clostridium histolyticum for Peyronie's Disease is not associated with worsening of erectile function. Int J Impot Res 2020; 34:100-107. [PMID: 33318638 DOI: 10.1038/s41443-020-00383-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022]
Abstract
The optimal management of suspected penile fractures post collagenase clostridium histolyticum (CCH) remains indeterminate, with some advocating for observation and others surgical repair. To address this issue, the current study sent surveys to 158 men with Peyronie's Disease (PD) who completed four CCH injection series. The survey included the Erectile Function Domain from the International Index of Erectile Function (IIEF-EFD) and questions regarding potential symptoms of corporal rupture (hematoma, popping, and detumescence). Men were categorized as having a suspected fracture (SF+) if they reported a popping sensation or rapid detumescence. All SF(+) men were managed conservatively without surgical intervention. Results were compared statistically against baseline IIEF-EFD values and between SF(+) and SF(-) groups. The key study objective was to determine whether erectile function was negatively impacted by conservative management of suspected fractures. Of the 53 returned surveys, 45 had complete data for review. The sample was statistically representative of the broader cohort of 158 men, except being older (60.0 vs 57.1 [SD 6.0 vs 9.0], p = 0.01) with shorter durations of PD (median 9 [IQR 5, 19] mo vs 13 [IQR 8, 24], p = 0.01). Overall, 7/45 (16%) of men were defined as SF(+), with all fractures occurring within 6 weeks of CCH administration. No demographic or pathophysiologic characteristics predicted SF(+). Importantly, SF(+) men did not experience worsened erectile function compared to SF(-), with a median IIEF-EFD change of +2 vs +1, p = 0.16, respectively. Curvatures were improved to a greater degree among SF(+) men (primary: median -30 [IQR -20, -32.5] vs -15 [-5, -26], p = 0.04; composite: -35 [-25, -40] vs -25 [-7, -30], p = 0.15). We concluded that suspected penile fractures in PD men undergoing CCH may be reasonably managed without surgical intervention and portend greater improvements in curvature correction.
Collapse
Affiliation(s)
| | - Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - David Yang
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Manaf Alom
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Landon Trost
- Department of Urology, Mayo Clinic, Rochester, MN, USA. .,Male Fertility and Peyronie's Clinic, Orem, UT, USA.
| |
Collapse
|
12
|
Abualruz AR, O'Malley R, Ponnatapura J, Holbert BL, Whitworth P, Tappouni R, Lalwani N. MRI of common penile pathologies and penile prostheses. Abdom Radiol (NY) 2020; 45:2825-2839. [PMID: 31154485 DOI: 10.1007/s00261-019-02080-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
MRI can delineate finer details of penile anatomy and pathology due to inherent higher soft-tissue contrast and spatial resolution. It can characterize inflammation and identify abscesses, localize penile fractures, guide surgical planning in penile fibrosis and Peyronie's disease, and depict components of the penile prosthesis and its complications. MRI is a great investigative tool for penile neoplasms, including locally infiltrative neoplasms where clinical examination is limited, and local staging is crucial for surgical planning.
Collapse
Affiliation(s)
- Abdul-Rahman Abualruz
- Department of Radiology, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ryan O'Malley
- University of Washington, 1959 NE Pacific St, Seatle, WA, 98195, USA
| | - Janardhana Ponnatapura
- Department of Radiology, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Brenda L Holbert
- Department of Radiology, Section of Abdominal Imaging, Wake Forest University Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Pat Whitworth
- Department of Radiology, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Rafel Tappouni
- Department of Radiology, Section of Abdominal Imaging, Wake Forest University Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Neeraj Lalwani
- Department of Radiology, Section of Abdominal Imaging, Wake Forest University Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| |
Collapse
|
13
|
Koreshin E, Efimtcev A, Gulko A, Popov S, Orlov I, Trufanov G, Zubkov M. Design of a RF-resonant set improving locally the B1+ efficiency. Applications for clinical MRI in andrology and urology. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2020; 317:106774. [PMID: 32589584 DOI: 10.1016/j.jmr.2020.106774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/25/2020] [Accepted: 06/13/2020] [Indexed: 06/11/2023]
Abstract
Modern diagnostic imaging methods for andrology and urology fall behind other well-developed applications such as cardiology or neurology. Particularly, MRI despite its superior soft tissue contrast is hardly used for MR-imaging of the penis, primarily due to the lack of the corresponding receive or transmit coils. In order to fix this, a new radio frequency resonator, based on the birdcage operating principles has been designed, simulated, fabricated, tested and compared experimentally to existing RF coils. In order to provide high transmit efficiency and high sensitivity, while maintaining the coil safety, the resonator spatially separates alternating magnetic and electric fields. The transmitted magnetic field (B1+) is concentrated in the centre of the imaging volume, while the electric field remains on its edge and does not lead to tissue heating. The resonator design was optimised for human MRI in 1.5 T scanners. Both simulations and experiment showed the resonator to provide around 100-fold specific absorption rate reduction, around 10-fold improvement of the transmit efficiency and more than 10-fold enhancement of the signal to noise ratio (SNR) in a phantom compared to the body coil, around 2-fold SNR enhancement in a phantom compared to the commercial flexible 4-element coil, and up to 1.5-fold enhancement compared to the same coil in-vivo.
Collapse
Affiliation(s)
- Eugene Koreshin
- ITMO University, Department of Physics and Engineering, 16 Birgevaya Line, St. Petersburg 199034, Russian Federation.
| | - Alexander Efimtcev
- Federal Almazov North West Medical Research, 2 Akkuratova Street, St. Petersburg 197341, Russian Federation.
| | - Alexander Gulko
- City Center of Endourology and New Technologies, 46 Chugunnaya Street, St. Petersburg 195009, Russian Federation.
| | - Sergey Popov
- City Center of Endourology and New Technologies, 46 Chugunnaya Street, St. Petersburg 195009, Russian Federation
| | - Igor Orlov
- City Center of Endourology and New Technologies, 46 Chugunnaya Street, St. Petersburg 195009, Russian Federation
| | - Gennady Trufanov
- Federal Almazov North West Medical Research, 2 Akkuratova Street, St. Petersburg 197341, Russian Federation.
| | - Mikhail Zubkov
- ITMO University, Department of Physics and Engineering, 16 Birgevaya Line, St. Petersburg 199034, Russian Federation.
| |
Collapse
|
14
|
Abstract
This article reviews the anatomy and magnetic resonance imaging (MRI) appearance of the penis. The recommended technique for MRI of the penis is outlined, with discussion of the benefits and drawbacks to imaging the penis after artificial erection. Common penile pathologies are reviewed, with a summary of their clinical features, MRI appearance, and treatment. The ability to demonstrate the erectile bodies and vasculature helps to evaluate vascular pathologies such as priapism, Mondor disease, and cavernosal thrombosis. MRI is also a useful tool to assess for traumatic abnormalities of the penis, with the depiction of soft tissue anatomy and fascial layers allowing for evaluation of penile fracture and penile contusion. Malignant disease of the penis is also reviewed, including squamous cell carcinoma, urethral carcinoma, metastases, and rare neoplasms. Staging of these neoplasms is addressed, with discussion of how MRI can be used to assess the extent of tumor involvement. MRI also clearly demonstrates the tunica albuginea, which allows for evaluation of Peyronie's disease.
Collapse
|
15
|
Bhoopathy SV, Kim LH. The value of pre-operative MRI in management of penile fractures. Urol Case Rep 2020; 31:101185. [PMID: 32322514 PMCID: PMC7160193 DOI: 10.1016/j.eucr.2020.101185] [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: 03/21/2020] [Accepted: 03/27/2020] [Indexed: 01/01/2023] Open
Abstract
Penile fracture is a urological emergency which requires urgent assessment and surgical intervention to avoid long term complications. In this report, we describe a case in which penile MRI was used for initial assessment and surgical planning. This allowed exact localisation of the tunical tear and allowed direct incision over the tear for repair. In this case, the man avoided circumcision, which would be often required with the conventional degloving approach.
Collapse
Affiliation(s)
| | - Lawrence H Kim
- Urology Department, Westmead Hospital, Westmead, NSW, 2145, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia
| |
Collapse
|
16
|
Review of Intralesional Collagenase Clostridium Histolyticum Injection Therapy and Related Combination Therapies in the Treatment of Peyronie's Disease (an Update). Sex Med Rev 2020; 9:340-349. [PMID: 32199788 DOI: 10.1016/j.sxmr.2020.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Collagenase Clostridium histolyticum (CCH) is an injectable agent used to treat Peyronie's disease (PD) by enzymatically degrading the interstitial collagen in plaques. CCH has been administered via multiple treatment protocols, in combination therapies, to patients with varying curvatures and in both the acute and stable phases of this condition. OBJECTIVES To review the current literature and provide an update on CCH as an injectable therapy for PD, as a singular therapy or in conjunction with combination therapies, and its associated complications. We provide a brief background of PD treatments, evaluate CCH efficacy in penile curvature reduction and subjective improvement in a variety of protocols, and compare combination therapies (penile traction, sildenafil), plaque location, and efficacy in both acute and stable diseases. METHODS We performed a systematic review of the existing PubMed literature pertaining to CCH injection therapy in the treatment of PD and compared the effectiveness to different treatment modalities. RESULTS CCH is a safe and effective injectable agent for all curvature directions in both acute and stable PD. It can be used in conjunction with multiple penile modeling techniques, in combination with sildenafil, and following a shortened administration protocol. Moderate to severe treatment-related adverse events occur at a rate of 9% and are typically managed conservatively. CONCLUSION Intralesional injections of CCH are FDA approved as a nonsurgical treatment for men with PD. The IMPRESS trials were instrumental in demonstrating the efficacy and safety of CCH and provided a standard protocol for administration. Additional studies are required to optimize treatment protocols and use in combination therapies. Further investigation of patients with ventral curvatures, hourglass deformities, and those in acute phase is needed. Natale C, McLellan D, Yousif A, et al. Review of Intralesional Collagenase Clostridium Histolyticum Injection Therapy and Related Combination Therapies in the Treatment of Peyronie's Disease (an Update). Sex Med 2021;9:340-349.
Collapse
|
17
|
Kominsky H, Beebe S, Shah N, Jenkins LC. Surgical reconstruction for penile fracture: a systematic review. Int J Impot Res 2020; 32:75-80. [PMID: 31685943 DOI: 10.1038/s41443-019-0212-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/30/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023]
Abstract
Penile fracture is a rare condition that describes the rupture of the corpus cavernosum following direct, high-pressure trauma to the erect penis. There is no standardized management algorithm for these patients. We performed a systematic review of the past 10 years regarding management of penile fractures. A complete PRISMA-P 2015 checklist was performed where we reviewed English articles published over the past 10 years to identify 105 articles, where 63 articles were of relevance and subsequently narrowed to a total of 28 articles into the final review for this study. We determined that immediate penile exploration and tunica repair is considered the most common and current management of penile fractures with experts demonstrating that it leads to the fastest in recovery in erectile function and positive cosmetic outcomes. However, we also determined that the specific algorithm can be variable-down to the suture material, use of catheterization, urethroplasty when involved, and length of recovery/follow-up. In the last several decades, men with penile fracture have been treated, in most cases, with immediate surgical intervention. This review highlights the varying practices regarding surgical exploration, injury repair, and postoperative management in men with a penile fracture. Immediate penile exploration and tunica repair have been the mainstay approach of management.
Collapse
Affiliation(s)
- Hal Kominsky
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sarah Beebe
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nayan Shah
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lawrence C Jenkins
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
18
|
Childs DD, Dyer RB, Holbert B, Terlecki R, Chouhan JD, Ou J. Multimodality imaging of the male urethra: trauma, infection, neoplasm, and common surgical repairs. Abdom Radiol (NY) 2019; 44:3935-3949. [PMID: 31440803 DOI: 10.1007/s00261-019-02127-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this article is to describe the indications and proper technique for RUG and MRI, their respective image findings in various disease states, and the common surgical techniques and imaging strategies employed for stricture correction. RESULTS Because of its length and passage through numerous anatomic structures, the adult male urethra can undergo a wide array of acquired maladies, including traumatic injury, infection, and neoplasm. For the urologist, imaging plays a crucial role in the diagnosis of these conditions, as well as complications such as stricture and fistula formation. While retrograde urethrography (RUG) and voiding cystourethrography (VCUG) have traditionally been the cornerstone of urethral imaging, MRI has become a useful adjunct particularly for the staging of suspected urethral neoplasm, visualization of complex posterior urethral fistulas, and problem solving for indeterminate findings at RUG. CONCLUSIONS Familiarity with common urethral pathology, as well as its appearance on conventional urethrography and MRI, is crucial for the radiologist in order to guide the treating urologist in patient management.
Collapse
Affiliation(s)
- David D Childs
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Ray B Dyer
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Brenda Holbert
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ryan Terlecki
- Department of Urology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Jyoti Dee Chouhan
- Department of Urology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Jao Ou
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| |
Collapse
|
19
|
Cozzi D, Verrone GB, Agostini S, Bartolini M, D'Amico G, Pradella S, Miele V. Acute penile trauma: imaging features in the emergency setting. Radiol Med 2019; 124:1270-1280. [PMID: 31302847 DOI: 10.1007/s11547-019-01065-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/07/2019] [Indexed: 11/27/2022]
Abstract
In an emergency department, penile traumas are uncommon and a prompt diagnosis is necessary. Penile injury may result from penetrating and non-penetrating trauma. Non-penetrating injuries can produce cavernosal hematomas or fractures: if not treated promptly, these lesions can result in fibrosis or erectile dysfunction. Penile traumatic lesions need a clinical approach first, but a radiological study is often required: ultrasonography with color and spectral Doppler study is usually the first approach. In some cases, magnetic resonance imaging may be performed to better recognize even small discontinuity of the tunica albuginea. Radiologists have to be aware of the various radiological patterns of penile traumatic lesions, in order to establish a prompt and correct diagnosis.
Collapse
Affiliation(s)
- Diletta Cozzi
- Department of Radiology, Careggi University Hospital, Florence, Italy.
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy.
| | - Giovanni Battista Verrone
- Department of Radiology, Careggi University Hospital, Florence, Italy
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Simone Agostini
- Department of Radiology, Careggi University Hospital, Florence, Italy
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Marco Bartolini
- Department of Radiology, Careggi University Hospital, Florence, Italy
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Giuseppe D'Amico
- Department of Radiology, Careggi University Hospital, Florence, Italy
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Florence, Italy
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| |
Collapse
|
20
|
Older age and a large tunical tear may be predictors of increased erectile dysfunction rates following penile fracture surgery. Int J Impot Res 2019; 32:226-231. [DOI: 10.1038/s41443-019-0159-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/14/2019] [Accepted: 04/20/2019] [Indexed: 11/09/2022]
|
21
|
Managing complications of collagenase Clostridium histolyticum (CCH) injection. World J Urol 2019; 38:287-292. [DOI: 10.1007/s00345-019-02817-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/17/2019] [Indexed: 12/13/2022] Open
|
22
|
Affiliation(s)
- Jesse Ory
- Department of Urology, Dalhousie University, Halifax NS, Canada
| | - Greg Bailly
- Department of Urology, Dalhousie University, Halifax NS, Canada
| |
Collapse
|
23
|
Tu LH, Spektor M, Ferrante M, Mathur M. MRI of the Penis: Indications, Anatomy, and Pathology. Curr Probl Diagn Radiol 2019; 49:54-63. [PMID: 30704768 DOI: 10.1067/j.cpradiol.2018.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 11/22/2022]
Abstract
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.
Collapse
Affiliation(s)
- Long H Tu
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT.
| | - Mike Spektor
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Marc Ferrante
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Mahan Mathur
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| |
Collapse
|