Circumferential Acquired Macropenis: Definition, Literature Review and Proposal of Geometrically-Based Reduction Corporoplasty

Introduction

Over the years, scattered cases of acquired penile girth increase have been published with different terms, the common clinical feature being a mechanically hampered penetration.

Aim

To search for all published cases of acquired penile girth increase, and to propose a geometrically-based reduction corporoplasty.

Methods

A case of acquired penile bilateral albuginea herniation prompted us to a PubMed, EMBASE and Google Scholar literature review from 1970 to 2021, in search for similar conditions.

Main Outcome Measure

We identified 7 cases of acquired penile girth increase; the geometric approach used to surgically correct bilateral corporal herniation proved successful in our case.

Results

In 5 of the 7 cases of acquired penile girth increase, priapistic episodes were deemed the causal factor; in the remaining 2 and in ours, a clear etiology could not be identified.

Conclusion

“Circumferential acquired macropenis” describes the unusual syndrome of acquired penile girth increase, that encompasses 2 distinct etiologies: post-priapistic cases, characterized by penile girth increase both in flaccidity and erection, and idiopathic cases, characterized by girth increase in erection only, and at surgery by a thinned albuginea in the affected area.

Pescatori ES, Drei B, Rabito S Circumferential Acquired Macropenis: Definition, Literature Review and Proposal of Geometrically-Based Reduction Corporoplasty. Sex Med 2022;10:100460.

Advanced diagnostics in erectile dysfunction: beyond the concept of hemodynamics

Axial rigidity is the most important characteristic of a functional erection. Three factors determine axial rigidity: intracavernosal pressure (addressed by hemodynamics), cavernosal tissue mechanical properties ("tissue expandability"), and the ratio between the two dimensions of the penis: length and circumference ("penile geometry"). Intracavernosal pressure only is addressed by hemodynamic diagnostics, dynamic cavernosometry being the only investigation that allows its direct determination. The appreciation of these three rigidity determinants has the implication that there might exist cases of erectile dysfunction for pure geometric reasons, i.e. an excessive erect length/circumference ratio (L/C R). We report our series of 57 consecutive dynamic cavernosometries with concomitant axial rigidity and penile dimensions recording. Six cases of purely "geometric erectile dysfunction (ED)", i.e. patients unable to physiologically develop a rigid erection for a pathologic L/C R were identified. These patients are characteristically young men (mean age: 28 yrs, range 22-33) with life-long ED not responding to oral or intracavernosal treatment. Our L/C R cut-off value for pure geometric ED is 1.31. We also report two surgical strategies that could possibly address pure geometric ED. In conclusion, hemodynamics is not sufficient to assess the potency status, as other factors come to determine penile rigidity. In particular, there are cases of pure geometric ED which, potentially, is surgically curable. These cases should not be erroneously labelled as psychogenic cases.

[Plasma-cell granuloma of the mediastinum]

Plasma-cell granuloma of the mediastinum is an unusual non-neoplastic lesion; a case of rare mediastinal localization is reported. Only the histopathological examination leads to a correct diagnosis. Since the possibility of local recurrence has been described, total excision is requested. Video-assisted thoracic surgery technique may be difficult to use in the management of these mediastinal tumors due to adhesions between the mass and the surrounding tissues. Complete open resection is the treatment of choice.

[Our experience in the surgical treatment of early breast cancer. Results of a prospective study of 204 cases]

The authors report the results of a prospective study on 204 patients (1980-1993) affected by early infiltrating breast cancer (size pounds 2 cm) as a part of a surgical series of 608 cases. 53 cases who underwent QUART (25.9%) and 151 cases (74.1%) who underwent mastectomy modified according to Patey have been collected. 10 years actuarial survival has been respectively 79% after extensive surgery and 78% after conservative treatment. Local recurrences have been observed in 9 cases after meticulous follow-up (median 74.8 months, range 12-178): 3 (5.66%) patients after QUART and 6 (3.97%) after mastectomy; furthermore 1 patients after a conservative treatment (1.88%) has developed a second tumor at the same side probably dependent on the presence in the primary tumor of an extensive intraductal component. No correlations between histological features, grading, positive nodes, receptor status and local recurrences have been found. Only the age of patients looks significantly correlated with frequency of recurrences: 44.45% of local recurrences have been observed in patients less than 45 years old. Local recurrences after QUART have obliged, in all cases, to a radical mastectomy. Furthermore, frequency of distant metastases has been considered: after QUART percentage is lower (9.43%) than after radical mastectomy (13.9%). This consideration looks correlated with the longer follow-up of the later group. A multidisciplinary approach is advised but the most important role is played by surgery. In conclusion it is outlined that conservative surgery is addressed to selection and consenting patients.

[Primary lymphoma of the breast. Three cases of non-Hodgkin lymphoma]

Primary and sole breast lymphoma is a very rare disease. With the review of our series of 616 cases operated on for breast cancer, only 3 cases (0.48%) of primary breast non-Hodgkin lymphoma (LNH) have been observed. The authors outline the problems concerning diagnosis and therapy of this rare disease: pathological and immunohistochemical aspects are discussed. They stress the importance of staging in order to plan a correct multidisciplinary approach.

[Natural history of breast cancer: lobular carcinoma versus ductal carcinoma in our experience]

Aim of the study is to evaluate the biology, the clinical evolution and the prognosis of lobular carcinoma of the breast. We retrospectively evaluated the patients treated in our institution during the last 13 years. 117 patients with lobular carcinoma of the breast and 117 patients, randomized out of 397 patients with 'classical' pattern of ductal carcinoma were compared. Age distribution, type of surgery, tumor size, TNM stage, axillary lymph node involvement, multifocality, multiple breast cancers, local and distant recurrences, overall survival and disease-free survival have been evaluated. There was not a significant difference in tumor size, lymph node involvement, stage distribution, estrogens and progesterone receptors status, local and distant recurrences. The only significant differences were found in multifocality and multiple breast cancers. The said difference does not seem to modify the overall survival and the disease-free survival that are the same in the two groups. Our research shows that tumor size and axillary lymph node status are the only elements that have to be considered in the choice of the surgical treatment and prognosis. It seems that the difference in distant metastatic pattern between lobular and ductal carcinoma is the distinctive feature in the follow-up of these patients.

[Benign giant ovarian cystadenoma. Description of a clinical case]

The authors describe a case of giant benign cystadenoma of the ovary in a 55 year old woman. The patient came to their observation complaining of severe abdominal pain which started right after she was treated with a paracentesis, because of the suspicion of cirrhosis with ascites. The authors briefly outline the two goals of the diagnostic strategy: the diagnosis of the disease and the diagnosis of the nature of the disease. They stress the utmost importance of ultrasound and computerized tomography scans in the diagnosis of disease. For the diagnosis of the nature of the disease the authors counted on Ca 125, CEA, LDH levels and on Ca 19.9 and ACE levels as well. The surgical management of abdominal mass, which is the only possible treatment, led to the removal of a 60 cm in diameter and 30 kg mucinous cystadenoma. After the viscera of the higher abdomen (liver and stomach) had been repositioned, a plastic closure of the enormously expanded anterior abdominal walls was performed.