Stereological comparison of smooth muscle, collagen, and elastic fibers of the clitoris and glans penis in young adults

OBJECTIVE

To compare the collagen, elastic fibers, and smooth muscle content of the clitoris and the glans penis in young adults.

MATERIALS AND METHODS

The clitoris and the glans penis of six women and six men (mean age 25±3) who died as a result of accidents were excised. The samples were placed under a formaldehyde solution and histologically processed. Masson's trichrome and Weigert's resorcin-fuchsin stain was used to highlight the elastic fibers, smooth muscle, and collagen. Stereological analysis was conducted in 5 random fields of 5 slides for each sample. For statistical analysis, the unpaired t-test was used to compare values between groups, and a value of P<0.05 was considered as significant for all analyses.

RESULTS

Stereology revealed a mean smooth muscle content of 35.84±6.46% and 31.64±4.74% for the clitoris and glans penis, respectively, while it also revealed collagen content of 26.11±7.41% and 28.44±3.55% and elastic fibers content of 24.12±4.34% and 30.97±6.13% for the clitoris and glans penis, respectively. The statistical analysis showed no significant differences between them.

CONCLUSION

Regardless of anatomical differences, the volumetric density of collagen, elastic fibers, and smooth muscle were similar for the clitoris and glans penis in young adults, a feature possibly explained by their embryology.

Lesions of the prepuce and penis in rams: A retrospective study

In the ovine reproductive management, a thorough breeding soundness evaluation including specific inspection of the male genital tract represents a valuable tool for assessing the reproductive potential of a selected subject and for diagnosing genital disorders. During examination, accurate inspection on penis and prepuce is necessary, since conditions affecting these structures may hamper regular coitus. Records from 1270 males undergoing breeding soundness evaluation (n = 1232) or admitted for genital disorders to the Section of Obstetrics and Gynaecology (n = 38) of the Department of Veterinary Medicine, were collected, and lesions of penis and prepuce were therefore classified. The data collected revealed that 47/1270 rams examined presented lesions of the penis and prepuce. The most frequent condition was urolithiasis accounting for over 2% of the cases, followed by lack of the urethral process (0.39% incidence), lack of the glans penis and hypospadias (0.23% cases). Moreover, most of the conditions (40%) were observed in animals less than 2 years old, suggesting the importance of a careful breeding soundness evaluation in animals at young age.

Penile shape discriminates two cryptic species of Akodon Meyen, 1833 (Mammalia, Rodentia, Cricetidae) from eastern Brazil

Glans penis morphology has been used as a powerful tool in mammal taxonomy to differentiate cryptic species. Neotropical rodent species Akodoncursor and A.montensis are cryptic, and interspecific hybrids are like their parental species. We investigated non-metric and metric phallic characters aiming to differentiate A.cursor from A.montensis. We also evaluated the parental species' influence of the phallic characters on hybrids. We analysed 96 male adults-56 A.cursor, 27 A.montensis, and 13 hybrids, subgrouping species by locality and hybrids by parental species (paternal vs maternal). We verified that A.cursor and A.montensis are distinguishable by penile-shape morphology: A.cursor has an elongated penile form with a flare in the distal portion and A.montensis has a barrel-shaped form. Also, dark spots in ventral view, if present in A.montensis, distinguish A.montensis from A.cursor. Although the non-metric characters differentiate the species, they do not distinguish the subgroups of A.cursor, A.montensis, and hybrids. The metric phallic characters indicated a significant difference between species and hybrids. These characters also differentiate the population groups of A.cursor. However, A.montensis subgroups and hybrids subgroups did not present a significant difference. This study shows the importance of penis morphology in the taxonomy of the cryptic rodent species A.cursor and A.montensis, representing a powerful tool to discriminate male specimens in mammal collections without karyotyping or sequencing, even though the specimens occurred in sympatric areas. Since most taxidermy protocols do not preserve the penis in mammal preparations, liquid preservation of some specimens or the removal of the penis before taxidermy for liquid preservation could be beneficial. We also recommend the organisation in museum collections of a penis bank for the A.cursor species group (or even all rodent species) to avoid losing this important information for species identification.

Glans ischemia after circumcision in children: Two case reports

BACKGROUND

Circumcision refers to the removal of the skin covering the tip of the penis and is one of the most common surgical procedures performed in childhood. Even though circumcision is a well-standardized operation, several minor and major complications may be experienced by paediatric surgeons. Glans ischemia (GI) has been widely reported in the paediatric literature as a complication following circumcision. Nonetheless, etiopathogenesis of GI is not well defined and management guidelines are lacking.

CASE SUMMARY

We describe our experience with this rare and scary complication using subcutaneous enoxaparin alone or in association with a topical vasodilator.

CONCLUSION

Hypothetical causes and different management strategies are discussed.

Anatomy of the mouse penis and internal prepuce

This paper addresses a confusing issue of preputial anatomy of the mouse. The term "internal prepuce" was used in 2013 to describe a preputial structure integral to the mouse glans penis. Subsequently in 2015 the same term was applied by another group to describe entirely different morphology, generating confusion in the literature. Because it is inappropriate to use the same term to describe entirely different structures, we take this opportunity to provide further descriptive information on the internal prepuce of the mouse employing gross dissection, analysis of serial histologic section sets, three-dimensional reconstruction, scanning electron microscopy and immunohistochemistry. For this purpose, we review and illustrate the relevant literature and provide some additional new data using standard morphological techniques including immunohistochemistry. The mouse internal prepuce is integral to the glans penis and clearly is involved in sexual function in so far as it contains a major erectile body innervated by penile nerves. The development of the mouse internal prepuce is described for the first time and related to the development of the corpus cavernosum glandis.

Post Circumcision Corona Obliteration

OBJECTIVE

Abnormal healing after neonatal ritual circumcision is a source of significant concern to patients' parents and their caregivers. This report presents a series of male infants who underwent ritual circumcision and subsequently developed obliteration of the normally distinct structure of the corona.

METHODS

We report a case series of infants recruited from the community and a medical center. The compulsory inclusion criterion was absence of the normal landmarks of the glans penis with confirmed integrity of normal male genitalia. Illustrative cases are presented. The possible pathogenetic mechanisms leading to this condition are discussed. A literature search was conducted to discern whether this phenomenon has ever been previously reported.

RESULTS

The eight cases we diagnosed were all otherwise normal. In one case, where we discovered use of an active substance on the circumcision wound, the condition persisted for an extended period but it resolved completely by 15 months of age. In all but one of the subjects the condition was transient and resolved over time. We could not reveal any previous publication on this topic.

DISCUSSION

This noteworthy complication of circumcision raises debate whether it was previously existent, though unreported or a novel phenomenon. We postulate that contributing factors leading to tissue injury may possibly be injured tissue exposure to irritating substances, vascular compromise, the technique chosen to control bleeding or an idiosyncratic response to tissue trauma. More attention to the occurrence of this phenomenon is compulsory to collect more data and learn of its incidence and eventual impact.

CONCLUSIONS

Obliteration of the corona, constitutes an unreported, rare albeit significant complication following circumcision. We recommend refraining from potentially inciting factors leading to this undesirable condition. More extensive experience with this disorder may enable us to employ preventive measures to eliminate it or at least provide reassurance wherever possible.

Cure of condyloma acuminata covering the glans penis using aminolevulinic acid/photodynamic therapy

Condyloma acuminata are a type of verrucous hyperplasia in the genital and perianal areas caused by human papilloma virus (HPV) infection. Traditional treatment methods for condyloma acuminata, such as topical medications, carbon dioxide (CO₂) laser, cryotherapy, and surgical excision, can be effective at removing warts, however, they do not eliminate subclinical and latent HPV infection, resulting in a high recurrence rate and even leaving trauma and scars. We report a case of condyloma acuminata covering the glans penis, considering our patient had a singular, large lesion, thus, to reduce the risk of recurrence and minimize the trauma caused by treatment, we chose ALA/photodynamic therapy (ALA-PDT). We provided eight rounds of ALA-PDT at a treatment interval of 7 days, the skin lesion disappeared completely, leaving a chapped, flushed glans without scarring. There was no recurrence during the 6-month follow-up period. Thus, we firmly believe that ALA-PDT is an effective, safe, and curative treatment, and is worth popularizing in clinical practice.

Leishmaniasis Caused by Leishmania major on the Glans Penis: A Case Report

Cutaneous leishmaniasis (CL) is one of the prevalent parasitic diseases in Iran principally caused by two species, Leishmania major and L. tropica. Here, we present a rare case of a congenital form of CL around the glans penis from the central part of Iran in 2017. A 24-yr-old male patient from the central part of Iran presented with biennial ulceration of the glans penis. Diagnostic methods included physical and preclinical examination, microscopic observation, leishmanin skin test (LST), and serological tests including direct agglutination test (DAT). Nested PCR and sequencing analysis were used on the positive smears for confirmation of CL and Leishmania species identification. The preclinical results were normal, and no anti-Leishmania antibodies were detected in the peripheral blood of the patient using DAT. In abdominal ultrasonography, the spleen and liver size were normal. LST was positive (≥5 mm) after 72 h, and a few amastigote forms of Leishmania sp. were demonstrated under light microscopy. L. major was confirmed using nested PCR and sequencing analysis. The patient responded to oral administration of miltefosine (2.5 mg/kg/d) for 28 days. To the best of our knowledge, genital CL due to L. major has not been previously reported from Iran.

Hypospadias repair with the glanular-frenular collar (GFC) technique

BACKGROUND

In the normal human penis, the glans wings merge in the midline ventrally, but are separated by the 'septum glandis' in conjunction with the frenulum. The frenulum is also included in the formation of the distal (glanular and subcoronal) urethra, which has a special part known as the 'fossa navicularis'. This has inspired a hypospadias repair technique that simulates the development of the glanular and subcoronal urethra, which can be incorporated into the repair of all cases of hypospadias.

MATERIAL AND METHOD

A total of 121 patients with varying degrees of hypospadias underwent surgery with the described technique: a Y-V plasty was used to dissect the inner foreskin, in a fashion that allowed for its ventral mobilization as a frenular mucosal collar. After tubularization of the proximal urethra, a partial spongioplasty was performed that extended up to the subcoronal level. The glans wings were approximated only at their outermost convexities, with a couple of subepithelial sutures, leaving a slit for the meatus. The cleft-like area between the split wings of the glans penis was filled with the terminal ends of the spongiosum and the dartos of the mucosal collar, which converged to form a septum and a neo-frenulum (glanular-frenular collar, GFC). The midline skin closure of the ventral collar and the circumferential foreskin closure was completed as usual.

RESULTS

At a mean follow-up of 10 months, two patients developed urethral fistula (2%), six had meatal stenosis (5%), and two had glans dehiscence (2%) that resulted in meatal retraction. Overall, patients had a cosmetically satisfying appearance (Figure). Forty-one received secondary circumcision; the parents of 80 (66%) patients were satisfied with the final foreskin appearance obtained with this method.

DISCUSSION

The split wings of the glans penis or so-called ventral cleft between the glans wings that accommodate the frenulum is part of normal anatomy. Hence, in hypospadias surgery, the approximated glans wings should allow for ventral support of the glanular and subcoronal urethra through a reconstructed neo-frenulum. Neither glanular surface enhancement nor extensive dissection of the glans wings and their full-length approximation are necessary, and may in fact be counter-productive.

CONCLUSIONS

The employment of a GFC provided: 1) an anatomical restoration of the distal (glanular and subcoronal) urethra, supported by a frenulum; 2) a protective (undissected) dartos layer over the distal part of the tubularized neourethra; and 3) a space for the re-formation of the fossa navicularis.

Parameatal Urethral Cyst in a Newborn-A Case Report and Review of the Literature

Parameatal urethral cysts are rare congenital lesions of the penis that are usually <1cm in diameter in the paediatric population and do not create any urinary difficulties. Their natural course is either to resolve or to be surgically excised without any postoperative complications. We report a case of a newborn with a parameatal urethral cyst that produced voiding difficulties and was treated by surgical excision.

Acute Ischemia of the Glans Penis after Circumcision Treated with Hyperbaric Therapy and Pentoxifylline: Case Report and Revision of the Literature

Acute severe ischemia of glans penis after circumcision is a very rare event and, if not treated, can lead to irreversible necrosis with severe consequences such as loss of part of the penis. The possible causes for this condition could be blood-vessel binding or cauterization, dorsal penile nerve block (DPNB), local anesthesia with vasoconstricting agents and wound dressing compression. The aim of the treatment is to provide good blood supply and thus, oxygen delivery to the ischemic penis. The therapeutic options include hyperbaric therapy (HBOT), pentoxifylline (PTX), enoxaparina, iloprost, antiplatelet, corticosteroids and peridural anesthesia. We report the case of a 24-year-old male who developed an acute severe glans penis ischemia after circumcision done under DPNB. The patient was successfully treated with HBOT in combination with PTX.

Acute Ischemia of the Glans Penis after Circumcision Treated with Hyperbaric Therapy and Pentoxifylline: Case Report and Revision of the Literature

Acute severe ischemia of glans penis after circumcision is a very rare event and, if not treated, can lead to irreversible necrosis with severe consequences such as loss of part of the penis. The possible causes for this condition could be blood-vessel binding or cauterization, dorsal penile nerve block (DPNB), local anesthesia with vasoconstricting agents and wound dressing compression. The aim of the treatment is to provide good blood supply and thus, oxygen delivery to the ischemic penis. The therapeutic options include hyperbaric therapy (HBOT), pentoxifylline (PTX), enoxaparina, iloprost, antiplatelet, corticosteroids and peridural anesthesia. We report the case of a 24-year-old male who developed an acute severe glans penis ischemia after circumcision done under DPNB. The patient was successfully treated with HBOT in combination with PTX.

Pseudoepitheliomatous, Keratotic and Micaceous Balanitis: A Case Report

Pseudoepitheliomatous, keratotic and micaceous balanitis (KPMB) is a rare condition affecting glans penis of elderly men. It is characterized by thick hyperkeratotic plaque with micaceous scaling often leading to phimosis. Here we are reporting a rare case of pseudoepitheliomatous, keratotic, and micaceous balanitis in 50-year-old man who has undergone circumcision 16 years back. Till date only a handful cases have been reported in world literature.

Nodulo-ulcerative Tuberculosis of the Glans Penis-A Case Report and a Discussion on Nomenclature of Genital Tuberculosis

Lupus vulgaris is a chronic paucibacillary form of cutaneous tuberculosis occurring in a person with a moderate to high degree of immunity. It commonly occurs over the buttocks and trunk in India. Involvement of the genitalia is uncommon, and lesions involving the penis, extremely rare with few cases reported worldwide. There also exists a confusion regarding nosology of tuberculosis of the genitalia. A brief discussion and review of literature are being discussed along with the report of a case of genital tuberculosis involving the glans penis.

Cavernous hemangioma of the glans penis

Cavernous hemangioma of the glans penis is a very rare lesion, and only a few cases are reported in the literature. Urologists are in a dilemma to treat such lesion with cosmetic and to obtain good functional outcome. Here, we report a case of cavernous hemangioma of the glans penis in a 22-year-old boy with a successful outcome by intralesional sclerotherapy with 3% sodium tetradecyl sulfate with a review of the literature on the subject.

Pseudoepitheliomatous keratotic and micaceous balanitis of Civatte

Pseudoepitheliomatous, keratotic, and micaceous balanitis is a rare condition characterized by verrucous excrescences with scaling. Most patients are over the age of 50 and frequently have been circumcised for phimosis in adult life. We present here a case of 35-year-old male patient with long standing phimosis presenting with a firm whitish plaque on the glans penis. The crusts were micaceous in nature. Histopathologically, there was pseudoepitheliomatous hyperplasia with acanthosis and no cellular atypia. The condition was explained to the patient and treatment options discussed. The patient was started on topical 5-fluorouracil cream on a daily basis as he did not express consent for operative intervention.

Penile length-somatometric parameters relationship in healthy Egyptian men

This study aimed to assess the penile length-somatometric parameters relationship in healthy Egyptian men. Two thousand physically normal men (22-40 years) were subjected to measurement of stretched penile length, glans penis, testis size, index finger, weight, height, span, body mass index (BMI), waist circumference, hip circumference and waist/hip ratio. The mean stretched penile length of the studied subjects was 13.84 ± 1.35 cm (range 12-19 cm), and the mean glans penis length was 2.6 ± 0.4 cm (range 1.7-3.8 cm). Penile length demonstrated positive significant correlation with glans penis length, index finger length, BMI and significant negative correlation with waist/hip ratio. On the other hand, penile length demonstrated nonsignificant correlation with age, weight, height, waist circumference, span or testicular size. It is concluded that the penile length-somatometric parameters relationship in healthy Egyptian men is mostly related to glans penis and index finger lengths.

Glans penis width in patients with hypospadias compared to healthy controls

PURPOSE

There are no reports of systematically-measured penile dimensions in boys with varying extents of hypospadias. To determine reference values, we prospectively measured maximum glans width in patients undergoing distal and proximal hypospadias repair as well as newborns undergoing elective circumcision.

METHODS

The maximum glans diameter was measured in consecutive boys aged 0-24 months presenting for newborn circumcision (controls), or repair of distal (distal shaft or glanular) and proximal (proximal shaft to perineal) hypospadias. Patients with proximal hypospadias and glans diameter <14 mm received intramuscular testosterone 2 mg/kg injection once monthly for 2-3 treatments, with measurements recorded prior to the first injection, and again intra-operatively 3-4 weeks after the final injection.

RESULTS

Data were obtained in 240 controls, 188 boys with distal hypospadias, and 39 boys with proximal hypospadias. Median ages were 1, 9 and 9 months, respectively. Males undergoing newborn circumcision were younger than both cohorts of hypospadias patients (p < 0.0001), but no difference in age was noted in those with distal and proximal hypospadias (p = 0.194). Average maximum glans diameters were significantly different: 14.3, 14.8, and 12.9 mm, respectively, for controls, distal and proximal hypospadias (p < 0.0001). Despite mean older age, 46 (24.5%) boys with distal hypospadias and 24 (61.5%) with proximal hypospadias had small glans diameter <14 mm. Increasing age was not correlated with increasing glans size in patients with distal or proximal hypospadias (r = -0.136, p = 0.062 and r = -0.089, p = 0.580) at 3-24 months of age.

CONCLUSION

Some boys with distal and the majority of those with proximal hypospadias have a glans width less than that of the average normal newborn. Glans size does not correlate with age in patients with hypospadias between 3 and 24 months old, supporting the decision to operate as early as 3 months in some centers.

A large cutaneous horn of the glans penis: a rare presentation

Cutaneous horn (cornu cutaneum) is a relatively uncommon lesion consisting of a projectile, conical, dense, hyperkeratotic nodule which resembles the horn of an animal. Cutaneous horns most frequently occur in sun-exposed parts and are typically found in the face and the scalp, but may also occur on the hands, eyelids, nose, chest, neck, shoulder and penis. Their occurrence on the penis is uncommon. We report a 42-year-old man presenting with penile cutaneous horn. The association with malignancy on the penis makes proper identification of these lesions essential. Standard treatment involves local excision, but the presence of malignancy mandates a partial penectomy.

Papulonecrotic tuberculid of glans penis: A common disease at an uncommon site

A 65-year-old man presented with multiple asymptomatic papulo-pustules and ulcers over glans penis since last 1 year. The lesions used to resolve spontaneously in a few days with scarring. The clinical features and histopathology were suggestive of papulonecrotic tuberculids of the glans penis.