Stem cells for the treatment of Peyronie's disease / 中华男科学杂志

Peyronie's disease (PD) is a connective tissue disorder characterized as fibrotic plaque localized in the tunica albuginea (TA), and its pathomechanism remains obscure. Endeavors are being made to explore effective and minimally invasive therapeutic strategies for PD, and some experimental studies have verified the preventative and therapeutic effects of stem cells (SC), especially adipose tissue-derived SCs (ADSC), on this disease and excavated some of their action mechanisms. Some scholars attempted the integration of SCs with graft tissues, aiming at the improvement of TA grafting and reconstruction. The only publicly available clinical trial of SC therapy for PD was encouraging, and further on-coming relevant researches are expected with simultaneous optimization of the scheme. In a word, the application of SCs in the prevention and treatment of PD is a promising topic for clinical research, and there remain quite a lot of unknowns to be explored. This article summarizes the existing researches in this field.

Anti-lysyl oxidase combined with a vacuum device induces penile lengthening by remodeling the tunica albuginea / 亚洲男科学杂志(英文版)

This study aimed to explore whether and how anti-lysyl oxidase (anti-LOX) combined with a vacuum device (VD) could promote penile lengthening and to evaluate the effect on erectile function. This study was performed on four groups of adult rats: control, anti-LOX, VD (negative pressure value of -300 mmHg), and anti-LOX + VD. Penile length was measured by a modified VD method and verified on exposed length data. Intracavernous pressure (ICP) and maximum ICP/mean arterial pressure (MAP) ratio were recorded to assess erectile function. For corpus cavernosum, LOX activity and concentrations of pyridinoline, desmosine, hydroxyproline, and elastin were analyzed; transmission electron microscope and Hart's elastin staining were performed to monitor microstructural changes. Anti-LOX and VD significantly lengthened the penis by 10.8% (3.75 mm) and 8.2% (2.48 mm) compared with the control group, respectively, while anti-LOX + VD achieved the longest penile size (40.58 ± 0.40 mm) which was 17.4% longer than the control group (34.58 ± 0.54 mm). After 1-week washout, no penile retraction was observed. Meanwhile, exposed penile length data confirmed that the penis in the anti-LOX + VD group was also significantly longer. Anti-LOX inhibited LOX activity to reduce pyridinoline level, which led the penile tunica albuginea remodeling. However, it had no effect on hydroxyproline, desmosine, and elastin levels. Moreover, anti-LOX had no impact on erectile function, which was determined by ICP and ICP/MAP ratio. These results suggest that anti-LOX elongates the penis by reducing pyridinoline, which induces tunica albuginea remodeling. This lengthening effect was more obvious when combined with a VD. All procedures had no impact on erectile function.

Emprego de Túnica albugínea heteróloga ovina como reforço de parede abdominal em ratos / Employment of ovine heterologous Tunic albuginea as abdominal wall reinforcement in rats

Hérnias são umas das afecções que mais acometem os pequenos e grandes animais, podendo ter origem traumática ou não. Estas afecções, geralmente, necessitam de um reparo cirúrgico o mais rápido possível, devido ao fato de suas consequências poderem levar o animal ao óbito. Alguns estudos têm avaliado o comportamento da túnica albugínea como biomaterial de enxertia para reforço de parede abdominal, obtendo resultados favoráveis. O presente trabalho tem como objetivo avaliar o comportamento do enxerto de túnica albugínea ovina na parede abdominal de ratos. Foram selecionados 30 ratos da raça Wistar, os quais foram divididos em 2 grupos de 15 animais, sendo um grupo controle (C), um grupo teste (TA), onde os animais receberam reforço de parede abdominal com túnica albugínea ovina. Cada grupo foi dividido em três subgrupos contendo cinco animais, que foram submetidos à eutanásia nos dias 7, 21 e 42. O material coletado foi submetido a análises macroscópicas e histopatológicas a fim de afirmar a aplicabilidade do material e propor a utilização da túnica albugínea heteróloga como material de enxertia para a reconstrução da parede abdominal. Nos animais do grupo TA observou-se maior infiltrado inflamatório, neovascularização, deposição de colágeno e fibrose do que nos animais do grupo controle, concluindo assim que a túnica albugínea ovina é um biomaterial que funciona como substrato e promove uma precocidade da cicatrização de parede abdominal de ratos.

Hernias are one of the infections that most affect small and large animals, and may have traumatic origin or not. These conditions usually require a surgical repair as soon as possible, due to the fact that its consequences can lead the animal to death. Some studies have evaluated the behavior of the Tunica albuginea as a biomaterial for grafting abdominal wall reinforcement, obtaining favorable results. This study aims to evaluate the ovine Tunica albuginea graft behavior in the abdominal wall of rats. We selected 30 Wistar rats, which were divided into 2 groups of 15 rats, with a control group (C) and a test group (TA) where the rats received abdominal wall reinforcement with ovine Tunica albuginea. Each group was divided into three subgroups with five rats that were sacrificed on days 7, 21 and 42. The collected material was submitted to macroscopic and histopathological analysis to affirm the suitability of the material and propose the use of heterologous Tunica albuginea as grafting material for the reconstruction of the abdominal wall. In the TA group there was a higher inflammatory infiltration, neovascularization and collagen deposition and fibrosis than in group control, thus concluding that the ovine Tunica albuginea is a biomaterial that acts as substrate and promotes precocity of the abdominal wall healing of rats.

Reparo de desvio peniano em bovinos com implante de ligamento nucal alógeno / Penis deviation repair in cattle with implant of allogenous nuchal ligament

Sete novilhos mestiços, com idade entre 12 e 18 meses, foram submetidos à remoção do ligamento apical do pênis. Após 60 dias, na presença de fêmeas em estro, verificaram-se desvios ventral e lateral direito do pênis, com incapacidade de cópula. Foi realizada uma incisão na superfície dorsal do pênis e um segmento do ligamento nucal alógeno preservado em glicerina a 98% foi implantado sobre a túnica albugínea. Decorridos 60 dias, os animais foram observados em monta natural e apresentaram correção do desvio de pênis sem alteração do comportamento sexual. O implante de ligamento nucal alógeno conservado em glicerina a 98%, implantado sobre a túnica albugínea, promove a correção do desvio ventral lateral e direito de pênis de bovinos, sem alterar a libido.

Seven crossbred calfs, aged between 12 and 18 months, were subjected to removal of the apical ligament of the penis. After 60 days, in the presence of females in estrus, was found ventral and right lateral deviation of the penis, with inability to copulate. Was performed an incision on the dorsal surface of the penis and a segment of the allogenous nuchal ligament, preserved in glycerin 98%, was implanted over the tunica albuginea. After 60 days, the animals were observed in natural mating and showed correction of penis deviation without changing sexual behavior. The implantation of allogenous nuchal ligament, preserved in glycerin 98%, implanted on the tunica albuginea, promotes repair of ventral and right lateral deviation of the penis in cattle, without affecting the libido.

Silk fibroin scaffolds seeded with stem cells for repair of tunica albuginea defect in rabbits / 中华创伤杂志

Objective To investigate the effect of silk fibroin scaffolds seeded with adipose mesenchymal stem cells (ADMSCs) in remodeling fiber for tunica albuginea defect in rabbits.Methods Fifty-six New Zealand rabbits were divided into 4 groups according to the random number table after a defect was created in the tunica albuginea:Group A (the defect was repaired with silk fibroin),Group B (with silk fibroin seeded with ADMSCs),Group C (with autologous tunica vaginalis) and Group D (left unrepaired),with 14 rabbits per group.Tunica albuginea sections were obtained for HE staining,Sirius red staining,Hart staining and immunofluorescence staining of macrophages at 6 and 12 weeks after surgery.Results At 12 weeks after surgery,HE staining revealed chaotically distributed new fiber ingrowth in Group D and orderly ingrowth in Groups A,B,and C.At 12 weeks after surgery,Sirius red staining revealed mean area of type Ⅰ collagen fibers was greater than that of type Ⅲ in Groups A (98 780 ±4 190 vs 51 177 ±5 464),B(94 855 ±9 010 vs 50 815 ±3 895),and C(99 860 ±6 015 vs 50 948 ± 6 595),but the difference in area of collagen fiber of the same type was insignificant among the three Groups.Moreover,less type Ⅰ collagen fibers (79 386 ±2 237) and more type Ⅲ collagen fibers (85 278 ± 2 645) were observed in Group D compared with other three Groups (P ＜ 0.01).At 12 weeks after surgery,Hart staining showed the mean area of elastic fibers in Groups A,B,C,and D was 2 805 ± 90,2 849 ±84,3 068 ±485,and 1 961 ±96 respectively.There was no statistical difference between Groups B and C,but less amount of fibers was observed in Group A (P ＜ 0.01) and least amount was observed in Group D (P ＜0.01).At 6 weeks after surgery,the number of infiltrating macrophages in Groups A,B,C and D was 4.10 ± 0.87,3.80 ± 0.78,3.70 ± 0.94,and 6.80 ± 1.63 respectively.There was no statistical difference in the number of macrophage infiltration among Groups A,B and C,but all were lower than that in Group D (P ＜ 0.01).Conclusion Silk fibroin seeded with ADMSCs is comparable to autologous grafts for repair of tunica albuginea defect in rabbits.

Desenvolvimento do pênis durante o período fetal humano (13 a 36 semanas pós-concepção) / Penile development during the fetal period in humans (13 to 36 weeks post conception)

Objetivo: Analisar, em fetos humanos, o crescimento da área do pênis, da túnica albugínea e das estruturas eréteis (corpos cavernosos e corpo esponjoso), bem como o aparecimento e modificações das principais estruturas que compõem estes tecidos (colágeno, músculo liso e fibra elástica) durante o período fetal (13 a 36 semanas pós-concepção), fornecendo padrões normativos de crescimento. Material e Métodos: Foram utilizados 56 fetos humanos do sexo masculino com idade gestacional compreendida entre 13 e 36 semanas pós-concepção (SPC). Foram utilizadas técnicas histoquímicas, imunohistoquímicas, e análises morfométricas, e analisados os seguintes parâmetros: área total do pênis, área do corpo cavernoso, área do corpo esponjoso e a espessura da túnica albugínea na região dorsal e ventral do corpo cavernoso. No corpo cavernoso e no corpo esponjoso, as fibras musculares, o colágeno e as fibras do sistema elástico, foram identificados e quantificados por percentagem, no programa Image J (NIH, Bethesda, EUA).Resultados: Da 13ª à 36ª semana pós-concepção, a área do pênis variou de 0,95mm2 a 24,25mm2. No mesmo período a área do corpo cavernoso variou de 0,28mm2 a 9,12mm2 e a área do corpo esponjoso de 0,14mm2 a 3,99mm2. No corpo cavernoso a percentagem de fibras colágenas, fibras musculares e fibras do sistema elástico variaram, respectivamente, de 19,88% a 36,60%, de 4,39 % a 29,76 % e de 1,91% a 8,92%. No corpo esponjoso a percentagem de fibras colágenas, fibras musculares e fibras do sistema elástico variaram, respectivamente de 34,65% a 45,89%, de 0,60% a 11,90% e de 3,22% a 11,93%. A espessura da túnica albugínea variou de 0,029 a 0,296 na região dorsal e de 0,014 a 0,113 na região ventral do corpo cavernoso.Conclusão: Existe correlação fortemente positiva entre o crescimento da área total, da área do corpo cavernoso e da área do corpo esponjoso, com a idade gestacional, assim como existe correlação entre o crescimento dos elementos constituintes do tecido...

Objective: To analyze the development of penile area, tunica albuginea thickness and the main components of the erectile tissue, such as collagen, smooth muscle and elastic system fibers, in human fetuses, in order to provide normative parameters of development. Material and Methods: We studied 56 male human fetuses aged 13 to 36 weeks postconception (WPC). We used histochemical, immunohistochemical and morphometric techniques to analyze the following parameters: total penile area, area of the corpora cavernosa, area of the corpus spongiosum and thickness of tunica albuginea in the dorsal and ventral region. In the corpora cavernosa and in the corpus spongiosum, the collagen, smooth muscle fibers and elastic system fibers were identified and quantified as percentage by using the Image J software (NIH, Bethesda, USA).Results: From 13 to 36 WPC, the area of the penis varied from 0.95 mm2 to 24.25 mm2. Also, the area of the corpora cavernosa varied from 0.28 mm2 to 9.12 mm2 and the area of the corpus spongiosum from 0.14 mm2 to 3.99 mm2. In the corpora cavernosa, the amount of collagen, smooth muscle fibers and elastic system fibers varied from 19.88% to 36.60%, from 4.39 % to 29.76 % and from 1.91% to 8.92%, respectively. In the corpus spongiosum, the amount of collagen, smooth muscle fibers and elastic system fibers varied from 34.65% to 45.89%, from 0.60% to 11.90% and from 3.22% to 11.93%, respectively. The thickness of the tunica albuginea varied from 0.029 to 0.296 in the dorsal region and from 0.014 to 0.113 in the ventral region of the corpora cavernosa. Conclusion: We found strong correlation between the total area, the corpora cavernosa and the corpus spongiosum penile area, with the fetal age in WPC, as well as between collagen, smooth muscle and elastic fibers with fetal age in WPC. The growth rate was more intense during the 2nd trimester (13 to 24 WPC) of gestation when compared to the 3rd trimester (25 to 36 WPC). The thickness of the tunica...

Long-term follow-up of penile curvature correction utilizing autologous albugineal crural graft

PURPOSE: Peyronie's disease is an acquired connective tissue disorder of the penile tunica albuginea with fibrosis and inflammation. The disease produces palpable plaques, penile curvature and pain during erections. Usually it results in impairment of the quality of life. Our objective is to review the long-term results of the albugineal grafting harvested from the penile crura for the treatment of severe penile curvature. MATERIALS AND METHODS: Thirty-three patients with Peyronie's disease were submitted to a grafting with tunica albuginea from the penile crura for the correction of penile curvature. The results were evaluated after 6 months of the procedure. Variables studied were overall satisfaction with the procedure, correction of the penile curvature, erectile capacity, penile shortening and the presence of surgical complications. RESULTS: Mean follow-up after surgery was 41 months. Complete correction of the curvature was achieved in 30 patients (90%). The mean preoperative curvature was 91.8 degrees and median plaque length was 2 cm (ranged from 1 to 5 cm). Three patients (9%) experienced recurrence of the penile curvature and required a new procedure. In 30 men (90%) the procedure fulfilled their expectations and in 31 patients (93.9%) their opinions were that sexual partners were satisfied with the penile correction. Penile shortening or augmentation was referred in 6 (18.1%) and 1 (3%) patient, respectively. CONCLUSION: Our series demonstrated that grafting the albugineal defect after incision of the tunica albuginea with tunica from the crus for the correction of penile curvature is safe and results in satisfactory straight erections duringa long-term follow-up.

Actualización sobre la enfermedad de Peyronie / Update on Peyronie´s disease

La enfermedad de Peyronie es un trastorno de la túnica albugínea del pene caracterizada por la formación de placas fibrosas que conlleva a curvaturas patológicas del mismo. El presente artículo tiene como objetivo revisar los nuevos conceptos y los avances en los tratamientos, tanto quirúrgicos como no quirúrgicos, los orales o intralesionales, para manejar adecuadamente al paciente o para seguir un tratamiento que conlleve la mejoría de la sintomatología y de la calidad de vida de los hombres que padecen esta enfermedad. La enfermedad de Peyronie es un trastorno que no es tan infrecuente en la población masculina, que se acompaña de disfunción eréctil, una de las alteraciones que genera más consultas urológicas.

Peyronie’s disease, it is a disorder of the tunica albuginea of the penis, characterized by the formation of fibrotic plates that cause pathological curvatures of this organ. The present article aims to update new concepts, and advances in the both surgical and non surgical oral or intralesional treatments, in order to manage adequately the patient, or to follow a treatment that would improve their symptomatology and the quality of life. Peyronie’s disease is a disorder, not so infrequent in the masculine population which accompanies erectile dysfunction, one of the disorders that seen in urological services.

Túnicas testiculares durante la fase de reposo y actividad sexual del conejo macho (Oryctolagus cuniculus) / Morphology of testes and it´s covers during the phase of rest and sexual activity of the male rabbit (Oryctolagus cuniculus)

La domesticación del conejo (Oryctolagus cuniculus), ha permitido el paso de una reproducción de tipo anual a una de tipo no estacional, observándose pariciones durante todo el año. Sin embargo, existen parámetros reproductivos que nos indican que aún existe cierta estacionalidad, por ejemplo, la ubicación testicular, correspondiendo el conejo a un estacional de días largos. El presente estudio analiza la morfología de testículos y epidídimos, comparando la bioestructura de las cubiertas testiculares del conejo macho (Oryctolagus cuniculus), durante los meses de Enero y Septiembre. Para esto, se utilizaron seis conejos machos, tres correspondientes al mes de Enero, y tres al mes de Septiembre. Los ejemplares se encontraban clínicamente sanos y sexualmente maduros, de peso promedio 2,5 kg. Se obtuvieron los testículos junto a sus respectivos sacos escrotales, los que se procesaron mediante técnica histológica corriente y tricrómico. Se consignó el Indice espermatogénico (IE) e índice celular interticial (ICI) según Grocock & Clarke. Durante el mes de Enero, se evidenció una clara disminución de los parámetros reproductivos testiculares, con un IE =3, y un ICI=4. Por el contrario, durante el mes de Septiembre, se observó un IE=5 y ICI=5. La túnica albugínea mostró diferencias de espesor en ambos períodos. Sin embargo, se encontró un gran desarrollo de la musculatura cremastérica en ambas etapas, por lo que se concluye que ésta última no sufre atrofia durante el mes de Enero, atribuible posiblemente, a la criptorquidia facultativa que posee esta especie.

The domestication of the rabbit (Oryctolagus cuniculus) has allowed the passage of a reproduction of the annual rate to a non-seasonal type, observing calving throughout the year. However, there are reproductive parameters which indicate that there is still some seasonality, for example, testicular position, which corresponds the rabbit to seasonal long days. This study examines the morphology of testes and epididymis, comparing the biostructure of testicular coverings of male rabbit (Oryctolagus cuniculus) during the resting phase and sexual activity. For this, six male rabbits were used, three for the month of January, and three in September. The specimens were clinically healthy, sexually mature, and had an average weight of 2.5 kg. Testes were obtained with their scrotal sacs, which are processed using current histological and trichromic technique. Spermatogenic index and interstitial cell index were recorded according to Grocock & Clarke. During the month of January, it showed a clear decrease in testicular reproductive parameters, with IE = 3, and ICI = 4. By contrast, during the sexual activity it was observed IE = 5 and ICI = 5. During both periods, the albuginea tunic showed no large variations in thickness. Further, there is a great development of the cremasteric muscle in both stages, it was concluded that it does not undergo atrophy during the regression phase, possibly attributable to the voluntary cryptorchidism that this species has.

Touch Imprint Cytology of Adenomatoid Tumor of the Tunica Albuginea: A Case Report / 대한세포병리학회지

Adenomatoid tumor is a benign neoplasm of a mesothelial origin, and it usually occurs in the reproductive organs, especially in the epididymis. The author experienced a case of adenomatoid tumor involving the tunica albuginea and testicular parenchyme without any evidence of epididymis involvement. The patient was a 36-year-old man with a painless scrotal mass that he had experienced for 2 months, and this mimicked testicular neoplasia, including metastatic carcinoma, or other benign lesions. The imprint cytology of the tumor showed a hypocellular smear with mainly arranged cells in cohesive monolayered clusters along with occasional singly dispersed cells and naked nuclei in a clean background. The cellular clusters formed vague glandular and cord-like structures. The tumor cells were large polygonal to columnar cells with a relatively monomorphic appearance. The nuclei were oval to round shape and they showed vesicular, fine chromatin and inconspicuous nucleoli. The cytoplasm was moderate to abundant, and it contained fine vacuoles in some tumor cells. Mitoses and cellular pleomorphism were not present. Awareness of the cytologic finding of this lesion is necessary to screen or differentiate a testicular or paratesticular mass before and/or during surgery because the cytology may be useful as a diagnostic tool. Pathologists should be aware of the cytologic features of common lesions in this anatomic region so as to avoid performing aggressive and unnecessary surgical procedures.

Cavernous body reduction in four patients with erectile dysfunction due to insufficient venous occlusion and a deficit of elastic fibers in the tunica albugínea

INTRODUCTION: The corpora cavernosa are cylindrical vessels containing fluid under pressure. Thus, if cavernous wall resistance decreases, the radius increases and internal pressure decreases (LaPlace's law). We reasoned that if we decrease the corpus cavernosum radius, by excising a strip from each tunica albuginea, intracavernous pressure would increase during erection. MATERIALS AND METHODS: We treated with this procedure, four patients (mean age 41.5) with long-standing erectile dysfunction due to veno-occlusive dysfunction, non-responders to phosphodiesterase-5 inhibitors and intracavernous PGE1 injection. RESULTS: Two months post-surgery, intracavernous PGE1 (40 mcg) induced a satisfactory erection in two patients and a 45 percent and 58 percent tumescence in the other two. PGE1 responders also responded to 100 mg sildenafil. After 100 mg sildenafil and 20 mg tadalafil, the two non-responders had erections that enabled penetration but were short lasting. CONCLUSION: The procedure described could be more effective than cavernous revascularization operations. The results seem to confirm the mathematical assumptions.

The Effect of Decreased Serum Glucose on Collagen Contents of Penile Tunica Albuginea and Endothelial Change of Corpus Cavernosum in Long Evans Rat / 대한비뇨기과학회지

PURPOSE: It is reported that 65% of diabetic male patients over 60 of their age are impotent. However, there is no report concerning the effect of serum glucose control on erectile dysfunction in diabetic patient. This study was performed to evaluate the effects of serum glucose control on erectile dysfunction. MATERIALS AMD METHODS: The development of Diabetes mellitus was defined that the serum glucose level was above 200mg/dL in random test at 25 weeks. We designed the experimental specimen into 3 groups; group I: diabetic OLETF (Otsuka Long Evans Tokushima Fatty) rats without blood sugar control (n=10), group II: diabetic OLETF rats with blood sugar control with 4U insulin subcutaneous injection daily from 26 to 46 weeks (n=10), group III: diabetic OLETF rats with blood sugar control with 10U insulin subcutaneous injection daily from 26 to 46 weeks (n=10). We estimated the collagen content of penile tunica albuginea with the scanning electron microscopy and observed the endothelial layers of corpus cavernosum with the transmission electron microscopy in each group. RESULTS: The serum glucose level was 249 +/- 4.1mg/dL, 234 +/- 2.7mg/dL, 215 +/- 3.0mg/dL respectively in group I, II, III, and decreased in order of group II, III. The differences among groups were statistically significant (p<0.05). The thickness of collagen bundles of penile tunica albuginea was 0.98 +/- 0.1 micrometer, 0.94 +/- 0.3 micrometer, 0.92 +/- 0.1 micrometer respectively in group I, II, III, and decreased in order of group II, III. The differences among groups were statistically significant (p<0.05). The endothelial layers of corpus cavernosum were decreased in II, III. CONCLUSIONS: The serum glucose control in diabetic rats decreases the collagen con tents in penile tunica albuginea and the endothelial layers of corpus cavernosum.

A Case of Leiomyoma of Testicular Tunica Albuginea / 대한비뇨기과학회지

Leiomyoma is an uncommon lesion which may originate anywhere including the genitourinary system where smooth muscle is present. Five cases of leiomyoma of the testicular tunica albuginea were reported in the world literature. A case of leiomyoma of testicular tunica albuginea in a 58 year old male is presented. We preserved the testis with tumor resection. This is the first report of leiomyoma of testicular tunica albuginea in Korea.

A Case of Testicular Tunica Albuginea Cyst with Psammoma Body / 대한남성과학회지

We report a case of testicular tunica albuginea cyst with psammoma body which was treated with excision and testicular preservation. The presumptive diagnosis of a simple intratesticular cyst was made by ultrasound. The intraoperative pathological diagnosis was benign serous cyst and then simple excision of the lesion with testicular masses, and it may permit identification of lesions that can be excised locally with testicular preservation. To our knowledge tunica albuginea cyst with psammoma body, a characteristic histological finding, has not been reported. Its histogenesis was also discussed.

A case of tunica albuginea cyst / 대한비뇨기과학회지

Tunica albuginea cyst is a rare disease and the most of which are benign lesion unlike most testicular mass. We report a 65-year-old man was admitted with testicular pain, tenderness and palpable mass. Preoperative ultrasonography demonstrated well marginated, cystic lesion in right testis, about 2.0 x 2.8 x 3.3 cm in size with partially thin walls. Orchiectomy was done and diagnosis was made by patho-histologic findings.