Padronização do exame ultrassonográfico do prepúcio e da parte livre do pênis em bovinos / Standardization of ultrasound examination of the prepuce and free end of the bovine penis

A ultrassonografia é um exame complementar não invasivo ainda pouco utilizado na avaliação prepucial e sem descrições detalhadas da parte livre do pênis (PLP) de bovinos. Este estudo objetivou padronizar a ultrassonografia prepucial em bovinos hígidos da raça Nelore com um ano de idade e, para tanto, descreveu o aspecto da lâmina interna prepucial (LIP) e da PLP, determinando as principais janelas acústicas, a viabilidade da utilização de contraste no lúmen da cavidade prepucial (LCP) e o melhor posicionamento do animal para a realização do exame. O escaneamento foi realizado com os animais na posição quadrupedal e em decúbito lateral direito. Foram determinadas cinco janelas acústicas a partir do óstio até a identificação do recesso prepucial. Os escaneamentos foram realizados nos planos longitudinais, transversais e dorsais, antes e após a infiltração de solução fisiológica a 0,9% no LCP. Como conclusões, o exame ultrassonográfico permitiu identificar a LIP e a PLP em todos os planos e em todas as janelas acústicas propostas. O melhor ponto de referência é a identificação da glande. O posicionamento quadrupedal é mais adequado para a realização do exame e o uso de contraste é recomendado para delimitação topográfica das estruturas.(AU)

Ultrasonography is a noninvasive complementary exam that is still rarely used in the preputial evaluation and without detailed descriptions of the bovine free end of the penis. The purpose of this study was to standardize preputial ultrasonography in one-year-old healthy Nelore cattle, describing the main acoustic windows, the viability of using contrast in the preputial cavity and the best positioning of the animal for performing the ultrasound examination. The scanning was performed with the animals in standing and decubitus position. Five acoustic windows were determined from the preputial ostium to the preputial fornix, at the free end of the penis. The scans were performed in longitudinal, transverse and dorsal planes, before and after infiltration of 0.9% saline solution into the preputial cavity. As conclusions, the ultrasound examination is able to identify the internal layer and the free part of the penis in all proposed planes and acoustic windows. The best landmark is the identification of the glans. Furthermore, standing positioning is the most appropriate to perform the exam and the use of contrast is recommended for topographic delimitation of the structures.(AU)

CT-guided minimally-invasive penile fracture repair

ABSTRACT We present the case of a 28 year old patient with an incomplete tear of the tunica albuginea occurred after having sexual intercourse in the female superior position. The diagnostic assessment was performed first clinically, then with CT, owing to its high resolution, allowed to exactly detect the tear location leading to precise preoperative planning. After adequate diagnosis through imaging and proper planning, the patient was performed a selective minimally invasive surgical approach to repair the lesion. The patient had good erection with no angular deformity or plaque formation after a 3-month follow-up.

Novel noninvasive quantification of penile corpus cavernosum lesions in hyperlipidemia-induced erectile dysfunction in rabbits by two-dimensional shear-wave elastography / 亚洲男科学杂志(英文版)

Structural alterations in fibroelastic components of the penile corpus cavernousum (CC) may impair its compliance, resulting in venous leakage and erectile dysfunction (ED). Our study evaluated the effectiveness of noninvasive two-dimensional shear-wave elastography (2-D SWE) in quantifying penile CC lesions in rabbits with hyperlipidemia-induced ED. A total of 12 New Zealand white rabbits were randomly divided into two groups. Six were fed a high-cholesterol diet containing 2% cholesterol and 8.5% lard for 10 weeks and the other six were fed normal diet as controls. We measured the shear-wave elastic quantitative (SWQ) value of penile CC by 2-D SWE. Erectile function was investigated by intracavernous injection of papaverine, and immunohistochemical (IHC) staining and the western blot analysis to determine the penile CC lesions. After 10 weeks, the SWQ values obtained from penile CC were remarkably higher in the high-cholesterol-fed compared with the control group, and the ΔICP (ICP plateau minus ICP baseline)/MAP (ICP: intracavernous pressure, MAP: mean arterial pressure) was markedly decreased. The IHC staining and western blot revealed extracellular matrix (ECM) accumulation in penile cavernous tissues, and the smooth muscle cell (SMC) phenotypic transition was affected, as indicated by reduced alpha-smooth muscle actin and calponin-1 expression and increased phospho-myosin light chain20 (p-MLC20)/MLC20 and osteopontin expression. Hyperlipidemia resulted in ECM accumulation accompanied with SMC phenotypic transition in penile CC and impaired the erectile function eventually. These might, in turn, lead to variations in the SWQ values. It suggests that 2-D SWE may be a novel, noninvasive and effective approach that distinguishes penile CC lesions secondary to hyperlipidemia from normal.

Sonographic patterns of Peyronie's disease in patients with absence of palpable plaques

ABSTRACT Purpose Non-palpable isolated septal plaques of the penis are likely present in a significant number of patients affected by erectile dysfunction (ED) and penile pain without deformity or curvature. The aim of this study was to evaluate the ultrasound (US) patterns observed in patients investigated for ED or penile pain without curvature. Materials and Methods We reviewed the medical records of 386 patients who underwent an initial colour-Doppler ultrasonography (CDU) of the penis for DE and/or penile pain without curvature. After satisfying inclusion criteria, 41 patients were individualized. All patients had a non-palpable plaque with involvement of the penile septum. Three US patterns were identified: focal hyperecoic thickening of the intercavernosum septum (IS) with acoustic shadow (pattern 1), non-calcified thickening (isoechoic or slightly hyperechoic (pattern 2), and microcalcifications in the IS without associated acoustic shadow (pattern 3). Results Patients' mean age was 51.3±16.7. ED was the predominant disorder in 73.2% of patients, followed by penile pain and length loss in 19.5% and 7.3% of patients, respectively. 32(78.1%) patients showed the pattern 1, 6 (14.6%) pattern 2, and 3 (7.3%) pattern 3. Plaques size varied from 3 to 13 mm. The penile hemodynamic response to CDU reported abnormal findings distally to the septal plaques in 20 patients (<25cm/sec). Median left and right cavernosum artery flows measured a peak systolic velocity of 31cm/sec and 33 cm/sec, respectively. Conclusions We believe that an US study with CDU provides a way to characterize, localize, and deliver treatment choice in patients with Peyronie's Disease.

Clear cell adenocarcinoma of the male urethral tract.

We present a rare case of clear cell adenocarcinoma of the male bulbomembranous urethra. Mostly these tumors have been described in the female urethral tract with its possible origin from mullerian remnants, wolffian remnants or paraurethral glands. Histologically, these tumors have typically tubulocystic pattern comprising of hobnailed cells with clear glycogenated cytoplasm along with well-defined cytoplasmic membranes. This case is being presented due to its rarity, aggressive behavior and to discuss, trauma as its possible etiological factor

Deteccion de la infección por virus papiloma humano en hombres: Penescopía como método de cribado / Detection of infection by human papilloma virus in men: Peniscopy as screening method

Este trabajo es el resultado de la preocupación relativa y la escasa atención que se le presta al hombre, como portador y posible trasmisor del Virus Papiloma Humano. La población estudiada quedó conformada por 45 hombres, de 18 a 60 años de edad, que concurrieron al consultorio de Dermatología del Hospital Dr. J M Cullen de la ciudad de Santa Fe. Se confeccionó una ficha clínica protocolizada y se les realizó una penescopía. La penescopía resultó positiva en el 53,3% de la muestra tomada. Se encontró asociación estadísticamente significativa con la falta de uso del preservativo regularmente (p=0,01) y con la promiscuidad (p=0,008). No se vislumbró asociación estadísticamente significativa entre el resultado de la penescopía con otras patologías y antecedentes personales relacionados. Las lesiones encontradas fueron: máculas (p=0,037), pápulas (p=0,000) y vegetaciones (p=0,245). Los resultados señalan que es recomendable realizar penescopía como instrumento diagnóstico, especialmente por ser económica y simple de efectuar. Además se concluyó que el uso de preservativo de manera regular así como evitar la promiscuidad, son esenciales para la prevención de infecciones con VPH.

Introduction: in most of the cases, the Human Papilloma Virus (HPV) infection is transmitted through sexual contact. The competent immune system limits its spread, making it latent or subclinical, and its clinical symptoms rarely result in high mortality. It's difficult to estimate precisely its incidence in males due to the lack of epidemiological studies. In this work, the peniscopy was selected as the screening method of the subclinical disease due to its high sensitivity and low cost. General objective: to detect male carriers of the Human Papilloma Virus (HPV), possible transmitters of the virus. Material and methods: the population studied consisted of 45 men, between 18 and 60 years old, who assisted to the Dermatology Department of the Hospital J M Cullen in the city of Santa Fe due to different conditions, between the months of July and December, 2007. A clinical record was made and a peniscopy was performed as screening method. A non experimental, prospective, descriptive and cross-section design was employed. The Statistical Package for the Social Science (SPSS) 11.5® program was used. In the descriptive analysis, the statistical association was determined by means of the chi-square test and contingency tables. A statistically significant association was considered when p<0.05 was found. Results: the peniscopy was positive in 53.3% of the sample taken. A statistically significant association was found due to the lack of regularity in the use of condom (p=0.01) and to promiscuity (p=0.008). The lesions found were maculae (p=0.037), papules (p=0.000) and vegetations (p=0.245). Conclusion: the results show that it's advisable to perform a peniscopy as a diagnostic measure, specially because it is inexpensive and simple to perform. The regular use of condom, as well as the avoidance of promiscuity, is essential to prevent HPV infections.

Analysis of Doppler ultrasonography in penile artery / 法医学杂志

OBJECTIVE@#To study nomal valuels of PI, RI and S/D in healthy male penile dorsum artery (DA) and cavernosal artery (CA).@*METHODS@#257 healthy mature men were divided into 5 groups by age. Group 1: <30, n=65; Group 2: 30-39, n=83; Group 3: 40-49, n=61; Group 4: 50-59, n=38; Group 5: > or = 60, n=10. Hibateral PI, RI and S/D values of penile dorsum artery and cavernosal artery were examined by Logidop(r)2 Type Digital Doppler Ultrasonography.@*RESULTS@#There were no significant difference for PI, RI and S/D of penile dorsum artery and cavernosal artery not only in personal left and right artery but also in different age groups. Normal values advised: (1)LDA:PI 1.43-3.43, RI 0.72-0.92, S/D 2.68-10.56. (2)RDA PI 1.47-3.47, RI 0.73-0.93, S/D 3.27-10.09. (3)LCA:PI 1.49-3.21, RI 0.74-0.90, S/D 3.17-9.55. (4)RCA:PI 1.93-3.27, RI 0.72-0.90, S/D 3.22-9.42.@*CONCLUSION@#Doppler ultrasonography is a favorable method in filtering penile arterial function.

Relation between coronary insufficiency and penile arterial circulation

Erectile dysfunction [ED] is a common condition and studies predict that it will become even more common in the future. There is increasing evidence to suggest that it is predominantly a vascular disease and may even be a marker for occult cardiovascular disease. The aim of this study was to detect the prevalence of penile artery affection in patients with proven ischemic heart disease. The present study included 44 patients diagnosed to have IHD, recruited from the Cardiology department. The ages ranged form 33 - 64 years with a mean of 51.45 +/- 7.7. All patients were subjected to complete history taking and clinical evaluation, standard 12-leads ECG, echocardiography, stress ECG with or without imaging and coronary angiography. Dynamic penile duplex examination for the cavernous arteries was performed. Rigiscan was done in three sessions to confirm the diagnosis of organic erectile dysfunction. Penile duplex study showed that 26 [59.1%] patients had arteriogenic erectile dysfunction and 18 [40.9%] had non arteriogenic erectile dysfunction of which 5 were normal and 13 had venogenic erectile dysfunction .i.e 39 patients [88.6%] had vasculogenic erectile dysfunction. An association was found between the functional classes of chest pain and different groups studied [p value < 0.05]. Also there was a highly statistical significant difference between the mean level of PSV in single and multi vessel coronary artery disease [CAD] [p value < 0.01], but there was no association between the number of vessels affected and different groups studied [p value > 0.05]. Our recommendation that we should perform the sexual consultation for every IHD patient due to high incidence of vasculogenic ED

role of combination therapy in the treatment of impotent patients with inadequate response to sildenafil and intracorporal injection monotherapy

We studied the efficacy of combination therapy in impotent patients with inadequate response to sildenafil and intracorporal injection monotherapy. Patients and Methods: Enrolled in this study were 23 impotent patients 28-55 years old [mean 46.7] with inadequate response to both sildenafil and intracorporal injection monotherapy. All patients underwent detailed history and physical examination, FBS determination, penile duplex doppler ultrasound and pharmaco-cavernosometry. A trial of combination therapy using oral sildenafil [50-100 mg] and intracorporal injection of trimixture [28 mg/ml papaverine, 0.58 mg/ml phentolamine and 10 micro ug alprostadil]. The response was evaluated and side effects recorded. The etiology of erectile dysfunction in the studied group was venogenic in 56.52%, arteriogenic in 21.73% and combined anteriogenic and venogenic in 21.73%. Seven out of these 23 patients [30.43%] responded to combination therapy either by complete erection in 4 patients or by moderate rigidity enough for intromission in 3. Non responders showed a higher FME and EDV than those responding to combined therapy. These differences in FME and EDV were statistically highly significant between both groups. All patients not responding to both oral sildenafil and intracorporal injection monotherapy had vasculogenic etiology for impotence. Combination treatment may potentially salvage one third of cases refractory to single modality treatment

Role of cavernosometry and cavernosography in the diagnosis of vasogenic impotence

This study included eighty-six men with ages ranging between twenty- three and sixty-seven years. They were divided into two groups, eight healthy volunteers and seventy-eight patients with clinical suspicious of vasogenic impotence. The work aimed to study the role of cavernosometry and cavernosography after intracorporeal injection of papaverine in the diagnosis of vasogenic impotence