Glans Penis Augmentation Using Hyaluronic Acid Gel as an Injectable Filler

Glans penis augmentation (GPA) has received little attention from experts despite the existence of a subset of patients who may be dissatisfied with a small glans or poor tumescence of the glans during erection. Recently, GPA using an injectable filler or implantation of a graft or filler has been developed. Despite a demanding injection technique and inevitable uneven undulation of the glandular surface, GPA using injectable hyaluronic acid (HA) gel is a novel and useful therapy and an effective and safe procedure for soft tissue enhancement. For long-term presence of implants, timed supplementation can be used similar to that for fascial plasty. In complications such as mucosal necrosis of the glans penis, most cases occur from the use of non-HA gel or an unpurified form and misunderstanding of the management protocol for immediate side effects. Currently, GPA using injectable HA gel is not recommended in the International Society for Sexual Medicine guideline due to possible sensory loss. In a 5-year long-term follow-up of GPA by subcutaneous injection of HA gel, the residual volume of implants decreased by 15% of the maximal glandular circumference, but was still effective for alleviating the hypersensitivity of the glans penis in premature ejaculation patients. For efficacy in premature ejaculation, selection of appropriate candidates is the most important factor for success. GPA does not harm erectile function and is less invasive and irreversible compared to dorsal neurectomy. To refine the procedure, more interest and well-designed studies are required for the establishment of the procedure.

Effects of Glans Penis Augmentation Using Hyaluronic Acid Gel for Premature Ejaculation / 대한남성과학회지

PURPOSE: We evaluated the effect of injectable hyaluronic acid gel(HA) for augmentation of the glans penis and treatment of premature ejaculation. MATERIALS AND METHODS: In 139 patients with premature ejaculation, dorsal neurectomy(Group I; n=25) and glandular augmentation using HA(Group II; n=114) were done. Six months after each procedure, ejaculatory latency, penile vibratory threshold, and patient and partner satisfaction were assessed in both groups. RESULTS: There was no significant difference in preoperative ejaculation time in the two groups, being 89.2+/-40.3 sec in Group I and 96.5+/-52.3 sec in Group II. Postoperatively, ejaculatory latency was significantly increased, to 235.6+/-58.6 sec in Group I and 324.2+/-107.6 sec in Group II(p<0.01). The postoperative vibratory threshold was also significantly increased in both groups(p<0.01). Satisfaction was expressed by both the patient and his partner in 68%(17/25) and 44%(11/25), respectively, in Group I and 79.8%(91/114) and 64.0% (73/114) in Group II. The maximal glandular girth was significantly increased, from 9.2+/-0.6 cm to 11.0+/-0.4 cm, in Group II. CONCLUSIONS: Glandular augmentation with injectable HA gel appears to be very effective for the treatment of premature ejaculation. Glandular augmentation with a bulking agent is anticipated to replace the hazardous, irreversible dorsal neurectomy.

Effects of Injectable Hyaluronic Acid Gel in Augmentation of Glans Penis / 대한남성과학회지

PURPOSE: Soft-tissue augmentation using hyaluronic acid (HA) gels is widely used in dermatology and plastic surgery. We performed this study to determine the feasibility of using HA gel to augment the glans penis. MATERIALS AND METHODS: In experiment I, 0.2 cc of HA gel was injected into the dermis of the glans penis of 25 New Zealand White rabbits via a 27-gauge needle. At 3, 7, 14, 30, and 90 days after injection, the histologic changes in the penis and systemic adverse effects were evaluated. In experiment II, 0.5 cc of HA gel was injected into the dermis of the glans penis of 14 Beagle dogs. Two weeks later, an additional 0.2 cc was injected in 7 of the dogs. For 6 months, the changes in the injected area were grossly evaluated using a 10-point visual scale, and at the end of the study, histologic changes were also evaluated. At autopsy, lung, liver, and spleen were studied for systemic adverse reactions. RESULTS: In the dogs receiving double injections, 85% to 90% of the initial volume was maintained at 6 months, with HA being identified in the lamina propria of the glans penis. Encapsulated material was confirmed to be HA by alcian blue stain and hyaluronidase immunohistochemical stain. No systemic adverse reaction was noticed in any animal. CONCLUSIONS: Hyaluronic acid gel is safe and effective for augmentation of the glans penis. Booster injection enhances the injected volume and facilitates injection of HA.

Altered Contractility of the in vivo Feline Trabecular Smooth Muscle under Acidosis / 대한비뇨기과학회지

PURPOSE: Previous studies concerning the ischemic priapism revealed that hypoxia alter the erectile and contractile responses of penis. But the effects of accompaning acidosis on the trabecular smooth muscle contractility have not been fully evaluated or understood yet. We performed this study to elucidate the role of acidosis on the trabecular smooth muscle contractility like in ischemic priapism. MATERIALS AND METHODS: Under the general anesthesia, 55 mature male cats were conditioned to systemic metabolic acidosis by hypoventilation with animal ventilator. The changes of intracavernous pressure to erectics(acetylcholine, L-arginine, PGE1), erectolytics(epinephrine, TXA2), K+-channel-related drugs (pinacidil, 4-aminopyridine, TEA, glibenclamide) and calcium ionophore were monitored at Set 1 (PO2>60mmHg, pH>7.25), Set 2(PO2 pH>7.0), Set 3(PO260mmHg, pH<7.0) in vivo. RESULTS: At Set 1 and Set 2, the acetylcholine or PGE1-induced relaxations were suppressed by epinephrine, TXA2 or ionomycin(n=9, p<0.01). The contractility was in order of epinephrine, TXA2 and ionomycin. Cavernous relaxations to acetylcholine or PGE1 were reduced by acidosis(n=8, p<0.01). TXA2 or ionomycin did not produced contraction even with higher concentration but epinephrine maintained contractility with higher concentration at acidosis (n=7, p<0.05). Acidosis-induced relaxation was not prevented by 4-aminopyridine, TEA, or glibenclamide(n=6, p<0.05). Pinacidil did not induced relaxation at acidosis(n=6, p<0.01). CONCLUSIONS: Acidosis impairs the contractile response of cavernous smooth muscle to submaximal stimulation with erectolytics. It may be the results of the interference by(H+) with the intra and extracellular mechanisms that regulate the homeostasis of(Ca2+). Conclusively, acidosis is another limiting factor of trabecular smooth muscle contractility like in ischemic priapism.

Pathologic Prognostic Indicators in Recurrence and Progression of Superficial Bladder Tumor / 대한비뇨기과학회지

PURPOSE: The identification of factors present at the time of initial evaluation may be important to predict the prognosis in patients with superficial bladder carcinoma. Attempts were made to identify predictive factors of recurrence and progression. MATERIALS AND METHODS: This study included twenty seven patients with superficial bladder tumor(pTa-pTl) who had no recurrence within 5 years. A comparative non-randomized study was performed of a control group of twenty six patients with same superficial bladder tumor who had recurrence within 1 year after transurethral resection of bladder tumor(TURBT) was done. Between the former and the latter patients cumulative and multivariate analyses were performed to estabilish predictive factors of pathological recurrence and progression. The resected tumors were immunohistochemically stained with anti-lamin rabbit serum to evaluate the presence or absence of basement membrane breakage, the vascular and/or lymphatic invasion, and to count number of neovascularizasion. RESULTS: In superficial bladder carcinoma, invasion of basement membrane, grade, invasion of lymphatics and vessels, and neoangiogenesis were significant factors affecting recurrence and progression, and these factors acted independently. CONCLUSIONS: These factors used to predict recurrence and progression of superficial bladder tumor were thought to be the important risk factors. These results suggested that close follow-up and aggressive treatment such as BCG instillation should be considered for the treatment of superficial bladder cancer with unfavourable prognostic factors.

Inhibitory Effects of BUP-4 on the Bladder Instability in Rats Induced by Infravesical Outflow Obstruction

No abstract available.

A Case of Inverted Papilloma of Ureter / 대한비뇨기과학회지

Inverted papilloma of the urinary tract is a unique and rare tumor. Although it is generally considered a benign lesion, the tumor has the possibility of malignant change. The most commonly associated clinical symptoms are hematuria and obstruction of urinary tract. We report a case of ureteral inverted papilloma which was proved histologically with the review of literature.

A Case of Inverted Papilloma of Ureter / 대한비뇨기과학회지

Inverted papilloma of the urinary tract is a unique and rare tumor. Although it is generally considered a benign lesion, the tumor has the possibility of malignant change. The most commonly associated clinical symptoms are hematuria and obstruction of urinary tract. We report a case of ureteral inverted papilloma which was proved histologically with the review of literature.