Diagnostic utility of penile ultrasound in Peyronie's disease.

PURPOSE: To review the literature regarding the use of penile ultrasound in the evaluation and management of Peyronie's disease. METHODS: A literature review was performed using PubMed from 1980 to 2018 using the keywords: Peyronie's disease, ultrasound, sonography, calcification, penile fracture, and penile hematoma. Articles were reviewed for study size, image protocols, and findings. In addition, we reviewed images from 227 penile ultrasounds performed on Peyronie's disease patients at the Walter Reed National Military Medical Center between 2014 and 2018. RESULTS: Through extensive urological and radiographic literature review over the last four decades, common patterns and characteristic of Peyronie's plaques were identified. These characteristics are not always delineated by physical examination alone. The ultrasound images often added objective information including etiology of erectile dysfunction and location or plaques, and presence of calcifications which aid in patient counseling and treatment protocols. CONCLUSIONS: The use of B-mode ultrasound with color Doppler in the evaluation and management of Peyronie's disease is a quick, cost-effective process that provides objective information that can assist the urologist in the treatment of patients with Peyronie's disease.

Seminal vesicle sperm aspiration from wounded warriors.

OBJECTIVE: To assess whether seminal vesicle sperm aspiration (SVSA) is an option for wounded warriors with severe genital and testicular injuries, with the goal of cryopreservation to use in future assisted reproductive technology (ART) cycles. DESIGN: Retrospective case series. SETTING: Tertiary care military hospital. PATIENT(S): Six wounded warriors. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Seminal vesicle fluid analysis after harvest, after thaw analysis, fertilization rates, pregnancy rates (PRs), live birth. RESULT(S): Six patients with lower extremity, pelvic, and genital injuries from dismounted improvised explosive devices underwent SVSA within 5-12 days of the initial injury. Sperm retrieved were analyzed (volume, 0.4-1.8 mL; concentration, 40-2,200 K; motility, 0-5%), washed, and cryopreserved. Two patients underwent IVF/intracytoplasmic sperm injection (ICSI) cycles using their samples. In one couple, fertilization rate was 38%. One grade V embryo was transferred with a negative pregnancy test. The second couple underwent two cycles. In their first cycle, fertilization rate was 44%, with one blastocyst transferred and a negative pregnancy test. In the second cycle, fertilization rate was 47%. Two blastocysts were cryopreserved due to ovarian hyperstimulation syndrome (OHSS) concerns. One blastocyst was later transferred in a frozen cycle resulting in a live birth. CONCLUSION(S): The SVSA is a reasonable option to retrieve sperm in wounded warriors or trauma patients with extensive genital injuries.

Vardenafil: efficacy, tolerability and future directions.

Vardenafil is a short-acting PDE5 inhibitor used in the treatment of male erectile dysfunction. It is the most potent and specific of the three commercially available PDE5 inhbitors, which may decrease incidence of side effects, although this has not been demonstrated clinically. Although its efficacy in the treatment of erectile dysfunction has been demonstrated in several studies, recent and continuing studies have shown vardenafil's promise as an effective agent in penile rehabilitation, decreasing lower urinary tract symptoms resulting from benign prostatic hyperplasia and management of pulmonary hypertension.

Isolated septal fibrosis or hematoma--atypical Peyronie's disease?

PURPOSE: Classically Peyronie's disease presents with penile curvature and/or pain, and is associated with a palpable penile plaque. We frequently examine patients with suspected Peyronie's disease ultrasonographically and have noted a subset of patients in whom we could identify only a circumscribed septal lesion. We identified characteristics of these patients. MATERIALS AND METHODS: Of our series of approximately 650 patients with Peyronie's disease 47 were identified with these lesions. RESULTS: Of the 47 patients 22 presented with penile curvature with or without accompanying or preceding pain. Of the 47 patients 17 had a significant history of trauma, although only had the classic stigmata of penile fracture. A total of 16 patients had no history of curvature, 7 presented with only penile shortening or focal lack of rigidity and 5 were incidentally found to have lesions during assessment for other complaints. Three patients presenting after trauma were noted to have septal liquefied hematomas, which we aspirated under ultrasound guidance. Followup ultrasound revealed minimal septal thickening. In 1 of these patients the hematoma was adjacent to more typical-appearing septal fibrosis. CONCLUSIONS: We theorize that these hematomas are due to septal fractures and may represent a forme fruste or possibly a precursor lesion of more typical septal fibrosis. Ultrasonographic evaluation may allow earlier identification and treatment of occult septal injuries or lesions and prevent subsequent fibrosis and its associated symptoms.

The design and implementation of a multidisciplinary prostate cancer clinic.

The authors describe how a "traditional" clinical center and research organization was transformed into a multidisciplinary clinic for patients with prostate cancer. How and why the clinic was designed and implemented, as well as benefits to patients, staff, and research initiatives, are detailed.

Treatment of Peyronie's disease with oral pentoxifylline.

BACKGROUND: A 51-year-old male presented with a penile deformity without obvious etiology. Physical examination revealed hard plaques in the dorsal and ventral penis. INVESTIGATIONS: Physical examination, penile ultrasound. DIAGNOSIS: Peyronie's disease. MANAGEMENT: Oral pentoxifylline.

Physiology of penile erection and pathophysiology of erectile dysfunction.

This article reviews the physiology of penile erection, the components of erectile function, and the pathophysiology of erectile dysfunction. The molecular and clinical under-standing of erectile function continues to gain ground at a particularly fast rate. Advances in gene discovery have aided greatly in working knowledge of smooth muscle relaxation/contraction pathways. The understanding of the nitric oxide pathway has aided not only in the molecular understanding of the tumescence but also greatly in the therapy of erectile dysfunction.

Crural ligation for primary erectile dysfunction: a case series.

PURPOSE: Some men with primary erectile dysfunction (ED) have maldevelopment of the crura of the penis. We report our experience with crural ligation for primary venous leakage ED in the last 5 years. MATERIALS AND METHODS: Between December 1998 and March 2004, 11 patients with primary ED underwent crural ligation surgery for congenital venous leakage. All patients were evaluated with pertinent history and physical examinations, color duplex ultrasound, nocturnal penile tumescence study with RigiScan, cavernosometry and cavernosography. Localized crural leakage was the pathognomonic feature in these patients. Surgery involved reflection of the dorsal and cavernous arteries and nerves off of the crura, followed by ligation of the 2 crura proximal to the entrance of the cavernous artery with umbilical tapes. Followup was performed by telephone interview or personal interview at the clinic. A retrospective preoperative and postoperative questionnaire, that is the abridged 5-item version of the 15-item International Index of Erectile Function, was given at the time of the interview. Statistical analysis was performed with the paired t test. RESULTS: Median patient age at surgery was 28 years (range 22 to 39) and mean followup after surgery was 34 months (range 6 to 58). Mean International Index of Erectile Function +/- SD preoperatively and postoperatively was 8.9 +/- 4.5 and 17.5 +/- 5.0, respectively. For questions 2, 3 and 5 mean postoperative scores were significantly better than postoperative scores (p <0.05). Marked improvement in erectile function was noted in 9 of our 11 patients. CONCLUSIONS: Penile venous surgery may not have a lasting result in men in whom venous leakage is due to systemic diseases or penile smooth muscle atrophy. However, in patients with a congenital venous leak abnormality of the crura ligation of the proximal crura with umbilical tapes seems to have a satisfactory, durable result.

Neuroregenerative strategies after radical prostatectomy.

Patients with erectile dysfunction (ED) following radical prostatectomy (RP) continue to present to practicing urologists. Although nerve-sparing RP has decreased the rates of ED significantly, new therapies for cavernosal nerve protection and recovery are now being developed. This report discusses the many agents available in neuroregeneration and neuroprotection to aid in the recovery of erectile function. Multiple agents and strategies have been used for neuroprotection and neuroregeneration of the cavernosal nerve following RP and in nerve injury models. Many of these agents display promise for the treatment of impotence. Early treatment for patients recovering from RP is becoming the standard of care. Natural recovery of erections may take as long as 18 to 24 months post RP; however, treatment plans may reduce the time to erectile recovery.

Leiomyosarcoma of the urinary bladder in a teenage male.

Malignant neoplasms of the bladder are typically transitional cell carcinoma with squamous cell carcinoma and adenocarcinoma comprising nearly all of the remaining cases. Leiomyosarcoma is a rarely seen neoplasm of the bladder with a generally poor prognosis. It is important to distinguish leiomyosarcomas from rhabdomyosarcoma with the aid of immunohistochemical markers. A therapeutic dilemma exists with regard to the need for urethrectomy. We present the third reported case of leiomyosarcoma of the bladder in a teenage male patient.

Peyronie's disease: advancements in recent surgical techniques.

PURPOSE OF REVIEW: The aim of this review is to discuss the recent advances in surgical techniques for the correction of Peyronie's disease. A review of the literature published in 2002 and 2003 regarding surgical treatment was performed in preparation for this article. RECENT FINDINGS: The surgical treatment of Peyronie's disease remains a debated topic. Generally, surgical therapy for Peyronie's disease can be divided into three main categories: wedge resection/plication surgeries; plaque excision/incision with grafting procedures; and the placement of a penile prosthesis. New reports have investigated suture selection, graft acceptability, and new surgical approaches. These new surgical enhancements will give urologists a greater choice in the surgical management of Peyronie's disease. This will aid the ability of the urologist to tailor the therapy necessary for each individual patient. SUMMARY: The correction of acquired penile deformity seen in Peyronie's disease patients can be a challenge for the practising urologist. Newer advancements in surgical techniques and materials will allow the urologist greater treatment options. The degree of curvature, the type of deformity, erectile dysfunction, and penile length are all characteristics that are assessed in choosing the best surgical intervention in Peyronie's disease. Surgical therapy can be quite beneficial for patients who suffer from penile deformity and can greatly improve their quality of life.

Erectile dysfunction and priapism.

BACKGROUND: A 46-year-old man presented with erectile dysfunction following a blunt perineal injury sustained 1 year previously. Oral phosphodiesterase type 5 inhibitors failed to improve his erections. The remainder of the patient's history, physical examination and laboratory tests were unremarkable except for a moderate tenderness in the left perineum and some 'fullness' in the corpora cavernosa during physical examination. INVESTIGATION: Physical examination, color duplex ultrasound of the penis and perineal area and Sexual Health Index for Men questionnaire. DIAGNOSIS: Non-ischemic priapism due to a ruptured left helicine artery, intermittent penile turgidity and erectile dysfunction. MANAGEMENT: Open suture ligation of the helicine artery and imbrication of the pseudocapsule.