ABSTRACT
BACKGROUND: Penile injection of foreign materials is an obsolete practice often performed by non-medical personnel in order to enlarge penile size. METHODS: A systematic review of the literature from 1956 to 2022 was conducted in accordance with the general guidelines recommended by the Primary Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We included full papers published from 1956 to 2022. We also described a case report of a 23 year old Bulgarian male affected by penile paraffinoma who underwent a 2-stages surgical technique. RESULTS: A total of 152 cases have been reported, with a median age of 37.9 ranging from 18 to 64 years. Six different techniques have been described in the whole literature: bilateral scrotal flap, simple excision of the paraffinoma with primary closure, two-stage scrotum skin flap, medial prepuce-soprapubic advancement flap technique and penile reconstruction using split thickness skin graft (STSG) or full thickness skin graft (FTSG). An analysis of the distribution among early and late complications was then carried out. CONCLUSION: In our experience, among the variety of surgical techniques described, a two-stage penile reconstruction using scrotal skin results in excellent cosmetic and functional outcomes, with a low rate of complications.
ABSTRACT
OBJECTIVE: To evaluate the impact on erectile and ejaculatory function following transrectal ultrasound-guided biopsies of the prostate (TRUS-Bx) in sexually active men. METHODS: Monocentric prospective study from May 2021 to January 2022 of consecutive patients with suspected prostate cancer [elevated prostate specific antigen (PSA) level and/or abnormal digital rectal examination] undergoing TRUS-Bx. The 15-item version of the International Index of Erectile Function (IIEF-15), Premature Ejaculation Diagnostic Tool (PDET) and short form of Male Sexual Health Questionnaire (MSHQ-EjD Short Form) were assessed before, one and three months after TRUS-Bx. The primary endpoint was to evaluate the risk of temporary post-biopsy erectile and/or ejaculatory dysfunctions. The statistical significance was set as p value < 0.05. RESULTS: A total of 276 consecutive patients were included in the study. The median age, PSA and biopsy cores were 65 years (IQR 59-69), 7 ng/ml (IQR 5-9.7) and 16 (IQR 12-16), respectively. We compared the IIEF subdomains before TRUS-Bx vs. one or three months: the erectile function (EF) decreased after one month (p<0.001) but recovered after three months (p=0.833); the Orgasmic Function (OF), the Sexual Desire (SD), the Intercourse Satisfaction (IS), the Overall Satisfaction (OS), and Total IIEF decreased significantly after both one and three months compared to pre-biopsy values (p < 0.05). As for ejaculatory function (EjF), PDET, MSHQ-EjD Short Form 1, 2, 3 and MSHQ-EjD Short Form 4 scores decreased significantly after one month (p < 0.001), but they returned to pre-biopsy values after 3 months: p = 0.538, p = 0.071 and p = 0.098, respectively. CONCLUSIONS: Our study proved that EF, assessed through IIEF- 15, and ejaculatory function, assessed through PDET and MSHQ-EjD Short Form, were negatively affected by TRUS-Bx one month after the procedure and recovered after three months. Interestingly, the other IIEF-15 subdomains (OF, SD, IS, OS and Total) resulted as significantly reduced also after 3 months: this issue highlights the importance of carefully considering the indication to TRUS-Bx.
