Surgical Treatment of Peyronie's Disease: Systematic Review of Techniques Involving or Not Tunica Albuginea Incision.

INTRODUCTION: Peyronie's disease is characterized by abnormal healing of the tunica albuginea (TA), resulting in the production of a fibrotic plaque that leads to penile curvature and considerable psychological impact. Precise knowledge of various surgical techniques is of fundamental importance for proper management of the patient. AIM: To compare results (including surgical success on quality of life and sexual satisfaction and complications) between 2 different techniques: with TA incision vs without TA incision. METHODS: The search was performed according to PRISMA in PubMed and Embase through September 2018. Key words searched were ["Peyronie" or "Peyronie's disease" or "penile curvature" or "penile induration"] and ["technique" or "surgery" or "surgical"] and ["quality of life" or "sexual quality of life" or "sexual satisfaction" or "outcome" or "outcomes"]. MAIN OUTCOME MEASURE: Thirty-one articles were considered for this review. The main outcomes were reported descriptively. RESULTS: The most significant results included penile straightening (88.5% vs 70.9% favoring not opening TA), perception of a palpable nodule (13.2% vs 27.4% favoring not opening TA), and loss of sensibility (11% vs 20% favoring not opening TA). Neither a prospective randomized study nor a direct comparison study has been performed for these techniques. There is no consensus among the studies on how to measure results. Subjective criteria were primarily used for evaluation, and there is a paucity of objective tools to quantify the outcomes. CONCLUSION: There is no consensus on which technique achieves better results or fewer complications; therefore, the decision on which technique to use is a matter of surgeon preference. Studies comparing distinctive techniques and either opening or not opening the tunica albuginea should be performed to support surgical decision making. In addition, guidelines that could assist in the standardization of criteria should be investigated in future studies, with the aim of better evaluating outcomes. Barbosa, ARG, Takemura LS, Cha JD, et al. Surgical Treatment of Peyronie's Disease: Systematic Review of Techniques Involving or Not Tunica Albuginea Incision. Sex Med Rev 2020;8:324-332.

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.(AU)

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.(AU)

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.

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

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.(AU)

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.(AU)

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.

Sonographic spectrum of tunica albuginea cyst.

Tunica albuginea (TA) cyst is the most common extratesticular benign mass, which is usually palpable. Ultrasound examination is the imaging modality of choice to characterize palpable testicular lesions. This pictorial essay presents the spectrum of sonographic features of TA cysts in order to assist radiologists in making the correct diagnosis and avoid unnecessary surgeries.

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.

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.