A. Muneer

Analysis of the outcome of intracytoplasmic sperm injection using fresh or frozen sperm

Study Type – Diagnostic (retrospective cohort)u2028 Level of Evidenceu20032b

Management of non-visualization following dynamic sentinel lymph node biopsy for squamous cell carcinoma of the penis.

To review the management and clinical outcomes of uni‐ or bilateral non‐visualization of inguinal lymph nodes during dynamic sentinel lymph node biopsy (DSNB) in patients diagnosed with penile cancer and clinically impalpable inguinal lymph nodes (cN0), and to develop an algorithm for the management of patients in which non‐visualization occurs.

Zentralisierung der Harnröhre und Pseudoglansbildung nach partieller Penektomie

ZusammenfassungDie operative Therapie des Peniskarzinoms hat sich im letzten Jahrzehnt stark verändert. Die Gewissheit, maligne Läsionen mit einem schmaleren Sicherheitsabstand sicher im Gesunden resezieren zu können, hat zur Einführung organerhaltender Operationstechniken geführt und damit die funktionellen und kosmetischen Ergebnisse optimiert. Im Falle einer partiellen Penektomie (PP) beklagen die Patienten postoperativ jedoch die abnormale ventrale Lage der Harnröhre. Zudem besteht ein hohes Risiko für die Entstehung einer Meatusstenose. Wir beschreiben unsere Operationstechnik zur Zentralisierung der Harnröhre und Pseudoglansbildung nach partieller Penektomie, die das kosmetische Aussehen des Penis nach Spalthautdeckung aufrecht erhält und einen weiten Meatus schafft. Die beschriebene UCAPP-Technik („urethral centralisation after partial penectomy“) ermöglicht im Falle einer partiellen Penektomie die Wiederherstellung der normalen Harnröhren-Mündung und verbessert durch Pseudoglansbildung das gesamte kosmetische Erscheinungsbild und reduziert somit die psychische Morbidität Betroffener.AbstractThe management of penile cancer has altered dramatically over the last decade. Confidence to excise lesions safely with smaller margins has led to the adoption of penile-preserving techniques and in turn improved the functional and cosmetic results. Patients undergoing partial penectomy (PP) find that the urethral meatus is located in an abnormal ventral position. In addition, there is axa0high risk of meatal stenosis. We describe our novel technique that allows the urethral meatus to be centralised after PP and creation of axa0pseudo-glans and wide meatus and therefore maintain the cosmetic appearance of the penis after split thickness skin grafting. The UCAPP technique allows the restoration of the normal meatal location and creation of axa0pseudo-glans in case of partial penectomy and therefore can improve the overall cosmetic appearance and reduce the psychological morbidity.The management of penile cancer has altered dramatically over the last decade. Confidence to excise lesions safely with smaller margins has led to the adoption of penile-preserving techniques and in turn improved the functional and cosmetic results. Patients undergoing partial penectomy (PP) find that the urethral meatus is located in an abnormal ventral position. In addition, there is axa0high risk of meatal stenosis. We describe our novel technique that allows the urethral meatus to be centralised after PP and creation of axa0pseudo-glans and wide meatus and therefore maintain the cosmetic appearance of the penis after split thickness skin grafting. The UCAPP technique allows the restoration of the normal meatal location and creation of axa0pseudo-glans in case of partial penectomy and therefore can improve the overall cosmetic appearance and reduce the psychological morbidity.

BAUS Consensus Document for the Management of Male Genital Emergencies - Penile Amputation

Male genital emergencies relating to the penis and scrotum are rare and require prompt investigation and surgical intervention. Clinicians are often unfamiliar with the management of these conditions and may not work in a specialist centre with on‐site expertise in genitourethral surgery. A series of consensus statements have been developed by an expert consensus committee comprising members of the British Association of Urological Surgeons (BAUS) Section of Andrology and Genitourethral Surgery together with experts from urology units throughout the UK. Penile amputation is a rare genital emergency, which requires prompt intervention and microsurgical reconstruction. The consensus statements will outline the management of these cases for non‐specialist units, as well as recommendations for reconstruction for specialists.

Partial segmental thrombosis of the corpus cavernosum presenting with perineal pain

We describe the case of a man aged 43u2005years who presented with a 2-week history of a palpable lump in the right proximal penile shaft. This was preceded by a 6-month history of perineal pain, accompanied by erectile dysfunction. An urgent MRI scan of his penis identified a thrombus within the right crus and corpus of the penis. His thrombophilia screen was normal. The patient was started on oral anticoagulation and a phosphodiesterase inhibitor (PDE-5i) to prevent thrombus progression and maintain erectile function. At 5u2005months, the patients symptoms had resolved and an MRI showed a reduction in the thrombus size. MRI is a useful imaging modality to diagnose a thrombus within the corpus cavernosum in patients presenting with a history of penile and perineal pain together with a palpable lump. The non-enhancement of the lesion helps to differentiate this from alternative rare lesions within the penis and perineum.

Necrotizing granulomatous inflammation of the glans penis

We describe the case of a 73-year-old man who presented with a 10-month history of an ulcerating lesion on the glans penis. Initially this was thought to be an invasive squamous cell carcinoma but a biopsy showed histological features consistent with necrotizing granulomatous inflammation. Extensive serological, immunological and microbiological tests only showed a positive antinuclear and perinuclear antineutrophil cytoplasmic antibodies indicating a possible autoimmune aetiology but an underlying systemic cause was not identified. Treatment with oral corticosteroids limited the inflammatory process but due to the gross destruction of the glans penis, he still required a glansectomy and split-skin graft reconstruction from which he recovered well. Although this patient ultimately required surgery for this rare presentation, this case highlights the differential diagnosis of penile ulceration (that transcends neoplasia) and the importance of performing and interpreting penile biopsies before undertaking potentially mutilating definitive surgery.