C. Van der Horst

Priapism: etiology, pathophysiology and management

The understanding of erectile physiology has improved the prompt diagnosis and treatment of priapism. Priapism is defined as prolonged and persistent erection of the penis without sexual stimulation and failure to subside despite orgasm. Numerous etiologies of this condition are considered. Among others a disturbed detumescence mechanism, which may due to excess release of contractile neurotransmitters, obstruction of draining venules, malfunction of the intrinsic detumescence mechanism or prolonged relaxation of intracavernosal smooth muscle are postulated. Treatment of priapism varies from a conservative medical to a drastic surgical approach. Two main types of priapism; veno-occlusive low flow (ischemic) and arterial high flow (non-ischemic), must be distinguished to choose the correct treatment option for each type. Patient history, physical examination, penile hemodynamics and corporeal metabolic blood quality provides distinction between a static or dynamic pathology. Priapism can be treated effectively with intracavernous vasoconstrictive agents or surgical shunting. Alternative options, such as intracavernous injection of methylene blue (MB) or selective penile arterial embolization (SPEA), for the management of high and low flow priapism are described and a survey on current treatment modalities is given.

Treatment of penile curvature with Essed-Schröder tunical plication: aspects of quality of life from the patients' perspective

To investigate retrospectively the long‐term functional results and quality of life of patients undergoing the Essed‐Schröder procedure (a simple plication of the tunica albuginea) to correct penile deviation, using a standardized questionnaire.

Male genital injury: diagnostics and treatment

This article reviews the current status of information on external male genital injuries, focusing on cause, diagnostic and therapeutic management of this uncommon entity. Because of the high risk of infection and the major importance of preserving fertility, male genital injuries represent a serious urological disorder that demands immediate urological treatment. The diagnostic procedure classically consists of taking a history and inspecting the wound; this provides enough diagnostic information for the correct choice of conservative or surgical treatment. In most cases open injuries of the genitalia require surgical exploration to determine the extent of possible scrotal, testicular, epididymal, cavernosal or urethral damage, to debride nonviable superficial or deep tissue, to drain existing haematomas or to control active bleeding. Furthermore, the correct therapeutic approach is crucial for preserving fertility and penile erection. In cases where bilateral ablation is necessary, measures to preserve sperm, e.g. testicular or microsurgical sperm extraction, or squeezing the ductus during orchidectomy, must be considered.

Penile fractures: controversy over surgical or conservative treatment.

Patients typically present with complaints of a classic ‘cracking’ sound, sharp penile pain, rapid detumescence and swelling with or without ecchymosis of the penile shaft. The penis may be bent as well as having ecchymosis confined to Buck’s fascia, resulting in massive oedema. Additionally, injured fascial compartments will lead to an extension of the ecchymosis into the scrotum, perineum, the suprapubic area and the inguinal regions [7]. The massive swelling will involve lateral penile deviation in the direction of the unaffected penile side [1,2,10], except for the rare case of a bilateral rupture, which will lead to dorsal or ventral deviation [15]. Sometimes there is a palpable defect in the tunica.

Slightly modified technique of the original essed plication procedure for congenital penile deviation

PURPOSEnThe Schroeder-Essed plication procedure is a standard technique for the correction of penile curvature. In a retrospective analysis we compared functional results and quality of life (LQ) of the original technique with inverted sutures as described by Schroeder-Essed and our slight modification consisting of horizontal incisions into the tunica albuginea.nnnMATERIALS AND METHODSnTwenty-six patients with congenital penis deviation were treated for penile deviation by the original Schroeder-Essed plication with inverted sutures (11 patients) and by the described modification (15 patients). In case of modified technique, horizontal and parallel incisions 4 mm to 6 mm apart and about 8 mm - 10 mm long were made through the tunica albuginea. The outer edges of the incisions were then approximated with permanent inverted sutures (Gore-Tex 3-0). Mean age was 21.6 years in the first group and 23.2 years in the second group. Average follow-up was 28 months and 13 months, respectively. The preoperative penile deviation angle was > 25 degrees in all patients without difference between the 2 groups.nnnRESULTSnAll patients in both groups reported an improvement in their quality of life and full ability to engage in sexual intercourse. Nine patients (88%) in the first group and 14 patients (93%) in the second group were satisfied with the cosmetic result. In contrast, 10 patients (91%) of the first and 13 patients (87%) of the second group complained of penile shorting. Recurrence of deviation was only noticed in 2 males in the first group (18%).nnnCONCLUSIONSnOur results indicate that this simple modification of the Schroeder-Essed plication offers good functional and cosmetic results. Most patients were satisfied with the penile angle correction results.