Charles E. Horton

Isolation and Characterization of Collagen in Peyronie’s Disease

Peyronies disease is characterized histologically by excessive collagen deposition in the lesion. We examined the collagen types in Peyronies disease plaque tissues compared to unaffected tissues from the same patient, other control tissues, and Dupuytrens contracture. Gel electrophoresis of pepsin-solubilized collagen demonstrated the presence of type I collagen and an increased content of type III collagen in plaque tissue. Increased type III collagen was detected in apparently normal tissue adjacent to the plaque and in Dupuytrens lesion, confirming previous findings. Although the cause of excessive collagen accumulation of Peyronies disease is unknown, the results suggest an imbalance in the regulation of extracellular matrix production leading to pathologic fibrosis.

Utricular Configuration in Hypospadias and Intersex

To evaluate the incidence and significance of an enlarged prostatic utricle in hypospadiac patients without underlying intersex 44 patients with the meatus located in the perineum, penoscrotal junction or proximal two-thirds of the penis were evaluated with cystourethroscopy immediately before the operation. There was an abnormally enlarged utricle in 57 per cent of the perineal, 10 per cent of the penoscrotal and none of the penile hypospadias and intersex revealed a high incidence of enlarged utricle or the presence of a vagina masculinus. Utricular enlargement in itself doses not indicate intersexuality but careful cystoscopic examination of its vault needs to be undertaken, searching for a cervix. An enlarged utricle can be a manifestation of delayed mullerian duct regression or decreased androgenic stimulation of the urogenital sinus.

Dermal Graft Repair of Peyronie’s Disease: Survey of 50 Patients

Abstract: Peyronie’s disease is characterized by localized fibrosis in the tunica albuginea of the corpus cavernosum. This inelastic segment causes bending of the erect penis and sexual incapacity in advanced cases. We reviewed 52 cases in which excision of the Peyronie’s plaque and replacement of the defect with a dermal graft have been done. An operation is an acceptable method to treat patients who are anatomic and sexual cripples. More than 70 per cent of our postoperative patients have been satisfied with sexual performance. Specific aspects of the postoperative course and surgical results are reviewed.

Penile Prosthesis Implantation in Total Phalloplasty

A series is presented of 8 patients who had undergone either total phalloplasty or free flap penile reconstruction. Our experience with prosthetic implantation is reviewed as is a brief history of phallic construction, including previously reported efforts at achieving rigidity with prosthetic implantation, autologous material implantation and so forth. We present in detail our current technique of implantation in these 8 patients, who underwent 10 attempts at implantation. In 4 patients infection necessitated removal of the prosthesis (2 have since undergone successful reimplantation). Of the 8 patients in whom implantation was attempted 6 (60%) currently have prostheses in place.

Chromosome abnormalities in Peyronie's disease.

Peyronies disease is a localized and progressive fibrosis of unknown etiology that affects the tunica albuginea of the penis. We examined cytogenetically cell cultures derived from plaque, adjacent tunica, dermis and lymphocytes in patients with Peyronies disease, and compared the results to cell cultures established from the tunica albuginea of control patients. Chromosomal abnormalities were detected in 9 plaque-derived cell cultures from 7 of 12 Peyronies disease patients (58 per cent). Cells cultured from adjacent tunica, dermis and lymphocytes from the same patients were karyotypically normal, as were cultures derived from control (chordee and penile scar) patients. Chromosomal aberrations consisted of 5 numerical changes and 4 structural rearrangements, and included chromosomal additions (trisomy 7 and trisomy 8), deletions (45X,-Y), reciprocal translocations and inversions or markers. In 2 instances cultures derived from plaque tissue contained 2 independent chromosomal abnormalities. The apparently random chromosomal changes associated with Peyronies disease suggests that karyotypic instability may be a common feature of cells within the plaque. It presently is unclear whether this finding represents multiple pathways for the development of Peyronies disease or secondary consequences of Peyronies disease.

Reconstruction of traumatically acquired defects of the phallus.

Trauma to the male phallus may be treated in a systematic approach to achieve aesthetically and functionally pleasing results. Isolated burns should be treated early with excision and preputial flap or skin graft closure. Avulsion injuries are closed primarily or skin grafted. Subtotal loss can be treated with penile lengthening techniques. Total loss is treated with reimplantation or microvascular free tissue transfer phalloplasty. There are reconstructive surgical options, instead of penectomy, in patients with penile malignancies.RésuméLe traumatisme du pénis peut Être traité avec une approche systématique afin dobtenir des résultats esthétiquement et fonctionnellement valables. Les brûlures isolées devraient Être soignées immédiatement par excision et lambeau préputial ou greffe de peau. Les lésions par avulsion sont traitées par fermeture primitive ou greffées. Une perte subtotale peut Être traitée avec des techniques dallongement pénien. Une perte totale est traitée par une réimplantation ou par une phalloplastie avec transfert libre et anastomoses microvasculaires. Il existe des possibilités de reconstruction chirurgicale au lieu de le pénectomie pour les patients qui ont des tumeurs malignes du pénis.ResumenEl trauma del falo masculino puede ser tratado mediante un aproche sistemático para lograr resultados estética y funcionalmente satisfactorios. Quemaduras aisladas deben ser tratados con resección precoz y cierre con colgajos prepuciales o injertos de piel. Las lesiones de avulsión son cerrados en forma primaria o mediante injertos de piel. Las pérdidas subtotales del miembro pueden ser manejados con técnicas de alargamiento peneano y la pérdida total con reimplantación o con faloplastia por transferencia microvascular de tejido libre. Las anteriores son opciones quirÚrgicas de reconstrucción, para realizar en vez de la penectomía, en pacientes con neoplasias malignas del pene.

Peyronie's disease: an electron microscopic study.

AbstractAn electron microscopic examination of penile plaques from 20 patients with Peyronie’s disease generally agreed with the light microscopic interpretation for lesions of short duration. Our data additionally show evidence for a reorganization of the interstitial matrix in vascular areas of the tunica albuginea. Penile plaques demonstrated nerve demyelination in 4 patients and the presence of bacteria in 1. Myofibroblast cells were not observed.

Congenital Anomalies Associated with Hypospadias

We did a retrospective survey on 200 patients with hypospadias to determine what other congenital anomalies were present. The 56 patients with associated anomalies included 16 who had abnormal excretory urograms and 10 of these 16 patients had defects requiring surgical correction.

Evaluation and Treatment of Patients With Failed Hypospadias Repair

Hypospadias repair is often accompanied by complications, some of which may be major. We herein analyze 70 patients whom we have seen and enumerate the defects, list the operative procedures that have been necessary to correct the lesions and illustrate the use of some of these techniques. Surgeons treating patients with hypospadias should have command of many techniques and use them aggressively with imagination and great care.

The Surgical Treatment of Chordee Without Hypospadias in Men

During a 2-year period we treated 26 young men for chordee without hypospadias. Many of these patients had straight erections as children but a ventral curvature developed as they achieved puberty. We describe the anatomical findings and discuss the possible cause for the development of this anomaly. Surgical therapy begins with a circumcising incision and reflection of the skin to expose the shaft of the penis. The corpus spongiosum containing the urethra was mobilized by resecting the dysgenetic tissue in the dartos and Bucks fascia layers. In 1 patient this dissection was sufficient to straighten the penis but in the remaining 25 the penis was not straight. In those patients we mobilized the dorsal bundle of vessels and nerves, and removed 1 or several ellipses of tunica albuginea to equalize the lengths of the ventral and dorsal aspects of the corpora cavernosa. The corpus spongiosum usually is elastic and the curve almost never is caused by shortness of the urethra, which stretches to fit the straightened penis. In 24 of the 26 patients the curvature was resolved with 1 operation, while 2 needed a second procedure.