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1.  Long-term Treatment Outcomes Between Surgical Correction and Conservative Management for Penile Fracture: Retrospective Analysis 
Korean Journal of Urology  2013;54(7):472-476.
Purpose
Early surgical management is the standard of care for penile fracture. Conservative treatment is an option with recent reports revealing lower success rates. We reviewed the data and long-term outcomes of patients with penile injury submitted to surgical or conservative treatment.
Materials and Methods
Between January 2004 and February 2012, 42 patients with penile blunt trauma on an erect penis were admitted to our center. We analyzed the following variables: age, etiology, symptoms and signs, diagnostic tests, treatment used, complications and erectile function during the follow-up. One patient was excluded due to missing information. Thirty-five patients underwent surgical repair and 6 patients were submitted to conservative management.
Results
Mean follow-up was 19.2 months (range, 7 days to 72 months). The mean elapsed time from trauma to surgery was 21.3±12.5 hours. Trauma during sexual relationship was the main cause (80.9%) of penile fracture. Urethral injury was present in five patients submitted to surgery. Dorsal vein injury occurred in three patients with false penile fracture and concomitant spongious corpus lesion was present in three patients. During follow-up, 31 cases (88.6%) of the surgical group and four cases (66.7%) of the conservative group reported sufficient erections for intercourse, with no voiding dysfunction and no penile curvature. However, the remaining two patients (33.3%) from the conservative group developed erectile dysfunction and three patients (50%) developed penile deviation.
Conclusions
Surgical approach provides excellent functional outcomes and lower complications. Early surgical management of penile fracture provides superior results and conservative approach should be avoided.
doi:10.4111/kju.2013.54.7.472
PMCID: PMC3715712  PMID: 23878691
Penis; Surgery; Therapy; Wounds and injuries
2.  False fracture of the penis: Different pathology but similar clinical presentation and management 
Urology Annals  2014;6(1):23-26.
Introduction:
Penile fracture is the most common presentation of acute penis. Rupture of the superficial dorsal penile vein (s) may mimic penile fractures with similar clinical presentation but with intact corporeal bodies. Our aim of the study is to highlight superficial dorsal penile vein (s) injury as true emergency with better prognosis.
Subjects and Methods:
Sixty-eight patients with suspected penile fractures presented to our hospital between June 2007 and January 2013. Out of these, 11 patients showed intact tunica albuginea on exploration with injured dorsal penile vein (s) identified. Records of such 11 cases were reviewed regarding age, etiology, symptoms, physical signs, findings of surgical exploration and post-operative erectile function.
Results:
All 11 patients were injured during sexual intercourse and presented with penile swelling and ecchymosis and gradual detumescence. Mild penile pain was encountered in 5 cases and the “snap” sound was noted in 2 cases. Examination revealed no localized tenderness, or tunical defect. All the patients regained penile potency without deformity after surgical ligation of the severed vessels. One patient developed penile hypoesthesia.
Conclusion:
Although the classic “snap” sound and immediate detumescence are usually lacking in the symptomology of dorsal penile vein rupture, its clinical presentation can be indistinguishable from true penile fracture. Surgical exploration is still required to avoid missing tunical tear with possible future complications. The long-term outcome and prognosis are excellent.
doi:10.4103/0974-7796.127015
PMCID: PMC3963338  PMID: 24669117
Dorsal penile vein; false penile fracture; penile fracture; tunica albuginea
3.  Recurrent furunculosis as a cause of isolated penile lymphedema: a case report 
Introduction
Isolated lymphedema of the penis is extremely rare: combined involvement of the scrotum and penis is the norm. Furunculosis as a cause is not, to our knowledge, previously reported. We present a case of isolated penile lymphedema that responded to excision of lymphedematous tissue and reconstruction with flaps.
Case presentation
A 32-year-old Arab man presented with a three-year history of a gradually increasing, painless penile swelling. Our patient's main complaint was non-erectile sexual dysfunction. The swelling was preceded by at least three prior episodes of severe furunculosis at the penile root. He had no other contributory past medical or family history. On examination there was gross penile enlargement, maximally at the mid shaft, associated with thickened skin at the sites of prior furunculosis. The glans and scrotum were normal. Both testes were palpable. Serology for filariasis, and urinary tract ultrasound and computed tomography scan were normal. The clinical diagnosis was lymphedema following recurrent penile furunculosis. At operation the lymphedematous tissues were removed. Closure of the penile shaft was accomplished by bilateral advancement of flaps from both ends of the penis. He resumed normal sexual activity one month after surgery. At 12 months, he had a good cosmetic result, with no signs of recurrence.
Conclusions
Furunculosis at the penile root may result in lymphedema confined to the penile shaft, sparing the scrotum. Excision of abnormal tissue and cover with a skin flap gave excellent cosmetic results, and allowed satisfactory sexual activity.
doi:10.1186/1752-1947-4-196
PMCID: PMC2902497  PMID: 20584337
4.  Isolated rupture of the superficial vein of the penis 
Penile emergencies are rare but when they do occur, prompt diagnosis and treatment are warranted. Emergent conditions of the male genitalia are mainly traumatic, vascular or infectious. Penile emergencies are usually caused by trauma to the penis, during sexual intercourse or manipulation of an erect penis during masturbation. One of the traumatic vascular penile emergencies is superficial penile dorsal vein rupture. This is a rare condition, with just a few reported cases. It is usually taken into differential diagnosis with the other acute penile injuries that present, such as acute penile edema or ecchymosis. We report a case of 59-year-old male with a superficial penile dorsal vein rupture which occurred during manipulation of the erect penis.
doi:10.5489/cuaj.1712
PMCID: PMC4039606  PMID: 24940469
5.  Circumcision in 'buried penis'--a cautionary tale. 
BACKGROUND: The aim of a circumcision is to remove sufficient foreskin from the penile shaft and preputial epithelium to uncover the glans. Removal of too much preputial skin may lead to an unsatisfactory cosmetic and functional result. Patients with a congenital anomaly known as 'buried penis' are particularly susceptible to this. In this condition, abnormal dartos fascial bands or muscle fibres tether the penile shaft and as a result conceal its true length. CASE REPORT: A 5-year-old boy underwent circumcision but his 'buried penis' was not recognised by the surgeon pre-operatively. Unfortunately, his penile shaft was left almost entirely denuded of skin as a result. The wound required a full thickness graft. Follow-up at 1 year has so far been satisfactory. CONCLUSIONS: This case highlights the importance of early recognition of a buried penis when considering circumcision. It demonstrates the abnormal anatomy of a buried penis and its management. It also provides a potential reconstructive option in cases of excess skin removal.
doi:10.1308/003588404772614669
PMCID: PMC1964023  PMID: 15005943
6.  Penile prostheses 
Penile prosthesis implantation is recognized as a valid option to obtain an artificial erection satisfactory for sexual intercourse in those patients in which a pharmacological approach is contraindicated or ineffective. Penile prostheses are subbject to continuous development and they are achieving ever better mechanical reliability and safety. The devices are divided into two general types: semirigid (malleable and mechanical) and inflatables. The AMS® (American Medical Systems) and Coloplast Ltd® produce the majority of inflatable and semirigid devices.
Malleable and mechanical prostheses have the disadvantage that the penis is always erect although it can be orientated in different ways, while the advantages are ease of use and the need for a simpler surgical procedure compared with inflatable prostheses. Three-component prostheses are more sophisticated than semirigid devices. The advantages of these devices are that the prosthesis feels softer than semirigid or two-piece devices when deflated, with a better cosmetic result, and it ensures a more natural erection than others kinds of prosthesis. The disadvantages are the possibility of malfunction and the need for a more complicated surgical technique. Implantation of a penile prosthesis can be performed in a short surgical time under locoregional anaesthesia, and for this reason hospitalization is usually brief and the patient can be discharged 2 days after the operation if complications are not evident. Patient and partner satisfaction reflect the quality and the effectiveness of this treatment. Even though the results are positive in the vast majority of patients, the possibility of several complications makes penile prosthesis implantation a delicate kind of surgery. Complications can happen when the operation is carried out, in the peri-operative and in the postoperative period, and include infections, erosions of the prosthesis and mechanical failure in case of inflatable prosthesis. Penile prostheses available on the market have improved the success of this kind of surgery, thanks to the introduction of new materials and designs.
doi:10.1177/1756287209359174
PMCID: PMC3126066  PMID: 21789081
penile prosthesis; erectile dysfunction; inflatable prosthesis; semirigid prosthesis
7.  Diagnosis of penile fracture in primary care: a case report 
Cases Journal  2009;2:8065.
Introduction
Penile fracture has been reported with sexual intercourse, masturbation, rolling over or falling on to the erect penis. Classically the history is with a sudden snap, pain, detumescence and a hematoma of the penis with deformity. Immediate surgical treatment is recommended. The patients may delay the admission due to fear and embarrassment or the condition may usually be underreported.
Case presentation
A 32-year-old man presented to primary care complaining of discoloration of penis without any significant history or symptom. Physical examination revealed swollen, ecchymotic, and deviated circumcised penis.
Conclusion
Although frequent and common diseases represent the majority of daily work, the primary care physician should be alert for possible unexpected history or symptom of a rare and often serious condition.
doi:10.4076/1757-1626-2-8065
PMCID: PMC2740298  PMID: 19830047
8.  Penile Augmentation with Resultant Foreign Material Granuloma and Sequalae 
Throughout history, a proportion of men appear to correlate penis size and dimensions directly with physical fitness and sexual prowess. Foreign materials, such as paraffin oil, paraffin balm, mineral oils, and silicone, have been used to promise an improvement in penile shaft contour and dimensions. These materials are injected directly into the penis; inducing granuloma formation to achieve increased penis length and girth. However, the result is a severely disfigured and swollen penis, which cannot achieve erection. Local complications of penile lipogranuloma include infection, ulceration, local migration, and cavernosal invasion; leading to functional impairment. Meanwhile, systemic complications include foreign body embolization, organ infarct, and death. Penile lipogranuloma is best treated surgically. Granulomatous skin needs to be completely excised; wound closure with a scrotal skin flap, Cecil’s inlay operation and split thickness skin graft commonly used options. Our case series has shown that penile lipogranuloma, induced by subcutaneous foreign body injections into the penile shaft, and its subsequent adverse outcomes to patients and their partners.
PMCID: PMC3629684  PMID: 23613653
augmentation; foreign body reaction; granuloma; silicone; penis
9.  Surgically Correctable Morbidity from Male Circumcision: Indications for Specialist Surgical Care in Lagos 
Aim/Objective:
To determine the pattern of morbidity and outcome among patients referred to the Pediatric Surgery Unit of the Lagos University Teaching Hospital (LUTH) following circumcision.
Materials and Methods:
Retrospective descriptive study of all patients with complications of circumcision who were managed in LUTH between 2008 and 2010.
Results:
There were 36 patients. The age range was between 2 days and 9 years (median-3 months). Fifteen cases (42.9%) were due to urethro-cutaneous fistula while there were six cases (16.7%) of postcircumcision bleeding. There were four cases (11.1%) each of partial penile amputation and buried penis. There were also cases of meatal stenosis, penile implantation cyst and glanulo-preputial skin bridge. With respect to the treatment offered, eleven (30.6%) patients had urethroplasty for the urethro-cutaneous fistulae while seven (19.4%) patients had penile refashioning for the buried penis and penile amputation. Appropriate surgical treatments were performed for the other complications.
Conclusion:
Urethrocutaneous fistula and penile amputation are the commonest complications of circumcision for which referral is made to LUTH. Treatment outcome was satisfactory. Health education and legislation to ensure procedure is performed by qualified medical and paramedical staff may reduce the morbidity.
doi:10.4103/1117-6806.103106
PMCID: PMC3762007  PMID: 24027397
Circumcision morbidity; indications; specialist care
10.  Management of Penile Fracture 
Oman Medical Journal  2008;23(3):162-165.
Objectives
To study clinical features and treatment of patients diagnosed with fractured penis.
Methods
All patients diagnosed with penis fracture from March 2000-March 2007 were retrospectively studied. No invasive investigation was used for diagnosis.
Results
Surgical intervention was done in 52 patients while 5 patients were managed conservatively. The constant finding recorded in all cases was that penis fracture occurred in erect penises. Most fractures were observed in the 16-30 years age group (50.88%). Left lateral tear was present in 53.84% cases. One patient had gangrene of penile skin after surgery.
Conclusion
Penis Fracture is not so uncommon as reported. A trauma to erect penis is mandatory for fracture to occur. Surgical intervention is the preferred mode of treatment.
PMCID: PMC3282318  PMID: 22359706
Penile fracture; trauma; Management
11.  A case of penile fracture with complete urethral disruption during sexual intercourse: a case report 
Penile fracture is a rare condition. Primarily it is a rupture of the corpus cavernosum that occurs when the penis is erect. The rupture can also affect the corpus spongiosum and the urethra.
We report a case of a 37 year old man who presented with acute penile pain, penile swelling and the inability to pass urine after a blunt trauma during sexual intercourse. In emergency surgery we found bilateral partial rupture of the corpus cavernosum with complete urethral and corpus spongiosum disruption. In the one year follow up the patient presented with normal erectile and voiding function.
Emergency surgical repair in penile fracture can preserve erectile and voiding function.
doi:10.1186/1752-1947-1-14
PMCID: PMC1867818  PMID: 17474981
12.  Long anterior urethral stricture: Reconstruction by dorsally quilted penile skin flap 
Urology Annals  2013;5(3):163-166.
Objectives:
We’d like to present our experience in treating long (>5 cm) anterior urethral stricture by penile skin flap as dorsal on-lay in one-stage procedure.
Patient and Methods:
Between January 1998 and December 2010, 18 patients (aged from 28-65 years) presented with long urethral stricture, 5.6-13.2 cm, (penile in 6, bulbar in 2, and combined in 10 cases), those were repaired utilizing long penile skin flaps placed as dorsal on-lay flap in one-stage (Orandi flap 6 cm in 6 cases, circular flaps 7-10 cm in 8, and spiral flaps 10-15 cm in 4). Uroflowmetry and RUG were done following catheter removal and at 6 and 12 months.
Results:
The urethral patency was achieved in 77% of patients. The complications were fistula in 1 patient (5.5%), re-stricture occurred in 3 patients (16.6%) that required visual internal urethrotomy (VIU), and 2 patients (11%) showed curvature on erection that did not interfere with sexual intercourse. Diverticulum (penile urethra) was seen in 1 patient (5.5%) containing stones and was excised surgically. There was penile skin loss in 3 patients (16.6%). All patients completed at least one year follow-up period.
Conclusion:
Free penile skin flaps offer good results (functional and cosmetic) in long anterior urethral stricture. Meticulously fashioned longitudinal, circular or spiral penile skin flaps could bridge urethral defects up to 15 cm long.
doi:10.4103/0974-7796.115735
PMCID: PMC3764896  PMID: 24049378
Dorsally quilted flaps; urethroplasty; urethral stricture
13.  A new plastic surgical technique for adult congenital webbed penis 
Objective: To introduce a novel surgical technique for correction of adult congenital webbed penis. Methods: From March 2010 to December 2011, 12 patients (age range: 14–23 years old) were diagnosed as having a webbed penis and underwent a new surgical procedure designed by us. Results: All cases were treated successfully without severe complication. The operation time ranged from 20 min to 1 h. The average bleeding volume was less than 50 ml. All patients achieved satisfactory cosmetic results after surgery. The penile curvature disappeared in all cases and all patients remained well after 1 to 3 months of follow-up. Conclusions: Adult webbed penis with complaints of discomfort or psychological pressure due to a poor profile should be indicators for surgery. Good corrective surgery should expose the glans and coronal sulcus, match the penile skin length to the penile shaft length dorsally and ventrally, and provide a normal penoscrotal junction. Our new technique is a safe and effective method for the correction of adult webbed penis, which produces satisfactory results.
doi:10.1631/jzus.B1200117
PMCID: PMC3437374  PMID: 22949367
Webbed penis; Plastic surgery; Inconspicuous penis; Penile anomalies
14.  Simple Anchoring of the Penopubic Skin to the Prepubic Deep Fascia in Surgical Correction of Buried Penis 
Korean Journal of Urology  2011;52(11):787-791.
Purpose
The aim of this study was to categorize concealed penis and buried penis by preoperative physical examination including the manual prepubic compression test and to describe a simple surgical technique to correct buried penis that was based on surgical experience and comprehension of the anatomical components.
Materials and Methods
From March 2007 to November 2010, 17 patients were diagnosed with buried penis after differentiation of this condition from concealed penis. The described surgical technique consisted of a minimal incision and simple fixation of the penile shaft skin and superficial fascia to the prepubic deep fascia, without degloving the penile skin.
Results
The mean age of the patients was 10.2 years, ranging from 8 years to 15 years. The median follow-up was 19 months (range, 5 to 49 months). The mean penile lengths were 1.8 cm (range, 1.1 to 2.5 cm) preoperatively and 4.5 cm (range, 3.3 to 5.8 cm) postoperatively. The median difference between preoperative and postoperative penile lengths was 2.7 cm (range, 2.1 to 3.9 cm). There were no serious intra- or postoperative complications.
Conclusions
With the simple anchoring of the penopubic skin to the prepubic deep fascia, we obtained successful subjective and objective outcomes without complications. We suggest that this is a promising surgical method for selected patients with buried penis.
doi:10.4111/kju.2011.52.11.787
PMCID: PMC3242994  PMID: 22195270
Abnormality; Penis; Surgery
15.  Evaluation of epidemiology, concomitant urethral disruption and seasonal variation of penile fracture: A report of 86 cases 
Canadian Urological Association Journal  2013;7(9-10):E572-E575.
Introduction:
Penile fracture (PF) is a well-recognized clinical entity and is often deemed a urological emergency. It is not uncommon in our region. The main objective of this study is to describe the clinical characteristics of patients diagnosed with penile fracture in the Qom Province, Iran. We evaluate surgical treatment, concomitant urethral disruption and its seasonal variation.
Methods:
This is a descriptive retrospective study, reviewing all the medical records of patients admitted with penile fracture from 2003 to 2012 at Kamkar Hospital of Qom, Iran. It takes into account variables related to the urological history, etiology, diagnosis and its surgical treatment. The epidemiologic data, marriage status and the seasonal variation were evaluated. In total, 86 patients, aged between 17 and 62, with PF were hospitalized in our centre. The average age of patients was 36.74 years. All operated cases were followed 3 months and 6 months after surgery.
Results:
Of the 86 patients, 34 (68%) were the ages of 20 and 40. In terms of marital status, 56 (65%) were married and 30 (35%) were single at the time of presentation. Twenty-six patients (30.2%) had episodes related to intercourse and 48 patients (56%) to manual habitual trauma; the remaining 12 patients had a direct blow to an erect penis or rolled/fell off a bed. Patients presented with swelling, pain and a popping or cracking sound in the penis. The diagnosis was made using history and physical examination in all patients. Unilateral corporeal ruptures were present in 80 (93%) and bilateral in 2 cases (2.32%). Surgical repair was performed with a circumferential sub-coronal degloving incision in 82 cases (95.35%). There were seasonal variations: 22 cases in spring; 25 in summer; 17 in autumn; 22 in winter. Patients had an average postoperative hospital stay of 1 day.
Conclusion:
Habitual manual trauma was the most common cause of PF in our study. Immediate surgical intervention has low morbidity, short hospital stay and rapid functional recovery. In the case of urethrorhagia, concomitant urethral injury should be evaluated. On the basis of our study, PF may have seasonal variation.
doi:10.5489/cuaj.179
PMCID: PMC3776031  PMID: 24069098
16.  Reconstruction of Long Anterior Urethral Strictures by Dorsally Quilted Penile Skin Flap 
ISRN Urology  2012;2012:651513.
Objective. To present the results of reconstruction of long (>5 cm), penile, bulbar, and bulbopenile urethral strictures by penile skin flap as dorsal onlay in one-stage procedure. Patients and Methods. Between January, 1998 and December, 2004, 18 patients (aged from 28-65 years) presented with long urethral strictures, 5.6–13.2 cm (penile in 6, bulbar in 2 and combined in 10 cases), those were repaired utilizing long penile skin flaps placed as dorsal onlay flap in one stage (Orandi flap 6 cm in 6 cases, circular flaps 7–10 cm in 8, and spiral flaps 10–15 cm in 4). Followup of all patients after reconstruction included urine flow rate at weekly intervals, RUG at 6–12 weeks, and urethrocystoscopy at 12 and 18 months. Results. The urethral patency was achieved in 77% of patients. The complications were fistula in one patient (5.5%), restricture occurred in 3 patients (16.6%) that required visual internal urethrotomy and two patients (11%) showed curvature on erection that dose not interfere with sexual intercourse. Diverticulum (penile urethra) was seen in one patient (5.5%) containing stones and was excised surgically. There was penile skin loss in 3 patients (16.6%). All patients completed at least one-year followup period. Conclusion. Free penile skin flaps offer good results (functional and cosmetic) in long penile and/or bulbar urethral strictures. Meticulously fashioned longitudinal, circular or spiral penile skin flaps could bridge urethral defects up to 15 cm long.
doi:10.5402/2012/651513
PMCID: PMC3329648  PMID: 22567421
17.  A physical sign of coital rupture of superficial dorsal vein of penis 
A 39-year-old man presented with penile swelling, pain and hematoma associated with sexual intercourse. On exploration, he was found to have ruptured the superficial dorsal vein of penis, which was ligated. He had an uneventful postoperative recovery and has resumed normal sexual life. A rectangular-shaped suprapubic and distal penile hematoma with sparing of the proximal penile skin was observed. We believe that this physical sign could aid clinical diagnosis of a ruptured superficial dorsal vein of penis.
doi:10.5173/ceju.2011.02.art9
PMCID: PMC3921708  PMID: 24578872
superficial dorsal vein; injury; sign; coitus
18.  Sexual function outcomes following fracture of the penis 
Introduction:
Fracture of the penis is a rare urological emergency which occurs as a result of abrupt trauma to an erect penis. There is paucity of data regarding long-term sexual function or erectile potency following fracture of the penis. The aim of this study is to objectively assess the overall sexual function following fracture of the penis.
Methods:
A retrospective analysis of 21 penile fractures was performed. A voluntary telephone questionnaire was performed to assess long term outcomes using three validated questionnaires-the Erection Hardness Grading Scale, the International Index of Erectile Function (IIEF-5) and the Brief Male Sexual Function inventory (BMSFI).
Results:
The mean age was 33.1 years (range: 19–63). The median follow up was 46 months (range: 3–144). All fractures were a result of sexual misadventure and all were surgically repaired. There were two concomitant urethral injuries. Seventeen patients were contactable. Fourteen patients demonstrated no evidence of erectile dysfunction (ED) (IIEF-5>22), 1 patient reported symptoms of mild ED (IIEF-5, 17–21) and one patient reported mild to moderate ED (IIEF-5, 12–16). No patients reported insufficient erection for penetration (EHGS: 1 or 2). Regarding the overall BMSFI, 13 (83%) patients were mostly satisfied or very satisfied with their sex life within the previous month.
Conclusion:
In a small surgical series of men with penile fracture managed within a short time frame from presentation, we demonstrate erectile potency is maintained. Long-term overall sexual satisfaction is promising.
doi:10.5489/cuaj.199
PMCID: PMC3758941  PMID: 24032060
19.  Penile Fracture: Experience from a Third World Country 
Advances in Urology  2013;2013:708362.
Aim. To ascertain the clinical presentation, commonest age group affected, and treatment of patients diagnosed to have penis fracture. Materials and Methods. We performed a retrospective study carried at a tertiary care hospital from January 2005 to January 2011. All the 36 patients diagnosed to have penile fracture were enrolled in the study group. The diagnosis was made based on the clinical findings in the patients. All, except two patients, were managed by a standard surgical procedure, same for all the patients, on the day of presentation to the hospital. All the data pertaining to the presentation, management, and followup of these patients were studied and scrutinized thoroughly. Results. Thirty-four patients were operated while 2 refused surgery. Most of our patients were between 16 and 30 years (55.6%) of age. The commonest presenting complaints were penile swelling and detumescence during sexual intercourse or an erection. All except two of our patients were managed with immediate surgical repair which had excellent results even in the presence of associated urethral injury. Conclusion. Fracture of the penis is a surgical emergency which can be best managed by immediate surgical repair with excellent results even in the presence of urethral injury.
doi:10.1155/2013/708362
PMCID: PMC3730138  PMID: 23956740
20.  Buried Penis: Evaluation of Outcomes in Children and Adults, Modification of a Unified Treatment Algorithm, and Review of the Literature 
ISRN Urology  2013;2013:109349.
Introduction. Buried penis is a difficult condition to manage in children and adults and conveys significant physical and psychological morbidity. Surgery is often declined due to morbid obesity, forcing patients to live in disharmony for years until the desired weight reduction is achieved. No single operative technique fits all. We present our experience and surgical approach resulting in an improved algorithm unifying the treatment of adults and children. Methods. We conducted a retrospective analysis of patients treated for buried penis between 2011 and 2012. All patients underwent penile degloving and basal anchoring. Penile shaft coverage was achieved with skin grafts. Suprapubic lipectomies were performed on adult patients. Results. Nine patients were identified: four children and five obese adults. Average postoperative stay was three days for children and five for adults. Three adults were readmitted with superficial wound problems. One child had minor skin breakdown. All patients were pleased with their outcomes. Conclusion. Buried penis is a complex condition, and treatment should be offered by services able to deal with all aspects of reconstruction. Obesity in itself should not delay surgical intervention. Local and regional awareness is essential to manage expectations in these challenging patients aspiring to both aesthetic and functional outcomes.
doi:10.1155/2013/109349
PMCID: PMC3893803  PMID: 24490087
21.  Urethral pseudodiverticulum secondary to penile fracture and complete urethra dissection 
A 22-year-old man reported cracking sound and acute pain during sexual intercourse followed by rapid penile detumescence and ecchymosis. He experienced more pain because he could not urinate and had a palpably full bladder. Moreover, his urethra was bleeding. Physical examination revealed swollen, ecchymotic and deviated penis and penis ultrasonography showed an injury of the tunica albuginea and Buck’s fascia with an expanding hematoma. Suprapubic catheter was positioned. Surgical exploration revealed a tear of tunica albuginea of both corpora cavernosa and complete urethral dissection. End-to-end urethral anastomosis and suture of corpora cavernosa lesion were performed. Vescical catheter was mantained for 6 days and suprapubic catheter for 3 months to allow a complete urethral healing. A pseudodiverticulum was found at anastomosis level on the urethrocistography 1 month after surgery. It disappeared by allowing micturition via the suprapubic catheter. The patient presented regular urinary flow and physiological erections 30 days later. In our experience, prompt surgical repair preserved erectile function and keeping the suprapubic catheter protected the urethra; this was the correct management for repairing the urethral lesion.
doi:10.5489/cuaj.1209
PMCID: PMC3668407  PMID: 23766837
22.  Peyronie's Reconstruction for Maximum Length and Girth Gain: Geometrical Principles 
Advances in Urology  2008;2008:205739.
Peyronie's disease has been associated with penile shortening and some degree of erectile dysfunction. Surgical reconstruction should be based on giving a functional penis, that is, rectifying the penis with rigidity enough to make the sexual intercourse. The procedure should be discussed preoperatively in terms of length and girth reconstruction in order to improve patient satisfaction. The tunical reconstruction for maximum penile length and girth restoration should be based on the maximum length of the dissected neurovascular bundle possible and the application of geometrical principles to define the precise site and size of tunical incision and grafting procedure. As penile rectification and rigidity are required to achieve complete functional restoration of the penis and 20 to 54% of patients experience associated erectile dysfunction, penile straightening alone may not be enough to provide complete functional restoration. Therefore, phosphodiesterase inhibitors, self-injection, or penile prosthesis may need to be added in some cases.
doi:10.1155/2008/205739
PMCID: PMC2593786  PMID: 19081785
23.  Penile lengthening procedure with V-Y advancement flap and an interposing silicone sheath: A novel methodology 
Surgery to augment penile length has become increasingly common. Lack of standardization of this controversial procedure has led to a wide variety of poorly documented surgical techniques, with unconvincing results. The most commonly used technique involves release of the suspensory ligament, with an advancement of an infrapubic skin flap onto the penis via a V-Y plasty. This technique has a major drawback of the possibility of reattachment of the penis to the pubis. We describe a new technique of interposing a silicone sheath along with V-Y advancement flap that overrides this drawback and minimizes the loss of the gained length.
doi:10.4103/0970-1591.102722
PMCID: PMC3507409  PMID: 23204668
Penile length; silicone sheath; suspensory ligament; symphysis pubis; V-Y plasty
24.  Penile self-mutilation preceded by bizarre delusions: two case reports 
Introduction
Genital self-mutilation is listed as a symptom of borderline personality disorder. The type of injury varies from simple skin laceration to total amputation of the penis and testicles. These injuries are urological and surgical emergencies.
Case presentation
We report two cases of penile self-mutilation precipitated by erotic and religious bizarre delusions.
Our first patient is a 24-year-old Moroccan man who visited our emergency room with a metallic ring at the root of his penis which had caused marked edema of his entire penis.
Our second patient is a 26-year-old Moroccan man evaluated in our emergency unit. A clinical examination revealed a wound at the dorsal side of his penis with complete transection of the dorsal vein and imperfect hemostasis.
The two patients were treated in our emergency unit after which a favorable clinical course was observed.
Conclusion
Cases of genital self-mutilation are urological and psychiatric emergencies, therefore it is important that surgical and psychiatric teams collaborate closely while managing cases of genital self-mutilation.
doi:10.1186/1752-1947-8-246
PMCID: PMC4105862  PMID: 25000934
Behavior disorder; Genital self-mutilation; Schizophrenia
25.  Advances in understanding of mammalian penile evolution, human penile anatomy and human erection physiology: Clinical implications for physicians and surgeons 
Summary
Recent studies substantiate a model of the tunica albuginea of the corpora cavernosa as a bi-layered structure with a 360° complete inner circular layer and a 300° incomplete outer longitudinal coat spanning from the bulbospongiosus and ischiocavernosus proximally and extending continuously into the distal ligament within the glans penis. The anatomical location and histology of the distal ligament invites convincing parallels with the quadrupedal os penis and therefore constitutes potential evidence of the evolutionary process. In the corpora cavernosa, a chamber design is responsible for facilitating rigid erections. For investigating its venous factors exclusively, hemodynamic studies have been performed on both fresh and defrosted human male cadavers. In each case, a rigid erection was unequivocally attainable following venous removal. This clearly has significant ramifications in relation to penile venous surgery and its role in treating impotent patients. One deep dorsal vein, 2 cavernosal veins and 2 pairs of para-arterial veins (as opposed to 1 single vein) are situated between Buck’s fascia and the tunica albuginea. These newfound insights into penile tunical, venous anatomy and erection physiology were inspired by and, in turn, enhance clinical applications routinely encountered by physicians and surgeons, such as penile morphological reconstruction, penile implantation and penile venous surgery.
doi:10.12659/MSM.883201
PMCID: PMC3560785  PMID: 22739749
penile anatomy; penile venous anatomy; tunica albuginea; distal ligament; erection hemodynamic mechanism

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