Correction of a rare malformation of the penis in two boys with a single cavernous body and classical bladder extrophy

Bladder extrophy - is a difficult malformation for the treatment. Aplasia of one of the cavernous bodies of the penis is an extremely rare pathology. In the available literature, we did not meet reports of correction of bladder extrophy in children with a single cavernous body of the penis.From 1990 to 2020, 545 children (364 boys) with extrophy have been repair. Two (0.5 %) boys only had a classic bladder extrophy combined with the aplasia of one cavernous body. The first patient with classical extrophy and multiple malformations (fingers of the right hand, fingers of the right foot, aplasia of the left kidney, left cavernous body, left testicle and hypoplasia of the left half of the scrotum) the penis with the single cavernous body on the right was somewhat thinner, but formed anatomically correctly with the presence of a urethra and closed prepuce. The primary closure of the bladder was performed with bilateral iliac osteotomy and the joint of pelvic bones at the age of 1 year. The patient had the anatomically properly formed bladder sphincter and urethra, penile correction was not required. After the operation, urinary continence had been achieved.The second boy was with classical extrophy and epispadia of the single cavernous body, he was given stage treatment. At the age of 5 days (2004) the primary closure of the bladder and the connection of the pelvic bones were performed. At the age of 4 years (2008) the formation of the urethra was carried out, the correction of the dorsal deformation of the single cavernous body by excision of the chord and the application of multiple superficial cross-cutting on the tunica albuginea. Bladder neck plastic by Kelly technique in combination with bilateral osteotomy of pelvic bones was performed at the age of 7 years in (2011). The boy of 15 years (2019) had a bladder volume of 350-400 ml. Dry 4-5 hours. Urinate freely with a wide stream. Then a two-stage plastic of the distal urethra was performed. We used the Bracka technique with augmentation of the glans penis and implantation a free graft of the mucous lip. We achieved a good result.Using modern penile correction technologies help to socially adapt patients with rare and difficult malformations.

COMPARİSON OF PREOPERATİVE PENİLE ELASTOGRAPHİC ULTRASOUND FİNDİNGS AND PATHOLOGİCAL TİSSUE RESULTS OF PATİENTS İMPLEMENTED WİTH PENİLE PROSTHESİS

Objective Histopathologically to determine the relationship between penile elastography ultrasonography and erectile dysfunction. Material and Method 12 patients who applied to our clinic for erectile dysfunction in the last 1 year and accepted this study were included . Preoperative two-dimensional shear wave elastography imaging was performed in 12 patients and recorded in the Pascal (kPa) unit. Approximately 0.5x0.5x0.5 cm tissue samples were taken from the right and left spongy tissue during penile prosthesis implantation operation. Tissue samples were sent to the pathology department. The percentage of the area covered by muscle fibers and elastic fibers in the corpus cavernosum was noted semi-quantitatively (ratio of muscle fibers and cavernous body elastic fiber score). All data obtained were compared with each other. Results Cavernous body elastic fiber score data(Grouped Score 1, 2 and 3) and percentage of cavernous body muscle fibers data (Grouped %10,%20,%30… %100) were compared with Shear wave elastography data (kPa). The results were not statistically significant according to the Kruskal Wallis Test and Spearman’s correlation test. Cavernous body elastic fiber score and the percentage of cavernous body muscle fibers were also compared, it was not statistically significant according to the Kruskal Wallis test and Spearman’s correlation test. The data we obtained as a result of our study showed that penile elastographic imaging is not a reliable method in the diagnosis of erectile dysfunction. Conclusions Penile shear wave elastography can be used clinically to quantitatively assess the amount of smooth muscle cells and elastic fibers in the penis, but it deserves to be studied with a larger number of patients and a more specific interpretation of the pathology preparation. Keywords: Penile elastography, erectile dysfunction, penile prosthesis, shear wave

A case of a high-flow priapism treated with superselective transcatheter embolization

High-flow priapism is a rare condition characterized by prolonged and painless erection. It is defined as contusion or thrombosis of the cavernous body of the penis usually secondary to blunt trauma. Due to the rarity of the disease, there is no well-defined consensus about treatment. Conservative treatment is often applied with non-steroidal anti-inflammatory drug. We present a case of 58-year-old man with proximal partial priapism that developed secondary to blunt trauma to the penis. The patient did not benefit from non-steroidal anti-inflammatory drug therapy and then was successfully treated with selective embolization.

Penile aseptic abscess in the cavernous body at the base of the penis: a case report

We report a case of aseptic abscess in the cavernous body at the base of the penis. In our clinical observation, the patient underwent puncture and drainage of the corpus cavernosum abscess, followed by surgical resection of the abscess wall, with the incisions closed layer by layer with primary suture. In addition, we paid attention to strengthening the postoperative management by using elastic bandages to wrap the penis intermittently to prevent edema; the incision would not be covered with dressings from the third day after the operation, so as to keep the incision site dry in an open way. During the period of indwelling of the catheter after the operation, we noticed the care of the external orifice of the urethra to reduce the occurrence of catheter-related infections. Finally, the patient was diagnosed with a penile aseptic abscess in the cavernous body at the base of the penis. The patient recovered well after surgery and was discharged 1 week later. At 1.5 years after the operation, the shape of the penis returned to normal, and the erectile function was normal. It was seen that good nursing concept is of great help for prognosis, which could avoid infection and edema, and is conducive to wound healing.

Rupture of the cavernous body diagnosed by contrast-enhanced ultrasound: Presentation of a clinical case

Penile trauma represents a urological emergency characterized by the breaking of the albuginea tunic. A fast diagnosis and early surgical repair are the best treatments to avoid post-operative sequelae such as curvatures or deformities of the penis. An ultrasound evaluation may not be able to identify the injury in the tunica albuginea due to the edematous swelling of the penis and clots within the tear deteriorate the image contrast and can hide the injury. We here report a case study of successful management via surgical treatment for rupture of the cavernous body diagnosed by contrast-enhanced ultrasound in a young patient with penile trauma.

Peyroni’s disease which imitated the large stone of urethra

A clinical observation of Peyronie’s disease in patient, who had large fibrous plaque in a cavernous body, which imitated the stone of urethra. Clarification of the diagnosis was possible only after performing multi-slice computer tomography. (For citation: Kazarov RL, Korol’ EI, Merkulov DV, et al. Peyroni’s disease which imitated the large stone of urethra. Urologicheskie vedomosti. 2017;7(3):49-51. doi: 10.17816/uroved7349-51).

Morfologi Hemipenis Biawak Air (Varanus salvator bivittatus)

Varanus salvator bivittatus has a pair of hemipenes, which is macroscopic anatomically like the copulatory organ in other amniotes, cylindrical-shaped (truncus) with quite flexible, and it located on the base of the caudal tailof the cloaca. However, information about the microscopic anatomy of hemipenes of this animal is scientifically unpublicized. Therefore, the aim of this research is to study the microscopic anatomy of hemipenes of male Varanussalvator bivittatus. The animals were sacrificed by exsanguination under deep anesthetized and fixed in 4 % paraformaldehyde through perfusion then observed visceral site and morphometric. Histomorphological evaluationwas obtained by paraffin preparation with section thickness of 3-4 μm then stained in Hematoxylin-Eosin (HE) and Masson’s Trichrome (MT). The results showed that truncus of hemipenes was lined by stratified squamousepithelium and supported with thick of dense connective tissue and contain cavernous body and blood vessels are found, the muscles not found. The presence of connective tissue that supported in the down part sometimesmake hemipenes are rigid while prurient condition. In the caudal of truncus hemipenes there is retractor muscle of hemipenes which arranged by striated muscles. Hemipenes is flexible because contain with much of blood vesselthat found in truncus hemipenes.