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Asian Journal of Urology 2023年第2期10卷 189-194页

作者： Mohammad Shazib Faridi Vikas Sharma Adittya K.Sharma Rahul Yadav Division of Urology Department of SurgeryHamdard Institute of Medical Sciences&Research and HAHC HospitalNew DelhiIndia Department of Urology Rajiv Gandhi Super Speciality HospitalTahirpurDelhiIndia Department of Urology Apollomedics Super Speciality HospitalLucknowUttar PradeshIndia

Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral ***:Thirty patients who met the inclusion criteria were randomised into two groups:TAU(Group A)and BMG urethroplasty(Group B).Surgical outcome was evaluated with pre-and post-operative work-up involving retrograde urethrogram,voiding cystourethrogram,uroflowmetry,and *** were followed up till 1 ***:Mean duration of surgery was statistically significant between two groups(p=0.0005).Maximum urine flow rate was comparable when compared between two groups(p=0.22)but statistically significant when compared pre-and post-operatively(p<0.001).At follow-up of 1 year,the successful outcomes were 80% in Group A and 87%in Group B.A total of five patients who had unsuccessful results required redo *** were minimal in both the ***:TAU provides outcomes equivalent to those of BMG *** has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.

关键词： Buccal mucosa Male urologic surgery tunica albuginea Urethral stricture Urethroplasty

Ultrastructural changes of penile tunica albuginea in diabetic rats

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Asian Journal of Andrology 2004年第4期6卷 365-368页

作者： Ying-LiLu Zhou-JunShen HuaWang Shan-WenChen Xie-LaiZhou Zhao-DianChen DepartmentofEndocrinology SirRunRunShawHospital DepartmentofUrology FirstAffiliatedHospitalSchoolofMedicineZhejiangUniversityHangzhou310016China

Aim: To clarify the ultrastructural changes of penile tunica albuginea (TA) in streptozotocin (STZ)-induced diabetic rats. Methods: Intraperitoneal injection of STZ was used to induce diabetes mellitus (DM) in 12 Sprague Dawley rats. Ten rats (age and weight-matched) were used as control. Blood samples from the tail snips of the rats were used for the determination of serum glucose levels with SureStep Plus Blood Meter. At week 4 and 10 after the injection, half of the rats in each group were sacrificed and penile samples were obtained from the middle third of the penile shaft for the examination of TA under scanning electron microscopy. Results: In the diabetic group, the serum glucose levels were higher (P<0.01 at both time points) and the TA were thinner (P<0.05) than those of the controls. In the control group, the fibers of TA were rich and arranged regularly and undulated, while in the diabetic group, the fibers were diminished, lost the undulations and were arranged irregularly. Conclusion: In rats, DM appeared to impair the penile TA ultrastructures and this impairment could contribute to diabetic erectile dysfunction in part by impairing the veno-occlusive function.

关键词： tunica albuginea penis diabetes mellitus scanning electron microscopy

Penile prosthesis implantation and tunica albuginea incision without grafting in the treatment of Peyronie＇s disease with erectile dysfunction

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Asian Journal of Andrology 2013年第3期15卷 391-394页

作者： Miroslav L Djordjevic Vladimir Kojovic School of Medicine University of Belgrade Belgrade 11000 Serbia

We evaluated penile prosthesis implantation with tunica albuginea-relaxing incisions without grafting in the treatment of Peyronie＇s disease associated with erectile dysfunction. Between April 2005 and June 2011, 62 patients underwent surgery due to severe Peyronie＇s disease associated with erectile dysfunction. Malleable and inflatable penile prostheses were inserted in 49 and 13 cases, respectively. Penile prostheses were inserted into the corpora cavernosa using the standard ventral approach. After lifting the neurovascular bundle, the tunica albuginea was incised and opened at the plaque region to correct the deformities and to lengthen the penis. Subsequently, the wide neurovascular bundle was replaced, and all incisions of the tunica albuginea were covered to prevent corporal grafting. In the median follow-up of 35 months （range 14-82 months）, the penis was completely straightened in 59 （95%） patients. Numbness of the glans, which the patients found initially upsetting, decreased or disappeared spontaneously 3-6 months later. Penile prosthesis implantation with tunica albuginea incisions is a viable alternative in the treatment of Peyronie＇s disease because the extensive dissection of the neurovascular bundle allows a good approach to the plaque and provides excellent covering of the incised tunica albuginea without additional grafting.

关键词： erectile dysfunction neurovascular bundle penile prosthesis Peyronie's disease tunica albuginea

Isolated ventral congenital penile curvature treated by incisionless plication of tunica albuginea in adults:A prospective case series

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Current Urology 2023年第3期17卷 206-212页

作者： Rabea A.Gadelkareem Mohammed A.Elgendy Adel Kurkar Ahmed M.El-Taher Islam F.Abdelkawi Assiut Urology and Nephrology Hospital Faculty of MedicineAssiut UniversityAssiut71515Egypt

Background:Numerous surgical techniques are available for the correction of isolated ventral congenital penile curvature(IVCPC).This study aimed to assess the outcomes and predictors of IVCPC treatment in adults using an incisionless plication *** and methods:This prospective case series examined patients with IVCPC who were treated in our hospital between October 2017 and February 2020 using incisionless plication of the tunica albuginea(Essed-Schroeder technique)with a covering pair of absorbable *** primary outcomes were successful correction(defined as a residual curvature≤15 degrees)and patient *** follow-ups were performed at 3,6,and 12 ***:A total of 23 patients were treated for IVCPC with a mean(range)age of 25.3(18-31)*** patients(78.3%)were single with cosmetic complaints,whereas the other 5 patients(21.7%)were married and presented with a difficult vaginal *** mean(range)curvature,length,and operative time were 40(30-50)degrees,15(10-19)cm,and 82(65-100)minutes,*** penile pain and numbness occurred in 13 patients(56.5%)and 7 patients(30.4%)only within the first month,*** suture knots were reported in 15 patients(65.5%)without being bothersome up to 12 *** postoperative means(ranges)of penile curvature and length were significantly different from that of the preoperative values at 3(5[0-20]degrees and 14.5[9-18.5]cm),6(5[0-20]degrees and 14.5[9-18.5]cm),and 12 months(5[0-30]degrees and 14.5[9-18.5]cm;all ptunica albuginea is effective and safe for the correction of IVCPC in adults with high success and patient satisfaction rates.

关键词： Congenital penile curvature Incisionless plication Isolated penile curvature tunica albuginea Ventral penile curvature

Effect of androgen deprivation on penile ultrastructure

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Asian Journal of Andrology 2003年第1期5卷 33-36页

作者： Zhou-JunSHEN Xie-LaiZHOU Ying-LiLU Zhao-DianCHEN DepartmentofUrology FirstAffiliatedHospital DepartmentofEndocrinology SirRunRunShawHospitalSchoolofMedicineZhejiangUniversityHangzhou310003China

Aim: To investigate the ultrastructural changes of penile corpus cavernosum and tunica albuginea in rats treated with castration or finasteride. Methods: Eighteen male Sprague-Dawley rats of nine weeks old were randomly divided into three groups with 6 rats each. Group A served as the control, Group B was castrated and Group C, treated with finasteride. Four weeks later, rats were anesthetized and blood samples obtained for the determination of serum testosterone (T) and dihydrotestosterone (DHT) levels; penile tissues were taken for scanning electron microscopy. Results: The T, free T and DHT levels in Group B and the DHT level in Group C were significantly lower than those in Group A (Ptunica albuginea was significantly thinner in Group B than that in Group A (P0.05). Elastic fibers in the tunica albuginea of Group A were very rich and arranged regularly and undulatedly, but in Group B, most of the elastic fibers were replaced by collagenous fibers. In Group C, the tunica albuginea was mainly composed of thick and irregular-arranged collagenous fibers. In Group A, there were abundant smooth muscle fibers in the trabeculae of corpus cavernosum, but they were much less in Group C and scarce or even disappeared in Group B. In Groups B and C, the diminished/disappeared smooth muscle fibers were replaced by irregularly arranged collagenous fibers. Conclusion: In rats, androgen is essential for maintaining the normal structure of penile tunica albuginea and corpus carvenosum.

关键词： corpus cavernosum tunica albuginea androgens penis scanning electron microscopy

Effects of extra-corporeal shock waves on penile hemodynamics and histopathology in rats

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Asian Journal of Andrology 2002年第4期4卷 249-253页

作者： Ahmet Tefekli Abdullah Armagan Bulent Erol Murat Celtik Isi Kilicaslan Asiye Nurten Ates Kadioglu Department of Urology Department of UrologyDepartment of UrologyDepartment of UrologyDepartment of Pathology Medical Faculty of IstanbulDepartment of Neuroscience Experimental Research Institution University of lstanbul TurkeyDepartment of Urology

Aim: To study the effect of extra-corporeal shock wave (ESW) on the penile hemodynamics and histopathology in rats. Methods: Adult male Sprague-Dawley rats were divided at random into 3 groups. ESW application was performed with a Siemens Lithostar with the rats under anesthesia lying prone on the balloon probe. Rats in Group Ⅰ received a total of 1000 shocks at 18 kV and immediately underwent hemodynamic evaluation performed by direct electrostimulation of the cavernous nerve and measurement of intracavernous pressure (ICP). Rats in Group Ⅱ received 3 times 1000 shocks at 18 kV at weekly intervals and hemodynamic evaluation was performed 1 month after the last ESW application. Group Ⅲ served as the control. Histopathological examinations of penile tissues were done on Masson's trichrome and hematoxylin and eosin stained sections. Results: Penile hemodynamic evaluation showed a trend toward a diminished mean maximal ICP, duration of erection, ICP during the plateau phase and maximal ICP/blood pressure ratio in Group Ⅰ, although there was no significant significance. The mean latency period in Groups Ⅰ and Ⅱ was prolonged. Petechial bleeding within tunical layers and small loci of hemorrhage within the corpora cavernosa were observed in Group Ⅰ. However, histopathological examination failed to reveal any significant differences between the groups in terms of smooth muscle content, tunical thickness, organization of collagen bundles and elastic fiber-lattice framework. Conclusion: ESW has certain damaging effects on the penis. (Asian J Androl 2002 Dec; 4: 249-253)

关键词： penis extra-corporeal shock wave Peyronie's disease tunica albuginea

Hypothesis of human penile anatomy,erection hemodynamics and their clinical applications

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Asian Journal of Andrology 2006年第2期8卷 225-234页

作者： Geng-Long Hsu Microsurgical Potency Reconstruction and Research Center: Taiwan Adventist Hospital Taipei 110TaiwanChina Geng-Long Hsu Foundation for Microsurgical Potency ResearchCA 91754USA

Aim： To summarize recent advances in human penile anatomy, hemodynamics and their clinical applications. Methods： Using dissecting, light, scanning and transmission electron microscopy the fibroskeleton structure, penile venous vasculature, the relationship of the architecture between the skeletal and smooth muscles, and erection hemodynamics were studied on human cadaveric penises and clinical patients over a period of 10 years. Results： The tunica albuginea of the corpora cavernosa is a bi-layered structure with inner circular and outer longitudinal collagen bundles. Although there is no bone in the human glans, a strong equivalent distal ligament acts as a trunk of the glans penis. A guaranteed method of local anesthesia for penile surgeries and a tunical surgery was developed accordingly. On the venous vasculature it is elucidated that a deep dorsal vein, a couple of cavernosal veins and two pairs of para-arterial veins are located between the Buck＇s fascia and the tunica albuginea. Furthermore, a hemodynamic study suggests that a fully rigid erection may depend upon the drainage veins as well, rather than just the intracavemosal smooth muscle. It is believed that penile venous surgery deserves another look, and that it may be meaningful if thoroughly and carefully performed. Accordingly, a penile venous surgery was developed. Conclusion： Using this new insight into penile anatomy and physiology, exact penile curvature correction, refined penile implants and promising penile venous surgery, as well as a venous patch, for treating Peyronie＇s deformity might be performed under pure local anesthesia on an outpatient basis. （Asian J Androl 2006 Mar; 8： 225-234）

关键词： penile venous anatomy curvature correction penile venous surgery tunica albuginea distal ligament deep dorsal vein cavemosal vein para-arterial vein ischiocavemosus bulbospongiosus

Surgical treatment of Peyronie＇s disease： choosing the best approach to improve patient satisfaction

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Asian Journal of Andrology 2008年第1期10卷 158-166页

作者： Paulo H. Egydio Urology Institute Rua lguatemi 192 Cj. 42 Sao Paulo 01451-010 Brazil

Aim： To discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyronie＇s disease. Methods： Recent advances in approaches to Peyronie＇s disease are discussed based on the literature and personal experiences. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed. Lengthening procedures on the convex side of the penile curvature by means of grafting offer the best possible gain from a reconstruction standpoint. Penile rectification and rigidity are required to achieve a completely functional penis. Most patients experience associated erectile dysfunction （ED）, and penile straightening alone may not be enough to restore complete function. Twenty-five patients were submitted to total penile reconstruction on length and girth with concomitant penile prosthesis implant. The maximum length restoration was possible and limited by the length of the dissected neurovascular bundle. The mean age was 55.4 years （32-69 years） and the mean angle of curvature 74.2± 22.4° （0-100°）. Pericardial grafting was used to cover the defect. The mean follow-up time was 11.2 ± 5.9 months （3-22 months）. Results： Mean functional penile length gain was 3.40 ＋ 0.73 cm （2-5 cm）. Penile prosthesis maintained the penis straight. No infections occurred. Sexual intercourse was restored in all patients and all reported recovered self-esteem. Conclusion： Improving patient satisfaction with the surgical treatment includes proper preoperative evaluation on stable disease, penile shortening, vascular and erectile status, patient decision and selection as well as extensive discussion on surgical technique for restoring functional penis （length and rigidity）. Length and girth restoration is very important for self-esteem and patient satisfaction.

关键词： Peyronie's disease erectile dysfunction induratio penis plastica penile induration tunica albuginea surgical technique penis graft surgery penile reconstruction

Identification of potential biomarkers of Peyronie's disease

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Asian Journal of Andrology 2005年第3期7卷 237-243,页

作者： Gui-Ting Lin Zhong Wang Ben-Chun Liu Tom F. Lu Ching-Shwun Lin Knuppe Molecular Urology Laboratory Department of Urology School of Medicine University of California San Francisco California 94143-1695 USA Department of Urology 9th Hospital Shanghai Second Medical University Shanghai 200011 China Department of Urology Huashan Hospital Fudan University Shanghai 200040 China

Aim： To identity proteins that are differentially expressed in cells derived from normal and diseased tunica albuginea （TA） as related to Peyronie＇s disease （PD）. Methods： Cells with characteristics of fibroblasts were isolated from two tissue sources. Those from the plaque of patients with PD were designated as PT cells, and those from the normally- appearing TA of the same patients were designated as NT cells. Messenger RNAs of these cells were analyzed by real-time polymerase chain reaction （RT-PCR） for the expression of monocyte chemoattractant protein 1 （MCP-1）. Crude protein lysates were analyzed by surface-enhanced laser desorption/ionization mass spectrometry （SELDI-MS） with IMAC30-Cu, CM10, and H50 chips. Each lysate was then separated into six fractions, which were further analyzed by SELDI-MS. Results： RT- PCR analysis showed that PT cells expressed higher levels of MCP-1 than their counterpart NT cells. SELDI-MS analysis showed that the crude protein lysates of all four cell strains produced similar and reproducible protein profiles on IMAC30-Cu and CM 10 chips. Additional SELDI-MS analyses with the fractionated lysates detected three proteins of 11.6 kDa, 14.5 kDa, 22.6 kDa that were upregulated in PT cells and two proteins of 6.3 kDa and 46,9 kDa that were downregulated in PT cells. Conclusion： MCP-1, which is often involved in tissue fibrosis, was expressed at higher levels in PT than that in NT cells. Five potential biomarkers for PD were identified by SELDI-MS analysis. （Asian J Androl 2005 Sep; 7： 237-243）

关键词： Peyronie's disease MCP-I tunica albuginea penis mass spectrometry SELDI

OJU Peyronie’s Disease in an Elderly Ghanaian Gentleman—A Case-Report and Literature Review

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Open Journal of Urology 2024年第10期14卷 519-531页

作者： Frank Obeng Aishah Fadila Adamu Samuel Edudzi Gavor Blessings Yao Setsoafia Sedem Atimpo Ebenezer Antwi Enoch Kwaku Adjaho Nana Yaa Agyenim Boateng Merveille Adjin Anum-Laryea Gwendolyn Egyefi Armah Juliet Enyonam Dzivenu Frank Fosu Joel Kwame Kwao Alexander Kofi Quansah Pearl Esi Demawu Hussein Rachel Akosua Sogbe Kafui Kossi Kekessie Mawuenyo Attawa Oyortey Ali Mamudu Ayamba Faculty of Surgery School of Medicine University of Health and Allied Sciences Ho Ghana Department of Surgery Ho Teaching Hospital Ho Ghana School of Medicine University of Health and Allied Sciences Ho Ghana

Background: Peyronie’s disease is characterized by fibrous plaque formation in the tunica albuginea, leading to penile curvature and sexual dysfunction. Surgical correction is often required in cases of severe deformity or significant functional impairment. Aim: To present the case of a patient with severe Peyronie’s disease who underwent surgical correction using an autologous fascia lata graft. Case Presentation: We report the case of a 77-year-old Black-African gentleman with Peyronie’s disease, presenting with a self-reported penile curvature of 70 degrees and significant sexual frustration. He was managed surgically with plaque excision followed by a tunica albuginea patch using a subcutaneously harvested autologous fascia lata graft, all performed in a single surgical session. Conclusion: This case highlights the importance of individualized surgical planning and patient-specific considerations in achieving optimal outcomes in the management of Peyronie’s disease, particularly in cases requiring grafting for severe curvature.

关键词： Peyronie’s Disease Penile Trauma tunica albuginea Penile Deformity Sexual Frustration Careful Diagnosis Tailored-Surgical Therapy Calcific-Plaques Autologous Fascia Lata Graft Water-Tight Repair