Objective:Peyronie’s disease(PD)is an abnormal wound healing in the penile tunica albuginea.After fibrotic plaque excision,different graft materials have been used to repair the defects,but the optimal graft remains ...Objective:Peyronie’s disease(PD)is an abnormal wound healing in the penile tunica albuginea.After fibrotic plaque excision,different graft materials have been used to repair the defects,but the optimal graft remains unknown.This study aimed to compare the functional outcomes of testicular tunica vaginalis grafts and bovine pericardium grafts in patients with severe PD.Methods:A retrospective comparative study was conducted on 33 PD patients undergoing partial plaque excision and grafting from September 2015 to May 2021.The patients were divided into two groups depending on the type of graft used.For 15 patients in Group B,testicular tunica vaginalis grafts were used to repair the defect,while for 18 patients in Group A,bovine pericardium grafts were used.Data of the patient’s age,comorbidities,sexual function,penile curvature,postoperative complications,need for further treatment,change in penile length,and satisfaction were gathered and compared between the groups.Sexual function was evaluated using the 5-item version of the International Index of Erectile Function(IIEF-5),and a functional less than 20-degree penile curvature after surgery was considered a successful intervention.Results:There was no difference in age,comorbidities,degree of curvature,perioperative IIEF-5,operative time,plaque size,or complication rates.After surgery,a statistically significant improvement in curvature degree(p<0.05)and satisfactory penile appearance(p<0.05)were seen in both groups without any superiority between the two groups(p=0.423 and p=0.840,respectively).With a 30-month follow-up,the IIEF-5 was consistent in both groups,with no statistical significance between the groups(p=0.492).The main change in penile length during the operation was increased and still positive in the last follow-up in both groups without statistical significance(p=0.255 and p=0.101,respectively).Conclusion:Partial plaque excision and corporoplasty with both testicular tunica vaginalis or bovine pericardium grafts are equally effective in treating males with clinically significant PD.展开更多
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 stricture.Methods:Thirty patients who met the inclu...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 stricture.Methods: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 urethroscopy.Patients were followed up till 1 year.Results: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 urethroplasty.Complications were minimal in both the groups.Conclusion:TAU provides outcomes equivalent to those of BMG urethroplasty.TAU has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.展开更多
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 Spra...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.展开更多
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 ...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.展开更多
Objective:The surgical repair of hypospadias is done in two stages in a select group of patients with severe anomaly.The first stage(Ⅰ)procedure consists of correction of penile shaft curvature and second stage(Ⅱ)re...Objective:The surgical repair of hypospadias is done in two stages in a select group of patients with severe anomaly.The first stage(Ⅰ)procedure consists of correction of penile shaft curvature and second stage(Ⅱ)repair involves the creation of a neourethra.This neourethra needs a cover of an intermediate layer in order to have good functional and cosmetic results.Among the various local flaps,tunica vaginalis flap is a good option for the use as an intermediate layer.Methods:We have managed 22 patients of chordee with hypospadias by staged repair.In Stage I,chordee correction was done by dividing the urethral plate and covering the penile shaft with dorsal prepucial flaps.In Stage Ⅱ,a neourethra was created and covered with tunica vaginalis flap either through the same incision(14/22)or via a subcutaneous tunnel(8/22).An indwelling catheter was kept for 10 to 12 days.Results:Eighteen(81.8%)patients had successful functional and cosmetic repair.Two patients(9.1%)had urethrocutaneous fistula of which one healed on subsequent dilatation while the other one(4.5%)needed repair.Overall fistula formation rate was 4.5%.In two patients,the external urinary meatus could be made upto subglanular or coronal level.Conclusion:Staged repair of chordee with hypospadias is valuable in selected group of patients and tunica vaginalis flap is an excellent intermediate layer to cover the neourethra.However preoperative counseling is particularly essential in patients where the external urinary meatus can be created at coronal or subglanular level.展开更多
The purpose of this study is to establish a gene delivery system for interstitial tissue-specific protein expression in mice testes using modified recombinant baculovirus. Green fluorescent protein （GFP）-expressing ...The purpose of this study is to establish a gene delivery system for interstitial tissue-specific protein expression in mice testes using modified recombinant baculovirus. Green fluorescent protein （GFP）-expressing recombinant baculovirus （GFP-baculovirus）, in which the insect cell-specific polyhedron promoter was replaced by the cytomegalovirus （CMV）-IE promoter, was used to transfect testicular cells in vitro, and for intra-tunica albuguineal injection of the interstitial tissue of the testis. GFP expression was monitored in frozen testes sections by fluorescence microscopy. Expression of GFP in testicular tissues was also assessed by reverse transcription polymerase chain reaction （RT-PCR）, and protein expression was assessed by Western blot. Testicular cells in vitro were infected efficiently by modified recombinant GFP-baculovirus. lntra-tunica albuguineal injection of GFP- baculovirus into the mouse testis resulted in a high level of GFP expression in the interstitial tissues. RT-PCR analysis clearly showed GFP gene expression in the testis, particularly interstitial tissues. Intra-tunica albuguineal injection of a modified baculovirus that encoded recombinant rat insulin-like growth factor binding protein （IGFBP）-5 resulted in an increase in IGFBP-5 in testis and semen. In conclusion, we have developed an efficient delivery system for gene expression in vivo in testicular cells, particularly cells of the interstitial tissue using intratunica albuguineal injection of a modified recombinant baculovirus. This method will be particularly relevant for application that requires gene delivery and protein expression in the testicular cells of the outer seminiferous tubule of the testis.展开更多
BACKGROUND Metastases from pancreas or ampullary malignancies are common,but the spread to testicle and paratesticular tissue is exceedingly rare.To the best of our knowledge,fewer than 30 cases have been reported in ...BACKGROUND Metastases from pancreas or ampullary malignancies are common,but the spread to testicle and paratesticular tissue is exceedingly rare.To the best of our knowledge,fewer than 30 cases have been reported in the literature.More rarely,metastasis to tunica vaginalis testis occurs without involvement of the testes and epididymis.CASE SUMMARY A 65-year-old male who complained of painless swelling of the left scrotum for over 1 wk was referred to the Department of Urology.Scrotal ultrasound showed left testicular hydrocele with paratesticular masses.Chest computed tomography revealed lung metastasis and enlarged left supraclavicular lymph node.The blood tumor markersalpha-fetoprotein,human chorionic gonadotropin,and serum lactate dehydrogenase were withinnormal limits.The preoperative diagnosis was left testicular tumor with lung metastasis.Then radical orchidectomy of the left testicle and high ligation of the spermatic cord were performed,and postoperative histopathology suggested metastatic tumors that was confirmed by an abdominal computed tomographic scan.The positive computed tomography findings,in conjunction with the expression of cytokeratin 7(CK7),CK20,CK5/6,and absence of expression of Wilms’tumor suppressor gene 1,calretinin,melanocyte,prostate-specific antigen,thyroid transcription factor-1,GATA binding protein 3,caudal type homeobox 2,and napsinA supported the diagnosis of pancreatic adenocarcinoma.The outcome of this patient was unsatisfactory,and he died 3 mo later.CONCLUSION This case suggests that pancreatic metastatic carcinoma must be considered in the differential diagnosis of scrotal enlargement.The advanced age of the patient wassuggestive of a secondary testicular tumor.In addition,careful physical examination and ultrasonography as well as radiological examination have become a standard modality.展开更多
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...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 technique.Materials 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 sutures.The primary outcomes were successful correction(defined as a residual curvature≤15 degrees)and patient satisfaction.Postoperative follow-ups were performed at 3,6,and 12 months.Results:A total of 23 patients were treated for IVCPC with a mean(range)age of 25.3(18-31)years.Eighteen patients(78.3%)were single with cosmetic complaints,whereas the other 5 patients(21.7%)were married and presented with a difficult vaginal intromission.The mean(range)curvature,length,and operative time were 40(30-50)degrees,15(10-19)cm,and 82(65-100)minutes,respectively.Postoperative penile pain and numbness occurred in 13 patients(56.5%)and 7 patients(30.4%)only within the first month,respectively.Palpable suture knots were reported in 15 patients(65.5%)without being bothersome up to 12 months.The 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 p<0.001).Age,preoperative penile curvature,penile length,postoperative pain,wound infections,and knot palpation insignificantly affected curvature recurrence.Seventeen patients(73.9%)were very satisfied with their surgical outcomes.Conclusions:Incisionless plication of the tunica albuginea is effective and safe for the correction of IVCPC in adults with high success and patient satisfaction rates.展开更多
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 deform...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.展开更多
Several andrological diseases require surgical repair or reconstruction of tunica albuginea, which envelops the corpora cavernosa penis. Despite intense research efforts involving a variety of biological materials, su...Several andrological diseases require surgical repair or reconstruction of tunica albuginea, which envelops the corpora cavernosa penis. Despite intense research efforts involving a variety of biological materials, such as skin, muscle aponeurosis, human dura mater, tunica vaginalis, and pericardium, engineered tunica albuginea suitable for graft use is yet to be obtained. The study investigates microsurgical tunica albuginea allotransplantation in an animal model with the purpose of creation of an organ-specific tissue bank to store penile tissue, from cadaveric donors and male-to-female trans-sexual surgery, for allogeneic transplantation. Materials were tunica albuginea tissue explanted from 15 donor rats, cryopreserved at -80~C, gamma-irradiated, and implanted in 15 recipient rats, of which three rats were used as controls. Penile grafts were explanted at different time intervals; after macroscopic evaluation of the organ, the grafts were processed to morphological, histochemical, and immunohistochemical examinations by light microscopy. Detection of pro-inflammatory cytokines was also performed. Examination of the tunica albuginea allografts collected 1, 3, or 6 months after surgery and of control tunica albuginea fragments showed that tunica albuginea implants achieved biointegration with adjacent tissue at all-time points. The integration of cryopreserved rat tunica albuginea allografts, documented by our study, encourages the exploration of tunica albuginea allotransplantation in humans. In conclusion, the effectiveness and reliability of the tunica albuginea conditioning protocol described here suggest the feasibility of setting up a tunica albuginea bank as a further tissue bank.展开更多
This study aimed to explore whether and how anti-lysyl oxidase(anti-LOX)combined with a vacuum device(VD)could promote penile lengthening and to evaluate the effect on erectile function.This study was performed on fou...This study aimed to explore whether and how anti-lysyl oxidase(anti-LOX)combined with a vacuum device(VD)could promote penile lengthening and to evaluate the effect on erectile function.This study was performed on four groups of adult rats:control,anti-LOX,VD(negative pressure value of-300 mmHg),and anti-LOX+VD.Penile length was measured by a modified VD method and verified on exposed length data.Intracavernous pressure(ICP)and maximum ICP/mean arterial pressure(MAP)ratio were recorded to assess erectile function.For corpus cavernosum,LOX activity and concentrations of pyridinoline,desmosine,hydroxyproline,and elastin were analyzed;transmission electron microscope and Hart’s elastin staining were performed to monitor microstructural changes.Anti-LOX and VD significantly lengthened the penis by 10.8%(3.75 mm)and 8.2%(2.48 mm)compared with the control group,respectively,while anti-LOX+VD achieved the longest penile size(40.58±0.40 mm)which was 17.4%longer than the control group(34.58±0.54 mm).After 1-week washout,no penile retraction was observed.Meanwhile,exposed penile length data confirmed that the penis in the anti-LOX+VD group was also significantly longer.Anti-LOX inhibited LOX activity to reduce pyridinoline level,which led the penile tunica albuginea remodeling.However,it had no effect on hydroxyproline,desmosine,and elastin levels.Moreover,anti-LOX had no impact on erectile function,which was determined by ICP and ICP/MAP ratio.These results suggest that anti-LOX elongates the penis by reducing pyridinoline,which induces tunica albuginea remodeling.This lengthening effect was more obvious when combined with a VD.All procedures had no impact on erectile function.展开更多
Introduction: Penile fracture is a urological emergency that occurs when the penis in an erect state suffers a blunt trauma resulting in a rupture of the tunica albuginea of either one or both corpora cavernosa. It is...Introduction: Penile fracture is a urological emergency that occurs when the penis in an erect state suffers a blunt trauma resulting in a rupture of the tunica albuginea of either one or both corpora cavernosa. It is often caused by vigorous sexual intercourse, hence the incidence of penile fracture is under-reported. We therefore present our experience of the clinical presentation and surgical management of penile fracture. Presentation of Cases: We report three cases of penile fracture and all were diagnosed based on their clinical presentation and examination findings. The patients include two middle aged men and one young man, all with history of hearing a popping sound and experiencing sudden onset pain with detumescence of the penis. No radiological investigations were carried out. An emergency surgical repair was done for all patients. Discussion: All the patients had no urethral injury on presentation and underwent immediate surgical repair. The erectile and voiding function of each patient was preserved. Conclusion: The management of penile fracture involves early diagnosis and immediate surgical repair. Early intervention is necessary to preserve penile function.展开更多
文摘Objective:Peyronie’s disease(PD)is an abnormal wound healing in the penile tunica albuginea.After fibrotic plaque excision,different graft materials have been used to repair the defects,but the optimal graft remains unknown.This study aimed to compare the functional outcomes of testicular tunica vaginalis grafts and bovine pericardium grafts in patients with severe PD.Methods:A retrospective comparative study was conducted on 33 PD patients undergoing partial plaque excision and grafting from September 2015 to May 2021.The patients were divided into two groups depending on the type of graft used.For 15 patients in Group B,testicular tunica vaginalis grafts were used to repair the defect,while for 18 patients in Group A,bovine pericardium grafts were used.Data of the patient’s age,comorbidities,sexual function,penile curvature,postoperative complications,need for further treatment,change in penile length,and satisfaction were gathered and compared between the groups.Sexual function was evaluated using the 5-item version of the International Index of Erectile Function(IIEF-5),and a functional less than 20-degree penile curvature after surgery was considered a successful intervention.Results:There was no difference in age,comorbidities,degree of curvature,perioperative IIEF-5,operative time,plaque size,or complication rates.After surgery,a statistically significant improvement in curvature degree(p<0.05)and satisfactory penile appearance(p<0.05)were seen in both groups without any superiority between the two groups(p=0.423 and p=0.840,respectively).With a 30-month follow-up,the IIEF-5 was consistent in both groups,with no statistical significance between the groups(p=0.492).The main change in penile length during the operation was increased and still positive in the last follow-up in both groups without statistical significance(p=0.255 and p=0.101,respectively).Conclusion:Partial plaque excision and corporoplasty with both testicular tunica vaginalis or bovine pericardium grafts are equally effective in treating males with clinically significant PD.
文摘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 stricture.Methods: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 urethroscopy.Patients were followed up till 1 year.Results: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 urethroplasty.Complications were minimal in both the groups.Conclusion:TAU provides outcomes equivalent to those of BMG urethroplasty.TAU has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.
文摘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.
文摘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.
文摘Objective:The surgical repair of hypospadias is done in two stages in a select group of patients with severe anomaly.The first stage(Ⅰ)procedure consists of correction of penile shaft curvature and second stage(Ⅱ)repair involves the creation of a neourethra.This neourethra needs a cover of an intermediate layer in order to have good functional and cosmetic results.Among the various local flaps,tunica vaginalis flap is a good option for the use as an intermediate layer.Methods:We have managed 22 patients of chordee with hypospadias by staged repair.In Stage I,chordee correction was done by dividing the urethral plate and covering the penile shaft with dorsal prepucial flaps.In Stage Ⅱ,a neourethra was created and covered with tunica vaginalis flap either through the same incision(14/22)or via a subcutaneous tunnel(8/22).An indwelling catheter was kept for 10 to 12 days.Results:Eighteen(81.8%)patients had successful functional and cosmetic repair.Two patients(9.1%)had urethrocutaneous fistula of which one healed on subsequent dilatation while the other one(4.5%)needed repair.Overall fistula formation rate was 4.5%.In two patients,the external urinary meatus could be made upto subglanular or coronal level.Conclusion:Staged repair of chordee with hypospadias is valuable in selected group of patients and tunica vaginalis flap is an excellent intermediate layer to cover the neourethra.However preoperative counseling is particularly essential in patients where the external urinary meatus can be created at coronal or subglanular level.
文摘The purpose of this study is to establish a gene delivery system for interstitial tissue-specific protein expression in mice testes using modified recombinant baculovirus. Green fluorescent protein （GFP）-expressing recombinant baculovirus （GFP-baculovirus）, in which the insect cell-specific polyhedron promoter was replaced by the cytomegalovirus （CMV）-IE promoter, was used to transfect testicular cells in vitro, and for intra-tunica albuguineal injection of the interstitial tissue of the testis. GFP expression was monitored in frozen testes sections by fluorescence microscopy. Expression of GFP in testicular tissues was also assessed by reverse transcription polymerase chain reaction （RT-PCR）, and protein expression was assessed by Western blot. Testicular cells in vitro were infected efficiently by modified recombinant GFP-baculovirus. lntra-tunica albuguineal injection of GFP- baculovirus into the mouse testis resulted in a high level of GFP expression in the interstitial tissues. RT-PCR analysis clearly showed GFP gene expression in the testis, particularly interstitial tissues. Intra-tunica albuguineal injection of a modified baculovirus that encoded recombinant rat insulin-like growth factor binding protein （IGFBP）-5 resulted in an increase in IGFBP-5 in testis and semen. In conclusion, we have developed an efficient delivery system for gene expression in vivo in testicular cells, particularly cells of the interstitial tissue using intratunica albuguineal injection of a modified recombinant baculovirus. This method will be particularly relevant for application that requires gene delivery and protein expression in the testicular cells of the outer seminiferous tubule of the testis.
基金National Natural Science Foundation of China,No.81901534.
文摘BACKGROUND Metastases from pancreas or ampullary malignancies are common,but the spread to testicle and paratesticular tissue is exceedingly rare.To the best of our knowledge,fewer than 30 cases have been reported in the literature.More rarely,metastasis to tunica vaginalis testis occurs without involvement of the testes and epididymis.CASE SUMMARY A 65-year-old male who complained of painless swelling of the left scrotum for over 1 wk was referred to the Department of Urology.Scrotal ultrasound showed left testicular hydrocele with paratesticular masses.Chest computed tomography revealed lung metastasis and enlarged left supraclavicular lymph node.The blood tumor markersalpha-fetoprotein,human chorionic gonadotropin,and serum lactate dehydrogenase were withinnormal limits.The preoperative diagnosis was left testicular tumor with lung metastasis.Then radical orchidectomy of the left testicle and high ligation of the spermatic cord were performed,and postoperative histopathology suggested metastatic tumors that was confirmed by an abdominal computed tomographic scan.The positive computed tomography findings,in conjunction with the expression of cytokeratin 7(CK7),CK20,CK5/6,and absence of expression of Wilms’tumor suppressor gene 1,calretinin,melanocyte,prostate-specific antigen,thyroid transcription factor-1,GATA binding protein 3,caudal type homeobox 2,and napsinA supported the diagnosis of pancreatic adenocarcinoma.The outcome of this patient was unsatisfactory,and he died 3 mo later.CONCLUSION This case suggests that pancreatic metastatic carcinoma must be considered in the differential diagnosis of scrotal enlargement.The advanced age of the patient wassuggestive of a secondary testicular tumor.In addition,careful physical examination and ultrasonography as well as radiological examination have become a standard modality.
文摘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 technique.Materials 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 sutures.The primary outcomes were successful correction(defined as a residual curvature≤15 degrees)and patient satisfaction.Postoperative follow-ups were performed at 3,6,and 12 months.Results:A total of 23 patients were treated for IVCPC with a mean(range)age of 25.3(18-31)years.Eighteen patients(78.3%)were single with cosmetic complaints,whereas the other 5 patients(21.7%)were married and presented with a difficult vaginal intromission.The mean(range)curvature,length,and operative time were 40(30-50)degrees,15(10-19)cm,and 82(65-100)minutes,respectively.Postoperative penile pain and numbness occurred in 13 patients(56.5%)and 7 patients(30.4%)only within the first month,respectively.Palpable suture knots were reported in 15 patients(65.5%)without being bothersome up to 12 months.The 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 p<0.001).Age,preoperative penile curvature,penile length,postoperative pain,wound infections,and knot palpation insignificantly affected curvature recurrence.Seventeen patients(73.9%)were very satisfied with their surgical outcomes.Conclusions:Incisionless plication of the tunica albuginea is effective and safe for the correction of IVCPC in adults with high success and patient satisfaction rates.
文摘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.
文摘Several andrological diseases require surgical repair or reconstruction of tunica albuginea, which envelops the corpora cavernosa penis. Despite intense research efforts involving a variety of biological materials, such as skin, muscle aponeurosis, human dura mater, tunica vaginalis, and pericardium, engineered tunica albuginea suitable for graft use is yet to be obtained. The study investigates microsurgical tunica albuginea allotransplantation in an animal model with the purpose of creation of an organ-specific tissue bank to store penile tissue, from cadaveric donors and male-to-female trans-sexual surgery, for allogeneic transplantation. Materials were tunica albuginea tissue explanted from 15 donor rats, cryopreserved at -80~C, gamma-irradiated, and implanted in 15 recipient rats, of which three rats were used as controls. Penile grafts were explanted at different time intervals; after macroscopic evaluation of the organ, the grafts were processed to morphological, histochemical, and immunohistochemical examinations by light microscopy. Detection of pro-inflammatory cytokines was also performed. Examination of the tunica albuginea allografts collected 1, 3, or 6 months after surgery and of control tunica albuginea fragments showed that tunica albuginea implants achieved biointegration with adjacent tissue at all-time points. The integration of cryopreserved rat tunica albuginea allografts, documented by our study, encourages the exploration of tunica albuginea allotransplantation in humans. In conclusion, the effectiveness and reliability of the tunica albuginea conditioning protocol described here suggest the feasibility of setting up a tunica albuginea bank as a further tissue bank.
基金the National Nature Science Foundation of China(No.81871147 and No.81671453)Sichuan Science and Technology Program(No.2018SZ0019 and No.2018TJPT0018).
文摘This study aimed to explore whether and how anti-lysyl oxidase(anti-LOX)combined with a vacuum device(VD)could promote penile lengthening and to evaluate the effect on erectile function.This study was performed on four groups of adult rats:control,anti-LOX,VD(negative pressure value of-300 mmHg),and anti-LOX+VD.Penile length was measured by a modified VD method and verified on exposed length data.Intracavernous pressure(ICP)and maximum ICP/mean arterial pressure(MAP)ratio were recorded to assess erectile function.For corpus cavernosum,LOX activity and concentrations of pyridinoline,desmosine,hydroxyproline,and elastin were analyzed;transmission electron microscope and Hart’s elastin staining were performed to monitor microstructural changes.Anti-LOX and VD significantly lengthened the penis by 10.8%(3.75 mm)and 8.2%(2.48 mm)compared with the control group,respectively,while anti-LOX+VD achieved the longest penile size(40.58±0.40 mm)which was 17.4%longer than the control group(34.58±0.54 mm).After 1-week washout,no penile retraction was observed.Meanwhile,exposed penile length data confirmed that the penis in the anti-LOX+VD group was also significantly longer.Anti-LOX inhibited LOX activity to reduce pyridinoline level,which led the penile tunica albuginea remodeling.However,it had no effect on hydroxyproline,desmosine,and elastin levels.Moreover,anti-LOX had no impact on erectile function,which was determined by ICP and ICP/MAP ratio.These results suggest that anti-LOX elongates the penis by reducing pyridinoline,which induces tunica albuginea remodeling.This lengthening effect was more obvious when combined with a VD.All procedures had no impact on erectile function.
文摘Introduction: Penile fracture is a urological emergency that occurs when the penis in an erect state suffers a blunt trauma resulting in a rupture of the tunica albuginea of either one or both corpora cavernosa. It is often caused by vigorous sexual intercourse, hence the incidence of penile fracture is under-reported. We therefore present our experience of the clinical presentation and surgical management of penile fracture. Presentation of Cases: We report three cases of penile fracture and all were diagnosed based on their clinical presentation and examination findings. The patients include two middle aged men and one young man, all with history of hearing a popping sound and experiencing sudden onset pain with detumescence of the penis. No radiological investigations were carried out. An emergency surgical repair was done for all patients. Discussion: All the patients had no urethral injury on presentation and underwent immediate surgical repair. The erectile and voiding function of each patient was preserved. Conclusion: The management of penile fracture involves early diagnosis and immediate surgical repair. Early intervention is necessary to preserve penile function.
