A case of gangrene of the penis, rarely seen at our University Hospital is reported. Urolithiasis, urinary tract infection, infected piles and anaemia were found to be associated with the condition. Because of rapid spread of the gangrene, partial amputation was required in this reported case.
Fractured penis has traumatic consequenoes on the patient as both his manhood and procreation ability are threatened. 2 cases of fractured penis successfully treated at the Armed Forces Hospital, Terendak, Melaka by a combination of surgical intervention and splintage are reported and the management discussed.
Fracture of the penis is not an uncommon urological emergency. Six patients with this injury, treated at the Institute of Urology, General Hospital, Kuala Lumpur, since 1988, were reviewed. Their ages ranged from 21 to 30 years old (mean 25). Four cases were self-inflicted by abnormal bending and 2 cases occurred during sexual intercourse. A sudden "cracking sound", violent pain, rapid flaccidity and deformity of the penis were documented. Duration of injury at presentation ranged from 12 to 90 hours (mean 35 hours). Primary repair of the tunica albuginea with absorbable suture was performed in all cases. The results of surgery was excellent, with restoration of normal function in 4 patients (2 patients defaulted follow-up). We advocate immediate surgical repair for this injury.
A case of marked penile skin loss following an adult circumcision is presented. The surgical requirement is to provide a soft and flexible cover for the penis to facilitate return of sensation and function. The two stage bilateral dartos musculocutaneous flaps offer an acceptable surgical alternative.
In this article, five cases with pearls in penile skin are discussed. These cases were viewed from multiple angles as number, colour, position of pearls, socio-economic status, occupation, sexual behaviour, and the background of the individuals. The number of pearls varied from one to five in these cases. The penile skin examination revealed old healed scar marks indicating that probably some had even more pearls. Three persons were directly or indirectly associated with drugs. One of the victim was HIV positive. Two of the cases were of homicide; one died in police custody; one died due to ischemic heart disease; and one had died in accident. The article also discusses the common beliefs behind this practice with review of the literature.
Many animals take advantage of the shaded, humid, and protected environments in subcortical spaces, i.e., thin spaces under the loosened bark of dead trees. Permanent inhabitants of subcortical spaces often show specialized morphologies, such as a miniaturized or dorsoventrally flattened body. However, the evolutionary consequences of these specialized morphologies on behavioral, ecological, and life-history traits have been little studied. We studied the mating biology and anatomy of Platylabia major (usually placed in the family Anisolabididae), which is an obligate inhabitant of subcortical spaces with a paper-like flattened body, and compared them with those of two thicker, spongiphorid earwigs, Nesogaster amoenus and Paralabellula curvicauda. Mating trials in various settings showed that Pl. major requires thin spaces sandwiched by two planes to accomplish genital coupling and insemination. In contrast, the thicker species, although also frequently found in subcortical spaces, could mate on a single horizontal plane due to the ability of the male to twist its abdomen through approximately 180°. Examination by micro-computed tomography and a reagent-based clearing technique revealed no substantive differences in the configuration of mid-abdominal musculature between the species. The dorsal and lateral muscles of Pl. major, which are almost parallel to the antero-posterior body axis for accommodation within the thin abdomen, seemed incapable of producing the power to twist the abdomen. The abdominal musculature conforms to a simple pattern in both male and female earwigs, which is repeated in each of the pregenital segments. We conclude that small differences in the range of motion of each abdominal segment can result in large differences in possible mating postures and positions. Surgical experiments also demonstrated that both right and left penises of Pl. major are competent and used for insemination with no lateral bias, as in most other earwigs with twin penises studied to date.
Penile reconstructive surgeries are performed mainly as radical treatment for conditions associated with congenital abnormalities of the urethra or penis, after penile trauma, penile cancer, short penis, corporal fibrosis and in cases of gender reassignment. We present here a method of penile reconstruction with a pre fabricated radial forearm free flap incorporating the segment of the radius for structural support.
The evolution of laterality, that is the biased use of laterally paired, morphologically symmetrical organs, has attracted the interest of researchers from a variety of disciplines. It is, however, difficult to quantify the fitness benefits of laterality because many organs, such as human hands, possess multimodal functions. Males of the earwig Labidura riparia (Insecta: Dermaptera: Labiduridae) have morphologically similar laterally paired penises, only one of which is used for inseminating the female during a single copulation bout, and thus provide a rare opportunity to address how selection pressure may shape the evolution of population-level laterality. Our population studies revealed that in 10 populations, located at 2.23-43.3° north, the right penis is predominantly used for copulating (88.6%). A damaged penis was found in 23% of rare left-handers, suggesting that the left penis can function as a spare when the right one is damaged. By pairing L. riparia females with surgically manipulated males, we found that males forced to use the right penis outperformed left-handed males in copulation (the probability of establishing genital coupling during the 1-hr observation period: odds ratio [OR] of 3.50) and insemination (probability of transferring a detectable amount of sperm: OR of 2.94). This right-handed advantage may be due to the coiled morphology of the sperm storage organ with a right-facing opening. Thus, female genital morphology may play a significant role in the evolution of handedness and may have acted as a driving force to reduce penis number in related taxa.
Priapism is caused by an imbalance between penile blood inflow and outflow. There are two types of priapism: low-flow priapism due to venous occlusion and high-flow priapism due to uncontrolled arterial flow to the veins. High-flow priapism most frequently occurs as a result of penile trauma in which the intercavernosal artery disruption causes an arteriocavernosal fistula. It is rarely encountered in the pediatric and prepubertal population. Clinically, it manifests as a painless, prolonged erection after perineal trauma. Treatment ranges from expectant management to open surgical exploration with vessel ligation. We report the successful treatment of high-flow priapism in a 12-year-old prepubertal boy with superselective embolization.
To report our experience with 5 cases of complications of penile enhancement procedures secondary to liquid silicone injections and our method of management of its debilitating effects. All five patients were treated with excision of penile shaft skin down to buck's fascia followed by resurfacing with split thickness skin grafting. We conclude that penile enhancement procedures with liquid silicone by non-medical personnel could result in devastating consequences. We also demonstrate that a simple method of excision of the entire penile shaft skin and resurfacing with split skin grafting showed improvement in cosmetic as well as functional outcome.
Clozapine is effective in treatment resistant schizophrenia. Priaprism is a rare side effect of Clozapine. It is a urological emergency and can lead to permanent damage to the penis. We present two cases two cases of clozapine induced priapism. Both patients were started on Clozapine in view of treatment resistant. For the first patient, priapism was noted after 2 years on Clozapine and treated conservatively. Clozapine was rechallenged in this patient but in a lower dosage and was augmented with amisulpride. He did not develop priaprism until date. In the second case, patient developed priaprism after 7 months on clozapine and required urological intervention. He redeveloped recurrent episode of priaprism as clozapine was restarted on the previous dose. In conclusion, priaprism is not related to dosage or duration of treatment of Clozapine. Thus, a careful risk-benefit assessment need to done as there is always a risk of priapism to recur when clozapine rechallenged.
Palpoxena hajeki sp. nov. from continental Malaysia, characterised by completely reddish brown body and deeply excavated anterior of male head with a pair of large twisted tufts of setae, is described and compared with the similar species. Colour photos of habitus, body details and penis are presented.
In the initial clinical examination of a child with ambiguous genitalia an accurate measurement of the corporeal length is needed. Most often the corporeal length is measured with a ruler from the symphysis pubis to the tip of the glans of a stretched penis. More recently, ultrasound has been successfully used to measure corporeal length. This study aimed to (i) establish normal values for corporeal length in normal male newborns using ultrasound measurement, (ii) compare these measurements to stretched corporeal measurements, (iii) compare the corporeal length of newborns of different races, and (iv) determine the relationship between corporeal length and birth weight, birth length and head circumference. This was a prospective study of 141 newborns. Ultrasound imaging was done in an oblique parasagittal plane such that the corpus could be included in a single image and measured, Stretched corporeal length was measured with the penis stretched alongside a wooden spatula and the length from the pubic bone to the tip of the glans was marked on the spatula and measured. By ultrasound measurement the mean corporeal length of the normal newborn was 3.18 +/- 0.56cm. There was no significant difference in the mean corporeal length when determined by ultrasound and by stretched corporeal measurement. There was no significant difference in the mean corporeal length of the different races when the length was determined by either ultrasound or stretched corporeal measurement. There was a positive correlation between ultrasound length and birth weight and birth length. However, there was no correlation between ultrasound length and head circumference. There was no significant correlation between the stretched length and either birth weight, birth length or head circumference.
This is a case of a male in his late 30s who died due to acute myocardial ischemia. His penis was bandaged. The penis was inflamed and had infected abrasions. The possible relevances of such an incidental finding and its contribution to sudden death is explored. The case report shows photographs of the bandage in situ and its components, inflammation of frenulum, injury to the shaft, and the generalized inflamed and mildly swollen penis. These changes were considered to be caused by bites. The micro-photographic findings in the case were of acute myocardial ischemia, pulmonary oedema, and fatty liver.
Hypospadias is a congenital deformity characterised by an abnormally located urethral opening, that could occur anywhere proximal to its normal location on the ventral surface of glans penis to the perineum. Many operations had been described for the management of this deformity.
The clinical features and management of 12 patients with Fournier's gangrene are described. The patients differed from the usual description of Fournier's gangrene in that they were older, the disease had a less abrupt onset and a definite predisposing factor was identified in 10 of the 12 patients. The importance of early diagnosis and excision of necrotic tissue is emphasized.
Priapism is a rare clinical presentation of a patient with chronic myeloid leukaemia (CML). Herein, we present a young Nepalese man that presented to the emergency department with an acute and painful penile erection for two days. Clinically, he was pale and abdominal examination revealed hepatomegaly. Combined oncologic and initial urological intervention with carvernosal aspiration and intracavernosal phenylephrine failed to achieve detumescence. The patient underwent an emergency corporoglandular shunting eventually. In this case report, we discuss the management compared with previously reported cases.