Ultrastructure of the Tunica Albuginea in Congenital Penile Curvature

Darewicz, Barbara; Kudelski, Jacek; Szynaka, B; Nowak, H.; Darewicz, J

doi:10.1016/s0022-5347(05)65671-6

Cited by 29 publications

(13 citation statements)

References 17 publications

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“…The cause of penile curvature is unknown but might be triggered by changes in the tissue structure of the tunica albuginea 4 . Ventral curvature is considered the most common 5 and in our series, 29/49 patients (59.1%) had ventral or left ventrolateral curvature.…”

Section: Discussionmentioning

confidence: 54%

New plication technique for the treatment of congenital penile curvature

Kato

Nagao²,

Ishii

et al. 2005

Reprod Medicine & Biology

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Conditions that cause curvature of the erect penis also lead to difficulties with intercourse. The present study presents an effective surgical treatment for congenital penile curvature. Between March 1996 and August 2004, 49 patients were diagnosed with congenital penile curvature at the Toho University Omori Hospital Reproduction Center, Tokyo. Of these, 27 eligible patients underwent surgical treatment. The operative technique used involved the tunica albuginea being exposed and a number of vertical incisions were made through its superficial layers. The superficial layer of the tunica albuginea was then resected using scissors. Inverted plication sutures were then placed in the raw surface of the corpus cavernosum using 2-0 nylon. In addition, 2-0 polyglactic acid (Vicryl) sutures were placed on either side of each nylon suture knot. Of a total of 49 patients, 27 eligible patients underwent surgical treatment with no serious postoperative complications. All 27 patients were able to sustain intercourse. There were no new cases of erectile dysfunction, penile pain or penile shortening. There were no recurrences of penile curvature. This new partial thickness shaving, inverted sutures reinforced with dissolving sutures plication method is an extremely effective surgical treatment for congenital penile curvature, with a superior safety profile. (Reprod Med Biol 2005;: 255-258).

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Section: Discussionmentioning

confidence: 54%

New plication technique for the treatment of congenital penile curvature

Kato

Nagao²,

Ishii

et al. 2005

Reprod Medicine & Biology

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show abstract

“…However, recent histopathologic studies have revealed that CPC is caused by abnormal development of the tunica albuginea of the corpora cavernosa and increased elasticity of tunica on the longer side, rather than urethral anomalies or short urethrae ( 13 ). In cases with ventral curvatures, asymmetric corporal development is responsible and the urethra is mostly normal, but in cases with lateral, dorsal or mixed curvatures, the abnormal development is always on the convex side of the tunica albuginea.…”

Section: Discussionmentioning

confidence: 99%

An unanswered question in pediatric urology: the post pubertal persistence of prepubertal congenital penile curvature correction by tunical plication

et al. 2017

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Objective:The aim of this study is to analyze post pubertal results of pre pubertal tunica albuginea plication with non-absorbable sutures in the correction of CPC.Materials and Methods:The files of patients who underwent tunica albuginea plication without incision (dorsal/lateral) were retrospectively reviewed. Patients younger than 13 years of age at the time of operation and older than 14 years of age in November 2015 were included. Patients with a penile curvature of less than 30 degrees & more than 45 degrees and penile/urethral anomalies were excluded. All of the patients underwent surgery followed by circumcision.Results:The mean age of patients at the time of the operation was 9.7 years (range, 6-13 years). The mean degree of ventral penile curvature measured during the operation was 39 degrees while it was 41 degrees in the lateral curvatures. All of the patients were curvature-free at the end of the operation. At the time of the follow-up examination, the mean age was 16.7 years (range, 14-25 years). Six patients had a straight (0-10 degrees) penis during erection and seven patients had recurrent penile curvatures ranging from 30 to 50 degrees.Conclusion:Pre pubertal tunica albuginea plication of congenital penile curvature (30-45 degrees) with non-absorbable sutures performed without incision is a minimal invasive method especially when performed during circumcision. However, recurrence might be observed in half of the patients after puberty.

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“…The presence of fibrin in the human PD plaque even months after development of the plaque, as has been previously shown by histochemical staining [6], is very characteristic of the human condition and we confirm by immunodetection the presence of fibrin, or its precursor, fibrinogen, in the plaque. The injection of fibrin alone into the TA of the rat can elicit a lesion characterized by oedema and inflammation followed by tunical thickening, collagen disorganization, elastin fragmentation, and increased TGF-b 1, ROS, ASMA and iNOS expression, as is seen in both human PD and the TGF-b 1-induced animal model of PD [7][8][9][11][12][13][14][15]. This supports the hypothesis that fibrin deposition after trauma to the penis could be the primary event triggering the expression of pro-fibrotic factors like TGF-b 1 that would lead to the development of a tunical plaque.…”

Section: Discussionmentioning

confidence: 99%

Fibrin as an inducer of fibrosis in the tunica albuginea of the rat: a new animal model of Peyronie's disease

et al. 2003

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RESULTSAt 1 week after injection of fibrin into the rat TA, only oedema was present; at 3 weeks, the oedema developed into a characteristic fibrotic PD-like plaque. The injection of TGFb 1 into the TA also induced oedema in the TA at 1 and 3 weeks but there was very little evidence of a recognisable plaque at either time. Injection with TGF-b 1 plus fibrin resulted in oedema at 1 week but at 3 weeks there was a smaller plaque than with fibrin only. At 6 weeks the induced plaques in the fibrin-only and fibrin + TGF-b 1 groups persisted, and were comparable with those elicited at this time by TGF-b 1 alone. The control animals showed no pathology at any of the sample times. At 3 weeks the PD plaque induced by injection with fibrin alone had not only greater expression of TGF-b 1 than the TA of the animals receiving TGF-b 1 alone, but also greater levels of other markers of fibrosis, e.g. HO1 (reactive oxygen species), ASMA (presence of myofibroblasts), apoptosis, and PAI (inhibitor of fibrinolysis). iNOS, a known antifibrotic agent, was also increased. In human PD plaque tissue, fibrin was detected by immunohistochemistry in all nine specimens. CONCLUSIONSThese results suggest that fibrin, when introduced into the TA of the rat penis, acts as a potential profibrotic protein, possibly via the local release of TGF-b 1, and induces a plaque not only histologically similar to that induced by TGF-b 1 but to that of the human condition. Because fibrin can extravasate from the blood into the human TA after an injury to the TA, and because fibrin persists in the plaque tissue, we hypothesise that fibrin may play a key role in the pathogenesis of human PD.

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Ultrastructure of the Tunica Albuginea in Congenital Penile Curvature

Abstract: Our results show that ultrastructural changes in the tunica albuginea may cause congenital penile curvature, possibly by altering mechanical properties.

Cited by 29 publications

References 17 publications

New plication technique for the treatment of congenital penile curvature

New plication technique for the treatment of congenital penile curvature

An unanswered question in pediatric urology: the post pubertal persistence of prepubertal congenital penile curvature correction by tunical plication

Fibrin as an inducer of fibrosis in the tunica albuginea of the rat: a new animal model of Peyronie's disease

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