Current treatment options for penile fractures

The diagnosis of "penile fracture" describes the traumatic rupture of the tunica albuginea of an erect penis. Penile fractures typically occur when the engorged penile corpora are forced to buckle and literally "pop" under the pressure of a blunt sexual trauma. Patients typically describe immediate detumescence, severe pain, and swelling as a result of the injury. Prompt surgical exploration and corporal repair is the most efficacious therapy. Although a majority of cases can be diagnosed from the history and physical examination alone, radiographic studies, including retrograde urethrography and corporal cavernosography can aid in the diagnosis of unusual cases.     

Cutaneous blood supply of the penis

Twelve male cadaver specimens were injected with a latex solution to define the cutaneous blood supply of the penis. The cutaneous blood supply of the penile shaft is derived solely from a pair of axial arteries running in the dartos layer. Additional deep perforating arteries from the dorsal penile artery and corporal vessels supply the glans and subcoronal region. An understanding of this anatomy allows one to develop safely a variety of penile skin flaps for difficult reconstructive problems.     

Effect of geometrical assumptions on numerical modeling of coronary blood flow under normal and disease conditions

Shear stress plays a pivotal role in pathogenesis of coronary heart disease. The spatial and temporal variation in hemodynamics of blood flow, especially shear stress, is dominated by the vessel geometry. The goal of the present study was to investigate the effect of 2D and 3D geometries on the numerical modeling of coronary blood flow and shear stress distribution. We developed physiologically realistic 2D and 3D models (with similar geometries) of the human left coronary artery under normal and stenosis conditions (30%, 60%, and 80%) using PROE (WF 3). Transient blood flows in these models were solved using laminar and turbulent (k-ω) models using a computational fluid dynamics solver, FLUENT (v6.3.26). As the stenosis severity increased, both models predicted a similar pattern of increased shear stress at the stenosis throat, and in recirculation zones formed downstream of the stenosis. The 2D model estimated a peak shear stress value of 0.91, 2.58, 5.21, and 10.09 Pa at the throat location under normal, 30%, 60%, and 80% stenosis severity. The peak shear stress values at the same location estimated by the 3D model were 1.41, 2.56, 3.15, and 13.31 Pa, respectively. The 2D model underestimated the shear stress distribution inside the recirculation zone compared with that of 3D model. The shear stress estimation between the models diverged as the stenosis severity increased. Hence, the 2D model could be sufficient for analyzing coronary blood flow under normal conditions, but under disease conditions (especially 80% stenosis) the 3D model was more suitable.     

Using in vivo Cine and 3D multi-contrast MRI to determine human atherosclerotic carotid artery material properties and circumferential shrinkage rate and their impact on stress/strain predictions

In vivo magnetic resonance image (MRI)-based computational models have been introduced to calculate atherosclerotic plaque stress and strain conditions for possible rupture predictions. However, patient-specific vessel material properties are lacking in those models, which affects the accuracy of their stress/strain predictions. A noninvasive approach of combining in vivo Cine MRI, multicontrast 3D MRI, and computational modeling was introduced to quantify patient-specific carotid artery material properties and the circumferential shrinkage rate between vessel in vivo and zero-pressure geometries. In vivo Cine and 3D multicontrast MRI carotid plaque data were acquired from 12 patients after informed consent. For each patient, one nearly-circular slice and an iterative procedure were used to quantify parameter values in the modified Mooney-Rivlin model for the vessel and the vessel circumferential shrinkage rate. A sample artery slice with and without a lipid core and three material parameter sets representing stiff, median, and soft materials from our patient data were used to demonstrate the effect of material stiffness and circumferential shrinkage process on stress/strain predictions. Parameter values of the Mooney-Rivlin models for the 12 patients were quantified. The effective Young's modulus (YM, unit: kPa) values varied from 137 (soft), 431 (median), to 1435 (stiff), and corresponding circumferential shrinkages were 32%, 12.6%, and 6%, respectively. Using the sample slice without the lipid core, the maximum plaque stress values (unit: kPa) from the soft and median materials were 153.3 and 96.2, which are 67.7% and 5% higher than that (91.4) from the stiff material, while the maximum plaque strain values from the soft and median materials were 0.71 and 0.293, which are about 700% and 230% higher than that (0.089) from the stiff material, respectively. Without circumferential shrinkages, the maximum plaque stress values (unit: kPa) from the soft, median, and stiff models were inflated to 330.7, 159.2, and 103.6, which were 116%, 65%, and 13% higher than those from models with proper shrinkage. The effective Young's modulus from the 12 human carotid arteries studied varied from 137 kPa to 1435 kPa. The vessel circumferential shrinkage to the zero-pressure condition varied from 6% to 32%. The inclusion of proper shrinkage in models based on in vivo geometry is necessary to avoid over-estimating the stresses and strains by up 100%. Material stiffness had a greater impact on strain (up to 700%) than on stress (up to 70%) predictions. Accurate patient-specific material properties and circumferential shrinkage could considerably improve the accuracy of in vivo MRI-based computational stress/strain predictions.     

Derivation of cable parameters for a reduced model that retains asymmetric voltage attenuation of reconstructed spinal motor neuron dendrites

Spinal motor neurons have voltage gated ion channels localized in their dendrites that generate plateau potentials. The physical separation of ion channels for spiking from plateau generating channels can result in nonlinear bistable firing patterns. The physical separation and geometry of the dendrites results in asymmetric coupling between dendrites and soma that has not been addressed in reduced models of nonlinear phenomena in motor neurons. We measured voltage attenuation properties of six anatomically reconstructed and type-identified cat spinal motor neurons to characterize asymmetric coupling between the dendrites and soma. We showed that the voltage attenuation at any distance from the soma was direction-dependent and could be described as a function of the input resistance at the soma. An analytical solution for the lumped cable parameters in a two-compartment model was derived based on this finding. This is the first two-compartment modeling approach that directly derived lumped cable parameters from the geometrical and passive electrical properties of anatomically reconstructed neurons.     

Load-dispersing design with twined-spring geometry of a distensible intracranial stent for cerebral aneurysms

Endovascular stents are increasingly being used to treat cerebral aneurysms. Mechanically, a cerebrovascular stent must have a low radial stiffness to prevent vessel dissection and rupture. To minimize these complications, we need to consider a stent design that has a low radial force and disperses the load within the stented artery. Therefore, highly distensible, load-dispersion stent designs are desirable for intracranial stenting. This study focused on closed-cell stent geometries and calculated the differences in stress within the artery because of the structure by using finite-element modeling. The results showed that the design with hexagonal cell geometry stretched in the circumferential direction had lower radial and circumferential stresses than did the other models. Comparing the maximum radial stress of our models, stress reduction of 35% was obtained with this design. Moreover, its radial stress was 47 kPa, which was similar to the critical stress of 42 kPa assumed in this study. This stent model was characterized by narrow strut spacing and a large surface area, which was dominated by the twined-spring geometry. It had low radial and circumferential stresses and a dispersed stress distribution compared with the other models. Therefore, this design is a desirable load-dispersing design for cerebrovascular treatment.     

The role of prostaglandins in penile erection

The balance of penile smooth muscle tone is finely controlled, with contractile factors acting in opposition to relaxant factors. The principal agents in this process are undoubtedly noradrenaline and nitric oxide. Prostaglandins probably have a crucial role in the 'fine tuning' of corporal smooth muscle tone. Their effects on control mechanisms in the healthy penis are more likely to be modulatory rather than direct.     

Initial stress in biomechanical models of atherosclerotic plaques

Rupture of atherosclerotic plaques is the underlying cause for the majority of acute strokes and myocardial infarctions. Rupture of the plaque occurs when the stress in the plaque exceeds the strength of the material locally. Biomechanical stress analyses are commonly based on pressurized geometries, in most cases measured by in-vivo MRI. The geometry is therefore not stress-free. The aim of this study is to identify the effect of neglecting the initial stress state on the plaque stress distribution. Fifty 2D histological sections (7 patients, 9 diseased coronary artery segments), perfusion fixed at 100 mmHg, were segmented and finite element models were created. The Backward Incremental method was applied to determine the initial stress state and the zero-pressure state. Peak plaque and cap stresses were compared with and without initial stress. The effect of initial stress on the peak stress was related to the minimum cap thickness, maximum necrotic core thickness, and necrotic core angle. When accounting for initial stress, the general relations between geometrical features and peak cap stress remain intact. However, on a patient-specific basis, accounting for initial stress has a different effect on the absolute cap stress for each plaque. Incorporating initial stress may therefore improve the accuracy of future stress based rupture risk analyses for atherosclerotic plaques.     

Blood flow and vessel mechanics in a physiologically realistic model of a human carotid arterial bifurcation

The pulsatile flow in an anatomically realistic compliant human carotid bifurcation was simulated numerically. Pressure and mass flow waveforms in the carotid arteries were obtained from an individual subject using non-invasive techniques. The geometry of the computational model was reconstructed from magnetic resonance angiograms. Maps of time-average wall shear stress, contours of velocity in the flow field as well as wall movement and tensile stress on the arterial wall are all presented. Inconsistent with previous findings from idealised geometry models, flow in the carotid sinus is dominated by a strong helical flow accompanied by a single secondary vortex motion. This type of flow is induced primarily by the asymmetry and curvature of the in vivo geometry. Flow simulations have been carried out under the rigid wall assumption and for the compliant wall, respectively. Comparison of the results demonstrates the quantitative influence of the vessel wall motion. Generally there is a reduction in the magnitude of wall shear stress, with its degree depending on location and phase of the cardiac cycle. The region of slow or reversed flow was greater, in both spatial and temporal terms in the compliant model, but the global characteristics of the flow and stress patterns remain unchanged. The analysis of mechanical stresses on the vessel surface shows a complicated stress field. Stress concentration occurs at both the anterior and posterior aspects of the proximal internal bulb. These are also regions of low wall shear stress. The comparison of computed and measured wall movement generally shows good agreement.     

A biomechanical model of Peyronie's disease

Peyronie's disease is a pathological condition of the penis which is characterized by localized ossification of the tunica albuginea. A common symptom of the chronic stage is penile deformity during erection, which is frequently associated with pain and erectile dysfunction. A two-dimensional biomechanical model of the penis was applied to study the development of Peyronie’s disease by simulating the mechanical stress distribution which would result from the interaction of the ossified tunical tissue with other penile soft tissues. The model was solved by using commercial finite element software for a characteristic erectile pressure. The results demonstrate that Peyronie’s plaques may induce intensified stresses around the penile nerves and blood vessels, up to double those in the normal penis. These elevated stresses may cause a painful sensation of neural origin or ischemia in regions of compressed vascular tissue. Severe penile deformities have been shown to develop if Peyronie’s plaques develop only around one of the corpora cavernosa due to the non-homogeneous resistance of the tunica to expansion during erection. The present model can be clinically applied as an aid in the planning process of reconstructive surgery or insertion of a prosthesis.     

Communication between the corpus cavernosum penis and the corpus spongiosum penis in a bull diagnosed by modified contrast cavernosography: A case report

Traditional methods of penile cavernosography failed to reveal a vascular defect or shunt from the corpus cavernosum penis of a 6-yr-old Brahman bull with a history of acquired failure of penile erection. When a tourniquet was applied to the penis and the contrast medium was introduced into the corpus cavernosum penis under pressure, however, a communication between the corpus cavernosum penis and corpus spongiosum penis was demonstrated. In a normal bull, cavernosography with the introduction of contrast medium under pressure produced a normal radiographic appearance. It is suggested that modification of accepted techniques of cavernosography to incorporate injection of contrast medium under pressure is useful in diagnosing this particular type of vascular abnormality, and may also aid in the detection of smaller vascular shunts from the corpus cavernosum penis to the superficial penile vasculature.     

The influence of out-of-plane geometry on the flow within a distal end-to-side anastomosis

This paper describes a computational and experimental investigation of flow in a proto-type model geometry of a fully occluded 45 deg distal end-to-side anastomosis. Previous investigations have considered a similar configuration where the centerlines of the bypass and host vessels lie within a plane, thereby producing a plane of symmetry within the flow. We have extended these investigations by deforming the bypass vessel out of the plane of symmetry, thereby breaking the symmetry of the flow and producing a nonplanar geometry. Experimental data were obtained using magnetic resonance imaging of flow within perspex models and computational data were obtained from simulations using a high-order spectral/hp element method. We found that the nonplanar three-dimensional flow notably alters the distribution of wall shear stress at the bed of the anastomosis, reducing the peak wall shear stress peak by approximately 10 percent when compared with the planar model. Furthermore, an increase in the absolute flux of velocity into the occluded region, proximal to the anastomosis, of 80 percent was observed in the nonplanar geometry when compared with the planar geometry.     

Multiscale modelling as a tool to prescribe realistic boundary conditions for the study of surgical procedures

This work was motivated by the problems of analysing detailed 3D models of vascular districts with complex anatomy. It suggests an approach to prescribing realistic boundary conditions to use in order to obtain information on local as well as global haemodynamics. A method was developed which simultaneously solves Navier-Stokes equations for local information and a non-linear system of ordinary differential equations for global information. This is based on the principle that an anatomically detailed 3D model of a cardiovascular district can be achieved by using the finite element method. In turn the finite element method requires a specific boundary condition set. The approach outlined in this work is to include the system of ordinary differential equations in the boundary condition set. Such a multiscale approach was first applied to two controls: (i) a 3D model of a straight tube in a simple hydraulic network and (ii) a 3D model of a straight coronary vessel in a lumped-parameter model of the cardiovascular system. The results obtained are very close to the solutions available for the pipe geometry. This paper also presents preliminary results from the application of the methodology to a particular haemodynamic problem: namely the fluid dynamics of a systemic-to-pulmonary shunt in paediatric cardiac surgery.     

Modeling Active Contraction and Relaxation of Left Ventricle Using Different Zero-load Diastole and Systole Geometries for Better Material Parameter Estimation and Stress/Strain Calculations

Modeling ventricle active contraction based on in vivo data is extremely challenging because of complex ventricle geometry, dynamic heart motion and active contraction where the reference geometry (zero-stress geometry) changes constantly. A new modeling approach using different diastole and systole zero-load geometries was introduced to handle the changing zero-load geometries for more accurate stress/strain calculations. Echo image data were acquired from 5 patients with infarction (Infarct Group) and 10 without (Non-Infarcted Group). Echo-based computational two-layer left ventricle models using one zero-load geometry (1G) and two zero-load geometries (2G) were constructed. Material parameter values in Mooney-Rivlin models were adjusted to match volume data. Effective Young’s moduli (YM) were calculated for easy comparison. For diastole phase, begin-filling (BF) mean YM value in the fiber direction (YMf) was 738%higher than its end-diastole (ED) value (645.39 kPa vs. 76.97 kPa, p=3.38E-06). For systole phase, end-systole (ES) YMf was 903% higher than its begin-ejection (BE) value (1025.10 kPa vs. 102.11 kPa, p=6.10E-05). Comparing systolic and diastolic material properties, ES YMf was 59% higher than its BF value (1025.10 kPa vs. 645.39 kPa. p=0.0002). BE mean stress value was 514% higher than its ED value (299.69 kPa vs. 48.81 kPa, p=3.39E-06), while BE mean strain value was 31.5% higher than its ED value (0.9417 vs. 0.7162, p=0.004). Similarly, ES mean stress value was 562% higher than its BF value (19.74 kPa vs. 2.98 kPa, p=6.22E-05), and ES mean strain value was 264% higher than its BF value (0.1985 vs. 0.0546, p=3.42E-06). 2G models improved over 1G model limitations and may provide better material parameter estimation and stress/strain calculations.     

Urogenital system of the spotted hyena (Crocuta crocuta Erxleben): a functional histological study

The unique urogenital anatomy and histology of female spotted hyenas (Crocuta crocuta Erxleben) was reexamined to identify adaptations of "structure" that enable/facilitate urination, mating, and parturition through the clitoris. Unusual features of penile anatomy required for meeting ceremonies and successful mating through a clitoral point of insertion were also examined. As reported previously, the upper urogenital tract of the female spotted hyena is typical of other carnivores and consists of the oviducts, uterine horns, uterine body, and vagina. An anatomically defined cervix is absent, even though a histologically defined transition zone between the uterine body and vagina was demonstrated. Adaptive features of the upper genital tract were a helical-shaped uterine cavity, extensive smooth muscle in the uterus and vagina, and a newly discovered submucosal mucous urogenital gland (SMUG) located immediately caudal to the vagina. The extensive smooth muscle facilitates the expulsion of the large pups at parturition through the recurved birth canal. Secretions of the SMUG provide lubrication and protection for the urogenital mucosa during mating and parturition. Two types of "erections" are suggested by behavioral observations: the common hemodynamic erection required for insertion and thrusting by the male, and phallic "flipping" that commonly occurs earlier in the mating sequence and is sometimes seen during meeting ceremonies. Phallic "flipping" appears to be accomplished by the coordinated contractions of the large ischiocavernosus and retractor muscles acting on the semirigid organ. The extremely thick tunica albuginea and interstitial collagen of the common corporal body of the penis and clitoris gives the flaccid phallus some degree of rigidity even in the resting state in males and nulliparous females. Phallic "flipping" implies a hinge region in which flexibility is the key feature. Such a proximal hinge region of the male and female phallus was defined and was notable for its diminished collagen content. The urogenital sinus traversing the clitoris was specialized for distensibility, thus facilitating receipt of the penis during mating and for passage of the infant to the tip of the glans clitoris, where it emerges at parturition. The morphology of the glans penis is notable for the tapered common corporal body that extends to the distal tip of the glans. This adaptation is suggested to be required for a clitoral (as opposed to a vaginal) point of insertion during mating. Finally, additional segments of erectile tissue devoid of a thick collagenous capsule were demonstrated in the glans penis and glans clitoris, which appear to account for the "partially-locking" of the male into the female during the late stages of a mating sequence. Taken together, it is evident that the unusual sexual behaviors of the male and female spotted hyenas are facilitated by unique structural modifications of the relevant organs.     

On dependency properties of the ISIs generated by a two-compartmental neuronal model

One-dimensional leaky integrate and fire neuronal models describe interspike intervals (ISIs) of a neuron as a renewal process and disregarding the neuron geometry. Many multi-compartment models account for the geometrical features of the neuron but are too complex for their mathematical tractability. Leaky integrate and fire two-compartment models seem a good compromise between mathematical tractability and an improved realism. They indeed allow to relax the renewal hypothesis, typical of one-dimensional models, without introducing too strong mathematical difficulties. Here, we pursue the analysis of the two-compartment model studied by Lansky and Rodriguez (Phys D 132:267–286, 1999), aiming of introducing some specific mathematical results used together with simulation techniques. With the aid of these methods, we investigate dependency properties of ISIs for different values of the model parameters. We show that an increase of the input increases the strength of the dependence between successive ISIs.     

The spatial properties of a model neuron increase its coding range

The coding properties of one-compartment and two-compartment model neurons are compared. The membrane depolarization in both models is described as a deterministic leaky integrator. Interspike intervals are identified with the periods between reset of the depolarization after firing and consecutive crossing of a fixed firing threshold. The two-point model has an input in the dendritic compartment and an output in the trigger-zone compartment. It is shown that the sensitivity threshold for the two-point model is shifted to the larger values of the input intensity with respect to the sensitivity threshold of its single-point counterpart. Further, its coding range is substantially larger than the coding range of the single-point model.     

A novel approach to in vivo mitral valve stress analysis

Three-dimensional (3-D) echocardiography allows the generation of anatomically correct and time-resolved geometric mitral valve (MV) models. However, as imaged in vivo, the MV assumes its systolic geometric configuration only when loaded. Customarily, finite element analysis (FEA) is used to predict material stress and strain fields rendered by applying a load on an initially unloaded model. Therefore, this study endeavors to provide a framework for the application of in vivo MV geometry and FEA to MV physiology, pathophysiology, and surgical repair. We hypothesize that in vivo MV geometry can be reasonably used as a surrogate for the unloaded valve in computational (FEA) simulations, yielding reasonable and meaningful stress and strain magnitudes and distributions. Three experiments were undertaken to demonstrate that the MV leaflets are relatively nondeformed during systolic loading: 1) leaflet strain in vivo was measured using sonomicrometry in an ovine model, 2) hybrid models of normal human MVs as constructed using transesophageal real-time 3-D echocardiography (rt-3DE) were repeatedly loaded using FEA, and 3) serial rt-3DE images of normal human MVs were used to construct models at end diastole and end isovolumic contraction to detect any deformation during isovolumic contraction. The average linear strain associated with isovolumic contraction was 0.02 ± 0.01, measured in vivo with sonomicrometry. Repeated loading of the hybrid normal human MV demonstrated little change in stress or geometry: peak von Mises stress changed by <4% at all locations on the anterior and posterior leaflets. Finally, the in vivo human MV deformed minimally during isovolumic contraction, as measured by the mean absolute difference calculated over the surfaces of both leaflets between serial MV models: 0.53 ± 0.19 mm. FEA modeling of MV models derived from in vivo high-resolution truly 3-D imaging is reasonable and useful for stress prediction in MV pathologies and repairs.