Atresia ani with diphallus and separate scrota in a calf: a case report

Atresia ani, a common genetic defect in animals, is often accompanied by urogenital defects in calves. This paper reports a case of atresia ani with diphallus and separate scrota in a calf. The calf was born with atresia ani; surgery (to open the anus) was performed 3 days after birth. No urogenital abnormalities were noticed until 4 months after birth. At that time, two separate scrota (each containing a testis) and a sac-like structure in the middle of two scrota, were visible. The gait was abnormal, with abduction of the hind limbs while walking. Additionally, the hind legs appeared wider than usual at the hip joints. Two weeks later, two peni (diphallia) was observed, each in a separate preputial sheath. The calf had a normal karyotype on cytogenetic examination. Plasma concentrations of testosterone at 5.5, 6, and 7 months of age were 3.5, 1.9, and 1.7 ng/ml, respectively. At necropsy (7 months of age), the prepuce was thick and the glans of the right penis was adhered to the prepuce. The left penis did not have a urethra or retractor penis muscles. The sac-like structure in the middle of the two scrota contained the urinary bladder and a loop of small intestine. The pubic bone had failed to fuse at the pelvic symphysis. In conclusion, this is the first reported case of atresia ani with diphallus, separate scrota, and pubic bone separation in a calf.     

Penile reconstruction for a victim of electrical injury with bilateral below-elbow amputations

We report on a young man who had complete loss of the penis and bilateral below-elbow amputations following severe electrical injury. Reconstruction of the penis was completed by using a deliberately tailored dorsalis pedis flap to solve the problems encountered by a migrated skin tube. Construction of a neourethra with release of the contracture was done simultaneously and brought about successful results.     

Blood flow to the corpus cavernosum penis in the bull and goat buck during penile quiescence

Bulls and bucks were used to study the blood flow into and out of the corpus cavernosum penis (CCP) during the non-erect state of the penis. When contrast medium was injected into the dorsal artery of the penis in a bull cadaver and into surgically implanted catheters of anesthetized bucks, it flowed into the cavernous spaces of the CCP via the penetrating arteries. When contrast medium was injected directly into the CCP of the bull and buck there was no evidence of vascular exits along the body of the penis. The only venous outlets from the CCP were in the crus penis area. In the non-erect penis the vascular pressure within the CCP was 17.8 mm Hg higher in the bull and 8.3 mm Hg higher in the buck at the glans area than the crus area. During the non-erect state of the penis most of the blood flow to the CCP is from the dorsal artery of the penis via the penetrating arteries. The results showed that the pressure gradient provides the means for flow of blood from the glans area toward the base or crus penis area. This flow prevents platelet aggregation and clot formation and provides nutrition to local tissue during the long periods of non-erection.     

Modified penis lengthening surgery: review of 52 cases

A modified surgical method for penis lengthening was, for the first time, set up in this laboratory. The procedure involves covering the dissected corpus cavernosum with either a scrotal flap or a skin graft after releasing the superficial ligament and even some deep suspensory ligament. The advantage of the scrotal flap is emphasized to cover the wound, and a V-Y suture was made to avoid the traction. The results, both in appearance and increased length, were satisfactory in 52 cases. Among the 52 patients, 39 suffered from congenital short penis and 13 from traumatic injuries. The significance and the blood supply of the penis are discussed.     

Ultrasound-guided injection of contrast medium into the crus penis for diagnosis of erection failure in bulls

The objectives of this study were to demonstrate the ability to cannulate the crurae of the bull's penis under ultrasound guidance, to demonstrate contrast medium injected by this route in the distal penis, and to confirm the technique to be safe and repeatable. Five adult bulls with normal serving ability were used, one being subjected to the procedure twice. The procedure was performed with the bulls under general anesthesia and in lateral recumbency. A spinal needle was passed through the skin and into the crus penis under ultrasound guidance and two syringes containing an iodine-based contrast medium were connected to it. Stimulation using an electro-ejaculator with a rectal probe was initiated, and when the penis started developing an erection, 50-100 ml of contrast medium was injected. Lateral and ventro-dorsal radiographs were taken of the extended penis during, and at intervals after, injection. After a rest period of 5 min, clearance of the contrast medium was confinned and the procedure was repeated on the other crus penis. Each case therefore, contained two attempts. Successful cannulation of the crus penis was confirmed by observing indentation of its fibrous wall by the needle, free flow of blood, lack of resistance to the injection of air, which could be seen in the crus, and fluctuation of resistance to injection in synchrony with the pulsation of the electroejaculator. Contrast medium was demonstrated in the mid or distal portion of the penis in all six cases, or on 9 of the 12 attempts. Attainment of penile erection, a larger volume of contrast medium, and the order of cannulation all enhanced flow of contrast medium to the distal portion of the penis, with the first crus giving better results. On one occasion the needle worked out of the crus penis during stimulation, resulting in injection of contrast medium into the corpus spongiosum penis. All bulls recovered uneventfully and returned to normal serving ability. It is concluded that ultrasound-guided cannulation of the crus penis is a safe and successful method for the injection of contrast medium for contrast studies of the penis, and is less invasive than the surgical method.     

Lymphedema of the penis.

Lymphangiectomy with primary closure or skin grafting appears to be the treatment of choice for lymphedema of the penis. The method offers good cosmetic and functional results.     

Studies of androgen metabolism and action in cultured hair and skin cells

In order to study the mechanism of action of androgen on pubic and scalp hair, we established these and skin epithelial cells in culture. Because 5 alpha-reductase has been suspected of playing a role in hair growth, we tested the possibility that these cells differ in their pattern of androgen metabolism. Furthermore, we tested the hypothesis that androgen exerts its distinctive effects on these hairs by differentially regulating keratin or DNA synthesis. Anagen hairs of men and women were plucked from the pubis or scalp vertex and were studied using an epithelial cell culture technique. DHT formation from [3H]T cultured skin cells increased in the following order: epidermal less than scalp less than pubic less than fibroblasts = 0.8:2.8:8.1:71%/mg DNA/min, respectively. Androstanediols were minor [3H]DHT metabolites of all these skin cell types. The only feature that distinguished among the cultured epithelial cells was the ratio of apparent 5 alpha-reductase (5 alpha-R) to 17 beta-hydroxysteroid dehydrogenase (17 beta-HSD) activity: this was significantly greater (P less than 0.05) in cultured pubic hair cells than in scalp hair or epidermal cells. Cultured scalp and pubic hair cells resembled freshly plucked hair follicle cells in their keratin pattern. 46, 50, 56 and 58 kdalton bands constituted 99% of the total keratins. This keratin pattern and the polygonal cell shape were also similar to that of cultured epidermal cells. However, this keratin pattern was distinctly different from that of hair shafts which have 53 and 63 kdalton keratins. Dihydrotestosterone did not affect the keratin pattern, pattern of incorporation of [35S]cysteine or [35S]methionine, or rates of protein synthesis or cell proliferation in cultured hair cells. Although the higher apparent 5 alpha-R/17 beta-HSD ratio of cultured pubic than of scalp hairs is compatible with modulation of hair development by androgen, these studies militate against the possibility that androgens directly affect hair cell proliferation or protein synthesis in pubic or scalp hair.     

Abnormal development of the os penis in male mice treated neonatally with tamoxifen

The os penis of male C57BL/Tw mice given 5 daily injections of 100 micrograms tamoxifen (Tx) starting on the day of birth (day 0) was examined at ages of 5-60 days; the bones of males given Tx injections for 5 days starting at 0-10 days and of those given neonatal injections of 100 micrograms clomiphene or nafoxidine were examined at 60 days. In the control males given the vehicle alone, the proximal segment of the os penis, composed of a compact cell mass found at day 0, developed at 5 days into the membrane bone with bone marrow and hyaline cartilage; the distal segment, composed of mesenchymatous cells until 10 days, developed at 30 days into fibrocartilage characterized by a distribution of type I collagen. By contrast, in Tx mice, fibrocartilage in the distal segment, and hyaline cartilage characterized by a distribution of type II collagen, and bone marrow in the proximal segment disappeared by 30 days. The maximum area of the proximal and distal segments gradually increased with age in control mice, whereas the proximal segment area remained unchanged in Tx mice. In clomiphene and nafoxidine mice at 60 days, the proximal segment was composed of hyaline cartilage; however, the distal segment lacked fibrocartilage. Hyaline cartilage in the proximal segment and fibrocartilage in the distal segment disappeared in all 60-day-old mice given Tx starting within 5 days. Neonatal castration did not suppress the formation of bone marrow and fibrocartilage in the os penis, though the bone size was smaller than in the intact controls. Formation of spines on the glans penis skin was suppressed by Tx given within 5 days.(ABSTRACT TRUNCATED AT 250 WORDS)     

Penile paralysis and paraphimosis associated with reserpine administration in a stallion

Reserpine was administered to an 8-yr-old Thoroughbred stallion at a dosage of 5 mg subcutaneously (s.c.) every 2 wk for a 2-mo period to control unmanageable behavior. Reserpine produced a satisfactory calming effect that lasted for about 2 wk. After the last injection, the stallion developed penile paralysis and was unable to retract his penis, resulting in paraphimosis and attendant penile edema. The prolapsed penis was reduced and kept within the prepuce by placing a purse string suture in the preputial orifice. Phenylbutazone was given orally (1 gm) and the stallion was exercised for 20 to 30 min twice daily. This treatment was continued for 20 d with little improvement. The purse string retention suture cut through the skin 5 d after the stallion was discharged from the clinic. The penis was then supported against the abdominal wall and the stallion was exercised by hand for 30 min each day. The stallion was not used for breeding within 34 mo after the last injection of reserpine. A breeding soundness examination was performed approximately 3 yr after the initial injury. At this time the stallion's penis was noted to extend 5 to 8 cm from the prepuce when in a detumescent state. Although the stallion protruded his penis when exposed to a mare in estrus, a full rigid erection was never attained. Examination of the penis revealed partial engorgement of the corpus cavernosum penis and a 2.5-cm-wide dorsal semi-circumferential depression of the penile shaft approximately 10 to 12 cm proximal to the glans penis. The penile shaft and glans penis distal to this depression were cooler than the proximal portion of the penis. Semen collection was attempted, aided by manual insertion of the penis into the artificial vagina. When serving the artificial vagina, no "belling" of the glans penis was observed, although ejaculation occurred. Semen evaluation indicated normal spermatozoal motility and morphology parameters. The stallion was able to breed several mares with manual assistance to guide the penis into the vagina and one mare was diagnosed pregnant.     

Localization of unmyelinated axons in rat skin and mucocutaneous tissue utilizing the isolectin GS-I-B

The a-D-galactose specific isolectin I-B4 from Griffonia simplicifolia (GS-I-B4) labels CNS microglia and certain peripheral neurons, including a subpopulation of small dark, type B dorsal root ganglion cells, some post-ganglionic sympathetic axons, and nearly all peripheral gustatory axons. The innervation patterns of GS-I-B4 reactive sensory ganglion cells are unknown for many peripheral target tissues, including their probable primary target, the skin. The present study describes the distribution of GS-I-B4 reactive axons in hairy and glabrous hindpaw skin and in the glans penis of rats, using both single and double-labelling histochemical techniques. Neuronal processes were identified using (1) histochemistry with horseradish peroxidase conjugated GS-I-B4 or (2) immunohistochemistry against PGP 9.5 to identify all axons, and biotinylated lectin histochemistry with avidin-FITC to identify the subpopulation of GS-I-B4 reactive axons. GS-I-B4 strongly labelled unmyelinated cutaneous sensory afferents, as well as some sympathetic efferents and visceral afferents. Lectin reactive axons were seen to innervate the upper hair shaft epidermis in hairy skin, and were abundant in the shallow dermis in hairy and glabrous skin and glans penis. Lectin reactive axons were also abundant in the lamina propria and distal urethral epithelium of the penis. These results provide new evidence for the cutaneous sensory role of GS-I-B4 reactive primary afferents, as well as evidence to support the contention that the lectin is a specific marker for a subpopulation of unmyelinated axons and not simply a marker for the myelination state of an axon.     

Influence of bicycle seat pressure on compression of the perineum: a MRI analysis

It is a common belief that bicycle seat pressure compresses neurovascular tissues in the perineum and may lead to perineal and penile pathologies in male cyclists. The purpose of this study was to examine the effect bicycle seat pressure has on compression of the perineal cavernous spaces, which house the penile neurovascular tissues. A second purpose was to identify where peak cavernous compression occurs in relation to a bicycle seat. Five males were assessed for compression of the corpus spongiosum and corpora cavernosa with and without bicycle seat pressure using MRI. Seat pressure was applied using a custom loading device designed to replicate seat pressure recorded during stationary bicycling. The distance between a horizontal midline of the seat and the point of peak cavernous space compression was made on sagittal plane images. Diameter measurements of the cavernous spaces at the point of peak compression were made on coronal plane images. Results revealed that peak cavernous space compression occurred below the pubic symphysis, 40.7(+/-11.4) mm anterior to the midline of the seat. Corpus spongiosum values in the unloaded condition were 148% greater than the loaded condition (p=0.008). Similarly, the left and right corpora cavernosa values for the unloaded condition were 252% and 232% greater, respectively, than the loaded condition (p=0.02-0.03). Cavernous spaces that house penile arteries and nerves were compressed maximally below the pubic symphysis. Because this location of peak compression was not different between subjects, it may be a universal impingement zone that limits blood flow and neural activity to and from the penis. This information can be used to optimize seat design and thus reduce perineal injuries.     

Identification of individual adult female Javan lutungs (Trachypithecus auratus sondaicus) by using patterns of dark pigmentation in the pubic area

In a series of field surveys of wild Javan lutungs (Trachypithecus auratus sondaicus) conducted at Pangandaran Nature Reserve in West Java, Indonesia, from 2011 to 2012, we tried to use a method of individual identification by using individual-specific patterns of dark pigmentation in the pubic area. During the 2011 dry season, we used a digital SLR camera with a 400-mm telephoto lens to photograph the pubic area of each individual of a habituated group. These photographs were the basis for identifying 14 different adult females. During the rainy season of 2011 and the dry season of 2012, we checked the presence/absence of each of the identified individuals and found that these patterns were stable, at least during our study period. We found that two adult females and one adult female disappeared from the subject group between the first and second and between the second and third surveys, respectively, and that one adult female gave birth between the first and second surveys, but the infant had disappeared from the group between the second and third surveys. We could not confirm the validity of the method for juvenile females because of the dense white hair in their pubic areas and the fact that few individuals had clear patterns. Furthermore, we could not use this method for males because of the lack of pigmentation in the pubic area. As patterns of pigmentation in the pubic area are known to be present in other Trachypithecus species, our method can be useful for identification of individual adult females of these species, on which few individual-based behavioral studies have been conducted. Collecting individual-based behavioral data would enable us to track the presence of individuals in groups or movements between groups; determine the effects of social rank and age on within-group competition and copulation; and examine population data.     

Les traumatismes de la verge: à propos de 23 cas

The authors report 23 cases of penile injuries based on a retrospective study of their urological practice in Senegal. The various cases were distributed as follows: fracture of the penis (19 cases), corpora cavernosa and urethral gunshot injuries (2 cases), rupture of the superficial dorsal vein of the penis (1 case) and laceration of the penile skin (1 case). The mean age of these patients was 32.4 years. Early surgical treatment of all penile fractures reduces the complication rate.     

Strangulation de la verge par anneau métallique compliquée d’une lésion urétrale

Penile incarceration is uncommon. The diagnosis is obvious, but extraction of the constrictive ring and repair of the damage can be challenging. The authors present the case of a 61-year-old man wh presented with pain and swelling of the penis 3 weeks after applying a metal ring (double key rings) at the base of penis for the purposes of self-mutilation. The key ring was removed immediately under local anaesthesia. One week later, a urethral fistula was observed, requiring suprapubic cystostomy. It was decided to perform secondary surgical closure of the fistula and reconstruction of the skin of the base of the penis after treatment of local sepsis. Penile incarceration should be considered to be an emergency, as the more rapidly the constrictive object is removed, the lower the risk of complications secondary to penile devascularization, urinary retention and urethral damage. The authors review the literature concerning this unusual injury and its management.     

Sensibility of the abdomen after abdominoplasty

Abdominal skin hypesthesia may occur after abdominoplasty. The purpose of this study was to find out (1) which sensibility modalities are decreased and (2) which areas of the abdominal wall are affected, so that patients can be warned preoperatively about this condition. Forty patients were divided in two groups of 20 patients each. In the control group, patients had no previous abdominal incisions. The sensibility evaluation of patients from the experimental group was made from 12 to 60 months after abdominoplasty, with an average of 31.5 months. These patients were divided into two groups of 10 patients each, a short-term follow-up group (12 to 30 months postoperatively) and a long-term follow-up group (31 to 60 months postoperatively). The abdominal skin was divided into 12 areas; nine were above the abdominoplasty incision and three were below it. Sensibility to superficial touch, superficial pain, and hot and cold modalities was recorded as positive in all areas by a variable number of patients of the experimental group. However, in area 8 (hypogastric area), a statistically significant number of patients had decreased sensibility in all sensibility modalities (Fisher's test and t test). Patients in the experimental group also showed decreased sensibility to hot and cold temperature in area 11 (pubic area). Sensibility to pressure decreased significantly in all areas of the abdomen when compared with the control group (t test). When patients of the short-term follow-up group were compared with those of the long-term follow-up group, there was no statistically significant difference for all modalities of sensibility in the areas studied, except for area 5. In this area it was found that long-term follow-up patients recovered sensibility to cold and hot temperatures. These findings help plastic surgeons to orient their patients about possible risk of exposure to injuries in the areas with decreased sensibility after abdominoplasty. Most importantly, as these patients have decreased sensibility to pressure and hot temperature in a more extensive area of the abdomen, they are exposed to a higher risk of burn injury.     

Experimental tissue molding for soft-tissue reconstruction: a preliminary report

Molding of pig omentum to create external structures, such as the ear or penis, was performed using silicone rubber molds. The omentum was mobilized on its gastroepiploic pedicle and brought out through a fascial defect. The molds containing the omentum were placed beneath the skin and panniculus carnosus for 4 weeks. Split-thickness skin grafts were placed on both surfaces of the mold, and a series of synthetic materials was placed within the omentum to provide structural support. When an appropriate amount of tissue had been placed within the device, omentum took on the contour of the mold. Excessive pressure associated with swelling resulted in necrosis, while an inadequate amount of tissue gave poor contour. Omentum molded without any support material rapidly lost its contour once removed from the mold. Omentum molded in combination with a synthetic material maintained its shape up to 1 month after mold removal in a limited number of animals. This model was designed to create structures with the fine detail of a prosthesis using autologous tissue. This "prosthesis" made from living tissue could then be transferred secondarily to its recipient area by microvascular technique.     

Sex determination in the common marmoset (Callithrix jacchus).

The general morphology of the external genitalia was examined in 43 common marmosets (Callithrix jacchus) ranging in age from newborn to adult. At birth, the scrotum was a small irregular fold of skin on either side of the caudal aspect of the penis. The testes were not present in the scrotum until 8--11 months of age. The scrotum covered the penis in the adult male, was devoid of fur, was covered by pearly while nodules, and presented a median raphe. In the young female, the pudendal pad closely resembled the scrotum of the male. The vulva was pendulous, and the small vestibular opening was located near its most ventral aspect and closely resembled the preputial opening of the male. In the adult female, the pudendal pad was pendulous, was studded with white nodules, and closely resembled the scrotum of the male. Sex determination by casual observation resulted in numerous errors. Accurate sex determination was based on differences in the preputial and vestibular openings, demonstration of the glans penis in the prepuce, and palpation of the testes in the scrotum or inguinal region.     

Silicone genital prosthesis for female-to-male transsexuals.

In the case of a female-to-male transsexual who has not yet undergone phalloplasty, one of the greatest concerns is how to give the appearance of having male external genitals. Many methods have been attempted by patients. We helped develop a silicone prosthesis after obtaining information on the demands of female-to-male transsexuals through a questionnaire sent to 120 of them. Three different models of the prosthesis were designed to enable three different methods of fixation. One of the methods of fixation involves the creation of a bipedicled skin flap in the pubic area. Thus this is the first of such prostheses that can be worn directly fixed to the body. It seems that the prosthesis developed in close cooperation with our department fulfills most of the needs of our patients.     

Os penis of the rat. IV. The proximal growth cartilage

Histomorphological and histochemical aspects of the proximal cartilage of os penis and its surrounding perichondrium in 60 rats aged between 1 and 100 days are described. Comparisons at 11-14 days with the mandibular condylar cartilage reveal a slight difference in their general morphological composition. The developmental changes which take place in the os penis cartilage reveal histomorphologic events, some of which may be brought into agreement with previous observations of patterns of transformations of the bone. Observations on an age-dependent morphological appearance of the area adjacent to the proximal surface of the cartilage suggest certain agreements between the mandibular angular cartilage and the os penis cartilage. The study of phosphomonoesterases in the os penis cartilage and its perichondrium reveals significant, unexplained differences in the distribution of alkaline phosphatase between this cartilage and the mandibular condylar cartilage.     

Are we aware how contaminated our mobile phones with nosocomial pathogens?

Vibrio spp. is a pathogen rarely isolated in cancer patients, and in most cases it is associated with haematological diseases. Cutaneous manifestations of this organism are even rarer. We report a case of Non-O1 Vibrio cholerae inguinal skin and soft tissue infection presenting bullous skin lesions in a young type II diabetic patient with a penis squamous cell carcinoma having a seawater exposure history.