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Background: To analyze the clinical characteristics, complications and patients satisfaction of MIP hypospadias variant. Methods: A retrospective analysis was performed for 31 patients with MIP admitted to our hospital from January 2008 to February 2023. All enrolled patients underwent telephone follow-up and a survey was conducted on the satisfaction of patients and their families. Outcome analysis was focused on clinical data includes age, position of the meatus, penile curvature, type of repair, complications and satisfaction survey results. Statistical analyses were performed using R software. Results: The average age of 31 MIP patients was 92.1 ± 40.7 months, and the median follow-up time was 49.0 [21.0–82.2] months. Twenty one patients (67.7%, 21/31) had ventral curvature and no dorsal curvature was observed. All cases were divided into chordee group and no chordee group. There was a statistical difference in age (80.4 ± 41.6 Vs 117.0 ± 26.0 months) and weight (22.7 [15.8–35.0] Vs 45.0 [32.0–46.0] kg) between the two groups. Six children (19.4%, 6/31) experienced post-operative complications; however, none required reoperation. The only risk factors for complications were the meatus position and whether urethroplasty was performed.Only the occurrence of complications may affect patients satisfaction. Conclusions: MIP hypospadias variants can exhibit severe ventral curvature. Surgery can achieve good results with a low incidence of complications. A satisfactory skin appearance and adequate curvature correction are key concerns for both patients and parents. [ABSTRACT FROM AUTHOR]

Background: The inelasticity of dartos tissue and the regulation of collagen expression are significant factors in the pathophysiology of chordee associated with hypospadias. While the COL2A1:COL1A1 ratio is recognised as a measure of cell differentiation, there is yet to be a study specifically examining this ratio in hypospadias. The aim of this study was to determine the COL2A1:COL1A1 ratio. Methods: We collected 55 samples of dartos tissue, comprising 35 from patients with hypospadias procured from urethroplasty procedures and 20 from patients with phimosis collected during circumcision without any lichen cases at our institution. The gene expression levels of COL1A1 and COL2A1 in the dartos tissue were analyzed using reverse-transcriptase polymerase chain reaction (qPCR). Results: Based on the type of penile abnormality, the expression levels of COL1A1 and COL2A1 measured by qPCR were downregulated in hypospadias, with value of 0.83 (0.38–2.53) and 0.43 (0.10–5.66), respectively, compared to phimosis, which had levels of 1.85 (1.24–4.61) and 0.94 (0.26–2.47) (p < 0.001). The expression levels of COL1A1 and COL2A1 were also significantly downregulated among mild, moderate, severe penile curvature, and control groups (p < 0.001 and p = 0.02). However, the COL2A1:COL1A1 ratio did not show statistically significant differences based on penile abnormalities and curvature (p > 0.05). Conclusion: The expression levels of COL1A1 and COL2A1 are significantly downregulated in patients with hypospadias and ventral curvature when compared to those in the phimosis group. However, the COL2A1:COL1A1 ratio was not significant. [ABSTRACT FROM AUTHOR]

Background Our team recently published outcomes of a novel technique for the administration of Collagenase Clostridium histolyticum (CCH), which resulted in improved curvature outcomes and reduced number of CCH injections required. Aim To provide a detailed and illustrated description of our CCH-administration technique. Methods A descriptive summary is provided of the technique, including drug administration, protocol modifications, and post-treatment protocols. Additional details are provided on measurement techniques and disease classification. Outcomes Key outcomes include a written and illustrated description of the injection technique and pre-, and postinjection management. Results The use of a modified CCH-administration technique has previously been shown to result in mean improvements of 54%–58% in penile curvature while significantly reducing the total number of injections applied. These findings represent the largest improvements published to date. Key aspects of the technique include back-to-back day administration of 0.9 mg suspended in 0.8 mL, application to an ~3 × 1 cm region, inclusion of the dorsal septum (exempting ventral curves), administration during a full erection (day 1), repeat artificial erections with the first injection of each series, in-office modeling (day 2), and post-treatment use of PDE5s and Restorex traction. Appropriate patient counseling on expectations and necessity of complying with all treatment protocols (including post-treatment wrapping) is critical to optimizing outcomes. Common side effects may include ecchymoses, hematomas, blood blisters, impacts on erections and penile sensation, bronzing of the skin, and skin scarring, while more severe complications are rare (<1%). Clinical Implications The current manuscript provides a more detailed description of previously published techniques to aid providers in implementation and to mitigate potential adverse events. Strengths and Limitations Strengths include reliance on the largest single-team series published on CCH outcomes, rigorous study methodology, prospective/sequential series, and step-wise improvements. Limitations include data obtained from a single center. Conclusion The current manuscript provides a detailed narrative and illustrated description of our current CCH-administration technique. [ABSTRACT FROM AUTHOR]

Purpose: Hypospadias, one of the congenital anomalies commonly associated with some degrees of ventral penile curvature that may arise from malformation of dartos fascia, the chordee. Our study aims to determine the correlation between the histopathology properties of dartos fascia and the severity of ventral penile curvature in hypospadias. Materials and methods: One hundred hypospadias patients with various degrees of ventral penile curvature were included in this cross-sectional analytical study from 2020 to 2022. During hypospadias repair, ventral dartos fascia was excised and analyzed for the degree of collagen thickness and the severity of the fibrotic condition. Results: Out of 100 patients, the mean age was 6.58 + 4.28 years, who were classified as mild to moderate (66%) and severe (34%) ventral curvature cases. The analyses showed significant differences in the severity of fibrotic condition and collagen thickness of dartos fascia to the severity of penile ventral curvature with p-values of 0.002 and 0.017, respectively. Conclusions: The difference in histopathology properties of dartos fascia may affect the severity of penile curvature in hypospadias patients. [ABSTRACT FROM AUTHOR]

Objective: To compare the safety profile and clinical outcomes of Altieri-modified Nesbit corporoplasty using two different anesthesia methods including spinal anesthesia and local anesthesia. Materials and methods: A total of 40 patients with congenital penile curvature (CPC) and Peyronie's disease (PD) underwent Altieri-modified Nesbit corporoplasty. Group 1 (n = 20) received spinal anesthesia, and Group 2 (n = 20) received local anesthesia. The patients were categorized into age groups (< 30 years, 31-45 years, 46-60 years, and 61-75 years) for analysis. Clinical outcomes, post-operative complications, hospital stay, pain levels, and other parameters were assessed. Results: The results showed that 2 patients (10%) reported postoperative complications, including headache, arterial hypotension, and penile foreskin necrosis from the spinal anesthesia group. Whereas, in the local anesthesia group, 1 patient (5%) reported scar phimosis. Further, post-operative pain was predominantly very mild, with 16 patients (80%) in the spinal anesthesia group and 14 patients (70%) in the local anesthesia group experiencing minimal discomfort. Age did not significantly impact hospital stay, post-operative intestinal disorders, constipation, lower urinary tract symptoms, voiding burning, or dysuria. Conclusions: Spinal anesthesia may lead to more post-operative complications and longer hospital stays compared to local anesthesia. Age does not significantly affect most clinical outcomes but can influence post-operative pain in patients receiving local anesthesia. [ABSTRACT FROM AUTHOR]

Endodontic therapy conserves the natural tooth by treating diseased pulp and promoting periapical healing. Curved root canals pose challenges in transportation, ledges, perforations, and instrument separation, impacting treatment results. Effective assessment and management are essential. Methodologies such as Schneider's and Weine's techniques, along with cone-beam computed tomography, refine the accuracy of curvature measurements. Proper techniques, involving anti-curvature filling and tactile controlled activation, are pivotal for successful treatment. Understanding root canal curvature and employing applicable approaches are vital for minimizing the complications and refining treatment success. An acclimatized approach grounded on curvature characteristics enhances endodontic sequels. This article reviews the cases involving patients with curved root canals, emphasizing treatment avenues and outcomes. [ABSTRACT FROM AUTHOR]

Peyronie's disease (PD) is a progressive, non-malignant disorder affecting the penile connective tissue, characterized by fibrous plaque formation leading to penile curvature and functional impairment. This study aimed to evaluate the effectiveness of hyaluronic acid (HA) as a therapeutic option for PD. A systematic review was conducted following PRISMA guidelines and utilizing the PICOT framework. Articles were sourced from PubMed, ScienceDirect, ProQuest, Wiley, and Google Scholar, focusing on studies published between 2012 and 2022 in English and with fulltext availability. Six studies were analyzed, including cohort studies and clinical trials. The findings revealed that intralesional HA injections significantly reduced plaque size, improved penile curvature, and enhanced erectile function, as measured by the International Index of Erectile Function (IIEF). HA's antiinflammatory and antioxidant properties, along with its ability to remodel collagen, contributed to these outcomes. Compared to other treatments, such as verapamil, HA demonstrated superior efficacy with minimal side effects. The discussion highlights HA's potential as a non-surgical treatment that addresses both physical symptoms and improves patient satisfaction. In conclusion, HA offers a promising, effective, and safe therapeutic alternative for PD, addressing critical gaps in the current management of the disease. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of low‑intensity pulsed ultrasound (LIPUS) for the treatment of Peyronie's disease (PD). Methods: To analyze the treatment effect of 106 PD patients, 56 patients treated with LIPUS as therapy group and 50 patients with oral L‐carnitine and vitamin E as control group. 56 patients were treated with LIPUS three times per week for four consecutive weeks (12 times totally). Penile erectile pain, erectile function, the size of penile plaques, and penile curvature were assessed for all of these 106 PD patients before treatment and at 4‐ and 24‐week follow‐ups to evaluate the treatment effect. Erectile pain was assessed by visual analog scale (VAS), while erectile function using the International Index of Erectile Function scale (IIEF‐5), and penile plaque size was measured by ultrasound. After alprostadil was injected into the penile body to induce a full erection, the penis was measured with a protractor at the maximum bending degree. Results: After 4‐weeks follow‐up, the VAS scores of the LIPUS group were significantly lower than the baseline (P < 0.01), while no significant differences were found in the control group (P > 0.05). After 24‐weeks follow‐up, the VAS scores of the control group reduced significantly but also were significantly higher than the LIPUS group (P < 0.01). The IIEF‐5 scores of the LIPUS group were significantly higher than the baseline (P < 0.01). While the IIEF‐5 scores of the control group showed no significant differences both after 4‐ and 24‐weeks follow‐up (P > 0.05). The penile plaque size showed no significant differences after 4‐ and 24‐weeks follow‐up both in the LIPUS group and the control group (P > 0.05). The penile curvature degrees showed a significant reduction after 4‐weeks follow‐up in LIPUS group (P < 0.01). While the penile curvature degrees of the control group showed no significant differences both after 4‐ and 24‐weeks follow‐up (P > 0.05). No complications, such as penile pain, hematoma, or skin ecchymosis, were observed during the entire process of LIPUS treatment, nor did they appear during follow‐up. Conclusions: In patients with acute PD, LIPUS could relieve erectile pain and improve erectile dysfunction. Moreover, it appears not to reduce plaque size and not to have a clinically significant effect on penile curvature. Furthermore, LIPUS also shows a good safety profile during the management of PD and should be recommended for the clinical management of PD. [ABSTRACT FROM AUTHOR]

Background: A systematic review of the evidence was conducted to assess the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) for patients with Peyronie's Disease (PD). Methods: A comprehensive search of the Cochrane Registry, PubMed and Embase databases was conducted to identify all controlled trials, including randomised controlled trials (RCTs), cohort studies and case-control studies, focusing on the efficacy of LI-ESWT in treating PD, and published before February 2023. The size of plaques, curvature deviation, visual analog scale [VAS] and International Index of Erectile Function (IIEF) were the most commonly used tool to evaluate the treatment effectiveness of LI-ESWT. Results: There were 7 studies including 475 patients from 1999 to 2023. The meta-analysis of the data revealed that LI-ESWT could considerably enhance the proportion of men experiencing a reduction in penile plaques (RD 0.27, 95% CI: 0.04–0.50, P = 0.02), improvement in penile curvature (RD: 0.13; 95% CI, 0–0.26; p = 0.05), alleviation of pain (RD 0.22, 95% CI: 0.01–0.42, P = 0.04), and complete remission (RD 0.38, 95% CI 0.23–0.52, P < 0.00001). However, there were no significant differences in improvement of sexual function (MD: 1.44; 95% CI, -3.10–5.97; p = 0.53) between LI-ESWT and the placebo group. Conclusions: According to these studies, LI-ESWT has the potential to decrease plaque size and improve penile curvature or pain in men with PD. The publication of robust evidence from additional well-designed long-term multicenter randomized controlled trials would provide more confidence regarding use of these devices in patients with PD. [ABSTRACT FROM AUTHOR]

Objective: This study examines the impact of surgical timing and suture materials on postoperative outcomes in penile fracture patients, particularly focusing on the development of penile curvature (PC). Specifically, it focuses on the role of delayed surgical intervention in the development of PC. Material and Methods: A retrospective analysis was conducted on 63 patients treated for penile fractures between 2015 and 2024. Data on the time to surgery, suture materials, and postoperative complications such as PC were collected. Results: PC occurred in 27% of patients, with a significantly longer surgical delay in those with PC compared to those without. Suture material type (2-0 Prolene vs. 3-0 Vicryl) had no significant effect on PC or nodule formation. Conclusion: Delayed surgical intervention is associated with an increased risk of PC. Early surgery is recommended to reduce complications, while suture material does not influence outcomes. [ABSTRACT FROM AUTHOR]

Introduction Materials and methods Results Conclusions There is inconsistent data regarding the possible inaccuracies in dynamic penile color Doppler duplex ultrasound (CDDU) measurements in men with penile curvature because of Peyronie's disease (PD). We sought to explore the relationship between the degree of penile curvature and CDDU parameters in men with PD.Comprehensive data from 154 consecutive men presenting with PD as their primary complaint at a single academic center were prospectively collected and analyzed. All men underwent CDDU. Penile curvature was measured using a goniometer at time of maximum erection during CDDU. Patients were grouped based on CDDU parameters into—normal (average peak systolic velocity [PSV] ≥ 35 cm/s and resistance index [RI] ≥ 0.85) and pathological CDDU (average PSV < 35 cm/s and/or RI < 0.85). Descriptive statistics was used to compare the two subcohorts. Linear regression models were fitted to explore the association between the degree of penile curvature and dynamic CDDU parameters.Overall, the median interquartile range (IQR) age was 56 (48−63) years. The median (IQR) PSV and degree of penile curvature were 48.8 cm/s (37.9−58.5) and 40 degrees (30‐60), respectively. At CDDU, the degrees of penile curvature were as follows: 10–30 degrees in 63 (40.9%) men, 30–70 degrees in 70 (45.5%) men, and 70–90 degrees in 21 (13.6%) men, respectively. Of all, 116 (75.3%) patients showed a PSV > 35 cm/s and RI ≥ 0.85. Patients with pathologic vs. normal CDDU parameters did not differ in median (IQR) curvature (32.5° [30°−58.7°] vs. 40° [30°−65°], p = 0.5) or in the distribution across curvature range groups. Linear regression analysis revealed that the degree of penile curvature did not significantly correlate with PSV at CDDU (coefficient: 0.06, p = 0.3).Our study confirms the lack of a significant correlation between the severity of penile curvature and CDDU parameters in men presenting with PD. These findings emerge to be relevant in terms of a more accurate management work‐up for PD patients and hold insightful medicolegal implications and in the real‐life setting. [ABSTRACT FROM AUTHOR]

Peyronie's disease (PD) has detrimental effects on the quality of life, mental health, sexual functioning and several other aspects that increase the risk of relationship problems. However, no study to date has assessed the risk of relationship separation in med with PD. Herein, we utilized data from Swedish national registers to examine the risk of relationship separation in men with PD. We conducted a matched cohort study on men born 1933–1992, followed from 1997 to 2013. PD was defined as a physician-assigned diagnosis according to the International Classification of Diseases, Tenth version. Each man with PD (n = 8020) was matched with 10 comparison men. We defined relationship separation as (1) ever separated, and (2) separation rate. We used log-linear regression to estimate the risk ratio, and rate ratio of relationship separation. We adjusted for matching variables (birth year and country of birth), and an indicator of each follow-up year. We found that men with PD had a 13% increased risk of relationship separation (risk ratio 1.13, 95% confidence interval [CI] 1.08–1.17). The rate of relationship separation events, measured on a yearly basis, was increased by 18% (rate ratio 1.18, CI 1.12–1.24), and remained similar when adjusting for follow-up year and socio-economic status. [ABSTRACT FROM AUTHOR]

Background/aim: Peyronie's disease (PD) is known as a wound-healing disorder for which surgery remains the gold-standard treatment, but studies comparing graft materials are limited in the literature. The aim of this study was to evaluate the mid- and long-term results of patients who underwent surgery for PD with grafting procedures performed by a single experienced surgeon according to graft materials. Materials and methods: Patients who underwent corporoplasty between 2014 and 2020 with grafting procedures performed by a single experienced surgeon were retrospectively reviewed. A total of 115 patients were divided into 4 groups according to the grafting material used: autologous saphenous venous grafts, Group 1 (n = 36); porcine pericardial extracellular matrix grafts (EMGs; XenoGuard, MBP Medical Biomaterial Products GmbH, Neustadt-Glewe, Germany), Group 2 (n = 40); porcine intestinal submucosal EMGs (BioDesign, Cook Medical, Bloomington, IN, USA), Group 3 (n = 36); and bovine pericardial EMGs (Tutopatch, Tutogen Medical, Inc., Alachua, FL, USA), Group 4 (n = 43). Results: The mean operation time for Group 1 was longer than that of the other groups (p < 0.001). When comparing the groups in pairs, it was observed that the duration of postoperative loss of sensation (LOS) was significantly shorter in Group 3 (12.3 ± 5.3 days) and Group 4 (15.1 ± 3.1 days) (p < 0.05). There was a statistically significant difference between Groups 1 and 4 in penile length loss when the groups were compared in pairs (p = 0.017). There was a statistically significant difference between patients with penile curvatures of 0° to 59° and patients with curvatures of ≥60° in terms of duration of postoperative LOS (14.4 ± 5 vs. 16.4 ± 5.8 days, respectively; p = 0.028) and penile length loss (2.6 ± 5 vs. 5.7 ± 6.8 mm, respectively; p = 0.002). Conclusion: The findings suggest that EMGs should be preferred to autologous venous grafts due to reduced postoperative erectile dysfunction, shorter operation time, and shorter recovery time for LOS. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to examine the combination of the mechanical effects of penile therapy with vacuum erection devices (VEDs) plus PDE5i, which improve clinical outcomes after extracorporeal shockwave therapy (ESWT) in men affected by erectile dysfunction (ED) associated with Peyronie's disease (PD). Methods: A total of 153 medical records of patients affected by PD in stable stage with ED and treated with ESWT were divided into two groups. Group A (GA) included 72 men treated with ESWT, mechanical stretching with VEDs and PDE5ì (Tadalafil 5 mg), and Group B (GB) included 81 men who received only ESWT plus Tadalafil 5 mg with the same protocol of GA. The patients in both groups were assessed at baseline and follow-up for erectile function, painful erections, penile plaque size, and penile curvature. The results were evaluated at baseline and 3, 6, and 12 months after the treatments. Results: Three months after the treatment, GA patients had a reduction in penile curvature degree from a mean ± SD of 33.91 ± 8.34° at baseline to a mean ± SD of 19.46 ± 7.15° after 12 months, whereas pain in an erection or during intercourse was resolved completely in 88.9% of the patients. The mean ± SD IIEF-15 score of patients affected by severe/moderate ED further improved significantly in the GA group (p < 0.001) after 3, 6, and 12 months of treatment. There were no permanent adverse sequelae after treatments. Conclusions: The regular use of a VED plus Tadalafil in patients who had undergone ESWT significantly provided more benefit in patients with PD in terms of penile deformity, pain, and erectile function. [ABSTRACT FROM AUTHOR]

Objective: To define the appropriate penile straightening procedures corresponding to the specific penile curvature by comparing the penile length resulting from various straightening procedures in hypospadias repair. Methods: We retrospectively analyzed hypospadias patients between 2017 and 2019. Patients were divided into three groups based on the penile curvature after degloving: <30°, 30°–45°, and >45°. The penile straightening procedures include dorsal plication (DP), simple urethral plate (UP) transection, and UP transection with ventral lengthening (VL). The paired t‐test was conducted for the penile length after fully straightening in each group, simultaneously calculating the length changes (∆T). In addition, the penile length changes among these procedures were compared using Spearman analysis to show the correlation between the penile curvature and the length. Results: The penile length changed significantly after fully straightening in all groups. The length decreased mildly after DP, while increased in the other procedures. The penile curvature after degloving was positively correlated with the absolute change in the penile length (P < 0.001, r = 0.424) and the ratio of ∆T in the original length (P < 0.001, r = 0.433). Conclusion: For hypospadias, the 30° after degloving may serve as the cut‐off for the selection of the straightening method from the perspective of the penile length. For those with < 30°, methods such as DP or UP transection can either be selected. In patients with > 30°, DP should be used with caution because of the potential risk to shorten the penis. In contrast, UP transection effectively corrects the penile curvature and increases the penile length concurrently, which should be primarily recommended in those patients. [ABSTRACT FROM AUTHOR]

Purpose: Our goal was to identify new Peyronie's disease (PD) subtypes, non-PD penile curvature classifications, and define active (acute) vs stable (chronic) phases of disease using evidence-based analyses. Materials and Methods: A retrospective review was performed of 1098 men who presented with penile deformity, including subjective standardized and nonstandardized questionnaires and objective measures. A second cohort of 719 men who were sent a mailed survey was also utilized for the relapsing/remitting subtype. Statistical analyses were performed to identify clusters of disease characteristics representative of distinct PD and non-PD categorizations, including sensitivity/specificity analyses and subtype comparisons. Results: Comparative analyses identified 4 distinct subtypes of PD: (1) classical and nonclassical, (2) calcifying—moderate/severe calcification, (3) progressive—subjective worsening following disease onset, and (4) relapsing/remitting—reactivation following ≥ 6 months of stability. Additional, non-PD categorizations included congenital (lifelong), maturational (developed around puberty), and trauma induced. Statistical analyses demonstrated unique profiles among each category. Penile pain was not found to be a reliable predictor for disease progression or stability. Stable phase disease (historically "chronic") was variably defined by subtype: classical (≥3 months); progressive, calcifying, or trauma induced (≥12 months + ≥3 months stable OR ≥6 months stable). Similarly, PD subtypes may be assigned at ≥ 3 months following disease onset. A PTNM staging system is proposed to help communicate disease states, in which P = PD component (Ca—calcifying, Cl—classical, P—progressive, R—relapsing/remitting, U—undifferentiated), T = trauma component (0—absent, 1—present), N = non-PD component (C—congenital, M—maturational, U—undifferentiated), and M = mode (0—stable, 1—active); for example, PClT1N0M0 = stable classical PD with prior trauma. Conclusions: The current study provides an evidence-based proposal for the establishment of new PD subtypes and non-PD curvature categorizations as well as a standardized definition for active vs stable phases of disease. [ABSTRACT FROM AUTHOR]

Flexural toppling occurs when a series of layered rock masses bend towards their free face. It is important to evaluate the maximum bending degree and the requirement of supports of flexural toppling rock mass to prevent rock mass cracking and even failure leading to a landslide. Based on the rock tensile strain-softening model, this study proposes a method for calculating the maximum curvature (Cppmax) of flexural toppling rock masses. By applying this method to calculate Cppmax of 9 types of rock masses with different hardness and rock layer thickness, some conclusions are drawn: (1) the internal key factors affecting Cppmax are E⋆ (E⋆= Ess/E0, where E0 and Ess are the mean deformation moduli of the rock before and after reaching its peak tensile strength, respectively), the strain εt corresponding to the tensile strength of rock, and the thickness (h) of rock layers; (2) hard rock layers are more likely to develop into block toppling than soft rock layers; and (3) thin rock layers are more likely to remain in flexural toppling state than thick rock layers. In addition, it is found that Cppmax for flexural toppling rock masses composed of bedded rocks such as gneiss is related to the tensile direction. [ABSTRACT FROM AUTHOR]

High-rise buildings are sensitive to multihazard loads from both short and long-term perspectives. Adding tuned mass dampers (TMDs) is a well-established method to improve the performance of tall buildings, but the cost-benefit of adding TMDs is still a research question to be tackled. To answer this question, a methodology for optimal simultaneous design of reinforced concrete components and TMDs in high-rise buildings is developed for the first time. A cost-benefit focused optimization problem is defined, adopting a monetary cost function that includes direct and indirect costs and the multihazard long-term repair costs. Design variables related to the primary structure and the dampers are selected, as well as a set of constraints. The shear wall rigidities and capacities are included by generating a database of moment-curvature relations, followed by a curve-fitting procedure. An efficient gradient-based algorithm is developed to solve these challenging problems. Using this algorithm, 35 problems are solved, considering three building heights and three metropolitan areas in Israel, with their specific hazard and cost inputs. The results show that for 40-story buildings, adding TMDs is not profitable. For 50-story buildings, this is profitable for Jerusalem, marginally profitable for Tel-Aviv and not practical for Haifa. For 60-story buildings, adding TMDs is profitable for all the locations, with the greatest benefit being detected for Jerusalem, and then for Tel-Aviv in second place. The results are explained by the different building heights, wind load magnitudes and surface selling prices. The framework is shown to be flexible and appropriate for a preliminary TMD profitability assessment. [ABSTRACT FROM AUTHOR]

Background: Peyronie's disease (PD) is a connective tissue disorder that affects the penis and is characterized by abnormal collagen structure in the penile tunica albuginea, resulting in plaque formation and penile deformity. PD's overall prevalence is estimated at 3.2% to 8.9%, with rates as high as 20.3% among men with type 2 diabetes mellitus (DM). However, the characteristics of DM associated with PD complications remain unclear. Aim: To explore clinical associations between DM characteristics and PD complications. Methods: We conducted a retrospective analysis of patients with DM and PD who presented at our institution between 2007 and 2022. We examined patients' clinical histories, DM- and PD-related clinical parameters, and complications. Penile deformities were assessed through physical examination, photographs, and penile Doppler ultrasound. Patients were categorized into subgroups based on age of DM onset: early (<45 years), average (45-65 years), and late (>65 years). Outcomes: Outcomes included effects of DM characteristics on PD development, progression, and severity. Results: In total, 197 patients were included in the evaluation. Early-onset diabetes and elevated hemoglobin A1c (HbA1c) levels exhibited significant correlations with the early development of PD (ρ = 0.66, P < .001, and ρ = –0.24, P < .001, respectively). Furthermore, having DM at an early age was associated with the occurrence of penile plaque (ρ = –0.18, P = .03), and there were no significant differences in plaque dimensions (ρ = –0.29, P = .053). A rise in HbA1c levels after the initial PD diagnosis displayed positive correlations with the formation of penile plaque (ρ = 0.22, P < .006). Clinical Implications: These findings emphasize the need for comprehensive assessments and personalized treatment strategies for individuals with DM and PD. Enhanced management approaches can improve outcomes for those facing both challenges. Strengths and Limitations: Limitations include the single-site retrospective design with potential selection bias, inaccuracies in medical record data, and challenges in controlling confounding variables. Conclusions: This study highlights that early-onset diabetes and poor diabetes control, as indicated by a subsequent rise in HbA1c levels following PD diagnosis, are significantly correlated with the onset and severity of PD. Revealing the mechanisms behind these findings will help us develop better management strategies for individuals with DM and PD. [ABSTRACT FROM AUTHOR]

Background: Erectile dysfunction (ED) is a disorder that makes it hard or impossible to keep or get an erection that is good enough for sexual activity. ED can be caused by physical, mental, or combined factors, and it is usually associated with a long-term health issue. Methods: The study is a prospective and cross-sectional research conducted in a hospital setting. It took place from December 2019 to December 2022 at Gezira Hospital for Renal Disease and Surgery. The study sample consisted of 246 patients. Results: The most frequently affected age groups were 30-40 years and 50-60 years, accounting for 26% and 25.2% of the sample, respectively, while the least affected age groups were >20 years and >70 years, representing 1.2% and 3.7% of the sample, respectively. The most common symptoms reported by the patients were ED alone (74%) and ED with penile curvature (22%). The most prevalent causes were psychogenic, Peyronie's disease, and venogenic, affecting 54.1%, 24.4%, and 16.3% of patients, respectively. The most frequent comorbidities associated with ED were diabetes mellitus (DM) and hypertension, occurring in 12.2% and 4.1% of the patients, respectively. There was a statistically significant correlation between age and etiology (P-value = 0.00), age and symptom (P-value = 0.012), and symptom and cause (P-value = 0.000). Conclusion: The age group of 30-40 years was the most affected by ED, and ED alone was the most frequent symptom. Psychological factors were the main cause of ED, and DM was the most common comorbidity associated with ED. [ABSTRACT FROM AUTHOR]

Globally, but especially in the Chinese Loess Plateau, landslides are considered to be one of the most severe and significant geological hazards. The purpose of this study is to design two ensemble machine learning methods, which are denoted as ADTree-Dagging and SVM-Dagging, for modeling landslide susceptibility in Lanzhou City (China). For this aim, the slope units extracted by the curvature watersheds method are used to construct landslide susceptibility modeling, and ten landslide conditioning factors are included in the landslide susceptibility evaluation (altitude, slope angle, slope aspect, cutting depth, surface roughness, relief amplitude, gully density, rainfall, distance to roads, and lithology). The conditioning factors selection and spatial correlation analysis were implemented by using the correlation attribute evaluation method and the frequency ratio model. The comprehensive performance of the models was tested using the receiver operating characteristic (ROC), area under the ROC curve (AUC), the root mean square error (RMSE), and several other performance metrics. For the training dataset, the results show that the SVM-Dagging model acquire the largest AUC value (0.953), lowest RMSE (0.3125), highest positive predictive value (96.0%), highest negative predictive value (91.2%), highest sensitivity (91.6%), highest specificity (95.8%), highest accuracy (93.6%), and highest Kappa (0.873). Similar results are observed in the validation dataset. Results demonstrated that the Dagging technique has improved significantly the prediction ability of SVM and ADTree models. The Dagging method can combine different models by leveraging the strengths of each model to create methods with higher flexibility than traditional machine learning methods. Therefore, in this study, the proposed new models can be applied for land-use planning and management of landslide susceptibility in the study area and in other areas containing similar geological conditions. [ABSTRACT FROM AUTHOR]

Introduction: Traditional anatomy-based penile venous surgery is deemed inadequate. Based on revolutionary insights into penile vasculature, penile venous stripping (PVS) shows promise in treating adolescent erectile dysfunction (AED). We aimed to report on this novel approach. Methods: We conducted a retrospective analysis of 223 individuals under 30 diagnosed with veno-occlusive dysfunction (VOD) between 2009 and 2023. Among them, 83 were diagnosed with AED and divided into the PVS (n = 37) and no-surgery (NS, n = 46) groups. All participants had been dissatisfied with conventional therapeutic options. Dual pharmaco-cavernosography was the primary diagnostic modality. PVS involved stripping the deep dorsal vein and two cavernosal veins after securing each emissary's vein with a 6-0 nylon suture. Erection restoration was accessed using the abridged five-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS). Statistical analysis was performed using IBM SPSS 21.0. Results: There were significant differences (both p < 0.001) between the preoperative and postoperative IIEF-5 scores in the PVS and NS groups (9.8 ± 3.0 vs. 20.4 ± 2.2; 9.9 ± 2.5 vs. 9.5 ± 2.1), as well as in the EHS scores (1.7 ± 0.7 vs. 3.5 ± 0.6 and 1.8 ± 0.5 vs. 1.3 ± 0.4). The satisfaction rate was 87.9% (29/33) in the PVS group and 16.7% (17/41) in the NS group. Conclusions: AED can be effectively treated using physiological methods, although larger patient cohorts are needed for validation. [ABSTRACT FROM AUTHOR]

Peyronie's disease (PD) affects the penile albuginea, resulting in penile deformity, pain, erectile dysfunction (ED), and an anxious–depressive state. PD diagnosis involves a thorough medical history, penile palpation, documentation of the penile deformation, a dynamic penile echo color Doppler ultrasound (PCDU), and the completion of questionnaires for the evaluation of pain, ED, and psychometric tests. The aim of this study was to evaluate the symptoms of PD and their prevalence in PD patients in the active phase who had access to our andrology clinic. Inclusion criteria: availability of data on patients diagnosed with PD, including detailed medical history, blood tests, penile palpation, photographic documentation of penile deformity, and penile PCDU. Exclusion criteria: PD patients in the stable phase or those without the specified tests and data mentioned above. Our study found a higher prevalence of PD in younger patients (24.2%), a higher coexistence of PD with chronic prostatitis (35.6%), a higher percentage of cases of association between penile deformity and penile curvature (84.4%), a higher prevalence of "significant anxiety" (88.4%), a higher presence of plaque calcification (35.6%), and the detection of a longer duration of the first phase of PD (>18 months). The most frequently observed type of penile curvature was dorsal, followed by left lateral, right lateral, and, less commonly, ventral. We observed a significant statistical correlation between patient age and IIEF score, indicating that patients over the age of 40 years are at a higher risk of experiencing ED. We found a strong statistical relationship between VAS score and age. As age increases, the VAS score decreases, suggesting that younger patients reported more penile pain compared to those who were older than 40 years. Furthermore, we found that penile pain has a significant impact on the psychological state of PD patients. We also found that 38.8% of PD patients suffered from severe anxiety. In relation to this, psychotherapy should be integrated into PD treatment to improve the quality of life and treatment adherence. [ABSTRACT FROM AUTHOR]

Background. In this study, long-term functional, cosmetic, and quality-of-life outcomes of patients with congenital penile curvature who were operated on using the modified Essed–Schröder procedure were evaluated. Materials and Methods. Between 2009 and 2022, 233 patients with congenital penile curvature were operated using a modification of the Essed–Schröder technique. The average age of the cases was found to be 23.7 Æ 4.6 (18–37). The mean postoperative follow-up period was 76.1 Æ 16.8 (18–153) months. At the end of the follow-up period, 203 of 233 patients were interviewed retrospectively, and standard questionnaires were filled out to evaluate the functional, cosmetic, and quality-of-life results of the procedure. Results. There was a curvature ventral in 103, left lateral in 40, right lateral in 30, dorsal in 17, dorsolateral in 8, and ventrolateral in 5 cases. The mean degree of curvature was found to be 51.7 Æ 9.4 (30–80). Recurrent curvature was detected in 16 cases (7.14%), and discomfort due to suture palpation was detected in 17 cases (8.37%). No case reporting erectile dysfunction was detected. 90.6% of the patients reported that they were satisfied with the operation. As a result, the curvature was effectively corrected, and the sensation of postoperative suture palpation was minimized. It has been determined that it increases patient and partner satisfaction and improves the quality of life. Conclusions. The modified Essed–Schröder technique is a relatively simple technique and provides successful functional and cosmetic results. It also provides a significant improvement in quality of life. [ABSTRACT FROM AUTHOR]

Background: Surgical exploration and closure of the tunica albuginea is the recommended treatment for penile fractures. The recovery of sexual function is the main result that surgeons and patients pursue. Objective: We sought to evaluate the sexual health effects of a surgically corrected penile fracture. Secondarily, we sought to identify risk factors that may influence long‐term sexual function and their effects on genital body image satisfaction. Methods: A retrospective analysis of patients who underwent surgical correction of penile fractures between 2007 and 2022 in a tertiary center was performed. Lesion characteristics, weeks until the resumption of sexual activity, and post‐operative sexual function were recorded. The presence of glans hypoesthesia, penile deformation, penile nodule palpation, and self‐satisfaction with body image were assessed. Results: Sixty‐nine patients with a mean age of 42.30 ± 12.98 years and a median follow‐up of 70 (20–134) months were identified. Sexual intercourse was recorded as a percentage. Penile deformation was the most common complication, appearing in 14.5% of patients, erectile dysfunction in 5.8%, penile nodules in 4.3%, and glans hypoesthesia in 2.9%. The median post‐operative International Index of Erectile Function‐5 was 24 (21.5–24). Self‐satisfaction with body image had a median of 9 and was negatively associated with bilateral lesions and penile deformation. Discussion and conclusion: Distal fractures could be linked to erectile dysfunction and glans hypoesthesia. Surgical correction of penile fractures shows positive functional and self‐reported outcomes, and the potential andrological complications rarely necessitate specific treatment. [ABSTRACT FROM AUTHOR]

Congenital dorsal curvature of the distal phalanx has been previously described as 'reverse Kirner' or 'ski-jump' deformity. This report describes bilateral occurrence in the thumbs. A 13-year-old male presented with difficulty caring for his thumbnails and in picking up small objects. Examination showed dorsal curvature of the distal phalanges of both thumbs, with greater curvature of the right side. Radiographs showed wedge-shaped epiphyses and dorsal curvature without coronal plane deviation of the distal phalanges. There was objective and subjective decrease in function associated with lateral pinch and tripod grasp. The reported aetiopathogenesis for Kirner deformity cannot explain the observed dorsal curvature. The bilateral nature makes a secondary physeal cause unlikely and suggests an embryologic basis. Due to the noticeable deficits in function, operative intervention may be warranted. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Aphallia is a rare congenital anomaly often associated with other urogenital anomalies. The management of aphallia cases for both the immediate and long-term treatment of patients with aphallia pose a major dilemma. Patients are at risk for psychosocial and psychosexual challenges throughout life. Methods: A systematic review was conducted on aphallia cases. We searched online databases until March 2023 for relevant articles and performed according to the PRISMA-P guidelines. Results: Of the 43 articles screened, there were 33 articles included. A total of 41 patients were analyzed qualitatively. Asia is the region with the most aphallia cases with 53% (n:22), while the United States is the country with the most most reported aphallia cases 31% (n:13). Most cases were identified as male sex (n: 40), and most cases were neonate with 68% (n:28) cases. Physical examination generally found 85% (N = 35) with normal scrotal development and palpable testes. The most affected system with anomalies is the genitourinary system with fistulas in 80% (n:29) cases. Initial management in 39% (n:16) of patients involved vesicostomy. Further management of 31% (n:13) included phalloplasty or penile reconstruction, and 12% (n:5) chose female sex. 17% (n:7) of patients refused medical treatment or were lost to follow-up, and 12% (n = 5) patients deceased. Conclusion: Aphallia is a rare condition and is often associated with other inherited genitourinary disorders. In most cases, physical examinations are normal except for the absence of a phallus, and laboratory testing shows normal results. The initial management typically involves the vesicostomy procedure. Subsequent management focuses on gender determination. Currently, male sex is preferred over female. Due to the significant variability, the rarity of cases, and the lack of long-term effect reporting in many studies on aphallia, further research is needed to minimize bias. [ABSTRACT FROM AUTHOR]

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The stomach is a muscular bag that forms the most dilated part of the gastrointestinal tract. It serves as a reservoir for food and aids in the conversion of food into chyme under the influence of hydrochloric acid. The stomach is prone to conditions such as peptic ulcers, Gastroesophageal Reflux Disease (GERD), birth defects like Infantile Hypertrophic Pyloric Stenosis (IHPS) and stomach carcinoma. Surgical manipulation of the stomach is performed by bariatric surgeons for treating obesity. A comprehensive understanding of stomach variations helps clinicians identify developmental defects during disease diagnosis and prevents inadvertent damage during surgeries. In a recent case involving a specimen obtained for studying anatomical stomach variations and histological alterations, an unusual tubular stomach was discovered in an 80-year-old female cadaver during routine dissection by medical students in the Department of Anatomy. The stomach was dissected by cutting through the oesophagus superiorly and the pyloric duodenal junction inferiorly, and then removed from the abdominal cavity. An incision was made along the greater curvature of the stomach for internal examination. This tubular-shaped stomach had a smaller number of rugae and measured 28 cm in length. Tissue samples were collected for histopathological examination using Haematoxylin and Eosin (H&E) stain. Different stomach shapes are closely linked to organogenesis. Various acquired stomach variations are clinically significant, such as those occurring in oesophagectomy, which involves the surgical division of the vagal nerve and vagal sparing oesophagectomy, a procedure for weight loss. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Formulating an effective root canal treatment plan necessitates clinician awareness of the complexities of the root canal system and possible anatomic challenges. The C‐shaped canal variation accompanying the radicular lingual groove makes the lingual dentinal wall so thin that cleaning and shaping of canals require accurate management. This report presents endodontic treatment of a C‐shaped mandibular second molar diagnosed with pulpal necrosis and asymptomatic apical periodontitis, that initial radiographic assessment revealed extremely thin (0.3 mm) width of the lingual wall of the canals prone to perforation. Mechanical preparation was performed through the anti‐curvature technique and basically by chemical irrigation rather than mechanical instrumentation. The C‐shaped isthmus was prepared up to 25/02 rotary system without dentinal defect while maintaining adequate dentin thickness so as to not significantly reduce the strength of the root. Follow‐up radiographs showed normal periodontal ligament and lamina dura indicating significant healing of the periapical lesion. [ABSTRACT FROM AUTHOR]

Background: The efficacy and safety of collagenase Clostridium histolyticum (CCH) have been demonstrated in the treatment of men with Peyronie's disease (PD); however, the pivotal clinical trials excluded men with ventral penile curvature. Aim: The study sought to evaluate outcomes of CCH treatment in men with ventral curvatures secondary to PD. Methods: Men with PD treated with CCH were identified from a prospective database. Patients received up to 4 series of CCH injections using a progressively modified protocol over time. Results were compared between those with baseline ventral vs nonventral penile curvatures. Outcomes: Changes in penile curvature, Peyronie's Disease Questionnaire scores, International Index of Erectile Function scores, nonstandardized assessments, and adverse events. Results: A total of 560 men with PD (85 ventral curvature, 475 nonventral curvature) were included in the analysis. Baseline median curvature was 60.0° (interquartile range, 48.8°-75.0°) in the ventral cohort and 65.0° (interquartile range, 45.0°-80.0°) in the nonventral cohort. Median change from baseline penile curvature was −25.0° in the ventral cohort vs −24.0° in the nonventral cohort (P =.08, between-group comparison), which corresponded to curvature reductions of 44.7% and 33.6%, respectively (P =.03). In the subset of patients who completed CCH treatment (ie, received 8 injections or discontinued early because of patient satisfaction with curvature reduction), median change from baseline was −35.0° in the ventral cohort vs −25.0° in the nonventral cohort (P <.05); median percent improvement was 48.3% and 37.5%, respectively (P = .11). Median change from baseline in Peyronie's Disease Questionnaire and International Index of Erectile Function domain scores and adverse events were similar between cohorts, with the exception of possibly higher hematoma rates in the nonventral group (50% vs 37%; P = .05). No urethral injuries were sustained in either cohort. Clinical Implications: Data support the use of CCH for the treatment of ventral as well as nonventral penile curvatures in men with PD. Strengths and Limitations: Study strengths are the inclusion of a general clinical population of men with PD, the prospective design, and the relatively large series of men with ventral curvature. Limitations include the single-center and observational nature of the study. Conclusion: CCH was safe and effective in the treatment of both ventral and nonventral penile curvatures in men with PD. [ABSTRACT FROM AUTHOR]

To determine change in the point of maximal curvature (POMC) during Collagenase Clostridium histolyticum (CCH) injections for Peyronie's disease (PD). A prospective database has been maintained of all men undergoing CCH injections since March 2014. For the current study, data were abstracted on the POMC with each curve assessment and correlated with demographic and clinical factors. Maximal changes were defined as the largest change in POMC from baseline. Six hundred and eighteen men underwent ≥1 series of CCH, with 313 having a baseline and subsequent POMC measurements available. Median baseline curvature was 60.0° and POMC 2.8 cm. Among 189 men who were satisfied or completed 8 CCH injections, the median improvement in penile curvature was −27.5° (40.9%). The median maximal change in POMC during CCH treatment was 1.0 cm (interquartile range, 0.5, 1.8). Overall, 55.6% had changes in POMC of ≥1 cm, 23.6% ≥2 cm, 8.9% ≥3 cm, and 3.8% ≥4 cm. Multivariate logistic regression identified ventral curvature as a predictor of larger change in POMC, after controlling for other variables. Study limitations included the observational, non-randomized study design and potential for intra- and inter-individual measurement variability. Strengths are the inclusion of an all-comer population, large series, prospective database, and routine objective assessments. Approximately half of men with PD undergoing CCH experience ≥1 cm of change in POMC during the treatment course, with nearly 1/4 experiencing ≥2 cm. Findings suggest that patients may benefit from repeat curvature assessments with each CCH series to optimize accuracy of drug administration. [ABSTRACT FROM AUTHOR]

Background: Cell therapy (CT) is a form of regenerative medicine under investigation for the management of male sexual dysfunction (MSD). Aim: We sought to perform a systematic review of published information on CT for MSD and provide an official position statements for the European Society for Sexual Medicine. Methods: A comprehensive bibliographic search on the MEDLINE, Web of Science, Scopus, and Cochrane Library databases was conducted in February 2023. Articles were selected based on the Population, Intervention, Comparator, Outcome, Study design (PICOS) model if they included male patients (P) undergoing CT (I) with or without comparison with other treatments (C) and evaluated the impact of CT on sexual function (O). Quantitative data were reported as found in the original studies (S). Level of evidence and grade of recommendation according to the Oxford Centre for Evidence-Based Medicine were assigned to each statement. Outcomes: Outcomes were determined based on assessment of erectile function, ejaculatory function, orgasmic function, sexual desire, and penile curvature. Results: A total of 19 studies and 421 patients were included. Most articles (n = 12, 63%) were case series, whereas a minority of papers (n = 6, 32%) had a comparative group; only 2 articles reported randomized controlled trials (RCTs) and 1 article reported a post hoc analysis of RCTs. Most articles (16, 84%) investigated patients with erectile dysfunction (ED). Improvements in the International Index of Erectile Function–Erectile Function Domain (IIEF-EF) or the IIEF 5-item version (IIEF-5) were found in 11/15 (73%) studies, with mean increases in IIEF-EF, mean IIEF-5, and median IIEF-EF between 8 and 14 points, 2 and 9 points, and 4.5 and 6 points, respectively. Two papers (20%) evaluated men with Peyronie's disease (PD). In both ot these articles penile curvature improvement and plaque volume reduction were described in all patients (n = 16, 100%). Objective measurements were performed in 1 study, which showed 10°-120° (15%-100%) curvature improvement and 90%-100% plaque reduction. Mild transient adverse events at the donor or administration sites were found in 7/16 (44%) papers on ED. Priapism was reported in one case (20%) and mild penile skin complications were reported in the majority of patients after CT for PD. No severe adverse events were described. Clinical Implications: Although high-quality evidence is lacking, CT appears to have potential benefits from application in patients with ED or PD. Strengths and Limitations: This report is to our knowledge the most comprehensive and up-to-date systematic review on the topic of CT for the management of MSD, including the position statements of the European Society for Sexual Medicine. Overall the assessment of available studies demonstrated low quality and significant heterogeneity. Conclusion: Preliminary findings support potential efficacy and safety of CT in patients with ED or PD. Low-quality papers, high methodological heterogeneity, uncertainty about the magnitude of the beneficial effects, and lack of long-term data limit the available evidence. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluates the inter-rater agreements of both the Glans–Urethral Meatus–Shaft (GMS) hypospadias score and Hypospadias Objective Penile Evaluation (HOPE) score, aiming to standardize disease classification for consistent agreement in clinically relevant characteristics of hypospadias. Methods: Photos of hypospadias in children were collected from two separate institutions. Three raters scored the photos using GMS and HOPE, excluding penile torsion and curvature assessment in HOPE due to photo limitations. Results: A total of 528 photos were included. With GMS, Fleiss' multi-rater kappa showed an agreement of 0.745 for glans–urethral plate, 0.869 for meatus, and 0.745 for shaft. For HOPE scores, the agreements were 0.888 for position of meatus, 0.669 for shape of meatus, 0.730 for shape of glans, and 0.708 for the shape of the skin. The lower agreement in the shape of the meatus evaluation may be attributed to the lack of a quantitative classification method in HOPE. Experts rely on their subjective judgment based on the provided example photos and their index patient. Conclusions: While there is high agreement among experts when evaluating hypospadias using the GMS and HOPE scoring criteria, only the position of the meatus achieved nearly perfect agreement highlighting that the current scoring systems entail a subjective element in disease classification. [ABSTRACT FROM AUTHOR]

Background: Despite the existence of conservative therapies for Peyronie's disease (PD), surgery is commonly utilized for the treatment of bothersome curvatures due to its potential effectiveness, although it carries intrinsic risks and may not universally lead to satisfactory outcomes. Aim: To explore the rate and factors influencing patients' willingness to undergo surgery for PD. Methods: Data were prospectively collected in 5 European academic centers between 2016 and 2020. Data included age, time from PD onset, penile pain, curvature degree, difficulty at penetration, hourglass deformity, erectile dysfunction (ED), and previous treatments. All patients were offered conservative treatments, either medications or injections. Tunical shortening or lengthening procedures were offered as an alternative to conservative treatments, when indicated. Penile prosthesis was offered to those with concomitant ED. Patients' attitudes with surgery were recorded. Logistic regression analyses tested the profile of patients who were more likely to be willing to undergo surgery. Outcomes: Patients' willingness to undergo surgery for PD. Results: This study included 343 patients with a median age of 57.3 years (IQR, 49.8-63.6) and a median penile curvature of 40.0° (IQR, 30.0°-65.0°). Overall, 161 (47%) experienced penetration difficulties and 134 (39%) reported ED. Additionally, hourglass deformity and penile shortening were reported by 48 (14%) and 157 (46%), respectively. As for previous treatments, 128 (37%) received tadalafil once daily; 54 (16%) and 44 (13%), intraplaque verapamil and collagenase injections; and 30 (9%), low-intensity shock wave therapy. Significant curvature reduction (≥20°) was observed in 69 (20%) cases. Only 126 (37%) patients were open to surgery for PD when suggested. At logistic regression analysis after adjusting for confounders, younger age (odds ratio [OR], 0.97; 95% CI, 0.95-1.00; P = .02), more severe curvatures (OR, 1.04; 95% CI, 1.03-1.06; P <.0001), and difficulty in penetration (OR, 1.88; 95% CI, 1.04-3.41; P = .03) were associated with a greater attitude to consider surgical treatment. Clinical Implications: The need for effective nonsurgical treatments for PD is crucial, as is comprehensive patient counseling regarding surgical risks and benefits, particularly to younger males with severe curvatures. Strengths and Limitations: Main limitations are the cross-sectional design and the potential neglect of confounding factors, Conclusions: Patients with PD, having a lower inclination toward surgery, emphasize the need for effective nonsurgical alternatives and accurate counseling on the risks and benefits of PD surgery, particularly for younger men with severe curvatures. [ABSTRACT FROM AUTHOR]

Peyronie's Disease (PD) causes penile curvature and pain in acute phase. In two preclinical studies, tamoxifen and vardenafil (T&T) together showed to be effective in the acute phase. The aim of this study was to describe the clinical results of the off-label treatment of PD patients with T&T in combination with vacuum erection device (VED) in St Antonius hospital, urology outpatient clinic. Baseline descriptive Statistics, Fisher Exact and Chi-Square Test were used. 48 Men were included, mean age 53.0 years (SD 9.5), baseline curvature 46.7° (SD 18.8), median duration four months, 70.8% (n = 48) painful erections. Dorsal curvature is found in 27 (56.3%) men, mean stretched penile length 13.4 cm. Mean use of T&T was 13 weeks (1–52 weeks). Curvature improvement in 27.7% men, pain reduction in 48.5% men, sexual intercourse/coitus improvement in 34.2% men, erection improvement in 14.6% men. Adverse reactions of T&T in 39.6% (n = 19). This was the first study investigating the use of T&T in acute phase PD patients. 27.7% of patients reported improvement in curvature with T&T. [ABSTRACT FROM AUTHOR]

To assess the relationship between baseline total serum testosterone (T) and clinical outcomes in men affected by Peyronie's disease (PD) stable stage and treated by extra corporeal shockwave therapy (ESWT). In this study, 168 patients affected by PD in stable stage (≥12 months) and treated with ESWT, were divided into 2 groups. Group 1 (G1) counted 71 patients with low T levels (≤ 300 ng/dL); group 2 (G2) consisted of 97 patients with normal T that received ESWT with the same protocol of G1 for 6 weeks. There were assessed at baseline and follow-up: Erectile dysfunction (ED), presence and severity of painful erections, penile plaque size, and penile curvature degree. The results were evaluated at baseline and 3, 6, 12, months after the treatment. Not statistically significant differences emerged between the 2 groups at baseline, except for higher presence of patients with ED in G1 (90%) vs G2 (52%). Three months after the treatment in G2 pain was resolved completely in 80.4% of the patients, compared with G1 (54.9%). G2 had a reduction of curvature degree after the 3-month treatment (P <.001). Mean plaque size decreased in both groups without statistically differences with baseline values. Mean ± SD International Index of Erectile Function-5 score progressively improved significantly in the eugonadal men. This study demonstrated greater efficacy for the treatment of PD in men with normal T concentrations compared with men with low T concentrations. The results obtained from this study suggest that may be valuable in considering T therapy in men with PD prior to ESWT. [ABSTRACT FROM AUTHOR]

Background: A penile fracture occurs when the tunica albuginea of penis tears during erection. Penile fracture is a rare but serious injury that occurs when the erect penis sustains a traumatic force. It is characterized by a sudden snapping or popping sound, followed by immediate pain, swelling, and discoloration. Its association with concomitant urethral injury is very rare. This case study describes such a rare case. Case presentation: In this case study, we present the case of a 47-year-old man who experienced sudden pain and lost erection with a popping sound while having sexual intercourse. There was bloody discharge from the urethral opening and showed the distinct sign of an "Eggplant Deformity." This result confirmed the diagnosis. Immediate surgical intervention revealed damage to the left corpora and urethra. The procedure involved repairing the tunica albuginea covering the corpora tissue and reconstructing the damaged urethra. The surgery went smoothly without complications. The patient reported satisfactory erectile function and normal urination on follow-up visit after 2 months. Conclusion: Penile fracture with urethral injury is a rare but serious emergency. Prompt detection and surgical intervention are crucial for optimal outcomes and minimal complications. Depending on severity, either catheterization or repair may be necessary. [ABSTRACT FROM AUTHOR]

Purpose: Gastrointestinal mesenchymal tumors (GMTs) include malignant, intermediate malignancy, and benign lesions. The aim is to propose a new surgical classification to guide the intraoperative minimally invasive surgical strategy in case of non-malignant GMTs less than 5 cm. Methods: Primary endpoint is the creation of a classification regarding minimally invasive surgical technique for these tumors based on their gastric location. Secondary endpoint is to analyze the R0 rate and the postoperative morbidity and mortality rates. Tumors were classified in two groups based on their morphology (group A: exophytic, group B: transmural/intragastric). Each group is then divided based on the tumor location and consequently surgical technique used in subgroup: AI (whole stomach area) and AII (iuxta-cardial and pre-pyloric areas) both for the anterior and posterior gastric wall; BIa (greater curvature on the anterior and posterior wall), BIb (lesser curvature on the anterior wall); BII (iuxta-cardial and pre-pyloric area in the anterior and posterior wall, including the lesser curvature on the posterior wall). Results: Forty-two patients were classified and allocated in each subgroup: 17 in AI, 2 in AII, 5 in BIa, 3 in BIb, and 15 in BII. Two postoperative Clavien-Dindo I complications (4.8%, subgroup BIa and BIb) occurred. One patient (2.4%, subgroup AI) underwent reintervention due to R0 resection. Conclusions: This classification proved to be able to classify gastric lesions based on their morphology, location, and surgical treatment, obtaining encouraging perioperative results. Further studies with wider sample of patients are required to draw definitive conclusions. [ABSTRACT FROM AUTHOR]

Introductıon:Congenital penile curvature is an anomaly that often accompanies hypospadias. It is the abnormal curvature of the erected penis without any abnormality in penile chord meatal position without hypospadias and it is a rare condition. We aimed to review our experiences in the light of the literature by presenting our cases of congenital chordee without hypospadias that we operated on in pediatric patients Methods:The data of the patients who were operated in our clinic between January 2020 and June 2022 for congenital chord without hypospadias were analyzed retrospectively. Patients who had previous surgical procedures were excluded from the study Results: Seventeen patients were included in the study. The ages of the patients were determined as 23-176 months (median 91.8 months). It was observed that the chordee degree of the patients was between 30-90 degrees.Seven of the 17 patients had chordee after degloving of the penis, that is, they had skin chordee. Heineke-Mikulicz plication was performed in 5 of the remaining ten patients and tunical plication was performed in 3 patients. Two patients with ventral cords underwent corporotomy and ventral grafting in their follow-up. Conclusion:The vast majority of penile cords without hypospadias can be corrected with simple degloving or plication techniques. No matter what technique we use, the protection of neurovascular structures and the urethral plate should be our main goal. Although penile cordis without hypospadias is rare, we argue that it can be performed in experienced centers with low complication rates and successful results. [ABSTRACT FROM AUTHOR]

The article discusses a surgical technique called the "V-I penoscrotal reconfiguration" for treating congenital webbed penis (CWP) to improve penile appearance and prevent psychological and sexual issues in patients. While the technique shows promising short-term outcomes, the authors suggest caution due to potential complications like scarring and penile curvature. They recommend considering alternative techniques using scrotal tissue to avoid such issues and emphasize the importance of longer follow-up studies for younger patients. The authors also highlight the vascular system of the scrotum as a source of tissue for penile shaft reconstruction, offering advantages like natural appearance and easier closure. [Extracted from the article]

Background: ESG is a safe and effective technique in the obesity management, usually indicated in class I and II obesity. It is also an acceptable treatment in patients with class III obesity who have high surgical risk or refuse surgery. This procedure results in a significant weight loss and important improvement in metabolic comorbidities. Nevertheless, there are several procedure-related complications. Few cases of gastric perforation following ESG have been reported. We present a case of septic shock after ESG with preoperative diagnostic uncertainties. Methods: We present the case of a 54-year-old male with a BMI of 43.6 kg/m2 who underwent ESG 7 days before in an external center. The patient came to the emergency department presenting abdominal pain, nausea, and vomiting since the day after the procedure. Physical examination revealed hemodynamic instability, altered level of consciousness, diffuse abdominal pain, and a painful umbilical lump due to a complicated umbilical hernia. Emergent surgery was decided after preoperative assessment. Results: Intraoperative gastroscopy was performed, viewing a gastric ischemic ulcer covered with fibrin and a mucosal defect and suspecting a covered gastric perforation. Firstly, we performed an open approach to the complicated umbilical hernia. Subsequently, an exploratory laparoscopy was performed through the hernial ring, where a fibrin-covered area was evidenced in the anterior face of the gastric body, adhered to the round ligament by a transmural suture of the ESG. Additionally, multiple transmural sutures were observed adhered to the greater omentum and lesser sac and an intramural hematoma in the greater gastric curvature. No intra-abdominal free fluid was evidenced. A laparoscopic barbed suture of the area covered with fibrin was performed, after its release from the round ligament. The adhesions of the sutures and metallic material from the ESG were released. Finally, two abdominal drains were placed in the anterior and posterior gastric face. The patient presented superficial incisional surgical site infection and was discharged 6 days after laparoscopic surgery. Conclusions: ESG is a novel procedure, which has proven to be an effective alternative in the treatment of obesity. However, this technique may have major complications that can require urgent surgery. [ABSTRACT FROM AUTHOR]

The constitutive matrices for 32 typical classes of crystalline solids are determined for elastic dielectrics considering couple stress, quadrupole, curvature-based flexoelectric, and other higher-order effects. According to the Neumann's principle, a simple but general method based on the transformation laws of tensor components is presented to derive the constitutive matrices of different classes of crystals. Derivations of constitutive matrices for curvature-based flexoelectricity of crystals of classes Oh (m3m) and C6v (6mm) are explicitly shown as examples. Based on our program, we have: (i) the classical elastic stiffness matrix, piezoelectric matrix, and dielectric matrix obtained in the current work are consistent with those existing results; (ii) the non-classical (higher-order) constitutive matrices in 32 typical classes of crystals, such as couple stress stiffness, coupling between Cauchy stress and couple stress, higher-order dielectrics for quadrupole, curvature-based flexoelectricity, and the converse of flexoelectricity are obtained. The number of independent material constants in constitutive matrices for 32 classes of crystals is also summarized. The present paper provides a reference for solid mechanics researchers facing higher-order multiple physics problems in different categories of crystals and guidance for relevant material experiments. [ABSTRACT FROM AUTHOR]

Background: Peyronie's disease (PD) represents a challenging urological disease, due to not optimal post-operative surgical outcomes. We aim to retrospectively evaluate if vacuum erection device (VED) treatment before penile curvature surgery is able to improve post-operative surgical outcomes. Methods: All enrolled patients were assigned to the following groups: (a) the treatment group: VED treatment (three times per week) starting 3 months before surgery and (three times per week) one month after surgery; and (b) the control group: VED treatment (three times per week) one month after surgery. Follow-up urologic visits were scheduled for 3 and 6 months after surgery, and the two groups were compared. Results: A total of 38 patients were enrolled (median age 67 years, 57–74, IQR): 20 in the treatment group and 18 in the control group. At the follow-up visits, the two groups were different in terms of IIEF-5 (26 vs. 24; p = 0.02), "yes" to SEP2 and 3 (85% vs. 55%; p < 0.001, 85% vs. 50%; p < 0.001, respectively), and PDQ (−16 vs. −11; p = 0.03). Complete correction of penile curvature was achieved in 36 patients (94.7%). In the treatment group, no hourglass deformity was reported, whereas one patient reported a mild hourglass deformity in the control group. In the treatment group, we obtained a longer total penile length (median +1.5 cm). The overall satisfaction rate was 98% in the treatment group and 96% in the control group. Conclusions: The VED treatment before penile curvature surgery in patients affected by PD was able to improve surgical outcomes. [ABSTRACT FROM AUTHOR]

Background: The therapeutic role of extracorporeal shockwave therapy (ESWT) for Peyronie's disease (PD) has been controversial in a long term. We aimed to further evaluate the therapeutic effect of ESWT for PD on the basis of available high-quality studies. Methods: The PubMed, CENTRAL and Embase databases were searched for articles published from January 1st, 2000 to December 31, 2022. Only randomized controlled trials (RCTs) using ESWT to treat PD were included. Meta-analysis and forest plots were carried out using Review Manager 5.4.1 software, and outcomes were reviewed by 2 authors independently. Using the Risk of Bias assessment form (ROB-2) by Cochrane Collaboration for quality assessment. PRISMA 2020 guidelines were used in this article to achieve the quantitative and qualitative synthesis of data. Results: A total of four RCTs were included. 151 patients in the ESWT group and 150 patients in the control group. The meta-analysis results showed that ESWT could significantly reduce plaque size (OR 2.59, 95%CI 1.15 to 5.85, P = 0.02) and relieve pain (MD -1.55, 95%CI -2.46 to -0.64, P = 0.0008); but it has no significant effect on reducing the penile curvature (OR 1.93, 95%CI 0.87–4.26, P = 0.11) and improving sexual function (MD 2.6, 95%CI -1.63 to 6.83, P = 0.23), there is also no significant difference in complication rates between groups (OR 2.94, 95%CI 0.66 to 13.03, P = 0.16). The risk of bias of results is low. The limitations of this study are that the number of included studies is too small, some experimental outcomes are missing, and the expression of outcomes is not unified. Conclusions: For PD, ESWT can be considered as a safe short-term treatment, which can reduce plaque size and relieve pain, but cannot improve penile curvature and sexual function. Its long-term efficacy remains to be discussed. Registration number: PROSPERO (ID: CRD42023436744). [ABSTRACT FROM AUTHOR]

Introduction: Hypospadias is a condition when the urethra distal opens on the bottom of the penis and has a ventral penile curvature. Hypospadias is the second most frequent genital birth abnormality in boys after cryptorchidism. Surgery is the standard treatment of choice and has a significant risk problem. There are many surgical procedure complications, especially in appearance and function. This article discusses the appropriate operative management and the best long-term outcome. Methods: The data was culled and selected from the ten years of full-text English publication (2012-2022) utilizing the PubMed and Google Scholar databases. Meta-analyses (PRISMA) paradigm and PICO investigation of management techniques and long-term outcomes in clinical and randomized clinical trials. Result: From 149 search articles, 7 met the inclusion criteria. The gland penis size and the meatal location did not affect the outcome of the surgical technique. However, 58/432 patients required reoperation, and 61(13%) had urethroplasty complications (UC), although not statistically significant (OR 0.8, 95% CI: 0.7-0.9). Testosterone is advised for small penises, narrow glands, thin urethral plates, and proximal hypospadias (67 vs. 87%). Preoperative antibiotics reduce the incidence of infection (17/150 repairs), tubularized incised plate (TIP), and the stent is recommended. Conclusion: The recommended strategies are good perioperative treatment, including antibiotics, testosterone treatment, surgery ages (6-18 months), tubularized incised plate (TIP) technique, and stent postoperative. [ABSTRACT FROM AUTHOR]

Purpose: To assess the clinical effectiveness of extra corporeal shockwave therapy (ESWT) administration compared with ESWT plus a low-intensity laser diode therapy (LILDT) in the management of Peyronie's disease (PD) stable stage. Methods: In this study, 214 patients affected by PD in stable stage (≥ 12 months), were divided into two groups. Group 1 (G1) counted 111 patients treated only with ESWT; Group 2 (G2) consisted of 103 patients that received ESWT with the same protocol of G1 plus LILDT for six weeks. The patients of both groups were assessed at baseline and follow-up for erectile function, painful erections, penile plaque size and penile curvature. The results were evaluated at baseline and 3, 6, 12 months after the treatment. Results: Three months after the treatment in G2 pain in an erection or during intercourse was resolved completely in 78.6% of the patients, whereas in 55.8% cases of G1 (p < 0.003). G2 patients had a reduction of curvature degree after the 3 months treatment (p < 0.002). However, mean plaque size decreased in both groups without statistically differences with baseline values. Mean ± SD IIEF-5 score further improved significantly in the group treated with ESWT plus LILDT (p < 0.001). There were no permanent adverse sequelae after treatments. Conclusion: This study demonstrates an interesting therapeutic strategy when combined to the synergistic action of a shock wave therapy with low-intensity laser therapy on the stable plaques with significant benefits in terms of pain perception, penile curvature and sexual activity. [ABSTRACT FROM AUTHOR]

Objectively measured in those undergoing surgery.Results: There were 51 men with a mean age of 42 years (18– 63). None had glans fusion around the meatus, and the main symptom was urine spraying in 81%. Penile curvature was present in 33%. Painful sexual activity was reported by 34% due to penile curvature, exposed urethral mucosa, or a scrotal web. All but one man experienced functional problems. In addition, 60% were bothered by their abnormal appearance.Conclusion: All but one of these men with uncorrected distal hypospadias had penile dysfunction, and 60% were additionally concerned about the atypical appearance of their penis. These results offer a different perspective than earlier reports which said that most men with uncorrected distal hypospadias were not bothered by their condition, and many were not aware of it. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to identify possible risk factors for urethral rupture and to evaluate the effect of urethral rupture repair on long-term functional outcomes and complications. Materials and methods: The medical records of consecutive penile fracture patients were retrospectively reviewed. Penile fracture patients with and without urethral rupture were compared according to demographics, clinical and intraoperative findings. Comparisons of postoperative functional results of the groups were performed using the 5-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS). Finally, among them, long-term penile complications including penile curvature, painful erection, palpable nodule, and paresthesia were assessed. Results: Fifty-three patients participated. Patients with urethral rupture (n = 8) were older (44.50 ± 10.69, 36.58 ± 10.33 years, p = 0.052). There was no significant difference in fracture etiology (p = 0.64). Urethral bleeding was present only in patients with urethral rupture (p < 0.001). Although no bilateral corpus cavernosum rupture was encountered in penile fracture patients without urethral rupture, this rate was significantly higher in those with urethral rupture at a rate of 62.5% (p < 0.001). The time from surgical repair to sexual activity was similar in both groups (p = 0.66). There was no significant difference in IPSS and IIEF-5 scores, the presence of erectile dysfunction and complication rates (p > 0.05). Conclusions: Older age is a possible risk factor for a concomitant urethral rupture with penile fracture and it seems to be associated with urethral bleeding and bilateral corpus cavernosum involvement. Additionally, urethral rupture repair neither adversely affected functional outcomes nor increased penile complication rates. [ABSTRACT FROM AUTHOR]