ANATOMY OF PENIS
Penis is seen to consist of three major buildings as we see on below. The top 2 of them (corpus cavernosum) are the structures who provide erection. The third in the bottom called the corpus spongiosum and has the structure which provides the evacuation of urine from the bladder through the urethra (urine tube). However, the sperm produced by the testes and all the produced semen at once discharged in secondary sex organs. There is an elastic membrane that protects penis except all these structures (tunica albuginea). Inside of Corpus spongiosums consists of a spongy tissue and thanks to this structure, it is provided the formation and maintenance of erection.
DISEASES OF PENIS
PHIMOSIS (tight foreskin of penis)
The end of the foreskin is too narrow. There is an opening up to a pinhead. The inner surface of the skin is attached to the head portion of penis. Skin can not be drawn behind of the head. This happens from birth or develops later after an inflammatory event. If it is too narrow, patient cannot urine. Even if the collection of urine under the skin occurs, foreskin swells like a balloon. Urine flows dropwise. If it is untreated at the end of the penis inflammation, irritation, inflammation develops in the urine, and this will cause wounds in the head. Treatment is circumcision.
PARAPHIMOSIS (escape to backwards of foreskin)
The foreskin cannot come forward again after back draw of the head of the penis. Usually it consists of strictures of the foreskin. The skin pulled back by the child or parents his father with the aim of cleaning, and then the skin swells and reddens and strangles the glans. If it is the early stages of treatment, the skin derives to forward. But if it is too late, there is no choice without circumcision.
INJURIES OF THE PENIS, TYPES OF PENIS DIFFERENCE
The penis is a playful organ protects itself against shocks. Completely break occurs after the cessation because of accidents or deliberates (because of jealousy and revenge). Blood comes from the penis on impacts. Breakage of the penis occurs as a result of bending of the hardened penis suddenly and sharply. Early treatment is important in order to avoid erection problems.
BALANOPOSTİT (inflammation of the penis)
It becomes because of stenosis in children and cleaning problems in adults. It takes the form of the foreskin and / or inflammation of the glans.
Although it is a harmless disease, the patient’s complaints should be treated. Rarely does it disappear on its own.
THE TREATMENT IN PEYRONIE’S DISEASE
Required treatment hasn’t found the exact solution of Peyronie’s disease yet. If the pain or twisting (torsion) in the penis is minimal, in other words, these can be tolerated by the patient and the sexuel lives of people affected by this situation, the doctor can wait before giving the treatment and there is no harm examine the patient three times a year.
When it comes to Medical treatments, one detail should not be forgotten; psychological effect of the drug which is called placebo effect is so good than the real effect of the drug.
The effect of oral medications in the treatment of Peyronie’s disease, which might be as follows:
VITAMIN E, POTABA, TAMOXIFEN, COLSISIN.
In general, all these drugs, such as whether a different effect from placebo, the patients are reluctant to serious gastrointestinal problems.
EXTRA CORPOREAL SHOCK WAVE TREATMENT
Initially influenced by the principle of breaking kidney stones, was thought to distribute the limestone plaques in the penis; but the studies show that they do not have benefits.
INTERFERON ALPHA 2 B
This substance which supports the immune system has anti-tumor effect. It can be used with Intralesional application or vessel the application. It can cause serious flu symptoms and also headache. In addition, this is a very expensive method.
USING EXTERNAL VACUUM OR OTHERWISE MECHANICAL DEVICES
Herein, purpose stretch the penis seriously and keep it into the strained atmosphere approximately 10-15 minutes. No serious effect is shown except for the supportive effect of medical therapy, applied up to 6 months 2-3 sessions a day as a very small Peyronie’s plaque.
Treatments can be locally applied to the plaque in order to distribute or dissolve the limestone plaque of the penis outside the medical treatments, were thought; nonetheless, it was found to pose Peyronie’s plaque because of being extremely painful due to trauma created by itself. A further disadvantage of these treatments which can be applied later makes the surgery difficult. Drugs most commonly used in local application: prostaglandin E1 (PGE1), verapamil, betamethasone, hyaluronidase and nicardipin.
ELECTROMOTIVE APPLICATION (EMDA)
In this method, known as iontophoresis, molecules of some drugs topically applied to the skin based on the fact that diffuses into the skin are subject to direct current. The principle is the same as injection therapy. However, this treatment has no important side effects. The only disadvantage is that an expensive application. Generally cases of the first year are more successful. (45%) used mixtures of drugs are like injection treatment. Especially young men up to 65% success reported cases not exceeding 2 cm length and limestone plate in young men.
XIAFLEX (COLLAGENASE CLOSTRIDIUM HISTOLYTICUM)
Xiaflex is combination of bacterial collagenases indicated for :
- The treatment of adult patients with Dupuytren’s contarcture with palpable cord ,
- The treatment of adult men with Peyronie’s disease with a palpable plaque and curvature deformity at least 30 degrees at the start of therapy.
Collagenases are proteinases that hydrolyze collagen in its native conformation resulting in lysis of the collagen deposits.
A treatment cycle consist of two XIAFLEX injection procedures and a penile modeling procedure .
The penis should be in a flaccid state before injecting XIAFLEX . 0.58 mg XIAFLEX must be injected into the target plaque once on each of two days . The patient must perform penile modeling procedure 1 to 3 days aftyer the second injection on each treatment cycle .
Up to four treatment cycles may be administered. Each treatment cycle may be repeated at approximately six week intervals. The treatment course therefore, consists of a maximum 0f 8 injection procedures and 4 modeling procedures.
In penile modeling the patient must gently straighten his penis in non erected condition 1 to 3 times a day for 6 weeks .
The most common side effects are; adverse drug reactions and penile hematoma, penile swelling and penile pain. The most serious complication is corporeal rupture which may require surgical intervention.
LI PEYRONIE SWT:
Low Intensity Shockwave Therapy for PEYRONIE’S DISEASE
The Omnispec Model ED1000 is designed to deliver extracorporeal, focused, low-intensity shockwave therapy to the penile area of patients suffering of PEYRONIE’S disease.
Omnispec Model ED1000 system is a device for Extracorporeal Shockwave therapy. It non-invasively delivers low-intensity shockwaves to specific areas in the patient penile shaft and crus consequently improving local blood perfusion in this area and helps the treatment of PEYRONIE’S disease.
The procedure in ED 1000 is completely painless . The shock wave is directed to the plaque.The machine can produce120 shocks per minute.Each session lasts approximately 30-40 minutes and should be performed at least 1-2 times a week.Treatment sessions depends on the size and oldness of the plaque and varies from 6 to 24 sessions.
Surgery should be done in delayed cases. Various surgical techniques are available.
Preoperative cases of Peyronie’s Post-operative corrected case
Long-term hardening of the penis without sexual desire or can be defined as a state prevent the loss of hardness even after orgasm.
It needs to have an erection longer than 6 hours for the separation from prolonged hardening (erection).
There are two forms. One of them is high pressure and the other is low-pressure type. High-pressure type (= arterial = painless non-ischemic type) is rare.
The patient feels much pain. It can occur at any age and it is seen the most frequently between the ages of 5 and 10 and also between the ages of 20 and 50.
The cause is usually the “sickle-cell anemia,” which is a blood disease, or some malignant diseases in young people.
Among elderly patients, cause is often “idiopathic” (which is of unknown cause can not be found).
In a special case, it may develop as a complication of injection into the penis and synthetic drugs which hardening (like papaverine) eliminating the problem of hardening or used to research the problem
Other than that, this situation may also occur after the use of drugs “After the genital area trauma” or “in antidepressant and some antipsychotic”.
It suddenly occurs and it is painful. Urine is held or it drops. the hardness continues after the empty semen. Hardening takes 1-2 days, sometimes for months.
Within the first 12 hours destruction begins in “cavernöz corpuscles” of erectile bodies, after 48 hours even if the penis is softened and returns to normal, in the end, impotence (impotence) occurs.
Therefore, it needs emergency response in the first 12 hours.
In treatment clotted blood is drained through the injector. Inside the cavernous bodies are washed with serum. If not enough; drugs which overcome clotting are given into the penis. Spinal anesthesia may be tried. However, if still not enough; inside of the cavernous bodies drains with some specialist surgical techniques.
* The above-mentioned is the type of low-pressure and frequently encountered. In high pressure type, tissue oxygenation doesn’t impair and there is no pain. The main reason is usually blunt perineal or genital trauma. There may be erections lasting for years. There is no pain in general because the lack of tissue ischemia and after no impotence develops. Treatment can be performed vascular surgery methods.