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INTRODUCTION Traditionally penile implant (PI) infections have been managed by removal with immediate or delayed replacement. Recently, interest has been focused on conservative therapy (CT) using antibiotic therapy. AIM To investigate the success rate and predictive factors affecting the outcome of CT in PI infection patients. METHODS Patients diagnosed with early, localized PI infection were considered candidates for CT. Exclusion criteria included temperature >37.5 Celsius, WBC >13,000/μL and appearance of any sign of sepsis. In patients with purulent drainage, culture swabs were taken and an antibiotic was chosen based on sensitivity results. Oral antibiotics were used until the local infection was completely resolved. Patients were evaluated weekly during this process. RESULTS 37 patients were retrospectively reviewed and constituted the study population. Mean age was 58.1 (range37–85; standard deviation 9.9) years. All were diabetic. Mean BMI was 31.8 (range 24–47; SD 5.0). PI was malleable in 33 and inflatable in 4 cases. Culture results (n=19) included: Staph epidermidis (42 %), Pseudomonas (21%), E coli (21%) and Staph aureus (16%). Four of thirty seven patients needed the PI removed due to CT failure and onset of systemic symptoms, at a mean time-point of 75±1.8 days after CT commencement. In men who were cured, mean time to complete healing was 49 (range 29–97; SD 15.8) days. Two of thirty seven patients (5%) had PI removal because of persistent penile pain despite complete wound healing, at a mean time point of 128±2.5 days after CT commencement. All men managed conservatively resumed sexual intercourse. CONCLUSIONS CT of localized PI infection appears to be a viable option for such patients with the majority of patients retaining their implant and resuming sexual activity.

Accurate data regarding the size of the erect penis is of great importance to several disciplines working with male patients, but little data exists on the best technique to measure penile length. While some previous small studies have suggested good correlation between stretched penile length, others have shown significant variability. Penile girth has been less well studied, and little data exist on the possible errors induced by differing observers and different techniques. Much of the published data report penile length measured from the penopubic skin junction-to-glans tip (STT) rather than pubic bone-to-tip (BTT). We wished to assess the accuracy of different techniques of penile measurements with multiple observers. Men who achieved full erection using dynamic penile Doppler ultrasound for the diagnosis of sexual dysfunction or a desire for objective penile measurement were included in the study. Exclusion criteria were penile scarring, curvature, or congenital abnormality. In each case, the penis was measured by one of the seven andrology specialists in a private air-conditioned (21 °C) environment. Each patient had three parameters measured: circumference (girth) of the penile shaft, length from suprapubic skin-to-distal glans (STT), and pubis-to-distal glans (BTT). The three measurements were recorded in the stretched flaccid state, and the same three measurements were then repeated in the fully erect state, following induction of full erection with intracavernosal injection. We analyzed the accuracy of each flaccid measurement using the erect measurements as a reference, for the overall patient population and for each observer. In total, 201 adult men (mean age 49.4 years) were included in this study. Assessing the penis in the stretched and flaccid state gave a mean underestimate of the erect measurement of ~20% (STT length 23.39%, BTT length 19.86%, and circumference 21.38%). In this large, multicenter, multi-observer study of penis size, flaccid measurements were only moderately accurate in predicting erect size. They were also significantly observer dependent. Measuring penile length from pubic bone to tip of glans is more accurate and reliable, the discrepancy being most notable in overweight patients.

BackgroundThe inflatable penile prosthesis (IPP) is typically the preferred implant for Peyronie’s disease (PD) and malleable penile prostheses (MPPs) have been discouraged.AimsTo evaluate the effectiveness and patient satisfaction of the MPP vs IPP in patients with PD.MethodsMen with PD and erectile dysfunction who elected for penile implant surgery constituted the study population. Preoperatively, demographic and comorbidity parameters were recorded. Curvature was measured with a goniometer at maximum rigidity after intracavernosal injection of a vasoactive agent. Postoperatively, overall satisfaction was measured at 3, 6, 12, and 24 months on 5-point Likert scale from 1 (dissatisfied) to 5 (very satisfied).Results166 men with a mean age of 59 ± 10 years were analyzed. The mean preoperative curvature in the entire cohort was 65° (range = 30–130°). 94% of patients with MPP had total resolution of their curvature at the end of the operation, whereas 8 patients (6%) had residual curvature (25–40°). In the IPP group 25 of 30 (83.3%) had a straight penis at the end of surgery, whereas 5 of 30 (16.7%) had residual curvature, with the mean magnitude being 33° in the MPP group and 30° in the IPP group. 86% of all patients had diabetes. There were no differences between the 2 implant groups in age, hemoglobin A1c, body mass index, or smoking status. The mean patient satisfaction was 4.42 ± 0.70 (range = 2–5) and there was no difference between the 2 groups. The mean follow-up period was 23.4 months (range = 6–29 months).ConclusionWe found that the MPP is as effective as the IPP in curvature correction in patients with PD, with similar patient satisfaction for the 2 groups.Habous M, Farag M, Tealab A, et al. Malleable Penile Implant Is an Effective Therapeutic Option in Men With Peyronie’s Disease and Erectile Dysfunction. Sex Med 2018;6:24–29.

Background: The diagnosis of sonographically indeterminate adnexal masses (AM) signifies a major challenge in clinical practice. Early detection and characterization have increased the need for accurate imaging evaluation before treatment. Purpose: To assess the validity and reproducibility of the ADNEX MR Scoring system in the diagnosis of sonographically indeterminate AM. Study Type: A prospective multicenter study. Population: In all, 531 women (mean age, 44 AE 11.2 years; range, 21-79 years) with 572 sonographically indeterminate AM. Field Strength/Sequence: 1.5T/precontrast T 1-weighted imaging (WI) fast spin echo (FSE) (in-phase and out-of-phase, with and without fat suppression); T 2-WI FSE; diffusion-WI single-shot echo planner with b-values of 0 and 1000 s/mm 2 ; and dynamic contrast-enhanced perfusion T 1-WI liver acquisition with volume acceleration (LAVA). Assessment: All MRI examinations were evaluated by three radiologists, and the AM were categorized into five scores based on the ADNEX MR Scoring system. Score 1: no AM; 2: benign AM; 3: probably benign AM; 4: indeterminate AM; 5: probably malignant AM. Histopathology and imaging follow-up were used as the standard references for evaluating the validity of the ADNEX MR Scoring system for detecting ovarian malignancy. Statistical Tests: Four-fold table test, kappa statistics (κ), and receiver operating characteristic (ROC) curve. Results: In all, 136 (23.8%) AM were malignant, and 436 (76.2%) were benign. Of the 350 AM classified as score 2, one (0.3%) was malignant; of the 62 AM classified as score 3, six (9.7%) were malignant; of the 73 AM classified as score 4, 43 (58.9%) were malignant; and of the 87 AM categorized as score 5, 86 (98.9%) were malignant. The best cutoff value for predicting malignant AM was score >3 with sensitivity and specificity of 92.9% and 94.9%, respectively. The interreader agreement of the ADNEX MR Scoring was very good (κ = 0.861).

Rhinoplasty modifies the aesthetic appearance and functional properties of the nose with operative manipulation of the skin, underlying cartilage, bone, and linings. A long nose is an aesthetically undesired feature disturbing the harmony of the face. The underlying pathology of the long nose may be due to either a long septum that invades the lip or dislocation of the alar cartilages downward from the aponeurotic attachments to the septal angle. The increase in the nasal height due to a dorsal nasal hump may give an illusion of a long nose. An absent or shallow frontonasal angle also gives the illusion of a long nose. With the introduction of the dynamics of the nasal structures and dynamics in rhinoplasty, recreation of a straight nasal dorsum and a normal frontonasal angle dynamically shortens the long nose. This study presents a multicenter experience (three centers) in rhinoplasty of long noses. The study included 138 patients who complained of having a long nose. The study employed the concept of structure rhinoplasty to address the three-dimensional nasal structures contributing directly or indirectly to the appearance of the long nose rather than the traditional excisional techniques. Based on objective and subjective evaluation, shortening of the nose was achieved in 122 patients (88.4%) with better overall nasal aesthetics. The study concluded that structure rhinoplasty, which addresses the three-dimensional nasal anatomy, maximizes the aesthetic and functional outcomes when treating the long-nose deformity.

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Introduction:The use of a mouthwash augments mechanical removal of plaque by brushing and flossing and helps maintain oral health through its antiplaque and antibacterial chemical properties. Aim: to evaluate and compare clinically and microbiologically the effectiveness of chlorhexidine and sodium hexametaphosphate mouth rinses on dental plaque in children. Materials and methods: This randomized clinical trial included 40 normal apparently healthy and cooperative children aged 8 to 10 years and selected from the outpatient dental clinic of Pediatric Dentistry Department, Faculty of Dentistry, Suez Canal University. Children were randomly divided into 2 groups as follows: Group I: included (20) children who rinsed with Chlorhexidine (0.2%) and Group II: included (20) children who rinsed with Sodium Hexametaphosphate (7%). Clinical evaluation was performed by measuring gingival and plaque indices scores at all evaluation periods. Microbiological evaluation was performed by direct examination of bacterial cultures. Results: Sodium hexametaphosphate 7% mouth rinse showed a superior effect compared to chlorhexidine 0.2% mouth rinse in terms of improvement in the clinical scores and decreasing the microbial counting. Conclusion: Sodium hexametaphosphate 7% mouth rinse is a promising candidate of mouthwashes.