Reconstructive Urology

Abstract

286Urological Survey and maintains the erect penis in an upright position during sexual intercourse, and its defect would cause significant deformations hindering normal erections and intercourse (1). Since 1979, patients with defects in the suspensory ligament were recognized in the urological literature (2), including congenital etiology. Nevertheless, the authors of the present paper, in the best of my knowledge, described systematically by the first time the clinical history, physical findings and treatment of suspensory ligament abnormalities.Here, I would like to highlight some points described by the authors in the article. The PSL has susceptibility to trauma following sexual intercourse, particularly with forced downwards pressure, leading to penile instability, deformity and a variable degree of erectile dysfunction (ED). Penile pain was the predominant symptom in 11 of the 15 patients who presented after sexual trauma, and ED was the presenting symptom in 13 of the 35 men. Other symptoms were penile instability and deformity. Concerning diagnosis, the authors showed that it is made clinically, characterized by the presence of a palpable gap between symphysis pubis and the penis. Nevertheless, this is not always present, and in this series only 15 of the 35 men had this sign; thus, the authors emphasize that a supportive history such as penile trauma or evidence of penile deformity/instability on examination also helps in formulating the diagnosis. The surgical technique for treating PSL abnormalities presented here is simple and offers good results.The authors pointed out that a fractured penis is one of the differential diagnoses to PSL trauma since the mechanism of injury is usually similar in both conditions and both can present with the patient complaining of hearing a "snap". Nevertheless, the authors teach us that men with a fractured penis usually have significant swelling and immediate detumescence; whereas men with PSL rupture usually do not have these signs.The final message of the authors from the present series is that abnormality of the PSL is a subtle diagnosis and men with this injury could present with a variety of symptoms and a variable degree of ED.I recommend this paper for all urologists involved with andrology and reconstructive surgery. Background: Fournier's gangrene is a rare and potentially fatal infectious disease characterized by necrotic fasciitis of the perineum and abdominal wall, along with the scrotum and penis in men and the vulva in women.