Floppy Glans Syndrome: Pathogenesis and Treatment

Bickell, Michael; Manimala, Neil J.; Parker, Justin; Steixner, Brian L.; Wiegand, Lucas; Carrión, Rafael

doi:10.1016/j.sxmr.2015.12.001

Cited by 23 publications

(12 citation statements)

References 9 publications

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“…Management options for correction of a floppy glans include glanulopexy, distal penile-plasty and, in cases of a significantly undersized implant, removal and replacement of the penile prosthesis. 5 Patients with a floppy or unstable glans who present in a delayed setting may have the surgical pseudocapsule already formed. Re-dilation through a capsule that has already formed may be challenging for the inexperienced surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…Floppy glans, commonly referred to as glans hypermobility, can occur in the setting of an improperly sized implant secondary to inadequate dilation. 5 This is often managed with a glanulopexy, 6 , 7 but when severely undersized ( Figure 1 ), may require explant of the cylinders, re-dilation and re-implantation of prosthetic cylinders. Moreover, impending cylinder erosion, also referred to as extrusion, is a rare complication during penile prosthesis surgery that is commonly managed with a counter-incision in the distal shaft ( Figure 2 ).…”

Section: Introductionmentioning

confidence: 99%

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Proximal Extracapsular Tunneling: A Simple Technique for the Management of Impending Cylinder Erosion and Complications Related to Corporal Dilation

Clavell-Hernández

2021

Sexual Medicine

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Introduction Impending cylinder erosion and floppy glans secondary to an undersized penile prosthesis are rare complications that can cause cosmetic deformity and patient discomfort. Aim To demonstrate a technique for the management of impending cylinder erosion and floppy glans secondary to cylinder under-sizing. Methods We retrospectively reviewed 6 patients who required the proximal extracapsular tunneling technique during penile prosthesis revision surgery. Main Outcome Measure Main outcome was successful placement of a penile prosthesis with proper cylinder placement. Results Mean patient age for these 6 patients was 71.2 years (64–86 y). After a mean follow-up of 6.6 months, all 6 patients who underwent this procedure had a functional penile prosthesis without evidence of recurrence. Conclusion The proximal extracapsular tunneling technique is a simple approach performed through a single incision that can be used for proper cylinder replacement during penile prosthesis revision surgeries. It may be utilized for the management of impending cylinder erosion and other cases with coporal dilation-related complications in which the surgical pseudo-capsule has already formed around the implant. This technique can be safely performed without the need of a distal counter-incision on the penis. Clavell-Hernández J. Proximal Extracapsular Tunneling: A Simple Technique for the Management of Impending Cylinder Erosion and Complications Related to Corporal Dilation. Sex Med 2021;9:100379 .

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Proximal Extracapsular Tunneling: A Simple Technique for the Management of Impending Cylinder Erosion and Complications Related to Corporal Dilation

Clavell-Hernández

2021

Sexual Medicine

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“…Glans hypermobility may also be associated with the placement of a penile prosthesis. This is an abnormality which can result when attachments between the corpora cavernosa and the glans penis are loose, possibly due to laxity of the corpora-glans ligament ( 75 , 76 ). The SST deformity can develop as a post-operative complication, resulting in an exaggerated angle present between the glans penis and the penile shaft ( 75 ).…”

Section: Discussionmentioning

confidence: 99%

“…The SST deformity can develop as a post-operative complication, resulting in an exaggerated angle present between the glans penis and the penile shaft ( 75 ). These two entities have been previously defined under the umbrella term “floppy glans syndrome” but differentiated based on etiology: glans hypermobility being the consequence of anatomical variation among patients which manifests following implantation and SST deformity as the result of utilizing an improperly sized or positioned cylinder leading to inadequate compression of the vasculature from the glans ( 76 ). Glans hypermobility and the SST deformity have been reported in variable rates, specifically 5% and 25% of patients undergoing penile prosthesis placement ( 36 , 77 ).…”

Section: Discussionmentioning

confidence: 99%

Prevention, identification, and management of post-operative penile implant complications of infection, hematoma, and device malfunction

O’Rourke¹,

Erbella²,

Zhang³

et al. 2017

Transl. Androl. Urol.

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Penile prosthesis implant surgery is an effective management approach for a number of urological conditions, including medication refractory erectile dysfunction (ED). Complications encountered post-operatively include infection, bleeding/hematoma, and device malfunction. Since the 1970s, modifications to these devices have reduced complication rates through improvement in antisepsis and design using antibiotic coatings, kink-resistant tubing, lock-out valves to prevent autoinflation, and modified reservoir shapes. Device survival and complication rates have been investigated predominately by retrospective database-derived studies. This review article focuses on the identification and management of post-operative complications following penile prosthetic and implant surgery. Etiology for ED, surgical technique, and prosthesis type are variable among studies. The most common post-operative complications of infection, bleeding, and device malfunction may be minimized by adherence to consistent technique and standard protocol. Novel antibiotic coatings and standard antibiotic regimen may reduce infection rates. Meticulous hemostasis and intraoperative testing of devices may further reduce need for revision surgery. Additional prospective studies with consistent reporting of outcomes and comparison of surgical approach and prosthesis type in patients with variable ED etiology would be beneficial.

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“…In addition, an elongation of the baculum would probably have to be accompanied by major anatomical adjustments; if followed by a rapid loss, this would exacerbate the severity of functional problems (e.g. Bickell et al 2016), which makes the scenario even less likely.…”

Section: The Elongation-loss Hypothesismentioning

confidence: 99%

The missing human baculum: a victim of conspecific aggression and budding self‐awareness?

Jakovlić

2021

Mammal Review

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Unlike most primates and all other great apes, humans Homo sapiens do not possess a baculum (penile bone). I discuss the shortcomings of previous hypotheses to explain the loss of the baculum, argue that they fail to explain it fully, and show that the evolutionary history of this loss remains enigmatic. I also propose a new hypothesis: that conspecific aggression, in combination with the development of self-awareness, may have played a role in the loss. If the presence of a baculum exacerbated the prevalence and severity of penile injuries resulting from blunt trauma to a flaccid penis, increasing ability to foresee the consequences of their actions would also enable hominins to realise that these injuries are a useful tool in male-male competition. This behavioural innovation, planned conspecific aggression with the goal of temporary exclusion of competitors from the breeding pool, would create an environment in which a genetic mutation for a penis without a baculum (or with an unossified baculum) would strongly increase the fitness of the mutant phenotype. Along with the hominin propensity for social learning and cultural transmission, this hypothetical scenario may explain why this phenotype became fixed in all human populations.

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Floppy Glans Syndrome: Pathogenesis and Treatment

Cited by 23 publications

References 9 publications

Proximal Extracapsular Tunneling: A Simple Technique for the Management of Impending Cylinder Erosion and Complications Related to Corporal Dilation

Proximal Extracapsular Tunneling: A Simple Technique for the Management of Impending Cylinder Erosion and Complications Related to Corporal Dilation

Prevention, identification, and management of post-operative penile implant complications of infection, hematoma, and device malfunction

The missing human baculum: a victim of conspecific aggression and budding self‐awareness?

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