Penile abnormality


Introduction
Although ultrasonography (US) has been the primary modality for cross-sectional imaging of the penis, the superior soft-tissue contrast and spatial resolution afforded by magnetic resonance (MR) imaging provide an opportunity to advance imaging evaluation of this organ. Clinical questions that remain unresolved after US examination can often be answered with penile MR imaging.

Anatomy and Physiology
The penis is composed of three cylindrical bodies of endothelium-lined cavernous spaces: the paired dorsolateral corpora cavernosa, and the single, ventral, and midline corpus spongiosum.
The variable MR signal intensity of these structures is dependent on the rate of blood flow within the cavernous spaces that constitute the corporal bodies. In general, the three corpora are of intermediate T1-weighted and high T2-weighted signal intensity. The corpora cavernosa are isointense relative to one another, as they are connected via fenestrations in their septum and therefore have similar flow. The corpus spongiosum is a separate space and may normally have flow and signal intensity characteristics different from those of the cavernosa.
The posterior portions of the corpora cavernosa are known as the crura, which flare laterally to attach to the ischiopubic rami. The corpus spongiosum arises within the perineum from the bulbous spongiosum and extends anteriorly to form the glans penis.

Vascular Anatomy
The arterial supply to the penis originates from the right and left internal pudendal arteries, which, in turn, arise from the anterior division of the internal iliac arteries. Each internal pudendal artery gives rise to the perineal and common penile arteries. The branches of the common penile artery are variable but classically consist of three: the bulbourethral artery, the dorsal artery of the penis, and the cavernosal artery. While the iliac, pudendal, perineal, and common penile arteries can be evaluated with three-dimensional MR angiography, the smaller end arteries of the penis have not yet been reliably demonstrable with MR angiography .

Physiology of Erection
Vascular resistance in the flaccid penis is high due to the normally contracted state of the helicine arteries and of the smooth muscle of the sinusoids. After stimulation, parasympathetic nerves promote the release of molecules that dilate the helicine arteries and relax sinusoidal smooth muscle, thereby increasing flow of blood in the cavernosal arteries. As the cavernous spaces fill with blood and expand, they compress the emissary veins against the nonexpandable tunica albuginea, thereby decreasing venous outflow and maintaining penile erection.
Penile Malignancies
Squamous Cell Carcinoma of the Penis
Most primary penile malignancies are squamous cell carcinomas and occur most often during the 6th and 7th decades of life. Although it is one of the most commonly diagnosed malignancies of men in Asia and Africa, the disease is rare in the United States, with only about 200 cases recorded in 1999. Uncircumcised men are more often affected, probably because of the chronic irritation effect of smegma. An association between human papilloma viruses 16 and 18 and squamous cell carcinoma has also been reported. In the United States, African-American men are affected at twice the rate of Caucasians.

Anterior Urethral Carcinoma
Carcinomas of the male urethra occur most often in the bulbous and membranous portions of the urethra, followed by the fossa navicularis. The anatomy of the urothelium changes along the course of the male urethra, with transitional cells lining the prostatic and membranous segments, stratified and pseudostratified columnar epithelium in the bulbous and pendulous parts, and squamous cells in the fossa navicularis and urethral meatus. Squamous cell carcinomas, followed by transitional cell carcinomas and adenocarcinomas, are the most common anterior urethral carcinomas

Penile Sarcoma
Primary sarcomas can also occur in the penis. These include epithelioid sarcoma, Kaposi sarcoma, leiomyosarcoma, and rhabdomyosarcoma. All these lesions are rare and together represent less than 5% of all penile malignancies.

Metastases to the Penis
Metastases to the penis are rare and may manifest with malignant priapism. In approximately 70% of cases, penile metastases arise from other primary malignancies of portions of the genitourinary tract such as the prostate or urinary bladder. Metastases from the colon, stomach, esophagus, and pancreas have been reported less often. Metastatic spread of malignancy to the penis represents an advanced stage of disease, and prognosis is generally poor.

Trauma
Although not often performed in the acute setting, MR imaging can play an important role in the evaluation of penile or urethral trauma.
MR imaging is highly accurate in the identification of penile fractures and tears of the tunica albuginea. Fracture generally occurs secondary to an unusual external force applied to the erect penis. Most cases result from vigorous sexual intercourse. MR imaging examination reveals discontinuity of the hypo intense tunica albuginea, with or without associated hematoma. MR imaging detection of disruption of the tunica and associated anterior urethral tear has also been reported.

Arteriogenic Impotence
Although catheter angiography and Doppler US have long been used for imaging of the penile vasculature, MR imaging may be a useful alternative in the evaluation of arteriogenic impotence. Arteriogenic impotence may be secondary to aortoiliac occlusive disease or to small vessel disease.
Dynamic gadolinium-enhanced MR angiography can be used reliably to evaluate the aorta, internal iliac arteries, and internal pudendal arteries

Penile Prostheses
A variety of MR imaging–compatible inflatable penile prostheses are available for treatment of impotence. Most of these consist of cylinders implanted in the paired corpora cavernosa, the degree of distension of which defines the state of penile flaccidity or erection. As both the paired cavernosal cylinders and the intraabdominal reservoirs used to fill the cylinders contain fluid, they are of high signal intensity on T2-weighted images and readily identified. MR imaging also can be used to examine for complications of penile prostheses. 

Common Penis Problems and Conditions

Here are five penis conditions that you should know about if you own a penis, or if you care about one. Men with penis problems usually only seek medical attention because of painful erections and or difficulty with intercourse.

Peyronie’s Disease:
Peyronie’s Disease (pay-row-KNEES) is acquired in adult life rather than at birth (like hypospadias). Men with Peyronie’s disease usually seek medical attention because of painful erections and difficulty with intercourse.
Peyronie’s Disease is caused by the formation of hard plaque on the upper or lower side of the penis. The plaque forms in layers containing erectile tissue. The local inflammation eventually develops into a full scar. This scar tissue is hard and inflexible, and causes the penis to bend when erect. The effects of this bend are far less noticeable when the penis is in a flaccid state.
Fran├žois de la Peyronie, a French surgeon first described Peyronie’s disease in 1743. Early writers classified it as a form of impotence, now called erectile dysfunction (ED). Peyronie’s disease can be associated with ED; however, experts now recognize ED as only one factor associated with the disease, a factor that is not always present.
This affliction leaves the penis bent distinctly in some direction. Often, the angle is in excess of 45 degrees and results in serious pain during erection and the impossibility of normal sexual intercourse.
Bear in mind that a gentle curve in the penis is natural and you probably don’t have Peyronie’s Disease! There is no need to worry about a curved penis unless the curve suddenly appeared and/or you’re penis has experienced some sort of trauma.
Unfortunately, symptoms of the disease may develop methodically or overnight. Overnight appearances are usually due to some sort of serious penile trauma, but not always. If you think that you have Peyronie’s Disease, then I highly recommend you see your healthcare provider, who may refer you to an urologist.

Hypospadias:
Hypospadias is a congenital disorder of the penis, an abnormality that may affect up to one out of every 400 to 500 male infants. Instead of having a urethral opening at the end of the penis, boys born with hypospadias have an opening on the underside of the shaft of their penis. If this causes a problem with urination, the condition can be surgically corrected. About 10% of boys born with this defect may also have undescended testicles.
Surgery is most often performed before the child reaches school age. The surgery involves creating a tube to extend the urethra to the end of the penis. The original hole is most often left as it is since the urethra now bypasses it. Although the penis has two holes, only one is functional. Otherwise it should be a normal functioning penis.

Priapism:
Priapism is an involuntary prolonged or painful erection that can persist for hours, days and is not associated with sexual arousal.
It can occur at any age and is a true emergency with risks of subsequent impotency. Primary priapism is the result of trauma or infection. Secondary causes include sickle cell disease, spinal cord injury and stroke. Various medications can also contribute to this condition.

Phimosis:
Phimosis refers to a tightening of the skin of the foreskin that prevents retraction over the glans—the sensitive erectile tip of the penis. There are two typical forms of this tightness: an infant phimosis and the phimotic ring or band.
An infant phimosis has an easily recognizable tubular form; this is common and healthy in infants but occasionally will continue into adulthood.
The adult phimosis is a thin contour of skin tissue located towards the front of the inner foreskin and it narrows the opening of the foreskin. A phimotic ring can make retraction of the foreskin over and behind the glans impossible, painful, or difficult, the foreskin may even get stuck behind the glans. This condition is often treated by circumcision, however, there are less invasive procedures depending upon the degree of phimosis, see several urologists for opinions if you have this condition.
For “simple” phimosis, stretching of the foreskin may be a method for treatment that may work. Steroids and surgery are other options.

Large Penis Veins:
It’s normal for men to have prominent veins on their penis. For some men, sometimes the appearance of veins is a result of poorly functioning valves in their testicles. If you see your veins changing in size or color, it’s time to see your friendly urologist.


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PENIS:-

This is the main male organ for coitus. This is considered the core symbol of masculinity. It is made of three bodies & covered with skin This varies in size from man to man in flaccid state.The largest organ was 14 cm (5.5 inches) in the flaccid state. It belonged to a slim man who was 5′ 7″ tall (170 cm).The smallest penis measured 6cm (2.25 inches). It belonged to a fairly heavily built man of 5′ 11″ (180cm).

GLANS:-

The tip of the penis is known as glans.
It is an expansion of the corpus spongiosum. The base of the glans projects out from the main body of the penis and this projecting margin is called corona.

PROSTATE:-

This gland appears to be a sexual organ. In animals which have seasonal sexuality, it is noticed, that the prostate enlarges during a mating season & then shrinks until the next. In the grown up human male, it is about 4 cms across at its base and is the size of a chestnut. The prostate is composed of muscular and glandular tissue. Its secretions pass down about 20 small ducts which lead to the section of the urethra that pierces the prostate gland, but their purpose is not yet fully understood.

SEMEN:-

This is a mixture of secretion from the prostate seminal fluids & spermatozoa from the testes. When a man reaches climax in sexual play, semen starts coming out of the penis with pressure. Each time in two days about 2 to 6 ml of semen comes out when man reaches orgasm.

SMEGMA:-

In clinical terms it is- sebaceous secretion about the penisor labia. Smegma is a mixture of dead skin cells & skin grease and looks like soap as it hides under the foreskin of the penis. In women it is found near clitoris. The presence of it denoted the poor standard of person’s hygiene, and it can contribute in transmitting diseases.

SPERM:-

This is the protozoa in semen. This is a male cell, which is capable of penetrating the ovum. Each sperm has an oval shaped head, a centre portion & A long tail. They are generated by testes and once shot into female reproductive tract, they live only a few hours. Many sperm hit the ovum before one pierces the exterior by means of enzyme action & penetrates it. Once one sperm enters the ovum,another sperm cannot enter in it

TESTES:-

Testes are fairly uniform in size about 4-5 cms in length, 2-5 cms in breadth & 3 cms in width. They are situated below penis. It’s main function is to produce sperms. Inside the testes there are about 250 glandular lobes. Tiny tubes collect the spermatozoa & eventually they enter the epididymis where a maturing process usually occurs.