Erectile dysfunction (ED) is often treated with phosphodiesterase type 5 inhibitors (PDE5i). However, some patients do not respond effectively to this treatment, making regenerative therapy a potential alternative. This study aims to evaluate the safety and efficacy of umbilical cord-derived mesenchymal stem cell (UC-MSC) secretome in patients with severe ED who are unresponsive to sildenafil therapy.

Penile cutaneous necrosis is an uncommon but severe clinical condition that may result from necrotizing infections, vascular compromise, or complications related to cosmetic procedures. The subcutaneous injection of non-medical modeling substances has been associated with chronic inflammatory reactions, fibrosis, and progressive tissue destruction that may ultimately lead to infection and skin necrosis. We report the case of a 68-year-old male with diabetes mellitus and cardiovascular comorbidities who developed extensive penile skin necrosis after subcutaneous injection of non-medical modeling substances for cosmetic augmentation. The patient presented with progressive penile pain, edema, and skin discoloration that evolved into a necrotizing soft tissue infection of the penile shaft. Radical surgical debridement was performed while preserving the corpora cavernosa and urethra. Due to the extent of the skin defect and the compromised condition of the recipient bed, immediate reconstruction was performed using a pedicled suprapubic fasciocutaneous flap based on local perforator vessels. Four weeks later, a second-stage procedure with pedicle division and definitive flap inset was successfully performed. The postoperative course was uneventful, with complete flap survival and satisfactory restoration of penile shaft coverage and contour. This case highlights the severe complications associated with non-medical penile augmentation procedures and demonstrates that pedicled suprapubic flaps represent a reliable reconstructive option for extensive penile defects, particularly in compromised surgical fields following infection or foreign-body reactions.

Mondor's disease of the penis is a rare, benign thrombophlebitis of the superficial dorsal vein, often presenting as a painful, cord-like induration along the penile shaft. Though alarming to patients, it is a self-limiting condition that responds well to conservative management. A 54-year-old male presented with pain and swelling over the dorsal shaft of the penis for 15 days. Examination revealed a tender, cord-like induration without ulceration or discharge. Laboratory parameters were normal. Doppler ultrasonography demonstrated a dilated, thrombosed superficial dorsal vein with loss of venous flow, confirming the diagnosis of penile Mondor's disease. The patient was treated conservatively with nonsteroidal anti-inflammatory drugs, fractionated flavonoids, warm compresses, vitamin supplements, and temporary sexual abstinence. Marked symptomatic relief was observed within 2 weeks, with complete resolution of induration by 6 weeks. Penile Mondor's disease is an uncommon but self-limiting condition that can be effectively managed with conservative therapy. Early recognition, reassurance, and avoidance of unnecessary interventions are essential. Fractionated flavonoids may provide additional benefit in symptom resolution and recovery.

This review systematically examines the underlying mechanisms linking erectile dysfunction (ED) with arthritis and explores multidisciplinary management strategies. Epidemiological studies confirm that patients with various arthritis-including osteoarthritis (OA), rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and gouty arthritis-exhibit significantly higher ED prevalence and incidence risks compared to the general population. This association remains independent of confounding factors such as age and comorbidities. Core mechanisms linking the two include chronic inflammation disrupting the "NO-cGMP-PKG" erectile molecular axis, vascular endothelial dysfunction causing insufficient penile blood supply, endocrine-metabolic disorders (e.g., insulin resistance, reduced testosterone), neuropsychological factors (anxiety, depression, chronic pain), and the synergistic effects of therapeutic agents (methotrexate, nonsteroidal anti-inflammatory drugs, glucocorticoids). Clinical recommendations advocate an "active screening-tiered assessment" approach, utilizing the International Index of Erectile Function (IIEF) combined with disease activity tools (e.g., DAS28, BASDAI) for screening and evaluation. Management should follow a multidisciplinary team (MDT) model integrating "control of underlying disease + individualized ED treatment + psychological intervention + lifestyle optimization" to improve patients' overall health outcomes ultimately.

Penile strangulation by foreign objects is a rare but serious urological emergency, most often associated with attempts to enhance sexual performance. Metallic rings are common offenders, and delayed intervention can lead to vascular compromise, ischemia, necrosis, and even penile loss. Management is particularly challenging when standard equipment is insufficient. We report the case of a 23-year-old male who presented with penile swelling and mild pain 5 h after symptom onset, following self-application of a metallic ring 12 h earlier. Manual removal attempts using lubrication were unsuccessful. Examination revealed marked edema with the ring firmly lodged at the penile base, without signs of necrosis or gangrene. Emergency removal was performed under spinal anesthesia. Tissue viability was confirmed intraoperatively. Due to the hardness of the ring and the lack of appropriate cutters, orthopedic instruments were utilized. An Alis bone gouge protected the underlying tissue while a Harrington jumbo rod cutter was used to cut the ring at two opposing points. The ring was successfully removed with minimal skin excoriation. Postoperatively, at 1-month follow-up, the patient had normal urinary and erectile function. Early intervention and innovative use of available tools are essential for the successful management of complex penile strangulation cases, especially in resource-limited settings.

Background Addressing the opioid epidemic in the United States requires minimizing the overprescription of opioid pain medications, which poses a challenge for urologic surgeons, as postoperative pain is common after procedures such as inflatable penile prosthesis (IPP) placement. This research aimed to evaluate the impact of an ultra-restrictive opioid prescription protocol (UROPP) on pain management and opioid usage following IPP implant surgery. Methodology Patients undergoing IPP surgery were treated perioperatively using a UROPP with 500 mg acetaminophen and 15 mg intravenous ketorolac every six hours and opioids as needed for breakthrough pain. At discharge, some patients were given a three-day prescription of 5 mg oxycodone/325 mg acetaminophen, and all patients were given prescriptions for seven-day supplies of acetaminophen (500 mg) and ibuprofen (600 mg). When IPP surgery was performed as a same-day procedure due to COVID-19 precautions, all patients were given a three-day prescription of 5 mg oxycodone/325 mg acetaminophen at discharge. The patients on the UROPP were compared with a retrospective cohort of IPP patients treated before the institution of the UROPP. Outcomes assessed were opioid use, including total morphine milligram equivalents (MMEs), the number of opioid pills prescribed, and the need for refills or postoperative emergency visits. Results In total, 96 patients were analyzed (46 pre-UROPP, 50 post-UROPP) with no significant differences in baseline demographics. UROPP implementation significantly reduced opioid prescribing at discharge (100% vs. 36%, p < 0.001), median opioid pills (19.0 vs. 0.0, p < 0.001), and total MME. There was no increase in 30-day emergency department visits. Inpatient UROPP patients had the greatest reduction, with 96% discharged without opioids and low refill rates, while outpatient UROPP patients had higher refill rates but remained significantly lower than pre-UROPP levels. Conclusions The UROPP seems feasible and effective in reducing potentially unnecessary opioid prescribing and the risk of abuse following IPP placement.