Optimal regional anesthesia for pediatric hypospadias repair remains controversial, with inconsistent evidence regarding postoperative pain control and complication rates. This study aimed to compare the effectiveness and safety of pudendal nerve block (PNB), penile block (PB), caudal block (CB), and general anesthesia (GA) using a network meta-analysis;Methods: A systematic search of PubMed, Embase, Scopus, Wiley, ProQuest, and Google Scholar was conducted from database inception to October 2024. Randomized controlled trials evaluating regional anesthesia techniques in children undergoing hypospadias repair were included. Primary outcomes were 24-hour postoperative pain scores and postoperative complications. A frequentist random-effects network meta-analysis was performed using the netmeta package in R. Continuous outcomes were analyzed as standardized mean differences (SMDs), and dichotomous outcomes as odds ratios (ORs). Risk of bias was assessed using the Cochrane RoB 2.0 tool, while certainty of evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) framework;Results: Eleven randomized controlled trials involving 750 pediatric patients were included. Six studies contributed to the pain network and five to the complication network. No regional anesthesia technique demonstrated statistically significant superiority in reducing 24-hour postoperative pain compared with CB (PB vs. CB: SMD -0.91, 95% CI -1.96 to 0.14; PNB vs. CB: SMD -0.63, 95% CI -1.46 to 0.21), although substantial heterogeneity was observed (I[2] = 85.5%). Treatment ranking suggested that PB and PNB had higher probabilities of improved analgesia than CB; however, these rankings reflected relative probabilities rather than clinical superiority. Similarly, no significant differences in postoperative complication rates were identified among CB, PB, and GA (all p > 0.05). Risk of bias was generally low across studies. CINeMA rated the certainty of evidence as low for pain outcomes because of imprecision and incoherence, and moderate for complication outcomes due to imprecision;Conclusion: Current evidence does not demonstrate statistically significant superiority of any regional anesthesia technique for pediatric hypospadias repair. Although PB and PNB showed higher probabilities of improved postoperative analgesia, the certainty of evidence remains limited by heterogeneity and imprecision. Additional well-designed randomized controlled trials with standardized reporting are needed to establish the comparative effectiveness and safety of regional anesthesia techniques in pediatric hypospadias surgery.

This retrospective single-arm pilot study evaluated a novel minimally invasive approach combining Botulinum Toxin A injection with penile traction therapy for the treatment of penile retraction. This study was conducted in 168 men with retractile penis treated between October 2023 and June 2025. Flaccid penile length was measured in the standing position with the penis in a naturally dependent state after a resting period in a room-temperature environment, using a rigid ruler from the pubic symphysis to the tip of the glans with compression of the suprapubic fat pad. Psychological outcomes were assessed using the Self-Esteem and Relationship questionnaire and the Index of Male Genital Image, while erectile function was evaluated using the five-item International Index of Erectile Function. Mean baseline flaccid penile length was 4.4 ± 0.66 cm, increasing significantly to 6.9 ± 0.81 cm at 6 months (P < 0.001). Improvements were also observed under thermal stimulation and in the penile retraction reduction ratio, which decreased from 27.3-11.6% at 6 months (P < 0.001). Erectile penile length and five-item International Index of Erectile Function scores showed no significant changes. Psychological outcomes improved significantly, with Self-Esteem and Relationship and Index of Male Genital Image scores increasing from 28.8 ± 4.3 and 39.3 ± 5.7-54.4 ± 5.6 and 59.0 ± 7.3, respectively (P < 0.001). Mild transient injection-site pain occurred in 11.3% of patients without other complications. This combined therapy may represent a feasible minimally invasive option for selected patients with penile retraction and reduced visible flaccid penile exposure. However, it does not confer true anatomical penile elongation, and given the exploratory single-arm design, the findings should be interpreted with caution. Further prospective randomized controlled studies using standardized penile measurements and longer follow-up are needed to clarify the durability of treatment effects and the independent contribution of each treatment component.

Corpus cavernosum thrombosis is rare, and its association with penile malignancy is exceptionally uncommon. Although most penile cancers are squamous cell carcinomas, primary synovial sarcoma is exceedingly rare. We report a 36-year-old man with bilateral corpus cavernosum thrombosis and persistent perineal pain, managed conservatively for two years, during which imaging failed to identify a neoplasm. He later developed a rapidly enlarging penile mass with nodal involvement; total penectomy with lymphadenectomy confirmed synovial sarcoma. Early recurrence with metastatic progression required palliative therapy, and he died eight months postoperatively. Persistent or unexplained corpus cavernosum thrombosis should prompt consideration of malignancy.

A 35-year-old transgender man with history of gender-affirming phalloplasty with radial forearm flap followed by inflatable penile prosthesis (IPP) placement had recurrent urethral stones from hair growth. He presented with pain from his implant and voiding difficulty and was confirmed to have infected IPP. At the time of implant removal, a significant burden of stones and luminal hair were found and treated with laser lithotripsy. For definitive management of hair-related complications, he underwent a staged urethroplasty with a first stage Johanson technique followed by 6 months of electrolysis of hair follicles along urethral plate before second stage repair.

Mondor's disease is a rare disease that presents as a superficial thrombophlebitis that most often occurs in breast tissue, but can also occur on the anterior chest wall, thoracoabdominal region, and even the penis. Mondor's disease generally presents as localized pain and a palpable cord-like structure. It is a benign and self-limiting disease that can be managed conservatively and typically resolves in about four weeks without any treatment. This condition is important to recognize clinically because it can easily be mistaken for lymphangitis, cellulitis, musculoskeletal chest wall pain, breast mass, or malignancy. We present the case of a 58-year-old female who presented to the family medicine clinic with a several-day history of bilateral breast pain. The patient had a prompt mammogram that was negative and breast ultrasound imaging that revealed a small thrombus in the left breast, suggesting Mondor's disease as the culprit. The patient was treated conservatively and provided with close breast ultrasound follow-up. The patient's symptoms improved and resolved over 12 weeks. This case highlights the importance for primary care physicians to remain attentive to red flags requiring further investigation and recognize Mondor's disease in primary care.

Penile fracture coexisting with urethral injury is very rare. We present a 35-year-old businessman with complaints of penile pain and a popping sound during sexual intercourse. Examination revealed a deformed phallus consistent with eggplant deformity, blood at the tip of the meatus and suprapubic swelling. A diagnosis of penile fracture coexisting with urethral injury and acute urinary retention was made. Immediate surgical intervention revealed a 1.5 x 0.5cm ventral transection of the mid-bulbar urethral and the right corpus cavernosum. He subsequently had urine diversion via suprapubic cystostomy, repair of ruptured tunica albuginea covering the corpora and urethroplasty over a size 16-FR silicone urethral catheter. Patient did well postoperatively with normal urination two weeks postop following removal of urethral stent. Penile fracture coexisting with urethral injury is a rare but serious urological emergency. Prompt detection and surgical intervention are crucial for a successful outcome.

Tamsulosin, a selective α1-adrenergic antagonist prescribed for benign prostatic hyperplasia and expulsion of ureteral stones, carries a rare risk of priapism. We present a 59-year-old male with hypogonadism, hypertension, and hyperlipidemia who developed painless priapism 72 hours after initiating tamsulosin for ureterolithiasis. Despite the atypical absence of pain, penile blood gas analysis confirmed ischemic priapism. Initial treatment with intracavernosal phenylephrine (1000 mcg) failed, requiring bilateral corpus spongiosum shunts for resolution. A literature review revealed that many of the 14 existing cases identified occurred within 24 hours of drug initiation in middle-aged or older patients without additional risk factors. Approximately half responded to intracavernosal vasoconstrictors, while refractory cases required surgical intervention. To our knowledge, this is the first reported case of painless tamsulosin-induced ischemic priapism, emphasizing the importance of patient counseling and prompt evaluation of persistent erections regardless of pain intensity.

Background/Objectives: Postoperative pain is an important determinant of early recovery and patient experience after penile prosthesis implantation. Although malleable, two-piece inflatable, and three-piece inflatable penile prostheses differ substantially in their mechanical characteristics, data comparing postoperative pain profiles among these devices remain limited. This study aimed to evaluate early postoperative pain perception following penile prosthesis implantation and compare pain outcomes according to prosthesis type. Methods: In this prospective observational study, 166 patients who underwent penile prosthesis implantation between January 2020 and December 2025 were evaluated. Patients were divided into three groups according to prosthesis type: malleable penile prosthesis (MPP; n = 35), two-piece inflatable penile prosthesis (2IPP; n = 72), and three-piece inflatable penile prosthesis (3IPP; n = 59). Postoperative pain was assessed using the visual analog scale (VAS) on postoperative day (POD) 1, 7, and 30. Total postoperative non-steroidal anti-inflammatory drug (NSAID) consumption was expressed as ibuprofen-standardized dose (mg). Multivariable linear regression analyses were performed to identify independent predictors of postoperative pain. Results: VAS scores on POD1 were comparable among the three groups (p = 0.61). However, significant differences emerged during follow-up. On POD7, both the MPP and 2IPP groups demonstrated significantly higher pain scores compared with the 3IPP group (p = 0.018 and p = 0.041, respectively). On POD30, pain scores remained significantly higher only in the MPP group, whereas no significant difference was observed between the 2IPP and 3IPP groups. Total postoperative NSAID consumption was highest in the MPP group and lowest in the 3IPP group (p < 0.001). In multivariable analysis, both MPP implantation (β = 0.95, 95% CI: 0.48-1.42; p < 0.001) and 2IPP implantation (β = 0.73, 95% CI: 0.24-1.22; p = 0.004) were independently associated with higher POD7 pain scores. For POD30, only MPP implantation remained an independent predictor of increased pain (β = 1.12, 95% CI: 0.58 -1.66; p < 0.001). Conclusions: Prosthesis type was associated with different postoperative pain trajectories after penile prosthesis implantation. While early postoperative pain appears similar across devices, malleable prostheses are associated with more persistent pain and greater analgesic requirements. Among the evaluated devices, three-piece inflatable prostheses were associated with the most favorable postoperative pain profile. These findings suggest that postoperative patient comfort should be considered alongside functional and technical factors when selecting a penile prosthesis.