Penile inversion vaginoplasty is a complex procedure performed as part of gender-affirming care. It is a highly complex procedure involving extensive genital deconstruction and reconfiguration. As a result, effective post-operative pain control is a central component of perioperative care in this patient population. This review aims to synthesize and consolidate the current evidence on regional anesthesia techniques for postoperative pain management in patients undergoing penile inversion vaginoplasty.

Genital Crohn's disease (GCD) is an infrequent extraintestinal manifestation of Crohn's disease characterized by ulceration, pain, edema, and erythema in the anogenital area. GCD poses significant diagnostic and management challenges, mainly because there are no standardized clinical protocols. This review analyzed 20 case reports and series from 1983 to 2024, focusing on patients with GCD. The databases used for this search were PubMed, Scopus, and Google Scholar. The most common presentation in male patients was genital edema or swelling, seen in 88.9% of cases. Pain was the main presentation in 71.9% of cases among female patients. Several complications were reported, including rectovaginal and enterovaginal fistulas, tubo-ovarian abscesses, and penile involvement. The diagnosis was made based on clinical evaluation, which was supported by laboratory tests, physical examinations, imaging, and endoscopic procedures. Histological examinations of biopsied genital ulcers demonstrated non-caseating granulomatous inflammation; however, this finding was observed in only 50% of patients. Moreover, pelvic magnetic resonance imaging is highlighted as a crucial diagnostic tool. The most common form of treatment is pharmacological therapy. Corticosteroids, immunosuppressants, and tumor necrosis factor-alpha inhibitors are the most frequently used drugs. A total of 14 studies reported that corticosteroids administered via intravenous and oral routes resulted in a notable reduction in disease severity. The tumor necrosis factor-alpha inhibitors adalimumab and infliximab showed notable efficacy. New therapies such as carbon laser therapy and autologous stem cell transplantation showed promising outcomes in refractory cases. Surgical procedures are reserved for refractory or complicated cases. This review highlights that medical management with corticosteroids, immunomodulators, and biologics remains the cornerstone of treatment for GCD, with surgery playing a role in refractory disease.

Using conducted electrical weapons (CEW) to incapacitate aggressive, hostile adults as a less-than-lethal approach has become a common law enforcement practice. The most widely used CEW in law enforcement worldwide is the Taser. The target is subdued when an electric circuit is established between two probes, delivering enough energy to cause pain and muscle incapacitation. Injuries and hospitalizations are rare and mainly occur from dart penetration. Removing the dart is usually straightforward and performed by either the target or law enforcement. No previous cases of glans penis injuries from Taser dart penetration have been reported. To our knowledge, no previous cases of glans penis injuries requiring urological surgery from Taser dart penetration have been reported based on a Medline search of the English language literature using the words Taser, case reports, and injury. A 44-year-old male was struck in the glans penis by an X2 Taser dart during a violent disturbance at the County Jail. He was taken to the Emergency Department because the dart was embedded in his penis just above his distal urethra and was deeply embedded. Urology removed the dart in the operating room by advancing the first barb, cutting it off, then backing out the second barb. The urethra was undamaged. Because of the location of the penetration, the decision-making process for probe removal was challenging. When taser dart removal is not straightforward, the type of dart and the location of the probe relative to surrounding structures may require changing strategies to safely remove the projectile while protecting the surrounding tissue.

Pediatric penile problems range from congenital anomalies to acquired and emergent conditions. Acquired conditions can result from various causes, including infectious and inflammatory conditions, hematologic conditions, strangulation conditions, trauma, and surgical injuries. This review provides an overview of the presentation, diagnosis, and management of pediatric penile problems that may present to the emergency department. Recommendations are given for evaluation and management, with emphasis on pain relief, restoration of normal anatomy, and timely treatment. Guidance is also provided on indications for emergent urologic consultation. Optimizing outcomes for pediatric patients with penile conditions requires addressing key challenges, including effective pain and anxiety management, thoughtful use of imaging, and careful evaluation for possible abuse.

Congenital megaprepuce (CMP) is a rare congenital disorder characterized by excess mucosa accompanied by a partial thickening of the ventral prepuce. This abnormality causes complete penis coverage without any additional penile abnormalities, leading to ballooning of the prepuce due to urinary retention, which is the primary complaint of patients. We report a 4-year-old boy who came to the urology clinic with complaint of difficult micturition, pain, and ballooning of the prepuce during urination. The ballooning was from the accumulation of urine in the preputium. It happened since the patient was an infant. The patient sometimes felt a fever every single month but was getting better after taking medication. Local examination of genitalia showed the penis appeared buried beneath a large amount of skin of preputium, which was excessively redundant and also not circumcised yet. During micturition, urine collects within this sac, leading to ballooning of the prepuce, and urine dribbling through the small prepuce orifice. The patient was planning for surgical intervention to release the glans penis with circumcision and reconstruction of the penis. Congenital megaprepuce (CMP) needs to be differentiated from other penile anomalies such as buried penis and webbed penis. Early recognition and surgical intervention are essential to prevent complications and achieve satisfactory cosmetic outcomes for the circumcised penis.

The relationship between psoriatic arthritis (PsA) and Peyronie's disease (PD) remains poorly understood. PsA is a chronic immune-mediated inflammatory disease, whereas PD is a fibroproliferative disorder of the penile tunica albuginea that leads to penile curvature, pain, and sexual dysfunction. Both conditions involve chronic inflammation and dysregulated tissue remodeling. We report the case of a 42-year-old man with long-standing PsA who developed acute inflammatory PD shortly after discontinuing biologic therapy because of loss of insurance and medication nonadherence. The patient presented with new-onset penile pain and a palpable dorsal plaque in the setting of uncontrolled psoriatic disease. Penile ultrasound demonstrated fibrous plaque formation with linear calcifications consistent with early PD. Management included oral pentoxifylline, topical nitroglycerin, and resumption of systemic immunosuppression with secukinumab through a patient-assistance program, resulting in improvement in both penile symptoms and psoriatic disease activity. To contextualize this presentation, we performed a narrative review of the literature examining reported associations between PD and autoimmune or fibroinflammatory conditions. Prior studies have reported heterogeneous epidemiologic findings, with some suggesting an increased prevalence of psoriasis and PsA among men with PD, while others support a shared profibrotic biology mediated by transforming growth factor-β rather than by classic autoimmunity. This case highlights a potential temporal and pathophysiologic association between uncontrolled systemic inflammation and localized penile fibrosis and underscores the impact of social determinants of health on disease progression. Awareness of this possible association may prompt earlier urologic evaluation in patients with inflammatory arthritis and emphasizes the importance of maintaining continuity of biologic therapy in chronic immune-mediated disease.

Penile strangulation is a rare urological emergency that can rapidly progress to vascular compromise and irreversible tissue damage. Metallic constricting devices pose the greatest challenge due to their rigidity and resistance to conventional removal techniques. We report the case of an adult male who developed progressive penile swelling and pain after self-application of a metallic wedding ring during an episode of emotional distress, necessitating mechanical sectioning with a tungsten-carbide orthopaedic cutter under continuous protective shielding for safe removal.

Background: Adult circumcision is an effective surgical treatment for symptomatic phimosis, but its effects on sexual function and psychosocial outcomes remain incompletely characterized. This study aimed to assess patient-reported motivations for circumcision due to phimosis and to evaluate changes in sexual function, genital self-image, and depressive symptoms after surgery. Methods: We performed a prospective, single-center observational pre-post cohort study of adult men who underwent circumcision for symptomatic phimosis at a tertiary academic center in Poland between January 2023 and April 2025. Participants completed an author-designed questionnaire and validated patient-reported outcome measures before surgery and at six months after circumcision. The primary endpoint was the change in sexual function measured by the International Index of Erectile Function (IIEF-15). Secondary endpoints included changes in genital self-image assessed using the Male Genital Self-Image Scale (MGSIS-7), depressive symptoms measured with the Beck Depression Inventory (BDI-II), and patient-reported motivations for surgery. Paired comparisons were performed using the Wilcoxon signed-rank test. Results: A total of 148 men were included in the study. The most common reasons for surgery were pain/discomfort (58/148, 39.2%) and impaired sexual activity (51/148, 34.5%). The total IIEF-15 score increased from 46.4 ± 20.4 to 57.5 ± 21.0 (p < 0.001), with significant improvements across all domains (all p < 0.001). The total MGSIS-7 score improved from 19.9 ± 4.5 to 23.1 ± 4.0 (p < 0.001). Paired BDI-II data were available for 77 men; the total BDI-II score decreased from 1.2 ± 3.8 to 0.3 ± 1.6 (p = 0.004). Most men reported improved sexual life (127/148, 85.8%) and cosmetic satisfaction (124/148, 83.8%), and 119/148 (80.4%) reported no complications. Conclusions: Circumcision for symptomatic phimosis was associated with improved sexual function and genital self-image, alongside a statistically significant but clinically negligible decrease in subclinical depressive symptoms.

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.