• Archives of Plastic Surgery
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• v.47 no.4
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• pp.354-359
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• 2020

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. In specific cases, it may prove superior to more commonly used options (e.g., anterolateral thigh flap and radial forearm free flap). Historically, a disadvantage of the MSAP flap is the relatively small surface area it provides for reconstruction. We recently encountered a patient with extensive pelvic injuries from prior trauma resulting in significant scarring and contracture of the groin, tethering of the penis, and loss of the scrotum and one testicle. The patient was unable to achieve erection from tethering and his remaining testicle had been buried in the thigh. In considering the reconstructive options, he was not a suitable candidate for a thigh-based or forearm-based flap. An extended MSAP flap measuring 25 cm×10 cm was used for resurfacing of the groin and pelvis as well as for the formation of a neoscrotum. This report is the first to document an MSAP flap utilized for simultaneous groin resurfacing and scrotoplasty. Additionally, the dimensions of this flap make it the largest recorded MSAP flap to date.

• Natural Product Sciences
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• v.5 no.3
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• pp.138-141
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• 1999

The effects of Eurycoma longifolia Jack were studied in maintaining mating behavior of sexually experienced castrated male rats after dosing them with 500 mg/kg daily of E. longifolia Jack for 10 days prior to test and later continued for two weeks where the rats were then castrated. The similar dosage was then continued for 12 weeks post-castration. However, $400\;{\mu}g/day$ of testosterone was administered subcutaneously on the day of castration and lasted for 6 weeks post-castration but later raised to $800\;{\mu}g/day$ until 12 week post-castration. Tests were conducted weekly from 2-6 weeks and 8-12 weeks post-castration. Results showed that all the experimental male rats exhibited mating behavior before castration. Further results also indicated that E. longifolia Jack successfully maintained mating behavior but less than precastration level from 2-6 weeks and later increased from 8-12 weeks post-castration. Similarly, $400\;{\mu}g/day$ of testosterone was effective in maintaining mating behavior from 2-6 weeks post-castration. However, $800\;{\mu}g/day$ of testosterone managed to return the male rats to the precastration level with all male rats exhibited mating behavior from 8-12 weeks post-castration. Further results also indicated that testosterone significantly increased the penis weights (p < 0.05) as compared to the E. longifolia Jack. In conclusion, this study shows that E. longifolia Jack continued to maintain mating behavior of sexually experienced castrated male rats, giving further evidence of the folkuse of this plant as aphrodisiac.

• Archives of Reconstructive Microsurgery
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• v.25 no.1
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• pp.19-24
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• 2016

Urethral reconstruction is a problematic issue, thus its management can be challenging. Different methods using various materials were introduced for urethral reconstruction. The authors have made some changes in the groin flap surgery, affording more successful urethral reconstruction for defects of long urethra and penile soft tissue. A 45-year-old male requested both functional and cosmetic reconstruction of his defected penis, caused by an iatrogenic urethral injury and chronic infection following removal of paraffin self-injected on the penile shaft. The defect affected the full length of the penile urethra, corpus spongiosum, and prepuce. A groin flap was designed, measuring $28{\times}10cm$. The most distal flap was utilized for the construction of the luminal surface of the neourethra; relaxed length measuring 8 cm, and the lumen wide enough. Competent external meatus and neourethra was confirmed by retrograde cystogram and the patient voided with sufficient urine caliber up to 2 years follow-up. This operative technique has advantages. Donor sites have non-hair bearing skin for the neourethra and minimal or almost notrecognizable donor site morbidity. After surgery, the patient was relieved from voiding difficulties combined with psychological stress. The author would like to introduce a unique approach for the urethral and ventral phalloplasty using the groin flap.

• Archives of Plastic Surgery
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• v.39 no.3
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• pp.257-260
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• 2012

This report describes the use of a tubularized random flap for the curative treatment of recurrent anterior urethral stricture. Under the condition of pendulous lithotomy and suprapubic cystostomy, the urethral stricture was removed via a midline ventral penile incision followed by elevation of the flap and insertion of an 18-Fr catheter. Subcutaneous buried interrupted sutures were used to reapproximate the waterproof tubularized neourethra and to coapt with the neourethra and each stump of the urethra, first proximally and then distally. The defect of the penile shaft was covered by advancement of the surrounding scrotal flap. The indwelling catheter was maintained for 21 days. A 9 month postoperative cystoscopy showed no flap necrosis, no mechanical stricture, and no hair growth on the lumen of the neourethra. The patient showed no voiding discomfort 6 months after the operation. The advantages of this procedure are the lack of need for microsurgery, shortening of admission, the use of only spinal anesthesia (no general anesthesia), and a relatively short operative time. The tubularized unilateral penile fasciocutaneous flap should be considered an option for initial flap urethroplasty as a curative technique.

• Archives of Plastic Surgery
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• v.39 no.3
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• pp.253-256
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• 2012

A radial forearm free flap has been conventionally used for urethral reconstruction. However, aesthetic and functional complications occur frequently at the donor site. The use of a superficial circumflex iliac artery perforator (SCIP) flap can resolve these disadvantages. Here, we report our case with a review of literature. A 69-year-old man visited our hospital with multiple contusions of the abdomen and genital amputation. After necrotic tissue debridement, the length of the residual corpus carvernosum was 1.5 cm and that of the corpus spongiosum and urethra was 1 cm. For the reconstruction of the penis, a SCIP flap and anterolateral thigh free flap was performed. The primary closure was performed at the donor site. Three weeks postoperatively, the patient had a urethral foley catheter removed. The neourethra was functioning well without stricture. Four months postoperatively, the patient had no complications such as urethral stricture. A good recovery was also achieved with no aesthetic deficits at the donor site. SCIP flap is appropriate for urethral reconstruction. Because of its proximity to the recipient sites, it makes surgical preparation easier and the primary closure at the donor site available. It is also advantageous in that its location is almost unnoticeable.

• Radiation Oncology Journal
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• v.36 no.3
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• pp.248-253
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• 2018

Radiation protection in the scrotum to reduce the risk of genetic effect in the future is very important. This study aimed to measure the scrotal dose outside the treatment fields by using the radio-photoluminescence glass dosimeter (RPLGD). The characteristics of RPLGD model GD-302M were studied. Scattered dose to scrotum was measured in one liposarcoma case with the prescribed dose of 60 Gy. RPLGDs were placed in three different locations: one RPLGD was positioned at the posterior area which closer to the scrotum, and the other two RPLGDs were placed between the penis and the scrotum. Three RPLGDs were employed in each location. The scattered doses were measured in every fraction during the whole course of treatment. The entire number of 100 RPLGDs showed the uniformity within ±2%. The signal from RPLGD demonstrated linear proportion to the radiation dose (r = 0.999). The relative energy response correction factor was 1.05. The average scrotal dose was 4.1 ± 0.9 cGy per fraction. The results presented a wide range since there was a high uncertainty during RPLGD placement. The total scrotal dose for the whole course of treatment was 101.9 cGy (1.7% of the prescribed dose). The RPLGD model GD-302M could be used to measure scattered dose after applying the relative energy correction factor.

• Journal of Physiology & Pathology in Korean Medicine
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• v.20 no.4
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• pp.1009-1013
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• 2006

The fallowing are the result of the experimental studies of KH-304 on the penile nitric oxide synthase (NOS) activity, SOD and the level of blood testosterone in old rat. KH-304 was tested for the expression and activity of eNOS, nNOS, SOD/Mn, caveol in-1, 3 in penis of old-rat. The penile expression level of the five enzyme were increased significantly after oral administration of the KH-304 100mg/kg for 100ays and the concentration of testosterone in the blood were increased. In vitro, the effect of SOD and free radical scavenging were increased significantly. Conclusively, KH-304 is capable of improving of sexual ability in old-rat.

• Journal of Species Research
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• v.11 no.3
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• pp.169-173
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• 2022

Three species belonging to the genus Trapania Pruvot-Fol, 1931 are redescribed from Korea in this paper: Trapania euryeia Gosliner & Fahey, 2008, T. japonica (Baba, 1935), and T. toddi Rudman, 1987. Among these species, T. japonica is newly added to Korean fauna. The genus Trapania is characterized by a pair of extra-rhinophoral appendages on each side of the head, tentacular foot corners, a pair of extra-branchial appendages present around the gill, radula formula N×1.0.1. and consists of denticulated teeth, triaulic reproductive system, and minute spines on the armed penis. Herein, synonyms of the genus Trapania are summarized through a detailed literature review and the diagnostic characters of the genus Trapania are provided. Three species of the genus Trapania from Korea are distinguished from each other based on the color of extra-rhinoporal appendages and extra-branchial appendages, ground color, and distribution range of the brown markings on the dorsal surface. A taxonomic key to the genus Trapania in Korea is provided. In addition, the morphological characteristics of three trapanian nudibranchs in Korea are described and detailed photos of living animal are provided.

• Archives of Plastic Surgery
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• v.49 no.3
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• pp.448-452
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• 2022

Total reconstruction of the penis (TPR) represents a challenge for urologists and plastic surgeons, especially when urethral length is severely reduced. We here describe, for the first time in an oncologic scenario, a double flap phalloplasty using a pedicled anterolateral thigh (ALT) flap for penile reconstruction and a radial forearm free flap (RFFF) for complete neourethra and glans reconstruction following penile amputation. A 48-year-old patient came to our department following a total penectomy with inferior urethral derivation. The indication for a double flap phalloplasty was posed as only way to fully reconstruct the urethra on its length avoiding possible complications of single flap reconstruction using tube-into-tube technique. Both flaps healed uneventfully with no neourethral strictures or fistulas described. At 18 months follow-up, the patient was extremely satisfied with the aesthetic result and was able to void in standing position. We think that a double free tissue transfer for TPR should be considered, particularly when a urethral length > 14 cm needs to be reconstructed. While the pedicled ALT can be used to reconstruct a proper penile shaft with an easily concealed scar, the RFFF can provide adequate neourethra length with satisfactory sensory recovery at the neoglans.

• Journal of Genetic Medicine
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• v.19 no.2
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• pp.115-119
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• 2022

The 46,XX testicular disorder of sex development (DSD) is a rare condition in which 46,XX individuals develop testicular differentiation and virilization. Translocation of the sex-determining region Y (SRY) onto the X chromosome is the main cause of 46,XX testicular DSD, whereas dysregulation between pro-testis and pro-ovarian genes can induce SRY-negative 46,XX testicular DSD. Nuclear receptor subfamily 5 group A member 1 (NR5A1), a nuclear receptor transcription factor, plays an essential role in gonadal development in XY and XX embryos. Herein, we report the first Korean case of SRY-negative 46,XX testicular DSD with a heterozygous NR5A1 p.Arg92Trp variant. The patient presented with a small penis, bifid scrotum, and bilateral undescended testes. Whole exome sequencing revealed a heterozygous missense variant (c.274C>T) of NR5A1. Our case highlights that NR5A1 gene variants need to be considered important causative factors of SRY-negative non-syndromic 46,XX testicular DSD.