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Congenital penile curvature

Congenital (congenital) penile deviation is a rare form of penile curvature. In contrast to acquired penile curvature (Induratio Penis Plastica), the curvature has existed since birth.
The cause of the congenital curvature of the penis is unclear. The congenital penile deviation can manifest itself to varying degrees. The curvature of the penis itself can be so severe that normal sexual intercourse is no longer possible, or sexual intercourse can lead to pain in the partner (dyspareunia).
The symptoms caused by the congenital curvature of the penis can lead to anxiety, loss of self-confidence and stress.

Symptoms:
Typical:
– Penile curvature: The penis is usually curved ventrally or ventrolaterally.
– Penis length: As a rule, patients with congenital penile curvature have a relatively normal penis length.
– Problems during sexual intercourse: these can occur in the patient or in the partner due to the curvature.

Causes:
The exact cause of the development of congenital penile curvature is unclear.

Complications: 
Depending on the severity, the following complications may occur:
– sexual intercourse disorder
– Erectile dysfunction
– Anxiety and stress before/ during sexual intercourse and about the penis image itself
– Stress for the partnership
– Fertility disorder, as undisturbed sexual intercourse can be hindered.</complications.

The diagnosis should be based on a detailed conversation. In addition, the degree of penile curvature and its characteristics should be examined by means of an artificially induced erection. A sonographic examination of the penis serves to detect additional pathologies in the penis. Furthermore, it is possible to clarify further vascular causes of erectile dysfunction (Venous Leak).

Therapy:
A surgical correction of the curvature can be performed at any time. Decisive for the surgical indication is the degree of curvature and the impairment of sexual intercourse due to the curvature of the penis.
In order to lose as little penis length as possible during the operation, we perform deviation corrections using a new surgical method. The excellent operation results and the high patient satisfaction rate confirm our approach.

Acquired curvature of the penis (Induratio Penis Plastica)

The so-called Induratio Penis Plastica (IPP) is an acquired penile deviation that manifests itself as fibrous scarring in the penis. This leads to a curvature of the penis, which can be painful in the acute stage. The IPP can manifest itself to varying degrees. The acute form is characterized by pain in the penis and by an increasing and decreasing curvature of the penis. The curvature of the penis itself can be so severe that normal sexual intercourse is no longer possible or sexual intercourse can lead to pain in the partner (dyspareunia). The symptoms caused by IPP can lead to anxiety, loss of self-confidence and stress.

Symptoms:
The symptoms of IPP can be either acute or slowly progressive.
– Scar tissue: So-called plaques (hardened scar tissue) can be felt in the penis.
– Curvature of the penis: The penis can be curved in all directions as a result of the scarring changes. In rare cases, a watch glass deformation can occur, which causes a narrowing of the penis shaft.
– Erection problems: Erectile function may be impaired due to IPP.
– Shortening of the penis length: Due to the scarred curvature, the penis loses length. A 60° curvature is usually accompanied by a loss of penis length of 2-3 cm.
– Penis pain: This can occur at any time. However, they are typical for the acute phase of the disease.
After the acute phase, in which IPP-typical changes in the penis occur, comes the chronic phase. This is characterised by a stable curvature and less pain.

The exact reason for the development of IPP is unclear. Microtraumas of the penis caused by sexual intercourse seem to play an important role in scarring. In some cases, however, this connection is not visible and an association with diseases of the immune system is thought to be causal.

Risk factors:
Microtraumas alone are not solely responsible for the disease. Various factors that affect wound healing can lead to scarring changes in the tunica albuginea of the erectile tissue of the penis. These include, for example:
– diabetes mellitus
– Inheritance: If your father or brother suffers from IPP, your risk is increased.
– Connective tissue diseases such as Dupuytren’s disease and Ledderhosen disease.
– Age-related changes in the connective tissue healing capacity

Complications
Depending on the severity, the following complications may occur:
– sexual intercourse disorder
– Erectile dysfunction
– Anxiety and stress before/ during sexual intercourse and about the penis image itself
– Stress for the partnership
– Fertility disorder, as undisturbed sexual intercourse can be hindered.

The diagnosis should be based on a detailed conversation. In addition, the degree of penile curvature and its characteristics should be examined by means of an artificially induced erection. A sonographic examination of the penis is used to detect the scarring of the penis at the erectile tissue, which leads to penile curvature. In addition, further vascular causes of erectile dysfunction can be clarified (Venous Leak).

Therapy:
In the acute painful phase, surgical correction is not recommended, as the remodelling processes are still in progress and can change the appearance of the penis.

In the acute phase, there are various approaches that do not stop the acute process, but improve the pain symptoms. For example, there have been efforts to establish shock wave therapy, iontopheresis, injection of verapamil, collagenase, POTABA, etc. as a standard therapy. Nowadays it is known that there is no sufficiently well-functioning means to combat the acute phase of IPP.

According to the guidelines of the European Society of Urology, surgical therapy in the sense of correcting the curvature should only be carried out in the stable phase. In this phase of the disease there is no change in the curvature and the penile pain must have clearly decreased or disappeared. This condition should be reached for at least three months before surgical therapy can be performed.

Erectile dysfunction

One speaks of erectile dysfunction (impotence) if the ability to get an erection is disturbed or if it is not sufficient for satisfactory sexual intercourse. However, occasional erectile dysfunction should not be considered a cause for concern, as it can occur due to stress, interpersonal problems, etc. Persistent erectile dysfunction should, however, be clarified and treated if necessary.
Although this topic may seem embarrassing, you should not be afraid to tell your doctor about your problem. In many cases you can be helped.

Symptoms:
An erectile dysfunction can manifest itself as follows:
– Problems getting an erection
– Problems keeping an erection long enough
– Reduced sex drive

Causes:
The development of an erection is based on a complex process in the brain, involving nerves, hormones, muscles and blood vessels. Each of these levels can be disrupted and interfere with the cascade to achieve a satisfactory erection. Physical and psychological stress can also have a negative effect on potency.
In most cases, erectile dysfunction has a physical cause:
– Heart Disease
– Atherosclerosis
– Hypercholesterolemia
– High blood pressure
– Diabetes
– Obesity
– Metabolic syndrome
– multiple sclerosis
– Parkinson
– Low Testosterone
– Curvatures of the penis (acquired vs. congenital)
– venous leak
– Etc.

Not to be neglected are also psychological causes, such as depression, anxiety, interpersonal problems, etc.

Risk factors:
It is a misconception that the erectile function inevitably deteriorates with age. Erectile dysfunction is often a precursor of other problems (especially cardiovascular diseases).
Various risk factors play a role in the development of erectile dysfunction:
– Diseases: especially diabetes and heart problems
– Smoking
– Overweight
– Psychological causes: stress, anxiety, depression, etc.
– Drugs and alcohol abuse

Complications
Erectile dysfunction can lead to a variety of complications in your life, for example:
– an unsatisfactory sex life
– Stress, fear of “failure”
– Shame, low self-esteem
– relationship problems
– Incapacity for procreation

Diagnosis:
We offer you the entire spectrum of the clarification of erectile dysfunction. The basis of any therapy is a detailed patient-physician consultation in which you should explain your problem in detail. With the help of modern laboratory tests and ultrasound examination we can help you with the therapy of your problem.

Therapy:
Depending on the underlying cause of her erectile dysfunction, there are different therapeutic approaches. These range from drug support, through hormone therapy to surgical interventions to restore erectile function. We also offer the implantation of an erectile tissue replacement (penile prosthesis) for those patients who have not been helped by any other therapy. All therapeutic decisions are based on the latest guidelines of the European Society of Urology.

Male breast growth (gynecomastia)

Gynecomastia is the unilateral or bilateral, painful or painless swelling of the mammary glands. This causes the male breast to take on a female appearance.
A distinction must be made between proper gynecomastia and pseudogynecomastia,
also known as lipomasty, which is an accumulation of fat in the breast of mostly clearly overweight men.
The most common form of correct gynecomastia is pubertal gynecomastia. It is caused by hormonal changes at the beginning of puberty and can occur on one or both sides.
The growth of the male breast in adult age can have various causes, such as
– Drugs that influence the hormonal balance
– Hormonal diseases
– Tumour neoplasms: Especially tumours of the testicles, the pituitary gland or the breast
– General diseases: e.g. liver diseases such as cirrhosis

Diagnosis:
The diagnosis of gynecomastia is based on the one hand on the clinical appearance of the male breast. On the other hand, this disease requires extensive diagnostics by means of hormone status, ultrasound of the testicles, etc.

Therapy:
Depending on the underlying disease, the therapy of gynecomastia varies and depends on the results of the diagnostic tests. It is not uncommon for the proliferated glandular tissue to be surgically removed.

urethral constrictions

The urethral stricture manifests itself by varying degrees of narrowing or complete closure of the urethral canal. Any part of the urethra can be affected. Patients with this condition have difficulty urinating and emptying the bladder. Urethral strictures are a huge functional, psychological, social and sexual problem for every patient.

Urethral strictures can be caused by:
injuries falls, pelvic fractures, etc.
– Infections Gonococcal and Chlamydia infections
– Skin diseases Lichen sclerosus
– Hereditary hypospadias, epispadias Penile anomalies
– Iatrogenic causes Catheterism, endoscopic examinations

Urethral strictures of unknown origin are called idiopathic.

In general, the disease has the following symptoms:
– Difficulty emptying the bladder Pain when urinating
– weak urine flow
– Uncontrolled spurting urine stream Dripping
– Urinary incontinence
– Recurrent urinary tract infections
– Reduced ejaculation force

Sometimes the above mentioned symptoms can also stay away.

Treatment
The treatment methods for urethral stenosis include
– dilatation, endoscopic incisions (urethrotomy) and surgical reconstruction (urethroplasty).
– Dilatation procedures:

The stricture is stretched with the help of a metallic dilator that can be enlarged in stages. Dilatation hardly contributes to healing and must therefore be repeated regularly. Pain, bleeding, infections and the creation of an “incorrect flow path” are considered the main problems associated with this procedure.

Urethrotomy procedure:
This is the incision of a narrowed segment of the urethra with a knife blade or laser. The procedure is performed endoscopically using a camera for bladder examination. This method can only be successful if the urethral strictures are very short. The urethrotomy, just like dilatation, can lead to excessive damage to the urethral tissue and to a progressively worsening urethral stricture.

Uretoplasty:
Open surgical reconstruction of the urethra leads to a complete treatment of the urethral stricture. Numerous methods are used for open reconstruction. The urethral canal can be reconstructed in simple stricture cases by cutting out the narrowed segment and suturing both healthy urethral stumps together. In more complicated urethral strictures, one- or two-stage surgery is required. The type of reconstruction depends on the type of stricture (location, length, degree of difficulty). Large narrowed urethral segments can, for example, be replaced by an oral mucosa graft.

Sterilization of man

If your family planning is complete, a further child can be prevented by vasectomy (male sterilisation).
In principle, the sterilization can be reversed. For more information, see Refertilisation surgery in men (vasovasostomy).

What are the risks and complications associated with the operation?
Complications are extremely rare, but there is always the risk of a problematic course with every operation. In addition to post-operative bleeding with the formation of a haematoma and swelling of the scrotum, an infection of the epididymis is particularly noteworthy.

From when do I no longer have to use contraception?Postoperatively, sperm can still collect in the spermatic ducts, so that after the operation, positive evidence can be found in the ejaculate. We therefore recommend a spermiogram control 3, 4 and 5 months after the operation. Only if azoospermia (no detection of sperm) is detectable in all 3 spermiograms can contraception be dispensed with.

Who bears the costs?
Sterilization measures are not covered by social security. You must bear the costs of these measures.

Refertilization operation for man

If you wish to have children again after a vasectomy, your fertility can be restored. There are basically two ways to fulfil this wish:
– Refertilisation can restore the patency of the vas deferens and thus natural conception can follow.
– The alternative is artificial insemination using cryopreserved sperm, or the surgical extraction of sperm from the testicles.

Both procedures have advantages and disadvantages, about which we will be happy to advise you individually in our consultation hours.

What is the difference between vasovasostomy and tubulostomy?
Both techniques can be used for refertilization. The difference lies in the amount of anastomosis (connection) of the separated spermatic duct ends. If only both separate spermatic duct ends are sutured together, it is called a vasovasostomy. Tubulovasostomy, on the other hand, refers to the connection of the vas deferens to the epididymis.

What risks and complications can arise from the operation?
Complications rarely occur after the operation. In addition to post-operative bleeding with formation of a bruise and swelling of the scrotum, an infection of the epididymis is particularly noteworthy.

What is the success rate?
Due to the microsurgical operation technique, a patency rate of approx. 80-90% is recorded.

Who bears the costs?
Again, the costs of refertilization are not covered by social security. You must bear the costs of these measures.

Disturbance of the male hormone balance

Hormone imbalances can disrupt a man’s general condition and libido. Here it is true that not only testosterone can be the cause, but a multitude of hormones can throw the balance of the organism off balance.

The most important disturbance of the hormone balance in men is the testosterone deficiency (hypogonadism). Its most common form is late-onset hypogonadism, which affects 20-30% of all men over the age of 40. It is a consequence of the continuous decline in testosterone production (1-2% per year) in the testicles.

Rarer disturbances of the hormone balance affect the formation of:
– Prolactin: e.g: Hyperprolactinaemia due to benign tumours of the pituitary gland
– Dehydroepiandrosterone (DHEA): e.g.: DHEA deficiency syndrome
– Oestrogen: e.g.: usually the result of a testosterone deficiency
– Thyroid gland dysfunction: e.g.: thyroid gland over/underfunction
– Melatonin: e.g.: disturbance of the sleep/wake rhythm

The basis of every therapy is a thorough basic examination during which the hormone status is determined. The next steps can be planned on the basis of your symptoms and the laboratory values.

Varicose vein formation in the area of the testicular veins (varicocele)

A varicocele is a varicose vein formation in the plexus pampiniformis, a venous plexus in the spermatic cord. Varicocele occurs on the incision side in 75-90% of cases.
Due to the chronic overheating of the testis by the varicocele, it can lead to a reduced sperm production and a worse
Sperm quality is coming. A reduced testicular volume can also be the result of a varicocele.
The diagnosis of a varicocele is simple and in most cases surgical therapy is not necessary. In case of complaints or unfulfilled desire to have children, surgical correction can be considered.

Symptoms:
In most cases, a varicocele does not cause any symptoms. However, sometimes there is a painful pulling in the groin. These complaints can be more severe when sitting, standing or during sports activities. The pain increases throughout the day and is quickly relieved when lying down. A varicocele can increase in size over time.

Causes:
The exact cause is still unclear. However, a defective venous valve mechanism seems to be at the root of the varicocele.

Risk factors:
A clear definition of the risk factors is not yet possible. Overweight can play a certain role in the development of varicocele.

Complications:
Due to the varicocele there is a chronic overheating of the testicular tissue, this can have various effects, for example:
– Testicular atrophy: The testicular volume can be significantly reduced in side comparison.
– Infertility: The cause of this is not fully understood. However, it appears that a varicocele can affect sperm production and its quality.

Diagnosis:
For the diagnosis of a varicocele a detailed medical history, a physical examination of the testis and an assessment by means of an ultrasound examination are necessary.

Therapy:
In most cases, a symptomless varicocele does not require treatment. Indications for surgery include chronic pain and infertility. Indications for surgery can only be made after a thorough examination.
At our clinic, a microsurgical varicocele ligation is performed using a high-resolution microscope in the event of an operation.

PROF. SHARIAT

Christina Mayer – Assistant
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RATHAUSSTR. 21/14 – 1010 WIEN 
Tel:+43 1 470 61 44 

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