Dear Dr. Reed,

i require revision of unsuccessful prior attempt…i would like to primarily address improvements in function and appearance of the external genitalia, at this time. also, what forms of payment do you accept?
Specific_Questions: i have developed problem with ‘priapism’ with competent oxygenation, past several years, near to post-surgical period, there was a loss of whole tip of clitoris, from which some tissue was banked. could phalloplasty technique, and banked tissue, ironically be adapted to reconstruct a clitoris upon remnant penile root inside? do you use methylene blue injection for priapism? i can’t wear any of my jeans, nor my wetsuit… although i’m 57, i don’t appear to be, and i have no issues with bp, cholesterol, diabetes, etc. although i do have fibromyalgia. what would be the cost of such a novel procedure, and what would it be called…?

Muriel

Good afternoon Muriel,

While we do revisions, for tissue banking and regeneration, perhaps write to
Dr. Anthony Atala at Wake Forest Institute, Winston Salem, NC.

Hope he can help with that.  For other aspects of your revision or perhaps
a simulated clitoral body, please confer with us.  In this area we do have
some experience and please see some of our revisions.  http://srsmiami.com/photography-m2f.htmlThere are medications to control the necrotizing effects priapism.

Intracaverous injection of  mehtylene blue certainly has been reported (vide infra)

Response from Allen D. Seftel, MD  http://www.medscape.com/viewarticle/440468

The penis is innervated by both autonomic and somatic nerves. Sympathetic and parasympathetic fibers in the cavernous nerves regulate blood flow into the corpus cavernosum during erection and detumescence. Erection begins with transmission of impulses from parasympathetic nerves and nonadrenergic, noncholinergic (NANC) nerves. This neural stimulus leads to the release of nitric oxide from the NANC nerves and possibly from the endothelial cells. Nitric oxide increases intracellular levels of cyclic guanosine monophosphate (cGMP) in the cavernosal smooth muscle, which relaxes cavernosal tissue, perhaps by activating protein kinase G and stimulating the phosphorylation of proteins that regulate corporal smooth muscle tone. The actions of the parasympathetic nervous system, nitric oxide, and cGMP permit rapid blood flow into the penis and the development of an erection. As pressure within the corporal body increases, small emissary veins transversing the tunica albuginea are occluded, trapping blood in the corpus cavernosum. The erection is maintained until ejaculation, which usually leads to detumescence, via the sympathetic nervous system inducing contraction of the corporal tissue via adrenergic nerves.^[1]

Priapism is a pathologic condition of a penile erection that persists beyond or is unrelated to sexual stimulation and typically involves the paired corpora cavernosa. Priapism is an important medical condition that requires evaluation and may require emergency management.^[2]

Priapism has 2 forms; the most common is low-flow priapism, commonly known as ischemic priapism. It is clinically characterized as a painful, rigid erection absent of cavernous blood flow. Ischemic priapism beyond 4 hours is identified as a compartment syndrome that requires emergent medical intervention. Potential consequences are irreversible corporal fibrosis and permanent erectile dysfunction.

Standard therapy for ischemic priapism includes injection of an alpha-agonist, such as phenylephrine, directly into the corpus cavernosum, to produce contraction of the smooth muscle tissue and achieve detumescence.

Recent studies have shown the efficacy of injecting methylene blue intracavernosally to achieve detumescence. Methylene blue inhibits the activity of guanylate cyclase, thus preventing cGMP formation. This may reverse the prolonged penile erection. Portillo and colleagues^[3] reported on 12 men with priapism, 10 of whom were successfully detumesced with 5 cc of methylene blue solution. Thus, methylene blue may be a first-line option for ischemic priapism.

Happy Memorial Day weekend,

Harold M. Reed, M.D
305-865-2000