Hussain M. Alnajjar

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Verified

Hussain verified their affiliation via an institutional email.

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• BSc (MedSci) MBBS MRCS ChM (Urol) FEBU FRCS (Urol)
• Consultant Urological and Andrological Surgeon, Associate Professor, UCL at University College London Hospitals NHS Foundation Trust

Penile cancer (PeCa) is rare but aggressive and life changing. Penile-preserving surgery (PPS) allows length preservation for sexual activity and normal voiding. Intraoperative frozen section examination (FSE) of resection margins helps to decide on how much penile tissue is excised. Oncological outcomes and diagnostic accuracy of FSE to date, howe...

Purpose: There is increased interest in regenerative therapies (RTs) to treat erectile dysfunction (ED). However, the need for society's guidelines has led to varied practices. This study aims to investigate current global practices, address the heterogeneity in treatment protocols and evaluations, and establish expert recommendations in clinical...

Penile intraepithelial neoplasia (PeIN) and penile squamous cell carcinoma (PeSCC) are both thought to be associated with male genital lichen sclerosus and human papillomavirus (HPV) infection through dichotomous pathways: (i) undifferentiated PeIN and warty/basaloid PeSCC are thought to be HPV related, whereas (ii) differentiated PeIN and usual Pe...

Purpose: This study aimed to examine current global practices in regenerative therapy (RT) for erectile dysfunction (ED) and to establish expert recommendations for its use, addressing the current lack of solid evidence and standardized guidelines.Materials and Methods: Materials and Methods: A 39-question survey was developed by senior Global Andr...

Background Penile cancer is a rare male genital malignancy. Surgical excision of the primary tumour is followed by radical inguinal lymphadenectomy if there is metastatic disease detected by biopsy, fine needle aspiration cytology (FNAC) or following sentinel lymph node biopsy in patients with impalpable disease. However, radical inguinal lymphaden...

Penile cancer (PeCa) is rare, and the oncological outcomes in younger men are unclear. We aimed to analyse and compare oncological outcomes of men age ≤50 years (y) and >50 years with PeCa. A retrospective analysis of men ≤50 y with penile squamous cell carcinoma managed at a tertiary centre was performed. A propensity score matched cohort of men >...

Premalignant penile lesions are often a diagnostic challenge with the natural history of many premalignant penile lesions remaining uncertain. Several lesions exist which may be defined as either Human Papilloma Virus related or non-related. Malignant transformation of these lesions into invasive carcinoma may result in patients requiring more aggr...

Background There is a well‐established association between squamous cell cancer and genital lichen sclerosus (GLSc). Although there have been several reported cases of vulval melanoma (MM) associated with LSc, particularly in the paediatric population, fewer cases of male genital (M) GLSc and penile (Pe)MM have been published. Objectives The aim o...

The association between squamous cell malignancies and genital lichen sclerosus (GLSc) is well established. There is an increasing literature regarding the relationship of GLSc with genital malignant melanoma (MM). While there have been several reported cases of vulvar melanoma associated with lichen sclerosus (LSc), there have been fewer cases pub...

The association between squamous cell malignancies and genital lichen sclerosus (GLSc) is well established. There is an increasing literature regarding the relationship of GLSc with genital malignant melanoma (MM). While there have been several reported cases of vulvar melanoma associated with lichen sclerosus (LSc), there have been fewer cases pub...

Objective To report the oncological survival outcomes of men with penile sarcomatoid squamous cell carcinoma (sSCC). Patients and Methods A retrospective analysis of men with penile sSCC diagnosed between January 2010 and January 2020 in a single centre was conducted. Disease‐specific (DSS), recurrence‐free (RFS) and metastasis‐free (MFS) survival...

Purpose To describe our surgical technique and report the oncological outcomes and complication rates using a fascial-sparing radical inguinal lymphadenectomy (RILND) technique for penile cancer patients with cN+ disease in the inguinal lymph nodes. Methods Over a 10-year period, 660 fascial-sparing RILND procedures were performed in 421 patients...

Injection of exogenous material into the penis and scrotum has been performed for augmentation purposes. Complications include cosmetic dissatisfaction, penile necrosis and lymphoedema. We report the complications and outcomes from a single centre with an updated systematic review of the literature. A retrospective review of all cases presenting wi...

VELRAD is the first multicentre feasibility randomised controlled trial comparing videoendoscopic radical inguinal lymphadenectomy versus open dissection for male genital cancer. We have randomised nine patients so far in our attempt to identify the best approach to inguinal lymph node dissection.

Penile cancer is a rare malignancy which HIV infection appears to increase the risk of. The magnitude of this risk and the pathogenesis remain unclear. A comprehensive review of the literature was undertaken using conventional search strategies. Twenty-four publications were identified by this methodology, of which nine were case reports and 15 wer...

From challenges presented in everyday clinical practice to the complex cases without simple answers, Challenging Cases in Urological Surgery is an effective reference and revision aid for trainees and consultants alike. Cases are examined from a multidisciplinary approach considering all aspects of diagnostic, practical, and evidence-based skills t...

From challenges presented in everyday clinical practice to the complex cases without simple answers, Challenging Cases in Urological Surgery is an effective reference and revision aid for trainees and consultants alike. Cases are examined from a multidisciplinary approach considering all aspects of diagnostic, practical, and evidence-based skills t...

Background: Lichen sclerosus (LSc) is a chronic, inflammatory, destructive skin disease with a predilection for the genitalia (GLSc). An association with vulval (Vu) and penile (Pe) squamous carcinoma (SCC) is now well established but melanoma (MM) has only rarely been reported complicating GLSc. Methods: We have performed a systematic literatur...

Context A dynamic sentinel lymph node biopsy (DSNB) is used for inguinal lymph node staging in patients presenting with primary penile cancer with clinically impalpable inguinal lymph nodes (cN0). Further completion radical inguinal lymph node dissection (RLND) is offered to patients diagnosed with metastatic inguinal nodes following a DSNB. Objec...

Context The outcomes and morbidity following treatment for persistent or varicocele recurrence remain controversial. Objective To conduct a systematic review relating to the outcomes following treatment (any surgical or radiological) for varicocele persistence/recurrence. Evidence acquisition A systematic review was conducted in accordance with t...

The efficacy of many non-surgical treatments for Peyronie’s disease is unclear. This systematic review aims to critically assess the currently available options and provide a recommendation for treatment based on this. A systematic literature search utilising the Medline (Pubmed), Embase, global health and Cochrane library databases was conducted u...

Objectives To report the management outcomes of men with ≤20‐mm small testicular masses (STMs) and to identify clinical and histopathological factors associated with malignancy. Patients and methods A retrospective analysis of men managed at a single centre between January 2010 and December 2020 with a STM ≤20 mm in size was performed. Results Ov...

Purpose To analyse the risk of inguinal lymph node (ILN) metastases in T1G2 penile cancer stratified by lymphovascular invasion (LVI), perineural invasion (PNI) and tumour size. Methods Retrospective study of men with localised T1G2 penile cancer with non-palpable lymph nodes and no local recurrence during follow-up at six European institutional h...

Priapism is a rare condition that can lead to long-term erectile dysfunction if left untreated. It is one of the few urological emergencies that require prompt medical intervention. Priapism refers to a penile erection that lasts for more than 4 hours and is unrelated to sexual stimulation or orgasm. The aims of immediate intervention for ischaemic...

The aim of this study is to describe the outcomes for a modified glans-resurfacing technique for benign and malignant penile conditions in which the uninvolved glans corona is preserved in order to maintain glans erogenous sensation. A total of 13 patients underwent coronal-sparing glans resurfacing (CSGR), with follow-up every 3 months for ≥2 year...

Background: Pseudoepitheliomatous keratotic and micaceous balanitis (PEKMB) is a clinicopathological entity characterised clinically by micaceous scale on the glans, and histologically by acanthosis, hyperkeratosis and pseudoepitheliomatous hyperplasia. We present a series of eight cases of this rare condition, the first series of more than two ca...

A range of drugs have a direct role in triggering ischaemic priapism. We aimed at identifying: a) which medications are associated with most priapism-reports; and, b) within these medications, comparing their potential to elicit priapism through a disproportionality analysis. The FDA Adverse Event Reporting System (FAERS) database was queried to id...

A limited number of studies have described patients on finasteride showing findings which were consistent with Peyronie’s disease (PD). We aimed to detect a pharmacovigilance signal of possible association between finasteride and PD-related clinical features. The Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database was...

This chapter covers assessment and management of erectile dysfunction including specialist diagnostic tests such as nocturnal penile. Tumescence studies, intracavernous injection tests, duplex ultrasound of the penis, cavernosography and treatment.KeywordsErectile dysfunctionAssessmentManagementSpecialist diagnostic tests

Objective The main aim of this study was to report the outcomes of azoospermic men with suspicious testicular lesions, undergoing microsurgical sperm retrieval (micro-oncoTESE) at the time of radical/partial orchidectomy. Patients and methods Testicular lesions suspicious for cancer were confirmed on ultrasound scanning. In patients undergoing rad...

Background: Male genital lichen sclerosus (MGLSc) can lead to significant sexual dysfunction and urological morbidity, and is also a risk factor for premalignant disease (penile intraepithelial neoplasia and penile cancer), particularly squamous cell carcinoma. Although the precise aetiopathogenesis of MGLSc remains controversial, accumulated evid...

Introduction A penile prosthesis (PP) may be inserted for erectile dysfunction (ED) and/or urinary management in men with spinal cord injury (SCI). This group of patients is considered high risk for complications due to their reduced mobility and sensation. Objectives To identify the complication and satisfaction rates following PP insertion in pa...

Objective Penile cancer (PeCa) is a rare disease with a global incidence of 36 068 new cases in 2020. This accounts for 0.4% of all male malignancies. The surgical management of penile cancer depends on the location of the tumour and depth of invasion. Here, we review the oncological and functional outcomes of penile-sparing surgery (PPS). Methods...

Background: Hematospermia, although often found to be a benign condition, can be an alarming sign. Consequently, patients can undergo multiple investigations with no current standardized pathway based on data from large series. The aim of this study was to evaluate the incidence of an underlying pathology and the value of diagnostic investigations...

Objective To develop a predictive model for additional inguinal lymph node metastases (LNM) at inguinal lymph node dissection (ILND) after positive dynamic sentinel node biopsy (DSNB) using DSNB characteristics to identify a patient group in which ILND might be omitted. Patients and Methods We conducted a retrospective study of 407 inguinal basins...

Penile cancer (PeCa) is a rare disease, with a global incidence of 36 068 new cases reported in the 2020 GLOBOCAN database. Narrower excision margins are now acceptable without compromising survival. Glansectomy is commonly performed for invasive PeCa confined to the glans penis. The majority of data on glansectomy are from small single-centre seri...

Penile mucosal melanoma is an aggressive and rare genital malignancy. The aim of the present study was to review the management and outcomes of a homogenous cohort of patients with histologically confirmed penile mucosal melanoma, at a single specialist centre. A retrospective review of an institutional database identified patients with penile muco...

Subfertility is a risk factor for testicular cancers (TT), and conversely, TT may induce subfertility due to local and regional toxic effects. We aimed to identify the association between TT characteristics and pre-orchidectomy azoospermia. A systematic review of the literature was performed according to the PRISMA checklist. Overall, eight non-ran...

A recent statement from the European-Society-for-Sexual-Medicine has highlighted the limitations of using the rat model for nerve-sparing prostatectomy. The use of young rats with no comorbidities and the early evaluation of the erectile function (EF) are deemed a source of bias. Our aim was to evaluate the long-term consequences in EF of bilateral...

Penile prosthesis implantation is the ultimate option for the treatment of end-stage erectile dysfunction (ED). Although recognised intraoperative complications are not frequently reported, recognition of complications intraoperatively provides the best opportunity to minimise patient dissatisfaction, the risk of infection, erosion or later revisio...

This chapter includes clinical cases, background, evidence-based practical management options, preventive measures, key-point summaries of retrograde ejaculation and anejaculation and answers to questions patients ask. Ejaculatory dysfunction is a rare cause of male infertility in which spermatogenesis is usually well preserved and sperm function i...

Penile cancer (PCa) is a rare disease, and the most common histological subtype is squamous cell carcinoma (SCC). The surgical management of PCa depends on the extent of invasion into deeper penile structures, and penile-preserving options are now the standard of care in specialist centres. Glansectomy can be offered to those with invasive disease...

Introduction MGLSc is an acquired, chronic, inflammatory cutaneous disease that is associated with significant morbidity and squamous cell carcinoma of the penis. Consideration of all of the evidence suggests that chronic exposure of susceptible epithelium to urinary occlusion by the foreskin is the most likely pathomechanism: MGLSc never occurs in...

Introduction: We reviewed the medical and surgical management and long-term outcomes for patients diagnosed with penoscrotal extramammary Pagets disease (EMPD) within an eUROGEN centre. Patients and methods: Retrospective review of cases from an institutional database with biopsy proven penoscrotal EMPD. Results: A total of 10 patients were id...

Objectives To develop an international consensus on managing penile cancer patients during the COVID-19 acute waves. A major concern for patients with penile cancer during the coronavirus disease 2019 (COVID-19) pandemic is how the enforced safety measures will affect their disease management. Delays in diagnosis and treatment initiation may have a...

Background: The option of semen cryopreservation following a diagnosis of testicular cancer shows a variable uptake with the option to cryopreserve before surgery often dependent on the preference of the treating clinician and the fertility laboratory resources available. Objectives: To assess whether the introduction of a patient-centric pathwa...

Background Penile length measurement techniques vary widely in published studies leading to inaccurate and nonstandardized measurements. Aim To review the methodology used to report data in studies evaluating penile length and provide a detailed recommendation in conducting future high-quality research. Methods The MEDLINE database was searched f...

Penile cancer is a rare disease that constitutes 0.2% of all male malignancies with the most common age of presentation in the sixth decade. Early diagnosis is key as the disease can result in devastating disfigurement and a five‐year survival rate of approximately 50%. In practice, for suspected inflammatory penile lesions, early biopsy is require...

The purpose of this study was to explore men's motivations and experiences of attending a penile cancer support group and critically analyse whether participating in the support group has an impact on their psychological well‐being. Eleven men attended a focus group facilitated by a cancer nurse specialist and a group facilitator. This was held in...

Background Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems. Methods During the peak of the pandemic in the United Kingdom, we set up a multicentre cancer network amongst 14 National Health Service institutions, performing uro...

Detection of positive nodes in men with moderate-risk to high-risk penile cancer and impalpable inguinal nodes is an important step in the therapeutic pathway. Detection using dynamic sentinel node biopsy with patent blue dye and radioisotope is associated with false negatives; indocyanine green might offer an alternative adjunct to improve detecti...

Objective: Ejaculatory duct obstruction (EDO) is an uncommon but potentially treatable cause of male factor infertility. However, there are limited data on transurethral resection of the ejaculatory ducts (TURED) as a treatment option. A systematic review was therefore conducted to assess its efficacy and identify patient subgroups that benefit fr...

Introduction: Penile intraepithelial neoplasia (PeIN) is a histological term for precancerous penile lesions. PeIN is important due to the high morbidity and mortality associated with progression to penile squamous cell carcinoma (PSSC). But PeIN is rare, contributing to a limited evidence-base for the relative efficacy of available treatment optio...

Background: Radical orchidectomy in patients who are subsequently diagnosed with benign testicular tumours represents an overtreatment due to the deleterious effects on endogenous testosterone, fertility and body image. For these reasons, the option of partial orchidectomy should be considered in certain groups of patients. Patients with bilateral...

Ischaemic priapism (IP) is characterised by a persistent, painful penile erection lasting for >4 h. Many causes of IP have been identified including haematological dyscrasias (particularly, sickle cell disease), drugs and rarely malignancy. There are also a large proportion of men, in which no aetiology is identified. Identification of men at risk...

Introduction Priapism is rare yet has the potential to inflict significant suffering on patients, often with lasting consequences such as erectile dysfunction, corporal muscle necrosis, and a loss of sexual function. Although rare, it is a pathology that has received little focus in the literature, particularly that caused by malignancy, and it is...