Patient Selection and Counseling for Urinary Diversion.

Patient selection and preoperative counseling are critical aspects of determining which urinary diversion to perform and should be emphasized at each stage of preoperative planning. The surgeon must have a thorough understanding of the patient's disease process, functional and psycho-emotional status, and social support network so that they can set appropriate expectations. It is also crucial to have a multidisciplinary team of individuals who are experienced with all aspects of urinary diversion care, including ostomy nurses, nurse navigators, and urologic surgeons skilled at teaching and trouble-shooting self-catheterization for continent cutaneous diversion and orthotopic diversion in the setting of hypercontinence.

Surgical bladder-preserving techniques in the management of muscle-invasive bladder cancer.

PURPOSE: Bladder preservation surgical strategies for the treatment of invasive bladder cancer have been developed to provide options to those patients who are medically unfit to undergo radical extirpative surgery or prefer conservative therapy for limited disease. The purpose of this manuscript is to review the available bladder-preserving surgical techniques for treatment of muscle-invasive bladder cancer. METHODS: We performed a thorough literature search to determine the available bladder-preserving treatments for muscle-invasive bladder cancer as well as their corresponding outcomes. RESULTS: Available surgical strategies include radical transurethral resection (TUR) with or without neoadjuvant chemotherapy, partial cystectomy and multi-modal therapy. Patient selection is critical in determining which patients can safely be offered bladder preservation therapies. Disease characteristics that portend more favorable outcomes in the setting of bladder preservation include cT2 stage, unifocal tumor, the absence of carcinoma in situ and hydronephrosis, and complete TUR. Several new technologies, including fluorescence and cryoablation treatment, have been incorporated into existing treatment modalities to improve surgical precision and margins. Ongoing studies aimed at improving the accuracy of clinical staging can further refine patient selection and improve clinical outcomes. CONCLUSIONS: Surgical bladder preservation techniques for treatment of invasive bladder cancer requires careful, long-term follow-up. Prospective, randomized studies comparing bladder sparing treatment modalities with radical cystectomy are needed, but ultimately will be difficult to accrue due to a variety of factors.

Special considerations for placement of an inflatable penile prosthesis for the patient with Peyronie's disease: techniques and patient preference.

Placement of an inflatable penile prosthesis (IPP) is the mainstay of surgical treatment for patients with Peyronie's disease (PD) and concomitant medication-refractory erectile dysfunction. Special considerations and adjunctive surgical techniques during the IPP procedure are often required for patients with PD to improve residual penile curvature, as well as postoperative penile length. The surgical outcomes and various adjunctive techniques are not significantly different from one another, and selection of the appropriate technique must be tailored to patient-specific factors including the extent of the deformity, the degree of penile shortening, and preoperative patient expectations. The aims of this review were to assess the current literature on published outcomes and surgical techniques involving IPP placement in the treatment of PD. Patient satisfaction and preferences are reported, along with the description and patient selection for surgical techniques that include manual penile modeling, management of refractory curvature with concurrent plication, and correction of severe residual curvature and penile shortening with tunica release and plaque incision and grafting. A thorough description of the available techniques and their associated outcomes may help guide surgeons to the most appropriate choice for their patients.