The effect of transobturator tape surgery on female sexual function: a systematic review and meta-analysis.

PURPOSE: We aimed to review the literature regarding the effects of trans obturator tape surgery (TOT) on sexual functions in women with stress urinary incontinence (SUI) to reveal compact data and to reach more consistent and reliable results. METHODS: PRISMA statement was used in the current review. The databases of PubMed (Medline), Science Direct, and Cochrane Central Register of Controlled Trials were detected independently. We evaluated the studies comparing the preoperative and postoperative sexuality parameters related to the TOT procedure in females. Studies presenting the mean and standard deviation(SD) of global and sub-item Female Sexual Function Index(FSFI) were included in the current study. RESULTS: We identified 783 studies in full publications or abstract forms using the methodology above and the search terms. Finally, eight studies were included in the meta-analysis. The pooled analysis of the mean difference demonstrated that the total sexual function scores of the patients improved after TOT surgery. CONCLUSION: The data collected from the current meta-analysis suggest that TOT surgery improves female sexual function.

Tissue Engineering Graft for Urethral Reconstruction: Is It Ready for Clinical Application?

Despite developing surgical techniques in urethral surgery, the outcome and complications are still unsatisfactory. Alternative treatment modality has been coming up, particularly in patients with longer stricture, under revision surgery, and penile stricture. Tissue engineering grafts are a promising approach for substituting urethral reconstruction. Over the decades, numerous preclinical studies have been published to show the efficacy and safety of different origins of materials, the presence of autologous cells (acellular matrices or autologous cell-seeded matrices), and the construction of engineered tissue (patch or tubularized constructs) on animal models. However, the results of these studies have not yet reached the intended level for daily clinical practice. A PubMed database search was performed for articles, using specific keywords, published between 1998 and 2022, with a selection on using tissue-engineered grafts for urethroplasty. Many materials have been used as a graft, such as acellular bladder matrix, small intestinal submucosa, acellular dermal matrix, and polyglycolic acid with or without cells, and were evaluated according to the functional and anatomical outcomes comprising complications. According to current literature, tubularized scaffolds constructed from co-cultured cells have promising results for the future. However, high-quality evidence through randomized controlled studies with larger sample sizes, with a long-term follow-up is required to determine accurate outcomes.

Evaluation of Satisfaction and Outcomes of Patients Who Underwent Two-Piece Inflatable Penile Prosthesis Implantation.

Introduction The aim of this study was to evaluate patient and partner satisfaction, device reliability, and complications in patients who underwent two-piece inflatable penile prosthesis (IPP) implantation. Patients and methods The data of 22 patients who underwent two-piece inflatable penile prosthesis implantation in our department between 2015 and 2018 were retrospectively analyzed, and a detailed review of all clinical reports was performed. Phone or face-to-face interviews were undertaken to assess the satisfaction rates of the patients and their partners using the modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Results The mean patient age and partner age were 57.95 ± 6.16 and 58.12 ± 6.66 years, respectively. The mean erectile dysfunction (ED) period was 5.33 ± 2.16 years, and the etiologies of erectile dysfunction were radical pelvic surgery (41%), diabetes mellitus (37%), and vascular disorders (22%). The mean operative time and postoperative hospital stay were 102 ± 29 minutes and 1.8 ± 0.66 days, respectively. Over a mean follow-up period of 29.04 ± 14.48 months, two (9%) cases underwent revision surgery due to mechanical device failure in one and infection in the other. The overall patient and partner satisfaction rates were 73% and 59%, respectively. Conclusions The two-piece inflatable penile prosthesis is an effective, reliable, and user-friendly prosthesis with acceptable complication and revision rates and provides a high level of patient and partner satisfaction in selected and fully informed patients.

Undescended Testis Does Not Affect the Outcome of Microdissection Testicular Sperm Extraction.

OBJECTIVE: To determine the sperm retrieval rates (SRRs) and predictive factors of patients with a history of undescended testis after testicular sperm extraction (TESE). METHODS: A total of 311 patients were diagnosed with nonobstructive azoospermia (NOA) and underwent TESE were included in this study. These patients were divided into 2 groups: an undescended group consisting of 62 patients who had a history of undescended testes and an idiopathic group consisting of 249 patients. Of the 62 patients with a history of undescended testes, 26 had a history of bilateral orchidopexy, 15 had a history of unilateral orchidopexy, and 21 had no history of surgery. RESULTS: The testicular spermatozoa were found in 134 (53.8%) and 31 (50%) patients in the idiopathic NOA and undescended testes groups, respectively. Similar to patients with idiopathic NOA, the overall SRRs were strongly associated with histopathology for patients with a history of undescended testes. These SRRs were 34.2%, 33.3%, 71.4%, 100%, and 100% for Sertoli Cell Only, late maturation arrest, early maturation arrest, hypospermatogenesis, and normal spermatogenesis, respectively (P <.001). In the undescended group, the SRRs of patients who underwent orchidopexy were not different than patients without a history of orchidopexy. However, patients who underwent unilateral orchidopexy had a higher SRR than those who underwent bilateral orchidopexy (P = .031). CONCLUSION: TESE is a successful treatment modality for men with NOA associated with or without a history of undescended testis. The testicular histopathology and unilateral undescended testis were identified as independent predictors of SRRs for men with a history of undescended testis.

Older age and a large tunical tear may be predictors of increased erectile dysfunction rates following penile fracture surgery.

Penile fracture is a rare urological occurrence resulting from a tear in the tunica albuginea of the penis. In this study, 26 patients diagnosed with a penile fracture were treated with early surgical correction. The mean age at the time of the injury was 41.7 years. The average follow-up time of the study population was 28.8 months. The mean time from fracture to surgery was 15.6 ± 19.9 h. In total, 23% of the patients had a penile nodule and 11.5% of these patients reported penile deviation. Post surgery, erectile dysfunction (ED) was present in nine (34.6%) patients. During the follow-up, the mean International Index of Erectile Function (IIEF-5) score was 20.9 ± 4.3 (10-25). There was no significant difference in the time from fracture to surgery among the patients with or without ED. However, the tunical tear size was significantly larger in the patients with ED as compared with those without ED. Furthermore, the patients with ED were older than those without ED. Older age and the size of the tunical tear appeared to be correlated with the development of ED. However, prospective large series are needed to confirm these results.

Anatomic and Functional Outcome Following Distal Shunt and Tunneling for Treatment Ischemic Priapism: A Single-Center Experience.

BACKGROUND: Ischemic priapism (IP) is a urologic emergency that requires early intervention. The main aim of IP treatment is to relieve the cavernosal pressure and provide erectile function. AIM: The aim of this study was to determine the correlation between preoperative risk factors (patient's age, duration of priapism, preoperative erectile function) and postoperative erectile dysfunction (ED). METHODS: This retrospective study consisted of 25 patients diagnosed with refractory IP between 2009-2017. The diagnosis of IP was confirmed by medical history, physical examination, and cavernosal blood gas analysis. All of the patients underwent the T-shunt procedure ± tunneling after a failed initial intervention. RESULTS: The mean age at the time of the IP diagnosis was 46.84 years (range 23-77). The average follow-up time of the study population was 40.4 months (range 3-114), and the median time from the occurrence of IP to surgery was 58 hours (range 24-240). In all cases, rapid resolution of the erection was achieved with the T-shunt ± tunneling procedure. In 1 patient, priapism recurred after 12 hours. Postoperative ED was reported by 16 (84.21%) patients, with degrees of mild, mild to moderate, and severe in 6, 1, and 9 of these cases, respectively. During the follow-up, the mean International Index of Erectile Function-5 (IIEF-5) score was 12.68 (range 5-23). Only 3 (15.78%) patients achieved successful sexual intercourse without any treatment. 6 (31.5%) patients required the aid of phosphodiesterase type 5 inhibitors, and 1 (5.26%) patient required the aid of a vacuum erection device. The 9 (47.36%) patients with severe ED failed to respond to medical treatment and were considered candidates for a penile implant. According to Kendall's tau-b correlation coefficient analysis, there was a positive correlation between the preoperative and postoperative IIEF-5 scores (P = .005), whereas the patient's age and duration of priapism were negatively correlated with the postoperative IIEF-5 score (P = .016 and P = .046, respectively). CLINICAL IMPLICATIONS: Treatment options of IP should be discussed with patients in terms of both preoperative erectile function and the duration of priapism. STRENGTHS & LIMITATIONS: The small sample size and retrospective nature of this study were the main limitations. CONCLUSIONS: Despite high success and low complication rates of T-shunt surgery, the rate of undisturbed erectile function is only 14.6%. The patient's age, the existence of preoperative ED, and the duration of priapism are associated with postoperative IIEF-5 scores. Ortaç M, Çevik G, Akdere H, et al. Anatomic and Functional Outcome Following Distal Shunt and Tunneling for Treatment Ischemic Priapism: A Single-Center Experience. J Sex Med 2019;16:1290-1296.

Factors affecting infectious complications following flexible ureterorenoscopy.

In the present study, we aimed to clarify predictive factors that may cause postoperative infectious complications after flexible ureterorenoscopy (f-URS). In a 4-year prospective study, charts of patients who underwent f-URS between January 2014 and January 2018 for renal stone(s) in a tertiary academic center were reviewed. A standardized f-URS procedure was performed for all patients. Post-operative infectious complications including fever, sepsis and septic shock were categorized into same group. Patients with and without infectious complications were compared in the terms of preoperative, operative and post operative characteristics. In total, 463 patients who did not face infectious complications and 31 patients who faced infectious complications were enrolled into the study. The mean age was significantly lower in patients who did face infectious complications (34.8 vs 44.7 years old, p < 0.001). On the other hand, presence of renal abnormality was significantly more common in patients with infectious complications (12.3% vs 35.5%, p < 0.001). The mean operation time was 65.3 min in patients with infectious complications and significantly longer when compared with patients who did not face infectious complication (47.8 min, p < 0.001). Stone-free rate was significantly higher in patients without infectious complications (85.3% vs 77.5, p = 0.009). Multivariate regression analysis revealed that longer operation time ≥ 60 min, presence of renal abnormality and age ≤ 40 years were predictive factors for infectious complications following f-URS. The present study has demonstrated that operation time ≥ 60 min, presence of renal abnormality and patients with ≤ 40 years were significantly associated with infectious complications following f-URS.

Peyronie's disease surgery: Surgical outcomes of 268 cases.

OBJECTIVE: To assess the outcomes of the surgical techniques used in Peyronie's disease (PD) surgery. MATERIAL AND METHODS: Two hundred and sixty-eight patients received surgical treatment for PD. Fifty four and 144 patients underwent simple corporoplasties (shortening procedure, SP, group 1) or plaque incision and grafting surgery (lengthening surgery, LP, group 2), respectively, whereas 70 patients with erectile dysfunction underwent penile prosthesis implantation. RESULTS: Penile plication and Nesbit surgeries were performed in 5 (9%) and 42 (78%) patients out of total 54 patients. In the remaining 7 (13%) patients, Nesbit and plication suture combination was required for complete penile straightening. Mean curvature degree was 52.2±12.3 degrees. Follow up time was 36.1±29.4 months. No significant difference was demonstrated between the two groups in the baseline features and co-morbidities except age. In 144 patients who underwent plaque incision and grafting, mean age and PD onset duration were 54.1±9.2 years and 28.2±17.3 months respectively. Mean curvature degree was 58.4±18.9 degrees. Post-operative follow up time of the second group was 51.1±39.6 months. Additional plication suture was used in 48 patients (33%) patients. Degree of curvature improvement was 37.9±19.1 and 52.1±23.5 in SP and LP respectively (p=0.01). The initial anatomic success rates were 90.4% and 87.5% at their early post-operative follow-ups for group 1 and 2 respectively. These rates dropped to 82.7% and 83.6% at the long term follow-up (36 and 51 months) respectively (p=0.9). Although the average follow-up time of LP group was longer than SP group (52.1 mo vs. 37.0 mo), recurrence rates of these two groups were comparable. The combined functional and anatomical success of patients were demonstrated to be 79% and 75% in shortening and grafting surgery. Shortening surgery was not statistically superior to grafting surgery for patients in terms of having erection with or without the aid of PDE-5 inhibitors (94.4% vs. 88.2%, p=0.28). Shortening surgery makes a difference in the long term follow-up for patients who had erections without the aid of PDE-5 inhibitors (90.7% vs. 67.3%, p=0.02). CONCLUSION: Both SP and LP are successful in terms of penile straightening in the short and long-term follow-up. Curvature degree improvement is greater in LP. Patients who undergo LP surgery may suffer from ED in the long-term follow-ups. Greater percentage of patients who underwent LP require PDE-5 inhibitors usage for sexual intercourse. Despite stated shortcomings, combined success (anatomic and functional) is achieved in three out of four patients for both groups. Penile prosthesis implantation should be preferred for patients with ED and penile deformity.

Prospective evaluation of complications in laparoscopic urology at a mid-volume institution using standardized criteria: Experience of 1023 cases including learning curve in 9 years.

AIM: To evaluate the laparoscopic operations performed in our department according to the modified Clavien classification system of complications. MATERIALS AND METHODS: Between September, 2005 and February, 2014, a total of 1023 laparoscopic cases were performed. This period was divided into three terms (Terms 1, 2 and 3 consisting of 38, 32 and 32 months, respectively). According to the European Scoring System (ESS), easy (E), slightly difficult (SD), fairly difficult (FD), difficult (D), very difficult (VD) and extremely difficult (ED) cases were 35, 88, 170, 390, 203 and 137, respectively. The perioperative complications were evaluated based on the 3 time periods, with a specific emphasis on determining the learning curve according to the modified Clavien classification system of complications. RESULTS: A total of 236 (23.1%) complications were observed according to the modified Clavien classification. The minor (Clavien I-II) and major (Clavien III, IV and V) complication rates were 20.5% (n = 210) and 2.4% (n = 26), respectively. Clavien I was the most frequently encountered type of complication (n = 120, %11.7). No significant difference was observed among all 3 time periods regarding total complication rates. The D cases had the highest complication rate compared to E, SD, FD, VD and ED cases among all three terms. The total number of complications increased significantly with increasing grade of technical difficulty according to the ESS. CONCLUSION: Complications encountered in our laparoscopic surgery experience were predominantly minor, and the rate of complications was not significantly increased during the learning curve. The present data can provide guidance and manage expectations for surgeons introducing laparoscopy into their practice.

Tadalafil therapy for erectile dysfunction following prostatectomy.

Erectile dysfunction is a major complication affecting the quality of life of patients and partners after radical prostatectomy. Evolving evidence suggests that early penile rehabilitation may provide better erectile function after surgery. Phosphodiesterase type 5 (PDE-5) inhibitors are routinely considered a first-line treatment option in most algorithms for penile rehabilitation owing to their efficacy, ease of use, wide availability and minimal morbidity. Tadalafil is a long-acting, potent PDE-5 inhibitor for erectile dysfunction, with demonstrated effect in animal studies at preserving penile smooth muscle content and prevention of fibrosis of cavernosal tissue. This article evaluates the existing literature on tadalafil and critically analyzes its impact on erectile function following radical prostatectomy.

Pharmacologic and surgical therapies for sexual dysfunction in male cancer survivors.

The recent recognition that many men experience sexual dysfunction following their diagnosis and treatment of genitourinary cancers, has led to the development multiple varied strategies that attempt to restore or preserve that function. In this manuscript we review the understanding of why it happens, highlight novel management strategies and discuss the concept of penile rehabilitation (PR) following prostate cancer (PCa) treatment, glans preserving strategies among men diagnosed with penile cancer and address the controversial issue of testosterone therapy in men with PCa.

Neurovascular bundle dissection for Nesbit procedure in congenital penile curvature patients: medial or lateral?

The objective of this study was to compare the outcomes of the modified Nesbit procedure using different techniques for dissecting the neurovascular bundle (NVB) to correct ventral congenital penile curvatures (CPCs). The bundle was mobilized using the medial and lateral dissection technique in 21 (Group 1) and 13 (Group 2) patients, respectively. In the medial technique, Buck's fascia is opened at the dorsal side of the penis, the deep dorsal vein is removed at the most prominent site of the curvature and a diamond-shaped tunica albuginea (TA) is excised from the midline of the penis. In the lateral technique, the bundle is mobilized using a longitudinal lateral incision of the Buck's fascia above the urethra at the 5 and 7 o'clock positions via a bilateral approach. The localization and degree of curvature was evaluated using the combined intracavernous injection stimulation test or from the patients' photographs. The mean patient age and degree of curvature were similar between groups. The mean operation time was longer for Group 2 (P = 0.01). In Group 1, nine patients (42.8%) required one diamond excision, 10 (47.6%) required two diamond excisions and two (9.5%) required more than two excisions; in Group 2, six patients (46.2%) required two diamond excisions and seven patients (53.8%) required more than two diamond excisions (P = 0.019). The differences in penile shortening, penile straightening and numbness of the glans penis were not statistically significant. Medial dissection of the bundle for the modified Nesbit procedure reduces the number of diamond-shaped removals of TA and thus shortens operation time in comparison with its lateral counterpart.

Laparoscopic nephrectomy in patients undergoing hemodialysis treatment.

BACKGROUND AND OBJECTIVES: To report our experience with laparoscopic nephrectomy (LN) in patients undergoing hemodialysis compared with normal counterparts. METHODS: Seventeen patients (20 renal units, Group 1) undergoing hemodialysis underwent LN, which was indicated due to nonfunctioning kidney in 17 and suspected malignancy in 3 renal units. Radical nephrectomy (RN), simple nephrectomy (SN), and simple nephroureterectomy (SNU) were performed in 3, 9, and 8 cases, respectively. For comparison, 101 patients (Group 2) without CRF (chronic renal failure) who had undergone LN were evaluated. In this group, RN, SN, SNU and radical nephroureterectomy (RNU) were performed in 48, 41, 8, and 4 patients, respectively. RESULTS: The mean age (36.9 ±13.1 vs. 48.7±19.4yr, P=0.002) and BMI (22.1±4.8 vs. 26.2±5.1kg/m(2), P=0.001) were lower in Group 1, whereas ASA (physical status score of American Society of Anesthesiologists) score (2.8±0.4 vs. 1.5±0.7, P<0.001) was lower in Group 2. The estimated blood loss (111±114 vs. 184±335mL, P=0.34) was higher in Group 2. Both groups were comparable in regard to mean operative time (133±79 vs. 119±45, P±0.70), hematocrit drop (4.69±3.9 vs. 3.86±3.0, P=0.29) and hospital stay (3.6±3.3 vs. 3.3±2.4 days, P=0.34). Meanwhile, when only patients undergoing SN and SNU in the study cohort (n=17 in Group 1 and n=49 in Group 2) are taken into consideration, no significant difference was observed between the 2 groups in terms of any kind of above-mentioned perioperative parameters. No case in Group 1 was converted to open surgery due to metabolic problems. CONCLUSIONS: LN in patients undergoing hemodialysis may be performed safely by an experienced laparoscopy team.