Prevalence, assessment and surgical correction of penile curvature in hypospadias patients treated at one European Referral Center: description of the technique and surgical outcomes.

PURPOSE: Penile curvature (PC) is a common component of hypospadias, but its presence is inconstantly assessed. We aim to report prevalence of PC in hypospadias patients, as well as to report our method to assess and correct PC, with the associated postoperative outcomes. METHODS: We scrutinized 303 pediatric hypospadias patients operated (2013-2018) at our referral center. PC was routinely assessed and eventually corrected with dorsal plications (DP) as one-stage procedure, or ventral tunica attenuations ± DP as two-stage repair. PC severity and surgical treatment of PC were compared between primary and failed hypospadias. Finally, PC severity, failed repair and PC treatment were tested as predictors of perioperative complications. RESULTS: PC (> 10°) was identified in 274/303 (90.4%) patients, 86.1% with distal, 91.8% with midshaft, and 100% with proximal hypospadias, respectively. PC was found in 51/64 (79.7%) of failed hypospadias. One-stage and two-stage procedures were adopted in 211/274 (77%) and 63/274 (23%) children, respectively. PC severity (p = 0.1) and PC treatment (p = 0.4) did not differ between primary and failed hypospadias. PC severity (all p > 0.2), failed repair (p = 0.8), and PC treatment (all p > 0.09) were not predictors of perioperative complications. 95.6% of patients achieved a straight penis. CONCLUSION: Less than 1/10 patients did not require PC correction. High rate of residual PC in failed hypospadias and similar severity between failed and primary suggest that PC was usually under-corrected. It is possible to correct PC completely and the resulting complication would not be associated with PC severity, failed repair or treatment adopted.

The clinical and psychosocial impact of Peyronie's disease.

Peyronie's disease (PD) is characterized by the formation of palpable fibrotic tissue in the tunica albuginea of the penis. It is thought to manifest in response to recurrent microtrauma during erection in those with risk factors that may include wound-healing disorders. The initial stage of PD is thought to last from 6 to 18 months, and it is characterized by an inflammatory period with pain in approximately one-third of men. This initial phase is followed by a chronic phase when pain typically resolves and the deformity stabilizes with no additional plaque development. PD has been reported to develop in up to 9% of adult males according to published literature, but the incidence may be even higher. The most frequently affected age group is men between 50 and 59 years. Because of the associated penile deformity and effect on sexual relations, psychosocial distress is very common in those with PD. It has been reported to negatively affect self-image, sexual activity, intimacy, and mood, and it is often associated with depression and erectile dysfunction (ED). At this time, nonsurgical treatments are unreliable and have variable efficacy, and surgical treatments are reserved for those with disabling disfigurement. Moreover, surgery may result in loss of penile length and ED, and there are only a few physicians in the United States that perform such surgeries. There is a great need to increase awareness of PD in patients and general practitioners, to elucidate the pathogenesis of PD, and for the development of novel treatments for this disfiguring disease.

Intermediate term assessment of the reliability, function and patient satisfaction with the AMS700 Ultrex penile prosthesis.

PURPOSE: The AMS700 Ultrex penile prosthesis is an example of the design changes that penile prostheses have undergone to improve mechanical reliability. Few studies have reviewed an overall experience with the AMS700 Ultrex prosthesis. We review patient outcomes, surgical complications, and Ultrex cylinder intermediate term mechanical reliability and function. MATERIALS AND METHODS: Between March 1990 and November 1994, 145 patients 32 to 79 years old (mean age 58) underwent insertion of an AMS700 Ultrex penile prosthesis. At a followup of 6 to 62 months (mean 42) patients were evaluated with a retrospective clinical record review, and patient and partner questionnaires. RESULTS: From the clinical record review of 145 patients our malfunction, reoperation, infection, erosion, major complication and minor complication rates were 8, 13, 2, 3, 13 and 7%, respectively. Patient responses to our questionnaire showed that 85% were satisfied overall, 85% had durable and reliable implant function, 86% had a sustained level of satisfaction with the implant and 83% remained satisfied after a revision for malfunction. Overall, partner satisfaction with the implant was 76%, and 42% reported maintenance of a good or improved nonsexual relationship after prosthesis implantation. CONCLUSIONS: Our data demonstrate the intermediate term mechanical reliability and function of the AMS700 Ultrex penile prosthesis, and high patient and partner satisfaction with this implant.