[Surgery to improve male fertility]. / Chirurgies visant à améliorer la fertilité masculine.

BACKGROUND: At a time when increasing attention is being paid to the limitations and risks of in vitro fertilisation techniques, surgeries to improve male fertility are attracting growing interest. METHODS: Systematic review based on a Pubmed search of surgeries to improve male fertility. RESULTS: Vasovasostomy (VV) gives patency rates of 70-97% and pregnancy rates of 30-76%. Vasoepididymostomy (VE) gives patency rates of 80-84%, with pregnancy rates of 40-44%. The duration of obstruction and the age of the partner are 2 predictive parameters for the occurrence of a natural pregnancy. In cases of obstructive azoospermia due to pelvic obstruction (prostatic cyst, obstruction of the ejaculatory ducts), several surgical procedures may be proposed. Transurethral resection of the ejaculatory ducts leads to an improvement in sperm parameters in 63-83% of patients, with spontaneous pregnancy occurring in 12-31% of cases. Microsurgical cure of varicocele by the subinguinal route is a benchmark technique with recurrence rates of less than 4%. It improves live birth and pregnancy rates, both naturally and by in vitro fertilization, as well as sperm count, motility and DNA fragmentation rates. CONCLUSION: Whenever possible, the urologist should present the surgical options for improving male fertility to the ART team and to the couple, discussing the benefit/risk balance of the operation as part of a personalized approach.

[Testicular and epididymal sperm extraction surgery]. / Chirurgies d'extraction de spermatozoïdes testiculaires et épididymaires.

BACKGROUND: Testicular and epididymal sperm extraction surgery is a frequent procedure. However, to date, there has been no French consensus on the technique to be preferred in the various situations of male infertility and on the best way to perform them. We therefore decided to proceed with a formalized expert consensus, using the method recommended by the French National Authority for Health. The aim was to provide the French urology community with practical advice on how best to perform these procedures. METHODS: Twenty-six international experts met online for the consensus. A research committee carried out a comprehensive literature review and prepared the 55 statements submitted to the rating group. After 2 rounds of scoring, 50 recommendations were validated in March 2023, having achieved a consensus of more than 85% among the experts. RESULTS: The consensus covered (1) preparation for sperm extraction surgery, (2) the different sperm extraction surgery techniques (Microsurgical epididymal sperm aspiration [MESA], Percutaneous epididymal sperm aspiration [PESA], Conventional Testicular Sperm Extraction [TESE], Microsurgical Testicular Sperm Extraction [micro-TESE]), (3) advice to be given to the patient concerning the postoperative period, before presenting the results of the sperm extraction surgeries. CONCLUSIONS: The expert consensus meeting on the performance of sperm extraction surgery presented a set of clinical guidelines based on the available literature and expert opinion. These guidelines should have a favourable effect on the development of this activity in France.

[The urologist's role in assisted reproductive technology (ART)]. / Place de l'urologue dans le parcours d'aide médicale à la procréation (AMP).

BACKGROUND: Following on from the Rapport vers une stratégie nationale de lutte contre l'infertilité (Report on a national strategy to combat infertility) submitted to the French Minister of Health in 2022, whose objective 13 is: to better identify and diagnose male infertility, we wanted to clarify with reproductive specialists what role the urologist should play in the management of the infertile couple. METHODS: An expert consensus was reached with the Pedagogical Committee and pilots of the Transversal Specialized Training in Reproductive Medicine and Biology - Andrology, and with the presidents, board and scientific council of the French Federation for Reproductive Study (FFER). RESULTS: In the case of infertility in a couple, the fertility of both partners should be assessed from the outset, and in the event of abnormality or failure of ART, the patient should be referred to a uro-andrologist for expert management. The uro-andrologist will set up medical or surgical treatments to improve the prognosis of the man's fertility, in conjunction with the entire ART team. It is also important for the urologist/andrologist to take charge of the man's health before conception, because of the benefits for the patient himself and for his offspring. CONCLUSION: This expert consensus has shed light on the role of the uro-andrologist in the ART pathway, on the need for training in Andrology and on the medical demography required.

[French language validation of the SSIPI questionnaire assessing the satisfaction of patients with penile implant]. / Validation linguistique française du questionnaire SSIPI évaluant la satisfaction des patients porteurs d'une prothèse pénienne.

INTRODUCTION: The objective of this study was to propose a French version of the satisfaction survey for inflatable penile implant (SSIPI) questionnaire. MATERIAL: Questionnaire validation was performed in three steps: translation into French by two urologists, its validation by the committee of andrologist and sexual medicine (CAMS) and an independent translation in English by another urologist to exclude any distortion with the original version. Furthermore, the questionnaire was tested in few patients having penile implant. RESULTS: The andrology committee approved the French version of the questionnaire. The final version of the questionnaire was successfully tested on all patients. Every patient (n=10) confirmed the good comprehension and pertinence of the questions, and the easy response selection. CONCLUSION: This French version of the SSIPI questionnaire will allow French-speaking urologists to assess the satisfaction of their patients with a penile implant on a large scale. LEVEL OF EVIDENCE: IV.

Penile Implant Surgery Satisfaction Assessment.

BACKGROUND: Several studies reported high satisfaction rates (> 90%) for patients and their partners after penile prosthesis (PP) implantation. AIM: To describe and critically discuss the current evidence regarding the assessment of patient and partner satisfaction after penile implant surgery. METHODS: A critical narrative review of the studies investigating the patient and partner satisfaction after PP implantation was designed. Papers in English-language published until January 2021 were included. OUTCOMES: The main outcome investigated was patient and partner satisfaction after penile implant surgery. RESULTS: The International Index of Erectile Function , the Erectile Dysfunction Inventory of Treatment Satisfaction , the Treatment Satisfaction Scale , and the Quality of Life and Sexuality with Penile Prosthesis are the best-known validated tools used to assess satisfaction after PP implantation. Except for Quality of Life and Sexuality with Penile Prosthesis , they were not validated in patients undergoing penile implant surgery. The lack of an "ad hoc" tool has led to the widespread of nonvalidated questionnaires. Several tools can be useful in the preimplantation counseling, such as the mnemonic Compulsive/obsessive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric , the Minnesota Multiphasic Personality Inventory, the Brief Sexual Symptom Checklist for Men , the Attitude towards Penile Implant , and the Attitude Attributed to the Partner towards Penile Implant . CLINICAL IMPLICATIONS: Improvement of knowledge regarding the available tools to evaluate the satisfaction after penile implant surgery. STRENGTHS & LIMITATIONS: Comprehensive and thorough review of all the main validated questionnaires available to assess satisfaction in patients with PP. Lack of a systematic approach and quantitative data analysis. CONCLUSION: Despite the high satisfaction rate reported in the literature, most of the studies used suboptimal or non-validated questionnaires to assess patients undergoing penile implant surgery. Future research is needed to develop and validate a specific, complete and easy-to-use questionnaire. Manfredi C, Fortier É, Faix A, et al. Penile Implant Surgery Satisfaction Assessment. J Sex Med 2021;18:868-874.

Unilateral versus bilateral sacral neuromodulation test in the treatment of refractory idiopathic overactive bladder: A randomized controlled pilot trial.

AIM: To compare treatment success rate in terms of improvement of bladder overactivity between unilateral and bilateral sacral neuromodulation testing. METHODS: A multicentric, parallel, randomized, open pilot trial (October 2012-September 2017) was conducted. Participants presented primary overactive bladder resistant to first-line treatments. Patients were excluded in case of secondary bladder, pelvic, or neurological condition. Patients were randomized between bilateral testing (n = 28) or unilateral testing (n = 27), to determine the best functional response before final implantation. The primary outcome was the rate of patients presenting at least 50% of clinical improvement at 1 month on urinary frequency, number of urge incontinence episodes or number of urinary urgency episodes. Symptom severity, implantation success rate, uroflowmetry, device tolerance, complications, and quality of life were also assessed. RESULTS: Fifty-five patients have been included. The rate of patients presenting at least one significant clinical improvement at month 1 was 62% in the bilateral group versus 84% in the unilateral group (P = .0891), RR = 0.74 (0.51; 1.07). There was no significant difference between bilateral and unilateral groups in terms of improvement of urinary frequency (0% and 17%; P = .1115), number of urge incontinence episodes (52% and 63%; P = .4929) or number of urinary urgency episodes (57% and 74%; P = .2411). More complications were reported in the bilateral group than in the unilateral group (9 [47%] vs 4 [16%], respectively; P = .0239). CONCLUSION: Systematic bilateral sacral neuromodulation testing before final implantation did not appear to increase success rate compared with unilateral stimulation in the treatment of overactive bladder.

[Penile prosthesis in the treatment of erectile dysfunction: updates in 2020]. / Place des implants péniens d'érection dans le traitement de la dysfonction érectile†: le point en 2020.

Penile erection implants are considered to be the «â€…Gold Standard ¼ for the treatment of erectile dysfunction with an organic component that escapes pharmacological and mechanical treatment. The place of preoperative information is fundamental. It is a simple and minimally invasive surgery. Penile Erection Implants are becoming more and more a full-fledged treatment line, which can be offered at the same time as other Erectile Dysfunction treatments. In this article, we will discuss the presentation of the different implants available, the elements underlying their indication, the place of preoperative information, the mains steps of the surgical procedure, the outcomes and satisfaction rates.

Les implants péniens d'érection (IPE) sont considérés comme le gold standard du traitement de la dysfonction érectile (DE) à composante organique échappant aux traitements pharmacologiques et au traitement mécanique. Ils sont très largement associés à des taux de satisfaction élevés, des taux de complication bas et à une fiabilité élevée. La place de l'information préopératoire est fondamentale. Il s'agit d'une chirurgie simple et peu invasive. Les IPE s'imposent de plus en plus comme une ligne de traitement à part entière. Dans cet article seront abordés la présentation des différents implants disponibles, les éléments sous-tendant leur indication, la place de l'information préopératoire, les grands principes de la chirurgie, les résultats postopératoires et les taux de satisfaction.

[Peyronie's Disease: update in 2020]. / Maladie de Lapeyronie†: le point en 2020.

Peyronie's disease (PD) is a relatively unknown cause of sexual dysfunction. Symptoms may include the appearance of an erectile deformity, pain in the penis and erectile dysfunction (ED). The etiology is most often unclear, and medical treatments are limited, although improvement is always possible. However, surgical treatment remains the only option when the disease has stabilized and in the event of significant erectile and sexual disability.

La maladie de Lapeyronie (MDL) est une cause relativement méconnue de dysfonction sexuelle. La symptomatologie peut associer l'apparition d'une déformation en érection, des douleurs de la verge et une dysfonction érectile (DE). L'étiologie est le plus souvent floue, et les traitements médicaux limités, même si une amélioration est toujours possible. Le traitement chirurgical reste cependant la seule solution lorsque la maladie est stabilisée et en cas de handicap érectile et sexuel important.

[Low-intensity extracorporeal shockwave therapy for erectile dysfunctio: a new option ?] / Traitement de la dysfonction érectile par ondes de choc à basse intensité : une nouvelle option ?

Vasculogenic Erectile dysfunction (ED) is one of the main causes of male sexual dysfunction. Several treatments exist to improve the quality of the erection, but the management of the cardiovascular factors is essential to hope a recovery of the erectile function. Recently, several studies have examined the use of low-intensity extracorporeal shock wave therapy (Li-ESWT) to improve vascular and endothelial factors involved in the mechanisms of erection. This article aims to take stock of this potential new therapeutic option.

La dysfonction érectile (DE) d'origine vasculaire est l'une des principales causes de la dysfonction sexuelle masculine. Plusieurs traitements existent pour améliorer la qualité de l'érection, mais la prise en charge des facteurs cardiovasculaires est essentielle pour espérer une récupération de la fonction érectile. Depuis quelques années, plusieurs études ont examiné l'utilisation du traitement par ondes de choc à basse intensité pour améliorer les facteurs vasculaires et endothéliaux impliqués dans les mécanismes de l'érection. Cet article a pour objectif de faire le point sur cette potentielle nouvelle option thérapeutique.

[Erectile dysfunction : up-date data and clinical guidelines]. / Nouvelles recommandations pour la prise en charge de la dysfonction érectile à l'usage du praticien.

In this paper, we are presenting a synthetic version of the third updated version of Guidelines for the first-line management by the non-sexologist practitioner of a man with erectile dysfunction (ED). This work applied the methodology recommended by the French High Authority of Health (in-depth documentary search of medical and scientific bibliographic data and review by a group of experts). Among the points to be highlighted since 2010, an important part has been devoted to updating epidemiological data that focus on the strong correlation between ED and vulnerable populations, on the question of the role of the partner's role in triggering or maintaining erectile dysfunction, previously poorly documented, and on the evolution of ED treatments and management algorithms.

Nous présentons dans cet article une synthèse de la troisième version actualisée des « Recommandations pour la prise en charge en première intention par le praticien non sexologue d'un homme souffrant de dysfonction érectile (DE) ¼. Ce travail a appliqué la méthodologie recommandée par la Haute autorité de santé française (analyse de la littérature par un groupe de travail et relecture par un groupe d'experts). Parmi les points à souligner depuis 2010, une part importante a été faite à l'actualisation des données épidémiologiques qui mettent l'accent sur la forte corrélation entre DE et populations vulnérables, sur la question du rôle du partenaire dans le déclenchement ou le maintien de la DE, auparavant peu documenté, ainsi que sur l'évolution des traitements de la DE et de ses algorithmes de prise en charge.

Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence.

BACKGROUND: After radical prostatectomy (RP), erectile dysfunction, often necessitating the need for inflatable penile prosthesis (IPP) insertion, and urinary incontinence and climacturia can ensue. AIM: To assess the efficacy and safety of the mini-jupette, a mesh used to approximate the medial aspects of the 2 corporotomies at the time of IPP insertion, for the management of climacturia and urine leakage in patients with minimal incontinence. METHODS: We conducted a pilot multicenter study of patients with post-RP erectile dysfunction and climacturia and/or mild urinary incontinence (≤2 pads/day [ppd]) undergoing IPP insertion with concomitant placement of a mini-jupette graft. OUTCOMES: Pre- and postoperative erectile function, continence and climacturia, and overall surgical outcomes were assessed. RESULTS: 38 patients underwent the mini-jupette procedure. The mean age of the population was 65.3 years (SD = 7.7). 30 had post-RP climacturia and 32 patients had post-RP incontinence (mean = 1.3 ppd, SD = 0.8). 31 patients received Coloplast Titan, 4 received AMS 700 LGX, and 3 received AMS 700 CX IPPs. Mean corporotomy size was 2.9 cm (SD = 1.0). Mean graft measurements were 3.2 cm (SD = 0.9) for width, 3.3 cm (SD = 1.3) for length, and 11.0 cm2 (SD = 5.1) for surface area. At a mean follow-up of 5.1 months (SD = 6.9), there were 5 postoperative complications (13.2%) of which 4 required explantation. Climacturia and incontinence were subjectively improved in 92.8% and 85.7%, respectively. Mean ppd decreased by 1.3 postoperatively. CLINICAL IMPLICATIONS: The Andrianne mini-jupette is a feasible adjunct to IPP placement that can be used for subsets of patients with post-RP climacturia and/or minimal incontinence. STRENGTHS AND LIMITATIONS: Strengths of this study include the novel nature of this intervention, the multi-institutional nature of the study, and the promising results demonstrated. Limitations include the retrospective nature of the study and the heterogeneity of the techniques and grafts used by different surgeons involved. CONCLUSION: Longer follow-up and larger patient cohorts are needed to confirm the long-term safety and benefits of this intervention. Yafi FA, Andrianne R, Alzweri L, et al. Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence. J Sex Med 2018;15:789-796.

Prostatic injection of botulinum toxin is not inferior to optimized medical therapy in the management of lower urinary tract symptoms due to benign prostatic hyperplasia: results of a randomized clinical trial.

OBJECTIVE: To explore efficacy and safety of Botulinum Neurotoxin Type A (BoNT-A) prostatic injection in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperperplasia. MATERIALS AND METHODS: A phase 3 multicenter open-labeled study randomised patients to receive BoNT-A prostatic injection or optimized medical therapy. BoNT-A injection consisted in trans-rectal injections of 200 UI in the transitional zone of the prostate. Optimal medical therapy consisted in oral medication with any drug patented for LUTS. One month (M1) after randomisation patients in the BoNT-A group were asked to stop any medical therapy related to LUTS. The main judgment criterion was the IPSS score at M4. Per-protocol analysis was performed with a non-inferiority hypothesis (ΔIPSS < 3). RESULTS: 127 patients were randomised to BoNT-A (n = 64) or medical therapy (n = 63). At randomisation mean IPSS was 16.9 ± 7.2 in the BoNT-A group vs 15.7 ± 7.3 in control. In the BoNT-A group, 44 patients (73.3%) could interrupt medical therapy for LUTS from M1 to M4. At M4, mean IPSS score was 12.0 ± 6.7 in the BoNT-A group vs 11.8 ± 6.9 in control. After adjustment for baseline IPSS, delta IPSS between groups was 0.01; 95% CI [- 2.14; 2.11] leading to accept the non-inferiority hypothesis. CONCLUSIONS: Four months after BoNT-A injection, most of the patients could interrupt LUTS-related medical treatments. In these patients, IPSS improvement was not inferior to optimized medical treatment, but the study design did not allow to conclude that this improvement was related with study drug rather than with sustained placebo effect. TRIAL REGISTRATION: NCT01275521.

Recommendations for the diagnosis and evaluation of premature ejaculation.

OBJECTIVES: The Association Interdisciplinaire Post-Universitaire de Sexologie (AIUS) has brought together a panel of experts to draw up French recommendations for the management of premature ejaculation. This article presents the recommendations for the diagnosis and evaluation of premature ejaculation. METHODS: Systematic review of the literature between 01/1995 and 02/2022. Using the method of recommendations for clinical practice (RPC). RESULTS: We recommend using the SIAMS definition for everyday clinical practice. PE is defined as: (i) a persistent and recurrent subjective perception of loss of control (management) of the ejaculatory mechanism in the presence of appropriate erotic stimuli; (ii) subjective, PE-related distress induced in the patient and sexual dissatisfaction or PE-related anorgamy in the partner; (iii) a short intravaginal ejaculatory latency time, whether subjectively perceived by the patient and the partner or objectively measured as less than 180seconds (generally). We suggest that the same definition be applied to practices other than vaginal penetration, such as masturbation, oral or anal intercourse, as well as to non-heterosexual contexts. We suggest using information reported by the patient, possibly supplemented by assessment tests/questionnaires (IPE, PEP, PEDT). We recommend investigating the presence of other sexual dysfunctions, in particular erectile dysfunction (ED), as well as any sexual dysfunctions of partners. We recommend taking a medical and psychosexological history, and carrying out a targeted physical examination in patients complaining of PE. CONCLUSION: These recommendations should help to improve the management of PE.

Survey on vasectomy practices in France in 2022.

OBJECTIVES: Prior to the publication of the recommendations of the French Association of Urology (AFU) on vasectomy, we conducted a survey to assess current practices and required training interventions in France regarding vasectomy. METHOD: An invitation with a link to a 38-item questionnaire on MonkeySurvey was sent in November 2022 to the 1760 urologist members of the AFU. RESULTS: A total of 352 (20%) urologists completed the survey. Among the participants, 20% reported refusing the surgery to patients aged 25 to 30 years old and 17% if they had no children, respectively. Three quarters of participants mentioned systematically performing a scrotal exam at the time of the pre-vasectomy consultation. Forty-one percent of respondents reported systematically performing vasectomy under general anesthesia. While 56% of participants mentioned performing a minimally invasive technique for exposing the vas, 70% said they were willing to learn the no-scalpel technique for this purpose. The most frequently reported occlusion techniques combine excision of a vas segment and ligation of both ends of the divided vas. Only 26% reported performing fascial interposition and 4% using the "open end" technique. A post-vasectomy semen analysis showing less than 100,000 non-motile sperm per millilitre makes only 38% of respondents recommending stopping other contraceptive methods. Half of the respondents considered that current reimbursement fee structure for the procedure restrains the development of this clinical activity. CONCLUSION: Our survey suggests that vasectomy practice and services in France do not meet the international standards. We identified the clinical and organizational changes needed to improve practices and access to vasectomy services in France. LEVEL OF EVIDENCE: Grade 3.

WHEN FIBROSIS INTERSECT: ASSOCIATION AND RISK FACTORS BETWEEN PEYRONIE'S AND DUPUYTREN'S DISEASES.

INTRODUCTION: Peyronie's and Dupuytren's diseases are benign but are source of significant functional impairment leading to considerable suffering. In this study, the aim is to investigate the association between Peyronie's and Dupuytren's diseases as well as their common and specific risk factors. MATERIAL & METHODS: From July 2022 to March 2024, we conducted a multicentric observational study on 450 patients. Patients followed up for Peyronie's and/or Dupuytren's disease were given a questionnaire that included a consent form, in order to screen one or the other associated disease and explore all risk factors. RESULTS: Among the 278 patients followed for Dupuytren's disease, 35 (12.3%) had Peyronie's disease. Of the 172 patients with initial Peyronie's disease, 50 (29.1%) were diagnosed with Dupuytren's disease. Eventually, 85 patients had both pathologies (18.9%). High blood pressure was significantly more prevalent in patients with both diseases, compared to subjects with Peyronie's disease only (37.7% vs. 38.4% vs. 24.4%; p=0.02). The same observation was made regarding smoking (62.3% vs. 60.7% vs. 48.8%; p=0.05) and daily alcohol consumption (52.9% vs. 41.7% vs. 35.8%; p=0.04). Patients diagnosed with isolated Dupuytren's disease were more likely to be diabetic (13.6% vs. 9.41%; p = 0.42). Blue eyes and family history were significantly more often reported in Dupuytren's patients (33.9% vs. 22.8%; p=0.03 ; p < 0.001). Ledderhose disease was significantly more prevalent in patients with both diseases or isolated Dupuytren's disease (21.2% vs. 12.4% vs. 3.3%; p=0.0003). CONCLUSION: This study confirms the association between Peyronie and Dupuytren diseases'. Smoking, alcohol daily consumption and hypertension are more prevalent in case of associated diseases. Blue eyes and family history are significantly more frequently found in case of Dupuytren's contracture. More powerful studies including a control group are necessary.

The habits of European urologists in the field of cryopreservation before the urological cancers treatment.

INTRODUCTION: Treatments against urogenital cancers frequently have fertility side-effects. The strategy to preserve fertility after oncologic treatments is still a matter of debate with a lack of evidence and international guidelines. The aim of this study is to investigate fertility preservation practices before urogenital cancer treatments and to compare national habits. MATERIAL AND METHODS: An online anonymous survey was submitted from January to June 2021 to six European urological societies. The 31-items questionnaire included questions about demography, habits of evaluation, and management of fertility preservation in case of urogenital cancer treatments. RESULTS: Two hundred twenty-eight urologists from six urological societies in five different countries (Belgium, The Netherlands, Luxembourg, France, Finland) filled out the survey. Three quarter (74%; n = 166) usually propose a cryopreservation before orchidectomy. In case of oligo/azoo-spermia, the technique performed for the sperm extraction during orchidectomy varies among the sample: 70.5% (n = 160) of the responders do not perform a Testicular Sperm Extraction (TESE) nor a Percutaneous Epididymal Sperm Aspiration (PESA). The cryopreservation for prostate cancer treatments is never proposed in 48.17% (n = 105) of responders but conversely it is always proposed in 5.05% (n = 11). The cryopreservation before bladder cancer treatments is not commonly proposed (67.5%, n = 154). CONCLUSION: Our study showed variable country specific tendencies in terms of fertility preservation in the period of treatment of urological cancers. These differences seem to be related to national guidelines recommendations. Standardization of international guidelines is urgently needed in the field of fertility for urological cancer patients.

European countries have different rates of sperm cryopreservation before vasectomy and at the time of reversal.

INTRODUCTION: Effective male contraceptive options are condoms and vasectomy. Vasectomy should not be considered a reversible method of contraception even if vasovasostomy can be offered to men to restore fertility after vasectomy. Therefore, there is a real questioning among urologists concerning cryopreservation before vasectomy. We carried out an international survey concerning the practice of cryopreservation before vasectomy and during vasovasostomy. MATERIAL AND METHODS: An online anonymous survey was submitted from January to June 2021 to six European urological societies. The 31-items questionnaire included questions about demography, habits of cryopreservation before vasectomy or during vasectomy reversal, and in case of urogenital cancers. RESULTS: 228 urologists from six urological societies in five different countries (Belgium, Netherlands, Luxembourg, France, Finland) answered the questionnaire. French urologists were more in favor of cryopreservation before vasectomy than other European urologists (p < 0.0001). They also significantly found that not talking about cryopreservation before vasectomy is a medical fault unlike other urologists (p < 0.0001). The specialization in andrology did not influence the choice of cryopreservation before vasectomy (p = 0.9452). The majority of urologists did not perform intraoperative sperm extraction during vasovasostomy (81%; n = 127) with a significant difference between urologists with or without andrology training (p = 0.0146). Success rates after vasovasostomy are significantly better for robot-assisted surgery (p = 0.0159) or with a microscope (p = 0.0456) versus without a microscope. CONCLUSION: Cryopreservation before definitive sterilization significantly varies among European urologists and seems to be mostly dictated by habits than by knowledge. An international consensus is needed to standardize practices and guide patients' choices.

Current practices regarding corporotomy localization during penoscrotal inflatable penile implant surgery: a multicenter cohort study.

Literature concerning corporotomy location in multicomponent inflatable penile prosthetic surgery via a penoscrotal approach is scarce if not nonexistent. Aim of our study was to report practices in low-, moderate-, and high-volume penile implant centers regarding corporotomy location and evaluate its potential impact on intraoperative and short-term postoperative complications. Data from 18 (13 European and 5 American) implant centers were collected retrospectively between September 1st, 2018 and August 31st, 2019. Variables included: intraoperative proximal and distal corpus cavernosum length measurement, total corporal length measurement, total penile implant cylinder length, and length of rear tip extenders. Eight hundred and nine virgin penile implant cases were included in the analysis. Mean age of participants was 61.5 ± 9.6 years old. In total, 299 AMS 700™ (Boston Scientific, USA) and 510 Coloplast Titan® (Minneapolis, MN USA) devices were implanted. The mean proximal/distal corporal measurement ratio during corporotomy was 0.93 ± 0.29 while no statistical difference was found among low-, moderate-, and high-volume penile implant centers. A statistically significant correlation between lower proximal/distal measurement ratio and higher age (p = 0.0013), lower BMI (p < 0.0001), lower use of rear tip extenders (RTE) (p = 0.04), lower RTE length (p < 0.0001), and absence of diabetes (p = 0.0004) was reported. In a 3-month follow up period, 49 complications and 37 revision procedures were reported. This is the first study reporting the current practices regarding corporotomy location during IPP placement in a multicenter cohort, particularly when including such a high number of patients. Nevertheless, the retrospective design and the short follow up period limits the study outcomes. Corporotomy location during penoscrotal IPP implantation does not correlate with intraoperative or short-term postoperative complication rates. Future studies with longer follow up are needed in order to evaluate the association of corporotomy location with long-term complications.

Erectile function and sexual satisfaction before and after penile prosthesis implantation in radical prostatectomy patients: a comparison with patients with vasculogenic erectile dysfunction.

INTRODUCTION: Patients with erectile dysfunction (ED) after radical prostatectomy (RP) may benefit from penile prosthesis (PP) implantation after failure of less invasive treatments. Aim. To assess surgical outcomes and satisfaction after PP implantation in RP patients and compare the results with those in patients with vasculogenic ED (controls). METHODS: A database of 415 consecutive PPs (January 1996-December 2008) was used to collate data on preimplantation ED treatments, surgical complications, satisfaction, and International Index of Erectile Function (IIEF) scores before and 3 months after implantation. The results for 90 post-RP implants (79 primary, 11 secondary) and 131 implants for vasculogenic ED were compared. MAIN OUTCOME MEASURES: The main outcome measures of this study are intra- and postoperative complications and IIEF domain scores. RESULTS: Mean follow-up of RP patients was 37.6 ± 26.8 months. Mean interval between RP and PP implantation was 31.5 ± 28.7 months. Nearly all primary implants (96.2%) were inflatable (3-piece, 70.1%; 2-piece, 24.1%). There was no significant difference between groups in terms of rates of infection (1.1%), mechanical failure (3.3%), and other surgical complications requiring revision surgery (migration, auto-inflation) (4.4%). For primary implants, the mean preimplantation IIEF score (all items) was significantly lower in RP patients than in controls (14.7 ± 5.9 vs. 22.6 ± 10.8, P = 0.003), chiefly because of significantly lower scores for erectile function, intercourse satisfaction, and orgasmic function. After PP implantation in RP patients, the scores for all domains improved, but the total score remained significantly lower than in controls (63.1 ± 7.0 vs. 68.5 ± 6.9, P = 0.005). The orgasmic function score was significantly lower (P < 0.001). Overall satisfaction rate was 86.1% in RP patients and 90.7% in controls (P = 0.3). CONCLUSIONS: PP implantation after RP is associated with low morbidity and high satisfaction. It improves the scores for all IIEF domains and, in particular, erectile function. Fibrosis of the retropubic space may require a second incision for reservoir placement or implantation of a 2-piece PP.

Combination of doxazosin and sildenafil exerts an additive relaxing effect compared with each compound alone on human cavernosal and prostatic tissue.

INTRODUCTION: Phosphodiesterase 5 inhibitors (PDE5) such as sildenafil are first-line treatment for erectile dysfunction (ED). Alpha1 (alpha1)-adrenoceptor antagonists such as doxazosin are indicated for the treatment of patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). ED and LUTS/BPH are conditions that are often associated. Accordingly, alpha1-adrenoceptor antagonists and PDE5 inhibitors will be often prescribed in real life setting together. AIM: To evaluate the effects of the combination of sildenafil and doxazosin on human cavernosal and prostatic tissue. METHODS: Prostatic and erectile tissues were obtained from nine to 12 patients, respectively. Patients underwent cystoprostatectomy for infiltrating bladder cancer or penile surgery for penile implant, congenital curvature or Peyronie's disease. MAIN OUTCOME MEASURES: In organ baths, prostatic and cavernosal strips were submitted to either concentration-response curves (CRC) to phenylephrine (Phe) or norepinephrine (NE), respectively, in presence of vehicle, sildenafil (10(-6) M, 10(-5) M), doxazosin (10(-8) M, 3.10(-8) M, or 10(-7) M), or a combination of both. Continuous electrical field stimulation (EFS; 32 Hz, 5 ms, 5 seconds, 300 mA) was performed on prostatic strips which were incubated with sildenafil 10(-6) M or vehicle before the successive addition of doxazosin (10(-7) M, 10(-6) M) or vehicle. Cavernosal strips were pre-incubated with doxazosin (10(-9) M, 10(-8) M) or vehicle, then CRC to sildenafil were constructed on NE (3.10(-6) M) precontracted cavernosal strips. RESULTS: Combination of sildenafil and doxazosin exerted a greater relaxing effect on CRC to Phe or NE compared with each compound alone in both tissues. Sildenafil significantly enhanced the relaxing effect of doxazosin on EFS-induced contractions in prostatic strips. Doxazosin significantly increased the ability of sildenafil to inhibit NE-induced contractions in cavernosal strips. CONCLUSIONS: Sildenafil and doxazosin reduced adrenergic tone of prostatic and cavernosal smooth muscle and their combination provided a significant benefit when targeting relaxation of both tissues. These experiments provide support for further clinical evaluation of the sildenafil and doxazosin combination in ED patients with LUTS/BPH.