[Priapism in children and adolescents]. / Priapismus bei Kindern und Jugendlichen.

Priapism is a prolonged erection without sexual stimulation. In most cases it requires prompt management in order to avoid long-term consequences such as erectile dysfunction or penile deformity. Priapism is rare in children, but haematological diseases play an important role. The diagnosis is generally not difficult. Blood gas analysis and Doppler sonography are used to establish the form of priapism and determine its further management. The management of low-flow priapism consists of immediate blood aspiration and intracavernosal injection of sympathomimetic drugs as needed. In case of treatment failure, a shunt is also necessary. High-flow priapism generally does not require any immediate treatment. X-ray-assisted selective embolisation in case of fistula is associated with a high success rate. The primary aim in stuttering priapism is reduction and prophylaxis of erections and patient education about the disease. Penile prostheses are not used in children.

The Staged Urethroplasty with Vascularised Scrotal Flap and Buccal Mucosa Graft after Failed Hypospadias Surgery: A Reliable Technique with a Novel Tool.

Background/Aims/Objectives: To report the outcome of staged urethroplasty with buccal mucosa and vascularised scrotal flap after failed hypospadias surgery. METHODS: n = 35. INCLUSION CRITERIA: destroyed urethral plate, deficient local skin, fistula and penile deviation. Five out of 35 patients also had a secondary proximal stricture. Stage 1: excision of scarred tissue and fistulae, correction of the penile deviation through dorsal plication and the ventral placement and quilting of buccal graft. Stage 2: tubularisation of the neourethral plate; in 20 patients with deficient penile skin a vascularised scrotal flap was developed and transferred on the tubularised urethra. In 5 patients, the proximal stricture was repaired during a separate operation by using buccal graft, the distal urethra was marsupialised. The repair of the distal urethra was performed later as described above. RESULTS: Thirty-three patients are recurrence-free without further interventions; successful reoperation was done in 2 cases. COMPLICATIONS: 1 graft necrosis; 1 coronary fistula; 1 scrotal flap necrosis and 1 case of hematoma. CONCLUSIONS: Complicated strictures after multiple failed hypospadias repair are well managed by using buccal graft. The vascularised scrotal flap is a very useful tool in case of deficient and scarred penile skin and could explain the low rate of fistula formation in our series.

Buccal mucosal graft in reconstructive urology: uses beyond urethral stricture.

The use of buccal mucosal grafts for the reconstruction of urethral strictures is an established procedure. Because of its robustness, the buccal mucosal graft could also potentially provide an alternative for other indications in reconstructive urology. We report here six consecutive patients who received a buccal mucosal graft for ureteral strictures, glans reconstruction and stoma stenosis. The follow up for all patients ranged from 26 to 50 months. The buccal mucosal graft showed excellent functional results for the ureteral strictures and stenosis from ureterocutaneostomy. For glans reconstructions, the buccal mucosal grafts delivered excellent cosmetic and functional results without causing meatal stenosis. We conclude the buccal mucosal graft can be used in reconstructive surgery beyond the reconstruction of urethral strictures.

Extensive necrosis of the bladder with hypostatic abscess: a late complication after radiotherapy.

BACKGROUND: Late urological complications after radiotherapy of a primary tumor in the pelvis are rare but challenging. We report a case of extensive bladder necrosis with hydronephrosis and sepsis nearly 45 years after radiotherapy. CASE REPORT: An 80-year-old woman with infected hydronephrosis and with a history of radiotherapy due to cervical carcinoma was treated with JJ stenting. Due to the absence of any improvement, we performed a computed tomography which showed bilateral hypostatic abscesses in both thighs that were not apparent at first look. The initiated series of diagnostics and therapies finally led to complete healing. The patient was discharged after 6 months with completely healed wounds and nearly normal renal parameters. CONCLUSION: Special emphasis should be put here on the extremely long latency period, the utmost importance of the past history, the individualized surgical management, and the notion about late complications after radiotherapy.

Head-to-head comparison of retropubic, perineal and laparoscopic radical prostatectomy.

OBJECTIVE: As more patients are diagnosed with prostate cancer at an early stage, it is becoming increasingly important to refine the technique of surgical excision. For this purpose we have generated objective data comparing three different surgical approaches used by three experienced surgeons. METHODS: We prospectively compared three contemporary personal series of 50 consecutive radical prostatectomy (RP) patients. The health-related quality of life was evaluated preoperatively and in months 1, 3, 6, 12 and 24. RESULTS: Considering in turn the patients undergoing retropubic, perineal and laparoscopic RP, the median procedure time was 2 h and 27 min, 1 h and 50 min and 4 h, with a transfusion rate of 2, 0 and 8%, respectively. In the perineal group there were more wound infections. Median catheter drainage was 7, 10 and 7 days and zero, 13 and one patients needed reinsertion of a catheter. Early continence varied considerably, with 57.4, 11.4 and 6.3% of patients pad-free after 1 month, but there were no differences in social continence (zero or one pad) with 97.8, 97.8 and 91.9% after 2 years. The Litwin score for incontinence (preoperative minus postoperative) was -24, -41 and -63% after 1 month and -13, +3 and -29% after 2 years. Twenty-nine, five and 15 patients had a preoperative five-item version of International Index of Erectile Function (IIEF-5) score of > or = 17 points and a nerve-sparing procedure. After 2 years, 48.1, 0 and 0% had an IIEF-5 score of > or = 17 points without the use of phosphodiesterase type 5 (PDE-5) inhibitors, but when including patients using inhibitors there were no significant differences. CONCLUSIONS: A comparison of morbidity, short-term convalescence and long-term side-effects of different surgical techniques is strongly biased by both the preoperative status of patients and the skill of the surgeons. Overall, we found some differences in the short-term results (e.g. early continence) and comparable long-term results.

Radical perineal prostatectomy and simultaneous extended pelvic lymph node dissection via the same incision.

OBJECTIVES: Assess the feasibility of extended bilateral pelvic lymph node dissection (ePLND) in radical perineal prostatectomy (RPP) via the same incision under direct vision. METHODS: In 90 consecutive patients with prostate cancer and a prostate-specific antigen level >10 ng/ml or a Gleason score >5 or more than two positive biopsies, RPP and ePLND via the same incision were performed in a prospective trial. After removing the prostate, the endopelvic fascia was opened with scissors and the bladder pushed medially. We performed an extended dissection along the obturator nerve, the external iliac vessels up to the ureter and along the internal iliac artery. Complications, number of nodes removed, and number of patients with tumour-positive nodes were recorded. Recovery of urinary continence and erectile function were assessed by a patient-reported questionnaire and the International Index of Erectile Function 5 questionnaire, respectively, administered preoperatively and at 1, 3, 6, and 12 mo. RESULTS: We removed a mean and median number of 19 and 18.7 lymph nodes, respectively. Twelve patients had lymph node metastasis. Mean operation time was 149 min, including the complete learning curves of three surgeons. Seven lymphoceles but no major complications occurred. After 1, 3, 6, and 12 mo, 32 (36%), 50 (56%), 74 (82%), and 84 (93%) patients were completely dry, using no pads. CONCLUSION: ePLND and RPP under direct vision via the same incision are feasible, efficient, and associated with a fast recovery of urinary continence and a low complication rate. Because lymphadenectomy needs no second access, the major disadvantage of RPP is resolved.