Outcomes of inflatable penile prosthesis insertion in 247 patients completing female to male gender reassignment surgery.

OBJECTIVES: To assess the oucomes of penile prosthesis (PP) implantation after total phallic reconstruction secondary to gender dysphoria. PATIENTS AND METHODS: We conducted a retrospective single-centre analysis of 247 consecutive patients. The recruitment period was January 2001 to October 2015. A total of 328 inflatable PPs were implanted. A two-staged inflatable PP implantation was carried out. As a first step, an extraperitoneal reservoir placement was performed simultaneously with the glans sculpture and the insertion of a single large testicular prosthesis into the labia majora. Subsequently, cylinder(s) and pump placement was performed. A Dacron envelope was fitted around the proximal and distal aspect of the cylinder(s) to anchor the device to the pubic bone and to prevent apical protrusion. The outcomes measured were postoperative complications, eventual need for revision surgery, and long-term survival of the implants. Patient and partner satisfaction rates were extrapolated from the administered non-validated questionnaires. The data were analysed using non-parametric tests, multivariate logistic regression analysis, and a Kaplan-Meier survival curve. RESULTS: The mean follow-up was 20 months. In all, 88% of patients were satisfied with the result, although only 77% used their device for sexual intercourse. The overall 5-year device survival was 78%, with no one device being superior. Device infection occurred in 8.5% of patients with an overall revision rate of 43%. According to the multivariate logistic regression analysis, only type of phalloplasty significantly affected the infection risk (P = 0.013). CONCLUSIONS: Implantation of a PP into a neophallus is a complex procedure but yields high satisfaction rates. Nevertheless, complication rates are high and patients must be warned that multiple revisions will be necessary throughout their lifetime.

When to perform bone scan in patients with newly diagnosed prostate cancer: external validation of a novel risk stratification tool.

PURPOSE: To externally validate the performance characteristics of the Briganti's risk stratification tool for baseline staging bone scan in patients with newly diagnosed prostate cancer (PCa). METHODS: From 2009 onwards, a consecutive series of patients with PCa were enrolled. All patients were staged to evaluate the presence of bone metastasis (BM) with a conventional total-body Tc 99 m MDP scintigraphy performed regardless of baseline PCa characteristics. The area under the curve (AUC) estimates were used to test the accuracy of the Briganti's risk stratification tool that recommended staging baseline bone scan for patients with a biopsy Gleason score >7 or with a prostate-specific antigen (PSA) >10 ng/ml and palpable disease (cT2/T3). The new tool was compared to the European Association of Urology (EAU) guideline. RESULTS: A total of 313 patients were consecutively enrolled. Median age was 68 (range 49-95 years), and median PSA was 7 ng/ml (range 0.81-2,670). Twenty (6.4 %) patients presented BMs. Patients with BMs were significantly older, with higher PSA and a higher Gleason score (p = 0.001). The novel Briganti's model was significantly (p = 0.001) more accurate (AUC: 0.75; CI: 0.632-0.859) than the EAU guideline (AUC: 0.64; CI: 0.52-0.761) for the prediction of BMs. CONCLUSIONS: Our study validated in a group of patients with PCa the novel risk stratification tool proposed by Briganti, which presented a higher accuracy for baseline staging bone scan when compared with the EAU guideline. In our experience, this approach would further reduce (about 60 %) the use of staging baseline bone scan without compromising the ability to detect BMs in patients with PCa.