Post-prostatectomy anastomotic stenosis: systematic review and meta-analysis of endoscopic treatment.

OBJECTIVE: To perform a systematic review and meta-analysis of endoscopic procedures for treating vesico-urethral anastomotic stenosis (VUAS) after prostatectomy, as initial VUAS management remains unclear. METHODS: A search of the MEDLINE database, the Cochrane database, and clinicaltrials.gov was performed (last search February 2023) using the following query: (['bladder neck' OR 'vesicourethral anastomotic' OR 'anastomotic'] AND ['stricture' OR 'stenosis' OR 'contracture'] AND 'prostatectomy'). The primary outcome was the success rate of VUAS treatment, defined by the proportion (%) of patients without VUAS recurrence at the end of follow-up. RESULTS: The literature search identified 420 studies. After the screening, 78 reports were assessed for eligibility, and 40 studies were included in the review. The pooled characteristics of the 40 studies provided a total of 1452 patients, with a median (interquartile range [IQR]) follow-up of 23.7 (13-32) months and age of 66 (64-68) years. The overall success rate (95% confidence interval [CI]) of all endoscopic procedures for VUAS treatment was 72.8% (64.4%-79.9%). Meta-regression models showed a negative influence of radiotherapy on the overall success rate (P = 0.012). After trim-and-fill (addition of 10 studies), the corrected overall success rate (95% CI) was 62.9% (53.6%-71.4%). CONCLUSION: This first meta-analysis of endoscopic treatment success rate after VUAS reported an overall success rate of 72.8%, lowered to 62.9% after correcting for significant publication bias. This study also highlighted the need for a more thorough reporting of post-prostatectomy VUAS data to understand the treatment pathway and provide higher-quality evidence-based care.

Determining the outcomes of urethral construction in phalloplasty.

OBJECTIVE: To evaluate the surgical and functional outcomes of urethral reconstruction associated with phalloplasty, depending on the surgical techniques and patient history. MATERIALS AND METHODS: We conducted a single-centre retrospective study including 89 patients who underwent phalloplasty with urethral reconstruction between 2007 and 2018. Patients included were trans-male patients undergoing gender-affirming surgery and cis-male patients undergoing penile reconstruction after trauma, congenital malformation, or cancer. Urethral reconstructions were performed by free flap or skin graft (total or thin). Secondary urethroplasty may include direct vision urethrotomy, excision-anastomosis, or augmentation urethroplasty (skin graft, buccal mucosa graft). Patient demographics, medical history, peri- and postoperative data were collected from patient files. Functional results were evaluated using individual questionnaires. RESULTS: The mean (±sd) follow-up duration was 5.5 (±3.7) years. No significant difference was found for total urethral complication rate (fistula and/or stricture) according to type of urethral construction (70.9% for free flap urethra vs 73.5% for skin graft urethra; P = 0.911), nor according to the patient's grounds for surgery (72.7% for cis-male vs 71.8% for trans-male patients; P = 1). A total of 36 patients (40.5%) answered the functional questionnaire, of whom 80.5% reported usually voiding while standing and 47.5% were comfortable with urinating in public. CONCLUSIONS: Urethral construction in phalloplasty is associated with a high complication and revision rate regardless of the type of urethral reconstruction. Voiding in a standing position is generally possible but should not conceal feeble functional results.

Microsurgical phalloplasty: Anatomical study evaluating the use of the external pudendal vessels as recipients.

The inferior epigastric artery (IEA) is commonly used as a recipient vessel in microsurgical phalloplasty but its use can be associated with abdominal parietal complications (hernia, bulging). To preclude such complications and avoid involvement of the femoral artery, we assessed an external pudendal artery (EPA) as a recipient vessel. We studied the disposition of the external pudendal system and its general anatomy. Then we compared the external diameter of the EPA to that of the first branches of the femoral artery. The most important point was to determine the location of the EPA through a reference line to facilitate a surgical approach. We then illustrated this preliminary study with a clinical case to check the reliability of the identified landmarks. Ten adult cadavers were dissected. The arteries of interest were part of a system consisting of either a common trunk or a duplicated system. The branches of the pudendal system arose from either the femoral artery or the deep femoral artery. On a horizontal reference line passing through the two pubic tubercles, we observed that 83% of EPAs arose between the reference line and 3 cm below it, at the level of a vertical axis centered on the femoral artery. The EPA could be suitable as recipient vessel in phalloplasty owing to its location, size, and ease of dissection. Using it instead of the IEA precludes abdominal parietal complications and reduces scarring in the recipient area.

Female Sexual Function and Body Image After Urinary Diversion for Benign Conditions.

BACKGROUND: Simple cystectomy with urinary diversion is the favored option for treating conditions responsible of neurogenic bladder dysfunction after failure of conservative treatments. Despite the existence of validated assessment tools, the impact of cystectomy on female sexual function remains scarcely investigated. AIM: The aim was to assess the sexual function and body image of female patients who underwent urinary diversion for a nonmalignant condition and to investigate the factors that may influence sexual life quality. METHODS: 36 female patients who underwent urinary diversion ± cystectomy for a benign condition between January 1, 2007 and December 15, 2019 were included. Standardized questionnaires were sent by mail between February and April 2021. Additional data were collected from patient computerized medical records. OUTCOMES: The Female Sexual Function Index (FSFI), Body Image Scale (BIS), and Stoma Quality Of life (StomaQOL) questionnaires were used to assess sexual activity, body image, and quality of life related to a noncontinent stoma, respectively. The quality of pre- and postoperative information was also assessed. RESULTS: The most frequent etiology of bladder dysfunction was multiple sclerosis (14, 38.9%). After surgery, 29 (80.6%) patients were sexually active and the mean (range) overall FSFI score was 15.2 (2-33.3). The mean (range) overall FSFI score and FSFI Arousal sub-score were lower for the 14 patients with an ileal conduit [11.1(2-33.3] and 1 (0-4.5)) compared to the 14 patients with a continent stoma or a native urethra [19.2 (2-29.3]; P = .04 and 3.15(0-5.4); P = .014). Regarding sexual counseling, 27 (79.4%) patients did not receive any information before surgery about possible consequences on their sexual activity, 31 (91.2%) were not asked about their sexual activity during follow-up. The mean BIS score was higher for patients with an ileal conduit (14.8) compared to patients with a continent stoma (9.7) or a native urethra (5.1; P = .002). Patients with an ileal conduit had a mean StomaQOL score of 52.56. CLINICAL IMPLICATIONS: Optimal management should include, at least, routine assessment of sexual function prior to simple cystectomy and screening for sexual dysfunction during follow-up. Strengths and limitations The main strength of this study lies in the use of validated standardized questionnaires, including the FSFI that is considered as the most relevant tool for assessing female sexual function. Limitations include the small number of patients and the potential memory bias. CONCLUSION: The present study suggests the urinary diversion mode has an impact on sexual function and body image after cystectomy for benign condition. Louar M, Morel-Journel N, Ruffion A, et al. Female Sexual Function and Body Image After Urinary Diversion for Benign Conditions. J Sex Med 2022;19:263-269.

Functional and surgical outcomes after phalloplasty in cis men.

PURPOSE: Evaluate the surgical outcomes along with a comprehensive assessment of functional outcomes in cis men (non-trans) who underwent phalloplasty. METHODS: All consecutive cis men who underwent phalloplasty from 2008 to 2018 for penile insufficiency due to various causes were included. These underwent phalloplasty by either a radial forearm free flap (RFFF) or suprapubic phalloplasty (SPP). Data were collected from medical files. A questionnaire was sent a minimum of 1 year after surgery to each patient to evaluate sexual function and self-esteem, satisfaction with genitals, and urinary function. RESULTS: Among the 19 patients included, 12 underwent RFFF and 7 SPP; 25% of those who had RFF and 14.3% of those with SPP had a Clavien-Dindo ≥ 2 complication. A total of 16 patients had a urethroplasty procedure, 50.0% of whom had a Clavien-Dindo ≥ 2 complication. Penile prostheses were implanted in 14 patients; 64.3% of whom had a complication. Seven patients answered the questionnaire (36.8%); the relationship satisfaction score was 89.5/100 and the confidence score was 100/100. Among the 5 patients who had a sexual relationship, all reported having a lot of pleasure during sexual intercourse and reached orgasm at least "regularly". At least 66.7% of the patients were "satisfied" or "very satisfied" about the size and the appearance of genitals. Among the 5 patients who answered questions regarding urinary function, 60.0% had standing micturition, and 80.0% reported being comfortable in public toilets. CONCLUSION: Despite the high frequency of complications and the need for revision surgery, phalloplasty seems to allow a satisfying psychosexual and urinary functions for cis men suffering from penile insufficiency.

Metoidioplasty With Implantation of a Specific Semirigid Prosthesis.

BACKGROUND: Metoidioplasty is a possibility for penis reconstruction in transmen that could be enhanced by a semi-rigid prosthesis support. AIM: Describe the surgical technique of metoidioplasty with implantation of a specifically designed semi-rigid prosthesis -the ZSI100D4- and analyze preliminary results. METHODS: Implantation of semi-rigid prosthesis was proposed to transmen who chose metoidioplasty for genital gender affirming surgery in a specialized university hospital. OUTCOMES: Surgical outcomes were collected from medical files. Functional outcomes and satisfaction were collected post-operatively with a questionnaire. RESULTS: A total of 15 patients were operated; the mean length of followup was 22 months (SD = 8.7). Median prosthesis size was 8.5 cm (range: 8.5-10). Seven (46.7%) minor complications (Clavien-Dindo grade 2; 5 wound dehiscence and 2 fistula, managed conservatively) and 1 severe (Clavien-Dindo grade 3b) complication (Hematoma that need surgical revision) occurred. Thirteen patients (86.6%) answered the questionnaire; 11 (84.6%) reported being either "very satisfied" or "satisfied" with the appearance of the new genitalia; 10 (76.9%) could void while standing; and 12 patients (92.3%) answered "not at all" to the question "do you have regrets about this surgery ?". CONCLUSION: Implantation of a semi-rigid prosthesis in an enlarged clitoris seems to be a valuable option and can be proposed as another possibility for the complex surgical answer to neophallus reconstruction in transmen. Neuville P, Carnicelli D, Paparel P, et al. Metoidioplasty With Implantation of a Specific Semirigid Prosthesis. J Sex Med 2021;18:830-836.

Enhanced Recovery after Robot-Assisted Partial Nephrectomy for Cancer: Is it Better for Patients to Have a Quick Discharge?

OBJECTIVES: The aim of the study was to assess the efficacy and safety of an enhanced recovery program (ERP) after robot-assisted partial nephrectomy (RAPN) for cancer. METHODS: It was a monocentric, retrospective, comparative study. An ERP after RAPN was introduced at our institution in 2015 and proposed to all consecutive patients admitted for RAPN. The control group for this study was composed of patients managed immediately before the introduction of the ERP. We collected information on patient characteristics, tumor sizes, ischemia times, biology, hospital length of stays, postoperative (≤30 days) complications, and readmission rates. Group comparisons were made using the Pearson χ2 test for qualitative data and the Student t test for quantitative data. RESULTS: Between 2015 and 2017, 112 patients were included in the ERP group. Fifty patients were included in the control group. Ninety patients in the ERP group (80.4%) were discharged at or before postoperative day (POD) 2 versus 10 patients (20%) in the control group (p < 0.001). There was no significant difference between the ERP and control groups for the urinary retention rate (respectively 3.6 vs. 2%; p = 0.593). Resumption of normal bowel function was significantly shorter in the ERP group (94.6% at POD1 vs. 69.6% in the control group, p < 0.001). There were no significant differences for postoperative complications (15.2% in the ERP group vs. 20% in the control group, p = 0.447) or readmissions within 30 days (8.04 vs. 0.2%, p = 0.140). CONCLUSIONS: ERP after RAPN seems to reduce postoperative length of stay without increasing postoperative complications or readmissions.

First Outcomes of the ZSI 475 FtM, a Specific Prosthesis Designed for Phalloplasty.

INTRODUCTION: The ZSI 475FtM is a new prosthesis that has recently been specifically designed for phalloplasty. It has several functions that have been conceived to answer the challenges of implantation after phalloplasty: a large base for pubic bone fixation, realistically shaped hard glans, and a pump shaped like a testicle. AIM: To assess the safety, feasibility, and patient satisfaction of the ZSI 475 FtM. METHODS: Surgical outcomes were analyzed after implantation of the prosthesis between June 2016 and September 2017 (single institution, single surgeon). Patients were then asked to answer a satisfaction questionnaire that included the International Index of Erectile Function-5, Erectile Dysfunction Inventory of Treatment Satisfaction, and Self-Esteem and Relationship, as well as other non-validated questions. MAIN OUTCOME MEASURE: Complication rates and the scores of the different questionnaires were reviewed. RESULTS: 20 patients who had gender dysphoria and underwent operation for a female-to-male procedure were included. The mean age was 37.9 years. Complications after 21 implantations included 2 (9.5%) infections that were medically treated (Clavien II), 1 (4.7%) infection treated by explantation (Clavien IIIb), 2 (9.5%) mechanical failures (Clavien IIIb), and 1 (4.7%) malpositioning (Clavien IIIb). The mean follow-up was 8.9 months (SD 4.0), with 50% of the implanted patients having >12 months of follow-up. 14 patients (70%) answered the satisfaction questionnaire. 12 patients (85.7%) had regular penetrative sexual intercourse. The mean International Index of Erectile Function-5 score was 20.2 of 25 (standard deviation [SD] 7.9), the mean Self-Esteem and Relationship score was 84.5 of 100 (SD 9.9), and the mean Erectile Dysfunction Inventory of Treatment Satisfaction score was 82 of 100 (SD 17.5). 13 patients (92.8%) were satisfied or very satisfied with the prosthesis. CLINICAL IMPLICATIONS: This new innovative prosthesis could better answer the challenges faced by the implantation of an erectile device by phalloplasty. STRENGTH & LIMITATIONS: Our study is the first to report data on this new prosthesis. The main limitation is the small number of patients and the short follow-up. CONCLUSION: Preliminary results for the ZSI 475 FtM are encouraging. Safety seems to be satisfactory, and patient satisfaction is high. Long-term studies are needed for further analysis. Neuville P, Morel-Journel N, Cabelguenne D, et al. First Outcomes of the ZSI 475 FtM, a Specific Prosthesis Designed for Phalloplasty. J Sex Med 2019;16:316-322.

Male Sexuality, Fertility, and Urinary Continence in Bladder Exstrophy-Epispadias Complex.

BACKGROUND: The bladder exstrophy-epispadias complex is a rare congenital malformation associated with severe dysfunction of the genital and urinary tracts and requiring a staged surgical reconstruction. AIM: The primary aims of this study were to report the sexuality, infertility, and urinary incontinence outcomes in a cohort of men born with bladder exstrophy-epispadias complex. The secondary aim was to highlight some predictive factors of infertility in this population. METHODS: We conducted a descriptive, cross-sectional study of men diagnosed with classic presentations of bladder exstrophy or epispadias. OUTCOMES: Patients were asked to complete 4 validated questionnaires: the International Index of Erectile Function (IIEF)-5, the Erection Hardness Score (EHS), the Self-Esteem and Relationship, and the International Consultation Incontinence modular Questionnaire-Short Form. Fertility potential was assessed with semen analysis and a non-validated questionnaire. RESULTS: 38 Patients 18-64 years old (M [mean] = 32.2) completed the questionnaires. The average IIEF-5 score was 18.1/25 (ranging from 3-25; SE = 7.62), with results indicating that 55% of the sample had normal erectile function. Results also showed higher scores for patients with normal spermatozoa concentration (M = 22.75, SE = 1.89, P = .08) than for those with oligospermia (M = 17.30, SE = 8.53, P = .08). Results on the IIEF-5 also indicated higher scores for patients who conceived children without assisted reproductive technologies (ART) (M = 22.83, SE = 2.317, P = .02) than for patients without children (M = 15.76, SE = 8.342, P = .02). The average EHS was 3.43/4 (ranging from 1-4, SE = 0.9). EHS was higher for patients who had reconstruction than for patients who had cystectomy (M = 3.88, SE = 1.07 and 2.78, SE = 1.09, P = .02). The average total Self-Esteem and Relationship score was 67.04/100 (ranging from 10.71-96.43, SE = 22.11). The average total International Consultation Incontinence modular Questionnaire-Short Form score was 4.97/21 (ranging from 0-18, SE = 5.44), higher score indicating more urinary incontinence. Among the patients surveyed, 31.6% were parents at the time of study and 50% of them benefited from ART. With regards to the 14 semen analyses performed, only 7.1% produced normal results and 44.7% indicated that ejaculation was weak and dribbling. CLINICAL TRANSLATION: Erectile function appears to be decreased and psychological aspects of sexuality indicate low self-esteem about sexual relationship. Although ethical problems could not allow prospective spermograms, our cohort is large enough to provide significant data. CONCLUSIONS: Early sperm storage for future ART, sexual medicine management, and complementary genital reconstruction in adulthood constitute potential treatment options for this population. Reynaud N, Courtois F, Mouriquand P, et al. Male Sexuality, Fertility, and Urinary Continence in Bladder Exstrophy-Epispadias Complex. J Sex Med 2017;15:314-323.

Complete Human and Rat Ex Vivo Spermatogenesis from Fresh or Frozen Testicular Tissue.

Until now, complete ex vivo spermatogenesis has been reported only in the mouse. In this species, the duration of spermatogenesis is 35 days, whereas it is 54 days in the rat and 74 days in humans. We performed long-term (until 60 days) cultures of fresh or frozen rat or human seminiferous tubule segments in a bioreactor made of a hollow cylinder of chitosan hydrogel. Testicular tissues were obtained from 8- or 20-day-old male rats or from adult human subjects who had undergone hormone treatments leading to a nearly complete regression of their spermatogenesis before bilateral orchiectomy for gender reassignment. The progression of spermatogenesis was assessed by cytological analyses of the cultures; it was related to a dramatic increase in the levels of the mRNAs specifically expressed by round spermatids, Transition protein 1, Transition protein 2, and Protamine 3 in rat cultures. From 2% to 3.8% of cells were found to be haploid cells by fluorescence in situ hybridization analysis of human cultures. In this bioreactor, long-term cultures of seminiferous tubule segments from prepubertal rats or from adult men allowed completion of the spermatogenic process leading to morphologically mature spermatozoa. Further studies will need to address the way of optimizing the yield of every step of spermatogenesis by adjusting the composition of the culture medium, the geometry, and the material properties of the chitosan hydrogel bioreactors. Another essential requirement is to assess the quality of the gametes produced ex vivo by showing their ability to produce normal offspring (rat) or their biochemical normality (human).

Surgical Outcomes of Erectile Implants After Phalloplasty: Retrospective Analysis of 95 Procedures.

INTRODUCTION: The creation of a neophallus is a complex surgery that must meet functional and esthetic requirements. It is a long and demanding surgical process whose final stage consists of the implantation of a rigid or inflatable material that can be used to reproduce an erection. Data in the literature are scarce, with only the pioneering series present, which includes the use of the first devices and techniques. AIM: To report the outcome of patients with phalloplasty after implantation of erectile implants using standardized surgical techniques and the use of recent prosthesis types with or without a vascular graft. METHODS: This is a retrospective hospital-based analysis of all patients with phalloplasty who underwent implantation of an erectile prosthesis from March 2007 to May 2015. Factors associated with complications were investigated by multivariate logistic regression analysis. MAIN OUTCOME MEASURES: Early-onset (during the first month after surgery) and late-onset complications, including erosion, infections, malpositioning, and dysfunction. RESULTS: Sixty-nine patients were included in the study and 95 procedures were analyzed. After a median follow-up of 4 years (minimum = 169 days, maximum = 6.1 years), the original prosthesis was still in place in 43 patients (62.3%). Patients underwent phalloplasty after female-to-male transsexualism (n = 62, 89.9%), malformation (n = 4, 5.8%), or trauma (n = 3, 4.3%). The proportions for the different types of phalloplasty were 58% for forearm free flap phalloplasty (n = 40), 33.3% for suprapubic phalloplasty (n = 23), and 7% for other (n = 6). The erectile prostheses used were the two-piece AMS Ambicor (n = 71, 74.7%), the Ambicor with a vascular graft (n = 19, 20.0%), and the AMS 700CXR, AMS 700CX, or AMS600-650 (n = 5, 5.2%). There were no early-onset complications in 89 procedures (93.7%) and, when present, they were always related to infection (n = 4, 4.2%). Late-onset complications were erosion (n = 4, 4.2%), infection (n = 4, 4.2%), dysfunction (n = 10, 10.5%), and malpositioning (n = 12, 12.6%). No significant difference was observed for malpositioning (12.7% vs 10.5%, P = .87) and dysfunction (7.0% vs 10.5%, P = .78) between the AMS Ambicor prosthesis and the Ambicor prosthesis with a vascular graft. CONCLUSION: This study provides updated data on complications after the implantation of erectile implants. Multicenter studies, including the evaluation of patient satisfaction, are needed to increase our understanding of factors associated with the outcomes.

Surgical outcomes and patients' satisfaction with suprapubic phalloplasty.

INTRODUCTION: Many techniques, specifically forearm free flap phalloplasty, are used in penile reconstructive surgery. Although satisfying, a major disadvantage is the large, stigmatizing scar on the donor site, which leads many patients to explore alternatives. AIM: The aim of this study is to assess the outcomes and satisfaction of patients offered the choice between metaidioplasty, forearm free flap, and suprapubic phalloplasty. METHODS: Medical outcomes from the three-stage surgery were collected from the hospital files of 24 patients, who were also interviewed to assess their satisfaction, sexual function, and psychosexual well-being. MAIN OUTCOME MEASURES: Medical complications, anthropometric measures, and interviewing questionnaire on satisfaction with appearance, sexual function, and psychological variables. RESULTS: Duration of surgery and of hospital stay was relatively short in the first (1 hour 30 minutes; 3 days) and last (1 hour 40 minutes; 3 days) stage of surgery involving tissue expansion and neophallus release. These two stages were associated with few complications (17% and 4% minor complications respectively, 12% additional complications with hospitalization for the first stage). The second stage involving tubing was associated with longer surgery and hospital stay (2 hour 15 minutes; 5 days) and had more complications (54% minor complications and 29% requiring hospitalization) although fewer than one-step surgery. No loss of neophallus was reported. Overall, 95% of patients were satisfied with their choice of phalloplasty, 95% with the appearance, 81% with the length (Mean = 12.83 cm), and 71% with the circumference (Mean = 10.83 cm) of their neophallus. Satisfactory appearance was significantly correlated (P < 0.01) with penile length (r = 0.69) and diameter (r = 0.77). Sexual satisfaction was significantly correlated with penile diameter (r = 0.758), frequency of orgasm (r = 0.71), perceived importance of voiding while standing (r = 0.56), presurgery satisfaction with sexuality (r = 0.58), current masculine-feminine scale (r = 0.58), attractive-unattractive scale (r = 0.69), and happy-depressed scale (r = 0.63). CONCLUSION: Suprapubic phalloplasty, despite the lack of urethroplasty, offers an interesting alternative for patients concerned with the stigmatizing scar on the donor site.

Management of long-term functional sequelae of pelvic fracture urethral injury.

Pelvic fracture (PF) is a rare emergency, which led to pelvic fracture urethral injury (PFUI) in 1.6% to 25% of cases. Urethral injury assessment requires a thorough analysis of the initial injury history and imaging that combine cystourethrography acutely, repeat urethral imaging as well as adjunctive use of MRI in the follow-up period. A more complex surgical approach to the delayed reconstruction of PFUI may be predicted by the urethral gap length (cysto-urethrography) or a lower pubo-urethral angle (MRI). Delayed urethroplasty is the treatment of choice, performed once the patient has recovered from other acute injuries, typically at least 3months post-injury. It consists in men in a bulbo-prostatic anastomotic urethroplasty which may require several steps of increasing complexity to allow a tension-free anastomosis: corpora splitting, partial inferior pubectomy, and rarely total pubectomy or urethra rerouting. More complex cases of PFUI repair may be encountered (long gap between the two urethral segments, bulbar necrosis, false passage after failed endoscopic realignment, orthopedic hardware in pubic symphyseal region, pediatric PFUI, failed previous urethroplasty, associated anterior urethral stricture, or recto-urethral fistula) and should be managed in expert centers. Urethral patency is achieved by surgical reconstruction with an overall success rate of 86%. Evaluation of potential associated sequelae including erectile dysfunction and urinary incontinence must be anticipated and taken into consideration in the path of rehabilitation.

French validation of the oMtFSFI Questionnaire for assessing the sexual function of Transgender women after vulvo-vaginoplasty.

INTRODUCTION: The Operated Male-to-Female Sexual Function Index (oMtFSFI) questionnaire is the first scoring system developed to assess sexual function after gender-affirming vulvo-vaginoplasty, and was initially developed and validated in Italian. The aim of this study was to provide linguistic validation of the questionnaire in French through several steps including use of the questionnaires across a series of patients who had undergone gender-affirming vulvo-vaginoplasty between 2020 and 2022 at two French academic centers. METHOD: The French version of the oMtFSFI questionnaire was obtained through a double translation (Italian to French) and a back-translation (French to Italian), validated by a scientific committee, and cognitively assessed by a panel of expert patients. The questionnaire was then distributed to transgender male to female patients who had undergone genital gender affirming surgery at two French academic centers. RESULTS: The oMtFSFI score consists of 18 questions exploring 7 domains (genital self-image, desire, arousal, lubrication, orgasm, satisfaction, sexual pain). Among the sixty-four patients who responded to the questionnaire, 16 patients (25%) reported abstaining from sexual activity involving vaginal penetration at the time of the study were excluded. The mean total score was 37, corresponding to mild to moderate sexual dysfunction and 60.4% of the patients reported normal overall sexual function. The level of sexual satisfaction was normal for 68.8% of the patients and the genital self-image was normal for 52.1%. Most of the patients (79.2%) reported at least mild dyspareunia and 10.4% had critical sexual dysfunction. Surgery improved gender dysphoria in 96.7% of patients. There was a strong correlation between the overall oMtFSFI score and the happiness Visual Analog Scale (VAS) (P<0.001) as well as with the quality of life VAS (P<0.001). CONCLUSION: The French version of the oMtFSFI questionnaire is the only scoring system specifically developed to assess sexual function after vulvo-vaginoplasty in transgender women linguistically validated in French. Its validation in French language makes it an interesting tool for research and clinical practice.

Surgical management for penile fracture: A retrospective, observational, multicenter study.

INTRODUCTION: The objective of this study is to make an inventory of surgical practices and their consequences in the short and medium term on sexuality and micturition comfort. MATERIALS AND METHODS: It is a retrospective multicenter study over ten years on 63 men who had an operation for a fracture of the corpora cavernosa associated or not with a urethral lesion. Patient history, clinical presentation, surgical management as well as postoperative data were collected from operative reports. Residual penis curvature, IIEF5 score, IPSS score and residual pain were collected during a telephone interview during data collection. RESULTS: No statistically significant difference was demonstrated for IIEF5, IPSS, sequelae curvature, pain during intercourse, time to resumption of sexual life, rate of surgical resumption between use of absorbable or non-absorbable threads and between the realization of an overlock or a separate point. We found a significant difference in the time taken to resume sexual activity, between surgical exploration by degloving compared to elective surgical exploration. CONCLUSION: Our study shows great variability in the surgical management of penile fractures, with no influence in the short and medium term on sexuality and urination comfort. Medium-term complications such as erectile dysfunction, curvature of the penis and pain during sexual intercourse seem frequent and insufficiently diagnosed, but decrease during urological follow-up.

Bilateral Pedicled Scrotal Flaps as an Alternative to Skin Graft in Penile Shaft Defects Repair.

OBJECTIVE: To analyze surgical and functional outcomes of bilateral pedicled scrotal flaps for penile shaft reconstruction. MATERIALS AND METHODS: A retrospective analysis was performed on 22 patients who underwent penile shaft reconstruction with bilateral pedicled scrotal flaps between 2009 and 2017. Demographics, peri-operative data, and surgical complications were collected. Functional outcomes were analyzed using a questionnaire made of the erection hardness score, the patient and observer scar assessment scale, and a 10-point Likert scale measuring patients... satisfaction about their skin coloration, sensitivity, elasticity and thickness, penile size, scrotal volume, erection quality, penetration ability, pain, sexual satisfaction, body image, masculinity, self-esteem, and global satisfaction. RESULTS: Patients exhibited a wide range of indications, including buried penis (27.2%), or subcutaneous injections of foreign material (27.2%). Early complications were suture dehiscence (31.8%), infection (13.6%) and hematoma (4.6%), associated with 9.1% of surgical revisions. Late complications were skin retraction (27.3%), testicular ascension (22.7%), pyramidal shape (4.6%) or shortening (13.6%) of the penis, associated with 27.3% of surgical revisions. For the 12 patients who answered the questionnaire, median erection hardness score and patient and observer scar assessment scale score [IQR] were 3.5 out of 4 [2.5-4] and 11.5 out of 60 [9.5-22], respectively. The patients reported a positive impact of the surgery on their psychological condition, with a median score of global satisfaction of 8 [IQR 7.5-9.5]. CONCLUSION: Bilateral pedicled scrotal flaps seem.ßto be a safe alternative for shaft defects reconstruction despite a potential need of surgical revision, providing satisfactory functional outcomes.

Rectourethral Fistula Induced by Localised Prostate Cancer Treatment: Surgical and Functional Outcomes of Transperineal Repair with Gracilis Muscle Flap Interposition.

BACKGROUND: Transperineal repair of rectourethral fistula (RUF) following prostate cancer treatment with gracilis muscle flap interposition (GMFI) leads to favourable outcomes, but published data are still lacking, notably concerning functional aspects. OBJECTIVE: To assess surgical and functional outcomes of this treatment of RUF. DESIGN, SETTING, AND PARTICIPANTS: A retrospective study was conducted in two referral hospitals including 21 patients who underwent RUF transperineal repair with GMFI between 2008 and 2020. SURGICAL PROCEDURE: The standard vertical perineal approach is performed for fistula dissection. Bladder and rectal defects are closed separately. After dissection from its facia, the flap is harvested, preserving its pedicle; it is brought to the perineum and placed between the urethra and the rectum to fully cover the sutures. MEASUREMENTS: Fistula closure (clinical data and postoperative cystography), digestive stoma closure, and complications graded according to the Clavien-Dindo classification were reviewed. Functional results were assessed using the Urinary Symptom Profile (USP) questionnaire, anal incontinence St Mark's score, Patient Observer Scar Assessment Scale (POSAS) score, and a nonvalidated Likert scale questionnaire assessing issues with lower extremity functionality. RESULTS AND LIMITATIONS: The median (interquartile range) follow-up was 27 (8-47) mo. Fistula closure was successful for 20 patients (95% success). Digestive stoma was closed in 10/12 shunted patients (83%). Two (9%) Clavien-Dindo grade ≥3b complications were reported (one urinoma in a kidney transplant patient and one thigh haematoma evacuation). Eighteen patients (86%) completed the postoperative questionnaire; 11/18 (61%) had significant urinary incontinence. The mean (standard deviation) USP dysuria score was 1/9 (1.2), mean St Mark's score was 5/24 (5), mean POSAS score was 19/70 (11), mean lower extremity functionality score was 2/20 (4), and mean procedure patient satisfaction score was 9/10 (2). The retrospective design and limited number of patients are the main limitations. CONCLUSIONS: The present study found an excellent success rate and low morbidity for RUF transperineal repair with GMFI. Functional outcomes were satisfactory despite a high urinary incontinence rate. PATIENT SUMMARY: We performed an analysis of the outcomes of perineal approach surgery with muscle interposition for closing abnormal communication between the bladder and the rectum after prostate cancer treatment. This surgical technique was found to be safe to perform and provides a high success rate, with patients being satisfied despite poor urinary continence outcomes.

Human ovarian cryopreservation: vitrification versus slow freezing from histology to gene expression.

Cryopreservation of ovarian tissue is one of the strategies offered to girls and women needing gonadotoxic treatment to preserve their fertility. The reference method to cryopreserve is slow freezing; vitrification is an alternative method. The aim was to evaluate which of the two is the best method for human ovarian tissue cryopreservation. Each ovary was divided into three groups: (i) fresh; (ii) slow freezing; and (iii) vitrification. An evaluation of the follicular density, quality and the expression six genes (CYP11A, STAR, GDF9, ZP3, CDK2, CDKN1A) were performed. We observed no significant difference in follicular density within these three groups. Slow freezing altered the primordial follicles compared to the fresh tissue (31.8% vs 55.9%, p = 0.046). The expression of genes involved in steroidogenesis varied after cryopreservation compared to the fresh group; CYP11A was under-expressed in slow freezing group (p = 0.01), STAR was under-expressed in the vitrification group (p = 0.01). Regarding the expression of genes involved in cell cycle regulation, CDKN1A was significantly under-expressed in both freezing groups (slow freezing: p = 0.0008; vitrification: p = 0.03). Vitrification had no effect on the histological quality of the follicles at any stage of development compared to fresh tissue. There was no significant difference in gene expression between the two techniques.

Long-Term Functional Outcomes After Surgical Correction of Congenital Penile Curvature.

OBJECTIVES: To present the surgical results and the functional outcomes after surgical correction of congenital penile curvature (CPC) by different plication techniques. METHODS: All consecutive patients operated for CPC from 2010 to 2019 in a university hospital of Lyon, France, were retrospectively identified and included for analyzing surgical results. They were proposed to answer a questionnaire (between January 2020 and May 2020) that included questions of the Peyronie's Disease Questionnaire (PDQ), the Erection Hardness Score (EHS), and the Internal Index of Erectile Function (IIEF5), along with non-validated specific questionnaires. RESULTS: A total of 31 patients were included, their mean (SD) age was 21.2 (4.9) years, their mean (SD) follow-up of 55.5 (33.7) months. The principal curvature was ventral for 25 (80.6%) patients. After the surgery, 28 (90.3%) patients had straight penis or a residual curvature less than 15°, and 2 (6.5%) required a second surgery. A total of 23 (74.2%) patients answered the post-operative questionnaire. The mean (SD) scores were 1.2/16 (1.8) for PDQ-Bothered Score, 1.5/24 (2.1) for PDQ Psychological and Physical, and 1.7/30 (2.7) for PDQ pain. The mean (SD) IIEF5 was 22.7/25 (4.6). All patients had an EHS of 4/4. There were 10 patients who never had sexual intercourse before the surgery and 4 who still had not when answering the questionnaire. All patients (23/23) were either "satisfied" or "very satisfied" with the outcomes of the operation, and 13 (56.5%) reported improvement of their sexual life after surgery. CONCLUSION: This study confirmed the favorable outcomes of surgical plication for CPC with low morbidity. A concomitant sexological care may be useful for some patients.