Risk of unfavorable outcomes after penile prosthesis implantation - results from a national registry (INSIST-ED).

Like all surgeries, penile prosthesis implantation (PPI) has the potential for both postoperative complications and suboptimal patient satisfaction. In order to assess risk factors for poor satisfaction, we reviewed patients who had been prospectively recruited in a national multi-institutional registry of penile prostheses procedures (INSIST-ED) from 2014 to 20121. Patient baseline characteristics and postoperative complications were recorded. The primary endpoint of this study was unfavorable outcomes after inflatable PPI, defined as significant postoperative complications (Clavien-Dindo ≥2) and/or Sexuality with Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) scores below the 10th percentile. A total of 256 patients were included in the study. The median age was 60 years (IQR 56-67). The most common cause of erectile dysfunction (ED) was organic (42.2%), followed by pelvic surgery/radiotherapy (39.8%) and Peyronie's disease (18.0%). Postoperative complications were recorded in 9.6%. High-grade complications (Clavien ≥2) occurred in 4.7%. At 1-year follow-up, the median QoLSPP total score was 71 (IQR 65-76). In all, 14.8% of patients were classified as having experienced unfavorable outcomes because of significant postoperative complications and/or QoLSPP scores below the 10th percentile. Logistic regression analysis demonstrated patient age to be non-linearly associated with the risk of experiencing unfavorable outcomes. A U-shaped correlation showed a lower risk for younger and older patients and a higher risk for middle-aged men. ED etiology and surgical volume were not associated with PPI outcomes. Physicians should, therefore, be aware that middle-aged men may be at higher risk of being unsatisfied following PPI compared to both younger and older patients.

INSIST-ED: Italian Society of Andrology registry on penile prosthesis surgery. First data analysis.

OBJECTIVES: The Italian Society of Andrology, i.e. "Società Italiana di Andrologia" (S.I.A.), launched on December 2014 a prospective, multicenter, monitored and internal review board approved Registry for penile implants, the "INSIST-ED" (Italian Nationwide Systematic Inventarisation of Surgical Treatment for ED) Registry. Purpose of this first report is to present a baseline data analysis of the characteristics of penile implant surgery in Italy. MATERIAL AND METHODS: The INSIST-ED Registry is open to all surgeons implanting penile prostheses (all brands, all models) in Italy, providing anonymous patient, device, surgical procedure, outcome, follow-up data, for both first and revision surgeries. A Registry project Board overviews all the steps of the project, and a Registry Monitor interacts with the Registry implanting surgeons. RESULTS: As by April 8, 2016, 31 implanting surgeons actively joined the Registry, entering 367 surgical procedures in its database, that comprise: 310 first implants, 43 prosthesis substitutions, 14 device explants without substitution. Implanted devices account for: 288 three-component devices (81,3%), 20 two-component devices (5,4%), 45 non-hydraulic devices (12,3%). Leading primary ED etiologies in first implant surgeries resulted: former radical pelvic surgery in 111 cases (35,8%), Peyronie's disease in 66 cases (21,3%), diabetes in 39 cases (12,6%). Two intraoperative complications have been recorded. Main reasons for 57 revision surgeries were: device failure (52,6%), erosion (19,3%), infection (12,3%), patient dissatisfaction (10,5%). Surgical settings for patients undergoing a first penile implant were: public hospitals in 251 cases (81%), private environments in 59 cases (19%). CONCLUSIONS: The INSIST-ED Registry represents the first European experience of penile prosthesis Registry. This baseline data analysis shows that: three-pieces inflatable prosthesis is the most implanted device, leading etiology of erectile dysfunction (ED) in patient receiving a prosthesis is former radical pelvic surgery, primary reason for revision surgery is device failure, primary settings for first penile implant surgery are public hospitals. Evaluation of penile implant impact on recipients quality of life is presently ongoing.

Once-a-day Tadalafil administration improves the spermogram parameters in fertile patients.

OBJECTIVES: We explored the safety of Tadalafil once-daily treatment for 12 week and its effects on semen quality in a clinical subpopulation of men with psychogenic erectile dysfunction (ED). PATIENTS AND METHODS: Twenty-seven men, between 19 and 35 years, unaware of their fertility status, suffering from psychogenic ED were enrolled. The examination of the seminal fluid was performed twice before administration of Tadalafil and twice after three months of continuous daily administration of Tadalafil 5 mg. The volume of the seminal fluid, the concentration of sperm, the concentration of sperm with type "a+b" motility, the concentration of sperm with type "a" motility, the concentration of normal sperm were taken into consideration. The results before treatment with Tadalafil (T0) and after 3 months of treatment (T3m) were compared. RESULTS: The administration of once-daily Tadalafil 5mg, brings to an average increase of the total number of sperm cells, both total and fast motility (type a) and the percentage of nemasperms, and to an average increase of semen volume of only 0.41 ml. These quantitative and qualitative improvements of the seminal fluid resulted statistically significant as regard motility, nemasperm percentage and seminal fluid volume. No unespected safety findings were observed. CONCLUSIONS: Tadalafil administration improves the quality of sperm cells and seminal fluid: in particular motility, percentage of nemasperms and volume of seminal fluid. We emphasize the safety of the once-daily treatment with tadalafil 5mg and the positive effects on spermatogenesis.

Spontaneous rupture of urinary bladder: a case report and review.

Spontaneous rupture of the bladder is a rare event. The clinical presentation shows the signs and symptoms of peritonitis, but the diagnosis is made at the operating table. This event is burdened with a high mortality rate. We present a case report of a 73-year-old man who came to our observation. He was a chronic carrier of urinary catheter, at least 7 times removed traumatically by himself. At the time of admission he showed drastic reduction in urine output, absence of hydronephrosis, normal functioning of the catheter, a tense and widely meteoric abdomen, the presence of air-fluid levels, normal kidneys, absence of free fluid in the abdomen. The CT showed a fluid collection of about 7 cm diameter between the bladder and rectum. The explorative laparotomy found a small fissuration of the posterior wall of the bladder. For his severe conditions, the patient died a few hours after surgery, in intensive care unit. Although it is a rare event, since 1980, 177 cases of spontaneous rupture of the bladder are reported in the literature. Their causes may be essentially divided into two groups: for increase of intravesical pressure; or for weakening of the bladder wall. In most cases, the spontaneous rupture of the bladder takes place in presence of a urothelial neoplasm or after radiation therapy of the pelvic organs. The etiology of spontaneous rupture of the bladder in our case does not relate to a bladder tumor or radiotherapy. It may have been caused by repeated episodes of acute retention of urine with extreme bladder distension up to 3 liters. It is not easy to think of a bladder perforation in patients presenting signs of peritonitis without a history of bladder cancer or pelvic radiotherapy. A CT with intravesical contrast medium could help the diagnostic orientation.

Torsion of a neoplastic intrascrotal testis: when the torsion reveals the mass. A case report and review.

Cases of torsion of the spermatic cord are rare in men over 30-years-old. Testicular tumors manifest themselves rarely with symptoms of acute scrotum. We report the case of a 38-years-old patient who presented for a suspected left testis torsion. On examination, the testicle was markedly increased in size and painful. The manual derotation made pain dramatically disappear. He came to our attention after about a month asking for an orchidopexy. During the surgery a biopsy was performed. The diagnosis was a Yolk Sac Tumor. A radical inguinal orchiectomy was performed with left hemiscrotal excision, "in block". He performed four cycles of chemotherapy and with no recurrence after 12 months of follow-up. In literature only seven cases of torsion of an intrascrotal testicle with cancer are reported. Our case is the eighth one.