How and why tobacco use affects reconstructive surgical practice: a contemporary narrative review.

Background and Objective: The overall negative impact of tobacco use on an individual's health has been well documented but the literature on tobacco's impact on post-surgical outcomes, specifically the outcomes after urologic surgery, is not as clear cut. The aim of this narrative review is to provide urologists with the information needed to have a nuanced pre-operative counseling conversation with patients about tobacco use. Here we combine publications on the histologic and physiologic changes induced by nicotine and tobacco use with publications from the wider surgical literature on post-operative outcomes in tobacco users. Methods: A literature search of PubMed, Google Scholar and Medline was performed using iterations of the following terms: tobacco, nicotine, changes, physiologic, histology, post-operative, and surgical. Non-English publications and abstracts were excluded. Inclusion required agreement from all authors and preference was given to human specimens over animal models for the basic science manuscripts and large database and meta-analyses over single institution experiences. Key Content and Findings: Tobacco use results in measurable changes in nearly every organ system in the body. While smokers have increased wound complications, there is no evidence that reconstructive surgery using grafts or flaps fail more frequently in tobacco users. Smokers have an increased risk of respiratory complications following endotracheal intubation. Conclusions: Surgeries should not be canceled due to a patient's inability to cease tobacco use. Urologists and patients should engage in joint decision making regarding the timing and pursuit of elective operations.

Evaluation and management of urologic complications following transmasculine genital reconstructive surgery.

AIMS: Transmasculine genital reconstructive surgery involves the creation of a neourethra by way of metoidioplasty or phalloplasty. We aim to describe approaches in identifying complications associated with these procedures as well as the various reparative techniques that can be utilized to reestablish the neourethral tract. METHODS: We prepared a guide to diagnostic and procedural interventions for urologic complications following transmasculine genital reconstructive surgery based on our clinical experience as well as those of our colleagues. We reviewed all current peer-reviewed publications based on this topic. RESULTS: These procedures have a considerable revision rate for urologic complications, which include urethrocutaneous fistulae, persistent vaginal remnant, and urethral strictures. These complications often present simultaneously and require appropriate workup and treatment. CONCLUSIONS: Several reconstructive techniques can be employed to restore the neourethral tract, as we describe in detail.

Epididymal leiomyoadenomatoid tumor: A case report of a rare benign paratesticular mass.

Primary tumors of the epididymis are rare and commonly benign in nature. Leiomyoadenomatoid tumors are a rare subvariant of adenomatoid tumors that combines features of leiomyomas. Tumor histology is notable for tubular spaces lined by mesothelial cells with a proliferative spindle cell component. To the best of our knowledge, few cases have been reported in the literature. We report a case of leiomyoadenomatoid tumor in a 58-year-old male.

Gender Affirmation Surgery, Transfeminine.

Feminizing genital surgery for transgender women is a feasible and fulfilling intervention in alleviating gender dysphoria. Several techniques in neovaginal creation can be offered, including vulvoplasty, penile skin inversion vaginoplasty, peritoneal vaginoplasty, and enteric vaginoplasty. Complication rates are low and often managed conservatively. Favorable sexual function outcomes indicate high satisfaction rates.

Combined intra- and extra-peritoneal bladder perforation following rectal impalement injury.

A 62-year-old male presented with abdominal pain and hematuria following impalement of the rectum with a wooden foreign object. CT imaging showed air and fluid in the peritoneum prompting the patient to undergo abdominal exploration. An anterior rectal perforation was discovered along with dual bladder lacerations of the posterior wall and dome. The patient underwent a diverting colostomy and primary bladder repair. Post-operative course was uncomplicated and bladder repair was followed via cystograms with catheter removal 2 months post-operatively. Four months after the injury the patient underwent colostomy closure and remains with normal bladder and bowel function at 21-month follow-up.

Destructive domino: Subcutaneous self-implanted penile foreign body implicated in rule-out penile fracture.

41-year-old male presented with significant penile swelling following sexual intercourse. Two years earlier while incarcerated, the patient self-inserted a 1.5 cm subcutaneous penile foreign body (FB) made from a domino piece. An original concern for penile fracture was successfully ruled out by penile ultrasound, and computed tomography ruled out deep infection. Bloodwork otherwise revealed leukocytosis, and the patient was admitted for intravenous antibiotics and observation. Penile cellulitis and hematoma clinically improved, and the FB did not require removal. At 18 month follow up, the patient maintains normal urological and sexual function.