Home modeling after penile prosthesis implantation in the management of residual curvature in Peyronie's disease.

The aim of this study was to study the clinical effectiveness of a structured home modeling (HM) protocol in Peyronie's disease (PD) patients who have residual curvature up to 45° after inflatable penile prosthesis (PP) placement. A total of 92 patients with PD and coexistent refractory erectile dysfunction received inflatable PP. If residual curvature after manual modeling (MM) was more than 45°, incision-grafting was performed. If curvature was <45° after MM, patients were instructed to perform HM daily for 6 months, after 4 weeks from PP implantation. The mean preoperative penile curvature was 39.4 ± 5.7° (30-60). Sixteen (17.4%) patients required incision-grafting and the remaining 76(82.6%) patients followed HM protocol. The mean postoperative residual curvature after MM was 29.7 ± 3.2° (5-50). Sixty-five (85.5%) patients who underwent HM had 10° or less residual curvature after 3 months and 72 (94.7%) patients had 10° or less residual curvature after 6 months. Seventy (92.1%) patients responded as satisfied or very satisfied on the questionnaire with the outcome after 6 months. HM of the penis over Inflatable PP may straighten the penis without the need for an additional surgical maneuver in vast majority of the PD patients having residual curvature of <45°.

Complications of robot assisted radical prostatectomy.

The urology community has adopted robot-assisted radical prostatectomy (RARP) as the most preferred surgical therapeutic approach in the management of localized prostate cancer. Safety and potential complications of RARP should be clearly known prior to attempting the surgery. The complications have been categorized as anesthesia & patient positioning related, vascular, non-vascular and delayed. European Associationof Urology guidelines recommend the use of Clavien-Dindo grading to report surgical complications.The median rate of over all complications of RARP is12.6%, with a range of 3.1-42%. Most of the complications are minor (Clavien-Dindo grades 1 and 2). With a dedicated approach, increasing experience, being aware of possible complications, and strict adherence to safety measures, most complications are preventable. RARP is a safe and reproducible technique.

ARTICULO SOLO EN INGLES.La comunidad urológica ha adoptado la prostatectomía radical asistida por robot (PRAR) como el abordaje terapéutico preferido en el tratamiento del cáncer de próstata localizado. La seguridad y las complicaciones potenciales de la PRAR deben ser claramente conocidas antes de intentar la cirugía. Las complicaciones se han clasificado como relacionadas con la anestesia y la colocación del paciente, vasculares, no vasculares y diferidas. Las guías clínicas de la Asociación Europea de Urología recomiendan utilizar la escala de Clavien-Dindo para comunicar las complicaciones. La tasa media global de complicaciones de la PRAR es del 12,6%, con un rango entre 3,1- 42%. La mayoría de complicaciones son menores (Clavien-Dindo grados 1-2). Con un abordaje dedicado, el aumento de la experiencia, conocer las posibles complicaciones y una estricta adherencia a las medidas de seguridad hacen que la mayoría de complicaciones sean prevenibles. La PRAR es una técnica segura y reproducible.