Inguinal Lymphadenectomy for Penile Cancer: An Interim Report from a Trial Comparing Open Versus Videoendoscopic Surgery Using a Within-patient Design.

Background and objective: Nodal metastasis is a major survival and prognostic factor in penile cancer (PeCa). Thus, accurate staging, prognosis, and treatment selection require adequate inguinal lymphadenectomy (ILND). ILND surgery should balance oncologic rigor with morbidity and postoperative complications. Our aim was to compare the feasibility and safety of open ILND (OILND) and videoendoscopic ILND (VEILND) in patients with PeCa. Methods: We conducted a single-center randomized trial with a within-patient design between October 2019 and April 2023. Patients who were undergoing either staging or radical ILND for PeCa were included and randomized to receive either OILND or VEILND on one side, with the other technique then used on the contralateral side. The trial was approved by the local ethics committee and was registered on ClinicalTrials.gov (NCT05887921). The primary outcome was the safety of VEILND. Secondary outcomes included intraoperative and postoperative morbidity rates and surgical outcomes for the two procedures, as well as oncological outcomes according to survival estimates. Key findings and limitations: We included 14 patients in the study. Median follow-up was 12 mo (interquartile range [IQR] 12-17). There were no significant differences in operative time and the number of lymph nodes removed between OILND and VEILND. However, the median time to drain removal was significantly shorter in the VEILND group (15 d, IQR 13-17, 95% confidence interval [CI] 12-17) than in the OILND group (27 d, IQR 20-41, 95% CI 24-31; p = 0.025). No intraoperative complications were observed, but postoperative complications occurred in three cases (21.4%, 95% CI 8.4-37.8%) in the VEILND group and eight (57.1%, 95% CI 18.6-54.3%) in the OILND group (p = 0.032). Conclusions and clinical implications: VEILND represents a safe technique to consider for either staging or curative intent in PeCa and seems to have an advantage over OILND in terms of morbidity. Further high-powered studies are warranted to confirm these preliminary results. Patient summary: We compared the outcomes of two different surgical techniques to remove lymph nodes in patients with penile cancer. We found that a video-assisted keyhole surgery approach seems to result in a lower rate of complications than after open surgery.

Shear Wave Elastography in Assessing Spongiofibrosis of Urethral Stricture: Is It Clinically Useful?

RATIONALE AND OBJECTIVES: To compare urethral stricture shear wave elastography (SWE) with normal areas and assess its association with other explanatory variables. SUBJECTS AND METHODS: we recruited all men with urethral stricture disease referred to our center between December 2021 and July 2023. Patients underwent SWE and elasticity in the stricture area, and one and three centimeters distant from the stricture were measured. Gathered data were analyzed using Freidman and post hoc analysis, correlation methods, student t-tests, and one-way ANOVA. RESULTS: 22 patients were recruited for our study. Spongiofibrosis was significantly higher in the stricture area relative to the one-centimeter-distant adjacent area (p < .0005), in the one-centimeter-distant compared to the three-centimeter-distant area (p = .002), and in the stricture area relative to the three-centimeter-distant area (p < .0005). There was no association between elasticity ratio and patient age or stricture location. Likewise, there was no difference in elasticity ratios between bulbar and pendulous strictures (p = 0.19) or among different etiologies of urethral strictures (p = 0.76). CONCLUSION: There is a significant difference in elasticity between the urethral stricture area and other parts of the corpus spongiosum. Normal areas closer to strictures are stiffer. The elasticity ratio is unrelated to patient age or prior internal urethromies. Neither stricture locations nor distinct urethral stricture etiologies differed in elasticity ratios.

Small intestinal submucosa graft bulbar urethroplasty is a viable technique: results compared to buccal mucosa graft urethroplasty after propensity score matching.

PURPOSE: Small intestinal submucosa (SIS) graft urethroplasty has been employed to decrease buccal mucosa morbidity and facilitate the procedure. The first published series had a short follow-up, inhomogeneous patient selection, and a lack of a control group. Our purpose is to report treatment outcomes at 13 years in a propensity score-matched cohort comparing bulbar urethroplasty with SIS (SISU) or buccal mucosa (BMU). METHODS: From our institutional database of 1132 bulbar urethroplasties, we used propensity score matching with the nearest-neighbor method without replacement to generate a study sample of 25 BMU and 25 SISU. Failure was defined as any treatment after urethroplasty. Survival analyses were used to analyze treatment failure occurrence with data censored at 156mo. RESULTS: Matching resulted in a complete correction of bias between the two samples except for the follow-up duration, which was slightly longer in the SIS group. The cumulative treatment success probability of BMU and SISU at 156mo was 83.4% and 68%, respectively. At multivariable Cox regression, SIS graft, previous urethrotomy, stricture length, and lower postoperative Qmax (within 2mo after catheter removal) were predictors of failure. Stricture length had a more remarkable effect in SISU, with estimated survival probabilities from the Cox model lower than 80% in strictures > = 3 cm. CONCLUSION: SIS has poorer outcomes compared to BM but may still be useful when BM grafting is not possible. The best candidates for SISU, with similar success to BMU, are patients with strictures shorter than 3 cm, preferably without a history of DVIU.

Effects of posterior tibial nerve stimulation (PTNS) on lower urinary tract dysfunction: An umbrella review.

BACKGROUND: Lower urinary tract dysfunction (LUTD) is a common, troublesome condition that often negatively affects patients' quality of life. Current literature has long been interested in how posterior tibial nerve stimulation (PTNS) can affect this condition. AIM: To extensively and systematically explore how PTNS affects LUTD based on the most recent systematic reviews. METHODS: A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the systematic reviews, with or without meta-analysis that assessed the effects of PTNS on LUTD were retrieved. The quality of the included studies was assessed using the Joanna Briggs Institute tool, and analysis was conducted using the Comprehensive Meta-Analysis version 3 tool. RESULTS: From a total of 3077 citations, 20 systematic reviews entered this study, and 13 of them included meta-analysis. The population of studies varied vastly, for instance, some studies included only children or women while other focused on a specific pathology like multiple sclerosis-induced neurogenic LUTD. The majority of included studies reported an overall improvement in LUTD following percutaneous PTNS, although admitting that these results were derived from moderate to low-quality evidence. CONCLUSION: The findings of this thorough umbrella review showed that the positive benefits of PTNS in treating LUTD are currently supported by low-quality evidence, and it is crucial to interpret them with great care.

Penoscrotal approach for inflatable penile prosthesis implant: why it should be preferred.

INTRODUCTION: Inflatable penile prosthesis are the definitive treatment for erectile dysfunction. The two most used surgical approaches to position the implants are the penoscrotal and the infrapubic. Current trends showed that the penoscrotal approach is extensively preferred however, there is not conclusive evidence demonstrating the superiority of one technique over the other. The aim of this review is to summarize the scientific evidence available and to underline strengths and weaknesses of the two techniques. EVIDENCE ACQUISITION: We conducted a comprehensive search of MEDLINE, Cochrane Library, and National Center for Biotechnology Information PubMed to identify relevant published articles. The included studies had to explicitly examine the use of three-piece inflatable penile prosthesis with a focus on the surgical access method and complications. EVIDENCE SYNTHESIS: Twenty-six articles were included in the review: seven narrative reviews, five retrospective observational studies, five prospective observational studies, and nine mixed methodology studies. The most frequent approach was the penoscrotal, which was also found more comfortable (RG1) by the operators in one study. The infrapubic approach lasts less and one study demonstrated higher satisfaction by the patients. CONCLUSIONS: There is no evidence of significant differences in complications among the penoscrotal and infrapubic approaches. While the infrapubic approach is faster and patients were more satisfied, the penoscrotal approach is the most used by far. This is likely related to the more straightforward procedure through this access and the excellent surgical field exposure. For these reasons, it is also preferred in the most complex cases.

Feasibility and Outcomes of Temporary Bulbar Urethral Stent Placement After Internal Urethrotomy in the Largest Multicenter Series.

BACKGROUND: Recent years have seen the development of a new generation of temporary urethral stents as an adjuvant option after direct vision internal urethrotomy (DVIU). Despite some early promising results, large series addressing their safety and outcomes are still lacking. OBJECTIVE: To report complications and outcomes from the largest series of patients receiving a temporary bulbar urethral stent to date. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective analysis of bulbar urethral stenting procedures after DVIU in seven centers. Patients either refused urethroplasty or were not fit for surgery. The stents were removed after at least 6 mo in place unless complications requiring earlier removal occurred. SURGICAL PROCEDURE: DVIU with a cold knife or laser is performed, followed by stent placement. At the end of the treatment period, the stent is removed under cystoscopy with gripping forceps. MEASUREMENTS: All patients underwent postoperative follow-up (FU) for assessment of complications while the stent was in place. After removal, the FU schedule consisted of office evaluation at 6 mo and 12 mo, and then annually. Failure was defined as any treatment for urethral stricture after stent removal. RESULTS AND LIMITATIONS: A total of 49% of the patients experienced complications. The most frequent were discomfort (23.8%), stress incontinence (17.5%), and stent dislocation (9.8%). Some 85% of the adverse events observed were Clavien-Dindo grade <3. The overall success rate at median FU of 38.2 mo was 76.9%. The success rate was significantly lower if the stent was removed before 6 mo (53.3% vs 79.7%; p = 0.026). CONCLUSIONS: Temporary urethral stents may be a safe choice with satisfactory results in patients not undergoing urethroplasty. A stent indwelling time shorter than 6 mo provides worse outcomes that are comparable to those with DVIU alone. PATIENT SUMMARY: We assessed complications and outcomes after placement of a temporary narrow tube in the urethra after surgery to widen a narrowing of the urethra. The treatment is safe and easily reproducible with satisfactory results. Further studies are needed to confirm our findings.

Use of Temporary Membrane-Covered Self-Expandable Metallic Stent - UVENTATM for Treatment of Recurrent Bulbar Urethral Stricture.

Introduction: Recurrent urethral stricture is a real challenge. Interestingly use of temporary double layered self-expanding nitinol urethral stent with polytetrafluoroethylene (PTFE) membrane coating (UventaTM, Taewoong Medical, South Korea) has been recently reported with promising short-term results in recurrent urethral stricture. However most of the reported studies are published as abstracts of either case reports or case series of miniscule numbers. The aim of our study is to evaluate the outcome of this temporary urethral stent in patients with recurrent urethral stricture after urethroplasty as well as after multiple visual internal urethrotomy. Materials and Methods: In this retrospective study, 22 patients had placement of double-layered self-expanding stent with PTFE membrane coating (Uventa, Taewoong Medical) for recurrent bulbar strictures. The present study included cases between 2017 and 2020. The stricture in each patient were evaluated with Uroflowmetry and ascending urethrography. The data of demographic and clinical characteristics included age, aetiology, location and length of stricture, along with maximum urinary flow rate (Qmax), number of previous interventions, and stent-related complications. Results: The overall clinical success was achieved in 13/22 (59.1%) of patients at a median follow-up of 17 months (range 2-44). The mean maximum urine flow rates were 7.07 ± 3.55mL/sec, 23.50 ± 10.41mL/sec, 21.41± 15.55 mL/sec, 14.88 ± 9.77 and 17.63 ± 12.28 mL/sec before, while stent in place, at 3 months, 6 months and 12 months after the procedure, respectively. Conclusion: In our study, the success rate of temporary urethral stent placement has remained at 59.1% at a median follow-up of 17 months. We conclude that further randomized controlled studies with long-term follow up are required to fully evaluate the outcome.

Penile injection of aedile silicone: A dangerous shortcut.

INTRODUCTION: The size of penis can cause concern in patients, even if the organ is clinically normal. Additionally, the cost of phosphodiesterase 5 inhibitors (iPDE5) and long waiting lists to access penile prosthesis placement can lead patients to resort to non-medical and potentially dangerous alternatives. One of these dangerous alternatives is the injection of building silicone at the level of the subcutis of the penis or the corpora cavernosa causing the formation of a granuloma that increases the girth and consistency of the penis. CASE REPORT: The article describes the case of a 43-year-old patient who self-injected aedile silicone at the level of his penis in an attempt to achieve greater penile size and greater rigidity. The patient reported that he could not economically afford the iPDE5.The persistence of severe pain in the penis forced the patient to go to a urological examination. The patient subsequently underwent the penile granuloma exeresis procedure and skin reconstruction with scrotal flap. CONCLUSION: The pursuit of sexual well-being can lead some patients to rely on unconventional and potentially harmful techniques. The role of the andrologist and of the scientific society should be to dissuade the patient from using these dangerous methods and to provide valid alternatives accessible to the patient. The economic difficulty in purchasing drugs that facilitate erection or the long waiting lists for the placement of penile prostheses can favor dangerous methods such as penile injection of silicon. There is therefore a clear need to facilitate access to drugs and surgical techniques that favor the patient's sexual well-being.

UVENTA urethral stents: Are we taking a step forward? The first clinical series. / Stent uretral UVENTA: ¿Un paso para adelante? La primera serie clínica.

OBJECTIVES: To describe first clinical results in term of safety, complications and short term efficacy of temporary placement of UVENTA urethral stent in the treatment of urethral and bladder neck strictures. METHODS: UVENTA urethral stent (Taewoong Medical) is a temporary self expandable covered metallic stent. Anti-migration system and different radial force distribution are the two main innovations. This is a retrospective evaluation of UVENTA stent temporary placements for urethral diseases in two urological Centers. RESULTS: 15 patients underwent UVENTA stent placement between 2016 and 2018. Stent placement was easy and quick in all cases. Considering indwelling period: one patient reported urethral pain related to the stent in the first month, three patients had urinary infection treated with antibiotics; temporary stress incontinence was noted in 21% of bulbar-membranous stents; stent migrations was noted in 3 out of 4 bladder neck cases whereas no bulbar-membranous stents migrated. At removal no significant incrustation, stone or tissue ingrowth were noted, as well as new proximal or distal strictures. Stent removal was uncomplicated in all cases. Median follow up is 9.5 months (6-24). Considering strictures overall success rate is 73% (11/15): 82% for bulbar urethra (9/11) and 50% for bladder neck (2/4). CONCLUSIONS: UVENTA urethral stent showed a satisfying safety profile with few and low grade complications. Absence of migration and damage on healthy mucosa are main achievements. Further cases are needed to confirm these results and to really explore its efficacy.

OBJETIVOS: Describir los primeros resultados clínicos en términos de seguridad, complicaciones y eficacia a corto plazo de la colocación temporal de stent uretral UVENTA en el tratamiento de estenosis de uretra y de cuello vesical.MÉTODOS: El stent uretral UVENTA (Taewoong Medical) es un stent metálico temporal autoexpandible. Las dos principales innovaciones son el sistema antimigración y la distribución de la fuerza radial. Esta es una evaluación retrospectiva de la colocación de UVENTA en enfermedades uretrales en dos centros urológicos. RESULTADOS: 15 pacientes recibieron UVENTA entre 2016 y 2018. La colocación del stent fue fácil y rápida en todos los casos. Teniendo en cuenta el periodo de catéter: un paciente describió dolor uretral relacionado con el stent en el primer mes, 3 pacientes tuvieron infección urinaria tratada con antibióticos; incontinencia urinaria de estrés en el 21% de pacientes con stent en uretra bulbomembranosa; la migración de stents se demostró en 3 de 4 casos con estenosis de cuello vesical, mientras, ningún caso de uretra bulbomembranosa migro. Al quitar el stent, no se observó incrustación significativa, litiasis o tejido en crecimiento, así como nuevas estenosis distales o proximales. La retirada del stent no fue complicada en la mayoría de casos. La mediana de seguimiento fue de 9,5 meses (6-24). Considerando la tasa de éxito en global fue de 73% (11/15): 82% para uretra bulbar (9/11) y 50% para cuello vesical (2/4). CONCLUSIONES: El stent uretral UVENTA demostró un perfil de seguridad satisfactorio con mínimas complicaciones. La ausencia de migración o daño de la mucosa sana son las principales virtudes. Son necesarios más casos para confirmar estos resultados y explorar su eficacia.

Uventa urethral stents: are we taking a step forward? The first clinical series / Stents uretrales de Uventa: ¿estamos dando un paso adelante? La primera serie clínica

Objetives: To describe first clinical results in term of safety, complications and short term efficacy of temporary placement of UVENTA urethral stent in the treatment of urethral and bladder neck strictures. Methods: UVENTA urethral stent (Taewoong Medical) is a temporary self expandable covered metallic stent. Anti-migration system and different radial force distribution are the two main innovations. This is a retrospective evaluation of UVENTA stent temporary placements for urethral diseases in two urological Centers. Results: 15 patients underwent UVENTA stent placement between 2016 and 2018. Stent placement was easy and quick in all cases. Considering indwelling period: one patient reported urethral pain related to the stent in the first month, three patients had urinary infection treated with antibiotics; temporary stress incontinence was noted in 21% of bulbar-membranous stents; stent migrations was noted in 3 out of 4 bladder neck cases whereas no bulbar-membranous stents migrated. At removal no significant incrustation, stone or tissue ingrowth were noted, as well as new proximal or distal strictures. Stent removal was uncomplicated in all cases. Median follow up is 9.5 months (6-24). Considering strictures overall success rate is 73% (11/15): 82% for bulbar urethra (9/11) and 50% for bladder neck (2/4). Conclusions: UVENTA urethral stent showed a satisfying safety profile with few and low grade complications. Absence of migration and damage on healthy mucosa are main achievements. Further cases are neededto confirm these results and to really explore its efficacy.(AU)

Objetivos: Describir los primeros resultados clínicos en términos de seguridad, complicacionesy eficacia a corto plazo de la colocación temporal de stent uretral UVENTA en el tratamiento de estenosis de uretra y de cuello vesical. Métodos: El stent uretral UVENTA (Taewoong Medical) es un stent metálico temporal autoexpandible. Lasdos principales innovaciones son el sistema antimigración y la distribución de la fuerza radial. Esta es unaevaluación retrospectiva de la colocación de UVENTA en enfermedades uretrales en dos centros urológicos. Resultados: 15 pacientes recibieron UVENTA entre 2016 y 2018. La colocación del stent fue fácil y rápida en todos los casos. Teniendo en cuenta el periodo de catéter: un paciente describió dolor uretral relacionado con el stent en el primer mes, 3 pacientes tuvieron infección urinaria tratada con antibióticos; incontinenciaurinaria de estrés en el 21% de pacientes con stent en uretra bulbomembranosa; la migración de stents se demostró en 3 de 4 casos con estenosis de cuello vesical, mientras, ningún caso de uretra bulbomembranosa migro. Al quitar el stent, no se observó incrustación significativa, litiasis o tejido en crecimiento, así como nuevas estenosis distales o proximales. La retirada del stent no fue complicada en la mayoría de casos. La mediana de seguimiento fue de 9,5 meses (6-24). Considerando la tasa de éxito en global fue de 73% (11/15): 82% para uretra bulbar (9/11) y 50% para cuello vesical (2/4). Conclusiones: El stent uretral UVENTA demostró un perfil de seguridad satisfactorio con mínimas complicaciones. La ausencia de migración o daño de la mucosasana son las principales virtudes. Son necesarios más casos para confirmar estos resultados y explorar su eficacia.(AU)

Long-Term Surgical, Functional, and Patient Reported Outcomes of a Modified Corporoplasty: A Tertiary Referral Center Experience.

BACKGROUND: Nesbit corporoplasty was proposed to address penile curvature (PC), both congenital (CPC) and acquired (APC). AIM: To evaluate surgical, functional, and patient reported outcomes (PROs) of a modified corporoplasty. METHODS: From May 2005 to January 2017, a consecutive series of patients underwent a modified corporoplasty. Data were retrospectively extrapolated. Intra and postoperative complications and hospital stay were recorded as surgical outcomes. 2 validated international questionnaires were administered preoperatively and at 12 months after surgery: International Index of Erectile Function and Sexual Encounter Profile (items 2-3). An "ad hoc" questionnaire was utilized to assess PROs. OUTCOMES: Postoperative surgical and functional outcomes and PROs were the primary outcomes assessed in this study. RESULTS: 87 out of 145 patients had complete data available and were included in the study. CPC was noted in 61 patients whilst APC, secondary to Peyronie's disease, was present in 26 patients. Median preoperative PC was 60° (interquartile range [IQR] 45-70). Functional and PROs were evaluated 12 months after surgery for all enrolled patients. Considering surgical outcomes, the median follow-up time was 110 months (IQR 27-132.5). Median operative time was 130 minutes for CPC (IQR 115-150) and 120 minutes for APC (IQR 95-140). Median hospital stay was 2 days for both groups (IQR 1-2). After the median follow-up time of 110 months (IQR 27-132.5), a recurrent curvature was observed in 9.2% of cases. Minor residual curvature (<20°) was detected in 13.8%. International Index of Erectile Function and Sexual Encounter Profile 2-3 scores improved in both groups. Long-term de novo postoperative erectile dysfunction was observed in 3.2% of CPC cases and in 38.5% in APC (P = .001). A multivariate analysis revealed that etiology (APC), patient age (>35 years), and postoperative complications represented independent risk factors for the development of postoperative erectile dysfunction. Postoperative complications, in terms of bleeding, infection, or poor esthetic wound healing, occurred in 12.6% of patients. No Clavien-Dindo grade III-IV intraoperative complications were reported. Postoperative hematoma was more frequent in CPC when compared to APC (P = .003). In relation to PROs, 26.4% of patients responded as being dissatisfied with postoperative penile length, with a higher incidence in the APC group (P = .001). Overall, a significant improvement in everyday and sexual life quality was observed in both categories. CLINICAL IMPLICATIONS: The modified corporoplasty described showed better residual curvature rates, whilst maintaining similar PROs even if APC patients reported less favorable outcomes when compared to CPC. STRENGTHS & LIMITATIONS: The primary limitations of this study are its retrospective nature, no objective evaluation of postoperative curvature, and no penile length assessment. CONCLUSION: The aforementioned corporoplasty may represent an excellent option for PC correction, with low complication rate and high patient satisfaction. Falcone M, CerutiC, Preto M, et al. Long-Term Surgical, Functional, and Patient Reported Outcomes of a Modified Corporoplasty: A Tertiary Referral Center Experience. J Sex Med 2020;17:1779-1786.

An outcomes analysis of penile prosthesis implantation following radical cystoprostatectomy and urinary diversion: a multicentric retrospective cohort study.

There is limited scientific literature regarding the management outcomes for end-stage erectile dysfunction (ED) following radical cystoprostatectomy (RCP). This study aims to evaluate the surgical outcomes of penile prosthesis (PP) implantation. A retrospective analysis over 17 years (2004-2017) was performed from the clinical records of patients in four tertiary referral centres, whom previously had undergone RCP, followed by PP implantation for end-stage ED. Outcome measures include both intra and postoperative complications, operative duration, a 5-point Likert hematoma scale as well as length of hospital stay. Additionally, a matched-pair cohort analysis was performed, dividing patients in 2 groups according to the type of urinary diversion (neobladder versus ileal conduit/cutaneous ureterostomy). The median time elapsed between RCP and PP implantation was 38 months (IQR 20-56). The median follow-up was 18 months (IQR 12-156). A 3-piece inflatable PP was implanted in 43 patients (91.5%) whereas a semirigid device was implanted in the remainder. Reservoir position was extra-peritoneal (utilising a separate abdominal incision) in 24 patients (54.8%), while an ectopic high-submuscular placement was preferred in the remainder. PP infection and mechanical failure occurred in 1 (2.1%) and 3 cases (6.3%) respectively. The comparative analysis of surgical outcomes did not show any statistically significant difference between the two groups. Our evidence suggests that PP implantation in patients with refractory ED following RCP may represent a safe and effective procedure associated with a low incidence of complications. The main limitation of this study is represented by the non-randomised, retrospective nature as well as the lack of patients' functional outcomes and the limited follow-up.

Self-Expandable Covered Metallic Stent (UVENTA) to Treat a Ureteral Stricture After Renal Transplant: A Case Report.

We present the use of a self-expandable covered metallic stent (UVENTA; TaeWoong Medical, Gyeonggi-do, South Korea) to treat a ureteral stricture after kidney transplant. In this report, we describe the procedure and short-term outcomes of a patient with a recurrent distal stricture who did not respond to percutaneous balloon dilation. We decided to place this temporary stent as an alternative to complex surgery. The aim of the procedure was to get a chronic dilation of the stricture up to 7 mm to stabilize the fibrotic tissue. The procedure was easily and quickly performed by an antegrade and retrograde combined approach. The postoperative course was uneventful. The stent was left in situ for 7 months. No complications were noted, and the renal function remained stable. The stent was easily removed, and 5 months later there were no signs of recurrence. The UVENTA device was shown to be an easy, safe, and effective minimally invasive treatment for ureteral stricture in renal transplant. Proper permanence time and long-term results need to be explored.

A Single-center Analysis on the Learning Curve of Male-to-Female Penoscrotal Vaginoplasty by Multiple Surgical Measures.

OBJECTIVE: To asses and quantify the learning curve (LC) of the penoscrotal inversion flap vaginoplasty (PSV). PATIENTS AND METHODS: We retrospectively reviewed clinical records of 69 patients who underwent PSV from January 2005 to January 2015. Two validated methods were used: a scatterplot representation and a splitting group. We selected as primary outcomes the operative time and vaginal depth. Surgical outcomes including blood losses, hospital stay, and postoperative complications such as vaginal stenosis or atresia or urethral meatus stenosis were also evaluated. RESULTS: The overall median operative time was 245 minutes. Severe intraoperative complications were not reported. The overall incidence of postoperative major complications was 21.7 %, most of them being urethral issues. The splitting group analysis revealed a statistically remarkable difference between groups for the operative time (P < .01), the vaginal depth (P = .01), the hospital stay (P < .01), and the intraoperative complication rate (P = .01). On the contrary, no differences were evidenced between the cohorts for the amount of blood loss (P = .08). The scatterplot logarithmic analysis demonstrated a clear visible LC for most parameters. The operative time showed a sharp decrease within the first 20-30 cases, reaching a plateau after 40 cases. Considering the analysis of the vaginal depth, the logarithmic scatterplot curve evidenced a slight increase within the first 10 cases, reaching a clear stabilization after nearly 30-40 cases. CONCLUSION: An evident LC for PSV is detectable, consisting of at least 40 cases needed to the surgical team to develop adequate skills to guarantee a safe and high-quality procedure.

A prospective multicentric international study on the surgical outcomes and patients' satisfaction rates of the 'sliding' technique for end-stage Peyronie's disease with severe shortening of the penis and erectile dysfunction.

OBJECTIVES: To report the results from a prospective multicentric study of patients with Peyronie's disease (PD) treated with the 'sliding' technique (ST). PATIENTS AND METHODS: From June 2010 to January 2014, 28 consecutive patients affected by stable PD with severe penile shortening and end-stage erectile dysfunction (ED) were enrolled in three European PD tertiary referral centres. The validated International Index of Erectile Function (IIEF) questionnaire, the Sexual Encounter Profile (SEP) Questions 2 and 3, and the Peyronie's disease questionnaire (PDQ) were completed preoperatively by all patients. At the follow-up visits (at 3, 6 and 12 months), the IIEF, the SEP Questions 2 and 3, the PDQ, and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) were completed. The outcome analysis was focused on penile length restoration, and intra- and postoperative complications classified according the Clavien-Dindo Classification. RESULTS: The mean (range) follow-up was 37 (9-60) months. A malleable penile prosthesis (PP) was implanted in seven patients, while an inflatable three-pieces PP was placed in the remainder. In the case of inflatable PP implantation, porcine small intestinal submucosa and acellular porcine dermal matrix were used to cover the tunical defects. While in patients undergoing malleable PP implantation, collagen-fibrin sponge was used. The mean operative time was 145 min in the inflatable PP group and 115 min in the malleable PP group. There were no intraoperative complications. Postoperative complications included profuse bleeding requiring a blood transfusion in one patient (3.5%) on anticoagulation therapy for a mechanical heart valve (Grade II) and PP infection requiring the removal of the device (7%) (Grade III). There were no late recurrences of the shaft deformation. The postoperative functional data showed a progressive improvement in the score of all questionnaires, peaking at 12 months postoperatively. The mean (range) penile lengthening was 3.2 (2.5-4) cm and no patient reported recurrence of the curvature. CONCLUSIONS: The present series suggests that, in the hands of experienced high-volume surgeons, penile length restoration with the use of the ST represents an effective option for end-stage PD associated with ED and severe shortening of the shaft. Larger series and longer follow-up will be required to fully establish the efficacy of this procedure.

Urological consequences following renal transplantation: a review of the literature.

Renal transplant (RT) represents the treatment of choice for end-stage renal disease (ESRD) but harbours a wide range of possible complications and therapeutic challenges of urological competence. Dialysis years and clinical medical background of these patients are risk factors for sexual dysfunction and lower urinary tract symptoms (LUTS). On the contrary, RT itself may have a number of possible surgical complications such as ureteral stenosis and urinary leakage, while immunosuppressive treatment is a known risk factor for de-novo malignancies.The present review describes the main urologic problems of RT patients and their up-to-date treatment options according to the most recently available literature evidences.

Sexual function after surgical treatment for penile cancer: Which organ-sparing approach gives the best results?

INTRODUCTION: We compared the postoperative sexual function of patients who underwent wide local excision (WLE) and glansectomy with urethral glanduloplasty for penile cancer. METHODS: We retrospectively reviewed clinical data of 41 patients affected by superficial, localized penile cancer (≤cT2a) between 2006 and 2013. Patients with severe erectile dysfunction and not interested in resuming an active sexual life were selected for penile partial amputation. Patients with preoperative satisfying erectile function and concerned about the preservation of their sexual potency were scheduled for WLE (Group A) or glansectomy with urethral glanduloplasty (Group B). Sexual function was assessed with the International Index of Erectile Function (IIEF) questionnaire and the Sex Encounter Profile (SEP). At 1 year, patients were asked to complete the questionnaires again and were questioned about their genital sensibility and ejaculatory reflex persistence. Postoperative complications were reported according to the Clavien-Dindo classification. Statistical analysis was performed by two-tailed test: Student t-test and chi-square. RESULTS: Among the 41 patients enrolled, 12 underwent WLE (29.2%), 23 glansectomy with urethral glanduloplasty (56%) and 6 with penile partial amputation (14.6%). A decrease in postoperative IIEF was recorded in both groups, but was statistically significant only in Group B (p = 0.003). As for the SEP, while no significant changes were recorded postoperatively in Group A, a marked reduction was reported for Group B, with a statistically significant decrease in the possibility of achieving penetrative intercourse (p = 0.006) and in the perceived satisfaction during sexual activity (p = 0.004). CONCLUSIONS: WLE lead to better sexual outcomes and less postoperative complications as compared to glansectomy with urethral glanduloplasty.

Two-sided urethra-sparing reconstruction combining dorsal preputial skin plus ventral buccal mucosa grafts for tight bulbar strictures.

OBJECTIVES: To report our initial experience with urethra-sparing reconstruction combining dorsal preputial skin and ventral buccal mucosa grafts for tight bulbar urethral strictures. METHODS: Between November 2006 and September 2012, 26 patients with tight bulbar strictures underwent urethroplasty. Using a ventral urethrotomy approach, the two-sided urethral reconstruction was carried out avoiding the transection of urethra and augmenting the preserved urethral plate by dorsal preputial skin plus ventral buccal mucosa grafts. The primary outcome was the objective urinary result, defined as the absence of stricture recurrence. The outcome was considered a failure when any postoperative instrumentation was required. Postoperative sexual dysfunctions were investigated using a validated questionnaire. RESULTS: Mean follow up was 30.1 months (range 12-79 months). Mean stricture length was 3.3 cm (range 1.5-6 cm). Mean length for dorsal preputial skin and ventral buccal mucosa grafts was 3.2 cm (range 2-7 cm) and 4.9 cm (range 4-6 cm), respectively. Of 26 cases, 23 (88.5%) were successful and three (11.5%) were failures with stricture recurrence. Failures were treated with perineal urethrostomy in one case, ventral buccal graft urethroplasty in one case and internal urethrotomy in one case. Among 12 sexually active men preoperatively, none reported postoperative penile curvature/shortening, impaired erection or dissatisfaction regarding erection; sexual activity was unaltered pre- and post-surgery. CONCLUSIONS: In tight bulbar urethra strictures, the two-sided urethroplasty combining dorsal preputial skin and ventral buccal mucosa grafts provides a safe and effective semi-circumferential reconstruction by augmenting the preserved urethral plate, with no impact on sexual function.

Male urethral strictures: a national survey among urologists in Italy.

OBJECTIVE: To determine national practice patterns in the management of male urethral strictures among Italian urologists. METHODS: We conducted a survey using a nonvalidated questionnaire mailed to 700 randomly selected Italian urologists. Data were registered into a database and extensively evaluated. Analysis was performed using SAS statistical software (version 9.2). Statistical significance was defined as P ≤.05. RESULTS: A total of 523 (74.7%) urologists completed the questionnaire. Internal urethrotomy and dilatation were the most frequently used procedures (practiced by 81.8% and 62.5% of responders, respectively), even if most urologists (71.5%) considered internal urethrotomy appropriate only for strictures no longer than 1.5 cm; 12% of urologists declared to use stents. Overall, minimally invasive techniques were performed more frequently that any open urethroplasty (P = .012). Particularly, 60.8% of urologists did not perform urethroplasty surgery, 30.8% performed 1-5 urethroplasties yearly, and only 8.4% performed >5 urethroplasty surgeries yearly. The most common urethroplasty surgery was one-stage graft technique, particularly using oral mucosa and ventrally placed. Diagnostic workup and outcome assessment varied greatly. CONCLUSION: In Italy, minimally invasive procedures are the most commonly used treatment for urethral stricture disease. Only a minimal part of urologists perform urethroplasty surgery and only few cases per year. The most preferred techniques are not traditional anastomotic procedures but graft urethroplasties using oral mucosa; the graft is preferably ventrally placed rather than dorsally. There is no uniformity in the methods used to evaluate urethral stricture before and after treatment.