Penile Surgery Research Articles

An epidermal cyst of the penis after distal hypospadias surgery: a case report

BackgroundEpidermoid cyst is a benign tumor that can occur anywhere in the body but is rarely seen in the penis. Congenital and previous penile surgeries have been reported to be involved in the etiology of the disease, which is usually asymptomatic. Here we describe a case of a patient with a penile epidermoid cyst, which occurred in the circumcision line on the left side of his penis, and urethral dehiscence following hypospadias surgery.Case summaryA 3-year-old white boy who underwent primary distal hypospadias surgery 1.5 years ago presented with a slowly growing mass in the left ventrolateral portion of the penile circumcision line and urethral dehiscence. The histology of the excised mass revealed an epidermal inclusion cyst. Since then, he has remained healthy.ConclusionsEpidermal inclusion cyst as a complication of hypospadias surgery is a very rare situation. The diagnosis is made histologically and surgical excision is sufficient for treatment.

Adherence to EAU guidelines on penile cancer translates into better outcomes: a multicenter international study.

We aimed to evaluate adherence to the EAU guidelines (GL) on penile cancer (PC) with regard to primary surgical treatment and management of lymph nodes and to estimate the influence of adherence to GL on clinical outcome. This is a retrospective multicenter study (PEnile Cancer ADherence study, PECAD Study) on PC patients treated at 12 European and American centers between 2010 and 2016. Adherence to the EAU GL on the surgical management of the primary penile tumor and lymphadenectomy was evaluated. Descriptive analyses were performed, and survival curves were estimated. Data on 425 patients were considered for the analysis. The EAU GL on surgical treatment of the primary tumor and lymphadenectomy were respected in 74.8% and 73.7% of cases, respectively. Survival analysis showed that adherence to the GL on primary penile surgery was significantly associated with a good overall survival [adjusted HR 0.40 (95% CI 0.20-0.83, p value = 0.014)]. Also, the adherence to the GL on lymphadenectomy was statistically significantly associated with overall survival [adjusted HR 0.48 (95% CI 0.24-0.96, p value = 0.038)]. Limited follow-up and retrospective design represent limitations of this study. Our findings suggest that there is a good adherence to the EAU GL on PC. However, this should be further reinforced, endorsed and encouraged as it might translate into better clinical outcomes for PC patients.

Utilization of Epigastric Vessels in Combined Penile Straightening and Revascularization Surgery

Utilization of Epigastric Vessels in Combined Penile Straightening and Revascularization Surgery

Stretched penile length and infertility, a new association

Male infertility can be associated with secondary sexual characteristics and several findings in the examination of external genitalia. We sought to identify if stretched penile length (SPL) is associated with infertility. Retrospective review of all males age 18-59 presenting to a Men’s health clinic from 2014 to 2017. SPL of patients with infertility were compared to patients with any other complaint such as erectile dysfunction or testicular pain. Patients with Peyronie’s disease, prior penile surgery, or prostatectomy were excluded from our study. Basic characteristics including age, body mass index (BMI), and race were collected. SPL was measured from pubic symphysis to meatus, with penis on maximal stretch by a total of 3 trained providers. T-test and Chi-square test were used to compare baseline characteristics between the two groups (infertile vs. other). Linear regression was used to assess the association between infertility with SPL after adjusting for patient age, BMI, and race. 815 men were included in our study (219 infertile, 596 other). Infertile men were younger than the other group (33.6 vs. 42.5 years, P<0.001). BMI did not significantly differ (29.2 vs 29.5 kg/m2, p=0.57). In both infertile and other group about 85% were white/Caucasian (85.6 vs. 84.3 respectively) but overall the difference in race was statistically significant (p=0.02). The unadjusted mean of SPL in the infertile group was 12.3 cm compared to 13.4 cm in the other group (p<0.001). When adjusted for age, BMI, and race, SPL in infertile group was 12.5 cm compared to 13.4 cm in other (p<0.001, 95% CI: 12.2-12.8 vs. 13.2-13.5 respectively). This is the first study to demonstrate an association between a shorter SPL and infertility. It is unknown if reduced length is a result of genetic or congenital factors associated with infertility such as testicular dysgenesis syndrome or the result of underlying hormonal differences between the two groups. Further investigation is needed to better understand the association of shorter stretched penile length with male infertility.

AB030. Penile surgery for premature ejaculation and augmentation

Premature ejaculation (PE) is a male sexual dysfunction characterized by short duration of vaginal penetration and difficult to delay ejaculation with negative personal consequence. Current management of PE includes psycho-behavioral therapy and medication (oral or topical using). Unfortunately, not all patients are benefit or effective to these therapies. On the other hand, some patients are not satisfied with the dependent of medication. As a result, some patients seek for surgery to solve their PE problems. Penile augmentation is an actually need? Still, common sense doesn’t stop size-obsessed guys from trying very sketchy treatments on a vital part of their anatomy. The typical erect penis is usually 12.5 to 15 cm long with a circumference of 10 to 12.5 cm. There’s more variation in the size of flaccid penises. Some guys are genuinely smaller than that. In rare cases, genetics and hormone problems cause a condition called micropenis—an erect penis of under 7 cm. Penile augmentation is a surgical procedure included penile lengthening or via increase in girth, or both. The lengthening of the penis involves release of the suspensory ligament of the penis via an incision just above the shaft of the penis. The release allows the penis to be brought outward in a straighter path thereby increasing the external length of the penis. In order to gain length, this was accomplished by the advancement of a pubic skin flap (V-Y flap). The gain varies depending on penis size, body build, and the amount of post-operative stretching performed. In some cases, additional procedures such as the pubic fat pad reducing with pubic liposuction can be performed to enhance the results. As far as increasing girth, there is augmentation via patient’s himself tissue or via biomaterial implantation.

A Single-Surgeon Retrospective and Preliminary Evaluation of the Safety and Effectiveness of the Penuma Silicone Sleeve Implant for Elective Cosmetic Correction of the Flaccid Penis

BackgroundSilicone blocks and sleeves are simple devices used in cosmetic surgery. They are generally viewed as safe and effective; however, there is little information on their use in the penis. AimThis study evaluates a large single-surgeon series using a novel silicone sleeve penile implant (Penuma) to cosmetically correct the flaccid penis. Methods526 patients underwent elective cosmetic penile surgery using a silicone sleeve penile implant between 2009 and 2014. Institutional Review Board approval was obtained for a retrospective analysis, and study consent was obtained from 400 patients. Penile circumference was measured before surgery, immediately after surgery, and 30–90 days after the implant surgery. Using the nonvalidated Augmentation Phalloplasty Patient Selection and Satisfaction Inventory (APPSSI), changes in self-confidence, self-esteem, and satisfaction scores were assayed 6–8 weeks postoperatively. Scores were again assayed 2–6 years postoperatively in 77% of patients. The questionnaires rated patient self-confidence, self-esteem, and satisfaction as very low, low, medium, high, or very high. Main Outcome MeasureOutcomes include changes in penile measurements; changes in APPSSI satisfaction, self-confidence, and self-esteem scores; and incidences of adverse events. ResultsIn the 400 patients, the implantation of the Penuma silicone implant increased midshaft circumference from an average of 8.5 ± 1.2 cm to 13.4 ± 1.9 cm (56.7% increase; P < .001). A 2-category improvement in self-confidence and self-esteem was noted in 83% of patients 6–8 weeks postoperatively. On long-term follow-up (2–6 years; mean 4 years), 72% patients remained improved (2-category improvement in APPSSI scoring), and 81% of subjects reported “high” or “very high” levels of satisfaction. The most frequently reported postoperative complications were seroma (4.8%), scar formation (4.5%), and infection (3.3%). No patients reported any changes in sexual function, erections, or ejaculation. 3% experienced adverse events necessitating device removal. Clinical ImplicationsThe Penuma silicone implant can help patients cosmetically correct the penis with increased flaccid penile girth and achieve enhanced self-confidence and self-esteem over the short- and long term. Strengths and LimitationsStrengths include the large number of subjects (400 men) and the long-term follow-up period (2–6 years). Limitations include the retrospective and single-surgeon (inventor) nature of the study; the presence of 126 non-consenting subjects, potentially impacting the complication rate; and the APPSSI’s lack of validation. ConclusionRetrospective analysis of 400 men electing to have penile cosmetic correction with the Penuma device demonstrates improvements in girth (56.7% increase) and high and sustained patient satisfaction, self-confidence, and self-esteem with minimal and manageable adverse events.Elist JJ, Valenzuela R, Hillelsohn J, et al. A Single-Surgeon, Retrospective, and Preliminary Evaluation of the Safety and Effectiveness of the Penuma Silicone Sleeve Implant for Elective Cosmetic Correction of the Flaccid Penis. J Sex Med 2018;15:1216–1223.

Pediatric penile surgery by a nurse practitioner in the operating room

With the growing shortage of pediatric urological surgeons, it was our aim to streamline our system to get patients with less complex penile procedures performed in a timely manner. To do this, an advanced practice provider (APP) was trained to perform minor penile procedures in children in the operating room(OR). The goal of our study was to show that with proper training an APP could safely perform a circumcision in the OR. After approval of the study center's credentialing committee, a NP was trained to perform revisions and initial circumcisions in children in the OR. The process involved: (1) observation, (2) first assisting and (3) performing the procedure with direct, and later in-direct, supervision. The first 100 cases were evaluated for surgical complications, post-operative complications and return rates to the OR. 100 independent cases were completed with 90 having only in-direct supervision. There were no operative complications, nor any documented emergency room or urgent care visits in the immediate post-operative period. There were no early returns to the OR and only 1 scheduled follow-up procedure for a penile skin bridge. It was demonstrated that with proper training a NP can safely perform minor penile procedures in the OR. This allows us to free up our pediatric urology physicians to see and operate on more complex pediatric urology problems. In addition, it allows those with minor penile issues to be cared for more expeditiously. A concern related to training NPs to do circumcisions could be the loss of control by urologists. In this situation, the attending physician is ultimately responsible from a medico-legal standpoint. That would not be true if the NP was practicing independently. With a shortage of urologists, this significantly expands the ability to care for our patient population. In additional, attending surgeons will have a greater freedom to perform major procedures. A limitation of the study was that a patient satisfaction survey was not obtained to see if there were concerns over a APP doing their circumcision. Personal feedback on 30 of the patients that did not return for the follow-up visit was not obtained. The authors of the study are primary providers of pediatric urology care in the study region, thus any individual with concerns would have been referred. It was demonstrated that a well-trained APP can safely perform minor penile procedures independently in the OR with indirect supervision.

Phosphodiesterase type 5 in men with vasculogenic and post-radical prostatectomy erectile dysfunction: is there a molecular difference?

To clarify the molecular basis of penile erection at the human level and distinguish the mechanisms underlying vasculogenic and post-radical prostatectomy (RP) erectile dysfunction (ED) subtypes. Erectile tissue was obtained from men without history of ED who underwent penile surgery for Peyronie's disease (control group, n = 5) and from men with ED who underwent penile prosthesis implantation (n = 17). ED was categorized into vasculogenic (n = 8) and post-RP (n = 9) subtypes. Penile erectile tissue samples were collected for molecular analyses of protein expressions of neuronal and endothelial isoforms of nitric oxide synthase (nNOS and eNOS, respectively), phospho-nNOS (Ser-1412), phospho-eNOS (Ser-1177), phospho-protein kinase B (Ser-473), phosphodiesterase type 5 (PDE5), α-smooth muscle actin, phospho-myosin phosphatase target subunit 1, RhoA/Rho-associated protein kinase (ROCK)-α, ROCK-β, 4-hydroxy-2-nonenal, and nNOS and eNOS uncoupling by Western blot. Vasculogenic ED was characterized by decreased eNOS protein expression and eNOS and nNOS phosphorylation on their activatory sites (Ser-1177 and Ser-1412, respectively), uncoupled eNOS, upregulated PDE5 protein expression, increased ROCK activity, and increased oxidative stress in erectile tissue. Post-RP ED was characterized by decreased nNOS protein expression, increased nNOS phosphorylation on its activatory site (Ser-1412), uncoupled nNOS, downregulated PDE5 protein expression, and increased oxidative stress in erectile tissue. The mechanisms of vasculogenic and post-RP ED in the human penis involve derangements in constitutive nitric oxide synthase function, PDE5 protein expression and ROCK activity, and increased oxidative stress, which conceivably provide a molecular basis for chronically reduced nitric oxide bioavailability and increased smooth muscle contraction contributing to erectile impairment. Selective differences in PDE5 protein expression suggest distinct molecular mechanisms are in play for these ED subtypes.

065 Complication rate and satisfaction data of complex penile surgery in comparison with simple prosthetic surgery in a 395 patient monocentric series. The more complex is more dangerous?

to verify if complex prosthetic procedures (plaque incision or sliding technique) have worse results (complications and satisfaction rate) in comparison with simple prosthetic surgery . We revised perioperative and follow up data prospectively collected of patients (pt) who underwent penile prosthetic surgery at our referral centre from 10/2004 to 1/2017. We had complete data of 395 pt, average age 61, 276 with a hydraulic prothesis, 119 with a non hydraulic. We divided patients in 2 groups: - group A: 308 pt (age 61), affected from simple ED or ED + mild curvature (<30°), treated with simple prosthesis implantation with or without Wilson modeling - group B: 87 pt (age 60), affected from important penile curvature or shortening due to Peyronie’s, treated with prosthesis + plaque surgery or sliding technique All patients had a follow up visit 1 year after surgery and filled IIEF, EDITS, SEP3 and a “ad hoc” question about general satisfaction. Statistical analysis: Fisher, Mann-Whithney.

Prospective Randomized Controlled Study Comparing Caudal Block versus Dorsal Penile Nerve Block as Postoperative Analgesia in Children Presented for Penile Surgery

AbstractBackground: Caudal block is recommended for analgesia during and after surface operation on the penis, for example circumcision and hypospadias repair. The aim of this study was to compare caudal block versus dorsal penile block in children undergoing penile surgery, regarding duration and quality of post-operative analgesia.Aim of the Study: To compare caudal block versus dorsal penile block in children undergoing penile surgery, our primary outcome was the duration of postoperative analgesia while our secondary outcome was the quality of post-operative analgesia.Patients and Methods: 60 children, ASA I-II, 1-4 year's old undergoing penile surgery under general anesthesia were enrolled in the study. Children were randomly classified into two groups: (Group I) (penile group=30 patients) received a penile block using a mixture of lidocaine 3mg/kg (2%) and plain bupivacaine 1mg/kg (0.25%) on each side, Group II (caudal block group=30 patients) patients of this group received a caudal block using a mixture of lidocaine 3mg/kg (2%) and plain bupivacaine 1mg/kg (0.25%). Assessment of post-operative will be done by the Faces Pain Scale which is a self-report measure of intensity developed for children. It was adapted from the Faces Pain Scale to make it possible to score the sensation of on the widely accepted 0-to-10 metric, 0 equals no pain and 10 equals very much pain. This done immediately postoperative and every 2H until 6H post-operative.Results: Faces score was significantly lower in group II at 2H, 4H and 6H post-operative with increase on the duration of block in Group II, also there was significant decrease in heart rate in Group II at 30min, 45min, 75min, 90min, 105min, 120min and 135min respectively from the start of surgery so there was significant increase of bradycardia and need of atropine in group.Conclusions: Caudal block seemed to be more effective in reducing post-operative score and decreasing the need of rescue analgesia with prolongation of the duration of the block.

Comparing Digital Photography via Email Correspondence With Traditional Telephone Communication for Assessment of Postoperative Pediatric Urology Patients

Introduction Postoperative concerns are commonly managed by a nurse practitioner (NP) via traditional telephone conversation (TTC). In recent years, electronic interaction, including digital photographs sent via email (PEC), has become an alternative, novel strategy to evaluate surgical site concerns. Its use may result in fewer unplanned clinic or emergency room (ER) visits as well as improve patient satisfaction. Herein, we present a pilot a study to determine the feasibility of conducting a definitive trial comparing the effectiveness of PEC versus TTC in reducing the number of unplanned clinic and ER visits as well as improving patient experience. Materials and Methods Children &lt; 18 years old at the time of surgery and within the 30-day postoperative period were recruited from June 2015 to January 2016 at a tertiary children’s hospital. Exclusion criteria were concerns occurring outside the 30-day postoperative period and inability/unwillingness to email photographs. Patients were allocated to PEC or TTC after initiating contact with the NP through an electronic centralized blocked randomization system. A standardized telephone script was used to gather relevant clinical data for both groups. These data informed a clinical plan, with those randomized to the PEC group sending digital photographs of the surgical site in addition to the traditional telephone call. Within 48 hours, families were sent a link to an electronic survey measuring patient experience using a validated questionnaire. Feasibility data on recruitment rates, compliance with sending photographs, and completing patient experience questionnaires were collected. Secondary outcomes included number of unplanned clinic/ER visits, number of follow-up phone calls, and patient experience scores. Results Of the 328 children who underwent urological procedures during the recruitment period, 215 (66%) consented to participate in the study. Of these, 42(13%) contacted the NP with postoperative concerns and were randomized. Two patients in the PEC group were excluded after randomization (one for contacting on Postoperative Day 31 and one for not sending photographs), resulting in 19 patients in the PEC group and 21 patients in the TTC group. Penile surgeries (hypospadias repair and circumcisions [43%]) were the most common procedures with postoperative concerns. Ninety-eight percent of the PEC patients were compliant in sending photographs. Overall, 98% of surveys were completed. Twice as many unplanned clinic visits were observed in the TTC group when compared with the PEC group (p = .28), despite a similar number of follow-up phone calls between groups (Table 1). Patient experience scores were also comparable in both groups, with families scoring high satisfaction with the experience regardless of the modality of communication. Conclusions A definitive trial examining the effectiveness of PEC versus TTC appears feasible and safe as seen by the high recruitment, photographic compliance, hospital visits, and survey completion rates in this pilot study.

MP84-06 PROSPECTIVE TRIAL COMPARING PENOSCROTAL VERSUS MINIMALLY INVASIVE INFRAPUBIC APPROACH FOR INFLATABLE PENILE PROSTHESIS PLACEMENT: A SINGLE-CENTRE MATCHED PAIRED ANALYSIS.

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease II1 Apr 2018MP84-06 PROSPECTIVE TRIAL COMPARING PENOSCROTAL VERSUS MINIMALLY INVASIVE INFRAPUBIC APPROACH FOR INFLATABLE PENILE PROSTHESIS PLACEMENT: A SINGLE-CENTRE MATCHED PAIRED ANALYSIS. Pietro Grande, Gabriele Antonini, Cristiano Cristini, Ettore De Berardinis, Giuseppe Gentile, Giovanni Di Lascio, Andrea Lemma, and Giovanni Battista Di Pierro Pietro GrandePietro Grande More articles by this author , Gabriele AntoniniGabriele Antonini More articles by this author , Cristiano CristiniCristiano Cristini More articles by this author , Ettore De BerardinisEttore De Berardinis More articles by this author , Giuseppe GentileGiuseppe Gentile More articles by this author , Giovanni Di LascioGiovanni Di Lascio More articles by this author , Andrea LemmaAndrea Lemma More articles by this author , and Giovanni Battista Di PierroGiovanni Battista Di Pierro More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2774AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Currently, approximately 80% of inflatable penile prosthesis (IPP) are placed by penoscrotal approach (PSA), although no superiority of this technique compared to infrapubic approach has ever been demonstrated.The aim of this study was to compare perioperative results, safety and efficacy profile in patients receiving inflatable penile prosthesis(IPP) via PSA or minimally invasive infrapubic approach(MIIA) for erectile dysfunction. METHODS Data were prospectively collected in our password-secured institutional database of implanted patients. A matched-pair analysis was performed including 42 patients undergoing IPP implantation via PSA(n=21) or MIIA(n=21) between 2011 and 2016. Excluded from the study were those patients with urinary incontinence, simultaneous surgery for congenital or acquired recurvatum, previous urethral or penile surgery and lack of follow-up data. All patients were invited to fill in validated self-administered questionnaires to evaluate various aspects of post-prosthesis sexual life. Specifically, questionnaires included: the International Index of Erectile Function(IIEF), Erectile Dysfunction Inventory of Treatment Satisfaction(EDITS) and Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaires. RESULTS Mean(SD) operative time was 128(40.6) min in group PSA and 91(43.0) min in group MIIA(p=0.041). Complications occurred in 3 (14%) and 2 (10%) patients in groups PSA and MIIA(p=0.832). Overall, no differences were observed concerning the device utilization (p=0.275). However, in group MIIA 4 (19%) patients were able to resume sexual activity prior to 4 postoperative weeks, while in group PSA no patient was (p=0.012). Mean(SD) scores for questionnaires were similar between groups PSA and MIIA: IIEF [20.9(7.3) vs 20.7(4.8); p=0.132], patient EDITS [76.0(25.6) vs 74.7(20.8); p=0.256] and partner EDITS [72.5(29.1) vs 73.1(21.4); p=0.114]. Similarly, QoLSPP showed comparable results among the groups PSA and MIIA: functional domain [3.9(1.4) vs 4.0(1.2); p=0.390], personal [4.0(1.2) vs 4.1(1.0); p=0.512], relational [3.7(1.5) vs 3.9(1.2); p=0.462] and social [4.0 (1.2) vs 3.9 (1.2); p=0.766]. CONCLUSIONS Penoscrotal and minimally invasive infrapubic approaches demonstrated to be safe and efficient techniques for IPP implantation, leading to high level of both patients and partners satisfaction. Additionally, the minimally invasive infrapubic approach showed a shorter operative time and a tendency for a faster return to sexual activity. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1126-e1127 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Pietro Grande More articles by this author Gabriele Antonini More articles by this author Cristiano Cristini More articles by this author Ettore De Berardinis More articles by this author Giuseppe Gentile More articles by this author Giovanni Di Lascio More articles by this author Andrea Lemma More articles by this author Giovanni Battista Di Pierro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Is Hba1c level of diabetic patients associated with penile prosthesis implantation infections?

Background and objectives: Diabetes mellitus is an important risk factor for erectile dysfunction (ED). Penile prosthesis implantation surgery is the final solution for diabetic patients with ED, but infections thereof are still a serious risk factor. While some studies suggest that most infections associated with penile prosthesis implantation are associated to high glycated hemoglobin (HbA1c) levels, other research did support such relationship.Materials and methods: The current study assessed retrospectively, the association between HbA1c level and penile prosthesis surgery infection. We retrieved and reviewed the records of 300 diabetic patients who had penile prosthesis surgery at our Institution (January 2012–November 2016). Patients’ mean age was 55.26 ± 10.9 years (31% patients were <50 years of age), and mean HbA1c was 7.60 ± 1.90%.Results: Infection rate among diabetics was 0.67%. Prevalence of prosthesis infection among patients with HbA1c ≤ 9% was 0.9%, compared with 0% among patients with HbA1c > 9%. Prosthesis infection risk did not significantly increase with higher HbA1c levels, with no meaningful difference in the median or mean level of HbA1c in the infected and non-infected diabetic patients.Conclusion: Findings do not support the use of HbA1c values among diabetic patients who are candidates for penile prosthesis implantation surgery in order to identify and exclude those who might be prone to increased risk of prosthesis infections. Future studies would benefit from larger sample sizes in order to support or refute our findings.

Outcomes of multidisciplinary treatment in penile cancer: Experience from Thailand.

555 Background: Penile cancer is relatively more common in Thailand compared to western countries. We report multidisciplinary treatment outcomes of penile squamous cell carcinoma at a regional center in northeast of Thailand. Methods: Using an institutional database, a total of 68 patients with squamous cell carcinoma of penis treated during 2009-2015 were identified. Patient demographics, pathological data, and treatment modality were reviewed. Survival data was calculated using the Kaplan-Meier method. Results: Median age was 53 years (25-89 years) and the median follow-time was 2.7 years. At presentation, 39 patients (57.4%) were node positive, and 9 (13.2%) had metastatic disease. Management was penile preserving surgery in 13 patients, partial penectomy in 36 patients, total penectomy in 15 patients, and palliative with radiation and/or chemotherapy in 4 patients. The 3-year overall survival for patients with N0-1 and N2-3 was 86% and 35% respectively. For those with high risk (N2/N3) non-metastatic disease, multimodality treatment improved overall survival significantly compared with surgery alone (13.7 mo vs 8.6 mo; HR 0.32, p-value = 0.04) Conclusions: Patients present with locally advanced disease had a poor prognosis. Multidisciplinary management improved overall survival N2/N3 patients.

Cosmetic Penile Augmentation Surgical Techniques with BellaDerm Graft

Introduction: Penile cosmetic augmentation surgery (cosmetic phalloplasty) is available in the cosmetic surgery field for about a quarter of century to enlarge penis length, girth, and glans of a man’s penis. This article describes penile cosmetic surgery augmentation (phalloplasty surgical techniques) using BellaDerm graft. Materials and methods: A total of 315 phalloplasty surgeries using BellaDerm graft were analyzed for this article. These surgeries were performed by the author during 15-year in multiple surgery centers in California, USA. BellaDerm is a graft that is a type of scaffolding or framework (matrix) that exists in human skin. This framework creates a place where cells and blood vessels can create new tissue. BellaDerm graft serves as a framework to support cellular repopulation and vascularization of the patient's own tissue. It's also performed penile augmentation based on the initial graft thickens. In cosmetic penile augmentation surgery, BellaDerm graft is used to enhance the girth and/or glans of the penis during cosmetic penile augmentation surgical procedures. Results: 63% percent of the patients, who underwent penile cosmetic augmentation surgery with BellaDerm graft, participated in postoperative survey. 89% of these patients reported great satisfaction with cosmetic penile augmentation surgery with BellaDerm graft. Complications: Infection, that required medical and surgical treatment, developed in 17 (5.4%) of these patients. All patients were cured from infection after graft removal and 2 weeks of continuous treatment with general and local antibiotics administered through the drain. All 17 patients were successfully signed off from the treatment with subsequent instructions regarding continuity of care. 9 patients were on anabolic steroids (anabolic steroids compromised post-surgical wound healing); 6 patients violated post-surgical protocol having been engaged in early sexual activity that lead to the skin separation on sub-coronal incision and let the wound open. 8 patients smoked heavily (chain smokers) and they did not disclose this matter before surgery. 24 patients (7.6%) reported post-surgical retraction that was successfully treated medically and surgically. Discussion: In 2002, the American Academy of Phalloplasty Surgeons established national and international standards for male cosmetic augmentation surgery, including the identification of indications, operative strategies, surgical techniques, and the assessment of results. These standards have been in effect for 15 years. When qualified surgeons, who completed education and training provided by the American Academy of Phalloplasty Surgeons have followed AAPS guidelines, these surgeries have become successful. Yet, despite successful physical results, the subjective evaluation of aesthetic results and the ethical implications of male cosmetic augmentation surgery continue to be debated. Conclusion: This article represents retrospective evaluation of patients who have undergone cosmetic penile augmentation surgery with BellaDerm graft. The study reported high satisfaction rate with this surgical technique for penile augmentation (Penile Dual and Triple Augmentation TM) developed, patented, and used by the author of this article.

The Role of CorrugateDrain In Decreasing Postoperative Complication Of Penile Fracture Surgery

Objective:tostudy the role of corrugate drain (which is used by some urosurgeons) followed surgical correction of fractured penis in decreasing post operative complications such as penile swelling, pain and curvature.&#x0D; Patient and method:comparative cross sectional study was carried out at the urological department of Al-Hilla teaching hospital from March 2008 to April 2011.&#x0D; Twenty male patients (age between 21-40 years) admitted to the urological department in Al-Hila teaching hospital suffering from penile fracture from March 2008 to April 2011 were included in this study.&#x0D; Immediate surgical repair done to all those patients ,corrugate drain put post operatively for 10 patients while the remaining 10 patients without drains.&#x0D; All patients are fallowed for at least 3 months regarding postoperative penile swelling, deformity, pain and sexual function.&#x0D; Result:regarding age distribution of patients suffering from fracture penis, from twenty patients included in this study 11 patients their agerange from (20-30)years, 7 patients their age group range from (31-45)years and only 2 patients their age range from (46-60)years. Fifteen patients are married and only 5 patients are unmarried. No one develop postoperative penile swelling in patients with corrugate drain and only one patient develops swelling in patients without corrugate drain. Regarding postoperative pain, in patients surgically corrected with drain, 6 patients develop pain and only 2 patients surgically corrected without drain develops pain.&#x0D; Conclusion:No beneficial effect of corrugate drain in decreasing postoperative penile swelling or curvature and on the other hand it increase post operative penile pain.

Brachytherapy for conservative treatment of invasive penile carcinoma in older patients: Single institution experience.

No study has examined the possibility to perform an organ sparing strategy in older patients with penile carcinoma, and amputation is frequently proposed. We report our experience of interstitial brachytherapy for the conservative treatment of penile carcinoma confined to the glans in patients aged of 70years and more. A total of 55 patients candidates to conservative brachytherapy were identified. Median age was 73.8years (range: 70-95years). Patients underwent a circumcision then 3-4weeks later, an interstitial brachytherapy was delivered, median dose of 65Gy (range 55-74Gy). Salvage surgery was discussed in patients with histological confirmation of residual/relapsed tumor. With median follow-up of 9.0years, eight patients (14.5%) experienced a relapse, including five patients with local relapse. Three patients with local relapse only underwent salvage penile surgery, including two partial glansectomies and one total penectomy, and were in second complete remission at last follow-up. Among 55 patients analyzed for late side effects, seven patients (13.0%) presented pain or ulceration, 12 (22.2%) experienced urethral or meatal stenosis requiring at least one dilatation, two patients (3.7%) experienced both ulcerations and urethral complication. Three patients (5.5%) needed partial glansectomy for focal necrosis. At five years, estimated overall survival rate was 74.5% (95%CI: 62.0-87.0%) and local relapse free rate was 91.0% (95%CI: 82.6-99.4%). Brachytherapy is feasible in selected older patients with penile carcinoma, with efficacy and toxicity rates comparable to that of other series in younger patients.

A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen

BackgroundGenital dissatisfaction is an important reason for transmen to undergo genital gender-confirming surgery (GCS; phalloplasty or metoidioplasty). However, little is known about motives for choosing specific techniques, how transmen benefit postoperatively, and whether psychosexual outcomes improve. AimTo evaluate motivations for and psychosexual outcomes after GCS. MethodsA longitudinal study of 21 transmen at least 1 year after GCS was conducted. Participants were recruited through their surgeon. Data were collected when they applied for surgery and at least 1 year after surgery. OutcomesData collection included semistructured questionnaires on motivations for surgery, postoperative experiences, and standardized measures of psychological symptoms, body image, self-esteem, sexuality, and quality of life (pre- and postoperative). Information on surgical complications and corrections was retrieved from medical records. ResultsMost participants underwent phalloplasty with urethral lengthening using a radial forearm flap. Although problematic voiding symptoms were prevalent, many participants were satisfied with their penile function. The strongest motivations to pursue penile surgery were confirmation of one's identity (100%), enabling sexual intercourse (78%), and voiding while standing (74%). No significant differences between postoperative and reference values were observed for standardized measures. After surgery, transmen were more sexually active (masturbation and with a partner) and used their genitals more frequently during sex compared with before surgery (31–78%). Clinical ImplicationsThe present study provides input for preoperative decision making: (i) main motives for surgery include identity confirmation, voiding, and sexuality, (ii) surgery can result in more sexual activity and genital involvement during sex, although some distress can remain, but (iii) complications and voiding symptoms are prevalent. Strength and LimitationsStudy strengths include its longitudinal design and the novelty of the studied outcomes. The main limitations include the sample size and the nature of the assessment. ConclusionCounseling and decision making for GCS in transmen should be a highly personalized and interdisciplinary practice.van de Grift TC, Pigot GLS, Boudhan S, et al. A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen. J Sex Med 2017;14:1621–1628.

Comparison of Intraoperative and Early Postoperative Outcomes of Caudal vs Dorsal Penile Nerve Blocks for Outpatient Penile Surgeries

To compare intraoperative and 1-hour postoperative outcomes in caudal vs dorsal penile nerve block (DPNB) patients undergoing penile surgeries. We performed a retrospective cohort study of boys <10 years old undergoing penile procedures (2013-2015) using the Pediatric Regional Anesthesia Network, Pediatric Health Information System databases, and our medical records. The primary outcome was a maximum Faces Limbs Activity Crying Consolability pain score of >3. Secondary outcomes were intraoperative-postanesthesia care unit (PACU) narcotics, preincision anesthesia time, adjusted operating room charges, and complications. We performed bivariate and multivariable analyses controlling for demographic and procedural characteristics and clustering by surgeon. Of 738 patients (mean age 2.1 years), 74.1% had a caudal block. DPNB patients were more likely to have a maximum pain score of >3 (19.5% vs 8.1%, P <.0001), receive intraoperative (33.0% vs 2.9%, P <.0001) and PACU (15.7% vs 7.5%, P = .0009) narcotics, and had shorter preincision anesthesia times (19.5 vs 27.9 minutes, P <.0001) and lower adjusted operating room charges ($9,402 vs $12,760, P <.0001). In a bivariate logistic regression, DPNB patients had 2.7 times the odds of a maximum pain score of >3 (95% confidence interval 1.7-4.4, P <.0001) and 5.2 times the odds of intraoperative and PACU narcotic administration (95% confidence interval 3.3-8.1, P <.0001). In multivariable analyses, caudal patients had longer preincision anesthesia times (27.9 ± 7.4 vs 19.5 ± 6.6 minutes, P <.0001) and higher adjusted operating room charges ($12,760 ± 4077 vs $9,402 ± 3741, P = .01). Caudal blocks may offer a small advantage in the immediate postoperative period, although cost-effectiveness is unproven.

Utilization of Postpenile Surgery Illustrated Healing Atlas: A Comparative Study

To determine the effect of the postpenile surgery illustrated healing atlas on caregivers' anxiety levels pre- and postoperatively, the frequency of family's postoperative communication with the urology care team, and the number of unplanned emergency room (ER) return for wound checks. A prospective cohort enrolled children who underwent penile surgeries (distal hypospadias repair and phalloplasty) with no concomitant procedures from December 2016 to June 2017. A 6-item short-form Spielberger State-Trait Anxiety Inventory (STAI) was used to determine baseline and postoperative anxiety levels of the caregivers. Two groups were created: caregivers who did not view the illustrated atlas vs caregivers who were shown the atlas. Baseline characteristics and demographics were compared, along with caregiver's pre- to postoperative anxiety level difference, frequency of postoperative communication, and number of unplanned ER return for wound checks. Fifty-four patients were enrolled with 27 families in each group. Baseline characteristics and demographics were comparable with no significant differences. The assessment of the pre- to postoperative anxiety levels in both groups showed no significant differences (median difference -5 [interquartile range -8 to -5] vs -5 [interquartile range -8 to -4], P = .94). Although no differences were noted for ER-return rates between the groups (18% vs 11.1%, P = .704), significantly less postoperative calls and e-mails were noted among families who received or viewed the postpenile surgery illustrated healing atlas (51.9% vs 11.1%, P = .003). The utilization of a postpenile surgery illustrated healing atlas as part of the postoperative support provided to families was able to decrease postoperative calls and e-mails.