Erectile Function Satisfaction Research Articles

(160) Prospective Evaluation of Proximal Decompression for the Management of Refractory Ischemic Priapism

Abstract Introduction A prolonged undesired erection of the penis that is often unrelated to sexual arousal is referred to as priapism. Over 95% of people who experience priapism are ischemic, which causes blood to become stuck in the corpora, increase hypoxia, hypercarbia, and acidosis that resemble compartment syndrome, and hinders penile venous outflow. IP is a urological emergency due to the risk of cavernosal fibrosis and consequent permanent ED. Injections of α-agonist and corporal irrigation/aspiration are the main forms of treatment for short-duration priapism, with distal shunting as a last resort. Patients with refractory and/or prolonged ischemic priapism (PIP) find their strategy more challenging. There is a low probability that irrigation/aspiration procedures, α-agonist injections, and distal shunting will work for people who have priapism that lasts longer than 24 hours. Objective This study was conducted on 21 male patients with refractory and\or prolonged IP to evaluate the outcomes of proximal decompression in the management of those patients. The primary end point was to assess priapism resolution in the patients. While the secondary end point was to assess erection recovery in those patients and their ability to perform sexual intercourse. Methods Patients’ information had been collected from the hospital data and connection with them had been through phone calls and hospital follow-up visits. Results Among the current study patients, the most detected etiology was tramadol intake (23.8%), followed by THC addiction and idiopathic ischemic priapism, while the least common were papaverine injection and hematological disorder (4.8%). 23.8% of the patients had twice aspirations, while 33.3% had a once. 14.3% of the patients had T shunt. 33.3% had bilateral PSD, and the other 66.7% had unilateral PSD. In the present study the decompression was successful in all the patients, where all the patients showed resolution of priapism, however 57.1% were able to perform sexual intercourse. The mean duration to achieve complete detumescence after surgery in this study was 24.2 ± 8.4 days. 33.3% had no complications, 52.4% had edema, while 14.3% had wound infection. The mean baseline IIEF score of the present study patients was 22.6 ± 2.2 (most of the patients (75%) hadn’t erectile dysfunction, 9.5% had mild erectile dysfunction and 4.8% had mild to ED), which was decreased after 3 months of the surgery (7.7 ± 2.8). Three months post-operatively severe ED was detected in 52.4% of the patients, 33.3% had moderate ED and 14.3% had mild to moderate ED. Six months after surgery the erectile dysfunction improved, where the mean IIEF score was 12.2 ± 5.0. Mild ED was detected in 23.8 %, Mild to moderate ED in 33.3 %, Moderate ED in 19 % and Severe ED in 23.8 %. The difference between the IIEF scores at base line, 3 months postoperatively and 6 months postoperatively was statistically significant. Conclusions Penoscrotal decompression (PSD) is a simple, safe, highly effective, and easily reproducible procedure for resolution of RIP with glans preservation in addition to more satisfactory erectile function outcomes to a certain extent Disclosure Yes, this is sponsored by industry/sponsor: alexandria main university hospital Clarification: Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: alexandria main university hospital.

Robot-assisted radical prostatectomy in patients after endoscopic surgeries on the prostate

Background. In literature, data on the results of robot-assisted radical prostatectomy (RARP) in patients after transurethral resection of the prostate (TURP) are contradictory.Aim. To evaluate surgical, functional, and oncological outcomes of RARP after TURP.Materials and methods. At the Urology Center of the Mariinsky Hospital (Saint Petersburg), RARP was performed on 410 patients. Among them, 28 (6.8 %) patients (1st group) previously underwent TURP due to infravesical obstruction. Among them, 18 (64.3 %) patients were diagnosed with prostate cancer after pathomorphological examination of the tissue resected during TURP, and on them RARP was performed on average 3.2 months later. In 10 (35.7 %) patients, prostate cancer was diagnosed during transrectal biopsy due to increased prostate-specific antigen level; on them RARP was performed on average 42.0 months after TURP. The following parameters were evaluated: operative time, time of bladder neck reconstruction and urethrovesical anastomosis formation, blood loss volume, tumor pathological stage, Gleason score, surgical margin status, rates of urine continence and preservation of erectile function.Results. Mean operative time was higher in the 1st group compared to the 2nd: 210 ± 36 min versus 180 ± 25 min (р <0.0001). In the 1st group compared to the 2nd, reconstruction of bladder neck was necessary more frequently (82.1 % versus 10.7 %; р <0.0001), urethrovesical anastomosis took longer time (32 ± 2.3 min versus 24.5 ± 3.1 min; р <0.0001), mean blood loss volume was higher (240 ± 39 mL versus 170 ± 32 mL; р <0.0001). Frequencies of positive surgical margin were 14.3 and 10.7 % respectively in the 1st and 2nd groups (р = 0.840). Frequencies of all complications were 28.6 and 21.4 %, respectively. Severe complications (≥IIIb grade per the Clavien classification) were observed in 2 (7.1 %) patients in both groups. Frequency of anastomosis stricture after surgery was significantly higher in the 1st group: in 2 (7.1 %) and 1 (3.6 %) case, respectively (р <0.05). In the 1st group, total urinary continence was achieved in 14 (50.0 %), 20 (71.5 %), 22 (78.5 %) and 25 (89.3 %) patients at early and 3-, 6and 12-month follow-up after RARP; in the 2nd group, it was achieved in 18 (64.3 %), 22 (78.6 %), 24 (85.7 %) and 26 (92.9 %) patients in the same follow-up periods. After 6 and 12 months, in the 1st group among 15 (53.6 %) patients with normal initial erectile function, satisfactory erectile function was preserved in 46.7 and 93.3 % of patients; in the 2nd group among 19 (67.8 %) patients, in 57.8 and 94.7 % patients, respectively.Conclusion. RARP after TURP is a relatively complicated surgical intervention with long operative time and high blood loss volume. However, functional and short-term oncological outcomes of RARP in these patients do not differ at 12 months.

Novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation and long-term outcomes for a single surgeon

Although novel techniques for avoiding incontinence during robot-assisted radical prostatectomy have been developed, long-term oncological outcomes are unknown. The objective of this study was to determine the long-term oncological outcomes and functional outcomes of novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation for a single surgeon. Data from 100 patients who underwent structure-preserving prostatectomies performed by a single surgeon were retrospectively analyzed. The median console time was 123 min. Bilateral nerve-sparing was performed in 43% of patients underwent, and 57% underwent unilateral nerve-sparing surgery. Most patients (96%) reached complete pad-zero urinary continence by one year after surgery. Satisfactory erectile function was achieved in 97% of patients who underwent bilateral nerve-sparing surgery, and 80% of patients who underwent unilateral nerve-sparing surgery. The surgical margin was positive for 25% of patients, and the biochemical recurrence-free rate at 5 years was 77%. The cancer-specific survival rate was 100% during the median follow-up period of 4.5 years. Clavien-Dindo grade III complications occurred in 1% of cases. The outcomes for novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation were similar to previously reported oncological outcomes, with satisfactory functional outcomes. This operative method may be useful for patients who are eligible for nerve-sparing surgery.

Penile fracture with urethral injury: a case report of rare double trouble

BackgroundA penile fracture occurs when the tunica albuginea of penis tears during erection. Penile fracture is a rare but serious injury that occurs when the erect penis sustains a traumatic force. It is characterized by a sudden snapping or popping sound, followed by immediate pain, swelling, and discoloration. Its association with concomitant urethral injury is very rare. This case study describes such a rare case.Case presentationIn this case study, we present the case of a 47-year-old man who experienced sudden pain and lost erection with a popping sound while having sexual intercourse. There was bloody discharge from the urethral opening and showed the distinct sign of an "Eggplant Deformity." This result confirmed the diagnosis. Immediate surgical intervention revealed damage to the left corpora and urethra. The procedure involved repairing the tunica albuginea covering the corpora tissue and reconstructing the damaged urethra. The surgery went smoothly without complications. The patient reported satisfactory erectile function and normal urination on follow-up visit after 2 months.ConclusionPenile fracture with urethral injury is a rare but serious emergency. Prompt detection and surgical intervention are crucial for optimal outcomes and minimal complications. Depending on severity, either catheterization or repair may be necessary.

A pilot study of inflatable penile prosthesis placement in transgender neophallus using Tutoplast® pericardium graft sock technique.

Placement of an inflatable penile prosthesis (IPP) in a transgender patient's neophallus carries unique considerations versus cis-gender IPP placement in mitigating infection, erosion, and overall complication rates. An example of this includes the lack of an anatomical corpus cavernosum and crura for cylinder placement and anchoring. Multiple grafting approaches and materials have been utilized to mitigate possible cylinder instability and improve anchoring. Here we describe our experience and surgical technique in IPP neophallus placement utilizing a single cylinder with distal and proximal cylinder human cadaver pericardium (Tutoplast®, IOP Ophthalmics, Costa Mesa, CA, USA) grafts. Our goals were to determine postoperative satisfaction and device functionality in patients undergoing transgender neophallus IPP placement using our technique. Both patients report satisfaction and no complications at last follow-up (currently up to 14 and 23 months post-operatively, respectively) with satisfactory erectile function and ability to perform penetrative intercourse. In neophallus IPP placement, the anatomical differences compared to cis-gender IPP operations require unique considerations such as cylinder grafting material selection for proximal cylinder fixation and mitigation of device erosion rates. Optimization of grafting material in neophallus IPP placement in an effort to reduce erosion rates has become increasingly important as frequency of this operation increases. Utilizing human cadaver pericardium graft in distal and proximal cylinder coverage shows beneficial preliminary outcomes in our patients.

(042) Inflatable Penile Prosthesis Placement In Transgender Neophallus Using Novel Human Cadaver Pericardium (Tutoplast®) Graft Sock Technique

Abstract Introduction Placement of an inflatable penile prosthesis (IPP) in a transgender patient’s neophallus carries unique considerations versus cis-gender IPP in mitigating infection, erosion, and overall complication rates. Traditionally, the IPP implants used in cis-males are also employed in transmasculine patients. However, there are unique challenges in the transmasculine population, with one of the most significant being the lack of anatomical corpus cavernosum and crura for cylinder placement and anchoring. To account for this, multiple grafting approaches and materials have been utilized in IPP neophallus placement with the goal of facilitating cylinder anchoring and stability. Here we detail our experiences using a novel grafting approach with Tutoplast® pericardium graft in a “sock” and “cap” technique in IPP placement in a transgender neophallus. Objective Our objective is to evaluate postoperative satisfaction and device functionality in patients undergoing transgender neophallic IPP placement using our technique. Methods We describe our experience and surgical technique in IPP neophallus placement utilizing a single cylinder with novel distal and proximal cylinder human cadaver pericardium (Tutoplast®) graft. Results We performed neophallus IPP placement with this novel grafting technique, with operative images and graft details shown below. Patients had no complaints post-operatively, with cylinder and pump found to be in good position at first post-operative visit 6 weeks following surgery. There was no difficulty with urinating through the neophallus. All patients report continued satisfaction with device as well as ability to perform penetrative intercourse with device activated. All patients reported satisfaction and no complications at last follow-up (range: 3.5 months to 13 months), with all patients possessing continued satisfactory erectile function. One patient noted occasional mild pain in neophallus that self-resolves and does not cause any concern. Conclusions In neophallus IPP placement, the anatomical differences compared to cis-gender IPP operations require unique considerations such as cylinder grafting material selection for proximal cylinder fixation and mitigation of device erosion rates. Utilizing human cadaver pericardium (Tutoplast®) graft in distal and proximal cylinder coverage shows positive preliminary outcomes in our patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Run Wang, MD, FACS is a consultant for Boston Scientific and Teleflex.

Penile Fracture at the Crus of the Penis - A Rare Case Report.

Penile fracture is an uncommon acute surgical emergency, typically occurring after sexual intercourse, self-manipulation and at times, may be accidental. We report here a 39-year male who attended the department of emergency with swelling and bruising of the scrotum and penis. Physical examination exhibited a diffuse abdominal and perineal ecchymosis. Imaging confirmed a crural penile fracture. Operative fixation was performed appropriately and satisfactory erectile function was reported at the follow-up. We report a very rarely documented case involving the penile crus fracture and its management. Key Words: Crus, Penile fracture, Surgical repair.

V09-06 PROSTATE-CAPSULE SPARING RADICAL CYSTECTOMY WITH MODIFIED W-POUCH ORTHOTOPIC NEOBLADDER RECONSTRUCTION

You have accessJournal of UrologyCME1 May 2022V09-06 PROSTATE-CAPSULE SPARING RADICAL CYSTECTOMY WITH MODIFIED W-POUCH ORTHOTOPIC NEOBLADDER RECONSTRUCTION Christopher Dall, Charlotte Goldman, James Mason, Lisa Chuong, Keith Kowalczyk, Lambros Stamatakis, and Ross Krasnow Christopher DallChristopher Dall More articles by this author , Charlotte GoldmanCharlotte Goldman More articles by this author , James MasonJames Mason More articles by this author , Lisa ChuongLisa Chuong More articles by this author , Keith KowalczykKeith Kowalczyk More articles by this author , Lambros StamatakisLambros Stamatakis More articles by this author , and Ross KrasnowRoss Krasnow More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002617.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For patients who undergo radical cystectomy (RC) with orthotopic neobladder, erectile dysfunction and urinary symptoms may have a large impact in quality of life. This video demonstrates our prostate-capsule sparing radical cystectomy (PSC-RC) surgical technique, which may improve these functional outcomes in appropriately selected patients. METHODS: In this video demonstration, we describe development of the posterior plane and dissection anterior to the seminal vesicles and vas deferens. The Space of Retzius is entered and the bladder mobilized anteriorly. The prostatic capsule is incised at the 11 o’clock and 1 o’clock positions and the prostate adenoma enucleated. The urethra is transected distally to the prostate adenoma. A modified W-pouch orthotopic neobladder is then created using 30 cm of dependent terminal ileum approximately 25-30cm proximal to the ileocecal valve. The ileum is first detubularized, followed by sewing of the posterior plate. The urethroenteric anastomosis is performed, following by closure of the anterior plate of the neobladder. The ureteroenteric anastomoses are then completed using the proximal and distal end of the neobladder pouch. RESULTS: Data presented in several papers indicates high levels of both daytime and nighttime continence. Satisfactory erectile function is similarly high. When compared to conventional RC, PSC-RC is associated with improved functional outcomes. In our patient series, oncologic outcomes are similar to conventional RC techniques with improved erectile and urinary function. CONCLUSIONS: PCS-RC is associated with improved erectile function and continence when compared to more conventional RC techniques. Our video describes a PCS-RC technique with modified W-pouch orthotopic neobladder reconstruction. Source of Funding:- © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e806 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Dall More articles by this author Charlotte Goldman More articles by this author James Mason More articles by this author Lisa Chuong More articles by this author Keith Kowalczyk More articles by this author Lambros Stamatakis More articles by this author Ross Krasnow More articles by this author Expand All Advertisement PDF DownloadLoading ...

Permanent perineal urethrostomy for anterior urethral strictures: A critical appraisal of long-term outcomes and erectile function.

In complex strictures, especially in elderly patients, perineal urethrostomy (PU) provide excellent voiding function. This study aimed at evaluating the long-term voiding and erectile function of PU as a permanent procedure for such strictures. We retrospectively evaluated 146 patients who underwent permanent PU at our institution from January 2000 to December 2018. All patients had complex urethral strictures. Patients with posterior urethral involvement were excluded. Patients were followed up at 3 months and then yearly. Failure was defined as the need for any additional procedures. They were also evaluated with the International Index of Erectile Function (IIEF-5) questionnaire. Fisher's exact test and χ2 test were used for statistical analysis. The median age at the time of surgery was 58±7.3 years. The mean stricture length was 6.5±2.1 cm. All the patients had a history of previous surgery, and the average number of procedures per patient was 2.4. The median follow-up period was 26 months. The most common early and late postoperative complications were bleeding and stenosis of the urethrostomy, respectively. A total of 129 (88.3%) patients had a successful surgery. The number of patients with no erectile dysfunction increased from 55.4% to 67.8% after PU. The mean IIEF-5 score improved from 20.07 to 21.31 after PU, but this did not achieve statistical significance (p=0.3558). Permanent PU is an acceptable option for complex long-segment anterior urethral strictures, especially in elderly patients, with an excellent long-term outcome. A majority of patients also maintain a satisfactory erectile function.

MP32-03 ERECTILE FUNCTION RESTORATION POST-RADICAL PROSTATECTOMY: UTILISATION OF A NEW NOVEL END-TO-SIDE NERVE GRAFTING PROCEDURE

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy II1 Apr 2018MP32-03 ERECTILE FUNCTION RESTORATION POST-RADICAL PROSTATECTOMY: UTILISATION OF A NEW NOVEL END-TO-SIDE NERVE GRAFTING PROCEDURE Christopher Coombs, Jeanette Reece, and David Dangerfield Christopher CoombsChristopher Coombs More articles by this author , Jeanette ReeceJeanette Reece More articles by this author , and David DangerfieldDavid Dangerfield More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1053AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Permanent erectile dysfunction (ED) is a common adverse side effect of radical prostatectomy (RP) that can significantly impact on health-related quality of life (HRQOL). We investigated the potential of our novel end-to-side sural nerve grafting technique to restore erectile function (EF) and improve HRQOL in a cohort of 11 men with permanent ED following RP. METHODS Eleven patients aged 58-70 years with moderate to severe ED, at least 2 years after nerve-sparing RP or 6 months after non-nerve-sparing RP, were candidates for novel nerve graft surgery to restore EF. The minimally invasive surgical technique involved two single bilateral end-to-side somatic-to-autonomic sural nerve grafts from the donor femoral nerve to the corpora cavernosa of the penis. EF outcomes were measured using the International Index of Erectile Function (IIEF5) and HRQOL outcomes were measured using the sexual domain of the Expanded Prostate Cancer Index Composite for clinical practice (EPIC-CP). Outcomes were assessed pre-RP, pre-nerve grafting and at 3-6 month intervals for 12-30 months following nerve grafting. All assessments were performed independently of the treating surgeons. RESULTS Pre-RP, all men had satisfactory EF (IIEF5 ≥ 17). Pre-nerve grafting, all men had ED insufficient to achieve and maintain sexual penetration (IIEF5 ≤ 11). Post-nerve grafting, EF recovery (IIEF5 ≥ 17) was observed in 9/11 (82%) men with confirmed ED following RP (3/4 men after non-nerve-sparing RP; 3/4 men after bilateral nerve-sparing RP and 3/3 men after unilateral nerve-sparing RP). EF recovery was observed in 4 men 6 months following nerve grafting and in 5 men 12 months following nerve grafting. Significant improvements in post-nerve grafting HRQOL summary, function and bother scores compared with pre-nerve grafting scores were observed in men with restored EF. Three patients could maintain spontaneous erections sufficient for sexual penetration without any penile rehabilitation therapy 12 months post-nerve grafting. Surgeries were performed in around 2.5 hours, followed by an overnight stay in hospital. There was one acute postoperative wound infection. CONCLUSIONS Our innovative end-to-side sural nerve grafting procedure offers a feasible treatment modality to restore EF in impotent men following nerve- or non-nerve sparing RP. EF restoration sufficient to achieve and maintain sexual penetration was observed in 82% of patients where prior to nerve grafting, the likelihood of EF recovery for these men was almost negligible. This minimally invasive nerve grafting technique also has the potential to significantly improve HRQOL. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e420-e421 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Christopher Coombs More articles by this author Jeanette Reece More articles by this author David Dangerfield More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Peak systolic velocity thresholds of cavernosal penile arteries in patients with and without risk factors for arterial erectile deficiency.

To simultaneously assess the peak systolic velocity (PSV) and the end-diastolic velocity (EDV) at dynamic duplex examination of the cavernosal penile arteries, and penile rigidity in subjects with satisfactory erectile function with and without risk factors for arterial erectile deficiency (ED). This multicenter prospective study examined two populations having satisfactory sexual function with dynamic duplex examination of the cavernosal arteries; one population had risk factors for arterial ED (65 patients, Group 1) and the other (60 patients, Group 2) had no risk factors. Penile rigidity was assessed using the Schramek grading system score (SGSS). The PSV, the EDV, and the SGSS values of Group 1 and of Group 2 were measured and compared using analysis of variance. The EDV and PSV data presented in this abstract are the arithmetical means of the data of the left and right cavernosal arteries. The Group 1 patients showed a mean±standard deviation PSV of 26.4±13.2cm/sec and the Group 2 patients showed a PSV of 44.7±9.6cm/sec (p=0.002). The EDV of Group 1 was -15.6±16.1cm/sec and the EDV of Group 2 was -14.9±13.7cm/sec (p=0.329). The SGSS in Group 1 was 3.2±0.3 and the SGSS in Group 2 was 4.8±0.2 (p=0.008). Intra- and inter-operator variability were not statistically significant. The PSVs and the SGSSs of patients with risk factors for ED and satisfactory erectile function were subnormal and significantly lower than the PSVs and the SGSSs of patients without risk factors. It has been hypothesized that compensatory mechanisms, probably of psychological origin, might allow satisfactory erectile response, even in the presence of a subnormal PSV.

Clinical outcomes after laparoscopic radical prostatectomy

Objective To discuss the postoperative outcomes of prostate cancer patients after laparoscopic radical prostatectomy (LRP). Methods There were 176 patients who underwent LRP in our center and had a follow–up more than 1 year from April 2011 to April 2014. The clinical data was retrospectively analyzed. The mean age was 67 years (57 to 81 years). The mean preoperative PSA was 8.6 μg/L (2.2 to 29.3 μg/L). Results The mean operation time was 127 min, and mean blood loss was 120 ml. Nineteen patients had a positive surgical margin, and 3 patients had positive lymph nodes. There were 17 complications (9.7%) of Clavien Ⅰ, 6 (3.4%) of Clavien Ⅱ, 4 (2.3%) of Clavien Ⅲ and none of Clavien Ⅳ or Ⅴ. One patient got biochemical recurrence after 6 months and 3 after 12 months. Complete urinary incontinence after 1, 3, 6, 12 months was 8(4.5%), 5(2.8%), 2(1.1%) and 2(1.1%) cases. Of the 19 nerve–sparing patients, satisfactory erectile function was gained in 3, 5, 5 and 6 cases at 1, 3, 6, 12 months postoperatively. Conclusions LRP could be a safe and effective treatment for localized prostate cancer. It is good at the control of complications, urinary continence and erectile function. It is also satisfactory in tumor control. Key words: Prostatic neoplasms; Radical prostatectomy; Laparoscopes; Treatment outcome

Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review

Penile fracture is a rare injury most commonly sustained duringsexual intercourse. We report the case of a 35-year-old man whopresented with bilateral rupture of the corpora cavernosa andcomplete disruption of the urethra. A review of the literature onpenile fracture is also presented. Urgent surgical exploration wasperformed and the injuries repaired primarily. In follow-up, thepatient reported satisfactory erectile function. This case highlightsthe importance of early surgical repair and evaluation for concomitanturethral injuries in cases of penile fracture.

Re: What is the Definition of a Satisfactory Erectile Function After Bilateral Nerve Sparing Radical Prostatectomy?

Re: What is the Definition of a Satisfactory Erectile Function After Bilateral Nerve Sparing Radical Prostatectomy?

A case of penile fracture at the crura of the penis without urethral involvement: Rare entity

Penile fracture is a rare injury, most commonly sustained during sexual intercourse. We report the case of a 29-year-old man who presented with bilateral rupture of the crura of the cavernosa without urethral injury. This is the first case in the literature to present with this unique finding. Urgent surgical exploration was performed and the injuries repaired primarily. At follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early diagnosis with unusual presentation and early surgical repair for better outcome.

Open Radical Retropubic Prostatectomy Using High Anterior Release of the Levator Fascia and Constant Haptic Feedback in Bilateral Neurovascular Bundle Preservation Plus Early Postoperative Phosphodiesterase Type 5 Inhibition: A Contemporary Series

BackgroundPatients with newly diagnosed localized prostate cancer who choose surgery want cure and decent quality of life, namely, pad-free urinary control and, often, erectile function satisfactory for sexual intercourse. ObjectiveDetermine in a prospective study the positive surgical margin rate and functional outcomes for a consecutive series of patients undergoing open radical retropubic prostatectomy (ORRP) with bilateral neurovascular bundle preservation (BNVBP) performed by one experienced surgeon. Design, setting, and participantsOf 197 consecutive patients undergoing BNVBP during 2008, 123 were evaluable, allowing both immediate postoperative phosphodiesterase type 5 inhibition (PDE5i) and a third-party questionnaire with validated urinary and erectile function domains provided preoperatively and at 3, 6, and 12 mo postoperatively. InterventionTwo interventions were used: (1) ORRP with ×4.3 optical loupes and constant digital tactile monitoring during BNVBP preceded by high anterior release (HAR) of levator fascia and neurovascular bundles and (2) early postoperative PDE5i. MeasurementsAge; biopsy Gleason score; clinical stage; preoperative prostate-specific antigen level; pathologic grade; stage; margin status; University of California, Los Angeles Prostate Cancer Index domain for urinary pad use and bother; and International Index of Erectile Function-5 (IIEF-5) were used. Results and limitationsSurgical margins were positive in 1 of the 123 evaluable patients (1%). At 1 yr, 95% of patients were pad-free. Satisfactory erectile function was achieved by 109 patients (89%): 82 (67%) scored an IIEF-5 of 22–25, and 27 (22%) scored <22–25 with ≥4 on either satisfaction or confidence questions or achieved “full” erection within the first year. Mean hospital stay was 1.3 d. Limitations were (1) observational, noncomparative, single-surgeon series and (2) in third-party methodology, failure to capture patient answers for all questionnaire intervals with resultant inability to address durability of functional results for all patients. ConclusionsORRP using ×4.3 optical loupe magnification, constant haptic feedback in BNVBP with HAR, and immediate postoperative PDE5i yielded satisfactory outcomes.

Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review

Penile fracture is a rare injury most commonly sustained during sexual intercourse. We report the case of a 35-year-old man who presented with bilateral rupture of the corpora cavernosa and complete disruption of the urethra. A review of the literature on penile fracture is also presented. Urgent surgical exploration was performed and the injuries repaired primarily. In follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early surgical repair and evaluation for concomitant urethral injuries in cases of penile fracture.

What Is the Definition of a Satisfactory Erectile Function After Bilateral Nerve Sparing Radical Prostatectomy?

Different cut-offs of the erectile function (EF) domain of the International Index of Erectile Function (IIEF) have been used as definition of postoperative EF recovery. To test the correlation between patient satisfaction and IIEF-EF domain score cut-offs. The IIEF was used to evaluate EF and satisfaction before and after bilateral nerve sparing radical prostatectomy (BNSRP). The study included 165 consecutive patients treated with retropubic BNSRP at a single institution. All patients had normal preoperative EF (IIEF-EF ≥ 26) and reached an IIEF-EF ≥ 17 following surgery. Complete data included EF, intercourse (IS), and overall satisfaction (OS) assessed by the corresponding domains of the IIEF administered prior and after surgery. Patients were divided into three groups according to the highest IIEF-EF score reached postoperatively, namely 17-21 (group 1), 22-25 (group 2), and ≥ 26 (group 3). One-way analysis of variance was used to compare IIEF-OS and IIEF-IS domain scores at the time the EF end point was reached. The same analyses were repeated separately in those patients with a complete EF recovery after surgery (group 3). Mean preoperative IIEF-OS and IIEF-IS domain score was 8.4, 8.8, 8.7 and 11.6, 11.8, 11.9 in group 1, 2, 3, respectively (all P ≥ 0.3). After a mean follow-up of 26.7 months, mean postoperative IIEF-OS and IIEF-IS domain scores assessed at the time of EF recovery were comparable for patients reaching an IIEF-EF of 22-25 and for patients scoring postoperatively ≥ 26 (8.1, 8.1, and 10.6, 11.4; all P ≥ 0.3). However, mean IIEF-OS and IIEF-IS domain scores of these patients were significantly higher as compared to patients reaching an IIEF-EF domain score < 22 (6.3 and 8.4, respectively; all P ≤ 0.006). Similar results were achieved considering only those patients (group 3) who had complete EF recovery after surgery. We demonstrated that in preoperatively fully potent patients treated with BNSRP a lower satisfaction is expected when an IIEF-EF cut-off of 17 is used. Conversely, no difference was found using a cut-off of 22 or 26. Therefore, our results support that a cut-off of IIEF-EF ≥ 22 might represent a reliable score for defining EF recovery after BNSRP.

Cooperation during implanting domestically-made penile prosthesis for treating erectile dysfunction surgery

Objective To explore the cooperation emphasis during implanting domestically-made penile prosthesis for treating erectile dysfunction (ED) surgery. Methods The operation nursing of 9 ED patients undergoing surgery were selected to analyze. It includes primary care, strengthening the preoperative psychological care, special equipment and carefully prepared specialty items; strict implementation of the principles of aseptic surgery, note the use of antibiotics each stage, familiar three-piece implant method of installation. Results The surgery was successful in 9 cases, no peri-operative infections were happened and postoperative erectile function satisfaction was good. Conclusions Nurses skilled surgical procedures, with the tacit understanding, strict aseptic technique is the key to obtain successful operation. Key words: Erectile dysfunction; Penile prosthesis; Cooperation

10-Year Experience With I-125 Prostate Brachytherapy at the Princess Margaret Hospital: Results for 1,100 Patients

To report outcomes for 1,111 men treated with iodine-125 brachytherapy (BT) at a single institution. A total of 1,111 men (median age, 63) were treated with iodine-125 prostate BT for low- or intermediate-risk prostate cancer between March 1999 and November 2008. Median prostate-specific antigen (PSA) level was 5.4 ng/ml (range, 0.9-26.1). T stage was T1c in 66% and T2 in 34% of patients. Gleason score was 6 in 90.1% and 7 or 8 in 9.9% of patients. Neoadjuvant hormonal therapy (2-6 months course) was used in 10.1% of patients and combined external radiotherapy (45 Gy) with BT (110 Gy) in 4.1% (n = 46) of patients. Univariate and multivariate Cox proportional hazards were used to determine predictors of failure. Median follow-up was 42 months (range, 6-114), but for biochemical freedom from relapse, a minimum PSA test follow-up of 30 months was required (median 54; n = 776). There were 27 failures, yielding an actuarial 7-year disease-free survival rate of 95.2% (96 at risk beyond 84 months). All failures underwent repeat 12-core transrectal ultrasound -guided biopsies, confirming 8 local failures. On multivariate analysis, Gleason score was the only independent predictor of failure (p = 0.001; hazard ratio, 4.8 (1.9-12.4). Median International Prostate Symptom score from 12 to 108 months ranged between 3 and 9. Of the men reporting baseline potency, 82.8% retained satisfactory erectile function beyond 5 years. Iodine-125 prostate BT is a highly effective treatment option for favorable- and intermediate-risk prostate cancer and is associated with maintenance of good urinary and erectile functions.