Anne-Françoise Spinoit

The AdVance male sling as a minimally invasive treatment for intrinsic sphincter deficiency in patients with neurogenic bladder sphincter dysfunction: A pilot study†‡

The aim of the study was to evaluate feasibility, efficacy, and safety of the AdVance male sling in neuropathic male patients with intrinsic sphincter deficiency.

Buccal Versus Lingual Mucosa Graft in Anterior Urethroplasty: A Prospective Comparison of Surgical Outcome and Donor Site Morbidity

PURPOSE We prospectively compared buccal mucosa graft and lingual mucosa graft urethroplasty with respect to donor site morbidity and urethroplasty outcome. MATERIALS AND METHODS Patients treated with buccal mucosa graft (29) or lingual mucosa graft (29) urethroplasty were included in the study. Oral pain and morbidity were assessed using the numeric rating scale (scale 0 to 10) as well as an in-home questionnaire administered 3 days, 2 weeks and 6 months postoperatively. RESULTS After a mean (± SD) followup of 30 (± 13) months successful urethroplasty was achieved in 24 (82.8%) and 26 (89.7%) patients treated with buccal mucosa graft and lingual mucosa graft, respectively (p = 0.306). Median numeric rating scale after 3 days, 2 weeks and 6 months was 4, 2 and 0 for buccal mucosa graft and 6, 3 and 0 for lingual mucosa graft, respectively, with no statistical differences between the groups. At day 3 significantly more patients in the lingual mucosa graft group had severe difficulties with eating and drinking (62.1% vs 24.1%, p = 0.004) and speaking (93.1% vs 55.2%, p = 0.001), and had dysgeusia (48.3% vs 13.8%, p = 0.01). Two weeks postoperatively speech impairment was still more frequent with lingual mucosa graft (55.2% vs 13.8%, p = 0.002), whereas oral tightness was more frequent with buccal mucosa graft (41.4% vs 6.9%, p = 0.005). After 6 months 44.8% and 31% of patients treated with buccal mucosa graft and lingual mucosa graft, respectively, still reported sensitivity disorders (p = 0.279). CONCLUSIONS The success of urethroplasty with lingual and buccal mucosa grafts was similar. Oral pain was not different after both grafts. In the early postoperative period there were differences in oral morbidity between buccal and lingual mucosa grafts. Long-term oral morbidity was not infrequent with both grafts.

Anastomotic Repair versus Free Graft Urethroplasty for Bulbar Strictures: A Focus on the Impact on Sexual Function

Objectives. To evaluate alterations in sexual function and genital sensitivity after anastomotic repair (AR) and free graft urethroplasty (FGU) for bulbar urethral strictures. Methods. Patients treated with AR (n = 31) or FGU (n = 16) were prospectively evaluated before, 6 weeks and 6 months after urethroplasty. Evaluation included International Prostate Symptom Score (IPSS), 5-Item International Index of Erectile Function (IIEF-5), Ejaculation/Orgasm Score (EOS), and 3 questions on genital sensitivity. Results. At 6 weeks, there was a significant decline of IIEF-5 for AR (−4.8; p = 0.005), whereas there was no significant change for FGU (+0.9; p = 0.115). After 6 months, differences with baseline were not significant overall and among subgroups. At 6 weeks, there was a significant decline in EOS for AR (−1.4; p = 0.022). In the FGU group there was no significant change (+0.6; p = 0.12). Overall and among subgroups, EOS normalized at 6 months. After 6 weeks and 6 months, respectively, 62.2 and 52% of patients reported alterations in penile sensitivity with no significant differences among subgroups. Conclusions. AR is associated with a transient decline in erectile and ejaculatory function. This was not observed with FGU. Bulbar AR and FGU are likely to alter genital sensitivity.

New Surgical Technique for the Treatment of Buried Penis: Results and Comparison with a Traditional Technique in 75 Patients

Introduction: Buried penis is a pathology for which several reconstructive techniques are described. We report our technique and its outcome. Patients and Methods: 75 patients underwent repair of buried penis by one surgeon (P.H.) between 1997 and 2011. The first 17 patients (mean age 2.6 years) underwent skin-sparing circumcision. The next 58 patients (47 children, mean age 4.4 years; 11 adults, mean age 38 years) underwent our new technique. Its key point consists in releasing dartos tissue and in anchoring the corpora cavernosa to dartos bundles at the penile base. Outcome was evaluated by reoperation rate, complications and satisfaction according to surgeon/patients/parents. Results: The results of skin-sparing circumcision performed in 17 children at 1 year were reported as good by the surgeon in 62.5% (n = 10) and in 82.4% (n = 14) by patients. Reoperation for recurrence occurred in 29.4% (n = 5) patients. Complications treated conservatively were reported in 35.3% (n = 6) of the children. The new technique was performed in 58 patients (47 children, 11 adults). The results were reported as good by the surgeon in 96.6% (n = 56) and in 91.4% (n = 53) by patients. Reoperation occurred in 4 patients (6.9%). Conclusions: The outcome of the new technique is superior to skin-sparing circumcision regarding complication/reoperation rate and cosmesis according to patients/parents/surgeon.

Isolated Male Epispadias: Anatomic Functional Restoration Is the Primary Goal.

Background. Isolated male epispadias (IME) is a rare congenital penile malformation, as often part of bladder-exstrophy-epispadias complex (BEEC). In its isolated presentation, it consists in a defect of the dorsal aspect of the penis, leaving the urethral plate open. Occurrence of urinary incontinence is related to the degree of dorsal displacement of the meatus and the underlying underdevelopment of the urethral sphincter. The technique for primary IME reconstruction, based on anatomic restoration of the urethra and bladder neck, is here illustrated. Patients and Methods. A retrospective database was created with patients who underwent primary IME repair between June 1998 and February 2014. Intraoperative variables, postoperative complications, and outcomes were assessed. A descriptive statistical analysis was performed. Results and Limitations. Eight patients underwent primary repair, with penopubic epispadias (PPE) in 3, penile epispadias (PE) in 2, and glandular epispadias (GE) in 3. Median age at surgery was 13.0 months [7–47]; median follow-up was 52 months [9–120]. Complications requiring further surgery were reported in two patients, while further esthetic surgeries were required in 4 patients. Conclusion. Anatomical restoration in primary IME is safe and effective, with acceptable results given the initial pathology.

Varicocele: the origin of benign prostatic hypertrophy? Testosterone dosages in the periprostatic plexus.

Objectives: In 2008, Gat et al. wrote the hypothesis that benign prostatic hypertrophy (BPH) was caused by reflux from high free testosterone containing blood from varicocele. The purpose of this study is to measure testosterone at the prostatic veins in patients operated for large BPH, confirming Gat’s theory. Material and methods: In 13 patients, operated by Millin technique, the periprostatic plexus was punctured in 45° tilted position in order to the measure total and free testosterone and dihydrotestosterone. Brachial blood was taken simultaneously for similar measurements. Seven patients had a clinical varicocele. Results: High testosterone levels, in comparison with the brachial blood, were detected in only two patients. Dihydrotestosterone was at least doubled in all cases, demonstrating that the puncture was done in prostatic drainage area. Conclusion: Gat’s theory, concerning the role of varicocele in the origin of BPH, could not be confirmed in this study. Technical limitations can be responsible for this.

Sequential robot-assisted radical right nephrectomy and cholecystectomy: a safe combined procedure

Kidney tumours are often found incidentally in the work‐up of abdominal pain. We are reporting, to the best of our knowledge, the first series of robot‐assisted radical nephrectomy (RARN) combined with cholecystectomy (RACH) in patients with organ‐confined right kidney tumour and gallbladder stones.

Re: Perioperative and Short-term Outcomes of Robotic vs Open Bladder Neck Procedures for Neurogenic Incontinence

Expert’s summary: The authors retrospectively compared open (O-BNR; n = 26) and robotically-assisted bladder neck reconstruction (RA-BNR; n = 19) without bladder augmentation in a pediatric population, with a mean age at surgery of 9.1 yr [1]. The indication for surgery in this pediatric series of 45 patients was refractory neurogenic urinary incontinence. The mean follow-up was 2.8 yr for surgeries performed between 2010 and 2014. The most frequent underlying cause of neurogenic refractory incontinence was spina bifida (34/45 cases). A sling-type BNR was performed in all cases. The results were comparable for both cohorts, without [1_TD

Duration of urethral catheterization after urethroplasty: how long is enough?

DIFF]any significant difference regarding outcome, except for a longer operative time in the RA-BNR group. The authors conclude that the two techniques are comparable except for operative time.

Commentary on “No effect of basic bladder advice in enuresis: A randomized controlled trial”

BACKGROUND To report the impact of duration of urethral catheterization (DUC) on the rate of extravasation on voiding cysto-urethrography (VCUG) and the subsequent need of catheter replacement in urethroplasty. METHODS Two hundred nineteen consecutive patients undergoing urethroplasty between October 2010 and November 2014 were evaluated for the impact of DUC. Patients were divided into 2 groups, based on the scheduled DUC≤10 days (group 1, N.=86) or >10 days (group 2, N.=133). RESULTS Fourteen patients (6.4%) had extravasation on VCUG with an additional period of catheter usage. In 10 of the 14 patients (71.4%) clinical signs of impaired wound healing were present. In group 1 (median DUC 8 days) 3 patients (3.5%) needed an additional period of urethral catheterization, compared to 11 patients (8.3%) in group 2 (median DUC 14 days). Strictures in group 2 were longer (4 vs. 2 cm, P<0.001) and more complex. Redo urethroplasty was needed in 9 of the 14 patients with extravasation. CONCLUSIONS In uncomplicated cases of urethroplasty, the urethral catheter can be safely removed after 8 to 10 days postoperatively. Extravasation on VCUG occurs in around 6% of urethroplasties and is a prognostic factor for stricture recurrence and reoperation.