Hannah H. Alphs

Preoperative Clinical and Diagnostic Characteristics of Patients Who Require Delayed IPP after Primary Peyronies Repair

INTRODUCTION Penile vascular abnormalities occur in a high proportion of patients with Peyronies disease (PD). Penile duplex ultrasonography (PDU) and dynamic infusion cavernosometry and cavernosography (DICC) are tools that can be used to help tailor individualized treatment for patients undergoing surgical intervention for their PD. However, precisely which parameters can be used to predict those patients with PD at risk for developing erectile dysfunction (ED) after intervention without inflatable penile prosthesis (IPP) has not been previously elucidated. AIM To evaluate preoperative vascular parameters that predispose PD patients for developing ED after intervention without IPP. METHODS Twenty-six patients receiving surgical intervention for their PD at a single center were retrospectively identified. Of these, 11 (42.3%) opted for primary repair without placement of an IPP. Three (27.2%) of these 11 patients went on to develop ED postoperatively. MAIN OUTCOME MEASURES We compared various demographic, PDU, and DICC parameters between patients who did and did not fail primary repair of their PD. RESULTS Mean age and follow-up of patients who went on to develop ED after repair of PD without IPP were not significantly different (P < 0.05). Resistive index (RI) and end diastolic volume were significantly different between these two groups (P < 0.05), while peak systolic volume, flow to maintain, and pressure decay were not significantly different. An RI cutoff of <0.80 was found to identify all patients who would later develop ED and fail primary repair without IPP. CONCLUSIONS Penile vascular assessment can aid in counseling patients about their risk of developing delayed ED after primary repair of PD. In our cohort of patients, PDU provided preoperative risk stratification for postoperative erectile dysfunction in men undergoing Peyronies repair without IPP. We propose the prospective study of an RI cutoff to identify patients at risk of failing primary PD repair without IPP.

Surgical Reconstruction of the Male Urethral Diverticulum

OBJECTIVES To describe the outcomes and reconstructive techniques used for men with symptomatic urethral diverticula in an attempt to standardize treatment based on the length of the urethral defect after diverticulum excision and the type of repair used. Urethral diverticula are rare in men and may be either congenital or acquired. METHODS Between 2003 and 2008, 13 men were treated surgically for symptomatic urethral diverticula at a single institution by a single surgeon (C.M.G.). A total of 6 (46.2%) patients had urethral defects of < 4 cm and underwent excision of the diverticulum with primary anastomosis. Substitution urethroplasty using either penile skin or buccal mucosa was used in 7 (53.8%) patients with urethral defects of >or= 4 cm. Demographic and preoperative characteristics were compared among patients according to the length of the urethral defect. RESULTS The mean age of men at the time of surgery was 38.4 years (+/- 13.0; range, 20.4-63.7), with a median follow-up time of 21.7 (+/- 29.0; range, 0.9-84.0) months. Neither age at the time of surgery, length of follow-up, or diverticulum volume was significantly different between men who underwent primary repair vs substitution urethroplasty. The overall success rate was 92% (12/13) with an overall complication rate of 42% at intermediate follow-up. CONCLUSIONS Outcomes after excision and primary anastomosis for diverticula associated with defects of < 4 cm were similar to outcomes after diverticulum excision and substitution urethroplasty for defect of >or= 4 cm.

Drugs that Affect Sexual Function

Multiple drugs are frequently assumed to induce sexual dysfunction as an unwanted side effect. In this chapter, we review the known mechanisms of sexual function and how the drugs hypothesized to cause sexual dysfunction are thought to interrupt these pathways. The management of drug-induced sexual dysfunction for physicians can be challenging; here, we discuss several management strategies for the treatment of drug-induced sexual dysfunction.

Presentation and management of a patient with subcutaneous metastatic transitional cell carcinoma of the bladder.

Background A 60-year-old female with a 6-month history of muscle-invasive transitional cell carcinoma of the bladder presented with an enlarging subcutaneous lesion involving her right flank. She had previously undergone radical cystectomy, bilateral pelvic lymphadenectomy and ileal orthotopic neobladder reconstruction.Investigations Axial fused fluorodeoxyglucose PET–CT of the chest, abdomen and pelvis, fine needle aspiration with direct ultrasound guidance, excisional biopsy and immunohistochemistry.Diagnosis Subcutaneous and liver metastases of transitional cell carcinoma.Management Wide local excision of the subcutaneous lesion followed by combination gemcitabine–cisplatin chemotherapy. Gemcitabine was administered at a dose of 1,000 mg/m2 on days 1, 8, and 15, and cisplatin was administered at a dose of 75 mg/m2 on day 1; the schedule was repeated every 28 days for three cycles.