M. Timpano

A New, Innovative, Lengthening Surgical Procedure for Peyronie's Disease by Penile Prosthesis Implantation with Double Dorsal-Ventral Patch Graft: The "Sliding Technique"

INTRODUCTION Peyronies disease is the result of the formation of fibrous plaques in the tunica albuginea of the penis; typical presentations of the disease are represented by pain during erection, erectile dysfunction, and penile deformities, such as curvature, narrowing, and penile shortening. The most complex treatment is related to penile shortening. AIM To find a safe procedure in penile shortening due to Peyronies disease providing a satisfactory lengthening, allowing an early stabilization of the penis, and preventing axial tension on the neurovascular bundles during dilation. METHODS We describe a new lengthening surgical procedure based on a ventro-dorsal incision of the tunica albuginea, penile prosthesis implantation, and double dorsal-ventral patch grafting with porcine small intestinal submucosa. Three patients, affected by Peyronies disease with penile shortening and erectile dysfunction, underwent this procedure with approval of our local ethical committee. We evaluated the penis lengthening, intraoperative and postoperative complications, patients preoperative and postoperative sexual life satisfaction (International Index of Erectile Function [IIEF] questionnaire). RESULTS The average operative time was 2 hours and 50 minutes. No major intraoperative nor postoperative complications occurred. No significant bleedings were recorded. Patients were discharged after 48-72 hours. The average increase in length obtained was 3.2 cm. All patients resumed sexual intercourses with satisfaction; no significant loss of sensitivity or any sign of vascular distress of the glans was recorded. The follow-up is 13 months. The average IIEF score is 60. CONCLUSIONS The lengthening of the penis by a double dorsal-ventral patch graft is an innovative procedure that is based on current techniques of plaque incision and grafting, and that can easily resolve severe shortening of the penis due to Peyronies disease. In the cases presented, this procedure resulted easily, effectively, and safely. Nevertheless, the technique proposed in this article shall be validated through prospective studies with larger samples.

Phosphodiesterase Type 5 Inhibitor Treatment for Erectile Dysfunction in Patients with End-Stage Renal Disease Receiving Dialysis or After Renal Transplantation

INTRODUCTION The phosphodiesterase type 5 (PDE5) inhibitors are generally well tolerated and effective for treating erectile dysfunction (ED), including in patients with significant comorbidity. Because of this benign safety profile, investigators have used PDE5 inhibitors to treat patients with ED and severe renal disease or those who have received renal transplants. AIM To assess safety and efficacy of PDE5 inhibitors in patients receiving dialysis or renal transplants. MAIN OUTCOME MEASURES Erectile function as assessed by the International Index of Erectile Function (IIEF) and Global Assessment Questions; adverse events (AEs). METHODS We reviewed published studies of PDE5 inhibitors in patients receiving dialysis or renal transplants. RESULTS In double-blind, placebo-controlled studies in patients receiving dialysis or renal transplants, sildenafil significantly improved erectile function as assessed by the IIEF, and 75-85% of patients reported improved erectile function on Global Assessment Questions; efficacy was more variable in less well-controlled studies. In >260 patients undergoing dialysis who received sildenafil in clinical studies, there were only six reported discontinuations because of AEs (headache [N=3], headache and nausea [N=1], gastrointestinal [N=1], and symptomatic blood pressure decrease [N=1]). In approximately 400 patients with renal transplants who received sildenafil, only three patients discontinued because of AEs. Vardenafil improved IIEF scores of up to 82% of renal transplant recipients in randomized, controlled studies (N=59, total), with no reported discontinuations because of AEs. Limited data also suggest benefit with tadalafil. CONCLUSIONS ED is common in patients undergoing renal dialysis or postrenal transplant and substantially affects patient quality of life. Sildenafil and vardenafil appear to be efficacious and well tolerated in patients receiving renal dialysis or transplant.

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

To report the results from a prospective multicentric study of patients with Peyronies disease (PD) treated with the ‘sliding’ technique (ST).

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

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

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

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

Lower Urinary Tract Symptoms in Male-to-Female Transsexuals: Short Terms Results and Proposal of a New Questionnaire

Presented at the 64th Annual Meeting of the SICPRE, September 17–19, 2015, Milan, Italy. SICPRE: La SICPRE, Societa Italiana di Chirurgia Plastica Ricostruttiva ed Estetica, national meeting, in Milano, Italy on September 17–19, 2015. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was supported by a grant of family Dioguardi, in memory of Professor Domenico Dioguardi, MD.

Does Sex Reassignment Surgery Induce Cerebral Modifications in MTF Transsexuals

DOI: 10.1111/jsm.12355Despite widely accepted biological theories, the etiopathogenesisof the gender dysphoria [1] remains largely unclear.Several studies have shown the existence of some gender-related cerebral areas. Indeed, various areas belonging to thelimbic system such as stria terminalis, preoptic nucleus, and amyg-dalaarecharacterizedbyasexualdimorphismbothinmacroscopicand microscopic structures [2,3]. Men and women are different inprocessing cognitive and emotional stimuli [4].A common neurophysiologic approach to assess cognitivefunctions is based on event-related potential (ERP) analysis, espe-cially on the evoked component called P300. The P300 wave is acentro-parietal positive deflection in human ERP, which occursabout 300 milliseconds after stimuli’s appearance and it is knownas the “cognitive wave” [5].Few scholars have studied male to female (MTF) transsexualsthrough neurophysiologic studies.We designed a prospective case-control study. Fifteen MTFtranssexuals, aged average 35 years and an age matched controlgroup of 20 healthy right-handed heterosexual volunteers (10males and 10 females) underwent an emotional ERP test. Thecognitive-emotional ERPs were achieved while the subjects werewatching slides extracted from the International Affective PictureSystem (IAPS). Sixty pictures, divided in two series with positive/neutral and negative/neutral valences were shown randomly to thesubjects. The area below the P300 wave, its amplitude and latencywere compared before and after sex reassignment surgery (SRS) intranssexuals and with control groups.The P300 component of control females was characterized bya larger latency, amplitude and area, comparing to the male’s one,in both the pleasant and unpleasant pictures (

Quality of Life After Sexual Reassignment Surgery

Quality of life (QoL) is a multidisciplinary and transversal topic that includes a variety of aspects related to medical, social, political, and economic sciences. It is a broad concept that concerns the well-being of a person or a community, comprehending physical and mental health, occupational satisfaction, social integration and economic welfare.

Sperm collection for medically assisted procreation in azoospermic patients

Infertility is defined as the inability of a sexually active non-contracepting couple to achieve spontaneous pregnancy in one year. Factors of male infertility are present in 50% of infertile couples. Azoospermia is defined as the absence of sperm in the ejaculate, even after centrifugation of the sample, and affects 10%-15% of the infertile male population. Therefore, it represents a pathological condition of primary importance in the context of infertility management. Any assisted reproductive procedure must first refer to the availability of a suitable number of good quality gametes. As regards sperm collection, if ejaculated semen is not suitable or available, it may be taken from the seminal duct or directly from the testicular parenchyma with different methodologies and techniques, which can be divided into percutaneous techniques and open surgical (TeSE and ESA) or microsurgical (micro-TeSE) techniques. The purpose of this work is to evaluate and compare the retrieval rate in infertile patients suffering from azoospermia and treated with the various surgical techniques.

T05-O-20 Plaque incision surgery with tunica vaginalis patch for penile curvature in La Peyronie's disease: preliminary report

Purpose Peyronies disease in men with significant penile curvature is often treated with plaque incision/excision and grafting; when erectile dysfunction is associated, a penile prosthesis implantation is mandatory. We present our initial experience of plaque incision surgery with tunica vaginalis patch and concomitant implantation of penile prosthesis in patients with severe curvature due to IPP. Material and methods Nine patients, with severe penile curvature and erectile dysfunction, due to IPP, were considered from January 2006 to October 2007. A circumferential subcoronal and a longitudinal penoscrotal incisions were made. An H-shaped incision was made on the tunica albuginea. The albuginea defect was measured. Through the penoscrotal incision, an adequate tunica vaginalis patch was obtained to restore the defect and it was sutured to the albuginea. Then the penile prosthesis was placed in a standard fashion. Results The mean operative time was 200 + 15 min. In four patients with mild erectile dysfunction a soft penile implant was placed; in five patients with complete erectile dysfunction an inflatable penile prosthesis was positioned. The mean follow up is 13.4 months. We recorded complications in only 1 patient (scrotal hematoma with spontaneous resolution). All patients are able to achieve sexual intercourse. No recurrence of penile curvature have been observed. Only one patient is unsatisfied, due to penile shortening. Conclusions Our experience shows that the plaque incision surgery with tunica vaginalis patch and concomitant implantation of penile prosthesis in patients with severe curvature due to IPP is a safe and efficacious technique, with encouraging satisfaction rate for patients.