Nim Christopher

The results of plaque incision and venous grafting (Lue procedure) to correct the penile deformity of Peyronie's disease.

Associate Editor

Total phallic reconstruction after penile amputation for carcinoma

To report our experience of total phallic reconstruction (TPR) with the use of the radial‐artery free flap (RAFF) in patients who have had a subtotal penectomy for penile or urethral cancer, as the goal of TPR is the creation of a sensate and cosmetically acceptable phallus with an incorporated neourethra that allows the patient to void while standing, and with the insertion of a penile implant to resume sexual activities, improving quality of life.

Total Phallic Reconstruction in Female-to-Male Transsexuals

BACKGROUND The goal of total phallic construction is the creation of a sensate and cosmetically acceptable phallus. An incorporated neourethra allows the patient to void while standing, and the insertion of a penile implant allows the patient to resume sexual activities, thus improving quality of life. OBJECTIVE To report our experience of total phallic construction with the use of the radial artery free flap in female-to-male transsexuals. DESIGN, SETTINGS, AND PARTICIPANTS The notes of the 115 patients who underwent total phallic construction with the use of the radial artery-based forearm free flap between January 1998 and December 2008 were reviewed retrospectively. MEASUREMENTS The surgical outcome, cosmesis of the phallus, complications, eventual need for revision surgery, and patient satisfaction were recorded during the follow-up. RESULTS AND LIMITATIONS This technique allowed the reconstruction of a cosmetically acceptable phallus in 112 patients; 3 patients lost the phallus due to venous thrombosis in the immediate postoperative period. After a median follow-up of 26 mo (range: 1-270 mo), 97% of patients are fully satisfied with cosmesis and size of the phallus. Sensation of the phallus was reported by 86% of patients. Urethral strictures and fistulae in the phallus and join-up site were the most common complications, occurring respectively in 9 and 20 patients; however, after revision surgery, 99% of patients were able to void from the tip of the phallus while standing. CONCLUSIONS The radial artery-based forearm free flap technique is excellent for total phallic construction, providing excellent cosmetic and functional results.

The role of vacuum pump therapy to mechanically straighten the penis in Peyronie’s disease

Study Type – Therapy (case series)
Level of Evidence 4

The management of genital lymphoedema

To report our experience and management of genital lymphoedema, as this condition can be extremely debilitating and difficult to manage.

The management of residual curvature after penile prosthesis implantation in men with Peyronie’s disease

Study Type – Therapy (case series)

Plaque incision and fascia lata grafting in the surgical management of Peyronie's disease.

To assess the outcome of using modified human fascia lata (TutoplastTM, Mentor Corp, Santa Barbara, CA, USA) in the surgical management of Peyronie’s disease (PD), as the penile deformity associated with PD can be corrected by plaque incision and saphenous vein grafting (Lue procedure).

Total urethral construction with the radial artery‐based forearm free flap in the transsexual

Study Type – Therapy (case series)
Level of Evidence 4

Factors influencing intracytoplasmic sperm injection (ICSI) outcome in men with azoospermia.

The management of patients with non‐obstructive azoospermia (NOA) and some cases of obstructive azoospermia involves testicular sperm extraction (TESE or micro‐dissection TESE) combined with intracytoplasmic sperm injection (ICSI). Several studies have investigated the effect of the male age, the cause of azoospermia, testicular histopathology, the type of sperm used, and the use of pentoxyphilline, on the ICSI cycle outcome in men with azoospermia. The present study showed that none of these factors influenced the ICSI outcome in men with azoospermia, thus once sperm is found in an azoospermic male, no other male factor seems to influence the ICSI outcome. To our knowledge this is the first study to comment on the outcome of ICSI in men with NOA based on testicular histopathology.

Novel PDE5 inhibitors for the treatment of male erectile dysfunction

Erectile dysfunction (ED) affects the lives of approximately 150 million men worldwide. ED may be a cause of male sub-fertility in a significant proportion of patients. There is now an expanding armamentarium for the management of ED, including oral agents such as phosphodiesterase type 5 (PDE5) inhibitors. PDE5 inhibitors may also be useful in situations of temporary ED in couples undergoing IVF. Two novel PDE5 inhibitors have been commercially launched in the European Union in the first quarter of 2003. This article reviews the pharmacology and clinical efficacy of these new agents and their potential role in treating patients with male sub-fertility.