O. Sedigh

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.

Oral mucosa harvest for urologic reconstruction: role of maxillofacial surgeon and donor-site morbidity evaluation.

PurposeThe aim of this study was to present retrospective analysis of our experience regarding complications associated with the donor site after oral mucosa harvest for urethral reconstruction. Materials and MethodsBetween May 2010 and January 2013, a total of 18 patients with recurrent urethral strictures received a buccal mucosal graft for urethral reconstruction at the San Giovanni Battista Hospital, University of Turin, Turin. All operations were performed in a 2-team approach. All patients were retrospectively evaluated by clinical examination and using a questionnaire. ResultsUrethroplasty with oral mucosa graft was performed successfully in a 1-step procedure in 17 of 18 patients. No intraoperative complications were observed.The most common complication occurring at the buccal donor site was scarring and contracture (n = 3). ConclusionsOral mucosa graft for urethroplasty is a simple and safe method in the interdisciplinary treatment of urethral strictures. Donor-site morbidity measured by clinical assessment and questionnaire is tolerable.

Prostate Cancer Treatment in Renal Transplant Recipients: A Systematic Review

The aim of this review was to summarize the current evidence and to highlight the main issues future research needs to address regarding prostate cancer (PCa) treatment in renal transpant recipients (RTRs). We conducted a search of AMED, Medline and Embase up to 17 November 2016 to investigate oncological and functional outcomes of PCa treatment in RTR. Type and use/protocols of immunosuppression and peri‐operative antibiotic drugs were also assessed. The search was implemented manually. Exclusion criteria were absence of full text or absence of information that allowed us to differentiate oncological and/or functional outcomes of each therapeutic approach used. We included 241 patients from 27 retrospective studies published between 1991 and 2016; seven of the studies were case–control and 20 were case series. We also considered nine case reports published between 1999 and 2016. Follow‐up ranged from 1 to 120 months. PCa was organ‐confined, with Gleason score ≤6 in 75.2% and 60.4% of patients. Surgery was the most frequent treatment used (n = 186), for which cancer‐specific (CSS) and overall survival (OS) rates were both 96.8%. Functional outcomes, including continence and erectile function, and complications were less frequently reported and were generally similar to those reported for radical prostatectomy (RP) in non‐RTRs. Other treatment methods in the patients included in the review were radiotherapy (RT) ± androgen deprivation therapy (ADT; n = 34; OS 88.2%; CSS 88.2%), ADT alone (n = 14; OS 42.9%; CSS 64.3%), brachytherapy (BT; n = 11; OS and CSS 100%), watchful waiting (n = 4) and active surveillance (n = 1). Overall no treatment‐related graft loss occurred. Immunosuppression and antibiotic schemes were poorly reported and inconsistent. Outcomes of PCa treatment in RTRs are encouraging and do not appear to be inferior to those of non‐RTR. RP was the most commonly assessed approach, whilst RT, BT and ADT were less frequent. Immunosuppression and antibiotic use were poorly reported and highly variable. High‐quality studies are needed because the current level of evidence is low, and our results should therefore be interpreted with caution.

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 (

Intraoperative superselective embolization of a biopsy-related arteriocalyceal fistula during a kidney transplantation.

A lthough macroscopic hematuria occurs in 3.4% to 10% of patients after renal transplant biopsies, major complications requiring invasive procedures are rare (1%). An arteriocalyceal fistula associated with severe gross hematuria has been reported in less than 0.1% of graft biopsies (1, 2). In such cases, an angiographic evaluation is indicated, and a superselective arterial embolization should be considered to save the kidney (3Y5). In the literature, some case reports describe the successful selective arterial embolization in arteriocalyceal fistulas caused by diagnostic biopsies performed for renal function impairment in transplanted kidneys (4, 6). To our knowledge, the case that we present is the first intraoperative treatment by superselective arterial embolization during a kidney transplantation of an arteriocalyceal fistula caused by a scoring biopsy on the graft performed at the moment of organ recovery.

Role of perioperative dynamic sentinel node biopsy for cN0 penile cancer management: experience from an Italian tertiary referral center

Purpose: Inguinal lymphadenectomy (iLAD) reduces mortality in patients with cN0 penile cancer but yields high complication rates. Thus, its prophylactic role has been questioned and dynamic sentinel node biopsy (DSNB) was introduced to select men who should undergo the procedure. Our aim was to investigate the accuracy of a contemporary DSNB cohort. Methods: We performed a retrospective analysis of ≥T1 or ≥G2 cN0 penile cancer undergoing perioperative DSNB from June 2009 to June 2015 at a tertiary referral center. We excluded men with <18 months follow-up or with local recurrence after primary curative treatment. Complications were graded according to the Clavien-Dindo classification. Results: Thirty-five men underwent DSNB; 85.71% had ≤T2 penile cancer with ≤G2a histology. Per groin detection rate was 80% (scintigraphy being positive bilaterally in 60% and unilaterally in 20.0%). In no cases did DSNB prolong the postoperative course compared to primary surgery. Nine men (n = 15/109 nodes removed) had positive results, 8 of whom underwent iLAD. Among negative DSNB patients, 2 developed nodal penile cancer recurrence; none of them had node biopsy due to inconclusive scintigraphy. At a median follow-up of 42 months (interquartile range 30-78 months), if considering only men with scintigraphy detected inguinal nodes, per-patient sensitivity and specificity were 50% and 80% whereas positive predictive value and negative predictive value were 25% and 92.3%, respectively. Conclusions: Perioperative DSNB is a safe procedure, yielding promising results when performed at a tertiary referral center. Future prospective large studies are needed to investigate how to optimize detection rate and reduce false-negative rates.

Subcapsular Hematoma Causing Anuria After Renal Graft Trauma.

A 67-year-old man presented to the emergency department 22 hours after a trauma to his kidney graft. He was asymptomatic during the first 10 hours, then he became anuric. His serum creatinine level was 2.73 mg/dL (baseline, 0.7 mg/dL), and his hemoglobin concentration was 13.1 g/dL. Computer tomography showed a 4-cm subcapsular hematoma without active bleeding. He underwent urgent decompression of the hematoma, and we did not find any active bleeding or parenchymal laceration. Urinary output had already recovered by the end of surgery without early or late complications. In conclusion, subcapsular hematoma, complicating a traumatic event on a kidney graft, can lead to a progressive parenchymal compression resulting in anuria. So, although in the absence of anemia, such events require urgent surgical decompression. Symptoms cannot be immediate, so all the graft trauma should be investigated with early ultrasound. Little is known in the case of major renal trauma but mildly symptomatic. Probably surgical exploration is better than observation to prevent possible early and late complications such as organ rejection or a Page kidney.

[A 8-year-forgotten ureteral stent after kidney transplantation: treatment and long-term follow-up].

Introduction Forgotten indwelling ureteral stents can cause significant urological complications. Only few cases are reported after kindney transplantation. Materials and Methods We present a case of a 39-year-old woman, transplanted in 1993 and referred to our Transplant Center 8 years later, because of a serious urinary tract infection with renal function impairment. Abdominal CT scan showed pyelonephritis and hydronephrosis in the transplanted kidney and the presence of a calcific ureteral stent, which had been forgotten in situ for 8 years. The stent was removed, but it was impossibile to replace it with a new stent both retrogradely and anterogradely, because of a tight obstruction of the mid ureter. So a uretero-ureteral anastomosis with up urinary tract was performed. Results No intra- or post-operative complications occurred. At 9 years’ follow-up, the patient shows an optimal renal function, with no urinary tract infection. Discussion A forgotten ureteral stent in a trasplanted kidney can cause a lot of complications and can lead to graft loss. The prosthesis may cause an irreversibile ureteral damage, so, as in our experience, forgetting a ureteral stent can result in a complex surgery.