Troy Sukhu

Distal Extrusion and Impending Cylinder Erosion of the Penile Prosthesis: a Clinical Challenge for the Urologist

Distal extrusion with impending cylinder erosion through the distal corpus cavernosum is a significant complication of penile prosthesis surgery. Surgical repair is indicated to prevent cylinder perforation or erosion through the skin, which leads to infection and requires removal of all prosthesis components. The underlying cause is typically unrecognized tunical perforation during surgery, aggressive distal dilation, oversized cylinders, or repeated trauma. Extrusion is more common in patients with microangiopathy, prior radiation, corporal fibrosis, or decreased distal sensation. The two most prevalent methods for repair are distal corporoplasty or windsock graft reconstruction. Distal corporoplasty has been demonstrated to have superior outcomes to windsock grafts and is the method of repair that these authors favor. The goal of this review is to provide a background on distal penile prosthesis extrusion, along with potential treatment approaches, so that the surgeon may be familiar with this seemingly difficult, albeit rare, complication of penile prosthesis surgery.

Urological Survivorship Issues Among Adolescent Boys and Young Men Who Are Cancer Survivors

BACKGROUND Urological survivorship issues encompass an area that may potentially be overlooked after treatment of childhood cancer in adolescent boys and young men. Side effects of cancer therapy may include subsequent development of erectile dysfunction (ED), hypogonadism, and infertility in adulthood. AIM The purpose of this review is to focus on the etiology and prevalence of the range of sexual and gonadal dysfunction in adolescent boys and young men who are cancer survivors, while discussing current recommendations for evaluation and treatment. METHODS We performed a literature review of articles evaluating hypogonadism, sexual dysfunction, ED, and infertility in young men cancer survivors. OUTCOMES There is compelling evidence that significant survivorship issues are faced by boys entering adulthood after completing cancer therapy. RESULTS Overall, young men cancer survivors are much more likely to report symptoms of sexual dysfunction than the general population of men. These patients can develop ED due to physiologic and psychological changes that take place with diagnosis of a malignancy and subsequent treatment. Primary hypogonadism can arise due to pelvic radiation or chemotherapy, and central hypogonadism may arise from pituitary insufficiency after brain radiation or surgery. Infertility develops from direct damage to the Sertoli cells and germinal epithelium from radiotherapy or chemotherapy. Cancer survivors who are men should therefore be screened for these important urological survivorship issues, although exact surveillance strategies remain unclear. CONCLUSIONS Urological survivorship issues including ED, hypogonadism, and infertility are common among cancer survivors and result in significant morbidity. Due to the medical complexity of cancer survivorship, the population of adolescent and young adult survivors would benefit from a network of multidisciplinary survivorship experts to aid the transition into adulthood. Improved research efforts may help to clarify risk factors and to develop enhanced strategies for evaluation and treatment. Sukhu T, Ross S, Coward RM. Urological Survivorship Issues Among Adolescent Boys and Young Men Who Are Cancer Survivors. Sex Med Rev 2018;6:396-409.