[70] Proximal corpora cavernosum approach for management of some penile prosthesis cylinder complications

Objective: To describe a new proximal corpora cavernosum approach for the management of some penile prosthesis cylinder complications. Penile prosthetic cylinder complications identified postoperatively are traditionally managed by approaching the corpora through the prior penoscrotal incision, risking contamination of the pump’s biofilm and giving poor exposure of the proximal cruras. This new approach addresses postoperative penile prosthesis cylinder abnormalities when they are located at the crura of a corpus cavernosum. This technique avoids any additional dissection of the previous wound, making the second surgical procedure easier and safer for the underlying implant. It also allows an optimal exposure for the required adjustment of the implant. Methods: The first step of procedure is identification of the affected part of the penis and identification of the type of penile implant anomaly. A 2-cm longitudinal skin incision is carried over the affected crura. A longitudinal incision of the tunica albuginea is done, allowing direct access to proximal part of the affected prosthesis cylinder. The prosthesis’ cylinder is then delivered through this incision allowing management of the problem under direct vision. Results: Our approach is safe, effective and can ensure that the existing penile prosthesis cylinder problem can be managed without the need to approach it through the traditional approach, which in our opinion may add difficulty to the surgery because of the adhesions from the previous intervention. In addition, using the scrotal approach may add a threat to the implant’s pump and tubing by either iatrogenic injury or possible violation of the surrounding biofilm. Conclusion: Our suggested approach is safe, simple and effective in managing some penile prosthetic cylinder complications that require access to the proximal crura and can be used for both inflatable and semi-rigid (malleable) penile prostheses

[69] A novel approach for the removal of an inflatable penile prosthesis

Objective: To describe a novel simple surgical method for the removal of an inflatable penile prosthesis (IPP), with minimal risk of urethral damage that avoids the penoscrotal incision and prevents additional fibrosis. The IPP has been used as definitive treatment for severe erectile dysfunction over last four decades. Although infection of IPPs is rare, such occurrences have critical clinical consequences and require urgent explantation. Removal of an IPP can be challenging, especially for the non-andrologist urologist and young urologists. Methods: Three incisions are made at the following sites: one incision on each side of the base of the penis, an inguinal incision, and a scrotal incision. Each incision provides direct access to one component of the IPP (cylinders, reservoir and pump). Conclusion: The classic penoscrotal incision for explanation can disrupt the anatomy, which makes future re-implantation difficult and increases the risks of complications. The present approach provides direct exposure of all components of the IPP without dissection of the adhesions of the previous implantation and reduces the risk of iatrogenic injury to the urethra

[61] Surgical management of pain as a complication of radio-embolisation of varicocoele

Objective: To present our experience of surgical management of pain as a complication of radio-embolisation of varicocoele. The indication to treat a painful varicocele is well established; however, the approach of treatment whether surgical or radiological remains controversial. The use of materials such as coils during radio-embolisation may lead to exacerbation of pain, which might require surgical removal of the endovascular material. Methods: All patients between March 2016 and February 2017, who experienced painful exacerbation after radio-embolisation of a varicocoele, were included in this retrospective single-centre study. Ultrasonography was performed to exclude recurrence or other aetiology. A transperitoneal laparoscopic surgical procedure allowed removal of embolisation material and gonadal vein after ligation between the internal inguinal ring and its distal end on the renal vein or inferior vena cava. Results: Three patients were operated upon using this technique. Two patients had unilateral left and one bilateral varicocoeles with radio-embolisation. No intraoperative complications were identified. The intervention reduced the pain allowing early recovery and continuation of usual daily activities. Conclusion: The exacerbation of pain in a varicocoele after radio-embolisation is a rare complication but has significant consequences on patient quality of life and thus requires appropriate care. Removal of the material laparoscopically seems a method of choice. The elimination of other painful causes before any surgical management remains essential

Recommandations pour l'évaluation et la prise en charge de la maladie de Lapeyronie : rapport du comité d'andrologie et de médecine sexuelle de l'AFU

International audienceIntroductionPeyronie's disease is a common cause for consultation in urology. Many controversies surround its treatment. No French Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations.Materials and methodsThese recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography.ResultsThe assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-graft or the placement of a penile implant according to the patient's wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered.ConclusionThe management of Peyronie's disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient's information and understanding of the expected effects, and the practitioner's experience.IntroductionLa maladie de Lapeyronie est un motif fréquent de consultation en urologie, dont le traitement reste sujet à de nombreuses controverses. Elle n’a fait l’objet d’aucune recommandation française jusqu’à présent. Le Comité d’Andrologie et de Médecine Sexuelle de l’Association Française d’Urologie propose donc une série de recommandations basées sur les preuves.Matériels et méthodesCes recommandations sont réalisées selon la méthode ADAPTE, en se basant sur les recommandations européennes (EAU, ESSM), américaines (AUA, ISSM) et canadiennes (CAU), en intégrant les spécificités françaises en raison de la disponibilité des traitements, et une mise à jour de la bibliographie récente.RésultatsL’évaluation de la maladie est clinique. Les patients présentant une gêne fonctionnelle ou un retentissement psychologique important peuvent se voir proposer un traitement. Les bénéfices et inconvénients de chaque traitement devront être explicités au patient. Concernant les traitements non chirurgicaux, aucun traitement disponible n’a l’autorisation de mise sur le marché en France. La vitamine E n’est pas recommandée. Des traitements à visée antalgiques (oraux ou ondes de choc de faible intensité) ou pro-érectiles peuvent être proposée selon le besoin, ainsi qu’une thérapie par traction. En raison de l’indisponibilité des injections de collagénase, les injections de vérapamil peuvent être proposées. Les traitements chirurgicaux sont à considérer en phase stabilisée de la maladie, et consistent en la réalisation d’une plicature, d’une incision-greffe ou de la pose d’un implant pénien en fonction du souhait du patient, de la courbure et de la taille de verge, ainsi que de la fonction érectile. Des traitements combinés peuvent être proposés.ConclusionLa prise en charge de la maladie de Lapeyronie est complexe, et les niveaux de preuve des traitements sont faibles dans l’ensemble. Le succès du traitement dépendra de la qualité de l’évaluation initiale, de l’information du patient et de sa compréhension des effets attendus, et de l’expérience du praticien