Male and Female Sexual Dysfunction (SD) after Radical Pelvic Urological Surgery

Major pelvic urological surgery comprises radical prostatectomy and radical cystectomy in the male patient and radical cystectomy in the female. Postsurgical sexual dysfunction (SD) has been reported with a high prevalence in both sexes and is becoming increasingly important in the patient's view as a result of improved cancer prognosis, refinements in surgical technique, and increased awareness of quality of life aspects that involve sexual satisfaction. The pathophysiology of the problem is essentially related to the disruption of the nerves during the procedure, although a vascular impairment may also be implicated. Nerve-sparing surgery enables the recovery and/or maintenance of sexual functioning in a significant proportion of patients and it is now also adopted for women. Validated questionnaires to assess preoperative baseline sexual function and postoperative outcomes have become available and their use in clinical practice should be promoted. A number of erectile aids are available to treat postsurgical male erectile dysfunction successfully. As far as female SD is concerned, a number of potential treatment options is currently under investigation

Augmentation cystoplasty in neurogenic bladder

The aim of this review is to update the indications, contraindications, technique, complications, and the tissue engineering approaches of augmentation cystoplasty (AC) in patients with neurogenic bladder. PubMed/MEDLINE was searched for the keywords “augmentation cystoplasty ,” “neurogenic bladder,” and “bladder augmentation.” Additional relevant literature was determined by examining the reference lists of articles identified through the search. The update review of of the indications, contraindications, technique, outcome, complications, and tissue engineering approaches of AC in patients with neurogenic bladder is presented. Although some important progress has been made in tissue engineering AC, conventional AC still has an important role in the surgical treatment of refractory neurogenic lower urinary tract dysfunction

Augmentation cystoplasty in neurogenic bladder

The aim of this review is to update the indications, contraindications, technique, complications, and the tissue engineering approaches of augmentation cystoplasty (AC) in patients with neurogenic bladder. PubMed/MEDLINE was searched for the keywords "augmentation cystoplasty," "neurogenic bladder," and "bladder augmentation." Additional relevant literature was determined by examining the reference lists of articles identified through the search. The update review of of the indications, contraindications, technique, outcome, complications, and tissue engineering approaches of AC in patients with neurogenic bladder is presented. Although some important progress has been made in tissue engineering AC, conventional AC still has an important role in the surgical treatment of refractory neurogenic lower urinary tract dysfunction

Simultaneous placement of Inflatable Penile Prosthesis and Artificial Urinary Sphincter following radical prostatectomy via penoscrotal approach: A Step-by-Step Surgical Technique

Introduction and Objective: Erectile dysfunction and urinary incontinence are the most common sequelae after radical prostatectomy surgery. Inflatable penile prosthesis (IPP) and Artificial Urinary Sphincter (AUS) placement are common surgical treatment options following conservative and medical treatment. Often these procedures require specific surgical expertise to improve patients’ quality of life and maximize outcomes. In select cases, patients require the treatment of both conditions either simultaneously or staged approach. To this extent, we acknowledged the paucity of high-quality surgical videos addressing the surgical nuance of simultaneous IPP and AUS implantation (1500). In this video, we aim to highlight a step-by-step surgical technique of IPP and AUS implantation. Methods: The patient is a 76-year-old African American male with a history of prostate cancer status post radical prostatectomy in 2019 complicated with PSA recurrence required subsequent external beam radiotherapy and androgen deprivation therapy with no evidence of disease recurrence at the time of the procedure. The patient presented to our cancer survivorship urologic clinic with bothersome Stress Urinary Incontinence (SUI) and medically refractory Erectile Dysfunction (ED) that failed prior therapeutic modalities as per AUA guidelines. After a thorough discussion of the risks, benefits, and potential complications, the patient elected to proceed with simultaneous IPP and AUS implantation via penoscrotal approach. During the procedure, we elected to first implant the AUS given the surgeon's preference and risk of the procedure. Following the successful placement of AUS, we proceeded to the IPP implantation. The corporotomy was made distally to the level of the AUS cuff to avoid damage and the IPP reservoir was placed on the contralateral side of the abdomen, opposite AUS pressure-regulating balloon. Results: The surgery was completed without complication and both the IPP and AUS were cycling well at the end of the surgery. At 6 weeks of clinic follow-up, the patient's devices were cycling properly, and the patient noted good erectile function and remarkable improvement in urinary continence. Conclusions: In select patients, a simultaneous IPP and AUS implantation can be a viable option for patients with bothersome ED and SUI

Reconstruction of complex midline septal corporal defect in a distal crossover penile implant cylinder: A step-by-step demonstration of surgical technique

Intro and objective: Inflatable penile prosthesis (IPP) placement is the most common and definitive treatment for medically refractory erectile dysfunction, with an estimated 20,000 procedures performed per year. However, complications after penile prosthesis can occur with approximately 4% for non-infectious complications. Among these non-infectious complications, complete cylinder crossover is a rare complication, but can occur due to variable windows that exist in the corporal septum. Here we present a case of a complex distal septal defect caused by distal cylinder crossover and repair with Tutoplast graft. Methods: The patient is a 59-year-old African American male with a history of prostate cancer status post robotic-assisted laparoscopic prostatectomy in 2018 and IPP in September 2020. In 2022, the patient noted painful leftward penile curvature with erections and incomplete deflation of penile prosthesis. A physical exam showed crossover of the right prosthesis cylinder to the left. After thorough discussion of the risks and benefits of surgical revision and reconstruction of the penile prosthesis, the patient agreed to proceed with the procedure. We performed a right corporotomy, septal corporal reconstruction with 5 × 2 cm Tutoplast graft, and left the uninfected, functioning cylinder, redirected into the neocorporal space. Results: The surgery was completed without complication and the IPP was cycling well at the end of the case. At 6 weeks clinic follow-up, the patient's device was cycling properly, and the patient noted excellent erectile function, ability to orgasm, and minimal pain. Conclusions: We conclude that even in complex cases of septal defects, Tutoplast graft and proper seating and redirection of the displaced cylinder without replacement of existing functional hardware is a viable surgical method for IPP revision

Preoperative Valsava Leak Point Pressure May Not Predict Outcome of Mid-Urethral Slings. Analysis from a Randomized Controlled Trial of Retropubic versus Transobturator Mid-Urethral Slings

Objective: To test the hypothesis that preoperative Valsalva leak point pressure (VLPP) predicts long-term outcome of midurethra slings for female stress urinary incontinence (SUI). Materials and Methods: One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT) or transobturator tape (TOT). They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6) and the impact of incontinence on quality of life (IIQ-7) questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS). Preoperative VLPP was correlated with primary and secondary outcome variables. Results: Mean follow-ups were 32 ± 12 months (range 12-55) for TVT and 31 ± 15 months (range 12-61) for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5%) patients showed a VLPP > 60 cm H2O and 50 (34.5%) patients had a VLPP ≤ 60 cm H2O. The overall objective cure rates were 75.8% for patients with VLPP > 60 cm H2O and 72% for those with VLPP ≤ 60 cm H2O (p 60 cm H2O (82 % vs. 68.9% p < 0.172); VLPP ≤ 60 cm H2O (68% vs. 76% p < 0.528). Conclusions: When patients were stratified for preoperative VLPP (≤ or > of 60 cm H2O), preoperative VLPP was not linked to outcome after TVT or TOT procedures

Gender confirmation surgery : guiding principles

Background At this time, no formal training or educational programs exist for surgeons or surgery residents interested in performing gender confirmation surgeries. Aim To propose guiding principles designed to aid with the development of formal surgical training programs focused on gender confirmation surgery. Methods We use expert opinion to provide a \u201cfirst of its kind\u201d framework for training surgeons to care for transgender and gender nonconforming individuals. Outcomes We describe a multidisciplinary treatment model that describes an educational philosophy and the institution of quality parameters. Results This article represents the first step in the development of a structured educational program for surgical training in gender confirmation procedures. Clinical Implications The World Professional Association for Transgender Health Board of Directors unanimously approved this article as the framework for surgical training. Strengths and Limitations This article builds a framework for surgical training. It is designed to provide concepts that will likely be modified over time and based on additional data and evidence gathered through outcome measurements. Conclusion We present an initial step in the formation of educational and technical guidelines for training surgeons in gender confirmation procedures. Schechter LS, D'Arpa S, Cohen MN, et al. Gender Confirmation Surgery: Guiding Principles. J Sex Med 2017;14:852\u2013856