Surgical Repair of Late Complications in Patients Having Undergone Primary Hypospadias Repair during Childhood: A New Perspective

Background. The repair of complications in patients who had undergone hypospadias repair is still an open problem. Patients and Methods. We conducted a retrospective study of patients treated for late complications after hypospadias repair. Study inclusion criteria were patients presenting urethral, corpora cavernosa deformity, and/or penile defects due to previous hypospadias repair. Exclusion criteria were precancerous or malignant lesions and incomplete data on personal medical charts. Preoperative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry, urethrography, urethral sonography, and urethroscopy. The patients were classified into four different groups. Success was defined as a normal functional urethra, with apical meatus, no residual penile curvature or esthetic deformity of the genitalia. Results. A total of 1,176 patients were entered in our survey. Out of the 1,176 patients, 301 patients (25.5%) underwent urethroplasty (group 1), 60 (5.2%) corporoplasty (group 2), 166 (14.1%) urethroplasty and corporoplasty (group 3), and 649 (55.2%) complex genitalia resurfacing (group 4). Mean followup was 60.4 months. Out of the 1,176 cases, 1,036 (88.1%) were considered successful and 140 (11.9%) failures. Conclusion. The majority of patients (55.2%) with failed hypospadias repair require surgical reconstruction to fully resurfacing the glans and penile shaft

The role of intrinsic pathway in apoptosis activation and progression in Peyronie’s disease

Peyronie’s disease (PD) is a connective tissue disorder where formation of fibrous plaques in tunica albuginea (TA) and erectile tissue can result in penile deformity, pain, and erectile dysfunction. Fibrosis, its major pathological manifestation, arises from fibroblast proliferation and accumulation of extracellular matrix; PD progresses with formation of plaques or even ectopic calcification having the appearance of scar tissue, which prevent TA expansion during erections. The mechanisms underpinning PD are unclear, and relatively little is known about the disease itself. To date corrective surgery is the sole effective treatment. A greater understanding of PD pathophysiology at the molecular level has the potential to help develop novel medical therapeutic approaches. The aim of this study was to investigate the activation of the apoptotic intrinsic apoptotic pathway in plaques from PD patients. Tunica albuginea from either PD and control patients were assessed for the expression of bax, bcl-2, caspase 9 and 3 using immunohistochemistry, and by measurement of apoptotic cells using TUNEL assay. Bax overexpression was observed in metaplasic bone tissue, in fibroblasts and in myofibroblast of plaques from PD patients. Little or no bcl-2 immunostaining was detected in samples from either patients or controls. Caspase 3 immunostaining was very strong in fibrous tissue, in metaplasic bone osteocytes and in primary ossification center osteoblasts. Moderate caspase 9 immunostaining was seen in fibrous cells plaques and in osteocytes and osteoblasts of primary ossification centers from PD patients. Control samples were negative for caspase 9 immunostaining. In PD patients the TUNEL immunoassay showed intense immunostaining of fibroblasts and myofibroblasts, the absence of apoptotic cells in metaplasic bone tissue and on the border between fibrous and metaplasic bone tissue. Apoptotic cell death occurs in stabilized PD plaques and is partly induced by the intrinsic mitochondrial pathway. The present findings can have clinical implications and may help devise improved treatment strategies. A therapeutic approach aimed at enhancing apoptosis-inducing molecules would at least help delay the progression of PD. Identification of target molecules for gene construct or biological or chemical reagent delivery to target sites could contribute to induce PD plaque stabilization

Current controversies in reconstructive surgery of the anterior urethra: a clinical overview

We performed an overview of the surgical techniques suggested for the treatment of anterior urethral strictures using MEDLINE. In applying the MEDLINE search, we used the "MeSH" (Medical Subject Heading) and "free text" protocols. The MeSH search was conducted by combining the following terms: "urethral stricture", "flap", "graft", "oral mucosa", "urethroplasty", "urethrotomy" and "failed hypospadias". Multiple "free text" searches were performed individually applying the following terms through all fields of the records: "reconstructive urethral surgery", "end-to-end anastomosis", "one-stage", "two stage". Descriptive statistics of the articles were provided. Meta-analyses were not employed. Seventy-eight articles were determined to be germane in this review. Six main topics were identified as controversial in anterior urethra surgery: the use of oral mucosa vs penile skin; the use of free grafts vs pedicled flaps in penile urethroplasty; the use of grafts vs anastomotic repair in bulbar urethral strictures; the use of dorsal vs ventral placement of the graft in bulbar urethroplasty; the use of definitive perineal urethrostomy vs one-stage repair in complex urethral strictures; the surgical options for patients with failed hypospadias repair. Different points of view are documented and presented in the literature by various authors from different countries. The aim of this clinical overview is to survey the main controversial issues in surgical reconstruction of the anterior urethra focusing on the use of flap or graft, substitute material, type of surgery and challenging situations, such as failed hypospadias or complex urethral stricture repair

Peyronie's disease: Update in 2020

Peyronie's disease (PD) is a relatively unknown cause of sexual dysfunction. Symptoms may include the appearance of an erectile deformity, pain in the penis and erectile dysfunction (ED). The etiology is most often unclear, and medical treatments are limited, although improvement is always possible. However, surgical treatment remains the only option when the disease has stabilized and in the event of significant erectile and sexual disability. © 2020 Editions Medecine et Hygiene. All rights reserved

Surgical outcomes after collagenase Clostridium histolyticum failure in patients with Peyronie’s disease in a multicenter clinical study

In the present study we aimed to investigate the surgical outcomes of patients with persistent penile curvature (PC) after Collagenase Clostridium histolyticum (CCH) intraplaque injections. Data from 90 patients with persistent PC after CCH in a multicentre study from 6 andrological centres were retrospectively reviewed. Three standardized surgical techniques were performed. Group 1: plaque incision grafting (PIG) with penile prosthesis implant (PPI); Group 2: PIG without PPI; Group 3: Nesbit technique. Hospital stay, operative time, postoperative complications and PC persistency/recurrence (> 20°) were evaluated. Overall satisfaction and functional outcomes were assessed through International Index of Erectile Function-Erectile Function (IIEF-EF), Peyronie’s Disease Questionnaire (PDQ), Female Sexual Function Index (FSFI) administered pre and 3 months postoperatively. Of all, 25 (27.8%) patients received grafting procedure + PPI (Group 1), 18 (20.0%) patients belonged to Group 2, and 47 (52.2%) to Group 3. Bovine pericardium graft and collagen fleece have been used in in 22 (51.2%) and 21 (48.8%) patients, respectively. Median penile length after surgery was 13.0 cm (IQR 12.0–15.0). After surgery, Group 1 showed higher increase in penile length after surgery and better improvements in terms of PDQ-PS. In contrast, both IIEF-EF and FSFI scores did not differ among groups. Overall, 86 (95.6%) did not report any complication. 4 (4.4%) patients had PC recurrence; of those, 2 (8.0%), 1 (5.6%) and 1 (2.1%) cases were observed in Group 1, Group 2 and Group 3, respectively. In case of persistent PC after CCH, surgical correction by grafting with or without concomitant PPI or Nesbit technique emerged as a technically feasible, effective and safe procedure, with no significant postoperative complications