Context: The management of high-grade (Grade IV-V) renal injuries remains controversial. There has been an increase in the use of (NOM) but limited data exists comparing outcomes with open surgical exploration. Objective: To conduct a systematic review to determine if NOM is the best first-line option for high-grade renal trauma in terms of safety and effectiveness. Evidence acquisition: Medline, Embase, and Cochrane Library were searched for all relevant publications, without time or language limitations. The primary harm outcome was overall mortality and the primary benefit outcome was renal preservation rate. Secondary outcomes included length of hospital stay and complication rate. Single-arm studies were included as there were few comparative studies. Only studies with more than 50 patients were included. Data were narratively synthesised in light of methodological and clinical heterogeneity. The risk of bias of each included study was assessed. Evidence synthesis: Seven nonrandomised comparative and four single-arm studies were selected for data extraction. Seven hundred and eighty-seven patients were included from the comparative studies with 535 patients in the NOM group and 252 in the open surgical exploration group. A further 825 patients were included from single-arm studies. Results from comparative studies: overall mortality: NOM (0-3%), open surgical exploration (0-29%); renal preservation rate: NOM (84-100%), open surgical exploration (0-82%); complication rate: NOM (5-32%), open surgical exploration (10-76%). Overall mortality and renal preservation rate were significantly better in the NOM group whereas there was no statistical difference with regard to complication rate. Length of hospital stay was found be significantly reduced in the NOM group. Patients in the open surgical exploration group were more likely to have Grade V injuries, have a lower systolic blood pressure, and higher injury severity score on admission. Conclusions: No randomised controlled trials were identified and significant heterogeneity existed with regard to outcome reporting. However, NOM appeared to be safe and effective in a stable patient with a higher renal preservation rate, a shorter length of stay, and a comparable complication rate to open surgical exploration. Overall mortality was higher in the open surgical exploration group, though this was likely due to selection bias. Patient summary: The data of this systematic review suggest nonoperative management continues to be favoured to surgical exploration in the management of high-grade renal trauma whenever possible. However, comparisons between both interventions are difficult as patients who have surgery are often more seriously injured than those managed nonoperatively, and existing studies do not report on outcomes consistently. (c) 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

To analyze urinary continence outcome following robot-assisted radical prostatectomy (RARP) for aggressive prostate cancer in men aged ≥ 70 and < 70 years. Retrospective analyses of prospectively collected long-term data from a monocentric cohort of 350 men with D’Amico high-risk prostate cancer undergone robot-assisted radical prostatectomy at a single institution between 2005 and 2016. The association between time since operation and zero-pad urinary continence recovery was comparatively analyzed by separate pre-operative and post-operative Cox proportional-hazard regression models. Median age in the age group ≥ 70 years was 73 years compared with 62 years in the < 70 year age group. Distribution of men receiving adjuvant and salvage radiotherapy/hormonal therapy was similar in both age groups. Urinary continence recovery rate at 12, 24, and 36 months after surgery of men aged ≥ 70 years was 66, 79 and 83%, respectively, and statistically similar to that of men < 70 years: 71, 81, and 85% (log-rank test p = 0.24). Multivariable analyses demonstrated no significant difference in return to continence between the two age groups (p = 0.28 and p = 0.17). In addition, clinical stage and type of nerve sparing (unilateral, bilateral or non-nerve sparing) were found to be independently predictive of pad-free continence recovery. Regardless of age, return to continence in men with aggressive prostate cancer undergoing RARP continues to improve way beyond the first 12 months after surgery. Considering the dire effects of post-operative radiotherapy on continence in this aggressive cancer cohort, advanced age alone should not discourage recommending multimodal therapy involving RARP.

Blunt trauma to the lower urinary tract is usually associated with pelvic fractures. The European Association of Urology (EAU) provides guidelines to diagnose and treat these injuries. The guidelines summarise the available evidence and provide recommendations on diagnosis and treatment of these patients. Therefore, these guidelines are important adjuncts to the urologist and emergency physician in the clinical decision-making. However, strict adherence to the guidelines is not always easy or possible because of concomitant injuries obscuring the clinical picture. This is illustrated by two case reports of concomitant injuries of the lower urinary tract (bladder with urethral injury). The clinical decisions will be discussed point by point and should serve as a practical teaching moment for the reader.

... To present our experience of a modified treatment regime for the conservative treatment of Peyronie's disease based on the injection therapy with collagenase clostridium histolyticum (Xiaflex) and the use of a traction device (Phallosan forte) and a vacuum pump. Since December 2015 a total of 4 patients underwent the aforementioned conservative treatment regime. The treatment consisted of collagenase clostridium histolyticum (Xiaflex) injections on day 1 and 2 of each cycle followed by a thorough penile modeling program based on the use of: - a traction device (Phallosan forte): 6-8 h daily - a vacuum pump: 30 minutes daily. The modeling program was followed for 4-6 weeks until the next cycle of collagenase injections was administered. All patients included were in the acute phase of the disease. No tunical calcifications were seen in the ultrasound evaluation. The mean penile curvature at the initial presentation was 45° (range, 30-80°). All patients underwent 2-3 cycles of the conservative treatment regime. A curvature reduction of 30-60° was encountered. A mean reduction of approximately 58% was achieved.

To demonstrate the safety and feasibility of a combined implantation of an artificial urinary sphincter (AMS 800) and the insertion of a hydraulic penile prosthesis. Following radical prostatectomy many patients are left with severe erectile dysfunction and urinary incontinence. In advanced case the patient has to undergo the insertion of a penile prosthesis to restore sexual function. Furthermore an artificial urinary sphincter is needed to control severe urinary incontinence. The multiple sliding technique (MUST) is an evolution of the sliding technique and the modified sliding technique (MOST) which aim to lengthen the penis during the insertion of a penile prosthesis. The video shows the various steps for the combined implantation of both devices. The insertion of a hydraulic penile prosthesis based on the principles of the MUST technique and the placement of an artificial urinary sphincter through a subcoronal circular circumcision incision is safe and feasible.

Background: Patients with severe erectile dysfunction (ED) and penile size issues, especially seen in Peyronie's disease (PD), are candidates for more invasive penile prosthesis insertion techniques that aim for penile length and girth reconstruction. Aim: To present the feasibility and safety of penile length and girth restoration based on the so-called multiple-slit technique (MUST) for patients with severe ED and significant penile shortening with or without PD. Methods: From July 2013 through January 2016, 138 patients underwent the MUST. The International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction were completed. Outcomes: Outcome analysis was focused on penile length restoration, penile curvature correction, intra-and postoperative complications, and patient satisfaction. Results: 138 patients underwent the procedure (103 malleable and 35 inflatable devices). Etiologies of penile shortening and narrowing were PD, severe ED, post-radical prostatectomy, and androgen-deprivation therapy with or without brachytherapy or external radiotherapy for prostate cancer, and post-penile fracture in 60.1%, 24.6%, 10.1%, 3.6%, and 2.2%, respectively. In PD cases, the mean deviation of the penile axis was 55 degrees (range = 0-90 degrees). Mean subjective penile length loss reported was 3.2 cm (range = 1-5 cm), and shaft constriction was present in 44.9%. Median follow-up was 15.2 months (range = 6-36 months). Mean penile length gain was 3.1 cm (range = 2-5 cm). No penile prosthesis infection caused device explantation. One glans necrosis was encountered. The average IIEF score increased from 22 points at baseline to 66 points at 6-month follow-up. Clinical Implications: The MUST helps address penile size issues in cases of severe ED with concomitant conditions that impair penile length or girth. Strengths and Limitations: The strength of the study is its applicability to provide surgeons with a solution for cases in which patients have severe ED and penile size impairment owing to underlying conditions such as PD. The study is limited by the relatively short follow-up. Conclusions: The MUST is an effective, safe, and viable treatment option for a selected patient cohort. Because of the potential complications, proper counseling should take place and only experienced surgeons should perform this type of surgery. Copyright (C) 2017, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Context: The evidence base for optimal acute management of pelvic fracture-related posterior urethral injuries needs to be reviewed because of evolving endoscopic techniques. The current standard of care is suprapubic cystostomy followed by delayed urethroplasty. Objective: To systematically review the evidence base comparing early endoscopic realignment with cystostomy and delayed urethroplasty regarding stricture rate, the need for subsequent procedures, and functional outcomes. Evidence acquisition: A systematic search in Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Review, and www.clinicaltrials.gov without time orlanguagelimitations. Both medical subject heading and free text terms as well as variations of root word were searched. Randomised controlled trials (RCTs), nonrandomised comparative studies and single-arm case series were included, as long as >= 10 patients were enrolled. Data were narratively synthesised in light of methodological and clinical heterogeneity. The risk of bias of each included study was assessed. Evidence synthesis: No RCTs were found. Six nonrandomised comparative studies and met inclusion criteria and were selected for data extraction. Noncomparative studies with more than 10 participants were included resulting in seven eligible studies. From the comparative papers the results of 219 patients were reported: 142 in the realignment group and 77 in the group undergoing cystostomy with delayed repair. The noncomparative studies reported on a further 150 cases. An overall stricture rate of 49% was evident in the endoscopic realignment group. Of these patients, 50% (28.1% overall) could be managed by endoscopic procedures and 40.3% (18.5% of intervention group) required anastomotic repair. Conclusions: No RCTs were found and the included nonrandomised studies have heterogeneous populations and a high degree of bias. About half of the patients were free of stricture and thus did not undergo delayed urethroplasty in case early endoscopic realignment had been performed. Patient summary: This systematic review of literature of urethral trauma revealed there are no well conducted comparative studies of newer endoscopic treatments versus standard treatments which include more extensive surgery. The results of the reports we selected based on specific characteristics are often influenced by variable factors. After careful analysis of these results we can conclude that the newer endoscopic techniques might resolve the risk of urethral injury due to pubic fractures in about half of the patients. Because of various confounders we cannot identify those patients who would benefit from this procedure or who might be possibly harmed. (c) 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

To explain and demonstrate the use of a collagen fleece (TachoSil®) as a graft material for severe penile curvatures, which demand an incision and grafting procedure based on the geometric principles of the Egydio technique. To highlight tips and tricks for a correct application of TachoSil® and the geometric principles of the Egydio technique. From March 2016-August 2016 a total of 18 patients underwent an incision and grafting procedure based on the geometric principles of the Egydio technique due to a severe penile curvature caused by Peyronie's disease. Inclusion criteria were: patients with severe Peyronie's disease - patients with good quality erections - patients who were concerned about further penile length loss. 16 patients had a dorsal penile curvature, and 2 patients had a lateral penile curvature. The mean penile curvature was 70 degrees (range, 50-100 degrees). All dorsal penile curvatures were straightened. One of the lateral curvatures had to be revised due to a residual curvature of > 20°. A residual curvature of less than 10 degrees was present in 2 patients. Permanent glans numbness was not present. The intraoperative measured stretched penile length increased by 2.0 cm (range, 1.5-3.0 cm). In foreskin sparing approaches (12 cases) a postoperative lymph edema of the foreskin was present in 50% of cases. All lymph edemas dissolved over the first 6 weeks. All patients resumed sexual intercourse postoperatively. No postoperative erectile dysfunction was recorded.

Dear Editor, We have recently developed a novel surgical approach for the management of bilateral testicular hypotrophy, allowing both the preservation of gonadic function and some penile lengthening: aim of this letter is to describe our surgical technique, reporting the first two cases treated with this approach. Both patients were affected by nonmosaic Klinefelter syndrome, presenting with infertility, severe testicular hypotrophy and small penile size: the main patient characteristics are shown in Table 1. They severely complained about their scrotal appearance and small penile size: their discomfort was such that body dysmorphic disorder (BDD) was diagnosed after psychiatric evaluation. Both patients required a procedure able to restore a satisfying scrotal appearance and to achieve an acceptable penile length, while allowing a bilateral microdissection testicular sperm extraction (micro-TeSE), all through a single surgical incision.Table 1: Patient characteristicsA V-shaped inverted suprapubic incision was performed, followed by an incision of the Scarpa's fascia proximal to the penopubic junction. The suspensor ligament of the penis was than isolated transversally incised and detached from the periosteum of the pubis bone. The spermatic chords were isolated bilaterally. The gonads were bilaterally externalized from the scrotum after incision of the gubernaculum testis on both sides. A micro-TeSE was bilaterally performed, together with testicular biopsy for histological evaluation. The right gonad was then mobilized and transferred to the contralateral hemiscrotum through the infrapubic incision, leaving in place the scrotal septum. In the right hemiscrotum, left empty, we placed medium-sized testicular prosthesis (20 cc). Finally, a V-Y skin plasty with an aesthetic running intradermal suture was performed (Figure 1).Figure 1: Bilateral testicular hypotrophy. The right gonad was mobilized and transferred to the contralateral hemiscrotum. A medium-size testicular prosthesis was placed in the empty right hemiscrotum.Mean operative time was 95 min. No intraoperative or postoperative complications were recorded. At follow-up visits scheduled at 1 week, 6 months and 1 year after surgery, both patients were satisfied with the cosmetic appearance of the scrotum: the placement of both testicles in the left hemiscrotum did not impair their blood supply, as demonstrated by the Color Doppler ultrasound. The endocrinological testicular function was preserved. Unfortunately, both patients were diagnosed with complete azoospermia with histological tubular sclerohyalinosis. The postoperative stretched penile measurement demonstrated a real penile lengthening of 1.5 cm in both cases, which was found acceptable by both patients. As for subjective aesthetic outcomes, both patients said to be completely satisfied with surgery outcomes, reporting a gain in self-confidence. A psychiatric evaluation, conducted 4 months postoperatively, described an improvement in body self-perception thanks to the encouraging cosmetic results of the procedure. Testicular hypotrophy is a rare condition that typically affects young patients, with strong psychological repercussions. Main causes are genetic disorders, such as Klinefelter or Kallmann syndrome.1 BDD is a disorder which further impairs the quality of life of these already frail patients, and must not be underestimated.2 Therefore, surgeries aiming to restore an acceptable body image at the cost of minimal morbidity are very important in this category of patients. Ugarte y Romano and González Serrano3 recently reported a new surgical approach using chin implants for testicular augmentation. In their case report, a single inguinal approach was used to manage a monolateral testicular hypotrophy. According to this technique, our patients would have required a bilateral inguinal incision. Moreover, the concomitant presence of the testicle and chin prosthesis in the hemiscrotum might lead to an increased risk of infection and testicular damage. In addition, there is a risk of nontolerability of the prosthetic device.4 Finally, our patients, affected by bilateral hypotrophy, would have required two prostheses, with higher costs of the procedure. Ferro et al.5 suggested an innovative approach in two young patients affected by Kallmann syndrome, which involved testicular transposition through the septum with a single testicular prosthesis implantation in the hemiscrotum left empty. In our opinion, testicular transposition via a scrotal approach presents the risk of torsion or compression of the cord of the mobilized testis during the passage through the scrotal septum. Moreover, leaving a communication between the two hemiscrotums can increase the risk of infection and testicular damage. All these problems are overcome in our novel approach, performed through a V-inverted suprapubic incision, which leaves intact the scrotal septum and creates no communication between the two hemiscrotums. Moreover, our technique allows the contemporary incision of the suspensor ligaments of the penis and the creation of a V-Y skin flap, with a satisfactory penile lengthening. The debate about the benefits of penile lengthening procedure in patients with “short penis” is still ongoing: some question that penile length is normal in most of these men who tend to overestimate normal phallic dimensions and do not need any surgical procedure.6 Furthermore, surgical procedures of lengthening phalloplasty remain a controversial issue.78 This feature is complicated by a lack of universally accepted parameters for normal penile size evaluation. According to Wessells et al.9 normal penile dimensions should be considered to be any length within 2 standard deviations of the mean, that is >4 cm for the flaccid state and >7.5 cm for the stretched state. We can say that BDD diagnosed in our patients was not a purely psychiatric issue, as both patients had penile measurements at the lowest limits of normality. We think that in this case, a surgical correction can be helpful to restore both a normal anatomy and an acceptable body image. Penile lengthening procedures can improve patient self-esteem in dysmorphophobic patients even if the length gain is not up to patient expectations.10 As for penile lengthening, our approach follows surgical techniques already well-known and effective:7 the real strength resides in the possibility of performing different procedures with the same, small incision, limiting the morbidity of the procedure. In summary, our novel combined technique has shown to be safe and effective: we believe that it represents a good way to contemporarily treat different problems and it is surely a good option in a complex setting of patients such as the hypogonadic Klinefelter ones. These promising results obviously need to be confirmed in a bigger series of patients, but we believe to have found a good strategy to address at the same time two major problems–testicular hypotrophy and short penis-which affect a considerable number of patients, especially with genetic disorders. AUTHOR CONTRIBUTIONS MT and MF carried out the surgery. Notwithstanding they participated to the acquisition of data, the analysis and the interpretation of data. They were involved in drafting and revising the manuscript. FK, CC, OS and MO participated to conception of the study and to the revision of the manuscript. PG, BF and LR conceived of the study, coordinated the study and helped to draft the manuscript. All authors read and approved the final manuscript. COMPETING INTERESTS All authors declare no competing interests.

To present our experience of penile length restoration in cases of severe corporal fibrosis. 11 patients with severe corporal fibrosis underwent an insertion of a malleable penile prosthesis and a concomitant penile length restoration from March 2008 till June 2014,. The mean age of patients at the time of surgery was 57 years (41-69y). The cause of corporal fibrosis wa a recurrent priapism in 2 cases, and in 9 cases corporal fibrosis was present after the explantation of an infected penile prosthesis. The preoperative stretched penile length was 8 cm (6-11cm). Severe corporal fibrosis was seen in all patients at the preoperative sonography of the penis. The mean penile length gain was 3.4 cm (2.5-5cm). No postoperative infection was encountered. Penile prosthesis insertion in cases of a corporal fibrosis is a very challenging operation. Nevertheless penile length restoration is a feasible option for patients who suffer significantly from penile length loss.

To present our experience with a modification of the Modified Sliding Technique (MOST), which is applied for patients with severe erectile dysfunction and penile shortening with or without penile curvature caused by Peyronie's disease (PD). From July 2013 till September 2014, 19 patients underwent the MUST technique. All of these patients suffered from therapy resistent ED and opted for the insertion of an inflatable penile prosthesis. Severe ED and penile shortening was present in 14 patients who also suffered from PD and in 5 patients after a radical prostatectomy. A waist deformity was present in 14 patients. The mean penile curvature was 50° (0-80°). The mean operative time was 120 min (100-164min). Postoperative hematomas at the base of the penis were seen in 5 patients. Tunical steps were palpated in 3 patients. Temporary glans numbness was present in 2 patients. Median follow up was 12 months (6-21months). Mean penile length gain was 3 cm (2-5cm). No infection of the penile prosthesis was encountered.

The development and publication of clinical guidelines is one of the core activities of the European Association of Urology (EAU). The guidelines have become an essential tool for clinicians (residents and specialists), and they are widely referenced. All guidelines are based on reviews of the relevant literature using multiple available databases. The urological trauma guidelines [ [1] Summerton DJ, Djakovic N, Kitrey ND, et al. EAU Urological Trauma Guidelines Panel. Guidelines on urological trauma. Presented at: European Association of Urology annual congress; March 20–24, 2015; Madrid, Spain. Google Scholar ] panel faces specific challenges because the majority of studies on this subject are case reports and use retrospective cohorts.

INTRODUCTION:We compared the postoperative sexual function of patients who underwent wide local excision (WLE) and glansectomy with urethral glanduloplasty for penile cancer.METHODS:We retrospectively reviewed clinical data of 41 patients affected by superficial, localized penile cancer (≤cT2a) between 2006 and 2013. Patients with severe erectile dysfunction and not interested in resuming an active sexual life were selected for penile partial amputation. Patients with preoperative satisfying erectile function and concerned about the preservation of their sexual potency were scheduled for WLE (Group A) or glansectomy with urethral glanduloplasty (Group B). Sexual function was assessed with the International Index of Erectile Function (IIEF) questionnaire and the Sex Encounter Profile (SEP). At 1 year, patients were asked to complete the questionnaires again and were questioned about their genital sensibility and ejaculatory reflex persistence. Postoperative complications were reported according to the Clavien-Dindo classification. Statistical analysis was performed by two-tailed test: Student t-test and chi-square.RESULTS:Among the 41 patients enrolled, 12 underwent WLE (29.2%), 23 glansectomy with urethral glanduloplasty (56%) and 6 with penile partial amputation (14.6%). A decrease in postoperative IIEF was recorded in both groups, but was statistically significant only in Group B (p = 0.003). As for the SEP, while no significant changes were recorded postoperatively in Group A, a marked reduction was reported for Group B, with a statistically significant decrease in the possibility of achieving penetrative intercourse (p = 0.006) and in the perceived satisfaction during sexual activity (p = 0.004).CONCLUSIONS:WLE lead to better sexual outcomes and less postoperative complications as compared to glansectomy with urethral glanduloplasty.

ObjectiveTo compare patient‐reported outcomes (PROs) of surgical correction of Peyronie's disease (PD) with the Nesbit procedure, plaque incision and grafting, and the insertion of a malleable penile implant after surgical correction of penile curvature.Patients and MethodsWe performed a retrospective review of men who underwent surgical correction of PD between January 2010 and December 2012 at six international centres. Treatment‐related PROs and satisfaction were evaluated with a non‐validated questionnaire.ResultsThe response rate to the questionnaire was 70.9%, resulting in a study cohort of 206 patients. The Nesbit procedure, plaque incision with grafting, or implantation of a malleable penile prosthesis was performed in 50, 48, and 108 patients, respectively. Overall, 79.1% reported a subjective loss of penile length due to PD preoperatively (range 2.1–3.2 cm). Those patients treated with a malleable penile implant reported the greatest subjective penile length loss, due to PD. A subjective loss of penile length of >2.5 cm resulted in reduced preoperative sex ability. Postoperatively, 78.0%, 29.2% and 24.1% patients in the Nesbit, grafting, and implant groups reported a postoperative, subjective loss of penile length (range 0.4–1.2 cm), with 86.3%, 78.6%, and 82.1% of the patients in each group, respectively, being bothered by the loss of length.ConclusionsPenile length loss due to PD affects most patients. Further penile length loss due to the surgical correction leads to bother among the affected patients, irrespective of the magnitude of the loss. The Nesbit procedure was associated with the highest losses in penile length. In patients with PD and severe erectile dysfunction, a concomitant lengthening procedure may be offered to patients to help overcome the psychological burden caused by the loss of penile length.

OBJECTIVE To evaluate the diagnostic accuracy of a new energy and radiation dose-reduced protocol for noncontrast computed tomography (NCCT) with dual-energy CT (DECT) analysis and its potential for the compositional analysis of uric acid (UA)-or non-uric acid (N-UA)-containing calculi.METHODS A retrospective evaluation was carried out in 61 patients who underwent dose-reduced DECT (tube A: 140 kV/55 mAs; tube B: 80 kV/303 mAs) with a tube current 38.8% lower than that set by the manufacturer. A protocol combining low-dose CT and targeted DE scans was used. Urinary stones were detected and classified as UA- or N-UA-containing or mixed based on DE software results. The accuracy of the compositional analysis was controlled by correlation with conventional infrared-based analysis.RESULTS The compositional stone differentiation was correct in 58 of 61 (95.1%) patients. The sensitivity of detecting pure UA-containing and pure N-UA-containing stones was 100%. The specificity of detecting UA- and pure N-UA-containing stones was 100% and 78.57%, respectively, as 3 of 7 mixed urinary stones (small fragments < 4 mm) were classified as N-UA calculi. The total radiation dose in patients with body mass index < 25 and > 25 kg/m(2) was 1.2 and 2.5 mSv, respectively.CONCLUSION Lowering the DECT tube current by up to 38% of the manufacturer's recommendations allows a reduced radiation dose without impairing detection accuracy and stone compositional analysis. Compared with previous studies, this protocol might significantly decrease patient radiation exposure without affecting the quality of results. (C) 2015 Elsevier Inc.

OBJECTIVES:To report the results from a prospective multicentric study of patients with Peyronie's disease (PD) treated with the 'sliding' technique (ST). PATIENTS AND METHODS:From June 2010 to January 2014, 28 consecutive patients affected by stable PD with severe penile shortening and end-stage erectile dysfunction (ED) were enrolled in three European PD tertiary referral centres. The validated International Index of Erectile Function (IIEF) questionnaire, the Sexual Encounter Profile (SEP) Questions 2 and 3, and the Peyronie's disease questionnaire (PDQ) were completed preoperatively by all patients. At the follow-up visits (at 3, 6 and 12 months), the IIEF, the SEP Questions 2 and 3, the PDQ, and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) were completed. The outcome analysis was focused on penile length restoration, and intra- and postoperative complications classified according the Clavien-Dindo Classification. RESULTS:The mean (range) follow-up was 37 (9-60) months. A malleable penile prosthesis (PP) was implanted in seven patients, while an inflatable three-pieces PP was placed in the remainder. In the case of inflatable PP implantation, porcine small intestinal submucosa and acellular porcine dermal matrix were used to cover the tunical defects. While in patients undergoing malleable PP implantation, collagen-fibrin sponge was used. The mean operative time was 145 min in the inflatable PP group and 115 min in the malleable PP group. There were no intraoperative complications. Postoperative complications included profuse bleeding requiring a blood transfusion in one patient (3.5%) on anticoagulation therapy for a mechanical heart valve (Grade II) and PP infection requiring the removal of the device (7%) (Grade III). There were no late recurrences of the shaft deformation. The postoperative functional data showed a progressive improvement in the score of all questionnaires, peaking at 12 months postoperatively. The mean (range) penile lengthening was 3.2 (2.5-4) cm and no patient reported recurrence of the curvature. CONCLUSIONS:The present series suggests that, in the hands of experienced high-volume surgeons, penile length restoration with the use of the ST represents an effective option for end-stage PD associated with ED and severe shortening of the shaft. Larger series and longer follow-up will be required to fully establish the efficacy of this procedure.

ObjectiveTo present the feasibility and safety of penile length and girth restoration based on a modified ‘sliding’ technique for patients with severe erectile dysfunction (ED) and significant penile shortening, with or without Peyronie's disease (PD).Patients and MethodsBetween January 2013 and January 2014, 143 patients underwent our modified ‘sliding’ technique for penile length and girth restoration and concomitant penile prosthesis implantation. It is based on three key elements: (i) the sliding manoeuvre for penile length restoration; (ii) potential complementary longitudinal ventral and/or dorsal tunical incisions for girth restoration; and (iii) closure of the newly created rectangular bow‐shaped tunical defects with Buck's fascia only.ResultsIn all, 143 patients underwent the procedure. The causes of penile shortening and narrowing were: PD in 53.8%; severe ED with unsuccessful intracavernosal injection therapy in 21%; post‐radical prostatectomy 14.7%; androgen‐deprivation therapy, with or without brachytherapy or external radiotherapy, for prostate cancer in 7%; post‐penile fracture in 2.1%; post‐redo‐hypospadias repair in 0.7%; and post‐priapism in 0.7%. In patients with ED and PD, the mean (range) deviation of the penile axis was 45 (0‒100)°. The mean (range) subjective penile shortening reported by patients was 3.4 (1‒7) cm and shaft constriction was present in 53.8%. Malleable penile prostheses were used in 133 patients and inflatable penile prostheses were inserted in 10 patients. The median (range) follow‐up was 9.7 (6‒18) months. The mean (range) penile length gain was 3.1 (2‒7) cm. No penile prosthesis infection caused device explantation. The average International Index of Erectile Function (IIEF) score increased from 24 points at baseline to 60 points at the 6‐month follow‐up.ConclusionPenile length and girth restoration based on our modified sliding technique is a safe and effective procedure. The elimination of grafting saves operative time and, consequently, decreases the infection risk and costs associated with surgery.

Objective: To present our 3-year experience with the Egydio's geometrical procedure for managing penile curvature with some modifications.Patients and methods: In all, 330 patients (mean age 51 years) that underwent the Egydio's procedure as day cases were included in this study.Results: The mean penile curvature was 45 degrees and 27.3% of the patients reported mild erectile dysfunction (ED) preoperatively. Partial excision of the calcified plaque was performed in 12.1% of the patients. Partial glans necrosis was recorded in one patient, while haematoma was recorded in 9%, and delayed wound healing in 3%. There was residual curvature (mean 20 degrees) requiring reoperation in 8.2% of the patients. In all, 10% of the patients were dissatisfied with their results, while of the remainder, 75.2% were totally satisfied and 14.8% partially satisfied. ED was reported in 31.8% of the patients (moderate: 17.3% and significant: 2.7%).Conclusions: The Egydio geometrical technique for the treatment of penile curvature seems to be a simple, reproducible, safe, and efficient operation. (C) 2015 Arab Association of Urology. Production and hosting by Elsevier B.V.

Penile curvature caused by Peyronie's disease (PD) and the subsequent difficulty with penetration and shortened stretched penile length are extremely distressing to men. Although plication may work for low magnitude simple curvature, plaque manipulation and grafting has been the preferred method for correcting large or complex deformities. Penile plication leads to "long side" penile shortening, whereas grafting may lead to erectile dysfunction. We describe the Modified Sliding Technique (MoST) for correcting PD combined with penile lengthening with neurovascular bundle (NVB) and urethral mobilization followed by inflatable penile implant placement, using a single sub-coronal incision.