PURPOSE:To identify variations in renal function and histology between Caucasian Americans (CA) and African Americans (AA) undergoing robotic nephron-sparing surgery (NSS). METHODS:A retrospective chart review was performed on patients who underwent NSS. Multivariate analysis identified factors affecting postoperative estimated glomerular filtration rate (eGFR). Histology was re-reviewed by pathology to confirm papillary type. RESULTS:A total of 331 patients underwent NSS: CA (n = 212), AA (n = 105), Hispanic (n = 10), and other (n = 4). AA average age (60.1 years) was lower than CA (62.3 years) (P < .001), with a higher proportion of AA women (46%) than CA (37%) (P = .021). AA had a higher incidence of diabetes (58.2%) and hypertension (93.9%). Preoperative average eGFR was similar: 70.35 mL/min for AA versus 69.06 mL/min for CA. Average postoperative eGFR was 50.59 mL/min for AA and 57.85 mL/min for CA. Postoperative creatinine increased more in AA (0.44 mg/dL) versus CA (0.33 mg/dL) (P < .001) even when stratified by pathological stage. Clear cell renal cell carcinoma (RCC) was the most common histology with AA (45%) and CA (60%). A greater than 2-fold higher incidence of papillary RCC was observed in AA (31%) versus CA (13%). AA exhibited a greater proportion of high-grade or type 2 papillary RCC (40% and 30%) versus CA (25% and 13%). CONCLUSIONS:AA patients were treated at a younger age, with a larger proportion of women. Postoperatively, AA experienced a greater increase in serum creatinine. Final histology demonstrated greater papillary RCC incidence in AA and increased likelihood for type 2 papillary RCC, a more aggressive histology.

Current gold standards of care for patients with significant post-prostatectomy erectile dysfunction (ED) and stress urinary incontinence (SUI) are the inflatable penile prosthesis (IPP) and the artificial urinary sphincter (AUS). We sought to report our experience with dual synchronous AUS/IPP insertion through a single penoscrotal incision. We retrospectively collected data on 33 patients who had synchronous dual insertion of AUS/IPP through a single penoscrotal incision between 2009 and 2014. Collected data included various patient, clinical, and surgical parameters. Post-surgical outcomes including erectile function, degree of incontinence, complications, and patient and partner satisfaction rates were also collected. The median age of the cohort was 64 (range 51-79). Co-morbidites included hypertension (67%), dyslipidemia (52%), coronary artery disease (30%), diabetes (24%), with 21% of the patients receiving post-prostatectomy radiotherapy. Distribution of AUS cuff sizes was 3.5cm (33%), 4.0cm (64%), and 4.5cm (3%). IPPs were 3-piece in 70% and 2-piece in 30%. At a median follow-up of 19 months (1-92), median SHIM score improved from 5 to 25 and median pads per day decreased from 6 to 1. Median patient and partner satisfaction rates were 9/10 and 10/10, respectively. Complications included 3 infections, 2 AUS cuff leaks, 2 AUS erosions and 1 IPP distal erosion, and occurred more commonly in patients with co-morbidities and/or previous radiotherapy.

OBJECTIVE: To detect and measure surgeons' head movement during laparoscopic simulator performance to determine whether expert surgeons have economy of motion in their head movement, including change of direction, compared with intermediate and novice surgeons. We investigated head movement as an objective tool for assessment of laparoscopic surgical skill and its potential use for assessing novice surgeons' progress on the learning curve.DESIGN: After obtaining institutional review board approval, medical students, urology residents, and attending staff surgeons from an academic institution were recruited. Participants were grouped by level of experience and performed tasks on the Electronic Data Generation for Evaluation laparoscopic simulator. Surgeons wore a commercially available wireless electroencephalogram monitor as a flexible, adjustable, and lightweight headband with 7 sensors-2 forehead sensors, 2 ear sensors, and 3 reference sensors. The headband incorporates a 3-axis accelerometer enabling head movement quantification. A variance analysis was used to compare the average head movement acceleration data between each group.SETTING: Tulane University Medical Center, New Orleans, LA, an academic medical center and the principal teaching hospital for Tulane University School of Medicine.PARTICIPANTS: A total of following 19 participants were recruited for the study and stratified by surgical experience into novice (n = 6), intermediate (n = 9), and expert (n = 4) laparoscopy groups: 6 medical students, 9 urology residents (postgraduate years 1 to 5), and 4 attending urologists, respectively.RESULTS: Analysis of the average acceleration rate of head movement showed statistically significant differences among groups on both the vertical axis (p = 0.006) and horizontal axis (p = 0.018) in the laparoscopic suturing task. This demonstrated the ability to distinguish between experts and novice laparoscopic surgeons. The average acceleration among groups did not demonstrate statistical significance on the vertical axis (p = 0.078) and horizontal axis (p = 0.077) in the peg transfer task. This may be in response to the ease of the task. The analysis of the forward-backward axis or depth perception also showed no significant differences between groups.CONCLUSION: Accelerometer-based motion analysis of head movement appears to be a useful tool to evaluate laparoscopic skill development of surgeons in terms of their economy of motion, and it could potentially be used for ergonomic assessment of training in the future, and progression on the learning curve. (c) 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Peyronie's disease is a localized connective tissue disease characterized by an active, inflammatory phase and a stable, quiescent phase, with the eventual development of collagenous plaques within the tunica albuginea of the penis. Risk factors primarily associated with Peyronie's disease include Dupuytren's contracture, penile trauma, and family history. A variety of treatment strategies have been utilized, including oral and topical agents, electromotive drug administration, intralesional injections, extracorporeal shockwave therapy, penile traction, and surgery. However, most of these strategies are ineffective, with surgery being the only definitive treatment. Collagenase clostridium histolyticum is a newly US Food and Drug Administration-approved agent for intralesional injection. It is thought to downregulate many of the disease-related genes, cytokines, and growth factors and degrade collagen fibers. It also suppresses cell attachment, spreading, and proliferation. Collagenase clostridium histolyticum has been clinically proven to be a safe and effective therapeutic option, demonstrating decreases in penile curvature and plaque consistency, as well as increases in patient satisfaction. During clinical evaluation, the Peyronie's Disease Questionnaire was validated as an effective tool for assessing treatment outcomes.

INTRODUCTION The risk of sexual dysfunction due to bicycling has been addressed in the literature for both men and women. New studies have provided information about the prevalence, pathophysiology, and strategies for prevention of sexual dysfunction as it relates to cycling. AIM The aim of this article is to review the current literature about bicycle-related sexual dysfunction in both genders, exclusive of that caused by cycling-related genitourinary trauma. METHODS A systematic comprehensive review of the English-language literature was performed in March 2014 using PubMed.gov, and search terms including (but not limited to) "cycling, bicycle, sexual dysfunction, and erectile dysfunction." RESULTS Several studies have documented a relationship between bicycling and sexual dysfunction. Of the symptoms described, perineal numbness (prevalence of 22-91%) and erectile dysfunction (prevalence of 1.8-50%) are the most commonly reported in the male population. The primary mechanisms leading to these symptoms in both genders appear to be perineal compression of the pudendal nerve within Alcock's canal and possible trauma. Communications have also postulated that potential cycling-related disruption of the hypothalamic-pituitary-gonadal axis, specifically in testosterone signaling, may indirectly lead to sexual dysfunction. Studies have provided evidence that the rider's position on the bicycle, as well as different types of bicycle seats, affect the degree of pudendal compression, and consequently the degree of resultant sexual dysfunction. CONCLUSIONS Although a number of studies have described mechanisms for cycling-related sexual dysfunction, further validated studies are needed to both better describe the dysfunction, as well as to develop strategies for prevention and treatment. Our best evidence indicates that the type of saddle used, as well as the position of the rider, has more effect on resultant sexual dysfunction than simply participation in cycling. Baran C, Mitchell GC, and Hellstrom WJG. Cycling-related sexual dysfunction in men and women: A review. Sex Med Rev 2014;2:93-101.

The risk of sexual dysfunction due to bicycling has been addressed in the literature for both men and women. New studies have provided information about the prevalence, pathophysiology, and strategies for prevention of sexual dysfunction as it relates to cycling.The aim of this article is to review the current literature about bicycle-related sexual dysfunction in both genders, exclusive of that caused by cycling-related genitourinary trauma.A systematic comprehensive review of the English-language literature was performed in March 2014 using PubMed.gov, and search terms including (but not limited to) "cycling, bicycle, sexual dysfunction, and erectile dysfunction."Several studies have documented a relationship between bicycling and sexual dysfunction. Of the symptoms described, perineal numbness (prevalence of 22-91%) and erectile dysfunction (prevalence of 1.8-50%) are the most commonly reported in the male population. The primary mechanisms leading to these symptoms in both genders appear to be perineal compression of the pudendal nerve within Alcock's canal and possible trauma. Communications have also postulated that potential cycling-related disruption of the hypothalamic-pituitary-gonadal axis, specifically in testosterone signaling, may indirectly lead to sexual dysfunction. Studies have provided evidence that the rider's position on the bicycle, as well as different types of bicycle seats, affect the degree of pudendal compression, and consequently the degree of resultant sexual dysfunction.Although a number of studies have described mechanisms for cycling-related sexual dysfunction, further validated studies are needed to both better describe the dysfunction, as well as to develop strategies for prevention and treatment. Our best evidence indicates that the type of saddle used, as well as the position of the rider, has more effect on resultant sexual dysfunction than simply participation in cycling. Baran C, Mitchell GC, and Hellstrom WJG. Cycling-related sexual dysfunction in men and women: A review. Sex Med Rev 2014;2:93-101.

The treatment of Peyronie's disease (PD) is a challenge for the clinician. In the quest to straighten the penis, alleviate pain, prevent further shortening, and restore erectile function, many non-surgical treatments have been offered in lieu of an operative approach, which is still considered the gold standard for definitive treatment. This communication is an update on the different approaches used in the minimally invasive management of this frustrating and yet intriguing condition.

Objective To describe use of a robotic-assisted laparoscopic partial nephrectomy technique utilizing the thulium laser for tissue welding without clamping the hilar vessels. Materials and Methods A Thulium laser at 30W and a 400 micron fiber placed through a robot arm to excise and achieve hemostasis during resection of renal masses. The masses were localized intraoperatively with a 10mm laparoscopic renal ultrasound probe. At no point during the procedure were the renal hilar vessels clamped. There was minimal blood loss during the operation. Following resection, the base of the tumor resection bed was oversewn with a running 2-0 Vicryl suture and secured with LapraTy clips. The renal capsule was then closed with 0 Vicryl over a Surgicel bolster together with Floseal for an additional degree of hemostasis. Results The robotic partial nephrectomies were completed without complication, with complete tumor excision confirmed by negative pathologic surgical margins. Final pathology demonstrated clear cell cell carcinoma. Patients were discharged on postoperative day 2, and have had no long term complications. Conclusions Partial nephrectomy continues to grow in application for treatment of T1 renal cell carcinoma. We present a technique for zero-ischemia robotic laser partial nephrectomy, which addresses current concerns focusing on renal ischemia during surgery.

Peyronie disease is a common cause of penile deformity and sexual dysfunction. Although surgery is regarded as the definitive management for this condition, there are many medical and minimally invasive therapies available, with widely varying efficacy reported in the literature. The purpose of this review is to describe the current state-of-the-art for each of the most commonly used as well as several developing non-surgical treatments. Further, we hope to offer perspectives that will aid practitioners in deciding among these treatments that are either already in use or have the potential to be used as alternatives to surgery in the management of this frustrating disease.