You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia (MP11)1 May 2024MP11-03 DISPARITIES IN FOURNIER'S GANGRENE OUTCOMES AND MANAGEMENT FOR THE AMERICAN INDIAN POPULATION OF NEW MEXICO Victor Showalter and Maxx Gallegos Victor ShowalterVictor Showalter and Maxx GallegosMaxx Gallegos View All Author Informationhttps://doi.org/10.1097/01.JU.0001008564.85995.11.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fournier's Gangrene is a rare but morbid condition occurring in 1.6 cases per 100,000 a year and mortality rates of 7.5% and 12.8% in males and females respectively. Minorities have been shown to have a higher odds ratio of Fournier's mortality than Caucasian counterparts. New Mexico's demographics are unique comprising a high percentage of American Indians (N). There is a concern that outcomes, hospital stay, and treatment modalities are worse in the American Indian population of New Mexico compared to the general population, these outcomes are examined in this study. METHODS: A retrospective chart review was completed utilizing data from 2012 to 2020 of all Fournier's patients' admitted and treated at University of New Mexico by the urology division. All patient's race demographics were obtained with risk factors, hospitalization details, and outcomes were compared. Patient's that passed away prior to assessment of wound healing, had loss to follow up or other illnesses preventing assessment of wound healing were excluded from the study. RESULTS: A total of 44 patients were included in the study. 10 other patients were excluded due to closure at alternative facility loss to follow up, discovery of malignancy prior to wound healing, or death prior to wound healing. 31 patients self designated as Caucasian or other (COO) were included and 12 self designated American Indian patients. Risk factors between the groups were not significantly different close to 2/3s of each cohort had diabetes, 1/3 of each had hypertension, the COA cohort had slightly higher alcohol abuse rates and smoking rates but these were low percentages of the cohort. American Indian patients were found to have a longer hospital stay with an average of 20.5 day compared to COO with avg of 15.5. American Indians presented generally 1 day later than COO. COO had a higher percentage of primary closure compared to American Indians patients, 66.6% versus 41.6% respectively. The American Indian patients also had a much longer duration in days until complete wound healing (90.3 vs 61.1). CONCLUSIONS: The high population percentage of American Indian in the New Mexico population makes this state unique, despite the minimal difference in risk factors for wound healing American Indians still have longer hospital stays and are less likely to receive primary wound closure. This reflects urologic disease outcomes in other minorities compared to Caucasian counterparts. The goal of this study is to draw attention to lack optimal management of minorities with Fournier's and improve their outcomes moving forward. Source of Funding: No funding required © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e150 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Victor Showalter More articles by this author Maxx Gallegos More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 May 2022PD29-09 PRIMARY CLOSURE IS SUPERIOR TO SECONDARY INTENTION FOR TREATING FOURNIER GANGRENE Peter Sam, Andrew Zilavy, Carolyn Ice, and Maxx Gallegos Peter SamPeter Sam , Andrew ZilavyAndrew Zilavy , Carolyn IceCarolyn Ice , and Maxx GallegosMaxx Gallegos View All Author Informationhttps://doi.org/10.1097/JU.0000000000002577.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Initial management of Fournier Gangrene (FG) is well-established. However, the optimal management post-debridement is still unclear. In general, most post-debridement FG wounds are allowed to heal by secondary intention (SI) with negative pressure wound dressings or treated with delayed primary closure (DPC) using flaps and/or grafts. We hypothesize that DPC is superior to closure by SI in terms of days in the hospital (LOS) and time until return to normal daily activity. Additionally, we hypothesize that DPC is not inferior to SI in terms of infection control. METHODS: At our single tertiary care center, we retrospectively assessed all cases of FG that underwent wound healing by SI vs DPC from 2016 to 2021. A transition to DPC began when our institution hired a GU reconstructive surgeon. Patients who died from their disease, those who were lost to follow up, or those whose closure deviated from our standardized protocol were excluded. Primarily, we collected data regarding LOS and time until return to normal daily activity. Secondarily, we evaluated if DPC or SI resulted in any further need for additional debridement for lack of infection control. T-tests were used to compare our two groups. RESULTS: 18 cases of DPC and 19 cases of SI met inclusion criteria. Patients who underwent DPC spent an average of 14.3 days in the hospital compared to 21.1 days in SI group, CI (-13.23 to -0.37) p <0.05. Time until return to normal daily activity was 43.6 days for the DPC group compared to 103.1 days for SI group CI (-92.14 to -26.86) p <0.005. None of the DPC or SI cases required any debridement beyond the initial 48 hours from presentation. CONCLUSIONS: At our institution, DPC was superior to closure by SI in regards to LOS and time until return to normal daily activity. Patients that underwent DPC enjoyed about 7 less LOS and returned to normal activity about 60 days earlier than patients in the SI group. DPC was non-inferior to SI for infection control. Multi-institutional prospective data is needed to confirm these findings. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e507 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Sam More articles by this author Andrew Zilavy More articles by this author Carolyn Ice More articles by this author Maxx Gallegos More articles by this author Expand All Advertisement PDF downloadLoading ...

Objectives The objectives of this study are (1) to estimate the incidence of midurethral sling revision/removal in women with preexisting pain diagnoses versus those without these diagnoses and (2) to describe associations between numbers and type of pain diagnoses with revision/removal. Methods Women who underwent midurethral sling surgery between 2009 through 2014 were identified in the MarketScan database and tracked and December 31, 2014. Patients with preoperative chronic pain diagnoses (fibromyalgia, endometriosis, irritable bowel, dyspareunia, low back pain, temporomandibular joint syndrome, interstitial cystitis, pelvic/perineal pain) were compared with controls (those without these diagnoses) regarding mesh sling revision/removal. Logistic regression identified variables associated with mesh revision/removal, and survival analysis compared timing of mesh removal/revision. Results There were 161,459 women who underwent midurethral sling surgery (pain, 83,484; nonpain, 77,975). Pain and nonpain groups differed in age (52.1 vs 53.5 years, P < 0.01) and insurance status (P < 0.01), with the pain group more commonly living in the South or West. Mean follow-up was 42.3 months. Cumulative risk for sling revision/removal was higher in patients with 1 pain diagnosis relative to controls (relative risk, 1.54; 95% confidence interval [CI], 1.41–1.54). Risks increased with increased pain diagnoses (≥4 diagnoses; relative risk, 3.13; 95% CI, 2.81–3.47). Pelvic pain conditions had greatest odds of mesh revision/removal (dyspareunia adjusted odds ratio [aOR], 2.44; 95% CI, 2.23–2.63; interstitial cystitis aOR, 1.46; 95% CI, 1.27–1.66; pelvic/perineal pain aOR, 1.41; 95% CI, 1.33–1.48). Co-occurrence of dyspareunia and interstitial cystitis or pelvic/perineal pain had 12.7% cumulative incidence of sling revision/removal. Cox proportional hazards revealed greatest risk for those with pelvic pain conditions (hazard ratio, 2.40; 95% CI, 2.13–2.70). Conclusions Chronic pain diagnoses increased risk of midurethral sling revision/removal; pelvic pain and numbers of diagnoses increased this risk.

You have accessJournal of UrologyCME1 May 2022MP20-15 DELAYED PRIMARY CLOSURE OF POST-DEBRIDEMENT FOURNIER'S GANGRENE WOUNDS REDUCES COST Andrew Zilavy, Peter Sam, Carolyn Ice, and Maxx Gallegos Andrew ZilavyAndrew Zilavy More articles by this author , Peter SamPeter Sam More articles by this author , Carolyn IceCarolyn Ice More articles by this author , and Maxx GallegosMaxx Gallegos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002553.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Initial management of Fournier's Gangrene (FG) is well established. After complete debridement optimal wound management is evolving. FG wounds are either treated by secondary intention(SI) utilizing negative pressure systems (NPS) or by Delayed Primary Closure (DPC) utilizing flaps and/or grafts. DPC has a shorter length of hospitalization (LOS) and faster return to normal daily activity. We hypothesize that DPC has a lower over all cost the medical system than SI. METHODS: We assessed all cases of FG treated at our hospital system from 2016 to 2021. Patients who died from FG, were lost to follow up or deviated from our treatment protocol were excluded. We collected data regarding LOS, cost of LOS, time utilizing NPS, institution specific KCI NPS cost data from our locoregional KCI representative. A KCI NPS costs $55 per day. Each canister costs $45 and each dressing costs $60. Patients will use about 3 canisters and dressings each week of NPS therapy. Average cost per day of hospitalization is $2,000. RESULTS: 18 cases of DPC and 19 cases of SI met inclusion criteria. DPC average cost of LOS for DPC was $28,600 compared to $42,200 in SI group CI (-26499.85 to -700.15) p <0.05. DPC total NPS therapy cost was $500 compared to $10,305 in SI group CI (-12804.10 to -6805.90) p <0.0001. Cost of surgery for DPC was $6,000. CONCLUSIONS: At our institution, DPC was superior to closure by SI in regards to both cost of LOS and cost of NPS therapy. Patients who underwent SI had an increased total cost of care as compared to DPC patients. Total cost of care, including cost of LOS, cost of NPS therapy and cost of DPC surgery, was increased by $17,405 for SI patients. This increased cost of SI is attributable to the associated increased length of hospital stay and increased length of time on NPS therapy. Multi-institutional prospective data is needed to confirm these findings. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e323 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Zilavy More articles by this author Peter Sam More articles by this author Carolyn Ice More articles by this author Maxx Gallegos More articles by this author Expand All Advertisement PDF downloadLoading ...

Optimum radiological assessment of the male urethra requires knowledge of the normal urethral anatomy and ideal imaging techniques based on the specific clinical scenario. Retrograde urethrography is the workhorse examination for male urethral imaging, usually utilized as the initial, and often solitary, modality of choice not only in the setting of trauma, but also in the pre- and post-operative evaluation of urethral strictures. There is, however, growing interest in utilization of ultrasound and magnetic resonance for evaluation of the male urethra owing to lack of ionizing radiation and improved delineation of the adjacent tissue. We review the various modalities utilized for imaging of the male urethra for a variety of known or suspected disorders, and provide an update on current treatments of urethral strictures. Additionally, we detail the key information needed by urologists to guide management of urethral strictures. We conclude with a brief discussion of neophallus urethral diseases following female-to-male sexual confirmation surgery.

You have accessJournal of UrologyCME1 May 2022HF01-12 UPDATES TO THE HISTORY OF GENDER-AFFIRMING VAGINOPLASTY TECHNIQUE Andrew Zilavy, Richard Santucci, and Maxx Gallegos Andrew ZilavyAndrew Zilavy More articles by this author , Richard SantucciRichard Santucci More articles by this author , and Maxx GallegosMaxx Gallegos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002541.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A growing number of urologic, plastic, gynecologic and general surgeons are becoming specialty trained in gender-affirmation surgery. Now it is especially relevant to revisit the fascinating history of gender-affirming vaginoplasty (GAV) technique. To determine the historical accuracy and completeness of the current history that persists to this day, we utilized a rigorous re-review of the primary literature, historical research and historical discovery. METHODS: A thorough literature review was performed of the existing history of GAV technique. Forums were searched for potential leads to new historical data. All major academic databases were searched including google scholar, PubMed, and worldcat. When electronic copies of historical documents were not available, hard copies were obtained using interlibrary loan system. The HathiTrust digital repository was utilized when necessary to obtain archived documents. RESULTS: The first bowel substitution GAV was performed in 1942 by Charles Wolf of Switzerland, predating the bowel substitution GAV performed by Colin Markland in 1978 which was previously thought to be the first. It was thought that the first peritoneal flap vaginoplasty was performed by M. I. Ksido in 1933 in cisgender women with vaginal atresia. We showed that Dmitry Oskarovich Ott performed it first, sometime before 1912 in cisgender women. It was known that John Brown first described the modern pedicled clitoroplasty for transgender patients in 1976. We showed that Barinka invented the technique for intersex patients in 1968. It was known that Harold Delf Gillies first described the penile inversion vaginoplasty for transgender patients in 1952. We showed that J. Riddle Goffe invented the technique for intersex patients in 1903. CONCLUSIONS: As we enter a new age of transgender surgery where more surgeons are seeking specialty training in GAV, the history of GAV technique is especially important. Following our inquiry several important updates have been made to the known history of GAV technique. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e215 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Zilavy More articles by this author Richard Santucci More articles by this author Maxx Gallegos More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-18 MAXIMIZING BUCCAL GRAFT HARVEST LENGTH USING THE V-MAXX TECHNIQUE Jordan Foreman and Maxx Gallegos Jordan ForemanJordan Foreman More articles by this author and Maxx GallegosMaxx Gallegos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A hurdle encountered during urethral reconstruction of long length strictures is the amount of substitution graft needed. Often buccal mucosa, lingual, and/or contralateral buccal mucosal are used. The objective of this study is to describe a novel technique to harvest buccal mucosal graft currently used at our institution for long length urethral strictures. METHODS: A retrospective review was performed looking at patients undergoing buccal substitution urethroplasty for long length urethral strictures using the V-Maxx technique for buccal harvest. The stretched length harvest was measured and comparable to the length of graft needed for urethroplasty. RESULTS: A retrospective review was performed identifying 10 patients who the V-Maxx technique was used. The pre-incision stretched graft length using a classical linear harvest, the pre-incision stretched V-Maxx length, and the post harvest V-Maxx graft length were all measured. On average, patients had 30% longer pre incision stretched grafts able to be harvested with the V-Maxx technique. The average post harvest V-Maxx graft length was 10cm long. All graft harvest sites were able to be closed. CONCLUSIONS: This study describes a novel technique to harvest buccal mucosal graft allowing for use of a single side buccal graft for strictures up to 12cm in length. With this technique morbidity can be decreased with only a single site of harvest. Future studies will include patient/clinical outcomes after urethroplasty with V-Maxx buccal harvest. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e975-e976 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jordan Foreman More articles by this author Maxx Gallegos More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVES: Recent studies have identified a rising utilization of urethroplasty relative to endoscopic interventions for management of urethral strictures.We hypothesized that this is, in part, due to increased exposure of recent graduates to urethroplasty techniques during residency.The aim of this study was to evaluate trends in urethral reconstruction exposure during residency training over time.METHODS: The Accreditation Council for Graduate Medical Education (ACGME) case logs for graduating chief residents were obtained and reviewed for those completing residency between 2010 and 2017.Male urethral cases logged as the primary surgeon, as well as those logged in any role, were evaluated during the study period.Male penis/incontinence cases were analyzed for comparison.Linear regression models were fit to determine association of graduation year and number of procedures performed.RESULTS: Review of available case log data revealed that graduating chief residents performed a mean of 13.9 AE 10.3 urethral procedures as surgeon and 16.1 AE 11 urethral procedures in any role during residency.Over the study period, there was a significant increase in the number of urethral surgeries logged as both primary surgeon (þ32.5%,R 2 [0.841, p[0.001), as well as in any role (þ39.7%,R 2 [0.885, p[0.0005).No significant changes in case logs were identified for penile or male urinary incontinence reconstructive procedures over the same time period.A significant increase was similarly noted in number of cases logged corresponding to the 50th, 70th and 90th percentiles (all p<0.01).The number of cases corresponding to the 10th percentile, however, remained stable with the number of mean logged procedures constant between 4 and 5.As such, the training gap between the lowest decile and all others widened over the study period.CONCLUSIONS: Exposure to urethral reconstruction during residency training appears to be rising.This increased experience may in part explain the higher utilization of urethroplasty identified within the community.However, increases in urethroplasty exposure appear to be disproportionately benefiting high-volume practices, such that significant disparities in resident training and potential preparedness for urethral reconstruction once in practice persist.

OBJECTIVES:To describe our buried penis repair technique that includes penile release, tissue resection, wound closure, and penile reconstruction.PATIENTS AND METHODS:In all, 73 patients were treated from 2007 to 2017. Patients can be categorised into five stages: Stage I, involves only a phimotic band; Stage 2, required excision of diseased penile skin with split-thickness skin grafting (STSG); Stage 3, requires scrotal excision; Stage 4, requires escutcheonectomy; and Stage 5, requires panniculectomy. Successful treatment hinges on adequate excision of diseased skin and de-bulking followed by replacement of deficient skin with STSG.RESULTS:In all, 36 of 73 (49%) patients had Stage 1-3 disease, whilst 37 of 73 (51%) were Stage 4-5. There were complications within the first 30 days in 44 of 73 (60%) patients. In all, 62 of 73 (85%) patients either had no complications or Clavien-Dindo grade I-II complications and nine (12%) had complications beyond 30 days. Only five of 36 (14%) patients with Stage 1-3 disease had complications. One patient developed recurrent phimosis.CONCLUSION:The buried penis is a challenging surgical entity where conservative treatment will most likely lead to failure. Surgery is the only means for a lasting cure in these patients and should be used as a first-line treatment. One should expect complications postoperatively, especially within the first 30 days; however, these are mostly limited to Clavien-Dindo grade I-II complications.

INTRODUCTION AND OBJECTIVES: Payers are increasingly focusing on preventable complications and hospital readmissions as they seek greater value for healthcare dollars.Many renal cancer patients are older, have multiple comorbidities, and are at increased risk for such complications.Measures of patient frailty have been validated in other fields as useful tools that simply and objectively identify patients at risk for complications and readmissions.This study evaluated the predictive value of a frailty index in identifying renal cancer patients at risk for postoperative Clavien III, IV or V complications.METHODS: We identified all patients diagnosed with renal cancer after undergoing open or minimally invasive radical or partial nephrectomy between 2005 and 2013 in the National Surgical Quality Improvement Program database.The modified frailty index (mFI) was calculated for each patient by scoring the presence /absence of comorbid conditions (Table 1).Univariate and multivariable regression analyses were performed to determine whether mFI and other clinical variables could independently predict serious complications.RESULTS: N¼11,755 patients underwent renal cancer surgery and 35.4% had mFI score ¼ 0, 52.5% had mFI¼1, 9.1% had mFI¼2, 2% had mFI¼3, and 0.7% had mFI4.Univariate analysis showed that higher mFI scores were associated with four-fold increased risk of sustaining a Clavien III, IV or V complication (p<0.0001).Higher mFI also predicted for suffering more than one of the 12 measured Clavien 3 complications (p <0.0001).Multivariable regression (Table 2) showed that patients with a frailty index of 1, 2, 3 and 4 had a monotonically increasing odds of suffering a Clavien 3 complication.Prolonged OR time, lower preoperative serum albumin and older age also predicted for increased risk of serious complications and readmissions.CONCLUSIONS: The modified Frailty Index is a simple and objective measure that independently predicts Clavien 3 complications and readmissions in renal cancer patients undergoing open or minimally invasive surgery.

Urethral stricture/stenosis is a narrowing of the urethral lumen. These conditions greatly impact the health and quality of life of patients. Management of urethral strictures/stenosis is complex and requires careful evaluation. The treatment options for urethral stricture vary in their success rates. Urethral dilation and internal urethrotomy are the most commonly performed procedures but carry the lowest chance for long-term success (0–9%). Urethroplasty has a much higher chance of success (85–90%) and is considered the gold-standard treatment. The most common urethroplasty techniques are excision and primary anastomosis and graft onlay urethroplasty. Anastomotic urethroplasty and graft urethroplasty have similar long-term success rates, although long-term data have yet to confirm equal efficacy. Anastomotic urethroplasty may have higher rates of sexual dysfunction. Posterior urethral stenosis is typically caused by previous urologic surgery. It is treated endoscopically with radial incisions. The use of mitomycin C may decrease recurrence. An exciting area of research is tissue engineering and scar modulation to augment stricture treatment. These include the use of acellular matrices or tissue-engineered buccal mucosa to produce grafting material for urethroplasty. Other experimental strategies aim to prevent scar formation altogether.

You have accessJournal of UrologyMale Voiding Dysfunction and Infection1 Apr 2013V410 TIPS FOR PRESERVING PUDENDAL NERVE INNERVATION TO THE MALE URINARY SPHINCTER DURING PELVIC SURGERY Satyan Shah, Trisha Fleet, Maxx Gallegos, and Betty Skipper Satyan ShahSatyan Shah Albuquerque, NM More articles by this author , Trisha FleetTrisha Fleet Albuquerque, NM More articles by this author , Maxx GallegosMaxx Gallegos Albuquerque, NM More articles by this author , and Betty SkipperBetty Skipper Albuquerque, NM More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1799AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The urinary rhabdosphincter is innervated by branches of the pudendal nerve, but the anatomic course of these nerves is underappreciated. We provide tips on how to identify and preserve these “continence nerves” during pelvic surgery. METHODS Video clips from 7 robotic-assisted radical prostatectomies show keys to successful preservation of pudendal nerve branches to the urinary sphincter: 1) close inspection of the lateral surface of the prostate after opening the endopelvic fascia 2) nerve mobilization outside the layers of periprostatic fascia, prior to potency-nerve sparing 3) identification of associated “worm-like” vasculature and 4) contralateral traction on the lateral surface of the prostate. Because the continence nerves are lateral to the cavernous nerves, a potency-nerve sparing procedure will often result in preservation these “continence nerves”, without formal mobilization. However, the techniques demonstrated in this video are particularly important when the potency nerves are to be widely excised. RESULTS Prospective identification of the continence nerves began with case 87 of our robotic prostatectomy program. Of the 89 subsequent cases through March 2012, the continence nerve(s) were identified and preserved in 50 (56%). Kaplan-Meier analysis showed no difference in the time to recovery of continence, regardless of whether or not the continence nerve(s) had been identified (log rank test, p=0.90). CONCLUSIONS We demonstrate techniques to preserve pudendal nerve innervation responsible for urinary continence. Preservation of these branches may be particularly valuable when the potency nerves are to be widely excised. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e166 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Satyan Shah Albuquerque, NM More articles by this author Trisha Fleet Albuquerque, NM More articles by this author Maxx Gallegos Albuquerque, NM More articles by this author Betty Skipper Albuquerque, NM More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...