Erectile dysfunction is a prevalent condition that may impact psychosocial health and quality of life. While various treatment modalities exist, penile prosthesis implantation offers a permanent solution. Surgery, however, carries inherent risks and potential complications. The aim of this study was to determine the incidence and risk factors of early postoperative complications after penile prosthesis surgery in a large, multicenter, prospective, cohort study. Data was analyzed from patients participating in the PHOENIX registry, an international study on penile prosthesis surgery conducted by the EAU Research Foundation. Patients were operated on from November 2021 until august 2024 in 30 centers from 8 countries. Our study was not limited to one device or brand, all available inflatable and malleable devices were eligible for inclusion. Postoperative complications were registered at different time points, up to 2 years post-surgery. For this analysis we studied complications that occurred within 2 weeks after surgery. Data on early complications after penile prosthesis surgery of 1072 patients were analyzed. Median age was 62 (range 24–88) years old at time of surgery. A total of 639 (59.6

INTRODUCTION:Renal trauma is the most common of urological trauma and accounts for up to 5% of all. The AAST scale is the most widely used to assess renal trauma. This study focuses on high-grade trauma, whose treatment has evolved towards a conservative approach, with techniques such as angioembolization. The aim is to describe the evolution in the management of high-grade renal trauma in all patients treated at La Paz University Hospital from 2001 to 2022. METHODS:A descriptive retrospective study was conducted on patients treated at the hospital. The study was divided into two periods (2001-2010 and 2011-2022). A total of 285 patients with renal trauma were collected, of which 54 were high grade. The main variable is the type of management, conservative (embolization) or interventional through nephrectomy. RESULTS:In the completed series, there was a decrease in radical nephrectomy in high-grade renal trauma from 50% to 13.8% over time, with an increase in embolization from 23,1% to 44,8%. In patients with isolated renal trauma, those treated with embolization increased from 28.6% to 69.2%, while those undergoing radical/partial nephrectomy decreased from 42.8% to 7.69%. CONCLUSION:The management of renal trauma has evolved over the years in our center. The number of patients treated by embolization has increased, while the number of complications and nephrectomies has decreased.

Introducción: El traumatismo renal es más común dentro de los urológicos y representa hasta un 5%. La escala de AAST es la más utilizada para valorarlo. Este trabajo, se centra en los traumatismos de alto grado cuyo tratamiento ha evolucionado hacia el manejo conservador, utilizando técnicas como la angioembolización. Se busca describir la evolución en el manejo del traumatismo renal de alto grado en todos los pacientes tratados en el Hospital Universitario La Paz desde 2001 hasta 2022.

The management of hypospadias during the neonatal period should be carried out exclusively in specialized medical centers because of the potential dire complications that may arise. In this report, we present a case of a 22-year-old male who underwent thirteen unsuccessful surgical procedures for his penoscrotal hypospadias in various hospitals. The purpose of this case report is to describe the surgical correction of severe corporal fibrosis and penile curvature that ensued from the multiple failed hypospadias corrections. We implanted an extra cavernosal malleable penile prosthesis and reconstructed the tunica albuginea defect with surgical meshes used in hernia repairs.

You have accessJournal of UrologyCME1 Apr 2023MP51-01 COMPARING THE TREATMENT OF PATIENTS WITH AQUABEAM® AND HOLEP FOR BENIGN PROSTATE HYPERPLASIA Carlos Toribio-Vázquez, Ramon Cansino, Esaú Fernández-Pascual, Aritz Eguibar, Hector Ayllon, Pablo Solano-Heranz, Jose Ramon Perez-Carral, Juan Antonio Mainez, Alvaro Yebes, Andrea Rodriguez, Maria Alonso, and Luis Martinez-Piñeiro Carlos Toribio-VázquezCarlos Toribio-Vázquez More articles by this author , Ramon CansinoRamon Cansino More articles by this author , Esaú Fernández-PascualEsaú Fernández-Pascual More articles by this author , Aritz EguibarAritz Eguibar More articles by this author , Hector AyllonHector Ayllon More articles by this author , Pablo Solano-HeranzPablo Solano-Heranz More articles by this author , Jose Ramon Perez-CarralJose Ramon Perez-Carral More articles by this author , Juan Antonio MainezJuan Antonio Mainez More articles by this author , Alvaro YebesAlvaro Yebes More articles by this author , Andrea RodriguezAndrea Rodriguez More articles by this author , Maria AlonsoMaria Alonso More articles by this author , and Luis Martinez-PiñeiroLuis Martinez-Piñeiro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.01AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic prostatic hydroablation (AquaBeam®) is a novel technique for the surgical treatment of benign prostatic hyperplasia (BPH). The objective of this study is to compare perioperative morbidity and treatment efficacy of prostatic hydroablation and Holmium laser prostate enucleation (HoLEP). METHODS: A total of 202 patients were analysed (101 by AquaBeam® and 101 by HoLEP) were analysed. A propensity score matching system was generated to obtain comparable cases from the HoLEP database at our institution. Patients included for analysis had undergone surgery in our department from April 2016 to October 2021. The following parameters where analysed: surgical time, haemoglobin (Hb) loss, length of stay, variation in Q-max, PSA, International Prostate Symptoms Score (IPSS), change in IPSS and in IPSS QoL, sexual function measured by the International Index of Erectile Function-5 item (IIEF-5), presence of ejaculation and perioperative morbidity. Median follow up was 12 months (IQR 12-36). RESULTS: Preoperative parameters were comparable between both groups (including prostate size, p=0.548). The perioperative and follow-up variables are shown in the following Table. No major differences in intraoperative complications were observed between both groups. With regards to postoperative complications, 17.3% vs 20.5% presented early urinary incontinence (AquaBeam® vs. HoLEP; p=0.62). 5 patients in the AquaBeam® group and 1 patient treated with HoLEP required blood transfusion (p=0.02). 2 patients treated with HoLEP and 5 with AquaBeam® required reoperation due to haematuria (p=0.03). 1 rectal perforation occurred and 1 patient died after a pneumonic process in the AquaBeam® group. CONCLUSIONS: Hydroablation surgery is an effective technique for patients with benign prostate hyperplasia. It offers good functional results whilst allowing the preservation of ejaculation. AquaBeam® presents a longer hospital admission mainly due to haematuria. The data presented compare our initial experience and learning curve with AquaBeam® with a well-established HoLEP technique in our department. Therefore, it must be regarded as preliminary. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e692 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlos Toribio-Vázquez More articles by this author Ramon Cansino More articles by this author Esaú Fernández-Pascual More articles by this author Aritz Eguibar More articles by this author Hector Ayllon More articles by this author Pablo Solano-Heranz More articles by this author Jose Ramon Perez-Carral More articles by this author Juan Antonio Mainez More articles by this author Alvaro Yebes More articles by this author Andrea Rodriguez More articles by this author Maria Alonso More articles by this author Luis Martinez-Piñeiro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Los tumores malignos del tracto urinario están asociados a gran morbimortalidad siendo su prevalencia variable a nivel global. Recientemente el estudio IDENTIFY ha publicado resultados sobre la prevalencia del cáncer del tracto urinario a nivel internacional. Este estudio evalúa la prevalencia de cáncer dentro de la cohorte española del estudio IDENTIFY para determinar si los resultados publicados son extrapolables a nuestra población. Se realizó un análisis de los datos de la cohorte de pacientes españoles del estudio IDENTIFY. Se trata de una cohorte prospectiva de pacientes derivados al hospital con sospecha de cáncer, predominantemente por hematuria. Los pacientes fueron reclutados entre diciembre de 2017 y diciembre de 2018. En total 706 pacientes procedente de 9 centros españoles fueron analizados. Doscientos setenta y siete pacientes (39,2%) fueron diagnosticados de cáncer, 259 (36,7%) de cáncer vejiga, 10 (1,4%) de tracto urinario superior, 9 (1,2%) renal y 5 (0,7%) de próstata. El aumento de la edad (OR: 1,05; IC 95%: 1,03-1,06; p < 0,001), presencia de hematuria visible (OR: 2,19; IC 95%: 1,13-4,24; p = 0,02) y el hábito tabáquico (exfumadores: OR: 2,11; IC 95%: 1,30-3,40; p = 0,002; fumadores: OR: 2,36; IC 95%: 1,40-3,95; p = 0,001) se asocia con mayor probabilidad de cáncer vesical. Este estudio resalta el riesgo que existe en pacientes con HV y hábito tabáquico de presentar cáncer de vejiga. El cáncer de vejiga presentó la mayor prevalencia, siendo esta mayor que la expuesta en series previas y la presentada en el estudio IDENTIFY. Trabajos futuros deben evaluar otros factores asociados que permitan crear modelos de predicción de cáncer para seguir aumentando la detección de estos en nuestros pacientes. Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population. An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018. A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR: 1.05; 95% CI: 1.03-1.06; P<.001), visible hematuria (VH) OR: 2.19; 95% CI: 1.13-4.24; P=.02)and smoking (ex-smokers: OR: 2.11; 95% CI: 1.30-3.40; P=.002); (smokers: OR: 2.36; 95% CI: 1.40-3.95; P=.001) were associated with higher probability of bladder cancer. This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients.

INTRODUCTION:Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population. PATIENTS AND METHODS:An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018. RESULTS:A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR 1.05 (95% CI 1.03-1.06; P < 0.001)), visible hematuria (VH) OR 2.19 (95% CI 1.13-4.24; P = 0.02)) and smoking (ex-smokers: OR 2.11(95% CI 1.30-3.40; P = 0.002); smokers: OR 2.36 (95% CI 1.40-3.95; P = 0.001)) were associated with higher probability of bladder cancer. CONCLUSION:This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients.

INTRODUCTION:The increased incidenceof diagnosis of kidney tumours has driveninvestigation in the area. It is known that the risk ofmalignancy is correlated with tumour size, but thereare still no specific and objective parameters to characterizethe degree of aggressiveness and to be ableto guide a treatment reliably. OBJECTIVE: To identify the relationship betweenrenal tumour size and the incidence of tumour aggressivecharacteristics.PATIENTS AND METHODS:A retrospective analysisof our series of renal cancers operated between 1998and 2018 was performed. The specific and cumulativeincidence of aggressive characteristics was studied.The following where considered as aggressive characteristics:Presence of sarcomatoid or epidermoiddifferentiation, tumour necrosis, stage pT3-4, histologicalhigh grade (3-4) and the presence of histologicalaggressive variants.RESULTS:A total of 651 patients that had undergonerenal mass surgery were analysed. In tumours below2 cm the appearance of aggressive characteristicsoccurred in less than 5%. For renal masses greaterthan 2 cm, each centimetre increase correlated with arise in cumulative incidence of 2-3% for each characteristicstudied.CONCLUSIONS:In tumours below 2cm and patientswith significant comorbidities active surveillance maybe a reliable alternative to surgery.

La fractura de pene (FP) es una urgencia urológica con baja incidencia, por lo que existe poca evidencia de los resultados a largo plazo. Este estudio se centra en las complicaciones postoperatorias y los resultados funcionales a largo plazo en pacientes que han sufrido una FP reparada quirúrgicamente en nuestro centro.Los registros clínicos de pacientes sometidos a cirugía urgente por FP en un hospital de tercer nivel entre 2006 y 2020 se revisaron retrospectivamente. Los resultados funcionales se evaluaron con visitas telefónicas voluntarias desde junio del 2020 a febrero del 2021. Se realizó un cribado de sintomatología del tracto urinario inferior mediante el cuestionario IPSS, de función sexual mediante el EHS y el IIEF-5, y de alteraciones morfológicas mediante pregunta directa a los pacientes.Cuarenta y un pacientes fueron sometidos a cirugía por FP; 11 de ellos además asociaron lesión uretral (mayor incidencia si había lesión de ambos cuerpos cavernosos, 19,4 vs. 80%, p < 0,05). Solo un paciente presentó una complicación Clavien-Dindo tipo 3a por dehiscencia de la herida, 4 (13%) tipo 2 y 9 (29%) tipo 1. Realizaron seguimiento a largo plazo 24 pacientes, de los cuales 20 (83,3%) presentaban una función sexual normal. Doce (50%) presentaban un nódulo palpable en la zona de la fractura, 8 (33,3%) curvatura peneana de nueva aparición y un paciente con lesión uretral previa presentó estenosis de uretra.En la fractura de pene, hay más incidencia de lesión uretral si se afectan ambos cuerpos cavernosos. Las secuelas funcionales a largo plazo tras la reparación quirúrgica de una FP son poco frecuentes.Penile fracture (PF) is a urological emergency with low incidence, and evidence of its long-term outcomes is scarce. This study focuses on postoperative complications and long-term functional outcomes in patients with PF and surgical repair at our center.Clinical records of patients undergoing urgent surgery for PF at a third level hospital between 2006 and 2020 were retrospectively reviewed. Functional outcomes were assessed with voluntary telephone interviews from June 2020 to February 2021. Lower urinary tract symptoms were screened by IPSS questionnaire, sexual function by EHS and IIEF-5, and morphological alterations by direct questions to patients.A total of 41 patients underwent surgery for PF. Eleven of them also had urethral injury (higher incidence if there was bilateral corpora cavernosa injury, 19.4 vs. 80%, P < .05). Only one patient presented a Clavien-Dindo type 3a complication due to wound dehiscence, 4 (13%) type 2 and 9 (29%) type 1. Twenty-four patients underwent long-term follow-up, of whom 20 (83.3%) presented normal sexual function. Twelve patients (50%) had a palpable nodule at the fracture site, 8 (33.3%) had new onset penile curvature and one patient with previous urethral injury presented urethral stricture.In cases of penile fracture, there is a higher incidence of urethral injury if both corpora cavernosa are affected. Long-term functional sequelae after surgical repair of a PF are rare.

Purpose of the Review Genital mutilation in males can range from minor injuries (cuts from a blade) to severe urological emergencies (testicular or penile amputation). Due to the rarity of these events, there is a lack of extensive reports, as most of the available literature is regarding single cases. Genital mutilation has been associated with psychotic and non-psychotic causes, psychiatric conditions, drug consumption, sexual practices, or even cultural or religious beliefs. It is crucial to perform a psychiatric evaluation of these patients to obtain the best therapeutic approach. This manuscript serves as a review of the currently available knowledge regarding male genital mutilation. Recent Findings A great variety of reasons have been associated with genital mutilation. Previous authors have distinguished between those that present with a clear mental health precursor from cases with no psychotic background. Nevertheless, sometimes, it is difficult to make this distinction. Recently, reconstructive techniques for amputation cases have moved towards a microsurgical approach in order to improve outcomes. A holistic therapeutic approach must be performed to increase the chances of effective treatment. Close collaboration between urologists, psychiatrists, and emergency doctors is essential to ensure the best care for patients performing genital mutilation. Future publications must evaluate differences in treatment options and the impact that these have on the long-term well-being of patients undergoing genital self-mutilation.

OBJECTIVES: In recent years, there has been a rise concerning the research and development of focal prostate cancer therapies as a consequence of the high percentage of low-risk and localized prostate cancers. These focal therapies aim at preserving the gland in selected patients to avoid overtreatment. The application of lasers for focal ablation and photodynamic therapy has shown promising results in exchange for a minimal rate of adverse events compared to radical treatments. MATERIAL AND METHODS: An extensive review of the available literature on focal laser treatments for localized prostate cancer was conducted. A search in PubMed and Embase was carried out by the following keywords: "Localised prostate cancer", "Low-risk prostate cancer", "Focal therapy", "Magnetic Resonance in localized prostate cancer", "Focal laser ablation" , "Photodynamic therapy" and "TOOKAD". RESULTS: Photodynamic therapy with TOOKAD is the only focal therapy evaluated in a phase III clinical trial, showing a lower rate of progression and a longer time to progression compared to active surveillance. Other studies carried out have revealed a percentage up to 80% of negative biopsies 6 months after TOOKAD. Likewise, the quality of life of patients treated using focal laser ablation techniques and photodynamic therapy has been minimally altered, as most adverse effects have been shown to be mild and transient, with dysuria and hematuria being the most frequent. CONCLUSIONS: Despite the fact that focal therapies are still not recommended outside the context of clinical trials and the lack of comparative studies between the different techniques, laser focal therapies seem to have a future within the new approaches for localized prostate cancer.

espanolLos farmacos anti CTLA-4, anti PD-L1 y antiPD-1 inhiben vias inhibidoras del sistema inmunitario, consiguiendo una vigilancia y eliminacion de celulas tumorales aumentada. El uso de terapias de regulacion inmune ha revolucionado el manejo de muchos canceres. Sin embargo, estos tratamientos tambien han traido una nueva serie de eventos adversos relacionados conel sistema inmune. OBJETIVO: Este articulo presenta una revision de los conocimientos disponibles sobre la clasificacion, incidencia, diagnostico y mantenimiento de los efectos adversos relacionados con el sistema inmune, de manera que pueda servir como una ayuda clinica para todos los medicos involucrados en las terapias inmunes. ADQUISICION DE EVIDENCIA: Realizamos una busqueda bibliografica exhaustiva de la literatura en ingles sobre articulos originales y de revision utilizando la base de datos Medline hasta junio de 2020, utilizando los terminos MeSH: “toxicidades del inhibidor del punto de control inmunitario” y “evento adverso relacionado con el sistema inmunitario”. CONCLUSIONES: En el futuro se debe investigar si el mayor riesgo de complicaciones ocasionado por las terapias inmunomoduladores de combinacion esta justificado por su mayor efecto terapeutico, debiendose igualmente identificar subgrupos de pacientes que mas pueden beneficiar. EnglishAnti CTLA-4, anti PD-L1 and anti PD-1 immune check point inhibitors (ICI) downregulate natural inhibitory pathways of the immune system, in turn increasing tumour surveillance and elimination. Cancer treatment through immune regulation has revolutionised many cancer therapies. However, these new treatments have also brought unique immune related adverse events (irAEs). OBJECTIVE: This paper presents a review of the available knowledge regarding irAE grading, incidence, diagnosis and management, serving as a clinical aid for all clinicians involved with ICI therapy. EVIDENCE ACQUISITION: A comprehensive English-language literature research of original and review articles in the Medline database until June 2020 has been carried out, using the MeSH terms: “immune check point inhibitor toxicities” and “immune related adverse event”. CONCLUSIONS: Further research should aim to investigate if the greater effect of combining ICI treatments is sufficient to justify the increased risk of complications, as well as to identify specific subgroups that will benefit the most from these.

Anti CTLA-4, anti PD-L1 and anti PD-1immune check point inhibitors (ICI) down regulate natural inhibitory pathways of the immune system, in turn increasing tumour surveillance and elimination. Cancer treatment through immune regulation has revolutionised many cancer therapies. However, these new treatments have also brought unique immune related adverse events (irAEs).OBJECTIVE:This paper presents a review of the available knowledge regarding irAE grading, incidence, diagnosis and management, serving as a clinical aid forall clinicians involved with ICI therapy.EVIDENCE ACQUISITION:A comprehensive English-language literature research of original and review articles in the Medline database until June 2020 has been carried out, using the MeSH terms: "immune checkpoint inhibitor toxicities" and "immune related adverseevent".CONCLUSIONS:Further research should aim to investigate if the greater effect of combining ICI treatments issufficient to justify the increased risk of complications, as well as to identify specific subgroups that will benefit the most from these.