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Objectives: To present our experience with immediate surgical treatment of penile fractures, using a midline ventral incision, as the choice of either immediate surgical or conservative treatment in penile fractures, as well as the type of surgical incision, remains controversial., Patients and Methods: In a period of 5 years (2002-2006) eight patients were treated in our department for a penile fracture. The diagnosis was established by a history and clinical examination. In six patients ultrasonography before surgery located the fracture in the right corpus cavernosum, distally from the penoscrotal junction. All patients had immediate surgery using a midline ventral incision and were followed for a mean of 1 year., Results: All patients presented with a penile haematoma, while five and two had concomitant scrotal and perineal haematomas, respectively. Penile urethral rupture was associated with corporal cavernosal rupture in one patient. In all patients a 5-cm midline ventral incision was made at the penile raphe. There was unilateral rupture of the corpus cavernosum in seven patients and bilateral rupture with concomitant urethral rupture in one. The fascial defect was sutured in all patients and an end-to-end anastomosis made if there was urethral rupture. The early and late periods after surgery were uneventful. Erectile function was unaffected during the follow-up., Conclusion: Immediate intervention for penile fractures, using a midline ventral incision, achieves good early and late results. Our technique has the advantage of direct access to both corpora cavernosa and the anterior urethra, with a minimal skin incision.

Objective: To assess the use of the Clavien classification system in documenting the complications related to open retropubic radical prostatectomy (RRP)., Patients and Methods: The medical records of 995 patients, who had open RRP during a period of 7 years, were reviewed retrospectively. Short- and long-term complications were classified according to the recently revised Clavien classification system. We also compared the results with a recently reported series of laparoscopic and robotic RRP., Results: The overall complication rate was 26.9%; Grade I, Id, II, IIIa, IIIb and V complications were recorded in 3.4%, 3.9%, 12.8%, 2.6%, 3.8% and 0.3% of cases, respectively. Rectal injuries (10) and postoperative wound infections (24) were included in the Grade I category. Anastomotic leakage was recorded in 39 patients and rated as Grade Id. Grade II included cases of deep vein thrombosis (11), urinary tract infections (42), lymphorrhoeas (22) and haemorrhage requiring transfusion (53). Anastomotic strictures (26) and incisional hernias (38) were included in Grade IIIa and IIIb, respectively. Pulmonary embolism was fatal for three patients (0.3%) of Grade IV and V., Conclusions: To avoid incoherence in reporting morbidity data, a reproducible and practical classification system is necessary. The Clavien system could provide, after refinement and validation, a common language among urologists.

Objective: To retrospectively evaluate the findings during re-exploration for obstructive ileus after radical cystectomy (RC) and ileal conduit diversion., Patients and Methods: During a 12-year period, 434 patients who had RC and ileal conduit diversion were retrospectively evaluated for the diagnosis of early (

Objective: To evaluate the effect on potency rates after surgery of applying local steroids to the neurovascular bundles (NVBs) of the prostate after bilateral nerve-sparing radical retropubic prostatectomy (BNS-RRP)., Patients and Methods: Sixty potent men undergoing BNS-RRP for clinically localized prostate cancer were prospectively randomized equally into two groups. In group 1, 10 mL of betamethasone cream 0.1% was applied locally to both NVBs, and group 2 had only the usual BNS-RRP with no corticoid cream. Complications and potency were evaluated at 3, 6 and 12 months in all patients and compared between the groups., Results: At 12 months, 57% and 60% of patients were potent in group 1 and 2, respectively; the respective mean International Index of Erectile Function (5-item) scores were 14.76 and 15.43 (P = 0.59). Potency rates at 3, 6 and 12 months were not significantly different between the groups, and the continence rates at 12 months were also similar, with 93% and 90% of patients in groups 1 and 2 being continent, respectively. Ten and five patients in groups 1 and 2, respectively, required a blood transfusion (P = 0.23). There were no fistulae, wound dehiscence or rectal perforations. One patient in group 2 presented 4 months after RRP with a bladder neck contracture., Conclusions: Local application of betamethasone does not improve or expedite the recovery of erectile function after BNS-RRP, but there were no complications associated with its use.

Objectives: To measure the quality-of-life (QoL) outcome and urinary and sexual function and bother after radical cystectomy and different types of urinary tract reconstruction (Bricker vs modified S-pouch neobladder), also assessing differences between them and a normal population., Patients, Subjects and Methods: Two groups of patients with bladder cancer were assessed; group 1 comprised 58 (mean age 65 years, mean follow-up 28 months) with an ileal conduit diversion, and group 2, 50 (mean age 61 years, mean follow-up 26 months) with a modified S-pouch neobladder. All were disease-free. Group 3 comprised 54 healthy subjects (a control population) of similar age, gender and comorbidities other than bladder cancer. A QoL questionnaire was used to study changes in QoL, and a specific questionnaire for urinary and sexual function and bother was also constructed., Results: There were no differences in the QoL scores among the three groups; group 3 (control) tended to have a better QoL for all domains except emotional functioning. Urinary function was seriously affected in group 1, with more daytime leakage than in groups 2 and 3 (37.8% vs 10%, P = 0.005, and 9.3%, P = 0.01), night loss of urine (39.5% vs 28%, P = 0.07, and 3.7%, P = 0.002) and urine odour (58.6% vs 4%, and 5.5%, both P = 0.001). Patients in group 2 differed from healthy individuals only in night loss of urine. Consequently urinary bother was more pronounced in group 1, as fewer were satisfied (68.9% vs 86% and 83.2%, both P = 0.03). Sexual function was seriously and similarly affected in groups 1 and 2; the erection rate was 28.9% for group 1, 35.5% for group 2 (P = 0.1) and 83.3% in group 3 (P = 0.003), while firm erections were present at 17.7%, 22.2% (P = 0.2) and 83.3% (P = 0.002). Women reported equivalent dysfunction in all three groups (15.4%, 20% and 16.6%, P = 0.3). Sexual desire was also equal in all groups (48.2%, 50% and 48.1). Patients in group 1 expressed more bother, while those in group 2 seemed more satisfied by their sexual life (84.4%, 68% and 68.5%, P = 0.04)., Conclusions: Radical cystectomy does not affect QoL whichever urinary reconstruction is used, and this implies a determination by the patients to live and adjust to their new conditions. On the contrary, urinary and sexual function are affected and related to the method used to reconstruct the urinary system.