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Background: Radical prostatectomy (RP) is recommended for the treatment of men with clinically localised prostate cancer. However, RP is associated with a high incidence of erectile dysfunction (ED), which can impact the quality of life (QoL) significantly. Objective(s): To evaluate the effectiveness of end-to-side nerve grafting surgery to restore erectile function and improve sexual QoL in men with ED after RP. Design, setting, and participants: A retrospective review of a single-centre experience of nerve grafting in men with ED following RP was performed. Seventeen men had surgery between March 2015 and October 2017 in Melbourne, Australia, which fulfilled study inclusion and exclusion criteria. Intervention(s): Microsurgical bilateral end-to-side nerve grafts from a selective fascicular neurotomy of the femoral nerve to the penile corpora cavernosa. Outcome measurements and statistical analysis: Results were serially measured utilising the International Index of Erectile Function (IIEF-5) and the sexual domain of Expanded Prostate Cancer Index Composite (EPIC-26). The proportion and 95% confidence interval (CI) of men recovering sexual function following nerve grafting were determined. Results and limitations: All patients had ED following their RP. Median age at nerve grafting was 64 yr (interquartile range [IQR] 60-66 yr). Median time between nerve- and non-nerve-sparing RP, and nerve grafting was 2.4 (IQR 2.1-3.1) and 2.2 (IQR 1.7-5.1) yr, respectively. Median follow-up was 18 (IQR 15-24) mo. At 12 mo after nerve grafting, 71% (95% CI 44-90%) of patients had erectile function recovery sufficient for satisfactory sexual intercourse, and 94% (95% CI 71-99%) and 82% (95% CI 57-96%) had clinically significant improvements in sexual function and reduced bother, respectively. There were two minor wound infections. Limitations include the retrospective study design. Conclusion(s): End-to-side nerve grafting restored erectile function in 71% of men with ED following

Study Objective: The aim of the current study was to evaluate the effect that high BMI (>=30) had on the surgical outcomes of patients undergoing operative laparoscopy for endometriosis. Design(s): Retrospective Cohort Study. Setting(s): Monash Health hospitals in Melbourne, Australia. Patient(s): All patients who underwent surgical treatment of endometriosis between July 1st 2009 and June 31st 2016. Intervention(s): None. Measurements and Main Results: 831 patients were included. The median age of the patients was 33 years (15-64, SD 8.6). The average BMI in our patient population was 25.8 (13.1-52.1, SD 6). 163 patients had a BMI >=30 (19.6%). 668 patients had a BMI <30 (80.4%). We did not find a significant impact of BMI on the stage of endometriosis in our study population. The main indication for surgery in both groups was pain (BMI >=30: 83.4%, BMI <30: 82.9%). Obese patients had more chronic pain (13.5% vs 8.4%, p = .04). Low BMI patients had infertility as a more frequent indication for surgery than obese patients (20.98% vs 14.11%, p = .04). Both groups had similar complication rates (4.9% for obese patients vs 3.14%). Obese patients had an increased conversion to laparotomy rate (3.06% vs 1.6%), however, this was not statistically significant (p = .1). We also did not find a difference in operating time between the two groups. Length of stay was not significantly longer for patients with BMI >=30 compared to BMI <30 (1.4 vs 1.5 days, p = .2). Conclusion(s): In this study we found that there was no difference in operating time or complication rates in women with BMI >=30. These findings suggest that when advanced laparoscopic surgery for endometriosis is performed in a unit with a high volume of obese patients, the complication rate is comparable to those with a BMI <30.

Study Objective: The objective of this study was to assess the surgical outcomes and complication rates of endometriosis related surgery over an 8-year period. Design(s): This was a retrospective study following women who underwent endometriosis surgery at Monash Health in Melbourne, Australia between the years of 2009 and 2016. Follow up data was collected to evaluate success of surgery based on reporting of pain and repeat surgeries. Setting(s): This Study was conducted in a Multicenter study conducted in a large tertiary health network in Melbourne Australia. Patient(s): 3034 patients presented with endometriosis to Monash Health during this time period. Of these 2150 patients underwent surgical treatment, 974 patients had sufficient data in their computerised records and were included in the analysis. Intervention(s): Laparoscopic Surgery for diagnosis and treatment of endometriosis. Measurements and Main Results: 658 (67.4%) of patients had stage 1 or 2 endometriosis and 316 (32.4%) had stage 3 or 4 endometriosis. In regards to surgical outcomes, conversion to laparotomy (14 vs 6 p = 0.001), complication rate (25 vs 11 p < 0.001), average time to discharge (1.9 vs 1.3 days p < 0.001) and average operating time for operative laparoscopies (126.1 vs 76.5 minutes p < 0.0001) were all significantly higher in the Stage 3 and 4 endometriosis group. Patients with Stage 3 and 4 endometriosis had significantly more symptom resolution or improvement following surgical treatment (141/186 vs 160/294 p = < 0.0001). Conclusion(s): The findings from this study reinforces that surgical treatment is effective for patients with severe endometriosis. Complication rates, operating time and length of stay in this series of patients were related to the severity of the endometriosis.