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We aimed to evaluate the feasibility and long‐term functional outcomes of surgical correction of adult buried penis patients due to complications of childhood circumcision. A retrospective analysis was performed for patients who underwent treatment for buried penis between 1997 and 2019. An autologous split‐thickness skin graft (STSG) was used. Surgical management steps included circumcision, resection of the bands between the corpora and other tissues, harvesting of STSG from femoral region and graft application. Surgical and functional outcomes were the primary end points. Thirteen patients were included with a mean age of 22.4 years and median body mass index 27. Patients had similar symptoms, including sexual dysfunction, inadequate penile length, impossible penetration and decreased quality of life. No early post‐operative complication was seen. During a median of 44‐month follow‐up, post‐operative long‐term complications were seen in 4 (30%) patients: decreased graft sensation (n = 2); graft contracture five months after surgery (n = 1); and retarded ejaculation (n = 1). Patients' post‐operative three‐month International Index of Erectile Function (IIEF) score and sexual satisfaction score (SSS) significantly increased compared with patients' pre‐operative scores (IIEF; 22.8 vs. 14.1, p =.03, SSS; 8.7 vs. 3.2, p <.01). Buried penis is a rare but challenging condition. Patients had excellent graft acceptance with successful functional outcomes. [ABSTRACT FROM AUTHOR]

Objectives To compare optimum outcome achievement in open partial nephrectomy (OPN) with that in robot-assisted partial nephrectomy (RAPN). Patients and methods Using our institutional partial nephrectomy (PN) database, we reviewed 605 cases performed for unifocal clinical T1 renal masses in non-solitary kidneys between 2011 and 2015. Tetrafecta, which was defined as negative surgical margins, freedom from peri-operative complications, ≥80% renal function preservation, and no chronic kidney disease upstaging, was chosen as the composite optimum outcome. Factors associated with tetrafecta achievement were assessed using multivariable logistic regression, with adjustment for age, gender, race, Charlson comorbidity score, body mass index, chronic kidney disease, tumour size, tumour complexity and approach. Results The overall tetrafecta achievement rate was 38%. Negative margins, freedom from complications, and optimum functional preservation were achieved in 97.1%, 73.6% and 54.2% of cases, respectively. For T1a masses, the tetrafecta achievement rate was similar between approaches (P = 0.97), but for T1b masses, the robot-assisted approach achieved significantly higher tetrafecta rates (43.0% vs 21.3%; P < 0.01). On multivariable analysis, the robot-assisted approach had 2.6-fold higher odds of tetrafecta achievement than the open approach, primarily because of lower peri-operative morbidity, specifically related to wound complications. Positive surgical margin rates and renal function preservation were similar in the two approaches. Conclusions Optimum outcomes are readily achieved regardless of PN approach. The robot-assisted approach may facilitate optimum outcome achievement for 4-7-cm masses by minimizing wound complications. [ABSTRACT FROM AUTHOR]

Objectives To assess differences in complications after robot-assisted ( RAPN) and open partial nephrectomy ( OPN) among experienced surgeons. Patients and Methods We identified patients in our institutional review board-approved, prospectively maintained database who underwent OPN or RAPN for management of unifocal, T1a renal tumours at our institution between January 2011 and August 2015. The primary outcome measure was the rate of 30-day overall postoperative complications. Baseline patient factors, tumour characteristics and peri-operative factors, including approach, were evaluated to assess the risk of complications. Results Patients who underwent OPN were found to have a higher rate of overall complications (30.3% vs 18.2%; P = 0.038), with wound complications accounting for the majority of these events (11.8% vs 1.8%; P < 0.001). Multivariable logistic regression analysis showed the open approach to be an independent predictor of overall complications (odds ratio 1.58, 95% confidence interval 1.03-2.43; P = 0.035). Major limitations of the study include its retrospective design and potential lack of generalizability. Conclusions The open surgical approach predicts a higher rate of overall complications after partial nephrectomy for unifocal, T1a renal tumours. For experienced surgeons, the morbidity associated with nephron-sparing surgery may be incrementally improved using the robot-assisted approach. [ABSTRACT FROM AUTHOR]