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Objective To investigate the safety of daily coadministration of α-blockers with tadalafil 5 mg in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. The standard-of-care medical therapy for moderate to severe symptoms of benign prostatic hyperplasia is α 1 -adrenergic antagonist (α-blocker) therapy. Methods Men aged ≥ 45 years receiving stable α-blocker therapy were evaluated for eligibility before a 2-week single-blind, placebo lead-in period. Subsequently, 318 men were randomized to tadalafil 5 mg or placebo once daily for 12 weeks. Enrollment was monitored to ensure inclusion of men ≥75 years old and men taking nonuroselective α-blockers. The primary objective was to compare the proportion of men reporting treatment-emergent dizziness between the 2 treatment groups. Orthostatic vital signs, general safety, and the International Prostate Symptom Score were also assessed. Results The proportion of patients who reported treatment-emergent dizziness was not significantly different between the 2 treatment groups (tadalafil 7.0%; placebo 5.7%; P = .403). No difference between treatment groups was observed with respect to patients meeting the criteria for a positive orthostatic test (30 per treatment group, P = 1.00). The incidence of discontinuations was low among both treatment groups. Conclusion Recognizing the limitations of the present study, the changes in the hemodynamic signs and symptoms were similar for the tadalafil and placebo groups in men with benign prostatic hyperplasia receiving concomitant α-blocker therapy. However, consistent with the results of previous clinical pharmacology studies of healthy subjects, a trend was seen for increased hemodynamic signs and symptoms in men taking nonuroselective α-blockers, most notably those taking doxazosin.

Robot-assisted radical prostatectomy (RARP) has been performed in Rochester, NY, since 2003. Currently, 10 area urologists perform RARP, and robotic training has become an important component of the residency. We present data describing the timeline for adoption, both in clinical practice and in the residency program.We reviewed the operating logs for all surgeons who were performing prostatectomies in all hospitals in Rochester, NY, from 2003 to 2007. We examined the influence RARP had on other treatments, including brachytherapy and cryotherapy. Surgical logs of graduating chief residents were also reviewed.Eleven surgeons in Rochester regularly perform radical prostatectomy (10 perform primarily RARP, one performs only open prostatectomy). Three of the city's four hospitals have robotic systems. In 2003-2004, there were 30 open prostatectomies performed monthly and fewer than 10 performed robotically. By 2006, the trend was reversed, with 50 robot-assisted prostatectomies performed each month and fewer than 10 open prostatectomies (P0.05). The rate of brachytherapy fluctuated, increasing in centers without a robot. The number of open prostatectomies in centers without a robot dropped significantly to fewer than 10 cases per year. There was also a significant decrease in the number of open prostatectomies performed by chief residents.Since the introduction of surgical robotics, significant changes have been seen. The volume of radical prostatectomies performed by surgeons at institutions with robotics has increased; the volume at robot-free institutions has become nominal. There is a trend toward increased radiation therapy at robot-free institutions. While radical prostatectomies logged by graduating chief residents have increased, open prostatectomy experience is now minimal.

We present 5 cases involving reinsertion of an artificial urinary sphincter after either erosion or infection. All 5 patients now have socially acceptable urinary continence.

Objectives To assess the efficacy and safety of the double-cuff artificial urinary sphincter over a long-term period. Methods Ninety-five patient charts were reviewed from December 1986 to November 1995. Data on the degree of urinary incontinence and complications were compiled and tabulated. Results There were 10 cuff erosions (10.5%) and one infection (1.1 %) requiring removal of the double-cuff system, with one death from unrelated causes. Two patients in the erosion group had a double-cuff system reinserted at a later date. Eighty-six patients have a double-cuff system, with 97.6% remaining dry. Conclusions A tandemly placed double-cuff artificial urinary sphincter is safe and effective in the treatment of severe postprostatectomy urinary incontinence.

Fracture of the penis is a relatively uncommon form of urologic trauma. Wereport an unusual case of rupture of both corpora cavernosa associated with partial disruption of the urethra. The patient underwent surgical repair using a Foley catheter as a urethral stent. The patient experienced excellent results with preservation of all functions.

Purpose: We reviewed our series of patients with an AMS700 Ultrex* penile prosthesis whose erectile deformities were corrected by replacement with AMS700CX cylinders.American Medical Systems, Minnetonka, Minnesota.Materials and Methods: Ultrex cylinders were replaced by AMS700CX cylinders in 7 men with erectile deformities.Results: Deformities were corrected successfully in all 7 patients. The penis is completely straight in 6 patients, while a mild 30-degree ventral curvature is present in 1.Conclusions: Erectile deformities with the AMS700 Ultrex penile prosthesis can be repaired successfully by replacement with the AMS700CX cylinders.

We report the first 3 cases of femoral nerve neuropathy after a psoas hitch vesicopexy, a technique commonly used with ureteroneocystostomy. The condition in 2 patients resolved with conservative therapy, and the third patient required reoperation with removal of an offending suture. All 3 patients recovered completely with no residual neurologic deficit. Urologists who use the psoas hitch must be familiar with this potential complication to prevent its occurrence.

Purpose: We reviewed the erosion rate of the double cuff artificial urinary sphincter.Materials and Methods: Charts of 95 patients were evaluated for erosions and underlying etiology.Results: Ten patients had erosion of the cuffs, for an erosion rate of 10.5 percent. Of the 10 erosions 4 (40 percent) were secondary to iatrogenic injuries.Conclusions: Addition of a second cuff to the artificial urinary sphincter remains a safe alternative for patients with severe urinary stress incontinence.