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Background Objectives Materials and methods Results Discussion Conclusions Intracavernosal injection therapy is often used as second‐line therapy for erectile dysfunction associated with radical prostatectomy when therapy with phosphodiesterase‐5 inhibitors has failed, but prostaglandin E1‐containing vasoactive agents are associated with penile pain in some men.To define the incidence of pain with prostaglandin E1‐containing intracavernosal injection mixtures for erectile dysfunction associated with radical prostatectomy when therapy with phosphodiesterase‐5 inhibitors has failed, and whether pain was a predictor of erectile function recovery.Men who underwent radical prostatectomy and were commenced on intracavernosal injection within 12 months of radical prostatectomy were included. A pain visual analog scale (0–10) was used to assess the degree of pain. Erectile function recovery was defined as the International Index of Erectile Function domain score ≥24 using phosphodiesterase‐5 inhibitors at 24 months.The study included 566 patients, mean age was 58 ± 14 (42–74) years. Duration post‐radical prostatectomy at intracavernosal injection training was 3.5 ± 3.5 m. Nerve sparing status: bilateral 76%, unilateral 13%, and non‐nerve sparing 11%. Incidence of pain with intracavernosal injection per nerve sparing status: bilateral 10% of patients, unilateral 32%, non‐nerve sparing 92% (p < 0.001). Median visual analog scale in those experiencing pain: bilateral 4 (interquartile range 3, 5), unilateral 5.5 (interquartile range 3, 6), non‐nerve sparing 7 (interquartile range 3, 9) (p < 0.001). Phosphodiesterase‐5 inhibitors success at 24 months (no pain vs. pain): bilateral 70% vs. 40% (p < 0.001), unilateral 50% vs. 28% (p < 0.001), non‐nerve sparing 10% vs. 0% (p < 0.001). On multivariate analysis, predictors of failure to respond to phosphodiesterase‐5 inhibitors at 24 months post‐radical prostatectomy included baseline erectile function, increasing age, incomplete nerve‐sparing surgery, and presence of pain.The presence of penile pain with intracavernosal injection is associated with poorer erectile function recovery post‐radical prostatectomy.Incidence of pain is high in men with non‐nerve sparing radical prostatectomy; older patient age, poorer nerve sparing, poor baseline erectile function, and the presence of penile pain with prostaglandin E1‐containing intracavernosal injection medication, were predictive of poor erectile function recovery using phosphodiesterase‐5 inhibitors at 24 months. [ABSTRACT FROM AUTHOR]

The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for stress urinary incontinence and is currently the gold standard. After 4 decades of existence, there is substantial experience with the AUS. Today AUS is most commonly placed for postprostatectomy stress urinary incontinence. Only a small proportion of urologists routinely place AUS. In a survey in 2005, only 4% of urologists were considered high-volume AUS implanters, performing >20 per year. Globally, ~11,500 AUSs are placed annually. Over 400 articles have been published regarding the outcomes of AUS, with a wide variance in success rates ranging from 61% to 100%. Generally speaking, the AUS has good long-term outcomes, with social continence rates of ~79% and high patient satisfaction usually between 80% and 90%. Despite good outcomes, a substantial proportion of patients, generally ~25%, will require revision surgery, with the rate of revision increasing with time. Complications requiring revision include infection, urethral atrophy, erosion, and mechanical failure. Most infections are gram-positive skin flora. Urethral atrophy and erosion lie on a spectrum resulting from the same problem, constant urethral compression. However, these two complications are managed differently. Mechanical failure is usually a late complication occurring on average later than infection, atrophy, or erosions. Various techniques may be used during revisions, including cuff relocation, downsizing, transcorporal cuff placement, or tandem cuff placement. Patient satisfaction does not appear to be affected by the need for revision as long as continence is restored. Additionally, AUS following prior sling surgery has comparable outcomes to primary AUS placement. Several new inventions are on the horizon, although none have been approved for use in the US at this point. [ABSTRACT FROM AUTHOR]

Background: Papillary cystadenoma is a rare benign neoplasm of the epididymis. It may occur sporadically or in association with von Hippel-Lindau disease (VHLD). Papillary cystadenoma of the epididymis (PCE) is a benign mimic of metastatic clear cell renal cell carcinoma (CCRCC) given their histologic similarities., Case Presentation: Herein, we present the case of a 40-year-old man with a four-year history of microhematuria and a recently detected right paratesticular mass. A testicular sonogram revealed a hypoechoic, hypervascular solid mass in the right epididymal head treated by surgical excision. Histopathological examination demonstrated a 1.1 cm papillary cystadenoma of the epididymis. Genetic testing performed later showed no signs of VHLD. However, heterozygous mutations in three genes - CASR , POT1 , and RAD51D - were found which have never been reported in PCE before., Conclusions: Papillary cystadenoma of the epididymis should always be considered in the differential diagnosis of epididymal lesions, especially those that are cystic. The mainstay of treatment remains surgical excision, which provides an excellent prognosis., Competing Interests: Conflict of interest: None, (Copyright © 2022 The Author(s).)