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We aimed to understand the risks and benefits of post-inflatable penile prosthesis (IPP) implantation drainage and optimal duration. Our patients were divided into 3 groups: Group 1 (n = 114) had no drain placed, Group 2 had a drain placed for 24 h (n = 114) and Group 3 had a drain placed for 72 h (n = 117). Postoperative scrotal hematoma and prosthesis infection rates were compared between the groups. The patients from Group 3 demonstrated a statistically significant lower incidence of hematoma on the 10th postoperative day: (n = 1, 0.9%) compared to Group 2: (n = 11, 9.6%) and Group 1: (n = 8, 7%), (p = 0.013). However, on the 3rd postoperative day, there was a statistically significant lower incidence of hematoma in both Groups 3 and 2: (0.9% and 6.1%, respectively) vs. Group 1: (11.4%), (p = 0.004). Hematoma rates followed the same group order after the first day of surgery: 1.7% (n = 2), 5.3% (n = 6), and 8.8% (n = 10), respectively, (p = 0.05). Five patients (4.4%) in Group 1 and four patients (3.5%) in Group 2 developed an IPP associated infection, opposed to only a single patient (0.85%) in Group 3, (p = 0.210). We concluded that prolonged scrotal drainage for 72 h after virgin IPP implantation significantly reduces hematoma and infection rates.

Objective: To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons. Methods: Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups. Results: More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures. Conclusion: Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology. Level of evidence: Level IV

Aim of the study: To evaluate the clinical utility of abdominopelvic CT performed for oncological surveillance of patients that have undergone radical orchiectomy for Stage I seminoma in a tertiary referral hospital. Materials and methods: The histopathological reports of all patients that underwent orchiectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum testis tumor markers after orchiectomy were included. Follow-up shorter than 12 months was exclusion criteria. Demographic, pathological features and postoperative follow-up data were collected and reviewed with particular regard to abdominopelvic imaging. Results: Of the 133 patients who have undergone orchiectomy in our center, 55 had stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded because of follow-up shorter than 12 months. Mean follow-up was 63,2 months (IQR: 30–73). The results of 211 abdominopelvic CTs performed for surveillance purpose were reviewed. Two (3,7%) patients developed recurrence of the malignancy; in one the recurrence consisted of a scrotal lump and was diagnosed with ultrasonography (US), while in the second it was a paraaortic nodal metastasis diagnosed with abdominopelvic CT. The recurrence was treated successfully in both patients, that are both still alive. Of note, a single abdominopelvic CT were useful for the detections of relapse in our entire study population. No cancer specific death has been reported. Discussion: Follow-up schedules for stage I seminoma exposes patients to a potential risk of radiation-induced tumors, emotional distress and represent a significant burden for the healthcare system. A better risk adapted follow-up program is needed in order to offer tailored follow-up schedules and to avoid unnecessary investigations.

Aim of the Study: In male infertility, the current challenge is to properly reconcile new and old techniques taking into account costbenefit and scientific evidence for both. The aim of our work was to evaluate if microsurgical reconstruction of the seminal pathway in patients with proximal obstruction can still be considered an effective treatment for infertile men suffering from obstructive azoospermia in the light of new medically assisted procreation techniques. Materials and Methods: From 1995 to 2016, at the Urological Clinic of the University of Trieste and the University College London Hospital (UCLH), 242 patients with obstructive azoospermia underwent microsurgical treatment of recanalization of the seminal pathways. Among these patients, 161 patients underwent Vasoepididimostomy (EDV), 72 at vasovasostomy (VV) and 9 at VV + EDV. The average age was 41 (±7.9). Patients were subdivided according to the type of microsurgical reconstruction performed. Patients previously undergoing unsuccessful attempts at microsurgical reconstruction, patients with infertile or poorly motivated female partners to have a child and patients undergoing recanalization after retention pain vasectomy were excluded from the study. The primary objective of the study was to evaluate the rate of patency of the seminal pathways and the pregnancy rate. Results: In patients undergoing EDV and VV, the success rate in terms of patency of the anastomosis was 75% and 42%, respectively, while the pregnancy rate of 55% and 13%. The patency of the cumulative anastomosis was 48% (109/185) and the general pregnancy rate of 19% (30/161). In the 92 patients who underwent “vasectomy reversal” the mean time interval between vasectomy and microsurgical reconstruction (IT) was 12.2 years (SD: 12.2 ± 6.41; 1–27). In this category of patients the results were inversely proportional to the average time spent by vasectomy. Discussion: According to the literature, our results confirm that microsurgical reconstruction of the seminal pathways remains a valid therapeutic option with an excellent cost/benefit ratio in patients with obstructive azoospermia. The best results are in previously vasectomized patients and are inversely proportional to the time elapsed.

To review the current literature on early penile prosthesis implantation in patients with refractory ischemic priapism (IP).A systematic search for the terms "penile prosthesis", "priapism", "impotence", "fibrosis", "downsized prosthesis cylinders", and "patient satisfaction" has been carried out in PubMed, EMBASE, Cochrane, SCOPUS and Science Citation Index databases.Cavernosal tissue damage in IP is time related. Conservative measures and aspiration with or without intracorporeal instillation of α-adrenergic agonists are usually successful in the early stages. Shunt surgery in patients remains debatable, as the lack of response to aspiration and instillation of α-adrenergic agonists indicates that irreversible changes in the cavernosal smooth muscle are likely to have already occurred. Immediate penile prosthesis implantation in patients with refractory IP settles the priapic episode, maintains the long term rigidity necessary to engage in penetrative sexual intercourse and prevents the otherwise inevitable penile shortening. Although complication rates after penile prosthesis implantation in acute priapism are higher than in virgin cases, they are still lower than after implantation in patients with severe corporal fibrosis due to chronic priapism. Regardless of the complication rates, penile prosthesis implantation in refractory IP should be preferred as it allows the preservation of penile length, which is one of the main factors influencing postoperative patient's satisfaction following surgery.

Erectile dysfunction (ED) is a problem that may affect up to 52% of men aged between 40 and 70. In the era of type-5 phosphodiesterase (PDE5) inhibitors, the treatment of ED can be simple and effective after the correct diagnosis which is made in the majority of cases with history, examination and some basic laboratory tests.

Peyronie’s disease frequently presents as a painful curvature of the erect penis. Once stabilized, a proportion of patients will require a surgical intervention to correct the curvature. Reconstructive surgery should be considered separately in each patient as those with significant erectile dysfunction may be better suited to the implantation of a penile prosthesis, which will correct both the curvature and impaired erection. The erect penis usually is straightened after the prosthesis insertion, but in a minority of patients, some curvature remains. When this occurs, additional procedures will be necessary to straighten the penis by plaque incision (with or without grafting) or by the modeling technique. These additional techniques are necessary to improve patient satisfaction.