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Resumen Introduccion y objetivos El objetivo de este estudio es evaluar las tasas de sobrevida global (OS), la sobrevida especifica del cancer (CSS), la sobrevida libre de recaida global (RFS), la sobrevida tiempo libre hasta la recaida local (LRFS) y la sobrevida tiempo libre hasta la recaida a distancia (DRFS), en los pacientes con carcinoma de celulas renales (CCR) pT3a considerando a la infiltracion de grasa (FI) perirrenal y/o sinusal como factores pronosticos. Materiales y metodos Cohorte retrospectiva de pacientes con CCR pT3a sometidos a cirugia. Los datos se extrajeron de la base de datos LARCG. Se evaluaron variables demograficas, clinicas, patologicas y quirurgicas. La FI se dividio en 4 grupos (vena, perirrenal, sinusal y ambas grasas). Se realizaron curvas de Kaplan-Meier y regresion de Cox. Resultados Se incluyeron 293 pacientes. La edad media fue de 61,4 anos. La mediana de seguimiento fue de 21 meses (r: 1-194). La CSS, la RFS, el LRFS y el DRFS estimadas a 3 anos en el grupo de ambas grasas infiltradas fueron 53,1, 45,1, 58,7 y 51,6 meses, respectivamente, en todos los casos estadisticamente inferiores al resto (p ˂ 0,005). En el analisis multivariable, la infiltracion de ambas grasas tuvo un aumento significativo de mortalidad especifica, recaida global y local con respecto a infiltracion de venas (HR: 4,5, 2,42 y 8,08, respectivamente). El grado de Fuhrman y la infiltracion de la pelvis renal fueron predictores independientes de la CSS y la RFS. Conclusiones La infiltracion de ambas grasas renales aumenta el riesgo de recaida global y local en pT3a RCC. Del mismo modo, se asocia con una menor sobrevida especifica del cancer, debiendo considerarse como un factor de mal pronostico.

Introduction and objectives The objective of this study is to evaluate overall survival (OS), cancer-specific survival (CSS), relapse-free survival, local and distant (LRFS and DRFS, respectively) rates in patients with pT3a renal cell carcinoma (RCC) considering the perirenal and/or sinus fat infiltration (FI) as prognostic factors. Materials and methods Retrospective cohort of patients with pT3a RCC who underwent radical or partial nephrectomy. The data were extracted from the LARCG (Latin American Renal Cancer Group) database. The demographic, clinical, pathological and surgical variables were evaluated. FI was divided into 4 groups (vein, perirenal, sinus and both fats infiltration). The Kaplan Meier and Cox regression curves were performed. Results 293 patients were included in the study. The mean age was 61.4 years. The median follow-up was 21 months (r: 1–194). CSS, RFS, LRFS and DRFS estimated at 3 years in the group of both fats’ infiltration were 53.1, 45.1, 58.7 and 51.6 months, respectively, and always statistically lower than the rest (p Conclusions Infiltration of both fats increases the risk of overall and local relapse in pT3a RCC. In the same way, it is associated with a lower cancer-specific survival and should be considered as a factor of poor prognosis.

To review the evidence regarding the current trends in surgical management of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombosis. Recent published series have shown the role of minimally invasive surgery in IVC thrombectomy. This review article evaluates the present RCC with venous extent literature to assess the role of open and minimally invasive surgery in this scenario. Robotic urological surgery has shown to have known benefits in radical prostatectomy, partial nephrectomy, and pyeloplasty. Recent published series showed feasibility of robotic IVC thrombectomy even for level IV cases. With growing number of robot-assisted and laparoscopic surgeries worldwide, there is a current tendency to treat this complex and challenging pathology with a minimally invasive approach, without compromising oncological outcomes.

PURPOSE To assess the effect of clinical and pathological variables on cancer-specific and overall survival (OS) in de novo metastatic patients from a collaborative of primarily Latin American countries. PATIENTS AND METHODS Of 4,060 patients with renal cell carcinoma diagnosed between 1990 and 2015, a total of 530 (14.5%) had metastasis at clinical presentation. Relationships between clinical and pathological parameters and treatment-related outcomes were analyzed by Cox regression and the log-rank method. RESULTS Of 530 patients, 184 (90.6%) had died of renal cell carcinoma. The median OS of the entire cohort was 24 months. American Society of Anesthesiology classification 3-4 (hazard ratio [HR]: 1.64), perirenal fat invasion (HR: 2.02), and ≥ 2 metastatic organ sites (HR: 2.19) were independent prognostic factors for 5-year OS in multivariable analyses. We created a risk group stratification with these variables: no adverse risk factors (favorable group), median OS not reached; one adverse factor (intermediate group), median OS 33 months (HR: 2.04); and two or three adverse factors (poor risk group), median OS 14 months (HR: 3.58). CONCLUSION Our study defines novel prognostic factors that are relevant to a Latin American cohort. With external validation, these easily discerned clinical variables can be used to offer prognostic information across low- and middle-income countries.

espanolAntecedentes: la incidencia del carcinoma de celulas renales (CCR) esta aumentando a nivel mundial debido al envejecimiento de la poblacion y al uso generalizado de estudios de imagenes. Objetivo: El objetivo de este estudio fue describir las caracteristicas y resultados perioperatorios de la cirugia de CCR en pacientes muy ancianos (PEV), ≥ 75 anos. Metodos: se trata de un estudio comparativo retrospectivo de 3656 pacientes que se sometieron al tratamiento por CCR entre 1990 y 2015 en 28 centros de ocho paises de America Latina. Comparamos las caracteristicas basales, asi como los resultados clinicos y perioperatorios segun los grupos de edad ( Resultados: Hubo 410 pacientes con PEV (11,2%). En el analisis bivariado, VEP tuvo un indice de masa corporal mas bajo (p 2 en 26.3% vs 12.4%, p estadio pT2 (OR 1,63, p = 0,04) se asociaron de forma independiente con complicaciones perioperatorias. Conclusiones: La reseccion quirurgica del CCR fue segura y exitosa en PEV. La edad ≥75 anos se asocio de forma independiente con complicaciones perioperatorias a los 30 dias. Sin embargo, la gran mayoria fueron complicaciones de bajo grado. La edad por si sola no debe orientar la toma de decisiones en estos pacientes, y el tratamiento debe adaptarse de acuerdo con el estado funcional y la gravedad de las comorbilidades. (REV INVEST CLIN.2020; 72 (5): 308-15) EnglishBackground: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups ( Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p 2 in 26.3% vs. 12.4%, p pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

Background: Tumor burden and metastatic disease sites are well-established prognostic factors in many malignancies, including metastatic Renal Cell Carcinoma (mRCC). Objective: We aimed to evaluate the impact of bone metastasis (BM) location on clinical outcome of mRCC patients. Methods: This study is a retrospective analysis of 4060 mRCC patients from the Latin American Renal Cancer Group (LARCG) database. Clinico-pathological characteristics, 24-months-survival, overall survival (OS), and BM sites were collected. To estimate the association between BM location and clinical outcomes we used Cox regression method. Results: Out of 4060 patients, 530 (14.5%) had metastatic disease. Among those, we analyzed the fifty-six that had only BM. The median follow-up was 20.8 months (range from 0 to 188 months). Non-spinal BM (NSBM) were identified in 33 (58.9%) patients and spinal BM (SBM) in 23 (41.1%) patients. Median OS was 35 months, and 24-months OS was 76% for patients with NSBM and 46% with SBM (HR: 2.22). In multivariable analysis SBM (HR: 3.08), ASA classification 3-4 (HR: 2.37), non-cc histology (HR: 5.11), and age (HR 1.06) were independent prognostic factors for OS. Conclusions: Our study showed that SBM predicted shorter OS, suggesting that the location of BM may impact the clinical outcome of patients with mRCC.

Resumen Introduccion El pene curvo congenito es una enfermedad relativamente rara, dada por una desviacion del pene en comparacion con el eje recto del cuerpo cuando se encuentra en ereccion. La prevalencia es dificil de determinar. Si bien indican que podria afectar hasta a un 10% de la poblacion masculina, la mayoria de estas desviaciones son menores, sin implicancia clinica ni psicologica, lo que determinaria el subdiagnostico. La correccion efectiva de la desviacion puede mejorar marcadamente la calidad de vida de estos adolescentes. Objetivo Evaluar la calidad sexual de los pacientes con diagnostico de pene curvo congenito a quienes se les realizo la correccion quirurgica. Materiales y metodos Diseno: estudio de cohortes retrospectivo, observacional. Se recabaron los datos de las historias clinicas de los pacientes a los que se les realizo la correccion quirurgica de pene curvo congenito entre junio del 2004 y agosto del 2016. A todos los pacientes se les efectuaron los siguientes cuestionarios autoadministrados: Sexual Quality of Life Questionnaire-Male (SQOL-M), International Index of Erectile Function 5 (IIEF 5) y «?Cuan satisfecho esta con los resultados de la cirugia? De «0 a 10». Resultados Se realizaron 22 corporoplastias para la correccion de pene curvo congenito. El promedio de edad de los pacientes fue de 23,4 anos (r 17-35). La media de grados de desviacion previo a la cirugia fue de 47,9° (r = 20-90°). El puntaje promedio tras responder el cuestionario SQOL-M fue de 52 puntos (r = 6-66). Los resultados al responder el IIEF 5 fue de 22,4 puntos. Conclusion El pene curvo congenito disminuye profundamente la calidad de vida y el tratamiento quirurgico temprano es fundamental para reparar la deformidad anatomica y, asi, restaurar significativamente el bienestar psicosocial y sexual de los pacientes.

Resumen Introduccion La cirugia de placa e injerto de pericardio bovino es una herramienta util en el tratamiento de la enfermedad de La Peyronie. Objetivo Determinar la satisfaccion de los pacientes tras la realizacion de esta cirugia. Materiales y metodos Estudio retrospectivo, observacional y descriptivo. Se recabaron los datos de las historias clinicas de los pacientes operados entre 2004 y 2015, y fueron evaluados mediante un cuestionario de satisfaccion postoperatoria. Resultados Se realizaron 28 cirugias. La correccion de la curva se logro en 26 pacientes (95,3%). Un paciente (3,57%) requirio correccion de la curva residual mediante tecnica de Yachia, y un paciente (3,57%) presento una complicacion grave consistente en infeccion protesica y fistula uretrocutanea. Veintiun pacientes (75%) se mostraron satisfechos con la cirugia. Conclusiones Nuestros resultados muestran un aceptable nivel de satisfaccion de nuestros pacientes con un bajo numero de complicaciones, aunque se necesitan mas trabajos, prospectivos, controlados y aleatorizados.

Objectives: To compare preoperative Charlson comorbidity Index (CCI) and postoperative complications after oncologic kidney surgery in patients aged 70 or older. To compare CCI and need for interdisciplinary evaluation, consults to the emergency department and need of readmission are secondary objectives. Patients and methods: This is a retrospective cohort study. Patients aged 70 or older who underwent partial or radical nephrectomy were collected from an institutional database. Period: February 2012–June 2014. Association between CCI and complications was estimated using Chi2. Results: Final population: 143 (male: 65%). Age median was 75. Minor postoperative complications were 33.88% (n = 41) for patients CCI ≤ 4 versus 9.09% (n = 2) for patients CCI > 4 (p > 0.05), and major postoperative complications were 9.91% (n = 12) versus 45.45% (n = 10), respectively (p 4 (p = 0.01). Readmission was needed for 9.09% (n = 11) and 40.1% (n = 11) respectively (p

Context The treatment of high-risk prostate cancer requires a multimodal approach to improve control of the disease. There is still no consensus as to the initial strategy of choice. The aim of this study is to review the results of radical prostatectomy as first step in management of patients with high-risk disease. Acquisition of evidence A search was conducted on PubMed of English and Spanish texts. We included those studies that reported the results of radical prostatectomy in patients with high-risk prostate cancer, as well as those that compared radical prostatectomy with other treatment alternatives. The last search was conducted in November 2015. Synthesis of the evidence The advantages of radical prostatectomy include a better pathological analysis, more accurate staging, better local control of the disease and better follow-up and adjuvant therapy strategies. When compared with external radiation therapy plus hormonal blockade, the patients who underwent prostatectomy had greater chances of healing and longer cancer-specific survival. The patients who most benefit from this approach are younger, have fewer comorbidities and no evidence of organ metastases. Conclusions The available scientific evidence to date is not without bias and confounders; however, they appear to favor radical prostatectomy as the initial approach of choice for high-risk prostate cancer.

Resumen Contexto El tratamiento del cancer de prostata de alto riesgo exige un abordaje multimodal para mejorar el control de la enfermedad. Todavia no hay consenso respecto de cual debe ser la estrategia inicial de eleccion. El objetivo de este trabajo es describir los resultados de la prostatectomia radical como primer paso terapeutico en el tratamiento de los pacientes de alto riesgo. Adquisicion de la evidencia Se realizo una busqueda en PubMed de textos en ingles y castellano. Se incluyeron aquellos trabajos que describian los resultados de la prostatectomia radical en pacientes con cancer de prostata de alto riesgo, asi como tambien aquellos que los comparaban con otras alternativas de tratamiento. La ultima busqueda se realizo en noviembre de 2015. Sintesis de la evidencia Las ventajas de la prostatectomia radical incluyen: mejor analisis patologico, estadificacion mas precisa, mejor control local de la enfermedad, mejor estrategia de seguimiento y adyuvancia. Al comparar con radioterapia externa mas bloqueo hormonal, los pacientes prostatectomizados presentan mayores oportunidades de curacion y mejor supervivencia cancer especifica. Los pacientes que mas se favorecen con este abordaje son los mas jovenes, con menos comorbilidades y sin evidencia de metastasis organica. Conclusiones La evidencia cientifica disponible hasta el momento no esta exenta de sesgos y confundidores, sin embargo impresiona favorecer la prostatectomia radical como abordaje inicial de eleccion en el cancer de prostata de alto riesgo.

Kidney cancers represent 2% of cancers worldwide; the most common type is renal clear cell carcinoma (RCC). Surgical treatment remains the only effective therapy for localized renal cell carcinoma. Approximately 20% to 38% of patients undergoing radical nephrectomy (RN) for localized RCC will have subsequent disease progression, with 0.8% to 3.6% of local recurrences within the ipsilateral retroperitoneum (RFR). The main objective of this study is to evaluate prognostic features, oncological outcomes, and current management for renal fossa recurrence in patients with history of RN for RCC.We retrospectively analyzed 733 patients who underwent open or laparoscopic RN for unilateral T1-T4 N0 M0 RCC between 2010 and 2016 at the Urology Department of Hospital Italiano de Buenos Aires.During the mentioned period, of a total of 733 RNs (open/laparoscopic), 561 patients with RCC were included in the study. After a median follow-up time of 24 months (12-36) (interquartile range), 21 (3.74%) patients out of 561, developed renal fossa recurrence. Of these, 13 (2.31%) patients were diagnosed with isolated local renal fossa recurrence and different treatment approaches were adopted; 11 patients underwent open surgical resection, 1 patient laparoscopic surgical resection, and 1 case was treated with cryoablation. Regarding cancer-specific survival, estimated 4-year cancer-specific survival in patients without RFR, with isolated RFR (iRFR) and not isolated RFR (niRFR) was 82.7% (CI 95% 70.2-95.2), 69.2% (IC 44.2-94.2) and 0%, respectively (log rank test P0.0001 being niRFR group different to others. Non isolated RFR was a death risk factor with a HR of 11.4 (4.8-27.2) compared with iRFR or no recurrence. Overall, 51% (IC 26.6-71.2) of patients with any RFR died at 4 years follow-up.Although RFR is a rare condition, in the absence of distant metastatic disease, aggressive surgical resection should be our aim. High pathological tumoral stage at original nephrectomy and high tumoral grade are independent risk factors for RFR. This group of patients needs closer follow-up to detect earlier recurrences and decide a treatment strategy.

Emphysematous cystitis is a rare type of urinary tract infection that is characterized by air pockets within the bladder wall and lumen, which come from gas that is mainly produced by gram-negative bacteria, notably Escherichia coli. This infection is more common in older women with poorly controlled diabetes. An abdominal computerized tomography (CT) scan is the gold standard method to make the diagnosis. The infection can be life-threatening, so prompt treatment is essential. We present a case of a 39-year-old woman with poorly controlled type 2 diabetes who developed emphysematous cystitis after a bilateral adrenalectomy. The infection was diagnosed by a CT scan that revealed gas in the bladder wall. A urine culture revealed 106 colonies/mL of Klebsiella pneumoniae. After a month of treatment with intravenous antibiotics (vancomycin plus meropenem plus colistin), bladder drainage, and strict glycemic control, the patient had a good outcome.

Purpose: To assess epidemiologic characteristics, clinical and pathologic patterns of presentation, and treatment strategies in a contemporary population with renal masses (RMs). Methods: The Clinical Research Office of the Endourological Society collected prospective epidemiologic, clinical, and pathologic data on consecutive patients with RMs who were treated during a 1-year period in 98 centers worldwide. Preoperative assessment and treatment were performed according to local clinical practice guidelines. Results: From January 2010 to February 2012, 4288 patients (4355 cases, 4815 tumors) were treated for a RM. The mean age of the cohort was 61.5 years, and the ratio male: female 1.8:1. Caucasians represented 75% of the population, and the median body mass index was 27. The cohort exhibited a high rate of comorbidity (65.6%), including a 48.5% rate of hypertension; one-third of patients had a combination of two or more comorbidities. One-third of patients (36%) had risk factors for renal-cell carcinoma (RCC), of which smoking and obesity were the most common. Diagnosis was incidental in 67% of cases, and 22.2% of cases had chronic kidney disease stage >= III at presentation. Median radiologic size was 44 mm (range 2-300 mm) and 68% were cT(1). Radical nephrectomy and nephron-sparing surgery (NSS) including ablation were performed in 52% and 46% of cases, respectively, while 3.6% of cases were actively surveyed. Median pathologic size was 43 mm (range 2300 mm) and 63% of the RCCs were pT(1). Conclusions: Current patterns of presentation of RMs are consistent with the decreasing trends in age and clinical or pathologic size and increasing incidental diagnosis. Patients exhibit a considerable basal comorbidity and presence of risk factors for RCC. Half of the cases are treated by a nephron-sparing modality with an increase in the penetration of NSS techniques in the contemporary urologic practice.

Objectives: To evaluate functional and oncologic outcomes of partial nephrectomy (PN) in patients with a solitary kidney. Materials and Methods: A retrospective analysis of patients with a solitary kidney undergoing nephron-sparing surgery between March 2003 and March 2013 was performed. GFR was recorded before the procedure and 3 months after surgery, thus establishing a change (cGFR). Several variables that may influence cGFR were analyzed. Complications are herein described, namely bleeding, fistula, acute renal failure and end-stage renal disease (ESRD). Local recurrence and margin status are also described. Survival rates were calculated using the Kaplan Meier method (2 patients with metastasis at the time of surgery were excluded from the analysis). Results: Forty-five patients were available for analysis. Median follow-up was 27.56 months (r 3-96). Mean cGFR was-7.12mL/min (SD 2.1). Variables significantly related with lower GFR after surgery were loss of renal mass (p=0.01)) and male gender (p=0.03). Four patients (8.8%) experienced hemorrhage. Nine patients (20%) developed a urinary fistula. Only one patient with bleeding required open surgery. Two patients (4.4%) needed transient dialysis. Three patients (6.6%) developed ESRD. Four patients (8.8%) had positive surgical margins (PSMs) and four patients (88%) had local recurrence (2 of these had PSMs). Five patients (11.1%) died during follow-up. Four patients (8.8%) died because of renal cancer. Estimated 2-year overall survival, disease-free survival and cancer specific survival rates were 88.4% (CI 95% 70.5-96); 87.7% (CI 95% 68.1-96) and 92.4% (CI 95% 75-98), respectively. Conclusion: Loss of renal mass and male gender were associated with lower postoperative GFR. Our outcomes were comparable with those in the World literature.

Background: The finding of new biomarkers is needed to have a better sub-classification of primary renal tumors (RCC) as well as more reliable predictors of outcome and therapy response. In this study, we evaluated the role of circulating FGF21, an endocrine factor, as a diagnostic and prognostic biomarker for ccRCC.Materials and Methods: Serum samples from healthy controls (HC), clear cell and chromophobe RCC cancer patients were obtained from the serum biobank ?Biobanco Público de Muestras Séricas Oncológicas? (BPMSO)of the ?Instituto de Oncología ?Ángel H. Roffo?. Serum FGF21 and leptin were measured by ELISA while other metabolic markers were measured following routinely clinical procedures.Results: One of our major findings was that FGF21 levels were significantly increased in ccRCC patients compared with HC. Moreover, we showed an association between the increased serum FGF21 levels and theshorter disease free survival in a cohort of 98 ccRCC patients, after adjustment for other predictors of outcome.Conclusion: Our results suggest that higher FGF21 serum level is an independent prognostic biomarker, associated with worse free-disease survival. Fil: Knott, María Elena. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Minatta, J.N. Hospital Italiano; Argentina Fil: Roulet, L.. Hospital Italiano; Argentina Fil: Gueglio G.. Hospital Italiano; Argentina Fil: Pasik, Leonardo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; Argentina Fil: Ranuncolo, Stella Maris. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Nuñez, M. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Puricelli, Lydia Ines. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; Argentina Fil: De Lorenzo, M. New Jersey Medical School; Estados Unidos

Resumen Objetivo Se evalua la presencia de celulas tumorales en el cordon espermatico en pacientes sometidos a exploracion testicular inguinal, con intencion de avalar si la colocacion de una pinza en el mismo resulta necesaria para evitar la diseminacion tumoral. Material y metodos Durante dos anos se realizo exploracion testicular inguinal a 38 pacientes con diagnostico de masa testicular. En todos los pacientes se evaluo la presencia de celulas tumorales en los vasos sanguineos o linfaticos del cordon. Resultados Existio neoplasia testicular en 28 pacientes (20 seminoma, 5 tumor mixto y tres carcinoma embrionario) con una edad promedio de 42 anos (rango 21-82). Fueron T1N0M0 21 casos, T1N1M0 tres, T2N0M0 dos y T2N1M0 dos, respectivamente. Independientemente del estadio y estirpe tumoral, en ninguno de los casos el examen de anatomia patologica evidencio celulas tumorales en los vasos del cordon. Conclusion En nuestra casuistica parece que el gesto quirurgico consistente en colocar una pinza precozmente en el cordon carece de fundamento cientifico. Sin embargo, este estudio tampoco permite afirmar que no realizar esta maniobra durante el procedimiento quirurgico sea oncologicamente seguro. Se establece asi un precedente para realizar estudios con mayor numero de pacientes que permitan corroborar esta observacion, lo que redundara en tecnicas quirurgicas menos traumaticas y seguras que permitan preservar el testiculo y su funcionalidad.

Objective The presence of tumor cells in the spermatic cord was evaluated in patients undergoing inguinal testis study in order to assure if the placement of a clamp in it was necessary to avoid tumor dissemination. Materials and methods Inguinal testis studies were performed over a two-year period in 38 patients diagnosed of testicular mass. The presence of tumor cells in blood vessels or lymph nodes of the cord was evaluated in all of the patients. Results Testicular tumors were found in 28 patients (20 seminoma, 5 mixed tumor and 3 embryonal) with an average age of 42 (range: 21–82) years. There were T1N0M0 21; T1N1M0 3; T2N0M0 2 and T2N1M0 2 cases, respectively. Independently of the stage and tumor lineage, tumor cells in the cord vessels were not observed in any of the cases through the pathology study. Conclusion In our causistics, it seems that the surgical act consisting of the placement of a clamp early in the cord lacks a scientific foundation. However, this study does not make it possible to state that not performing this maneuver during the surgical procedure is oncologically safe. Thus, a precedent is established to perform studies with a larger number of patients who will make it possible to corroborate this observation. This would result in less traumatic and safer surgical techniques that would allow conserving the testis and its functionality.

Erection depends largely on the release of nitric oxide (NO) by vascular endothelial cells. Insulin resistance (IR) is a metabolic abnormality that produces endothelial dysfunction characterized by decreased synthesis and release of NO. The aim of this paper is to evaluate the effect of treatment with metformin on the response to sildenafil in patients with erectile dysfunction (ED) and IR enrolled in a prospective, randomized, controlled, double-blind placebo study. We included 30 male patients with ED, IR, and poor response to sildenafil. Exclusion criteria included pharmacologic, anatomic, or endocrine ED; diabetes; prostatic surgery; or chronic illnesses. Erectile function was rated according to the International Index of Erectile Function 5 (IIEF-5); IR was measured by homeostasis model assessment (HOMA; IR = HOMA ≥ 3). Patients were randomized to receive metformin (n = 17) or placebo (n = 13). After treatment with metformin, patients with ED showed a significant increase in IIEF-5 score and a significant decrease in HOMA, both occurring at month 2 (IIEF-5: 17.0 ± 6.0 vs 14.3 ± 3.9, P = .01; HOMA: 3.9 ± 1.6 vs 5.5 ± 2.4, P = .01) to 4 of treatment (IIEF-5: 19.8 ± 3.8 vs 14.3 ± 3.9, P = .005; HOMA: 4.5 ± 1.9 vs 5.5 ± 2.4, P = .04), with no changes in these parameters in patients with ED receiving placebo. Patients treated with metformin had more adverse events than those who received placebo: 61.5% compared with 7.7%, P = .03, respectively. Adverse events were mild, mainly gastrointestinal, and did not cause discontinuation of treatment. Treatment with metformin in patients with ED and poor response to sildenafil reduced the IR and improved erectile function.

Erectile dysfunction (ED) is associated with metabolic and endocrine diseases including obesity, metabolic syndrome (MS), and type 2 diabetes mellitus (DM2). Insulin resistance (IR), present in patients with obesity, MS, and DM2, causes disturbances in the signaling pathways required for nitric oxide production, with subsequent endothelial dysfunction. In addition, IR appears to alter testosterone production. We evaluated in eugonadal patients with ED: 1) the presence of obesity and IR, 2) testosterone levels and their association with obesity and IR, and 3) the degree of ED according to the presence of IR. In a prospective study, 78 eugonadal patients with ED (group P) were recruited and compared with 17 men without ED as a control group (group C). Erectile function was evaluated according to the International Index of Erectile Function 5 (IIEF-5). IR was measured by homeostasis model assessment (HOMA). IR was defined as HOMA of 3 or greater. Patients with ED had significantly higher body mass index (BMI), waist circumference (WC), HOMA values, and prevalence of IR when compared with group C. Total (TT) and bioavailable testosterone (BT) levels were lower in group P compared with group C. There was a significant negative correlation between HOMA and IIEF-5, HOMA and TT, WC and IIEF-5, WC and TT, and WC and BT. Group P patients with IR had higher WCs and lower IIEF-5 scores when compared with patients in group P without IR. In conclusion, patients with ED showed a higher BMI, WC, and HOMA and lower levels of TT and BT. There is a negative correlation between erectile function and IR and abdominal obesity. The TT levels are lower in patients with increased BMI, WC, and IR. However, a negative correlation was shown only between BT (biologically active fraction) and abdominal obesity.

The aim of this paper is to describe the epidemiological characteristics, clinical management and pathologic patterns in a population with renal tumors in our institution. Prospective data collection was performed over a period of 4.5 years, from January 2010 to June 2014. A total of 819 cases (796 patients) were treated for renal mass during this period. The mean age was 60.7 years (SD 13.1). There were 553 (69.5%) males (male to female ratio: 2.2: 1). Twenty nine per cent (230 patients) were obese (BMI = 30). The diagnosis was incidental in 653 cases (79.7%), 48.8% presented one or more risk factors, being smoking the most frequent (34%). In 238 patients (29.9%) there was more than one comorbidity; 18% had preoperative creatinine = 1.3 mg/dl. Lesions were = 4 cm (cT1a) in 45% of the patients, and 10.8% (86) had metastases at diagnosis. The lesions were resected in 93.5% and actively monitored in 6.5% (not resected). In surgery treated patients, radical nephrectomy was performed in 51.5% of cases, and nephron sparing surgery in 48.5% of them. The laparoscopic approach was used in 56.2%. The pattern of presentation of renal masses is characterized by incidental diagnosis in early disease stages. Nephron sparing surgery is the first choice in nearly half of patients. Active surveillance has been used in a greater percentage than previously reported.

INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) is the preferred surgical treatment for most patients with cT1 renal masses, while radical nephrectomy (RN) is reserved for larger tumors, locally advanced tumors, and tumors not amenable to PN. Identifying patients that benefit most from PN is active area of investigation. Because the renal functional benefit of PN is realized over many years and is the procedure is associated with a higher complication rate than RN, elderly patients may not receive the benefit of PN at the cost of higher risk. We sought to characterize perioperative, renal functional and oncologic outcomes of elderly patients undergoing surgery. METHODS: Our institutional renal mass registry was queried for patients > 65 years who underwent PN or RN. Clinicopathologic features and perioperative outcomes were compared between groups. Renal function outcomes as measured by change in GFR and freedom from GFR < 45 were analyzed. Overall survival (OS) and cancer-specific survival (CSS) were compared using the Kaplan-Meier method and Cox proportional hazard regression. RESULTS: Overall, 889 patients met inclusion criteria. Of these 441 (49.6) underwent PN and 448 (50.4) underwent RN. Patients undergoing RN tended to be older (median age 71.9 vs 70.3 years, p < 0.001), had larger tumors (5.5 vs 2.8 cm, p < 0.001), a higher proportion of RCC (89.8% vs 76.6%m p < 0.001) but had similar ASA scores (median score 3 vs 3, p 1⁄40.1). There were no difference in between RN and PN in terms of operative time (median time 186 vs 195 minutes, p1⁄40.5), median estimated blood loss (200 vs 200, p 1⁄4 0.7). Complications rates were similar for RN and PN (overall 51.5% vs 48.5%, p 1⁄4 0.5 ; Clavien I-II 30.9 vs26.9%, p 1⁄40.2, Clavien III-IV 8.9% vs 10.8%, p 1⁄40.2 ). RN was associated with a greater median change in GFR on last follow-up (19.2 vs 7.6, p < 0.001) and freedom from GFR

Benign prostatic hyperplasia (BPH) is highly prevalent in primary care. It is the main reason for consultation because of uro-logical problems in adult males and is the first diagnosis that we should think in patients older than 50 years consulting forobstructive (difficulty initiating urination, decreased force and caliber of urine stream, postvoid dribbling, sensation of incom-plete emptying) and/or irritative symptoms (urinary urgency, frequency, nocturia) accounting several months of evolution.Diagnosis of BPH is usually made on clinical grounds and should be presumed in all patients 50 years old or older who com-plain for slowly progressive irritative or obstructive urinary symptoms with spontaneous remission and recurrence which hasno other clear condition to explain those symptoms.The only useful physical examination maneuver is digital rectal examination, whose main objective is to try to rule outprostate cancer. Although the prostate may be enlarged in BPH, it is important to note that the size of the gland correlatespoorly with the presence or absence of obstruction to urinary flow and that a preserved prostate volume do not exclude thediagnosis of obstructive BPH.The only two laboratory studies that should ordered as routine part of the initial evaluation are urinalysis and serum creati-nine (both serve to rule out other diagnoses and to detect complications).The dosage of the prostate specific antigen (PSA) in BPH evaluation is controversial. Most practice guidelines defined it asan optional study, depending on the clinical judgment of the physician. Prostate ultrasound with assessment of bladder residual urine volume and urine flow assessment are also optional diagnostic studies that can assist in monitoring and in mak-ing therapeutic decisions.BPH complications are rare and include acute urinary retention, renal failure, urinary tract infections, bladder stones andmacrohematuria.Management strategies for this entity include watchful waiting, medical therapy (alphablocker drugs, inhibitors of 5-alfareductasa or herbal) and surgical treatment, either through minimally invasive techniques (i.e. such as conventionaltransurethral resection, bipolar transurethral resection and laser procedures) or by open prostatectomy.

Clear-cell renal cell carcinoma (ccRCC), the most frequent renal parenchyma malignant neoplasm, is considered a cell metabolic disease. The finding of new biomarkers is needed for better sub-classification of renal cell tumors as well as reliable predictors of outcome and therapy response. Fibroblast Growth Factor 21 (FGF21) is a hepatokine that regulates glucose, energy and lipid metabolism during stress-induced pathologies. Despite the beneficial effects of FGF21 in diabetes and obesity; up to date, the clinical implication of FGF21 as a cancer biomarker was not investigated. Our main goal was to evaluate the role of circulating FGF21 as a diagnostic and prognostic biomarker for ccRCC. Initially, we measured the levels of circulating FGF21 in human healthy controls (HC, n = 51) using a quantitative ELISA test (R&D Systems, Inc.). No associations were observed between FGF21 serum concentration and gender or age. FGF21 levels significantly correlated only with triglycerides levels (Spearman's test: p Citation Format: Maria Elena Knott, Jose Nicolas Minatta, Lucia Roulet, Guillermo Gueglio, Leonardo Pasik, Stella Maris Ranuncolo, Myriam Nuñez, Lydia Ines Puricelli, Mariana Silvia De Lorenzo. Circulating fibroblast growth factor 21 (FGF21) as diagnostic and prognostic biomarker in renal cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 431.

To determine if elevated levels of high-sensitivity C-reactive protein (CRP) in plasma are associated with locally advanced renal cell carcinoma (LARCC) after surgery.Retrospective cross-sectional study conducted from May 2009 to January 2011. Altogether, 192 patients with non-disseminated disease and with preoperative quantitative determination of the CRP were evaluated. We evaluated the relation between age, gender, history of smoking, symptoms and CRP higher than 10 mg/L, with LARCC. The chi-square and Fisher's tests were used to compare categorical variables. For the multivariate analysis, we used logistic regression methods.The median age was 62 years (r=23-85), 72.4% were males. The median CRP was 2.40 mg/L (r=0.1-173). Of all the patients, 43.2% had a history of smoking and 81.8% were asymptomatic. As for the tumors, 77.1%were clear cell carcinoma, 14.6% chromophobe, 4.7% papillary, 2.6% oncocytomas, and 1% other varieties of renal cell carcinoma. As for the TNM classification, 45.8% corresponded to stage pT1a, 27.6% pT1b, 13% pT2, and 13.5% pT3, pT4 was not found. In the multivariate analysis, the presence of symptoms (p=0.002, OR=3.1) and the presence of CRP higher than 10 mg/L (p=0.006, OR=4) remained as the only prognostic variables of LARCC.Values of CRP higher than 10 mg/L increase 4 times the possibilities of finding LARCC in the pathological study of the surgical specimen. This variable should be taken into account when deciding what is the best surgical option.

Penile fracture is a rare lesion that occurs almost exclusively during erection. This lesion may be associated with rupture of the urethra in 20-30% of the cases. We describe a case that has been treated at our institution and review the literature.A-42-year-old patient suffered fracture of penis, with urethral section, during sexual intercourse. The patient underwent surgical exploration, the lesions of the corporal bodies and urethra were identified. Both lesions were repaired.patient's recovery was satisfactory without complications or esthetical or functional sequelae.Penile fracture with urethral section is an exceptional disease, the most frequent cause of which in occident is violent sexual activity. For diagnosis it is necessary in most cases a correct anamnesis and physical examination. Early surgical approach and closure of the albuginea's lesion and repair of the urethral lesion is the best way of treatment.

Urinary incontinence is one of the main complications after radical prostatectomy (RP). Preoperative kinetic physiotherapy could be useful as a preventive treatment of these complication. The objective of this work is to demonstrate the usefulness of preoperative perineal kinetic physiotherapy for early recovery of urinary continence after radical prostatectomy.Randomized controlled clinical trial. 38 patients were divided into groups of 19 before radical prostatectomy. The first group (K) received preoperative kinesic treatment whereas the second group (NK) did not (control group). Urinary continence was evaluated at 14, 30 and 60 days after catheter retrieval.There were not epidemiological or tumor biology differences between groups. The percentages of continent patients in group K at 14, 30 and 60 days were 47.36%, 47.36% and 78.9% respectively, whereas in the NK group where 47.36%, 47.36%, and 89.4% respectively (p0.05).Kinesic perineal exercises before radical prostatectomy did not diminish the times of urinary continence recovery or its appearance.

Objetivo: La incontinencia urinaria es una de las principales complicaciones luego de la realización de prostatectomía radical (PR). La rehabilitación kinésica preoperatoria, podría ser de utilidad como tratamiento preventivo de esta complicación. Demostrar la utilidad de la kinesiología perineal preoperatoria en la recuperación precoz de la continencia urinaria post prostatectomía radical. Métodos: Ensayo Clínico Controlado Randomizado Aleatorizado. 38 pacientes fueron divididos en dos grupos de 19 previo a la realización de la PR. El primer grupo (K) recibió tratamiento kinésico preoperatorio, mientras que el segundo grupo (NK) no (grupo control). Se evaluó la continencia de orina a los 14, 30 y 60 días post extracción de sonda. Resultados: No hubo diferencias epidemiológicas y de biología tumoral entre grupos. El porcentaje de pacientes continentes en el grupo K al los 14, 30 y 60 días, respectivamente fue de 47,36%, 47,36% y 78,9%, respectivamente, mientras que en el grupo NK fueron de 47,36%, 47,36% y 89,4%, respectivamente (p>0,05). Conclusión: Los ejercicios kinésicos perineales previos a la prostatectomía radical, no disminuyeron los tiempos de recuperación de la continencia urinaria ni la ocurrencia de la misma.

Objetivo: La fractura de pene es una lesión que responde habitualmente a un traumatismo cerrado que ocurre con el pene en erección. Cerca del 20-30% de los casos en occidente, se asocian a lesión del cuerpo esponjoso. Presentamos el caso de un paciente atendido en nuestro servicio y realizamos una revisión de la literatura. Métodos: Se trata de un paciente de 42 años de edad, que luego de una relación sexual violenta, presentó una fractura de pene con lesión asociada de uretra. Se lo intervino quirúrgicamente, se constató la lesión de ambos cuerpos cavernosos y la sección completa de de la uretra. Ambas lesiones fueron reparadas en el mismo acto quirúrgico. Resultados: El paciente evolucionó satisfactoriamente sin complicaciones y sin secuelas estéticas ni funcionales. Conclusiones: La fractura de pene con lesión asociada de uretra es una patología excepcional, cuya etiología más frecuente en occidente se debe a una relación sexual violenta. Una correcta anamnesis y un examen físico correcto son suficientes en la mayoría de los casos para hacer diagnóstico. El abordaje quirúrgico temprano y el cierre de la albuginea junto a la reparación de la uretra, permite alcanzar los mejores resultados.

To analyze the correlation between preoperative variables in patients with kidney cancer and subsequent finding of bad prognosis factors.Retrospective cohort study reviewing the charts of all patients undergoing surgery at the HIBA bet- ween June 1988 and April 2003. 555 patients were included, registering age, gender, and clinical presentation. Pathology reports were classified following WHO for histology, Furhman for tumor grade, and AJCC for tumor stage. Intrarenal disease was defined as tumorsor = T2; the rest of the tumors were considered extrarenal. Statistical analysis was performed using the Statistic 7 Software, performing Students t test, proportions comparison test, chi-square test, and odds ratio.Mean age was 58.8 years (r: 20-94), 388 (69.9%) patients were males and 167 (30.1%) females. 209 (37.7%) were smokers or ex-smokers. 256 (46.1%) tumors were incidentally diagnosed, 299 (53.9%) were symptomatic. The right kidney was affected more often (54.6%), and 2.3% were bilateral synchronic tumors. Grade II was the most frequent grade (62.2%). T1 was the predominant TNM with 273 patients (49.2%). Mean tumor size was 6.7 cm, with 5.54 cm for the intrarenal tumors and 8.67 cm for the extrarenal (Student t test p0.00001). 49.6% (127) of the 256 asymptomatic patients have extrarenal tumors, in comparison with only 26.4% (79) of the 299 symptomatic patients (chi-square p0.00001). Ninety-two (44%) of the 209 smokers had extrarenal tumors in comparison with 114 (32.9%) of the non-smokers.We may say that patients having a symptomatic renal tumor have between 2 and 3 times more probability to have non organ-confined disease at the time of surgery This also increases, although in smaller amounts, between smokers and older than 70 years patients. The presence of a tumor greater than 7 cm almost triplicates of the possibility of extrarenal involvement.

Objetivo: Analizar la correlación existente entre factores preoperatorios en pacientes con cáncer de riñón, y el hallazgo posterior de factores de mal pronostico. Métodos: Estudio de cohorte retrospectiva, con revisión de historias clínicas de pacientes operados entre junio de 1988 y abril 2003 en el HIBA. Se seleccionaron 555 pacientes, de los cuales se tomaron edad, sexo y forma de presentación. Las anatomías patológicas fueron clasificadas según el W.H.O. para histología, Fuhrman para grado tumoral, y segun la A.J.C.C. para estadio tumoral. Se consideraron tumores con enfermedad intrarrenal (EIR) a aquellas con enfermedad menor a T2, siendo extrarrenales (EER) los restantes. Los datos fueron evaluados estadísticamente con el Student T test, Test de comparaciones de proporciones, Test Chi-Cuadrado y el Odds Ratio. Se utilizo el software Statistic 7 para la realización de los test descriptos. Resultados: La edad promedio fue de 58,8 anos (r:20-94), 388 (69,9%) hombres y 167 (30,1%) mujeres. Del total, 209 (37,7%) eran tabaquistas o ex-tabaquistas. En forma incidental se presentaron 256 (46,1%) y 299 (53,9%) en forma sintomática. El riñón derecho fue el mas afectado (54,6%), y 2,3% fueron sincrónicos bilaterales. El 85,4% (474) eran carcinomas de células claras. El grado tumoral mas frecuente fue el II con un 62,2%. El TNM que predomino fue el T1 con 273 pacientes(49,2). La media de tamaño tumoral fue de 6,7cm. Siendo para los EIR de 5,54 cm, mientras que los EER fue de 8,67 cm. (Student T test, p

To assess prospectively the impact of extracorporeal circulation on erectile function and the probable prognosis of future erectile function in patients undergoing myocardial revascularization surgery.30 patients who met the following criteria were analyzed: a) age less than 80 years, b) elective surgery, c) use of extracorporeal circulation and d) stable partner. Pre-operative erectile function was determined and other cardiovascular risk factors by means of a written questionnaire. The patients were classified into three groups according to the preoperative erectile function: good (group A), fair (group B) and poor (group C). All patients underwent myocardial revascularization surgery.3 patients (27.2%) of group A reported poor erections after surgery, while 8 (72.7%) reported no changes in erectile function. Four patients (44.4%) of group B reported poor erection postoperatively, another 4 (44.4%) reported no significant changes in erectile function and 1 (11.1%) reported improvement in erectile function. One patient (10%) of group C reported improved erectile function, while the remaining patients reported no changes. To determine the influence of extracorporeal circulation and clamping time on erectile function as independent variables, the patients were classified into group I (patients of groups A and B that preserved or improved erectile function postoperatively) and group II (patients of groups A and B that reported poor erectile function postoperatively). The mean extracorporeal circulation time was 99 mins for group I and 116 mins for group II (p = 0.7102). The mean clamping time for group I was 56.84 mins and 69.57 mins for group II (p = 0.5375). No statistically significant differences were found (Wilcoxon test).A) Patients with good erectile function undergoing myocardial revascularization surgery with extracorporeal circulation have a high probability of preserving the quality of erectile function postoperatively. B) Patients with erectile dysfunction are not likely to improve after myocardial revascularization surgery. C) Extracorporeal circulation and clamping times do not appear to influence the postoperative results. These were significantly shorter in patients that preserved or improved erectile function than in those that reported poor erectile function postoperatively and may be due to less intraoperative complexity. D) The preoperative erectile function was found to be the most important predictive factor of outcome. E) Further studies on larger series of patients are warranted to corroborate the foregoing findings.

Clinicians face important pitfalls in the treatment of Renal cell carcinoma (RCC), such as absence of symptoms in early stages of the disease, its high metastatic potential and its resistance to conventional therapy. These facts emphasize the requirement of early diagnosis to optimize the chance of cure. ccRCC, the most common histological type of RCC, is considered a cell metabolic disease which develops from the activation of pseudohypoxic pathways. The transmembrane enzyme CAIX, involved in pH homeostasis and expressed in ccRCC tumors, is considered to be one of the best cellular biomarkers of hypoxia. Our aim was to study the role of serum CAIX as diagnostic biomarker of ccRCC, taking into account that serum contains a rich untapped source of disease-specific information. Employing a quantitative ELISA test (R&D System), the expression of serum CAIX of 30 ccRCC patients and 16 healthy controls was evaluated. Samples from cancer patients were taken before surgery, without any previous treatment (S1), and after tumor removal (S2). ccRCC patients showed significantly elevated values of serum CAIX (Median 75.89 pg/ml, range 30,8-1482,9) respect to the levels observed in healthy controls (23.29, 0.0-79.9). On the basis of the optimal cut-off point of 34,821 pg/ml serum CAIX, 22/30 cancer patients showed high values of CAIX versus only 1/15 healthy controls (p< 0.01, Chi square test). The assay of serum CAIX expression in our population exhibited a sensitivity of 93.8% and a specificity of 73.3%. Besides, we demonstrated that Stage I ccRCC patients showed significantly lower levels of the circulating enzyme (Md, range expressed in pg/ml CAIX: Stage I= 45.3, 30.8-107.9 vs Stage IV=102.9, 36.2-1482.9; MW test p We conclude that serum CAIX could be a useful diagnostic biomarker in ccRCC patients. This would be of relevant importance as there is a lack of molecular biomarkers for this pathology. Citation Format: Maria Elena Knott, Myriam Nuñez, Maria Natalia Gandur Quiroga, Gaston Boggio, Julieta Grasselli, Guillermo Gueglio, Pedro Rondot Radío, Mariano Brzesinski, Leonardo Pasik, Carla Pulero, Ana Alvarez, Hector Malagrino, Patricio Garcia Marchiñena, Alberto Jurado, Elisa Bal de Kier Joffe, Maria Guadalupe Pallotta, Lydia I. Puricelli. Serum carbonic anhydrase IX (CAIX) as diagnostic biomarker in clear cell renal cell carcinoma (ccRCC) patients . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 12. doi:10.1158/1538-7445.AM2013-12

Objective: surgical treatment for severe Peyronie's disease is a challenge for urologists throughout the world. The aim of this video is to show the Gelbard's technique of split plaque incisions and the use of bovine pericardium grafts in a patient with severe dorsal curvature (90 o ) and no hourglass deformity. Material and Methods: the video shows the operation of a 58 years old man who consulted for severe Peyronie's disease and firm erections. First, the x‐ray and the ultrasound studies are shown and so are the auto‐photographs. Then the main steps of the surgery are displayed in a didactic way. A pair of split incisions are performed in the plaque after lifting the neuro‐vascular bundle and measuring of the penis. After the incisions, 3 cms. are gained in the penile length. Then, 2 grafts of bovine pericardium are placed to cover the gaps, tailoring them 20% bigger than the gaps. No corporoplasty was added. After closure of Buck's fascia, circumcision is routinely performed. Once the skin is closed, a Coban dressing is applied. Results: using this technique we have operated on 6 patients since September 2003. Mean follow‐up is 6 months (9‐2) and so far the results are very good in terms of straightness and firmness of the erections. As the problem is only the curvature, there is no need for an H shaped incision thus reducing the probability of post‐op ED. In this small series, only one patient reported a slight decrease in the firmness of his post‐op erections. Conclusion: although the number of patients is low and the follow‐up is short, it seems that split plaque incisions and bovine pericardium grafts is a sound alternative in patients with severe dorsal curvature and no hourglass deformity. Disclosure: Was this work supported by industry? No.