Immediately repaired penile fractures: age is the only predictor of postoperative long-term functional outcomes.

Background: Penile fractures can lead to many functional complications, especially erectile dysfunction (ED). Few studies have evaluated the factors that predict late complications of an immediately repaired penile fracture. Aim: To identify the potential predictors of long-term poor functional outcomes following immediate surgical intervention for penile fractures. Methods: Sixty-eight consecutive patients with suspected penile fracture between 2003 and 2022 were retrospectively reviewed. Functional outcomes, postoperative complications, and follow-up duration were obtained from the records of follow-up visits. Age at presentation, location and length of the tunical tear, the presence of urethral rupture, and time to surgery were all analyzed as potential risk factors for postoperative functional outcomes. Outcomes: Postoperative erectile function and intercourse satisfaction were measured by the IIEF-5 (the 5-item version of the International Index of Erectile Function). Penile curvature, a palpable nodule, and paresthesia/numbness were detected by physical examination. Uroflowmetry was used to assess urinary flow in patients who underwent urethral repair. Results: Fifty-eight patients were analyzed. The mean ± SD age was 38.1 ± 10.4 years; the median follow-up was 79.0 months (range, 13-180); the median time to surgery was 9.8 hours (4-30); and the median tunical tear length was 15.5 mm (4-40). Urethral rupture was observed in 8 patients (13.8%). In univariable analyses, urethral rupture was associated with postoperative complications (P = .034). In addition, age at presentation and tunical tear size were significantly associated with postoperative complications and ED (P < .05). However, in multivariable analyses, only age at presentation significantly predicted postoperative complications and ED (P = .004 and P = .037). Clinical Implications: Age at presentation is the most important factor determining the prognosis of immediate surgical repair of the penile fracture, which aids in predicting potential complications and discussing them with patients prior to surgical intervention and during the follow-up period. Strengths and Limitations: The study's retrospective design is an important limitation. Furthermore, there were no data on an IIEF-5 outcome measuring preoperative erectile function. Conclusion: These results revealed an association between (1) urethral rupture, longer tunical tears, and older age and (2) the development of late complications. The remarkable finding of this study was that age at presentation was the only significant predictor of functional complications based on multivariable analyses. This relationship also remained robust in tests evaluating the covariance of the effects of aging on ED.

Bulbar Urethral Stents for Bulbar Urethral Strictures: Long-Term Follow-Up after Stent Removal.

BACKGROUND/AIM: The aim of this study was to assess long-term clinical efficacy of temporary bulbar urethral stent (BUS) used for treatment of recurrent bulbar urethral stricture (US). MATERIALS AND METHODS: A total of 168 patients with recurrent bulbar US who underwent BUS placement after internal urethrotomy between 2009 and 2019 were enrolled. An indwelling time of 12 months was planned for the stents. After stent removal, the criteria for success of BUS treatment were defined as follows: no evidence of stricture on urethrogram or endoscopy, more than 15 mL/s of urinary peak flow, and no recurrent urinary tract infections. Patients were divided into 2 groups based on clinical success and compared. RESULTS: The mean age, US length, and indwelling time were 46.7 (±8.3) years, 2.32 (±0.4) cm, and 9.7 (±2.3) months, respectively. Median (range) follow-up was 71 (8-86) months. Clinical success was achieved in 77.9% patients. Longer indwelling time (8-18 [81.88%] vs. 3-7 [60%] months) and US length <2 cm (84.25% [<2 cm] vs. 58.5% [≥2 cm]) were significantly associated with clinical success (p < 0.05). CONCLUSION: This study is both the largest patient series and the longest follow-up for BUS in bulbar US. Our results suggest that BUS can be a safe and minimally invasive treatment alternative among bulbar US treatment options.

SERPIN A5 may have a potential as a biomarker in reflecting the improvement of semen quality in infertile men who underwent varicocele repair.

We aimed to identify proteins that were differentially regulated in spermatozoal samples collected from fertile healthy men (FHM) and infertile patients with varicocele (IFPV) before and after varicocelectomy. Seminal samples were collected from 20 IFPV before and after varicocelectomy and from 14 FHM as controls. Samples underwent seminal examination and proteomic analysis. Extracted spermatozoal proteins were analysed using two-dimensional gel electrophoresis, and differentially regulated spermatozoal proteins (DRSPs) were identified. In particular, attention was placed on those DRSPs in which the concentration changed after varicocelectomy and corrected to approximate levels observed in FHM. Varicocelectomy significantly improved the sperm count and concentration in IFPV (p < 0.05). Proteomic analysis showed that 11 DRSPs were identified when comparisons were made among the three groups. Among these 11 proteins, change in the SERPIN A5 concentrations was notable because it was 100-fold downregulated in pre-operative IFPV samples and nearly resembled to control concentrations following varicocelectomy. Western blot analysis using an anti-SERPIN antibody validated the changes observed in SERPIN A5 levels before and after varicocelectomy operation. Increase in SERPIN A5 after varicocelectomy may be due to improvement in semen quality, suggesting that SERPIN A5 is a potential seminal biomarker for assessment of semen quality in varicocele-related infertility.

Buried penis in adults as a complication of circumcision: Surgical management and long-term outcomes.

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.

Non-infected penile prosthesis cultures during revision surgery; comparison between antibiotic coated and non - coated devices

ABSTRACT Introduction: Aim of this study is to investigate bacterial growth on non-infected devices and compare antibiotic-coated and non-coated implants. Materials and methods: The charts of 71 patients who underwent revision surgeries for penile prosthesis between 1995 and 2013 were reviewed. Of those, 31 devices were antibiotic-coated prostheses, while 40 of the implants were non-coated. Swab cultures were routinely obtained from corporal, pump or reservoir site during the operation. If a bacterial biofilm was determined on the prosthesis, it was also cultured. Results: A total of 5 different organisms were cultured from 18 patients. Of them, 4 devices were antibiotic-coated and the other 14 were non-coated devices. Staphylococcus epidermidis was the most common organism, while Staphylococcus hominis, beta hemolitic streptococcus, Escherichia coli and Proteus mirabilis were also cultured. All patients who had positive cultures were treated with appropriate antibiotics for four weeks postoperatively. Median follow-up time was 41 months, ranging between 8 and 82 months. One prosthesis (non-coated) became clinically infected in the follow-up period with a totally different organism. Culture positivity rates of antibiotic-coated and non-coated devices were 13% and 35% respectively and the result was significant (p=0.00254). Conclusions: Positive bacterial cultures are present on non-infected penile prostheses at revision surgeries in some of the patients. Antibiotic coated prostheses have much less positive cultures than non-coated devices.

Non-infected penile prosthesis cultures during revision surgery; comparison between antibiotic coated and non - coated devices.

INTRODUCTION: Aim of this study is to investigate bacterial growth on non-infected devices and compare antibiotic-coated and non-coated implants. MATERIALS AND METHODS: The charts of 71 patients who underwent revision surgeries for penile prosthesis between 1995 and 2013 were reviewed. Of those, 31 devices were antibiotic-coated prostheses, while 40 of the implants were non-coated. Swab cultures were routinely obtained from corporal, pump or reservoir site during the operation. If a bacterial biofilm was determined on the prosthesis, it was also cultured. RESULTS: A total of 5 different organisms were cultured from 18 patients. Of them, 4 devices were antibiotic-coated and the other 14 were non-coated devices. Staphylococcus epidermidis was the most common organism, while Staphylococcus hominis, beta hemolitic streptococcus, Escherichia coli and Proteus mirabilis were also cultured. All patients who had positive cultures were treated with appropriate antibiotics for four weeks postoperatively. Median follow-up time was 41 months, ranging between 8 and 82 months. One prosthesis (non-coated) became clinically infected in the follow-up period with a totally different organism. Culture positivity rates of antibiotic-coated and non-coated devices were 13% and 35% respectively and the result was significant (p=0.00254). CONCLUSIONS: Positive bacterial cultures are present on non-infected penile prostheses at revision surgeries in some of the patients. Antibiotic coated prostheses have much less positive cultures than non-coated devices.

Persistent very high output lymphatic drainage after radical nephrectomy successfully treated with surgical management.

Persistent lymphatic drainage is uncommon after most of the surgical operations. It is related with mechanical, nutritional and immunological problems as well as electrolyte imbalance and protein deficiency. It is most commonly seen in retroperitoneal surgeries including abdominal aortic surgery and retroperitoneal lymph node dissection. Conservative management is the first treatment choice and resolves the problem in most cases. However persistent high output drainage may not be resolved with conservative approach and surgical or invasive treatment may become necessary. Additionally, surgical management of persistent lymphatic drainage has not been sufficiently discussed in the literature. In this study, we present a case of persistent very high output lymphatic drainage after right radical nephrectomy which failed with conservative approach and was successfully treated with surgical management.

Varicocele Repair Improves Testicular Histology in Men with Nonobstructive Azoospermia.

OBJECTIVE: To determine the histopathological differences after varicocele repair in testicular tissue in males with nonobstructive azoospermia. METHODS: Between 2009 and 2014, 45 men with complete azoospermia and palpable varicocele, presenting with primary infertility of at least 1 year, undergoing varicocele repair at our institution were selected for the study. A standard systematic testicular 6-core Tru-Cut biopsy was performed during varicocele repair. Other biopsies were obtained from each testicle of all patients at the time of microscopic sperm extraction procedure. RESULTS: Nineteen patients were selected for the study. Testicular biopsy specimens were classified as Sertoli cell only on preoperative histopathological analysis in 14 patients. After varicocele repair, focal spermatogenesis (n = 3) and late maturation arrest (n = 2) were found in these patients. Average Johnsen score was significantly increased after varicocelectomy (P = 0.003). Motile sperm was found in one patient on postoperative semen analyses and in 10 more patients in the microscopic sperm extraction procedure. Preoperative high serum follicle stimulating hormone level and venous reflux were significantly and negatively correlated with the increase in average Johnsen score (P < 0.05). CONCLUSIONS: Our findings suggest significant improvement in testicular histology after varicocele repair.

A novel method for repair of testis rupture after gunshot trauma: repair with Tutoplast processed pericardium.

Gunshot wound injury to the external genitalia is relatively uncommon. However, if a testis isaffected in such a case, early surgical exploration should be carried out. A 16-year-old boy presented with right testicular rupture. Tunica albugineal defect could not be closed primarily. We used a Tutoplast® processed bovine pericardium to repair the defect of tunica albuginea. At his 3-month follow-up visit, there was no complication. Doppler blood flow of testis was normal. In this case, preservation of testis tissue was obtained with early exploration and repair of the big tunica albugineal defect with Tutoplast® processed pericardium.