Prospective and long-term evaluation of erect penile length obtained with inflatable penile prosthesis to that induced by intracavernosal injection.

We compared erect penile length after inflatable penile prosthesis (IPP) implantation with that induced by in-tracavernosal injection (ICI) before surgery. A total of 11 patients with full erections induced by ICI of 0.25 mL of Trimix (papaverine, phentolamine and prostaglandin E1) at the time of penile color duplex Doppler ultrasonography were enrolled in this study. The patients subsequently underwent IPP implantation as the ultimate treatment for their erectile dysfunction (ED). Erect penile length consequent to IPP implantation was measured at 6 weeks, 6 months and at 1 year after surgery. The Sexual Health Inventory for Men (SHIM) was administered before, and at 6 months and 1 year after IPP implantation. Erect penile length (mean +/- s.e.) as induced by ICI was 13.2 +/- 0.4 cm, whereas the lengths attained with IPP were 12.4 +/- 0.3, 12.5 +/- 0.3 and 12.5 +/- 0.4 cm at the sixth week, sixth month and 1-year follow-ups, respectively. There were 0.83 +/- 0.25, 0.75 +/- 0.20 and 0.74 +/- 0.15 cm decreases in erect penile length at 6 weeks, 6 months and 1 year, respectively, after IPP implantation when compared with that after ICI (P < 0.05). The SHIM scores for patients reporting shorter penises were the same as those for patients without complaints at the 6-month and 1-year follow-ups (P > 0.05). To our knowledge, this is the first study to objectively show a significant decrease in erect penile length after IPP implantation when compared with that after ICI. However, this decrease did not affect the effectiveness of IPP in treating ED.

Staging refinements in renal cell carcinoma.

PURPOSE OF REVIEW: Accurate pathologic staging systems provide valuable prognostic information. As our understanding of the biology of renal cell carcinoma improves, so does the staging system has undergo periodic modification. The modification of the tumor-node-metastasis staging system in 2002 has been applied to various populations, and several changes have been proposed. RECENT FINDINGS: The tumor diameter chosen as a break point in the staging system for noninvasive tumors is debated. Although 4 cm, the break point between T1a and T1b tumors, was chosen, in part, to select tumors amenable to partial nephrectomy, newer data show that this may no longer be appropriate. Size appears to have continual prognostic significance, especially in the range of 4-6 cm. T3a tumors with adrenal involvement appear to have a poor prognosis similar to T4 tumors. In addition, while renal sinus invasion may have a worse prognosis, perinephric fat invasion appears to have less impact on survival than overall tumor size. SUMMARY: Refinements of the current staging system on the basis of current understanding of tumor characteristics will improve prognostic accuracy. The addition of molecular markers and other features should be considered while not allowing increased complexity to disrupt clinical utility.