Evidence-Based Management Guidelines on Peyronie's Disease.

INTRODUCTION: Despite recent advances in our knowledge and treatment strategies in Peyronie's Disease (PD), much remained unknown about this disease. AIM: To provide a clinical framework and key guideline statements to assist clinicians in an evidence-based management of PD. METHODS: A systematic literature search was conducted to identify published literature relevant to PD. The search included all relevant articles published up to June 2015, including preclinical studies and published guidelines. References used in the text were assessed according to their level of evidence, and guideline recommendations were graded based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Owing to the paucity of larger series and randomized placebo-controlled trials with regard to surgical intervention, guideline statements are provided as clinical principle or expert opinion. MAIN OUTCOME MEASURES: This literature was discussed at a panel meeting, and selected articles with the highest evidence available were used to create consensus guideline statements for the Fourth International Consultation on Sexual Medicine guidelines on PD. RESULTS: In addition to existing Third International Consultation on Sexual Medicine guidelines on PD, seven new summary recommendations were created. CONCLUSION: A greater understanding of the scientific basis of PD is greatly needed to address our understanding of the pathophysiology, clinical epidemiology, psychosocial, and diagnostic assessment as well as treatment strategies.

The impact of sexual activity on serum hormone levels after penile prosthesis implantation.

OBJECTIVES: Penile prosthesis implantation is the final treatment option for patients who have erectile dysfunction. Most of the patients use their penile prosthesis successfully and frequently for penile-vaginal intercourse. Previous literature showed that decrease in sexual activity resulted in decreased serum testosterone levels and vice versa. The aim of this study was to examine the impact of sexual activity on serum sex hormone levels after penile prosthesis usage. MATERIAL AND METHODS: In this study, we examined sixtyseven patients for their sex hormone changes who had penile prosthesis surgery 2.7 ± 1.5 years ago. RESULTS: Patients were using their penile prosthesis for sexual activity with a mean of 9.9 ± 5.7 times per month. Dehydroepiandrosterone sulfate was significantly higher compared to pre-surgery results (5.3 ± 2.6 vs 4.5 ± 2.9; p = 0.031). Mean serum total testosterone levels of patients before and after penile prosthesis usage were clinically significant 15.78 ± 4.8 nmol/L and 16.5 ± 6.1 nmol/L, respectively. Mean serum luteinizing hormone levels of patients before and after penile prosthesis usage were 3.98 ± 2.16 IU/L and 5.47 ± 4.76 IU/L, respectively. No statistical significance difference was observed in the mean total and free testosterone, estradiol and luteinizing hormone levels between pre- and post-surgery. CONCLUSION: This study results demonstrated that sexual activity changed sex hormone levels positively among those men who were implanted penile prosthesis because of erectile dysfunction.

Subcutaneous cod liver oil injection for penile augmentation: review of literature and report of eight cases.

OBJECTIVES: To study the presentations and treatment outcome of 8 consecutive patients for whom cod liver oil was injected in the subcutaneous area of their penises by a lay person for purpose of augmentation. METHODS: Various amounts of cod liver oil were injected in the subcutaneous area of the penis of 8 low socioeconomic class patients by a nonmedical person. They presented by various complications ranging from paraphimosis up to abscess formation and necrosis of penile skin. All the patients underwent emergency initial surgical intervention ranging from dorsal preputial slit to skin debridement. Definitive surgical treatment was carried out using local penile flap and V-Y plasty. RESULTS: The severity of complications was correlated to the amount of oil injected and the time interval between injections and presentation. All the 8 patients were cured after different staged surgical procedures. The postoperative course was uneventful in 6 patients, and 2 patients suffered from wound infection after the secondary treatment. All patients had acceptable cosmetic and functional outcome, and were satisfied regarding the length of the penis. None reported erectile dysfunction. CONCLUSIONS: Increased public awareness is indicated to avoid this problem. Early detection and prompt treatment give acceptable anatomic and functional results.

Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches.

PURPOSE: We compared the outcomes of 3 techniques of varicocelectomy in infertile patients with varicocele. MATERIALS AND METHODS: The study included 298 infertile patients (446 varicoceles) who were randomized to varicocelectomy by an open inguinal technique in 92, laparoscopy in 94 and subinguinal microsurgery in 112. The 3 techniques were compared regarding intraoperative, and early and late postoperative parameters, changes in semen parameters and the pregnancy rate. Patients were followed a +/- mean +/- SD of 21 +/- 9 months (range 4 to 35). RESULTS: Operative time was significantly longer in the microscopic group. Early postoperative complications were comparable in the 3 groups. At followup none of the patients in the microsurgical group had hydrocele, while it was observed in 4 of 143 (2.8%) in the open group and in 8 of 148 (5.4%) in the laparoscopy group, representing a significance difference in favor of microsurgery. The incidence of recurrent varicocele was significantly lower in the microsurgical group than in the open and laparoscopy groups (4 of 155 patients or 2.6% vs 16 of 143 or 11% and 25 of 148 or 17%, respectively). Compared to preoperative values in the 3 groups postoperative semen parameters showed significant improvement in sperm concentration, motility and morphology. The incidence of patients with improved sperm count and motility was significantly higher in the microsurgical group. The pregnancy rate at 1 year was not significantly different among the 3 groups. CONCLUSIONS: Compared with open and laparoscopic varicocele treatment microsurgical varicocelectomy has the advantages of no hydrocele formation, a lower incidence of recurrent varicocele, and better improvement in sperm count and motility.

Extracorporeal shock wave lithotripsy monotherapy for treatment of patients with urethral and bladder stones presenting with acute urinary retention.

OBJECTIVES: To present our experience with extracorporeal shock wave lithotripsy (ESWL) monotherapy for the treatment of patients with urethral and bladder stones presenting with acute urinary retention. METHODS: A total of 64 patients (62 male and 2 female) with urethral or bladder stones underwent ESWL monotherapy. All patients presented to the emergency department with acute urinary retention. The mean patient age was 40 +/- 13.2 years (range 11 to 74). The exclusion criteria were urethral strictures, associated bladder growths detected by pelvic ultrasonography, and bladder stones larger than 25 mm in the largest diameter. After fixation of a Foley catheter, ESWL monotherapy was performed with a Storz SL 20 lithotriptor. The catheter was removed after confirmation of stone fragmentation. RESULTS: Fine fragmentation was obtained and uncomplicated spontaneous evacuation occurred without the need for adjuvant procedures in 60 patients. Four patients developed acute urinary retention due to urethral stone impaction. In 3 patients, the urethral catheter was successfully refixed, and an additional session of ESWL resulted in fine fragmentation of the stones, with spontaneous evacuation after catheter removal. In the remaining patient, the stone could not be pushed into the bladder and crushing was performed endoscopically. CONCLUSIONS: ESWL monotherapy is safe and effective for the treatment of urethral and bladder stones in patients with no other causes of infravesical obstruction.