Implantation of AMS 700 LGX penile prosthesis preserves penile length without the need for penile lengthening procedures.

Implantation of an inflatable penile prosthesis (IPP) is a well-established definitive solution for erectile dysfunction when conservative treatments fail. Penile implants may shorten the penis. The AMS 700 LGX IPP is in common use but reports on its mechanical reliability, medium-term postsurgical patient satisfaction, and mean penile length preservation are lacking. We investigate the mean penile length, mechanical reliability, and patient satisfaction at 6 and 12 months after implantation of the AMS 700 LGX. This prospective study consecutively enrolled men undergoing first-time IPP implant surgery from February 2009 to April 2012. Stretched flaccid penile length, penile length at 50% and 100% of stiffness (P50 and P100) and International Index of Erectile Function (IIEF) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores, were measured at 6 and 12 months postsurgery. Of 45 patients who underwent AMS 700 LGX implantation (median age 61 years) and completed 6 months' follow-up, 36 (80%) completed the study. A significant difference in stretched flaccid penile length was seen between 6 and 12 months (P = 0.033). P100 was also significantly increased at 6 and 12 months, with a mean 10% increase (1.3 ± 0.4 cm) from baseline to 12 months. Differences in mean IIEF scores at 6 and 12 months were significant for the desired domain (P = 0.0001) and for overall satisfaction (P = 0.002); however, mean EDITS scores at 6 and 12 months were not significantly improved. AMS 700 LGX is a powerful tool for preserving penile length in men undergoing penile prosthesis implantation.

Time-related changes of metabolic and physicochemical profiles in patients with mechanical ileal neobladders.

OBJECTIVE: To investigate metabolic disturbances, possibly leading to stone disease, in the Camey II technique for creating a urinary reservoir from an intestinal segment. PATIENTS, SUBJECTS AND METHODS: Thirty patients with a Camey II ileal neobladder and 26 controls had metabolic investigations of blood samples, and 24-h and fasting urine samples, to assess renal function, the risk of stone formation, and bone turnover. The state of saturation with calcium oxalate, uric acid and brushite were calculated using a computer program. RESULTS: The patients had lower renal clearances than the controls (P < 0.001), with a slight tendency to decrease with time from surgery. Metabolic hyperchloraemic acidosis occurred in 57% of the patients and tended to be worse at lower glomerular filtration rates (P < 0.05). Severe hypocitraturia in both daily and fasting urine was the most striking urinary feature. There was no difference in the other variables. The state of saturation with brushite was slightly higher in patients due to the slightly higher urinary pH. There was a trend to lower bone turnover, involving markers of both resorption and formation, in the patients. CONCLUSIONS: The Camey II technique led to only minor functional or metabolic changes; renal function tended to deteriorate and mild metabolic acidosis was the main feature. Fasting and 24-h hypocitraturia occurred in most patients, representing a potential threat for calcium stone formation.

Cyanoacrylic glue: a minimally invasive nonsurgical first line approach for the treatment of some urinary fistulas.

PURPOSE: We evaluated the adaptability and the efficacy of a cyanoacrylic glue for the conservative treatment of urinary fistulas of different etiologies using an endoscopic, percutaneous or endovaginal approach. MATERIALS AND METHODS: From May 1998 to July 2004, 13 patients with long lasting iatrogenic and/or inflammatory urinary fistulas were treated conservatively with endoscopic, percutaneous or endovaginal application of 1 to 3 cc of cyanoacrylic glue. RESULTS: The complication rate in this cohort of 13 patients was low. Occlusion therapy failed in 2 genitourinary fistulas which were wider (diameter greater than 1 cm) and short. In the remaining 11 cases urinary fistulas were successfully sealed and at a median followup of 35 months no relapses were observed. CONCLUSIONS: Cyanoacrylic glue is suitable for endoscopic, percutaneous and endovaginal use. This occlusion therapy represents a safe and minimally invasive approach that might be offered as a first line option for the treatment of urinary fistulas, especially narrow and long tract fistulas.

New serosal lined antireflux ureteroileal implantation technique on a gia stapler detubularised ileal neobladder: technical considerations and results.

OBJECTIVES: To evaluate the adaptability and the possible advantages of the antireflux mechanism of the serous lined extramural tunnel for ureter re-implantation on a gastrointestinal anastomosis (GIA) Stapler detubularised ileal neobladder METHODS: From April 1998 to July 2002 43 male patients underwent radical cystectomy and the creation of a Camey II ileal neobladder using this antireflux technique. Follow-up in all cases included excretory urography or T.C. scan and a retrograde cystography at 6 months and a renal scintigraphy with DMSA at 1 year follow-up, besides serum creatinine, blood urea and serum electrolytes every three months and renal-neovesical ultrasound every six months. RESULTS: Early and late complications were low. At follow-up 1 case of neovesico-ureteral reflux and 2 cases of ureteroileal anastomotic strictures were found. DMSA scintigraphy showed no further renal scars. CONCLUSIONS: This preliminary experience was favourable due to overall reduced operating time (about 1 hour 45 minutes to create the orthotopic neobladder and the ureteroileal anastomosis), simplicity of execution and a low complication rate (6.9%) at a median follow-up of 38 months (range 12-52 months).

[Ultrasonography-guided transrectal perineal drainage of retroanastomotic collections in orthotopic neobladder]. / Drenaggio perineale ecoguidato transrettale delle raccolte retroanastomotiche in neovescica ortotopica.

Pelvic collections are not an uncommon complication of pelvic surgery. Usually, such a complications are managed by TC-guided percutaneous drainage or even by more invasive surgical operations. Here, we describe a transperineal TRUS-guided drainage technique of pelvic urinomas occurring after a radical cystectomy (RC) for invasive Bladder Cancer (BC) in two patients, respectively 55 and 77 YOM. Respectively, 10 and 20 days after catheter had been taken out patients began complaining a severe pelvic pain associated to fever (over 40 degrees C). Physical examination and an ultrasound, followed by a CT-scan, showed a huge retroanastomotic pelvic urinoma (width over 10 cm). CT-guided percutaneous drainage was considered at increased risk of iatrogenic injury of mesenterial neobladder because of its location. A TRUS-guided percutaneous perineal drainage of urinomas with a pig-tail 8 ch was carried out. Urinomas were successfully drained and no significant complications were encountered. At a median follow-up of 11 months no late complications were found. Our preliminary experience with this procedure is favourable regarding mininvasivity, lack of complications and its feasibility by urologists themselves. Its impact on cost/benefit rate is favorable too. We believe that this technique might be considered as an alternative to CT-guided percutaneous drainage.