Surgical outcomes and complications of Tube® (Promedon) malleable penile prostheses in diabetic versus non-diabetic patients with erectile dysfunction.

OBJECTIVE: To evaluate surgical outcome, complications, and patients satisfaction with the Tube® (Promedon, Cordoba, Argentina) malleable penile prosthesis in diabetic and non-diabetic patients with refractory erectile dysfunction (ED). PATIENTS AND METHODS: The records of 128 eligible patients who received Tube malleable penile prostheses at our institute between September 2008 and October 2015 were reviewed. RESULTS: Of the 128 patients, who received Tube penile prostheses at our institute, 53 were diabetics and 75 were non-diabetics. Both groups of patients were comparable for mean age, education level, marital status, hospital stay, time to commencing sexual intercourse, and median follow-up. Complications included: inter-corporeal septal perforation (2.3%), glanular urethral injury (1.5%), acute urinary retention (3.9%), superficial wound infection (7%), penile discomfort (9.4%), and penile prostheses infection (5.5%). Moreover, 3.9% developed atrophy of the cavernosal tissue, 5.5% experienced bad cosmesis, 6.3% experienced ejaculatory disorders, and 2.3% developed bladder calculi. In all, 13 prostheses (9.4%) were removed, seven of them due to infection, three on the patients' demand and three due to mechanical failure. The satisfaction rates with the prostheses were 77.3% and 79.4% in the diabetic and non-diabetic patients, respectively; with an overall satisfaction rate of 78.5%. There was no significant difference in the complication rate or prostheses infection between diabetic and non-diabetic patients. CONCLUSION: Tube malleable penile prostheses are associated with low complication and high satisfaction rates. There was no significant difference in the complication rate or prostheses infection between diabetic and non-diabetic patients. A prospective comparative study with a large number of patients is recommended.

Adjustable vs. ordinary transobturator tape for female stress incontinence. Is there a difference?

OBJECTIVES: To determine whether there are any significant differences in complications and success rate between adjustable transobturator tape (TOA) and ordinary transobturator tape (TOT) in the treatment of female stress urinary incontinence (fSUI), as the TOA was recently introduced for the treatment of female SUI, its advantage being the ability to adjust the tape after surgery to address over- or under-correction. PATIENTS AND METHODS: In all, 96 women with SUI (mean age 53 years, SD 10) were included in the study. Patients were randomised into two equal groups (group 1, TOA, vs. group 2, TOT). The operative duration, blood loss, intra- and post-operative complications, and the success rate, were compared between the groups. RESULTS: There was no statistically significant difference between the groups in cure rates (83% vs. 80%, groups 1 and 2, respectively) or in postoperative stay. The mean operative duration in group 2 was significantly shorter than in group 1. No intraoperative bleeding requiring a blood transfusion was recorded, and there were no bladder injuries. Postoperative adjustment of the tape was only required in three patients in group 1. CONCLUSIONS: The TOA is a safe and accurate method for treating fSUI, but with experienced surgeons there was no difference in the cure rate and postoperative outcome between TOA and TOT.

Reduced expression of erythropoietin-producing hepatocyte B6 receptor tyrosine kinase in prostate cancer.

Loss of erythropoietin-producing hepatocyte (Eph) B6 gene expression is associated with poor prognosis in neuroblastoma, melanoma and other tumors. The present study evaluated the expression of EphB6 receptor tyrosine kinase in normal and prostate cancer tissue using immunohistochemistry. The association between EphB6 expression, clinicopathological findings, proliferating-cell nuclear antigen (PCNA; another prognostic marker) and progression of prostate cancer was analyzed. Tissue microarray samples of normal prostatic tissue and prostate cancer tissue from 46 patients treated with radical prostatectomy for prostate cancer were included in this study. Polyclonal anti-EphB6 and monoclonal anti-PCNA antibodies were used to assess EphB6 and PCNA expression by immunohistochemistry. EphB6 was expressed in normal and prostate cancer tissue; however, its expression was significantly reduced in prostate cancer tissue compared with normal prostatic tissue (P<0.0001), in high volume (≥4 cm3) cancer compared with low volume (<4 cm3; P=0.015), and in pT3 stage compared with pT2 stage of the disease (P=0.0007). No correlation was observed between the expression of EphB6 and PCNA. Short biochemical progression-free survival was associated with low EphB6 protein expression (P=0.157). This study revealed that EphB6 may have a tumor suppressor effect in prostate cancer, at least during early stages of this disease. This provides new insight into the potential utility of EphB6 receptor as a diagnostic/prognostic marker for prostate cancer.

Cystoscopically guided percutaneous suprapubic cystolitholapaxy in children.

PURPOSE: To evaluate the safety and efficacy of endoscopically guided percutaneous suprapubic artery forceps litholapaxy for pediatric vesical and posterior urethral stone <1 cm in diameter. MATERIALS AND METHODS: A retrospective series study of 73 children (68 boys and 5 girls) with vesical and urethral stones less than 1 cm in diameter with an average age of 3.5 years (range 1-9 years) were included in this study. Cases with previous suprapubic surgery, stones of more than 1 cm in diameter, multiple bladder or urethral stone, anterior urethral stones and cases with neurological or anatomical abnormalities were excluded from our study. The bladder was filled and punctured suprapubically by an artery forceps under the vision of the pediatric cystoscopy then the stone is completely crushed. All intraoperative and postoperative complications were recorded. The stone-free rate status was evaluated 2 weeks postoperatively using plain X-ray/ultrasonography. RESULTS: All cases were successful, and the stones were completely crushed to smaller insignificant fragments in a single session. No intraoperative bladder perforation or bleeding was recorded. The mean operative time was 12.5 min (ranging from 9 to 17 min). There were no postoperative complications apart from 2 cases of persistent suprapubic leakage postoperatively for 24 h and the leakage stopped after 48 h with the insertion of 8 Fr Foley catheter. In all cases, no significant stone fragments were found 2 weeks postoperatively. CONCLUSION: Our technique for management of pediatric vesical and posterior urethral stone less than 1 cm is an easy and safe with no intraoperative or postoperative significant complications.

Modified N-shaped ileal neobladder after radical cystectomy.

OBJECTIVE: We report on the feasibility and outcomes of the N-shaped pouch with an afferent tubular isoperistaltic segment as a new technique for creating a capacious, low pressure bladder substitute following radical cystectomy. METHODS: Between April 2000 and April 2006, 42 patients (36 male, 6 female) with invasive bladder cancer were considered good candidates for orthotopic urinary diversion. All had radical cystectomy with bilateral pelvic lymphadenectomy and orthotopic bladder substitution by an ileal low pressure reservoir (N-shaped) with an afferent isoperistaltic tubular segment. Of the 42 patients, 36 (86%) had squamous cell carcinoma; 6 had transitional cell carcinoma. None of the patients had positive lymph nodes after pathologic examination of the specimen. The patients were available for a median follow-up period of 24.8 months. Follow-up included clinical and radiographic studies to determine functional and oncological outcomes. RESULTS: Eleven patients (26.2%) had early complications during the period ≤ 3 months following surgery. Seven of these patients had complications such as wound infection, prolonged ileus, persistent urinary leakage, and deep venous thrombosis that were treated conservatively. One female patient developed a pouch-vaginal fistula that required repair. The remaining 3 patients had oncologic failures, 1 of which was isolated urethral recurrence. Late complications occurred in 15 patients (35.7%). These included pouch stones, outflow obstruction, mucus retention, and adhesive bowel obstruction. Daytime and night-time continence was achieved in 92% and 80% of the patients, respectively, and ureteroileal stricture was observed in 5%. The upper tracts remained unchanged or improved in nearly 95% of the patients. CONCLUSIONS: Ileal orthotopic bladder substitution (N-shaped) with an afferent ileal tubular segment offers good functional results with good preservation of the renal units. It is considered a safe and technically feasible surgical procedure.