Non-Tensile Tunica Albuginea Plication for the Correction of Penile Curvature

Objective: To evaluate the efficacy of non-tensile tunica albuginea plication (NTTAP) using nonabsorbable sutures for the correction of congenital and acquired penile curvature and to determine the key points for a successful outcome of this procedure. Patients and Methods: From June 2004 to July 2007; 43 patients with penile curvature (35 congenital and 8 secondary to Peyronie's disease) underwent surgical correction by NTTAP. The indications were difficult or impossible vaginal penetration; and a cosmetically unacceptable penis. For tunica albuginea plication (TAP) we applied the 16 dot procedure using non-absorbable sutures (Tycronr 2/0 polyester fiber). Results: After a mean follow-up period of 18 months; successful results with respect to penile straightening; normal erection; penetration and sensation; confirmed both subjectively and objectively; were achieved in all patients. Post-operative penile shortening of less than 1.5 cm was present in 50of the cases; but did not affect intercourse. Post-operative complications were mild and reversible; they consisted of penile skin necrosis after circumcising incisions and post-operative pain upon nocturnal erection that subsided after a few weeks with the frequent use of ice compresses. The overall satisfaction rate was nearly 100(35/43 very satisfied and 8/43 satisfied). Conclusion:NTTAP is a simple and effective method for the correction of congenital and acquired penile curvature. The key points for successful appropriate expectations; and careful discussion of the location of the suture sites. There is no need for mobilization of the urethra or neurovascular bundle; which adds a great advantage to this easy and simple technique. Cutting through the tunica albuginea; which may prevent postoperative erectile dysfunction; is not necessary. A disadvantage of this procedure is that it cannot correct hour-glass deformity

Alemtuzumab induction and sirolimus plus mycophenolate mofetil maintenance for CNI and steroid-free kidney transplant immunosuppression.

We performed a pilot study in which 22 kidney recipients (14 LD: 8 DCD) were given alemtuzumab induction (30 mg day 0 and 1), steroids (500 mg mp day 0 and 1, none thereafter), mycophenolate mofetil (MMF) maintenance (500 mg b.i.d) and sirolimus (concentration controlled 8-12 ng/mL). With a mean follow-up of 15.9 months, patient survival is (21/22) 96% and graft survival (19/22) 87%. Acute rejections occurred in (8) 36.3% (two humoral). Of 19 surviving grafts, 18 (95%) remain steroid and 15 (79%) CNI-free. At 1 year, mean creatinine was 1.43 mg/dL. Overall infection rates were low, but 2 patients developed severe acute respiratory distress syndrome (ARDS) at month 3 and 7, respectively, resulting in mortality in one and a graft loss in the other. No cancer or PTLD was observed. Leukopenia was common and MMF dose was reduced or eliminated in 6/22 (27%) patients. The reported higher than expected rate of acute rejection, leukopenia and possible pulmonary toxicity suggests excessive morbidity. Modifications such as an initial period of CNI use should be considered.

Whole-mount prostate sections reveal differential endoglin expression in stromal, epithelial, and endothelial cells with the development of prostate cancer.

Endoglin is a nonsignaling receptor for transforming growth factor that contributes to the action of this growth factor in diverse cell types. It may also exhibit a function of its own. Endoglin levels vary with disease states and is a marker of new blood vessels. We studied endoglin expression in whole-mount prostate sections from 64 patients with localized prostate cancer, assessing reactivity in the epithelium, the stroma, and blood vessels. Cells in normal/benign acini were negative but significantly immunoreactive (P<0.001) in both prostatic intraepithelial neoplasia (PIN; 52% of cases) and malignant areas (77% of cases). In tumors, this involved less than 25% of malignant cells in 59% of specimens. The endoglin-stained stroma was detected mainly in areas surrounding PIN acini and tumors. Endoglin antibodies detected more microvessels than von Willebrand Factor antibodies in all prostatic areas (P<0.01). In addition, the number of microvessels increased with the development of cancer and correlated with Gleason score (P<0.01). Changes in endoglin expression in PIN and malignant cells, the surrounding stroma, and related blood vessels, suggest that endoglin function may be altered in prostate cancer.

Mechanism of continence after repair of post-traumatic posterior urethral strictures.

OBJECTIVES: To determine the mechanism of urinary continence after repair of post-traumatic posterior urethral strictures by perineal anastomotic urethroplasty. METHODS: Two groups of male patients were enrolled in this study. Group 1 consisted of 8 patients (mean age 31 years) who had undergone bulboprostatic anastomotic urethroplasty for strictures complicating a pelvic fracture urethral disruption. Group 2 consisted of 8 patients (mean age 32.5 years) with a normal urethra who were used as controls. All 16 patients underwent urethral pressure profilometry both at rest and with cough and hold maneuvers. RESULTS: In group I, urethral pressure profilometry showed much lower mean maximal urethral pressures and maximal urethral closure pressures, as well as a much shorter mean functional profile length than in group 2 (48 and 39 cm H(2)O versus 75 and 65 cm H(2)O and 2.4 versus 4 cm, respectively, P <0.0003). On cough maneuver, intra-abdominal pressure changes were transmitted along the entire functional profile length in group 1 and only along its first part in group 2. The hold maneuver increased urethral pressure in 5 patients (65%) in group 1 and in all 8 patients (100%) in group 2. CONCLUSIONS: Continence after anastomotic urethroplasty for post-traumatic posterior urethral strictures is maintained solely by the proximal urethral mechanism. Transmission of intra-abdominal pressure changes and contraction of pelvic floor musculature may augment urethral closure in these cases during stress conditions.