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Since ancient times, men have tried to change the size and shape of their genitals. Bites from insects or poisonous snakes and weights were among the first methods used for this purpose. In the first half of the 1900s, the scientific push regarding male genital aesthetic surgery began. Scrotoplasty, penile suspensory ligament release, injection of hyaluronic acid as filler, use of several types of grafts, lipofilling, and liposuction are techniques currently used. The Penuma® implant has recently been described with promising results. We are living in the era of tailored surgery and regenerative medicine. Shortly the surgeons will have to know several surgical techniques and adapt them to the patient. New fillers with ideal characteristics, innovative prosthetic devices, and stem cells will probably be the protagonists of future aesthetic surgery. The main effort of the scientific community should be directed towards the design of new randomized controlled trials to increase the evidence on the efficacy and safety of the topic, with the ultimate aim of allowing clear recommendations from scientific societies.

Objective The aim of this study was to compare the surgical, anatomical, and functional outcomes of sacrocolpopexy (SCP) using polyvinylidene fluoride (PVDF) mesh versus SCP using the standard polypropylene (PP) mesh. Study design This was a retrospective single centre case-control study including female patients who underwent laparoscopic or abdominal SCP for POP with either PP (Cousin Biotech®) or PVDF (DynaMesh®-PRS) mesh between March 2005 and May 2015. Anatomical outcomes were assessed by the Pelvic Organ Prolapse Quantification (POP-Q) system. Functional outcomes included voiding and storage urinary symptoms (VS and SS, respectively), urgency and stress urinary incontinence (UUI and SUI) and sexual dysfunction (SD). Symptoms and their impact on patients’ quality of life (QoL) were assessed using validated questionnaires as Incontinence Impact Questionnaire (IIQ-7), Urinary Distress Inventory (UDI-6) and Female Sexual Function Index (FSFI). Global patient perception of improvement (PGI-I questionnaire) and mesh erosion rates were also recorded. Results Of the 166 patients enrolled, 136 could be included in the analysis: 73 in the PP group and 63 in the PVDF group. The mean follow-up was 94± 17.31 months for the PP and 25.6± 13.8 months for the PVDF group. There were no statistically significant differences in patient demographics and preoperative clinical characteristics. Postoperative anatomical correction were not significantly different between the two groups. The PVDF group showed superior results in term of storage symptoms (PVDF = 0% versus PP = 8.2%; p = 0.02) and lower rate of sexual dysfunction (PVDF = 0% versus PP = 16,4%; p = 0.001). Only 1 patient in PP group and 2 in PVDF group (p = 0.47) presented a mesh exposure. There was no statistical difference in PGI-I scores (PP = 1.5 ± 1.0 vs PVDF = 1.8 ± 0.5; p = 0.40). Conclusions Our findings suggest that both meshes can be safely and effectively used with good anatomical outcomes. Interestingly, PVDF use was associated with significantly less storage symptoms and sexual dysfunction.

Please cite this paper as: Frajzyngier V, Ruminjo J, Asiimwe F, Barry T, Bello A, Danladi D, Ganda S, Idris S, Inoussa M, Lynch M, Mussell F, Podder D, Barone M. Factors influencing choice of surgical route of repair of genitourinary fistula, and the influence of route of repair on surgical outcomes: findings from a prospective cohort study. BJOG 2012;119:1344–1353. Objective The abdominal route of genitourinary fistula repair may be associated with longer term hospitalisation, hospital-associated infection and increased resource requirements. We examined: (1) the factors influencing the route of repair; (2) the influence of the route of repair on fistula closure 3 months following surgery; and (3) whether the influence of the route of repair on repair outcome varied by whether or not women met the published indications for abdominal repair. Design Prospective cohort study. Setting Eleven health facilities in sub-Saharan Africa and Asia. Population The 1274 women with genitourinary fistula presenting for surgical repair services. Methods Risk ratios (RRs) and 95% confidence intervals (95% CIs) were generated using log-binomial and Poisson (log-link) regression. Multivariable regression and propensity score matching were employed to adjust for confounding. Main outcome measures Abdominal route of repair and fistula closure at 3 months following fistula repair surgery. Results Published indications for abdominal route of repair (extensive scarring or tissue loss, genital infibulation, ureteric involvement, trigonal, supratrigonal, vesico-uterine or intracervical location or other abdominal pathology) predicted the abdominal route [adjusted risk ratio (ARR), 15.56; 95% CI, 2.12–114.00]. A vaginal route of repair was associated with increased risk of failed closure (ARR, 1.41; 95% CI, 1.05–1.88); stratified analyses suggested elevated risk among women meeting indications for the abdominal route. Conclusions Additional studies powered to test effect modification hypotheses are warranted to confirm whether the abdominal route of repair is beneficial for certain women.

Vesicoureteral reflux (VUR) is the most common uropathy affecting children. Compared to children without VUR, those with VUR have a higher rate of pyelonephritis and renal scarring following urinary tract infection (UTI). Options for treatment include observation with or without antibiotic prophylaxis and surgical repair. Surgical intervention may be necessary in patients with persistent reflux, renal scarring, and recurrent or breakthrough febrile UTI. Both open and endoscopic approaches to reflux correction are successful and reduce the occurrence of febrile UTI. Estimated success rates of open and endoscopic reflux correction are 98.1% (95% CI 95.1, 99.1) and 83.0% (95% CI 69.1, 91.4), respectively. Factors that affect the success of endoscopic injection include pre-operative reflux grade and presence of functional or anatomic bladder abnormalities including voiding dysfunction and duplicated collecting systems. Few studies have evaluated the long-term outcomes of endoscopic injection, and with variable results. In patients treated endoscopically, recurrent febrile UTI occurred in 0–21%, new renal damage in 9–12%, and recurrent reflux in 17–47.6% of treated ureters with at least 1 year follow-up. These studies highlight the need for standardized outcome reporting and longer follow-up after endoscopic treatment.

Objectives To evaluate for the first time in the literature the learning curve of Inside-out transobturator tape (TVT-O™). Study design A prospective observational study was conducted in a tertiary reference center. Consecutive women treated by TVT-O™ performed by one surgeon were included. Data regarding subjective, objective cure rates, and adverse events were collected. Trends, over the number of procedures, were estimated using assay analyses. Number of procedures and variables were interpolating in standard curves using linear lines. Results Three hundred and seventy two procedures were included. Postoperative pain levels decreased with the increase in the level of expertise (pain levels: 1-day: from 6.6 (±3.3) to 4.3 (±3.1); 95%CI: −0.01603 to 0.001235, p =0.04; 2-day: from 5.6 (±4.1) to 3.6 (±3.7); 95%CI: −0.02092 to −0.002497, p =0.01; 12-month: from 0.1 (±0.7) to 0 (±0); 95%CI: −0.001814 to 0.05019, p =0.07). Overall, objective cure rate was achieved in 93.5% of patients. Additionally, 88.2% and 88.7% patients reported "much better" feeling at PGI-I scale and 80% reduction in UDI score, respectively. We observed, that delta ICIQ-sf (from 12 (±8.7) to 14 (±6.0); p =0.04) and delta-UDI (from 91% to 97%; p =0.04) improved over the time. Conclusions TVT-O procedure offers excellent outcomes with high objective and subjective cure rates and low complications rate, even at the beginning of the surgeon's learning curve. However, a high experience of the surgeon could significantly improve the subjective cure rate and could reduce postoperative the groin pain.

Background/Aims: The hydrocele rate is very low after microsurgical subinguinal varicocelectomy, but microsurgical expertise is not always available in pediatric centers. We describe a modified technique to reduce the hydrocele rate after subinguinal varicocelectomy performed without an operating microscope. Methods: A retrospective review was performed of 142 non-microsurgical subinguinal varicocelectomies performed at a single pediatric center. In 96 patients, varicocelectomy was combined with the excision and eversion of the tunica vaginalis (‘pre-emptive hydrocelectomy’) while in the remaining 46 cases the vaginalis was left untouched. Results: Pre-emptive hydrocelectomy allowed a significant reduction in the hydrocele rate in comparison to cases in whom the vaginalis was left untouched, hydrocele rate 4.3 vs. 13% (p = 0.04). In patients undergoing preemptive hydrocelectomy, hydrocele occurred in 3 of 54 (5.5%) cases in whom the vaginalis was only excised and only 1 of 42 (2.4%) in whom it was also everted. No testicular complications were observed. Conclusions: In centers performing subinguinal varicocelectomy without the aid of an operating microscope, preemptive hydrocelectomy with eversion of the vaginalis might be offered as an adjunctive treatment with limited associated morbidity that might be able to reduce the incidence of postoperative hydrocele.

Objectives We report the results of a 4-month survey implemented at the urologic clinic of an Italian university hospital, with the following aims: (1) to describe the incidence of nosocomial infections (NI) in our setting for comparison within and between urologic wards and (2) to provide relevant information to monitor and target infection control policies. Methods A 4-month prospective survey was performed from April to July 2004, preceded by the 1-month surveillance pilot study; both performed in accordance with the methods, protocols and definitions of the National Nosocomial Infections Surveillance System. The following indicators were included site-specific incidence rates and device-adjusted infection rates. For surgical site infections, rates were calculated by operative procedure and risk index category. Antimicrobial usage was also monitored. Results Incidence of symptomatic urinary tract infections was 1.4 per 1000 patient-days, 1.3 per 100 catheterized patients and 3.0 per 1000 urinary catheter-days. Incidence and incidence density of surgical site infections were respectively 1.3 per 100 patients and 1.8 per 1000 patient-days. Conclusions Our study represents a contribution to improve the quality of care in our urologic ward by monitoring the size of the NI problem using standardized definitions, data collection and indicators to compare the results of the unit with possible future ones, and by identifying practices that should be changed. This study supports close surveillance of antibiotic administration among urologists who may be unaware of the inappropriate antibiotic administration in their patients. Two major items were identified for planning future intervention: focusing on the use of closed urinary drainage systems and on appropriate antimicrobial prophylaxis.

QUESTION: A 3-year-old boy is seen in a medical student-run clinic at a transitional housing village for homeless families. He is brought in by his mother for a routine well-child visit. The child is reported to be healthy, and his immunization status is up to date. The child is playful and cooperative during the examination. His weight and height are normal for his age. Auscultation of his heart and lungs elicits no abnormalities. Examination of the genitalia reveals a circumcised penis and scrotum without palpable testes. What would you do now? ANSWER: Attempt to palpate the testes in both inguinal canals. A sweep of the inguinal regions reveals both testes elevated. When the examiner manipulates the left testis into the scrotum, it immediately ascends to its original position upon release. The right testis cannot be manipulated downward and stays fixed in the inguinal region. QUESTION: What is the diagnosis for these findings, for what conditions is the boy at increased risk, and what is the appropriate treatment, if any? ANSWER: The boy has an undescended right testis and an ectopic left testis. He is at increased risk for testicular cancer, future infertility, and possibly testicular torsion and inguinal herniation.1 Hormonal or surgical intervention, or orchiopexy, is indicated.1

Contains fulltext : 153675.pdf (Publisher’s version ) (Open Access) The repair of cloacal malformations is most often performed using a posterior sagittal anorecto-vagino-urethroplasty (PSARVUP) or total urogenital mobilization (TUM) with or without laparotomy. The aim of this study was to systematically review the frequency and type of postoperative complication seen after cloacal repair as reported in the literature. A systematic literature search was conducted according to preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA). Eight records were eligible for this study which were qualitatively analyzed according to the Rangel score. Overall complication rates reported in included studies ranged from 0 to 57 %. After meta-analysis of data, postoperative complications were seen in 99 of 327 patients (30 %). The most common reported complications were recurrent or persistent fistula (n = 29, 10 %) and rectal prolapse (n = 27, 10 %). In the PSARVUP group, the complication rate was 40 % and in the TUM group 30 % (p = 0.205). This systematic review shows that postoperative complications after cloacal repair are seen in 30 % of the patients. The complication rates after PSARVUP and TUM were not significantly different. Standardization in reporting of surgical complications would inform further development of surgical approaches. Other techniques aiming to lower postoperative complication rates may also deserve consideration.

Introduction and hypothesis Two types of laparoscopic vesicovaginal fistula (VVF) repairs, the traditional transvesical (O’Conor) and extravesical techniques, dominate the literature. We present our 15-year experience of primary and recurrent cases of VVF utilizing an extravesical technique, which we first described in 1999. Methods An IRB approved retrospective study revealed 44 female patients with either primary or recurrent VVF. Laparoscopic extravesical repair was performed without an omental flap in the majority of cases. A three-layer closure technique was performed utilizing a double-layer bladder closure and a single-layer vaginal closure followed by bladder testing. A suprapubic catheter was utilized for 2–3 weeks postoperatively for bladder decompression. Results A review of our experience reveals a 97 % (32 out of 33) cure for primary VVF and 100 % (11 out of 11) rate for recurrent fistulas, with an overall cure rate of 98 % (43 out of 44) at a mean follow-up of 17.3 months (range 3–64). An omental flap was not utilized in 98 % of patients (43 out of 44), with a success rate of 98 % (42 out of 43). The mean estimated blood loss was 39 mL (range 0–450), mean hospital stay was 1.1 days (range 1–3), and none of the patients suffered any major intra- or postoperative complications. None of the patients required a conversion to open laparotomy. Conclusions Based upon our experience we believe that performing laparoscopic extravesical VVF repair using a three-layer closure technique without an interposition omentum is a safe, effective, minimally invasive technique with excellent cure rates in an experienced surgeon’s hands.