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Lichen sclerosus (LS) is a chronic inflammatory skin condition that can cause debilitating sexual and urinary sequelae in men and women. In this review, we discuss the etiology, clinical presentation, and management options for genital LS. While medical and surgical management of LS has remained similar for quite some time, techniques such as the Kulkarni urethroplasty have made one stage reconstruction for panurethral LS strictures more feasible. Perineal urethrostomy has become an increasingly preferred treatment modality for complex LS patients. Current LS research has focused on the pathophysiology of the LS at the protein level and possible targets for treatment. While exact etiology of LS remains unknown, many theories have been hypothesized. The mainstay of medical treatment includes topical steroids. Various reconstructive techniques may be used depending on patient symptoms, extent of involvement, and the location of disease. Non-genital skin grafts, such as buccal mucosa, are recommended in LS patients requiring grafting for urethral reconstruction. Genital skin flaps are not recommended, as they have a high failure rate in this setting. Long-term follow-up is recommended, as LS can be associated with the development of squamous cell carcinoma.

To review risk factors for AUS complications and present a systematic approach to their diagnosis and management. Established risk factors for AUS complications include catheterization, channel TURP, pelvic radiation, urethroplasty, anticoagulation, cardiovascular disease, diabetes mellitus, frailty index, hypertension, low albumin, and low testosterone. We present our algorithm for diagnosis and management of AUS complications. Despite being the gold standard of treatment for men with SUI, major and minor complications can occur at any point after AUS insertion. Careful consideration of the urologic, medical, and operative risk factors for each patient can help prevent complications. A systematic approach to early and late complications facilitates their identification and effective management. The evaluating urologist must have a thorough understanding of potential AUS complications in order to restore quality of life in men with bothersome SUI.

To discuss mechanical and surgical innovations in inflatable penile prosthesis (IPP) surgery and their implications on reservoir placement and patient outcomes. The past decade has seen a new emphasis on optimizing outcomes and minimizing complications associated with IPP reservoirs. Innovations in device design have accordingly yielded safer, more durable IPP outcomes over the past four decades. Modifications in surgical approach for reservoir placement abound for both traditional space of Retzius and ectopic reservoir placement techniques. Surgical and medical history, patient anatomy, and patient preference should all be considered when choosing approach for IPP reservoir placement. Prosthetic urologists should be proficient in multiple approaches to provide the best care to their patients.

Keywords Focalrelapse .ProstatecancerC.H.isan80-yearoldman.In1992atage59,hewasingoodgeneral health and was found by his private urologist to haveanabnormalDREwithfirmnessoftheentirerightlobeandattheapexoftheleftlobeoftheprostate.HisPSAwas30ng/ml.A bone scan was negative for metastases. Sextant TRUSprostate biopsies revealed“moderately differentiatedprostate adenocarcinoma in 6/6 biopsies.” The TRUSimages showed distinct borders and definition of thebladder base, the prostate, and the seminal vesicles.LHRH analog androgen deprivation therapy was initiated,and C.H. was referred to UT Southwestern Medical Centerfor further treatment.Repeat DRE revealed that the prostate was mobile, but theentire right lobe was firm, and the firmness seemed to extendinto the base of the right seminal vesicle. The left apex of theprostatewasalsofirm.C.H.wasthoughttohaveclinical-stagebulky T2 or early T3 disease. Following discussion of thedisease natural history and all treatment options then avail-able, C.H. elected to undergo open radical retropubic prosta-tectomyandlymphnodedissectiononOctober22,1992.Thepathology report showed Gleason 3+4+7 prostate cancer,stage pT3aN0Mx. Tumor focally invaded the capsule on theright side, but all margins and all 19 resected lymph nodeswere negative. Postoperative PSA was undetectable(

A compromise in erectile function is commonly experienced after radical prostatectomy and has been attributed to injury to vascular, neurogenic, and smooth muscle. The concept of rehabilitation after organ injury is not a novel concept and is one that has been applied to all aspects of medicine. Penile rehabilitation has been classically defined as the use of a device or pharmacologic agent to aid erectile function recovery after radical prostatectomy. Here we redefine penile rehabilitation as the use of any device, medication, or intervention to promote male sexual function as a primer before and after any insult to the penile erectile physiologic axis. We also review the epidemiology, rational and current literature on penile rehabilitation after prostatectomy.