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Introduction: Sexual function after colorectal surgery is a largely ignored topic. In patients being treated for colon and rectal cancers, the risk of sexual dysfunction after surgery is high and is influenced by multiple factors., Aim: To examine the factors involved with sexual dysfunction after colorectal surgery and review gender-specific sexual complaints most reported on in the literature., Methods: A comprehensive review of peer-reviewed publications on the topic was performed through a PubMed search. Key search terms and phrases included colorectal surgery, sexual dysfunction, risk factors, cancer, erectile dysfunction, dyspareunia, and counseling., Main Outcome Measures: The main outcome measures were gender-specific sexual complaints after colorectal surgery and risk factors involved., Results: The type of excision and surgical technique strongly influences sexual dysfunction risk, where newer nerve-preserving techniques seem to be associated with better sexual outcomes in contrast to more extensive surgeries. Adjunctive radiotherapy negatively affects sexual health when combined with surgical resection. The most common postoperative sexual complaints reported by men include erectile dysfunction, ejaculatory dysfunction, and dysorgasmia, whereas for women dyspareunia and poor lubrication are common., Conclusions: Sexual morbidity after treatment for colorectal cancer is common and inadequately addressed by healthcare providers in the preoperative setting. Towe M, Huynh LM, El-Khatib F, et al. A Review of Male and Female Sexual Function Following Colorectal Surgery. Sex Med Rev 2019;7:422-429., (Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Accurate data regarding the size of the erect penis is of great importance to several disciplines working with male patients, but little data exists on the best technique to measure penile length. While some previous small studies have suggested good correlation between stretched penile length, others have shown significant variability. Penile girth has been less well studied, and little data exist on the possible errors induced by differing observers and different techniques. Much of the published data report penile length measured from the penopubic skin junction-to-glans tip (STT) rather than pubic bone-to-tip (BTT). We wished to assess the accuracy of different techniques of penile measurements with multiple observers. Men who achieved full erection using dynamic penile Doppler ultrasound for the diagnosis of sexual dysfunction or a desire for objective penile measurement were included in the study. Exclusion criteria were penile scarring, curvature, or congenital abnormality. In each case, the penis was measured by one of the seven andrology specialists in a private air-conditioned (21 °C) environment. Each patient had three parameters measured: circumference (girth) of the penile shaft, length from suprapubic skin-to-distal glans (STT), and pubis-to-distal glans (BTT). The three measurements were recorded in the stretched flaccid state, and the same three measurements were then repeated in the fully erect state, following induction of full erection with intracavernosal injection. We analyzed the accuracy of each flaccid measurement using the erect measurements as a reference, for the overall patient population and for each observer. In total, 201 adult men (mean age 49.4 years) were included in this study. Assessing the penis in the stretched and flaccid state gave a mean underestimate of the erect measurement of ~20% (STT length 23.39%, BTT length 19.86%, and circumference 21.38%). In this large, multicenter, multi-observer study of penis size, flaccid measurements were only moderately accurate in predicting erect size. They were also significantly observer dependent. Measuring penile length from pubic bone to tip of glans is more accurate and reliable, the discrepancy being most notable in overweight patients.

Purpose: We performed a meta-analysis of published series of laparoscopic and open pyeloplasty. We compared these data to open pyeloplasty at our institution using diuretic renography as the indicator for obstruction and postoperative success., Materials and Methods: Laparoscopic studies included 19 series published between 1995 and 2007 comprising 346 kidneys. Open pyeloplasty studies included 9 series published between 1998 and 2007 comprising 486 kidneys. Data from our institution included records for 213 patients (224 kidneys). We defined reoperative intervention as unplanned placement of a nephrostomy tube or ureteral stent, balloon dilation or redo pyeloplasty., Results: In the laparoscopic studies 171 cases (49%) were evaluated by preoperative and 137 (40%) by postoperative diuretic renography. Of patients undergoing postoperative diuretic renography 10 (7%) underwent reoperative intervention, including redo pyeloplasty (6, 4%), nephrostomy (3, 2%) and balloon dilation (1, 1%). In the open pyeloplasty studies performed elsewhere 165 cases (34%) were evaluated by preoperative and 230 (47%) by postoperative diuretic renography. Of patients undergoing postoperative diuretic renography redo pyeloplasty was required in 3 (1%). Of 224 cases managed by open pyeloplasty at our institution 215 (96%) had preoperative and postoperative diuretic renography data available. Of these patients 7 (3%) underwent reoperative intervention, including redo pyeloplasty (4, 2%), ureteral stent (2, 1%) and nephrostomy (1, 0.4%)., Conclusions: Most publications do not confirm preoperative obstruction or, following laparoscopic or open pyeloplasty, postoperative success via diuretic renography. While not statistically significant, in the minority of studies with postoperative diuretic renography results the reoperative intervention rate and redo pyeloplasty rate following laparoscopy are approximately double those of open pyeloplasty.

Objectives: To determine whether the presence of a median lobe can be predicted preoperatively and whether its presence affects postoperative urinary function and immediate pathologic outcomes after robot-assisted radical prostatectomy., Methods: A retrospective review of 345 consecutive patients who underwent robot-assisted radical prostatectomy at our institution from August 2004 to March 2007 was performed. Of these 345 patients, 29 (8%) were found at surgery to have a median lobe. All 29 patients were compared with 29 consecutive patients without a median lobe in terms of preoperative parameters, intraoperative parameters, and the pathologic and clinical outcomes., Results: Of the preoperative parameters, the two groups were similar in age, race, preoperative Gleason score, and urinary bother score. Of the 10 patients with a median lobe who had undergone preoperative computed tomography scans, 7 (70%) had a visible median lobe. The presence of a median lobe did not increase the operative time required for bladder neck dissection or anastomosis (including reconstruction). Of the 29 patients with a median lobe, 16 (55%) required bladder neck reconstruction compared with 1 (4%) without a median lobe. Postoperatively, the two groups had similar Gleason score, but patients with a median lobe had larger prostates (60 cm(3) versus 26 cm(3); P = 0.003). The surgical margins were similar between the two groups. No significant difference was found in the postoperative urinary bother score or the interval to social or perfect continence between the two groups., Conclusions: The results of this study have shown that the presence of a median lobe does not alter the outcomes in patients who undergo robot-assisted prostatectomy.