Search

Purpose of review To review the current literature and guidelines regarding salvage therapy for local and regional recurrence of primary penile cancer. Recent findings While invasive surgical management has not significantly changed, penile sparing treatments (PSTs) may have a promising role in the management of local recurrence. Penile sparing surgeries do appear to have higher rates of recurrence. However, the overall survival rate is comparable to that of partial and total penectomies. Additionally, a combination of therapies may have a more profound effect on management of penile cancer. Summary Clinicians must discuss the role of each type of therapy for penile cancer with their patients, and tailor their management to the extent of disease in each patient. While it is important to discuss the balance between quality of life and rates of relapse, one must also emphasize the rates of overall survival in patients with local recurrence who are treated with PSTs.

Objectives To determine the role of slings and artificial urinary sphincters (AUS) in the management of mild and moderate stress urinary incontinence (SUI). Methods A retrospective review of our single-surgeon male SUI database was completed. Men having AUS or AdVance sling procedures between 2008 and 2019 were included in the analysis. Those with severe incontinence and/or incomplete pre- or postoperative data were excluded. All patients were evaluated by standing cough test and stratified according to the Male Stress Incontinence Grading Scale. Scores of 0-1 and 2-3 defined mild and moderate SUI, respectively. We performed 2 analyses: (a) sling outcomes were compared between mild vs moderate SUI patients, and (b) for men with moderate SUI, we compared outcomes between slings and AUS. Treatment failure was defined as >1 pad per day or need for subsequent incontinence procedure. Results Among 202 sling cases, those with mild SUI had significantly higher success rate (69/88, 78%) than those with moderate SUI (72/114, 63%; P = .02). Among the 179 men with moderate SUI, those who underwent AUS had significantly higher success rate (52/65, 80%) than those who underwent sling (72/114, 63%; P = .02). Conclusion Male slings are more effective for men with mild SUI than for men with moderate SUI. Men with moderate SUI have a higher success rate with AUS than with sling.

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.

BACKGROUND: The transcorporal (TC) artificial urinary sphincter (AUS) has traditionally been utilized in high-risk patients with urethral atrophy or prior urethral erosion. The 3.5 cm AUS cuff has been developed for use in a similar population. We compared the outcomes of TC AUS and 3.5 cm cuff patients to assess whether the TC approach was protective against urethral complications. METHODS: We performed a retrospective review for all men who underwent TC AUS and 3.5 cm AUS implantation by a single surgeon from 2007 to 2018 at a tertiary medical center. Demographic and outcomes data were collected and analyzed after database review to evaluate for rates of urethral erosion. Multivariate logistic regression was performed to identify co-morbid factors associated with urethral erosion. RESULTS: In our database of 625 AUS patients, we identified 59 (9%) men with TC AUS and 168 (27%) having a 3.5 cm cuff. Over a median follow-up time of 49 months, 28 (47%) men with TC cuffs developed urethral erosion compared with 25 (15%) men with a 3.5 cm cuff. On univariate analysis, a TC cuff was associated with increased odds of erosion (OR 6.65, 95% CI: 3.20–14.4, P

AIMS To examine the rate of lower urinary tract complications (LUTC) and urinary diversion (UD) after artificial urinary sphincter (AUS) explantation with the acute reconstruction of AUS cuff erosion defects. METHODS We performed a retrospective study of patients who underwent in-situ urethroplasty (ISU) for AUS cuff erosion from June 2007 to December 2020. Outcomes included LUTC (urethral stricture, diverticulum, fistula), AUS reimplantation, and UD. Defect size was prospectively estimated acutely and a subanalysis was performed to determine the impact of erosion severity (small erosions [

Introduction Current management of ischemic priapism revolves around 3 principles: resolving the acute event, preserving erectile function, and reducing the risk of future recurrences. Although more conservative management options, such as aspiration, irrigation, and surgical shunts, are effective in many patients, those who are refractory to these interventions or have prolonged priapism may benefit from placement of a penile prosthesis (PP). Aim To provide a comprehensive overview of priapism management, highlight the current literature on the utility of penile implants for refractory priapism, and provide insight from a high-volume center on surgical decision making and technique. Methods A complete review of the current guidelines and associated literature was performed. Associated algorithms were evaluated, and our experience was overlaid on the data present in the literature. Main Outcome Measures The current management algorithm for priapism was evaluated. Subsequently, the data on acute and delayed PP placement were assessed. Rates of postoperative infection, erectile dysfunction, and patient satisfaction were also examined. Results Overall, both delayed and early PP implants are associated with higher rates of failure than routine PP implants. In patients with refractory or prolonged priapism, early implantation may be technically easier, with decreased loss of penile length and associated complications. Conclusion Patients should be evaluated on an individual basis and counseled on the risks and benefits of PP implantation in early and delayed time frames. Although there is no definitive evidence at this time regarding the ideal device or timing of implantation, there are well-established pros and cons of malleable vs inflatable prostheses and of acute vs delayed implantation.

Introduction Many men suffering from erectile dysfunction are overweight with generous suprapubic fat pads, which often contribute to a decrease in visible exophytic phallic length. Aim To present a novel surgical concept of suprapubic fat pad excision with a concomitant placement of inflatable penile prosthesis. Methods A transverse incision begins slightly medial to the anterior superior iliac spine, with the superior edge crossing transversely to the contralateral anterior superior iliac spine. The inferior border is incised in a curvilinear fashion, with the medial apex being approximately 1 cm above the base of the penis. Dissection is carried down to the lower abdominal anterior fascia, which leads to excision of the suprapubic fat pad. Using this same exposure, the inflatable penile prosthesis (IPP) is placed via an infrapubic approach. The wound is reapproximated in multiple layers, and 2 drains are placed, 1 subcutaneous in the area of the fat pad excision and the other in the scrotum around the pump. Main Outcome Measures Primary outcomes included penile implant functionality, ability to engage in sexual activity, and cosmetic satisfaction. Results A total of 8 patients have undergone suprapubic fat pad excision with simultaneous placement of IPP at our institution. Average body mass index of our patient cohort was 36.6. 1 patient developed prosthetic infection after inadvertent removal of his drains in the immediate postoperative period. At last follow-up, all other patients have excellent cosmetic and functional outcomes. Clinical Implications This technique can lead to higher patient satisfaction with their penile implant, enhanced sexual performance, and improved quality of life for patients with concurrent erectile dysfunction and significant suprapubic fat pad. Strengths & Limitations This unique technique has never been previously described. It allows placement of IPP in the setting of fat pad excision without any additional incisions. Limitations include the small patient population and relatively short follow-up. Conclusions Suprapubic fat pad excision is a safe and reproducible technique that can be performed simultaneously with the placement of an IPP in appropriately selected patients. Patients must be counseled appropriately on the expectations of surgeries and the theoretical increased risk of postoperative complications, such as infection.

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 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.

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.

Background Over the past decade, high submuscular (HSM) placement of inflatable penile prosthesis (IPP) reservoirs has emerged as a viable alternative to space of Retzius (SOR) placement; however, data comparing the feasibility and complications of HSM vs SOR reservoir removal do not presently exist. Aim To present a comparison of the safety, feasibility, and ease of removal of HSM vs SOR reservoirs in a tertiary care, university-based, high-volume prosthetic urology practice. Methods Data were retrospectively collected on patients who underwent IPP reservoir removal between January 2011 and June 2020. Cases were separated into 2 cohorts based on reservoir location. Statistical analysis was performed using Fisher's exact and Chi-squared tests for categorical variables and Student's t-test for continuous variables. Timing from IPP insertion to explant was compared between the HSM and SOR groups using the Mann-Whitney U test. Outcomes Time from IPP insertion to explant, operative time, intraoperative and postoperative complications, and need for a counter incision were compared between the HSM and SOR groups. Results Between January 2011 and June 2020, 106 (73 HSM, 33 SOR) patients underwent IPP removal or replacement by a single surgeon at our institution. Average time from IPP insertion to removal was 43.6 months (24.2 HSM, 52.7 SOR, P = .07)—reservoir removal occurred at the time of device explant in 70 of 106 (66%) cases. More HSM reservoirs were explanted at the time of IPP removal compared with the SOR cohort (54 of 73, 74% HSM vs 16 of 33, 48.5% SOR, P = .01). Similar rates of complications were noted between the HSM and SOR groups (1.9% vs 6.3%, P = .35). There was no significant difference in need for counter incision between the 2 groups (24 [42%] HSM vs 4 [25%] SOR, P = .16) or in average operative times (76.5 ± 38.3 minutes HSM vs 68.1 ± 34.3 minutes SOR, P = .52). Clinical Implications Our experience with explanting HSM reservoirs supports the safety and ease of their removal. Strengths and Limitations Although the absolute cohort size is relatively low, this study reflects one of the largest single-institution experiences examining penile implant reservoir removal. In addition, reservoir location was not randomized but was instead determined by which patients presented with complications necessitating reservoir removal during the study period. Conclusions HSM reservoir removal has comparable perioperative complication rates and operative times when compared with SOR reservoir removal.

Objectives To report our multi-institutional experience using penoscrotal decompression (PSD) for the surgical treatment of prolonged ischaemic priapism (PIP). Materials and methods We retrospectively reviewed clinical records for patients with PIP treated with PSD between 2017 and 2020. Priapisms were confirmed as ischaemic based on clinical presentations and cavernosal blood gas abnormalities. Treatment with irrigation and injection of α-agonists in all patients had failed prior to PSD. Patient characteristics, peri-operative variables and outcomes, and changes in International Index of Erectile Function (IIEF) scores were evaluated. Results We analysed 25 patients who underwent a total of 27 PSD procedures. The mean duration of priapism at initial presentation was 71.0 h. Irrigations and injections in all patients had failed, while corporoglanular shunt treatment in 48.0% of patients (12/25) had also failed prior to PSD. Of the 10 patients who underwent unilateral PSD, two (20.0%) had priapism recurrence. Both were treated with bilateral PSD, with prompt and lasting detumescence. Among the 15 patients undergoing primary bilateral PSD, none had priapism recurrence. Of the 15 patients with documented sexual function status at last follow-up, nine (60%) reported spontaneous erectile function adequate for penetration, while six (40%) reported erectile dysfunction. The median (interquartile range) decrease in IIEF-5 score was 3.5 (0-6.75) points after PSD. Two patients underwent uneventful inflatable penile prosthesis placement following PSD. Conclusions Penoscrotal decompression presents a simple, safe, highly effective and easily reproducible procedure for resolution of PIP. PSD should be considered as a viable salvage or alternative strategy to corporoglanular shunt procedures.

We describe and compare artificial urinary sphincter cuff erosion sites and associated clinical implications.We retrospectively reviewed men who presented with artificial urinary sphincter erosion treated by a single surgeon between 2007 and 2019 at a tertiary medical center. Transcorporal indications included complications of prior anti-incontinence procedures and prior urethral reconstruction. Location of artificial urinary sphincter cuff erosion defects was assessed by cystoscopy prior to device explantation, and findings were stratified into patients who had transcorporal vs standard artificial urinary sphincter placement.Out of 723 artificial urinary sphincter cases in 611 patients we identified 54 (7.5%) cuff erosions. Erosion developed in 15 of 82 (18.3%) cases of transcorporal artificial urinary sphincter and 39 of 641 (6.1%) cases of standard artificial urinary sphincter (p0.05). Artificial urinary sphincter cuff erosions occurred predominantly ventrally in both groups (66.7% for transcorporal and 79.5% for standard artificial urinary sphincter, p=0.4) followed by lateral urethral location (33.3% transcorporal and 20.5% standard, p=0.3). Dorsal erosions were rare in both groups (20% transcorporal and 5.1% standard, p=0.1). History of artificial urinary sphincter and previous erosion were associated with transcorporal artificial urinary sphincter erosion. History of radiotherapy, prior urethroplasty, hypogonadism and urethral cuff size were similar between groups.Artificial urinary sphincter cuff erosions appear to occur ventrally and laterally in most patients regardless of cuff placement. Dorsal erosions were the least common in both groups. The protective effect of transcorporal artificial urinary sphincter could not be conclusively demonstrated.

Objectives To compare our extended experience with high submuscular (HSM) reservoir placement to traditional space of Retzius (SOR) placement and to present our current, refined 'Five-Step' technique (FST) for HSM placement. Patients and methods Data were retrospectively collected on patients undergoing inflatable penile prosthesis (IPP) placement between January 2009 and June 2019. Re-operative cases were excluded. Reservoir-related complications and subsequent revisions were compared between SOR (2009-2012) and HSM reservoir groups (2012-2019). HSM patients were subdivided into two cohorts: 'Initial Technique' (2012-2014) and FST (2014-2019). The refined FST protocol was developed in 2014 to optimise outcomes and includes the following steps: (i) Position and Access; (ii) Develop Lower HSM Pocket; (iii) Develop Upper HSM Pocket; (iv) Reservoir Delivery (fill and fine-tune); (v) Confirm and Connect. Results Between January 2009 and June 2019, 733 total IPP procedures (586 HSM, 147 SOR) were performed by a single surgeon at our institution, 561 of which were virgin cases (430 HSM, 131 SOR) and included in this analysis. Overall, surgical revision was required in 10/430 (2.3%) HSM cases (one delayed bowel obstruction, nine herniations) and six of 131 (4.6%) SOR cases (one bladder erosion, two vascular injuries, and three herniations, P = 0.22). When comparing the FST to the Initial Technique, we noted a significant decrease in complications requiring surgical revision (P = 0.01). Among 133 cases performed with the Initial Technique, seven (5.3%) required surgical revision (one bowel obstruction after placement into the peritoneal cavity, six herniations). Among 297 FST cases, three (1.0%) required revision, all due to herniation. Conclusion HSM placement of IPP reservoirs is a safe alternative to traditional SOR placement. Major deep pelvic reservoir complications were minimised using our current refined FST.

AIMS Although artificial urinary sphincter (AUS) has long been the gold standard treatment for severe stress urinary incontinence, poor tissue quality in patients with prior cuff erosions may preclude this option. Formal supravesical diversion and/or bladder neck closure comprise alternative salvage options but are associated with significant morbidity and mortality. We review our experience with permanent urethral ligation (PUL) among patients deemed not to be candidates for AUS replacement following cuff erosion. METHODS From a single-center database of 396 patients undergoing AUS from 2014 to 2020, 20 men underwent PUL with suprapubic tube (SPT) diversion. Clinical characteristics and outcomes were evaluated. Quality of life (QOL) was assessed using chart review, Michigan Incontinence Symptom Index (M-ISI), and Patient Global Impression of Improvement (PGI-I). RESULTS PUL resulted in continence in 18 (90%) men; 15 after the initial surgery and three after repeat ligation. Patients were elderly (average age 75) with significant comorbidities. A total of 11 (55.5%) patients experienced complications in the 90-day postoperative period (seven Clavien-Dindo Grade II, four Grade III). Over an average follow-up of 30.3 months (interquartile range: 15.75-48.75), four patients underwent cystectomy and one underwent perineal urethrostomy. In the remaining patients managed by PUL, 13 had satisfactory M-ISI scores and indicated overall improvement on PGI-I. CONCLUSIONS For men with AUS cuff erosion who are poor candidates for replacement, PUL with chronic SPT drainage represents an acceptable alternative option to restore continence and improve QOL. Though complications are not uncommon, the morbidity profile still compares favorably to more invasive formal urinary diversion.

INTRODUCTION AND OBJECTIVE:Although transcorporal (TC) placement of artificial urinary sphincter (AUS) has traditionally been used as a protective strategy in patients at risk for urethral erosion,...

INTRODUCTION AND OBJECTIVE:Permanent urethral ligation (PUL) with chronic suprapubic tube (SPT) drainage has previously been proposed as an emerging treatment option for debilitated men with persis...

Objective To report our experience with isolated pressure regulating balloon (PRB) replacement for artificial urinary sphincter (AUS) malfunction in the setting of PRB herniation. Methods A retrospective review of our large single-surgeon male AUS database was completed. We analyzed men with herniated PRBs palpable in the groin within an otherwise intact system. Patients with evidence of AUS fluid loss were excluded. PRBs were replaced in a submuscular location through a lower abdominal incision. Continence was defined as requiring ≤1 pad per day. Cystoscopic improvement of sphincter coaptation was confirmed intraoperatively. Results Of the 725 patients who underwent AUS surgery between 2011 and 2019, we identified 23 (3.2%) with PRB herniation and persistent or bothersome stress urinary incontinence who underwent isolated PRB replacement (median age 72 years, interquartile range 66-80). Four of the 23 patients were excluded from the analysis for subsequent explant unrelated to PRB replacement. At a mean follow-up of 21.7 months (range 2-99 months), 94.7% of patients (18/19) noted significant improvement in their stress urinary incontinence, and 78.9% of patients (15/19) achieved continence. Median time between AUS placement and PRB revision was 13 months (interquartile range 6-34 months). Conclusion PRB replacement appears to be a safe and effective salvage therapy for AUS patients with PRB herniation and persistent incontinence without mechanical failure. Intraoperative cystoscopic confirmation of enhanced sphincter coaptation appears to be a reliable predictor of treatment success.

We evaluated recurrence outcomes of penile sparing surgery in what is to our knowledge the largest multicenter cohort of patients to date.We retrospectively identified patients treated with penile sparing surgery from May 1990 to July 2016 at 5 tertiary referral institutions. Treatments consisted of circumcision, wide local excision, laser therapy with or without local excision, partial or total glansectomy and glans resurfacing. The study primary end point was local recurrence-free survival, defined from initial treatment to time of local recurrence and estimated with the Kaplan-Meier method.After applying study exclusion criteria 1,188 patients were included in analysis. During the median followup of 43.0 months there were 252 local recurrences (21.2%), of which 99 (39.3%) developed in year 1. Median time to local recurrence was 16.3 months and the 5-year local recurrence-free survival incidence was 73.6%. When stratified by stage, the 5-year local recurrence-free survival rate was 75.0%, 71.4% and 75.9% in Ta/Tis, T1 and T2 cases, respectively (log rank p = 0.748). Of the recurrences 58.3% were treated with repeat organ sparing procedures and the secondary partial (total) penectomy rate was 19.0%. Only margin status was significantly associated with local recurrence on multivariate analysis (p = 0.001). Study limitations included the retrospective design and the heterogeneous clinical approach.Penile sparing surgery can provide excellent local control for superficial penile tumors as well as for appropriately selected invasive lesions. Strict followup in the early postoperative period is highly recommended.

Introduction The use of intralesional injection of collagenase Clostridium histolyticum (CCH) has become a valid treatment option in the management of Peyronie's disease (PD). Multiple studies have shown the drug's safety and efficacy. However, sparse literature exists on the utility of the injection protocol's 14-day “observation period,” in which patients are instructed to abstain from all sexual activity. Aim To summarize the contemporary literature and report on our series of patients treated with CCH in an effort to explore the effectiveness of the postinjection observation period. Methods We retrospectively reviewed the clinical course of men treated with at least one CCH injection at our institution from April 2014 through February 2017. Main Outcome Measures The main outcome measure for our cohort was complication rate (hematoma, fracture). Secondary outcomes included progression to corrective surgery. Results Of the 102 patients treated, 5 (4.9%) developed a corporal fracture. Four of these occurred outside the 14-day observation period. One fracture was managed conservatively and the rest underwent surgical exploration and repair. Twelve penile hematomas were reported; one of these patients was surgically explored because of suspicious magnetic resonance imaging findings. Seven patients (6.9%) progressed to corrective surgery. Conclusion Penile hematoma and corporal fracture are serious complications that must be discussed with patients before initiation of intralesional CCH treatment. Little evidence exists to direct physicians on the proper management of post-CCH penile fractures; many caregivers and patients elect to treat these injuries conservatively and avoid surgical exploration. Further studies are warranted to generate discussion and reassessment regarding the safety and effectiveness of this 14-day observation period. Beilan JA, Wallen JJ, Baumgarten AS, Morgan KN, Parker JL, Carrion RE. Intralesional Injection of Collagenase Clostridium histolyticum May Increase the Risk of Late-Onset Penile Fracture. Sex Med Rev 2018;6:272–278.

To analyze the recurrence and survival outcomes of glansectomy in patients with penile squamous cell carcinoma.We performed a retrospective review of 410 patients across 5 international tertiary referral centers between 1999 and 2016. All patients had tumors involving the glans penis and underwent glansectomy as primary treatment. The Kaplan-Meier method and log-rank test were used to calculate survival and recurrence. Median follow-up was 42 months (interquartile range [IQR] 29-56).The median age was 64 years (IQR 53-72). Median tumor size was 2.2 cm (IQR 1.5-3.0). A total of 240 patients (58.5%) had pT2 disease, whereas only 43 patients (10.5%) had pT3 or pT4 disease. The majority of the cohort had poorly differentiated tumors (43.7%). Most recurrences were local at 7.6% (31 patients). Only 14 patients (3.4%) had regional recurrence and 9 patients (2.2%) had distant recurrence. When stratified by pathologic stage, tumors that were pT2 or higher were (P .001) and were more likely to be poorly differentiated (P .001). There were no differences in recurrence location among pathologic stages (P = .15). The 1-, 2-, and 5-year recurrence-free survival were 98%, 94%, and 78%, respectively. There were no differences in overall survival when stratified by stage (P = .67).Glansectomy is an oncologically safe treatment modality for squamous cell carcinoma of the glans in appropriately selected invasive tumors.

Objectives To evaluate recurrence after penile sparing surgery (PSS) in the management of carcinoma-in-situ (CIS) of the penis in a large multicenter cohort of patients. Patients and Methods We identified consecutive patients from 5 major, academic centers treated from June 1986 to November 2014 who underwent PSS for pathologically proven penile CIS. Primary outcome was local recurrence free survival (RFS) and estimated using the Kaplan-Meier method. Results A total of 205 patients were identified. Treatment modalities included circumcision, glansectomy, wide local excision, laser therapy and total glans resurfacing. Over a median follow-up of 40 months (interquartile range [IQR]: 26-65.6), there were 48 local recurrences with 45.8% occurring in the first year and 81.3% occurring by year 5. Majority of recurrences were observed in the laser group (58.3%). Median time to local recurrence was 15.9 months (5.66-26.14). The 1, 2, and 5-yr RFS were 88.4, 85.6, and 75%, respectively; and the median RFS was 106.5 months (80.2-132.2). Conclusions Among patients with penile CIS selected for surgical management, durable responses at intermediate to long-term follow-up were noted. For those with glandular CIS, glans resurfacing offered the best outcomes. This article is protected by copyright. All rights reserved.

Penile cancer is a rare and potentially disfiguring disease. There are multiple treatment options for primary penile lesions. Penile sparing approaches offer an attractive option as they can provide several quality of life benefits without detrimental oncologic outcomes. With appropriate diagnostic evaluation and staging, penile sparing techniques provide proper cancer control with improved cosmetic and functional results. Regardless of the chosen treatment modality, a commitment to close follow-up remains a critical component of all treatment considerations. The goal of this review is to provide an overview of the multiple treatment strategies for primary penile tumors with a focus on penile sparing surgical approaches.

Penile cancer is a rare malignancy in the United States and Europe but has a much higher prevalence in certain geographical areas including South America and Africa. Compared with other urological malignancies, there remains a paucity of information regarding the molecular mechanisms involved in penile cancer carcinogenesis. It is generally understood that there are two separate molecular pathways that contribute to carcinogenesis, one of which is largely related to human papillomavirus (HPV) infection. The second mechanism is much less clearly understood and is related to a combination of factors including those influenced by environmental effects and somatic or epigenetic changes. However, there also remains an element of interplay between the two mechanisms that adds to the complexity of understanding the disease. The aim of this review is to outline the current understanding of the genetic factors, current research and future directions involved in understanding the disease. Key Concepts Penile cancer is a rare entity and the mechanisms behind its carcinogenesis are not completely understood. It is generally understood that the pathogenesis of penile cancer may related to both HPV mediated and non-mediated mechanisms. The ability of the human papillomavirus to lead to malignancy is dependent on breakdown of normal cell degradation mechanisms as well as cell cycle alterations leading to uninhibited cell proliferation. Non-HPV mediated pathogenesis has numerous potential mechanisms and remains an ongoing area of study. Continued focus on centers of excellence as well as international collaborations will be needed to continue to develop a full understanding of the disease. Keywords: penile cancer; malignancy; human papillomavirus; tumorigenesis; mutations; mTOR; inflammation

Purpose of review Management of genitourinary malignancy is likely to encompass a large portion of most of the urologist's practice. The challenge for the modern urologist is not only in understanding the management of commonly seen genitourinary malignancies, but also in recognizing unusual variants and their differences in management. This is evermore important as new technologies have refined the ability to identify rare entities. This review presents a brief overview of the various genitourinary malignancy subtypes seen within urology. Recent findings All major organ subtypes are highlighted along with an overview of the current understanding of their associated malignancies. An update on the current state management paradigms as well as future directions is also outlined. Summary After reading this review, the urologist should have a deeper understanding of the breadth of disorders in genitourinary oncology and a clearer approach to the management of these problems. Additionally, ongoing avenues for research are highlighted.

Paragangliomas are rare extra-adrenal neuroendocrine tumors and presentation within the scrotum is exceedingly rare. Only thirteen other cases have been reported in medical literature, with only one other case presenting within the testicle itself. We present the second known case of paraganglioma of the testicle in a patient who initially presented with a two-week history of right testicular pain with no associated dysuria and hematuria. Ultrasound imaging indicated a solid heterogenous mass in the right testicle concerning for malignancy and was treated surgically with right radical orchiectomy. Gross and histological investigation demonstrated a morphology and immunophenotype consistent with a paraganglioma.

INTRODUCTION AND OBJECTIVES:Robotic Assisted Radical Prostatectomy (RALP) has improved the treatment of patients with prostate cancer in comparison with previous open techniques. Unfortunately, str...

Background High submuscular (HSM) placement of inflatable penile prosthesis (IPP) reservoirs is a promising new FDA approved alternative to traditional space of Retzius reservoir placement. In 2011, we began placing all reservoirs in a HSM position at our tertiary center. In 2014, we proposed a refined, “Five-Step” HSM reservoir placement technique (FST) to prevent deep pelvic complications. Objectives To describe our HSM technique and report on our extended experience. Material Our refined FST was developed to optimize outcomes and includes the following steps: (1) Position and Access; (2) Develop Lower HSM Pocket; (3) Develop Upper HSM Pocket; (4) Reservoir Delivery (Fill and Fine-Tune); (5) Confirm and Connect. Data was retrospectively collected on patients undergoing reservoir placement by FST between January 2014 and June 2019. A survey analyzing subjective outcomes and patient satisfaction was performed among 100 randomly selected patients. Results We placed 297 consecutive HSM IPP reservoirs via FST during this time period. Three patients (1.0%) required surgical revision (all for herniation). No deep pelvic (vascular, bladder, bowel) complications were reported. Of the 100 patients that were randomly surveyed, 86% of patients reported no palpability of the reservoir, and 95% of patients reported satisfaction with the procedure and would recommend the procedure to a friend. Conclusion The FST for HSM reservoir placement is a simple and safe procedure with good outcomes and excellent patient satisfaction. This technique appears to effectively eliminate the risks of deep pelvic complications.