robot-assisted-lingual-mucosa-graft-onlay-reconstruction-for-ureteric

Robot-Assisted Lingual Mucosa Graft Onlay Reconstruction for Ureteric Strictures Refractory to Endoscopic Treatment

This study describes the detailed technique and initial experience with robot-assisted lingual mucosal graft onlay ureteric reconstruction (RLUR) in ...

University of Turin

Background: Low-chance retrieval non-obstructive azoospermic (NOA) patients are a subpopulation of NOA patients. The objective of this study is to compare the surgical outcome of microsurgical-assisted testicular sperm extraction (M-TeSE) and combined trifocal/M-TeSE in low-chance retrieval NOA patients. Material and Methods: A single-center retrospective analysis of NOA patients who underwent testicular sperm extraction was performed. Low-chance retrieval NOA (testicular volume < 10 cc and FSH > 12.4 UI/L) was set as the inclusion criteria. Re-do TeSE procedures were excluded from the current analysis. Data were extrapolated from clinical records and operative notes. We compared data from patients who underwent classic M-TeSE (group A) with that from patients submitted to combined trifocal/M-TeSE (group B). Sperm retrieval rate (SRr) was the primary outcome of the study. Surgical outcomes and postoperative complications were evaluated. A multivariate analysis was conducted to investigate predictive factors for positive SR. Results: Overall, 80 patients (60 patients in Group A and 20 patients in Group B) fulfilled the inclusion criteria. The average (SD) age was 35 (8.2) years. The average preoperative FSH was 27.5 (13) UI/L. The average testicular volume was 6.3 (3) cc on the left side and 6.8 (2.5) cc on the right. Groups were similar in terms of preoperative parameters. The overall SRr was 28%. Patients in group B had higher SRr than those in group A (29.4% vs. 26.9%, p < 0.03). We identified a significant association between testicular histopathology and positive SR (hypospermatogenesis 100%, spermatogenic arrest 32%, and Sertoli cell-only syndrome 22%). The histopathology report was the only significant predicting factor for SR in the multivariate analysis. Conclusion: The combined trifocal and M-TeSE approach is safe and may represent a valuable approach to enhance the SRr in low-chance retrieval NOA. The histopathology report is confirmed to be the only valuable predicting factor for a positive SR.

Combined Trifocal and Microsurgical Testicular Sperm Extraction Enhances Sperm Retrieval Rate in Low-Chance Retrieval Non-Obstructive Azoospermia.

Functional and surgical outcomes after surgical correction of adult acquired buried penis (AABP) are limited in the current literature. We retrospectively recruited patients underwent surgical treatment of AABP in a single institution from 2017 to 2021. Surgical repair was classified according to surgical complexity following Pariser-Santucci's classification. The primary endpoint of the study was the recurrence-free rate survival. The secondary endpoints were surgical, functional and patients' reported outcomes. Overall 28 patients were included in the study. Median follow-up was 27.5 (18.5-34.5). The most common complaints at presentation were sexual (53.6%) and voiding (39.3%) dysfunction. Surgical management steps ranged from circumcision to more complex procedures, such as suprapubic fat pad excision, abdominoplasty and/or penile shaft skin grafting. Overall postoperative complications were recorded in 32.1%. High-grade complications (Clavien≥3) occurred in 7.1%. One-year recurrence-free survival was 88.7%. Postoperatively IPSS and IIEF-15 questionnaires showed a significant improvement in urinary 8 (0-12) vs 2 (0-3), p = 0.03 and sexual function 37 (23-68) vs 68 (45-72), p = 0.001 respectively. Overall, patients reported functional improvement and 93.8% experienced a positive impact of QoL. AABP surgical repair, despite the high incidence of complications, seems to allow satisfactory outcomes and a significant improvement in patients' QoL.

The outcomes of surgical management options for adult acquired buried penis.

Correction to: The outcomes of surgical management options for adult acquired buried penis.

: The peak of incidence of testicular cancer (TC) occurs among individuals in their reproductive age, emphasizing the importance of fertility preservation as an integral aspect of disease management. Sperm cryopreservation performed before orchiectomy is ineffective in azoospermic men, necessitating alternative approaches such as microdissection testicular sperm extraction (mTESE) at the time of orchiectomy (onco-mTESE) to obtain viable sperm. This study presents the findings from our institution's experience with onco-mTESE and critically discusses our results in light of the existing body of literature. : This is a tertiary center retrospective analysis of onco-mTESE procedures performed at a single center between December 2011 and July 2022. The included patients were post-puberal men with testicular tumors requiring orchiectomy, along with concomitant severe oligozoospermia or azoospermia. Bilateral mTESE was performed in all cases. Surgical outcomes, sperm retrieval rates, the usage of preserved viable sperm, assistive reproductive techniques' results, and post-operative serum testosterone were recorded. : A total of nine patients were included, with a median age of 34 (IQR 29-36) years. All patients had germ cell tumors (GCTs), with seminomatous and non-seminomatous GCTs accounting for 44.4% ( = 4) and 55.6% ( = 5) of patients, respectively. Sperm retrieval occurred in three (33%) patients: one patient in the ipsilateral testis, one in the contralateral testis, and one in both testes. No complications were reported during the procedure, and no post-operative hypogonadism was observed. Among the three patients with successful sperm retrieval, an intracytoplasmic sperm injection (ICSI) was performed in two patients, resulting in two pregnancies, leading to one healthy live birth and one miscarriage. : In the context of TC, it is essential to conduct a thorough evaluation of testicular function, including a semen analysis and cryopreservation. Onco-mTESE has proven its safety in preserving fertility in azoospermic cases while ensuring the efficacy of oncological treatment.

Onco-TESE (Testicular Sperm Extraction): Insights from a Tertiary Center and Comprehensive Literature Analysis.

Neurological disease is a known entity for causing erectile dysfunction (ED). Pharmacological therapies are not always effective these patients - penile prosthesis implant (PPI) is an established surgical treatment option. For a variety of reasons, neurological patients may experience differing outcomes of PPI compared to those whose ED arises from other causes. We investigated outcomes of PPI in neurological patients using the Italian multi-institutional national registry of penile prostheses [Italian Nationwide Systematic Inventarization of Surgical Treatment for ED (INSIST-ED)].

The outcomes of penile prosthesis in neurologic patients: a multicentric retrospective series.

Adult Acquired Buried Penis (AABP) is a pathological condition necessitating surgical correction, ranging from simple to complex procedures involving the utilization of full-thickness (FTSG) or split-thickness (STSG) skin grafts especially in cases of substantial viable penile skin loss. In this retrospective study, we aimed to compare the surgical, functional, and patient-reported outcomes (PROs) of graft types that were utilized to treat AABP among 39 patients at a single center between November 2017 and May 2023. Among these patients, 22 needed skin grafts, with 9 undergoing FTSG and the remainder receiving STSG. Lichen Sclerosus (LS) was the primary cause (54.6%) of AABP requiring skin grafts. Patients primarily presented with voiding (63.6%) and sexual (27.3%) dysfunction. The STSG group had a lower mean age (64.7 ± 11.6) than the FTSG group (66.7 ± 11.6; P = 0.015), with no significant differences in BMI (p = 0.643). Complex repairs (Santucci grade ≥3) were performed in 81.0% of cases, with 88.9% in the FTSG group and 75.0% in the STSG group. Operative times were similar (160.2 ± 31.7 vs 161.5 ± 50.3, p = 0.945). No significant differences in preoperative penis length were found between the FTSG and STSG groups (P = 0.918). Postoperative complications occurred in 36.4% of patients, with severe complications (Clavien grade ≥3) in 9.1%. General postoperative complications and recurrence rates did not significantly differ between groups (P = 0.397 and 0.375; respectively). Functional outcomes, evaluated using the International Index of Erectile Function and the International Prostate Symptom Score, improved significantly in both groups after surgical procedures (P < 0.001 for all). Patient-reported satisfaction for the operation was 81.3% calculated by ad-hoc questionnaire. In conclusion, no discernible differences in outcomes were observed between STSG and FTSG. Larger comparative studies with extended follow-up periods and validated questionnaires are warranted for confirmation. Physicians should consider specialized centers for AABP surgical repair due to its intricacies.

No difference between split-thickness and full-thickness skin grafts for surgical repair in adult acquired buried penis regarding surgical and functional outcomes: a comparative retrospective analysis.

The first-line treatment of penile cancer confined to the glans (Tis-T2) is based on organ-sparing approaches. Our aim is to report functional outcomes of total glans resurfacing (TGR), wide local excision (WLE) and glansectomy. A retrospective analysis was conducted from January 2013 to October 2022. Ninety-nine patients were enrolled (22 TGR, 29 WLE, and 48 glansectomy). Sexual and urinary outcomes were explored using ad hoc and validated questionnaires (IIEF-15 and IPSS). The mean follow-up was 25.28 ± 24.87 months [95% CI: 20.38; 30.18]. 44 patients (12 TGR, 10 WLE, and 22 glansectomy) were assessed for functional outcomes. Overall, 86.36% of patients were satisfied with the surgery. The mean IIEF-15 score pre-operation was 54.91 ± 21.38 [95% CI: 48.41-61.41], and at 12 months post-operation, it was 44.39 ± 23.01 [95% CI: 37.39-51.39], with the change being statistically significant (mean difference: -10.52, (-19.15), p < 0.001). During the 0-12-month interval, IIEF-15 scores decreased across all techniques. Glansectomy and WLE showed significant decreases (Glansectomy: -12.955, -24.14%, [95% CI: -21.52, -4.38], p = 0.002; WLE: -14.1, -22.92%, [95% CI: -26.8, -1.39], p = 0.025 respectively), whereas TGR experienced a non-significant decrease (-3.083, -5.97%, CI: [-14.68, 8.51], p = 1.0). Concerning urinary function, only 18.18% of overall patients reported a negative impact of surgery. At 12-months, patients returned almost to pre-intervention IPSS values. Organ-sparing surgery guarantees a decent preservation of both erectile and voiding functions. TGR seems to provide better sexual outcomes when compared to other organ sparing approaches.

Functional outcomes of organ sparing surgery for penile cancer confined to glans and premalignant lesions.

Adult Acquired Buried Penis (AABP) is a morbid condition that often requires surgical intervention. This retrospective study of 46 patients who underwent AABP surgery from November 2017 to July 2023 evaluates surgical outcomes, functional outcomes, and patient-reported outcomes. The median follow-up (FU) was 46 months. Patients were categorized by surgical complexity using the Pariser classification, with 76.1% undergoing high-complexity procedures (Pariser ≥ III). Common comorbidities included obesity (58.7%), prior circumcision (52.2%), and hypertension (52.2%). The low-complexity group had a shorter hospital stay ( = 0.02). No other significant differences were noted between groups in terms of Body Mass Index, operative time, or FU. Sexual dysfunction (45.7%) and urinary issues (38.1%) were the main reasons for surgical consultation. Skin grafting was required in 63.0% of patients; partial graft loss was more common in full thicknes skin graft group ( = 0.04). Postoperative complications occurred in 32.6% of patients, 13.3% of which were classified severe (Clavien ≥ III). The median increase in stretched penile length was 2 cm. The recurrence rate was 21.7%. The 12-month recurrence-free survival rate was 89.1%. All groups saw significant improvements in urinary and sexual function post-surgery ( < 0.05), and high patient satisfaction was reported (90.3%). Despite the complication rate, AABP surgery significantly improves quality of life, with ongoing advancements in technique anticipated to enhance outcomes further.

The Outcomes of Adult Acquired Buried Penis Surgical Reconstruction.

This study aims to report the oncological, surgical and functional outcomes in 15 patients with locally advanced penile cancer who underwent total penile amputation with perineal urethrostomy (PU). A single-center retrospective analysis was conducted from January 2018 to September 2023. Outcomes included postoperative complications, cancer-specific survival (CSS), and overall survival (OS). Functional outcomes and pre and postoperative quality of life (QoL) were assessed by the International Prostate Symptom Score (IPSS) validated questionnaire. The median follow-up period was 10 months (SD±7). The median age of patients was 73 years (IQR 63-77), with a median Body Mass Index (BMI) of 28.1 kg/m (IQR 25.0-29.9). Risk factors included lack of circumcision (60.0%), history of lichen sclerosus (33.3%), and obesity (26.7%). The primary symptom reported was pain (67.0%). Total penectomy with PU was the initial surgery in 40.0% of cases; the rest underwent surgery after recurrence after penile organ-sparing surgery or partial penile amputation. Median operative time was 170 minutes (IQR 142.5-211.5), and the median hospital stay was 6 days (IQR 5-10). No local recurrence occurred during follow-up. The overall complication rate was 33.4%, with one patient (6.7%) requiring surgical revision (Clavien ≥ III). CSS was 80.0% with a median time to death of 6 months (IQR 3-13), and OS was 60.0%. Urinary symptoms and QoL significantly improved postoperatively (P = 0.0005 and P = 0.0012, respectively). Total penile amputation with PU is a safe procedure with acceptable complications and favorable functional outcomes.

Total penectomy and perineal urethrostomy configuration in locally advanced penile cancer: oncological, surgical and functional outcomes.

 To compare surgical outcomes and sperm retrieval rates (SRRs) between conventional microsurgical-assisted testicular sperm extraction (m-TeSE-Group A) and testicular sperm extraction performed with surgical loupes (l-TeSE-Group B) in adult males with non-obstructive azoospermia (NOA).  A multicentric prospective randomized trial (ethics committee no. 202/2022) in accordance with the CONSORT guidelines was conducted from March 2022 to April 2024. Adult males with NOA without genetic alterations who signed the informed consent were enrolled. SRRs, intra- and postoperative complications (according to the Clavien-Dindo classification), and hormonal profile changes were considered as outcomes during the follow-up period.  A total of 42 NOA patients were enrolled. The median age was 35 years (IQR: 33-49). The preoperative median FSH was 16.5 mIU/mL (IQR: 11.6-22.5) and the total testosterone was 4.6 (3.5-5.6). Overall, the SRR was 22.6%, with sperm retrieved from 19 testes. Histopathological findings reported Sertoli cell-only syndrome (SCOS) in 46.4% (39 cases), hypospermatogenesis in 26.2%, and germ cell arrest in 26.2% of the patients. No intraoperative complications were recorded. The postoperative complications were minimal (Clavien-Dindo grade I), but no significant differences were recorded in-between the two surgical approaches. Considering the operative time of the testicular exploration alone, Group B seemed to be faster than the m-TeSE, with a median time saving of 8 min ( < 0.01).  The use of surgical loupes was safe and comparable with m-TeSE in terms of the SRRs and complication rates. L-TeSE offered a reduction in the operative time compared with m-TeSE.

Preliminary Results of Microsurgical Sperm Retrieval in Azoospermic Patients: A Randomized Controlled Trial Comparing Operating Microscope vs. Surgical Loupes.

The ideal device to be implanted into a neophallus has yet to be identified. Since 2016 Zephyr Surgical Implant 475 Female To Male (ZSI 475 FtM, Switzerland) series penile prosthesis (PP) have been proposed as "ad hoc" device. The aim of the study is to compare the outcomes of cis-male Dacron modified PP with ZSI 475 FTM PP. A single-center prospective study was performed between March 2011 and April 2024. Patients received either the implantation of a cis-male Dacron modified PP or ZSI 475 FTM PP. The primary endpoint was the comparison of the surgical outcomes. The secondary endpoint was the evaluation of device survival. 47 assigned female at birth (AFAB) patients were included in: 29 underwent a cis-male Dacron modified PP, 18 received ZSI 475 FTM PP. The median follow-up was 36 months (IQR 13-70). A significantly shorter operative time was observed in ZSI FTM PP group when compared to cis-male Dacron modified PP group (mean value of 85 (IQR 78-97) VS. 105 (IQR 89-150) minutes, p 0.001). No statistically significant differences were found regarding the rate of postoperative complications, although the cis-male Dacron-modified PP appeared to have a higher tendency for infection (24.1% vs. 5.6%) and mechanical failure (31% vs. 22.2%, p = 0.09 and p = 0.51, respectively) compared with the ZSI 475 FTM PP. Explantation free survival (EFS) at 12 months was higher in the ZSI 475 FTM PP group (100 VS. 79.3%, p-value 0.039). However, at 24 months, this advantage was lost (94.4% VS. 72.4%, p value 0.062). Both cis-male Dacron modified and ZSI 475 FTM PP may guarantee satisfactory surgical outcomes. High powered prospective trials are warranted to confirm the data.

The outcomes of inflatable penile prosthesis implantation in the context of Genital Gender Affirming Surgery in Assigned Female At Birth patients: A comparative study between cis-male Dacron modified and Zephyr Surgical Implants 475 Female To Male Penile Prosthesis.

Surgical reconstruction for posterior urethral injuries associated with pelvic fractures (PFUI) is complex. Perineal posterior urethroplasty via excision and primary anastomosis (EPA) is the standard treatment. This study evaluates risk factors for stenosis recurrence after primary EPA and analyzes predictors of postoperative complications.

Posterior urethroplasty for pelvic fracture urethral injuries: risk factors for recurrence and complications.

This study investigate the preliminary surgical and functional outcomes of a new direct somatic-to-autonomic penile neurotization procedure transposing the gracilis branch of the obturator nerve to the corpora cavernosa bilaterally in patients affected by erectile dysfunction (ED) after radical prostatectomy (RP).

Surgical and Functional Outcomes of Penile Neurotization to Treat Post-Prostatectomy Erectile Dysfunction: Preliminary Results of a Novel Direct Somatic-to-Autonomic Procedure.

Article	Year
Combined Trifocal and Microsurgical Testicular Sperm Extraction Enhances Sperm Retrieval Rate in Low-Chance Retrieval Non-Obstructive Azoospermia. Journal of clinical medicine\| PubMed ID: 35887821	2022
The outcomes of surgical management options for adult acquired buried penis. International journal of impotence research\| PubMed ID: 36400942	2023
Correction to: The outcomes of surgical management options for adult acquired buried penis. International journal of impotence research\| PubMed ID: 36585522	2023
Onco-TESE (Testicular Sperm Extraction): Insights from a Tertiary Center and Comprehensive Literature Analysis. Medicina (Kaunas, Lithuania)\| PubMed ID: 37512038	2023
The outcomes of penile prosthesis in neurologic patients: a multicentric retrospective series. Therapeutic advances in urology\| PubMed ID: 37664080	2023
No difference between split-thickness and full-thickness skin grafts for surgical repair in adult acquired buried penis regarding surgical and functional outcomes: a comparative retrospectiv... International journal of impotence research\| PubMed ID: 38326548	2024
Functional outcomes of organ sparing surgery for penile cancer confined to glans and premalignant lesions. International journal of impotence research\| PubMed ID: 39187573	2024
The Outcomes of Adult Acquired Buried Penis Surgical Reconstruction. Life (Basel, Switzerland)\| PubMed ID: 39459621	2024
Total penectomy and perineal urethrostomy configuration in locally advanced penile cancer: oncological, surgical and functional outcomes. American journal of translational research\| PubMed ID: 39678598	2024
Preliminary Results of Microsurgical Sperm Retrieval in Azoospermic Patients: A Randomized Controlled Trial Comparing Operating Microscope vs. Surgical Loupes. Journal of clinical medicine\| PubMed ID: 39941640	2025
The outcomes of inflatable penile prosthesis implantation in the context of Genital Gender Affirming Surgery in Assigned Female At Birth patients: A comparative study between cis-male Dacron... International journal of impotence research\| PubMed ID: 40696146	2025
Posterior urethroplasty for pelvic fracture urethral injuries: risk factors for recurrence and complications. World journal of urology\| PubMed ID: 40748395	2025
Surgical and Functional Outcomes of Penile Neurotization to Treat Post-Prostatectomy Erectile Dysfunction: Preliminary Results of a Novel Direct Somatic-to-Autonomic Procedure. Andrology\| PubMed ID: 41693465	2026

Natalia Plamadeala

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