Various techniques have been described for reconstructing the skin of the penile shaft; however, no universally accepted standard exists for correcting buried penis in adults. We aimed to describe a new technique for correcting an adult-acquired buried penis through a diamond-shaped incision at the penopubic junction. We retrospectively analyzed data from patients treated with our technique between March 2019 and June 2023 in the Department of Andrology, Nanjing Drum Tower Hospital (Nanjing, China). Forty-two adult males with buried penises, with a mean (±standard deviation [s.d.]) age of 26.6 (±6.6) years, underwent surgery. All patients were obese, with an average (±s.d.) body mass index of 35.56 (±3.23) kg m -2 . In addition to phalloplasty, 32 patients concurrently underwent circumcision, and 28 underwent suprapubic liposuction. The mean (±s.d.) duration of the operation was 98.02 (±13.28) min. The mean (±s.d.) duration of follow-up was 6.71 (±3.43) months. The length in the flaccid unstretched state postoperatively was significantly greater than that preoperatively (mean ± s.d: 5.55±1.19 cm vs 1.94±0.59 cm, P < 0.01). Only minor complications, such as wound disruption (7.1%) and infection (4.8%), were observed. The mean (±s.d.) score of patient satisfaction was 4.02 (±0.84) on a scale of 5. This technique provides excellent cosmetic and functional outcomes with a minimal risk of complications. However, additional clinical studies are needed to evaluate the long-term effects of this procedure.
Humans ; Male ; Patient Satisfaction ; Adult ; Lipectomy/methods* ; Penis/surgery* ; Retrospective Studies ; Treatment Outcome ; Plastic Surgery Procedures/methods* ; Young Adult ; Penile Diseases/surgery* ; Urologic Surgical Procedures, Male/methods*

Since their popularization, genitourinary prosthetics have remained a gold-standard therapy for the treatment of erectile dysfunction and stress urinary incontinence and in cases of testicular loss or dysfunction. They have also represented an area of significant innovation, which has contributed to excellent long-term outcomes. Given this history, the objective of the current review was to provide a 5-10-year outlook on anticipated trends and developments in the field of genitourinary prosthetics. To accomplish this objective, a PubMed and patent search was performed of topics relating to penile and testicular prostheses and urinary sphincters. In regard to penile prostheses, findings demonstrated several new concepts including temperature-sensitive alloys, automated pumps, devices designed specifically for neophalluses, and improved malleable designs. With artificial urinary sphincters, new concepts include the ability to add or remove fluid from an existing system, two-piece systems, and new mechanisms to occlude the urethra. For testicular prosthetics, future implementations may not only better replicate the feel of a biological testicle but also add endocrinological functions. Beyond device innovation, the future of prosthetics is also one of expanding geographic boundaries, which necessitates variable cost modeling and regulatory considerations. Surgical trends are also changing, with a greater emphasis on nonnarcotic, postoperative pain control, outpatient surgeries, and adjunctive techniques to lengthen the penis and address concomitant stress incontinence, among others. Concomitant with device and surgical changes, future considerations also include a greater need for education and training, particularly given the rapid expansion of sexual medicine into developing nations.
Erectile Dysfunction/surgery* ; Humans ; Male ; Penile Implantation ; Penile Prosthesis/trends* ; Prostheses and Implants/trends* ; Prosthesis Design/trends* ; Prosthesis Implantation/trends* ; Testicular Diseases/surgery* ; Urinary Incontinence, Stress/surgery* ; Urinary Sphincter, Artificial/trends* ; Urologic Surgical Procedures, Male/trends*

The testicular prosthesis can be an afterthought for providers when performing an orchiectomy for testicular cancer, torsion, atrophic testis, or trauma. However, data suggest that patients find the offer of a testicular prosthesis and counseling regarding placement to be extremely important from both a pragmatic and a psychosocial perspective. Only two-thirds of men undergoing orchiectomy are offered an implant at the time of orchiectomy and of those offered about one-third move forward with prosthesis placement. The relatively low acceptance rate is in stark contrast with high patient satisfaction and low complication rates for those who undergo the procedure. The most common postoperative patient concerns are minor and involve implant positioning, size, and weight. Herein, we provide an up-to-date review of modern preoperative evaluation, patient selection, expectation management, surgical technique, and expected outcomes for testicular prostheses.
Counseling ; Gonadal Dysgenesis, 46,XY/surgery* ; Humans ; Male ; Orchiectomy ; Patient Satisfaction ; Patient Selection ; Postoperative Complications/epidemiology* ; Prosthesis Implantation/methods* ; Spermatic Cord Torsion/surgery* ; Testicular Diseases/surgery* ; Testicular Neoplasms/surgery* ; Testis/surgery* ; Urologic Surgical Procedures, Male/methods*

OBJECTIVE: To discuss the efficacy and safety of simultaneous bilateral endoscopic surgery (SBES) for bilateral upper urinary tract calculi, and to summarize the initial experience. METHODS: Patients diagnosed with bilateral upper urinary tract calculi who underwent SBES in the Department of Urology, Beijing Chao-Yang Hospital from January 2019 to January 2020 were enrolled retrospectively. The demographic and clinical data of the patients were recorded, and the operation status, stone free rate (SFR) and peri-operative complications were analyzed. The primary end point was SFR, and second end point was peri-operative complications. RESULTS: A total of 23 patients underwent SBES, of which SBES was completed in 19 patients (12 males, and 7 females). The mean age was (41.3±12.0) years. Fourteen patients underwent modified supine position surgery and 4 patients in prone split-leg position. There was no statistical difference in the demographic and baseline clinical data of the patients in different positions. One patient underwent right percutaneous nephrolithotomy (PCNL) and left endoscopic combined intra-renal surgery (ECIRS) in the prone split-leg position, while 18 patients received simul-taneous surgery with PCNL and contralateral retrograde intra-renal surgery (RIRS). The mean anesthesia and operation time was (128.7±26.5) min and (70.7±20.3) min, respectively, which was significantly longer in the patients with prone split-leg position than in the patients with modified supine position, anesthesia time in the patients with prone split-leg position and modified supine position: (148.4±20.4) min vs. (121.6±25.3) min, respectively, t=－2.121, P=0.049, while the operation time in the patients with prone split-leg position and modified supine position: (86.4±21.1) min vs. (65.1±17.4) min, respectively, t=－2.222, P=0.040. There was no significant difference between the two groups in indwelling of nephrostomy [prone split-leg position and modified supine position: (2.6±0.9) d vs. (2.1±1.0) d, respectively; t=－0.880, P=0.391] and the length of hospital stay [prone split-leg position and modified supine position: (6.0±2.7) d vs. (5.2±1.8) d, respectively; t=－0.731, P=0.475]. One month after the operation, the SFR was 78.9%, and 3 patients had minor peri-operative complications (Clavien-Dindo grades Ⅰ/Ⅱ) without any serious complications (Clavien-Dindo grades Ⅲ/Ⅳ/Ⅴ). CONCLUSION The simultaneous bilateral endoscopic surgery would decrease the operation time and anesthesia exposure under the premise of ensuring the SFR, which is helpful to reduce the risk of peri-operative complications, especially to the patients who can not tolerate the second-stage or long-time operation.
Adult ; Calcinosis/surgery* ; Endoscopy ; Female ; Humans ; Kidney Calculi ; Male ; Middle Aged ; Nephrolithotomy, Percutaneous ; Nephrostomy, Percutaneous ; Retrospective Studies ; Treatment Outcome ; Urologic Diseases/surgery*

Objective: To evaluate the clinical effect of embedding sutures of single inner- and outer-prepuce flap in the treatment of concealed penis. METHODS: This retrospective analysis included 37 cases of concealed penis treated by embedding sutures of single inner- and outer-prepuce flap between July 2011 and May 2015. Catheters were pulled out from the patients within 24 hours and the dressing removed about 1 week after surgery. All the patients were followed up for 12－24 months postoperatively for evaluation of the long-term outcomes of surgery. RESULTS: One-stage wound healing was achieved in all the patients. No foreskin flap necrosis, inflammation, edema, voiding dysfunction, or painful erection was found during the follow-up. The penises were extended by 2－4 cm. No complications were observed axcept 8 cases of mild prepuce edema, which all subsided with 6 months postoperatively. CONCLUSIONS Embedding sutures of single inner- and outer-prepuce flap, with the advantages of simple operation, rapid recovery and few complications, is a desirable surgical option for the treatment of concealed penis.
Foreskin ; Humans ; Male ; Penile Diseases ; surgery ; Penis ; abnormalities ; surgery ; Postoperative Complications ; pathology ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Surgical Flaps ; pathology ; transplantation ; Suture Techniques ; Sutures ; Urologic Surgical Procedures, Male ; methods ; Wound Healing

The clinical effect of laparoscopic rectal cancer curative excision with pelvic autonomic nerve preservation (PANP) was investigated. This study evaluated the frequency of urinary and sexual dysfunction of 149 male patients with middle and low rectal cancer who underwent laparoscopic or open total mesorectal excision with pelvic autonomic nerve preservation (PANP) from March 2011 to March 2013. Eighty-four patients were subjected to laparoscopic surgery, and 65 to open surgery respectively. The patients were followed up for 12 months, interviewed, and administered a standardized questionnaire about postoperative functional outcomes and quality of life. In the laparoscopic group, 13 patients (18.37%) presented transitory postoperative urinary dysfunction, and were medically treated. So did 12 patients (21.82%) in open group. Sexual desire was maintained by 52.86%, un-ability to engage in intercourse by 47.15%, and un-ability to achieve orgasm and ejaculation by 34.29% of the patients in the laparoscopic group. Sexual desire was maintained by 56.36%, un-ability to engage in intercourse by 43.63%, and un-ability to achieve orgasm and ejaculation by 33.73% of the patients in the open group. No significant differences in urinary and sexual dysfunction between the laparoscopic and open rectal resection groups were observed (P>0.05). It was concluded that laparoscopic rectal cancer radical excision with PANP did not aggravate or improve sexual and urinary dysfunction.
Adult ; Autonomic Nervous System ; injuries ; Humans ; Laparoscopy ; adverse effects ; Male ; Middle Aged ; Peripheral Nerve Injuries ; etiology ; prevention & control ; Postoperative Complications ; Rectal Neoplasms ; surgery ; Sexual Dysfunction, Physiological ; etiology ; Urologic Diseases ; etiology

Laparoscopic procedures for urological diseases in children have been proven to be safe and effective. However, the availability of laparoscopic procedures is still partly limited to experienced, high-volume centers because the procedures are technically demanding. The da Vinci robot system is being used for an increasing variety of reconstructive procedures because of the advantages of this approach, such as motion scaling, greater optical magnification, stereoscopic vision, increased instrument tip dexterity, and tremor filtration. Particularly in pediatric urologic surgery, where the operational field is limited owing to the small abdominal cavity of children, robotic surgical technology has its own strengths. Currently, robots are used to perform most surgeries in children that can be performed laparoscopically. In this review, we aimed to provide a comprehensive overview of the current role of robot-assisted laparoscopic surgery in Pediatric Urology by analyzing the published data in this field. A growing body of evidence supports the view that robotic technology is technically feasible and safe in pediatric urological surgery. Robotic technology provides additional benefits for performing reconstructive urologic surgery, such as in pyeloplasty, ureteral reimplantation, and enterocystoplasty procedures. The main limitations to robotic surgery are its high purchase and maintenance costs and that the cost-effectiveness of this technology remains to be validated.
Child ; Humans ; Laparoscopy/*methods ; Robotic Surgical Procedures/*methods ; Urologic Diseases/*surgery ; Urologic Surgical Procedures/*methods

Crossed fused renal ectopia is a rare anomaly and may be associated with pelvic ureteric junction obstruction (PUJO). The L-shaped fusion variety is even rarer. We report such a case with a crossed fused ectopic pelvic kidney (L-type) with PUJO and its successful laparoscopic management. Through this report we emphasize the importance of adequate preoperative imaging and intraoperative details to avoid mishaps.
Adolescent ; Female ; Humans ; Kidney/*abnormalities ; Kidney Diseases/*complications/congenital/surgery ; Kidney Pelvis/*surgery ; Laparoscopy/*methods ; Reconstructive Surgical Procedures/*methods ; Ureter/*surgery ; Ureteral Obstruction/etiology/*surgery ; Urologic Surgical Procedures/methods

OBJECTIVETo review and summarize the experience of urethral reconstruction using lingual mucosal graft for the treatment of complex hypospadias.

METHODSWe evaluated the methods using lingual mucosal graft for the treatment of complex hypospadias. The dorsal inlay graft method and the tube graft method were used in our study.

RESULTSFrom Nov. 2010 to Oct. 2011,21 cases were treated. All the cases had at least one failed hypospadisa surgery before. The dorasl inlay grafting technique was used for 16 patients, the tube grafting technique was carried out in 5 patients(2 cases received Tube + Duply method). The follow-up period ranged from 3 months to 12 months (by average 6 months). The success rate of the methods was 61.9% with complications in 8 cases. Urethral fistula developed in 3 patients and urethral stricture developed in 5 patients. All cases who suffered stricture received the tube grafting technique. The fistula and urethral stricture were occurred at the site of the urethral termonoterminal anostomosis. Urethral stricture is the most common complication after the tube graft method for the treatment of the complex hypospadias.

CONCLUSIONSHarvesting the lingual mucosal graft is feasible and easy to perform. The complex hypospadias repair technique using lingual mucosal graft method provides good results. There fore it should be one of the preferred techniques for complex hypospadias repair. The dorsal inlay grafting technique has lower complication rate than the tube grafting technique. Early and regular urethral sounding should be carried out when patients received the tube graft method.

Adolescent ; Child ; Humans ; Hypospadias ; surgery ; Male ; Mouth Mucosa ; transplantation ; Reconstructive Surgical Procedures ; adverse effects ; Tongue ; Urethra ; surgery ; Urethral Diseases ; etiology ; Urethral Stricture ; etiology ; Urinary Fistula ; etiology ; Urologic Surgical Procedures, Male ; adverse effects

OBJECTIVETo investigate the application of Koyanagi technique for repairing proximal hypospadias with penoscrotal transposition.

METHODSKoyanagi procedure was used for repairing proximal hypospadias with penoscrotal transposition in 26 boys (mean age 4.2 years) between July 2005 and June 2010.

RESULTSPrimary healing was achieved in 22 cases. Three patients suffered from urinary fistula and the external urethral orifice in one patient was retracted to penis coronary sulcus, who were re-operated successfully. Two cases showed slight penile ventral curvature. Slight stricture of the urethral external orifice was noted in one case, which relieved after one to two times of urethral sounding every week for eight months. 20 patients were followed up for 6-36 months (mean 10.5 months) with good cosmetic result and normal urethra function. The penoscrotal transposition was also corrected.

CONCLUSIONSThe original Koyanagi procedure might be one of the simple and effective method for repairing proximal hypospadias with penoscrotal transposition.

Abnormalities, Multiple ; surgery ; Child ; Child, Preschool ; Free Tissue Flaps ; Humans ; Hypospadias ; surgery ; Male ; Penis ; abnormalities ; surgery ; Reconstructive Surgical Procedures ; methods ; Scrotum ; abnormalities ; surgery ; Urethra ; surgery ; Urethral Diseases ; surgery ; Urologic Surgical Procedures, Male ; methods