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 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

The aim of this study was to figure out the predictors of early postoperative catheter-related bladder discomfort (CRBD) after urological surgery. We designed a prospective observational study in our hospital. Consecutive adult patients undergoing surgery under general anaesthesia or epidural anaesthesia necessitating urinary catheterization were included during a 3-month period. severity of bladder discomfort was assessed on a 4-point scale: (1) no pain, (2) mild pain (revealed only by interviewing the patient), (3) moderate (a spontaneous complaint by the patient of a burning sensation in the urethra and/or an urge to urinate and/or sensation of urethral foreign body without any emotional agitation) and (4) severe discomfort (agitation, loud complaints and attempt to remove the bladder catheter associated with a burning sensation in the urethra). Predictors of CRBD were identified by univariate and multivariate analysis. Totally, 116 patients were included, of which 84.5% had CRBD (mild CRBD: 40.5%; moderate or severe CRBD: 44.0%) at day 1, while 31.9% developed CRBD (mild CRBD: 29.3%; moderate or severe CRBD: 2.6%) at day 3. We evaluated 9 potential forecast factors of CRBD, and univariate Chi-square test showed male gender [OR=2.4, 95%CI (1.1-5.6), P<0.05], abdominal open surgery compared with transurethral surgery [OR=0.3, 95%CI (0.1-0.6), P<0.05], abdominal surgery compared with laparoscopic surgery [OR=3.3, 95%CI (1.2-8.9), P<0.05] and history of catheterization [OR=0.5, 95%CI (0.2-0.9), P<0.05] were independent predictors of moderate or severe CRBD in the patients after surgery. While multivariate logistic regression analysis showed that the abdominal open surgery [EXP(B)=3.074, 95%CI (1.3-7.4), P<0.05] and the history of catheterization [EXP(B)=2.458, 95%CI (1.1-5.9), P<0.05] might contribute more to the occurrence of moderate or severe CRBD. In conclusion, this observational study identified that the type of surgery and the history of catheterization might be predictive factors of moderate and severe CRBD after urological surgery.
Adult ; Aged ; Catheters ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Pain ; etiology ; pathology ; physiopathology ; Postoperative Complications ; pathology ; physiopathology ; Prospective Studies ; Urinary Bladder Diseases ; etiology ; pathology ; physiopathology ; Urologic Surgical Procedures ; adverse effects

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

BACKGROUNDThe research of cancer in patients on hemodialysis (HD) in China has not been reported. The aim of this study was to investigate the clinical and histological features and outcomes of cancer in Chinese HD patients.

METHODSThe study subjects were 49 cancer patients (1.4%) out of 3448 end stage renal disease (ESRD) patients maintained on HD at China-Japan Friendship Hospital from October 1997 to July 2011.

RESULTSUrinary tract cancer (74%) was the most common followed by gastrointestinal tract cancer (12%), breast cancer (6%), lung cancer (4%), thyroid cancer (2%), and hematologic cancer (2%). Thirty-three patients (67%) had urinary tract transitional cell carcinoma (TCC) and 29 of them had aristolochic acid nephropathy (AAN) as underlying disease. Death occurred in eight patients out of 49, and the survival rate of HD patients with cancer was similar to those without cancer (P = 0.120).

CONCLUSIONThe urinary tract TCC is the most common cancer in HD patients with AAN in one of the centers of northern China.

Adult ; Aged ; Aged, 80 and over ; Aristolochic Acids ; metabolism ; Carcinoma, Transitional Cell ; complications ; epidemiology ; metabolism ; China ; Female ; Humans ; Kidney Diseases ; epidemiology ; etiology ; metabolism ; Male ; Middle Aged ; Renal Dialysis ; adverse effects ; Retrospective Studies ; Urologic Neoplasms ; complications ; epidemiology ; metabolism

PURPOSE: We report our experience to date with 171 patients who underwent laparoendoscopic single-site surgery for diverse urologic diseases in a single institution. MATERIALS AND METHODS: Between December 2008 and August 2010, we performed 171 consecutive laparoendoscopic single-site surgeries. These included simple nephrectomy (n=18; robotic surgeries, n=1), radical nephrectomy (n=26; robotic surgeries, n=2), partial nephrectomy (n=59; robotic surgeries, n=56), nephroureterectomy (n=20; robotic surgeries, n=12), pyeloplasty (n=4), renal cyst decortications (n=22), adrenalectomy (n=4; robotic surgeries, n=2), ureterolithotomy (n=10), partial cystectomy (n=3), ureterectomy (n=1), urachal mass excision (n=1), orchiectomy (n=1), seminal vesiculectomy (n=1), and retroperitoneal mass excision (n=1). All procedures were performed by use of a homemade single-port device with a wound retractor and surgical gloves. A prospective study was performed to evaluate outcomes in 171 cases. RESULTS: Of the 171 patients, 98 underwent conventional laparoendoscopic single-site surgery and 73 underwent robotic laparoendoscopic single-site surgery. Mean patient age was 53 years, mean operative time was 190.8 minutes, and mean estimated blood loss was 204 ml. Intraoperative complications occurred in seven cases (4.1%), and postoperative complications in nine cases (5.3%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification for surgical complications). Conversion to mini-incision open surgery occurred in seven (4.1%) cases. Regarding oncologic outcomes, no cancer-related events occurred during follow-up other than one aggressive progression of Ewing sarcoma. CONCLUSIONS: Laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases; however, surgical experience and long-term follow-up are needed to test the superiority of laparoendoscopic single-site surgery.
Adrenalectomy ; Cystectomy ; Follow-Up Studies ; Gloves, Surgical ; Humans ; Intraoperative Complications ; Kidney ; Laparoscopy ; Nephrectomy ; Operative Time ; Orchiectomy ; Postoperative Complications ; Prospective Studies ; Robotics ; Surgical Procedures, Minimally Invasive ; Ureter ; Urologic Diseases

Deafness ; etiology ; Facial Paralysis ; etiology ; Hematologic Diseases ; etiology ; Humans ; Meningitis ; etiology ; Mucocutaneous Lymph Node Syndrome ; complications ; Respiratory Tract Diseases ; etiology ; Urologic Diseases ; etiology

The present paper serves as a review of the associations between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), with a focus on common and combined pathways for treatment. LUTS and ED are common conditions seen in general urologic practice. Research has started to establish epidemiologic and pathophysiologic links between the two conditions and a strong association confirmed across multiple studies. Men seeking care for one condition should always be interviewed for complaints of the other condition. Proposed common pathways include alpha-1 adrenergic receptor imbalance, Rho-kinase overactivity, endothelial cell dysfunction and atherosclerosis-induced ischemia. Medical therapy has replaced surgery as the first-line treatment for LUTS in most patients, with the incorporation of alpha-adrenergic receptor antagonists (alpha-ARAs) and 5-alpha-reductase inhibitors (5-ARIs) into everyday practice. Treatment with alpha-ARAs contributes to some improvement in ED, whereas use of 5-ARIs results in worsened sexual function in some patients. Phosphodiesterase-5 (PDE-5) inhibitors have revolutionized the treatment of ED with a simple oral regimen, and new insights demonstrate a benefit of combined use of PDE-5 inhibitors and alpha-ARAs. The mechanisms of action of these medications support these observed benefits, and they are being studied in the basic science and clinical settings. In addition, novel mechanisms for therapy have been proposed based on clinical and research observations. The minimally invasive and surgical treatments for LUTS are known to have adverse effects on ejaculatory function, while their effects on erectile function are still debated. Much remains to be investigated, but it is clear that the associations between LUTS and ED lay the foundation for future therapies and possible preventative strategies.
5-alpha Reductase Inhibitors ; Adrenergic alpha-Antagonists ; therapeutic use ; Atherosclerosis ; complications ; Endothelium, Vascular ; Erectile Dysfunction ; etiology ; therapy ; Humans ; Male ; Phosphodiesterase Inhibitors ; therapeutic use ; Prostatic Hyperplasia ; complications ; surgery ; Receptors, Adrenergic, alpha ; physiology ; Urologic Diseases ; etiology ; therapy ; rho-Associated Kinases ; metabolism

OBJECTIVETo evaluate the urodynamic risk factors of upper urinary tract dilatation (UUTD) secondary to spinal cord injury (SCI).

METHODSNinety-six SCI patients of Tangshan earthquake were divided into 2 groups by ultrasonography: 16 SCI patients (group A) with UUTD and 80 SCI patients (group B) without UUTD received urodynamic test. Responses were evaluated using single and multiple analysis after examination.

RESULTSThe incidence of male was significantly higher than that of female. Residual urine volume, maximum cystometric capacity, detrusor leak point pressure and the incidence of bladder low compliance in group A were significantly higher than those in group B. There were no significant differences in age, the incidence of detrusor hyperreflexia, relative safe bladder capacity, the incidence of detrusor-sphincter dyssynergia, maximum flow rate and maximum urethral closure pressure between 2 groups. Bladder low compliance was cardinal risk factors according to Logistic regression analysis.

CONCLUSIONAn early urodynamic examination and treatment for SCI patients are important to prevent from bladder low compliance and upper urinary tract damage.

Aged ; Dilatation, Pathologic ; etiology ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Spinal Cord Injuries ; complications ; Urodynamics ; Urologic Diseases ; etiology ; physiopathology