Introduction The principal goal of surgical techniques for male to female gender reassignment is to provide aesthetic and functional external female genitalia. Aim To present a new surgical technique which permits a safer and faster construction of the neoclitoris and the configuration of a natural-looking mons veneris. Main Outcome Measures The neoclitoris sensitivity was reported by the patients themselves and checked during the follow-up medical examination. In order to define the degree of the patients' satisfaction with the mons veneris appearance, we used a simple questionnaire. Methods From April 2004 to February 2007, 26 patients underwent male to female sex reassignment surgery. The new technique was applied in the last 15 cases. A strip of albuginea, with the penile dorsal neurovascular bundle and a little portion of glans, was prepared, bended on itself, and fixed in the suprapubic area in order to create the mons veneris and the neoclitoris. Results This technique was easy to perform, permitting the safe preservation of the penile dorsal neurovascular bundle and a reduction in the operation time of 30–45 minutes. No major complications occurred in this series. Neoclitoris trophism and sensitivity were preserved in all patients. At follow-up, ranging from 3 to 20 months, the genital appearance was satisfactory, and the neoclitoris was pleasantly sensitive after a short period of hypersensitivity. Moreover, seven patients reported some form of climax during intercourse. The technical outcome was successful in all cases. The patients' satisfaction was extremely high for the neoclitoris sensitivity (present in all patients) and high in 11 out of 15 for the appearance of the mons veneris. Conclusions The neoclitoris and mons veneris configuration with a strip of albuginea is a new, safe, and time-saving surgical procedure. The cosmetic appearance and function of transsexual female external genitalia appears to be improved by using this technique.

BACKGROUND. Phytotherapy has been used to treat patients with lower urinary tract symptoms (LUTS). We evaluated the efficacy and tolerability of combination therapy between Serenoa Repens (SeR), Lycopene (Ly), and Selenium (Se) þ tamsulosin versus single therapies. METHODS. PROCOMB trial (ISRCTN78639965) was a randomized double-blinded, doubledummy multicenter study of 225 patients between 55 and 80 years old, PSA 4 ng/ml, IPSS !12, prostate volume 60 cc, Qmax 15 ml/sec, postvoid residual urine (PVR) <150 ml. Participants were randomized group A (SeR-Se-Ly), group B (tamsulosin 0.4 mg), group C (SeR-Se-Ly þ tamsulosin 0.4 mg). The primary endpoints of the study were the reduction of IPSS, PVR, and increase of Qmax in group C versus monotherapy groups. RESULTS. The decrease for combination therapy was significantly greater versus group A (P < 0.05) and group B (P < 0.01) for IPSS and versus group A (P < 0.01) for PVR from baseline This study has been designed and conducted independently. Konpharma provided support for this study. Data collection and management and all statistical analyses were performed and retained by data manager (R.A.). The corresponding author and other co-authors interpreted the data and participated in the preparation, review and approval of the manuscript. to 6 months. A greater decrease in IPSS was observed for Group C versus group A (P < 0.01) and increase in Qmax versus group B (P < 0.01), from 6 months to 12 months. At one year, the changes of IPSS and Qmax were greater for Group C versus monotherapies (each comparison <0.05). The proportions of men with a decrease of at least three points (each comparison P < 0.05) and decrease of 25% for IPSS (each comparison P < 0.01) were greater for Group C. CONCLUSION. SeR-Se-Ly þ tamsulosin therapy is more effective than single therapies in improving IPSS and increasing Qmax in patients with LUTS.

No abstract

Fournier's gangrene is a life-threatening acute necrotizing fasciitis of perianal,genitourinary and perineal areas. Nowadays, is well known that Fournier gangrene is almost never an idiopathic disease. In this article we report a case of a 70-year-old patient that initially was not treated properly. The gold standard therapy of the Fournier's gangrene remains today a complete, early and extended surgical debridement.