A delayed approach to gonadectomy and vaginal reconstruction respects patient autonomy and allows a more mature patient to handle the psychological and physical trauma of surgery and rehabilitation. Since we recognize the small number of patients in this series, strict guidelines cannot be proposed.

A simple intervention which successfully prevents renal warm-ischemic damage would expand the number of surgeons and patients who benefit from laparoscopic NSS. There is no evidence that this preconditioning regimen ameliorated the ischemia-reperfusion injury. Endeavors are ongoing to determine if alternative preconditioning regimens may be beneficial.

While the transscrotal approach to artificial urinary sphincter placement has the advantage of technical ease, the anatomical and manometric findings of this cadaver study suggest that the perineal approach offers a more proximal cuff location, more robust urethral size and more effective urethral coaptation than the transscrotal approach.

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