Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the coronavirus that causes an infectious disease, called COVID-19, first detected in patients with pneumonia in Wuhan (People's Republic of China) on December 2019. Italy was the first European country to state the outbreak of the infection and its Council of Ministers declared the state of health emergency on 31.01.2020, then the World Health Organization ruled a global pandemic on 11.03.2020. The nasopharyngeal swab is based on the detection of virus RNA and is the only reliable one for declaring COVID-19 infection. The most common symptoms observed in COVID-19 patients before hospitalization may be fever, chills, cough, dyspnea, asthenia, myalgia and/or arthralgia. This symptomatology can be often complicated in a dramatically increasing manner such as to require hospitalization starting from the third-fourth week. COVID-19 outbreak has dramatically affected the quality of life by changing inter-personal relationships, community life and obviously sexual health. The purpose of this work, based on available evidence, is to provide recommendations to help the population to face their sexual life in this critical period.
The purpose of this study is to evaluate the quality of information on YouTube regarding penile prosthesis. We searched the term ‘penile prosthesis’ on YouTube recording the first 100 video links. Each video was analysed by three evaluators through the validate Patient Education Materials Assessment Tool (PEMAT), the DISCERN quality criteria for consumer health information and a misinformation assessment tool specifically created for this subject. All the videos were viewed 10′011′232 times. Median duration time was 5′13″ (IQR = 7′25″–1′58″). Sixty‐eight per cent were nonsurgical videos and 32% of them contained surgical procedures. Most of the videos were uploaded by Private Companies (51%). Videos were primarily directed at patients (73 of 100 videos). The mean PEMAT understandability score was 57.8% ± 19.2%, the actionability score was 0% (IQR = 33%–0%). The median DISCERN score was 26 (IQR = 30–21). None of the videos provided a complete patients’ information and the overall mean misinformation score was 3.21 ± 2.24. Based on our data, video's quality according to PEMAT and DISCERN score is mostly poor. Furthermore popularity does not correlate with the quality of the videos, and most of them fail to provide adequate patient's information.
The available studies that provide a detailed analysis of functional and surgical outcomes after surgical correction of adult acquired buried penis(AABP) are limited. 28 patients who underwent surgical treatment of AABP from 2017 to 2021 were retrospectively recruited. AABP repairs were classi ed according to surgical complexity following Santucci's classi cation. The primary endpoint of the study was the recurrence-free rate(RFR) survival. The secondary endpoints were surgical, functional and patients' reported outcomes(PROs). The most common complains at presentation were sexual(54%) and voiding(39%) dysfunction. 79% underwent a complex repair(≥III). Surgical management steps ranged from circumcision to more complex procedures, such as abdominoplasty(71%). When skin grafting was needed, a split thickness(25%) or full thickness skin graft(28.6%) was applied. Overall postoperative complications were recorded in 32.1%. High-grade complications(Clavien ≥3) occurred in 7.1%, all in high-complexity group. 1-year RFR survival was 88.7%. 57% answered the questionnaires. IPSS showed an improvement in urinary functon(pre=8(0-12) vs post=2(0-3)) and IIEF-15 in sexual functon(pre=37(23-68) vs post=68(45-72)) in postoperative settings. Overall, patients reported functional improvement and 93.5% were fully satis ed of the outcomes. QoL improved in 93.8% after the operation. Surgical management of AAPB, despite the high incidence of complications, guarantees satisfactory outcomes leading to a signi cant improvement in patients' QoL.
Background and Objectives: 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. Materials and Methods: 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. Results: 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% (n = 4) and 55.6% (n = 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. Conclusions: 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.
Introduction: Premature ejaculation (PE) represents the most prevalent male sexual issue. Before beginning treatment, it is essential to discuss the patient's expectations thoroughly. Methods: Herein, we report the results of an expert panel discussion about perceptions, expectations, preferences, and attitudes towards PE, its diagnosis and treatment. The panel took place in October 2019 and involved 30 Italian urologists experienced in the management of male sexual dysfunction. It aimed at investigating physicians' points of view about selected aspects of PE management which emerged during the counselling of PE patients over the previous two years. Treatment-related questions were mainly focused on topical treatment with Fortacin™. Results: Overall, 83.3% of those interviewed declared that most of their patients perceive PE as a bother rather than a disease. The percentage of urologists interviewed perceived that improved subjective control over ejaculation and prolonged intravaginal ejaculatory latency time (IELT) as the main benefit expected by the majority of their patients was 56.5% and 10%, respectively. Eighty percent of urologists reported on-demand regimen as the dosage modality preferred by the majority of their patients and half of them reported the topical route to be the way of administration preferred in most cases. Moreover, 73.3% of urologists reported that adherence to treatment was higher in patients undergoing topical treatment. Finally, 80% of urologists perceived Fortacin to be efficacious in patients with acquired PE and 70% of them perceived its efficacy to be independent from IELT. Discussion: Most patients perceive PE as a bother rather than a disease and mainly advocate an improved control over ejaculation. Fortacin is perceived as efficacious in patients with acquired PE, and independent from IELT.
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.
Objectives Our study aim is to analyze the surgical and functional outcomes after urethral reconstruction in consecutive series of transgender men who underwent genital gender-confirming surgery. Methods A retrospective monocentric cohort study was conducted. From 2015 to 2022, patients who underwent urethral lengthening in the context of GGCS were enrolled. Surgical outcomes and postoperative complications were reported. Three questionnaires were administered to evaluate patients’ urinary function (CCO-EPIC, ICIQ-SF) and patients’ psychological well-being (BDI - scale of depression). A 6-item ad hoc created questionnaire was administered to inquire patients’ reported outcomes. Results 31 patients were included in the study. 11 underwent metoidioplasty (Group A), while 20 underwent phalloplasty with different techniques (Group B). The descriptive characteristics between the two groups were comparable, except for the BMI resulting greater in Group B (p-value 0.012). Average follow-up was 18 months (±18SD). Mean operative time was 160 minutes (±43 SD). No significant intraoperative complications occurred. Early postoperative complication rate resulted significantly higher for group B (83.3% p-value 0.034). The most frequent complication, urethral fistula, healed in all cases after prolonged catheterization. Overall 9.6% of patients needed a surgical revision to address urethral complications. CCO-EPIC and ICIQ-SF administered preoperatively and 1-year after surgery showed worsening in urinary function (p-value = 0.04 and p-value = 0.02 respectively), BDI score showed a significant improvement in postoperative settings (p-value= 0.02). 82 % of the patients after 1-year follow-up were satisfied with the procedure and 81 % declared that surgery had a positive impact on their quality of life. The main limitations of the study are the limited follow-up, the non-randomized nature of the study and the small number of patients. Conclusions Urethral reconstruction in the context of GGCS is a challenging reconstructive surgery burdened by high incidence of postoperative complications. Despite that, it may contribute to improve the psychological well-being of transgender men. Conflicts of Interest This study is free from commercial influence or bias and the authors had no conflict of interest.
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