Introduction The surgical treatment of disorders of male sexual function requires specific exposure to correct the underlying problem safely and efficiently. Currently, sub-coronal exposure is used for treatment of phimosis, Peyronie's disease plaque (PDP), and semirigid penile prosthesis insertion. Infra-pubic and scrotal incisions are used for inflatable penile prosthesis (IPP) placement. However, men who present with several disorders might require multiple procedures and surgical incisions. Aim To report a prospective review of our surgical experience and outcomes with a single sub-coronal incision for IPP placement with a modified no-touch technique. This approach allows for access to the entire corporal body for multiple reconstructive procedures. Methods Two hundred men had IPPs placed through a sub-coronal incision using our modified no-touch technique. The penis was degloved to the level of the penoscrotal junction and the dartos muscle was everted and secured to the drapes. This allowed exclusion of the scrotal and penile skin from the operative field. After artificial erection, the patient's corpora were inspected for PDP and other abnormalities. Penoscrotal IPP models were placed in all cases with insertion proximal to the penoscrotal junction. After placement of the IPP, the abnormalities were repaired. Main Outcome Measures Feasibility of the procedure, operative times, complication rate, utilization of accessory, reconstructive procedures, and post-operative penile length. Results Of the 200 men who had IPP placement, 92 had PDP that was treated, 106 (53%) consented to circumcision, 24 (12%) had their reservoir placed ectopically, and 31 (16%) had a prosthesis exchanged through the sub-coronal technique. Mean operative time was 73 minutes (39–161 minutes). Conclusion Specialists in the surgical treatment of disorders of male sexual function can perform multiple procedures safely and easily through a modified no-touch single sub-coronal incision. This approach allows access to the entire corporal body, providing excellent visibility and allowing the surgeon to perform multiple penile reconstructive surgeries through a single incision.

Patients treated by higher volume implanters are less likely to require reoperation after inflatable penile prosthesis insertion than those treated by lower volume surgeons. This trend appears to be driven by associations between surgeon volume and the risk of prosthesis infection.

Cystoscopy performed solely for recurrent UTI is low yield in patients with normal imaging studies, but a small number of abnormal findings may be missed by foregoing this element of the patient workup. No studied risk factor was predictive of an abnormal workup. Neurourol. Urodynam. 36:692-696, 2017. © 2016 Wiley Periodicals, Inc.

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pT3b prostate cancer is a heterogeneous disease commonly associated with several high-risk features. Stratifying men with SVI by prognostic features (i.e., Gleason, PSA, node status, surgical margin status) and using these features to augment the CAPRA score will improve identification of those at higher risk for BCR that should be strongly considered for adjuvant XRT.

IntroductionNon-curvature penile deformities associated with loss of erect penile volume are often overlooked and have not been thoroughly investigated.AimTo describe the prevalence and functional impact of penile volume-loss deformities in our cohort of men with Peyronie’s disease (PD).MethodsWe retrospectively examined medical records of patients with PD consecutively evaluated by a specialized urologist from December 2012 to June 2016. We excluded patients with prior surgical correction of PD, prior penile prosthesis, and inadequate erection during office examination. All patients underwent deformity assessment of the erect penis after intracavernosal injection. The assessment included measurement of penile curvature; evaluation for hourglass deformities, indentations, and distal tapering; and application of axial force to assess for penile buckling. Prior to the deformity assessment, each patient completed the Male Sexual Health Questionnaire and was asked if he experienced psychological distress and functional impairment related to his penile deformity.Main Outcome MeasureThe primary clinical parameters that we evaluated were presence or absence of axial instability, functional impairment, psychological distress, penile pain, erectile dysfunction, ejaculatory dysfunction, sexual dissatisfaction, decreased sexual activity, and decreased sexual desire.Results128 patients met criteria for inclusion. 83 patients (65%) had volume-loss deformities. Unilateral indentations, hourglass deformities, and distal tapering were present in 50 (39%), 30 (23%), and 16 (13%) patients, respectively. Penile curvature <10° degrees was present in 115 patients (90%). After controlling for angle of curvature, patients with volume-loss deformities had significantly higher rates of axial instability (odds ratio [OR] = 3.5, P = .01) and psychological distress (OR = 2.6, P = .03), as well as decreased sexual activity (OR = 2.7, P = .02), than patients with non–volume-loss deformities.ConclusionVolume-loss penile deformities are highly prevalent in men with PD. These deformities are associated with penile axial instability and psychological distress, which may contribute to decreased frequency of sexual activity.Margolin EJ, Pagano MJ, Aisen CM, et al. Beyond curvature: prevalence and characteristics of penile volume-loss deformities in men with Peyronie's disease. Sex Med 2018;6:309–315.

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Introduction Standard operating procedures (SOP) for penile duplex Doppler ultrasound (PDDU) were published in 2013 to promote uniform vascular assessment for erectile dysfunction (ED). However, SOPs do not specify a standard anatomic location for cavernosal artery (CA) imaging. Aim The aim of this study was to determine the effects of CA imaging location on measured penile hemodynamics assessed by PDDU. Methods PDDU was performed in men with ED and/or Peyronie's disease. CA peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured at three points: the origin of the CA within the penile crus, the proximal CA, and mid-CA. Differences in PSV and EDV were assessed by Friedman test and categorical vascular outcomes by Fisher's exact test. Data were analyzed for the main cohort, the subgroup with maximal smooth muscle relaxation (SMR) as defined by negative EDV, and the subgroup with valid-for-intromission erections. Main Outcome Measures Mean PSV and EDV at three specified CA locations and the vascular diagnoses resulting from these measurements. Results One hundred four CAs were imaged in 52 men. Mean PSVs at the crus, proximal, and mid-CA were 52.9 ± 20.2, 29.5 ± 15.1, and 21.6 ± 10.6 cm/s, respectively (P &lt; 0.0001); mean EDVs were 2.1 ± 8.9, 3.2 ± 5.4, and 3.3 ± 3.5 cm/s, respectively (P = 0.1225). The distribution of arteriogenic (P &lt; 0.0001) and venogenic (P &lt; 0.0001) diagnoses both differed significantly by location. Significant differences in vasculogenic diagnoses were also observed in the subgroup of CAs with definite maximal SMR (n = 38, arteriogenic P &lt; 0.0001, venogenic P = 0.007) and in those with valid-for-intromission erections (n = 68, arteriogenic P &lt; 0.0001, venogenic P = 0.0002). Conclusion There is large variability in measured PSV and EDV on PDDU depending on the site of Doppler imaging, which can often sway clinical diagnosis. Future guidelines should attempt to incorporate standard locations of CA imaging, and new normative values may be necessary for each location.