Severe persistent stress incontinence following radical prostatectomy for prostate cancer treatment, although not very common, remains the most annoying complication affecting patient's quality of life, despite good surgical oncological results. When severe incontinence persists after the first postoperative year and conservative treatment has been failed, surgical treatment has to be considered. In these cases it is generally accepted that artificial urinary sphincter is the gold standard treatment. AUS 800 by American Medical Systems has been successfully used for more than 35 years. Recently three more sphincter devices, the Flow-Secure, the Periurethral Constrictor, and the ZSI 375, have been developed and presented in the market. A novel type of artificial urinary sphincter, the Tape Mechanical Occlusive Device, has been inserted in live canines as well as in human cadavers. These new sphincter devices are discussed in this paper focusing on safety and clinical results.

Introduction Patient and female partner satisfaction after implantation of an inflatable penile prosthesis (IPP) assessed by objective means, and the correlation between the partners, is important for determining postoperative sexual life. Aim The primary goal was to evaluate patients' erectile function and patients' and their partners' satisfaction after IPP implantation. A secondary aim was to investigate potential determinative factors of satisfaction according to device characteristics, demographics, and cause of erectile dysfunction (ED). Methods Ninety patients, who underwent IPP implantation as an alternative to refractory or undesirable medical treatment for ED, were evaluated. Patients who could not or refused to participate, or were out of a relationship, were excluded. The 69 remaining patients were evaluated for their pre- and postoperative erectile function and posttreatment satisfaction for themselves and their partners. Main Outcome Measures Preoperative and postoperative scores on the International Index of Erectile Function Questionnaire–five items (IIEF-5) were compared. The Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) was given to males and their female partners. Patient demographics, etiology of ED, and implant characteristics were correlated also with patients' EDITS scores. Results Mean IIEF-5 scores demonstrated a significant improvement after IPP implantation: from 8.88 ± 3.75 to 20.97 ± 4.37 (P < 0.001). The mean patients' EDITS score was 75.48 ± 20.54, whereas mean female partners' score was 70.00 ± 22.92, highlighting high posttreatment satisfaction for both. Regression analysis suggested a direct linear correlation of satisfaction between the sexual partners as a degree of satisfaction. There were no statistically significant differences according to level of education or implant characteristics. Concerning the etiology of ED, no conclusions could be made. Conclusions Overcoming previous limitations in determining post-IPP implantation satisfaction, our study reiterates high rates of patient and partner satisfaction. Of particular note, patient satisfaction appears independent of prosthesis type and cylinder length.

We present a rare and interesting case of a mixed epithelial and stromal tumour (MEST) of the kidney. The case is unique as it involves a male patient with no history of hormonal therapy presenting with a filling defect in the renal collecting system and positive urine cytology. The patient was diagnosed with transitional cell carcinoma of the renal pelvis and subjected to nephroureterectomy, which revealed a solid tumour arising from the lower calyces and extending into the renal pelvis and upper ureter. Pathology revealed a MEST. The patient was disease-free at the 6-month follow-up. Case presentationA 50-year-old male was found with a mass in his left kidney on abdominal ultrasound during routine evaluation for lower urinary tract symptoms. On colour ultrasound, the mass was irregular, hypoechoic and involved the renal pelvis and lower calyces (Fig. 1). The patient's medical and family histories were insignificant and his physical examination did not reveal any abnormalities. The ultrasound findings were further evaluated with intravenous urography (IVU), which also revealed a smaller (about 9 cm) ectopic right kidney located in the true pelvis. The collecting system of the left kidney was mildly dilated with the presence of a filling defect in the lower calyces extending into the renal pelvis. The ectopic, smaller, right kidney was not dilated and the contrast medium was normally secreted to the bladder (Fig. 2).This finding raised a strong suspicion for transitional cell carcinoma (TCC) of the collecting system, although the patient was not a smoker. We ordered a computed tomography urography (CTU) for further clarification and staging and we planned a cystoscopy.Cystoscopy revealed a normal bladder urothelium. A ureteral catheter was advanced into the upper tract for barbotage and urine collection for cytology. Two voided specimens of urine were also collected for cytology. Cytology from the urine collected via the ureteral catheter was positive for high-grade transitional cell carcinoma (TCC).CTU confirmed the findings of IVU and revealed the presence of a filling defect caused by soft tissue mass arising from the anterior lower calyx and extending into the renal pelvis and the upper part of the ureter. The mass was causing dilatation of the renal pelvis. although there were no signs of enlarged lymph nodes or other pathology (Fig. 3, Fig. 4). Differential diagnosis included hemangioma, tuberculosis and TCC of the collecting system. However, in view of the positive urine cytology, the diagnosis of TCC of the collecting system was considered the most possible diagnosis. Nephroureterectomy was scheduled and nephrology consultation was requested because the patient had a possibly miss-functioning ectopic right kidney and was about to lose his other kidney.A renal scan with 99m Tc (DTPA) was done to evaluate renal function. Total glomerular filtration rate was 48 mL/ min (normal: >74 mL/min) and split renal function was 36.8 mL/min for the left kidney (77% of the total renal function) and 11 mL/min fo...

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