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Sexual outcomes after partial penectomy for penile cancer： results from a multi-institutional study

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Asian Journal of Andrology 2017年第1期19卷 57-61页

作者： salvatore sansalone Mauro Silvani Rosario Leonardi Giuseppe Vespasiani Valerio Iacovelli Department of Experimental Medicine and Surgery - Urology Tor Vergata University of Rome 00133 Rome Italy Department of Urology Biella General Hospital 13900 Biella Italy Musumeci GECAS Clinic Gravina di catania 95127 Catania Italy.

Penile cancer is an uncommon malignancy. Surgical treatment is inevitably mutilating. Considering the strong impact on patients＇ sexual life we want to evaluate sexual function and satisfaction after partial penectomy. The patients in this study （n = 25） represented all those who attended our institutions and were diagnosed and treated for penile cancer from October 2011 to November 2013. All patients underwent partial penectomy and followed-up （mean： 14 months; range： 12-25）. Sexual presurgical baseline was estimated using the International Index of Erectile Dysfunction 15 （IIEF-15）. Sexual outcomes of each patient were estimated considering four standardized and validated questionnaires. We analyzed the means and ranges of IIEF-15 including erectile function （IIEF-1-5 and -15）, orgasmic function （IIEF-9 and -10）, sexual desire （IIEF-11 and -12）, intercourse satisfaction （IIEF-6-8）, and overall satisfaction （IIEF-13 and -14）. Then, we also used Quality of Erection Questionnaire （QEQ）, Erectile Dysfunction Inventory of Treatment Satisfaction （EDITS） and Self-Esteem and Relationship （SEAR） to evaluate the sexual function and satisfaction of our patients. The final results showed that penile cancer leads to several sexual and psychosexual dysfunctions. Nevertheless, patients who undergo partial penectomy for penile cancer can maintain the sexual outcomes at levels slightly lower to those that existed in the period before surgery.

关键词： partial penectomy penectomy penile cancer penile tumor sexual outcomes

History and evolution of the use of oral mucosa for urethral reconstruction

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Asian Journal of Urology 2017年第2期4卷 96-101页

作者： Guido Barbagli Sofia Balo Francesco Montorsi salvatore sansalone Massimo Lazzeri Centro Chirurgico Toscano ArezzoItaly Division of Oncology/Unit of Urology IRCCS Ospedale San RaffaeleMilanItaly Department of Experimental Medicine and Surgery University of Tor VergataRomeItaly Department of Urology Istituto Clinico Humanitas IRCCSClinical and Research HospitalRozzanoItaly

We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in *** that time,many authors have contributed to develop,improve and popularize the use of oral mucosa as a substitute *** urologists should be considered pioneers on the use of oral mucosa as they used it to repair primary and failed *** use of oral mucosa to repair penile and bulbar urethral strictures was described,for the first time,in *** evolutions in the technique for harvesting oral mucosa from the cheek were reported in ***,oral mucosa is considered the gold standard material for any type of anterior urethroplasty in a one-or two-stage repair due to its biological and structural characteristics that make it a highly versatile that is adaptable to any environment required by the reconstructive urethral *** the future approaches,tissue engineering techniques will provide patients with new materials originating from the oral epithelial mucosal cells,which are cultured and expanded into a ***,the path to reach this ambitious objective is still long and many difficulties must be overcome along the way.

关键词： Oral mucosa Cheek Urethra Urethroplasty Tissue engineering Reconstructive urology

Microsurgical tunica albuginea transplantation in an animal model

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Asian Journal of Andrology 2017年第6期19卷 694-699页

作者： salvatore sansalone Carla Loreto Rosario Leonardi Giuseppe Vespasiani Giuseppe Musumeci Claudia Lombardo Sergio Castorina Venera Cardile Rosario Caltabiano Department of Experimental Medicine and Surgery Tor Vergata University Rome Italy Department of Biomedical and Technological Sciences Section of Human Anatomy and Histology University of Catania Catania Italy Musumeci CLinic GECS Catania Italy Department of Bio-Medical Sciences Section of Physiology University of Catania Catania Italy Department of Medical and Surgical Sciences and Advanced Technology "G.E Ingrassia" Section of Anatomic Pathology University of Catania Catania Italy.

Several andrological diseases require surgical repair or reconstruction of tunica albuginea, which envelops the corpora cavernosa penis. Despite intense research efforts involving a variety of biological materials, such as skin, muscle aponeurosis, human dura mater, tunica vaginalis, and pericardium, engineered tunica albuginea suitable for graft use is yet to be obtained. The study investigates microsurgical tunica albuginea allotransplantation in an animal model with the purpose of creation of an organ-specific tissue bank to store penile tissue, from cadaveric donors and male-to-female trans-sexual surgery, for allogeneic transplantation. Materials were tunica albuginea tissue explanted from 15 donor rats, cryopreserved at -80~C, gamma-irradiated, and implanted in 15 recipient rats, of which three rats were used as controls. Penile grafts were explanted at different time intervals; after macroscopic evaluation of the organ, the grafts were processed to morphological, histochemical, and immunohistochemical examinations by light microscopy. Detection of pro-inflammatory cytokines was also performed. Examination of the tunica albuginea allografts collected 1, 3, or 6 months after surgery and of control tunica albuginea fragments showed that tunica albuginea implants achieved biointegration with adjacent tissue at all-time points. The integration of cryopreserved rat tunica albuginea allografts, documented by our study, encourages the exploration of tunica albuginea allotransplantation in humans. In conclusion, the effectiveness and reliability of the tunica albuginea conditioning protocol described here suggest the feasibility of setting up a tunica albuginea bank as a further tissue bank.

关键词： penile tunica albuginea rat model transplant

Long-term results of the surgical treatment of Peyronie＇s disease with Egydio＇s technique： a European multicentre study

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Asian Journal of Andrology 2011年第6期13卷 842-845页

作者： salvatore sansalone Giulio Garaffa Rados Djinovic Stefano Pecoraro Mauro Silvani Guido Barbagli Alessandro Zucchi Giuseppe Vespasiani Carla Loreto Department of Urology School of Medicine Tor Vergata University of Rome Rome 00133 italy St Peter＇s Andrology University College London Hospitals London WIG 6BJ UK Department of Urology School of Medicine Serbian Academy of Science and Arts University of Belgrade Belgrade 11000 Serbia Department of Nephro-Urology Malzoni Medical Center Avellino Avellino 83100 Italy Department of Urology General Hospital Biella 13900 Italy Center for Reconstructive Urethral Surgery Arezzo 52100 Italy Department of Urology and Andrology University of Perugia Perugia 06123 Italy Department of Bio-Medical Sciences Anatomy Section University of Catania Catania 95100 Italy

The long-term outcomes of 157 patients affected by Peyronie＇s disease （PD） who underwent penile straightening with Egydio＇s technique between January 2004 and December 2008 are reported. Only patients with PD who were stable for at least 6-12 months prior to surgery were enrolled in this study. Preoperative assessment included a dynamic echo colour Doppler ultrasound scan to evaluate the degree of penile deformity and the peak systolic velocity in the cavernosal arteries and an assessment of erectile function with the administration of the International Index of Erectile Function 5 （IIEF-5） questionnaire. Stretched penile length was recorded pre- and postoperatively. Surgical complications, cosmesis and sexual function, patient satisfaction and postoperative erectile function were assessed postoperatively at 3 months, I year and 2 years, respectively. After a median follow-up period of 20 months （range： 12-24 months）, we found that mild residual curvature （12%） and glans hypoesthesia （3%） were the only causes of partial dissatisfaction. No rejection of the graft was observed. All patients recovered their ability to penetrate with no difficulty. In addition, an intraoperative average increase of 2.5 cm （range： 1.7-4.1 cm） in stretched penile length was recorded, with all patients engaging in penetrative sexual intercourse. In conclusion, this procedure represents a safe and reproducible technique for the correction of penile curvature resulting from PD and yields excellent cosmetic and functional results.

关键词： Egydio's technique erectile dysfunction graft Peyronie's disease

The Role of Dilation and Internal Urethrotomy as a Risk Factor of Failure in Patients Who Undergoing One-Stage Bulbar Oral Graft Urethroplasty

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Open Journal of Urology 2012年第1期2卷 16-19页

作者： Guido Barbagli Giorgio Guazzoni salvatore sansalone Giuseppe Romano Massimo Lazzeri 3Clinical Research Institute “Prof. M. Fanfani” Florence Italy

Purpose: To test the hypothesis if dilation or direct visual internal urethrotomy (DVIU) are predictive of urethroplasty failure. Retrospective study, from 1999 to 2010, including184 patients (median age 37 years) who underwent ventral onlay oral graft urethroplasty for bulbar strictures. Exclusion criteria were traumatic strictures, lichen sclerosus, failed hypospadias repair, failed urethroplasty, panurethral strictures, and incomplete medical charts. Pre-operative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry, urethrography, ultrasound and urethroscopy. Surgery was considered a failure when any post-operative instrumentation was needed. Median follow-up was 48 months. Out of 184 patients, 38 (20.7%) had not undergone previous treatment, 7 (3.8%) had undergone dilation, 81 (44%) DVIU and 58 (31.5%) DVIU associated with dilation. Out of 184 patients, 157 (85.3%) were successful and 27 (14.7%) failures. Out of 38 patients who had not undergone previous treatment, 33 (86.8%) were successful;out of 7 patients who had undergone dilation, 6 (85.7%) were successful;out of 81 patients who had undergone DVIU, 72 (88.9%) were successful;out of 58 patients who had undergone DVIU and dilation, 46 (79.3%) were successful. According to the number of previous DVIU, ventral graft urethroplasty for bulbar strictures showed high failure rate in patients who had undergone more than four DVIU associated or not with dilation.

关键词： Urethral Stricture Direct Vision Internal Urethrotomy Dilation Urethroplasty