INTRODUCTION AND OBJECTIVE: Treatment of patients with vesicourethral anastomotic contracture (VUAS) /membranous stenosis (Sp) following a combination of prostatectomy and radiation treatment for prostate cancer (CaP) are understudied. We evaluate feasibility of dorsal onlay buccal mucosal graft urethroplasty (D-BMGU) and evaluate patency and continence outcomes in patients with a history of prior radical prostatectomy and radiation therapy.METHODS: Retrospective multi-institutional review of patients with post-prostatectomy, post-radiation VUAS/Sp from 8 institutions between 2013-2021 was performed. Patients with at least 8-months follow-up were assessed. Patient demographics, stenosis characteristics, peri-operative outcomes, and post-operative clinical and patient-reported outcomes were analyzed. The primary outcomes were recurrence and development of de-novo stress urinary incontinence (SUI). Secondary outcomes were surgical complications, changes in voiding and patient-reported satisfaction using a Global Response Assessment (GRA).RESULTS: Of 48 patients treated with D-BMGU for stenosis following prostatectomy and radiation, 38 met the inclusion criteria. Median age and stenosis length were 68.5 years, (IQR 63.25-72), and 2.75 cm (IQR 2-4 cm), respectively. Prior CaP treatment modalities included primary robotic prostatectomy and subsequent salvage or adjuvant radiotherapy in 89% (34/38) and primary radiation and salvage prostatectomy in 11% (4/38). The mean length of stay after D-BMGU was 1.5 days (IQR 1-2). At a median follow-up of 21 months (IQR 13-39), 5 patients (13%) had recurrence. Among 11 preoperativelycontinent patients (31%) all retained continence. Of 20 patients with preoperative SUI (52%), all but one (95%) remained incontinent postoperatively. Continence was unknown for 7 patients and 3 had post operative incontinence. 47% (17/36) of the cohort subsequently received an artificial urinary sphincter. Patients experienced significant improvement in PVR (158 to 47 cc, p <0.001) and Uroflow (6.3 to 15.4 cc/s, p <0.001), and also reported high overall satisfaction, with 84% reporting a GRA of þ2 or better.CONCLUSIONS: Dorsal onlay buccal mucosa graft urethroplasty is a safe and feasible technique in patients with post-radiation post prostatectomy anastomotic contracture. Although our findings suggest the DBMGU technique may confer lower rates of de-novo SUI compared to conventional urethral transection, head-to-head comparisons are needed to further characterize any continence benefit.

Purpose: Our aim was to determine if the AUA-recommended prophylaxis (vancomycin D gentamicin alone) for primary inflatable penile prosthesis surgery is associated with a higher infection risk than nonstandard regimens. Materials and Methods: We performed a multicenter, retrospective study of patients undergoing primary inflatable penile prosthesis surgery. Patients were divided into those receiving vancomycin D gentamicin alone and those receiving any other regimen. A Cox proportional-hazards model was constructed adjusted for major predictors. A subgroup analysis to identify the appropriate dosage of gentamicin was also performed.

Background Corporal fibrosis is known to result from prolonged priapism; however, the impact of the timing of penile prosthesis placement after priapism on complication rates is poorly understood. Aim We sought to evaluate the impact of timing of inflatable penile prosthesis (IPP) placement on complications in men with a history of ischemic priapism. Methods We performed a multicenter, retrospective cohort study of patients with a history of priapism undergoing IPP placement by 10 experienced implantation surgeons. We defined early placement as ≤6 months from priapism to IPP. We identified a 1:1 propensity-matched group of men without a history of priapism and compared complication rates between men who had early placement, late placement, and no history of priapism. Outcomes Our primary outcome was postoperative noninfectious complications, and secondary outcomes included intraoperative complications and postoperative infection. Results A total of 124 men were included in the study with a mean age of 50.3 ± 12.7 years. A total of 62 had a history of priapism and 62 were matched control subjects. The median duration of priapism was 37 (range, 3-168) hours and the median time from ischemic priapism to IPP placement was 15 months (range, 3 days to 23 years). Fifteen (24%) men underwent early (≤6 months) IPP placement at a median time of 2 months (range, 3 days to 6 months) following the ischemic priapism event. The remaining 47 (76%) underwent placement &gt;6 months following priapism at a median time of 31.5 months (range, 7 months to 23 years). The complication rate in the delayed placement group was 40.5% compared with 0% in the early placement group and control group. Cylinder-related complications such as migration or leak accounted for 8 (57%) of 14 of the postoperative noninfectious complications. Full-sized cylinders were used in all patients who had a cylinder related complication. Clinical Implications Priapism patients should be referred to prosthetic experts early to decrease complication rates in those needing an IPP. Strengths and Limitations This is a multicenter study from experienced prosthetic urologists but is limited by the retrospective nature and small number of patients in the early placement group. Conclusion IPP complication rates are high in men with a history of ischemic priapism, especially when implantation is delayed beyond 6 months.

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This is a case of a patient who presented to our clinic for evaluation of erosion of his IPP. He has had erectile dysfunction since 2012. He initially had a malleable placed in 2014 followed by a three piece inflatable penile prosthesis in 2015. Over time, the right side of his penis began to appear deformed. He then moved and was seen by a different provider for evaluation of gross hematuria. After noting the corporal defect on the right side, the patient was referred to us for further evaluation and management. After workup revealed no urethral erosion and no underlying abscess, we took him to the operating room for repair. Once we dissected down to the corporal body, we noticed thinning in the proximal-mid corpora with an obvious defect and erosion of the cylinder. Due to the thinning of the tissue, we used the pseudocapsule to provide for an additional coverage layer for our repair. We were able to replace the cylinder in the correct anatomic position and once closed, there was no longer any deformity present.