Objective: : To review the literature on adult penile reconstruction due to Peyronie's disease, trauma and cosmesis, while emphasising specific surgical techniques and procedures such as phalloplasty, radial forearm free flap reconstruction, and penile transplant. Methods: : A comprehensive review of the literature for the years 1992-2020 of the PubMed and SpringerLink databases was performed to identify articles on penile reconstruction. Search terms included 'penile reconstruction', 'penile trauma', 'phalloplasty', 'penile transplant', and 'treatment of Peyronie's'. Relevant articles were selected. All included studies were performed on adults and written in English. Results: : We were able to identify 46 papers from PubMed and SpringerLink that included the research terms. From these, we included technical details of procedures and gleaned photographs of their works. Additionally, we included photographs from our institution's own plication surgery cases. Conclusions: : The field of adult penile reconstruction is performed for a plethora of reasons. From cosmetic to urgent and from routine to complex, it is most certainly a growing subset of Urology that plays a vital role for the men who need it. To our knowledge, this is the most up-to -date review of adult penile reconstruction.

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Introduction The etiology of the uncommon presentation of persistent genital arousal disorder (PGAD) can provide an insight into the hormonal imbalances that effect sexual function and dysfunction in females. We examine, review, and analyze the correlation of the known cases of PGAD that involved hormonal imbalances with a focus on hormone imbalances (HI) from a urological perspective. Objective To review the literature regarding hormonal imbalances in females with PGAD with a focus on HI. Methods A literature review of articles and clinical studies was performed to define the diagnosis, etiology, and treatment outcomes of PGAD. Search terms included hormone imbalances and/or, persistent genital arousal disorder, diagnosis of persistent genital arousal disorder, defining persistent genital arousal disorder, as well as treatment of persistent genital arousal disorder. Results We found the of onset of PGAD on average was 49.2± 13.1 years with the average length of symptoms 4.7± 11.2 years. The common etiology of cases presented as hormonal imbalances with most individuals experiencing this as their only etiology. Overall, individuals who underwent treatment had a 72.2% rate of symptoms being resolved. The treatments administered involved pharmacological, clinical intervention, diet modification, and hypnotherapy. Clinical intervention was used the less than pharmacological treatment but was more successful. Conclusions There was a high frequency of PGAD presentation and treatment involving dopamine medications such as selective serotonin receptor inhibitors (SSRI). When evaluating for this rare disease it is important to keep in consideration the effect of hormone imbalances. Further studies are needed to get a more thorough understanding of the effects of dopamine may have on sexual dysfunction disorders such as PGAD. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast and Boston Scientific

tachosil patch. The advancement of the surgery leads us to look for alternatives that are easy to perform and that shorten surgical times, the total or partial incision of the peyronie plate plus tachosil graft leads us to obtain surgical results with a success rate of 83.8%. Tachosil is a sealing fibrin patch that is placed over the wound made, then covered with a compress moistened with warm saline for three minutes. Treatment of Peyronie's disease with Vivostat. Activated autologous fibrin is also being used as a sealant. During anesthetic induction, 120 ml of blood from the patient is obtained to which citrate is added, subsequently it is put for 25 minutes in the processor unit and a solution of 5 to 6 ml of autologous fibrin is obtained ready for use. We make some transverse incisions in the plate without having to resect it, later with the help of the vivostat applicator we fill the incisions made with the autologous fibrin solution we have obtained. Regardless of the surgical technique used, all patients should undergo penile rehabilitation with the help of vacuum device or an extender, to avoid shrinkage and shortening.CONCLUSIONS: There is no single approach to peyronie disease, it depends on the surgical skills of the surgeon and the involvement of the patient to achieve success

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