Because of our experience, use of a barbed suture for UVA during RARP seems to lead to better immediate and early (first month) urinary continence rates and a shorter UVA time.

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Introduction:In this retrospective study, we report outcomes of robot-assisted laparoscopic radical prostatectomy (RARP) in high-risk prostate cancer (HRPC) classified according to a D'Amico risk group with minimum 1-year follow-up. Methods: A total of 34 patients who had at least one preoperative HRPC feature and who underwent RARP were included. Mean patient age and preoperative serum prostate-specific antigen levels were 62.6±6.4 years and 12.2±9.1 ng/mL, respectively. Preoperatively, two (5.8%), one (2.9%), eleven (32.3%), three (8.8%), and 17 (50%) patients had prostate biopsy Gleason scores of 5+4, 4+5, 4+4, 3+5, and ,8, respectively. Bilateral neurovascular bundle (NVB)-sparing, unilateral NVB-sparing, and non-NVB-sparing surgery was performed in 16 (47%), five (15%), and 13 (38%) patients, respectively. Results: Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 162.1±64.4 minutes, 232.2±255.1 cc, 4.1±2.1 days, and 12.6±6.2 days, respectively. During the perioperative period (0-30 days), three minor and five major complications occurred as classified using the modified Clavien classification. No complication was detected during postoperative 31-90 days. Postoperative pathologic stages included pT0, pT2a, pT2b, pT2c, pT3a, and pT3b disease in two (5.8%), five (14.7%), three (8.8%), six (17.6%), ten (29.4%), and eight (23.5%) patients, respectively. Positive surgical margin rate was 32.3%. Mean lymph node yield was 11.8±8.3 (range three to 37). Mean follow-up was 27.8±11.1 months. Biochemical recurrence was detected in nine (26.4%) patients. Of the patients, 17 (50%) were fully continent (zero pads/day), six (17.7%) wore a safety pad/day, six (17.7%) wore one pad/day, three (8.8%) wore two pads/day, and two (5.9%) wore more than two pads/day. Of the 24 patients with no preoperative erectile dysfunction, 15 (44.1%) had no erectile dysfunction at a mean follow-up of 1 year. Trifecta and pentafecta rates were 38% and 26%, respectively. Conclusion: Based on our experience, RARP in HRPC is a safe procedure with satisfactory oncologic and functional outcomes.

This study aimed to investigate the long-term outcomes of the surgical combination of revascularization and penile corrective techniques after having obtained promising preliminary results from a previous study. Between 2008 and 2015, the combined treatment was undertaken for 60 patients with Peyronie's disease and erectile dysfunction. A preoperative urological evaluation was performed with penile color Doppler ultrasonography, electromyography of the corpus cavernosum and cavernosometry. All the patients completed 15-item and 5-item IIEFs preoperatively and at postoperative follow-up. The mean age of the patients was 53.78 ± 6.48 years ranging from 47 to 63. The mean follow-up period was 48 (14-68) months. The degree of penile angulation was >40 in all the patients. Urethra dissection was required in five patients. Penile disassembly was performed on one patient due to distal complex corporeal deformity. None of the patients reported complications after surgery. The mean total IIEF score was reported to be 25.4 ± 2.8 before the operation and 52.23 ± 1.2 at the end of the follow-up (p < 0.05). The mean IIEF-5 score was 7.3 ± 1.3 preoperatively and 20.9 ± 1.9 at the end of follow-up (p < 0.05). The results of IIEF-15 for erectile function demonstrated that 32 patients had a cutoff value of >26, indicating no ED. Although all patients had complete penile straightening, 7 (11.66%) reported shortening of the penis but was not dissatisfied with the treatment. The number of patients satisfied with the outcomes of the operation was 53. The statistically significant improvement and satisfactory results achieved with the IIEF questionnaires suggest that the proposed combined treatment could be an alternative to penile prosthesis in highly selected patients with Peyronie's disease, particularly those with erectile dysfunction; however, more studies are needed to confirm these results.

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