ESSM Newsletter # 38

16 ESSM Today Have you read ? Best of the best: Clinical research by Nicola Mondaini Dr. Nicola Mondaini Associate Editor Department of Urology Ospedale Santa Maria Annunziata (Ponte a Niccheri) Via dell’Antella, 58 – Bagno a Ripoli Florence, Italy mondatre@hotmail.com INDURATIO PENIS PLASTICA Seveso M, Melegari S, De Francesco O, Mac- chi A, Romero Otero J, Taverna G, Bozzini G: Surgical correction of Peyronie’s disease via tunica albuginea plication: Long-term follow-up. Andrology. 2017 Dec. Peyronie’s disease (PD) is an acquired con- nective tissue disorder of the tunica albuginea with fibrosis and inflammation that lead to palpable plaques formation, penile curvature, and pain during erection. Patients report nega- tive effects on main domains such as physical appearance and self-image, sexual function, and performance. The aim of this study was to evaluate plication of the albuginea outcomes after a long-term follow-up period. Between 1998 and 2006, a total of 204 patients with PD underwent surgical correction with albuginea plication technique. We obtained complete long- term follow-up data in 187 cases. The follow-up data included evaluation of curvature correction, penile shortening, sexual function, complications, and patient satisfaction. After a mean follow-up of 141 months, the most common postoperative complications were: loss of length (150 patients had a minimal penile shortening ≤ 1.5 cm, 37 patient between 1.5, and 3 cm, none >3 cm), recurrent or residual penile curvature (15 pa- tients, without impairing sexual intercourse), erectile dysfunction (15 patients had IIEF-5 < 10 at 5 years of follow-up vs. 28 patients at 10 years), change in penile sensation (37 patients experienced paresthesia of the glans 1 year after surgery, 28 at 5 years, and 15 at 10 years); painful or palpable suture knots (in 20 cases) spontaneously healed in 3 months. Overall, 77% of the patients and partners were completely sat- isfied, 14% partially satisfied, and 9% unsatis- fied. Plication procedure is safe and simple to be performed compared with the classical Nesbit’s procedure. It has a shorter surgical time, lower costs, and could be successfully performed by less experienced surgeons too. It has a minimal risk of de novo erectile dysfunction, injury to the dorsal neurovascular bundle. Results are good in terms of patient satisfaction according to anatomical outcome and functional correction. ERECTILE DYSFUNCTION Capece M, Gillo A, Cocci A, Garaffa G, Timpano M, Falcone M: Management of refractory is- chemic priapism: Current perspectives. Res Rep Urol. 2017 Aug 29;9:175-179. The aim of the present manuscript is to review the current literature on priapism, focusing on the state-of-the-art knowledge of both the diagnosis and the treatment of the refractory ischemic priapism (IP). Pubmed and EMBASE search engines were used to search for words “priapism”, “refractory pria- pism”, “penile prosthesis”, “diagnosis priapism”, “priapism treatment”, “penile fibrosis”, “priapism therapy”. All the studies were carefully examined by the authors and then included in the review. First-line treatment involves ejaculation, physical exercise and cold shower followed by corporal blood aspiration and injection of α -adrenoceptor agonists. Subsequently, a distal or proximal shunt may be considered. If none of the treatment is effective or the priapism episode lasts >48 hours penile prosthesis implantation could be the only option to solve the priapism and treat the ongo- ing erectile dysfunction. The management of IP is to achieve detumescence of persistent penile erection and to preserve erectile function after resolution of the priapic episode. On the other hand, penile fibrosis and following shortening should be prevented. Early penile prosthesis im- plantation in patients with refractory IP is able to solve both the priapic episode and prevent the otherwise certain penile shortening. Penile pros- thesis implantation is the actual gold standard of care in cases of refractory IP. Loeb S, Ventimiglia E, Salonia A, Folkvaljon Y, Stattin P: Meta-analysis of the associa- tion between phosphodiesterase inhibitors (PDE5Is) and risk of melanoma. J Natl Cancer Inst. 2017 Aug 1 The US Food and Drug Administration recently announced the need to evaluate the association between PDE5is and melanoma. We performed a meta-analysis on the association between PDE5i and melanoma using random effects models and examined whether it met Hill’s criteria for causality. A systematic search of Medline, EMBASE, and the Cochrane Library from 1998 to 2016 identified three case-control studies and two cohort studies, including a total of 866 049 men, of whom 41 874 were diag- nosed with melanoma. We found a summary estimate indicating an increased risk of mela- noma in PDE5i users (relative risk = 1.11, 95% confidence interval = 1.02 to 1.22). However, the association was only statistically significant among men with low PDE5i exposure (not high exposure) and with low-stage melanoma (not high stage), indicating a lack of dose response and biological gradient. PDE5i use was also associated with basal cell cancer, suggesting a lack of specificity and likely confounding by ultraviolet exposure. Thus, although this meta- analysis found a statistically significant associa- tion between PDE5i and melanoma, it did not satisfy Hill’s criteria for causality.