==inizio objective==

Penile prosthesis (PP) implantation represents a well-stablished treatment for medically refractory erectile dysfunction (ED) (1). Despite the clear evidences of the high incidence of the burden of ED after radical cystoprostatectomy (RCP), this issue is rarely addressed in the scientific literature.
The aim of this study was to report the outcomes of a multicentric series of patients underwent a PP implantation following RCP.

==fine objective==

==inizio methodsresults==

A multicentric database, involving 4 tertiary referral centers, was created. From December 2004 to September 2017 65 patients underwent a PP implantation for a medically refractory ED following a RCP for a muscle-invasive bladder cancer. Clinical records were retrospectively reviewed. 47 patients, presenting comprehensive intraoperative and postoperative information were enrolled in the study. Patients were confined in 2 main groups according to the urinary diversion: neobladder (A) or other diversions (B), including ileal conduit and ureterocutaneostomy. The intraoperative complications, the hospital stay, a postoperative haematoma scale and the postoperative complications were selected as variables for the surgical outcomes.

==fine methodsresults==

==inizio results==

14 patients (29.8%) were enrolled in group A, whereas the remainders were in group B. Only a minority of cases (8.5%) of RCP were carried out with minimally invasive techniques (robotic or laparoscopic). A chemotherapy in adjuvant settings was frequently reported, particularly in group B. Patients in group A resulted sharply younger than in group B (p=0.0001). Penile shaft deformities, either curvature or severe shortening, turned up to be rare issue, reported in only 15% of cases.
Despite the overall young age of patients, a vast minority of them was referred preoperatively to a sexual counselor. On the other hand, a consistent percentage (65.9%) of patients were referred to an early postoperative sexual counseling, with a median time of 12 months after surgery. Most of the patients (65.9%) started pde-5 inhibitors as a first line treatment and less than half of the them (44.7%) used, in salvage settings, intracavernous injections (ICI).
Surgical outcomes are listed in Table 1. The time elapsed between the RCP and the PP implant was extremely long, with a median of 38 months. Nevertheless, the median implant length resulted to be satisfactory (19 cm) and the need of a reduced diameter cylinder (CXR) was a rare event. Despite the previous pelvic surgery, most of the PP implanted were three-pieces. The spherical reservoir was the most used, compared to the low-profile (Conceal) (2). In most of the cases a safe placement of the reservoir in the extraperitoneal space through a second abdominal incision was the preferred surgeon’s choice. However, the ectopic high-submuscolar placement was found in up to 30% of cases in group A. Both intraoperative and postoperative complications resulted to be rare events (3). Finally, the multivariate statistical analysis (logistic regression) did not show any independent predictive risk factor for postoperative complications.

==fine results==

==inizio discussions==

From our analysis resulted that a small percentage of patients was referred to a pre-cistectomy psychosexual counselling while an important percentage of patients was referred to an early postoperative sexual counseling. This demonstrates how patients do not care about the sexual problem at the time of diagnosis of cancer, while approximately one year after the radical cystectomy they started a sexual counseling. Although traditional placement of reservoir into the space of Retzius is widely utilized and have been safely employed in complex cases, potential complications are described, including bladder perforation or erosion and vascular damages. However our multicentric analysis shows that the high submuscular alternative placement strategy was considered only in a small number of departments as a viable alternative to the traditional placement of reservoir. A low rate of intraoperative and postoperative complications was reported without no well-defined risk factors as predictor of complications. Maybe the big surgical experience of the centers enrolled in this study helped to reach this good results.

==fine discussions==

==inizio conclusion==

Despite the high incidence of cases, ED after RCP is rarely addressed by urologists. PP implantation, despite the type of urinary diversion, represents a safe and satisfactory solution to address this issue.

==fine conclusion==

==inizio reference==

1-Pescatori E, Alei G, Antonini G, Avolio A, Bettocchi C, Bitelli M, Boezio F, Cai T, Caraceni E, Carrino M, Colombo F, Conti E, Corvasce A, Dehò F, Fiordelise S, Ghidini N, Italiano E, La Pera G, Liguori G, Maretti C, Mondaini N, Natali A, Negro C, Palmieri A, Palumbo F, Paradiso M, Polito M, Pozza D, Silvani M, Tamai A, Timpano M, Utizi L, Varvello F, Vicini P, Vitarelli A, Franco G. INSIST-ED: Italian Society of Andrology registry on penile prosthesis surgery. First data analysis.Arch Ital Urol Androl. 2016 Jul 4;88(2):122-7.

2- M. Carrino, L.Pucci, F.Chiancone, R.Riccio, C.Meccariello, P.Fedelini. Heterotopic placement of prosthesis reservoir in penile prosthetic surgery: exception or rule. 22° Congresso nazionale Auro.it 24/26 maggio 2015.

3- Zafer Kozacioglu, Bulent Gunlusoy, Tansu Degirmenci, Suleyman Minareci, Yasin Ceylan, Tarik Yonguc. Perioperative and Postoperative Classification of Surgical Complications of Penile Prosthesis Surgery. Journal of universal surgery. 2012 Vol. 1 No. 3:1.

==fine reference==

==inizio objective==

Penile implant surgery is the most commonly preferred strategy for men with erectile dysfunction (ED) refractory to pharmacotherapy. Satisfaction rate reported for this kind of surgery is usually high (Furlow WL et al, >90%) (1). Shortening of the penis is a common cause of patient dissatisfaction after penile implant surgery (2). This dissatisfaction can be prevented by adequate counselling on the issue that he’ll have “the erection” but not the erection “he had before”.
Some patient requires more accurate information on length after surgery. In this case we suggest that it will be almost the same of stretched penis preoperatively. Are we telling the truth?
This prospective study aimed to evaluate the correlation between stretched penile length and flaccid girth measured before surgery and postoperative penile size during erection.

==fine objective==

==inizio methodsresults==

31 consecutive penile prosthesis implants were assessed from March 2016 to September 2017. Penile length and penile girth during standardised stretching were measured in operating room, and remeasured at the end of the surgery with maximally inflated implant.
All patients received AMS 700 LGX implant (Boston Scientific ©) and cylinder lengths were recorded. Patients with IPP (Induratio Penis Plastica) disease and with curvature > 20° were excluded, and so those with severe fibrosis. BMI (body mass index) and other co-morbidities (hypertension, diabetes mellitus, heart disease etc.) were assessed.

==fine methodsresults==

==inizio results==

The mean preimplant stretched length was 11.8 cm (D.S. + 0.6) and mean flaccid girth was 9.8 cm (+ 0.5). At the end of the surgery, with fully inflated cylinders, the length was 12.6 cm (+ 0.8) and the girth was 10.3 (+ 0.5). These results indicate a statistically significant (P value < 0.05) increase in both post-operative penile length and girth. No correlations between post-operative outcomes and co-morbidities were found (P value > 0.05).

==fine results==

==inizio discussions==

Many men believe that length of the penis is the expression of their virility. Patients undergoing a radical prostatectomy have a higher risk of experiencing penile shortening compared with healthy population (3). The loss of penile size could negatively affect patient satisfaction rates and sexual quality of life following successful penile prosthetic implant surgery.
Masters et al. (4) reported that size of the penis has no real physiologic effect on female sexual satisfaction because the vagina adapts to fit the size of the penis.
Many studies suggested the idea that stretched penile length before surgery is a reliable indicator of post-operative penile length after implantation (5, 6).
Deveci et al. evaluated the stretched flaccid penile length of 56 patients who underwent penile prosthesis implant surgery pre-operatively and 6 months after the surgery. Although 40 out of 56 patients (72%) reported a subjective decrease in penile length, there was no significant difference in terms of objective stretched penile length before and after surgery (7).
Our study indicates that inflatable prosthesis does not decrease penile size compared to pre-operative evaluation, but also increase it for most patients. The gain does not appear related to co-morbidities such as diabetes mellitus, hypertension or BMI.
Recording pre-operative stretched penile length and agreeing it with the patient could be useful. Moreover, couple sex education before surgery may be a way to reduce unrealistic expectations. Patients should understand that penile implants may not restore the full length once achieved by natural erections.

==fine discussions==

==inizio conclusion==

Penile implant surgery does not decrease penile size compared to pre-operative “stretched penis”. Diabetes mellitus, hypertension and other co-morbidities do not appear to be related with post-operative penile length. This issue can be discussed with patient before surgery with an easy to imagine prospective model, in order to improve satisfaction level of penile size postoperatively.

==fine conclusion==

==inizio reference==

1. Implantation of model AMS 700 penile prosthesis: long-term results; Furlow WL, Goldwasser B, Gundian JC.; J Urol 1988;139:741–2
2. Supersizing the penis following penile prosthesis implantation; Shaeer O et al.; J Sex Med. 2010 Jul;7(7):2608-16.
3. Self-perceived penile shortening after radical prostatectomy;Carlsson S et al.; Int J Impot Res. 2012 Sep;24(5):179-84
4. Human sexual response; Masters WH, Johnson VE; Boston: Little, Brown; 1966
5. Penile prosthesis implantation preserves and may increase penile size irrespective of implant type; S. Giona et al.; European Urology Supplements; March 2017, Volume 16, Issue 3, Pages e651–e652
6. Penile length in the flaccid and erect states: guidelines for penile augmentation; Wessells H, Lue TF, McAninch JW. J; Urol 1996; 156:995-7
7. Penile length alterations following penile prosthesis surgery; Deveci S et al; Eur Urol 2007; 51:1128-31

==fine reference==

==inizio objective==

The AdVance male sling (American Medical Systems, Minnetonka, MN, USA) is a synthetic transobturator sling, which is placed in a minimally invasive fashion, for the treatment of male stress urinary incontinence(SUI). Corona Mortis(CM), also known as sensational name crown of death, is an anatomical variant, an anastomosis between the obturator and the external iliac or inferior epigastric arteries or veins. Therefore, CM may be damaged, with conspicuous bleeding, during transobturator passage of the tape in stress-urinary incontinence correction. We decided to evaluate prospectively the incidence of postoperative pelvic hematoma in men with radiological evidence of CM after the position of AdVance male sling.

==fine objective==

==inizio methodsresults==

In order to assess bleeding incidence due to CM injury, we started in January 2012 to enroll all men prospectively in this study who needed to be surgically treated their SUI and who had a pre-operatory contrast-enhanced abdominal multidetector computed tomography(CT) performed because of other reasons. Indeed, CM can be easily identified on contrast-enhanced multidetector CT, using 1.25-mm thick images. 53 males underwent an AdVance male sling to correct SUI. Among them, 41 had a pre-operatory abdominal CT performed. all CT scans were evaluated by a vascular radiologist. CM was identified in 11 men, bilaterally in three cases. Postoperative monitoring was performed every 12 hours for 24 hours with a red blood cells count, systemic blood pressure measurements, heart rate, reported nausea and/or pain, and lower abdominal examination in order to palpate any mass. An abdominal ultrasonography was performed in all cases before hospital discharge by a radiologist, who was blinded of the study outcomes. Pelvic hematoma was defined as a large collection of fluid in a cul de sac.

==fine methodsresults==

==inizio results==

All procedures were performed by single experienced pelvic surgeon. Surgery ended in all cases with a cystoscopy to rule out bladder injury, positioning a 16-Fr indwelling urethral catheter and a perineal packing. Mean operative time was 58.5 ± 7.8 minutes. No major bleeding during surgery, nor rectal and bladder injuries were seen. Mean drop in postoperative haemoglobin was 1.4 ± 0.9 g/dl. No mass was palpated in any patient. All men underwent an abdominal ultrasonography and no pelvic haematoma was identified. Catheter and perineal packing were removed the morning after surgery. Only one patient, who had an acute urinary retention. All patients were discharged 24 hours after surgery

==fine results==

==inizio discussions==

In our study, we found no major bleeding during surgery, no postoperatively (such as large pelvic hematoma) in 11 men with CM. The transobturator way avoids major vascular structures, such as obturator vessels. The anatomical structures crossed by the tapes are muscles and fascia, as very well demonstrated. Furthermore, it is clear from all female cadaver studies analyzed(1) that CM lies in a relative “long” distance far from transobturator needle passage, always situated above the levator ani muscle, and is therefore not concerned by the normal course of the TO needle, making transobturator surgery safe regarding serious and life-threatening bleeding. In this study, no serious bleeding complications were encountered; transobturator surgery in SUI correction and in POP repair seems to be a safe way in the presence of the dreaded CM. However, our study represents a small series and further studies, including comparative, are needed to confirm these preliminary findings

==fine discussions==

==inizio conclusion==

Transobturator surgery seems to be a safe way in the presence of the corona mortis. However, further studies are needed to confirm these preliminary findings.

==fine conclusion==

==inizio reference==

(1)Delmas V. Anatomical risks of transobturator suburethral tape in the treatment of female stress urinary incontinence. Eur Urol. 2005;48(5):793-798.

==fine reference==

==inizio objective==

Radical prostatectomy is regarded as the gold standard surgical treatment for organ confined prostate cancer. Even though the surgical technique has been improved steadily stress urinary incontinence(SUI) is a well-known side effect of this procedure with reported incidence rates of up to 20%. The synthetic transobturator sling (AdVance male sling, American Medical Systems, Minnetonka, MN, USA), introduced in 2006, is a safe and effective minimally invasive treatment for mild/severe SUI in male patients. This study was performed to evaluate functional outcome of the AdVance male sling in the treatment of SUI caused by prior prostate surgery.

==fine objective==

==inizio methodsresults==

From June 2012 to January 2017, 51 patients with stress urinary incontinence after prostate surgery were treated with AdVance male sling in the our Department of Urology. All patients had undergone radical prostatectomy for prostate cancer. The implantation of the male sling system was performed at least 6 months after initial treatment. Preoperative work-up included physical examination, uroflowmetry (Qmax), postvoid residual urine (PVR) and flexible urethroscopy to assess sphincter function and mobility of the membranous urethra. ICIQ-UI SF score, a validated self-report questionnaire, was assessed to evaluate urinary incontinence and its impact on quality of life. Degree of incontinence was classified by the number of pads used per 24 hours and categorized in 3 grades (mild: 1-2 pads/24h; moderate: 3-5 pads/24h; severe: >5 pads/24 h) patients were re-evaluated after 3, 6, and 12 months concerning the number of pads used daily, the current ICIQ-UI SF score, Qmax and PVR. Cure was defined as no pad usage, improvement was defined as a use of 1-2 pads/day or ≥50% reduction of the preoperative pad use.

==fine methodsresults==

==inizio results==

Based on pad test results at last follow-up the cure rate (no pad usage) was 74.5% (38 of 51 patients). The improvement rate (1-2 pads/day or ≥50% reduction) was 9.8% (5 patients). The success rate was durable since only one patient initially classified as cured at the 3-month visit subsequently had to use pads again in the course of follow-up. Overall mean pad use decreased from 5.0 ± 1.3 to 1.1 ± 0.7 pads daily (p < 0.001). The ICIQ-UI score improved from a mean of 14.9 ± 3.5 before sling implantation to 5.1 ± 6.3 after surgery (p < 0.001). No changes in postvoid residual urine (PVR) were observed after surgery (7.3±12.8 mL vs 11.0 ± 19.0 mL; p≥0.05). Uroflowmetry demonstrated significant decreased Qmax rates (mean: 20.1 ± 11.9 versus 25.9 ± 18.6 mL/sec) after sling implantation (p < 0.001). No perioperative serious complications occurred with the exception of 1 (1.9%) case of external iliac artery injury and 4 (7.6%) cases of urthral-bladder injuries. Postoperative acute urinary retention was seen in 5 patients (9.8%). All of these patients were treated with a transurethral catheter. In all cases the catheter could be removed after 1–2 weeks without further treatment with residual urine ≤50 mL at time of catheter removal. ==fine results== ==inizio discussions== The artificial urinary sphincter (AUS) is considered the gold standard in the treatment of post prostatectomy incontinence, however, there is a need for less invasive treatment options. On one hand, there is a significant re-operation rate > 35% after 10 years in patients with AUS implantations even in experienced hands(1). One may consider a less invasive treatment form. In addition, some men do not have sufficient fine-motor control or the motivation to operate the implanted pump used with an AUS. Male slings provide an alternative surgical treatment for patients with SUI who are not AUS candidates or who elect not to undergo AUS placement.
The AdVance male sling is a non-compressive retrourethral sling that is believed to support the dorsal structure of the sphincter. Interestingly, the recently published data show varying success rates after AdVance male sling placement: While some authors report success rates between 60-80%(2), others observed no improvement in 36.5% and even worsening in 9%(3). The most common side effects after AdVance male sling implantation occur frequently and consist of postoperative perineal pain and urinary retention. urgency is a well-known complication after placement of midurethral slings and is attributed to obstructive or locally irritative causes. few cases of infection or erosion are reported in the literature.

==fine discussions==

==inizio conclusion==

The AdVancemale sling represents a safe and effective treatment option for patients with post-prostate surgery SUI

==fine conclusion==

==inizio reference==

(1)Venn SN, Greenwell TJ, Mundy AR: The long-term outcome of artificial urinary sphincters. J Urol. 2000; 164: 702-6
(2)Cornu JN, Sèbe P, Ciofu C, Peyrat L, Beley S, Tligui M, et al.: The AdVance transobturator male sling for postprostatectomy incontinence: clinical results of a prospective evaluation after a minimum follow-up of 6 months. Eur Urol. 2009; 56: 923-7.
(3)Cornel EB, Elzevier HW, Putter H: Can advance transobturator sling suspension cure male urinary postoperative stress incontinence? J Urol. 2010; 183: 1459-63

==fine reference==

==inizio objective==

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance (1). The diagnosis of ED is based on anamnesis, objective exam, hormonal panel, dynamic penile color-duplex ultrasound (D-PCDU) with PGE1. Many studies have found that the restore of normal blood testosterone levels in men with hypogonadism is correlated with an improvement in the blood flow of the cavernous arteries.
The aim of our study was to evaluate the correlation between testosterone replacement therapy, Peak Systolic Velocity (PSV) and the caliber of penile arteries during the D-PCDU in men with Late Onset Hypogonadism (LOH).

==fine objective==

==inizio methodsresults==

We evaluated 35 consecutive LOH men (mean age 44,5 years) affected by Erectile Dysfunction that underwent Testosterone replacement therapy (TTh) with testosterone undecanoate 1000 mg/4mL (Nebid) from February 2013 to October 2016. Patients with Induratio Penis Plastica, PSA > 4 ng/ml, diabetes mellitus, hypertension, metabolic syndrome, more than 20 cigarettes/die, BMI > 35, obstructive sleep apnea syndrome (OSA) were excluded. At the baseline we collected data on demographic and anthropometric features (age, weight, height, BMI), lifestyle characteristics (smoke, alcohol), any comorbidities (hypertension, diabetes mellitus, etc.). Then the patients underwent to clinical evaluation (comprised general, genital, neurologic and urologic examination). If the patient respects inclusion criteria, IIEF-5 (International Index of Erectile Function-5) questionnaire and D-PCDU were performed. A dose of 10 mcg of alprostadil was used in all patients. IIEF-5 and D-PCDU were repeated after 12 months of replacement therapy. PSV and the caliber of penile arteries were evaluated during the D-PCDU.

==fine methodsresults==

==inizio results==

33 of 35 patients showed an increase of the PSV and a decrease of the diastolic velocity. 2 of 35 patients did not show an improvement in D-PCDU parameters after TTh. A statistically significant global differences in PSV and diastolic velocity before and after the TTh was reported (P-value < 0.05). All 35 patients showed an improvement of the IIEF-5 after therapy, with a statistically significant differences before and after the TTh (P-value < 0.05). No correlation between the caliber of basal penile arteries and testosterone was found (P-value > 0.05).

==fine results==

==inizio discussions==

Endogenous testosterone has long been recognized as being critical for the normal promotion of sexual desire; however, many studies also have suggested a potentially important role in many aspects of the erectile process. Testosterone deficiency is one of the most frequent cause of ED in younger men and can be one of many etiologic factors in older men (2). Most men have a lowering of their blood testosterone levels with age, but these levels usually are not low enough to induce ED. Preclinical studies have indicated that testosterone is important for preserving the veno-occlusive function and therefore erectile function (3). Clinical studies showed that TTh improved erectile function (4). Administration of TTh improves libido, sexual function and nocturnal penile tumescence (NPT) response in men with hypogonadism (5). Canguven et al. demonstrated that TTh improved also peak systolic velocity and significantly decreased the end diastolic velocity in men with LOH (6).
Our data suggest that TTh is correlated with an improvement of PSV during the D-PCDU in men with LOH. No correlation between the caliber of penile arteries and testosterone was found. In terms of erectile function, our findings, based on the IIEF-5 score, showed that TTh significantly improved erectile function.

==fine discussions==

==inizio conclusion==

Our study suggests that TTh is associated with an improvement of PSV during the D-PCDU in men with LOH. This therapy also improved erectile function as showed by IIEF-5 score. No correlation between the caliber of penile arteries and testosterone was found. Larger prospective studies with repeated measurements of D-PCDU, IIEF-5, and blood chemistry would be of great value.

==fine conclusion==

==inizio reference==

1. Impotence. NIH Consens Statement 1992;7-9;10(4):1-31.
2. Endocrine aspects of male sexual dysfunctions; Buvat J, Maggi M, Gooren L, et al.; J Sex Med. 2010;7(4 pt 2):1627-1656.
3. Are androgens critical for penile erections in humans? Examining the clinical and preclinical evidence; Traish AM, Guay AT; J Sex Med 2006;3:382–404.
4. Treatment of sexual dysfunction of hypogonadal patients with long-acting testosterone undecanoate (Nebido); Yassin AA, Saad F; World J Urol 2006;24:639–44.
5. Relationship between testosterone and erectile dysfunction; Rajfer J. et al.; Rev Urol 2000; 2:122–8.
6. RigiScan data under long-term testosterone therapy: improving long-term blood circulation of penile arteries, penile length and girth, erectile function, and nocturnal penile tumescence and duration; Canguven et al.; Aging Male. 2016 Dec;19(4):215-220. Epub 2016 Oct 1.

==fine reference==

==inizio objective==

We reviewed our personal data about Peyronie Disease (PD) lenghtening procedures performed in our Unit from January 2010 to June 2017. We focus the attention only on the lengthening procedures for the correction of PD penile curvature in patients without Erectile Dysfunction (ED) at the time of diagnosis in respect of EAU guidelines(1). Particular we try to asset the efficacy to reduce the post-operative ED with the graft free Z plasty compared to classical albugineal incision and grafting procedure(2,3).

==fine objective==

==inizio methodsresults==

From January 2010 and June 2017 58 patients (pts) with symptomatic penile curvature due to PD underwent surgical lengthening procedures. Inclusion criteria for surgery comprise: penile curvature due to PD in stable phase(3) (=>6 months) and no ED (IIEF-5>19; EHS>3(4). For 36 out of 58 pts classical H-shape plaque incision and graft was performed (30 cases using a collagen dermal matrix graft, 6 cases with saphenous vein graft) – Group A. For 22 out of 58 pts graft-free Z-plasty were performed (Group B). History (IIEF-5 and PDQ Scale Q2 to Q6(5)), physical examination (EHS) and curvature degree have been reported for each patients at the time of surgery as after 18 months at follow of control.

==fine methodsresults==

==inizio results==

At baseline median values of age, curvature degree, plaque diameter, IIEF-5, PDQ Scale has been: Group A 58.1 yrs; 62.3° dorsal; 23.1 points; 15.7 points. For group B: 59 yr; 66° dorsal; 22,8 points, 16.1 points. 56 up to 58 patients has been available for evaluation with follow up (FU) up to 18 months. Group A: complete resolution of the curvature has been jointed all cases but with a complete subjective satisfaction in 28/36 (77.7%) with median IIEF-5 20.1; median PDQ Scale 6.89; with stable ED in 23.6% of cases. Group B: complete resolution of the curvature has been jointed all cases with a complete subjective satisfaction with median IIEF-5 22,8; median PDQ Scale 3,33; non residual ED. Minor gland hypoaesteshia in all pts from 6 to 12 months from surgery.

==fine results==

==inizio discussions==

Our results seem to be effective in term of restoration of the penile shape with a complete functional straight of the penis in both groups. In terms of erection rigidity for sexual intercourse graft free procedure seems shows best outcome (all patients refers absence of ED with a post-operatory mean IIEF-5 score of 22,8) in a range follow up observation over 18 months. We assay the subjective satisfaction of the patients using the PDQ Scale (from Q2 to Q6) score, that decrease from a mean value of 16,7 at baseline to 3,33 post-operatory in Group B different from Group A where the decrease was low significant (from 15.7 to 6.89) and where stable ED was found 23% with IEFF-5 score about 20.1 versus 22.8 of Group B. For Group B pts. we submit three direct questions at the time of the 18 month follow up visit. All 22 patients eligible for the evaluation describe as full satisfaction (Q1, answer 1) after surgery and, at the same time, they answer “yes” at the Q2 and Q3 question. The answers at these last two questions represent the most important result that encourage us to continue in this surgical strategy for PD, because patients suggest that they would re-do the surgery and they would be suggest the same surgery to relations or friends meaning the complete real subjective satisfaction in terms of sexual behavior and sexual wellbeing.

==fine discussions==

==inizio conclusion==

Results obtained suggests that the length of the PD plaque, and the traslocation of the PD scar forces, on the short site of the penis with a graft free Z-plasty seems to be effectiveness to reduce penile curvature and avoid post-operative ED.

==fine conclusion==

==inizio reference==

(1) Hatzimouratidis K, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Salonia A, Vardi Y, Wespes E. European Association of Urology Guidelines on penile curvature. Europena Urology 2012; 62: 543-552
(2) Montorsi F, Salonia A, Maga T, et al. Evidence based assessment of long-term results of plaque incision and vein grafting for Peyronie’s disease. J Urol 2000; 163: 1704-8
(3) Ralph DJ. Long-term results of the surgical treatment of Peyronie’s disease with plaque incisione and grafting. Asian Journal of Andrology 2011; 13: 797
(4) Mulhall JP, Goldstein I, Bushmakin AG, Cappelleri JC, Hvidsten K. Validation of the erection hardness score. J Sex Med 2007 Nov; 4(6): 1626-34
(5) Rosen R, Catania J, Lue T, S Althof, J Henne, W Hellstrom, L Levine. Impact of Peyronie’s disease on sexual and psychosocial functioning: qualitative finding in patientd and controls. J Sex Med 2008; 5: 1977-1984

==fine reference==