==inizio objective==

Communication in sexology is always a hard matter because the terapist must listen to and inform the patient and in the same time take care of him : so that the concept of “communication” have to change in “communi-care “. Uroandrological , Obstetric– Gynecological departments and ambulatory outpatients represent a challenge in sexology both in case of anamnesis collection , explanation of side effects and complications of drugs, surgery and in case of physical exam or nursing . (1,2,3)

==fine objective==

==inizio methodsresults==

A simple 8 items questionnaire was submitted :
a) in 10 Obstetric – Gynecological Departments inside Marche country – Italy from July to October 2017
b) During a professional uroandrological training course about “communi-care “ held on october 2016. AIM of the questionnaire is the evaluation of the sexual status and feeling about sex of the health care staff and the relevance of sexual matters and personal problems in approaching patients
Items: 1) Do you think that sex is important in your life? 2) Do you feel to have “sexological problems” in this moment ? 3) Are there sexological questions to which do you like to have answers? 4) Do you consult a specialist to deepen any curiosity or sexual problems? 5) Have you any trouble talking about sex ? 6) Have you any trouble talking about sex with your partner? 7) Do your personal sexological problems affect your professional activities ? 8) Do your personal sexological problems affect your dialogue with patients?

==fine methodsresults==

==inizio results==

questionnaire distribution : a) 414 in Obstetric– Gynecological Departments
b) 83 in participants in professional uroandrological course
questionnaire returned a) 221/414 (53 %) b) 76/83 (91.5 %) ; total returned 297/497 (59,7 %)
a) 10 males , 211 female: 83 obstetric nurses, 34 obstetric nurses in training, 49 nurses, 27 gynecologists, 28 other professional workers aged 19- 63 years
item 1 : yes 193/221 (87 %)
item 2 : no 207/221 (93.6 %)
item 3: yes 63/221 (28,5 %)
item 4 : no 114/221 (51.5 %)
item 5 : no 205/221 (92.7 %)
item 6 : no 211/221 (95.4 %)
item 7 : no 213/221 (96.3 %)
item 8 : no 216/221 (97.7 %)

b) 14 males , 52 females ,10 not decleared sex; 13 medical doctors, 41 nurses, 4 psychologists , 5 other professional workers 13 not decleared profession, aged 23 -64 years
item 1 : yes 72/76 (94.7 %)
item 2 : no 60/76 (78,9 %)
item 3: yes 53/76 (69.7 %)
item 4 : no 42/76 (55,2 %)
item 5 : no 63/76 (82,8 %)
item 6 : no 68/76 (89,4 %)
item 7 : no 73/76 (96 %)
item 8 : no 75/76 (98,6 %)
Total a) + b) 297 questionnaires 24 males , 263 female 10 not decleared sex : 83 obstetric nurses, 34 obstetric nurses in training, 90 nurses, 27 gynecologists, 13 medical doctors , 4 psychologists 33 other professional workers 13 not decleared profession aged 19- 64 years

==fine results==

==inizio discussions==

Discussion 89,8 % of the participants decleared NO “sexological problems”, BUT 30,9 % YES had to ask some sexological questions and a statistically significant difference (p < 0,00001) was noted between the two groups : 28 % of Gynecological Departments versus 69,7 % of the uroandrological training course Females seems to have more sexological problems (25 % versus 14.3% of the male) and have more questions to be answered (77 % versus 57.1 % of the male ) Furthermore females decleared a bit more trouble talking about sex (18.8 % versus 7.2% of the male) 100 % of the male decleared NO trouble in talking about sex either with the partner or with patients Only 1 male and 1 female decleared that personal sexological problems affected professional activity and the dialogue with the patient respectively : the others showed very clear and strong positions thinking and feeling about communication in sex Perhaps this strong unanimuos response may hide any psychological resistances or underlying problems? ==fine discussions== ==inizio conclusion== Discrepancy revealed by an accurate analysis of the answers underlines the importance of treating sexual matters in uroandrological environment and in the same time a kind of personal psychological involvement by health care staff: so sexological informations is needed togheter with a basical sexological training ==fine conclusion== ==inizio reference== 1)Biopsychosocial aspects of Prostate cancer . EJS Kunkel JR Bakker RE Myers, O Oyesanmi, LG Gomella Psychosomatics 2000; 41:85-94 2)Longitudinal effects of social support and adaptive coping on the emotional well-being of survivors of Localized Prostate Cancer RES Zhou, FJ Penedo et al J Support Oncol 2010; 8 (5):196-201 3) Perceptions and opinions of men and women on a man's sexual confidence and its relationship to ED: results of the European Sexual Confidence Survey. San Martín C1, Simonelli C, Sønksen J, Schnetzler G, Patel S. Int J Impot Res. 2012 Nov-Dec;24(6):234-41. doi: 10.1038/ijir.2012.23. Epub 2012 Jun 21. ==fine reference==

==inizio objective==

Food and sex are strictly connected under the psychological and physiological aspects as they are both sources of pleasure and gratification Communication in sexology is also a hard matter because the terapist must listen to himself and inform, cure the patient and in the same time take care of both of them AIM of the questionnaire is the evaluation of the sexual status, feeling about sex versus feeling about eating and drinking of uro-andrological health care staff in order to point out the relevance of sexual matters in conditioning eating feeling an behaviour (1-2-3)

==fine objective==

==inizio methodsresults==

A simple 10 items questionnaire was submitted during a professional uroandrological training course about Sexology and eating habits held on october 2017
Items:
1) Do you feel you have a proper diet?
2) Do You think you are overweight
3) Do You think you are underweight
4) Do you think your diet is affected by “dietary habits”
5) Have you any trouble talking about sex ?
6) Are there sexological questions to which do you like to have answers?
7) Do you feel to have “sexological problems” in this moment ?
8) Do your sexual sex problems affect your way of drinking?
9) Do your sexual sex problems affect your way of eating ?
10) Does it exist the “gastronomic orgasm”?

==fine methodsresults==

==inizio results==

questionnaire distribution : 85 in participants in professional uroandrological course and 12 in eating and sexological course 86,6 % of the participants decleared NO “sexological problems”, and NO trouble talking about sex, and so their sexual problems (if exist…) DO NOT affect the way of drinking (91. 6% ) and eating (89,6% )BUT 56.7 % YES had to ask some sexological questions . Furthermore 64.9 % of the participants feel to have a proper diet, but 43,2 % think to be overweight (statistically significant p< 0.01) ==fine results== ==inizio discussions== Discrepancy revealed by an accurate analysis of the answers underlines the difficulties in speaking about sed and feeding and the importance of treating sexual matters in uroandrological environment and in the same time a kind of personal psychological involvement by health care staff both in sexual and in alimentary eating / drinking behaviour ==fine discussions== ==inizio conclusion== Uro-andrological health care staff need more sexological informations togheter with a basical sexological training ==fine conclusion== ==inizio reference== 1) Biopsychosocial aspects of Prostate cancer . EJS Kunkel JR Bakker RE Myers, O Oyesanmi, LG Gomella Psychosomatics 2000; 41:85-94 2) Longitudinal effects of social support and adaptive coping on the emotional well-being of survivors of Localized Prostate Cancer RES Zhou, FJ Penedo et al J Support Oncol 2010; 8 (5):196-201 3) Perceptions and opinions of men and women on a man's sexual confidence and its relationship to ED: results of the European Sexual Confidence Survey. San Martín C1, Simonelli C, Sønksen J, Schnetzler G, Patel S. Int J Impot Res. 2012 Nov-Dec;24(6):234-41. doi: 10.1038/ijir.2012.23. Epub 2012 Jun 21. ==fine reference==

==inizio objective==

Penile prosthesis implantation is usually considered the definitive treatment to restore sexual function to motivated man with erectile dysfunction not responsive to medical treatments.
At our institution, a total of 154 penile prosthesis implantation were performed between January 2011 and December 2016.
The aim of this study is to evaluate the perioperative and postoperative complications of our series of penile prosthesis surgery.

==fine objective==

==inizio methodsresults==

Intraoperative and postoperative complications were collected in a prospectively maintained database and analyzed. The two most common grading systems of surgical complications were used; the Satava system (1) for perioperative complications, and the modified Clavien-Dindo (CD) grading system (2) for the postoperative complications on the surgical complications of penile prosthesis surgery. We defined the intra operative complications as: corporeal crossover, corporeal perforation and bladder perforation. Postoperative complications were defined as: postoperative haematoma, infection, erosion, reservoir complications, connecting tubes complications, glandular problems and mechanical failure.

==fine methodsresults==

==inizio results==

All procedures were performed by a single surgical team with a penoscrotal approach. An antibiotic prophylaxis was somministrated to all patients and the general rules for disinfection during prosthetic surgery were carefully comply. 31 out of 154 patients underwent a heterotopic implant of reservoir into a potential space between the transversalis fascia and the rectus abdominis muscle (3). 9 patients underwent a malleable penile prosthesis and 129 patients a three component prosthesis implantation. In 7 patients an artificial urinary sphincter (AUS) and in 11 patients an urethral sling were synchronously implanted.
Table 1 reports intraoperative and post-operative complications according to Satava and CD systems, respectively (4).

==fine results==

==inizio discussions==

Among the intraoperative complications, the corporeal crossover usually will not cause important consequences, if properly recognized. According to Henry et al. (5) and others, the intraoperative cross-over management, both proximal and distal, can be based on placing a caliber 13 dilatator in the cavernous body not interested by crossover and the carefully re-dilatation of the corpora interested by the crossover. The authors suggest to dilatate more lateral as possible, using the other dilator as a reference point.
Infection is one of the most dangerous complications that can occur within a wide range of time, from a few weeks to more than a year (6). The infection rate reduced in the last decades thanks to the antibiotic prophylaxis and the use of antibiotic-impregnated or hydrophilic-coated implants (7). Some categories of patients have a bigger risk of infection related complications like patients with spinal cord injuries, diabetes mellitus and history of urinary tract infection. In our series all patients that experienced an infection related complication had an history of type one diabetes mellitus.
The high global rate of complications (46.2%) was related to a 18.5% of patients that experience a not significative haematoma and a 4.5% of the patients that complain the loss of glandular erection. This last complication was considered a CD II grade complication (4).

==fine discussions==

==inizio conclusion==

Penile prosthetic surgery can be associated to important complications, in particular in some categories of patients or when the procedure is particularly challenging (“the ghost fibrosis”) (8). In our opinion, surgeon experience and the right planning of the procedure can reduce the rate of complications during a penile prosthesis implantation.

==fine conclusion==

==inizio reference==

1-Kazaryan AM, Røsok BI, Edwin B (2013) Morbidity assessment in surgery: refinement proposal based on a concept of perioperative adverse events. ISRN Surg 16(2013):625093

2- Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D et al (2009) The Clavien–Dindo classification of surgical complications:five-year experience. Ann Surg 250(2):187–196

3- Morey AF, Cefalu CA, Hudak SJ. High submuscular placement of urologic prosthetic balloons and reservoirs via transscrotal approach. J Sex Med. 2013 Feb;10(2):603-10.

4- 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.

5-Mulcahy JJ et al.The Prevention and Management of Noninfectious Complications of Penile Implants; Sex Med Rev. 2015 Jul;3(3):203-213.

6- Kabalin LN, Kessler R. Infectious complications of penile prosthesis surgery. J Urol. 1988; 139: 953-5.

7- Carson CC. Efficacy of antibiotic impregnation of inflatable penile prosthesis in decreasing infection in original implants. J Urol. 2004 Apr; 171 (4): 1611-4.

8- Carrino M., Chiancone F., Pucci L., Battaglia G., Mattace Raso D., Persico F., Fedelini P. An unforeseen problem during penile prosthesis surgery: the ghost fibrosis. XXIII Congresso Nazionale Auro.it 2016-Roma 22/24 maggio 2016.

==fine reference==

==inizio objective==

To evaluate the relationship between the failure of the surgical correction of erectile dysfunction (ED) resulting from venous leakage and anomalous venous drainage highlighted by Caverno-Computed Tomography (CCT) in patients not responders to the maximum dosage of various phosphodiesterase type 5 inhibitors.

==fine objective==

==inizio methodsresults==

The study enrolled 58 consecutive patients (age 18-42 years old) suspected to have a venous leak from February 2014 to May 2017. Each patient gave his informed consent for the study and International Index of Erectile Function-Erectile Function Domain (IIEF-EF) questionnaire, medical history, physical examination, routine blood analysis, hormonal analysis were checked. Venous leak was firstly studied by penile dinamic doppler ultrasound and then confirmed by dynamic infusion cavernosometry (DIC) using flow-to-maintain measurement (FTM) as the defining parameter; FTM value upon 5 ml/minute defined a venous leak. To detect the venous leak site, we used a CCT that consisted in an intracavernous injection (ICI) of 1 mL of alprostadil (10 mcg), an ICI of 20-60 cc of diluted contrast media (1/3) using 20 cc of Ioprimide (300 mg/mL) and a spiral multidetector computer tomography acquisition and three dimensional volume rendering. Under local anesthesia with mepivacaine, we performed a short penile dorsal midline incision at the corona of the glans penis in order to ligate the superficial dorsal vein. The deep dorsal vein was distally ligated with absorbable suture and cavernosal veins were ligated as well. Conversely the proximal end was catheterized with a 20 Gauge steel needle after placing a tourniquet at the root of the penis and 3 ml aethoxysklerol foam 3% was injected for venoablation. Each patient was evaluated six months after surgery. Statistical analyses were conducted using SAS version 9.3 software (SAS Institute, Inc., NC). Mean values with standard deviations (±SD) were computed and reported for all items. Statistical significance was achieved if p-value was ≤0.05 (two-sides).

==fine methodsresults==

==inizio results==

No intraoperative complications were demonstrated. We just reported minor and transient side effects (hematoma and painful erections in 3 and 9 patients respectively). The CCT showed several patterns of penile venous drainage causing venous leak: 1) drainage through the deep vein (33 %), 2) drainage through the cavernous veins (71%), 3) drainage through the superficial vein (31%), 4) drainage through both superficial and deep vein (27%), 5) drainage through the crural veins (38 %). At 6-month follow-up 40 out of 58 patients (69%, group A) reported to have acceptable erections to allow a sexual intercourse without the use of any drugs or additional devices. 13 out of 58 patients (22,4 %, group B) reported to have erections sufficient to permit vaginal penetration with the use of low-moderate dose of PDE5i while 5 out of 58 patients (8,6%, group C) did not report any improvement. In group B and C, the CCT showed a prevalence of crural drainage through the internal pudendal vein and internal iliac vein in 14 out 18 patients (77,8%), while in 2 out 18 patients we observed a venous drainage through both the deep and superficial dorsal vein (11,1 %). In other 2 patients there was a leak through the cavernous veins. Preoperative IIEF-EF scores changed significantly at 6-month follow up (p<0,05). Volumetric analysis of the penis showed a significant increase (p<0,05) at 6-months follow up. ==fine results== ==inizio discussions== The CCT is an accurate and low invasive way to study vasculogenic erectile dysfunction due to venous leakage (1,2). Thanks to its three-dimensional volume rendering, we are able to discover the site of venous drainage in order to program the best surgical approach to correct venous leakage in erectile dysfunction patients unresponsive to oral or intracavernous medical treatments. In our study we performed a modified technique of embolization of the deep dorsal vein achieving similar results to other studies (3). An interesting aspect was the fact that in unresponsive or low- responsive to surgery patients, a great percentage of them had a crural venous drainage through internal pudendal vein responsible of persistence or unsuccess due to the presence of collateral veins that cannot be reached by a single penile dorsal midline approach. ==fine discussions== ==inizio conclusion== This study confirms that the presence of crural venous leakage, represents a prognostic negative factor for classical surgical correction of a venous vasculogenic ED, for which other and more invasive techniques should be advised (4,5). ==fine conclusion== ==inizio reference== 1-Virag R, Paul JF. New classification of anomalous venous drainage using caverno-computed tomography in men with erectile dysfunction- J Sex Med. 2011 May;8(5):1439-44. doi: 10.1111/j.1743-6109.2011.02226.x. Epub 2011 Mar 2-Kawanishi Y, Izumi K, Muguruma H, Mashima T, Komori M, Yamanaka M, Yamamoto A, Numata A, Kishimoto T, Kanayama HO. Three-dimensional CT cavernosography: reconsidering venous ligation surgery on the basis of the modern technology. BJU Int. 2011 May;107(9):1442-6. doi: 10.1111/j.1464-410X.2010.09644.x. Epub 2010 Sep 24. 3-Herwig R, Sansalone S. Venous leakage treatment revisited: pelvic venoablation using aethoxysclerol under air block technique and Valsalva maneuver. Arch Ital Urol Androl. 2015 Mar 31;87(1):1-4. doi: 10.4081/aiua.2015.1.1. 4-Rahman NU, Dean RC, Carrion R, Bochinski D, Lue TF. Crural ligation for primary erectile dysfunction: a case series. J Urol. 2005 Jun;173(6):2064-6. 5-Molodysky E, Liu SP, Huang SJ, Hsu GL. Penile vascular surgery for treating erectile dysfunction: Current role and future direction. Arab J Urol. 2013 Sep;11(3):254-66. doi: 10.1016/j.aju.2013.05.001. Epub 2013 Jun 10. ==fine reference==