ESSM Newsletter # 40

20 ESSM Today Have you read? Best of the best: Clinical research Hypogonadism Defeudis G, Mazzilli R, Gianfrilli D, Lenzi A, Isi- dori AM. The CATCH checklist to investigate adult-onset hypogonadism. Andrology 2018; 6: 665–679 Adult-onset hypogonadism is a syndrome often underdiagnosed, undertreated, or incompletely explored. There are various reasons for this: Firstly, undefined age range of men in whom testosterone levels should be investigated and then no definitive serum cut-off point for the diagnosis of hypogonadism; and finally, vari- able and non-specific signs and symptoms; men and physicians do not pay adequate attention to sexual health. All these factors make the diag- nostic criteria for hypogonadism controversial. The evaluation of the clinical features and causes of this syndrome, its link with age, the role of testosterone and other hormone levels, and the presence of any comorbidities are all useful fac- tors in the investigation of this population. The purpose of this manuscript, after an accurate analysis of current literature, is to facilitate the diagnosis of hypogonadism in men through the use of the CATCH acronym and a checklist to offer a practical diagnostic tool for daily clinical practice. A useful new acronym CATCH (Clinical features and Causes, Age, Testosterone level, Comorbidities, and Hormones) and a practical checklist to facilitate the evaluation of hypog- onadism in aging men were developed. Surgery Lue TF, Shindel AW. Five things I wish I would have known earlier in my career: Lessons learned in Peyronie's disease surgery. J Sex Med 2018; 15(8): 1070-1072. In this invited commentary the internationally recognized urologist in Peyronie disease (PD) surgery, Tom F. Lue, shares his thoughts on 5 surgical dilemmas from his past several dec- ades: Use of saphenous vein for plaque incision and grafting, management of large calcified or ossified plaques, circumcising vs. longitudinal incisions, management of hourglass deformity and circumferential narrowing and management of residual curvature after penile prosthesis im- plantation. Tom Lue also proposes the following treatment algorithm for PD: No treatment is rec- ommended in patients for whom penile deformity poses no or minimal bother. Surgery is indicated for large ossified plaques, severe hourglass de- formities or indentations with marked hinging, curvatures greater than 90º, and failures of col- lagenase. All other patients are recommended collagenase injections as a safe and effective first-line therapy for bothersome PD. Djordjevic ML, Bumbasirevic U, Stojanovic B et al. Repeated penile girth enhancement with biodegradable scaffolds: Microscopic ultras- tructural analysis and surgical benefits. Asian J Androl. 2018; 20(5): 488-492. Autologous tissue engineering using biodegrad- able scaffolds as a carrier is a well-known proce- dure for penile girth enhancement. We evaluated a group of previously treated patients with the aim to analyze histomorphometric changes after tissue remodeling and to estimate the benefits of repeated procedure. A group of 21 patients, aged 22 –37 underwent a repeated penile girth enhancement procedure with biodegradable scaffolds. Procedure included insertion of two poly-lactic-co-glycolic acid scaffolds seeded with laboratory-prepared fibroblasts from scrotal tis- sue specimens. During this procedure, biopsy specimens of tissue formed after the first sur- gery were taken for microscopic analysis. The mean follow-up was 38 months. Ultrastructural analysis of these tissue samples discovered the presence of large quantities of collagen fibrils running parallel to each other, forming bundles, with a few widely spread fibroblasts. In total, the mean values of flaccid and erect gain in girth after the second surgery were 1.1 ± 0.4 (range: 0.6 – 1.7) cm and 1.0 ± 0.3 (range: 0.6– 1.5) cm, respectively. Microscopic evaluation of newly formed tissue, induced by autologous tissue en- gineering using biodegradable scaffolds, showed the presence of vascularized loose connective tissue with an abundance of collagen fibers, fibroblasts, and inflammatory cells, indicating active neovascularization and fibrinogenesis. The benefit of the repeated enhancement procedure was statistically significant. Jun MS, Gallegos MA, Santucci RA. Contempo- rary management of adult-acquired buried penis. BJU Int 2018; 122(4): 713-715. The authors present their experience on the bur- ied penis repair technique that includes penile release, tissue resection, wound closure, and penile reconstruction. 73 patients were treated from 2007 to 2017 and were categorized into five stages: Stage 1, involves only a phimotic band; Stage 2, required excision of diseased penile skin with split-thickness skin grafting (STSG); Stage 3, requires scrotal excision; Stage 4, requires escutcheonectomy; and Stage 5, re- quires panniculectomy. Results: 36 of 73 (49%) patients had Stage 1–3 disease, whilst 37 of 73 (51%) were Stage 4 – 5. There were complica- tions within the first 30 days in 44 of 73 (60%) patients. In all, 62 of 73 (85%) patients either had no complications or Clavien-Dindo grade I – II complications and nine (12%) had complications beyond 30 days. Only 5 of 36 (14%) patients with Stage 1–3 disease had complications. One patient developed recurrent phimosis. Conclu- sion: Buried penis is a challenging surgical entity where conservative treatment will most likely lead to failure. Surgery is the only means for a lasting cure in these patients and should be used as a first-line treatment. One should expect complications postoperatively, especially within the first 30 days but mostly limited to Clavien- Dindo grade I – II. Strother MC, Skokan AJ, Sterling ME, et al. Adult buried penis repair with escutcheonectomy and split-thickness skin grafting . J Sex Med 2018; 15(8): 1198-1204. Components of successful buried penis repair include return of directed voiding, elimination of local skin inflammation and infection, improve- ment in hygiene, return of sexual functioning, cosmesis, and patient satisfaction. The authors describe a technique for surgical correction of adult buried penis, including a technique for skin graft harvesting from the escutcheonectomy