During the most recent years, a variety of new techniques of penile reconstruction have been described in the literature. This paper focuses on the most recent advances in male genital reconstruction after trauma, exc...During the most recent years, a variety of new techniques of penile reconstruction have been described in the literature. This paper focuses on the most recent advances in male genital reconstruction after trauma, excision of benign and malignant disease, in gender reassignment surgery and aphallia with emphasis on surgical technique, cosmetic and functional outcome.展开更多
Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the ...Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes-the so-called ＇trifecta＇. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser- guided robotics, catheter-free prostatectomy and image-guided robotics are discussed.展开更多
Penile reconstruction still represents a formidable challenge for the urologist. In this review, the most recent advances in penile reconstruction after trauma, excision of benign and malignant disease and in patients...Penile reconstruction still represents a formidable challenge for the urologist. In this review, the most recent advances in penile reconstruction after trauma, excision of benign and malignant disease and in patients with micropenis, aphallia or female to male gender dysphoria are reported.展开更多
The long-term outcomes of 157 patients affected by Peyronie＇s disease （PD） who underwent penile straightening with Egydio＇s technique between January 2004 and December 2008 are reported. Only patients with PD who ...The long-term outcomes of 157 patients affected by Peyronie＇s disease （PD） who underwent penile straightening with Egydio＇s technique between January 2004 and December 2008 are reported. Only patients with PD who were stable for at least 6-12 months prior to surgery were enrolled in this study. Preoperative assessment included a dynamic echo colour Doppler ultrasound scan to evaluate the degree of penile deformity and the peak systolic velocity in the cavernosal arteries and an assessment of erectile function with the administration of the International Index of Erectile Function 5 （IIEF-5） questionnaire. Stretched penile length was recorded pre- and postoperatively. Surgical complications, cosmesis and sexual function, patient satisfaction and postoperative erectile function were assessed postoperatively at 3 months, I year and 2 years, respectively. After a median follow-up period of 20 months （range： 12-24 months）, we found that mild residual curvature （12%） and glans hypoesthesia （3%） were the only causes of partial dissatisfaction. No rejection of the graft was observed. All patients recovered their ability to penetrate with no difficulty. In addition, an intraoperative average increase of 2.5 cm （range： 1.7-4.1 cm） in stretched penile length was recorded, with all patients engaging in penetrative sexual intercourse. In conclusion, this procedure represents a safe and reproducible technique for the correction of penile curvature resulting from PD and yields excellent cosmetic and functional results.展开更多
The market for active implants and biosensors is of high economic and medical interest. As health economic considerations get into focus in terms of business planning and reimbursement, valid and flexible economic fea...The market for active implants and biosensors is of high economic and medical interest. As health economic considerations get into focus in terms of business planning and reimbursement, valid and flexible economic feasibility studies get more important. Unfortunately, literature mostly provides only single economic views on specific aspects like cost savings from reduced rehabilitation in a special patient cohort. To make planning and technology value negotiation more effective and more valid, a methodology to collect relevant data from different studies and normalize it to a common set of parameters was developed for the field of cardiac monitoring in a mixed example population with an approach of simple external weight, ECG and blood-pressure measurement or implanted devices for cardiac monitoring. The target entities taken into account by the simulation model were the impacts on heart attack, stroke, heart failure and the process of implant monitoring. Simulation took place at an example population of 500 patients with specific morbidity criteria. The health economic value was calculated over a period of three years and was split into a technology effectiveness measurement in Quality-adjusted-Lifetime-Years (QALYs) and a “cost- saving-part”. QALYs were chosen as technology effectiveness parameter for a combined and weighted mortality- and morbidity-reduction. Allocating 24.000 Euro to a saved QALY, 42% of the cost would be allocated to QALYs meaning money being spent for gained lifetime-years. The remaining 58% would be the different real cost savings: a per patient gross saving of 3.308 € per year would result for that part (21% on heart attack, 3% on stroke, 68% on heart failure and 8% on implant monitoring). Up-to-date studies do not provide a simple mechanism to allow custom-tailored health economic feasibility study results in terms of other specific population mixes or outcome parameters. Target audiences for the methodology of the described simulation are payors and solution providers targeting a specific patient population or specific telemedical situations. This way product development can address market-related needs more specific and healthcare providers can compare different outcome parameters in the given entities.展开更多
文摘During the most recent years, a variety of new techniques of penile reconstruction have been described in the literature. This paper focuses on the most recent advances in male genital reconstruction after trauma, excision of benign and malignant disease, in gender reassignment surgery and aphallia with emphasis on surgical technique, cosmetic and functional outcome.
文摘Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes-the so-called ＇trifecta＇. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser- guided robotics, catheter-free prostatectomy and image-guided robotics are discussed.
文摘Penile reconstruction still represents a formidable challenge for the urologist. In this review, the most recent advances in penile reconstruction after trauma, excision of benign and malignant disease and in patients with micropenis, aphallia or female to male gender dysphoria are reported.
文摘The long-term outcomes of 157 patients affected by Peyronie＇s disease （PD） who underwent penile straightening with Egydio＇s technique between January 2004 and December 2008 are reported. Only patients with PD who were stable for at least 6-12 months prior to surgery were enrolled in this study. Preoperative assessment included a dynamic echo colour Doppler ultrasound scan to evaluate the degree of penile deformity and the peak systolic velocity in the cavernosal arteries and an assessment of erectile function with the administration of the International Index of Erectile Function 5 （IIEF-5） questionnaire. Stretched penile length was recorded pre- and postoperatively. Surgical complications, cosmesis and sexual function, patient satisfaction and postoperative erectile function were assessed postoperatively at 3 months, I year and 2 years, respectively. After a median follow-up period of 20 months （range： 12-24 months）, we found that mild residual curvature （12%） and glans hypoesthesia （3%） were the only causes of partial dissatisfaction. No rejection of the graft was observed. All patients recovered their ability to penetrate with no difficulty. In addition, an intraoperative average increase of 2.5 cm （range： 1.7-4.1 cm） in stretched penile length was recorded, with all patients engaging in penetrative sexual intercourse. In conclusion, this procedure represents a safe and reproducible technique for the correction of penile curvature resulting from PD and yields excellent cosmetic and functional results.
文摘The market for active implants and biosensors is of high economic and medical interest. As health economic considerations get into focus in terms of business planning and reimbursement, valid and flexible economic feasibility studies get more important. Unfortunately, literature mostly provides only single economic views on specific aspects like cost savings from reduced rehabilitation in a special patient cohort. To make planning and technology value negotiation more effective and more valid, a methodology to collect relevant data from different studies and normalize it to a common set of parameters was developed for the field of cardiac monitoring in a mixed example population with an approach of simple external weight, ECG and blood-pressure measurement or implanted devices for cardiac monitoring. The target entities taken into account by the simulation model were the impacts on heart attack, stroke, heart failure and the process of implant monitoring. Simulation took place at an example population of 500 patients with specific morbidity criteria. The health economic value was calculated over a period of three years and was split into a technology effectiveness measurement in Quality-adjusted-Lifetime-Years (QALYs) and a “cost- saving-part”. QALYs were chosen as technology effectiveness parameter for a combined and weighted mortality- and morbidity-reduction. Allocating 24.000 Euro to a saved QALY, 42% of the cost would be allocated to QALYs meaning money being spent for gained lifetime-years. The remaining 58% would be the different real cost savings: a per patient gross saving of 3.308 € per year would result for that part (21% on heart attack, 3% on stroke, 68% on heart failure and 8% on implant monitoring). Up-to-date studies do not provide a simple mechanism to allow custom-tailored health economic feasibility study results in terms of other specific population mixes or outcome parameters. Target audiences for the methodology of the described simulation are payors and solution providers targeting a specific patient population or specific telemedical situations. This way product development can address market-related needs more specific and healthcare providers can compare different outcome parameters in the given entities.
