Re: Comparison of Outcomes of Salvage Robot-Assisted Laparoscopic Prostatectomy for Post-Primary Radiation vs Focal Therapy.

available at http://www.ncbi. nlm.nih. gov/pubmed/31430422 Editorial Comment: The authors review their experience with 126 salvage robot-assisted radical prostatectomies (RARPs) after primary radiation (75% of cases) or primary focal ablation (25%, mostly high intensity focused ultrasonography or cryoablation). As would be expected, functional outcomes were superior for patients who had previously received focal therapy, with shorter catheterization times and better 1-year continence outcomes. I have found that salvage RARP after focal therapy is technically less challenging, which likely accounts for these results. What is concerning is that the patients previously receiving focal therapy had higher rates of pT3 disease (71% vs 50%) and positive surgical margins (44% vs 17%). The whole gland fibrotic response to radiation therapy generally does not permit nerve sparing salvage RARP and thus likely explains the low positive margin rate in this group. Conversely focal therapy allows for better tissue planes accounting for the technical ease, although this clearly can mislead the surgeon and raises concern for performing ipsilateral nerve sparing in these patients. The higher pT3 disease rate also underscores the importance of preoperative staging with magnetic resonance imaging in this cohort and provides insight into where/how primary focal therapy fails in some patients. Jeffrey A. Cadeddu, MD Suggested Reading Thompson JE, Sridhar AN, Tan WS et al: Pathological findings and magnetic resonance imaging concordance at salvage radical prostatectomy for local recurrence following partial ablation using high intensity focused ultrasound. J Urol 2019; 201: 1134. Nunes-Silva I, Barret E, Srougi V et al: Effect of prior focal therapy on perioperative, oncologic and functional outcomes of salvage robotic assisted radical prostatectomy. J Urol 2017; 198: 1069. Male and Female Sexual Function and Dysfunction; Andrology Re: Paternity, Erectile Function, and Health-Related Quality of Life in Patients Operated for Pediatric Testicular Torsion E. P. M€ akel€ a, R. P. Roine and S. Taskinen Department of Pediatric Surgery, New Children’s Hospital, Helsinki University Hospital, Helsinki, and Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland J Pediatr Urol 2019; Epub ahead of print. doi: 10.1016/j.jpurol. 2019.10. 008 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/31734118available at http://www.ncbi. nlm.nih. gov/pubmed/31734118 Editorial Comment: This study compared paternity rates in adults who had spermatic cord torsion (SCT) in childhood vs a control population. Secondary outcomes were paternity rates after testis preserving surgery vs orchiectomy, and erectile function and health related quality of life (HRQoL). Questionnaires concerning paternity, erectile function (International Index of Erectile Function-5 questionnaire) and HRQoL (15D questionnaire) were mailed to 74 men treated for SCT and 92 controls treated for testicular appendage torsion between 1977 and 1995 who were older than 30 years at the time of the study. Paternity rates and HRQoL were similar between patients with SCT and controls. Type of surgery (orchiectomy vs detorsion) 168 MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. did not affect paternity rates statistically. Moderate or significant erectile dysfunction was rare in both groups. Allen D. Seftel, MD Suggested Reading Gielchinsky I, Suraqui E, Hidas G et al: Pregnancy rates after testicular torsion. J Urol 2016; 196: 852. Re: Correlation between Internal Pudendal Artery Stenosis and Erectile Dysfunction in Patients with Suspected Coronary Artery Disease H. W. Park, S. H. Her, B. H. Park, D. S. Han, S. M. Yuk, D. W. Kim, C. S. Youn and H. Jang Departments of Cardiology and Urology, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea PLoS One 2019; 14: e0225179. doi: 10.1371/journal.pone. 0225179 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/31714923available at http://www.ncbi. nlm.nih. gov/pubmed/31714923 Editorial Comment: Stenoses of internal pudendal arteries (IPAs) appear to be related to erectile dysfunction (ED). Nevertheless, the correlation between severity of ED and IPA stenosis is not well established. A total of 91 patients who were scheduled for angiography due to suspected coronary artery disease participated in this study. ED was assessed using the International Index of Erectile Function questionnaire. The authors diagnosed 88 patients (96.70%) with ED. There was no correlation between increasing age and severity of ED (r e0.063, p[0.555). Of the patients 72 had maximum stenosis less than 50% and 19 had maximum stenosis greater than 50%. In the former group 62 patients were diagnosed with ED even though no stenosis was observed. No significant correlation was found between ED severity and extent of IPA stenosis (r e0.118, p[0.265). Important data to be aware of.