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My point is that the likelihood is that ��50% of the patients in this series actually had, or had had, GLS so would be at risk of recurrence of LS after surgery, https://www.selleckchem.com/products/INCB18424.html especially if urinary leakage occurred from the neo-meatus and there were present the anatomical requisites for occlusion, as described above. Surgery works in MGLS if it relieves susceptible epithelium from chronic occluded exposure to urine. Surgery fails if it does not achieve this goal or if the damage to urethral structural and functional integrity is beyond intervention. Surgery may inadvertently worsen the problem by increasing the overall incontinence of the distal urinary system. The laudable goals of organ saving surgery in penis cancer, admirably rehearsed by Abdelkardy et?al., should include the avoidance of new or, more likely, recurrent LS, because of the ensuing morbidity and risk of second cancer, usually of the verrucous type (as occurred here). Fundamental to planning of all penile surgery is the recognition of the pernicious role in the initiation and progression of MGLS played by the chronic occluded exposure of genital skin to urine. ""Sir, Roger Kirby��s call to raise the priority of patient safety in urological practice is a welcome one [1]. There are two points that were alluded to in the article, but which merit further discussion: firstly, the importance of minor events and ��near-misses��; and secondly the need to adopt an integrated approach to patient safety. Thankfully, adverse events (AEs) that result in the https://www.selleckchem.com/products/SB-431542.html loss of life or limb (or organ) are taken very seriously. However, https://www.selleck.cn/products/VX-770.html lies [3]. Furthermore, the root causes of all AEs, including ��near misses��, show the same underlying patterns of failure. By addressing ��near misses�� and minor AEs, the underlying causes can be corrected before they lead to more tragic incidents [4]. As in the case above, AEs arise from various causes relating to interventions, systems and human factors [4]. These factors are not isolated, but interrelated. Delivering high-quality care, from surgery to multidisciplinary team working, should be seen as an integrated system, dependent on interventions (e.g. medication, equipment), systems (e.g. WHO checklist, safety training) and human factors (e.g. technical skills, communication skills, fatigue, stress) [5,6]. Innovations that improve patient safety, such as the WHO Surgical Checklist, crew resource management training, or reporting mechanisms, should not be seen in isolation, but should be utilised together. Taking ��near-misses�� seriously, along with consideration of the role of interventions, systems and human factors in patient safety will help us to adopt a culture of safety and quality in clinical practice.