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Narasimman M, Sandler M, Bernstein A, Loloi J, Saltzman RG, Bernie H, Ramasamy R. A primer on the restorative therapies for erectile dysfunction: a narrative review. Sex Med Rev 2024; 12:505-512. [PMID: 38494449 DOI: 10.1093/sxmrev/qeae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a common condition that affects millions worldwide. Patients and urologists alike are seeking alternative therapies that can provide long-lasting results in the treatment of ED. This review provides a comprehensive overview of restorative treatments available for ED, such as platelet-rich plasma, stem cell therapy, and shockwave therapy. OBJECTIVE The aim of this narrative review is to provide a primer for urologists and general practitioners on the basics of implementing ED restorative therapies in their practice. METHODS The PubMed, MEDLINE, and Google Scholar databases were searched for articles in the English language through August 31, 2023, that included key terms such as "erectile dysfunction," "restorative therapy," "shockwave therapy," "platelet-rich plasma," "stem cell therapy," and "stromal vascular fraction." Reference lists of selected studies were manually reviewed to find articles not identified by the initial database search. RESULTS Shockwave therapy has demonstrated effectiveness in treating ED, with devices like the Medispec ED1000 and Storz Duolith showing statistically significant improvements in patient scores for International Index of Erectile Function (IIEF)-Erectile Function scores in clinical trials. In reported studies of platelet-rich plasma injections, a substantial percentage of patients reached a minimal clinically important difference in the IIEF-Erectile Function scale after treatment. Studies of ED treatment with stem cell therapy, while limited and with small sample sizes, have demonstrated encouraging improvements in patient scores for the abridged 5-item version of the IIEF after treatment. CONCLUSION Shockwave, platelet-rich plasma, and stem cell therapies are important, novel, noninvasive restorative treatments for ED that can provide relief for patients wishing to avoid a more invasive approach. While these therapies have shown promising results in clinical trials, more research is required to establish them as standardized and efficacious options in the management of ED.
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Affiliation(s)
- Manish Narasimman
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Max Sandler
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Ari Bernstein
- Department of Urology, New York University Langone Health, New York, NY10016, United States
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, United States
| | - Russell G Saltzman
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Helen Bernie
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
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Goodstein T, Jenkins LC. A narrative review on malleable and inflatable penile implants: choosing the right implant for the right patient. Int J Impot Res 2023; 35:623-628. [PMID: 37741958 DOI: 10.1038/s41443-023-00765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
A penile prosthesis/implant is an excellent option for men with erectile dysfunction refractory to medical treatment or with contraindications to medical management. In this narrative review, we discuss the different types of penile prostheses and the considerations for patient and device selection to maximize satisfaction. There are three main prosthesis types to choose from: three-piece inflatable devices, two-piece inflatable devices, and malleable/semirigid devices. The three-piece devices are the gold standard in advanced economy countries but require reservoir placement and manual dexterity, which can be limiting to some patients. The two-piece inflatable devices are a good option for patients who have standard-sized penises, lack significant penile pathology, have limited dexterity issues, or should avoid reservoir placement due to potential complications. The malleable devices are popular in countries where insurance coverage is limited but are increasingly used in advanced economy countries for length conservation in specific patient populations. Finally, not every patient needs an implant, and assessing partner sexual function is an important consideration for patient-partner satisfaction. Surgeons need to be familiar with the strengths and limitations of each device and the patient characteristics that will yield the best outcome from penile prosthesis surgery.
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Affiliation(s)
- Taylor Goodstein
- Department of Urology, The Ohio State University, Columbus, OH, 43210, USA
| | - Lawrence C Jenkins
- Department of Urology, Tulane University, 1430 Tulane Ave, #8642, New Orleans, LA, 70112, USA.
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Smelser AM, VanDyke ME, Nealon SW, Badkhshan S, Langford BT, Peedikayil J, El-Eishy AF, Monaghan TF, Sanders SC, Franzen BP, Morey AF. Mechanical indications for inflatable penile prosthesis revision: analysis and implications for revision surgery. J Sex Med 2023; 20:1044-1051. [PMID: 37189017 DOI: 10.1093/jsxmed/qdad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Despite technical advancements, inflatable penile prostheses (IPPs) are inherently at risk of mechanical failure given their nature as hydraulic devices. AIM To characterize IPP component failure location at the time of device revision and stratify by manufacturer: American Medical Systems (Boston Scientific [BSCI]) and Coloplast (CP). METHODS A retrospective review of penile prosthesis cases from July 2007 to May 2022 was conducted, identifying men who underwent revision surgery. Cases were excluded if documentation did not denote the cause of failure or the manufacturer. Mechanical indications for surgery were categorized by location (eg, tubing, cylinder, or reservoir leak; pump malfunction). Nonmechanical revisions were excluded (component herniation, erosion, or crossover). Categorical variables were assessed with Fisher exact or chi-square analysis; Student t-test and Mann-Whitney U test were used for continuous variables. OUTCOMES Primary outcomes included specific location of IPP mechanical failure among BSCI and CP devices and time to mechanical failure. RESULTS We identified 276 revision procedures, 68 of which met inclusion criteria (46 BSCI and 22 CP). Revised CP devices were longer than BSCI devices (median cylinder length, 20 vs 18 cm; P < .001). Log-rank analysis revealed a similar time to mechanical failure between brands (P = .096). CP devices failed most often due to tubing fracture (19/22, 83%). BSCI devices had no predominant site of failure. Between manufacturers, tubing failure was more common in CP devices (19/22 vs 15/46 for BSCI, P < .001), while cylinder failure was more common among BSCI devices (10/46 vs 0/22 for CP, P = .026). CLINICAL IMPLICATIONS The distribution of mechanical failure is significantly different between BSCI and CP devices; this has implications regarding the approach to revision surgery. STRENGTHS AND LIMITATIONS This is the first study to directly compare when and where mechanical failure occurs in IPPs and to compare the 2 main manufacturers head-to-head. This study would be strengthened by being repeated in a multi-institutional fashion to provide more robust and objective evaluation. CONCLUSION CP devices commonly failed at the tubing and rarely elsewhere, while BSCI devices showed no predominant failure site; these findings may inform decision making regarding revision surgery.
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Affiliation(s)
- Ashton M Smelser
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Maia E VanDyke
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Samantha W Nealon
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Shervin Badkhshan
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Brian T Langford
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Josh Peedikayil
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Al-Frooq El-Eishy
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Thomas F Monaghan
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Sarah C Sanders
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Bryce P Franzen
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Allen F Morey
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
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Argiolas A, Argiolas FM, Argiolas G, Melis MR. Erectile Dysfunction: Treatments, Advances and New Therapeutic Strategies. Brain Sci 2023; 13:802. [PMID: 37239274 PMCID: PMC10216368 DOI: 10.3390/brainsci13050802] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Erectile dysfunction (ED) is the inability to get and maintain an adequate penile erection for satisfactory sexual intercourse. Due to its negative impacts on men's life quality and increase during aging (40% of men between 40 and 70 years), ED has always attracted researchers of different disciplines, from urology, andrology and neuropharmacology to regenerative medicine, and vascular and prosthesis implant surgery. Locally and/or centrally acting drugs are used to treat ED, e.g., phosphodiesterase 5 inhibitors (first in the list) given orally, and phentolamine, prostaglandin E1 and papaverine injected intracavernously. Preclinical data also show that dopamine D4 receptor agonists, oxytocin and α-MSH analogues may have a role in ED treatment. However, since pro-erectile drugs are given on demand and are not always efficacious, new strategies are being tested for long lasting cures of ED. These include regenerative therapies, e.g., stem cells, plasma-enriched platelets and extracorporeal shock wave treatments to cure damaged erectile tissues. Although fascinating, these therapies are laborious, expensive and not easily reproducible. This leaves old vacuum erection devices and penile prostheses as the only way to get an artificial erection and sexual intercourse with intractable ED, with penile prosthesis used only by accurately selected patients.
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Affiliation(s)
- Antonio Argiolas
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.M.A.); (M.R.M.)
| | - Francesco Mario Argiolas
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.M.A.); (M.R.M.)
| | - Giacomo Argiolas
- General Medicine Unit, Hospital San Michele, ARNAS“G. Brotzu”, Piazzale Ricchi 1, 09100 Cagliari, Italy;
| | - Maria Rosaria Melis
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.M.A.); (M.R.M.)
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Singh A, Cooper CA, Hou SW, Raheem OA. A Systematic Review of Partner Satisfaction After Penile Prosthesis with Special Emphasis on LGBTQ + Populations. Curr Urol Rep 2023; 24:105-115. [PMID: 36670232 DOI: 10.1007/s11934-022-01126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Despite the current surgical advances and patients' satisfactions after penile prosthesis (PP) implantation, there has been paucity of data on reported partner satisfaction and their quality-of-life (QoL). Our objective was to summarize the current literature on partner satisfaction for both heterosexual and non-heterosexual populations, respectively. We specifically conducted a systematic review according to the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, and stratified studies into three tiers by methodological rigor. RECENT FINDINGS After an initial search of 172 articles, 33 studies met the inclusion criteria for the final review: 30 for heterosexual partner satisfaction, and 3 for LGBTQ patient satisfaction were included due to lack of published literature on partner satisfaction for LGBTQ patients. For heterosexual partner satisfaction, 10 studies were classified as Tier 1, 11 studies were classified as Tier 2, and 9 studies were classified as Tier 3. From an initial search of 13 records, three studies consisting of 272 patients met the inclusion criteria for our LGBTQ review. Across all the tiers, studies noted satisfaction rates between 50 and 90% and improved satisfaction and sexual QoL metrics compared to pre-surgery rates. That said, partner satisfaction rates were also consistently lower than patient satisfaction rates. Although the range of evidence quality varies, the available literature suggests significant improvements in and relatively high rates of partner satisfaction after PP implantation. Given the diversity of study designs and widespread use of non-validated or non-specific questionnaires in the current literature, future research should focus on prospective studies and/or data collection using validated, PP-specific questionnaires.
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Affiliation(s)
- Armaan Singh
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Caleb A Cooper
- Department of Surgery, Section of Urology, University of Chicago Medicine, Chicago, IL, USA
| | - Sean W Hou
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Omer A Raheem
- Department of Surgery, Section of Urology, University of Chicago Medicine, Chicago, IL, USA.
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Moussa M, Papatsoris AG, Abou Chakra M, Dabboucy B, Fares Y. Erectile dysfunction in common neurological conditions: A narrative review. ACTA ACUST UNITED AC 2020; 92. [PMID: 33348971 DOI: 10.4081/aiua.2020.4.371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022]
Abstract
Neurogenic erectile dysfunction (NED) can be defined as the inability to achieve or maintain an erection due to central or peripheral neurologic disease. Neurologic diseases can also affect the physical ability and psychological status of the patient. All these factors may lead to a primary or secondary NED. Medication history plays an important role since there are many drugs commonly used in neurologic patients that can lead to ED. The assessment of NED in these patients is generally evolving with the application of evoked potentials technology in the test of somatic and autonomic nerves, and functional magnetic resonance imaging. With the electrophysiological examinations, neurogenic causes can be determined. These tools allow to categorize neurologic lesion and assess the patient prognosis. The first-line treatment for NED is phosphodiesterase inhibitors. Second-line treatments include intracavernous and intraurethral vasoactive injections. Third-line treatments are penile prostheses. The efficacy and safety of each treatment modality depend on the specific neurologic condition. This review discusses the physiology, pathophysiology, diagnosis, and treatment of ED in multiple peripheral and central neurologic conditions, as well as for future research.
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Affiliation(s)
- Mohamad Moussa
- Urology Department, Zahraa Hospital, University Medical Center, Beirut.
| | - Athanasios G Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens.
| | - Mohamad Abou Chakra
- Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Baraa Dabboucy
- Department of Neurosurgery, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Youssef Fares
- Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut.
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Cost-utility analysis comparing surgical and nonsurgical interventions in the treatment of erectile dysfunction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01644-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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8
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Crowdsourcing the public’s perception of microsurgical and nonsurgical interventions for erectile dysfunction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01639-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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9
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Shauly O, Gould DJ, Patel KM. Emerging nonsurgical and surgical techniques to treat erectile dysfunction: A systematic review of treatment options and published outcomes. J Plast Reconstr Aesthet Surg 2018; 72:532-538. [PMID: 30765240 DOI: 10.1016/j.bjps.2018.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/10/2018] [Accepted: 12/09/2018] [Indexed: 01/17/2023]
Abstract
Erectile dysfunction (ED) is one of the most common causes of morbidity in male patients, with a prevalence of 50-60% in men aged 40-70 years. EDs may be caused by physical or psychological trauma, the former of which may be treatable through surgical intervention. Physical trauma may be further categorized as vasculogenic, neurogenic, or idiopathic in nature. Although many patients do not respond well to nonsurgical treatment options, few opt for surgical intervention. This is likely due to the difficulty of the procedures, as well as relatively low historical success rates. As such, a systematic review of the literature was performed to identify novel surgical interventions for ED. A total of 19 manuscripts were included in this review, representing data of three minimally invasive approaches to ED treatment and seven novel surgical techniques. The data revealed compelling evidence in support of microsurgical treatments for ED - namely, microvascular arterial bypass penile revascularization surgery (MABS) and cavernous nerve graft reconstruction. Nerve grafts varied, with the use of end-to-side ilioinguinal, genitofemoral, and sural grafts, all demonstrating high rates of success. Furthermore, minimally invasive botulinum toxin (BoNT-A) treatment and adipose-derived stem cell (ADSC) therapy have shown extreme promise in rat models; with BoNT-A treatment entering phase II human clinical trials this year. Many of the surgical methods investigated in this review are microsurgical interventions that demonstrate high rates of success in patients with neurogenic or vasculogenic ED. As such, microsurgeons are uniquely trained and positioned to be of value to ED treatment.
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Affiliation(s)
- Orr Shauly
- Department of Plastic and Reconstructive Surgery, University of Southern California, Keck Hospital of USC, 1510 San Pablo Street, Suite 4000, Los Angeles, CA 90033, United States
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, University of Southern California, Keck Hospital of USC, 1510 San Pablo Street, Suite 4000, Los Angeles, CA 90033, United States
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, University of Southern California, Keck Hospital of USC, 1510 San Pablo Street, Suite 4000, Los Angeles, CA 90033, United States.
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Cordes J, Zimbelmann M, Merseburger AS, Kramer M, Vonthein R, Büttner H, Recke A, Kahle BK. Transient increased tumescence of the glans penis during penile erection after endovenous ablation of the great saphenous vein. J Vasc Surg Venous Lymphat Disord 2018; 7:387-391. [PMID: 30477979 DOI: 10.1016/j.jvsv.2018.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/21/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The primary objective of our study was to investigate the impact of endovenous ablation of the great saphenous vein (GSV) on the degree of tumescence of the glans penis during penile erection as well as on global erectile function (EF). METHODS We included patients scheduled for one of three different methods of endoluminal treatment. Our questionnaire was composed of the EF domain of the International Index of Erectile Function, an additional question that has been validated for assessment of swelling (tumescence) of the glans penis, and a question on the use of erectogenic medication. RESULTS There were 62 patients enrolled in the study. Seven patients (11%) reported a postoperative enlargement of the glans penis on penile erection compared with the subjectively assessed glans tumescence before surgery. Three patients (5%) reported an increased tumescence of the glans 1 week after surgery, and four (7.4%) different patients reported the effect 3 months after surgery. Of these seven men, three had normal EF (score ≥26) at any time. One patient had mild erectile dysfunction before the operation, with an improvement to normal EF from week 1 throughout the observation in the study (3 months). CONCLUSIONS This is the first prospective study that confirms an unexpected side effect of endoluminal treatment of the GSV occurring in approximately 10% of men. It might be of interest for insufficient responders to phosphodiesterase type 5 inhibitors with varicosis of the GSV in the future.
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Affiliation(s)
| | | | | | | | - Reinhard Vonthein
- Institute of Statistics, UKSH, Lübeck, Germany; ZKS Luebeck, University of Luebck, Lübeck, Germany
| | - Hartwig Büttner
- Medical Department, Lilly Deutschland GmbH, Bad Homburg, Germany
| | - Andreas Recke
- Clinic of Dermatology Luebeck Campus, University Medical Center, Schleswig-Holstein, Lübeck, Germany
| | - Birgit K Kahle
- Clinic of Dermatology Luebeck Campus, University Medical Center, Schleswig-Holstein, Lübeck, Germany
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Yafi FA, Andrianne R, Alzweri L, Brady J, Butcher M, Chevalier D, DeLay KJ, Faix A, Hatzichristodoulou G, Hellstrom WJG, Jenkins L, Kohler TS, Osmonov D, Park SH, Schwabb MD, Valenzuela R, van Renterghem K, Wilson SK. Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence. J Sex Med 2018. [PMID: 29523479 DOI: 10.1016/j.jsxm.2018.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND After radical prostatectomy (RP), erectile dysfunction, often necessitating the need for inflatable penile prosthesis (IPP) insertion, and urinary incontinence and climacturia can ensue. AIM To assess the efficacy and safety of the mini-jupette, a mesh used to approximate the medial aspects of the 2 corporotomies at the time of IPP insertion, for the management of climacturia and urine leakage in patients with minimal incontinence. METHODS We conducted a pilot multicenter study of patients with post-RP erectile dysfunction and climacturia and/or mild urinary incontinence (≤2 pads/day [ppd]) undergoing IPP insertion with concomitant placement of a mini-jupette graft. OUTCOMES Pre- and postoperative erectile function, continence and climacturia, and overall surgical outcomes were assessed. RESULTS 38 patients underwent the mini-jupette procedure. The mean age of the population was 65.3 years (SD = 7.7). 30 had post-RP climacturia and 32 patients had post-RP incontinence (mean = 1.3 ppd, SD = 0.8). 31 patients received Coloplast Titan, 4 received AMS 700 LGX, and 3 received AMS 700 CX IPPs. Mean corporotomy size was 2.9 cm (SD = 1.0). Mean graft measurements were 3.2 cm (SD = 0.9) for width, 3.3 cm (SD = 1.3) for length, and 11.0 cm2 (SD = 5.1) for surface area. At a mean follow-up of 5.1 months (SD = 6.9), there were 5 postoperative complications (13.2%) of which 4 required explantation. Climacturia and incontinence were subjectively improved in 92.8% and 85.7%, respectively. Mean ppd decreased by 1.3 postoperatively. CLINICAL IMPLICATIONS The Andrianne mini-jupette is a feasible adjunct to IPP placement that can be used for subsets of patients with post-RP climacturia and/or minimal incontinence. STRENGTHS AND LIMITATIONS Strengths of this study include the novel nature of this intervention, the multi-institutional nature of the study, and the promising results demonstrated. Limitations include the retrospective nature of the study and the heterogeneity of the techniques and grafts used by different surgeons involved. CONCLUSION Longer follow-up and larger patient cohorts are needed to confirm the long-term safety and benefits of this intervention. Yafi FA, Andrianne R, Alzweri L, et al. Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence. J Sex Med 2018;15:789-796.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sun Hung Park
- Sewum Prosthetic Urology Center of Excellence, Seoul, Korea
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12
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Johnsen NV, Kaufman MR, Dmochowski RR, Milam DF. Erectile Dysfunction Following Pelvic Fracture Urethral Injury. Sex Med Rev 2017; 6:114-123. [PMID: 28757357 DOI: 10.1016/j.sxmr.2017.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/10/2017] [Accepted: 06/23/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Although pelvic fracture urethral injuries (PFUIs) are rare, approximately half these patients will report erectile dysfunction (ED) after their injuries. The anatomic relations of the cavernosal nerves and arteries to the bones of the pelvis and the urethra put these structures at significant risk at the time of PFUI. This review examines the epidemiology, evaluation, and management of ED in this patient population. AIM To evaluate the epidemiology, pathophysiology, diagnosis, and management of patients with ED after PFUI. METHODS A literature review was performed to identify articles on PubMed published before May 2017 addressing PFUI and ED. MAIN OUTCOME MEASURES Incidence, mechanisms, risk factors, evaluation, and management strategies of ED after PFUI were analyzed. RESULTS Patients with pelvic fractures are at risk of post-injury ED, whereas those with PFUI appear to be at even higher risk. Different potential mechanisms contributing to the pathophysiology of ED in this setting have been described in the literature, including damage to the nervous supply to the penis, arterial insufficiency, and veno-occlusive dysfunction. However, there is a lack of consensus on the predominant etiology. Appropriate diagnostic evaluation can help to elucidate the underlying pathophysiology on an individual basis and can help guide management. Oral therapies, intracavernosal injections, and inflatable penile prostheses have shown great success. Furthermore, unlike patients with ED from other causes, select patients with isolated arteriogenic ED are potentially eligible for penile revascularization procedures. CONCLUSION Because most patients with pelvic trauma are younger than 40 years with a significant life expectancy, appropriate diagnosis and management of ED after PFUI can greatly improve quality of life and allow resumption of post-injury sexual function. Identification of the causative pathology can help tailor treatment on an individual basis. Johnsen NV, Kaufman MR, Dmochowski RR, Milam DF. Erectile Dysfunction Following Pelvic Fracture Urethral Injury. Sex Med Rev 2018;6;114-123.
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Affiliation(s)
- Niels V Johnsen
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Melissa R Kaufman
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roger R Dmochowski
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas F Milam
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Rudolph E, Boffard C, Raath C. Pelvic Floor Physical Therapy for Erectile Dysfunction-Fact or Fallacy? J Sex Med 2017; 14:765-766. [PMID: 28583337 DOI: 10.1016/j.jsxm.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Elna Rudolph
- My Sexual Health, National Multidisciplinary Sexual Health Team, Johannesburg, South Africa.
| | - Catriona Boffard
- My Sexual Health, National Multidisciplinary Sexual Health Team, Johannesburg, South Africa
| | - Cecilia Raath
- My Sexual Health, National Multidisciplinary Sexual Health Team, Pretoria, South Africa
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14
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Critical Analysis of Satisfaction Assessment After Penile Prosthesis Surgery. Sex Med Rev 2017; 5:244-251. [DOI: 10.1016/j.sxmr.2017.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/24/2016] [Accepted: 01/01/2017] [Indexed: 01/09/2023]
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Biofilm and Infectious Agents Present at the Time of Penile Prosthesis Revision Surgery: Times Are a Changing. Sex Med Rev 2017; 5:236-243. [PMID: 28242178 DOI: 10.1016/j.sxmr.2017.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/18/2016] [Accepted: 01/01/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Although infection rates have decreased with the use of antibiotic-coated implants and other enhancements, the risk of infection is still considered a serious concern in penile implant revision surgeries. AIM To review the literature for advances made in inflatable penile prosthesis (IPP) revision surgery and organisms found at the time of revision, the significance of biofilm in prosthetic infection, and the bacteriology of infection. METHODS PubMed was reviewed for articles spanning the past three decades that discussed micro-organisms and biofilm in relation to penile implant revision surgery. MAIN OUTCOME MEASURES All articles were reviewed for evidence of bacteria found at revision IPP surgeries and any improvements made in surgical techniques and prosthesis enhancements. RESULTS During the period examined, several improvements have lowered the rate of infection in penile implant surgery: notably, antibiotic-coated IPPs, revision washout, and alcohol-based skin preparations. The biofilm composition on clinically uninfected and infected IPPs appears to have changed over time. The abundance of staphylococcal species-particularly coagulase-negative organisms-in positive cultures has decreased in infected implants, and clinically uninfected implants also have shown a decrease in the proportion of staphylococcal species. Conversely, other isolates such as fungi, Escherichia coli, and Enterococcus species have increased in clinically uninfected and infected implants, and there has been an overall increase in unique isolates that form the biofilm. CONCLUSION A multitude of enhancements has decreased the presence of micro-organisms and the subsequent formation of biofilm. Nevertheless, the formation of biofilm on penile implants has been noted more frequently in the past decade, and the microbial composition of biofilms seems to be changing. Dawn LE, Henry GD, Tan GK, Wilson SK. Biofilm and Infectious Agents Present at the Time of Penile Prosthesis Revision Surgery: Times Are a Changing. Sex Med Rev 2017;5:236-243.
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Casabé AR, Sarotto N, Gutierrez C, Bechara AJ. Satisfaction assessment with malleable prosthetic implant of Spectra (AMS) and Genesis (Coloplast) models. Int J Impot Res 2016; 28:228-233. [DOI: 10.1038/ijir.2016.33] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/12/2016] [Accepted: 07/23/2016] [Indexed: 01/23/2023]
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