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Rajamohan N, Kapoor H, Khurana A, Nelson L, Ganesh HS, Khatri G, Nair RT. MR imaging of penile pathology and prostheses. Abdom Radiol (NY) 2024:10.1007/s00261-024-04417-2. [PMID: 39066812 DOI: 10.1007/s00261-024-04417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 07/30/2024]
Abstract
Penile MRI is a vital yet underutilized diagnostic tool that provides detailed information crucial for managing various penile pathologies. Due to its infrequent use, many radiology trainees lack confidence in interpreting these exams. This article reviews the anatomy, key technical considerations, and interpretive pearls for penile trauma, Peyronie's disease, priapism, penile neoplasms, prosthesis evaluation, and a few miscellaneous conditions. Through illustrative case examples, this review aims to enhance the understanding and proficiency of radiologists in performing and interpreting penile MRI in these clinical scenarios.
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Affiliation(s)
- Naveen Rajamohan
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9004, USA.
| | - Harit Kapoor
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
| | - Aman Khurana
- Department of Radiology, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Leslie Nelson
- Department of Radiology, University of Wisconsin, Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - Halemane S Ganesh
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9004, USA
| | - Rashmi T Nair
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
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Blum KA, Mehr JP, Green TP, Macharia K, Kim D, Westney OL, Wang R. Complication rates in concurrent inflatable penile prosthesis and incontinence surgery: Comparing the penoscrotal versus perineal incision approach. Int J Impot Res 2024; 36:89-93. [PMID: 36357570 DOI: 10.1038/s41443-022-00628-7] [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: 07/11/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022]
Abstract
The main objective of this study was to assess the IPP complication rates of patients undergoing placement via perineal incision versus more traditional penoscrotal approach in synchronous dual implantation. We identified 38 patients who underwent dual implantations of an IPP and AUS or urethral sling from 2011 to 2021 at a single tertiary center, 24 via perineal and 14 via penoscrotal incision. All IPP implants were done by a single surgeon. IPP postoperative complications were captured using the Clavien-Dindo classification at three separate time points, < 30 days, 30 days - 6 months, and > 6 months. The perineal group had two complications, IPP explantation due to rectourethral fistula (Grade III, > 6 months), and IPP explantation due to chronic genital pain (Grade III, > 6 months). The penoscrotal group had three complications, post-operative urinary retention requiring catheterization (Grade I, < 30 days), incision site infection (Grade I, < 30 days), and IPP explantation due to infection (Grade III, 30 days to < 6 months). There was no statistically significant difference in rate of patients with IPP complications between the two groups (p = 0.546) or in rate of IPP device malfunction (p = 0.264). These preliminary findings suggest that the single perineal incision is a viable surgical approach in synchronous dual implantation.
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Affiliation(s)
- Kyle A Blum
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Justin P Mehr
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Travis P Green
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Kirema Macharia
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Daniel Kim
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
| | | | - Run Wang
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA.
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA.
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Moukhtar Hammad MA, Barham DW, Sanford DI, Amini E, Jenkins L, Yafi FA. Maximizing outcomes in penile prosthetic surgery: exploring strategies to prevent and manage infectious and non-infectious complications. Int J Impot Res 2023; 35:613-619. [PMID: 37828138 PMCID: PMC10622320 DOI: 10.1038/s41443-023-00773-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
Inflatable Penile Prostheses (IPP) implantation is a surgical treatment for patients desiring definitive treatment for erectile dysfunction. While this procedure has proven to be effective, it also carries its own set of unique risks that need to be carefully considered. The article reviews the current understanding of complications associated with penile prosthetic surgery and provides strategies to mitigate these adverse events. This article covers various aspects of IPP implantation, including the risks of infection, bleeding, injury to nearby structures, glans ischemia, and device malfunction. It also discusses the importance of careful preoperative screening to identify risk factors and the implementation of infection reduction strategies such as antimicrobial prophylaxis, skin prep, and operative techniques. In addition, it emphasizes the need for postoperative vigilance and prompt management of any complications that may arise. Overall, the article provides a comprehensive overview of the risks and strategies for mitigating complications associated with IPP implantation. Our recommendations are given based on the current consensus in the field and highlight the importance of careful planning, attention to detail, and effective communication between healthcare providers and patients. Despite the potential risks, this review underscores the fact that complications following penile prosthesis implantation are relatively rare.
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Affiliation(s)
| | - David W Barham
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Daniel I Sanford
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Artificial Intelligence Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | | | - Lawrence Jenkins
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, Orange, CA, 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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Munoz-Lopez C, Lewis K, Dewitt-Foy M, Lone Z, Montague DK, Angermeier KW, Gill BC. Outcomes of Inflatable Penile Prosthesis following Radical Cystectomy - A matched Cohort Analysis. Urology 2023:S0090-4295(23)00144-9. [PMID: 36796542 DOI: 10.1016/j.urology.2023.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To evaluate outcomes of inflatable-penile-prosthesis (IPP) implantation after radical-cystectomy compared with other etiologies of erectile dysfunction. MATERIALS AND METHODS All inflatable penile prostheses within the past 20 years in a large regional health system were reviewed, and erectile dysfunction etiology was determined as radical-cystectomy, radical-prostatectomy, or organic/other ED. Cohorts were generated by 1:3 propensity score match using age, body mass index, and diabetes status. Baseline demographics and relevant comorbidities were evaluated. Clavien-Dindo complications, grade, and reoperation were assessed. Multivariable logarithmic regression was used to identify the predictors of 90-day complications following IPP implantation. Log-rank analysis was used to assess the time-to-reoperation after IPP implantation in patients with a history of cystectomy compared with non-cystectomy etiologies. RESULTS Of 2600 patients, 231 subjects were included in the study. Comparing patients undergoing IPP for cystectomy vs. pooled non-cystectomy indications, those who underwent radical-cystectomy had a higher overall complication rate(24% vs. 9%, p=0.02). Clavien-Dindo complication grades did not differ across groups. Reoperation was significantly more common following cystectomy (cystectomy: 21% vs. non-cystectomy: 7%, p=0.01), however time to reoperation did not differ significantly by indication (cystectomy: 8 years vs non-cystectomy: 10 years, p=0.09). Among cystectomy patients, 85% of reoperations were due to mechanical failure. CONCLUSION Compared to other erectile dysfunction etiologies, patients undergoing IPP with a history of cystectomy have an increased risk of complications within 90-days of implantation and need for surgical device revision, but no greater risk for high-grade complications. Overall IPP remains a valid treatment option after cystectomy.
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Affiliation(s)
- Carlos Munoz-Lopez
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Kevin Lewis
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Molly Dewitt-Foy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Zaeem Lone
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Drogo K Montague
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Bradley C Gill
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Kosk P, McKay A, McPhee A, Cowell D, Fraser M. Isolated nerve palsy following insertion of a three-piece inflatable penile prosthesis. BJR Case Rep 2022; 8:20210158. [PMID: 36177264 PMCID: PMC9499437 DOI: 10.1259/bjrcr.20210158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/08/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Case report of a 57-year-old male who underwent insertion of an inflatable penile prosthesis due to erectile dysfunction, secondary to poorly controlled Type 2 diabetes and Peyronie’s disease. The surgical procedure was uneventful and there were no immediate post-operative complications. During a routine follow-up, the patient described problems with the deflation of the implant and severe lower back and leg pain. Diagnostic MRI scans revealed reservoir migration, impingement of the obturator nerve and oedema in the adductor muscle group. The reservoir was initially repositioned, and later on removed due to ongoing symptoms.
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Affiliation(s)
- Paulina Kosk
- Clinical Development Fellow, Urology Department, Glasgow Royal Infirmary, Glasgow, UK
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Uski ACVR, Piccolo LM, Abud CP, Pedroso MHNI, Seidel Albuquerque K, Gomes NBN, Fernandes JDÁ. MRI of Penile Prostheses: The Challenge of Diagnosing Postsurgical Complications. Radiographics 2021; 42:159-175. [PMID: 34919468 DOI: 10.1148/rg.210075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Penile implants are surgically inserted devices used for the treatment of erectile disfunction. Improvements in surgical techniques and in the manufacturing of these implants have reduced the risk of intra- and postoperative complications and increased the popularity and use of this therapeutic option. Routine imaging is not recommended before penile prosthesis surgery. Malleable penile prostheses use noninflatable shafts inserted into each corpus cavernosum, which appear hypointense on T1- and T2-weighted MR images. Inflatable penile prostheses (IPPs) may consist of two or three parts and are composed of two cylinders inserted into the corpora cavernosa that are filled with a saline solution to produce rigidity. These appear homogeneously T2 hyperintense and the silicone-based covering of the cylinders appears T2 hypointense, thereby clearly delineating the cylinders. In the case of three-piece IPPs, a reservoir containing the fluid may be placed in the pelvis. The most frequent complications are related to infection and mechanical failure, the latter being more common in IPPs because more components are involved. Less common complications include malpositioning. Detection and management of postoperative complications are challenging, and MRI plays a crucial role as it permits evaluation of the positioning and configuration of the prosthesis components, as well as assists in functional evaluation of IPPs when images are obtained of both the flaccid and inflated states. ©RSNA, 2021.
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Affiliation(s)
- Ana Cláudia Vincenzi Raduan Uski
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
| | - Luciana Maksoud Piccolo
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
| | - Carolina Pereira Abud
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
| | - Maria Helena Naves Inácio Pedroso
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
| | - Kamila Seidel Albuquerque
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
| | - Natália Borges Nunes Gomes
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
| | - José de Ávila Fernandes
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
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Albasha H, Wang SS, Revels JW, Beckett K, Flink CC. Imaging review of penile pathologies encountered in the emergency department. Emerg Radiol 2021; 29:147-159. [PMID: 34596782 DOI: 10.1007/s10140-021-01988-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
While penile pathology is uncommon, prompt diagnosis and treatment of emergent and urgent penile pathology are necessary to prevent complications. This paper will review the imaging findings of the most common critical penile pathologies, including traumatic, vascular, infectious, foreign body-related, and urethral pathology, in addition to penile prosthesis complications. Each entity will be discussed in the context of presentation and treatment and complications of each pathology will be discussed.
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Affiliation(s)
- Heba Albasha
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH, 45267-0761, USA.
| | - Sherry S Wang
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East #1A71, Salt Lake City, UT, 84132, USA
| | - Jonathan W Revels
- Department of Radiology, University of New Mexico, MSC 10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Katrina Beckett
- Department of Radiology, University of California, Los Angeles, 1250 16th Street, Suite 2340, Santa Monica, CA, 90404, USA
| | - Carl C Flink
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH, 45267-0761, USA
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Revision Surgery for Inflatable Penile Prosthesis (IPP): A Single-Center Experience and Pictorial Representation. Urology 2021; 152:42-51. [PMID: 33548247 DOI: 10.1016/j.urology.2020.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/29/2020] [Accepted: 11/29/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To elucidate factors influencing Inflatable Penile Prosthesis (IPP) revision and describe outcomes associated with revision surgery. METHODS A single surgeon, retrospective review of all patients who underwent IPP revision between 2008-2016, was performed. Patient age, BMI, operative duration, blood loss, hospital duration, time from most recent penile implant to revision surgery, etiology of revision, and whether the patient had a prior failed revision surgery were all collected and analyzed. RESULTS A total of 57 patients, who had undergone IPP revision between the years 2008-2016, with at least 3 years of follow-up, were included in the investigation. Mean patient age and BMI were 68 and 29.2 kg/m2, respectively. The mean time between the most recent implant operation to revision was 8.4 years. Four patients (7%) reported IPP revision failure within a 3-year follow-up period. CONCLUSION IPP revision demonstrates a relatively high success rate, in the short term, and should be offered to patients as a safe and effective option.
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Al-Shaiji TF, Yaiesh SM, Al-Terki AE, Alhajeri FM. Infected penile prosthesis: literature review highlighting the status quo of prevention and management. Aging Male 2020; 23:447-456. [PMID: 30317910 DOI: 10.1080/13685538.2018.1519786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Erectile dysfunction affects over 50% of men 70 years and above, and penile prosthesis (PP) is its third-line treatment. Complications of PPs include infection, however, no formal guidelines exist for its management. METHODS We performed a literature search and reviewed 53 recent published literatures of experiences with management of PP infections, prevention, and treatment. RESULTS Acute infection can present early with pain and discharge and detection of early signs is of utmost importance. MRI studies are more sensitive than CT studies to diagnose and plan surgical intervention. Introduction of antibiotic impregnated devices attributed to the reduction of infection rates with superiority proven for certain types; the no-touch technique had further reduced this rate. The Mulcahy salvage remains the most widely used surgical approach for treatment despite modifications and novel techniques described; conservative management of PP infections is recently reported with promising results. CONCLUSIONS Despite absence of strict guidelines for the management of infected PPs, we reviewed and discussed numerous panel opinions and suggestions throughout literature. More research into the pathology, prevention, conservative management and advances in surgical treatment of this condition are called for to produce guidelines that unite the efforts to tackle these infections.
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Affiliation(s)
- Tariq F Al-Shaiji
- Urology Unit, Department of Surgery, Amiri Hospital, Kuwait City, Kuwait
| | - Said M Yaiesh
- Kuwait Urology Board, Kuwait Institute for Medical Specialization, Kuwait City, Kuwait
| | | | - Faisal M Alhajeri
- Urology Unit, Department of Surgery, Farwaniya Hospital, Kuwait City, Kuwait
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Huynh LM, Osman MM, Yafi FA. Risk profiling in patients undergoing penile prosthesis implantation. Asian J Androl 2020; 22:8-14. [PMID: 31489849 PMCID: PMC6958986 DOI: 10.4103/aja.aja_92_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Penile prosthesis implantation is the gold standard of surgical therapy for patients with medication-refractory erectile dysfunction. However, this umbrella definition includes significant heterogeneity and associated risk profiles that should be candidly discussed and addressed perioperatively. Factors associated with operative success and patient satisfaction are often surgery specific; however, risk profiling via patient selection, preoperative optimization, proper device selection, and intraoperative consideration are highly correlated. Some examples of common risk profiles include comorbidity(ies) such as cardiovascular disease, diabetes mellitus, prior abdominal surgery, Peyronie's disease, and psychological risk factors. Similarly, integration of surgeon- and patient-amenable characteristics is key to decreasing risk of infection, complication, and need for revision. Finally, patient risk profiling provides a unique context for proper device selection and evidence-based intraoperative considerations.
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Affiliation(s)
- Linda M Huynh
- Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Mohamad M Osman
- Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA
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12
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Abualruz AR, O'Malley R, Ponnatapura J, Holbert BL, Whitworth P, Tappouni R, Lalwani N. MRI of common penile pathologies and penile prostheses. Abdom Radiol (NY) 2020; 45:2825-2839. [PMID: 31154485 DOI: 10.1007/s00261-019-02080-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
MRI can delineate finer details of penile anatomy and pathology due to inherent higher soft-tissue contrast and spatial resolution. It can characterize inflammation and identify abscesses, localize penile fractures, guide surgical planning in penile fibrosis and Peyronie's disease, and depict components of the penile prosthesis and its complications. MRI is a great investigative tool for penile neoplasms, including locally infiltrative neoplasms where clinical examination is limited, and local staging is crucial for surgical planning.
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Affiliation(s)
- Abdul-Rahman Abualruz
- Department of Radiology, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ryan O'Malley
- University of Washington, 1959 NE Pacific St, Seatle, WA, 98195, USA
| | - Janardhana Ponnatapura
- Department of Radiology, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Brenda L Holbert
- Department of Radiology, Section of Abdominal Imaging, Wake Forest University Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Pat Whitworth
- Department of Radiology, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Rafel Tappouni
- Department of Radiology, Section of Abdominal Imaging, Wake Forest University Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Neeraj Lalwani
- Department of Radiology, Section of Abdominal Imaging, Wake Forest University Baptist Health, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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13
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Abstract
To discuss the imaging appearances of various pathologies affecting adult male urethra and to review the role of imaging in the assessment of artificial urinary sphincters and penile prostheses. Diagnosis of common male urethral diseases heavily depends on two conventional fluoroscopic techniques namely retrograde urethrography and voiding cystourethrography. These are useful in evaluating common urethral diseases like traumatic injury, infections, and strictures. Cross-sectional imaging can be useful in evaluating periurethral pathologies. Artificial urinary sphincters, slings, and periurethral bulking agents are used in the management of urinary incontinence and imaging can be utilized to detect complications in these devices. Cross-sectional imaging especially MRI plays a significant role in evaluating the different types of penile prostheses and their malfunctioning.
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14
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Tu LH, Spektor M, Ferrante M, Mathur M. MRI of the Penis: Indications, Anatomy, and Pathology. Curr Probl Diagn Radiol 2019; 49:54-63. [PMID: 30704768 DOI: 10.1067/j.cpradiol.2018.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 11/22/2022]
Abstract
The purpose of this review is to discuss the role of magnetic resonance imaging (MRI) in the evaluation of penile pathology. Normal penile anatomy as well as the appearance of neoplastic and non-neoplastic entities on MRI will be reviewed. While ultrasound remains the first line imaging modality in evaluating most penile pathology, MR imaging has specific advantages owing to improved soft tissue resolution, ability to evaluate less accessible or complex anatomy (such as at the base of the penis), and the ability to detect subtle enhancement. Therefore, MRI is useful for when ultrasound and/or clinical findings are equivocal or incongruent. In addition, MR imaging is essential for preoperative surgical planning and is the imaging modality of choice in evaluating penile prostheses. The added value of MRI in these settings makes it an integral component to the management of many pathological entities affecting the penis.
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Affiliation(s)
- Long H Tu
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT.
| | - Mike Spektor
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Marc Ferrante
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Mahan Mathur
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT
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15
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Chou HL, Mohsen NA, Garber BB, Feldstein DC. CT imaging of inflatable penile prosthesis complications: a pictorial essay. Abdom Radiol (NY) 2019; 44:739-748. [PMID: 30173304 DOI: 10.1007/s00261-018-1764-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Inflatable penile prostheses (IPPs) are widely used in the United States, for patients with erectile dysfunction refractory to other treatments. Complications subsequent to IPP insertion include infection, hematoma, fluid leak, component (cylinder/pump/reservoir) complications, and retained previous IPP components. Radiologists are often called upon to identify and characterize these complications utilizing CT prior to intervention. Our paper aims to provide a guide to familiarize radiologists with normal IPP component imaging and review the CT findings of commonly encountered complications. METHODS In this study, we retrospectively reviewed CT reports with descriptions of IPPs from 108 patients. We collected CT images of normal IPP components as well as reevaluated the CT findings of 33 patients with an IPP complication and correlated with immediately subsequent operative report. RESULTS The CT appearance of appropriately positioned normal IPP components in asymptomatic patients and each complication were described and compared to previous literature. CONCLUSIONS CT is a very useful modality to assess an IPP-related complication. It is inexpensive, fast, and immediately available in emergent situations, e.g., infection, hematoma, and component erosion. Additionally, CT is very sensitive and makes it easier to diagnose a system leak. It can identify most cylinder complications and pump malposition and can be extremely helpful to the surgeon in preoperative planning if revision is needed. After this review, the radiologist should be able to identify normal IPP components and their complications.
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Affiliation(s)
- Huan L Chou
- Department of Radiology and Urology, Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA.
| | - Nancy A Mohsen
- Department of Radiology and Urology, Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Bruce B Garber
- Department of Radiology and Urology, Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - David C Feldstein
- Department of Radiology and Urology, Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
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16
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Introduction to Imaging of Penile Prostheses: A Primer for the Radiologist. AJR Am J Roentgenol 2018; 210:1192-1199. [DOI: 10.2214/ajr.17.18942] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Comprehensive Multimodality Imaging Review of Complications of Penile Prostheses. AJR Am J Roentgenol 2018. [DOI: 10.2214/ajr.17.18943] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Pacheco Usmayo A, Torregrosa Andrés A, Flores Méndez J, Luján Marco S, Rogel Bertó R. Usefulness of magnetic resonance imaging in the postsurgical assessment of patients with inflatable penile prostheses. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Lin DJ, Wong TT, Ciavarra GA, Kazam JK. Adventures and Misadventures in Plastic Surgery and Soft-Tissue Implants. Radiographics 2017; 37:2145-2163. [DOI: 10.1148/rg.2017170090] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Dana J. Lin
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032 (D.J.L., T.T.W., J.K.K.); and the Department of Radiology, NYU Langone Medical Center–Hospital for Joint Diseases, New York, NY (G.A.C.)
| | - Tony T. Wong
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032 (D.J.L., T.T.W., J.K.K.); and the Department of Radiology, NYU Langone Medical Center–Hospital for Joint Diseases, New York, NY (G.A.C.)
| | - Gina A. Ciavarra
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032 (D.J.L., T.T.W., J.K.K.); and the Department of Radiology, NYU Langone Medical Center–Hospital for Joint Diseases, New York, NY (G.A.C.)
| | - Jonathan K. Kazam
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032 (D.J.L., T.T.W., J.K.K.); and the Department of Radiology, NYU Langone Medical Center–Hospital for Joint Diseases, New York, NY (G.A.C.)
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20
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Pacheco Usmayo A, Torregrosa Andrés A, Flores Méndez J, Luján Marco S, Rogel Bertó R. Usefulness of magnetic resonance imaging in the postsurgical assessment of patients with inflatable penile prostheses. RADIOLOGIA 2017; 59:504-510. [PMID: 28552215 DOI: 10.1016/j.rx.2017.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe the types of penile prostheses and their components, to review the appropriate magnetic resonance imaging (MRI) acquisition protocol, and to describe the normal imaging findings and possible complications in patients with inflatable penile implants. CONCLUSION Three-piece inflatable penile prostheses are the last link in the treatment chain for erectile dysfunction. They can develop complications, which are classified as non-infectious related to the surgical technique, infectious, or due to mechanical failure of the device. MRI is the most appropriate imaging technique for the postsurgical evaluation of penile prostheses. Images are acquired in three planes using sequences with high spatial resolution, first with the prosthesis at rest and then with the prosthesis activated.
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Affiliation(s)
- A Pacheco Usmayo
- Área de Imagen Médica, Hospital Universitari i Politècnic La Fe, Valencia, España.
| | - A Torregrosa Andrés
- Área de Imagen Médica, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - J Flores Méndez
- Área de Imagen Médica, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - S Luján Marco
- Servicio de Urología, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - R Rogel Bertó
- Servicio de Urología, Hospital Universitari i Politècnic La Fe, Valencia, España
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