Radiological assessment of penile prosthesis: the role of magnetic resonance imaging

Revision Surgery for Inflatable Penile Prosthesis (IPP): A Single-Center Experience and Pictorial Representation

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.

Intraoperative and postoperative complications of penile implant surgery. Diagnosis and treatment

We describe the most frequent complications associated with penile implant surgery, paying special attention to their practical management. We have analyzed preoperative complications and postoperative complications separately. The intraoperative include perforation of the corpora cavernosa during dilation, cylinder cross-over or cross-placement and urethral injury during implantation. The most frequent postoperative complications are mechanical failure, cylinder erosion and prosthesis infection. We emphasize on rescue surgery and reimplantation techniques in cavernous tissue fibrosis.

MRI of the Penis: Indications, Anatomy, and Pathology

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.

Usefulness of magnetic resonance imaging in the postsurgical assessment of patients with inflatable penile prostheses

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.

The Prevention and Management of Noninfectious Complications of Penile Implants

INTRODUCTION

Penile implants have been a mainstay in the treatment of erectile dysfunction for more than four decades. The satisfaction rate with the functioning of these devices has been very high. Problems can develop with the device itself or with the tissues surrounding it. Knowledge of preventing and managing these adverse events is critical to a successful outcome and sustained patient satisfaction.

AIM

A narrative of the prevention and management of noninfectious complications of penile implant placement gained from the author's extensive experience is presented.

METHODS

Each category of penile implant complications is presented as a separate subtitle. The initial categories are intraoperative problems; the subsequent groups involve postoperative adverse events.

MAIN OUTCOME MEASURE

To gather information for this manuscript, I reviewed 40 publications and found 32 relevant and helpful.

RESULTS

Attending to the details necessary for proper placement of prosthetic parts during the initial surgery will minimize the chance of problems developing. Prompt attention to postoperative problems will thwart their progression to a more extensive adverse situation, which will be more difficult to remedy.

CONCLUSIONS

Complications during penile implant placement and in the postoperative period may occur. Knowledge of maneuvers to avoid their occurrence and prompt attention to correcting problems as they arise are paramount to a successful outcome and to maintaining high satisfaction rates. Mulcahy JJ. The prevention and management of noninfectious complications of penile implants. Sex Med Rev 2015;3:203-213.

Penile prosthesis surgery in the management of erectile dysfunction

Introduction

We reviewed retrospectively the use of penile prostheses, including the indications and complications of penile prosthesis surgery.

Methods

We identified publications and the reported advances in penile prosthesis surgery between 1987 and 2012 in Pub-Med, and published information from American Medical Systems, Inc. (Minnetonka, MN, USA) and Coloplast Corporation (Humlebaek, Denmark), using the keywords ‘penile prosthesis’, ‘erectile dysfunction’, ‘mechanical reliability’, ‘complications’ and ‘infection’.

Results

We describe the novel indications for the use of penile prostheses, the significant advances in implant designs with improved mechanical reliability, the changing landscape of device infection, and the current management of complications. Sixty-eight publications with a grade A, B and C level of evidence are cited.

Conclusion

The clinical indications to implant a penile prosthesis have expanded beyond organic erectile dysfunction. With the many different devices currently available, the choice of which device to implant can be tailored based on an individual’s unique medical conditions, manual dexterity and expectations, and surgeon preference. There must be a conscious effort to prevent device infection, in the light of the development of increasingly virulent organisms. Penile prosthesis surgery is an integral part of the treatment of erectile dysfunction when non-surgical options fail or are contraindicated.

Complications associated with retained foreign bodies from infected penile implants: proposal for the use of an implant-specific checklist at the time of device removal

INTRODUCTION

Infection of a penile prosthesis requires that all device hardware and associated foreign materials are removed, irrespective of whether a salvage procedure will be performed. Failure to remove all foreign bodies from the operative field may result in persistent infection, necessitating surgical intervention.

AIM

To review our experience with complications arising from retained foreign bodies following removal of an infected penile prosthesis. We highlight the clinical features that should raise suspicion of retained device-associated materials, and also the role of imaging in evaluating these patients. Finally, a rational approach to prevent these occurrences is proposed with the implementation of an implant-specific checklist.

METHODS

Medical records and imaging studies of patients presenting to our center with retained foreign bodies following removal of an infected penile prosthesis were reviewed.

MAIN OUTCOME MEASURES

Clinical and radiologic details of each of these cases were abstracted, including patient demographics, presenting symptoms, characteristics of retained materials, bacterial cultures, treatment, and follow-up.

RESULTS

Presenting symptoms included: (i) persistent and relapsing drainage from cutaneous fistulae; (ii) cellulitis overlying an infected reservoir; (iii) persistent penile pain; and (iv) an asymptomatic individual requesting elective placement of a second implant. Infected foreign materials retrieved included: two rear-tip extenders, a tubing connector, two infected reservoirs, and nonabsorbable mesh. Preoperative computerized tomography scan confirmed the presence and the location of all of these materials. Using this data, we propose using an implant-specific checklist to insure removal of all device-related foreign bodies when explanting an infected penile prosthesis.

CONCLUSIONS

A number of adverse sequelae may result from inadvertently leaving behind device-related materials when an infected implant is removed. Ultimately it is the responsibility of the surgeon removing an infected implant to insure that all device components and associated materials are removed. We believe that implementing a two-step implant-specific checklist is a rational prevention strategy.

Penile Prosthesis Surgery: A Review of Prosthetic Devices and Associated Complications

INTRODUCTION

Although more invasive than some of the other currently available therapies, penile prosthesis surgery has the advantages of high patient satisfaction rates and avoidance of systemic adverse events in the vast majority of cases.

AIM

This article provides a review of the more widely used implants and some of the more frequently encountered complications of penile prosthesis surgery.

METHODS

A retrospective review peer reviewed publications relevant to the field of penile prosthesis surgery.

MAIN OUTCOME MEASURES

Review of historical milestones and newer penile prostheses, as well as a review of prosthesis surgery complications.

RESULTS

Improved designs and materials have resulted in decreased incidence of mechanical failures or infectious complications while simultaneously simplifying the operation of these devices.

CONCLUSIONS

Penile prosthesis surgery remains an excellent alternative for restoring erectile function to those in whom medical therapies such as phosphodiesterase inhibitors are contraindicated or who have failed more conservative measures.

Real-time three-dimensional ultrasound visualization of erection and artificial coitus

To investigate the feasibility of imaging penile erection and coitus in real time and in three dimensions, a 'Live' three-dimensional (3-D) ultrasound system was used to acquire the volume of interest at 25 Hz from five healthy men. Water baths and gel-made artificial vaginas were devised to facilitate the 3-D scans without the probe being in direct contact with the penis. For the first volunteer scanned with the water bath alone, the penis failed to erect within 30 min. For the other four volunteers, the 'vagina' successfully initiated and maintained the erection and allowed artificial intercourse. Results have shown that the 'Live' 3-D ultrasound and minimally compressive imaging techniques together can offer an objective means for visualizing erection and coitus in spatial totality and temporal reality. They can be further developed to reveal more reliable details about the dynamic morphology, improving scientific understanding of sexual activities and clinical management of related problems.