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Hawks-Ladds N, Babar M, Labagnara K, Loloi J, Patel RD, Aalami Harandi A, Zhu M, Salami A, Maria P. Risk factors for reoperation of inflatable penile prosthesis among an ethnically diverse urban population in a high-volume center. Int J Impot Res 2024:10.1038/s41443-024-00966-8. [PMID: 39187572 DOI: 10.1038/s41443-024-00966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/06/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
Inflatable penile prosthesis (IPP) is a surgical treatment for erectile dysfunction refractory to medical therapy or for those who desire permanent treatment. Complications like mechanical failure and infection may necessitate reoperation, and patients with certain risk factors remain predisposed to reoperation. We retrospectively analyzed 530 patients undergoing primary IPP implantation at a large, urban, multiethnic hospital with a high volume of IPP implantations. Primary outcomes were reoperation due to any reason and reoperation due to infection. Patient characteristics and intraoperative factors were compared between those requiring reoperation and those not requiring reoperation. Overall, 12.1% of patients underwent reoperation, primarily due to infection, with a median time to reoperation of 4 months. Analysis revealed an increased likelihood of reoperation with Peyronie's disease (OR = 2.47), hemoglobin A1c over 8 (OR = 2.25), active smoking (OR = 2.75), and estimated blood loss (EBL) ≥ 25cc (OR = 2.45). A decreased likelihood of reoperation was observed when Arista™ powder was used intraoperatively (OR = 0.38). Reoperation specifically due to infection was associated with an infrapubic approach (OR = 2.56) and hypertension (OR = 9.12). Our findings confirm smoking and diabetes as risk factors for reoperation, while also providing insights into factors like estimated blood loss and Arista™ powder use. However, long-term survival rates were limited by loss to follow-up. (Clinical trial registration N/A).
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Affiliation(s)
| | | | - Kevin Labagnara
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Rutul D Patel
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Michael Zhu
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Pedro Maria
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
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2
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Fraiman E, Nandwana D, Chambers K, Rhodes S, Pope R, Scarberry K, Gupta S, Mishra K. Complication and Explantation Rates of Penile Prostheses in Transmasculine Patients: A Meta-Analysis. Urology 2024:S0090-4295(24)00697-6. [PMID: 39191293 DOI: 10.1016/j.urology.2024.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 07/22/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVE To synthesize current literature on penile prosthesis implantation post-gender affirming phalloplasty to correlate implant types and complication rates. METHODS A meta-analysis of penile prosthesis in transmasculine patients was initiated in December 2022. Inclusion criteria encompassed randomized clinical trials, cohort studies, and cross-sectional studies reporting on penile prosthesis complications post-gender-affirming phalloplasty. Exclusion criteria were review articles, meta-analyses, studies that exclusively reported on cisgender patients or surgeries other than penile prosthesis implantation. An initial search of five databases yielded a total of 1593 articles. Upon screening, 15 full-text articles were eligible for inclusion. 9 studies were included in the analysis. RESULTS The overall complication rate for the inflatable prosthesis group was 38% (95% CI: 21, 59) and for the malleable prosthesis group was 37% (95% CI: 18, 62). The most probable complications in the inflatable group were infection (14.5%), dysfunction (12.9%), dislocation (5.7%), and leakage (5.4%). The most probable complications in the malleable group were dislocation (14.9%), infection (11.2%), dysfunction (9.1%), and extrusion (7.6%). There was no significant difference in the probability of any complications between the malleable and inflatable prosthesis groups. The best estimate of explantation rates for any reason for the inflatable group was 19% (95% CI: 9, 38) and for the malleable group 13% (95% CI: 4, 33). There was no significant difference in the probability of any reason for explantation between the malleable and inflatable prosthesis groups.
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Affiliation(s)
- Elad Fraiman
- Case Western Reserve University School of Medicine; University Hospitals, Urology Institute.
| | - Devika Nandwana
- Case Western Reserve University School of Medicine; University Hospitals, Urology Institute
| | - Kelly Chambers
- Case Western Reserve University School of Medicine; University Hospitals, Urology Institute
| | | | - Rachel Pope
- Case Western Reserve University School of Medicine; University Hospitals, Urology Institute
| | - Kyle Scarberry
- Case Western Reserve University School of Medicine; University Hospitals, Urology Institute
| | - Shubham Gupta
- Case Western Reserve University School of Medicine; University Hospitals, Urology Institute
| | - Kirtishri Mishra
- Case Western Reserve University School of Medicine; University Hospitals, Urology Institute; Metro Health Medical Center Division of Urology
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Sun A, Williams AO, Rojanasarot S, Moore G, McGovern AM, Hargens LM, Turner E, Babbar P. Downstream Revenue Realized by Facilities Placing Inflatable Penile Prosthesis in Medicare Beneficiaries to Treat Erectile Dysfunction. Urology 2024; 189:112-118. [PMID: 38677374 DOI: 10.1016/j.urology.2024.04.018] [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: 01/01/2024] [Revised: 04/01/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To quantify the incremental downstream revenue generated from subsequent treatment of men who received an inflatable penile prosthesis (IPP) to treat erectile dysfunction (ED), compared to men without ED. METHODS The 100% Medicare Standard Analytic Files were used to conduct a retrospective claims analysis of the 5-year revenue generated by patients receiving IPP to treat their ED, compared to a propensity-matched cohort of men without ED. Men aged 65 years or older with ED who underwent IPP implantation (Current Procedural Terminology 54405) in a hospital outpatient setting between January 1, 2016 and December 31, 2021, and who had continuous Medicare Parts A and B enrollment for 12 months pre-index IPP and 5 years post-index IPP discharge date were included in the study. Men without ED but with comparable characteristics were identified and used as a comparator group. Revenue received by hospitals from Medicare was defined as the sum of payments for patient services, other payor-paid amounts, patient deductibles, copayments, and coinsurance. Revenue was inflated to 2022 US dollars. The mean values and their corresponding standard deviations (SD) are reported. RESULTS After matching, there were 2905 men with ED who received an IPP and 7462 men without ED. The IPP cohort showed a significantly higher 5-year cumulative revenue (mean=$34,571 [SD=$50,234]) compared to the men without ED (mean=$3189 [SD=$11,527]). When stratified by diagnosis type, the differences in revenue were $10,258 for circulatory disease, $2646 for diabetes, $2013 for urology, and $1043 for prostate cancer. Significantly more IPP patients had at least 1 health encounter for these conditions over the 5-year follow-up period than their matched controls (55.0% vs 7.8% for circulatory, 46.7% vs 16.8% for urology, 19.3% vs 3.6% for diabetes, and 19.0% vs 3.0% for prostate cancer). CONCLUSION Men with ED who received IPP generated substantially higher revenue for the healthcare system over a 5-year period, nearly 10 times as much, compared to men without ED, excluding the initial cost of the IPP procedure. The presence of ED, coupled with IPP usage, is associated with significantly increased healthcare revenue across a range of medical conditions compared to men without ED. These findings emphasize the financial implications for advanced ED programs to improve access to necessary care for these patients. Healthcare facilities may leverage these insights to effectively allocate resources to deliver critical healthcare to men with ED.
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Affiliation(s)
- Andrew Sun
- Urology Partners of North Texas, Arlington, TX.
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Elmarasi M, Alsaeedi A, Elmakaty I, Elsayed B, Khalil IA, Aldeeb M, Khalafalla K, Al Kubaisi K, Arafa M, Majzoub A. Early vs delayed insertion of penile prosthesis in patients with refractory priapism: a systematic review and meta-analysis. Sex Med Rev 2024; 12:528-536. [PMID: 38465856 DOI: 10.1093/sxmrev/qeae007] [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: 12/10/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Refractory priapism, characterized by persistent and prolonged painful erections despite initial treatment maneuvers, can significantly impair erectile function secondary to ischemia-induced corporal tissue fibrosis. These patients will likely require subsequent penile prosthesis (PP) surgery to regain sexual activity, yet consensus regarding the optimal timing of implantation remains lacking. OBJECTIVES To evaluate and compare the clinical outcomes associated with early vs delayed PP implantation in individuals with priapism-induced erectile dysfunction (ED). METHODS We included studies that focused on refractory priapism leading to ED and its management with PP implantation. We assessed cohort study bias with a risk-of-bias tool and case series bias with the modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were calculated by a fixed-effect model. RESULTS We included 9 studies, comprising 4 cohort studies and 5 case series, involving a total of 278 patients. Total complications were higher in the delayed group (OR, 4.16; 95% CI, 2.77-6.26). Fibrosis was significantly more pronounced in the delayed group (OR, 118.18; 95% CI, 20.06-696.32). The odds of erosion, infections, and penile injury did not show statistically significant differences between the groups (OR, 2.52 [95% CI, 0.67-9.49], 0.89 [0.38-2.10], 1.83 [0.79-4.26], respectively). Patients' satisfaction resulted in a pooled OR of 0.15 (95% CI, 0.04-0.49) in favor of the early PP insertion group. CONCLUSION The results from this study favor an early approach to ED (within 30 days) following ischemic priapism. However, it is important to consider patients' preferences, values, and psychological factors to make an informed decision.
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Affiliation(s)
| | - Ahmad Alsaeedi
- Department of Urology, Hamad Medical Corporation, Doha, 3050,Qatar
| | | | - Basel Elsayed
- College of Medicine, Qatar University, Doha, 2713, Qatar
| | - Ibrahim A Khalil
- Department of Urology, Hamad Medical Corporation, Doha, 3050,Qatar
| | - Maya Aldeeb
- Department of Medical Education, Family Medicine Residency Program, Hamad Medical Corporation, Doha, 3050, Qatar
| | | | | | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, 3050,Qatar
| | - Ahmed Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, 3050,Qatar
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Nguyen V, McGovern AM, Rojanasarot S, Patel DP, Bhattacharyya S, Hargens LM, Aworunse O, Hsieh TC. Patient out-of-pocket costs for guideline-recommended treatments for erectile dysfunction: a medicare cost modeling analysis. Int J Impot Res 2024:10.1038/s41443-024-00903-9. [PMID: 38926632 DOI: 10.1038/s41443-024-00903-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/25/2024] [Accepted: 05/03/2024] [Indexed: 06/28/2024]
Abstract
Patient out-of-pocket (OOP) cost represents an access barrier to erectile dysfunction (ED) treatment. We determined OOP cost for men with ED covered by Fee-for-Service Medicare. Coverage policies were obtained from the Medicare Coverage Database for treatments recommended by the 2018 American Urological Association (AUA) guidelines. OOP cost was retrieved from the 2023 Centers for Medicare & Medicaid Services Final Rule. OOP cost for treatments without Medicare coverage were extracted from GoodRx® or literature and inflated to 2022 dollars. Annual prescription costs were calculated using the published estimate of 52.2 yearly instances of sexual intercourse. Medicare has coverage for inflatable penile prostheses (IPP; strong recommendation), non-coverage for vacuum erection devices (VED; moderate recommendation) and phosphodiesterase type-5 inhibitors (PDE5i; strong recommendation), and no policies for intracavernosal injections (ICI; moderate recommendation), intraurethral alprostadil (IA; conditional recommendation), or low-intensity extracorporeal shock wave therapy (ESWT; conditional recommendation). Annual IA prescription is most costly ($4022), followed by ICI prescription ($3947), one ESWT course ($3445), IPP ($1600), PDE5i prescription ($696), and one VED ($213). PDE5i and IPP, both strongly recommended by AUA guidelines, are associated with lower OOP cost. Better understanding of patient financial burden may inform healthcare decision-making.
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Affiliation(s)
- Vi Nguyen
- Department of Urology, UC San Diego Health, San Diego, CA, USA.
| | | | | | - Darshan P Patel
- Department of Urology, UC San Diego Health, San Diego, CA, USA
| | | | | | | | - Tung-Chin Hsieh
- Department of Urology, UC San Diego Health, San Diego, CA, USA
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Li Y, Gao D, Zhang J, Wang M, Lan X, Yu X, Chang D. Penile prosthesis implantation: a bibliometric-based visualization study. Int J Impot Res 2024:10.1038/s41443-024-00927-1. [PMID: 38851852 DOI: 10.1038/s41443-024-00927-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/22/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024]
Abstract
The treatment of erectile dysfunction (ED) using penile prosthesis implantation (PPI) has recently garnered significant interest, but reports of bibliometric analyses of studies on PPI have yet to appear. Therefore, the purpose of this study is to use visualization techniques to statistically and qualitatively assess the state of knowledge, current research topics, and trends in this field. The Science Citation Index-Expanded (SCI-E) from the Web of Science Core Collection (WoSCC) was searched for publications about PPI from the inception of the database to 2023. VOSviewer (version 1.6.19), CiteSpace (version 6.2. R2), and Excel (version 2021) were used for the data analysis. The results show a total of 1015 original articles and reviews on PPI published over this nearly 50 years, with an increasing trend in the number of studies published each year. The United States is the country with the most published studies (n = 578). Mayo Clinic is the organization with the most publications overall (n = 46). The Journal of Sexual Medicine has the most publications (n = 184). The most prolific author is Wilson, Steven K (n = 31). The most commonly used terms were erectile dysfunction (n = 509), penile prosthesis (n = 332), implantation (n = 207), satisfaction (n = 201), surgery (n = 200), infection (n = 134), outcomes (n = 128), Peyronie's disease (n = 121), men (n = 115), and experience (n = 109). Current research focuses on four main areas: complications of PPI, the current status of inflatable penile prosthesis (IPP), the use of PPI in radical prostatectomy and Peyronie's disease populations, and patient satisfaction after PPI. Improving patient satisfaction with PPI through improved mechanical design and surgical techniques is a key concern for future research.
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Affiliation(s)
- Yingxi Li
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dawei Gao
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Jingyi Zhang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Meijing Wang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiucheng Lan
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xujun Yu
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Degui Chang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Razdan S, Zisman A, Valenzuela R. Scrotal approach for tunica expansion procedure (TEP) for penile girth and length restoration during penile prosthesis implantation in patients with penile angulation due to Peyronie's disease and erectile dysfunction: technique and outcomes. Int J Impot Res 2024; 36:146-150. [PMID: 36528741 DOI: 10.1038/s41443-022-00652-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
Peyronie's disease is often comorbid with erectile dysfunction and can cause significant penile shortening. We describe our modified tunica expansion procedure (TEP) technique of penile length preservation and girth enhancement with correction of penile angulation in patients with mild Peyronie's disease (<30 degree angulation, or hourglass deformity, no hinging) and erectile dysfunction presenting for inflatable penile prosthesis (IPP) surgery. A retrospective review of IPP placement from one high volume surgeon was performed. A total of 474 patients' charts from June 2017 to June 2021 were reviewed and those charts of patients undergoing modified TEP in the setting of Peyronie's disease were analyzed. Average increase in length and girth were measured and means with standard deviations calculated. The modified TEP is performed through a scrotal approach and involves complete eversion of the penis with dissection of Buck's fascia off the underlying tunica. Subsequently, staggered scorings of the underlying tunica are performed allowing for circumferential girth enhancement and length preservation. In men with Peyronie's disease, these scorings are preferentially concentrated on the side of the plaque to allow straightening without loss of length. A total of 32 patients with Peyronie's disease from the larger cohort underwent the modified TEP. Mean increase in length of distal corpora was 2.8 ± 0.8 cm (range 2.0-3.4 cm) (measured using Furlow before and after penile eversion with TEP), while mean increase in girth (measured at midphallus prior to prosthesis insertion and after IPP inflation) was 1.6 ± 0.4 cm (range 1.2-2.2 cm). There were no reported complications. A scrotal approach to TEP is an easy to perform technique that can be used to restore length and enhance girth in men with Peyronie's disease undergoing insertion of IPP. Additionally, it is a customizable approach that can also be used to correct mild penile angulation.
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Affiliation(s)
- Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Ariel Zisman
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Robert Valenzuela
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Manfredi C, Russo GI, Capogrosso P, Falcone M, Capece M, Sokolakis I, Verze P, Salonia A, Tsambarlis P, Seligra Lopes L, Romero-Otero J, DE Sio M, Levine L. Quality of life and sexuality with penile prosthesis: a systematic review and pooled analysis. Minerva Urol Nephrol 2024; 76:166-175. [PMID: 37795696 DOI: 10.23736/s2724-6051.23.05466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) is the first validated questionnaire to specifically evaluate the satisfaction of patients undergoing penile prosthesis implantation. Our primary aim was to conduct a systematic review and pooled analysis of articles reporting QoLSPP. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE, Scopus, Web of Science, and Cochrane Library databases was performed in April 2023. Studies were selected if they assessed male subjects (P) undergoing penile prosthesis implantation (I) with or without comparison with other treatments (C), reporting the patient satisfaction according to QoLSPP (O). Prospective and retrospective original studies were included (S). The risk of bias was assessed using the ROBINS-I tool and the Knoll method. Means and standard deviations (SDs) of QoLSPP scores were included in the pooled analysis. PROSPERO ID: "CRD42023427261." EVIDENCE SYNTHESIS A total of 10 studies investigating 1105 patients were included in the systematic review; of these, eight articles describing the outcomes of 693 subjects were eligible for the pooled analysis. Overall serious risk of bias was found in 2/3 of nonrandomized comparative studies (66%), while seven single-arm studies (100%) were classified as having a high risk of bias. Pooled analysis of the QoLSPP-Functional domain revealed an overall effect size (ES) of 4.22 points (95% CI 4.04-4.40; P<0.001). The QoLSPP-Relational pooled score was 4.17 points (95% CI 4.03-4.31; P<0.001). The QoLSPP-Social pooled score corresponded to 4.21 points (95% CI 4.02-4.40; P<0.001). Pooled analysis of the QoLSPP-Personal domain showed an overall ES of 3.97 points (95% CI 3.61-4.32; P<0.001). There was insufficient data to pool QoLSPP total scores. CONCLUSIONS Patients undergoing penile prosthesis implantation report positive scores in all QoLSPP domains, demonstrating high satisfaction levels. Future studies are needed to improve the evidence on the topic.
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Affiliation(s)
- Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy -
- Department of Urology, Rush University Medical Center, Chicago, IL, USA -
| | - Giorgio I Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Marco Falcone
- Department of Urology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Marco Capece
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ioannis Sokolakis
- Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paolo Verze
- Scuola Medica Salernitana, Department of Medicine, Surgery, Dentistry, University of Salerno, Salerno, Italy
| | - Andrea Salonia
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Peter Tsambarlis
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | | | | | - Marco DE Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Laurence Levine
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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Di Pierro GB, Di Lascio G, Lemma A, Grande P, Frisenda M, Del Giudice F, Antonini G, Nardi F, De Berardinis E, Cristini C, Franco G, Sciarra A, Salciccia S. Mid-term outcomes of minimally invasive infrapubic approach for inflatable penile prosthesis implantation: A single-center study and literature review. Andrology 2024; 12:624-632. [PMID: 37452742 DOI: 10.1111/andr.13497] [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: 02/07/2023] [Revised: 03/22/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The minimally invasive infrapubic approach (MIIA) for inflatable penile prosthesis (IPP) placement has shown favorable peri-operative safety and efficacy profile, but scarce data exist on long-term follow-up. OBJECTIVES We investigated the safety and efficacy of IPP implantation via the MIIA after a minimum 5-year follow-up. MATERIALS AND METHODS We identified data of implanted patients prospectively included in our institutional database. Complications and functional outcomes were assessed by using validated tools. Specifically, quality of life and patient satisfaction were evaluated by the Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Kaplan-Meier method was used to analyze IPP survival (defined as a working IPP). RESULTS Overall, 67 patients implanted by MIIA with a median (IQR) age of 64 years (61-70) were included. The median (IQR) follow-up duration was 71 months (63-80). Fifteen (22%) patients experienced complications: minor (Clavien ≤2) events included changes in penile sensitivity (n = 1; 1.5%), orgasmic dysfunction (n = 1; 1.5%), pain (n = 5; 7%), urinary tract infection (n = 2; 3%), and chronic discomfort (n = 1; 1.5%); major (Clavien 3) complications were represented by mechanical failure (n = 3; 4.5%), IPP infection (n = 1; 1.5%), and cylinder protrusion (n = 1; 1.5%). The estimated IPP survival was 94% (95% CI, 91.4-96.6), 92.5% (95% CI, 89.7-95.3), and 92.5% (95% CI, 89.7-95.3) at 3, 5, and 7 years after implantation, respectively. In patients using the device at follow-up (n = 61; 91%), median (IQR) scores for QoLSPP domains demonstrated favorable functional outcomes and patient satisfaction: functional 21 (19-23), personal 16 (15-18), relational 14 (12-15), and social 12 (11-14). DISCUSSION AND CONCLUSION This study represents the longest follow-up using validated tools to assess the outcomes of IPP implantation via MIIA so far. IPP placement via MIIA confirms to be safe and to offer high satisfaction to both patients and partners at mid-term evaluation.
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Affiliation(s)
| | - Giovanni Di Lascio
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Andrea Lemma
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Pietro Grande
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Marco Frisenda
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Gabriele Antonini
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Francesco Nardi
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Ettore De Berardinis
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Cristiano Cristini
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Giorgio Franco
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Stefano Salciccia
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
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10
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Beirnaert J, Pinar U, Benarroche D, Akakpo W, Rouprêt M. Evaluation of patient satisfaction using the validated French version of the SSIPI questionnaire after inflatable penile implantation. J Sex Med 2023; 21:67-71. [PMID: 38014798 DOI: 10.1093/jsxmed/qdad154] [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: 08/04/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Penile prothesis (PP) is a recommended treatment for erectile dysfunction that is refractory to less invasive treatments, but there are few validated tools to assess patient satisfaction. AIM The aim of this study was to assess patient satisfaction after PP implantation using the French Satisfaction Survey for Inflatable Penile Implant (SSIPI) questionnaire. METHODS Demographic, clinical, and perioperative data were collected from all consecutive patients who underwent PP implantation in our center between 2016 and 2021. The French SSIPI questionnaire was completed during a telephone call with each patient by an independent investigator. OUTCOMES A good functional result was considered when the total SSIPI score was >48, corresponding to a score of >3 for each item. RESULTS The median global SSIPI score for the cohort was 66 (interquartile range [IQR], 60-73), and 53 (89.8%) patients were satisfied. The appearance of the penis with the PP was the item that had the lowest score for satisfaction (median score 23 [IQR, 19-26]), while the patients reported almost no pain (median score 10 [IQR, 9-10]). When patients with a total score of ≤64 were compared with those with a score of >64, PP size was significantly greater in the group with better functional results (P = .03). CLINICAL IMPLICATIONS Assessment of patient satisfaction with a PP is important because this is the main criterion used to judge the success of surgery. STRENGTHS AND LIMITATIONS To our knowledge, this is the first study to evaluate the satisfaction of patients with a PP using the French-validated version of SSIPI questionnaire. However, patients came from a single center and the population size was small. CONCLUSION Almost 90% of patients with a PP were satisfied with the device when satisfaction was assessed using the SSIPI questionnaire.
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Affiliation(s)
- Jeanne Beirnaert
- GRC 5 Prédictive Onco-Uro, Urologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, F-75013 Paris, France
- Service d'Urologie, Hôpital Erasme, Université Libre de Bruxelles, 1080 Brussels, Belgium
| | - Ugo Pinar
- GRC 5 Prédictive Onco-Uro, Urologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, F-75013 Paris, France
| | - Davy Benarroche
- GRC 5 Prédictive Onco-Uro, Urologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, F-75013 Paris, France
| | - William Akakpo
- Service d'Urologie, Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France
| | - Morgan Rouprêt
- GRC 5 Prédictive Onco-Uro, Urologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, F-75013 Paris, France
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11
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Ricapito A, Sedigh O, Rubino M, Gobbo A, Falagario UG, Annese P, Mancini V, Ferro M, Buffi N, Cormio L, Carrieri G, Busetto GM, Bettocchi C. Penoscrotal approach for inflatable penile prosthesis implant: why it should be preferred. Minerva Urol Nephrol 2023; 75:711-717. [PMID: 38126284 DOI: 10.23736/s2724-6051.23.05475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Inflatable penile prosthesis are the definitive treatment for erectile dysfunction. The two most used surgical approaches to position the implants are the penoscrotal and the infrapubic. Current trends showed that the penoscrotal approach is extensively preferred however, there is not conclusive evidence demonstrating the superiority of one technique over the other. The aim of this review is to summarize the scientific evidence available and to underline strengths and weaknesses of the two techniques. EVIDENCE ACQUISITION We conducted a comprehensive search of MEDLINE, Cochrane Library, and National Center for Biotechnology Information PubMed to identify relevant published articles. The included studies had to explicitly examine the use of three-piece inflatable penile prosthesis with a focus on the surgical access method and complications. EVIDENCE SYNTHESIS Twenty-six articles were included in the review: seven narrative reviews, five retrospective observational studies, five prospective observational studies, and nine mixed methodology studies. The most frequent approach was the penoscrotal, which was also found more comfortable (RG1) by the operators in one study. The infrapubic approach lasts less and one study demonstrated higher satisfaction by the patients. CONCLUSIONS There is no evidence of significant differences in complications among the penoscrotal and infrapubic approaches. While the infrapubic approach is faster and patients were more satisfied, the penoscrotal approach is the most used by far. This is likely related to the more straightforward procedure through this access and the excellent surgical field exposure. For these reasons, it is also preferred in the most complex cases.
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Affiliation(s)
- Anna Ricapito
- Andrology Unit, Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Omid Sedigh
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Department of Urology and Reconstructive Andrology, Humanitas Gradenigo Hospital, Turin, Italy
| | - Matteo Rubino
- Andrology Unit, Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Andrea Gobbo
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ugo G Falagario
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Pasquale Annese
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Vito Mancini
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Matteo Ferro
- European Institute of Oncology (IEO) - IRCCS, Milan, Italy
| | - Nicolò Buffi
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy -
| | - Carlo Bettocchi
- Andrology Unit, Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
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12
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Schifano N, Capogrosso P, Cakir OO, Dehò F, Garaffa G. Surgical tips in difficult penile prosthetic surgery: a narrative review. Int J Impot Res 2023; 35:690-698. [PMID: 36261536 DOI: 10.1038/s41443-022-00629-6] [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: 06/19/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 11/08/2022]
Abstract
Penile prosthesis implantation continues to represent a reliable solution to address erectile dysfunction when oral medications fail, are not tolerated or are contraindicated, and most typically is associated with excellent satisfaction rates and durable results. Despite the dramatic improvements in the prostheses' design, in the surgical instruments and techniques over the years, certain categories of patients still pose a significant surgical challenge. The aim of the current review is to provide a quick and useful practical guidance based on our expertise in the identification and management of the difficult penile prosthesis implantation cases. A narrative review design was here preferred to fulfil our purpose. The search strategy included a range of terms, e.g. penile prosthesis, corporal fibrosis, infection, ischaemic priapism, Peyronie's disease, radical prostatectomy, pelvic surgery. Extensive corporal fibrosis after explantation of an infected device or after prolonged ischaemic priapism may represent the most difficult situations to deal with in penile prosthesis implantation surgery. Penile prosthesis implantation in patients with Peyronie's disease and in those who previously underwent radical prostatectomy also presents with an increased risk of complications. Experienced surgeons need to be able to recognise promptly and manage urethral perforation, cylinder crossover, tunical perforation and erosion, as these complications are more common when dealing with difficult penile prosthesis implantation cases. Applying penile lengthening techniques and principles can be useful in selected cases to ensure better postoperative satisfaction rates, especially in those patients who have experienced a more significant degree of loss of length preoperatively. High-volume-implanting surgeons should always be involved in complex cases to minimise the risk of complications. A thorough preoperative counselling can set realistic patients' expectations in this context, further contributing to postoperative satisfaction.
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Affiliation(s)
- Nicolò Schifano
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Paolo Capogrosso
- ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy
| | - Onur Omer Cakir
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | - Federico Dehò
- ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy
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13
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Yassin M, Chen R, Ager M, Desouky E, Minhas S. Penile implants in low flow priapism. Int J Impot Res 2023; 35:651-663. [PMID: 37898653 DOI: 10.1038/s41443-023-00787-1] [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: 02/14/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
Priapism is a persistent or prolonged erection, in the absence of sexual stimulation, that fails to subside. Prolonged ischaemic or low flow priapism is defined as a full or partial erection persisting for more than 4 h and unrelated to sexual interest or stimulation, characterised by little or no cavernous blood flow. Low flow priapism leads to progressive corporal fibrosis, which could, in turn, lead to long-lasting erectile dysfunction if left untreated. Penile prosthesis implantation is recognised as a management option in refractory and delayed low flow priapism for restoring erectile function with high patient satisfaction rates. However, the ensuing corporal fibrotic scarring poses a surgical challenge to clinicians, given the higher complication rates in this patient subset. Postoperative patient satisfaction has been closely linked to preoperative expectations and perceived loss of penile length. Therefore, thorough patient counselling concerning the risk and benefits of penile implants should be a priority for all clinicians. Moreover, there is a lack of consensus on the ideal prosthesis choice and procedural timing in refractory low flow priapism. In this review, we will examine the existing literature on penile implants in patients with priapism and discuss the options for managing complications associated with penile prosthesis surgery.
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Affiliation(s)
- Musaab Yassin
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Runzhi Chen
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Michael Ager
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elsayed Desouky
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
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14
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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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15
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Chew L, Chang C, Simhan J. Climacturia: what treatment options do we offer to those with and without concomitant erectile dysfunction? Int J Impot Res 2023; 35:634-638. [PMID: 37161059 DOI: 10.1038/s41443-023-00714-4] [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: 11/30/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/11/2023]
Abstract
Radical prostatectomy for prostate cancer carries many sequelae, including climacturia, which is not commonly discussed and often under-recognized. To better understand treatment options for incontinence and climacturia, as well as those at time of penile implantation surgery, we completed a comprehensive literature review to identify nonoperative and operative treatments for patients with climacturia alone and those with concomitant climacturia and erectile dysfunction. Nonoperative interventions include behavioral modifications, physical therapy, and tension loops. Operative interventions include the artificial urinary sphincter, male urethral slings, Mini-Jupette sling, and a periurethral prosthesis. We also explore options that can be offered to patients who are also in need of penile prosthesis for concomitant erectile dysfunction. Contemporary work suggests that synchronous implantation of certain devices to treat both climacturia and erectile dysfunction can be done with proven safety and efficacy.
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Affiliation(s)
- Lauren Chew
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Chrystal Chang
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA.
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16
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Erol İ, Yıldız A, Karamık K, Anıl H, İslamoğlu E, Çakır T, Ateş M, Savaş M. Electrophysiological evaluation of alterations in penile sensation due to penile prosthesis implantation in patients with erectile dysfunction. Asian J Urol 2023; 10:541-545. [PMID: 39186443 PMCID: PMC10659965 DOI: 10.1016/j.ajur.2021.04.013] [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: 02/28/2021] [Revised: 03/31/2021] [Accepted: 04/22/2021] [Indexed: 10/18/2022] Open
Abstract
Objective The present study was aimed to determine the effect of penile prosthesis implantation (PPI) surgery on penile sensation by evaluating the penile electromyography (EMG) variables. Methods The research was designed as a prospective study. Thirty patients who were diagnosed with organic erectile dysfunction and had underwent PPI surgery between January 2017 and January 2018 in the Urology Clinic of Antalya Training and Research Hospital were included in this study. Penile sensory EMG was performed on each patient 1 day prior to the surgery by the Physical Therapy and Rehabilitation clinic. Additionally, the control EMG study was also performed in the 3rd and 6th postoperative months. Results We included 27 patients in this study who attended regular follow-ups and had complete EMG results. Out of the 27 patients, 23 (85.2%) patients had received malleable (ProMedon) penile prosthesis, one (3.7%) patient had received a two-piece inflatable (Ambicor) penile prosthesis, and three (11.1%) patients had received a three-piece inflatable (AMS 700 CXR) penile prosthesis. The mean nerve conduction value (NCV) of the patients was 29.85 (standard derivation: 22.54; range: 0-78.4) m/s during the preoperative period, whereas it was 27.64 (standard derivation: 24.72; range: 0-83.3) m/s in the 3rd postoperative month and 24.80 (standard derivation: 22.31; range: 0-88.4) m/s in the 6th postoperative month. There was no significant difference between preoperative NCV and 3rd postoperative month NCV (p=0.607). Similarly, no significant difference was observed between preoperative NCV and 6th postoperative month NCV (p=0.276). Additionally, the change between NCV values at postoperative 3rd and 6th months was not statistically significant (p=0.553). Conclusion Significant loss of penile sensation does not occur in patients who undergo PPI surgery.
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Affiliation(s)
- İbrahim Erol
- Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Ali Yıldız
- Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Kaan Karamık
- Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Hakan Anıl
- Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Ekrem İslamoğlu
- Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Tuncay Çakır
- Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Mutlu Ateş
- Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Murat Savaş
- Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
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17
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Ziegelmann MJ, Langbo WA, Bajic P, Levine LA. Comparison of patient-reported outcomes after penile prosthesis placement in men with and without Peyronie's disease. Int J Impot Res 2023; 35:569-576. [PMID: 36038732 DOI: 10.1038/s41443-022-00600-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 11/08/2022]
Abstract
We evaluated outcomes in patients undergoing penile prothesis (PP) implantation for erectile dysfunction (ED) and concurrent Peyronie's Disease (PD). A clinician-developed survey to assess satisfaction was sent to 354 patients who underwent PP placement from 2012-2018 by a single-surgeon. Results were compared based on the presence or absence of concurrent PD. 79 patients completed the survey (response rate 22%), including 38 patients (48%) with concurrent ED and PD (ED/PD). Mean follow-up was 31 months (standard deviation 19). 87% felt their condition was "very much" or "much" improved. There was no significant difference in patient-reported overall satisfaction with their PP or satisfaction with current penile length/girth based on the presence or absence of PD. 87% of patients with PD were satisfied with their degree of penile straightening after PP plus or minus concurrent straightening maneuvers such as modeling, plication, or incision/grafting. Sub-group analyses were performed to evaluate outcomes in those with concurrent PD/ED who required plaque incision/grafting at the time of PP placement for more severe deformity (n = 19). 47% of these patients were dissatisfied with their current penile length, compared with only 16% of those patients with PD/ED who did not require grafting (p = 0.05). In conclusion, the presence of PD alone may not impact PP satisfaction, but patients with more severe baseline deformity who require incision/grafting may be less satisfied with outcomes including penile length.
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Affiliation(s)
| | - William A Langbo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Petar Bajic
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Laurence A Levine
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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18
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Braun AE, Swerdloff D, Sudhakar A, Patel RD, Gross MS, Simhan J. Defining the incidence and management of postoperative scrotal hematoma after primary and complex three-piece inflatable penile prosthesis surgery. Int J Impot Res 2023:10.1038/s41443-023-00697-2. [PMID: 37156930 PMCID: PMC10166027 DOI: 10.1038/s41443-023-00697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023]
Abstract
Scrotal hematoma is a challenging complication of penile prosthesis surgery. We characterize the risk of hematoma formation with implementation of standardized techniques to mitigate hematomas and assess for any associated factors in a large multi-institutional penile implant cohort. This was a retrospective review from February 2018 to December 2020 of all patients who underwent inflatable penile prosthesis implantation at 2 high volume implant centers. Cases were defined as "complex" if they involved revision, salvage with removal/replacement, or were performed with concurrent penile, scrotal or intra-abdominal surgeries. The incidence of scrotal hematoma among primary and complex IPP recipients was measured and modifiable and innate risk factors associated with hematoma formation within the two cohorts were tracked. Of 246 men who underwent penile prosthesis surgery, 194 (78.9%) patients underwent primary implantation and 52 (21.1%) were complex. Although hematoma formers in the complex group had comparable drain outputs to primary patients on postoperative day 0 (66.8cc ± 32.5 vs 48.4 ± 27.7, p = 0.470) and postoperative day 1 (40.3cc ± 20.8vs 21.8 ± 11.3 p = 0.125), hematomas in the complex group had a higher propensity for OR evacuation (p = 0.03). Difference in duration of temporary device inflation between 2 (64, 26%) and 4 weeks (182, 74%) did not contribute to hematoma formation (p = 0.562). The incidence of postoperative hematoma formation in complex cases was 9.6% (5/52) and 3.6% in primary cases (7/194) (HR = 2.61, p = 0.072). Complex IPP surgery performed for revision or with ancillary procedures are more likely to result in clinically significant hematomas that require surgical management, suggesting a need for heightened caution in managing these individuals.
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Affiliation(s)
- Avery E Braun
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Rutul D Patel
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Martin S Gross
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA.
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19
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Sun HH, Isali I, Mishra K, Callegari M, Sellke NC, Tay KS, Gupta S, Chen ML. Surgical Outcomes at a Single Institution of Infrapubic Insertion of Malleable Penile Prosthesis in Transmen. Urology 2023; 173:209-214. [PMID: 36669571 DOI: 10.1016/j.urology.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/04/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To describe our technique for the infrapubic approach for malleable penile prosthesis (MPP) insertion after phalloplasty in transgender men and review surgical outcomes. METHODS The infrapubic prosthesis insertion technique involves a horizontal incision anterior to the pubic symphysis, allowing dissection of the neophallus tract and anchor site on the pubic symphysis. Surgical outcomes by a single surgeon using a Spectra or Genesis MPP between October 2017 and May 2022 were retrospectively reviewed. Complications were categorized into erosions, infections, device detachment, device malposition, pain or activity limitation, urethral injury, and flap loss. Implant survival kinetics were assessed by evaluating time to surgical revision. RESULTS Forty patients underwent infrapubic MPP insertion; 35 patients had a prior radial forearm free flap (RFFF) and 5 had a prior anterolateral thigh flap (ALT) phalloplasty. Of 30 patients who maintained follow-up, mean follow-up was 34.9 months. Complications were not mutually exclusive, with 7 implant detachments from the anchor site, 3 malpositions, 2 with pain/activity limitation, and 1 infection. Surgical revision was required in 12/30 patients (40%). There were no neophallus erosions, flap loss, nor urethral injuries. More complications occurred with the Spectra (9/17 or 53%) than the Genesis MPP (3/13 or 23%), but this was not statistically significant (P = .10). CONCLUSION Infrapubic insertion in transmen after phalloplasty using commercially available MPPs is safe compared with other post-phalloplasty penile prosthesis insertion techniques, with similarly high surgical revision rates. Further study of techniques is needed to improve outcomes after penile prosthesis insertion in transmen.
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Affiliation(s)
- Helen H Sun
- Urology Institute, Case Western Reserve University / University Hospitals Cleveland, Cleveland, OH.
| | - Ilaha Isali
- Urology Institute, Case Western Reserve University / University Hospitals Cleveland, Cleveland, OH
| | - Kirtishri Mishra
- Urology Institute, Case Western Reserve University / University Hospitals Cleveland, Cleveland, OH
| | - Michael Callegari
- Urology Institute, Case Western Reserve University / University Hospitals Cleveland, Cleveland, OH
| | - Nicholas C Sellke
- Urology Institute, Case Western Reserve University / University Hospitals Cleveland, Cleveland, OH
| | - Kimberly S Tay
- Urology Institute, Case Western Reserve University / University Hospitals Cleveland, Cleveland, OH
| | - Shubham Gupta
- Urology Institute, Case Western Reserve University / University Hospitals Cleveland, Cleveland, OH
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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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Injectable thermo-sensitive hydrogel containing ADSC-derived exosomes for the treatment of cavernous nerve injury. Carbohydr Polym 2023; 300:120226. [DOI: 10.1016/j.carbpol.2022.120226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
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22
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Chung E, Wang J. State-of-art review of current malleable penile prosthesis devices in the commercial market. Ther Adv Urol 2023; 15:17562872231179008. [PMID: 37465318 PMCID: PMC10350748 DOI: 10.1177/17562872231179008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/12/2023] [Indexed: 07/20/2023] Open
Abstract
The malleable penile implant is often considered an inferior device to the three-piece inflatable penile prosthesis implant. Nonetheless, the malleable prosthesis has its unique advantages such as lower cost, easier to perform and fewer mechanical complications than inflatable prostheses. Furthermore, its role can be extended to patients with issues relating to poor manual hand dexterity, those undergoing a salvage for infection prosthesis and as an emergency surgical measure in patients presenting with acute ischaemic priapism. Over the past few decades, there have been numerous design and technological advancements to improve overall clinical efficacy, mechanical durability, axial rigidity and device concealability of malleable penile prostheses. The following article provides a narrative review of the six major contemporary malleable penile prosthesis devices in the commercial market, namely, the Coloplast Genesis prosthesis, the Boston Scientific Tactra prosthesis, the Zephyr ZSI 100 and 100 (female-to-male) FTM devices, the Rigi10 prosthesis, the TUBE malleable prosthesis and the Shah prosthesis and evaluates the published outcomes. Appropriate patient selection and strict counselling regarding what to expect with malleable prostheses coupled with adherence to safe surgical principles are paramount to ensure excellent clinical success and patient satisfaction rates.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Suite 3, 530 Boundary Street, Brisbane, QLD 4000, Australia
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
- Macquarie University Hospital, Sydney, NSW, Australia
| | - Juan Wang
- AndroUrology Centre, Brisbane, QLD, Australia
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23
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Micallef D, Wightman S, Naqi M, Modgil V, Pearce I. Is the infrapubic approach a safe option for patients with poorly controlled diabetes mellitus and obesity undergoing inflatable penile prosthesis surgery? JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221136351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective: Inflatable penile prosthesis (IPP) surgery is an effective treatment for patients with erectile dysfunction (ED). The two most used surgical approaches are infrapubic (IP) and penoscrotal (PS). Concerns exist whether raised Body Mass Index (BMI) or poor glycaemic control negatively affect outcome. We conducted a retrospective review of 50 consecutive virgin IP IPP cases investigating the effect of BMI and glycaemic control on post-operative complications and implant utilisation. Patients and Methods: Data collected included demographics, ED aetiology and risk factors, diabetic status, HbA1c and post-operative complications focusing on infection and re-operation. Telephone survey provided implant usage at 3, 6, 12 and 24 months post-operatively. All patients followed the same pre-, peri- and post-operative pathway, including antibiotic prophylaxis and implant preparation. Results: Complication rates of patients with BMI ⩾ 30 (2/20; 10%) and BMI < 30 (0/28, 0%) ( p = 0.169) and of patients with poorly controlled diabetes mellitus (DM), HbA1c > 69 mmol/mol (0/6, 0%) versus HbA1c ⩽ 69 (2/21, 9.52%) ( p = 1) were not significantly different. Two patients reported complications. Implant utilisation did not differ significantly between low or high BMI and HbA1c cohorts. Conclusion: Our study shows pre-operative HbA1c and BMI do not significantly impact complication rates or implant utilisation in patients undergoing IP IPP insertion. Level of Evidence: 2b
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Affiliation(s)
- Dariush Micallef
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK
| | - Stuart Wightman
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK
| | - Muhammad Naqi
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK
| | - Vaibhav Modgil
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK
| | - Ian Pearce
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK
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24
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La Croce G, Schifano N, Pescatori E, Caraceni E, Colombo F, Bettocchi C, Carrino M, Vitarelli A, Pozza D, Fiordelise S, Varvello F, Paradiso M, Silvani M, Mondaini N, Natali A, Falcone M, Ceruti C, Salonia A, Antonini G, Cai T, Palmieri A, Dehò F, Capogrosso P. Which patient may benefit the most from penile prosthesis implantation? Andrology 2022; 10:1567-1574. [PMID: 36088578 DOI: 10.1111/andr.13294] [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: 08/18/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Penile prosthesis implantation has been associated with overall good functional outcomes. Of relevance, some patients reported higher level of satisfaction and quality of life. AIM We investigated the profile of the patients who may benefit the most from penile prosthesis implantation. MATERIALS AND METHODS Data from a national multi-institutional registry of penile prostheses including patients treated from 2014 to 2017 in Italy (Italian Nationwide Systematic Inventarization of Surgical Treatment for Erectile Dysfunction) were analyzed. All data have been prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and revised by a single data manager. Patients' baseline characteristics were recorded. In order to simultaneously evaluate perceived penile prosthesis function and quality of life, all patients were re-assessed at 1-year follow-up using the validated questionnaire Quality of Life and Sexuality with Penile Prosthesis. High quality of life after surgery was defined as a score higher than the 75th percentile in each of the subdomains of the Quality of Life and Sexuality with Penile Prosthesis questionnaire. Logistic regression analysis tested the association between clinical characteristics and high quality of life after penile prosthesis implantation. RESULTS Follow-up data were available for 285 patients (median age 60 years; interquartile range: 56-67) who underwent penile prosthesis implantation. Erectile dysfunction etiology was organic in 40% (114), pelvic surgery/radiotherapy in 39% (111), and Peyronie's disease in 21% (60) of the cases. Patients showed good overall Quality of Life and Sexuality with Penile Prosthesis scores at 1-year follow-up for functional (22/25), personal (13/15), relational (17/20), and social (13/15) domains. Overall, 27.0% (77) of patients achieved scores consistent with the high quality of life definition. These patients did not differ in terms of median age (60 vs. 62), type of prosthesis (inflatable penile prostheses: 95% in both of the cases), and post-operative complications (10% vs. 14%) than those with lower quality of life score (all p > 0.1). At logistic regression analysis, erectile dysfunction etiology was the only factor independently associated with high quality of life at 1 year after surgery (p = 0.02). Patients treated for Peyronie's disease (odds ratio: 2.62; p = 0.01; 95% confidence interval: 1.20-5.74) were more likely to report better outcomes after accounting for age, post-operative complications, and surgical volume. CONCLUSION Penile prosthesis implantation is associated with an overall good quality of life. The subset of patients affected by erectile dysfunction secondary to Peyronie's disease seemed to benefit the most from penile prosthesis implantation in terms of functional outcomes, relationship with their partners and the outside world, and perceived self-image. The systematic use of validated questionnaires specifically addressed at evaluating quality of life and satisfaction after penile prosthesis implantation should be further implemented in future studies to better define the predictors of optimal satisfaction after penile prosthesis implantation.
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Affiliation(s)
| | - Nicolò Schifano
- Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| | | | - Enrico Caraceni
- Department of Urology, Area Vasta 3 Asur Marche, Civitanova Marche, Italy
| | - Fulvio Colombo
- Andrology Unit, Sant'Orsola University Hospital, University of Bologna, Italy
| | | | | | | | - Diego Pozza
- Studio di Andrologia e di Chirurgia Andrologica, Rome, Italy
| | | | | | - Matteo Paradiso
- Department of Urology, Ospedale Cardinal Massaia, Asti, Italy
| | - Mauro Silvani
- Department of Urology, Ospedale di Biella, Biella, Italy
| | - Nicola Mondaini
- Department of Urology, Villa Donatello Hospital, Florence, Italy
| | - Alessandro Natali
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Falcone
- Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Carlo Ceruti
- Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Andrea Salonia
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Federico Dehò
- Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| | - Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy
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25
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Ansari M, Mangal RK, Stead TS, Carman M, Ganti L. Epididymo-Orchitis and Pelvic Abscess in a Patient With Inflatable Penile Prosthesis. Cureus 2022; 14:e29715. [PMID: 36320940 PMCID: PMC9616694 DOI: 10.7759/cureus.29715] [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] [Accepted: 09/28/2022] [Indexed: 11/21/2022] Open
Abstract
This report discusses a case of a 79-year-old male with a urethral injury following implantation of an inflatable penile prosthesis, leading to frequent urinary tract infections. The patient presented with scrotal pain and swelling, as well as abdominal and suprapubic tenderness and rebound. He was diagnosed with epididymo-orchitis, penile prosthetic infection, and pelvis abscess, and was treated with cephalexin. The patient was admitted for urology consultation and had an uneventful hospital stay.
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Chung E, Lowy M, Gillman M, Love C, Katz D, Neilsen G. Urological Society of Australia and New Zealand (
USANZ
) and Australasian Chapter of Sexual Health Medicine (
AChSHM
) for the Royal Australasian College of Physicians (
RACP
) clinical guidelines on the management of erectile dysfunction. Med J Aust 2022; 217:318-324. [DOI: 10.5694/mja2.51694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Eric Chung
- Princess Alexandra Hospital Brisbane QLD
- University of Queensland Brisbane QLD
- AndroUrology Centre Brisbane QLD
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27
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Evaluation of Quality of Life After Inflatable Penile Implantation and Analysis of Factors Influencing Postsurgery Patient Satisfaction. J Sex Med 2022; 19:1472-1478. [DOI: 10.1016/j.jsxm.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022]
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28
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Chung E, Bettocchi C, Egydio P, Love C, Osmonov D, Park S, Ralph D, Xin ZC, Brock G. The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant. Nat Rev Urol 2022; 19:534-546. [PMID: 35711059 DOI: 10.1038/s41585-022-00607-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 01/06/2023]
Abstract
Despite significant scientific advances in the modern three-piece inflatable penile prosthesis implant surgery, it is not without surgical risks and can carry additional cosmetic and psychosocial consequences in poorly selected and consented individuals. To address this problem, an international group of key opinion leaders and high-volume prosthetic surgeons reviewed the current guidelines and clinical evidence, discussed their experiences, and formed a consensus regarding inflatable penile prosthesis surgery. The findings of this consensus panel were presented at the 17th biennial Asia Pacific Society of Sexual Medicine scientific meeting. The experts concluded that proper patient selection, informed consent and strict adherence to safe surgical principles are important to optimize clinical outcomes. Furthermore, most intraoperative complications, if recognized, can be addressed intraoperatively to enable placement of the device at the time of initial surgery. Men with significant corporal fibrosis due to Peyronie's disease, prior prosthesis explantation and priapism, and men who have undergone construction of a neophallus, as well as men who receive concurrent continence surgery, are complex cases requiring additional care and advanced techniques to obtain optimal surgical outcomes. Variability in patient care - in terms of postoperative antibiotic use, pain management, scrotal care, and cycling of the penile prosthesis implant - must be reduced to enable optimization and assessment of outcomes across patient groups.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, Queensland, Australia.
- University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
- AndroUrology Centre and Macquarie University Hospital, Sydney, New South Wales, Australia.
- AndroUrology Centre, Sydney, New South Wales, Australia.
| | | | | | - Chris Love
- Urology South, Level 2, Holmesglen Private Hospital, Moorabbin, Victoria, Australia
| | | | - Sean Park
- Sewum Prosthetic Urology Center of Excellence, Seoul, Korea
| | - David Ralph
- Institute of Urology, University College London Hospital, London, UK
| | - Zhong Cheng Xin
- Andrology Center, Peking University First Hospital, Beijing, China
| | - Gerald Brock
- University of Western Ontario, London, Ontario, Canada
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29
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Wong J, Witherspoon L, Flannigan RK. Under-recognized factors affecting penile implant satisfaction in patients. Can Urol Assoc J 2022; 16:294-300. [PMID: 35302472 PMCID: PMC9343162 DOI: 10.5489/cuaj.7720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Surgical management via penile prosthesis is an option for patients who have failed medical management. There is a paucity of literature surrounding factors contributing to patient satisfaction after implant surgery. The objective of this study was to characterize patients' and surgeons' attitudes toward factors affecting satisfaction with this procedure. METHODS Two patient cohorts were identified and contacted via email: a medical management of erectile dysfunction (ED) cohort and a penile implant patient cohort. A third cohort, Canadian urologists who perform penile implant surgeries, was also contacted. The surveys consisted of 5-7 questions, including a rating question regarding the importance of various penile implant factors. RESULTS Forty-six ED patients, 45 post-implant patients, and 12 urologists completed the survey. The mean overall satisfaction on a 10-point scale was 6.49 (standard deviation [SD] 2.92). Most (67%) urologists selected patient satisfaction as one of their least favorite aspects of penile implant surgery. Compared to postimplant patients, ED patients reported greater importance in the areas of appearance (p=0.035), soft glans (p=0.040), and concealment of implant (p=0.007). Urologists ranked natural feel (p=0.019) and generating a discrete erection (p=0.022) as less important than patients. CONCLUSIONS This is the first study that examines which specific variables of penile implant surgery are associated with satisfaction while comparing surgeons' understanding of what patients desire from this surgery. This study identifies several factors deemed important by patients but under-recognized by urologists. This knowledge can aid urologists in optimizing preoperative counselling and improving patient satisfaction.
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Affiliation(s)
- Julie Wong
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Luke Witherspoon
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Ryan K Flannigan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
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30
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O'Sullivan NJ, Casey RG. Getting the diagnosis of priapism wrong; when not to aspirate. Andrologia 2022; 54:e14505. [PMID: 35747930 DOI: 10.1111/and.14505] [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: 04/18/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022] Open
Abstract
Priapism is defined as a full or partial erection lasting greater than 4 h due to a fault in the normal detumescence mechanism of the penis. We describe the case of a confused 73-year-old gentleman presenting with painless priapism, a 2 cm non-tethered lesion in the scrotum and a vague palpable pelvic mass. On the presumption that this was a case of high-flow non-ischaemic priapism secondary to pelvic malignancy, the urology registrar attempted corporal body aspiration. Clear fluid was aspirated and the penis became flaccid instantly. A CT scan performed to determine the presence of a pelvic mass, revealed a penile prosthesis and artificial reservoir. While iatrogenic penile prosthesis malfunctions are well established in the literature, a case managed as an acute priapism is yet to be reported. This case teaches us the importance of taking an adequate medical history and clinical examination prior to formulating a diagnosis and administering treatment.
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Affiliation(s)
| | - Rowan G Casey
- Department of Urology, Tallaght University Hospital, Dublin 24, Ireland
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31
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Lentz AC. IPP Salvage in 2021. J Sex Med 2022; 19:895-898. [PMID: 35341726 DOI: 10.1016/j.jsxm.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Aaron C Lentz
- Duke Urology Men's Health Center, Raleigh, NC, USA; Duke University School of Medicine, Durham, NC, USA; Division of Urology, Duke University Medical Center, Durham, NC, USA.
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32
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Shen C, Jain K, Shah T, Schaefer E, Zhou S, Fried D, Helmer DA, Sadeghi-Nejad H. Relationships between erectile dysfunction, prostate cancer treatment type and inflatable penile prosthesis implantation. Investig Clin Urol 2022; 63:316-324. [PMID: 35534219 PMCID: PMC9091830 DOI: 10.4111/icu.20210445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The prevalence of erectile dysfunction (ED) and the utilization of inflatable penile prosthesis (IPP) among prostate cancer patients are understudied. The aim of the study was to examine the relationships between ED, prostate cancer treatment type and IPP implantation in a national cohort. MATERIALS AND METHODS We identified a retrospective cohort of Surveillance, Epidemiology, and End Results (SEER)-Medicare patients diagnosed with locoregional prostate cancer between 2006 and 2011 and treated with surgery or radiation. Chi-square tests were used to detect significant differences in ED rates as well as use of IPP among the subset with ED. Multivariable logistic regression was used to examine factors associated with the use of IPP. RESULTS Among 31,233 patients in our cohort, 10,334 (33.1%) received prostatectomy and 20,899 (66.9%) received radiation. ED within 5 years was significantly more common in the prostatectomy group relative to those the radiation group (65.3% vs. 33.8%, p<0.001). In the subset of 13,812 patients with ED, the radiation group had greater median time to ED diagnosis compared to the prostatectomy group (346 vs. 133 days, p<0.001). IPP implantation was more frequent for prostatectomy patients than for radiation patients (3.6% vs. 1.4%, p<0.001). Cancer treatment type, race, and marital status were significantly associated with IPP utilization. CONCLUSIONS ED is highly prevalent among prostate cancer patients, and IPP implantation is be underutilized. ED rates, time to ED diagnosis and utilization of IPP differed significantly by prostate cancer treatment type.
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Affiliation(s)
- Chan Shen
- Department of Surgery, Division of Outcomes Research and Quality, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Division of Health Services and Behavioral Research, Penn State College of Medicine, Hershey, PA, USA.
| | - Kunj Jain
- Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Tejash Shah
- Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Eric Schaefer
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Penn State College of Medicine, Hershey, PA, USA
| | - Shouhao Zhou
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Penn State College of Medicine, Hershey, PA, USA
| | - Dennis Fried
- War-Related Injury & Illness Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Hossein Sadeghi-Nejad
- War-Related Injury & Illness Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
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Atmoko W, Felizio J, Birowo P, Rasyid N, Taher A, Garaffa G. Plaque excision with the Shah Penile Implant™ and tunica vaginalis graft in Peyronie's disease with erectile dysfunction: A case report. Int J Surg Case Rep 2022; 94:106976. [PMID: 35439722 PMCID: PMC9026975 DOI: 10.1016/j.ijscr.2022.106976] [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: 01/23/2022] [Revised: 03/15/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022] Open
Abstract
Peyronie's disease (PD) is a condition characterized by the deposition of scar tissue in the tunica albuginea of the penis. Peyronie's disease often causes pain, worsens the quality of erections, a variable degree of penile deformation and shortening, which can cause severe distress for the patient and the partner and impact negatively on self-esteem and quality of life in general. Surgery still represents the gold standard treatment for PD in the chronic phase, and it aims to guarantee a penis straight and rigid enough to allow the patient to resume penetrative sex with confidence. Penile prosthesis implantation should be reserved for patients with refractory erectile dysfunction or in these patients with complex deformities and impaired erections. Herein is reported the case of a 51-year-old male with a large ossified PD plaque and erectile dysfunction who underwent simultaneous plaque excision and grafting and penile implantation surgery with a semirigid penile prosthesis. This was the first case of penile prosthesis implantation for Peyronie's disease in Indonesia. Penile prosthesis implantation should be reserved to patients with refractory erectile dysfunction or in these patients with complex deformities and impaired erections. Autologous tunica vaginalis has several advantages, including simple harvesting, fewer morbidity, and excellent quality This was the first case of simultaneous plaque excision, grafting and penile implantation in Indonesia for Peyronie's disease treatment
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34
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Habous M, Omar M, Farag M, Abdelwahab O, Laban O, Binsaleh S, Mulhall JP, Ralph D, Aziz M. Malleable Penile Implant Rod Diameter Predicts Complications and Patient Satisfaction. Sex Med 2022; 10:100486. [PMID: 35217441 PMCID: PMC9023239 DOI: 10.1016/j.esxm.2021.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 12/03/2022] Open
Abstract
Background One of the most common complaints after malleable prosthesis implantation (MPI) is thinning of the penis and decreasing girth. Some surgeons try to insert the largest diameter they can to improve patient satisfaction Aim To investigate if malleable rod diameter (MRD) has an impact on outcome and patient satisfaction Methods Consecutive malleable prosthesis implantation (MPI) was assessed in a high-volume center over 1 year. The same preoperative, intraoperative, and postoperative protocols were used for all patients and one brand of the malleable device was used only. We recorded MRD and length for all patients. All patients had data on comorbidities including glycated hemoglobin (HbA1c) and clinical Peyronie's disease (PD). Revision cases and those who lost for follow-up were excluded from the study. We also excluded patients operated on by low-volume surgeons. All complications, minor (edema, ecchymosis, pain), and major (infection and erosion) were recorded. After 1-year, patients were assessed and given a Likert scale from 1 to 5 where 5 is most satisfied with their MPI. We stratified patients according to MRD into 2 groups: group A for diameter 9.5 and 11 mm and group B for 13 mm. Outcome : Larger diameter of malleable penile implants may be associated with more complications Results 183 patients had full data and filled the questionnaire after 1-year follow-up. All patients had Coloplast, Genesis penile implants. Major complications rate (infection, erosion, and removal) was significantly higher in group B 11% vs 1.2% in group A (P = .016). At 4 weeks postoperative visit, 90 % of group A showed no complications vs 60% only in group B that was statistically significant (P = .0003). Satisfaction rate was more in patients in group A (88.6%) compared to patients in group B (75.7%) but this did not reach to be statistically significant (P = .0519) Clinical Implications MRD predicts outcome. Strengths & Limitations The strengths of our study include that it is the first prospective study with good number of malleable implants. Limitations include: no validated satisfaction instrument and MRD choice was based on surgeon preference. Conclusions Larger diameter of malleable penile implants are not associated with a higher rate of patient satisfaction Habous M, Omar M, Farag M et al. Malleable Penile Implant Rod Diameter Predicts Complications and Patient Satisfaction. Sex Med 2022;10:100486.
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Affiliation(s)
| | | | - Mohammed Farag
- Urology Department, Azhar University, Assuit Branch, Egypt
| | | | - Osama Laban
- Urology Department, King Fahad Hospital, Tabuk, Saudi Arabia
| | - Saleh Binsaleh
- Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - John P Mulhall
- Sexual & Reproductive Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - David Ralph
- St. Peters Institute of Andrology, University College London Hospital, London, UK
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35
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Wang VM, Levine LA. Safety and Efficacy of Inflatable Penile Prostheses for the Treatment of Erectile Dysfunction: Evidence to Date. MEDICAL DEVICES: EVIDENCE AND RESEARCH 2022; 15:27-36. [PMID: 35177941 PMCID: PMC8844936 DOI: 10.2147/mder.s251364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022]
Abstract
Erectile dysfunction (ED) is a common problem, and prevalence rates are expected to rise as life expectancy increases worldwide. In more severe cases of ED, penile prosthesis implantation has been an excellent option for patients. Over the past few decades, significant design improvements have been made to the penile prosthesis and modifications to surgical technique to improve clinical outcomes. The purpose of this review is to summarize the safety and efficacy of FDA-approved penile implants in the US market. Design modifications have greatly improved the safety and reliability of the implant. Development of improved surgical techniques has decreased intraoperative injuries and reservoir-related complications. With its high overall satisfaction rates and low risk of complications, the inflatable penile prosthesis remains an excellent option for patients with erectile dysfunction.
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Affiliation(s)
- Vinson M Wang
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
- Correspondence: Laurence A Levine, Email
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Krishnappa P, Manfredi C, Sinha M, Arcaniolo D, Matippa P, Moncada I. Penile Modeling in Peyronie's Disease: A Systematic Review of the Literature. Sex Med Rev 2022; 10:434-450. [DOI: 10.1016/j.sxmr.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/09/2021] [Accepted: 01/04/2022] [Indexed: 01/22/2023]
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Gallo L, Pecoraro S, Sarnacchiaro P. Adjuvant daily therapy with L-arginine 2,500 mg and tadalafil 5 mg increases efficacy and duration of benefits of low-intensity extracorporeal shock wave therapy for erectile dysfunction: A prospective, randomized, single-blinded study with 1-year follow-up. Investig Clin Urol 2022; 63:83-91. [PMID: 34983126 PMCID: PMC8756145 DOI: 10.4111/icu.20210317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate a therapeutic protocol for erectile dysfunction (ED) based on the combination of low-intensity extracorporeal shock wave therapy (Li-ESWT), tadalafil, and L-arginine. Materials and Methods Recruited patients completed the International Index of Erectile Function erectile function domain (IIEF-EF) and the Erection Hardness Score (EHS) questionnaires at baseline and were randomly assigned in two groups: A (treatment group) and B (control group). Men in both groups received six weekly applications of Li-ESWT. Group A was prescribed adjuvant oral therapy with tadalafil 5 mg and L-arginine 2,500 mg. Follow-up visits were scheduled 1, 6, and 12 months after the last Li-ESWT application. At each follow-up visit, the IIEF-EF and EHS questionnaires were administered again. The main outcome measures were the changes from baseline to every follow-up visit in IIEF-EF and EHS scores. Results The mean IIEF-EF score in group A was 16.0±4.0, 24.8±3.4, 23.3±4.6, and 21.6±5.5 at baseline, 1, 6, and 12 months of follow-up, respectively, whereas in group B the mean IIEF-EF score was 16.5±4.1, 22.7±4.2, 21.5±4.5, and 19.5±4.9, respectively. We reported an increase in the mean EHS score in group A from 2.07±0.72 at baseline to 3.39±0.59, 3.17±0.67, and 2.98±0.72 at 1, 6, and 12 months, respectively, and in group B from 2.12±0.80 at baseline to 3.07±0.78 and 2.95±0.76 at 1 and 6 months, respectively. Conclusions Adjuvant daily therapy with L-arginine 2,500 mg and tadalafil 5 mg was safe and effective in increasing the efficacy and the duration of benefits of Li-ESWT.
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Meng F, Liao X, Chen H, Deng S, Wang L, Zhao M, Li H, Liu D, Gao G, Li H, Wang J. Bibliometric and visualization analysis of literature relating to diabetic erectile dysfunction. Front Endocrinol (Lausanne) 2022; 13:1091999. [PMID: 36568113 PMCID: PMC9780376 DOI: 10.3389/fendo.2022.1091999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Diabetic erectile dysfunction (DMED) refers to erectile dysfunction secondary to diabetes. Erectile dysfunction is characterized by a persistent inability to achieve and maintain an erection sufficient to permit satisfactory sexual activity. METHODS Based on the Web of Science core collection database, we firstly analyzed the quantity and quality of publications in the field of DMED, secondly profiled the publishing groups in terms of country, institution, author's publication and cooperation network, and finally sorted out and summarized the hot topics of research. RESULTS From 2001 to 2022, a total of 1,403 articles relating to this topic were published in 359 journals. They represent the global research status, potential hotspots, and future research directions. The number of DMED-related publications and citations has steadily increased over the few past decades. Academic institutions from Europe and the United States have played a leading role in DMED research. The country, institution, journal, and author with the most publications were the United States (294), INHA University (39), the Journal of Sexual Medicine (156), and Ryu, Ji-Kan (29), respectively. The most common keywords were erectile dysfunction (796), men (256), diabetes (254), diabetes mellitus (239), prevalence (180), corpus cavernosum (171), dysfunction (155), mellitus (154), nitric-oxide synthase (153), and expression (140). The main keyword-based research topics and hotspots in the DMED field were oral sildenafil, smooth muscle relaxation, nitric oxide synthase, gene therapy, metabolic syndrome, cavernous nerve injury, stem cell, and penile prosthesis. DISCUSSION The terms oral sildenafil, smooth muscle relaxation, nitric oxide synthase, gene therapy, metabolic syndrome, cavernous nerve injury, stem cell, and penile prosthesis will be at the forefront of DMED-related research.
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Affiliation(s)
- Fanchao Meng
- Urology Surgery, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoxing Liao
- Urology Surgery, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Haimin Chen
- Department of Nephroendocrinology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Sheng Deng
- Department of Andrology, Shunyi Hospital, Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Lu Wang
- Department of Surgery, Beijing Xuanwu Traditional Chinese Medicine Hospital, Beijing, China
| | - Mengjie Zhao
- Urology Surgery, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Haibin Li
- Urology Surgery, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Dong Liu
- Urology Surgery, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Guojing Gao
- Urology Surgery, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Haisong Li
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Haisong Li, ; Jisheng Wang,
| | - Jisheng Wang
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Haisong Li, ; Jisheng Wang,
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Campbell SP, Kim CJ, Allkanjari A, Nose B, Selph JP, Lentz AC. Small Diameter Penile Implants: A Survey on Current Utilization and Review of Literature. Sex Med 2021; 10:100458. [PMID: 34844142 PMCID: PMC8847827 DOI: 10.1016/j.esxm.2021.100458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/03/2021] [Accepted: 10/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background Inflatable penile prostheses (IPPs) with smaller diameter cylinders have been in use for over 30 years, yet the literature is sparse on their utilization patterns amongst prosthetic surgeons. Aim To understand current usage of small diameter penile implants (SDPI) among prosthetic surgeons. Methods IRB approval was obtained to conduct a survey of prosthetic surgeons. A 23-question online survey was distributed via email to physician members of the Sexual Medicine Society of North America (SMSNA) and Society of Urologic Prosthesis Surgeons (SUPS). The survey included questions regarding surgeon experience and volume, frequency of SDPI utilization, indications for SDPI, surgical strategy in the setting of SDPI (approach, use of concordant modeling/grafting), reservoir and pump management, and perceived infection risk and patient satisfaction. Main Outcome Measure SDPI were utilized by the vast majority of respondents in certain clinical situations such as corporal fibrosis or anatomically small corpora, and surgeons have had a favorable experience with these as a final destination implant or as a place-holder until reimplantation with a normal diameter device. Results Fifty individuals responded to the survey, 48 of whom routinely utilized SDPI. The most common indication for SDPI placement was corporal fibrosis from prior infection, followed by anatomically small corpora and priapism. The most common maximal dilation diameter was 10 mm (47%), an additional 23% of respondents utilized SDPI with 11 mm dilation. 75.4% of respondents sometimes or always intended to upsize to standard diameter cylinders in the future. 68.8% of surgeons routinely counseled patients on the possibility of reduced grith and rigidity with SDPI. Patient satisfaction was perceived to be comparable to standard diameter cylinders in 56.3% of respondents, while the remaining 43.6% believed it to be lower than traditional cylinders. Utilization of SDPI can be an important tool for prosthetic surgeons faced with difficult cases due to corporal fibrosis or small corpora. This survey provides new insight into patterns of SDPI utilization by surgeons. A limitation of the study is that patient satisfaction is indirectly addressed through surgeons’ perception and experience, further research will be necessary to include patient questionnaires regarding device satisfaction. Conclusion SDPI are necessary in certain scenarios that preclude the use of normal diameter cylinders. These implants may offer satisfactory erections, but can also be upsized to standard diameter cylinders in the future. Campbell SP, Kim CJ, Allkanjari A et al. Small Diameter Penile Implants: A Survey on Current Utilization and Review of Literature. Sex Med 2022;10:100458.
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Affiliation(s)
- Scott P Campbell
- Division of Urology, Duke University Medical Center, Durham, NC, USA.
| | - Christopher J Kim
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Armand Allkanjari
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Brent Nose
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - J Patrick Selph
- Department of Urology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Aaron C Lentz
- Division of Urology, Duke University Medical Center, Durham, NC, USA
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Baird BA, Parikh K, Broderick G. Penile implant infection factors: a contemporary narrative review of literature. Transl Androl Urol 2021; 10:3873-3884. [PMID: 34804829 PMCID: PMC8575569 DOI: 10.21037/tau-21-568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/27/2021] [Indexed: 11/20/2022] Open
Abstract
Objective We aim to review and summarize published literature that features implanted penile devices and details infection of these devices as a complication. In particular, we will detail the factors that influence infection of penile implants. Background Types of penile prostheses (PP) include inflatable implants and semirigid implants; these are utilized for treatment of erectile dysfunction. Likely the most feared complication of penile implants is infection. There are a handful of factors that are implicated in device infection. Methods Searches were performed using MEDLINE and PubMed databases using keywords and phrases ‘penile implant AND infection’; ‘penile prosthesis AND infection’; ‘penile implant infection’. We have presented results from our literature search. We divided these into ‘Surgical Elements’ and ‘Patient Selection and Factors.’ Each topic is discussed in its own section. Conclusions Strides have been made since the initial penile prosthesis (IPP) surgeries to improve infection rates including diabetes control, antibiotic coating of devices, and antibiotic implementation. Going forward, more studies, especially randomized control trials, need to focus on defining levels of diabetic control (sugar control and A1C control), determining the role of metabolic syndrome in infection promotion and determining laboratory values which could be predictive of infection. We present a discussion of important factors to consider in the realm of PP infections. In addition, we include studies which discuss topics for future directions in decreasing the number of infections seen with PP.
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Neophallus Construction and Penile Prosthesis Implantation: Techniques and Complications. CURRENT SEXUAL HEALTH REPORTS 2021. [DOI: 10.1007/s11930-021-00316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cayetano-Alcaraz AA, Yassin M, Desai A, Tharakan T, Tsampoukas G, Zurli M, Minhas S. Penile implant surgery-managing complications. Fac Rev 2021; 10:73. [PMID: 34632459 PMCID: PMC8483239 DOI: 10.12703/r/10-73] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments or vacuum constriction devices. Contemporary literature suggests that penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient’s quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. Several factors – such as appropriate patient selection, methodical preoperative assessment and patient optimization, specific intraoperative protocols and postoperative recommendations – can reduce the risk of surgical complications. This narrative review discusses the diagnosis and management of both intraoperative and postoperative complications of penile prosthesis surgery.
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Affiliation(s)
| | - Musaab Yassin
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Ankit Desai
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Tharu Tharakan
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | | | - Martina Zurli
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Suks Minhas
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
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Shaeer O, Raheem AA, Elfeky H, Seif A, Abdel-Raheem TM, Elsegeiny A, Soliman MS, Basalious EB, Shaeer K. Urethral instillation of chlorhexidine gel is an effective method of sterilisation. Arab J Urol 2021; 19:419-422. [PMID: 34552794 PMCID: PMC8451623 DOI: 10.1080/2090598x.2021.1956832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/09/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To examine the effectiveness of preoperative urethral sterilisation with chlorhexidine gel in rendering the urethra as sterile as the skin of the genital area, with the skin sterilised as per the International Society for Sexual Medicine guidelines for penile prosthesis implantation. Patients and methods: A total of 111 male patients undergoing sterile andrological surgical procedures were divided into a control group (N = 61) and a chlorhexidine gel group (N = 50). Patients in the chlorhexidine group received urethral instillation with 6 mL of chlorhexidine preoperatively and on table. Patients from both groups received on-table skin preparation using povidone iodine and chlorhexidine povidone iodine. At the end of surgery, swabs were obtained from urethra and the penile skin. Skin and urethral swabs were compared for bacterial colonisation by culture and sensitivity. Results: Of the 111 patients, 16 had urethral colonisation and 10 had skin contamination, and they were all in the control group. The most common organism detected in both the urethral and skin samples was coagulase-negative Staphylococcus aureus. Urethral colonisation was significantly greater in the control group compared to the chlorhexidine group, at 16/61 vs 0/50 (P = 0.001). Similarly, skin colonisation was significantly greater in the control group compared to the chlorhexidine group, at 10/61 vs 0/50, (P = 0.002). Conclusion: Chlorhexidine gel is a powerful sterilising agent that will render the urethra sterile.
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Affiliation(s)
- Osama Shaeer
- Andrology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr Abdel- Raheem
- Andrology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Haitham Elfeky
- Andrology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmad Seif
- Andrology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tarek M. Abdel-Raheem
- Medical Physiology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amgad Elsegeiny
- Andrology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - May Sherif Soliman
- Clinical and Chemical Pathology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Emad B. Basalious
- Pharmaceutics and Industrial Pharmacy Department, Cairo University Cairo, Cairo, Egypt
| | - Kamal Shaeer
- Andrology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
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Capece M, Di Giovanni A, Cirigliano L, Napolitano L, La Rocca R, Creta M, Califano G, Crocetto F, Collà Ruvolo C, Celentano G, Palmieri A. YouTube as a source of information on penile prosthesis. Andrologia 2021; 54:e14246. [PMID: 34519075 DOI: 10.1111/and.14246] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study is to evaluate the quality of information on YouTube regarding penile prosthesis. We searched the term 'penile prosthesis' on YouTube recording the first 100 video links. Each video was analysed by three evaluators through the validate Patient Education Materials Assessment Tool (PEMAT), the DISCERN quality criteria for consumer health information and a misinformation assessment tool specifically created for this subject. All the videos were viewed 10'011'232 times. Median duration time was 5'13″ (IQR = 7'25″-1'58″). Sixty-eight per cent were nonsurgical videos and 32% of them contained surgical procedures. Most of the videos were uploaded by Private Companies (51%). Videos were primarily directed at patients (73 of 100 videos). The mean PEMAT understandability score was 57.8% ± 19.2%, the actionability score was 0% (IQR = 33%-0%). The median DISCERN score was 26 (IQR = 30-21). None of the videos provided a complete patients' information and the overall mean misinformation score was 3.21 ± 2.24. Based on our data, video's quality according to PEMAT and DISCERN score is mostly poor. Furthermore popularity does not correlate with the quality of the videos, and most of them fail to provide adequate patient's information.
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Affiliation(s)
- Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Angelo Di Giovanni
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Lorenzo Cirigliano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
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Di Pierro GB, Lemma A, Di Lascio G, El Motassime A, Grande P, Di Giulio I, Salciccia S, Maggi M, Antonini G, De Berardinis E, Cristini C, Sciarra A. Primary versus revision implant for inflatable penile prosthesis: A propensity score-matched comparison. Andrologia 2021; 53:e14240. [PMID: 34498769 PMCID: PMC9285038 DOI: 10.1111/and.14240] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022] Open
Abstract
Inflatable penile prosthesis (IPP) provides excellent outcomes after virgin implants. However, few data on IPP after revision surgery are available. This study aimed at comparing the outcomes of IPP in patients undergoing primary or revision implant surgery. Patients who underwent revision implant surgery (Group 1) between 2013 and 2020 were identified. Overall, 20 patients (Group 1) could be matched with a contemporary matched pair cohort of surgery‐naive patients (Group 2) in a 1:1 ratio. Patients in Group 2 had a significantly shorter operative time [median (IQR): 84 (65–97) vs. 65 (51–75) min; p = .01] and lower rate of overall complications (25% vs. 10%; p = .01). Of note, mean (SD) scores for the Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire demonstrated high satisfaction and IPP efficacy in both Groups 1 and 2: functional domain [3.9 (1.0) vs. 4.0 (1.2); p = .4], personal [3.9 (1.1) vs. 4.0 (1.1); p = .3], relational [3.8 (1.3) vs. 3.9 (1.1); p = .5] and social [3.9 (1.1) vs. 4.0 (1.2); p = .2]. These results suggest that in experienced hands, IPP offers high satisfaction to both patients and partners even in the setting of revision implant. However, it is mandatory to inform those patients about the increased risk of perioperative complications.
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Affiliation(s)
| | - Andrea Lemma
- Department of Maternal and Child Health and Urological Sciences, 'Sapienza' University, Rome, Italy
| | - Giovanni Di Lascio
- Department of Maternal and Child Health and Urological Sciences, 'Sapienza' University, Rome, Italy
| | - Alessandro El Motassime
- Department of Maternal and Child Health and Urological Sciences, 'Sapienza' University, Rome, Italy
| | - Pietro Grande
- Department of Maternal and Child Health and Urological Sciences, 'Sapienza' University, Rome, Italy
| | - Ivan Di Giulio
- Department of Maternal and Child Health and Urological Sciences, 'Sapienza' University, Rome, Italy
| | - Stefano Salciccia
- Department of Maternal and Child Health and Urological Sciences, 'Sapienza' University, Rome, Italy
| | - Martina Maggi
- Department of Maternal and Child Health and Urological Sciences, 'Sapienza' University, Rome, Italy
| | - Gabriele Antonini
- Department of Maternal and Child Health and Urological Sciences, 'Sapienza' University, Rome, Italy
| | - Ettore De Berardinis
- Department of Maternal and Child Health and Urological Sciences, 'Sapienza' University, Rome, Italy
| | - Cristiano Cristini
- Department of Maternal and Child Health and Urological Sciences, 'Sapienza' University, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal and Child Health and Urological Sciences, 'Sapienza' University, Rome, Italy
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Hebert KJ, Findlay BL, Yang DY, Houlihan MD, Bole R, Avant RA, Andrews JR, Jimbo M, Ziegelmann MJ, Helo S, Köhler TS. Incidence of Venous Thromboembolism and Safety of Perioperative Subcutaneous Heparin During Inflatable Penile Prosthesis Surgery. Urology 2021; 157:155-160. [PMID: 34411598 DOI: 10.1016/j.urology.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/14/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify the incidence of venous thromboembolism (VTE) risk factors, postoperative VTE, and to assess the morbidity of perioperative pharmacologic VTE prophylaxis in men undergoing inflatable penile prosthesis (IPP) surgery. METHODS We retrospectively reviewed 215 patients undergoing IPP surgery between July 2017 and June 2019. Univariate and multivariate statistical analyzes were performed to assess pre-operative Caprini risk score and compare post-operative day 0 scrotal drain output, scrotal hematoma formation, and VTE in men who received subcutaneous heparin (SqH) vs those who did not receive SqH. RESULTS Of 215 IPP patients, 84% were classified as high or highest risk for VTE utilizing the Caprini risk score. A total of 119 (55%) received perioperative SqH with or without additional anti-thrombotics. Post-operative day 0 scrotal drain output was higher in those who received SqH compared to those who did not receive SqH, 99.9 mL vs 75.6 mL, respectively (P = .001). Minor scrotal hematomas occurred in similar rates in patients who received perioperative SqH vs those who did not, 3.8% vs 6.3%, respectively (P = .38). Similar results were found on subgroup analysis when eliminating patients who received SqH concurrently with other anti-thrombotics. The overall rate of postoperative VTE was 0.9%. No post-operative infections occurred. CONCLUSION Patients undergoing IPP surgery are at elevated risk for VTE. To our knowledge, this is the first study showing SqH use in the perioperative IPP surgery setting is safe when used in conjunction with a scrotal drain. Preoperative VTE risk stratification may be performed and can be used to guide clinical decision making regarding pharmacologic prophylaxis.
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Affiliation(s)
| | | | - David Y Yang
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Ross A Avant
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Masaya Jimbo
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Sevan Helo
- Department of Urology, Mayo Clinic, Rochester, MN
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Bettocchi C, Osmonov D, van Renterghem K, Djiovic R, Ralph DJ. Management of Disastrous Complications of Penile Implant Surgery. J Sex Med 2021; 18:1145-1157. [PMID: 34274041 DOI: 10.1016/j.jsxm.2021.04.003] [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: 02/12/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE Penile Prosthesis Implantation (PPI) is the definitive treatment for Erectile Dysfunction not responsive to conservative management strategies. Furthermore, it is a staple of surgical treatment of severe Peyronie's Disease (PD) and phallic reconstruction. Expert implantologists occasionally face disastrous complications of penile implant surgery which can prove to be very challenging. In this article we present a selected number of case reports which exemplify this kind of situations and discuss management strategies while also commenting on plausible aetiologies. PATIENTS' CONCERNS The first case describes a PPI performed in end-stage fibrotic corpora after multiple instances of implantation/explant. The second and third cases show two diametrically opposed approaches to the management of glans necrosis after PPI in post-radical cystectomy patients. The fourth case describes the history of a diabetic patient suffering from glandular, corporal and urethral necrosis after a complicated PPI procedure. The fifth case reports the surgical treatment of a case of recurring PD due to severe scarring and shrinking of a vascular Dacron patch applied in a previous operation. DIAGNOSIS Complication diagnosis in all patient was mainly clinical, intra- and postoperative, with Penile Color Doppler Ultrasonography performed when needed in order to demonstrate penile blood flow. INTERVENTIONS The patients underwent complex surgical procedures that addressed each specific complication. Complex penile implants with fibrosis-related complications, penile prosthesis explant with and without surgical debridement of necrotic areas, penile prosthesis explant with necrotic penile shaft and urethral amputation with perineostomy, and complex corporoplasty with scar tissue excision and patch application with PPI were performed in the five patients. OUTCOMES Penile anatomy and erectile function with PPI was achieved in 4 out of 5 patients. 1 of 5 patient is scheduled to undergo a total phallic reconstruction procedure at the time of this writing. LESSONS Management of disastrous complications of penile implant surgery can be very challenging even in expert hands. In-and-out knowledge of possible PPI and PD complications is required to achieve an acceptable outcome. Bettocchi C, Osmonov D, van Renterghem K, et al. Management of Disastrous Complications of Penile Implant Surgery. J Sex Med 2021;18:1145-1157.
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Affiliation(s)
- C Bettocchi
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.
| | - D Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - K van Renterghem
- Department of Urology, Jessa Hospital, Hasselt, Belgium; Faculty of medicine, Hasselt University, Hasselt, Belgium; University Hospitals Leuven, Leuven, Belgium
| | - R Djiovic
- Sava Perovic Foundation, Center for Genito Urethral Reconstructive Surgery, Belgrade, Serbie
| | - D J Ralph
- Department of Urology, University College London Hospitals & St Peters Andrology Centre, London, UK
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Alonso-Isa M, García-Gómez B, García-Rojo E, Medina-Polo J, Manfredi C, Rodríguez-Antolín A, Romero-Otero J. [Penile prosthesis implantation in the covid era. post-surgery follow up and management of complications]. Rev Int Androl 2021; 20:62-67. [PMID: 34303628 PMCID: PMC8295190 DOI: 10.1016/j.androl.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To provide recommendations regarding surgery, follow-up, and management of possible complications related to penile prostheses implantation, during the COVID-19 pandemic. MATERIAL AND METHODS We designed a critical narrative review of the studies investigating the impact of COVID-19 on urology practice and on penile prosthetic implantology. A comprehensive search in the MEDLINE database was performed. Different combinations of the following keywords were used according to a free-text protocol:: "SARS-CoV-2", "COVID19", "COVID Urology", "COVID19 surgery", "penile prostheses". Papers in English and Spanish language, published until September 2020 were included in the review. RESULTS Penile prosthesis implantation is an elective surgery which should always be deferred when it cannot be performed in maximum safety conditions. However, it may lead to complications wich must be resolved urgently even within the COVID-19 Era. CONCLUSIONS Currently, it is mandatory to develop shared strategies to avoid potential COVID-19-related complications for surgical patients. Penile prosthesis implantation should be deferred to avoid unnecessary risks and all preventive measures should be taken to minimize the risks in the event of non-delayable surgery.
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Affiliation(s)
- Manuel Alonso-Isa
- Departmento de Urología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, España.
| | - Borja García-Gómez
- Departmento de Urología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, España
| | - Esther García-Rojo
- Departmento de Urología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España
| | - José Medina-Polo
- Departmento de Urología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, España
| | - Celeste Manfredi
- Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, España; Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, España; Unidas of Urología, Universidad de Campania Luigi Vanvitelli, Nápoles, Italia
| | - Alfredo Rodríguez-Antolín
- Departmento de Urología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España
| | - Javier Romero-Otero
- Departmento de Urología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, España; Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, España
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Penile Hemodynamic Response to Phosphodiesterase Type V Inhibitors after Cavernosal Sparing Inflatable Penile Prosthesis Implantation: A Prospective Randomized Open-Blinded End-Point (PROBE) Study. Adv Urol 2021; 2021:5548494. [PMID: 34257646 PMCID: PMC8257370 DOI: 10.1155/2021/5548494] [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: 01/27/2021] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 02/05/2023] Open
Abstract
Forceful corporal dilatation amidst penile prosthesis implantation may injure cavernosal arteries compromising penile vasculature. In this study, we aimed to compare the conventional and cavernosal sparing techniques regarding cavernosal artery preservation. Overall, 33 patients underwent inflatable penile prosthesis implantation with Coloplast Titan Touch® three-piece inflatable penile implants. 16 patients had conventional implantations with serial vigorous dilatations, while 17 patients were implanted with the cavernosal sparing technique, consisting of a single minimal corporal dilatation after an intraoperative intracavernosal injection (ICI) of Alprostadil. Postoperatively, a penile duplex Doppler ultrasound study was performed. Whenever a cavernosal artery was spared and thus successfully probed, its hemodynamics were studied before and after an oral administration of a phosphodiesterase type 5 inhibitor (PDE5i). A cavernosal artery was successfully probed in 16/17 (94%) of patients in the cavernosal sparing group compared to 5/16 (31%) of patients in the conventional group with a significant statistical difference (P=0.001). This demonstrated that the cavernosal sparing technique was superior to the conventional approach in preserving the cavernosal artery (odds ratio 35.2, 95% IC 3.5–344.2; P=0.0022). Whenever a cavernosal artery could be probed, its hemodynamic responsiveness was also preserved. This trial is registered with NCT03733860.
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Chung E, Mulhall J. Practical Considerations in Inflatable Penile Implant Surgery. J Sex Med 2021; 18:1320-1327. [PMID: 34247953 DOI: 10.1016/j.jsxm.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Penile prosthesis implantation remains an effective solution for men with medical-refractory erectile dysfunction (ED) following radical pelvic surgery. Despite the distortion of pelvic anatomy, a penile implant can be performed with excellent clinical outcomes provided strict patient selection, proper preoperative workup and safe surgical principles are adhered to. AIM To provide practical recommendations on inflatable penile prosthesis (IPP) implantation in patients with medical-refractory ED, with an emphasis on patient selection and counselling, preoperative workup as well as surgical considerations to minimize intraoperative complications. METHODS A Medline search on relevant English-only articles on penile prostheses and pelvic surgery was undertaken and the following terms were included in the search for articles of interest: "bladder cancer", "prostate cancer", "rectal cancer", "pelvic surgery" and "inflatable penile implant". OUTCOMES Clinical key recommendations on patient selection, preoperative workup and surgical principles. RESULTS Patients should be made aware of the mechanics of IPP and the informed consent process should outline the benefits and disadvantages of IPP surgery, alternative treatment options, cost, potential prosthetic complications and patient's expectations on clinical outcomes. Specialised diagnostic test for workup for ED is often not necessary although preoperative workup should include screening for active infection and optimising pre-existing medical comorbidities. Precautionary measures should be carried out to minimise infective complication. Corporal dilation and reservoir placement can be challenging in this group, and surgeons may require knowledge of advanced reconstructive surgical techniques when dealing with specific cases such as coexisting Peyronie's disease and continence issue. CLINICAL TRANSLATION Strict patient selection and counselling process coupled with safe surgical principles are important to achieve excellent linical outcomes and patient satisfaction rates. STRENGTHS AND LIMITATIONS This masterclass paper provides an overview of the practical considerations for men who are undergoing IPP surgery following radical pelvic surgery. Limitations include the lack of highquality data and detailed surgical description on each surgical troubleshooting steps for various prosthetic-related complications. CONCLUSION The IPP implantation can be performed efficiently and safely in patients following radical pelvic surgery. Chung E, Mulhall J. Practical Considerations in Inflatable Penile Implant Surgery. J Sex Med 2021;18:1320-1327.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane QLD, Australia; Princess Alexandra Hospital, University of Queensland, Brisbane QLD, Australia; Macquarie University Hospital, Sydney, NSW, Australia.
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