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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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Rogers MJ, Ramirez-Fort MK, Kashanian JA, Broster SA, Matta J, Mahase SS, Fort DV, Niaz MJ, McClelland S, Bander NH, Fort M, Lange CS, Schlegel P, Mulhall JP. Prostatic irradiation-induced sexual dysfunction: A review and multidisciplinary guide to management in the radical radiotherapy era (Part II on Urological Management). Rep Pract Oncol Radiother 2020; 25:619-624. [PMID: 32549795 DOI: 10.1016/j.rpor.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/27/2020] [Accepted: 03/16/2020] [Indexed: 12/14/2022] Open
Abstract
Prostate cancer is the most common malignancy in men and the second leading cause of cancer-related death in men. Radiotherapy is a curative option that is administered via external beam radiation, brachytherapy, or in combination. Sexual dysfunction is a common toxicity following radiotherapy, similar to men undergoing radical prostatectomy, but the etiology is different. The pathophysiology of radiation-induced sexual dysfunction is multi-factorial, and the toxicity is a major cause of impaired quality of life among long-term prostate cancer survivors. Management of a patient's sexual function during and after radiotherapy requires multidisciplinary coordination of care between radiation oncology, urology, psychiatry, pharmacy, and dermatology. This review provides a framework for clinicians to better understand prostatic radiotherapy-induced sexual dysfunction diagnosis, evaluation, and a patient-centered approach to toxicity preventive strategies and management.
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Affiliation(s)
- Marc J Rogers
- Urology, Medical University of South Carolina, Charleston, SC, United States
| | - Marigdalia K Ramirez-Fort
- Life Sciences, BioFort Corp., Guaynabo, PR, United States.,Urology, Weill Cornell Medicine, New York, NY, United States.,Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | | | - Seth A Broster
- Urology, Medical University of South Carolina, Charleston, SC, United States
| | - Jaime Matta
- Pharmacology and Toxicology, Ponce Health Sciences University, Ponce, PR, United States
| | - Sean S Mahase
- Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
| | - Digna V Fort
- Life Sciences, BioFort Corp., Guaynabo, PR, United States
| | - M Junaid Niaz
- Urology, Weill Cornell Medicine, New York, NY, United States
| | | | - Neil H Bander
- Urology, Weill Cornell Medicine, New York, NY, United States
| | - Migdalia Fort
- Life Sciences, BioFort Corp., Guaynabo, PR, United States
| | - Christopher S Lange
- Life Sciences, BioFort Corp., Guaynabo, PR, United States.,Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | - Peter Schlegel
- Urology, Weill Cornell Medicine, New York, NY, United States
| | - John P Mulhall
- Sexual and Reproductive Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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