Courbe d’apprentissage d’implantation de prothèse pénienne

The learning curve of bilateral laparoscopic varicocelectomy: a prospective study

Varicocele occurs in 15% of general male population and in 35% of infertile men. Since 1992, surgical correction with laparoscopic varicocelectomy is the gold standard for treatment of symptomatic patients or patients with abnormal seminal analysis. The learning curve for this frequently performed procedure has not yet been described. In the present study, we investigated the learning curve of a single urologist in training performing his first 21 laparoscopic varicocelectomies using qualitative and quantitative tools to evaluate his performance during the process. Our results show that 14 bilateral laparoscopic varicocelectomies are enough to achieve the plateau of the learning curve.

Reduction in ionizing radiation exposure during minimally invasive anterior plate osteosynthesis of distal radius fracture: Naive versus deliberate practice

This study aimed to decrease surgeon exposure to ionizing radiation through a new learning technique, "deliberate practice", which consists in improving performance by setting goals with feedback. The hypothesis was that exposure to ionizing radiation during distal radius fracture surgery using the minimally invasive plate osteosynthesis (MIPO) technique decreased faster with "deliberate" practice than with "naïve" practice. Radiographic dosimetry was measured in the first 30 fractures operated on by MIPO by 6 surgeons. The first 3 surgeons operated "naively" (Group 1) and the next 3 according to the "deliberate" procedure (Group 2). Group 2 received weekly feedback (number of exposed hands, number of fluoroscopic views, exposure duration, and X-ray dose). An expert, using fluoroscopic images and surgical videos, provided suggestions for improvement. Mean number of exposed hands was 23.66 in Group 1 and 1.9 in Group 2. Mean number of fluoroscopic views was 78.31 and 35.0, respectively. Mean X-ray exposure time was 74.34 and 32.89 s, respectively. Mean dosimetry was 1.40 mGy (and 0.59 mGy, respectively. The hypothesis was thus confirmed: dosimetry decreased faster in Group 2 than in Group 1. Teaching this deliberate practice should be generalized, to decrease the growth phase and increase the plateau phase of the learning curve.

Penile implant infection factors: a contemporary narrative review of literature

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.

Penile prosthesis implantation: A single center 25 years of experience

OBJECTIVES

We analyzed the long-term results of malleable and inflatable penile prosthesis: the rates of complications, revision surgery and patient satisfaction.

MATERIALS AND METHODS

Between January 1996 and December 2020, a total of 138 patients underwent implantation of a malleable or inflatable types penile prosthesis. The data of the patients were derived from the patient files and digital recording system. The patients were contacted face-to-face interaction if possible. If it is not possible, phone connection was made.

RESULTS

The median age of patients was 56 (21-83) years. Fourteen (10.2%) 1-piece, 46 (33.3%) 2-piece and 78 (56.5%) 3-piece penile prosthesis were implanted. The mostly used perioperative antibiotic was teicoplanin+amikacin in 107 patients. Total complication rate was 30% (n=42). Prosthesis infection constituted 9% (n=13) of these complications. The total satisfaction rate was 89.1%. There was no correlation between the complications and antibiotic regimen or prosthesis type (P=0.488, P=0.454, respectively). The rate of infection showed a slight increase in 3-piece penile prosthesis without any statistically significance (P=0.633). The patients with complications expressed more dissatisfaction compared to those without complications (P=0.001).

CONCLUSIONS

In our series, penile prosthesis implantation seems to be a recommended treatment method with high patient satisfaction in the treatment of refractory erectile dysfunction.

LEVEL OF EVIDENCE

4.

[Survival and associated factors with long-term survival of penile prosthesis]

INTRODUCTION

Implantation of penile prosthesis is constantly growing but little long-term data is available concerning the associated factors of prosthesis survival. Our aim was to describe the long-term survival of penile prostheses and to identify factors influencing long-term prosthesis survival.

METHODS

This is a retrospective, monocentric cohort of patients who underwent their first implantation of a penile prosthesis, between May 2000 and March 2017, at the Reims University Hospital. Prosthesis survival was calculated by the Kaplan-Meier method. A univariate and multivariate analysis to estimate the risk of surgical removal/revision of the prosthesis was performed using a Cox model.

RESULTS

150 patients were included, and 61 patients underwent surgical removal of the prosthesis (40.7%). Mean follow-up was 76.12 months (0-176 months). Prosthesis survival was 69.7% at 5 years (95% CI, 62.2-77.3) and 58.5% at 10 years (95% CI, 50.0-66.9). In multivariate analysis, the factors influencing prosthesis survival were: type of prosthesis (other vs. Coloplast TITAN®, HR 1.89, CI 95%, 1.03-3.45) and prosthesis final length (20-29cm vs. 12-17cm, HR 0.27, 95% CI, 0.09-0.77).

CONCLUSION

At 10 years, the penile prosthesis survival is close to 60%. Type of implant and final length of the prosthesis may have a significant influence in long-term prosthesis survival. Patients undergoing penile prosthesis implantation must be informed about the risk of surgical removal/revision of the prosthesis.

LEVEL OF EVIDENCE

3.