1
|
García S, Peña Rodríguez S, Alarcon JC. Comment on: Technological advances in penile implants: past, present, future. Int J Impot Res 2024; 36:545-546. [PMID: 37291230 DOI: 10.1038/s41443-023-00720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/11/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Sandra García
- Department of Urology, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia.
| | | | | |
Collapse
|
2
|
Corona G, Santi D, Cocci A, Vena W, Pizzocaro A, Vignozzi L, Isidori AM, Pivonello R, Salonia A, Minhas S, Bettocchi C, Reisman Y, Maggi M. Long-term penile prosthesis couple's satisfaction: A systematic review and meta-analysis. Andrology 2024. [PMID: 39010798 DOI: 10.1111/andr.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/19/2024] [Accepted: 07/02/2024] [Indexed: 07/17/2024]
Abstract
CONTEXT Data supporting successful and satisfactory penile prosthesis (PP) implantation outcomes are mainly based on subjective, rather than objective, analysis. OBJECTIVE To systematically review and objectively analyze, all available data related to patient and partner PP satisfaction. EVIDENCE ACQUISITION An extensive search was performed, including the following key-words: ("penile prosthesis" and "satisfaction"). The search, which accrued data from January 1, 1969, up to July 31, 2023, was restricted to English-language articles including human participants. EVIDENCE SYNTHESIS Out of 663 retrieved articles, 83 were considered including, 12,132 subjects with a mean age and mean follow-up of 58.6 [range 20; 77.1] years and 47.6 [range 6; 374] months, respectively. Overall, a high patient satisfaction rate was observed 83[80; 86]%. The satisfaction rate increased in subjects with three-piece PP and in those with a higher rate of cardiovascular or neurological diseases and was independent of the patient's age. Partner's satisfaction rate was lower when compared to that observed in men and it increased according to the use of inflatable devices and the presence of patient Peyronie's disease. The long-term complication rate was limited ranging from 3% for erosion to 4.6% when mechanical failure was considered. CONCLUSIONS Patient and partner satisfaction is excellent and increases with time. The number of complications is limited and is strongly associated with the presence of diabetes mellitus. PATIENT SUMMARY We found a high couple satisfaction score that was higher when reported by males compared to females. Patient satisfaction increased with time, and it was independent of age.
Collapse
Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Azienda AUSL Bologna, Ospedale Maggiore, Bologna, Italy
| | - Daniele Santi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Andrea Cocci
- Department of Urology, University of Florence, Florence, Italy
| | - Walter Vena
- Endocrinology, Humanitas Gavazzeni-Castelli, Bergamo, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Pizzocaro
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Mario Serio "Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Unità di Andrologia e Medicina della Riproduzione, Sessualità e Affermazione di Genere, Università Federico II di Napoli, Naples, Italy
- Staff of UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Suks Minhas
- Department of Urology, Imperial College NHS Healthcare, London, UK
| | - Carlo Bettocchi
- Andrology and Male Genitalia Reconstructive Surgery Unit, University of Foggia, Foggia, Italy
| | - Yacov Reisman
- Sexual Medicine, Flare-Health, Amsterdam, the Netherlands
| | - Mario Maggi
- Endocrinology Unit, Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| |
Collapse
|
3
|
Bozkurt YE, Akdeniz CB, Gümüş BH. Long-term results of three-part penile prosthesis implantation with Ectopic reservoir placement in the treatment of erectile dysfunction: is supramuscular tubulation a reliable method? Basic Clin Androl 2024; 34:8. [PMID: 38831330 PMCID: PMC11149340 DOI: 10.1186/s12610-024-00225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/15/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Penile prosthesis implantation is the last resort for refractory erectile dysfunction. Reservoir placement is one of the biggest challenges in inflatable penile prosthesis implant surgery in several cases, especially in patients with abnormal pelvic anatomy. Ectopic reservoir placement with supramuscular approach has many advantages in these cases. RESULTS No complications were encountered except wound site infection in 2 patients which could be controlled with antibiotic treatment. EDITS scores were not statistically different between patients divided into 2-year groups according to follow-up time. Median values of EDITS scores were high in all groups, suggesting that couples had high sexual satisfaction both in the long term and in the short term. CONCLUSIONS We recommend placement of the supramuscular tube and reservoir through the incision described, especially in patients whose pelvic anatomy has been modified by lower abdominal surgery.
Collapse
Affiliation(s)
- Yunus Erol Bozkurt
- Department of Urology, Manisa Merkez Efendi State Hospital, Manisa, Türkiye.
| | | | - Bilali Habeş Gümüş
- Faculty of Medicine, Department of Urology, Manisa Celal Bayar University, Manisa, Türkiye
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Shaeer O, El-Shaarawy EAA, Emam HY, Elsisi I, Sokar E, Shaeer K. Sub-gluteal ligation of the internal pudendal vein for management of veno-occlusive erectile dysfunction (Shaeer's Vein Ligation-I): the cadaveric study. Int J Impot Res 2024:10.1038/s41443-024-00846-1. [PMID: 38424355 DOI: 10.1038/s41443-024-00846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
Vein ligation for veno-occlusive erectile dysfunction is being abandoned due to the recurrence rate. Among the reasons for failure is inability to ligate the deep system of veins; the internal pudendal vein. The vein exits the pelvis in the gluteal region, from the lesser sciatic foramen to the greater sciatic foramen, coursing over the ischial spine and sacro-spinous ligament, under the gluteus maximus. This work aims to verify feasibility of the first surgical procedure to ligate the internal pudendal vein through the gluteal approach. This cadaveric study involved five formalin-fixed cadavers. A surface anatomical landmark was designed to identify the ischial spine, at the intersection of two lines: a vertical line from posterior superior iliac spine to ischial tuberosity, and a horizontal line extending from sacro-coccygeal joint, laterally. An incision is cut encompassing the target point. Subcutaneous fat is dissected down to the gluteus maximus, which is split along the direction of its fibers. The vein can be found crossing over the ischial spine. "Shaeer's Vein Ligation - I" appears to be surgically feasible. A protocol for a surgical study is registered at clinicaltrials.gov, and is open for participation.
Collapse
Affiliation(s)
- Osama Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt.
- The Middle East Society for Sexual Medicine, Cairo, Egypt.
| | - Ehab A A El-Shaarawy
- Department of Anatomy and Embryology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam Y Emam
- Department of Anatomy and Embryology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Islam Elsisi
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eslam Sokar
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Kamal Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
7
|
Stroie FA, Taylor L, Fernandez-Crespo R, Parker J, Carrion R. Patient selection, counseling and preparation for penile prosthesis. Int J Impot Res 2023; 35:609-612. [PMID: 37607962 DOI: 10.1038/s41443-023-00735-z] [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: 01/25/2023] [Revised: 04/23/2023] [Accepted: 07/05/2023] [Indexed: 08/24/2023]
Abstract
The penile prosthesis has revolutionized the management of erectile dysfunction and is a mainstay in the treatment of this clinical entity. The goal of proper patient selection and counseling is to achieve a satisfactory outcome for the patient. Most patients receiving a penile prosthesis are satisfied with their outcome, and while the penile prosthesis generally allows for high satisfaction rates, avenues for dissatisfaction can arise. Our aim is to aid the prosthetic urologist in identifying such avenues by discussing what factors can lead to a dissatisfied patient. Even a technically successful surgical outcome in the improperly counseled patient can have negative consequences for the patient and the patient-physician relationship. Satisfaction in the penile prosthesis arena can be variably defined and viewed from different perspectives. As such, establishing a personalized framework of expectation management, even in the patient who poses challenging factors, is paramount in preparation for penile prosthesis implantation.
Collapse
Affiliation(s)
- Florian A Stroie
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Laura Taylor
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Raul Fernandez-Crespo
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Justin Parker
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Rafael Carrion
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA.
| |
Collapse
|
8
|
Moukhtar Hammad MA, Barham DW, Sanford DI, Amini E, Jenkins L, Yafi FA. Maximizing outcomes in penile prosthetic surgery: exploring strategies to prevent and manage infectious and non-infectious complications. Int J Impot Res 2023; 35:613-619. [PMID: 37828138 PMCID: PMC10622320 DOI: 10.1038/s41443-023-00773-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
Inflatable Penile Prostheses (IPP) implantation is a surgical treatment for patients desiring definitive treatment for erectile dysfunction. While this procedure has proven to be effective, it also carries its own set of unique risks that need to be carefully considered. The article reviews the current understanding of complications associated with penile prosthetic surgery and provides strategies to mitigate these adverse events. This article covers various aspects of IPP implantation, including the risks of infection, bleeding, injury to nearby structures, glans ischemia, and device malfunction. It also discusses the importance of careful preoperative screening to identify risk factors and the implementation of infection reduction strategies such as antimicrobial prophylaxis, skin prep, and operative techniques. In addition, it emphasizes the need for postoperative vigilance and prompt management of any complications that may arise. Overall, the article provides a comprehensive overview of the risks and strategies for mitigating complications associated with IPP implantation. Our recommendations are given based on the current consensus in the field and highlight the importance of careful planning, attention to detail, and effective communication between healthcare providers and patients. Despite the potential risks, this review underscores the fact that complications following penile prosthesis implantation are relatively rare.
Collapse
Affiliation(s)
| | - David W Barham
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Daniel I Sanford
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Artificial Intelligence Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | | | - Lawrence Jenkins
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, Orange, CA, USA
| |
Collapse
|
9
|
La J, Loeb CA, Barham DW, Miller J, Chung E, Gross MS, Hatzichristodoulou G, Park SH, Perito PE, Suarez-Sarmiento A, Van Renterghem K, Yafi FA. Satisfaction rates of inflatable penile prosthesis in men who have sex with men are high. Int J Impot Res 2023; 35:564-568. [PMID: 35941220 DOI: 10.1038/s41443-022-00603-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/09/2022]
Abstract
Men with erectile dysfunction (ED) have high patient satisfaction after placement of inflatable penile prostheses (IPP). The impact on satisfaction and quality of life has never been studied in men who have sex with men (MSM). This study sought to assess the satisfaction rates and quality of life of MSM after placement of IPP for ED. This study was a multi-institutional, retrospective study that enrolled adult men who self-identified as MSM and underwent IPP placement. Two questionnaires were administered at one time point post-operatively, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), and the Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Results of these questionnaires were analyzed with descriptive statistics. Forty-nine MSM were assessed retrospectively with median age of 62 years with average follow-up of 15.2 months. Median EDITS score was 93.2/100 (range, 70.5-100). Median overall QoLSPP score was 72/80 (58-79), with median scores of 22/25 (16-25), 19/20 (13-20), 18/20 (12-20), and 14/15 (9-15), for the functional, personal, relational, and social domains respectively. Overall, MSM report high satisfaction rates and quality of life after IPP placement. A better understanding of the needs and demands of this patient population may lead to improved patient satisfaction and quality of life.
Collapse
Affiliation(s)
- Justin La
- University of California at Irvine, Orange, CA, USA
| | | | | | - Jake Miller
- University of California at Irvine, Orange, CA, USA
| | - Eric Chung
- Androurology Centre, Brisbane, Australia
| | | | | | - Sung Hun Park
- Sewum Prosthetic Urology Center of Excellence, Seoul, South Korea
| | | | | | | | | |
Collapse
|
10
|
Lauwers NL, Van Renterghem K, Osmonov D, Suarez-Sarmiento A, Perito P, Park S, Andrianne R, Ralph D, Mykoniatis I. Analysis of the effects of different surgical approaches on corporotomy localization in inflatable penile implant surgery performed by expert implant surgeons. Int J Impot Res 2023; 35:539-543. [PMID: 35760888 DOI: 10.1038/s41443-022-00593-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/08/2022]
Abstract
Inflatable penile prostheses may be a solution for patients with erectile dysfunction. To our knowledge, no data exist regarding the effect of different surgical approaches used during implantation on the site of the corporotomy. The main purpose of this multicentre study was to investigate the influence of different surgical approaches on the corporotomy site.Data were collected from six expert implant surgeons. Surgical notes were searched for the incision site, proximal, distal and total corporal length measurement, total cylinder length, length of rear tip extenders, surgery time, type of implant, and reservoir placement. The association between the proximal/distal corporal length and the recorded covariates was examined using a linear mixed model.A total of 1757 patients who underwent virgin prosthesis implantation were included in the analysis. Analysis of proximal/distal measurements was performed on 1709 patients. The proximal/distal ratio had a mean of 0.8 ± 0.3 in penoscrotal incisions (n = 391), 0.7 ± 0.2 in infrapubic incisions (n = 832) and 0.7 ± 0.2 in subcoronal (n = 486) incisions. We observed no significant differences in proximal/distal measurements between the highest-volume surgeons.We could not draw a firm conclusion about the difference in corporotomy site between different surgical approaches, but we found no significant difference between the highest-volume surgeons using different techniques.
Collapse
Affiliation(s)
- N L Lauwers
- University of Leuven, Department of Urology, Leuven, Belgium.
| | - K Van Renterghem
- University of Leuven, Department of Urology, Leuven, Belgium.
- University of Hasselt, Hasselt, Belgium.
- Jessa Hospital, Department of Urology, Hasselt, Belgium.
| | - D Osmonov
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of Urology, Kiel, Germany
| | | | - P Perito
- Perito Urology, Department of Urology, Miami, United States of America
| | - S Park
- Sewum Prosthetic Urology Center of Excellence, Seoul, South Korea
| | - R Andrianne
- Le Centre Hospitalier Universitaire de Liège, Department of Urology, Liege, Belgium
| | - D Ralph
- University College Hospital, Department of Urology, London, United Kingdom
| | - I Mykoniatis
- Aristotle University of Thessaloniki, Department of Urology, Thessaloniki, Greece
| |
Collapse
|
11
|
Osmonov D, Ragheb AM, Petry T, Eraky A, Bettocchi C, Lamers KG, Van Renterghem K, Tropmann-Frick M, Chung E, Jünemann KP, Garaffa G, Porst H, Mohamed AG, Wilson SK. Value of prolonged scrotal drainage after penile prosthesis implantation: a multicenter prospective nonrandomized pilot study. Int J Impot Res 2023:10.1038/s41443-023-00710-8. [PMID: 37169878 DOI: 10.1038/s41443-023-00710-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
We aimed to understand the risks and benefits of post-inflatable penile prosthesis (IPP) implantation drainage and optimal duration. Our patients were divided into 3 groups: Group 1 (n = 114) had no drain placed, Group 2 had a drain placed for 24 h (n = 114) and Group 3 had a drain placed for 72 h (n = 117). Postoperative scrotal hematoma and prosthesis infection rates were compared between the groups. The patients from Group 3 demonstrated a statistically significant lower incidence of hematoma on the 10th postoperative day: (n = 1, 0.9%) compared to Group 2: (n = 11, 9.6%) and Group 1: (n = 8, 7%), (p = 0.013). However, on the 3rd postoperative day, there was a statistically significant lower incidence of hematoma in both Groups 3 and 2: (0.9% and 6.1%, respectively) vs. Group 1: (11.4%), (p = 0.004). Hematoma rates followed the same group order after the first day of surgery: 1.7% (n = 2), 5.3% (n = 6), and 8.8% (n = 10), respectively, (p = 0.05). Five patients (4.4%) in Group 1 and four patients (3.5%) in Group 2 developed an IPP associated infection, opposed to only a single patient (0.85%) in Group 3, (p = 0.210). We concluded that prolonged scrotal drainage for 72 h after virgin IPP implantation significantly reduces hematoma and infection rates.
Collapse
Affiliation(s)
- D Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany.
| | - A M Ragheb
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - T Petry
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - A Eraky
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - C Bettocchi
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - K G Lamers
- Departmentof Urology, Jessa Hospital Hasselt, Hasselt, Belgium
| | | | | | - E Chung
- Princess Alexandra Hospital Southside Clinical Unit, Faculty of Medicine, Woolloongabba, QLD, Australia
| | - K P Jünemann
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - G Garaffa
- Andrologia Internazionale, Rome, Italy
| | - H Porst
- European Institute for Sexual Health (EIHS), Hamburg, Germany
| | - A G Mohamed
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - S K Wilson
- Instutute of Urologic Excellence, La Quinta, CA, USA
| |
Collapse
|
12
|
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.
Collapse
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.
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Aboul Fotouh El Gharably M, Ghoneima W, Lotfi MA, AbdelWahab M, Elkady A, Abdel-Rassoul MA. The Efficacy of Suspensory Ligament Release and Pubic Lipectomy Via Penopubic Z Plasty During Penile Prosthesis Implantation in Improving Sexual Satisfaction: A Prospective Randomized Controlled Trial. J Sex Med 2022; 19:852-863. [PMID: 35370101 DOI: 10.1016/j.jsxm.2022.02.024] [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: 10/13/2021] [Revised: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The utility of penile suspensory ligament release (SLR) in the setting of penile prosthesis implantation (PPI) has received limited attention in the literature. AIM To assess the efficacy and safety of penile SLR release, pubic lipectomy (PL), and the utility of penopubic Z-plasty (ZP) during malleable PPI in improving sexual satisfaction compared to that achieved with the conventional method. METHODS Between August 2018 and April 2020, 61 patients with refractory erectile dysfunction were prospectively randomized into 2 groups; group A included 31 patients who underwent PPI with SLR and PL via ZP, and group B included 30 patients who underwent conventional PPI via a penoscrotal incision. OUTCOMES Penile length was assessed at 3 months, and sexual satisfaction was assessed up to 1 year after PPI using both validated and non-validated tools. RESULTS The median operative time was higher in group A than in group B (170 min; interquartile range [IQR] [160-190] vs 97.5 min; IQR [90-110] P < .001).The median pre- to postoperative differences in functional and visible penile lengths for group A were 1.5 cm; IQR [0-2] and 2.5 cm; IQR [1-3.5], respectively, while those in group B were both 0 cm; IQR [-1 to 0] P < .001). Group A patients reported higher scores in the International Index of Erectile Function satisfaction domains than the group B patients did (13; IQR [12-14] and 9; IQR [8-10] vs 11; IQR [9.5-12] and 8; IQR [6.5-8.5], respectively, P < .001). Moreover, the postoperative Erectile Dysfunction Inventory of Treatment Satisfaction score was higher in group A than that in group B (95.40; IQR [91-97.7] vs 85.20; IQR [72.7-91], respectively, P < .001). Common complications in group A were penile edema (77.4%), penile instability (9.7%) and glans numbness (9.7%). CLINICAL IMPLICATIONS The benefit in patient satisfaction following SLR and PL via ZP during PPI may outweigh the incremental increase in complications. STRENGTH & LIMITATIONS To our knowledge, this is the first prospective randomized controlled study to evaluate the efficacy and safety of SLR, PL, and ZP during PPI. However, because an optimal tool for assessing sexual satisfaction after PPI is lacking at this time, we alternatively adopted the most used assessment tools. Further, our data applies only to malleable penile prosthesis. CONCLUSION SLR and PL via ZP during PPI resulted in a substantial improvement of the patients' sexual satisfaction without serious complications. Fotouh El Gharably MA, Ghoneima W, Lotfi MR, et al. The Efficacy of Suspensory Ligament Release and Pubic Lipectomy Via Penopubic Z Plasty During Penile Prosthesis Implantation in Improving Sexual Satisfaction: A Prospective Randomized Controlled Trial. J Sex Med 2022;19:852-863.
Collapse
Affiliation(s)
| | | | | | | | - Amr Elkady
- Urology Department, Cairo University, Cairo, Egypt
| | | |
Collapse
|
15
|
Bhalla RG, Furuyama W, Calvert JK, Ball M, Dropkin BM, Milam DF, Kaufman MR, Johnsen NV. Impact of Health Literacy on Satisfaction Following Male Prosthetic Surgery. Urology 2022; 164:255-261. [PMID: 35120965 DOI: 10.1016/j.urology.2021.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether a patient's health literacy impacts patient satisfaction following inflatable penile prosthesis (IPP) or artificial urinary sphincter (AUS) placement. METHODS A retrospective study of patients who underwent IPP or AUS between January 1st 2016 and July 31st 2020 was performed. A telephone questionnaire assessed overall satisfaction and if patients would undergo surgery again. Health literacy was measured using the Brief Health Literacy Screen (BHLS). Multivariate ordinal logistic regression was used to assess the association between health literacy and patient satisfaction. RESULTS At a median follow up of 2.4 years, 113 (70%) of the 162 IPP patients were either satisfied or very satisfied with their procedure and 120 (74%) patients would undergo surgery again. Of the 76 AUS patients, 65 (86%) were either satisfied or very satisfied with their procedure and 65 (86%) patients would undergo surgery again. After adjustment for potential confounders, increasing BHLS score was significantly associated with satisfaction for both IPP (OR 1.31, 95% CI 1.11-1.54; p=0.001) and AUS surgery (OR 1.25, 95% CI 1.02-1.56; p=0.034), as well as with likelihood of undergoing IPP surgery again (OR 1.53, 95% CI 1.25-1.87; p<0.001). BHLS was not associated, however, with likelihood of undergoing AUS surgery again (p=0.403). CONCLUSIONS Men with lower health literacy are less likely to be satisfied following prosthetic surgery. The BHLS is an important tool that can be used to identify patients who may benefit from increased preoperative counseling to improve patient expectations and quality of life following prosthetic surgery.
Collapse
Key Words
- AUASI, American Urological Association symptom index
- AUS, Artificial urinary sphincter
- BHLS, Brief health literacy screen
- BMI, Body mass index
- Heath literacy, quality of life, men's health, penile prosthesis, artificial urinary sphincter. Key of Definitions for Abbreviations, AUA, American Urological Association
- IPP, Inflatable penile prosthesis
- PPD, Pads per day
- SHIM, Sexual health inventory for men;QOL, Quality of life
Collapse
Affiliation(s)
- Rohan G Bhalla
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
| | - William Furuyama
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Joshua K Calvert
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Douglas F Milam
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa R Kaufman
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Niels V Johnsen
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Özbay E, Salar R, Oncel HF. Does two-piece PPI provide improvement in patient-partner quality of life? ACTA ACUST UNITED AC 2021; 93:237-240. [PMID: 34286563 DOI: 10.4081/aiua.2021.2.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/02/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study is to retrospectively examine patient-partner satisfaction and changes in quality of life due to two-piece penile prosthesis implantation (PPI). There is no data about partner Quality of Life (QoL) related to two-piece PPI in the literature. MATERIAL AND METHODS SF 36 scale and modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), which were filled before two-piece PPI and at the sixth postoperative month follow-up by male patients (n = 45) and female partners (n = 45), were evaluated. RESULTS We found patient-partner satisfaction rates as 80% and 86% respectively. The changes in all mean scores of SF 36 (mean total score, mean physical health score and mean mental health score) were statistically significant (p < 0.01). Again, the differences between all mean scores of SF 36 according to the level of patient-partner satisfaction were statistically significant (p < 0.01). CONCLUSIONS Two-piece PPI is an important option for ED treatment. It provides significant improvement in patient-partner QoL with high treatment satisfaction.
Collapse
Affiliation(s)
- Engin Özbay
- SBU Istanbul Kanuni Sultan Süleyman Research and Training Hospital, Department of Urology.
| | - Remzi Salar
- SBU Sanlıurfa Mehmet Akif I˙nan Research and Training Hospital, Department of Urology.
| | - Halil Ferat Oncel
- SBU Sanlıurfa Mehmet Akif I˙nan Research and Training Hospital, Department of Urology.
| |
Collapse
|
18
|
Kazemi Z, Mousavi MS, Etemadifar M. The effect of counseling based on the PLISSIT model on sexual quality of life of married women with multiple sclerosis referring to MS center in 2019: a randomized, controlled trial. Arch Womens Ment Health 2021; 24:437-444. [PMID: 33175238 DOI: 10.1007/s00737-020-01080-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Multiple sclerosis is the most common progressive neurological disability in young adults. Sexual quality of life is mainly attributed to feelings of sexual attraction, showing interest and participating in sexual activity. The PLISSIT model shows 4 levels of intervention: Permission, limited Information, Specific Suggestions, and Intensive Therapy. The purpose of this study was to investigate the effect of counseling based on the PLISSIT model on the sexual quality of life of married women with multiple sclerosis referring to MS center in 2019. This randomized controlled trial study was conducted on 62 married women with multiple sclerosis. In the experimental group, based on the PLISSIT model, face-to-face counseling was conducted weekly in 4 sessions and each session lasted between 45 and 75 min. The control group received no intervention. Due to ethical issues, after completing the research, an educational guide on the quality of sexual life was given to the control group. The data collection tool was a questionnaire of sexual quality of life containing 18 questions. Data were analyzed using descriptive statistics and SPSS software. The results showed that there was no significant difference between the two groups before the intervention (P > 0.05). However, 2 weeks and 2 months after the intervention, the overall level of sexual quality of life in the experimental group was significantly better than the control group (P < 0.05). This study showed that counseling based on the PLISSIT model could have better results on the quality of life in sex.
Collapse
Affiliation(s)
- Zahra Kazemi
- Community Health Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, P.O. Box: 81595-158, Jey Street, Isfahan, Iran
| | - Mahsa Sadat Mousavi
- Community Health Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, P.O. Box: 81595-158, Jey Street, Isfahan, Iran.
| | - Masoud Etemadifar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
19
|
Kohn TP, Rajanahally S, Hellstrom WJG, Hsieh TC, Raheem OA. Global Trends in Prevalence, Treatments, and Costs of Penile Prosthesis for Erectile Dysfunction in Men. Eur Urol Focus 2021; 8:803-813. [PMID: 34034995 DOI: 10.1016/j.euf.2021.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 11/04/2022]
Abstract
CONTEXT Penile prosthesis is a durable and effective treatment for erectile dysfunction (ED). Even as other treatment options for ED have been brought to market, penile prosthetic surgery remains a mainstay for urologists treating ED. No systematic study has yet summarized the global trends in penile prosthetic surgery. OBJECTIVE To systematically review studies of trends in penile prosthetic surgery to determine global movements in implantation rates, malleable versus inflatable prosthetic surgery, inpatient versus outpatient implantation surgery, proportion of men with ED undergoing penile prosthetic surgery, and prosthetic cost. EVIDENCE ACQUISITION A systematic review of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov was performed for studies assessing trends in penile prosthetic surgeries and costs associated with penile prosthetic device and inclusive surgical costs. EVIDENCE SYNTHESIS Twenty-seven studies were identified during the systematic review, comprising 447,204 penile prosthetic surgeries reported from 1988 to 2019. A trend analysis demonstrates that rates of penile prosthetic surgery declined dramatically in the late 1980s and early 1990s, but have demonstrated modest growth since the mid-2000s. Outpatient inflatable penile prosthetic surgery has strongly trended upward. Costs of penile prosthetic device have matched the rate of inflation, but inclusive surgical cost has radically outpaced inflation. Growth has mainly been seen in the USA, with a more modest global growth. CONCLUSIONS Penile prosthesis remains a viable option for the treatment of ED. Trends such as outpatient surgery and inflatable penile prosthesis placement may be driving the recent steady growth of penile prosthetic surgeries, but surging inclusive surgical cost may present a barrier for some patients without insurance coverage. PATIENT SUMMARY Penile prostheses continue to be an important treatment for erectile dysfunction. While the volume of penile prosthetic surgeries dropped when phosphidiesterase-5 inhibitors became available, prosthetic surgery is becoming more patient centric, as seen by increases in inflatable prosthetic placement and outpatient surgery.
Collapse
Affiliation(s)
- Taylor P Kohn
- Department of Urology, Johns Hopkins, Baltimore, MD, USA
| | | | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California, San Diego, La Jolla, CA, USA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
| |
Collapse
|
20
|
Manfredi C, Fortier É, Faix A, Martínez-Salamanca JI. Penile Implant Surgery Satisfaction Assessment. J Sex Med 2021; 18:868-874. [PMID: 33903044 DOI: 10.1016/j.jsxm.2021.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Several studies reported high satisfaction rates (> 90%) for patients and their partners after penile prosthesis (PP) implantation. AIM To describe and critically discuss the current evidence regarding the assessment of patient and partner satisfaction after penile implant surgery. METHODS A critical narrative review of the studies investigating the patient and partner satisfaction after PP implantation was designed. Papers in English-language published until January 2021 were included. OUTCOMES The main outcome investigated was patient and partner satisfaction after penile implant surgery. RESULTS The International Index of Erectile Function , the Erectile Dysfunction Inventory of Treatment Satisfaction , the Treatment Satisfaction Scale , and the Quality of Life and Sexuality with Penile Prosthesis are the best-known validated tools used to assess satisfaction after PP implantation. Except for Quality of Life and Sexuality with Penile Prosthesis , they were not validated in patients undergoing penile implant surgery. The lack of an "ad hoc" tool has led to the widespread of nonvalidated questionnaires. Several tools can be useful in the preimplantation counseling, such as the mnemonic Compulsive/obsessive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric , the Minnesota Multiphasic Personality Inventory, the Brief Sexual Symptom Checklist for Men , the Attitude towards Penile Implant , and the Attitude Attributed to the Partner towards Penile Implant . CLINICAL IMPLICATIONS Improvement of knowledge regarding the available tools to evaluate the satisfaction after penile implant surgery. STRENGTHS & LIMITATIONS Comprehensive and thorough review of all the main validated questionnaires available to assess satisfaction in patients with PP. Lack of a systematic approach and quantitative data analysis. CONCLUSION Despite the high satisfaction rate reported in the literature, most of the studies used suboptimal or non-validated questionnaires to assess patients undergoing penile implant surgery. Future research is needed to develop and validate a specific, complete and easy-to-use questionnaire. Manfredi C, Fortier É, Faix A, et al. Penile Implant Surgery Satisfaction Assessment. J Sex Med 2021;18:868-874.
Collapse
Affiliation(s)
- Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Édouard Fortier
- Department of Urology, Montpellier University Hospital, Montpellier, France
| | - Antoine Faix
- Centre de sexologie et andrologie de la Méditerranée (CESAME), Montpellier, France; Men's Health International Surgical Center (MHISC), Genolier, Switzerland.
| | - Juan Ignacio Martínez-Salamanca
- Department of Urology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Lyx Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain
| |
Collapse
|
21
|
Current practices regarding corporotomy localization during penoscrotal inflatable penile implant surgery: a multicenter cohort study. Int J Impot Res 2021; 34:302-307. [PMID: 33846587 DOI: 10.1038/s41443-021-00431-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/24/2021] [Accepted: 03/25/2021] [Indexed: 11/08/2022]
Abstract
Literature concerning corporotomy location in multicomponent inflatable penile prosthetic surgery via a penoscrotal approach is scarce if not nonexistent. Aim of our study was to report practices in low-, moderate-, and high-volume penile implant centers regarding corporotomy location and evaluate its potential impact on intraoperative and short-term postoperative complications. Data from 18 (13 European and 5 American) implant centers were collected retrospectively between September 1st, 2018 and August 31st, 2019. Variables included: intraoperative proximal and distal corpus cavernosum length measurement, total corporal length measurement, total penile implant cylinder length, and length of rear tip extenders. Eight hundred and nine virgin penile implant cases were included in the analysis. Mean age of participants was 61.5 ± 9.6 years old. In total, 299 AMS 700™ (Boston Scientific, USA) and 510 Coloplast Titan® (Minneapolis, MN USA) devices were implanted. The mean proximal/distal corporal measurement ratio during corporotomy was 0.93 ± 0.29 while no statistical difference was found among low-, moderate-, and high-volume penile implant centers. A statistically significant correlation between lower proximal/distal measurement ratio and higher age (p = 0.0013), lower BMI (p < 0.0001), lower use of rear tip extenders (RTE) (p = 0.04), lower RTE length (p < 0.0001), and absence of diabetes (p = 0.0004) was reported. In a 3-month follow up period, 49 complications and 37 revision procedures were reported. This is the first study reporting the current practices regarding corporotomy location during IPP placement in a multicenter cohort, particularly when including such a high number of patients. Nevertheless, the retrospective design and the short follow up period limits the study outcomes. Corporotomy location during penoscrotal IPP implantation does not correlate with intraoperative or short-term postoperative complication rates. Future studies with longer follow up are needed in order to evaluate the association of corporotomy location with long-term complications.
Collapse
|
22
|
Dos Reis MDMF, Barros EAC, Pollone M, Molina MBG, Westin CPDV, Glina S. Preoperative Psychological Evaluation for Patients Referred for Penile Prosthesis Implantation. Sex Med 2021; 9:100311. [PMID: 33714883 PMCID: PMC8072176 DOI: 10.1016/j.esxm.2020.100311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients may remain dissatisfied after penile prosthesis implantation for the treatment of erectile dysfunction. Studies showing the results of standardized protocols for preoperative psychological evaluation are lacking. PURPOSE To estimate the rate of patients considered psychologically unfit for penile prosthesis implantation and to compare their characteristics with those considered fit after the implementation of a standardized psychological profile evaluation protocol for men with erectile dysfunction. METHODS Cross-sectional evaluation of men referred for penile prosthesis implantation by their urologists, based on organic causes for the erectile dysfunction, including a semi-structured (sexual and relational anamnesis of the patient and their partner, information about expectations about the results of the penile prosthesis implantation and possible complications) and a structured instrument including validated tools for the evaluation of depression and/or anxiety symptoms. These were the Self Reporting Questionnaire (SRQ-20), the 36-Item Short-Form Health Survey for quality of life, and the Five-Factor Model (FFM) for behavioral tendencies. After at least 3 interviews, the psychology team rated the patients as fit or unfit for surgery. Unfit patients were those with any of a set of warning signals indicating risk for dissatisfaction even after penile implantation. MAIN OUTCOME MEASURE The prevalence of patients considered "unfit for surgery." RESULTS The quality of life scores were good, but 27.6% of patients (95% confidence interval, CI: 16.7-40.9%) were unfit for surgery. Being unfit was associated with obesity (P = .027), anxiety and/or depression symptoms (P < .001) and high levels of neuroticism (P = .001). CONCLUSION The preoperative evaluation protocol combining standardized and validated tools shows that more than one-quarter of patients with a medical indication for penile prosthesis implantation were not in good psychological conditions for the surgery. The development of psychological evaluation protocols can help identify patients in need of adequate care before penile implantation. M de Mello Ferreira dos Reis, EA Corrêa Barros, M Pollone, et al. Preoperative Psychological Evaluation for Patients Referred for Penile Prosthesis Implantation. Sex Med 2021;9:100311.
Collapse
Affiliation(s)
- Margareth de Mello Ferreira Dos Reis
- Psychologist, Coordinator of the Psychological Care, Sexual Medicine Outpatient Clinic, Urology Department, Faculdade de Medicina do ABC, Santo André (SP), Brazil.
| | - Eduardo Augusto Corrêa Barros
- Urologist, Director of the Sexual Medicine Outpatient Clinic, Urology Department, Faculdade de Medicina do ABC, Santo André (SP), Brazil
| | - Marilisa Pollone
- Psychologist, Sexual Medicine Outpatient Clinic, Urology Department, Faculdade de Medicina do ABC, Santo André (SP), Brazil
| | - Maria Beatriz Gracia Molina
- Psychologist, Sexual Medicine Outpatient Clinic, Urology Department, Faculdade de Medicina do ABC, Santo André (SP), Brazil
| | | | - Sidney Glina
- Urologist, Chief professor, Urology Department, Faculdade de Medicina do ABC, Santo André (SP), Brazil
| |
Collapse
|
23
|
Pozza D, Berardi A, Pozza M, Mosca A, Pozza C. The woman and the penile prosthetic implant. Primary or secondary role? Personal experiences on 355 implanted patients. ACTA ACUST UNITED AC 2021; 93:53-57. [PMID: 33754610 DOI: 10.4081/aiua.2021.1.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/22/2020] [Indexed: 11/23/2022]
Abstract
In a group of 355 pts submitted to Penile Prosthesis Implant (PPI) we recorded data on their relationships with the woman (wife, partner, girlfriend, lover); the aspects of their sexual life; if they were married, divorced or widowed; if they had a lover; if they frequented brothels; if they were satisfied of their actual couple's life; after operation we recorded data concerning if they had some difficulties utilizing the PPI and their level of satisfaction. After operation most pts (93%) confirmed their satisfaction. Relational aspects: Unmarried pts: 6 pts (21-30 years old) who weren't able to penetrate their girlfriends managed to have regular sex with PPI and could marry. 42/46 unmarried pts after PPI decided to marry. In the group of married pts 3 pts weren't able to penetrate their wives; after PPI they managed to have regular intercourses and pregnancies. 15 widowers and 23 divorced pts decided to have a PPI for possible sexual encounters or stable relationships. 96/271 (28,2%) married pts declared a stable extramarital relation that could represent the main reason for having a PPI. The results of PPI are commonly accepted. Until now PPI may re-establish penile rigidity and maintenance. In our opinion the simple act of penetrate and ejaculate in vagina, without considering the importance of personal, relational, emotional factors often well linked to the specific woman, cannot be considered the ideal target of PPI.
Collapse
Affiliation(s)
- Diego Pozza
- Studio di Andrologia e di Chirurgia Andrologica, Rome.
| | | | | | | | | |
Collapse
|
24
|
Ziegelmann MJ, Farrell MR, Levine LA. Modern treatment strategies for penile prosthetics in Peyronie's disease: a contemporary clinical review. Asian J Androl 2020; 22:51-59. [PMID: 31424027 PMCID: PMC6958979 DOI: 10.4103/aja.aja_81_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Peyronie's disease is a common condition resulting in penile deformity, psychological bother, and sexual dysfunction. Erectile dysfunction is one common comorbid condition seen in men with Peyronie's disease, and its presence significantly impacts treatment considerations. In a man with Peyronie's disease and significant erectile dysfunction who desires the most reliable treatment, penile prosthesis placement should be strongly considered. In some instances, such as those patients with relatively mild curvature, prosthesis placement alone may result in adequate straightening. However, many patients will require additional straightening maneuvers such as manual modeling, penile plication, and tunica albuginea incision with or without grafting. For patients with severe penile shortening, penile length restoration techniques may also be considered. Herein, we provide a comprehensive clinical review of penile prosthesis placement in men with Peyronie's disease. Specifically, we discuss preoperative indications, intraoperative considerations, adjunctive straightening maneuvers, and postoperative outcomes.
Collapse
Affiliation(s)
| | - M Ryan Farrell
- Division of Urology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, IL 60612, USA
| |
Collapse
|
25
|
Perioperative management of patients undergoing penile prosthesis surgery in the UK: A survey of current practice. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820931263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: This study aimed to define contemporary perioperative management of patients undergoing penile implant surgery in the UK. Methods: All consultant urological surgeons responsible for the insertion of penile prostheses in the UK were invited to complete an online survey comprising of 25 questions relating to surgeon demographics, patient selection, preoperative work-up, intraoperative management and postoperative care. Anonymised responses underwent descriptive statistical analysis, with particular focus on measures employed to reduce the risk of perioperative infection. Results: Of the 34 invited surgeons, 26 (76.5%) responded to the survey. The majority reported undertaking between 10 and 30 cases in 2018 ( n=17; 65.4%). A total of 23 (88.5%) respondents reported employing a threshold for diabetic control, although the exact limit varied between surgeons. Most respondents ( n=22; 84.6%) reported routinely sampling urine for microscopy, culture and sensitivity. All but one ( n=25; 96.2%) reported routinely performing cavernosal washouts, with the most common solution being a mixture of gentamicin and vancomycin (42.3%). All reported routinely giving intravenous antibiotics on induction of anaesthesia, and although there was no clear consensus, most surgeons preferentially used an aminoglycoside in combination with one other agent (including penicillins or teicoplanin). Conclusion: The variation in current perioperative management demonstrates a potential need for the development and introduction of evidence-based guidelines to standardise practice nationwide. Level of evidence: 5
Collapse
|
26
|
Knoll P, Rai S, Talluri S, Bezinque A, Micciche R, Rao G, Ankem MK. A Survey of Usage of Penile Prosthesis. J Sex Med 2020; 17:2287-2290. [PMID: 32883632 DOI: 10.1016/j.jsxm.2020.07.082] [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: 05/03/2020] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Implantation of an inflatable penile prosthesis (IPP) has high success and satisfaction rates, but there remains a paucity of evidence examining non-usage of IPP and reasons for discontinuation. AIM To identify how frequent patients use their prosthesis and their personal reasons for no longer using it. METHODS We conducted a survey of all patients who underwent an IPP implantation by a single surgeon over a 6-year period, between 2012 and 2018. After application of inclusion and exclusion criteria, a total of 114 patients formed the final cohort. Patients were initially surveyed via mail with a questionnaire; those who did not respond were surveyed via telephone. The factors determining patient selection for IPP implantation included suitability for general anesthesia, manual dexterity to use the device by the patient or their partner on a demonstration device, and presence of refractory erectile dysfunction, HbA1C lower than 8.5, or need for a revision of a previously placed IPP. Universally, a 3-piece AMS 700 Series implant was placed via the penoscrotal approach. Data were analyzed with Pearson chi square test, and survivability of the device was assessed with Kaplan-Meier survival curve. OUTCOMES The main outcomes of this study are the frequency of IPP usage and reasons for discontinuation. RESULTS The survey participation rate was 97%. The mean age of patient was 64 years (range 34-83 years), and the mean time between surgery and completion of survey was 2.98 years (range 0.25-7.4 years). Kaplan-Meier curve demonstrated that 68% of the patients were using the IPP at 5 years after implantation. Using the age 70 years as a cutoff, 18 (22%) patients younger than 70 years and 14 (42%) patients older than 70 years discontinued using the IPP (P = .029). The commonest reasons for discontinuation were poor health to engage in sexual activity (2.6%), loss of companion (19%), loss of interest in sex (2.6%), and device malfunction with no further interest in revision of prosthesis (14%). CLINICAL IMPLICATIONS The clinical implication of this study was improved patient selection for device implantation. STRENGTHS AND LIMITATIONS To our knowledge, no other study has investigated reasons for patients no longer using their prosthesis. Our study has several limitations including that it is a cross-sectional analysis, our survey is not validated, this is a single-surgeon experience, we have a small sample size, and we did not differentiate between virgin implant and reimplantation. CONCLUSION Our study shows a high rate (28%) of non-usage of IPP, more so in men older than the age of 70 years in the first 5 years of implantation. Knoll P, Rai S, Talluri S, et al. A Survey of Usage of Penile Prosthesis. J Sex Med 2020;17:2287-2290.
Collapse
Affiliation(s)
- Paul Knoll
- Department of Urology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Samarpit Rai
- Department of Urology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Sriharsha Talluri
- Department of Urology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Adam Bezinque
- Department of Urology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Ross Micciche
- Department of Urology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Ganesh Rao
- Department of Urology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Murali K Ankem
- Department of Urology, University of Louisville School of Medicine, Louisville, KY, USA.
| |
Collapse
|
27
|
Carlos EC, Nosé BD, Barton GJ, Davis L, Lentz AC. The Absence of a Validated English-Language Survey to Assess Prosthesis Satisfaction: A Prospective Cohort Using the Sexual Quality of Life After Penile Prosthesis. J Sex Med 2020; 17:2307-2310. [PMID: 32811792 DOI: 10.1016/j.jsxm.2020.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/05/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prior assessments of sexual quality of life (SQoL) after penile prosthesis implantation have been performed without validated implant-specific tools. The Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire was designed and validated in Italian to specifically evaluate SQoL after a penile prosthesis is placed. AIM We aim to better characterize prosthesis-specific SQoL after inflatable penile prosthesis placement using the English translation of the QoLSPP questionnaire. METHODS A total of 395 consecutive patients received an inflatable penile prosthesis between January 1, 2009 and November 27, 2017, and 270 had functional emails to whom the QoLSPP questionnaire was sent. 90 surveys were completed by 75 first-time implantees and 15 patients who underwent removal/replacement surgery. Responses were considered positive if ≥ 3. Among first-time implantees, subpopulation analysis was carried out by age at survey completion (<55 years, 55-65 years, and ≥66 years), age of penile prosthesis at survey completion (<1 year, 1-5 years, and >5 years), device model (Coloplast Titan, AMS 700 CX, and AMS LGX), history of a psychiatric diagnosis, etiology of erectile dysfunction, total device length > or ≤ 21 cm, diabetes status, and body mass index < /≥ 30. Responses were analyzed in R using t-tests for continuous variables and Chi-squared tests (Fisher's for small counts) for categorical variables. OUTCOMES The main outcome measure of this study was sexual quality of life assessed by QoLSPP. RESULTS Patients completed the survey on average 3.15 years from their most recent prosthesis placement. 84% of first-time implantees had positive responses. Among them, there were no significant differences in the proportion of positive responses by device type, age, history of a psychiatric diagnosis, total implanted device length, etiology of erectile dysfunction, diabetes, or body mass index statuses (all P > .05). There was no difference in SQoL between first-time implantees and those who underwent removal/replacement surgery (P = 1.0). CLINICAL IMPLICATIONS Patients experience a positive impact on their SQoL following implantation of a penile prosthesis. STRENGTHS & LIMITATIONS Our study is the first to apply the English language QoLSPP which demonstrates high prosthesis specific SQoL but is limited by size and a lack of a validated English language tool. CONCLUSIONS The positive impact on patients' SQoL with penile prosthesis is 84% when assessed by the English QoLSPP questionnaire. While these results mirror those reported from Italy, the English-speaking patient population is plagued with a lack of a validated tool to assess satisfaction, a void the academic and prosthetic community must fill to better understand the impact prostheses have on their patients. Carlos EC, Nosé BD, Barton GJ, et al. The Absence of a Validated English-Language Survey to Assess Prosthesis Satisfaction: A Prospective Cohort Using the Sexual Quality of Life After Penile Prosthesis. J Sex Med 2020;17:2307-2310.
Collapse
Affiliation(s)
- Evan C Carlos
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Brent D Nosé
- Division of Urology, Duke University Medical Center, Durham, NC, USA.
| | - Gregory J Barton
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Leah Davis
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Aaron C Lentz
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
28
|
Marchioni M, De Francesco P, Castellucci R, Papalia R, Sarikaya S, Gomez Rivas J, Schips L, Scarpa RM, Esperto F. Management of erectile dysfunction following robot-assisted radical prostatectomy: a systematic review. MINERVA UROL NEFROL 2020; 72:543-554. [PMID: 32748616 DOI: 10.23736/s0393-2249.20.03780-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION We aimed to summarize evidences about the efficacy of available treatments for erectile disfunction after robotic assisted radical prostatectomy (RARP). EVIDENCE ACQUISITION A systematic literature review searching on PubMed (Medline), Scopus, and Web of Science databases was performed in December 2019. PRISMA guidelines were followed. Population consisted of patients with erectile disfunction after RARP (P), conservative and surgical intervention were considered of interest (I). No comparator was considered mandatory (C). Outcomes of interest were the recovery of erectile function after conservative treatments and sexual function after surgical treatments (O). EVIDENCE SYNTHESIS Eleven studies were included. Seven studies focused on the use of phosphodiesterase-5 inhibitors (PDE5i) alone (five studies) or associated with other treatments (two studies). All the studies confirmed the efficacy of PDE5i, while the most promising association is with vacuum pump erectile devices. Two studies investigated topical treatments, namely low intensity extracorporeal shock wave therapy and alprostadil. Low intensity extracorporeal shock wave therapy may be a promising option in patients in whom nerve-sparing surgery was performed. The use of alprostadil could be an effective alternative to intracorporeal injection in those who underwent non-nerve-sparing surgery. One study focused and confirmed the efficacy of penile implants. Furthermore, one study reported the efficacy of a multi-modal treatment with preoperative medication, showing the benefits of a multimodal approach. CONCLUSIONS Penile rehabilitation with PDE5i is effective after nerve sparing RARP. The association of PDE5i with vacuum devices could led to a faster recovery. A multimodal approach with preoperative specific care seems to be effective to fasten erectile function recovery.
Collapse
Affiliation(s)
- Michele Marchioni
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy - .,Department of Urology, ASL Abruzzo 2, Chieti, Italy - .,European Associations of Urology-European Society of Residents in Urology (EAU-ESRU) -
| | | | | | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Selçuk Sarikaya
- European Associations of Urology-European Society of Residents in Urology (EAU-ESRU).,Department of Urology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Juan Gomez Rivas
- European Associations of Urology-European Society of Residents in Urology (EAU-ESRU).,Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Luigi Schips
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy.,Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Esperto
- European Associations of Urology-European Society of Residents in Urology (EAU-ESRU).,Department of Urology, Campus Bio-Medico University, Rome, Italy
| |
Collapse
|
29
|
Ziegelmann MJ, Bajic P, Levine LA. Peyronie's disease: Contemporary evaluation and management. Int J Urol 2020; 27:504-516. [PMID: 32253786 DOI: 10.1111/iju.14230] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/27/2020] [Indexed: 01/02/2023]
Abstract
Peyronie's disease is a common yet poorly understood condition characterized by penile pain, curvature, sexual dysfunction and psychological bother. Peyronie's disease represents a penile wound healing disorder, and is thought to arise from exuberant scarring in response to penile trauma in genetically predisposed men. In the absence of active treatment, the majority of men experience stable or worsening symptoms, with few reporting spontaneous resolution in penile curvature or other deformity. In contrast, penile pain improves or resolves in the majority of men. Treatment options vary based on symptom severity and stability. Several oral therapies are commonly prescribed, although to date there are no strong data to support any oral agents as monotherapy for Peyronie's disease. Other options including penile traction therapy and intralesional injections result in modest improvements for many patients, particularly when used early after symptom onset. Penile straightening through approaches, such as penile plication and plaque incision or partial excision and grafting, represent the most rapid and reliable approach to correct penile curvature once the symptoms have stabilized. Side-effects vary based on the type of surgery carried out, and include penile shortening, sensation changes and erectile dysfunction in the minority of men. In patients with drug refractory erectile dysfunction and Peyronie's disease, placement of a penile prosthesis will address both issues, and is associated with high levels of patient satisfaction. The current review provides a practical approach to the modern evaluation and management of patients presenting with Peyronie's disease.
Collapse
Affiliation(s)
- Matthew J Ziegelmann
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA.,Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Petar Bajic
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
30
|
Ziegelmann MJ. Penile prosthesis infection-moving the needle forward: a commentary on risk factors associated with penile prosthesis infection: systematic review and meta-analysis. Int J Impot Res 2020; 32:635-637. [PMID: 32152469 DOI: 10.1038/s41443-020-0250-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 11/09/2022]
|
31
|
Lu JY, Miller EJ, Welliver C. A Thematic Analysis of the Online Discussion Board, FrankTalk, Regarding Penile Implant. J Sex Med 2019; 17:325-330. [PMID: 31866124 DOI: 10.1016/j.jsxm.2019.11.258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/23/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Medical websites and discussion boards are commonly used by patients to obtain information. The online forum FrankTalk.org provides a venue specifically for men to discuss sexual dysfunction and particularly inflatable penile prosthesis (IPP). By querying and better understanding the content of this forum related to implants, we can better understand patient concerns before and after IPP. AIM The aim of this study is to understand the main topics being discussed about IPPs online and to use these topics to understand patient concerns and patient needs and to improve care. METHODS Messages posted in a 6-month window from January 2018 to June 2018 under the topic "Implant" were identified on FrankTalk.org. Posts were broken down into preoperative and postoperative and then organized using a 3-stage analysis to determine central themes of each post: open coding, axial coding, and selective coding. MAIN OUTCOME MEASURE The primary outcome measure is the prevalence of each selective code. RESULTS Of all 587 posts, 304 were written preoperatively with the most common theme being "Size" (23.0%), followed by "seeking support" (18.4%). 283 posts were considered postoperative, of which the most common theme was "Concern about healing" (22.6 %) which questioned if they needed to see a physician, followed by size concerns (20.1%).When analyzed with the 3-stage coding system, there were a total of 41 axial codes which were organized into 6 selective codes: "Social Support" (27.8% of all posts), "Pre-Operative Worries" (23.58%),"Technical Issues" (11.1%), "Prosthesis Logistics" (14.37%), "Post-Operative Worries" (20.22%), "Forum and Misc" (2.93%) for topics outside the scope of penile prosthesis. CLINICAL IMPLICATIONS The percentage of men seeking medical opinion is concerning, and providers should consider using resources to better educate patients on normal postoperative findings. Implanters should continue to preoperatively counsel patients on size-related changes with surgery. STRENGTH & LIMITATIONS Strengths include the use of a common online website for men to discuss IPPs and a systematic coding system. Limitations include the applicability of these results to nonheterosexual men as these are likely oversampled in this population. The inherent bias of those willing to post on an online forum may have influenced results along with no oversight for factual accuracy. CONCLUSION Patients use online discussion boards like FrankTalk.org for social support, medical advice, and validation of their concerns. Providers should be aware of these online topic focuses to help open a discussion with patients about concerns they may feel are difficult to approach with providers. Lu JY, Miller EJ, Welliver C. A Thematic Analysis of the Online Discussion Board, FrankTalk, Regarding Penile Implant. J Sex Med 2020;17:325-330.
Collapse
Affiliation(s)
- Jennifer Y Lu
- Albany Medical Center, 50 New Scotland Ave, Albany 12208 NY, USA
| | - Eric J Miller
- Upstate University Hospital, 750 E Adams St, Syracuse 13210 NY, USA
| | - Charles Welliver
- Albany Medical Center, 50 New Scotland Ave, Albany 12208 NY, USA.
| |
Collapse
|
32
|
Fallatah M, Bin Mosa M, Aljuhayman A, Alhathal N. A 3-piece penile prosthesis salvage in the presence of late-onset infected hematoma: Clinical, radiological and intraoperative findings-A case report. Int J Surg Case Rep 2019; 65:309-312. [PMID: 31760219 PMCID: PMC6883338 DOI: 10.1016/j.ijscr.2019.10.084] [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: 08/23/2019] [Revised: 10/26/2019] [Accepted: 10/31/2019] [Indexed: 11/04/2022] Open
Abstract
Penile prosthesis infection is a serious complication often managed radically. In selected patients, infected prosthesis can be salvaged without removal. Wound washout with antimicrobials and antiseptics is a key component of the management.
Introduction Erectile dysfunction (ED) is a common health problem affecting 30% of young men worldwide. Despite the availability of non-invasive lines of management, penile prosthesis insertion is considered as a definite solution for ED. Despite strict perioperative measures, infection still complicates around 3% of penile prosthesis surgeries. Presentation of case This is a case of a 36-year-old male who had an infected scrotal hematoma that led to prosthesis malfunction due to the inability to locate the pump to activate and deactivate the device. Intraoperatively, the prosthesis was salvaged after hematoma evacuation and ensuring a good device functionality. Discussion and conclusion Infected penile prostheses are usually either removed completely with a new device insertion a few months later or exchanged at the same setting with vigorous wound washout. We suggest salvaging penile implants which are surrounded by infected hematomas in selected patients who don’t manifest systemic signs of infection. This approach will help in cost reduction and avoiding further intraoperative complications.
Collapse
Affiliation(s)
- Moayid Fallatah
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Manerh Bin Mosa
- Division of Urology, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
| | - Ahmed Aljuhayman
- Division of Urology, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
| | - Naif Alhathal
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| |
Collapse
|
33
|
Özbay E, Aydın A, Salar R, Durmuş E, Karlıdağ İ, Öncel HF, Sönmez MG. Sexual experiences between partners after penile prosthesis: Who is more satisfied? Andrologia 2019; 52:e13461. [PMID: 31696574 DOI: 10.1111/and.13461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/09/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022] Open
Abstract
Penile prosthesis implantation (PPI) is the final stage treatment in erectile dysfunction (ED). In this study, we planned to investigate the effect of PPI application on sexual functionality in the patients and their partners. After taking permission and consent for the study, from 20 male patients who were applied penile prosthesis due to ED between March 2013 and June 2018 and their partners, the couples were included in the study. Patients and partners filled in Arizona Sexual Experiences Scale (ASEX) form before PPI. After starting to use prosthesis, 20 patients and 19 partners were asked to fill in modified EDITS and ASEX form in the follow-ups in the sixth month. Average age was 54.35 years for the patients and 43.84 for the partners. Although post-PPI sexual satisfaction ratio was detected higher in female partners compared with the male patients, this difference was not statistically significant (p = .71). A significant recovery was also observed in total scale score, physiological stimulation, orgasm capacity and satisfaction scores in both groups after PPI. Penile prosthesis implantation is an operation providing high satisfaction for both the partner and the patient and is still one of the best options of ED.
Collapse
Affiliation(s)
- Engin Özbay
- Department of Urology, Şanlıurfa M. Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | - Arif Aydın
- Department of Urology, NEÜ Meram Medicine Faculty, Konya, Turkey
| | - Remzi Salar
- Department of Urology, Şanlıurfa M. Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | | | - İsmail Karlıdağ
- Department of Urology, Şanlıurfa M. Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | - Halil Ferat Öncel
- Department of Urology, Şanlıurfa M. Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | | |
Collapse
|
34
|
Dave CN, Khalaf A, Patel HD, Kohn TP, Burnett AL. Neurogenic bladder is an independent risk factor for complications associated with inflatable penile prosthesis implantation. Int J Impot Res 2019; 32:520-524. [PMID: 31645755 DOI: 10.1038/s41443-019-0210-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 11/09/2022]
Abstract
Men with neurogenic bladder (NGB) often have concomitant erectile dysfunction and may be considered for inflatable penile prosthesis (IPP) placement. However, it is unclear if NGB is a risk factor for complications associated with IPP placement. The aim of this study is to compare surgical outcomes after IPP placement in a contemporary cohort of patients with NGB to that of a non-neurogenic control group. To accomplish this, consecutive records of patients who underwent IPP implantation between 2007 and 2018 were retrospectively reviewed. Patients with a known neurologic lesion and documented NGB by clinical or urodynamic criteria were compared with a non-neurogenic control group of men with erectile dysfunction. We found that patients in the NGB cohort were younger (median age 48 vs. 62 years, p < 0.001) and less likely to void spontaneously prior to surgery (3% vs. 97%, p < 0.001). The most common cause for NGB was spinal cord injury (46%). There was a 24.3% overall rate of complication (infection, erosion, or mechanical failure) in the NGB cohort compared with a 7.5% rate in the non-neurogenic control group (p = 0.001). On multivariate logistic regression modeling, NGB (OR 3.47; 95% CI 1.13-10.71; p = 0.03) was independently associated with risk of IPP complication. First time penile prosthesis was associated with lower risk of IPP complication (OR 0.25 95% CI 0.09-0.71; p = 0.01). In conclusion, patients with NGB are at increased risk for complications after IPP placement. Patients should be counseled accordingly, and all efforts should be made to stabilize bladder function prior to surgery.
Collapse
Affiliation(s)
- Chirag N Dave
- Johns Hopkins University School of Medicine, Brady Urological Institute, Baltimore, MD, USA
| | - Ahmed Khalaf
- Johns Hopkins University School of Medicine, Brady Urological Institute, Baltimore, MD, USA
| | - Hiten D Patel
- Johns Hopkins University School of Medicine, Brady Urological Institute, Baltimore, MD, USA
| | - Taylor P Kohn
- Johns Hopkins University School of Medicine, Brady Urological Institute, Baltimore, MD, USA
| | - Arthur L Burnett
- Johns Hopkins University School of Medicine, Brady Urological Institute, Baltimore, MD, USA.
| |
Collapse
|
35
|
Commentary on posteroperative vaccuum therapy following AMS LGX 700 inflatable penile prosthesis placement: penile dimension outcomes and overall satisfaction : Is there a benefit to adjunctive vacuum therapy after penile prosthesis placement? Int J Impot Res 2019; 32:142-143. [PMID: 31474752 DOI: 10.1038/s41443-019-0191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 11/08/2022]
|
36
|
Comparison of Long-Term Results and Couples’ Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation. J Sex Med 2019; 16:1092-1099. [DOI: 10.1016/j.jsxm.2019.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 01/08/2023]
|
37
|
Valenzuela RJ, Ziegelmann MJ, Hillelsohn JH, Farrell MR, Kent MA, Levine LA. Preliminary Outcomes of the Male Urethral "Mini-Sling": A Modified Approach to the Andrianne Mini-Jupette Procedure With Penile Prosthesis Placement for Climacturia and Mild Stress Urinary Incontinence. J Sex Med 2019; 16:1310-1317. [PMID: 31109775 DOI: 10.1016/j.jsxm.2019.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/08/2019] [Accepted: 04/13/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Previous worked showed that the Andrianne Mini-Jupette (AMJ) procedure with inflatable penile prosthesis (IPP) significantly improves climacturia or stress urinary incontinence (SUI) that may accompany erectile dysfunction (ED) after radical prostatectomy. However, with the AMJ procedure, the graft is incorporated into the medial aspect of the corporotomy, thereby requiring a more complex closure. Moreover, in the original report, multiple graft materials were used. AIM To describe our technique for "male urethral mini-sling" (MUMS) with a Virtue sling mesh, which is a modified approach to the AMJ, and to assess early postoperative outcomes. METHODS A retrospective chart review was performed for men who underwent IPP and MUMS placement with a modified Virtue mesh by 2 high-volume prosthetic urologic surgeons using the same technique. After proximal urethral exposure, the MUMS is sutured to the latera corpora over the bulbar urethra, proximal to and separate from the planned corporotomy, with care taken to avoid excessive urethral tension. The IPP is then placed in standard fashion. Changes in patient-reported climacturia and pads per day for SUI were assessed before and after surgery. RESULTS 36 men underwent both IPP and MUMS placement between January 2016-October 2018. Mean patient age was 68 years. Etiology for ED and urinary symptoms was prostatectomy alone in 30 of 36 (83%) and prostatectomy plus radiation in 6 of 36 (17%). Preoperative urinary symptoms included climacturia in 30 of 36 (83%) and SUI in 27 of 36 (75%). Mean (SD) follow-up was 5.9 (3.7) months. Climacturia resolved in 28 of 30 (93%), and SUI improved in 23 of 27 (85%). The mean (SD) number of pads per day for those patients with SUI decreased significantly from 1.4 (1.1) before surgery to 0.4 (0.6) after surgery (P = .02). 1 patient required MUMS explantation for urethral erosion after prolonged postoperative catheterization. CLINICAL IMPLICATIONS The MUMS with modified Virtue mesh at the time of IPP placement can be used to treat ED with climacturia or mild SUI after radical prostatectomy. STRENGTHS & LIMITATIONS Strengths include the use of a consistent operative technique with a single graft material by 2 experienced prosthetic urologic surgeons. Limitations include the retrospective study design, use of subjective postoperative outcomes, lack of comparison group, and relatively moderate follow-up duration. CONCLUSIONS Our early results suggest that the MUMS significantly improves bothersome climacturia and mild SUI in addition to treating ED, with little added morbidity. Although further study, including longer-term follow-up, is needed, this approach may be considered in the appropriately counseled patient. Valenzuela RJ, Ziegelmann MJ, Hillelsohn JH, et al. Preliminary Outcomes of the Male Urethral "Mini-Sling": A Modified Approach to the Andrianne Mini-Jupette Procedure With Penile Prosthesis Placement for Climacturia and Mild Stress Urinary Incontinence. J Sex Med 2019;16:1310-1317.
Collapse
Affiliation(s)
- Robert J Valenzuela
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, NY, USA
| | | | - Joel H Hillelsohn
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, NY, USA
| | - M Ryan Farrell
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Marissa A Kent
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, NY, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|