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Hawks-Ladds N, Babar M, Labagnara K, Loloi J, Patel RD, Aalami Harandi A, Zhu M, Salami A, Maria P. Risk factors for reoperation of inflatable penile prosthesis among an ethnically diverse urban population in a high-volume center. Int J Impot Res 2024:10.1038/s41443-024-00966-8. [PMID: 39187572 DOI: 10.1038/s41443-024-00966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/06/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
Inflatable penile prosthesis (IPP) is a surgical treatment for erectile dysfunction refractory to medical therapy or for those who desire permanent treatment. Complications like mechanical failure and infection may necessitate reoperation, and patients with certain risk factors remain predisposed to reoperation. We retrospectively analyzed 530 patients undergoing primary IPP implantation at a large, urban, multiethnic hospital with a high volume of IPP implantations. Primary outcomes were reoperation due to any reason and reoperation due to infection. Patient characteristics and intraoperative factors were compared between those requiring reoperation and those not requiring reoperation. Overall, 12.1% of patients underwent reoperation, primarily due to infection, with a median time to reoperation of 4 months. Analysis revealed an increased likelihood of reoperation with Peyronie's disease (OR = 2.47), hemoglobin A1c over 8 (OR = 2.25), active smoking (OR = 2.75), and estimated blood loss (EBL) ≥ 25cc (OR = 2.45). A decreased likelihood of reoperation was observed when Arista™ powder was used intraoperatively (OR = 0.38). Reoperation specifically due to infection was associated with an infrapubic approach (OR = 2.56) and hypertension (OR = 9.12). Our findings confirm smoking and diabetes as risk factors for reoperation, while also providing insights into factors like estimated blood loss and Arista™ powder use. However, long-term survival rates were limited by loss to follow-up. (Clinical trial registration N/A).
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Affiliation(s)
| | | | - Kevin Labagnara
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Rutul D Patel
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Michael Zhu
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Pedro Maria
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
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2
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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.
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Abou Chawareb E, Nakamura H, Hammad MAM, Miller JA, Lumbiganon S, Azad BK, Yafi FA. Search traffic for inflatable penile prosthesis increased following the COVID-19 pandemic in the United States: a Google Trends analysis. Int J Impot Res 2024:10.1038/s41443-024-00922-6. [PMID: 38816575 DOI: 10.1038/s41443-024-00922-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
We aimed to determine the impact of the COVID-19 pandemic on search trends for inflatable penile implants in the US. Search trends for inflatable penile implants ranging from 2016 through 2023 were analyzed utilizing Google Trends. Associations between search trends and US Census Bureau data, including average household income and per capita income, were analyzed. Pre- and post- COVID-19, the interest in inflatable penile implants has been steadily increasing on average in the US. The average household income for counties with the highest interest in inflatable penile implants during the pre-COVID era was $53,136, whereas for the counties with the highest interest in inflatable penile implants in the post-COVID era, the average decreased to $50,940. Similarly, the average per capita median decreased from $35,209 to $34,547. Search traffic for inflatable penile prosthesis increased following the pandemic in the US. Nevertheless, post-pandemic, individuals with lower income levels showed no change in interest in penile implant searches compared to the pre-pandemic period. Understanding this steadiness in interest can inform healthcare professionals and policymakers to tailor interventions and educational efforts to reach a broader audience, ensuring equitable access to information and healthcare resources.
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Affiliation(s)
| | - Hana Nakamura
- Department of Urology, University of California, Irvine, CA, USA
| | | | - Jake A Miller
- Department of Urology, University of California, Irvine, CA, USA
| | - Supanut Lumbiganon
- Department of Urology, University of California, Irvine, CA, USA
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Babak K Azad
- Department of Urology, University of California, Irvine, CA, USA
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, CA, USA
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4
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Bernstein AP, Loloi J, Hillelsohn J. Comment on: "Scrotal approach for tunica expansion procedure (TEP) for penile girth and length restoration in patients with penile angulation due to Peyronie's disease and erectile dysfunction: technique and outcomes". Int J Impot Res 2024; 36:164-165. [PMID: 36670285 DOI: 10.1038/s41443-023-00665-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Ari P Bernstein
- New York University Langone Health, Department of Urology, New York, NY, USA.
| | - Justin Loloi
- Montefiore Medical Center, Department of Urology, Bronx, NY, USA
| | - Joel Hillelsohn
- New York University Langone Health, Department of Urology, New York, NY, USA
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5
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Razdan S, Zisman A, Valenzuela R. Scrotal approach for tunica expansion procedure (TEP) for penile girth and length restoration during penile prosthesis implantation in patients with penile angulation due to Peyronie's disease and erectile dysfunction: technique and outcomes. Int J Impot Res 2024; 36:146-150. [PMID: 36528741 DOI: 10.1038/s41443-022-00652-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
Peyronie's disease is often comorbid with erectile dysfunction and can cause significant penile shortening. We describe our modified tunica expansion procedure (TEP) technique of penile length preservation and girth enhancement with correction of penile angulation in patients with mild Peyronie's disease (<30 degree angulation, or hourglass deformity, no hinging) and erectile dysfunction presenting for inflatable penile prosthesis (IPP) surgery. A retrospective review of IPP placement from one high volume surgeon was performed. A total of 474 patients' charts from June 2017 to June 2021 were reviewed and those charts of patients undergoing modified TEP in the setting of Peyronie's disease were analyzed. Average increase in length and girth were measured and means with standard deviations calculated. The modified TEP is performed through a scrotal approach and involves complete eversion of the penis with dissection of Buck's fascia off the underlying tunica. Subsequently, staggered scorings of the underlying tunica are performed allowing for circumferential girth enhancement and length preservation. In men with Peyronie's disease, these scorings are preferentially concentrated on the side of the plaque to allow straightening without loss of length. A total of 32 patients with Peyronie's disease from the larger cohort underwent the modified TEP. Mean increase in length of distal corpora was 2.8 ± 0.8 cm (range 2.0-3.4 cm) (measured using Furlow before and after penile eversion with TEP), while mean increase in girth (measured at midphallus prior to prosthesis insertion and after IPP inflation) was 1.6 ± 0.4 cm (range 1.2-2.2 cm). There were no reported complications. A scrotal approach to TEP is an easy to perform technique that can be used to restore length and enhance girth in men with Peyronie's disease undergoing insertion of IPP. Additionally, it is a customizable approach that can also be used to correct mild penile angulation.
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Affiliation(s)
- Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Ariel Zisman
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Robert Valenzuela
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Manfredi C, Russo GI, Capogrosso P, Falcone M, Capece M, Sokolakis I, Verze P, Salonia A, Tsambarlis P, Seligra Lopes L, Romero-Otero J, DE Sio M, Levine L. Quality of life and sexuality with penile prosthesis: a systematic review and pooled analysis. Minerva Urol Nephrol 2024; 76:166-175. [PMID: 37795696 DOI: 10.23736/s2724-6051.23.05466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) is the first validated questionnaire to specifically evaluate the satisfaction of patients undergoing penile prosthesis implantation. Our primary aim was to conduct a systematic review and pooled analysis of articles reporting QoLSPP. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE, Scopus, Web of Science, and Cochrane Library databases was performed in April 2023. Studies were selected if they assessed male subjects (P) undergoing penile prosthesis implantation (I) with or without comparison with other treatments (C), reporting the patient satisfaction according to QoLSPP (O). Prospective and retrospective original studies were included (S). The risk of bias was assessed using the ROBINS-I tool and the Knoll method. Means and standard deviations (SDs) of QoLSPP scores were included in the pooled analysis. PROSPERO ID: "CRD42023427261." EVIDENCE SYNTHESIS A total of 10 studies investigating 1105 patients were included in the systematic review; of these, eight articles describing the outcomes of 693 subjects were eligible for the pooled analysis. Overall serious risk of bias was found in 2/3 of nonrandomized comparative studies (66%), while seven single-arm studies (100%) were classified as having a high risk of bias. Pooled analysis of the QoLSPP-Functional domain revealed an overall effect size (ES) of 4.22 points (95% CI 4.04-4.40; P<0.001). The QoLSPP-Relational pooled score was 4.17 points (95% CI 4.03-4.31; P<0.001). The QoLSPP-Social pooled score corresponded to 4.21 points (95% CI 4.02-4.40; P<0.001). Pooled analysis of the QoLSPP-Personal domain showed an overall ES of 3.97 points (95% CI 3.61-4.32; P<0.001). There was insufficient data to pool QoLSPP total scores. CONCLUSIONS Patients undergoing penile prosthesis implantation report positive scores in all QoLSPP domains, demonstrating high satisfaction levels. Future studies are needed to improve the evidence on the topic.
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Affiliation(s)
- Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy -
- Department of Urology, Rush University Medical Center, Chicago, IL, USA -
| | - Giorgio I Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Marco Falcone
- Department of Urology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Marco Capece
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ioannis Sokolakis
- Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paolo Verze
- Scuola Medica Salernitana, Department of Medicine, Surgery, Dentistry, University of Salerno, Salerno, Italy
| | - Andrea Salonia
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Peter Tsambarlis
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | | | | | - Marco DE Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Laurence Levine
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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7
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Ziegelmann MJ, Langbo WA, Bajic P, Levine LA. Comparison of patient-reported outcomes after penile prosthesis placement in men with and without Peyronie's disease. Int J Impot Res 2023; 35:569-576. [PMID: 36038732 DOI: 10.1038/s41443-022-00600-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 11/08/2022]
Abstract
We evaluated outcomes in patients undergoing penile prothesis (PP) implantation for erectile dysfunction (ED) and concurrent Peyronie's Disease (PD). A clinician-developed survey to assess satisfaction was sent to 354 patients who underwent PP placement from 2012-2018 by a single-surgeon. Results were compared based on the presence or absence of concurrent PD. 79 patients completed the survey (response rate 22%), including 38 patients (48%) with concurrent ED and PD (ED/PD). Mean follow-up was 31 months (standard deviation 19). 87% felt their condition was "very much" or "much" improved. There was no significant difference in patient-reported overall satisfaction with their PP or satisfaction with current penile length/girth based on the presence or absence of PD. 87% of patients with PD were satisfied with their degree of penile straightening after PP plus or minus concurrent straightening maneuvers such as modeling, plication, or incision/grafting. Sub-group analyses were performed to evaluate outcomes in those with concurrent PD/ED who required plaque incision/grafting at the time of PP placement for more severe deformity (n = 19). 47% of these patients were dissatisfied with their current penile length, compared with only 16% of those patients with PD/ED who did not require grafting (p = 0.05). In conclusion, the presence of PD alone may not impact PP satisfaction, but patients with more severe baseline deformity who require incision/grafting may be less satisfied with outcomes including penile length.
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Affiliation(s)
| | - William A Langbo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Petar Bajic
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Laurence A Levine
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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8
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Kaynak Y, Gruenwald I. Long-term effects of combination treatment comprising low-intensity extracorporeal shockwave therapy and tadalafil for patients with erectile dysfunction: a retrospective study. Int J Impot Res 2023:10.1038/s41443-023-00757-7. [PMID: 37644168 DOI: 10.1038/s41443-023-00757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
This study retrospectively examined the effects of low-intensity extracorporeal shockwave therapy and tadalafil on erectile dysfunction patients. 116 patients got low-intensity extracorporeal shockwave therapy twice weekly for 3 weeks, 5 mg of tadalafil daily for 3 weeks, and adjuvant therapy for 6 months. Group A (1 year), Group B (2 years), Group C (3 years), and Group D (4+ years) were treated patients' follow-up groups. The patients' International Index of Erectile Function-5 (IIEF-5) scores were gathered at the start of treatment via face-to-face interviews and at the end of follow-ups by telephone conversations. IIEF-5 scores and the minimal clinically significant differences were the main outcomes. Mean follow-up length, age, and IIEF-5 scores of the patients were 2 ± 1.16 years, 47.34 ± 12.65 years, and 12.09 ± 3.66 points, respectively. Compared to baseline, treatment increased the median IIEF-5 scores of patients in groups A, B, C, and D by 7 [3-12], 6 [0-8], 7 [1-9], and 6.5 [2.5-10] points, respectively (p = 0.001). 71%, 63%, 65.8%, and 65% of treated patients in groups A, B, C, and D met the minimal clinically significant differences criteria (n = 77). Mild disease patients were 9.14 times more likely to respond to treatment than severe illness patients (OR, 9.14; 95% CI, 1.28-65.46; P = 0.02). Low-intensity extracorporeal shockwave therapy and 5 mg of tadalafil can treat erectile dysfunction for up to 4 years with sustained outcomes. This treatment is optimal for mild illnesses.
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Affiliation(s)
- Yurdaer Kaynak
- Urology Clinic of Private Umit Visnelik Hospital, Eskişehir, Turkey.
| | - Ilan Gruenwald
- Neuro-Urology Unit, Rambam Healthcare Campus, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Beirnaert J, Benarroche D, Tabourin T, Weis S, Faix A, Beley S, Huyghe E, Guillot-Tantay C, Droupy S, Akakpo W, Pinar U, Rouprêt M. [French language validation of the SSIPI questionnaire assessing the satisfaction of patients with penile implant]. Prog Urol 2023; 33:21-26. [PMID: 36153223 DOI: 10.1016/j.purol.2022.09.007] [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: 06/29/2022] [Revised: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The objective of this study was to propose a French version of the satisfaction survey for inflatable penile implant (SSIPI) questionnaire. MATERIAL Questionnaire validation was performed in three steps: translation into French by two urologists, its validation by the committee of andrologist and sexual medicine (CAMS) and an independent translation in English by another urologist to exclude any distortion with the original version. Furthermore, the questionnaire was tested in few patients having penile implant. RESULTS The andrology committee approved the French version of the questionnaire. The final version of the questionnaire was successfully tested on all patients. Every patient (n=10) confirmed the good comprehension and pertinence of the questions, and the easy response selection. CONCLUSION This French version of the SSIPI questionnaire will allow French-speaking urologists to assess the satisfaction of their patients with a penile implant on a large scale. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jeanne Beirnaert
- Sorbonne université, GRC 5 prédictive onco-uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France; Université Libre de Bruxelles, hôpital Erasme, service d'urologie, 1080 Bruxelles, Belgique
| | - Davy Benarroche
- Sorbonne université, GRC 5 prédictive onco-uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Thomas Tabourin
- Sorbonne université, GRC 5 prédictive onco-uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Sylvia Weis
- Sorbonne université, GRC 5 prédictive onco-uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Antoine Faix
- Polyclinique Saint-Roch, service d'urologie, 34070 Montpellier, France
| | - Sébastien Beley
- Hôpital américain de Paris, service d'urologie, 92200 Neuilly-sur-Seine, France
| | - Eric Huyghe
- CHU de Toulouse, hôpital Rangueil, service d'urologie, 31059 Toulouse, France
| | | | | | - William Akakpo
- Clinique Ambroise Paré, service d'urologie, 92200 Neuilly-sur-Seine, France
| | - Ugo Pinar
- Sorbonne université, GRC 5 prédictive onco-uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Morgan Rouprêt
- Sorbonne université, GRC 5 prédictive onco-uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France.
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10
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Swanton AR, Gross MS. Comment on Does knowing pre-operative penile length influence patient satisfaction post penile prosthesis implantation? Int J Impot Res 2022; 34:800. [PMID: 35064253 DOI: 10.1038/s41443-021-00517-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/28/2021] [Accepted: 12/07/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Amanda R Swanton
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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11
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Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022; 10:409-420. [PMID: 35772849 DOI: 10.1016/j.sxmr.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Across many cultures, penis size has been associated with virility, and concerns about penile length are commonplace. Peyronie's disease (PD) is a known acquired cause of penile shortening. OBJECTIVES This paper describes the psychosocial impacts of penile length on men and their partners, both generally and in men with PD, and evaluates the effect of PD treatments (eg, collagenase clostridium histolyticum , surgery, mechanical therapy) on this outcome measure. METHODS A PubMed database search was performed for English language articles through July 2021. Main outcome measures were association of penile length with emotional well-being, selfesteem, and relationship satisfaction in men with PD, and change from baseline penile length after treatment. RESULTS Shortened penile length caused by PD can negatively impact patient and partner quality of life, including effects on body image, emotional well-being, sexual function, and interpersonal relationships. In men with PD, studies have demonstrated an association between loss of penile length and emotional problems, reduced satisfaction with sexual performance, poor self-esteem, depression, and relationship difficulties. Loss of penile length can frequently occur after surgery for PD (including plication, plaque incision/excision with grafting, and penile implant). Advanced surgical techniques may preserve/increase penile length, but the increased risks associated with these complex procedures must be carefully considered. Treatment with collagenase clostridium histolyticum does not appear to negatively impact penile length, and 5-year follow-up data suggest potential longterm posttreatment improvements in this outcome measure. Penile traction therapy, either alone or as adjunctive therapy, may increase penile length in men with PD, but nonadherence may limit improvement. CONCLUSION Changes in penile length are important to many men, particularly those with PD, and should be considered during PD treatment selection. Penile length should be measured objectively before and after treatment for PD and should be included as an outcome measure in future studies on treatment effectiveness. Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022;10:409-420.
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12
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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.
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Affiliation(s)
| | | | | | | | - Amr Elkady
- Urology Department, Cairo University, Cairo, Egypt
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13
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Naughton A, Muheilan MM, Casey RG. Intra-abdominal migration of a penile prosthesis reservoir. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211039741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ailish Naughton
- Department of Urology, Tallaght University Hospital, Ireland
| | | | - Rowan G Casey
- Department of Urology, Tallaght University Hospital, Ireland
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Cayetano-Alcaraz AA, Yassin M, Desai A, Tharakan T, Tsampoukas G, Zurli M, Minhas S. Penile implant surgery-managing complications. Fac Rev 2021; 10:73. [PMID: 34632459 PMCID: PMC8483239 DOI: 10.12703/r/10-73] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments or vacuum constriction devices. Contemporary literature suggests that penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient’s quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. Several factors – such as appropriate patient selection, methodical preoperative assessment and patient optimization, specific intraoperative protocols and postoperative recommendations – can reduce the risk of surgical complications. This narrative review discusses the diagnosis and management of both intraoperative and postoperative complications of penile prosthesis surgery.
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Affiliation(s)
| | - Musaab Yassin
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Ankit Desai
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Tharu Tharakan
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | | | - Martina Zurli
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Suks Minhas
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
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Chung E, Mulhall J. Practical Considerations in Inflatable Penile Implant Surgery. J Sex Med 2021; 18:1320-1327. [PMID: 34247953 DOI: 10.1016/j.jsxm.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Penile prosthesis implantation remains an effective solution for men with medical-refractory erectile dysfunction (ED) following radical pelvic surgery. Despite the distortion of pelvic anatomy, a penile implant can be performed with excellent clinical outcomes provided strict patient selection, proper preoperative workup and safe surgical principles are adhered to. AIM To provide practical recommendations on inflatable penile prosthesis (IPP) implantation in patients with medical-refractory ED, with an emphasis on patient selection and counselling, preoperative workup as well as surgical considerations to minimize intraoperative complications. METHODS A Medline search on relevant English-only articles on penile prostheses and pelvic surgery was undertaken and the following terms were included in the search for articles of interest: "bladder cancer", "prostate cancer", "rectal cancer", "pelvic surgery" and "inflatable penile implant". OUTCOMES Clinical key recommendations on patient selection, preoperative workup and surgical principles. RESULTS Patients should be made aware of the mechanics of IPP and the informed consent process should outline the benefits and disadvantages of IPP surgery, alternative treatment options, cost, potential prosthetic complications and patient's expectations on clinical outcomes. Specialised diagnostic test for workup for ED is often not necessary although preoperative workup should include screening for active infection and optimising pre-existing medical comorbidities. Precautionary measures should be carried out to minimise infective complication. Corporal dilation and reservoir placement can be challenging in this group, and surgeons may require knowledge of advanced reconstructive surgical techniques when dealing with specific cases such as coexisting Peyronie's disease and continence issue. CLINICAL TRANSLATION Strict patient selection and counselling process coupled with safe surgical principles are important to achieve excellent linical outcomes and patient satisfaction rates. STRENGTHS AND LIMITATIONS This masterclass paper provides an overview of the practical considerations for men who are undergoing IPP surgery following radical pelvic surgery. Limitations include the lack of highquality data and detailed surgical description on each surgical troubleshooting steps for various prosthetic-related complications. CONCLUSION The IPP implantation can be performed efficiently and safely in patients following radical pelvic surgery. Chung E, Mulhall J. Practical Considerations in Inflatable Penile Implant Surgery. J Sex Med 2021;18:1320-1327.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane QLD, Australia; Princess Alexandra Hospital, University of Queensland, Brisbane QLD, Australia; Macquarie University Hospital, Sydney, NSW, Australia.
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