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Ancha N, Eldin M, Woodle T, Gereta S, Hariprasad K, Butler I, Charles Osterberg E. Current devices, outcomes, and pain management considerations in penile implant surgery: an updated review of the literature. Asian J Androl 2024; 26:335-343. [PMID: 38376174 PMCID: PMC11280207 DOI: 10.4103/aja202386] [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: 07/12/2023] [Accepted: 12/11/2023] [Indexed: 02/21/2024] Open
Abstract
Penile prosthesis surgery is a definitive treatment for erectile dysfunction (ED). The two categories of penile prosthesis are endorsed by professional guidelines, inflatable penile prosthesis (IPP) and malleable penile prosthesis (MPP). Each modality of penile prosthesis offers distinct advantages and incorporates specific design features, allowing for personalized device selection that aligns with individual needs and preferences. While the overall complication rate of penile implant surgery remains low, surgeons should maintain a high index of suspicion for complications in the perioperative time period. Multimodal analgesic regimens including nerve blocks and narcotic-free pathways should be administered to manage perioperative pain. Finally, the high patient satisfaction after penile prosthesis surgery underscores the success of this ED treatment option.
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Affiliation(s)
- Nirupama Ancha
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - Maya Eldin
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - Tarah Woodle
- Department of Urology, Brooke Army Medical Center, San Antonio, TX 78234, USA
| | - Sofia Gereta
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - Krishna Hariprasad
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Imani Butler
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - E Charles Osterberg
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
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Satwikananda H, Laksita TB, Djatisoesanto W, Soebadi DM. Efficacy and safety of malleable penile prosthesis compared to inflatable penile prosthesis in erectile dysfunction patients. Arch Ital Urol Androl 2024; 96:12353. [PMID: 38934528 DOI: 10.4081/aiua.2024.12353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/24/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Erectile dysfunction can cause self-withdrawal and decreased quality of life. Patients who do not respond to pharmacological therapy and other conservative treatments are urged to undergo penile prosthesis implantation. Malleable penile prosthesis was the first prosthesis developed, but then inflatable penile prosthesis was developed to give a more natural erection. There is no meta-analysis comparing inflatable and malleable penile prostheses in terms of safety and efficacy. This study is conducted to evaluate patient and partner satisfaction, ease of use, mechanical failure, and infection rate in patients who underwent penile prosthesis implantation. METHOD This meta-analysis followed Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols. Five eligible studies were included from Pubmed, Scopus, ScienceDirect, and SemanticScholar databases. RESULT In this study, patient and partner satisfaction are significantly better (OR 3.39, 95% CI 1.66-6.93, p = 0.0008) (OR 2.32, 95% CI 1.75-3.08, p < 0.00001). Mechanical failure is also significantly higher in inflatable penile prostheses (OR 5.60, 95% CI 2.02-15.53, p = 0.0009). There is no significant difference in terms of ease of use and infection rate in inflatable or malleable penile prostheses. CONCLUSIONS This study concluded that inflatable penile prosthesis is better in terms of patient and partner satisfaction, but mechanical failures occur more frequently in this type of prosthesis.
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Affiliation(s)
- Handaru Satwikananda
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Tetuka Bagus Laksita
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Universitas Airlangga Teaching Hospital, Surabaya, East Java.
| | - Wahjoe Djatisoesanto
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Universitas Airlangga Teaching Hospital, Surabaya, East Java.
| | - Doddy Moesbadianto Soebadi
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Universitas Airlangga Teaching Hospital, Surabaya, East Java.
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Al-Madhagi H, Tarabishi AA. Nutritional aphrodisiacs: Biochemistry and Pharmacology. Curr Res Food Sci 2024; 9:100783. [PMID: 38974844 PMCID: PMC11225857 DOI: 10.1016/j.crfs.2024.100783] [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: 03/11/2024] [Revised: 04/08/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
In 2022, the global prevalence of erectile dysfunction (ED) was estimated to be at least 150 million cases. This number is greatly suspected to be underestimate as most men withhold information about ED. Also, about 15% of world population have infertility troubles, and male factors are responsible for almost half of these cases. Studies have shown that the quality of semen has decreased in the past several decades owing to various health factors and environmental toxicants. The current medical interventions involve the inhibition of phosphodiesterase 5 which suffer from serious side effects and costly. One of the popular and most sought interventions are the natural and nutritional remedies as they are foods in essence and potentially with no harm to the body. Therefore, the goal of this paper is to provide a review of the most common nutritional aphrodisiacs with increasing libido and fertility highlighting the potential active constituents as well as the underlying mechanisms.
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Byrne ER, Ungerer GN, Ziegelmann MJ, Kohler TS. Complications and troubleshooting in primary penile prosthetic surgery-a review. Int J Impot Res 2023; 35:679-685. [PMID: 37106087 DOI: 10.1038/s41443-023-00699-0] [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: 01/28/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Penile implant surgery is the gold standard to treat erectile dysfunction with success rates of over 90%. The first penile implants were developed in the early 1900s. Since then, several types of implants have been developed including malleable implants, two-piece inflatable implants, and three-piece inflatable implants. The three-piece inflatable penile prosthesis, which was introduced in 1973, is the most widely used type of penile implant in the United States. Penile implant surgery has undergone numerous advancements over the years, improving outcomes and patient satisfaction. However, as with any surgical procedure, there are risks and complications associated with penile implant surgery. It is important for surgeons to understand these potential complications and to have strategies in place to manage and prevent them to achieve the best possible outcomes for their patients.
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May E, Hanley M, Mulcahy JJ, Gross MS. Technological advances in penile implants: past, present, future. Int J Impot Res 2023; 35:629-633. [PMID: 36977850 DOI: 10.1038/s41443-023-00689-2] [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: 12/01/2022] [Revised: 02/26/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
Attempts to "cure" erectile dysfunction (ED) are as old as recorded history. The history of penile prosthetic devices dates back over 500 years, when a French military surgeon designed the first known wooden prosthesis to support micturition. There have since been a great many technological advancements in penile prosthetics. Penile implants for the improvement of sexual function date to the twentieth century. Like all human endeavors, penile prosthesis innovations have progressed via trial and error. This review aims to provide an overview of penile prostheses for the treatment of ED since their introduction in 1936. More specifically, we aim to highlight important advances in penile prosthesis development and discuss dead ends that were abandoned. Highlights include two-piece inflatables, three-piece inflatables, and malleable/semirigid, along with modifications and updates to each basic design that improved both insertion and usability. Dead ends include innovative ideas that were lost to history due to a variety of factors. We also look to the future and discuss expected advances, including remotely activated devices and prostheses designed for special populations, including transgender men.
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Affiliation(s)
- Emily May
- Dartmouth College Geisel School of Medicine, Hanover, NH, USA
| | - Meg Hanley
- Dartmouth College Geisel School of Medicine, Hanover, NH, USA
| | - John J Mulcahy
- Department of Urology, University of Arizona, Tucson, AZ, USA
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
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Falcone M, Capogrosso P, Cirigliano L, Geretto P, Preto M, Timpano M, Ceruti C, Peretti F, Ferro I, Plamadeala N, Dehò F, Bettocchi C, Manfredi C, Spirito L, Palmieri A, Manassero A, Blecher G, Gontero P. The outcomes of penile prosthesis in neurologic patients: a multicentric retrospective series. Ther Adv Urol 2023; 15:17562872231194921. [PMID: 37664080 PMCID: PMC10472821 DOI: 10.1177/17562872231194921] [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: 01/20/2023] [Accepted: 07/22/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Neurological disease is a known entity for causing erectile dysfunction (ED). Pharmacological therapies are not always effective these patients - penile prosthesis implant (PPI) is an established surgical treatment option. For a variety of reasons, neurological patients may experience differing outcomes of PPI compared to those whose ED arises from other causes. We investigated outcomes of PPI in neurological patients using the Italian multi-institutional national registry of penile prostheses [Italian Nationwide Systematic Inventarization of Surgical Treatment for ED (INSIST-ED)]. Methods Patients undergoing PPI were investigated via the INSIST-ED registry, from 2014 to 2021. Data were prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and reviewed by a data manager. We subselected patients with neurological disease undergoing PPI for ED, and these patients were reviewed at 3, 6, and 12 months, and annually thereafter. Postoperative complications and functional outcomes were evaluated through validated questionnaires [International Index of Erectile Function-5 (IIEF-5), Sexual Encounter Profile 2-3, and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS)]. A nonvalidated questionnaire was administered to assess patient satisfaction. Results A total of 33 patients were included with a median age of 49 [interquartile range (IQR) 41-55]. Median follow-up was 83 months (IQR 67-99.5). A penoscrotal approach for PPI was performed in most cases (90.9%), while infrapubic was used in three cases (9.1%). Inflatable and malleable devices were implanted in 30 (90.9%) and 3 cases (9.1%), respectively. Intraoperative complications occurred in one case (3%). Early postoperative complications (<90 days) were observed in three cases (9.1%): two wound dehiscence (Clavien-Dindo G1 and G3a respectively) and one device infection requiring prosthesis explant (Clavien-Dindo G3a). Mechanical failures of inflatable devices were not observed during the follow-up period. Median IIEF-5 before surgery was 8 (IQR 7-9). At the latest follow-up, IIEF-5 was 22 (IQR 19-23.5), and median EDITS was 79 (IQR 64-88). A total of 28 patients (84.8%) self-reported to be fully satisfied with the PPI. Conclusion Although PPI in the neurological population has been historically considered to be at increased risk, in our study, PPI complications and infections rates in this cohort did not differ from general population.
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Affiliation(s)
- Marco Falcone
- Department of Neurourology – A.O.U. “Città della Salute e della Scienza” – Unità Spinale Unipolare, Corso Bramante 88/90, Torino, Italy
- Department of Urology, University of Turin, Città della Salute e della Scienza di Torino – Molinette Hospital, Torino, Italy
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Paolo Capogrosso
- Department of Urologia e Andrologia, Ospedale di Circolo e Fondazione Macchi di Varese, ASST-Sette Laghi, Varese, Italy
| | - Lorenzo Cirigliano
- Department of Urology, University of Turin, Città della Salute e della Scienza di Torino – Molinette Hospital, Torino, Italy
| | - Paolo Geretto
- Neurourology Clinic – A.O.U. “Città della Salute e della Scienza” – Unità Spinale Unipolare, Torino, Italy
| | - Mirko Preto
- Department of Urology, University of Turin, Città della Salute e della Scienza di Torino – Molinette Hospital, Torino, Italy
| | - Massimiliano Timpano
- Department of Urology, University of Turin, Città della Salute e della Scienza di Torino – Molinette Hospital, Torino, Italy
| | - Carlo Ceruti
- Department of Urology, University of Turin, Città della Salute e della Scienza di Torino – Molinette Hospital, Torino, Italy
| | - Federica Peretti
- Department of Urology, University of Turin, Città della Salute e della Scienza di Torino – Molinette Hospital, Torino, Italy
| | - Ilaria Ferro
- Department of Urology, University of Turin, Città della Salute e della Scienza di Torino – Molinette Hospital, Torino, Italy
| | - Natalia Plamadeala
- Department of Urology, University of Turin, Città della Salute e della Scienza di Torino – Molinette Hospital, Torino, Italy
| | - Federico Dehò
- Department of Urologia e Andrologia, Ospedale di Circolo e Fondazione Macchi di Varese, ASST-Sette Laghi, Varese, Italy
| | | | - Celeste Manfredi
- Department of Urology, University Luigi Vavnvitelli, Napoli, Italy
| | - Lorenzo Spirito
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Unit of Urology, Napoli, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Napoli, Italy
| | - Alberto Manassero
- Neurourology Clinic – A.O.U. “Città della Salute e della Scienza” – Unità Spinale Unipolare, Torino, Italy
| | - Gideon Blecher
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
- Department of Urology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Paolo Gontero
- Department of Urology, University of Turin, Città della Salute e della Scienza di Torino – Molinette Hospital, Torino, Italy
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Male Sexual Dysfunction and Infertility in Spinal Cord Injury Patients: State-of-the-Art and Future Perspectives. J Pers Med 2022; 12:jpm12060873. [PMID: 35743658 PMCID: PMC9225464 DOI: 10.3390/jpm12060873] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Abstract
Spinal cord injury (SCI) is a relevant medical and social problem. According to the World Health Organization, the commonly estimated worldwide annual incidence of SCI is 40 to 80 cases per million population. After the SCI experience, most men present with sexual dysfunction (erectile dysfunction (ED) and ejaculatory dysfunction), fertility problems (such as impaired spermatogenesis, abnormalities in sperm viability, motility, and morphology), and systemic disorders such as genitourinary infection and endocrine imbalances. The best options available for managing the ejaculatory disorders in patients suffering from SCI are penile vibratory stimulation (PVS) and electroejaculation (EEJ). Furthermore, the treatment of ED in SCI patients consists of medical therapies including phosphodiesterase 5 inhibitors (PDE5i), intracavernosal injections (ICI), vacuum erection devices (VEDs), and surgical as penile prosthesis (PP). This review provides a snapshot of the current evidence for the mechanisms of sexual dysfunction and infertility in SCI patients, discusses the best management strategies for these conditions, and offers our perspective on the direction of future research.
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