1
|
Pozzi E, Sandler MD, Swayze A, Yanes J, Ramasamy R. Early versus late penile prosthesis surgery: a cross-sectional real-life study unveiling predictive factors. Int J Impot Res 2024:10.1038/s41443-024-00880-z. [PMID: 38615111 DOI: 10.1038/s41443-024-00880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Abstract
Penile prosthesis implantation (PP surgery) is a well-established solution for severe, medication-refractory erectile dysfunction (ED). Despite its effectiveness, limited data exists on patient characteristics influencing the timing of PP surgery after ED onset. We aimed to investigate predictors for early PP surgery and compare preoperative factors in men who had early (<12 months) vs. late PP surgery (≥12 months). We analyzed data from 210 men undergoing inflatable PP surgery for medication-refractory ED to investigate predictors for early PP surgery. Men with early PP surgery were older (64 vs. 61 years), had more comorbidities, (97.2% vs. 63.3% CCI ≥ 1). Linear regression analysis showed that more comorbidities were associated with an earlier time to PP surgery (Coeff: -1.82, 95% CI: -3.08 to -0.56, p = 0.004). At multivariate Cox regression analysis, CCI ≥ 1 emerged as the sole predictor of early PP surgery (OR: 1.29, 95% CI: 1.07-1.56, p = 0.007) after adjusting for age, ED etiology, and ethnicity. Our study sheds light on factors influencing decisions for early vs. late PP surgery post-medication-refractory ED. Men with more comorbidities were more likely to receive early PP surgery, emphasizing the importance of preoperative counseling and personalized treatment plans.
Collapse
Affiliation(s)
- Edoardo Pozzi
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Max D Sandler
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Aden Swayze
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Julio Yanes
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
| |
Collapse
|
2
|
Baran C, Kutluturk EG, Otunctemur A, Kadioglu A. High flow priapism following the insertion of an inflatable penile prosthesis mimicking autoinflation: a case report. Int J Impot Res 2024; 36:3-5. [PMID: 37838811 DOI: 10.1038/s41443-023-00776-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/16/2023]
Abstract
Penile prosthesis implantation is a surgical option for erectile dysfunction when other treatments fail or the patient prefers implantation. Although penile prosthesis is generally considered safe and effective, various complications have been reported in the literature. High-flow priapism, resulting from an arteriovenous fistula between the cavernosal artery and the corpora cavernosa, is a rare complication after penile prosthesis implantation. Managing the condition as autoinflation may lead to unfortunate complications. A 54-year-old male patient underwent a penile prosthesis implantation due to erectile dysfunction lasting for 5 years. Doppler ultrasound revealed arterial insufficiency that was refractory to oral and intracavernosal treatments. A 3-piece inflatable penile prosthesis (Coloplast - Titan) was implanted through a midline penoscrotal incision without any complications. The patient reported uncontrolled tumescence after activating the device, which led us to suspect autoinflation. The final diagnosis was high-flow priapism due to an arteriovenous fistula in the cavernosal artery. The patient was given an antiandrogenic medication and the prosthesis was deflated for 3 months. The fistula closed without any additional intervention. High-flow priapism is a rare but potential complication of penile prosthesis implantation. Careful evaluation and management of patients' symptoms are necessary for diagnosing and treating this condition. This case highlights the importance of considering high-flow priapism as a potential cause of uncontrolled tumescence after penile prosthesis implantation and the possibility of successful non-surgical management.
Collapse
Affiliation(s)
- Caner Baran
- Department of Urology, University of Health Science, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey.
| | - Eren Gorkem Kutluturk
- Department of Urology, University of Health Science, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Alper Otunctemur
- Department of Urology, University of Health Science, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ates Kadioglu
- Department of Urology, Section of Andrology, Istanbul Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
3
|
Van Huele A, Lenaers M, Renterghem KV. Preoperative counseling for penile implant surgery: standardized approach in a high-volume center of excellence. Int J Impot Res 2024:10.1038/s41443-024-00828-3. [PMID: 38278942 DOI: 10.1038/s41443-024-00828-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 01/28/2024]
Abstract
Shared-decision making is crucial in today's society. Although penile prosthesis surgery has had significant improvements regarding technique and materials over the last few decades - with the highest satisfaction rate in erectile dysfunction treatment at present time -, dissatisfaction can occur because of bad preoperative counseling with the creation of unrealistic expectations. This paper includes a small narrative review regarding the most important preoperative variables to be discussed in the preoperative setting. Literature search was conducted in December 2023 using PubMed. Additionally, our own standardized flowchart for preoperative counseling was added. The most important aspects of preoperative counseling include a description of the pathophysiology of erectile dysfunction as well as alternative treatments. Information should be given about which implant categories exist. Additionally, some information about the procedure itself as well as the financial aspect should be communicated. The most frequent and most important complications should be illustrated. Last but not least, the patient's expectations should be evaluated. Our added standardized flowchart with figure acts as a practical guideline for professionals as well as for patients. Our standardized approach for preoperative counseling emphasizes reasonable postoperative expectations aiming for a well-informed patient with high postoperative satisfaction. Our general strategy is to underpromise and overdeliver.
Collapse
Affiliation(s)
- Andries Van Huele
- Dept. of Urology, Jessa Hospital, Hasselt, Belgium.
- Dept. of Urology, Ghent University Hospital, Ghent, Belgium.
| | | | - Koenraad Van Renterghem
- Dept. of Urology, Jessa Hospital, Hasselt, Belgium
- Hasselt University, Hasselt, Belgium
- Dept. of Urology, University Hospital Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Preto M, Falcone M, Plamadeala N, Schifano N, Bettocchi C, Colombo F, Fiordelise S, Vitarelli A, Silvani M, Mondaini N, Paradiso M, Ceruti C, Varvello F, Palumbo F, Avolio A, Antonini G, Corvasce A, Pozza D, Franco G, Bitelli M, Boezio F, Conti E, Caraceni E, Negro C, Carrino M, Vicini P, Ghidini N, Alei G, Italiano E, Timpano M, Polito M, Natali A, Tamai A, Pescatori E, Dehò F, Gideon B, Gontero P, Palmieri A, Capogrosso P. Risk of unfavorable outcomes after penile prosthesis implantation - results from a national registry (INSIST-ED). Int J Impot Res 2023:10.1038/s41443-023-00784-4. [PMID: 37907669 DOI: 10.1038/s41443-023-00784-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/30/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Abstract
Like all surgeries, penile prosthesis implantation (PPI) has the potential for both postoperative complications and suboptimal patient satisfaction. In order to assess risk factors for poor satisfaction, we reviewed patients who had been prospectively recruited in a national multi-institutional registry of penile prostheses procedures (INSIST-ED) from 2014 to 20121. Patient baseline characteristics and postoperative complications were recorded. The primary endpoint of this study was unfavorable outcomes after inflatable PPI, defined as significant postoperative complications (Clavien-Dindo ≥2) and/or Sexuality with Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) scores below the 10th percentile. A total of 256 patients were included in the study. The median age was 60 years (IQR 56-67). The most common cause of erectile dysfunction (ED) was organic (42.2%), followed by pelvic surgery/radiotherapy (39.8%) and Peyronie's disease (18.0%). Postoperative complications were recorded in 9.6%. High-grade complications (Clavien ≥2) occurred in 4.7%. At 1-year follow-up, the median QoLSPP total score was 71 (IQR 65-76). In all, 14.8% of patients were classified as having experienced unfavorable outcomes because of significant postoperative complications and/or QoLSPP scores below the 10th percentile. Logistic regression analysis demonstrated patient age to be non-linearly associated with the risk of experiencing unfavorable outcomes. A U-shaped correlation showed a lower risk for younger and older patients and a higher risk for middle-aged men. ED etiology and surgical volume were not associated with PPI outcomes. Physicians should, therefore, be aware that middle-aged men may be at higher risk of being unsatisfied following PPI compared to both younger and older patients.
Collapse
Affiliation(s)
- Mirko Preto
- Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy.
| | - Marco Falcone
- Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy
| | - Natalia Plamadeala
- Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy
| | - Nicolò Schifano
- Unit of Urology, ASST Sette Laghi, Circolo e Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| | | | - Fulvio Colombo
- Sant'Orsola University Hospital, Andrology Unit, University of Bologna, Bologna, Emilia-Romagna, Italy
| | | | | | - Mauro Silvani
- Department of Urology, Ospedale di Biella, Biella, Italy
| | - Nicola Mondaini
- Department of Urology, Villa Donatello Hospital, Florence, Italy
| | - Matteo Paradiso
- Department of Urology, Ospedale Cardinal Massaia, Asti, Italy
| | - Carlo Ceruti
- Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy
| | | | | | - Antonio Avolio
- Studio di Urologia e Andrologia - Centro Medico Iside, Ascoli Piceno, Italy
| | | | | | - Diego Pozza
- Studio di Andrologia e di Chirurgia Andrologica, Rome, Italy
| | - Giorgio Franco
- Department of Urology, 'La Sapienza' University of Rome, Rome, Italy
| | - Marco Bitelli
- Department of Urology, Frascati Hospital H1, Rome, Italy
| | | | - Enrico Conti
- Department of Urology, Levante Ligure Hospital, Italy, La Spezia, Italy
| | - Enrico Caraceni
- Department of Urology, Area Vasta 3 Asur Marche, Civitanova Marche, Italy
| | - Carlo Negro
- Department of Urology, Ospedale Evangelico Internazionale Genova, Genova, Italy
| | | | - Patrizio Vicini
- Department of Urology, Italian Neurotraumatologic Institute Grottaferrata 'I.N.I.', Grottaferrata, Rome, Italy
| | | | - Giovanni Alei
- Department of Plastic Surgery, Sapienza University of Rome, Rome, Italy
| | - Emilio Italiano
- Operative Unit of Urology, Hospital 'Villa Sofia-Cervello', Piazzetta Salerno, Palermo, Italy
| | - Massimiliano Timpano
- Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy
| | - Massimo Polito
- Department of Clinical and Specialist Sciences, Division of Urology, Polytechnic University of the Marche Region Medical School, Ancona, Italy
| | - Alessandro Natali
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Aldo Tamai
- Department of Urology, Data Clinica, Vicenza, Italy
| | | | - Federico Dehò
- Unit of Urology, ASST Sette Laghi, Circolo e Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| | - Blecher Gideon
- Department of Urology, The Alfred Hospital, Melbourne, VIC, Australia
- Monash Health, Bentleigh East, VIC, Australia
| | - Paolo Gontero
- Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Paolo Capogrosso
- Unit of Urology, ASST Sette Laghi, Circolo e Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| |
Collapse
|
7
|
Van Huele A, Van Renterghem K. Simultaneous implant of inflatable penile prosthesis and artificial urinary sphincter: a single high-volume center experience. Int J Impot Res 2023:10.1038/s41443-023-00718-0. [PMID: 37188772 DOI: 10.1038/s41443-023-00718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023]
Abstract
Erectile dysfunction and stress urinary incontinence are both an important sequel after local therapy for prostate cancer, such as radical prostatectomy and radiotherapy. The implant of an inflatable penile prosthesis or an artificial urinary sphincter is an option if other treatments fail in both cases. There is a lack of literature regarding a simultaneous dual implantation. The aim of this study is to describe per- and postoperative morbidity and functional results. We included 25 patients operated between January 2018 and August 2022. Data were collected retrospectively. Standardized questionnaires for evaluating satisfaction were administered. There was a median operative time of 45 min (IQR 41.25-58). No intra-operative complications were seen. Four patients needed revision surgery, all of them regarding the sphincter prosthesis. One of these patients had additional revision surgery due to leakage of the penile implant reservoir. There were no infectious complications. There was a median follow-up time of 29 months (IQR 9.5-43). There was a satisfaction rate of 88% with patients and 92% with partners. Postoperative pads per day were reduced to zero or one in 96% of patients. We conclude that the dual implantation of an inflatable penile prosthesis and an artificial urinary sphincter was a safe and effective treatment in our series for patients with conservative treatment-refractory stress urinary incontinence and erectile dysfunction.
Collapse
Affiliation(s)
- Andries Van Huele
- Department of Urology, Jessa Hospital, Hasselt, Belgium.
- Department of Urology, Ghent University Hospital, Ghent, Belgium.
| | - Koenraad Van Renterghem
- Department of Urology, Jessa Hospital, Hasselt, Belgium
- Hasselt University, Hasselt, Belgium
- Department of Urology, University Hospital Leuven, Leuven, Belgium
| |
Collapse
|