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Nanda De Niro AJ, Duarsa GWK, Harvy Wicaksono M, Tirtayasa PMW, Santosa KB, Yudiana IW, Prayudi NG. A systematic review and meta-analysis of short- and long-term complications of early versus delayed penile prosthesis implantation in patients with ischemic priapism. Arch Ital Urol Androl 2024; 96:12576. [PMID: 39356025 DOI: 10.4081/aiua.2024.12576] [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: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND This study determined pooled estimates of short- and long-term complications of early versus delayed implantation of penile prosthesis in patients with ischemic priapism. METHODS We searched Pubmed, ProQuest, Scopus, EBSCOHost, and other sources from January 1, 2013, to March 2023. All study designs were included except animal studies, review articles, and consensus documents. Of the 214 articles, four studies were included in the systematic review, and further meta-analysis included three studies (PROSPERO CRD42023411005). RESULTS The short-term complication rate was lower with early implantation than with later implantation (β= -2.08; 95% Confidence Interval [CI] = -3.54, -0.6; p = < 0.05). A similar value was also found in the pooled analysis for long-term outcomes, defined as overall satisfaction rate, which is better with early implantation than later (β = 2.18; 95% CI = 1.35, 3.02; p= < 0.05). CONCLUSIONS The results of the pooled analysis confirmed that short-term complications were significantly lower with early implantation than with delayed implantation. Overall satisfaction rates were higher in early implantation than in delayed implantation of penile prostheses.
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Affiliation(s)
| | | | | | | | | | - I Wayan Yudiana
- Surgery Department, Prof. dr. I.G.N.G Ngoerah General Hospital, Bali.
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Elmarasi M, Alsaeedi A, Elmakaty I, Elsayed B, Khalil IA, Aldeeb M, Khalafalla K, Al Kubaisi K, Arafa M, Majzoub A. Early vs delayed insertion of penile prosthesis in patients with refractory priapism: a systematic review and meta-analysis. Sex Med Rev 2024; 12:528-536. [PMID: 38465856 DOI: 10.1093/sxmrev/qeae007] [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: 12/10/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Refractory priapism, characterized by persistent and prolonged painful erections despite initial treatment maneuvers, can significantly impair erectile function secondary to ischemia-induced corporal tissue fibrosis. These patients will likely require subsequent penile prosthesis (PP) surgery to regain sexual activity, yet consensus regarding the optimal timing of implantation remains lacking. OBJECTIVES To evaluate and compare the clinical outcomes associated with early vs delayed PP implantation in individuals with priapism-induced erectile dysfunction (ED). METHODS We included studies that focused on refractory priapism leading to ED and its management with PP implantation. We assessed cohort study bias with a risk-of-bias tool and case series bias with the modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were calculated by a fixed-effect model. RESULTS We included 9 studies, comprising 4 cohort studies and 5 case series, involving a total of 278 patients. Total complications were higher in the delayed group (OR, 4.16; 95% CI, 2.77-6.26). Fibrosis was significantly more pronounced in the delayed group (OR, 118.18; 95% CI, 20.06-696.32). The odds of erosion, infections, and penile injury did not show statistically significant differences between the groups (OR, 2.52 [95% CI, 0.67-9.49], 0.89 [0.38-2.10], 1.83 [0.79-4.26], respectively). Patients' satisfaction resulted in a pooled OR of 0.15 (95% CI, 0.04-0.49) in favor of the early PP insertion group. CONCLUSION The results from this study favor an early approach to ED (within 30 days) following ischemic priapism. However, it is important to consider patients' preferences, values, and psychological factors to make an informed decision.
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Affiliation(s)
| | - Ahmad Alsaeedi
- Department of Urology, Hamad Medical Corporation, Doha, 3050,Qatar
| | | | - Basel Elsayed
- College of Medicine, Qatar University, Doha, 2713, Qatar
| | - Ibrahim A Khalil
- Department of Urology, Hamad Medical Corporation, Doha, 3050,Qatar
| | - Maya Aldeeb
- Department of Medical Education, Family Medicine Residency Program, Hamad Medical Corporation, Doha, 3050, Qatar
| | | | | | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, 3050,Qatar
| | - Ahmed Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, 3050,Qatar
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Yassin M, Chen R, Ager M, Desouky E, Minhas S. Penile implants in low flow priapism. Int J Impot Res 2023; 35:651-663. [PMID: 37898653 DOI: 10.1038/s41443-023-00787-1] [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: 02/14/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
Priapism is a persistent or prolonged erection, in the absence of sexual stimulation, that fails to subside. Prolonged ischaemic or low flow priapism is defined as a full or partial erection persisting for more than 4 h and unrelated to sexual interest or stimulation, characterised by little or no cavernous blood flow. Low flow priapism leads to progressive corporal fibrosis, which could, in turn, lead to long-lasting erectile dysfunction if left untreated. Penile prosthesis implantation is recognised as a management option in refractory and delayed low flow priapism for restoring erectile function with high patient satisfaction rates. However, the ensuing corporal fibrotic scarring poses a surgical challenge to clinicians, given the higher complication rates in this patient subset. Postoperative patient satisfaction has been closely linked to preoperative expectations and perceived loss of penile length. Therefore, thorough patient counselling concerning the risk and benefits of penile implants should be a priority for all clinicians. Moreover, there is a lack of consensus on the ideal prosthesis choice and procedural timing in refractory low flow priapism. In this review, we will examine the existing literature on penile implants in patients with priapism and discuss the options for managing complications associated with penile prosthesis surgery.
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Affiliation(s)
- Musaab Yassin
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Runzhi Chen
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Michael Ager
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elsayed Desouky
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
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Barham DW, Chang C, Hammad M, Pyrgidis N, Swerdloff D, Gross K, Hatzichristodoulou G, Hsieh TC, Hotaling JM, Jenkins LC, Jones JM, Modgil V, Osmonov D, Pearce I, Perito P, Sadeghi-Nejad H, Suarez-Sarmiento A, Sempels M, Service CA, Simhan J, Yafi FA, Gross MS. Delayed placement of an inflatable penile prosthesis is associated with a high complication rate in men with a history of ischemic priapism. J Sex Med 2023; 20:1052-1056. [PMID: 37279440 DOI: 10.1093/jsxmed/qdad075] [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: 02/10/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Corporal fibrosis is known to result from prolonged priapism; however, the impact of the timing of penile prosthesis placement after priapism on complication rates is poorly understood. AIM We sought to evaluate the impact of timing of inflatable penile prosthesis (IPP) placement on complications in men with a history of ischemic priapism. METHODS We performed a multicenter, retrospective cohort study of patients with a history of priapism undergoing IPP placement by 10 experienced implantation surgeons. We defined early placement as ≤6 months from priapism to IPP. We identified a 1:1 propensity-matched group of men without a history of priapism and compared complication rates between men who had early placement, late placement, and no history of priapism. OUTCOMES Our primary outcome was postoperative noninfectious complications, and secondary outcomes included intraoperative complications and postoperative infection. RESULTS A total of 124 men were included in the study with a mean age of 50.3 ± 12.7 years. A total of 62 had a history of priapism and 62 were matched control subjects. The median duration of priapism was 37 (range, 3-168) hours and the median time from ischemic priapism to IPP placement was 15 months (range, 3 days to 23 years). Fifteen (24%) men underwent early (≤6 months) IPP placement at a median time of 2 months (range, 3 days to 6 months) following the ischemic priapism event. The remaining 47 (76%) underwent placement >6 months following priapism at a median time of 31.5 months (range, 7 months to 23 years). The complication rate in the delayed placement group was 40.5% compared with 0% in the early placement group and control group. Cylinder-related complications such as migration or leak accounted for 8 (57%) of 14 of the postoperative noninfectious complications. Full-sized cylinders were used in all patients who had a cylinder related complication. CLINICAL IMPLICATIONS Priapism patients should be referred to prosthetic experts early to decrease complication rates in those needing an IPP. STRENGTHS AND LIMITATIONS This is a multicenter study from experienced prosthetic urologists but is limited by the retrospective nature and small number of patients in the early placement group. CONCLUSION IPP complication rates are high in men with a history of ischemic priapism, especially when implantation is delayed beyond 6 months.
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Affiliation(s)
- David W Barham
- Department of Urology, University of California, Irvine, Orange, CA 92868, United States
| | - Chrystal Chang
- Department of Urology/Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Muhammed Hammad
- Department of Urology, University of California, Irvine, Orange, CA 92868, United States
| | - Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich 80539, Germany
| | - Daniel Swerdloff
- Department of Urology/Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Kelli Gross
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT 90491, United States
| | | | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego, La Jolla, CA 92103, United States
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT 90491, United States
| | - Lawrence C Jenkins
- Department of Urology, University of California, Irvine, Orange, CA 92868, United States
| | - James M Jones
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, United States
| | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Daniar Osmonov
- Department of Urology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Ian Pearce
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Perito
- Perito Urology, Coral Gables, FL, United States
| | | | | | - Maxime Sempels
- Department of Urology, University Hospital of Liège, Liège, Belgium
| | - C Austin Service
- Department of Urology, University of California San Diego, La Jolla, CA 92103, United States
| | - Jay Simhan
- Department of Urology/Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, Orange, CA 92868, United States
| | - Martin S Gross
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, United States
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Bettocchi C, Osmonov D, van Renterghem K, Djiovic R, Ralph DJ. Management of Disastrous Complications of Penile Implant Surgery. J Sex Med 2021; 18:1145-1157. [PMID: 34274041 DOI: 10.1016/j.jsxm.2021.04.003] [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: 02/12/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE Penile Prosthesis Implantation (PPI) is the definitive treatment for Erectile Dysfunction not responsive to conservative management strategies. Furthermore, it is a staple of surgical treatment of severe Peyronie's Disease (PD) and phallic reconstruction. Expert implantologists occasionally face disastrous complications of penile implant surgery which can prove to be very challenging. In this article we present a selected number of case reports which exemplify this kind of situations and discuss management strategies while also commenting on plausible aetiologies. PATIENTS' CONCERNS The first case describes a PPI performed in end-stage fibrotic corpora after multiple instances of implantation/explant. The second and third cases show two diametrically opposed approaches to the management of glans necrosis after PPI in post-radical cystectomy patients. The fourth case describes the history of a diabetic patient suffering from glandular, corporal and urethral necrosis after a complicated PPI procedure. The fifth case reports the surgical treatment of a case of recurring PD due to severe scarring and shrinking of a vascular Dacron patch applied in a previous operation. DIAGNOSIS Complication diagnosis in all patient was mainly clinical, intra- and postoperative, with Penile Color Doppler Ultrasonography performed when needed in order to demonstrate penile blood flow. INTERVENTIONS The patients underwent complex surgical procedures that addressed each specific complication. Complex penile implants with fibrosis-related complications, penile prosthesis explant with and without surgical debridement of necrotic areas, penile prosthesis explant with necrotic penile shaft and urethral amputation with perineostomy, and complex corporoplasty with scar tissue excision and patch application with PPI were performed in the five patients. OUTCOMES Penile anatomy and erectile function with PPI was achieved in 4 out of 5 patients. 1 of 5 patient is scheduled to undergo a total phallic reconstruction procedure at the time of this writing. LESSONS Management of disastrous complications of penile implant surgery can be very challenging even in expert hands. In-and-out knowledge of possible PPI and PD complications is required to achieve an acceptable outcome. Bettocchi C, Osmonov D, van Renterghem K, et al. Management of Disastrous Complications of Penile Implant Surgery. J Sex Med 2021;18:1145-1157.
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Affiliation(s)
- C Bettocchi
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.
| | - D Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - K van Renterghem
- Department of Urology, Jessa Hospital, Hasselt, Belgium; Faculty of medicine, Hasselt University, Hasselt, Belgium; University Hospitals Leuven, Leuven, Belgium
| | - R Djiovic
- Sava Perovic Foundation, Center for Genito Urethral Reconstructive Surgery, Belgrade, Serbie
| | - D J Ralph
- Department of Urology, University College London Hospitals & St Peters Andrology Centre, London, UK
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Joice GA, Liu JL, Burnett AL. Medical treatment of recurrent ischaemic priapism: a review of current molecular therapeutics and a new clinical management paradigm. BJU Int 2021; 127:498-506. [PMID: 33606327 DOI: 10.1111/bju.15370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine the current molecular therapeutics in the medical treatment of recurrent ischemic priapism (RIP). To propose a stepwise clinical management paradigm for the treatment of RIP. METHODS We performed a literature search using the PubMed database for the terms 'recurrent ischemic priapism' and 'stuttering priapism' up until December 2020. We assessed pre-clinical and clinical studies regarding medical management of RIP and molecular pathophysiology. Case series and randomized trials were evaluated by study quality and patient outcomes to determine a potential clinical management scheme. RESULTS Recent research has fostered an improved understanding of the underlying molecular pathophysiology of RIP that has paved the way forward for developing new therapeutic agents. Medications targeting neurovascular, hormonal and haematological mechanisms associated with RIP show great promise towards remedying this condition. A host of therapeutic agents operating across different mechanistic directions may be implemented according to a clinical management scheme to potentially optimize RIP outcomes. CONCLUSION RIP remains a medically neglected condition with current management focused on treating the acute condition rather than modulating the course of disease. Continued research into the molecular mechanisms of RIP and standardized clinical pathways can improve the quality of care for patients suffering from this condition.
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Affiliation(s)
- Gregory A Joice
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James L Liu
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arthur L Burnett
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Wilson SK, Simhan J, Gross MS. Cylinder insertion into scarred corporal bodies: prosthetic urology's most difficult challenge: some suggestions for making the surgery easier. Int J Impot Res 2020; 32:483-494. [PMID: 32313089 DOI: 10.1038/s41443-020-0282-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 12/27/2022]
Abstract
Corporal fibrosis is a process that involves excessive deposition of scar tissue in response to infection, trauma, or ischemia. It does not occur merely as a result of previous IPP surgery. Excessive development of corporal fibrosis is certain after extraneous and disastrous events such as priapism or the removal of a device for infection. The usual surgical planes and spaces are obliterated by proliferation of scar both in the tissues overlying the corpora and the space within the corpora previously occupied by erectile tissue. To maximize success, specialized instruments, downsized cylinders, and lots of experience are necessities. Prosthetic urology produces, for the most part, happy patients. Fibrosis guys, to a man are not happy. Let the expert have the unhappy patient!
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Affiliation(s)
- Steven K Wilson
- Department of Urology, Institute for Urologic Excellence, La Quinta, CA, USA.
| | - Jay Simhan
- Department of Urology, Einstein Healthcare Network, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Martin S Gross
- Department of Urology, Dartmouth-Hitchcock Medical Center, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
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