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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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Revision Surgery for Inflatable Penile Prosthesis (IPP): A Single-Center Experience and Pictorial Representation. Urology 2021; 152:42-51. [PMID: 33548247 DOI: 10.1016/j.urology.2020.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/29/2020] [Accepted: 11/29/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To elucidate factors influencing Inflatable Penile Prosthesis (IPP) revision and describe outcomes associated with revision surgery. METHODS A single surgeon, retrospective review of all patients who underwent IPP revision between 2008-2016, was performed. Patient age, BMI, operative duration, blood loss, hospital duration, time from most recent penile implant to revision surgery, etiology of revision, and whether the patient had a prior failed revision surgery were all collected and analyzed. RESULTS A total of 57 patients, who had undergone IPP revision between the years 2008-2016, with at least 3 years of follow-up, were included in the investigation. Mean patient age and BMI were 68 and 29.2 kg/m2, respectively. The mean time between the most recent implant operation to revision was 8.4 years. Four patients (7%) reported IPP revision failure within a 3-year follow-up period. CONCLUSION IPP revision demonstrates a relatively high success rate, in the short term, and should be offered to patients as a safe and effective option.
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Kucukturkmen I, Topcu YK, Degirmenci T, Aydogdu O, Bozkurt IH, Yarimoglu S, Polat S. Pararectal Migration of a Malleable Rod: An Unusual Late Complication. World J Mens Health 2016; 34:145-7. [PMID: 27574598 PMCID: PMC4999488 DOI: 10.5534/wjmh.2016.34.2.145] [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: 05/02/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/30/2022] Open
Abstract
A 75-year-old male had failed to respond conservative therapy for erectile dysfunction and had undergone insertion of a malleable penile prosthesis in 1995. Twenty years after the initial implant he presented with right-sided prosthesis localized in the buttock. There was no infection. The prosthesis was extracted through an incision in the right hip. As in the recent case, mechanical failures in malleable penile prosthesis models, can occur. Penile implant migration back to the buttock without a curve deformity is an extremely rare complication. Clinicians should be alert about possible late complications of penile prosthesis.
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Affiliation(s)
- Ibrahim Kucukturkmen
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Yusuf Kadir Topcu
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Tansu Degirmenci
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Ozgu Aydogdu
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Ibrahim Halil Bozkurt
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Serkan Yarimoglu
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Salih Polat
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Karabaglar, Izmir, Turkey
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Reznicek DG, Bryson R, Kramer AC. Review: Alternative Placement of Penile Prosthesis Reservoir and AUS Pressure Regulating Balloon. Sex Med Rev 2015; 3:48-55. [DOI: 10.1002/smrj.38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Simon R, Hakky TS, Henry G, Perito P, Martinez D, Parker J, Carrion RE. Tips and Tricks of Inflatable Penile Prosthesis Reservoir Placement: A Case Presentation and Discussion. J Sex Med 2014; 11:1325-33. [DOI: 10.1111/jsm.12481] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tran CN, Boncher N, Montague DK, Angermeier KW. Erosion of Inflatable Penile Prosthesis Reservoir into Neobladder. J Sex Med 2013; 10:2343-6. [DOI: 10.1111/jsm.12239] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Karpman E, Sadeghi-Nejad H, Henry G, Khera M, Morey AF. Current opinions on alternative reservoir placement for inflatable penile prosthesis among members of the Sexual Medicine Society of North America. J Sex Med 2013; 10:2115-20. [PMID: 23679798 DOI: 10.1111/jsm.12203] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The Sexual Medicine Society of North America (SMSNA) includes as its members the most experienced prosthetic surgeons in North America who implant inflatable penile prostheses (IPPs). Obliteration of the space of Retzius (SOR) resulting from robotic-assisted laparoscopic prostatectomy (RALP) is a growing concern that has prompted many surgeons to look for alternative locations for reservoir placement during IPP implantation. AIM The aim of this article is to educate the community of prosthetic urologists about potential complications and alternative locations for IPP reservoir placement. METHODS A panel of high-volume experienced prosthetic surgeons discussed their views on alternative IPP reservoir implantation during a symposium focused on this topic. After reviewing reservoir complications, physician members of the SMSNA in attendance were surveyed using an audience response system (ARS) to facilitate sharing of knowledge, opinions, and recommendations related to reservoir implantation. MAIN OUTCOME MEASURES Six ARS questions were used to identify the percentages of SMSNA member physicians with concerns about traditional IPP reservoir placement and utilizing alternative reservoir placement (ARP), and the impact of changing practice patterns on patient safety. RESULTS A majority (81%) of experienced implant surgeons surveyed think that RALP sometimes or frequently makes traditional IPP reservoir placement more difficult. Placement of the reservoir in an alternative location is sometimes or frequently advantageous for patient safety. A vast majority (97%) of the 95 respondents indicated that ARP techniques should be included in physician training courses. CONCLUSIONS Physicians have concerns about reservoir placement in the SOR in RALP patients, which may explain why ARP is popular among SMSNA members. Device manufacturers should support physician training that provides for ARP. Clinical outcomes in RALP patients are needed to better understand the risks and benefits, and define the ideal location of reservoir placement in this population.
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Affiliation(s)
- Edward Karpman
- Men’s Health, Male Reproductive and Sexual Medicine, Microsurgery, El Camino Urology Medical Group, Inc., A Division of Urological Surgeons of Northern California (USNC), 2490 Hospital Drive,Suite 210, Mountain View, CA 94040, USA.
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Intravesical penile implant reservoir: case report, literature review, and strategies for prevention. Int J Impot Res 2012; 25:41-4. [DOI: 10.1038/ijir.2012.31] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Levine LA, Hoeh MP. Review of penile prosthetic reservoir: complications and presentation of a modified reservoir placement technique. J Sex Med 2012; 9:2759-69. [PMID: 22672516 DOI: 10.1111/j.1743-6109.2012.02807.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Multiple modifications have been made to the inflatable penile prosthesis (IPP) since its inception in the 1970s. These modifications have made reservoir-related mechanical malfunctions highly unlikely in current IPP models. Although these complications are rare, it would be incumbent upon the implanting surgeon to be aware of these potential complications, how they present, how they are best treated, and how to prevent them from occurring. AIMS The aim of this article was to present our experience with complications associated with penile prosthesis reservoirs, perform a review of the literature regarding reservoir-related complications, and present our modified technique to place the reservoir into the space of Retzius. MAIN OUTCOME MEASURES Reservoir-related complications including inguinal herniation, erosion into bladder or bowel, intraperitoneal reservoir placement with subsequent visceral injury, vascular injury, autoinflation, and infection. METHODS We retrospectively reviewed our experience with penile prosthesis reservoir complications or procedures requiring an alternative implantation approach at our center over the past 10 years where over 400 devices were implanted. We also review reservoir-related complications published in the English literature since the 1980s. RESULTS While exceedingly rare, reservoir complications do occur. Six cases from our institution are presented including one reservoir herniation, one postoperative direct inguinal hernia, one bladder laceration during revision surgery, one ectopic reservoir placement due to morbid obesity, one iliac vein compression syndrome, and one vascular laceration during reservoir revision. Reported reservoir complications include inguinal herniation, erosion into the bladder or bowel, intraperitoneal reservoir placement with subsequent injury to the ureter or bowel, vascular injury, autoinflation, and infection. CONCLUSION Penile prosthesis reservoirs rarely fail mechanically but are associated with a variety of complications or may require alternate implantation technique. In our experience, the Jorgensen scissors technique allows safe entry into the space of Retzius with diminished risk of hernia as well as vascular, bladder, or bowel injury.
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Affiliation(s)
- Laurence A Levine
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA.
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Does a replacement or revision of an inflatable penile prosthesis lead to decreased patient satisfaction? Int J Impot Res 2011; 23:39-42. [PMID: 21307871 DOI: 10.1038/ijir.2011.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To analyze the reason for replacement, revision and overall satisfaction of a cohort who underwent surgical replacement of an inflatable penile prosthesis (IPP). A cohort of 105 patients who underwent IPP replacement from 2005-2007 was retrieved from the prosthesis database. Approximately 21.9% (23) underwent replacement or revision of their prosthesis because of complications, and were further analyzed. Reason for removal was stratified into infectious and non-infectious (erosion, non-function and patient discomfort). Age, race (African American vs non-African American), smoking history, hypertension, diabetes, coronary artery disease and hyperlipidemia were stratified by reason for removal. Finally, we contacted patients and recorded subjective satisfaction with their IPP. The reason for removal was most commonly because of a non-functional IPP (47.8%), followed by infection (30.4%), erosion (17.4%) and patient discomfort (4.3%). Age and race did not show a significant difference when analyzing reason for replacement (P > 0.05). Patients who were smokers (P = 0.907) had hypertension (P = 0.554), diabetes (P = 0.591) or hyperlipidemia (P = 0.219) did not have significantly higher infection rates. Approximately 58.3% were satisfied with their prosthesis, 75% would have the surgery performed again and 91.7% would still recommend prosthesis surgery. Device malfunction was the primary reason for replacement/removal at our institution. Despite the complications of prosthesis reoperation, the majority of patients were still satisfied with their prosthesis, would have the surgery performed again and would recommend prosthesis surgery to a friend.
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Eldefrawy A, Kava BR. An Unusual Complication During Inflatable Penile Prosthesis Implantation. Urology 2010; 76:847. [DOI: 10.1016/j.urology.2009.11.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 11/05/2009] [Accepted: 11/17/2009] [Indexed: 11/29/2022]
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Kramer AC, Sausville J, Schweber A. Practice patterns of urologists performing penile prosthesis surgery vary based on surgeon volume: results of a practice pattern survey. Int J Impot Res 2010; 22:262-6. [PMID: 20555345 DOI: 10.1038/ijir.2010.13] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Inflatable penile prostheses (IPPs) are widely accepted as a means of surgical treatment of erectile dysfunction. It has been suggested that surgeon volume influences patient outcomes after IPP implantation. We used a written questionnaire to ask urologists who perform IPP surgery about their practice patterns. Our analysis correlated specific practices to self-reported IPP volume. A written questionnaire was distributed to 1968 urologists. Responses were collated and analyzed. Respondents were defined as high volume implanters (HVIs) if they placed >or=20 IPPs in the year preceding the survey, or low volume implanters (LVIs) if they placed <or=19. Our main outcome measures were surgeon volume, approach to initial IPP placement (penoscrotal vs infrapubic), strategy for reservoir management during IPP revision surgery, strategy for reservoir replacement when deemed necessary, approach to suspected IPP infections, and utilization of revision washout protocols. This study does not require institutional review board approval from our institution, given that patient information is not used at all, this is a practitioner survey only. HVIs were significantly more likely to incorporate both penoscrotal and suprapubic approaches into their armamentarium, more likely to manipulate previously placed IPP reservoirs during revision surgery, and more likely to operate immediately when confronted with a suspected IPP infection. They were also more likely than LVIs to use the Mulcahy revision washout protocol. There are significant differences in the self-reported practice patterns of HVIs and LVIs. The importance of these differences for patient outcomes remains undefined.
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Affiliation(s)
- A C Kramer
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Kramer AC, Chason J, Kusakabe A. CASE REPORTS: Report of Two Cases of Bladder Perforation Caused by Reservoir of Inflatable Penile Prosthesis. J Sex Med 2009; 6:2064-7. [DOI: 10.1111/j.1743-6109.2009.01277.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
INTRODUCTION Although more invasive than some of the other currently available therapies, penile prosthesis surgery has the advantages of high patient satisfaction rates and avoidance of systemic adverse events in the vast majority of cases. AIM This article provides a review of the more widely used implants and some of the more frequently encountered complications of penile prosthesis surgery. METHODS A retrospective review peer reviewed publications relevant to the field of penile prosthesis surgery. MAIN OUTCOME MEASURES Review of historical milestones and newer penile prostheses, as well as a review of prosthesis surgery complications. RESULTS Improved designs and materials have resulted in decreased incidence of mechanical failures or infectious complications while simultaneously simplifying the operation of these devices. CONCLUSIONS Penile prosthesis surgery remains an excellent alternative for restoring erectile function to those in whom medical therapies such as phosphodiesterase inhibitors are contraindicated or who have failed more conservative measures.
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Affiliation(s)
- Hossein Sadeghi-Nejad
- UMDNJ New Jersey Medical School-Department of Surgery, Division of Urology, Newark, NJ, USA.
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Borges F, Hakim L, Kline C. Surgical technique to maintain penile length after insertion of an inflatable penile prosthesis via infrapubic approach. J Sex Med 2006; 3:550-3. [PMID: 16681481 DOI: 10.1111/j.1743-6109.2006.00232.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aim of this study was to provide an overview of the principal author's experience in maintaining penile length after implantation of a three-piece inflatable penile prosthesis (IPP). For many patients with erectile dysfunction, who choose surgical treatment, loss of penile length after implantation of an IPP is a common concern. In the principal author's experience, release of the suspensory ligament during IPP implant surgery can maintain penile length, alleviating this concern. METHODS After implantation with an IPP, the principal author released the patient's suspensory ligament. Main Outcome Measures. The main outcome measure was patient satisfaction with penile length after IPP surgery. A second outcome measure was a substudy measuring the patient's penile length after IPP implantation both before and after suspensory ligament release. RESULTS From August 1997 through September 2002, the principal author implanted a total of 303 Alpha 1 IPPs into men who suffered from erectile dysfunction (ED). All had their suspensory ligament released. Postoperative complications were minimal and for the most part transitory. Ninety-three percent reported satisfaction with IPP performance, penile length, and willingness to undergo the IPP surgery again. None of the patients reported penile shortening, with some of them reporting an increase in penile length, as compared with preoperative measurements. CONCLUSION Release of the suspensory ligament appears to maintain or even increase penile length, with a minimum of complications, and a high degree of patient satisfaction.
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