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Beirnaert J, Pinar U, Benarroche D, Akakpo W, Rouprêt M. Evaluation of patient satisfaction using the validated French version of the SSIPI questionnaire after inflatable penile implantation. J Sex Med 2023; 21:67-71. [PMID: 38014798 DOI: 10.1093/jsxmed/qdad154] [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: 08/04/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Penile prothesis (PP) is a recommended treatment for erectile dysfunction that is refractory to less invasive treatments, but there are few validated tools to assess patient satisfaction. AIM The aim of this study was to assess patient satisfaction after PP implantation using the French Satisfaction Survey for Inflatable Penile Implant (SSIPI) questionnaire. METHODS Demographic, clinical, and perioperative data were collected from all consecutive patients who underwent PP implantation in our center between 2016 and 2021. The French SSIPI questionnaire was completed during a telephone call with each patient by an independent investigator. OUTCOMES A good functional result was considered when the total SSIPI score was >48, corresponding to a score of >3 for each item. RESULTS The median global SSIPI score for the cohort was 66 (interquartile range [IQR], 60-73), and 53 (89.8%) patients were satisfied. The appearance of the penis with the PP was the item that had the lowest score for satisfaction (median score 23 [IQR, 19-26]), while the patients reported almost no pain (median score 10 [IQR, 9-10]). When patients with a total score of ≤64 were compared with those with a score of >64, PP size was significantly greater in the group with better functional results (P = .03). CLINICAL IMPLICATIONS Assessment of patient satisfaction with a PP is important because this is the main criterion used to judge the success of surgery. STRENGTHS AND LIMITATIONS To our knowledge, this is the first study to evaluate the satisfaction of patients with a PP using the French-validated version of SSIPI questionnaire. However, patients came from a single center and the population size was small. CONCLUSION Almost 90% of patients with a PP were satisfied with the device when satisfaction was assessed using the SSIPI questionnaire.
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Affiliation(s)
- Jeanne Beirnaert
- GRC 5 Prédictive Onco-Uro, Urologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, F-75013 Paris, France
- Service d'Urologie, Hôpital Erasme, Université Libre de Bruxelles, 1080 Brussels, Belgium
| | - Ugo Pinar
- GRC 5 Prédictive Onco-Uro, Urologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, F-75013 Paris, France
| | - Davy Benarroche
- GRC 5 Prédictive Onco-Uro, Urologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, F-75013 Paris, France
| | - William Akakpo
- Service d'Urologie, Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France
| | - Morgan Rouprêt
- GRC 5 Prédictive Onco-Uro, Urologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, F-75013 Paris, France
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Chang C, Barham DW, Dalimov Z, Swerdloff D, Sadeghi-Nejad H, Andrianne R, Sempels M, Hsieh TC, Hatzichristodoulou G, Hammad M, Miller J, Osmonov D, Lentz A, Perito P, Suarez-Sarmiento A, Hotaling J, Gross K, Jones JM, van Renterghem K, Park SH, Nicholas Warner J, Ziegelmann M, Modgil V, Jones A, Pearce I, Gross MS, Yafi FA, Simhan J. Single Dilation in Primary Inflatable Penile Prosthesis Placement Is Associated With Fewer Corporal Complications Than Sequential Dilation. Urology 2023; 181:150-154. [PMID: 37574145 DOI: 10.1016/j.urology.2023.06.037] [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: 05/01/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To assess the difference in outcomes between single dilation (SingD) and sequential dilation (SeqD) in primary penile implantation, hypothesizing that patients who undergo SeqD had higher rates of noninfectious complications. METHODS We performed a multicenter, retrospective study of men undergoing primary inflatable penile prosthesis placement. Intraoperative complications and postoperative noninfectious outcomes were assessed between the two groups. Multivariable analysis was performed to identify predictors of complications. RESULTS A total of 3293 patients met inclusion criteria. After matching, there were 379 patients who underwent SingD and 379 patients who underwent SeqD. There was no significant difference in intraoperative complications between patients who underwent SingD vs SeqD, nor was there any difference in cylinder length (20 cm with interquartile range [IQR] 18-21 cm vs 20 cm with IQR 18-20 cm respectively, P = .4). On multivariable analysis, SeqD (OR 5.23 with IQR 2.74-10, P < .001) and older age (OR 1.04 with IQR 1.01-1.06, P = .007) were predictive of postoperative noninfectious complications. There was no significant difference in intraoperative complications between patients who underwent SingD vs SeqD, nor was there any difference in cylinder length. SeqD and older age were predictive of postoperative noninfectious complications. CONCLUSION During inflatable penile prosthesis placement in the uncomplicated patient without fibrosis, SingD is a safe technique to utilize during implantation that will minimize postoperative adverse events, and promote device longevity without loss of cylinder length.
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Affiliation(s)
- Chrystal Chang
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - David W Barham
- Department of Urology, University of California, Irvine, Orange, CA
| | | | - Daniel Swerdloff
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Robert Andrianne
- Service d'urologie, Centre Hospitalier Universitaire de Liege, Liege, Belgium
| | - Maxime Sempels
- Service d'urologie, Centre Hospitalier Universitaire de Liege, Liege, Belgium
| | - Tung-Chin Hsieh
- Department of Urology, University of California, San Diego, La Jolla, CA
| | | | - Muhammed Hammad
- Department of Urology, University of California, Irvine, Orange, CA
| | - Jake Miller
- Department of Urology, University of California, Irvine, Orange, CA
| | - Daniar Osmonov
- Department of Urology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Aaron Lentz
- Department of Urology, Duke University, Durham, NC
| | | | | | - James Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Kelli Gross
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - James M Jones
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Sung Hun Park
- Sewum Prosthetic Urology Center of Excellence, Seoul, South Korea
| | | | | | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Adam Jones
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ian Pearce
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, Orange, CA
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA.
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Polchert M, Dick B, Raheem O. Narrative review of penile prosthetic implant technology and surgical results, including transgender patients. Transl Androl Urol 2021; 10:2629-2647. [PMID: 34295749 PMCID: PMC8261434 DOI: 10.21037/tau-20-1279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/20/2020] [Indexed: 01/15/2023] Open
Abstract
Over the past 40 years, the technological and surgical advancements in penile prostheses have led to increased patient satisfaction rates and decreased complication and infection rates. In cis males with erectile dysfunction (ED), these technological improvements tremendously improve quality of life. In female to male transgender patients, prostheses provide the ability to engage in penetrative intercourse and to urinate standing. This review evaluates technological and surgical advancements in penile prosthetics in the context of documented patient satisfaction and complication rates from prosthesis surgeries. Retrospective studies of penile implant usage in female to male gender-affirming surgeries report that infection and complication rates are higher than those seen in cis males. There are newer prostheses developed specifically for female to male reassignment surgeries, but outcome data is limited. Continued research and development are needed to develop more efficacious penile implantation options for gender affirmation surgery.
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Affiliation(s)
- Michael Polchert
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Brian Dick
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Omer Raheem
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Shah T, Wang R. A Review of Factors Affecting Patient Satisfaction With Inflatable Penile Prosthesis. Sex Med Rev 2021; 9:350-357. [DOI: 10.1016/j.sxmr.2020.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/17/2020] [Accepted: 04/26/2020] [Indexed: 01/19/2023]
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Ziegelmann MJ, Farrell MR, Levine LA. Modern treatment strategies for penile prosthetics in Peyronie's disease: a contemporary clinical review. Asian J Androl 2020; 22:51-59. [PMID: 31424027 PMCID: PMC6958979 DOI: 10.4103/aja.aja_81_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Peyronie's disease is a common condition resulting in penile deformity, psychological bother, and sexual dysfunction. Erectile dysfunction is one common comorbid condition seen in men with Peyronie's disease, and its presence significantly impacts treatment considerations. In a man with Peyronie's disease and significant erectile dysfunction who desires the most reliable treatment, penile prosthesis placement should be strongly considered. In some instances, such as those patients with relatively mild curvature, prosthesis placement alone may result in adequate straightening. However, many patients will require additional straightening maneuvers such as manual modeling, penile plication, and tunica albuginea incision with or without grafting. For patients with severe penile shortening, penile length restoration techniques may also be considered. Herein, we provide a comprehensive clinical review of penile prosthesis placement in men with Peyronie's disease. Specifically, we discuss preoperative indications, intraoperative considerations, adjunctive straightening maneuvers, and postoperative outcomes.
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Affiliation(s)
| | - M Ryan Farrell
- Division of Urology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, IL 60612, USA
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Colombo F, Gentile G, Vagnoni V, Fiorillo A, Piazza P, Sartorio F, Franceschelli A. Initial experience of a single center with the use of ZSI 475 penile prosthesis. Asian J Urol 2020; 8:176-182. [PMID: 33996473 PMCID: PMC8099647 DOI: 10.1016/j.ajur.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/03/2019] [Accepted: 10/09/2019] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate surgical outcomes after implantation of the Zephyr ZSI 475 inflatable penile prosthesis (IPP) and patients' quality of life. Methods From December 2014 to September 2018, 15 patients underwent prosthesis implantation with ZSI 475. A retrospective review of clinical data was performed. Patients' quality of life after implantation was investigated with Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Results The median age of patients was 57 years and the average follow-up time was 22 months. Twelve patients received a standard implantation due to severe erectile dysfunction (ED); three patients also presented penile curvature and additional corporoplasty with grafting was necessary. Three procedures had to be interrupted due to defects of the insertion tools. In one case a manufacturing defect resulted in a pump leak. In one case, a severe postoperative complication occurred, which requested explanation of the device. During the follow-up, four patients experienced mechanical failure of the prosthesis. Results of QoLSPP questionnaire at 12 months were skewed toward the positive end of the scale in all domains. Conclusion In our initial experience, ZSI 475 suffered a high rate of mechanical failures; on the other hand, the company showed great commitment in order to improve the quality and reliability of the device. The lower cost of ZSI 475 may add to the chances of the product to become a cost-effective alternative to treat those patient who need a IPP.
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Affiliation(s)
- Fulvio Colombo
- Andrology Unit, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Giorgio Gentile
- Andrology Unit, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Valerio Vagnoni
- Andrology Unit, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | | | - Pietro Piazza
- Department of Urology, University of Bologna, Bologna, Italy
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Houlihan MD, Köhler TS, Wilson SK, Hatzichristodoulou G. Penoscrotal approach for IPP: still up-to-date after more than 40 years? Int J Impot Res 2019; 32:2-9. [DOI: 10.1038/s41443-019-0206-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/10/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022]
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Sharma KL, Alom M, Trost L. Surgical and Non-surgical Penile Elongation Techniques. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Wallen JJ, Madiraju SK, Wang R, Henry GD. Implementation of length expanding inflatable penile prosthesis is not sufficient to prevent postsurgical penile shortening. Asian J Androl 2018; 21:242213. [PMID: 30264738 PMCID: PMC6337945 DOI: 10.4103/aja.aja_77_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/05/2018] [Indexed: 01/22/2023] Open
Abstract
A single armed, prospective, two-center study was conducted with an aim of evaluating the effectiveness of the AMS 700 LGX cylinders in maintaining or increasing penile length postimplantation. The LGX has the unique ability to expand in length with inflation. Only 23.1% (6) of the patients were able to maintain stretched penile length. We now recommend leaving the implant inflated 60%–80% in the immediate postoperative setting for approximately 6 weeks. Then we teach pump training with deflation at around 6 weeks, prior to a maximum inflation protocol daily. Further studies would be required to validate if these interventions have significantly increased the number of patients who maintain or gain stretched penile length.
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Affiliation(s)
- Jared J Wallen
- Department of Urology, Florida Hospital Tampa Urology, Tampa, FL 3100, USA
| | | | - Run Wang
- Department of Urology, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Gerard D Henry
- Department of Urology, Ark-La-Tex Urology, Bossier City, LA 71111, USA
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Abstract
In the population of patients with prostate cancer, survivorship has come to the forefront of continuity-of-care. In addition to urinary control, erectile function is a significant issue after radical pelvic surgery. Penile prosthesis surgery remains an excellent option for restoring erectile function to those for whom more conservative measures have failed. This review article outlines the anatomical, surgical and post-operative consideration involved in the placement of a penile prosthesis in this special patient population.
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Affiliation(s)
- Nelson Bennett
- Department of Urology, Northwestern Memorial Hospital, Chicago, IL, 60611, USA
| | - I-Shen Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
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12
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Otero JR, Cruz CR, Gómez BG, Geli JS, Polo JM, Castañé ER, Antolín AR. Comparison of the patient and partner satisfaction with 700CX and Titan penile prostheses. Asian J Androl 2018; 19:321-325. [PMID: 26806085 PMCID: PMC5427788 DOI: 10.4103/1008-682x.172822] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Most widespread three-component penile prosthesis models are 700CX™ and Titan®. Our purpose is to assess patient and partner satisfaction after the first implant. This is a multicenter, retrospective, nonrandomized study in which all patients who met the inclusion criteria between 2009 and 2013 were included. In total, 248 patients agreed to participate. To evaluate patient satisfaction, a validated but modified 11-question questionnaire was completed (EDITS); and a nonvalidated two-item questionnaire was given to the partner. Statistical analysis used an ordinal logistic regression model. Two hundred and forty-eight patients (194 with 700CX™vs 54 with Titan®) and 207 couples completed the questionnaire (165 with 700CX™vs 42 with Titan®). Overall satisfaction was high. Both showed great reliability for sexual intercourse and high compliance with prior expectations. Most patients were able to manage the penile prosthesis correctly within 6 months. Postoperative penile shortening led to some dissatisfaction in 42% and 46% of cases (700CX™ /Titan®). Significant differences were found in three questions of patients’ questionnaire. There were more patients satisfied with the 700CX™ (P = 0.0001). No patient with Titan® implant took longer than 6 months to optimal management. Only 4% of patients with 700CX™ implant were dissatisfied with the deflation, in contrast to 24% with the Titan® (P = 0.0031). Of the two partners’ questions, one showed a statistically significant difference (P = 0.0026). It seems that group 700CX™ would recommend to re-implant the prosthesis with a greater tendency. The overall satisfaction was very high for both prostheses. The final aspect of the erected and flaccid penis was satisfactory, but both groups showed significant discontent with its final size. Partners’ overall satisfaction was high.
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Affiliation(s)
| | | | | | | | - Jose Medina Polo
- 12 de Octubre University Hospital, Department of Urology, Madrid, Spain
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13
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Xie D, Nicholas M, Gheiler V, Perito D, Siano L, Kislinger I, Nehrenz GM, Klopukh B, Bianco FJ, Perito P, Gheiler E. A prospective evaluation of penile measures and glans penis sensory changes after penile prosthetic surgery. Transl Androl Urol 2017; 6:529-533. [PMID: 28725595 PMCID: PMC5503964 DOI: 10.21037/tau.2017.05.34] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background With better designed devices and lower infection rates, satisfaction with inflatable penile prosthesis (IPP) placement is increasingly high. However, dissatisfaction is still present and there is disagreement regarding length and sensation changes after the IPP placement. The aim of this study was to evaluate changes in penile length, girth and sensitivity after IPP placement. Methods From August 2012 to January 2013 all patients undergoing “de novo” IPP surgery were invited to participate in this study. Eighty six patients met inclusion criteria while 62 agreed to participate in this observational study. A week before surgery, penile length and circumference, and glans/elbow biothesiometer readings were recorded 15 minutes after Trimix induced erection. Same measures were taken at postoperative week 6 and month 6. Results Amperage from Glans biothesiometer readings showed statistically significant shorter readings than elbow biothesiometer preoperatively, 6 weeks and 6 months after surgery (P<0.001 each). No significant sensory difference in the glans penis after IPP was noted. However, compared to preoperative Trimix induced erections, penile length and circumference were greater after IPP placement (P=0.04 and P=0.001, respectively). Conclusions We observed statistically significant increase in penile length and girth after IPP placement without significant changes in sensory conduction.
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Affiliation(s)
- Donghua Xie
- Urological Research Network, Hialeah, FL, USA.,Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Marilin Nicholas
- Urological Research Network, Hialeah, FL, USA.,Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Victor Gheiler
- Urological Research Network, Hialeah, FL, USA.,Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Dylan Perito
- Urological Research Network, Hialeah, FL, USA.,Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Luanda Siano
- Urological Research Network, Hialeah, FL, USA.,Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | - Guy M Nehrenz
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Boris Klopukh
- Urological Research Network, Hialeah, FL, USA.,Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Fernando J Bianco
- Urological Research Network, Hialeah, FL, USA.,Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Paul Perito
- Urological Research Network, Hialeah, FL, USA.,Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Edward Gheiler
- Urological Research Network, Hialeah, FL, USA.,Nova Southeastern University, Fort Lauderdale, FL, USA
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Pryor MB, Carrion R, Wang R, Henry G. Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis. Asian J Androl 2017; 18:754-8. [PMID: 26459782 PMCID: PMC5000799 DOI: 10.4103/1008-682x.163266] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements. This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1–2 h daily for 6–24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer (30.8%) or the same (46.2%) as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject (96.5%) was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.
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Affiliation(s)
- Michael B Pryor
- Regional Urology, 255 Bert Kouns Industrial Loop, Shreveport, LA, USA
| | - Rafael Carrion
- Department of Urology, University of South Florida, Tampa, Florida, USA
| | - Run Wang
- Department of Urology, University of Texas School of Medicine at Houston and MD Anderson Cancer Center, Houston, TX, USA
| | - Gerard Henry
- Regional Urology, 255 Bert Kouns Industrial Loop, Shreveport, LA, USA
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Abstract
INTRODUCTION Loss of penile size is a common complaint that can negatively affect patient satisfaction rates following successful penile prosthetic implant surgery. OBJECTIVE The aim of this review is to describe the various strategies that have been used to maintain penile length or girth after the insertion of a penile prosthetic implant. METHODS An extensive systematic literature review was performed, based on a search of the PUBMED database for articles published between 2002 to 2012. The following key words were used: penile prosthesis, implant, penile length, size, penis, enhancement, enlargement, phalloplasty, girth, lengthening, and augmentation. Only English-language articles that were related to penile prosthetic surgery and penile size were sought. DISCUSSION Based on the results of our search, strategies were classified into 3 groups based on the timepoint in relation to the primary penile prosthetic insertion surgery, which included pre-insertion, intraoperative and post-insertion. CONCLUSIONS Strategies to preserve and potentially increase penile size are of great importance to all implanters. Besides traction therapies and surgeries to enhance perceived penile size, refinements in the surgical approach are simple ways to optimize penile length. A direct comparison of treatment outcomes evaluating the various approaches is not currently possible, owing to divergent study techniques. The implanting surgeon can best serve his patient by adopting a combination of different strategies that are individualized and specific to the patient's needs.
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Affiliation(s)
- King Chien Joe Lee
- 1 Department of Urology, National University Hospital, Singapore ; 2 Division of Urology, St Joseph's Health Care, London, ON, Canada
| | - Gerald B Brock
- 1 Department of Urology, National University Hospital, Singapore ; 2 Division of Urology, St Joseph's Health Care, London, ON, Canada
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Carvalheira A, Santana R, Pereira NM. Why Are Men Satisfied or Dissatisfied with Penile Implants? A Mixed Method Study on Satisfaction with Penile Prosthesis Implantation. J Sex Med 2015; 12:2474-80. [PMID: 26639576 DOI: 10.1111/jsm.13054] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Studies have demonstrated high levels of satisfaction with penile prosthesis implantation (PPI). However, qualitative research exploring the experience of PPI through men's narratives is scarce. AIM The main goals were to analyze (i) the level of sexual satisfaction (quantitatively), and (ii) the reasons for satisfaction and/or dissatisfaction with PPI (qualitatively). METHOD Participants were 47 men with erectile dysfunction who underwent surgery between 2003 and 2012, placed by a single surgeon. Structured telephone interviews were carried out. MAIN OUTCOME MEASURES Satisfaction with PPI was a qualitative and quantitative measure assessed through the following four items: (i) "Would you repeat the PPI surgery?"; (ii) "Would you recommend the PPI surgery?"; (iii) "How satisfied are you with the PP?"; and (iv) "Could you explain the motives of your satisfaction/dissatisfaction?". RESULTS The majority of men (79%) reported to be satisfied with PPI. Content analysis revealed four main themes for men's satisfaction with the PPI: (i) psychological factors were reported 54 times (n = 54) and included positive emotions, self-esteem, confidence, enhancement of male identity, major live change, and self-image; (ii) improvement of sexual function was reported 54 times (n = 54) and referred to achievement of vaginal penetration, increase of sexual desire, sexual satisfaction, penis size, and improvement of erectile function; (iii) relationship factors were reported 11 times (n = 11) and referred to relationship improvement and the possibility of giving pleasure to the partner; and (iv) improvement in urinary function (n = 3). CONCLUSIONS The level of satisfaction with the implementation of penile prostheses is very high, therefore constituting a treatment for erectile dysfunction with a positive impact on the experience of men at sexual, psychological and relational level.
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Affiliation(s)
- Ana Carvalheira
- William James Center for Research, ISPA-University Institute, Lisbon, Portugal
| | | | - Nuno M Pereira
- iSex-Association of Advanced Study of Human Sexuality, Lusófona University, Lisbon, Portugal
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Trost L, Hellstrom WJG. History, Contemporary Outcomes, and Future of Penile Prostheses: A Review of the Literature. Sex Med Rev 2015; 1:150-163. [PMID: 27784554 DOI: 10.1002/smrj.8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Since their introduction, penile prostheses have consistently remained a superior treatment option for men with erectile dysfunction (ED) refractory to conservative measures. Ongoing enhancements to prosthetic design, materials, and surgical techniques have resulted in improved outcomes. AIM To review available literature on notable historical advancements and improvements of the penile prosthesis, summarize contemporary outcomes of recent devices, and discuss possible future directions of the penile prosthesis. METHODS A PubMed search was performed of all articles published from 1960 to present relating to penile prosthesis. Priority was given to series with 12 months of follow-up or greater, larger series, and studies reporting on outcomes of more recent prosthetic models. MAIN OUTCOME MEASURES Main outcomes included historical review of improvements leading to, and contemporary series reporting on rates of mechanical failures, infections, and satisfaction with penile prostheses. RESULTS Penile prostheses have undergone numerous enhancements since initial reports of synthetic materials utilized in the 1950s. Among others, recent notable device enhancements include Parylene coating, Bioflex® material, InhibizoneTM antibacterial impregnation, hydrophilic coating, lockout valves, and easy release pump mechanisms, all of which have improved mechanical reliability, reduced infection rates, and/or improved patient satisfaction with penile prostheses. Contemporary series of 3-piece penile prostheses report mechanical survival of 81-94%, 68-89%, and 57-76% at 5, 10, and 15 years, respectively. Infection rates of current devices are 1-2% in first-time, low-risk populations, and 2-3% for higher risk groups, with patient and partner satisfaction at 92-100% and 91-95%, respectively. Two-piece and malleable devices are associated with slightly higher mechanical reliability and decreased patient satisfaction. Minimal data currently exist on the outcomes of selected patient populations, including Peyronie's disease and corporal fibrosis. CONCLUSIONS Penile prostheses are associated with excellent, long-term outcomes and remain the gold-standard treatment for men with refractory ED. Additional research with prospective studies utilizing objective measures and standardized questionnaires is required. Trost L and Hellstrom WJG. History, contemporary outcomes, and future of penile prostheses: A review of the literature. Sex Med Rev 2013;1:150-163.
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Affiliation(s)
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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Lledó‐García E, Jara‐Rascón J, Moncada Iribarren I, Piñero‐Sánchez J, Aragón‐Chamizo J, Hernández‐Fernández C. Penile Prosthesis First and Replacement Surgeries: Analysis of Patient and Partner Satisfaction. J Sex Med 2015; 12:1646-53. [DOI: 10.1111/jsm.12932] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Henry GD, Carrion R, Jennermann C, Wang R. Prospective evaluation of postoperative penile rehabilitation: penile length/girth maintenance 1 year following Coloplast Titan inflatable penile prosthesis. J Sex Med 2015; 12:1298-304. [PMID: 25872574 DOI: 10.1111/jsm.12833] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The most prevalent long-term complaint after successful inflatable penile prosthesis (IPP) surgery is reduction of penile length. The purpose of this study was to evaluate penile measurements in patients whose implantation experience included the aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation (daily inflation) of the implant for 1 year. Moreover, we aimed to document objective data concerning dimensional changes of the phallus over time. Postoperative IPP rehabilitation has been discussed and presented at meetings, but no multi-institutional prospective data have been published. AIM Our goal was to assess results using the Coloplast Titan IPP, with NLMT, and postoperative rehabilitation. METHODS After IRB approval, we conducted a prospective, three-center study of 40 patients who underwent IPP placement, with NLMT for end organ failure erectile dysfunction with the Coloplast Titan IPP. The patient was instructed to inflate daily for 6 months and then inflate maximally for 1-2 hours daily for 6-12 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. MAIN OUTCOME MEASURE Penile length measurements after implantation compared with 12 months postimplantation. RESULTS Penile measurement changes were statistically significantly improved at 12 months as compared with immediately postoperative and at 6 months. A total of 64.5% of subjects were satisfied with their length at 1 year, and 74.2% had perceived penile length that was longer (29%) or the same (45.2%) as prior to the surgery; 61.3% and 16.1% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared with prior to IPP surgery. All but two subjects (93.4%) were satisfied with the overall function and dimensions of their IPP. CONCLUSION This study suggests using the Coloplast Titan IPP with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol may help optimize patient satisfaction and erectile penile measurements.
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Affiliation(s)
| | | | | | - Run Wang
- Urology, UT-Houston Medical School, Houston, TX, USA
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Henry GD, Mahle P, Caso J, Eisenhart E, Carrion R, Kramer A. Surgical Techniques in Penoscrotal Implantation of an Inflatable Penile Prosthesis: A Guide to Increasing Patient Satisfaction and Surgeon Ease. Sex Med Rev 2015; 3:36-47. [DOI: 10.1002/smrj.39] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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The evolution of the inflatable penile prosthetic device and surgical innovations with anatomical considerations. Curr Urol Rep 2014; 15:410. [PMID: 24756452 DOI: 10.1007/s11934-014-0410-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Historically, early surgical treatment for erectile dysfunction involved the placement of rigid devices outside of the corpora cavernosa. This practice resulted in high rates of erosion and infection. Today, most urologists in the United States place an inflatable penile prosthesis (IPP) with an infection-retardant coating inside the corpora cavernosa. In addition to changes in the type of implant used, surgical techniques have evolved greatly in recent years, resulting in reduced operating times, lower infection rates, and improved outcomes. However, anatomical considerations have directed the prosthetic surgeon to improve patient outcomes and satisfaction rates by employing both new surgical techniques and postoperative maneuvers.
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Trost LW, Boonjindasup AG, Hellstrom WJG. Comparison of infrapubic versus transcrotal approaches for inflatable penile prosthesis placement: a multi-institution report. Int J Impot Res 2014; 27:86-9. [DOI: 10.1038/ijir.2014.35] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 08/12/2014] [Accepted: 09/11/2014] [Indexed: 11/10/2022]
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Current Management of Penile Implant Infections, Device Reliability, and Optimizing Cosmetic Outcome. Curr Urol Rep 2014; 15:413. [DOI: 10.1007/s11934-014-0413-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pharmacologically induced erect penile length and stretched penile length are both good predictors of post-inflatable prosthesis penile length. Int J Impot Res 2014; 26:128-31. [PMID: 24430278 DOI: 10.1038/ijir.2013.50] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 10/27/2013] [Accepted: 12/12/2013] [Indexed: 11/08/2022]
Abstract
Inflatable penile prosthesis (IPP) remains the gold standard for the surgical treatment of refractory erectile dysfunction; however, current literature to aid surgeons on how best to counsel patients on their postoperative inflated penile length is lacking. The aim of this study was to identify preoperative parameters that could better predict postoperative penile length following insertion of an IPP. Twenty men were enrolled in a prospective study examining penile lengths before and after IPP surgery. Patients with Peyronie's disease were excluded from this analysis. Baseline preoperative characteristics, including body mass index, history of hypertension, diabetes, Sexual Health Inventory for Men scores and/or prior radical prostatectomy were recorded. All patients underwent implantation with a three-piece inflatable Coloplast penile prosthesis. We compared stretched penile length to pharmacologically induced erect lengths. Postoperatively, we measured inflated penile lengths at 6 weeks and assessed patients' perception of penile size at 12 weeks. The median (±interquartile range) stretched penile length and pharmacologically induced erect penile length was 15 (±3) and 14.25 (±2) cm, respectively (P=0.5). Median post-prosthesis penile length (13.5±2.13 cm) was smaller than preoperative pharmacologically induced length (P=0.02) and preoperative stretched penile length (P=0.01). The majority of patients (70%) had a decrease in penile length (median loss 0.5±1.5 cm); however, this loss was perceptible by 43% of men. Stretched penile length and pharmacologically induced erect penile length were equally good predictors of postoperative inflated length (Spearman's correlation 0.8 and 0.9, respectively). Pharmacologically induced erect penile length and stretched penile lengths are equal predictors of post-prosthesis penile length. The majority of men will experience some decrease in penile length following prosthesis implantation; however <50% report a subjective loss of penile length.
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Shirvanian V, Lemperle G, Araujo Pinto C, Elist JJ. Shortened penis post penile prosthesis implantation treated with subcutaneous soft silicone penile implant: case report. Int J Impot Res 2013; 26:100-4. [PMID: 24305609 DOI: 10.1038/ijir.2013.44] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/11/2013] [Accepted: 10/21/2013] [Indexed: 11/09/2022]
Abstract
Penile prosthesis surgery for erectile dysfunction has the highest satisfaction rates among all treatment options but is often associated with subjective and objective loss of penile length and girth following surgery. To present a novel technique using a subcutaneous soft silicone implant for reversal of penile shortening and narrowing after prosthesis surgery, with additional gains in overall penile length and girth. Nine patients were treated with the insertion of a subcutaneous soft silicone penile implant. All patients had previously reported a loss in penile length (0.5-2 cm), and seven of nine patients also reported a loss in penile girth (0.5-2.6 cm) after penile prosthesis surgery. During a follow-up period of 4-24 months, penile length and girth measurements showed a mean increase in length of 2.4 cm (±0.75 cm) and a mean increase in girth of 3.4 cm (±0.94 cm). The additional insertion of a subcutaneous soft silicone implant in patients with decreased penile length and girth after penile prosthesis surgery is an effective treatment option that provides reversal of lost penile length and girth.
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Affiliation(s)
- V Shirvanian
- Johann Wolfgang Goethe University, Frankfurt am Main, Frankfurt, Germany
| | - G Lemperle
- Division of Plastic Surgery, University of California San Diego, San Diego, CA, USA
| | - C Araujo Pinto
- Instituto Paulista Tratamento Disfunncao Eretil, Sau Paulo, Brazil
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Trost LW, Baum N, Hellstrom WJ. Managing the Difficult Penile Prosthesis Patient. J Sex Med 2013; 10:893-906; quiz 907. [DOI: 10.1111/jsm.12115] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Henry GD, Jennermann C, Eid JF. Evaluation of Satisfaction and Axial Rigidity with Titan XL Cylinders. Adv Urol 2012; 2012:896070. [PMID: 22997510 PMCID: PMC3446653 DOI: 10.1155/2012/896070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 07/16/2012] [Indexed: 11/17/2022] Open
Abstract
The inflatable penile prosthesis (IPP) has high patient satisfaction rates and good mechanical reliability rates in multiple studies. The number one patient compliant at six months is penile length. Recently, new technique for aggressive sizing of the cylinders has been published on in the literature. One IPP company has produced a new product that has longer length cylinders (XL) than those available. However, traditionally long cylinders were felt to lack axial rigidity. Therefore, a prospective, multicenter, central IRB-approved, monitored study was performed on the new product to address these concerns. At 2 centers, a total of 17 patients underwent surgical implantation of these new XL cylinders. These patients were questioned for patient satisfaction and tested for axial rigidity using a Fastsize Erectile Quality Monitor. The results showed excellent patient satisfaction rates and great axial rigidity with the Fastsize Erectile Quality Monitor. The XL cylinders appear to give the IPP surgeon the ability to use longer cylinders with good patient satisfaction and great axial rigidity.
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Affiliation(s)
- Gerard D. Henry
- Regional Urology, Department of Urology, 255 Bert Kouns, Shreveport, LA 71199, USA
| | - Caroline Jennermann
- Regional Urology, Department of Urology, 255 Bert Kouns, Shreveport, LA 71199, USA
| | - J. Francois Eid
- Advanced Urological Care, P.C., Department of Urology, 435 East 63rd Street, New York, NY 10065, USA
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Contemporary patient satisfaction rates for three-piece inflatable penile prostheses. Adv Urol 2012; 2012:707321. [PMID: 22899909 PMCID: PMC3412090 DOI: 10.1155/2012/707321] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 05/30/2012] [Indexed: 12/16/2022] Open
Abstract
Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. Specifically, the placement of a three-piece inflatable penile prosthesis (IPP) confers the highest rates of satisfaction. We reviewed the literature over the past 20 years regarding satisfaction rates for penile prostheses, with a focus on patients who had undergone an initial IPP implantation for erectile dysfunction. In all, 194 articles were reviewed, and of these, nine met inclusion criteria for analysis and data collation. We determined contemporary satisfaction rates to reflect patients' experiences with newer products and surgical approaches. Of importance, we noted that varied metrics were used to determine patient satisfaction, and overall satisfaction could not be precisely determined. Nevertheless, we found that patients in general were quite satisfied with their three-piece IPPs and restoration of sexual function. We also identified reasons for patient dissatisfaction and reviewed the literature to find ways by which satisfaction could be improved. Given the various means by which patient satisfaction was determined, future efforts should include standardized and validated questionnaires.
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