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Rajamohan N, Kapoor H, Khurana A, Nelson L, Ganesh HS, Khatri G, Nair RT. MR imaging of penile pathology and prostheses. Abdom Radiol (NY) 2024:10.1007/s00261-024-04417-2. [PMID: 39066812 DOI: 10.1007/s00261-024-04417-2] [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: 04/15/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 07/30/2024]
Abstract
Penile MRI is a vital yet underutilized diagnostic tool that provides detailed information crucial for managing various penile pathologies. Due to its infrequent use, many radiology trainees lack confidence in interpreting these exams. This article reviews the anatomy, key technical considerations, and interpretive pearls for penile trauma, Peyronie's disease, priapism, penile neoplasms, prosthesis evaluation, and a few miscellaneous conditions. Through illustrative case examples, this review aims to enhance the understanding and proficiency of radiologists in performing and interpreting penile MRI in these clinical scenarios.
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Affiliation(s)
- Naveen Rajamohan
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9004, USA.
| | - Harit Kapoor
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
| | - Aman Khurana
- Department of Radiology, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Leslie Nelson
- Department of Radiology, University of Wisconsin, Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - Halemane S Ganesh
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9004, USA
| | - Rashmi T Nair
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
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Chang KS, Chung CH, Chang YK, Hsu GL, Tsai MH, Chueh JSC. Coil Embolization Is Not Justified for Treating Patients with Veno-Occlusive Dysfunction: Case Series and Narrative Literature Review. Life (Basel) 2024; 14:911. [PMID: 39063664 PMCID: PMC11278194 DOI: 10.3390/life14070911] [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: 05/06/2024] [Revised: 05/26/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Introduction: Herein, we explore whether coil embolization (CE) is effective in treating veno-occlusive dysfunction (VOD). We present five cases with seven CE episodes and a narrative literature review. Methods: From 2013 to 2018, refractory impotence prompted five men to seek penile vascular stripping (PVS), although seven CE episodes were included. All received dual cavernosography in which erection-related veins and VOD were documented. PVS entailed the venous stripping of one deep dorsal vein and two cavernosal veins. The abridged five-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS) were used, and yearly postoperative follow-ups were conducted via the Internet. Using Pub Med, a narrative literature review was performed on CE treatment for VOD or varicocele. Results: Inserted coils were scattered along the erection-related veins, including the deep dorsal veins (n = 4), periprostatic plexus (n = 5), iliac vein (n = 5), right pulmonary artery (n = 2), left pulmonary artery (n = 2), and right ventricle (n = 1). PVS resulted in some improvements in the IIEF-5 score and EHS scale. Six articles highly recommend CE treatment for VOD. All claimed it is a minimally invasive effective treatment for varicocele. Conclusions: CE is not justified as a VOD treatment, regardless of its viability in the treatment of varicocele.
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Affiliation(s)
- Ko-Shih Chang
- Division of Cardiovascular Medicine, Microsurgery Potency Reconstruction and Research Center, Yuan Rung Hospital, Yuanlin, Changhua 51052, Taiwan
- School of Nursing, National Taipei University of Nursing and Health Science, Taipei 112303, Taiwan
| | - Cho-Hsing Chung
- Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Yi-Kai Chang
- Department of Urology, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Geng-Long Hsu
- Division of Cardiovascular Medicine, Microsurgery Potency Reconstruction and Research Center, Yuan Rung Hospital, Yuanlin, Changhua 51052, Taiwan
- Department of Urology, National Taiwan University Hospital, Taipei 10002, Taiwan
- Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology and Shu-Tien Urology Ophthalmology Clinic, Taipei 10662, Taiwan
| | - Mang-Hung Tsai
- Department of Anatomy, China Medical University, Taichung 40402, Taiwan
| | - Jeff SC Chueh
- Department of Urology, National Taiwan University Hospital, Taipei 10002, Taiwan
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Raikin J, Woodruff M, Meshekow G, Debski ND, Germaine P, Gor R. Urologic prosthetics: an imaging review of short- and long-term complications. Abdom Radiol (NY) 2024:10.1007/s00261-024-04491-6. [PMID: 38985291 DOI: 10.1007/s00261-024-04491-6] [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: 05/02/2024] [Revised: 06/26/2024] [Accepted: 06/30/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Urologic prosthetics offer significant quality of life enhancements for patients with stress urinary incontinence and erectile dysfunction. Artificial urinary sphincter and penile prosthesis are the most commonly used prosthetics for these patients. Radiographic imaging offers important insight, guiding treatment when patients present with complications. Herein, we pictorialize normal radiographic findings and complications alike. METHODS We reviewed our IRB-approved prosthetics database, highlighting patients with prosthetic complications with available imaging. We collected imaging from patients without complications for baseline reference. RESULTS The radiographic appearance of orthotopic genitourinary prosthetics and a review of short- and long-term complications including hematoma, infection, malpositioning, leak and erosion are pictorialized. CONCLUSION Radiologic imaging serves as a vital complement to history and physical examination, aiding in the identification of complications and potentially streamlining surgical preparations. It is important for radiologists to familiarize themselves with standard prosthetic nomenclature, normal positioning and appearance, along with imaging findings of common complications.
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Affiliation(s)
- Jared Raikin
- Department of Surgery, Cooper University Healthcare, Camden, NJ, USA.
| | - Mary Woodruff
- Department of Diagnostic Radiology, Cooper University Healthcare, Camden, NJ, USA
| | - Gabriel Meshekow
- Department of Diagnostic Radiology, Cooper University Healthcare, Camden, NJ, USA
| | | | - Pauline Germaine
- Department of Diagnostic Radiology, Cooper University Healthcare, Camden, NJ, USA
| | - Ronak Gor
- Department of Surgery, Cooper University Healthcare, Camden, NJ, USA
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Veletić M, Apu EH, Simić M, Bergsland J, Balasingham I, Contag CH, Ashammakhi N. Implants with Sensing Capabilities. Chem Rev 2022; 122:16329-16363. [PMID: 35981266 DOI: 10.1021/acs.chemrev.2c00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because of the aging human population and increased numbers of surgical procedures being performed, there is a growing number of biomedical devices being implanted each year. Although the benefits of implants are significant, there are risks to having foreign materials in the body that may lead to complications that may remain undetectable until a time at which the damage done becomes irreversible. To address this challenge, advances in implantable sensors may enable early detection of even minor changes in the implants or the surrounding tissues and provide early cues for intervention. Therefore, integrating sensors with implants will enable real-time monitoring and lead to improvements in implant function. Sensor integration has been mostly applied to cardiovascular, neural, and orthopedic implants, and advances in combined implant-sensor devices have been significant, yet there are needs still to be addressed. Sensor-integrating implants are still in their infancy; however, some have already made it to the clinic. With an interdisciplinary approach, these sensor-integrating devices will become more efficient, providing clear paths to clinical translation in the future.
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Affiliation(s)
- Mladen Veletić
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ehsanul Hoque Apu
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Division of Hematology and Oncology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48105, United States
| | - Mitar Simić
- Faculty of Electrical Engineering, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Jacob Bergsland
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ilangko Balasingham
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Christopher H Contag
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States
| | - Nureddin Ashammakhi
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Department of Bioengineering, University of California, Los Angeles, California 90095, United States
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5
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Wang VM, Levine LA. Safety and Efficacy of Inflatable Penile Prostheses for the Treatment of Erectile Dysfunction: Evidence to Date. MEDICAL DEVICES: EVIDENCE AND RESEARCH 2022; 15:27-36. [PMID: 35177941 PMCID: PMC8844936 DOI: 10.2147/mder.s251364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022]
Abstract
Erectile dysfunction (ED) is a common problem, and prevalence rates are expected to rise as life expectancy increases worldwide. In more severe cases of ED, penile prosthesis implantation has been an excellent option for patients. Over the past few decades, significant design improvements have been made to the penile prosthesis and modifications to surgical technique to improve clinical outcomes. The purpose of this review is to summarize the safety and efficacy of FDA-approved penile implants in the US market. Design modifications have greatly improved the safety and reliability of the implant. Development of improved surgical techniques has decreased intraoperative injuries and reservoir-related complications. With its high overall satisfaction rates and low risk of complications, the inflatable penile prosthesis remains an excellent option for patients with erectile dysfunction.
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Affiliation(s)
- Vinson M Wang
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
- Correspondence: Laurence A Levine, Email
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Uski ACVR, Piccolo LM, Abud CP, Pedroso MHNI, Seidel Albuquerque K, Gomes NBN, Fernandes JDÁ. MRI of Penile Prostheses: The Challenge of Diagnosing Postsurgical Complications. Radiographics 2021; 42:159-175. [PMID: 34919468 DOI: 10.1148/rg.210075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Penile implants are surgically inserted devices used for the treatment of erectile disfunction. Improvements in surgical techniques and in the manufacturing of these implants have reduced the risk of intra- and postoperative complications and increased the popularity and use of this therapeutic option. Routine imaging is not recommended before penile prosthesis surgery. Malleable penile prostheses use noninflatable shafts inserted into each corpus cavernosum, which appear hypointense on T1- and T2-weighted MR images. Inflatable penile prostheses (IPPs) may consist of two or three parts and are composed of two cylinders inserted into the corpora cavernosa that are filled with a saline solution to produce rigidity. These appear homogeneously T2 hyperintense and the silicone-based covering of the cylinders appears T2 hypointense, thereby clearly delineating the cylinders. In the case of three-piece IPPs, a reservoir containing the fluid may be placed in the pelvis. The most frequent complications are related to infection and mechanical failure, the latter being more common in IPPs because more components are involved. Less common complications include malpositioning. Detection and management of postoperative complications are challenging, and MRI plays a crucial role as it permits evaluation of the positioning and configuration of the prosthesis components, as well as assists in functional evaluation of IPPs when images are obtained of both the flaccid and inflated states. ©RSNA, 2021.
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Affiliation(s)
- Ana Cláudia Vincenzi Raduan Uski
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
| | - Luciana Maksoud Piccolo
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
| | - Carolina Pereira Abud
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
| | - Maria Helena Naves Inácio Pedroso
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
| | - Kamila Seidel Albuquerque
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
| | - Natália Borges Nunes Gomes
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
| | - José de Ávila Fernandes
- From the Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Santa Catarina, Rua Artur Prado 394, São Paulo, SP 01322-000, Brazil (A.C.V.R.U., L.M.P., J.d.Á.F.); and Department of Diagnostic Imaging, Division of Abdominal Radiology, Hospital Beneficência Portuguesa, São Paulo, Brazil (A.C.V.R.U., C.P.A., M.H.N.I.P., K.S.A., N.B.N.G.)
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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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Shaeer O, Raheem AA, Elfeky H, Seif A, Abdel-Raheem TM, Elsegeiny A, Soliman MS, Basalious EB, Shaeer K. Urethral instillation of chlorhexidine gel is an effective method of sterilisation. Arab J Urol 2021; 19:419-422. [PMID: 34552794 PMCID: PMC8451623 DOI: 10.1080/2090598x.2021.1956832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/09/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To examine the effectiveness of preoperative urethral sterilisation with chlorhexidine gel in rendering the urethra as sterile as the skin of the genital area, with the skin sterilised as per the International Society for Sexual Medicine guidelines for penile prosthesis implantation. Patients and methods: A total of 111 male patients undergoing sterile andrological surgical procedures were divided into a control group (N = 61) and a chlorhexidine gel group (N = 50). Patients in the chlorhexidine group received urethral instillation with 6 mL of chlorhexidine preoperatively and on table. Patients from both groups received on-table skin preparation using povidone iodine and chlorhexidine povidone iodine. At the end of surgery, swabs were obtained from urethra and the penile skin. Skin and urethral swabs were compared for bacterial colonisation by culture and sensitivity. Results: Of the 111 patients, 16 had urethral colonisation and 10 had skin contamination, and they were all in the control group. The most common organism detected in both the urethral and skin samples was coagulase-negative Staphylococcus aureus. Urethral colonisation was significantly greater in the control group compared to the chlorhexidine group, at 16/61 vs 0/50 (P = 0.001). Similarly, skin colonisation was significantly greater in the control group compared to the chlorhexidine group, at 10/61 vs 0/50, (P = 0.002). Conclusion: Chlorhexidine gel is a powerful sterilising agent that will render the urethra sterile.
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Affiliation(s)
- Osama Shaeer
- Andrology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr Abdel- Raheem
- Andrology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Haitham Elfeky
- Andrology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmad Seif
- Andrology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tarek M. Abdel-Raheem
- Medical Physiology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amgad Elsegeiny
- Andrology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - May Sherif Soliman
- Clinical and Chemical Pathology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Emad B. Basalious
- Pharmaceutics and Industrial Pharmacy Department, Cairo University Cairo, Cairo, Egypt
| | - Kamal Shaeer
- Andrology Department, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
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9
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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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10
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Management of Urethral Injury During Penile Prosthesis Surgery. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Bettocchi C, Santoro V, Sebastiani F, Lucarelli G, Colombo F, Ralph DJ, Habous M, Ditonno P, Battaglia M, Spilotros M. Management of severe complications following penile surgery for erectile dysfunction and Peyronie disease: Three case reports. Medicine (Baltimore) 2020; 99:e18690. [PMID: 32049780 PMCID: PMC7035019 DOI: 10.1097/md.0000000000018690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Erectile dysfunction (ED) and Peyronie's disease (PD) are conditions commonly observed in andrology. Despite the surgical refinement and the technical improvement in this field, even in expert hands, detrimental consequences have been reported and it can be related to patient's comorbidities or misconduct in the postoperative period. In this article we report anecdotal cases of severe complications following penile surgery for ED and PD in high volume centers, describe the strategies adopted to treat it and discuss the options that would have helped preventing these events. PATIENTS' CONCERNS The first case describes a patient with history of ED and PD causing penile shortening and a slight dorsal deviation of penile shaft. In the second case it is described a corporeal necrosis and urethral fistula following inflatable penile prosthesis implant. In the last case it is described the migration of reservoir into the abdomen after inflatable penile prosthesis implantation post-radical prostatectomy. DIAGNOSIS All 3 patients were investigated with a penile doppler ultrasound with PGE1 intracorporeal injection for ED and PD diagnosis. An abdominal computed tomography scan and magnetic resonance imaging were ordered for patient of case three. INTERVENTIONS The patients underwent different combined procedures depending on the case and including: glansectomy, penile prosthesis implantation associated with a penile elongation with double dorsal-ventral patch graft ("sliding technique"), penile urethroplasty with buccal mucosa graft, and laparotomy for reservoir removal. OUTCOMES No further serious complications were reported after the procedures described. LESSONS Penile surgery in patients with concomitant PD and systemic comorbidities can be at high risk of complications. As shown in this series there are possible dramatic evolution of these complications that may cause irreversible consequences to the patient. For this reason, a dedicated surgical and nursing team is necessary to reduce the chances that it happens. When this event occurs, a team trained in their management can improve the patient outcome.
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Affiliation(s)
- Carlo Bettocchi
- Division of Urology, Department of Emergency and Organ Transplantation, University of Bari, Bari
| | - Valeria Santoro
- Division of Urology, Department of Emergency and Organ Transplantation, University of Bari, Bari
| | - Francesco Sebastiani
- Division of Urology, Department of Emergency and Organ Transplantation, University of Bari, Bari
| | - Giuseppe Lucarelli
- Division of Urology, Department of Emergency and Organ Transplantation, University of Bari, Bari
| | - Fulvio Colombo
- Department of Urology, Sant’Orsola Hospital - University of Bologna, Bologna, Italy
| | - David John Ralph
- The Institute of Urology, University College London Hospitals, London, UK
| | - Mohamad Habous
- Department of Urology and Andrology, Elaj Medical Center, Jeddah, Saudi Arabia
| | - Pasquale Ditonno
- Division of Urology, Department of Emergency and Organ Transplantation, University of Bari, Bari
| | - Michele Battaglia
- Division of Urology, Department of Emergency and Organ Transplantation, University of Bari, Bari
| | - Marco Spilotros
- Division of Urology, Department of Emergency and Organ Transplantation, University of Bari, Bari
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Reddy AG, Tsambarlis PN, Akula KP, Dick BP, Hong J, Hellstrom WJG. Retained Reservoirs of Inflatable Penile Prosthesis: A Systematic Review of the Literature and a Guide to Perioperative Management. Sex Med Rev 2019; 8:355-363. [PMID: 31526635 DOI: 10.1016/j.sxmr.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Retained reservoirs can be a complex problem for clinicians who manage patients with inflatable penile prostheses (IPPs). Although the general safety of retained reservoirs is well documented, data on the long-term outcomes of these foreign bodies is scarce. In recent years, complications associated with retained reservoirs and the subsequent management of these cases have become more recognized. AIM To review, analyze, and summarize the concept of retained reservoirs and their associated complications with retained reservoirs and to provide a guide for management of complicated retained reservoir patients. METHODS We performed a systematic review of the PubMed database on retained reservoir-related complications and perioperative management. MAIN OUTCOME MEASURES We reviewed all publications that detailed complications associated specifically with retained penile prosthesis reservoirs and analyzed perioperative strategies used by providers. Any publication outlining IPP reservoir-related complication(s) stemming from a reservoir that was part of a functioning IPP was excluded. RESULTS Although the risk is low, serious complications can and do arise from retained reservoirs. To properly manage these patients, clinicians must have knowledge of the prosthetic history and maintain a low threshold for obtaining cross-sectional imaging. By using methodical perioperative planning, the need for reintervention in patients with complications can be reduced, and improved surgical outcomes can be achieved. CONCLUSIONS The management of retained reservoirs and their complications can be a clinical challenge for prosthetics providers. As such, more data regarding long-term outcomes and management strategies of retained reservoirs are required to better serve this subset of patients with prostheses. Reddy AG, Tsambarlis PN, Akula KP, et al. Retained Reservoirs of Inflatable Penile Prosthesis: A Systematic Review of Literature. Sex Med Rev 2020;8:355-363.
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Affiliation(s)
- Amit G Reddy
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Peter N Tsambarlis
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Kole Prasad Akula
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Brian P Dick
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Jennifer Hong
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA.
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Bettocchi C, Spilotros M, Lucarelli G, Utano E, Sebastiani F, Bittner L, Ditonno P, Battaglia M. Penile prosthesis implant for primary erectile dysfunction in patient with Klippel-Trenaunay syndrome complicated by consumptive coagulopathy: A case report. Medicine (Baltimore) 2019; 98:e16741. [PMID: 31393387 PMCID: PMC6708871 DOI: 10.1097/md.0000000000016741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Klippel-Trenaunay syndrome (KTS) is a congenital disorder characterized by cutaneous port wine capillary malformations, varicose veins with hemihypertrophy of soft tissue and bone.Pelvic and retroperitoneal vascular malformations have been described up to the 30% of patients with KTS while hemangiomas of the urinary tract have been reported in 6% PATIENT CONCERNS:: A 30-year-old man with KTS was referred to our center for primary erectile dysfunction (ED) associated with varicosities of unusual distribution and asymmetry of the lower limbs. Furthermore, he suffered from hypertension and autosomal dominant polycystic kidney disease.During penile prosthesis implantation, a significant intraoperative bleeding (1 liter) due to large scrotal venous malformations and profuse bleeding from both corpora was recorded. One month later, the day after the first prosthesis training session, the patient returned with swelling in the penoscrotal region. A large inguino-scrotal hematoma was drained. There was a complete bilateral dehiscence of corpora cavernosa with a spread venous bleeding in the scrotum. DIAGNOSES CT scan showed hypertrophy of the right hypogastric artery with severe vascular malformations: the right pudendal artery was massively dilated with early visualization of venous drainage without evidence of arteriovenous fistulae; regular bulbocavernous capillary blush; right upper gluteus artery hypertrophic and dilated. Multiple twisting and aneurysms of the right internal pudenda artery were bleeding from multiple points. Cystoscopy showed a fistula between the proximal urethra and the penoscrotal dartos. Coagulation tests revealed the presence of factor XIII deficiency INTERVENTIONS:: The patient underwent several procedures including percutaneous scleroembolization of the internal pudendal arteries, removal of the penile implant, recombinant factor XIII (FXIII) administration, and cord blood platelet gel application. OUTCOMES The patient was discharged after almost 3 months in hospital, hemodynamically stable. LESSONS Experience regarding management of ED in KTS patient is limited and in case of concomitant factor XIII deficiency, the clinical scenario can be life-threatening. A multidisciplinary approach including a urologist, an interventional radiologist and a hematologist in our experience represented the key approach in case of severe bleeding following surgery for ED.
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Carlos EC, Sexton SJ, Lentz AC. Urethral Injury and the Penile Prosthesis. Sex Med Rev 2018; 7:360-368. [PMID: 30078620 DOI: 10.1016/j.sxmr.2018.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/07/2018] [Accepted: 06/16/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The relative infrequency of urethral injuries during penile prosthesis implantation has caused the event to be understudied relative to the morbidity and cost associated with their management. AIM To draw attention to both acute intraoperative and delayed urethral injuries via cylinder erosion by compiling and evaluating the available literature on their cause, diagnosis, and management. METHODS A literature review was performed through PubMed from 1985 to 2018 regarding urethral injuries in the setting of penile prosthesis implantation. Comorbidities and anatomic factors that predispose a patient to a urethral injury were also queried. MAIN OUTCOME MEASURES The goal is to identify at-risk populations and assess options for managing distal, mid-pendulous, and proximal acute urethral injuries that occur in the setting of penile prosthesis implantation. We also examine strategies to manage prosthesis erosion into the urethra. RESULTS Although urethral injuries are rare, certain patient populations are at higher risk for the event. Injuries at various locations along the urethra present unique challenging and morbid clinical scenarios. However, there are a variety of management options available that allow a patient to ultimately void normally and have a successfully implanted penile prosthesis. CONCLUSION Overall, penile prostheses offer many patients an improved sexual quality of life. In the setting of prosthesis implantation both acute and delayed urethral injuries are rare, but their associated morbidity can undercut the benefits of the device. Our understanding of these injuries has matured, and we now possess management strategies that can mitigate the morbidity and frustration that accompany this complication. Carlos EC, Sexton SJ, Lentz AC. Urethral injury and the penile prosthesis. Sex Med Rev 2019;7:360-368.
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Affiliation(s)
- Evan C Carlos
- Duke University, Division of Urology, Durham, NC, USA.
| | | | - Aaron C Lentz
- Duke University, Division of Urology, Durham, NC, USA
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O’Rourke TK, Erbella A, Zhang Y, Wosnitzer MS. Prevention, identification, and management of post-operative penile implant complications of infection, hematoma, and device malfunction. Transl Androl Urol 2017; 6:S832-S848. [PMID: 29238663 PMCID: PMC5715191 DOI: 10.21037/tau.2017.06.07] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/05/2017] [Indexed: 01/26/2023] Open
Abstract
Penile prosthesis implant surgery is an effective management approach for a number of urological conditions, including medication refractory erectile dysfunction (ED). Complications encountered post-operatively include infection, bleeding/hematoma, and device malfunction. Since the 1970s, modifications to these devices have reduced complication rates through improvement in antisepsis and design using antibiotic coatings, kink-resistant tubing, lock-out valves to prevent autoinflation, and modified reservoir shapes. Device survival and complication rates have been investigated predominately by retrospective database-derived studies. This review article focuses on the identification and management of post-operative complications following penile prosthetic and implant surgery. Etiology for ED, surgical technique, and prosthesis type are variable among studies. The most common post-operative complications of infection, bleeding, and device malfunction may be minimized by adherence to consistent technique and standard protocol. Novel antibiotic coatings and standard antibiotic regimen may reduce infection rates. Meticulous hemostasis and intraoperative testing of devices may further reduce need for revision surgery. Additional prospective studies with consistent reporting of outcomes and comparison of surgical approach and prosthesis type in patients with variable ED etiology would be beneficial.
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Affiliation(s)
- Timothy K. O’Rourke
- Quinnipiac University Frank H. Netter MD School of Medicine, Hamden, CT, USA
| | - Alexander Erbella
- Quinnipiac University Frank H. Netter MD School of Medicine, Hamden, CT, USA
| | - Yu Zhang
- Quinnipiac University Frank H. Netter MD School of Medicine, Hamden, CT, USA
| | - Matthew S. Wosnitzer
- Quinnipiac University Frank H. Netter MD School of Medicine, Hamden, CT, USA
- Yale New Haven Health—Northeast Medical Group Urology/Male Reproductive Medicine and Surgery, Fairfield, CT, USA
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16
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Palma-Zamora I, Sood A, Dabaja AA. 30-day adverse event rates following penile prosthesis surgery: an American College of Surgeons National Surgical Quality Improvement Program based evaluation. Transl Androl Urol 2017; 6:S767-S773. [PMID: 29238657 PMCID: PMC5715172 DOI: 10.21037/tau.2017.04.25] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Commonly utilized as a third-line therapy for erectile dysfunction (ED) management, the penile prostheses have become a staple treatment for ED refractory to pharmacological interventions. There is however a paucity of data in the literature pertaining to short-term adverse outcomes following penile prosthesis surgery. We thus sought to leverage the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to evaluate such outcomes within 30 days of surgery in these patients. We hypothesized that such data will lead to a more informed patient-physician consultation. Methods Relying on the ACS-NSQIP database [2005–2013], patients undergoing penile prosthesis placement were identified utilizing the Current Procedural Terminology (CPT) codes: 54400, 54401, 54405, 54406, 54407, 54408, 54410, 54411, 54416 and 54417. Outcomes assessed included system-wise categorized complications, length-of-stay (LOS), and re-intervention, readmission and 30-day mortality rates. Descriptive statistics were used to analyze available data. Multivariate analysis could not be performed due to small sample size. Results Overall, 98 cases of patients who underwent surgery for penile prosthesis placements between the years 2005 and 2013 were reported by the ACS-NSQIP affiliated hospitals. The median age was 65 years (interquartile range, 58–70 years). The overall 30-day complication rate was 11.3% (n=11); 5 of the 11 complications were infectious in etiology, and three were a postoperative blood transfusion event. The median LOS was 1 day. One (1.0%) patient needed to return to the operating room, two patients (2.6%) were readmitted and there was one (1.0%) death within 30 days of the original surgery. Conclusions Surgery for penile prosthesis appears to be a safe operation despite the routinely advanced age of the patients requiring it. Complications in the immediate postoperative setting are usually infectious. This data can be used in the clinical setting for a more informed patient-physician discussion and patient expectation management.
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Affiliation(s)
| | - Akshay Sood
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.,Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Ali A Dabaja
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
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AlDallal S, AlDallal N, Alam A. Sickle cell-induced ischemic priapism. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1268357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Salma AlDallal
- Kuwait Ministry of Health, Amiri Hospital, Sharq, Kuwait
| | - Nasser AlDallal
- Kuwait Ministry of Health, Farwaniya Hospital, Kuwait City, Kuwait
| | - Adel Alam
- Kuwait Ministry of Health, Farwaniya Hospital, Kuwait City, Kuwait
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Canguven O, Talib RA, Campbell J, De Young L, El Ansari W, Al-Ansari A. Is the daily use of vacuum erection device for a month before penile prosthesis implantation beneficial? a randomized controlled trial. Andrology 2016; 5:103-106. [PMID: 27654466 DOI: 10.1111/andr.12258] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 11/28/2022]
Abstract
Patient concerns about penile length after penile prosthesis (PP) implantation for erectile dysfunction (ED) have significant impact on patients and their partners. In addition, corporal fibrosis is associated with difficult PP implantation. The preoperative use of vacuum erectile devices (VED) is an uncommon physical treatment for such concerns. Therefore, the current randomized controlled study assessed two outcomes: whether pre-operative VED use for a month before surgery would significantly increase flaccid stretched penile length (SPL) on the day of surgery, and facilitate easier corporal dilatation intraoperatively. Fifty-one patients scheduled for PP implantation for ED were randomized to either intervention group (pre-operative VED use; 10-15 min/day for ≥30 days; Group A; n = 25), or control group (no intervention; Group B; n = 26). A research assistant (blinded to the treatment assignments) recorded SPL at baseline (initial consultation) and on day of surgery. The surgeons performing the PP implantation (also blinded to the treatment assignments) provided subjective assessments of the ease of corporal dilatation. Baseline patient characteristics, demographics, and comorbidities were the same in both groups. Baseline measurements (SPL-1) were 10.71 ± 1.28 and 10.87 ± 1.26 cm in Group A and Group B, respectively; and the day of surgery measurements (SPL-2) were 11.50 ± 1.33 and 11.06 ± 1.34 cm in Group A and Group B, respectively. In terms of outcomes: mean SPL increase in Group A was significantly more by a mean of 0.80 ± 0.38 cm (p < 0.05) compared to Group B; and surgeons' subjective report of surgical ease indicated smoother corporal dilatation for Group A compared to Group B. VED use (10-15 min/day during the month prior to PP implantation) was associated with significantly increased SPL on day of surgery, and facilitated easier corporal dilatation intraoperatively. Future studies should examine the long-term outcomes of penile prosthesis implantation after pre-operative use of vacuum erectile devices.
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Affiliation(s)
- O Canguven
- Department of Urology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - R A Talib
- Department of Urology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - J Campbell
- Department of Urology, University of Western Ontario, London, ON, Canada
| | - L De Young
- Department of Urology, University of Western Ontario, London, ON, Canada
| | - W El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - A Al-Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Habous M, Farag M, Williamson B, Laban O, Mahmoud S, Abdelwahab O, Elkhouly M, Kamil U, Binsaleh S, Tal R, Ralph D, Mulhall JP. Conservative Therapy is an Effective Option in Patients With Localized Infection After Penile Implant Surgery. J Sex Med 2016; 13:972-6. [PMID: 27162191 DOI: 10.1016/j.jsxm.2016.04.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/05/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Traditionally, penile implant (PI) infections have been managed by removal with immediate or delayed replacement. Recently, interest has been focused on conservative therapy (CT) using antibiotic therapy. AIM To investigate the success rate and predictive factors affecting the outcome of CT in PI infection patients. METHODS Patients diagnosed with early, localized PI infection were considered candidates for CT. Exclusion criteria included temperature >37.5°C, WBC >13,000/μL, and appearance of any sign of sepsis. In patients with purulent drainage, culture swabs were taken and an antibiotic was chosen based on sensitivity results. Oral antibiotics were used until the local infection was completely resolved. Patients were evaluated weekly during this process. RESULTS Thirty-seven patients were retrospectively reviewed and constituted the study population. Mean age was 58.1 (range 37-85; SD 9.9) years. All were diabetic. Mean BMI was 31.8 (range 24-47; SD 5.0). PI was malleable in 33 cases and inflatable in 4 cases. Culture results (n = 19) included Staphylococcus epidermidis (42 %), pseudomonas (21%), Escherichia coli (21%), and S aureus (16%). Four of 37 patients needed the PI removed due to CT failure and onset of systemic symptoms, at a mean time-point of 75 ± 1.8 days after CT commencement. In men who were cured, mean time to complete healing was 49 (range 29-97; SD 15.8) days. Two of 37 patients (5%) had PI removal because of persistent penile pain despite complete wound healing, at a mean time point of 128 ± 2.5 days after CT commencement. All men managed conservatively resumed sexual intercourse. CONCLUSION CT of localized PI infection appears to be a viable option for such patients, with the majority of patients retaining their implant and resuming sexual activity.
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Affiliation(s)
- Mohamad Habous
- Elaj Medical Centers, Urology and Andrology Department, Jedda, Saudi Arabia.
| | | | | | | | - Saad Mahmoud
- Elaj Medical Centers, Urology and Andrology Department, Jedda, Saudi Arabia
| | | | - Mohamed Elkhouly
- Elaj Medical Centers, Urology and Andrology Department, Jedda, Saudi Arabia
| | - Usama Kamil
- Elaj Medical Centers, Urology and Andrology Department, Jedda, Saudi Arabia
| | - Saleh Binsaleh
- Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Raanan Tal
- Male Sexual Dysfunction & Male Infertility, Urology Department, Rambam Health Care Campus, Haifa, Israel
| | - David Ralph
- St Peters Andrology Centre &The Institute of Urology, UCLH, London, UK
| | - John P Mulhall
- Sexual & Reproductive Medicine Program, Memorial Sloan Kettering Cancer Center, New York, USA
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20
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Penile intracavernosal pillars: lessons from anatomy and potential implications for penile prosthesis placement. Int J Impot Res 2016; 28:114-9. [DOI: 10.1038/ijir.2016.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/14/2015] [Accepted: 02/23/2016] [Indexed: 11/08/2022]
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21
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Multiple Site Fracture of Both Rods in a Malleable Penile Implant. Case Rep Urol 2016; 2016:9564904. [PMID: 27066289 PMCID: PMC4811081 DOI: 10.1155/2016/9564904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/02/2016] [Indexed: 11/25/2022] Open
Abstract
Penile prosthesis implant is the definitive treatment for refractory erectile dysfunction. Fracture of malleable prosthesis is rarely described due to its low incidence. We describe a case of multiple, bilateral fracture of a malleable penile implant, ten years after implantation. After the diagnosis, a review surgery was performed and the implants were replaced. No corporal rupture or urethral lesion was observed. Review of the literature shows few articles reporting penile implant fractures, and to our knowledge no other article has described multiple, bilateral fractures of a penile prosthesis.
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Salvage Procedure in Case of Urethrocavernous Fistula after Revision Surgery for Malfunctioning Three-Piece Penile Prosthesis. Case Rep Urol 2016; 2016:4179862. [PMID: 26925286 PMCID: PMC4748101 DOI: 10.1155/2016/4179862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/03/2016] [Indexed: 11/18/2022] Open
Abstract
Urethrocavernous fistula is a rare complication of penile prosthesis. Literature lacks any materials regarding this complication's treatment. We report our experience with a 66-year-old man who developed urethrocavernous fistula after penile prosthesis implant. Our technique involves the careful closure of urethral and corpus cavernosum defects with application of TachoSil® above the sutures. After the salvage procedure, no recurrence of fistula occurred and patient was able to have sexual intercourse. We believe that our technique may be successfully used in case of urethrocavernous fistula after penile prosthesis implant.
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Karakoyunlu N, Sarı S, Ozdemir H, Topaloglu H, Ozok U, Sagnak L, Ersoy H. Malfunctioned and Fractured Penile Prosthesis Caused by Cross Placement: Case Report. Urol Case Rep 2016; 3:80-1. [PMID: 26793509 PMCID: PMC4714312 DOI: 10.1016/j.eucr.2015.03.001] [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: 02/13/2015] [Revised: 02/25/2015] [Accepted: 03/02/2015] [Indexed: 10/31/2022] Open
Abstract
Penile prosthesis is a functional option for patients who have erectile dysfunction after failed medical and intracavernosal treatments. Malleable penile prosthesis is a good alternative. Penile prosthesis implantation is a surgical process. Seldomly complications occur. In this study we presented a 61 y old man who has malfunctioned and broken penile prosthesis due to cross implantation.
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Affiliation(s)
- Nihat Karakoyunlu
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sercan Sarı
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Harun Ozdemir
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Hikmet Topaloglu
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ugur Ozok
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Levent Sagnak
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Hamit Ersoy
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; Hitit University, Department of Urology, Corum, Turkey
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Bozkurt IH, Arslan B, Yonguc T, Kozacıoglu Z, Degirmenci T, Gunlusoy B, Minareci S. Patient and partner outcome of inflatable and semi-rigid penile prosthesis in a single institution. Int Braz J Urol 2015. [PMID: 26200547 PMCID: PMC4752147 DOI: 10.1590/s1677-5538.ibju.2014.0241] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Penile prostheses are subject to a continuous development and have gained better mechanical reliability and safety during the last decades. In this study, we aimed to investigate the outcomes and satisfaction rates of inflatable penile prosthesis (IPP) and semirigid penile prosthesis (SPP) implantation. MATERIALS AND METHODS From August 2001 to June 2012, 257 men with erectile dysfunction (ED) underwent penile prosthesis implantation (PPI) at our institution. Of the 257 patients, 118 underwent implantation of IPP and 139 underwent SPP implantation. The pre-operative and post-operative erectile status of the patients were assessed by international index of erectile function (IIEF) questionnaire. The satisfaction of patients and partners were evaluated by a telephone interview using the erectile dysfunction inventory of treatment satisfaction (EDITS) questionnaire and EDITS partner survey. RESULTS The overall major complication rate was higher in IPP group. PPI led to a significant improvement in IIEF scores in both groups. For IPP and SPP groups the average EDITS scores were 78±11and 57±8, respectively, and that for the partners were 72±10 and 49±7, respectively (p<0.05). CONCLUSION Although the IPP implantation have better satisfaction rates, the SPP implantation is still a viable treatment option in the surgical treatment of ED because of low cost and high durability with acceptable satisfaction rates.
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Affiliation(s)
| | - Burak Arslan
- Department of Urology Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Tarik Yonguc
- Department of Urology Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Zafer Kozacıoglu
- Department of Urology Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Tansu Degirmenci
- Department of Urology Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Bulent Gunlusoy
- Department of Urology Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Suleyman Minareci
- Department of Urology Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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Anele UA, Le BV, Burnett AL. Suprapubic cystostomy for the management of urethral injuries during penile prosthesis implantation. Sex Med 2014; 2:178-81. [PMID: 25548649 PMCID: PMC4272249 DOI: 10.1002/sm2.44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction Urethral injury is an uncommon surgical complication of penile prosthesis (PP) surgery. Conventional dogma requires abortion of the procedure if the adjacent corporal body is involved or delayed implantation to avert device infection associated with urinary extravasation. Besides the setback of the aborted surgery, this management approach also presents the possible difficulty of encountering corporal fibrosis at the time of reoperation. Aim We report an approach using primary urethral repair and temporary suprapubic cystostomy for the management of incidental urethral injuries in a cohort of patients allowing for successful completion of unaborted PP implantation. Materials and Methods We performed a retrospective analysis of all patients receiving PPs from 1990 to 2014 in which incidental urethral injuries were repaired and PP implantation was completed with suprapubic cystostomy (suprapubic tube [SPT] insertion). After allowing for urethral healing and urinary diversion via SPT for 4–8 weeks, the PP was activated. Main Outcome Measures Successful management was determined by the absence of perioperative complications within 6 months of implantation. Results We identified four cases, all receiving inflatable PPs, managed with temporary suprapubic cystostomy. These patients sustained urethral injuries during corporal dissection (one patient), corporal dilation (one patient), and penile straightening (two patients). All patients were managed safely and successfully. Conclusion Primary urethral repair followed by temporary suprapubic cystostomy offers a surgical approach to complete PP implantation successfully in patients who sustain urethral injury complications, particularly for complex PP surgeries. Anele UA, Le BV, and Burnett AL. Suprapubic cystostomy for the management of urethral injuries during penile prosthesis implantation.
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Affiliation(s)
- Uzoma A Anele
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine Baltimore, MD, USA
| | - Brian V Le
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine Baltimore, MD, USA
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine Baltimore, MD, USA
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Bettocchi C, Palumbo F, Spilotros M, Palazzo S, Saracino GA, Martino P, Battaglia M, Selvaggi FP, Ditonno P. Penile prostheses. Ther Adv Urol 2011; 2:35-40. [PMID: 21789081 DOI: 10.1177/1756287209359174] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Penile prosthesis implantation is recognized as a valid option to obtain an artificial erection satisfactory for sexual intercourse in those patients in which a pharmacological approach is contraindicated or ineffective. Penile prostheses are subbject to continuous development and they are achieving ever better mechanical reliability and safety. The devices are divided into two general types: semirigid (malleable and mechanical) and inflatables. The AMS® (American Medical Systems) and Coloplast Ltd® produce the majority of inflatable and semirigid devices.Malleable and mechanical prostheses have the disadvantage that the penis is always erect although it can be orientated in different ways, while the advantages are ease of use and the need for a simpler surgical procedure compared with inflatable prostheses. Three-component prostheses are more sophisticated than semirigid devices. The advantages of these devices are that the prosthesis feels softer than semirigid or two-piece devices when deflated, with a better cosmetic result, and it ensures a more natural erection than others kinds of prosthesis. The disadvantages are the possibility of malfunction and the need for a more complicated surgical technique. Implantation of a penile prosthesis can be performed in a short surgical time under locoregional anaesthesia, and for this reason hospitalization is usually brief and the patient can be discharged 2 days after the operation if complications are not evident. Patient and partner satisfaction reflect the quality and the effectiveness of this treatment. Even though the results are positive in the vast majority of patients, the possibility of several complications makes penile prosthesis implantation a delicate kind of surgery. Complications can happen when the operation is carried out, in the peri-operative and in the postoperative period, and include infections, erosions of the prosthesis and mechanical failure in case of inflatable prosthesis. Penile prostheses available on the market have improved the success of this kind of surgery, thanks to the introduction of new materials and designs.
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Affiliation(s)
- Carlo Bettocchi
- Department of Emergency and Organ Transplantation - Urology, Andrology and Kidney Transplantation Unit, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
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