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Moncada I, Krishnappa P, Zaccaro C, Fraile A, Romero-Otero J, Martinez-Salamanca JI, Lledó-Garcia E. Penile prosthesis implantation is safe and effective in Peyronie's disease patients with and without erectile dysfunction. Int J Impot Res 2024:10.1038/s41443-024-00938-y. [PMID: 38909107 DOI: 10.1038/s41443-024-00938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
Penile prosthesis (PP) is the mainstay of treatment in Peyronie's disease (PD) with co-existent refractory erectile dysfunction (ED). This study aimed to assess the clinical outcomes of patients who underwent PP as the first-line surgical treatment in PD without ED. A total of 636 patients underwent PP for PD from 2012 to 2022, but only 168 patients who underwent PP as first-line surgical management for PD with or without ED were included in the study. The mean (SD) age of 168 patients was 56.3 years (12.4). The mean curvature of the "PD with ED" group and the "PD without ED" group were 38.2 (5.6) degrees and 42.2 (5.9) degrees. The median (IQR) follow-up was 56.0 months (34.5- 61.4). Most (86.9%) patients underwent 3-piece inflatable PP. An important finding is that 33 patients (19.6%) without ED had undergone PP. Mechanical failure requiring revision surgery was less common in the 'without ED' group than in the ED group (6.8% vs. 10.2%, p 0.04). Most PD patients without ED (87.9%, 29/33) and with ED (88.9%, 120/135) were "satisfied" after PP implantation at six months, as defined by a score of ≥4 on a 5-point Likert scale. If surgery is offered in PD, PP may be considered a safe and effective first-line surgical treatment regardless of the ED, given the acceptable complications and high satisfaction rates. However, this new concept warrants further research.
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Affiliation(s)
- Ignacio Moncada
- Department of Urology and Robotic Surgery, Hospital Universitario Sanitas la Zarzuela, 28023, Madrid, Spain
| | - Pramod Krishnappa
- Department of Urology and Robotic Surgery, Hospital Universitario Sanitas la Zarzuela, 28023, Madrid, Spain.
- Andrology Division, Department of Urology, AndroNeo, Orchidz Health, NU Hospitals, Bangalore, 560010, India.
| | - Claudia Zaccaro
- Department of Urology and Robotic Surgery, Hospital Universitario Sanitas la Zarzuela, 28023, Madrid, Spain
| | - Augustin Fraile
- Department of Urology, Hospital Universitario Ramon y Cajal, 28034, Madrid, Spain
| | | | - Juan Ignacio Martinez-Salamanca
- Lyx Institute of Urology, Universidad Francisco de Victoria, Hospital Universitario Puerta De Hierro-Majadahonda, 28222, Madrid, Spain
| | - Enrique Lledó-Garcia
- Department of Urology, Hospital General Universitario Gregorio Marañón, 28007, Madrid, Spain
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Fernandez Crespo RE, Stroie F, Taylor L, Pignanelli M, Parker J, Carrion R. Penile fibrosis-still scarring urologists today: a narrative review. Transl Androl Urol 2024; 13:127-138. [PMID: 38404545 PMCID: PMC10891380 DOI: 10.21037/tau-23-206] [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: 04/04/2023] [Accepted: 12/07/2023] [Indexed: 02/27/2024] Open
Abstract
Background and Objective Implantation of penile prosthesis (PP) into scarred and fibrotic corpora can be a difficult challenge. In this review article, we provide a review of penile fibrosis, discuss current medical and surgical management and summarize preventative strategies. Methods In this study, we searched PubMed between the years 2000-2023 for publications with search strategy: "penile fibrosis" OR "scarred corpora" OR "fibrosed corpora". Key Content and Findings This search returned a total of 137 articles. We examine the evidence for preoperative patient evaluation and penile ultrasound (US), oral phosphodiesterase-5 inhibitors, pentoxifylline, and L-arginine, vacuum device therapy and the use of surgical approaches and tools in the context of complex penile fibrosis cases. Severe penile fibrosis is most associated with priapism and infection. Estimating the degree of fibrosis via preoperative US may help set realistic patient expectations. Phosphodiesterase inhibitors and L-arginine reduce fibrosis in animal models however their impact in humans remains unclear despite theoretical advantage for their use. Vacuum device therapy may preserve penile length following priapism and infected PP cases. The use of Coloplast Narrow-Based or AMS-700 CXR implants are used primarily for severe fibrosis. Various surgical excisional/incisional techniques, the Carrion-Rossello, Mooreville Uramix cavernotomes and reverse cutting scissors are all options, and their use varies from case to case. Finally, prevention of penile fibrosis in patients with history of penile implant infection and the safety of early implantation of a penile implant in patients with refractory priapism is encouraged. Conclusions The management of penile fibrosis remains a challenge but there are multiple options to assist clinicians. Complex cases should be managed and studied at high volume centers.
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Affiliation(s)
| | - Florian Stroie
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Laura Taylor
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Michael Pignanelli
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Justin Parker
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Rafael Carrion
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
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3
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Giordano A, Smarrazzo F, Cilio S, Califano G, Collà Ruvolo C, Verze P. History of penile implants: from implants made of bone to modern inflatable penile implants. Int J Impot Res 2023; 35:601-608. [PMID: 37085736 DOI: 10.1038/s41443-023-00695-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/23/2023]
Abstract
Penile prostheses are implantable devices used to definitively treat erectile dysfunction when previous forms of treatment have failed. The first example of a penile implant dates to 1935, when a rib was inserted in a neo-phallus reconstructed after a traumatic amputation. Since then, alternative artificial devices were adopted as penile prosthetic implants. The evolution of prosthetic devices had a dramatic thrust in 1973 when the first inflatable penile prosthesis was worldwide presented. Thanks to advances in device materials, design, surgical implant techniques, and perioperative management, nowadays inflatable penile prostheses are one of the most adopted definitive therapy for patients with drug-refractory erectile dysfunction or refusing alternative forms of treatments. Moreover, the clinical indications for inflatable penile prosthesis have also expanded, including female-to-male transmen or men underwent penile reconstruction due to congenital aphallia or traumatic or surgical penile amputation. In order to summarise the process behind the development and evolution of penile prosthesis, we aimed at performing a historical review of the currently available literature to provide an easy and comprehensive overview of the topic. The understanding of the historical process behind the evolution of inflatable penile prostheses will drive further innovation to increase efficiency and the rate of patients satisfaction.
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Affiliation(s)
- Alessandro Giordano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Francesco Smarrazzo
- Urology Unit, Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Simone Cilio
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy.
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Paolo Verze
- Urology Unit, Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
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Smelser AM, VanDyke ME, Nealon SW, Badkhshan S, Langford BT, Peedikayil J, El-Eishy AF, Monaghan TF, Sanders SC, Franzen BP, Morey AF. Mechanical indications for inflatable penile prosthesis revision: analysis and implications for revision surgery. J Sex Med 2023; 20:1044-1051. [PMID: 37189017 DOI: 10.1093/jsxmed/qdad064] [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: 01/11/2023] [Revised: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Despite technical advancements, inflatable penile prostheses (IPPs) are inherently at risk of mechanical failure given their nature as hydraulic devices. AIM To characterize IPP component failure location at the time of device revision and stratify by manufacturer: American Medical Systems (Boston Scientific [BSCI]) and Coloplast (CP). METHODS A retrospective review of penile prosthesis cases from July 2007 to May 2022 was conducted, identifying men who underwent revision surgery. Cases were excluded if documentation did not denote the cause of failure or the manufacturer. Mechanical indications for surgery were categorized by location (eg, tubing, cylinder, or reservoir leak; pump malfunction). Nonmechanical revisions were excluded (component herniation, erosion, or crossover). Categorical variables were assessed with Fisher exact or chi-square analysis; Student t-test and Mann-Whitney U test were used for continuous variables. OUTCOMES Primary outcomes included specific location of IPP mechanical failure among BSCI and CP devices and time to mechanical failure. RESULTS We identified 276 revision procedures, 68 of which met inclusion criteria (46 BSCI and 22 CP). Revised CP devices were longer than BSCI devices (median cylinder length, 20 vs 18 cm; P < .001). Log-rank analysis revealed a similar time to mechanical failure between brands (P = .096). CP devices failed most often due to tubing fracture (19/22, 83%). BSCI devices had no predominant site of failure. Between manufacturers, tubing failure was more common in CP devices (19/22 vs 15/46 for BSCI, P < .001), while cylinder failure was more common among BSCI devices (10/46 vs 0/22 for CP, P = .026). CLINICAL IMPLICATIONS The distribution of mechanical failure is significantly different between BSCI and CP devices; this has implications regarding the approach to revision surgery. STRENGTHS AND LIMITATIONS This is the first study to directly compare when and where mechanical failure occurs in IPPs and to compare the 2 main manufacturers head-to-head. This study would be strengthened by being repeated in a multi-institutional fashion to provide more robust and objective evaluation. CONCLUSION CP devices commonly failed at the tubing and rarely elsewhere, while BSCI devices showed no predominant failure site; these findings may inform decision making regarding revision surgery.
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Affiliation(s)
- Ashton M Smelser
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Maia E VanDyke
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Samantha W Nealon
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Shervin Badkhshan
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Brian T Langford
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Josh Peedikayil
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Al-Frooq El-Eishy
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Thomas F Monaghan
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Sarah C Sanders
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Bryce P Franzen
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Allen F Morey
- Urology Department, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
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Aboul Fotouh El Gharably M, Ghoneima W, Lotfi MA, AbdelWahab M, Elkady A, Abdel-Rassoul MA. The Efficacy of Suspensory Ligament Release and Pubic Lipectomy Via Penopubic Z Plasty During Penile Prosthesis Implantation in Improving Sexual Satisfaction: A Prospective Randomized Controlled Trial. J Sex Med 2022; 19:852-863. [PMID: 35370101 DOI: 10.1016/j.jsxm.2022.02.024] [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: 10/13/2021] [Revised: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The utility of penile suspensory ligament release (SLR) in the setting of penile prosthesis implantation (PPI) has received limited attention in the literature. AIM To assess the efficacy and safety of penile SLR release, pubic lipectomy (PL), and the utility of penopubic Z-plasty (ZP) during malleable PPI in improving sexual satisfaction compared to that achieved with the conventional method. METHODS Between August 2018 and April 2020, 61 patients with refractory erectile dysfunction were prospectively randomized into 2 groups; group A included 31 patients who underwent PPI with SLR and PL via ZP, and group B included 30 patients who underwent conventional PPI via a penoscrotal incision. OUTCOMES Penile length was assessed at 3 months, and sexual satisfaction was assessed up to 1 year after PPI using both validated and non-validated tools. RESULTS The median operative time was higher in group A than in group B (170 min; interquartile range [IQR] [160-190] vs 97.5 min; IQR [90-110] P < .001).The median pre- to postoperative differences in functional and visible penile lengths for group A were 1.5 cm; IQR [0-2] and 2.5 cm; IQR [1-3.5], respectively, while those in group B were both 0 cm; IQR [-1 to 0] P < .001). Group A patients reported higher scores in the International Index of Erectile Function satisfaction domains than the group B patients did (13; IQR [12-14] and 9; IQR [8-10] vs 11; IQR [9.5-12] and 8; IQR [6.5-8.5], respectively, P < .001). Moreover, the postoperative Erectile Dysfunction Inventory of Treatment Satisfaction score was higher in group A than that in group B (95.40; IQR [91-97.7] vs 85.20; IQR [72.7-91], respectively, P < .001). Common complications in group A were penile edema (77.4%), penile instability (9.7%) and glans numbness (9.7%). CLINICAL IMPLICATIONS The benefit in patient satisfaction following SLR and PL via ZP during PPI may outweigh the incremental increase in complications. STRENGTH & LIMITATIONS To our knowledge, this is the first prospective randomized controlled study to evaluate the efficacy and safety of SLR, PL, and ZP during PPI. However, because an optimal tool for assessing sexual satisfaction after PPI is lacking at this time, we alternatively adopted the most used assessment tools. Further, our data applies only to malleable penile prosthesis. CONCLUSION SLR and PL via ZP during PPI resulted in a substantial improvement of the patients' sexual satisfaction without serious complications. Fotouh El Gharably MA, Ghoneima W, Lotfi MR, et al. The Efficacy of Suspensory Ligament Release and Pubic Lipectomy Via Penopubic Z Plasty During Penile Prosthesis Implantation in Improving Sexual Satisfaction: A Prospective Randomized Controlled Trial. J Sex Med 2022;19:852-863.
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Affiliation(s)
| | | | | | | | - Amr Elkady
- Urology Department, Cairo University, Cairo, Egypt
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6
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Abstract
PURPOSE OF REVIEW The goal of this paper is to understand the reasons behind penile length and girth issues after penile prosthesis surgery and review the literature for current strategies employed to decrease these issues. RECENT FINDINGS Measurement inconsistencies triggering further studies have shown there is a real loss of penile length and girth after prosthesis surgery. There have been varying hypotheses of why this happens, and numerous approaches have been proposed to help combat this in the preoperative, intraoperative, and postoperative settings. Erectile dysfunction prevalence is expected to increase; therefore it is important for urologists to understand the treatment options, including prosthesis surgery. Numerous techniques have been hypothesized and studied in smaller settings in the preoperative, intraoperative, and postoperative settings with regard to prosthetics surgery. However, larger studies are still needed to confirm these findings in order to help to counsel and educate patients preoperatively in addition to employing tactics to help minimize penile shortening.
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Moncada I, Krishnappa P, Ascencios J, Lopez I, Martinez-Salamanca JI. Home modeling after penile prosthesis implantation in the management of residual curvature in Peyronie's disease. Int J Impot Res 2020; 33:616-619. [PMID: 32641777 DOI: 10.1038/s41443-020-0325-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/24/2020] [Accepted: 06/29/2020] [Indexed: 01/28/2023]
Abstract
The aim of this study was to study the clinical effectiveness of a structured home modeling (HM) protocol in Peyronie's disease (PD) patients who have residual curvature up to 45° after inflatable penile prosthesis (PP) placement. A total of 92 patients with PD and coexistent refractory erectile dysfunction received inflatable PP. If residual curvature after manual modeling (MM) was more than 45°, incision-grafting was performed. If curvature was <45° after MM, patients were instructed to perform HM daily for 6 months, after 4 weeks from PP implantation. The mean preoperative penile curvature was 39.4 ± 5.7° (30-60). Sixteen (17.4%) patients required incision-grafting and the remaining 76(82.6%) patients followed HM protocol. The mean postoperative residual curvature after MM was 29.7 ± 3.2° (5-50). Sixty-five (85.5%) patients who underwent HM had 10° or less residual curvature after 3 months and 72 (94.7%) patients had 10° or less residual curvature after 6 months. Seventy (92.1%) patients responded as satisfied or very satisfied on the questionnaire with the outcome after 6 months. HM of the penis over Inflatable PP may straighten the penis without the need for an additional surgical maneuver in vast majority of the PD patients having residual curvature of <45°.
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Affiliation(s)
- Ignacio Moncada
- Department of Urology and Robotic Surgery, Hospital Universitario La Zarzuela, Madrid, Spain
| | - Pramod Krishnappa
- Department of Urology and Andrology, NU Hospitals, Bengaluru, India.
| | - Julmar Ascencios
- Department of Urology and Robotic Surgery, Hospital Universitario La Zarzuela, Madrid, Spain
| | - Inigo Lopez
- Department of Urology and Robotic Surgery, Hospital Universitario La Zarzuela, Madrid, Spain
| | - Juan Ignacio Martinez-Salamanca
- Department of Urology, Hospital Puerta De Hierro Majadahonda & Lyx Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain
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Osmonov D, Christopher AN, Blecher GA, Falcone M, Soave A, Dahlem R, Czeloth K, Bannowsky A, Matanes E, Ward S, Martínez-Salamanca JI, Bettocchi C, Garaffa G, Reisman Y, Corona G. Clinical Recommendations From the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances. J Sex Med 2020; 17:210-237. [PMID: 31812683 DOI: 10.1016/j.jsxm.2019.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION To date, several aspects of inflatable penile prosthesis (IPP) surgical procedure have been poorly studied. AIM The aim of this study was to review the evidence associated with IPP implantation and provide clinical recommendations on behalf of the European Society for Sexual Medicine (ESSM). Overall, 130 peer-reviewed studies and systematic reviews, which were published from 2007-2018 in the English language, were included. METHODS MEDLINE and EMBASE were searched for randomized clinical trials, meta-analyses, and open-label prospective and retrospective studies. MAIN OUTCOME MEASURE The panel provided statements exploring patients and partner expectations, satisfaction in male and phalloplasty cohorts, the impact of penile length, girth and implant type, reservoir placement, the influence of comorbidities, and social circumstances. Levels of evidence were provided according to the Oxford 2011 criteria and graded as for the Oxford Centre for Evidence-Based Medicine recommendations. RESULTS In the preoperative setting, it is fundamental to identify and interact with difficult patients with the intention of enhancing the surgeon's ability to establish the surgeon-patient relationship, reduce physical and legal risk, as well as enhancing patient satisfaction. To address this need, the mnemonic Compulsive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric ("CURSED") has been suggested to identify patients who are at high risk of dissatisfaction. The current recommendations suggest improving glycemic control in patients with diabetes. Available evidence suggests evaluating transplant recipients with the criteria of Barry, consisting of stable graft function for >6 months, avoidance of intra-abdominal reservoir placement, and low-dose immunosuppression. HIV status does not represent a contraindication for surgery. Smoking, peripheral vascular disease, and hypertension may be associated with an increased risk of revision surgery. Patients with spinal cord injury may receive IPP. Patients aged ≥70 years, as well as obese patients, can be offered IPP. The IPP implantation can be performed in patients with stable Peyronie's disease. Ectopic high submuscular reservoir placement can be considered as an alternative method. CLINICAL IMPLICATIONS There is a relevant lack of high-level data and definite conclusions in certain areas remain difficult to draw. STRENGTH & LIMITATIONS All studies have been evaluated by a panel of experts providing recommendations for clinical practice. Because of lack of sufficient prospective data, some of the included studies are retrospective and this could be stated as a limitation. CONCLUSION This ESSM position statement provides recommendations on optimization of patient outcome by patient selection, and individualized peri- and intra-operative management. ESSM encourages centers to collaborate and to create prospective, multicenter registries in order to address this topic of increasing importance. Osmonov D, Christopher AN, Blecher GA, et al. Clinical Recommendations from the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances. J Sex Med 2020;17:210-237.
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Affiliation(s)
- Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Andrew Nim Christopher
- Department of Urology, University College London Hospitals & St Peters Andrology Centre, London, UK
| | - Gideon A Blecher
- Department of Urology, The Alfred Hospital, Melbourne, Australia; Monash Health, Melbourne, Australia
| | - Marco Falcone
- Department of Urology, University of Turin - Cittàdella Salute e della Scienza, Turin, Italy
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karen Czeloth
- Vitus Prostata Center Offenbach, Prof. Stehling Institut für bildgebende Diagnostik, Germany
| | | | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Sam Ward
- Department of Urology, Clinique Saint Jean, Brussels; Medicis Medical Center, Woluwe, Belgium
| | - Juan Ignacio Martínez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda Lyx Institute of Urology, Universidad Autónoma de Madrid, Spain
| | - Carlo Bettocchi
- Department of Urology, University of Bari, Bari, Apulia, Italy
| | - Giulio Garaffa
- The Institute of Urology, University College London Hospitals, London, UK
| | - Yacov Reisman
- Department of Urology, Amstelland Hospital, Amstelveen, The Netherlands
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, AziendaUsl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
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Commentary on posteroperative vaccuum therapy following AMS LGX 700 inflatable penile prosthesis placement: penile dimension outcomes and overall satisfaction : Is there a benefit to adjunctive vacuum therapy after penile prosthesis placement? Int J Impot Res 2019; 32:142-143. [PMID: 31474752 DOI: 10.1038/s41443-019-0191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 11/08/2022]
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10
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Abstract
PURPOSE OF REVIEW To provide an evidence based discussion of preoperative, intraoperative, and postoperative factors that lead to successful outcomes in penile prosthesis surgery. RECENT FINDINGS In the preoperative period, careful patient selection, appropriate counseling, thorough evaluation, and sufficient time for physical and emotional adaptation to an inflatable penile prosthesis are the key. During surgery, the entire device should be explanted whenever possible. A drain and retain strategy for the reservoir is a safe alternative in situation where the reservoir is not easily removable. The mechanical cleansing of lavage is more important than chemical sterilization. Postoperative instructions should be made clear and nursing phone calls may reduce the number of ER visits. Careful preoperative counseling, attention to intraoperative details, and vigilance in the postoperative period are necessary for a successful outcome with penile prosthesis revision surgery.
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Affiliation(s)
- Anton Wintner
- Duke University Division of Urologic Surgery, 3480 Wake Forest Rd., Suite 506, Raleigh, NC, 27609, USA
| | - Aaron C Lentz
- Duke University Division of Urologic Surgery, 3480 Wake Forest Rd., Suite 506, Raleigh, NC, 27609, USA.
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11
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Postoperative vacuum therapy following AMS™ LGX 700® inflatable penile prosthesis placement: penile dimension outcomes and overall satisfaction. Int J Impot Res 2019; 32:133-139. [PMID: 30745567 DOI: 10.1038/s41443-019-0125-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 02/06/2023]
Abstract
Penile shortening after inflatable penile prosthesis for erectile dysfunction is a common postoperative patient complaint and can reduce overall satisfaction with the procedure. In this prospective study we report our results regarding penile dimensions and patient satisfaction outcomes after 1 year of follow-up from AMS™LGX700® penile prosthesis implant with 6 months of vacuum erectile device therapy. Seventy-four selected patients with medically refractory erectile dysfunction underwent AMS™ LGX 700® IPP placement. Postoperatively, patients were assigned vacuum device therapy for 5 min twice daily. Follow-up continued for 1 year after surgery. Dimensional and functional results were assessed. Baseline median preoperative stretched penile length and girth were 14 cm (range 10-17) and 9 cm (range 7-12), respectively. At the end of the study penile median dimensional outcomes were 17 cm (range 13-23) for length and 11 cm (range 10-13) for girth while a median number of 24 pumps (range 18-29) to fully inflate the device was seen. Baseline median International Index of Erectile Function (IIEF-5) score was 9 (range 5-11), at 6 months 20 (range 18-26) and at 1 year was 25 (range 20-27) (p < 0.0001). Median Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) score at the end of the follow-up was 74 (range 66-78). Our postoperative rehabilitation program is feasible and should be recommended after prothesis surgery in order to increase overall satisfaction with the procedure. Penile postoperative dimensional outcomes were statistically significant improved and complications were negligible.
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12
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Biomechanical Studies of the Inflatable Penile Prosthesis: A Review. Sex Med Rev 2019; 7:369-375. [PMID: 30655195 DOI: 10.1016/j.sxmr.2018.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/03/2018] [Accepted: 11/06/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The penile prosthesis remains the primary surgical treatment for refractory erectile dysfunction. Over the decades, inflatable penile prostheses' mechanical reliability, patient satisfaction, safety, and functional erectile restoration have greatly improved. During this time, many studies of biomechanical properties of the prosthesis have been conducted to better understand their biomimicry to the erect human phallus. AIM To review all current literature on the biomechanical properties of the penile prosthesis, including prosthesis biomechanical function, and variability in model-related performance. METHODS A Medline PubMed search was used to identify all articles of interest related to subjects involving the penile prosthesis and its related biomechanical properties. The following were included in the search for articles of interest: "biomechanics," "mechanics," "mechanical properties," "axial rigidity," "penile implant," and "penile prosthesis." Articles were further screened for content and English language. MAIN OUTCOME MEASURE Here we perform a literature review of the bio-mechenical function, performance, and patient satisfaction of penile implants. RESULTS Axial rigidity helps determine the ability of an erect penis to complete vaginal intromission and pelvic thrusting without buckling. Recent cadaveric data show that at maximum inflation, Coloplast and American Medical Systems (AMS) implants had comparable performance. Variability was seen at various lower fill pressures, where more severe buckling was observed. Coloplast Titan showed a tendency toward better resistance to longitudinal and horizontal forces. The AMS CX device showed similar performance to the Titan, and the AMS LGX device was shown to be most sensitive to fill pressure variation. Additionally, rear tip extenders (RTEs) appear to negatively affect axial loading, especially in settings of larger implants. CONCLUSION Current research suggests that circumferentially expanding devices, such as AMS CX and Coloplast Titan, show better resistance to longitudinal (penetration) and horizontal (gravity) forces and, unlike the AMS LGX device, are less sensitive to device fill pressure. Additionally, RTEs have been shown to negatively impact axial loading, especially in larger cylinder inflatable penile prostheses >20 cm in length. Madiraju SK, Wallen JJ, Rydelek SP, et al. Biomechanical Studies of the Inflatable Penile Prosthesis: A Review. Sex Med Rev 2019;7:369-375.
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