1
|
Dawod MS, Alswerki MN, Al Ja'ar SM, Keilani DZ, Keilani LZ, Alani MA, Saimeh TH, Al-Tamimi S, Al-Shibly SM, Saimeh ZH, Al-Juboori MA, Alelaumi A, Alsheikh FT, Kamal TW, Khanfar A. Optimizing Recovery After Carpal Tunnel Syndrome Release Surgery: The Role of Counseling in Pain Management and Perioperative Functional Enhancement. J Multidiscip Healthc 2024; 17:971-980. [PMID: 38465327 PMCID: PMC10921890 DOI: 10.2147/jmdh.s451008] [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: 11/26/2023] [Accepted: 02/26/2024] [Indexed: 03/12/2024] Open
Abstract
Background Preoperative patient education is pivotal in improving patient outcomes during the perioperative phase, involving a thorough explanation of what patients can expect. This enhances adherence and reduces perioperative anxiety. In orthopedics, carpal tunnel syndrome, a common and painful hand condition, is effectively managed through surgical release under local anesthesia. Inadequate counseling before such procedures may intensify intraoperative anxiety and increase pain responses. Thus, this research aims to investigate the effects of comprehensive preoperative counseling on various parameters in carpal tunnel release surgery. Methods A case-control study design was adopted for this study. A retrospective analysis of patients who underwent carpal tunnel release surgery was performed. These patients were categorized into two distinct groups: one group received comprehensive counseling during their clinic visits, while the other group reported receiving less effective counseling. Evaluation encompassed patient-related factors, disease-related aspects, and perioperative variables for both groups. Results The study comprised 681 participants, with 526 (77.2%) being females, 421 (61.8%) undergoing surgery on the right side, and 519 (76.2%) employed in non-manual occupations. Moreover, 559 (82.1%) were non-smokers, while approximately two-thirds of the cohort had both diabetes and hypertension. The average age of participants was 52 years, and they reported a mean functional disability score of 7.2 out of 10. The comprehensive preoperative counseling group consisted of 333 patients, while the other group included 348 patients. The analysis revealed statistically significant differences between the two groups, including reduced intra-procedural anxiety (p = 0.043), decreased intraoperative pain (p = 0.005), lower rates of wound complications (p = 0.022), and improved self-reported pain relief (p = 0.3). Conclusion Our study emphasizes the crucial role of preoperative counseling in improving patient experiences during perioperative care, leading to reduced anxiety, milder pain responses, fewer complications, decreased reliance on postoperative pain medication, and increased self-reported pain relief. Level of Evidence Level III, Case-control retrospective study.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Sulaf Moh Al-Shibly
- Jordan University of Science and Technology School of Medicine, Irbid, Jordan
| | | | | | - Ahmad Alelaumi
- Jordan University Hospital, Orthopedic Department, Amman, Jordan
| | | | | | - Aws Khanfar
- Upper limb & Orthopedic Surgery Consultant, Jordan University Hospital, Amman, Jordan
| |
Collapse
|
2
|
Stroie FA, Taylor L, Fernandez-Crespo R, Parker J, Carrion R. Patient selection, counseling and preparation for penile prosthesis. Int J Impot Res 2023; 35:609-612. [PMID: 37607962 DOI: 10.1038/s41443-023-00735-z] [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: 01/25/2023] [Revised: 04/23/2023] [Accepted: 07/05/2023] [Indexed: 08/24/2023]
Abstract
The penile prosthesis has revolutionized the management of erectile dysfunction and is a mainstay in the treatment of this clinical entity. The goal of proper patient selection and counseling is to achieve a satisfactory outcome for the patient. Most patients receiving a penile prosthesis are satisfied with their outcome, and while the penile prosthesis generally allows for high satisfaction rates, avenues for dissatisfaction can arise. Our aim is to aid the prosthetic urologist in identifying such avenues by discussing what factors can lead to a dissatisfied patient. Even a technically successful surgical outcome in the improperly counseled patient can have negative consequences for the patient and the patient-physician relationship. Satisfaction in the penile prosthesis arena can be variably defined and viewed from different perspectives. As such, establishing a personalized framework of expectation management, even in the patient who poses challenging factors, is paramount in preparation for penile prosthesis implantation.
Collapse
Affiliation(s)
- Florian A Stroie
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Laura Taylor
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Raul Fernandez-Crespo
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Justin Parker
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Rafael Carrion
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA.
| |
Collapse
|
3
|
Byrne ER, Ungerer GN, Ziegelmann MJ, Kohler TS. Complications and troubleshooting in primary penile prosthetic surgery-a review. Int J Impot Res 2023; 35:679-685. [PMID: 37106087 DOI: 10.1038/s41443-023-00699-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Penile implant surgery is the gold standard to treat erectile dysfunction with success rates of over 90%. The first penile implants were developed in the early 1900s. Since then, several types of implants have been developed including malleable implants, two-piece inflatable implants, and three-piece inflatable implants. The three-piece inflatable penile prosthesis, which was introduced in 1973, is the most widely used type of penile implant in the United States. Penile implant surgery has undergone numerous advancements over the years, improving outcomes and patient satisfaction. However, as with any surgical procedure, there are risks and complications associated with penile implant surgery. It is important for surgeons to understand these potential complications and to have strategies in place to manage and prevent them to achieve the best possible outcomes for their patients.
Collapse
|
4
|
Köhler TS. The future of penile implants IJIR special edition: 50 th year anniversary on penile implants. Int J Impot Res 2023; 35:593-595. [PMID: 37587367 DOI: 10.1038/s41443-023-00751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
|
5
|
Flaherty KR, Demirjian CC, Nelson CJ. The Psychological Reasons for Limiting Implant Surgery for Men With Erectile Dysfunction. J Sex Med 2022; 19:1499-1501. [DOI: 10.1016/j.jsxm.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
|
6
|
Aziz H, Ahmed Z, Abdimajid M, Sekigami Y, Hertl M, Goodman MD. Association between Preoperative Steroids and Outcomes in Patients Undergoing Pancreaticoduodenectomy using the National Surgical Quality Improvement Program. J Gastrointest Surg 2022; 26:1198-1204. [PMID: 35141835 DOI: 10.1007/s11605-022-05260-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/22/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND A national study analyzing the association between preoperative steroid use and outcomes after pancreatic resections is lacking. The purpose of this study is to evaluate the association between preoperative steroids and outcomes after pancreaticoduodenectomy using a national database. MATERIALS AND METHODS A retrospective analysis of patients undergoing pancreaticoduodenectomy was performed using the National Surgical Quality Improvement Program (NSQIP) database (2014-2019). In addition, we utilized propensity score matching to compare patients on preoperative steroids to those who were not. Outcomes measured included 30-day complications and mortality, need for readmission, a prolonged hospital length of stay, delayed gastric emptying, and pancreatic fistula. RESULTS After propensity score matching, there were 438 patients in the steroid group and 876 patients in the no steroid group. There was no difference in pancreatic fistula (23.8% vs. 21.7%; p-0.3), delayed gastric emptying (21.1% vs.20.1%; p-0.06), major complications (31.8% vs. 30.1%; p-0.1), and mortality (3.5% vs. 3.2%; p-0.6) between the two groups. CONCLUSION Glucocorticoids did not reduce the incidence of overall complications, postoperative fistula, and delayed gastric emptying following pancreaticoduodenectomy.
Collapse
Affiliation(s)
- Hassan Aziz
- Tufts Medical Center, Tufts University School of Medicine, South Building, Floor 4, 860 Washington St, Boston, MA, 02111, USA.
| | - Zubair Ahmed
- Tufts Medical Center, Tufts University School of Medicine, South Building, Floor 4, 860 Washington St, Boston, MA, 02111, USA
| | - Mohamed Abdimajid
- Tufts Medical Center, Tufts University School of Medicine, South Building, Floor 4, 860 Washington St, Boston, MA, 02111, USA
| | - Yurie Sekigami
- Tufts Medical Center, Tufts University School of Medicine, South Building, Floor 4, 860 Washington St, Boston, MA, 02111, USA
| | - Martin Hertl
- Tufts Medical Center, Tufts University School of Medicine, South Building, Floor 4, 860 Washington St, Boston, MA, 02111, USA
| | - Martin D Goodman
- Tufts Medical Center, Tufts University School of Medicine, South Building, Floor 4, 860 Washington St, Boston, MA, 02111, USA
| |
Collapse
|
7
|
Glina FR, Glina S. Organic or psychological? It does matter! Int Braz J Urol 2022; 48:579-582. [PMID: 35168317 PMCID: PMC9060174 DOI: 10.1590/s1677-5538.ibju.2022.99.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/22/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Flavia Ramos Glina
- Faculdade de Psicologia e Ciências da Educação da Universidade do Porto, Porto, Portugal
| | - Sidney Glina
- Disciplina de Urologia do Centro Universitário - FMABC - Santo André, SP, Brasil
| |
Collapse
|
8
|
Tomada N, Egydio P. Inflatable penile prosthesis reservoir placement-Are we ready for a paradigm change? Rev Int Androl 2022; 20:163-169. [PMID: 35337772 DOI: 10.1016/j.androl.2020.12.002] [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: 07/19/2020] [Revised: 10/21/2020] [Accepted: 12/06/2020] [Indexed: 11/26/2022]
Abstract
In 2002, Steve Wilson pioneered new procedures for alternative placement of reservoirs for inflatable prostheses in patients who have suffered damage to the space of Retzius following pelvic surgery or obliteration of the transversalis fascia by mesh hernia repair. Since then, surgical techniques and tools for ectopic reservoir placement have gradually gained acceptance to minimize palpability, and the risk of visceral and vascular lesions for high risk patients has been all but eliminated. Lockout valves and high submuscular placement techniques are now recommended, and reports of vascular, bowel or bladder injuries are uncommonly rare. While surgeons continue their search for safer and more effective placement methods, new skills and instruments are constantly being introduced to make recommendations to minimize complications and provide safety and functionality. Additional studies and comparisons of techniques are needed to achieve a consensus of best practice for reservoir placement solutions.
Collapse
Affiliation(s)
- Nuno Tomada
- Department of Urology, Hospital da Luz Arrábida, Praceta Henrique Moreira 150, 4400-346 Vila Nova de Gaia, Portugal; Instituto de Investigação e Inovação em Saúde (I3S), Rua Alfredo Allen 208, 4200-135 Porto, Portugal.
| | - Paulo Egydio
- Egydio Medical Center, Urology-Andrology, Av. Faria Lima 4.300, Ed. FL Offices conj. 710, 04538-132 São Paulo, Brazil
| |
Collapse
|
9
|
Woo X, Yap NKB, Toh TH, Yiek SH. Accidental Low-Velocity Penetrating Brain Injury by Glass Marble. Asian J Neurosurg 2022; 17:116-119. [PMID: 35873856 PMCID: PMC9298579 DOI: 10.1055/s-0042-1749125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
AbstractPenetrating brain injury from marble is rare. Marbles, commonly known as “guli” among locals, is a popular children's traditional game in Malaysia. This study discusses two cases of intracranial marble injury, both accidentally shot by children with home-made air guns during the period of Movement Control Order with one elderly patient who passed away. While the diagnosis was uneventful, the management was not straightforward. Strategies of prehospital, operative, postoperative management, and rehabilitation are discussed, including prognostic factors. Because of its rarity, the management of such injuries is complex and nonstandardized.
Collapse
Affiliation(s)
- Xiangling Woo
- Department of Neurosurgery, Sarawak General Hospital, Jalan Hospital, Sarawak, Malaysia
| | | | - Teck Hock Toh
- Department of Paediatrics and Clinical Research Center, Sibu Hospital, Jalan Ulu Oya, Sarawak, Malaysia
| | - Siew Hong Yiek
- Department of Neurosurgery, Sarawak General Hospital, Jalan Hospital, Sarawak, Malaysia
| |
Collapse
|
10
|
Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative. Cancers (Basel) 2022; 14:cancers14051161. [PMID: 35267469 PMCID: PMC8909015 DOI: 10.3390/cancers14051161] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments.
Collapse
|
11
|
Clavell-Hernández J. Proximal Extracapsular Tunneling: A Simple Technique for the Management of Impending Cylinder Erosion and Complications Related to Corporal Dilation. Sex Med 2021; 9:100379. [PMID: 34082302 PMCID: PMC8240336 DOI: 10.1016/j.esxm.2021.100379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Impending cylinder erosion and floppy glans secondary to an undersized penile prosthesis are rare complications that can cause cosmetic deformity and patient discomfort. Aim To demonstrate a technique for the management of impending cylinder erosion and floppy glans secondary to cylinder under-sizing. Methods We retrospectively reviewed 6 patients who required the proximal extracapsular tunneling technique during penile prosthesis revision surgery. Main Outcome Measure Main outcome was successful placement of a penile prosthesis with proper cylinder placement. Results Mean patient age for these 6 patients was 71.2 years (64–86 y). After a mean follow-up of 6.6 months, all 6 patients who underwent this procedure had a functional penile prosthesis without evidence of recurrence. Conclusion The proximal extracapsular tunneling technique is a simple approach performed through a single incision that can be used for proper cylinder replacement during penile prosthesis revision surgeries. It may be utilized for the management of impending cylinder erosion and other cases with coporal dilation-related complications in which the surgical pseudo-capsule has already formed around the implant. This technique can be safely performed without the need of a distal counter-incision on the penis. Clavell-Hernández J. Proximal Extracapsular Tunneling: A Simple Technique for the Management of Impending Cylinder Erosion and Complications Related to Corporal Dilation. Sex Med 2021;9:100379.
Collapse
Affiliation(s)
- Jonathan Clavell-Hernández
- University of Texas Health Science Center - McGovern Medical School at Houston, Texas, USA; St Joseph Medical Center, Houston, Texas, USA.
| |
Collapse
|
12
|
Javaroni V. Editorial comment: 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. Int Braz J Urol 2021; 47:663-665. [PMID: 33621019 PMCID: PMC7993974 DOI: 10.1590/s1677-5538.ibju.2021.03.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Valter Javaroni
- Hospital Federal do AndaraíDepartamento de AndrologiaRio de JaneiroRJBrasilDepartamento de Andrologia, Hospital Federal do Andaraí, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
13
|
Dos Reis MDMF, Barros EAC, Pollone M, Molina MBG, Westin CPDV, Glina S. Preoperative Psychological Evaluation for Patients Referred for Penile Prosthesis Implantation. Sex Med 2021; 9:100311. [PMID: 33714883 PMCID: PMC8072176 DOI: 10.1016/j.esxm.2020.100311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients may remain dissatisfied after penile prosthesis implantation for the treatment of erectile dysfunction. Studies showing the results of standardized protocols for preoperative psychological evaluation are lacking. PURPOSE To estimate the rate of patients considered psychologically unfit for penile prosthesis implantation and to compare their characteristics with those considered fit after the implementation of a standardized psychological profile evaluation protocol for men with erectile dysfunction. METHODS Cross-sectional evaluation of men referred for penile prosthesis implantation by their urologists, based on organic causes for the erectile dysfunction, including a semi-structured (sexual and relational anamnesis of the patient and their partner, information about expectations about the results of the penile prosthesis implantation and possible complications) and a structured instrument including validated tools for the evaluation of depression and/or anxiety symptoms. These were the Self Reporting Questionnaire (SRQ-20), the 36-Item Short-Form Health Survey for quality of life, and the Five-Factor Model (FFM) for behavioral tendencies. After at least 3 interviews, the psychology team rated the patients as fit or unfit for surgery. Unfit patients were those with any of a set of warning signals indicating risk for dissatisfaction even after penile implantation. MAIN OUTCOME MEASURE The prevalence of patients considered "unfit for surgery." RESULTS The quality of life scores were good, but 27.6% of patients (95% confidence interval, CI: 16.7-40.9%) were unfit for surgery. Being unfit was associated with obesity (P = .027), anxiety and/or depression symptoms (P < .001) and high levels of neuroticism (P = .001). CONCLUSION The preoperative evaluation protocol combining standardized and validated tools shows that more than one-quarter of patients with a medical indication for penile prosthesis implantation were not in good psychological conditions for the surgery. The development of psychological evaluation protocols can help identify patients in need of adequate care before penile implantation. M de Mello Ferreira dos Reis, EA Corrêa Barros, M Pollone, et al. Preoperative Psychological Evaluation for Patients Referred for Penile Prosthesis Implantation. Sex Med 2021;9:100311.
Collapse
Affiliation(s)
- Margareth de Mello Ferreira Dos Reis
- Psychologist, Coordinator of the Psychological Care, Sexual Medicine Outpatient Clinic, Urology Department, Faculdade de Medicina do ABC, Santo André (SP), Brazil.
| | - Eduardo Augusto Corrêa Barros
- Urologist, Director of the Sexual Medicine Outpatient Clinic, Urology Department, Faculdade de Medicina do ABC, Santo André (SP), Brazil
| | - Marilisa Pollone
- Psychologist, Sexual Medicine Outpatient Clinic, Urology Department, Faculdade de Medicina do ABC, Santo André (SP), Brazil
| | - Maria Beatriz Gracia Molina
- Psychologist, Sexual Medicine Outpatient Clinic, Urology Department, Faculdade de Medicina do ABC, Santo André (SP), Brazil
| | | | - Sidney Glina
- Urologist, Chief professor, Urology Department, Faculdade de Medicina do ABC, Santo André (SP), Brazil
| |
Collapse
|
14
|
Haskins IN, Strassle PD, Parker BTN, Catterall LC, Duke MC, Farrell TM. Minimally invasive Heller myotomy with partial posterior fundoplication for the treatment of achalasia: long-term results from a tertiary referral center. Surg Endosc 2021; 36:728-735. [PMID: 33689011 DOI: 10.1007/s00464-021-08341-0] [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: 09/18/2020] [Accepted: 01/27/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Few studies have reported the long-term results of minimally invasive Heller myotomy (HM) for the treatment of achalasia. Herein, we detail our 17-year experience with HM for the treatment of achalasia from a tertiary referral center. METHODS All patients undergoing elective HM at our institution from 2000 to 2017 were identified within a prospective institutional database. These patients were sent mail and electronic surveys to capture their symptoms of dysphagia, chest pain, and regurgitation pre- and postoperatively and were asked to evaluate their postoperative gastrointestinal quality of life. Responses from adult patients who underwent minimally invasive Heller myotomy with partial posterior (i.e., Toupet) fundoplication (HM-TF) were analyzed. RESULTS 294 patients were eligible for study inclusion; 139 (47%) completed our survey. Median time from HM-TF to survey response was 5.6 years. A majority of patients reported improvement in their dysphagia (91%), chest pain (70%), and regurgitation (87%) symptoms. Patients who underwent HM-TF more than 5 years ago were most likely to report heartburn symptoms. One (1%) patient went on to require esophagectomy for ongoing dysphagia and one (1%) patient required revisional fundoplication for their heartburn symptoms. CONCLUSIONS Minimally invasive Heller myotomy and posterior partial fundoplication is a durable treatment for achalasia over the long term. Additional prospective and multi-institutional studies are needed to validate our results.
Collapse
Affiliation(s)
- Ivy N Haskins
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA. .,Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Paula D Strassle
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | | | - Lauren C Catterall
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Meredith C Duke
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Timothy M Farrell
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
15
|
Loh-Doyle JC, Lin JS, Doumanian LR, Patil MB, Boyd SD. Outcomes of Alternative Reservoir Placement in the Lateral Retroperitoneum During Inflatable Penile Prosthesis Placement. Urology 2021; 152:35-41. [PMID: 33647306 DOI: 10.1016/j.urology.2021.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To describe outcomes of reservoir placement, exchange, and extraction from the lateral retroperitoneum (LR) in complex patients with a three-piece inflatable penile prosthesis (IPP). METHODS A retrospective chart review was performed on all patients that underwent placement of an IPP from 2009 to 2019. Patients with placement of the reservoir in the LR were identified. Intraoperative complications during reservoir placement, exchange, or removal, reservoir-related outcomes, and secondary device-related outcomes were collated and compared to patients who underwent traditional Space of Retzius reservoir placement. RESULTS A total of 587 men underwent primary IPP placement with 321 patients undergoing reservoir placement in the SOR and 266 in the LR. No significant differences were found in intra-operative reservoir-related outcomes (P=.272) between the 2 groups during placement, replacement, or extraction. Bowel injury occurred in 1 patient in the LR group during placement. No significant differences were found in postoperative reservoir complications (P= .534). Both groups each had one instance of patient reported bulge and pain at reservoir site (P= .6777). Two (0.6%) patients in the SOR group and 3 (1.1%) patients in the LR group had a reservoir failure or leak. There was a trend towards a lower rate of device infections in the LR group (1.9%) compared to the SOR group (4.7%) (P= .063). There were no significant differences in overall device mechanical failure rates between both groups (P= .919). CONCLUSIONS Reservoir placement in the LR is safe in patients with complex pelvic anatomy with equivalent device durability and no difference in surgical outcomes compared to standard retropubic reservoir placement.
Collapse
Affiliation(s)
- Jeffrey C Loh-Doyle
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Jeffery S Lin
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Leo R Doumanian
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Mukul B Patil
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Stuart D Boyd
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
16
|
Huynh LM, Osman MM, Yafi FA. Risk profiling in patients undergoing penile prosthesis implantation. Asian J Androl 2020; 22:8-14. [PMID: 31489849 PMCID: PMC6958986 DOI: 10.4103/aja.aja_92_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Penile prosthesis implantation is the gold standard of surgical therapy for patients with medication-refractory erectile dysfunction. However, this umbrella definition includes significant heterogeneity and associated risk profiles that should be candidly discussed and addressed perioperatively. Factors associated with operative success and patient satisfaction are often surgery specific; however, risk profiling via patient selection, preoperative optimization, proper device selection, and intraoperative consideration are highly correlated. Some examples of common risk profiles include comorbidity(ies) such as cardiovascular disease, diabetes mellitus, prior abdominal surgery, Peyronie's disease, and psychological risk factors. Similarly, integration of surgeon- and patient-amenable characteristics is key to decreasing risk of infection, complication, and need for revision. Finally, patient risk profiling provides a unique context for proper device selection and evidence-based intraoperative considerations.
Collapse
Affiliation(s)
- Linda M Huynh
- Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Mohamad M Osman
- Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA
| |
Collapse
|
17
|
Penile implant infection prevention part 1: what is fact and what is fiction? Wilson's Workshop #9. Int J Impot Res 2020; 33:785-792. [PMID: 32694583 DOI: 10.1038/s41443-020-0326-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/22/2020] [Accepted: 06/29/2020] [Indexed: 01/03/2023]
Abstract
Inflatable penile prosthesis (IPP) infections are undeniably devastating for patient and surgeon alike. While less common in this modern era, the landscape of prosthesis infection is shifting. Continued examination of risk factors for infection and re-evaluation of common practices remain critical should we aim to advance the field. Quality research on this topic is limited by several factors, among which small sample size and lack of coordinated effort pose the most precarious of challenges. Nonetheless, careful analysis of available data in conjuncture with judicious utilization of established research from other prosthetic fields can help us better grasp the issue at hand. In this review, we aim to do exactly that-to examine available evidence in an effort to discern fact from fiction. In this first part of the three part series, we aim to summarize our understanding of the pathogenesis behind prosthesis infections, explore known preoperative risk factors, and discuss intraoperative considerations for infection prevention. In the second part of this series, we will examine the game changing effect of infection retardant implant coatings. Part three of the series details postoperative prevention strategies, reviews salvage techniques, and discusses additional key considerations.
Collapse
|
18
|
Manka MG, Yang D, Andrews J, Chalmers B, Hebert K, Köhler TS, Trost L. Intraoperative Use of Betadine Irrigation is Associated With a 9-Fold Increased Likelihood of Penile Prosthesis Infection: Results From a Retrospective Case-Control Study. Sex Med 2020; 8:422-427. [PMID: 32601002 PMCID: PMC7471124 DOI: 10.1016/j.esxm.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Infection remains a persistent complication of penile prosthesis (PP) surgery. Despite popularity of Mulcahy’s PP washout protocol, Betadine has known tissue toxicity. Aim We evaluated PP infection rate based on the type of intraoperative irrigation used, ½ strength Betadine vs vancomycin/gentamicin. Methods We reviewed a prospective database of men undergoing primary, revision, and salvage PPs. No other changes to operative or perioperative techniques occurred after the change in irrigation solution. Univariate and logistic regression analyses were used to evaluate differences in infection rate with use of Betadine vs vancomycin/gentamicin irrigation. Potential confounders were reviewed. Main Outcome Measure The primary outcome was rate of PP infection before and after change of intraoperative irrigation. Results From 2014 to 2018, 217 patients underwent PP placement at our institution by a single surgeon; of whom, 21 (9.7%) experienced an infection (primary = 10 [7.1%], revision = 11 [17.19%], salvage = 0 [0%]). Overall, 152 (70%) received irrigation with Betadine and 65 (30%) with Vancomycin/Gentamicin. Univariate analysis demonstrated significantly increased infection rates with Betadine irrigation (odds ratio [OR]: 4.64, P = .006) and with revision surgery (OR: 2.68, P = .02). Significance of increased infection rate with Betadine was maintained (OR: 9.3; P = .025) after controlling for age, body mass index, Charlson comorbidity index, smoking, diabetes, primary vs revision/salvage, prior penile surgery, use of ectopic reservoir, and adjunctive glanulopexy. Conclusions Changing from intraoperative Betadine to vancomycin/gentamicin solution dramatically reduced infection rates among men undergoing PP placement in both primary and revision cases. We hypothesize that differences in infection rate may relate to the relative toxicity or non-sterile nature of Betadine. Manka MG, Yang D, Andrews J, et al. Intraoperative Use of Betadine Irrigation is Associated With a 9-Fold Increased Likelihood of Penile Prosthesis Infection: Results From a Retrospective Case-Control Study. Sex Med 2020;8:422–427.
Collapse
Affiliation(s)
- Madeleine G Manka
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - David Yang
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Jack Andrews
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Brian Chalmers
- Department of Orthopedics, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Kevin Hebert
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Tobias S Köhler
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA.
| | - Landon Trost
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| |
Collapse
|
19
|
Elist JJ, Levine L, Wang R, Wilson SK. Patient selection protocol for the Penuma® implant: suggested preoperative evaluation for aesthetic surgery of the penis. Int J Impot Res 2020; 32:149-152. [DOI: 10.1038/s41443-020-0237-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 11/10/2022]
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Trost L. Consenting the Patient for Penile Implant Surgery. J Sex Med 2020; 17:4-6. [PMID: 31870489 DOI: 10.1016/j.jsxm.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 11/17/2022]
|
22
|
Clavell-Hernández J, Shah A, Wang R. Non-Infectious Reservoir-Related Complications During and After Penile Prosthesis Placement. Sex Med Rev 2019; 7:521-529. [PMID: 30786958 DOI: 10.1016/j.sxmr.2018.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Inflatable penile prosthesis (IPP) surgery offers a high satisfaction rate and low rate of complications when performed by experienced surgeons. However, reservoir placement, either in the space of Retzius (SOR), or alternative/ectopic locations, may lead to an array of serious complications that may require revision surgery. AIM To review the prevalence and management options for non-infectious intraoperative and postoperative complications related to prosthetic reservoirs. METHODS A Medline PubMed search was used to identify articles related to IPP reservoir-related complications including bladder and bowel injury, vascular injury, autoinflation, herniation, palpability, leakage, and tubing torsion. MAIN OUTCOME MEASURE Rates and types of reservoir-related complications during and after IPP surgery. RESULTS Non-infectious reservoir-related complications in the intraoperative setting include injury to pelvic structures such as bladder, bowel, and blood vessels. In the postoperative setting, patients may experience autoinflation and reservoir herniation that might require revision surgery. Patients undergoing alternative reservoir placement (ARP) may complain of reservoir palpability and premature mechanical failure secondary to reservoir leakage or tubing torsion. CONCLUSION Although most surgeons continue to use the SOR as the main location for reservoir placement, ARP has gained popularity owing to its low risk of bother, minimal loss of functionality, and safety advantages in patients with history of pelvic surgery. Both reservoir placement in the SOR and ARP carry a low rate of complications while maintaining a high satisfaction rate. Clavell-Hernández J, Shah A, Wang R. Non-Infectious Reservoir-Related Complications During and After Penile Prosthesis Placement. Sex Med Rev 2019;7:521-529.
Collapse
Affiliation(s)
| | - Anuj Shah
- Division of Urology, University of Texas Health Science Center-McGovern Medical School at Houston, Department of Surgery, Houston, TX, USA
| | - Run Wang
- Division of Urology, University of Texas Health Science Center-McGovern Medical School at Houston, Department of Surgery, Houston, TX, USA; University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
23
|
Han K, Lee JM, Achanta A, Kongkaewpaisan N, Kongwibulwut M, Eid AI, Kokoroskos N, van Wijck S, Meier K, Nordestgaard A, Rodriguez G, Jia Z, Lee J, King D, Fagenholz P, Saillant N, Mendoza A, Rosenthal M, Velmahos G, Kaafarani HMA. Emergency Surgery Score Accurately Predicts the Risk of Post-Operative Infection in Emergency General Surgery. Surg Infect (Larchmt) 2018; 20:4-9. [PMID: 30272533 DOI: 10.1089/sur.2018.101] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Emergency Surgery Score (ESS) was validated recently as an accurate and user-friendly post-operative mortality risk calculator specific for Emergency General Surgery (EGS). ESS is calculated by adding one to three integer points for each of 22 pre-operative variables (demographics, co-morbidities, and pre-operative laboratory values); increasing scores accurately and gradually predict higher mortality rates. We sought to evaluate whether ESS can predict the occurrence of post-operative infectious complications in EGS patients. PATIENTS AND METHODS Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2007-2015, all EGS patients were identified by using the "emergent" ACS-NSQIP variable and a concomitant surgery Current Procedural Terminology code for "digestive system." Patients with any missing ESS variables or those who died within 72 hours from the surgical procedure were excluded. A composite variable, post-operative infection, was created and defined as the post-operative occurrence of one or more of the following: superficial, deep incisional or organ/space surgical site infection, surgical site disruption, pneumonia, sepsis, septic shock, or urinary tract infection. ESS was calculated for all included patients, and the correlation between ESS and post-operative infection was examined using c-statistics. RESULTS Of a total of 4,456,809 patients, 90,412 patients were included. The mean age of the population was 56 years, 51% were female, and 70% were white; 22% developed one or more post-operative infections, most commonly sepsis/septic shock (12.2%), surgical site infection (9%), and pneumonia (5.7%). The ESS gradually and consistently predicted infectious complications; post-operative infections developed in 7%, 24%, and 49% of patients with an ESS of 1, 5, and 10, respectively. The c-statistics for overall post-operative infection, post-operative sepsis/septic shock, and pneumonia were 0.73, 0.75, and 0.80, respectively. CONCLUSION The ESS accurately predicts the occurrence of post-operative infectious complications in EGS patients and could be used for pre-operative clinical decision-making as well as quality benchmarking of infection rates in EGS.
Collapse
Affiliation(s)
- Kelsey Han
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Jae Moo Lee
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Aditya Achanta
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Napaporn Kongkaewpaisan
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Manasnun Kongwibulwut
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Ahmed I Eid
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Nikolaos Kokoroskos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Suzanne van Wijck
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Karien Meier
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Ask Nordestgaard
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Gabriel Rodriguez
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Zhenyi Jia
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Jarone Lee
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - David King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Peter Fagenholz
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - April Mendoza
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Martin Rosenthal
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| |
Collapse
|
24
|
Predictors of Satisfaction in Men After Penile Implant Surgery. J Sex Med 2018; 15:1180-1186. [PMID: 30017718 DOI: 10.1016/j.jsxm.2018.05.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Despite the high satisfaction with penile implant (PI) surgery reported in the literature, a significant proportion of patients remain dissatisfied. AIM To evaluate satisfaction after PI surgery, using a single question and a scoring system. Furthermore, we attempted to define factors that predicted high patient satisfaction. METHODS The study population consisted of all patients undergoing PI surgery between 2009 and 2015. Comorbidity, demographic, and implant information were recorded. Complications recorded included: minor (requiring no re-operation) such as penile or scrotal hematoma, superficial wound breakdown; major (requiring hospitalization or re-operation) such as device infection, erosion, and mechanical malfunction. Patient satisfaction was defined using a single question posed to the patient 6 months after surgery using a 5-point Likert scale (5 being the most satisfied). Descriptive statistics were used to define complication rates and multivariable analysis (MVA) was performed to define predictors of high satisfaction (score ≥ 4), including presence and degree of complications, Peyronie's disease (PD), diabetes mellitus (DM), number of vascular comorbidities, body mass index (BMI) > 30, and patient age. MAIN OUTCOME MEASURE Patients with a major complication, with or without an additional minor complication, had a higher likelihood of being dissatisfied (25%) compared to patients with no complication or only minor complication 1.9% (no complications) and 3.7% (only minor complications), P < .001. RESULTS 902 patients were analysed. Mean age was 56.6 ± 10.6 years. Mean BMI was 30 ± 5. Comorbidity profile was diabetes 75%, dyslipidaemia 44%, hypertension 33%, cigarette smoking 32%, and PD 34%. 76% had a malleable implant (MPP) and 24% an inflatable implant (IPP). 31% had a minor complication and 9% a major complication. 93% had high satisfaction (score ≥4). Patients with any complication had a reduced rate of high satisfaction (97.5% vs 87.7%; P < .001) and even more pronounced with a major complication (96.7% vs 64.2%; P < .001). On MVA, only the absence of a major complication was a significant predictor of high satisfaction (OR 20, 95% CI 9-50, P < .001). CONCLUSION A high percentage of men are satisfied after penile implant surgery. Only the presence of a major complication is linked to a lower likelihood of achieving high satisfaction. Habous M, Tal R, Tealab A, et al. Predictors of Satisfaction in Men After Penile Implant Surgery. J Sex Med 2018;15:1180-1186.
Collapse
|
25
|
Counseling in urogynecology: A difficult task, or simply good surgeon-patient communication? Int Urogynecol J 2018; 29:943-948. [PMID: 29845304 DOI: 10.1007/s00192-018-3673-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
Surgical treatments for pelvic organ prolapse (POP) and urinary incontinence (UI) have greatly changed in recent years. Prompted by increases in reports of adverse outcomes in relation to such treatments, several scientific societies and researchers have emphasized providing patients with thorough counseling before treating them. Patient-centered communication has become the gold standard for excellence in clinical care. This challenges clinicians to be cognizant of their patients' perspectives, motivations, expectations, fears, concerns, and social contexts to enable them to reach a shared understanding with patients. Considering this, urogynecology counseling represents a crucial process through which women can gain a clear understanding of their clinical condition and the risks and benefits of potential treatment options. However, many urogynecologists believe that proposing a treatment and providing only enough detail to secure informed consent constitutes counseling. This article is intended to describe good counseling for women undergoing urogynecological surgery and to suggest optimal methodologies for implementation.
Collapse
|
26
|
Infection risk of undergoing multiple penile prostheses: an analysis of referred patient surgical histories. Int J Impot Res 2018; 30:147-152. [PMID: 29795529 DOI: 10.1038/s41443-018-0026-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/14/2018] [Accepted: 03/28/2018] [Indexed: 11/08/2022]
Abstract
Inflatable penile prosthesis (IPP) is the gold standard for medically refractory erectile dysfunction. Infectious complications remain a significant concern in IPP revision surgery. We sought to evaluate the impact of number of IPP surgeries on subsequent infection rates. A retrospective analysis was performed on all new patients (self or outside provider referred) presenting for consideration of IPP revision or salvage surgery between 2013 and 2015. Histories were reviewed including number of prior IPPs, reason for evaluation, and rate, number, and timing of prior IPP infections. No patients were operated on by the primary investigator prior to data acquisition. We identified 44 patients with at least one prior IPP presenting for consultation regarding IPP revision/salvage. There were 88 IPPs placed by 28 different surgeons. In patients with two or more devices, 55% had at least two different surgeons. The most common reason for presentation was malfunction (52%). The risk of specific device infection was strongly correlated and increased based on number of prior IPPs: 1st (6.8%; 3/44), 2nd (18.2%; 4/22), 3rd (33.3%; 4/12), 4th (50%; 4/8), and 5th (100%; 2/2) (R2 = 0.90, p = 0.01). Similarly, overall rates of infection positively correlated with number of prior IPP-related surgeries performed (R2 = 0.97, p < 0.01). The median time to development of infection after most recent IPP surgery was 2 months (IQR 1-3.3 months). Infection rates of revision/salvage IPP surgery increase with each subsequent IPP placement or following IPP-related surgeries. The majority of patients referred for penile implant surgery can expect to have experienced at least one infection by their 4th device. These data represent a change in paradigm on revision prosthetic surgery.
Collapse
|