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Drevik JA, Dalimov Z, Lucas J, Simhan J, Cohn JA. Factors associated with postoperative urinary retention in patients undergoing penile prosthesis implantation. Int J Impot Res 2024; 36:201-205. [PMID: 36198809 DOI: 10.1038/s41443-022-00622-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 11/09/2022]
Abstract
Placement of penile prosthesis had been well described in the outpatient setting, however, one barrier to same-day discharge is postoperative urinary retention (POUR). POUR remains a condition encountered during ambulatory surgical procedures and has yet to be characterized in patients undergoing penile prosthesis. We characterized POUR in a cohort of penile prosthesis recipients along with risk factors and management. Patients undergoing penile prosthesis implantation from 2014 through 2020 without pre-existing retention were included. All patients underwent a void trial immediately following penile prosthesis in the post-anesthesia care unit. POUR was strictly defined as (1) any patient requiring catheter replacement after prosthesis, (2) a rising post-void residual, or (3) inability to void after 6 h regardless of whether a catheter was placed. Independent procedures, demographic, intraoperative, and postoperative risk factors for POUR were assessed. 317 men were included of whom 27.1% experienced POUR. Men experiencing POUR and those not in retention were essentially indistinguishable with respect to previously described risk factors for POUR. Only use of both α-blockers and 5-α-reductase inhibitors was significantly associated with a greater risk of POUR, a finding maintained on adjusted analysis (adjusted odds ratio 10.1, 95% confidence interval 2.1 to 49.8). POUR resolved without intervention in 3.5%, a single episode of clean intermittent catheterization (CIC) in 7.0% of patients, and repeated CIC or indwelling catheter placement with a successful delayed void trial in 88.4% of patients. Rate of prosthesis infection in patients who experienced POUR did not significantly differ from those who did not experience POUR (4.7% vs. 2.2% p = 0.26). Our findings suggest that POUR is experienced in as many as 1 in 4 men undergoing penile prosthesis placement, most of whom must be managed with indwelling catheterization or repeated CIC. Those with indicators of symptomatic prostate enlargement are at significantly greater risk of urinary retention.
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Affiliation(s)
- Johnathan A Drevik
- Einstein Healthcare Network, Department of Urology, Philadelphia, PA, USA.
- Fox Chase Cancer Center, Department of Surgery, Philadelphia, PA, USA.
| | - Zafardjan Dalimov
- Einstein Healthcare Network, Department of Urology, Philadelphia, PA, USA
- Fox Chase Cancer Center, Department of Surgery, Philadelphia, PA, USA
| | - Jacob Lucas
- Einstein Healthcare Network, Department of Urology, Philadelphia, PA, USA
- Fox Chase Cancer Center, Department of Surgery, Philadelphia, PA, USA
| | - Jay Simhan
- Fox Chase Cancer Center, Department of Surgery, Philadelphia, PA, USA
| | - Joshua A Cohn
- Fox Chase Cancer Center, Department of Surgery, Philadelphia, PA, USA
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Barham DW, Pyrgidis N, Amini E, Hammad M, Miller J, Andrianne R, Burnett AL, Gross K, Hatzichristodoulou G, Hotaling J, Hsieh TC, Jenkins LC, Jones JM, Lentz A, Modgil V, Osmonov D, Park SH, Pearce I, Perito P, Sadeghi-Nejad H, Sempels M, Suarez-Sarmiento A, Simhan J, van Renterghem K, Warner JN, Ziegelmann M, Yafi FA, Gross MS. Does climate impact inflatable penile prosthesis infection (IPP) risk? Assessment of temperature and dew point on IPP infections. J Sex Med 2024; 21:500-504. [PMID: 38481017 DOI: 10.1093/jsxmed/qdae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Variations in climate have been associated with a greater risk of surgical site infections, urinary tract infections, and changes in the skin microbiome; however, limited data exist on the impact of climate on inflatable penile prosthesis (IPP) infections. AIM We sought to evaluate the impact of climate on the risk of IPP infections in a large international, multicenter cohort. METHODS We performed a multi-institutional, retrospective study of patients undergoing IPP surgery. We then evaluated whether the month or season, during which surgery was performed, affected device infections. Implant infections were defined as infections requiring device explantation. A univariate logistic regression analysis was undertaken. OUTCOMES Our primary outcome was implant infection. RESULTS A total of 5289 patients with a mean age of 62.2 ± 10.8 years received IPP placement. There was a fairly even distribution of implants performed in each season. A total of 103 (1.9%) infections were recorded. There were 32 (31.1%) IPP infections in patients who underwent surgery in the summer, followed by 28 (27.2%) in the winter, 26 (25.2%) in the spring, and 17 (16.5%) in the fall. No statistically significant differences were recorded in terms of season (P = .19) and month (P = .29). The mean daily temperature (P = .43), dew point (P = .43), and humidity (P = .92) at the time of IPP placement was not associated with infection. CLINICAL IMPLICATIONS These findings provide reassurance to prosthetic urologists that infection reduction strategies do not need to be tailored to local climate. STRENGTHS AND LIMITATIONS Climate data were not directly recorded for each hospital, but rather based on the monthly averages in the city where the surgery was performed. CONCLUSION The climate at time of IPP placement and time of year of surgery is not associated with IPP infection risk.
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Affiliation(s)
- David W Barham
- Urology Section, Department of Surgery, Brooke Army Medical Center, San Antonio, TX 78234, United States
| | | | - Eliad Amini
- Department of Urology, University of California, Irvine, Irvine, CA 92868, United States
| | - Muhammed Hammad
- Department of Urology, University of California, Irvine, Irvine, CA 92868, United States
| | - Jake Miller
- Department of Urology, University of California, Irvine, Irvine, CA 92868, United States
| | - Robert Andrianne
- Department of Urology, University Hospital of Liège, Liege, Belgium
| | - Arthur L Burnett
- Department of Urology, Johns Hopkins University, Baltimore, MD 21287, United States
| | - Kelli Gross
- Department of Surgery, University of Utah, Salt Lake City, Utah 84132, CA
| | | | - James Hotaling
- Department of Surgery, University of Utah, Salt Lake City, Utah 84132, CA
| | - Tung-Chin Hsieh
- Department of Urology, University of California, San Diego, San Diego, CA 92103, United States
| | - Lawrence C Jenkins
- Department of Urology, University of California, Irvine, Irvine, CA 92868, United States
| | - James M Jones
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, United States
| | - Aaron Lentz
- Department of Urology, Duke University, Durham, NC 27710, United States
| | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Daniar Osmonov
- Department of Urology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Ian Pearce
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Perito
- Perito Urology, Coral Gables, FL 33146, United States
| | | | - Maxime Sempels
- Department of Urology, University Hospital of Liège, Liege, Belgium
| | | | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | | | - J Nicholas Warner
- Department of Urology, Mayo Clinic, Rochester, MN 55905, United States
| | | | - Faysal A Yafi
- Department of Urology, University of California, Irvine, Irvine, CA 92868, United States
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, United States
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3
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Osmonov D, Wilson SK. Avoiding vascular complications at the time of penile implant surgery. J Sex Med 2024; 21:359-360. [PMID: 38693840 DOI: 10.1093/jsxmed/qdae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/05/2024] [Accepted: 01/29/2024] [Indexed: 05/03/2024]
Affiliation(s)
- D Osmonov
- FECSM Department of Urology, University Medical Center, European Institute for Sexual Health, Hamburg, Germany
- University Medical Center Schleswig Holstein, Campus Lübeck, Germany
| | - S K Wilson
- University of AR for Medical Sciences, United States
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Di Pierro GB, Di Lascio G, Lemma A, Grande P, Frisenda M, Del Giudice F, Antonini G, Nardi F, De Berardinis E, Cristini C, Franco G, Sciarra A, Salciccia S. Mid-term outcomes of minimally invasive infrapubic approach for inflatable penile prosthesis implantation: A single-center study and literature review. Andrology 2024; 12:624-632. [PMID: 37452742 DOI: 10.1111/andr.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/22/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The minimally invasive infrapubic approach (MIIA) for inflatable penile prosthesis (IPP) placement has shown favorable peri-operative safety and efficacy profile, but scarce data exist on long-term follow-up. OBJECTIVES We investigated the safety and efficacy of IPP implantation via the MIIA after a minimum 5-year follow-up. MATERIALS AND METHODS We identified data of implanted patients prospectively included in our institutional database. Complications and functional outcomes were assessed by using validated tools. Specifically, quality of life and patient satisfaction were evaluated by the Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Kaplan-Meier method was used to analyze IPP survival (defined as a working IPP). RESULTS Overall, 67 patients implanted by MIIA with a median (IQR) age of 64 years (61-70) were included. The median (IQR) follow-up duration was 71 months (63-80). Fifteen (22%) patients experienced complications: minor (Clavien ≤2) events included changes in penile sensitivity (n = 1; 1.5%), orgasmic dysfunction (n = 1; 1.5%), pain (n = 5; 7%), urinary tract infection (n = 2; 3%), and chronic discomfort (n = 1; 1.5%); major (Clavien 3) complications were represented by mechanical failure (n = 3; 4.5%), IPP infection (n = 1; 1.5%), and cylinder protrusion (n = 1; 1.5%). The estimated IPP survival was 94% (95% CI, 91.4-96.6), 92.5% (95% CI, 89.7-95.3), and 92.5% (95% CI, 89.7-95.3) at 3, 5, and 7 years after implantation, respectively. In patients using the device at follow-up (n = 61; 91%), median (IQR) scores for QoLSPP domains demonstrated favorable functional outcomes and patient satisfaction: functional 21 (19-23), personal 16 (15-18), relational 14 (12-15), and social 12 (11-14). DISCUSSION AND CONCLUSION This study represents the longest follow-up using validated tools to assess the outcomes of IPP implantation via MIIA so far. IPP placement via MIIA confirms to be safe and to offer high satisfaction to both patients and partners at mid-term evaluation.
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Affiliation(s)
| | - Giovanni Di Lascio
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Andrea Lemma
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Pietro Grande
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Marco Frisenda
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Gabriele Antonini
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Francesco Nardi
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Ettore De Berardinis
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Cristiano Cristini
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Giorgio Franco
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
| | - Stefano Salciccia
- Department of Maternal and Child Health and Urological Sciences, ''Sapienza'' University, Rome, Italy
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Blum KA, Mehr JP, Green TP, Macharia K, Kim D, Westney OL, Wang R. Complication rates in concurrent inflatable penile prosthesis and incontinence surgery: Comparing the penoscrotal versus perineal incision approach. Int J Impot Res 2024; 36:89-93. [PMID: 36357570 DOI: 10.1038/s41443-022-00628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022]
Abstract
The main objective of this study was to assess the IPP complication rates of patients undergoing placement via perineal incision versus more traditional penoscrotal approach in synchronous dual implantation. We identified 38 patients who underwent dual implantations of an IPP and AUS or urethral sling from 2011 to 2021 at a single tertiary center, 24 via perineal and 14 via penoscrotal incision. All IPP implants were done by a single surgeon. IPP postoperative complications were captured using the Clavien-Dindo classification at three separate time points, < 30 days, 30 days - 6 months, and > 6 months. The perineal group had two complications, IPP explantation due to rectourethral fistula (Grade III, > 6 months), and IPP explantation due to chronic genital pain (Grade III, > 6 months). The penoscrotal group had three complications, post-operative urinary retention requiring catheterization (Grade I, < 30 days), incision site infection (Grade I, < 30 days), and IPP explantation due to infection (Grade III, 30 days to < 6 months). There was no statistically significant difference in rate of patients with IPP complications between the two groups (p = 0.546) or in rate of IPP device malfunction (p = 0.264). These preliminary findings suggest that the single perineal incision is a viable surgical approach in synchronous dual implantation.
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Affiliation(s)
- Kyle A Blum
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Justin P Mehr
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Travis P Green
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Kirema Macharia
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Daniel Kim
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
| | | | - Run Wang
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA.
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA.
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6
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Baran C, Kutluturk EG, Otunctemur A, Kadioglu A. High flow priapism following the insertion of an inflatable penile prosthesis mimicking autoinflation: a case report. Int J Impot Res 2024; 36:3-5. [PMID: 37838811 DOI: 10.1038/s41443-023-00776-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/16/2023]
Abstract
Penile prosthesis implantation is a surgical option for erectile dysfunction when other treatments fail or the patient prefers implantation. Although penile prosthesis is generally considered safe and effective, various complications have been reported in the literature. High-flow priapism, resulting from an arteriovenous fistula between the cavernosal artery and the corpora cavernosa, is a rare complication after penile prosthesis implantation. Managing the condition as autoinflation may lead to unfortunate complications. A 54-year-old male patient underwent a penile prosthesis implantation due to erectile dysfunction lasting for 5 years. Doppler ultrasound revealed arterial insufficiency that was refractory to oral and intracavernosal treatments. A 3-piece inflatable penile prosthesis (Coloplast - Titan) was implanted through a midline penoscrotal incision without any complications. The patient reported uncontrolled tumescence after activating the device, which led us to suspect autoinflation. The final diagnosis was high-flow priapism due to an arteriovenous fistula in the cavernosal artery. The patient was given an antiandrogenic medication and the prosthesis was deflated for 3 months. The fistula closed without any additional intervention. High-flow priapism is a rare but potential complication of penile prosthesis implantation. Careful evaluation and management of patients' symptoms are necessary for diagnosing and treating this condition. This case highlights the importance of considering high-flow priapism as a potential cause of uncontrolled tumescence after penile prosthesis implantation and the possibility of successful non-surgical management.
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Affiliation(s)
- Caner Baran
- Department of Urology, University of Health Science, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey.
| | - Eren Gorkem Kutluturk
- Department of Urology, University of Health Science, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Alper Otunctemur
- Department of Urology, University of Health Science, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ates Kadioglu
- Department of Urology, Section of Andrology, Istanbul Faculty of Medicine, Istanbul, Turkey
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7
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Schifano N, Capogrosso P, Cakir OO, Dehò F, Garaffa G. Surgical tips in difficult penile prosthetic surgery: a narrative review. Int J Impot Res 2023; 35:690-698. [PMID: 36261536 DOI: 10.1038/s41443-022-00629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 11/08/2022]
Abstract
Penile prosthesis implantation continues to represent a reliable solution to address erectile dysfunction when oral medications fail, are not tolerated or are contraindicated, and most typically is associated with excellent satisfaction rates and durable results. Despite the dramatic improvements in the prostheses' design, in the surgical instruments and techniques over the years, certain categories of patients still pose a significant surgical challenge. The aim of the current review is to provide a quick and useful practical guidance based on our expertise in the identification and management of the difficult penile prosthesis implantation cases. A narrative review design was here preferred to fulfil our purpose. The search strategy included a range of terms, e.g. penile prosthesis, corporal fibrosis, infection, ischaemic priapism, Peyronie's disease, radical prostatectomy, pelvic surgery. Extensive corporal fibrosis after explantation of an infected device or after prolonged ischaemic priapism may represent the most difficult situations to deal with in penile prosthesis implantation surgery. Penile prosthesis implantation in patients with Peyronie's disease and in those who previously underwent radical prostatectomy also presents with an increased risk of complications. Experienced surgeons need to be able to recognise promptly and manage urethral perforation, cylinder crossover, tunical perforation and erosion, as these complications are more common when dealing with difficult penile prosthesis implantation cases. Applying penile lengthening techniques and principles can be useful in selected cases to ensure better postoperative satisfaction rates, especially in those patients who have experienced a more significant degree of loss of length preoperatively. High-volume-implanting surgeons should always be involved in complex cases to minimise the risk of complications. A thorough preoperative counselling can set realistic patients' expectations in this context, further contributing to postoperative satisfaction.
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Affiliation(s)
- Nicolò Schifano
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Paolo Capogrosso
- ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy
| | - Onur Omer Cakir
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | - Federico Dehò
- ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy
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Shumaker L, Zulia N, Kennedy E, Beilan J, Ortiz N, Baumgarten A. Delayed closed-suction drain removal following inflatable penile prosthesis placement: a multi-institutional experience. J Sex Med 2023; 20:1440-1445. [PMID: 37872726 DOI: 10.1093/jsxmed/qdad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND There are little published data regarding longer percutaneous drain durations following inflatable penile prosthesis placement; despite this, drain proponents suggest reduced scrotal hematoma formation, while detractors cite the risk of retrograde device seeding. AIM Here, we quantify the outcomes of a multi-institutional cohort with drain durations of 48 hours or greater. METHODS Data were collected retrospectively for patients undergoing primary 3-piece inflatable penile prosthesis (IPP) placement who had a postoperative drain placed. Cases were performed by 3 surgeons at 3 high-volume centers between January 1, 2020, and March 31, 2022. It was the routine practice of these surgeons to leave percutaneous drains for an interval of 48 hours or greater. R software was used to perform statistical analysis and data visualization. OUTCOMES Primary outcomes included rates of infection and hematoma formation. Secondary outcomes included device explantation. RESULTS During the study period, there were 224 patients meeting initial inclusion criteria. Of these, 15 patients had their drains removed before 48 hours, leaving 209 patients for the analysis. Mean drain duration was 67 ± 24.7 hours. The mean follow-up interval was 170 days. Diabetes mellitus was present in 84 (40%) patients with a mean hemoglobin A1c of 7.2%. Penoscrotal and infrapubic approaches were employed (n = 114 [54.5%] vs n = 95 [45.5%]). Reservoir location was split between space of Retzius and high submuscular, with space of Retzius being more common (n = 164 [78.5%] vs n = 45 [21.5%]). Discrete hematomas were observed in 7 patients, with subsequent operative intervention on 2. Notably, both of these were infection cases. There were 3 (1.4%) total device infections. Revision for noninfection causes was required in 9 (4.3%) patients. Fisher's exact testing demonstrated significant association between hematoma formation and anticoagulation and/or antiplatelet therapy (P = .017). On multivariable logistic regression, only anticoagulation and/or antiplatelet therapy remained significant (P = .035). CLINICAL IMPLICATIONS Maintaining percutaneous closed-suction bulb drains for >48 hours following IPP placement is safe. STRENGTHS AND LIMITATIONS This multi-institutional study fills a hole in IPP perioperative literature, as there have been no previously published data regarding drain durations >48 hours. The primary limitations are the retrospective nature and lack of a control population. CONCLUSION Maintaining closed-suction bulb drains for >48 hours following IPP implantation is safe and associated with infection rates comparable to other modern cohorts and a very low rate of hematoma formation.
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Affiliation(s)
- Luke Shumaker
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Nicholas Zulia
- Advanced Urology Institute, Largo, FL 33771, United States
| | - Emmett Kennedy
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
| | | | - Nicolas Ortiz
- Department of Urology, University of Virginia Health System, Charlottesville, Virginia 22903, United States
| | - Adam Baumgarten
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, United States
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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10
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Moukhtar Hammad MA, Barham DW, Sanford DI, Amini E, Jenkins L, Yafi FA. Maximizing outcomes in penile prosthetic surgery: exploring strategies to prevent and manage infectious and non-infectious complications. Int J Impot Res 2023; 35:613-619. [PMID: 37828138 PMCID: PMC10622320 DOI: 10.1038/s41443-023-00773-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
Inflatable Penile Prostheses (IPP) implantation is a surgical treatment for patients desiring definitive treatment for erectile dysfunction. While this procedure has proven to be effective, it also carries its own set of unique risks that need to be carefully considered. The article reviews the current understanding of complications associated with penile prosthetic surgery and provides strategies to mitigate these adverse events. This article covers various aspects of IPP implantation, including the risks of infection, bleeding, injury to nearby structures, glans ischemia, and device malfunction. It also discusses the importance of careful preoperative screening to identify risk factors and the implementation of infection reduction strategies such as antimicrobial prophylaxis, skin prep, and operative techniques. In addition, it emphasizes the need for postoperative vigilance and prompt management of any complications that may arise. Overall, the article provides a comprehensive overview of the risks and strategies for mitigating complications associated with IPP implantation. Our recommendations are given based on the current consensus in the field and highlight the importance of careful planning, attention to detail, and effective communication between healthcare providers and patients. Despite the potential risks, this review underscores the fact that complications following penile prosthesis implantation are relatively rare.
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Affiliation(s)
| | - David W Barham
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Daniel I Sanford
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Artificial Intelligence Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | | | - Lawrence Jenkins
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, Orange, CA, USA
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11
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Yassin M, Chen R, Ager M, Desouky E, Minhas S. Penile implants in low flow priapism. Int J Impot Res 2023; 35:651-663. [PMID: 37898653 DOI: 10.1038/s41443-023-00787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
Priapism is a persistent or prolonged erection, in the absence of sexual stimulation, that fails to subside. Prolonged ischaemic or low flow priapism is defined as a full or partial erection persisting for more than 4 h and unrelated to sexual interest or stimulation, characterised by little or no cavernous blood flow. Low flow priapism leads to progressive corporal fibrosis, which could, in turn, lead to long-lasting erectile dysfunction if left untreated. Penile prosthesis implantation is recognised as a management option in refractory and delayed low flow priapism for restoring erectile function with high patient satisfaction rates. However, the ensuing corporal fibrotic scarring poses a surgical challenge to clinicians, given the higher complication rates in this patient subset. Postoperative patient satisfaction has been closely linked to preoperative expectations and perceived loss of penile length. Therefore, thorough patient counselling concerning the risk and benefits of penile implants should be a priority for all clinicians. Moreover, there is a lack of consensus on the ideal prosthesis choice and procedural timing in refractory low flow priapism. In this review, we will examine the existing literature on penile implants in patients with priapism and discuss the options for managing complications associated with penile prosthesis surgery.
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Affiliation(s)
- Musaab Yassin
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Runzhi Chen
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Michael Ager
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elsayed Desouky
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
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12
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Conlon WJ, Herzog BJ, Hellstrom WJG. Residual penile curvature correction by modeling during penile prosthesis implantation in Peyronie's disease patients. Int J Impot Res 2023; 35:639-642. [PMID: 37055523 DOI: 10.1038/s41443-023-00694-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023]
Abstract
With the advent of new surgical techniques to treat Peyronie's disease with concomitant erectile dysfunction, there remains a question of whether manual modeling (MM), an older technique, still has a place in the treatment algorithm within penile prosthesis (PP) surgery. While the implantation of a PP often corrects moderate to severe curvature, penile curvature can remain greater than 30°, even when concurrent MM is performed during prothesis implantation. There are new variations of the MM technique that have been recently utilized in the intraoperative and postoperative setting to achieve penile curvature less than 30° when the implant is fully inflated. The inflatable PP, regardless of the specific model of choice, is preferred over the noninflatable PP when utilizing the MM technique. MM should be the first line of treatment for persisting intraoperative penile curvature after the placement of a PP due to its long-term efficacy, noninvasive approach, and significantly low risk of adverse effects.
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Affiliation(s)
- William J Conlon
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Bryan J Herzog
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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Goodstein T, Jenkins LC. A narrative review on malleable and inflatable penile implants: choosing the right implant for the right patient. Int J Impot Res 2023; 35:623-628. [PMID: 37741958 DOI: 10.1038/s41443-023-00765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
A penile prosthesis/implant is an excellent option for men with erectile dysfunction refractory to medical treatment or with contraindications to medical management. In this narrative review, we discuss the different types of penile prostheses and the considerations for patient and device selection to maximize satisfaction. There are three main prosthesis types to choose from: three-piece inflatable devices, two-piece inflatable devices, and malleable/semirigid devices. The three-piece devices are the gold standard in advanced economy countries but require reservoir placement and manual dexterity, which can be limiting to some patients. The two-piece inflatable devices are a good option for patients who have standard-sized penises, lack significant penile pathology, have limited dexterity issues, or should avoid reservoir placement due to potential complications. The malleable devices are popular in countries where insurance coverage is limited but are increasingly used in advanced economy countries for length conservation in specific patient populations. Finally, not every patient needs an implant, and assessing partner sexual function is an important consideration for patient-partner satisfaction. Surgeons need to be familiar with the strengths and limitations of each device and the patient characteristics that will yield the best outcome from penile prosthesis surgery.
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Affiliation(s)
- Taylor Goodstein
- Department of Urology, The Ohio State University, Columbus, OH, 43210, USA
| | - Lawrence C Jenkins
- Department of Urology, Tulane University, 1430 Tulane Ave, #8642, New Orleans, LA, 70112, USA.
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Chang C, Barham DW, Dalimov Z, Swerdloff D, Sadeghi-Nejad H, Andrianne R, Sempels M, Hsieh TC, Hatzichristodoulou G, Hammad M, Miller J, Osmonov D, Lentz A, Perito P, Suarez-Sarmiento A, Hotaling J, Gross K, Jones JM, van Renterghem K, Park SH, Nicholas Warner J, Ziegelmann M, Modgil V, Jones A, Pearce I, Gross MS, Yafi FA, Simhan J. Single Dilation in Primary Inflatable Penile Prosthesis Placement Is Associated With Fewer Corporal Complications Than Sequential Dilation. Urology 2023; 181:150-154. [PMID: 37574145 DOI: 10.1016/j.urology.2023.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To assess the difference in outcomes between single dilation (SingD) and sequential dilation (SeqD) in primary penile implantation, hypothesizing that patients who undergo SeqD had higher rates of noninfectious complications. METHODS We performed a multicenter, retrospective study of men undergoing primary inflatable penile prosthesis placement. Intraoperative complications and postoperative noninfectious outcomes were assessed between the two groups. Multivariable analysis was performed to identify predictors of complications. RESULTS A total of 3293 patients met inclusion criteria. After matching, there were 379 patients who underwent SingD and 379 patients who underwent SeqD. There was no significant difference in intraoperative complications between patients who underwent SingD vs SeqD, nor was there any difference in cylinder length (20 cm with interquartile range [IQR] 18-21 cm vs 20 cm with IQR 18-20 cm respectively, P = .4). On multivariable analysis, SeqD (OR 5.23 with IQR 2.74-10, P < .001) and older age (OR 1.04 with IQR 1.01-1.06, P = .007) were predictive of postoperative noninfectious complications. There was no significant difference in intraoperative complications between patients who underwent SingD vs SeqD, nor was there any difference in cylinder length. SeqD and older age were predictive of postoperative noninfectious complications. CONCLUSION During inflatable penile prosthesis placement in the uncomplicated patient without fibrosis, SingD is a safe technique to utilize during implantation that will minimize postoperative adverse events, and promote device longevity without loss of cylinder length.
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Affiliation(s)
- Chrystal Chang
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - David W Barham
- Department of Urology, University of California, Irvine, Orange, CA
| | | | - Daniel Swerdloff
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Robert Andrianne
- Service d'urologie, Centre Hospitalier Universitaire de Liege, Liege, Belgium
| | - Maxime Sempels
- Service d'urologie, Centre Hospitalier Universitaire de Liege, Liege, Belgium
| | - Tung-Chin Hsieh
- Department of Urology, University of California, San Diego, La Jolla, CA
| | | | - Muhammed Hammad
- Department of Urology, University of California, Irvine, Orange, CA
| | - Jake Miller
- Department of Urology, University of California, Irvine, Orange, CA
| | - Daniar Osmonov
- Department of Urology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Aaron Lentz
- Department of Urology, Duke University, Durham, NC
| | | | | | - James Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Kelli Gross
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - James M Jones
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Sung Hun Park
- Sewum Prosthetic Urology Center of Excellence, Seoul, South Korea
| | | | | | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Adam Jones
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ian Pearce
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, Orange, CA
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA.
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15
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Jue JS, Eid JF. Repair of penile prosthesis-induced impending erosion using xenograft during simultaneous inflatable penile prosthesis replacement. J Sex Med 2023; 20:1353-1358. [PMID: 38324457 DOI: 10.1093/jsxmed/qdad127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/02/2023] [Accepted: 09/07/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Penile prosthesis (PP)-induced impending erosion is a rare complication that has not been well characterized. AIM This study evaluates the role of prosthesis sizing and of the safety of xenograft windsock repair (AlloDerm, Tutoplast, ArthroFLEX) of impending erosion. METHODS This was a retrospective review of xenograft use during inflatable penile prosthesis (IPP) replacement. Patient demographics, prior PP characteristics, and xenograft-augmented IPP characteristics were obtained. Paired-samples t tests were used to compare the PP cylinder size, rear tip extender size, and calculated PP length between the most recent prior PP and the xenograft-augmented IPP. Complications and follow-up data were obtained. OUTCOMES The primary outcome was comparing the corporal body and device measurements between the PP presenting with impending erosion and the implanted xenograft-augmented IPP. The secondary outcome was evaluating the incidence of subsequent explantation. RESULTS A total of 24 patients underwent xenograft repair with simultaneous IPP replacement from 2012 to 2022. The median number of prior PP was 1 (interquartile range, 1-2.75). The median time between the most recent prior PP and xenograft-augmented IPP placement was 21 (interquartile range, 14-79) months. The prior PP was significantly longer at the time of explantation compared with the measured corporal body length in both the left (21.4 cm vs 20.1 cm; P < .01) and right (21.4 cm vs 20.1 cm; P < .01) sides. However, there was no significant difference in length between the xenograft-augmented IPP length at the time of implantation and measured corporal body length in both the left (20.1 cm vs 20.0 cm; P = .67) and right (20.2 cm vs 20.1 cm; P = .56) sides. A total of 16 (66.7%) cases required bilateral xenograft corporal body use. Only 1 (4.2%) patient had an IPP infection requiring explantation within 90 days of xenograft-augmented IPP placement. A total of 2 (8.3%) patients had device malfunction and 1 (4.2%) patient had impending erosion recurrence requiring removal/replacement of their initial xenograft-augmented IPP in a median time of 56 months from placement. CLINICAL IMPLICATIONS PP oversizing may increase risk of PP-induced impending erosion, which is a delayed process. STRENGTHS AND LIMITATIONS This is the largest retrospective study of xenograft use during IPP replacement for impending erosion but does not have a control cohort. This study is limited by its retrospective nature, limited follow-up, and absence of a treatment comparison. CONCLUSION PP-induced impending erosion may be due to PP oversizing but can be successfully repaired with xenograft windsock during simultaneous IPP replacement.
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Affiliation(s)
- Joshua S Jue
- Department of Urology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New York, NY 10075, United States
| | - Jean-Francois Eid
- Department of Urology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New York, NY 10075, United States
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Park SH, Wilson SK, Wen L. Subcoronal Incision for Inflatable Penile Prosthesis Does Not Risk Glans Necrosis. J Urol 2023; 210:678-687. [PMID: 37490615 DOI: 10.1097/ju.0000000000003619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE Glans vascular compromise had previously been considered a rare but devastating complication of the subcoronal incision for inflatable penile prosthesis surgery. Here, we describe the largest series of subcoronal implants to date to assess contemporary complication rates. MATERIALS AND METHODS A retrospective review of subcoronal prosthesis placements by a single surgeon from Seoul, South Korea, was performed. Patients were randomly assigned either Coloplast Titan or AMS 700 device per institutional practice. RESULTS A total of 898 patients who underwent subcoronal implants from May 2015 to March 2022 were analyzed. Median follow-up was 41 months (IQR 40). Preoperative patient comorbidities included diabetes (36.6%) and Peyronie's disease (4%). The most common complication was transient distal penile edema (74.7%). Transient incisional paresthesia (20.6%) was more common in patients with diabetes (31.9% vs 13.9%, P < .01). Five cases (0.5%) of distal penile skin necrosis were reported in patients who had previously been circumcised. Of these, 3 were managed successfully with wet-to-dry dressing, 1 required skin grafting, and 1 required device explant. Device infection without incisional compromise occurred in 2 cases (0.2%). There were no instances of glans necrosis or ischemia observed in this cohort. Of the first-time implants (817, 90.9%), most (62.3%) were successfully completed under local anesthetic alone, with the remainder of surgeries completed with the addition of adjunctive conscious sedation. CONCLUSIONS Subcoronal incision for first-time or revision penile implant surgery is not a risk factor for glans ischemia or necrosis and can be safely completed under local anesthetic with or without conscious sedation.
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Affiliation(s)
- Sung Hun Park
- Sewum Prosthetic Urology Center of Excellence, Seoul, South Korea
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17
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Wilson SK, Haxhimolla H, Kua B, Testa G, Love C, Rossello M, Carvajal A, Lynch W, Hammad MAM, Gross M. Survival From Revision Surgery for New Rigicon Infla10 Three-piece Inflatable Penile Prosthesis Is Comparable to Preceding Devices. Urology 2023; 180:257-261. [PMID: 37517678 DOI: 10.1016/j.urology.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To report the incidence of the reoperation surgeries of nearly all the Rigicon Infla10 implants performed since device introduction in 1/2019. Inflatable penile prosthesis has some of the highest survival from revision surgery of any medical device implanted in humans [1]. We expand on previous Rigicon Infla10 research, adding more patients and increasing follow-up duration [2]. MATERIALS AND METHODS 535 patients had Rigicon Infla10 devices implanted from 1/2019 to 8/2022. 103 surgeons from 26 centers in 15 countries participated in the study. Patient information forms were analyzed from virtually all implantations. Explantation or revision surgery for mechanical failure, infection, other medical reasons, and patient dissatisfaction were cataloged. SPSS 25.0 (IBM) was used for the statistical analysis of Kaplan Meier survival statistics. RESULTS Mean follow-up was 24.2months (7-43months). Mean patient age was 56years. Reoperation was necessary for 3.5% of subjects. Revision for mechanical failure occurred in 2.24% (12/535). The rate of explant for patient dissatisfaction was 0.56% (3/535). Revision for component out of place was 0.37% (2/535) with an infection rate and unsuccessful Peyronie's correction being 0.19% (1/535). Survival from requiring another corrective surgery at 1, 2, and 3years was 96.4%, 95.0%, and 94.0%, respectively. These initial survival rates compare favorably to devices currently available, which have been repeatedly enhanced to improve reliability. CONCLUSION In its first 2-3years of availability, The Rigicon Infla10 inflatable penile prosthesis shows freedom from revision comparable to existing enhanced devices that have been on the market for decades.
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Affiliation(s)
- Steven K Wilson
- Institute for Urologic Excellence, La Quinta, CA; Department of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Hodo Haxhimolla
- Haximolla Urology, Canberra, Australia; Department of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Boon Kua
- Urobriz, Wesley Hospital, Brisbane, Australia; Department of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Gerard Testa
- Shire Urology, Sydney, Australia; Department of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Christopher Love
- Urology South, Melbourne, Australia; Department of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Mariano Rossello
- Instituto Medico Rossello, Palma De Majorca, Spain; Department of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Alejandro Carvajal
- Department of Urology, CES University, Medellin, Colombia; Department of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - William Lynch
- St George Urology, Sydney, Australia; Department of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Muhammed A M Hammad
- Department of Urology, University of California Irvine Health, Orange, CA; Department of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH.
| | - Martin Gross
- Department of Urology, University of California Irvine Health, Orange, CA; Department of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
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18
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Tua-Caraccia RD, Adams ES, Watters CR, Lentz AC. Management of urologic prosthetic reservoirs at the time of inguinal or pelvic surgery. Sex Med Rev 2023; 11:431-440. [PMID: 37200135 DOI: 10.1093/sxmrev/qead018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION The artificial urinary sphincter and 3-piece inflatable penile prosthesis each require a fluid storage component and thus have components in the inguinal and pelvic regions. Because of this, patients with urologic prosthetics sometimes present challenges during future nonprosthetic operations. Presently, there is no established guideline for device management with ensuing inguinal or pelvic surgery. AIMS This article outlines concerns during pelvic and inguinal surgery for patients with an artificial urinary sphincter and/or inflatable penile prosthesis and proposes an algorithm for preoperative surgical planning and decision making. METHODS We conducted a narrative review of the literature on operative management of these prosthetic devices. Publications were identified by searching electronic databases. Only peer-reviewed publications available in English were considered for this review. RESULTS We review the important considerations as well as available options for operative management of these prosthetic devices during subsequent nonprosthetic surgery and highlight the advantages and disadvantages of each. Finally, we suggest a framework for helping surgeons determine which management strategy is most appropriate for their individual patients. CONCLUSION The best management strategy will differ depending on patient values, the planned surgery, and patient-specific factors. Surgeons should understand and counsel patients on all available options and encourage informed, shared decision making to determine the best individualized approach.
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Affiliation(s)
- Rafael D Tua-Caraccia
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27609, United States
| | - Eric S Adams
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27609, United States
| | - Christopher R Watters
- Section of General and Minimally Invasive Surgery, Division of Surgical Oncology, Department of Surgery, Duke General Surgery of Raleigh, Raleigh, NC 27609, United States
| | - Aaron C Lentz
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27609, United States
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Köhler TS, Wen L, Wilson SK. Penile implant infection part 3: the changing spectrum of treatment. Int J Impot Res 2023; 35:512-518. [PMID: 33750937 DOI: 10.1038/s41443-020-00382-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/12/2020] [Accepted: 11/18/2020] [Indexed: 11/09/2022]
Abstract
Penile prosthesis infection remains a rare but devastating complication of implantation. Historically, management of device infection was always extirpation. While certainly effective, device removal leaves an unhappy patient with a shortened penis. In this last part of a three-part series on the topic of penile prosthesis infection, we seek to highlight new and emerging ideas of infection management which have allowed surgeons the option of preserving the implanted status in select patients.
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Affiliation(s)
| | | | - Steven K Wilson
- Department of Urology, Institute for Urologic Excellence, La Quinta, CA, USA
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Chen ML, Sun HH, Kasabwala K, Freniere B, Moses RA. Glans Adipodermal Augmentation for Management of Neophallus Fat Atrophy After Penile Implant Insertion: Surgical Technique and Outcomes. Urology 2023; 178:61-66. [PMID: 37271188 DOI: 10.1016/j.urology.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe our surgical technique and outcomes of glans augmentation with autologous adipodermal or acellular dermal matrix (ADM) interposition grafts for fat atrophy of the neophallus following penile implant insertion. METHODS We retrospectively reviewed the outcomes of glans augmentation in phalloplasty patients presenting with fat atrophy following penile prosthesis insertion. Glans augmentation is performed by making a small posterior coronal incision to preserve the shaft-to-glans dermal blood supply. A plane is made between the glans skin and the capsule of the distal penile implant cylinder. An adipodermal graft or ADM sheet graft is then sized to the glans dissection space and inserted, covering the implant capsule and filling the glans. The graft harvest site and posterior coronal incisions are then closed. The primary postoperative outcome was the recurrence of implant glans skin impingement or erosion. RESULTS From October 2017 through January 2023, 15 patients underwent glans augmentation after penile prosthesis insertion. The mean follow-up was 20 months. Adipodermal grafts were placed in 12 (80%) patients and ADM grafts in 3 (20%) patients. Two patients developed complications requiring surgical revision and 3 patients are considering a secondary glans augmentation, for a potential surgical revision rate of 33% (5/15). There were no wound infections, implant infections, or erosions. CONCLUSION Glans augmentation with adipodermal or ADM graft interposition between the glans skin and implant capsule improves the neophallus appearance and may help prevent future implant erosion in phalloplasty patients who develop fat atrophy after penile implant insertion.
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Affiliation(s)
| | - Helen H Sun
- Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH
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21
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Barham DW, Chang C, Hammad M, Pyrgidis N, Swerdloff D, Gross K, Hatzichristodoulou G, Hsieh TC, Hotaling JM, Jenkins LC, Jones JM, Modgil V, Osmonov D, Pearce I, Perito P, Sadeghi-Nejad H, Suarez-Sarmiento A, Sempels M, Service CA, Simhan J, Yafi FA, Gross MS. Delayed placement of an inflatable penile prosthesis is associated with a high complication rate in men with a history of ischemic priapism. J Sex Med 2023; 20:1052-1056. [PMID: 37279440 DOI: 10.1093/jsxmed/qdad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Corporal fibrosis is known to result from prolonged priapism; however, the impact of the timing of penile prosthesis placement after priapism on complication rates is poorly understood. AIM We sought to evaluate the impact of timing of inflatable penile prosthesis (IPP) placement on complications in men with a history of ischemic priapism. METHODS We performed a multicenter, retrospective cohort study of patients with a history of priapism undergoing IPP placement by 10 experienced implantation surgeons. We defined early placement as ≤6 months from priapism to IPP. We identified a 1:1 propensity-matched group of men without a history of priapism and compared complication rates between men who had early placement, late placement, and no history of priapism. OUTCOMES Our primary outcome was postoperative noninfectious complications, and secondary outcomes included intraoperative complications and postoperative infection. RESULTS A total of 124 men were included in the study with a mean age of 50.3 ± 12.7 years. A total of 62 had a history of priapism and 62 were matched control subjects. The median duration of priapism was 37 (range, 3-168) hours and the median time from ischemic priapism to IPP placement was 15 months (range, 3 days to 23 years). Fifteen (24%) men underwent early (≤6 months) IPP placement at a median time of 2 months (range, 3 days to 6 months) following the ischemic priapism event. The remaining 47 (76%) underwent placement >6 months following priapism at a median time of 31.5 months (range, 7 months to 23 years). The complication rate in the delayed placement group was 40.5% compared with 0% in the early placement group and control group. Cylinder-related complications such as migration or leak accounted for 8 (57%) of 14 of the postoperative noninfectious complications. Full-sized cylinders were used in all patients who had a cylinder related complication. CLINICAL IMPLICATIONS Priapism patients should be referred to prosthetic experts early to decrease complication rates in those needing an IPP. STRENGTHS AND LIMITATIONS This is a multicenter study from experienced prosthetic urologists but is limited by the retrospective nature and small number of patients in the early placement group. CONCLUSION IPP complication rates are high in men with a history of ischemic priapism, especially when implantation is delayed beyond 6 months.
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Affiliation(s)
- David W Barham
- Department of Urology, University of California, Irvine, Orange, CA 92868, United States
| | - Chrystal Chang
- Department of Urology/Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Muhammed Hammad
- Department of Urology, University of California, Irvine, Orange, CA 92868, United States
| | - Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich 80539, Germany
| | - Daniel Swerdloff
- Department of Urology/Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Kelli Gross
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT 90491, United States
| | | | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego, La Jolla, CA 92103, United States
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT 90491, United States
| | - Lawrence C Jenkins
- Department of Urology, University of California, Irvine, Orange, CA 92868, United States
| | - James M Jones
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, United States
| | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Daniar Osmonov
- Department of Urology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Ian Pearce
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Perito
- Perito Urology, Coral Gables, FL, United States
| | | | | | - Maxime Sempels
- Department of Urology, University Hospital of Liège, Liège, Belgium
| | - C Austin Service
- Department of Urology, University of California San Diego, La Jolla, CA 92103, United States
| | - Jay Simhan
- Department of Urology/Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, Orange, CA 92868, United States
| | - Martin S Gross
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, United States
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22
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La Croce G, Schifano N, Pescatori E, Caraceni E, Colombo F, Bettocchi C, Carrino M, Vitarelli A, Pozza D, Fiordelise S, Varvello F, Paradiso M, Silvani M, Mondaini N, Natali A, Falcone M, Ceruti C, Salonia A, Antonini G, Cai T, Palmieri A, Dehò F, Capogrosso P. Which patient may benefit the most from penile prosthesis implantation? Andrology 2022; 10:1567-1574. [PMID: 36088578 DOI: 10.1111/andr.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Penile prosthesis implantation has been associated with overall good functional outcomes. Of relevance, some patients reported higher level of satisfaction and quality of life. AIM We investigated the profile of the patients who may benefit the most from penile prosthesis implantation. MATERIALS AND METHODS Data from a national multi-institutional registry of penile prostheses including patients treated from 2014 to 2017 in Italy (Italian Nationwide Systematic Inventarization of Surgical Treatment for Erectile Dysfunction) were analyzed. All data have been prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and revised by a single data manager. Patients' baseline characteristics were recorded. In order to simultaneously evaluate perceived penile prosthesis function and quality of life, all patients were re-assessed at 1-year follow-up using the validated questionnaire Quality of Life and Sexuality with Penile Prosthesis. High quality of life after surgery was defined as a score higher than the 75th percentile in each of the subdomains of the Quality of Life and Sexuality with Penile Prosthesis questionnaire. Logistic regression analysis tested the association between clinical characteristics and high quality of life after penile prosthesis implantation. RESULTS Follow-up data were available for 285 patients (median age 60 years; interquartile range: 56-67) who underwent penile prosthesis implantation. Erectile dysfunction etiology was organic in 40% (114), pelvic surgery/radiotherapy in 39% (111), and Peyronie's disease in 21% (60) of the cases. Patients showed good overall Quality of Life and Sexuality with Penile Prosthesis scores at 1-year follow-up for functional (22/25), personal (13/15), relational (17/20), and social (13/15) domains. Overall, 27.0% (77) of patients achieved scores consistent with the high quality of life definition. These patients did not differ in terms of median age (60 vs. 62), type of prosthesis (inflatable penile prostheses: 95% in both of the cases), and post-operative complications (10% vs. 14%) than those with lower quality of life score (all p > 0.1). At logistic regression analysis, erectile dysfunction etiology was the only factor independently associated with high quality of life at 1 year after surgery (p = 0.02). Patients treated for Peyronie's disease (odds ratio: 2.62; p = 0.01; 95% confidence interval: 1.20-5.74) were more likely to report better outcomes after accounting for age, post-operative complications, and surgical volume. CONCLUSION Penile prosthesis implantation is associated with an overall good quality of life. The subset of patients affected by erectile dysfunction secondary to Peyronie's disease seemed to benefit the most from penile prosthesis implantation in terms of functional outcomes, relationship with their partners and the outside world, and perceived self-image. The systematic use of validated questionnaires specifically addressed at evaluating quality of life and satisfaction after penile prosthesis implantation should be further implemented in future studies to better define the predictors of optimal satisfaction after penile prosthesis implantation.
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Affiliation(s)
| | - Nicolò Schifano
- Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| | | | - Enrico Caraceni
- Department of Urology, Area Vasta 3 Asur Marche, Civitanova Marche, Italy
| | - Fulvio Colombo
- Andrology Unit, Sant'Orsola University Hospital, University of Bologna, Italy
| | | | | | | | - Diego Pozza
- Studio di Andrologia e di Chirurgia Andrologica, Rome, Italy
| | | | | | - Matteo Paradiso
- Department of Urology, Ospedale Cardinal Massaia, Asti, Italy
| | - Mauro Silvani
- Department of Urology, Ospedale di Biella, Biella, Italy
| | - Nicola Mondaini
- Department of Urology, Villa Donatello Hospital, Florence, Italy
| | - Alessandro Natali
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Falcone
- Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Carlo Ceruti
- Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Andrea Salonia
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Federico Dehò
- Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| | - Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy
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23
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Balzano FL, Mian AH, Abramowitz DJ, Kohler TS, Warner JN. Novel Peyronie's algorithm at the time of penile implant. Can J Urol 2022; 29:11255-11261. [PMID: 35969730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Peyronie's disease (PD) is a fibrous transformation of the tunica albuginea within the corpora cavernosa causing curvature of the penis while erect. This cannot only be painful but can also cause narrowing, shortening, an hourglass deformity and problems with penetrative intercourse. There are many means of management of Peyronie's disease at the time of penile implant. Modeling is a commonly used approach but leaves the penis without increased length. Multi-incisional techniques enhance length restoration, but risk significant vascular and neurologic compromise. Herein, we present our experience with a novel algorithm to approach Peyronie's disease with an effort to enhance and restore length without elevation of the neurovascular bundle. MATERIALS AND METHODS A retrospective review was performed of an institutional review board approved database. Patients treated for Peyronie's disease and erectile dysfunction with penile implant from 8/16/18 to 8/20/2020 were evaluated. RESULTS In our cohort of 33 patients there is an average of 1.9 cm average stretch difference in stretch penile length before and after management. There was a 2.15 cm difference in the cohort subset that utilized the Brock technique. We had no loss of sensation or glans ischemia. There was one patient with autoinflation. All patients had less than 10 degrees of residual curvature. CONCLUSION With the proposed algorithm, we are able to safely maximize length restoration without elevation of the neurovascular bundle. More patients with longer follow up is needed to ensure the safety and validity of this algorithm.
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Affiliation(s)
- Felicia L Balzano
- Department of Urology, Mayo Clinic: Rochester, Rochester, Minnesota, USA
| | - Abrar H Mian
- Midwestern University College of Osteopathic Medicine, Downers Grove, Illinois, USA
| | | | - Tobias S Kohler
- Department of Urology, Mayo Clinic: Rochester, Rochester, Minnesota, USA
| | - Jonathan N Warner
- Department of Urology, Mayo Clinic: Rochester, Rochester, Minnesota, USA
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24
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Briles BL, Middleton RY, Celtik KE, Crane CN, Safir M, Santucci RA. Penile Prosthesis Placement by a Dedicated Transgender Surgery Unit: A Retrospective Analysis of Complications. J Sex Med 2022; 19:641-649. [PMID: 35241370 DOI: 10.1016/j.jsxm.2022.01.518] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Penile prostheses may be used as a component of genital gender affirmation surgery for the purpose of achieving penile rigidity after phalloplasty, and transgender individuals experience higher complication rates than cisgender individuals. AIM To observe complications with transmasculine penile prosthesis surgery over time and across surgical conditions. METHODS Retrospective chart review of all transmasculine patients with phalloplasty undergoing penile prosthesis placement between 4/14/2017 and 2/11/2020 (80 patients). OUTCOMES Independent variables include implant type, previous genital surgeries, and simultaneous genital surgeries. Dependent variables include prosthesis infection and mechanical complication (device malfunction, dislodgement, erosion). RESULTS There was an overall complication requiring surgery rate of 36% and infection rate of 20% (15/67 for inflatable prostheses and 1/13 for semirigid), with 14% (11/80) experiencing infection requiring removal. Differences in infection rates appeared insignificant across categories of previous surgery or with simultaneous surgery, but we did notice a markedly lower rate for semirigid prostheses compared to inflatable. There was a significant relationship between infection and case number, with the probability of infection decreasing over time. Device loss at 9 months was 21% overall. Preoperative conditions of the neophallus such as prior stricture correction and perioperative factors such as simultaneous clean and clean-contaminated procedures seemed to pose no additional increase in complication rates. CLINICAL IMPLICATIONS Type and number of prior and simultaneous non-prosthetic surgeries should not be considered as a risk factor for penile prosthesis after phalloplasty for transmasculine patients, even those that are clean-contaminated STRENGTHS & LIMITATIONS: Our cohort size is large compared to currently available studies, although not large enough to generate sufficient power for group comparisons. We have reported every genital surgical step between phalloplasty and penile prosthesis placement and recorded complications with subsequent devices after failure. Patient-reported outcomes were not collected. CONCLUSION We demonstrate that preoperative conditions of the neophallus, such as prior stricture correction, and perioperative factors, such as simultaneous clean and clean-contaminated procedures, seem to pose no additional increase in complication rates. Our data suggest that surgical experience may further decrease complications over time. B. L. Briles, R. Y. Middleton, K. E. Celtik, et al. Penile Prosthesis Placement by a Dedicated Transgender Surgery Unit: A Retrospective Analysis of Complications. J Sex Med 2022;19:641-649.
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Affiliation(s)
| | - Ravyn Y Middleton
- Long School of Medicine, UT Health San Antonio; San Antonio, TX, USA
| | - Kenan E Celtik
- Department of Urology, Houston Methodist Hospital; Houston, TX, USA
| | | | - Michael Safir
- Crane Center for Transgender Surgery; Austin, TX, USA
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25
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Schardein JN, Trussell JC. Reservoir induced bladder rupture: a complication of inflatable penile prosthesis revision surgery. Can J Urol 2021; 28:10946-10952. [PMID: 34895401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Reservoir induced bladder rupture is a rare complication of inflatable penile prosthesis (IPP) revision surgery. Our aim is to review the literature and describe our experience with this complication using two case reports that involved reusing an in-situ reservoir. In each case, an episode of gross hematuria indicated that a bladder rupture had occurred. From our experience, we propose ways to possibly avoid and if necessary, manage this rare complication.
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Affiliation(s)
- Jessica N Schardein
- Department of Urology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - J C Trussell
- Department of Urology, SUNY Upstate Medical University, Syracuse, New York, USA
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26
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Isguven S, Chung PH, Machado P, Delaney LJ, Chen AF, Forsberg F, Hickok NJ. Minimizing Penile Prosthesis Implant Infection: What Can We Learn From Orthopedic Surgery? Urology 2020; 146:6-14. [PMID: 32991908 DOI: 10.1016/j.urology.2020.08.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 11/18/2022]
Abstract
The implantation of penile protheses for the surgical treatment of erectile dysfunction has risen in popularity over the past several decades. Considerable advances have been made in surgical protocol and device design, specifically targeting infection prevention. Despite these efforts, device infection remains a critical problem, which causes significant physical and emotional burden to the patient. The aim of this review is to broaden the discussion of best practices by not only examining practices in urology, but additionally delving into the field of orthopedic surgery to identify techniques and approaches that may be applied to penile prothesis surgery.
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Affiliation(s)
- Selin Isguven
- Department of Orthopaedic Surgery, Thomas Jefferson University Philadelphia, Philadelphia, PA; Department of Radiology, Thomas Jefferson University Philadelphia, Philadelphia, PA
| | - Paul H Chung
- Department of Urology, Thomas Jefferson University Philadelphia, Philadelphia, PA.
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University Philadelphia, Philadelphia, PA
| | - Lauren J Delaney
- Department of Radiology, Thomas Jefferson University Philadelphia, Philadelphia, PA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham & Women's Hospital, Boston, MA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University Philadelphia, Philadelphia, PA
| | - Noreen J Hickok
- Department of Orthopaedic Surgery, Thomas Jefferson University Philadelphia, Philadelphia, PA
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27
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Scarberry KA, Thomas GM, Cowper M, Chouhan JD, Thakker PU, Matz EL, Dutta R, Terlecki RP. Sustained Glycemic Control Observed in Diabetic Men Who Improve Hemoglobin A1c Values to Allow for Elective Penile Prosthesis Placement. Urology 2020; 146:140-144. [PMID: 32946909 DOI: 10.1016/j.urology.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/15/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We hypothesize that men with diabetes mellitus whose inflatable penile prosthesis (IPP) implantation is delayed for unacceptably high hemoglobin A1c (HbA1c) will have durable improvements in their glycemic control after achieving acceptable HbA1c levels for surgery. METHODS Per institutional protocol, an A1c <9% must be documented prior to IPP placement. After IRB approval, a single surgeon IPP database was retrospectively queried for data specific to diabetes mellitus management. Men without HbA1c values at ≥1-year follow-up were excluded. Univariate and multivariate statistical analyses were performed to assess associations with sustained HbA1c control. RESULTS From January 2011 to March 2019, 138 diabetics undergoing IPP were identified. Thirty-seven were excluding for insufficient follow-up. Nineteen of the 101 analyzed men (18.8%) were delayed a median 4 months (range 2-17) for elevated HbA1c values (median 10.1, range 9.1-12.3). Following improvements, median preoperative HbA1c remained higher (8.2% vs 7.0%) in delayed men (P < .001). Among delayed recipients, 11 (58%) improved without medication changes while insulin was newly initiated (5) or dosage was increased (5) in 42%. At 32 months follow-up, a HbA1c <9% was similarly maintained in delayed and nondelayed men (74% vs 87%, P = .17). Delayed men more commonly required insulin therapy at follow-up (89.5% vs 54.9%, P = .008), but had a similar median change in BMI (+0.1 vs +0.1, P = .65). Device infection occurred in 1 nondelayed patient (0.7%). CONCLUSION Men who improve HbA1c for IPP surgery are likely to demonstrate persistent improvement. IPP implantation appears to be safe in diabetic men with HbA1c <9%.
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Affiliation(s)
- Kyle A Scarberry
- Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center, Cleveland, OH.
| | | | | | | | | | | | - Rahul Dutta
- Wake Forest Baptist Health, Winston-Salem, NC
| | - Ryan P Terlecki
- Wake Forest School of Medicine, Winston-Salem, NC; Wake Forest Baptist Health, Winston-Salem, NC
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28
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Picola N, Torremade J, Fiol M, Fernández-Concha JJ, Beato S, Vigués F. Analysis of satisfaction and surgical outcomes of a major ambulatory surgery program for penile implant. Actas Urol Esp 2020; 44:262-267. [PMID: 32151471 DOI: 10.1016/j.acuro.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/16/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND OBJECTIVE Penile prosthesis (PP) surgery is performed in many institutions as an inpatient procedure. We have recently initiated a major ambulatory surgery (MAS) program, thus reducing the hospital stay. The objective of this study was to assess the feasibility, complications and satisfaction of the implantation of outpatient surgery PP program in our hospital. MATERIAL AND METHODS Retrospective observational study evaluating the results and satisfaction of PP implanted as an outpatient procedure in Bellvitge University Hospital during 2018. RESULTS During 2018 we implanted 49 PP: 27 (55%) inpatient surgeries vs. 22 (45%) outpatient surgeries. Of these 22, 2 (9%) were second implants. All patients underwent both general anesthesia and crural, proximal dorsal nerve and transversus abdominis plane block (TAP). Complication rates between inpatient and outpatient procedures were similar, 2 (7%) and 1 (5%), respectively, without reporting infections or requiring PP removal. Postoperatively, a satisfaction telephone survey was conducted in 19 (86%) patients: 16 (84%) considered the time of hospital stay as appropriate, 15 (79%) would have preferred to be operated again in an outpatient care setting and 15 (79%) would recommend it. The patients' main concerns were related to being at home with no medical assistance at home and about coming back the next day for drainage removal. All patients reported well-controlled pain without requiring opioid intake in any case. CONCLUSIONS In our series, PP implantation in an ambulatory care setting is feasible and safe. Although there are some aspects that should be improved, the program showed acceptable satisfaction rates and an adequate postoperative pain control, neither raising the administration of opioids, nor increasing complications and re-admission rates.
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Affiliation(s)
- N Picola
- Departamento de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - J Torremade
- Departamento de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - M Fiol
- Departamento de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - J J Fernández-Concha
- Departamento de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - S Beato
- Departamento de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - F Vigués
- Departamento de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Shaeer O, Soliman Abdelrahman IF, Mansour M, Shaeer K. Shaeer's Punch Technique: Transcorporeal Peyronie's Plaque Surgery and Penile Prosthesis Implantation. J Sex Med 2020; 17:1395-1399. [PMID: 32389586 DOI: 10.1016/j.jsxm.2020.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/02/2020] [Accepted: 03/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Penile prosthesis implantation in cases of severe Peyronie's disease may require plaque excision/incision and grafting, which may require mobilization of the neurovascular bundle or urethra, posing the risks of penile hyposensitivity or urethral injury, and is time-consuming, possibly increasing infection risk. AIM Evaluating transcorporeal debulking of Peyronie's plaques by "Shaeer's punch technique." METHODS Penile prosthesis implantation and punch technique (PPI-Punch) was performed for 26 patients. After corporotomy and dilatation, Peyronie's plaques were punched out from within the corpora cavernosa using the punch forceps, and then a penile prosthesis was implanted. Comparison to a matching retrospective group of 18 patients operated upon by plaque excision-grafting and penile prosthesis implantation was performed. OUTCOMES The study outcomes were straightness of the erect penis, complication, satisfaction with length on a 5-point scale, the International Index of Erectile Function-5, and the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. RESULTS Average preoperative curvature angle was 58.1 ± 11.7 in the Punch group and 58 ± 14.8 in the excision-grafting group, p=0.99. After surgery, all patients had a straight penis. No tunical perforations, urethral injuries, or extrusions were noted. Average additional operative time for Punch technique ranged from 5 to 10 minutes (7.3 ± 1.7), in contrast to the excision-grafting group where plaque surgery duration was 50.8 minutes ± 11.1, an 85% difference, p < 0.0001. Septal plaques in the latter group could not be removed. In the PPI-Punch group, penile sensitivity was preserved in all patients, compared with the excision/grafting group, with 7 of 18 patients reporting hyposthesia of the glans. Infection occurred in 1 of 26 patients in the PPI-Punch group, compared with 2 of 18 patients in the excision/grafting group. Satisfaction with length on a 5-point scale was 3.8 ± 0.9 in the punch group, versus 3.1 ± 1.1 in the excision-grafting group, p=0.009. CLINICAL IMPLICATIONS The proposed technique is minimally invasive and prompt, possibly decreasing the known complications of plaque surgery and PPI including sensory loss. STRENGTHS & LIMITATIONS One limitation is the inability to accurately measure preoperative erect length in patients with erectile dysfunction with poor response to intracavernous injections. CONCLUSION Shaeer's punch technique is a minimally invasive procedure for transcorporeal excavation of Peyronie's plaques before penile prosthesis implantation, omitting the need for mobilization of the neurovascular bundle or spongiosum, and hence, there is low or no risk for nerve or urethral injury and brief plaque surgery time. Shaeer O, Soliman Abdelrahman IF, Mansour M, et al. Shaeer's Punch Technique: Transcorporeal Peyronie's Plaque Surgery and Penile Prosthesis Implantation. J Sex Med 2020;17:1395-1399.
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Affiliation(s)
- Osama Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt.
| | | | - Mohamed Mansour
- Department of Anesthesia, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Kamal Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
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30
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Dardenne E, Manach Q, Grande P, Campi R, Gomez F, Granger B, Misrai V, Bitker MO, Mozer P, Roupret M. Satisfaction and surgical outcomes in patients undergoing penile prosthesis implantation for drug-refractory erectile dysfunction: mid-term results in a single center French cohort. Can J Urol 2019; 26:10039-10044. [PMID: 31860421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION To investigate the mid-term results of penile prosthesis (PP) implantation in patients with erectile dysfunction (ED) from a "real-life" historic cohort in a French academic center. MATERIALS AND METHODS All patients receiving an inflatable PP between 2004 and 2014 in our institution were included in this study. ED was assessed preoperatively using the IEEF-5 questionnaire. Postoperative satisfaction with the PP was assessed using the EDITS questionnaire at each follow up visit. Postoperative complications were classed according to the Clavien classification. Surgical and functional outcomes were recorded prospectively. RESULTS Seventy-six men received a PP during the 10 year study period. Median (IQR) age was 62 (58-69) years. The main causes of ED were radical prostatectomy (n = 40; 53%) and diabetes mellitus (n = 28; 36.8%). Five patients (6.6%) had a non-functioning PP in place requiring complete substitution or a previous penile implant which had already been removed at the time of surgery. Sixty-nine (90.8%) patients received an AMS 700 CX device and seven (9.2%) a Coloplast Titan. The surgical approach was penoscrotal in 45 (59.2%) and infrapubic in 31 (40.8%). Intraoperative complications occurred in four (5%) patients, without compromising the intervention. Postoperative complications occurred in 27 (35.5%) patients: 17 (22%) were Clavien I-II and 10 (15%) Clavien III. All major complications resulted in prosthesis removal (n = 9; 11.8%) or revision (n = 1; 1.3%). Median (IQR) follow up was 43 (34-55) months. At the end of follow up, 70 (92.1%) patients had a functional implant. Fifty-four (71.1%) patients were satisfied with the device at the 6 month follow up visit and beyond. Early satisfaction (at 3 months) was reported by 44 (57.9%) patients. A previous PP was the only significant risk factor for prosthesis removal (p = 0.001). CONCLUSION PP implantation is a safe and satisfactory treatment for ED. However, patient selection remains crucial in determining the post-surgical success of this procedure.
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Affiliation(s)
- Emilie Dardenne
- Sorbonne Universite, GRC no5, ONCOTYPE-URO, AP-HP, Urology, Hopital Pitie-Salpetriere, F-75013 Paris, France
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Chierigo F, Capogrosso P, Dehò F, Pozzi E, Schifano N, Belladelli F, Montorsi F, Salonia A. Long-Term Follow-Up After Penile Prosthesis Implantation-Survival and Quality of Life Outcomes. J Sex Med 2019; 16:1827-1833. [PMID: 31501062 DOI: 10.1016/j.jsxm.2019.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/29/2019] [Accepted: 08/04/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Hydraulic penile prostheses have shown an overall good mechanical reliability up to 10 years after surgery; however, few data have been published on very long-term follow-up. AIM We looked at long-term (≥15 years) complications, including functional and quality of life (QoL) outcomes, after 3-piece inflatable penile prosthesis (IPP) implantation in patients with erectile dysfunction (ED). METHODS Data regarding 149 patients submitting to IPP placement before 2001 were analyzed. All patients were implanted with AMS CX and Ultrex Plus 3-piece prostheses. MAIN OUTCOME MEASURE Patients were reassessed to evaluate rates of complications and functional outcomes. The validated questionnaire Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) was used to assess patient QoL. Kaplan-Meier analysis estimated the probability of prosthesis survival (defined as working device/not-explanted). RESULTS Median follow-up of 51 patients was 206 months (interquartile range [IQR], 145-257). The etiology of ED was vasculogenic (n = 20; 39%), Peyronie's disease (n = 15; 29%), pelvic surgery (n = 4; 7.8%), organic other than vasculogenic (n = 3; 5.9%), or other (n = 9; 18%). Throughout the follow-up, 24 patients (49%) experienced complications: mechanical failure (n = 19; 79%), pain (n = 3; 12%), orgasmic dysfunctions (n = 1; 4.5%), or device infection (n = 1; 4.5%). The estimated IPP survival was 53% (95% CI, 36-67) at 20-year follow-up. Baseline characteristics (age, Charlson comorbidity index, body mass index, and erectile dysfunction etiology) were not significantly associated with the risk of IPP failure over time by Cox regression analysis. At 20-year follow-up, 41% (95% CI, 19-49) of the patients were still using the device. Among them, QoLSPP median domain scores were high: functional 22/25 (IQR, 20-23), relational 17/20 (IQR, 15-18), personal 14/15 (IQR, 12-15), and social 14/15 (IQR, 11-15). CLINICAL IMPLICATIONS The longevity of the device and long-term satisfaction rates should be comprehensively discussed during patient consultation for IPP surgery. STRENGTHS & LIMITATIONS To our knowledge, this is the first study reporting long-term QoL outcomes using a dedicated questionnaire for penile prostheses. The low response rate for the telephone interviews, the retrospective design of the study, and the relatively small number of patients are the main limitations. CONCLUSION Long-term follow-up data after IPP placement showed that almost half of the devices still worked properly 20 years after the original penile implant, as 60% of patients were still using the device with high satisfaction and adequate QoL outcomes. Both patients and physicians should be aware of the expected life and outcomes of IPP implants. Chierigo F, Capogrosso P, Dehò, et al. Long-Term Follow-Up After Penile Prosthesis Implantation-Survival and Quality of Life Outcomes. J Sex Med 2019;16:1827-1833.
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Affiliation(s)
- Francesco Chierigo
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Dehò
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
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McAbee KE, Pearlman AM, Terlecki RP. Infection following penile prosthesis placement at an academic training center remains low despite involvement of surgeons-in-training. Investig Clin Urol 2018; 59:342-347. [PMID: 30182080 PMCID: PMC6121020 DOI: 10.4111/icu.2018.59.5.342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/22/2018] [Indexed: 01/09/2023] Open
Abstract
Purpose Primary care providers harbor misconceptions regarding penile prosthetic surgery, largely overestimating the rate of infection. Rates of infection following surgery for primary placement and revision are estimated as 1% to 3% and 10% to 18%, respectively. Our objective was to determine the contemporary incidence of infection following inflatable penile prostheses surgery at an academic training center where surgeons-in-training are routinely involved. Materials and Methods Review of a prospectively collected single-surgeon database was performed. All cases of inflatable penile prostheses placement from January 2011 through June 2017 were reviewed. Information regarding training level of assistant surgeon(s) was collected, and follow-up data was compiled regarding postoperative infections and need for revision surgery. Results Three hundred nine cases meeting inclusion criteria were identified. Mean patient age was 64.2 years, and mean follow-up was 28.7 months. Distribution involved 257 (83.2%) for primary placement, 45 (14.6%) for removal/replacement, and 7 (2.3%) in setting of prior device removal. Diabetes was noted in 31.1% of men. Surgeon-in-training involvement was noted in 100% of cases. Infection was confirmed in a patient who had skin breakdown over an area of corporal reconstruction with polytetrafluoroethylene. The overall postoperative infection rate was 0.3%. Conclusions In this series from an academic training center, infection following penile prosthetic surgery is low, similar to other centers of excellence, even with 100% involvement of surgeons-in-training. This data should be used to better inform primary care providers and members of the general public potentially interested in restoration of sexual function.
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Affiliation(s)
- Kara E. McAbee
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Amy M. Pearlman
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Ryan P. Terlecki
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Pearlman AM, Terlecki RP. Proximal Corporal Perforation During Penile Prosthesis Surgery: Prevention, Recognition, and Review of Historical and Novel Management Strategies. J Sex Med 2018; 15:1055-1060. [PMID: 29729971 DOI: 10.1016/j.jsxm.2018.04.635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/29/2018] [Accepted: 04/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Proximal corporal perforation at time of dilation, although rare, may occur due to factors related to patient anatomy, presence of intra-cavernosal fibrosis, and/or surgical technique. AIM To describe tools and techniques designed to prevent and identify proximal corporal perforation, and maneuvers to minimize the risk of subsequent cylinder migration once proximal perforation has been recognized, such that the operation may proceed and result in an acceptable outcome. METHODS We discuss tips for prevention, recognition, and management of proximal corporal perforation by presenting a review of the literature as well as our preferences based on a high-volume experience with penile prosthesis surgery. OUTCOMES Described techniques aim to minimize risk of cylinder migration in the absence of true proximal repair. RESULTS Although proximal perforation may be obvious at times, particularly with a sudden loss of resistance during dilation, discrepant corporal measurements and/or dissimilar proximal deflection of the dilator should also increase the index of suspicion. Numerous techniques have been employed to theoretically reduce the risk of cylinder migration in the setting of proximal corporal perforation. These include formal corporal repair (historical), windsock repairs with non-absorbable grafts, absorbable plugs, and suture fixation of the rear tip extender or shod material covering implant tubing. CLINICAL TRANSLATION Intra-operative recognition of proximal corporal perforation, coupled with understanding of surgical strategies to minimize the risk of future device migration, may allow completion of an operation that still results in an optimal outcome. CONCLUSIONS Techniques described to prevent proximal migration are not strongly evidence-based, but rooted in logic and supported by high-volume implanters. Intra-operative perforation of the proximal corpora, although rare, can threaten the success of penile implant surgery, though the techniques described herein have been developed to mitigate the potential for subsequent device migration, allowing surgery to proceed and to achieve the desired clinical result. Pearlman AM, Terlecki RP. Proximal Corporal Perforation During Penile Prosthesis Surgery: Prevention, Recognition, and Review of Historical and Novel Management Strategies. J Sex Med 2018;15:1055-1060.
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Antonini G, De Berardinis E, Del Giudice F, Busetto GM, Lauretti S, Fragas R, Chung BI, Conti SL, Giannarelli D, Sperduti I, Gross MS, Perito PE. Inflatable Penile Prosthesis Placement, Scratch Technique and Postoperative Vacuum Therapy as a Combined Approach to Definitive Treatment of Peyronie's Disease. J Urol 2018; 200:642-647. [PMID: 29678456 DOI: 10.1016/j.juro.2018.04.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE Peyronie's disease is a devastating condition resulting in penile malformation, erectile dysfunction, pain and emotional distress. In this prospective, 2 institution study we evaluated a multimodal surgical and mechanical combined approach to the definitive treatment of Peyronie's disease and concomitant erectile dysfunction. MATERIALS AND METHODS A total of 145 select patients underwent endocavernous disruption of Peyronie's disease plaques via the scratch technique, followed by inflatable penile prosthesis insertion. Postoperatively patients were assigned to vacuum device therapy for 3 minutes twice daily to continue penile curvature correction. Followup continued for 1 year after surgery. Anatomical and functional results were assessed. RESULTS Patients with plaques in the proximal third, middle third and subcoronal areas of the penis had a mean ± SD postoperative residual curvature of 21.5 ± 4.5, 17.3 ± 4.8 and 14.1 ± 3.1 degrees, respectively. After 24 weeks of vacuum therapy the mean penile curvature deviation decreased to 8.7 ± 2.5, 9.1 ± 2.9 and 7.7 ± 0.9 degrees, respectively. The mean IIEF-5 (International Index of Erectile Function) score was 9.8 ± 2.3 preoperatively, 18.9 ± 3.1 at 6 months (p <0.001) and 24.1 ± 3.6 at 1 year (p <0.001). The mean EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) score at the end of followup was 64.6 ± 11.8. Operative and postoperative complications were minimal. CONCLUSIONS Our novel combination of intraoperative and postoperative therapies in the treatment of patients with Peyronie's disease and an inflatable penile prosthesis was safe and efficacious with excellent functional outcomes. Penile curvature corrections were statistically significant and complications were negligible.
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Affiliation(s)
- Gabriele Antonini
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Ettore De Berardinis
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | | | - Gian Maria Busetto
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Stefano Lauretti
- Department of Urology, Santa Caterina della Rosa Clinic ASL RM-C, Rome, Italy
| | | | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Simon L Conti
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Paul E Perito
- Department of Urology, Coral Gables Hospital, Coral Gables, Florida
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Grande P, Antonini G, Cristini C, De Berardinis E, Gatto A, Di Lascio G, Lemma A, Gentile G, Di Pierro GB. Penoscrotal versus minimally invasive infrapubic approach for inflatable penile prosthesis placement: a single-center matched-pair analysis. World J Urol 2018; 36:1167-1174. [PMID: 29492584 DOI: 10.1007/s00345-018-2249-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/21/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare perioperative results, safety and efficacy profile in patients receiving inflatable penile prosthesis (IPP) via penoscrotal (PS) or minimally invasive infrapubic (MII) approach for erectile dysfunction. METHODS A matched-pair analysis was performed including 42 patients undergoing IPP implantation via PS (n = 21) or MII (n = 21) between 2011 and 2016. Clinical and surgical data were prospectively collected. Patients' and partners' outcomes were assessed by the International Index of Erectile Function (IIEF), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaires. RESULTS Mean (SD) operative time was 128 (40.6) min in group PS and 91 (43.0) min in group MII (p = 0.041). Complications occurred in 3/21 (14%) and 2/21 (10%) patients in groups PS and MII (p = 0.832). Overall, no differences were observed concerning the device utilisation (p = 0.275). However, in group MII 4/21 (19%) patients were able to resume sexual activity prior to 4 postoperative weeks, while in group PS no patient was (p = 0.012). Mean (SD) scores for questionnaires were similar between groups PS and MII: IIEF [20.9 (7.3) vs. 20.7 (4.8); p = 0.132], patient EDITS [76.0 (25.6) vs. 74.7 (20.8); p = 0.256] and partner EDITS [72.5 (29.1) vs. 73.1 (21.4); p = 0.114]. Similarly, QoLSPP showed comparable results among the groups PS and MII: functional domain [3.9 (1.4) vs. 4.0 (1.2); p = 0.390], personal [4.0 (1.2) vs. 4.1 (1.0); p = 0.512], relational [3.7 (1.5) vs. 3.9 (1.2); p = 0.462] and social [4.0 (1.2) vs. 3.9 (1.2); p = 0.766]. CONCLUSIONS PS and MII demonstrated to be safe and efficient techniques, leading to high level of both patients and partners satisfaction. Additionally, the minimally invasive infrapubic approach showed a shorter operative time and a tendency for a faster return to sexual activity.
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Affiliation(s)
- Pietro Grande
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Gabriele Antonini
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Cristiano Cristini
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Ettore De Berardinis
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Antonio Gatto
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giovanni Di Lascio
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Andrea Lemma
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | - Giovanni Battista Di Pierro
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, 'Sapienza' University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Abstract
OBJECTIVES To investigate frailty as a predictor of surgical outcome in elderly patients undergoing penile prosthesis implantation. MATERIAL AND METHODS A total of 54 elderly patients, above 60 years of age, underwent penile prosthesis implantation between 2012 and 2014. Their data were collected and retrospectively analyzed. A modified frailty index (mFI) was calculated for each patient based on 11 risk factors from the Canadian Study of Health and Aging Frailty Index. The 1-year adverse outcomes were correlated with mFI, patients' and procedure's risk factors. RESULTS Mean age was 64.9 ± 5.2 years. No mortality was reported in our patients, however, one-year adverse outcomes were encountered in 43 (79.6%) patients. Among all studied variables, the 1-year adverse outcomes was not significantly association with mFI, but with preoperative glycosylated hemoglobin A1c (HbA1c) (p = 0.031) and associated Peyronie's disease (PD) (p = 0.000). HbA1c, dyslipidemia, hypertension, PD and duration of the procedure were predictive of infection complications (p < 0.05). Only PD and HbA1c sustained an independent significant impact. CONCLUSIONS mFI is not a predictive of post-penile prosthesis implantation adverse outcomes in elderly patients with impotence. Degree of diabetic control and association with PD was associated with the 1-year adverse outcomes and infection complications.
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Affiliation(s)
- Khaled Madbouly
- a Department of Urology , Prince Mohammed Bin Abdulaziz Hospital , Riyadh , Saudi Arabia
| | - Dulaim AlHajeri
- b Division of Urology , Department of Surgery, Faculty of Medicine, King Saud University , Riyadh , Saudi Arabia , and
| | - Mohamad Habous
- c Urology Department, Elaj Medical Group , Jeddah , Saudi Arabia
| | - Saleh Binsaleh
- b Division of Urology , Department of Surgery, Faculty of Medicine, King Saud University , Riyadh , Saudi Arabia , and
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Onyeji IC, Sui W, Pagano MJ, Weinberg AC, James MB, Theofanides MC, Stember DS, Anderson CB, Stahl PJ. Impact of Surgeon Case Volume on Reoperation Rates after Inflatable Penile Prosthesis Surgery. J Urol 2016; 197:223-229. [PMID: 27545573 DOI: 10.1016/j.juro.2016.08.083] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE We investigated the impact of surgeon annual case volume on reoperation rates after inflatable penile prosthesis surgery. MATERIALS AND METHODS The New York Statewide Planning and Research Cooperative System database was queried for inflatable penile prosthesis cases from 1995 to 2014. Multivariate proportional hazards regression was performed to estimate the impact of surgeon annual case volume on inflatable penile prosthesis reoperation rates. We stratified our analysis by indication for reoperation to determine if surgeon volume had a similar effect on infectious and noninfectious complications. RESULTS A total of 14,969 men underwent inflatable penile prosthesis insertion. Median followup was 95.1 months (range 0.5 to 226.7) from the time of implant. The rates of overall reoperation, reoperation for infection and reoperation for noninfectious complications were 6.4%, 2.5% and 3.9%, respectively. Implants placed by lower volume implanters were more likely to require reoperation for infection but not for noninfectious complications. Multivariable analysis demonstrated that compared with patients treated by surgeons in the highest quartile of annual case volume (more than 31 cases per year), patients treated by surgeons in the lowest (0 to 2 cases per year), second (3 to 7 cases per year) and third (8 to 31 cases per year) annual case volume quartiles were 2.5 (p <0.001), 2.4 (p <0.001) and 2.1 (p=0.01) times more likely to require reoperation for inflatable penile prosthesis infection, respectively. CONCLUSIONS Patients treated by higher volume implanters are less likely to require reoperation after inflatable penile prosthesis insertion than those treated by lower volume surgeons. This trend appears to be driven by associations between surgeon volume and the risk of prosthesis infection.
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Affiliation(s)
- Ifeanyi C Onyeji
- Department of Urology, Columbia University Medical Center, New York, New York.
| | - Wilson Sui
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Mathew J Pagano
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Aaron C Weinberg
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Maxwell B James
- Department of Urology, Columbia University Medical Center, New York, New York
| | | | | | | | - Peter J Stahl
- Department of Urology, Columbia University Medical Center, New York, New York
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Morey AF. Re: Alternative Placement of Penile Prosthesis Reservoir and AUS Pressure Regulating Balloon. J Urol 2015; 194:762. [PMID: 26292887 DOI: 10.1016/j.juro.2015.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Seftel AD. Re: Penile prostheses and the litigious patient: a legal database review. J Urol 2015; 193:1323. [PMID: 25890540 DOI: 10.1016/j.juro.2014.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Giraldi L, Felbo J, Sønksen J, Fode M. [Penile implants is a good last treatment option in erectile dysfunction]. Ugeskr Laeger 2015; 177:V12140660. [PMID: 25872677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
When other treatments fail, penile implants represent the last treatment option in erectile dysfunction. The most commonly used implant is the inflatable three-piece device, which allows the penis to be rigid for sexual intercourse and flaccid during the remaining time. Earlier penile implants were associated with high rates of infection and mechanical malfunction. However, technical improvements have greatly reduced these problems. This has resulted in a patient satisfaction rate of 80-90% in most studies. Thus, penile implants are a valid option in motivated patients with erectile dysfunction.
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Affiliation(s)
- Laura Giraldi
- Urologisk Afdeling, Roskilde Sygehus, Køgevej 7-13, 4000 Roskilde.
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Tausch TJ, Morey AF, Zhao LC, Knoll P, Simhan J, Scott JF, Flemons JR, Wilson SK. High submuscular versus space of Retzius placement of inflatable penile prosthesis reservoirs: results of a surgeon survey. Can J Urol 2014; 21:7465-7469. [PMID: 25347372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION High submuscular (HSM) inflatable penile prosthesis (IPP) reservoir insertion is a new technique that involves placing the reservoir high beneath the muscles of the abdominal wall. We queried a variety of surgeons to assess their impressions of how HSM reservoir placement compares with traditional space of Retzius (SOR) placement. MATERIALS AND METHODS A nationwide group of urologists trained in HSM reservoir placement was surveyed to assess preferences and concerns compared to SOR placement. Using a Likert scale survey, we compared HSM to traditional SOR placement with regard to ease of implementation, surgical preference, and patient safety. Results were analyzed according to numbers of implants performed by the surgeons. RESULTS A total of 25 urologists from eight states participated in this survey (12 residents and 13 attending surgeons). Overall, surgeons report that HSM placement is safer (p < 0.001). The participants believed it conveyed lower risk to visceral (p < 0.001) and vascular (p < 0.001) structures. Moreover it was easier to learn (p = 0.008) and to teach (p = 0.002). The majority (17/25, 68%) prefer HSM reservoir placement, while 4/25 (16%) are neutral, and 4/25 (16%) prefer SOR. Among high volume implanters (> 20 implants/year), 7/9 (78%) prefer the HSM technique and report that it is safer (p = 0.001) with lower risk of visceral (p = 0.010) and vascular (p < 0.001) injuries. CONCLUSIONS Urologists trained in HSM reservoir placement report that this technique is readily implemented, strongly preferred, and safer for patients.
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Ciftci H, Verit A, Savas M. Late complications of spontaneous urethral erosion of a malleable penile prosthesis in a young patient. Singapore Med J 2012; 53:e120-e121. [PMID: 22711048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
While oral agents are currently suggested for the initial treatment of erectile dysfunction, penile prosthesis implantation (malleable or inflatable) is accepted as a third-line therapy if intracorporeal injection and intraurethral treatment fail as a secondary choice. Urethral erosion of the malleable penile prosthesis is a well-known complication, mostly due to the indwelling catheter. We report a case of urethral erosion of the malleable penile prosthesis after 23 years. The patient was a 45-year-old man without any underlying risk factors. He subsequently underwent a unilateral rod extraction under regional anaesthesia. It appears that urethral erosion of penile prostheses can appear at any time post operation, without any known facilitative factors and in any age group. Furthermore, simple office manoeuvres may not be possible in some patients.
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Affiliation(s)
- Halil Ciftci
- Department of Urology, School of Medicine, Harran University, TR 63100 Sanliurfa, Turkey.
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Carpenter CP, Daniali LN, Shah NP, Granick M, Jordan ML. Distal urethral reconstruction with AlloDerm: a case report and review of the literature. Can J Urol 2012; 19:6207-6210. [PMID: 22512968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Reconstruction of large urethral defects is a complex problem for which no standardized surgical guidelines exist due to the lack of clinical trials demonstrating definitively the superiority of one technique over another. AlloDerm has been used in other surgical specialties with success, however, its utility in urologic surgery and, more specifically, for urethral reconstruction has been limited. In this case report, we demonstrate its application in a single-staged closure of a significant anterior urethral defect following distal penile necrosis secondary to an extruded penile prosthesis in a diabetic patient.
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Affiliation(s)
- Christina P Carpenter
- Division of Urology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School Newark, New Jersey 07102, USA
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Miagkov IL, Iudin VE, Ivanov VN, Sergienko NF, Vasil'chenko MI. [Erectile dysfunction: choice of the treatment method]. Urologiia 2011:37-41. [PMID: 22066240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The 15-year clinical experience with falloendoprosthetic operations (FEPO) in patients with erectile dysfunction is reviewed including algorithm of diagnostic examination, prostheses of different generations, indications and contraindications for falloendoprosthetic surgery. The results of 117 FEPO are outlined with special emphasis on 19 cases of postoperative complications. The conclusion is made that FEPO is most effective in erectile dysfunction by the presented criteria of the erectile dysfunction treatment efficacy.
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Abstract
We present a rare clinical case of distal penile gangrene in a patient with type 2 diabetes mellitus after the implantation of malleable penile prosthesis. Necrosis of the glans penis, urethral meatus, dorsal penile shaft, and corpora cavernosa was observed, and a distal penectomy was performed.
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Affiliation(s)
- Asif Yildirim
- Department of Urology, SB Istanbul Goztepe Training and Research Hospital, Hamidiye Mah, Barisyolu Sok, Dumankaya Cekmekoy Evleri, A6-20, Cekmekoy, 34782, Umraniye, Istanbul, Turkey.
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Durazi MH, Jalal AA. Penile prosthesis implantation for treatment of postpriapism erectile dysfunction. Urol J 2008; 5:115-119. [PMID: 18592465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Our aim was to evaluate the procedure and outcome of penile prosthesis surgery in the treatment of men with postpriapism erectile dysfunction. MATERIALS AND METHODS During the period between 1997 and 2004, a total of 17 patients with postpriapism erectile dysfunction underwent penile prosthesis implantation at our institution. Prosthesis implantation was done electively 6 to 18 months after priapism, when the patients presented with erectile dysfunction. Of the prosthesis implanted, 11 were malleable, 4 were 2-piece, and 2 were 3-piece prostheses (AMS, Minnetonka, Minnesota, USA). RESULTS All the 17 patients were successfully implanted with penile prosthesis. Intra-operatively, corporeal dilation was difficult due to extensive corporeal fibrosis, which led to urethral injury in 2 patients. There were no major postoperative complications. The median hospital stay was 5 days. The follow-up period ranged from 2 to 9 years (median, 6 years). All the patients were satisfied with the prosthesis. CONCLUSION Penile prosthesis implantation is the modality of treatment for patients with postpriapism erectile dysfunction at our institution. It has a high patient satisfaction rate. Although procedure-related complications are common due to corporeal fibrosis, they were mostly minor ones and did not affect the outcome of the procedure.
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Affiliation(s)
- Mohammed H Durazi
- Department of Surgery, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
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Hatzimouratidis K, Koliakos N, Koutsogiannis I, Moisidis K, Giakoumelos A, Hatzichristou D. Removal of a detached head of the Brooks dilator from the corpora cavernosa during penile prosthesis implantation. J Sex Med 2007; 4:1179-81. [PMID: 17484773 DOI: 10.1111/j.1743-6109.2007.00506.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Several complications during and after penile implantation have been reported. The most difficult part of the procedure seems to be the dilatation of the corpora, especially in fibrotic cases. AIM To report a rare intraoperative complication during dilatation of the corpora and its management. METHODS During dilation of the corpora cavernosa with Brooks dilators for the implantation of penile prosthesis, its head was detached and stuck at the tip of the corpus cavernosum. Several trials to remove the head of the dilator using different kinds of clamps were unsuccessful. Finally, an incision was performed to the distal lateral part of the corpora cavernosa and the head of the dilator was removed. Implantation was completed uneventfully. RESULTS The patient instructed to inflate the prosthesis and use it for sexual intercourse after 6 weeks. Follow-up was 14 months and the patient is using properly the prosthesis. CONCLUSIONS Although this is a very rare complication not previously described, we recommend examination of the dilators before use.
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Affiliation(s)
- Konstantinos Hatzimouratidis
- Aristotle University of Thessaloniki--2nd Department of Urology and Center for Sexual and Reproductive Health, Thessaloniki, Greece
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Abstract
INTRODUCTION Although more invasive than some of the other currently available therapies, penile prosthesis surgery has the advantages of high patient satisfaction rates and avoidance of systemic adverse events in the vast majority of cases. AIM This article provides a review of the more widely used implants and some of the more frequently encountered complications of penile prosthesis surgery. METHODS A retrospective review peer reviewed publications relevant to the field of penile prosthesis surgery. MAIN OUTCOME MEASURES Review of historical milestones and newer penile prostheses, as well as a review of prosthesis surgery complications. RESULTS Improved designs and materials have resulted in decreased incidence of mechanical failures or infectious complications while simultaneously simplifying the operation of these devices. CONCLUSIONS Penile prosthesis surgery remains an excellent alternative for restoring erectile function to those in whom medical therapies such as phosphodiesterase inhibitors are contraindicated or who have failed more conservative measures.
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Affiliation(s)
- Hossein Sadeghi-Nejad
- UMDNJ New Jersey Medical School-Department of Surgery, Division of Urology, Newark, NJ, USA.
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Abstract
INTRODUCTION Complications that arise after placement of a penile prosthesis may result in the need for revision surgery. Few contemporary penile prosthesis series have focused solely on describing the efficacy and patient satisfaction associated with penile prosthesis revision surgery. AIM To determine the overall success of penile prosthesis revision surgery in providing the patient with a functional implant. Device efficacy and patient satisfaction with penile prosthesis revision surgery will be assessed using psychometrically validated instruments. MAIN OUTCOME MEASURES The erectile function (EF) and satisfaction domains of the International Index of Erectile Function (IIEF) were used to quantify the overall efficacy and patient satisfaction with revision surgery. METHODS Data were derived from a prospective database of consecutive patients undergoing penile prosthesis revision surgery performed by a single surgeon (B.R.K.). Eleven patients filled out the IIEF prior to surgery and 26 completed it following surgery. RESULTS Thirty-nine consecutive patients underwent 55 revision procedures related to a prior penile prosthesis. Thirty-four patients (87%) have a functional implant with a median follow-up of 6.5 months (range 1-42 months). Significant improvements in the overall IIEF, EF domain, and satisfaction domain were seen in those patients studied prior to and following revision surgery. The total IIEF, EF domain, and satisfaction domain of the IIEF for the group of 26 responders were 60.7 +/- 19.3, 26.6 +/- 8.7, and 15.7 +/- 5.6, respectively. Patients with fibrotic corporal bodies scored significantly lower on the EF and satisfaction domains than did any other group. CONCLUSIONS Penile prosthesis revision surgery is highly successful in providing men with a functional implant. The prostheses function well and patients are satisfied with their devices. Further study of those men with corporal fibrosis is warranted in order to determine the factors needed to improve their overall satisfaction with revision surgery.
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Affiliation(s)
- Bruce R Kava
- Urology, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
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