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Andino JJ, Leelani N, Sato R, Shin Y, Rojanasarot S, Furtado T, Bernie HL, Bajic P, Salter CA, Halpern JA. Association between surgeon procedure volume and reoperation rates for penile prosthesis implantation. J Sex Med 2025; 22:916-923. [PMID: 40173076 DOI: 10.1093/jsxmed/qdaf064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Revised: 02/26/2025] [Accepted: 03/02/2025] [Indexed: 04/04/2025]
Abstract
BACKGROUND Prior studies have examined patient-specific predictors of reoperation following penile prosthesis (PP) insertion at the local and regional level, but little is known about patient factors and volume-outcome relationships at the national level. AIM To assess the impact of patient characteristics and surgeon volume on reoperation rates following PP placement in a Medicare population. METHODS We utilized the 100% Medicare Standard Analytical Files to identify men aged ≥65 years who underwent PP implantation between 2018 and 2021. Surgeon volume data were obtained from the Atlas All-Payor Claims dataset, and quartiles were calculated. Multivariable logistic regression was used to evaluate associations between reoperation rates, patient characteristics, and surgeon volume. OUTCOMES The reoperation rate at 1-year post-implantation, the cause of reoperation, and factors associated with a higher reoperation rate. RESULTS Among 8343 patients, 2.3% required reoperation at 90 days and 6.3% at 1 year. The most common comorbidities were diabetes (35.2%), cardiovascular disease (23.9%), Peyronie's disease (15.4%), and obesity (11.5%). Surgeon volume quartiles were calculated, with the highest-volume surgeons performing >31 cases annually versus <6 for the lowest quartile. Lower surgeon volume, older patient age, and smoking were associated with higher reoperation rates. Patients treated by top-quartile surgeons had 25%-28% lower odds of reoperation at 1 year [OR 0.72; 95% CI 0.56-0.93; OR 0.75; 95% CI 0.59-0.97]. CLINICAL IMPLICATIONS While higher surgeon volume was associated with lower reoperation rates, PP surgery remained safe across all volume levels. STRENGTHS AND LIMITATIONS Strengths include the use of a nationally representative Medicare dataset and All-Payor volume-outcome analysis. Limitations include accuracy of claims data, inability to fully characterize reoperations, and lack of data for procedures performed in ambulatory surgery centers. CONCLUSION In a nationally representative Medicare cohort, PP reoperation rates were low (6.3%), with mechanical complications accounting for 41% of reoperations (2.6% of the cohort). Higher-volume surgeons had lower reoperation rates, but outcomes remained acceptable across all volume levels, reinforcing the overall safety of the procedure.
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Affiliation(s)
- Juan J Andino
- University of California Los Angeles Health Urology, Santa Monica, Los Angeles, CA 90404, United States
| | - Navid Leelani
- Maimonides Medical Center Urology, Brooklyn, NY 11220, United States
| | - Ryoko Sato
- Boston Scientific, 300 Boston Scientific Way, Marlborough, MA 01752, United States
| | - Young Shin
- Boston Scientific, 300 Boston Scientific Way, Marlborough, MA 01752, United States
| | - Sirikan Rojanasarot
- Boston Scientific, 300 Boston Scientific Way, Marlborough, MA 01752, United States
| | - Thiago Furtado
- University of California Los Angeles Health Urology, Santa Monica, Los Angeles, CA 90404, United States
| | - Helen L Bernie
- Indiana University, Department of Urology, Indianapolis, IN 46202, United States
| | - Petar Bajic
- Glickman Urological Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Carolyn A Salter
- Madigan Army Medical Center, Urology, Joint Base Lewis-McChord, WA 98431, United States
| | - Joshua A Halpern
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Posterity Health, Centennial, CO 80112, United States
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Andino JJ. Editorial Comment on "A Nationwide Analysis of Post-Penile Prosthesis Infection: Do Hospital and Surgeon Volume Matter?". Urology 2025:S0090-4295(25)00389-9. [PMID: 40262676 DOI: 10.1016/j.urology.2025.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2025] [Accepted: 04/15/2025] [Indexed: 04/24/2025]
Affiliation(s)
- Juan J Andino
- University of California Los Angeles Health, Los Angeles, CA.
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Nguyen V, Sato R, Loh-Doyle J, Brant W, Rojanasarot S, Telang S, Hsieh TC. A Nationwide Analysis of Postpenile Prosthesis Infection: Do Hospital and Surgeon Volume Matter? Urology 2025:S0090-4295(25)00291-2. [PMID: 40179988 DOI: 10.1016/j.urology.2025.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 03/10/2025] [Accepted: 03/26/2025] [Indexed: 04/05/2025]
Abstract
OBJECTIVE To evaluate the association between hospital and surgeon procedural volumes of inflatable penile prosthesis implantation and postoperative infection rates, and to examine patient risk factor differences across volume quartiles. METHODS A retrospective cohort study of US males undergoing de novo inflatable penile prosthesis insertion (2016-2022) used the Premier PINC AI Healthcare Database. Patients were categorized by hospital and surgeon procedural volumes. Infection rates, defined by diagnosis and procedure codes, were compared between lowest and highest volume quartiles. Established risk factors for infection (eg, age, smoking, diabetes, HIV, prior pelvic radiation, obesity, concomitant circumcision, Peyronie's disease) were analyzed. Logistic and Cox regressions assessed associations between volume quartiles, infection rates, and risk factors. RESULTS Among 18,475 patients, hospital and surgeon data were available for 100% and 70.2%, respectively. Median follow-up was 3years. Infection rates were lower at high-volume hospitals (2.4%) than low-volume hospitals (3.7%; HR 0.64, 95% CI [0.489, 0.834], P=.001). Surgeon volume showed a similar but insignificant trend (2.7% vs 3.2%; HR 0.87, 95% CI [0.644, 1.181], P=.377). Patients at high-volume hospitals and with high-volume surgeons less frequently had risk factors (21.9% vs 25.8%, P<.001; 21.4% vs 25.8%, P<.001). Type 2 diabetes was less common at high-volume hospitals (6.7% vs 9.7%, P<.001) and among high-volume surgeons (7.1% vs 10.2%, P<.001), while circumcision and Peyronie's disease were more prevalent in high-volume settings (P<.001). CONCLUSION High-volume facilities and surgeons were linked to lower infection rates, suggesting targeted interventions could improve outcomes at low-volume sites.
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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, Warner JN, Ziegelmann M, Modgil V, Jones A, Pearce I, Burnett AL, Gross MS, Yafi FA, Simhan J. New findings regarding predictors of Poor Corporal Integrity in Penile Implant Recipients: A Multicenter International Invesigation. BJU Int 2025; 135:528-534. [PMID: 39658322 DOI: 10.1111/bju.16607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2024]
Abstract
OBJECTIVES To evaluate the pre- and intraoperative variables that impact the integrity of the corporal bodies over time after inflatable penile prosthesis (IPP) placement, as predictors of intraoperative corporal perforation and delayed cylinder complications have not been well characterized. PATIENTS AND METHODS We retrospectively reviewed a 16-centre multi-institutional database of IPP surgeries performed by experienced implanters from 2016 to 2021. Poor corporal integrity (PCI) was defined as intraoperative (iPCI) corporal complications or postoperative (pPCI) corporal complications. Multivariable analysis was performed to identify independent predictors of PCI, iPCI, and pPCI. Primary outcomes included intra- and postoperative corporal complications. RESULTS We identified 5153 patients for analysis from 5406 IPP cases, finding 152 (2.95%) cases of PCI. On multivariable analysis, predictors of PCI included revision IPP surgery (odds ratio [OR] 8.16, 95% confidence interval [CI] 5.15-12.92; P < 0.001), sequential dilatation (OR 2.12, 95% CI 1.32-3.39; P = 0.002), coronary artery disease (CAD)/peripheral vascular disease (PVD) (OR 1.81, 95% CI 1.18-2.77; P = 0.006), older age (OR 1.02, 95% CI 1.01-1.04; P = 0.013), and corporal scarring (OR 1.58, 95% CI 1.0-2.5; P = 0.049). Predictors of iPCI included revision IPP surgery (OR 7.34, 95% CI 4.18-12.88; P < 0.001), corporal scarring (OR 2.77, 95% CI 1.64-4.69; P < 0.001), radiation therapy (OR 2.25, 95% CI 1.0-5.04; P = 0.049), and older age (OR 1.03, 95% CI 1.0-1.05; P = 0.025). Revision IPP surgery (OR 7.92, 95% CI 3.69-17.01; P < 0.001), sequential dilatation (OR 3.4, 95% CI 1.61-7.19; P = 0.001), CAD/PVD (OR 2.98, 95% CI 1.56-5.72; P = 0.001), and history of priapism (OR 3.59, 95% CI 1.08-11.99; P = 0.038) were predictive of pPCI. CONCLUSION Coronary artery disease/PVD, being of older age, having corporal scarring, undergoing IPP revision surgery and sequential dilatation were predictive risk factors for complications associated with PCI. Identifying patients who are at risk of having PCI may improve patient-specific counselling, consideration of referral to more experienced implanters, and surgical planning to potentially promote longer-term device viability.
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Affiliation(s)
- Chrystal Chang
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - David W Barham
- Department of Urology, University of California Irvine, Orange, CA, USA
| | - Zafardjan Dalimov
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Daniel Swerdloff
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - 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, USA
| | | | - Muhammed Hammad
- Department of Urology, University of California Irvine, Orange, CA, USA
| | - Jake Miller
- Department of Urology, University of California Irvine, Orange, CA, USA
| | - Daniar Osmonov
- Department of Urology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Aaron Lentz
- Department of Urology, Duke University, Durham, NC, USA
| | | | | | - James Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kelli Gross
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - James M Jones
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - 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
| | - Arthur L Burnett
- Department of Urology, Johns Hopkins University, Baltimore, MD, USA
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Faysal A Yafi
- Department of Urology, University of California Irvine, Orange, CA, USA
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Braun AE, Swerdloff D, Sudhakar A, Patel RD, Gross MS, Simhan J. Defining the incidence and management of postoperative scrotal hematoma after primary and complex three-piece inflatable penile prosthesis surgery. Int J Impot Res 2025; 37:82-86. [PMID: 37156930 PMCID: PMC10166027 DOI: 10.1038/s41443-023-00697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023]
Abstract
Scrotal hematoma is a challenging complication of penile prosthesis surgery. We characterize the risk of hematoma formation with implementation of standardized techniques to mitigate hematomas and assess for any associated factors in a large multi-institutional penile implant cohort. This was a retrospective review from February 2018 to December 2020 of all patients who underwent inflatable penile prosthesis implantation at 2 high volume implant centers. Cases were defined as "complex" if they involved revision, salvage with removal/replacement, or were performed with concurrent penile, scrotal or intra-abdominal surgeries. The incidence of scrotal hematoma among primary and complex IPP recipients was measured and modifiable and innate risk factors associated with hematoma formation within the two cohorts were tracked. Of 246 men who underwent penile prosthesis surgery, 194 (78.9%) patients underwent primary implantation and 52 (21.1%) were complex. Although hematoma formers in the complex group had comparable drain outputs to primary patients on postoperative day 0 (66.8cc ± 32.5 vs 48.4 ± 27.7, p = 0.470) and postoperative day 1 (40.3cc ± 20.8vs 21.8 ± 11.3 p = 0.125), hematomas in the complex group had a higher propensity for OR evacuation (p = 0.03). Difference in duration of temporary device inflation between 2 (64, 26%) and 4 weeks (182, 74%) did not contribute to hematoma formation (p = 0.562). The incidence of postoperative hematoma formation in complex cases was 9.6% (5/52) and 3.6% in primary cases (7/194) (HR = 2.61, p = 0.072). Complex IPP surgery performed for revision or with ancillary procedures are more likely to result in clinically significant hematomas that require surgical management, suggesting a need for heightened caution in managing these individuals.
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Affiliation(s)
- Avery E Braun
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Rutul D Patel
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Martin S Gross
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA.
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Bole R, Alom M, Habashy E, Ahmed M, Ziegelmann M, Kohler T, Helo S. The clinical significance of imperfection: is idiopathic corporal asymmetry related to curvature during penile prosthesis placement? Int J Impot Res 2024; 36:820-824. [PMID: 36797455 DOI: 10.1038/s41443-023-00669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/18/2023]
Abstract
Patient satisfaction after inflatable penile prosthesis (IPP) has been linked to preexisting curvature; however the association with intraoperative asymmetric corporal measurements (ACM) has not been well described. We sought to identify incidence of ACM during IPP surgery, and relationship to penile curvature. A retrospective review of all patients undergoing primary IPP placement between 6/2019 and 6/2021 was performed. Logistic regression analysis was performed to identify factors associated with ACM and need for adjunct straightening techniques. A total of 273 patients underwent primary IPP. 27.8% had Peyronie's disease (PD) diagnosed preoperatively or detected intraoperatively. ACM was identified in 20.1% (55/273) patients. There was no significant difference in ACM in PD versus non-PD patients (p = 0.55). Most patients with ACM (78.2%, 43/55) underwent placement of asymmetric device. ACM did not predict need for invasive straightening maneuvers (p = 0.12). However ACM patients were significantly more likely to have mild residual curvature than those with symmetry (p < 0.0001). Our study is first to address management of idiopathic ACM and association with curvature, providing new insight into a common situation. While ACM was detected in 20%, it did not predict need for adjunct straightening techniques. Our findings may provide reassurance to urologists troubleshooting idiopathic ACM during corporal dilation during IPP surgery.
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Affiliation(s)
- Raevti Bole
- Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Manaf Alom
- Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Engy Habashy
- Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mohammed Ahmed
- Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Tobias Kohler
- Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Sevann Helo
- Department of Urology, Mayo Clinic Rochester, Rochester, MN, USA.
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Pyrgidis N, Schulz GB, Chaloupka M, Volz Y, Pfitzinger PL, Rodler S, Berg E, Weinhold P, Jokisch F, Stief CG, Becker AJ, Marcon J. Perioperative outcomes of penile prosthesis implantation in Germany: results from the GRAND study. Int J Impot Res 2024; 36:848-853. [PMID: 37980375 PMCID: PMC11624133 DOI: 10.1038/s41443-023-00796-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
We aimed to assess the recommended annual hospital volume for inflatable penile prosthesis implantation (PPI) and to provide evidence on perioperative outcomes of semi-rigid and inflatable PPI in Germany. We used the GeRmAn Nationwide inpatient Data (GRAND) from 2005 to 2021 and report the largest study to date with 7,222 patients. 6,818 (94.4%) patients underwent inflatable and 404 (5.6%) semi-rigid PPI. Inflatable PPI was significantly associated with shorter length of hospital stay (difference of 2.2 days, 95%CI: 1.6-2.7, p < 0.001), lower odds of perioperative urinary tract infections (5.5% versus 9.2%; OR: 0.58, 95%CI: 0.41-0.84, p = 0.003) and surgical wound infections (1% versus 2.5%; OR: 0.42, 95%CI: 0.22-0.88, p = 0.012) compared to semi-rigid PPI. Overall, 4255 (62.4%) inflatable PPIs were undertaken in low- ( < 20 PPI/year) and 2563 (37.6%) in high-volume ( ≥ 20 PPI/year) centers. High-volume centers were significantly associated with shorter length of hospital stay (difference of 1.4 days, 95%CI: 1.2-1.7, p < 0.001) compared to low-volume centers. Our findings suggest that inflatable PPI leads to a shorter length of hospital stay and lower rates of perioperative urinary tract and surgical wound infections compared to semi-rigid PPI. Patients undergoing surgery in high-volume centers for inflatable PPI are discharged earlier from the hospital.
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Affiliation(s)
- Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich, Germany.
| | - Gerald B Schulz
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Chaloupka
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Yannic Volz
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | | | - Severin Rodler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Elena Berg
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Weinhold
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Armin J Becker
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Julian Marcon
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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Preto M, Falcone M, Plamadeala N, Schifano N, Bettocchi C, Colombo F, Fiordelise S, Vitarelli A, Silvani M, Mondaini N, Paradiso M, Ceruti C, Varvello F, Palumbo F, Avolio A, Antonini G, Corvasce A, Pozza D, Franco G, Bitelli M, Boezio F, Conti E, Caraceni E, Negro C, Carrino M, Vicini P, Ghidini N, Alei G, Italiano E, Timpano M, Polito M, Natali A, Tamai A, Pescatori E, Dehò F, Gideon B, Gontero P, Palmieri A, Capogrosso P. Risk of unfavorable outcomes after penile prosthesis implantation - results from a national registry (INSIST-ED). Int J Impot Res 2024; 36:842-847. [PMID: 37907669 DOI: 10.1038/s41443-023-00784-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/30/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Abstract
Like all surgeries, penile prosthesis implantation (PPI) has the potential for both postoperative complications and suboptimal patient satisfaction. In order to assess risk factors for poor satisfaction, we reviewed patients who had been prospectively recruited in a national multi-institutional registry of penile prostheses procedures (INSIST-ED) from 2014 to 20121. Patient baseline characteristics and postoperative complications were recorded. The primary endpoint of this study was unfavorable outcomes after inflatable PPI, defined as significant postoperative complications (Clavien-Dindo ≥2) and/or Sexuality with Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) scores below the 10th percentile. A total of 256 patients were included in the study. The median age was 60 years (IQR 56-67). The most common cause of erectile dysfunction (ED) was organic (42.2%), followed by pelvic surgery/radiotherapy (39.8%) and Peyronie's disease (18.0%). Postoperative complications were recorded in 9.6%. High-grade complications (Clavien ≥2) occurred in 4.7%. At 1-year follow-up, the median QoLSPP total score was 71 (IQR 65-76). In all, 14.8% of patients were classified as having experienced unfavorable outcomes because of significant postoperative complications and/or QoLSPP scores below the 10th percentile. Logistic regression analysis demonstrated patient age to be non-linearly associated with the risk of experiencing unfavorable outcomes. A U-shaped correlation showed a lower risk for younger and older patients and a higher risk for middle-aged men. ED etiology and surgical volume were not associated with PPI outcomes. Physicians should, therefore, be aware that middle-aged men may be at higher risk of being unsatisfied following PPI compared to both younger and older patients.
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Affiliation(s)
- Mirko Preto
- Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy.
| | - Marco Falcone
- Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy
| | - Natalia Plamadeala
- Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy
| | - Nicolò Schifano
- Unit of Urology, ASST Sette Laghi, Circolo e Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| | | | - Fulvio Colombo
- Sant'Orsola University Hospital, Andrology Unit, University of Bologna, Bologna, Emilia-Romagna, Italy
| | | | | | - Mauro Silvani
- Department of Urology, Ospedale di Biella, Biella, Italy
| | - Nicola Mondaini
- Department of Urology, Villa Donatello Hospital, Florence, Italy
| | - Matteo Paradiso
- Department of Urology, Ospedale Cardinal Massaia, Asti, Italy
| | - Carlo Ceruti
- Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy
| | | | | | - Antonio Avolio
- Studio di Urologia e Andrologia - Centro Medico Iside, Ascoli Piceno, Italy
| | | | | | - Diego Pozza
- Studio di Andrologia e di Chirurgia Andrologica, Rome, Italy
| | - Giorgio Franco
- Department of Urology, 'La Sapienza' University of Rome, Rome, Italy
| | - Marco Bitelli
- Department of Urology, Frascati Hospital H1, Rome, Italy
| | | | - Enrico Conti
- Department of Urology, Levante Ligure Hospital, Italy, La Spezia, Italy
| | - Enrico Caraceni
- Department of Urology, Area Vasta 3 Asur Marche, Civitanova Marche, Italy
| | - Carlo Negro
- Department of Urology, Ospedale Evangelico Internazionale Genova, Genova, Italy
| | | | - Patrizio Vicini
- Department of Urology, Italian Neurotraumatologic Institute Grottaferrata 'I.N.I.', Grottaferrata, Rome, Italy
| | | | - Giovanni Alei
- Department of Plastic Surgery, Sapienza University of Rome, Rome, Italy
| | - Emilio Italiano
- Operative Unit of Urology, Hospital 'Villa Sofia-Cervello', Piazzetta Salerno, Palermo, Italy
| | - Massimiliano Timpano
- Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy
| | - Massimo Polito
- Department of Clinical and Specialist Sciences, Division of Urology, Polytechnic University of the Marche Region Medical School, Ancona, Italy
| | - Alessandro Natali
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Aldo Tamai
- Department of Urology, Data Clinica, Vicenza, Italy
| | | | - Federico Dehò
- Unit of Urology, ASST Sette Laghi, Circolo e Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| | - Blecher Gideon
- Department of Urology, The Alfred Hospital, Melbourne, VIC, Australia
- Monash Health, Bentleigh East, VIC, Australia
| | - Paolo Gontero
- Department of Urology, A.O.U. Città della Salute e della Scienza - Turin, Umbria, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Paolo Capogrosso
- Unit of Urology, ASST Sette Laghi, Circolo e Fondazione Macchi Hospital, University of Insubria, Varese, Italy
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9
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Alkhandari O, Mazouin C, Alshuaibi M, Balkau B, Koffi D, Gaudry JL, Eschwege P, Mazeaud C, Larose C. Penile prosthesis for erectile dysfunction in France: A six-year nationwide database analysis. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102669. [PMID: 38909781 DOI: 10.1016/j.fjurol.2024.102669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/15/2024] [Accepted: 06/19/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION Urological consultations for erectile dysfunction (ED) are increasing worldwide. Penile prosthesis (PP) implantations are performed when other treatments are unsuccessful. However, there is no data regarding PP implantations in France beyond the year 2016. OBJECTIVES This study aimed to describe the changes in the number and type of PP implants used for the treatment of ED in France from 2016 to 2021 and the hospitalization rates following implantation using French national data from the Program for the Medicalization of Information Systems (PMSI). MATERIALS AND METHODS We analyzed data on PP implantations in all France hospitals. PPs were coded into three types according to the Common Classification of Medical Procedures (CCAM). The number of patients admitted to hospital with complications twelve months after implantation was also recorded. RESULTS During the study period, 3675 men received 3868 PPs in France. A gradual increase in the total number of implanted PPs was observed, with an overall increase of 33.8%. In 2020, there was a sharp decline in the number of implanted PPs, primarily owing to the COVID-19 pandemic. The most commonly used implant was PPs with an extracavernous compartment, comprising 85% of all PPs. Twelve months after implantation, only 1-2% of the patients were rehospitalized. CONCLUSION PP implantation surgeries are highly reproducible and have a low incidence of complications, in terms of rehospitalization after one year of placement (1.8%). Moreover, there was an increase in the demand for penile prosthesis implantations in France between 2016 and 2021. LEVEL OF EVIDENCE 4: Descriptive epidemiological study.
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Affiliation(s)
- Omar Alkhandari
- Department of Urology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France.
| | - Clement Mazouin
- Department of Urology, Private Hospital of Lorraine -Nancy, Nancy, France
| | - Muaath Alshuaibi
- Department of Urology, Faculty of Medicine, University of Ha'il, 55476 Ha'il, Saudi Arabia; Department of Urology, Clinique Turin, Groupe Almaviva Santé, Paris, France
| | - Beverley Balkau
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Deborah Koffi
- Tekkare Society, Healthcare Data service, Montrouge, Île-de France, France
| | - Jean Luc Gaudry
- Tekkare Society, Healthcare Data service, Montrouge, Île-de France, France
| | - Pascal Eschwege
- Department of Urology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France; Biopathology Laboratory, CNRS-CRAN UMR 7039, Nancy University, Vandœuvre-lès-Nancy, France
| | - Charles Mazeaud
- Department of Urology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France; IADI-UL Laboratory, INSERM-U1254, Nancy University, Vandœuvre-lès-Nancy, France
| | - Clement Larose
- Department of Urology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
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Chung E, Bettocchi C, Egydio P, Love C, Osmonov D, Park S, Ralph D, Xin ZC, Brock G. The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant. Nat Rev Urol 2022; 19:534-546. [PMID: 35711059 DOI: 10.1038/s41585-022-00607-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 01/06/2023]
Abstract
Despite significant scientific advances in the modern three-piece inflatable penile prosthesis implant surgery, it is not without surgical risks and can carry additional cosmetic and psychosocial consequences in poorly selected and consented individuals. To address this problem, an international group of key opinion leaders and high-volume prosthetic surgeons reviewed the current guidelines and clinical evidence, discussed their experiences, and formed a consensus regarding inflatable penile prosthesis surgery. The findings of this consensus panel were presented at the 17th biennial Asia Pacific Society of Sexual Medicine scientific meeting. The experts concluded that proper patient selection, informed consent and strict adherence to safe surgical principles are important to optimize clinical outcomes. Furthermore, most intraoperative complications, if recognized, can be addressed intraoperatively to enable placement of the device at the time of initial surgery. Men with significant corporal fibrosis due to Peyronie's disease, prior prosthesis explantation and priapism, and men who have undergone construction of a neophallus, as well as men who receive concurrent continence surgery, are complex cases requiring additional care and advanced techniques to obtain optimal surgical outcomes. Variability in patient care - in terms of postoperative antibiotic use, pain management, scrotal care, and cycling of the penile prosthesis implant - must be reduced to enable optimization and assessment of outcomes across patient groups.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, Queensland, Australia.
- University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
- AndroUrology Centre and Macquarie University Hospital, Sydney, New South Wales, Australia.
- AndroUrology Centre, Sydney, New South Wales, Australia.
| | | | | | - Chris Love
- Urology South, Level 2, Holmesglen Private Hospital, Moorabbin, Victoria, Australia
| | | | - Sean Park
- Sewum Prosthetic Urology Center of Excellence, Seoul, Korea
| | - David Ralph
- Institute of Urology, University College London Hospital, London, UK
| | - Zhong Cheng Xin
- Andrology Center, Peking University First Hospital, Beijing, China
| | - Gerald Brock
- University of Western Ontario, London, Ontario, Canada
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11
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Mani SB, Henry GD, Karpman E. Penile Length Loss After Penile Implant Surgery. J Sex Med 2022; 19:887-889. [DOI: 10.1016/j.jsxm.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 11/24/2022]
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Abstract
INTRODUCTION Management protocols for treatment of severe erectile dysfunction have changed little in the last 20 years. Most algorithms consider penile prostheses as the last option of treatment in patients who have failed medical management. Despite multiple advances in current devices, prosthetic infection remains the most feared complication by implanting surgeons and patients. This report tries to make a compilation of the factors that can be impacted to prevent penile implant infections, and to make penile implantation a safer and more reliable way to solve an erection deficit. PURPOSE OF REVIEW List events related to the surgical act (pre-operative, intra-operative, and post-operative) that are related to the risk of infection to contextualize possible actions/measures used to avoid prosthetic infection. RECENT FINDINGS The impact of coated implants on reduction of infection rates. The recommendation to use chlorhexidine-based solutions over iodine solution for preoperative skin preps. Appears to be no difference in infection rates according to the approach chosen by the surgeon (infrapubic vs penoscrotal). The change in the microbial colonies that are colonizing implants in recent years are dramatic. Lack of evidence of which solutions to use for salvage or revision washout surgery: Chemical eradication or mechanical lavage cleansing?. Despite the importance of metabolic control in the literature, there is a disparity in exact glycemic values prior to the intervention in our literature. Factors such as preparation of the operative site, presence of comorbidities or previous surgeries, surgical time, or additional maneuvers during surgery can negatively impact the final result of penile prosthetic surgery.
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Baird BA, Parikh K, Broderick G. Penile implant infection factors: a contemporary narrative review of literature. Transl Androl Urol 2021; 10:3873-3884. [PMID: 34804829 PMCID: PMC8575569 DOI: 10.21037/tau-21-568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/27/2021] [Indexed: 11/20/2022] Open
Abstract
Objective We aim to review and summarize published literature that features implanted penile devices and details infection of these devices as a complication. In particular, we will detail the factors that influence infection of penile implants. Background Types of penile prostheses (PP) include inflatable implants and semirigid implants; these are utilized for treatment of erectile dysfunction. Likely the most feared complication of penile implants is infection. There are a handful of factors that are implicated in device infection. Methods Searches were performed using MEDLINE and PubMed databases using keywords and phrases ‘penile implant AND infection’; ‘penile prosthesis AND infection’; ‘penile implant infection’. We have presented results from our literature search. We divided these into ‘Surgical Elements’ and ‘Patient Selection and Factors.’ Each topic is discussed in its own section. Conclusions Strides have been made since the initial penile prosthesis (IPP) surgeries to improve infection rates including diabetes control, antibiotic coating of devices, and antibiotic implementation. Going forward, more studies, especially randomized control trials, need to focus on defining levels of diabetic control (sugar control and A1C control), determining the role of metabolic syndrome in infection promotion and determining laboratory values which could be predictive of infection. We present a discussion of important factors to consider in the realm of PP infections. In addition, we include studies which discuss topics for future directions in decreasing the number of infections seen with PP.
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Cayetano-Alcaraz AA, Yassin M, Desai A, Tharakan T, Tsampoukas G, Zurli M, Minhas S. Penile implant surgery-managing complications. Fac Rev 2021; 10:73. [PMID: 34632459 PMCID: PMC8483239 DOI: 10.12703/r/10-73] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments or vacuum constriction devices. Contemporary literature suggests that penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient’s quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. Several factors – such as appropriate patient selection, methodical preoperative assessment and patient optimization, specific intraoperative protocols and postoperative recommendations – can reduce the risk of surgical complications. This narrative review discusses the diagnosis and management of both intraoperative and postoperative complications of penile prosthesis surgery.
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Affiliation(s)
| | - Musaab Yassin
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Ankit Desai
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Tharu Tharakan
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | | | - Martina Zurli
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
| | - Suks Minhas
- Andrology Department, Imperial College Healthcare NHS Trust, Charing Cross, London, UK
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15
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Development and content validation of a competency-based assessment tool for penile prosthesis surgery. Int J Impot Res 2021; 34:187-194. [PMID: 33762713 DOI: 10.1038/s41443-021-00415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/24/2020] [Accepted: 01/29/2021] [Indexed: 11/08/2022]
Abstract
The aim of this study was to identify potential hazards for the inflatable penile prosthesis (IPP) surgical procedure and from this develop and content validate an IPP intraoperative competency-based assessment tool. A multi-institutional longitudinal prospective observational study was conducted over a 6-month period. Healthcare Failure Mode and Effects Analysis (HFMEA) methodology was used to prospectively risk assess the IPP procedure using a collaborative multidisciplinary team (MDT) approach. International content validation of the developed tool was then undertaken via face-to-face meetings and WebEx seminars. A total of 22 h of observation led to the construction of a detailed process map consisting of 11 stages and 49 sub-stages. HFMEA identified 50 failure modes and 45 failure mode effects, nine failure modes were excluded after analysis leaving 41 key failure modes included in the checklist. The high-risk steps identified were related to corporal dilatation, incorrect sizing of the prosthesis cylinders and incorrect localisation of the superficial inguinal ring for blind reservoir placement. The final content validated IPP assessment tool (PPAT) consisted of 13 processes and 27 sub-processes. We concluded that HFMEA methodology successfully allowed for the identification of key steps within the IPP procedure from which the PPAT was developed. Formal international content validation confirmed that all key procedural steps were included in the PPAT and that completion of all steps would indicate trainee competency in the procedure. Further validation is required before the tool can be used to assess learning curves for the IPP procedure.
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16
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Gon LM, de Campos CCC, Voris BRI, Passeri LA, Fregonesi A, Riccetto CLZ. A systematic review of penile prosthesis infection and meta-analysis of diabetes mellitus role. BMC Urol 2021; 21:35. [PMID: 33691670 PMCID: PMC7945372 DOI: 10.1186/s12894-020-00730-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/25/2020] [Indexed: 01/16/2023] Open
Abstract
Background Infection is the most feared complication of a penile prosthesis. Diabetes mellitus (DM) is widely known to increase the risk of several infections, but its role in the penile prosthesis is still controversial. This systematic review aims to show the contemporary scenario of penile prosthesis infection and present a meta-analysis about DM contribution to penile prosthesis infection. Methods The review was performed with no language or time limitation, including ten databases. The included articles were about the male population who received a penile prosthesis with no model restriction, with a minimum follow up of 1 year, and outcomes adequately reported. Results The mean infection incidence of penile prosthesis ranged from 0.33 to 11.4%. In early 2000, the general incidence of infection was 3 to 5%, then, the introduction of coated materials decreased it to 0.3 to 2.7%. The meta-analysis showed that diabetes mellitus is related to an increased risk of penile prosthesis infection with an odds ratio of 1.53 (95% CI 1.15–2.04). Conclusions Penile prosthesis infection decreased in the last decades but remains a significant cause of reoperation, and it is related to lower prosthesis survival. Meta-analysis concludes that diabetes mellitus is related to a higher risk of penile prosthesis infection.
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Affiliation(s)
- Lucas Mira Gon
- Division of Urology of Department of Surgery, Faculty of Medical Sciences, Hospital de Clinicas, University of Campinas - UNICAMP, Rua Vital Brazil, 250, Campinas, SP, 13083-590, Brazil.
| | - Caio César Citatini de Campos
- Division of Urology of Department of Surgery, Faculty of Medical Sciences, Hospital de Clinicas, University of Campinas - UNICAMP, Rua Vital Brazil, 250, Campinas, SP, 13083-590, Brazil
| | - Brunno Raphael Iamashita Voris
- Division of Urology of Department of Surgery, Faculty of Medical Sciences, Hospital de Clinicas, University of Campinas - UNICAMP, Rua Vital Brazil, 250, Campinas, SP, 13083-590, Brazil
| | - Luís Augusto Passeri
- Division of Urology of Department of Surgery, Faculty of Medical Sciences, Hospital de Clinicas, University of Campinas - UNICAMP, Rua Vital Brazil, 250, Campinas, SP, 13083-590, Brazil
| | - Adriano Fregonesi
- Division of Urology of Department of Surgery, Faculty of Medical Sciences, Hospital de Clinicas, University of Campinas - UNICAMP, Rua Vital Brazil, 250, Campinas, SP, 13083-590, Brazil
| | - Cássio Luís Zanettini Riccetto
- Division of Urology of Department of Surgery, Faculty of Medical Sciences, Hospital de Clinicas, University of Campinas - UNICAMP, Rua Vital Brazil, 250, Campinas, SP, 13083-590, Brazil
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Baunacke M, Groeben C, Borkowetz A, Uhlig A, Leitsmann M, Volkmer B, Thomas C, Huber J. [Health care reality of urological endoprosthetics in Germany from 2006 to 2016]. Urologe A 2021; 60:351-360. [PMID: 33481064 PMCID: PMC7979589 DOI: 10.1007/s00120-021-01444-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
Hintergrund Die Behandlung von Harninkontinenz und erektiler Dysfunktion verbessert die Lebensqualität vieler Patienten. Insbesondere die Endoprothetik mit Sphinkter- und Penisprothesen erzielt hierbei sehr gute Ergebnisse, wenn konservative Therapieoptionen ausgeschöpft sind. Ziel dieser Studie ist eine Darstellung der Entwicklung und aktuellen Versorgungslage der Sphinkter- und Penisprothesenimplantation in Deutschland. Material und Methoden Wir führten eine Analyse der Diagnosis-Related-Groups-Abrechnungsdaten in Deutschland im Zeitraum von 2006 bis 2016 durch. Die Versorgungslage im Jahr 2016 beschrieben wir auf Basis der Qualitätsberichtsdaten der deutschen Krankenhäuser. Ergebnisse Von 2006 bis 2012 stieg die Zahl der implantierten Sphinkterprothesen in Deutschland von 739 auf 1112 (p < 0,001) und die Zahl der implantierenden Kliniken von 129 auf 206 (p < 0,001). Von 2012 bis 2016 fielen die Fallzahlen auf 980 und die Zahl der Kliniken auf 198. Im Jahr 2016 implantierten 168 (88 %) urologische Kliniken 1–9 Sphinkterprothesen und 23 (12 %) Kliniken ≥ 10 Sphinkterprothesen. Die 10 Top-Kliniken (≥20 Sphinkter) implantierten 34 % (283/839) aller Sphinkter. Von 2006 bis 2013 stieg die Zahl der implantierten Penisprothesen kontinuierlich von 263 auf 503 (p < 0,001) sowie die Zahl der implantierenden Kliniken von 71 auf 107 (p < 0,001). Von 2013 bis 2016 stagnierte die Fallzahl (p = 0,9) und die Zahl der implantierenden Kliniken (p = 0,5). Der Anteil implantierter Penisprothesen im Rahmen von Geschlechtsumwandlungen stieg von 17 % im Jahr 2006 auf 25 % im Jahr 2016 (p = 0,03). Im Jahr 2016 implantierten 83 (85 %) urologische Kliniken 1–6 Penisprothesen und 14 (15 %) Kliniken ≥ 7 Prothesen. Die 7 Top-Kliniken (≥20 Prothesen/Jahr) implantierten 232/448 (52 %) der Prothesen. Diskussion Der Versorgungsstand der urologischen Endoprothetik in Deutschland zeigt eine deutliche Zentrenbildung, aber auch eine große Zahl von Kliniken mit geringer Fallzahl. Seit 2012/2013 zeigt sich eine Stagnation der Fallzahlen von Penis- und Sphinkterprothesenimplantationen, die in Zusammenschau mit den Prostatektomiefallzahlen eine Unterversorgung vermuten lässt. Zusatzmaterial online Die Online-Version dieses Artikels (10.1007/s00120-021-01444-5) enthält weitere Tabellen zu Fallzahlen von Sphinkterprothesen und Penisprothesenimplantationen. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.
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Affiliation(s)
- Martin Baunacke
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Christer Groeben
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Angelika Borkowetz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Annemarie Uhlig
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Marianne Leitsmann
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Björn Volkmer
- Klinik für Urologie, Klinikum Kassel, Kassel, Deutschland
| | - Christian Thomas
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Johannes Huber
- Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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Abstract
With the onset of a metabolic syndrome epidemic and the increasing life expectancy, erectile dysfunction (ED) has become a more common condition. As incidence and prevalence increase, the medical field is focused on providing more appropriate therapies. It is common knowledge that ED is a chronic condition that is also associated with a myriad of other disorders. Conditions such as aging, diabetes mellitus, hypertension, obesity, prostatic hypertrophy, and prostate cancer, among others, have a direct implication on the onset and progression of ED. Characterization and recognition of risk factors may help clinicians recognize and properly treat patients suffering from ED. One of the most reliable treatments for ED is penile prosthetic surgery. Since the introduction of the penile prosthesis (PP) in the early seventies, this surgical procedure has improved the lives of thousands of men, with reliable and satisfactory results. The aim of this review article is to characterize the epidemiology of men undergoing penile prosthetic surgery, with a discussion about the most common conditions involved in the development of ED, and that ultimately drive patients into electing to undergo PP placement.
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Affiliation(s)
- Jose A Saavedra-Belaunde
- Department of Surgery/Division of Urology, University of Texas Medical Science Center at Houston, Houston, TX 77030, USA
| | | | - Run Wang
- Department of Surgery/Division of Urology, University of Texas Medical Science Center at Houston, Houston, TX 77030, USA
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19
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Huynh LM, Osman MM, Yafi FA. Risk profiling in patients undergoing penile prosthesis implantation. Asian J Androl 2020; 22:8-14. [PMID: 31489849 PMCID: PMC6958986 DOI: 10.4103/aja.aja_92_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Penile prosthesis implantation is the gold standard of surgical therapy for patients with medication-refractory erectile dysfunction. However, this umbrella definition includes significant heterogeneity and associated risk profiles that should be candidly discussed and addressed perioperatively. Factors associated with operative success and patient satisfaction are often surgery specific; however, risk profiling via patient selection, preoperative optimization, proper device selection, and intraoperative consideration are highly correlated. Some examples of common risk profiles include comorbidity(ies) such as cardiovascular disease, diabetes mellitus, prior abdominal surgery, Peyronie's disease, and psychological risk factors. Similarly, integration of surgeon- and patient-amenable characteristics is key to decreasing risk of infection, complication, and need for revision. Finally, patient risk profiling provides a unique context for proper device selection and evidence-based intraoperative considerations.
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Affiliation(s)
- Linda M Huynh
- Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Mohamad M Osman
- Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine Medical Center, Orange, CA 92868, USA
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Muneer A, Fowler S, Ralph DJ, Summerton DJ, Rees RW. UK practice for penile prosthesis surgery: baseline analysis of the British Association of Urological Surgeons (BAUS) Penile Prosthesis Audit. BJU Int 2020; 127:326-331. [PMID: 32869902 DOI: 10.1111/bju.15219] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To undertake a prospective multicentre national audit of penile prosthesis practice in the UK over a 3-year period. PATIENTS AND METHODS Data were submitted by urological surgeons as part of the British Association of Urological Surgeons Penile Prosthesis National Audit. Patients receiving a penile prosthesis (inflatable or malleable) were included as part of a prospective registry over a 3-year period. Data were validated and then analysed using a software package (Tableau). RESULTS A total of 1071 penile prosthesis procedures were included from 22 centres. The three commonest aetiological factors for erectile dysfunction were diabetes, prostate surgery and Peyronie's disease. Of the recorded data, inflatable penile prostheses were the commonest devices implanted, with 665 devices used (62.1%), whereas malleable prostheses accounted for 14.2% of the implants. Recorded intra-operative complications included urethral injury (0.7%, n = 7), corporal perforation (1.1%, n = 12) and cross-over (0.6%, n = 6). Known postoperative complications were recorded in 9.8% of patients (74/752), with the two most frequently reported being postoperative penile pain (n = 11) and scrotal haematoma (n = 14). CONCLUSION This baseline analysis is the largest prospective registry of penile prostheses procedures to date. The data show that, over the 3-year collection period in the UK, there are now fewer surgeons performing the procedure, together with a reduction in the number of centres. Peri-operative complications were infrequent, and the rate of implant abortion (e.g. as a result of urethral injury) was very low. Further follow-up data will be required to publish long-term outcomes and patient satisfaction.
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Affiliation(s)
- Asif Muneer
- NIHR Biomedical Research Centre, University College London Hospital, London, UK.,Division of Surgery and Interventional Science UCL, London, UK
| | | | | | | | - Rowland W Rees
- University Hospitals Southampton NHS Trust, Southampton, UK
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Rezaee ME, Goddard B, Munarriz RM, Gross MS. Regional Variation in Penile Prosthesis Utilization among Medicare Patients with Erectile Dysfunction. Urology 2020; 141:64-70. [DOI: 10.1016/j.urology.2020.01.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 01/10/2023]
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Rezaee ME, Gross MS. AUTHOR REPLY. Urology 2020; 141:70. [PMID: 32591051 DOI: 10.1016/j.urology.2020.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Michael E Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH
| | - Martin S Gross
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH.
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Fuentes JL, Yi YA, Davenport MT, Bergeson RL, Ward EE, Morey AF. Long-term sequelae of inflatable penile prosthesis: clinical characteristics of patients who develop distal cylinder tip extrusion. Transl Androl Urol 2020; 9:38-42. [PMID: 32055464 DOI: 10.21037/tau.2019.08.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Impending distal cylinder tip extrusions (DCTE) make up approximately 5-33% of all inflatable penile prosthesis (IPP) reoperations. While there have been a few case reports of DCTE in patients with diabetes and trauma, the current literature regarding risk factors for DCTE is limited. In this study, we examined the long-term sequelae among a large cohort of IPP patients to identify clinical risk factors for impending DCTE. Methods A retrospective review was completed of our single surgeon IPP database of 797 IPP placement cases from the years 2007 to 2018. We identified those who had a surgical intervention for a confirmed DCTE. Infected prostheses were excluded. The primary clinical end point of this study was to identify the time to extrusion repair from original penile prosthesis placement. Secondary clinical end points included location of extrusion and presence of corporal fibrosis. Results Between the years 2007 to 2018, 26 cases (3%) of impending or complete cylinder extrusions were identified in our IPP database (n=797). The mean age at initial IPP placement was 58 years, compared to a mean of 66 years at the time of extrusion. The mean time from initial placement to extrusion repair surgery was 8.4 years (median 5.5 years). Most patients (15/26, 57.7%) had a history of prior IPP placement, five of whom had two or more prior prostheses. Location among the 26 extrusions varied-12 (46.2%) lateral, 9 (34.6%) distal urethra, 2 (7.7%) glanular, 2 (7.7%) mid-shaft, and 1 (3.8%) coronal sulcus. Concomitant pathologies identified include Peyronie's disease (7, 26.9%), idiopathic corporal fibrosis (7, 26.9%) and sickle cell disease with priapism induced erectile dysfunction (3, 11.5%). Conclusions The risk of IPP extrusion appears to be associated with increased time from initial prosthesis placement, prior history of IPP placement, and the presence of corporal fibrosis or deformity. Patients should be counseled to recognize this important long-term sequela of IPP surgery.
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Affiliation(s)
- Jorge L Fuentes
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yooni A Yi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael T Davenport
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rachel L Bergeson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ellen E Ward
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Fleck-Lavergne D, Marconi M, Mercado-Campero A, Hidalgo JP, Marchant F, Palma-Ceppi C. [Penile prostheses: Description of a series of implants with and without dilatation of the corpora cavernosa]. Rev Int Androl 2019; 19:16-24. [PMID: 31780332 DOI: 10.1016/j.androl.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/13/2019] [Accepted: 07/05/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Penile prosthesis (PP) implantation is the treatment of choice for refractory erectile dysfunction (ED). They show a high satisfaction rate (75%-100%) and a complication rate that varies between 2.1% and 28.8%. The standard surgical technique includes dilatation of the corpora cavernosa (CC) prior to the insertion of the cylinders. This step takes time and is critical for the occurrence of complications. The aim of this study is to describe the results of a series of PP implanted using the techniques with and without dilatation of the CC. MATERIALS AND METHODS One-hundred and 20 patients with refractory ED in whom a PP was implanted by 2 surgeons in different centers. Comorbidities, operative characteristics, satisfaction and postoperative complications were evaluated. RESULTS The average age was 61±9.6 years. The most prevalent comorbidities were: history of radical prostatectomy, high-blood pressure and diabetes mellitus. Forty-two malleable and 78 hydraulic prostheses were implanted. Eleven patients had a previous PP. The median operative time was 70minutes (35-140). The satisfaction reported was 95.8%. Ten patients presented complications. In the group in which the surgery was performed without dilatation of the CC (n=80), the operative time was shorter (62.5minutes [35-105] versus 90minutes [60-140] respectively, p<0.0001). There was no difference in complications (p=0.73) or levels of satisfaction (p=0.196) when comparing the technique with and without dilatation of the CC. CONCLUSION In our series, a shorter operative time was observed with the technique without dilatation of the CC, but there were no differences in complications. A prospective and randomized study is required to make a stronger recommendation regarding to dilatation of the CC.
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Affiliation(s)
| | - Marcelo Marconi
- Unidad de Andrología, Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Alejandro Mercado-Campero
- Servicio de Urología, Hospital Clínico Universidad de Chile, Santiago, Región Metropolitana, Chile; Departamento de Urología, Clínica Las Condes, Santiago, Región Metropolitana, Chile
| | - Juan Pablo Hidalgo
- Servicio de Urología, Hospital Clínico Universidad de Chile, Santiago, Región Metropolitana, Chile
| | - Fernando Marchant
- Servicio de Urología, Hospital Clínico Universidad de Chile, Santiago, Región Metropolitana, Chile; Departamento de Urología, Clínica Las Condes, Santiago, Región Metropolitana, Chile
| | - Cristián Palma-Ceppi
- Servicio de Urología, Hospital Clínico Universidad de Chile, Santiago, Región Metropolitana, Chile; Departamento de Urología, Clínica Las Condes, Santiago, Región Metropolitana, Chile
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Rezaee ME, Butaney M, Thirumavalavan N, Gross MS, Munarriz RM. Advances in Infection Prevention Strategies for Penile Prosthesis Surgery. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00235-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Houlihan MD, Köhler TS, Wilson SK, Hatzichristodoulou G. Penoscrotal approach for IPP: still up-to-date after more than 40 years? Int J Impot Res 2019; 32:2-9. [DOI: 10.1038/s41443-019-0206-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/10/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022]
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Bates AS, Pearce I, Terry TR. The future of penile prosthetic surgery in the UK. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415819836618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The provision of penile prosthetic surgery (PPS) in the United Kingdom needs to be reviewed given the twin popular philosophies of Centres of Excellence, as defined by high case volume yielding best outcomes, and Getting It Right First Time (GIRFT), defined as effective and efficient use of resources. Methods: To recognise centres of high volume of PPS and their location, we interrogated Hospital Episode Statistic (HES) data between 2014 and 2017. From this analysis we advance a model of the 10 British Association of Urological Surgeons (BAUS) regions in England providing PPS, working largely to recommendations made by National Health Service (NHS) England through its Clinical Commissioning Policy for Penile Prosthesis. Results: Between 2014 and 2017, there were 2361 surgical procedures undertaken, and of these, primary implantations numbered 1330 and revisions 1031. University College London Hospitals performed more than 50% of all primary implantations and 52% of all revisions. Across England for the year 2017, there were 301 primary implantations and 442 revisions. Discussion: We suggest that revision surgery for device mechanical failure should be within the remit of these centres but referral of complex revision surgery irrespective of aetiology may warrant referral to defined tertiary centres in London, the Midlands and the North of England. Conclusion: Prospective data on patient outcomes from PPS are urgently needed, and NHS England should regard a national database of PPS as essential. We advance a model of the 10 BAUS regions in England providing PPS as a distributed and geographically equitable network for primary implantation. A regionalised network of revision surgery should be considered. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
| | - I Pearce
- Manchester University Hospitals NHS Foundation, UK
| | - TR Terry
- Nottingham University Hospitals, UK
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Damage Control Considerations During IPP Surgery. Curr Urol Rep 2019; 20:10. [PMID: 30701330 DOI: 10.1007/s11934-019-0872-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the latest reports in inflatable penile prosthesis (IPP) complication management. RECENT FINDINGS IPP complications are rare, and reports are limited to retrospective studies. However, recent multi-institutional studies and use of national databases have provided further insight into risk factors for complications. Guidance on complication management is largely limited to techniques recommended by experts within the field. American Urological Association guidelines place IPP implantation as a first line erectile dysfunction treatment. However, the majority of cases are performed by low-volume (≤ 4 cases/year) surgeons. Herein, we summarize the IPP literature and our personal experience to provide guidance on managing IPP complications.
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Lokeshwar SD, Bitran J, Madhusoodanan V, Kava B, Ramasamy R. A Surgeon's Guide to the Various Antibiotic Dips Available During Penile Prosthesis Implantation. Curr Urol Rep 2019; 20:11. [PMID: 30701340 DOI: 10.1007/s11934-019-0874-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Inflatable penile prosthesis (IPP) is a treatment for erectile dysfunction. IPPs have undergone improvements; however, post-surgical infections still occur. Furthermore, the type of pathogens infecting the implants has changed recently from Gram-positive to Gram-negative bacteria and fungi due to advances in antibiotic dips targeting the skin flora. To protect against infection, the AMS 700 is pre-coated with InhibiZone (mixture of Rifampin/Minocycline) and the Coloplast Titan, with several antibiotic dip options of differing efficacies. This review discusses strategies to decrease the infection rates in implant surgery, focusing on antibiotic dips. RECENT FINDINGS Current research endorses the use of rifampin/gentamicin as the most studied combination; however, some studies have utilized different dips for additional coverage including the InhibiZone on the AMS 700. With the increasing prevalence of diabetes and Gram-negative organisms, there is a need to develop strategies for increased coverage against infections. Controlled studies with different antibiotic combinations are needed to identify the ideal cocktail to decrease infection.
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Affiliation(s)
- Soum D Lokeshwar
- Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Joshua Bitran
- Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Vinayak Madhusoodanan
- Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Bruce Kava
- Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA.
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30
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Infection Prevention Strategies Prior to Penile Implant Surgery. Eur Urol Focus 2018; 4:317-320. [DOI: 10.1016/j.euf.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 01/26/2023]
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Canguven O, Talib R, El Ansari W, Khalafalla K, Al Ansari A. Is Hba1c level of diabetic patients associated with penile prosthesis implantation infections? Aging Male 2018; 22:28-33. [PMID: 29523037 DOI: 10.1080/13685538.2018.1448059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Diabetes mellitus is an important risk factor for erectile dysfunction (ED). Penile prosthesis implantation surgery is the final solution for diabetic patients with ED, but infections thereof are still a serious risk factor. While some studies suggest that most infections associated with penile prosthesis implantation are associated to high glycated hemoglobin (HbA1c) levels, other research did support such relationship. MATERIALS AND METHODS The current study assessed retrospectively, the association between HbA1c level and penile prosthesis surgery infection. We retrieved and reviewed the records of 300 diabetic patients who had penile prosthesis surgery at our Institution (January 2012-November 2016). Patients' mean age was 55.26 ± 10.9 years (31% patients were <50 years of age), and mean HbA1c was 7.60 ± 1.90%. RESULTS Infection rate among diabetics was 0.67%. Prevalence of prosthesis infection among patients with HbA1c ≤ 9% was 0.9%, compared with 0% among patients with HbA1c > 9%. Prosthesis infection risk did not significantly increase with higher HbA1c levels, with no meaningful difference in the median or mean level of HbA1c in the infected and non-infected diabetic patients. CONCLUSION Findings do not support the use of HbA1c values among diabetic patients who are candidates for penile prosthesis implantation surgery in order to identify and exclude those who might be prone to increased risk of prosthesis infections. Future studies would benefit from larger sample sizes in order to support or refute our findings.
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Affiliation(s)
| | - Raidh Talib
- b Department of Urology & Andrology , Hamad General Hospital , Doha , Qatar
| | - Walid El Ansari
- c Department of Surgery , Hamad General Hospital , Doha , Qatar
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Kovac JR. Centers of excellence for penile prosthetics are a novel concept that will likely prove difficult to implement. Transl Androl Urol 2017; 6:S898-S899. [PMID: 29239399 PMCID: PMC5715184 DOI: 10.21037/tau.2017.11.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jason R Kovac
- Men's Health Center, Indianapolis, Indiana 46260, USA
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Sharma D, Smith RP. Troubleshooting intraoperative complications of penile prosthesis placement. Transl Androl Urol 2017; 6:S892-S897. [PMID: 29238668 PMCID: PMC5715183 DOI: 10.21037/tau.2017.07.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Placement of a penile prosthesis is an excellent option for well-selected patients, offering high patient satisfaction and a low rate of complications. Most urologists who perform the procedure are not high volume implanters and may have limited experience with troubleshooting intraoperative issues. In this review, the authors use current literature to provide recommendations for the management of various intraoperative issues such as difficultly with dilation, incongruent measurement, perforation, urethral injury, crossover, complications of reservoir placement, penile curvature, glans mobility, and hemostasis are all discussed. Preparedness for the management of intraoperative issues can help improve patient outcomes and limit morbidity.
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Affiliation(s)
- Devang Sharma
- Department of Urology, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Ryan P Smith
- Department of Urology, University of Virginia Health System, Charlottesville, VA 22908, USA
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Ziegelmann M, Köhler TS, Bailey GC, Miest T, Alom M, Trost L. Surgical patient selection and counseling. Transl Androl Urol 2017; 6:609-619. [PMID: 28904893 PMCID: PMC5583047 DOI: 10.21037/tau.2017.07.19] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The objectives of patient selection and counseling are ultimately to enhance successful outcomes. However, the definition for success is often narrowly defined in published literature (ability to complete surgery, complications, satisfaction) and fails to account for patient desires and expectations, temporal changes, natural history of underlying diseases, or independent validation. Factors associated with satisfaction and dissatisfaction are often surgery-specific, although correlation with pre-operative expectations, revisions, and complications are common with most procedures. The process of appropriate patient selection is determined by the integration of patient and surgeon factors, including psychological capacity to handle unsatisfactory results, baseline expectations, complexity of case, and surgeon volume and experience. Using this model, a high-risk scenario includes one in which a low-volume surgeon performs a complex case in a patient with limited psychological capacity and high expectations. In contrast, a high-volume surgeon performing a routine case in a male with low expectations and abundant psychiatric reserve is more likely to achieve a successful outcome. To further help identify patients who are at high risk for dissatisfaction, a previously published mnemonic is recommended: CURSED Patient (compulsive/obsessive, unrealistic, revision, surgeon shopping, entitled, denial, and psychiatric). Appropriate patient counseling includes setting appropriate expectations, reviewing the potential and anticipated risks of surgery, post-operative instruction to limit complications, and long-term follow-up. As thorough counseling is often a time-consuming endeavor, busy practices may elect to utilize various resources including educational materials, advanced practice providers, or group visits, among others. The consequences for poor patient selection and counseling may range from poor surgical outcomes and patient dissatisfaction to lawsuits, loss of credibility, or even significant patient or personal harm.
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Affiliation(s)
| | | | | | - Tanner Miest
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Manaf Alom
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Landon Trost
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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MacDonald S, Colaco M, Terlecki R. Waves of Change: National Trends in Surgical Management of Male Stress Incontinence. Urology 2017; 108:175-179. [PMID: 28709851 DOI: 10.1016/j.urology.2017.04.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/25/2017] [Accepted: 04/30/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the trend in surgical management of male stress urinary incontinence (SUI) in the context of the rate of radical prostatectomy (RP) as reported by a national database. Traditionally, the artificial urinary sphincter (AUS) has been the gold standard, but the male sling represents a newer and popular alternative. Refinements in prostate surgery may reduce the incidence and degree of subsequent SUI. MATERIALS AND METHODS A retrospective cross-sectional analysis was performed using the National Inpatient Survey database, which captures discharge data from inpatient and overnight admissions. Cases were identified by their International Classification of Diseases, Ninth Revision procedure codes. We queried the codes 58.93 (implantation of AUS), 59.4 (suprapubic sling operation), 59.5 (retropubic urethral suspension), and 59.6 (paraurethral suspension). We also queried 60.5 (RP) for comparison. Data were collected from January 2000 to December 2012 and weighted to a national average using National Inpatient Survey guidelines. RESULTS A total of 32,416 anti-incontinence operations (20,790 AUS and 11,625 sling procedures) were performed over the study period. There was a significant downward trend in the total number of incontinence procedures (F(1,11) = 6.15, P = .03). However, when stratifying the data by procedure type, only AUS placement demonstrated a significant decline (F(1,11) = 21.70, P <.01), whereas sling procedures significantly increased (F(1,11) = 12.95, P <.01). There was no significant change in the annual incidence of RP. CONCLUSION Inpatient surgery for male SUI is decreasing overall. Placement of the AUS declined significantly, whereas sling placement became more common. Future study will determine the etiology of these trends.
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Affiliation(s)
- Susan MacDonald
- Department of Urology, Penn State Hershey Medical Center, Hershey, PA.
| | - Marc Colaco
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ryan Terlecki
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC
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The Status of Biofilms in Penile Implants. Microorganisms 2017; 5:microorganisms5020019. [PMID: 28420206 PMCID: PMC5488090 DOI: 10.3390/microorganisms5020019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 02/01/2023] Open
Abstract
Erectile dysfunction is prevalent among men and will continue to become more so with the aging population. Of the available treatment options, implantable prosthetic devices are typically thought of as a third line treatment even though they have the highest satisfaction rate and continually improving success rates. Infection and mechanical failure are the most common reasons for implant revision in the past. Since the development of more reliable devices, bacterial biofilms are coming to the forefront of discussion as causes of required revision. Biofilms are problematic as they are ubiquitous and exceedingly difficult to prevent or treat.
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Biardeau X, Aharony S, Campeau L, Corcos J. Artificial Urinary Sphincter: Report of the 2015 Consensus Conference. Neurourol Urodyn 2017; 35 Suppl 2:S8-24. [PMID: 27064055 DOI: 10.1002/nau.22989] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The AMS800™ device, by far the most frequently implanted artificial urinary sphincter (AUS) worldwide, is considered to be the "gold-standard" when male incontinence surgical treatment is contemplated. Despite 40 years of experience, it is still a specialized procedure with a number of challenges. Here, we present the recommendations issued from the AUS Consensus Group, regarding indications, management, and follow-up AMS800™ implantation or revision. MATERIALS AND METHODS Under ICS auspices, an expert panel met on July 10, 2015 in Chicago, IL, USA in an attempt to reach a consensus on diverse issues related to the AMS800™ device. Participants were selected by the two co-chairs on the basis of their practice in a University hospital and their experience: number of implanted AUSs according to AMS (American Medical System Holdings Inc., Minnetonka, MN) records and/or major published articles. Topics listed were the result of a pre-meeting email brainstorming by all participants. The co-chairs distributed topics randomly to all participants, who then had to propose a statement on each topic for approval by the conference after a short evidence-based presentation, when possible. RESULTS A total of 25 urologists were invited to participate, 19 able to attend the conference. The present recommendations, based on the most recent and relevant data available in literature as well as expert opinions, successively address multiple specific and problematic issues associated with the AMS800™ trough a eight-chapter structure: pre-operative assessment, pre operative challenges, implantation technique, post-operative care, trouble-shooting, outcomes, special populations, and the future of AUSs. CONCLUSION These guidelines undoubtedly constitute a reference document, which will help urologists to carefully select patients and apply the most adapted management to implantation, follow-up and trouble-shooting of the AMS800™.
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Affiliation(s)
- X Biardeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - S Aharony
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | | | - L Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - J Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
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[Evolution of the number and type of penile prostheses implanted in France for erectile dysfunction: Analysis of French national coding database (2006-2013)]. Prog Urol 2016; 26:485-91. [PMID: 27590101 DOI: 10.1016/j.purol.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/15/2016] [Accepted: 08/01/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Patients who are not responding to injectable and/or vacuum oral pharmacological treatments can receive a penile prosthesis. Three types of penile prostheses are used in France: rigid, semi-rigid and inflatable prostheses 3-piece or 2-piece. We have assessed the National surgical insertion practices between 2006 and 2013 (number of prostheses insertions, types, procedure locations, number of surgeons and distribution [public or private sectors]). MATERIALS AND METHODS Data analysis from the French Technical Agency of Information on Hospitals (ATIH) (2006-2013) using the common classification of medical acts (CCAM) and after code extractions related to this surgery (JHLA002, JHLA003, JHLA004). RESULTS Between 2006 and 2013, the number of penile implants in France doubled (307 to 633), inflatable penile prostheses with an extracavernous component remained the most frequently used (87 %) (228 to 552) (+142 %). The use of semi-rigid prostheses declined by 26.7 %. The distribution between the private and public sector was close to 1 in 2013. More than half of French penile prostheses were implanted in three regions (Île-de-France, Languedoc-Roussillon, Rhône-Alpes). Nearly 62 % of surgeons implanted only one or two three-compartment prostheses in 2013. CONCLUSION The number of penile prostheses in France doubled between 2006 and 2013. Three regions were particularly active as far as this surgery is concerned (Île-de-France, Languedoc-Roussillon, Rhône-Alpes). They were boosted by 5 surgeons with more than 20 prostheses surgeries a year. LEVEL OF EVIDENCE 4.
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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: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [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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Elmussareh M, Goddard JC, Summerton DJ, Terry TR. Minimising the risk of device infection in penile prosthetic surgery: a UK perspective. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415813488367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We have reviewed articles published on penile prosthetic infection in Medline and EMBASE databases from 2000 to 2012 with the intention of signposting ‘best evidence’ for the UK prosthetic implanter. Using the Oxford Centre for Evidence-based Medicine Levels of Evidence (LE), no paper exceeded an LE of 2b and the majority were LE 4 (case series) and LE 5 (expert opinion). This is not surprising from a UK perspective since HES data for 2009 to 2010 reported 263 penile prosthetic surgeries performed in 35 hospitals, with only five hospitals performing 15 or more. Our literature review suggests that the use of antibiotic-coated IPPs and measures aimed at reducing inoculating bacteria into the surgical wound with alcohol skin preparation, a no-touch technique and peri-operative antibiotic use are most important in minimising the risk of device infection. The use of post-operative antibiotics is contentious (LE 5). It remains unproven whether diabetics have a higher rate of prosthetic infection compared to nondiabetics. In cases of re-implantation for mechanical failure, it remains debatable whether a washout technique should be used and indeed uncertainty remains regarding the pathological role of biofilm in the causation of device infection in this scenario. A washout technique during salvage penile prosthetic surgery for device infection is advocated. Further research on biofilm may offer the best chance of reducing the incidence of device infections overall.
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Oberlin DT, Flum AS, Lai JD, Meeks JJ. The effect of minimally invasive prostatectomy on practice patterns of American urologists. Urol Oncol 2016; 34:255.e1-5. [PMID: 26935867 DOI: 10.1016/j.urolonc.2016.01.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES To determine how robotic prostatectomy affects practice patterns of urologists, we examined the case volume characteristics among certifying urologists for the surgical treatment of prostate cancer. We hypothesized that the utilization of open and robotic prostatectomy as well as lymph node dissection changed dynamically over the last 10 years. METHODS A total of 6-month case log data of certifying urologists from 2003 to 2013 were obtained for the American Board of Urology. Cases were identified using Current Procedural Terminology codes for open radical prostatectomy (ORP) and laparoscopic or robotic-assisted laparoscopic prostatectomy (RALP) with a corresponding diagnosis of prostate cancer as defined by ICD-9 code 185.0. RESULTS OBTAINED A total of 6,563 urologists submitted case logs, of which 68% (4,470/6,563) reported performing at least one radical prostatectomy (RP), totaling 46,030 RPs logged. There was a 376% increase in the performance of RALP over the study period with robotic volume increasing from 22% of all RP in 2003 to 85% in 2013. Among surgeons performing ORP, the median number performed was 2; of surgeons who performed RALP, the median number performed was 8 (P<0.001). Overall, 39% of surgeons logging ORP performed 2 or fewer RP, whereas 19% of surgeons who performed RALP performed 2 or less RP (P<0.001). The highest volume robotic surgeons (top 10% surgical volume) performed 41% of all RALP with the highest performing robotic surgeon recording 658 prostatectomies over 6 months. Oncologists represented 4.1% of all surgeons performing RP and performed 15.1% of all RP (P<0.001); general urologists performed the majority of RP (57.8%). When performed open, there was no influence of surgeon specialty on the performance of lymph node dissection (LND); if performed robotically, oncologists were significantly more likely to perform LND compared with general surgeons (47% vs. 25.9%, respectively, P<0.001). CONCLUSIONS Robotic prostatectomies are performed 5 times more commonly than open prostatectomy and represent 85% of all RP performed by board-certified urologists in 2013. Compared to RALP, ORP are significantly more likely to be performed by lower volume surgeons. Oncologists perform a higher relative percentage of RPs and are significantly more likely to perform LND if performed robotically when compared with general urologists.
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Affiliation(s)
- Daniel T Oberlin
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Andrew S Flum
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeremy D Lai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua J Meeks
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Abstract
INTRODUCTION Loss of penile size is a common complaint that can negatively affect patient satisfaction rates following successful penile prosthetic implant surgery. OBJECTIVE The aim of this review is to describe the various strategies that have been used to maintain penile length or girth after the insertion of a penile prosthetic implant. METHODS An extensive systematic literature review was performed, based on a search of the PUBMED database for articles published between 2002 to 2012. The following key words were used: penile prosthesis, implant, penile length, size, penis, enhancement, enlargement, phalloplasty, girth, lengthening, and augmentation. Only English-language articles that were related to penile prosthetic surgery and penile size were sought. DISCUSSION Based on the results of our search, strategies were classified into 3 groups based on the timepoint in relation to the primary penile prosthetic insertion surgery, which included pre-insertion, intraoperative and post-insertion. CONCLUSIONS Strategies to preserve and potentially increase penile size are of great importance to all implanters. Besides traction therapies and surgeries to enhance perceived penile size, refinements in the surgical approach are simple ways to optimize penile length. A direct comparison of treatment outcomes evaluating the various approaches is not currently possible, owing to divergent study techniques. The implanting surgeon can best serve his patient by adopting a combination of different strategies that are individualized and specific to the patient's needs.
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Affiliation(s)
- King Chien Joe Lee
- 1 Department of Urology, National University Hospital, Singapore ; 2 Division of Urology, St Joseph's Health Care, London, ON, Canada
| | - Gerald B Brock
- 1 Department of Urology, National University Hospital, Singapore ; 2 Division of Urology, St Joseph's Health Care, London, ON, Canada
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Abstract
Penile prostheses have remained the gold-standard therapy for medically refractory erectile dysfunction (ED) since their popularization. Advances in device design and surgical techniques have yielded improved rates of infection, satisfaction, and mechanical survival of devices. Operative techniques in penile prosthesis surgery include the use of adjunctive procedures (such as ventral phalloplasty and release of the suspensory ligament), management of penile fibrosis, and manoeuvres to correct Peyronie's-disease-related curvature. Complications include urethral and corporal perforation, crossover, infection, impending erosion, and/or supersonic transporter deformity. Long-term data regarding mechanical, overall, and infection-free survival demonstrate excellent results, and, given the consistently high satisfaction rates and limited alternatives for medically refractory ED, penile prostheses are likely to remain a relevant and important treatment strategy for the foreseeable future.
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Holland B, Kohler T. Minimizing Penile Implant Infection: A Literature Review of Patient and Surgical Factors. Curr Urol Rep 2015; 16:81. [DOI: 10.1007/s11934-015-0554-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Trost L, Hellstrom WJG. History, Contemporary Outcomes, and Future of Penile Prostheses: A Review of the Literature. Sex Med Rev 2015; 1:150-163. [PMID: 27784554 DOI: 10.1002/smrj.8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Since their introduction, penile prostheses have consistently remained a superior treatment option for men with erectile dysfunction (ED) refractory to conservative measures. Ongoing enhancements to prosthetic design, materials, and surgical techniques have resulted in improved outcomes. AIM To review available literature on notable historical advancements and improvements of the penile prosthesis, summarize contemporary outcomes of recent devices, and discuss possible future directions of the penile prosthesis. METHODS A PubMed search was performed of all articles published from 1960 to present relating to penile prosthesis. Priority was given to series with 12 months of follow-up or greater, larger series, and studies reporting on outcomes of more recent prosthetic models. MAIN OUTCOME MEASURES Main outcomes included historical review of improvements leading to, and contemporary series reporting on rates of mechanical failures, infections, and satisfaction with penile prostheses. RESULTS Penile prostheses have undergone numerous enhancements since initial reports of synthetic materials utilized in the 1950s. Among others, recent notable device enhancements include Parylene coating, Bioflex® material, InhibizoneTM antibacterial impregnation, hydrophilic coating, lockout valves, and easy release pump mechanisms, all of which have improved mechanical reliability, reduced infection rates, and/or improved patient satisfaction with penile prostheses. Contemporary series of 3-piece penile prostheses report mechanical survival of 81-94%, 68-89%, and 57-76% at 5, 10, and 15 years, respectively. Infection rates of current devices are 1-2% in first-time, low-risk populations, and 2-3% for higher risk groups, with patient and partner satisfaction at 92-100% and 91-95%, respectively. Two-piece and malleable devices are associated with slightly higher mechanical reliability and decreased patient satisfaction. Minimal data currently exist on the outcomes of selected patient populations, including Peyronie's disease and corporal fibrosis. CONCLUSIONS Penile prostheses are associated with excellent, long-term outcomes and remain the gold-standard treatment for men with refractory ED. Additional research with prospective studies utilizing objective measures and standardized questionnaires is required. Trost L and Hellstrom WJG. History, contemporary outcomes, and future of penile prostheses: A review of the literature. Sex Med Rev 2013;1:150-163.
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Affiliation(s)
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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Welliver C, Kottwitz M, Ahmad AE, Wilson SK, Köhler TS. Manufacturers' data show increasing implanted cylinder sizes and measured corporal lengths in inflatable penile implants. World J Urol 2015; 34:993-8. [PMID: 26475275 DOI: 10.1007/s00345-015-1705-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/03/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION We sought to determine whether measured corporal length (MCL) or implanted device size (IDS) has changed. METHODS Data were obtained from the two major penile implant companies from the years of 2005-2010 and analyzed. While we requested similar data, companies supplied information at their discretion with MCL provided by American Medical Systems and IDS provided by Coloplast. Intra-patient corporal discrepancies, disease state effects, rear tip extenders (RTEs) use and place of implantation were also provided in some part by companies. RESULTS MCL and IDS increased during the study period. Despite the general trend of MCL/IDS, clinically significant (0.5 cm or greater) decreases in MCLs were noted in patients with Peyronie's disease (PD) or a history of radical pelvic surgery (excludes prostatectomy). In only 2.7 % of cases was there an intra-patient discrepancy in cylinder size (>1 cm). IDS was longer in the USA (US, 19.4 cm) compared to outside the US (OUS, 17.7 cm, p < 0.0001). Cylinders were implanted without RTEs in 48.3 % of US cases and 73.7 % of OUS cases (p < 0.0001). In Coloplast devices there was an overall statistically significant change in the use of 16 cm (less utilized) and 20 and 22 cm (more utilized) cylinder lengths during the study period in US implants. CONCLUSION MCL and IDS increased during the study period. Men with a history of PD or radical pelvic surgery are at highest risk to have shorter MCL and to possibly receive shorter implants. Intra-patient IDS inconsistency is rare and should prompt investigation.
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Affiliation(s)
- Charles Welliver
- Division of Urology, Albany Medical College, 23 Hackett Boulevard, Albany, NY, 12208, USA. .,Division of Urology, Albany Stratton Veterans Affairs Hospital, Albany, NY, USA. .,Urological Institute of Northeastern New York, Albany, NY, USA.
| | - Michael Kottwitz
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ardalan E Ahmad
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Tobias S Köhler
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
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Lavien G, Churukanti G, Kishor A, Kramer A. Resident Education in Penile Prosthesis Surgery. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-015-0051-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lledó‐García E, Jara‐Rascón J, Moncada Iribarren I, Piñero‐Sánchez J, Aragón‐Chamizo J, Hernández‐Fernández C. Penile Prosthesis First and Replacement Surgeries: Analysis of Patient and Partner Satisfaction. J Sex Med 2015; 12:1646-53. [DOI: 10.1111/jsm.12932] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Oberlin DT, Matulewicz RS, Bachrach L, Hofer MD, Brannigan RE, Flury SC. National Practice Patterns of Treatment of Erectile Dysfunction with Penile Prosthesis Implantation. J Urol 2015; 193:2040-4. [DOI: 10.1016/j.juro.2014.11.095] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Daniel T. Oberlin
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Richard S. Matulewicz
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Laurie Bachrach
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthias D. Hofer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Robert E. Brannigan
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sarah C. Flury
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Sunaryo PL, Colaco M, Terlecki R. Penile Prostheses and the Litigious Patient: A Legal Database Review. J Sex Med 2014; 11:2589-94. [DOI: 10.1111/jsm.12649] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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