1
|
Razdan S, Zisman A, Valenzuela R. Scrotal approach for tunica expansion procedure (TEP) for penile girth and length restoration during penile prosthesis implantation in patients with penile angulation due to Peyronie's disease and erectile dysfunction: technique and outcomes. Int J Impot Res 2024; 36:146-150. [PMID: 36528741 DOI: 10.1038/s41443-022-00652-7] [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: 06/24/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
Peyronie's disease is often comorbid with erectile dysfunction and can cause significant penile shortening. We describe our modified tunica expansion procedure (TEP) technique of penile length preservation and girth enhancement with correction of penile angulation in patients with mild Peyronie's disease (<30 degree angulation, or hourglass deformity, no hinging) and erectile dysfunction presenting for inflatable penile prosthesis (IPP) surgery. A retrospective review of IPP placement from one high volume surgeon was performed. A total of 474 patients' charts from June 2017 to June 2021 were reviewed and those charts of patients undergoing modified TEP in the setting of Peyronie's disease were analyzed. Average increase in length and girth were measured and means with standard deviations calculated. The modified TEP is performed through a scrotal approach and involves complete eversion of the penis with dissection of Buck's fascia off the underlying tunica. Subsequently, staggered scorings of the underlying tunica are performed allowing for circumferential girth enhancement and length preservation. In men with Peyronie's disease, these scorings are preferentially concentrated on the side of the plaque to allow straightening without loss of length. A total of 32 patients with Peyronie's disease from the larger cohort underwent the modified TEP. Mean increase in length of distal corpora was 2.8 ± 0.8 cm (range 2.0-3.4 cm) (measured using Furlow before and after penile eversion with TEP), while mean increase in girth (measured at midphallus prior to prosthesis insertion and after IPP inflation) was 1.6 ± 0.4 cm (range 1.2-2.2 cm). There were no reported complications. A scrotal approach to TEP is an easy to perform technique that can be used to restore length and enhance girth in men with Peyronie's disease undergoing insertion of IPP. Additionally, it is a customizable approach that can also be used to correct mild penile angulation.
Collapse
Affiliation(s)
- Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Ariel Zisman
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Robert Valenzuela
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
2
|
Ancha N, Eldin M, Woodle T, Gereta S, Hariprasad K, Butler I, Osterberg Iii EC. Current devices, outcomes, and pain management considerations in penile implant surgery: an updated review of the literature. Asian J Androl 2024:00129336-990000000-00167. [PMID: 38376174 DOI: 10.4103/aja202386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/11/2023] [Indexed: 02/21/2024] Open
Abstract
ABSTRACT Penile prosthesis surgery is a definitive treatment for erectile dysfunction (ED). The two categories of penile prosthesis are endorsed by professional guidelines, inflatable penile prosthesis (IPP) and malleable penile prosthesis (MPP). Each modality of penile prosthesis offers distinct advantages and incorporates specific design features, allowing for personalized device selection that aligns with individual needs and preferences. While the overall complication rate of penile implant surgery remains low, surgeons should maintain a high index of suspicion for complications in the perioperative time period. Multimodal analgesic regimens including nerve blocks and narcotic-free pathways should be administered to manage perioperative pain. Finally, the high patient satisfaction after penile prosthesis surgery underscores the success of this ED treatment option.
Collapse
Affiliation(s)
- Nirupama Ancha
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - Maya Eldin
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - Tarah Woodle
- Department of Urology, Brooke Army Medical Center, San Antonio, TX 78234, USA
| | - Sofia Gereta
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - Krishna Hariprasad
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Imani Butler
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| | - E Charles Osterberg Iii
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX 78712, USA
| |
Collapse
|
3
|
Ricapito A, Sedigh O, Rubino M, Gobbo A, Falagario UG, Annese P, Mancini V, Ferro M, Buffi N, Cormio L, Carrieri G, Busetto GM, Bettocchi C. Penoscrotal approach for inflatable penile prosthesis implant: why it should be preferred. Minerva Urol Nephrol 2023; 75:711-717. [PMID: 38126284 DOI: 10.23736/s2724-6051.23.05475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Inflatable penile prosthesis are the definitive treatment for erectile dysfunction. The two most used surgical approaches to position the implants are the penoscrotal and the infrapubic. Current trends showed that the penoscrotal approach is extensively preferred however, there is not conclusive evidence demonstrating the superiority of one technique over the other. The aim of this review is to summarize the scientific evidence available and to underline strengths and weaknesses of the two techniques. EVIDENCE ACQUISITION We conducted a comprehensive search of MEDLINE, Cochrane Library, and National Center for Biotechnology Information PubMed to identify relevant published articles. The included studies had to explicitly examine the use of three-piece inflatable penile prosthesis with a focus on the surgical access method and complications. EVIDENCE SYNTHESIS Twenty-six articles were included in the review: seven narrative reviews, five retrospective observational studies, five prospective observational studies, and nine mixed methodology studies. The most frequent approach was the penoscrotal, which was also found more comfortable (RG1) by the operators in one study. The infrapubic approach lasts less and one study demonstrated higher satisfaction by the patients. CONCLUSIONS There is no evidence of significant differences in complications among the penoscrotal and infrapubic approaches. While the infrapubic approach is faster and patients were more satisfied, the penoscrotal approach is the most used by far. This is likely related to the more straightforward procedure through this access and the excellent surgical field exposure. For these reasons, it is also preferred in the most complex cases.
Collapse
Affiliation(s)
- Anna Ricapito
- Andrology Unit, Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Omid Sedigh
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Department of Urology and Reconstructive Andrology, Humanitas Gradenigo Hospital, Turin, Italy
| | - Matteo Rubino
- Andrology Unit, Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Andrea Gobbo
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ugo G Falagario
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Pasquale Annese
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Vito Mancini
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Matteo Ferro
- European Institute of Oncology (IEO) - IRCCS, Milan, Italy
| | - Nicolò Buffi
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy -
| | - Carlo Bettocchi
- Andrology Unit, Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| |
Collapse
|
4
|
Stroie FA, Taylor L, Fernandez-Crespo R, Parker J, Carrion R. Patient selection, counseling and preparation for penile prosthesis. Int J Impot Res 2023; 35:609-612. [PMID: 37607962 DOI: 10.1038/s41443-023-00735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/23/2023] [Accepted: 07/05/2023] [Indexed: 08/24/2023]
Abstract
The penile prosthesis has revolutionized the management of erectile dysfunction and is a mainstay in the treatment of this clinical entity. The goal of proper patient selection and counseling is to achieve a satisfactory outcome for the patient. Most patients receiving a penile prosthesis are satisfied with their outcome, and while the penile prosthesis generally allows for high satisfaction rates, avenues for dissatisfaction can arise. Our aim is to aid the prosthetic urologist in identifying such avenues by discussing what factors can lead to a dissatisfied patient. Even a technically successful surgical outcome in the improperly counseled patient can have negative consequences for the patient and the patient-physician relationship. Satisfaction in the penile prosthesis arena can be variably defined and viewed from different perspectives. As such, establishing a personalized framework of expectation management, even in the patient who poses challenging factors, is paramount in preparation for penile prosthesis implantation.
Collapse
Affiliation(s)
- Florian A Stroie
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Laura Taylor
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Raul Fernandez-Crespo
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Justin Parker
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Rafael Carrion
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA.
| |
Collapse
|
5
|
Yassin M, Chen R, Ager M, Desouky E, Minhas S. Penile implants in low flow priapism. Int J Impot Res 2023; 35:651-663. [PMID: 37898653 DOI: 10.1038/s41443-023-00787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
Priapism is a persistent or prolonged erection, in the absence of sexual stimulation, that fails to subside. Prolonged ischaemic or low flow priapism is defined as a full or partial erection persisting for more than 4 h and unrelated to sexual interest or stimulation, characterised by little or no cavernous blood flow. Low flow priapism leads to progressive corporal fibrosis, which could, in turn, lead to long-lasting erectile dysfunction if left untreated. Penile prosthesis implantation is recognised as a management option in refractory and delayed low flow priapism for restoring erectile function with high patient satisfaction rates. However, the ensuing corporal fibrotic scarring poses a surgical challenge to clinicians, given the higher complication rates in this patient subset. Postoperative patient satisfaction has been closely linked to preoperative expectations and perceived loss of penile length. Therefore, thorough patient counselling concerning the risk and benefits of penile implants should be a priority for all clinicians. Moreover, there is a lack of consensus on the ideal prosthesis choice and procedural timing in refractory low flow priapism. In this review, we will examine the existing literature on penile implants in patients with priapism and discuss the options for managing complications associated with penile prosthesis surgery.
Collapse
Affiliation(s)
- Musaab Yassin
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Runzhi Chen
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Michael Ager
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elsayed Desouky
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
| |
Collapse
|
6
|
Argiolas A, Argiolas FM, Argiolas G, Melis MR. Erectile Dysfunction: Treatments, Advances and New Therapeutic Strategies. Brain Sci 2023; 13:802. [PMID: 37239274 PMCID: PMC10216368 DOI: 10.3390/brainsci13050802] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Erectile dysfunction (ED) is the inability to get and maintain an adequate penile erection for satisfactory sexual intercourse. Due to its negative impacts on men's life quality and increase during aging (40% of men between 40 and 70 years), ED has always attracted researchers of different disciplines, from urology, andrology and neuropharmacology to regenerative medicine, and vascular and prosthesis implant surgery. Locally and/or centrally acting drugs are used to treat ED, e.g., phosphodiesterase 5 inhibitors (first in the list) given orally, and phentolamine, prostaglandin E1 and papaverine injected intracavernously. Preclinical data also show that dopamine D4 receptor agonists, oxytocin and α-MSH analogues may have a role in ED treatment. However, since pro-erectile drugs are given on demand and are not always efficacious, new strategies are being tested for long lasting cures of ED. These include regenerative therapies, e.g., stem cells, plasma-enriched platelets and extracorporeal shock wave treatments to cure damaged erectile tissues. Although fascinating, these therapies are laborious, expensive and not easily reproducible. This leaves old vacuum erection devices and penile prostheses as the only way to get an artificial erection and sexual intercourse with intractable ED, with penile prosthesis used only by accurately selected patients.
Collapse
Affiliation(s)
- Antonio Argiolas
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.M.A.); (M.R.M.)
| | - Francesco Mario Argiolas
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.M.A.); (M.R.M.)
| | - Giacomo Argiolas
- General Medicine Unit, Hospital San Michele, ARNAS“G. Brotzu”, Piazzale Ricchi 1, 09100 Cagliari, Italy;
| | - Maria Rosaria Melis
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.M.A.); (M.R.M.)
| |
Collapse
|
7
|
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 2023:10.1038/s41443-023-00669-6. [PMID: 36797455 DOI: 10.1038/s41443-023-00669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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.
Collapse
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.
| |
Collapse
|
8
|
Wang CM, Wu BR, Xiang P, Xiao J, Hu XC. Management of male erectile dysfunction: From the past to the future. Front Endocrinol (Lausanne) 2023; 14:1148834. [PMID: 36923224 PMCID: PMC10008940 DOI: 10.3389/fendo.2023.1148834] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
Erectile dysfunction is a common disease of the male reproductive system, which seriously affects the life quality of patients and their partners. At present, erectile dysfunction is considered as a social-psychological-physiological disease with complex etiology and various treatment methods. Oral PDE5I is the first-line treatment for erectile dysfunction with the advantages of high safety, good effect and non-invasiveness. But intracavernosal injection, hormonal replacement therapy, vacuum erection device, penile prosthesis implantation can also be alternative treatments for patients have organic erectile dysfunction or tolerance to PDE5I. With the rapid development of technologies, some new methods, such as low-intensity extracorporeal shock wave and stem cell injection therapy can even repair the organic damage of the corpora cavernosa. These are important directions for the treatment of male erectile dysfunction in the future. In this mini-review, we will introduce these therapies in detail.
Collapse
Affiliation(s)
| | | | | | - Jun Xiao
- *Correspondence: Jun Xiao, ; Xue-Chun Hu,
| | | |
Collapse
|
9
|
La Croce G, Schifano N, Pescatori E, Caraceni E, Colombo F, Bettocchi C, Carrino M, Vitarelli A, Pozza D, Fiordelise S, Varvello F, Paradiso M, Silvani M, Mondaini N, Natali A, Falcone M, Ceruti C, Salonia A, Antonini G, Cai T, Palmieri A, Dehò F, Capogrosso P. Which patient may benefit the most from penile prosthesis implantation? Andrology 2022; 10:1567-1574. [PMID: 36088578 DOI: 10.1111/andr.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Penile prosthesis implantation has been associated with overall good functional outcomes. Of relevance, some patients reported higher level of satisfaction and quality of life. AIM We investigated the profile of the patients who may benefit the most from penile prosthesis implantation. MATERIALS AND METHODS Data from a national multi-institutional registry of penile prostheses including patients treated from 2014 to 2017 in Italy (Italian Nationwide Systematic Inventarization of Surgical Treatment for Erectile Dysfunction) were analyzed. All data have been prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and revised by a single data manager. Patients' baseline characteristics were recorded. In order to simultaneously evaluate perceived penile prosthesis function and quality of life, all patients were re-assessed at 1-year follow-up using the validated questionnaire Quality of Life and Sexuality with Penile Prosthesis. High quality of life after surgery was defined as a score higher than the 75th percentile in each of the subdomains of the Quality of Life and Sexuality with Penile Prosthesis questionnaire. Logistic regression analysis tested the association between clinical characteristics and high quality of life after penile prosthesis implantation. RESULTS Follow-up data were available for 285 patients (median age 60 years; interquartile range: 56-67) who underwent penile prosthesis implantation. Erectile dysfunction etiology was organic in 40% (114), pelvic surgery/radiotherapy in 39% (111), and Peyronie's disease in 21% (60) of the cases. Patients showed good overall Quality of Life and Sexuality with Penile Prosthesis scores at 1-year follow-up for functional (22/25), personal (13/15), relational (17/20), and social (13/15) domains. Overall, 27.0% (77) of patients achieved scores consistent with the high quality of life definition. These patients did not differ in terms of median age (60 vs. 62), type of prosthesis (inflatable penile prostheses: 95% in both of the cases), and post-operative complications (10% vs. 14%) than those with lower quality of life score (all p > 0.1). At logistic regression analysis, erectile dysfunction etiology was the only factor independently associated with high quality of life at 1 year after surgery (p = 0.02). Patients treated for Peyronie's disease (odds ratio: 2.62; p = 0.01; 95% confidence interval: 1.20-5.74) were more likely to report better outcomes after accounting for age, post-operative complications, and surgical volume. CONCLUSION Penile prosthesis implantation is associated with an overall good quality of life. The subset of patients affected by erectile dysfunction secondary to Peyronie's disease seemed to benefit the most from penile prosthesis implantation in terms of functional outcomes, relationship with their partners and the outside world, and perceived self-image. The systematic use of validated questionnaires specifically addressed at evaluating quality of life and satisfaction after penile prosthesis implantation should be further implemented in future studies to better define the predictors of optimal satisfaction after penile prosthesis implantation.
Collapse
Affiliation(s)
| | - Nicolò Schifano
- Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| | | | - Enrico Caraceni
- Department of Urology, Area Vasta 3 Asur Marche, Civitanova Marche, Italy
| | - Fulvio Colombo
- Andrology Unit, Sant'Orsola University Hospital, University of Bologna, Italy
| | | | | | | | - Diego Pozza
- Studio di Andrologia e di Chirurgia Andrologica, Rome, Italy
| | | | | | - Matteo Paradiso
- Department of Urology, Ospedale Cardinal Massaia, Asti, Italy
| | - Mauro Silvani
- Department of Urology, Ospedale di Biella, Biella, Italy
| | - Nicola Mondaini
- Department of Urology, Villa Donatello Hospital, Florence, Italy
| | - Alessandro Natali
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Falcone
- Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Carlo Ceruti
- Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Andrea Salonia
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Federico Dehò
- Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| | - Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| |
Collapse
|
10
|
Evaluation of Quality of Life After Inflatable Penile Implantation and Analysis of Factors Influencing Postsurgery Patient Satisfaction. J Sex Med 2022; 19:1472-1478. [DOI: 10.1016/j.jsxm.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022]
|
11
|
Miller LE, Khera M, Bhattacharyya S, Patel M, Nitschelm K, Burnett AL. Long-term Survival Rates of Inflatable Penile Prostheses: Systematic Review and Meta-Analysis. Urology 2022; 166:6-10. [DOI: 10.1016/j.urology.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/08/2022] [Accepted: 03/29/2022] [Indexed: 11/27/2022]
|
12
|
Defeudis G, Mazzilli R, Tenuta M, Rossini G, Zamponi V, Olana S, Faggiano A, Pozzilli P, Isidori AM, Gianfrilli D. Erectile dysfunction and diabetes: A melting pot of circumstances and treatments. Diabetes Metab Res Rev 2022; 38:e3494. [PMID: 34514697 PMCID: PMC9286480 DOI: 10.1002/dmrr.3494] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023]
Abstract
Diabetes mellitus (DM), a chronic metabolic disease characterised by elevated levels of blood glucose, is among the most common chronic diseases. The incidence and prevalence of DM have been increasing over the years. The complications of DM represent a serious health problem. The long-term complications include macroangiopathy, microangiopathy and neuropathy as well as sexual dysfunction (SD) in both men and women. Erectile dysfunction (ED) has been considered the most important SD in men with DM. The prevalence of ED is approximately 3.5-fold higher in men with DM than in those without DM. Common risk factors for the development of DM and its complications include sedentary lifestyle, overweight/obesity and increased caloric consumption. Although lifestyle changes may help improve sexual function, specific treatments are often needed. This study aims to review the definition and prevalence of ED in DM, the impact of DM complications and DM treatment on ED and, finally, the current and emerging therapies for ED in patients with DM.
Collapse
Affiliation(s)
- Giuseppe Defeudis
- Unit of Endocrinology and DiabetesDepartment of MedicineUniversity Campus Bio‐Medico di RomaRomeItaly
| | - Rossella Mazzilli
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Marta Tenuta
- Department of Experimental MedicineSapienza University of RomeRomeItaly
| | - Giovanni Rossini
- Unit of Endocrinology and DiabetesDepartment of MedicineUniversity Campus Bio‐Medico di RomaRomeItaly
| | - Virginia Zamponi
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Soraya Olana
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Antongiulio Faggiano
- Department of Clinical and Molecular MedicineSapienza University of RomeRomeItaly
| | - Paolo Pozzilli
- Unit of Endocrinology and DiabetesDepartment of MedicineUniversity Campus Bio‐Medico di RomaRomeItaly
| | - Andrea M. Isidori
- Department of Experimental MedicineSapienza University of RomeRomeItaly
| | | |
Collapse
|
13
|
Capece M, Di Giovanni A, Cirigliano L, Napolitano L, La Rocca R, Creta M, Califano G, Crocetto F, Collà Ruvolo C, Celentano G, Palmieri A. YouTube as a source of information on penile prosthesis. Andrologia 2021; 54:e14246. [PMID: 34519075 DOI: 10.1111/and.14246] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study is to evaluate the quality of information on YouTube regarding penile prosthesis. We searched the term 'penile prosthesis' on YouTube recording the first 100 video links. Each video was analysed by three evaluators through the validate Patient Education Materials Assessment Tool (PEMAT), the DISCERN quality criteria for consumer health information and a misinformation assessment tool specifically created for this subject. All the videos were viewed 10'011'232 times. Median duration time was 5'13″ (IQR = 7'25″-1'58″). Sixty-eight per cent were nonsurgical videos and 32% of them contained surgical procedures. Most of the videos were uploaded by Private Companies (51%). Videos were primarily directed at patients (73 of 100 videos). The mean PEMAT understandability score was 57.8% ± 19.2%, the actionability score was 0% (IQR = 33%-0%). The median DISCERN score was 26 (IQR = 30-21). None of the videos provided a complete patients' information and the overall mean misinformation score was 3.21 ± 2.24. Based on our data, video's quality according to PEMAT and DISCERN score is mostly poor. Furthermore popularity does not correlate with the quality of the videos, and most of them fail to provide adequate patient's information.
Collapse
Affiliation(s)
- Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Angelo Di Giovanni
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Lorenzo Cirigliano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| |
Collapse
|
14
|
Penile Hemodynamic Response to Phosphodiesterase Type V Inhibitors after Cavernosal Sparing Inflatable Penile Prosthesis Implantation: A Prospective Randomized Open-Blinded End-Point (PROBE) Study. Adv Urol 2021; 2021:5548494. [PMID: 34257646 PMCID: PMC8257370 DOI: 10.1155/2021/5548494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 02/05/2023] Open
Abstract
Forceful corporal dilatation amidst penile prosthesis implantation may injure cavernosal arteries compromising penile vasculature. In this study, we aimed to compare the conventional and cavernosal sparing techniques regarding cavernosal artery preservation. Overall, 33 patients underwent inflatable penile prosthesis implantation with Coloplast Titan Touch® three-piece inflatable penile implants. 16 patients had conventional implantations with serial vigorous dilatations, while 17 patients were implanted with the cavernosal sparing technique, consisting of a single minimal corporal dilatation after an intraoperative intracavernosal injection (ICI) of Alprostadil. Postoperatively, a penile duplex Doppler ultrasound study was performed. Whenever a cavernosal artery was spared and thus successfully probed, its hemodynamics were studied before and after an oral administration of a phosphodiesterase type 5 inhibitor (PDE5i). A cavernosal artery was successfully probed in 16/17 (94%) of patients in the cavernosal sparing group compared to 5/16 (31%) of patients in the conventional group with a significant statistical difference (P=0.001). This demonstrated that the cavernosal sparing technique was superior to the conventional approach in preserving the cavernosal artery (odds ratio 35.2, 95% IC 3.5–344.2; P=0.0022). Whenever a cavernosal artery could be probed, its hemodynamic responsiveness was also preserved. This trial is registered with NCT03733860.
Collapse
|
15
|
Topuz B, Ebiloğlu T, Zor M, Kaya E, Sarıkaya S, Emrah Coğuplugil A, Gürdal M, Bedir S. Penile prosthesis implantation: A single center 25 years of experience. Prog Urol 2021; 31:663-670. [PMID: 34215514 DOI: 10.1016/j.purol.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/10/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We analyzed the long-term results of malleable and inflatable penile prosthesis: the rates of complications, revision surgery and patient satisfaction. MATERIALS AND METHODS Between January 1996 and December 2020, a total of 138 patients underwent implantation of a malleable or inflatable types penile prosthesis. The data of the patients were derived from the patient files and digital recording system. The patients were contacted face-to-face interaction if possible. If it is not possible, phone connection was made. RESULTS The median age of patients was 56 (21-83) years. Fourteen (10.2%) 1-piece, 46 (33.3%) 2-piece and 78 (56.5%) 3-piece penile prosthesis were implanted. The mostly used perioperative antibiotic was teicoplanin+amikacin in 107 patients. Total complication rate was 30% (n=42). Prosthesis infection constituted 9% (n=13) of these complications. The total satisfaction rate was 89.1%. There was no correlation between the complications and antibiotic regimen or prosthesis type (P=0.488, P=0.454, respectively). The rate of infection showed a slight increase in 3-piece penile prosthesis without any statistically significance (P=0.633). The patients with complications expressed more dissatisfaction compared to those without complications (P=0.001). CONCLUSIONS In our series, penile prosthesis implantation seems to be a recommended treatment method with high patient satisfaction in the treatment of refractory erectile dysfunction. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- B Topuz
- Gülhane Training and Research Hospital, Department of Urology, 06010 Etlik, Ankara, Turkey.
| | - T Ebiloğlu
- Gülhane Training and Research Hospital, Department of Urology, 06010 Etlik, Ankara, Turkey
| | - M Zor
- Gülhane Training and Research Hospital, Department of Urology, 06010 Etlik, Ankara, Turkey
| | - E Kaya
- Gülhane Training and Research Hospital, Department of Urology, 06010 Etlik, Ankara, Turkey
| | - S Sarıkaya
- Gülhane Training and Research Hospital, Department of Urology, 06010 Etlik, Ankara, Turkey
| | - A Emrah Coğuplugil
- Gülhane Training and Research Hospital, Department of Urology, 06010 Etlik, Ankara, Turkey
| | - M Gürdal
- Gülhane Training and Research Hospital, Department of Urology, 06010 Etlik, Ankara, Turkey
| | - S Bedir
- Gülhane Training and Research Hospital, Department of Urology, 06010 Etlik, Ankara, Turkey
| |
Collapse
|
16
|
Wen L, Köhler TS, Helo S. A narrative review of the management of benign prostatic hyperplasia in patients undergoing penile prosthesis surgery. Transl Androl Urol 2021; 10:2695-2704. [PMID: 34295754 PMCID: PMC8261430 DOI: 10.21037/tau-20-1225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/13/2021] [Indexed: 11/24/2022] Open
Abstract
Penile prosthesis surgery is an effective and durable treatment modality for patients who have failed conservative management for erectile dysfunction (ED). Thorough patient counseling and appropriate preoperative workup lay the foundation for a successful outcome. While the risk of infection of penile prosthesis is rare, it is a dreaded complication with dire consequences. The goal of the prosthetic surgeon is to minimize the risk of preventable complications. Given the common prevalence of benign prostatic hyperplasia (BPH) in this patient population, it is essential that providers are familiar with the implications and nuances of managing both conditions in order to maximize the chances of a favorable result. Due to the relatively infrequent nature of complications associated with the management of BPH in the setting of a penile prosthesis, literature regarding this topic is scarce. In this narrative review we present our own case series illustrating some of the most common scenarios that a prosthetic surgeon may encounter. We have included our suggestions for management in these difficult situations based on our clinical experience. In the following review we have highlighted the importance of identifying and treating BPH in penile implant candidates to reduce postoperative morbidity and to offer critical insights into managing BPH-related complications this population.
Collapse
Affiliation(s)
| | | | - Sevann Helo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
17
|
[Quality of life in patients who suffered erectile dysfunction and underwent penile implant surgery in terms of sexual satisfaction of the patient and partner]. Urologe A 2020; 60:344-350. [PMID: 33355683 PMCID: PMC8219580 DOI: 10.1007/s00120-020-01418-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 10/27/2022]
Abstract
BACKGROUND Erectile dysfunction is a condition that shows a continuously growing prevalence in the male population. The penis prosthesis implant (PPI) qualifies as an effective form of therapy. OBJECTIVES The aim of this study was to analyze the sexual satisfaction rate and quality of life in patients who had suffered from erectile dysfunction and who were treated with a penile prosthesis. The patient's partners were also surveyed. METHODS We collected data from patients who underwent surgery in the Center of Excellence for Penile Implants, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. Questionnaires with validated scores (EDITS, EDITS Partner) were sent to all patients and their partners via mail. RESULTS The satisfaction rate in this study was high which shows that the patients and partners are pleased, and the high sexual satisfaction rate led to a higher quality of life. CONCLUSION The penile prosthesis implantation as a last option of therapy for erectile dysfunction is useful and brings more than adequate results.
Collapse
|
18
|
Whalen S, Langille G, White J, Bailly G. Access to penile prostheses differ across provinces in Canada: A survey of Canadian urologists. Can Urol Assoc J 2020; 15:E346-E349. [PMID: 33382371 DOI: 10.5489/cuaj.6867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Surgical implantation of a penile prosthesis is the gold standard treatment for refractory erectile dysfunction. The purpose of this study was to investigate the use of and access to these procedures in Canada. METHODS Canadian urologists known to perform penile prostheses procedures were surveyed on areas such as surgical volume, type of device used, and the direct cost to patients for both malleable and inflatable devices. RESULTS Of the 50 urologists invited to participate in the study, 34 (68%) completed the online survey. Participants represented nine Canadian provinces and included a mix of academic (65%) and community (35%) urologists. Most participants (79%) performed less than 10 procedures per year. Roughly three-quarters of participants (74%) used inflatable devices in over 90% of cases, while half implanted inflatable devices exclusively. The most common devices implanted were American Medical Systems (AMS). Participants from Alberta, Manitoba, New Brunswick, and Newfoundland reported full coverage for both malleable and inflatable devices. Saskatchewan was the only province where no coverage was reported. The remaining provinces were found to have variable degrees of coverage. Across all centers without full coverage, the median reported cost to patients for a malleable and inflatable device was $5000 and $6000, respectively. CONCLUSIONS The urologists surveyed most commonly perform inflatable penile prostheses procedures. Significant geographical differences exist with respect to reported coverage for these procedures. This study highlights the need for continued advocacy on behalf of the urological community towards the goal of equity in coverage for penile prostheses across Canada.
Collapse
Affiliation(s)
- Stewart Whalen
- Department of Urology, Dalhousie University, Halifax, NS Canada
| | - Gavin Langille
- Department of Urology, Dalhousie University, Saint John, NB, Canada
| | - Josh White
- Department of Urology, Dalhousie University, Halifax, NS Canada
| | - Greg Bailly
- Department of Urology, Dalhousie University, Halifax, NS Canada
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Nosé BD, Grimberg DCD, Lentz AC. Update on Intraoperative Cultures, Biofilms, and Modifiable Factors During Revision of Clinically Non-Infected Penile Implants. Sex Med Rev 2020; 9:160-168. [PMID: 32943351 DOI: 10.1016/j.sxmr.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Penile implants have a limited lifespan, and as the population using inflatable penile prostheses ages, revision surgery has become increasingly common. Devices are frequently cultured during non-infectious revision surgeries, providing a burgeoning of evidence of positive cultures without clinical infection. However, the clinical significance of these cultures remains unclear. OBJECTIVES We aim to review the current literature on culture results from revision surgery for clinically non-infected devices and summarize the available data to formulate a synopsis of clinically significant organisms and their significance and modifiable approaches to prosthesis surgery. METHODS A literature review was performed on 1 March, 2020 in PubMed and Google Scholar. Search terms centered on penile prosthesis revision surgery, cultures, and infection. Titles and abstracts were reviewed for topical relevance with emphasis placed on literature from the last 20 years. Most publications comprised small case series aside from a single meta-analysis. RESULTS Since 1995, seven series have been published examining culture positivity at the time of revision surgery for clinically non-infected devices. Isolated organisms are most commonly from the Staphylococcus genus with Staphylococcus epidermidis being the most frequently isolated organism on clinically non-infected devices. Reported culture positivity rates at the time of revision range between 9.8% and 80%. CONCLUSION Current literature pertaining to the clinical significance of culture positivity at the time of revision surgery for clinically non-infected penile prostheses is lacking; however, multiple series do report high rates of culture positivity. This does appear to confer a higher rate of subsequent infection and a lower revision-free survival. Staphylococcus epidermidis is the most commonly isolated organism followed by other members of the Staphylococcus genus. Further studies are needed to determine the impact of modifiable variables or techniques on asymptomatic culture positivity and the ideal technologies for biofilm prevention. Nosé BD, Grimberg DCD, Lentz AC. Update on Intraoperative Cultures, Biofilms, and Modifiable Factors During Revision of Clinically Non-Infected Penile Implants. Sex Med Rev 2021;9:160-168.
Collapse
Affiliation(s)
- Brent D Nosé
- Division of Urology, Duke University Medical Center, Durham, NC, USA.
| | | | - Aaron C Lentz
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
21
|
A prospective study analyzing both inflation and deflation preference for commonly available inflatable penile prostheses. Int J Impot Res 2020; 33:652-659. [PMID: 32778772 DOI: 10.1038/s41443-020-0339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/02/2020] [Accepted: 07/24/2020] [Indexed: 11/08/2022]
Abstract
Despite popularity, satisfaction rates of inflatable penile prosthesis (IPP) use can be improved by evaluating the ability to operate devices in the preoperative setting. The purpose of this study was to prospectively analyze the preference of three commonly available IPPs. In total, 125 IPP-naïve men 60 years of age or older were prospectively recruited from an outpatient Urology clinic from June 2019 to January 2020. A questionnaire standardized to all encounters was utilized to collect demographics, selected medical information, and key pinch strength. Participants were then asked to rank three models in terms of preference (from 1 to 3, 1 representing most preferred) for each inflation and deflation in a double-blinded manner. Statistical analysis was performed using ANOVA, a Chi-square test and multivariable logistical regression analysis. The results demonstrated preference for Coloplast Titan (44%) for inflation, and preference for AMS 700 (40%) for deflation. Men who preferred the Coloplast Titan inflation had a lower chance of preferring the AMS 700 MS deflation (OR = 0.29; p = 0.010) and Coloplast Titan Touch deflation (OR = 0.27; p = 0.012). Preference for Coloplast Titan was weakly associated with participant history of coronary artery disease (OR = 5.96, p = 0.006) and osteoarthritis (OR = 3.04, p = 0.044). Neither key pinch strength nor age was associated with preference for a particular model. IPP-naïve men over 60 years favor Coloplast Titan for inflation and AMS 700 for deflation, and men who preferred the Coloplast Titan for inflation were less likely to choose the AMS 700 MS or Coloplast Titan Touch for deflation. Further studies should aim to confirm these findings.
Collapse
|
22
|
Picola N, Torremade J, Fiol M, Fernández-Concha JJ, Beato S, Vigués F. Analysis of satisfaction and surgical outcomes of a major ambulatory surgery program for penile implant. Actas Urol Esp 2020; 44:262-267. [PMID: 32151471 DOI: 10.1016/j.acuro.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/16/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND OBJECTIVE Penile prosthesis (PP) surgery is performed in many institutions as an inpatient procedure. We have recently initiated a major ambulatory surgery (MAS) program, thus reducing the hospital stay. The objective of this study was to assess the feasibility, complications and satisfaction of the implantation of outpatient surgery PP program in our hospital. MATERIAL AND METHODS Retrospective observational study evaluating the results and satisfaction of PP implanted as an outpatient procedure in Bellvitge University Hospital during 2018. RESULTS During 2018 we implanted 49 PP: 27 (55%) inpatient surgeries vs. 22 (45%) outpatient surgeries. Of these 22, 2 (9%) were second implants. All patients underwent both general anesthesia and crural, proximal dorsal nerve and transversus abdominis plane block (TAP). Complication rates between inpatient and outpatient procedures were similar, 2 (7%) and 1 (5%), respectively, without reporting infections or requiring PP removal. Postoperatively, a satisfaction telephone survey was conducted in 19 (86%) patients: 16 (84%) considered the time of hospital stay as appropriate, 15 (79%) would have preferred to be operated again in an outpatient care setting and 15 (79%) would recommend it. The patients' main concerns were related to being at home with no medical assistance at home and about coming back the next day for drainage removal. All patients reported well-controlled pain without requiring opioid intake in any case. CONCLUSIONS In our series, PP implantation in an ambulatory care setting is feasible and safe. Although there are some aspects that should be improved, the program showed acceptable satisfaction rates and an adequate postoperative pain control, neither raising the administration of opioids, nor increasing complications and re-admission rates.
Collapse
Affiliation(s)
- N Picola
- Departamento de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - J Torremade
- Departamento de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - M Fiol
- Departamento de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - J J Fernández-Concha
- Departamento de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - S Beato
- Departamento de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - F Vigués
- Departamento de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| |
Collapse
|
23
|
Infrapubic surgical approach for penile prosthesis surgery: Indications and technique. Actas Urol Esp 2020; 44:301-308. [PMID: 32115278 DOI: 10.1016/j.acuro.2019.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/28/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Penile prosthesis surgery is currently the most effective treatment for erectile dysfunction when medical treatment is ineffective or contraindicated. Among the surgical approaches described in the literature, the scrotal, infrapubic and subcoronal are the most common in the daily clinical practice. OBJECTIVES The main objectives were to describe the infrapubic surgical technique evaluating its indications and complications, as well as comparing its advantages and disadvantages with the penoscrotal approach. ACQUISITION AND SYNTHESIS OF THE EVIDENCE A literature review from 1983 until current date was carried out in Medline (PubMed and Cochrane Library databases) following PRISMA standards. Sixteen studies were included: 4 prospective, 4 retrospective, one systematic review, one randomized trial, one original article, 5 expert opinion/surgical technique descriptive paper. DISCUSSION According to the literature reviewed, although the penoscrotal approach is the most applied, the infrapubic approach showed a shorter operative time and a tendency for an earlier recovery of sexual activity after surgery. Complications are rare, having similar rates to the penoscrotal approach; no cases of glans hypoesthesia have been reported and peri-prosthetic infection rates were less than 3%. Satisfaction rates of infrapubic penile prosthesis were higher than 80%. CONCLUSIONS Penile prosthesis implantation requires of a profound knowledge of the different surgical approaches in order to best adapt each technique based on each individualized case. The infrapubic approach, even if it is not the most used, is as feasible and reliable as the penoscrotal approach. The infrapubic approach is effective and safe, with high level of both, patients and partners' satisfaction.
Collapse
|
24
|
Fraile Poblador A, Díaz Pérez D, Hevia Palacios M, Burgos Revilla F. Analysis of preoperative and postoperative expectations of penile implant candidates. Actas Urol Esp 2020; 44:345-350. [PMID: 32354643 DOI: 10.1016/j.acuro.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/24/2020] [Indexed: 12/25/2022]
Abstract
Penile prosthesis implantation is a good option for the treatment of refractory erectile dysfunction. However, the patient's expectations, among other factors, condition his satisfaction after surgery. This review article aims to present the scientific evidence available concerning patient satisfaction with penile prosthesis surgery.
Collapse
|
25
|
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: 1.3] [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.
Collapse
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
| |
Collapse
|
26
|
Osmonov D, Christopher AN, Blecher GA, Falcone M, Soave A, Dahlem R, Czeloth K, Bannowsky A, Matanes E, Ward S, Martínez-Salamanca JI, Bettocchi C, Garaffa G, Reisman Y, Corona G. Clinical Recommendations From the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances. J Sex Med 2020; 17:210-237. [PMID: 31812683 DOI: 10.1016/j.jsxm.2019.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION To date, several aspects of inflatable penile prosthesis (IPP) surgical procedure have been poorly studied. AIM The aim of this study was to review the evidence associated with IPP implantation and provide clinical recommendations on behalf of the European Society for Sexual Medicine (ESSM). Overall, 130 peer-reviewed studies and systematic reviews, which were published from 2007-2018 in the English language, were included. METHODS MEDLINE and EMBASE were searched for randomized clinical trials, meta-analyses, and open-label prospective and retrospective studies. MAIN OUTCOME MEASURE The panel provided statements exploring patients and partner expectations, satisfaction in male and phalloplasty cohorts, the impact of penile length, girth and implant type, reservoir placement, the influence of comorbidities, and social circumstances. Levels of evidence were provided according to the Oxford 2011 criteria and graded as for the Oxford Centre for Evidence-Based Medicine recommendations. RESULTS In the preoperative setting, it is fundamental to identify and interact with difficult patients with the intention of enhancing the surgeon's ability to establish the surgeon-patient relationship, reduce physical and legal risk, as well as enhancing patient satisfaction. To address this need, the mnemonic Compulsive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric ("CURSED") has been suggested to identify patients who are at high risk of dissatisfaction. The current recommendations suggest improving glycemic control in patients with diabetes. Available evidence suggests evaluating transplant recipients with the criteria of Barry, consisting of stable graft function for >6 months, avoidance of intra-abdominal reservoir placement, and low-dose immunosuppression. HIV status does not represent a contraindication for surgery. Smoking, peripheral vascular disease, and hypertension may be associated with an increased risk of revision surgery. Patients with spinal cord injury may receive IPP. Patients aged ≥70 years, as well as obese patients, can be offered IPP. The IPP implantation can be performed in patients with stable Peyronie's disease. Ectopic high submuscular reservoir placement can be considered as an alternative method. CLINICAL IMPLICATIONS There is a relevant lack of high-level data and definite conclusions in certain areas remain difficult to draw. STRENGTH & LIMITATIONS All studies have been evaluated by a panel of experts providing recommendations for clinical practice. Because of lack of sufficient prospective data, some of the included studies are retrospective and this could be stated as a limitation. CONCLUSION This ESSM position statement provides recommendations on optimization of patient outcome by patient selection, and individualized peri- and intra-operative management. ESSM encourages centers to collaborate and to create prospective, multicenter registries in order to address this topic of increasing importance. Osmonov D, Christopher AN, Blecher GA, et al. Clinical Recommendations from the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances. J Sex Med 2020;17:210-237.
Collapse
Affiliation(s)
- Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Andrew Nim Christopher
- Department of Urology, University College London Hospitals & St Peters Andrology Centre, London, UK
| | - Gideon A Blecher
- Department of Urology, The Alfred Hospital, Melbourne, Australia; Monash Health, Melbourne, Australia
| | - Marco Falcone
- Department of Urology, University of Turin - Cittàdella Salute e della Scienza, Turin, Italy
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karen Czeloth
- Vitus Prostata Center Offenbach, Prof. Stehling Institut für bildgebende Diagnostik, Germany
| | | | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Sam Ward
- Department of Urology, Clinique Saint Jean, Brussels; Medicis Medical Center, Woluwe, Belgium
| | - Juan Ignacio Martínez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda Lyx Institute of Urology, Universidad Autónoma de Madrid, Spain
| | - Carlo Bettocchi
- Department of Urology, University of Bari, Bari, Apulia, Italy
| | - Giulio Garaffa
- The Institute of Urology, University College London Hospitals, London, UK
| | - Yacov Reisman
- Department of Urology, Amstelland Hospital, Amstelveen, The Netherlands
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, AziendaUsl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
| |
Collapse
|
27
|
Abstract
The field of prosthetic urology demonstrates the striking impact that simple devices can have on quality of life. Penile prosthesis and artificial urinary sphincter implantation are the cornerstone procedures on which this specialty focuses. Modern research largely concentrates on decreasing the rates of complication and infection, as the current devices offer superior rates of satisfaction when revision is not necessary. These techniques are also able to salvage sexual function and continence in more difficult patient populations including female-to-male transgender individuals, those with ischemic priapism, and those with erectile dysfunction and incontinence secondary to prostatectomy. This review summarizes modern techniques, outcomes, and complications in the field of prosthetic urology.
Collapse
Affiliation(s)
- Kole P Akula
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, 86-42, New Orleans, LA 70112-2699, USA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, 86-42, New Orleans, LA 70112-2699, USA
| |
Collapse
|
28
|
Borregales LD, Saavedra-Belaunde J, Wang R, Clavell-Hernández J. Novel protective penile collar following inflatable penile prosthesis placement: The "Wang Collar". Asian J Androl 2019; 22:481-484. [PMID: 31854332 PMCID: PMC7523615 DOI: 10.4103/aja.aja_123_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Penile rehabilitation after inflatable penile prosthesis (IPP) implantation for the treatment of erectile dysfunction includes leaving the device partially inflated so as to preserve the penile length and to maintain hemostasis. With a partially inflated device, the penis becomes more sensitive and more susceptible to unintended insults during the immediate postoperative management. The “Wang Collar,” a device intended to protect the penis in the early postoperative period, is hereby described. Three hundred and forty-eight patients had the “Wang Collar” included as part of their post-IPP management from August 2014 to February 2019. The protective collar, devised from a polystyrene cup with the bottom removed, is secured with a tape over the previously dressed and partially inflated penis. In order to evaluate the effectiveness of this device, we conducted surveys on the perioperative staff at three different institutions. The “Wang Collar” has been found to be beneficial in the early postoperative care of patients. Based on the answers to our questionnaire, the perioperative personnel found this device to be highly protective, especially when transporting the patient after IPP surgery, easy to work with, and almost never bothersome or irritative to the patient. We present a novel penile device after IPP placement, which we have found to improve patient satisfaction in the postoperative period. In addition, it eases the care of the patient by the perioperative staff. It is now our routine to use this device after IPP surgery. Further research is necessary to evaluate whether this device can decrease postoperative wound complications.
Collapse
Affiliation(s)
- Leonardo D Borregales
- Division of Urology, The University of Texas Health Science Center, Houston, TX 77030, USA
| | - Jose Saavedra-Belaunde
- Division of Urology, The University of Texas Health Science Center, Houston, TX 77030, USA
| | - Run Wang
- Division of Urology, The University of Texas Health Science Center, Houston, TX 77030, USA.,MD Anderson Cancer Center, Houston, TX 77030, USA
| | | |
Collapse
|
29
|
High-submuscular vs. space of Retzius reservoir placement during implantation of inflatable penile implants. Int J Impot Res 2019; 32:18-23. [DOI: 10.1038/s41443-019-0201-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/16/2019] [Accepted: 08/16/2019] [Indexed: 11/08/2022]
|
30
|
Jayadevan R, Eleswarapu SV, Mills JN. Infrapubic approach for placement of inflatable penile prosthesis: contemporary review of technique and implications. Int J Impot Res 2019; 32:10-17. [PMID: 31537910 DOI: 10.1038/s41443-019-0193-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/31/2019] [Accepted: 07/10/2019] [Indexed: 11/09/2022]
Abstract
Inflatable penile prosthesis (IPP) is an effective treatment for erectile dysfunction refractory to nonsurgical management. The infrapubic approach for IPP placement is less frequently employed than the penoscrotal approach, with only about 25% of IPPs placed via this method. Underutilization of the infrapubic method may be due to fear of injuring the penile dorsal neurovascular bundle, perceived difficulties of scrotal pump placement through a distant location, or insufficient distal corporal exposure. However, this approach appears to result in favorable operative times, faster time to device activation, equivalent postoperative satisfaction and quality of life, and similar complication rates. We provide a contemporary review of literature published before May 2019 regarding the infrapubic approach for IPP placement, technical considerations, and postoperative expectations.
Collapse
Affiliation(s)
- Rajiv Jayadevan
- Department of Urology, University of California, Los Angeles, CA, USA
| | | | - Jesse N Mills
- Department of Urology, University of California, Los Angeles, CA, USA.
| |
Collapse
|
31
|
Chierigo F, Capogrosso P, Dehò F, Pozzi E, Schifano N, Belladelli F, Montorsi F, Salonia A. Long-Term Follow-Up After Penile Prosthesis Implantation-Survival and Quality of Life Outcomes. J Sex Med 2019; 16:1827-1833. [PMID: 31501062 DOI: 10.1016/j.jsxm.2019.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/29/2019] [Accepted: 08/04/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Hydraulic penile prostheses have shown an overall good mechanical reliability up to 10 years after surgery; however, few data have been published on very long-term follow-up. AIM We looked at long-term (≥15 years) complications, including functional and quality of life (QoL) outcomes, after 3-piece inflatable penile prosthesis (IPP) implantation in patients with erectile dysfunction (ED). METHODS Data regarding 149 patients submitting to IPP placement before 2001 were analyzed. All patients were implanted with AMS CX and Ultrex Plus 3-piece prostheses. MAIN OUTCOME MEASURE Patients were reassessed to evaluate rates of complications and functional outcomes. The validated questionnaire Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) was used to assess patient QoL. Kaplan-Meier analysis estimated the probability of prosthesis survival (defined as working device/not-explanted). RESULTS Median follow-up of 51 patients was 206 months (interquartile range [IQR], 145-257). The etiology of ED was vasculogenic (n = 20; 39%), Peyronie's disease (n = 15; 29%), pelvic surgery (n = 4; 7.8%), organic other than vasculogenic (n = 3; 5.9%), or other (n = 9; 18%). Throughout the follow-up, 24 patients (49%) experienced complications: mechanical failure (n = 19; 79%), pain (n = 3; 12%), orgasmic dysfunctions (n = 1; 4.5%), or device infection (n = 1; 4.5%). The estimated IPP survival was 53% (95% CI, 36-67) at 20-year follow-up. Baseline characteristics (age, Charlson comorbidity index, body mass index, and erectile dysfunction etiology) were not significantly associated with the risk of IPP failure over time by Cox regression analysis. At 20-year follow-up, 41% (95% CI, 19-49) of the patients were still using the device. Among them, QoLSPP median domain scores were high: functional 22/25 (IQR, 20-23), relational 17/20 (IQR, 15-18), personal 14/15 (IQR, 12-15), and social 14/15 (IQR, 11-15). CLINICAL IMPLICATIONS The longevity of the device and long-term satisfaction rates should be comprehensively discussed during patient consultation for IPP surgery. STRENGTHS & LIMITATIONS To our knowledge, this is the first study reporting long-term QoL outcomes using a dedicated questionnaire for penile prostheses. The low response rate for the telephone interviews, the retrospective design of the study, and the relatively small number of patients are the main limitations. CONCLUSION Long-term follow-up data after IPP placement showed that almost half of the devices still worked properly 20 years after the original penile implant, as 60% of patients were still using the device with high satisfaction and adequate QoL outcomes. Both patients and physicians should be aware of the expected life and outcomes of IPP implants. Chierigo F, Capogrosso P, Dehò, et al. Long-Term Follow-Up After Penile Prosthesis Implantation-Survival and Quality of Life Outcomes. J Sex Med 2019;16:1827-1833.
Collapse
Affiliation(s)
- Francesco Chierigo
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Dehò
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
| |
Collapse
|
32
|
Scrotoplasty at Time of Penile Implant is at High Risk for Dehiscence in Diabetics. J Sex Med 2019; 16:602-608. [DOI: 10.1016/j.jsxm.2019.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/02/2019] [Accepted: 02/05/2019] [Indexed: 11/23/2022]
|
33
|
Abstract
PURPOSE OF REVIEW To provide an evidence based discussion of preoperative, intraoperative, and postoperative factors that lead to successful outcomes in penile prosthesis surgery. RECENT FINDINGS In the preoperative period, careful patient selection, appropriate counseling, thorough evaluation, and sufficient time for physical and emotional adaptation to an inflatable penile prosthesis are the key. During surgery, the entire device should be explanted whenever possible. A drain and retain strategy for the reservoir is a safe alternative in situation where the reservoir is not easily removable. The mechanical cleansing of lavage is more important than chemical sterilization. Postoperative instructions should be made clear and nursing phone calls may reduce the number of ER visits. Careful preoperative counseling, attention to intraoperative details, and vigilance in the postoperative period are necessary for a successful outcome with penile prosthesis revision surgery.
Collapse
Affiliation(s)
- Anton Wintner
- Duke University Division of Urologic Surgery, 3480 Wake Forest Rd., Suite 506, Raleigh, NC, 27609, USA
| | - Aaron C Lentz
- Duke University Division of Urologic Surgery, 3480 Wake Forest Rd., Suite 506, Raleigh, NC, 27609, USA.
| |
Collapse
|
34
|
Impact of key pinch strength on patient preference for inflatable penile prosthesis: a prospective study comparing Coloplast™ and AMS™ models. Int J Impot Res 2019; 32:113-116. [DOI: 10.1038/s41443-019-0129-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 11/08/2022]
|
35
|
|
36
|
Abstract
PURPOSE OF REVIEW After radical cystoprostatectomy, patients often develop erectile dysfunction refractory to first- and second-line treatments. In this review, we summarize and analyze the literature describing the technical considerations and outcomes of penile implant surgery in bladder cancer patients with history of radical cystectomy and urinary diversion. RECENT FINDINGS Penile prosthesis surgery in patients after radical cystectomy and urinary diversion has been infrequently described in the literature. Recent studies have shown that the three-piece inflatable penile prosthesis can be placed safely after significant prior intraabdominal surgery due to the development and refinement of several techniques to place the reservoir. Further studies are needed to objectively determine the impact of penile prosthetic surgery on functional outcomes in this historically undertreated yet increasingly significant patient population. As health-related quality of life outcomes continue to gain increasing importance after radical cystectomy, urologists should offer motivated bladder cancer survivors the inflatable penile prosthesis as the treatment of choice for refractory erectile dysfunction due to its safety and unmatched ability to restore erectile function.
Collapse
Affiliation(s)
- Jeffrey C Loh-Doyle
- Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089-9178, USA.
| |
Collapse
|
37
|
Habous M, Giona S, Tealab A, Aziz M, Sherif H, Abdelwahab O, Binsaleh S, Ralph D, Bettocchi C, Mulhall JP, Muir G. Penile length is preserved after implant surgery. BJU Int 2018; 123:885-890. [DOI: 10.1111/bju.14604] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mohamad Habous
- Department of Urology and Andrology; Elaj Medical Centers; Jeddah Saudi Arabia
| | | | - Alaa Tealab
- Department of Urology; Zagazig University; Zagazig Egypt
| | - Mohammed Aziz
- Department of Urology; Menoufia University; Menoufia Egypt
| | | | | | - Saleh Binsaleh
- Division of Urology; Department of Surgery; Faculty of Medicine; King Saud University; Riyadh Saudi Arabia
| | - David Ralph
- St. Peters Institute of Andrology; University College London Hospitals; London UK
| | - Carlo Bettocchi
- Department of Urology, Andrology and Kidney Transplantation Unit; Department of Emergency and Organ Transplantation; University of Bari; Bari Italy
| | - John P. Mulhall
- Sexual and Reproductive Medicine; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | | |
Collapse
|
38
|
Palmisano F, Boeri L, Cristini C, Antonini G, Spinelli MG, Franco G, Longo F, Gadda F, Colombo F, Montanari E. Comparison of Infrapubic vs Penoscrotal Approaches for 3-Piece Inflatable Penile Prosthesis Placement: Do We Have a Winner? Sex Med Rev 2018; 6:631-639. [DOI: 10.1016/j.sxmr.2018.03.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/19/2018] [Accepted: 03/24/2018] [Indexed: 11/26/2022]
|
39
|
Capogrosso P, Pescatori E, Caraceni E, Mondaini N, Utizi L, Cai T, Salonia A, Palmieri A, Deho’ F. Satisfaction rate at 1-year follow-up in patients treated with penile implants: data from the multicentre prospective registry INSIST-ED. BJU Int 2018; 123:360-366. [PMID: 29956870 DOI: 10.1111/bju.14462] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Paolo Capogrosso
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | | | | | | | | | - Tommaso Cai
- Department of Urology; Santa Chiara Regional Hospital; Trento Italy
| | - Andrea Salonia
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | | | - Federico Deho’
- Università Vita-Salute San Raffaele; Milan Italy
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| |
Collapse
|
40
|
Scherzer ND, Dick B, Gabrielson AT, Alzweri LM, Hellstrom WJG. Penile Prosthesis Complications: Planning, Prevention, and Decision Making. Sex Med Rev 2018; 7:349-359. [PMID: 30033128 DOI: 10.1016/j.sxmr.2018.04.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Inflatable penile prosthesis (IPP) is an established treatment option for men with erectile dysfunction (ED) refractory to medical therapy. Standardization of surgical technique and improvements in device construction have reduced all-cause complication rates to less than 5% in recent reports. Nonetheless, complications do exist, and can strongly impact morbidity and the quality of life of patients. Prosthetic urologists must be aware of the constellation of complications that can arise during or after IPP placement. AIM To provide a comprehensive review of penile prosthesis complications and discuss preventative strategies, as well as proper preoperative, intraoperative, and postoperative decision making. METHODS A review of the available literature from 1973 to 2018 was performed using PubMed with regard to IPP complications. MAIN OUTCOME MEASURES We reviewed publications that outlined preoperative planning strategies and the following IPP complications: hematoma, floppy glans, corporal fibrosis, corporal perforation and crossover, urethral injury, infection, impending erosion, and glandular ischemia. RESULTS Careful patient and device selection, setting realistic expectations of postsurgical outcomes, and adherence to a perioperative checklist is essential in the preoperative period. Intraoperatively, anticipate corporal fibrosis situations and always dilate laterally during corporal passage to reduce the risk of crossover and urethral injury. Limit perioperative antiplatelet therapy, apply compressive dressing, use a closed suction drain if indicated, and leave the device partially inflated postoperatively to reduce risk of hematoma. After surgery, monitor patients for potential complications that may warrant device explantation or salvage: IPP infection, glans ischemia, and impending erosion. CONCLUSIONS By using evidence and expert opinion-based decision-making strategies in the preoperative, intraoperative, and postoperative period of IPP placement, surgeons can reduce the risk of complications and dissatisfaction, even in ED patients with multiple comorbid conditions. Scherzer ND, Dick B, Gabrielson AT, et al. Penile Prosthesis Complications: Planning, Prevention, and Decision Making. Sex Med Rev 2019;7:349-359.
Collapse
Affiliation(s)
- Nickolas D Scherzer
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Brian Dick
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Andrew T Gabrielson
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Laith M Alzweri
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA.
| |
Collapse
|
41
|
Predictors of Satisfaction in Men After Penile Implant Surgery. J Sex Med 2018; 15:1180-1186. [PMID: 30017718 DOI: 10.1016/j.jsxm.2018.05.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Despite the high satisfaction with penile implant (PI) surgery reported in the literature, a significant proportion of patients remain dissatisfied. AIM To evaluate satisfaction after PI surgery, using a single question and a scoring system. Furthermore, we attempted to define factors that predicted high patient satisfaction. METHODS The study population consisted of all patients undergoing PI surgery between 2009 and 2015. Comorbidity, demographic, and implant information were recorded. Complications recorded included: minor (requiring no re-operation) such as penile or scrotal hematoma, superficial wound breakdown; major (requiring hospitalization or re-operation) such as device infection, erosion, and mechanical malfunction. Patient satisfaction was defined using a single question posed to the patient 6 months after surgery using a 5-point Likert scale (5 being the most satisfied). Descriptive statistics were used to define complication rates and multivariable analysis (MVA) was performed to define predictors of high satisfaction (score ≥ 4), including presence and degree of complications, Peyronie's disease (PD), diabetes mellitus (DM), number of vascular comorbidities, body mass index (BMI) > 30, and patient age. MAIN OUTCOME MEASURE Patients with a major complication, with or without an additional minor complication, had a higher likelihood of being dissatisfied (25%) compared to patients with no complication or only minor complication 1.9% (no complications) and 3.7% (only minor complications), P < .001. RESULTS 902 patients were analysed. Mean age was 56.6 ± 10.6 years. Mean BMI was 30 ± 5. Comorbidity profile was diabetes 75%, dyslipidaemia 44%, hypertension 33%, cigarette smoking 32%, and PD 34%. 76% had a malleable implant (MPP) and 24% an inflatable implant (IPP). 31% had a minor complication and 9% a major complication. 93% had high satisfaction (score ≥4). Patients with any complication had a reduced rate of high satisfaction (97.5% vs 87.7%; P < .001) and even more pronounced with a major complication (96.7% vs 64.2%; P < .001). On MVA, only the absence of a major complication was a significant predictor of high satisfaction (OR 20, 95% CI 9-50, P < .001). CONCLUSION A high percentage of men are satisfied after penile implant surgery. Only the presence of a major complication is linked to a lower likelihood of achieving high satisfaction. Habous M, Tal R, Tealab A, et al. Predictors of Satisfaction in Men After Penile Implant Surgery. J Sex Med 2018;15:1180-1186.
Collapse
|
42
|
Morgado A, Cavadas AS, Pacheco Figueiredo L, Tomada N. Long-term patient-reported satisfaction with different inflatable penile prosthesis: Comparison between AMS 700CX and Coloplast Titan. Rev Int Androl 2018; 16:112-118. [DOI: 10.1016/j.androl.2017.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/13/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
|
43
|
Introduction to Imaging of Penile Prostheses: A Primer for the Radiologist. AJR Am J Roentgenol 2018; 210:1192-1199. [DOI: 10.2214/ajr.17.18942] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
44
|
Loh-Doyle J, Patil MB, Sawkar H, Wayne K, Boyd SD. 3-Piece Inflatable Penile Prosthesis Placement Following Radical Cystoprostatectomy and Urinary Diversion: Technique and Outcomes. J Sex Med 2018; 15:907-913. [DOI: 10.1016/j.jsxm.2018.01.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/06/2018] [Accepted: 01/21/2018] [Indexed: 11/24/2022]
|
45
|
Colson M, Cuzin B, Faix A, Grellet L, Huyghes E. Actualité des implants péniens. SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2018.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
46
|
Chung PH, Siegel JA, Tausch TJ, Klein AK, Scott JM, Morey AF. Inflatable penile prosthesis as tissue expander: what is the evidence? Int Braz J Urol 2017; 43:911-916. [PMID: 28537700 PMCID: PMC5678524 DOI: 10.1590/s1677-5538.ibju.2016.0528] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/11/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Many patients who undergo inflatable penile prosthesis (IPP) replacement are often upsized to larger cylinders, suggesting the IPP may serve as a tissue expander and increase internal penile length. The objective of this study is to evaluate whether cylinder length increases with subsequent IPP insertion. MATERIALS AND METHODS We queried American Medical Systems and Coloplast Patient Information Form databases to identify patients who underwent IPP placement and replacement between 2004-2013. Patients were grouped by device type and time to replacement (<2 or ≥2 years). We selected the 2-year mark for subgroup analysis to allow time for tissue expansion to occur and to exclude patients who underwent early explantation (e.g. erosion or infection). RESULTS Two thousand, seven hundred and forty nine patients (1,532 AMS 700 LGX, 717 AMS 700 CX, and 500 Coloplast Titan) met the inclusion criteria. Mean time between implants was earlier for LGX (29 months) than CX (39 months) and Titan (48 months) patients (p<0.001). Patients who underwent device replacement at <2 years did not experience an increase in mean cylinder length. On the contrary, patients who underwent device replacement at ≥2 years did experience significant increases in mean cylinder length (LGX 1.2 cm, CX 1.1 cm, and Titan 0.9 cm, p<0.001). The mean increases in length at ≥2 years were similar between the 3 devices (p=0.20). Sixty percent of patients demonstrated increases of >0.5 cm and 40% demonstrated increases of ≥1 cm. CONCLUSIONS As demonstrated, the IPP may provide tissue expansion over time. Further evaluation is needed to determine if increased cylinder length correlates to increased functional length and patient satisfaction.
Collapse
Affiliation(s)
- Paul H Chung
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jordan A Siegel
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy J Tausch
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexandra K Klein
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeremy M Scott
- 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
| |
Collapse
|
47
|
Narang GL, Figler BD, Coward RM. Preoperative counseling and expectation management for inflatable penile prosthesis implantation. Transl Androl Urol 2017; 6:S869-S880. [PMID: 29238666 PMCID: PMC5715186 DOI: 10.21037/tau.2017.07.04] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The inflatable penile prosthesis (IPP) is the gold standard surgical treatment for medical refractory erectile dysfunction (ED). While the modern IPP has enjoyed high satisfaction rates as a product of its continued innovation, reliability, and performance, patient dissatisfaction can still occur. IPP implantation restores physiologic function with cosmetic and psychological consequences, both of which place inherent emphasis on preoperative counseling and expectation management. This review aims to highlight the complex nature of such counseling and provide practitioners with a roadmap to navigate the landscape. Preoperative counseling begins with appropriate patient selection and identification of those patients who are at risk for dissatisfaction as a result of personality characteristics. The informed consent provides a natural framework to discuss the host of complications and risks that are associated with surgery, including infection, device malfunction, damage to nearby structures, and device erosion. Device selection is a nuanced process that merges patient preference with clinical factors and consideration. We address device selection through a description of cylinder construction, pump design, and reservoir placement in the context of preoperative counseling. Lastly, we draw attention to expectation management with a specific focus on possible post-operative changes to penile length and sensation as well as partner involvement. The modern IPP provides excellent results with high patient and partner satisfaction. Ultimately, satisfaction is dependent on multiple factors, but providing accurate, realistic counseling and expectation management prepares patients for the best possible outcomes.
Collapse
Affiliation(s)
- Gopal L Narang
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Bradley D Figler
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Robert M Coward
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA.,UNC Fertility, LLC, Raleigh, NC, USA
| |
Collapse
|
48
|
O’Rourke TK, Erbella A, Zhang Y, Wosnitzer MS. Prevention, identification, and management of post-operative penile implant complications of infection, hematoma, and device malfunction. Transl Androl Urol 2017; 6:S832-S848. [PMID: 29238663 PMCID: PMC5715191 DOI: 10.21037/tau.2017.06.07] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/05/2017] [Indexed: 01/26/2023] Open
Abstract
Penile prosthesis implant surgery is an effective management approach for a number of urological conditions, including medication refractory erectile dysfunction (ED). Complications encountered post-operatively include infection, bleeding/hematoma, and device malfunction. Since the 1970s, modifications to these devices have reduced complication rates through improvement in antisepsis and design using antibiotic coatings, kink-resistant tubing, lock-out valves to prevent autoinflation, and modified reservoir shapes. Device survival and complication rates have been investigated predominately by retrospective database-derived studies. This review article focuses on the identification and management of post-operative complications following penile prosthetic and implant surgery. Etiology for ED, surgical technique, and prosthesis type are variable among studies. The most common post-operative complications of infection, bleeding, and device malfunction may be minimized by adherence to consistent technique and standard protocol. Novel antibiotic coatings and standard antibiotic regimen may reduce infection rates. Meticulous hemostasis and intraoperative testing of devices may further reduce need for revision surgery. Additional prospective studies with consistent reporting of outcomes and comparison of surgical approach and prosthesis type in patients with variable ED etiology would be beneficial.
Collapse
Affiliation(s)
- Timothy K. O’Rourke
- Quinnipiac University Frank H. Netter MD School of Medicine, Hamden, CT, USA
| | - Alexander Erbella
- Quinnipiac University Frank H. Netter MD School of Medicine, Hamden, CT, USA
| | - Yu Zhang
- Quinnipiac University Frank H. Netter MD School of Medicine, Hamden, CT, USA
| | - Matthew S. Wosnitzer
- Quinnipiac University Frank H. Netter MD School of Medicine, Hamden, CT, USA
- Yale New Haven Health—Northeast Medical Group Urology/Male Reproductive Medicine and Surgery, Fairfield, CT, USA
| |
Collapse
|
49
|
Brennan MS, Barlotta RM, Simhan J. Frailty Assessments in Surgical Practice: What is Frailty and How Can It Be Used in Prosthetic Health? Sex Med Rev 2017; 6:302-309. [PMID: 28756048 DOI: 10.1016/j.sxmr.2017.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Surgical frailty is a previously unrecognized clinical entity that objectifies a multiorgan decrease in physiologic reserve in those undergoing surgery. Although penile implantation has been demonstrated to be an effective means of restoring erectile function in patients whose previous conservative measures have failed, there are limited data regarding the assessment of frailty in patients undergoing penile implantation. AIM To review the various objective methods used to describe surgical frailty in medical and surgical disciplines, report on methodologies of frailty assessment, and discuss the relevance of surgical frailty in the preoperative evaluation of patients undergoing implantation of an inflatable penile prosthesis. METHODS A literature review was performed through PubMed regarding surgical frailty in the disciplines of medicine, surgery, and urology. Key words and phrases included frailty, elderly, aging, erectile dysfunction, penile implantation, and penile prosthesis. MAIN OUTCOME MEASURE Critical assessment of frailty in medicine and its application to male prosthetic health. RESULTS Frailty has been assessed by different metrics in multiple fields. Validated modalities to determine physiologic reserve include an accumulation of deficits and phenotypic objective assessments that are reviewed in detail. Frail patients experience longer length of stay, postoperative complications, unplanned returns to the operating room, and readmissions and are less likely to be discharged to home. Novel frailty assessments objectified through grip strength measurements from our institution demonstrate that a considerable number of patients, young and old, undergoing penile implantation exhibit surgical frailty. CONCLUSION There is a growing need to incorporate frailty assessment in the preoperative risk stratification of patients undergoing penile implantation. Grip strength evaluation seems to be an obvious standard because it is likely the easiest to measure and is clinically relevant given the user's dependence on manual dexterity to use the device. Screening for frailty does not create a substantial time, financial, or resource burden for the urologist. Brennan MS, Barlotta RM, Simhan J. Frailty Assessments in Surgical Practice: What is Frailty and How Can It Be Used in Prosthetic Health? Sex Med Rev 2018;6:302-309.
Collapse
Affiliation(s)
- Matthew S Brennan
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Ryan M Barlotta
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jay Simhan
- Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA.
| |
Collapse
|
50
|
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: 26] [Impact Index Per Article: 3.7] [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.
Collapse
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
| |
Collapse
|