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Shumaker LA, Compher TR, Selph JP. Delayed management of artificial urinary sphincter cuff erosion: a case series. Transl Androl Urol 2023; 12:944-948. [PMID: 37305620 PMCID: PMC10251094 DOI: 10.21037/tau-22-809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/17/2023] [Indexed: 06/13/2023] Open
Abstract
Background The artificial urinary sphincter (AUS) has been used to treat post-prostatectomy incontinence in men for decades with excellent outcomes and low complication rates. A successful AUS placement can dramatically improve the quality of life in men with stress urinary incontinence. Consequently, complications in this population can be devastating for the patient. One of the most troublesome complications is cuff erosion, which necessitates explantation of the device and dooms a man to recurrent incontinence. While the device can be replaced, device replacements are fraught with high erosion rates. Furthermore, it is not uncommon for men undergoing AUS placement to have multiple medical comorbidities that make urgent surgery for explantation unideal. Nonetheless, men with cellulitis and significant symptoms must undergo removal of an eroded AUS. There is little to no literature published on the timing or need for device removal in the man who has an asymptomatic erosion. Case Description We report a case series of five men undergoing delayed or no explantation of an asymptomatic cuff erosion. All five men were asymptomatic at the time of presentation and underwent a delayed explant or no explant. No man required urgent device explant while the erosion was present. Conclusions Urgent device explantation may not be necessary in the asymptomatic AUS cuff erosion, and further study may be able to elucidate men who can avoid removal of cuff erosion when no symptoms are present.
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Affiliation(s)
- Luke A. Shumaker
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tyler R. Compher
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John P. Selph
- Urology Associates of Nashville, Nashville, Tennessee, USA
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Barham DW, Choi E, Hammad M, Swerdloff D, Berk BD, Chung E, Clavell-Hernandez J, Gross MS, Jenkins LC, Jones JM, Kathrins MN, Lentz AC, Schammel J, Selph JP, Simhan J, Welliver C, Yafi FA. Partial Component Exchange of a Non-Infected Inflatable Penile Prosthesis is Associated With a Higher Complication Rate. Urology 2023; 174:128-134. [PMID: 36669572 DOI: 10.1016/j.urology.2022.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To describe the infectious and non-infectious complications in men undergoing Inflatable penile prosthesis (IPP) revision with partial and complete component exchange for mechanical malfunction. METHODS We performed a multicenter retrospective cohort study of patients who underwent IPP revision. Men undergoing procedures for implant infection were excluded. Patients were divided into those who had complete exchange of the entire device or partial exchange of only one or 2 components. Infectious and non-infectious complications were compared between groups. RESULTS Three hundred sixty-eight men had complete exchange of the entire device and 85 had partial component exchange. Men undergoing partial exchange had a significantly higher infection rate (7.1% vs 2.2%, P = .031). The partial exchange group also was more likely to receive antifungals (51.8 vs 16.6%, P < .001), have a modified salvage washout (77.4 vs 60.2%, P = .004), and less likely to receive vancomycin and gentamicin (63.5 vs 83.7%, P < .001). Time to revision was significantly shorter in the partial exchange group (44.9 vs 168.2 months, P < .001). Mean follow-up was slightly longer in the complete exchange group (18.3 vs 13.0 months). In multivariable analysis, partial exchange surgery, vancomycin and gentamicin prophylaxis, modified salvage washout, and antifungal prophylaxis were no longer associated with postoperative infections. The partial exchange group had greater rates of non-infectious complications (21.2% vs 9.5%, P = .005) such as pump malfunction and tubing breakage. CONCLUSION Patients undergoing partial component revision had more infectious and non-infectious complications. These findings suggest that partial component exchange increases complications in men undergoing IPP revision.
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Affiliation(s)
- David W Barham
- Department of Urology, University of California, Irvine, Orange, CA.
| | - Edward Choi
- Department of Urology, University of California, Irvine, Orange, CA
| | - Muhammed Hammad
- Department of Urology, University of California, Irvine, Orange, CA
| | - Daniel Swerdloff
- Department of Urology/Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Brittany D Berk
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Jonathan Clavell-Hernandez
- Clavell Urology, Houston, TX; Division of Urology, Department of Surgery, University of Texas McGovern Medical School, Houston, TX
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - Martin N Kathrins
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Aaron C Lentz
- Division of Urology, Department of Surgery, Duke University, Durham, NC
| | | | | | - Jay Simhan
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Faysal A Yafi
- Department of Urology, University of California, Irvine, Orange, CA
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Sawyer KN, Cofield SS, Selph JP. AUTHOR REPLY. Urology 2022; 163:75. [DOI: 10.1016/j.urology.2021.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/19/2021] [Indexed: 11/15/2022]
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Sawyer KN, Cofield SS, Selph JP. Race as a Predictor of Recurrence and Complications After Urethroplasty in Men With Urethral Stricture Disease. Urology 2022; 163:69-75. [PMID: 34852248 PMCID: PMC9142758 DOI: 10.1016/j.urology.2021.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the role of race in surgical outcomes of and complications after urethroplasty. METHODS A single institution, retrospective review was conducted from 2011 to 2019 on male patients ≥18 years of age who underwent urethroplasty. Exclusion criteria included previous urethral cancer, lack of follow up, or revision urethroplasty. Failure of urethroplasty was defined as requiring revision surgery or recurrence on imaging or cystoscopy. Risk factors for recurrence were determined using descriptive statistics, Wilcoxon comparisons, and multivariate logistic regression. RESULTS Three hundred and seven patients were identified with 234 patients meeting inclusion criteria. 63.2% identified as White/Caucasian (CA), 32.5% Black/African American (AA), and 4.3% other race. Mean age was 49.4 years. Between CA and AA patients, there was no difference in mean age, body mass index, smoking status, prior urethroplasty, or prior dilation/DVIU. CAs were more likely to have a fossa navicularis stricture compared to AAs (P = .0094), but there were no significant differences in bulbar, penile, or posterior stricture rates (all P >.05) or length (P = .32). The overall stricture recurrence rate was 15.8% with a median of 242 days to recurrence and no significant difference by race for either outcome (P = .83, P = .64). The only predictor of stricture recurrence was prior dilation/DVIU (P = .0404, OR 2.3, 95% CI 1.0, 5.6). Overall complication rate was 17.5%, with no difference between CA and AAs rates (P = .83) or complication type (P = .62). CONCLUSION There was no significant difference in the rate of surgical failure for urethral stricture repair based on race. The only predictor of surgical failure was having a prior urethral dilation/DVIU.
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Affiliation(s)
| | - Stacey S Cofield
- Department of Biostatistics, University of Alabama at Birmingham, School of Public Health, Birmingham, AL
| | - John P Selph
- Department of Urology, University of Alabama School of Medicine, Birmingham, AL.
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Campbell S, Kim C, Allkanjari A, Nose B, Selph JP, Lentz A. Small Diameter Penile Implants: A Survey on Current Utilization and Review of Literature. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Glaser Z, Selph JP. Penile Entrapment by Metal Ring: A Video Guide to Surgical Removal. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Van Gerwen OT, Aryanpour Z, Selph JP, Muzny CA. Anatomical and sexual health considerations among transfeminine individuals who have undergone vaginoplasty: A review. Int J STD AIDS 2022; 33:106-113. [PMID: 34615399 PMCID: PMC9713597 DOI: 10.1177/09564624211046997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As acceptance of transgender and gender diverse individuals continues to increase, gender-affirming surgery, a cornerstone in the management of gender dysphoria, is becoming more readily available. HIV and sexually transmitted infections (STIs) disproportionately affect these populations, but there are limited epidemiologic and management data on STIs in people who have undergone gender-affirming genital surgery such as vaginoplasty. This review will provide clinicians with anatomical details about the various vaginoplasty procedures currently being performed, complications associated with these procedures, and an overview of the current literature describing HIV/STI epidemiology among transfeminine individuals who have undergone vaginoplasty.
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Affiliation(s)
- Olivia T Van Gerwen
- Department of Medicine, Division of Infectious Diseases, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zain Aryanpour
- Department of Medicine, 9967University of Alabama School of Medicine, Birmingham, AL, USA
| | - John P Selph
- Department of Urology, 9968University of Alabama at Birmingham, Birmingham, AL, USA.Increase
| | - Christina A Muzny
- Department of Medicine, 9967University of Alabama School of Medicine, Birmingham, AL, USA
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Abstract
The erector spinae plane block (ESPB) is an interfascial plane block that has been used to provide perioperative analgesia for a variety of indications. This case report describes the novel use of the sacral ESPB on a transgender patient undergoing male-to-female gender reassignment surgery for perioperative pain control. The sacral ESPB technique was described and post-operative pain score and opioid requirements were reported. The sacral ESPB was successfully used as an alternative to neuraxial, caudal, or peripheral nerve blocks for gender reassignment surgery.
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Affiliation(s)
- Promil Kukreja
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Paige Deichmann
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - John P Selph
- Urology, University of Alabama at Birmingham, Birmingham, USA
| | - John Hebbard
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Hari Kalagara
- Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
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Kahokehr AA, Selph JP, Belsante MJ, Bashir M, Sofue K, Tausch TJ, Brand TC, Lloyd JC, Goldsmith ZG, Walter JR, Peterson AC. Mechanism of Action of the Transobturator Sling for Post-Radical Prostatectomy Incontinence: A Multi-institutional Prospective Study Using Dynamic Magnetic Resonance Imaging. Urology 2018; 116:185-192. [PMID: 29567018 DOI: 10.1016/j.urology.2018.01.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/22/2018] [Accepted: 01/27/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the length of the membranous (functional) urethra in male patients who underwent the male transobturator sling (TOS) for postradical prostatectomy urinary incontinence (PPI). The TOS is in established use for treatment of PPI; however, the precise mechanism of action is unknown. MATERIALS AND METHODS This is a prospective case-controlled study on men undergoing male TOS surgery from 2008 to 2014. The comparison arm included patients without incontinence after radical prostatectomy. All participants underwent dynamic magnetic resonance imaging (MRI) at baseline and this was repeated after TOS placement for those who underwent the procedure. Three standardized points were measured using MRI and compared in both groups in addition to clinical measures. RESULTS Thirty-nine patients were enrolled and 31 patients completed the protocols. The controls (N = 14) had a longer vesicourethral anastomosis to urethra measured at the penile bulb (functional urethral length) distance compared to the pre-TOS group at rest (1.92 cm controls vs 1.27 cm pre-TOS, P = .0018) and at Valsalva (2.13 cm controls vs 1.72 cm pre-TOS, P = .0371). Placement of the sling (N = 17) increased the functional urethral length distance at rest (1.92 cm control vs 1.53 cm post-TOS, P = .09) and at Valsalva (1.94 cm post-TOS vs 2.13 cm control, P = .61), so that the difference was no longer statistically significant. CONCLUSION We identified that one possible mechanism in improvement in stress urinary incontinence post-TOS placement is the lengthening of the vesicourethral anastomosis to bulbar-urethra distance. This is the first such study utilizing dynamics MRI in post prostatectomy controls, incontinent pre-TOS, and post-TOS to assess and show these findings.
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Affiliation(s)
- Arman A Kahokehr
- Division of Urology, Duke University Medical Center, Durham, NC.
| | - John P Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Mustafa Bashir
- Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC
| | - Keitaro Sofue
- Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC
| | - Timothy J Tausch
- Department of Urology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Timothy C Brand
- Division of Urology, Madigan Army Medical Center, Tacoma, WA
| | - Jessica C Lloyd
- Division of Urology, Duke University Medical Center, Durham, NC
| | | | - Jack R Walter
- Division of Urology, Madigan Army Medical Center, Tacoma, WA
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10
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Yarlagadda VK, Kilgore ML, Selph JP. Analysis of cost of component replacement versus entire device replacement during artificial urinary sphincter revision surgery. Neurourol Urodyn 2018; 37:1931-1936. [DOI: 10.1002/nau.23533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/15/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Vidhush K. Yarlagadda
- Department of Urology; University of Alabama at Birmingham School of Medicine; Birmingham, Alabama
| | - Meredith L. Kilgore
- School of Public Health; University of Alabama at Birmingham; Birmingham, Alabama
| | - John P. Selph
- Department of Urology; University of Alabama at Birmingham School of Medicine; Birmingham, Alabama
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Gordetsky J, Gennaro KH, Selph JP, Rais-Bahrami S. Nephrogenic Adenoma: Clinical Features, Management, and Diagnostic Pitfalls. Urology 2016; 95:29-33. [PMID: 27138263 DOI: 10.1016/j.urology.2016.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 04/20/2016] [Accepted: 04/26/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To review the diagnosis and management of nephrogenic adenoma (NA), an uncommon benign lesion found in the urinary tract. This lesion arises from a proliferation of implanted renal tubular cells. Although more common in adults, it can occur in all ages. NAs can recur and cause significant morbidity in patients. NAs are also a potential diagnostic pitfall as they can clinically and histologically mimic malignancy in the urinary tract. MATERIALS AND METHODS We performed an Institutional Board Review approved search of our surgical pathology database from 2005 to 2015 for cases of NA. A retrospective chart review was performed with a focus on the clinical, pathologic, and radiographic findings in these patients. RESULTS We identified 32 cases of NA in 31 patients. Lesions were most common in Caucasian males (male-to-female ratio of 2:1) with an average age at diagnosis of 55 years (range 25-77). Bladder was the most common site of occurrence (81.2%), followed by ureter (9.4%), urethra (6.3%), and intrarenal collecting system (3.1%). Most patients (72%) were symptomatic and presented with hematuria (41%), lower urinary tract symptoms (28%), pelvic or flank pain (6%), hydronephrosis (19%), or urinary incontinence (13%). NA was asymptomatic and identified incidentally in 9 (28%) patients. One patient (3%) had a renal transplant and 8 (26%) patients had diabetes mellitus. Twenty-six (84%) patients were managed with endoscopic resection of their tumors. CONCLUSION NAs are benign lesions that may cause significant morbidity and mimic malignant tumors. There should be increased suspicion in patients with predisposing factors.
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Affiliation(s)
- Jennifer Gordetsky
- University of Alabama at Birmingham, Department of Pathology, Birmingham, AL; University of Alabama at Birmingham, Department of Urology, Birmingham, AL.
| | - Kyle H Gennaro
- University of Alabama, School of Medicine, Birmingham, AL
| | - John P Selph
- University of Alabama at Birmingham, Department of Urology, Birmingham, AL
| | - Soroush Rais-Bahrami
- University of Alabama at Birmingham, Department of Urology, Birmingham, AL; University of Alabama at Birmingham, Department of Radiology, Birmingham, AL
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Ajay D, Zhang H, Gupta S, Selph JP, Belsante MJ, Lentz AC, Webster GD, Peterson AC. The Artificial Urinary Sphincter is Superior to a Secondary Transobturator Male Sling in Cases of a Primary Sling Failure. J Urol 2015; 194:1038-42. [PMID: 25963183 DOI: 10.1016/j.juro.2015.04.106] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We compared continence outcomes in patients with post-prostatectomy stress urinary incontinence treated with a salvage artificial urinary sphincter vs a secondary transobturator sling. MATERIALS AND METHODS We retrospectively reviewed the records of patients undergoing salvage procedures after sling failure from 2006 to 2012. Postoperative success was defined as the use of 0 or 1 pad, a negative stress test and pad weight less than 8 gm per day. We performed the Wilcoxon test and used a Cox regression model and Kaplan-Meier survival analysis. RESULTS A total of 61 men presenting with sling failure were included in study, of whom 32 went directly to an artificial urinary sphincter and 29 received a secondary sling. Of the artificial urinary sphincter cohort 47% underwent prior external beam radiation therapy vs 17% of the secondary sling cohort (p = 0.01). Average preoperative 24 hour pad weight and pad number were higher in the artificial urinary sphincter cohort. Median followup in artificial urinary sphincter and secondary sling cases was 4.5 (IQR 4-12) and 4 months (IQR 1-5), respectively. Overall treatment failure was seen in 55% of patients (16 of 29) with a secondary sling vs 6% (2 of 32) with an artificial urinary sphincter (unadjusted HR 7, 95% CI 2-32 and adjusted HR 6, 95% CI 1-31). CONCLUSION In this cohort of patients with post-prostatectomy stress urinary incontinence and a failed primary sling those who underwent a secondary sling procedure were up to 6 times more likely to have persistent incontinence vs those who underwent artificial urinary sphincter placement. These data are useful for counseling patients and planning surgery. We currently recommend placement of an artificial urinary sphincter for patients in whom an initial sling has failed.
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Affiliation(s)
- Divya Ajay
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
| | - Haijing Zhang
- School of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Shubham Gupta
- Department of Urology, University of Kentucky, Lexington, Kentucky
| | - John P Selph
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael J Belsante
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Aaron C Lentz
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - George D Webster
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Andrew C Peterson
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Donovan ST, Rohman GT, Selph JP, Rajan R, Stocks RM, Thompson JW. Methicillin-resistant Staphylococcus aureus as a cause of neonatal suppurative parotitis: a report of two cases and review of the literature. Ear Nose Throat J 2014; 92:269-71. [PMID: 23780594 DOI: 10.1177/014556131309200609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Suppurative parotitis is an uncommon entity identified in newborns. While Staphylococcus aureus has been frequently identified as the causative pathogen among the few patients diagnosed with neonatal suppurative parotitis (NSP), there has only been one prior case described in the literature that was due to methicillin-resistant Staphylococcus aureus (MRSA). Because of its virulence, MRSA presents new and substantial challenges for the surgeon; we describe two cases of NSP caused by MRSA and the subsequent surgical intervention necessitated for cure. We also include a review of all cases of NSP described in the English-language literature.
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Affiliation(s)
- Sean T Donovan
- Department of Otolaryngology, The University of Florida and Shands Hospital, 1600 SW Archer Rd., Gainesville, FL 32610, USA.
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14
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Raynor MC, Smith A, Vyas SN, Selph JP, Carson CC. Dorsal penile nerve block prior to inflatable penile prosthesis placement: a randomized, placebo-controlled trial. J Sex Med 2012; 9:2975-9. [PMID: 22642415 DOI: 10.1111/j.1743-6109.2012.02756.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Dorsal penile nerve block (DPNB) has been previously shown to provide effective analgesia for penile surgeries. To date, few studies have examined the role of DPNB prior to inflatable penile prosthesis (IPP) implantation. AIM The purpose of this study was to assess the efficacy of local penile nerve block prior to IPP implantation for postoperative pain control. MAIN OUTCOME MEASURES The primary outcome was postoperative pain rated using the visual analog scale (VAS). Secondary outcome measures included total narcotic usage during hospitalization. METHODS Institutional Review Board approval was obtained. Patients with erectile dysfunction scheduled for IPP implantation were approached for study participation. Patients were excluded if they had a previous IPP scheduled for revision or replacement or were undergoing additional procedures during the same operative session. Patients were then randomized to either DPNB with 1% lidocaine and 0.5% bupivacaine without epinephrine or injectable saline placebo. Only the resident surgeon assisting in the case was aware of randomization. All procedures were performed by a single surgeon (C.C.C.). Postoperatively, patients were asked to rate their pain using a VAS hourly while in recovery, at 4 hours, and at 23 hours postoperatively. Total narcotic usage was also measured. RESULTS A total of 30 patients underwent randomization with 15 patients in each group. Baseline demographic data were similar in each group. There was a significant reduction in pain in the immediate postoperative period and at 4 hours after surgery in the treatment group when compared with placebo (VAS 2.5 vs. 5.3, P = 0.009 at 0 hours; VAS 2.8 vs. 5.1, P = 0.011 at 4 hours). Narcotic usage was similar among both groups. There were no perioperative or early postoperative complications in either group. CONCLUSIONS DPNB is safe and effective for reducing pain in the early postoperative period following penile prosthesis implantation.
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Affiliation(s)
- Mathew C Raynor
- Division of Urology, The University of North Carolina School of Medicine, Chapel Hill, NC 27599-7235, USA.
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Rohman GT, Selph JP, Rajan R, Thompson JW. Methicillin Resistant Staphylococcus Aureus as a Cause of Neonatal Suppurative Parotitis. Laryngoscope 2009. [DOI: 10.1002/lary.20463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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