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Quesada-Olarte J, Nelwan D, Fernandez-Crespo R, Parker J, Carrion RE. “Pumpology”: Evolution of the Penile Implant Pump and What Is on the Horizon. Curr Sex Health Rep 2022. [DOI: 10.1007/s11930-022-00348-5] [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: 12/05/2022]
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Quesada-Olarte J, Carrion RE, Fernandez-Crespo R, Henry GD, Simhan J, Shridharani A, Carrion RE, Hakky TS. Extended Reality-Assisted Surgery as a Surgical Training Tool: Pilot Study Presenting First HoloLens-Assisted Complex Penile Revision Surgery. J Sex Med 2022; 19:1580-1586. [PMID: 36088277 DOI: 10.1016/j.jsxm.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Extended reality-assisted urologic surgery (XRAS) is a novel technology that superimposes a computer-generated image on the physician's field to integrate common elements of the surgical process in more advanced detail. An extended reality (XR) interface is generated using optical head-mounted display (OHMD) devices. AIM To present the first case of HoloLens-assisted complex penile revision surgery. METHODS We describe our pilot study of HoloLens-assisted penile revision surgery and present a thorough review of the literature regarding XRAS technology and innovative OHMD devices. OUTCOMES The ability of XRAS technology to superimpose a computer-generated image of the patient and integrate common elements of the surgical planning process with long-distance experts. RESULTS XRAS is a feasible technology for application in complex penile surgical planning processes. CLINICAL TRANSLATION XRAS and OHMD devices are novel technologies applicable to urological surgical training and planning. STRENGTHS AND LIMITATIONS Evidence suggests that the potential use of OHMD devices is safe and beneficial for surgeons. We intend to pioneer HoloLens technology in the surgical planning process of a malfunctioning penile implant due to herniation of the cylinder. This novel technology has not been used in prosthetic surgery, and current data about XRAS are limited. CONCLUSION OHMD devices are effective in the operative setting. Herein, we successfully demonstrated the integration of Microsoft HoloLens 2 into a penile surgical planning process for the first time. Further development and studies for this technology are necessary to better characterize the XRAS as a training and surgical planning tool. Quesada-Olarte J, Carrion RE, Fernandez-Crespo R, et al. Extended Reality-Assisted Surgery as a Surgical Training Tool: Pilot Study Presenting First HoloLens-Assisted Complex Penile Revision Surgery. J Sex Med 2022;19:1580-1586.
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Slongo J, Loeb A, Carrion RE. Urolift® with median lobe resection for trilobar BPH. Int Braz J Urol 2020; 46:868. [PMID: 32648435 DOI: 10.1590/s1677-5538.ibju.2019.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 10/06/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Julio Slongo
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Aram Loeb
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Rafael E Carrion
- Department of Urology, University of South Florida, Tampa, FL, USA
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Gross MS, Reinstatler L, Henry GD, Honig SC, Stahl PJ, Burnett AL, Maria PP, Bennett NE, Kava BR, Kohler TS, Beilan JA, Carrion RE, Munarriz RM. Multicenter Investigation of Fungal Infections of Inflatable Penile Prostheses. J Sex Med 2020; 16:1100-1105. [PMID: 31255212 DOI: 10.1016/j.jsxm.2019.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Fungal infections of inflatable penile prostheses (IPPs) are inadequately understood in the literature. AIM To review a multi-institution database of IPP infections to examine for common patient and surgical factors related to IPP fungal infections. METHODS This is a retrospective Institutional Review Board-approved analysis of 217 patients at 26 institutions who underwent salvage or device explant between 2001 and 2018. Patient data were compiled after an extensive record review. OUTCOMES 26 patients (12%) with fungal infections were identified. RESULTS 23 of 26 patients (83%) with a fungal IPP infection were either diabetic or overweight. 15 patients had undergone primary IPP implantation, and the other 11 had previously undergone an average of 1.7 IPP-related surgeries (range 1-3; median 2). The average age at implantation was 63 years (range 31-92; median 63). 18 of the 26 patients with fungal infection had diabetes (69%), with a mean hemoglobin A1c (HbA1c) value of 8.4 (range 5.8-13.3; median 7.5). Twenty-two patients (85%) were overweight or obese. The mean body mass index for all patients was 30.1 kg/m2 (range 23.7-45 kg/m2; median 28.4 kg/m2), and that for diabetic patients was 30.8 kg/m2 (range 24.1-45 kg/m2, median 29.7 kg/m2). Ninety-one percent of implants were placed with intravenous antibiotics, consistent with current American Urological Association guidelines: an aminoglycoside plus first- or second-generation cephalosporin or vancomycin or ampicillin/sulbactam or piperacillin/tazobactam. 65% (17 of 26) of infected IPPs had only fungal growth in culture. No patient had concomitant immunosuppressive disease or recent antibiotic exposure before IPP implantation. CLINICAL IMPLICATIONS More than two-thirds of the fungal infections occurred in diabetic patients and 85% occurred in overweight or obese patients, suggesting that antifungal prophylaxis may be appropriate in these patients. STRENGTHS & LIMITATIONS This is the largest series of fungal infections reported to date in the penile prosthesis literature. The overall number of such cases, however, remains small. CONCLUSION Fungal infections represent 12% of all penile prosthesis infections in our series and were seen mostly in diabetic or overweight patients, who may benefit from antifungal prophylaxis. Gross MS, Reinstatler L, Henry GD, et al. Multicenter Investigation of Fungal Infections of Inflatable Penile Prostheses. J Sex Med 2019;16:1100-1105.
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Affiliation(s)
- Martin S Gross
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
| | - Lael Reinstatler
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Stanton C Honig
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Peter J Stahl
- Department of Urology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Arthur L Burnett
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pedro P Maria
- Department of Urology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nelson E Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jonathan A Beilan
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Rafael E Carrion
- Department of Urology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ricardo M Munarriz
- Department of Urology, Boston University Medical Center, Boston, MA, USA
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Abstract
INTRODUCTION Management for distal impending erosion can be difficult and has been previously managed with counter incisions which can lead to unsightly scars and increased infection risk. AIM To demonstrate a novel technique in management of impending erosion. METHODS We retrospectively reviewed patients who underwent placement of a distal biologic cap for impending erosion. MAIN OUTCOME MEASURE The main outcome was thesuccessful placement of inflatable penile prosthesis through a single incision. RESULTS All patients who underwent this procedure are functional and have had no evidence of recurrence. CLINICAL IMPLICATIONS A simple approach to manage impending distal erosion. STRENGTH & LIMITATIONS Limitations include small sample size and short duration of follow-up. CONCLUSION The distal biologic cap is a simple alternative technique to treat distal impending erosion of an inflatable penile prosthesis and can be performed safely without the need for additional incisions on the penis and with a minimal increase in operative times. Karpman E, DiGiorgio L, Carrion RE. Distal Biologic Cap for Impending Distal Erosion. J Sex Med 2020;17:551-555.
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Affiliation(s)
- Edward Karpman
- El Camino Urology Medical Group, Mountain View, CA, USA.
| | | | - Rafael E Carrion
- University of South Florida Department of Urology, Tampa, FL, USA
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Baumgarten AS, Beilan JA, Shah BB, Loeb A, Bickell M, Parker J, Henry GD, Carrion RE. Suprapubic Fat Pad Excision with Simultaneous Placement of Inflatable Penile Prosthesis. J Sex Med 2019; 16:333-337. [PMID: 30692027 DOI: 10.1016/j.jsxm.2018.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/03/2018] [Accepted: 12/10/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Many men suffering from erectile dysfunction are overweight with generous suprapubic fat pads, which often contribute to a decrease in visible exophytic phallic length. AIM To present a novel surgical concept of suprapubic fat pad excision with a concomitant placement of inflatable penile prosthesis. METHODS A transverse incision begins slightly medial to the anterior superior iliac spine, with the superior edge crossing transversely to the contralateral anterior superior iliac spine. The inferior border is incised in a curvilinear fashion, with the medial apex being approximately 1 cm above the base of the penis. Dissection is carried down to the lower abdominal anterior fascia, which leads to excision of the suprapubic fat pad. Using this same exposure, the inflatable penile prosthesis (IPP) is placed via an infrapubic approach. The wound is reapproximated in multiple layers, and 2 drains are placed, 1 subcutaneous in the area of the fat pad excision and the other in the scrotum around the pump. MAIN OUTCOME MEASURES Primary outcomes included penile implant functionality, ability to engage in sexual activity, and cosmetic satisfaction. RESULTS A total of 8 patients have undergone suprapubic fat pad excision with simultaneous placement of IPP at our institution. Average body mass index of our patient cohort was 36.6. 1 patient developed prosthetic infection after inadvertent removal of his drains in the immediate postoperative period. At last follow-up, all other patients have excellent cosmetic and functional outcomes. CLINICAL IMPLICATIONS This technique can lead to higher patient satisfaction with their penile implant, enhanced sexual performance, and improved quality of life for patients with concurrent erectile dysfunction and significant suprapubic fat pad. STRENGTHS & LIMITATIONS This unique technique has never been previously described. It allows placement of IPP in the setting of fat pad excision without any additional incisions. Limitations include the small patient population and relatively short follow-up. CONCLUSIONS Suprapubic fat pad excision is a safe and reproducible technique that can be performed simultaneously with the placement of an IPP in appropriately selected patients. Patients must be counseled appropriately on the expectations of surgeries and the theoretical increased risk of postoperative complications, such as infection. Baumgarten AS, Beilan JA, Shah BB, et al. Suprapubic Fat Pad Excision with Simultaneous Placement of Inflatable Penile Prosthesis J Sex Med 2019;16:333-337.
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Affiliation(s)
| | | | - Bhavik B Shah
- University of South Florida, Department of Urology, Tampa, FL, USA
| | - Aram Loeb
- University Hospitals Urology Institute/Case Western Reserve University, Cleveland, OH, USA
| | | | - Justin Parker
- University of South Florida, Department of Urology, Tampa, FL, USA
| | - Gerard D Henry
- Ark-La-Tex Urology and Prostate Cancer Institute, Bossier City, LA, USA
| | - Rafael E Carrion
- University of South Florida, Department of Urology, Tampa, FL, USA.
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Affiliation(s)
- Bhavik B. Shah
- Department of Urology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Kevin Tayon
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - SriGita Madiraju
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Rafael E. Carrion
- Department of Urology, Morsani College of Medicine, University of South Florida, Tampa, Florida
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Beilan JA, Wallen JJ, Baumgarten AS, Morgan KN, Parker JL, Carrion RE. Intralesional Injection of Collagenase Clostridium histolyticum May Increase the Risk of Late-Onset Penile Fracture. Sex Med Rev 2018; 6:272-278. [DOI: 10.1016/j.sxmr.2017.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/23/2017] [Accepted: 07/23/2017] [Indexed: 11/25/2022]
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Beilan JA, Manimala NJ, Slongo J, Loeb A, Spiess PE, Carrion RE. Surgical Reconstruction After Penile Cancer Surgery. Curr Sex Health Rep 2017. [DOI: 10.1007/s11930-017-0134-1] [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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Baumgarten AS, Fisher JS, Lawindy SM, Pavlinec JG, Carrion RE, Spiess PE. Penile sparing surgical approaches for primary penile tumors: preserving function and appearance. Transl Androl Urol 2017; 6:809-819. [PMID: 29184777 PMCID: PMC5673820 DOI: 10.21037/tau.2017.04.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 12/20/2022] Open
Abstract
Penile cancer is a rare and potentially disfiguring disease. There are multiple treatment options for primary penile lesions. Penile sparing approaches offer an attractive option as they can provide several quality of life benefits without detrimental oncologic outcomes. With appropriate diagnostic evaluation and staging, penile sparing techniques provide proper cancer control with improved cosmetic and functional results. Regardless of the chosen treatment modality, a commitment to close follow-up remains a critical component of all treatment considerations. The goal of this review is to provide an overview of the multiple treatment strategies for primary penile tumors with a focus on penile sparing surgical approaches.
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Affiliation(s)
| | - John S Fisher
- Division of Urology, University of Tennessee, Knoxville, USA
| | | | | | | | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, USA
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Abstract
Background Compromised sexual function is often a side effect for patients following radical surgical procedures for bladder or prostate cancer. Methods The authors review the classification and physiology of sexual function and dysfunction. Moreover, they explain the possible pathophysiology directly resulting from surgery, and they discuss several approaches available to address these problems. Results Options for male sexual dysfunction, primarily erectile dysfunction resulting from radical prostatectomy or surgery for bladder cancer, range from patient education to penile prosthesis implantation. Female sexual dysfunction caused by surgical intervention for bladder cancer includes problems with libido, arousal, orgasm, and dyspareunia. Treatment options for women can include sex therapy, hormonal therapy, and preventive strategies. However, no consensus has been established on the most effective agents and time points to treat male or female sexual dysfunction following radical cystectomies or prostatectomies. The chronic intermittent treatment of erectile dysfunction following radical prostatectomy has been commonly referred to as penile rehabilitation. Conclusions Additional research is needed to obtain further data concerning sexual dysfunction in both men and women following radical pelvic surgeries. Modification of surgical techniques, the use of various treatment modalities for sexual dysfunction, and the development of new agents will help to successfully minimize or prevent damage and restore normal sexual function after local surgical therapy for prostate or bladder cancer in the future.
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Abstract
Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass® optical head-mounted display to train urology residents in how to place an inflatable penile prosthesis. We use the phrase Augmented Reality Assisted Surgery to describe this novel application of augmented reality in the setting of surgery. The application demonstrates the steps of the surgical procedure of inflatable penile prosthesis placement. It also contains software that allows for detection of interest points using a camera feed from the optical head-mounted display to enable faculty to interact with residents during placement of the penile prosthesis. Urology trainees and faculty who volunteered to take part in the study were given time to experience the technology in the operative or perioperative setting and asked to complete a feedback survey. From 30 total participants using a 10-point scale, educational usefulness was rated 8.6, ease of navigation was rated 7.6, likelihood to use was rated 7.4, and distraction in operating room was rated 4.9. When stratified between trainees and faculty, trainees found the technology more educationally useful, and less distracting. Overall, 81% of the participants want this technology in their residency program, and 93% see this technology in the operating room in the future. Further development of this technology is warranted before full release, and further studies are necessary to better characterize the effectiveness of Augmented Reality Assisted Surgery in urologic surgical training.
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Affiliation(s)
- Ryan M Dickey
- Scott Department of Urology, Baylor College of Medicine, Houston 77030, USA
| | - Neel Srikishen
- Scott Department of Urology, Baylor College of Medicine, Houston 77030, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston 77030, USA
| | - Philippe E Spiess
- University of South Florida, Department of Urology, Tampa 33606, USA
| | - Rafael E Carrion
- University of South Florida, Department of Urology, Tampa 33606, USA
| | - Tariq S Hakky
- Scott Department of Urology, Baylor College of Medicine, Houston 77030, USA
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Gross MS, Phillips EA, Carrasquillo RJ, Thornton A, Greenfield JM, Levine LA, Alukal JP, Conners WP, Glina S, Tanrikut C, Honig SC, Becher EF, Bennett NE, Wang R, Perito PE, Stahl PJ, Rosselló Gayá M, Rosselló Barbará M, Cedeno JD, Gheiler EL, Kalejaiye O, Ralph DJ, Köhler TS, Stember DS, Carrion RE, Maria PP, Brant WO, Bickell MW, Garber BB, Pineda M, Burnett AL, Eid JF, Henry GD, Munarriz RM. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. J Sex Med 2017; 14:455-463. [PMID: 28189561 DOI: 10.1016/j.jsxm.2017.01.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/27/2016] [Accepted: 01/03/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements, and adoption of antibiotic prophylaxis guidelines. AIM To investigate penile prosthesis infection microbiology to consider which changes in practice could decrease infection rates, to evaluate current antibiotic prophylaxis guidelines, and to develop a proposed algorithm for penile prosthesis infections. METHODS This retrospective institutional review board-exempt multi-institutional study from 25 centers reviewed intraoperative cultures obtained at explantation or Mulcahy salvage of infected three-piece inflatable penile prostheses (IPPs). Antibiotic usage was recorded at implantation, admission for infection, and explantation or salvage surgery. Cultures were obtained from purulent material in the implant space and from the biofilm on the device. MAIN OUTCOME MEASURES Intraoperative culture data from infected IPPs. RESULTS Two hundred twenty-seven intraoperative cultures (2002-2016) were obtained at salvage or explantation. No culture growth occurred in 33% of cases and gram-positive and gram-negative organisms were found in 73% and 39% of positive cultures, respectively. Candida species (11.1%), anaerobes (10.5%) and methicillin-resistant Staphylococcus aureus (9.2%) constituted nearly one third of 153 positive cultures. Multi-organism infections occurred in 25% of positive cultures. Antibiotic regimens at initial implantation were generally consistent with American Urological Association (AUA) and European Association of Urology (EAU) guidelines. However, the micro-organisms identified in this study were covered by these guidelines in only 62% to 86% of cases. Antibiotic selection at admissions for infection and salvage or explantation varied widely compared with those at IPP implantation. CONCLUSION This study documents a high incidence of anaerobic, Candida, and methicillin-resistant S aureus infections. In addition, approximately one third of infected penile prosthesis cases had negative cultures. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14% to 38% of cases. These findings suggest broadening antibiotic prophylaxis guidelines and creating a management algorithm for IPP infections might lower infection rates and improve salvage success. Gross MS, Phillips EA, Carrasquillo RJ, et al. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. J Sex Med 2017;14:455-463.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sidney Glina
- Faculdade de Medicina do ABC/Instituto H. Ellis, Bela Vista, SP, Brazil
| | | | | | | | | | - Run Wang
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Peter J Stahl
- Columbia University College of Physicians & Surgeons, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Miguel Pineda
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Beilan JA, Baumgarten AS, Bickell M, Parker J, Carrion RE. Suspected Penile Fracture After Xiaflex Injection and Use of a VED. Urology 2016; 98:4-7. [DOI: 10.1016/j.urology.2016.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/19/2016] [Accepted: 07/23/2016] [Indexed: 12/01/2022]
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Abstract
MAIN FINDINGS A 26-year-old man suffering from partial priapism was successfully treated with a regimen including pentoxifylline, a nonspecific phosphodiesterase inhibitor that is often used to conservatively treat Peyronie's disease. CASE HYPOTHESIS: Partial priapism is an extremely rare urological condition that is characterized by thrombosis within the proximal segment of a single corpus cavernosum. There have only been 36 reported cases to date. Although several factors have been associated with this unusual disorder, such as trauma or bicycle riding, the etiology is still not completely understood. Treatment is usually conservative and consists of a non-steroidal anti-inflammatory and anti-thrombotic. Promising future implications: This case report supports the utilization of pentoxifylline in patients with partial priapism due to its anti-fibrogenic and anti-thrombotic properties.
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Affiliation(s)
- Meghan A. Cooper
- Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Rafael E. Carrion
- Department of Urology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Christopher Yang
- Department of Urology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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Hakky TS, Martinez D, Yang C, Carrion RE. Reduction corporoplasty. Int Braz J Urol 2015; 41:397; discussion 398. [PMID: 26005988 PMCID: PMC4752110 DOI: 10.1590/s1677-5538.ibju.2015.02.33] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 12/09/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Here we present the first video demonstration of reduction corporoplasty in the management of phallic disfigurement in a 17 year old man with a history sickle cell disease and priapism. INTRODUCTION Surgical management of aneurysmal dilation of the corpora has yet to be defined in the literature. MATERIALS AND METHODS We preformed bilateral elliptical incisions over the lateral corpora as management of aneurysmal dilation of the corpora to correct phallic disfigurement. RESULTS The patient tolerated the procedure well and has resolution of his corporal disfigurement. CONCLUSIONS Reduction corporoplasty using bilateral lateral elliptical incisions in the management of aneurysmal dilation of the corpora is a safe an feasible operation in the management of phallic disfigurement.
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Affiliation(s)
- Tariq S Hakky
- Department of Urology and Division of Andrology, University of South Florida, FL, USA
| | - Daniel Martinez
- Department of Urology and Division of Andrology, University of South Florida, FL, USA
| | - Christopher Yang
- Department of Urology and Division of Andrology, University of South Florida, FL, USA
| | - Rafael E Carrion
- Department of Urology and Division of Andrology, University of South Florida, FL, USA
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Wallen JJ, Baumgarten AS, Kim T, Hakky TS, Carrion RE, Spiess PE. Optimizing penile length in patients undergoing partial penectomy for penile cancer: novel application of the ventral phalloplasty oncoplastic technique. Int Braz J Urol 2015; 40:708-9. [PMID: 25498284 DOI: 10.1590/s1677-5538.ibju.2014.05.18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/15/2014] [Indexed: 11/22/2022] Open
Abstract
The ventral phalloplasty (VP) has been well described in modern day penile prosthesis surgery. The main objectives of this maneuver are to increase perceived length and patient satisfaction and to counteract the natural 1-2 cm average loss in length when performing implantation of an inflatable penile prosthesis. Similarly, this video represents a new adaptation for partial penectomy patients. One can only hope that the addition of the VP for partial penectomy patients with good erectile function will increase their quality of life. The patient in this video is a 56-year-old male who presented with a 4.0x3.5x1.0 cm, pathologic stage T2 squamous cell carcinoma of the glans penis. After partial penectomy with VP and inguinal lymph node dissection, pathological specimen revealed negative margins, 3/5 right superficial nodes and 1/5 left superficial nodes positive for malignancy. The patient has been recommended post-operative systemic chemotherapy (with external beam radiotherapy) based on the multiple node positivity and presence of extranodal extension. The patient's pre-operative penile length was 9.5 cm, and after partial penectomy with VP, penile length is 7 cm.
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Affiliation(s)
- Jared J Wallen
- Department of Urology, University of Southern Florida, USA
| | | | - Tim Kim
- Department of Genitourinary Oncology, Moffitt Cancer Center, USA
| | - Tariq S Hakky
- Department of Urology, University of Southern Florida, USA
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Baumgarten AS, Hakky TS, Carrion RE, Lockhart JL, Spiess PE. A single-institution experience with metallic ureteral stents: a cost-effective method of managing deficiencies in ureteral drainage. Int Braz J Urol 2014; 40:225-31. [PMID: 24856490 DOI: 10.1590/s1677-5538.ibju.2014.02.13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 11/26/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The limitations of traditional ureteral stents in patients with deficiencies in ureteral drainage have resulted in frequent stent exchanges. The implementation of metallic stents was introduced to improve the patency rates of patients with chronic upper urinary tract obstruction, obviating the need for frequent stent exchanges. We report our clinical experiences with the use of metallic ureteral stents in the management of poor ureteral drainage. MATERIALS AND METHODS Fifty patients underwent metallic ureteral stent placement from 2009 to 2012. Stent failure was defined as an unplanned stent exchange, need for nephrostomy tube placement, increasing hydronephrosis with stent in place, or an elevation in serum creatinine. Stent life was analyzed using the Kaplan-Meier methodology, as this was a time dependent continuous variable. A cost analysis was similarly conducted. RESULTS A total of 97 metallic stents were placed among our cohort of patients: 63 in cases of malignant obstruction, 33 in the setting of cutaneous ureterostomies, and 1 in an ileal conduit urinary diversion. Overall, stent failure occurred in 8.2% of the stents placed. Median stent life was 288.4 days (95% CI: 277.4-321.2 days). The estimated annual cost for traditional polymer stents (exchanged every 90 days) was $9,648-$13,128, while the estimated cost for metallic stents was $4,211-$5,313. CONCLUSION Our results indicate that metallic ureteral stent placement is a technically feasible procedure with minimal complications and is well tolerated among patients. Metallic stents can be left in situ for longer durations and provide a significant financial benefit when compared to traditional polymer stents.
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Affiliation(s)
- Adam S Baumgarten
- Department of Urology, University of South Florida and Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Tariq S Hakky
- Department of Urology, University of South Florida and Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Rafael E Carrion
- Department of Urology, University of South Florida and Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Jorge L Lockhart
- Department of Urology, University of South Florida and Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Fl, USA
| | - Philippe E Spiess
- Department of Urology, University of South Florida and Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Fl, USA
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Hakky TS, Baumgarten AS, Parker J, Zheng Y, Kongnyuy M, Martinez D, Carrion RE. Penile rehabilitation: the evolutionary concept in the management of erectile dysfunction. Curr Urol Rep 2014; 15:393. [PMID: 24578299 DOI: 10.1007/s11934-014-0393-6] [Citation(s) in RCA: 12] [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] [Indexed: 01/15/2023]
Abstract
A compromise in erectile function is commonly experienced after radical prostatectomy and has been attributed to injury to vascular, neurogenic, and smooth muscle. The concept of rehabilitation after organ injury is not a novel concept and is one that has been applied to all aspects of medicine. Penile rehabilitation has been classically defined as the use of a device or pharmacologic agent to aid erectile function recovery after radical prostatectomy. Here we redefine penile rehabilitation as the use of any device, medication, or intervention to promote male sexual function as a primer before and after any insult to the penile erectile physiologic axis. We also review the epidemiology, rational and current literature on penile rehabilitation after prostatectomy.
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Affiliation(s)
- Tariq S Hakky
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33606, USA,
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Pavlinec JG, Hakky TS, Yang C, Massis K, Munarriz R, Carrion RE. Penile Artery Shunt Syndrome: A Novel Cause of Erectile Dysfunction after Penile Revascularization Surgery. J Sex Med 2014; 11:2338-41. [DOI: 10.1111/jsm.12543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Simon R, Hakky TS, Henry G, Perito P, Martinez D, Parker J, Carrion RE. Tips and Tricks of Inflatable Penile Prosthesis Reservoir Placement: A Case Presentation and Discussion. J Sex Med 2014; 11:1325-33. [DOI: 10.1111/jsm.12481] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
PURPOSE To present the surgical technique of ventral phalloplasty as an adjunct procedure to the classic prosthetic surgery. MATERIALS AND METHODS In this video we demonstrate how to perform a ventral phalloplasty in a patient that has undergone a penile prosthesis implantation. Our technique consists of: delineation of the penile scrotal web, excision of this redundant skin, and re-approximation of the wound to mimic the natural median raphe. RESULTS The ventral phalloplasty improves the perception of phallic length, as well as patients' satisfaction after prosthetic surgery. CONCLUSION Penile length perception is the main concern of patients that have undergone penile prosthesis implantation. In this video we demonstrate that the ventral phalloplasty can improve perception of phallic length, and can be an important adjunct to the classic prosthetic surgery.
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Affiliation(s)
- Tariq S Hakky
- Department of Urology, Moffitt Cancer Center, Tampa, FL, USA.
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Hakky TS, Ferguson D, Spiess PE, Bradley P, Lue TF, Carrion RE. Three-dimensional mapping and comparative analysis of the distal human corpus cavernosum and the inflatable penile prosthesis. Asian J Androl 2013; 15:567-70. [PMID: 23542138 DOI: 10.1038/aja.2012.172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/16/2012] [Accepted: 01/20/2013] [Indexed: 11/09/2022] Open
Abstract
The intricate anatomy of the corpus cavernosum in both the flaccid and tumescent state has not been fully elucidated. We report our experience using a three-dimensional (3D) scanner to reconstruct cadaveric casts and compare them with 3D images of two prototypes of penile prosthesis. Two different models of the Titan Coloplast inflatable penile prosthesis were analyzed using a 3D scanner. The first was the standard model and the second was a newer model with a rounder silicone tip. Two cadaveric phalluses were harvested using Smooth-Cast 300Q polyurethane molding. The molds were excised and scanned along side the penile prosthesis. 3D scans were completed and analyzed using Leios Mesh software, and GOM Inspect software. The 3D scans demonstrated the mean human corporal radii 2 mm from the distal tip to be 36.51 mm (36.01-37.0 mm), which is an obtuse angle. The standard Titan penile prosthesis spherical radius at the same level was 202.52 mm, while the new silicone tip prosthesis had a radius of 139.33 mm. 3D mapping further demonstrated the trajectory of the cavernosa appeared curvilinear and the distal ends appeared blunt. The use of cadaveric cavernosal molds in combination with the 3D scanner allowed us to accurately image the corpus cavernosum for the first time. Our findings suggest that anatomically accurate corporal tips appear to be relatively blunt and that the new Titan silicone tip penile prosthesis more closely resembles the human corporal tip.
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Affiliation(s)
- Tariq S Hakky
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL 33602, USA
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Davila HH, Arison CN, Hall MK, Salup R, Lockhart JL, Carrion RE. ANALYSIS OF THE PSA RESPONSE AFTER TESTOSTERONE SUPPLEMENATATION IN PATIENTS WHO HAVE PREVIOUSLY RECEIVED MANAGEMENT FOR THEIR LOCALIZED PROSTATE CANCER. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61255-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Davila HH, Parker J, Webster JC, Lockhart JL, Carrion RE. Subarachnoid Hemorrhage as Complication of Phenylephrine Injection for the Treatment of Ischemic Priapism in a Sickle Cell Disease Patient. J Sex Med 2008; 5:1025-1028. [DOI: 10.1111/j.1743-6109.2007.00715.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Davila HH, Mamcarz M, Nadelhaft I, Salup R, Lockhart J, Carrion RE. Visualization of the neurovascular bundles and major pelvic ganglion with fluorescent tracers after penile injection in the rat. BJU Int 2007; 101:1048-51. [PMID: 18070171 DOI: 10.1111/j.1464-410x.2007.07344.x] [Citation(s) in RCA: 15] [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] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether fluorescent tracers can consistently label the neurovascular bundles (NVBs) and major pelvic ganglion (MPG) after an intracavernosal penile injection, as the reported incidence of erectile dysfunction (ED) in men after radical prostatectomy (RP) is 55-65% and thus preservation of erectile function, sparing one or both of the NVBs remains one of the most vital factors. MATERIALS AND METHODS Male Sprague-Dawley rats (3 months old) received penile injections (20 microL; seven rats/group) of either deionized water (DW), Fluoro-Gold (FG), Fast-Blue (FB), Fluoro-Ruby (FR) or green fluorescent pseudorabies virus (GF-PRv). The rats were killed at 2, 3 and 14 days after injection and the NVBs and MPG were harvested and placed directly under fluorescence light. Image analysis was done by computer, coupled to a microscope equipped with a digital camera. Each NVB and MPG were analysed for its staining pattern and consistency. RESULTS When compared with the FB, FR and GF-PRv rats, the FG-injected rats had better staining of the NVB at 2, 3 and 14 days after injection. Under x200, FG highlighted the axons of the cavernous nerve (CN) and cell bodies (MPG). This indicates that FG injection into the penis induced the strongest CN labelling (positive staining) at 2 and 3 days after injection as compared with FB-, FR- and GF-PRv-injected rats. CONCLUSION FG injection into the penis has consistent retrograde staining of the NVBs and MPG after 3 days. Therefore, we predict that FG could potentially be used to improve the identification of the NVB in other models. However, further studies need to be carried out before these tracers can be used in humans.
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Affiliation(s)
- Hugo H Davila
- Department of Interdisciplinary Oncology at Moffitt Cancer Center, Division of Urology, University of South Florida, College of Medicine, Tampa, FL 33612, USA
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Rahman NU, Phonsombat S, Bochinski D, Carrion RE, Nunes L, Lue TF. An animal model to study lower urinary tract symptoms and erectile dysfunction: the hyperlipidaemic rat. BJU Int 2007; 100:658-63. [PMID: 17590178 DOI: 10.1111/j.1464-410x.2007.07069.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To present evidence that rats fed a high-fat diet could serve as a useful animal model to study both lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), as recent epidemiological studies have shown a strong association between LUTS and ED but the physiological basis behind this relationship is unknown. MATERIALS AND METHODS In all, 24 male Sprague-Dawley rats were divided into two groups: nine controls were fed a 'normal' diet and 15 were fed a high-fat diet (hyperlipidaemic rats). After 6 months all the rats had bladder and erectile functions evaluated using awake cystometry and cavernosal nerve electrostimulation, respectively. After the functional studies were completed, the penis, prostate and bladder were collected for immunohistochemical analysis. RESULTS The hyperlipidaemic rats had significantly higher serum cholesterol and low-density lipoprotein than the controls (P < 0.05). The hyperlipidaemic rats also had significantly worse erectile function (P = 0.004) and developed more bladder overactivity (P = 0.004) than the controls. In the hyperlipidaemic rats there was significant muscle hypertrophy in the peri-urethral lobe of the prostate (P < 0.001) and in the bladder (P < 0.05). There was also greater P2X(1) (purinoceptor) staining as well as other molecular changes in the bladder of the hyperlipidaemic rats. CONCLUSIONS In this hyperlipidaemic rat model three abnormalities were consistently detected: prostatic enlargement, bladder overactivity, and ED. This rat model could be a useful research tool for understanding the common causes of LUTS and ED, as well as facilitating the development of preventive measures and better therapies to treat both conditions.
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Affiliation(s)
- Nadeem U Rahman
- Knuppe Molecular Urology Laboratory, Department of Urology, University of California San Francisco School of Medicine, San Francisco, CA 94143-0788, USA
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Henry GD, Cornell RJ, Flynn BJ, Simmons CJ, Carrion RE. 1492: A Multicenter Study on Perineal Versus Penoscrotal Approach for Implantation of an Artificial Urinary Sphincter: Cuff Size and Control of Male Stress Urinary Incontinence. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31693-8] [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: 11/15/2022]
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Bella AJ, Hayashi N, Minor TX, Carrion RE, Price R, Lue TF. 778: The Non-Immunosuppressant Immunophilin Ligand FK1706 Enhances the Recovery of Erectile Function Following Bilateral Cavernous Crush Injury in the Rat. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31018-8] [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: 11/25/2022]
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Carrion H, Caso JR, Henry GD, Webster JC, Carrion RE. 941: Peripheral and Corporal Blood Levels of Preoperative Vancomycin and Gentamycin in Patients Undergoing Penile Prosthesis Implantation. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31169-8] [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: 12/01/2022]
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Bella AJ, Hayashi N, Carrion RE, Price R, Lue TF. FK1706 Enhances the Recovery of Erectile Function Following Bilateral Cavernous Nerve Crush Injury in the Rat. J Sex Med 2007; 4:341-6; discussion 346-7. [PMID: 17367429 DOI: 10.1111/j.1743-6109.2007.00438.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Advances in neurobiology have led to a surge of clinical interest in the development of protective and regenerative neuromodulatory strategies, as surgical therapies for prostate cancer often result in neuronal damage and debilitating loss of sexual function. AIM To investigate the dose-dependent efficacy of FK1706, a nonimmunosuppressant immunophilin ligand, for the recovery of erectile function following bilateral cavernous nerve crush injury in the rat. MAIN OUTCOME MEASURES Recovery of erectile function was assessed by cavernous nerve electrostimulation and reported as maximal increase of intracavernous pressure (ICP) and area under the curve (AUC). Changes in animal weights, percentage completion of treatment course, and survival were compared between groups. METHODS; Thirty-five Sprague-Dawley male rats were randomly divided into five equal groups: seven animals received a sham operation, whereas 28 animals underwent bilateral cavernous nerve crush injury, followed by subcutaneous injection of vehicle alone (1.0 mL/kg), or low (0.1 mg/kg), medium (0.32 mg/kg), or high dose (1.0 mg/kg) FK1706 5 days per week for 8 weeks. RESULTS Erectile dysfunction did not occur in the sham group (mean maximal ICP increase of 100.8 +/- 6.3 cmH(2)O), whereas nerve injury and vehicle treatment produced a significant reduction in ICP response to 34.4 +/- 12.8 cmH(2)O. The mean ICP increase for high-dose FK106 treatment was 73.9 +/- 6.3 cmH(2)O (P < 0.01 vs. vehicle) compared with 58.3 +/- 7.4 cmH(2)O and 56.9 +/- 8.3 for low and medium doses (P > 0.05). Similar stepwise findings were observed using AUC data. No significant maximal aortic blood pressure or weight differences occurred between groups and all animals completed treatment. CONCLUSION High-dose subcutaneous FK1706 therapy promoted recovery of erectile function following bilateral cavernous nerve crush injury in the rat. No significant differences between groups were observed for changes in weight, and the 8-week treatment course was completed for all animals.
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Affiliation(s)
- Anthony J Bella
- Division of Urology, University of California San Francisco, San Francisco, CA, USA.
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Davila HH, Mamcarz M, Nadelhaft I, Salup R, Lockhart J, Carrion RE. 1019: Visualization of the Neurovascular Bundles and Major Pelvic Ganglion with Fluorescent Proteins after Penile Injection. J Urol 2006. [DOI: 10.1016/s0022-5347(18)33244-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hayashi N, Minor TX, Nunes L, Price R, Lue TF, Carrion RE. 1200: Erectile Recovery Effect of FK1706 Following A Bilateral Cavernous Nerve Crush Injury in a Rat Model. J Urol 2006. [DOI: 10.1016/s0022-5347(18)33425-6] [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: 10/17/2022]
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Davila HH, Carrion RE, Salup R, Rajfer J, Gonzalez-Cadavid NF. 1071: Alterations of the Corpora Cavernosa Associated with Aging and Veno-Oclussive Dysfunction in the Rat. J Urol 2005. [DOI: 10.1016/s0022-5347(18)35227-3] [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: 10/17/2022]
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Rahman NU, Carrion RE, Bochinski D, Lue TF. Combined penile plication surgery and insertion of penile prosthesis for severe penile curvature and erectile dysfunction. J Urol 2004; 171:2346-9. [PMID: 15126818 DOI: 10.1097/01.ju.0000124042.74905.70] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE For persistent penile curvature after corporeal dilation and prosthesis placement other maneuvers, such as plaque incision with or without grafting, or penile modeling, must be used to complete penile straightening. However, each of these techniques is associated with increased morbidity, which includes higher rates of infection and urethral injury. We describe a new technique for correcting severe penile curvature and erectile dysfunction using combined penile plication and placement of a 3 piece inflatable penile prosthesis. MATERIALS AND METHODS Between February 2000 and June 2003, 5 patients with erectile dysfunction and severe curvature for which other treatment modalities had failed were treated with combined inflatable penile prosthesis and additional plication to correct the severe malformation. Detailed medical and sexual history was obtained as well as preoperative duplex ultrasound prior to surgery. RESULTS The age range of our patient population was 22 to 55 years. In each case penile prosthesis placement was insufficient to correct the malformation and the addition of multiple plication sutures was required. The malformation in all patients was corrected with this technique. To date no patients have reported any complications with followup (range 3 to 36 months). CONCLUSIONS In cases of severe penile deformity and curvature with erectile dysfunction the combination of penile plication and inflatable penile prosthesis placement is a method of repair that is well tolerated.
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Affiliation(s)
- Nadeem U Rahman
- Department of Urology, University of California-San Francisco, San Francisco, California 94143, USA
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Wang Z, Lin G, Carrion RE, Rahman N, Bochinski D, Lue TF, Lin CS. 1251: Wogonin Suppresses Cellular Proliferation and Expression of Monocyte Chemoattractant Protein 1 in Peyronie's Plaque-Derived Cells. J Urol 2004. [DOI: 10.1016/s0022-5347(18)38476-3] [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: 10/17/2022]
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Rahman N, Carrion RE, Bochinski D, Lue TF. 892: Treatment of Primary Erectile Dysfunction: Crural Vein Ligation Revisited. J Urol 2004. [DOI: 10.1016/s0022-5347(18)38141-2] [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: 10/17/2022]
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