A Surgeon's Guide to the Various Antibiotic Dips Available During Penile Prosthesis Implantation

PURPOSE OF REVIEW

Inflatable penile prosthesis (IPP) is a treatment for erectile dysfunction. IPPs have undergone improvements; however, post-surgical infections still occur. Furthermore, the type of pathogens infecting the implants has changed recently from Gram-positive to Gram-negative bacteria and fungi due to advances in antibiotic dips targeting the skin flora. To protect against infection, the AMS 700 is pre-coated with InhibiZone (mixture of Rifampin/Minocycline) and the Coloplast Titan, with several antibiotic dip options of differing efficacies. This review discusses strategies to decrease the infection rates in implant surgery, focusing on antibiotic dips.

RECENT FINDINGS

Current research endorses the use of rifampin/gentamicin as the most studied combination; however, some studies have utilized different dips for additional coverage including the InhibiZone on the AMS 700. With the increasing prevalence of diabetes and Gram-negative organisms, there is a need to develop strategies for increased coverage against infections. Controlled studies with different antibiotic combinations are needed to identify the ideal cocktail to decrease infection.

Leaky Bodies, Bawdy Books: Gonorrhea and Reading in Eighteenth-Century Britain

In eighteenth-century Britain, reading lewd books was understood to exacerbate gonorrhea. That pathology corresponded to a specific physiological model, which historians describe as the leaky male body. This article demonstrates how the connection between reading and gonorrhea correlated to three phenomena: 1) the neuro-sexual economy of bodily fluids; 2) the effects of reading on the sensible mind and body; and 3) the crossover of erotic and medical literatures. Aware of the physiological power of imagination, authors intentionally wrote to elicit strong physiological and sexual responses in readers. Concerns about the pathological and moral consequences of reading provocative material similarly informed criticisms of both the outright pornographic and the ostensibly medical. Partly in response to such criticisms, medical authors developed a more careful, decorous, and objective tone for writing about sexual topics. Ultimately, the culture of sensibility receded, as did anxieties about involuntary leaks of bodily fluids caused by reading.

"It is caused of the womans part or of the mans part": the role of gender in the diagnosis and treatment of sexual dysfunction in early modern England

Philip Barrough wrote in 1590 that barrenness 'is caused of the womans part or of the mans part'. By the eighteenth century, however, barrenness was perceived as a female disorder distinguished from male impotence. Few historians have addressed the uncertainty surrounding early modern definitions of infertility, choosing instead to adopt set terms that fit comfortably with modern ideas. This article will highlight the difficulties surrounding the gender distinction of the terms 'barrenness' and 'impotence' during this period. Moreover, the discussion will examine the role of gender in diagnosing these disorders to sufferers. The article will argue that ideas of gender were more central to diagnosis of poor sexual health than to effectual treatment. Although it appears that barrenness and impotence were treated with separate remedies, many treatments were described as effectual for both sexes. Additionally, the ingredients used in such recipes were often sexual stimulants explained without reference to gender.

[On warrior virgins, effeminate men, and infertility among ancient Scythians]

The Hippocratic text 'On the winds, waters and places' contains a fairly long description of an ancient Scythian tribe, the nomadic Sauromats. In this tribe the gender roles appear to have been inverted to some degree. The virgin women fight from horseback with swords, bows and arrows, and are not allowed to marry before they have killed three enemies. The married women are often infertile. The Hippocratic author ascribes this to the pronounced fatness of these women. Many men suffer from impotence and as a consequence dress as women, talk like them and carry out feminine household work. The Hippocratic author emphasises that the male impotence and the female infertility stem from the cold, damp climate and the Scythians' way of living, particularly the men spending most of their time riding. In contrast Herodotus states that the male impotence is Aphrodite's revenge because the Scythians ravaged her temple in Ascalon many years earlier. The difference between the Hippocratic emphasis on natural explanations for all natural phenomena, including health and disease and the occasional divine intervention promoted by Herodotus is underlined. There seems to be no plausible modern explanation for the impotence and infertility as described by the Hippocratic author.

Impotence in the 18th and 19th century: concepts of etiology and approaches to therapy

The old word impotence is derived from the Latin word impotencia, which literally translated means "lack of power." Impotence, in the course of the history, has been attributed to mental pathology, anxiety, or demons or witches. Historically, the pharmacological treatments for impotence started in Greek times, when a myriad of herbal medications were applied locally to the genitals to enhance "sexual strength." In the 18th century, theories about the main factors inducing impotence saw it as an abnormal state of the fibers, a defect in the solid or liquid substances or a bad structure (tumor, inflammation, abscess, ulcer or foreign body). According to these mechanisms, when impotence depended on the state of the muscular fibers, treatment included a tepid bath and a clyster. In very fat or very weak people, who get particularly tired, it was important to use the remedies able to give energy to the fibers, such as ferrous mineral waters, for a month. Moreover, other suggestions were to ride a horse, to sleep few hours, to breathe good country air, to take a purge every 2 weeks, to drink half a glass of wine from Borgogne or to distract the mind continuously. In the 19th century, therapies regarding impotence included slight electric stimulation through the application of stimulators on the scrotum in the testis or epididymis areas, until pain was induced. In the same period, another method for treating impotence was flagellation. This method consisted of little flagellations with leather strips.

[Forbidden sexualities: madness and the male gender]

The article identifies and studies male sexuality and affectivity as forbidden and imprisoned in Brazilian asylums in the first decades of the Republic. By analyzing psychiatric records from that era, it explores the notion that sexual and affective behavior had little to do with the construction of male profiles deemed 'deviant' and/or 'pathological'. This reflection shifts the focus of analysis to the gender specificities that determine the various traits displayed in 'mental disturbances' attributed to certain sexual and affective behavior.

Impotence in the XVIII-XIX century as described by Gian Pietro Fusanacci and Tommaso Eduardo Beatty

In 1992, the definition of erectile dysfunction (ED) replaced the old term of impotence that had been used for many centuries, in order to avoid the general confusion existing until today in this field. In the past, the origin of impotence had been attributed to different causes such as psychological diseases, or witches and demons. In 1764, Fusanacci described impotence that can occur in the male as well as in the female, as a defect in reproduc-tion. The main causes responsible for impotence were identified as inability to achieve erection, a very fluid seminal ejaculation, a defective organ, dryness of testicles, and lack of copulative power after many sexual intercourses with healthy women. Some decades later in 1847, Beatty affirmed that one of the most remarkable changes that can be observed in the passage from childhood to maturity is the development of the sexual organs, followed by the appearance of new sensations. He distinguished impotence that occurs only in men from sterility that for him affects women, and divided the causes of impotence into 3 classes: organic, functional and moral (today defined as psychological). For Beatty, the progress of knowledge had taken away magic and sorcery from the human mind and now it was widespread only among the lowest and most ignorant classes of humble people. In this way, he shows the evolution of medical science in XIX century in accepting only the rational explanation of the human diseases.

Reproduction concepts and practices in ancient Egypt mirrored by modern medicine

The treasured ancient papyri provide a glimpse into understanding of common concepts and practices in ancient Egypt. The Kahun gynecological papyrus and other texts unveil the traditions of reproduction, conception and delivery. This article addresses the rationale of beliefs and practices of that era. Frequently, the reason for common traditions exercised at the time is based on medical knowledge of female anatomy and physiology during pregnancy. Surprisingly some of the remedies commonly used in ancient Egypt were recently explored and found intriguing. This paper was aimed to look at the reflection of archaic practices and concepts of ancient Egypt by the modern mirror of evidence-based medicine.

Male pelvic floor: history and update

Our understanding of the male pelvic floor has evolved over more than 2,000 years. Gradually medical science has sought to dispel ancient myths and untruths. The male pelvic floor has many diverse functions. Importantly, it helps to support the abdominal contents, maintains urinary and fecal continence, and plays a major role in gaining and maintaining penile erection. Weakness of the male pelvic floor muscles may cause urinary and fecal incontinence and erectile dysfunction. Function may be restored in each of these areas by a comprehensive pelvic floor muscle training program. Spasm of the pelvic floor muscles may produce pain and require relaxation techniques. Additional research is needed to add further evidence to our knowledge base.

Pathologizing male sexuality: Lallemand, spermatorrhea, and the rise of circumcision

Although spermatorrhea as a disease entity and an episode in nineteenth-century medical history has received significant scholarly attention over the past decade, many aspects of its nature, origins, and consequences remain obscure. The aim of this article is to indicate its origins in and links with medical anxiety about masturbation and to discuss the therapies devised to treat the condition. Particular attention is given to the work of Claude-Francois Lallemand and his influence on English doctors, especially William Acton, and the implications of their identification of the foreskin as the major risk factor for childhood masturbation and later spermatorrhea. It is further argued that fear of spermatorrhea was an important factor in the acceptance of circumcision as a valid medical intervention in the late nineteenth century.

HISTORY: Adrian Walton Zorgniotti (1925–1994): Renaissance Urologist

Adrian Zorgniotti was born on March 3, 1925 and died on July 6, 1994. During his 47 years as a physician, he brought innovation and imagination to the field of Urology, especially in the field of erectile dysfunction (ED). Biographical information was obtained from Dr. Zorgniotti's curriculum vitae, his published articles, and his eulogies. Several of his colleagues and peers were also interviewed by telephone. In addition, personal experiences of this author, from the 9 years we spent as associates, and of several other friends were recounted. Dr. Zorgniotti's involvement with the history of Urology began in 1970 when he published his first historical treatise on Rome's first doctor, Arcagathus. He continued his involvement when he served as moderator for the History Forum of the American Urological Association (AUA) from 1975 to 1988 and as Historian for the AUA from 1979 to 1988. This innovator brought vision to the field of ED when he introduced the combination of papaverine and phentolamine as an intracavernous injection for the treatment of ED. He also organized the first International Conference on Corpus Cavernolum Revascularization in 1978 at New York University and published long-term results with this therapy. Adrian Zorgniotti will probably be best remembered by the multitude of Urologists whose lives he has touched for his generosity of spirit and for his ability to help shape our careers with a kind gesture, suggestion, or phone call. I am proud to call him a mentor, a colleague, and a friend.

Sexual life in Pharaonic Egypt: towards a urological view

Sex is a basic human need, common to all people at all times. It is evident that the ancient Egyptians were real human beings, not only a people who built massive pyramids and made mummies of their dead. The ancient Egyptians had a rich and varied sexual life, which they found an opportunity to describe in words and pictures. As in the other early primitive civilizations, erotic matters were of prime importance and became an integral part of life. In Pharaonic times, the Egyptians described impotence and recorded several methods to increase the sexual power. In the present paper, we will shed light on some aspects of the sexual life in ancient Egypt that may be interesting to the urologists, including ancient Egyptian concepts of sex and erotic matters, their own way of treatment of impotence and Min, the Egyptian fertility God.

Physiologie und Pathophysiologie der erektilen Dysfunktion

Notions and hypotheses of the pathophysiologic process in erectile dysfunction--its errors and embarrassment--are focused on beginning with Aristotle and continued in the Renaissance and the Enlightenment. Only in the middle of the nineteenth century was there recognition of the central role of relaxation of the trabecular muscles. It took another 100 years until we had a useful treatment option at hand.

Natural remedies for impotence in medieval Persia

Man's preoccupation with potency, or the lack thereof, has been present through the ages. Several documents still exist from which the clinical approaches of erectile dysfunction (ED) in medieval Persia can be ascertained. The medieval physicians described definitions and apparent causes of ED. They also noted hygienic and dietary rules as well as long lists of natural substances used in the treatment of ED. Many of the approaches of practitioners in medieval Persia are accurate and accepted even today; however, still more of them could be of use to modern medicine. The present review provides an overview of the knowledge of ED at the time.

[Henry IV of Castilla (1454-1474). An exceptional urologic patient. An endocrinopathy causing the uro-andrological problems of the monarch. Impotence and penile malformation (III)]

OBJECTIVES

To review, in accordance to contemporary and current chronicles and manuscripts, all data known about impotence and presumptive penile malformation suffered by Henry IV of Castile. Although currently the monarch's homosexuality is almost totally rejected, because according to many authors slandering, mainly of the sexual kind, was used as a political arm to discredit him by his enemies, it is yet to be demonstrated if his erectile dysfunction and presumptive genital anomaly were also slanderly disseminated by his detractors to avoid recognizing his daughter Juana "La Beltraneja" as successor to the throne.

METHODS

We reviewed a total of 10 chronicles, 5 contemporary texts and manuscripts, and 25 books about the figure of Henry IV published before year 2000, analyzing medical works in detail, particularly those from Marañon, Eisenberg, and Irvine and Mackay, who studied both pathologies trying to differentiate if both diseases could be justified by the kind of endocrinopathy the monarch suffered.

RESULTS

Although it is understandable that the study could be mistaken by document manipulation undertaken during Henry IV's life and posteriorly during the reign of the "Catholic Kings", and due to the lack of impartiality of some of his chroniclers, it is my opinion that the most probable cause of Enrique IV's erectile dysfunction was a GH and prolactine producing hypophyseal tumor, that he suffered from his youth producing complete impotence and acromegaly. It is not well documented if the Monarch also suffered a congenital penile anomaly.

A historical review of erectile dysfunction

Over the last three decades, there has been a significant increase in our understanding of the physiologic mechanisms responsible for erectile dysfunction. Erectile dysfunction has become a topic of considerable media and societal interest and acceptance. Paralleling the increase in knowledge has been an explosion in therapeutic options. This article will evaluate the therapeutic options, from a historical perspective of what has been available, and outline the progress that has been made.

[In venerem ignavus: medicine, impotence and law in modern age]

Surgical and forensic medical texts of modern age classifies male impotence according to two different patterns. If both psychological and functional causes can be admitted as responsible of male disfunctions, physical deficiencies only can be regarded as legal reason to obtain divorce.

Apomorphine to Uprima: the development of a practical erectogenic drug: a personal perspective

The development process for apomorphine SL as an effective treatment for patients with erectile dysfunction has been somewhat unusual. As often is the case, much of the impetus for the basic research originated in academia. However, somewhat unusually, the impetus for early stage clinical research also lay in the hands of the academics. This article represents a historical perspective from one of those involved throughout.

The history of erectile dysfunction management

This article describes the evolution or revolution in the management of erectile dysfunction over the centuries. In recent history there has been a rapid movement away from a predominant role for the specialist towards the primary care physician. The physician is increasingly faced with the need to individualize therapy to meet patient expectations.

Historical advances in penile prostheses

In the 25 y since their introduction, semi-rigid and inflatable penile implants have become remarkably dependable mechanical instruments associated with high patient satisfaction. This report attempts to quantify the historical milestones of significance pertaining to these devices. As with any historical 'best of ' list, there will be controversy and omissions. Three broad topics contributing to the advancement of penile prosthetic surgery, devices and techniques are discussed: (1) Prosthetic design changes contributing to freedom from revision: distention controlled cylinders, Bioflex cylinders, connectionless systems and reservoir lockout valves; (2) Instrument innovations to facilitate prosthetic surgery: Scott retractor, Furlow inserter, Brooks dilators, Carrion-Rossello cavernotomes; (3) Clever surgical applications: SST repair, transverse scrotal incision, modeling for Peyronie's disease, salvage for infection and natural tissue repair. International Journal of Impotence Research (2000) 12, Suppl 4, S101-S107.

[A study on evolution of the term impotence and its classification and diagnosis]

Called "bu qi" (unable to erect) in the pre-Qin period, it was called "yin wei" (yin flabbiness) during Qin-Han to Jin-yuan dynasties, and called "yang wei" (yang flabbiness) since the Ming dynasty, though a few books called it Yin-flabbiness, but both Yang- and Yin- flabbiness didn't appear simultaneously in the same work. It was categorized under seven-injuries, kidney disorders, consumptive diseases, five non-masculine and sexual diseases before the Tang dynasty, and categorized under miscellaneous diseases since Jin dynasty. It was typed into bu ju (non erected), bu jian (non hardened) and bu jiu (non persistent). Some classified on the basis of etiology. It was pointed out that this disorder refers to inability to errect though the patient has a desire to erect, instead of unwilling to erect. The changes of the idea reflect the different levels of recognition in different historical periods.

Myxoedema madness

Images

Some mythologic, religious, and cultural aspects of impotence before the present modern era

Impotence is not only a problem of modern society. Centuries ago man has sought for causes and remedies for impotence, originally looking much more outside himself rather than within himself. This article reviews and reflects on mythological, religious and cultural aspects of impotence, especially before the beginning of the 18th century.

History of the prosthetic treatment of impotence

Early records of observations of the os penis or baculum in mammals go back to Aristotle. These heritable cartilaginous supports were noted to help the penis during copulation. Prosthetic surgery for treatment of impotence was born from the initial experience with the use of the "artificial os penis" (rib cartilage) in post-traumatic reconstruction in 1936. Slow progress was made with the use of extracavernosal acrylic stents, followed by intracavernosal polypropylene rods, and finally the silicone prosthesis over the next 20 years. The introduction in 1973 of the inert silicone semirigid prosthesis and inflatable prosthesis met with great successes. Most recently (1985), there has been development of self-contained prostheses that are technically more simple to insert. Today, much more is known about specific organic causes of impotence that are amenable to many successful nonprosthetic alternative therapies, adding more stimuli to continued innovations in prosthetic surgery for erectile dysfunction.

Arterially originated erectile disturbances: surgical possibilities and their alternatives--some personal thoughts

The arterially originated erectile disturbances are the most common form of impotence due to morphological reasons. The concepts of therapy range from the surgical revascularization, to the intracavernous self-injection of vasoactive substances and to the implantation of penis prostheses. The advantages and disadvantages are discussed and weighed against each other.