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Prebay ZJ, Fu DH, Chung PH. Androgens and Urethral Health: How Hypogonadism Affects Postoperative Outcomes of Patients Undergoing Artificial Urinary Sphincter or Inflatable Penile Prosthesis Placement. Urology 2024; 184:266-271. [PMID: 37972898 DOI: 10.1016/j.urology.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To determine the role of androgens in penile and urethral health, we sought to understand what impact hypogonadism may have on artificial urinary sphincter (AUS) and inflatable penile prosthesis (IPP) outcomes. We hypothesize that patients with hypogonadism are at increased risk of reinterventions, complications, and infections. METHODS We queried the TriNetX Global Database in March 2023 for patients receiving an AUS or IPP, looking at lifetime reintervention, complication, and infection rates. We conducted multiple comparisons: (1) eugonadal patients against hypogonadal patients, (2) hypogonadal patients on testosterone replacement therapy (TRT) against hypogonadal patients not on TRT, and (3) hypogonadal patients on TRT against eugonadal patients. RESULTS Hypogonadal patients undergoing AUS had more complications (33.5% vs 28.3%), higher reintervention rates (27.7% vs 24.3%) and higher infection rates (7.3% vs 6.8%), albeit none reaching significance. Hypogonadal patients undergoing IPP had significantly higher infection rates (6.3% vs 4.4%, RR 1.5 (1.04, 2.04)) and reintervention rates (14.9% vs 11.9%, RR 1.3 (1.04, 1.61)), but not complication rates (21.9% vs 18.9%). When comparing patients with hypogonadism on TRT vs off TRT, there was not a significant difference in reinterventions, or complications, in AUS and IPP patients, but there were significantly more infections in IPP patients (7.0% vs 3.9%, RR 1.9 (1.002, 3.5)). CONCLUSION Hypogonadal patients have more reinterventions, complications, and infections following urologic implant surgery, to varying levels of significance. TRT may not be completely protective to improve tissue health but with many limitations that should be explored in further research.
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Affiliation(s)
- Zachary J Prebay
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - David H Fu
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
| | - Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Capogrosso P, Pozzi E, Russo GI, Hatzichristodoulou G, Cocci A, Falcone M, Martinez-Salamanca JI, Fernández-Pascual E, Candela L, Schifano N, Dehò F, Salonia A. Patients' attitude with surgery for Peyronie's disease: results from a multicentric European study. J Sex Med 2023; 21:54-58. [PMID: 37973410 DOI: 10.1093/jsxmed/qdad145] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Despite the existence of conservative therapies for Peyronie's disease (PD), surgery is commonly utilized for the treatment of bothersome curvatures due to its potential effectiveness, although it carries intrinsic risks and may not universally lead to satisfactory outcomes. AIM To explore the rate and factors influencing patients' willingness to undergo surgery for PD. METHODS Data were prospectively collected in 5 European academic centers between 2016 and 2020. Data included age, time from PD onset, penile pain, curvature degree, difficulty at penetration, hourglass deformity, erectile dysfunction (ED), and previous treatments. All patients were offered conservative treatments, either medications or injections. Tunical shortening or lengthening procedures were offered as an alternative to conservative treatments, when indicated. Penile prosthesis was offered to those with concomitant ED. Patients' attitudes with surgery were recorded. Logistic regression analyses tested the profile of patients who were more likely to be willing to undergo surgery. OUTCOMES Patients' willingness to undergo surgery for PD. RESULTS This study included 343 patients with a median age of 57.3 years (IQR, 49.8-63.6) and a median penile curvature of 40.0° (IQR, 30.0°-65.0°). Overall, 161 (47%) experienced penetration difficulties and 134 (39%) reported ED. Additionally, hourglass deformity and penile shortening were reported by 48 (14%) and 157 (46%), respectively. As for previous treatments, 128 (37%) received tadalafil once daily; 54 (16%) and 44 (13%), intraplaque verapamil and collagenase injections; and 30 (9%), low-intensity shock wave therapy. Significant curvature reduction (≥20°) was observed in 69 (20%) cases. Only 126 (37%) patients were open to surgery for PD when suggested. At logistic regression analysis after adjusting for confounders, younger age (odds ratio [OR], 0.97; 95% CI, 0.95-1.00; P = .02), more severe curvatures (OR, 1.04; 95% CI, 1.03-1.06; P < .0001), and difficulty in penetration (OR, 1.88; 95% CI, 1.04-3.41; P = .03) were associated with a greater attitude to consider surgical treatment. CLINICAL IMPLICATIONS The need for effective nonsurgical treatments for PD is crucial, as is comprehensive patient counseling regarding surgical risks and benefits, particularly to younger males with severe curvatures. STRENGTHS AND LIMITATIONS Main limitations are the cross-sectional design and the potential neglect of confounding factors. CONCLUSIONS Patients with PD, having a lower inclination toward surgery, emphasize the need for effective nonsurgical alternatives and accurate counseling on the risks and benefits of PD surgery, particularly for younger men with severe curvatures.
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Affiliation(s)
- Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese 28001, Italy
| | - Edoardo Pozzi
- Vita-Salute San Raffaele University, Milan 20151, Italy
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan 20151, Italy
| | - Giorgio I Russo
- Urology Section, Department of Surgery, University of Catania, Catania 95100, Italy
| | | | - Andrea Cocci
- Department of Urology, University of Florence, Careggi Hospital, Florence 50100, Italy
| | - Marco Falcone
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin 10024, Italy
| | | | | | - Luigi Candela
- Vita-Salute San Raffaele University, Milan 20151, Italy
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan 20151, Italy
| | - Nicolò Schifano
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese 28001, Italy
| | - Federico Dehò
- Department of Urology, Circolo & Fondazione Macchi Hospital-ASST Sette Laghi, Varese 28001, Italy
| | - Andrea Salonia
- Vita-Salute San Raffaele University, Milan 20151, Italy
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan 20151, Italy
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3
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van Renterghem K, Jorissen C, Van Huele A. Penile length changes after penile implant surgery. J Sex Med 2023; 20:1364-1366. [PMID: 38037429 DOI: 10.1093/jsxmed/qdad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Koenraad van Renterghem
- Department of Urology, Jessa Hospital, Hasselt 3500, Belgium
- Faculty of Medecin, Hasselt University, Hasselt 3000, Belgium
- Department of Urology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Cedric Jorissen
- Department of Urology, Jessa Hospital, Hasselt 3500, Belgium
- Department of Urology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Andries Van Huele
- Department of Urology, Jessa Hospital, Hasselt 3500, Belgium
- Department of Urology, University Hospitals Ghent, Ghent 9000, Belgium
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4
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van Renterghem K. Education in penile prosthesis implantation. Int J Impot Res 2023; 35:620-622. [PMID: 36966226 DOI: 10.1038/s41443-023-00688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/27/2023] [Accepted: 03/13/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Koenraad van Renterghem
- Jessa Hospital Hasselt, Hasselt, Belgium.
- Hasselt University, Hasselt, Belgium.
- University Hospitals Leuven, Leuven, Belgium.
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5
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Chung E, Blecher G. Perspective: Residual penile curvature correction during penile prosthesis implantation by plication in Peyronie's patients. Int J Impot Res 2023; 35:643-646. [PMID: 37864087 PMCID: PMC10622317 DOI: 10.1038/s41443-023-00774-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/22/2023]
Abstract
For patients with large calcified tunical plaque or severe corporal fibrosis which are likely to have a pronounced and persistent residual curvature which may not be correct by penile prosthesis implantation alone, other adjunctive manoeuvres such as penile plication and/or plaque incision with grafting may be necessary. The sequence between penile plication and penile prosthesis implantation is largely dependent on several factors such as the severity of penile curvature, the presence of (calcified) tunical plaque(s) and whether aggressive corporal dilation and subsequent penile remodelling with an inflated implant can straighten any residual penis curvature. The advantages of pre-placement of penile plication sutures prior to penile prosthesis implantation are the avoidance of inadvertent damage to the underlying penile prosthesis implant, the ability to adjust the tension on the rows of the plication sutures based on residual curvature with the device fully inflated, and potentially minimising the duration of surgery. In contrast, penile prosthesis implantation followed by penile plication to correct residual curvature, this sequence of surgery may negate the need for penile plications if penile remodelling is effective, or the residual curvature is less than 15 degrees where postoperative manual remodelling may continue to improve the penile cosmesis. When performed by expert surgeons and adhering to safe surgical principles, there is no doubt that patients will be satisfied with the outcomes and highly appreciative of the final penile cosmesis and the ensuing optimal outcomes.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, QLD, Australia.
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.
- Department of Urology, Macquarie University Hospital, Sydney, NSW, Australia.
| | - Gideon Blecher
- Department of Surgery, Monash University, Melbourne, VIC, Australia
- Department of Urology, The Alfred Hospital, Melbourne, VIC, Australia
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6
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Mulcahy JJ. Penile implants have had a prominent place in the management of erectile dysfunction for the past 50 years. Int J Impot Res 2023; 35:591-592. [PMID: 37087530 DOI: 10.1038/s41443-023-00706-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/24/2023]
Affiliation(s)
- John J Mulcahy
- Indiana University School of Medicine, Indianapolis, IN, USA.
- University of Alabama Medical Center, Birmingham, AL, USA.
- University of Arizona College of Medicine, Tucson, AZ, USA.
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7
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Stroie FA, Taylor L, Fernandez-Crespo R, Parker J, Carrion R. Patient selection, counseling and preparation for penile prosthesis. Int J Impot Res 2023; 35:609-612. [PMID: 37607962 DOI: 10.1038/s41443-023-00735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/23/2023] [Accepted: 07/05/2023] [Indexed: 08/24/2023]
Abstract
The penile prosthesis has revolutionized the management of erectile dysfunction and is a mainstay in the treatment of this clinical entity. The goal of proper patient selection and counseling is to achieve a satisfactory outcome for the patient. Most patients receiving a penile prosthesis are satisfied with their outcome, and while the penile prosthesis generally allows for high satisfaction rates, avenues for dissatisfaction can arise. Our aim is to aid the prosthetic urologist in identifying such avenues by discussing what factors can lead to a dissatisfied patient. Even a technically successful surgical outcome in the improperly counseled patient can have negative consequences for the patient and the patient-physician relationship. Satisfaction in the penile prosthesis arena can be variably defined and viewed from different perspectives. As such, establishing a personalized framework of expectation management, even in the patient who poses challenging factors, is paramount in preparation for penile prosthesis implantation.
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Affiliation(s)
- Florian A Stroie
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Laura Taylor
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Raul Fernandez-Crespo
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Justin Parker
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA
| | - Rafael Carrion
- Department of Urology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33603, USA.
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8
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Wilson SK, Gross MS. Celebrating 50 years of penile implants. Int J Impot Res 2023; 35:596-600. [PMID: 36650316 PMCID: PMC10622314 DOI: 10.1038/s41443-023-00663-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/26/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023]
Affiliation(s)
- Steven K Wilson
- Department of Urology, Institute for Urologic Excellence, La Quinta, CA, USA
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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9
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May E, Hanley M, Mulcahy JJ, Gross MS. Technological advances in penile implants: past, present, future. Int J Impot Res 2023; 35:629-633. [PMID: 36977850 DOI: 10.1038/s41443-023-00689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/26/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
Attempts to "cure" erectile dysfunction (ED) are as old as recorded history. The history of penile prosthetic devices dates back over 500 years, when a French military surgeon designed the first known wooden prosthesis to support micturition. There have since been a great many technological advancements in penile prosthetics. Penile implants for the improvement of sexual function date to the twentieth century. Like all human endeavors, penile prosthesis innovations have progressed via trial and error. This review aims to provide an overview of penile prostheses for the treatment of ED since their introduction in 1936. More specifically, we aim to highlight important advances in penile prosthesis development and discuss dead ends that were abandoned. Highlights include two-piece inflatables, three-piece inflatables, and malleable/semirigid, along with modifications and updates to each basic design that improved both insertion and usability. Dead ends include innovative ideas that were lost to history due to a variety of factors. We also look to the future and discuss expected advances, including remotely activated devices and prostheses designed for special populations, including transgender men.
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Affiliation(s)
- Emily May
- Dartmouth College Geisel School of Medicine, Hanover, NH, USA
| | - Meg Hanley
- Dartmouth College Geisel School of Medicine, Hanover, NH, USA
| | - John J Mulcahy
- Department of Urology, University of Arizona, Tucson, AZ, USA
| | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
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10
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Köhler TS. The future of penile implants IJIR special edition: 50 th year anniversary on penile implants. Int J Impot Res 2023; 35:593-595. [PMID: 37587367 DOI: 10.1038/s41443-023-00751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
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11
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Chew L, Chang C, Simhan J. Climacturia: what treatment options do we offer to those with and without concomitant erectile dysfunction? Int J Impot Res 2023; 35:634-638. [PMID: 37161059 DOI: 10.1038/s41443-023-00714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/11/2023]
Abstract
Radical prostatectomy for prostate cancer carries many sequelae, including climacturia, which is not commonly discussed and often under-recognized. To better understand treatment options for incontinence and climacturia, as well as those at time of penile implantation surgery, we completed a comprehensive literature review to identify nonoperative and operative treatments for patients with climacturia alone and those with concomitant climacturia and erectile dysfunction. Nonoperative interventions include behavioral modifications, physical therapy, and tension loops. Operative interventions include the artificial urinary sphincter, male urethral slings, Mini-Jupette sling, and a periurethral prosthesis. We also explore options that can be offered to patients who are also in need of penile prosthesis for concomitant erectile dysfunction. Contemporary work suggests that synchronous implantation of certain devices to treat both climacturia and erectile dysfunction can be done with proven safety and efficacy.
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Affiliation(s)
- Lauren Chew
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Chrystal Chang
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA.
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12
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Garber BB. Letter to the Editor on "Mechanical indications for inflatable penile prosthesis revision: analysis and implications for revision surgery". J Sex Med 2023; 20:1359. [PMID: 37786332 DOI: 10.1093/jsxmed/qdad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Bruce B Garber
- Urologic Surgeons, Inc., Bryn Mawr, PA 19010, United States
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13
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Sokolakis I. Comment on "Comparison of patient-reported outcomes after penile prosthesis placement in men with and without Peyronie's disease". Int J Impot Res 2023; 35:577-578. [PMID: 36221031 DOI: 10.1038/s41443-022-00626-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Ioannis Sokolakis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany.
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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14
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Jiang D, Barnard J, Barham DW, Furr J, Lentz A, van Renterghem K, Selph P, Yafi FA. Immediate salvage with inflatable penile prosthesis in an infected field is associated with a high success rate. Int J Impot Res 2023; 35:490-491. [PMID: 35534580 DOI: 10.1038/s41443-022-00576-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Daniel Jiang
- Department of Urology, University of California Irvine School of Medicine, Orange, CA, USA.
| | - John Barnard
- Department of Urology, University of California Irvine School of Medicine, Orange, CA, USA
| | - David W Barham
- Department of Urology, University of California Irvine School of Medicine, Orange, CA, USA
| | - James Furr
- Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | - Aaron Lentz
- Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Raleigh, NC, USA
| | | | - Patrick Selph
- Department of Urology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Faysal A Yafi
- Department of Urology, University of California Irvine School of Medicine, Orange, CA, USA
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15
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Swanton AR, Munarriz RM, Gross MS. Partner Involvement Reduces Postoperative Care Burden Following Penile Prosthesis Placement. Urology 2023; 178:91-97. [PMID: 37196829 DOI: 10.1016/j.urology.2023.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/07/2023] [Accepted: 03/22/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To determine whether preoperative partner involvement at clinic appointments is associated with deviation from a standardized postoperative care pathway for patients undergoing an inflatable penile prosthesis placement. METHODS This is a retrospective study of 170 patients undergoing primary inflatable penile prosthesis placement performed by a single surgeon between 2017 and 2020. A standardized postoperative clinical pathway was used, including planned follow-up visits at 2 weeks (for wound check and device deflation) and 6 weeks (for device teaching). Patient characteristics, including demographics, partner involvement, and the number of follow-up visits were obtained from the medical record. Logistic regression modeling was performed to determine whether partner involvement was associated with unanticipated follow-up visits. RESULTS Partners were involved in preoperative visits for 92 patients (54%). Additional unplanned follow-up visits were observed for 58 patients (34%) between 0 and 6 weeks and for 28 patients (16%) after 6 weeks from surgery. Partner involvement was associated with reduced odds of unanticipated follow-up visits, both between 0 and 6 weeks (odds ratios 0.37, 95% CI 0.18-0.75) and after 6 weeks (odds ratios 0.33, 95% CI 0.13-0.81) in adjusted models. CONCLUSION Having a patient's partner involved during the preoperative period is associated with a significant reduction in unanticipated follow-up. We would recommend that urologists routinely encourage patients considering the insertion of a penile prosthesis to involve their partners in perioperative visits. Further research needed is needed to determine how to best support patients during surgical decision-making and through the postoperative period.
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Affiliation(s)
- Amanda R Swanton
- Dartmouth Hitchcock Medical Center, Lebanon, NH; Boston Medical Center, Boston, MA
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16
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Lin M, Wang H, Wang Y, Jiang SW. An atypical erectile dysfunction patient with infertility treated with penile prosthesis implantation and testicular epididymal sperm aspiration (TESA)-intracytoplasmic sperm injection (ICSI): A case report. Medicine (Baltimore) 2023; 102:e34023. [PMID: 37352063 PMCID: PMC10289588 DOI: 10.1097/md.0000000000034023] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/26/2023] [Indexed: 06/25/2023] Open
Abstract
RATIONALE Erectile dysfunction (ED) is common in middle-aged and elderly men, affecting more than 100 million males worldwide. Most ED cases can be attributed to organic and/or psychological factors. Here we report an atypical ED case with no clear manifestation fitting the diagnosis for recognized types of ED. PATIENT CONCERNS The 35-year-old male is unable to have normal erection since puberty, and unable to complete intercourse with his wife. He had no history of trauma, surgery or psychiatric/psychological disease. The patient has a normal male karyotype. There is no significant finding in physical examination, nocturnal penile tumescence test, and ultrasound measurement of penis vascular functions. The serum levels of major hormones are all in normal ranges. DIAGNOSES Atypical ED, psychogenic ED not excluded; infertility. INTERVENTIONS Oral phosphodiesterase inhibitors Tadalafil (20 mg, BIW) or Sildenafil (50 mg, BIW) had no effect in this patient. Penile prosthesis implantation helped the patient to acquire normal sexual life, but did solve the ejaculation failure and infertility. Motile sperms were obtained by testicular epididymal sperm aspiration under the guidance of ultrasound, and intracytoplasmic sperm injection was performed with occytes retrieved from his wife. OUTCOMES The patient sexual life was significantly improved after penile prosthesis implantation; the patient wife is currently in the first trimester of pregnancy as the result of in vitro fertilization. CONCLUSIONS The no response to phosphodiesterase type 5 inhibitors (PDE5) treatment may suggest an impediment of PDE5-related pharmacological pathways or the presence of defect/injury in the neural system. This special case raises a question if some patients with persistent ED may have similar manifestations and can be treated with the same procedures.
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Affiliation(s)
- Mengyuan Lin
- Center of Reproductive Medicine, Women’s Hospital of Jiangnan University, Wuxi Jiangsu, China
| | - Honghua Wang
- Center of Reproductive Medicine, Women’s Hospital of Jiangnan University, Wuxi Jiangsu, China
| | - Yan Wang
- Center of Reproductive Medicine, Women’s Hospital of Jiangnan University, Wuxi Jiangsu, China
| | - Shi-Wen Jiang
- Center of Reproductive Medicine, State Key Laboratory of Reproductive Medicine, Research Institute for Reproductive Health and Genetic Diseases, Women’s Hospital of Jiangnan University, Wuxi Jiangsu, China
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Gardezi M, Choksi AU, Lokeshwar SD, Syed J, Honig SC. Distal erosion of an inflatable penile prosthetic as a complication of prone positioning in a COVID-19 respiratory supported patient. Int J Impot Res 2023; 35:409-410. [PMID: 35393534 PMCID: PMC8989101 DOI: 10.1038/s41443-022-00571-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Mursal Gardezi
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Ankur U Choksi
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Soum D Lokeshwar
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Jamil Syed
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Stanton C Honig
- Department of Urology, Yale School of Medicine, New Haven, CT, USA.
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18
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Prebay ZJ, Foss H, Ebbott D, Hyman J, Li M, Chung PH. Do Sodium-Glucose Co-Transporter 2 Inhibitors Increase the Risk of Urologic Implant Reintervention? Urology 2023; 174:191-195. [PMID: 36754235 DOI: 10.1016/j.urology.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To understand whether patients taking sodium-glucose co-transporter 2 inhibitors (SGLT2i) would be at a similar risk of genitourinary device infection or failure as patients not taking these medications. METHODS We queried the TriNetX database for all adult male patients undergoing artificial urinary sphincter (AUS) or inflatable penile prosthesis (IPP) and compared patients taking SGLT2i against those not. Cohorts and outcomes were defined using current procedural terminology and International Classification of Diseases (ICD-10) codes. We used Age, body mass index, diabetes, smoking history and history of prostatectomy to generate propensity score matching. Our primary outcome was need for reintervention after implantation based on current procedural terminology codes. Secondary outcomes included infection rate and overall complication rate based on ICD-10 codes. Analytics were performed via TriNetX which calculated risk ratios. RESULTS Analyses were run on November 28, 2022. After propensity score matching, there were 319 and 83 patients in each IPP and AUS cohort and comorbidity profiles were similar. Patients with an IPP on an SGLT2i were at a lower risk of overall complication (10.6% vs 16.1%, RR 0.66, P = .049). There was similar rates for AUS and risk of complication and for either implant on risk of infection or reintervention. CONCLUSION Patients taking SGLT2is may be safely offered urologic implants. Patients taking an SGLT2 had a lower risk of complication for IPP, and there were similar rates of infection and reintervention for both IPP and AUS.
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Affiliation(s)
- Zachary J Prebay
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Halle Foss
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - David Ebbott
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Jason Hyman
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Michael Li
- Center for Digital Health and Data Science, Thomas Jefferson University, Philadelphia, PA
| | - Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
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19
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Brant A, Lewicki P, Punjani N, Kang C, Marinaro J, Callegari M, Prunty M, Thirumavalavan N, Halpern JA, Shoag JE, Kashanian JA. Trends in Antimicrobial Prophylaxis for Inflatable Penile Prosthesis Surgery From a Large National Cohort. Urology 2023; 172:131-137. [PMID: 36450316 DOI: 10.1016/j.urology.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/04/2022] [Accepted: 11/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess changes in antibiotic prophylaxis for inflatable penile prosthesis surgery following publication of the American Urological Association (AUA) Best Practice Statement in April 2008. MATERIALS AND METHODS The Premier Healthcare Database was queried for inflatable penile prosthesis surgeries from January 2000 to March 2020. The primary outcome was administration of an AUA-adherent antimicrobial regimen and secondary outcome was 90-day explant. Piecewise linear regression was used to compare antimicrobial trends before vs after guideline publication. Multivariable logistic regression models were constructed for primary and secondary outcomes. RESULTS A total of 26,574 patients who underwent inflatable penile prosthesis surgery were identified, of whom 17,754 (67%) received AUA-adherent antibiotics. After guideline publication, there was a 42% relative increase in AUA-adherent regimen usage, with an increase in the usage trend on piecewise linear regression (from 0.1% to 0.8% of encounters per quarter, R2 = 0.75, P < .001). Increased usage trends were also observed for gentamicin (from 0.0% to 1.0% of encounters per quarter, R2 = 0.84, P < .001) and vancomycin (0.1%-0.7%, R2 = 0.77, P < .001). On multivariable regression, odds of AUA-adherence increased after guideline publication (OR: 1.67, 95% CI: 1.54-1.80, P < .001) and with surgery by a high-volume surgeon (OR: 2.21, 95% CI: 2.07-2.35, P < .01). Nonadherence to an AUA-recommended regimen with use of nonstandard antibiotics (OR: 1.16, 95% CI: 0.78-1.71, P = .5) or excess antibiotics (OR: 0.91, 95% CI: 0.62-1.30, P = .6) was not independently associated with increased risk of 90-day explant. CONCLUSIONS Publication of the AUA Best Practice Statement was associated with subsequent increases in the usage of guideline-adherent antibiotic regimens, particularly vancomycin and gentamicin, despite absence of level-1 evidence supporting this combination.
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Affiliation(s)
- Aaron Brant
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Patrick Lewicki
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Nahid Punjani
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Caroline Kang
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Jessica Marinaro
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Michael Callegari
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Megan Prunty
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Nannan Thirumavalavan
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jonathan E Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - James A Kashanian
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
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20
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Lentz AC. IPP Salvage in 2021. J Sex Med 2022; 19:895-898. [PMID: 35341726 DOI: 10.1016/j.jsxm.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Aaron C Lentz
- Duke Urology Men's Health Center, Raleigh, NC, USA; Duke University School of Medicine, Durham, NC, USA; Division of Urology, Duke University Medical Center, Durham, NC, USA.
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21
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Campbell JD, Matti D, Abed H, Di Pierdominico A. Technological Advancements for Treating Erectile Dysfunction and Peyronie's Disease. Urol Clin North Am 2021; 49:175-184. [PMID: 34776050 DOI: 10.1016/j.ucl.2021.07.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past decade, there have been several advancements in the technologies available to treatment erectile dysfunction and Peyronie's disease. Vacuum erection devices, penile traction devices, low-intensity extracorporeal shockwave therapy, and penile prosthesis surgery have evolved and are changing the way we treat men's health. Although significant improvements have been made, further work is needed to standardize treatment, create universal algorithms for technological applications, and simply their use.
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Affiliation(s)
- Jeffrey D Campbell
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.
| | - Danny Matti
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Haider Abed
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
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22
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Zhang JH, DeWitt-Foy M, Jankowski J, Wood HM. The Dilemma of Penile Prosthesis Implantation in Sex Offenders. J Sex Med 2021; 18:1826-1829. [PMID: 34620571 DOI: 10.1016/j.jsxm.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/06/2021] [Revised: 07/18/2021] [Accepted: 09/03/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Penile prosthesis surgeons face an ethical dilemma when confronted with a sex offender who seeks surgical management of erectile dysfunction. AIM To provide practice guidelines to screen and manage patients with a history of sexual violence prior to surgery. METHODS Three urologists with expertise in penile prosthesis surgery and 1 medical bioethicist were asked to contribute their opinions and provide recommendations to address this controversial topic. OUTCOMES Expert opinion supported by analysis of available literature and institutional experience. RESULTS The authors review current United States legislation, published literature on sex offender registration, and institutional data on the prevalence of sex offenders among men seeking penile prosthesis placement. Within a context established by medical bioethical principles, the authors propose a practice guideline for screening sex offenders prior to penile implantation surgery and referral for trained psychological evaluation prior to surgical management. STRENGTHS & LIMITATIONS Strengths: multidisciplinary approach in data acquisition including bioethical and legal review. LIMITATIONS Lack of available evidence regarding recidivism risk in sex offenders who undergo penile prosthesis placement. CONCLUSION Sex offenders exist among the population of patients seeking surgical placement of a penile prosthesis. A standardized practice guideline for management of this population should be employed with the intention to reduce future harm. Zhang JH, DeWitt-Foy M, Jankowski J, et al. The Dilemma of Penile Prosthesis Implantation in Sex Offenders. J Sex Med 2021;18:1826-1829.
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Affiliation(s)
- Jj H Zhang
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Molly DeWitt-Foy
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jane Jankowski
- Center for Bioethics, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Hadley M Wood
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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23
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Walton AB, Hellstrom WJG, Garcia MM. Options for Masculinizing Genital Gender Affirming Surgery: A Critical Review of the Literature and Perspectives for Future Directions. Sex Med Rev 2021; 9:605-618. [PMID: 34493480 DOI: 10.1016/j.sxmr.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/05/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Masculinizing genital gender affirmation surgery (MgGAS) has witnessed significant change in recent years. With the increasing number of patients seeking out GAS, optimization of techniques is mandated. OBJECTIVES To critically review the evolution of MgGAS, in a manner that encompasses the history and scope of the procedures, including phalloplasty with and without urethral lengthening, metoidioplasty with and without urethral lengthening, penile prosthesis placement, scrotoplasty, testicular prosthesis placement, vaginectomy, and hysterectomy. METHODS A comprehensive literature review was conducted in accordance with PRISMA guidelines, using PubMed. For our search, we generated a comprehensive list of MgGAS, combined with synonyms for GAS to ensure that articles included transgender cohorts. We identified a total of 547 articles from the search terms. Of these articles, 144 abstracts were relevant. Among these abstracts, 108 manuscripts were reviewed in full of which 98 were acceptable for inclusion. We excluded non-English-language studies without translation and studies that did not describe primary gGAS (eg, revision surgeries). RESULTS The evolution of MgGAS encompasses mostly refinements of pre-existing procedures, rather than new techniques or "watershed" procedures. The literature is somewhat lacking in outcomes-reporting that identifies the specific anatomy and surgical technique(s) used during gGAS. Without clarity regarding anatomy and technique, it is not feasible to compare surgical outcomes. CONCLUSION There is no ideal MgGAS; thus, it is critical that the physician assist the patient in understanding the outcomes and potential morbidity of the procedures to make the most informed decision. We envision that the future of MgGAS will advance with refinement of surgical techniques that minimize complications, improvement of tissue therapeutic technologies, new surgical tools and prosthetics designed for gGAS, advances in aftercare, and an immense selection of surgical options. Walton A, Hellstrom WJG, Garcia M. Options for Masculinizing Genital Gender Affirming Surgery: A Critical Review of the Literature and Perspectives for Future Directions. Sex Med Rev 2021;9:605-618.
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Affiliation(s)
- Alice B Walton
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA.
| | - Maurice M Garcia
- Cedars-Sinai Medical Center, Department of Urology, Los Angeles, CA, USA
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24
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Looney AT, Seery BE, Yap LC, Mohan P. A 10-year Audit of Penile Prosthesis Insertion. Ir Med J 2021; 114:408. [PMID: 34520643] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Introduction Penile prosthesis (PP) insertion is the gold standard surgical treatment option for men with refractory Erectile Dysfunction (ED). PP insertion is considered effective but has a well-documented array of complications. Our aim was to assess outcomes following single-surgeon insertion of PP for ED within an Irish cohort. Methods Following review of the Hospital In-Patient Enquiry (HIPE) system, a retrospective chart review of all patients who underwent PP insertion over a 10-year period from 2008-2017 inclusive was performed, and an electronic database was analysed for results. Results One-hundred-and-eleven PPs were inserted in 96 patients. The most common aetiology for ED in our cohort was post-prostatectomy, affecting 25 (26%) patients. The most frequently implanted device was a 3-piece inflatable PP (3p-IPP) (AMS 700TM; American Medical Systems Inc., Minnesota, USA) and the peno-scrotal approach was utilised in the majority of patients (86, 77.5%). No intraoperative complications were recorded. Twelve (12.5%) patients developed peri-operative complications. Thirteen (13.5%) patients required device revision, the majority for device failure. Of the 71 patient satisfaction responses, 61 (85.9%) patients were satisfied with their PP. Conclusions This single-surgeon retrospective audit of PP surgery demonstrates complication rates in-line with internationally published data. Patients should be adequately counselled regarding possible complications, including device failure and erosion. PP insertion should be considered for suitable patients with refractory ED.
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Affiliation(s)
| | | | - L C Yap
- Beaumont Hospital, Dublin, Ireland
| | - P Mohan
- Beaumont Hospital, Dublin, Ireland
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25
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Javaroni V. Editorial comment: Clinical Recommendations From the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances. Int Braz J Urol 2021; 47:663-665. [PMID: 33621019 PMCID: PMC7993974 DOI: 10.1590/s1677-5538.ibju.2021.03.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Valter Javaroni
- Hospital Federal do AndaraíDepartamento de AndrologiaRio de JaneiroRJBrasilDepartamento de Andrologia, Hospital Federal do Andaraí, Rio de Janeiro, RJ, Brasil
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Mykoniatis I, van Renterghem K, Sokolakis I, Hatzichristodoulou G, Sempels M, Andrianne R. Climacturia: a comprehensive review assessing pathophysiology, prevalence, impact, and treatment options regarding the "leak of pleasure". Int J Impot Res 2021; 33:259-270. [PMID: 32203427 DOI: 10.1038/s41443-020-0257-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 12/19/2022]
Abstract
Aim of this review is to summarize and evaluate the current literature on the pathophysiology, prevalence, sociosexual impact, and potential treatment options of climacturia. Climacturia, defined as orgasm-associated urinary incontinence and characterized by great prevalence variability, ranging between 15.7 and 93% was, so far, a relatively neglected post-radical prostatectomy functional side-effect. Recent studies have shown that it can significantly impact the quality of life of couples after prostate cancer treatment. A knowledge gap characterizes the pathophysiologic pathways while treatment is based on empirically chosen treatment options (condom use, presexual intercourse urination) or on therapeutic modalities proposed by low-quality studies (pelvic floor muscle training, penile applied devices). Evidence regarding efficacy of surgical techniques (artificial urinary sphincter, male sling, or dual implantation of penile prosthesis with a sling) for climacturia treatment are limited but with an increasing trend of relevant published data in the last 5 years. The mini-jupette sling plus inflatable penile prosthesis placement is a promising surgical technique that has been studied in a multi-institutional cohort with encouraging results regarding climacturia, erectile dysfunction, and mild-incontinence control. However, future studies with longer follow-up and larger sample sizes are certainly needed to confirm the long-term safety and benefits of this intervention.
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Affiliation(s)
- Ioannis Mykoniatis
- Centre Hospitalier Universitaire de Liège, Service d'Urologie, Hasselt, Belgium.
- Department of Urology, Jessa Hospital, Hasselt, Belgium.
| | - Koenraad van Renterghem
- Department of Urology, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine, Hasselt University, Hasselt, Belgium
- University Hospitals Leuven, Leuven, Belgium
| | - Ioannis Sokolakis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | | | - Maxime Sempels
- Centre Hospitalier Universitaire de Liège, Service d'Urologie, Hasselt, Belgium
| | - Robert Andrianne
- Centre Hospitalier Universitaire de Liège, Service d'Urologie, Hasselt, Belgium
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Neuville P, Carnicelli D, Paparel P, Ruffion A, Morel-Journel N. Metoidioplasty With Implantation of a Specific Semirigid Prosthesis. J Sex Med 2021; 18:830-836. [PMID: 33741289 DOI: 10.1016/j.jsxm.2021.01.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/25/2020] [Revised: 11/23/2020] [Accepted: 01/16/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Metoidioplasty is a possibility for penis reconstruction in transmen that could be enhanced by a semi-rigid prosthesis support. AIM Describe the surgical technique of metoidioplasty with implantation of a specifically designed semi-rigid prosthesis -the ZSI100D4- and analyze preliminary results. METHODS Implantation of semi-rigid prosthesis was proposed to transmen who chose metoidioplasty for genital gender affirming surgery in a specialized university hospital. OUTCOMES Surgical outcomes were collected from medical files. Functional outcomes and satisfaction were collected post-operatively with a questionnaire. RESULTS A total of 15 patients were operated; the mean length of followup was 22 months (SD = 8.7). Median prosthesis size was 8.5 cm (range: 8.5-10). Seven (46.7%) minor complications (Clavien-Dindo grade 2; 5 wound dehiscence and 2 fistula, managed conservatively) and 1 severe (Clavien-Dindo grade 3b) complication (Hematoma that need surgical revision) occurred. Thirteen patients (86.6%) answered the questionnaire; 11 (84.6%) reported being either "very satisfied" or "satisfied" with the appearance of the new genitalia; 10 (76.9%) could void while standing; and 12 patients (92.3%) answered "not at all" to the question "do you have regrets about this surgery ?". CONCLUSION Implantation of a semi-rigid prosthesis in an enlarged clitoris seems to be a valuable option and can be proposed as another possibility for the complex surgical answer to neophallus reconstruction in transmen. Neuville P, Carnicelli D, Paparel P, et al. Metoidioplasty With Implantation of a Specific Semirigid Prosthesis. J Sex Med 2021;18:830-836.
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Affiliation(s)
- Paul Neuville
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'urologie, Chemin du Grand Revoyet, 69310 Pierre-Benite, France.
| | - Damien Carnicelli
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'urologie, Chemin du Grand Revoyet, 69310 Pierre-Benite, France
| | - Philippe Paparel
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'urologie, Chemin du Grand Revoyet, 69310 Pierre-Benite, France
| | - Alain Ruffion
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'urologie, Chemin du Grand Revoyet, 69310 Pierre-Benite, France
| | - Nicolas Morel-Journel
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'urologie, Chemin du Grand Revoyet, 69310 Pierre-Benite, France
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Dinerman BF, Telis L, Eid JF. New Advancements in Inflatable Penile Prosthesis. Sex Med Rev 2021; 9:507-514. [PMID: 33610493 DOI: 10.1016/j.sxmr.2020.09.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/09/2020] [Accepted: 09/27/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Inflatable penile prosthesis (IPP) technology is a mainstay in the treatment of erectile dysfunction refractory to medical management. Technological advancements in the design of 3-piece IPPs have been improved to optimize concealability and surgical placement since the 1980s. Recent advancements over the past 10 years include pump, reservoir, tubing, and cylinder updates. OBJECTIVES This review examines the latest updates in IPP technology, reviews recent relevant research, and is based on over 32 years of experience performing IPP surgery in addition to concurrent postoperative management. METHODS A literature review was conducted for studies published over the last 10 years through March 2020 with an emphasis on technical updates of IPP, specifically the pump, reservoir, tubing, and cylinder, and their functional outcomes. Anti-infective coating and transgender innovations, in addition to postoperative management, are also reviewed. RESULTS Technological advancements include a flat reservoir designed for improved discreteness and a prosthesis with optimized tubing length, a one-touch deflatable 3-piece system, narrow-base cylinders, a 0° angle design between the cylinders and tubing to aid in cylinder placement, a soft molding cylinder tip redesign that better mimics human anatomy, and a 3-piece IPP specifically designed for neophallus use. Furthermore, the Food and Drug Administration approved the submuscular reservoir placement. CONCLUSION Penile prosthesis has evolved over time to improve functional outcomes, ease of use, and minimize postoperative complications and pain. Penile prosthesis implantation continues to be a life-changing procedure for patients and it is imperative for surgeons to be up-to-date on the latest developments and research in order to provide the best functional outcomes for those they take care of. Dinerman BF, Telis L, Eid JF. New Advancements in Inflatable Penile Prosthesis. Sex Med Rev 2021;9:507-514.
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Affiliation(s)
- Brian F Dinerman
- Department of Urology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Leon Telis
- Department of Urology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Jean Francois Eid
- Department of Urology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY; Advanced Urological Care, PC, New York, NY.
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29
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Manka MG, White LA, Yafi FA, Mulhall JP, Levine LA, Ziegelmann MJ. Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. J Sex Med 2021; 18:363-375. [PMID: 33423972 PMCID: PMC8519165 DOI: 10.1016/j.jsxm.2020.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/11/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Peyronie's disease (PD) is a challenging clinical entity. To assist clinicians with diagnosis and management, four separate organizations have published PD guidelines over the past five years, but there remains a lack of consensus and data-driven recommendations for many aspects of diagnosis and treatment. AIM To compare and contrast PD guidelines, highlighting key similarities and differences among the guideline panel recommendations and identify areas for further research. METHODS We performed an extensive review to compare and contrast diagnosis and treatment recommendations from publically available published PD guidelines from four different organizations: American Urological Association, European Association of Urology, Canadian Urologic Association, and the International Society of Sexual Medicine. OUTCOMES Key similarities and differences with regards to definition, evaluation, nonsurgical and surgical treatments were compared. RESULTS Points of general consensus among the guideline panels included: History is adequate for diagnosis of PD, and intracavernosal injection is a gold standard to evaluate penile deformity prior to invasive intervention. Careful counseling with shared decision-making is required prior to treatment. In general, plication and incision and/or grafting surgery is reserved for patients with preserved erectile function whereas penile prosthesis implantation is the only surgical option for PD patients with erectile dysfunction. Overall, nonsurgical treatments have inferior evidence of efficacy with these being the main area of controversy; however, all societies recognize that intralesional injections may be used. 0Further research into the pathophysiology of PD may direct novel treatments targeted towards early intervention and rigorous outcomes research may direct best practices for the surgical treatment of PD in the future. CLINICAL IMPLICATIONS PD is a challenging clinical entity. Direct comparison of the published PD guidelines highlights clear standards of care as well as areas where more research is needed to promote higher levels of evidence-based practice. STRENGTHS & LIMITATIONS To our knowledge this is the first report to directly compare and contrast published guidelines pertaining to the diagnosis and management of PD. Limitations include the lack of evidence-quality review pertaining to individual guideline recommendations, although this was not the aim of this review. CONCLUSION We highlight consensus of major urologic societies on many aspects of work up and management of PD with notable exceptions which may guide further research. Manka MG, White LA, Yafi FA, et al. Comparing and Contrasting Peyronie's Disease Guidelines: Points of Consensus and Deviation. J Sex Med 2021;18:363-375.
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Affiliation(s)
| | | | - Faysal A Yafi
- Department of Urology, University of California, Irvine, CA, USA
| | - John P Mulhall
- Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
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Verla W, Goedertier W, Lumen N, Spinoit AF, Waterloos M, Waterschoot M, Buncamper M, Monstrey S, Hoebeke P. Implantation of the ZSI 475 FTM Erectile Device After Phalloplasty: A Prospective Analysis of Surgical Outcomes. J Sex Med 2021; 18:615-622. [PMID: 33349569 DOI: 10.1016/j.jsxm.2020.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/30/2020] [Revised: 11/11/2020] [Accepted: 11/20/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Until recently, all available erectile devices were manufactured in accordance with the anatomy of a native penis and led to high explantation rates when implanted in the neophallus. AIM The aim of this study was to investigate surgical outcomes after implantation of the ZSI 475 FTM in the neophallus; this is the first erectile device specifically manufactured for implantation after phalloplasty. METHODS This is a prospective observational study of patients undergoing implantation of the ZSI 475 FTM in the neophallus at a tertiary referral center since September 2017. Patients with a follow-up < 3 months were excluded from this analysis. OUTCOMES Intraoperative and postoperative complications were analyzed with descriptive statistics and explantation-free survival was assessed using a Kaplan-Meier survival analysis. RESULTS In total, 57 patients were included with a median (IQR) follow-up of 16 (10-21) months. No intraoperative complications occurred. Postoperative complications were seen in 18 of 57 (32%) patients and included cylinder protrusion (1/57, 1.8%), infection (8/57, 14%), malpositioning (4/57, 7.0%), mechanical failure (4/57, 7.0%), and urinary retention (1/57, 1.8%). A total of 13 of 57 (23%) devices were explanted which corresponds with an estimated explantation-free survival rate (SD) of 84% (4.9), 80% (5.6), and 80% (5.6) after, respectively, 6, 12, and 18 months of follow-up. CLINICAL IMPLICATIONS By better addressing the specific needs after phalloplasty, this innovative erectile device might lead to improved cylinder protrusion, malpositioning, and mechanical failure rates, but device infection remains common. STRENGTHS & LIMITATIONS This is the largest study on this topic to date and the first to report prospective data. Main limitations involve the relatively small sample size and the limited follow-up. CONCLUSION Short-term cylinder protrusion, malpositioning, and mechanical failure rates are encouraging, although device infection remains a common problem. These complications resulted in a device explantation rate of 23%. Verla W, Goedertier W, Lumen N, et al. Implantation of the ZSI 475 FTM Erectile Device After Phalloplasty: A Prospective Analysis of Surgical Outcomes. J Sex Med 2021;18:615-622.
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Affiliation(s)
- Wesley Verla
- Department of Urology, Ghent University Hospital, Ghent, Belgium.
| | | | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Marjan Waterloos
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Marlon Buncamper
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Stan Monstrey
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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Cocci A, Ralph D, Djinovic R, Hatzichristodoulou G, Morelli G, Salonia A, Capogrosso P, Romano A, Cito G, Di Maida F, Fernández-Pascual E, Romero-Otero J, Egydio P, Falcone M, Preto M, Chiriacò G, Beck J, Albersen M, Minhas S, Cacciamani G, Salamanca JIM, Mondani N, Minervini A, Russo GI. Surgical outcomes after collagenase Clostridium histolyticum failure in patients with Peyronie's disease in a multicenter clinical study. Sci Rep 2021; 11:166. [PMID: 33420247 PMCID: PMC7794401 DOI: 10.1038/s41598-020-80551-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/23/2020] [Indexed: 12/14/2022] Open
Abstract
In the present study we aimed to investigate the surgical outcomes of patients with persistent penile curvature (PC) after Collagenase Clostridium histolyticum (CCH) intraplaque injections. Data from 90 patients with persistent PC after CCH in a multicentre study from 6 andrological centres were retrospectively reviewed. Three standardized surgical techniques were performed. Group 1: plaque incision grafting (PIG) with penile prosthesis implant (PPI); Group 2: PIG without PPI; Group 3: Nesbit technique. Hospital stay, operative time, postoperative complications and PC persistency/recurrence (> 20°) were evaluated. Overall satisfaction and functional outcomes were assessed through International Index of Erectile Function-Erectile Function (IIEF-EF), Peyronie's Disease Questionnaire (PDQ), Female Sexual Function Index (FSFI) administered pre and 3 months postoperatively. Of all, 25 (27.8%) patients received grafting procedure + PPI (Group 1), 18 (20.0%) patients belonged to Group 2, and 47 (52.2%) to Group 3. Bovine pericardium graft and collagen fleece have been used in in 22 (51.2%) and 21 (48.8%) patients, respectively. Median penile length after surgery was 13.0 cm (IQR 12.0-15.0). After surgery, Group 1 showed higher increase in penile length after surgery and better improvements in terms of PDQ-PS. In contrast, both IIEF-EF and FSFI scores did not differ among groups. Overall, 86 (95.6%) did not report any complication. 4 (4.4%) patients had PC recurrence; of those, 2 (8.0%), 1 (5.6%) and 1 (2.1%) cases were observed in Group 1, Group 2 and Group 3, respectively. In case of persistent PC after CCH, surgical correction by grafting with or without concomitant PPI or Nesbit technique emerged as a technically feasible, effective and safe procedure, with no significant postoperative complications.
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Affiliation(s)
- Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - David Ralph
- St. Peter's Andrology Centre and UCLH, London, UK
| | - Rados Djinovic
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, BelMedic General Hospital, Belgrade, Serbia
| | | | - Girolamo Morelli
- Department of Urology, Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Romano
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianmartin Cito
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | | | | | - Marco Falcone
- Urology Department, Città della Salute e della Scienza-Molinette Hospital, University of Turin, Turin, Italy
| | - Mirko Preto
- Urology Department, Città della Salute e della Scienza-Molinette Hospital, University of Turin, Turin, Italy
| | | | - Jack Beck
- Department of Urology and Men's Health, St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands
| | | | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Giovanni Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | | | - Nicola Mondani
- Andrology Center, Villa Donatello Private Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Giorgio Ivan Russo
- Department of Surgery, Urology Section, University of Catania, Catania, Italy.
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Abstract
PURPOSE It was aimed to evaluate the changes in quality of life in patients with erectile dysfunction (ED) after inflatable penile prosthesis implantation. MATERIAL AND METHODS Forty-one patients who underwent to an inflatable penile prosthesis implantation surgery due to ED were included in the study. The age of the patients, the indications for surgery, and the type of prosthesis implanted were recorded. All patients were implanted two-piece inflatable (AMS Ambicor™) or three-piece inflatable (AMS 700™) prostheses. A 36-item short form (SF-36) was used to assess the life quality of patients. The scores obtained from these forms were recorded and used to compare the preoperative and postoperative quality of life of the patients. RESULTS The mean age of the patients was 59.9 (38-78) years. The mean follow-up was 25.1 (12-39) months. A three-piece inflatable penile prosthesis was implanted in 11 (26.8%) of the 41 patients and the others were implanted with a two-piece inflatable penile prosthesis. Average SF-36 scores were increased significantly after surgery in all groups. CONCLUSIONS Inflatable penile prosthesis implantation is one of the most satisfactory treatment methods of ED and our study shows that with this treatment the patients can be provided a significant improvement in life quality.
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Affiliation(s)
- Iyimser Ure
- Faculty of Medicine, Department of Urology, Osmangazi University, Eskisehir, Turkey
| | - Ata Ozen
- Faculty of Medicine, Department of Urology, Osmangazi University, Eskisehir, Turkey
| | - Cavit Can
- Faculty of Medicine, Department of Urology, Osmangazi University, Eskisehir, Turkey
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Kavoussi M, Bhanvadia RR, VanDyke ME, Baumgarten AS, Ortiz NM, Khouri RK, Ward EE, Hudak SJ, Morey AF. Explantation of High Submuscular Reservoirs: Safety and Practical Considerations. J Sex Med 2020; 17:2488-2494. [PMID: 33214048 DOI: 10.1016/j.jsxm.2020.09.010] [Citation(s) in RCA: 3] [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: 07/20/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Over the past decade, high submuscular (HSM) placement of inflatable penile prosthesis (IPP) reservoirs has emerged as a viable alternative to space of Retzius (SOR) placement; however, data comparing the feasibility and complications of HSM vs SOR reservoir removal do not presently exist. AIM To present a comparison of the safety, feasibility, and ease of removal of HSM vs SOR reservoirs in a tertiary care, university-based, high-volume prosthetic urology practice. METHODS Data were retrospectively collected on patients who underwent IPP reservoir removal between January 2011 and June 2020. Cases were separated into 2 cohorts based on reservoir location. Statistical analysis was performed using Fisher's exact and Chi-squared tests for categorical variables and Student's t-test for continuous variables. Timing from IPP insertion to explant was compared between the HSM and SOR groups using the Mann-Whitney U test. OUTCOMES Time from IPP insertion to explant, operative time, intraoperative and postoperative complications, and need for a counter incision were compared between the HSM and SOR groups. RESULTS Between January 2011 and June 2020, 106 (73 HSM, 33 SOR) patients underwent IPP removal or replacement by a single surgeon at our institution. Average time from IPP insertion to removal was 43.6 months (24.2 HSM, 52.7 SOR, P = .07)-reservoir removal occurred at the time of device explant in 70 of 106 (66%) cases. More HSM reservoirs were explanted at the time of IPP removal compared with the SOR cohort (54 of 73, 74% HSM vs 16 of 33, 48.5% SOR, P = .01). Similar rates of complications were noted between the HSM and SOR groups (1.9% vs 6.3%, P = .35). There was no significant difference in need for counter incision between the 2 groups (24 [42%] HSM vs 4 [25%] SOR, P = .16) or in average operative times (76.5 ± 38.3 minutes HSM vs 68.1 ± 34.3 minutes SOR, P = .52). CLINICAL IMPLICATIONS Our experience with explanting HSM reservoirs supports the safety and ease of their removal. STRENGTHS AND LIMITATIONS Although the absolute cohort size is relatively low, this study reflects one of the largest single-institution experiences examining penile implant reservoir removal. In addition, reservoir location was not randomized but was instead determined by which patients presented with complications necessitating reservoir removal during the study period. CONCLUSIONS HSM reservoir removal has comparable perioperative complication rates and operative times when compared with SOR reservoir removal. Kavoussi M, Bhanvadia RR, VanDyke ME, et al. Explantation of High Submuscular Reservoirs: Safety and Practical Considerations. J Sex Med 2020;17:2488-2494.
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Affiliation(s)
- Mehraban Kavoussi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Raj R Bhanvadia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maia E VanDyke
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adam S Baumgarten
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nicolas M Ortiz
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roger K Khouri
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ellen E Ward
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven J Hudak
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Canguven O. Commentary on infected penile prosthesis: literature review highlighting the status quo of prevention and management. Aging Male 2020; 23:171. [PMID: 30449236 DOI: 10.1080/13685538.2018.1529157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Onder Canguven
- Hamad General Hospital, Doha, Qatar
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
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35
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Weinberg AC, Siegelbaum MH, Lerner BD, Schwartz BC, Segal RL. Inflatable Penile Prosthesis in the Ambulatory Surgical Setting: Outcomes From a Large Urological Group Practice. J Sex Med 2020; 17:1025-1032. [PMID: 32199854 DOI: 10.1016/j.jsxm.2020.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/08/2020] [Accepted: 02/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The definitive treatment for erectile dysfunction is the surgical implantation of a penile prosthesis, of which the most common type is the 3-piece inflatable penile prosthesis (IPP) device. IPP surgery in outpatient freestanding ambulatory surgical centers (ASC) is becoming more prevalent as payers and health systems alike look to reduce healthcare costs. AIM To evaluate IPP surgical outcomes in an ASC as compared to contemporaneously-performed hospital surgeries. METHODS A database of all patients undergoing IPP implantation by practitioners in the largest private community urology group practice in the United States, from January 1, 2013 to August 1, 2019, was prospectively compiled and retrospectively reviewed. Cohorts of patients having IPP implantation performed in the hospital vs ASC setting were compared. MAIN OUTCOME MEASURE The primary outcome measure was to compare surgical data (procedural and surgical times, need for hospital transfer from ASC) and outcomes (risk for device infection, erosion, and need for surgical revision) between ASC and hospital-based surgery groups. RESULTS A total of 923 patients were included for this analysis, with 674 (73%) having ASC-based surgery and 249 (27%) hospital-based, by a total of 33 surgeons. Median procedural (99.5 vs 120 minutes, P < .001) and surgical (68 vs 75 minutes, P < .001) times were significantly shorter in the ASC. While the risk for device erosion and need for surgical revision were similar between groups, there was no higher risk for prosthetic infection when surgery was performed in the ASC (1.7% vs 4.4% [hospital], P = .02), corroborated by logistic regression analysis (odds ratio 0.39, P = .03). The risk for postoperative transfer of an ASC patient to the hospital was low (0.45%). The primary reason for mandated hospital-based surgery was medical (51.4%), though requirement as a result of insurance directive (39.7%) was substantial. CLINICAL IMPLICATIONS IPP implantation in the ASC is safe, has similar outcomes compared to hospital-based surgery with a low risk for need for subsequent hospital transfer. STRENGTHS & LIMITATIONS The strengths of this study include the large patient population in this analysis as well as the real-world nature of our practice. Limitations include the retrospective nature of the review as well as the potential for residual confounding. CONCLUSION ASC-based IPP implantation is safe, with shorter surgical and procedural times compared to those cases performed in the hospital setting, with similar functional outcomes. These data suggest no added benefit to hospital-based surgery in terms of prosthetic infection risk. Weinberg AC, Siegelbaum MH, Lerner BD, et al. Inflatable Penile Prosthesis in the Ambulatory Surgical Setting: Outcomes From a Large Urological Group Practice. J Sex Med 2020;17:1025-1032.
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Affiliation(s)
| | | | | | - Blair C Schwartz
- Division of General Internal Medicine, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, QC, Canada
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36
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Akhvlediani ND, Chernushenko AS, Pushkar DY, Bernikov AN, Reva IA. [Surgical approaches for implanting of three-piece penile prosthetics]. Urologiia 2019:166-169. [PMID: 32003189] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Implantation of three-piece penile prosthesis is a gold standard in patients with severe erectile dysfunction. Currently, three surgical approach (scrotal, suprapubic and subcoronal) are used for prosthetic implantation. A method of implantation for three-piece penile prosthesis is still under discussion. The literature dedicated to an influence of surgical approach on the results of implantation for three-piece penile prosthesis in patients with severe erectile dysfunction is reviewed. The advantages and drawbacks of each technique are mentioned.
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Affiliation(s)
- N D Akhvlediani
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A S Chernushenko
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - D Yu Pushkar
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A N Bernikov
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - I A Reva
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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37
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De Bonis W, Casabe A, Saroto N, Bechara A. [Ectopic finding of malleable penile prosthesis extension Tip.]. ARCH ESP UROL 2019; 72:1043-1045. [PMID: 31823854] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To report the finding of malleable penile prosthesis extension tips in an ectopic position. METHOD We retrospectively analyzed two clinical cases of ectopic finding of prosthetic implant extension tips and performed a bibliographic review. RESULTS In the cases described, conservative behavior was decided given the absence of signs, symptomatology and the efficacy of the normally positioned implant. CONCLUSION The migration of the penile prosthetic implant is a very uncommon complication, more so the finding of a tip extension in an ectopic position. Reports in the literature on the behavior to follow in this type of complications are absent.
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Affiliation(s)
- Walter De Bonis
- Departamento de Cirugía. División Urología. Hospital General de Agudos "Dr. C.G. Durand". Buenos Aires. Argentina
| | - Adolfo Casabe
- Departamento de Cirugía. División Urología. Hospital General de Agudos "Dr. C.G. Durand". Buenos Aires. Argentina
| | - Nicolás Saroto
- Departamento de Cirugía. División Urología. Hospital General de Agudos "Dr. C.G. Durand". Buenos Aires. Argentina
| | - Amado Bechara
- Departamento de Cirugía. División Urología. Hospital General de Agudos "Dr. C.G. Durand". Buenos Aires. Argentina
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38
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Akhvlediani ND, Reva IA, Bernikov AN, Chernushenko AS, Pushkar DY. [Penile prosthesis implantation through subcoronal approach in patients with total cavernous fibrosis]. Urologiia 2019:96-100. [PMID: 31535813] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Penile prosthesis implantation is a treatment choice in patients with erectile dysfunction (ED) accompanied by cavernous fibrosis. Methods for creation of space for penile cylinders during prosthesis implantation in patents with total cavernous fibrosis are still under discussion, considering high risk of complications and decrease in penile size. In the presented clinical case, a new surgical technique for performing a three-piece penile prosthesis implantation through subcoronal approach in patient with ED, complicated by total cavernous fibrosis, is described. This clinical case represents our first experience of excavation excision of scar tissue in cavernous bodies through an innovative subcoronoral approach. As a result of performing of excavation excision of scar tissue in cavernous bodies, capacious spaces were created which allowed to use a three-piece prosthesis with a standard cylinder diameter. It ensured good long-term functional and cosmetic results. The first experience of excavation excision of fibrotic cavernous bodies during inflatable penile prosthesis implantation through subcoronal approach suggests its potential efficacy and safety in patients with ED and total cavernous fibrosis.
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Affiliation(s)
- N D Akhvlediani
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - I A Reva
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A N Bernikov
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A S Chernushenko
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - D Yu Pushkar
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Akhvlediani ND, Pushkar DY, Bernikov AN, Chernushenko AS, Reva IA. [Penile prosthesis implantation through subcoronal approach with graft-free corporoplasty in patients with Peyronie disease with concomitant erectile dysfunction]. Urologiia 2019:124-127. [PMID: 31356025] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Penile prosthesis implantation is a treatment choice in patients with erectile dysfunction (ED) and concomitant penile curvature due to Peyronie disease. Methods for correction of penile deformity during prosthesis implantation are still under discussion, considering variable efficiency and higher risk of complications. Our aim was to describe clinical case which represent our first experience of performing multiple corporal incisions through innovative subcoronoral approach without subsequent substitution of tunica albuginea. As a result of graft-free technique an effective penile straightening was achieved after three-piece prosthesis implantation with good long-term functional and cosmetic results. The first experience of graft-free technique of corporotomy during penile prosthesis implantation through subcoronal approach suggests its potential efficacy and safety in patients with a combination of ED and Peyronie disease.
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Affiliation(s)
- N D Akhvlediani
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - D Yu Pushkar
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A N Bernikov
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A S Chernushenko
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - I A Reva
- Department of Urology of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Clinical medical center of A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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40
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Abstract
Since the original inflatable penile prosthesis in the 1970s, several enhancements to penile prosthesis implant design, implant surgical technique, and post-operative care have been developed to increase overall patient (and partner) satisfaction rates. We, in this communication, seek to discuss these advancements and the overall impact in combating erectile dysfunction. As we continue to pursue avenues of effective and definitive treatment modalities for erectile dysfunction refractory to medical therapy, rates of infection and mechanical failure will hopefully continue to decline in the perioperative setting.
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Affiliation(s)
| | - Joshua Halpern
- Department of Urology, Northwestern University, Chicago, IL, USA
| | - Nelson Bennett
- Department of Urology, Northwestern University, Chicago, IL, USA
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41
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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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Djordjevic ML, Bencic M, Kojovic V, Stojanovic B, Bizic M, Kojic S, Krstic Z, Korac G. Musculocutaneous latissimus dorsi flap for phalloplasty in female to male gender affirmation surgery. World J Urol 2019; 37:631-637. [PMID: 30673829 DOI: 10.1007/s00345-019-02641-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Despite a variety of free flaps that have been described for creation of the neophallus in gender affirmation surgery, none present an ideal solution. We evaluated our patients and outcomes after gender affirmation phalloplasty using musculocutaneous latissimus dorsi free flap. METHODS Between January 2007 and May 2017, 129 female transsexuals, aged 20-53 years (mean 24 years) underwent total phalloplasty using latissimus dorsi free flap. Urethral lengthening was performed by combining a vaginal flap, labia minora flaps and a clitoral skin flap. Suitable sized testicular implants are inserted into the new scrotum. Penile prosthesis implantation, additional urethral lengthening and glans reshaping were performed in the following stages. RESULTS The mean follow-up period was 43 months (ranged from 13 to 137 months). There were one partial and two total flap necrosis. The average size of the neophallus was 14.6 cm in length and 12.4 cm in girth. Total length of the reconstructed urethra during the first stage ranged from 13.4 to 21.7 cm (mean 15.8 cm), reaching the proximal third or the midshaft of the neophallus in 91% of cases. Satisfactory voiding in standing position was confirmed in all patients. Six urethral fistulas and two strictures were observed and repaired by minor revision. Malleable and inflatable prostheses were implanted in 39 and 22 patients, respectively. CONCLUSION Musculocutaneous latissimus dorsi flap is a good choice for phalloplasty in gender affirmation surgery. It provides an adequate amount of tissue with sufficient blood supply for safe urethral reconstruction and penile prosthesis implantation.
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Affiliation(s)
- Miroslav L Djordjevic
- Belgrade Center for Genital Reconstructive Surgery, Belgrade, Serbia.
- University Children's Hospital, Belgrade, Serbia.
- School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Marko Bencic
- Belgrade Center for Genital Reconstructive Surgery, Belgrade, Serbia
- University Children's Hospital, Belgrade, Serbia
| | - Vladimir Kojovic
- Belgrade Center for Genital Reconstructive Surgery, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Borko Stojanovic
- Belgrade Center for Genital Reconstructive Surgery, Belgrade, Serbia
- University Children's Hospital, Belgrade, Serbia
| | - Marta Bizic
- Belgrade Center for Genital Reconstructive Surgery, Belgrade, Serbia
- University Children's Hospital, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sinisa Kojic
- Belgrade Center for Genital Reconstructive Surgery, Belgrade, Serbia
| | - Zoran Krstic
- Belgrade Center for Genital Reconstructive Surgery, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gradimir Korac
- Belgrade Center for Genital Reconstructive Surgery, Belgrade, Serbia
- University Children's Hospital, Belgrade, Serbia
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Preto M, Garaffa G, Falcone M, Gontero P, Rolle L. Response and Rebuttal to Editorial Comment "A Comparative Study Between 2 Different Grafts Used as Patches After Plaque Incision and Inflatable Penile Prosthesis Implantation for End-Stage Peyronie's Disease". J Sex Med 2018; 15:1061-1062. [PMID: 29861353 DOI: 10.1016/j.jsxm.2018.04.646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Mirko Preto
- Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | - Giulio Garaffa
- Andrology Unit, University College of London Hospital, London, United Kingdom
| | - Marco Falcone
- Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Paolo Gontero
- Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Luigi Rolle
- Urology Clinic, Città della Salute e della Scienza, University of Turin, Turin, Italy
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Seftel AD. Re: Trends in Penile Prosthetics: Influence of Patient Demographics, Surgeon Volume, and Hospital Volume on Type of Penile Prosthesis Inserted in New York State. J Urol 2018; 199:1379. [PMID: 29783561 DOI: 10.1016/j.juro.2018.03.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Seftel AD. Re: Glans Necrosis following Penile Prosthesis Implantation: Prevention and Treatment Suggestions. J Urol 2018; 199:14-16. [PMID: 29310158 DOI: 10.1016/j.juro.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/18/2022]
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Dormal M, Andrianne R, Sempels M, Waltregny D. [Early implantation of a penile prosthesis as an optimal treatment of retractory low flow priapism]. Rev Med Liege 2017; 72:454-456. [PMID: 29058838] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Low flow priapism is a urologic emergency because it leads to erectile dysfunction due to cavernosal fibrosis. Several treatments exist, including cavernosal aspiration, washing with or without alpha-mimetic agent or shunting surgery. In case of failure of these methods or prolonged priapism (superior to 36 hours), the option of early penile prostheses implantation should be discussed with a motivated patient in order to improve sexual satisfaction.
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Affiliation(s)
- M Dormal
- Service d'Urologie, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - R Andrianne
- Service d'Urologie, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - M Sempels
- Service d'Urologie, CHU de Liège, Site Sart Tilman, Liège, Belgique
| | - D Waltregny
- Service d'Urologie, CHU de Liège, Site Sart Tilman, Liège, Belgique
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Seftel AD. Re: Sexual Function and Quality of Life before and after Penile Prosthesis Implantation following Radial Forearm Flap Phalloplasty. J Urol 2017; 198:467. [PMID: 28817885 DOI: 10.1016/j.juro.2017.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Morey AF. Re: Sub-Coronal Inflatable Penile Prosthesis Placement with Modified No-Touch Technique: A Step-by-Step Approach with Outcomes. J Urol 2016; 196:1518-1519. [PMID: 27751481 DOI: 10.1016/j.juro.2016.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 11/16/2022]
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Morey AF. Re: Subcutaneous Placement of Inflatable Penile Prosthesis Reservoirs. J Urol 2016; 196:787-8. [PMID: 27597078 DOI: 10.1016/j.juro.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Seftel AD. Re: The Importance of Psychosexual Counselling in the Re-Establishment of Organic and Erotic Functions after Penile Prosthesis Implantation. J Urol 2016; 195:1074. [PMID: 27302805 DOI: 10.1016/j.juro.2016.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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