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Kennady EH, Bryk DJ, Ali MM, Ratcliffe SJ, Mallawaarachchi IV, Ostad BJ, Beano HM, Ballantyne CC, Krzastek SC, Clements MB, Gray ML, Rapp DE, Ortiz NM, Smith RP. Low-intensity shockwave therapy improves baseline erectile function: a randomized sham-controlled crossover trial. Sex Med 2023; 11:qfad053. [PMID: 37965376 PMCID: PMC10642534 DOI: 10.1093/sexmed/qfad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/19/2023] [Accepted: 09/27/2023] [Indexed: 11/16/2023] Open
Abstract
Background Low-intensity shockwave therapy for erectile dysfunction is emerging as a promising treatment option. Aim This randomized sham-controlled crossover trial assessed the efficacy of low-intensity shockwave therapy in the treatment of erectile dysfunction. Methods Thirty-three participants with organic erectile dysfunction were enrolled and randomized to shockwave therapy (n = 17) or sham (n = 16). The sham group was allowed to cross over to receive shockwave therapy after 1 month. Outcomes Primary outcomes were the changes in Sexual Health Inventory for Men (SHIM) score and Erection Hardness Score at 1 month following shockwave therapy vs sham, and secondary outcomes were erectile function measurements at 1, 3, and 6 months following shockwave therapy. Results At 1 month, mean SHIM scores were significantly increased in the shockwave therapy arm as compared with the sham arm (+3.0 vs -0.7, P = .024). Participants at 6 months posttreatment (n = 33) showed a mean increase of 5.5 points vs baseline (P < .001), with 20 (54.6%) having an increase ≥5. Of the 25 men with an initial Erection Hardness Score <3, 68% improved to a score ≥3 at 6 months. When compared with baseline, the entire cohort demonstrated significant increases in erectile function outcomes at 1, 3, and 6 months after treatment. Clinical Implications In this randomized sham-controlled crossover trial, we showed that 54.6% of participants with organic erectile dysfunction met the minimal clinically important difference in SHIM scores after treatment with low-intensity shockwave therapy. Strengths and Limitations Strengths of this study include a sham-controlled group that crossed over to treatment. Limitations include a modest sample size at a single institution. Conclusions Low-intensity shockwave therapy improves erectile function in men with erectile dysfunction as compared with sham treatment, which persists even 6 months after treatment. Clinical Trial Registration ClinicalTrials.gov NCT04434352.
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Affiliation(s)
- Emmett H Kennady
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
| | - Darren J Bryk
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
| | - Marwan M Ali
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
| | - Sarah J Ratcliffe
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22903, United States
| | - Indika V Mallawaarachchi
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22903, United States
| | - Bahrom J Ostad
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
| | - Hamza M Beano
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
| | | | - Sarah C Krzastek
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
| | - Matthew B Clements
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
| | - Mikel L Gray
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
| | - David E Rapp
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
| | - Nicolas M Ortiz
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
| | - Ryan P Smith
- Department of Urology, University of Virginia, Charlottesville, VA 22903, United States
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Bryk DJ, Zillioux J, Kennady EH, Sun F, Hasken W, Ortiz NM, Rapp DE, Smith RP. The impact of cognitive impairment in urologic implants: a narrative review. Transl Androl Urol 2023; 12:1426-1438. [PMID: 37814692 PMCID: PMC10560334 DOI: 10.21037/tau-23-226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/13/2023] [Indexed: 10/11/2023] Open
Abstract
Background and Objective With the general population aging and thus more patients developing bothersome erectile dysfunction, stress urinary incontinence and overactive bladder, there will likely be a higher demand for three common interactive implants in urology, the penile prosthesis, artificial urinary sphincter (AUS) and sacral neuromodulation (SNM). Further, the prevalence of mild and major neurocognitive disorders (also known as mild cognitive impairment and dementia, respectively) is expected to increase. While the aforementioned urologic implants have excellent short and long term outcomes, there are also known device issues such as malfunction or misuse that may require surgical removal and/or revision. The objective of this narrative review is to describe the association of cognitive impairment and urologic implants. Methods We performed a search on PubMed between the years 1975-2023 for English language articles that reported on any type or severity of cognitive impairment and its association with penile prosthesis, AUS and/or SNM. While peer-reviewed published manuscripts were prioritized, abstracts that fit our search criteria were also included. Key Content and Findings Data assessing outcomes of patients with cognitive impairment who undergo placement of a urologic implant are limited. There is an association between AUS failure or misuse with cognitive impairment. SNM is efficacious in this population in the short term. In patients who develop dementia, an inflatable penile prosthesis can be deflated via in-office needle puncture and an AUS can be deactivated. The Memory Alteration Test, Quick Screen for Mild Cognitive Impairment and the Saint Louis University Mental Status Examination are relatively quick screening tests with good sensitivity and specificity for mild cognitive impairment. Conclusions While data on the association between urologic implants and cognitive impairment are sparse, there are tools that urologists can use to screen patients for cognitive impairment. With screening, urologists can provide appropriate preoperative counseling (including recommending against implantation) and can provide closer postoperative monitoring. Further study is required to assess which patients should be excluded from device implantation and how to properly assess for cognitive impairment in a manner that is both beneficial for the patient and convenient and efficient for a urologist.
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Affiliation(s)
- Darren J Bryk
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | | | - Emmett H Kennady
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Fionna Sun
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - William Hasken
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Nicolas M Ortiz
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - David E Rapp
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Ryan P Smith
- Department of Urology, University of Virginia, Charlottesville, VA, USA
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Ali M, Smith RP, Ortiz NM. The Impact of Vitamin Deficiencies on Sexual Health. J Sex Med 2022; 19:1313-1316. [DOI: 10.1016/j.jsxm.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/15/2022]
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Ali M, Hutchison DD, Ortiz NM, Smith RP, Rapp DE. A narrative review of pelvic floor muscle training in the management of incontinence following prostate treatment. Transl Androl Urol 2022; 11:1200-1209. [PMID: 36092846 PMCID: PMC9459549 DOI: 10.21037/tau-22-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Objective Urinary incontinence following prostate treatment (IPT) is a common complication with corresponding negative impacts on quality of life. Pelvic floor muscle training (PFMT) is a non-invasive treatment strategy to treat combat this clinical issue, and has been recognized by medical associations globally and increasingly supported by large bodies of literature. Accordingly, many studies demonstrate a significant benefit of pelvic floor muscle training to continence status and quality of life in men with incontinence following prostate treatment. However, related research is limited by variety in treatment regimens, outcome measures, and study designs, with unclear impact on treatment success. We aim to provide a brief overview of pathology and incidence of incontinence following prostate surgery and an understanding how PFMT is currently used to treat and prevent this clinical consequence. Methods A comprehensive literature search was conducted utilizing PubMed, Medline, and Google Scholar. Search criteria included systematic reviews and randomized control trials published in the year 2000 to present. References of resulting studies were further analyzed to identify further articles of relevance. Keywords searched included: “post-prostatectomy incontinence”, “pelvic muscle strengthening”, “Benign Prostatic Hyperplasia”, and “pelvic floor muscle training”. Peer-reviewed publications that demonstrated a novel addition to the existing body of literature on this subject were included. Key Content and Findings Upon review of the current research landscape, PFMT is largely supported in treatment of IPT. Analysis of current literature on this subject demonstrates heterogeneity in protocols, measures of treatment success, and patient numbers. Nevertheless, benefits to continence and quality of life are noted across an expansive body of literature and as such, PFMT is therefore recommended as an important part of the treatment algorithm following radical prostatectomy. Conclusions PFMT is an important and effective part of the treatment algorithm in the prevention and treatment of IPT. Additional research is needed to more extensively assess PFMT’s role in treating this clinical consequence, especially following other prostate surgeries.
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Affiliation(s)
- Marwan Ali
- Department of Urology, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Dylan D Hutchison
- Department of Urology, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Nicolas M Ortiz
- Department of Urology, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Ryan P Smith
- Department of Urology, University of Virginia Medical Center, Charlottesville, VA, USA
| | - David E Rapp
- Department of Urology, University of Virginia Medical Center, Charlottesville, VA, USA
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Hutchison D, Ali M, Zillioux J, Ortiz NM, Smith R, Rapp DE. Pelvic Floor Muscle Training in the Management of Female Pelvic Floor Disorders. Curr Bladder Dysfunct Rep 2022. [DOI: 10.1007/s11884-022-00653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chertack NA, Caldwell KM, Joice GA, Kavoussi M, Dropkin BM, Ortiz NM, Baumgarten AS, Shakir NA, Sanders SC, Hudak SJ, Morey AF. Long-term lower urinary tract sequelae following AUS cuff erosion. Neurourol Urodyn 2021; 41:229-236. [PMID: 34559913 DOI: 10.1002/nau.24801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/26/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022]
Abstract
AIMS To examine the rate of lower urinary tract complications (LUTC) and urinary diversion (UD) after artificial urinary sphincter (AUS) explantation with the acute reconstruction of AUS cuff erosion defects. METHODS We performed a retrospective study of patients who underwent in-situ urethroplasty (ISU) for AUS cuff erosion from June 2007 to December 2020. Outcomes included LUTC (urethral stricture, diverticulum, fistula), AUS reimplantation, and UD. Defect size was prospectively estimated acutely and a subanalysis was performed to determine the impact of erosion severity (small erosions [<33% circumferential defect] and large erosions [≥33%]) on these outcomes. Kaplan-Meier curves were created to compare survival between the two groups. RESULTS A total of 40 patients underwent ISU for urethral cuff erosion. The median patient age was 76 years old with a median erosion circumference of 46%. The overall LUTC rate was 30% (12/40) with 35% (14/40) of patients requiring permanent UD. Secondary AUS placement occurred in 24/40 (60%) patients with 11/24 (46%) leading to repeat erosion. On subanalysis, small erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation. CONCLUSIONS Lower urinary tract complications are common after AUS cuff erosion and can lead to the need for permanent UD. Patients with larger erosions are more likely to undergo UD and reach this end-stage condition earlier compared to patients with small erosions.
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Affiliation(s)
- Nathan A Chertack
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kelly M Caldwell
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gregory A Joice
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mehraban Kavoussi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin M Dropkin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicolas M Ortiz
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Adam S Baumgarten
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nabeel A Shakir
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah C Sanders
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Steven J Hudak
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Beano H, Morgan JT, Ortiz NM. Penile Plication in Peyronie’s Disease: Technique Evolution and Recent Advances. Curr Sex Health Rep 2021. [DOI: 10.1007/s11930-021-00303-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wolfe AR, Ortiz NM, Baumgarten AS, VanDyke ME, West ML, Dropkin BM, Joice GA, Sanders SC, Hudak SJ, Morey AF. Most men with artificial urinary sphincter cuff erosion have low serum testosterone levels. Neurourol Urodyn 2021; 40:1035-1041. [PMID: 33792973 DOI: 10.1002/nau.24663] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/11/2022]
Abstract
AIMS To evaluate the relationship between serum testosterone (T) levels and artificial urinary sphincter (AUS) cuff erosion in a population of incontinent men who underwent AUS placement. METHODS A retrospective analysis of our single-surgeon AUS database was performed to identify men with T levels within 24 months of AUS placement. Men were stratified into two groups based on serum testosterone: low serum testosterone (LT) (<280 ng/dl) and normal serum testosterone (NT) (>280 ng/dl). Multivariable analysis was performed to control for risk factors. The outcome of interest was the incidence of and time to spontaneous urethral cuff erosion; other risk factors for cuff erosion were also evaluated. RESULTS Among 161 AUS patients with serum testosterone levels, 84 (52.2%) had LT (mean: 136.8 ng/dl, SD: 150.4 ng/dl) and 77 (47.8%) had NT (mean: 455.8 ng/dl, SD: 197.3 ng/dl). Cuff erosion was identified in 42 men (26.1%) at a median of 7.1 months postoperatively (interquartile range: 3.6-13.4 months), most of whom (30/42, 71.4%) were testosterone deficient. LT levels were less common (54/119, 45.4%) in the non-erosion cohort (p = 0.004). Men with low T were nearly three times as likely to suffer AUS erosion than men with normal T (odds ratio = 2.519, p = 0.021). LT level was the only factor associated with AUS erosion on multivariable analysis. CONCLUSIONS LT is an independent risk factor for AUS cuff erosion. Men with LT are more likely to present with cuff erosion, but there is no difference in time to erosion.
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Affiliation(s)
- Avery R Wolfe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicolas M Ortiz
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Adam S Baumgarten
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Maia E VanDyke
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mary L West
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin M Dropkin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gregory A Joice
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah C Sanders
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Steven J Hudak
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Khouri RK, Ortiz NM, Dropkin BM, Joice GA, Baumgarten AS, Morey AF, Hudak SJ. Artificial Urinary Sphincter Complications: Risk Factors, Workup, and Clinical Approach. Curr Urol Rep 2021; 22:30. [PMID: 33779844 DOI: 10.1007/s11934-021-01045-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review risk factors for AUS complications and present a systematic approach to their diagnosis and management. RECENT FINDINGS Established risk factors for AUS complications include catheterization, channel TURP, pelvic radiation, urethroplasty, anticoagulation, cardiovascular disease, diabetes mellitus, frailty index, hypertension, low albumin, and low testosterone. We present our algorithm for diagnosis and management of AUS complications. Despite being the gold standard of treatment for men with SUI, major and minor complications can occur at any point after AUS insertion. Careful consideration of the urologic, medical, and operative risk factors for each patient can help prevent complications. A systematic approach to early and late complications facilitates their identification and effective management. The evaluating urologist must have a thorough understanding of potential AUS complications in order to restore quality of life in men with bothersome SUI.
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Affiliation(s)
- Roger K Khouri
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Nicolas M Ortiz
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Benjamin M Dropkin
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Gregory A Joice
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Adam S Baumgarten
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Steven J Hudak
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
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Khouri RK, Yi YA, Ortiz NM, Baumgarten AS, Ward EE, VanDyke ME, Hudak SJ, Morey AF. Standing cough test stratification of moderate male stress urinary incontinence. Int Braz J Urol 2021; 47:415-422. [PMID: 33284545 PMCID: PMC7857773 DOI: 10.1590/s1677-5538.ibju.2020.0551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Patient-reported history of pads per day (PPD) is widely recognized as a fundamental element of decision-making for anti-incontinence procedures. We hypothesize that SUI severity is often underestimated among men with moderate SUI. We sought to compare patient history of incontinence severity versus objective in-office physical examination findings. MATERIALS AND METHODS We retrospectively reviewed our single-surgeon male SUI surgical database from 2007-2019. We excluded patients with incomplete preoperative or postoperative data and those who reported either mild or severe SUI, thus having more straightforward surgical counseling. For men reported to have moderate SUI, we determined the frequency of upgrading SUI severity by recording the results of an in-office standing cough test (SCT) using the Male Stress Incontinence Grading Scale (MSIGS). The correlation of MSIGS with sling success rate was calculated. Failure was defined as >1 PPD usage or need for additional incontinence procedure. RESULTS Among 233 patients with reported moderate SUI (2-3 PPD), 89 (38%) had MSIGS 3-4 on SCT, indicating severe SUI. Among patients with 2-3 PPD preoperatively, sling success rates were significantly higher for patients with MSIGS 0-2 (76/116, 64%) compared to MSIGS 3-4 (6/18, 33%) (p <0.01). CONCLUSIONS Many men with self-reported history of moderate SUI actually present severe SUI observed on SCT. The SCT is a useful tool to stratify moderate SUI patients to more accurately predict sling success.
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Affiliation(s)
- Roger K. Khouri
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Yooni A. Yi
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Nicolas M. Ortiz
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Adam S. Baumgarten
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Ellen E. Ward
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Maia E. VanDyke
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Steven J. Hudak
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Allen F. Morey
- University of Texas Southwestern Medical CenterDepartment of UrologyDallasTexasUSADepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Correspondence address: Allen F. Morey, MD, Department of Urology, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA. 75390-9110 Telephone: + 1 214 648-0202 E-mail:
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VanDyke ME, Baumgarten AS, Ortiz NM, Dropkin BM, Joice GA, Khouri RK, Filho JEP, Ward EE, Hudak SJ, Morey AF. Extended Primary Anastomosis With Penile Plication (EPAPP): A Promising New Alternative to Perineal Urethrostomy for Reconstruction of Long Urethral Strictures. Urology 2020; 149:245-250. [PMID: 33301744 DOI: 10.1016/j.urology.2020.11.048] [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: 10/14/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE At present, excision and primary anastomosis (EPA) urethroplasty is a highly reliable method of reconstruction for short bulbar urethral strictures. Longer strictures are often managed with grafting techniques to ensure a tension-free repair. Here we report our initial experience with a new, extended anastomotic technique for long bulbar strictures that incorporates plication of the ventral corporal bodies to reduce the distance between the urethral ends and obviates the need for grafting. METHODS We reviewed records for all urethroplasties performed by a single surgeon at our institution between January 2018 and February 2020. We identified a cohort of older patients with complex strictures who underwent Extended Primary Anastomosis with Penile Plication (EPAPP). Patient demographics, stricture characteristics, perioperative 75 parameters, and postoperative outcomes were evaluated. RESULTS Of 346 urethroplasty records reviewed, 10 patients (2.9%) underwent EPAPP. Mean stricture length was 3.75 ± 1.4 cm. EPAPP patients were older than those repaired by other techniques (mean age 66.6 vs 55.6, P = .024), and most were not sexually active preoperatively. Postoperative voiding cystourethrogram confirmed urethral patency without extravasation in all patients. At a median follow up of 9.7 months (IQR 8.5-11.5) 8 patients remained asymptomatic after EPAPP alone and 2 patients required a single balloon dilation for stricture recurrence. CONCLUSION EPAPP is a promising alternative option for the management of long bulbar strictures among appropriately selected patients.
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Affiliation(s)
- Maia E VanDyke
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Adam S Baumgarten
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Nicolas M Ortiz
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Benjamin M Dropkin
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Gregory A Joice
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Roger K Khouri
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Joao E Pinto Filho
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Ellen E Ward
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Steven J Hudak
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Allen F Morey
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX.
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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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Baumgarten AS, Kavoussi M, Ortiz NM, Khouri RK, Ward EE, Hudak SJ, Morey AF. High Submuscular IPP Reservoir Placement: The “Five-Step” Technique. Urology 2020; 145:298. [DOI: 10.1016/j.urology.2020.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/26/2022]
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Baumgarten AS, VanDyke ME, Yi YA, Keith CG, Fuchs JS, Ortiz NM, Cordon BH, Pagliara TJ, Ward EE, Jaderlund JW, Teeple CS, Christine BS, Yafi FA, Hudak SJ, Morey AF. Favourable multi‐institutional experience with penoscrotal decompression for prolonged ischaemic priapism. BJU Int 2020; 126:441-446. [DOI: 10.1111/bju.15127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Adam S. Baumgarten
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Maia E. VanDyke
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Yooni A. Yi
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Christopher G. Keith
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Joceline S. Fuchs
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Nicolas M. Ortiz
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Billy H. Cordon
- Division of Urology Mount Sinai Medical Center Miami Beach FLUSA
| | | | - Ellen E. Ward
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | | | | | | | - Faysal A. Yafi
- Department of Urology University of California Irvine Orange CA USA
| | - Steven J. Hudak
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Allen F. Morey
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
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Baumgarten AS, Kavoussi M, VanDyke ME, Ortiz NM, Khouri RK, Ward EE, Hudak SJ, Morey AF. Avoiding deep pelvic complications using a ‘Five‐Step’ technique for high submuscular placement of inflatable penile prosthesis reservoirs. BJU Int 2020; 126:457-463. [DOI: 10.1111/bju.15106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Adam S. Baumgarten
- Department of Urology University of Texas Southwestern Medical Center Dallas TX USA
| | - Mehraban Kavoussi
- 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
| | - 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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Khouri RK, Ortiz NM, Baumgarten AS, Ward EE, VanDyke ME, Hudak SJ, Morey AF. Artificial Urinary Sphincter Outperforms Sling for Moderate Male Stress Urinary Incontinence. Urology 2020; 141:168-172. [DOI: 10.1016/j.urology.2020.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/15/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022]
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Khouri RK, Baumgarten AS, Ortiz NM, Ward EE, Baker RC, VanDyke ME, Yi YA, Hudak SJ, Morey AF. Pressure Regulating Balloon Herniation: A Correctable Cause of Artificial Urinary Sphincter Malfunction. Urology 2020; 139:188-192. [DOI: 10.1016/j.urology.2020.01.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 01/22/2023]
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