Inflatable Penile Prosthesis Insertion Research Articles

Penile Prosthesis Implantation in Patients With Peyronie's Disease: Results of the PROPPER Study Demonstrates a Decrease in Patient-Reported Depression

BackgroundAlthough there is a strong correlation between erectile dysfunction and Peyronie's disease (PD), there are limited data on the efficacy and satisfaction of inflatable penile prosthesis (IPP) placement in this population. AimTo assess the efficacy and overall satisfaction of IPP placement in men with erectile dysfunction and concomitant PD using the Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration (PROPPER). MethodsData from the PROPPER study were examined to determine patient baseline characteristics and primary and secondary etiologies before IPP treatment and included type and size of implant received, presence of corporal fibrosis, and operative time. Men completed 5 validated questionnaires at baseline and annually out to 5 years. OutcomesIPP placement was performed in 250 patients with PD with comparable surgical times and outcomes as in patients without PD. Results1,180 men underwent IPP insertion at 11 sites; of these, 250 (21.2%) were diagnosed with PD. This is an ongoing study; 1- and 2-year data are available for 177 (70.8%) and 130 (52.0%) patients, respectively. Intraoperatively, 51.2% patients with PD had corporal fibrosis, with an average operative time of 52.8 minutes. At baseline, 19.3% of men (36 of 187) with PD reported being depressed, with a decrease to 10.5% (6 of 57; P = .02) and 10.9% (5 of 46; P = .07) at 1- and 2-year follow-ups, respectively. More than 80% of patients with PD were satisfied or very satisfied at 1- and 2-year follow-ups. In addition, more than 88% of patients with PD were using their device at the 1- and 2-year follow-up visits. Clinical ImplicationsPatients with concomitant PD and erectile dysfunction can safely and effectively have an IPP placed with similar outcomes as patients without PD. Strengths and LimitationsThe 1st limitation was that all participating prosthetic urologists were high-volume implanters and these results might not be representative of those of general urologists. A 2nd limitation was that none of the patients were randomized. A 3rd limitation was that although most study points were mandatory, some of the data collection, including depression data, was optional, with not all sites participating. A 4th limitation was that depression data were self-reported. ConclusionIPP can be inserted in patients with PD with acceptable patient satisfaction and usage and depressive symptoms appear to lessen in patients with PD after IPP placement.Khera M, Bella A, Karpman E, et al. Penile Prosthesis Implantation in Patients With Peyronie's Disease: Results of the PROPPER Study Demonstrates a Decrease in Patient-Reported Depression. J Sex Med 2018;15:786–788.

Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence

BackgroundAfter radical prostatectomy (RP), erectile dysfunction, often necessitating the need for inflatable penile prosthesis (IPP) insertion, and urinary incontinence and climacturia can ensue. AimTo assess the efficacy and safety of the mini-jupette, a mesh used to approximate the medial aspects of the 2 corporotomies at the time of IPP insertion, for the management of climacturia and urine leakage in patients with minimal incontinence. MethodsWe conducted a pilot multicenter study of patients with post-RP erectile dysfunction and climacturia and/or mild urinary incontinence (≤2 pads/day [ppd]) undergoing IPP insertion with concomitant placement of a mini-jupette graft. OutcomesPre- and postoperative erectile function, continence and climacturia, and overall surgical outcomes were assessed. Results38 patients underwent the mini-jupette procedure. The mean age of the population was 65.3 years (SD = 7.7). 30 had post-RP climacturia and 32 patients had post-RP incontinence (mean = 1.3 ppd, SD = 0.8). 31 patients received Coloplast Titan, 4 received AMS 700 LGX, and 3 received AMS 700 CX IPPs. Mean corporotomy size was 2.9 cm (SD = 1.0). Mean graft measurements were 3.2 cm (SD = 0.9) for width, 3.3 cm (SD = 1.3) for length, and 11.0 cm2 (SD = 5.1) for surface area. At a mean follow-up of 5.1 months (SD = 6.9), there were 5 postoperative complications (13.2%) of which 4 required explantation. Climacturia and incontinence were subjectively improved in 92.8% and 85.7%, respectively. Mean ppd decreased by 1.3 postoperatively. Clinical ImplicationsThe Andrianne mini-jupette is a feasible adjunct to IPP placement that can be used for subsets of patients with post-RP climacturia and/or minimal incontinence. Strengths and LimitationsStrengths of this study include the novel nature of this intervention, the multi-institutional nature of the study, and the promising results demonstrated. Limitations include the retrospective nature of the study and the heterogeneity of the techniques and grafts used by different surgeons involved. ConclusionLonger follow-up and larger patient cohorts are needed to confirm the long-term safety and benefits of this intervention.Yafi FA, Andrianne R, Alzweri L, et al. Andrianne Mini-Jupette Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-Prostatectomy Climacturia and Minimal Urinary Incontinence. J Sex Med 2018;15:789–796.

024 “Andrianne Mini-jupette” Graft at the Time of Inflatable Penile Prosthesis Placement for the Management of Post-prostatectomy Climacturia and Minimal Urinary Incontinence

Following radical prostatectomy (RP), erectile dysfunction may ensue, often necessitating the need for inflatable penile prosthesis (IPP) insertion. Other consequences of RP include urinary incontinence and climacturia. The “mini-jupette” is a mesh that is used to approximate the medial aspects of the bilateral corporotomies at the time of IPP insertion. We hypothesize that, as the cylinders expand on inflation, this may help limit climacturia, as well as leakage in patients with minimal incontinence. We conducted a pilot multi-center study of patients with post-RP ED and climacturia and/or mild urinary incontinence (≤2pads/day) undergoing IPP insertion with concomitant placement of a “mini-jupette” graft. Twenty patients underwent the “mini-jupette” procedure. The mean age of the population was 64.2 years (SD 7.4). Fourteen patients had post-RP climacturia and 18 patients had post-RP incontinence (mean 1.5 pads/day [SD 0.8]). Fifteen patients received Coloplast Titan, 3 AMS 700 LGX, and 2 AMS 700 CX IPPs. Mean corporotomy size was 2.7cm (1.7). Mean graft measurements were as follows: length 3.3cm (1.3), width 3.1cm (0.9), and surface area 10.5cm2 (6.3). At a median follow-up of 3 months (0-10), there was 1 post-operative complication (5%) of urinary retention requiring suprapubic catheter placement and ensuing device infection requiring explantation. Climacturia and incontinence were subjectively improved in 15 (88%) and 12 patients (86%), respectively.

217 Maximization of Penile Length and Girth with Inflatable Penile Prosthesis Insertion: A Cadaver Study

Penile length and girth after insertion of an inflatable penile prosthesis (IPP) are a concern for patients and surgeons alike. Stretched penile length (SPL) has been described as a good surrogate measure of erect penile length after prosthesis placement. In addition, several surgical techniques have been described to increase penile length during prosthetic surgery; however, these techniques have never been directly compared in terms of overall length increase. Utilizing cadaveric male pelves, we aimed to 1) determine the relationship between SPL and post implant length and 2) compare two techniques for penile lengthening. Ten previously frozen male cadaveric pelvises were obtained for a surgical training lab. Anatomic measurements were conducted from the pubis to the tip of the glans and at the midshaft of the penis to determine length and girth respectively. Inflatable penile prostheses were then inserted using a standard penscrotal incision under direct supervision by fellowship trained prosthetic urologists. The finger trap and the sliding technique penile lengthening procedures were performed as previously described in 5 cases each.

Oxidized Regenerated Cellulose (Fibrillar) Reduces Risk of Postoperative Corporal Bleeding Following Inflatable Penile Prosthesis Surgery

To report our initial experience with oxidized regenerated cellulose (ORC; Surgicel Fibrillar) as a hemostatic adjunct during inflatable penile prosthesis (IPP) surgery. Beginning in April 2016, ORC pledgets were placed within the corporotomy closures of all men undergoing IPP insertion. Perioperative characteristics and outcomes including cumulative postoperative drain output were evaluated among consecutive cases with (April 2016 to October 2016) and without ORC (December 2015 to March 2016) using an identical surgical technique by a single surgeon. During the study period, 64 men underwent IPP implantation, of whom 32 (50%) received ORC. There was a significant reduction in median drain output relative to controls (33 mL vs 65 mL; P = .01). Postoperatively, ORC use was associated with a reduction in the number of patient phone calls for scrotal-related concerns in the immediate postoperative period (average 0.5 vs 1.1; P = .03). There were 3 IPP explantations in the non-ORC group (2/3 for infection)-one of which was directly related to an infected hematoma. After controlling for other clinical features, the use of ORC (β -32, 95% confidence interval: -61 to -5; P = .02) was independently associated with a reduction in drain output. ORC use during IPP corporotomy closure reduces postoperative drain output, a known risk factor for hematoma-related complications.

PD25-05 ′ANDRIANNE MINI-JUPETTE′ GRAFT AT THE TIME OF INFLATABLE PENILE PROSTHESIS PLACEMENT FOR THE MANAGEMENT OF POST-PROSTATECTOMY CLIMACTURIA AND MINIMAL URINARY INCONTINENCE

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy III1 Apr 2017PD25-05 ′ANDRIANNE MINI-JUPETTE′ GRAFT AT THE TIME OF INFLATABLE PENILE PROSTHESIS PLACEMENT FOR THE MANAGEMENT OF POST-PROSTATECTOMY CLIMACTURIA AND MINIMAL URINARY INCONTINENCE Faysal A. Yafi, Robert Andrianne, Georgios Hatzichristodoulou, Jeffrey D. Brady, Murray D. Schwalb, and Steven K. Wilson Faysal A. YafiFaysal A. Yafi More articles by this author , Robert AndrianneRobert Andrianne More articles by this author , Georgios HatzichristodoulouGeorgios Hatzichristodoulou More articles by this author , Jeffrey D. BradyJeffrey D. Brady More articles by this author , Murray D. SchwalbMurray D. Schwalb More articles by this author , and Steven K. WilsonSteven K. Wilson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1200AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Following radical prostatectomy (RP), erectile dysfunction may ensue, often necessitating the need for inflatable penile prosthesis (IPP) insertion. Other consequences of RP include urinary incontinence and climacturia. The ″mini-jupette″ is a mesh that is used to approximate the medial aspects of the bilateral corporotomies at the time of IPP insertion. We hypothesize that, as the cylinders expand on inflation, this may help limit climacturia, as well as leakage in patients with minimal incontinence. METHODS We conducted a pilot multi-center study of patients with post-RP ED and climacturia and/or mild urinary incontinence (≤2pads/day) undergoing IPP insertion with concomitant placement of a ″mini-jupette″ graft. RESULTS Seven patients underwent the ″mini-jupette″ procedure. The median age of the population was 61 years (53-70). Four patients had post-RP climacturia and 7 patients had post-RP incontinence (mean 1.9 pads/day [SD 0.4]). Four patients received a Coloplast Titan, 2 an AMS 700 LGX, and 1 an AMS 700 CX IPP. Mean corporotomy size was 3.2cm (1.3). Types of grafts used were Tutoplast pericardium in 4 patients, biomesh/polypropylene in 2, and Vypro-mesh in 1.Mean graft measurements were as follows: length 3.1cm (1.4), width 3.0cm (0.9), and surface area 9.6cm2 (7.6). No intra-operative or post-operative complications were reported at a mean follow-up of 2.7 months (1.5). Climacturia and incontinence were subjectively improved in 3 (75%) and 7 patients (100%), respectively. All patients were satisfied with the use of their IPP. CONCLUSIONS The ″mini-jupette″ procedure is an excellent, safe and easy technique that can be used for subsets of patients with post-RP climacturia and/or minimal incontinence. Longer follow-up and larger patient cohorts are needed to confirm the long term safety and benefits of this intervention. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e503 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Faysal A. Yafi More articles by this author Robert Andrianne More articles by this author Georgios Hatzichristodoulou More articles by this author Jeffrey D. Brady More articles by this author Murray D. Schwalb More articles by this author Steven K. Wilson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of Surgeon Case Volume on Reoperation Rates after Inflatable Penile Prosthesis Surgery

We investigated the impact of surgeon annual case volume on reoperation rates after inflatable penile prosthesis surgery. The New York Statewide Planning and Research Cooperative System database was queried for inflatable penile prosthesis cases from 1995 to 2014. Multivariate proportional hazards regression was performed to estimate the impact of surgeon annual case volume on inflatable penile prosthesis reoperation rates. We stratified our analysis by indication for reoperation to determine if surgeon volume had a similar effect on infectious and noninfectious complications. A total of 14,969 men underwent inflatable penile prosthesis insertion. Median followup was 95.1 months (range 0.5 to 226.7) from the time of implant. The rates of overall reoperation, reoperation for infection and reoperation for noninfectious complications were 6.4%, 2.5% and 3.9%, respectively. Implants placed by lower volume implanters were more likely to require reoperation for infection but not for noninfectious complications. Multivariable analysis demonstrated that compared with patients treated by surgeons in the highest quartile of annual case volume (more than 31 cases per year), patients treated by surgeons in the lowest (0 to 2 cases per year), second (3 to 7 cases per year) and third (8 to 31 cases per year) annual case volume quartiles were 2.5 (p <0.001), 2.4 (p <0.001) and 2.1 (p=0.01) times more likely to require reoperation for inflatable penile prosthesis infection, respectively. Patients treated by higher volume implanters are less likely to require reoperation after inflatable penile prosthesis insertion than those treated by lower volume surgeons. This trend appears to be driven by associations between surgeon volume and the risk of prosthesis infection.

A review of surgical strategies for penile prosthesis implantation in patients with Peyronie's disease.

The introduction of the inflatable penile prosthesis (IPP) has revolutionized the treatment of patients with both Peyronie’s disease (PD) and erectile dysfunction (ED). A thorough literature review was performed in order to review the surgical strategies used to treat PD, using the PubMed online database with the keywords “penile prosthesis”, “surgical management” and “Peyronie’s disease”. Patient satisfaction rates of 72–100% and partner satisfaction rates of 89% have been reported in the literature, although strong preoperative education may be needed to prepare patients for risks such as penile shortening, seen in up to 54% of patients. Three-piece IPPs are most commonly used, and when comparing the two most popular models (AMS 700 CX vs. Coloplast Titan), no significant differences were seen in functional outcomes or patient satisfaction. Simple insertion of an IPP has been shown to resolve curvature in 33–90% of patients, but surgeons may often need to also utilize ancillary straightening procedures for residual curvatures. Manual modeling can correct residual curvature with an 86–100% success rate, but with a 4% risk of urethral injury. When the post-modeling residual curvature exceeds 30 degrees, a plaque-releasing incision or plication is recommended to further reduce curvature. Grafting is recommended if the resulting incisional defect is larger than two centimeters. Alternative straightening techniques such as plication prior to IPP insertion, endoscopic plaque resection, the “scratch technique” and bone saw plaque incision have also been described.

060 The Impact of Surgical Approach on Corporal Sizing for Inflatable Penile Prosthesis Insertion

060 The Impact of Surgical Approach on Corporal Sizing for Inflatable Penile Prosthesis Insertion

V3-01 INFLATABLE PENILE PROSTHESIS INSERTION WITH SYNCHRONOUS PENILE PLICATION FOR THE TREATMENT OF ERECTILE DYSFUNCTION AND PEYRONIE’S DISEASE

You have accessJournal of UrologyMale Voiding/Sexual Dysfunction/BPH/ Incontinence/Infection/Infertility1 Apr 2016V3-01 INFLATABLE PENILE PROSTHESIS INSERTION WITH SYNCHRONOUS PENILE PLICATION FOR THE TREATMENT OF ERECTILE DYSFUNCTION AND PEYRONIE’S DISEASE Paul H. Chung, Ryan J. Flemons, and Allen F. Morey Paul H. ChungPaul H. Chung More articles by this author , Ryan J. FlemonsRyan J. Flemons More articles by this author , and Allen F. MoreyAllen F. Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1521AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Twenty to thirty percent of patients with Peyronie’s disease have erectile dysfunction refractory to medical therapy. We present clinical outcomes of inflatable penile prosthesis (IPP) placement with synchronous penile plication for the simultaneous correction of Peyronie’s disease and erectile dysfunction. METHODS Patients receiving IPP placement with synchronous penile plication were reviewed. After induction of an artificial erection through saline intracorporal injection, plication was performed through a penoscrotal incision retracted distally along the penile shaft as needed for correction. IPP placement was then conducted through the same incision. RESULTS 27 patients with dorsal, lateral, or biplanar curvature with a mean age of 63 years underwent IPP with synchronous penile plication from 2010 to 2015. Mean pre-op curvature was 37 degrees corrected to <5 degrees after plication. A mean of 4 sutures (range 3-6) were used for PP with each suture providing a mean correction of 8 degrees. No patient suffered post-operative complications and all patients were discharged home on post-operative day one. Upon follow up, three patients reported residual curvature; however, no patient reported continued pain or required release of plication sutures. CONCLUSIONS IPP placement with synchronous penile plication is a reliable option for correction of erectile dysfunction and Peyronie’s disease. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e466 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Paul H. Chung More articles by this author Ryan J. Flemons More articles by this author Allen F. Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Contemporary Review of Artificial Urinary Sphincters for Male Stress Urinary Incontinence.

The most common cause of urinary incontinence in men after radical prostatectomy is intrinsic sphincter deficiency, which can affect long-term quality of life. The prevalence of stress urinary incontinence (SUI) after radical prostatectomy has been reported to be 2.5% to 90%. For patients with moderate to severe male SUI, the artificial urinary sphincter (AUS) is considered the gold standard in surgical treatment. To review the available literature on the development, patient selection, surgical technique, complications, and management of AUS for male SUI. A literature review was performed through PubMed from 1947 to 2015 regarding AUS for male SUI. To assess various surgical techniques related to AUS insertion, outcomes, and complications and to offer recommendations regarding management of complications. The AUS can be placed through a perineal or trans-scrotal incision, particularly in the setting of dual insertion of an AUS and an inflatable penile prosthesis. The most commonly used cuff is 4.0 cm. The efficacy of InhibiZone is debatable. Pressure-regulating balloons can be filled with saline or contrast material and can be placed in an orthotopic or an ectopic location. In a systematic review of the literature, dry or improved continence rates are achieved in 79% of patients, with 90% reporting satisfaction and improved quality-of-life index scores after surgery. The most common AUS complications include a nonfunctioning device, sub-cuff atrophy, erosion, and infection. These complications are managed by strategies such as cuff downsizing, tandem cuff placement, and explantation. Dual AUS and inflatable penile prosthesis insertion is feasible for patients with SUI and erectile dysfunction. The AUS is a durable and effective device for the management of SUI. Surgeons should be versed in the different device components, their potential complications, and their management.

Intraoperative Decision-making for Precise Penile Straightening During Inflatable Penile Prosthesis Surgery

To present a novel algorithm for definitive reconstruction of penile curvature in men undergoing inflatable penile prosthesis (IPP) surgery as an alternative to manual penile modeling and grafting procedures. Patients with erectile dysfunction and concomitant penile curvature undergoing IPP placement were divided into 2 treatment groups: (1) group 1, penile deformity known preoperatively, and (2) group 2, penile curvature recognized intraoperatively after IPP placement. Group 1 patients underwent penile plication after artificial erection and immediately before IPP insertion via the same penoscrotal incision, whereas group 2 patients were treated with a Yachia (Heineke-Mikulicz) corporoplasty over the intact cylinders. Patients completed postoperative Patient Global Impression of Improvement (PGI-I) questionnaires assessing overall satisfaction. Among 405 men receiving IPP at our institution from 2007 to 2014, 30 patients received synchronous correction of penile curvature (7%). Group 1 included 23 of 30 (77%) patients, and 7 of 30 (23%) were in group 2. Overall mean initial curvature was 36°, and all patients were corrected to < 10°. Average operative times were 18 minutes longer compared with patients who underwent IPP placement alone (82 vs 64 minutes, P <.05). At an average follow-up of 13 months (range 7-32), 19 of 20 (95%) group 1 and 6 of 7 (86%) group 2 patients who completed surveys reported an improved overall condition. No patient reported chronic pain, recurrent deformity, or device malfunction. Penile curvature can be safely and reliably corrected at the time of IPP placement, regardless of whether the deformity was identified preoperatively.

PD48-09 VERSATILE ALGORITHMIC APPROACH FOR DEFINITIVE STRAIGHTENING WITHOUT MODELING DURING PENILE PROSTHESIS SURGERY

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Peyronie's Disease1 Apr 2015PD48-09 VERSATILE ALGORITHMIC APPROACH FOR DEFINITIVE STRAIGHTENING WITHOUT MODELING DURING PENILE PROSTHESIS SURGERY Timothy Tausch, Paul Chung, Jordan Siegel, Alexandra Klein, and Allen Morey Timothy TauschTimothy Tausch More articles by this author , Paul ChungPaul Chung More articles by this author , Jordan SiegelJordan Siegel More articles by this author , Alexandra KleinAlexandra Klein More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2766AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present a novel algorithm for definitive reconstruction of penile curvature in men undergoing concomitant inflatable penile prosthesis (IPP) surgery as an alternative to penile modeling. METHODS Patients receiving IPP placement who also had penile curvature were divided into two treatment groups based on when the deformity was recognized: group A) when the penile deformity was known preoperatively, the patient underwent penile plication immediately prior to IPP insertion via the same penoscrotal incision; group B) patients whose penile curvature was recognized after inflation of the newly inserted IPP were treated with a Yachia (Heineke-Mikulicz) corporoplasty over the intact cylinders. A qualitative survey assessing penile curvature, adequacy for intercourse and overall patient satisfaction after surgery was administered. RESULTS Among 405 men receiving IPP at our institution from 2007-2014, 30 patients received synchronous reconstruction for penile curvature (7%). Group A included 23/30 (77%) patients, and 7/30 (23%) were in group B. Mean pre-op curvature overall was 37° corrected to <10°. A median of 4 sutures (range 3-6) were used for plication with each suture providing correction of approximately 8°. Average operative times were only 24 minutes longer compared to patients who underwent IPP placement only (88 vs 64 minutes, p<0.05). At an average 8 months of follow-up, 17/18 (94%) patients who completed surveys reported no residual curvature, erections adequate for sexual intercourse and an improved overall condition. One patient (7%) who underwent a complex biplanar plication reported minor residual curvature. No patient reported chronic pain or recurrent deformity. CONCLUSIONS Penile curvature can be safely and reliably reconstructed at the time of IPP placement in a definitive manner, regardless of whether or not the deformity was identified preoperatively. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e969 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy Tausch More articles by this author Paul Chung More articles by this author Jordan Siegel More articles by this author Alexandra Klein More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

High Patient Satisfaction of Inflatable Penile Prosthesis Insertion with Synchronous Penile Plication for Erectile Dysfunction and Peyronie's Disease

Twenty to thirty percent of patients with Peyronie's disease (PD) have erectile dysfunction (ED) refractory to medical therapy and may benefit from a combined procedure addressing both conditions. The aim of this study was to show the efficacy of inflatable penile prosthesis (IPP) insertion and synchronous penile plication for correcting penile curvature and ED in patients with PD. A retrospective review was performed of all patients who underwent IPP insertion with synchronous penile plication at our tertiary care center between 2010 and 2013. All patients received an intraoperative saline intracorporal injection to induce an artificial erection. After the tunica albuginea was exposed via a standard transverse scrotal incision over the proximal penile shaft, the incision was retracted distally and/or laterally as needed for plication suture placement. Plication sutures were placed in parallel opposite the angle of greatest curvature. The incision was returned proximally to the standard penoscrotal junction for IPP insertion. Demographic and surgical data were collected from the patients' medical records. Patient satisfaction was assessed postoperatively using a nonvalidated questionnaire. The focus of this study was surgical outcomes, both technical and patient-reported satisfaction. Eighteen patients with a mean age of 63 years underwent IPP insertion with synchronous penile plication. Patients presented with dorsal (n = 11), lateral (n = 2), and biplanar curvature (n = 5). Mean preoperative curvature was 39 degrees (range 30-60) and was corrected on average to <5 degrees (range <5-12) using a median of four plication sutures (range 3-6). Among 15 patients completing a postoperative satisfaction survey at a mean of 11 months, all reported improvement in their overall condition and penile curvature; one with biplanar deformity reported minor residual curvature. None reported continued pain or required suture release. IPP insertion with synchronous penile plication for the correction of ED and PD is effective and results in high patient satisfaction.

Combined Inflatable Penile Prosthesis-Artificial Urinary Sphincter Implantation: No Increased Risk of Adverse Events Compared to Single or Staged Device Implantation

Little data exist on the outcome of combined inflatable penile prosthesis and artificial urinary sphincter insertion for erectile dysfunction and stress urinary incontinence. We assessed patient outcomes for combined vs single device implantation at a single institution. We retrospectively reviewed the records of all patients who underwent inflatable penile prosthesis and artificial urinary sphincter insertion at our hospital from January 2000 to December 2011. A total of 55 combined procedures were performed compared to the single insertion of 336 inflatable penile prostheses and 279 artificial urinary sphincters. The surgical approach consisted of penoscrotal incisions for inflatable penile prostheses and transperineal incisions for artificial urinary sphincter cuff placement with a secondary lower abdominal incision for reservoir placement. Men treated with combined implantation had greater mean age and were at greater risk for prostate cancer diagnosis and treatment, and at lesser risk for Peyronie disease than men who received an inflatable penile prosthesis alone (each p<0.05). Although operative time was significantly longer for the combined procedure than for the inflatable penile prosthesis alone and the AUS alone (mean 218.1 vs 145.9 and 114.7 minutes, respectively, p<0.0001), the rate of device infection, erosion or malfunction was not increased irrespective of combined or staged procedures (p>0.05). Combined inflatable penile prosthesis-artificial urinary sphincter implantation and staged prosthesis implantation are feasible without an increased risk of adverse outcomes compared to implantation of a single prosthesis. Patients with concomitant erectile dysfunction and stress urinary incontinence should be counseled about the possible advantages of this surgical option, which include a single anesthesia event and faster resumption of sexual activity and urinary control.

1670 THE FATE OF PATIENTS DEVELOPING ERECTILE DYSFUNCTION AFTER PLAQUE INCISION AND GRAFTING FOR PEYRONIE'S DISEASE

required during inflatable penile prosthesis (IPP) insertion to ensure that the penis will be straight enough for penetrative intercourse. The aim of this study was to compare the outcomes of men undergoing SM employed during IPP insertion compared to those wherein these maneuvers were not required. METHODS: A retrospective review of 391 patients undergoing IPP insertion at the Johns Hopkins Hospital from January 2000-December 2011 was performed. Patients in whom some SM was employed (SM, n 93, 23.9% of the overall cohort) were compared to those for whom SM was not required (IPP group, n 297). Comparisons between groups were performed using Chi-square tests for categorical data; the means of continuous data were compared by using the t test and non-parametric alternate if the distribution could not be normalized or the variance was not equal. P-values 0.05 were considered statistically significant. RESULTS: Patients in whom a SM was used were younger (55.4 vs. 62.3 years) and more likely to have Peyronie’s disease, and less likely to have prostate cancer, radical prostatectomy or to have previously used erectile aids (all P 0.05). Mean surgical time in the SM group was longer (173.8 vs. 152.9 minutes, P 0.003). Within the SM group, modeling was performed in 40 (43%), tunical relaxing incisions in 37 (39.8%), and tunical reconstruction in 16 (17.2%) (most commonly using allograft dermis or pericardium, or synthetic gore-tex grafts) patients. There were no significant differences in terms of device infection (P 0.807), mechanical failure (P 0.212) or cylinder erosion (P 0.051). A significantly higher overall rate of tubing or pump erosion (defined as a visible penetration through the skin) was noted in the SM (10/93, 10.8%) vs. the IPP groups (13/297, 4.4%), P 0.022. The median time to device explantation or revision was 463 days (range 2-1908). CONCLUSIONS: IPP insertion in men with penile deformity requiring complex reconstruction to achieve straightening may be done proficiently. While straightening maneuvers may carry elevated risk, they can nevertheless achieve good results with an overall high safety profile.

1228 MRI ANALYSIS OF ANATOMICAL LANDMARKS WITH RESPECT TO INFLATABLE PENILE PROSTHESIS RESERVOIR PLACEMENT

INTRODUCTION AND OBJECTIVES: Insertion of a threepiece inflatable penile prosthesis (IPP) reservoir is a “blind procedure”. The traditional reservoir placement in the space of Retzius can result in damage to bladder, bowel and femoral blood vessels. A single cadaveric study has delineated pertinent anatomic relationships. We have attempted to evaluate similar anatomical measurements in an in vivo model using magnetic resonance imaging (MRI). METHODS: Endorectal MRI studies in men being evaluated for prostate cancer were reviewed. Prior pelvic surgery, radiation or an in situ urinary catheter were exclusions. Endorectal MRI was performed on a 3 Tesla system with T1 and T2 weighted images reviewed usingboth axial and sagittal planes. Pertinent anatomical landmarks were evaluated by 2 independent readers, blinded to clinical and pathological data. All measurements were defined by an experienced radiologist. Measurements included (i) distance from external inguinal ring(EIR) to external iliac vein(EIV) (ii) superior aspect of pubic symphysis (PS) to bladder and (iii) EIR to nearest bladder point. Correlation was measured between bladder volume and (iii). For distances (i) and (iii) bilateral measurements were obtained and data averaged as no significant differences were observed. Means and standard deviations are presented. Pearson correlations were used to assess the relationship between variables, and regression analysis use to predict changes in (iii) with respect to bladder volume. RESULTS: 24 MRI studies were reviewed. Mean distances: EIR to EIV 3.09cm (2.23-3.84);superior aspect of PS to nearest point of bladder (midline) 0.86cm (0.37-1.24); EIR to the nearest point of the bladder 1.76cm (0.08-3.66). Correlation between EIR-bladder distance and bladder volume was r -0.36, p 0.9. Average bladder volume was 93.04cm3 (34.5-177.6),(SD 36). On regression analysis as bladder volume increases by 10 cm3 the distance to the EIR decreased by 1mm. CONCLUSIONS: This is the first attempt to analyse anatomical landmarks with respect to IPP reservoir placement in an in vivo model. The close proximity of the external iliac vein and bladder should alert surgeons to the potential for damage to these structures during this procedure. This also emphasizes the importance of decompressing the bladder during reservoir placement.

564 OUTCOMES OF COMBINED INFLATABLE PENILE PROSTHESIS-ARTIFICIAL URINARY SPHINCTER VS. INDIVIDUAL DEVICE INSERTION-A RETROSPECTIVE SINGLE INSTITUTION STUDY

You have accessJournal of UrologyUrodynmaics/Incontinence/Female Urology: Incontinence, Evaluation & Therapy (I)1 Apr 2013564 OUTCOMES OF COMBINED INFLATABLE PENILE PROSTHESIS-ARTIFICIAL URINARY SPHINCTER VS. INDIVIDUAL DEVICE INSERTION-A RETROSPECTIVE SINGLE INSTITUTION STUDY Robert Segal, Marcelo Cabrini, Elaine Harris, Zhaoyong Feng, Bruce Trock, Jacek Mostwin, Trinity Bivalacqua, and Arthur Burnett Robert SegalRobert Segal Baltimore, MD More articles by this author , Marcelo CabriniMarcelo Cabrini Baltimore, MD More articles by this author , Elaine HarrisElaine Harris Baltimore, MD More articles by this author , Zhaoyong FengZhaoyong Feng Baltimore, MD More articles by this author , Bruce TrockBruce Trock Baltimore, MD More articles by this author , Jacek MostwinJacek Mostwin Baltimore, MD More articles by this author , Trinity BivalacquaTrinity Bivalacqua Baltimore, MD More articles by this author , and Arthur BurnettArthur Burnett Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1960AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a relative paucity of data on outcomes for combined 3-piece Inflatable Penile Prosthesis (IPP) and Artificial Urinary Sphincter (AUS) Insertion for the definitive treatment of erectile dysfunction and male stress incontinence, respectively. The objective of this study was to assess and compare patient demographics and outcomes for combined procedures vs. procedures wherein 1 individual device is implanted at a single institution. METHODS A retrospective review of all patients undergoing IPP and AUS insertion at the Johns Hopkins Hospital from January 2000-December 2011 was performed. A total of 54 combined procedures were performed, compared with 337 IPP and 281 AUS procedures. Comparisons between groups were performed using Chi-square tests for categorical data; the means of continuous data were compared by using the t test and non-parametric alternate if the distribution could not be normalized or the variance was not equal. All statistical tests were two sided and P < 0.05 was considered statistically significant. RESULTS The surgical approaches consisted of midline penoscrotal incisions for IPP, and transperineal incisions for AUS cuff placement with a secondary lower abdominal incision for AUS reservoir placement. Significant demographic differences between groups included those men undergoing combined implantation having a higher mean age (65.3 years vs. 59.9 years), risk of prostate cancer, prostatectomy and radiation therapy, and a lesser risk of Peyronie's disease, compared to men undergoing IPP alone (all P < 0.05). Although the duration of surgery was significantly longer for the combined procedure (mean 218.1 minutes vs. 145.9 minutes for IPP alone and 114.7 minutes for AUS alone, P < 0.0001), there was no increased risk of device infection, erosion or malfunction requiring surgical revision in the patients who received combined procedures (P = 0.37). Mean hospitalization duration for the combined procedure was 1.2 days (with 45/54 [83.3%] staying <24 hours), and mean follow-up for the combined procedure was 1.62 years, for IPP alone was 1.47 years, and for AUS alone, 2.98 years. CONCLUSIONS Combined IPP-AUS insertion is a safe procedure with no increased risk of adverse outcomes compared to individual prosthetic implantation. Patients should be counseled about this surgical option given the clear benefits of this approach, which include a single anesthesia event and faster restoration of erectile function and continence. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e231-e232 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Segal Baltimore, MD More articles by this author Marcelo Cabrini Baltimore, MD More articles by this author Elaine Harris Baltimore, MD More articles by this author Zhaoyong Feng Baltimore, MD More articles by this author Bruce Trock Baltimore, MD More articles by this author Jacek Mostwin Baltimore, MD More articles by this author Trinity Bivalacqua Baltimore, MD More articles by this author Arthur Burnett Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

UP-03.057 Early Insertion of Inflatable Penile Prosthesis for Intractable Ischemic Priapism

UP-03.057 Early Insertion of Inflatable Penile Prosthesis for Intractable Ischemic Priapism

Antibiotic Patterns with Inflatable Penile Prosthesis Insertion

A clear set of guidelines has not been defined in the use of antibiotics in penile prosthesis implantation. Aim. We surveyed urologists throughout the United States to determine current practice patterns regarding antibiotic use in primary and revision penile prosthesis surgery. Fifty-two Sexual Medicine Society of North America (SMS) member urologist and 164 non-SMS member urologist responses were obtained. The survey contained 10 questions regarding antibiotic selection for primary and revision inflatable penile prosthesis (IPP) implantation. One hundred percent of responders in both groups utilize intraoperative antibiotics, most commonly vancomycin and gentamicin in both groups. Of SMS members, 94% prescribed postoperative home oral antibiotics in contrast to 88% of non-SMS members (P = 0.3). Among SMS members, the most common antibiotic prescribed postoperatively was levofloxacin 500 mg daily while among non-SMS members, the most common antibiotic postoperatively was cephalexin 500 mg 2-4 times daily. Of SMS members, antibiotic irrigation intraoperatively occurred with 100% and with 92% of non-SMS members (P = 0.04). Thirty-seven percent SMS physicians and 15% non-SMS physicians made modifications of intraoperative and postoperative antibiotics for high-risk patients (P = 0.001). In the circumstance of revision of a clinically noninfected IPP, 23% SMS and 16% non-SMS member physicians utilized additional antibiotics/treatment (P = 0.3). Sixteen of those surveyed admitted that they had been approached by their institution about their antibiotic use and asked to change. In the past 5 years, 29% surveyed have changed their practice patterns in antibiotic use. There is significant difference between practice patterns of SMS and non-SMS urologists in terms of antibiotic irrigation usage, modifications for high-risk patients, and consensus about the importance of antibiotic use with Coloplast Titan implant (Coloplast, Minneapolis, MN, USA). A significant lack of uniformity exists among urologists performing prosthetic surgery with regard to antibiotic protocols. A standard set of guidelines may prove useful to implanters.