Malleable Prosthesis Research Articles

A Novel Thermal-activated Shape Memory Penile Prosthesis: Comparative Mechanical Testing

To compare a novel nickel-titanium (Ni-Ti) shape memory alloy (SMA) penile prosthesis of our own design with commercially available prostheses using a format similar to mechanical testing done at major penile prosthesis manufacturers. We evaluated the mechanical parameters of commercially available penile prostheses and used this information to guide the development of the Ni-Ti-based physiological penile prosthesis that expands and becomes erect with a small amount of heat applied. A penile prosthesis consisting of an exoskeleton of temperature-tuned Nitinol was designed and prototyped. Mechanical testing was performed in a model of penile buckling, penile lateral deviation, and original penile shape recovery commonly used by penile prosthesis manufacturers for testing. Our SMA penile prosthesis demonstrated useful mechanical characteristics, including rigidity to buckling when activated similar to an inflatable penile prosthesis (2.62 kgf SMA vs 1.42 kgf inflatable penile prosthesis vs 6.45 kgf for a malleable prosthesis). The Ni-Ti also became more pliable when deactivated within acceptable mechanical ranges of existing devices. It could be repeatedly cycled and generate a restorative force to become erect. An SMA-based penile prosthesis represents a promising new technology in the treatment of erectile dysfunction. We demonstrated that an Ni-Ti-based prosthesis can produce the mechanical forces necessary for producing a simulated erection without the need for a pump or reservoir, comparable with existing prostheses.

Satisfaction assessment with malleable prosthetic implant of Spectra (AMS) and Genesis (Coloplast) models.

The malleable prosthetic implant is widely accepted among patients and physicians owing to a lower degree of surgical complexity, its rare mechanic failures and lower cost. We have compared the degree of satisfaction with malleable prosthetic implant in 60 patients, 36 with Spectra (AMS) and 24 with Genesis (Coloplast). For assessment purposes, we implemented the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) satisfaction questionnaire adapted for penile prosthetic implants. The mean age and follow-up was 61.7 years (31-82) and 19.9 months (1-61), respectively. Mean EDITS scores did not indicate superiority of one implant over the other, overall satisfaction index being 77.1% and 75.6% for Genesis and Spectra prosthesis, respectively (P=0.4970). Our results revealed that these two models of malleable prostheses present a high level of satisfaction and confirm that the malleable prosthetic implant is an excellent option to treat patients with ED refractory to medical treatment.

Current Literature Review.

Current Literature Review.

Outcome of penile prosthesis implantation: are malleable prostheses an appropriate treatment option in patients with erectile dysfunction caused by prior radical surgery?

The aim of our study was to evaluate the outcome of penile prosthesis implantation in patients with various comorbidities as a cause of erectile dysfunction (ED). The data of 181 patients who underwent surgery between 1998 and 2012 in two centers were evaluated. The mean age of the patients was 52.2 years (range: 31–71 years). The study group contained 162 patients (89.5%) with malleable prostheses and 19 (10.5%) with inflatable implants. All patients were re-evaluated 1 month later to assess prosthesis function and complications, and further re-examinations were performed if needed. Satisfaction was defined as having satisfactory intercourse and happiness with the device in general. The follow-up period was at least 12 months for each patient. The postoperative complication rate was 32% (n = 58). The number of complications with inflatable and malleable prostheses was 7 (3.9%) and 51 (28.1%), respectively. Overall, 21 prostheses (11.6%) had to be removed because of various complications and patient dissatisfaction. Patients with prior radical surgery had higher extraction rates (ƛ = 14.606, P < 0.05, Chi-square test). The main reasons for removal were erosion (n = 11; 6.1%) and infection (n = 3; 2.1%). With respect to satisfaction during intercourse, we found that 104 (57.5%) patients described themselves as very satisfied with the prosthesis, while 21 (11.6%) were unsatisfied. The high explantation rate in patients with prior surgery was remarkable in our study. Our results revealed that a malleable prosthesis should not be the preferred type of implant for patients with prior surgery.

Multiple Site Fracture of Both Rods in a Malleable Penile Implant.

Penile prosthesis implant is the definitive treatment for refractory erectile dysfunction. Fracture of malleable prosthesis is rarely described due to its low incidence. We describe a case of multiple, bilateral fracture of a malleable penile implant, ten years after implantation. After the diagnosis, a review surgery was performed and the implants were replaced. No corporal rupture or urethral lesion was observed. Review of the literature shows few articles reporting penile implant fractures, and to our knowledge no other article has described multiple, bilateral fractures of a penile prosthesis.

Surgical Treatment of Erectile Dysfunction and Peyronie's Disease Using Malleable Prosthesis.

Peyronie's disease (PD) is a condition of middle aged men and frequently accompanied by erectile dysfunction (ED) which was attributed to penile deformity, vascular pathology and psychological components. The implantation of semi-rigid penile prosthesis allows for these patients to undergo a simple procedure aimed at correction both penile deformity and ED. The aim of this study was to investigate surgical and clinical outcomes and patient satisfaction rate at long term follow-up after semi-rigid penile prosthesis implantation (PPI) in men with PD and ED. A total of 66 patients with mean age of 49.2 (range, 30-76) years old underwent semi-rigid PPI between 1995 and 2006. Genesis (Coloplast®) was used for implantation in a standard manner by penoscrotal approach without using any graft and remodeling technique. In all patients, dilatation of corpora was performed without any difficulty and straightening of the penis was achieved. A retrospective review of clinical database and prospective telephone survey were conducted in all patients. The mean follow-up time was 9.7 years (range, 6 to 17). There wasn't any clinical infection and complication during follow-up period. Fifty-nine patients were sexually active at the time of the interview. None of the patients reported residual curvature. The overall patient satisfaction was 91.5% (54 patients). Primary reasons for dissatisfaction were decreased penile length and prosthesis problems. Based on our results semi-rigid PPI is effective and easy procedure for treatment of men with PD and ED without any complication and with high patient satisfaction rate in long-term follow up period.

Penile Prosthesis Implantation in Patients with a History of Total Phallic Construction

Outcomes following penile prosthesis implantation in patients with a history of total phallic construction are not well described. The aim of this study was to evaluate outcomes following neophallus penile prosthesis placement. Retrospective review penile prosthesis placement in patients with prior total phallic construction. GORE-TEX® (Gore Medical, Flagstaff, AZ) sleeve neotunica construction was utilized in all patients. Success defined as patient sexual activity with a functioning prosthesis. Thirty-one patients underwent neophallic prosthesis implantation at a mean 35.6 years of age. Prosthesis placement occurred at an average 56.3 months following phallic construction and follow-up was a mean of 59.7 months. Malleable prostheses were placed in 21 patients and inflatable in 10; implants were bilateral in 94%. Six percent experienced operative complications including a bladder injury (1) and phallic flap arterial injury (1). Postoperative complications occurred in 23% at a median 5.5 months following placement. Five prostheses were explanted secondary to infection or erosion and two additional required revisions. Of the explanted prosthesis two were later replaced without further complication. Eighty-one percent of patients were sexually active following prosthesis placement. Penile prosthesis placement is possible in patients with prior penile reconstruction/phallic construction. Although complications rates appear to be elevated in this population compared with historic controls of normal anatomic men, the majority of patients in this series were sexually active following prosthesis placement. This demonstrates the utility of prosthesis implantation in these difficult patients.

The Evolution and Utility of the Small-Carrion Prosthesis, Its Impact, and Progression to the Modern-Day Malleable Penile Prosthesis.

Erectile dysfunction has plagued humanity for millennia. For years, treatment had been in the hands of mental health professionals. It was not until the 1970s that urologists created a modality that was marketable, reproducible, and consistently successful at treating impotence, the Small-Carrion Penile Prosthesis. We present the evolution of the malleable/semi-rigid penile prosthesis, concentrating our efforts reviewing and critiquing the pivotal article published by Drs. Michael P. Small, Hernan M. Carrion, and Julian A. Gordon. We then discuss its continued advancement, current-day utilization, and the future of the malleable prosthesis. From the early 1900s, surgeons have been toying with the idea of creating a penile implant. These initial attempts utilized rib cartilage, and eventually synthetic materials, including acrylic, silicone, and polyethylene. In 1975, Drs. Carrion and Small presented their initial experience of 31 patients utilizing their silicone implant. In their manuscript titled, "The Small-Carrion Penile Prosthesis: New Implant for the Management of Impotence," they discuss their technique, perioperative management of complications, and results. The malleable penile prosthesis continued to evolve throughout the years to the current day Genesis and Spectra. Although the current market is dominated by the inflatable penile prosthesis, there are specific situations where the malleable is ideally utilized. The pivotal article by Drs. Carrion and Small helped pave the way for the "New Era" of penile prosthetics and still remains one of the most impactful contributions to the management of erectile dysfunction.

The Malleable Implant Salvage Technique: Infection Outcomes after Mulcahy Salvage Procedure and Replacement of Infected Inflatable Penile Prosthesis with Malleable Prosthesis

Since its introduction in 1996 Mulcahy salvage has significantly improved outcomes for the removal and replacement of infected inflatable penileprostheses. Long-term followup data of Mulcahy salvage show an infection-free rate of 82%. A multicenter retrospective analysis of the malleable implant salvage technique was conducted to assess infection outcomes and thefeasibility of conversion from malleable device back to inflatable penile prosthesis. This is a retrospective, institutional review board exempt, multi-institution study of 58 patients who underwent Mulcahy salvage with inflatable penile prosthesis removal and replacement with malleable prosthesis. Patient operative notes and charts were extensively reviewed to compile study data. Between 2002 and 2014 a total of 58 patients underwent infected inflatable penile prosthesis removal and replacement with a malleable prosthesis via Mulcahy salvage. Of these patients 54 (93%) have remained infection-free postoperatively. Average patient age was 56.4 years and average operative time was 148 minutes. Postoperative followup (as of May 2015) ranged from 1month to 84 months. Of the 54 patients 37 retained the malleable prosthesisand 17 (31%) subsequently underwent replacement with an inflatable penile prosthesis. This occurred on average 6.7 months after Mulcahy salvage. Four patients had persistent infection after Mulcahy salvage with the malleable prosthesis and underwent explantation. This retrospective analysis of Mulcahy salvage procedure and replacement of inflatable penile prosthesis with malleable prosthesis shows a high infection-free rate. Additionally, 17 of the 54 patients who remained infection-free were able to successfully undergo subsequent removal of the malleable prosthesis and replacement with an inflatable penile prosthesis. Further prospective studies are needed to compare salvage with malleable vs inflatable penile prosthesis.

Early insertion of a malleable penile prosthesis in ischaemic priapism allows later upsizing of the cylinders

Objective: Early insertion of a penile prosthesis in prolonged ischaemic priapism is easier to perform than late prosthesis placement, and preserves the penile length. The aim of this study was to assess whether a delayed exchange to an inflatable implant allows upsizing of the cylinders in patients who have undergone early insertion for refractory ischaemic priapism. Materials and methods: Over a 30 month period, 10 patients with ischaemic priapism underwent an early insertion of a malleable penile prosthesis. The mean age was 41.3 years and the mean duration of priapism was 188 h. Following a median period of 130.5 days, all of these patients underwent exchange of the malleable to an inflatable prosthesis. Results: At the time of penile implant exchange, a median upsize in the length of the cylinders of 1 cm in either one or both corporal bodies (range 0–3 cm) was recorded. Five patients had deliberate downsizing at the initial operation owing to a previous shunt. The mean score on the five-item International Index of Erectile Function (IIEF-5) before insertion of the malleable prosthesis was 24 (range 20–25). Three months after the initial insertion of a malleable penile implant the satisfaction rate according to the IIEF-5 score was 80%. Three months after the exchange, the patient satisfaction rate increased to 90%. Conclusion: Insertion of a malleable penile prosthesis is an acceptable option for patients with refractory ischaemic priapism. Although some patients deliberately have a shorter implant inserted initially owing to a previous distal shunt procedure, following a period of resolution the cylinders can be upsized at a later operation.

Penile prosthesis – a viable solution for erectile dysfunction refractory to conservative therapy

Introduction: Erectile dysfunction(ED) is a serious condition which can affect men of all ages, with an important impact over the quality of life. When conservative therapy fails, a viable solution is the penile prosthesis implantation (PPI). Objective: The purpose of this paper is to present data from recent literature regarding the satisfaction rates of men who have undergone penile PPI and as well as the partners satisfaction rates, ease of use, informations regarding long term survival of these prosthesis, postoperative complications and long distance complications, the effectiveness and the way that penile prosthesis have influenced the quality of life of the men who have opted for this solution. Material and methods: We have analyzed recent long term studies concerning the outcomes of the PPI, studies which were made retrospectively, over a period of time of 10 to 15 years. Results: Compared with the conservative treatment for ED, the satisfaction rates achieved after penile prosthesis implantation are higher. According to these studies, the overall patient’s satisfaction is 70-90%. The difference between patient and their partners’ satisfaction rate is negligible, this difference ranging between 2 to 8%. The satisfaction rate regarding the adequate erection for sexual intercourse is 80-90%. The overall satisfaction rates for the malleable prostheses are lower compared with inflatable devices, 30-75%, respectively 75-90% for the inflatable prosthesis. The mechanical and overall survival rates for the malleable prosthesis range between 65-80% at 10 years, and 58-75% for the inflatable devices. Overall ease of use is rated as 78%. Complications after implantation can be encountered in less than 5% of cases and infections in less than 2%. The likelihood of continued use is higher in the group of the patients with the inflatable prosthesis compared with the malleable ones 70-80%, respectively 50-60%. Up to 85- 90% of patients with inflatable prosthesis would recommend them. Conclusions: PPI is a high effective treatment for erectile dysfunction, refractory to pharmacological treatment. The inflatable penile prosthesis (IPP) provides more overall satisfaction than the malleable ones. The patients with IPP are more likely to continue using their devices than those with the malleable prosthesis. PPI improves significantly the quality of life for patients with erectile dysfunction.

PD26-04 IMPROVED INFECTION OUTCOMES AFTER MULCAHY SALVAGE PROCEDURE AND REPLACEMENT OF INFECTED IPP WITH MALLEABLE PROSTHESIS

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy I1 Apr 2015PD26-04 IMPROVED INFECTION OUTCOMES AFTER MULCAHY SALVAGE PROCEDURE AND REPLACEMENT OF INFECTED IPP WITH MALLEABLE PROSTHESIS Martin Gross, Francois Eid, Christopher Yang, Ross Simon, Daniel Martinez, Rafael Carrion, Paul Perito, Laurence Levine, Jason Greenfield, and Ricardo Munarriz Martin GrossMartin Gross More articles by this author , Francois EidFrancois Eid More articles by this author , Christopher YangChristopher Yang More articles by this author , Ross SimonRoss Simon More articles by this author , Daniel MartinezDaniel Martinez More articles by this author , Rafael CarrionRafael Carrion More articles by this author , Paul PeritoPaul Perito More articles by this author , Laurence LevineLaurence Levine More articles by this author , Jason GreenfieldJason Greenfield More articles by this author , and Ricardo MunarrizRicardo Munarriz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1080AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since its introduction in 1996, Mulcahy salvage has significantly improved outcomes for removal and replacement of infected IPPs. Long-term follow-up data of Mulcahy salvage shows an infection-free rate of 82%. Since 2002, 58 patients have undergone Mulcahy salvage with IPP removal and replacement with malleable prosthesis at our institutions. Of these patients, 54 (93%) have remained infection free postoperatively. Additionally, 15 of these 54 patients have undergone subsequent malleable replacement with IPP. METHODS This is a retrospective multi-institution study of 58 patients who underwent Mulcahy salvage with IPP removal and replacement with malleable prosthesis. Patients' operative notes and charts were extensively reviewed to compile study data. RESULTS Between 2002 and 2014, 58 patients underwent infected IPP removal and replacement with malleable prosthesis via Mulcahy salvage. Average age was 57.7, range 26 to 79. Average operative time was 122 minutes, range 47 to 209. Postoperative follow-up ranged from 2 weeks to 84 months. Thirty-nine of 54 patients retained malleable prosthesis, 15 patients subsequently underwent replacement with IPP. This occurred on average 6.9 months after Mulcahy salvage, range from 1 to 29 months. Four patients had persistent infection after Mulcahy salvage with malleable and underwent explant. CONCLUSIONS Mulcahy salvage procedure and replacement of IPP with malleable prosthesis has an improved infection-free rate of 93% when compared to the 82% infection-free rate after IPP removal and replacement. Additionally, 15 of the 54 patients who remained infection free were able to successfully undergo subsequent removal of malleable prosthesis and replacement with IPP an average of 6.9 months later. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e567 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin Gross More articles by this author Francois Eid More articles by this author Christopher Yang More articles by this author Ross Simon More articles by this author Daniel Martinez More articles by this author Rafael Carrion More articles by this author Paul Perito More articles by this author Laurence Levine More articles by this author Jason Greenfield More articles by this author Ricardo Munarriz More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

MP29-03 PENILE PROSTHESIS PLACEMENT IN PATIENTS WITH A HISTORY OF TOTAL PHALLIC CONSTRUCTION.

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma II1 Apr 2015MP29-03 PENILE PROSTHESIS PLACEMENT IN PATIENTS WITH A HISTORY OF TOTAL PHALLIC CONSTRUCTION. Jack Zuckerman, Kate Smentkowski, Dave Gilbert, Ramon Virasoro, Jeremy Tonkin, Gerald Jordan, and Kurt McCammon Jack ZuckermanJack Zuckerman More articles by this author , Kate SmentkowskiKate Smentkowski More articles by this author , Dave GilbertDave Gilbert More articles by this author , Ramon VirasoroRamon Virasoro More articles by this author , Jeremy TonkinJeremy Tonkin More articles by this author , Gerald JordanGerald Jordan More articles by this author , and Kurt McCammonKurt McCammon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.606AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Describe technique and outcomes for penile prosthesis placement in patients with a history of total phallic construction. METHODS Retrospective review penile prosthesis placement in patients with prior total phallic construction at a single center. Gortex sleeve corporal construction and pubic rami fixation was utilized in all patients. RESULTS Thirty-one patients underwent neophallus prosthesis placement at a mean 35.6 years of age. Prosthesis placement occurred an average 56.3 months following phallic construction and follow-up was a mean of 59.8 months. Malleable prostheses were placed in 21 patients and inflatable in 10; implants were bilateral in 94%. Six percent experienced operative complications including a bladder injury (1) and phallic flap arterial injury (1). Post-operative complications occurred in 23% at a median 5.9 months following placement. Five prosthesis (16%) were explanted secondary to infection or erosion and two additional required revision. Of the explanted prosthesis one was later replaced without further complication. Eighty-one percent of patients were sexually active following prosthesis placement. CONCLUSIONS Penile prosthesis placement is possible in patients with prior phallic construction. Although complications rates appear to be increased in this population compared to historic controls of normal anatomic males, the majority in this series were sexually active following prosthesis placement. This demonstrates the utility of prosthesis implantation in these difficult patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e340 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jack Zuckerman More articles by this author Kate Smentkowski More articles by this author Dave Gilbert More articles by this author Ramon Virasoro More articles by this author Jeremy Tonkin More articles by this author Gerald Jordan More articles by this author Kurt McCammon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

National Practice Patterns of Treatment of Erectile Dysfunction with Penile Prosthesis Implantation

The increase in medical options to manage erectile dysfunction has changed how urologists approach erectile dysfunction. We reviewed contemporary trends in penile prosthesis implantation in the United States with an emphasis on practice patterns, demographics and temporal changes. Annualized case log data of penile prosthesis surgeries from certifying and recertifying urologists from 2003 to 2012 were obtained from the American Board of Urology. CPT code 54400 was used to identify malleable prosthesis surgeries and CPT codes 54401 and 54405 were used to identify inflatable prosthesis surgeries. To evaluate the association between surgeon characteristics and practice patterns we used the chi-square test. The surgical cohort included 6,615 urologists who placed a total of 9,558 penile prostheses during the study period. Only 23.9% of urologists reported performing a penile prosthesis operation. Of the prostheses 75% were placed by surgeons who completed 4 or fewer such operations per year. Of urologists who recorded logs 1.5% considered themselves to be specialists in andrology and yet they were responsible for a disproportionate 10% of all prostheses implanted (OR 5.9, p <0.0001). The proportion of inflatable penile prostheses compared to malleable prostheses increased twelvefold in 10 years. The number of logged prosthesis surgeries was skewed toward more implants placed by the most experienced urologists than by new urologists (OR 1.92, p <0.0001). Although specialists and high volume surgeons perform a disproportionate number of implant surgeries, low volume surgeons place most penile prostheses in the United States. Additional research is needed to determine best practices to achieve optimal patient outcomes in penile prosthesis surgery.

PD20-01 SURGICAL PRACTICE PATTERNS FOR ERECTILE DYSFUNCTION: ANALYSIS OF CASE LOGS FROM CERTIFYING AMERICAN UROLOGISTS

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy1 Apr 2014PD20-01 SURGICAL PRACTICE PATTERNS FOR ERECTILE DYSFUNCTION: ANALYSIS OF CASE LOGS FROM CERTIFYING AMERICAN UROLOGISTS Daniel T. Oberlin, Richard S. Matulewicz, Laurie Bachrach, Sarah C. Flury, and Robert E. Brannigan Daniel T. OberlinDaniel T. Oberlin More articles by this author , Richard S. MatulewiczRichard S. Matulewicz More articles by this author , Laurie BachrachLaurie Bachrach More articles by this author , Sarah C. FlurySarah C. Flury More articles by this author , and Robert E. BranniganRobert E. Brannigan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1691AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The increase in medical treatment options for the treatment of erectile dysfunction (ED) has changed how urologists manage ED. We reviewed contemporary surgical trends in penile prosthesis implantations in the United States with emphasis on practice patterns, surgeon characteristics, and practice types. Methods Annualized case log data of penile prosthesis surgeries from certifying and recertifying urologists were obtained from the American Board of Urology from 2003 to 2012. CPT code 54400 was used to identify malleable prosthesis surgeries; 54401 and 54405 was used to identify inflatable prosthesis surgeries. Chi-square tests and logistic regression models were used to evaluate the association between surgeon characteristics and practice patterns. Results A total 6,615 urologists were included in the surgical cohort with a total of 9,558 penile prosthesis placed over this time period. Only 23.9% of urologists reported placing a penile prosthesis (1587 urologists). Of all urologists recording logs, 1.5% considered themselves to be specialists in andrology. These andrologists, however, were responsible for a disproportionate 10% of all prostheses implanted (OR=5.9, p<.0001). The proportion of inflatable penile prosthesis compared to malleable prosthesis was 10:1 with an overall stable ratio of inflatable: malleable implants over this nine-year period. The number of prosthesis surgeries logged was skewed toward the most experienced urologists performing more implants than both new urologists (OR=1.92, p<.0001) and urologists undergoing their first recertification (OR=1.1, p=.006). Conclusions Despite an increase in the use of pharmacologic and non-surgical methods to correct erectile dysfunction, surgical intervention remains an important modality of treatment. Among urologists in the United States, those specializing in andrology perform a disproportionate number of implants. Interestingly, less than a quarter of urologists recorded case logs reports for penile implants, and urology seniority was directly correlated to total penile prosthesis case volume. This may suggest that surgeon experience and sub-specialization are key driving forces in performing penile prosthesis surgery. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e611 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Daniel T. Oberlin More articles by this author Richard S. Matulewicz More articles by this author Laurie Bachrach More articles by this author Sarah C. Flury More articles by this author Robert E. Brannigan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Penile prosthesis implantation in Chinese patients with severe erectile dysfunction: 10-year experience

We retrospectively evaluated the clinical outcome of penile prosthesis implantation (PPI) in Chinese patients with severe erectile dysfunction (SED). From July 2000 to December 2011, 224 patients (mean age: 35.9±11.8 years, range: 20-75 years) with SED underwent PPI by experienced surgeon according to standard PPI procedure at our centre. A malleable prosthesis (AMS 650) was implanted in 45 cases (20.1%), and a three-piece inflatable prosthesis (AMS 700 CXM or AMS 700 CXR) was implanted in 179 cases (79.9%). Surgical outcomes, including postoperative complications, clinical efficacy and couple satisfaction, were evaluated over than 6 months postoperatively using medical record abstraction, IIEF-5, quality of life (QoL) scores, and the patient/partner sexual satisfaction score proposed by Bhojwani et al. Of the 224 patients eligible for the study, 201 subjects (89.7%) completed follow-up. All of patients could perform sexual intercourse post PPI with the mean postoperative IIEF-5 and QoL scores were 20.02±2.32 and 5.28±0.76, respectively, which were significantly improved compared with the preoperative scores (6.29±1.5 and 2.13±0.84, P<0.01). Of the 201 men, mechanical malfunction occurred in four cases (2.0%) and three cases were re-implanted new device, and two cases (1.0%) developed a mild curvature of the penis. Scrotal erosion with infection occurred in one case with diabetes mellitus (0.5%) and required complete removal of the implanted AMS 700 CXM. Satisfactory sexual intercourse at least twice per month was reported by 178 men (88.6%), and overall satisfaction with the PPI surgery was reported by 89.0% of men and 82.5% of partners. Patient satisfaction in the three-piece inflatable prosthesis group was higher than in the malleable prosthesis group (P<0.05). Satisfaction, however, between the types of prostheses, did not differ in the partner survey. PPI is a safe and effective treatment option for Chinese patients with SED and experienced surgeon perform PPI according to standard PPI procedure could reduce the postoperative complications of PPI and could improve patient satisfaction ratio and QoL.

V1587 PENILE PROSTHESIS IMPLANTATION IN FEMALE TO MALE TRANSSEXUAL

You have accessJournal of UrologyInfertility, Sexual Dysfunction and Testis1 Apr 2013V1587 PENILE PROSTHESIS IMPLANTATION IN FEMALE TO MALE TRANSSEXUAL Carlo Trombetta, Giovanni Liguori, Nicola Pavan, Stefano Bucci, Giorgio Mazzon, Sara Benvenuto, and Salvatore Siracusano Carlo TrombettaCarlo Trombetta Trieste, Italy More articles by this author , Giovanni LiguoriGiovanni Liguori Trieste, Italy More articles by this author , Nicola PavanNicola Pavan Trieste, Italy More articles by this author , Stefano BucciStefano Bucci Trieste, Italy More articles by this author , Giorgio MazzonGiorgio Mazzon Trieste, Italy More articles by this author , Sara BenvenutoSara Benvenuto Trieste, Italy More articles by this author , and Salvatore SiracusanoSalvatore Siracusano Trieste, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3137AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The final step in approach of gender reassignment therapy in female-to-male transsexuals consists of the construction of a neophallus. Different techniques have been used to obtain rigidity in the neophallus, but often, they resulted in complications and failure. In this video we present a penile prosthesis implantation in female to male transsexual. METHODS In this video, we have successfully inserted a malleable prosthesis using the Coloplast Genesis Flexible Rod penile implant in a 45 year old transsexual, who had a large bulky neophallus constructed from a fasciocutaneous microvascular free flaps about 9 years ago. A Dacron tubular graft 9 mm diameter with one end closed like a windsock is created using an abdominal aortic aneurism Dacron stent graft and is placed around the penile implant cylinder before insertion. The best surgical approach to gain access into the base of the penis was accurately defined preoperatively by a combined color Doppler ultrasound and MRI study. RESULTS Operative time was 90 minutes. A prosthesis was inserted in patient without intraoperative and postoperative complications, with a follow up of 12 months. The patient returned to his regular activities on postoperative day ten. CONCLUSIONS Despite possible complications, implantation of penile prosthesis remains the best option for achieving the possibility of sexual intercourse in female-to-male transsexuals. Supplementary Data Video © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e651-e652Supplementary Materials Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlo Trombetta Trieste, Italy More articles by this author Giovanni Liguori Trieste, Italy More articles by this author Nicola Pavan Trieste, Italy More articles by this author Stefano Bucci Trieste, Italy More articles by this author Giorgio Mazzon Trieste, Italy More articles by this author Sara Benvenuto Trieste, Italy More articles by this author Salvatore Siracusano Trieste, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1241 VALIDITY AND RELIABILITY OF A SMARTPHONE APPLICATION FOR THE ASSESSMENT OF PENILE DEFORMITY IN PEYRONIE'S DISEASE

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation (I)1 Apr 20131241 VALIDITY AND RELIABILITY OF A SMARTPHONE APPLICATION FOR THE ASSESSMENT OF PENILE DEFORMITY IN PEYRONIE'S DISEASE Ryan Hsi, James Hotaling, Andrea Hartzler, and Thomas Walsh Ryan HsiRyan Hsi Seattle, WA More articles by this author , James HotalingJames Hotaling Seattle, WA More articles by this author , Andrea HartzlerAndrea Hartzler Seattle, WA More articles by this author , and Thomas WalshThomas Walsh Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2594AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Available methods to evaluate men with Peyronie's Disease (PD) are limited by the inability to accurately and reproducibly measure penile deformity. The purpose of this study was to evaluate the measurement performance of a smartphone application for the assessment of penile narrowing and curvature. METHODS A smartphone application, UWPEN (Peyronie's Examination Network), was developed for this purpose. To assess penile curvature angulation, 15 single cylinders of malleable prostheses were molded to varying curvature angles. Three blinded observers non-sequentially measured the angle of curvature for each prosthetic cylinder in triplicate using a protractor, goniometer, and UWPEN. To assess girth narrowing, six clay models of the penile shaft were constructed to represent conditions of normal, partial hourglass, circumferential hourglass, and pencil narrowing. Girth measurements were recorded as a ratio of minimum to maximum diameters using a ruler and UPEN in triplicate by the same blinded observers. Statistical analyses compared inter-test, interobserver, and intraobserver reliability using the interclass correlation coefficient (ICC). An ICC above 0.80 is considered to show high reliability among measurements. RESULTS Inter-test reliability for angle measurements yielded an ICC for the 3 methods of 1.000. Separately, the ICC for UWPEN versus the goniometer and protractor was 0.999 and 0.999, respectively. The intraobserver ICC for UWPEN, goniometer, and protractor was 0.998, 1.000, and 0.999, respectively. Inter-test reliability for girth narrowing measurements yielded an ICC of 0.991. The intraobserver ICC for girth narrowing for UWPEN and the ruler was 0.978 and 0.986, respectively. CONCLUSIONS The measurement performance of UWPEN is comparable to and highly correlated with angle measurements obtained from the goniometer and protractor as well as with girth narrowing measurements obtained from a ruler. Measurements are reproducible among different operators. This instrument may provide an accurate, reliable, and widely accessible method to characterize and track PD over time as well as the mechanism to generate robust crowd-sourced research data. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e508 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Hsi Seattle, WA More articles by this author James Hotaling Seattle, WA More articles by this author Andrea Hartzler Seattle, WA More articles by this author Thomas Walsh Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Catalog of Magnetic Resonance Imaging Compatibility of Penile Prostheses

Erectile dysfunction has been successfully treated with penile prosthesis implantation for over 50 years. Ferromagnetic implants or devices may create a potentially hazardous or painful situation during magnetic resonance imaging (MRI). A modern catalog of the MRI compatibility of penile prostheses is not available. Evaluate the safety profile of implanted, penile prostheses during MRI. Review available in vitro safety data and reported patient complications experienced during MRI with a penile prosthesis in place. A search of PubMed™ for articles documenting a penile prosthesis present during MRI was performed. Radiology texts and product information from manufacturers' producing a penile prosthesis were reviewed. Direct discussion with product manufacturers was also performed to obtain additional safety and compatibility information. Nine clinical articles noted the presence of a penile prosthesis at the time of magnetic resonance imaging. No articles documented a complication from MRI of a man with a penile prosthesis. A single patient with an unnamed malleable prosthesis was noted to have twisting of the device during MRI which did not result in discomfort or malfunction of the device. In vitro studies support the safety of most prostheses during MRI. The available data suggests there is little risk for most patients with a penile prosthesis who undergo MRI. Notable exceptions include Dacomed's Omniphase and Duraphase device and the MRI-conditional Spectra device manufactured by AMS. Current manufacturers of penile implants provide wallet cards and medical letters to support safety when undergoing an MRI. Prior prosthesis implantation should not preclude patients from having an MRI.

Infrapubic approach for malleable penile implant

Today, we find that the implant of malleable prostheses still plays a leading role in the surgical treatment of erectile dysfunction. These may involve patients for which the cosmetic advantages of inflatable devices are not as important as low cost, the easier use and less incidence of mechanical complications in the malleable implants. This paper demonstrates infrapubic approach as a technical option for this kind of implant. It offers technical resources and emphasizes the facility in using the method, reducing cutaneous exposure, which diminishes risks of contamination. As occurs in inflatable implants, when implanting malleable prostheses through the infrapubic access, care must also be taken regarding the possibility of lesion to the vascular-nervous bundle. On the other hand, the approach through the dorsal surface of the corpora cavernosa has a natural capacity for anatomical protection of the urethra, not requiring transurethral catheterization. This benefit is of the utmost importance when considering possible causes of per and postoperative morbidity. Accordingly, we can consider that the infrapubic approach is an effective method and prevails as a technical option for implanting malleable prostheses.