Penile Prosthesis Implantation Research Articles

Surgical tips in difficult penile prosthetic surgery: a narrative review.

Penile prosthesis implantation continues to represent a reliable solution to address erectile dysfunction when oral medications fail, are not tolerated or are contraindicated, and most typically is associated with excellent satisfaction rates and durable results. Despite the dramatic improvements in the prostheses' design, in the surgical instruments and techniques over the years, certain categories of patients still pose a significant surgical challenge. The aim of the current review is to provide a quick and useful practical guidance based on our expertise in the identification and management of the difficult penile prosthesis implantation cases. A narrative review design was here preferred to fulfil our purpose. The search strategy included a range of terms, e.g. penile prosthesis, corporal fibrosis, infection, ischaemic priapism, Peyronie's disease, radical prostatectomy, pelvic surgery. Extensive corporal fibrosis after explantation of an infected device or after prolonged ischaemic priapism may represent the most difficult situations to deal with in penile prosthesis implantation surgery. Penile prosthesis implantation in patients with Peyronie's disease and in those who previously underwent radical prostatectomy also presents with an increased risk of complications. Experienced surgeons need to be able to recognise promptly and manage urethral perforation, cylinder crossover, tunical perforation and erosion, as these complications are more common when dealing with difficult penile prosthesis implantation cases. Applying penile lengthening techniques and principles can be useful in selected cases to ensure better postoperative satisfaction rates, especially in those patients who have experienced a more significant degree of loss of length preoperatively. High-volume-implanting surgeons should always be involved in complex cases to minimise the risk of complications. A thorough preoperative counselling can set realistic patients' expectations in this context, further contributing to postoperative satisfaction.

Infection rate of penile prosthesis implants in men with spinal cord injury: a meta-analysis of available evidence.

The risk of penile prosthesis implants (PPIs) infection in men with spinal cord injury (SCI), empirically theorized to be high, is widely variable among the studies. We performed a meta-analysis to define the pooled PPI infection rate and its possible risk factors in men with SCI. A thorough search of PubMed, Scopus and Web of Science was performed. The eighteen included studies provided information on 1079 implantation procedures, determining a pooled PPI infection rate of 8.0% (95% CI: 5.0-11.0%), with significant heterogeneity (I² = 67.0%). Trim-and-fill adjustment for publication bias had a small effect on the pooled estimate (adjusted odds ratio: 6.3%, 95% CI: 2.5-10.0%) with a substantial reduction in heterogeneity (I2 = 32.4%). The PPI infection rate was higher for inflatable PPIs than for malleable PPIs (16.4% vs 8.9%, p = 0.027). No differences were found between the different levels of SCI. In conclusion, the risk of PPI infection in SCI would be higher than that reported in the general population. However, the results were produced from dated and low/moderate quality studies that may not fully reflect the outcomes of modern PPIs and implantation protocols. There is an urgent need to gather more information on this topic through studies relevant to contemporary practice.

New findings regarding the influence of assistants on surgical outcomes in penile prosthesis implantation.

Penile prosthesis implantation is the definitive treatment for refractory erectile dysfunction, yet exposure to this procedure during training of urology residents is often limited. To assess the effects of resident participation in penile prosthesis surgery, we compared surgical outcomes in a retrospective case series of 253 penile prosthesis surgeries by a single surgeon at the same institution between 2017 and 2020 with the assistance of either a registered nurse first assistant (RNFA) or a resident. Pertinent patient characteristics and surgical complications including device complications, surgical site infection, postoperative bleeding, iatrogenic injury, cardiovascular events, pulmonary events, and urinary retention were documented. Measured outcomes included operative time, Emergency Room (ER) visits, unplanned postoperative visits, pain medication refills, and surgicalcomplications. Compared to RFNAs, resident-assisted penile prosthesis surgery was associated with significant increase in mean operative time (71.4 min vs. 87.9 min, p < 0.01) and postoperative ER visits (3.0% vs. 10.6%, p = 0.03) but not surgical complications (19.7% vs. 20.8%, OR 1.03, 95% CI [0.46 -2.30]) or other measured outcomes. Compared to a dedicated RFNA, Resident assistance increased operative time by approximately 17 min, but did not increase post-operative surgical complications, supporting the notion that resident assistance in these procedures may be appropriate as an integral part of training.

Factors associated with postoperative urinary retention in patients undergoing penile prosthesis implantation.

Placement of penile prosthesis had been well described in the outpatient setting, however, one barrier to same-day discharge is postoperative urinary retention (POUR). POUR remains a condition encountered during ambulatory surgical procedures and has yet to be characterized in patients undergoing penile prosthesis. We characterized POUR in a cohort of penile prosthesis recipients along with risk factors and management. Patients undergoing penile prosthesis implantation from 2014 through 2020 without pre-existing retention were included. All patients underwent a void trial immediately following penile prosthesis in the post-anesthesia care unit. POUR was strictly defined as (1) any patient requiring catheter replacement after prosthesis, (2) a rising post-void residual, or (3) inability to void after 6 h regardless of whether a catheter was placed. Independent procedures, demographic, intraoperative, and postoperative risk factors for POUR were assessed. 317 men were included of whom 27.1% experienced POUR. Men experiencing POUR and those not in retention were essentially indistinguishable with respect to previously described risk factors for POUR. Only use of both α-blockers and 5-α-reductase inhibitors was significantly associated with a greater risk of POUR, a finding maintained on adjusted analysis (adjusted odds ratio 10.1, 95% confidence interval 2.1 to 49.8). POUR resolved without intervention in 3.5%, a single episode of clean intermittent catheterization (CIC) in 7.0% of patients, and repeated CIC or indwelling catheter placement with a successful delayed void trial in 88.4% of patients. Rate of prosthesis infection in patients who experienced POUR did not significantly differ from those who did not experience POUR (4.7% vs. 2.2% p = 0.26). Our findings suggest that POUR is experienced in as many as 1 in 4 men undergoing penile prosthesis placement, most of whom must be managed with indwelling catheterization or repeated CIC. Those with indicators of symptomatic prostate enlargement are at significantly greater risk of urinary retention.

Which patient may benefit the most from penile prosthesis implantation?

Penile prosthesis implantation has been associated with overall good functional outcomes. Of relevance, some patients reported higher level of satisfaction and quality of life. We investigated the profile of the patients who may benefit the most from penile prosthesis implantation. Data from a national multi-institutional registry of penile prostheses including patients treated from 2014 to 2017 in Italy (Italian Nationwide Systematic Inventarization of Surgical Treatment for Erectile Dysfunction) were analyzed. All data have been prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and revised by a single data manager. Patients' baseline characteristics were recorded. In order to simultaneously evaluate perceived penile prosthesis function and quality of life, all patients were re-assessed at 1-year follow-up using the validated questionnaire Quality of Life and Sexuality with Penile Prosthesis. High quality of life after surgery was defined as a score higher than the 75th percentile in each of the subdomains of the Quality of Life and Sexuality with Penile Prosthesis questionnaire. Logistic regression analysis tested the association between clinical characteristics and high quality of life after penile prosthesis implantation. Follow-up data were available for 285 patients (median age 60 years; interquartile range: 56-67) who underwent penile prosthesis implantation. Erectile dysfunction etiology was organic in 40% (114), pelvic surgery/radiotherapy in 39% (111), and Peyronie's disease in 21% (60) of the cases. Patients showed good overall Quality of Life and Sexuality with Penile Prosthesis scores at 1-year follow-up for functional (22/25), personal (13/15), relational (17/20), and social (13/15) domains. Overall, 27.0% (77) of patients achieved scores consistent with the high quality of life definition. These patients did not differ in terms of median age (60vs. 62), type of prosthesis (inflatable penile prostheses: 95% in both of the cases), and post-operative complications (10%vs. 14%) than those with lower quality of life score (all p&gt;0.1). At logistic regression analysis, erectile dysfunction etiology was the only factor independently associated with high quality of life at 1year after surgery (p=0.02). Patients treated for Peyronie's disease (odds ratio:2.62; p=0.01; 95% confidence interval: 1.20-5.74) were more likely to report better outcomes after accounting for age, post-operative complications, and surgical volume. Penile prosthesis implantation is associated with an overall good quality of life. The subset of patients affected by erectile dysfunction secondary to Peyronie's disease seemed to benefit the most from penile prosthesis implantation in terms of functional outcomes, relationship with their partners and the outside world, and perceived self-image. The systematic use of validated questionnaires specifically addressed at evaluating quality of life and satisfaction after penile prosthesis implantation should be further implemented in future studies to better define the predictors of optimal satisfaction after penile prosthesis implantation.

Synchronous Surgical Management of Erectile Dysfunction and Stress Urinary Incontinence: A Systematic Review and Meta-Analysis of Reoperation Rates.

The efficacy, safety, and postoperative outcomes of synchronous surgery for concomitant erectile dysfunction (ED) and stress urinary incontinence (SUI) remain unclear. We performed a systematic review and meta-analysis to evaluate the available synchronous surgical approaches for concomitant ED and SUI and to assess the reoperation rates compared to asynchronous surgery and surgery only for ED or SUI. We searched PubMed, Cochrane Library, and Embase databases until June 2022 for relevant studies. Based on data availability, we performed a meta-analysis of odds ratios (ORs) comparing reoperation rates after synchronous surgery in patients with concomitant ED and SUI versus asynchronous surgery, as well as surgery solely for ED or SUI (PROSPERO: CRD42022326941). We included 18 studies in the systematic review (16,517 patients) and 5 in the meta-analysis. Comparing synchronous implantation of penile prosthesis and artificial urinary sphincter (AUS) versus asynchronous surgery, no statistically significant differences were observed in the reoperation rates [OR:0.98, 95% confidence interval (CI): 0.52-1.84, I2:0%). Comparing synchronous implantation of both penile prosthesis and AUS versus implantation of only a penile prosthesis or an AUS, combined surgery was associated with higher reoperation rates (OR:2.02, 95%CI: 1.29-3.16, I2:36% and OR:1.7, 95%CI: 1.25-2.32, I2:0%, respectively). Synchronous surgery led to high satisfaction rates and significant improvement in ED and SUI. Evidence for the combination of penile prosthesis with a male sling or the ProACT device is low, but data suggests it may be safe and effective. The synchronous placement of a Mini-Jupette sling and penile prosthesis represents a promising treatment modality for the correction of ED and mild SUI and/or climacturia. Synchronous penile prosthesis and AUS implantation appears safe and effective in patients with severe ED and SUI. Further high-quality studies are mandatory to strengthen the current scarce evidence for synchronous surgery in patients with ED and SUI.

Comparison of preoperative penile elastographic ultrasound findings and pathological tissue results of patients implemented with penile prosthesis.

Histopathological analysis of the relationship between penile elastography and erectile dysfunction. 12 patients who applied to our clinic for erectile dysfunction in the last 1year and accepted this study were included. Preoperative two-dimensional shear wave elastography imaging was performed in 12 patients and recorded in the Pascal (kPa) unit. Approximately 0.5 × 0.5 × 0.5cm tissue samples were taken from the right and left cavernous tissue during penile prosthesis implantation operation. Tissue samples were sent to the pathology department. The percentage of the area covered by muscle fibers and elastic fibers in the corpus cavernosum was noted semi-quantitatively (ratio of muscle fibers and cavernous body elastic fiber score). All data obtained were compared with each other. Cavernous body elastic fiber score data(Grouped Score 1, 2 and 3) and percentage of cavernous body muscle fibers data (Grouped %10, %20, %30… %100) were compared with Shear wave elastography data (kPa). The results were not statistically significant according to the Kruskal Wallis Test. Cavernous body elastic fiber score and the percentage of cavernous body muscle fibers were also compared, it was not statistically significant according to the Kruskal Wallis test and Spearman's correlation test. Penile shear wave elastography can be used clinically to quantitatively assess the amount of smooth muscle cells and elastic fibers in the penis, but it deserves to be studied with a larger number of patients and a more specific interpretation of the pathology preparation.

The Gullwing Technique: A Novel Method of Transcorporal Artificial Urinary Sphincter Placement for the Fragile Urethra

To describe the novel gullwing technique for artificial urinary sphincter (AUS) placement. The transcorporal technique for AUS placement is beneficial in patients with 'fragile urethras' (previous failed AUS, urethroplasty or history of radiation) however limitations include insufficient lateral and ventral urethral support in addition to potential cinching during corporotomy closure which, in the absence of additional grafting may restrict our ability to conserve internal corporal capacity and limit options for future preservation of erectile function via penile prosthesis placement. The gullwing variation of the technique offers the potential to circumvent these disadvantages. This case describes the gullwing variation of transcorporal AUS placement in a complex patient with a history of abdominopelvic trauma and prior failed AUS placements secondary to urethral erosion. Transcorporal AUS placement in patients with prior urethral compromise has been shown to result in lower revision and erosion rates. The gullwing modification of the technique is a novel variation providing improved circumferential urethral protection and, with the addition of corporal grafting, aims to enable the preservation of the three-dimensional corporal volume necessary for ease of subsequent penile prosthesis implantation. However, studies assessing the long-term functional outcomes and durability of this technique are needed.

Employer Health Plan Exclusions are a Barrier to Access of Penile Implants for Erectile Dysfunction

Introduction: Many commercial insurers and Medicare have published coverage policies detailing the medical necessity and accessibility of erectile dysfunction (ED) treatment, including implantable penile prosthesis (IPP). Approximately 61% of adults aged 18–64 years in the United States (US) receive health benefits via employer-sponsored health plans (ESHP) and 23% of employers reported medical benefit exclusion for sexual dysfunction treatment. Objective: To obtain nationwide US estimates of the proportions of patients denied IPP treatment due to ESHP exclusions (overall and by state, healthcare insurer, and labor sector industry). Methods: De-identified data from an industry IPP insurance benefit verification database from October 1, 2018 to December 31, 2021 were analyzed to evaluate ESHP-related barriers to IPP access. Results: Among 2,638 patients with commercial insurance and employer data, 34.0% were denied IPP treatment due to ESHP benefit exclusions. ESHPs in Washington (60.7%), Louisiana (55.4%), Arizona (46.6%), Nebraska (45.5%), Ohio (43.3%), and Georgia (43.1%) had the highest exclusion rates, whereas Iowa (19.0%), Alabama (18.9%), Maryland (17.3%), Rhode Island (13.0%), and New York (7.1%) had the lowest exclusion rates. Patients with Aetna insurance had the greatest proportion of exclusions (62.4%), followed by Cigna (61.0%), employer-owned health plans (47.2%), other commercial plans (41.8%), Anthem (37.3%), Blue Cross Blue Shield (BCBS) state plans (24.1%), United Healthcare (15.4%), and Humana (0.0%). The exclusion rate was highest for employees of the leisure and hospitality industry (51.9%), followed by religious organizations (50.0%), health care (40.5%), construction, mining, or agriculture (39.1%), education (38.9%), retail and wholesale trade (36.9%), manufacturing (36.7%), utilities (36.2%), professional and business services (35.4%), transportation (32.6%), finance and insurance (29.1%), labor union organizations (26.9%), and finally public, state, and government administration (25.1%). Conclusions: Despite insurance carrier medical policies, 34.0% of men with an ESHP are denied access to IPP ED treatment due to their ESHP benefit exclusions. ESHP exclusion rates varied geographically, by insurer, and by labor sector industry.

Penile Prosthesis Implantation Combined With Grafting Techniques in Patients With Peyronie's Disease and Erectile Dysfunction: A Systematic Review.

Penile prosthesis (PP) implantation combined with grafting techniques is indicated in patients with Peyronie's disease (PD) and erectile dysfunction (ED) nonresponsive to medical and conservative treatment that present with residual penile curvature greater than 30°, severe penile deformity or significant penile shortening. To address the preoperative evaluation, the surgical procedure and the functional outcomes of grafting techniques combined with PP implantation in patients with PD and concomitant ED and to provide future perspectives on the matter. We performed a systematic review of the literature based on the PRISMA statement (PROSPERO ID: CRD42021224517). Records were identified by searching Medline, Scopus, The Cochrane Library and Web of Science databases as well as sources of gray literature from inception to December 2020. The quality of all included records was assessed based on a modified version of the Newcastle-Ottawa Scale for cohort studies. A total of 935 patients with a mean age of 59.6 ± 9.2 years from 23 studies were included in this systematic review. All studies reported excellent short- and long-term postoperative results, as well as high satisfaction rates ranging from 80 to 100%. A mean increase of 2.7 ± 1.4 cm in penile length was observed. Among different grafting materials and different types of PP, no significant differences in terms of preoperative, perioperative and postoperative functional outcomes or complications were demonstrated. Still, the operative time was shorter in studies applying the collagen fleece TachoSil. PP implantation combined with grafting is a safe and highly effective surgical procedure in patients with PD and concomitant ED. All grafting materials provide similar beneficial outcomes, but TachoSil subsequently reduces the operative time and does not require suturing. Still, no definite conclusions can be drawn regarding the superiority of one grafting technique over the other, as randomized clinical trials are lacking. Sokolakis I, Pyrgidis N, Ziegelmann M, etal. Penile Prosthesis Implantation Combined With Grafting Techniques in Patients With Peyronie's Disease and Erectile Dysfunction: A Systematic Review. Sex Med Rev 2022;10:444-452.

Evaluation of Satisfaction and Outcomes of Patients Who Underwent Two-Piece Inflatable Penile Prosthesis Implantation.

IntroductionThe aim of this study was to evaluate patient and partner satisfaction, device reliability, and complications in patients who underwent two-piece inflatable penile prosthesis (IPP) implantation.Patients and methodsThe data of 22 patients who underwent two-piece inflatable penile prosthesis implantation in our department between 2015 and 2018 were retrospectively analyzed, and a detailed review of all clinical reports was performed. Phone or face-to-face interviews were undertaken to assess the satisfaction rates of the patients and their partners using the modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire.ResultsThe mean patient age and partner age were 57.95 ± 6.16 and 58.12 ± 6.66 years, respectively. The mean erectile dysfunction (ED) period was 5.33 ± 2.16 years, and the etiologies of erectile dysfunction were radical pelvic surgery (41%), diabetes mellitus (37%), and vascular disorders (22%). The mean operative time and postoperative hospital stay were 102 ± 29 minutes and 1.8 ± 0.66 days, respectively. Over a mean follow-up period of 29.04 ± 14.48 months, two (9%) cases underwent revision surgery due to mechanical device failure in one and infection in the other. The overall patient and partner satisfaction rates were 73% and 59%, respectively.ConclusionsThe two-piece inflatable penile prosthesis is an effective, reliable, and user-friendly prosthesis with acceptable complication and revision rates and provides a high level of patient and partner satisfaction in selected and fully informed patients.

The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant.

Despite significant scientific advances in the modern three-piece inflatable penile prosthesis implant surgery, it is not without surgical risks and can carry additional cosmetic and psychosocial consequences in poorly selected and consented individuals. To address this problem, an international group of key opinion leaders and high-volume prosthetic surgeons reviewed the current guidelines and clinical evidence, discussed their experiences, and formed a consensus regarding inflatable penile prosthesis surgery. The findings of this consensus panel were presented at the 17th biennial Asia Pacific Society of Sexual Medicine scientific meeting. The experts concluded that proper patient selection, informed consent and strict adherence to safe surgical principles are important to optimize clinical outcomes. Furthermore, most intraoperative complications, if recognized, can be addressed intraoperatively to enable placement of the device at the time of initial surgery. Men with significant corporal fibrosis due to Peyronie's disease, prior prosthesis explantation and priapism, and men who have undergone construction of a neophallus, as well as men who receive concurrent continence surgery, are complex cases requiring additional care and advanced techniques to obtain optimal surgical outcomes. Variability in patient care - in terms of postoperative antibiotic use, pain management, scrotal care, and cycling of the penile prosthesis implant - must be reduced to enable optimization and assessment of outcomes across patient groups.

Global Perspective on the Management of Peyronie's Disease.

IntroductionPeyronie's disease is the disease that results in an alteration in the curvature of the penis, which can lead to a shortening of length, pain in erection, or difficulties in penetration, thus leading the patient to psychological alterations due to loss of functionality such as aesthetic alteration. That is why there are several studies to define the best form of treatment, which currently continues to be the first choice surgical treatment.ObjectiveWe present the most recommended therapies for Peyronie's disease and suggest an algorithm as a guide to direct therapy.MethodsWe used the PubMed platform to review the literature related to Peyronie's disease. Various editorials were reviewed as well as original articles and reviews focusing on the various treatments as well as their indications and results.ResultsPeyronie's disease in which conservative or drug treatment does not have a response, surgical treatment with corporoplasty, penile prosthesis implantation or both may be indicated. Corporoplasty refers to both the plication of the tunica albuginea as well as the incision of the tunica with the placement of a graft. An accurate history should always be carried out to identify erectile dysfunction as well as to be able to guide you on the repercussions of the treatment. If refractory erectile dysfunction is present, placement of a penile prosthesis with or without further adjunctive straightening maneuvers is recommended. We reviewed the indications, advantages, disadvantages, and results of the available techniques, and proposed a surgical treatment algorithm.ConclusionPenile shortening procedures are usually indicated in curvatures <60°, in penises with adequate length. Partial excision/incision and grafting are indicated for curvatures >60°, hourglass or hinge deformities, and short penises, if the patient's erectile function is adequate. The presence of “borderline” erectile function and/or ventral curvature tilts the choice toward shortening procedures, and refractory erectile dysfunction is an indication for penile prosthesis placement. An accurate risk/benefit assessment of the individual patient as well as meticulous patient counseling are critically important.

Shaeer's punch technique: Trans-corporeal Peyronie's plaque surgery and penile prosthesis implantation

ABSTRACT Introduction Penile prosthesis implantation in cases of severe Peyronie's disease may require plaque excision/incision and grafting, that may require mobilization of the neurovascular bundle (NVB) or urethra, posing the risks of penile hyposensitivity or urethral injury, and is time consuming, possibly increasing infection risk. Objective Evaluating trans-corporeal debulking of Peyronie's plaques by “Shaeer's Punch Technique”. Methods Penile prosthesis implantation and Punch technique (PPI-Punch) was performed for 26 patients. Following corporotomy and dilatation, Peyronie's plaques were punched-out from within the corpora cavernosa using the punch forceps then a penile prosthesis implanted. Comparison to a matching retrospective group of 18 patients operated upon by plaque excision-grafting and penile prosthesis implantation was performed. Outcomes were in terms of straightness of the erect penis, complication, satisfaction with length on a 5-point scale , the International Index of Erectile Function-5 (IIEF), and the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire (EDITS). Results Average pre-operative curvature angle was 58.1 ± 11.7 in the Punch group and 58 ± 14.8 in the excision-grafting group, p=0.99. Following surgery, all patients had a straight penis. No tunical perforations, urethral injuries or extrusions were noted. Average additional operative time for Punch technique ranged from 5 to 10 minutes (7.3 ± 1.7), in contrast to the excision-grafting group where plaque surgery duration was 50.8 minutes ± 11.1, an 85% difference, p &amp;lt; 0.0001. Septal plaques in the latter group could not be removed. In the PPI-Punch group, penile sensitivity was preserved in all patients, compared to the excision/grafting group with 7/18 patients reporting hyposthesia of the glans. Infection occurred in 1/26 patients in the PPI-Puch group, compared to 2/18 patients in the excision/grafting group. Satisfaction with length on a 5-point scale was 3.8 ± 0.9 in the punch group, versus 3.1 ± 1.1 in the excision-grafting group, p=0.009.. Conclusions Shaeer's Punch Technique is a minimally invasive procedure for trans-corporeal excavation of Peyronie's plaques prior to penile prosthesis implantation. There is no need for mobilization of the neurovascular bundle or spongiosum, hence low or no risk for nerve or urethral injury and brief plaque surgery time. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Coloplast, BSC, Rigicon).

PD23-09 AUXETIC EXPANSION OF THE TUNICA ALBUGINEA FOR PENILE LENGTH AND GIRTH RESTORATION WITHOUT A GRAFT: A CASE SERIES.

You have accessJournal of UrologyCME1 May 2022PD23-09 AUXETIC EXPANSION OF THE TUNICA ALBUGINEA FOR PENILE LENGTH AND GIRTH RESTORATION WITHOUT A GRAFT: A CASE SERIES. Alexandre Miranda Alexandre MirandaAlexandre Miranda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002565.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile length and girth loss may be caused by many conditions like Peyronie's disease, post-radical prostatectomy, erectile dysfunction following ischemic priapism. A new surgical technique has been created to restore penile length and girth loss in patients with severe erectile dysfunction submitted to penile prosthesis implantation (Auxetic technique). The objective of this work is to describe the first use of the new Auxetic technique in seven patients. METHODS: Seven consecutive patients with penile shortening complain affected by Peyronie's disease, or penile fibrosis were enrolled in this study after the approval of the ethical committee of research. They were submitted to penile prosthesis implantation after tunica albuginea incision using a new auxetic guide device to generate the standardized star-shape incision on the corpora cavernosa [Figure1 - Auxetic technique in the fibrotic corpora cavernosa. a) Auxetic guide device (blue) fixed over the corpora cavernosa; b) Tunica albuginea incision guided by the auxetic device; c) Final result after removing the auxetic guide device]. The incisions create a rotating triangles system, which generates the tunica albuginea expansion in two dimensions, resulting in tissue increasement. RESULTS: The average increase in length obtained was 1,4 cm. All the patients with extensive fibrosis expanded the girth significantly to allow the corpora cavernosa dilation to 13mm in diameter. After the auxetic incisions, all the penile curvature presented in Peyronie's disease cases were corrected. No major intraoperative complications occurred. Postoperatively one patient had paraphimosis demanding surgical correction. No other complications were noted after a mean follow-up period of 10,1 months. All patients except one were very satisfied with the result and would undergo surgery again. CONCLUSIONS: The auxetic technique was successfully used to correct any penile curvature without a graft and create sufficient space to insert a penile prosthesis implant in cases of extensive fibrosis. Further research is needed to confirm the efficacy of this procedure. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e412 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandre Miranda More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD23-07 PATIENTS' COMPLIANCE WITH SURGERY FOR PEYRONIE DISEASE: A MULTICENTRE EUROPEAN STUDY

You have accessJournal of UrologyCME1 May 2022PD23-07 PATIENTS' COMPLIANCE WITH SURGERY FOR PEYRONIE DISEASE: A MULTICENTRE EUROPEAN STUDY Paolo Capogrosso, Luigi Candela, Georgios Hatzichristodoulou, Juan I. Martinez Salamanca, Andrea Cocci, Marco Falcone, Edoardo Pozzi, Nicolò Schifano, Giorgio Ivan Russo, and Andrea Salonia Paolo CapogrossoPaolo Capogrosso More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Georgios HatzichristodoulouGeorgios Hatzichristodoulou More articles by this author , Juan I. Martinez SalamancaJuan I. Martinez Salamanca More articles by this author , Andrea CocciAndrea Cocci More articles by this author , Marco FalconeMarco Falcone More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Giorgio Ivan RussoGiorgio Ivan Russo More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002565.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgery still remains the most effective treatment for Peyronie Disease (PD), despite different conservative therapies have been suggested over time. However, surgical procedures are associated with a non-negligible risk of complications and failures. We investigated patients’ willingness of being operated for PD. METHODS: Data of PD patients were prospectively collected in 5 different European academic centers between 2016 and 2020. Baseline data included age, time from PD onset, penile pain, curvature degree, difficulty at penetration, hour-glass deformity, erectile dysfunction (ED) and previous treatments. All patients were offered conservative treatments, including either oral therapy or topical injections. Tunical shortening or lengthening procedures were offered as an alternative to conservative treatments, when indicated. Penile prosthesis implantation was offered to those with concomitant ED. Patients compliance with surgery was recorded. Logistic regression analyses tested the profile of patients who were more likely to comply with surgery. RESULTS: Data were available for 343 patients. Median (IQR) age was 57.3 (49.8, 63.6) years. Median curvature was 40.0° (30.0, 65.0); of all, 48 (14%) patients had concomitant hour-glass deformity and 157 (46%) reported penile shortening. Difficulty at penetration and ED were reported by 161 (47%) and 134(39%) patients, respectively. Overall, 128 (37%) patients had been treated with tadalafil once daily for no less than 12 months; 54 (16%) received verapamil injections; 30 (9%) ESWT; and, 44 (13%) CCH injections. A significant improvement (defined as a curvature reduction≥20°) was reported in 69 (20%) cases. Overall, only 37% (126) patients were willing to undergo surgery for PD. Younger patients (OR:0.97, 95%CI: 0.95, 1.00; p=0.02), patients with more severe curvatures (OR:1.04; 95%CI: 1.03, 1.06 ; p=<0.0001) and patients reporting difficulties at penetration (OR: 1.88; 95%CI 1.04-3.41; p=0.03) were more likely to comply with surgery, after accounting for other clinical variables. CONCLUSIONS: Compliance to surgery is low among patients with PD, thus further stressing the urgent need for effective conservative treatments. Surgery should be comprehensively discussed with younger patients with a severe curvature. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e411 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paolo Capogrosso More articles by this author Luigi Candela More articles by this author Georgios Hatzichristodoulou More articles by this author Juan I. Martinez Salamanca More articles by this author Andrea Cocci More articles by this author Marco Falcone More articles by this author Edoardo Pozzi More articles by this author Nicolò Schifano More articles by this author Giorgio Ivan Russo More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF DownloadLoading ...

To drain or not to drain an inflatable penile prosthesis implantation? A multi-institutional experience tracking scrotal hematoma and infection occurrence

ABSTRACT Introduction Although the placement of a drain after inflatable penile prosthesis (IPP) implantation has become a current recommendation by many surgeons, some institutions still disagree believing drainage to be a potential source of infection. Objectives We hereby present our data to defy this belief and to add to the body of evidence supporting postoperative (PO) drainage. Furthermore, we attempt to define the optimal duration for drainage. Methods Our subjects underwent IPP implantation by three European high volume surgeons. All implantations were performed via the penoscrotal access using the Coloplast Titan Touch device. Only patients without a previous penile implantation were included. We divided our patients into 3 groups: Group 1: no-drain (n=60), Group 2: 24-hour drain (n=60) and Group 3: 72-hour drain (n=60). All patients received similar perioperative antibiotics accordingly to clinical guidelines. Surgical outcomes such as presence or absence of PO scrotal hematoma and infection were evaluated and compared between the 3 groups. We defined hematoma as a scrotal swelling correlated with evidence of scrotal free floating fluid on ultrasound examination. The ultrasound was done after 24 hours and on the 3rd and 10th PO days. Overall PO follow up was for 80 days. Results There were no significant differences in age, BMI, operative time, medical comorbidities among our study groups. The patients from Group 3 developed significantly less hematoma compared to Groups 1 and 2. The exact distribution of hematoma incidence was greatest in Group 1: n=12 (20%, p=0.005) followed by Group 2: n=8 (13.3%, p=0.05) and least in Group 3: n=1 (1.7%, p=0.002). Four patients in the no-drain group (6.7% p=0.005) developed IPP associated infection requiring device removal. All four had a hematoma prior to the infection. Groups 2 and 3 were infection-free. Conclusion Prolonged drainage up to 72 hours after virgin IPP implantation significantly reduces hematoma rates without the increased risk of drain-associated infections. Moreover, we believe that the development of a scrotal hematoma, by itself, may be a potential cause for surgical site infection. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Coloplast).

Is immediate preoperative blood glucose or hemoglobin A1c a risk factor for infection following penile prosthesis placement? A systematic review of literature

ABSTRACT Introduction Diabetes mellitus is historically associated with increased risk of surgical site infection, but its role in increasing infection following penile prosthesis implantation is controversial. Objective The present systematic review seeks to assess whether preoperative hemoglobin a1c (HbA1c) or serum glucose are independent predictors of infection following PP implantation in diabetic men. Methods A stepwise literature search of MEDLINE database resulted in 192 articles regarding PP and DM. Of the 16 articles including either HbA1c and/or serum glucose in diabetic men with and without infection, studies utilizing only healthy controls and non-human subjects were excluded, resulting in 9 studies. Results Eight and three studies assessing HbA1c and serum glucose (n¼3,516 patients), respectively, and meeting inclusion criteria were included. Three studies indicated HbA1c as a significant indicator of PP infection, all of which included both diabetic and healthy controls; the remaining five included only diabetic patients and found no associations between HbA1c and infection. One study reported serum glucose to be significantly higher in those with PP infection, but included a significant number of patients with uncontrolled DM. Of note, since the year 2000, following advent of antibiotic-impregnated prosthesis and the no-touch surgical technique, studies have found no association between HbA1c or serum glucose with risk of infection. Furthermore, these studies reported significantly lower (&amp;lt;4%) infection rate in diabetic patients undergoing PP implantation. Conclusions Data exploring HbA1c and serum glucose on PP infection were heterogeneous in time period, study design, and patient populations. Only three (33%) and one (11%) of the studies reported p HbA1c and serum glucose levels to be predictive of PP infection, respectively. However, studies following the year 2000 and restricted to only diabetic patients did not find HbA1c nor blood glucose to be accurate predictors of PP infection. Disclosure Work supported by industry: no.

Are patients really willing to undergo surgery for Peyronie's disease?

ABSTRACT Introduction There is a current lack of effective conservative treatments for Peyronie Disease (PD). Surgery represents an effective treatment, despite being associated with bothering complications, including erectile dysfunction (ED). Objective We investigated patients wish of being operated for PD at a single center. Methods Data were prospectively collected for patients managed for penile curvature because of PD in 2016-2020. Baseline data included age, time from PD onset, penile pain, curvature degree, difficulty at penetration, concomitant hour-glass deformity and ED. All patients were offered conservative treatments, including oral therapy or topical injections regardless of curvature degree. Tunical shortening or lengthening procedures were offered as an alternative to conservative treatments. Penile prosthesis implantation was offered to those with concomitant ED. Patients compliance with surgery was recorded. Logistic regression analyses tested the profile of patients who were more likely to comply with surgery. Results Data were available for 218 patients. Median(IQR) age was 57(49,63) yrs and length of PD after onset was 14(3,28) months. Median curvature was 30°(20,45); of 218, 8(3.7%) patients had concomitant hour-glass deformity. Pain was complained by 30(14%) patients, while difficulty at penetration and ED were reported by 62(28%) and 87(40%) patients. Of all, 78(32%) patients had been treated with tadalafil OaD; 41(19%) patients received iontophoresis with verapamil; 35(16%) SWT; and, 31(14%) CCH injections. A significant improvement (defined as a curvature reduction≥20°) was reported in 52(24%) cases. Overall, only 59 (27%) patients were willing to eventually undergo surgery for PD. Younger patients (OR:0.95, 95%CI: 0.92,0.98;p=0.003) and patients with more severe curvatures (OR:1.03; 95%CI: 1.01,1.04;p=&amp;lt;0.001) were more likely to comply with surgery, after accounting for other clinical variables. According to this model, a man aged 50 yrs with a curvature &amp;lt;20° would accept surgery only in 24% of cases compared to 45% for a same age man with &amp;gt;45° of curvature (Fig1). Conclusions Compliance to surgery is low among patients with PD, thus further stressing the urgent need for effective conservative treatments. Surgery should be comprehensively discussed with younger patients with a severe curvature. Disclosure Work supported by industry: no.

V12-08 SST AND THE FROZEN PUMP

You have accessJournal of UrologyCME1 May 2022V12-08 SST AND THE FROZEN PUMP Engy Habashy, and Tobias Kohler Engy HabashyEngy Habashy More articles by this author , and Tobias KohlerTobias Kohler More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002638.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Glanular hypermobility (GH) or supersonic transporter (SST) deformity are occasionally encountered during or after penile prosthesis (PP) implantation. The “frozen pump” is a phenomenon that patients experience postoperatively where they encounter difficulty inflating the device due to a rigid capsule formation around the pump leading to pump failure. In our video we describe our surgical approach in the management of GH, and the Frankenstein technique we utilize to address a "frozen pump". METHODS: Our video demonstrates our standard technique of using permanent sutures to repair GH with bilateral distal dorsal anchoring sutures and a deep glans suture. It also demonstrates our Frankenstein pump revision technique where a different brand device component may be utilized to replace the original device pump to ease device inflation. RESULTS: Successful repair of GH/SST deformity and revision of a non-functioning PP pump. CONCLUSIONS: Glanulopexy with permanent suture successfully corrects severe GH or SST in men with inflatable PP. Using different brand components to revise PP pump can be done without compromise to mechanical function. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e969 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Engy Habashy More articles by this author Tobias Kohler More articles by this author Expand All Advertisement PDF DownloadLoading ...