Penile Prosthetic Implantation Research Articles

A contemporary systematic review of penile lengthening procedures with penile prosthesis.

Penile prosthetic devices are the standard treatment for erectile dysfunction (ED) after failure of maximum medical therapy and conservative options. Several penile lengthening procedures (PLPs) can be performed concurrently with penile prosthesis (PP) insertion in patients with severe ED, penile shortening, and/or Peyronie's disease to help combat negative emotional and psychological concerns from penile length loss with penile prosthetic device placement. An extensive, systematic literature review of the various pre-, intra-, and post-operative techniques that can be applied to preserve, restore or enhance penile length at the time of penile prosthetic implantation. Numerous pre-operative and post-operative inflation protocols exists with vacuum erection devices and penile traction therapy. Intraoperative surgical techniques include cavernosal sparing and channeling without dilatation, subcoronal incision with circumferential penile degloving and grafting, the sliding technique, the modified sliding technique, the multiple-slit technique, the tunical expansion procedure (TEP), modified TEP, and the auxetic expansion procedure. These approaches can be meaningful to restore and/or preserve length for patients undergoing PP insertion. PLPs can be performed by surgeons who have extensive penile reconstruction experience and have been trained to do these procedures, as there is significant risk to the patient and limitations to what can be expected. Each patient must be counseled in detail about the risks and benefits of these procedures and have their expectations managed as the average postoperative penile length recovery is around 3 cm and can range from 0-4.0 cm. Future research is needed to identify the appropriate candidate for each approach, and how much length gain the patient can expect.

(240) Evaluation of Factors Associated with Reoperation Rates for Penile Prosthetic Implantation in Erectile Dysfunction: A Medicare Analysis

Abstract Introduction As the prevalence of erectile dysfunction (ED) in the U.S. continues to rise due to an aging population, the use of penile prostheses (PP) to treat refractory ED is expected to increase. In 2017, Onyeji et al analyzed a New York state surgical database and found that the highest quartile implanters had lower re-operation rates in long-term follow-up. Due to a higher risk of infection and morbidity in PP reoperations, compared to primary surgery, minimizing PP reoperations is important. Objective This study evaluates the association between patient/clinical characteristics and reoperation rates at 90-days and 1-year among men undergoing PP implantation using a national database. Methods This retrospective claims data analysis used the 100% Medicare Standard Analytical Files (SAF) to identify men aged ≥65 who received PP (malleable and inflatable) between 2017 and 2020. The patients were required to have a continuous enrollment 1-year pre- and post-index PP encounter. The outcomes of interest were reoperation rates (defined as removal, repair, and removal and replacement of PP with or without infection) at 90 days and 1 year following initial implantation. Multivariable logistic regression was used to examine the relationship between reoperation rates and patient demographics and comorbidities: age, geographic region, race (White, Black, and Others [American Indian, Asian, Hispanic, Other, Unknown]), urbanization, baseline Charlson Comorbidity Index (CCI) and comorbidities (diabetes and prostate cancer therapy), primary diagnosis at the index PP implantation, type of index PP procedure, and prosthetic surgeon procedure volume. Urbanization was categorized as urban vs rural based on patient’s county of residence and the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. The prosthetic surgeon procedure volume was split into low (1-24 surgeries) and high-volume (≥25 surgeries) based on the 2022 PP International Consensus Forum definition. Results This study included 12,350 patients who underwent PP implantation. Nearly 50% were aged 65-69 years, 77.2% White, 82.6% in urban areas, and 56.2% had a CCI score of 0 (Table 1). Most of these men (96.0%) received an inflatable PP and 91.2% had ED as their primary diagnosis. The overall reoperation rates at 90-day and 1-year post-implant were 2.19% and 6.15%, respectively. Logistic regression found that low-volume implanters were associated with a 34% (OR 1.34; 95% CI 1.01, 1.78) and 35% (OR 1.35; 95% CI 1.14, 1.60) higher odds of reoperation at 90-day and 1-year post-implant, respectively, compared to high-volume implanters. Men with a baseline CCI of 0 had 19% higher odds of 1-year reoperation (OR 1.19; 95% CI 1.01, 1.40) compared to their counterparts with a CCI of ≥1. Black patient race was associated with 35% lower odds of 90-day reoperation compared to White patients (OR 0.65; 95% CI 0.43, 0.99) but this difference did not persist at 1-year of follow-up. Conclusions This study highlights that higher case volume reduces the risk of reoperation in the short to medium term, consistent with state-specific data of long-term follow-up. The impact of race and comorbidities warrants further evaluation to optimize patient counseling as they seek surgical treatment of ED. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast, BK Medical.

(472) The AM-EDITS: A New Tool for Evaluating the Arab Patient and Partner Satisfaction Following Penile Prosthesis Implantation

Abstract Introduction The Modified Erectile Dysfunction Inventory of Treatment Satisfaction (M-EDITS) is recognized as a useful tool in English language to assess post penile prosthetic implantation (PPI) satisfaction. Nevertheless, a more global questionnaire remains to be introduced for the Arab population, where malleable PPI (MPPI) remains more popular, compared to the inflatable types. Due to the sensitivity of the topic and the conservative nature of the Middle East and North Africa (MENA) region, a scarce body of related research is available. Objective Our primary goal was to develop a validated Arabic version of the M-EDITS adapted to the Arabic culture and introduce it as the AM-EDITS. Our secondary goal was to utilize it to investigate the levels of Arab patient and partner satisfaction after MPPI and its sustainability during and after the first 6 months of surgery. Methods This was a prospective 6-month follow-up study of 120 patients undergoing MPPI at our unit by a single surgeon. Three telephone encounters were conducted for each couple at 1 month, 3 months, and 6 months postoperative (PO). For our study, we developed a validated Arabic version of the M-EDITS, coined as the AM-EDITS. The first encounter covered general patient perioperative experience, beginning from preoperative counseling till early after surgery. The second and third encounters focused on patient and partner satisfaction regarding implant utilization. Results The mean ages for the men and their spouses were 54.7±8.4 and 32.9±4.6 years, respectively. Over 82% of the patients in our study showed a decreased level of anxiety after preoperative counseling. 96% of the patients reported a positive experience regarding their early PO days with above half exceeding their expectations. After 3 months, 82.5% of the men were satisfied, describing their erections to be 80% close to natural. Of the 92.5% satisfied wives at 3 months, 78.5% were highly satisfied. Feeling sexually desirable by their husbands was reported in 93.4%. As opposed to the significant rise in men’s overall satisfaction and AM-EDITS index by 11.6% and 5.2 ± 0.8% (P <0.001), respectively after 6 months PO, partners demonstrated a 12.4% and 5.9 ± 0.8 decline (P <0.001), respectively, compared to the 3 months follow up. Conclusions The AM-EDITS may expand the global application of the original M-EDITS. MPPI represents a good quality of life treatment option for middle to low-income countries. Time has a positive effect on the Arab men’s PO satisfaction as opposed to their partners’. These findings should be considered during perioperative counseling of both parties to ensure sustainable satisfaction. Extended studies are necessary to confirm our findings as well as assess long-term PO satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast

(462) Penile Implant Cancellations During the COVID-19 Pandemic- A Retrospective Cohort Study

Abstract Introduction During the early stages of the COVID-19 pandemic, hospitals prioritized the availability of ventilators, anesthesia personnel, hospital beds, and personal protective equipment; consequently, widespread recommendations were made to postpone or cancel all elective procedures [1,2]. Determination of what was considered “elective” in urology was ill-defined, though there was consensus by international and European urologic societies that the “lowest priority” tier of procedures included those for functional and reconstructive urology, urogynecology, infertility, and prosthetic surgery [3,4]. Though these are indicated for benign conditions, the long-term impact of remaining under-treated is unknown. No data in the existing literature describe the effect of prosthetic surgery cancelations on patient outcomes during the COVID-19 pandemic. Objective To determine the primary reasons for cancelation of penile prosthetic implantation during the COVID-19 pandemic and to assess subsequent patient outcomes. Methods In this retrospective cohort study, all male patients ≥18 years old scheduled for implantation of a penile prosthesis at our institutions during a 2-year span (1/1/20 to 1/1/22) were eligible for inclusion. Data were abstracted from Epic with ICD-10 and CPT codes for erectile dysfunction and penile prostheses, respectively. Information collected about patients included age, ethnicity, marital status, SHIM score, prior penile implant status, prostate cancer history and therapy, initial date of surgery, cardiac/medical clearance status, cancelation status and cause, whether surgery was rescheduled, and if the surgery ultimately occurred. Crude and adjusted associations between factors related to cancellations were assessed using binary logistic regression and summarized as odds ratio (OR) along with 95% confidence intervals (CI). All statistical analyses were performed using SPSS 28.0.1. Results Of the 284 patients that met inclusion criteria, 77 (27.1%) had their surgeries canceled; of those, 33 (42.9%) were later rescheduled, with 31 (93.9%) ultimately undergoing the procedure. There was no significant difference in the average age or SHIM score of those who were and were not canceled. Only 9 (11.7%) of the cancelations were ordered by the hospital, with 4 (5.2%) canceled because of the restriction on elective procedures and 4 (5.2%) due to patients testing positive for COVID. 68 (88.3%) of the cancelations were at the behest of patients; 3 (3.9%) elected not to undergo surgery during the pandemic. The remaining 65 (84.4%) canceled for a variety of reasons, including not getting a pre-procedure UA or COVID test. Patients who did not receive cardiac/medical clearance were three times more likely to cancel (OR 3.04; 95% CI = 1.72-5.37; P<0.001). This association remained statistically significant after adjusting for insurance status (OR 2.32; 95% CI = 1.24-4.34; P=0.009). Conclusions Our data revealed that most cancelations of penile prosthetic implantations during COVID-19 were patient-instigated, with few cancelations due to COVID-19 infection or reluctance to have surgery during the pandemic. Most cancelations appeared secondary to difficulties with pre-procedure labs/testing, likely to have been an indirect consequence of the COVID-19 pandemic. Severely limited availability of PCP or lab appointments caused patients increased difficulty obtaining the necessary testing before surgery. Nevertheless, many of the canceled patients were able to reschedule, with nearly all ultimately undergoing the procedure. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Rigicon, Coloplast, Baxter.

History of penile implants: from implants made of bone to modern inflatable penile implants.

Penile prostheses are implantable devices used to definitively treat erectile dysfunction when previous forms of treatment have failed. The first example of a penile implant dates to 1935, when a rib was inserted in a neo-phallus reconstructed after a traumatic amputation. Since then, alternative artificial devices were adopted as penile prosthetic implants. The evolution of prosthetic devices had a dramatic thrust in 1973 when the first inflatable penile prosthesis was worldwide presented. Thanks to advances in device materials, design, surgical implant techniques, and perioperative management, nowadays inflatable penile prostheses are one of the most adopted definitive therapy for patients with drug-refractory erectile dysfunction or refusing alternative forms of treatments. Moreover, the clinical indications for inflatable penile prosthesis have also expanded, including female-to-male transmen or men underwent penile reconstruction due to congenital aphallia or traumatic or surgical penile amputation. In order to summarise the process behind the development and evolution of penile prosthesis, we aimed at performing a historical review of the currently available literature to provide an easy and comprehensive overview of the topic. The understanding of the historical process behind the evolution of inflatable penile prostheses will drive further innovation to increase efficiency and the rate of patients satisfaction.

2022. Evaluation of Antimicrobial Prophylaxis and Infectious Outcomes in Penile Prosthetic Implants at VA Long Beach Healthcare System

Abstract Background Penile prosthetic implants (PPI) offer an effective treatment for erectile dysfunction. The risk of postoperative infection in primary PPI is estimated at 0.33-11.4% and up to 18% in revision surgery. The most common causative organisms include Escherichia coli and coagulase negative Staphylococcus. The AUA guidelines recommend perioperative antibiotics for no more than 24 hours. However, a survey of urologists revealed that the majority used oral antibiotics for 5-14 days after surgery. There have been increasing reports of anaerobic and fungal infections, but the AUA guidelines do not recommend antimicrobial prophylaxis against these organisms. Methods This is a retrospective, chart review, quality-improvement study. Veterans who had a PPI procedure between May 1999 to July 2021 were included. Patients with only removal of the prosthesis were excluded. For patients who had multiple procedures, only the most recent procedure was considered. Data collection included demographics, pertinent medical history (history of polysubstance abuse, homelessness, smoking, chronic immunosuppression, anticoagulation, diabetes, HIV, spinal cord injury, Peyronie’s disease or priapism), prior PPI, relevant labs (BMP, A1C), microbiologic results, and medications prescribed. Results 176 patients underwent a PPI-related procedure between May 1999 and July 2021. 137 patients were included in this study. 14 patients (10.2%) experienced a PPI infection. For all patients, the average total duration of antimicrobial prophylaxis was 11.8 days. Mean duration of antimicrobial therapy after procedure was 12.4 days and 10.5 days for the infection and no infection group, respectively (p-value 0.118). The most common antibiotic combination was vancomycin and gentamicin. There were no statistically significant difference in patient risk factors between infection and no infection groups, but the most common risk factors were smoking and prior implant. Gram positive organisms were most commonly isolated. There were no incidences of fungal infections. 2.2% incidence of AKI and 1.5% incidence of antimicrobial resistance were observed. Conclusion Further evaluation of the necessity of prolonged duration of antimicrobial prophylaxis and antifungal prophylaxis should be evaluated. Disclosures All Authors: No reported disclosures.

Acne, folliculitis and post-operative infection rates of penile prosthetic implants

ABSTRACT Introduction and Objective Acne vulgaris is the inflammation of the pilosebaceous unit due to overgrowth of Propionibacterium acnes while folliculitis is inflammation of the hair follicle commonly due to Staphylococcus aureus. Whether these microbes are pathogenic in urologic procedures is yet to be determined. In this database study, we investigated whether acne or folliculitis were associated with an increased risk of post-surgical infection in men who received a penile prosthetic implant (PPI). Methods The IBM MarketScan® Claims dataset was utilized to assess penile prosthesis encounters. Men 18-years and older who received a PPI were included in this study. Acne and folliculitis were analyzed separately as independent variables. Demographic factors that influence infection rates were examined including age, immunosuppressed status, coronary artery disease (CAD), diabetes, smoking status, and spinal cord injury (SCI). (Table 1a-b). A log-rank test of Kaplan-Meier curves determined whether having acne or folliculitis was significantly associated with time to post-operative infection within 6 months. Cox Proportional-Hazard models included covariates deemed most clinically relevant. Results Our analysis included 17,031 men who received a PPI. When analyzing men with acne, aside from being younger (59.9 vs 62.4, p<0.001), there were no statistical difference compared to men without (Table 1a). By 6 months, having acne was not associated with increased rates of infection (Figure 1a, Table 2a). Men with folliculitis were found to have significantly higher rates of diabetes, immunocompromised status, and CAD compared to men without (Table 1b). Having folliculitis was not associated with increased rates of infection by 6 months even after adjusting for covariates (Figure 1a, Table 2b). Conclusions There appears to be no association between acne and folliculitis and rates of PPI infection. These findings allude to the difficulty in predicting which microorganism within the natural skin flora may be inoculant and which are pathogenic in surgical incisions. Furthermore, infection rates of PPI's may be due to other factors such as intraoperative aseptic techniques and post-operative hygiene. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Antares Pharma, Clarus Therapeutics, Coloplast, Promescent, Viome).

PD28-11 VALUE OF ROUTINE PRE-OPERATIVE CYSTOSCOPY PRIOR TO INSERTION OF PENILE PROSTHESIS

You have accessJournal of UrologyCME1 May 2022PD28-11 VALUE OF ROUTINE PRE-OPERATIVE CYSTOSCOPY PRIOR TO INSERTION OF PENILE PROSTHESIS Leonid Aksenov, Zachary Dionise, Faysal Yafi, and Aaron Lentz Leonid AksenovLeonid Aksenov More articles by this author , Zachary DioniseZachary Dionise More articles by this author , Faysal YafiFaysal Yafi More articles by this author , and Aaron LentzAaron Lentz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002576.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile prosthetic implants have been used for almost 50 years for refractory erectile dysfunction, with approximately 20,000 annual implants in the United States alone. Historically, some urologists have advocated for routine pre-operative cystoscopy to evaluate for the presence of lower urinary tract obstruction prior to prosthesis placement. The rationale being that the treatment of lower urinary obstruction should supersede prosthetic placement and management of these conditions may be complicated with a prosthetic in place. Anecdotally, the risk of such significant asymptomatic urethral pathology is quite low. Cystoscopy, in addition to carrying the risk of peri-procedural infection, does have a substantial associated cost. Thus, our objective was to retrospectively evaluate the prevalence and cost of incidentally discovered urethral pathology during inflatable penile prosthesis (IPP) placement. METHODS: We retrospectively identified all inflatable IPP insertions (CPT 54405 or 54410) performed or aborted by a single surgeon (ACL) from 1/1/14 to 9/15/21. Of those, we then identified and reviewed patients who underwent intraoperative urethral dilation (CPT 52281), direct vision internal urethrotomy (CPT 55276), or cystoscopy (CPT 52000). Costs were calculated based on our institution’s cost data. Total and average cost of routine office cystoscopy for each IPP was compared to total cost of aborted IPPs. RESULTS: A total of 726 inflatable IPP placement cases were identified. An intraoperative cystoscopy was performed in 13 (1.8%) cases. Of those, 5 (0.7%) cystoscopies were planned and 8 (1.1%) were unplanned. Of the IPP cases with unplanned cystoscopies, 4 cases were aborted (0.5%); 3 cases were aborted due to a urethral stricture and 1 case was aborted due to a urethral perforation following corporal dilation. Unplanned intraoperative cystoscopies and interventions had an average supply cost of $216, totaling $1,732. The total supply cost of aborted IPPs due to urethral stricture was $4,182, an average of $1,394 per case. If every IPP case underwent a pre-operative cystoscopy, the estimated total cost would have been $234,498 ($323 per case). CONCLUSIONS: Given the rarity of incidental urethral strictures requiring aborted IPP and intervention, the cost of routine pre-operative cystoscopy far exceeded the cost of aborted IPP procedures. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e502 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leonid Aksenov More articles by this author Zachary Dionise More articles by this author Faysal Yafi More articles by this author Aaron Lentz More articles by this author Expand All Advertisement PDF DownloadLoading ...

Erectile Functioning as a Risk Factor for Committing a Sexual Offense?

Zhang et al1 describe the ethical dilemma associated with penile prosthesis implantation in men with a history of sexual offending. Focused mainly on penile prosthetic implantation, they suggest practical guidelines including a standardized questionnaire to screen for sexual violence and sexual addiction. However, a positive screening does not preclude a patient from surgical management of ED. What they suggest is that sexual counseling and psychiatric evaluation is rather aimed at reducing future risk of sexual violence through the assessment of psychosocial factors associated with the offense.

Acne, Folliculitis and Post-Operative Infection Rates of Penile Prosthetic Implants

ABSTRACT Introduction Acne vulgaris is the inflammation of the pilosebaceous unit due to overgrowth of Propionibacterium acnes while folliculitis is inflammation of the hair follicle commonly due to Staphylococcus aureus. Whether these microbes are pathogenic in urologic procedures is yet to be determined. Objective In this database study, we investigated whether acne or folliculitis were associated with an increased risk of post-surgical infection in men who received a penile prosthetic implant (PPI). Methods The IBM MarketScan® Claims dataset was utilized to assess penile prosthesis encounters. Men 18-years and older who received a PPI were included in this study. Acne and folliculitis were analyzed separately as independent variables. Demographic factors that influence infection rates were examined including age, immunosuppressed status, coronary artery disease (CAD), diabetes, smoking status, and spinal cord injury (SCI). (Table 1a-b). A log-rank test of Kaplan-Meier curves determined whether having acne or folliculitis was significantly associated with time to post-operative infection within 6 months. Cox Proportional-Hazard models included covariates deemed most clinically relevant. Results Our analysis included 17,031 men who received a PPI. When analyzing men with acne, aside from being younger (59.9 vs 62.4, p<0.001), there were no statistical difference compared to men without (Table 1a). By 6 months, having acne was not associated with increased rates of infection (Figure 1a, Table 2a). Men with folliculitis were found to have significantly higher rates of diabetes, immunocompromised status, and CAD compared to men without (Table 1b). Having folliculitis was not associated with increased rates of infection by 6 months even after adjusting for covariates (Figure 1a, Table 2b). Conclusions There appears to be no association between acne and folliculitis and rates of PPI infection. These findings allude to the difficulty in predicting which microorganism within the natural skin flora may be inoculant and which are pathogenic in surgical incisions. Furthermore, infection rates of PPI's may be due to other factors such as intraoperative aseptic techniques and post-operative hygiene. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma, Clarus Therapeutics, Coloplast, Promescent, Viome

The Tunneling Technique: A Universal Approach for Salvage Penile Prosthetic Implantation in Severely Scarred Corporal Bodies

ABSTRACT Introduction IPP implantation in severe cases of intracorporal scarring poses a daunting challenge, even to experts in the field, owing to associated difficulty and high rates of complications. Objective In a step-by-step video, we demonstrate the successful implantation of an IPP in a case of total intracorporal fibrosis utilizing the tunneling technique through the subcoronal approach. We aspire this video to serve as an instructive resource for treating these special cases. Methods We present our approach performed on a 32 year old African male patient suffering complete intracorporal fibrosis as a result of a full week episode of ischemic priapism due to sickle cell anemia. The penile shaft was degloved via a subcoronal incision. In addition to the conventional instruments required for IPP implantation, for tunneling and dilation, we used the Wilson's backward cutting scissors, the Uramix original cavernotomes (http://www.uramix.com/category/og/), the Carrion-Rossello cavernotomes (https://www.coloplast.co.uk/rossello-en-gb.aspx), and the Zephyr cavernotomes. Apart from the unique corporal dilation steps, IPP implantation was performed in the classic fashion. A closed suction drain was utilized as part of our routine protocol. Our patient was followed up the patient for one month on a weekly basis then again after 3 months. Results After successful corporal tunneling utilizing our special instruments we were able to seamlessly implant a size 20 Coloplast Narrow-Base Titan Touch prosthesis with 2 cm rear tips on both sides. The patient demonstrated an eventless postoperative follow-up period for up to 3 months and was highly satisfied with his implant. Conclusions We believe that corporal tunneling via the subcoronal approach may be both a successful and universal option for cases of severe intracorporal fibrosis provided both adequate surgeon experience and special instruments were available. It is a minimally invasive approach excluding the need for corporal reconstruction and utilization of additional grafting thus lowering the risk of postimplantation infection. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast

Modified malleable prosthesis with a fixed mesh: case series for the Ghattas technique.

Penile prosthetic implantation represents a cornerstone for patients with organic erectile dysfunction (ED) that is refractory, unsatisfactory, or contra-indicated for other approved medical or mechanical options. In this study, we introduce the “Ghattas technique,” wherein we constructed a polypropylene mesh sheath that surrounds and is fixed to a 13-mm malleable prosthesis cylinder, which can increase the cylinder diameter for cases that need a larger prosthesis. All patients underwent preoperative evaluation and completed the five-item International Index of Erectile Function questionnaire (IIEF-5). Postoperative outcomes were evaluated by IIEF-5 and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires at final follow-up. The mean age of the 23 included patients was 57.9 (standard deviation [s.d.]: 11.4) years and the mean duration of ED was 8.5 (s.d.: 7.9) years. Erection improvement was determined by comparing mean preoperative and postoperative IIEF-5 scores (8.3 [s.d.: 3.9] vs 24.6 [s.d.: 0.6], P < 0.001). High treatment satisfaction was determined according to a mean EDITS score of 94.9 (s.d.: 9.9). The proposed Ghattas technique was safe and effective in our patients, and provides opportunity for cases that need a diameter larger than 13 mm. Further studies are needed to confirm these results.

Penoscrotal Decompression—Promising New Treatment Paradigm for Refractory Ischemic Priapism

BackgroundFor prolonged ischemic priapism, outcomes after distal shunt are poor, with only 30% success for priapic episodes lasting longer than 48 hours. AimTo present a novel, glans-sparing approach of corporal decompression through a penoscrotal approach for cases of refractory ischemic priapism (RIP) after failed distal shunt procedures. MethodsWe describe the technique and present our initial experience with penoscrotal decompression (PSD) for treatment of RIP after failed distal shunt. We compared outcomes of patients with RIP undergoing surgical management using PSD or malleable penile prosthesis (MPP) placement after failed distal penile shunt procedures (2008–2017). OutcomesOur initial experience showed favorable outcomes with PSD compared with early MPP placement in patients with RIP whose distal shunt failed. ResultsOf 14 patients with RIP undergoing surgical management after failed distal penile shunt procedures, all patients presented after a prolonged duration of priapism (median = 61 hours) after which the priapism was refractory to multiple prior treatments (median = 3, range = 1–75) including at least 1 distal shunt. MPP was inserted in 8 patients (57.1%), whereas the most recent 6 patients (42.9%) underwent PSD. All patients with PSD (6 of 6, 100%) were successfully treated with corporal decompression without additional intervention and noted immediate relief of pain postoperatively. In contrast, 37.5% of patients (3 of 8) undergoing MPP after failed distal shunt procedures required a total of 8 revision surgeries during a median follow-up of 41.5 months. The most common indications for revision surgery after MPP placement included distal (4 of 8, 50%) and impending lateral (2 of 8, 25%) extrusion. Clinical ImplicationsPSD is a simple, effective technique in the management of RIP after failed distal shunt procedures with fewer complications than MPP placement. Strengths and LimitationsAlthough PSD is effective in the management of RIP after failed distal shunt procedures, long-term assessment of erectile function and ease of future penile prosthetic implantation is needed. ConclusionCorporal decompression resolves RIP through a glans-sparing approach and avoids the high complication rate of prosthetic insertion after failed distal shunt procedures.Fuchs JS, Shakir N, McKibben MJ, et al. Penoscrotal Decompression—Promising New Treatment Paradigm for Refractory Ischemic Priapism. J Sex Med 2018;15:797–802.

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.

Sexual satisfaction among patients with erectile dysfunction on oral phosphodiesterase inhibitors and among patients with penile prosthetic implants

Sexual satisfaction among patients with erectile dysfunction on oral phosphodiesterase inhibitors and among patients with penile prosthetic implants

The treatment of erectile dysfunction in patients with neurogenic disease.

Erectile dysfunction (ED) related to compromise of the nervous system is an increasingly common occurrence. This may be due to the multifactorial nature of ED, the myriad of disorders affecting the neurotransmission of erectogenic signals, and improved awareness and diagnosis of ED. Nevertheless, neurogenic ED remains poorly understood and characterized. Disease related factors such as depression, decreased physical and mental function, the burden of chronic illness, and loss of independence may preclude sexual intimacy and lead to ED as well. The amount of data regarding treatment options in subpopulations of differing neurologic disorders remains scarce except for men with spinal cord injury. The treatment options including phosphodiesterase inhibitors, intracavernosal or intraurethral vasoactive agents, vacuum erection devices (VED) and penile prosthetic implantation remain constant. This review discusses the options in specific neurologic conditions, and briefly provides insight into new and future developments that may reshape the management of neurogenic ED.

500 penile prostheses implanted by a surgeon in Italy in the last 30 years.

The aim of our study was to report our experience with patients affected by Erectile Dysfunction (ED) and undergoing penile prosthetic implantation (PPI) in a single center by a single surgeon. We retrospectively evaluated the clinical outcome of 500 patients (mean age: 51.5 years, range: 20-86 years) affected by ED and referred to our private andrological center from January 1984 to December 2013 who underwent penile prosthesis implantation, including the reported level of patient satisfaction. 182 silicone, 180 malleable, 18 monocomponent hydraulic and 120 multicomponents hydraulic prostheses were implanted by the same experienced surgeon. All patients were hospitalized for the procedure. All patients were evaluated immediately, 1 month (496 patients) and, for the great majority, every year after implantation. One hundred twenty five patients were lost to follow-up. Twenty two patients underwent revision surgery for complications in the postoperative period. The most serious postoperative complications were mechanical problems (45 patients, 9.0%) and infection (15 patients, 3%). Forty two (8.4%) prostheses were explanted. Overall, 80% (400/500) of patients were able to have sexual intercourse and were fully satisfied with the results. In our experience prosthetic surgery should be considered a good solution for men affected by ED and not responsive to other therapeutic solutions. Prosthetic surgery can be performed not only in large public hospitals but also in smaller private facilities.

Historical approach to the surgical treatment of erectile dysfunction

Abstract Introduction Throughout human history, erectile dysfunction has represented one of the most omnipresent health problems. This has resulted in a search for solutions that, one after the other, have been shown to be fruitless. In this context, the emergence of possible surgical solutions at the start of the 20th century represented a revolution that, even then, would take several decades to demonstrate their effectiveness. Acquisition of evidence We performed a literature review that shows the process in the development of potential surgical treatments for hormonal restoration for erectile dysfunction, followed by the sudden emergence of vascular surgery, with new anastomosis techniques, and in the future, the development of penile prosthetic implants as alternative treatments. Summary of the evidence The publication of results from erectile dysfunction surgery has been lagging for decades due to a lack of objectivity, given that sexual function is a topic restricted by patients’ privacy. This situation has led to a reliance on results reported by various authors whose actual credibility could not be verified, with subsequent demonstrations showing that some of these results were not reproducible. Conclusions This article reviews some of the most important milestones in the progress of surgeries designed to treat erectile dysfunction. The achievements and apparent failures provide a reason for reflection on how far we have come and how far we can go in the near future.

Aproximación histórica al tratamiento quirúrgico de la disfunción eréctil

IntroductionThroughout human history, erectile dysfunction has represented one of the most omnipresent health problems. This has resulted in a search for solutions that, one after the other, have been shown to be fruitless. In this context, the emergence of possible surgical solutions at the start of the 20th century represented a revolution that, even then, would take several decades to demonstrate their effectiveness. Acquisition of evidenceWe performed a literature review that shows the process in the development of potential surgical treatments for hormonal restoration for erectile dysfunction, followed by the sudden emergence of vascular surgery, with new anastomosis techniques, and in the future, the development of penile prosthetic implants as alternative treatments. Summary of the evidenceThe publication of results from erectile dysfunction surgery has been lagging for decades due to a lack of objectivity, given that sexual function is a topic restricted by patients’ privacy. This situation has led to a reliance on results reported by various authors whose actual credibility could not be verified, with subsequent demonstrations showing that some of these results were not reproducible. ConclusionsThis article reviews some of the most important milestones in the progress of surgeries designed to treat erectile dysfunction. The achievements and apparent failures provide a reason for reflection on how we far we have come and how far we can go in the near future.

Laparascopic Capsulotomy to Treat Autoinflation of Inflatable Penile Prostheses

Inflatable penile prosthetic implants are a reliable treatment for erectile dysfunction. Mechanical failures now are the most common reason for revision of this type of device, and autoinflation is a common cause for device revision. There are currently no published surgical treatments for this malfunction. To describe a simple outpatient surgical revision for an automatically inflating device using laparascopic dissection. Complete deflation of penile prosthesis on follow-up visit, intraoperative and postsurgical complications, and length of procedure. We performed a retrospective review of patients treated for inflatable penile prosthesis autoinflation with laparascopic capsulotomy to release constricting connective tissue rind surrounding the device reservoir at a single institution. We collected information about etiology of impotence, surgical procedures relating to implant and revision of prosthetic devices, and follow-up evaluations. Four patients underwent laparascopic capsulotomy to treat autoinflation. Mean operative time was 45 minutes, and no adverse surgical or perioperative outcomes occurred. All four patients had deflated corporal cylinders at the time of follow-up evaluation. Laparascopic capsulotomy is an easy and reliable method of treating inflatable penile prosthesis autoinflation that can be performed in the outpatient setting.