Prosthetic Placement Research Articles

Rehab Considerations for Recovery after a Prosthetic Joint Placement.

Rehab Considerations for Recovery after a Prosthetic Joint Placement.

Dyspnea due to an uncommon vascular tumor: leiomyosarcoma of the infrahepatic vena cava inferior

BackgroundLeiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare malignancy that originated from the smooth muscle tissue of the vascular wall. Diagnoses, as well as, treatment of the disease are still challenging and to date, a radical surgical resection of the tumor is the only curative approach.Case reportWe report on the case of a 49-year old male patient who presented with suddenly experienced dyspnea. Besides bilateral pulmonary arterial embolism, a lesion close to the head of the pancreas was found using CT scan, infiltrating the infrahepatic IVC. Percutaneous ultrasound-guided biopsy revealed a low-grade LMS. Intraoperatively, a tumor of the IVC was observed without infiltration of surrounding organs or distant metastases. Consequently, the tumor was removed successfully, by en-bloc resection including prosthetic graft placement of the IVC. Histological workup revealed a completely resected (R0) moderately differentiated LMS of the IVC.ConclusionLMS of the infrahepatic IVC is an uncommon tumor, which may present with dyspnea as its first clinical sign. Patients benefit from radical tumor resection. However, due to the poor prognosis of vascular LMS, a careful follow-up is mandatory.

PD20-01 VALIDATION OF A PENILE PROSTHETICS PLACEMENT SIMULATION PLATFORM FOR SURGICAL TRAINING: A COMPARATIVE STUDY WITH CADAVERS

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy I (PD20)1 Apr 2020PD20-01 VALIDATION OF A PENILE PROSTHETICS PLACEMENT SIMULATION PLATFORM FOR SURGICAL TRAINING: A COMPARATIVE STUDY WITH CADAVERS Rachel Melnyk, Patrick Saba, Michael Witthaus*, Gareth Warren, Divya Ajay, Timothy Campbell, Alexander Cranwell, Ahmed Ghazi, and Ricardo Munarriz Rachel MelnykRachel Melnyk More articles by this author , Patrick SabaPatrick Saba More articles by this author , Michael Witthaus*Michael Witthaus* More articles by this author , Gareth WarrenGareth Warren More articles by this author , Divya AjayDivya Ajay More articles by this author , Timothy CampbellTimothy Campbell More articles by this author , Alexander CranwellAlexander Cranwell More articles by this author , Ahmed GhaziAhmed Ghazi More articles by this author , and Ricardo MunarrizRicardo Munarriz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000870.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Simulation training is particularly relevant in prosthetic urology because of limited training during residency, low prosthetic surgical experience and decreased availability of cadavers. To overcome these limitations, a high-fidelity, non-biohazardous, procedural simulation was developed and validated for inflatable penile prosthetic (IPP) placement to supplement surgical training. METHODS: Using a combination of 3D printing and hydrogel molding, an anatomical male genital model was created and approved by experts. The model was constructed to replicate the appropriate steps of IPP placement: corporal exposure, dilation, measurement, reservoir and pump placement, and closure (Figure 1). Three expert level surgeons (>250 cases), 3 low volume faculty (<50 cases) and 6 residents performed IPP simulations on a cadaver followed by the hydrogel model via an infrapubic and penoscrotal approach. Questionnaires compared the simulations in regards to their realism and value as a training tool. RESULTS: Overall, 66.7% of the participants found the hydrogel models to be an equivalent training platform to cadavers. In terms of tissue texture, physical appearance and safety, the model was rated as similar or superior by 25%, 58.3%, and 92.7% of participants, respectively. Experts rated corporal dilation as the most beneficial step of the procedure, followed by corporal exposure then reservoir placement. Similar results were found in low volume faculty and residents, combined. All participants believed an operative checklist would be an ideal assessment tool. Experts recommended that trainees should complete an average of 3.3 simulations as a prerequisite to live surgical training. Participants believed the model's biggest advantage was its non-biohazardous nature (83.3%), and could potentially replace cadavers without the need for specialized facilities (66.7%). The most requested modifications included improvement of tissue texture (25%) and the addition of bleeding (25%). CONCLUSIONS: This procedural penile prosthesis simulation offers the opportunity to practice each step of IPP placement, obviating the need for specialized facilities. The non-biohazardous nature of this model provides a safe and accessible supplement for penile prosthesis surgical training. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e447-e447 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel Melnyk More articles by this author Patrick Saba More articles by this author Michael Witthaus* More articles by this author Gareth Warren More articles by this author Divya Ajay More articles by this author Timothy Campbell More articles by this author Alexander Cranwell More articles by this author Ahmed Ghazi More articles by this author Ricardo Munarriz More articles by this author Expand All Advertisement PDF downloadLoading ...

Is there a relationship between general and oral health-related quality of life in partially edentulous patients before and after implant treatment? A quasi-experimental study.

The aim of this study was to determine the relationship between Oral Health Related Quality of Life (OHRQoL) and general health-related quality of life (GHRQoL) in partially edentulous patients before and after implant placement. After obtaining informed consent, using convenient sampling method, 102 participants (64 female and 38 male participants with an age range of 18-81years) were included in the study. Participants were required to fill EuroQol-5D (EQ-5D) and the Oral Health Impact Profile-14 (OHIP-14) questionnaire before implant surgery and three months after prosthetic placement. Data were not normally distributed, so non-parametric tests were used for data analysis. Data analysis was carried out on 93 participants. After implant treatment, Visual Analogue Scale (VAS) and EQ-5D score significantly increased by 0.05 and 0.06 units, respectively (p<.001 and p=.004, respectively). Also, the total OHIP-14 score significantly decreased from 15.89 to 6.18 after implant treatment (p<.001). Results indicated an increase in general and oral health-related quality of life after implant treatment. According to this study, there was a positive weak relationship between GHRQoL and OHRQoL before and after implant treatment.

INTRAVASCULAR HEMOLYSIS AS THE FIRST INDICATION OF MELODY VALVE FAILURE

Intravascular hemolysis is an uncommon but serious risk in those who undergo prosthetic heart valve placement, which has been reduced by using bioprosthetic valves. Throughout the multicenter Investigational Device Exemption (IDE) Melody valve trial, there were no documented cases of post-

Secondary Tracheoesophageal Puncture After Laryngectomy Increases Complications With Shunt and Voice Prosthesis.

To evaluate the demographics, clinical features, management, and prognostic indicators of tracheoesophageal puncture complications in patients undergoing placement of voice prosthesis following cancer treatment. Retrospective analysis. A retrospective analysis was conducted of cases from a tertiary referral center diagnosed between 1996 and 2015. Multivariate logistic regression was used to determine factors associated with tracheoesophageal puncture (TEP) and voice prostheses-complication-free survival (TEP/VP-CFS). One hundred fourteen cases were identified. Most patients were males (92.9%) with pT3 (26.8%) or pT4 (58.1%) N+ (53.6%) tumors. All patients received laryngectomy as the primary treatment, with 75% of patients receiving adjuvant radiation therapy or chemoradiotherapy. Complications with TEP were common (65.2%). The most frequent problem was salivary leakage (50.0%), which at the same time was the most common reason for changing the prosthesis. On univariate regression analysis, prosthesis placement time after adjuvant radiotherapy (hazard ratio [HR]: 4.17, 95% confidence interval [CI]: 2-8.69), secondary prosthesis placement after primary surgery (HR: 3.97, 95% CI: 1.99-7.9), and laryngectomy with flap reconstruction (HR: 1.96, 95% CI: 0.99-3.89) were significant prognosticators for complications. Multivariate regression analysis revealed secondary prosthesis placement after adjuvant radiotherapy (HR: 3.66, 95% CI: 1.39-9.68) or after primary surgery (HR: 2.57, 95% CI: 0.92-7.2) to be the strongest predictors of reduced TEP/VP-CFS. Secondary prosthesis placement after primary surgery, placement after previous irradiation, and laryngectomy with flap reconstruction are predictors of poor TEP/VP-CFS. Planned adjuvant radiotherapy is not a contraindication for TEP with prosthetic placement, but it is very important to place the prosthesis during the primary surgery or at least before scheduled radiotherapy. 4 Laryngoscope, 2020.

Direct maxillary sinus floor augmentation and simultaneous implant placement for rehabilitation of the severely resorbed posterior maxilla: A prospective clinical study.

The aim of this prospective clinical study was to evaluate the success of one-stage direct (lateral) sinus lift procedure in severely atrophic posterior maxilla. One-stage direct (lateral) sinus lift procedure was carried out at 15 sites in 13 patients. All patients included in the study presented with partially edentulous posterior maxilla with one or more missing teeth and residual bone height less than 5 mm. Three months after surgery, patients were evaluated to access increase in residual bone height, density of new bone formed and implant stability. Patients were also evaluated after 3 months of prosthetic placement for the success of implant-supported prosthesis. At 3 months post-operatively, increase in residual bone height was 8.31 ± 1.63 mm and the mean density of the newly formed bone around the implants was 417 ± 66.61 HU. All implants were stable and successfully osseointegrated, except one implant that was lost. The success rate of implant stability was 96.3% during the study period. Single-stage direct (lateral) maxillary sinus floor augmentation is a good treatment option with predictable outcome for patients with deficient alveolar bone in posterior maxilla.

Update in Implant-Based Breast Reconstruction.

Implant-based techniques represent the most common means of reconstruction after mastectomy. Over the last decade, new developments in implant technology, surgical technique, and bioprosthetic or synthetic adjuncts have enhanced the predictability and outcomes after implant-based reconstruction. Objective methods of mastectomy skin flap perfusion assessment have the potential to further improve surgical outcomes. The last five years have also witnessed a renewed and transformative interest in prepectoral prosthetic placement, facilitated by the availability of bioprosthetic materials for pocket control and device coverage. Together, these developments are advancing the boundaries of implant-based strategies for breast reconstruction, including reconstruction in the setting of challenging frontiers such as postmastectomy radiation, direct-to-implant reconstruction, and nipple-sparing mastectomies.

Synchronous Urethral Repair During Prosthetic Surgery: Safety of Planned and Damage Control Approaches Using Suprapubic Tube Urinary Diversion

BackgroundUrethral injury during inflatable penile prosthesis (IPP) or artificial urinary sphincter (AUS) placement is rare, and traditionally most prosthetic surgeons abort prosthetic implantation when urethral repair is necessary. AimTo report our experience with synchronous urethroplasty (SU) as a planned or damage control surgery during urologic prosthetic surgery, to evaluate the safety and outcomes of the procedure. MethodsA retrospective review of our IPP and AUS database was completed to identify patients who underwent an SU between 2007 and 2018. We included patients who underwent an SU during prosthetic surgery in either a planned procedure for known stricture or diverticulum or a “damage control” procedure after intraoperative injury. OutcomePatient characteristics and surgical outcomes were assessed, with success defined as the absence of urethral stricture and revision surgery. ResultsFrom our database of 1,508 prosthetic cases, we identified 7 patients (0.46%) who had an SU in the same setting as complete prosthesis placement (4 AUS and 3 IPP [1 combined IPP/AUS], and 1 sling). Three patients underwent planned repair of a known urethral abnormality (urethral diverticulum, urethrocutaneous fistula, and urethral stricture), and 4 underwent repair of an intraoperative urethral injury. Among the patients who experienced an intraoperative urethral injury, contributing etiologies included previous anti-incontinence surgery with periurethral fibrosis (n = 2), severe corporal fibrosis from priapism, and previous urethral disruption from pelvic fracture. Nearly all of the urethroplasties (6 of 7; 86%) were completed with a primary closure. The average indwelling duration of suprapubic tube (SPT) catheters was 4.1 weeks (range, 7 to 47 days). The average duration of follow-up was 21.5 months, and all patients were continent at follow-up. No device infections or urethral complications were identified. Clinical ImplicationsOur study illustrates the safety of concomitant urethral repair at time of prosthetic placement as an option to avoid the use of 2 anesthetics and prevent further scarring in high-risk patients. Strengths & LimitationsThis is the first study to address definitive urethral reconstruction during anti-incontinence procedures along with planned concomitant urethroplasty during IPP placement. This promising initial experience is relevant for surgeons who may encounter concomitant urethral pathology in the setting of complex reoperative prosthetic cases. The need for SU is rare, and thus our cohort size was limited in this retrospective, single-institution experience. ConclusionSU with prolonged SPT urinary diversion offers a safe damage control approach for men with concomitant urethral pathology during prosthetic surgery without conferring an increased risk of infection or stricture.Yi YA, Fuchs JS, Davenport MT, et al. Synchronous Urethral Repair During Prosthetic Surgery: Safety of Planned and Damage Control Approaches Using Suprapubic Tube Urinary Diversion. J Sex Med 2019;16:1106–1110.

Correlation of radiographic variables to guide safe implant positioning during acetabular surgery and hip replacement: a retrospective observational study

BackgroundKnowledge of periacetabular anatomy is crucial for prosthetic cup placement in total hip arthroplasty and for screw placement in anterior fixation with acetabular fractures. It is known that degree of hip dysplasia correlates with medial bone stock and that medial bone stock shows a weak correlation to Lequesne’s acetabular index (AI). Aim of this study was to investigate a possible correlation between AI and the newly proposed medial safe zone.MethodsAI and the medial save zone were measured on 419 hips using a computed-tomography scan of the pelvis. AI was assessed on a 2D reconstructed anterior-posterior view of the pelvis using VOXAR™. Correlation was measured using the Pearson correlation coefficient.ResultsMean AI was 4.2 degrees (SD 4.9 degrees). Mean medial safe zone was 8.1 mm (SD 1.9 mm). There was a significant correlation between AI and medial save space with a Pearson correlation coefficient r = 0.33 (p = .001).ConclusionThere is a weak correlation between AI and medial safe zone. AI should not be used to predict medial safe zone. Due to the weakness in correlation AI is not suited for predicting medial safe zone. However, a low or negative AI can be a warning sign for less medial safe zone, prompting surgeons to take care when reaming in THA or placing periacetabular screws.

Meta-analysis of randomized clinical trials comparing clinical and patient-reported outcomes between extra-short (≤6mm) and longer (≥10mm) implants.

To compare the clinical outcomes of ≤6mm extra-short implants (test group) versus ≥10mm long implants (control group), with and without bone augmentation procedures. A systemic literature search of randomized clinical trials was performed using the PubMed (MEDLINE) and EMBASE databases. A quantitative meta-analysis was conducted to compare all the outcome variables. Meta-regression analysis determined the effect of bone augmentation procedures and the influence of other clinical covariates on the results. Eighteen studies comprising 1,612 implants (793 extra-short and 820 long implants) were selected for the meta-analysis. No statistically significant difference in the survival rate was observed at 1 and 3years (p>0.05). Extra-short implants displayed less marginal bone loss (MBL) from both implant placement time points (1 and 3years) and prosthetic placement (1year), as well as less biological complications, surgical time and treatment cost (p<0.05). Contrarily, a statistically significant small number of prosthetic complications were reported with long implants (p<0.05). Placement of extra-short implants (≤6mm) presented as an equivalent option in the treatment of patients with an atrophic posterior arch up to 3-year follow-up. However, the long-term effectiveness of extra-short dental implants remains to be further studied.

Case report of a newly designed narrow-diameter implant with trapezoid-shape for deficient alveolar bone

Long-term survival and prognosis of narrow-diameter implants have been reported to be adequate to consider them a safe method for treating a deficient alveolar ridge. The objective of this study was to perform case report of narrow-diameter implants with a trapezoid-shape in anterior teeth alveolar bone. A 50-year-old male patient presented with discomfort due to mobility of all of the maxillary teeth and mandibular incisors. Due to destruction of alveolar bone, four anterior mandibular teeth were extracted. Soft tissue healing was allowed for approximately 3 months after the extraction, and a new design of implant placement was planned for the mandibular incisor area, followed by clinical and radiological evaluation. Implant placement was determined using an R2GATE surgical stent. The stability of the implants was assessed by ISQ measurements at the first and second implant surgery and after prosthetic placement. At 1 and 3 months and 1 year after implantation of the prosthesis, clinical and radiological examinations were performed. Another 50-year-old male patient presented with discomfort due to mobility of the mandibular central incisors. For the same reason as in the first patient, implant placement was carried out in the same way after extraction. ISQ measurements and clinical and radiological examinations were performed as in the previous case. In these two clinical cases, 12 months of follow-up revealed that the implant remained stable without inflammation or additional bone loss, and there was no discomfort to the patient. In conclusion, computer-guided implant surgery was used to place an implant in an optimal position considering the upper prosthesis. A new design of a narrow-diameter implant with a trapezoid-shape into anterior mandibular alveolar bone is a less invasive treatment method and is based on the contour of the deficient alveolar ridge. Through all of these procedures, we were able to reduce the number of traumas during surgery, reduce the operation time and total treatment period, and provide patients with more comfortable treatment.

Our experience with using a uniform prophylactic protocol in neurosurgery: surgical-site infection did not occur in 272 operations

Purpose: Surgical site infection (SSI) is a source of concern in any surgical procedure. Although studies with high numbers of patients are available, most of these studies were performed by different surgeons and the exact anti-SSI protocol is not mentioned or is not homogeneous in all patients.Materials and methods: We present the results of 272 cases where SSI was successfully prevented in our neurosurgical units and in this study we explain our institutional protocol for achieving this positive result. We included all neurosurgical procedures in our two centers that needed an operating room, undertaken between 9 November 2015 and 6 December 2016, retrospectively. Then we compare our results with the existing literature.Results: We performed 272 neurosurgical procedures on 245 patients. 155 patients were male and 90 were female. We re-operated on 24 patients and 3 of them operated on three times in each instance case and others were operated on twice. The patient’s ages ranged from 2 to 86years with the mean being 42.39 ± 19 years. The cranial site of surgery was more common (129 procedures, 47.4%) and overall 118 operations (43.4%) were accompanied with a prosthetic device placement. We performed 96 emergency procedures. The mean hospitalization time was 6.19 ± 6.77 days. We followed all patients for at least six months. There were no reports of SSI in our neurosurgical units.Conclusion: With a fixed protocol of antisepsis, hand protection and prophylactic antibiotics, there were achieved good results. We recommend the current protocol as an effective measure in the control of infection in the neurosurgical ward. However, further studies are needed with more patients and a stronger study design.

Evaluating the Role of Postoperative Oral Antibiotic Administration in Artificial Urinary Sphincter and Inflatable Penile Prosthesis Explantation: A Nationwide Analysis

To determine whether postoperative oral antibiotics are associated with decreased risk of explantation following artificial urinary sphincter (AUS) or inflatable penile prosthesis (IPP) placement. Although frequently prescribed, the role of postoperative oral antibiotics in preventing AUS or IPP explantation is unknown. We queried the MarketScan database to identify male patients undergoing AUS or IPP placement between 2003 and 2014. The primary end point was device explantation within 3 months of placement. Multivariate regression analysis controlling for clinical risk factors assessed the impact of postoperative oral antibiotic administration on explant rates. We identified 10,847 and 3594 men who underwent IPP and AUS placement, respectively, between 2003 and 2014. Postoperative oral antibiotics were prescribed to 60.6% of patients following IPP placement and 61.1% of patients following AUS placement. The most frequently prescribed antibiotics were fluoroquinolones (35.6%), cephalexin (17.7%), trimethoprim/sulfamethoxazole (7.0%), and amoxicillin-clavulanate (3.2%). Explant rates did not differ based upon receipt of oral antibiotics (antibiotics vs no antibiotics: IPP: 2.2% vs 1.9%, P = .18, AUS: 3.9% vs 4.0%, P = .94). On multivariate analysis, no individual class of antibiotic was associated with decreased odds of device explantation. Postoperative oral antibiotics are prescribed to nearly two-thirds of patients but are not associated with reduced odds of explant following IPP or AUS placement. Given the risks to individuals associated with use of antibiotics and increasing bacterial resistance, the role of oral antibiotics after prosthetic placement should be reconsidered and further studied in a prospective fashion.

Goldilocks Mastectomy: A Safe Bridge to Implant-Based Breast Reconstruction in the Morbidly Obese.

Background:Reconstructive surgeons are encountering an increasing number of obese women requiring postmastectomy reconstruction. These patients are poor candidates for autologous and prosthetic-based reconstructions as they have a high rate of reconstructive failure, surgical complications, and poor aesthetic outcomes. We demonstrate here the utility of the previously described Goldilocks mastectomy with free nipple grafts as a safe bridge to second stage implant-based breast reconstruction.Methods:Ten consecutive morbidly (BMI > 40) or super obese (BMI>50) women underwent bilateral Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral implant placement at least three months postoperatively. Patients were assessed for implant-related complications including malposition, capsular contracture, dehiscence, and extrusion.Results:Ten postmastectomy reconstructions in patients with BMIs ranging from 37 to 50 with a mean BMI of 45 underwent bilateral Goldilocks mastectomy with free nipple grafts. Two patients had wound healing complications after Goldilocks mastectomy but were completely healed within 8 weeks. There were no instances of delayed wound healing or reconstructive failure after prosthetic placement. With at least 9 months of follow-up on all patients, no patient has had a capsular contracture, significant malposition, or other complication requiring reoperation.Conclusion:The obese patient poses a significant reconstructive challenge for which no reproducible approach has been described. Here, we present a 2-stage strategy: the previously described Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral definitive implant placement. This is the first proposed description of a reliable strategy for postmastectomy reconstruction in the morbidly and super obese.

Evaluation of feasibility of preoperative concurrent chemoradiotherapy in locally advanced operable oral cancer and resection and reconstruction of mandibular/maxillary segment with prefabricated free fibular graft.

e17558 Background: Every year more than 500,000 patients are diagnosed with oral cancer worldwide and majority require surgery and radiotherapy as a definitive curative treatment. Loss of bony segment of mandibular/maxillary bone with resultant loss of shape, function and ability to chew the food is known. Neoadjuvant chemoradiotherapy is known to have improved disease outcomes in many solid tumours. Methods: Total Seven patients underwent the planned protocol of 100 days. All patients were male and median age was 46 years. Six patients had disease involving lower alveolus and one had upper alveolus. All had no palpable nodes clinically. Step 1 a. Neoadjuvant treatment of Radiotherapy to Primary disease and draining lymph nodes dose of 45 to 50 Gy in 25 fractions over 5 weeks along with concurrent weekly Cisplatin 40mg/m2 for 5 cycles b. Mock surgery on 3D models with defining of insertion site of implants on fibular segment. Step 2 Insertion of dental implants in fibula and split skin graft in the desired fibular site in second week of radiotherapy. Step 3 Definitive surgery 6 weeks after completion of chemoradiotherapy and reconstruction by free fibular segment with primary dental prosthesis checking occlusion of oral bite. Results: Six patients(85.7%) are alive and free of disease at median follow up of 6.7 months. Three(42.8%) patients underwent prosthetic placement with acceptable outcome. Two patients had trismus and undergoing oral physiotherapy. Six patients had orocutaneous fistula. One had extrusion of fibular graft and one patient died. Five(71.4%) patients had complete response on final histopathology report and two had partial response. Conclusions: : A novel technique for better functional and aesthetic results with possible improved survival in operable oral cancer. Future randomized studies are needed for validation.

Placement of Zygomatic Implants into the Malar Prominence of the Maxillary Bone for Apical Fixation: A Clinical Report of 5 to 13 Years.

This study was designed to evaluate long-term performance of zygomatic implants using an alternative apical fixation point to establish the posterior restorative foundation for fixed full-arch restoration. A retrospective study of all consecutively treated patients with advanced maxillary resorption who were treated with zygomatic implants to support fixed prostheses from August 14, 2001 through November 24, 2009 was conducted; the final follow-up was August 31, 2015. All zygomatic implants were placed using the malar prominence of the maxillary bone for apical fixation. Initial study casts were analyzed to compute the anterior/posterior implant distribution, distance between bilateral zygomatic implants, and variation from ideal zygomatic implant positioning relative to the soft tissue crest. Soft tissue, implant, and restorative complications also were recorded. Fifty-eight consecutively treated patients with advanced maxillary resorption were included in the study- 18 men and 40 women, with a mean ± SD age of 65.3 ± 8.0 years and range of 49 to 85 years. Forty-nine patients received bilateral zygomatic implants placed apically into the malar process of the maxillary bone, and nine patients received similarly placed unilateral zygomatic implants with 107 zygomatic implants reported. All patients had supplemental anterior implants and were restored with a one-piece splint framework and fully implant-supported restoration. Follow-up of 5 to 13 years was conducted, with a mean follow-up time of 8.4 years per zygomatic implant. No losses of zygomatic implants occurred. No major surgical or restorative complications were observed. Utilizing the malar prominence of the maxilla for apical fixation of zygomatic implants predictably allows prosthetic placement of the implant platform in a favorable first molar position, eliminating prosthetic compromise.

Testicular prostheses in children: Is earlier better?

The absence of a testis occurs for various reasons in children, but testicular prosthesis implantation in children is uncommon. The optimal time for prosthesis placement is still unclear, and its complication rate has been poorly studied in children. The aim of this study was to determine the risk factors of complications in cases of testicular prosthesis implantation in children. A monocentric, retrospective review was performed of children implanted with a testicular prosthesis between 2008 and 2014. All implantations were performed through an inguinal incision with a standardized procedure. Children were divided into two groups depending on the interval after orchiectomy: (A) early implantation (delay between surgeries <1 year); and (B) delayed surgeries (delay ≥1 year). Statistical analysis was performed with Student and Fisher tests. Twenty-six patients (A, 15; B, 11) had a total of 38 testicular prostheses placements. Mean follow-up was 36.2 months. First surgery was performed at the mean age of 11.8 years (range 0-17.9) (A, 14.1; B, 8.1; P=0.01) and testicular prosthesis implantation at the mean age of 14.7 years (range 9-18) (A, 14.3; B, 14.6) with a mean delay of 36.1 months (A, 1.3; B, 80.3). Indications were mainly spermatic cord torsion (27%), bilateral anorchia (27%), and testicular atrophy after cryptorchidism surgery (19.2%). Complications (10.5%) included two cases of extrusion, one infection and one migration. Patient 1 had a history of acute lymphoblastic leukemia with testicle relapse 2 years after induction therapy. High-dose chemotherapy, total body irradiation and bilateral orchiectomies were performed, and bilateral prostheses were implanted 12 years after the end of chemotherapy. Complications happened 85 days after surgery. Patient 2 was followed-up for a proximal hypospadias. The tunica vaginalis flap, which was used during a redo urethroplasty, lead to testicular atrophy. Thirteen years after the last penile surgery, a testicular prosthesis was placed through an inguinal incision, and extrusion occurred 203 days after surgery. Bacterial cultures of the prostheses were sterile and histological review showed no sign of granuloma or graft rejection. The complication rate was significantly higher if the delay between the two surgeries exceeded 1 year (P=0.01). Indications of orchiectomy, prior scrotal incision, and prosthesis size were not risk factors. Testicular prosthesis implantation was relatively safe in a pediatric cohort. The complication rate was significantly higher if the delay between the orchiectomy and the prosthetic placement exceeded 1 year. These results suggest that reducing the delay between orchiectomy and prosthesis implantation may lead to fewer complications.

Novel Evidence-Based Classification of Cavernous Venous Occlusive Disease

The primary aim of our study was to determine whether an evidence-based rationale could categorize cavernous venous occlusive disease into mild, moderate and severe erectile dysfunction. A total of 863 patients underwent color duplex Doppler ultrasound from January 2010 to June 2013 performed by a single urologist. We identified a cohort of 75 patients (8.7%) with a diagnosis of cavernous venous occlusive disease based on a unilateral resistive index less than 0.9, and right and left peak systolic velocity 35 cm per second or less after visual sexual stimulation. At a median followup of 13 months patients were evaluated for treatment efficacy. A total of 75 patients with a median age of 60 years (range 19 to 83) and a mean body mass index of 26.3 kg/m(2) (range 19.0 to 39.3) satisfied the criteria of cavernous venous occlusive disease. When substratified into tertiles, resistive index cutoffs were obtained, including mild cavernous venous occlusive disease-81.6 to 94.0, moderate disease-72.6 to 81.5 and severe disease-59.5 to 72.5. Using these 3 groups the phosphodiesterase type 5-inhibitor failure rate (p= 0.017) and SHIM (Sexual Health Inventory for Men) score categories (1 to 10 vs 11 to 20, p = 0.030) were statistically significantly different for mild, moderate and severe cavernous venous occlusive disease. Treatment satisfaction was also statistically significantly different. Penile prosthetic placement was a more common outcome among patients with erectile dysfunction and more severe cavernous venous occlusive disease. Our retrospective analysis supports a correlation between the phosphodiesterase type 5 inhibitor failure rate, SHIM score and the rate of surgical intervention using resistive index values. Our data further suggest that an evidence-based classification of cavernous venous occlusive disease by color Doppler ultrasound is possible and can triage patients to penile prosthetic placement.

A retrospective 3- to 5-year study of the reconstruction of oral function using implant-supported prostheses in patients with hypohidrotic ectodermal dysplasia.

The aim of this study was to evaluate oral function rehabilitation in patients with hypohidrotic ectodermal dysplasia (HED) using implant-supported prostheses based on bone augmentation. From September 2005 and March 2009, 25 HED patients were chosen for clinical data analysis in this study. The criteria for patient selection included the following: the display of clinical features of HED, the number of congenitally missing teeth (>5), the patient age (>16 years), the patient's willingness, and the patient's tolerance for bone graft surgery and implant placement. Follow-up evaluations were initiated from the time of implant prosthetic placement and scheduled annually for 3-5 years. The effects of oral function reconstruction were assessed based on the cumulative survival and success rates of implants, the health of the peri-implant area, and the degree of patient satisfaction. Twenty-five HED patients received 169 conventional implants and 10 zygomatic implants (179 total implants). During 3-5 years of post-loading evaluations, 5 of the 179 implants failed and 3 implants were removed. The 3-year success and cumulative survival rates were 97.2% and 98.3%, respectively. Furthermore, periodontal probing and radiographic assessments showed that the 3-year incidence of peri-implantitis was 4.5%. Finally, HED patients expressed high degrees of satisfaction with their facial contours, masticatory function, pronunciation ability, and comfort with the implant-supported prostheses. The results of this 3- to 5-year retrospective study indicate that the oral function of HED patients can be effectively reconstructed using bone augmentation and implant-supported prostheses; however, longer term results are warranted in the future.