Semirigid Prosthesis Research Articles

Trends and outcomes of hospitalized patients with priapism in Germany: results from the GRAND study.

We aimed to provide evidence on the trends and in-hospital outcomes of patients with low- and high-flow priapism through the largest study in the field. We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2008-2021), and performed multiple patient-level analyses. We included 6,588 men with low-flow and 729 with high-flow priapism. Among patients with low-flow priapism, 156 (2.4%) suffered from sickle cell disease, and 1,477 (22.4%) patients required shunt surgery. Of them, only 37 (2.5%) received a concomitant penile prosthesis implantation (30 inflatable and 7 semi-rigid prosthesis). In Germany, the total number of patients with low-flow priapism requiring hospital stay has steadily increased, while the number of patients with high-flow priapism requiring hospital stay has decreased in the last years. Among patients with high-flow priapism, 136 (18.7%) required selective artery embolization. In men with low-flow priapism, sickle cell disease was associated with high rates of exchange transfusion (OR: 21, 95% CI: 14-31, p < 0.001). The length of hospital stay (p = 0.06) and the intensive care unit admissions (p = 0.9) did not differ between patients with low-flow priapism due to sickle cell disease versus other causes of low-flow priapism. Accordingly, in men with high-flow priapism, embolization was not associated with worse outcomes in terms of length of hospital stay (p > 0.9), transfusion (p = 0.8), and intensive care unit admission (p = 0.5). Low-flow priapism is an absolute emergency that requires shunt surgery in more than one-fifth of all patients requiring hospital stay. On the contrary, high-flow priapism is still managed, in most cases, conservatively.

Five-year overview of penile prosthesis implantation: general considerations from real-life practice

Objective: Penile prosthesis (PP) is the third-line therapy for erectile dysfunction in patients who do not respond to pharmacotherapy or who prefer a permanent solution to their problem. Even though the satisfaction rate is high, implantation is irreversible, and complications such as infection can lead to catastrophic outcomes. The objective of this study is to provide a 5-year (2018-2022) overview of patients who underwent penile prosthesis implantation, including techniques using both an inflatable penile prosthesis and semirigid prosthesis. Materials and Methods: Aspects of the study include pre-surgical counseling, patient and device selection, operative technique, and special considerations in relation to implantation in complex cases, such as those involving corporal fibrosis, Peyronie’s disease, or revision procedures. Results: This 5-year overview demonstrates that the techniques remain effective and safe (0% infection rate) with a high satisfaction rate (84%) when compared to several prior studies. Better understanding and advancement in surgical techniques provide good outcomes; thus, implantation of a penile prosthesis is a good option for treatment of erectile dysfunction. Conclusion: This 5-year review of PP implantation carried out in 35 patients by a single surgeon shows a very low complication rate after surgery with a high level of patient satisfaction. To maximize the potential for a good outcome, prior to surgery the physical status of patients should be evaluated and counseling is essential. In patients identified as being at a high risk, the implantation team should be prepared for complications using evidence-based data.

Surgical outcomes, motivations, sexuality, and urinary function of metoidioplasty with semi-rigid prosthesis

Background Preliminary results of a specific semi-rigid prosthesis for metoidioplasty (ZSI® 100D4; Zephyr Surgical Implants, Geneva) have been reported, suggesting a safe procedure that may enhance the metoidioplasty outcomes by stiffening and increasing protrusion of the constructed neo-phallus. Aim The objective of the present study was to report the updated surgical results of metoidioplasty with implantation of the ZSI®100D4, along with a comprehensive evaluation of the outcomes including, motivations, sexuality, and urinary function. Methods All individuals who underwent a metoidioplasty with implantation of the ZSI®100D4 between August 2017 and January 2021 with at least 1 year of follow-up were included and their data retrospectively collected. They were contacted by telephone between November 2020 and May 2022 and invited to answer a questionnaire exploring motivations, satisfaction with genitals and sexual life, as well as urinary and sexual function. Results Twenty-one individuals were included and followed-up during a median [IQR] period of 19.5 months [12.8–24.2]. Most individuals (n = 13; 62.0%) had a post-operative complication, the most frequent was wound dehiscence (n = 6; 28.6%). Three urinary fistula (14.3%) were reported, all managed conservatively (Clavien-Dindo grade 2) with a prolonged urinary diversion. Among the 18 individuals who answered the questionnaire, 16 (88.9%) were sexually active, and 11 (61.1%) were engaged in a sexual relationship. The total median [IQR] self-esteem and relationship questionnaire score was 92 [91–97]. The reported urinary symptoms of delay, intermittency, lagging drops and spraying were mostly never or rarely reported. The satisfaction regarding overall genital aspect was highly favorable as 15 (83.3%) individuals reporting being very satisfied or satisfied, although 5 (27.8%) reported being dissatisfied with the size of their genitals. Conclusion Implantation of a semi-rigid prosthesis in a metoidioplasty seems a safe procedure, with no reported complications related to the prosthesis. Overall, satisfaction regarding genitals, sexual and urinary function are favorable.

(247) Complication Rates After Penile Prostheses In Men with History of Priapism – A Retrospective Claims Database Cohort Analysis

Abstract Introduction Penile prostheses can be placed in men with a history of priapism who develop erectile dysfunction, or as initial management of acute ischemic priapism. However, little is known about long-term complications associated with prostheses in these men. Objective To assess the risk of penile prosthesis complications in men with a history of priapism. Methods We searched the TriNetX insurance claims database to create a cohort of men ages ≥16 years old with 1) a diagnosis of priapism (ICD-10: N48.4), 2) a diagnosis of erectile dysfunction (ICD-10: N52), and 3) had undergone prosthesis placement (insertion of penile prosthesis inflatable and self-contained [CPT: 54401], insertion of semi-rigid penile prosthesis [CPT 54400], or insertion of multiple component inflatable penile prosthesis [CPT: 54405]). Three complications were assessed: penile prosthesis infection (ICD-10: T83.61), penile prosthesis mechanical breakdown (ICD-10: T83.410A), and penile prosthesis displacement or migration (ICD-10: T83.420). Rates of and duration to IPP removal (CPT: 54415-17, 54406, 54410-11) were also assessed. To compare rates of complications, the priapism cohort was compared to a cohort of men with a diagnosis of erectile dysfunction and prosthesis placement but without a history of priapism or corpora cavernosal irrigation, matched by age, race, diabetes status, and obesity (E66). When assessing risk of prosthesis complications, we utilized 1:1 greedy nearest-neighbor propensity score matching to control for confounding variables. Results A total of 665 men were identified with a diagnosis of priapism and erectile dysfunction who subsequently received a penile prosthesis. A control group of 31,345 patients with erectile dysfunction and a penile prosthesis but without priapism or history of irrigation was identified, and ultimately 660 men in the case and control cohorts were matched by age, race, diabetes status, and obesity. Men of with a history of priapism were more likely to experience penile prosthesis infection (5.0% vs 2.7%; Risk Ratio (RR): 1.83, 95% Confidence Interval (CI) 1.04-3.22) and mechanical breakdown of the prosthesis (7.3% vs 3.8%, RR: 1.92, 95%CI 1.20-3.08). There was no difference in the rate of penile prosthesis displacement or migration (3.5% vs 2.4%, RR: 0.76, 95%CI 0.77-2.70). Overall rates of penile prosthesis explantation were higher in men with a history of priapism 14.6% vs 8.4% (RR: 1.73, 95%CI 1.27-2.36). Rates of early explantation (within 6 months of placement) were similar between the two groups, 3.3% vs 2.9% (RR: 1.16, 95%CI 0.63-2.11). Rate of explantation of semi-rigid prostheses were significantly higher in men with a history of priapism, 27% vs 9.6% (RR: 2.54, 95%CI 1.62-3.93). Of the 17 men undergoing explantation of semi-rigid prosthesis with history of priapism, only 4 men (23%) went on to have a 3-piece penile prosthesis placed. Conclusions In this US claims-based database comparison between prosthetic complications in men with and without a history of priapism, men with priapism were more likely to experience infection, mechanical breakdown and explantation. There was no difference in rate of device displacement or migration, or in timing of device explantation. This real-world data provides context for counseling men with priapism who undergo prosthesis placement. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Urogen Pharma, Janssen Global Services, Regeneron Pharmaceuticals

Penile Prosthesis Placement by a Dedicated Transgender Surgery Unit: A Retrospective Analysis of Complications

BackgroundPenile prostheses may be used as a component of genital gender affirmation surgery for the purpose of achieving penile rigidity after phalloplasty, and transgender individuals experience higher complication rates than cisgender individuals. AimTo observe complications with transmasculine penile prosthesis surgery over time and across surgical conditions. MethodsRetrospective chart review of all transmasculine patients with phalloplasty undergoing penile prosthesis placement between 4/14/2017 and 2/11/2020 (80 patients). OutcomesIndependent variables include implant type, previous genital surgeries, and simultaneous genital surgeries. Dependent variables include prosthesis infection and mechanical complication (device malfunction, dislodgement, erosion). ResultsThere was an overall complication requiring surgery rate of 36% and infection rate of 20% (15/67 for inflatable prostheses and 1/13 for semirigid), with 14% (11/80) experiencing infection requiring removal. Differences in infection rates appeared insignificant across categories of previous surgery or with simultaneous surgery, but we did notice a markedly lower rate for semirigid prostheses compared to inflatable. There was a significant relationship between infection and case number, with the probability of infection decreasing over time. Device loss at 9 months was 21% overall. Preoperative conditions of the neophallus such as prior stricture correction and perioperative factors such as simultaneous clean and clean-contaminated procedures seemed to pose no additional increase in complication rates. Clinical ImplicationsType and number of prior and simultaneous non-prosthetic surgeries should not be considered as a risk factor for penile prosthesis after phalloplasty for transmasculine patients, even those that are clean-contaminated Strengths & LimitationsOur cohort size is large compared to currently available studies, although not large enough to generate sufficient power for group comparisons. We have reported every genital surgical step between phalloplasty and penile prosthesis placement and recorded complications with subsequent devices after failure. Patient-reported outcomes were not collected. ConclusionWe demonstrate that preoperative conditions of the neophallus, such as prior stricture correction, and perioperative factors, such as simultaneous clean and clean-contaminated procedures, seem to pose no additional increase in complication rates. Our data suggest that surgical experience may further decrease complications over time.B. L. Briles, R. Y. Middleton, K. E. Celtik, et al. Penile Prosthesis Placement by a Dedicated Transgender Surgery Unit: A Retrospective Analysis of Complications. J Sex Med 2022;19:641–649.

PD31-12 PENILE PROSTHESIS PLACEMENT USING AN OPTIMIZED METHOD BY A DEDICATED TRANSGENDER SURGERY UNIT: A SLOW DECREASE IN HIGH COMPLICATION RATES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD31)1 Sep 2021PD31-12 PENILE PROSTHESIS PLACEMENT USING AN OPTIMIZED METHOD BY A DEDICATED TRANSGENDER SURGERY UNIT: A SLOW DECREASE IN HIGH COMPLICATION RATES Ravyn Middleton, Brenna Briles, Kenan Celtik, Curtis Crane, Michael Safir, and Richard Santucci Ravyn MiddletonRavyn Middleton More articles by this author , Brenna BrilesBrenna Briles More articles by this author , Kenan CeltikKenan Celtik More articles by this author , Curtis CraneCurtis Crane More articles by this author , Michael SafirMichael Safir More articles by this author , and Richard SantucciRichard Santucci More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002032.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female to male transgender individuals may seek penile prostheses as part of genital gender affirmation surgery for the purpose of achieving penile rigidity, as this is not achieved with phalloplasty alone. This study aims to observe the types and rates of complications of penile prostheses after phalloplasty, over time and across surgical conditions, and to seek improvements in the complication rate by diligent adherence to proven principles. METHODS: Data was gathered via retrospective chart review of 81 patients at our high-volume center. The natural history of each prosthesis was followed through time. RESULTS: There was an overall complication rate of 36% and infection rate of 20%, with 15% experiencing infection requiring removal. Differences in infection rates were not significant across categories of previous surgery or with simultaneous surgery, but we did notice a markedly lower rate for semirigid prostheses compared to inflatable [infection rate 22% (15/67) for inflatable prostheses and 7% (1/14) for semirigid (p=0.19)]. Infection rates decrease with time and surgical experience: the rate of prosthesis infection improved over time, and the slope of the cumulative curves are much lower for infections (r=0.013) than expected for the number of cases performed over time (r=0.082) (p=0.979). The first 40 patients had an overall infection rate of 28% (11/40), a slope of 0.071 for cases vs time, and 0.013 for infections vs time (p=0.975). The most recent set of 41 patients had a lower overall infection rate of 12% (5/41), a slope of 0.079 for cases, and 0.006 for infections (p=0.969). CONCLUSIONS: Improvements were achieved by strict adherence to proven techniques: no touch techniques (Level 3 evidence), appropriate pre-operative intravenous antimicrobial prophylaxis (Level 2), control of blood sugar in diabetics (Level 2), antibiotic soaked implants (Level 2), hair clipping instead of razor shaving (Level 1), and use of chlorhexidine-based surgical scrub (Level 1). Overall, 28% of patients required surgery for complications. This compares favorably to the meta-analysis of penile prosthesis placements in phalloplasty patients, where the overall rate of complications requiring surgery was 45% for inflatable prostheses, and 42% for non-inflatable prostheses. Using careful surgical technique advised by specific knowledge of phalloplasty anatomy, and following proven infection control methods developed in the cisgender population, we hypothesized and then achieved lower rates of complication in this risky procedure. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e543-e543 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ravyn Middleton More articles by this author Brenna Briles More articles by this author Kenan Celtik More articles by this author Curtis Crane More articles by this author Michael Safir More articles by this author Richard Santucci More articles by this author Expand All Advertisement Loading ...

Metoidioplasty With Implantation of a Specific Semirigid Prosthesis

Metoidioplasty is a possibility for penis reconstruction in transmen that could be enhanced by a semi-rigid prosthesis support. Describe the surgical technique of metoidioplasty with implantation of a specifically designed semi-rigid prosthesis -the ZSI100D4- and analyze preliminary results. Implantation of semi-rigid prosthesis was proposed to transmen who chose metoidioplasty for genital gender affirming surgery in a specialized university hospital. Surgical outcomes were collected from medical files. Functional outcomes and satisfaction were collected post-operatively with a questionnaire. A total of 15 patients were operated; the mean length of followup was 22 months (SD = 8.7). Median prosthesis size was 8.5 cm (range: 8.5-10). Seven (46.7%) minor complications (Clavien-Dindo grade 2; 5 wound dehiscence and 2 fistula, managed conservatively) and 1 severe (Clavien-Dindo grade 3b) complication (Hematoma that need surgical revision) occurred. Thirteen patients (86.6%) answered the questionnaire; 11 (84.6%) reported being either "very satisfied" or "satisfied" with the appearance of the new genitalia; 10 (76.9%) could void while standing; and 12 patients (92.3%) answered "not at all" to the question "do you have regrets about this surgery ?". Implantation of a semi-rigid prosthesis in an enlarged clitoris seems to be a valuable option and can be proposed as another possibility for the complex surgical answer to neophallus reconstruction in transmen. Neuville P, Carnicelli D, Paparel P, etal. Metoidioplasty With Implantation of a Specific Semirigid Prosthesis. J Sex Med 2021;18:830-836.

Infrapubic versus Penoscrotal Approaches for Implantation of Semi-Rigid Penile Prosthesis

Background: Modification of surgical techniques to minimize wound infections in penile implant surgery using malleable prosthesis which is easy to use, of very low risk of mechanical failure and is financially suitable to improve outcome and ensures less complications. The aim of the study is to compare infrapubic approach and Penoscrotal approach in penile semi-rigid prosthesis implantation surgery. Patients and methods: Fifty patients were randomly divided into two groups and each group underwent one approach. Results: No statically significant differences were found between both groups in terms of operative time. Corporeal cross over was the most common intraoperative complications, 3 cases in IP approach and 6 cases in PS but not statistically significant. Peyronie’s disease patients underwent penile implant through infrapubic approach in 3 cases and PS in 4 cases with one recorded complication of keloid formations with IP. Urethral false passage reported only in one case with PS approach without affecting the procedure. Only minor complications including superficial wound infection which was significantly more with PS, 6/25 (24%) and IP 1/25 (4%), p value = 0.041. Penile and scrotal edema was common with IP approach (92%) in comparison with PS approach (60%). The urethral catheter can be abandoned with IP to avoid the risk of catheterizations. No significant relation between diabetes and infections and no erosions were encountered. Conclusion: Through this research work, infrapubic approach is better than Penoscrotal approach even if it is not commonly used by surgeon.

Évolution du nombre et du type de prothèses péniennes posées en France pour dysfonction érectile : analyse des données nationales de codage pour la période 2006–2013

Patients who are not responding to injectable and/or vacuum oral pharmacological treatments can receive a penile prosthesis. Three types of penile prostheses are used in France: rigid, semi-rigid and inflatable prostheses 3-piece or 2-piece. We have assessed the National surgical insertion practices between 2006and 2013 (number of prostheses insertions, types, procedure locations, number of surgeons and distribution [public or private sectors]). Data analysis from the French Technical Agency of Information on Hospitals (ATIH) (2006-2013) using the common classification of medical acts (CCAM) and after code extractions related to this surgery (JHLA002, JHLA003, JHLA004). Between 2006and 2013, the number of penile implants in France doubled (307to 633), inflatable penile prostheses with an extracavernous component remained the most frequently used (87%) (228to 552) (+142%). The use of semi-rigid prostheses declined by 26.7%. The distribution between the private and public sector was close to 1in 2013. More than half of French penile prostheses were implanted in three regions (Île-de-France, Languedoc-Roussillon, Rhône-Alpes). Nearly 62% of surgeons implanted only one or two three-compartment prostheses in 2013. The number of penile prostheses in France doubled between 2006and 2013. Three regions were particularly active as far as this surgery is concerned (Île-de-France, Languedoc-Roussillon, Rhône-Alpes). They were boosted by 5surgeons with more than 20prostheses surgeries a year. 4.

Endofalloprosthesis with a one-component semirigid prosthesis in a patient with an arteriovenous fistula of the cavernous artery and the development of priapism

Phalloprosthesis in patients with various durations and different hemodynamic types of priapism is a disputable problem. Rigid penile prosthesis placement may be deemed to be a possible method for the torpid treatment of ischemic priapism, particularly if other medical and surgical procedures have been ineffective and the time of pathological erection is over 36–72 hours. The paper gives an example of how such a patient was treated. Imaging techniques, such as color Doppler mapping of the penile vessels, selective iliacography, and compression sono elastography, were used for diagnosis. These techniques could make a correct diagnosis and provide a rationale for endofalloprosthesis.

Post-operative pulmonary and shoulder function after sternal reconstruction for patients with chest wall sarcomas.

Sternal resection is occasionally required for patients with malignant tumors, particularly sarcomas, in the sternal region. Few reports have described post-operative respiratory and shoulder function after sternal resection for patients with bone and soft-tissue sarcomas. Eight consecutive patients with bone and soft tissue sarcomas requiring sternal resection were the focus of this study. Chest wall was reconstructed with a non-rigid or semi-rigid prosthesis combined, in most cases, with soft tissue flap reconstruction. Clinical outcomes investigated included complications, shoulder function, evaluated with Musculoskeletal Tumor Society-International Symposium of Limb Salvage system, and respiratory function, evaluated by use of spirometry. The anterior chest wall was reconstructed with non-rigid strings for 3 patients and with polypropylene mesh for 5. There were no severe post-operative complications, for example surgical site infection or pneumonia. All 3 patients with non-rigid reconstruction experienced paradoxical breathing, whereas none with polypropylene mesh did so. Post-operatively, FEV(1)% was unchanged but %VC was significantly reduced (p = 0.01), irrespective of the reconstruction method used (strings or polypropylene mesh). Shoulder function was not impaired. Among patients undergoing sternal resection, post-operative shoulder function was excellent. Pulmonary function was slightly restricted, but not sufficiently so to interfere with the activities of daily living (ADL). Paradoxical breathing is a slight concern for non-rigid reconstruction.

Hospital-based trends in penile prosthetic surgery.

We examined national and regional trends in hospital-based penile prosthetic surgery and identified patient-specific factors predicting receipt of inflatable vs. semi-rigid penile prostheses. To improve our understanding of the surgical treatment for erectile dysfunction (ED). We utilized the Nationwide Inpatient Sample (NIS) from 1998 to 2010 in the United States and the California Office of Statewide Health Planning and Development (OSHPD) database from 1995 to 2010. Total number of penile implants performed and proportions of inflatable vs. semi-rigid prosthesis were examined. Multivariate analysis (MVA) was performed to identify factors associated with selection of inflatable vs. semi-rigid prostheses. Primary outcome measure is the total number of hospital-based penile prosthetic surgeries performed in the United States over a 12-year period (1998-2010). Secondary outcome measures include proportion of inflatable and semi-rigid prosthesis implantations and factors influencing receipt of different prostheses. We identified 53,967 penile prosthetic surgeries in the NIS; annual number implanted decreased from 4,703 to 2,338. Inflatable prostheses incurred higher costs but had a similar length of stay (LOS). In MVA, Caucasian race, Peyronie's disease, and private insurance were independently associated with receipt of an inflatable prosthesis. We identified 7,054 penile prostheses in OSHPD; annual number implanted decreased from 760 to 318. The proportion of inflatable prostheses increased significantly from 78.4% to 88.4% between 2001 and 2010. Inflatable prostheses incurred higher costs but had similar median LOS. In MVA, Caucasians and men without spinal cord injury were more likely to receive inflatable prosthesis. Hospital-based penile prosthetic surgery has decreased substantially both nationwide and in California. In the United States, Caucasian race, Peyronie's disease, and private insurance were independently associated with receipt of an inflatable penile prosthesis. California population data correlated with national trends and can be utilized to further study surgical management of ED.

Inflatable penile prosthesis technique and outcomes after radial forearm free flap neophalloplasty

The aim of this study was to describe the technical aspects and short-term outcomes of inflatable penile prosthesis (IPP) implantation after neophallus reconstruction at a single institution. Nine men with previously constructed radial forearm neophalli underwent IPP implantation. The etiologies of their penile anomaly were bladder exstrophy complex in five, disorder of sexual differentiation in two and genital obliteration secondary to ballistic trauma in two. Median follow-up was 9.6 months (range 1.5-139.7). The records for these patients were retrospectively reviewed and outcomes recorded. Mean age was 23.6 (range 18-31) years, and mean time interval from neophalloplasty to IPP implantation was 22.1 months (range 3-48). In all cases, 3-piece IPPs were employed, with eight of patients having one cylinder implanted in the native corporal body and extending into the neophallus. Mean surgical time was 222 min (range 142-409). Median length of implanted device was 22 cm. No intraoperative complications were observed. At the most recent follow-up, six patients (66.7%) had functional devices, with acceptable surgical outcomes. Three patients (33.3%) sustained device infections, and three (33.3%) sustained cylinder erosion. In three patients in whom neo-tunica albuginea were fashioned by ensheathing the cylinder with allograft human dermal tissue matrix, no erosions occurred. One patient underwent two revisions, the first for the associated erosion and infection and the second for genital pain, and was left with a semi-rigid prosthesis. IPP implantation affords the best opportunity for functionality for patients with a radial forearm free flap neophallus. Caution must be taken to ensure viability of the neophallus intraoperatively, and protocols to minimize the risk of infection should be followed. Fashioning neo-tunica albuginea using graft material may reduce risk of erosion.

Tubing erosion of an inflatable penile prosthesis long after implantation.

IntroductionErosion through skin of connecting tubing of an inflatable penile prosthesis (IPP) has not been previously reported.AimThe aim of this study was to present a case of tubing erosion, review the pertinent literature, and discuss the possible causes and management options, including preservation of the device and its components.MethodsA 42-year-old male failing to respond to medical treatment for erectile dysfunction underwent insertion of an AMS 700 IPP in 1986. Six years later, a revision was necessary because of a leak in the right cylinder and 4 years after, the pump was replaced. Fourteen years after the original implant, he presented with a portion of the tube connecting the pump to the right cylinder eroding through the skin. There was no infection. The skin area involved was resected and the original pump and tubing were buried in a new scrotal pocket after thorough irrigation.ResultsThe IPP remained in place, allowing vaginal penetration and without infection for another 11 years. Three years later, it was de-functionalized, converted into a fixed volume device. It eventually was replaced 25 years after originally implanted with a semirigid prosthesis because it did not provide sufficient rigidity and because of concerns about the presence of “screws” detected during pelvic imaging.ConclusionsMechanical failures in the early IPP models, as illustrated in this case, were expected. However, the long survival of the device is remarkable. Erosion of the connecting tubing through the skin is unique and, under exceptional circumstances, may be managed conservatively without replacing components of the IPP. Clinicians unfamiliar with procedures involving inflatable devices need to be aware of “foreign bodies” visible in radiological examinations in men who have had revisions of an IPP. Morales A. Tubing erosion of an inflatable penile prosthesis long after implantation. Sex Med 2014;2:103–106.

Autoinflation leading to failure of two-piece ambicor implantable penile prosthesis: an outcome from a methodical treatment of recalcitrant stuttering priapism.

Introduction. We present the case of a patient who received a two-piece Ambicor penile prosthesis for idiopathic recurrent “stuttering” priapism refractory to other treatment options. The patient returned unable to deflate the device due to an interesting anatomically induced mechanical failure. Aims. To describe the method and findings of this inflatable prosthesis failure. Results. Prosthesis failure occurred due to restrictive corporal diameter and the unique characteristics of fluid reservoir location in the two-piece inflatable prosthesis. The patient was successfully converted to a semirigid prosthesis with resolution of the pain that was due to his prosthesis autoinflation. Conclusion. Stuttering priapism remains a challenging clinical problem. Penile implantation is a reasonable long-term solution in a patient refractory to less invasive options. In patients with fibrotic corpora, a malleable device should be considered (at least temporarily) if unable to dilate comfortably to 13 mm.

EXPERIENCE 2500 IMPLANTATION OF PENILE SEMI-RIGIDITY PROSTHESES FOR ERECTILE DYSFUNCTION

The results of 2500 implantations we have developed semi-rigid prostheses, made between 1981 and 2013. Demonstrated surgical technique, its high efficacy in the treatment of erectile dysfunction resistant to drug therapy, and the low rate of postoperative complications.

V1558 SUBCORONAL PLACEMENT OF SEMI-RIGID PENILE PROSTHESES CAN BE PERFORMED WITH ADEQUATE TWO LAYERED CLOSURE

You have accessJournal of UrologyInfertility, Sexual Dysfunction, Trauma & Teaching Technique1 Apr 2012V1558 SUBCORONAL PLACEMENT OF SEMI-RIGID PENILE PROSTHESES CAN BE PERFORMED WITH ADEQUATE TWO LAYERED CLOSURE Justin Parker, Tariq Hakky, Peter Mennie, Alejandro Rodriguez, and Rafael Carrion Justin ParkerJustin Parker Tampa, FL More articles by this author , Tariq HakkyTariq Hakky Tampa, FL More articles by this author , Peter MenniePeter Mennie Tampa, FL More articles by this author , Alejandro RodriguezAlejandro Rodriguez Tampa, FL More articles by this author , and Rafael CarrionRafael Carrion Tampa, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1329AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Semi-rigid or malleable penile prostheses may be placed through a variety of approaches. The subcoronal approach to placement of semi-rigid prostheses has been previously described. This technique has the benefit of a short operative time, short recovery time for wound healing, and improved cosmetic results when utilizing the previous circumcision scar. However, it has been criticized due to the poor availability of local tissue for coverage at the time of closure. We propose that with careful elevation of the dartos fascia, a thick layer can be developed allowing for a two layered closure with minimal overlap of suture lines. METHODS In this video, we demonstrate our technique for subcoronal placement of a semi-rigid penile prosthesis. A hemi-circumfrential skin incision can be made on the ventral surface of the phallus 1-2 cm proximal to the glans at the previous circumcision scar. The underlying dartos layer can then be carefully elevated off the tunica albuginea and urethra and incised transversely. Longitudinal corporotomies are made allowing for dilation and placement of the implant cylinders. A retractor is utilized to lift the distal end of the corporotomy to allow for placement of the distal cylinder tip. The corporotomies are then closed and the preserved dartos fascia is reapproximated with a running suture. The skin is then closed as a second layer. RESULTS 8 patients successfully underwent placement of AMS Spectra penile prosthesis through a subcoronal approach. Mean operative time was 30 minutes with minimal blood loss. No perioperative or postoperative complications were observed. Distinct dartos flaps were successfully raised in all patients allowing a successful two layered closure and minimal overlap of suture lines. CONCLUSIONS The AMS Spectra penile prostheses can be successfully placed through a subcoronal incision. This allows a rapid placement and good cosmetic result. The criticism of inadequate tissue for closure does not appear to apply as thick dartos flaps can be carefully created to allow for a two layered closure with minimal overlap of suture lines. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e632 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Parker Tampa, FL More articles by this author Tariq Hakky Tampa, FL More articles by this author Peter Mennie Tampa, FL More articles by this author Alejandro Rodriguez Tampa, FL More articles by this author Rafael Carrion Tampa, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Severe penile injuries: a problem of severity and reconstruction

To report our experience of treating severe penile injuries with different causes and treatments, as penile trauma presents a difficult physical and psychological problem, and the type and extent of injury varies from mild to severe, sometimes even with total amputation. We analysed retrospectively 43 patients (mean age 28 years, range 5-52 years) with severe penile injuries referred to us from March 1999 to August 2007. The causes of penile injuries differed, including iatrogenic trauma (20), traffic accidents (11), burns (three), self-amputation (two), ritual circumcision (two), penile fracture (two), gunshot trauma (two) and electrocution (one). The management required a wide variety of surgical techniques tailored to each patient depending on the type and extent of injury. The mean (range) follow-up was 47 (10-108) months. The aesthetic and functional results, including satisfactory sexual intercourse were good in 35 patients. There were complications in seven patients; infection after implanting an inflatable penile prosthesis in one, protrusion of a semirigid prosthesis in one, urethral complications (one stenosis and two fistulae) in three and partial skin flap necrosis in two. Severe penile injuries should be treated on an individual basis, applying different techniques. However, treatment can be effective and safe only in specialized centres.

The Larynxane ST® intralaryngeal endoprosthesis for laryngotracheal pathologies

The authors present their experience of a new intralaryngeal silicone prosthesis used to manage laryngotracheal pathologies associated with severe deglutition and respiratory disorders. This retrospective study, conducted in the head and neck surgery department of the Strasbourg University Hospital, France, included 10 patients (12 prostheses inserted) and was conducted from November 2000 to November 2003. A pre-operative clinical examination and a computed tomography and/or magnetic resonance scan assessed patients' laryngeal function. Two different semirigid laryngotracheal prostheses were used, inserted under general anaesthetic into the region from the supraglottic area to the first tracheal cartilages including the vocal folds and the ventricles. In group one (n = 5), patients presented with laryngeal stenosis with preserved deglutition function, and patent prostheses were used to restore laryngeal patency. In group two (n = 5), patients suffered from severe deglutition disorders and were in poor general condition and so required a cuffed tracheostomy tube, therefore obstructed prostheses were inserted to stop aspirations and to suppress the cuff of the tracheostomy tube. The study was performed under the authorization of the Biomedical Research Patients' Protection Committee of Alsace I, France. The mean implantation duration was six months. The prosthesis used in the first group restored laryngeal patency without further complications such as aspiration or prosthesis (mucous) obstruction. The prosthesis used in group two prevented aspiration and allowed to change a cuff by an uncuffed tracheostomy tube. The intralaryngeal prosthesis used in group one constituted a reversible and effective method of treating laryngotracheal stenoses. The intralaryngeal prosthesis used in group two constituted an alternative to classical larynx exclusion techniques. The insertion is performed in few minutes under general anaesthetic through an endoscopic procedure. This reversible technique aimed to treat patients rapidly to reduce complications and post-operative morbidity.

Hardness evaluation of penile prostheses

This work investigates the hardness and buckling force of penile prostheses to further understand the rigidity of penile prostheses before and after implantation. Evaluated herein are four prosthetic samples (three inflatable, one semi-rigid), five real prostheses (one inflatable, four semi-rigid), and one prosthesis after implantation. The hardness is measured with a Shore Durimeter by pressing the tester's indentor to the surface of the specimen. A volunteer with inflatable prosthesis implantation is evaluated with respect to penile hardness versus various numbers of pumping. The buckling force of the prosthesis is also determined by a push-pull gauge and a specially designed sampling table. Results in this study demonstrate that although the inflatable prosthesis could only be pumped to a certain amount of hardness, hardness and buckling force correlate well with each other. After reaching the hardness limit, prostheses can even be pumped a further few times. However, continuous pumping only puts more tension on the prosthetic material without increasing hardness and could induce mechanical failure of the prosthesis. Results also indicate that the buckling force decreases with increasing length of the semirigid prostheses, and increases when the prosthesis has a larger diameter. This mechanical measurement of rigidity in penile prostheses could provide more information to clinicians about the penile prosthesis before surgical implantation, and to patients about prosthesis usage after implantation.