Surgical Treatment Of Erectile Dysfunction Research Articles

The Evolution of the Inflatable Penile Prosthetic Device and Surgical Innovations with Anatomical Considerations

Historically, early surgical treatment for erectile dysfunction involved the placement of rigid devices outside of the corpora cavernosa. This practice resulted in high rates of erosion and infection. Today, most urologists in the United States place an inflatable penile prosthesis (IPP) with an infection-retardant coating inside the corpora cavernosa. In addition to changes in the type of implant used, surgical techniques have evolved greatly in recent years, resulting in reduced operating times, lower infection rates, and improved outcomes. However, anatomical considerations have directed the prosthetic surgeon to improve patient outcomes and satisfaction rates by employing both new surgical techniques and postoperative maneuvers.

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.

Advances in Prosthetic Urology

The inflatable penile prosthesis (IPP) has become the gold standard treatment for erectile dysfunction among men refractory to medical therapies. Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates and low mechanical failure rates. In this special issue, seven articles are presented, including primary research, reviews, and methodological reports, to highlight outcomes related to patient satisfaction with IPPs, advances in surgical placement techniques, and methods for penile size enhancement concomitant with implant placement. The safety and efficacy of the IPP have been well documented, but in spite of this, urologists may be reluctant to offer an IPP to older patients due to various concerns, including impaired dexterity of older patients and their ability to operate an inflatable device. To determine the outcomes of and satisfaction with the multicomponent IPP in the elderly male, Villarreal and Jones retrospectively assessed patients using chart review and telephone interview. To analyze overall patient satisfaction with IPPs with a consistent approach, Bernal and Henry conducted a review of the literature over the past 20 years. Nine articles met inclusion criteria for analysis and data collation. Despite the fact that varied metrics were used to determine patient satisfaction, they found that patients in general were very satisfied with their three-piece IPPs and restoration of sexual function, and they identified common reasons for patient dissatisfaction. The number one patient complaint after IPP placement is loss of penile length. One IPP company has recently remade a product that has longer length cylinders than those formerly available. However, traditionally, longer cylinders were believed to lack axial rigidity. Henry et al. present a prospective, multicenter research study, performed on the new product to address this concern. In a methodology report, Hakky et al. present an overview of various techniques performed concomitantly with IPP placement surgery to enhance penile length and girth. Outcomes can be improved by combining the use of adjunct surgical techniques; these adjuvant procedures are a key addition in the armamentarium for the serious implant surgeon. In two methodological articles, surgical techniques and outcomes are described related to surgical treatment of erectile dysfunction. First, Martinez et al. describe common surgical techniques for treatment of Peyronie's disease, a clinical condition that interferes with erectile function. Despite attempts to uncover the pathophysiology behind Peyronie's disease, it remains an enigma, with a reported incidence that is rising, in part because more men come forth to seek treatment. Second, Karpman reports on a streamlined approach for infrapubic placement of an IPP. A better understanding of operative techniques and recent clinical outcome studies have led to an evolution of the original infrapubic approach with significant contributions by Dr. Perito as discussed in the erratica. Small incisions and efficient operative maneuvers can shorten operative times and expedite postoperative recovery. Finally, Henry et al. present a review of outcomes for subarachnoid versus general anesthesia during IPP surgery. The leading patient complaint during the perioperative period for penile prosthesis implantation is postoperative pain, while emesis and urticaria also affect the procedure's perceived success. This paper retrospectively reviews 90 consecutive, primary inflatable penile prosthetic operations performed by a single surgeon at one private medical center. As erectile dysfunction is highly prevalent in our society, increasing with age, and life expectancy continues to increase, continued research and development regarding IPPs remain an important area of work. Gerard D. Henry Andrew C. Kramer Rafael E. Carrion Brian Christine

14 Surgical treatment for erectile dysfunction

14 Surgical treatment for erectile dysfunction

Infrapubic approach for malleable penile implant

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

Practice patterns of urologists performing penile prosthesis surgery vary based on surgeon volume: results of a practice pattern survey

Inflatable penile prostheses (IPPs) are widely accepted as a means of surgical treatment of erectile dysfunction. It has been suggested that surgeon volume influences patient outcomes after IPP implantation. We used a written questionnaire to ask urologists who perform IPP surgery about their practice patterns. Our analysis correlated specific practices to self-reported IPP volume. A written questionnaire was distributed to 1968 urologists. Responses were collated and analyzed. Respondents were defined as high volume implanters (HVIs) if they placed >or=20 IPPs in the year preceding the survey, or low volume implanters (LVIs) if they placed <or=19. Our main outcome measures were surgeon volume, approach to initial IPP placement (penoscrotal vs infrapubic), strategy for reservoir management during IPP revision surgery, strategy for reservoir replacement when deemed necessary, approach to suspected IPP infections, and utilization of revision washout protocols. This study does not require institutional review board approval from our institution, given that patient information is not used at all, this is a practitioner survey only. HVIs were significantly more likely to incorporate both penoscrotal and suprapubic approaches into their armamentarium, more likely to manipulate previously placed IPP reservoirs during revision surgery, and more likely to operate immediately when confronted with a suspected IPP infection. They were also more likely than LVIs to use the Mulcahy revision washout protocol. There are significant differences in the self-reported practice patterns of HVIs and LVIs. The importance of these differences for patient outcomes remains undefined.

Salvage surgery for penile prosthesis infection

Penile implants offer an effective surgical treatment for erectile dysfunction, with very high patient satisfaction rates. One of the most devastating complications of this procedure is infection, which requires removal of the device and all associated foreign material. With more recent developments in product design and understanding of infection, surgeons now have more options to offer patients. Surgeons may leave the device out and allow the wound to heal before returning in the future to replace the prosthesis, or they may cleanse the wound and replace the device in the same setting. Immediate salvage surgery has had good results with appropriate patient selection. This paper reviews the related literature and provides expert testimony on the current state of salvage surgery.

Prótesis de pene: Resultados de calidad y morbilidad

To study patient satisfaction and complications appeared in a series of patients with erectile dysfunction undergoing implant of penile prosthesis. Retrospective study of all patients undergoing surgical treatment for erectile dysfunction by penile prosthesis implant between 1993 and 2003. Collected data included patient age at the time of surgery, previous treatment, and significant medical history. We reviewed the models of prosthesis employed, incisions, and complications appeared. Finally, a questionnaire was elaborated to establish the level of patient satisfaction. 24 prostheses were implanted between 1993 and 2003. Mean patient age was 56.6 +/- 7.56 years (36-63), median 59.5 yr. Penile-scrotal incision was employed in 13 (54.16%) patients, suprapubic incision in 6 (25%) and subcoronal incision in 1 (4.16%). Type of prosthesis: semirrigid AMS 600 9 (37.5%), semirrigid AMS 650 10 (41.66%); the two component hydraulic prosthesis AMS Ambicor was used only in one case. Six (25%) patients presented complications. 16.66% were minor, cavernositis, pain, hematoma or prosthesis extrusion. Prosthesis extraction was necessary in 2 (8.33%) cases. 13 (54.16%) patients responded to the telephone survey 85% of them use their prosthesis. 54% percent refer adequate self-satisfaction and partner satisfaction (well satisfied/much satisfaction). 23% not too bad, and the remainder 23% bad or very bad. Despite the highest rate of postoperative complications, penile prosthesis is adequately accepted by patients with erectile dysfunction, even malleable models. Patient satisfaction is high, being higher in partners. Most patients would desire to undergo surgery again if they were in the same situation.

The role of the partner in erectile dysfunction and its treatment.

Advances in pharmacological, mechanical, and surgical treatment for erectile dysfunction (ED) now allow erectile function to be re-established in most men who experience this problem. However, re-establishing erectile function and re-establishing a satisfying sexual interaction with a partner are totally different objectives, and when the latter is not met, the man may re-present with treatment failure or withdraw from treatment altogether. All nontalking therapies focus on the penis as the dysfunctional element, and all too often clinicians fail to appreciate that ED can result from problems in the patient's partner and/or difficulties in their relationship. This article examines the role of the partner in the etiology, assessment, and treatment of ED.

Future considerations: advances in the surgical management of erectile dysfunction

As treatment options for erectile dysfunction (ED) continue to expand, and with more attractive alternatives such as effective systemic treatment becoming available, the number of men presenting for treatment of ED is increasing exponentially. Since a subset of these men continue to require surgical therapy, there is a potential for the number of operations for the treatment of ED and related disorders to actually increase. Areas in the surgical treatment of ED where improvements are needed are identified, including: measures to prevent penile prosthesis infections, better penile implants, improved penile augmentation procedures, better surgical procedures for the treatment of Peyronie's disease, improved penile revascularization procedures, and new motor and sensory penile nerve grafting procedures. International Journal of Impotence Research (2000) 12, Suppl 4, S140-S143.

Glaucoma and Impotence

To the Editor.— Drs Swartz and Todd 1 discuss the safety of intracavernous papaverine for the treatment of impotence in patients who have glaucoma. I wish to add a further note about the coexistence of these two common conditions. Glaucoma medications can cause impotence. This is true for β-adrenergic blocking eye drops, such as timolol, levobunolol, and betaxolol, 2 as well as for oral carbonic anhydrase inhibitors. 3 A change of glaucoma medication may relieve impotence, thereby preventing the morbidity of medical or surgical treatment for erectile dysfunction.

329 - Statistical Analysis of Psycho-Sexual Results in the Surgical Treatment of Erectile Dysfunction

329 - Statistical Analysis of Psycho-Sexual Results in the Surgical Treatment of Erectile Dysfunction