Time Of Penile Prosthesis Placement Research Articles

Treatment of male stress urinary incontinence at time of inflatable penile prosthesis placement a review of contemporary literature.

Male stress urinary incontinence (SUI) and erectile dysfunction (ED) are well established diagnoses within Men's Health, often more specifically within the prostate cancer survivorship cohort. Taken individually, well defined treatment algorithms exist with which many surgeons are comfortable; however, treatment of both in a single setting or staged fashion introduces complexity. Emerging treatment options also exist, and there is immature or minimal data when these are combined with inflatable penile prosthesis (IPP) insertion, radiation history, and/or variable degrees of incontinence. Our objective was to describe and summarize the currently available treatment options for SUI particularly at the time of IPP insertion. A literature review was performed to summarize contemporary treatment of SUI at time of IPP placement. Anecdotal experience was added from high volume, subspecialty trained Men's Health and Reconstructive Urologists. Non-invasive approaches such as pelvic floor muscle training (PFMT), behavioral modification, and external compression devices play some limited role in treatment and/or management of SUI, particularly in the early post operative period, or for those unwilling or unable to undergo more definitive intervention. More invasive options such as artificial urinary sphincter (AUS) implantation, male sling, or other implantable devices are more appropriate for good surgical candidates with higher bother and/or more severe incontinence. These options can be concomitant or staged relative to IPP placement. Climacturia, particularly with mild or no bothersome SUI, can successfully be addressed at the time of penile prosthesis placement with the utilization of the Mini-Jupette suburethral sling. A variety of treatment options exist for concomitant treatment of SUI at time of IPP, and both safety and efficacy have been demonstrated for many in the same operative setting. As with treatment of ED or SUI in isolation, patient selection, careful counseling, and management of expectations can lead to high patient satisfaction.

The SAPOC technique: A novel approach utilizing multiple slices around point of maximal curvature for the correction of penile curvature at the time of penile prosthesis placement in patients with severe Peyronie's Disease

ABSTRACT Introduction Placement of an inflatable penile prosthesis (IPP) is indicated for patients with severe Peyronie's disease (PD) and erectile dysfunction (ED) that do not respond to medications. When utilizing plaque incision and graft placement, most surgeons perform an incision at the point of maximal curvature. In most cases of severe PD, this incision results in a large defect that requires placement of a large graft while postoperative penile shortening remains a concern among patients. Objective To present a novel technique for the treatment of severe PD and ED during IPP implantation, in which multiple relaxing incisions are made around the point of maximal curvature. This technique minimizes the size or even the need of a graft and maximizes length restoration. Methods A total of 35 patients with PD and severe ED underwent IPP placement with penoplasty by a single surgeon from October 2018 to March 2021. 27 of these patients underwent the SAPOC technique at the time of IPP placement through a non-degloving approach. This technique involves elevation of the neurovascular bundle for dorsal or lateral curvatures along with elevation of the urethra for ventral curvatures. After the point of maximal curvature is identified, 2 to 4 transverse relaxing incisions (slices) are made around the point of curvature approximately 1 to 1.5cm apart in order to minimize the size of the defect, and hence the size of the graft, while allowing for maximal restoration of length. Primary outcome measurements included straightening rates, patient satisfaction, change in penile length, immediate and late complications. Results The SAPOC technique was applied to 27 patients. Mean patient age was 58.2. Mean preoperative curvature was 71.9 degrees. Mean pre-operative stretched penile length at the time of surgery was 14.18 cm. Mean increase in erect penile length after IPP with SAPOC technique was 0.94 cm (p=0.006) (range 0 to 2.5 cm). A total of 12 patients (44.4%) did not require graft placement. After a mean follow-up of 13.5 months, 23 of 27 (85.2%) patients had a totally straight penis. 4 patients (14.8%) had less than 20 degrees residual curvature which was sufficient for penetrative intercourse. 26 patients (96.2%) were satisfied with their postoperative result. Complications included delayed ejaculation (n=4, 11%, all of which resolved within 12 months), device malfunction (n=1) after 2 years of initial surgery which was revised successfully, device infection at 6 weeks (n=1) and intractable pain 2 years after implantation (n=1), both of which required removal of the prosthesis. Conclusion The SAPOC technique at the time of IPP placement is a novel, safe and feasible technique for the management of complex Peyronie's disease and erectile dysfunction. This technique allows the surgeon to complete the procedure without graft placement in some occasions which theoretically will decrease operative time. It also provides for length restoration which will increase patient satisfaction. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Consultant for Coloplast and Boston Scientific).

The SAPOC Technique: A Novel Approach Utilizing Multiple Slices Around Point of Maximal Curvature for the Correction of Penile Curvature at the Time of Penile Prosthesis Placement in Patients with Severe Peyronie's Disease

ABSTRACT Introduction Placement of an inflatable penile prosthesis (IPP) is indicated for patients with severe Peyronie's disease (PD) and erectile dysfunction (ED) that do not respond to medications. When utilizing plaque incision and graft placement, most surgeons perform an incision at the point of maximal curvature. In most cases of severe PD, this incision results in a large defect that requires placement of a large graft while postoperative penile shortening remains a concern among patients. Objective To present a novel technique for the treatment of severe PD and ED during IPP implantation, in which multiple relaxing incisions are made around the point of maximal curvature. This technique minimizes the size or even the need of a graft and maximizes length restoration. Methods A total of 35 patients with PD and severe ED underwent IPP placement with penoplasty by a single surgeon from October 2018 to March 2021. 27 of these patients underwent the SAPOC technique at the time of IPP placement through a non-degloving approach. This technique involves elevation of the neurovascular bundle for dorsal or lateral curvatures along with elevation of the urethra for ventral curvatures. After the point of maximal curvature is identified, 2 to 4 transverse relaxing incisions (slices) are made around the point of curvature approximately 1 to 1.5cm apart in order to minimize the size of the defect, and hence the size of the graft, while allowing for maximal restoration of length. Primary outcome measurements included straightening rates, patient satisfaction, change in penile length, immediate and late complications. Results The SAPOC technique was applied to 27 patients. Mean patient age was 58.2. Mean preoperative curvature was 71.9 degrees. Mean pre-operative stretched penile length at the time of surgery was 14.18 cm. Mean increase in erect penile length after IPP with SAPOC technique was 0.94 cm (p=0.006) (range 0 to 2.5 cm). A total of 12 patients (44.4%) did not require graft placement. After a mean follow-up of 13.5 months, 23 of 27 (85.2%) patients had a totally straight penis. 4 patients (14.8%) had less than 20 degrees residual curvature which was sufficient for penetrative intercourse. 26 patients (96.2%) were satisfied with their postoperative result. Complications included delayed ejaculation (n=4, 11%, all of which resolved within 12 months), device malfunction (n=1) after 2 years of initial surgery which was revised successfully, device infection at 6 weeks (n=1) and intractable pain 2 years after implantation (n=1), both of which required removal of the prosthesis. Conclusions The SAPOC technique at the time of IPP placement is a novel, safe and feasible technique for the management of complex Peyronie's disease and erectile dysfunction. This technique allows the surgeon to complete the procedure without graft placement in some occasions which theoretically will decrease operative time. It also provides for length restoration which will increase patient satisfaction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for Coloplast, Boston Scientific, and Endo Pharmaceuticals

Additional procedures performed at time of penile prosthesis implantation: a review of current literature

Penile prosthesis implantation for treatment of medical refractory erectile dysfunction remains the gold standard. However, some men have additional pathology present such as Peyronie's Disease, penile shortening, penoscrotal webbing, buried penis or other penoscrotal anatomical abnormalities that may be addressed at the time of prosthesis implantation. Although several techniques are described, there remains a lack of data regarding the outcomes. We sought to identify the results of available literature regarding the additional procedures performed at the time of penile prosthesis implantation that provide defined surgical outcomes rather than merely describe surgical techniques. Surgical outcomes to procedures provide more realistic clinical outcome for readers than simply the description of novel techniques or expert opinions. We performed a review of the MEDLINE database to identify additional procedures performed in conjunction with penile prosthesis placement. Many procedures are described in review articles, however, with limited data regarding their outcomes. The included articles must describe additional procedures performed in conjunction with penile prosthesis placement. Perioperative office techniques and management were included if it changed the surgical technique. All abstracts obtained through search criteria were reviewed. Only articles written in English, on human subjects with documented surgical results and relevant articles were included in this study. After a thorough literature search, a total of 24 articles were identified. Penile lengthening procedures at the time of penile prosthesis comprise most of the literature on this subject. Lengthening procedures are as simple as Peyronie's plaque excision and grafting to complex sliding and lengthening procedures requiring complete neurovascular bundle and partial urethral mobilization. Additionally, aggressive cylinder sizing and prolonged postoperative cycling at home are also described. Glanulopexy may be necessary when malpositioning of the glans is present. Other options such as scrotoplasty are also available options for those patients with scrotal webs. Notably there is a paucity of published literature regarding girth enhancement, buried penis repair, hernia repair, and vasectomy at time of penile prosthesis placement. There are numerous procedures that can be performed in the same operative setting as penile prosthesis. Although the procedures do have a common goal to provide optimal postoperative natural appearance, length, straightness, girth and function, the techniques employed must be tailored to each patient as there is not a one-procedure fits all in this patient population.

A Contemporary Evaluation of Peyronie's Disease During Penile Prosthesis Placement: MOST, MUST, and More.

The use of penile implant for the treatment of both erectile dysfunction and Peyronie's disease has changed little in the last 40years, primarily limited to modeling and plaque incision. In the current review, I explore the history of Peyronie's treatment at the time of penile prosthesis placement and explore new surgical options that help resolve several of the issues that were not treated with the traditional approaches. Advancements have been made in the area of graft material, lengthening procedures, and transcorporal techniques. The goal of these operations is not only to correct curvature, but also to restore length. Not surprisingly, the more complex and aggressive the attempt to correct the curvature, the more complications are possible. While modeling has a low rate of urethral injury, complex lengthening procedure with neurovascular bundle and urethral mobilization may lead to the dreaded complication of glans necrosis. Meanwhile, transcorporal techniques seem to offer a more modest improvement for length and curvature restoration with fewer risks than those seen in more aggressive lengthening procedures. The main limitation to the historical treatment of Peyronie's disease during penile prosthesis, modeling, and plaque incision is there is often no resolution to the penile length-as the maneuvers are made after the implant is already in place. Newer lengthening procedures are promising, however carry increased risks and complexity.