Underwent Penile Prosthesis Implantation Research Articles

(O-10) CLINICAL PROFILE AND SATISFACTION LEVEL OF PATIENTS UNDERGOING PENILE PROSTHESIS IMPLANTATION AT PEDRO ERNESTO UNIVERSITY HOSPITAL (HUPE/UERJ) 2018-2022

Abstract Introduction Erectile dysfunction (ED) can significantly impact couples' sexual quality of life, with penile prosthesis implants often yielding satisfaction rates of up to 90%. This treatment remains underutilized, less than 5% of refractory ED patients to undergo this therapy. This study aims to assess the satisfaction levels of patients who have undergone penile prosthesis implantation and explore associated factors. Methods We reviewed 48 medical records of patients who underwent penile prosthesis implantation between 2018-2022 and administered satisfaction questionnaires 6 months after the procedure. Results 93% expressed satisfaction post-surgery, with 66% reporting increased libido. Additionally, 83% noted ease in achieving penetration, 75% were content with the prosthesis size, and 95% stated willingness to undergo the surgery again. Common causes of sexual dysfunction were post-radical prostatectomy (45%), followed by diabetes mellitus (22%). Peyronie's disease was the etiology in 6% of cases, and priapism in 2%. The average age was 63 years (range: 27-80), with 20% being obese, 37% having diabetes mellitus, and 56% experiencing systemic arterial hypertension. Approximately 20% of procedures presented complications, surgical wound infection being the most common and prosthesis extrusion the most severe. Discussion Literature identifies predictors associated with satisfaction after penile prosthesis implantation, such as Peyronie's disease, BMI > 30, post-radical prostatectomy, implant type, postoperative complications, and patient age; our study revealed that only 7% expressed dissatisfaction, primarily due to postoperative complications. Conclusion Penile prosthesis implantation proves to be a safe procedure with a high success rate and satisfaction level. Dissatisfaction primarily arises from postoperative complications, emphasizing the importance of offering this therapeutic option to patients with severe ED. Financing No conflict.

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.

Salvage Case of Corpus Cavernosum Necrosis and Urethral Perforation associated with Infection after Penile Prosthesis Insertion

Penile prosthesis implantation can be considered in patients with unsuccessful treatment with phosphodiesterase type 5 inhibitors for erectile dysfunction. Its associated postoperative complications include infection and urethral injury. Nevertheless, only a few studies have reported the successful management of severe cases. Herein, we report a case of corpus cavernosum necrosis and distal urethral perforation caused by infection after penile prosthesis insertion, which had favorable outcomes. A 60-year-old man with multiple atherosclerotic risks underwent penile prosthesis implantation for erectile dysfunction at another hospital. Postoperatively, he developed infectious necrosis and underwent prosthesis removal. However, he presented at our department because of technical difficulties in the treatment at other hospitals. The initial examination revealed extensive necrosis of the corpus cavernosum and perforation of the peripheral urethra. A thin urethral catheter was inserted, and the necrotic corpus cavernosum was debrided to preserve the artery and urethra. Then, the perforated urethra was sutured. Subsequent negative pressure wound therapy resulted in sufficient granulation and closure of the perforated urethra. One month after the surgery, the scar was resected and sutured following the circumcision line. Despite experiencing this severe postoperative complication, good functional and cosmetic outcomes were achieved after minimal surgery with a blood-flow-conserving method.

Evidence for residual SARS-CoV-2 in corpus cavernosum of patients who recovered from COVID-19 infection.

The COVID-19 is an ongoing health problem with millions of cases and deaths worldwide. Although the virus is transmitted with droplets through the respiratory system, the involvement of different organs has been reported. The pandemic caused urological procedures to be postponed when patient is infected with SARS-CoV-2. However, the reliability of 1 month postpone period and long-term complications of the virus, such as a possible erectile dysfunction (ED) is not clarified. We aimed to compare the corpus cavernosum of patients 1 and 7 months after COVID-19 infection with control patients who had not COVID-19 and search for SARS-CoV-2 in tissues using immunohistochemistry and electron microscopy. Three groups of subjects underwent penile prosthesis implantation and Nesbit procedure for Peyronie's disease 1 and 7 months after COVID-19 infection and control group without previous COVID-19 infection. We searched for SARS-CoV-2 in penile tissue using RT-PCR, electron microscopy and immunohistochemistry. Electron microscopy and immunohistochemical staining showed SARS CoV-2 virus in the penile corpus cavernosum of patients 1 month after COVID-19 recovery. Immunohistochemical staining intensity correlated with the severity of previous infection. Transmission electron microscopy revealed intracellular virtual particles of about 80nm with a typical morphology of prominent spikes and electron-dense dots of nucleocapsid in addition to vesicles filled with virus-like particles. Cells showed increased membrane trafficking. The 1 month after COVID-19 group showed an increased number of fibroblasts. The 7 months after COVID-19 group had similar morphology and immunoreactivity as control group. This is the first study of late post-COVID examination of penis and the second study of early post-COVID examination of corpus cavernosum. For 1 month post-COVID patients, the aetiology of ED could be the viral infection that is also affecting corpora cavernosa. We hypothesize that viral infection affects the endocytic and exocytic pathways, hence the metabolic activity of cells that can be the reason of altered functions in some post-COVID patients. This study is important because it did not detect any virus residue in the tissue samples at the seventh month. In addition, we can say that the penile surgeries should be postponed more than 1 month after the COVID infection according to this study. But, there is a need for new studies with large series and high levels of evidence that can show how long the virus remains in the corpus cavernosum. Patients should be followed in this respect.

Which patient may benefit the most from penile prosthesis implantation?

Penile prosthesis implantation has been associated with overall good functional outcomes. Of relevance, some patients reported higher level of satisfaction and quality of life. We investigated the profile of the patients who may benefit the most from penile prosthesis implantation. Data from a national multi-institutional registry of penile prostheses including patients treated from 2014 to 2017 in Italy (Italian Nationwide Systematic Inventarization of Surgical Treatment for Erectile Dysfunction) were analyzed. All data have been prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and revised by a single data manager. Patients' baseline characteristics were recorded. In order to simultaneously evaluate perceived penile prosthesis function and quality of life, all patients were re-assessed at 1-year follow-up using the validated questionnaire Quality of Life and Sexuality with Penile Prosthesis. High quality of life after surgery was defined as a score higher than the 75th percentile in each of the subdomains of the Quality of Life and Sexuality with Penile Prosthesis questionnaire. Logistic regression analysis tested the association between clinical characteristics and high quality of life after penile prosthesis implantation. Follow-up data were available for 285 patients (median age 60 years; interquartile range: 56-67) who underwent penile prosthesis implantation. Erectile dysfunction etiology was organic in 40% (114), pelvic surgery/radiotherapy in 39% (111), and Peyronie's disease in 21% (60) of the cases. Patients showed good overall Quality of Life and Sexuality with Penile Prosthesis scores at 1-year follow-up for functional (22/25), personal (13/15), relational (17/20), and social (13/15) domains. Overall, 27.0% (77) of patients achieved scores consistent with the high quality of life definition. These patients did not differ in terms of median age (60vs. 62), type of prosthesis (inflatable penile prostheses: 95% in both of the cases), and post-operative complications (10%vs. 14%) than those with lower quality of life score (all p>0.1). At logistic regression analysis, erectile dysfunction etiology was the only factor independently associated with high quality of life at 1year after surgery (p=0.02). Patients treated for Peyronie's disease (odds ratio:2.62; p=0.01; 95% confidence interval: 1.20-5.74) were more likely to report better outcomes after accounting for age, post-operative complications, and surgical volume. Penile prosthesis implantation is associated with an overall good quality of life. The subset of patients affected by erectile dysfunction secondary to Peyronie's disease seemed to benefit the most from penile prosthesis implantation in terms of functional outcomes, relationship with their partners and the outside world, and perceived self-image. The systematic use of validated questionnaires specifically addressed at evaluating quality of life and satisfaction after penile prosthesis implantation should be further implemented in future studies to better define the predictors of optimal satisfaction after penile prosthesis implantation.

Penile Prosthesis Utilization After Radical Cystoprostatectomy for Bladder Cancer

ABSTRACT Introduction Radical cystoprostatectomy for bladder cancer may adversely affects sexual function in up to 80% of men. Penile prosthesis implantation can restore erectile function in these men, but the extent to which penile prosthesis is utilized in this patient population is unknown. Objective We aimed to determine the rate of and time to penile prosthesis implantation for men who have previously undergone radical cystectomy for bladder cancer. Methods Using the Premier Healthcare Database, we investigated all male patients undergoing radical cystectomy between 2000 and 2020 and identified the subgroup of patients undergoing penile prosthesis implantation. We compared sociodemographic characteristics in men who did and did not undergo implantation. Categorical variables were analyzed with Chi-squared tests and continuous variables were analyzed with Kolmogorov-Smirnov tests. Results We identified 142 men who underwent cystoprostatectomy and subsequently underwent penile prosthesis implantation. Among these 142 patients, 16 (11.27%) had a penile prosthesis placed on the day of cystectomy and 106 (74.65%) had a subsequent penile prosthesis placed at a median of 503.5 days (IQR 214-821 days) following cystectomy. Patients who underwent penile implant were statistically younger (64 years vs 68 years, p<0.001) and more likely to have private insurance (39% vs 25%, p<0.001), as compared to patients who did not have a follow up for penile prosthesis. Conclusions Sexual function is an important aspect of cancer survivorship and treatment of post-cystectomy erectile dysfunction should be considered a critical component of care. When penile prosthetics were utilized, this occurred with significant delay (median 503.5 days). Efforts to increase education about available treatment options, inclusion of sexual medicine urologists in post-cystectomy care pathways, and decreasing time to penile implantation may all improve quality of life for bladder cancer survivors. Disclosure No

P0494 - Comparison of the surgical outcomes and couples’ satisfaction with the type of penile prosthesis; Malleable versus Inflatable penile prosthesis: From 157 patients with erectile dysfunction who underwent penile prosthesis implantation in single center

P0494 - Comparison of the surgical outcomes and couples’ satisfaction with the type of penile prosthesis; Malleable versus Inflatable penile prosthesis: From 157 patients with erectile dysfunction who underwent penile prosthesis implantation in single center

Comparison of Satisfaction With Penile Prosthesis Implantation in Patients With Radical Prostatectomy or Radical Cystoprostatectomy to the General Population.

IntroductionPenile prosthesis implantation is a widely used treatment option for erectile dysfunction. Data is limited with regard to patient satisfaction with a penile prosthesis following radical prostatectomy/cystoprostatectomy vs patients with erectile dysfunction of other etiologies.AimTo examine patient satisfaction with penile prosthesis implantation and determine if a difference in satisfaction exists in post-prostatectomy/cystoprostatectomy patients vs patients with erectile dysfunction of other etiologies. We hypothesize that etiology does not affect satisfaction.MethodsA total of 164 patients underwent penile prosthesis implantation at our institution between August 2017 and December 2019, with 102 patients completing a validated 14 item questionnaire, Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), at 6 months postoperation. Demographics, surgical characteristics, and erectile dysfunction etiology were recorded. Patients were assigned to one of 2 groups: postprostatectomy/postcystoprostatectomy erectile dysfunction or other etiologies. The study group was further analyzed between radical prostatectomy or radical cystoprostatectomy.Main Outcome MeasuresSatisfaction based on key EDITS questions with postradical prostatectomy/cystoprostatectomy vs patients with erectile dysfunction of other etiologies.ResultsResponses to 3 questions were analyzed: overall satisfaction, expectations met in the past 4 weeks, and confidence in the ability to participate in sexual activity. Chi-square analysis was performed to determine the difference in responses. No difference was seen in overall satisfaction (P = .96), expectations (P = .78), or confidence (P = .78) between groups. On subgroup analysis, there was no difference in reported overall satisfaction (P = .47) or confidence (P = .080) between postprostatectomy and postcystoprostatectomy patients. Postprostatectomy and postcystoprostatectomy patients differed in whether the penile prosthesis implantation met expectations (P = .033). Postprostatectomy patients reported a mean score of 3.5/4 compared to postcystoprostatectomy patients, who reported a mean of 3.0/4.ConclusionsOur analysis suggests that key erectile function scores are not significantly different between postprostatectomy/postcystoprostatectomy patients compared to other etiologies. The difference in measures between postprostatectomy and postcystoprostatectomy patients is not significant or of unclear significance.Registration # of clinical trial: HSC-MS-19-0320Howell S, Palasi S, Green T, et al. Comparison of Satisfaction With Penile Prosthesis Implantation in Patients With Radical Prostatectomy or Radical Cystoprostatectomy to the General Population. Sex Med 2021;9:100300.

PS-3-8 Testosterone Induces Relaxation of Human Corpus Cavernosum Tissue of Patients With Erectile Dysfunction

Previous research in the field of cardiovascular diseases suggests a relaxing effect of testosterone (T) on smooth muscle cells. Therefore, it was hypothesized that T could play a significant role in erection development. We aimed to investigate the relaxing effect of T and other molecules of the T signaling pathway on human corpus cavernosum (HCC) tissue. Samples of HCC tissue were obtained from men who underwent penile prosthesis implantation (n = 33) for erectile dysfunction. Samples were used for Isometric Tension Measurement Ex Vivo experiments. Following standardized precontraction with phenylephrine, increasing doses of T or dihydrotestosterone (DHT) were administered and blocked by NO/H2S synthesis inhibitors, a KATP blocker and flutamide (androgen receptor inhibitor). A dose-dependent relaxing effect of DHT and T was observed with a relaxation of respectively 24.9% ± 23.4% (P < 0.0001) and 41.7% ± 19.1% (P=0.01) compared to 6.8% ± 15.9% for vehicle (DMSO) at 300 μM. The relaxing effect of T was not countered by blocking NO synthesis, H2S synthesis, KATP channels or the androgen receptor. Strength of the study is the use of fresh HCC tissues with reproducible results. Limitation is the need of supraphysiological T levels to induce the observed effect.

Risk factors associated with penile prosthesis infection: systematic review and meta-analysis

The aim of this study was to identify the factors associated with infection in patients who undergo penile prosthesis implantation. We performed a systematic review/meta-analysis, including clinical trials, quasi-experiments, retrospective and prospective cohort studies, and case-control studies. Searching was done in CENTRAL, MEDLINE, and EMBASE databases. Participants were patients who had erectile dysfunction, regardless of the etiology, and underwent penile prosthesis implantation. Two researchers reviewed each reference by title and abstract. The statistical analysis was performed using Review Manager 5.3 (RevMan® 5.3). A total of 513 studies were found with the search strategies. After excluding duplicates, 40 studies with a total of 175,592 patients were included in the qualitative and quantitative analysis. Among patient characteristics, we found that diabetes mellitus and immunosuppression appear to have increase odds of infection. Related to the procedure, infection-retardant-coated penile prosthesis and primary (first) surgery appear to lower odds of infection. Diabetes mellitus and immunosuppression were associated with increased infection rates; infection-retardant coating of the prosthesis and primary surgery were associated with reduced infection rates.

Testosterone Induces Relaxation of Human Corpus Cavernosum Tissue of Patients With Erectile Dysfunction.

IntroductionPrevious research in the field of cardiovascular diseases suggests a relaxing effect of testosterone (T) on smooth muscle cells. Therefore, it was hypothesized that T could play a significant role in erection development.AimTo investigate the relaxing effect of T and other molecules of the T signaling pathway on human corpus cavernosum (HCC) tissue.MethodsSamples of the HCC tissue were obtained from men who underwent penile prosthesis implantation (n = 33) for erectile dysfunction. Samples were used for isometric tension measurement in Ex Vivo experiments. Following standardized precontraction with phenylephrine, increasing doses of T or dihydrotestosterone were administered and blocked by NO/H2S synthesis inhibitors, a KATP blocker, and flutamide (androgen receptor inhibitor).Main Outcome MeasureThe outcome was relaxation of the HCC tissue, normalized to a maximum precontraction achieved by phenylephrine.ResultsA dose-dependent relaxing effect of dihydrotestosterone and T was observed with a relaxation of, respectively, 24.9% ± 23.4% (P < .0001) and 41.7% ± 19.1% (P = .01) compared with 6.8% ± 15.9% for vehicle (dimethylsulfoxide) at 300 μM. The relaxing effect of T was not countered by blocking NO synthesis, H2S synthesis, KATP channels, or the androgen receptor.Clinical ImplicationsBy understanding the underlying mechanisms of T-induced HCC relaxation, potential new therapeutic targets can be identified.Strengths & LimitationsThe strength of the study is the use of fresh HCC tissues with reproducible results. The limitation is the need for supraphysiological T levels to induce the observed effect.ConclusionRapid androgen-induced relaxation of HCC is likely to occur via nongenomic mechanisms. Previously suggested mechanisms of action by which T modulates HCC relaxation have been excluded.Van den Broeck T, Soebadi MA, Falter A, et al. Testosterone Induces Relaxation of Human Corpus Cavernosum Tissue of Patients With Erectile Dysfunction. J Sex Med 2019; 8:114–119.

Comparison of Long-Term Results and Couples’ Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation

IntroductionNo study has compared surgical outcomes and couples’ satisfaction among the 3 types of implants, with all brands available on the markets. AimsTo compare long-term complications, mechanical reliability, and couples’ satisfaction with penile implant types and brands in patients who underwent penile prosthesis implantation. We also investigated whether there are risk factors that might predict couples’ dissatisfaction. MethodsThis retrospective study included 883 patients with erectile dysfunction who underwent penile prosthesis implantation. Of the patients, 349 had malleable penile implant, 26 had 2-piece implants, and 508 had 3-piece implants. Main Outcome MeasureCouples’ satisfaction after surgery was evaluated with the modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. Surgical outcomes, mechanical reliability, and couples’ satisfaction were compared according to type and brand of the penile implants in all patients. ResultsThe mean age and follow-up period of the patients were 57.74 ± 9.59 years and 67.81 ± 49.11 months, respectively. The couples’ satisfaction rates were significantly higher in the 3-piece implant group than in the malleable group (P < .001), but there was no significant difference between the 2-piece and 3-piece implant groups. There was no difference in terms of couples’ satisfaction according to the brand of the implants. Of the patients who had malleable implants, 27 (7.7%) underwent 3-piece penile prosthesis implantation due to dissatisfaction; however, only 1 (0.2%) of the patients with a 3-piece implant was switched to a malleable implant (P < .001). The highest rate of revision surgery due to penile corporal perforation was in the malleable group (2.6%), whereas the highest rate of revision surgery due to penile implant malfunction occurred in the 3-piece implant group (5.5%) (P = .021 and .001, respectively). To analyze risk factors, using multivariate analysis, presence of complication was the only predictor that might cause couples’ dissatisfaction (P = .003). Conclusions3-piece and 2-piece implants have higher couples’ satisfaction rates than the malleable implant. Brands of implants did not have any effect on the couples’ satisfaction. Regarding detail of the complications, the 3-piece implant has a lower rate of penile corporal perforation and a higher rate of penile implant malfunction than the malleable implant. Patients with erectile dysfunction who need a penile implant should be informed about surgical outcomes, brands, and types of penile implants. Prosthesis choice should be customized to individual patient’s expectations/conditions and tailored accordingly.Çayan S, Aşcı R, Efesoy O, et al. Comparison of Long-Term Results and Couples’ Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation. J Sex Med 2019;16:1092–1099.

350 - Comparison of long term results and couples’ satisfaction with penile implant types and brands: Lessons learned from 883 patients with erectile dysfunction who underwent penile prosthesis implantation

Abstract Introduction No study has compared surgical outcomes and couples’ satisfaction among the 3 types of implants, with all brands available on the markets. Aims To compare long-term complications, mechanical reliability, and couples’ satisfaction with penile implant types and brands in patients who underwent penile prosthesis implantation. We also investigated whether there are risk factors that might predict couples’ dissatisfaction. Methods This retrospective study included 883 patients with erectile dysfunction who underwent penile prosthesis implantation. Of the patients, 349 had malleable penile implant, 26 had 2-piece implants, and 508 had 3-piece implants. Main Outcome Measure Couples’ satisfaction after surgery was evaluated with the modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. Surgical outcomes, mechanical reliability, and couples’ satisfaction were compared according to type and brand of the penile implants in all patients. Results The mean age and follow-up period of the patients were 57.74 ± 9.59 years and 67.81 ± 49.11 months, respectively. The couples’ satisfaction rates were significantly higher in the 3-piece implant group than in the malleable group (P Conclusions 3-piece and 2-piece implants have higher couples’ satisfaction rates than the malleable implant. Brands of implants did not have any effect on the couples’ satisfaction. Regarding detail of the complications, the 3-piece implant has a lower rate of penile corporal perforation and a higher rate of penile implant malfunction than the malleable implant. Patients with erectile dysfunction who need a penile implant should be informed about surgical outcomes, brands, and types of penile implants. Prosthesis choice should be customized to individual patient’s expectations/conditions and tailored accordingly. Cayan S, Asci R, Efesoy O, et al. Comparison of Long-Term Results and Couples’ Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation. J Sex Med 2019;16:1092–1099.

Phosphodiesterase type 5 in men with vasculogenic and post-radical prostatectomy erectile dysfunction: is there a molecular difference?

To clarify the molecular basis of penile erection at the human level and distinguish the mechanisms underlying vasculogenic and post-radical prostatectomy (RP) erectile dysfunction (ED) subtypes. Erectile tissue was obtained from men without history of ED who underwent penile surgery for Peyronie's disease (control group, n = 5) and from men with ED who underwent penile prosthesis implantation (n = 17). ED was categorized into vasculogenic (n = 8) and post-RP (n = 9) subtypes. Penile erectile tissue samples were collected for molecular analyses of protein expressions of neuronal and endothelial isoforms of nitric oxide synthase (nNOS and eNOS, respectively), phospho-nNOS (Ser-1412), phospho-eNOS (Ser-1177), phospho-protein kinase B (Ser-473), phosphodiesterase type 5 (PDE5), α-smooth muscle actin, phospho-myosin phosphatase target subunit 1, RhoA/Rho-associated protein kinase (ROCK)-α, ROCK-β, 4-hydroxy-2-nonenal, and nNOS and eNOS uncoupling by Western blot. Vasculogenic ED was characterized by decreased eNOS protein expression and eNOS and nNOS phosphorylation on their activatory sites (Ser-1177 and Ser-1412, respectively), uncoupled eNOS, upregulated PDE5 protein expression, increased ROCK activity, and increased oxidative stress in erectile tissue. Post-RP ED was characterized by decreased nNOS protein expression, increased nNOS phosphorylation on its activatory site (Ser-1412), uncoupled nNOS, downregulated PDE5 protein expression, and increased oxidative stress in erectile tissue. The mechanisms of vasculogenic and post-RP ED in the human penis involve derangements in constitutive nitric oxide synthase function, PDE5 protein expression and ROCK activity, and increased oxidative stress, which conceivably provide a molecular basis for chronically reduced nitric oxide bioavailability and increased smooth muscle contraction contributing to erectile impairment. Selective differences in PDE5 protein expression suggest distinct molecular mechanisms are in play for these ED subtypes.

Long-acting liposomal bupivacaine decreases inpatient narcotic requirements in men undergoing penile prosthesis implantation.

A new extended-release bupivacaine suspension bupivacaine (ERSB) delivers 3 days of local anesthetic and has been shown to reduce pain and narcotic usage in some patient groups but this issue is largely unstudied in urologic surgery. We performed a single-surgeon retrospective chart review of the patients who underwent penile prosthesis implantation. Pain scores and standardized morphine equivalent (ME) dose data were collected during 23 hour- observation period. Subjects who received ERSB were compared with those who received standard bupivacaine or no local anesthesia. In a study population of 37 patients, those who received (n=13), and did not receive (n=24) ERSB were grouped, respectively. The groups were comparable demographically. ME was used 3.2 fold more frequently in the non-ERSB group (18.0, and 5.6 for non-ERSB, and ESRB groups, respectively (p=0.04). Mean overall pain scores were 3.8/10 for ERSB and 3.9/10 for non-ERSB group, respectively. Per patient medication cost for the control, and ERSB groups were $5.16 and $285.54, respectively. The use of a new ERSB in penile prosthesis implants did lead to reduced narcotic consumption with comparable postoperative pain control to the non-ERSB group. However, the cost of the ERSB ($285/dose) may be prohibitive for its use.

Erectile dysfunction patients are more satisfied with penile prosthesis implantation compared with tadalafil and intracavernosal injection treatments.

There are various treatment modalities for erectile dysfunction with different success and satisfaction rates. We aim to compare patient satisfaction with tadalafil, intracavernosal injection, and penile prosthesis implantation in patients with erectile dysfunction. The records of 3448 men with erectile dysfunction were evaluated retrospectively. A total of 356 men with organic erectile dysfunction were enrolled into this study. Of these patients, 132 (37%) received tadalafil 20mg twice a week for 12weeks, 106 (30%) patients received tadalafil 5mg once-daily for 12weeks, 96 (27%) patients used intracavernosal injection therapy (Bi-mix; papaverine and phentolamine). Moreover, 22 patients underwent penile prosthesis implantation. Patient and partner satisfaction were assessed with International Index of Erectile Function (IIEF) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Patients' mean age was 52.4±25.76 (32-71). The etiology of erectile dysfunction was chronic systemic diseases in 133 (44%) and radical prostatectomy in 121 patients (40%). The mean IIEF-5 scores improvement after the treatment was higher in penile prosthesis implantation group (12.4±1.3) compared with tadalafil 5mg (6.7±1.5) (p<0.01), tadalafil 20mg (6.2±1.5) (p<0.01), and intracavernosal injection group (8.4±3.2) (p<0.05). The EDITS score was significantly higher in penile prosthesis implantation group (78.2±11.3) compared with intracavernosal injection (60.3±6.3), tadalafil 5mg (72.5±4.5), and tadalafil 20mg 70.7±3.4 groups (p<0.05). Partners' EDITS scores were 70.1±10 in penile prosthesis implantation group, 50.2±1.5 in intracavernosal injection group, 62.9±7.8 in tadalafil 5mg, and 61.3±5.3 in tadalafil 20mg group (p<0.05). Erectile dysfunction patients who underwent penile prosthesis implantation seem to be more satisfied compared with tadalafil treatment and intracavernosal injection. Future clinical trials are warranted to confirm our results.

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

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

Impact of the surgical correction of Peyronie's disease: a patient's perspective

Peyronie's disease (PD) is an acquired benign connective tissue disorder of the tunica albuginea of the penis that leads to the formation of fibrous inelastic plaques. As a result of pain, worsening quality of erections, penile shortening and deformity, the quality of life of both the patient and their partner may be significantly affected, and this may lead to depression, low self-esteem and relationship difficulties 1. At present, surgery represents the ‘gold standard’ treatment when PD is stable, and should be offered to guarantee a penis straight and rigid enough to allow penetrative intercourse. The flow chart in the 2010 guidelines on PD indicates the type of surgery that should be offered according to the preoperative quality of the erection, degree of deformity and penile length, but patient perception of preoperative penile shortening is not taken into consideration 2. Penile shortening does play an important part, however, with regard to postoperative patient satisfaction, as confirmed by Akin-Olugbade et al. 3, whose series of patients with PD reported the lowest satisfaction rates after penile prosthesis implantation. According to the present series by Kueronya et al. 4, in which patient-perceived pre- and postoperative penile length loss in patients with PD was evaluated, 79.1% of patients perceived a degree of length loss attributable to PD, and a subjective loss of length of >2.5 cm translated into reduced ability with regard to sexual intercourse. In particular, patients who underwent penile prosthesis implantation reported more significant perceived shortening. This is not surprising, as patients with larger plaques, more severe forms of PD and fibrosis are more likely to have erectile dysfunction and ultimately to require a penile prosthesis implantation. Among patients who did not undergo penile prosthesis implantation, those requiring Nesbit plication reported less preoperative shortening than those requiring plaque incision and grafting, as the latter group presented with more severe deformities. Further penile length loss caused by the surgical correction leads to bother to the patients, irrespective of the magnitude of the loss. The message from the present series by Kueronya et al. is that, to achieve higher postoperative satisfaction rates in this unfortunate cohort of patients, the choice of the type of surgery should take into consideration patient's perceived preoperative penile shortening and not be based solely on the 2010 PD guidelines algorithm, because ultimately patients wish to obtain full restoration of the shape and size of penis they had before the onset of PD 2. As patient's perceived penile length plays such an important role in a patient's postoperative satisfaction and because patients undergoing penile prosthesis implantation are those who have lost more length, length restoration should be offered simultaneously with penile prosthesis implantation 5, 6. Kueronya et al. should be congratulated for their work, which is the first series evaluating patient's perceived penile shortening and may represent a significant step towards the restoration of an adequate sex life in patients with PD. None declared.

Clinical Evaluation of Outcomes of Penile Prosthesis Implantation and Partner Satisfaction

Objective: We aimed to compare the outcomes of malleable and inflatable penile prosthesis implantations and partner satisfaction. Materials and Methods: Data of 34 patients who underwent penile prosthesis implantation in two centers between September 2009 and March 2013 were retrospectively analyzed. Types of prosthesis and complication rates were compared. A telephone interview was performed to assess the satisfaction rates of patients and their partners by EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) questionnaire. Results: The mean age was 56.16±14.49 years for Group 1 and 58.13±10.41 years for Group 2. The mean follow-up dura- tions for Groups 1 and 2 were 29.39±9.38 and 24.13±10.27 months, respectively. The mean hospital stay was 3.56±2.85 and 3.38±2.27 days for Groups 1 and 2, respectively. No significant difference was observed in terms of age, hospital stay, and follow-up duration between groups. Satisfaction questions were similar between the two groups. Patients using the malleable device found it easier to use (p<0.05). Conclusion: Using EDITS, we found that it was easier to use the malleable devices, but both patients and their partners had equal satisfaction rates. Randomized controlled trials addressing bigger populations should be conducted to support our findings.

EPA-0053 - Personality profile, anxiety, and sexual satisfaction: A comparison between implanted penile prosthesis and intracorporeal injection

Purpose of the study To evaluate personality profile, anxiety, patient satisfaction in patients with erectile dysfunction treated with penile prosthesis as compared to those on Intracorporeal Injection (ICI) home therapy. Patients and methods A total of 40 male patients complaining of erectile dysfunction were classified into two equal groups according to the line of treatment: Intracorporeal Injection (ICI) and penile prosthesis. Patients were subjected to the following questionnaires: Beck Anxiety Scale, Eysenck Personality Questionnaire, sexual Satisfaction Scale and International Index of Erectile Function Questionnaire (IIEF-5). Results Results for Beck Anxiety Scale showed statistically significant difference between both groups (P = 0.000), while for Eysenck Personality Questionnaire, no significant difference was found in Psychoticism (P = 0.056), Neuroticism (P = 0.169), in Extraversion (P = 0.225), Lie scale (P = 0.159), and in Criminality (P = 0.378). Statistically significant difference between both groups was found in the results of sexual Satisfaction Scale, (P = 0.013) and for the results of International Index of Erectile Function Questionnaire (IIEF-5), (P = 0.000). Conclusion Patients who underwent penile prosthesis implantation showed lower level of anxiety, better sexual satisfaction and erectile function, while no significant difference was found when comparing personality profile five dimensions Psychoticism, Neuroticism, Extraversion, Lie scale and Criminality.