Use Of Penile Prosthesis Research Articles

(240) Evaluation of Factors Associated with Reoperation Rates for Penile Prosthetic Implantation in Erectile Dysfunction: A Medicare Analysis

Abstract Introduction As the prevalence of erectile dysfunction (ED) in the U.S. continues to rise due to an aging population, the use of penile prostheses (PP) to treat refractory ED is expected to increase. In 2017, Onyeji et al analyzed a New York state surgical database and found that the highest quartile implanters had lower re-operation rates in long-term follow-up. Due to a higher risk of infection and morbidity in PP reoperations, compared to primary surgery, minimizing PP reoperations is important. Objective This study evaluates the association between patient/clinical characteristics and reoperation rates at 90-days and 1-year among men undergoing PP implantation using a national database. Methods This retrospective claims data analysis used the 100% Medicare Standard Analytical Files (SAF) to identify men aged ≥65 who received PP (malleable and inflatable) between 2017 and 2020. The patients were required to have a continuous enrollment 1-year pre- and post-index PP encounter. The outcomes of interest were reoperation rates (defined as removal, repair, and removal and replacement of PP with or without infection) at 90 days and 1 year following initial implantation. Multivariable logistic regression was used to examine the relationship between reoperation rates and patient demographics and comorbidities: age, geographic region, race (White, Black, and Others [American Indian, Asian, Hispanic, Other, Unknown]), urbanization, baseline Charlson Comorbidity Index (CCI) and comorbidities (diabetes and prostate cancer therapy), primary diagnosis at the index PP implantation, type of index PP procedure, and prosthetic surgeon procedure volume. Urbanization was categorized as urban vs rural based on patient’s county of residence and the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. The prosthetic surgeon procedure volume was split into low (1-24 surgeries) and high-volume (≥25 surgeries) based on the 2022 PP International Consensus Forum definition. Results This study included 12,350 patients who underwent PP implantation. Nearly 50% were aged 65-69 years, 77.2% White, 82.6% in urban areas, and 56.2% had a CCI score of 0 (Table 1). Most of these men (96.0%) received an inflatable PP and 91.2% had ED as their primary diagnosis. The overall reoperation rates at 90-day and 1-year post-implant were 2.19% and 6.15%, respectively. Logistic regression found that low-volume implanters were associated with a 34% (OR 1.34; 95% CI 1.01, 1.78) and 35% (OR 1.35; 95% CI 1.14, 1.60) higher odds of reoperation at 90-day and 1-year post-implant, respectively, compared to high-volume implanters. Men with a baseline CCI of 0 had 19% higher odds of 1-year reoperation (OR 1.19; 95% CI 1.01, 1.40) compared to their counterparts with a CCI of ≥1. Black patient race was associated with 35% lower odds of 90-day reoperation compared to White patients (OR 0.65; 95% CI 0.43, 0.99) but this difference did not persist at 1-year of follow-up. Conclusions This study highlights that higher case volume reduces the risk of reoperation in the short to medium term, consistent with state-specific data of long-term follow-up. The impact of race and comorbidities warrants further evaluation to optimize patient counseling as they seek surgical treatment of ED. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast, BK Medical.

Penile Prosthesis in Transgender Men after Phalloplasty.

A penile prosthesis can be successfully implanted after phalloplasty in transgender men to permit sexual intercourse. A prosthesis can be categorized as malleable or inflatable. The most common penile prosthesis implanted after masculinizing genital surgery is the inflatable prosthesis but this can be a challenging operation with high complication rates. Penile prosthesis in transgender patients differs from cis-patients in many respects but one critical difference is the absence of the tough, protective tunica of the corporal body to contain the prosthesis. This causes greater mobility of the prosthesis under the skin and increases the risk of migration and erosion of the device through the skin. In addition, to overcome the absence of a corpora cavernosa, the proximal portion of the prosthesis must be anchored to bone. Complications include injury to the urethra, vascular injury, skin breakdown, infection, device migration, device failure, extrusion, and erosion. There is no robust data on the use of penile prosthesis in transgender men with only multiple reports of small numbers of patients. While successful implantation can improve patients' quality of life, surgeons should counsel patients about the relatively high risk of the need for revision surgery.

The use of penile prostheses in the management of priapism.

Priapism is a relatively uncommon condition that can result in erectile dysfunction (ED) and corporal fibrosis. Cases of prolonged priapism are particularly prone to ED, which arises when priapism is treatment refractory or had a delayed presentation. Due to the emergent nature of priapism, it behooves urologists to be familiar with all potential treatment modalities to minimize adverse outcomes. In this review paper, we aim to summarize the literature regarding the use of penile prosthesis (PP) implantation in the setting of ischemic priapism (IP). In some patients who present later or have prolonged initial treatment, early insertion of PP may be indicated.

Priapism in sickle-cell disease: Emergency room intervention

Priapism is one of the diverse complications of sickle cell disease (SCD). SCD is one of the many causes of priapism. Ischaemic and stuttering priapisms are the types seen in SCD. Apart from pain and psychological trauma associated with ischaemic and stuttering priapism, erectile dysfunction and impotence are the most severe complications of priapism in SCD that may require the use of penile prosthesis in SCD patients. The outcome of priapism complications is time-dependent and dependent on the type of management administered. This review highlights, the anatomy of the penis, physiology of normal erection, focusing on pathophysiology and management of priapism in SCD so as to create better awareness of this condition amongst physicians involved in the management of SCD.

Combined Implantation of a Penile Prosthesis and Adjustable Continence Therapy ProACT in Patients with Erectile Dysfunction and Urinary Incontinence after Radical Prostatectomy: Results of a Prospective Pilot Study.

The treatment of postradical prostatectomy erectile dysfunction (post-RP-ED) and stress urinary incontinence (post-RP-SUI) may require the combined implantation of a penile prosthesis and incontinence surgery. However, there is a lack of consensus regarding which incontinence surgery should be associated with a penile implant. To evaluate the combined implantation of a penile prosthesis and the adjustable continence therapy ProACT in patients with post-RP-ED and post-RP-SUI. We implanted the ProACT device and a penile prosthesis synchronously (n = 6) and asynchronously (n = 4) in 10 patients with moderate post-RP-SUI and severe post-RP-ED. We evaluated the effects on urinary incontinence using the ICIQ and PGI-I scores and pad use. We evaluated the effect on sexual function using the EHS and Global Assessment Questionnaire (GAQ), and we evaluated satisfaction with the penile prosthesis on a 5-point scale. Postoperative pain associated with each procedure was evaluated by a numeric rating scale. No cases of urinary retention or prosthesis infection were observed. Postoperative pain was mainly related to penile prosthesis implantation. After a mean follow-up of 22.7 ± 20.9 months (range: 6-53), significant improvements of the ICIQ score (15.3 ± 3.7 vs. 4.7 ± 2.3, P < 0.001) and pad use per day (2.8 ± 1.2 vs. 0.3 ± 0.5, P < 0.001) were observed compared with baseline. According to the PGI-I questionnaire, eight patients described a very much improved (n = 6) or much improved (n = 2) urinary condition. All patients declared an EHS = 4 with the use of penile prosthesis; all patients were very satisfied (n = 6) or satisfied (n = 4) with their penile prosthesis. All patients answered the GAQ positively. The combined implantation of a Pro-ACT device and penile prosthesis represents a feasible therapeutic option in patients with post-RP-SUI and post-RP-ED. The absence of postoperative pain associated with the ProACT procedure may represent the main interest in this therapy.

A rare complication of a malleable penile prosthesis: migration to the thigh region

A rare complication of a malleable penile prosthesis: migration to the thigh region

Transurethral Sphincterotomy

No AccessJournal of UrologyOpposing Views1 Apr 2009Transurethral Sphincterotomy Inder Perkash Inder PerkashInder Perkash More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.02.014AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Transurethral Sphincterotomy." The Journal of Urology, 181(4), pp. 1539–1540 References 1 : Use of the Memokath for detrusor-sphincter dyssynergia after spinal cord injury—a cautionary tale. Spinal Cord1998; 36: 39. Google Scholar 2 : Long-term follow-up study of intraurethral stents in spinal cord injured patients with detrusor-sphincter dyssynergia. Spinal Cord2007; 45: 621. Google Scholar 3 : The use of the Memokath stent in the treatment of detrusor sphincter dyssynergia in spinal cord injury patients: a single-centre seven-year experience. Eur Urol2003; 43: 539. Google Scholar 4 : Detrusor-sphincter dyssynergia and detrusor hyperreflexia leading to hydronephrosis during intermittent catheterization. J Urol1978; 120: 620. Link, Google Scholar 5 : The various types of neurogenic bladder dysfunction: an update of current therapeutic concepts. Paraplegia1990; 28: 217. Google Scholar 6 : Contact laser sphincterotomy: further experience and longer follow-up. Spinal Cord1996; 34: 227. Google Scholar 7 : Transurethral sphincterotomy provides significant relief in autonomic dysreflexia in spinal cord injured male patients: long-term followup results. J Urol2007; 177: 1026. Link, Google Scholar 8 : Use of penile prostheses to maintain external condom catheter drainage in spinal cord injury patients. Paraplegia1992; 30: 327. Google Scholar 9 : Bladder leak pressure: the measure for sphincterotomy success in spinal cord injured patients with external detrusor-dyssynergia. J Urol1998; 159: 493. Link, Google Scholar Surgical Service, VA Palo Alto and Stanford University, Stanford, California© 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4April 2009Page: 1539-1540 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Inder Perkash More articles by this author Expand All Advertisement PDF DownloadLoading ...

Erectile Dysfunction Following Radical Retropubic Prostatectomy

Radical prostatectomy has been the time-honoured and standard treatment option for prostate cancer. Erectile dysfunction (ED) is one of the common quality-of-life issues following radical prostatectomy. The recovery of potency following radical prostatectomy varies from 16% to 86%. Although major modifications in surgical technique appear to be promising, the reported ED rates are still high. The time period required for the recovery of erectile function after surgery varies from 6 to 24 months. During this period of neuropraxia lack of natural erections produces cavernosal hypoxia. This cavernosal hypoxia has been implicated as one of the most important factors in the pathophysiology of ED. Cavernosal hypoxia predisposes to cavernosal fibrosis, ultimately producing venous leak and long-term ED. Interruption of this cascade of events has been the major challenge for physicians. Physicians have several options available for the treatment of ED. However, oral treatment options have quickly become established as first-line treatment options. Sildenafil has been most extensively studied in the radical prostatectomy population. In patients who do not respond to oral therapy alone, standard treatment options (intracavernosal injections, vacuum constriction devices and intraurethral alprostadil) are useful. Use of penile prostheses is one of the oldest treatment options available for the treatment of ED but is used only as a last resort. Initial attempts to promote the earlier recovery of erectile function appear to be promising. However, further confirmatory studies are essential. The roles of gene transfer and growth factors are still in experimental stages. In this review we discuss the epidemiology, pathophysiology and treatment options available for ED following radical prostatectomy.

Reconstructive surgery using urological prostheses.

Urological prostheses have been available and widely used for the past two decades. The use of penile prostheses, artificial urinary sphincters, and testicular implants for genitourinary reconstruction for erectile dysfunction, incontinence, and orchiectomy have been successful, widely used and of low morbidity. More recently designed devices, innovations in implantation techniques, and improved intraoperative and postoperative care have resulted in the successful worldwide use of these prosthetic devices.

The use of penile prostheses in the treatment of impotence.

The use of penile prostheses in the treatment of impotence.

Prostheses in surgery of transsexuals

The Authors describe the use of penile prostheses in the building of a penis cast with some considerations about the complications.

The Geriatric Patient with Penile Prosthesis

To the Editor:–The use of penile prosthesis in the treatment of erection impotence has steadily increased since its introduction in 1973. Details about different models of prostheses, surgical techniques, and complications have been presented elsewhere.1, 2 However, the clinical aspects of implanted penile prostheses have remained confined to those specialists who are treating this problem. The majority of medical staff may never have the opportunity to see penile implanted patients or the related complications. Among penile prostheses carriers, more than 50% are men aged 60 years or more. Ten percent of them are in the 70 to 80-year age group.2, 3 With the increasing number of elderly patients, geriatricians have to bear this possibility in mind. Failure to recognize penile prosthesis may have undesirable consequences. Factors that contribute to such failure are cognitive disfunction, confusion due to acute disease, or reluctance of the patients family to discuss the prosthesis. An 80 year old patient was admitted to a general hospital because of acute cardiac failure. His treatment in the acute phase included urethral catheterization for urine monitoring. The catheter was removed a few days later. The presence of penile implant was unnoticed. Later on he was transferred to our long-term care unit. Shortly afterwards, he developed urinary retention, and again, a urethral catheter was introduced. Despite close clinical attention the presence of the penile prosthesis was undetected. The urologist ordered to investigate the cause of urinary retention immediately detected the penile implant. Inquiry among the medical staff (including geriatricians, internists and registered nurses) revealed that although they were informed about the subject, they had never before encountered a penile prosthesis carrier. Urethral catheterization of elderly patients with penile prostheses must be done carefully, with close follow-up thereafter. In the presence of a urethral catheter, urinary infections are more frequent.4 Urinary tract infections are major risk factors for penile implant infections, as are diabetes mellitus, neurogenic bladder, and general debilitation.2, 3 Elderly patients having permanent erection or unusual induration on penis palpation may have a penile prosthesis implant. Recognizing it in time may prevent infection, penile pressure sores, and medico-legal complications.

Use of penile prostheses to maintain external condom catheter drainage in spinal cord injury patients.

This is a retrospective analysis of 79 spinal cord injury patients who have had penile implants from one to 14 years. The primary indication for implants was the loss of condom catheter with a small retractile penis. Mean period after injury to when the implants were placed was 8.24 years (range 1-21 years). Mean total length of time the implants have been followed was 7.08 years (1-14 years). Sixty patients responded to our detailed questionnaire and they have been subjected to further analysis: prior to the implant 46 patients (77%) frequently lost their condoms. Fourteen of the patients (23%) had indwelling catheters, and 3 (5%) had a suprapubic cystostomy since they could not retain an external condom for urinary drainage because of retraction of a small penis. Post implant, 81% of patients had no accidents involving condom loss, while 19% still lost condoms. All indwelling catheters could be removed except for one patient who continued with a suprapubic catheter following transurethral sphincterotomy (TURS) and a penile implant. Sixty-eight percent used the implant for sex and felt their wives were satisfied. Patient satisfaction survey showed a markedly increased self esteem, increased mobility without fear of condom loss, and an improved sex life. Overall, the long term prosthesis failure rate was 8%. The specific infection complication rate was less than 2%. The Flexirod semirigid, hinged prosthesis proved ideal in meeting the requirements for these patients.

Experience With Penile Prostheses in the Treatment of Impotence in Diabetic Men

Increasing use of penile prostheses to treat impotence in diabetic men warrants a detailed assessment of functional and subjective outcomes within this group. This study uses record review and patient-partner questionnaire techniques to examine this population and evaluate postoperative satisfaction in terms of changes in patterns of sexual activity, health status, and complication rates. The satisfaction rates among patients and partners were 81% and 83%, respectively. Frequency of sexual activity was increased, and physical enjoyment was improved among satisfied recipients. Most postoperative complications were treatable and led to dissatisfaction only if they were irreparable. Most prostheses are therefore being used successfully. We recommend that impotent diabetic men be informed of the availability of prosthetic implants.