-
Translational Andrology and Urology Nov 2017Penile prosthesis implant surgery is an effective management approach for a number of urological conditions, including medication refractory erectile dysfunction (ED).... (Review)
Review
Penile prosthesis implant surgery is an effective management approach for a number of urological conditions, including medication refractory erectile dysfunction (ED). Complications encountered post-operatively include infection, bleeding/hematoma, and device malfunction. Since the 1970s, modifications to these devices have reduced complication rates through improvement in antisepsis and design using antibiotic coatings, kink-resistant tubing, lock-out valves to prevent autoinflation, and modified reservoir shapes. Device survival and complication rates have been investigated predominately by retrospective database-derived studies. This review article focuses on the identification and management of post-operative complications following penile prosthetic and implant surgery. Etiology for ED, surgical technique, and prosthesis type are variable among studies. The most common post-operative complications of infection, bleeding, and device malfunction may be minimized by adherence to consistent technique and standard protocol. Novel antibiotic coatings and standard antibiotic regimen may reduce infection rates. Meticulous hemostasis and intraoperative testing of devices may further reduce need for revision surgery. Additional prospective studies with consistent reporting of outcomes and comparison of surgical approach and prosthesis type in patients with variable ED etiology would be beneficial.
PubMed: 29238663
DOI: 10.21037/tau.2017.06.07 -
Translational Andrology and Urology Nov 2017
PubMed: 29239402
DOI: 10.21037/tau.2017.11.17 -
The Journal of Sexual Medicine Aug 2018Cavernoscopy (using a cystoscope in the corpora) is traditionally used to retrieve rear tip extenders (RTEs) that are embedded at the time of removal or replacement of... (Review)
Review
INTRODUCTION
Cavernoscopy (using a cystoscope in the corpora) is traditionally used to retrieve rear tip extenders (RTEs) that are embedded at the time of removal or replacement of inflatable penile prostheses.
AIM
To describe indications and techniques of cavernoscopy.
METHODS
We describe our preferred method of cavernoscopy to retrieve retained rear tips and present a thorough review of the literature regarding cavernoscopy.
MAIN OUTCOME MEASURE
Ability of cavernoscopy to retrieve embedded rear tips without causing complications.
RESULTS
Cavernoscopy is feasible anecdotally in case reports, but other less-invasive methods of retrieving RTEs seem to have similar efficacy.
CONCLUSION
Cavernoscopy is a technically feasible procedure that can be attempted as part of a stepwise algorithm for removing retained RTEs. Thirumavalavan N, Hoover CRV, Gross MS. Surgeons Corner: Cavernoscopy for Rear Tip Extender Removal. J Sex Med 2018;15:1195-1197.
Topics: Algorithms; Humans; Intraoperative Care; Male; Penile Prosthesis; Penis
PubMed: 29960890
DOI: 10.1016/j.jsxm.2018.05.010 -
Therapeutic Advances in Urology 2022One of the most challenging aspects of inflatable penile prosthesis (IPP) surgery is reservoir placement. The traditional space of Retzius (SOR) is not suitable for all...
INTRODUCTION
One of the most challenging aspects of inflatable penile prosthesis (IPP) surgery is reservoir placement. The traditional space of Retzius (SOR) is not suitable for all patients. For example, radical cystectomy or prostatectomy may alter the anatomical SOR. Hence, traditional placement of the reservoir in this space increases the risk of bowel or vascular injury. Also, patients with bilateral inguinal hernias repaired with mesh, or those with previous reservoirs that have been retained, are not eligible for a Retzius reservoir. Our study reports on the use of midline sub-rectus muscle placement of a penile prosthesis reservoir in these patients as an alternative to high submuscular placement commonly used.
METHODS
A retrospective chart review of male patients who underwent IPP surgery between June 2017 and 2021 was conducted. Patients were divided into two groups based on the location of the reservoir: SOR Midline Submuscular Reservoir (MSMR). Complication rates were compared, including herniated reservoirs, infections, bowel injuries, and vascular injuries.
RESULTS
Our cohort included 461 patients who underwent IPP surgery between June 2017 and 2021 in one tertiary center. SOR was used in 89% of patients and MSMR in 11% of patients ( = 413 and 48, respectively). Median follow-up for all patients was 28 months. The mean age was 67 ± 8 years. There was no statistically significant difference between the two groups regarding age or comorbidities (BMI, diabetes mellitus, hypertension, hyperlipidemia, and coronary artery disease). The complication rate was low in both the SOR and MSMR groups, with device malfunction being the most common (2% 4%, respectively; = 0.32). The infection rate was 0.5% in the SOR group with no infections in the MSMR group (NS). There was only one case of herniation requiring surgical revision in the SOR group and no cases of bowel or vascular injury.
CONCLUSION
Placement of a penile prosthesis reservoir within a midline rectus submuscular space is a safe and effective technique when the SOR is compromised by previous surgery or bilateral inguinal canals are not accessible.
PubMed: 36504599
DOI: 10.1177/17562872221139109 -
Translational Andrology and Urology May 2023The artificial urinary sphincter (AUS) remains the gold standard for treatment of stress urinary incontinence (SUI). However, highly complex patients such as those with... (Review)
Review
BACKGROUND AND OBJECTIVE
The artificial urinary sphincter (AUS) remains the gold standard for treatment of stress urinary incontinence (SUI). However, highly complex patients such as those with bulbar urethral compromise, bladder pathology, and lower urinary complications pose a particular challenge for the surgeon. In this article, we will address critical risk factors and synthesize existent data across relevant disease states to support surgeons in successful management of SUI in high-risk patients.
METHODS
A comprehensive review of current literature was performed utilizing the search term "artificial urinary sphincter" in conjunction with any of the following additional terms: "radiation", "urethral stricture", "posterior urethral stenosis", "vesicourethral anastomotic stenosis", "bladder neck contracture", "pelvic fracture urethral injury", "penile revascularization", "inflatable penile prosthesis", and "erosion". Guidance is provided based upon expert opinion where existing literature was sparse or nonexistent.
KEY CONTENT AND FINDINGS
Several known patient risk factors are associated with AUS failure and can ultimately lead to device explantation. Each risk factor requires careful consideration and investigation, or intervention as appropriate, prior to device placement. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients. Several surgical strategies to decrease device complications can be considered: optimization of testosterone, avoidance of 3.5 cm AUS cuff, transcorporal AUS cuff placement, relocation of AUS cuff site, use of lower pressure-regulating balloon, penile revascularization, and intermittent nocturnal deactivation.
CONCLUSIONS
A number of patient risk factors are associated with AUS failure and can ultimately lead to device explantation. We present an algorithm for management of high-risk patients. Optimization of urethral health, confirmation of anatomic and functional stability of the lower urinary tract, and thorough patient counseling are a necessity for these high-risk patients.
PubMed: 37305622
DOI: 10.21037/tau-22-727 -
Translational Andrology and Urology Aug 2017In this invited article, we briefly review the history of the penile prosthesis and the various surgical approaches that have been described. With intra-operative photos... (Review)
Review
In this invited article, we briefly review the history of the penile prosthesis and the various surgical approaches that have been described. With intra-operative photos and illustrations, we discuss Dr. Perito's infrapubic surgical approach. We also highlight the patient selection, post-operative care and complications.
PubMed: 28904894
DOI: 10.21037/tau.2017.07.14 -
Therapeutic Advances in Urology 2023The leakage of urine during sexual arousal, known as climacturia, is an under-recognized clinical condition often overshadowed by erectile dysfunction in men who have... (Review)
Review
BACKGROUND
The leakage of urine during sexual arousal, known as climacturia, is an under-recognized clinical condition often overshadowed by erectile dysfunction in men who have undergone radical prostatectomy.
OBJECTIVES
This study aims to determine and evaluate the role of the Mini-Jupette technique and its alternatives in the treatment of climacturia.
DATA SOURCES AND METHODS
We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. We searched Medline PubMed, Scopus, and the Cochrane Library databases until October 2022.
RESULTS
We included seven studies involving 120 patients with climacturia. Different types of grafts were used, ranging from synthetic mesh to autologous grafts. In all seven studies, the use of the Adrianne Mini-Jupette (AMJ) and its alternatives showed a high percentage of improvement in climacturia, with reported complete resolution ranging from 65% to 93%. Regarding postoperative complications, one study reported the highest sling explantation rate at 11% (4/38), while other studies reported complications ranging from subjective symptoms such as dysuria and perineal pain to the need for subsequent artificial urinary sphincter placement.
CONCLUSION
The AMJ sling and its variations are low-cost, time-efficient, and relatively safe procedures with high patient satisfaction rates among those treated for climacturia.
PubMed: 38090352
DOI: 10.1177/17562872231215180 -
Canadian Urological Association Journal... May 2022Procedural specialties are at higher risk for malpractice claims than non-procedural specialties. Previous studies have examined common damages and malpractice lawsuits...
INTRODUCTION
Procedural specialties are at higher risk for malpractice claims than non-procedural specialties. Previous studies have examined common damages and malpractice lawsuits resulting from specific procedures. Our goal was to analyze urological interventions that led to sexual dysfunction (SD) claims.
METHODS
The Casetext legal research platform was queried using search terms for medical malpractice and common men's health procedures between 1993 and 2020. In total, 236 cases were found, and 21 cases met the inclusion criteria: malpractice cases against a urologist or urology group, clearly stated legal outcome, and allegation of sexual dysfunction from an intervention that directly caused damages.
RESULTS
A total of 42 damages were cited in 21 lawsuits. The top three damages claimed were erectile dysfunction (ED) (14/42, 33.3%), genital pain syndrome (7/42, 16.7%), and urinary incontinence (5/42, 11.9%). The most commonly cited treatments were urinary catheter placement or removal (3/21, 14.3%), robotic-assisted laparoscopic radical prostatectomy (RALP) (3/21, 14.3%), circumcision (3/21, 14.3%), and penile implant (3/21, 14.3%). In 19 of 21 suits (90.4%), the outcome favored the defendant. Two cases favored the plaintiff: penile implant (failure to prove the patient was permanently, organically impotent prior to the procedure; missed urethral injury at time of surgery, $300 000) and vasectomy (damage to vasculature resulting in loss of testicle, $300 000).
CONCLUSIONS
Most suspected malpractice cases resulting in SD favored the defendant urologist. Interestingly, urinary catheter placement is as likely to result in litigation as other operative interventions, such as RALP, inflatable penile prosthesis, and circumcision. It is possible that thorough preoperative counselling and increased responsiveness to patients' postoperative concerns may have avoided litigation in several cases.
PubMed: 34941485
DOI: 10.5489/cuaj.7393 -
Revista Da Associacao Medica Brasileira... Jun 2017
Topics: Erectile Dysfunction; Female; Humans; Male; Patient Satisfaction; Penile Implantation; Sexuality; Spouses
PubMed: 28876419
DOI: 10.1590/1806-9282.63.06.475 -
Translational Andrology and Urology Aug 2017Optimizing outcomes with placement of inflatable penile prostheses (IPPs) can be challenging, especially in inexperienced hands. In this article, we outline Dr.... (Review)
Review
Optimizing outcomes with placement of inflatable penile prostheses (IPPs) can be challenging, especially in inexperienced hands. In this article, we outline Dr. Köhler's penoscrotal penile prosthesis surgical approach. We also highlight patient selection, post-operative care and complications.
PubMed: 28904895
DOI: 10.21037/tau.2017.07.32