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Healthcare (Basel, Switzerland) May 2024Inflatable penile prostheses are a widely utilized treatment for erectile dysfunction. While MRI is the optimal imaging modality for patients with suspected implant...
Inflatable penile prostheses are a widely utilized treatment for erectile dysfunction. While MRI is the optimal imaging modality for patients with suspected implant complications, it is often unavailable in the acute setting. In light of these limitations, we present a case of urethral perforation by an implanted penile cylinder and its evaluation with contrast-enhanced computed tomography (CT) in an emergent setting.
PubMed: 38786376
DOI: 10.3390/healthcare12100964 -
Translational Andrology and Urology Feb 2024Erectile dysfunction (ED) is a common condition in men, and many patients refractory to conservative treatment may undergo penile prostheses (PPs) placement. The primary... (Review)
Review
BACKGROUND AND OBJECTIVE
Erectile dysfunction (ED) is a common condition in men, and many patients refractory to conservative treatment may undergo penile prostheses (PPs) placement. The primary concern following PP implantation is device infection. Although antibiotic and hydrophilic coatings have reduced the incidence of inflatable PP (IPP) infections, there remains room for improvement. Optimization of PP outcomes requires a practical model to better understand mechanisms of infection and to test new infection control strategies. We aimed to describe a new rabbit model which contains a functional IPP and review previously reported animal PP models.
METHODS
An IPP was placed into rabbit flanks and cycled for functionality testing. Rabbits were evaluated for signs of pain and distress over 14 days. Separately, narrative review methodology was utilized to search the PubMed and Scopus databases for all publications through March 21, 2023, which studied PP within an setting. Three independent reviewers ultimately selected 12 papers from 1992-2021 for inclusion.
KEY CONTENT AND FINDINGS
Several animal studies highlighted the initial functionality or feasibility of devices for ED before their introduction in the clinical setting. There are several subsequent studies aimed at optimizing the type of antibiotic use or coating material using segments of PP material in an setting. However, the literature lacks a contemporary animal model containing a functional IPP. Our novel rabbit model offers a safe, practical way to implant a functioning IPP and investigate new perioperative infection prevention and treatment strategies before trials in the clinical setting.
CONCLUSIONS
Animal models have played a key role in testing medical devices, including PPs, prior to their clinical introduction. Our review uncovered no modern animal studies involving placement of a functional PP. A new animal model can facilitate study of evolving microorganism profiles, novel methods to enhance antibiotic delivery, and proposed treatment options.
PubMed: 38481874
DOI: 10.21037/tau-23-353 -
Translational Andrology and Urology Nov 2023Treatment for medication-refractory erectile dysfunction (ED) is based on a shared decision-making model. The gold standard treatment for medication refractory ED is... (Review)
Review
BACKGROUND AND OBJECTIVE
Treatment for medication-refractory erectile dysfunction (ED) is based on a shared decision-making model. The gold standard treatment for medication refractory ED is penile prosthesis (PP) placement. Patient satisfaction rates with PP are high with adequate counseling and expectation-setting. However, as with any elective surgery, patient selection is key to minimizing complications and ultimately patient dissatisfaction. Psychological well-being is an important consideration in the preoperative evaluation and postoperative management of patients undergoing PP placement.
METHODS
We performed a PubMed literature review to identify pertinent studies for this narrative review. Specifically, we sought describe preoperative evaluation including appropriate counseling and patient selection as well relevant intraoperative and postoperative factors for patients undergoing PP placement with a specific focus on optimizing preoperative psychiatric factors and treatment-related patient satisfaction to identify pertinent articles describing ways to optimize patient satisfaction with PP.
KEY CONTENT AND FINDINGS
A patient's psychological state can influence the degree of understanding of their condition, affect perception of their treatment team, and limit their ability to cope with complications. All patients should undergo a thorough medical history and physical examination to screen for psychiatric health disorders, substance abuse, and chronic pain conditions. Establishing patient expectations with regards to treatment-related outcomes during the preoperative consultation will ensure congruency between the patient and performing surgeon. Patients with a more significant psychiatric distress related to their underlying sexual dysfunction may require additional evaluation and counseling preoperatively.
CONCLUSIONS
PP placement is associated with high levels of overall satisfaction in appropriately screened patients. Specific considerations during preoperative counseling and careful patient selection, intraoperative decision making to avoid or anticipate possible complications, and postoperative cares are necessary to ensure the best result for an individual patient.
PubMed: 38106683
DOI: 10.21037/tau-23-144 -
Translational Andrology and Urology Sep 2023We evaluated the prevalence, distribution, and specialist to population ratio of male and female reconstruction and andrology/prosthetics faculty within United States...
Understanding the prevalence and distribution of fellowship trained female and male genitourinary reconstruction and men's health/andrology academic faculty in the United States.
BACKGROUND
We evaluated the prevalence, distribution, and specialist to population ratio of male and female reconstruction and andrology/prosthetics faculty within United States urologic training programs. Our objective was to help determine the current need/demand for reconstructive fellowship trained faculty for necessary clinical exposure during residency in the midst of a nationwide residency expansion.
METHODS
All non-military urology residency programs were evaluated. Programs were sorted into their American Urologic Association Sections and websites were analyzed for evidence of fellowship training and/or clinical expertise/interest: (I) male genitourinary reconstruction (MGR); (II) female genitourinary reconstruction (FGR) and (III) infertility/andrology/men's health (AMH). The 2020 US Census data was used to determine specialist to population ratios by sections.
RESULTS
Of 137 evaluated programs, FGR had the highest percentage of fellowship-trained faculty (76%) followed by AMH (66%) and MGR (61%). Clinical/surgical interest was noted in pelvic organ prolapse (88%), inflatable penile prosthesis (79%) and urethral stricture disease (75%). Over 10% of training programs had two or more faculty with MGR, FGR and AMH fellowship training. Significant geographic variation amongst academic programs exists with the South and Southeastern parts of the US being relatively underserved, both in percentage of programs with fellowship-trained faculty, and by faculty per 1,000,000 inhabitants.
CONCLUSIONS
The majority of US urology residencies have faculty with fellowship training and/or stated clinical interest in MGR, FGR and AMH. Still, many programs remain without these faculty while others have two or more in their respective fields. The geographic trends noted here have both educational and recruitment significance.
PubMed: 37814690
DOI: 10.21037/tau-23-159 -
Basic and Clinical Andrology Apr 2024Chronic post-penile prosthesis pain is de novo pain persisting > 2 months post-operatively. This pain is inadequately reported, poorly understood and undermanaged....
BACKGROUND
Chronic post-penile prosthesis pain is de novo pain persisting > 2 months post-operatively. This pain is inadequately reported, poorly understood and undermanaged. The purpose of this current pilot study was to improvise a medical approach to alleviate the condition and assess the combination of Pregabalin and Amitriptyline in its management.
RESULTS
The study enrolled 9 patients complaining of idiopathic penile, pelvic, or scrotal pain persisting > 2 months after penile prosthesis implantation. Patients were prescribed pregabalin 75mg/12h (escalated after 1 week to 150mg/12h upon demand) and Amitriptyline 25mg once daily for 3 months. The pain was reassessed after 10, 30 and 100 days. The dose of pregabalin required and the side effects of the medication were noted. Findings revealed a significant decrease in pain duration (p = 0.007), frequency (p < 0.001), and intensity (p < 0.001); in glanular (p = 0.008), shaft pain (p = 0.046) but not scrotal (p = 0.112). Moreover, a significant decrease was found in sharp pain (p = 0.003) and pain aggravated by touch (p = 0.008) but not aching pain (p = 0.277). Additionally, significant improvement was reported in QoL (p < 0.001) and dose escalation of pregabalin to 150mg/12h was required in only 1 case (11%).
CONCLUSION
The combination of pregabalin and amitriptyline is very effective in the management of chronic idiopathic pain following penile prosthesis implantation. However, due to the ambiguity and lack of reporting of the condition, we recommend a multicentric contribution to acknowledge the condition, and weigh its prevalence accurately, whilst evaluating the efficacy of our approach. This study received ethical approval from Ain Shams University Research Ethics Committee (REC) FWA 000017585, on 04/13/2023 ([email protected]).
TRIAL REGISTRATION
no FMASU R98/2023.
PubMed: 38565989
DOI: 10.1186/s12610-024-00223-4 -
International Journal of Impotence... Nov 2023Surgical implantation of an inflatable penile prosthesis (IPP) remains the gold-standard treatment for severe erectile dysfunction. The ideal surgical technique requires...
Surgical implantation of an inflatable penile prosthesis (IPP) remains the gold-standard treatment for severe erectile dysfunction. The ideal surgical technique requires a thorough understanding of the relevant anatomy. This includes anatomic considerations related to, but not limited to, dissection and exposure of penoscrotal fasciae and tissues, corporal configuration, and abdominal structures. Insights obtained from pre-dissected anatomic specimens can obviate urethral injury, nerve damage, corporal perforation, inappropriate sizing, crossover, or implant malposition. We present penile implant-specific anatomic dissections and topographic landmarks identified over the last decade in the course of surgical training programs provided for IPP implantation.
Topics: Male; Humans; Penile Prosthesis; Penile Implantation; Erectile Dysfunction
PubMed: 37179421
DOI: 10.1038/s41443-023-00715-3 -
Case Reports in Urology 2024This case report presents a unique and previously unreported case of malfunction, infection, and erosion of an inflatable penile prosthesis (IPP) resulting from...
This case report presents a unique and previously unreported case of malfunction, infection, and erosion of an inflatable penile prosthesis (IPP) resulting from iatrogenic injury during a priapism aspiration procedure performed by an emergency medicine physician. The patient, a 75-year-old male with a history of IPP placement for erectile dysfunction, presented with urinary retention and priapism, leading to inadvertent deflation of the IPP during aspiration. Subsequent evaluation revealed a pinhole opening on the scrotum, indicating infection and erosion of the prosthesis tubing. The patient underwent emergent explantation of the infected IPP, washout, cystoscopy, and insertion of a suprapubic tube. Intraoperative cultures identified Escherichia cloacae as the causative pathogen. This case highlights the importance of thorough chart review to identify patients with IPPs before aspiration procedures and emphasizes the need for healthcare provider education regarding potential complications in this patient population. Early recognition and management of such complications are crucial for optimal patient outcomes. While IPP placement remains a highly satisfactory treatment for erectile dysfunction, this case highlights the importance of vigilance to ensure the best care for patients with penile prostheses. It is noteworthy that ultimately, a new IPP was not placed in this patient due to the patient's significant medical comorbidities.
PubMed: 38681214
DOI: 10.1155/2024/3794872 -
Asian Journal of Andrology Feb 2024Penile prosthesis surgery is a definitive treatment for erectile dysfunction (ED). The two categories of penile prosthesis are endorsed by professional guidelines,...
Penile prosthesis surgery is a definitive treatment for erectile dysfunction (ED). The two categories of penile prosthesis are endorsed by professional guidelines, inflatable penile prosthesis (IPP) and malleable penile prosthesis (MPP). Each modality of penile prosthesis offers distinct advantages and incorporates specific design features, allowing for personalized device selection that aligns with individual needs and preferences. While the overall complication rate of penile implant surgery remains low, surgeons should maintain a high index of suspicion for complications in the perioperative time period. Multimodal analgesic regimens including nerve blocks and narcotic-free pathways should be administered to manage perioperative pain. Finally, the high patient satisfaction after penile prosthesis surgery underscores the success of this ED treatment option.
PubMed: 38376174
DOI: 10.4103/aja202386 -
The French Journal of Urology Jun 2024Urological consultations for erectile dysfunction (ED) are increasing worldwide. Penile prosthesis (PP) implantations are performed when other treatments are...
INTRODUCTION
Urological consultations for erectile dysfunction (ED) are increasing worldwide. Penile prosthesis (PP) implantations are performed when other treatments are unsuccessful. However, there is no data regarding PP implantations in France beyond the year 2016.
OBJECTIVES
This study aimed to describe the changes in the number and type of PP implants used for the treatment of ED in France from 2016 to 2021 and the hospitalization rates following implantation using French national data from the Program for the Medicalization of Information Systems (PMSI).
MATERIALS AND METHODS
We analyzed data on PP implantations in all France hospitals. PPs were coded into three types according to the Common Classification of Medical Procedures (CCAM). The number of patients admitted to hospital with complications twelve months after implantation was also recorded.
RESULTS
During the study period, 3675 men received 3868 PPs in France. A gradual increase in the total number of implanted PPs was observed, with an overall increase of 33.8%. In 2020, there was a sharp decline in the number of implanted PPs, primarily owing to the COVID-19 pandemic. The most commonly used implant was PPs with an extracavernous compartment, comprising 85% of all PPs. Twelve months after implantation, only 1-2% of the patients were rehospitalized.
CONCLUSION
PP implantation surgeries are highly reproducible and have a low incidence of complications, in terms of rehospitalization after one year of placement (1.8%). Moreover, there was an increase in the demand for penile prosthesis implantations in France between 2016 and 2021.
LEVEL OF EVIDENCE
4 : Descriptive epidemiological study.
PubMed: 38909781
DOI: 10.1016/j.fjurol.2024.102669 -
Acta Biomaterialia Apr 2024Erectile dysfunction (ED) predominantly affects men in their 40-70s and can lead to poor quality of life. One option for ED treatment is surgical implantation of an...
Erectile dysfunction (ED) predominantly affects men in their 40-70s and can lead to poor quality of life. One option for ED treatment is surgical implantation of an inflatable penile prosthesis (IPP). However, they can be associated with negative outcomes including infection, migration or fibrosis. To improve outcomes, the interaction between the IPP device and surrounding tissues needs further investigation and this could be achieved using pre-clinical testbeds, but they need to be informed by extensive tissue testing. In this study, an experimental approach is adopted to characterise the mechanics of horse penile tissue and establish a testing protocol for penile tissue. The whole penis segments were tested in plate compression tests to obtain whole penis behaviour which is necessary for validation of a pre-clinical testbed, whilst tensile and compression tests were performed on individual penile tissues, namely corpus cavernosa and tunica albuginea. The second part of the paper deals with the development of a computational model employing an inverse finite element approach to estimate the material parameters of each tissue layer. These material parameters are in good agreement with the experimental results obtained from the individual tissue layers and whole organ tissue tests. This paper presents the first study proposing realistic nonlinear elastic material parameters for penile tissues and offers a validated testbed for IPPs. STATEMENT OF SIGNIFICANCE: Erectile Dysfunction (ED) affects over half the male population aged 40-70 potentially leading to poor quality of life. Patients not responding to conventional treatments of ED, are advised to use penile prostheses which can create an erection using implanted inflatable cylinders. A significant drawback of such prostheses, however, is the substantial tissue damage they can induce during their usage. Preclinical testbeds, including computational and bench-top models, could offer an efficient means of improving device designs to mitigate this damage but such testbeds require extensive knowledge of penile tissue properties. In this study, the authors determine penile tissue mechanics and apply an inverse FE approach to characterise the penile material properties required to validate preclinical models of the penis.
Topics: Male; Penis; Finite Element Analysis; Animals; Horses; Tensile Strength; Penile Prosthesis; Erectile Dysfunction; Biomechanical Phenomena
PubMed: 38494081
DOI: 10.1016/j.actbio.2024.03.013