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Urology Jun 2021Defining risks associated with diabetes mellitus (DM) in patients undergoing penile prosthesis (PP) implantation remains controversial. This systematic review seeks to...
A Systematic Review of Literature Regarding Whether Immediate Preoperative Hemoglobin A1c or Serum Glucose Are Risk Factors for Infection Following Penile Prosthesis Implantation.
Defining risks associated with diabetes mellitus (DM) in patients undergoing penile prosthesis (PP) implantation remains controversial. This systematic review seeks to assess whether preoperative hemoglobin a1c (HbA1c) or serum glucose have been shown to predict infection following PP implantation in diabetic men. A stepwise literature search was performed. Eight and four studies assessing HbA1c and serum glucose respectively were included. Overall, data exploring HbA1c and serum glucose on PP infection were heterogeneous in time period, study design, and patient populations. Contemporary studies did not support either HbA1c nor blood glucose as predictors of PP infection in diabetic men.
Topics: Blood Glucose; Glycated Hemoglobin; Humans; Male; Penile Implantation; Penile Prosthesis; Preoperative Period; Prosthesis-Related Infections; Risk Factors; Time Factors
PubMed: 33705821
DOI: 10.1016/j.urology.2021.01.066 -
International Journal of Impotence... Nov 2020
Meta-Analysis
Topics: Humans; Male; Penile Diseases; Penile Implantation; Penile Prosthesis; Penis; Prosthesis-Related Infections; Risk Factors
PubMed: 32152469
DOI: 10.1038/s41443-020-0250-8 -
International Journal of Impotence... Jan 2021Successful treatment of erectile dysfunction (ED) is associated with improvements in quality of life; however, treatment utilisation is sub-optimal. The aim of this...
Successful treatment of erectile dysfunction (ED) is associated with improvements in quality of life; however, treatment utilisation is sub-optimal. The aim of this systematic review was to identify the rates of ED treatment utilisation and the barriers and enablers men experience when using treatment. We searched: MEDLINE, Embase, the Cochrane library; AMED; HMIC; HTA; CINAHL; PsychARTICLES; PsychINFO up to August 2018. Data on rates of treatment utilisation and barriers and enablers of utilisation were extracted and summarised. Fifty studies were included. Discontinuation rates ranged from 4.4 to 76% for phosphodiesterase type 5 inhibitors, 18.6 to 79.9% for intracavernosal injections, and 32 to 69.2% for urethral suppositories. In relation to those with a penile prosthesis, 30% discontinued having sex due to, e.g. device complications, lack of partner or a loss of sexual interest. Most research included in the current review examined barriers to treatment utilisation and therefore focussed on reasons for discontinuing treatment. However, a small number explored factors that men found helpful with regards to treatment utilisation. The most prevalent barriers to utilisation were treatment ineffectiveness, side effects, the quality of men's intimate relationships and treatment costs. With regards to treatment enablers, the most salient finding was that men who reported side effects to a healthcare professionals (HCPs) were significantly less likely to discontinue treatment. There were limitations in methodology in that the studies did not use validated measures of treatment utilisation or barriers and enablers and no study used psychological theory to inform the examination of factors that influenced treatment utilisation. This review identifies a number of influential factors relating to ED treatment utilisation and highlights the importance of men's beliefs with regards to ED and its treatment. Beliefs are potentially modifiable and therefore the findings of this review highlight important considerations for HCPs with regards to supporting men to make better use of treatment.
Topics: Erectile Dysfunction; Humans; Male; Phosphodiesterase 5 Inhibitors; Quality of Life; Sexual Behavior; Sexual Partners
PubMed: 32231275
DOI: 10.1038/s41443-020-0249-1 -
The Journal of Sexual Medicine Oct 2020Modern-day penile prostheses use infection retardant coating to decrease rates of postoperative infection, subsequently reducing explantation and revision rates as well....
Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients With Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis.
BACKGROUND
Modern-day penile prostheses use infection retardant coating to decrease rates of postoperative infection, subsequently reducing explantation and revision rates as well. The Coloplast Titan models are dipped into antimicrobial solutions right before implantation, and the components used for dipping can be tailored toward the patient.
AIM
To compare infection, explantation, and revision rates among different dipping solutions used before implantation for patients with diabetes receiving a Coloplast Titan implant.
METHODS
We systematically reviewed 932 patients with diabetes receiving a primary penile implant across 18 different centers from the period April 2003 to August 2018. Of those patients, 473 received a Coloplast device, whereas 459 received an AMS device. Data regarding the type of antimicrobial solution used before implantation were recorded for 468 patients receiving a Coloplast Titan, including whether or not they suffered a postoperative infection and if they underwent explantation and/or revision. Outcome rates were compared using Fisher's exact and Pearson's chi-square tests, and logistic regression modeling was performed to account for covariates.
OUTCOMES
The main outcome measures of this study were postoperative infection, explantation, and revision rates.
RESULTS
Of the total 932 patients reviewed, 33 suffered a postoperative infection. Of 468 patients receiving Coloplast implants, there was a 3.4% infection rate. The most commonly used antibiotic combination before dipping was vancomycin + gentamicin (59.0%). There was a significantly lower rate of postoperative infection, explantation, and revision when vancomycin + gentamicin was used than those associated with the use of all other dipping solutions ([1.4% vs 6.4%; P = .004], [1.1% vs 8.3%; P < .001], and [2.5% vs 12.5; P < .001], respectively). After adjusting for age, body mass index, preoperative blood glucose level, and hemoglobin A1c, the use of other dips was an independent predictor of postoperative infection (odds ratio: 0.191; P = .049). The inclusion of rifampin in the dipping solution trended toward being a significant risk factor for infection (P = .057). Including antifungals in the dipping solution did not affect infection (P = .414), explantation (P = .421), or revision (P = .328) rates.
CLINICAL IMPLICATIONS
Vancomycin + gentamicin was the most efficacious combination of antibiotics used for dipping in terms of preventing postoperative infection and subsequent explantation and revision.
STRENGTHS AND LIMITATIONS
Data were sampled across multiple institutions providing a large sample that may be more representative of the population of interest. A key limitation of the study was its retrospective nature, which prevented us from controlling certain variables.
CONCLUSION
The use of rifampin did not provide the same type of protection, possibly representing a shift in resistance patterns of common bacteria responsible for device infection. Towe M, Huynh LM, Osman MM, et al. Impact of Antimicrobial Dipping Solutions on Postoperative Infection Rates in Patients With Diabetes Undergoing Primary Insertion of a Coloplast Titan Inflatable Penile Prosthesis. J Sex Med 2020;17:2077-2083.
Topics: Diabetes Mellitus; Gentamicins; Humans; Male; Penile Implantation; Penile Prosthesis; Retrospective Studies
PubMed: 32807707
DOI: 10.1016/j.jsxm.2020.07.009 -
Minerva Urologica E Nefrologica = the... Oct 2020We aimed to summarize evidences about the efficacy of available treatments for erectile disfunction after robotic assisted radical prostatectomy (RARP).
INTRODUCTION
We aimed to summarize evidences about the efficacy of available treatments for erectile disfunction after robotic assisted radical prostatectomy (RARP).
EVIDENCE ACQUISITION
A systematic literature review searching on PubMed (Medline), Scopus, and Web of Science databases was performed in December 2019. PRISMA guidelines were followed. Population consisted of patients with erectile disfunction after RARP (P), conservative and surgical intervention were considered of interest (I). No comparator was considered mandatory (C). Outcomes of interest were the recovery of erectile function after conservative treatments and sexual function after surgical treatments (O).
EVIDENCE SYNTHESIS
Eleven studies were included. Seven studies focused on the use of phosphodiesterase-5 inhibitors (PDE5i) alone (five studies) or associated with other treatments (two studies). All the studies confirmed the efficacy of PDE5i, while the most promising association is with vacuum pump erectile devices. Two studies investigated topical treatments, namely low intensity extracorporeal shock wave therapy and alprostadil. Low intensity extracorporeal shock wave therapy may be a promising option in patients in whom nerve-sparing surgery was performed. The use of alprostadil could be an effective alternative to intracorporeal injection in those who underwent non-nerve-sparing surgery. One study focused and confirmed the efficacy of penile implants. Furthermore, one study reported the efficacy of a multi-modal treatment with preoperative medication, showing the benefits of a multimodal approach.
CONCLUSIONS
Penile rehabilitation with PDE5i is effective after nerve sparing RARP. The association of PDE5i with vacuum devices could led to a faster recovery. A multimodal approach with preoperative specific care seems to be effective to fasten erectile function recovery.
Topics: Erectile Dysfunction; Humans; Male; Penile Prosthesis; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 32748616
DOI: 10.23736/S0393-2249.20.03780-7