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Therapeutic Advances in Urology 2024Penile shortening, frequently resulting from end-stage Peyronie's disease (PD), has a negative impact on patients' sexual activity and overall quality of life,... (Review)
Review
Risk and benefits of penile length preservation techniques during penile prosthesis implantation: a systematic review by the young academic urologists sexual and reproductive health working group.
BACKGROUND
Penile shortening, frequently resulting from end-stage Peyronie's disease (PD), has a negative impact on patients' sexual activity and overall quality of life, especially when accompanied by Erectile dysfunction (ED). Various surgical techniques have been described to manage concomitant ED and penile shortening through penile prosthesis (PP) implantation.
OBJECTIVES
To evaluate the benefits and risks of different penile length preservation techniques during PP implantation.
DESIGN
A systematic review of the available literature on the use of penile length preservation maneuvers in conjunction with PP implantation was conducted.
DATA SOURCES AND METHODS
For this systematic review, three databases (Medline, Embase and Cochrane) and clinical trial.gov were queried for relevant publications from 1 January 1990 to 1 September 2022. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
RESULTS
The qualitative analysis included 15 relevant articles involving 1186 adult patients who underwent penile length preservation techniques during PP implantation. Penile lengthening of 1-7 cm was reported. Overall, postoperative complications were described in up to 21.7% of cases. Only five studies reported functional outcomes, showing a significant improvement in postoperative period based on the administered questionnaire (e.g. IIEF - International Index of Erectile Function, EDITS - Erectile Dysfunction Inventory of Treatment Satisfaction).
CONCLUSION
Penile length preservation procedures appear to offer a viable option for managing acquired penile shortening, particularly in cases of PD. However, they are associated with a significant risk of complications. Proper patient selection, thorough discussion of risks and benefits, and referral to high-volume centers are mandatory to achieve optimal outcomes and minimizing complications.
TRIAL REGISTRATION
PROSPERO database registration CRD42022360758.
PubMed: 38205393
DOI: 10.1177/17562872231215177 -
Translational Andrology and Urology Apr 2024Penile prosthetic devices are the standard treatment for erectile dysfunction (ED) after failure of maximum medical therapy and conservative options. Several penile... (Review)
Review
BACKGROUND
Penile prosthetic devices are the standard treatment for erectile dysfunction (ED) after failure of maximum medical therapy and conservative options. Several penile lengthening procedures (PLPs) can be performed concurrently with penile prosthesis (PP) insertion in patients with severe ED, penile shortening, and/or Peyronie's disease to help combat negative emotional and psychological concerns from penile length loss with penile prosthetic device placement.
METHODS
An extensive, systematic literature review of the various pre-, intra-, and post-operative techniques that can be applied to preserve, restore or enhance penile length at the time of penile prosthetic implantation.
RESULTS
Numerous pre-operative and post-operative inflation protocols exists with vacuum erection devices and penile traction therapy. Intraoperative surgical techniques include cavernosal sparing and channeling without dilatation, subcoronal incision with circumferential penile degloving and grafting, the sliding technique, the modified sliding technique, the multiple-slit technique, the tunical expansion procedure (TEP), modified TEP, and the auxetic expansion procedure. These approaches can be meaningful to restore and/or preserve length for patients undergoing PP insertion.
CONCLUSIONS
PLPs can be performed by surgeons who have extensive penile reconstruction experience and have been trained to do these procedures, as there is significant risk to the patient and limitations to what can be expected. Each patient must be counseled in detail about the risks and benefits of these procedures and have their expectations managed as the average postoperative penile length recovery is around 3 cm and can range from 0-4.0 cm. Future research is needed to identify the appropriate candidate for each approach, and how much length gain the patient can expect.
PubMed: 38721300
DOI: 10.21037/tau-23-354 -
Sexual Medicine Feb 2024Cell therapy (CT) is a form of regenerative medicine under investigation for the management of male sexual dysfunction (MSD).
BACKGROUND
Cell therapy (CT) is a form of regenerative medicine under investigation for the management of male sexual dysfunction (MSD).
AIM
We sought to perform a systematic review of published information on CT for MSD and provide an official position statements for the European Society for Sexual Medicine.
METHODS
A comprehensive bibliographic search on the MEDLINE, Web of Science, Scopus, and Cochrane Library databases was conducted in February 2023. Articles were selected based on the Population, Intervention, Comparator, Outcome, Study design (PICOS) model if they included male patients (P) undergoing CT (I) with or without comparison with other treatments (C) and evaluated the impact of CT on sexual function (O). Quantitative data were reported as found in the original studies (S). Level of evidence and grade of recommendation according to the Oxford Centre for Evidence-Based Medicine were assigned to each statement.
OUTCOMES
Outcomes were determined based on assessment of erectile function, ejaculatory function, orgasmic function, sexual desire, and penile curvature.
RESULTS
A total of 19 studies and 421 patients were included. Most articles (n = 12, 63%) were case series, whereas a minority of papers (n = 6, 32%) had a comparative group; only 2 articles reported randomized controlled trials (RCTs) and 1 article reported a post hoc analysis of RCTs. Most articles (16, 84%) investigated patients with erectile dysfunction (ED). Improvements in the International Index of Erectile Function-Erectile Function Domain (IIEF-EF) or the IIEF 5-item version (IIEF-5) were found in 11/15 (73%) studies, with mean increases in IIEF-EF, mean IIEF-5, and median IIEF-EF between 8 and 14 points, 2 and 9 points, and 4.5 and 6 points, respectively. Two papers (20%) evaluated men with Peyronie's disease (PD). In both ot these articles penile curvature improvement and plaque volume reduction were described in all patients (n = 16, 100%). Objective measurements were performed in 1 study, which showed 10°-120° (15%-100%) curvature improvement and 90%-100% plaque reduction. Mild transient adverse events at the donor or administration sites were found in 7/16 (44%) papers on ED. Priapism was reported in one case (20%) and mild penile skin complications were reported in the majority of patients after CT for PD. No severe adverse events were described.
CLINICAL IMPLICATIONS
Although high-quality evidence is lacking, CT appears to have potential benefits from application in patients with ED or PD.
STRENGTHS AND LIMITATIONS
This report is to our knowledge the most comprehensive and up-to-date systematic review on the topic of CT for the management of MSD, including the position statements of the European Society for Sexual Medicine. Overall the assessment of available studies demonstrated low quality and significant heterogeneity.
CONCLUSION
Preliminary findings support potential efficacy and safety of CT in patients with ED or PD. Low-quality papers, high methodological heterogeneity, uncertainty about the magnitude of the beneficial effects, and lack of long-term data limit the available evidence.
PubMed: 38344213
DOI: 10.1093/sexmed/qfad071 -
International Journal of Impotence... Jan 2020Several strategies to optimize penile length in the presence of Peyronie's Disease (PD) have been described so far. In case of severe curvature and preserved erectile...
Several strategies to optimize penile length in the presence of Peyronie's Disease (PD) have been described so far. In case of severe curvature and preserved erectile function, plaque incision/excision (PIG/PEG) are advisable in order to maximize penile length, despite the risk of postoperative erectile dysfunction (ED), recurrent curvature, or penile shortening. For men with PD deformities associated to a certain degree of ED several lengthening techniques associated to penile prosthesis (PPI) implantation can be considered. Because of the potential postoperative complications, the indication must be balanced between patient's risk factors and surgeon's experience. Furthermore, adjuvant surgeries, such as prepubic V-Y plasty, suspensory ligament release, suprapubic lipectomy, and ventral phalloplasty, can be performed simultaneously or in a staged fashion to maximize the outcomes. Restoration a decent penile length in the case of a severe PD represents a real challenge for reconstructive surgeons. We present a systematic review of the literature on the current practices for penile lengthening in severe PD, providing the reader with a practical overview on the existing surgical strategies and their surgical and functional outcomes.
Topics: Erectile Dysfunction; Humans; Male; Patient Satisfaction; Penile Erection; Penile Implantation; Penile Induration; Penile Prosthesis; Penis; Postoperative Complications; Postoperative Period; Risk Factors
PubMed: 31481708
DOI: 10.1038/s41443-019-0189-9 -
Minerva Urology and Nephrology Apr 2021Penile prosthesis implantation (PPI), performed with or without adjunct straightening techniques, is one of the available surgical options in cases of Peyronie's disease...
INTRODUCTION
Penile prosthesis implantation (PPI), performed with or without adjunct straightening techniques, is one of the available surgical options in cases of Peyronie's disease (PD) with concomitant erectile dysfunction (ED). The aim of the study was to systematically identify and evaluate evidence regarding IPP in patients with PD and ED.
EVIDENCE ACQUISITION
Using Cochrane's methodological recommendations on systematic reviews, we conducted a systematic review of the literature on clinical research regarding the use of PPI, alone or in combination with any straightening maneuvers in the treatment of patients with PD and ED. The search was carried until January 2020. We included studies in English language with primary population patients with PD and ED who underwent IPP with the intent to treat the PD. All studies that were not original clinical research articles, reported insufficient data or included fewer than 5 patients were excluded from the final analysis.
EVIDENCE SYNTHESIS
In total 43 clinical articles with more than 2000 patients (N.=2143) investigating the effects of penile prosthesis implantation (PPI) for the treatment of PD with or without ED were included in the study. Depending on the severity of the penile curvature, additional penile deformities (i.e. hourglass deformity), penile length, prior operations and surgeons experience, 6 main categories of surgical techniques of PPI for penile straightening and treatment of PD were identified: PPI only, PPI with modelling of the penis, PPI with plication of the penis on the convex side of the curvature, PPI with plaque incision(s), PPI with plaque incision/excision plus grafting and PPI with grafting and penile lengthening.
CONCLUSIONS
Overall, patients with PD and ED can expect excellent outcomes with PPI against a minimal risk of side effects. No definite conclusions can be made regarding which technique is superior.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penile Induration; Penile Prosthesis; Treatment Outcome
PubMed: 33179867
DOI: 10.23736/S2724-6051.20.03890-4 -
Asian Journal of Andrology Jan 2024Peyronie's disease (PD) is characterized by abnormal penile curvature, and various surgical methods have been developed using different graft materials. However, there...
Peyronie's disease (PD) is characterized by abnormal penile curvature, and various surgical methods have been developed using different graft materials. However, there is currently no universal agreement on which type of graft is the best. The objective of this review was to evaluate the available literature and identify the most effective graft material for penile curvature correction in PD. A literature search was conducted using electronic databases, including PubMed, Scopus, and the Cochrane Library. The patients, intervention, comparison, and outcome (PICO) approach was used to define the eligibility of studies. Two authors independently selected studies, evaluated them, and extracted data. Random-effect models using the DerSimonian-Laird method were used. Most studies were single-arm studies and had a high risk of bias. Buccal mucosa grafts (BMG) were found to result in the highest penile straightening rates and were associated with the least de novo erectile dysfunction. TachoSil grafts demonstrated a high success rate in straightening despite a higher mean preoperative curvature, while Tutoplast grafts had a higher incidence of postoperative erectile dysfunction. BMG had the highest percentage of postoperative penile straightening. Overall, the TachoSil graft showed the best performance when preoperative curvature is taken into account. Based on the available literature, BMG appear to be the most effective for penile curvature correction in PD, but this is offset by the requirement for low preoperative curvature. The TachoSil graft shows the best overall performance when preoperative curvature is considered. Comparative randomized clinical trials are still needed to determine graft superiority.
PubMed: 38265253
DOI: 10.4103/aja202358 -
The Journal of Sexual Medicine Feb 2020Although an infrequent cause of small penile size in adult men, acquired penile shortening represents a particular reconstructive challenge due to preexisting penile...
INTRODUCTION
Although an infrequent cause of small penile size in adult men, acquired penile shortening represents a particular reconstructive challenge due to preexisting penile anatomic deformities.
AIM
With numerous techniques being performed, the purpose of our study is to assess available literature on length enhancement procedures used for acquired penile shortening deformities.
METHODS
A systematic review was performed using the guidelines outlined in the Preferred Reporting Items for Systematic reviews and Meta-analyses. Medline/PubMed, Scopus, and Cochrane Databases were used to identify papers on augmentation Phalloplasty in non-transgender males with acquired penile shortening from 1990 to 2018.
MAIN OUTCOME MEASURE
Outcomes, complications, and patient-reported satisfaction were analyzed.
RESULTS
12 articles, involving 931 patients and 8 primary procedures, met our inclusion criteria. The majority of articles had level of evidence of 4 (83%) and Newcastle Ottawa Scale score of 6 (92%, moderate risk of bias). All studies reported mean penile length gain; however, inconsistent methodology was used when measuring penile dimensions. Mean length gain ranged from 0.6 to 6.4 cm. Overall, the mean complication rate for all techniques ranged from 0% to 50%. Post-operative satisfaction was reported in 10 (83%) studies, 7 of which used a validated scale. Patients were generally satisfied, with reported satisfaction rates ranging from 77% to 100%.
CLINICAL IMPLICATIONS
While numerous procedures have been described, the significant limitations in the available data preclude identifying a single superior procedure.
STRENGTHS & LIMITATIONS
The significant heterogeneity in the reported literature is a limitation of this study and highlights the need for standardized reporting. However, this study is the first to analyze augmentation phalloplasty literature in the setting of acquired penile shortening.
CONCLUSION
Augmentation phalloplasty techniques for acquired penile shortening are evolving and are continuously being modified; best-practice guidelines are crucial to achieve safe and satisfactory outcomes in this population. Abu-Ghname A, Banuelos J, Davis MJ, et al. Augmentation Phalloplasty for Acquired Penile Shortening: A Systematic Review of Techniques, Outcomes, Patient Satisfaction, and Limitations. J Sex Med 2020;17:331-341.
Topics: Adult; Humans; Male; Patient Satisfaction; Penile Induration; Penis; Postoperative Period; Plastic Surgery Procedures
PubMed: 31831387
DOI: 10.1016/j.jsxm.2019.11.260