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Sexual Medicine Reviews Jul 2019Most men seeking penile girth augmentation have physiologically normal penises but may suffer from severe preoccupation with penis size known as penile dysmorphophobic... (Review)
Review
INTRODUCTION
Most men seeking penile girth augmentation have physiologically normal penises but may suffer from severe preoccupation with penis size known as penile dysmorphophobic disorder.
AIM
To describe the medical, procedural, and reconstructive techniques available for penile girth enhancement and to review the success and complications of each modality.
METHODS
A comprehensive review of peer-reviewed publications on the topic was performed through a PubMed search. Key search terms included penis, enhancement, enlargement, phalloplasty, reconstruction, girth, and augmentation.
MAIN OUTCOME MEASURE
We wanted to summarize the motivations behind penile girth enhancement and review the outcomes for girth augmentation treatments.
RESULTS
Various medical, traction, injection, prosthetic, and reconstructive modalities have been studied for penile girth enhancement, with increases in girth ranging from 0-4.9 cm. Complications were reported in a minority of patients, but they may be devastating and include penile fibrosis, sexual dysfunction, device infection, and death.
CONCLUSION
A variety of penile girth augmentation techniques have been studied. Clinical guidelines are lacking, and complications of penile girth enhancement are likely underreported. Until more rigorous investigation with accurate reporting of complications is achieved, penile girth augmentation procedures should be considered experimental. Hehemann MC, Towe M, Huynh LM, et al. Penile Girth Enlargement Strategies: What's the Evidence? Sex Med 2019;7:535-547.
Topics: Humans; Male; Penile Diseases; Penile Erection; Penile Prosthesis; Penis; Plastic Surgery Procedures
PubMed: 30612977
DOI: 10.1016/j.sxmr.2018.11.003 -
Asian Journal of Andrology 2020The global population is collectively getting older, and age is directly correlated with erectile dysfunction (ED). With the advent of effective oral agents and wide...
The global population is collectively getting older, and age is directly correlated with erectile dysfunction (ED). With the advent of effective oral agents and wide availability of the Internet, a larger portion of the population is becoming aware of the different treatment options for men with ED. The penile prosthesis is a definitive and effective treatment for ED which has been available for just over half a century.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penile Prosthesis
PubMed: 31571641
DOI: 10.4103/aja.aja_102_19 -
Ugeskrift For Laeger Oct 2022This review covers erectile dysfunction (ED) in men with metabolic syndrome. Men suffering from metabolic syndrome, and all its components, are at increased risk of ED.... (Review)
Review
This review covers erectile dysfunction (ED) in men with metabolic syndrome. Men suffering from metabolic syndrome, and all its components, are at increased risk of ED. Men with ED should be metabolically screened with BMI, waist circumference, blood pressure, HbA1c and lipids. Components of the metabolic syndrome should be well-controlled as first step in treating ED using lifestyle changes and pharmaceutical therapies. Symptomatic treatments include phosphodiesterase type 5 inhibitors, penile injections, intraurethral medication, vacuum pumps and penile implants.
Topics: Male; Humans; Erectile Dysfunction; Metabolic Syndrome; Penile Prosthesis; Phosphodiesterase 5 Inhibitors
PubMed: 36305253
DOI: No ID Found -
Faculty Reviews 2021Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to... (Review)
Review
Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments or vacuum constriction devices. Contemporary literature suggests that penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient's quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. Several factors - such as appropriate patient selection, methodical preoperative assessment and patient optimization, specific intraoperative protocols and postoperative recommendations - can reduce the risk of surgical complications. This narrative review discusses the diagnosis and management of both intraoperative and postoperative complications of penile prosthesis surgery.
PubMed: 34632459
DOI: 10.12703/r/10-73 -
The World Journal of Men's Health Sep 2019Penile prosthesis infection is the most significant complication following prosthesis implant surgery leading to postoperative morbidity, increased health care costs,... (Review)
Review
Penile prosthesis infection is the most significant complication following prosthesis implant surgery leading to postoperative morbidity, increased health care costs, and psychological stress for the patient. We aimed to identify risk factors associated with increased postoperative penile prosthesis infection. A review of the literature was performed PubMed using search terms including inflatable penile prosthesis, penile implant, and infection. Articles were given a level of evidence score using the 2011 Oxford Centre for Evidence-Based Medicine Guidelines. Multiple factors were associated with increased risk of post-prosthesis placement infection (Level of Evidence Rating) including smoking tobacco (Level 1), CD4 T-cell count <300 (Level 4), nasal carriage (Level 2), revision surgery (Level 2), prior spinal cord injury (Level 3), and hemoglobin A1c level >8.5 (Level 2). Factors with no effect on infection rate include: preoperative cleansing with antiseptic (Level 4), history of prior radiation (Level 3), history of urinary diversion (Level 4), obesity (Level 3), concomitant circumcision (Level 3), immunosuppression (Level 4), age >75 (Level 4), type of hand cleansing (Level 1), post-surgical drain placement (Level 3), and surgical approach (Level 4). Factors associated with decreased rates of infection included: surgeon experience (Level 2), "No Touch" technique (Level 3), preoperative parenteral antibiotics (Level 2), antibiotic coated devices (Level 2), and operative field hair removal with clippers (Level 1). Optimization of pre-surgical and intraoperative risk factors is imperative to reduce the rate of postoperative penile prosthesis infection. Additional research is needed to elucidate risk factors and maximize benefit.
PubMed: 30929326
DOI: 10.5534/wjmh.180123 -
Current Urology Reports Feb 2023Numerous innovations have been made since the first inflatable penile prosthesis was introduced in 1973-not just of the implant apparatus itself, but crucially also in... (Review)
Review
PURPOSE OF REVIEW
Numerous innovations have been made since the first inflatable penile prosthesis was introduced in 1973-not just of the implant apparatus itself, but crucially also in the surgical instruments used for prosthetic surgery. Starting with Dr. Furlow's revolutionary inserter tool, advancements were quickly made in dilators, retractors, and cavernotomes.
RECENT FINDINGS
More recent innovations have been made in inserter tools, forceps, needle holders, clamps, and disposable instruments. Leading companies Boston Scientific and Coloplast have contributed significantly to the evolution of IPP surgical placement, and companies such as Uramix and Rigicon are developing a wide array of new specialized tools. We aim to summarize the instruments needed for IPP placement, with a focus on describing the variety of instrument innovations since Dr. Brantley Scott designed and placed the first IPP.
Topics: Male; Humans; Penile Prosthesis; Penile Implantation; Erectile Dysfunction
PubMed: 36542215
DOI: 10.1007/s11934-022-01136-3 -
Asian Journal of Andrology 2020The field of prosthetic urology demonstrates the striking impact that simple devices can have on quality of life. Penile prosthesis and artificial urinary sphincter... (Review)
Review
The field of prosthetic urology demonstrates the striking impact that simple devices can have on quality of life. Penile prosthesis and artificial urinary sphincter implantation are the cornerstone procedures on which this specialty focuses. Modern research largely concentrates on decreasing the rates of complication and infection, as the current devices offer superior rates of satisfaction when revision is not necessary. These techniques are also able to salvage sexual function and continence in more difficult patient populations including female-to-male transgender individuals, those with ischemic priapism, and those with erectile dysfunction and incontinence secondary to prostatectomy. This review summarizes modern techniques, outcomes, and complications in the field of prosthetic urology.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penile Prosthesis; Postoperative Complications; Prostatectomy; Prosthesis Failure; Prosthesis Implantation; Prosthesis-Related Infections; Surgical Wound Infection; Urethra; Urinary Incontinence, Stress; Urinary Retention; Urinary Sphincter, Artificial; Urology
PubMed: 31696834
DOI: 10.4103/aja.aja_108_19 -
Actas Urologicas Espanolas Jun 2020Inflatable penile prosthesis was developed in 1973 as a definitive treatment for erectile dysfunction. Since then these prosthetic devices underwent huge modifications,... (Review)
Review
Inflatable penile prosthesis was developed in 1973 as a definitive treatment for erectile dysfunction. Since then these prosthetic devices underwent huge modifications, and scientific and technologic advances were accomplished, improving reliability, longevity and the surgical outcomes. Surgical implantation of a penile prosthesis may be considered in patients with erectile dysfunction who do not respond to pharmacotherapy or who prefer a permanent solution to their problem. According to the 2019 EAU Guidelines, regardless of the indication, prosthesis implantation has one of the highest satisfaction rates (92-100% in patients and 91-95% in partners) among the treatment options for erectile dysfunction based on appropriate consultation. The penoscrotal handling is the most common approach accounting for >80% of inflatable penile prosthesis placed worldwide. Most frequent complaints and dissatisfaction with inflatable penile prosthesis are related to technical issues or poor surgical outcomes such as the final length of the penis. There is an urgent need to improve the patient awareness in inflatable penile prosthesis in the preoperative arena, including the high expectation management, and an effort to select the proper patients for definitive treatment.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penile Prosthesis; Penis; Prosthesis Design; Scrotum
PubMed: 32493599
DOI: 10.1016/j.acuro.2020.01.010 -
Current Urology Reports May 2022Management protocols for treatment of severe erectile dysfunction have changed little in the last 20 years. Most algorithms consider penile prostheses as the last... (Review)
Review
INTRODUCTION
Management protocols for treatment of severe erectile dysfunction have changed little in the last 20 years. Most algorithms consider penile prostheses as the last option of treatment in patients who have failed medical management. Despite multiple advances in current devices, prosthetic infection remains the most feared complication by implanting surgeons and patients. This report tries to make a compilation of the factors that can be impacted to prevent penile implant infections, and to make penile implantation a safer and more reliable way to solve an erection deficit.
PURPOSE OF REVIEW
List events related to the surgical act (pre-operative, intra-operative, and post-operative) that are related to the risk of infection to contextualize possible actions/measures used to avoid prosthetic infection.
RECENT FINDINGS
The impact of coated implants on reduction of infection rates. The recommendation to use chlorhexidine-based solutions over iodine solution for preoperative skin preps. Appears to be no difference in infection rates according to the approach chosen by the surgeon (infrapubic vs penoscrotal). The change in the microbial colonies that are colonizing implants in recent years are dramatic. Lack of evidence of which solutions to use for salvage or revision washout surgery: Chemical eradication or mechanical lavage cleansing?. Despite the importance of metabolic control in the literature, there is a disparity in exact glycemic values prior to the intervention in our literature. Factors such as preparation of the operative site, presence of comorbidities or previous surgeries, surgical time, or additional maneuvers during surgery can negatively impact the final result of penile prosthetic surgery.
Topics: Erectile Dysfunction; Humans; Male; Penile Diseases; Penile Implantation; Penile Prosthesis; Penis
PubMed: 35247139
DOI: 10.1007/s11934-022-01090-0 -
Asian Journal of Andrology 2020Inflatable penile prostheses are an important tool in the treatment of medically refractory erectile dysfunction. One of the major complications associated with these... (Review)
Review
Inflatable penile prostheses are an important tool in the treatment of medically refractory erectile dysfunction. One of the major complications associated with these prostheses is infections, which ultimately require device explanation and placement of a new device. Over the past several decades, significant work has been done to reduce infection rates and optimize treatment strategies to reduce patient morbidity. This article reviews the current state of knowledge surrounding penile prosthesis infections, with attention to the evidence for methods to prevent infection and best practices for device reimplantation.
Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bandages; Carrier State; Chlorhexidine; Coated Materials, Biocompatible; Device Removal; Diabetes Mellitus; Erectile Dysfunction; Gram-Negative Bacterial Infections; Hair Removal; Humans; Immunocompromised Host; Male; Penile Implantation; Penile Prosthesis; Preoperative Care; Prosthesis-Related Infections; Reoperation; Risk Factors; Spinal Cord Injuries; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis; Surgical Drapes; Surgical Instruments; Surgical Wound Infection
PubMed: 31489848
DOI: 10.4103/aja.aja_84_19