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Der Urologe. Ausg. A Jun 2021The insertion of a penile prosthesis (PP) is a definitive treatment option for erectile dysfunction (ED), induratio penis plastica, after phalloplasty or priapism. The... (Review)
Review
The insertion of a penile prosthesis (PP) is a definitive treatment option for erectile dysfunction (ED), induratio penis plastica, after phalloplasty or priapism. The aim is a "normal" erection with the possibility of a satisfactory sexual life. The costs of the operation are covered by the health insurance. In addition, manual dexterity, concomitant diseases and possible contraindications should be considered preoperatively. While semirigid PPs are simply aligned in the desired position when used, inflatable PPs must be activated and deactivated via a pump. In addition to injury to local structures and postoperative infections, long-term complications such as mechanical implant failure or an undesirable cosmetic result may also occur. Careful patient selection and a detailed counselling and information session are therefore of decisive importance. Implantation is performed in the supine or lithotomy position via an infrapubic or penoscrotal approach. PPs should not be implanted if cutaneous, systemic or urinary tract infections are present. Inflatable PPs are preferred by most patients as they come closest to a "natural" erection. A PP offers one of the highest satisfaction rates among treatment options, regardless of indication, and is highly rated by patients and their partners across models due to product reliability. Differences between the models of the various manufacturers could not be demonstrated. The choice of prosthesis should therefore be adapted to the patient's individual requirements and health conditions.
Topics: Erectile Dysfunction; Humans; Male; Patient Satisfaction; Penile Erection; Penile Implantation; Penile Prosthesis; Penis; Prosthesis Design; Reproducibility of Results
PubMed: 33928422
DOI: 10.1007/s00120-021-01531-7 -
Sexual Medicine Reviews Jul 2019Inflatable penile prosthesis (IPP) surgery offers a high satisfaction rate and low rate of complications when performed by experienced surgeons. However, reservoir... (Review)
Review
INTRODUCTION
Inflatable penile prosthesis (IPP) surgery offers a high satisfaction rate and low rate of complications when performed by experienced surgeons. However, reservoir placement, either in the space of Retzius (SOR), or alternative/ectopic locations, may lead to an array of serious complications that may require revision surgery.
AIM
To review the prevalence and management options for non-infectious intraoperative and postoperative complications related to prosthetic reservoirs.
METHODS
A Medline PubMed search was used to identify articles related to IPP reservoir-related complications including bladder and bowel injury, vascular injury, autoinflation, herniation, palpability, leakage, and tubing torsion.
MAIN OUTCOME MEASURE
Rates and types of reservoir-related complications during and after IPP surgery.
RESULTS
Non-infectious reservoir-related complications in the intraoperative setting include injury to pelvic structures such as bladder, bowel, and blood vessels. In the postoperative setting, patients may experience autoinflation and reservoir herniation that might require revision surgery. Patients undergoing alternative reservoir placement (ARP) may complain of reservoir palpability and premature mechanical failure secondary to reservoir leakage or tubing torsion.
CONCLUSION
Although most surgeons continue to use the SOR as the main location for reservoir placement, ARP has gained popularity owing to its low risk of bother, minimal loss of functionality, and safety advantages in patients with history of pelvic surgery. Both reservoir placement in the SOR and ARP carry a low rate of complications while maintaining a high satisfaction rate. Clavell-Hernández J, Shah A, Wang R. Non-Infectious Reservoir-Related Complications During and After Penile Prosthesis Placement. Sex Med Rev 2019;7:521-529.
Topics: Erectile Dysfunction; Humans; Intraoperative Complications; Male; Penile Implantation; Penile Prosthesis; Penis; Postoperative Complications; Prosthesis Failure
PubMed: 30786958
DOI: 10.1016/j.sxmr.2018.12.005 -
Urology May 2024
Topics: Humans; Male; Penile Prosthesis; Microbiota; Biomedical Research; Prosthesis-Related Infections
PubMed: 38494141
DOI: 10.1016/j.urology.2024.03.024 -
Asian Journal of Andrology 2021Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie's disease. Currently, there is a variety of... (Review)
Review
Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie's disease. Currently, there is a variety of options for the correction of residual curvature, including penile modeling, plication techniques, as well as tunical incision/excision with or without grafting. A literature search of PubMed and Medline databases was conducted from 1964 until 2020, using search terms for all articles in the English language. In this article, we provide a review of the techniques and the outcomes, according to the published literature.
Topics: Humans; Male; Penile Induration; Penile Prosthesis; Prosthesis Implantation; Plastic Surgery Procedures; Treatment Outcome; Urologic Surgical Procedures, Male
PubMed: 33106463
DOI: 10.4103/aja.aja_62_20 -
Sexual Medicine Reviews Jul 2021Peyronie's disease results in penile curvature, shortening, instability, or pain upon erection-hindering sexual performance and leading to psychological distress.... (Review)
Review
INTRODUCTION
Peyronie's disease results in penile curvature, shortening, instability, or pain upon erection-hindering sexual performance and leading to psychological distress. Despite extensive research, surgery is still the mainstay of treatment.
OBJECTIVE
To present an organized description of the most common surgical techniques used in the correction of Peyronie's disease and to propose a surgical algorithm to guide management.
METHODS
Using PubMed, we reviewed the published literature regarding surgical treatment of Peyronie's disease and its outcomes. We identified original articles, review articles, and editorials addressing the subject, with a focus on surgical techniques, their indications, and outcomes.
RESULTS
Peyronie's disease can be treated by corporoplasty or penile prosthesis implantation. Corporoplasty includes convex side-shortening procedures and concave side lengthening procedures. It is indicated when the erectile function is adequate. Shortening procedures include excisional, incisional, and plication-only techniques, and lengthening procedures include partial excision or incision followed by grafting. When refractory erectile dysfunction is present, placement of a penile prosthesis with or without further straightening maneuvers is recommended. We reviewed the indications, advantages, disadvantages, and outcomes of the available techniques and proposed a surgical algorithm to guide management.
CONCLUSION
Penile shortening procedures are usually indicated in curvatures <60°, in penises with adequate length. Partial excision/incision and grafting are indicated for curvatures >60°, hourglass or hinge deformities, and short penises, if the patient's erectile function is adequate. The presence of "borderline" erectile function and/or ventral curvature tilts the choice toward shortening procedures, and refractory erectile dysfunction is an indication for penile prosthesis placement. Peyronie's disease management remains challenging with many options available, making an accurate risk/benefit assessment of each case and meticulous patient counseling critically important. Almeida JL, Felício J, Martins FE. Surgical Planning and Strategies for Peyronie's Disease. Sex Med Rev 2021;9:478-487.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penile Induration; Penile Prosthesis; Penis
PubMed: 33023863
DOI: 10.1016/j.sxmr.2020.07.008 -
Sexual Medicine Reviews Oct 2021The most common cause of patient dissatisfaction after penile prosthesis placement is penile shortening compared with one's memory of a natural erection. Surgical... (Review)
Review
INTRODUCTION
The most common cause of patient dissatisfaction after penile prosthesis placement is penile shortening compared with one's memory of a natural erection. Surgical techniques as well as preoperative and postoperative protocols have been reported to preserve and possibly enhance penile length in someone undergoing penile prosthesis surgery.
OBJECTIVES
This article presents a description of as well as the authors' experience with presurgical protocols, intraoperative techniques, and postsurgical protocols that allow for preservation or enhancement of penile length for patients who undergo inflatable penile prosthesis insertion.
METHODS
An extensive, systematic literature review was performed using PubMed searching for key terms including penile lengthening, inflatablepenile prosthesis, penile girth, buried penis, and penile enhancement. All articles with subjective and/or objective penile length outcomes were reviewed.
RESULTS
Several preoperative treatment protocols were found for penile length preservation and enhancement, which included use of a vacuum erection device as well as traction therapy. Intraoperative techniques included cavernosal sparing, channeling without dilatation, circumferential penile degloving, ventral phalloplasty, suprapubic lipectomy, liposuction, suspensory ligament release, sliding technique, modified sliding technique, multislice technique, and aggressive implant sizing. Postoperative protocols included early device inflation and cycling. Table 1 summarizes and compares the various preoperative, intraoperative, and postoperative strategies identified during literature review with their corresponding reported length gain.
CONCLUSIONS
Many preoperative, intraoperative, and postoperative surgical techniques can be performed by high-volume implanters to improve one's perceived or true penile length. In the hands of experienced, high-volume implanters, these techniques can be very meaningful for patients undergoing penile prosthesis insertion, particularly those who are concerned with penile length. Shah B, Kent M, Valenzuela R. Advanced Penile Length Restoration Techniques to Optimize Penile Prosthesis Placement Outcomes. Sex Med Rev 2021;9:641-649.
Topics: Humans; Male; Penile Erection; Penile Implantation; Penile Prosthesis; Penis; Sex Reassignment Surgery
PubMed: 32653404
DOI: 10.1016/j.sxmr.2020.05.007 -
The Aging Male : the Official Journal... Dec 2020Erectile dysfunction affects over 50% of men 70 years and above, and penile prosthesis (PP) is its third-line treatment. Complications of PPs include infection,... (Review)
Review
INTRODUCTION
Erectile dysfunction affects over 50% of men 70 years and above, and penile prosthesis (PP) is its third-line treatment. Complications of PPs include infection, however, no formal guidelines exist for its management.
METHODS
We performed a literature search and reviewed 53 recent published literatures of experiences with management of PP infections, prevention, and treatment.
RESULTS
Acute infection can present early with pain and discharge and detection of early signs is of utmost importance. MRI studies are more sensitive than CT studies to diagnose and plan surgical intervention. Introduction of antibiotic impregnated devices attributed to the reduction of infection rates with superiority proven for certain types; the no-touch technique had further reduced this rate. The Mulcahy salvage remains the most widely used surgical approach for treatment despite modifications and novel techniques described; conservative management of PP infections is recently reported with promising results.
CONCLUSIONS
Despite absence of strict guidelines for the management of infected PPs, we reviewed and discussed numerous panel opinions and suggestions throughout literature. More research into the pathology, prevention, conservative management and advances in surgical treatment of this condition are called for to produce guidelines that unite the efforts to tackle these infections.
Topics: Anti-Bacterial Agents; Erectile Dysfunction; Humans; Male; Penile Prosthesis
PubMed: 30317910
DOI: 10.1080/13685538.2018.1519786 -
International Journal of Impotence... Aug 2022William Costerton, the pioneer of bacterial biofilm research and Wilson published a review of this subject in 2012. Recent events and false claims have prompted an... (Review)
Review
William Costerton, the pioneer of bacterial biofilm research and Wilson published a review of this subject in 2012. Recent events and false claims have prompted an update for urologists regarding the science of penile implant biofilm. The recent biofilm literature has been investigated and new conclusions regarding penile implant biofilm physiology are clarified in this review. The timeline of biofilm formation is as follows. The wound is contaminated upon incision, and the inoculum of bacteria ceases with incision closure. Almost immediately planktonic bacteria attach to the implant and secrete biofilm which alters the host's ability to eradicate the bacteria. Infection retardant coatings impair clinical infection by common skin organisms including coagulase negative staphylococci, the most frequent offenders. In the modern era of availability of infection retardant coated implants, the increasingly rare penile implant infections are now usually caused by more virulent bugs. Antibiotic elution from the surface of the implant is a tiny dose and only truly helpful in the first 24 h. AMS and Coloplast infection retardant coatings reduce infection equally and contemporary primary implant infections are far lower in experienced implant surgeons' practices.
Topics: Anti-Bacterial Agents; Biofilms; Humans; Male; Penile Diseases; Penile Prosthesis; Prosthesis-Related Infections
PubMed: 33714988
DOI: 10.1038/s41443-021-00423-w -
The Journal of Sexual Medicine Aug 2021Penile prosthesis implantation remains an effective solution for men with medical-refractory erectile dysfunction (ED) following radical pelvic surgery. Despite the... (Review)
Review
BACKGROUND
Penile prosthesis implantation remains an effective solution for men with medical-refractory erectile dysfunction (ED) following radical pelvic surgery. Despite the distortion of pelvic anatomy, a penile implant can be performed with excellent clinical outcomes provided strict patient selection, proper preoperative workup and safe surgical principles are adhered to.
AIM
To provide practical recommendations on inflatable penile prosthesis (IPP) implantation in patients with medical-refractory ED, with an emphasis on patient selection and counselling, preoperative workup as well as surgical considerations to minimize intraoperative complications.
METHODS
A Medline search on relevant English-only articles on penile prostheses and pelvic surgery was undertaken and the following terms were included in the search for articles of interest: "bladder cancer", "prostate cancer", "rectal cancer", "pelvic surgery" and "inflatable penile implant".
OUTCOMES
Clinical key recommendations on patient selection, preoperative workup and surgical principles.
RESULTS
Patients should be made aware of the mechanics of IPP and the informed consent process should outline the benefits and disadvantages of IPP surgery, alternative treatment options, cost, potential prosthetic complications and patient's expectations on clinical outcomes. Specialised diagnostic test for workup for ED is often not necessary although preoperative workup should include screening for active infection and optimising pre-existing medical comorbidities. Precautionary measures should be carried out to minimise infective complication. Corporal dilation and reservoir placement can be challenging in this group, and surgeons may require knowledge of advanced reconstructive surgical techniques when dealing with specific cases such as coexisting Peyronie's disease and continence issue.
CLINICAL TRANSLATION
Strict patient selection and counselling process coupled with safe surgical principles are important to achieve excellent linical outcomes and patient satisfaction rates.
STRENGTHS AND LIMITATIONS
This masterclass paper provides an overview of the practical considerations for men who are undergoing IPP surgery following radical pelvic surgery. Limitations include the lack of highquality data and detailed surgical description on each surgical troubleshooting steps for various prosthetic-related complications.
CONCLUSION
The IPP implantation can be performed efficiently and safely in patients following radical pelvic surgery. Chung E, Mulhall J. Practical Considerations in Inflatable Penile Implant Surgery. J Sex Med 2021;18:1320-1327.
Topics: Erectile Dysfunction; Humans; Male; Patient Satisfaction; Penile Implantation; Penile Prosthesis; Penis
PubMed: 34247953
DOI: 10.1016/j.jsxm.2021.05.017 -
Research and Reports in Urology 2022Ischemic priapism accounts for more than 95% of all priapic episodes. It has to be considered a urological emergency because its time extension may lead to necrosis of... (Review)
Review
Ischemic priapism accounts for more than 95% of all priapic episodes. It has to be considered a urological emergency because its time extension may lead to necrosis of smooth muscle cells of the corpora cavernosa, resulting in a complete erectile dysfunction, penile shortening and loss of girth. In the present systematic review, we perform an up-to-date literature search for patients suffering from refractory ischemic priapism who undergo penile prosthesis implantation with particular interests to the patients characteristics. The conservative management of the priapic episode consists of a sympathomimetic agent in the first istance. Failure or recurrence of priapism following these conservative measures is an indication for surgical management. Shunt procedures between the corpora cavernosa and the neighbouring structures are often used first line; however, in refractory ischemic priapism the success rate is minimal. In such cases (>48 h) an indication of immediate placement of a penile prosthesis could be the best solution.
PubMed: 35059330
DOI: 10.2147/RRU.S278807