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Minerva Urology and Nephrology Dec 2023Inflatable penile prosthesis are the definitive treatment for erectile dysfunction. The two most used surgical approaches to position the implants are the penoscrotal... (Review)
Review
INTRODUCTION
Inflatable penile prosthesis are the definitive treatment for erectile dysfunction. The two most used surgical approaches to position the implants are the penoscrotal and the infrapubic. Current trends showed that the penoscrotal approach is extensively preferred however, there is not conclusive evidence demonstrating the superiority of one technique over the other. The aim of this review is to summarize the scientific evidence available and to underline strengths and weaknesses of the two techniques.
EVIDENCE ACQUISITION
We conducted a comprehensive search of MEDLINE, Cochrane Library, and National Center for Biotechnology Information PubMed to identify relevant published articles. The included studies had to explicitly examine the use of three-piece inflatable penile prosthesis with a focus on the surgical access method and complications.
EVIDENCE SYNTHESIS
Twenty-six articles were included in the review: seven narrative reviews, five retrospective observational studies, five prospective observational studies, and nine mixed methodology studies. The most frequent approach was the penoscrotal, which was also found more comfortable (RG1) by the operators in one study. The infrapubic approach lasts less and one study demonstrated higher satisfaction by the patients.
CONCLUSIONS
There is no evidence of significant differences in complications among the penoscrotal and infrapubic approaches. While the infrapubic approach is faster and patients were more satisfied, the penoscrotal approach is the most used by far. This is likely related to the more straightforward procedure through this access and the excellent surgical field exposure. For these reasons, it is also preferred in the most complex cases.
Topics: Humans; Male; Observational Studies as Topic; Patient Satisfaction; Penile Implantation; Penile Prosthesis; Penis; Retrospective Studies
PubMed: 38126284
DOI: 10.23736/S2724-6051.23.05475-7 -
International Journal of Impotence... Jan 2020Penile fracture is a rare condition that describes the rupture of the corpus cavernosum following direct, high-pressure trauma to the erect penis. There is no... (Review)
Review
Penile fracture is a rare condition that describes the rupture of the corpus cavernosum following direct, high-pressure trauma to the erect penis. There is no standardized management algorithm for these patients. We performed a systematic review of the past 10 years regarding management of penile fractures. A complete PRISMA-P 2015 checklist was performed where we reviewed English articles published over the past 10 years to identify 105 articles, where 63 articles were of relevance and subsequently narrowed to a total of 28 articles into the final review for this study. We determined that immediate penile exploration and tunica repair is considered the most common and current management of penile fractures with experts demonstrating that it leads to the fastest in recovery in erectile function and positive cosmetic outcomes. However, we also determined that the specific algorithm can be variable-down to the suture material, use of catheterization, urethroplasty when involved, and length of recovery/follow-up. In the last several decades, men with penile fracture have been treated, in most cases, with immediate surgical intervention. This review highlights the varying practices regarding surgical exploration, injury repair, and postoperative management in men with a penile fracture. Immediate penile exploration and tunica repair have been the mainstay approach of management.
Topics: Catheterization; Humans; Male; Penile Erection; Penile Prosthesis; Penis; Postoperative Care; Plastic Surgery Procedures; Rupture; Suture Techniques
PubMed: 31685943
DOI: 10.1038/s41443-019-0212-1 -
Urologia Internationalis 2022The aim of this study is to review the literature on the use of antifungal prophylaxis in penile prosthesis (PP) surgery and provide a summary on its efficacy as an...
OBJECTIVE
The aim of this study is to review the literature on the use of antifungal prophylaxis in penile prosthesis (PP) surgery and provide a summary on its efficacy as an adjunct to current prophylactic regimes in patients undergoing PP surgery.
MATERIALS AND METHODS
PubMed, Medline, and EMBASE databases were systematically searched up to May 2020. All included studies were analysed and the information extracted included author, title of study, year of publication, type of study, journal of publication, and main findings regarding post PP implantation fungal infections.
RESULTS
Nine relevant studies were included in this review, comprising retrospective single-centre studies and retrospective multicentre studies ranging from 2017 to 2020. Fungal infections were found responsible for 11.1% of all PP infections, with a greater risk in patients with diabetes, obesity, and from warmer climates. Current American Urological Association (AUA) and European Association of Urology (EAU) prophylaxis guidelines do not incorporate the use of antifungals. Trials of antifungal prophylaxis regimes combined with antibiotic prophylaxis have demonstrated a reduction in PP fungal infections.
CONCLUSIONS
Fungal infections represent a significant proportion of implant infections and therefore antifungal prophylaxis is warranted. Future studies comparing the efficacy of traditional antibiotic prophylaxis as set out by AUA/EAU with novel prophylaxis regimes including the addition of an antifungal may provide more definitive guidance on this issue. Until then antifungal prophylaxis in all patients undergoing PP procedures may provide a significant cost-effect benefit.
Topics: Antifungal Agents; Humans; Male; Mycoses; Penile Diseases; Penile Prosthesis; Retrospective Studies
PubMed: 35235938
DOI: 10.1159/000522173 -
Archivio Italiano Di Urologia,... Jun 2024Erectile dysfunction can cause self-withdrawal and decreased quality of life. Patients who do not respond to pharmacological therapy and other conservative treatments... (Comparative Study)
Comparative Study Meta-Analysis
INTRODUCTION
Erectile dysfunction can cause self-withdrawal and decreased quality of life. Patients who do not respond to pharmacological therapy and other conservative treatments are urged to undergo penile prosthesis implantation. Malleable penile prosthesis was the first prosthesis developed, but then inflatable penile prosthesis was developed to give a more natural erection. There is no meta-analysis comparing inflatable and malleable penile prostheses in terms of safety and efficacy. This study is conducted to evaluate patient and partner satisfaction, ease of use, mechanical failure, and infection rate in patients who underwent penile prosthesis implantation.
METHOD
This meta-analysis followed Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols. Five eligible studies were included from Pubmed, Scopus, ScienceDirect, and SemanticScholar databases.
RESULT
In this study, patient and partner satisfaction are significantly better (OR 3.39, 95% CI 1.66-6.93, p = 0.0008) (OR 2.32, 95% CI 1.75-3.08, p < 0.00001). Mechanical failure is also significantly higher in inflatable penile prostheses (OR 5.60, 95% CI 2.02-15.53, p = 0.0009). There is no significant difference in terms of ease of use and infection rate in inflatable or malleable penile prostheses.
CONCLUSIONS
This study concluded that inflatable penile prosthesis is better in terms of patient and partner satisfaction, but mechanical failures occur more frequently in this type of prosthesis.
Topics: Humans; Male; Erectile Dysfunction; Penile Prosthesis; Patient Satisfaction; Prosthesis Design; Penile Implantation; Treatment Outcome; Quality of Life; Prosthesis Failure
PubMed: 38934528
DOI: 10.4081/aiua.2024.12353 -
The Journal of Urology Nov 2012This systematic review was done to compare the effectiveness of infection retardant coated inflatable penile prostheses vs noncoated devices. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This systematic review was done to compare the effectiveness of infection retardant coated inflatable penile prostheses vs noncoated devices.
MATERIALS AND METHODS
We systematically reviewed PubMed® and Galileo® to identify all relevant case studies. The postoperative infection incidence rate was compared for coated and noncoated inflatable penile prostheses to determine whether coating the implant affects the rate of surgical implant infection.
RESULTS
Included in analysis were 14 clinical case studies in a total of 9,910 patients with a first time implant, including 5,214 inflatable penile prostheses without an infection retardant coating and 4,696 coated inflatable penile prostheses impregnated with minocycline/rifampin (3,158), rifampin/gentamycin immersion (181), vancomycin/gentamycin immersion (181) and a hydrophilic coating only (1,176). For noncoated vs coated prostheses the infection rate was 2.32% vs 0.89% (p <0.01), including 0.63%, 0.55%, 4.42% and 1.11% for minocycline/rifampin, rifampin/gentamycin immersion, vancomycin/gentamycin immersion and hydrophilic coatings, respectively.
CONCLUSIONS
This analysis documents a significant advantage of using coated compared to noncoated inflatable penile prostheses to prevent postoperative device infection. Infection retardant coatings that allow antibiotics to elute off the device components decrease the incidence of device infection by approximately 50%. Future studies must address novel techniques, such as preventing bacterial adhesion, to further decrease infectious etiologies.
Topics: Anti-Bacterial Agents; Coated Materials, Biocompatible; Humans; Incidence; Male; Penile Prosthesis; Prosthesis Design; Prosthesis-Related Infections
PubMed: 22999690
DOI: 10.1016/j.juro.2012.07.022 -
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 -
Asian Journal of Andrology 2020With the onset of a metabolic syndrome epidemic and the increasing life expectancy, erectile dysfunction (ED) has become a more common condition. As incidence and...
With the onset of a metabolic syndrome epidemic and the increasing life expectancy, erectile dysfunction (ED) has become a more common condition. As incidence and prevalence increase, the medical field is focused on providing more appropriate therapies. It is common knowledge that ED is a chronic condition that is also associated with a myriad of other disorders. Conditions such as aging, diabetes mellitus, hypertension, obesity, prostatic hypertrophy, and prostate cancer, among others, have a direct implication on the onset and progression of ED. Characterization and recognition of risk factors may help clinicians recognize and properly treat patients suffering from ED. One of the most reliable treatments for ED is penile prosthetic surgery. Since the introduction of the penile prosthesis (PP) in the early seventies, this surgical procedure has improved the lives of thousands of men, with reliable and satisfactory results. The aim of this review article is to characterize the epidemiology of men undergoing penile prosthetic surgery, with a discussion about the most common conditions involved in the development of ED, and that ultimately drive patients into electing to undergo PP placement.
Topics: Diabetes Complications; Diabetes Mellitus; Erectile Dysfunction; Humans; Hypertension; Impotence, Vasculogenic; Male; Pelvic Bones; Penile Implantation; Penile Induration; Penile Prosthesis; Penis; Prostatectomy; Prostatic Neoplasms; Radiation Injuries; Radiotherapy; Reoperation; Spinal Cord Injuries; Vascular Diseases; Wounds and Injuries
PubMed: 31793443
DOI: 10.4103/aja.aja_124_19 -
The Journal of Sexual Medicine May 2019Penile prostheses are commonly used to achieve erectile rigidity after phalloplasty in trans masculine patients. Implantation poses significant challenges because of the...
BACKGROUND
Penile prostheses are commonly used to achieve erectile rigidity after phalloplasty in trans masculine patients. Implantation poses significant challenges because of the delicate nature of the neophallus and lack of native erectile tissue. Many groups have developed novel phalloplasty and prosthesis insertion techniques, but none have proven superior.
AIM
To analyze and aggregate reported characteristics and outcomes of penile prosthesis implantation in the trans masculine patient.
METHODS
A comprehensive literature search of Medline, EMBASE, and Cochrane Registry databases was conducted for studies published through February 19, 2019, with multiple search terms related to penile prosthesis use in gender-affirming surgical procedures.
OUTCOMES
Studies were included and tabulated if they reported prosthesis outcomes in patients who received a neophallus as part of a gender-affirming procedure.
RESULTS
23 journal articles met inclusion criteria from 434 references identified. All selected articles were either retrospective or case series/reports. A total of 1,056 patients underwent phalloplasty, and 792 received a penile prosthesis. Most (83.6%) of the prostheses were inflatable, whereas 16.4% were non-inflatable. The number of cylinders used for each prosthesis was 61.0% single-cylinder and 39.0% double-cylinder. The mean follow-up duration was 3.0 years. Of patients who received a prosthesis, 36.2% reported a prosthesis complication; at follow-up 60.0% of patients had their original implant present, and 83.9% reported achieving penetration.
CLINICAL IMPLICATIONS
Prosthesis implantation in gender-affirming operations poses significant risk of complication, but it is still a reasonable and useful method to achieve rigidity necessary for sexual intercourse.
STRENGTH & LIMITATION
This is the first study to aggregate all reported penile prosthesis characteristics and outcomes in trans masculine patients. This study was significantly limited by inconsistent reporting of demographics, sensation, urinary health, patient satisfaction, and penetrative sex. The lack of comparative studies precluded any meaningful meta-analytical comparison.
CONCLUSIONS
There is a great need for a prosthesis designed to meet the specific needs of the trans masculine patient after phalloplasty. Standardized methods of reporting implant outcomes including sexual function, sensation, and patient satisfaction should be refined for future studies. This study can assist patients and surgeons about the risks and benefits of this procedure. Rooker SA, Vyas KS, DiFilippo EC, et al. The Rise of the Neophallus: A Systematic Review of Penile Prosthetic Outcomes and Complications in Gender-Affirming Surgery. J Sex Med 2019;16:661-672.
Topics: Female; Humans; Male; Patient Satisfaction; Penile Erection; Penile Implantation; Penile Prosthesis; Penis; Transsexualism
PubMed: 30956105
DOI: 10.1016/j.jsxm.2019.03.009 -
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 -
The Journal of Sexual Medicine Apr 2016Penile prosthesis implantation has emerged as a definitive treatment to restore sexual function to the motivated man with erectile dysfunction. Substantial improvements... (Review)
Review
INTRODUCTION
Penile prosthesis implantation has emerged as a definitive treatment to restore sexual function to the motivated man with erectile dysfunction. Substantial improvements in the design of inflatable devices have been made since they first became available more than four decades ago.
AIM
To review the history of the penile prosthesis, the indications, preoperative evaluation, and patient and partner satisfaction. The current approaches to addressing intra- and postoperative complications, provide an understanding of prosthesis infection, and placement of these devices will be reviewed.
METHODS
A committee of worldwide experts in this field was assembled during the 2015 International Consultation on Sexual Medicine (ICSM) and performed a systematic review of the peer-reviewed published medical literature pertaining to penile prosthesis. Particular attention was given to higher level trials when available. Recommendations are based upon the Oxford Criteria.
MAIN OUTCOME MEASURES
Unfortunately there is limited level 1 and 2 evidence, and where expert opinion was utilized, the decision was unanimous within the committee with a goal of presenting a clinically relevant guideline pertaining to penile prostheses.
RESULTS
Penile prosthesis has undergone an evolution over the past 40 years resulting in a more effective and reliable treatment for advanced erectile dysfunction not responding to less invasive methods including oral treatment with PDE5 inhibitors, vacuum erection device, and intracorporal injection therapy. It should be considered an appropriate treatment option for the man who wishes to restore erectile function and who understands the potential risk of mechanical failure and infection, both of which are less common now as a result of improvements made in device design as well as surgical protocols adhered to in the operating room. Patients must be clearly informed of the risks associated with penile prosthesis including mechanical failure, infection, shortening of the penis, change in sensation and configuration of the penis, as well as injury to local structures. Intraoperative complications are unusual but do occur and can usually be addressed intraoperatively to allow placement of the device at the time of initial surgery. Postoperative complications may also be addressed when they occur but may require more advanced reconstructive surgical techniques. Men with Peyronie's disease, corporal fibrosis due to infection, trauma, prior prosthesis explantation, priapism, and men who have undergone construction of a neophallus may require additional advanced maneuvers to obtain optimum results with a penile prosthesis.
CONCLUSION
Penile prosthesis remains as an important, viable, and effective treatment for male erectile dysfunction that does not respond to other less invasive approaches or when these approaches are contraindicated or not acceptable to the patient. These devices provide the patient with the ability to engage in penetrative sexual activity without interfering with urination, ejaculation, sensation, or orgasm. Although mechanical failure can occur, the current devices are more reliable as a result of design modifications. Infection remains the most dreaded complication but since the introduction of antibiotic and hydrophilic coatings, infection is less common. Overall, patient and partner satisfaction appear to be reasonably high when a penile prosthesis is used to restore erectile function.
Topics: Adult; Erectile Dysfunction; History, 20th Century; Humans; Male; Penile Implantation; Penile Prosthesis; Penis; Postoperative Complications; Plastic Surgery Procedures; Referral and Consultation; Treatment Outcome
PubMed: 27045255
DOI: 10.1016/j.jsxm.2016.01.017