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Surgical Infections Feb 2016Controversy still exists in some centers on whether diabetes mellitus is a risk factor for penile prosthesis infection. The aim of this review is to examine the evidence... (Review)
Review
BACKGROUND
Controversy still exists in some centers on whether diabetes mellitus is a risk factor for penile prosthesis infection. The aim of this review is to examine the evidence correlating penile implant infections to the presence of diabetes mellitus in patients with organic erectile dysfunction.
METHODS
We performed a systematic review searching through Medline database from 1960 to 2014, using keywords; penile prosthesis(es), penile implant(s), and diabetes mellitus. We used the Prisma 2009 Flow diagram for systematic reviews. Thirty-eight publications were selected for inclusion in this qualitative analysis.
RESULTS
Most case series reporting a greater infection rate in patients with diabetes mellitus date from the 1970s to 1990s. These series reported an infection rate of 5.5 to 20% and contained small cohort of patients. In the 1990s larger case series reported a lower infection rate in patients with diabetes mellitus compared with patients with paraplegia, pelvic trauma, and patients on steroids, but still reported an infection rate as high as 10.6%. With the implementation of antibiotic coated implants in 2001, infection rates reduced further with reported rates becoming less than 2% in patients with diabetes mellitus. The latest and largest case series by Eid et al. (2012) reported an infection rate of 0.46% with antibiotic coated implants and "no touch" technique in a cohort of 1511 cases, out of which 41% were patients with diabetes mellitus.
CONCLUSION
Strong evidence exists that the risk of penile prosthesis infection has reduced over the decades with device improvement and surgical expertise. In larger case series infection rates in patients with diabetes mellitus is not statistically significant from that experiences in the population at large.
Topics: Diabetes Complications; Erectile Dysfunction; Humans; Male; Penile Prosthesis; Prosthesis-Related Infections; Risk Assessment
PubMed: 26426099
DOI: 10.1089/sur.2015.164 -
Cureus Nov 2020There are only two three-piece inflatable penile prostheses (IPP) available to patients in the American market: the AMS (American Medical Systems) 700 series (Boston... (Review)
Review
There are only two three-piece inflatable penile prostheses (IPP) available to patients in the American market: the AMS (American Medical Systems) 700 series (Boston Scientific, Massachusetts) and the Coloplast Titan® series (Coloplast, Minnesota), and data comparing the two are scant. The aim of our study was to summarize the current scientific evidence comparing the two. A systematic literature review was conducted on PubMed. A 10-year filter was placed to include only studies published after Coloplast launched the Titan Touch® release pump. Eligibility criteria included articles discussing specifically the AMS 700 and Coloplast Titan® models. Further searches for studies on patient/partner satisfaction were conducted. Abstracts were reviewed to include studies focusing specifically on the models we are studying and studies on patient satisfaction using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. The Coloplast device demonstrated slightly greater resistance to the stimulated forces of penetration and gravity. Coloplast implants coated with vancomycin/gentamicin had the highest infection rate followed by the AMS penile prosthesis and the rifampin/gentamicin coating had the lowest infection rate. Prosthesis durability and survival were similar between both brands. Overall satisfaction was high but comparisons are inconsistent. The literature is inconclusive about which device is superior. We suggest randomized, multicenter, prospective studies to help further elucidate the highlights of each product.
PubMed: 33304685
DOI: 10.7759/cureus.11350 -
Sexual Medicine Reviews Jul 2022Penile modeling to correct the penile curvature in Peyronie's disease (PD) may be achieved manually (intra-operatively or post-injection) or by using assisted devices...
INTRODUCTION
Penile modeling to correct the penile curvature in Peyronie's disease (PD) may be achieved manually (intra-operatively or post-injection) or by using assisted devices (penile traction, vacuum device, or penile prosthesis).
OBJECTIVES
To evaluate the efficacy, safety, and satisfaction associated with penile modeling in patients with PD.
METHODS
A PROSPERO registered (CRD42021241729) systematic search in MEDLINE and Cochrane Library was done following PRISMA. PICO: Studies were deemed eligible if they assessed patients with PD (P) undergoing modeling procedures (I) with or without a comparative group(C) evaluating the efficacy, safety, or patient satisfaction (O). Retrospective and prospective primary studies were included. The primary outcome measure is the change in penile curvature after modeling. The secondary outcome measures are the change in stretched penile length, adverse events, and patient satisfaction after modeling.
RESULTS
A total of 23 studies, involving 1,238 patients were included. Most studies (13, 56.5%) evaluated penile traction therapy. The studies were of low and intermediate quality (mean Newcastle-Ottawa Scale score of 5.7 and mean Jadad score of 3.3) with a mean level of evidence of 3.4. The mean penile curvature at baseline was between 31 and 80.8 degrees. Nine (39.1%) studies found a significant improvement (P < .05) of penile curvature after penile modeling, ranging between 11.7, and 37.2 degrees. An increase in mean stretched penile length was reported in 7 (30.4%) articles, varying between 0.4, and 1.8 cm. Serious complications such as penile prosthesis malfunctions (3.3-11.1%) and urethral injuries (2.9%) were only reported for intra-operative manual modeling.
CONCLUSION
Although individual studies have noted improvement in penile curvature and stretched penile length, specific recommendations regarding penile modeling in PD cannot be provided due to limited evidence available. Further RCTs with adequate sample size, validated assessment tools, and longer follow-up are needed. Krishnappa P, Manfredi C, Sinha M et al. Penile Modeling in Peyronie's Disease: A Systematic Review of the Literature. Sex Med Rev 2022;10:427-443.
Topics: Humans; Male; Penile Induration; Penis; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 35153155
DOI: 10.1016/j.sxmr.2022.01.001 -
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 -
Therapeutic Advances in Urology 2023The leakage of urine during sexual arousal, known as climacturia, is an under-recognized clinical condition often overshadowed by erectile dysfunction in men who have... (Review)
Review
BACKGROUND
The leakage of urine during sexual arousal, known as climacturia, is an under-recognized clinical condition often overshadowed by erectile dysfunction in men who have undergone radical prostatectomy.
OBJECTIVES
This study aims to determine and evaluate the role of the Mini-Jupette technique and its alternatives in the treatment of climacturia.
DATA SOURCES AND METHODS
We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. We searched Medline PubMed, Scopus, and the Cochrane Library databases until October 2022.
RESULTS
We included seven studies involving 120 patients with climacturia. Different types of grafts were used, ranging from synthetic mesh to autologous grafts. In all seven studies, the use of the Adrianne Mini-Jupette (AMJ) and its alternatives showed a high percentage of improvement in climacturia, with reported complete resolution ranging from 65% to 93%. Regarding postoperative complications, one study reported the highest sling explantation rate at 11% (4/38), while other studies reported complications ranging from subjective symptoms such as dysuria and perineal pain to the need for subsequent artificial urinary sphincter placement.
CONCLUSION
The AMJ sling and its variations are low-cost, time-efficient, and relatively safe procedures with high patient satisfaction rates among those treated for climacturia.
PubMed: 38090352
DOI: 10.1177/17562872231215180 -
Sexual Medicine Reviews Jun 2024
Correction to: A systematic review comparing different approaches for inflatable penile prosthesis revision: partial-component exchange, complete-component exchange, or reservoir "drain and retain".
PubMed: 38909274
DOI: 10.1093/sxmrev/qeae047 -
Progres En Urologie : Journal de... Mar 2014The aim of the current study was to provide an overview about the surgical and medical management of acquired and congenital penile's curvature. (Review)
Review
INTRODUCTION
The aim of the current study was to provide an overview about the surgical and medical management of acquired and congenital penile's curvature.
MATERIALS AND METHODS
[corrected] A systematic review of the literature was done from the PubMed database by searching the following keywords alone or in combination: Congenital penile curvature; Congenital penile deviation; Acquired penile curvature; Acquired penile deviation; Peyronie's disease.
RESULTS
The treatment of congenital curvature is only surgical. The most common technique is the Nesbit's technique which consists in making elliptical excisions of the tunica albuginea. There are also incison or plication procedures which are efficient as well. Acquired curvature is most of the time represented by the Peyronie's disease or is post-traumatic. Among oral treatments available, the Potaba is the only drug which has proved a significant reduction in penile plaque size. Injections of interferon and nicardipine have also shown their efficacy. Ionotophoresis and extracorporeal shock-wave therapy may be beneficial for penile pain. Other therapies (vacuum, traction devices, topical Verapamil) can be interesting but other studies are necessary to recommend them. Surgical treatment is recommended during the fibrotic phase. The most common technique is also the Nesbit's technique. In case of severe curvature (curve superior to 60°), small penis, major deformations, graft techniques can be used. Moreover, if there is a sexual dysfunction, penile prosthesis is recommended.
CONCLUSION
Other studies are necessary to prove the efficacy of most of the drugs already available in the treatment of the penile curvature. It seems to be interesting to combine the different treatments to improve the results of those therapies.
Topics: Congenital Abnormalities; Humans; Male; Penile Induration; Penis; Urologic Surgical Procedures, Male
PubMed: 24560211
DOI: 10.1016/j.purol.2013.08.328 -
Sexual Medicine Reviews Apr 2016The most common cause of urinary incontinence in men after radical prostatectomy is intrinsic sphincter deficiency, which can affect long-term quality of life. The... (Review)
Review
INTRODUCTION
The most common cause of urinary incontinence in men after radical prostatectomy is intrinsic sphincter deficiency, which can affect long-term quality of life. The prevalence of stress urinary incontinence (SUI) after radical prostatectomy has been reported to be 2.5% to 90%. For patients with moderate to severe male SUI, the artificial urinary sphincter (AUS) is considered the gold standard in surgical treatment.
AIM
To review the available literature on the development, patient selection, surgical technique, complications, and management of AUS for male SUI.
METHODS
A literature review was performed through PubMed from 1947 to 2015 regarding AUS for male SUI.
MAIN OUTCOME MEASURES
To assess various surgical techniques related to AUS insertion, outcomes, and complications and to offer recommendations regarding management of complications.
RESULTS
The AUS can be placed through a perineal or trans-scrotal incision, particularly in the setting of dual insertion of an AUS and an inflatable penile prosthesis. The most commonly used cuff is 4.0 cm. The efficacy of InhibiZone is debatable. Pressure-regulating balloons can be filled with saline or contrast material and can be placed in an orthotopic or an ectopic location. In a systematic review of the literature, dry or improved continence rates are achieved in 79% of patients, with 90% reporting satisfaction and improved quality-of-life index scores after surgery. The most common AUS complications include a nonfunctioning device, sub-cuff atrophy, erosion, and infection. These complications are managed by strategies such as cuff downsizing, tandem cuff placement, and explantation. Dual AUS and inflatable penile prosthesis insertion is feasible for patients with SUI and erectile dysfunction.
CONCLUSION
The AUS is a durable and effective device for the management of SUI. Surgeons should be versed in the different device components, their potential complications, and their management.
Topics: Humans; Male; Patient Satisfaction; Prostatectomy; Quality of Life; Urinary Incontinence, Stress; Urinary Sphincter, Artificial
PubMed: 27872025
DOI: 10.1016/j.sxmr.2015.11.004 -
Sexual Medicine Reviews Oct 2022The efficacy, safety, and postoperative outcomes of synchronous surgery for concomitant erectile dysfunction (ED) and stress urinary incontinence (SUI) remain unclear. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The efficacy, safety, and postoperative outcomes of synchronous surgery for concomitant erectile dysfunction (ED) and stress urinary incontinence (SUI) remain unclear.
OBJECTIVES
We performed a systematic review and meta-analysis to evaluate the available synchronous surgical approaches for concomitant ED and SUI and to assess the reoperation rates compared to asynchronous surgery and surgery only for ED or SUI.
METHODS
We searched PubMed, Cochrane Library, and Embase databases until June 2022 for relevant studies. Based on data availability, we performed a meta-analysis of odds ratios (ORs) comparing reoperation rates after synchronous surgery in patients with concomitant ED and SUI versus asynchronous surgery, as well as surgery solely for ED or SUI (PROSPERO: CRD42022326941).
RESULTS
We included 18 studies in the systematic review (16,517 patients) and 5 in the meta-analysis. Comparing synchronous implantation of penile prosthesis and artificial urinary sphincter (AUS) versus asynchronous surgery, no statistically significant differences were observed in the reoperation rates [OR:0.98, 95% confidence interval (CI): 0.52-1.84, I:0%). Comparing synchronous implantation of both penile prosthesis and AUS versus implantation of only a penile prosthesis or an AUS, combined surgery was associated with higher reoperation rates (OR:2.02, 95%CI: 1.29-3.16, I:36% and OR:1.7, 95%CI: 1.25-2.32, I:0%, respectively). Synchronous surgery led to high satisfaction rates and significant improvement in ED and SUI. Evidence for the combination of penile prosthesis with a male sling or the ProACT device is low, but data suggests it may be safe and effective. The synchronous placement of a Mini-Jupette sling and penile prosthesis represents a promising treatment modality for the correction of ED and mild SUI and/or climacturia.
CONCLUSIONS
Synchronous penile prosthesis and AUS implantation appears safe and effective in patients with severe ED and SUI. Further high-quality studies are mandatory to strengthen the current scarce evidence for synchronous surgery in patients with ED and SUI. Pyrgidis N, Barham DW, Hammad M, et al. Synchronous Surgical Management of Erectile Dysfunction and Stress Urinary Incontinence: A Systematic Review and Meta-Analysis of Reoperation Rates. Sex Med Rev 2022;10:782-790.
Topics: Erectile Dysfunction; Humans; Male; Penile Prosthesis; Reoperation; Urinary Incontinence, Stress; Urinary Sphincter, Artificial
PubMed: 36175310
DOI: 10.1016/j.sxmr.2022.08.003 -
International Journal of Impotence... Nov 2020A phalloplasty is a complex genital reconstruction procedure of creating a neophallus. Several techniques to create a neophallus are described, based on different... (Review)
Review
A phalloplasty is a complex genital reconstruction procedure of creating a neophallus. Several techniques to create a neophallus are described, based on different vascularized flaps, and each of them has its advantages and drawbacks. The aim of this study is to present musculocutaneous latissimus dorsi (MLD) flap as a viable option for total phalloplasty, with an interest in clinical outcomes and complications. A comprehensive literature review of all available reports about MLD flap phalloplasty was made. The following keywords were used on PubMed: latissimus dorsi musculocutaneous/myocutaneous free flap and phalloplasty. Research criteria revealed five articles and the results of 182 patients were analyzed. A total number of the patients, indications, operative technique, follow-up period, postoperative results, and complications were presented. In conclusion, MLD free flap presents a good choice for phalloplasty providing sufficient amount of tissue for safe implantation of penile prosthesis and successful penetrative sexual intercourse. The erogenous sensitivity is preserved with clitoris or glans penis incorporated into the base of the neophallus, and voiding in a standing position is achievable after urethral reconstruction. The main drawback is the lack of tactile sensation of the neophallus and the significant advantage is a well-concealed donor site.
Topics: Female; Humans; Male; Penile Prosthesis; Penis; Plastic Surgery Procedures; Surgical Flaps; Urethra
PubMed: 33184508
DOI: 10.1038/s41443-020-00371-x