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International Journal of Impotence... May 2022The term scrotoplasty embraces several techniques which aim to restore a normal scrotal appearance and function. We provide here a quick reference tool to allow the... (Review)
Review
The term scrotoplasty embraces several techniques which aim to restore a normal scrotal appearance and function. We provide here a quick reference tool to allow the urologist to select the appropriate surgical strategy among the several available options. A comprehensive research was carried out on MEDLINE/PubMed to identify relevant studies concerning this topic, including a range of key words, e.g., scrotoplasty, ventral phalloplasty, scrotal reconstruction, scrotomegaly, penoscrotal web, scrotal lifting, scrotal reduction, scrotectomy, scrotal lymphoedema. Scrotal skin defects may be related with Fournier's gangrene, traumatic events, and surgery for genital cancers or peno-scrotal lymphoedema. The reconstructive management of these conditions is relatively reproducible in the hands of experienced urologists, if aware of the basics of scrotal surgery. Primary tension-free wound closure and local pedicled flaps typically allow optimal surgical outcomes for repairing most of these scrotal defects, with split-thickness skin grafts (STSGs) and/or distant flaps being required only when dealing with extensive skin losses. The demand for genitals' aesthetic surgery among adults is on the increase recently. Although the scientific evidence regarding this topic is scarce, reduction scrotoplasty and peno-scrotal webbing correction techniques are easy, safe and effective solutions to improve genital cosmesis, being carried out in isolation or in combination with penile prosthesis implantation. More robust scientific evidence is needed to achieve a uniformed consensus regarding the optimal surgical management in this broad field, and surgical innovation should continue to refine current reconstructive techniques.
Topics: Adult; Fournier Gangrene; Humans; Lymphedema; Male; Plastic Surgery Procedures; Scrotum; Surgical Flaps
PubMed: 34635818
DOI: 10.1038/s41443-021-00468-x -
European Urology Focus Sep 2020The genesis of neurogenic sexual dysfunction (NSD) can be central, peripheral, or both. The correct stratification of the level of sexual dysfunction allows the...
CONTEXT
The genesis of neurogenic sexual dysfunction (NSD) can be central, peripheral, or both. The correct stratification of the level of sexual dysfunction allows the clinician to choose the best type of treatment, in order to reduce sexual complaints.
OBJECTIVE
The aim of our review is to focus on the management of NSD due to central nervous system disorders and peripheral neuropathy.
EVIDENCE ACQUISITION
A systematic review of the English-language literature was completed until July 2019 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The following terms were included: [(neurogenic sexual dysfunction) OR neurogenic erectile dysfunction)] AND (treatment OR management). An Excel file was created respecting the following criteria: participants, interventions, comparators, outcomes, and study design (PICOS).
EVIDENCE SYNTHESIS
Overall, from 505 identified records, 52 full-text articles were assessed for eligibility. Finally, 46 original researches were included in quantitative analysis.
CONCLUSIONS
The phosphodiesterase type 5 inhibitors sildenafil, tadalafil, and vardenafil were proved to be effective and safe in first-line therapy of erectile dysfunction caused by neurogenic disorders. In addition, intracavernous injections of prostaglandin E1, papaverine, or phentolamine and vacuum systems have been a mainstay of second-line treatment for NSD, extremely successful in the spinal cord injury population. Surgical therapy via penile prosthesis implantation remains a viable alternative as a third-line approach and may also be utilised to assist men with bladder management, despite higher complication rates of infections. Despite poor evidence, a better understanding of female sexual dysfunction due to neurological complaints is needed, in order to find more efficacious therapies for intercourse and orgasmic phase. Further prospective studies are required to better clarify the more successful treatment in improving sexual function and quality of life of these patients.
PATIENT SUMMARY
Management of neurogenic sexual dysfunction includes phosphodiesterase type 5 inhibitors, intracavernous injections/vacuum devices, and penile prosthesis implantation. Female sexual dysfunction due to neurological disease needs to be better investigated.
Topics: Central Nervous System Diseases; Female; Humans; Male; Peripheral Nervous System Diseases; Sexual Dysfunction, Physiological
PubMed: 31879263
DOI: 10.1016/j.euf.2019.12.002 -
Actas Urologicas Espanolas Jun 2020Reduction in penile size is due to numerous conditions including Peyronie's disease, previous penile surgeries, diabetes, trauma, erectile dysfunction, pelvic surgery,...
INTRODUCTION
Reduction in penile size is due to numerous conditions including Peyronie's disease, previous penile surgeries, diabetes, trauma, erectile dysfunction, pelvic surgery, and aging. Elasticity of the tunica albuginea is adversely affected by any of the above. Fibrosis then triggers progressive erectile dysfunction OBJECTIVES: When a penile prosthesis is indicated, it is important to determine whether the penis has already diminished in size prior to insertion of the implant. Because a prosthesis only provides axial rigidity and is not associated with the enlargement of the penis, reflection of strategies to simultaneously enlarge the size of the penis while implanting a device is recommended.
MATERIAL AND METHODS
A systematic review of current scientific literature regarding procedures and tactics currently available for penile implants and enlargement was conducted.
RESULTS
The literature demonstrates that the evolution of penile implant surgery, accompanied by consideration of enlargement, has evolved through 5 fundamental techniques: Incision with Grafting; Sliding with Grafting; Modified Sliding without Grafting (MoST); Multiple Slit without Grafting (MUST); and the Egydio Paradigm for Tunica Expansion Procedures (TEP), a further evolution of previous strategies to achieve state of the art penile implantation accompanied by maximum penile enlargement. Evolving technology of tunica expansion procedures has led to diminution of the size of tunica defects and avoidance of grafts to prevent bulging and indentation, while developing solutions to preserve the strength of the tunica albuginea for firm positioning of the cylinders in the interior of the corpora cavernosa.
CONCLUSIONS
The evolution of these techniques is the transformation of larger tunica defects into smaller ones. While grafts are often used to reinforce the penile structure due to large defects, multiple incisions of the tunica albuginea are gaining popularity to promote girth and length enlargement without grafts and without the loss of tunica strength necessary to support the cylinders inside the corpora.
Topics: Humans; Male; Organ Size; Penile Implantation; Penile Prosthesis; Penis; Prosthesis Design; Urologic Surgical Procedures, Male
PubMed: 32278614
DOI: 10.1016/j.acuro.2019.10.015 -
Urology Case Reports Sep 2017We present a case from a running series of inflatable penile prosthesis failure due to improper folding of the Conceal™ reservoir. The Conceal™ Low-Profile reservoir...
We present a case from a running series of inflatable penile prosthesis failure due to improper folding of the Conceal™ reservoir. The Conceal™ Low-Profile reservoir gained popularity due to claims of improved cosmesis and ease of implantation. As the number of patients receiving this and other low-profile reservoirs increases, it is imperative to review and document any novel complications. While the Conceal™ reservoir may be preferred in ectopic placement, it may be more prone to fluid lockout facilitated by conformational change. Our review did not identify prior reports of improper folding, which we believe is unique to these low-profile reservoirs.
PubMed: 28791220
DOI: 10.1016/j.eucr.2017.06.009 -
Sexual Medicine Reviews Jul 2019Ischemic priapism (IP) is the most common form of priapism. In cases of priapism persisting for >36 hours, conservative management usually fails, and the patients'...
INTRODUCTION
Ischemic priapism (IP) is the most common form of priapism. In cases of priapism persisting for >36 hours, conservative management usually fails, and the patients' erectile tissue will be inevitably compromised, resulting in corporal fibrosis, shortening of the penis, and refractory erectile dysfunction. In this subset of patients, early implantation of a penile prosthesis (PP) could be a solution for both the priapic episode and the erectile dysfunction.
AIM
To analyze the current literature with regard to the correlation between refractory ischemic priapism and immediate implantation of PP.
METHODS
An extensive literature research was conducted to retrieve studies focusing on immediate PP implantation in patients suffering from refractory ischemic priapism (RIP).
MAIN OUTCOME MEASURES
We evaluated the functional outcomes of patients who have undergone the immediate insertion of a PP as treatment for an acute episode of IP refractory to medical therapy or shunt surgery.
RESULTS
Nine studies were included in this systematic review, including 3 case reports and 6 retrospective analyses. All studies agreed that in patients with RIP, early insertion of a PP is a safe and effective procedure, and all studies but 1 preferred malleable implants to inflatable implants.
CONCLUSION
The systematic review does not demonstrate superiority of immediatePP implantation over delayed PP implantation, because none of the studies was designed with this purpose. However, considering the reduced complication rate and the ease of the procedure, all studies are in favor of early implantation over delayed implantation. Capece M, La Rocca R, Mirone V, et al. A Systematic Review on Ischemic Priapism and Immediate Implantation: Do We Need More Data? Sex Med Rev 2018;7:530-534.
Topics: Humans; Ischemia; Male; Penile Erection; Penile Implantation; Penile Prosthesis; Priapism; Time Factors
PubMed: 30898595
DOI: 10.1016/j.sxmr.2018.10.007 -
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
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, I2:0%). 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, I2:36% and OR:1.7, 95%CI: 1.25-2.32, I2:0%, 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.
Topics: Humans; Male; Erectile Dysfunction; Urinary Incontinence, Stress; Penile Implantation; Reoperation; Prostatectomy
PubMed: 37051965
DOI: 10.1016/j.sxmr.2022.08.003 -
Journal of Pediatric Urology Jun 2021We present a different salvage procedure for penile prosthesis implantation in a De Castro neophallus.
INTRODUCTION
We present a different salvage procedure for penile prosthesis implantation in a De Castro neophallus.
METHODS
A patient with congenital aphallia had been operated at the age of 11. Ten years later he had two non successful attempts of prosthesis implantation. Surgery consisted of adapting the implants into the aortic graft and folding it in the middle over the cylinders to reinforce its strength.
RESULTS
Patient had a successful postoperative course and has now 6 months of follow-up.
DISCUSSION
In a systematic review of penile prosthetic outcomes and complications in gender-affirming surgery, most of the prostheses were inflatable (83.6%) and single-cylinder (61.0%). At a mean follow-up of 3.0 years: 36.2% of prosthesis complications, 60.0% of patients had their original implant present and 83.9% reported achieving penetration. We decided to use vascular grafts as a scaffold because of former non successful attempts.
CONCLUSION
The use of vascular prosthesis as a device to implant the penile prosthesis seems to be a safe and effective alternative in an attempt to offer erectile function to the neophallus in case of congenital aphallia.
Topics: Erectile Dysfunction; Humans; Male; Patient Satisfaction; Penile Diseases; Penile Implantation; Penile Prosthesis; Penis; Prosthesis Implantation; Sex Reassignment Surgery
PubMed: 33716000
DOI: 10.1016/j.jpurol.2021.02.018 -
International Journal of Impotence... Feb 2024Surgical treatments for ischemic priapism (IP) include shunts or penile implants. Non-ischemic priapism (NIP) is usually the result of penile/perineal trauma causing an... (Review)
Review
Surgical treatments for ischemic priapism (IP) include shunts or penile implants. Non-ischemic priapism (NIP) is usually the result of penile/perineal trauma causing an arterial fistula and embolisation may be required. We conducted a systematic review on behalf of the EAU Sexual and Reproductive health Guidelines panel to analyse the available evidence on efficacy and safety of surgical modalities for IP and NIP. Outcomes were priapism resolution, sexual function and adverse events following surgery. Overall, 63 studies (n = 923) met inclusion criteria up to September 2021. For IP (n = 702), surgery comprised distal (n = 274), proximal shunts (n = 209) and penile prostheses (n = 194). Resolution occurred in 18.7-100% for distal, 5.7-100% for proximal shunts and 100% for penile prostheses. Potency rate was 20-100% for distal, 11.1-77.2% for proximal shunts, and 26.3-100% for penile prostheses, respectively. Patient satisfaction was 60-100% following penile prostheses implantation. Complications were 0-42.5% for shunts and 0-13.6% for IPP. For NIP (n = 221), embolisation success was 85.7-100% and potency 80-100%. The majority of studies were retrospective cohort studies. Risk of bias was high. Overall, surgical shunts have acceptable success rates in IP. Proximal/venous shunts should be abandoned due to morbidity/ED rates. In IP > 48 h, best outcomes are seen with penile prostheses implantation. Embolisation is the mainstay technique for NIP with high resolution rates and adequate erectile function.
Topics: Male; Humans; Priapism; Retrospective Studies; Reproductive Health; Penis; Penile Erection; Penile Prosthesis
PubMed: 36151318
DOI: 10.1038/s41443-022-00604-1 -
The French Journal of Urology Jun 2024The salvage procedure for infected penile implants (IPs) has been a subject of interest since its inception in the late 1980s, yet its widespread adoption remains... (Review)
Review
BACKGROUND
The salvage procedure for infected penile implants (IPs) has been a subject of interest since its inception in the late 1980s, yet its widespread adoption remains limited. The aim of this study was to realize a systematic literature review to provide a comprehensive analysis of salvage techniques for IPs and assess their efficacy, specifically focusing on functional success.
METHODS
A systematic literature review was conducted using PubMed, employing Mesh terms related to penile prosthesis, penile implant, infection, and salvage procedures. Articles in French or English were considered for the final analysis, with exclusion of literature reviews.
RESULTS
Fifteen articles detailing various salvage techniques for IPs were identified. Mulcahy's initial technique was described in 1996, and consisted of complete removal of infected components, extensive lavage, and subsequent replacement with a similar implant. Success rates ranged from 80% to 100%, with emerging trends favoring the use of malleable implants during salvage. Unfortunately, functional data remained limited. When salvage penile prosthesis placement involved a malleable prosthesis, between 20% and 33% of patients underwent conversion to hydraulic prosthesis.
CONCLUSION
The salvage procedure for infected penile implants is a reliable method, with success rates surpassing 80%. The need for comparative studies assessing the type of implant used during salvage is required to tailor conservative management strategies for optimal patient outcomes. Finally, few data have been published regarding subsequent conversions from malleable penile implants to hydraulic penile implants after salvage.
Topics: Humans; Male; Salvage Therapy; Penile Prosthesis; Prosthesis-Related Infections; Treatment Outcome; Penile Implantation; Device Removal
PubMed: 38697265
DOI: 10.1016/j.fjurol.2024.102641 -
Urology Jun 2021Defining risks associated with diabetes mellitus (DM) in patients undergoing penile prosthesis (PP) implantation remains controversial. This systematic review seeks to...
A Systematic Review of Literature Regarding Whether Immediate Preoperative Hemoglobin A1c or Serum Glucose Are Risk Factors for Infection Following Penile Prosthesis Implantation.
Defining risks associated with diabetes mellitus (DM) in patients undergoing penile prosthesis (PP) implantation remains controversial. This systematic review seeks to assess whether preoperative hemoglobin a1c (HbA1c) or serum glucose have been shown to predict infection following PP implantation in diabetic men. A stepwise literature search was performed. Eight and four studies assessing HbA1c and serum glucose respectively were included. Overall, data exploring HbA1c and serum glucose on PP infection were heterogeneous in time period, study design, and patient populations. Contemporary studies did not support either HbA1c nor blood glucose as predictors of PP infection in diabetic men.
Topics: Blood Glucose; Glycated Hemoglobin; Humans; Male; Penile Implantation; Penile Prosthesis; Preoperative Period; Prosthesis-Related Infections; Risk Factors; Time Factors
PubMed: 33705821
DOI: 10.1016/j.urology.2021.01.066