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Current Urology Reports Feb 2019The purpose of this review is to critically analyze and summarize recent studies in the area of penile prosthesis surgery outcomes with a focus on infection prevention... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to critically analyze and summarize recent studies in the area of penile prosthesis surgery outcomes with a focus on infection prevention in high-risk patients.
RECENT FINDINGS
Reduction of surgical time in complex prosthesis surgery may reduce infection risk. Concomitant implant surgery is not associated with increased infection risk. Certain immunocompromised patients may be more likely to have penile implant infections, but these may not include patients with well-controlled HIV, well-controlled diabetes, or transplant recipients. Substance abuse is correlated with increased risk of infection after penile implant surgery. Careful patient selection and preoperative optimization can reduce infection risk in spinal cord injury patients. In the last 5 years, there have been several important studies investigating the risk of penile prosthesis infection in complex patients, clarifying which patient categories are at increased risk and how that risk can be mitigated.
Topics: Humans; Male; Penile Diseases; Penile Implantation; Penile Prosthesis; Penis; Prosthesis-Related Infections; Risk Factors
PubMed: 30707308
DOI: 10.1007/s11934-019-0875-7 -
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 -
Sexually Transmitted Diseases Oct 2021
Topics: Gonorrhea; Humans; Male; Penis; Skin
PubMed: 33783410
DOI: 10.1097/OLQ.0000000000001428 -
Current Opinion in Urology May 2020In this review, we synthesize the most current data on strategies for the prevention and reduction of infections in men undergoing penile prosthesis surgery. We... (Review)
Review
PURPOSE OF REVIEW
In this review, we synthesize the most current data on strategies for the prevention and reduction of infections in men undergoing penile prosthesis surgery. We highlight important strategies for preventing infections along every step from patient selection, to the preoperative, intraoperative and postoperative states.
RECENT FINDINGS
Over the last decade, significant advances have been made to help minimize penile implant infections, with the most impactful likely being the introduction of antibiotic coated penile implants. Although this has led to infection rates lower than 0.5% being reported in some series, it appears that more virulent organisms are causing a larger share of infections.
SUMMARY
The change in the microbiology and persistent occurrence of penile implant infections challenges us to develop strategies to target these organisms by using novel antibiotic mixes for irrigation, dips and implant coatings. Equally important is the continual search to identify patient risk factors for the development of infections and the further optimization of the use of oral and intravenous antibiotics. It is likely we will find inspiration by looking at nonurological surgical specialties where implantation of permanent devices is routine.
Topics: Anti-Bacterial Agents; Humans; Male; Penile Implantation; Penile Prosthesis; Penis; Prosthesis-Related Infections
PubMed: 32168195
DOI: 10.1097/MOU.0000000000000744 -
Urology Dec 2020The implantation of penile protheses for the surgical treatment of erectile dysfunction has risen in popularity over the past several decades. Considerable advances have... (Review)
Review
The implantation of penile protheses for the surgical treatment of erectile dysfunction has risen in popularity over the past several decades. Considerable advances have been made in surgical protocol and device design, specifically targeting infection prevention. Despite these efforts, device infection remains a critical problem, which causes significant physical and emotional burden to the patient. The aim of this review is to broaden the discussion of best practices by not only examining practices in urology, but additionally delving into the field of orthopedic surgery to identify techniques and approaches that may be applied to penile prothesis surgery.
Topics: Anti-Bacterial Agents; Anti-Infective Agents; Antibiotic Prophylaxis; Biofilms; Cost-Benefit Analysis; Erectile Dysfunction; Humans; Male; Operating Rooms; Orthopedic Procedures; Penile Implantation; Penile Prosthesis; Penis; Prosthesis-Related Infections; Staphylococcus aureus; Surgical Wound Infection; Urology
PubMed: 32991908
DOI: 10.1016/j.urology.2020.08.060 -
The Journal of Sexual Medicine May 2019When a penile prosthesis is implanted, a fibrous tissue capsule gradually forms around it. In case of penile prosthesis infection, salvage and immediate reimplantation...
INTRODUCTION
When a penile prosthesis is implanted, a fibrous tissue capsule gradually forms around it. In case of penile prosthesis infection, salvage and immediate reimplantation into the same capsule that envelops the infected prosthesis is a trial to avoid the difficulty and shortening encountered with explantation and delayed reimplantation.
AIM
We propose that, on salvage, the infected prosthesis be explanted, the capsule washed out and then abandoned, and the replacement prosthesis implanted in the extracapsular sinusoidal space, between the capsule and tunica albuginea. This aims at decreasing contact between the replacement implant and the pyogenic membrane in the capsule.
METHODS
This study was performed in a tertiary implantation center, involving 20 prospective cases referred with either an infected implant or pump erosion. Through a penoscrotal incision, lateral corporotomies were performed by superficial cuts, in a trial to identify the extracapsular sinusoidal space before opening the capsule. The capsule was then opened. All components of the implant were explanted, and the capsules were washed out. The extracapsular space within the corpora cavernosa was developed between the capsule and the tunica albuginea by sharp dissection initially, then bluntly dilated with a Hegar dilator. A malleable penile prosthesis was implanted in the extracapsular space bilaterally.
MAIN OUTCOME MEASURES
The reinfection rate was evaluated though 7-38 months after surgery.
RESULTS
We were able to identify and dilate the extracapsular space in 18 of 20 cases. Reinfection occurred in 1 case (1 of 18, 5.6%). Development of the extracapsular space added approximately 10 minutes to the operative time.
CLINICAL IMPLICATION
If salvage of an infected penile implant can be delayed until capsule maturation, extracapsular implantation may decrease the reinfection rate.
STRENGTH & LIMITATIONS
The limitations are the lack of a control group of intra-capsular classic salvage and the relatively limited sample number.
CONCLUSION
On penile prosthesis salvage surgery, whether for infection or extrusion, implantation of the replacement prosthesis in the extracapsular sinusoidal tissue is associated with low infection rates, because it bypasses the capsule, which may still harbor bacterial contamination despite the wash-out. Shaeer O, Shaeer K, AbdelRahman IFS. Salvage and Extracapsular Implantation for Penile Prosthesis Infection or Extrusion. J Sex Med 2019;16:755-759.
Topics: Device Removal; Humans; Male; Penile Diseases; Penile Implantation; Penile Prosthesis; Penis; Prospective Studies; Prosthesis-Related Infections; Reoperation; Salvage Therapy
PubMed: 30898492
DOI: 10.1016/j.jsxm.2019.02.005 -
Progres En Urologie : Journal de... Jun 2002Infection of penile prostheses, estimated to occur in 3% of cases, represent the major complication of this type of prosthesis. Early sepsis occurs during the first week... (Review)
Review
Infection of penile prostheses, estimated to occur in 3% of cases, represent the major complication of this type of prosthesis. Early sepsis occurs during the first week and presents in the form of frank clinical features (pain, erythema, penile discharge); highly virulent bacteria are isolated, such as Staphylococcus aureus. Late sepsis occurs after an interval of several weeks to several months with less specific clinical features; Staphylococcus epidermidis is isolated in more than 50% of cases. Conventional treatment of these infections consists of antibiotics adapted to the local flora and removal of the prosthesis, sometimes followed by deferred reimplantation. Prosthetic material salvage procedures are now proposed. Patient-related risk factors for infection include diabetes, urinary tract infection and immunodepression, while procedure-related risk factors include the length of hospital stay, poor operative technique, prolonged operating time and iatrogenic urethral injuries. Prevention of sepsis of penile prostheses is based on prevention of these risk factors and prophylactic antibiotics or prolonged antibiotic therapy.
Topics: Bacterial Infections; Diabetes Complications; Drug Therapy, Combination; Erectile Dysfunction; Humans; Male; Penile Prosthesis; Penis; Postoperative Complications; Rifampin; Risk Factors; Vancomycin
PubMed: 12189743
DOI: No ID Found -
BMC Urology Aug 2021Penile enhancement with injectable agents is a rising trend and yet has received little scientific attention despite the potential for serious complications. These...
BACKGROUND
Penile enhancement with injectable agents is a rising trend and yet has received little scientific attention despite the potential for serious complications. These include cosmetic, functional and systemic complications that may require complex penile reconstructive surgery. We report a case of delayed severe infection following penile filler insertion leading to multi-organ failure and intensive care support.
CASE PRESENTATION
A 31-year-old man presented with fevers and progressive pain and swelling of the penile shaft, 3 days after unprotected sexual intercourse. The patient received subcutaneous hyaluronic filler injections at a cosmetic clinic for penile enlargement two months prior to presentation. Relevant social history include polysubstance abuse and multiple sexual partners. Physical examination revealed gross penile oedema and erythema, with a ventral curvature of the penile shaft and a superficial abrasion on the distal ventral penile shaft. Within 24 h the patient developed septic shock with anuria, hypotension and fevers to 40 °C, requiring transfer to the Intensive Care Unit (ICU) for vasopressor and inotropic support. Intraoperative penile exploration revealed multiple pus stained fillers which were drained and grew Streptococcus Pyogenes on cultures. There was no abscess or evidence of necrotising fasciitis intraoperatively. The patient improved with intravenous antibiotics and was stepped down from the ICU after four days and discharged on day eight. One month post admission there was significant superficial skin loss to both ventral and lateral aspect of the penis, with healthy granulation tissue at the base. The patient opted for conservative management with regular dressings. He reported normal sexual and urinary function three months post admission.
CONCLUSION
This is the first published case of sepsis from a penile infection in the context of hyaluronic acid penile fillers. In an era of escalating demand for penile cosmetic procedures, there is an increasing need for early recognition and appropriate management of penile filler infections. We report an unusual case of a localised penile infection rapidly progressing to sepsis with multi-organ failure requiring intensive care support. The case demonstrates early surgical intervention with targeted antimicrobials can result in successful eradication of infection, with satisfactory cosmetic and functional outcomes for patients.
Topics: Adult; Anti-Bacterial Agents; Dermal Fillers; Humans; Hyaluronic Acid; Male; Penile Diseases; Penis; Streptococcal Infections; Streptococcus pyogenes
PubMed: 34429077
DOI: 10.1186/s12894-021-00878-5 -
The New England Journal of Medicine Mar 2020
Topics: AIDS-Related Opportunistic Infections; CD4 Lymphocyte Count; HIV Infections; Herpesvirus 8, Human; Humans; Male; Middle Aged; Penile Neoplasms; Penis; Sarcoma, Kaposi
PubMed: 32187472
DOI: 10.1056/NEJMicm1908438 -
International Journal of STD & AIDS Oct 2020Prospective data are limited on human papillomavirus (HPV) acquisition and clearance among circumcised men from resource-limited geographical regions, particularly...
Prospective data are limited on human papillomavirus (HPV) acquisition and clearance among circumcised men from resource-limited geographical regions, particularly Africa. The goal of this study was to estimate incidence and clearance of type-specific genital HPV infection in men. Penile exfoliated cell specimens were collected from the glans/coronal sulcus and shaft of 1,037 circumcised Kenyan men at baseline and 6-, 12- and 18-month follow-up visits between 2003-2007. Specimens were tested with GP5+/6+ PCR to detect 44 HPV types. The median age of participants at baseline was 21 years (range 18-28). The 12- and 18-month incidence rates (IRs) for any HPV were 34.9/100 person-years (95% confidence interval [CI]: 31.2-39.0) and 36.4/100 person-years (95% CI: 32.9-40.2), respectively. The 18-month cumulative risk for high-risk HPV was 30% compared to 16% for low-risk HPV. Cumulative risk was not associated with age or anatomical site. The estimated probability of any HPV infection clearing by 12 months was 0.92. Time until HPV clearance was not associated with age, anatomical site, or whether HPV infection type was high-risk or low-risk. HPV IRs among circumcised men in this study were comparable to other circumcised populations.
Topics: Adolescent; Adult; Circumcision, Male; Humans; Incidence; Kenya; Male; Papillomaviridae; Papillomavirus Infections; Penile Diseases; Penis; Polymerase Chain Reaction; Sexually Transmitted Diseases; Young Adult
PubMed: 32928051
DOI: 10.1177/0956462420948370