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The Journal of Sexual Medicine May 2022In 2016, we reported the first case of high flow priapism and arteriocavernosal fistula caused by penile prosthesis insertion that mimicked device autoinflation. (Review)
Review
BACKGROUND
In 2016, we reported the first case of high flow priapism and arteriocavernosal fistula caused by penile prosthesis insertion that mimicked device autoinflation.
AIM
To raise awareness amongst implanters, we describe further cases from our institution and perform a systematic review of the literature to understand the rarity of this phenomenon.
METHODS
Patient demographics, management and outcomes were extracted retrospectively. A systematic search of the EMBASE, PubMed and PubMed Central libraries for studies reporting arteriocavernosal fistula mimicking autoinflation since 1946 was performed.
OUTCOMES
To identify and report all known cases of high flow priapism and arteriocavernosal fistula presenting as autoinflation of an inflatable penile prosthesis.
RESULTS
Four patients in total (median age 56, range 46-60 years) were identified. Catastrophic bleeding (1.8L) occurred during revision surgery for presumed autoinflation in Patient 1 and subsequent ultrasound (US) confirmed a fistula which was embolized. Patient 2 redeveloped autoinflation following revision surgery. Ultrasound confirmed high flow priapism from an arteriocavernosal fistula. Patient 3 underwent penile magnetic resonance imaging (MRI) to investigate autoinflation and residual penile curvature. MRI showed a tumescent penis despite a deflated device and the fistula was embolized successfully. Patient 4 with sleep-related painful erections did not improve following insertion of penile prosthesis. Doppler US identified 2 fistulae that was embolized but with no resolution of symptoms. Subsequent embolization of both common penile arteries were done to control his symptoms. No other publications apart from the published abstract from 2016 reporting patient 1 was found.
CLINICAL IMPLICATIONS
If considered prior to revision surgery, the fistula can be managed safely by minimally invasive percutaneous angioembolisation avoiding surgery which can potentially be associated with significant complications.
STRENGTHS AND LIMITATIONS
The rarity of this phenomenon was supported by a systematic review. Our study however does present the findings from a small number of patients.
CONCLUSION
Damage to the cavernosal artery during inflatable penile prosthesis insertion can create an arteriocavernosal fistula that mimics autoinflation, leading to catastrophic intra-operative bleeding or unnecessary surgery. Lee WG, Satchi M, Skrodzka M, et al. A Rare Cause of Autoinflation after Penile Prosthesis Insertion: Case Series and Systematic Review. J Sex Med 2022;19:879-886.
Topics: Fistula; Humans; Male; Middle Aged; Penile Implantation; Penile Prosthesis; Penis; Priapism; Retrospective Studies
PubMed: 35184996
DOI: 10.1016/j.jsxm.2022.01.262 -
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... Sep 2022Severe Peyronie's disease (PD) and concomitant erectile dysfunction (ED) may require plaque incision/excision and grafting (PIG) as an adjunct to penile prosthesis... (Review)
Review
Severe Peyronie's disease (PD) and concomitant erectile dysfunction (ED) may require plaque incision/excision and grafting (PIG) as an adjunct to penile prosthesis implantation (IPP). Currently, there is no available consensus on the best graft material to use. Our aim was to systematically review graft materials used as patches following PIG + IPP. Literature search was performed in March 2021. Only original articles in English with a series of 10 or more patients were included. Overall, a total of 17 studies were included, corresponding to a cohort of 662 patients. The mean age ranged from 45 to 65 years and most patients had curvatures >45°. Average penile lengthening ranged from 1 to 3.5 cm, average residual curvatures from 0 to 20% and decreased glans sensitivity from 0 to 20%. Eighty to 100% of patients were satisfied with cosmetic and functional results. PIG + IPP with the use of various grafts offers promising results for the treatment of patients suffering from severe PD with concomitant ED. Unfortunately, the absence of high quality and comparative studies makes it difficult to establish the optimum graft. Therefore, the level of experience of the surgical team with one or more methods should guide their choice.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penile Induration; Penile Prosthesis; Penis
PubMed: 34718344
DOI: 10.1038/s41443-021-00479-8 -
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 -
Sexual Medicine Reviews Jul 2022Penile prosthesis (PP) implantation combined with grafting techniques is indicated in patients with Peyronie's disease (PD) and erectile dysfunction (ED) nonresponsive... (Review)
Review
INTRODUCTION
Penile prosthesis (PP) implantation combined with grafting techniques is indicated in patients with Peyronie's disease (PD) and erectile dysfunction (ED) nonresponsive to medical and conservative treatment that present with residual penile curvature greater than 30°, severe penile deformity or significant penile shortening.
OBJECTIVES
To address the preoperative evaluation, the surgical procedure and the functional outcomes of grafting techniques combined with PP implantation in patients with PD and concomitant ED and to provide future perspectives on the matter.
METHODS
We performed a systematic review of the literature based on the PRISMA statement (PROSPERO ID: CRD42021224517). Records were identified by searching Medline, Scopus, The Cochrane Library and Web of Science databases as well as sources of gray literature from inception to December 2020. The quality of all included records was assessed based on a modified version of the Newcastle-Ottawa Scale for cohort studies.
RESULTS
A total of 935 patients with a mean age of 59.6 ± 9.2 years from 23 studies were included in this systematic review. All studies reported excellent short- and long-term postoperative results, as well as high satisfaction rates ranging from 80 to 100%. A mean increase of 2.7 ± 1.4 cm in penile length was observed. Among different grafting materials and different types of PP, no significant differences in terms of preoperative, perioperative and postoperative functional outcomes or complications were demonstrated. Still, the operative time was shorter in studies applying the collagen fleece TachoSil.
CONCLUSIONS
PP implantation combined with grafting is a safe and highly effective surgical procedure in patients with PD and concomitant ED. All grafting materials provide similar beneficial outcomes, but TachoSil subsequently reduces the operative time and does not require suturing. Still, no definite conclusions can be drawn regarding the superiority of one grafting technique over the other, as randomized clinical trials are lacking. Sokolakis I, Pyrgidis N, Ziegelmann M, et al. Penile Prosthesis Implantation Combined With Grafting Techniques in Patients With Peyronie's Disease and Erectile Dysfunction: A Systematic Review. Sex Med Rev 2022;10:444-452.
Topics: Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Patient Satisfaction; Penile Implantation; Penile Induration; Penile Prosthesis
PubMed: 34219005
DOI: 10.1016/j.sxmr.2021.03.007 -
European Urology Focus May 2022Penile prosthesis is a durable and effective treatment for erectile dysfunction (ED). Even as other treatment options for ED have been brought to market, penile... (Review)
Review
CONTEXT
Penile prosthesis is a durable and effective treatment for erectile dysfunction (ED). Even as other treatment options for ED have been brought to market, penile prosthetic surgery remains a mainstay for urologists treating ED. No systematic study has yet summarized the global trends in penile prosthetic surgery.
OBJECTIVE
To systematically review studies of trends in penile prosthetic surgery to determine global movements in implantation rates, malleable versus inflatable prosthetic surgery, inpatient versus outpatient implantation surgery, proportion of men with ED undergoing penile prosthetic surgery, and prosthetic cost.
EVIDENCE ACQUISITION
A systematic review of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov was performed for studies assessing trends in penile prosthetic surgeries and costs associated with penile prosthetic device and inclusive surgical costs.
EVIDENCE SYNTHESIS
Twenty-seven studies were identified during the systematic review, comprising 447,204 penile prosthetic surgeries reported from 1988 to 2019. A trend analysis demonstrates that rates of penile prosthetic surgery declined dramatically in the late 1980s and early 1990s, but have demonstrated modest growth since the mid-2000s. Outpatient inflatable penile prosthetic surgery has strongly trended upward. Costs of penile prosthetic device have matched the rate of inflation, but inclusive surgical cost has radically outpaced inflation. Growth has mainly been seen in the USA, with a more modest global growth.
CONCLUSIONS
Penile prosthesis remains a viable option for the treatment of ED. Trends such as outpatient surgery and inflatable penile prosthesis placement may be driving the recent steady growth of penile prosthetic surgeries, but surging inclusive surgical cost may present a barrier for some patients without insurance coverage.
PATIENT SUMMARY
Penile prostheses continue to be an important treatment for erectile dysfunction. While the volume of penile prosthetic surgeries dropped when phosphidiesterase-5 inhibitors became available, prosthetic surgery is becoming more patient centric, as seen by increases in inflatable prosthetic placement and outpatient surgery.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penile Prosthesis; Penis; Prevalence
PubMed: 34034995
DOI: 10.1016/j.euf.2021.05.003 -
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 -
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 -
BMC Urology Mar 2021Infection is the most feared complication of a penile prosthesis. Diabetes mellitus (DM) is widely known to increase the risk of several infections, but its role in the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Infection is the most feared complication of a penile prosthesis. Diabetes mellitus (DM) is widely known to increase the risk of several infections, but its role in the penile prosthesis is still controversial. This systematic review aims to show the contemporary scenario of penile prosthesis infection and present a meta-analysis about DM contribution to penile prosthesis infection.
METHODS
The review was performed with no language or time limitation, including ten databases. The included articles were about the male population who received a penile prosthesis with no model restriction, with a minimum follow up of 1 year, and outcomes adequately reported.
RESULTS
The mean infection incidence of penile prosthesis ranged from 0.33 to 11.4%. In early 2000, the general incidence of infection was 3 to 5%, then, the introduction of coated materials decreased it to 0.3 to 2.7%. The meta-analysis showed that diabetes mellitus is related to an increased risk of penile prosthesis infection with an odds ratio of 1.53 (95% CI 1.15-2.04).
CONCLUSIONS
Penile prosthesis infection decreased in the last decades but remains a significant cause of reoperation, and it is related to lower prosthesis survival. Meta-analysis concludes that diabetes mellitus is related to a higher risk of penile prosthesis infection.
Topics: Diabetes Complications; Humans; Male; Penile Prosthesis; Prosthesis-Related Infections
PubMed: 33691670
DOI: 10.1186/s12894-020-00730-2 -
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