RESUMO
OBJECTIVE: To assess the difference in outcomes between single dilation (SingD) and sequential dilation (SeqD) in primary penile implantation, hypothesizing that patients who undergo SeqD had higher rates of noninfectious complications. METHODS: We performed a multicenter, retrospective study of men undergoing primary inflatable penile prosthesis placement. Intraoperative complications and postoperative noninfectious outcomes were assessed between the two groups. Multivariable analysis was performed to identify predictors of complications. RESULTS: A total of 3293 patients met inclusion criteria. After matching, there were 379 patients who underwent SingD and 379 patients who underwent SeqD. There was no significant difference in intraoperative complications between patients who underwent SingD vs SeqD, nor was there any difference in cylinder length (20 cm with interquartile range [IQR] 18-21 cm vs 20 cm with IQR 18-20 cm respectively, P = .4). On multivariable analysis, SeqD (OR 5.23 with IQR 2.74-10, P < .001) and older age (OR 1.04 with IQR 1.01-1.06, P = .007) were predictive of postoperative noninfectious complications. There was no significant difference in intraoperative complications between patients who underwent SingD vs SeqD, nor was there any difference in cylinder length. SeqD and older age were predictive of postoperative noninfectious complications. CONCLUSION: During inflatable penile prosthesis placement in the uncomplicated patient without fibrosis, SingD is a safe technique to utilize during implantation that will minimize postoperative adverse events, and promote device longevity without loss of cylinder length.
Assuntos
Disfunção Erétil , Implante Peniano , Prótese de Pênis , Masculino , Humanos , Prótese de Pênis/efeitos adversos , Estudos Retrospectivos , Dilatação , Implante Peniano/efeitos adversos , Implante Peniano/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Complicações Intraoperatórias/etiologia , Disfunção Erétil/etiologiaRESUMO
OBJECTIVES: Evidence regarding demand trends for erectile dysfunction (ED) treatments are scarce in South America. This study aims to evaluate trends in ED treatments in Chile over a 10-year period (2010- 2020) and estimate the potential number of candidates for penile prosthesis. MATERIALS AND METHODS: Sales trends of pharmacological treatments and penile prosthesis were obtained from market studies. The potential number of candidates for penile prosthesis implantation was calculated by crossing epidemiological data with previously reported ED prevalence, proportion of sexually active men, percentage of men seeking medical assistance for ED, and the proportion of patients who are non-responders to ED oral drug therapies Results: In the 10-year studied period, the Chilean male population older than 50 years increased 34.7%, with an average annual variation (AAV) of 3.4%. For the same period, the sales of oral drug therapies for ED increased by 71.3% (AAV 6.2%), the sales of intracavernosal vasoactive agents (ICVA) decreased by 0.4% (AAV -0.2%), and penile prosthesis sales increased by 113% (AAV 6.7%). We estimated that only 0.05% of sexually active men older than 50 years old with ED who sought medical assistance finally had a penile prosthesis implanted to manage their condition. CONCLUSIONS: Demand for ED oral drug therapies significantly increased in Chile during the last decade, while ICVA remained stable. The annual rate of penile prosthesis implantation increased. However, the gap between the potential penile prosthesis candidates and the actual number of devices implanted is suspected to remain extremely high.
Assuntos
Disfunção Erétil , Implante Peniano , Prótese de Pênis , Administração Oral , Chile/epidemiologia , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Implante Peniano/efeitos adversosRESUMO
INTRODUCTION: Management protocols for treatment of severe erectile dysfunction have changed little in the last 20 years. Most algorithms consider penile prostheses as the last option of treatment in patients who have failed medical management. Despite multiple advances in current devices, prosthetic infection remains the most feared complication by implanting surgeons and patients. This report tries to make a compilation of the factors that can be impacted to prevent penile implant infections, and to make penile implantation a safer and more reliable way to solve an erection deficit. PURPOSE OF REVIEW: List events related to the surgical act (pre-operative, intra-operative, and post-operative) that are related to the risk of infection to contextualize possible actions/measures used to avoid prosthetic infection. RECENT FINDINGS: The impact of coated implants on reduction of infection rates. The recommendation to use chlorhexidine-based solutions over iodine solution for preoperative skin preps. Appears to be no difference in infection rates according to the approach chosen by the surgeon (infrapubic vs penoscrotal). The change in the microbial colonies that are colonizing implants in recent years are dramatic. Lack of evidence of which solutions to use for salvage or revision washout surgery: Chemical eradication or mechanical lavage cleansing?. Despite the importance of metabolic control in the literature, there is a disparity in exact glycemic values âprior to the intervention in our literature. Factors such as preparation of the operative site, presence of comorbidities or previous surgeries, surgical time, or additional maneuvers during surgery can negatively impact the final result of penile prosthetic surgery.
Assuntos
Disfunção Erétil , Doenças do Pênis , Implante Peniano , Prótese de Pênis , Disfunção Erétil/etiologia , Disfunção Erétil/prevenção & controle , Disfunção Erétil/cirurgia , Humanos , Masculino , Doenças do Pênis/etiologia , Implante Peniano/efeitos adversos , Implante Peniano/métodos , Prótese de Pênis/efeitos adversos , Pênis/cirurgiaRESUMO
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.
Assuntos
Disfunção Erétil/cirurgia , Procedimentos Ortopédicos/métodos , Implante Peniano/efeitos adversos , Prótese de Pênis/efeitos adversos , Pênis/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Urologia/métodos , Antibacterianos/uso terapêutico , Anti-Infecciosos/administração & dosagem , Antibioticoprofilaxia , Biofilmes , Análise Custo-Benefício , Humanos , Masculino , Salas Cirúrgicas , Staphylococcus aureusRESUMO
OBJECTIVES: To assess outcomes of a variant of traditional modeling ("optimal modeling," OM) in patients with residual curvature following prosthesis implantation. METHODS: We performed a retrospective review of all patients who underwent penile implant insertion. Patients with >30° of residual curvature after cylinder placement and inflation underwent OM and were compared 1:1 to a demographically-matched cohort who received implantation without ancillary straightening. Optimal modeling was performed by forcibly bending the erect penis in the direction opposite the point of maximal curvature while maintaining glanular pressure to prevent urethral injury. This was performed for 90-second intervals for as many cycles as necessary to achieve <15° curvature. RESULTS: Eighty patients were included in the final analysis; 40 (50.0%) underwent optimal modeling while 40 (50.0%) did not need additional straightening following surgery. The mean premodeling curvature was 47.8° (range 30°-90°) while post-modeling curvature improved to a mean of 10.6° (range 0°-30°, P < .001); 87.5% of patients had <15° of residual curvature. Patients in the OM cohort experienced longer operative times (82.7 vs 75.8 min, Pâ¯=â¯.15). No patient in either group experienced an intraoperative or postoperative complication at a mean follow-up of 29.9 months. CONCLUSION: Although many prosthetic urologists forego manual modeling in cases of moderate-severe penile curvature, our contemporary series shows it to be both safe and effective. OM may preclude the need for more time-consuming and complex surgical procedures.
Assuntos
Disfunção Erétil/cirurgia , Implante Peniano/efeitos adversos , Induração Peniana/cirurgia , Prótese de Pênis/efeitos adversos , Complicações Pós-Operatórias/terapia , Idoso , Disfunção Erétil/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Implante Peniano/instrumentação , Induração Peniana/complicações , Pênis/anatomia & histologia , Pênis/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: The aim of this study was to identify the factors associated with infection in patients who undergo penile prosthesis implantation. METHODS: We performed a systematic review/meta-analysis, including clinical trials, quasi-experiments, retrospective and prospective cohort studies, and case-control studies. Searching was done in CENTRAL, MEDLINE, and EMBASE databases. Participants were patients who had erectile dysfunction, regardless of the etiology, and underwent penile prosthesis implantation. Two researchers reviewed each reference by title and abstract. The statistical analysis was performed using Review Manager 5.3 (RevMan® 5.3). RESULTS: A total of 513 studies were found with the search strategies. After excluding duplicates, 40 studies with a total of 175,592 patients were included in the qualitative and quantitative analysis. Among patient characteristics, we found that diabetes mellitus and immunosuppression appear to have increase odds of infection. Related to the procedure, infection-retardant-coated penile prosthesis and primary (first) surgery appear to lower odds of infection. CONCLUSIONS: Diabetes mellitus and immunosuppression were associated with increased infection rates; infection-retardant coating of the prosthesis and primary surgery were associated with reduced infection rates.
Assuntos
Disfunção Erétil , Implante Peniano , Prótese de Pênis , Disfunção Erétil/etiologia , Disfunção Erétil/cirurgia , Humanos , Masculino , Implante Peniano/efeitos adversos , Prótese de Pênis/efeitos adversos , Estudos Prospectivos , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To examine possible etiology and treatment outcomes in 21 patients with glans necrosis following penile prosthesis implantation. METHODS: Glans necrosis typically presented with a dusky glans on the first postoperative day following prosthesis implantation. RESULTS: The blood supply to the glans penis consists of the dorsal arteries and the terminal branches of the spongiosal arteries. Using the cohort in our study, we compiled preoperative comorbidities and adjunctive surgical maneuvers that might compromise glans vascularity, leading to glans necrosis. Preoperative risk factors were arteriosclerotic cardiovascular disease (90%), diabetes mellitus (81%), smoking (81%), previous prosthesis explantation (57%), and previous radiation therapy (48%). The most prevalent intraoperative and postoperative factor was subcoronal incision for reasons as simple as coincident circumcision or as complex as for penile degloving (86%). Other factors detected were penile wrapping with an occlusive elastic bandage (62%), use of a sliding technique for penile lengthening (33%), and coincident distal urethral injury repair (29%). Seventeen patients (81%) managed expectantly with preservation of implanted prosthesis sustained significant glandular loss. Four patients managed with immediate prosthesis removal healed without sequelae. CONCLUSION: Patients with preoperative risk factors undergoing penile prosthesis implantation should avoid high-risk adjunctive surgical maneuvers. Upon development of signs of glans necrosis postoperatively, in the setting of these high-risk factors, immediate implant removal may prevent subsequent glans necrosis.
Assuntos
Implante Peniano/efeitos adversos , Prótese de Pênis/efeitos adversos , Pênis/patologia , Complicações Pós-Operatórias/prevenção & controle , Austrália/epidemiologia , Brasil/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/etiologia , Necrose/prevenção & controle , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco , Arábia Saudita/epidemiologia , Ultrassonografia Doppler Dupla , Reino Unido/epidemiologia , Estados Unidos/epidemiologiaRESUMO
INTRODUCTION: The management of penile prosthesis protrusion and the implantation of a prosthesis in fibrotic penile corporal bodies represents a challenging task even for experienced surgeons. AIM: To demonstrate the long-term efficacy and safety of a new technique for distal shaft reconstruction and reinforcement in cases of penile prosthesis protrusion or cases of penile prosthesis implantation in corporal fibrosis. METHODS: Between August 2007 and August 2012, 69 patients underwent surgery for penile prosthesis protrusion (45 patients) or severe distal corporal fibrosis (24 patients). The mean age at the time of surgery was 56 years (range 38-69). All patients underwent distal shaft reconstruction using our technique, involving the creation of two neocorpora ("double windsocks"). MAIN OUTCOME MEASURES: Functional outcome and patient satisfaction were evaluated with item numbers 1 and 7 of the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Furthermore, clinical data concerning the early postoperative outcome were analyzed retrospectively. RESULTS: Mean follow-up time was 22.5 months (range 6-48). Based on answers to EDITS questionnaire item 1, 42 patients (60.9%) were very satisfied and 19 patients (27.5%) were somewhat satisfied with the outcome of the procedure. Furthermore, answers to the self-confidence domain question (EDITS item 7) revealed that 63 patients (91.3%) felt that the treatment had a positive effect with respect to their ability to engage in sexual activity. No patient exhibited device extrusion, postoperative infection, or skin dehiscence, and glans sensation as well as orgasmic ability were also preserved in all cases. Neuropraxia was reported in five cases (3.4%) immediately after the operation. The recovery of orgasmic ability was delayed in 17 (24.6%) patients. All patients were able to perform sexual intercourse postoperatively. CONCLUSION: The "double-windsocks" technique is an effective option for difficult cases of distal penile shaft reconstruction and reinforcement.
Assuntos
Implante Peniano/instrumentação , Prótese de Pênis , Pênis/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adulto , Idoso , Coito , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Implante Peniano/efeitos adversos , Pênis/patologia , Pênis/fisiopatologia , Falha de Prótese , Procedimentos de Cirurgia Plástica/efeitos adversos , Recuperação de Função Fisiológica , Reoperação , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE To evaluate the indications for penile prosthesis implantation in the treatment of erectile dysfunction (ED) before and after the introduction of sildenafil. PATIENTS AND METHODS Penile prosthesis implantation was indicated in 144 men with ED at our institution between 1992 and 2007; 83 (55.6%) accepted the procedure, 55 (38.2%) refused it and six (4.2%) accepted but eventually had no surgery. Sixty-seven patients were operated primarily, and the remainder were referred cases with complications after or dissatisfaction with primary operations done elsewhere. Thirty-two were operated before the introduction of sildenafil (BS) and 35 after (AS). RESULTS In the BS group the most frequent aetiology was vascular disease, with 11(34%) vs two (6%) in the AS group. The most frequent aetiology in the AS group was previous radical pelvic surgery (radical prostatectomy, sigmoidectomy, etc.) with 17 (49%) vs none in the BS group. There were no significant differences in complication rates in both groups. Satisfaction rates in patients with malleable and inflatable devices were 36 (86%) and 17 (85%), respectively. CONCLUSIONS After the introduction of oral therapy for ED there were some changes in the aetiology of refractory ED; ED after radical prostatectomy is gaining acceptance as the main reason for a penile implant.
Assuntos
Disfunção Erétil/terapia , Implante Peniano/métodos , Prótese de Pênis , Inibidores de Fosfodiesterase/uso terapêutico , Piperazinas/uso terapêutico , Sulfonas/uso terapêutico , Humanos , Masculino , Satisfação do Paciente , Implante Peniano/efeitos adversos , Implante Peniano/tendências , Prótese de Pênis/efeitos adversos , Prótese de Pênis/tendências , Complicações Pós-Operatórias/etiologia , Prostatectomia , Purinas/uso terapêutico , Citrato de Sildenafila , Resultado do TratamentoRESUMO
Analisar cinquenta e três pacientes com impotência sexual, tratados cirurgicamente com o implante de prótese peniana. Método e Casuística: estudo retrospectivo da experiência pessoal com o implante de prótese peniana. Vinte e oito pacientes tiveram como etiologia uma disfunção vascular peniana; 17, diabetes mellitus; quatro, pós-prostatectomia radical retropúbica em decorrência de câncer de próstata; dois, doença de peyronie, um paraplégico e outro devido a câncer de próstata com bloqueio androgênico. Em 16 pacientes, o implante foi realizado simultaneamente com outras operações. Foi seguido um protocolo rigoroso com 14 medidas antissépticas preventivas e antibiótico prevenção adequada, tendo como objetivo impedir infecção pós-operatória e consequente perda do implante peniano. A incisão foi penoescrotal, com os pacientes internando-se no dia da operação e com alta hospitalar na manhã do segundo dia de pós-operatório. Resultados: Não houve perda de nenhum implante e as complicações ocorridas não comprometeram o pós-operatório nem o resultado estético e funcional. O grau de satisfação obtido pelos pacientes foi de 96,2%. Conclusão: As medidas adotadas são de grande eficácia, não havendo perda do implante e ótimo resultado funcional e estético.
Analysis of 53 sexually impotent patients, surgically treated with penile prosthesis implantation. Material and Methods: Retrospective review of a personal experience with prosthesis implantation. The etiologies of the impotence were: penile vascular dysfunction (28 cases), diabetes mellitus (17 cases); retropubic radical prostatectomy as treatment of prostatic cancer (4 cases), Peyronie disease (2 cases), paraplegia and androgen suppression as treatment of prostatic cancer one case, each). In 16 patients implantation was performed simultaneously with other surgeries. A rigorous protocol was followed with 14 preventive antiseptic measures including adequate antibiotic in order to prevent postoperatory infection and consequent loss of penile implant. Results: There was no implant loss and complications did not compromise postoperative functional and aesthetic results. The satisfaction degree was 96.2%. Conclusions: It can be concluded that the adopted measures are very effective, with no implant loss and with excellent functional and aesthetic results.