ABSTRACT
We aimed to evaluate ten-year outcomes of penile prosthesis (PP) implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection (EPI). We identified 549 men who underwent 576 PP placements between 2008 and 2018. Univariate and multivariate analyses were used to identify potential predictors of EPI. An EPI predictive nomogram was developed. Thirty-five (6.1%) cases of EPI were recorded with an explant rate of 3.1%. In terms of satisfaction, 82.0% of the patients defined themselves as "satisfied," while partner's satisfaction was 88.3%. Diabetes (P = 0.012), longer operative time (P = 0.032), and reinterventions (P = 0.048) were associated with EPI risk, while postoperative ciprofloxacin was inversely associated with EPI (P = 0.014). Rifampin/gentamicin-coated 3-piece inflatable PP (r/g-c 3IPP) showed a higher EPI risk (P = 0.019). Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients, redo surgeries, or when a r/g-c 3IPP was used (all P < 0.03). We showed that diabetes, longer operative time, and secondary surgeries were the risk factors for EPI. Postoperative ciprofloxacin was associated with a reduced risk of EPI, while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant. After further validation, the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.
Subject(s)
Humans , Male , Erectile Dysfunction/surgery , Patient Satisfaction , Penile Implantation , Penile Prosthesis , Penis/surgery , Tertiary Care CentersABSTRACT
Testicular volume (TV) is considered a good clinical marker of hormonal and spermatogenic function. Accurate reference values for TV measures in infertile and fertile men are lacking. We aimed to assess references values for TV in white-European infertile men and fertile controls. We analyzed clinical and laboratory data from 1940 (95.0%) infertile men and 102 (5.0%) fertile controls. Groups were matched by age using propensity score weighting. TV was assessed using a Prader orchidometer (PO). Circulating hormones and semen parameters were investigated in every male. Descriptive statistics, Spearman's correlation, and logistic regression models tested potential associations between PO-estimated TV values and clinical variables. Receiver operating characteristic (ROC) curves were used to find TV value cutoffs for oligoasthenoteratozoospermia (OAT) and nonobstructive azoospermia (NOA) status in infertile men. The median testicular volume was smaller in infertile than that of fertile men (15.0 ml vs 22.5 ml; P < 0.001). TV positively correlated with total testosterone, sperm concentration, and progressive sperm motility (all P ≤ 0.001) in infertile men. At multivariable logistic regression analysis, infertile status (P < 0.001) and the presence of left varicocele (P < 0.001) were associated with TV < 15 ml. Testicular volume thresholds of 15 ml and 12 ml had a good predictive ability for detecting OAT and NOA status, respectively. In conclusion, infertile men have smaller testicular volume than fertile controls. TV positively correlated with total testosterone, sperm concentration, and progressive motility in infertile men, which was not the case in the age-matched fertile counterparts.
ABSTRACT
Our aim was to report the first case of computer-assisted lead placement (CALP) for a peripheral nerve evaluation (PNE) test in a 55-year-old woman affected by chronic pelvic pain, who was a candidate for sacral neuromodulation (SNM). The first PNE test failed due to nonoptimal lead placement. We utilized a surgical navigation system (SNS) with electromagnetic tracking to guide the lead placement to the S3 right nerve roots. Neither intra- nor postoperative complications occurred. After 2 weeks, the patient reported >50% symptom improvement, so she was recommended to receive a definitive SNM implant. Our case report demonstrated the feasibility and safety of CALP for the PNE test. Since the use of an SNS may guide easy and precise lead placement along the S3 afferent nerve roots, further studies are mandatory to outline the advantages and limits of this innovative technique.
ABSTRACT
Our aim was to report the first case of computer-assisted lead placement (CALP) for a peripheral nerve evaluation (PNE) test in a 55-year-old woman affected by chronic pelvic pain, who was a candidate for sacral neuromodulation (SNM). The first PNE test failed due to nonoptimal lead placement. We utilized a surgical navigation system (SNS) with electromagnetic tracking to guide the lead placement to the S3 right nerve roots. Neither intra- nor postoperative complications occurred. After 2 weeks, the patient reported >50% symptom improvement, so she was recommended to receive a definitive SNM implant. Our case report demonstrated the feasibility and safety of CALP for the PNE test. Since the use of an SNS may guide easy and precise lead placement along the S3 afferent nerve roots, further studies are mandatory to outline the advantages and limits of this innovative technique.