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Diagn. tratamento ; 26(2): 79-84, abr.-jun. 2021.
Article in Portuguese | LILACS | ID: biblio-1280729


A doença de Peyronie, notória desde 1743, segue sendo um grande desafio na prática médica, com prevalência relevante e grande impacto na vida sexual dos casais. O tratamento cirúrgico é a principal modalidade terapêutica capaz de restabelecer a vida sexual nos pacientes com doença de Peyronie significativa. A escolha do momento de implementação do tratamento cirúrgico, bem como a escolha da técnica a ser empregada, varia de acordo com três pontos centrais: a fase da doença, a deformidade apresentada e a função erétil. Estes pilares para a decisão terapêutica do paciente com doença de Peyronie possuem nuances, não sendo simples a caracterização destes fatores em muitos casos. Uma avaliação pré-operatória criteriosa, fundamental para a melhor escolha terapêutica, exige experiência e um conhecimento aprofundado sobre o tema. O objetivo do presente artigo é promover uma ampla discussão acerca de fatores primordiais da avaliação pré-operatória de pacientes com doença de Peyronie.

Penile Diseases , Penile Induration , Preoperative Care , Penile Implantation , Erectile Dysfunction
Int. braz. j. urol ; 44(2): 355-361, Mar.-Apr. 2018. graf
Article in English | LILACS | ID: biblio-892977


ABSTRACT Purpose We present a novel AUS implantation technique using a single perineal incision for single device placement or in combination with an inflatable penile prosthesis (IPP). Urinary and sexual dysfunction following the management of prostate cancer has a significant impact on the quality of life of our patients. While there are marginal changes in the prosthetic devices, we strive to reduce post-operative morbidity while maximizing efficacy. Materials and Methods We retrospectively reviewed the outcomes of 6 patients who underwent single perineal incision placement of a virgin AUS in 2014, 3 with simultaneous IPP placement. In all cases, the pressure regulating balloons (PRB) were placed in a high sub-muscular ectopic position and the pumps were placed into a sub-dartos pouch through the perineal incision, which was also validated using a cadaveric model. Results The mean patient age was 61 (SD, 7.5 years) with mean body mass index of 31 (SD, 5.9). The average pre-operative pad usage was 7.7 (SD 1.63) pads per day. The mean follow-up was 13.9 months (SD 9.45). Four out of the six patients reported utilizing ≤1 pad daily at follow-up. The one patient who was not initially dry required downsizing of his cuff to 3.5cm; the remaining patient was lost to follow-up. There were no identifiable perioperative or post-operative complications. Conclusions We present our initial report of using a single perineal incision for AUS implantation with a validated sub-dartos pump location, which is safe and effective for implantation of an AUS as a single or double implantation in well-selected patients.

Humans , Male , Urinary Incontinence, Stress/surgery , Urinary Sphincter, Artificial , Prosthesis Implantation/methods , Cadaver , Feasibility Studies , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Penile Implantation/methods , Middle Aged
Article in English | WPRIM | ID: wpr-714393


PURPOSE: There are many grey areas in the field of penile rehabilitation after radical prostatectomy (RP). The preservation of the full dimensions of the penis is an important consideration for improving patients' compliance for the treatment. We present the first case series of patients treated by laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) in order to preserve the full length of the penis and to improve patients' satisfaction. MATERIALS AND METHODS: From June 2013 to June 2014, 10 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis) and RP. Patients were evaluated by means of urological visits, questionnaires, and objective measurements before surgery, at discharge from the hospital, on postoperative days 21 to 28, each 3 months for the first year, and each 6 months thereafter. The main outcome measures were biochemical recurrence-free rate, penile length, and quality of life. RESULTS: Ten patients (mean age of 61 years; completed the study follow-up period (median, 32.2 months). No difference was found between the time of surgery and the 2-year follow-up evaluation in terms of penile length. The pre-surgery 36-Item Short Form Health Survey (SF-36) median score was 97. Patients were satisfied with their penile implants, and couples' level of sexual satisfaction was rated median 8. The median postoperative SF-36 score was 99 at 3 months follow-up. CONCLUSIONS: Laparoscopic extraperitoneal RP surgery with simultaneous PPI placement seems to be an interesting possibility to propose to motivated patients for preserving the length of the penis and improving their satisfaction.

Compliance , Erectile Dysfunction , Follow-Up Studies , Health Surveys , Humans , Male , Orgasm , Outcome Assessment, Health Care , Penile Implantation , Penile Prosthesis , Penis , Prostatectomy , Prostatic Neoplasms , Quality of Life , Rehabilitation
Article in English | WPRIM | ID: wpr-742350


Ischemic priapism is a urological emergency that has been associated with long-standing and irreversible adverse effects on erectile function. Studies have demonstrated a linear relationship between the duration of critically ischemic episodes and the subsequent development of corporal fibrosis and irreversible erectile function loss. Placement of a penile prosthesis is a well-established therapeutic option for the management of erectile dysfunction secondary to ischemic priapism, and will be the focus of this review. Review of the current literature demonstrates a growing utilization of penile prostheses in the treatment of erectile dysfunction secondary to ischemic priapism. Unfortunately, there is a paucity of randomized-controlled trials describing the use of prosthesis in ischemic priapism. As a result, there is a lack of consensus regarding the type of prosthesis (malleable vs. inflatable), timing of surgery (acute vs. delayed), and anticipated complications for each approach. Both types of prostheses yielded comparable complication rates, but the inflatable penile prosthesis have higher satisfaction rates. Acute treatment of priapism was associated with increased risk of prosthetic infection, and could potentially cause psychological trauma, whereas delayed implantation was associated with greater corporal fibrosis, loss of penile length, and increased technical difficulty of implantation. The paucity of high-level evidence fuels the ongoing discussion of optimal use and timing of penile prosthesis implantation. Current guidance is based on consensus expert opinion derived from small, retrospective studies. Until more robust data is available, a patient-centered approach and joint decision-making between the patient and his urologist is recommended.

Consensus , Emergencies , Erectile Dysfunction , Expert Testimony , Fibrosis , Humans , Joints , Male , Penile Implantation , Penile Prosthesis , Priapism , Prostheses and Implants , Psychological Trauma , Retrospective Studies
Article in English | WPRIM | ID: wpr-77197


PURPOSE: Due to the increasing numbers of radical prostatectomies (RP) performed for prostate cancer, a substantial and increasing number of patients suffer from postoperative urinary incontinence and erectile dysfunction (ED). The objective of our study was to see whether an inflatable penile prosthesis implantation could control urinary incontinence for patients with the dual problems of ED and incontinence. MATERIALS AND METHODS: From March 2010 through May 2015, 25 post-RP patients were referred to our clinic with ED or incontinence. The degree of incontinence was classified according to the International Consultation on Incontinence Questionnaire-Short Form. Inflatable penile prostheses were implanted in all 25 patients. RESULTS: For one month after implantation, partial or full inflation was performed progressively to control urine leakage. Of 18 patients, 13 patients were categorized with mild or moderate stress incontinence. All 13 patients obtained control of incontinence with partial inflation (30% to 60%) and all reported satisfactory outcomes. Five out of the 18 patients were categorized with severe total incontinence. Three of the 5 patients could tolerate incontinence with full inflation on and off. Thirteen patients out of the total of 18 (72.2%) had their incontinence controlled by an inflating penile prosthesis. CONCLUSIONS: An inflatable penile prosthesis is highly recommended as an initial procedure, especially in patients with the dual problems of ED and incontinence.

Erectile Dysfunction , Humans , Inflation, Economic , Male , Penile Implantation , Penile Prosthesis , Prostatectomy , Prostatic Neoplasms , Urinary Incontinence
Int. braz. j. urol ; 41(3): 535-541, May-June 2015. tab
Article in English | LILACS | ID: lil-755876



Penile prostheses are subject to a continuous development and have gained better mechanical reliability and safety during the last decades. In this study, we aimed to investigate the outcomes and satisfaction rates of inflatable penile prosthesis (IPP) and semirigid penile prosthesis (SPP) implantation.

Materials and Methods:

From August 2001 to June 2012, 257 men with erectile dysfunction (ED) underwent penile prosthesis implantation (PPI) at our institution. Of the 257 patients, 118 underwent implantation of IPP and 139 underwent SPP implantation. The pre-operative and post-operative erectile status of the patients were assessed by international index of erectile function (IIEF) questionnaire. The satisfaction of patients and partners were evaluated by a telephone interview using the erectile dysfunction inventory of treatment satisfaction (EDITS) questionnaire and EDITS partner survey.


The overall major complication rate was higher in IPP group. PPI led to a significant improvement in IIEF scores in both groups. For IPP and SPP groups the average EDITS scores were 78±11and 57±8, respectively, and that for the partners were 72±10 and 49±7, respectively (p<0.05).


Although the IPP implantation have better satisfaction rates, the SPP implantation is still a viable treatment option in the surgical treatment of ED because of low cost and high durability with acceptable satisfaction rates.


Adult , Aged , Humans , Male , Middle Aged , Erectile Dysfunction/surgery , Penile Prosthesis , Patient Satisfaction/statistics & numerical data , Penile Implantation/methods , Erectile Dysfunction/physiopathology , Postoperative Complications , Prosthesis Design , Penile Prosthesis/adverse effects , Retrospective Studies , Sexual Partners , Statistics, Nonparametric , Surveys and Questionnaires , Treatment Outcome
Korean Journal of Urology ; : 99-108, 2015.
Article in English | WPRIM | ID: wpr-217670


Although disease-free survival remains the primary goal of prostate cancer treatment, erectile dysfunction (ED) remains a common complication that affects the quality of life. Even though several preventive and therapeutic strategies are available for ED after radical prostatectomy (RP), no specific recommendations have been made on the optimal rehabilitation or treatment strategy. Several treatment options are available, including phosphodiesterase-5 inhibitors, vacuum erection devices, intracavernosal or intraurethral prostaglandin injections, and penile prostheses. Urologists must consider more effective ways to establish optimal treatments for ED after RP. ED is an important issue among patients with prostate cancer, and many patients hope for early ED recovery after surgery. This review highlights the currently available treatment options for ED after RP and discusses the limitations of each.

Alprostadil/therapeutic use , Erectile Dysfunction/etiology , Humans , Male , Penile Implantation , Phosphodiesterase 5 Inhibitors/therapeutic use , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Risk Factors , Vacuum , Vasodilator Agents/therapeutic use
Korean Journal of Urology ; : 179-186, 2015.
Article in English | WPRIM | ID: wpr-60936


Penile implant usage dates to the 16th century yet penile implants to treat erectile dysfunction did not occur until nearly four centuries later. The modern era of penile implants has progressed rapidly over the past 50 years as physicians' knowledge of effective materials for penile prostheses and surgical techniques has improved. Herein, we describe the history of penile prosthetics and the constant quest to improve the technology. Elements of the design from the first inflatable penile prosthesis by Scott and colleagues and the Small-Carrion malleable penile prosthesis are still found in present iterations of these devices. While there have been significant improvements in penile prosthesis design, the promise of an ideal prosthetic device remains elusive. As other erectile dysfunction therapies emerge, penile prostheses will have to continue to demonstrate a competitive advantage. A particular strength of penile prostheses is their efficacy regardless of etiology, thus allowing treatment of even the most refractory cases.

Biomedical Technology , Erectile Dysfunction/surgery , Forecasting , Humans , Male , Penile Implantation/methods , Penile Prosthesis/trends , Penis/surgery
Article in English | WPRIM | ID: wpr-7829


PURPOSE: A nationwide survey was conducted of Korean urologists to illustrate physicians' perceptions and real practical patterns regarding Peyronie disease (PD). MATERIALS AND METHODS: A specially designed questionnaire exploring practice characteristics and attitudes regarding PD, as well as patient satisfaction with each treatment modality, was e-mailed to 2,421 randomly selected urologists. RESULTS: Responses were received from 385 practicing urologists (15.9%) with a median time after certification as an urologist of 12 years. Regarding the natural course, 87% of respondents believed that PD is a progressive disease, and 82% replied that spontaneous healing in PD occurred in fewer than 20% of patients. Regarding diagnosis of PD, the methods used were, in order, history taking with physical examination (98%), International Index of Erectile Function questionnaires (40%), intracavernous injection and stimulation (35%), and duplex sonography (28%). Vitamin E was most preferred as an initial medical management (80.2%), followed by phosphodiesterase-5 inhibitors (27.4%) and Potaba (aminobenzoate potassium, 20.1%). For urologists who administered intralesional injection, the injected agent was, in order, corticosteroid (72.2%), verapamil (45.1%), and interferon (3.2%). The most frequently performed surgical procedure was plication (84.1%), followed by excision and graft (42.9%) and penile prosthesis implantation (14.2%). Among the most popular treatments in each modality, the urologists' perceptions regarding the suitability of treatment and patient satisfaction were significantly different, favoring plication surgery. CONCLUSIONS: The practice pattern of urologists depicted in this survey is in line with currently available Western guidelines, which indicates the need for development of further local guidelines based on solid clinical data.

4-Aminobenzoic Acid , Certification , Cyclic Nucleotide Phosphodiesterases, Type 5 , Data Collection , Diagnosis , Electronic Mail , Humans , Injections, Intralesional , Interferons , Male , Patient Satisfaction , Penile Implantation , Penile Induration , Physical Examination , Potassium , Surveys and Questionnaires , Transplants , Verapamil , Vitamin E , Vitamins
Singapore medical journal ; : e120-1, 2012.
Article in English | WPRIM | ID: wpr-334461


While oral agents are currently suggested for the initial treatment of erectile dysfunction, penile prosthesis implantation (malleable or inflatable) is accepted as a third-line therapy if intracorporeal injection and intraurethral treatment fail as a secondary choice. Urethral erosion of the malleable penile prosthesis is a well-known complication, mostly due to the indwelling catheter. We report a case of urethral erosion of the malleable penile prosthesis after 23 years. The patient was a 45-year-old man without any underlying risk factors. He subsequently underwent a unilateral rod extraction under regional anaesthesia. It appears that urethral erosion of penile prostheses can appear at any time post operation, without any known facilitative factors and in any age group. Furthermore, simple office manoeuvres may not be possible in some patients.

Catheters, Indwelling , Erectile Dysfunction , General Surgery , Humans , Male , Middle Aged , Penile Implantation , Penile Prosthesis , Prosthesis Failure , Time Factors , Treatment Outcome , Urethra , General Surgery
Int. braz. j. urol ; 37(1): 94-99, Jan.-Feb. 2011. ilus
Article in English | LILACS | ID: lil-581542


PURPOSE: Today, we find that the implant of malleable prostheses still plays a leading role in the surgical treatment of erectile dysfunction. These may involve patients for which the cosmetic advantages of inflatable devices are not as important as low cost, the easier use and less incidence of mechanical complications in the malleable implants. This paper demonstrates infrapubic approach as a technical option for this kind of implant. SURGICAL TECHNIQUE: It offers technical resources and emphasizes the facility in using the method, reducing cutaneous exposure, which diminishes risks of contamination. COMMENTS: As occurs in inflatable implants, when implanting malleable prostheses through the infrapubic access, care must also be taken regarding the possibility of lesion to the vascular-nervous bundle. On the other hand, the approach through the dorsal surface of the corpora cavernosa has a natural capacity for anatomical protection of the urethra, not requiring transurethral catheterization. This benefit is of the utmost importance when considering possible causes of per and postoperative morbidity. Accordingly, we can consider that the infrapubic approach is an effective method and prevails as a technical option for implanting malleable prostheses.

Humans , Male , Penile Prosthesis , Penile Implantation/methods , Penis/surgery , Erectile Dysfunction/surgery , Medical Illustration , Prosthesis Design , Penile Implantation/instrumentation , Treatment Outcome
Int. braz. j. urol ; 36(5): 591-601, Sept.-Oct. 2010. tab
Article in English | LILACS | ID: lil-567899


PURPOSE: We performed a retrospective study to analyze the effectiveness of implantable penile prostheses in the treatment of erectile dysfunction. MATERIALS AND METHODS: This study included 249 patients who received implants between 2001 and 2008. A total of 139 patients who underwent penile prosthesis implantation were interviewed. RESULTS: Approximately half of patients had previously used oral drugs before implantation of the prosthesis. About 45 percent had diabetes, 25.9 percent had previously undergone radical prostatectomy (RP), and 64 percent had hypertension. Exchange was performed in 5.7 percent for fracture, inadequate size, or extrusion. A total of 24.5 percent of men had immediate postoperative pain, 7.9 percent had local infection, and 8.6 percent had other complications. Patients who had previously undergone RP were 3.2 times more likely to experience a postoperative complication than patients who had not (p = 0.061). Eighty-nine (64 percent) patients returned to having sex as they had before being diagnosed with ED. Ninety-two of the men (66.2 percent) had sexual intercourse one to two times per week. One hundred twenty patients (86.3 percent) rated their level of satisfaction as good, excellent or very good, which was similar to the percentage of partners. The mean follow-up was 40 months. CONCLUSION: Higher rates of postoperative infections and mechanical problems with the implant were found in this study as compared to other studies, which was probably associated with the relative lack of experience of the trainees who were performing the surgeries. Patients with a history of RP or diabetes mellitus prior to implantation were at higher risk of postoperative complications.

Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Erectile Dysfunction/surgery , Penile Prosthesis , Penile Implantation/methods , Chi-Square Distribution , Follow-Up Studies , Latin America , Postoperative Complications , Patient Satisfaction/statistics & numerical data , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome
Article in Korean | WPRIM | ID: wpr-87187


PURPOSE: Many men are to some degree unsatisfied with the size of their penis, whether it is normal in size and appearance or not. We report a novel surgical technique for penile augmentation using a superficial external pudendal artery pedicle. MATERIALS AND METHODS: In total, 8 patients underwent penile augmentation from March 2003 to February 2004. Their mean age was 37.3 years. Five patients were unsatisfied about the size of their penis, and three patients had complications after insertion of foreign material. This penile augmentation technique was developed by using a low abdominal fat-flap where blood is supplied from the external pudendal artery. Spinal or epidural anesthesia was done during the operation, and the fat-flap was elevated and transpositioned to the site of lesion. RESULTS: All cases of patients were performed successfully by autografting using adipose tissue where blood flow was supplied from the external pudendal artery. There were no complications except one case of hematoma after the operation. The mean operative time was 80 min. The mean follow-up period after operation was about 6 months and all patients had a normal sexual life and no voiding dysfunctions. CONCLUSIONS: This novel surgical technique has several advantages. First, reconstruction without skin necrosis was possible even though the defect was large, because the blood supply was favorable. Second, there was no size limitation in augmentation with dermoplasty. Third, there was no evidence of atrophy of the flap.

Adipose Tissue , Anesthesia, Epidural , Arteries , Atrophy , Follow-Up Studies , Hematoma , Humans , Male , Necrosis , Operative Time , Penile Implantation , Penis , Skin , Transplantation, Autologous
Korean Journal of Urology ; : 202-207, 2010.
Article in English | WPRIM | ID: wpr-115455


PURPOSE: We investigated erectile and ejaculatory function after penile prosthesis implantation. MATERIALS AND METHODS: A total of 121 patients were enrolled in the surgery group (SG) and 120 patients in the nonsurgery group (NSG). All subjects were evaluated by use of the following questionnaires: the erection function and intercourse satisfaction domains of the International Index of Erectile Function (IIEF) and the ejaculation domain of the Male Sexual Health Questionnaire (MSHQ-EjD). Comparisons were made between the SG and the NSG, by prosthesis types, and of postoperative periods and complication rates for each prosthesis type. RESULTS: Differences in the erection function and intercourse satisfaction domains of the International Index of Erectile Function (IIEF-EF and IIEF-IS) between before and after treatment were significantly higher in the SG group than in the NSG group (p=0.02, 0.03, respectively). When comparing prosthesis types, differences in the erection confidence and intercourse satisfaction items between before and after surgery were significantly higher in the SG group (p=0.03, 0.04, respectively). In the comparison of each prosthesis type by postoperative period, differences in the IIEF-EF and IIEF-IS between before and after surgery were not statistically significant but the MSHQ-EjD domain after surgery was significantly lower in cases of >5 years (p=0.02, 0.03, respectively). CONCLUSIONS: Subjective symptoms such as erectile confidence and erectile function were improved more in the SG group than in the NSG group, especially in the inflatable group. It appeared that there was no significant difference in improvement in ejaculatory function depending on the treatment method, but that ejaculatory function decreased as time passed.

Ejaculation , Humans , Male , Penile Erection , Penile Implantation , Penile Prosthesis , Postoperative Period , Prostheses and Implants , Reproductive Health