Penile prosthesis implant in the special populations: diabetics, neurogenic conditions, fibrotic cases, concurrent urinary continence surgery, and salvage implants / 亚洲男科学杂志(英文版)

Penile prosthesis implant (PPI) remains an effective and safe treatment option for men with erectile dysfunction (ED). However, PPI surgery can be associated with a higher risk of complications in certain populations. This article provides a critical review of relevant publications pertaining to PPI in men with diabetes, significant corporal fibrosis, spinal cord injury, concurrent continence surgery, and complex salvage cases. The discussion of each category of special populations includes a brief review of the surgical challenges and a practical action-based set of recommendations. While specific patient populations posed considerable challenges in PPI surgery, strict pre- and postoperative management coupled with safe surgical practice is a prerequisite to achieving excellent clinical outcomes and high patient satisfaction rate.

Risk profiling in patients undergoing penile prosthesis implantation / 亚洲男科学杂志(英文版)

Penile prosthesis implantation is the gold standard of surgical therapy for patients with medication-refractory erectile dysfunction. However, this umbrella definition includes significant heterogeneity and associated risk profiles that should be candidly discussed and addressed perioperatively. Factors associated with operative success and patient satisfaction are often surgery specific; however, risk profiling via patient selection, preoperative optimization, proper device selection, and intraoperative consideration are highly correlated. Some examples of common risk profiles include comorbidity(ies) such as cardiovascular disease, diabetes mellitus, prior abdominal surgery, Peyronie's disease, and psychological risk factors. Similarly, integration of surgeon- and patient-amenable characteristics is key to decreasing risk of infection, complication, and need for revision. Finally, patient risk profiling provides a unique context for proper device selection and evidence-based intraoperative considerations.

Non-infected penile prosthesis cultures during revision surgery; comparison between antibiotic coated and non - coated devices

ABSTRACT Introduction: Aim of this study is to investigate bacterial growth on non-infected devices and compare antibiotic-coated and non-coated implants. Materials and methods: The charts of 71 patients who underwent revision surgeries for penile prosthesis between 1995 and 2013 were reviewed. Of those, 31 devices were antibiotic-coated prostheses, while 40 of the implants were non-coated. Swab cultures were routinely obtained from corporal, pump or reservoir site during the operation. If a bacterial biofilm was determined on the prosthesis, it was also cultured. Results: A total of 5 different organisms were cultured from 18 patients. Of them, 4 devices were antibiotic-coated and the other 14 were non-coated devices. Staphylococcus epidermidis was the most common organism, while Staphylococcus hominis, beta hemolitic streptococcus, Escherichia coli and Proteus mirabilis were also cultured. All patients who had positive cultures were treated with appropriate antibiotics for four weeks postoperatively. Median follow-up time was 41 months, ranging between 8 and 82 months. One prosthesis (non-coated) became clinically infected in the follow-up period with a totally different organism. Culture positivity rates of antibiotic-coated and non-coated devices were 13% and 35% respectively and the result was significant (p=0.00254). Conclusions: Positive bacterial cultures are present on non-infected penile prostheses at revision surgeries in some of the patients. Antibiotic coated prostheses have much less positive cultures than non-coated devices.

infections des protheses parietales

The authors have reviewed retrospectively the series of eventrations and hernias being operated in their department and treated by the use or prostheses between 1987 and 1999. Among 275 prostheses, 8 cases [2,9%] of deep infection which affects the plate were detected in, 5 cases [3,5%] after hernia surgery and 3 cases after eventration surgery [2,2%]. The other complications of this surgery are represented as: 6 cases [2,02] of serohematoma and 16 cases [5,8%] of superficial infections. However, the authors compare the results of their series with the other series in the literature, discuss the different therapeutic procedures proposed and plead for first preventive measures in the treatment of these infections

Periimplantitis infecciosa: propuesta de un plan preventivo / Infectious peri-implantitis: proposing a preventive plan

Se presentan tres casos de periimplantitis en pacientes de la tercera edad, de ambos sexos, dos desdentados totales y uno parcial, que habían recibido implantes de titanio de distinto origen. El estado general de dos pacientes era satisfactorio y el de otro evidenció una diabetes posterior al acto quirúrgico. Uno tuvo una infección de bida a Candida sp. y otros dos presentaron complicaciones por Actinomyces sp. Los diagnósticos se realizaron por técnicas microscópicas; el tratamiento fue exitoso en dos enfermos, mientras que un paciente, en quien se detectó diabetes, se decidió extraer los implantes. Se propone un plan preventivo de estas patologías

Cimento com vancomicina: farmacocinética do antibiótico na ovelha e no homem / Vancomycin-loaded cement: pharmacokinetic study in sheep and human beings

Os autores estudaram, in vivo, a farmacocinética da vancomicina associada ao cimento acrílico, implantado em ovelhas e no homem. As análises do tecido ósseo do fêmur das ovelhas, após a implantaçäo intramedular, revelaram a presença do antibiótico em três camadas da cortical, em concentraçöes bacteriologicamente eficazes durante pelo menos cinco meses. No homem, a implantaçäo de 2 ou 3g de vancomicina por dose de cimento, quando de artroplastias primárias do quadril, mostrou apreciáveis concentraçöes do antibiótico nos líquidos de exsudaçäo durante o período de drenagem, acompanhadas de baixos níveis séricos, que se anularam rapidamente. Os autores concluem que a adiçäo de vancomicina ao cimento, ortopédico representa importante recurso, tanto na profilaxia das infecçöes cirúrgicas das artroplastias primárias como nas revisöes de artroplastias infectadas.

Infecciones en prótesis de pene: tratamiento y prevención / Infections of penile prosthesis: treatment and prevention

To date, there are 10,000,000 men with impotence in the United States and it is estimated that at least 17,000 penile prosthesis are implanted annually. The most fearsome complication is the infection of the prosthesis which is usually caused by Staphylococcus epidermidis (in 40-80 of the cases). In general, the incidence of infection is actually 0.8-8.3, but it can increase to 37 in patients with tertiary implants. The initial empiric treatment is usually with vancomycin and aminoglycosides and prophylaxis is recommended with a penicillinase-resistant synthetic penicillins, first generation cephalosporins, or vancomycin in case of penicillin allergy