Effects of plication procedures in special cases of Peyronie's disease: a single-center retrospective study of 72 patients / 亚洲男科学杂志(英文版)

General recommendations regarding surgical techniques are not always appropriate for all Peyronie's disease (PD) patients. Therefore, the purpose of this study was to investigate the effects of plication procedures in PD patients with severe penile curvature and the effects of early surgical correction in patients who no longer have progressive deformities. The clinical data from 72 patients who underwent plication procedures were analyzed in this study. Patients were divided into Groups A and B according to the curvature severity (≤60° or >60°) and Groups 1 and 2 according to the duration of disease stabilization (≥3 months or <3 months). At the 1-year follow-up, 90.0% (36/40) and 90.6% (29/32) patients reported complete penile straightening, and 60.0% (24/40) and 100.0% (32/32) patients reported penile shortening in Groups A and B, respectively. No curvature recurrence occurred in any patient, and no significant differences were observed in postoperative International Index of Erectile Function-Erectile Function domain (IIEF-EF), erectile pain, sensitivity, or suture knots on the penis whether such outcomes were grouped according to the curvature severity or the duration of stabilization. However, the duration from symptom onset to surgical management in Group 1 was significantly longer than that in Group 2 (mean ± standard deviation [s.d.]: 20.9 ± 2.0 months and 14.3 ± 1.2 months, respectively, P < 0.001). The present study showed that the plication procedures seemed to be an effective choice for the surgical treatment of PD patients with severe penile curvature. In addition, the early surgical treatment seemed to benefit those patients who already had no erectile pain and no longer exhibited progressive deformity.

Modified malleable prosthesis with a fixed mesh: case series for the Ghattas technique / 亚洲男科学杂志(英文版)

Penile prosthetic implantation represents a cornerstone for patients with organic erectile dysfunction (ED) that is refractory, unsatisfactory, or contra-indicated for other approved medical or mechanical options. In this study, we introduce the "Ghattas technique," wherein we constructed a polypropylene mesh sheath that surrounds and is fixed to a 13-mm malleable prosthesis cylinder, which can increase the cylinder diameter for cases that need a larger prosthesis. All patients underwent preoperative evaluation and completed the five-item International Index of Erectile Function questionnaire (IIEF-5). Postoperative outcomes were evaluated by IIEF-5 and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires at final follow-up. The mean age of the 23 included patients was 57.9 (standard deviation [s.d.]: 11.4) years and the mean duration of ED was 8.5 (s.d.: 7.9) years. Erection improvement was determined by comparing mean preoperative and postoperative IIEF-5 scores (8.3 [s.d.: 3.9] vs 24.6 [s.d.: 0.6], P < 0.001). High treatment satisfaction was determined according to a mean EDITS score of 94.9 (s.d.: 9.9). The proposed Ghattas technique was safe and effective in our patients, and provides opportunity for cases that need a diameter larger than 13 mm. Further studies are needed to confirm these results.

Ten-year experience with penile prosthetic surgery for the treatment of erectile dysfunction: outcomes of a tertiary referral center and predictors of early prosthetic infection / 亚洲男科学杂志(英文版)

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.

Patient and partner outcome of inflatable and semi-rigid penile prosthesis in a single institution

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.

Evolution of penile prosthetic devices

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.

Infrapubic approach for malleable penile implant

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.

Penile prosthesis implantation in an academic institution in Latin America

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.

Experimental model of human corpus cavernosum smooth muscle relaxation

PURPOSE: To describe a technique for en bloc harvesting of the corpus cavernosum, cavernous artery and urethra from transplant organ donors and contraction-relaxation experiments with corpus cavernosum smooth muscle. MATERIALS AND METHODS: The corpus cavernosum was dissected to the point of attachment with the crus penis. A 3 cm segment (corpus cavernosum and urethra) was isolated and placed in ice-cold sterile transportation buffer. Under magnification, the cavernous artery was dissected. Thus, 2 cm fragments of cavernous artery and corpus cavernosum were obtained. Strips measuring 3 x 3 x 8 mm3 were then mounted vertically in an isolated organ bath device. Contractions were measured isometrically with a Narco-Biosystems force displacement transducer (model F-60, Narco-Biosystems, Houston, TX, USA) and recorded on a 4-channel Narco-Biosystems desk model polygraph. RESULTS: Phenylephrine (1µM) was used to induce tonic contractions in the corpus cavernosum (3 - 5 g tension) and cavernous artery (0.5 - 1g tension) until reaching a plateau. After precontraction, smooth muscle relaxants were used to produce relaxation-response curves (10-12M to 10-4 M). Sodium nitroprusside was used as a relaxation control. CONCLUSION: The harvesting technique and the smooth muscle contraction-relaxation model described in this study were shown to be useful instruments in the search for new drugs for the treatment of human erectile dysfunction.

Penile prosthesis implantation for treatment of postpriapism erectile dysfunction

Our aim to evaluate the procedure and outcome of penile prosthesis surgery in the treatment of men with postpriapism erectile dysfunction. During the period between 1997 and 2004, a total of 17 patients with postpriapism erectile dysfunction underwent penile prosthesis implantation at our institution. Prosthesis implantation was done electively 6 to 18 months after priapism, when the patients presented with erectile dysfunction. Of the prosthesis implanted, 11 were malleable, 4 were 2-piece, and 2 were 3-piece prostheses [AMS, Minnetonka, Minnesota, USA]. All the 17 patients were successfully implanted with penile prosthesis, which led to urethral injury in 2 patients. There were no major postoperative complications. The median hospital stay was 5 days. The follow-up period ranged from 2 to 9 years [median, 6 years]. All the patients were satisfied with the prosthesis. Penile prosthesis implantation is the modality of treatment for patients with postpriapism erectile dysfunction at our institution. It has a high patient satisfaction rate. Although procedure-related complications are common due to corporeal fibrosis, they wre mostly minor ones and did not affect the outcome of the procedure

Prótese peniana / Penile prosthesis

A disfunção erétil do pênis é uma condição de alta prevalência na população mascuina a partir dos 50 anos de idade, principalmente em pacientes portadores de arteriosclerose, diabetes e naqueles submetidos a cirurgias pélvicas, como prostatectomia radical ou amputação abdominoperineal. Várias formas de tratamento clínico e cirúrgico estão disponíveis para este tipo de paciente. A utilização de próteses penianas é uma alternativa segura e eficaz no tratamento de pacientes com disfunção erétil. Neste artigo é realizada uma revisão dos principais tipos de prótese, as indicações para a sua utilização, dos cuidados pré, per ou pós-operatórios em pacientes que se submeterão a este tipo de cirurgia, bem como dos seus resultados e complicações.

Cirugía de implante de prótesis de pene en hombres en la novena década de la vida / Penile prosthesis in elderly men

La población anciana mundial está aumentando aceleradamente, por lo que se prevee un aumento significativo de consultas por disfunción eréctil (D.E) dentro de este grupo etario. La D.E. del anciano es principalmente organogénica por lo que el implante protésico es una alternativa válida frente a la falta de respuesta a fármacos orales. Algunas consideraciones sicosociales y biológicas especiales deben tenerse presentes cuando se enfrenta este grupo de pacientes.

A worldwide growth of ageing population is projected for this century, so an increase in the number of men with ED should be expected in the very next years. Organic ED is predominant in this population, probably non-responders to oral pharmacological agents. Penile prosthesis are a good option for this group of patients as they complaint of a maintained desire for an active sexual life. Some psychosocial and biological considerations should be kept in mind when treating these patients.

Plastía de pene tipo peri-cavernoplastía para el manejo de la disfunción eréctil / Penis Peri-Cavernoplasty for Erectile Disfunction Treatment

La cirugía venosa del pene para tratamiento de la disfunción eréctil (D.E.) se hizo muy popular en la década de los '80, pero los pobres resultados a largo plazo hicieron que fuera dejada de lado; resultados mejorados asociados a criterios estrictos de selección han permitido un renovado interés por esta alternativa terapéutica de la D.E. Presentamos nuestra experiencia con la técnica de pericavernoplastía con cinta de Dacron descrita por Rossi: tres de los nueve pacientes operados presentaban erecciones útiles al control a los doce meses (33 por ciento); probablemente este bajo resultado fue más relacionada con la selección de los pacientes que con falla en la técnica quirúrgica. Creemos que puede ser una alternativa válida para servicios de salud sin acceso a prótesis de pene.

Penile venous surgery was very popular in the ’80 ies, but unsatisfactory long-term results reduced this indication for the therapy of erectile dysfunction. Better selection criteria have been associated to an increased success rate and renewed interest in venous surgery. We made an experience with the Rossi’s pericavernoplasty technique: only 33% of the patients in our group reported a good erection in the longterm follow up at 12 months. This low rate is probably more related to a poor selection of the patients than a failure of the surgical technique. We consider this could be a good option for health services with no access for penile prosthesis.

Tratamento da disfunção erétil: [revisão] / Treatment of erectile dysfunction: [review]

A disfunção erétil (DE) é a dificuldade de ereção observada em homens de todas as idades. As drogas inibidoras da fosfodiesterase 5, (i PDE 5) são atualmente o de mais eficiente no tratamento da DE. A terapia de fármaco ereção induzida - TFI, tem sua indicação limitada ao diagnóstico da DE. Já o implante de próteses penianas readquiriu seu valor e é também uma opção válida, para casos selecionados, com bons resultados. A terapia de reposição hormonal (TRH) pode ajudar principalmente homens com baixa da libido e baixos níveis de testosterona. Drogas como apomorfina e fentolaminas não apresentam efeitos satisfatórios comparados as iPDE 5. Dispositivos como a "Bomba a vácuo" e o "Muse" têm seu uso restrito e pouco eficiente. A terapia sexual é sempre importante e sua associação com as iPDE 5 aumentam o sucesso do tratamento. Após o diagnóstico e o tratamento o paciente tem grande chance de ter uma vida sexual restabelecida.

Erectile dysfunction (ED) is the result of a difficulty to obtain penile erection to perform a satisfactory sexual intercourse. ED occurs in men of all ages. The inhibitors of phosphodiesterase 5 (iPDE 5) are the most efficient treatment for ED. Penile prothesis is indicated in selected cases. Hormone replacement therapy can help men with hypogonadism. Drugs like apomorfine and fentolamina, "MUSE" and "vacuum engine" are not as efficient as iPDE 5. Sexual therapy associated to iPDE 5 improves te treatment success.

Cirurgia sem perdas das próteses penianas / Zero loss surgery of penile prosthesis

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.

Eficácia e segurança da prótese peniana inflável no tratamento de disfunçäo erétil em pacientes diabéticos / Efficacy and safety of inflatable penile prosthesis in erectile dysfunction treatment in diabetic patients

A microangiopatia e a neuropatia periférica säo dois dos principais fatores envolvidos na patogenia da disfunçäo erétil em pacientes com diabetes mellitus (DM). Os pacientes diabéticos com disfunçäo erétil grave têm resultados pobres com o uso de drogas orais, sendo que o tratamento fica restrito a injeçöes intracavernosas e à colocaçäo de próteses penianas na maioria dos casos. Neste grupo de pacientes o risco de infecçöes relacionadas à baixa imunidade gerada pelo DM traz preocupaçöes em relaçäo à perda da prótese e mesmo à segurança do tratamento. Analisamos prospectivamente o tratamento de cinco pacientes diabéticos insulino-dependentes através da colocaçäo de prótese peniana inflável modelo AMS 700 CX. Os cinco pacientes apresentaram boa evoluçäo pós-operatória e nenhum deles apresentou infecçöes relacionadas à cirurgia. Todos exercem atividade sexual regular. O estudo mostrou que o tratamento da disfunçäo erétil em diabéticos pode ser feito com segurança através do uso de prótese penianas infláveis, proporcionando uma atividade sexual adequada, sem complicaçöes infecciosasem período de seguimento máximo de 14 meses.