Penile prosthesis in the organ transplant recipient.

OBJECTIVES: To determine whether pelvic organ transplant recipients are at a higher risk of developing complications after placement of a penile prosthesis relative to those receiving a penile prosthesis who did not undergo pelvic organ transplantation. METHODS: Two hundred eleven men underwent placement of a penile prosthesis by a single urologist at our institution between July 1994 and March 2000. Of these, 46 patients had undergone pelvic organ transplantation before placement of the penile prosthesis. The average time from transplantation was 43 months. The average follow-up after prosthesis placement was 23 months. These patients were monitored for various complications, including infection, malfunction, autoinflation, and injury to the prosthesis. They were compared with a cohort of men who had had a prosthesis placed but had not received pelvic organ transplantation. RESULTS: The overall complication rate was significantly higher in the transplant patients (22%) than in the nontransplant patients (7.9%) receiving prostheses (P <0.01). Infection was seen in 2 transplant patients (4.3%) and in 7 nontransplant patients (4.2%) (P <1). Malfunction occurred in 4 of the transplant patients (8.7%) and 6 of the nontransplant patients (3.6%) (P <0.2). In those patients with a prosthesis malfunction, 9 of 10 involved a three-piece prosthesis. All four malfunctions in the transplant group occurred in three-piece prostheses. The difference in the rate of malfunction was statistically significant (P <0.001) when comparing the three-piece prosthesis in the transplant and nontransplant patients (P <0.001). Surgical injury to the retroperitoneal reservoir occurred in 4 transplant patients (8.7%) (all with three-piece prostheses) and in none of the nontransplant patients (P <0.001). CONCLUSIONS: The risk of infection after insertion of penile prostheses in patients with pelvic organ transplantation was similar to that in nontransplant patients. The risk of malfunction and injury to the prosthesis (three-piece) was higher in transplant patients. The overall complication rate was significantly higher in patients after transplantation and can be attributed to the reservoir complications related to three-piece prostheses. In patients with a prosthesis that did not have a retroperitoneal reservoir, no significant difference in the overall complication rate was observed. Pelvic organ transplant recipients in whom traditional conservative therapy for erectile dysfunction fails should be considered candidates for penile prosthesis placement. However, three-piece prostheses should be avoided, as these patients are best served with prostheses that do not require a retroperitoneal reservoir.

Future concepts in the medical therapy of benign prostatic hyperplasia.

The standard medical therapy for symptomatic benign prostatic hyperplasia is still alpha-blockers and 5alpha-reductase inhibitors. Ongoing studies demonstrate the long-term safety and efficacy of these two classes of therapeutic approaches. Although there have been no new Food and Drug Administration approved medical therapies for the treatment of benign prostatic hyperplasia over the past year, interest in and the use of phytotherapeutic agents continues to increase. In this review, we will discuss the developments that have occurred over the past year in the medical management of benign prostatic hyperplasia. In addition, we present ongoing efforts at our center to obtain a better understanding of and manipulate the apoptotic pathway as it pertains to the pathophysiology of benign prostatic hyperplasia.

Open laparoscopic access using a radially dilating trocar: experience and indications in 50 consecutive cases.

BACKGROUND: Laparoscopy can be performed using needle access for initial insufflation or open access. PATIENTS AND METHODS: A technique for open laparoscopic access to the abdomen using a radially dilating cannula was used in 52 operations in 50 patients. Indications included age <2 years, severe kyphosis, and creation of an umbilical stoma. RESULTS: There was one case of minor leakage of carbon dioxide that did not affect the procedure being performed. There were two cases of preperitoneal placement, which were recognized immediately; in both, peritoneal access was easily obtained. CONCLUSION: Open laparoscopic access is safely and easily performed with a radially dilating trocar. This is the preferred technique at our institution for patients who meet the criteria for open access.