Evaluation of Quality of Life After Inflatable Penile Implantation and Analysis of Factors Influencing Postsurgery Patient Satisfaction.

BACKGROUND: Most of the published literature addressing the satisfaction postinflatable penile implant (IPP) placement includes non-validated surveys. AIM: The study aims to report the survey outcomes of the English version of The QoLSPP and to evaluate the different factors that could influence these results. METHODS: Patients who underwent inflatable penile implant placement from January 2017 to December 2019 received a survey by phone and had a visit scheduled no sooner than 27 months after surgery. In the clinic, they were inquired about the penile size and underwent measurements of postoperative penile length and diameter. The survey responses were rated from zero to 5 following QoLSPP, and answers ≥3 were considered positive. An evaluation of the factors influencing the quality-of-life score of patients post-IPP placement was performed. Variables included age (<60, 60-70, >70), BMI classification, Charlson Comorbidity Index, diabetes diagnosis, implant type (AMS 700CX vs Titan), ED etiology, revisions, postoperative time in months (<30, 30-40, >40) and preoperative vs postoperative penile dimensions in those who attended the clinic. OUTCOMES: The primary outcome was to obtain accurate patient-reported satisfaction after inflatable penile implantation. RESULTS: Within the timeframe, 542 patients underwent first-time IPP placements. Of that group, 322(n) completed the surveys, and 109 patients attended the clinic to compare preoperative vs postoperative dimensions. Of note, 67 (61.4%) and 54 (49.4 %) demonstrated enlargement in length and diameter, respectively. Conversely, 12 (11%) and 4 (3.7%) experienced a shortening in length and girth. We found 66 (60.5%) patients who complained about a penile size decrease after the intervention. The survey had a positive response in 93.1% of the cases. There were no statistically significant differences in positive responses concerning the variables investigated. The subpopulation analysis of the penile-sized group neither showed response variations. CLINICAL IMPLICATIONS: The investigation allowed a better understanding of patient-reported satisfaction post-IPP placement. STRENGTHS & LIMITATIONS: The performance of all the procedures in a high-volume center by a single surgeon limits its generalization. CONCLUSION: The overall results after IPP surgery are positive in most patients who underwent the procedure and the variables investigated did not influence the overall outcomes of the QoLSPP survey in the study. Luna E, Rodriguez D, Barrios D, et al. Evaluation of Quality of Life After Inflatable Penile Implantation and Analysis of Factors Influencing Postsurgery Patient Satisfaction. J Sex Med 2022;19:1472-1478.

Permanent Deactivation of Inflatable Penile Prosthesis via Puncture.

OBJECTIVE: To describe our technique and early results for inflatable penile prosthesis (IPP) deactivation via puncture and drainage in the office setting to avoid penile explanting interventions in high-risk surgical patients. METHODS: A retrospective chart review of patients with high perioperative risk who had undergone IPP prosthesis puncture in the office setting between March 2020 and May 2021 was performed. Variables included age, the reason for penile prosthesis implantation and deactivation, time frame from implantation to deactivation, type of penile implant, follow-up time, and complications. Clinical information and procedural consent from patients with mental impairment were obtained from caretakers or legal guardians. RESULTS: In all the cases, the implants were in a good position and cycled well without difficulty before undergoing the drainage. Ten patients underwent the deactivation procedure, with ages ranging from 81 to 93 years old (mean 88 ± 3.74), 9 cases had a dementia diagnosis, and 1 case of penile implant aversion. Mean follow-up was 8.4 months ± 2.3, and there were no reported complications during the follow-up period. CONCLUSION: Permanent deactivation of IPP via in-office puncture and drainage represents a safe, feasible, and reliable option for those patients with multiple comorbidities and caretakers who desire removal of normally cycling, well-positioned, and uninfected penile implants. We strongly recommend all our patients with severe cognitive decline have their implants devices punctured to prevent any potential complications.

Reconstrucción de la vía biliar junto al tratamiento adyuvante con ácidoursodesoxicólico en lesiones/estenosisiatrogénicas posterior a colecistectomías. Resultados iniciales / Biliary reconstruction surgery follow by adju-vant therapy with ursodesoxicolcy acid in injury/stenosis after cholecistectomy. Prelimi-nary results

El tratamiento de la estenosis biliar benigna (EBB) constituye unreto médico, más del 70% de los casos son resueltos endoscópica-mente, reservando los más complejos para el abordaje quirúrgico,con una tasa éxito que ronda del 92 % al 60%. Una técnica qui-rúrgica impecable junto a factores favorables del paciente es la prin-cipal garantía de éxito. Objetivo: Mantener un adecuado flujo biliar es uno de los factoresprincipales para evitar inflamación y éstasis biliar, por lo que hemosemprendido el siguiente protocolo de estudio con terapia adyuvantecon ácido ursodesoxicólico posterior a la reconstrucción biliar.Métodos: Ensayo clínico prospectivo no aleatorizado, donde seincluyen pacientes con estenosis biliar benigna desde agosto 2012hasta agosto 2014.Resultados:Se han incluido 13 pacientes con preponderancia delsexo femenino con un 77 %, las estenosis tipo Bismuth 1 y 2 ocu-paron un 23 %, mientras que para Bismuth 4 y 5 un 15,38 % res-pectivamente, las EBB producto en anastomosis biliodigestiva ocu-rrió en un 23 %. El seguimiento promedio fue de 13,3 meses.Posterior al tratamiento, sólo 1 paciente experimentó colangitis enausencia de estenosis. Hasta la fecha de seguimiento ninguno hapresentado re-estenosis.Conclusión: Una técnica quirúrgica impecable junto al tratamientoadyuvante con ácido ursodesoxicólico pareciera ofrecer buenosresultados a fin de evitar la re-estenosis y la colangitis, por lo que suaplicación debe ser estudiada por periodos de tiempo prolongados(AU)

The benign biliary stenosis is a medical challenge; more than 70%of them are resulted endoscopically, leaving the most difficult casesfor surgical treatment, which can reach a success between 92% and60%. Meticulous surgical techniques with better patient prognosticfactors are guarantee of success. Objective:The adequate biliary flow is related with less inflationand less biliary stasis, that's why we decide to use ursodesoxicolicacid as an adjuvant treatment after biliary reconstruction surgery.Methods: Non randomized clinical trial, including patients betweenAugust 2012 to August 2014 with benign biliary stenosis.Results:Were included 13 patients, most of them women 77%.Type 1 and 2 Bismuth 23%, Bismuth 4 -5 15,38 % respectively, and23 % for stenosis of the biliodigestive anastomosis. The medianfollow up was 13,3 months. After surgical reconstruction there wereonly 1 patient who revealed cholangitis, and no restenosis in thefollow up period. Conclusion:A meticulous surgical technique and adjuvant treat-ment with ursobilanic acid seem to show good results avoiding re-stenosis and cholangitis, prolong study period is required(AU)