Iatrogenic injuries to reservoirs of inflatable penile prosthesis during urologic surgery: a scoping review and case report.

INTRODUCTION: First-line treatment options for patients with erectile dysfunction whose medical management has failed include the inflatable penile prosthesis (IPP). Many patients with an IPP require subsequent urologic surgery, during which the reservoir of the IPP can be injured. OBJECTIVES: This review aims to present a summary of current literature related to iatrogenic injuries to the IPP sustained during urologic surgery. METHODS: Two reviewers independently performed a systematic search on PubMed using standardized search terms to identify pertinent articles. After preliminary review, relevant studies were analyzed to identify the presence of perioperative complications resulting in IPP reservoir injury. Results were categorized by surgical procedures. RESULTS: Among 13 articles included, all were based on urologic surgery. Four studies identified IPP reservoir injury as a result of surgical injury. Of these, injuries occurred during radical prostatectomy (n = 3) and prostatic urethral lift surgery (UroLift, n = 1). Most radical prostatectomy studies without IPP reservoir injuries also described intentional surgical techniques that were employed to prevent reservoir damage, including modulation of reservoir inflation-deflation (n = 3), temporary reservoir repositioning (n = 1), or reservoir capsule dissection to improve visualization (n = 1). Findings from an additional novel case report on IPP injury during a UroLift procedure are presented in this review. CONCLUSION: Approximately one-third of studies identified intraoperative IPP reservoir injury as a significant complication of urologic surgery, particularly during radical prostatectomy. Novel case report findings also contribute the only other case of IPP reservoir damage sustained from delivery of UroLift implants. Findings are used to create a standardized surgical checklist that guides perioperative planning measures prior to pursuing surgery in adjacent spaces.

Improved Efficacy and Reduced Toxicity Using a Custom-Designed Irinotecan-Delivering Silicasome for Orthotopic Colon Cancer.

Irinotecan is a key chemotherapeutic agent for the treatment of colorectal (CRC) and pancreatic (PDAC) cancer. Because of a high incidence of bone marrow and gastrointestinal (GI) toxicity, Onivyde (a liposome) was introduced to provide encapsulated irinotecan (Ir) delivery in PDAC patients. While there is an ongoing clinical trial (NCT02551991) to investigate the use of Onivyde as a first-line option to replace irinotecan in FOLFIRINOX, the liposomal formulation is currently prescribed as a second-line treatment option (in combination with 5-fluorouracil and leucovorin) for patients with metastatic PDAC who failed gemcitabine therapy. However, the toxicity of Onivyde remains a concern that needs to be addressed for use in CRC as well. Our goal was to custom design a mesoporous silica nanoparticle (MSNP) carrier for encapsulated irinotecan delivery in a robust CRC model. This was achieved by developing an orthotopic tumor chunk model in immunocompetent mice. With a view to increase the production volume and to expand the disease applications, the carrier design was improved by using an ethanol exchange method for coating of a supported lipid bilayer (LB) that entraps a protonating agent. The encapsulated protonating agent was subsequently used for remote loading of irinotecan. The excellent irinotecan loading capacity and stability of the LB-coated MSNP carrier, also known as a "silicasome", previously showed improved efficacy and reduced toxicity when compared to an in-house liposomal carrier in a PDAC model. Intravenous injection of the silicasomes in a well-developed orthotopic colon cancer model in mice demonstrated improved pharmacokinetics and tumor drug content over free drug and Onivyde. Moreover, improved drug delivery was accompanied by substantially improved efficacy, increased survival, and reduced bone marrow and GI toxicity compared to the free drug and Onivyde. We also confirmed that the custom-designed irinotecan silicasomes outperform Onivyde in an orthotopic PDAC model. In summary, the Ir-silicasome appears to be promising as a treatment option for CRC in humans based on improved efficacy and the carrier's favorable safety profile.