A 10-year Audit of Penile Prosthesis Insertion.

Introduction Penile prosthesis (PP) insertion is the gold standard surgical treatment option for men with refractory Erectile Dysfunction (ED). PP insertion is considered effective but has a well-documented array of complications. Our aim was to assess outcomes following single-surgeon insertion of PP for ED within an Irish cohort. Methods Following review of the Hospital In-Patient Enquiry (HIPE) system, a retrospective chart review of all patients who underwent PP insertion over a 10-year period from 2008-2017 inclusive was performed, and an electronic database was analysed for results. Results One-hundred-and-eleven PPs were inserted in 96 patients. The most common aetiology for ED in our cohort was post-prostatectomy, affecting 25 (26%) patients. The most frequently implanted device was a 3-piece inflatable PP (3p-IPP) (AMS 700TM; American Medical Systems Inc., Minnesota, USA) and the peno-scrotal approach was utilised in the majority of patients (86, 77.5%). No intraoperative complications were recorded. Twelve (12.5%) patients developed peri-operative complications. Thirteen (13.5%) patients required device revision, the majority for device failure. Of the 71 patient satisfaction responses, 61 (85.9%) patients were satisfied with their PP. Conclusions This single-surgeon retrospective audit of PP surgery demonstrates complication rates in-line with internationally published data. Patients should be adequately counselled regarding possible complications, including device failure and erosion. PP insertion should be considered for suitable patients with refractory ED.

Effects of magnesium sulfate pretreatment on succinylcholine-facilitated tracheal intubation.

Magnesium sulfate may prevent increase in serum potassium produced by succinylcholine and cause transient hypotension. The present study was designed to evaluate the effect of magnesium sulfate on heart rate, blood pressure and hyperkalemic response following succinylcholine injection during tracheal intubation. Twenty patients, ASA class I-II, scheduled for elective surgery were equally and randomly allocated to two groups. Heart rate, blood pressure, venous and arterial potassium levels were measured immediately before intubation. Induction was achieved with fentanyl 2 ug/kg and thiopental 5 mg/kg i.v., and intubation was facilitated with succinylcholine 1.0 mg/kg i.v. In the magnesium group (group I), 60 mg/kg of magnesium sulfate was infused intravenously in 1-1.5 min immediately before succinylcholine injection. The control group (group II) received an equal volume of normal saline in the same way. Heart rate, blood pressure, venous and arterial potassium levels were measured at 1, 3, 5 and 10 minutes after intubation. The results showed that magnesium sulfate could attenuate the hypertensive response at 1 minute and the hyperkalemic response at 1 and 3 minutes following succinylcholine-facilitated intubation; the tachycardiac response at 1 minute after intubation could not be reduced by this agent. We concluded that bolus infusion of magnesium sulfate may be of help in reducing the hypertensive response during laryngoscopy and intubation.