Contemporary management of ischemic priapism: A 12-year population-based analysis from a large US database.

BACKGROUND: Priapism is a urological condition characterized by a persistent erection. The management varies based on its subclassifications. Despite established clinical guidelines for ischemic priapism, there is a lack of large-scale research focused on patient characteristics and management strategies. OBJECTIVES: To analyze the contemporary management of ischemic priapism in the US, exploring patient demographics and clinical characteristics, as well as predictors of erectile dysfunction (ED) and penile prosthesis implantation (PPI). MATERIALS AND METHODS: We performed a retrospective analysis of the PearlDiver Mariner database, reviewing records from 2010-2021. Adult males diagnosed with ischemic priapism were included. Data analysis covered demographic, clinical variables, and management strategies. Predictors of de novo ED and PPI were evaluated using multivariable logistic regression analysis. RESULTS: Of 36,120 patients, most (93%) received only medical management, and a minority underwent surgical interventions (penile shunt surgery [PSS], PPI or both). Medical management was typically effective, as 67.08% of the patients in this group experienced only one episode of priapism. However, de novo ED occurred in 16.57% of these patients. The majority of patients undergoing PPI had an inflatable prosthesis (81%). Older age (odds ratio, OR 1.02), the presence of metabolic diseases (OR 1.39), neurogenic disorders (OR 1.72), solid pelvic malignancies (OR 1.09), and multiple episodes of priapism were identified as significant predictors of de novo ED (all p < 0.05). Similarly, age (OR 1.03), the presence of metabolic diseases (OR 1.23), solid pelvic malignancies (OR 1.99), and multiple episodes of priapism were associated with higher likelihood of PPI (all p < 0.05). CONCLUSION: Most cases of ischemic priapism are managed with the medical therapy. Less than 3% of patients with ischemic priapism receive PPI, and when this occurs an inflatable prosthesis is favored. Age, specific comorbidities, and multiple episodes of priapism appear to be significant predictors of ED and PPI.

Changing trends in penile prosthesis implantation in China and an overview of postoperative outcomes from a single center.

BACKGROUND: Surgical penile prosthesis implantation (PPI) procedures have only recently been introduced to mainland China, with the overall number of such procedures having been conducted to date remaining relatively low. Accordingly, relatively little remains known with respect to the annual trends in PPI. Accordingly, this study was developed with the goal of clarifying these trends across different hospitals in mainland China, while also providing a single-center overview of post-PPI patient outcomes. RESULTS: To identify males in mainland China who had undergone PPI, a retrospective review of data from January 2019 - October 2023 was conducted. This approach revealed an increase in the total PPI caseload from 120 in 2019 to 413 within the first 10 months of 2023. Over this same interval, the number of surgeons performing PPI rose from 33 to 74. A retrospective review of the 112 patients who had undergone PPI at Shanghai General Hospital from 2019-2023 revealed that these patients had a median age of 39 [27-63] years, and PPI treatment led to a significant increase in median International Index of Erectile Function-5 (IIEF-5) scores from a baseline value of 10.23 ± 1.26 to a post-treatment value of 22.6 ± 2.73. The underlying causes of erectile dysfunction for these patients included vasculogenic factors (58/112; 51.8%), diabetes mellitus (21/112; 18.8%), and injuries to the spinal cord or pelvis (14/112; 12.5%). The overall rates of satisfaction with the PPI reported by patients and their partners were 93.0% and 90.4%, respectively, and the 3-year PPI survival rate for this cohort was 87%. CONCLUSION: These data highlight a rising trend in the number of PPI being performed in China, with these steadily increasing rates since 2019 emphasizing the increasingly high levels of acceptance of this procedure by patients and clinicians as a means of treating erectile dysfunction. However, the expertise is restricted to a small number of surgeons. Even so, it is a safe and efficacious approach to managing severe erectile dysfunction for patients in China, and when performed by experienced surgeons based on standardized protocols, low complication rates can be achieved while providing patients and their sexual partners with high levels of satisfaction.

RéSUMé: CONTEXTE: Les procédures chirurgicales d'implantation de prothèses péniennes (IPP) n'ont été que récemment introduites en Chine continentale, le nombre total de procédures de ce type ayant été effectuées à ce jour restant relativement faible. On ne sait donc encore que relativement peu de choses sur les tendances annuelles de l'IPP. La présente étude a été développée dans le but de clarifier ces tendances dans différents hôpitaux de Chine continentale, tout en fournissant une vue d'ensemble des résultats des patients post-IPP dans un seul centre. RéSULTATS: Afin d'identifier les hommes de Chine continentale qui avaient subi un IPP, une recherche rétrospective des données a été effectuée de janvier 2019 à octobre 2023. Cette approche a révélé une augmentation du nombre total de cas d'IPP de 120 en 2019 à 413 au cours des 10 premiers mois de 2023. Au cours de cette même période, le nombre de chirurgiens pratiquant des IPP est passé de 33 à 74. L'étude rétrospective des 112 patients qui avaient subi un IPP à l'hôpital général de Shanghai de 2019 à 2023 a révélé qu' ils avaient un âge médian de 39 [27­63] ans, et que le traitement par IPP a entraîné une augmentation significative des scores médians de l'indice international de la fonction érectile-5, qui sont passés d'une valeur de base de 10,2 ± 1,3 à une valeur post-traitement de 22,6 ± 2,7. Les causes sous-jacentes de la dysfonction érectile chez ces patients comprenaient des facteurs vasculogéniques (58/112; 51,8%), un diabète (21/112; 18,8%) et des lésions de la moelle épinière ou du bassin (14/112; 12,5%). Les taux globaux de satisfaction à l'égard de l'IPP, rapportés par les patients et leurs partenaires, étaient respectivement de 93,0% et 90,4%, et le taux de survie à 3 ans de l'IPP dans cette cohorte était de 87%. CONCLUSION: Ces données mettent en évidence une tendance à la hausse du nombre d'IPP pratiquées en Chine; ces taux en constante augmentation depuis 2019 soulignent les niveaux de plus en plus élevés d'acceptation de cette procédure par les patients et les cliniciens comme moyen de traitement de la dysfonction érectile. Cependant, l'expertise est limitée à un petit nombre de chirurgiens. Malgré cela, il s'agit d'une approche sûre et efficace pour gérer la dysfonction érectile sévère pour les patients en Chine, et lorsqu'elle est effectuée par des chirurgiens expérimentés sur la base de protocoles standardisés, de faibles taux de complications peuvent être atteints tout en offrant aux patients et à leurs partenaires sexuels des niveaux élevés de satisfaction.

MR imaging of penile pathology and prostheses.

Penile MRI is a vital yet underutilized diagnostic tool that provides detailed information crucial for managing various penile pathologies. Due to its infrequent use, many radiology trainees lack confidence in interpreting these exams. This article reviews the anatomy, key technical considerations, and interpretive pearls for penile trauma, Peyronie's disease, priapism, penile neoplasms, prosthesis evaluation, and a few miscellaneous conditions. Through illustrative case examples, this review aims to enhance the understanding and proficiency of radiologists in performing and interpreting penile MRI in these clinical scenarios.

Antibiotic dip and irrigation solutions confer increased antimicrobial efficacy of inflatable penile prosthesis hydrophilic surfaces compared with 0.05% chlorhexidine gluconate.

BACKGROUND: Chlorhexidine gluconate (CHG) (0.05%) has recently been suggested as both a dip for the hydrophilic surface and an irrigation solution in the setting of penile prosthesis (PP) surgery. AIM: The study sought to compare the antimicrobial efficacy of 0.05% CHG with vancomycin and gentamicin (VG) antibiotics as dip and/or irrigation solutions in the setting of a hydrophilic PP surface in vitro. METHODS: Sterile PPs with a hydrophilic coating were obtained. A series of experiments were performed to evaluate the efficacy of normal saline (NS), 0.05% CHG, or VG as dip and/or irrigation solutions to reduce methicillin-sensitive Staphylococcus aureus adhesion to PP surfaces. The 8-mm discs from PPs were incubated in 105 colony-forming units/mL of methicillin-sensitive S aureus for 48 hours, plated, and counted. Disc-diffusion tests were conducted by suspending 6-mm discs for 2 minutes in NS, 0.05% CHG, or VG, then placing them coated side down onto plates streaked with the following organisms: methicillin-sensitive S aureus, S epidermidis, Enterococcus, and Escherichia coli. After 24 hours of growth, zones of inhibition were measured. OUTCOMES: We found average bacterial counts (colony-forming units/mL) and zones of inhibition (mm) following a series of treatment protocols of PP discs. RESULTS: PP discs dipped in VG reduced bacterial adhesion to the implant surface >0.05% CHG (~5.5 log vs ~1.5 log; P < .01). Discs irrigated with either 0.05% CHG or NS removed all dip solution adsorbed to the hydrophilic surface, allowing bacterial growth. VG irrigation adsorbed to the hydrophilic surface even after 0.05% CHG or NS dips, reducing bacterial adherence (~3 log). Dipping and irrigating discs with VG was most effective in reducing adherent bacteria (~5.5 log) and was the only irrigation that showed antimicrobial activity. CLINICAL TRANSLATION: VG, when used both as a prophylactic dip and as an intraoperative irrigation solution for hydrophilic penile implant surfaces, has improved efficacy to 0.05% CHG and NS. STRENGTHS AND LIMITATIONS: This is the first study to compare the use of VG, 0.05% CHG, and NS as prophylactic dips and intraoperative irrigations for hydrophilic penile implant surfaces. Limitations include the use of in vitro studies, which serve as a proxy for in vivo practices and may not be entirely accurate nor translatable clinically. CONCLUSION: We demonstrated the superior efficacy of VG as a combined dip and irrigation solution for hydrophilic penile implant surfaces compared with 0.05% CHG.

Minocycline-rifampin-impregnated penile prosthesis surfaces retain antimicrobial activity following irrigation with 0.05% chlorhexidine gluconate and antibiotic solutions.

BACKGROUND: 0.05% Chlorhexidine gluconate (CHG; Irrisept [IrriMax]) is a commercial wound irrigation solution approved by the Food and Drug Administration that has seen recent adoption in the field of prosthetic urology; however, no study has evaluated whether 0.05% CHG is compatible with the minocycline-rifampin-impregnated surface (InhibiZone) of the AMS 700 penile prosthesis (Boston Scientific). AIM: To evaluate whether 0.05% CHG alters the antibiotic efficacy of the minocycline-rifampin-impregnated penile prosthesis surface. METHODS: Discs (8 mm) were taken by a punch biopsy (Sklar) from sterile penile prosthesis reservoirs whose surfaces had been impregnated with rifampin and minocycline. Discs (n = 10) were suspended in 0.05% CHG, vancomycin and gentamicin, or normal saline for 2 minutes to simulate intraoperative irrigation. Discs were then rinsed in normal saline to remove any unbound solution and incubated with methicillin-sensitive Staphylococcus aureus for 48 hours. Adherent surface bacteria were suspended by shaking in a 0.3% Tween 20 solution, serially diluted, plated onto 3M PetriFilms, and counted. Kirby-Bauer disc diffusion assays were conducted to generalize findings across various organisms. OUTCOMES: Outcomes included (1) bacterial adherence to the implant surface measured as bacterial counts (in colony-forming units per milliliter) and (2) bacterial growth reduction measured as zones of inhibitions (in millimeters). RESULTS: Incubation of implant surfaces in 0.05% CHG did not alter recovered bacterial counts as compared with normal saline and vancomycin/gentamycin. Similarly, within a single bacterial species, 0.05% CHG and vancomycin/gentamycin did not alter zone-of-inhibition measurements in Kirby-Bauer disc diffusion studies. CLINICAL TRANSLATION: This study demonstrates in vitro that 0.05% CHG may be used directly on the minocycline-rifampin-impregnated surface without altering the antibiotic efficacy of the coating. STRENGTHS AND LIMITATIONS: Strengths include that this is the first study to evaluate if 0.05% CHG affected the minocycline-rifampin-impregnated surface. Limitations include the use of in vitro studies, which serve as a proxy for in vivo practices and may not be entirely accurate or translatable in a clinical setting. CONCLUSION: 0.05% CHG does not alter the antimicrobial activity of the minocycline-rifampin-impregnated surface as compared with vancomycin/gentamycin and normal saline in vitro; however, its efficacy in clinical practice remains to be evaluated.

Penile Prosthetic Pump Reservoir Mimicking a Cecal Subepithelial Mass.

Intestinal subepithelial lesions are often encountered during endoscopy. Etiologies can include lesions intrinsic or extrinsic to the gastrointestinal wall. They can present a diagnostic dilemma as simple mucosal biopsies are often nondiagnostic. The combination of characteristic radiographic, endoscopic, and endosonographic features can aid in a definitive diagnosis precluding the need for unnecessary tissue sampling of extrinsic compressive etiologies. The location of the space of Retzius which is the traditional site of penile prosthetic pump reservoir insertion can predispose to cecal compression. We present a rare case of a penile prosthetic pump reservoir presenting as a cecal subepithelial mass on endoscopy.

Long-term penile prosthesis couple's satisfaction: A systematic review and meta-analysis.

CONTEXT: Data supporting successful and satisfactory penile prosthesis (PP) implantation outcomes are mainly based on subjective, rather than objective, analysis. OBJECTIVE: To systematically review and objectively analyze, all available data related to patient and partner PP satisfaction. EVIDENCE ACQUISITION: An extensive search was performed, including the following key-words: ("penile prosthesis" and "satisfaction"). The search, which accrued data from January 1, 1969, up to July 31, 2023, was restricted to English-language articles including human participants. EVIDENCE SYNTHESIS: Out of 663 retrieved articles, 83 were considered including, 12,132 subjects with a mean age and mean follow-up of 58.6 [range 20; 77.1] years and 47.6 [range 6; 374] months, respectively. Overall, a high patient satisfaction rate was observed 83[80; 86]%. The satisfaction rate increased in subjects with three-piece PP and in those with a higher rate of cardiovascular or neurological diseases and was independent of the patient's age. Partner's satisfaction rate was lower when compared to that observed in men and it increased according to the use of inflatable devices and the presence of patient Peyronie's disease. The long-term complication rate was limited ranging from 3% for erosion to 4.6% when mechanical failure was considered. CONCLUSIONS: Patient and partner satisfaction is excellent and increases with time. The number of complications is limited and is strongly associated with the presence of diabetes mellitus. PATIENT SUMMARY: We found a high couple satisfaction score that was higher when reported by males compared to females. Patient satisfaction increased with time, and it was independent of age.

Erosion of IPP components into bladder lumen and prostatic urethra.

The incidence of erosion of inflatable penile prosthesis (IPP) components into adjacent organs is low (<0.1 %). During a transurethral resection of the prostate (TURP) in a patient with prior IPP placement, we encountered IPP tubing that had eroded into the prostate. The pump and cylinders were later explanted through a penoscrotal approach, with the reservoir drained and retained with plan for follow up cystoscopy in 4-6 weeks. Cystoscopy 1 month later demonstrated reservoir erosion into the bladder lumen. An open cystotomy was performed to retrieve the reservoir. This is the first reported case of IPP tubing eroding into the prostate.

Unveiling the Hidden Perils: A Comprehensive Review of Fungal Infections in Inflatable Penile Prosthesis Surgery.

Inflatable penile prosthesis (IPP) surgery is an effective treatment for erectile dysfunction (ED), but infections pose a significant threat to its success. Current guidelines lack antifungal recommendations, despite rising fungal infection rates post-IPP surgery. This review examines epidemiology, risk factors (including diabetes mellitus, immunosuppression, and obesity), and pathogenesis, highlighting the role of biofilm formation in device contamination. Clinical manifestations vary from acute to delayed, with fungal biofilms presenting challenges in diagnosis. Prophylactic strategies, including broad-spectrum antibiotics and antifungals, are crucial, with evidence suggesting a 92% reduction in infections. With fungal infections showing lower salvage rates, management involves culture-guided treatment, irrigation, and oral antibiotics. Future research aims to understand biofilm mechanisms and develop biomaterials to reduce infection rates. Implementing antifungal therapy, along with standard practices like the no-touch technique and antibiotic dips, is crucial in preventing IPP infections.

Penile prosthesis for erectile dysfunction in France: A six-year nationwide database analysis.

INTRODUCTION: Urological consultations for erectile dysfunction (ED) are increasing worldwide. Penile prosthesis (PP) implantations are performed when other treatments are unsuccessful. However, there is no data regarding PP implantations in France beyond the year 2016. OBJECTIVES: This study aimed to describe the changes in the number and type of PP implants used for the treatment of ED in France from 2016 to 2021 and the hospitalization rates following implantation using French national data from the Program for the Medicalization of Information Systems (PMSI). MATERIALS AND METHODS: We analyzed data on PP implantations in all France hospitals. PPs were coded into three types according to the Common Classification of Medical Procedures (CCAM). The number of patients admitted to hospital with complications twelve months after implantation was also recorded. RESULTS: During the study period, 3675 men received 3868 PPs in France. A gradual increase in the total number of implanted PPs was observed, with an overall increase of 33.8%. In 2020, there was a sharp decline in the number of implanted PPs, primarily owing to the COVID-19 pandemic. The most commonly used implant was PPs with an extracavernous compartment, comprising 85% of all PPs. Twelve months after implantation, only 1-2% of the patients were rehospitalized. CONCLUSION: PP implantation surgeries are highly reproducible and have a low incidence of complications, in terms of rehospitalization after one year of placement (1.8%). Moreover, there was an increase in the demand for penile prosthesis implantations in France between 2016 and 2021. LEVEL OF EVIDENCE: 4: Descriptive epidemiological study.

Assessing artificial intelligence responses to common patient questions regarding inflatable penile prostheses using a publicly available natural language processing tool (ChatGPT).

INTRODUCTION: The evolving landscape of healthcare information dissemination has been dramatically influenced by the rise of artificial intelligence (AI) driven chatbots, providing patients with accessible and interactive platforms to obtain knowledge about medical procedures and conditions. Among the various surgical interventions in urology, inflatable penile prosthesis (IPP) is a common treatment for men with erectile dysfunction. As patients increasingly seek comprehensive resources to understand what this procedure entails, AI-based chat technologies, such as ChatGPT, have become more prominent. This study aimed to assess the capacity of ChatGPT to provide accurate and easily understandable responses to common questions regarding the IPP procedure. MATERIALS AND METHODS: Ten frequently asked questions (FAQ) about the IPP procedure were presented to the ChatGPT chatbot in separate conversational sessions without follow up questions or repetitions. An evidence-based approach was employed to assess the accuracy of the chatbot's responses. Responses were categorized as "excellent response not requiring clarification," "satisfactory requiring minimal clarification," "satisfactory requiring moderate clarification," or "unsatisfactory requiring substantial clarification." RESULTS: Upon review, 70% of ChatGPT's answers to questions regarding the IPP procedure were rated as "excellent," not necessitating further clarification. Twenty percent were considered "satisfactory," requiring minimal clarification, notably on the omission of statistical data and the depth of discussion on certain topics. Ten percent of the responses were "unsatisfactory," requiring substantial clarification, including a failure to provide a definitive answer when necessary. CONCLUSIONS: This study reveals that ChatGPT has a substantial capability to produce evidence-based, understandable responses to a majority of common questions related to the IPP procedure. While there is room for improvement, ChatGPT can serve as an advantageous tool for patient education, enhancing preoperative understanding and contributing to informed decision-making during urological consultations for IPP.

Long-term results of three-part penile prosthesis implantation with Ectopic reservoir placement in the treatment of erectile dysfunction: is supramuscular tubulation a reliable method?

BACKGROUND: Penile prosthesis implantation is the last resort for refractory erectile dysfunction. Reservoir placement is one of the biggest challenges in inflatable penile prosthesis implant surgery in several cases, especially in patients with abnormal pelvic anatomy. Ectopic reservoir placement with supramuscular approach has many advantages in these cases. RESULTS: No complications were encountered except wound site infection in 2 patients which could be controlled with antibiotic treatment. EDITS scores were not statistically different between patients divided into 2-year groups according to follow-up time. Median values of EDITS scores were high in all groups, suggesting that couples had high sexual satisfaction both in the long term and in the short term. CONCLUSIONS: We recommend placement of the supramuscular tube and reservoir through the incision described, especially in patients whose pelvic anatomy has been modified by lower abdominal surgery.

RéSUMé: CONTEXTE: L'implantation d'une prothèse pénienne est le dernier recours pour les dysfonctions érectiles réfractaires. La mise en place d'un réservoir est l'un des plus grands défis de la chirurgie d'implant de prothèse pénienne gonflable dans de nombreux cas, en particulier chez les patientes présentant une anatomie pelvienne anormale. RéSULTATS: Aucune complication n'a été rencontrée, à l'exception d'une infection du site de la plaie chez 2 patients, qui a pu être contrôlée par un traitement antibiotique. Les scores du questionnaire EDITS ne furent pas statistiquement différents entre les patients classés en groupes de 2 ans en fonction du temps de suivi. Les valeurs médianes des scores du questionnaire EDITS étaient élevées dans tous les groupes, ce qui suggère que les couples avaient une satisfaction sexuelle élevée à la fois à court et à long termes. CONCLUSIONS: Nous recommandons la mise en place du tube supramusculaire et du réservoir à travers l'incision décrite, en particulier chez les patients dont l'anatomie pelvienne a été antérieurement modifiée par une chirurgie abdominale basse.

Emerging strategies for the prevention of bacterial biofilm in prosthetic surgery.

Penile prosthesis implantation is an effective treatment for erectile dysfunction (ED) with high patient satisfaction and effectiveness. Unfortunately, infections remain a dreaded complication, often necessitating device removal and imposing a substantial healthcare cost. Biofilms are communities of microorganisms encased in a self-produced polymeric matrix that can attach to penile prostheses. Biofilms have been demonstrated on the majority of explanted prostheses for both infectious and non-infectious revisions and are prevalent even in asymptomatic patients. Biofilms play a role in microbial persistence and exhibit unique antibiotic resistance strategies that can lead to increased infection rates in revision surgery. Biofilms demonstrate physical barriers through the development of an extracellular polymeric substance (EPS) that hinders antibiotic penetrance and the bacteria within biofilms demonstrate reduced metabolic activity that weakens the efficacy of traditional antibiotics. Despite these challenges, new methods are being developed and investigated to prevent and treat biofilms. These treatments include surface modifications, biosurfactants, tissue plasminogen activator (tPA), and nitric oxide (NO) to prevent bacterial adhesion and biofilm formation. Additionally, novel antibiotic treatments are currently under investigation and include antimicrobial peptides (AMPs), bacteriophages, and refillable antibiotic coatings. This article reviews biofilm formation, the challenges that biofilms present to conventional antibiotics, current treatments, and experimental approaches for biofilm prevention and treatment.

Salvage procedures for infected penile implants: A comprehensive review and analysis of functional outcomes.

BACKGROUND: The salvage procedure for infected penile implants (IPs) has been a subject of interest since its inception in the late 1980s, yet its widespread adoption remains limited. The aim of this study was to realize a systematic literature review to provide a comprehensive analysis of salvage techniques for IPs and assess their efficacy, specifically focusing on functional success. METHODS: A systematic literature review was conducted using PubMed, employing Mesh terms related to penile prosthesis, penile implant, infection, and salvage procedures. Articles in French or English were considered for the final analysis, with exclusion of literature reviews. RESULTS: Fifteen articles detailing various salvage techniques for IPs were identified. Mulcahy's initial technique was described in 1996, and consisted of complete removal of infected components, extensive lavage, and subsequent replacement with a similar implant. Success rates ranged from 80% to 100%, with emerging trends favoring the use of malleable implants during salvage. Unfortunately, functional data remained limited. When salvage penile prosthesis placement involved a malleable prosthesis, between 20% and 33% of patients underwent conversion to hydraulic prosthesis. CONCLUSION: The salvage procedure for infected penile implants is a reliable method, with success rates surpassing 80%. The need for comparative studies assessing the type of implant used during salvage is required to tailor conservative management strategies for optimal patient outcomes. Finally, few data have been published regarding subsequent conversions from malleable penile implants to hydraulic penile implants after salvage.

Inflatable Penile Prosthesis Complication in the Emergency Department.

Inflatable penile prostheses are a widely utilized treatment for erectile dysfunction. While MRI is the optimal imaging modality for patients with suspected implant complications, it is often unavailable in the acute setting. In light of these limitations, we present a case of urethral perforation by an implanted penile cylinder and its evaluation with contrast-enhanced computed tomography (CT) in an emergent setting.

Penile prosthesis in priapism: a systematic review of outcomes and complications.

Background: Priapism is a rare condition characterized by persistent erection of the penis that lasts more than 4 hours in the absence of sexual stimulation and is associated with significant morbidity and complications, including erectile dysfunction and penile fibrosis. Surgical management of priapism can be extremely challenging. We herein provide a comprehensive review that aims to evaluate the role of penile prosthesis (PP) implantation in the management of priapism. Methods: A systematic literature search was performed using the following databases: PubMed, Embase, and Scopus to identify studies that evaluated the effectiveness of PP implantation in treating priapism and the long-term complications, outcomes, and patients' satisfaction rate. Results: Out of 717 English-language studies published between 2002 and 2022, 17 were chosen for this review. Majority of patients had a malleable PP (MPP) implant, either early or delayed after the priapism episode. Early placement (EP) of PP is widely defined between studies ranging from less than 72 hours, within 1 week, and within 3 weeks. Most common causes of priapism were sickle cell anemia (SCA), medication-induced, and idiopathic. Studies show a higher satisfaction rate ranging between 80% and 100%, with sexual intercourse achievement ranging between 64.2% and 100%. Based on the GRADE system, included studies rated as very low quality of evidence. Commonly reported complications that arise after PP procedures, include device infection, erosion, curvature, and mechanical malfunction, such as auto-inflation. Conclusions: PP can be an effective treatment option for priapism, particularly in cases of ischemic priapism lasting more than 36 hours or recurrent priapism that is medically refractory. However, due to the very low quality of evidence, larger, well-designed studies are warranted where long-term outcomes, patients' satisfaction, and complications following priapism-related PP implantation are measured as endpoints.

Narrative review of immediate salvage for penile prosthesis infection.

Background and Objective: Implantation of a penile prosthesis is a reliable option for men with erectile dysfunction (ED) refractory to less invasive therapies. While the frequency of penile prosthesis infections have decreased, they remain a devastating complication. Herein we discuss why immediate salvage surgery is an essential technique for the management of implant infections. We will also describe the relevant advancements to this technique. Methods: We conducted a narrative review via computer based search of PubMed for all relevant articles on penile prosthesis infection management, including guidelines, case series, reviews, and expert opinions. Search terms used included: "inflatable penile prosthesis", "IPP", "penile prosthesis", "salvage", "treatment", "delayed", "immediate". Only English peer-reviewed publications were included. Key Content and Findings: Historically, patients who presented with penile prosthesis infections were exclusively managed with complete removal of the prosthesis without replacement. Although this strategy is safe, it hastens immediate ED and corporal fibrosis, resulting in loss of penile length and increased difficulty with subsequent prosthesis replacement. Previous case series have reported successful treatment of localized penile prosthesis infections with nonsurgical treatment, but the role of conservative treatment remains limited. The current standard of immediate salvage entails removal of the infected prosthesis and washout followed by immediate replacement with a new penile prosthesis. This technique has been demonstrated to be safe and effective, thus allowing patients to resume intercourse and maintain penile length. Conclusions: Immediate salvage surgery is safe and effective, and has emerged as the preferred strategy for the management of most patients with a penile prosthesis infection.

Overcoming barriers to immediate penile implant salvage surgery: a narrative review.

Background and Objective: Since immediate salvage (IS) surgery for infected penile prosthesis (PP) was introduced nearly 30 years ago, an abundance of evidence has emerged in support of its use. IS remains underutilized by the modern urologist despite its distinct advantages. While some medical literature proposes reasons for the underuse of IS, no comprehensive review attempts to address the numerous factors limiting its implementation. Our objective is to analyze the barriers to IS surgery for infected PP with the goal of expanding utilization of this technique through a practical and standardized approach for treating urologists. Methods: A narrative review of available English, peer-reviewed, medical literature relevant to the barriers to IS was completed. Searches were expanded to include literature from surgical specialties in general if hypothesized barriers were incompletely described in available PP publications. Key Content and Findings: The major barriers that are likely contributing to the low rates of IS for PP surgery can be broadly classified into three major categories: institutional/systemic, medical/surgical, and patient preference. Institutional/systemically driven barriers include surgeon comfort with PP surgery, low national availability of urologists, inaccessibility of prosthetics or critical ancillary staff at the time of patient presentation and limited operating room (OR) access. Medical/surgical barriers primarily relate to reinfection fears, perceived contraindications to IS, and overall patient stability at the time of presentation. Patient preference factors inhibiting IS involve loss of trust in the medical team, psychosocial distress, dissatisfaction with the initial device prior to infection and anxiety regarding postoperative recovery. Many of the identified barriers can be overcome with increased surgical training, improved patient and surgeon understanding of PP infection, or precautionary planning. Conclusions: Of the factors that contribute to low utilization of IS, many are misunderstood or unknown. Recognition of these barriers may equip urologists to provide better care to patients with prosthesis infection.