Urologic trauma from vaginal dilation for congenital vaginal stenosis: A newly-described and challenging complication.

Vaginal dilation is first line therapy for vaginal agenesis. No major urologic complications have even been described. We present the management and successful outcome of immediate repair for urethral trauma in a patient with history of congenital anomalies managed with vaginal dilation. Proper exposure is difficult, but urologic repair can be achieved with or without concomitant vaginal repair.

Biomechanical Studies of the Inflatable Penile Prosthesis: A Review.

INTRODUCTION: The penile prosthesis remains the primary surgical treatment for refractory erectile dysfunction. Over the decades, inflatable penile prostheses' mechanical reliability, patient satisfaction, safety, and functional erectile restoration have greatly improved. During this time, many studies of biomechanical properties of the prosthesis have been conducted to better understand their biomimicry to the erect human phallus. AIM: To review all current literature on the biomechanical properties of the penile prosthesis, including prosthesis biomechanical function, and variability in model-related performance. METHODS: A Medline PubMed search was used to identify all articles of interest related to subjects involving the penile prosthesis and its related biomechanical properties. The following were included in the search for articles of interest: "biomechanics," "mechanics," "mechanical properties," "axial rigidity," "penile implant," and "penile prosthesis." Articles were further screened for content and English language. MAIN OUTCOME MEASURE: Here we perform a literature review of the bio-mechenical function, performance, and patient satisfaction of penile implants. RESULTS: Axial rigidity helps determine the ability of an erect penis to complete vaginal intromission and pelvic thrusting without buckling. Recent cadaveric data show that at maximum inflation, Coloplast and American Medical Systems (AMS) implants had comparable performance. Variability was seen at various lower fill pressures, where more severe buckling was observed. Coloplast Titan showed a tendency toward better resistance to longitudinal and horizontal forces. The AMS CX device showed similar performance to the Titan, and the AMS LGX device was shown to be most sensitive to fill pressure variation. Additionally, rear tip extenders (RTEs) appear to negatively affect axial loading, especially in settings of larger implants. CONCLUSION: Current research suggests that circumferentially expanding devices, such as AMS CX and Coloplast Titan, show better resistance to longitudinal (penetration) and horizontal (gravity) forces and, unlike the AMS LGX device, are less sensitive to device fill pressure. Additionally, RTEs have been shown to negatively impact axial loading, especially in larger cylinder inflatable penile prostheses >20 cm in length. Madiraju SK, Wallen JJ, Rydelek SP, et al. Biomechanical Studies of the Inflatable Penile Prosthesis: A Review. Sex Med Rev 2019;7:369-375.

Placement of Inflatable Penile Implants in Patients With Prior Radical Pelvic Surgery: A Literature Review.

BACKGROUND: Penile prosthesis for erectile restoration remains the only surgical option for medical refractory erectile dysfunction. Many expert prosthetic surgeons recommend special care when placing a reservoir in a patient who has undergone prior radical pelvic surgery (PRPS) due to distortion of anatomy and obliteration of the dead space in the traditionally used space of Retzius. AIM: Review all the current literature on penile prosthesis implantation in patients with prior pelvic surgery, with an emphasis on tips and tricks for reservoir placement in this unique population. METHODS: A Medline PubMed search was used to identify articles of interest related to all topics surrounding pelvic surgery and penile prostheses. The following terms were included in the search for articles of interest: "bladder cancer," "prostate cancer," "rectal cancer," "colon cancer," "pelvic surgery," "penile implants," "penile implant reservoir," and "penile prosthesis." Articles were further screened for content and English language. MAIN OUTCOME MEASURE: Outcomes and adverse event rates in this population. Review of options for reservoir placement. RESULTS: The outcomes, satisfaction, and adverse event profiles are similar between patients in the PRPS group and those who are not, regardless of the cause for pelvic surgery. For surgeons uncomfortable with placing a reservoir in the compromised pelvis, a 2-piece inflatable penile implant (AMS Ambicor) is a viable option. For surgeons who recommend 3-piece implants in this patient population, alternative positions for the reservoir have been developed in the hope of avoiding catastrophic bowel, bladder, and vascular injuries. CONCLUSION: In patients with PRPS, placing an inflatable penile prosthesis is not only feasible, it is definitive therapy with excellent patient satisfaction. Reservoir placement outside the space of Retzius or placing a 2-piece inflatable device can be easily performed with equivalent safety and efficacy. Madiraju SK, Hakky TS, Perito PE, et al. Placement of Inflatable Penile Implants in Patients With Prior Radical Pelvic Surgery: A Literature Review. Sex Med Rev 2019;7:189-197.