Safety and efficacy of Rezum™ in erectile dysfunction patients with and without an inflatable penile prosthesis[[es]]Seguridad y eficacia del sistema Rezum® en pacientes con disfunción eréctil con y sin prótesis de pene inflable.

PURPOSE: This study evaluates the safety and efficacy of Rezum™ in erectile dysfunction (ED) patients with and without an inflatable penile prosthesis (IPP). MATERIALS AND METHODS: This was a retrospective review of ED patients who underwent Rezum™ by a single surgeon over 12 months. Patient age, presence of IPP, number of benign prostatic hyperplasia medications, International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (QOL), uroflowmetry maximum flow rate (Qmax), and uroflowmetry average flow rate (Qavg) before and after Rezum™ were obtained. Independent two-sample T-tests were used to compare preoperative and postoperative characteristics between patients with and without an IPP. Linear regression was performed to identify factors associated with postoperative Qmax or Qavg. RESULTS: A total of 17 patients with ED who underwent Rezum™ were identified, including 11 patients with an IPP. The median follow-up after Rezum™ was 65 days. There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP. Postoperative Qmax (10.9 mL/s vs 9.8 mL/s, p = 0.04) and Qavg (7.5 mL/s vs 6.0 mL/s, p = 0.03) were significantly higher in patients with an IPP compared to patients without an IPP. There were no factors associated with postoperative Qmax or Qavg on linear regression. Two patients without an IPP went into urinary retention, while no complications occurred in IPP patients. CONCLUSION: Rezum™ is a safe and effective procedure to perform in ED patients, particularly those with an IPP. IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP.

Seguridad y eficacia del sistema Rezum en pacientes con disfunción eréctil con y sin prótesis de pene inflable / Safety and efficacy of Rezum in erectile dysfunction patients with and without an inflatable penile prosthesis

Objetivo Este estudio evalúa la seguridad y la eficacia del sistema Rezūm® en los pacientes con disfunción eréctil (DE) con y sin prótesis peneana inflable (PPI). Materiales y métodos Se trata de una revisión retrospectiva de los pacientes con DE tratados con Rezūm® por un único cirujano durante 12 meses. De cada paciente se obtuvo la edad, la presencia de PPI, el número de medicamentos para la hiperplasia prostática benigna, la puntuación internacional de síntomas prostáticos (IPSS), el índice de calidad de vida (QOL) de la IPSS, la tasa de flujo máximo (Qmáx) en la uroflujometría y la tasa de flujo promedio (Qavg) en la uroflujometría antes y después del tratamiento con Rezūm®. Se utilizaron pruebas T para 2 muestras independientes con objeto de comparar las características preoperatorias y postoperatorias entre los pacientes con y sin PPI. Se realizó una regresión lineal para identificar los factores asociados con el Qmáx o Qavg postoperatorio. Resultados Se identificaron un total de 17 pacientes con DE sometidos al sistema Rezūm®, incluyendo 11 pacientes con una PPI. La mediana de seguimiento tras el tratamiento con Rezūm® fue de 65 días. No hubo diferencias significativas en cuanto a los datos demográficos y las características clínicas basales entre los pacientes con y sin PPI. El Qmáx postoperatorio (10,9 frente a 9,8ml/s; p=0,04) y el Qavg (7,5 frente a 6,0ml/s; p=0,03) fueron significativamente mayores en los pacientes con PPI en comparación con los pacientes sin PPI. No hubo factores asociados con el Qmáx o el Qavg postoperatorio en la regresión lineal. Dos pacientes sin PPI resultaron en retención urinaria, mientras que en los pacientes con PPI no se produjeron complicaciones. Conclusión Rezūm® es un procedimiento seguro y eficaz para realizar en pacientes con DE, especialmente en aquellos con una PPI. Los pacientes con PPI pueden experimentar un incremento mayor en los parámetros de uroflujometría en comparación con los pacientes con DE sin PPI (AU)

Purpose This study evaluates the safety and efficacy of Rezūm™ in erectile dysfunction (ED) patients with and without an inflatable penile prosthesis (IPP). Materials and methods This was a retrospective review of ED patients who underwent Rezūm™ by a single surgeon over 12 months. Patient age, presence of IPP, number of benign prostatic hyperplasia medications, International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (QOL), uroflowmetry maximum flow rate (Qmáx), and uroflowmetry average flow rate (Qavg) before and after Rezūm™ were obtained. Independent two-sample T-tests were used to compare preoperative and postoperative characteristics between patients with and without an IPP. Linear regression was performed to identify factors associated with postoperative Qmáx or Qavg. Results A total of 17 patients with ED who underwent Rezūm™ were identified, including 11 patients with an IPP. The median follow-up after Rezūm™ was 65 days. There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP. Postoperative Qmáx (10.9ml/s vs. 9.8ml/s, P=.04) and Qavg (7.5ml/s vs. 6.0ml/s, P=.03) were significantly higher in patients with an IPP compared to patients without an IPP. There were no factors associated with postoperative Qmáx or Qavg on linear regression. Two patients without an IPP went into urinary retention, while no complications occurred in IPP patients. Conclusion Rezūm™ is a safe and effective procedure to perform in ED patients, particularly those with an IPP. IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP (AU)

[Ectopic finding of malleable penile prosthesis extension Tip.] / Hallazgo ectópico de tip de extensión de prótesis peneana maleable.

OBJECTIVE: To report the finding of malleable penile prosthesis extension tips in an ectopic position. METHOD: We retrospectively analyzed two clinical cases of ectopic finding of prosthetic implant extension tips and performed a bibliographic review. RESULTS: In the cases described, conservative behavior was decided given the absence of signs, symptomatology and the efficacy of the normally positioned implant. CONCLUSION: The migration of the penile prosthetic implant is a very uncommon complication, more so the finding of a tip extension in an ectopic position. Reports in the literature on the behavior to follow in this type of complications are absent.

OBJETIVO: Comunicar el hallazgo en posición ectópica de los Tips de extensión de prótesis peneana maleable.MÉTODO: Se analizaron retrospectivamente dos casos clínicos de hallazgo ectópico de tip de extensión de implante protésico y se realizó una revisión bibliográfica. RESULTADOS: En los casos descritos se decidió conducta conservadora dada la ausencia de signos, sintomatología y a la eficacia del implante normoposicionado.CONCLUSIÓN: La migración del implante protésico peneano es una complicación muy infrecuente, más aun el hallazgo en posición ectópica de un tip de extensión. No se reportan informes en la literatura sobre la conducta a seguir ante este tipo de complicaciones.

Total phallic reconstruction using radial forearm free flap after iatrogenic penile amputation. / Reconstrucción fálica total con colgajo libre antebraquial radial tras amputación peneana iatrogénica.

INTRODUCTION: The iatrogenic loss of the penis is a rare situation. We present a challenging case of deferred total penile reconstruction in a genetic male. MATERIAL AND METHODS: A 57-year-old man with the loss of the penis due to a penile abscess and necrosis secondary to penile curvature surgery. The reconstruction was performed over several operations using a radial forearm free flap (RFFF) and placement of a customised inflatable prosthesis a year later. RESULTS: During the first operation, the penile abscess was drained, the necrotic residues were debrided and placement of hypogastric drainage. Seven weeks later, phalloplasty was performed with RFFF and a tube-in-tube neourethra was constructed. Multiple microsurgical anastomosis was performed, and the donor site was coated with a skin graft from the thigh of partial thickness. The surgery lasted 10hours and had the complication of hair growth in the neourethra, which required mechanical endoscopic depilation on repeated occasions. The patient regained penile sensitivity. Eighteen months after the phalloplasty, a Zephyr single-body inflatable prosthesis (Geneva, Switzerland) was implanted, using the tunica albuginea of the proximal corpus cavernosum. The patient was satisfied with the aesthetics and urinary and sensory function. Four months later, the patient is gaining confidence to consider penetration. CONCLUSIONS: Despite the risk of postoperative complications and the need for multiple operations, phallic reconstruction with RFFF and the placement of a customised prosthetic implant can improve urinary and sexual function secondary to the loss of the penis.

Evaluación clínica y calidad de vida de los pacientes con implante de prótesis peneana / Clinical evaluation and life quality of patients with penile prosthesis

Se realizó un estudio descriptivo y longitudinal de 29 pacientes con disfunción sexual grave o moderada, atendidos en la consulta de Sexología del Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany" de Santiago de Cuba, desde enero del 2008 hasta diciembre del 2011, a los que posteriormente se les implantó prótesis peneana maleable por no responder a otras terapias. Fueron analizados los indicadores de calidad de vida (antes y después de aplicado el tratamiento quirúrgico) por medio de la escala de autovaloración Dembo-Rubinstein y se obtuvo que previo a la intervención 89,6 % de los afectados tenía función eréctil muy deteriorada, pero luego de la terapéutica alcanzaron índices de erección peneana que les permitió la penetración. Del total de la serie, 3 integrantes no mejoraron dicha disfunción, pues padecieron la extrusión de 1 o 2 cilindros; no obstante, de los 2 que expulsaron un cilindro, uno logró erección favorable (3,4 %). A pesar de que 2 operados (9,6 %) no experimentaron la mejoría deseada, el tratamiento resultó eficaz en la mayoría de los pacientes, quienes mostraron un elevado grado de satisfacción.

A descriptive and longitudinal study was carried out in 29 patients with moderate or severe sexual dysfunction, attended in the Sexology Department of "Dr. Joaquín Castillo Duany" Clinical Surgical Teaching Hospital of Santiago de Cuba, from January 2008 to December 2011, in whom a malleable penile prosthesis was subsequently implanted for not responding to other therapies. Indicators of life quality (before and after surgery) by means of Dembo-Rubistein self-evaluation scale were analyzed, and it was found that before surgery 89.6% of those affected had a marked impairment of erectile function, but after treatment they reached levels of penile erection that allowed penetration. Of the total of the series, 3 patients did not improve this dysfunction, as they suffered extrusion of 1 or 2 cylinders; however, of the two patients that expelled a cylinder, one achieved positive erection (3.4%). Although 2 patients operated (9.6%) did not experience the desired improvement, the treatment was effective in most patients who showed a high level of satisfaction.

Evaluación clínica y calidad de vida de los pacientes con implante de prótesis peneana / Clinical evaluation and life quality of patients with penile prosthesis

Se realizó un estudio descriptivo y longitudinal de 29 pacientes con disfunción sexual grave o moderada, atendidos en la consulta de Sexología del Hospital Clinicoquirúrgico Docente Dr Joaquín Castillo Duany de Santiago de Cuba, desde enero del 2008 hasta diciembre del 2011, a los que posteriormente se les implantó prótesis peneana maleable por no responder a otras terapias. Fueron analizados los indicadores de calidad de vida (antes y después de aplicado el tratamiento quirúrgico) por medio de la escala de autovaloración Dembo-Rubinstein y se obtuvo que previo a la intervención 89,6 por ciento de los afectados tenía función eréctil muy deteriorada, pero luego de la terapéutica alcanzaron índices de erección peneana que les permitió la penetración. Del total de la serie, 3 integrantes no mejoraron dicha disfunción, pues padecieron la extrusión de 1 o 2 cilindros; no obstante, de los 2 que expulsaron un cilindro, uno logró erección favorable (3,4 por ciento ). A pesar de que 2 operados (9,6 por ciento ) no experimentaron la mejoría deseada, el tratamiento resultó eficaz en la mayoría de los pacientes, quienes mostraron un elevado grado de satisfacción(AU)

A descriptive and longitudinal study was carried out in 29 patients with moderate or severe sexual dysfunction, attended in the Sexology Department of Dr Joaquín Castillo Duany Clinical Surgical Teaching Hospital of Santiago de Cuba, from January 2008 to December 2011, in whom a malleable penile prosthesis was subsequently implanted for not responding to other therapies. Indicators of life quality (before and after surgery) by means of Dembo-Rubistein self-evaluation scale were analyzed, and it was found that before surgery 89.6 percent of those affected had a marked impairment of erectile function, but after treatment they reached levels of penile erection that allowed penetration. Of the total of the series, 3 patients did not improve this dysfunction, as they suffered extrusion of 1 or 2 cylinders; however, of the two patients that expelled a cylinder, one achieved positive erection (3.4 percent). Although 2 patients operated (9.6 percent) did not experience the desired improvement, the treatment was effective in most patients who showed a high level of satisfaction(AU)